NHS Blackburn with Darwen CCG - GOVERNING BODY MEETING Wednesday 2 November 2016 … CCG GB... ·...

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CLINICAL COMMISSIONING GROUP (CCG)

GOVERNING BODY MEETING

Wednesday 2nd November 2016 at 1 pm Meeting Rooms 1 and 2, Blackburn Central Library

Town Hall Street, Blackburn BB2 1AG

A G E N D A

Item No: Agenda Item Member Responsible

Report

PUBLIC PARTICIPATION 1. Chair’s Welcome

Mr Graham Burgess Verbal

2. Apologies for Absence and Confirmation of Quoracy


3. Declarations of Interest relating to items on the agenda


4. Questions from Members of the Public


5. Stroke Update

Mrs Debbie Nixon Presentation

PART 1 BUSINESS (APPROXIMATELY 1.30 PM) 6.

6.1

6.2 6.3

Minutes of Previous Meetings Minutes of the Annual General Meeting Held on 7th September 2016 Minutes of the Meeting Held on 7th September 2016 Extract from Part 2 of the Minutes of the Meeting held on 7th September 2016

Mr Graham Burgess

Attached Attached

Attached

7. 7.1

Matters Arising Action Matrix

Mr Graham Burgess Attached

8. Clinical Chief Officer’s Report

Mr Roger Parr Attached

9. 9.1

Chief Finance Officer’s Report Quality, Innovation, Productivity and Prevention Update

Mr Roger Parr Attached

Verbal

10.

10.1

Contract, Quality and Performance Report Cancer Performance Update

Mr Roger Parr/ Dr Malcolm Ridgway Dr Malcolm Ridgway

Attached

Attached

11. External Audit Services – Contract Award Recommendation Report

Mr Paul Hinnigan Attached

FOR INFORMATION 12. Managing Conflicts of Interest in the NHS: A

Consultation

Mr Paul Hinnigan Attached

13. Sub-Committees and Groups’ Minutes

Mr Iain Fletcher Attached

Questions from members of the public will be received under Item 4; if submitted in advance in line with the protocol on the CCG’s website: http://www.blackburnwithdarwenccg.nhs.uk/about-us/governing-body-meetings/

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14. Any Other Business

All Verbal

15. Date and Time of Next Meeting: Wednesday 18th January 2017 in Meeting Rooms 1 and 2, Blackburn Central Library, Town Hall Street, Blackburn BB2 1AG


EXCLUSION OF THE PRESS AND PUBLIC – ‘That representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest’ (Section1(2)Public Bodies(Admission to Meetings)Act 1960)

PART 2 (APPROXIMATELY 2.30 PM) A/16 Minutes of Part 2 of the Meeting held on 7th

September 2016


B/16 B/16.1

Matters Arising Action Matrix


C/16 Pennine Lancashire Clinical Commissioning Groups’ Confidential Provider Update

Dr Malcolm Ridgway Attached

D/16 Finance Update

Mr Roger Parr Verbal

E/16 Clinical Senate Feedback

Dr Penny Morris Verbal

F/16 Transforming Care Update

Mr Roger Parr Verbal

G/16 G/16.1

Pennine Lancashire Next Steps Feedback Pennine Lancashire Reporting

Mr Graham Burgess Verbal Attached

H/16 Lancashire and South Cumbria Sustainability and Transformation Plan

Mr Graham Burgess To Follow

I/16 Any Other Business

All Verbal

J/16 Contract Update for Lancashire Care NHS Foundation Trust Community Services and East Lancashire Medical Services

Mr Roger Parr/ Mrs Debbie Nixon

Attached

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Item 6.1


Minutes of the Governing Body Annual General Meeting

Wednesday 7th September 2016 at 12.30 pm Meetings Room 1 and 2, Blackburn Central Library,

Town Hall Street, Blackburn BB2 1AG

PRESENT: Mr Graham Burgess Chair Dr Chris Clayton Clinical Chief Officer Mr Roger Parr Chief Finance Officer Dr Malcolm Ridgway Clinical Director for Primary Care and Quality Dr Adam Black General Practitioner Executive Member Dr John Randall General Practitioner Executive Member Dr Preeti Shukla General Practitioner Executive Member Mr Paul Hinnigan Lay Member – Governance Dr Nigel Horsfield Lay Member – Clinical Advisor Dr Geraint Jones Lay Member – Secondary Care Doctor (Retired) Mr Dominic Harrison Director of Public Health, Blackburn with Darwen Borough Council (BwD

BC) IN ATTENDANCE: Mr Iain Fletcher Head of Corporate Business Mrs Pauline Milligan Corporate Support Officer Min No: 16.068 Chair’s Welcome

The Chair welcomed everyone to the CCG’s Annual General Meeting (AGM). The Chair stated that this was a very important time of the year for the CCG, as it had to formally account to the public for its actions over the past year and outline its plans for this year. The Chair added that he hoped that those present found the presentations useful and interesting.

16.069 Apologies for Absence and Confirmation of Quoracy Apologies for absence were received from Dr Penny Morris, General Practitioner Executive Member and Vice Chair, Mrs Debbie Nixon, Chief Operating Officer and Dr Zaki Patel, General Practitioner (GP) Executive Member. The meeting was confirmed as quorate.

16.070 Declarations of Interest Relating to Items on the Agenda No declarations of interest were made with regards to items on the agenda.

16.071 Minutes of the Annual General Meeting Held on 28th September 2015 The minutes of the AGM held on 28th September 2015 had been approved as a correct record and ratified by the Governing Body on 4th November 2015.

Subject to approval at the next meeting

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RESOLVED: That the minutes of the Annual General Meeting held on 28th September 2015 were noted.

16.072

Review of the Year 2015/16 The Chair commenced the presentation with a brief outline of the CCG’s membership, which consisted of 27 member practices all of whom were part of the CCG’s Clinical Senate. The Chair explained that the practices had been grouped into four localities; namely Blackburn North, Blackburn East, Blackburn West and Darwen. The Chair continued to explain how this was important, in relation to the improvement of the integration of services within those neighbourhoods, along with colleagues in the Local Authority and other public services. The Chair informed the meeting that the Clinical Senate met on a regular basis throughout the year and was attended by all the GP Practices and, on some occasions, by all the GPs. There were some members of the Clinical Senate on the CCG’s Governing Body and, whilst the CCG was accountable to the public, it was also accountable to the membership of the Clinical Senate. The Chair explained that the CCG’s boundaries extended beyond that of the Borough and, whilst the Blackburn with Darwen (BwD) Borough’s population amounted to approximately 146,000; the CCG’s population amounted to approximately 167,000 and included people who live on the periphery of BwD who were registered with its GP Practices. The Chair outlined the social and economic profile of BwD and some of the challenges faced within the Borough in developing local health services. The Chair informed the meeting of the strong history of partnership working between health services and the Local Authority and reminded members of the Government’s plans to fully integrated Health and Social Care Services by 2020. He explained that joined-up working across Health and Social Care Services in the Borough was already well underway and work would continue to advance progress. The Chair stressed the increasing importance of all the CCG’s partnerships; e.g. as the lead commissioner for Mental Health Services; with voluntary and community organisations and the third sector and in its collaborations with organisations across Pennine Lancashire and Lancashire wide. The Chair summarised that the CCG’s partnership working was strong but needed to be developed further to meet the financial challenges faced by the CCG. The Chair provided examples of the CCG’s engagement activities over the last year and how it had strengthened its programme to ensure the improvement of its engagement with the patients and communities it served. In conclusion, the Chair stated that the CCG operated within the CCG Assurance Framework. The framework comprised of five components and in 2015/16 had been rated as follows:

• Well led organisation (good); • Delegated functions (good); • Finance (requires improvement); • Performance (good); • Planning (good).

The Chair explained that the CCG’s overall assurance status was “requires improvement” but this was due to the fact that the CCG had not fully met the 1% financial surplus business rules and had spent all of its available resources.

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Questions and answers followed. Dr Chris Clayton continued the presentation with a review of 2015/16 and a look ahead to planning for the future. Dr Clayton outlined key areas and highlighted finance as being a critical area for the NHS. Dr Clayton referred to media reporting of the current financial position of the NHS and reaffirmed the Chair’s earlier comments about the CCG’s financial assurance and its current significance, which had determined the CCG’s overall annual assurance rating. Dr Clayton reminded those present of the CCG’s vision and how its work, in partnership with others, would continue throughout this year. Dr Clayton referred to the statutory responsibilities of the CCG related to:

• CCG Assurance; Dr Clayton provided examples of evidence of the CCG’s assurance:

o the CCG had continue to remain “assured”; o the CCG had recently completed its 360O Stakeholder Survey and was

collating the results; o the CCG had met its objectives related to Equality and Diversity; o there was active staff engagement to support the Sustainable

Development Management Plan; o Dr Clayton had recently received confirmation of “full assurance” on the

CCG’s Better Care Fund Plan; o the CCG had achieved all of its statutory financial duties.

• Annual Review of the CCG’s Constitution;

Dr Clayton reminded those present that the CCG was a membership body made up of its General Practitioner (GP) Practices and explained the importance of regularly reviewing the CCG’s Constitution to ensure that it reflected the changing picture of the NHS. The changes made in October 2015 related to:

o the updated role and responsibilities related to Primary Care Co-commissioning;

o changes to meeting arrangements; o updates related to the appointment/re-appointment process and notice

periods; o updates related to delegated decision making arrangements; o updates related to meeting Terms of Reference.

• Monitoring the CCG’s Performance;

Dr Clayton explained that the performance monitoring of key indicators for health and action with providers of service was a major role of the CCG to ensure that improvements were made where targets were not met. In 2015/16 these related to:

o operational standards for treating 95% of patients within 4 hours at Accident and Emergency (A&E);

o response times for ambulances; o waiting times for cancer diagnosis and treatment; o waiting times for planned treatment.

Dr Clayton continued to reflect on the CCG’s key successes in 2015/16 related to:

• Mental Health; • Primary Care; • Medicines Management; • Integrated Care and Better Care Fund; • Scheduled Care; • Unscheduled Care; • Children and Adolescent Mental Health; • Paediatrics.

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Dr Clayton concluded that, as he reflected upon in his presentation, 2015/16 had been a very busy year in which the CCG had achieved a great deal. He invited questions from those present. Questions and answers followed. RESOLVED: That the Governing Body noted the content of the review of the year 2015/16.

16.073

Financial Review 2015/16 Mr Roger Parr introduced himself as the CCG’s Chief Finance Officer and provided an overview of the financial reports for 2015/16. Mr Parr referred to the former presentations and remarked that, as both presentations had referred to the financial aspects of the CCG, this indicated how important issues related to finance currently were within the NHS. Mr Parr presented the 2015/16 financial position of the CCG and thanked the Finance Team, including staff from the Midlands and Lancashire Commissioning Support Unit, for their hard work to ensure that the CCG’s accounts and financial statements were produced in line with national deadlines. The accounts and financial statements had been subjected to scrutiny from the CCG’s appointed External Auditors, Grant Thornton, and the process had been overseen by the CCG’s Audit Committee. The CCG achieved each of its key financial duties in 2015/16: Statutory Duties Target Performance Achieved CCG to remain within its revenue allocation

£241,912k £240,323k Yes

CCG to remain within its running cost allocation

£3,555k £3,473k Yes

Better Payment Practice Code Target Number NHS Payables 95.0% 99.0% Non NHS Payables 95.0% 98.8%

Mr Parr explained that from a total CCG allocation of almost £242m, the CCG spent just over £240m. The CCG’s running costs, which amounted to approximately £22 per head of population, resulted in a slight underspend. Another external target of the CCG was how the CCG paid its invoices in a timely fashion and the CCG had achieved this target. Mr Parr referred to the CCG’s income and expenditure and highlighted the CCG’s surplus for 2015/16 of just under £1.6m against a 1% target surplus. This meant that the CCG missed its target by £0.6m and resulted in the finance component of the assurance framework being rated as ‘requires improvement’. Mr Parr explained that the £1.6m would be returned to the CCG in 2016/17 and the CCG would again be expected to deliver a 1% surplus. Mr Parr outlined investments and developments in 2015/16 in:

• Primary Care Co-Commissioning; • Quality Improvement in Primary Care; • Prime Minister’s Challenge Fund; • Better Care Fund; • Intensive Home Support;

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• Mental Health. Mr Parr drew members attention to the CCG’s total spend of £240m, which amounted to £1,413 per head of the GP population and that 52% of the CCG’s total spend was spent within secondary care. Mr Parr continued that the CCG was working to understand different ways of supporting patients outside of a hospital setting. The expenditure per head was spent as follows: Total Spend £240m £1,413 per head % Acute Care £739 52% Primary Care £311 22% Community Based Care £101 8% Mental Health £101 7% Continuing Health Care £53 4% Other £101 7%

Mr Parr outlined hospital activity (the majority of which was at East Lancashire Hospitals NHS Trust) and this equated to:

• 23,109 scheduled care admissions; • 19,800 emergency admissions (54 admissions per day); • 165,532 out-patient attendances (662 attendances per day); • 61,288 A&E attendances (168 average attendances per day) • 1,752 hospital births; • 1,130 cataract operations.

Mr Parr looked to the future and reported that the CCG had allocations notified for the current and next financial year. The CCG had received the national minimum allocation of 3.05% and, therefore, remained under its target allocation by almost 2.5%, i.e. just over £5m; a significant amount. 2016/17 2017/18Programme Allocation £219,522k £224,450kRunning Cost Allocation £3,537k £3,518kPrimary Care Co-Commissioning £23,263k £23,691kTotal Allocation £246,322k £251,659k

Mr Parr explained that, in terms of the 3.05% increase this year, the level of efficiencies required by the CCG’s providers had reduced, i.e. instead of a reduction in prices from the providers the prices had actually increased by approximately 2%. New business rules had been introduced which meant that the CCG had to hold back 1% of its allocation, which would be used to support transformation and sustainability. This had resulted in 3% of the CCG’s allocation being accounted for outside its control, which indicated how challenging it would be for the CCG to reach its financial targets in 2016/17 and 2017/18. Mr Parr outlined the CCG’s investments and developments in 2016/17 related to:

• Primary Care; • Mental Health; • Continuing Health Care; • Learning Disabilities; • Better Care Fund; • 1% Transformation Fund.

Mr Parr concluded his presentation and invited questions on any aspect of the CCG’s finance or anything that had previously been presented. Questions and answers followed.

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RESOLVED: That the Governing Body noted the content of the financial review of 2015/16.

16.074 Any Other Business No further business was discussed.

16.075 Closing Remarks The Chair drew the meeting to a close and thanked everyone for their attendance and contribution to the meeting.

Signed Date

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Item Item 6.2

CLINICAL COMMISSIONING GROUP (CCG) Minutes of the Governing Body Meeting held on

Wednesday 7th September 2016 at 1.30 pm in Rooms 1 and 2, Blackburn Central Library,

Town Hall Street, Blackburn, BB2 1AG PRESENT: Mr Graham Burgess Chair Dr Chris Clayton Clinical Chief Officer Mr Roger Parr Chief Finance Officer Dr Malcolm Ridgway Clinical Director for Primary Care and Quality Dr Adam Black General Practitioner Executive Member Dr John Randall General Practitioner Executive Member Dr Preeti Shukla General Practitioner Executive Member Dr Zaki Patel General Practitioner Executive Member Mr Paul Hinnigan Lay Member – Governance Dr Nigel Horsfield Lay Member – Clinical Advisor Dr Geraint Jones Lay Member – Secondary Care Doctor (Retired) Mr Dominic Harrison Director of Public Health, Blackburn with Darwen Borough Council (BwD BC) IN ATTENDANCE: Mr Iain Fletcher Head of Corporate Business Mrs Pauline Milligan Corporate Support Officer Min No: 16.076 Chair’s Welcome

The Chair opened the meeting by welcoming all attendees and members of the public.

16.077 Apologies for Absence and Confirmation of Quoracy Apologies for absence had been received in respect of Mrs Debbie Nixon, Chief Operating Officer and Dr Penny Morris, General Practitioner (GP) Executive Member and Vice Chair. The meeting was confirmed as quorate.

16.078 Declarations of Interest Relating to Items on the Agenda No declarations of interest were made with regards to items on the agenda at this point. The Chair reminded members that they should, if appropriate, make a declaration should a conflict emerge during the meeting and these would be recorded against the relevant agenda item.

16.079

Q

Questions from Members of the Public The Chair confirmed that there had been a question submitted by a member of the public. My question is can you explain just where you are as Chair of the CCG in creating a policy decision which will prevent and repeated happenings of separating two older people who have lived together for years and both enter hospital and when the hospital treatment has been complete both require Continuing Care but are not placed in separate facilities when they were unable to get to see one another ever again.

Subject to approval at the next meeting

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A

This is I believe the Blackburn with Darwen Council agreed policy about NOT separating couples: Blackburn with Darwen Council Adult Services Policy statement on enabling married and co-habiting couples to reside together where both are in receipt of funded social care outside their domicile Good practice in social care assessment dictates that the needs and wishes of individuals and their partners must always be established and taken into account, including where those assessed are part of a marriage, civil partnership or other long term cohabiting relationship. Unfortunately, there are occasions where couples are split up due to one needing care and support which cannot be provided in their home. This statement refers to situations where both partners require 24-hour care and support in a residential or nursing home. The 1948 United Nations Universal Declaration of Human Rights Article 16 states that:

1. Men and women of full age, without any limitation due to race, nationality or religion, have the right to marry and to found a family. They are entitled to equal rights as to marriage, during marriage and at its dissolution.

2. Marriage shall be entered into only with the free and full consent of the intending spouses.

3. The family is the natural and fundamental group unit of society and is entitled to protection by society and the State

Article 12 of the Human Rights Act (1998) also protects the right of men and women of marriageable age to marry and to start a family. On occasion the Department will arrange and fund social care services for adults or older people who are part of a couple and where both require support in residential or nursing care. It is an integral part of the duty to promote wellbeing of the individuals that we take into account the wishes and the needs of married or cohabiting couples to continue living together once it becomes clear that both require care in a setting such as those named above. Where one or both partners have been assessed as lacking mental capacity within the meaning of the Mental Capacity Act (2005) then a best interest decision/s must be reached in accordance with the established process, and recommendations made accordingly. In the absence of evidence to the contrary, it would normally be assumed that it is in the interests of a couple with long standing relationship to be kept together where there is a care and support environment which can meet both there assessed needs. The CCG has been working with the other 6 CCGs in Lancashire to develop a Choice and Equity policy to support decision making around Continuing Health Care situations. The policy has taken some time to be agreed across 7 CCG governance structures with all the CCGs to ensure a consistent approach. The policy has subsequently been scrutinised by Hill Dickinson Solicitors to ensure it fits legally within current case law and will now be released to stakeholders for consultation for an 8-week period. The policy refers to the fact that the CCG will carefully consider the view of individuals, families and others as appropriate and act on all reasonable requests including keeping couples together where practically possible. The policy has been aligned to both Blackburn with Darwen Borough Council and Lancashire County Council policies. In relation to the CCG specific case I can confirm the following:

• An update on lessons learnt from the case has been received by the CCG Governing Body which highlighted where improvements need to be made;

• The CCG policy regarding Equity and Choice has been developed. However, each case

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will still need to be reviewed individually and assessed on merit. The CCG would always put the best interest and safeguarding as significant factors when assessing the level of care for people;

• The CCG has continued discussions with Lancashire Care NHS Foundation Trust

regarding the provision of Community Services to support residents with such complex needs.

The Chair summarised that there had been a case that had caused concern and the CCG Governing Body had received a special report on the case. It had since developed a policy in consultation with appropriate legal advice. The Chair continued that it was now an important part of the process that the policy went through the 8-week consultation period to enable all groups to discuss the content and raise any concerns or challenges.

16.080

16.080.1

Minutes of the Meeting held on 6th July 2016 The minutes of the meeting were reviewed and accepted as an accurate record. RESOLVED: That the minutes of the meeting held on 6th July 2016 were approved as an accurate record. Extract of Part 2 of the Minutes of the Meeting held on 6th July 2016 The extract of Part 2 of the minutes of the meeting held on 6th July 2016 was accepted as an accurate record. RESOLVED: That the Extract of Part 2 of the Minutes of the Meeting held on 6th July 2016 2016 was approved as an accurate record.

16.081

16.081.1

Matters Arising/Action Matrix Matters Arising There were no Matters Arising which were not listed on the Action Matrix. Action Matrix The Action Matrix was reviewed and the following were noted: Minute 16.005 – Stroke Update This item was deferred until the November meeting at the request of the Chair. Minute 16.047 – Suicide Prevention Strategy It was agreed that a verbal update would be provided to the November meeting.

16.082 Clinical Chief Officer’s Report Dr Chris Clayton presented his report and highlighted key items of national interest. Dr Clayton informed the meeting that the report had been tailored to highlight items mostly of national interest, as local items had been picked up at the Annual General Meeting. Items of note related to:

• Department of Health appointments; • Junior Doctors’ Contract; • Mental Health Fund; • Congenital Heart Disease.

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There were no questions. RESOLVED: That the GB noted the content of the report.

16.083 Chief Finance Officer’s Report Mr Roger Parr presented the Financial Summary, which provided details of the CCG’s overall financial position at the end of month 4; period ended 31st July 2016. Mr Parr drew members’ attention to the summary financial position, which indicated that the CCG was reporting a year to date surplus of £592k that was £152k under the year to date planned surplus of £744k. The CCG aimed to deliver its 1% surplus at year-end of £2,232K. Mr Parr reported that the main risks related to the continued increase in demand around activity in acute services and Continuing Healthcare. Mr Parr highlighted a current piece of work, which focused on reducing and eliminating prescribing waste. Mr Parr confirmed that the CCG was currently behind target and one of the main reasons for this was its annual Quality, Innovation, Productivity and Prevention (QIPP) target that, this year, had been set £2m higher than the last financial year. The CCG was close to identifying its full programme, however, there was currently a gap £0.9m. The CCG was working to identify the remainder of the balance and it was hoped this would be achieved through financial recovery. Questions and answers followed. A discussion took place on potential methods to reduce medicines waste. Following comments from Dr John Randall, it was agreed that the Medicines Management Team and GP Practices who had volunteered to be part of the pilot scheme should be recognised for their efforts to reduce prescribing waste across the CCG, including the reduction in the prescribing of ‘special’ medicines. RESOLVED: That the GB noted the content of the report and the overall position of the CCG at the end of July 2016, noting the risks and detailed appendices supporting the narrative; in particular the risk of the unidentified QIPP.

16.084 Contract, Quality and Performance Report Mr Parr presented the contracting section of the month 3 report and then suggested he defer to Dr Malcolm Ridgway to highlight the key points related to quality and performance. Mr Parr highlighted key items:

• Lancashire Care NHS Foundation Trust (LCFT) – Mental Health Services (page 2): o Psychological Therapies – for those entering treatment the target was over

achieved by almost 30%. o Referrals had increased. o Admissions to mental health in patient wards had decreased. o Bed days and length of stay were being closely monitored.

• East Lancashire Hospitals NHS Trust (ELHT) (page 3): o The activity variances on elective and non-elective had decreased but acuity

figures had increased. o Referrals – the total number of patients on an incomplete pathway and waiting

over 36 weeks had increased and there were two patients waiting for over 52 weeks. These were being closely monitored.

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Dr Ridgway drew members’ attention to key elements of the report related to quality:

• LCFT – Mental Health Services (page 2): o Psychological Therapies – Dr Ridgway reported that the 50% recovery target was

currently being reached. The prevalence target was also being reached. o Memory Assessment Service – there was an issue in getting patients through the

system and the target was currently not being reached. However, a recovery plan was being developed.

• ELHT (page 3): o Accident and Emergency (A&E) – Dr Ridgway reported that the monthly

performance was 85.47% and the year to date performance was 86.41%. The Pennine Lancashire System Resilience Group was leading on a system-wide recovery plan.

o Trolley Waits – there were three 12-hour A&E breaches for complex mental health patients in June. Root Cause Analysis investigations were progressing in line with due process. The Royal College of Psychology and Emergency Medicine was due to undertake a whole system review in October 2016.

o Cancer Waits – Dr Ridgway drew members’ attention to pages 14 and 15 and highlighted some issues related to urgent referrals for breast symptoms, as the target had not been reached in June. Dr Ridgway added that this was unusual and was being closely monitored. There was also concern about the 62-day wait target, which had not been reached and work was underway to improve the position.

• Primary Care (page 4): o Practice Visits – Dr Ridgway confirmed that, over the past year, 25 out of 27

practice visits had taken place. Each practice had been required to produce a report and action plan for improvement. The report review process was underway.

o Vulnerable Practice Scheme – Dr Ridgway referred to the assessment process, which had been developed by NHS England. Five practices in Blackburn with Darwen (BwD) had been identified as ‘vulnerable’ and it was noted that those practices would be offered tailored packages of support.

o Care Quality Commissioning (CQC) – Dr Ridgway reported that the second round of inspections had begun throughout BwD. The CCG had received one published result that had been rated as “good”. The CCG would continue to receive reports on practices over the next few months and would work with the CQC to ensure any improvements required were made.

• LCFT – Community Services (page 6): Dr Ridgway informed members that there were now several new targets within Community Services. He reminded members that Chorley South Ribble CCG was the lead commissioner for the contract. He added that there appeared to be an improved set of measures to monitor against the target than there had been previously.

o Category A Ambulance Calls – Dr Ridgway reported that there were issues with the target that were being picked up by the Pennine Lancashire System Resilience Group (PLSRG) and these partly reflected problems within the urgent care system as a whole.

Questions and answers followed. ACTION: Following a request from Mr Paul Hinnigan, Mr Roger Parr agreed to oversee the reinstatement of information related to referrals and waiting lists in the report. ACTION: Following a comment from Mr Hinnigan, Dr Ridgway agreed to pick up the issues related to the community contract staffing levels at the CCG’s contract meetings with the lead commissioner. RESOLVED: That the GB noted the content of the report and supported the actions as identified.

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16.085 Governing Body Assurance Framework Update Mr Parr presented the quarterly update of the Governing Body Assurance Framework (GBAF). The GBAF was a key document that linked the corporate objectives to risks, controls and assurances and was the main tool used by the GB to discharge its overall responsibility for internal control. Mr Parr reminded GB members that the Quality, Performance and Effectiveness Committee (QPEC) scrutinised the GBAF and the Audit Committee was responsible for overseeing the process around assurance and the management of risk. Mr Parr drew members’ attention to the strategic risks to the CCG’s Corporate Objectives 2016/17 (page 2) and highlighted the highest rated strategic risk which was:

• CO6.2 Clinical Workforce Capacity – current workforce capacity may impact plans for future primary care delivery (“20”).

Mr Parr drew out section 3.2, which listed a series of actions taken to support the mitigation of the risk. Members were also requested to note section 4 (page 3) which listed the following risk, which it was expected would be reduced to target risk within the next quarter and would be included in the next update to the GB:

• CO6.1 Inability to secure active participation from member practices for delivering the CCG’s plans around Primary Care at scale.

Mr Parr referred to plans under the CCG’s Quality and Outcomes Enhanced Services Transformation (QOEST) scheme and it was expected that there would be a series of participation plans developed by member practices to secure the delivery of Primary Care at scale. Mr Parr drew members’ attention to the detailed appendices, which provided a copy of the GBAF and the impact assessment risk grading scoring mechanism. Questions and answers followed. Mr Hinnigan informed members that there had been a recent report produced by the Mersey Internal Audit Agency, which had benchmarked how CCGs manage their GBAFs. BwD had scored well and recorded a ‘green’ rating in the majority of scoring, with the exception of an ‘amber’ rating, which related to the way in which GB discussions related to risk were recorded. There were also some other minor recommendations, which were being discussed via the QPEC. The Chair echoed Mr Hinnigan’s comments and reiterated the importance of the GB’s discussions around risk and that they were recorded in full. Dr Clayton informed members that he always discussed risk at every Clinical Senate meeting and highlighted to the membership the highest rated risks to the CCG’s Corporate Objectives. RESOLVED: That the GB noted the content of the report.

16.086 System Resilience Update Dr Clayton provided an update on the current position related to system resilience and spoke to a briefing paper provided by the PLSRG. Dr Clayton explained the background the establishment of the PLSRG in June 2015. The

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group, chaired by Dr Clayton, was formed in response to national guidance, which required local systems to implement such committees. The PLSRG had worked hard to understand the complex risks within the health economy and develop ways to mitigate them. The remit of the SRGs had developed to become much wider than urgent care system resilience. The SRGs were requested to consider a wide range of issues, e.g. including Referral to Treatment (RTT) times, cancer waiting times, ambulance services and mental health services. Over the last 18 months the PLSRG, attended by a broad range of senior level staff, had reviewed a wide range of work streams. The PLSRG was developing its own Risk Register and this had highlighted some areas that required particular attention. These were the 4-hour A&E standard, the ambulance targets and some of the mental health pathways. It was recognised that the A&E standard was a national problem; however, Dr Clayton commented that local performance up to the Christmas period in 2015 had been comparatively good. However, performance had deteriorated since then and it had become a considerable challenge to meet the target. Dr Clayton explained that some of the reasons why the target was not being reached were complex. He added that a whole system 4 Hour Recovery Plan had been developed with specific targets for delivery. Dr Clayton continued that national guidance had directed that the SRGs were required to change and their main focus would be to deliver system recovery and the achievement of the 4-hour A&E standard. He explained that the SRGs would be reformed into A&E Delivery Boards. The PL A&E Delivery Board was expected to be in place by October, with senior representation from the whole health economy. Dr Clayton drew members’ attention to the fact that, whilst the work of the PL A&E Board was paramount, the CCG also had to ensure that the important work previously undertaken by the PLSRG was transferred to other forums and arrangements would be communicated to the GB as necessary. Questions and answers followed. The GB debated the reasons why patients continued to access services via the A&E Department when other services were available and how the CCG could work to inform patients of the other services available and encourage their use. It was noted that a media campaign around system resilience was due to be launched in the near future. RESOLVED: That the GB noted the content of the update.

16.087 Annual Report of the Audit Committee Mr Hinnigan presented the Annual Report of the Audit Committee, which informed the GB of the role and activities of the Audit Committee during the financial year 2015/16, as stated in its Terms of Reference, for information. There were no questions. RESOLVED: That the GB noted the content of the report.

16.088 Review of Register of Interests Mr Parr presented the quarterly review and update of the GB’s Register of Interests, which was presented to the Audit Committee on 30th August 2016, for information. There were no questions. RESOLVED: That the GB noted the content of the report.

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16.089 Sub-Committee and Groups’ Minutes Mr Iain Fletcher presented the Sub Committees and Groups’ Report, which informed the GB of delegated and key decisions taken and provided information regarding items of particular interest or potential risk, for information. Questions and answers followed. ACTION: Following a comment by Mr Hinnigan, it was agreed that the minutes of the Remuneration Committee should be included in the next report to the GB; as the meetings generally only took place on an annual basis and meant that the minutes would not be received in a timely manner. Mr Fletcher to oversee. RESOLVED: That the GB noted the content of the report.


16.091 Date and Time of Next Meeting The next meeting will be held on Wednesday 2nd November 2016 at 1 pm in Meeting Rooms 1 and 2 Blackburn Central Library, Town Hall St, Blackburn, BB2 1AG. The Chair thanked everyone for their attendance and input and the meeting closed.

EXCLUSION OF THE PRESS AND PUBLIC – ‘That representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest’ (Section1(2)Public Bodies(Admission to Meetings)Act 1960).

Signed ………………………………………………. Chair ……………………………………………… Date

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Item 6.3


Extract from Part 2 of the Minutes of the Governing Body (GB) Meeting held on Wednesday 7th September 2016 at 2.30 pm

in Rooms 1 and 2, Blackburn Central Library, Town Hall Street, Blackburn, BB2 1AG

PRESENT: Mr Graham Burgess Chair Dr Chris Clayton Clinical Chief Officer Mr Roger Parr Chief Finance Officer Dr Malcolm Ridgway Clinical Director for Primary Care and Quality Dr Adam Black General Practitioner Executive Member Dr John Randall General Practitioner Executive Member Dr Preeti Shukla General Practitioner Executive Member Dr Zaki Patel General Practitioner Executive Member Mr Paul Hinnigan Lay Member – Governance Dr Nigel Horsfield Lay Member – Clinical Advisor Dr Geraint Jones Lay Member – Secondary Care Doctor (Retired) Mr Dominic Harrison Director of Public Health, Blackburn with Darwen Borough

Council (BwD BC) IN ATTENDANCE: Mr Iain Fletcher Head of Corporate Business Mrs Pauline Milligan Corporate Support Officer

Re-Confirmation of Apologies for Absence and Quoracy Apologies for absence had been received in respect of Mrs Debbie Nixon, Chief

Operating Officer and Dr Penny Morris, General Practitioner (GP) Executive Member and Vice Chair. The meeting was confirmed as quorate.

Re-Confirmation of Declaration of Interests No declarations of interest were made with regards to items on the agenda at this point.

The Chair reminded members that they should, if appropriate, make a declaration should a conflict emerge during the meeting and these would be recorded against the relevant agenda item.

A/16 Minutes of Part 2 of the Meeting held on 6th July 2016 The Minutes of Part 2 of the Meeting held on 6th July 2016 were reviewed and accepted as an accurate record. RESOLVED: That the Minutes of Part 2 of the Meeting held on 6th July 2016 were approved as an accurate record.

B/16

B/16.1

Matters Arising There were no matters arising. Action Matrix The Action Matrix was reviewed and it was noted that all the actions had been completed.

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C/16

C/16.1

C/16.2

C/16.3

Draft Lancashire and South Cumbria Sustainability and Transformation Plan The Chair introduced the circulated June submission of the draft Lancashire and South Cumbria (LSC) Sustainability and Transformation Plan (STP). The Chair informed members that the final version of the STP was due to be submitted towards the end of October. On reviewing the document, the Chair drew members’ attention to some of the comments which required clarification. RESOLVED: That the GB noted the content of the document. LSC Joint Committee of CCGs’ (JCCCGs) Draft Terms of Reference The Chair presented the amended Terms of Reference (ToR) and reminded members that the collated comments from previous discussions had been submitted to the LSC Change Programme (CP). Following discussion, the GB agreed to accept the amended JCCCGs’ ToR. RESOLVED: That the GB agreed to accept the amended JCCCGs’ ToR. Constitution Amendment Proposals Mr Iain Fletcher stated that the CCG would have to make some changes to its Constitution in light of the approval of the JCCCGs’ ToR. Mr Fletcher outlined the key areas which would need to be amended. Dr Chris Clayton explained that he had informed the LSCCP that, if the CCG GB accepted the JCCCGs’ ToR, it would then be presented to the Membership for final formal agreement. RESOLVED: That the GB noted the content of the update. Pennine Lancashire Reporting The Chair presented the draft minutes of the System Leaders Forum dated 20th July 2016 for information. There were no questions. RESOLVED: That the GB noted the content of the minutes.

D/16 Reportable Events Dr Malcolm Ridgway presented the Reportable Events report and drew key elements to the attention of members. Questions and answers followed. RESOLVED: That the GB noted the content of the update.

E/16

Primary Care Update It was agreed that Dr Ridgway had covered this item earlier in the meeting.

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F/16 Finance Report Mr Roger Parr provided an updated on the financial position of the CCG, as at month 5. Mr Parr recapped the 2015/16 position, in which the CCG had experienced activity and demand pressures in acute and complex cases. There had been a shortfall of circa £500k of the CCG’s target at the end of the last financial year. The financial plans for 2016/17 were approved by the GB in March. The CCG’s allocation had been below fair share and the minimum uplift had been received. Mr Parr reported that the Quality, Innovation Productivity and Prevention (QIPP) target was the largest to date at £6.9m (£2m higher than last year). Mr Parr explained the process and plans to enable the CCG to deliver its QIPP target for 2016/17. Questions and answers followed. RESOLVED: That the GB noted the content of the update.

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Item 7.1 GOVERNING BODY (GB) MEETING - ACTION MATRIX PART 1

Action Origin

GB Ref Action Owner Due Date Status

16.005

Stroke Update It was agreed that a report on progress related to the Stroke Services review would be brought to a future meeting.

CC

NOVEMBER

COMPLETED

NOVEMBER AGENDA.

16.047 Suicide Prevention Strategy Following an enquiry from the Chair, Mr Harrison agreed to explore the correlation between the shift in age range of male suicide being linked to the economic downturn and areas of deprivation.

DH

NOVEMBER

IN PROGRESS.

VERBAL UPDATE TO JANUARY 2017 MEETING.

16.059

Clinical Chief Officer’s Report – Public Health England Strategic Plan 2016 – 2020 It was agreed that the GB would welcome a full report from Mr Harrison on the Public Health England Strategic Plan at a future meeting.

DH

NOVEMBER

IN PROGRESS

PRESENTATION TO JANUARY 2017 MEETING.

16.064

Communication and Engagement Report Mr Hinnigan requested that future reports provided more detailed information which indicated whether activity was going up or down, e.g. followers on social media, website hits or the number of people attending events. Mr Iain Fletcher to oversee.

IF

OCTOBER

COMPLETED.

INFORMATION CONTAINED WITH OCTOBER REPORT

TO DEVELOPMENT SESSION.

16.066

Any Other Business – Conflicts of Interest Following the mapping exercise, Mr Iain Fletcher to bring a detailed report on the implications of the revised statutory guidance to a future meeting of the GB.

IF

OCTOBER

COMPLETED.

OCTOBER DEVELOPMENT SESSION AGENDA.

16.084 Contract, Quality and Performance Report Following a request from Mr Paul Hinnigan, Mr Roger Parr agreed to oversee the reinstatement of information related to referrals and waiting lists in the report.

RP

NOVEMBER

COMPLETED.

INFORMATION CONTAINED IN CONTRACT, QUALITY

AND PERFORMANCE REPORT.

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16.084 Contract, Quality and Performance Report Following a comment from Mr Hinnigan, Dr Ridgway agreed to pick up the issues related to the community contract staffing levels at the CCG’s contract meetings with the lead commissioner.

MR

NOVEMBER

COMPLETED.

INFORMATION CONTAINED WITHIN THE CONTRACT,

QUALITY AND PERFORMANCE REPORT.

16.089 Sub-Committee and Groups’ Minutes

Following a comment by Mr Hinnigan, it was agreed that the minutes of the Remuneration Committee should be included in the next report to the GB; as the meetings generally only took place on an annual basis and meant that the minutes would not be received in a timely manner. Mr Fletcher to oversee.

IF

NOVEMBER

COMPLETED.

REMUNERATION COMMITTEE MINUTES

INCLUDED IN THE SUB-COMMITTEE AND GROUPS’

REPORT.

Report of the Clinical Chief Officer – 2nd November 2016 Page 1 of 9

GOVERNOVERNING BODY MEETING


TITLE OF PAPER: CLINICAL CHIEF OFFICER’S REPORT

Date of Meeting 2nd November 2016 Agenda Item 8

CCG Corporate Objectives

Through better commissioning, improve local health outcomes by addressing poor outcomes and inequalities X

To work collaboratively to create safe, high quality health care services X

To maintain financial balance and improve efficiency and productivity X

To deliver a step change in the NHS preventing ill health and supporting people to live healthier lives X

To maintain and improve performance against core standards and statutory requirements X

To commission improved out of hospital care X

CCG High Impact Changes

Delivering high quality Primary Care at scale and improving access X

Self-Care and Early Intervention X

Enhanced and Integrated Primary Care and Better Care Fund X

Access to Re-ablement and Intermediate Care X

Improved hospital discharge and reduced length of stay X

Community based ambulatory care for specific conditions X

Access to high quality Urgent and Emergency Care X

Scheduled Care X

Quality √

Clinical Lead: Chris Clayton

Senior Lead Manager Iain Fletcher

Finance Manager Roger Parr

Equality Impact and Risk Assessment completed: The report is for the information of members only.

Patient and Public Engagement completed: The report is for the information of members only.

Financial Implications The report is for the information of members only.

Risk Identified The report is for the information of members only.

Report authorised by Senior Manager: Chris Clayton

Decision Recommendations The Governing Body is requested to receive this report and to note the items as detailed.


Y



2ND NOVEMBER 2016

CLINICAL CHIEF OFFICER’S REPORT

1) Introduction

This report provides an update on national and local issues of interest to Governing Body (GB) members not covered elsewhere on the agenda, and also provides an indication of where the Clinical Chief Officer’s (CCO) efforts have been directed since the last meeting.

2) Department of Health

2.1 Health Information Technology

In response to the report by the national Advisory Group on Health Information Technology in England, chaired by Professor Robert Wachter, the Health Secretary, Jeremy Hunt, announced new plans to fast track digital excellence and improve the digital skills of the NHS workforce. 12 new global exemplars to pioneer best practice and a new academy dedicated to training NHS staff in digital skills will be established. As global exemplars, the 12 successful NHS organisations will receive up to £10m and be expected to deliver pioneering approaches to digital services and help others in the NHS to learn from their experience. These Trusts will be partnered with an international organisation of their choice, to take full advantage of their expertise.

Alongside investment in technology and infrastructure, the funding will be used to improve training for staff and will also encourage a new generation of Chief Clinical Information Officers to drive forward advances in digital technology.

Meanwhile, Universities will be invited to host the new NHS digital academy, which will help train NHS professionals in the key skills they will need to deliver next generation, digital healthcare.

Further funding will be available for another 20 Trusts to become national exemplars, receiving an intensive programme of support from the new NHS digital academy, and up to £5m each, to improve how digital technology is used across their organisation. New digital services for patients will enable them to register with a General Practitioner (GP), access healthcare records and get medical advice via their tablet or smartphone all in one place. The services, which will be available from the end of next year, are intended to make the NHS easier to use for the increasing numbers of people using smartphones and other mobile devices to access public services.

2.2 Health Research

It has also been announced that leading NHS Clinicians and Universities will benefit from new world class facilities and support services built by the 5-year funding package totalling £816m; the largest ever investment into health research.


Mental health research will see funding increase to nearly £70m, dementia to over £45m, deafness and hearing problems will receive over £15m and antimicrobial resistance research will rise to around £45m.

The funding has been awarded to 20 NHS and University partnerships across England through the National Institute for Health Research (NIHR). Each of the 20 biomedical research centres will host the development of new, ground-breaking treatments, diagnostics, prevention and care for patients in a wide range of diseases like cancer and dementia.

Amongst the successful applicants who will receive a share of the £816m investment is a North West partnership. Central Manchester University Hospitals NHS Foundation Trust and the University of Manchester will receive funding of £28,500,000 for 5 years from 1st April 2017 for advanced radiotherapy, cancer prevention and early detection, cancer precision medicine, dermatology, hearing health, respiratory medicine and targeted therapy in musculoskeletal diseases.

2.3 United Nations Declaration of Antimicrobial Resistance

A landmark declaration agreeing to combat antimicrobial resistance has been signed by 193 countries at the United Nations (UN) General Assembly. The agreement follows a worldwide campaign led by the Chief Medical Officer, Professor Dame Sally Davies, and Health Secretary, Jeremy Hunt, to highlight the threat posed to modern medicine by antimicrobial resistance (AMR).

Every signatory has agreed that drug resistant infections must be tackled as a priority. The nations have committed to:

• develop surveillance and regulatory systems on the use and sales of antimicrobial medicines for humans and animals;

• encourage innovative ways to develop new antibiotics, and improve rapid diagnostics; • raise awareness among health professionals and the public on how to prevent drug-

resistant infections.

Drug-resistant infections pose the biggest threat to modern medicine. Currently, it is estimated that more than 700,000 people die annually due to drug-resistant infections such as Tuberculosis, Human Immunodeficiency Virus (HIV) and Malaria but, because of the lack of global data, it is thought that the real number is likely to be far more.

By 2050, if left unchecked, drug-resistant infections will kill 10m people a year and cost the worldwide economy $100 tn. Chemotherapy would not be possible and even simple surgeries, such as hip operations, could be become life-threatening.

The UN Secretary General will now convene a group including UN agencies to accelerate action and report back in two years.

The Declaration builds on the important commitments made by G20 leaders earlier this month to consider how to stimulate research and the development of new antimicrobial products.

2.4 Medical Training

The number of medical training places available to students each year will be expanded to ensure the NHS has enough Doctors to continue to provide safe, compassionate care in the future, Health Secretary, Jeremy Hunt, announced on the 4th October 2016.

From September 2018, the Government will fund up to 1,500 additional student places through medical school each year. Students will be able to apply for the extra places from next year in order to take them up from the academic year 2018/19.


The Health Secretary also pledged to reform the current cap on the total number of places that medical schools can offer, which is set at just over 6,000 a year. Currently, Universities can only offer places to half of those who apply to study medicine, but this new measure will allow all domestic students with the academic grades, skills and capability to train as a Doctor to have the chance to do so.

2.5 Community Pharmacies

The Government has announced plans to modernise Community Pharmacies, to ensure a better quality service for patients and relieve pressure in other parts of the NHS. The changes follow an extensive consultation earlier this year.

New measures, supported by NHS England, will include the first ever reward system for Pharmacies that are providing a high quality service.

The Government currently funds Community Pharmacy at £2.8bn a year. The way Community Pharmacies are rewarded and funded for NHS services was last reviewed 10 years ago.

Over the last 10 years the budget for Community Pharmacy has gone up by more than 40%. The number of Community Pharmacies in England is over 11,500, which is up by 18% in 10 years, and two-fifths of Pharmacies in England are within 10 minutes’ walk of 2 or more other Pharmacies.

The average Pharmacy costs £220,000 a year for NHS pharmaceutical services, including fixed £25,000 ‘establishment payments’ that most Pharmacies receive annually, regardless of the service they provide. The new package will phase out the establishment payment and place greater emphasis on rewarding Pharmacies for the quality of services provided to the public.

Government spending for pharmacy will remain at around £2.6bn a year, and will ensure that those people in isolated areas with higher health needs will have access to a Pharmacy through a new pharmacy access scheme.

Pharmacies that might have narrowly missed out on the Pharmacy Access Scheme funding through the distance criteria, but are in an area of high deprivation, will be eligible to ask for a review. This will cover Pharmacies that are located in the top 20% most deprived areas in England and are 0.8 miles or more from another Pharmacy and are critical to access. Funding for successful reviews will be made available as required from outside of this package.

The savings made will go into improved NHS services throughout the country, to ensure that patients get the highest-quality provision possible.

3) NHS England 3.1 Annual General Meeting NHS England held its Annual General Meeting on 25th October 2016.

The meeting looked back on the progress the NHS had made over the last twelve months towards delivering on its shared plan for improved health, transformed care and a financially sustainable health and care system. Senior NHS, health, care and local government leaders from the across the country were invited to participate in two panels, covering a broad range of issues including:

• the work of Sustainability and Transformation Plans (STPs); • efficiencies; • delivering for patients on cancer, mental health, learning disabilities and urgent and

emergency care.

A live stream of the meeting can be accessed via: https://www.england.nhs.uk/livestreams/


3.2 NHS Operational Planning and Contracting Guidance 2017-19

The NHS Operational Planning and Contracting Guidance 2017-19 document was published on 22nd September 2016. This was a joint document between NHS England (commissioners) and NHS Improvement (providers). The planning guidance covers two financial years, to provide greater stability and support transformation and is underpinned by a two-year tariff and two-year NHS Standard Contract. Alongside the planning guidance the draft National Tariff prices, Quality Premium guidance and draft national Commissioning for Quality and Innovation (CQUIN) have also been released. The guidance is built around STPs, although there is still a requirement for commissioner and provider organisational level plans in 2017/18 and 2018/19. Organisational plans will need to demonstrate:

• how they will be delivering the nine ‘must-dos’; • how they support delivery of the local STP, including clear and credible milestones and

deliverables; • the planned contribution to savings; • how risks have been jointly identified and mitigated through an agreed contingency plan; • the impact of new care models.

The key planning dates are: 22nd September 2016 Planning guidance published 21st October 2016 Submission of STPs 24th November 2016 Submission of full draft 17/18 and 18/19 operational plans 23rd December 2016 National deadline for signing of contracts 23rd December 2016 Submission of final 17/18 and 18/19 operational plans aligned with

contracts Further information via: https://www.england.nhs.uk/ourwork/futurenhs/deliver-forward-view/

3.3 Specialised Commissioning

NHS England has launched a consultation on four related policies that describe how it will make decisions on funding for treatments that are not currently routinely commissioned.

The four policies are: in-year service developments, individual funding requests, funding experimental and unproven treatments, and continuing funding after clinical trials. The public consultation, announced on 13th October 2016 and which will be open for 12 weeks, will ensure the policies help NHS England make the most effective, sustainable and fair use of its finite resources. The key themes of the consultation findings and feedback will be published on the NHS England website.

The draft policies are the result of a review of the eleven existing policies established when NHS England became responsible for commissioning of specialised services in 2013. The review, which took into account the lessons learned from using the policies in practice, as well as feedback from stakeholders, found that many of the original eleven are now covered by Department of Health or other NHS England policy. The four areas that still require distinct policies are the focus of the consultation.

A series of events will be run in conjunction with the consultation.


Further information via: https://www.england.nhs.uk/2016/10/specialised-comms-consultation/ 4) Care Quality Commission

4.1 State of Care Report

The Care Quality Commission (CQC) has produced its annual ‘State of Care’ report on the quality and health and social care in England.

This year’s report shows that, despite increasingly challenging circumstances, much good care is being delivered and encouraging levels of improvement are taking place.

The CQC has seen services providing good and outstanding care and making improvements by collaborating outside traditional organisational boundaries - hospitals working with GPs, GPs working with social care and all services working with people who use services.

However, it has also seen some deterioration in quality, and some services are struggling to improve.

The CQC has raised concerns that the sustainability of the adult social care market is approaching a tipping point. The fragility of the market is now beginning to impact both on the people who rely on these services and on the performance of NHS care. The combination of a growing and ageing population, more people with long-term conditions, and a challenging economic climate means greater demand on services and more problems for people in accessing care

Further information via: http://www.cqc.org.uk/content/state-of-care

5) Lancashire and South Cumbria

5.1 STP

Lancashire and South Cumbria’s STP will be published in the coming weeks. The plan will be designed to deliver better health and care for the public now and in the future.

Partners have formed five local development plans across the region in Central Lancashire, the Fylde Coast, Morecambe Bay, West Lancashire and our own in Pennine Lancashire for ‘Together: A Healthier Future’. This joint approach will help Healthier Lancashire and South Cumbria achieve its objectives across the NHS, Local Government and the Third Sector.

The partners want a wide range of people to get involved and have their say to make sure local people’s views are listened to as the plans begin to take shape. Once the report is published, the partners will also announce how people can get involved.

The STP is the plan to deliver the Five Year Forward View across Lancashire and South Cumbria for which 33 NHS and local Council organisations have come together to develop.

5.2 Lancashire Care NHS Foundation Trust

At the end of December 2016, Hurstwood Ward (Ward 22) located at Burnley General Hospital is relocating to the ground floor site at Hillview, Royal Blackburn Hospital. The ward provides 18 beds for males and females with Advanced Care needs with an acute mental health issue, such as depression, anxiety, bi-polar disorder, schizophrenia and some patients with mild to moderate dementia.


Last year, the CQC highlighted some issues with the accommodation on ward 22 and, whilst these have been addressed as far as possible, the ward was not able to meet completely the needs of the client group for which it was intended. The staff on the ward will fully support patients and carers to ensure that the relocation happens with the minimum amount of disruption and they will be kept informed as plans progress. FAQs have been shared with both staff and patients on the ward.

6) Pennine Lancashire

6.1 Engagement Event

Residents and other stakeholders attended a successful engagement event in the 1882 Lounge at Burnley Football Club’s Turf Moor stadium on 19th October 2016 to discuss emerging models of care. The event gave people a chance to express their views on what works well with local health and social care, what needs improving and how together we can face the challenges ahead. The feedback will be collated and published widely.

6.2 Health Celebration Event

Members of the CCG attended the recent Health Celebration event at Blackburn Cathedral, which proved to be a great success. The event highlighted the good practice and innovation in healthcare that has taken place over recent years in Pennine Lancashire. On the day, hundreds of people were in attendance to see and hear from the likes of comedian and Coronation Street actor, Gareth Berliner, who took time out to share his personal experiences of depression, living with a long term condition and how he overcame a number of obstacles. Teachers Tim and Kerry Meek, along with their daughters Amy (11) and Ella (9), led mini-workshops and gave a talk about their incredible experiences of travelling the UK and making some radical life changes. Suco Suco Samba – a drum and dance troupe for people in recovery from addiction formed by East Lancashire support group ‘Juice’ - brought the samba sounds and there were also demonstrations of the North West Ambulance NHS Trust’s telecare services, virtual visits designed to reduce social isolation, health Skyping and 3D printing of prosthetic hands.

6.3 Influenza

Parents with young children are being urged to get them vaccinated against the misery of influenza as winter approaches. Children who will be aged two, three and four on or before 31 August 2016 will be eligible for a free ‘flu vaccination and GPs from East Lancashire and Blackburn with Darwen are urging parents and guardians to look out for a letter offering their child the opportunity.

The vaccination is the best protection against what is an unpredictable virus. It can cause severe illness and can even be fatal in some cases. It’s also vital that children get vaccinated every year, vaccines are not for life and just as the virus changes each year so does the vaccine – it will protect children and those they come into contact with.

Further information via: www.nhs.uk/staywell

6.4 East Lancashire Hospitals NHS Trust

The Trust has announced that it is working with the University of Central Lancashire as its main provider of medical undergraduate education and training as part of the new MBBS (Bachelor of Medicine, Bachelor of Surgery) degree programme.


The Trust has a well-established reputation for undergraduate and postgraduate education and is confident that its planned ‘teaching hospital’ status will help both Burnley General and Royal Blackburn hospitals to attract and retain high quality clinical staff.

7) Blackburn with Darwen Clinical Commissioning Group 7.1 Clinical Senate

The CCG held a full membership meeting on the 20th October 2016. The Senate agreed to a number of key constitutional changes:

• To form a Joint Committee of Lancashire and South Cumbria CCGs; • To form a joint Quality Committee across Pennine Lancashire; • To change the definition of the post of the Clinical Director of Quality and Effectiveness; • To provide a mandate for commissioners to explore the development of a Multi-Speciality

Community Provider (MCP) model of care for Blackburn with Darwen, following the partially integrated option.

7.2 Consultation on Gluten Free Food on Prescription

The CCG is currently engaging with people on its policy on gluten-free food on prescription. For the past 30 years the NHS has prescribed gluten-free foods to patients who have been diagnosed with coeliac disease. This service started when gluten-free foods were not as readily available as they are today. The NHS has a limited budget and with an increasing demand for services it must evaluate every service it pays for. In 2015/16 the CCG spent £110,000 on gluten-free products. This can be re-invested into alternative patient services. The CCG is proposing to stop prescribing them. The consultation is open until 11th November 2016.

The consultation questionnaire is available at: https://www.surveymonkey.co.uk/r/gfconsultation

8) Good News

8.1 General Practice Awards 2016

I am pleased to announce that Darwen Healthcare, of which I am a GP partner, has been shortlisted in three categories in the General Practice awards.

• Practice Manager of the Year; • Clinical Team of the Year – Diabetes; • Nursing Team of the Year.

The awards are designed to recognise, highlight, and reward the hard work and innovation that gets carried out every day in GP surgeries up and down the UK. The winners will be announced at an awards event to be held on 24th November.

9) Meetings

Members may be interested to note the following meetings and events which have taken place during the course of the last two months.


11th August Pennine Lancashire System Resilience Group 11th August 4 Hour System Recovery Meeting 1st September Pennine Lancashire System Resilience Group 1st September Stakeholder Event, Blackburn Library 7th September Annual General Meeting, Blackburn Library 7th September Governing Body Meeting, Blackburn Library 8th September Local Medical Committee Liaison Meeting 8th September Pennine Lancashire Community Safety Partnership 9th September Accident and Emergency Delivery Board 12th September Pennine Lancashire Solution Design Public Engagement Event 13th September Collaborative Commissioning Board Meeting 13th September Accident and Emergency Delivery Board 14th September Commissioning Business Group Meeting 19th September Pennine Lancashire Community Safety Steering Group 21st September Very Senior Leaders Forum 21st September Pennine Lancashire System Leaders Forum 26th September Primary Care Capital Transformation Group 27th September Blackburn with Darwen Health and Well-being Board 28th September Age UK 40th Anniversary Celebration 3rd October Pennine Lancashire Community Safety Steering Group 4th October NHS England/Blackburn with Darwen CCG Mid-Year Review 5th October Governing Body Meeting 5th October Clinical and Management Executive Team Meeting 6th October STP Planning Event 10th October Local Strategic Partnership Board Meeting 11th October Collaborative Commissioning Board Meeting 12th October Commissioning Business Group Meeting 18th October STP Leadership Forum 19th October Lancashire and South Cumbria Urgent and Emergency Care Network 19th October Pennine Lancashire System Leaders Forum 20th October Pennine Lancashire Transformation Programme Board 24th October Primary Care Capital Transformation Group 25th October NHS England Annual General Meeting 26th October Lancashire Accountable Officer’s Meeting 26th October Clinical and Management Executive Team Meeting

10) Recommendation The Governing Body is requested to receive this report and to note the items as detailed.

Dr. Chris Clayton Clinical Chief Officer 25th October 2016

Governing Body Meeting Page 1 of 2

GOVERNING BODGOVERNING BODY MEETING

Y


Chief Finance Officer Report





To maintain financial balance and improve efficiency and productivity Y












Scheduled Care X

Quality X

Clinical Lead: N/A

Senior Lead Manager Mr Roger Parr

Finance Manager Mrs Linda Ring

Equality Impact and Risk Assessment completed: N/A

Patient and Public Engagement completed: N/A

Financial Implications None

Risk Identified As shown

Report authorised by Senior Manager: Mr Roger Parr

Decision Recommendations The CCG Governing Body is asked to note the contents of this financial summary and the financial position of the CCG at the end of September 2016.


Executive Financial Summary Month 6 – Period Ending 30th September 2016

Year to Date Full year forecast Budget Actual Variance Budget Actual Variance £000 £000 £000 £000 £000 £000

Funds Available 122,949 122,949 0 246,748 246,748 0

Commissioning 91,120 92,107 (987) 180,398 181,632 (1234)

Primary Care 26,973 26,724 249 53,788 53,279 509Corporate 3,440 3,403 37 6,886 6,816 70Reserves 300 0 300 3,444 2,789 655Balance 1,116 715 (401) 2,232 2,232 0

Summary Financial Position – The CCG is reporting a year to date surplus of £715k which £401k under the ytd planned surplus of £1,116k. Whilst the CCG is reporting achieving its year end control total, the ytd position shows expenditure in excess of its plan. A financial recovery plan has been produced and the CCG continues to look to manage the risks identified.

Commissioned Services • Healthcare Commissioning is reporting a YTD overspend of £987k with

a year‐end forecast overspend of £1,234k mainly on inpatient day case, outpatients and non‐electives.

• Primary Care Services are reporting a YTD underspend of £249k mainly on prescribing, enhanced services and primary care co‐commissioning. A forecast year end underspend of £509k is reported. Prescribing is reporting a ytd underspend of £218k and year end forecast underspend of £523k.

• Corporate Services are reporting an underspend of £30k and a forecast year end underspend of £70k.

Uncommitted Reserve • The CCG awaits confirmation of the use of the 1% uncommitted

reserve from NHS England.

RISKS • Acute activity levels continue to be a key factor in 2016‐17. Schemes

are in place to manage demand. • Continuing health care and complex packages continues to be a key

risk. The CCG continues to closely monitor this area of expenditure. • Prescribing expenditure is volatile and is monitored closely by the

Medicines Management Team. • The application of the 1% uncommitted reserve

QIPP • 21.2 % of the QIPP target has been achieved at month 6. This is

behind the plan to meet the full year savings target of £6.9m. The CCG is currently reviewing services to identify where savings can be made to meet this target. Unidentified QIPP totals £890k. Capital

• The CCG has received confirmation of its capital allocation for GP IT of £143k.

Recommendation: The CCG Governing Body is asked to note the contents of this financial summary and the financial position of the CCG at the end of September 2016.

APPENDIX A

NHS Blackburn with Darwen CCG

Summary Governing Body Report ‐ September 2016

Budget to Date£000

Expenditure to Date £000

Variance to Date£000

Annual Budget £000

Annual Forecast£000

Annual Forecast Variance£000

Revenue Resource Limit

Confirmed (122,949) (122,949) 0 (246,748) (246,748) 0

Anticipated 0 0 0 0 0 0

Total Revenue Resource Limit (122,949) (122,949) 0 (246,748) (246,748) 0

Expenditure

Commissioning (Page 2) 118,093 118,832 (739) 234,186 234,911 (725)

Corporate (Page 4) 1,693 1,663 30 3,349 3,319 30

Reserves (Page 4) 300 0 300 3,444 2,789 655

Healthcare Sub Total 120,086 120,495 (409) 240,979 241,019 (40)

Running Costs (Page 4) 1,747 1,740 7 3,537 3,497 40

Total Expenditure 121,833 122,235 (402) 244,516 244,516 0

Surplus/(Deficit) 1,116 714 (402) 2,232 2,232 0

Better Payment Practice Code YTD Value (%) YTD Volume (%) FOT Value (%) FOT Volume (%) Target (%)

NHS 100.0 100.0 97.6 98.1 95.0

Non NHS 100.0 99.6 99.4 99.4 95.0

APPENDIX B


Healthcare Commissioning Report ‐ September 2016

Budget to Date £000



Annual Budget £000



Acute Services

NHS contracts (includes Ambulance Services) 59,376 59,572 (196) 118,644 119,036 (392)

Non NHS Providers 3,727 3,830 (103) 7,373 7,580 (207)

NHS Contract Exclusions / Cost per Case 474 451 23 582 517 65

Non Contract Activity 595 768 (173) 1,192 1,535 (343)

Other 0 0 0 0 0 0

Sub Total Acute Contracts 64,172 64,621 (449) 127,791 128,668 (877)

Mental Health Services

NHS contracts 7,836 7,804 32 15,685 15,686 (1)

Non NHS Providers 424 402 22 718 676 42

NHS Contract Exclusions / Cost per Case 197 163 34 255 181 74

Non Contract Activity 17 28 (11) 33 57 (24)

Other (29) 6 (35) (29) (29) 0

Sub Total Mental Health Services 8,445 8,403 42 16,662 16,571 91

Community Health Services

NHS contracts 7,278 7,278 0 14,266 14,266 0

Non NHS Providers 617 697 (80) 1,183 1,323 (140)

NHS Contract Exclusions / Cost per Case 13 18 (5) 25 39 (14)

Non Contract Activity 0 0 0 0 0 0

Hospices 525 523 2 1,050 1,050 0

Other 0 0 0 0 0 0

Sub Total Community Services 8,433 8,516 (83) 16,524 16,678 (154)

Total Healthcare Contracts 81,050 81,540 (490) 160,977 161,917 (940)

Continuing Care Services

Continuing Care 3,800 4,026 (226) 7,192 7,193 (1)

Free Nursing Care 304 413 (109) 608 826 (218)

Sub Total Continuing Care Services 4,104 4,439 (335) 7,800 8,019 (219)

Primary Care Services

Prescribing 13,865 13,647 218 26,582 26,059 523

Enhanced Services 557 546 11 1,115 1,107 8

Primary Care Co‐Commissioning 10,893 10,859 34 22,686 22,678 8

Out of Hours 809 809 0 1,618 1,618 0

Commissioning 533 533 0 1,155 1,155 0

Other 316 330 (14) 632 662 (30)

Sub‐total Primary Care services 26,973 26,724 249 53,788 53,279 509

Other Programme Services

Other Non Acute 3,821 3,874 (53) 7,331 7,341 (10)

Complex Cases & Individual Funding Requests2,145 2,255 (110) 4,290 4,355 (65)

Sub Total Other Programme Services 5,966 6,129 (163) 11,621 11,696 (75)

Surplus/(Deficit) 118,093 118,832 (739) 234,186 234,911 (725)

APPENDIX C


Main Healthcare Contracts ‐ September 2016

Budget to Date£000



Annual Budget £000



Acute Contracts

Main Provider

East Lancashire Hospitals NHS Trust 50,695 51,313 (618) 101,284 102,520 (1,236)

Other Lancashire Providers

Lancashire Teaching Hospitals NHS FT 2,825 2,516 309 5,651 5,032 619

Blackpool Fylde & Wyre Hospitals NHS FT 231 307 (76) 461 614 (153)

University Hospitals Morecambe Bay NHS FT 64 43 21 127 86 41

North West Ambulance Service NHS Trust (Block) 3,605 3,605 0 7,211 7,211 0

Sub Total Other Lancashire Providers 6,725 6,471 254 13,450 12,943 507

Greater Manchester Providers

University Hospital South Manchester NHS FT 352 256 96 704 512 192

Salford Royal NHS FT 158 123 35 315 247 68

Royal Bolton Hospitals NHS FT 161 162 (1) 321 323 (2)

Wrightington, Wigan & Leigh NHS FT 332 358 (26) 664 716 (52)

Central Manchester University Hospital NHS FT 798 738 60 1,597 1,476 121

Pennine Acute NHS Trust 69 94 (25) 137 189 (52)

Sub Total Greater Manchester Providers 1,870 1,731 139 3,738 3,463 275

Merseyside Providers

Royal Liverpool & Broadgreen NHS Trust 86 56 30 173 112 61

Sub Total Merseyside Providers 86 56 30 173 112 61

Independent Sector Contracts

BMI Healthcare (Beardwood, Beaumont, Gisburne) 3,003 3,068 (65) 6,006 6,136 (130)

Ramsay 297 336 (39) 595 671 (76)

Sub Total 3,300 3,404 (104) 6,601 6,807 (206)

Total Acute Contracts 62,676 62,975 (299) 125,246 125,845 (599)

Mental Health Contracts

Lancashire Care NHS FT (Block) 7,713 7,678 35 15,544 15,544 0

Calderstones Partnership NHS FT (Block) 106 108 (2) 106 108 (2)

Greater Manchester West NHS FT 16 16 0 32 32 0

Total Mental Health Contracts 7,835 7,802 33 15,682 15,684 (2)

Community Health Contracts

Lancashire Care NHS FT (Block) 7,278 7,278 0 14,266 14,266 0

Total Community Health Contracts 7,278 7,278 0 14,266 14,266 0

Surplus/(Deficit) 77,789 78,055 (266) 155,194 155,795 (601)

APPERNDIX D


Non Healthcare Commissioning Report ‐ September 2016

Budget to Date£000



Annual Budget £000



Other Corporate Costs (Non‐Running Costs)

CSU re‐charge 260 260 0 519 519 0

NHS Property Services re‐charge1,074 1,074 0 2,149 2,149 0

Other 359 329 30 681 651 30

Sub Total Corporate Costs 1,693 1,663 30 3,349 3,319 30

Plan requirements & reserves

Reserves 300 0 300 3,444 2,789 655

Sub Total Reserves 300 0 300 3,444 2,789 655

Running Costs

CCG Pay 825 833 (8) 1,658 1,664 (6)

CSU re‐charge 654 654 0 1,307 1,311 (4)

NHS Property Services re‐charge 33 33 0 99 99 0

Other 235 220 15 473 423 50

Running Costs Reserve 0 0 0 0 0 0

Sub Total Running Costs 1,747 1,740 7 3,537 3,497 40

Surplus/(Deficit) 3,740 3,403 337 10,330 9,605 725

APPENDIX E


Statement of Financial Position ‐ September 2016

Statement of Financial PositionSeptember

£000

Non Current AssetsProperty, Plant, Equipment 0

Total Non Current Assets 0

Current AssetsTrade and Other Receivables 1,503Financial Assets 0Current Assets 0Cash and Bank 47

Total Current Assets 1,550

Total Assets 1,550

Current LiabilitiesTrade and Other Payables (10,271)Other Liabilities 0Provisions (29)Borrowings 0

Total Current Liabilities (10,300)

Total Assets less Current Liabilities (8,750)

Non Current LiabilitiesTrade and Other Payables 0Provisions 0Borrowings 0Other Liabilities 0

Total Non Current Liabilities 0

Total Assets Employed (8,750)

Financed ByGeneral Fund (8,750)Revaluation Reserve 0Donated Asset Reserve 0Government Grant Reserve 0Other Reserves 0

Total Equity (8,750)

Governing Body Meeting 1 | P a g e


Contract, Quality and Performance Report

Date of Meeting 02 November 2016 Agenda Item 10


Through better commissioning, improve local health outcomes by addressing poor outcomes and inequalities

To work collaboratively to create safe, high quality health care services

To maintain financial balance and improve efficiency and productivity

To deliver a step change in the NHS preventing ill health and supporting people to live healthier lives

To maintain and improve performance against core standards and statutory requirements

To commission improved out of hospital care


Delivering high quality Primary Care at scale and improving access

Self-Care and Early Intervention

Enhanced and Integrated Primary Care and Better Care Fund

Access to Re-ablement and Intermediate Care x

Improved hospital discharge and reduced length of stay

Community based ambulatory care for specific conditions

Access to high quality Urgent and Emergency Care

Scheduled Care

Quality

Clinical Lead: Dr Malcolm Ridgway – Director of Quality and Performance Mr Roger Parr - Chief Finance Officer

Senior Lead Manager Mr Paul Hopley – Deputy Executive Nurse – Mental Health & Quality

Finance Manager Mr Roger Parr - Chief Finance Officer

Equality Impact and Risk Assessment completed: Not Required

Patient and Public Engagement completed: Not Required

Financial Implications None identified at this stage

Risk Identified Fluctuating performance and potential impact on the quality of patient care

Report authorised by Senior Manager: Dr Malcolm Ridgway – Director of Quality and Performance Mr. Roger Parr - Chief Finance Officer

Decision RecommendationsTo note the contents of the report and support actions as identified.


Contract & Information Lancashire Care Foundation Trust (LCFT) Mental Health ‐ Executive Summary

Month 5 Psychological Therapies ‐ Blackburn with Darwen Clinical Commissioning Group (BwD CCG) has a nominal monthly target of 246 patients entering psychological treatment to meet the 15% prevalence target. During month 5, 179 patients entered treatment with Lancashire Care Foundation Trust (LCFT). On a year to date (YTD) basis, LCFT reports that access rates are above target (+24 patients, +1.9%). Factoring in Lancashire Women’s Centre (LWC) data reveals the YTD performance being substantially above target (+218 patients, +17.7%).

Referrals ‐ BwD CCG referrals to LCFT Mental Health Services have increased on YTD 2015‐16 levels +193 (+15.5%). When compared to 2016‐17 plans, referrals are above the expected level +345 (+31.5%). Admissions ‐ The number of admissions to Mental Health inpatient wards, is below the number admitted YTD in the previous year i.e. 161 in 2016‐17, versus 187 in 2015‐16 ‐26 (‐13.9%). Including Out of Area admissions, and based on plans which consider total admissions (all CCGs) over the previous 3 years, BwD CCG patients account for more than BwD CCG’s weighted population share of admissions +28 (+21.4%). This is indicative of an above average prevalence of high level mental health need among the BwD population. Bed Days ‐ Including Out of Area bed days, and based on plans which are calculated by taking LCFT’s total available bed days, BwD CCG patients account for more than BwD CCG’s weighted population share of bed days +1,198 (+26.9%). This has contributed to on‐going high occupancy rates at LCFT, and high numbers of Out of Area Treatments (OATs) incurred by all CCGs. OATS ‐ Mental Health OATs for 2016‐17 are 24.8% of admissions and 22.1% of all bed days for BwD CCG. In terms of admissions this is decreased versus the same period last year (15‐16 OATs = 26.7% of all admissions). In terms of Bed Days, this has increased versus the same period last year (15‐16 OATs = 16.2% of all bed days.

Quality & Performance Lancashire Care Foundation Trust (LCFT) Mental Health ‐ Executive Summary

Month 5 Care Programme Approach (CPA) ‐ The target for 95% of patients on CPA to be followed up within seven days of discharge from psychiatric inpatient care was met for BwD CCG in August 2016, at 100%, with a year to date (YTD) position of 98.59% (Trust performance: 98.00% in‐month and 96.59% YTD). Psychological Therapies ‐ The notional 1.25% monthly target for Improving Access to Psychological Therapies (IAPT) Prevalence was not met for BwD CCG in August 2016, at 1.00%, with a cumulative YTD position of 6.51%, against a trajectory of 6.25%. The 50% Recovery target was not met for BwD CCG in August 2016, with performance at 48.31%, and a YTD position of 50.10% (Trust performance, 49.27% in‐month and 48.71% YTD). The standard for 75% of patients to enter treatment within 6 weeks was met for BwD CCG in August 2016, at 98.89%, as well as YTD at 96.76% (Trust performance, 92.13% in‐month and 90.12% YTD). The standard for 95% of patients to enter treatment within 18 weeks was also met for BwD in‐month, at 100%, as well as YTD at 100% (Trust performance, 99.48% in‐month and 99.24% YTD). Memory Assessment Service (MAS) ‐ The target for 70% of patients to be seen by the MAS within 6 weeks was not met for BwD CCG in August 2016, at 23.80%, or at Trust level, at 34.4%. A MAS Optimisation Plan has been submitted by LCFT. Longer‐term, a review of Dementia pathways is underway in Pennine Lancashire, which is also intended to inform MAS redesign across Lancashire. Lancashire Quality and Performance Group has recently asked that this redesign is expedited. Safer Staffing – the quality of the data presented for mental health services has improved significantly and assurance was given that staffing levels are safe. On appositive. On a positive note mandatory training levels are increasing month on month with most close to target.


Contract & Information East Lancashire Hospitals NHS Trust (ELHT) ‐ Executive Summary

Month 5

Activity £ A&E (including MIU) ‐453 (‐1.8%) +£84K (+3.3%) Elective (Ordinary + Day Cases) ‐157 (‐2.4%) +£204K (+3.3%) Non Elective inc. Non‐Emerg ‐334 (‐3.9%) ‐£27K (‐0.2%) Outpatients First Attends ‐262 (‐1.8%) +£9K (+0.4%) Outpatient Follow‐up Attends +1324 (+4.5%) +£29K (+1.3%) Outpatient Procedure – New +391 (+14.7%) +£70K (+17.5%) Outpatient Procedure – Review +349 (+7.1%) +£41K (+5.1%)

Elective Care – The first 5 months of the year are below plan in terms of activity (‐157 spells, ‐2.4%). However, costs are above plan (+£204K, +3.3%). This is indicative of a relatively complex mix of admissions so far this year, compared to what is forecast within plans. The specialties mainly responsible for the year to date cost over trade are Medical Specialties (+£171K) and Trauma & Orthopaedics (+£96K).

Non‐elective admissions (including non‐elective non‐emergency) are close to plan in terms of cost: ‐£27K (‐0.2%). However, this is from relatively low levels of activity (‐334 spells) which is 3.9% below plan. Specialities to note against this overall underperformance are: Medical Specialties +£37K (+1%) [‐162 spells, ‐4%]; Surgical Specialties ‐£75K (‐5%) [‐80 spells, ‐10%]; Trauma & Orthopaedics ‐£36K (‐4%) [‐37 spells, ‐10%]; Paediatrics +£3K (+0%) [‐66 spells, ‐5%]; and Urology +£25K (+7%) [‐13 spells, ‐5%].

Total Outpatient performance is above plan: +£150K (+2.6%) [+1,802 attendances/procedures, +3.4%]. Trauma and Orthopaedics and Cardiology Outpatient Procedures have been queried with the Trust due to the large increases. The former has led to a re‐classification of 85 procedures (and cost correction of £18K), although there is still an over trade (+37 procedures, +127%). In respect of the latter, a response is still awaited.

Referral to Treatment – the number of BwD CCG patients awaiting treatment at ELHT has increased to 7,005 (versus 5,954 at the end of 2105/16). Performance against the Incomplete Pathway metric (target 92%) has remained stable, although there are now 15 patients waiting >36 weeks (compared to typically 0 to 2 per month during 2015/16).

Quality & Performance East Lancashire Hospitals NHS Trust (ELHT) ‐ Executive Summary

Month 5 A&E 4 Hour ‐ The 95% 4 hour waiting time target for A&E was not met in August 2016 at East Lancashire Hospitals Trust (ELHT), with in‐month performance at 77.90% and a YTD performance of 84.34%. A schedule of meetings has been planned through the A&E Delivery Board, with senior representation focussed on a system‐wide recovery plan to address the underperformance against the standard. Trolley Wait ‐ There were nine 12 hour A&E breaches for complex mental health patients reported in August 2016 at ELHT. Timelines have been submitted for each case and actions and lessons learned are being collated into an overarching action plan. As previously reported the Royal College of Psychologists and The Royal College of Medicine are undertaking a system review, this has been postponed to early November 2016. Cancer 62 Day Target ‐ Latest information shows the 62 Day Cancer target continues to be failed both in month and year to date across both CCGs. Additional, the 62 day target following referral from a cancer screening service has also been missed in August 2016, although year to date performance remains above target. In the main this has been caused by an expected increase in referrals following the adoption of new NICE guidance but there are also issues regarding patient choice and complexity. The data shows that BwD has particular problems in urology, lower and upper gastrointestinal, haematology, skin and lung. There is a comprehensive action plan in place that is being refreshed to recover this target together with ongoing work to ensure patients with cancer are diagnosed and treated early to improve outcomes.


Contract & Information Primary Care ‐ Executive Summary

Month 5

Out of Hours ‐ Compared to last year’s Month 5 YTD data total activity for the Out of Hours service provided by ELMS is over plan by +154 (+2.0%). The main over performance is in Dr Advice: +261 (+13.1%), with Home Visits: ‐59 (‐5.3%), and Primary Care Centre attendances: ‐48 (‐1.0%) slightly underperforming.

Year to date ‐ Activity Full Year Forecast ‐ Activity

16/17 15/16 Variance Status

16/17 15/16 Variance Status

Primary Care Centre

4,524 4,572 ‐48 ‐1.0% G

11,064 11,347 ‐283 ‐2.5% G

Dr Advice

2,255 1,994 261 13.1% R

5,515 4,819 696 14.4% R

Home Visits

1,057 1,116 ‐59 ‐5.3% G

2,585 2,621 ‐36 ‐1.4% G

Total 7,836 7,682 154 2.0% A 19,164 18,787 377 2.0% A

Alternative Provider Medical Services (APMS) General Practitioner Contracts – The BwD APMS procurement programme had been delayed however the CCG is now continuing with the Invitation to Tender (ITT) process, documentation is being posted on the procurement portal from 28th October. The "caretaker" arrangement for Waterside is now operational.

Quality and Outcomes Enhanced Services Transformation (QOEST) ‐ The Quality and Outcomes Enhanced Services Transformation (QOEST) scheme is now being worked through by the local GP federation Local Primary Care on behalf of all BwD GP practices. A project plan, with a QOEST delivery group and relevant subgroups has been set up. There are 3 subgroups looking at the Quality, Access and Sustainability aspects of the scheme. The draft plan being is currently being assembled with an initial draft completion submission date of 30th October.

Prime Ministers Challenge Fund (PMCF) ‐ The scheme is delivering extended access to routine General Practice across the borough, 7 days a week. At the weekends the federation is collaborating with the GP Out of Hours to ensure the service is fully utilised. The Federation is currently remodelling the service to deliver increased access out of core hours, it is also developing a resilence scheme to cover the Christmas and New year period working in collaboration with ELMS.

Quality & Performance Primary Care ‐ Executive Summary

Month 4

Care Quality Commission (CQC) ‐ 19 out of the 27 practices have now been inspected with a total of 10 having been given an overall rating of ‘Good’

The Family Practice has been rated as ‘Inadequate’. Redlam Surgery has been rated ‘Requires Improvement’ and the remaining practices are still awaiting publication of their rating.

The CCG will be offering support to all practices that have been inspected with any areas that require improvement. For practices rated as “inadequate” the CCG will give intensive support and oversee improvement plans. Monthly meetings are taking place with the Family Practice having commenced on the 13th October. They have shared their comprehensive improvement plan with the CCG and we are working with them to ensure all recommendations are implemented prior to their re‐inspection (usually after 6 months).

Practice Quality visits ‐ BwD CCG quality team will visit the two remaining GP practices in November 2016. Those practices that have already been visited have submitted a quality improvement plan.

The CCG is currently developing a report to capture all the ratings and recommendations from the CQC visits. This report will highlight those practices that have been rated as requiring improvement in one or more areas and will be used to prioritise visits for the future. A themed report developed form the quality visits undertaken by the CCG is being compiled and will be shared with the team implementing QOEST to inform the quality improvement aspect of that scheme.

Practice Nurse Forum – Individual feedback from Nurses has expressed their gratitude to the CCG for the organisation of the comprehensive timetable. The Forum in October was attended by 43 nurses who listened to presentations around Falls and COPD. The next Forum will take place in December which will cover ‘ The End of Life pathway’ and ‘ Revalidation process for Nurses.

Pennine Lancashire Quality Committee. This committee has been formed to


streamline the Primary Care Quality agenda across BWD CCG and East Lancs CCG. The first meeting took place on 28th September 2016 at Walshaw House. Plans are that the CCG’s will host the meeting on a six month rotation. Primary Care quality reports will be presented on a quarterly basis.


Contract & Information Lancashire Care Foundation Trust Community ‐ Executive Summary

Month 5

Community IV Therapy (‐300, ‐39.2%) ‐ The step up referral pathway is now working well with medical oversight from ELMS enabling cellulitis patients to be treated in community. The step down referral pathway has been limited over the past 12 weeks due to restricted capacity in ELHT facilitating patients out into community.

Complex Case Managers (‐89, ‐5.5%) ‐ The new complex case management service activity baselines have been agreed for the CCM service which began delivering in June 2016. This is based on 4 staff delivering 6 contacts/day = 4800 contacts. There are currently 3 CCM's in post and there has been annual leave and compassionate leave within this team during July which may have impacted on activity levels. The new delivery model is becoming clearer within the wider service and IHSS referrals are picked up by this team where appropriate. CCM's are starting to become involved in RAT triage processes to embed the service within a blended offer. Complex case managers are still within preceptorship and have been attending training sessions within ELHT to ensure that care plans are mirrored across trusts.

Diabetes Specialist Nursing Service (DSN) (‐443, ‐18.4%) – The Trust has advised that annual leave and the induction of a new staff member, has contributed to the slight decrease in activity in July. August has subsequently seen a reduction in the previously reported under performance. September is likely to show further improvement in performance, when the new staff member will have a full month of autonomous working, and leave pressures will have subsided.

Intermediate Care (‐1,089, ‐20.2%) ‐ A month on month decrease in activity has been evident since April 2016. Activity levels are historically higher in the winter months and an increase in activity is predicted to achieve full recovery. A recovery trajectory has been formulated for August’s data submission, which was received in September. Further details on LCFT Community variances are contained in Appendix 4.

Quality & Performance Lancashire Care Foundation Trust Community ‐ Executive Summary

Month 5 Pressure Ulcers ‐ There have been 14 Grade 3 Pressure Ulcers and 1 Grade 4 Pressure Ulcer reported in Month 5, at LCFT. 6 cases were deemed ‘unavoidable’ following review and 9 cases are awaiting review. As lead commissioner, CSR CCG are leading on a number of initiatives to reduce the number of pressure ulcers, such as: attending the LCFT Harm Free Care meetings on a monthly basis to understand the improvement work that is currently underway at the Trust, and utilising the Safety Thermometer ‘hot spot’ report along with reports from Datix to focus on quality improvements. Safer Staffing – issues with the community data presented was raised at the recent Lancashire Quality and Performance Group. The quality of the data was challenged robustly and as a consequence LCFT will be looking to improve this urgently, to a standard acceptable to commissioners.


Contract & Information Other Significant Contracts ‐ Executive Summary

Month 5

North West Ambulance Service ‐ ‘All Incidents’ ‐ Blackburn with Darwen CCG ‘All Incidents’ activity provided by the ambulance service at Month 5 is over plan by 4.1%.

Performance Line Comparison to Plan

Plan Actual Variance + % R1 (% <8 mins) 286 285 ‐1 (‐0.4%) R2 (% <8 mins) 4,452 4,704 +252 (+5.7%) All Reds (%<19 mins) 4,738 4,989 +251 (+5.3%) Green 6,450 6,665 +215 (+3.3%) AS3 75 70 ‐5 (‐6.4%) All Incidents 11,263 11,724 +461 (+4.1%)

The key drivers of this over performance are the YTD activity volumes for ‘Red 2’ +252 (+5.7%) and ‘Green’ +215 (+3.3%). Red 2 relates to ambulance calls that result in an emergency response arriving within 8 minutes; Green relates to the activity that requires a face to face response and often requires a transfer to A&E. BMI Beardwood – year to date Elective activity is +21.5% over plan, costing 20.2% more than plan (+£102K), almost entirely through Daycases. The HRG AB08Z (Pain Radiofrequency Treatments) accounts for +£73K of the Pain Management Elective over trade. It appears that the majority of this activity is for patients having repeat procedures. The CCG has drafted a policy to limit the number of facet joint injections that can be provided. This policy is due to be ratified at the Pennine Lancs Quality Committee on the 28th September 2016.

Quality & Performance Other Significant Contracts ‐ Executive Summary

Month 5 Category A ambulance calls ‐ In August 2016, the Category A ambulance calls target was not met at BwD CCG level for: Red 1 (immediately life threatening) and Red 2 (life threatening but less time critical) emergency calls to be responded to within 19 minutes performance at 91.85%, against a target of 95% (YTD, 91.71%); and Red 2 – 8 minute performance at 66.41% (YTD, 69.17%), against a target of 75%. At BwD CCG level, the Category A ambulance calls target for Red 1 – 8 minutes was met with performance at 77.97% (YTD, 73.41%), against a target of 75%. An Ambulance Concordat has been established between EL CCG, ELHT and North West Ambulance Service, with joint work ongoing to strengthen processes and improve all aspects of system wide performance. Ambulance Handovers – In August 2016, at ELHT there were 475 handovers over 30 minutes (YTD, 1930), 94 handovers over 60 minutes (YTD, 376). Performance is linked directly to pressures within the Emergency Department.

8 | P a g e

Appendix 1 East Lancashire Hospitals NHS Trust: BwD CCG Contract 1st April 2016 – 31st August 2016

Blackburn with Darwen CCG's position at

EAST LANCASHIRE

HOSPITALS NHS TRUST

Year to Date

Activity Plan

Activity Actual

Activity Variance

%

Variance Cost Plan

Cost Actual

Cost Variance

%

Variance

A&E (including MIU)

24,792 24,339 ‐453 ‐1.8% £2.582M £2.666M £84K 3.3%

Elective (Ordinary + Daycases)

6,522 6,365 ‐157 ‐2.4% £6.246M £6.449M £204K 3.3%

Excess Bed Days (Non Elective + Elective)

3,602 4,194 592 16.4% £788K £908K £121K 15.3%

Non Elective 7,461 7,104 ‐357 ‐4.8% £11.010M £10.956M ‐£54K ‐0.5%

Non Elective Non‐Emergency

1,141 1,163 22 2.0% £1.941M £1.968M £27K 1.4%

Outpatient First Attends 14,840 14,578 ‐262 ‐1.8% £2.217M £2.226M £9K 0.4%

Outpatient Follow‐up Attends

29,469 30,793 1,324 4.5% £2.243M £2.273M £29K 1.3%

Outpatient Procedure – New

2,618 3,009 391 14.7% £401K £472K £70K 17.5%

Outpatient Procedure – Review

6,263 6,612 349 7.1% £806K £847K £41K 5.1%

Total £28.234M £28.765M £532K 1.9%

Other £13.870M £14.589M £719K 5.2%

Grand Total £42.104M £43.355M £1.251M 3.0%

9 | P a g e

Appendix 2

All Providers: BwD CCG Contract 1st April 2015 – 31st August 2016 Blackburn with Darwen CCG's position at

ALL ACUTE HOSPITAL

PROVIDERS

Year to Date

Activity Plan

Activity Actual

Activity Variance

% Variance

Cost Plan Cost Actual

Cost Variance

%

Variance

A&E (including MIU)

25,898 25,448 ‐450 ‐1.7% £2.709M £2.786M £77K 2.8%

Elective (Ordinary + Daycases)

9,212 9,354 142 1.5% £9.352M £9.788M £436K 4.7%

Excess Bed Days (Non Elective + Elective)

3,872 4,430 558 14.4% £847K £965K £118K 13.9%

Non Elective 7,782 7,386 ‐396 ‐5.1% £11.633M £11.497M ‐£136K ‐1.2%

Non Elective Non‐Emergency

1,204 1,225 21 1.8% £2.055M £2.160M £105K 5.1%

Outpatient First Attends 18,377 18,213 ‐165 ‐0.9% £2.771M £2.804M £33K 1.2%

Outpatient Follow‐up Attends

39,166 40,656 1,491 3.8% £3.106M £3.157M £51K 1.6%

Out‐patient Proc‐

‐edure

New 2,776 3,148 372 13.4% £425K £495K £70K 16.4%

Review 6,641 6,944 304 4.6% £865K £901K £36K 4.2%

Unspecified 873 824 ‐49 ‐5.6% £141K £138K ‐£2K ‐1.5%

Total £33.905M £34.693M £788K 2.3%

Other £15.095M £15.876M £781K 5.2%

Grand Total £49.000M £50.569M £1.569M 3.2%

Tables Based upon Version 1 of the Contract Monitoring Pivot, updated at 03/10/2016

10 | P a g e

Appendix 3

Referrals to Secondary care ‐ 1st April 2015 – 31st August 2016 GP Referrals

Specialty

Number of Referrals Referrals per Working Day

GP Referrals 2016‐17


Variance Quantity

Variance %

2016‐17 (107 days)

2015‐16 (104 days)

Variance %

Cardiology 655 625 30 4.8% 6.1 6.0 1.9%

Community Paediatrics 5 160 160 0 0.0% 1.5 1.5 -2.8%

Dermatology 930 870 60 6.9% 8.7 8.4 3.9%

E.N.T. 1039 997 42 4.2% 9.7 9.6 1.3%

General Medicine group 2 1152 1061 91 8.6% 10.8 10.2 5.5%

General Surgery group 1 1820 1847 -27 -1.5% 17.0 17.8 -4.2%

Gynaecology 945 1015 -70 -6.9% 8.8 9.8 -9.5%

Oncology 128 108 20 18.5% 1.2 1.0 15.2%

Ophthalmology 1115 1089 26 2.4% 10.4 10.5 -0.5%

Other Specialty group 6 308 330 -22 -6.7% 2.9 3.2 -9.3%

Paediatrics 4 493 481 12 2.5% 4.6 4.6 -0.4%

Pain Management group 3 95 90 5 5.6% 0.9 0.9 2.6%

Rheumatology 204 260 -56 -21.5% 1.9 2.5 -23.7%

Trauma & Orthopaedics 979 935 44 4.7% 9.1 9.0 1.8%

Urology 616 600 16 2.7% 5.8 5.8 -0.2%

Grand Total 10639 10468 171 1.6% 99.4 100.7 -1.2%

Subspecialties / Groups General Medicine and Gastroenterology 750 713 37 5.2% 7.0 6.9 2.2%

Respiratory Medicine 296 247 49 19.8% 2.8 2.4 16.5%

General Surgery and Vascular Surgery 1211 1270 -59 -4.6% 11.3 12.2 -7.3%

Breast Surgery 609 577 32 5.5% 5.7 5.5 2.6% 1 General Surgery, Breast Assessment and Vascular Surgery 2 General Medicine, Gastroenterology, Diabetic, Elderly and Respiratory Medicine 3 Pain Management and Anaesthetics 4 Paediatrics, Paediatric Surgery and Paediatric Cardiology 5 Community Paediatrics and Paediatric Respiratory Nursing 6 A&E, Cardiothoracic Surgery, Child & Adolescent Psychiatry, Clinical Genetics,

Critical Care Medicine, Clinical Haematology, Endocrinology, Medical Oncology, Neonatology, Palliative Medicine, Radiotherapy, Rehabilitation

11 | P a g e

Other Referrals

Specialty




Variance Quantity

Variance %

2016‐17 (107 days)

2015‐16 (104 days)

Variance %

Cardiology 346 388 -42 -10.8% 3.2 3.7 -13.3%

Community Paediatrics 5 412 382 30 7.9% 3.9 3.7 4.8%

Dermatology 123 130 -7 -5.4% 1.1 1.3 -8.0%

E.N.T. 596 535 61 11.4% 5.6 5.1 8.3%

General Medicine group 2 1218 1181 37 3.1% 11.4 11.4 0.2%

General Surgery group 1 667 645 22 3.4% 6.2 6.2 0.5%

Gynaecology 473 508 -35 -6.9% 4.4 4.9 -9.5%

Oncology 219 148 71 48.0% 2.0 1.4 43.8%

Ophthalmology 1189 1146 43 3.8% 11.1 11.0 0.8%

Other Specialty group 6 890 1022 -132 -12.9% 8.3 9.8 -15.4%

Paediatrics 4 376 372 4 1.1% 3.5 3.6 -1.8%

Pain Management group 3 117 148 -31 -20.9% 1.1 1.4 -23.2%

Rheumatology 136 90 46 51.1% 1.3 0.9 46.9%

Trauma & Orthopaedics 2167 2380 -213 -8.9% 20.3 22.9 -11.5%

Urology 256 278 -22 -7.9% 2.4 2.7 -10.5%

Grand Total 9185 9353 -168 -1.8% 85.8 89.9 -4.5%

Subspecialties / Groups General Medicine and Gastroenterology 284 310 -26 -8.4% 2.7 3.0 -11.0%

Respiratory Medicine 790 730 60 8.2% 7.4 7.0 5.2%

General Surgery and Vascular Surgery 513 517 -4 -0.8% 4.8 5.0 -3.6%

Breast Surgery 154 128 26 20.3% 1.4 1.2 16.9%

Summary

Referral Type


2016‐17 2015‐16 Variance %

2015‐16 (107 days)

2014‐15 (104 days) Variance %

GP 1 10639 10468 1.6% 99.4 100.7 ‐1.2% Other 2 5915 5918 ‐0.1% 55.3 56.9 ‐2.9% Excluded 3 3270 3435 ‐4.8% 30.6 33.0 ‐7.5% Total 19824 19821 0.0% 185.3 190.6 ‐2.8%

1 From GP 2 From non‐GP professional (e.g. Consultant, Nurse Specialist) 3 From non‐GP other (e.g. Self‐Referral, A&E department, Midwife

12 | P a g e

Appendix 4 LCFT Community Contract ‐ LCFT: Service Line Activity Against Plan – August 2016

Service Line

Year to date – Activity Full Year ‐ Activity Year‐on‐Year Comparison

Plan Actual Variance Var % Status^ Plan Forecast 15/16 16/17 Variance Var %

Adult Learning Disabilities 679 1,285 606 89.2% 1620 3066 719 1,285 566 44.0%

Children's Learning Disabilities 423 407 ‐16 ‐3.7% 1008 971 406 407 1 0.2%

Children's Speech & Language 2027 2,326 299 14.7% 4836 5549 2,471 2,326 ‐145 ‐6.2%

Children's Occupational Therapy 453 662 209 46.2% 1080 1579 1,016 662 ‐354 ‐53.5%

Children's Physiotherapy 0 22 22 N/A N/A 0 52 18 22 4 18.2%

Chronic Fatigue Syndrome 30 51 21 69.0% 72 122 104 51 ‐53 ‐103.9%

Community Neurological Service 0 32 32 N/A N/A 0 76 81 32 ‐49 ‐153.1%

Community Respiratory Service 0 2,565 2,565 N/A N/A 0 6119 64 2,565 2,501 97.5%

Community Stroke Service 2540 3,096 556 21.9% 6060 7386 1,810 3,096 1,286 41.5%

Dermatology 2193 2,496 303 13.8% 5232 5955 2,369 2,496 127 5.1%

DESMOND (Plan as Actual) 42 42 0 0.0% 100 100 1 42 41 97.6%

Diabetes Specialist Nursing Service 2404 1,961 ‐443 ‐18.4% 5736 4678 1,671 1,961 290 14.8%

District Nursing 41,455 N/A 37,870 41,455 3,585 8.6%

District Nursing (Out of Hours) 3,670 N/A 3,921 3,670 ‐251 ‐6.8%

District Nursing (inc. Out of Hours) 43304 45,125 1,821 4.2% 103308 107651 41,791 45,125 3,334 7.4%

Intermediate Care Services 5382 4,293 ‐1,089 ‐20.2% 12840 10241 5,020 4,293 ‐727 ‐16.9%

13 | P a g e

Intensive Home Support 8305 7,917 ‐388 ‐4.7% 19812 20742 6,385 2,759 ‐3,626 ‐131.4%

Community IV Service BwD 765 465 ‐300 ‐39.2% 1824 1109 16 465 449 96.6%

Complex Case Management 1605 2,294 ‐89 ‐5.5% 3828 5473 6,369 1,987 ‐4,382 ‐220.5%

COPD (Reporting Awaited) 2515 2,515 0 0.0% 6000 6000 N/A

RAT Deflection (Reporting Awaited) 3420 3,420 0 0.0% 8160 8160 N/A

Oxygen Service 1615 2,958 1,343 83.2% 3852 7057 1,366 2,958 1,592 53.8%

Podiatry 8647 9,592 945 10.9% 20628 22883 8,769 9,592 823 8.6%

Pulmonary Rehabilitation 2933 3,789 856 29.2% 6996 9039 3,019 3,789 770 20.3%

Rapid Assessment Team 6987 6,239 ‐748 ‐10.7% 16668 14884 7,676 6,239 ‐1,437 ‐23.0%

Treatment Rooms 37449 37036 ‐413 ‐1.1% 89340 88354 31823 37036 5,213 14.1%

Treatment Room Unspecified 34436 33,562 ‐874 ‐2.5% 82152 80066 29,386 33,562 4,176 12.4%

Ear Care (Treatment Room) 337 458 121 35.9% 804 1093 278 458 180 39.3%

Healthy Legs (Treatment Room) 463 463 0 0.0% 1104 1105 438 463 25 5.4%

Minor Injury (Treatment Room) 815 921 106 13.0% 1944 2197 736 921 185 20.1%

Ulcer & Vascular (Treatment Room) 926 917 ‐9 ‐0.9% 2208 2188 624 917 293 32.0%

Tissue Viability (Treatment Room) 473 715 242 51.2% 1128 1706 361 715 354 49.5%

Grand Total 125413 132672 6,480 5.2% 299188 316504 116,579 163,953 47,374 28.9%

Reporting Tolerances Under Plan <‐5% Close to Plan >‐5% to <+5% Above Plan >+5% ^ Trend direction vs previous month = within 5%

NB. At month 5, the reported Intensive Home Support line consisted of the Community IV Service and Community Matron Service. However, from month 4, Complex Case Management (which has replaced the Community Matron Service line) is now being reported under Intensive Home Support, with COPD and Rapid Assessment Team to be added in the near future.

14 | P a g e

Appendix 5 LCFT MH quality measures currently underperforming against target

Ref Indicator Threshold(2016/17) Level Apr

16 May16

June16

July16

Aug16 YTD

E.B.S.3 CPA: 7 day follow up from psychiatric inpatient care 95%

Trust 95.96% 94.92% 96.63% 97.83% 98.00% 96.59% BwD 94.74% 100.00% 100.00% 100.00% 100.00% 98.59% EL 95.00% 90.32% 95.00% 100.00% 100.00% 95.80%

E.H.1 IAPT: seen within 6 weeks 75% Trust 89.43% 88.28% 89.17% 91.75% 92.13% 90.12% BwD 95.24% 98.90% 93.81% 97.16% 98.89% 96.76% EL 89.31% 88.51% 93.10% 93.87% 92.13% 91.38%

E.H.2 IAPT: seen within 18 weeks 95% Trust 99.19% 98.71% 99.53% 99.31% 99.48% 99.24% BwD 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% EL 99.24% 99.62% 99.62% 100.00% 99.21% 99.54%

LQR_1

IAPT: Prevalence 1.25% notional

monthly (15% annual)

Trust 1.24% 1.36% 1.26% 1.31% 1.34% 6.50% BwD 1.14% 1.55% 1.46% 1.36% 1.00% 6.51% EL 1.14% 1.17% 1.13% 1.32% 1.22% 5.98%

IAPT: Recovery 50% Trust 47.84% 45.86% 49.32% 51.38% 49.27% 48.71% BwD 48.04% 51.28% 50.57% 51.91% 48.31% 50.10% EL 47.97% 50.58% 54.32% 53.06% 51.75% 51.52%

E.H.4 Early Intervention Psychosis: seen within 2 weeks 50%

Trust 77.00% 77.80% 86.70% 77.10% 66.70% 77.18% BwD 25.00% 100.00% 50.00% 71.40% 0.00% 61.90% EL 100.00% 100.00% 90.00% 100.00% 100.00% 95.83%

LQR_2 MAS: seen within 6 weeks 70% Trust 47.68% 33.86% 40.11% 38.36% 34.40% 39.17% BwD 46.15% 23.08% 29.63% 48.00% 23.80% 33.10% EL 43.48% 25.29% 32.43% 22.86% 20.20% 29.02%

OATs Out Area of Treatments 0 (Tolerance 15) Trust 25 36 42 40 32

15 | P a g e

Appendix 6 ELHT quality measures currently underperforming against target

Ref Indicator Threshold 16/17

Apr16

May16

Jun16

Jul16

Aug16

Sep16

Oct16

Nov16

Dec16

Jan17

Feb17

Mar 17

YTD

E.B.5 A&E 4 Hour 95% 88.50% 85.47% 85.47% 84.26% 77.91% 84.34%

E.B.S.2 Cancelled Operations 0 0 1 0 1 1 3

E.A.S.5 Clostridium Difficile 28 1 2 3 4 1 11

E.B.12 Cancer 62 day urgent GP 85% 85.6% 82.8% 81.6% 87.8% 84.45%

E.B.S.4 52 week wait 0 1 2 1 1 0 5

E.B.S.5 Trolley wait 0 2 3 3 7 9 24

E.B.S.7a Ambulance Handover > 30min

0 329 366 329 431 475 1930

E.B.S.7b Ambulance Handover >60min

0 50 57 73 102 94 376

E.B.S.7 Missed handover stamps

0 148 157 198 117 179 799

LQR_5 Stroke 4 Hour SSNAP 65% 63.64% 50.00% 35.29% 40.74% 27.66% 43.50%

LQR_6 Time on a stroke unit 80% 86.21% 79.75% 71.67% 78.33% 80.30% 79.32%

LQR_19 Medication errors causing serious harm

0 0 0 1 0 0 1

16

NH

| P a g e

HS Constitutiion AAppendix 77

17 | P a g e

Level Period TargetAug 2016 Position

Year to Date

Position

CCG Aug 2016-17 85.00% 82.76% 81.13%

CCG Q1 2016-17 85.00% 80.65% 80.65%

CCG Aug 2016-17 90.00% 87.50% 90.91%

CCG Q1 2016-17 90.00% 100.00% 100.00%

CCG Aug 2016-17 81.25% 88.10%

CCG Q1 2016-17 88.33% 88.33%

CCG YTD 20 17 17

CCG YTD 2,285 3,311 3,311

CCG YTD 5,246 1,921 1,921

CCG YTD 18,473 20,803 20,803

CCG YTD 12,661 12,787 12,787

CCG Aug 2016-17 0 0 0

CCG Aug 2016-17 0 1 11

CCG Aug 2016-17 50.00% 0.00% 61.90%

Episode of Psychosis

2099: First episode of psychosis w ithin tw o w eeks of referral

Other performance measures

1067: Mixed sex accommodation breaches - All Providers

EMSA

Referral to Treatment (RTT) & Diagnostics

1839: Referral to Treatment RTT - No of Incomplete Pathw ays Waiting >52 w eeks

Cancer waits – 62 days

Metric

NHS Constitution support measures

539: % of patients receiving 1st definitive treatment for cancer w ithin 2 months (62 days) (MONTHLY)

540: % of patients receiving treatment for cancer w ithin 62 days from an NHS Cancer Screening Service (MONTHLY)

1878: % of patients receiving treatment for cancer w ithin 62 days upgrade their priority (QUARTERLY)

1885: % of patients receiving 1st definitive treatment for cancer w ithin 2 months (62 days) (QUARTERLY)

1886: % of patients receiving treatment for cancer w ithin 62 days from an NHS Cancer Screening Service (QUARTERLY)541: % of patients receiving treatment for cancer w ithin 62 days upgrade their priority (MONTHLY)

HCAI

24: Number of C.Diff icile infections

2018: Number of Completed Admitted RTT Pathw ays

2016: Number of Diagnostic Tests/Procedures (excluding Endoscopy)

Activity Measures

2019: Number of Completed Non-Admitted RTT Pathw ays

Referral to Treatment (RTT) & Diagnostics

2015: Number of Endoscopy Diagnostic Tests/Procedures



Y


Title of Paper: NHS EAST LANCASHIRE (EL) CCG AND NHS BLACKBURN WITH DARWEN (BWD) CCG CANCER PERFORMANCE UPDATE: AUGUST 2016

Date of Meeting 2nd November 2016 Agenda Item 10.1






To maintain and improve performance against core standards and statutory requirements



Delivering high quality Primary Care at scale and improving access

Self-Care and Early Intervention

Enhanced and Integrated Primary Care and Better Care Fund x

Access to Re-ablement and Intermediate Care x

Improved hospital discharge and reduced length of stay

Community based ambulatory care for specific conditions x

Access to high quality Urgent and Emergency Care x

Scheduled Care

Quality

Clinical Lead: Dr Neil Smith, Pennine Lancashire Macmillan GP

Senior Lead Manager Cathy Gardener, Head of Commissioning Scheduled Care/Mental Health

Finance Manager Mrs Kirsty Hollis, Chief Finance Officer

Equality Impact and Risk Assessment completed: Not Required

Patient and Public Engagement completed: Ongoing

Financial Implications NHS Constitution premiums

Risk Identified Fluctuating performance and potential impact on the quality of patient care and delivery of NHS Constitution

Report authorised by Senior Manager: Dr Malcolm Ridgway – Director of Quality and Performance

Decision Recommendations To note the contents of the report and support actions as identified.

NHS

1.0

2.0

3.0 3.1

Augus

Standard

14 day (914 day br31 day fir(96%) 31 subse(94%) 31 subsechemothe31 day suradiother62 day st62 screen62 consu(86%)

East Lanc

IntroductioAchievemePriorities wand NHS Cindicator oorganisatio

Purpose oThe purpostandards progress ag

Summary The tablesBlackburn standards groups and

st 2016 in m

d (target)

93%) reast (93%) rst treatment

equent surgery

equent erapy (98%) ubsequent rapy (94%) tandard (85%)ning (90%)

ultant upgrade

cashire (ECancer

on ent of Natiowithin the CCConstitutionof the quaons deliver.

of the reporse of this and prioritgainst these

of CWT Pes below pro

with Darwand, in add

d providers

month, qua

Auguperforma

94.3%95.0%96.1%

y 100.0%

100.0%

100.0%

) 76.3%80.0%77.1%

EL) CCG anr Performa

onal CanceCG Improven measuresality of can

rt report is ties and toe plans, to s

erformanceovide an o

wen CCG adition, a higinvolved.

arter 1 16/1

East L

ust ance

Au actbrea

% 103% 14% 15

% 36

% 6

% 62

% 76% 10% 35

1

nd NHS Bance Upda

er Waiting Tement and A, is considencer diagn

to outline to provide asupport the

e overview of and East gh level an

Table 1

7 and year

Lancashire

ugust tivity / aches

Pe

39 / 59 40 / 7 53 / 6

6 / 0

68 / 0

2 / 0

6 / 18 0 / 2 5 / 8

lackburn ate: Augu

Time (CWTAssessmenered by patosis, treat

the current an overview

delivery of

the positioLancashire

nalysis of n

r to date 16

e CCG

Quarter 1 erformance

95.2% 95.2% 98.3%

97.6%

100.0%

97.0%

81.1% 97.9% 90.7%

with Darwst 2016

T) standardnt Framewotients and tment and

position inw of the pthese stand

on of East e Hospitals numbers of

6/17 CWT p

Quarter 1Activity / breaches

3,120 / 15460 / 22 535 / 9

126 / 3

156 / 0

135 / 4

296 / 56 47 / 1 97 / 9

wen (BwD)

ds, Cancer ork (IAF) 20the public t

care whic

n relation tplans in pladards.

t Lancashir Trust agaf breaches,

performanc

s

2016/17 to dat

performa

1 95.1% 95.6%

98.0%

97.9%

99.6%

98.3%

81.9%94.6%87.3%

) CCG

Clinical 16/2017 to be an ch NHS

to CWT ace and

re CCG, ainst all tumour

ce data

year te ance

2016/17 date ac

breac

% 5,129% 754 /% 850 /

% 194

% 274

% 233

% 447 /% 74 % 165 /

year to ctivity / ches

/ 254 / 33 / 17

/ 4

/ 1

/ 4

/ 81 / 4 / 21

Standard


Standard


Pf

%d (target)


equent surgery


ultant upgrade

d (target)


equent surgery


ultant upgrade

6065707580859095

100

Performan

ce %

ELH

Augusperforma

93.3%97.9%96.7%

y 100.0%

100.0%

95.5%

) 82.8%87.5%81.3%

East L

Augusperforma

93.9%96.6%96.3%

y 97.6%

100.0%

) 80.8%96.4%82.4%

HT 62 da

Blackburst ance

Augusbre

% 43% 4% 6

% 1

% 1

% 2

% 2% % 1

Lancashire

st ance

Augus/ bre

% 1.40% 17% 16

% 41

% 63

% 91 /% 14% 45

ay standaadju

2

rn with Darst activity / eaches P

31 / 29 47 / 1 60 / 2

11 / 0

12 / 0

22 / 1

29 / 5 8 / 1 16 / 3

Hospital N

st activity eaches Pe

02 / 86 75 / 6 64 / 6

1 / 1

3 / 0

/ 17.5 / 0.5

5.5 / 8

Table 2

ard perfoustment

rwen CCGQuarter1

Performance

94.5% 92.2% 98.9%

94.6%

100.0%

97.7%

80.4% 100.0% 88.3%

NHS Trust (

Quarter 1 erformance

94.9% 94.1% 99.2%

98.3%

100.0%

83.1% 100.0% 92.1%

ormance(Source ELH

Quarter 1 Activity / breaches

1212 / 67 191 / 15 180 / 2

37 / 2

55 / 0

44 / 1

92 / 18 3 / 0 60 / 7

(ELHT)

Quarter1 Activity / breaches

4,100 / 210596 / 35 610 / 5

118 / 2

172 / 0

343 / 58 46.5 / 0

152.5 / 12

and witHT)

2016/17 yedate

performa

94.4%94.0%98.6%

96.7%

100.0%

97.6%

81.1%90.9%88.1%

s

2016/17 to dat

performa

0 94.8% 95.3%

98.7%

98.0%

99.7%

N/A

83.5% 98.1%

2 90.0%

th 42 day

Ope

Adju

Perf

ear to

nce

2016/17 date a/breac

% 2,016 /% 298 /% 295

% 60

% 91 /

% 82

% 159 /% 11 % 84 /

year te ance

2016/17date ac

breac

% 6,759% 970 % 947 /

% 202

% 301

N/

% 528.5% 77.5 % 240 /

y

en Exeter Perf

usted Performanc

formance Standa

year to ctivity ches

/ 112 / 18 / 4

/ 2

/ 0

/ 2

/ 30 / 1 10

year to ctivity / ches

/ 354 / 46 / 12

/ 4

/ 1

/A

5 / 87 / 1.5 / 24

ce

rd

East L

0

20

40

60

80

100

120

140

Referrals

0

5

10

15

20

25

30

35

40

1

Referrals

Lancashire

Aug15/16

Sept15/16 1

e and BwD

EL ‐ 6

Oct5/16

Nov15/16

D15

BwD ‐

CCGs: Ca Augus

2 Day Stand

Dec5/16

Jan15/16

F15

62 Day Stan

3

Table 3ncer Perfost 15 – Aug

Table 4

dard Referr

eb5/16

Mar15/16

A16/

ndard Refer

rmance aggust 16

rals ‐ 2015/

pr/17

May16/17

Jun16/

rrals ‐ 2015

gainst the 6

16 & 2016/

ne/17

July16/17

Aug16/1

/16 & 2016

62 day stan

0

10

20

30

40

50

60

70

80

90

100

Percentage

/17

50

55

60

65

70

75

80

85

90

95

100

g17

Percentage

6/17

ndards

90+ days

63‐90 da

49‐62 da

32‐48 da

up to 31

EL %agemeeting

Nationameeting

CWT tar85%

90+ days

63‐90 days

49‐62 days

32‐48 days

up to 31 da

BwD %agemeeting taNational %meeting ta

s

ays

ays

ays

1 days

g target

l %ageg target

get

s

s

s

ays

arget%agearget

62 day stan

ELHT

Apr‐16May‐16Jun‐16Jul‐16Aug‐16

Lancs Teach


Blackpool


Airedale


National


ELCCGAprilMayJune July August

CCG 6

dard performance

Brain Bre66666

hing Hospital NHSTBrain Bre

6 1006 1006 10066 100

Brain Bre66666

Brain Bre66666

Brain Bre6 1006 1006 94.166 100

Breast100.00%100.00%92.90%100.00%100.00%

0

50

100

150

Patie

nts o

n pa

thway

EL C

Provider

62 day Perfo

e across tumour gr

ast Gynae100 72.7100 10095.9 90.9100 100100 100

T ast Gynae

100 5091.7 60100 52.297.3 86.7100 90

ast Gynae100 88.9100 33.394.1 60100 60100 81.8

ast Gynae100 66.7100 100100 100100 77.8100 66.7

ast Gynae94.8 77.594.6 77.495.1 77.294.9 74.994.8 77.1

Gynae Haem% 57.10% 75.% 100.00% 100.% 66.70% 100.% 100.00% 100.% 66.70% 75.

CCG 2016/1

r 62 day Pe

ormance b

oups Target 8

Haem H&N100 6471.4 7271.4 58100 8375

Haem H&N100 5877.8 3587.5 7888.980 47

Haem H&N100100 4466.7 183.375 62

Haem H&N100 1100 17510075

Haem H&N79.7 6585 58

78.5 6677.5 6579.3 69

m H&N Low.00% 57.10%.00% 66.70%.00% 60.00%.00% 50.00%.00% 40.00%

17 ‐ cumula

4

erformance

Table 5

by Tumour

85%

Lower GI Lung4.3 52.42.7 758.3 85.23.3 71.470 55.6

Lower GI Lung8.8 64.75.7 66.78.6 7560 60.97.1 82.6

Lower GI Lung40 91.34.4 100100 10075 76.92.5 100

Lower GI Lung100 86.7100 800 100

83.3100

Lower GI Lung5.5 71.28.9 70.56.5 73.85.8 70.39.6 74.1

wer GI Lung50.00% 90.00%100.00% 83.30%84.60% 80.00%57.10% 100.00%62.50% 100.00%

ative 62 daygroup

e by Tumou

Group by M

g Other S87

86.7 10081.892.3100 100

g Other S10073.7 5088

77.3 10066.7 100

g Other S80 100

64.5 10089.7 10065.2 10079.2 100

g Other S100 100100 10092.9 50100100 100

g Other S74.5 78.469.2 72.472.9 76.775.5 7572.2 78.5

Other Sarcom%% 100.00%% 0.00% 100.%% 100.00%

y performan

ur Group

Month targ

Sarcoma Skin9486

100 870 10

82

Sarcoma Skin60 10100 93

94100 10100 96

Sarcoma Skin101096109

Sarcoma Skin

100

Sarcoma Skin64.6 9667.1 9565.9 9566.2 9671.4 95

ma Skin UG85.70%92.30%

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Y


EXTERNAL AUDIT SERVICES – CONTRACT AWARD RECOMMENDATION REPORT

Date of Meeting 2ND NOVEMBER 2016 Agenda Item 11
















Scheduled Care X

Quality √

Clinical Lead: N/A

Senior Lead Manager Mr Roger Parr

Finance Manager Mr Roger Parr



Financial Implications £38k per annum for 5 years

Risk Identified N/A


Decision Recommendations The Governing Body is requested to approve the recommendation of the CCG’s Auditor Panel to appoint Grant Thornton to be the External Auditor of the CCG for the next five years, at a cost of £38k per annum.




2ND NOVEMBER 2016

EXTERNAL AUDIT SERVICES –

CONTRACT AWARD RECOMMENDATION REPORT

1. Introduction

In March 2016 the Department of Health published a report that provided CCGs with guidance on appointing its External Auditors. An appointment needed to be made by the end of the year due to the inherited contracts coming to an end. The CCG followed this guidance and this paper provides the Governing Body with the outcome of the appointment process, and requests approval of the recommendation from its Auditor Panel

2. Auditor Panel The CCG established an Auditor Panel to oversee the appointment of the external auditors for a five year period. The minutes of the last Auditor Panel are attached for information (Appendix 1). The CCG sought best value from the market and went out to tender with four other CCGs. All five Auditor Panels are making the same recommendations to their Governing Bodies. The assessment of the bids was based on 70% Quality and 30% Cost. The quality criteria was subdivided into methodology and approach (30%), and resources, organisational capability and experience (40%). Panel member evaluations were done independently and three bidders were invited to present to a joint panel of Audit Chairs representing all five CCG’s. Grant Thornton, who are the CCG’s current external auditors, received the highest score.

3. Recommendations

The CCG’s Auditor Panel have considered the evaluation of the procurement exercise and recommends the appointment of Grant Thornton to be the External Auditor of the CCG for the next five years, at a cost of £38k per annum. The Governing Body is requested to approve this recommendation.

Paul Hinnigan

Audit Committee Chair and Auditor Panel Chair 20th October 2016

of 2

Appendix 1


Minutes of the Auditor Panel held on 11th October 2016 at 11.30 a.m. in the Chief Finance Officer’s Office, Fusion House

Evolution Park, Haslingden Road, Blackburn, BB1 2FD PRESENT: Mr Paul Hinnigan Lay Member – Governance (Chair) Dr Geraint Jones Lay Member – Secondary Care Doctor Dr Nigel Horsfield Lay Member – Clinical Advisor IN ATTENDANCE: Mr Roger Parr Chief Finance Officer Mrs Pauline Milligan Corporate Support Officer (minutes) Min No: 16.014 Chair’s Welcome

The Chair welcomed everyone to the meeting of the Clinical Commissioning Group’s (CCG’s) Auditor Panel. For the benefit of Dr Geraint Jones, who was attending his first meeting as a member of the Auditor Panel, the Chair explained the function and remit of the Auditor Panel.

16.015 Apologies for Absence and Confirmation of Quoracy It was noted that Dr John Randall, who had replaced Dr Tom Phillips on the panel, was not in attendance; however, this was due to the meeting being convened at short notice and had been arranged to follow on from a pre-arranged meeting of the Lay Members. The meeting was confirmed as quorate.

16.016 Declarations of Interest There were no declarations of interest.

16.017

Minutes of the meeting held on 26th April 2016 The minutes of the previous meeting were reviewed and agreed as an accurate record. RESOLVED: That the minutes of the meeting held on 26th April 2016 were approved as an accurate record of the meeting.

16.018 Matters Arising There were no matters arising

16.019 External Audit Services Contract Award Recommendations Report The Chair provided an overview of the circulated report and explained the background to the procurement of External Audit Services. The procurement was required as a result of guidance published by the Department of Health in March 2016 in its document “Guidance on the Local Procurement of External Auditors for NHS Trusts and CCGs”. The organisations that participated in the procurement were:

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• Blackburn with Darwen CCG; • East Lancashire CCG; • West Lancashire CCG; • Greater Preston CCG; • Chorley and South Ribble CCG.

The Chair reported that a number of options were presented in the guidance and the panel of Audit Chairs from each participating CCG opted for the use of the Crown Commercial Service ConsultancyONE Framework. The Chair explained that the framework had eight bidders of which four responded to the Invitation to Quote. Three of the four respondents were identified as being the strongest bids following a process of consensus scoring. These were:

• Grant Thornton; • PricewaterhouseCoopers; • KPMG.

The Chair drew members’ attention to the report which provided details of the scoring criteria and the final evaluation following the presentations and interviews which took place on 30th September 2016. The Chair concluded that the highest overall scoring bid was achieved by Grant Thornton. The CCG Audit Chairs’ panel had recommended that the contract for the service was awarded to Grant Thornton. The appointment would be for a five year period. Questions and answers followed. Blackburn with Darwen CCG Auditor Panel approved the recommendation of the CCG Audit Chairs’ panel that the contract for the service was awarded to Grant Thornton and agreed to recommend it to the CCG Governing Body for final ratification. ACTION: The Chair to oversee the presentation of the recommendation to the next meeting of the Governing Body for ratification. RESOLVED: That Blackburn with Darwen CCG Auditor Panel approved the recommendation of the CCG Audit Chairs’ panel that the contract for the service was awarded to Grant Thornton and agreed to recommend it to the CCG Governing Body for final ratification.


16.021 Date and Time of Next Meeting To be confirmed as necessary. The Chair thanked everyone for their attendance and the meeting closed.

Governing Body Meeting Page 1


Y


Title of Paper: Managing Conflicts of Interest in the NHS: A Consultation

Date of Meeting 2ND NOVEMBER 2016 Agenda Item 12






To maintain and improve performance against core standards and statutory requirements Y



Delivering high quality Primary Care at scale and improving access Y

Self-Care and Early Intervention Y

Enhanced and Integrated Primary Care and Better Care Fund Y

Access to Re-ablement and Intermediate Care Y

Improved hospital discharge and reduced length of stay Y

Community based ambulatory care for specific conditions Y

Access to high quality Urgent and Emergency Care Y

Scheduled Care Y

Quality Y

Clinical Lead: DR CHRIS CLAYTON

Senior Lead Manager MRS CLAIRE MOIR

Finance Manager N/A



Financial Implications Nil

Risk Identified Nil


Decision Recommendations The Governing Body is requested to note the contents of the report.


NHS Blackburn with Darwen Clinical Commissioning Group

Governing Body

Managing Conflicts of Interest in the NHS: A Consultation

1. Introduction

1.1 The purpose of this report is to provide Blackburn with Darwen (BwD) Clinical Commissioning

Group’s (CCG) Governing Body with the responses to NHS England’s Conflicts of Interest (CoI) Consultation document for information.

2. Background

2.1 On 20th September 2016, NHS England launched a major consultation on proposals for managing CoI across the NHS; responses were required to be uploaded via a web based portal: https://www.england.nhs.uk/2016/09/conflicts-of-interest/

2.2 The proposals included:

• Setting out what is and is not acceptable in relation to individual types of interest such as the need to seek prior approval from the employing NHS organisation for any outside employment

• The process by which interests should be identified and conflicts of interest managed appropriately

• Information which organisations must publish in relation to the interests of their staff • Ensuring staff understand what constitutes both interests and conflicts of interest as well

as the circumstances in which they can occur • The process which organisations should have in place to ensure they appropriately

manage any breaches of conflicts of interests policy

3.

CCG Responses

3.1

The Governing Body was requested to consider the consultation and provide their responses by 21st October 2016. Those responses have been submitted to NHS England in line with the deadline of 31st October 2016 and are attached at Appendix 1.

4. Recommendation

4.1 The Governing Body is requested to note the contents of the report.

Claire Moir Governance, Assurance and Delivery Manager 25th October 2016


Appendix 1 Managing Conflicts of Interest in the NHS: A Consultation

Governing Body Responses

Proposal Question CCG Comments Change to definition of Conflict of Interest [page 14]

Q1. Do you agree with the definition? If no please explain why. Q2. Are the circumstances identified within the definition enough to capture all instances of possible conflict?

Yes Yes

Sub-classification of types of interest [page 15]

Do you agree with the sub-classifications? If no please explain why.

Yes

Definition of senior staff [page 18]

Do you agree with the proposed definition of senior staff? If no please explain why.

Paragraph 43 “we would expect this to include” – we suggest this should read “must as a minimum include”. We then agree with the definition.

Gifts [pages 19/39]

Do you agree with the proposals regarding gifts? If no please explain why.

Table under paragraph 45: 2nd bullet point “gifts or cash must always be declined” (when the conditions of bullet point 1 are applicable) 8th bullet point – “gifts associated with procurement and/or service supply must be declined”

Hospitality [pages 21/39]

Do you agree with the proposals regarding hospitality? If no please explain why.

We think this should relate to all staff and not just “senior staff”. Is it appropriate that hospitality over the value of £25 should be declared but then there is no requirement to say what the value is?

Principles and rules regarding outside employment [pages 22/39]

Do you agree with the proposals regarding outside employment? If no please explain why.

Yes but consideration must be given by the employing organisation that an employee does not take on too many commitments


Principles and rules regarding private practice [pages 23/39]

Q1. Do you agree with the proposals regarding private practice? If no please explain why. Q2. In particular do you agree with the proposal regarding declarations of interest about private practice, including information about earnings? If no please explain why.

Yes Yes

General Sponsorship [pages 25/39]

Do you agree with the proposals regarding general sponsorship? If no please explain why.

Yes

Sponsored Events [pages 26/39]

Do you agree with the proposals regarding sponsored events? If no please explain why.

Para 52 4th bullet point in table: “should this have to be stated?”

Sponsored Research [pages 27/39]

Do you agree with the proposals regarding sponsored research? If no please explain why.

Yes

Sponsored Posts [pages 28/39]

Do you agree with the proposals regarding sponsored posts? If no please explain why.

Yes but written approval should be required.

Shareholdings [pages 29/40]

Do you agree with the proposals regarding shareholdings? If no please explain why.

Does this apply to just “senior staff” or all staff? Please clarify.

Patents [pages 30/40]

Do you agree with the proposals regarding patents? If no please explain why.

Yes

Donations [pages 31/40]

Do you agree with the proposals regarding donations?

Yes


If no please explain why. Loyalty Interests [pages 32/40]

Do you agree with the proposals regarding loyalty interests? If no please explain why.

Yes

What should be published [page 39/40]

Q1. Do you agree that information on interests held by senior staff described in the table on pages 39/40 should be published? If no please explain why. Q2. Do you agree that information on interests should be published in a consistent way across organisations using the format described in the table on pages 39/40? If no please explain why. Q3. Do you agree that information on interests should be published (at least annually) by organisations? If no please explain why. Q4. Do you that that further consideration should be given to aggregating returns on MyNHS, or another suitable web portal? If no please explain why. Q5. Do you believe that we should pursue the approached described above to ensure greater compliance with the Disclosure UK initiative? If no please explain why

Yes Yes Yes but the frequency may mean the information is not up to date.

Breaches and Sanctions [page 43]

Do you agree with our proposals on breaches and sanctions

Yes

Conclusion

Do you agree that the underlying principles and rules in this consultation should apply to non NHS providers in respect of NHS funded services they

Yes – all providers should have to comply with the rules and principles


[page 45]

provide? If no please explain why.



Y


Title of Paper: SUB-COMMITTEES AND GROUPS’ MINUTES

















Scheduled Care X

Quality √

Clinical Lead: N/A

Senior Lead Manager Mr Iain Fletcher

Finance Manager N/A

Equality Impact and Risk Assessment completed: Report for information only

Patient and Public Engagement completed: Report for information only

Financial Implications Report for information only

Risk Identified Report for information only

Report authorised by Senior Manager: Mr Iain Fletcher

Decision Recommendations The Governing Body is requested to receive and note the content of the report.



2ND NOVEMBER 2016

SUB-COMMITTEES AND GROUPS’ MINUTES

1. Introduction

This report presents the minutes of the Governing Body Sub-Committees and Groups for receipt and note by members. The minutes inform members of delegated and key decisions taken and provide information regarding items of particular interest or potential risk.

2. Sub-Committees and Groups

2.1 Primary Care Co-Commissioning Committee

The ratified minutes of the meeting held on 19th July 2016 are attached as Appendix 1.

2.2 Quality, Performance and Effectiveness Committee

The ratified minutes of the meeting held on 30th August 2016 are attached as Appendix 2.

2.3 Remuneration Committee

The draft minutes of the meeting held on 4th May 2016 are attached as Appendix 3.

2.4 Commissioning Business Group

The ratified minutes of the meetings held on 10th August 2016 and 14th September 2016 are attached as Appendices 4 and 5.

3. Recommendation

The Governing Body is requested to receive and note the content of the report.

Iain Fletcher Head of Corporate Business 21st October 2016

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Appendix 1


Minutes of the Primary Care Co-Commissioning Committee (PCCC) held on Tuesday 19th July 2016 at 12.30 p.m.

in Meeting Rooms 1 and 2, Kings Court, 33 King Street, Blackburn, BB2 2EF

PRESENT: Mr Graham Burgess Lay Chair (Chair) Dr Malcolm Ridgway Clinical Director for Primary Care and Quality Mr Roger Parr Chief Finance Officer Mr Paul Hinnigan Lay Member - Governance Dr Nigel Horsfield Lay Member - Clinical Advisor IN ATTENDANCE: Dr Stephen Gunn Primary Care Development Lead Mrs Sarah Danson NHS England Mrs Angie Ashworth NHS England Mr Mark Rasburn Chief Executive, Blackburn with Darwen Healthwatch Mr Gifford Kerr Consultant in Public Health, Blackburn with Darwen Borough Council Mr Joe Slater Lay Person Representative Mrs Jess Tomlinson Liaison Officer, Lancashire Pennine Local Medical Committee Mrs Catherine Lawless Primary Care Support Officer (minutes) Min No:

8.01

Chair’s Welcome The Chair welcomed everyone to the meeting and gave a short brief with regards to the content of the agenda and housekeeping.

8.02 Apologies for Absence and Confirmation of Quoracy Mr Peter Sellars Primary Care Transformation Manager Mr Iain Grimshaw Lay Person Representative Mr Duncan McGrath Lancashire Pennine Local Medical Committee Representative Mrs Debbie Nixon Chief Operating Officer The meeting was confirmed as quorate.

8.03 Declarations of Interest The Chair asked members if they would like to declare any Conflicts of Interest (CoI) relating to items on the agenda. The Chair reminded those present that if, during the course of discussion a CoI became apparent, it should be declared at that point. Dr Stephen Gunn raised a CoI in relation to Item 9 – Blackburn with Darwen (BwD) Estates Strategy; as a former partner of Witton Medical Practice, with a potential financial interest in any future sale of the premises. The Chair requested clarification if Dr Gunn’s CoI was of a pecuniary or personal nature, as he was presenting the paper. Mr Roger Parr advised that, as the CCG was currently in the early stages of procurement, Dr Gunn could be present and take part in subsequent discussions.

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RESOLVED: That the PCCC noted the CoI raised by Dr Gunn and agreed that, at this stage, he could take part in discussions.

8.04 Questions from Members of the Public No questions had been received from members of the public.

8.05 Minutes of the Meeting held on 31st May 2016 The minutes of the previous meeting were reviewed and accepted as an accurate record. RESOLVED: That the Minutes of the Meeting held on 31st May 2016 were approved as an accurate record.

8.06 Matters Arising/Action Matrix There were no matters arising. The action matrix was reviewed and completed actions were accepted as such by the Committee. Item 7.10 – Primary Care Quality Report The Chair recommended that a deadline date for completion be inserted into the matrix. Any suggestions to be forwarded in the next couple of weeks. The report is then to be presented to the Quality, Performance and Effectiveness Committee (QPEC) and then back to the next PCCC meeting. ACTION: Mrs Catherine Lawless to coordinate the amendment of the Action Matrix. Item 7.14 – Primary Care Services – Financial Summary Mr Parr confirmed that he has raised the issue at the Chief Finance Officers’ meeting and is currently awaiting a response.

8.07 Primary Care Update Report Dr Malcolm Ridgway provided the Committee with an update on national and local primary care news and drew the Committee’s attention to key items of information. Primary Care Workforce Development On 4th July the CCG participated in a Careers Day hosted by East Lancashire Careers Hub funded by Health Education England North West (HEE NW). Dr Ridgway advised that the event was successful with over 80 students from local schools in attendance. General Practice All practices have now signed up to the Quality and Outcomes Enhanced Service Transformation Scheme (QOEST), which will be delivered by the GP Federation. Update from the Primary Care Group The CCG has submitted three bids against the Estates and Technology Transformation Fund and confirmed that the bids are for North and West locality and the Primary Care Access Centre (PCAC). Prime Minister’s Challenge Fund (PMCF)

• PCAC – Dr Ridgway confirmed that work is ongoing in developing the PCAC and it has been agreed in principle.

• Locality Spokes – The PMCF’s three access hubs are up and running between Monday to Friday with access over the weekend operated from Barbara Castle Way Health Centre.

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• Telephone Triage – Patient Signposting – Dr Ridgway advised that there are renewed efforts to try and get practices to sign up to the telephone triage system, which is an alternative way of improving access.

• Pharmacy Scheme – Accessing Health Care – Dr Ridgway reported work is ongoing with BwD Community Pharmacies on how to make better use of their services to help with patient access. Dr Ridgway briefly commented that an audit has been carried out which shows that 30% of hub appointments could have been dealt with by a Community Pharmacy.

Questions and answers followed. Estate and Technology Transformation Fund Mr Joe Slater asked in what order of priority are the bids being addressed to which Dr Ridgway confirmed that the bids in order of priority are West, PCAC and then North. Telephone Triage – Patient Signposting Mr Slater asked what other ideas are being taken in to consideration to improve access and patient choice and also what will the funding be used for if not for telephone triage. Dr Ridgway advised that email, apps on iPhones and Skype are suggested alternative forms of improving access. Mr Mark Rasburn enquired if there was any feedback from patients of their experiences. Dr Ridgway advised that there is currently only national feedback. Pharmacy Scheme – Accessing Health Care Mr Slater requested assurance that, when consulting with Pharmacies, patients would be included in the consultation process. Dr Ridgway confirmed that consultation will be provided through various groups and gave the example of the Patient Participation Group. Mr Rasburn confirmed that the CCG has been invited to attend a public meeting to discuss some of the issues around Community Pharmacy which will also cover the patient’s point of view. Mr Parr suggested inviting NHS England to the public meeting as they are the direct commissioner for Community Pharmacy. ACTION: Mr Rasburn agreed to invite NHS England to the public meeting. Primary Care Access Centre (PCAC) The Chair requested confirmation that whether an end date has been set for discussions with the Trust. Mr Parr confirmed that a meeting with the Trust and the Federation Representatives have discussed a new model of care and the various options. The Trust is to discuss with individual providers on how they are going to work together. The Chair asked for a more detailed report to come to the next meeting and to also include timescales. ACTION: Mr Parr agreed to provide an update report with timescales to the next meeting. The Chair commented that, with regards to Appendix 1 and the poor use of access in the North, he is pleased to note that figures have improved but commented that it was still important for the Committee to monitor. RESOLVED: That the PCCC noted the content of the report.

8.08 Draft Version of the Primary Care Strategy Update Dr Ridgway requested that Committee members note the content of the draft Primary Care Strategy and approve the strategic direction. Primary Care Vision Dr Ridgway outlined the Primary Care Vision to get the best out of general practice and outlined that to achieve this vision it is imperative that General Practice changes from its current fragmented model.

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Local Challenges Dr Ridgway outlined the local challenges for BwD and the greatest potential for Primary Care could be reached by General Practice by working closely together to become more efficient and productive. Dr Ridgway outlined the ongoing work in BwD and confirmed that the integrated teams based in localities are working with community nursing and social care keeping patients out of hospital. Service Delivery Vision Dr Ridgway briefly outlined that there are now two Physician Associates who are based in BwD practices which are part of a team of 10 across Pennine Lancashire. Dr Ridgway invited questions and comments from members. Dr Nigel Horsfield queried the plans that the Trust has to appoint General Practitioners and how this would impact on the Strategy. In reply Dr Ridgway confirmed that the Trust do have their own Clinical Strategy but that he is not sure if it is coherent with the CCG’s Strategy; however, he asked the Committee to note that the Trust are part of Sustainable Transformation Programme Planning process across Pennine Lancs. Dr Horsfield asked for confirmation whether this has been discussed with the Trust on how their model for General Practitioners fits in. Dr Ridgway confirmed that it has been discussed informally. ACTION: Following a request from the Chair for a more formal discussion, Dr Ridgway agreed to formally discuss with the Trust. Mr Slater raised a query around whether the CCG are expecting BwD Borough Council (BwD BC) to jointly fund the Strategy and whether the Strategy will go to the Health and Wellbeing Board for approval. In reply, Dr Ridgway confirmed that he is to meet with Mr Stephen Tingle, Director of Adults, BwD BC, to discuss. The Chair requested that the final version of the Primary Care Strategy is presented to the BwD Health and Wellbeing Board. ACTION: Dr Ridgway to ensure that the final draft of the Primary Care Strategy will be presented to the BwD Health and Wellbeing Board. After discussion and agreement the Committee requested that the Strategy is updated with the following recommended changes:

• More clarity/information is provided in the Strategy regarding the CCG’s current position, the direction of travel and identified risks.

• More information is provided regarding financial resources and Information Technology.

• The Strategy should contain a detailed analysis identifying the strengths and weaknesses of the options.

• The Strategy should include Public Health information and how the Strategy will promote healthy living.

• The Strategy should include information determining how the CCG will manage the support provided by NHS England to deliver the Strategy.

ACTION: Dr Ridgway noted the above outlined recommended changes and agreed to oversee their inclusion, in line with discussions, in the final draft of the Strategy and bring back for review to the November meeting. RESOLVED: That the PCCC noted the content of the draft Primary Care Strategy Update.

8.09 Blackburn with Darwen Estates Strategy Dr Gunn provided committee members with an estates overview for the BwD CCG area which

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is covered by 27 GP practices and amounts to a total registered population of approximately 170,000. Dr Gunn asked the Committee to note that GP Practices and community providers operate from a mixture of old and new properties in varying conditions. Dr Gunn outlined the Estate Plan for BwD which is for a new GP and community care facility in Blackburn West area to which 3 GP practices will be relocated; followed by a new GP development care facility in the North locality area to which 6 practices will be relocated and finally the PCAC. It was noted that funding for the plans has been provisionally agreed and will be managed by the CCG. In conclusion, Dr Gunn said that the Strategy will deliver modern premises and allow care closer to home, collaborative working and, by doing so, allow cost savings to be made. Mr Parr commented that the Strategic Estates Group in Pennine Lancashire is looking at premises utilisation and how it will update and amalgamate current prime estate. It was noted that the Estates Team has looked at Barbara Castle Way Health Centre and plan to do a further deep dive at Darwen Health Centre to review space utilisation. Dr Gunn invited questions and comments. After discussion and agreement the Chair requested that the BwD Estates Strategy be updated with the following recommended changes:

• Information around finances where the funding is coming from internal/external sources;

• Estate priorities need to be outlined / determined; • Public estates approach what are other people doing and what opportunities are there

available to share premises; • Map expansion to show areas of development and how they may impact on practice

size; • Population status is incorrect.

ACTION: Dr Gunn thanked committee members for their comments and agreed to feed them back for inclusion in the final draft of the strategy and bring it back to the next meeting. RESOLVED: That, following the inclusion of the above amendments, the PCCC agreed to receive the final version Blackburn with Darwen Estates Strategy for approval at the next meeting.

8.10 Chair’s Action North Locality Estates Bid Dr Gunn briefly outlined the Chair’s Action to support the North Locality bid for a new health centre development following the Estates and Technology Infrastructure Fund. It was noted that the CCG was informed in May 2016 that the electronic submissions portal would only be operational from 3rd June – 30th June to which all bids had to be submitted. It was noted that the Executive Team and the Chair of the Primary Care Co Commissioning Group had reviewed the bid and, due to the tight submission date, had agreed to support the scheme in principal. After a brief discussion, the Committee agreed to support the bid in principal but requested that Appendix 1 be circulated following the meeting. ACTION: Mrs Catherine Lawless to share Appendix 1 with Committee members. RESOLVED: That the PCCC agreed to ratify the PCCC Chair’s Action to support the North Locality bid for a new Health Centre development.

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8.11 CCG Assurance Framework 2016/17 Delegated Functions – Self Certification Quarter 1 Dr Ridgway presented the Self-Certification for Quarter 1 (Q1) for information. It was noted that Dr Chris Clayton, Clinical Chief Officer and Mr Paul Hinnigan, Audit Committee Chair, will sign off the CCG’s Self-Certification Q1. ACTION: Mrs Lawless to submit the signed document to NHS England. RESOLVED: That the PCCC noted the content of the Self-Certification Q1 submission.

8.12 Primary Care Services – Financial Summary Mr Parr commented that the CCG is still waiting clarification from NHS England around the CCG’s running costs associated with Primary Care, which remained outstanding. Mr Parr drew the Committee’s attention to how the budget is split and asked the Committee to note that 50% of the budget is on prescribing. Mr Parr further commented that prescribing is an area that the CCG’s Sub-Committees will be focusing on for cost savings and that further information will be brought to the Committee for their attention. ACTION: It was agreed that a Prescribing Report will be presented to a future meeting by Mrs Julie Kenyon, Senior Operating Officer, Primary Care and Medicines Commissioning. Mrs Lawless to action and add to a future meeting agenda. RESOLVED: That the PCCC noted the contents of the financial summary and the overall position at the end of May 2016, noting the risk.

8.13 Part 2 Meetings - Mr Parr briefly outlined that he has received an email from Duncan McGrath, Lancashire Pennine Local Medical Committee Representative, regarding the management of Part 2 meetings. Mr McGrath enquired about LMC exclusion from Part 2, where their contribution to discussions could be beneficial. It was suggested that authors/those presenting papers should be aware of LMC’s willingness to be a useful contributory to the Part 2 meetings and could be invited to attend / contribute to Part 2 discussions if the view of GP providers would be pertinent to the issues being discussed. RESOLVED: The PCCC members agreed that authors/those presenting papers should be aware to invite the LMC representative or any other officer to attend for the corresponding section of the Part 2 meetings where their views would add value to the discussion.

8.14 Date and Time of Next Meeting The next meeting of the PCCC will be held on Tuesday 20th September 12.30 – 2.00 p.m. in Meeting Rooms 1 and 2 Blackburn Central Library, Town Hall Street, Blackburn BB2 1AG. The Chair thanked everyone for their attendance and input and the meeting closed.

EXCLUSION OF THE PRESS AND PUBLIC – ‘That representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest’ (Section1(2)Public Bodies(Admission to Meetings)Act 1960).

Signed Chair 20th September 2016 Date

QUALITY PERFORMANCE AND EFFECTIVENESS COMMITTEE

1 Item 3.2 QPEC Mins 30th August 2016

Minutes Approved 28/9/16 at Pennine Lancs Quality Committee

Minutes of the Quality Performance and Effectiveness Committee (QPEC) Tuesday 30th August, 12.30 – 2.30 p.m. Boardroom, BwD CCG, Fusion House, Blackburn

Present Dr Nigel Horsfield Dr Malcolm Ridgway Dr Stephen Gunn Dr Geraint Jones Mr Michael Connell

CCG Lay Member – Chair (Clinical Advisor) (NH) Director of Quality & Performance (MR) CCG Primary Care Development (SG) CCG Lay Member – Secondary Care Doctor (GJ) Quality and Performance Specialist (MC) Midlands and Lancashire Commissioning Support Unit (MLCSU) BwD

In Attendance Mrs Dorothy Ross

Mrs Natalie Koncsol Mrs Claire Moir Mrs Susan Clarke Mrs Sheila Morris Mrs Elaine Johnstone Mrs Louise Williamson Mrs Catherine Bentley Mrs Samantha Jones Mrs Louise Williamson

Public Voice Lay Person (DRO) CCG Support Assistant (NK) (Note Taker) Risk & Governance Manager (CM) Head of Safeguarding – Designated Nurse (SC) Designated Nurse for Looked After Children, Safeguarding Children (SM) Service Director (EJ) Quality and Performance Specialist – Clinical (LW) Equality and Inclusion Business Partner (North) (CB) Senior Commissioning Manager – Scheduled Care (SJ) Quality & Performance Specialist - Clinical (LW)

ITEM POINT ACTION

1. Welcome and Apologies for Absence Apologies: Mr David Rintoul

Info

2. Declarations of Interest & Confirmation of Quoracy The Chair asked members if they would like to declare any conflicts of interest relating to items on the agenda. The Chair reminded those present that if, during the course of discussion, a conflict of interest became apparent, it should be declared at that point. Recording/Dictaphone Consent: No devices were used at this meeting.

Info

3. Minutes of the meeting held on 26th July, 2016 The minutes were accepted as a true and accurate record.

Matters Arising - Action Matrix 3.1 Review of Terms of Reference (TOR) Dr Malcolm Ridgway (MR) updated the group on how negotiations are currently taking place on the TOR for the new Pennine Lancs Quality Committee meeting (PLQC) that will be taking over from the current Quality Performance and Effectiveness Committee (QPEC). Dr Nigel Horsfield (NH) expressed that he




would like to stand down from his current role as Chair for QPEC. It was advised that NH doesn’t need to attend the Pennine Lancs Quality Committee meeting in the capacity as Chair. Dr Geraint Jones (GJ) will be acting as deputy moving forward. It was raised by the group that quoracy be adhered to at the new PLQC. 6.2 Effectiveness From the Research and Development Update that was presented at July’s QPEC meeting by Dr Stephen Gunn (SG), SG updated the group highlighting that East Lancs appointments and funding have suggested going alone.

4. STANDING ITEMS

4.1

Quality Schedule and CQUIN Performance Report Month 3: Mr Michael Connell (MC) provided the Committee with a summary of the quality, performance and effectiveness report for month 3, June 2016. MC asked the Committee to note the contents of the Performance Report and drew the Committee to key items. Quality Premium MC reported the quality premium baselines are now available NHS Constitution Measure Referral to treatment times (18 weeks) – 92% of patients on incomplete emergency pathways (yet to start treatment) should have been waiting no more than 18 weeks from referral over the course of the 2016/17 year. The current month position as at month 3 is at 92.53% and 2016/17 position is 92.98%. A&E Waits – 95% of patients should be admitted, transferred or discharged within four hours of their arrival at an A&E department over the course of the 2016/17 year. The current month position as at month 3 is at 85.4% with 2016/17 position being 86.41% Cancer waits – 62 days – at least 85% of patients should wait a maximum of two months (62 days) from urgent GP referral to first definitive treatment for cancer over the course of the 2016/17 year. The current month position as at month 3 is at 86.49% with the 2016/17 position being 80.43%. Category A Red 1 ambulance calls – achieved for at least 75% of Red 1 ambulance calls result in an emergency response arriving within 8 minutes over the course of the 2016/17 year. The current month position as month 3 is at 73.06% and the 2016/17 position being 74.63%. BwD CCG Cancer 2 Weeks (Breast) was not met in June 2016, with performance at 88.57% (8 patients). The Q1 position was also below target as a result, due to the small numbers concerned, with performance at 92.06%. Performance has been historically strong; however the position for June 2016 shows special cause variation with June 2016 performance falling outside of the process limits on the SPC chart. It was highlighted that 7 out of the 8 patients were patient choice that to be seen out of the 2 weeks.




Cancer – 62 Day (Standard) – Although the standard for 85% of patients to receive ‘first definite treat for cancer within 2 month (62 days)’ was met in June 2016 (86.49%), with variations in performance historically, the Q1 target was not met with performance at 80.65%. This was as a result of the target not being met in months 1 and 2. 52 weeks – there are two reported 52 week referral to treatment (RTT) breaches in June 2016, with one Birmingham patient declining treatment offered in London. MR informed the group of a meeting to discuss cancer targets is due to take place this afternoon. Care Programme Approach: 7 day follow up The target for 95% of patients on Care Programme Approach (CPA) to be followed up within seven days of discharge from Psychiatric inpatient care was met for BwD CCG in June 2016, at 100%, as well as for Q1, at 96.62% (Trust performance, 96.63%/95.75%). The CPA follow up target was not met for two Lancashire CCG areas in-month: Lancashire North at 90% (1 patient); and West Lancashire at 75% (1 patient). The target was not met at the end of Q1 for three CCG areas: Lancashire (92.96%); Greater Preston (92.86%); and Lancashire North (93.94%). Improving Access to Psychological Therapies Prevalence – The notional 1.25% monthly target for Improving Access to Psychological Therapies (IAPT) Prevalence was met for BwD CCG in June 2016 at 1.46% (Trust Performance, 1.26%). Recovery – The 50% recovery target was met for BwD CCG in June 2016, for the second month in succession with performance at 50.6% (Trust Performance 49.32%) Waiting Times – the standard for 75% of patients to enter treatment within 6 weeks was for BwD CCG in June 2016 at 93.81%, as well as for Q1 at 95.90% (Trust Performance 89.17%/88.96%). The standard for 95% of patients to enter treatment within 18 weeks was also met for BwD in-month at 100%, as well as for Q1 at 100% (Trust Performance 99.53%/99.14%). Early Interventions Psychosis The standard for 50% of patients experiencing a first episode of psychosis (EIP) to commence a NICE concordant package of care within 2 weeks of referral was met for BwD CCG in June, at 50% as well as for Q1, at 61.54% (Trust Performance, 86.70%/82.46%). The numbers are small and that is why this not looked at monthly. Memory Assessment Service The target for 70% of patients to be seen by the Memory Assessment Service (MAS) within 6 weeks was not met for BwD CCG in June 2016 at 30% or at Trust level at 40.11%. The number of patients waiting across Lancashire remains above the target of 500 with 890 patients (on date of meeting now moved to over 1000 with 7.4 weeks waiting time) on the Trust waiting list at the end of June




2016. NH asked how many people have been diagnosed with dementia; with the information not being available at that time, the question was unable to be answered. A three month review of Dementia Primary pathways and Shared Care Protocols has also commenced in Pennine Lancashire led by John McGrath to inform longer-term MAS service redesign. It is felt that something radically different needs to be done with the redesign as currently can’t cope with demand. Are we able to get benchmarking for other areas to help understand the better use of services? A&E 4 Hour The 95% 4 hour waiting time target for A&E was not met in June 2016 at East Lancashire Hospitals Trust (ELHT), with in-month performance at 85.4%. System leaders recognize the importance of recovery against the A&E 4 hour performance standard a scheduled meetings has been planned through the Pennine Lancashire System Resilience Group (SRG), with senior representation focused on the development and ownership of a system wide recovery plan to address the underperformance against the standard. MC responded that this may not be available as Memory Assessment Service varies across the country. However, this may form part of the ongoing review where available. Trolley Wait There were three 12 hour A&E breaches for complex mental health patients reported in June 2016 at ELHT. The Royal College of Psychiatry and Emergency Medicine are undertaking a review in October. Ambulance Handovers In June 2016 there were 329 handovers over 30 minutes, 73 handovers over 60 minutes and 198 missed handover stamps. Performance is linked directly to pressures within the Emergency Department. Time on Stroke Unit Performance against the local target for 80% of patients hasn’t been met for the last couple of months. Functional Independence Measure and Functional Assessment Measure (BwD): percentage of patients achieving an increase in a least 1 domain on the FIM/FAM at point of discharge (for those receiving active rehab) The Functional Independence Measure and Functional Assessment Measure (FIM+FAM) is a measure designed for measuring disability in the brain-injured (i.e. stroke patients). The percentage of patients achieving an increase on the FIM+FAM in at least 1 domain on discharge, for those receiving active rehab, within the BwD area, was 77% during Q1 of 2016/17 against a target of 95%. LCFT report this is due to 4 patients declined input and 3 deceased patients. Mrs Elaine Johnstone (EJ) queried the 3 deceased patients and MC confirmed that this was also raised at the Community Contract meeting, more information expected in future meetings. RESOLVED: The Committee noted the contents of the Quality, Performance




4.1.2

4.2

and Effectiveness Report for Month 3, June 2016. Focus Area MC updated the group on the Mental Health Services NICE Report explaining how the report provides an update on the NICE guidance published during quarter 4 2015-16 and gives details of the new guidelines published during quarter one 2016. MC asked the group if looking at these reports is worth continuing to the new Pennine Lancs Quality Committee meeting or whether providing the minutes of the LCFT A&P meeting would suffice as per audit recommendation. CONCLUSION: The group concluded that using the minutes from previous meetings would suffice. CCG Monthly Risk Register Mrs Claire Moir (CM) updated the group on the monthly risk management report. There are 9 operational risks and 7 strategic risks held on the register, which are reviewed weekly at the CCG’s Operational Delivery Group meeting and monthly by the Clinical Chief Officer and the Extended Executive Team meeting. The highest rated strategic risk held on the full CRR is C04.3 (20) Clinical Workforce Capacity. The Extended Executive Team last month has asked that 2013/02 (20) 4 hour A&E target be reviewed. Both Ms Elizabeth Flemming and Mr Alex Walker are working on this. Dr Chris Clayton has asked CM to look at static risks. Initial Health Assessments for Looked After Children 2015/03 are not being completed within 20 working days. ACTION: CM to pick up Initial Health Assessments for Looked After Children with Susan Clarke (SC) Though there are no new risks for inclusion on the CRR, there are however, two assessment forms in progress. No risks have been put forward from QPEC. ACTION: CM to follow up assessment forms CM confirmed that 62 Day Cancer has no change in the risk rating.

CM/SC

CM

BUSINESS ITEMS

5.

5.1

Healthwatch Blackburn with Darwen Snapshot of Local Services Dr Malcolm Ridgway updated the group on the Snapshot of Local Services paper. There is a new QOEST Scheme that is going to get into practices. The group considered the Healthwatch Report. A discussion was held around the format of the report and feedback was collated. The group suggested that getting feedback/comments both negative and positive along with stating which practice it refers to would be helpful. The group feels having a representative from Healthwatch to come and give more details on the project at another meeting




5.2

5.3

would be helpful. ACTION: Mrs Dorothy Ross (DR) sits on the Healthwatch panel and will ask about representation. Lancashire Procedures of Limited Clinical Value Mrs Samantha Jones updated the group on the Procedures of Limited Clinical Value: Policy Review. The purpose of the report is to provide an update in relation to the Pan Lancashire review of Procedures of Limited Clinical Value Policies for discussion and adoption by Blackburn with Darwen CCG. SJ informed the group that the review of the individual policies was underway when this piece of work was taken over. Members of the Pan Lancashire Commissioning Policy Group have undertaken a robust review of each procedural/treatment policy individually. The process has been that each Lancashire CCG will undertake a clinical review of their allocated policy in line with NICE guidance, best practice and use of the clinical evidence/effectiveness available. Drs Gunn, Black and Ridgway have looked at the policy for clinical oversight but feel that they need to go through a policy group as QPEC can review from a quality view only. The current policies have little financial impact and with further work being undertaken by the CCG. Guidelines are being pulled together on policies and visited practices that refer. This information will hopefully be available to see on EMIS (Egton Medical Information System), discussions currently taking place within localities at the moment. EJ commented that Dr Zaki Patel is reviewing the Planned Caesarean and Home Birth policy. Dr Geraint Jones (GJ) asked how we compare to other CCGs? It is felt that a full consultation is needed. ACTION: SJ to send the policies separately, electronically to the committee to review. CONCLUSION: The committee noted the contents of the report but felt that it wasn’t this group’s role to be sighted on these policies and that each area should have a clinical lead who can guide/advise on the policies. The committee advised to take the paper to the next Care Professionals Board as they felt to be the most relevant group. Quarterly Report Quality and Inclusion Mrs Catherine Bentley updated the group on the Equality and Inclusion Quarterly Report. The report provides Blackburn with Darwen Clinical Commissioning Group (CCG) Quality, Performance and Effectiveness Committee with an update on the equality and Inclusion (E&I) work that has been undertaken on behalf of the CCG by the E&I team in the last quarter. ACTION: Equality Inclusion strategy is on-going, CB to send out draft with papers for comment.

DR

SJ

CB




5.4

The EDS assessment for 2016 was supported by an Equality and Inclusion survey that was distributed to all staff by an email with a link to an electronic survey. With only 42% of staff completing the survey and with a poor response rate, the CCG are going to re-run the survey later on in the year after staff have had an opportunity to attend an Equality and Inclusion training session. Face to face training is preferred and being pushed by managers. The Workforce Race Equality Standard report for 2016 has been uploaded onto the CCGs website by the deadline of 31st July 2016. The WRES report has been sent to NHS England along with a link to the CCGs WTES page on the website. CB went through a number of Equality Impact and Risk Assessments highlighting the Prioritisation Policy that has been sent through to Mrs Samantha Jones for sign off and is expected back soon. The Risk Management Strategy has been signed off along with Community Equipment, though still waiting to see if stage 2 is needed. Under expected EIRAs the Decommission of Chronic Fatigue Syndrome Service currently showing as status requiring EIRA Stage 1, has been funded by Chorley and South Ribble since transfer to CCG. This is now not going to be funded by Chorley and South Ribble and currently work has not been undertaken. This needs to go to commissioners for a decision; it was recommended the Collaborative Commissioning Board may be able to help. CONCLUSION: The committee noted the contents of the Equality and Inclusion Quarterly report. CCG Annual Looked After Children Health Report Mrs Sheila Morris and Mrs Susan Clarke updated the committee on the CCG Annual Looked After Children Health Report. This is the 2015-2016 Blackburn with Darwen CCG report in relation to Looked After Children (LAC) produced in partnership with Lancashire Care Foundation Trust (LCFT), East Lancashire Hospital Trust (ELHT) and Public Health (PH); the report covers the period from 1 April 2015 to 31 March 2016. The purpose of the report is to inform the reader and five assurances that the CCG are meeting their statutory requirements in commissioning services for looked after children that are safe, effective, caring, responsive and well-lead within Blackburn with Darwen (BwD). All targets and strategy guidelines are being achieved. Discussions are on-going around doctor capacity as consultants are struggling with capacity to deliver assessments. The paper is going to the Corporate Parenting Advisory (CPA) Group after being seen by QPEC. It was highlighted that Electronic Care Records should be taken off before going to the CPA Board. SM commented that the narrative in section 14 has been written in the least challenging way. CONCLUSION: The committee noted the contents of the CCG Annual Looked After Children Health Report.

AOB

6. Louise Williamson (LW) familiarised the group on her role within Quality and Performance - monitoring quality data for the Care Home Sector from a clinical perspective. LW presented a report on Continuing Health Care and Independent Sector Mental Health, Quarter One, April to June 2016. The report provides the position at quarter 1 for services commissioned under the Framework Agreement




for the provision of Social, Personal and Nursing Care for Adults within a residential setting and the Independent Sector Mental Health Framework (ISMH) managed by Midlands and Lancashire Commissioning Support Unit (CSU) on behalf of Blackburn with Darwen Clinical Commissioning Group (CCG). The Quest4Care (Q4C) pilot continues and there are now 20 nursing providers taking part in the pilot which began in March 2016. Q4C is a web based data collection tool currently being piloted by nursing providers within Chorley and South Ribble, Greater Preston and East Lancashire CCG’s, along with residential providers from Lancashire County Council. Janet Barnsley is helping with this project. Looking at the level of information provided it is showing that no serious incidents have been reported in the last 3 / 4 months. This needs to be looked into as this level of data is self-reporting. The information that has been collected is helping in identifying where homes need additional help/support. ACTION: LW to send report to Mrs Natalie Koncsol (NK) to circulate to the committee. ACTION: Mrs Elaine Johnstone (EJ) and MC to link in with LW to help with the co-ordination of work and ensure that work is duplicated by different departments/people. CONCLUSION: The Committee thanked LW for providing the update around the Quality and Performance Report for Continuing Health Care and Independent Sector Mental Health.

LW/NK

EJ/MC

DATE AND TIME OF NEXT MEETING Info

7. The next meeting is the new Pennine Lancashire Quality Committee, 28th September 2016, 13:00 – 16:00 in Meeting Room 1 at Walshaw House

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Appendix 3

CLINICAL COMMISSIONING GROUP (CCG) Minutes of the Remuneration Committee Meeting held on

Wednesday 4th May 2016 at 4 pm in Rooms 1 and 2, Blackburn Central Library,

Town Hall Street, Blackburn, BB2 1AG

PRESENT: Mr Graham Burgess Chair (Chair) Mr Paul Hinnigan Lay Member – Governance

Mrs Anne Asher Lay Member - Nurse Representative on the Governing Body Dr Nigel Horsfield Lay Member - Secondary Care Doctor on the Governing Body IN ATTENDANCE:

Mr Roger Parr Chief Finance Officer Dr Chris Clayton Clinical Chief Officer Mrs Jacquie Allan Business Administration Manager (Minutes – transcribed by Mrs

Pauline Milligan, Corporate Support Officer) Min No:

16.001 Chair’s Welcome The Chair welcomed everyone to the meeting of the Clinical Commissioning Group’s (CCG’s) Remuneration Committee.

16.002 Apologies for Absence and Confirmation of Quoracy There were no apologies. The meeting was confirmed as quorate.

16.003 Review of Terms of Reference The Chair presented the Terms of Reference (ToR) for review. Mr Roger Parr suggested that section 5 – Membership was amended to read that “the Committee shall comprise the CCG Governing Body Chair and all Lay Members”, rather than listing the Lay Members by title. This was agreed. Mr Paul Hinnigan suggested that the last sentence of section 1 – Purpose of the Committee was removed. This was agreed Dr Chris Clayton added that the wording of the whole section should be clarified. Mr Hinnigan suggested that there should be consistency in the wording of sections 1 and 2 regarding the remuneration of the CCG’s staff groups. ACTION: Mr Roger Parr to oversee the rewording of sections 1 and 2 of the ToR to reflect discussions and clarify the Remuneration Committee’s delegated authority to determine the remuneration levels for the CCG’s various staff groups. RESOLVED: That the Remuneration Committee approved the ToR; subject to the suggested amendments being made and clarification of its delegated authority.

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16.004 Minutes of the Meeting on 1st April 2015 The minutes of the meeting were considered and accepted as an accurate record. RESOLVED: That the Minutes of the Meeting held on 1st April 2015 were approved as a correct record.

16.005

Matters Arising There were no matters arising.

16.006

2016/17 Pay Award for Non-Agenda for Change Staff Mr Roger Parr presented the report and explained that the Government had accepted recommendations from the independent pay review bodies that all NHS staff groups under Agenda for Change be awarded a 1% consolidated pay increase with effect from April 2016. Mr Parr requested that members consider the approach for non-Agenda for Change staff who work for the CCG. Mr Parr drew members’ attention to section 2 of the report which listed all the staff groups affected, i.e. all those subject to local pay scales, and highlighted the cost to the CCG of awarding a 1% increase to those staff groups, which amounted to £6,880 per annum. Mr Parr recommended that the pay award should be consistent across all groups. Questions and answers followed. The Chair stated that the two final groups of staff could not be agreed by the Remuneration Committee, as they involved the Lay Members. Dr Chris Clayton declared a conflict of interest at this point as he was a member of the first staff group. He left the meeting and did not take part in the discussion or decision. The Chair proposed that a 1% increase was offered to the first three staff groups namely; the Clinical Chief Officer and Director of Quality and Primary Care Development; Executive General Practitioners and Clinical Leads. This was agreed by all members. RESOLVED: That the members of the Remuneration Committee agreed to a 1% increase to the three staff groups namely; Clinical Chief Officer and Director of Quality and Primary Care Development; Executive General Practitioners and Clinical Leads. Dr Clayton returned to the meeting. Mr Parr proposed that those present discussed the proposal for the two final groups of staff, which involved the Lay Members and made a recommendation for the Governing Body to approve. This was agreed by all members. The Chair and Lay Members declared a conflict of interest at this point as they were members of the two final groups of staff. They left the meeting and did not take part in the discussion or decision. Dr Clayton proposed that a 1% increase was offered to the final two staff groups namely; the Chair and Lay Members. This was agreed by Mr Parr. It was agreed that the proposal would be recommended to the Governing Body for approval.

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The Chair and Lay Members returned to the meeting.

16.007 Any Other Business Lay Member Remuneration Dr Clayton raised a point related to Lay Member remuneration and the potential future inequity of remuneration amongst the members. He informed the meeting that he planned to produce a paper for discussion under Part 2 of the Governing Body meeting in June.

16.008 Date and Time of Next Meeting To be scheduled as necessary.

1 Commissioning Business Group Minutes 10 August 2016

Minutes of the Commissioning Business Group (CBG) Meeting Wednesday 10th August 1.00 – 3.30 p.m. Faraday Suite, Evolution Park

Present Dr John Randall (JR)

Dr Malcolm Ridgway (MR) Dr Chris Clayton (CC) Dr Geriant Jones (GJ) Mr Paul Hinnigan (PH) Mrs Debbie Nixon (DN) Dr Adam Black (AB) Dr Preeti Shukla (PS) Mr R Parr (RP) Dr Penny Morris (PM)

General Practitioner – Chair Clinical Director for Primary Care & Quality Clinical Chief Officer Lay Member – Secondary Care Doctor (Retired) Lay Member - Governance Chief Operating Officer General Practitioner Executive Member General Practitioner Executive Member Chief Finance Officer General Practitioner Executive Member

In Attendance Mr Neil Holt (NH)

Miss Claire Jackson (CJ) Mrs Elaine Johnstone (EJ) Ms Jacquie Allan (JA) Mrs Samantha Jones (SJ)

Head of Commissioning Performance Programme Director for Integrated Commissioning MLSCU Service Director Business Administration Manager Senior Commissioning Manager – Scheduled Care

Item Point Action 07/16/01 Apologies for Absence

The Chair welcomed Dr Geraint Jones as a new member to CBG colleagues. Apologies for absence had been received in respect of Dr Preeti Shukla General Practitioner (GP) Executive Member and Mr Roger Parr, Chief Finance Officer. It was noted that Dr Zaki Patel would join the meeting at 2.00pm and Dr Penny Morris would have to leave the meeting at 2.45pm. The meeting was confirmed as quorate.

07/16/02 Declarations of Interest & Confirmation of Quoracy The Chair asked members if they would like to declare any conflicts of interest relating to items on the agenda. The Chair reminded those present that if, during the course of discussion, a conflict of interest became apparent, it should be declared at that point. CONCLUSION:

1. Generic conflict of interest from GP’s in attendance for Item 08/16/07 in relation to the Minor Surgery Local Improvement Scheme and the audit recommendations which had been reviewed.

2. Item 8.16.08 East Lancashire Medical Services – Acute Visiting Service Options Appraisal: This was removed from the 10th August 2016 CBG agenda, as the item was a direct conflict of

Info


interest to the group and an extraordinary Governing Body Meeting of the Non GP’s and Lay Members was to be arranged.

The Chair reminded attendees that members can be part of the discussions for these items but if any decisions are to be made they must leave the meeting

07/16/03 Minutes of the Previous Meeting The minutes of the previous meeting were reviewed and were accepted as true and accurate.

JA

07/16/04 Matters Arising - Action Matrix The action matrix was reviewed and updated as required. Item 7.16.06: Rightcare Update – MSK – BMI Data : Dr Chris Clayton asked for the Executive Team to carry out a full review of the information provided. Mrs Debbie Nixon to forward MSK policy.

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07/16/05 Declaration of Any Other Business No Any Other Business was declared.

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Standing Item 07/16/06

Rightcare/QIPP Update – Mr Neil Holt did his regular monthly update on Right Care / QIPP to CBG. Mr Neil Holt asked the CBG to note two particular priority areas identified in the Rightcare report.

• Circulation • Respiratory

There are still other areas to scope, and we are currently picking up the 3 high priority areas which will have the main affect to get the maximum impact to close the gap. The BMI data back injections, were discussed and it was noted that a poor response had been received by the CCG on 9th August 2016 as such this was being taken to a contract meeting on the 11th August 2016. A new policy is currently being written with local clinicians and public engagement will be undertaken through the MLCSU and Hilary Fordham. Final agreement will be taken through the Collaborative Commissioning Board (CCB) as part of the Lancashire Commissioning Plan. A full detailed presentation will be given in September highlighting the Challenge – we were are now and were we will be in March 2017. From December 2016 we will be moving to two year contracts.

CONCLUSION: The Operational Group are meeting weekly to discuss the QIPP Gap, the schemes and what can be achieved, and these will be presented at CBG in September 2016

NH


For Decision

08/16/07

Minor Surgery Local Improvement Scheme A generic conflict of interest was raised by the GP’s present, and it was agreed they could join in the discussions. Dr Adam Black and Mrs Samantha Jones (SJ) presented the paper which outlined the changes and improvements to the Minor Surgery LIS contract for 2016/17 in response to the recent audit recommendations. The Scheduled Care team undertook a review of the minor surgery activity and scheme as part of the service redesign of Dermatology Services. This highlighted some inconsistencies in the activity levels and tariffs claimed by different practices as part of the Local Improvement Service (LIS) 2 contract. Mersey internal Audit Agency (MIAA) were asked to review the current procedures and their advice was to change the current LIS Contract. The MIAA concentrated on three areas, LIS payment arrangements, contractual rules and CCG Authorisation process and 7 recommendations were made, which required input and support from the CCG and MLSCU support teams. Mrs Samantha Jones had already met with the 5 Minor Surgery GP Practices and discussed the changes. A discussion took place regarding cost saving and the service specifications, and referrals, which included skill mixes, using nurses to carry out minor procedures and GPs doing their own injections, and all agreed that the next phase of Mini Surgery review should be undertaken. Conclusion: CBG noted the content of the report and accepted the recommendations from the MIAA.

Info

08/16/08

Lancashire and South Cumbria Change Programme (LSCCP)– Case for Change: Mrs Debbie Nixon presented the draft version of the Case for Change version 3 to CBG. In connection with the Sustainability and Transformation Plan (STP) this is being written for NHS England, but an abbreviated version will go into the public domain. CBG noted areas which were very light, had been written by Public Health and had grammar and spelling errors which were noted for feedback. A number of workshops were taking place and the STP was now moving at speed within LSCCP. Mrs Debbie Nixon was asked to confirm timescales and deadlines and feedback to CBG. ACTION: LSCCP / STP is to be a standing agenda item on CBG


For Information 08/16/09 Investments Schedule

The investment schedule had not been circulated with the papers.

08/16/10 East Lancashire Medicines Management Board Minutes

Date and Time of Next Meeting – Wednesday 14th September 2016, 1 p.m. Faraday Suite, Evolution Park, Blackburn. The Chair thanked everyone for their attendance and the meeting closed.

Info

1 Commissioning Business Group Minutes 13th July 2016

Minutes of the Commissioning Business Group (CBG) Meeting Wednesday 14th September 2016 1.00 – 3.30 p.m.

Faraday Suite, Evolution Park, Haslingden Road, Blackburn BB1 2FD Present Dr John Randall (JR)

Dr Malcolm Ridgway (MR) Dr Chris Clayton (CC) Mrs Debbie Nixon (DN) Dr Adam Black (AB) Dr Preeti Shukla (PS) Dr Zaki Patel Mr R Parr (RP)

General Practitioner – Chair Clinical Director for Primary Care & Quality Clinical Chief Officer Chief Operating Officer General Practitioner Executive Member General Practitioner Executive Member General Practitioner Executive Member Chief Finance Officer

In Attendance Mr Neil Holt (NH)

Miss Claire Jackson (CJ) Mr Alex Walker Ms Jacquie Allan (JA) Mrs Samantha Jones (SJ) Mrs Lucie Higham Mrs Julie Kenyon Mr Paul Hopley Mr Peter Sellars Mrs Lisa Kiernan

Head of Commissioning Performance Programme Director for Integrated Commissioning Programme Director for Urgent Care Business Administration Manager Senior Commissioning Manager – Scheduled Care Communications Manager Senior Operating Office Primary Care and Medicines Deputy Executive Nurse - Mental Health and Quality Primary Care Transformation Lead Head of Primary Care and Integrated Community Services

Item Point Action 09/16/01 Apologies for Absence

Apologies for absence had been received in respect of Dr Penny Morris General Practitioner (GP) Executive Member and Mr Paul Hinnigan, Lay Member Governance.

09/16/02 Declarations of Interest & Confirmation of Quoracy The Chair asked members if they would like to declare any conflicts of interest relating to items on the agenda. The Chair reminded those present that if, during the course of discussion, a conflict of interest became apparent, it should be declared at that point. It was noted that Dr Geraint Jones was not in attendance and therefore the meeting was not quorate. The agenda was reviewed and it was agreed that Chairs Action would be taken for any decisions required.

Info

09/16/03 Minutes of the Previous Meeting The minutes of the previous meeting were reviewed and were accepted as true and accurate.

JA

09/16/04 Matters Arising - Action Matrix


The action matrix was reviewed and updated as required. As per the review completed by the Audit Committee, the members reviewed the new format for the Matrix and agreed the changes made.

Info

09/16/05 Declaration of Any Other Business No Any Other Business was declared.

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Standing Item 09/16/06

Rightcare/QIPP Update – Mr Neil Holt did his regular monthly update on Right Care / QIPP to CBG. Mr Neil Holt asked the CBG to note three areas identified.

• Medicines Waste • Rightcare Variations • The Red Box Gap

There are still other areas to scope, and we are currently picking up the 3 high priority areas which will have the maximum impact to close the gap. The issue of the Red Box Gap is being cascaded through correspondences by Dr Chris Clayton to the members. It was agreed if the members understood the nature of the challenge faced by the CCG that they would be more supportive and therefore this should also be an agenda item on Hot Topic Events, Senate and Locality Meetings.

CONCLUSION: The Operational Group continue to meet weekly to discuss the QIPP Gap, the schemes and what can be achieved, and these are reviewed weekly through the Executive Team Meeting.

NH

For Decision

09/16/07

Commissioning Intentions Mr Neil Holt presented BwD CCG Commissioning Intentions, which have to be signed off and submitted to NHS England. These have to be aligned to the Local Delivery Plans (LDP) and Sustainability Transformation Plans (STPs). The ongoing financial pressures were discussed and the wider system shift. It was noted that the real challenge was to the scale and pace of change requested from the system. Each of the individual areas were discussed by the Programme Directors, including:

• Primary Care • Integration • Children and Young People • Scheduled Care • Mental Health • Safeguarding

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Conclusion: CBG noted the content of the presentation and accepted the recommendations and supported the work completed by the team.

09/16/08

Lancashire and South Cumbria Change Programme (LSCCP) – Update Mrs Debbie Nixon gave a brief verbal update on the STP submissions from the LSCCP. As requested at the previous CBG, Mrs Debbie Nixon confirmed that the draft submission was 16th September 2016, with the final draft submission being 6th October 2016 and the full narrative being completed by 30th October 2016. ACTION: LSCCP / STP is to be a standing agenda item on CBG

09/16/09 Community Equipment Service (CES) – Long Term Provision Mrs Lisa Kiernan presented the paper on Dr Penny Morris’s behalf. In May 2016 Blackburn with Darwen Clinical Commissioning Group (CCG) and Blackburn with Darwen Borough Council (BwDBC) undertook a procurement exercise to appoint a short term stability partner to deliver CES in the short term to ensure continuity of service provision. Medequip were the only providers who submitted a tender and were subsequently appointed to deliver the service. Medequip are the appointed providers of the CES for the rest of Lancashire and therefore Blackburn with Darwen had the advantage of being able to use Midlands and Lancashire Commissioning Support Unit (MLCSU) contracting and procurement support to ensure the service replicates the wider Lancashire offer. The stability partner has been appointed on 6 month contract with effect from 1 June 2016 with the option to extend on a month by month basis for up to a further 6 months. The specification and timescales for the procurement of a permanent partner were discussed and CBG were asked to support the specification for the tender process. ACTION: CBG agreed the Specification

09/16/10 Terms of Reference (TORs) Dr Randall presented the TORs and asked CBG to agree the amendments to the change in Chair and addition of Deputy Chair. It was agreed that Dr Adam Black would become Deputy Chair. The TORs will be presented at April 2017 CBG for agreement. RESOLVED: The CBG agreed the changes to the TOR.

For Information 08/16/09 Investments Schedule


The investment schedule had not been circulated with the papers.

08/16/10 East Lancashire Medicines Management Board Minutes Noted

Date and Time of Next Meeting – Wednesday 12th October 2016, 1 p.m. Faraday Suite, Evolution Park, Blackburn. The Chair thanked everyone for their attendance and the meeting closed.

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