System Leadership Board Meeting in Public Thursday 5 ... · 13 Annual Plan Delivery 2019/20 Report RD Enc To note 12.05 System Leadership Board – Meeting in Public – Agenda Thursday

NO ITEM LEAD FORMAT PURPOSE TIME

1. Welcome and apologies for absence RT Verbal To note 10.30

2. Declarations of Interest RT Verbal To note

3. Minutes of the last meeting held on 4 July 2019

RT Enc. To approve

4. Matters Arising and action log update DS Enc. To note

OUR TEAMS

5. Presentation from our teams on delivering improvements in care: Thriving Communities. CC Presentation To note

10.35

SYSTEM DEVELOPMENT

6. National & Regional – an update on developments

SE Verbal To note 10.50

7. Developing our Clinical Network and Clinical Leadership

JH Verbal To note 10.55

8. Organisational Form Transaction - an update on the work between Cumbria Partnership NHS FT and North Cumbria University Hospitals NHS Trust

SE Enc To note 11.05

9. Stakeholder Engagement – an update on developments and key events in the future

Carlisle and Eden Community Forum

JR Enc To note 11.10

10. Third Sector – an update on the work in support of the delivery of our Strategy

CE Enc To note 11.20

STRATEGY

11. Care Home Strategy AS Enc To note 11.25

12. NHS Long Term Plan and our local strategy refresh

RD To note 11.40

13 Annual Plan Delivery 2019/20 Report RD Enc To note 12.05

System Leadership Board – Meeting in Public –Agenda Thursday 5 September 2019 at 10.30 – 12.30 Venue: LEP Conference Centre, Redhills, Penrith, CA11 0DT

Enc

DELIVERY

14. People Plan / Workforce Strategy JT Enc To note 12.15

15. Quality Plan

Quality Highlights and Exception Report

Quality Plan

AS

Enc

12.20

OTHER ISSUES

16. Questions from members of the public relating to the agenda items

RT Verbal For discussion

12.25

17. Any Other Urgent Business

FUTURE MEETINGS 2019/20: 10.30 – 12.30 7 November 2019 (No meetings in January) 5 March 2020

Membership

Organisations Role Name

North Cumbria University NHS Trust

1 Chair [email protected]

2 Non-Executive Director [email protected]

3 Joint Chief Executive [email protected]

4 Deputy CEO [email protected]

Cumbria Partnership NHS FT


6 Non-Executive Director [email protected]

/ Joint Chief Executive [email protected]

/ Deputy CEO [email protected]

North Cumbria CCG 7 Accountable Officer [email protected]


9 Lay Member [email protected]

10 Chief Operating Officer [email protected]

Cumbria County Council* 11 Director of Public Health [email protected]

12 Assistant Director of Adult Social Care

[email protected]

13 Assistant Director – Integration & Partnerships

[email protected]

14* Cabinet Member for Public Health

[email protected]

15* Cabinet Member for Health & Care

[email protected]

General Practice 16 17

GP ICC Lead Representative(s) x 2

Niall McGreevy (NMG) ICC GP Lead, CCG Mark Alban (MA) ICC GP Lead, CCG

*Agenda and papers to be copied to 14,15 and [email protected]

Note: Other Directors and Officers may be required to attend for specific items

Enc

mailto:[email protected]


















In attendance: Michelle Skeer, Chief Constable, Cumbria Police Constabulary | Ramona Duguid, Executive Director of Strategy | Alison Smith, System Executive Chief Nurse | Judith Toland, System Executive Director of People & Digital | Mandy Nagra, System Executive Chief Operating Officer | Vince Connolly, System Medical Director | Daniel Scheffer, Joint Company Secretary CPFT & NCUHT | Julie Clayton, Head of Communications, NCCCG | Michael Smillie, Executive Director of Finance & Estates | Charles Welbourn, Chief Finance Officer, NCCCG | Clare Edwards, Health Partnerships Officer, Cumbria CVS | David Blacklock, Healthwatch Cumbria CEO | John Lawlor, NTW CEO | Francesca Bee, Corporate Governance Administrator, CPFT

Presenters: xxx

GLOSSARY

Abbrev. In full

AF Atrial Fibrillation

AHP’s Approved Health Professionals

CAMHS Child and Adolescent Mental Health Services

CIC Cumberland Infirmary, Carlisle

CT Computerised Tomography

CVD Cardio Vascular Disease

ESSD Extend Early Supported Stroke Discharge

HASU Hyper Acute Stroke Unit

IHCS Integrated Health and Care System

JD Job Description

LD Learning disabilities

LOS Length Of Stay

MDT Multi-Disciplinary Teams

MH Mental Health

MLU Midwife Led Unit

MRI Magnetic Resonance Imaging

MSK Muscular Skeletal

RCPCH Royal College of Psychiatry

SRO Senior Responsible Officer

SSPAU Short Stay Paediatric Assessment Unit

TOR Terms of Reference

WCH West Cumberland Hospital, Whitehaven

V1 Page 1 of 9 File Ref: SLB

UNCONFIRMED MINUTES OF SYSTEM LEADERSHIP BOARD PUBLIC MEETING HELD ON 4 JULY 2019 AT LEP CONFERENCE CENTRE, REDHILLS, PENRITH

Members Present:

NCUH CPFT NCCCG GP Representatives

CCC

Prof. Robin Talbot, Chair Mr Jon Rush, Chair

Dr Mark Alban, ICC GP Lead (NC CCG)

Mr Colin Cox, Director of Public Health

Prof. Stephen Eames, Chief Executive

Mr Peter Rooney, COO

Dr Niall McGreevy, ICC GP Lead (NCCCG)

Prof. John Howarth, Deputy Chief Executive / System Clinical Lead

Mr David Rodgers, AO

Mr Malcolm Cook, NED

In Attendance:

Mrs Ramona Duguid, Director of Strategy (ICS)

Ms Julie Clayton, Head of Communications (NC CCG)

Mr Daniel Scheffer, Company Secretary (CPFT / NCUH)

Miss Francesca Bee, Corporate Governance Administrator (CPFT)

Mr Kevin Windebank, Lay Member (NCCCG)

Clare Edwards, Health Partnerships Officer (CVS)

Ms Judith Toland, System Director of People and Digital

Mr John Lawlor, Chief Executive (NTW)

Dr Vince Connolly, System Executive Medical Director

Mr David Blacklock, Chief Executive, Health Watch Cumbria

Mandy Nagra, System Chief Operating Officer

Mr John Whitehouse, Governing Body Lay Member

Pauline Carlyle, Occupational Therapist

Apologies:

Ms Heike Horsburgh, NED (CPFT)

Ms Patricia Bell, Cabinet Member for Health & Care (CCC)

Ms Catherine Whalley, Assistant Director of ASC (CCC)

Mr David Rodgers, AO (NCCCG)

Ms Alison Smith, System Executive Chief Nurse

Mr Michael Smillie, Director of Finance and Strategy (CPFT/NCUH)


Agenda No.

Minute

Action by

1. Welcome and Apologies for Absence Prof. Robin Talbot, Chair welcomed everyone including members of the public to the public meeting of the System Leadership Board (SLB) and apologies were noted.

2. Declarations of Interest Mr Lawlor declared that his partner works at CPFT.

3. Minutes of the previous public meeting held on 2 May 2019 Minutes of the Public System Leadership Board meeting held on 2 May 2019 were approved.

4. Matters Arising and action log update Mr Scheffer noted that there are two actions on the action log. The first action is in relation to the people plan and this will be brought as a substantive item to the meeting in September. The second item is not due until next year.

OUR TEAMS

5

Presentation from our teams on delivering improvements in care Dementia Action Alliance Film Ms Carlyle and Ms Desborough gave members a brief background to the how they are supporting Carlisle to become more Dementia Friendly and introduced the Dementia Action Alliance Film before it was shown to members. Mr Whitehouse discussed how it would be powerful to show the film to a wider audience and it was noted that as part of Dementia Action Week the film was shown to various communities including in Brampton and Longtown. Members discussed the need to project the view that you can live positively and well with Dementia and therefore it is suggested that the film should not be shown in isolation. It was noted that each time the film has been shown there has been staff from our service and members of Dementia Alliance around. Dr Connolly explained the need to ensure positive interactions with patients who have Dementia. Ms Edwards noted that there are 2 full day workshops planned bringing third sector organisations together to work much more as a team. Ms Nagra queried if there is anything members


2019/20 SLB8

can do to support the alliance. Ms Caryle and Ms Desborough suggest ensuring the film is shown in the correct context, ensuring it is framed probably before showing it and that the correct support is available afterwards. The impact of the sponsorship in Carlisle from the Rotary Club was noted. Professor Howarth informed members that two thirds of people who have Dementia live at home and if they get admitted to hospital they have about 30% to 40% chance of not coming home, therefore acknowledged the importance of working with partner organisations to try to keep patients at home as much as possible. Professor Howarth also acknowledged the importance of the role of carers. Professor Talbot noted that importance of the SLB receiving regular updates on this issue. Professor Eames noted Mr Whitehouse’s offer of how the film could be translated nationwide and it was agreed that Ms Clayton would link with relevant individuals regarding this.

JC

SYSTEM DEVELOPMENT

6 National & Regional – an update on developments ICS Maturity Matrix Professor Eames explained that the ICS Maturity Matrix has been designed to aid the development of ICS’s. He noted that recently three new Integrated Care Systems have been announced, one of which is the North East and North Cumbria. The important relationship with the North East is emphasized by representation from John Lawlor at this meeting and the link with both Mental Health Services and Cancer Services. Professor Eames noted that North Cumbria could also learn from the North East.

7. Organisational Form Transaction – an update on the work between Cumbria Partnership NHS FT and North Cumbria University Hospital NHS Trust Professor Eames noted that the merger is progressing well and to timetable and there was a productive meeting last week with national and regional colleagues. Mr Scheffer explained that we have now passed stage 2 of the process which is the development of the business case as it was approved by both Boards last week and has been submitted to NHS Improvement. Mr Scheffer explained the range of activities which need to be completed in terms of the approvals process. This includes a Board to Board meeting and after this meeting there will be further consideration by NHS Improvement before a risk rating is issued on 10th September.


The issuing of the risk rating then requires the Board and the Governor’s Council to undertake a formal approval of the risk rating and then we need to work with the Department of Health and Social Care and commissioners regarding the dissolution of North Cumbria University Hospitals Trust.

8. 2019/20 SLB9

Stakeholder Engagement – An Update on Developments and Key Events in the future Mr Rush provided a summary of the key updates from the stakeholder engagement events and noted the positive messages that can be sent nationwide regarding what we are doing in Cumbria. Mr Rush noted the importance of building relationships with different organisations within Cumbria and discussed how we are working together Third Sector organisations to support patients. Mr Rush also recognised the positive interaction with local MPs and the examples of projects and initiatives that we are undertaking jointly as a system, some of which have been nominated for parliamentary awards. Mr Rush discussed the importance of our relationship with key stakeholders which have now been built on strong foundations, involving listening, involvement and then coming to a balanced decision. He gave the example of the community groups campaigning for West Cumberland Hospital who have said that they have gone from public meetings to shared ambition. Mr Blacklock supported this engagement as business as usual. Professor Eames explained that the way we have constructed the process of planning with colleagues in local government and third sector gives us a good platform with the ICCs being key to this. He noted that there are some big service questions in the new strategy which would benefit from discussions about the different options, their co-production and measures of success. Professor Eames noted that some of the ICCs are already very engaged in this on a very local basis but there are going to be some big service questions in the new strategy. Mr Rush noted that a lot of stakeholder engagement is undertaken by senior people with the organisations and discussed where some of the local stakeholder engagement can take place to harness the creativity, innovation and desire from members of our community to support what we are trying to achieve. Mr Houston acknowledged that in terms of the ICC model local communities and building local connections is key and Ms Edwards quoted the really good model developing in Allerdale. Mr Rush agreed to liaise with Ms Edwards around the level of engagement with the ICCs in order to bring a report to a future meeting around the level of engagement. Members noted the report.

JR


9. Third Sector – An Update on the work in support of the delivery of our strategy Ms Edwards presented the Third Sector update report and highlighted the case study contained within the report. The case study involved a small community led project based in a GP surgery in Maryport supported by local business and community volunteers and has helped 200 individuals in the past year. This case study follows on from the Familiar Faces presentation which was delivered at the last meeting. Early indications should that this project has saved around 2 days of GP time per month as it offers support for a large number of vulnerable people. Ms Edwards discussed the recent activity in terms of the third sector and noted that we now have 2 of the 3 third sector referral co-ordinators in post, one in the Eden ICC Hubs and the other in the Cockermouth/Maryport ICC Hub. Approval is still awaited for recruitment to the third post holder. Ms Edwards discussed the broad future strategy for the integration of the third sector within the developing ICS and explained that four broad themes have emerged and each will be developed from wider discussions within the Third Sector. Ms Edwards noted that there have been significant challenges in the first 12 months of the Health Partnership post, but engagement has begun and between us these significant challenges are being worked through. Ms Edwards then discussed the themes that have emerged to guide our work over the next 12 months. Mr Cook queried the current position regarding the Information Governance issues and noted that the discussion with NHS Improvement around Information Governance has been postponed until September and this subject continues to be an area of discussion and noted that the Third Sector referral co-ordinators are very much part of the solution. It was acknowledged that a national solution is required for this issue.

STRATEGY

10. Mental Health, Learning Disabilities & CAMHS Professor Eames noted that we are slightly ahead in the timetable with the transfer of services to NTW than to LCFT, but LCFT are catching up. We are expecting both services to transfer on 1st October 2019 and that it is expected that SLB in September will approve an update of the plans. Professor Eames explained that recently CPFT has had a well-led inspection review follow up and noted that the feedback was positive


especially about the significant leadership provided to the Mental Health and Learning Disabilities agenda provided by NTW particularly by the role undertaken by Mr O’Hare. Mr Lawlor acknowledged that it feels like everything is coming together in advance of the formal transfer and Professor Eames explained that a Memorandum of Understanding has recently been signed between the two organisations.

11. North Cumbria Health & Care Strategy 2019-2024 – an update on the development of our Strategy in line with the NHS Long Term Plan Mr Rooney presented this report on behalf of Ms Duguid and explained that the national long term plan was produced in January and there was an expectation for a local strategic plan. A lot of work has been undertaken in developing the emerging strategy and the engagement document which has been well received so far. Mr Rooney explained that the purpose of the report today is to draw attention to the publication of national guidance around local plans such as an expectation of a 5 year system delivery plan draft version to be in place by September with a final version by November. It was noted that a lot of the features of the national guidance already feature in the ongoing workstreams in Cumbria. It was noted that for both the September and November documents there will be detailed templates around money, workforce, future demand prediction and activity. In the future we will be held to account around the content of these templates. Mr Rooney noted that there was a good clinical engagement event for clinical leaders a couple of weeks ago including how we share the strategy and its implementation. Mr Rooney acknowledged the need to focus on clinical leadership and the clinical voice. Professor Talbot noted the need to move from creating the strategy to implementation. Members noted the report.

12. Aligning System Strategies – updates on: Population Health Framework & Plan and Cumbria Health and Wellbeing Strategy Dr Howarth acknowledged that this is a joint report on behalf of the NHS and public health and explained that we are trying to operationalise the public health agenda to work with the communities and partners to maximise prevention. Dr Howarth noted that the challenge is how to put this into a coherent framework and acknowledged that we are consistently on a learning curve. Dr Howarth explained that the framework looks at


both causes and risk factors including looking at national statistics including what are the early causes of death or disability but noted that there is gaps in the system including capacity and skills. Dr Howarth noted the use of business intelligence software to support this work. Dr Howarth also discussed the concept of rurality. Mr Rush noted that the Population Health Framework and Cumbria Health and Wellbeing Strategy overlap and queried whether named individuals are aware of their responsibilities. Dr Howarth confirmed that on the whole yes, but there can be a disconnect in the ICCs between ambition and capacity. Professor Eames noted that resource is one of the areas to prioritize. Concern was raised that some of the interventions were NHS focussed. Professor Howarth acknowledged that we need to find a way of segmenting our population at ICC level into the highest risk groups and by definition patients with Mental Health issues or Learning Disabilities fall into these groups straight away. Professor Howarth noted that the Cumbria Health and Wellbeing Strategy provides the context for the Population Health Framework. Members approved the Population Health Framework.

13. Primary Care Networks – Update on the development in line with the NHS Long Term Plan This item was taken after Agenda Item 5. Dr McGreevy explained that the new GP contract groups practices together and that the NHS long term plan gives patients and communities a better say in the services we provide as well as improving out of hospital care. It was noted that the footprint for the eight primary care networks will be the same configuration as the ICCs and members were informed that only two networks were approved with a population of less than 20,000 patients, one being Brampton/Longtown with the other being in Morecambe Bay. Mr McGreevy described the current main activities of the Primary Care Networks including working on the provision of extended hours. As from the 1st July all patients in all practices must have availability of appointments outside of the core hours. Also the networks will seek the recruitment of more community pharmacists. Dr Alban noted the huge challenge and explained that this is all linked to population health Members noted the update.

DELIVERY

14. Learning Disability Services – an update providing assurance on service provision


Dr Connolly explained that this paper provides an update in terms of actions that have been taken in relation to the Whorlton Hall incident. Work is ongoing to provide assurance around the care and support of Learning Disability patients in the Cumbria Health System including Cumbria residents who are placed out of county. Mr Blacklock confirmed that he was been working with the CCG on the system response to the Whorlton Hall incident and have been working with NHS England is produce an enhanced advocacy check. He explained that one of the problems is that whilst patients have advocacy, these advocacy visits are incredibly transactional and are very time limited. Mr Blacklock discussed the benefits of enhanced advocacy and also noted that short term reviews and audits are not effective. Mr Rooney discussed institutional based care in a broader setting and noted that there are more people living in institutional and nursing home beds than hospital beds. He noted that there have been a number of incidents in institutions some of which have led to successful criminal prosecutions. Mr Rooney explained that there has been reduced NHS provision which has led to an increase in the independent sector provision and queried whether we need to think again about reducing the Learning Disability NHS bed base. Mr Rooney also noted that more people with Learning Disabilities do go into these institutions but still have reduced health outcomes and therefore this should form part of the Population Health Framework. Mr Rooney also noted that people with Learning Disabilities are more frequently victims of crime and also fear crime more strongly than the rest of the population. Professor Howarth acknowledged the importance of working as a system and noted the importance of including learning disabilities in conversations at every level of the system but especially around primary care. Ms Edwards highlighted the valuable work of third sector networks which bring together the third sector organisations from across the county and noted that there is also Learning Disabilities Provider Forum network. Professor Talbot acknowledged the value of the System Leadership Board as the forum for cross network, cross sector discussions.

15. People Plan – an update on issues and delivery of the plan Ms Toland gave members a brief update on the People Plan and explained that a more substantive item will be presented in September. Ms Toland explained a number of key developments including progress on our volunteer approach and how we are working and engaging with


our volunteers. Ms Toland noted the progress with workforce planning and acknowledged that we have quite a lot of work at a strategic level but more work is needed at the execution level especially involving the wider system.

OTHER ISSUES

16. Questions from members of the public relating to the agenda items

None raised.

17. Any Other Urgent Business

None raised.

Date, time and venue of next meeting

10.30am, 5th September 2019 in the LEP Conference Centre, Redhills, Penrith

Confirmed minutes approved by:

………………………………………………………………… Date: ……………………………… Prof. Robin Talbot, Chair

System Leadership Public Board North Cumbria Health Care

2018/19

SLB602/05/2019 5

How public health and wellbeing

could be taken forward in the

People Plan at July meeting.

Judith Toland to be asked to talk about how

public health and wellbeing could be taken

forward in the People Plan at July meeting.

ICS JT 05/09/2019

September 2019 - Update on the North Cumbria

ICS People Plan to be presented at the meeting

including information on wellbeing.

June 2019 - The integrated workforce strategy is

under development and this along with an action

plan will be brought to the September meeting

Proposed

Yes

2018/19

SLB702/05/2019 9

All engagement with

stakeholders to be mapped on

an annual basis.

All members of the SLB to contact the CCG

Communications Team to advise them who,

when and where they have engaged throughout

the coming year

CCG JR 30/04/2020

September 2019 - Summary of engagement

undertaken presented at each meeting of the SLB

with annual report being collated for April. SLB

members are reminded to provide details of

engagement to Julie Clayton.

No

Issue to be addressed (why do

we need an action?)

SYSTEM LEADERSHIP PUBLIC BOARD ACTION LOG

Update Report

Action

Complete

(Propose

Yes/Yes/

No)

Action No Date of MeetingAgenda

ItemAction Lead Timescale

ISSUE ACTION

Org

02/09/2019 File Ref: SLB

Thriving Communities

What is “Thriving Communities”?

Customer and Digital Services

Promoting Independence

Thriving Communities

Enterprise

Organisational Development

A County Council Transformation Programme...

…a new approach to services

Pre-1940s1940s-1980s

1980s-late 2010s Late 2010s+

Local Government is evolving…

Civic Paradigm

• Basic services designed and delivered by voluntary and mutual associations and limited local state

• Alleviating destitution and delivering basic local infrastructure

State Paradigm

• Public services designed and delivered by experts employed by the state

• Meeting cradle to grave needs and slaying the five ‘giant evils’

Market Paradigm

• Public services designed and delivered to work like a business transaction and act like a market

• Operating efficiently and meeting user demand for choice

Community Paradigm

• Public services designed and delivered by and with communities

• Reducing rising demand by meeting citizen appetite for participation

A powerful case for change

Thriving Communities: VisionPeople and communities in Cumbria are thriving:

• There are personal and community networks in place which help peoplefeel safe and supported.

• If there are increased risks or emerging problems there is local early helpavailable (friends, family, community, and where necessary public services)to reduce those risks or the impact of problems for the person orcommunity.

• The council works closely with partners, third sector and the community tobuild relationships and enable the development of the infrastructurerequired to support thriving communities.

• Council resource and input is insightful, targeted at key localities, andfocused on prevention and early intervention to tackle underlying issuesand ensure financial sustainability.

High need threshold

High need population

Increasing Need

Nu

mb

er

of

pe

op

leClassic Public Health ModelAct universally to shift the whole population curve

High need threshold

High need population

Increasing Need

Nu

mb

er

of

pe

op

leThriving Communities Variation

Targeted action to change the shape of the curve

Targeted action with more vulnerable groups

Whole Systems ApproachSet through

Council Plan and

Thriving

Communities

Programme

vision

One Pathfinder in the pipeline; further proposals to be developed building on peer review feedback

Pathfinders in place: further details in this presentation

Being considered

through pathfinders

and wider

engagement with

staff and partners

Thriving Communities PathfindersConnecting Communities: Demand reduction in adult social care

• Drawing on HAWCs, Community Development, Social Care, locality public health staff, provider services staff

• Pilot Barrow and South Lakes

Think Family: Demand reduction in children’s services

• New approach using HAWCs, Children’s Services, Early Help

• Pilot in West Cumbria

Innovation Festival (tbc)

• Focus on communities designing solutions in Eden

• Exploring different relationships with VCS

0-19/early help integration

• Aligned to the Thriving Communities programme

• Emphasising “functionally integrated” teams between third sector, CCC and NHS

Complex dependency (tbc)

• Focus on people/families with multiple challenge (DV, substance misuse, mental health)

New approach to services?

20th C. Welfare

21st C. Radical

Help

Fix the Problem

Manage Need

Transactional Culture

Audit Money

Contain Risk

Closed/ Targeted

Grow the Good Life

DevelopCapability

Above all, Relationships

Connect multiple forms of resource

Create Possibility

Open –take careof everyone

Credit: Radical Help (Hilary Cottam)

Outcomes• Better outcomes (adults, children):

– Preventing future demand

– Reducing existing demand(both complex demand and demand as a result of not working in a strength based way)

• Empowered and motivated staff

• Improved relationships with third sector, and third sector playing new roles

• Financially sustainable organisation

Thriving Communities: The ChallengeHow do we enable our teams to respond to this

new world?• How can we build on people’s strengths and empower them,

their families and communities to live the best life they can, rather than trying to fix individual problems?

• How can we use and build the skills in our teams and the connections between them to provide a more holistic response?

• How can we work better with the third sector and local community enterprises, maximising their input and developing those sectors further?

1

PURPOSE

The purpose of this report is to update System Leadership Board (SLB) on the progress being

made with the organisational form transaction between North Cumbria University Hospitals

NHS Trust (NCUH) and Cumbria Partnership NHS FT (CPFT). The aim of the transaction is to

form a single NHS provider organisation in line with the North Cumbria Integrated Health &

Care System strategy.

KEY POINTS TO HIGHLIGHT

Full Business Case (FBC) has been developed in line with transaction guidance from NHS

Improvement (NHSI) as the regulator;

The FBC has been approved by both Boards of Directors and submitted to NHSI in order to

enable the necessary review and scrutiny. Following this review, the FBC is scheduled to

proceed to the approvals phase of the process;

NHS North Cumbria CCG together with all commissioning bodies of NCUH have provided

supporting letters confirming the commissioning provision under one provider organisation;

Key element of the process undertaken following Board to Board meeting with NHSI on the

23rd August;

The timetable remains in place for the transaction to be enacted on the 1st October 2019

NEXT STEPS / AREAS OF WORK TO BE PROGRESSED

Approvals stage with NHSI with view to enacting the merger on 1st October 2019

RECOMMENDATION

System Leadership Board is asked to note this paper for information.

System Leadership Board Date: 5th

September 2019 Enc:

Title: Organisational Form Transaction

Author: Daniel Scheffer

8

2

Organisational Form Programme Update

5th September 2019

1. Introduction

At the meeting held on 24th May 2018, both boards agreed that the arrangements between Cumbria Partnership NHS Foundation Trust (CPFT) and North Cumbria University Hospitals Trust (NCUH) as set out within the Memorandum of Understanding (MoU) needed to progress to the next stage. As a result, it was agreed to formally explore opportunities to merge in order to form one NHS Foundation Trust. This paper is provided to the System Leadership Board to update on progress with this work. Since May 2018, a small internal programme team has been in place which has been considering and developing options, engaging with internal and external stakeholders together with providing formal updates to the Boards. The work of the programme team has been undertaken in line with Transaction guidance published by NHS Improvement (NHSI). NHSI are the regulator with responsibility for such transactions. The Transaction guidance provides a clear framework and sets out three clear stages for approval by NHSI. The stages are: Stage 1: The development of a strategic case Stage 2: If the strategic case is approved, a Full Business Case (FBC) will be

developed by the Trusts which includes detailed plans on how the transaction will be delivered successfully;

Stage 3: Approvals – includes all the necessary regulatory and legal steps involved in completing the transaction.

Stages 1 and 2 have been completed with the Strategic Case formally submitted to NHSI in December 2018 and the FBC in July 2019.

2. Programme Update

The FBC was approved by both NCUH and CPFT Board of Directors on 27th June 2019 and submitted to NHSI in early July. Following submission of the FBC, a range meetings took place between NHSI and individuals from within the trusts leading to a Board to Board meeting on the 23rd August. At the time of this report, the trusts are awaiting clarification of the Transaction Risk Rating from NHSI in order to confirm formal approval. In the meantime, the programme continues to move forward at pace with work streams under the leadership of executive directors working to deliver the implementation plans. The timeline below set out the key dates with for the remaining part of the transaction. An extraordinary Board of Directors is scheduled to take place on 19th September with the Board of Directors being provided with:

The Transaction Risk Rating from NHSI

Request for formally to apply to NHSI to enact the merger between CPFT and NCUH.

3

Following approval by the Board of Directors, approval will be sought from the CPFT Governors Council that in reaching its decision, the Board of Directors has followed an appropriate process and taken account of the interests of the members and the public.

The timeline and key activities for the next phase are identified below:

Business Case Development January – June 2019

Board Approval of Business Case June 2019

Business Case Submission to NHSI 1st July 2019

NHSI Approvals Engagement Process July – August 2019

Submission of external opinions for Working Capital and Financial Reporting

August 2019

Board to Board Meeting 23rd August 2019

NHSI Risk Rating 10th September 2019

CPFT & NCUH Board Meeting to agree transaction 19th September 2019

CPFT Governors Meeting to a approve transaction process 19th September 2019

CPFT Formally apply to NHSI to dissolve NCUH & form North Cumbria Integrated Care NHS Foundation Trust

20th September 2019

NHSI Process to dissolve NCUH 20th September – 30th Sept

Formation of new Trust 1st October 2019

3. Conclusion

The SLB is asked to note the information contained in the report and the associated

timetable to enable the completion of the transaction by 1st October 2019.

1

PURPOSE

This report is to update on engagement activity for our North Cumbria Health and Care

System through July and August


A visit from NHS Primary Care Leaders

Engagement around the development of a five year strategy for North Cumbria Health

and Care System

The development of a Carlisle and Eden Community Forum by Healthwatch Cumbria

with support from the NHS


Engagement with district councils to be developed

RECOMMENDATION

To receive this update for information

System Leadership Board

PUBLIC

Date : 5th September 2019

Enc:

Title: Engagement activity for the North Cumbria Health and Care System Author: Jon Rush – chair NHS North Cumbria CCG

9

2

Title: Engagement activity for the North Cumbria Health and Care System Author: Jon Rush – chair NHS North Cumbria CCG

Date: 5th September 2019

Introduction

Engaging across our health and care system is important to developing the relationships which will ensure the successful delivery of our plans for future health and care services. Involving patients and our community in shaping those plans is one of our system’s key principles.

Process/Timescales

Update for July and August 2019.

Progress to date

It has been a busy summer for the North Cumbria Health and Care leadership. We have been engaging on the system’s five year strategy in response to the NHS Long Term Plan and this has involved considerable engagement with staff, community groups, some patient groups, the third sector, our partners, local businesses and young people. This included more than 68 meetings. We are especially grateful to the youth councils supported by Cumbria County Council for their insight and valuable feedback and to the Parkinson’s Support Group in Carlisle for their honesty and constructive suggestions.

On July 7 the community-led and NHS-supported Copeland Community Stroke Prevention Project held a successful health testing and information day at the Distington Vintage Rally. Our thanks go to the volunteers and Community Pharmacy Cumbria (and Dr John Howarth) for supporting this exemplar population health approach.

On July 12 we took part in the West Cumbria Community Forum which was a longer session than usual and hosted a presentation from the We Will Group from the Ewanrigg Trust. There was a further meeting with the young people to see how the NHS can support their innovative and effective approaches.

On July 17 the Working Together Group met and agreed to review how we approach co-production as we move forward from the positive maternity decision. A workshop will be held in the Autumn and members of the System Leadership Board will be vital in supporting the next stage of this work.

On August 12 Jon Rush and Robin Talbot met members of the We Need West Cumberland Hospital group to talk about how we can connect more closely in areas of shared ambition and to develop a stronger relationship. The meeting was constructive and recognising the energy for a stronger partnership we have agreed to continue meeting.

3

On August 15 Jon and Robin welcomed the newly appointed Chief Executive of Cumbria CVS to look at strengthening our relationship.

On August 22 north Cumbria hosted a visit from some senior NHS primary care leaders keen to see first hand the developments in Primary Care and in our Integrated Care Communities, as well as how our wider health and care system is developing. They included:

Prof. Simon Gregory Deputy Medical Director for Primary and Integrated Care HEE

Dr Rosie Benneyworth Chief Inspector of Primary Medical Services & IntegratedCare, CQC

Prof. Graham Rutt Director Postgraduate School of Primary Care HEE Northeast &North Cumbria

Ned Naylor Director of Primary Care Provider Transformation NHSE/I

Alex Morton Director of Primary Care and Public Health Commissioning NE &Yorkshire

They visited Eden Medical Group in Carlisle and the Eden ICC Hub. They met with a number of PCN Clinical Directors and ICC staff as well as members of the CCG and the Trust.

They had some very positive things to say about the work being done locally and were enthused by the progress that our ICCs are making and our local GP leaders. They were very impressed by how staff from across the NHS and social care teams are working so closely together.

The development of a new Carlisle and Eden Community Forum

Healthwatch Cumbria organise and support the valued West Cumbria Community Forum (WCCF) which started in 2014.

For some time there has been a desire to hold something similar for the other part of north Cumbria and work has been progressing involving Healthwatch Cumbria, NHS leaders, councillors and Trust governors to establish a similar forum.

The first meeting of the Carlisle and Eden Community Forum (CECF) is planned for Friday September 20 between 10am-noon at The Stoneybeck Inn at Penrith.

The intention is to mirror the West Cumbria Community Forum approach with support from senior NHS leaders and people attending to feedback to their groups – a network of networks. It will be chaired by the Venerable Richard Pratt.

Documents outlining the activity and support required are attached in the Appendix

Proposal for CECF

TOR for CECF

Provisional Agenda for CECF

Invitation to CECF

4

The WCCF is an effective and well established place for open conversations and developing relationships. It is hoped in time the Carlisle and Eden Community Forum will enjoy the same success for those interested in health services and developments.

The commitment of senior leaders - both clinical and non-clinical - within the NHS and wider health and care system is key to make the forum effective and valuable

Recommendation

To note the report and to request that System Leadership Board members to support the

development of the Carlisle and Eden Community Forum

CECF Proposal Version 4 – 20th August 2019

1

NEW LOGO IN DEVELOPMENT


Inaugural meeting Friday 20th September 2019

Stoneybeck Inn, Penrith 10am to 12noon

Introduction An inaugural meeting of the new Carlisle and Eden Community Forum (CECF) will take place on Friday 20th September at Stoneybeck Inn from 10am to 12noon. This Forum is modelled on the hugely successful West Cumbria Community Forum which has been meeting since 2014. A wide range of key health and care decision makers and representatives of communities of interest and place from across the Carlisle and Eden districts of Cumbria have been invited to attend.

Background Healthwatch Cumbria (HWC) has facilitated the West Cumbria Community Forum (WCCF) since 2014. This model, which creates the conditions for effective “conversations about a healthier future”, brings together representatives of community groups of interest and place and senior representatives of the health and care system. Its effectiveness is greatly enhanced by the skills and approach of its independent chair, the Archdeacon of West Cumberland, Richard Pratt and by the relationships and informal networks amongst its members which have been developed over time.

It has been acknowledged that the WCCF has served a very distinct and useful purpose in tackling a specific set of challenges in west Cumbria, that it evolved at a time of huge anxiety, anger and concern amongst the local communities and that it has connected representatives and leaders from the system with representatives and leader of local communities in west Cumbria in a new and helpful way.

However, the original model has evolved, learning from those challenges, and now provides opportunities for coproduction, involvement and information sharing between the highest level of health and care decision makers and a wide range of representatives of communities of interest and place.


2

The success factors are;

Common purpose

Consistent strategic leadership and support from system leaders

Independent Chair by Archdeacon Richard Pratt

Independent facilitation by Healthwatch Cumbria (HWC)

Clear Terms of Reference and culture built on network of networks - people are representing groups and required to feedback to them

A culture of problem solving

The development of shared energy, confidence, willingness, persistence and tenacity to address difficult issues together

Willingness to also address challenges softly and directly between meetings - The Chair has taken time to build individual relationships based on trust which has helped to ease tensions

Its ability to keep going – it has gone through the recognised group dynamic stages of forming, storming, norming and performing

Relationship building between all partners through regular meetings - it has been noted that where once the representatives of the system and communities sat at opposite sides of board-room style set-up, now there is a healthier mix around the room

Safe environment to share views - sometimes explosive

Transparency - early sight of information - trust has been established both ways and information has been shared which may not normally have been openly discussed in a public domain

A willingness to hear and address misunderstandings

Better understanding of concerns, context and challenges on all sides

Local MPs and councillors have continued to support the Forum Replicating the model – the CECF HWC has a role to act as the consumer champion for everyone who uses health and care services and to provide mechanisms for their voices to be heard in a variety of ways. The WCCF model does that in a very direct and immediate way, but by definition is focused on the geography and issues of west Cumbria. It has now been agreed to replicate this model in Carlisle and Eden in conjunction with North Cumbria Integrated Care System (NC ICS) colleagues and in line with existing engagement and communication plans. This will help to ensure that more people’s voices are heard at a time when the whole health and care system is changing in line with the aspirations of the NHS Long Term Plan and will help to involve people in the local changes being considered by NC ICS. Senior leaders in the ICS have stated clearly that the system needs to engage more locally and has recognised that HWC is well placed to bring people and decision makers together. To do this we must work closely with local communities, community representatives, community groups and interested parties and provide evidence that this type of collaborative working, or coproduction, can work and result in services that are more person centred. Local people have the right to be confident that planned changes will lead to better outcomes for them and their families. They need


3

to know exactly what will happen in the future. Practically they want to know where they will go, for what and why, on an everyday healthcare basis. The new CECF will help to ensure that people’s voices, hopes and concerns from these districts are heard, that informative conversations can take place and that accurate and timely information is shared. It is important to note that HWC is in place to operate as the champion and representative of the people and is independent of the health and social care commissioners and providers involved. HWC will use its role as a facilitator and enabler to bring key stakeholders together with local people for constructive dialogue and information exchange. HWC is delighted that Archdeacon Richard Pratt has indicated that he is prepared to provide independent leadership for this new Forum and to act as its Chair. CECF will have the following objectives:

o To welcome key representatives, including Local MPs, all three tiers of

elected members, local community representatives, representatives of third sector providers, and representatives of North Cumbria ICS to come together on a regular basis for informed discussion focused on the change process and its likely impact in Carlisle and Eden.

o To provide additional mechanisms to; o Ensure people are informed about the developing health and care system o Ensure that people's concerns, anxieties, questions, ideas, and

experiences, are heard by decision makers o Ensure that commissioners and providers can answer questions from the

community, listen first-hand to concerns and provide timely and accurate information about planned changes

o Ensure commissioners and providers involve people in shaping proposed developments and changes and in considering how these can improve outcomes

o Provide regular accurate briefings about strategic and operational developments

o Ensure that the public are clear about which decisions will be subject to formal public consultation and explain exactly how and when this will happen – and that their views are taken into consideration over what processes might be used for consultation

o Ensure that there are opportunities with community leaders to discuss, test out and demonstrate how real life scenarios will be managed in Carlisle and Eden settings

CECF will adopt positive behaviours as the norm as set out in detail in the Terms of Reference; Appendix A HWC is aiming to ensure that the CECF meetings are attended by a wide range of people and that all communities are represented. However, these will not be public meetings but will have an invited audience. Representatives will be required to ensure that they meet regularly with the communities they are representing both before and


4

after meetings of the Forum and that effective two-way communications are maintained. The Forum will be focused on debate and discussion about shared issues and concerns that have been brought forward through its representatives and for which there is a demonstrable evidence base. The Forum will not be in place to address individual experiences, concerns or complaints; these can be shared directly with the appropriate ICS commissioner or provider organisations through, for example, complaints processes, or directly with HWC, or the NHS Complaints Advocacy service. Connections to the North Cumbria Health and Care System draft strategy The engagement documents recently published by the North Cumbria Health and Care System clearly describe a changing landscape which puts the involvement of people at the heart of making improvements and change. The system has adopted a co-production toolkit developed locally from our own experience. This commitment to working with patients, staff, the third and voluntary sector and community runs through all the priorities identified by the system which can be delivered and enhanced by the development of the CECF. Draft Terms of Reference are included as Appendix 1 Time line

Action Responsible Group

Deadline

Agree CECF proposal and timescales HWC Board SLB

Completed 5th September 19

Develop Comms Plan to include:

A summary of what has changed and ow the WCCF has helped - good recent example re maternity and the Bill Kirkup work

initial press release to explain why this is happening, who is to be involved, what is the purpose

introductory letter to all key stakeholders

use of social media, websites (consistent info to be used on all websites) etc.

HWC NC ICS

End August

Contact and brief identified Forum representatives

CECF Steering Group

End August 19


5

Arrange first Forum meeting including setting times and selecting and booking initial venue

HWC 20th September 19 Stoneybeck Inn 10am to 12noon

Identify initial issues and speakers for first meeting Include one or more of; Stephen Eames John Howarth Ramona Duguid

In line with agreed date for first meeting

First agenda to be agreed;

Rationale, purpose and draft T of R, including membership, frequency and times of meetings

System update and implications of LTP, including the ICC and how to get involved

CIC Cancer Centre and/or HASU

HWC End August 19

Subsequent meetings booked HWC To be agreed

Review effectiveness after one year HWC NC ICS

CECF Members HWC and other members of the CECF Steering Group will identify and brief potential representatives for CECF by end August 2019 as follows;

Meet with Responsible person

Local community champions and representatives activity

Sue S

Local MPs Julie C

Elected members through CCC Local Committees of Carlisle and Eden

Julie

Directors and Assistant Directors of CCC Sue S

Elected members of Carlisle and Eden district councils

Sue S

Cumbria Association of Local Councils (CALC) - parish councils

Sue S

Senior Representatives of NC ICS Julie C

Third Sector Executive and Action for Health David

Health and social care support group leaders Julie C

North West Ambulance Service Julie C

Cumbria Health Scrutiny Committee David

Elected members/Governors of new Trust Jane S


6

How will we know we have been successful? (Success Criteria)

It has been agreed that during the development phase success will not be determined by numbers attending the Forum but rather by;

Relationships established and developed so that we are working together in a sustainable way

The group has been able to influence X and Y

The group has been able to identify and resolve challenges as they have arisen Sue Stevenson Chief Operating Officer – People First Independent Advocacy 20th August 2019

Appendix 1 CECF T or R V 2 April 19

1


Terms of Reference

Introduction Healthwatch Cumbria (HWC) has established the Carlisle and Eden Community Forum (CECF) in the spring of 2019 in partnership with key representatives of communities of place and interest across west Cumbria and with key stakeholders from the North Cumbria Integrated Care System (NC ICS). The Forum was set up as a vehicle to enable “conversations about a healthier future” and to involve people in informing and shaping the future provision and delivery of health and care services in Carlisle and Eden. The Forum has been modelled on the highly successful West Cumbria Community Forum (WCCF) which was set up in Autumn 2014 and is still running at the request of its participants. The WCCF and has enabled information sharing and debate to take place, directly involving people in the development and delivery of the Success Regime programme of activity which ultimately resulted in the consultation “West North and East Cumbria Healthcare For The Future” and in the implementation of its decisions thereafter; as well as being involved in other aspects of health and care provision across West Cumbria. Members of the WCCF agreed that the Forum has achieved its ambitions to “encourage good conversation” and to exist as a “network of networks” and stated that they would like it to continue to operate within this ethos. The CECF will aim to replicate this successful format and culture. Role of CECF HWC wants to ensure that the passion and voice of local people is heard loudly in all the right places as decisions affecting their health and care are made moving forward and also that people are properly informed. To do this we must continue to work closely with local communities, community representatives, community groups and interested parties and ensure that key decision makers are involved, listening and responding.


2

We want to define and deliver “coproduction” in practice. This means using the NC CCG/HWC/CLIC Coproduction Model and Toolkit (see link below) to aid understanding and practice about what this is and how it can be achieved. http://www.northcumbriahealthandcare.nhs.uk/making-it-happen/co-production/co-production-tool-kit/

It should be noted that CECF will not be focused on single issues or lobbying, but rather on debate and discussion about shared issues and concerns that have been brought forward through its representatives and for which there is a demonstrable evidence base. Where individual experiences, concerns or complaints exist these can be shared directly with the appropriate NHS commissioner or provider organisations through, for example, complaints processes, or directly with HWC, or the NHS Complaints Advocacy service. Chair

The CECF will be independently chaired by The Archdeacon of West Cumbria, Richard Pratt Meetings of CECF

The Forum will be facilitated by HWC

The members of the Forum will agree the T of R and consider and fill any gaps in membership

The Forum will meet at times and intervals to be agreed by its membership

Issues discussed at the Forum will be pre-identified, as far as is possible, by the nominated representatives and through ongoing engagement

Representatives will be required to ensure that matters discussed and information shared during the Forum meetings are shared with those communities that they are representing

A range of mechanisms will be used to ensure that Forum meetings are conducted in the spirit of openness and transparency, that they are well publicised and that information from the meetings is shared - this will include through press releases, the HWC website, NC ICS websites and other social media methods.

Membership

CECF meetings are open to a wide membership and will seek to ensure that a wide range of people and that all communities are formally represented by nominated representatives. Representatives will be required to ensure that they meet regularly with the communities they are representing both before and after meetings of the Forum and that effective two-way communications are maintained.

The meetings, whilst not public meetings, will be held in public so members of the public who are not nominated representatives but who wish to attend can do so to observe and be given the opportunity to ask questions pertinent to the agenda.

http://www.northcumbriahealthandcare.nhs.uk/making-it-happen/co-production/co-production-tool-kit/

http://www.northcumbriahealthandcare.nhs.uk/making-it-happen/co-production/co-production-tool-kit/


3

Members will include;

Local MPs

County and District council elected members

Parish councillors

Representatives from Cumbria County Council, including senior representatives of Adult Social Care, Public Health Locality Managers, representatives of area teams in Carlisle and Eden

Representatives of local communities of interest and place

Representatives of third sector organisations

Senior representatives from North Cumbria ICS

Healthwatch Cumbria (HWC)

The Forum is principally a network of networks members of the public will always be made welcome

Objectives:

To ensure that people are involved and informed about developments and changes to health and care services that impact on the population of Carlisle and Eden

To ensure that coproduction, as defined above, is at the heart of everything that happens with regard to the design and delivery of health and care services that impact on people across Carlisle and Eden, including; o To be involved in the development and delivery of the NC ICS with regard to

its impact in Carlisle and Eden

o To work closely with those involved in the development and implementation of Integrated Care Communities (ICCs) as the basis for patient centered healthcare across Carlisle and Eden.

By; o Involving and engaging representatives of the people of Carlisle and Eden

through a number of different mechanisms in discussions about their health and care services

o Involving a wide range representatives of community and place and thus

being an effective “network of networks”

o Operating within an ethos of openness and transparency, encouraging good conversation

o Coming together on a regular basis to address issues of concern, discuss

ways of ensuring that accurate and timely information is shared and ensure that all opportunities are taken for local engagement


4

o Ensuring that people's concerns, anxieties, questions, ideas, and experiences, are heard by decision makers

o Ensuring that commissioners and providers have opportunities to answer

questions from the community, listen first-hand to concerns and provide timely and accurate information about planned changes

o Ensuring commissioners and providers have opportunities to explain future

proposed changes and describe how these can improve outcomes

o Providing regular accurate briefings about strategic and operational developments

o Ensuring that the public are clear about which decisions will be subject to

formal public consultation and explain exactly how and when this will happen – and that their views are taken into consideration over what processes might be used for consultation

o Ensuring that there are opportunities with community leaders to discuss,

test out and demonstrate how real life scenarios will be managed in Carlisle and Eden settings

o Ensuring that all opportunities for communicating with the public are used,

including the use of short videos demonstrating real life experiences where outcomes have been improved through changed care pathways

Identifying Representatives Representatives will need to be able to demonstrate that they;

Are able to be representative of a community of interest or geography, accepting and demonstrating that responsibility

Recognise that, by attending, they are contributing to the Forum operating as a network of networks

Have mechanisms in place to gather, analyse, share and disseminate views prior to, and after meetings of the Forum

Have mechanisms in place to share findings and disseminate information following meetings of the Forum

Are not focused on single issues or lobbying

Have capacity to be able to be a regular attender at most meetings of the CECF Culture and behaviours In order to be successful, the CECF will require members to adopt the following behaviours which support the culture and ethos of coproduction;

To listen with respect and courtesy

To share everything early and to learn as much as possible about the current state, current improvements and actions and current risks


5

To expect to be able to make your point

To expect, and to role-model, co-operation

For all suggestions to be considered and discussed – ideas should not be ridiculed

To respect people’s professional roles and responsibilities

To respect the time and energy committed by volunteers

To share information provided at the Forum through networks unless otherwise stated when confidentiality should be respected

To work to an ethos of trust – ‘Chatham House Rule’ – the freedom to express views within this process without having those views attributed to a particular individual outside of the process. This means notes of meetings will reflect the discussion.

Members should feel safe to challenge behaviours seen as not in line with this agreement during meetings and with each other (and should always respond positively to constructive criticism) but should never criticise each other’s behaviour outside of the group.

We expect there will be times when things will go wrong – everyone is committed to learning when things go wrong, not to attributing blame. Ways of working?

Our way of working intends to form resolutions by consensus.

The ‘terms of reference’ are subject to annual review

Sue Stevenson Chief Operating Officer Healthwatch Cumbria 23th May 2019

+

LOGO IN DEVELOPMENT

Friday 20th September 2019

10am – 12 noon

Stoneybeck Inn, Penrith

AGENDA

Chair – The Venerable Dr Richard Pratt, Archdeacon of West Cumberland

1. 10:00am

The Venerable Dr Richard Pratt

Welcome and introductions

Rationale and purpose for the Carlisle and Eden Community Forum (CECF)

Draft Terms of Reference

2. 10.30am

The North Cumbria Integrated Care System (NC ICS)

Dr J Howarth, Deputy CEO, Cumbria Partnership NHS Foundation Trust and

North Cumbria University Hospitals Trust

3. 10.50am

The NHS Long Term Plan

NC ICS Strategic Response

Ramona Duguid, Director of Strategy, North Cumbria Integrated Care System

4. 11.10

The future of Mental Health Services in North Cumbria

xxxxxxxxxxxxxx

5. 11.30am

CIC Cancer Centre and/or HASU

Xxxxxxxxxxxxxxx

6. 12 noon

Close

Dates of Future Meeting Dates:2019/20

To be agreed

CECF LOGO IN DEVELOPMENT

Invitation to the inaugural meeting of Carlisle and Eden Community Forum

Friday 20th September, 10am to 12 noon, Stoneybeck Inn, Penrith

Dear Colleague I am writing to invite you to the inaugural meeting of the Carlisle and Eden Community Forum (CECF) which will take place on Friday 20th September from 10am to 12 noon in Stoneybeck Inn, Penrith. I have enclosed a detailed proposal for this new CECF which sets out the rationale and purpose of the Forum which is based on the successful West Cumbria Community Forum which has been operating since 2014. I have also enclosed the draft Terms of Reference and from this you will see that the Forum is intended to act as a network or networks which representatives attending on behalf of communities of interest and or place from across Carlisle ad Eden along with senior representatives of the health and care system. If you are not able to attend I would be grateful if you could please identify a suitable representative. Background to the setting up of the Carlisle and Eden Community Forum Healthwatch Cumbria (HWC) has an independent role to act as the consumer champion for those who use health and care services and the Forum will help to ensure that people’s voices are heard at this critical time for the health and care system. Forum members will be able to hear, share and be involved in shaping the system. The Forum will help to improve communications between all key stakeholders. The establishment of the Forum has the support of Cumbria Clinical Commissioning Group (CCG), North Cumbria University Hospitals NHS Trust (NCUHT) and Cumbria Partnership NHS Foundation Trust (CPFT) and all three (SEE NOTE BELOW) are committed to attending the meetings and providing members of the Forum with timely information. They have agreed that a key objective of the Forum is to develop increased and focussed community engagement in Carlisle and Eden with regard to the future delivery of health and care services.

Acting independently of these main NHS bodies, HWC wants to make sure that the passion and voice of local people is heard loudly in all the right places as decisions are made. HWC wants to ensure that people are properly informed as and when changes are considered and appropriately consulted when it is right to do so. This level of two way communication will only be achieved if representatives of all local communities and community groups together with representatives of local provider organisation and other interested parties are part of the Forum and that appropriate mechanisms are in place to make sure that discussions at the Forum are inform by and can inform all sectors of the community of Carlisle and Eden. At the same time, the NHS is clear that it needs to engage more locally and wants to work with HWC to create more opportunities for the voices of local people to be heard in the shaping of services for the future. HWC has sent this invitation to a wide range of people and groups with the intention that all communities are represented. However, numbers will inevitably be limited so the intention is to relay meetings of the Forum through social media mechanisms and minutes of the meetings will be posted on the HWC website. Representative will be required to ensure that they meet regularly with the communities they are representing both before and after meetings of the Forum and that effective two-way communications are maintained. It should be noted that the Forum will not be focused on single issues or lobbying, but rather on debate and discussion about shared issues and concerns that have been brought forward through its representatives and for which there is a demonstrable evidence base. Where individual experiences, concerns or complaints exist these can be shared directly with the appropriate NHS commissioner or provider organisations through, for example, complaints processes, or directly with HWC, or the NHS Complaints Advocacy service. More information about our NHS Complaints Advocacy Service can be found on the link below:

http://www.bestlife.org.uk/nhs_complaints

Please let me know if you will be able to attend this meeting by emailing [email protected] Please also let me know if you wish to nominate an alternative representative or if you are aware of any groups that have not received an invitation to this Forum.

Yours sincerely The Venerable Richard Pratt Archdeacon of West Cumberland *Attached: Proposal Draft Terms of Reference

Third Sector Programme Report 05.09.2019

AGENDA ITEM: System Development 10:

THIRD SECTOR PROGRAMME REPORT - Health Partnerships Officer Report for SLB Board 05.09.2019

Progress in relation to paper presented at previous SLB meetings

Subject Progress Recommendations/issues/concerns

A Strategic System Partner - bringing its expertise; strength and diversity to contribute on an equal basis to the planning, shaping, decision making, and implementation of agreed local priorities.

Social Prescribing System wide Social Prescribing planning & development now underway 4 areas of work HIPPO involved at Management level ICC Third Sector Reps are likely to be involved in ICC based initiatives:

Effective link worker / connector roles within communities

Robust ‘directories of services’

Effective referral processes between services, link workersand community groups

Identification of ways that a North Cumbria SP strategy cansupport the development of local community groups andthird sector. This includes resourcing/funding third sectorprovision and in-kind support to enable them to respondto the anticipated increase in demand for their services

System to measure benefits / outcomes

It is anticipated that the majority ofrecommendations from this work willbe cost neutral requiring a change toways of working. However it isanticipated that there will be a need forthe system to addressresourcing/funding third sectorprovision to enable localised responseto need. This may require the creationof a community investment fund forsmall scale, local initiatives

Information Governance A solution needs to be found to issues relating to IG and the sharing of patient information with representatives of the third sector.

2 x ICC Hub based Third Sector Referral Co-ordinators inpost 24.06.2019 (Eden ICC and Maryport & CockermouthICC). Post holders have been well received & are producingpositive outcomes

HIPPO continues to seek opportunities to engage withnational discussions about this matter

Whilst both Post holders have HonoraryContracts with CPFT in place & haveundertaken all appropriate training theyare still awaiting final IG approval & areunable to use EMIS

We continue to await final approval offunding from CPFT Charitable Funds tosupport a third pilot post.

There is a continuing need to findinnovative solutions to IG & GDPRissues particularly as our systemaddresses the delivery of a range ofinitiatives identified in the NHS LongTerm Plan e.g. social prescribing,


personalization that require further integration of the third sector

ICCs Third Sector Representatives are increasingly recognised as having key development & innovation skills that can support the further development of ICCs.

ICCs are moving into a further development phase it is recognised that ICC Third Sector Representative’s skills are not best utilised within current ICC governance structures. There is a need to consider either a change to current structure or for Third Sector ICC Reps to work within ICC Leadership Groups

Third Sector Representation at System Leadership Board HIPPO & Cumbria CVS CEO currently in discussion with System Leadership about this matter

A Service Provider - improving health and wellbeing outcomes by responding to local and diverse health and wellbeing needs

Third Sector Referral Pathways To develop a clear system wide pathway for referrals to and from the third sector using the ICC Hub function

The proposed pilot of the referral pathway is now being undertaken in the two ICC Hubs where Third Sector Referral Co-ordinators are hosted. This however remains problematic as both post holders do not yet have final IG approval & access to EMIS

Investment in Third Sector System staff currently mapping investment by North Cumbria Health and Care into the third sector including:

In kind resources e.g. hot desking, office space, co-location, staff time

Funding/grants

Contracts/SLA’s

Access to national funding pots (particularly where statutory sector partnership is key)

Once this mapping has been achieved there is a need to review if investment is:

fit for purpose in light of ICC development and the expectations the system has on the sector to support and deliver key elements of the ICC programme

and to

develop a strategic investment plan for the sector in relation to ICC development programme

develop a better understanding of how in-kind support to the sector is offered and to develop more effective systems to enable the growth of this area of support


support key management staff/teams to invest time to understand the principles outlined in The Cumbria Compact and adhere to these in relation to issues relating to capacity and resource for the sector

An Enabler of the Community Voice and

Representation Co-Production There is increasing confidence using Co-Production models within the system. There is also increasing recognition of the resourcing required to undertake good quality Co-Production & an ability to draw down funds to support this

There is still a need to consider how the system can effectively resource Co-Production in the longer term

ICC Stakeholder groups ICC Third Sector Reps are considered a key part of ICC teams developing events & activities to engage & co-produce with local communities

Some ICCs are still struggling to develop stakeholder engagement activity. There remains a lack of strategic steer in relation to this

Unpaid Carers There is a recognition at a strategic level that support for unpaid carers is a key element to ensure the delivery of appropriate community based health & care services

There is a need to identify how the system can increase and improve the support & training offered to unpaid carer

A Source of support for volunteering, fund raising and using all assets in our communities

Public Health funded Partnership Fundraising post will be recruited to in Autumn 2019. The post will work across sectors to develop partnerships delivering community based health initiatives and support them to secure additional funding for our health & care system

It is key that all system partners engage with this project as many funding sources require active system wide partnership working

1

PURPOSE

The Purpose of this report is to provide the System Leadership Board with an overview of the

ongoing work Quality improvement work through the Enhanced Health in Care programme

work. The paper will also introduce the board to the work required to deliver the programme of

work in Primary Care Networks.


Excellent progress in the delivery of React to Red, Red Bag Scheme and the Capacity

Tracker

The reluctance of providers to engage in the Trusted Assessor model due to concerns

re the patients they will receive.

The delivery of two care home conferences in the spring and a further two planned for

the autumn

Work has started on planning and implementation of the enhanced primary care elements of

the EHCH programme through the 8 new Primary Care Networks and ICCs


The plan to work with a large nursing home provider to develop the Trusted assessor

model.

Development of individual ICC / PCN plans to identify how primary care elements of EHCH

will be delivered from April 2020 onward.

RECOMMENDATION

The Board are asked to note the progress made in The NHSE Enhanced Health in Care Home projects.

System Leadership Board Date 21/8/19 Enc:

Title: Enhanced Health in Care Homes

Author: Anna Stabler, Director of Nursing & Quality

11

2

Title: Enhanced Health in Care Homes

Date: 20/8/19

Introduction

The Purpose of this report is to provide the System Leadership Board with an overview of

the ongoing work quality improvement work through the Enhanced Health in Care

programme work. The paper will also introduce the board to the work required to deliver

the programme of work in Primary Care Networks.

Background

In 2016 across England, six vanguards were working to improve the quality of life, healthcare and planning for people living in care homes. One in seven people over age 85 is living permanently in a care home. The evidence suggested that many of these people were not having their needs properly assessed and addressed. As a result, they often experienced unnecessary, unplanned admissions to hospital, and sub-optimal medication. This work resulted in a suite of evidence based interventions that were designed to be delivered within and around care homes in a coordinated manner to make the biggest difference to the residents. NHS North Cumbria CCG commenced the planning, implementation and delivery of the interventions in March 2018. The interventions are:

React to Red

Hospital Transfer Pathway

Capacity Tracker

Trusted Assessor Model

In addition the CCG have also implemented

Stop and Watch

Care Home Conferences With the advent of Primary Care Networks (PCN) and as detailed in the 10 year plan there is an expectation for PCN to further engage and support improvements in care in the care home market. Under the new PCN contract, from April 2020 PCNs will be expected to deliver primary care elements of the EHCH vanguard model in conjunction with community health service partners. ie:

Ensuring residents have access to consistent named GP who is linked to a wider primary care team.

One to one mapping of GP practices to care homes

Weekly ‘ward rounds’ to review and plan care

Completing Comprehensive Geriatric Assessment (CGA) for all new residents and undertaking 6 monthly reviews

Clinical pharmacist led structured medicine reviews linked to CGA process hydration and nutrition support

3

Progress to date

The is a bi-monthly collaborative meeting to support the delivery of the Enhanced Care in

Care Homes (ECHC) quality improvement work, terms of reference can be found in

appendix A.

The Stop and Watch tool to support the recognition of deterioration was launched October

2018, funding from the Academic Health Science Network was allocated to support the

delivery of training to the non-registered workforce, and parents and carers. To date a total

of 224 individuals have been trained and it has also been incorporated into the Trusts’

Care Certificate training.

The CCG held two care homes conferences in the spring where we had around 160

people attending; as well as discussing the initiatives below attendees were introduced to

NEWS2, No Place Like Home and Good Hydration. A number of homes volunteered to

pilot either NEWS2 or also work with the team to develop No Place Like Home material

specifically for care homes.

A further two conferences are planned for the autumn that will focus on building clinical

skills in the care home workforce.

The table below details the progress to date for the delivery of the NHSE vanguard

initiatives.

React to Red

Update

R2R packs delivered

Nursing Homes - 16 (100%) Residential Care - 77 (85%) Packs and a demonstration were made available, at the care home conferences which took place 30.4.2019, and 02.5.2019. To complete this initiative, there is a plan to distribute the information to the remainder of the residential care sector by the end of March 2020, with a quarter on quarter increase until that date. Each home is being contacted individually, and there will also be an opportunity to give out information at the Clinical Skills Care Home Conferences planned for October 2019.

Hospital Transfer Pathway

Update

Implementation plan developed

Nursing Homes - 16 (100%) Residential Care 77 (85%) The Red Bag programme and React to Red are being run in parallel; delivered to the nursing homes by members of the CCG Nursing & Quality Teams, and in engagement events. To complete coverage, we have an action plan to distribute Red Bags to the remainder of the residential care sector by the end of March 20, with a quarter on quarter increase until that date. Each home is being contacted individually. There will also be an opportunity to give out Red Bags at the Clinical Skills Care Home Conferences planned for October

4

PCN initiatives Update

PCNs and community services are still waiting to receive specifications which are expected to set out in detail PCN and community service requirements in relation to delivery of EHCH. In recognition that significant work will be required planning has commenced and an initial meeting has taken place to review requirements (known to date) and to develop an implementation plan.

Though PCNs are expected to take a lead in delivery of EHCH requirements there is recognition that without the full input of community health services PCNs will not be able to deliver their forthcoming service requirements – and vice versa. Therefore, PCNs will be working with community partners through the local ICC delivery groups to map current care home provision on ICC /PCN footprint and establish support currently received. This will help PCNs/ICCs develop individual ICC EHCH plans which will include identifying how existing ICC MDTs can be used to support EHCH requirements around virtual ward rounds.

The primary care team is supporting PCNs in recruitment of Clinical Pharmacists whose role will include providing medicine reviews.

2019.

This has been feedback from care homes about bags going missing and not returning to the Care Home. This was highlighted with the Trust, and who have undertaken a communications relaunch, and used screensavers to highlight the message.

Capacity Tracker Update

There are now 61 care homes registered on the capacity tracker, leaving 22 (8 of which are Cumbria Care homes) to register a further 24 are out of scope currently as these are learning disability beds. The funding of the capacity tracker has been through NHSE, however for 19/20 it has moved to the CCGs, North Cumbria CCG has committed to pay to ensure we have a robust bed monitoring system.

Trusted Assessor Model

Update

There has been resistance from our care home providers to engage in this piece of work due to concerns that they may be sent patients that they cannot adequately care for. There was focused discussion at the Care Home Collaborative Meeting in June, where it was agreed that there is some system analysis work required and a sub-group being set-up to take this work forward. To support this work NCCCG has also received 20k of funding from the Better Care Fund; to start the work the CCG have agreed to do some joint work with the largest nursing home provider in north Cumbria in looking at the format that they use to assess any new resident, and look at how this could be a way of developing a trusted assessment, which could simplify the hospital discharge pathway, and potentially remove delays in the current system.

5

Recommendation

The System Leadership Board is asked to note the progress made in the NHSE Enhanced Health in Care Home projects.

Anna Stabler, Director of Nursing & Quality

North Cumbria CCG

6

Appendix 1

Scope

The Regulated Care Sector in North Cumbria.

Primarily, but not exclusively, Services for Older People.

Purpose

To work collaboratively, building on existing work, to improve care in care homes through:

Developing a shared understanding of the evidence base and the implications ofimplementing best practice – including mapping against the 7 core elements fromthe Enhanced Health in Care Homes Framework.

Overseeing developments from the EHCH initiative.

Sharing current local and national changes in law and guidance and innovations.

Facilitating consistency in approach/standards/systems and processes where groupmembers feel this is appropriate and there are clear benefits to care homeresidents

Combining local authority and healthcare perspectives and intelligence to createsynergy and thereby maximise benefits for residents of care homes

Developing a shared work plan

The purpose of the group is not to share intelligence about individual providers but to agree and implement actions to progress improvement work.

Membership

Chair – CCG Senior Nurse

NHS England CNE Independent Care Sector Leads

NCCCG contracting leads

NCCCG Quality Improvement Facilitator

CPFT Community Senior Manager

Local Authority:

o Relevant Local Commissioning Leads

o Quality Implementation Lead

Skills for Care Representative

NHS North Cumbria Clinical Commissioning Group Care Home Collaborative

Terms of Reference

7

Meds Optimisation Lead NHSE

Medicines Optimisation Lead – NECS

NWAS Representative

Local Authority IPC Lead

Other staff invited as appropriate

Reporting arrangements

North Cumbria System Quality Assurance Committee

North Cumbria A&E Delivery Board

Support

NCCCG Admin Support

Task and Finish Groups to proceed with developments

Frequency of meetings

8 weekly or more frequently if required

Approval and Review

Date reviewed 25 June 2019

Date approved 25 June 2019

Date to be reviewed 25 June 2020