PART I AGENDA · James Wigg and Queens Crescent Practices Yes Yes No Direct GP Partner 15/11/2016...

Meeting in Public of the Camden CCG Governing Body Wednesday 17 January 2018 14:000-16.30

PART I AGENDA

Item Title Presenter Action Paper Time Page

1. Introduction

1.1 Apologies for Absence Dr Neel Gupta Note Verbal 14:00 -

1.2 Declarations of Interest Dr Neel Gupta Note 1.2 14:01 1

1.3 Declarations of Gifts and Hospitality Dr Neel Gupta Note 1.3 14:03 -

1.4 Minutes of the Previous Meeting Dr Neel Gupta Approve 1.4 14:05 5

1.5 Action Log

Dr Neel Gupta Note 1.5 14:10 17

2. Chair, Accountable Officer, Patient and Quality Reports

2.1 Chair’s Report

Dr Neel Gupta Note 2.1 14:15 19

2.2 Accountable Officer’s Report Helen Pettersen

Note 2.2 14:20 23

2.3 The Patient Voice Report

Kathy Elliott Note 2.3 14:25 27

2.4 Quality and Clinical Effectiveness Report

Jane Davis Note 2.4 14:35 35

3. Strategy

3.1 Proposal to take in-house a range of Commissioning Support Unit Services

Paul Sinden Approve 3.1 14.40 43

4. Finance and Performance

4.1 Finance and QIPP Report

Simon Goodwin

Note 4.1 14.55 51

4.2 Performance Report Charlotte Mullins

Note 4.2 15.05 61

5. Governance

5.1 Board Assurance Framework Richard Strang Note 5.1 15.15 83

5.2 Audit Committee in Common Simon Goodwin

Approve 5.2 15.25 95

6. Committee Reports – For information

6.1 Finance, Performance and QIPP Committee

Dr Birgit Curtis Note 6.1 15.40 117

6.2 Integrated Commissioning Committee

Dr Matthew Clark

Note 6.2 15.50 123

6.3 Localities Report

Dr Jonathan Levy

Note 6.3 16.00 127

6.4 Procurement Committee Kathy Elliott

Note 6.4 16.10 131

6.5 NCL Primary Care in Common Committee

Paul Sinden Note 6.5 16.20 133

7. Any other Business

7.1 Draft Agenda 14 March 2018 Meeting Dr Neel Gupta Note 7.1 16:25 137

8. Questions from the Public Verbal 16:25 -

Members of the public have the opportunity to ask questions. These must relate to items that are on the agenda for this meeting and should take no longer than three minutes per person.

9. Date of Next Meeting: 14 March 2018

REGISTER OF INTERESTS A register of members’ interests is available on the Camden CCG website

http://www.camdenccg.nhs.uk

A conflict of interest is defined as “a set of circumstances by which a reasonable person would consider

that an individual’s ability to apply judgement or act, in the context of delivering, commissioning, or assuring taxpayer funded health and care services is, or could be, impaired or influenced by another

interest they hold”.

Managing conflicts of interests in the NHS: Guidance for staff and organisations 2017.

Camden Clinical Commissioning Group Governing Body Members' Register of Interests 2017/18

Declared From Updated

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Swiss Cottage Surgery Yes Yes No Direct Owner and GP Partner 16/12/2016 01/07/2007 13/6/2017Haverstock Healthcare Ltd Yes Yes No Direct Swiss Cottage Surgery is a shareholder 16/12/2016 01/07/2007 13/6/2017Swiss Cottage Private General Practice Yes Yes No Direct Owner and Shareholder 16/12/2016 01/01/2016 13/6/2017CHE Neighbourhood Yes Yes No Direct Swiss Cottage Surgery is affiliated to this neighbourhood 16/12/2016 01/08/2016 13/6/2017Cadence Minerals PLC Yes No No Direct Shareholder 16/12/2016 01/07/2014 13/6/2017Docmartin Residential Yes No No Direct Owner shareholder of property investment company 18/02/2017 13/6/2017Children's Trust Partnership No Yes No Indirect CCG Representative 16/12/2016 01/07/2014 13/6/2017North Camden Zone No Yes No Indirect CCG Representative 16/12/2016 01/07/2015 13/6/2017Camden Youth Foundation No Yes No Indirect CCG Representative 16/12/2016 01/08/2016 13/6/2017Central Health Evolution Limited Yes Yes No Direct Shareholder and Founding Member 22/03/2017 13/6/2017Hampstead Group Practice Yes Yes No Direct Nurse Practitioner 18/07/2017Haverstock Healthcare Limited Yes Yes No Direct Works at out of hours hub at weekend 18/07/2017Camden LMC No Yes No Direct Practice Nurse Representative, Not voting, observer role 18/07/2017Royal College of Nursing No Yes No Direct Member 18/07/2017City University Yes Yes No Direct Honourary lecturer for nursing and midwifery 29/09/2017West Hampstead Medical Centre Yes Yes No Direct GP Partner 14/12/2016 01/11/2012 05/07/2017Haverstock Healthcare Ltd Yes Yes No Direct West Hampstead Medical Centre is a shareholder 14/12/2016 01/11/2012 05/07/2017KCA Architects No No Yes Indirect Company Secretary and husband is a Director 14/12/2016 01/01/1998 05/07/2017Central Health Evolution Limited Yes Yes No Direct Shareholder 22/03/2017 05/07/2017Prince of Wales Group Practice Yes Yes No Direct Practice Manager 13/12/2016 12/06/2017SanKtus Welfare Project - Welfare Charity No No Yes Direct Treasurer 13/12/2016 12/06/2017

Dr Neel Gupta Elected GP and GB Chair The Keats Group Practice Yes Yes No Direct Salaried Employee 15/11/2016 01/08/2011 14/8/2017

James Wigg and Queens Crescent Practices Yes Yes No Direct GP Partner 15/11/2016 01/09/2015 12/06/2017Haverstock Healthcare Ltd Yes Yes No Direct Shareholder in GP Federation 15/11/2016 01/09/2015 12/06/2017Hampstead Group Partner Yes Yes No Direct Partner 29/11/2016 14/06/2017Haverstock Healthcare Ltd Yes Yes No Direct Shareholder in GP Federation 29/11/2016 14/06/2017CCAS Assessor Yes Yes No Direct GP Assessor 29/11/2016 14/06/2017Bloomsbury Surgery Yes Yes No Direct GP Partner 13/06/2017 13/06/2017Haverstock Healthcare Ltd Yes Yes No Direct GP Practice is a Member 13/06/2017 13/06/2017Central Health Evolution Limited Yes Yes No Direct GP Practice is a Member 13/06/2017 13/06/2017CCAS Assessor Yes Yes No Direct 2-4 sessions per month 13/06/2017 23/8/2017

Parliament Hill Medical Centre Yes Yes No DirectSalaried Employee. The partners at Parliament Hill Medical Centre are shareholders of Haverstock Health. 11/07/2017

Care UK, HMP Pentonville Yes Yes No Direct Salaried GP (1 day per week) 11/07/2017

Public Health England No No Yes IndirectPartner, Mr Peter Graham is a civil servant and works at Public Health England as a partnership marketing manager. 11/07/2017

Charlotte Cooley

Dr Philip Taylor Elected GP Representative

Dr Martin Abbas Elected GP Representative

Dr Birgit Curtis Elected GP Representative

Elected GP Representative

Elected Practice Nurse

Elected Voting Members

Jonathan Duffy Elected Practice Manager

Dr Jonathan Levy Elected GP Representative

Dr Sarah Morgan

Dr Kevan Ritchie Elected GP Representative

Nature of InterestDeclared Interest- (Name of the

organisation and nature of business)Name

Position (s) held- i.e. Governing

Body, Member practice,

Employee or other

Date of InterestType of Interest

Is the interest

direct or

indirect?

1


Director of Public Health Camden and IslingtonYes Yes No Direct Salaried Employee 15/11/2016 01/02/2013 12/06/2017Vice-chair of London Association of Directors of Public Health No Yes No Direct 15/11/2016 01/01/2014 12/06/2017Lewisham and Greenwich NHS Trust Yes Yes No Direct Paediatric Registrar 15/11/2016 01/03/2013 12/06/2017Welbodi Partnership - registered UK Charity No No Yes Direct Board Member 15/11/2016 08/08/2008 12/06/2017

Kings College London No No No Indirect

Wife is a research fellow which is funded by the NHS National Institute of Health Research and Tommy's Charitable Trust 15/11/2016 01/10/2014 12/06/2017

Nursing and Midwifery Council No Yes No Direct Registrant Panellist for the Conduct and Competence Panels 16/11/2016 01/02/2013 12/06/2017The Order of St John Priory Group for Greater London No No Yes Direct Member 29/03/2017 12/06/2017Caversham Group Practice No Yes No Direct Member of the Patient Participation Group 12/12/2016 13/06/2017Kaeconsulting - independent consultancy Yes No No Direct Owner/Director 12/12/2016 13/06/2017UK Public Health Register (UKPHR) No Yes No Direct Assessor and Chair of the Registration Panel 12/12/2016 13/06/2017Faculty of Public Health No Yes No Direct Member 12/12/2016 13/06/2017PHAST - public health consultancy No Yes No Direct Associate 12/12/2016 13/06/2017

Simon Goodwin Chief Finance Officer, NCL CCGs East London NHS Foundation Trust Yes No No Indirect Wife is a senior manager 14/06/2017 14/06/2017

Helen PettersenAccountable Officer, NCL CCGs and NCL STP Convenor No declared interests Nil return 05/04/2017

Richard Strang Lay Member Tavistock and Portman NHS Foundation Trust No Yes Yes Direct Former Non-Executive Director 31/07/2017

Young Foundation Yes Yes No Direct Chief Executive Officer 09/08/2017

Member of the House of Lords Yes Yes No DirectBaroness Thornton - Labour and Co-operative Member From 1.11.2017: Opposition spokesperson for Health 09/08/2017 23/07/1998 1/11/2017

London School of Economics No Yes Yes Direct Emeritus Governor 09/08/2017

Social Enterprise UK No Yes Yes Direct Patron 09/08/2017

Healthcare and Assistive Technology Society No Yes Yes Direct Chair of the Advisory Panel and Patron 09/08/2017

Cabinet Member for Health and Adult Social Care Yes Yes No Direct Councillor, Camden Borough Council 02/10/2017St Michael's Primary School No Yes No Direct Governor of St Michael's Primary School 02/10.2017Unison No Yes No Direct Union Member 02/10/2017Camden LMC No Yes No Direct Chair 20/09/2016 18/06/2017

Camden, Barnet and Brent GP Practices Yes Yes No DirectLocum GP working across multiple GP practices and GP Appraiser (paid work) 18/01/2017 18/06/2017

Medical Women's Federation No Yes No Direct Trustee - unpaid 18/01/2017 18/06/2017UK General Practitioners Committee Yes Yes No Direct Elected Member - paid honoraria for attendance 18/01/2017 18/06/2017

NHS Digital Yes Yes No Indirect

Husband is a member of an advisory panel for e-Consult and is currently seconded to NHS Digital as a national medical director clinical fellow 18/01/2017 18/06/2017

Pulse Live Conferences Yes Yes No Direct Speaker - paid honoraria 18/01/2017 18/06/2017

Medical Student OSCE examiner Yes Yes No Direct Paid for work completed 18/01/2017 18/06/2017

Simone Hensby Voluntary Sector Representative Voluntary Action Camden Yes Yes No Direct Executive Director 19/12/2016 18/06/2017

Glenys Thornton Lay Member

Dr Farah Jameel LMC Observer

Patricia Callaghan Health and Wellbeing Board Observer

Lay Member

Jane Davis OBE Registered Nurse

Non-Voting Members

Appointed Voting Members

Julie Billett Public Health Representative

Dr Mathew Clark Secondary Care Doctor

Kathy Elliott

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Camden Patient & Public Engagement Group No Yes Yes Direct Chair 16/08/2017 14/08/2017

Adelaide Medical Centre No Yes Yes Direct Chair of Patient Participation Group 16/08/2017

Universal Offer Delivery Group No Yes Yes Direct CPPEG Patient Representative 27/09/2017London Borough of Camden Yes Yes No Direct Director of Integrated Commissioning 23/11/2016 13/06/2017Camden Schools Project Ltd Yes Yes No Direct Director 23/11/2016 13/06/2017Camden BSF SPV Ltd Yes Yes No Direct Director 23/11/2016 13/06/2017Camden SPV Holdings Ltd Yes Yes No Direct Director 23/11/2016 13/06/2017Camden Healthwatch No Yes No Direct Chair 29/06/2017 12/07/2017Chomley Garden Surgery Practice No Yes No Direct Patient Participation Group Representative 06/01/2016 12/07/2017UK National Thalassemia and Sickle Cell Group (NHS England) No Yes No Direct Lay Member 06/01/2016 12/07/2017Ambassador Little Village Charity No No Yes Direct 12/07/2017 12/07/2017Camden Reach Pregnancy Project Yes Yes No Direct Project Coordinator 12/07/2017 12/07/2017London Antenatal Screening Programme No Yes No Direct Lay Member representative 12/07/2017 12/07/2017

Rebecca Booker Deputy Chief Finance Officer No interests declared Nil return 18/10/2017Mike Cooke Chief Executive No interests declared Nil return 21/11/2016 28/06/2017Sally MacKinnon Transformation Programme Director Change the Record Management Consultancy No No Yes Indirect Executive Director. Company owned by husband David

MacKinnon 25/11/2016 01/10/2014 20/06/2017Sarah Mansuralli Chief Operating Officer No interests declared Nil return 12/06/2017 12/06/2017Charlotte Mullins Director of Sustainable Insights No interests declared Nil return 28/11/2016 13/06/2017Trevor Myers Interim Director of Commissioning

and ContractingGoosegate Consultancy Ltd Yes Yes No Direct Director

04/09/2017Ian Porter Director of Corporate Services No interests declared Nil return 14/11/2016 16/06/2017Neeshma Shah Director of Quality and Clinical

EffectivenessIndependent consultant Yes Yes No Direct Occasional ad hoc consultancy work on sole trader basis on

subject matter relating to medicine, the pharmacy profession and the health and social care landscape 25/11/2016 24/04/2013 18/06/2017

Attendees

Saloni Thakrar Healthwatch Representative

Richard Lewin Local Authority Representative

Patient RepresentativeHilary Lance

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Agenda Item 1.4

CAMDEN CLINICAL COMMISSIONING GROUP GOVERNING BODY

Minutes of the Part 1 Meeting held on Wednesday, 8 November 2017

Camden Town Hall, Judd Street, WC1H 9JE

Present: Elected Voting Members: Dr Neel Gupta Chair Dr Martin Abbas Elected GP Representative Charlotte Cooley Elected Practice Nurse Dr Birgit Curtis Elected GP Representative Dr Jonathan Duffy Elected Practice Manager Dr Jonathan Levy Elected GP Representative Dr Sarah Morgan Elected GP Representative Dr Kevan Ritchie Elected GP Representative Dr Philip Taylor Elected GP Representative Appointed Voting Members: Julie Billett Director Of Public Health, Camden and Islington LBCs Dr Matthew Clark Secondary Care Doctor Jane Davis, OBE Registered Nurse Kathy Elliott Lay Member Simon Goodwin Chief Finance Officer, NCL CCGs Helen Pettersen Accountable Officer, NCL CCGs Richard Strang Lay Member Glenys Thornton Lay Member Non-Voting Members: Simone Hensby Voluntary Sector Representative Dilini Kalupahana LMC Observer Hilary Lance Patient Representative Richard Lewin Local Authority Representative, London Borough of Camden (LBC) Saloni Thakrar Healthwatch Representative In Attendance: Matthew Black Commissioning Manager, Camden CCG (item 3.2) Rebecca Booker Deputy Chief Finance Officer, Camden CCG Vikki Gray Designated Nurse Safeguarding Adults, Camden CCG (item 5.2) Jane Lindo Deputy Programme Director Primary Care, Healthy London Partnership (item 3.1) Tyrieana Long Board Secretary, Camden CCG Sally MacKinnon Transformation Programme Director, Camden CCG Sarah Mansuralli Chief Operating Officer, Camden CCG Charlotte Mullins Director of Sustainable Insights Partnerships, Camden CCG Trevor Myers Interim Director of Commissioning and Contracting, Camden CCG Martin Pratt Executive Director of Supporting People, LBC (until 14:30) John Sheedy Programme Support, Healthy London Partnership (item 3.1)

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Agenda Item 1.4

1. Introduction

1.1 Welcome and Apologies for Absence 1.1.1 The Chair welcomed and introduced Rebecca Booker, Dilini Kalupahana and Martin Pratt

who were attending the meeting for the first time. 1.1.2 Apologies were received from Councillor Patricia Callaghan, Mike Cooke and Ian Porter. 1.2 Declaration of Interests 1.2.1 Dr Martin Abbas confirmed that he was a CCG representative at the Camden Youth

Foundation. There no further new declarations of interest. 1.3 Declarations of Gifts and Hospitality 1.3.1 There were no declarations of gifts or hospitality. 1.4 Minutes of the meeting held on 13 September 2017 1.4.1 The Governing Body considered the minutes of the meeting held on 13 September 2017 and

no points of accuracy were made. 1.4.2 The Governing Body agreed that the minutes of the meeting held on 13 September

2017 were a true record. 1.5 Action Log 1.5.1 The Governing Body considered the updates on the actions arising from the previous

meeting. 1.5.2 With regard to the second action point, it was noted that the meeting of the Primary Care

Transformation Group had not been held on 1 November 2017 as planned. Instead, a voluntary sector engagement event on neighbourhoods, or appropriate alternative engagement activity will be delivered in early 2018 when 2018/19 plans are available for discussion. Richard Lewin requested that the Local Authority was also invited to the neighbourhood engagement event in view of their joint commissioning work with the CCG.

1.5.3 It was noted that the information on this year’s flu vaccine as described in the update for

action point six had been added to the CCG’s website. 1.5.4 With regard to action point eight, Saloni Thakrar requested further details on the

improvements that had been put in place in response to the Community Health Annual Patient Survey at Central North West London NHS Foundation Trust. Kathy Elliott advised that a summary report was available and it was agreed that this would be circulated to the Governing Body following the meeting. Action 1: Board Secretary to circulate summary report.

1.5.5 In relation to action point nine, the Governing Body noted the £560k cost pressure to date that

had arisen from a rise in the cost of category M drugs (readily available NHS drugs) which are linked to the community pharmacy contract. The cost pressures across the sector were confirmed as in the region of £2m.

1.5.6 The Governing Body agreed to note the Action Log.

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Agenda Item 1.4


2.1 Chair’s Report 2.1.1 The above report was taken as read. 2.1.2 The Governing Body agreed to note the Chair’s Report. 2.2 Accountable Officer’s Report 2.2.1 The report was taken as read. Helen Pettersen highlighted the considerable winter planning

work that had been carried out to improve resilience over the winter period and also the review of the CCGs’ corporate services and associated staff consultation which was due to close at the end of November 2017.

2.2.2 Helen Pettersen reported two additional items for noting. Firstly, the Governing Body had

recently considered the current commissioning arrangements and CCG operating model. As a result the Governing Body had agreed a new operating model for the CCG with Camden Council which will require the decoupling of adults integrated commissioning and transfer of the commissioning of adult community services and continuing healthcare to the CCG.

2.2.3 The anticipated benefits of the new operating model were:

Increased commissioning capacity within the CCG for core commissioning and contracting

activities Integration of primary and community commissioning to enable the development of new

models of care to be accelerated Greater capacity within the CCG to focus on delivery of Quality, Innovation, Productivity

and Prevention (QIPP) initiatives Increased financial control to manage the deteriorating financial outlook for the CCG.

2.2.4 Helen Pettersen advised that the Governing Body had confirmed that the decision did not

change the local vision for health and care as set out in the Local Care Strategy and there was a strong commitment to maintaining an effective partnership with the Council and to working in collaboration to deliver the vision. There was no expectation that patients or service users would be affected by the change in the commissioning of adult community services once the transfer was implemented. She thanked the Council for their support and confirmed that the transfer of responsibilities would be conducted with due diligence and in accordance with appropriate Council and CCG governance processes.

2.2.5 Secondly, Helen Pettersen announced that the CCG had recently been accredited with the

London Healthy Workplace Charter. The Charter provides a framework to help employers across London ensure good practice in supporting the health and wellbeing of their staff.

2.2.6 The achievement of this accreditation was the result of a number of related initiatives that the

CCG had put in place for staff, including the very recent "Healthy Living Week" that took place in September 2017. She thanked all the CCG staff who had supported the work and recognised the significant achievement for the CCG. The Chair also acknowledged the accreditation that had been awarded and thanked Ian Porter and the Corporate Services Team for their work.

2.2.7 In response to the announcement on the change to the CCG’s operating model:

a) Glenys Thornton highlighted the need for a joint communication from the CCG and Local Authority to confirm that the shared vision had not changed, that integrated commissioning would continue for mental health and learning disabilities services and that there would be no adverse impact on patients and Camden residents.

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Agenda Item 1.4

b) The Governing Body acknowledged the CCG’s different financial position and the need to establish local control and autonomy, without moving away from collaborative working.

c) Simone Hensby requested clear messaging on the continued collaborative and integrated working to reduce anxiety for staff and stakeholders.

d) Dr Matthew Clark advised that the Integrated Commissioning Committee (ICC) would continue to consider the ‘how’ and ‘what’ in commissioning decisions and focus on delivery of services for patients.

e) Martin Pratt, agreed that the ICC was an important joint committee and as the committee’s Vice Chair he was hopeful that there would be no disruption. He confirmed that the CCG’s decision would be reported to the December 2017 meeting of the Council Cabinet with the emphasis very much on continued partnership working.

2.2.8 The Governing Body agreed to note the Accountable Officer’s Report. 2.3 The Patient Voice Report 2.3.1 Kathy Elliott introduced the Patient Voice Report and began by thanking CPPEG members for

their feedback, Saloni Thakrar for the helpful joint meeting with Healthwatch and their summary of work priorities which was included in the Patient Voice Report, and also for the contributions from CCG staff in progressing the work of the Citizen’s Panel.

2.3.2 Since the last Governing Body meeting the patient and public engagement highlights were:

a) An update at the CPPEG open meeting on the Long Term Conditions Strategy. b) Also received at the public CPPEG open meeting were the future plans for the

Primary Care Paediatric Service c) The alignment of patient and public engagement between local and North Central

London initiatives, especially the learning from other CCGs and thorough the Joint Overview and Scrutiny Committee.

2.3.3 Hilary Lance followed on with a patient story involving an older patient who, on the doctor’s

advice, contacted Connect Health about their shoulder pain. The patient requested that the landline telephone number was used for any contact and was annoyed when a few days later a text message was received on their mobile telephone, even though the number had not been divulged.

2.3.4 The text message requested feedback on the appointment which had not yet taken place.

The patient was unable to reply to this text and a second follow-up text because the phone provider advised that all calls to premium numbers had been previously blocked.

2.3.5 The patient reported they were cynical about Connect Health’s motives, about the pressure to

respond to text messages and the failure to inform service users about the premium telephone number. This was interpreted as greedy and dishonest and there was also concern about the cost implication for other patients.

2.3.6 On a more positive note, a patient whose husband had recently been diagnosed with

Alzheimers expressed great appreciation of training offered by the Peckwater Health Centre on the role of a carer and ways of coping with living with someone with dementia. The training was described as really helpful.

2.3.7 Finally, the care received by an elderly retired couple living in an assisted living facility in

Camden was highlighted. Mrs X has dementia and her disabled husband has recurring problems following an accident. He is sometimes hospitalised or has the Rapid Response Team visiting on a regular basis. Thanks to a package of care received from the health professionals, a devoted couple are able to live together and be kept safe. Their GP was described as excellent and someone who “understands them and values them as people, not just as patients.”

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Agenda Item 1.4

2.3.8 The Governing Body noted that the CCG’s Corporate Services Team was investigating the

issues raised regarding Connect Health. 2.3.9 The Governing Body agreed to note the Patient Voice Report. 2.4 Quality and Clinical Effectiveness Report 2.4.1 Charlotte Cooley introduced the above report which was taken as read. The Governing Body:

a) Noted the highlighted areas in the report regarding never event incidents which occurred within dentistry at the University College London Hospitals NHS Foundation Trust (UCLH) and also serious incidents reported at the Royal Free London NHS Trust (RFL). Also noted were the outstanding actions that required further work further to the CQC visit at the Camden and Islington NHS Foundation Trust.

b) Raised a concern about the lack of interpreter services at UCLH involving expectant mothers with planned ‘C sections’ who were required to give consent.

c) Noted that local engagement would be included as part of the national consultation launched by NHS England on items that should not be routinely prescribed in primary care.

d) Acknowledged the scale of the work involved in the national consultation on medicines and the possible implications for patients if certain medicines could no longer be prescribed.

e) Noted the Healthwatch support of one consultation for patients to obtain their medication.

2.4.2 The Governing Body agreed to note the Quality and Clinical Effectiveness Report.

3. Strategy

3.1 Healthy London Partnership Update 3.1.1 The Chair welcomed Jane Lindo and John Sheedy from the Healthy London Partnership

(HLP) Team and invited them to update the Governing Body on the HLP work programme. 3.1.2 Jane Lindo briefly provided some background on HLP explaining that:

a) The partnership was formed in May 2015 as a collaboration of London’s 32 CCGs and NHS England London.

b) The partnership is funded annually by the CCGs and NHS London. c) NHS England provides assurance on the HLP work programme which is separate

from NHS England. d) HLP delivers the Five Year Forward View and Better Health for London. e) There were 13 programmes of work, which were resourced to deliver over a five year

timeframe. f) The overall aim was to make London the healthiest global city in the world.

3.1.3 The Chair invited questions and discussion. The Governing Body:

a) Noted that engagement with CCGs was achieved via the STPs which had emerged as local structures in the delivery of transformation.

b) Noted that HLP Programme Leads were in a position to negotiate nationally and possibly achieve a better deal, for example Primary Care access.

c) Identified the need to avoid duplication of work, especially when resources were scarce.

d) Acknowledged that a clearer narrative was needed to see the link through from HLP, STP and NCL and noted that this was anticipated within the next 6 months.

e) Noted that there was a limited HLP core team who had not always obtained views, through pan London engagement, that were representative of the issues on the ground.

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Agenda Item 1.4

f) Welcomed the creative approach to health issues, such as the training with professional football clubs for overweight men.

g) Noted that specific help for refugees was being considered. 3.1.4 The Governing Body agreed to note the Healthy London Partnership update paper and

receive further details on the link with the STP in the next report. Action 2: Board Secretary to add to Annual Cycle of Business.

3.2 Camden CCG Estates Strategy 3.2.1 The Chair welcomed Matthew Black to the meeting and invited him to highlight the key areas

for consideration in the Estates Strategy paper. These were confirmed as: a) The need to have good access to primary and community care services in the areas of

greatest deprivation such as Kilburn. b) The leases that were due to expire in the next five years and the requirement to have

sufficient capacity to meet patient demand. c) The opportunity to secure value for money in a Borough that has expensive estate

costs. 3.2.2 The paper was taken as read and the Chair invited discussion. The Governing Body:

a) Welcomed the helpful report and the year by year approach to address the estates

issues. b) Noted the opportunity to work with partners to improve estate quality and patient

experience. c) Noted the Council’s regeneration plans in several areas of Camden and their support

for the St Pancras redevelopment. d) Noted that Camden had been unsuccessful in obtaining funding from NHS England

for improving GP facilities. Helen Pettersen advised that limited funding was available and the primary care estate in other parts of North Central London was in a much poorer condition in comparison with Camden.

e) Noted that GP practices could apply for section 106 funding from the Council for capital projects.

f) Identified the need for multi-agency groups to work together on new developments and to have early dialogue on costs, utilisation of space and alignment with the Local Care Strategy.

g) Identified that a risk assessment was required on the leases that were due to expire. h) Noted that the Estates Strategy largely provided a decision making framework to

react to new estate issues as they arise, especially in relation to costs when commercial rates would need to be negotiated, rather than allowing proactive planning of the estate needs which is difficult in the absence of the Primary Care Vision and Strategy.

i) Noted that population growth was an important factor when considering the long term viability and sustainability of the Camden estate.

j) Noted that the Estates Strategy would need to be updated to reflect the work on the Primary Care Vision and Strategy.

3.2.3 The Governing Body agreed to approve the refreshed CCG Estates Strategy. 3.3 Camden 2017/18 Winter Plans 3.3.1 Dr Matthew Clark introduced the above report which was being presented to the Governing

Body for the first time. He advised that there were difficult capacity issues to address in the emergency pathway and the paper set out the planned initiatives to absorb pressure and improve patient flow over the winter period and throughout the year.

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Agenda Item 1.4

3.3.2 The Governing Body:

a) Noted the scrutiny measures that were in place to monitor the safety and quality of emergency care.

b) Noted that 24 hour Psychiatric Liaison Service is now in place at the Royal Free hospital with the recent addition of overnight cover. The service at UCLH has had an increase in staffing following NHSE pump-priming and is close to meeting core 24 model requirements at UCLH.

c) Noted that the winter plan had been mobilised and all providers were reporting on their A&E performance seven days a week.

d) Noted that A&E performance at UCLH had deteriorated and that a recovery improvement plan was being monitored by the CCG.

e) Noted that the system needed to work together to fully utilise all parts of the health service. Early engagement on mobilisation of contingency planning was also identified as a key component.

3.3.3 The Governing Body agreed to note the Camden 2017/18 Winter Plans. 3.4 Camden Better Care Fund 2017/19 3.4.1 Richard Lewin introduced the final version of the Better Care Fund (BCF) Narrative Plan

which was submitted to NHS England in September 2017 and which sets out the delivery plan for 2017/19 and the joint priorities for BCF investment.

3.4.2 The value of the total BCF pooled budget in 2017/18 is £27.3m. Richard Lewin confirmed that

the Integrated Commissioning Committee was responsible for ensuring that all BCF projects met the BCF metrics and were alignment with the Local Care Strategy. The Committee had undertaken to review all of the BCF schemes to assess value for money and savings of 2m had been identified for the CCG through the review process.

3.4.3 The Governing Body agreed to note the 2017/19 Better Care Fund Narrative Plan and

the process in place to review BCF schemes.


4.1 Finance Report 4.1.1 Simon Goodwin introduced the Finance Report and advised that a standard format was being

adopted for finance reporting across North Central London (NCL). 4.1.2 With regard to the NCL CCG budgets, Barnet CCG was reporting a deficit, Islington CCG was

on plan and Haringey CCG was in a more precarious position. He advised that Camden CCG was roughly on plan and he thought it was possible that the CCG could achieve a balanced budget at the end of the reporting year.

4.1.3 Simon Goodwin confirmed that Islington CCG had agreed to hold an underspend of £2m to

offset the overspend that Camden CCG had incurred from the delegation of primary care commissioning at the start of the financial year. The main aim was to achieve a balance overall for NCL.

4.1.4 The Governing Body noted the acute expenditure position and over performance at month 6:

a) Royal Free - £4m b) Imperial - £1m c) UCLH - £0.6m

11

Agenda Item 1.4

4.1.5 Simon Goodwin advised that the Royal Free had no agreed reconciliation position which was attributable to three components - patient transport, productivity metrics and claims and challenges. Paul Sinden, NCL Director of Performance and Acute Commissioning was working on behalf of NCL to address the Royal Free’s over performance.

4.1.6 The Governing Body also noted:

a) The non acute expenditure at month 6. b) That PbR contracts for the acute sector were likely to remain for the foreseeable

future. c) That the threshold for readmission funding had increased and with money reinvested

in admissions avoidance. Action Point 3: Governing Body to receive an update on readmission funds at the next meeting.

d) The financial challenge facing the health system and the need to modernise and organise service provision in the right way.

e) That continuing healthcare and children’s services were subject to analysis to enable robust reporting of non acute expenditure

f) That a CCG needed a strategy to capitalise on the quality premium. 4.1.7 The Governing Body agreed to note the Finance Report. 4.2 Development of the 2018/19 Operational Plan 4.2.1 The above report was taken as read. Rebecca Booker drew the Governing Body’s attention to

the focus on QIPP and the minimal growth the CCG will receive until 2020/21 as a result of the Comprehensive Spending Review.

4.2.2 The Governing Body agreed to note the process in place for developing the 2018/19

operational plans. 4.3 Integrated Performance Report 4.3.1 Charlotte Mullins highlighted the key performance issues from the October 2017 Integrated

Performance Report (IPR). These were:

a) UCLH’s non compliance with the 18 week RTT standard. A recovery plan has been developed and the Trust is forecasting compliance from January 2018.

b) UCLH reported a strong compliance year to date position in relation to the diagnostics standard. However overall, the CCG did not meet the diagnostics standard in August 2017.

c) A&E year to date performance is below the 90% standard. The remedial action plan has been revised. A GP service is being used to manage demand within the emergency department at UCLH and a majority of patients being treated are from outside of the North Central London area.

d) Both UCLH and the Royal Free hospitals are non compliant with the 62 day cancer wait standard. A recovery trajectory has been agreed with the Royal Free.

e) Delayed transfer of care performance and continuing healthcare (CHC) performance which was requested to be reported at public board meetings by NHS England. The CHC target is for 85% of assessments to be carried out outside of an acute setting. The performance for September 2017 was 61.1%.

f) Performance against the CCG’s Operating Plan and the deep dive taking place on all data sources to verify acute activity.

g) The CCG’s performance against the six clinical priority areas. 4.3.2 The Governing Body:

a) Noted the detailed work being done on the Royal Free’s data to be able to understand the link with performance and finance.

b) Noted the UCLH A&E performance and contributing factors.

12

Agenda Item 1.4

c) Noted that the non-elective deep dive was to obtain a clearer picture of the coding and contractual data elements used by the acute providers.

4.3.3 The Governing Body agreed to note the contents of the Integrated Performance Report. 4.4 Business Plan Report 4.4.1 Sarah Mansuralli introduced the updated 2017/18 Business Plan. Of the 40 Business Plan

initiatives, 26 were progressing to plan, 13 had some risks and issues which required action and one initiative, namely Finance and QIPP, was red rated and was being actively managed.

4.4.2 Sarah Mansuralli advised that the 2018/19 Business Plan would focus on key deliverables

and concentrate on fewer initiatives. 4.4.3 The Governing Body agreed to note the Business Plan report and receive the end of

year report as the next update.

5. Governance

5.1 Board Assurance Framework 5.1.1 Richard Strang introduced the Board Assurance Framework (BAF) and as the Audit

Committee Chair he confirmed that the Audit Committee was responsible for oversight of the CCG’s risk processes that underpinned the production of the BAF.

5.1.2 There were 13 risks on the BAF, of which 6 were new. A new risk on acute performance had

been added further to the Governing Body’s request. Finance, QIPP, winter pressures and the delivery of the STP plans were the most significant risks. A new risk had also been added in relation to QIPP planning and delivery in 2018/19.

5.1.3 The Governing Body noted the role of the committees in reviewing and challenging the

organisation’s risks. In response to a question from Hilary Lance on the total numbers of CCG risks, the Chair requested that the full picture was captured in the next BAF report. Action 4a: Ian Porter

5.1.4 Jane Davis reminded the Governing Body of the earlier discussion on the Estates Strategy

and identified that the financial risks raised with regard to primary care estate should also be added to the BAF. Action 4b Ian Porter

5.1.5 The Governing Body agreed to note the Board Assurance Framework. 5.2 Safeguarding Adults Annual Report 5.2.1 Vikki Gray introduced the above report which set out how Camden CCG had delivered its

statutory responsibilities for safeguarding adults in 2016/17. 5.2.2 The Governing Body welcomed the excellent report and in particular the multi-agency working

demonstrated in the CCG’s safeguarding adults work. The Governing Body: a) Noted the priorities for the coming year. b) Noted the breadth of the safeguarding adults work and increasing responsibilities. c) Noted the good GP attendance at the Safeguarding Adult CCG Network and the

Prevent training that had been tailored specifically for primary care and delivered at the GP Education events.

d) Noted the challenges ahead for community providers to deliver services and comply with the safeguarding adults requirements.

5.2.3 The Governing Body agreed to note the 2016/17 Annual Safeguarding Adults Report.

13

Agenda Item 1.4

5.3 Primary Care Co-Commissioning Committee in Common 5.3.1 The Governing Body agreed to approve three minor amendments to the terms of

reference in respect of the North Central London Primary Care Co-Commissioning Committee in Common.

5.4 2017 Annual General Meeting Minutes 5.4.1 The Governing Body received the 2017 AGM minutes for review. No points of accuracy were

raised. 5.4.2 The Governing Body agreed to note the 2017 AGM minutes. 6. Committee Reports

6.1 Audit Committee Report 6.1.1 The above report was taken as read. Richard Strang advised that Andrew Spicer was working

on harmonising the terms of reference for the Audit Committees to enable more formal collaboration across North Central London. An informal meeting of Audit Chairs was due to be held in December 2017 for further discussion on joint working.

6.1.2 Richard Strang also highlighted that the Audit Committee would consider a paper on contract

management and performance at the next meeting in January 2018. 6.1.3 Hilary Lance raised a concern about an online consultation service that had been launched in

West London which applied strict exclusion criteria for online consultations which appeared to be discriminatory.

6.1.4 The Governing Body identified that there was a risk of destabilising primary care

commissioning and that more information was needed to understand the service that was being offered the Chair and Helen Pettersen agreed to look into this further with NCL CCG colleagues and consider writing to NHS England on behalf of NCL to outline concerns around commissioning and service provision. Action 5: Neel Gupta and Helen Pettersen

6.1.5 The Governing Body agreed to note the Audit Committee Report. 6.2 Finance and Performance Committee Report 6.2.1 The above report was taken as read. The Governing Body noted the new arrangements for

QIPP governance and the proposed new change of the Committee to reflect its new responsibilities.

6.2.2 The Governing Body agreed to approve the change of name of the Finance and

Performance Committee to the Finance, Performance and QIPP Committee and to note the summary report of the September and October 2017 meetings.

6.3 Health and Wellbeing Report 6.3.1 The above report was taken as read. 6.3.2 The Governing Body agreed to note the summary report of the October 2017 meeting

of the Health and Wellbeing Board.

14

Agenda Item 1.4

6.4 Integrated Commissioning Committee Report 6.4.1 The above report was taken as read. 6.4.2 The Governing Body agreed to note the Integrated Commissioning Committee Report. 6.5 Localities Report 6.5.1 The above report was taken as read. 6.5.2 The Governing Body agreed to note the Localities Report.

7. Any Other Business

7.1 Draft January 2018 Meeting Agenda 7.1.1 The Governing Body agreed to note the planned agenda items for the January 2018

Governing Body meeting. 7.2 2018 Meeting Dates 7.2.1 The Governing Body agreed to note the 2018 meeting dates.

8. Questions from the Public

8.1 There were no questions from members of the public. 8.2 The Chair thanked the Board Secretary for her excellent service to the CCG over the last four

years and wished her well in her new NHS post. 8.3 There was no further business and the Chair closed the meeting at 16:35.

These minutes are agreed to be a correct record of the Part 1 meeting of Camden Clinical Commissioning Group held on 8 November 2017

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

15

Agenda Item 1.4

16

Agenda Item: 1.5

CAMDEN CLINICAL COMMISSIONING GROUP GOVERNING BODY 2017/18 ACTION LOG - PART 1

Meeting Date

Action No.

Action Lead Deadline Update

8 November

1 Healthy London Partnership Board Secretary to add to annual cycle of business.

Board Secretary

March 2018 Added to cycle of business.

8 November

2 Finance Report Update GB on the readmissions threshold increase and investment in admissions avoidance

Rebecca Booker and

Trevor Myers

January 2018

The re-admission threshold has been retained at the current level; but with the agreed condition that the entire re-investment of over £1m is brought to the A&E Delivery Board in March 2018 for consideration and agreement.

8 November 3

Risk Register a) Confirm the total number of all CCG risks in the

next BAF Report and b) Capture the risks attached to the Estates

Strategy in relation to primary care and finance

Ian Porter January 2018

(a) There are currently 55 corporate risks that are being managed through the corporate framework.

(b) The Estate Strategy risks around the Kings

Cross and Belsize Priory Developments are being presented in a paper to the January 2018 Finance, Performance and QIPP Committee. The wider finance risks will be managed through the finance risk register.

8 November 4 NHS App On behalf of NCL write to NHS England about the on-line app which has been launched in West London to understand the reasons for the implementation of the new technology/approach and to point out the impact on commissioners.

Charlotte Mullins

January 2018

Completed; but Chairs and NCL SMT agreed to defer sending on the basis that LMC are making representations on behalf of all London practices.

13

September 5 STP Programme Spend

GB to consider detailed STP programme spend and evidence of delivery/value for money at March 2018 meeting.

Helen Pettersen

March 2018

17

Agenda Item: 1.5

18

Camden Clinical Commissioning Group Governing Body Meeting 17 January 2018

Report Title Chair’s Report

Agenda Item 2.1 Date 05/01/2018

Committee Chair (where applicable)

Lead Director Dr Neel Gupta, Chair Tel/Email [email protected] Report Author Tel/Email GB Sponsor(s) (where applicable)

Tel/Email

Report Summary

The purpose of this report is to highlight the Chair’s business activities and to provide an update on key areas of work.

Purpose Information

Approval To note √

Decision

Recommendation The Governing Body is asked to note the content of this report.

Strategic Objectives Links

The Chair’s business activities are linked to all the CCG’s strategic objectives.

Identified Risks and Risk Management Actions

Where applicable any risks are identified within the report.

Conflicts of Interest

None

Resource Implications

Not applicable

Engagement

Engagement activities are contained within the report.

Equality Impact Analysis

There are no equality impacts arising from this report.

Report History and Key Decisions

The Chair’s Report is a standing item on the Governing Body agenda.

Next Steps None

Appendices

None

19

Chair report November 2017 to January 2018 1. Introduction This is my regular written report to the Governing Body, updating on the business that I undertake on behalf of the CCG and highlighting key areas of work being progressed in the CCG. 2. Meetings and Visits Together with the Chief Operating Officer, Sarah Mansuralli, I have been undertaking visits to our member practices. To date, we have visited 11 practices and will continue these throughout the year. Discussions have consistently been insightful and provided useful intelligence for future commissioning and service improvement priorities. 3. CCG Quality, Innovation, Productivity and Prevention (QIPP) and Business Plan

2018/19 The Governing Body has continued to refine its priorities for 2018/19 with a further workshop in January to finalise the priorities aligned to the QIPP Plan for 2018/19 and Sustainability and Transformation Plan (STP) deliverables. The focus on ensuring financial sustainability is a key feature of all CCG plans for 2018/19 in order to regain a positive financial outlook which will support local control and autonomy of strategic commissioning decisions. As part of this, there has been significant focus on developing the 2018/19 QIPP plan. This year the plan was subject to an assurance process undertaken by Deloitte (for North Central and North West London CCGs) at the request of NHS England. The outcome of the assurance process for Camden was positive with the CCG scoring well on the majority of components assessed, with good governance underpinning our QIPP plan. The review provided some suggested next steps that the CCG will implement during quarter 4. 4. Financial recovery plan To address the continuing financial pressures being experienced by the CCG, an in year financial recovery plan has been developed and is being implemented. Implementation of the recovery plan is led by Rebecca Booker, Deputy Chief Finance Officer, and monitoring of the plan is undertaken through the CCG’s Finance, QIPP and Performance Committee. Full delivery of this recovery plan will enable the CCG to achieve a balanced financial position for 2017/18 but this is subject to mitigating any further in year pressures which may arise. 5. Celebrating Success Camden CCG and Orion Health were shortlisted for two prestigious awards for the Care Integrated Digital Record (CIDR) late last year: Tech Project of the Year (Health Technology Newspaper Awards) and Enhancing Care by Sharing Data and Information (Health Service Journal awards). We won Tech Project of the Year, recognising the innovation that has been achieved by the CCG towards integrated digital records. The Camden GP Website was also successful at the User Experience UK Awards, winning the Best Public Sector Website Award.

21

In December 2017, Camden CCG also received a ‘good’ rating for our 2016-17 patient and public engagement work from NHS England, under their new Assessment and Improvement Framework metrics. 6. Extended Access The new Camden GP Extended Access service commenced on 1 December 2017, operating from four hub locations to provide 8-8, 7 day a week appointments. The newly commissioned service enables patients to book an appointment via their own practice, a dedicated call centre open 12 hours per day, via the service website or direct via NHS 111. The new service has had a good start with early data indicating use is already significantly higher than the historic service, at 75% of GP appointments each week. A public promotion campaign commenced before Christmas, and is continuing, to enhance patient awareness of this service and drive uptake. 7. Staff Changes Over the next couple of months we will be saying goodbye to a few individuals who have made a significant contribution to the work of the CCG during their time with us. Firstly Gordon Houliston, Assistant Director of Primary Care, is leaving in early February. Gordon has been with us for two years and has achieved an incredible amount in this time – including the successful establishment of GP neighbourhoods, our challenging transition to fully delegated primary care commissioning, the development and implementation of the Universal Offer, and rolling out our GP Extended Access service. Gordon is moving to become Director of Operations for Children and Young People Services at Whittington Health, so we hope paths will continue to cross. Charlotte Mullins (Director of Sustainable Insights) and Delyth Ford (Head of Sustainable Insights) are sadly also off to new pastures at the end of February. Charlotte and Delyth have been with us for five years and have led the CCG in developing truly innovative approaches to using population health data to commission local services, as well as ensuring we have robust performance analysis to evidence the impact of our work. They will be taking on a new challenge in 2018, moving to the Hertfordshire and West Essex STP to establish a new approach to population health management. Finally, I want to offer our congratulations to Ian Porter, who has been appointed to the role of North Central London Director of Corporate Services, and will lead the newly established NCL corporate services function. I would like to thank Ian, Gordon, Charlotte and Delyth for their invaluable contribution and dedication to Camden CCG and wish them every success for the future. Dr Neel Gupta Chair Camden Clinical Commissioning Group

22


Report Title Accountable Officer’s Report


Lead Director N/A

Tel/Email

Report Author Helen Pettersen, NCL Accountable Officer

Tel/Email [email protected]

GB Sponsor(s) (where applicable)

Tel/Email

Report Summary The Accountable Officer’s Report highlights key issues for the Governing

Body’s consideration that are not covered elsewhere on the agenda.

Purpose (tick one only)

Information Approval To note

Decision

Recommendation The Governing Body is asked to note the contents of this report.


The Accountable Officer highlights a variety of issues within the report and these may link with all strategic objectives.


Where applicable any risks are identified within the report.


There are no conflicts of interest arising from this report.


No direct implications, although each area described has resource implications for the CCG.

Engagement

Engagement activities are highlighted as appropriate.



Report History This report is a standing item on the Governing Body agenda.

Next Steps None

Appendices None

23

1. Introduction

This report provides an update on the key activities that the senior team and I have been involved in since the last Governing Body meeting.

2. Welcome A warm welcome to Jennifer Murray Robertson as Director of Commissioning and Contracting for Camden CCG. Jennifer takes on the substantive role from Trevor Myers to ensure Camden CCG continues to effectively deliver its statutory commissioning and contracting responsibilities to achieve high quality yet cost effective services. We have also recruited Sarah McDonnell to the role of Director of Primary Care/Deputy Chief Operating Officer. Sarah takes up post on 28th May 2018, following a planned sabbatical. I would like to extend a warm welcome to Meena Mahil as interim Director of Primary and Community Commissioning, who will provide senior interim cover for Sarah’s sabbatical. Meena brings a wealth of primary care commissioning and service development knowledge, having worked in similar roles across London. I’m also pleased to advise that John Wardell, substantive Chief Operating Officer for Enfield CCG officially took up post on 4th December. This completes recruitment to all NCL Senior Management Team positions.

3. Camden CCG operating model

Further to the Governing Body’s approval of a new operating model in November 2017, the Chief Operating Officer has established a Transition Steering Group to oversee the transfer of commissioning functions from the Council to the CCG. The first phase of the transfer has concluded with the Continuing Healthcare (CHC) and Delayed Transfers of Care (DTOC) team transferring on 11th December 2017. The adult community commissioning function will transfer back to the CCG on 31st January. To enable a smooth and seamless transfer of responsibilities and associated contracts, January will be a month of transition. Since November, the revised operating model has been shared with staff for comments prior to moving into implementation. The implementation phase will be overseen by the CCG’s Executive Management team and monitored against an implementation plan that aims to conclude by April 2018.

4. Winter planning

The winter period is putting increased pressure on health and social care services. In response, staff from across the NHS and its partners have been working hard to put plans in place to mitigate the additional demand and pressures. As these pressures have increased, acute trusts have been supported by system partners and the CCG to maintain flow throughout hospitals by placing significant emphasis on reducing the delays that can sometimes be associated with discharges. This has helped to ensure that those who do not need to be in hospital can recover in the community or in the comfort of their own homes. Winter is not just all about hospitals though and primary care and community services have also been under increased pressure. All the hard work to ensure flu vaccination uptake is maximised has been important and staff are working extremely hard to manage additional demand. Primary care is also supporting acute trusts by accepting redirections for those with primary care needs, attending the emergency department.

Some of the things we have been doing this winter, include:

Launching a Discharge to Assess pathway to support people to have their social care and

continuing healthcare needs assessed in the community, rather than in hospital. The CCG’s Continuing Healthcare (CHC) and Delayed Transfers of Care (DTOC) teams are on track to deliver the trajectory for reducing the number of DTOCs and increase the number of CHC assessments being undertaken in the community.

24

Securing an additional £626k of additional funding for UCLH, Camden and Islington Foundation Trust and partners within the Camden Accident and Emergency Care Delivery Board to fund and staff 10 transition beds, an enhanced admission avoidance service for cross border patients, enabling an electronic coordination centre within UCLH to maximise patient flow, a mental health Bed Management Hub and an Assertive Discharge Team for mental health patients.

Strengthening escalation processes relating to Medically Optimised patients and Delayed Transfers of Care, so that our senior leaders get involved when there are unacceptable delays to getting patients home or to community settings

Providing almost 2,900 primary care appointments during extended hours each month through extended access services

We will continue to regularly update the Governing Body as winter progresses.

5. NCL CCG Primary Care Strategy A highly interactive workshop was held in December to start the process of developing an NCL CCG’s Primary Care Strategy. Transforming primary care is a substantial work programme of the NCL Sustainability and Transformation Plan. The strategy aims to provide more detail on our collective vision for primary care and its role in improving health and well being outcomes for patients. We will be working with local residents, GP practices, GP Federations and other partners to co create the strategy which is due for completion by April 2018. The draft strategy will be discussed at a future Governing Body meeting.

6. Corporate services in the CCG

I am pleased to report that the NCL CCGs staff consultation on a new operating model for corporate services concluded on 11th December 2017. The proposed organisational change to the current delivery model and underpinning structure has been designed following the views sought from staff, NCL Senior Management Team and Governing Body Members. Of particular importance, were the views from some staff of welcoming the opportunity for a more collaborative approach across the CCGs that would result in the reduction of duplication, whilst at the same time acknowledging the need to also maintain a local presence. Overall, the proposals were supported by the majority of staff and as a direct result of staff comments and feedback and helpful suggestions some proposals have been amended and are outlined within the Outcome Consultation Document. The creation of the new NCL Corporate Services Directorate, with an underpinning staffing structure, was approved by the NCL Senior Management Team on the 12 December 2018. As there is no requirement to declare any member of staff “at risk” as a result of this organisational change, staff being slotted-in to the revised structure have all received a formal letter detailing their personal circumstances. We will work to fully implement the new model in early January 2018 and anticipate a smooth transition to a collaborative, responsive NCL service that meets the needs of our individual CCGs, patients and STP footprint going forward.

7. Proposed Redevelopment of St Pancras Hospital Site

Camden and Camden Foundation Trust (CIFT) are proposing to redevelop the St Pancras Hospital site and bring it up to 21st century standards for the delivery of healthcare services. We are working closely with CIFT, Islington CCG and a range of other organisations who provide services on the St Pancras Hospital site on what the proposals are for where services will be located if the site is redeveloped. We will be carrying out a public consultation on the proposals once they are fully crystalized and we will be working very closely with Camden Council on the approach to the consultation and with local residents, partners and stakeholders.

Helen Pettersen Accountable Officer Barnet, Camden, Enfield, Haringey and Islington CCGs

25

Camden Clinical Commissioning Group Governing Body Meeting Wednesday 17th January

Report Title Patient Voice Report



Not Applicable

Lead Director Ian Porter, Director of Corporate Services


Report Author Martin Emery, Deputy Head of Engagement & Francesca McNeil, Head of Communications and Engagement

Tel/Email [email protected] [email protected]


Kathy Elliott, Lay Governing Body member responsible for Patient and Public Engagement


Report Summary

This paper gives a synopsis of the patient and public engagement activity undertaken since the previous Governing Body meeting.

Purpose (tick one box only) [See note 6]

Information

Approval To note X

Decision

Recommendation The Governing Body is asked to note the content of the report.


Objective E: Work jointly with the people and patients of Camden to shape the services we commission


Not Applicable


Not Applicable


Not Applicable

Engagement

Engagement documented in report.


No equality impact assessment is required for this report.


The Patient Voice is reported to the Governing Body on a Bi-monthly basis

Next Steps Not Applicable

Appendices

Not Applicable

Internal Control Only: This paper together with any proposals have been approved by:

27

[See note 16] Lead Director

YES/NO

Name

Date

[See note 17] Sponsor (if applicable)

YES/NO

Name

Date

[See note 18] Finance Team (if applicable)

YES/NO

Name

Date

Delete as applicable

28

The Patient Voice Report (January 2018)

This paper covers work undertaken over the past two months, relating to: 1. Camden Patient and Public Engagement Group (CPPEG) 2. Business Plan Objective E: Work jointly with the people and patients of Camden to shape the services we commission.

1. Camden Patient & Public Engagement Group (CPPEG) Since the last Governing Body meeting the CCG has held one CPPEG operational meeting and one open public meeting. Key themes and issues arising are described below. 1.1 CPPEG operational meeting (06/11/2017) CCG Committee reports CPPEG committee representative reports and the Governing Body Patient Voice report were discussed, approved and disseminated to PPGs for information, which can be accessed here. Site Development – St Pancras Hospital Malcolm McFrederick Transformation Programme Director, Camden & Islington NHS Foundation Trust gave an overview of the Trust plans for development of some areas of the St Pancras hospital site. The presentation is here. The plan includes proposals to move some services into community hubs, build a new state-of-the-art inpatient facility next to the current Highgate centre, and a new building on the St Pancras site for community services and research. The plan would involve selling or leasing site land to another NHS organisation, and for housing. CPPEG members welcomed the opportunity to comment in advance of the formal consultation stage. Feedback was given in relation to proposed consultation questions, with agreement that CPPEG members would have the opportunity to further review these. The Trust was invited to attend a future CPPEG open meeting to present plans to the wider population. GP Extended Access update Martin Emery, Deputy Head of Engagement, informed CPPEG that from December Camden patients can book an evening or weekend GP appointment at one of four local GP surgery ‘hubs’ (Brondesbury Medical Centre, Somers Town Medical Centre, Caversham Practice, Swiss Cottage Surgery). The Extended Access service is available to anyone who lives in the borough of Camden or who is registered with a Camden GP. CPPEG members welcomed the update, and confirmation that the service will be proactively promoted. The Primary Care team and AT Medics will attend an upcoming operational meeting to report on mobilisation of the service. You Said We Did CPPEG committee report: CPPEG committee reports approved. Site Development – St Pancras Hospital: CPPEG members welcomed the presentation and the opportunity to give comment on the consultation proposal & site development plans. Camden GP Extended Access Service: CPPEG members welcomed the update and asked that an update is given at a future date on mobilising the service.

Camden CCG has: Disseminated reports to PPGs via the monthly PPG newsletter and made available on CPPEG webpage. Camden will: Invite representatives from Camden & Islington NHS Foundation Trust to present the proposal and site development plans to the wider public. Ensure CPPEG members have an opportunity to comment on the final consultation materials for the public Camden has: Disseminated the presentation to PPGs and made it available on CPPEG webpage.

Camden CCG will: Invite representatives from the Primary Care team and AT Medics to an operational meeting to update CPPEG on progress made with mobilising the service.

29

1.2 CPPEG open meeting (11/12/2017) CPPEG open meetings occur bi-monthly and allow an opportunity for members of the public to hear about and engage with the work of the CCG. The December open meeting was attended by 31 members of the public. Presentation 1: Camden Integrated Musculoskeletal Service update The presentation by Dr Natasha Curran, Camden Integrated Musculoskeletal Service (CIMS) Clinical Lead, University Central London Hospital NHS Foundation Trust (UCLH) can be viewed here. The presentation focused on mobilisation progress, future plans for involving patients and how the patient outcomes will be measured and reported. The attendees welcomed the presentation and plans for the appointment of a Patient Director, with recent experience of MSK services in Camden. Presentation 2: NHS England Assurance Rating: New patient & community engagement rating The presentation by Kathy Elliott, Camden CCG vice Chair and Lay Governing Body Member responsible for patient engagement, can be viewed here. The presentation outlined the new NHS England assessment process for CCG patient and public engagement work. Camden CCG was awarded as ‘good’ for 2016-17. Attendees welcomed the CCG ambition to move from ‘good’ to ‘outstanding’ over the next 12 months. Presentation 3: Long Term Conditions Strategy update The presentation given by Martin Emery, Deputy Head of Patient Engagement, Camden CCG can be viewed here, summarising activity undertaken and public feedback to date. A member of CPPEG will assist the commissioning team with the drafting of the strategy. Attendees welcomed the update. Presentation 4: Mental Health Acute Day Units Consultation update: The presentation given by Nick McClelland, Senior Communications and Engagement Manager, can be viewed here. The presentation outlined reasons for the proposed option and engagement to date. Attendees welcomed the opportunity to give feedback and to attend the last public meeting (4 Jan 2018). You Said We Did CIMS update: Attendees welcomed the presentation and the plan to appoint a Patient Director NHS England Assurance Rating: Attendees welcomed the CCG rating and the CCG’s drive to attain the ‘outstanding’ rating in the upcoming 12 months. Long Term Conditions Strategy update: Attendees welcomed the CCG engagement activity and involvement of a CPPEG representative in the drafting of the strategy. Acute Day Units Consultation update: Attendees welcomed the CCG consultation activity and the opportunity to comment.

Camden CCG have: A CCG representative (Deputy Head of Engagement) on the interview panel for the appointment of a Patient Director. Camden CCG will: Invite a representative from UCLH to a future meeting to report back on the patient experience and outcomes achieved in 6-8 months. Camden CCG have: Disseminated the presentation and rating score to PPGs and the public via the PPG Newsletter.

Camden CCG will: Disseminate the LTC Strategy to CPPEG, PPGs and the public via the public website and PPG newsletter. Camden CCG have: Disseminated the date and location of the last public meeting via the public website, social media and the PPG newsletter.

2. Business Plan Objective E: Work jointly with the people and patients of Camden to shape the services we commission The following summarises other key engagement activity undertaken by the CCG over the last two months to support Objective E:

30

NHS England Assurance Rating Patient and Community Engagement (2016/17): NHS England has added new metrics to the CCG Improvement and Assessment Framework on patient and public engagement. Initial ratings for 2016-17 were awarded in December 2017. Camden CCG was rated as ‘good’ - achieving outstanding in two domains, good in two, and requiring improvement in one. For additional information – click here. To improve Domain D, the Communications & Engagement team will support CCG teams to evidence the impact that patient and public engagement work has on commissioning plans and decisions. We will also ensure more information about local demographics and local health inequalities is publically available (Domain E) and consider how we can increase public involvement in the production of the 2017/18 Annual Report (Domain B). Collectively, these steps will move us towards an overall rating of ‘outstanding’ and will provide Governing Body with updates through future Patient Voice reports. Domain Rating A - Governance: Involve the public in governance of the organisation Implement assurance and improvement systems Hold providers to account

Outstanding

B - Annual Reporting: Demonstrate public involvement in the Annual Reports

Good

C - Day to Day Practice: Explain public involvement in commissioning plans Promote and publish public involvement Assess, plan and take action to involve Provide support for effective engagement

Outstanding

D - Feedback & Evaluation: Feedback and evaluation of engagement work

Requires Improvement

E - Equalities & Health Inequalities: Advance equality and reduce health inequality

Good

Acute Day Units (Mental Health) Consultation The public consultation ended on Wednesday 10 January 2018 and consideration is currently being given to the feedback received. The Communications & Engagement team supported the Mental Health commissioning team by: Hosting four public meetings to collate service user and public views on the proposals. Presenting the proposals at a CPPEG open meeting. Holding individual meetings with service users at the Acute Day Units. Disseminating an online survey (Inc. hard copies of the survey) to service users and local mental

health groups in Camden to give feedback on the consultation. Long Term Conditions Strategy Development The engagement work has been completed and a CPPEG representative is currently assisting the commissioning lead in drafting the strategy. The Communications & Engagement team supported the Adults commissioning team by: Facilitating a focus group with services users and carers. Disseminating a survey (online and hard copy) to LTC patients and carers. Disseminating an online survey to General Practice staff.

Camden General Practice Extended Access The Communications & Engagement team is supporting AT Medics to raise awareness with the public and PPGs in relation to the provision and location of the new services via our public website, social media and newsletters. National General Practice Survey

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The Communications & Engagement team is supporting the Primary Care team by raising public awareness of the national survey (1 Jan - 31 Mar 2018) via our website, social media and PPG newsletter. Involvement opportunities for people affected by cancer The Communications & Engagement team is currently working in partnership with UCLH cancer collaborative in raising awareness of supporting work in pathway boards and patient reference groups. “Camden 2025” The CCG Communications & Engagement team is supporting the council to raising awareness of the opportunity for audiences to contribute the development of their ‘Camden 2025’ plan. The plan will set updated priorities for 2018 up to 2025, to make Camden a better place for everyone to live by 2025. Care Navigation and Social Prescribing Workshop The Transformation team and Adults Commissioning team are currently working with local community groups in developing the care navigation service, self-care and social prescribing provision for Camden residents. National consultation on managing prescribable items of low priority for NHS funding The Communications & Engagement team have raised awareness of the NHS England consultation on prescribable items of low priority for NHS funding with PPGs and the public, via social media, public website, public meetings and PPG newsletters. Deaf Awareness Training – Camden General Practices The Communications & Engagement team is working with a local service user to facilitate free deaf awareness training for practice staff - with 7 practices trained to date. Feedback from clinical and administrative staff has been exceedingly positive. Accessible Information Standard (AIS) – Camden General Practices The CCG, Healthwatch Camden and Camden LMC are partnering to offer practices support to meet AIS requirements. Healthwatch Camden have17 practice visits scheduled to date and additional dates will be offered in New Year. Our thanks to Healthwatch Camden for providing this resource. Camden CCG Governing Body Member training 10 new and existing Governing Body members attended a Patient and Public Involvement workshop, facilitated by the Head of Communications & Engagement, Deputy Head of Engagement and Policy Director at Healthwatch Camden. Our thanks to Anna Wright, Healthwatch Camden, for participating. You Said We Did Acute Day Units (Mental Health) Consultation: The public consultation ended 10 Jan 2018 Long Term Conditions Strategy: The engagement ended 30 Dec 2017 AIS Support sessions: 17 practices have signed up for a Healthwatch Camden session to date

Camden CCG will: Consider the feedback received and publish the decision, with C&I NHS Foundation Trust. Camden CCG will: Analyse the feedback to inform the strategy, with involvement of a CPPEG representative. Camden CCG will: Continue to promote AIS and Lay Member will provide updates to Governing Body

3.0 Looking ahead The following activity is currently planned for January 2018: Monday 17 January - Patient Director Interview (UCLH CIMS) Tuesday 18 January - CPPEG Operational Meeting Tuesday 23 January - Equality Delivery Scheme 2 pre-grading workshop with community interest

groups.

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Through 2018, the Communications and Engagement team will look at how we: Can best support commissioners to share information transparently with residents about service

changes or consultations under consideration Link commissioning decisions being taken at a North Central London (STP or Joint Commissioning

Committee) level into our local Camden patent and public engagement activity and communication channels.

Include examples of the impact that patient and public engagement work has on commissioning plans and decisions in future Patient Voice reports, which Lay Member Kathy Elliott will highlight (linked to NHS England Assurance Rating feedback on Domain D).

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Camden Clinical Commissioning Governing Body 17 January 2017 Report title Quality and Clinical Effectiveness Report

Agenda item 2.4 Date 17 November 2017

CCG Clinical Lead

Charlotte Cooley Tel/Email [email protected]

Lead director Neeshma Shah Tel/Email [email protected]

Report author Quality and Safety team Tel/Email [email protected]

Report summary This report provides a summary of key quality, safety and clinical effectiveness

information for Camden CCG. Areas to highlight to the Governing Body are: UCLH The Trust provided assurances regarding the implementation of the National Early Warning Score (NEWS), as one of their Quality Account priorities for 2017/18. This contributes to early detection of deteriorating patients in A&E, e.g. early identification and treatment of sepsis. Previously there had been some concerns around this early identification and escalation, and there was Trust-wide learning from these. RFL Four more Never Events have been reported since the last report to this committee. Barnet CCG as lead commissioner have requested a thematic analysis of these incidents and mitigations taken to prevent recurrence. CNWL Current processes for applying to authorise deprivations of liberty occurring outside the DoLs scheme (e.g. outside care homes and hospitals) is not robust. A desktop analysis of care packages is being undertaken and will be shared with the CCG. The Trust confirmed at CQRG that they have identified cases to date. CIFT The CQC undertook a re-inspection of CIFT on week commencing 4th December 2017; at the time of writing this report the CCG had not received any feedback on this visit. Concerns still remain over non-compliance relating to mandatory training.

Purpose

Information Approval To note Decision

Recommendation The Governing Body is asked to NOTE the content of this report, and to read in conjunction with the CCG’s annual safeguarding children report.

Strategic objectives links

Objective A: Commission the delivery of NHS Constitutional rights and pledges Objective B: Improve the quality and safety of commissioned services Objective C: Improve health outcomes, address inequalities and achieve parity of esteem

√

35

Identified risks and risk management actions

Provider management of quality and safety issues affecting patient care and experience. These are being managed through regular clinical quality review (CQR) meetings and regular liaison with respective provider leads.

Resource implications

Competent and resourced teams

Equality impact analysis

An equality impact assessment has not been conducted on this document as it is a summary report and record of the key outcomes of the Quality and Safety Committee meeting.

Report history This report is a summary report of the work of the QSC. Next steps None. Appendices None. Glossary CHC Continuing Health Care CHR Clinical Harm Review CPN Contract Performance Notice CP-IS Child Protection Information Sharing CQC Care Quality Commission CQRG Clinical Quality Review Group CIFT Camden and Islington NHS

Foundation Trust CNWL Central North West London NHS

Foundation Trust CSCB Camden Safeguarding Children’s

Board DoLS Deprivation of Safeguard Liberties DVA Domestic Violence and Abuse ED Emergency Department IAPT Improving Access to Psychological

Therapies iCope Local IAPT Service IDSVA Independent Domestic and Sexual

Violence Advisor IPU Integrated Practice Unit IRIS Identification & Referral to Improve

Safety LBC London Borough of Camden LCS Locally Commissioned Services LSCBs Local Safeguarding Children’s

Boards LCW London Central and West

Unscheduled Care Collaborative MCA Mental Capacity Act MDT Multidisciplinary Team NE Never Event NEWTT Neonatal Early Warning Trigger and Track

NHSE NHS England NHSI NHS Improvement NICE National Institute for Health and Care

Excellence PEWS Paediatric Early Warning System PMVA Prevention and Management of

Violence and Aggression PROMs Patient Reported Outcome Measures PWPs Psychological Wellbeing

Practitioners QAS Quality Alert System QISTs Quality Improvement Support Teams QSC Quality and Safety Committee QIPP Quality Innovation Productivity and Prevention RFL Royal Free London Foundation Trust RTT Referral to Treatment SAPB Safeguarding Adults Partnership

Board SAR Safeguard Adults Review SI Serious incidents STP Sustainability & Transformation

Partnership TAP Team Around the Practice T&P Tavistock and Portman NHS

Foundation Trust UCLH University College London Hospital

NHS Foundation Trust VBC Value Based Commissioning RCGP Royal College of General

Practitioners WRAP Workshop Raising Awareness on

Prevent

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Executive summary

This report provides an update on Provider quality and safety, including medicines management and the CCG’s statutory duties under safeguarding children and vulnerable adults. The CCG’s Quality and Safety Committee (QSC) received reports from Camden Diabetes Integrated Practice Unit (IPU), Primary Care Extended Access, Care Home and Care Agency Quality Assurance report, InHealth Diagnostics, Team Around the Practice (TAP), Improving Access to Psychological Therapies (IAPT), Primary Care Locally Commissioned Services – Universal Offer, North Central London (NCL) SI Trend Report, Quality Alerts System, Domestic Violence Project update, Quarterly Safeguarding Children’s report, Quarterly Safeguarding Adults report, and the Camden Medicines Management Committee. The Quality and Clinical Effectiveness Risk Register is reviewed monthly. Key points and actions from these reports and discussions are noted below. University College Hospital London (UCLH) UCLH provided assurance on the Trust wide implementation the National Early Warning Scores (NEWS). The Trust have investigated a number of incidents where failure to recognise the deteriorating patient and escalation to an appropriate senior clinician were identified as areas which required improvement. Accurate recording and escalation of NEWS is vital to patient safety, as it provides standardised notation of critical signs for patients in acute settings. Modified versions are available within paediatrics, Paediatric Early Warning Score (PEWS) and Neonatal Early Warning Trigger and Track (NEWTT). Clinical Harm Reviews (CHRs) were undertaken by the Trust on patients who have breached the Referral to Treatment (RTT), and 62 day cancer targets. There have been no incidents of harm associated with waiting times reported to date. UCLH cancer collaborative is one of five pilot sites selected by NHSE in November, to trial a new ‘quality of life metric’, using questionnaires to measure the effectiveness of support for individuals following treatment for cancer. The metric will be used within breast, colorectal and prostate cancer divisions. Royal Free London (RFL) The Trust reported four Never Events (NE) since the last report to the GB - one of a retained foreign object, treatment in the wrong eye and two related to excision of carcinomas. Barnet CCG as lead commissioner have requested a report for the next CQRG in January 2018 which sets out the thematic issues arising from these eight Never Events since April 2017.

CHRs are undertaken by the Trust on all patients who have breached waiting times and are reported at CQRG. There have been no incidents of harm associated with waiting times reported to date.

The Trust is addressing the safety of patients in A&E by using the ED checklist recently developed by NHSI.

Camden and Islington Foundation Trust (CIFT) The Care Quality Commission (CQC) carried out a re-inspection during the week commencing 4th December 2017, following their inspection in February 2017. Camden CCG had not received feedback following this visit at the time of producing this report.

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The Trust works collaboratively with the London Boroughs of Camden and Islington, in relation to their Safeguarding processes. In order to create synergy with the organisations and to streamline processes, the Trust have developed a single referral form which will be used by both boroughs. CIFT are reporting non-compliance against a number of training modules, including some mandatory modules. Compliance against mandatory training was identified by the CQC as a concern when they inspected the Trust in February 2017.

1. Prevention and Management of Violence and Aggression (PMVA). 2. Information Governance. 3. Basic Life Support (BLS) and Immediate Life Support (ILS). 4. Conflict Resolution.

There were a number of reasons cited for this including, issues with obtaining funding and the availability of external trainers to provide these sessions. Assurances have been provided at CQRG to the lead commissioner that there are robust action plans in place to achieve rapid recovery in compliance rates. Central and North West London Foundation Trust (CNWL) CNWL provides Continuing Health Care (CHC) assessment services for the CCG. Some of these packages of care can be restrictive resulting in a deprivation of the patient’s liberty under Article 5 of the Human Rights Act 1998. Authorisation for such situations of deprivation of liberty are not covered by the DoLS legislation. The Trust policy on Mental Capacity Act (MCA) and Deprivation of Liberties Safeguards (DoLs) does not cover this and is being followed up with the Trust by the CCG’s Designated Professional for Safeguarding Adults. A desktop analysis of care packages is being undertaken and will be shared with the CCG. The Trust confirmed at CQRG that they have identified cases to date. North Central London (NCL) Quarter 2 Serious Incident Trend Report The QSC received the above report which captures themes and trends identified within investigation reports for Serious Incidents (SI), which occurred within Trusts during Q2. The top themes identified from the SI reports across all the NCL Providers reviewed during Q2 are:

1. Communication. 2. Staff knowledge and training. 3. Deviation from policy / protocol. 4. Documentation. 5. Clinical decisions and escalation.

Assurances regarding the implementation of learning from SI actions plans is obtained through lead commissioners and their respective acute providers. Care Home and Care Agency Quality Assurance report All Camden Care Homes in the borough have been rated as ‘Good’ by the CQC with the exception of Wellesley Road who has a rating of ‘Requires Improvement’, as reported in May 2017. An improvement plan was developed collaboratively with Shaw Healthcare, who manage Wellesley Road, and the London Borough of Camden. Regular monitoring meetings occur with the Provider, Local Authority and the CCG, to review progress against this plan. The CQC conducted a follow up inspection in September and the initial feedback was good. The final inspection report was not available at the time of writing this paper.

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Camden Diabetes Integrated Practice Unit (IPU) The Integrated Commissioning Committee approved a 12 month extension for this contract with the RFL from 01 April 2018, subject to the requirement for the RFL, as lead provider, to agree a quality and safety reporting schedule, including medicines optimisation. Camden CCG have discussed and agreed the details of the quality schedule where the service not only monitors and reports on quality and safety issues specific to the service, but also demonstrates a process of continuous learning and improvement. Agreement has been reached between the CCG’s Medicines Management Team and RFL on the medicines management section of the broader quality and safety schedule. Team Around the Practice (TAP) The Office of Public Management was commissioned to conduct an evaluation of the TAP service. A final version of the report has now been shared with commissioners. The report highlights that TAP is an effective, well-managed, safe and good quality service that meets unmet need, particularly for patients from BME communities and/or who do not quite meet the criteria for secondary care services. Patients reported positive outcomes in relation to their mental wellbeing, as well as their functioning at work and socially, with 91% of 123 respondents said they would recommend TAP to others. Improving Access to Psychological Therapies (IAPT) The Five Year Forward View for Mental Health, sets out the expectation that IAPT services will be offered to an increased cohort of patient’s year on year. NHS England expects at least 50% of those completing IAPT treatment to move to recovery. In 2017/18, Camden’s recovery rate has exceeded the national target every month. The mean recovery rate for the first two quarters of 2017/18 is 51.3%. Nationally, there is a concern that NHS England plans to withdraw funding for Psychological Wellbeing Practitioners (PWPs). PWPs make up a large part of Camden’s iCope service (44% of first assessments during Q1and 2 of 2017/18 were carried out by PWPs) and impact of these NHSE plans would need to be considered should they go ahead. Primary Care Locally Commissioned Services – Universal Offer The Universal Offer (UO), supporting a number of local and national priorities, was implemented on 01 April 2017, in response to moving towards population health based commissioning. This further supports the commitment to delivering universal coverage of local commissioned services to improve population outcomes and patient experience by ensuring that, every patient registered with a Camden GP has equal access to all locally commissioned services. The UO supports delivery of the GP Five Year Forward View through growing and developing workforce, driving efficiencies in workload and relieving demand. This was the first report received by the QSC and assurances were provided regarding the alignment of this with other primary care workstreams and priorities across the Sustainability Transformation Partnership (STP), including the development of neighbourhoods and Quality Improvement Support Teams (QISTs). The focus of this work on the UO in 2017/18 has enabled a more critical look at quality and performance on a neighbourhood scale. In 2017/18 the processes for monitoring locally commissioned services have been significantly strengthened. It is difficult to give a full update on quality monitoring at this time, as much of the audit and other work is not due until the end of the year, and will be included in the next report to the QSC.

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Primary Care Extended Access The Extended Access Service provided an update regarding the quality and safety of this service provided by Haverstock Health, prior to the transfer of this service to a new provider ATMedics, on 01 December 2017. There have been no Serious Incidents reported within this service since its inception. Assurances have been regularly provided to the QSC regarding the learning and dissemination of learning from incidents and near misses, which are discussed during governance meetings. Quality Alerts System (QAS) The QSC received a report identifying themes during Q2 through Quality Alerts received by the Quality and Safety team for commissioned providers. The key themes are centred on communication with GPs and patients, concerns whereby patients are discharged after one non-attendance, failure to communicate changes to medications, and delays in communicating results of investigations with GPs. In order to strengthen processes to triangulate information regarding the quality and safety of these commissioned services the CCG has established meetings with the GP liaison officers at UCLH and the RFL to triangulate data, explore how this correlates with information obtained through complaints and understand the governance arrangements for managing these alerts within these organisations. Domestic Violence and Abuse Project The QSC received a report on the progress of the two projects. The first of these is Hospital based Independent Domestic and Sexual Violence Advisor (Hospital IDSVA) in both Royal Free and University College London Hospitals and the second is the IRIS project (Identification & Referral to Improve Safety). The IDVSA are based within UCLH and the RFL hospitals and co-located with the Safeguarding leads within both organisations. They provide training and raising awareness sessions within the hospitals for medical staff, to assist with the identification of domestic violence cases by encouraging staff to routinely ask questions and refer victims of abuse to appropriate specialist support. Solace Women’s Aid have been re-commissioned to deliver a training and support programme targeted at primary care clinicians and administrative staff, leading to improved referral to specialist domestic violence services, and recorded identification of women experiencing domestic violence. It is important that all Camden GP Practices engage in the IRIS project and the Named GP lead for safeguarding adults is following this up with a handful of practices who to date have not engaged with the programme. Quarterly Safeguarding Children’s report Assurances were provide to the QSC with regards to the safeguarding arrangements for children in Camden. Training Compliancy for Governing Body Members has improved and is now at 77%, following the election of new members during the summer. Additional training slots will be provided in the New Year to achieve full compliancy. CCG Staff training compliancy has fallen during Q2. Directors have been asked to review this mandatory training compliance within their directorates. Compliance issues with mandatory safeguarding training within local Providers was noted by the QSC.

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The Department of Education are currently out to consultation on the document “Working together to Safeguard Children”. This consultation takes account of the legislative changes introduced through the Children and Social Work Act 2017 which recommended the replacement of Local Children Safeguarding Boards (LCSBs) with new local arrangements led by 3 partners – the local authorities, chief officers of police, and clinical commissioning groups, and places an equal duty on those partners to make arrangements to work together and with any relevant agencies for the purpose of safeguarding and promoting the welfare of children in their area. This new guidance will underpin the Children & Social Care Act 2017 and articulate the changes and responsibilities that the CCG will have for safeguarding children. The consultation closed on 31 December 2017, the full report is expected to be published in April 2018 Ofsted Inspection Ofsted inspected Children’s Social Care Services, Children in need of help and protection, Looked After Children and Care Leavers and reviewed the Safeguarding Children’s Board in September 2017; their report was published in November. The Ofsted inspectors judged the work of the Board as “outstanding” and found “highly effective arrangements and exceptional commitment to continuously improve frontline practice”. Camden were one of only seven boroughs across the country to achieve this rating. Safeguarding was found to be integrated across the partnership, with robust governance arrangements, strategic priorities were based on local need. This was evident within the work of the sub-groups, which were identified by the inspectors as a real strength. The report was highly complementary of the effectiveness of Serious Case Review (SCR) workshops and commented how the focus on inclusion of GPs has led to an increase in referrals from this group. This inspectors reported strong evidence that Camden CCG is fulfilling its statutory requirements under section 13 of Children Act 2004. Quarterly Safeguarding Adults Report Assurances were provide to the QSC with regards to the safeguarding arrangements for adults in Camden. Safeguarding Training for new Governing Body members was delivered in November 2017, to maintain compliance. The Named GP and Designated Nurse facilitated a training event for GPs on domestic abuse, safeguarding adults and mental capacity in September. The session focused on learning from a recent Camden Domestic Homicide Review and Safeguarding Adult Review, safeguarding leads from 27 practices attended. Majority of our local Providers were compliant with their safeguarding adults training with the exception of Tavistock and Portman. Prevent NHS England identified Tavistock and Portman, UCLH and the Royal Free Hospital as being at significant risk of not meeting the compliance target of 85% for level 3 Workshop to Raise Awareness of Prevent (WRAP) training and required them to submit a training needs analysis and plan to address this. The providers complied with the request and have received offers of support through ‘train the trainer’ events on a shorter version of the WRAP. Trusts continue to provide quarterly updates for Prevent and will benefit from the launch of a new E-Learning for Health package due in December 2017 which will also meet level 3 requirements. GPs are required to demonstrate level 3 competency in Prevent and will soon be able to benefit from the new e-learning package to enable them to meet this requirement. NHSE have contacted all Prevent leads to be mindful of the ways in which their health platforms and premises are being used by external organisations, and to make sure that this usage does not directly contravene with our shared values. This has arisen from a recent incident where an NHS provider rented

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out a space to an external group and realised afterwards that their business involved extreme right wing views. As a result they are highlighting the need for all NHS organisations to be clear on who they are allowing to use their premises. Safeguarding Adult Reviews (SAR) A SAR was commissioned by the Safeguarding Adults Partnership Board (SAPB) following the death of an adult, known as YY, who had significant health and social care and support services and who often did not wish to engage with services or follow advice. This has been published, the following recommendations are specific to health:

1. Hospital discharge processes should achieve shared agreement with community based professionals on arrangements for care and rapid response plans for those who do not engage or decline care. This includes greater engagement with GPs and Safeguarding leads.

2. The SAPB should seek assurance from agencies that staff make use of national guidance issued by the National Institute for Health and Care Excellence (NICE) on the recognition and treatment of eating disorders, and are aware of the local referral pathways to access specialist eating disorder services.

3. Learning from this SARs was a key component of within the Annual Safeguarding Adults Conference in November 2017. The CCG will contribute and provide assurance of the contribution to the multi and single agency actions in response to the SAR.

Camden Medicines Management Committee (CMMC)

The CMMC’s focus at the December meeting was on 2018-19 QIPP schemes and the challenge for Camden where locally (NCL and London) and nationally it is benchmarked as one of the most efficient prescribing in primary care.

Also discussed was the impact of some national guidances relating to the Misuse of Drugs Regulations, and Responsibilities for prescribing between primary and secondary care.

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Report Title Proposal to take in house a range of

Commissioning Support Unit Services



Lead Director Paul Sinden, NCL Director of Performance and Acute Commissioning


Report Author David Stout, Senior Programme Director



Helen Pettersen Tel/Email [email protected]

Report Summary

This report sets out a proposal to take in-house a range of services from North East London Commissioning Support Unit (NELSU) to the five CCGs across North Central London.

Purpose Information

Approval

√

To note

Decision

Recommendation The Governing Body is asked to: Note the report Support the proposed approach Approval to give notice to NELCSU of the CCGs intention to bring

services in-house


The in-housing of the provision of a range of NELCSU services will contribute to the successful delivery of all the CCG’s objectives.


There are a number of risks which will be managed through the transfer process. A full register will be developed as part of the change programme to ensure risks are considered and mitigated.


None


Section 6.4 of the report sets out the financial work to be undertaken in relation to the proposal.

Engagement

N/A


N/A

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N/A

Next Steps Section 4 of the report sets out the financial work to be undertaken in relation to this proposal.

Appendices

None.

44

Proposal to take in-house a range of Commissioning Support Unit Services

1. Introduction This paper sets out a proposals to take in-house a range of services currently provided by North East London Commissioning Support Unit (NELCSU) to the five CCGs across North Central London (NCL).

The paper sets out the key issues which will need to be considered and an outline timetable, together with a proposed project approach.

2. Background NELCSU provides a range of services to NCL CCGs under a service level agreement (SLA) with a total value of £16.0m in 2017/18, which reduces to £15.4m in 2018/19 – see Appendix One for details.

Over the last few weeks the CCG management team has reviewed the current service provision from NELCSU in light of the new management arrangements for the five NCL CCGs and the development of the NCL Sustainability & Transformation Partnership (STP).

The review concluded that it would be beneficial to bring in-house NELCSU’s Point of Delivery Multi-Disciplinary Team (POD MDT) services for the NCL CCGs. This conclusion was not driven by concerns about the quality of the services provided, but that this change would support work to reduce duplication across the five boroughs, provide improved value for money and better support the CCGs. It would also deliver a more effective alignment of these services with the new CCG management structures across the 5 CCGs and with the NCL STP footprint.

There have been informal discussions with senior managers within NELCSU who have confirmed that they understand the logic of these proposed changes and that they will work with NCL CCGs to ensure the proposed changes are managed effectively.

The next step is for the five NCL CCGs to give formal notice to NELCSU. This paper seeks approval from the Governing Body to proceed to give notice.

3. Proposed approach We recognise that changes of this sort bring risks. Therefore we want to approach these proposed changes collaboratively between the CCGs and the CSU so that this is a shared change programme. We believe that this will maximise the likelihood of a successful transfer and minimise the risk of loss of confidence of staff and of unintended consequences on remaining CSU services so that services are effectively maintained during the transition period.

We want to implement these changes as quickly as is reasonable without compromising due process. This will enable us to minimise the period of uncertainty for staff. As such we will need to discuss whether it would be appropriate to transfer services more quickly than the formal 6 month notice period as specified in the SLA.

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4. High level deliverables and timetable At a high level, the proposed deliverables and timetable are as follows:

CCG Governing Body agreement of intention to take a range of CSU services in house – January 2018

Confirmation of services to transfer – January 2018 CCGs to issue formal notice to CSU – end January 2018 Agreement of structure for CSU staff to transfer into within the CCGs – February 2018 Sign off NHS England business case – February 2018 Formal consultation with CSU staff – up to three months from beginning of March 2018 Sign-off of decisions following consultation – early June 2018 Agreement of asset transfer details – June 2018 Agreement of revised SLA value for services remaining with CSU – by June 2018 Transfer of staff to be completed – 1 July 2018 (preferred date but subject to agreement with

CSU regarding notice period)

The issues which will need to be addressed to achieve this timetable are set out in the next section of this paper.

5. Implementation There are two phases to the implementation:

Phase 1 – Mobilisation, Due Diligence & Decision Making Develop an overarching HR work stream plan ensuring that all parties are working to an agreed

timetable and within agreed governance arrangements. Identify and develop a risks and issues log and escalate/propose mitigation as appropriate to NCL

SMT. Oversee the joint consultation and engagement with NELCSU, and staff side for both sender and

receiver organisations. Work with NELCSU to manage staff communications and responses to questions from staff, key

stakeholders and staff side within an agreed communications protocol. Develop a score card of key metrics as part of the reporting process for the NCL CCG Senior

Management Team (SMT). Working closely together with NELCSU to consider what staff well-being interventions need

developing as part of the support offer to staff Develop a dependencies log as appropriate e.g. estates, finance, communications.

Phase 2 – Transition Implementation

Oversee the implementation of the work stream plan, ensuring that all staff are appropriately jointly consulted on the HR transition process and are treated in a fair and consistent manner.

Monitor progress, and continue to mitigate/escalate risks and issues, and provide regular reports to NCL CCG SMT

Oversee the TUPE/COSOP transfer to receiver organisations under management of change policy

6. Issues

46

6.1 Confirmation of services to transfer We have agreed that we intend to transfer the POD MDT services back in-house. These currently comprise approximately 84 staff.

There may however be some further central CSU services which it would make sense to also transfer where they are integral to the work of the POD MDT and so to dislocate them would not make operational sense. There may also be other changes instigated by other STP areas in London or the London-wide work on business intelligence which may have a knock-on effect which will need to be taken into account. We will confirm the full scope of services to transfer during January. We will also agree what degree of redesign of these services we wish to achieve during the transfer.

6.2 HR issues We will ensure that any HR issues associated with the transfer are addressed. Michelle Chadwick, Director of HR/OD, NCL CCGs will provide expert HR advice. This will include agreement of which CCG will employ the staff transferring from NELCSU.

6.3 Estates/assets We will need to ensure that we have adequate office accommodation for any staff who transfer. CSU POD MDT staff already spend significant portions of their time in CCG accommodation, but also spend an amount of time back in CSU HQ at Clifton House. We need to consider whether we still need a central location to bring them together and if so whether we continue to use Clifton House in the short term or find an alternative location within the NCL CCG footprint. We also need to ensure planning for relocation from Stephenson House for Camden CCG takes the accommodation needs of transferred staff into account.

In principle we would expect transferring staff to bring associated assets with them (most notably IT kit). However we need to consider compatibility of IT kit with local CCG systems.

6.4 Finance We have already agreed financial savings as part of the existing SLA for CSU services (see Appendix One). The POD MDT services which transfer will incorporate these cost reductions. If we wish to achieve further savings on services which transfer then this will need to be included as part of any service redesign.

We will need to agree a revised SLA value for the CSU services which will continue to be provided to NCL CCGs from the date of transfer. We recognise that the transfer of services may leave the CSU with some stranded costs as a result of for example vacated office space or management overheads. The expectation is that these will be short-term as they can be anticipated and planned for. However we will need to agree the value of any stranded costs and timescale which they will remain alongside the pricing of the remaining services.

47

Matt Backler, Deputy Director of Finance, Barnet CCG will lead finance input into the process. We will ensure that CCG audit committees are briefed on the transfer process.

6.5 Communications/stakeholder engagement Excellent communications will be key to success. Communications with CSU staff and CCG staff need to be regular and consistent throughout the process. The approach will need to be agreed, but is likely to be in the form of a regular newsletter/email, backed up by line management briefings and periodic open staff meetings throughout the process. During the staff consultation period, these will be particularly critical. Initial communications have been sent to staff affected within NELCSU and to CCG staff.

There will also be a need for wider stakeholder management. In particular there will be a need to engage NHS England and the other CCGs/STPs in London to ensure that we have a mutual understanding of plans in relation to the CSU.

7. Project Management and oversight Clearly this change programme is complex. David Stout has been asked to act as Programme Director to oversee the work, reporting to Paul Sinden (Director of Performance & Acute Commissioning, NCL CCGs) and liaising directly with Steve Rubery (CSU sector director – North London)

We will establish a project team to oversee the work from January 2018. The Project Team will report to the CCG SMT and to the CSU executive management team.

We propose to establish a CCG Governing Body subgroup with membership from each of the five CCG bodies to provide oversight of the transfer process.

8. Conclusion The Governing Body is asked to:

Note the report; Support the proposed approach; and Agree to give notice to NELCSU of the CCG’s intention to bring services in-house

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Appendix One

NCL SLA ValuesClosing 16/17

Barnet CCGCamden CCG Enfield CCG

Haringey CCG

Islington CCG NCL Total

Business Support Services 296,325 375,896 346,856 219,578 137,870 1,376,525Comms 38,204 36,952 36,042 23,380 23,380 157,958Continuing Health Care 0 0 0 0 0 0Contracting 1,820,871 1,388,570 1,486,996 1,338,516 1,122,019 7,156,972Finance Services 306,744 273,383 306,911 234,593 281,136 1,402,767FOI 0 6,929 7,208 0 0 14,137HR 137,623 136,045 144,922 107,676 80,154 606,420IFR Process Management 117,715 79,403 53,709 43,041 154,080 447,948

Medicines Management (Primary and Secondary Care) 41,254 41,992 39,684 39,860 43,920 206,710Quality 70,581 54,039 61,901 56,695 50,913 294,129Reporting & BI 1,111,508 812,611 989,924 921,063 862,199 4,697,305

3,940,825 3,205,820 3,474,153 2,984,402 2,755,671 16,360,871

2017/18 Percentage Reduction 2.5%


Haringey CCG




3,842,304 3,125,675 3,387,299 2,909,792 2,686,779 15,951,849

2018/19 Percentage Reduction 3.5%


Haringey CCG




3,707,824 3,016,276 3,268,744 2,807,949 2,592,742 15,393,535

NCL

NCL

NCL

49


Report Title Finance and QIPP Report November

2017

Agenda Item 4.1 Date 17 January

2017


Lead Director Simon Goodwin, Chief Finance Officer


Report Author Becky Booker, Deputy Director of Finance



Dr Birgit Curtis, Finance, Performance & QIPP Committee Chair


Report Summary

This report sets out the CCG’s financial position at the end of month 8, November 2017 and the latest position with regard to QIPP.

Purpose (tick one box only) [See note 6]

Information

Approval To note ✓

Decision



Maintain financial stability and ensure sustainability through robust planning and commissioning of value-for money services


This report sets out the financial risks and opportunities for 2017/18.


None


This report sets out the CCG’s financial position at the end of November 2017 together with the forecast spend for the year.

Engagement

Not applicable for the purpose of this report.




The Governing Body receives regular Finance and QIPP updates.

51

Next Steps Continued oversight by the Finance and Performance Committee.

Appendices

Not applicable

52

Camden Clinical Commissioning Group (CCG)

Finance Report: 1 April 2017 to 30 November 2017 (Month 8) 1. Introduction 1.1 This paper presents to the Governing Body of Camden Clinical Commissioning Group the finance and

QIPP performance position as at month 8, November 2017. 2. Executive Summary 2.1 The month 8 financial performance can be summarised as follows: Table 1: Financial Performance Summary

2.2 At month 8 the CCG is forecast to meet its control total of £414.7m for financial year 2017/18.

2.3 In month 8 the CCGs total expenditure budget increased by £6.7m from £408.0m to £414.7m. This

increase is mainly due to receiving the allocation for overseas visitors.

53

Working with the people of Camden to achieve the best health for all 2

2.4 Within this, the CCG is forecasting over-performance of £7.6m. This over-performance is due to:-

acute spend over-performance £4.5m non-acute spend over-performance £2.3m primary care delegated commissioning cost pressure £1.5m Less under-spends in investment (£0.1m) Less underspends in general overheads (0.6m)

2.5 Over-performance is contained within the CCGs control total by use of contingencies and non-recurrent reserves.

2.6 The most significant points to note include:- There has been a small decrease in acute over performance from £4.8m in month 7 to £4.5m in

month 8.

The main areas of over-performance in the acute trusts continue to be Royal Free £2.8m, UCLH £1m and Imperial £1m.

The main point of delivery (POD) driver for over-performance in the acute sector is non-elective

expenditure, being £5.9m at month 8.

The non-acute sector if forecasting a year-end over-performance of £2.3m at month 8. This is an increase on reported over-performance by £0.8m from £1.5m at month 7. The main over-performance services are,

Continuing Health Care (CHC) £0.9m Mental Health Services £0.2m Learning Disabilities £0.1m Children Services £0.4m Primary Care Prescribing £0.7m

The main movement from the month 7 position is £0.7m over-performance against the Primary

Care Prescribing. This over-performance relates to £1m for no cheaper stock available (NCSO’s) medicines. This is offset by £0.3m under-performance in other budget lines.

Financial risks and mitigations are detailed in section 8. Unmitigated financial risks at month 8 are £2.5m, this risk is being proactively managed through the £2.8m financial recovery plan in place.

The CCG control total has been met by use of reserves and contingencies that have been

released to offset over-performance.

3. Acute Expenditure

3.1 Acute contracts are forecast to overspend by £4.5m at year end. The current year to date over-performance is c£3.3m. Table 2 below shows the acute spend per provider. Where appropriate the marginal rate and STP QIPP on acute contracts has been applied. Table 2: Acute Expenditure

54


3.2 Details of acute spend by point of delivery (POD) is detailed in table 3 below. At POD level the main drivers of over-performance continues to be non-electives, £6.2m and diagnostic imaging, £1.7m slightly offset by an under spend in electives of £1m. Table 3: Expenditure at POD Level

Table 4: Expenditure at POD Level by Trust

55


4. Non-Acute Expenditure

Table 5: Non Acute Expenditure

56


4.1 At month 8 non-acute is forecasting an over-performance of £2.3m at year end. This is a £0.8m increase in the month 7 position of £1.5m. 4.2 An area of over-performance remains Continuing Healthcare which continues to forecast over-performance of £0.9m. In addition Quality & Clinical Effectiveness is now forecasting an over-performance of 0.7m. This is driven by an over performance within Prescribing (£1m) due to NCSOs. At month 8 this is offset by circa £0.3m of under-performance on other service lines. 4.3 The other main pressure areas, as previously reported, continue to be Mental Health £0.2m and Children’s Services £0.4m.

5. Delegated Primary Care Commissioning Expenditure

5.1 The below table 6 provides a summary of the delegated primary care commissioning budget to expenditure. As at month 8 this service is reporting a cost pressure of £1.5m. Table 6: Delegated Primary Care Commissioning

6. Other Budgets

6.1 Investment programmes budgets, which includes programmes for Primary Care, Children and Mental Health of £8.3m are forecast to deliver a £0.1m underspend by the end of the financial year against a budget of £8.3m 6.2 Running costs are forecast to deliver on target. These costs include the CSU contract, estates charges and staffing.

7. QIPP

7.1 The total QIPP plan is £18.1m. At month 8 the FOT is £16.6m, an underperformance on QIPP of £1.5m.

57


Table 7: QIPP Summary

8. Risks and Mitigations

The below table 8 provides details of the financial risks and mitigations as at month 8. A recovery plan for £2.8m is identified to proactively manage this risk. Table 8: Risks and Mitigations

58


9. Summary

9.1 As at month 8 Camden CCG is reporting to meet its 2017-18 control total of £414.7m. Within this the CCG is proactively managing potential financial over-performance.

9.2 The most significant areas of risk are QIPP slippage, acute contract over-performance and the Continuing Healthcare service.

59


60


Report Title Integrated Performance Report

Agenda Item

4.2

Date 10/1/2018

Lead Director Charlotte Mullins, Director

Sustainable Insights

Tel/ Email

[email protected]

Report Author Richard Cartwright Head of Performance

Tel/ Email

[email protected]

Sponsor(s) (where applicable)

Dr Birgit Curtis Tel/ Email

[email protected]

Report Summary The Integrated Performance Report reports on provider performance against the

constitutional targets, financial performance, quality and outcomes. The main areas of concern for the CCG are currently performance against the A&E, 62 day cancer, and RTT waiting times standards.

Purpose (tick one only)

Information Approval To note

Decision

Recommendation The Governing Body is asked to note the contents of the October 2017 Integrated Performance Report.


Commission the delivery of NHS Constitutional rights and pledges Improve the quality and safety of commissioned services


These are identified within the report.



Engagement




Report History This report is a standing item on the Governing Body agenda.

Next Steps None

Appendices None

61

Integrated Performance ReportGoverning Body January 2018

63

Key messages:

• RTT, Cancer waiting times and A&E 4 hour waits are the key areas of concern and focusfor the CCG.

• In November London was ranked 3rd of the four regions for A&E performance for themonth with 16 of 22 Trusts not achieving the 95% standard.

• The CCG developed a comprehensive winter plan, with priority actions identified withinthe refreshed UCLH RAP. Assurance around the impact of winter planning is beingprovided to NHSE and NHSI through regular joint meetings and calls with UCLH. The RAPand winter planning will be proactively managed via the new A&E delivery board whichwill now be jointly chaired by Camden CCG and UCLH.

• October RTT performance for Camden was impacted by both Royal Free and UCLH notmeeting the standard. The CCG’s year to date position is currently meeting the standard,however expected underperformance in future months will mean that this is not thecase.

• Cancer 62 day performance for Camden has improved significantly. The CCG was close toreporting a compliant position in October.

• The CCG did not meet the diagnostics standard in October. This was largely driven byunderperformance at the Royal Free.

1. Access 1.1 CCG Operating Plan Targets

Camden CCG 2017/18 Performance Scorecard

Target/

Threshold

RTT Incomplete Pathways within 18 Weeks 92% Oct-17 91.2% 92.0%

RTT 52+ week waiters 0 Oct-17 12 49

Diagnostics Diagnostics - 6+ week waiters 99% Oct-17 98.8% 98.7%

A&E 4 Hour Waits 95% Nov-17 87.3% 85.6%

Delayed Transfers of Care - Acute - Oct-17 315 2327

Delayed Transfers of Care - Non-Acute - Oct-17 272 1363

Total delayed days per 100,000 18+ population

- Oct-17 296 n/a

2 week wait 93% Oct-17 93.9% 93.9%

2 week wait breast symptomatic 93% Oct-17 100.0% 96.2%

31 day 1st definitive treatment 96% Oct-17 98.0% 97.8%

31 day 1st subsequent treatment - surg. 94% Oct-17 83.3% 89.5%

31 day 1st subsequent treatment - chemo. 98% Oct-17 100.0% 100.0%

31 day 1st subsequent treatment - radio. 94% Oct-17 100.0% 99.0%

62 day standard 85% Oct-17 84.0% 84.5%

62 day standard - screening 90% Oct-17 100.0% 100.0%

62 day standard - upgrade No Target Oct-17 100.0% 97.5%

Mixed Sex Mixed Sex Accommodation Breaches 0 Oct-17 5 33

MRSA Reported Cases (CCG Assigned) 0 Oct-17 0 1

C.Difficile Reported Cases Oct-17 3 42

Cat A (RED1): Response within 8 Min 75% Oct-17 79.2% 81.1%


Cat A: Response within 19 Min 95% Oct-17 94.9% 94.7%

Cat A (RED1) Trajectory - Oct-17 75% 75%



Cat A: Response within 19 Min 95% Oct-17 94.9% 94.6%

CPA Follow-ups 95% 2017/18 Q2 93.8% 96.1%

IAPT Access 4% 2017/18 Q1 4.8% 4.8%

IAPT Recovery Rates (NB national data presented) 50% 2017/18 Q1 47.0% 47.0%

6 Weeks IAPT Waiting Times 75% Aug-17 89.0% 88.1%

18 Weeks IAPT Waiting Times 95% Aug-17 100.0% 99.3%

Dementia Diagnosis Rate 67% Oct-17 89.0% 88.1%

Psychosis (EIP) - 2 Week Wait, NICE approved package 50% Oct-17 100.0% 95.5%

Eating Disorders Waiting Times (4Wk Routine) 95% 2017/18 Q2 100.0% 94.0%

Eating Disorders Waiting Times (1Wk Urgent) 95% 2017/18 Q2 No activity No activity

New children and young people receiving treatment from

NHS funded community services30% 2017/18 Q2

Await MHSDS

V2 data, tbc

Await MHSDS

V2 data, tbc

Individual children and young people receiving treatment

by NHS funded community services30% 2017/18 Q2

Await MHSDS

V2 data, tbc

Await MHSDS

V2 data, tbc

Utilisation of e-RS booking

50% (April 2017)

80% (Oct 2017)Sep-17 42.0% 43.0%

Wheelchair

ServiceRTT Childrens Wheelchairs within 18 Weeks 100% 2017/18 Q2 90.9% 95.5%

PHBs per 100,000 GP registered pop.11.23 (2017/18 Q1) 2016/17 Q4

12.9

n/a

Camden CCG -

Current monthTrend

Camden CCG -

YTDTrend

e-RS

Personal Health

Budgets

Cancer - 31 day

Cancer - 62 day

HCAIAnnual

RTT

LAS

(Camden)

LAS

(London wide)

Mental Health

A&E

Indicator Type

Camden DTOCs

(days)

Cancer - 2

week

Reporting Period

64

RTTUCLH became non-compliant in July against the 18 Weeks RTT standard for the first timesince 2014 despite demand not appearing to be increasing. As part of the ongoing workaround data assurance, RTT data performance is being triangulated with activity and referraldata to further understand the issues behind RTT underperformance and activity.Preliminary findings suggest that capacity issues, not booking patients in order andelongated pathways are the cause of the drop in performance.An RTT recovery plan is in place at the Trust which has been reviewed and agreed by theCCG, and the Trust is currently forecasting compliance with the RTT standard from March2018. Specialty level recovery trajectories are being closely monitored by the CCG and theissue managed in accordance with the CCG’s performance management framework.

DiagnosticsUCLH returned to compliance in the diagnostics standard in July, and is reporting a strongcompliant year to date position.The Royal Free Diagnostics position appears to be driven by performance at the Hampsteadsite, as Enfield and Barnet CCG’s performance has not been impacted to the same extent.

A&EThe UCLH A&E RAP has been refreshed, prioritising key areas which will drive A&Eperformance. These areas have been identified following detailed analysis of the drivers ofunderperformance. Through this exercise timelines have been re-established, actionsclarified and clear accountability structures established for each of the work packages. Thetrajectory has also been refreshed alongside the RAP to indicate the impact of each workpackage and to monitor performance. This will be proactively monitored at the A&E deliveryBoard.

CancerUCLH returned to compliance in the 31 Day Standard in October, following five months ofnon-compliance. The Trust has also achieved the 2WW Breast Symptomatic standard thismonth following non-compliance in September.UCLH have seen strong improvement against the 62 day standard, particularly against theinternal performance trajectory set in the RAP. An external clinically led review is currentlyunderway at the Trust and will recommend new actions to further improve performance.Once the review is complete the recommended actions will be added in to the existing RAP.

Royal Free performance is managed by Barnet CCG. Camden CCG works closely withcolleagues from Barnet, and across NCL to ensure that performance issues that impactCamden patients are resolved.

1. Access1.2 Provider Access Targets

London A&E PerformanceIn November London was ranked 3rd of the four regions for A&E performance for the month with 16 of 22 Trusts not achieving the 95% standard.

NCL A&E performance

Aug-17 Sep-17 Oct-17

LONDON #REF! 91.0% 90.2% 90.7% 90.4% 89.5% 17.4% 9

North East London 89.8% 89.1% 89.4% 88.7% 88.5% 17.1% 1

BARKING, HAVERING AND REDBRIDGE UNIVERSITY HOSPITALS NHS TRUST 86.2% 87.0% 84.9% 84.2% 85.8% 19.8% 0BARTS HEALTH NHS TRUST 88.7% 86.6% 87.0% 87.2% 85.5% 20.2% 0HOMERTON UNIVERSITY HOSPITAL NHS FOUNDATION TRUST 96.1% 95.6% 95.2% 94.4% 94.5% 18.1% 0MOORFIELDS EYE HOSPITAL NHS FOUNDATION TRUST 98.1% 99.4% 99.5% 97.7% 98.4% 3.0% 0NORTH EAST LONDON NHS FOUNDATION TRUST 99.8% 99.3% 99.7% 99.0% 99.2% 0.0% 0NORTH MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST 80.3% 85.8% 87.2% 77.2% 82.5% 19.3% 0ROYAL FREE LONDON NHS FOUNDATION TRUST 88.7% 84.3% 87.0% 89.6% 86.3% 20.7% 0THE WHITTINGTON HOSPITAL NHS TRUST 90.5% 89.9% 90.1% 87.8% 89.1% 17.2% 0UNIVERSITY COLLEGE LONDON HOSPITALS NHS FOUNDATION TRUST 88.9% 87.9% 88.2% 88.6% 88.6% 22.0% 1

North West London 91.6% 90.0% 91.7% 92.3% 90.2% 14.0% 3

CENTRAL LONDON COMMUNITY HEALTHCARE NHS TRUST 99.6% 98.9% 99.0% 99.9% 99.0% 0.0% 0CHELSEA AND WESTMINSTER HOSPITAL NHS FOUNDATION TRUST 95.3% 93.7% 95.0% 94.4% 92.5% 17.3% 0HOUNSLOW AND RICHMOND COMMUNITY HEALTHCARE NHS TRUST 99.9% 100.0% 100.0% 100.0% 100.0% 0.0% 0IMPERIAL COLLEGE HEALTHCARE NHS TRUST 88.8% 86.9% 86.6% 88.9% 88.1% 17.9% 3LONDON NORTH WEST HEALTHCARE NHS TRUST 85.7% 81.4% 86.7% 89.1% 83.7% 19.1% 0THE HILLINGDON HOSPITALS NHS FOUNDATION TRUST 88.2% 88.0% 89.7% 86.5% 85.3% 15.2% 0

South London 91.6% 91.3% 91.3% 90.6% 89.9% 21.3% 5

CROYDON HEALTH SERVICES NHS TRUST 90.1% 90.9% 94.8% 91.8% 89.0% 20.7% 0EPSOM AND ST HELIER UNIVERSITY HOSPITALS NHS TRUST 94.0% 95.2% 93.7% 94.3% 95.0% 27.8% 0GUY'S AND ST THOMAS' NHS FOUNDATION TRUST 90.7% 91.9% 90.4% 90.3% 88.1% 25.1% 0KING'S COLLEGE HOSPITAL NHS FOUNDATION TRUST 86.2% 85.1% 82.8% 84.5% 83.0% 20.4% 4KINGSTON HOSPITAL NHS FOUNDATION TRUST 91.3% 91.7% 92.6% 92.4% 89.4% 24.8% 0LEWISHAM AND GREENWICH NHS TRUST 92.5% 89.9% 92.3% 85.8% 88.2% 22.8% 1ST GEORGE'S UNIVERSITY HOSPITALS NHS FOUNDATION TRUST 90.0% 90.0% 88.0% 90.6% 89.9% 32.0% 0

# delays >

12 hrs in

current

month

13 month

performance

Performance

(against 95% standard)

Current 12

month

rolling

perf

% A&E

attendances

admitted (12

month rolling)

Previous

12 month

rolling

perf

Aug-17 Sep-17 Oct-17

LONDON #REF! 91.0% 90.2% 90.7% 90.4% 89.5% 17.4% 9

North East London 89.8% 89.1% 89.4% 88.7% 88.5% 17.1% 1

BARKING, HAVERING AND REDBRIDGE UNIVERSITY HOSPITALS NHS TRUST 86.2% 87.0% 84.9% 84.2% 85.8% 19.8% 0BARTS HEALTH NHS TRUST 88.7% 86.6% 87.0% 87.2% 85.5% 20.2% 0HOMERTON UNIVERSITY HOSPITAL NHS FOUNDATION TRUST 96.1% 95.6% 95.2% 94.4% 94.5% 18.1% 0MOORFIELDS EYE HOSPITAL NHS FOUNDATION TRUST 98.1% 99.4% 99.5% 97.7% 98.4% 3.0% 0NORTH EAST LONDON NHS FOUNDATION TRUST 99.8% 99.3% 99.7% 99.0% 99.2% 0.0% 0NORTH MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST 80.3% 85.8% 87.2% 77.2% 82.5% 19.3% 0ROYAL FREE LONDON NHS FOUNDATION TRUST 88.7% 84.3% 87.0% 89.6% 86.3% 20.7% 0THE WHITTINGTON HOSPITAL NHS TRUST 90.5% 89.9% 90.1% 87.8% 89.1% 17.2% 0UNIVERSITY COLLEGE LONDON HOSPITALS NHS FOUNDATION TRUST 88.9% 87.9% 88.2% 88.6% 88.6% 22.0% 1

North West London 91.6% 90.0% 91.7% 92.3% 90.2% 14.0% 3

CENTRAL LONDON COMMUNITY HEALTHCARE NHS TRUST 99.6% 98.9% 99.0% 99.9% 99.0% 0.0% 0CHELSEA AND WESTMINSTER HOSPITAL NHS FOUNDATION TRUST 95.3% 93.7% 95.0% 94.4% 92.5% 17.3% 0HOUNSLOW AND RICHMOND COMMUNITY HEALTHCARE NHS TRUST 99.9% 100.0% 100.0% 100.0% 100.0% 0.0% 0IMPERIAL COLLEGE HEALTHCARE NHS TRUST 88.8% 86.9% 86.6% 88.9% 88.1% 17.9% 3LONDON NORTH WEST HEALTHCARE NHS TRUST 85.7% 81.4% 86.7% 89.1% 83.7% 19.1% 0THE HILLINGDON HOSPITALS NHS FOUNDATION TRUST 88.2% 88.0% 89.7% 86.5% 85.3% 15.2% 0

South London 91.6% 91.3% 91.3% 90.6% 89.9% 21.3% 5

CROYDON HEALTH SERVICES NHS TRUST 90.1% 90.9% 94.8% 91.8% 89.0% 20.7% 0EPSOM AND ST HELIER UNIVERSITY HOSPITALS NHS TRUST 94.0% 95.2% 93.7% 94.3% 95.0% 27.8% 0GUY'S AND ST THOMAS' NHS FOUNDATION TRUST 90.7% 91.9% 90.4% 90.3% 88.1% 25.1% 0KING'S COLLEGE HOSPITAL NHS FOUNDATION TRUST 86.2% 85.1% 82.8% 84.5% 83.0% 20.4% 4KINGSTON HOSPITAL NHS FOUNDATION TRUST 91.3% 91.7% 92.6% 92.4% 89.4% 24.8% 0LEWISHAM AND GREENWICH NHS TRUST 92.5% 89.9% 92.3% 85.8% 88.2% 22.8% 1ST GEORGE'S UNIVERSITY HOSPITALS NHS FOUNDATION TRUST 90.0% 90.0% 88.0% 90.6% 89.9% 32.0% 0

# delays >

12 hrs in

current

month

13 month

performance

Performance

(against 95% standard)

Current 12

month

rolling

perf

% A&E

attendances

admitted (12

month rolling)

Previous

12 month

rolling

perf

UCLH and Royal Free 2017/18 Scorecard Royal Free YTD

Target/

Threshold

Reporting

PeriodPerformance Trend Performance Trend Performance Trend Performance Trend

RTT Incomplete Pathways 92% Oct-17 90.6% 91.7% 86.9% 90.2%

RTT 52+ week waiters 0 Oct-17 5 17 37 109

Diagnostics Diagnostics - 6+ week waiters 99% Oct-17 99.2% 99.3% 98.5% 99.1%

A&E 4 Hour Waits 95% Nov-17 85.4% 88.9% 82.7% 85.6%

A&E 12 Hour Waits 0 Nov-17 0 1 0 0

Delayed Transfers of Care (days) - Trust level - Oct-17 751 5108 987 6679

Delayed days per occupied beds % 2.5% Oct-17 5.0% 5.3% 9.1% 9.0%

2 week wait 93% Oct-17 93.9% 94.2% 93.8% 94.2%

2 week wait breast symptomatic 93% Oct-17 99.0% 95.5% 95.8% 94.5%

31 day 1st definitive treatment 96% Oct-17 96.9% 94.6% 99.2% 97.8.4%

31 day 1st subsequent treatment - surg. 94% Oct-17 94.9% 94.3% 100.0% 100.0%

31 day 1st subsequent treatment - chemo 98% Oct-17 100.0% 100.0% 100.0% 100.0%

31 day 1st subsequent treatment - radio 94% Oct-17 100.0% 100.0% 100.0% 100.0%

62 day standard 85% Oct-17 71.4% 68.9% 83.2% 82.3%

62 day standard - screening 90% Oct-17 84.6% 77.8% 87.5% 89.4%

62 day standard - upgrade 90% (UCLH) Oct-17 75.9% 80.2% 81.2% 84.0%

Mixed Sex Mixed Sex Accommodation Breaches 0 Oct-17 37 178 41 234

Cancelled Ops for non-clinical reasons rebooked

>28 days100% 2017/18 Q2 94.3% 91.7% 75.0% 84.3%

Urgent operation cancelled for the 2nd time 0 Oct-17 0 0 0 0

MRSA Reported Cases (Trust assigned) 0 Oct-17 0 1 0 2

C.Difficile Reported Cases Oct-17 6 39 7 47

Handover time over 30min of arrival 0 Oct-17 248 1508 131 1173

Handover time over 60min of arrival 0 Oct-17 57 147 97 566

% of Data recorded electronically 90% Oct-17 93.5% 93.2% 89.9% 88.2%

VTE VTE Risk Assessed Admissions 95% Jun-17 95.2% 95.7% 95.7% 96.6%

SHMI Summary Level Hospital Mortality Indicator <100

April 2016 to

March 201777.7 n/a 88.0 n/a

RTT

UCLH UCLH YTD Royal Free

Indicator Type

A&E

DTOCs

Cancer - 2

week

Cancer - 62 day

Cancer - 31 day

Cancelled Ops

HCAI-

Ambulance

Handover

65

1. Access1.3 Demand Management

Extended AccessAT Medics took over the full extended access contract on 1st December 2017, and early indications are that utilisation rates have improved significantly. This can be attributed to:- There are now four hubs operational (previously two)- All hubs now operate seven days per week- A full data sharing agreement is now in place meaning patient data from the source practice can now be seen- NHS 111 is now able to book directly into extended access slots

2016/17

The current provision of weekends across all hubs and weekdays at the South hub was mobilised by Nov 16.

Utilisation improved as the service became embedded.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

North South West North South West North South West North South West North South West

Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

Current EA Service: Utilisation 2016/17

YTD 2017/18

The West hub continues to have better utilisation than North or South In Jul 17, the South hub is at its second highest point since service

commencement (the South hub has been subcontracted since 1 Jul 17)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

North South West North South West North South West North South West

Apr-17 May-17 Jun-17 Jul-17

Current EA Service: YTD

The service provider, AT Medics, is implementing an agreed communications and engagement plan with oversight by the CCG. Progress is being monitored through weekly contract monitoring meetings in December.

Messaging focuses on the new direct booking route for patients: a dedicated phone number, open 8-8 seven days a week.

Communication activity includes: • practice training, focusing on those with lowest historical referral rates. • digital and print advertising in practices, pharmacies, libraries and leisure centres• targeted leaflet drops to households• outdoor advertising (primarily on bus stop poster sites from 16 January 2017)• social media updates • editorial in the Camden Magazine (council publication delivered to all Camden households in February 2017) • advertising in local media (Camden New Journal and Ham and High)• content in CCG partner websites, social media and publications.

This activity will be bolstered by a four-week London-wide extended access campaign by the Healthy London Partnership in Dec/Jan.

66

1. Access1.4 Delayed Transfer Of Care (DTOCs)

Benchmarking data for DTOC suggests that Camden performs better than both England and London, however recent data shows a pressure on DTOC performance due completion of social careassessments.Placements remain an issue, and the integrated commissioning team is working to resolve this. The team are also expediting discharges for self-funding patients exercising choice. A black alert was reportedat St Pancras at the end of October, resulting in longer waits for rehab beds.

Based on September 2017 data for London:

• 17 of the HWBs were performing better than the key November target

• 8 of the HWB are currently classified as red (>50% above the November target)

• ASC accounts for the majority of DToCs within the HWBs classified as red

• 73% of London HWBs are within 5 bed days of their November target

0

50

100

150

200

250

Camden Local Authority Delayed Discharge reasons (Number of delayed days)

A) COMPLETION OF ASSESSMENT B) PUBLIC FUNDING

C) WAITING FURTHER NHS NON-ACUTE CARE DI) AWAITING RESIDENTIAL HOME PLACEMENT OR AVAILABILITY

DII) AWAITING NURSING HOME PLACEMENT OR AVAILABILITY E) AWAITING CARE PACKAGE IN OWN HOME

F) AWAITING COMMUNITY EQUIPMENT AND ADAPTIONS G) PATIENT OR FAMILY CHOICE

H) DISPUTES I) HOUSING - PATIENTS NOT COVERED BY NHS AND COMMUNITY CARE ACT

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1. Access1.4 Delayed Transfer Of Care (DTOCs)

Camden CCG and UCLH continue to work closely on a daily basis to ensure numbers ofDTOC’s and MO’s are kept within acceptable limits.

UCLH has been identified as one of the top 5 performing Acute trusts in London (thoseclosest to their target) and are being proactively supported by the CC2H team to ensurebest practice is shared and improvement sustained.

Barnet CCG continue to lead on DTOC meetings for Royal Free, which are held twice eachday to expedite early discharges and free up bed capacity in acute setting.

The PMO structure is being established by Barnet CCG and the Recovery Action Plan hasbeen refreshed to help the trust meet the 4 hour A&E target.

September snapshot September snapshot

68

1. Access1.5 DTOCs and CHC performance against trajectory

DTOC Performance against target for November (to date)Target = 10.73 monthly average daily delaysPerformance for November = 14.78 average daily delays

Continuing Healthcare

Target < 15% of assessments in the acute setting

Performance for October = 40%

Assessments completed within 28 days

Target 100%

Performance for November = 100%

Month Jul-17

Aug-17

Sep-17

Oct-17

Nov-17

Dec-17

Jan-18

Feb-18

Mar-18

Total Days 15.8 14.46 13.53 11.93 10.73 10.73 10.73 10.73 10.73

Total Days - Actual 17.1 15.66 15.71 20.5 14.78

NHS Attributable 6.85 6.85 7.07 7.02 7.05 7.05 7.05 7.05 7.05

NHS Attributable - Actual 6.61 7.13 6.94 10.77 5.04 Unify Average daily cases/days of Delayed Transfers of Care - NHS Attributable 6.61 7.97 6.09

ASC Attributable 8.95 7.6 6.46 4.91 3.68 3.68 3.68 3.68 3.68

ASC Attributable - Actual 10.48 8.53 8.77 9.73 9.74 Unify Average daily cases/days of Delayed Transfers of Care - ASC Attributable 10.48 8.90 9.55

Month

Q1

2017/18

Actual

Sep-17 Oct-17 Nov-17Dec-

17

Jan-

18

Feb-

18

Mar

-18

Percentage of CHC decision support tool

assessments (taken from total number of Non-Fast

Track assessments) to take place in the acute

hospital setting

57.89%

30%

(39%

Actual)

25%

(33%

Actual)

21%

(30%

Actual)

18% 15% 15% 15%

69

1. Access1.6 CNWL Access

CNWL community services access targets

6 week wait performanceUnderperformance against this measure was identified early on as a data entry issue rather than patients genuinely having long waits. All services reviewed their outstanding patients and discharged referrals where required. CNWL also identified some areas where patients should not be included in this measure and the clinical system has been modified to accurately record and report patient waiting times. Performance on this KPI has steadily improved throughout the year with the improvement in data recording and streamlined processes and the target of 95% has been achieved in October.

District nursing referrals responded to within 48 hoursThis has also been identified as a data quality issue rather than a genuine performance issue and the service has worked with the performance team and SystmOne configuration team to identify and address the issues. CNWL are regularly reviewing these waits, with the service receiving a daily report to identify and correct any apparent breaches. This led to steady incremental improvements throughout the past six months and ultimately resulted in the service achieving and exceeding the target in September, which is expected to be maintained. The year to date performance will not reach 95% this year due to the lower performance levels earlier in the year.

Urgent Out Of Hours referrals responded to within 2 hoursThe service reviewed all apparent breaches and as a result identified a number of recording issues, and have been working throughout 2017 to resolve these. A robust process is in now in place that ensures all relevant information is recorded, and performance has steadily improved throughout the year with the service achieving the 95% target for past two months. Due to the underperformance early in the year it will not be possible to achieve a full year performance of 95%, however the service is expected to maintain performance on or above target each month.

Performance across all indicators is discussed and managed at the regular CNWL CRG meetings, attended by the Integrated Commissioning team and CSU.

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1. Access1.7 Patient Engagement

How are we doing?• In 2015/16 NHS England assured our patient and public engagement (PPE) activity as ‘good’. • This year (2016/17), NHSE introduced new statutory guidance on PPE, with metrics added to the CCG Improvement and Assessment Framework.• Camden CCG were rated as ‘good’ - achieving outstanding in two domains, good in two, and requiring improvement in one.• The CCG will use NHSE’s recommendations to consider how we can continue to progress. As we deliver our QIPP target, involving some potentially difficult decisions, PPE will remain

crucial.

CCG name NHS CAMDEN CCG

Overall RAG rating GREEN

Overall score 11

Domain A (Governance): grade 3

Domain B (Annual Reporting): grade 2

Domain C (Practice): grade 3

Domain D (Feedback and Evaluation): grade 1

Domain E (Equalities and Health Inequalities): grade 2

Key Grade

0 Inadequate

1 Requires improvement

2 Good

3 Outstanding

Comments

The CCG shows good knowledge and engagement with a variety of people with information made available

in appropriate languages. The establishment of a Citizen's Panel will help the CCG regularly listen to people

without it being part of an ad hoc consultation and therefore limited in scope and relationship building.

Recommendations:

The CCG's Commissioning Plan and Intentions 16/17 has little reference to public participation and only

references 'a stronger role for the voluntary sectory' but nothing else. Consider how the CCG can engage

and collaborate in different ways with the VCSE and also with networks of identity such as LGBT. Create a

tab on the website homepage for You Said We Did or a direct link to public participation achievements.

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1. Access1.8 NCL Integrated Urgent Care Service (IUC) Performance against Quality and Performance KPIs

Data Source: LCW Reports There is a similar pattern to the types of call response for each CCG with most patients being supported by speaking to the call advisor.

Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17

NCL-IUC NCL-IUCNCL-IUCNCL-IUC NCL-IUC NCL-IUC NCL-IUC NCL-IUC

Engaged calls Performance 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%Abandoned calls Performance 0.4% 0.9% 0.8% 1.4% 1.5% 3.0% 3.2% 4.8%Answer Time Performance 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%Call waiting time Performance 95.6% 91.0% 91.2% 86.3% 88.3% 81.6% 80.5% 73.3%Life threatening referrals Quality 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%Meeting individuals needs Quality 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%Safeguarding Quality 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%Triage rate Quality 106.6% 108.1% 108.2% 106.4% 104.9% 104.0% 109.1% 106.8%Transfer to 999 Performance 9.6% 9.7% 10.3% 10.4% 10.9% 11.7% 11.5% 11.6%Attend Accident & Emergency Department Performance 9.4% 9.8% 10.1% 10.5% 9.4% 10.1% 10.0% 9.8%Referred to Primary Care and other dispositions Performance 55.5% 52.8% 52.5% 52.9% 51.9% 51.0% 51.5% 51.9%Warm Transfers Performance 68.1% 66.0% 68.0% 71.6% 73.8% 66.5% 73.3% 72.2%Time taken for call back Performance 10.6% 13.1% 10.8% 54.6% 54.0% 53.5% 49.1% 48.7%Notifications Quality 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%Patient Education Quality 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Qrt3Qrt 2Qrt 1Quality and Performance Indicators KPI Type

Call waiting time continues to be impacted by rostering issues and shortfall in overall WTE - workforce plan in place is progressing to trajectory

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2. Commissioned Services Register Monitoring

SummaryThe Commissioned Services Register is comprised of a list of contracts that Camden CCG wholly or partly funds. The Register provides monthly oversight of these contracts, broken down into spend and performance, for the purposes of contract monitoring and informed decision-making regarding their future or maintenance.

This month (Dec ’17) the focus is on those contracts with a high attention level whose overall RAG status is Red or Amber.

Please note that at the time of the report the financial position has not yet been finalised and so final figures may be amended.

Highlights• UCLH – Acute Hospital Services: There is an over-performance of £1.9m, with the largest pressures continuing to be in non-elective, outpatients and drugs & devices. This is subject to both STP and

Marginal rate adjustments which will be added for Hard Close. There are a number of misattribution queries raised in Month 7+1 claims letter, which NELCSU is awaiting response on. • Royal Free – Acute Hospital Services: There is an over-performance of £6.6m, an unfavourable movement of £290k from previous month. This is driven largely in diagnostic imaging, non-elective,

outpatients and other. Adjustments made at M7+1 include reporting CQUIN to plan (£286k), counting & coding challenge (-£455k), agreed claims and challenges (-£558k), productivity metrics (-£608k), UCC rebate (-£177k), to bring PTS back to plan (-£782k), MSK (-£3.3m) and Diabetes VBC (-£203k). Escalated items in Q1 reconciliation agreed and reflected in adjustments. Remaining issues being worked through.

• UCLH – MSK Services: Issues around implementation of contracting and reporting arrangements, quality & safety reporting and activity & finance reporting continue. The CCG has requested fortnightly meetings with UCLH CIMS team to ensure outstanding actions/issues are being identified and actioned. A £1.1m overperformance has been identified under RFL SLAM return which will be validated prior to removal from main acute contract.

• Whittington Hospital – Acute Hospital Services: The contract is forecast to underperform by £76k, showing an adverse movement of £30k from the previous month as seen across outpatients, maternity and other PODs. YTD and FOT positions are uncorrelated due to adjustments made for claims and challenges as agreed in Q1 reconciliation where the impact of A&E coding change is only relevant to Q1 and Q2 and not extrapolated into the FOT. Q1 reconciliation has now been agreed, reflected in the position and extrapolated forward to inform the FOT.

• Whittington Health – Adult & Children Community Services: Progress on the disaggregation work has been slow and a draft letter to Whittington Health highlighting the high risk of contract termination is awaiting approval from Richard Lewin / Sarah Mansuralli and relevant governing body leads. There will be a high impact on children’s but a low impact on adults if the whole contract is terminated. Commissioners have carried out an options appraisal and made recommendations about a course of action for each service.

73

3. Quality3.1 Serious Incidents (SIs)

UCLHSerious Incidents (SI)Assurances regarding organisational wide learning following SI investigations, were provided tothe Clinical Quality Review Group (CQRG) meeting on 05 December 2017.

Royal Free LondonSerious Incidents (SI) and Never Events

The Trust have reported five Never Events since April 2017. These have been reported asSerious Incidents and are currently under investigation in line with the 2015 NHS SeriousIncident Framework. These were discussed in detail at the CQRG meeting on 29 November 2017.

74

3. Quality3.2 Complaints and Friends & Family Test

UCLHComplaintsImprovements in responding to complaints has been

sustained, as reported to CQRG on 05 December 2017.Friends and Family Test (FFT)Response rates have plateaued, the Trust have reinstatedthe use of paper forms to obtain feedback in paediatrics,due to popular demand.

Royal Free LondonComplaintsClinical treatment and communication remain theprimary focus of complaints received by the Trust, asreported to CQRG on 29 November 2017.

Friends and Family TestFFT reporting remains steady across the Trust.

75

4. Activity4.1 Performance Against Operating Plan

Referrals – The plan was based on the data that was flowing at the point of planning. Camden's deepdive data assurance work with the Royal Free and the CSU has identified a large volume of follow-upattendances included within the referral data. RFH are being supported to correct their submissions to bein line with national guidance. This impacts commissioners differently due to different sites within theprovider being utilised by different commissioners.

First Outpatient Attendances – There has been a significant change in the recording of diagnostic imagingat UCLH, impacting Camden (approximately 3,500 attendances) and Islington CCGs. With this taken intoaccount Camden is below plan.

Follow-up Outpatient Attendances - There has been a fall in the volume of follow up attendances relatingto Diagnostic Imaging (approximately 6,000 fewer attendances). UCLH report that this is due to a switchin recording from follow up to first and the bundling of multi site MRIs into one record. This over inflatesthe under performance.

Total Elective - Lower volumes of elective activity is being reported across providers. This is beinginvestigated by the CSU to be assured that this is a true reflection of activity and whether there will beimpact on other areas of performance.

A&E Attendances – During the rebasing exercise in July the Camden plan was increased significantly,driven by the inclusion of overseas visitors. Discussions have taken place with NHSE as to whether theplan should be resubmitted to reflect the flow of data coming through, and Camden were advised not toresubmit the plan. Year on year growth is flat.

The CCG is required to submit an Operating Plan to NHS England on an annual basis. The plan takes into account expected demographic and non-demographic growth along withany increases expected due to new guidance. The performance against Plan is monitored by NHS England throughout the year, historically via a monthly return from the CCG andthen additionally in 2017/18 via an NCL wide teleconference to review activity and QIPP across the system.

2016/17 saw unprecedented over performance on Royal Free and UCLH contracts, but not on the CCG’s Operating Plan. Although measured on different data sources (Contract =SLAM, Operating Plan = SUS SEM), the direction of travel should be similar in both. The CCG is currently undertaking a forensic deep dive of all data sources to ensure that activity isbeing reported accurately, and that data issues are not affecting the CCG’s financial position.

Activity variance -5% to +5% above plan

Criteria Measured by NHSE

YTD Plan YTD Actual Variance % Variance

All Referrals 55804 50042 -5762 -10.33

Outpatient First

Attendance 59017 59716 699 1.2

Outpatient Follow Up

Attendances101731 90791 -10940 -10.75

Total Outpatients* 160748 150507 -10241 -6.4

Total Elective 12198 11408 -790 -6.48

Non- Elective 9261 9349 88 1.0

Total Inpatient* 21459 20757 -702 -3.3

A&E 64432 60366 -4066 -6.3

Operating Plan Performance 2017/18 Month 6

76

4. Activity4.2 QIPP Plan 2017/19 - Executive Summary

Overview & Progress

The purpose of this paper is to provide the committee with an update of the QIPP plan at month 7 of 17/18.

The CCG submitted is monthly position with an underachievement of £1.39m YTD. The overall CCG rating is amber based on a forecast of £16.59m against a plan of £18.14m, with a negative variance of £1.55m against a month 6 position of £1.22m.

Overall negative impact in month was £330k, with slippage of £610k in profile savings offset by £280k of efficiencies set out in the Month 7 Variance Report further detailing monthly movements.

The month 7 position starts to introduce planned savings for schemes expected to deliver in the second half of the year. Enhanced Rapid Response and Demand Management initiatives are reporting efficiencies YTD of c.£200k with further work underway by commissioners to ensure full year delivery.

Camden’s plan continues to rely on savings profiled for the last quarter of 17/18. Risk remains for reaching an agreement of a tariff for Primary Care @ Front Door and any financial penalties as an outcome of the PoLCE audit. Commissioners continue to progress negotiations with Trusts to mitigate these risks.

This report also provides an update for 2018/19 QIPP planning and actions to identify further opportunities as we move closer to our next submission for the end of November.

QIPP Position

Split of QIPP FOT for 17/18 by RAG status (£,000):

Keys Risks

The main risk remains the pace of change to develop and implement new models of care in-year. Although the CCG is reporting 52% of it’s plan closed (blue), this is disproportionately related to contract efficiencies and budgets. The majority of QIPP lines rated as Red or Amber are associated to transformation and STP work streams with start dates now adjusted for mid-year delivery of Oct/Dec. Teams are currently developing plans for the priority transformation schemes to ensure robust delivery in the second half of 17/18.

8628

3558

1116

3288

1550

Blue Green Amber Red Gap

77

4. Activity4.2 QIPP Plan 2017/19 - Status

Non-IFSE Return Summary

The CCG submitted its month 7 QIPP position to NHSE with a YTD position of £6.80m representinga negative variance of £1.39m. This is an increase of £720k adverse effect against plan highlightingslippage in transformation projects vs the QIPP profile.

Overall Camden is reporting a FOT position of £16.59m with a negative variance of £1.55m, anegative impact of £330k from month 6.

78

5. Finance

Overview

As at month 8 the CCG is forecast to meet its control total of £414.7m as at the end of the 2017-18 financial year.

Within this the CCG is forecasting over-performance of £7.6m. This over-

performance is due to,

Acute spend over-performance £4.5m

Non-acute spend over-performance £2.3m

Primary care delegated commissioning cost pressure £1.5m

Less under-spends within investment programmes (£0.1m)

Less underspends in general overheads (0.6m)

Over-performance is contained within the CCGs control total by use of,Non-recurrent reservesCCG contingencies

79

6. Improvement & Assessment Framework6.2 2017/18 Dashboard

The IAF dashboard, published by NHSE at the endof November 2017, covers indicators located in fourdomains: Better Health, Better Care,Sustainability and Leadership.

Indicators that the CCG appears in the bottom quartilefor England:

NB work is being undertaken to understand thediscrepancies between local and national IAPTdata. Local data suggests that the CCG has met therecovery rate standard for six of the last sevenmonths.

Indicators that the CCG appears in the top quartile forEngland:

NHS Camden CCG

Better Health Period CCG Peers England Trend Better Care Period CCG Peers England Trend

R 102a % 10-11 classified overweight /obese2013/14 to 2015/16 35.5% 5/11 143/207 R 121a High quality care - acute 17-18 Q1 57 9/11 151/207

103a Diabetes patients who achieved NICE targets2015-16 42.4% 1/11 37/207 R 121b High quality care - primary care17-18 Q1 65 5/11 137/207

103b Attendance of structured education course2014 19.1% 1/11 17/207 R 121c High quality care - adult social care17-18 Q1 65 2/11 9/207

R 104a Injuries from falls in people 65yrs +16-17 Q4 2,388 8/11 175/207 122a Cancers diagnosed at early stage2015 54.2% 3/11 61/207

R 105b Personal health budgets 17-18 Q1 16 3/11 67/207 122b Cancer 62 days of referral to treatment16-17 Q4 82.2% 5/11 96/207

R 106a Inequality Chronic - ACS & UCSCs16-17 Q4 2,360 6/11 133/207 122c One-year survival from all cancers2014 71.1% 4/11 50/207

R 107a AMR: appropriate prescribing 2017 06 0.606 1/11 1/207 R 122d Cancer patient experience 2016 8.6 9/11 148/207

R 107b AMR: Broad spectrum prescribing2017 06 9.4% 5/11 130/207 R 123a IAPT recovery rate 2017 06 47.3% 10/11 167/207

108a Quality of life of carers (not available) R 123b IAPT Access 2017 07 3.4% 2/11 38/207

Sustainability Period CCG Peers England Trend R 123c EIP 2 week referral 2017 08 85.8% 3/11 49/207

R 141b In-year financial performance 17-18 Q1 Amber #N/A #N/A 123d MH - CYP mental health (not available)

R 144a Utilisation of the NHS e-referral service2017 06 41.7% 6/11 141/207 123f MH - OAP (not available)

Leadership Period CCG Peers England Trend 123e MH - Crisis care and liaison (not available)

R 162a Probity and corporate governance17-18 Q1 Fully Compliant #N/A #N/A R 124a LD - reliance on specialist IP care17-18 Q1 58 8/11 114/207

163a Staff engagement index 2016 3.83 4/11 48/207 124b LD - annual health check 2015-16 54.9% 1/11 10/207

163b Progress against WRES 2016 0.20 11/11 206/207 124c Completeness of the GP learning disability register (not available)

164a Working relationship effectiveness16-17 59.80 11/11 185/207 R 125d Maternal smoking at delivery 17-18 Q1 4.5% 3/11 22/207

166a CCG compliance with standards of public and patient participation (not available) 125a Neonatal mortality and stillbirths2015 5.1 8/11 132/207

R 165a Quality of CCG leadership 17-18 Q1 Green #N/A #N/A 125b Experience of maternity services2015 76.4 8/11 169/207

Key 125c Choices in maternity services 2015 67.7 4/11 51/207

Worst quartile in England R 126a Dementia diagnosis rate 2017 08 87.6% 2/11 4/207

Best quartile in England 126b Dementia post diagnostic support2015-16 80.0% 6/11 66/207

Interquartile range R 127b Emergency admissions for UCS conditions16-17 Q4 2,268 5/11 96/207

R 127c A&E admission, transfer, discharge within 4 hours2017 09 87.1% 8/11 137/207

R 127e Delayed transfers of care per 100,000 population2017 08 9.3 3/11 63/207

R 127f Hospital bed use following emerg admission16-17 Q4 439.3 4/11 33/207

105c % of deaths with 3+ emergency admissions in last three months of life (not available)

R 128b Patient experience of GP services2017 83.8% 5/11 130/207

128c Primary care access (not available)

R 128d Primary care workforce 2017 03 1.00 3/11 91/207

R 129a 18 week RTT 2017 08 90.8% 6/11 106/207

130a 7 DS - achievement of standards (not available)

R 131a % NHS CHC assesments taking place in acute hospital setting16-17 Q4 68.4% 2/11 19/207

132a Sepsis awareness (not available)

Good

Note: There is no data for NHS Manchester CCG (14L) for the following indictors: 121a, 121b, 121c, 122c, 122d, 124a, 125b, 125c,

126b, 130a, 141b, 163a, 163b, 164a & 165a

2016/17 Year End Rating:

Diabetes patients who achieved NICE targets

Attendance of structured education course

AMR: appropriate prescribing

Staff engagement index

High quality care - adult social care

One-year survival from all cancers

IAPT Access

EIP 2 week referral

LD - annual health check

Maternal smoking at delivery

Choices in maternity services

Dementia diagnosis rate

Hospital bed use following emerg admission

% NHS CHC assesments taking place in acute hospital setting

Injuries from falls in people 65yrs +

Progress against WRES

Working relationship effectiveness

IAPT recovery rate

Experience of maternity services

80

CCG leads are assigned to each of the QualityPremium indicators and actions in place to assistwith delivery of the targets.

To gain access to Quality Premium funds, CCGsmust also pass the following two gateways:

1. Quality Gateway - no cases of seriousquality failures at a local provider whereCCG is not considered to have madeappropriate, proportionate response with itspartners to resolve failures. Payments will bediscretionary and subject to CCG assuranceprocess criteria in relation to quality failureswhere gateway is not achieved.

2. Financial Gateway - operate in a mannerconsistent with Managing Public Money;does not incur unplanned deficit in 2017/18,or require unplanned support to avoidunplanned deficit; and does not incur aqualified audit report in respect of 2017/18.

7. Quality Premium7.2 2017/18 Quality Premium

Measure Target Latest Data

Quality

Premium

allocation

Maximum

Available

Performance Risk

Rating

Early Cancer Diagnosis 4% point improvement

OR

At least 60% diagnosed at stage 1 & 2

44.1% (2013)

45.8% (2014)

54.2% (2015)

17% £227,165

GP Access and Experience 85% of respondents who said they had a good experience of making an

appointment

OR

3 percentage point increase from July 2017

79.4% (2015)

83.0% (2016)

71% (2017)

17% £227,165

Continuing Healthcare Part a) in more than 80% of cases with a positive NHS CHC Checklist,

the NHS CHC eligibility decision is made by the CCG within 28 days from

receipt of the Checklist

Part b) less than 15% of all full NHS CHC assessments take place in an

acute hospital setting.

Part a) 91%

(Q1 2017/18)

Part b) 68%

(Q1 2017/18)

17% £227,165

Mental Health Total number of bed days relating to out of area placements to have

reduced by 33%

tbc 17% £227,165

Bloodstream Infections 2017/18 Part a) 10% reduction (or greater) in all E coli BSI

Part b)

b1 - 10% reduction (or greater) in the Trimethoprim: Nitrofurantoin

prescribing ratio

b2 - 10% reduction (or greater) in the number of trimethoprim items

prescribed to patients aged 70 years or greater

Part c)

items per STAR-PU must be equal to or below 1.161 items per STAR-PU

Part a) 185

(Jan - Dec 2016)

Part b1) 0.954

(Jun 15 -May 16)

Part b2) 1936

(Jan - Dec 2016)

Part c) 0.61

(Mar 2017)

17% £227,165

Local indicator: The percentage of people waiting 6

or more weeks for a colonoscopy.

93.2% 94.6% (Sep 2017) 15% £200,440

NHS Constitution requirement Target Latest Data WeightingWeight

Value

Performance

Risk RatingMaximum 18 weeks from referral to treatment –

incomplete standard.

STF/ Op Plans for Q4 17/18 - 92% 90.8%

(Sep 2017 YTD)

25% £334,066

Maximum four hour waits in A&E departments -

standard.

STF/ Op Plans for Q4 17/18 - 95% 90.2%

(Aug 2017 YTD)

25% £334,066

Maximum two month (62-day) wait from urgent GP

referral to first definitive treatment for cancer.

STF/ Op Plans for Q4 17/18 - 85% 84.5%

(Sep 2017 YTD)

25% £334,066

Maximum 8 minute response for Category A (Red 1)

ambulance calls.

STF/ Op Plans for Q4 17/18 - 75% 80.5%

(Jul 2017 YTD)

25% £334,066

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8. Glossary

Abbreviation Full Term Description

2WW Two Week Wait cancer standard Cancer waiting times standard

A&E Accident and Emergency Hospital emergency department

CCAS Camden Clinical Assessment Service CCG referral management service

CSU Commissioning Support Unit Provides commissioning support functions to CCGs

CWT Cancer Waiting Times Set of indicators measuring cancer performance

DTOC Delayed Transfer of Care When an adult inpatient is ready to be discharged from hospital but this is delayed

EIP Early Intervention in Psychosis Access standard - 50% of patients should be treated within 2 weeks of referral

IAF Improvement and Assessment Framework Set of indicators on which CCG performance is assessed

IAPT Improving Access to Psychological Therapies Programme for treating people with depression and anxiety disorders.

MAR Monthly Activity Return Central activity data return

QIPP Quality, Innovation, Productivity and Prevention Programme to improve quality of care while making efficiency savings

RAG Red, Amber Green Colour coded rating based on performance

RAP Remedial Action Plan Recovery plan to bring performance back to compliance

RTT Referral to Treatment target NHS constitution target to start consultant-led non-emergency treatment within 18 weeks of referral

SI Serious Incident A serious event that warrants using additional resources to mount a comprehensive response

STF Sustainability and Transformation Fund Funding to acute trusts based on delivery of quarterly milestones

SUS Secondary Uses Service Repository for healthcare data

82

Camden Clinical Commissioning Group Governing Body Meeting on 17th January 2018

Report Title Board Assurance Framework

Agenda Item 5.1 Date 10th January 2018

Lead Director Ian Porter,

Director of Corporate Services Tel/Email [email protected]

Report Author Andrew Spicer, NCL Head of Governance and Risk



Richard Strang, Lay Member Tel/Email [email protected]

Report Summary

The Board Assurance Framework (‘BAF’) captures the most serious risks identified as threatening the achievement of the CCG’s eight strategic objectives. Risks on the BAF include some NCL wide risks escalated from the NCL Joint Commissioning Committee which takes a wider pan-NCL perspective. Number of risks There are 13 risks on the BAF with one new risk. One risk has been removed from the BAF. New Risk The new risk on the BAF is JCC 20 which a risk to the delivery of the Referral To Treatment waiting time standard. This has been escalated from the NCL Joint Commissioning Committee. The CCG is continuing to work with UCLH and Royal Free London to deliver the Remedial Action Plans. The activity plans and traffic arrangements for Clinical Advice and Navigation are being developed. Winter pressures may have an adverse impact on recovery. The risk due to winter pressures is managed through risk JCC 13. An update on this risk is provided below. Removed Risk Risk 363, relating to successful completion of a PMS review, has been removed from the BAF as the review has been approved and completed. The PMS is now moving into the implementation phase. Key Highlights Risk 362- System Resilience (Threat): A community bed review was undertaken in September 2017. Weekend Hub Access is currently in place and a re-provision exercise has been completed to enhance utilisation. Extended hours access is also in place and re-provision exercise has been completed to enhance utilisation. The CCG has also recently put into place senior CCG support at UCLH to support increased patient flow and reduce Delayed Transfers of Care. Risk 382 - Failure to deliver a robust QIPP Plan for 2017/18 (Threat): The unidentified QIPP in the most recent plan was reduced down to zero, leaving a £22.4m gross QIPP savings required for 2017-18. The CCG is

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currently under delivering £1.5m against target. Planning is underway to mitigate this and additional strategic QIPP capacity has been put into place with a shared QIPP Director being recruited. Risk 434 - Delivery of Cancer 62 Day Waiting Time Standard (Threat): The Performance Team continues to work with providers to meet the standard. UCL Hospitals is predicting recovery of the standard by the end of March 2018. Risk 432 - Increased costs due to acute over-performance (Threat): if expenditure on acute contracts exceeds planned contract baselines this increased expenditure could lead to a requirement for additional in-year and future QIPP delivery, This may impact on delivering a balanced control total; and may increase baseline acute costs in 2018/19 Risk 432 - Failure to deliver a robust QIPP plan for 2018/19 (Threat): This risk complements risk 382. If the CCG fails to produce and deliver a robust QIPP plan for 2018/19 that meets NHS mandated control totals there is a risk that the CCG may not have a balanced budget for 2018-19 and not meet NHS England control totals. The CCG is developing a robust QIPP plan for 2018/19 and this is being regularly scrutinised and reviewed by the Finance, Performance and QIPP Committee. In addition, the QIPP targets have been developed across NCL to ensure consistence of approach and a positive assurance meeting with NHS England was held in December 2017. There remains £2m of unidentified QIPP with work being undertaken to address this. This is supported by a shared QIPP Director who is in post. Risk JCC 13- Ensuring that management of winter pressures supports recovery of waiting time standards for A&E and cancer and protects capacity for elective pathways (Threat). A&E delivery boards have developed additional winter plans to provide capacity in both hospital and community settings this includes supplementary plans which received additional funding in December 2017. Risk Owners Two risks have changed risk owners to reflect changes in Directors’ responsibilities. Risks 382 and 432 have transferred from Becky Booker, Deputy CFO, to Sally MacKinnon, Director of Transformation, Planning and Delivery. These two risks have also been reframed from focussing on production and delivery of the QIPP plans to focussing on delivery.

Purpose

Information

Approval To note

Decision

Recommendation The Governing Body is asked to review the risks and provide feedback on the updated BAF.


The BAF focuses on risks relating to the strategic objectives of the CCG: Commission the delivery of NHS constitutional rights and pledges Improve the quality and safety of commissioned services Improve health outcomes, address inequalities and achieve parity of esteem Integrate and enable local services to deliver the right care in the right setting

at the right time Work jointly with the people and patients of Camden to shape the services

we commission Involve member practices and commissioning partners in key commissioning

decisions Maintain financial stability and ensure sustainability through robust planning

and commissioning of value-for- money services

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Build a high performing organisation that attracts, develops and retains a skilled and motivated workforce.


The BAF is a risk management document which is presented at every Governing Body report. It is available to members of the public on the CCG’s website.


None identified.


Updating of the BAF is the responsibility of each risk owner and their respective directorates. The Governance Team helps to support this by providing monitoring, guidance and advice.

Engagement



This report was written in accordance with the provisions of the Equality Act 2010.

Report History

The BAF was last reviewed by the Governing Body at on 8th November 2017 and by the Camden Executive Team on 9th January 2018. Risks are kept under review by committees of the Governing Body and risk owners.

Next Steps To continue to manage risk across the organisation in a robust way.

Appendices

The following is attached: 1. BAF; 2. BAF Heat Map; 3. Risk Scoring Key.

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ID Director Objectives Risk Controls in Place Evidence of ControlsOverall Effectiveness of

Controls in Place

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Actions Update on Actions Action Competion Date

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362

Jennifer Murray-Robertson,Director of Commissioning and Contracts

Commission the delivery of NHS Constitutional rights and pledges

TITLE: System Resilience (Threat)

CAUSE: There may be insufficient capacity within the system

EFFECT: Which may lead to the risk that the system may be unable to cope with changes and increases of activity at times of high demand, such as the winter time.

IMPACT: This may lead to performance issues in A&E (UCLH), referral to treatment targets, and elective care which may impact on patient care. The CCG may also suffer reputational damage.

C1. An A&E delivery board has been established which has executive level representation from key providers in the system.C2. A&E Delivery Board has developed a 'Heat Map' dashboard which monitors key parts of the system to highlight any issues in terms of capacity and/or performance.C3. With key providers, and using funding available to the A&E Delivery Board, agreed which parts of the system would benefit from increased capacity or efficiency changes. C4. Continued monitoring of the action plan (RAP) against agreed outcome measures.C5. A North Central London ('NCL') wide review of how winter went across NCL took place on 6th April 2017 to share lessons learned.C6. The A&E Delivery Board submitted plans to NHS England for winter 2017/18 based on experiences and pressures in 2016/17.

C1. A&E Delivery Board papers (meets monthly)C2. Heat Map discussed at each A&E Delivery Board meetingC3. Bids submitted and considered at the A&E Delivery BoardC4. Monitored through the monthly UCLH performance meetingC5. Notes from the workshop.C6. Winter plan

AVERAGE: The controls have a 61 – 79% chance of successfully controlling the risk

4 4 16

Very High

A1. Community Bed Review.A2. Have in place Weekend Hub Access to give increased access to GP services.A3. Access to Extended Hours service.A4. Put senior CCG support into place at UCLH to support increased patient flow and DTOCs.

A1. The 'Full Community Bed' review was scheduled to be completed by the end of September 2017. The ambition of this review is to identify further resources required to support Winter Resillience A2. Currently in place, reprovision exercise has been completed to enhance utilisation.A3.Currently in place, reprovision exercise has been completed to enhance utilisation.A4. Senior CCG support present in Trust to support directly from w.c 2/1 to be continued at Trust request during peak periods

A1. Completed 31.10.2017.A2. Completed.A3. Completed 31/12/2017.A4. Completed. live from 02.01.201

4 2 8

High

434


Commission the delivery of NHS constitutional rights and pledges

TITLE: Delivery of Cancer 62-day waiting

time standard (Threat)

Cause: Performance against the 62 day waiting time standard at UCLH is impacted by whole system performance, particularly late inter-trust transfers.

Effect: There is a risk that the Trust may be unable to cope with the level of demand.

Impact: This may result in patients not receiving treatment within 62 days.

C1. Regular performance meetings with providers and strengthened CCG performance management process in place.C2. Use of contractual leavers where applicable.C3. RAPs being implemented and monitored.C4. North Central London ('NCL') cancer governance arrangements established to cover both performance and transformation.C5. Improvement trajectory agreed with NHS England and NHS Improvement.C6. 38 day transfer protocol in place for inter-provider transfers from district general hospitals to tertiary services with the 38 day standard compatible with treatment commencing within 62 days.

C1. Meeting papers and notes.C2. CPN issued.C3. RAPs monitored at the monthly performance meetingC4. Transfer protocol document.C5. TrajectoryC6. Transfer protocol.


4 4 16

Very High

A1. Continue to work with providers on delivering the trajectories.A2. Continue to work with providers to ensure sustainable delivery and includes work through the cancer vanguard.A3. UCLH recovery of the 62 day standard by end of March 2018.

A1. Meeting with providers on a monthly basis and ensuring their plans are consistent with agreed trajectories.A2. Meeting with providers on a monthly basis.A3. Currently on track for delivery.

A1. Meetings are held continuously on a monthly basis.A2. Meetings are held continuously on a monthly basis.A3. 31.03.2018

4 3 12

High

432


Maintain financial stability and ensure sustainability through robust planning and commissioning of value-for- money services

TITLE: Increased costs due to acute over-

performance (Threat)

Cause: if expenditure on acute contracts exceeds planned contract baselines

Effect: Increased acute expenditure leading to requirement for additional in-year and future QIPP delivery

Impact: recovery plan and additional in-year and future QIPP requirements. may impact on delivering a balanced control total. May increase baseline acute costs in 18-19

C1. Signed contracts in place for 2017/18 and 2018/19C2. Contracts include marginal rate payments/deductions for variances from plan and 3% growth (higher than historic growth trends) C3. Contract management framework in place with providersC4. Issue of contract notices in line with contact provisionsC5.. Mobilisation of STP and QIPP plans (see JCC10)C6. North Central London Finance and Activity Modelling (FAM) Group, with commissioner and provider membership. that oversees system financial positionC7. Work on alternative contract forms to support the Sustainability and Transformation Plan (STP) through the Acute Contract Modelling Group (with commissioner and provider membership)C8. Monthly finance and performance monitoring of acute contracts

C1. Signed contractsC2. Signed contractsC3. Meeting minutes and papersC4. Contract documentation and correspondence including remedial action plansC5. See JCC10C6. Meeting minutes and papersC7. Meeting minutes and papersC8. Finance & Performance reporting


5 4 20

Very High

A1. Develop, in co-production, with providers, proposals for alternative contract forms for hospital providersA2. Pursue all contractual remedies for inappropriate charging beyond standard challenges. These include PoLCE (incorporating RLHIM), 30-day readmission threshold at local trust, application of access policy, and coding notification issues at a neighbouring trust.A3. Conduct independent analysis of reconciliation between data sources to validate charging in specific areas

A1. Consideration of models used elsewhere - Aligned Incentive Contract in Bolton; Accountable Care models. This work is being developed with the STP throughout 2018.A2. This work has commenced and partially completed. There are some on-going challenges regarding quarter 2 which are being addressed.A3. This work was reported to Finance, Performance and QIPP committee 25th October 2017 and the Committee continues to maintain oversight of overperformance risks. CSU deeper dive carried out with FU queries to be investigated. Small audit by single GP of RFH case mix coding against clinical notes now underway supported by Care Insights team. This action is completed.

A1. 31.12.18.A2. 31.3.18.A3. 25.10.17.

4 4 16

Very High

A1. Completed on 15/09/2017A2. Implementation is on going.A3. Monitoring is on-going on a monthyl basis.A4. 8.1.18.

Very High

16

Very High

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A1. Develop PIDs/Project plans for all QIPP schemes in line with NCL STP plans and continue to participate in the Capped Expenditure Process.A2. Develop and implement a financial recovery plan to offset potential unmitigated financial risks.A3. Monthly monitoring and updating of financial recovering plan to mitigate potential financial risks.A4. Put into place additional strategic QIPP capacity.

A1. Finance plans were revised in May 2017 in accordance with NHS England's requirements and to recognise the devolvement of primary care commissioning to CCGs. The unidentified QIPP in the most recent plan was reduced down to zero, leaving a £22.4m gross QIPP savings required for 2017-18. A NCL wide capped expenditure process summit was held on 24th April 2017 to identify opportunities for additional savings through difficult decisions. Both commissioners and providers are seeking to identify the locality solutions jointly.A2. Planning and actions under-way, being reported to Finance and Performance Committee.A3. Planning and actions under-way, being reported to Finance and Performance Committee.A4 Shared strategic QIPP lead in post from 08/01/2018.

382

Sally MacKinnon- Director of Transformation, Planning and Delivery

Maintain financial stability and ensure sustainability through robust planning and commissioning of value for money services

TITLE: Failure deliver and robust QIPP

plan for 2017/18 (Threat)

CAUSE: If the CCG fails to produce and deliver a robust QIPP plan for 2017/18 that meets NHS mandated control totals.

EFFECT: There is a risk that the CCG will not have a balanced budget for 2017-18 and not meet NHS England control totals.

IMPACT: This may result in the CCCG being placed into Directions/special measures by NHS England, destabilisation of the CCG, destabilisation of local providers, a wider negative impact on the NCL health economy and loss of influence of quality of patient care.

C1. QIPP cabinet is overseeing the development of the 2017/18 QIPP plan. C2. Finance and Performance Committee reviews and approves the overall financial plan including QIPP. C3 Currently going through a review of avoidable spend, assigning priorities to spend areas with a view to reducing or ceasing low priority spend.C4. QIPP Manager to support the QIPP Programme is in role.C5. QIPP Planning started in September 2016.C6. Obtained from Governing Body direction on lower priority spend areas for savings.C7. Root and branch review of all spend across the organisation completed.C8. Deloitte review of QIPP completed.C9. PMO taking a strengthened role in QIPP.C10. Governing Body direction on lower priority spend areas obtained.C11. Contractual arrangements with acute providers in place.C12. Clinical and manager leads in place for each area of QIPP.C13. QIPP Challenge Panel established to oversee operational delivery of QIPP.C14. Camden CCG is part of the NCL STP which has shared responsibility to ensure financial stability. This includes commissioners and providers.

C1. Minutes and papers of the QIPP cabinet;C2. Minutes and papers of the Finance and Performance Committee;C3. Minutes and papers of the QIPP Cabinet and Finance and Performance Committee.C4. Contract of Service.C5. Minutes of meetings and meeting reports.C6. Governing Body forum note.C7. Updated financial assessment.C8. Deloitte feedback.C9. PMO reports.C10. Minutes of workshop.C11. Contracts with acute providers.C12. QIPP registerC13. Meeting notes and papers.C14. A NCL STP Finance and Activity Modelling meeting occurs every two weeks to ensure NCL remains on track with QIPP delivery.


5 4 20

187


Controls in Place

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431

Sally MacKinnon- Director of Transformation, Planning and Delivery

Maintain financial stability and ensure sustainability through robust planning and commissioning of value for money services

TITLE: Failure to deliver a robust QIPP

plan for 2018/19 (Threat)

CAUSE: If the CCG fails to produce and deliver a robust QIPP plan for 2018/19 that meets NHS mandated control totals.

EFFECT: There is a risk that the CCG may not have a balanced budget for 2018-19 and not meet NHS England control totals.

IMPACT: This may result in the CCG being placed into directions/special measures by NHS England, destabilisation of the CCG, destabilisation of local providers, a wider negative impact on the NCL health economy and loss of influence of quality of patient care.

C1. QIPP Workshop is overseeing the development of the 2018/19 QIPP plan. C2. Finance and Performance Committee reviews and approves the overall financial plan including QIPP. C3 Currently going through a review of avoidable spend, assigning priorities to spend areas with a view to reducing or ceasing low priority spend.C4. QIPP Manager to support the QIPP Programme is in role.C5. QIPP Planning started in September 2017.C6. Obtained from Governing Body direction on lower priority spend areas for savings.C7. Root and branch review of all spend across the organisation completed.C8. Consistent NCL approach to planning .C9. PMO taking a strengthened role in QIPP.C10. Governing Body direction on lower priority spend areas obtained.C11. Contractual arrangements with acute providers in place.C12. Clinical and manager leads in place for each area of QIPP.C13. QIPP Challenge Panel established to oversee operational delivery of QIPP.C14. Camden CCG is part of the NCL STP which has shared responsibility to ensure financial stability. This includes commissioners and providers.C15. Review of all exising QIPP schemes completed.

C1. Minutes and papers of the QIPP cabinet;C2. Minutes and papers of the Finance and Performance Committee;C3. Minutes and papers of the QIPP Cabinet and Finance and Performance Committee.C4. Contract of Service.C5. Minutes of meetings and meeting reports.C6. Governing Body forum note.C7. Updated financial assessment.C8. NCL QIPP & planning meetings.C9. PMO reports.C10. Minutes of workshop.C11. Contracts with acute providers.C12. QIPP registerC13. Meeting notes and papers.C14. A NCL STP Finance and Activity Modelling meeting occurs every two weeks to ensure NCL remains on track with QIPP delivery.C15. Outcome of review documents.


5 4 20

Very High

A1. NCL Financial Planning to develop 18/19 QIPP targets -Target 31.1.18A2. Initial QIPP targets schemes identified and PIDs developed.A3. Attend NHSE QIPP Assurance meeting in Dec 2017.A4. Share STP QIPP PIDs with provider to provide opportunity to develop in partnership.A5. Undertake work to meet unidentified QIPP of circa 2m.A6. Refresh QIPP target when planning guidance is issues- expected January 2018

A1. QIPP target developed across NCL to ensure consistent approach –done 30.917. Completed.A2. The QIPP programme has now identified £24m of schemes, against a target of £26m opportunities for unidentified QIPP are currently being modelled. Completed.A3. Positive assurance meeting held in Dec 17. Final assurance report from NHS E due in Jan 18.A4. Action completed on 22.12.17.A5. Work on this action is in progress. Shared QIPP director now in place.A6. Guidance is expected in January 2018.

A1. 31.08.2018A2. 15.12.17A3. 22.12.17A4. 22.12.17A5. 31.3.18.A6. 31.1.18.

4 4 16

Very High

JCC 1

Paul Sinden, NCL Director of Performance

and Acute Commissioning

62 Days Waiting Time Standard is Met

Delivery of Cancer 62-day waiting time

standard (Threat)

Cause: There may be insufficient capacity within the system, and inefficiencies along pathways in particular for inter-provider transfers.

Effect: There is a risk that the system may be unable to cope with the level of demand and has limited resilience to unexpected events.

Impact: This may result in people not receiving treatment within 62 days with potential adverse impact on their health outcome.

C1. North Central London ('NCL') cancer governance arrangements established to cover both performance and transformation.C2. Improvement trajectory agreed with NHS England and NHS Improvement.C3. Remedial Action Plans in place with providers that are not meeting the 62 day standard. Updated plan received from Royal Free London.C4. 38 day transfer protocol in place for inter-provider transfers from district general hospitals to tertiary services with the 38 day standard compatible with treatment commencing within 62 days.C5. Trajectory agreed with providers to meet the 38-day standard for transfers of care

C1. Meeting papers and notes.C2. Plans and trajectories in place with providers to allow NCL to meet the standard overall. Backlog analysis indicates reduction towards sustainable level. Progress most marked at Royal Free London in October and November. C3. Plans. C4. Transfer protocol document.C5. Provider trajectories

Weak

4 4 16

Very High

A1. Continue to work with providers on delivering the trajectories.A2. Continue to work with providers to ensure sustainable delivery and includes work through the cancer vanguard.A3. NCL recovery of the 62 day standard by December 2017.A4. UCLH recovery of the 62 day standard by end of March 2018 and is consistent with system recovery by December 2017. Updated recovery plan required from the Trust.

A1. Meeting with providers on a fortnightly basis and ensuring their plans are consistent with agreed trajectories.A2. Meeting with providers on a fortnightly basis.A3. Currently on track for delivery.A4. Further assurance on UCLH delivery of the standard by March 2018 required.

A1. 31.07.2017A2. 31.07.2017A3. 30.09.2017.A4. 31.03.2018.

3 4 12

High

JCC 2



A&E 4 Hour Time Waiting Standard is Met

Delivery of four-hour waiting time

standard for A&E (Threat)

Cause: There may be insufficient capacity across hospital and community services to meet peaks in emergency care demand.

Effect: There is a risk that people will spend more than four hours within emergency departments before receiving definitive treatment or be located in the wrong part of the system due to pressures along the emergency care pathway.

Impact: This may result in people experiencing delays in treatment, admission to a hospital bed and/or discharge back into the community.

C1. A&E Delivery Boards established and meet monthly which have executive level representation from key providers and commissioners in the systemC2. A&E Delivery Boards are informed by dashboards that monitor key parts of the system to highlight any issues in terms of capacity and/or performance.C3. With key providers, and using resilience funding available A&E Delivery Boards have agreed which parts of the system would benefit from increased capacity or efficiency changes. C4. Continued monitoring of the plan (i.e. initiatives) against agreed outcome measures by A&E Delivery Boards.C5. Funding is targeted to support the remedial action plans (RAPs) agreed with UCLH. C6. A North Central London (NCL) wide review of how winter went across NCL took place on 6th April 2017 to share lessons learnt.C7. All A&E Delivery Boards submitted plans to NHS England for winter 2017/18 based on experiences and pressures in 2016/17

C1. Meeting papers and notes.C2. Meeting papers and dashboards.C3. Remedial Action Plans, meeting papers and notes.C4. Meeting papers, notes and dashboards.C5. Plans to utilise winter resilience monies.C6. Report.C7. Plans

Weak

4 4 16

Very High

A1 . Develop a demand and capacity plan for both hospital and community services.A2. Implement STP initiatives.A3. Develop mutual aid plans for January 2018 to meet peaks in demand.

A1. A&E Delivery Boards are developing system wide demand and capacity plans.A2. STP initiatives are being implemented in accordance with individual plans. Progress on implementation is reviewed in CCGs and STP work streams monthly.A3. Providers developing plans to release clinical resource to support emergency patient flow through A&E and wards

A1. 30.08.2017A2. 31.07.2017A3. 08.12.2017

3 4 12

High

288


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JCC 10



Effective mobilisation of Sustainability and

Transformation (STP) plans and CCG QIPP

plans to ensure contracts remain within resource

envelopes

Mobilisation of STP and QIPP plans

(Threat)

Cause: if we do not ensure that STP and QIPP plans are delivered in accordance with planning assumptions

Effect: There is a risk that contracts will not be delivered within resource envelopes for 2017/18

Impact: This may result in delays to service changes, higher contract baselines for 2018/19 than anticipated in financial plans for CCGs, and a wider system financial gap.

C1. Signed contracts in place for 2017/18 and 2018/19C2. Contract frameworks in place with each provider including Local Delivery Teams to support the STPC3. In-year contract variances subject to marginal rates rather than full tariff adjustments C4. Collaborative arrangements in place through Finance and Activity Modelling (FAM) Group as part of STP governance frameworkC5. Sustainability and Transformation Plan governance and supporting work streams with commissioner and provider membership in place

C1. Signed contractsC2. Meeting minutes and papersC3. Signed contractsC4. Meeting minutes and papersC5. Meeting papers

Average

4 4 16

Very High

A1. Finalise proposals to increase support for STP work streams A2. Progress the work of the acute contract modelling group to consider alternative contract forms

A1. To discuss the approach to this at SMT.A2. To include the ambition to change system incentives in system intentions

A1. 31.07.2017.A2. 30.09.2017

4 3 12

High

JCC11



Management of acute contracts to ensure

contracts are delivered within contact baselines

(CCG resource envelopes)

Managing acute contracts within contract

baselines (Threat)

Cause: if expenditure on acute contracts exceeds planned contract baselines

Effect: There is a risk that CCGs will not meet their financial duties and/or investment is withheld to support delivery of the Sustainability and Transformation Plan

Impact: This may result in delays to investing in primary care and community capacity and perpetuate the risk over performance on acute hospital contracts

C1. Signed contracts in place for 2017/18 and 2018/19C2. Contracts include marginal rate payments/deductions for variances from plan and 3% growth (higher than historic growth trends) C3. Contract management framework in place with providersC4. Issue of contract notices in line with contact provisionsC5.. Mobilisation of STP and QIPP plans (see JCC10)C6. North Central London Finance and Activity Modelling (FAM) Group, with commissioner and provider membership. that oversees system financial positionC7. Work on alternative contract forms to support the Sustainability and Transformation Plan (STP) through the Acute Contract Modelling Group (with commissioner and provider membership)C8. Quarter one reconciliation agreed with providers as a precursor to establishing the opening contract baseline for 2018/19

C1. Signed contractsC2. Signed contractsC3. Meeting minutes and papersC4. Contract documentation and correspondence including remedial action plansC5. See JCC10C6. Meeting minutes and papersC7. Meeting minutes and papersC8. Meeting minutes and papers

Average

4 4 16

Very high

A1. Develop and sign-off system intentions for 2018/19A2. Develop, in co-production, with providers, proposals for alternative contract forms for hospital providers

A1. System intentions issued to providers. A2. Consideration of models used elsewhere - Aligned Incentive Contract in Bolton; Accountable Care models

A1. 30.09.2017A2. 31.10.2017

4 3 12

High

JCC 13



Management of winter pressures to support

recovery of A&E waiting time standard and protect capacity for

delivery of cancer and referral-to-treatment

waiting time standards

Ensuring that management of winter

pressures supports recovery of waiting

time standards for A&E and cancer and

protects capacity for elective pathways

(Threat)

Cause: if we are unable to manage non-elective flows within planned hospital and community capacity to meet winter pressures

Effect: There is a risk that patients may receive sub-optimal care and long waiting times leading to the local system missing waiting time standards for A&E and referral-to-treatment. Historically capacity to meet cancer waiting time standards has been successfully ring-fenced.

Impact: Patients may remain in inpatient placements longer than anticipated as community care packages are developed.

C1. Establishment of A&E Delivery Boards with representation across health and care system C2. Establishment of NCL Urgent and Emergency Care (UEC) BoardC3. STP work streams for urgent and emergency care established for long-term sustainability.C4. Winter plans for 2017/18 prepared by each A&E Delivery BoardC5. Recovery plans submitted by each A&E Delivery Board to regain A&E four-hour waiting time standardC6. See JCC2 - recovery of A&E four-hour waiting time standard

C1. Meeting papers and minutes from A&E Delivery BoardsC2. Meeting papers and minutes from UEC Board .C3. Work streams plans and QIPP monitoring reportsC4. Plans submitted and reports/dashboards monitoring progress.C5. Plans submitted and reports/dashboards monitoring progress.C6. See JCC2

Average

4 5 20

Very high

A1. Agree escalation process for NCL with NHS England and NHS Improvement A2. Hold winter workshop on 27 SeptemberA3. Identification of further recover plans through winter workshop and A&E Delivery Boards.A4. A&E delivery boards to develop additional winter plans to provide capacity.

A1. NCL approach to escalation agreed in principle with NHS England A2. Actions from winter workshop will be actioned through A&E Delivery Boards A3. Response from regulators to winter plans will specify further actions to be taken to alleviate winter pressures.A4. A&E delivery boards have developed additional winter plans to provide capacity in both hospital and community settings this includes supplementary plans which received additional funding in December 2017.

A1. 13.10.2017A2. 30.09.2017 - write up of actionsA3. 31.10.2017. A4. 30.12.17- Completed.

4 4 16

Very high

389


Controls in Place

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JCC 14



Mobilising STP schemes that shifts activity away

from acute providers in a way that allows those providers to release

capacity and costs, and thereby reduce overall

system costs

STP and local plans target the shift of

care from hospital into community

settings, to reduce the overall system

financial deficit this needs to be done in a

way that allows hospital providers to

reduce capacity and costs. This risk

follows on from the initial risk of

mobilising STP and local plans in JCC10

(Threat)

Cause: if we are unable to shift care from hospital to community settings that allow providers to make a step-change in capacity

Effect: There is a risk that hospital providers are left with stranded costs and we do not reduce overall system costs

Impact: STP and local interventions do not help reduce the system financial deficit in the anticipated way.

C1. Signed contracts for 2017/18 and 2018/19 that include the impact of STP interventionsC2. System intentions for 2018/19 that seek to align intentions across CCGS so we commission at scaleC3. Agreement of approach to planning round for 2018/19 with providers through STP finance meetings. Contract baselines for 2018/19 to include the impact of STP interventions. C4. Work with providers on alternative contract forms to support STP delivery, with the work informed by provider cost profiles.C5. STP Finance meetings with commissioners and providers that has a common understanding of financial position in NCL system

C1. Contract documentationC2. NCL Systems Intentions letterC3. Meeting paper and notes.C4. Meeting papers and notes. C5. Meeting papers and notes.

Average

4 4 16

Very high

A1. Work streams development of STP plans for 2018/19.A2. Agree option for setting contract baselines for 2018/19.A3. Negotiation of contract baselines for 2018/19 incorporating 2017/18 plan/outturn, growth and impact of interventions.A4. Agree models for alternative contract forms to be shadow run in 2018/19A5. Create finance and activity schedules that support the shadow running od the alternative contract forms.

A1. STP work streams notified on planning timetable and working to identify interventions. A2. Options for setting contract baselines went to STP finance meeting on 01.09.2017 and will go to meeting on 29.09.2017 for decision.A3. To follow on from finance STP decision (see A2)A4. Acute contract modelling group establishedA5. Open book approach to provider cost profiles agreed

A1. 30.11.2017A2. 13.10.2017A3. 31.12.2017A4. 31.12.2017A5. 01.01.2018

3 3 9

High

JCC 18



Reducing the system financial deficit in line

with planning assumptions

NCL is a system in deficit. One of the

aims of our Sustainability and

Transformation Plan is to deliver financial

recovery and maintain and sustainable

health and care system. The STP sets out

the challenges to financial recovery from

demographic and demand trends.

(Threat)

Cause: if our plans do not deliver financial balance

Effect: There is a risk that additional savings plans will need to be developed that have a greater impact on service delivery and access than current plans, and the local system comes under greater scrutiny from regulators.

Impact: Delivery of our STP developments is slowed down and impact reduced. Greater local resource is taken up with assurance processes

C1. STP finance meeting established that has a common view of system deficit C2. Collaborative approach to contracting round for 2017/18 and 2018/19 C3. Work on alternative contract forms for future years to support cost reductionC4. Monthly reporting cycle and monitoringC5. working groups established for areas of pressure and with scope for cost reduction - estates, continuing healthcare, demand management etc.C6. Iterative CCG QIPP plans

C1. Meeting papers and minutes from STP finance group C2. Contract documentation; notes from STP finance group.C3. Notes from acute contract modelling groupC4. ReportsC5. Meeting notesC6. Reports.

Average

4 5 20Very high

A1. Finalise quarter one reconciliation process to identify opportunities for year-end settlementsA2. Continue to identify further savings opportunities A3. 2081/19 planning round to set contract baselines for 2018/19

A1. Quarter one reconciliation process underwayA2. Opportunities being developed through STP finance group and locally by CCGs A3. Process for planning round agreed through STP finance group

A1. 30.10.2017A2. This action is continuing.A3. 31.12.2017

4 4 16

Very high

JCC 20



18-week referral-to-treatment waiting time

standard is met

Delivery of referral-to-treatment (RTT)

waiting time standard (Threat)

Cause: There may be insufficient capacity within the system, and inefficiencies along pathways.

Effect: There is a risk that the system may be unable to cope with the level of demand and has limited resilience to unexpected events.

Impact: This may result in people not receiving treatment within 18 weeks of referral from their GP with potential adverse impact on their health outcome.

C1. Contract governance arrangements established to cover performance.C2. Remedial action plan agreed with UCLH. C3. Planned Care work stream considering demand management schemes to support RTT delivery including Clinical Advice and Navigation.

C1. Meeting papers and notes.C2. Agreed remedial action plan C3. STP Project Initiation Documents (PIDs)

Average

4 4 16

Very High

A1. Continue to work with UCLH and Royal Free London on delivery of remedial action plansA2. Continue to work with providers to ensure sustainable delivery including work through the STPA3. Develop activity plans for 2018/19 for sustainable deliveryA4. Develop tariff arrangements for Clinical Advice and Navigation

A1. Monitor remedial action plans through contract meetings. A2. Development of planned care initiatives for 2018/19 underway. A3. Development of activity plans for 2018/19 underwayA4. Initial work on potential tariffs has started

A1. 04.12.2017A2. 30.11.2017A3. 20.12.2017A4. 20.12.2017

3 3 9

High

490

BAF Risk Heat Map

2 3 4 5

3

4

5

Consequence

Likelihood

2

1

1

434

Temp 1

382

Current Risk Score: Target Risk Score:x x

382

362362

JCC 1

JCC 1

JCC 2

JCC 2

JCC 10

JCC 10

JCC 11

JCC 20

JCC 13JCC 13

JCC 14

JCC 14

JCC 18

JCC 18

432

431

431

432

JCC 20JCC 11

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Risk Scoring Key This document sets out the key scoring methodology for risks and risk management.

1. Overall Strength of Controls in Place There are four levels of effectiveness: Level Criteria Zero The controls have no effect on controlling the risk. Weak The controls have a 1- 60% chance of successfully controlling the risk. Average The controls have a 61 – 79% chance of successfully controlling the risk Strong The controls have a 80%+ chance or higher of successfully controlling the risk

2. Risk Scoring

This is separated into Consequence and Likelihood. Consequence Scale: Level of Impact on the Objective

Descriptor of Level of Impact on the Objective

Consequence for the Objective

Consequence Score

0 - 5% Very low impact Very Low 1 6 - 25% Low impact Low 2 26-50% Moderate impact Medium 3 51 – 75% High impact High 4 76%+ Very high impact Very High 5

Likelihood Scale: Level of Likelihood the Risk will Occur

Descriptor of Level of Likelihood the Risk will Occur

Likelihood the Risk will Occur

Likelihood Score

0 - 5% Highly unlikely to occur

Very Low 1

6 - 25% Unlikely to occur Low 2 26-50% Fairly likely to occur Medium 3 51 – 75% More likely to occur

than not High 4

76%+ Almost certainly will occur

Very High 5

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3. Level of Risk and Priority Chart

This chart shows the level of risk a risk represents and sets out the priority which should be given to each risk:

LIKELIHOOD

CONSEQUENCE

Very Low (1)

Low (2)

Medium (3)

High (4)

Very High (5)

Very Low (1)

1 2 3 4 5

Low (2)

2 4 6 8 10

Medium (3)

3 6 9 12 15

High (4)

4 8 12 16 20

Very High (5)

5 10 15 20 25

1-3

Low Priority

4-6

Moderate Priority

8-10

High Priority

15-25

Very High Priority

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Camden Clinical Commissioning Group Governing Body Meeting on 17th January 2018

Report Title NCL Audit Committee in Common

Agenda Item 5.2 Date 3rd January

2018 Committee Chair (where applicable)

Richard Strang, Lay Member for Audit and Governance

Lead Director Ian Porter, NCL Director of Corporate Services


Report Author Andrew Spicer, NCL Head of Governance and Risk



Tel/Email

Report Summary

This report proposes the establishment of the NCL Audit Committee in Common, sets out the benefits of this and asks the Governing Body to approve the establishment of the NCL Audit Committee in Common.

Purpose (tick one box only)

Information

Approval

To note Decision

Recommendation The Governing Body is asked to: 1. Note the report; 2. Approve the establishment of the NCL Audit Committee in Common; 3. Approve the Terms of Reference for the NCL Audit Committee in

Common and the Camden CCG audit committee.


This report supports all of the CCG’s strategic objectives.


This report helps to maximise the opportunities for strategic collaboration across four of the five North Central London Clinical Commissioning Groups and strengthens oversight and assurance of our internal control mechanisms.


Conflicts of interest have been managed in accordance with the NCL Conflicts of Interest Policy.


This report if approved will: Reduce duplication of effort across four of the five North Central London

Clinical Commissioning Groups; Reduce the amount of internal and external auditor resource needed to

carry out effective scrutiny of our internal control mechanisms; Better deploy resources and increase expertise, effectiveness and

learning through information, knowledge and skills sharing. Provide the flexibility to work together or individually when it best suits

the needs of an effective audit function.

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Engagement

The lay members for governance and audit in each of the five North Central London Clinical Commissioning Groups were consulted.


This report has been written in accordance with the provisions of the Equality Act 2010.

Report History

This report builds on the work approved by Governing Bodies in November 2016 to support the development and delivery of their Sustainability and Transformation Plan and integrated working arrangements.

Next Steps If the recommendations in the report are approved the next step is to mobilise the NCL Audit Committee in Common.

Appendices

There are two appendices: 1. Draft Forward Plan; 2. NCL Audit Committee in Common and Individual Audit Committees’

Terms of Reference.

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NCL Audit Committee in Common

Introduction The five North Central London (‘NCL’) Clinical Commissioning Groups are in a period of transition. They have a single NCL wide management team and are in the process of integrating their operational functions to support these arrangements and organisational effectiveness. This includes establishing a common NCL approach to CCGs’ internal control mechanisms such as finance, risk, governance and Human Resources (‘HR’). Each Clinical Commissioning Group (‘CCG’) Governing Body has established an audit committee whose role is to critically review and report to their respective Governing Body on the relevance and robustness of the governance and assurance processes on which each relies. In developing the common internal control mechanisms there is the opportunity to strengthen strategic collaboration between the CCGs, share knowledge, expertise and information, strengthen oversight and assurance of the internal control mechanisms and significantly reduce duplication of effort and costs by establishing a common approach to audit committees. This paper proposes the establishment of the NCL Audit Committee in Common which is a committee in common between the audit committees of Camden, Enfield, Haringey and Islington Clinical Commissioning Groups. At this stage the NCL Audit Committee in Common would not include Barnet CCG but this could be reconsidered at a later date. This approach is supported by the recent change in internal and external audit reporting which is now being undertaken on an NCL wide basis which means that there is no need for the auditors and local counter fraud specialists to attend four to five rounds of audit committee meetings when this could be done together once. This a potentially a significant time and cost saving whist maintaining the robustness and quality of the current arrangements. Proposed Approach The proposed approach has three elements which are:

NCL Audit Committee in Common; Individual Audit Committees; Chairing Arrangements

NCL Audit Committee in Common Under legislation is it not possible to establish a joint audit committee and each CCG is required to establish their own individual audit committee. However, it is possible to hold these individual audit committees with other CCGs’ audit committees at the same time, in the same place, with a common agenda, forward plan and Chair as a committee in common. This has been confirmed by legal advice from Capsticks. In this paper this committee in common is known as the ‘NCL Audit Committee in Common.’ Individual Audit Committees Whilst it is expected that most items of business are suitable for the NCL Audit Committee in Common there may be some items which are better suited to being presented individual audit committees. Therefore, the proposal is to retain the ability for each individual audit committee to meet by itself where this is appropriate. An example of this may be when the draft annual reports and accounts are considered before final sign off. However, it will be a developing process and items will be considered as appropriate on a case by case basis.

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It is expected that most audit committee meetings will be held as the NCL Audit Committee in Common and individual audit committee meetings will be held by exception only. Chairing Arrangements It is proposed that the NCL Audit Committee in Common would be chaired by a lay member for audit and governance from a participating NCL CCG. However, as the audit committees are meeting as a committee in common the Chair would only be able to vote on resolutions for his or her own CCG except where that person was also a member of another participating NCL CCG audit committee. The lay member for audit and governance from each CCG would have the casting vote on their own individual committees. When the individual audit committees meet by themselves the Chair would be the lay member for audit and governance from their CCG. The Chair would have the casting vote. Audit Committee Forward Planner To support the business of the audit committees and the NCL Audit Committee in Common and to help understand the appropriate forum for items of business the NCL Governance Leads/Board Secretaries have developed a draft Forward Plan. This is attached at Appendix 1. Terms of Reference The proposed Terms of Reference for both the NCL Audit Committee in Common and the individual audit committees is contained in Appendix 2. The key highlights in the Terms of Reference are: Area NCL Audit Committee in

Common Individual Audit Committees

Membership The Governing Body lay member for audit and governance. The lay Member for audit and governance from another participating NCL Clinical Commissioning Group (this will be a specific named individual) A person who is either:

A Governing Body member who is not the NCL Accountable Officer nor the NCL Chief Finance Officer nor the Chair of the CCG Governing Body; or

A second lay member for audit and governance from another NCL Clinical Commissioning Group.

The Governing Body lay member for audit and governance. The lay Member for audit and governance from another participating NCL Clinical Commissioning Group (this will be a specific named individual) A person who is either:



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Chair A lay member for audit and

governance from a participating NCL CCG.

The CCG’s lay member for audit and governance.

Vice Chair A lay member for audit and governance from a participating NCL CCG but from a different CCG to the Chair.

Another lay member.

Quorum Two members from each of

the four individual audit committees or their nominated deputies must be present. Each of the four individual audit committees must be present for the NCL Audit Committee in Common to be quorate. If one audit committee is not quorate the other CCGs may hold individual audit committees and may choose to do so at the same time and in the same place.

Two members or their nominated deputies.

Voting Resolutions pass by simple

majority. A vote of one audit committee is not binding on any other.

Resolutions pass by simple majority.

Casting Vote The audit committee lay

member for audit and governance or their nominated deputy

The audit committee Chair or their nominated deputy

Proposed Mobilisation Date It is proposed that the NCL Audit Committee in Common is mobilised for Financial Year 2018-19. Recommendation The Governing Body is asked to:

1. Note the report; 2. Approve the establishment of the NCL Audit Committee in Common; 3. Approve the Terms of Reference for the NCL Audit Committee in Common and the

CCG’s audit committee.

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NCL Audit Committee in Common and Individual Audit Committees

Terms of Reference

1. Introduction 1.1 The Governing Bodies of four of the Clinical Commissioning Groups in North Central London

(‘NCL’) have each established their own audit committees to critically review and report to their respective Governing Body on the relevance and robustness of the governance and assurance processes on which each relies.

1.2 The four NCL Clinical Commissioning Groups referred to in these Terms of Reference are: NHS Camden Clinical Commissioning Group (‘Camden CCG’); NHS Enfield Clinical Commissioning Group (‘Enfield CCG’); NHS Haringey Clinical Commissioning Group (‘Haringey CCG’); NHS Islington Clinical Commissioning Group (‘Islington CCG’).

1.3 The NCL Clinical Commissioning Groups are working together to form and operate with a

common set of controls. To support this and provide strengthened oversight the NCL Clinical Commissioning Groups have agreed to hold their audit committees together at the same time, in the same place, with a common agenda and a common chair as a committee in common. This audit committee in common is known as the ‘NCL Audit Committee in Common.

1.4 The NCL Clinical Commissioning Groups have also agreed to retain the flexibility for their individual audit committees to meet by themselves where doing so best achieves an effective audit committee function.

1.5 These Terms of Reference set out the membership, remit, responsibilities and reporting arrangements of both the individual Clinical Commissioning Group (‘CCG’) audit committees and the NCL Audit Committee in Common.

2. Committees in Common

2.1 The following committees form the NCL Audit Committee in Common:

NHS Camden CCG Audit Committee; NHS Enfield CCG Audit Committee; NHS Haringey CCG Audit Committee; NHS Islington CCG Audit Committee.

3. Statutory Framework 3.1 The four key statutory requirements for Clinical Commissioning Group audit committees are:

Provision Requirement Section 14(M) of the NHS Act 2006 (as amended)

A governing body of a clinical commissioning group must have an audit committee

Section 14(1) of the Clinical Commissioning Group Regulations 2012

The audit committee of a CCG Governing Body must have a chair, to be appointed by the CCG for a term to be determined by the CCG

Section 14(2) of the Clinical Commissioning Group Regulations 2012

The chair of the audit committee must be a lay person who has qualifications, exertise or experience such as to enable the person to

100

express informed views about financial management and audit.

Section 7(3) of Schedule 1A to the NHS Act 2006 (as amended)

CCG Constitutions may include provision for the audit committee to include individuals who are not members of the governing body.

3.2 The individual audit committees and the NCL Audit Committee in Common are established in

line with legislation and with the Constitutions of each of the NCL Clinical Commissioning Groups.

4. Role of the Committee 4.1 The role of the individual audit committees and the NCL Audit Committee in Common is to

carry out the duties listed in sections 5 to 13 below. These apply regardless of whether the individual audit committees are meeting by themselves or together as part of the NCL Audit Committee in Common.

5. Integrated Governance, Risk Management and Internal Control 5.1 The audit committee shall review the establishment and maintenance of an effective system

of integrated governance, risk management and internal control, across the whole of the CCG’s activities that supports the achievement of the CCG’s objectives.

5.2 In particular the audit committee will review the adequacy and effectiveness of:

All risk and control related disclosure statements (in particular the annual governance statement), together with any accompanying Head of Internal Audit Opinion, external audit opinion or other appropriate independent assurances;

The underlying assurance processes that indicate the degree of achievement of the organisation’s objectives, the effectiveness of the management of principal risks and the appropriateness of the above disclosure statements;

The policies for ensuring compliance with relevant regulatory, legal and code of conduct requirements and any related reporting and self-certifications;

The policies and procedures for all work related to counter fraud and security as required by NHS Counter Fraud Authority;

The policies and procedures for managing conflicts of interest; The policies and procedures for managing gifts and hospitality.

5.3 In carrying out this work the audit committee will primarily utilise the work of internal audit,

external audit and other assurance functions, but it will not be limited to these sources. It will also seek reports and assurances from directors and managers as appropriate, concentrating on the over-arching systems of integrated governance, risk management an internal control, together with an indication of their effectiveness. These will be evidenced through the audit committee’s use of an effective assurance framework to guide its work and the audit and assurance functions that report to it.

5.4 As part of its integrated approach the audit committee will have effective relationships with other key Governing Body committees so that it underpins processes and linkages. However, these other committees must not usurp the audit committee’s role.

6. Internal Audit

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6.1 The audit committee shall ensure that there is an effective internal audit function that meets the Public Sector Internal Audit Standards 2013 and provides appropriate independent assurance to the audit committee, NCL Accountable Officer and Governing Body. This will be achieved by:

Considering the provision of the internal audit service and the costs involved; Reviewing and approving the audit strategy, annual internal audit plan and more

detailed programme of work, ensuring that this is consistent with the audit needs of the organisation as identified in the assurance framework;

Considering the major findings of internal audit work (and management’s response), and ensuring co-ordination between the internal and external auditors to optimise the use of audit resources;

Ensuring that the internal audit function is adequately resourced and has appropriate standing within the organisation;

Monitoring the effectiveness of internal audit and carrying out an annual review.

7. External Audit 7.1 The audit committee shall review and monitor the external auditors’ independence and

objectivity and the effectiveness of the audit process. In particular, the audit committee will review the work and findings of the external auditors and consider the implications and management’s responses to their work. This will be achieved by:

Considering the appointment and performance of the external auditors; Discussing and agreeing with the external auditors before the audit commences the

nature and scope of the audit as set out in the annual plan; Discussing with the external auditors their evaluation of audit risks and assessment of

the organisation and the impact of the audit fee; Reviewing all external audit reports, including the report to those charged with

governance (before its submission to the Governing Body as appropriate) and any work undertaken outside of the annual audit plan, together with the appropriateness of management responses;

Ensuring that there is in place a clear policy for the engagement of external auditors to supply non-audit services.

8. Other Assurance Functions 8.1 The audit committee shall review the findings of other significant assurance functions, both

internal and external to the CCG, and consider the implications for the governance of the CCG. 8.2 These will include, but will not be limited to, any reviews by Department of Health arm’s length

bodies or regulators/inspectors (for example, the Care Quality Commission, NHS Litigation Authority etc) and professional bodies with responsibility for the performance of staff or functions (for example, Royal Colleges, accreditation bodies etc).

8.3 In addition, the audit committee will review the work of other committees within the CCG, whose work can provide relevant assurance to the audit committee’s own areas of responsibility.

9. Counter fraud

9.1 The Committee shall satisfy itself that the organisation has adequate arrangements in place

for counter fraud and security that meet NHS Counter Fraud Authority’s standards and shall review the outcomes of work in these areas. This will be achieved by:

Considering the provision of the counter fraud service and the costs involved;

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Reviewing and approving the counter fraud strategy, annual internal audit plan and more detailed programme of work, ensuring that this is consistent with the needs of the organisation;

Considering the major findings of internal audit work and management’s response; Ensuring that the counter fraud function is adequately resourced and has appropriate

standing within the organisation; Monitoring the effectiveness of counter fraud and carrying out an annual review.

10. Management

10.1 The audit committee shall request and review reports, evidence and assurances from directors

and managers on the overall arrangements for governance, risk management and internal control.

10.2 The audit committee may also request specific reports from individual functions within the

organisation. 11. Financial reporting 11.1 The audit committee shall monitor the integrity of the financial statements of the organisation

and any formal announcements relating to its financial performance. 11.2 The audit committee should ensure that the systems for financial reporting to the Governing

Body, including those of budgetary control, are subject to review as to the completeness and accuracy of the information provided.

11.3 The audit committee shall review the annual report and financial statements focussing

particularly on: The wording in the annual governance statement and other disclosures relevant to the

terms of reference of the Committee; Changes in, and compliance with, accounting policies, practices and estimation

techniques; Unadjusted misstatements in the financial statements; Significant judgments in preparation of the financial statements; Significant adjustments resulting from the audit; Letters of representation; Explanations for significant variances; Ease of understanding of the contents for patients and the public.

12. Whistleblowing 12.1 The audit committee shall review the effectiveness of the arrangements in place for allowing

staff to raise (in confidence) concerns about possible improprieties in financial, clinical or safety matters and ensure that any such concerns are investigated proportionately and independently.

13. Reporting 13.1 The audit committee shall report to the Governing Body on how it discharges its

responsibilities. 13.2 The minutes of the audit committee’s meetings shall be formally recorded by the Secretariat

and submitted to the Governing Body as required. The Chair of the Committee shall draw to

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the attention of the Governing Body any issues that require disclosure to the full Governing Body, or require executive action.

13.3 The audit committee will report to the Governing Body at least annually on its work in support

of the annual governance statement, specifically commenting on: The fitness for purpose of the assurance framework; The completeness and ‘embeddedness’ of risk management in the organisation; The integration of governance arrangements; The appropriateness of evidence that shows the organisation is fulfilling regulatory

requirements relating to its existence as a functioning business; The robustness of the processes behind the quality accounts.

13.4 The annual report should also describe how the audit committee has fulfilled its terms of

reference and give details of any significant issues that the audit committee considered in relation to the financial statements and how they were addressed.

14. Membership

14.1 When the audit committees are meeting as the NCL Audit Committee in Common or as individual audit committees the membership of each audit committee is as follows:

The CCG’s Governing Body lay member for audit and governance; A Governing Body lay member for audit and governance from another NCL Clinical

Commissioning Group; An additional member who is either:

o A Governing Body member who is not the NCL Accountable Officer nor the NCL Chief Finance Officer nor the Chair of the CCG Governing Body; or

o A second Governing Body lay member for audit and governance from another NCL Clinical Commissioning Group who is a different person that that referred to in the second bullet point of section 14.1 above.

14.2 The membership requirements are summarised in Schedule 2. 14.3 Audit committee members may nominate deputies to represent them in their absence and

make decisions on their behalf. 14.4 The list of voting members is contained in Schedule 1. 15. Attendance 15.1 The individual audit committees and the NCL Audit Committee in Common shall have the

following non-voting attendees: NCL Chief Finance Officer or a nominated deputy; Head of Internal Audit and internal audit representatives; External audit representatives; Local Counter Fraud Specialists; A representative from the NCL Corporate Services Directorate; A representative from North and East London Commissioning Support Unit, as

required; Other directors and/or managers as appropriate; Representatives from other organisations, as required.

15.2 The NCL Accountable Officer will be invited to attend an audit committee meeting at least

once per year to discuss the process for assurance that supports the annual governance statement and the annual report and accounts.

104

15.3 The individual audit committees and/or the NCL Audit Committee in Common may meet

privately with the internal and external auditors at their absolute discretion. 15.4 Non-voting attendees may nominate deputies to represent them in their absence. 15.5 The individual audit committees and/or the NCL Audit Committee in Common may call

additional experts to attend meetings on a case by case basis to inform discussion. 15.6 The individual audit committees and/or the NCL Audit Committee in Common may invite or

allow additional people to attend meetings as attendees. Attendees may present at meetings and contribute to the relevant discussions but are not allowed to participate in any formal vote.

15.7 The individual audit committees and/or the NCL Audit Committee in Common may invite or

allow people to attend meetings as observers. Observers may not present at meetings, contribute to any discussion or participate in any formal vote.

15.8 The list of non-voting attendees is contained in Schedule 1.

16. Chair and Vice Chair 16.1 The NCL Clinical Commissioning Groups’ Governing Bodies have agreed that the Chair and

Vice Chair of the audit committee shall vary depending on whether the audit committees are meeting as the NCL Audit Committee in Common or individually by themselves.

16.2 When the audit committees are meeting as the NCL Audit Committee in Common the Chair

of the NCL Audit Committee in Common shall be a lay member for audit and governance from either Camden CCG, Enfield CCG, Haringey CCG or Islington CCG.

16.3 When the audit committees are meeting as the NCL Audit Committee in Common the Vice

Chair of the NCL Audit Committee in Common shall be a lay member for audit and governance from either Camden CCG, Enfield CCG, Haringey CCG or Islington CCG.

16.4 The Chair and the Vice Chair of the NCL Audit Committee in Common shall be from different

CCGs. 16.5 The Chair and Vice Chair of the NCL Audit Committee in Common shall be appointed upon

the agreement of each of the audit committees comprising the NCL Audit Committee in Common.

16.6 When the audit committees are meeting individually by themselves the Chair shall be the lay

member for audit and governance. The Vice Chair shall be another lay member.

16.7 The Chair and Vice Chair requirements are summarised in Schedule 2: 17. Quoracy

17.1 When the audit committees are meeting as the NCL Audit Committee in Common each audit

committee comprising the NCL Audit Committee in Common must be quorate. Each audit committee is quorate when two members from the respective audit committee or their nominated deputies are present.

17.2 When the audit committees are meeting individually by themselves at least two members or

their nominated deputies must be present for the meeting to be quorate.

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17.3 If the NCL Audit Committee in Common is not quorate the individual audit committees have the option of meeting as individual audit committees at their absolute discretion and as long as the quorum requirements contained in section 17.2 above are satisfied. The individual audit committees may decide to meet at the same time and in the same room as each other at their absolute discretion.

17.4 The quorum requirements are summarised in Schedule 2:

17.5 If any representative is conflicted on a particular item of business they will not count towards

the quorum for that item of business. If this renders a meeting or part of a meeting inquorate a non-conflicted person may be temporarily appointed or co-opted to satisfy the quorum requirements.

18. Voting 18.1 The NCL Clinical Commissioning Groups’ Governing Bodies have agreed that the voting

requirements shall vary depending on whether the audit committees are meeting as the NCL Audit Committee in Common or individually by themselves.

18.2 When the audit committees are meeting as the NCL Audit Committee in Common each audit

committee member shall have one vote with resolutions passing by simple majority. Each audit committee shall vote and make decisions for their CCG only. A vote of one audit committee is not binding on any other audit committee. The lay member for audit and governance from the respective audit committee’s own CCG or their nominated deputy shall have the casting vote on any resolution.

18.3 When the audit committees are meeting as the NCL Audit Committee in Common the Chair

or Vice Chair of the NCL Audit Committee in Common may not participate in the vote of any individual audit committee unless he or she is a member of that audit committee.

18.4 When the audit committees are meeting individually by themselves each audit committee member shall have one vote with resolutions passing by simple majority. The audit committee Chair has the casting vote on any resolution.

18.5 The voting requirements are summarised in Schedule 2: 19. Decisions 19.1 The individual audit committees and the NCL Audit Committee in Common will make decisions

within the bounds of their remit. 20. Authority and Access 20.1 The individual audit committees and the NCL Audit Committee in Common are Governing

Body committees. They must act within the remit of these terms of reference and have no executive powers other than those specifically set out in these terms of reference.

20.2 The Head of Internal Audit, representatives of external audit and counter fraud specialists

have a right of access to the Chair of the individual audit committees and the Chair of the NCL Audit Committee in Common.

20.3 The individual audit committees and the NCL Audit Committee in Common are authorised by

the Governing Bodies to investigate any activity within these terms of reference. They are

106

authorised to seek any information they require from any employees or officers and all employees and officers are directed to co-operate with any request made in this regard.

20.4 The individual audit committees and the NCL Audit Committee in Common are authorised by

the Governing Bodies to obtain outside legal or other independent professional advice and to secure the attendance of outsiders with relevant experience and expertise if they consider this necessary.

21. Secretariat 21.1 The Secretariat to the Committee shall be provided by the NCL Corporate Services

Directorate.

22. Frequency of Meetings 22.1 It is expected that the NCL Audit Committee shall meet four times per year. Whilst it is

expected that most items of business are suitable for the NCL Audit Committee in Common there may be some items which are better suited to being presented to individual audit committees. Therefore, individual audit committees may meet as required. This is expected to be approximately once per year.

22.2 The NCL Audit Committee in Common and/or the individual audit committees may hold additional meetings as required.

23. Notice of Meetings 23.1 Notice of a meeting shall be sent to all members no less than 7 days in advance of the meeting. 23.2 The meeting shall contain the date, time and location of the meeting.

24. Agendas and Circulation of Papers 24.1 Before each meeting an agenda setting out the business of the meeting will be sent to every

member no less than 7 days in advance of the meeting. 24.2 Before each meeting the papers of the meeting will be sent to every member no less than 7

days in advance of the meeting. 24.3 If a member wishes to include an item on the agenda they must notify the Chair via the

Secretariat no later than 7 days prior to the meeting. The decision as to whether to include the agenda item is at the absolute discretion of the Chair.

25. Minutes and Reporting 25.1 The minutes of the proceedings of a meeting shall be prepared by the Secretariat and

submitted for agreement at the following meeting. 25.2 Each individual CCG will comply with their own Governing Body’s reporting requirements. 26. Conflicts of Interest 26.1 Conflicts of Interest shall be dealt with in accordance with the NCL Conflicts of Interest Policy

and NHS England statutory guidance for managing conflicts of interest. The NCL Conflicts of Interest Policy is a master document containing the single conflicts of interest policy agreed

107

by each of the NCL CCGs together with a schedule setting out each CCG’s local variations to that policy.

26.2 The individual audit committees and the NCL Audit Committee in Common shall have a Conflicts of Interest Register that will be presented as a standing item on the agenda.

27. Gifts and Hospitality 27.1 Gifts and Hospitality shall be dealt with in accordance with the NCL Conflicts of Interest Policy

and NHS England statutory guidance for managing conflicts of interest. 27.2 The individual audit committees and the NCL Audit Committee in Common shall have a Gifts

and Hospitality Register that will be presented as a standing item on the agenda. 28. Standards of Business Conduct 28.1 Members, attendees and/or observers must maintain the highest standards of personal

conduct and in this regard must comply with: The law of England and Wales; The NHS Constitution; The Nolan Principles; The standards of behaviour set out in each NCL CCG Constitution; Any additional regulations or codes of practice relevant to the Committee.

29. Training and Information 29.1 It is the responsibility of each organisation referred to in section 1.3 above to ensure that their

representatives are provided with appropriate training and information to allow them to exercise their responsibilities effectively.

30. Quick Reference Guide 30.1 A quick reference guide to the voting members, chair, vice chair, quoracy, voting methodology

and casting votes of the individual audit committees and the NCL Audit Committee in Common can be found in Schedule 2.

31. Review of Terms of Reference 31.1 These Terms of Reference will be reviewed from time to time, reflecting experience of the

individual audit committees and the NCL Audit Committee in Common in fulfilling its functions and the wider experience of CCGs in overseeing a common system of controls.

31.2 These Terms of Reference will be formally reviewed in April each year. These Terms of

Reference may be changed or amended by mutual agreement of the individual audit committees and the NCL Audit Committee in Common and on being approved by each of the Governing Bodies of the NCL Clinical Commissioning Groups in accordance with their Constitutions.

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Schedule 1 List of Members

This schedule sets out the membership, attendees, Chair and Vice Chair of each individual audit committee and the NCL Audit Committee in Common. NCL Audit Committee in Common: The voting members of the NCL Audit Committee in Common are as follows: Committee Voting Members Name and Title Camden CCG Audit Committee

Lay member for audit and governance from Camden CCG

Camden CCG Audit Committee

Lay member for audit and governance from another NCL Clinical Commissioning Group

Camden CCG Audit Committee

A person who is either: A Governing Body

member who is not the NCL Accountable Officer nor the NCL Chief Finance Officer nor the Chair of the CCG Governing Body; or

A second lay member for audit and governance from another NCL Clinical Commissioning Group

Enfield CCG Audit Committee

Lay member for audit and governance from Enfield CCG





member who is not the NCL Accountable Officer nor the NCL Chief Finance Officer nor the Chair of the

109

CCG Governing Body; or


Haringey CCG Audit Committee

Lay member for audit and governance from Haringey CCG







Islington CCG Audit Committee

Lay member for audit and governance from Islington CCG






A second lay member for audit and governance from another NCL Clinical

110

Commissioning Group.

Chair and Vice Chair of the NCL Audit Committee in Common Position Name and Title CCG Chair

Vice Chair

Individual Audit Committees: Camden CCG Audit Committee The voting members of the Camden CCG Audit Committee are as follows: Position Name Title Lay member for audit and governance from Camden CCG


A person who is either: Governing Body



Chair Lay Member for Audit and

Governance at Camden CCG

Enfield CCG Audit Committee The voting members of the Enfield CCG Audit Committee are as follows: Position Name Title Lay member for audit and governance from Enfield CCG

111






Governance at Enfield CCG

Haringey CCG Audit Committee The voting members of the Haringey CCG Audit Committee are as follows: Position Name Title Lay member for audit and governance from Haringey CCG





112

Chair Lay Member for Audit and Governance at Haringey CCG

Islington CCG Audit Committee The voting members of the Islington CCG Audit Committee are as follows: Position Name Title Lay member for audit and governance from Islington CCG






Governance at Islington CCG

Attendees The non-voting attendees at the individual audit committees and the NCL Audit Committee in

Common are:

Position Name Title NCL Accountable Officer Ms Helen Pettersen NCL Accountable Officer NCL Chief Finance Officer Mr Simon Goodwin NCL Chief Finance Officer Head of Internal Audit and Internal Audit Representatives

Mr Clive Makombera

External Audit Representatives

Local Counter Fraud Specialists

A representative from the NCL Corporate Services Directorate

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A representative from North and East London Commissioning Support Unit

The roles referred to in the list of voting members and non-voting attendees above describe the members’ and non-voting attendees’ substantive roles and/or any successor equivalent roles only and not the individual title or titles of any member. Names and job titles are provided for information purposes only and may be updated as required without the need to formally amend the Terms of Reference.

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Quick Reference Guide

No Meeting Voting Members Chair Vice Chair Quoracy Voting Methodology

Casting Vote

1. Audit committee when meeting as part of the NCL Audit Committee in Common

The Governing Body lay member for audit and governance. The lay Member for audit and governance from another NCL Clinical Commissioning Group A person who is either:



A lay member for audit and governance from an NCL CCG

A lay member for audit and governance from an NCL CCG but from a different CCG than the Chair

Two members from each of the four individual audit committees or their nominated deputies must be present. Each of the four individual audit committees must be present for the NCL Audit Committee in Common to be quorate. If the NCL Audit Committee in Common is not quorate the individual audit committees may decide to meet at the same time and in the same room as each other at their absolute discretion.

Resolutions pass by simple majority. A vote of one audit committee is not binding on any other.

The audit committee lay member for audit and governance or their nominated deputy

2. Audit committee when meeting individually by itself and not as part of the NCL Audit Committee in Common.

The Governing Body lay member for audit and governance. The lay Member for audit and governance from another NCL Clinical Commissioning Group A person who is either:



The CCG’s lay member for audit and governance

Another lay member

Two members or their nominated deputies.

Resolutions pass by simple majority.

The audit committee Chair or their nominated deputy

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NCL Audit Committee in Common- Draft Forward Planner 2018-19 Appendix 1

Agenda Items Individ

ual

Meetin

g 1

Meetin

g 2

Meetin

g 3

Meetin

g 4

April May Sept Jan March1. Standing Items

Apologies √ √ √ √ √Declarations of Interests √ √ √ √ √Register of Gifts and Hospitality √ √ √ √ √Minutes of Last Meeting √ √ √ √ √Action Log and Matters Arising √ √ √ √ √Forward Agenda √ √ √ √ √Tender Waivers and Compensation √ √ √ √ √Conflicts of Interest- Issues Arising √ √ √ √ √Meeting Evaluation √ √ √ √ √AOB √ √ √ √ √2. Internal Auditors Reports

Progress Report √ √ √ √Audit Strategy √Audit Plan √NEL CSU Assurance Process √ √ √ √Head of Internal Audit Opinion √ √Risk Management Audit Report √Conflicts of Interest Audit Report √3. External Auditors Reports

Progress Report √ √ √ √Audit Plan √Yearly Report √Annual Audit Letter √ √4. Local Counter Fraud Specialists Reports

Progress Report √ √ √ √NHS Counter Fraud Authoirty Self Assessment √Counter Fraud Plan √Yearly Review √5. Policies

Conflicts of Interest Policy Annual Review √Gifts and Hospitality Policy Annual Review √Standards of Buisness Conduct Policy Annual Review √Risk Management Policy Annual Review √Whistleblowing Policy √Anti-Fraud and Bribery Policy Annual Review √6. Business

Draft Annual Report and Accounts √Annual Reports and Accounts √Review of Approach to Registers of Interest √Committee Effectiveness Review √Information Governance Update and Toolkit √ √Risk Management Approach √ √

116


Report Title Finance, Performance and QIPP

Committee Report


Lead Director Simon Goodwin,

NCL Chief Finance Officer Tel/Email [email protected]

Report Author Carolyn Cullen, Board Secretary

(interim) Tel/Email [email protected]

GB Sponsor(s)

Dr Birgit Curtis Tel/Email [email protected]

Report Summary

A summary report of the meetings of 22 November and 20 December 2017 is attached.

Purpose

Information

Approval To note

Decision

Recommendation The Governing Body is asked to note the report.


This report links with the following strategic objectives: Commission the delivery of NHS constitutional rights and pledges; Improve health outcomes, address inequalities and achieve parity of esteem; Maintain financial stability and ensure sustainability through robust planning

and commissioning of value-for- money services.


The Committee oversees performance and finance risks rated 12 or higher in line with the CCG’s standard risk management processes


There are no conflicts of interests arising from this report. The Committee identifies and manages conflicts of interests in line with CCG processes.


None

Engagement

This summary report is shared with the Camden Public and Patient Engagement Group.


There are no equality impacts arising from this work

Report History

The Finance and Performance Committee reports to each Governing Body Meeting.

Next Steps The Committee and QIPP Workshops will continue to meet as planned

Appendices

None

117

Name of committee: Finance and Performance Committee Date of meeting: 22 November 2017 Issues discussed Finance Report: Month 7

At the end of Month 7 the CCG is forecast to meet its control total; included within reporting is forecast over performance of £8.1m

Acute over performance rose in month; the main source of over spending is non-elective activity

The non-acute sector is forecasting an over performance; the main areas of over performance relate to continuing health care, mental health and children’s services

A recovery plan has been developed and is being implemented with immediate effect The CCG control total will be met by use of reserves and contingencies to offset over-

performance. Finance Recovery Plan

Financial Recovery Plan sets out how the CCG will offset unmitigated financial risks at month 7 of £4.5m

The Finance Recovery Plan will be monitored monthly through the Finance, Performance and QIPP Committee.

QIPP Report: Month 7

There is under achievement of QIPP savings of £1.39m year to date Meetings are being held to align QIPP plans across NCL and identify common savings;

benchmarking exercises across NCL are also being undertaken to identify further QIPP opportunities.

Integrated Performance Report

The main concerns are performance against waiting time standards: the 4 hour wait A&E target, the 62 day cancer target and the 18 week Referral to Treatment (RTT) waiting time standard

Remedial action plans (RAPs) are in place 62 day cancer and A&E targets. Work in also underway to improve RTT

Data Assurance Report

In response to over-performance in non-elective services analytics work is in progress. Camden CCG are now attending technical meetings at the Royal Free London Data assurance will now be a standing item at this Committee.

Analysis of Non-Elective Acute In-Patient Activity

Detailed analysis had been undertaken in response to the recognition of the over performance of in-patient non-elective activity at UCLH, the Royal Free London and Imperial Healthcare Trust

Analysis of the three A&E HRGs responsible for between 60-80% of admissions at all three providers show that the overall level of attendance remains flat but there is an increase in acuity of patients attending and needing admission; this is being further investigated.

118

Issues for the Governing Body None. Decisions for the Governing Body None

119

Name of committee: Finance and Performance Committee Date of meeting: 20 December 2017 Issues discussed Finance Report: Month 8

The CCG is forecasting to meet its control total; however there is over-performance of £7.6m due to a £4.5m overspend on acute services, a £2.3m overspend on non-acute services and a £1.5m overspend on primary care

Acute sector projected overspend in month has improved from £4.8m to £4.5m There is a rise in overspending on non-acute services up to £2.3m from £1.5m in month Sufficient reserves exist to ensure that the control total for 2017/18 will be met; however

reserves once spent will be not be available in future years and consequently in 2018/19 there needs to be tighter financial control and improved QIPP savings identification.

Financial Recovery Plan

The original recovery plan identified actions of £4.6m; as at Month 8 £2m (43%) of the original £4.6m plan had been delivered and reported in the Month 8

New actions of circa £250k have been identified to improve the financial position. Financial Risk Register

The three highly rated risks are: failure to deliver the 2017/18 QIPP savings, failure to produce a robust QIPP plan for 2018/19 and increased costs due to over-performance in the acute sector

Mitigating actions are in place to address these risks; and that the risk ratings have not changed since Month 7.

QIPP Report: Month 8

Camden is forecasting a QIPP saving of £16.59m against a plan of £18.14m; the negative variance of £1.55m is unchanged from Month 7

Camden’s plan continues to rely on savings profiled for the last quarter of 2017/18; work is progressing on delivery of dermatology savings and reducing expenditure on gynaecological scans; also demand management schemes are delivering a reduction in GP referrals to the acute sector

Ongoing work with the Emergency Department at UCLH is helping to reduce the number of admissions; the lead consultant is delivering this change using organisation development to enable the cultural change required

Deloitte, on behalf of NHS England, has audited the top 10 QIPP schemes and their initial feedback gives assurance that Camden is on course to deliver its savings. This audit had been undertaken in all London CCGs and Camden has performed comparatively well. The finalised report from Deloitte’s will be delivered in January.

QIPP 2018/19 Plan

Since September projects have been developed locally and across NCL; 70% of the 2018/19 QIPP plan will come from Sustainable Transformation Plan (STP) schemes which will be pan-NCL; and 30% will be local Camden schemes

Providers are being asked to deliver schemes to the value of 6%; rather than the 3% of previous years; this is a significant change

Project Initiation Documents (PIDs) were being agreed for each scheme; and an overall project plan for each provider is also being agreed; for the 2018/19 QIPP there will be both a SRO (Senior Responsible Officer) and CRO (Clinical Responsible Officer) for each scheme; each will have responsibility for sign off and delivery

There is a Governing Body workshop on 10 January which will review the 2018/19 QIPP.

120

Integrated Performance Report

Main areas of concern are the three waiting time standards: A&E, 62 day cancer and Referral to Treatment (RTT).

In October 2017, 16 out of 22 London Trusts failed to meet the A&E 4 hour wait target; including UCLH and the Royal Free London

Both the Royal Free London and UCLH are not meeting their 18 week Referral to Treatment targets

Benchmarking data for Delayed Transfers of Care suggest that Camden is performing better than the London average; and is rated as Amber

A black alert was reported at St Pancras Hospital at the end of October, resulting from the long waits for rehab beds.

Data Assurance Action Plan

A data assurance action plan has been drawn up to assess if demand is increasing Work to review elective activity; understanding the relationship between demand, contract

performance and RTT performance is ongoing On non-elective work: understanding the relationship between demand, A&E attendance and

contract performance is also being undertaken. Update on Contracting Arrangements for 2018/19

Negotiations to agree a baseline position at UCLH were nearing completion QIPP 2018/19 savings agreement is more difficult as savings targets have risen from 3% to 6% Concern regarding Imperial Healthcare Trust over performance has led to agreement that

Camden CCG will attend the Imperial Associates meeting in 2018.

Issues for the Governing Body None Decisions for the Governing Body None

121


Report Title Integrated Commissioning

Committee Report


Lead Director Richard Lewin, Director of

Integrated Commissioning Tel/ Email

[email protected]

Report Author Carolyn Cullen Board Secretary (Interim)

Tel/ Email

[email protected]


Dr Matthew Clark Tel/ Email

[email protected]

Report Summary This paper presents a summary of the Integrated Commissioning

Committee meetings held on 22 November and 20 December 2017.

Purpose

Information Approval

To note

Decision

Recommendation The Governing Body is asked to note the Integrated Commissioning Committee Report.


Commission the delivery of NHS constitutional rights and pledges Improve health outcomes, address inequalities and achieve parity of

esteem

Identified Risks and Risk Management actions

Any major risks are highlighted as part of this report.


There are no conflicts of interest arising from this report.


None

Engagement

This summary report is shared with the Camden Public and Patient Engagement Group.



Report History The Committee reports to each Governing Body meeting.

Next Steps None

123

Name of Committee: Integrated Commissioning Date of meeting: 22 November and 20 December 2017 Issues discussed Neighbourhood Development – CHE Primary Care Mental Health Service Integrated Community Equipment Service Reablement and Discharge Dementia Services Homeless Healthcare Services Update Enhanced Primary Care Mental Health Services Update Update on Whittington Community Services Clinical Cabinet Revised Terms of Reference.

Decisions Made: Neighbourhood Development – CHE Primary Care Mental Health Service A primary care mental health business case is being developed for approval; the CHE primary care mental health service initiative is seen as a pilot, just in the CHE neighbourhood, for the proposed models of care which could be rolled out across Camden. The Committee approved the proposal to implement the CHE primary care mental health service from January to March 2018 using the CHE neighbourhood funding allocated for neighbourhood development. Reablement and Discharge The Committee considered a wide-ranging appraisal of Better Care Fund projects to enable assessments to be shifted away from acute hospitals. The Committee agreed to continue funding LT Care Finders, the Virtual Reablement team (Enhanced Reablement Service) and the Hospital Social Work Teams. The Committee also agreed that further work would be undertaken to produce three business cases in early 2018 on Carelink, the Community Geriatricians service with the GP Care Homes LES (which will include an assessment of the alignment with the neighbourhood frailty pilot) and the Home from Hospital service. The Committee also agreed to decommission the Hospital Discharge Team to achieve a saving of £144,000 to Health. The Committee also agreed to decommission the Roseberry Mansions reablement flats and assessment flats and to increase capacity at Henderson Court from 4 to 14 units with a re-negotiated admissions criteria; realising a saving of £238,000 to Adult Social Care. Dementia Services The Committee considered the dementia services funded through the Better Care Fund; it was agreed to extend the contract for the Dementia Action Alliance at a cost of £21,786 per annum for one year, with an end date of 31 March 2019 and to continue funding the Age UK Camden Dementia Service and the Camden Memory Service. The Committee also agreed to undertake a review of the current dementia pathways to identify areas for further efficiency and identify potential QIPP savings.

124

Homeless Healthcare Services Update An update was given on the performance of the current homeless healthcare service since it was decided to decommission the homeless healthcare services provided by St Mungo’s in July 2017. The Committee was assured that the new arrangements had so far performed well. Update on the Whittington Community Services An update was given on the review of Whittington Health Community Services; a memorandum of understanding was signed on 22 September 2017 to agree to an improvement plan. Subsequently some progress has been made in the delivery of services but there are still a number of outstanding concerns and unmet deadlines. It was agreed that a review of speech and language services, a £2m a year service, would be considered at the February Committee. Clinical Cabinet Terms of Reference The Committee completed its annual review of the Clinical Cabinet’s terms of reference. The Clinical Cabinet is an important part of Camden CCG’s governance structure and as such has the power to make recommendations to the Integrated Commissioning Committee; however the Clinical Cabinet is not a Governing Body committee or sub-committee. Issues for the Governing Body: None to report.

125


Report Title Locality Committees Report

Agenda Item Item 6.3 Date 05/01/2018

Lead Director Ian Porter, Director of

Corporate Services Tel/ Email

[email protected]

Report Author Tori Awani Member Relations Manager

Tel/ Email

[email protected]

Report Summary

This paper is a summary report of Locality Committees held in November 2017

Purpose (tick one box only)

Information

Approval To note

Decision



Involve member practices and commissioning partners in key commissioning decisions.


There are no risks associated with this report.


None


None

Engagement Not applicable for the purpose of this report Equality Impact Analysis

Not applicable for the purpose of this report

Report History The Locality Committees Report is presented at every Governing Body

meeting Next Steps None

Appendices None

127

Camden CCG Locality Committees Report

1. Introduction One of the key ways that Camden CCG engages with its members is through Locality Committees. The South Locality Committee is chaired by Dr Jonathan Levy, the North by Dr Martin Abbas and the West by Dr Birgit Curtis. In November 2017, the North and West met as a committee-in-common. There were no Committees held in December.

2. November 2017 Locality Committees

The following commissioning items were brought to the Committees in November:

2.1 Extended GP access service Pal Bhambra and Serena Ledger attended from AT Medics, who have been contracted to provide the new Extended GP Access service in Camden. Expressions of interest from practices to host hubs were assessed by an independent evaluation panel against specific criteria and the service launched at four selected hub locations on 1 December 2017. There was varied discussion at the Committees, with some members welcoming the outcome and some, including the CPPEG West representative, querying elements of the process and the selected West hub. At the South Committee, the length of the GP shift was discussed. Questions were addressed by AT Medics and CCG representatives.

2.2 PMS Review reinvestment

Sally MacKinnon, Transformation Director, provided an update on the PMS Review process. Members fed back positively on the reinvestment proposal and the reassurance that monitoring would be light-touch and linked to Local Care Strategy outcomes framework. The increased impact for, and support available to, smaller practices was discussed, re: protecting diversity and excellence of patient care. The Committee patient representatives enquired about provision of information to the public on the impact on individual practices and collectively on services – and the CCG confirmed patients would be engaged over the next year.

2.3 2018 - 2019 Quality Improvement Support Team (QIST) Plans

Vanessa Cooke, Senior Commissioning Manager, confirmed work is underway on a proposal for investment funding and outcomes that QISTs would be responsible for delivering. Members discussed developing clearly benchmarked priority outcomes and measurable metrics that practices feel they can impact. Practices were invited to contribute to the development of the Business Case for the January Integrated Commissioning Committee.

2.4 Long Term Conditions (LTC) Strategy

Dr Jeremy Sandford, Long Term Conditions Clinical Lead and Olivia Waller, Strategic Commissioner, sought feedback on current LTC services and recommendations for future improvements to inform a strategy. Members provided a range of feedback, including: • Standardising the multiple different referral processes into local LTC services • Increasing presence of consultants at practices / named service leads with contact details • A need for consistent consultant advice and guidance, readily available to GPs • Challenges referring into the community respiratory service • Reducing the COPD service boundary-focused way of working.

2.5 Health Visiting Baby Clinic Update (North and West Committee in Common only) The commissioning team returned to respond to feedback shared by practices at the September round of committees on the proposed changes to heath visitor baby clinics. Regarding feedback that the planned Hubs would result in a lack of capacity in the North of the borough, the team is exploring the option of a practice-based hub in this area. The impact on practice infant vaccination rates was raised again, and the CCG will review this moving forward.

128

3 Forward look The member relations function will transition to sit within the Primary Care team from

January 2018, overseen by Amanda Rimington. January Locality Committees: North: Thurs 18, West: Fri 19 and South: Wed 24. Healthwatch Camden will continue to offer practices a support session on implementing the

Accessible Information Standard (AIS) throughout January / February. Neel Gupta and Sarah Mansuralli are continuing to visit all Camden practices on a rolling

basis.

129


Report Title Report of the Procurement

Committee

Agenda Item Date

Lead Director Simon Goodwin,

Chief Finance Officer Tel/ Email

[email protected]

Report Author Carolyn Cullen Board Secretary (Interim)

Tel/ Email

[email protected]

GB Sponsor(s) Kathy Elliott, Lay Member Tel/ Email

[email protected]

Report Summary

This report provides a summary of the issues considered by the Procurement Committee meetings held in May and June 2017.

Purpose

Information

Approval To note

Decision





There are no identified risks arising from this report.


The Procurement Committee’s role is to: Ensure conflicts of interest are managed; Preserve the integrity of the CCG’s decision making processes and to Ensure that the CCG’s decision making is not open to legal challenge.


None.

Engagement




Report History

The Governing Body receives regular reports from the Procurement Committee.

Next Steps None

Appendices

None

131

Report of the Procurement Committee

Summary of the Meetings Held on 15 November 2017

The Procurement Committee (‘Committee’) considered one item of business Personal Medical Services (PMS) Investment Proposal. 1. Personal Medical Services (PMS) Investment Proposal

The Committee considered the proposal which is to redistribute the PMS premium across all practices in Camden in a fair and equitable way to meet the needs of patients who place high levels of demand on primary or secondary care either by virtue of them having complex needs or because they are frequent attenders at the practice.

The Committee was asked to:

Provide assurance that the PMS Investment proposal is free from bias and fair for all GP practices in Camden and that the money will be invested in accordance with the PMS contract criteria

Provide assurance that the proposal is consistent with the primary care strategy for Camden and did not duplicate existing commissions in primary care

Note NHS England/LMC’s assurance process for PMS investment Sign off the PMS Specification.

The Committee:

Agreed that the PMS Investment proposal was free from bias and fair to all GP practices in Camden and that the money will be invested in accordance with the PMS contract criteria also that the proposal is consistent with the primary care strategy for Camden which is based on the national agenda and does not duplicate existing contracts with primary care in Camden

Noted the NHS England/LMC’s assurance process for PMS investment Approved the PMS Specification.

132


Report Title Report of the NCL Primary Care in

Common Report


Lead Director Paul Sinden Tel/

Email [email protected]

Report Author Andrew Spicer Tel/ Email

[email protected]

GB Sponsor(s) Tel/ Email

Report Summary

This report provides a summary of the issues considered by the Primary Care Co-Commissioning Committee held on 22 September 2017.

Purpose

Information

Approval To note

Decision





There are no identified risks arising from this report.


None.


None.

Engagement



This report was written in accordance with the provision of the Equality Act 2010.

Report History

The Governing Body receives regular reports from the NCL Primary Co-Commissioning Committee.

Next Steps None

Appendices

None

133

Name of Committee: NCL Primary Care in Common Report Date of meeting: 22 September 2017 Issues discussed Contract Variations PMS Review Update Primary Care Governance Review Alternative Patients Allocation Scheme Quality Report Finance Report.

Discussions and Decisions Made: Contract Variations The following contract variations were approved:

Brondesbury Medical Centre: A GP is resigning and two GPs are joining to cover the sessions;

Keats Group Practice: A partner is retiring and a new GP is joining to cover the sessions;

Camden Health Improvement Practice: The contract was due to end on 30th November 2017 and has been extended for one year;

Highgate Group Practice: A GP is resigning and two GPs are joining to cover the sessions;

Angel Surgery: A GP is joining to cover a period of absence of another GP; Ravenscroft Medical Practice: A branch of the practice is closing and moving to the main

surgery on Golders Green Road; Vale Drive: Additional space to support an increase in staff, services and list size. The

rent reimbursement would be cost neutral to Barnet CCG as funding is from the existing primary care budget;

St Peter’s Medical Practice: The catchment area has been reduced. Personal Medical Services (PMS) Review Update The meeting discussed the PMS review and transition timescales. The Committee noted that to go live on 1st April 2018 contracts would need to be agreed in December 2017 with three months needed for mobilisation. Camden CCG raised a concern regarding two practices which may need to go through the exceptional circumstances process to ensure their viability over any transition period. The committee noted the report with further work to be undertaken. Primary Care Governance Review The Committee agreed to the following changes to the Terms of Reference:

Urgent and Immediate decisions needing to be made outside of committee meetings could be made by the Chief Operating Officer, lay member and clinical representative from the relevant CCG;

Low Risk and non-contentious decisions that need to be made outside of committee meetings could be made by the NCL Director of Performance and Acute Commissioning with the relevant clinician and lay member from each CCG.

Alternative Patient Allocation Scheme The start date for the Alternative Patient Allocation Scheme has been delayed due to IT connectivity difficulties. NHS England has been working on a London-wide specification for the

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Alternative Patient Allocation Scheme, with the aim of starting procurement in January 2018. The local service is required to run until the introduction of the London-wide specification. Quality Report Work is underway to develop a single report for the five CCGs. The information access standard will be included in the report. A concern raised was that the response rate for the Friends and Family Test (FFT) needed to be improved; and a consistent approach to collecting this information was needed across the five CCGs. Finance Report The cumulative North Central London (NCL) delegated primary care budget position at Month 5 showed overspending of £0.1m year to date but is forecasting an underspend of £1.9m at year end due to forecast outturn underspends at Enfield CCG and Barnet CCG. Camden, Haringey and Islington CCGs forecast that they would spend to plan by year end. NHS England has stated that primary care delegated funds (including reserves and surpluses) can only be spent on primary care services. Any underspends or overspends from individual CCGs going must be managed across the NCL area as long as NCL as a whole financially balances. Going forward from April 2018 any surpluses or deficits against a single CCG’s Primary Care delegated budget would either improve or worsen the same CCG’s bottom line. Proposals with respect to Camden CCG’s potential £2.1m delegated primary care budget pressure for 2017-18 were yet to be formally agreed. There was an expectation that Enfield CCG’s wider ‘risk share’ shortfall of £2.2m would also need to be addressed in the same exercise. It was noted that the net pressure for Camden was £1.5m and for Enfield was £1.1m once CCG specific primary care reserves and headroom were taken in to consideration. The Committee did not recommend any option contained in the paper but noted the following: • Noted that reduced allocations from NHS England were received late in the day making it difficult for Camden CCG to plan and manage within its allocation (£2m less than existing practice budgets); • Noted that 2018/19 will hold similar local and delegated primary care financial pressures as 2017/18. In order to prevent a similar position next year, Camden will modify their commissioning intentions given the team had more time to do this than for 2017/18; • Noted that there needed to be a long term solution to the underspend and overspend issue; • Noted that LMC would like to see the paper go to NHS England executive regarding how the money can be used. LMC highlighted that PMS premium funding is outside the delegated primary care budget. It was agreed that a further finance paper would be presented at the November 2017 committee meeting. Issues for the Governing Body:

Continuing to ensure that the issues around Camden CCG’s primary care budget pressures are effectively managed.

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Meeting in Public of the Camden CCG Governing Body Wednesday 14 March 2018 14:00

PART I AGENDA

Item Title Presenter Action Paper Time Page

1. Introduction

1.1 Apologies for Absence Dr Neel Gupta Note Verbal 14:00 -

1.2 Declarations of Interest Dr Neel Gupta Note 1.2

1.3 Declarations of Gifts and Hospitality Dr Neel Gupta Note 1.3 -

1.4 Minutes of the Previous Meeting Dr Neel Gupta Approve 1.4

1.5 Action Log

Dr Neel Gupta Note 1.5


2.1 Chair’s Report

Dr Neel Gupta Note 2.1

2.2 Accountable Officer’s Report Helen Pettersen

Note 2.2

2.3 The Patient Voice Report

Kathy Elliott Note 2.3

2.4 Quality and Clinical Effectiveness Report

Jane Davis Note 2.4

3. Strategy

3.1 NCL Digital Helen Pettersen

Approve 3.1


4.1 Budget Setting Report

Simon Goodwin

Note 4.1

4.2 Finance Report Simon Goodwin

Note 4.2

4.3 Performance Report Charlotte Mullins

Note 4.3

5. Governance

5.1 Board Assurance Framework Richard Strang Note 5.1

5.2 Information Governance Report Chair

Note 5.2

6. Committee Reports – For information

6.1 Finance, Performance and QIPP Committee

Dr Birgit Curtis Approve/Note

6.1

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6.2 Integrated Commissioning Committee

Dr Matthew Clark

Note 6.2

6.3 Localities Report

Dr Jonathan Levy

Note 6.3

6.4 Procurement Committee Kathy Elliott Note 6.4

6.5 Health and Wellbeing Board Dr Julie Billett Note 6.5

7. Any other Business

7.1 Draft Agenda 9 May 2018 Meeting Dr Neel Gupta Note 7.1

8. Questions from the Public Verbal 16:45 -

Members of the public have the opportunity to ask questions. These must relate to items that are on the agenda for this meeting and should take no longer than three minutes per person.

9. Date of Next Meeting: 9 May 2018

REGISTER OF INTERESTS A register of members’ interests is available on the Camden CCG website

http://www.camdenccg.nhs.uk

A conflict of interest is defined as “a set of circumstances by which a reasonable person would consider

that an individual’s ability to apply judgement or act, in the context of delivering, commissioning, or assuring taxpayer funded health and care services is, or could be, impaired or influenced by another

interest they hold”.

Managing conflicts of interests in the NHS: Guidance for staff and organisations 2017.

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GLOSSARY

Acronym Meaning

A A&E Accident and Emergency ACHS Adult Community Health Services ADHD Attention Deficit Hyperactivity Disorder AHSNC Academic Health Science Networks and Centres ALB Arms’ Length Body AMR Anti-Microbial Resistance AMS Ancillary Medical Services AoMRC Academy of Medical Royal College APE Accountable Provider Entity APMS Any Provider Medical Services AQP Any Qualified Provider ASC Adult Social Care AWP Any Willing Provider B BAU Business As Usual BC Business Continuity BCDR Business Continuity and Disaster Recovery BCF Better Care Fund BEHMHT Barnet, Enfield and Haringey Mental Health Trust BMA British Medical Association BME Black and Minority Ethnic BNF British National Formulary C C2C Clinician to Clinician CAF Common Assessment Framework CAMHS Child and Adolescent Mental Health Services CAP Common Assurance Process CBT Cognitive Behavioural Therapy CC2H Care Closer to Home CCAS Camden Clinical Assessment Service CCG Clinical Commissioning Group CCU Critical Care Unit CDiff Clostridium Difficile CDF Cancer Drugs Fund CDS Commissioning Data Set CDU Clinical Decision Unit CEPN Community Education Provider Network CG Caldicott Guardian CHC Continuing Health Care CHP Camden Health Partnership CICS Camden Integrated Care Service CIDR Camden Integrated Digital Record CIFT Camden and Islington Foundation Trust CIP Cost Improvement Plans CIT Clinical Information Technology CKD Chronic Kidney Disease CLD Chronic Liver Disease CMHT Community Mental Health Team

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http://www.haringeyccg.nhs.uk/Downloads/Board%20Papers/20140130/Item%203.3a%20-%20Better%20Care%20Fund%20cover%20sheet.pdf

http://www.beh-mht.nhs.uk/

http://www.nhs.uk/chq/Pages/2392.aspx?CategoryID=68

http://www.nhs.uk/Conditions/Kidney-disease-chronic/Pages/Introduction.aspx

CMT Controlled Medical Terminology CNWL Central and North West London NHS Foundation Trust COPD Chronic Obstructive Pulmonary Disease CPPEG Camden Patient and Public Engagement Group CPRD Clinical Practice Research Datalink CQC Care Quality Commission CQN Contract Query Notice CQRG Clinical Quality Review Group CQUIN Commissioning for Quality and Innovation CSIPS Continuous Service Improvement Plans CSU Commissioning Support Unit D DBS Disclosure and Barring Service DES Directed Enhanced Service DH or DoH Department of Health DNA Did not attend DOAC Direct Oral Anticoagulants DOLS Deprivation of Liberty Safeguards DR Disaster Recovery DTOC Delayed Transfer Of Care (where patients are ready to

return home or transfer to another form of care but still occupy a hospital bed)

DVA Domestic Violence and Abuse E EA Equality Analysis E&D Equality and Diversity ED Emergency Department EDS Early Discharge Service (was REDS)

/ Equality Delivery System EMIS Electronic Management Information System EMT Executive Management Team EOLC End of Life Care EPR Electronic Patient Record ERR Enhanced Rapid Response (Lambeth) F F2F Face to Face F&P Finance & Performance FBC Full Business Case FE Frail and Elderly FFT Friends and Family Test FNC Funded Nursing Care FoI Freedom of Information FT Foundation Trust G GB Governing Body GDP Gross Domestic Product GMS General Medical Services GP General Practice (or General Practitioner)

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http://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease/Pages/Introduction.aspx

http://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease/Pages/Introduction.aspx

http://www.haringeyccg.nhs.uk/about-us/new_page.htm

http://www.haringeyccg.nhs.uk/about-us/EDHR.htm

http://www.haringeyccg.nhs.uk/about-us/EDHR.htm

http://www.nhs.uk/planners/end-of-life-care/pages/end-of-life-care.aspx

http://www.nhs.uk/chq/Pages/what-is-nhs-funded-nursing-care.aspx

http://www.foundationtrustnetwork.org/about-foundation-trusts/

http://www.nhs.uk/NHSEngland/AboutNHSservices/doctors/Pages/NHSGPs.aspx

GPSU General Practice Support Unit H HASU Hyper Acute Stroke Unit HCA Health Care Assistant HCC Health Care Commission HEE Health Education England HHC/HHL Haverstock Healthcare Ltd HLP Healthy Living Pharmacy (Programme) HPA Health Protection Agency HPSS Health and Personal Social Services HSC Health Scrutiny Committee HSCIC Health and Social Care Information Centre HSSI Higher Severity Service Incident HVS Home Visiting Service HWBB Health and Wellbeing Board I IAPT Improving Access to Psychological Therapies ICAS Independent Complaints Advocacy Service ICAT Integrated Community Ageing Team (Islington) ICO Information Commissioner's Office iCOPE Camden and Islington Psychological Therapies ICP Integrated Care Pathway ICT Information and Communication Technology IDSVA Independent Domestic and Sexual Violence Adviser IFR Individual Funding Request IG Information Governance IHM Institute of Healthcare Management INR International Normalised Ratio IPC Integrated Personal Commissioning IPU Integrated Practice Unit IRIS Identification and Referral to Improve Safety ISBHaSC Information Standards Board for Health and Social Care ISIP Integrated Service Improvement Programme ISTC Independent Sector Treatment Centre ITF Integrated Transformational Fund ITT Invitation to Tender J JCC Joint Commissioning Committee JGPITC Joint GP IT Committee JSNA Joint Strategy Needs Assessment K KPI Key Performance Indicator L LAs Local Authority LAS London Ambulance Service LCS Locally Commissioned Service LES Locally Enhanced Service LGA Local Government Association LHB Local Health Board LHS Local Hospital Strategy LMC Local Medical Committee LSOA Lower Safer Output Access LSP Local Service Provider

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http://www.hscic.gov.uk/

http://www.haringeyccg.nhs.uk/about-us/individual-funding-requests.htm

LTC Long Term Conditions M MARSG Multi-Agency Reablement Steering Group MASH Multi-Agency Safeguarding Hub MBSR Mindfulness Based Stress Reduction MCA Mental Capacity Act MCP Multispecialty Community Providers MDT Multi-Disciplinary Team MHAAT Mental Health Assessment and Advice Team MHRA Medicines and Healthcare products Regulatory Agency MRSA Methicillin Resistant Staphylococcus Aureus MSA Mixed Sex Accommodation MSK Musculoskeletal N N.A.P.P. National Association for Patient Participation NCL North Central London NCL JFC North Central London Joint Formulary Committee NCL MON North Central London Medicines Optimisation Network NCEL North Central and East London NE Never Event NEL CSU North East London Commissioning Support Unit NES National Enhanced Service NHSE National Health Service England NHS IQ NHS Improving Quality NIB National Information Board NICA National Integration Centre and Assurance NICE National Institute for Health and Care Excellence NIHR National Institute for Health Research NMP Non-Medical Prescribing NMUH North Middlesex University Hospital NP Nurse Practitioner NPSA National Patient Safety Agency NQB National Quality Board NRLS National Reporting & Learning System NSF National Service Framework O OBC Outline Business Case OBR Office for Budget Responsibility OCD Obsessional Compulsive Disorder OOH Out of Hours P PACE Post-Acute Care Enablement PACS Primary and Acute Care Systems PALS Patient Advice and Liaison Service PAS Patient Administration System PASA Purchasing and Supply Agency PBC Practice-Based Commissioning PC Primary Care PCT Primary Care Trust PCTF Primary Care Transition Fund PD Personality Disorder PDT Programme Delivery Team PGD Patient Group Directions

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http://www.northmid.nhs.uk/

PH Public Health PHB Personal Health Budget PHE Public Health England PID Person Identifiable Data/

Project Initiation Document PIL Patient Information Leaflet PIRU Policy Innovation Research Unit PM Practice Manager PMO Project Management Office PMS Primary Medical Services PN Practice Nurse PNA Pharmaceutical Needs Assessment PPE Patient and Public Engagement PPG Patient Participation Group PPI Patient and Public Involvement PQQ Pre-Qualification Questionnaire PQS Prescribing Quality Scheme PRC Programme Review Committee PREMS Patient Related Experience Measures PREVENT Part of the government’s counter-terrorism strategy PROMS Patient Related Outcome Measures PTL Patient Tracking List PTSD Post-Traumatic Stress Disorder Q Q&S Quality and Safety QAS Quality Alerts System QGG Quality Governance Group QIPP Quality, Innovation, Productivity and Prevention QM Quality Matters Newsletter QOF Quality Outcome Framework (Assessor Validation

Reports) QP Quality Premium QP(I) Quality Performance (Indicators) R R&R Rehabilitation and Recovery RACI Responsible Accountable Consulted Informed RAG Red Amber Green (a rating system for indicating the risk

status using the traffic light colours) RAID Rapid Assessment, Intervention and Discharge Service (a

mental health service) RAPIDS Rapid Response Admission Avoidance Service (a mental

health service) RAS Rapid Access Service RCP Royal College of Physicians RCGP Royal College of General Practitioners RCT Randomised Controlled Trials REDS Rapid Early Supported Discharge RFL Royal Free London NHS Foundation Trust consisting of

Barnet, Chase Farm and Royal Free Hospitals RFL DTC RFL - Drugs & Therapeutics Committee

RNTNEH Royal National Throat Nose and Ear Hospital RRP Responsible Respiratory Prescribing Subgroup RTT Referral to Treatment

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http://www.haringeyccg.nhs.uk/about-us/patient-and-public-engagement-strategy.htm

http://www.hscic.gov.uk/proms

http://www.nhs.uk/Services/Trusts/Overview/DefaultView.aspx?id=2418




S SBS Shared Business Services SCAS Assessment Service for Children with Autism SCG Shared Care Guideline SCR Serious Case Review SEND Special Educational Needs and Disabilities SFI Standing Financial Instructions SHA Strategic Health Authority SHMI Summary Hospital-level Mortality Indicator SHOT Serious Hazards of Transfusion SIGN Scottish Intercollegiate Guidelines Network SIs Statutory Instruments SI Serious Incident SLA Service Level Agreement SMI Service Measurement Index or Supplier Management

Inventory SMT Senior Management Team SOC Single Overriding Contract SPA Single Point of Access SPC Summary of Product Characteristics SPG Strategic Planning Group SPOR Single Point of Referral STEIS Strategic Executive Information System STP Sustainable Transformation Plan T TAP (Mental Health) Team Around the (GP) Practice TDA NHS Trust Development Authority TFT Thyroid Function Test TIA Transient ischaemic attack TOPS Termination of Pregnancy Service ToR Terms of Reference TREAT Triage and Rapid Elderly Assessment Team TSDO Transformation Strategy Delivery Office TTA Tablets to Take Away TUPE Transfer of undertaking protection of employment

regulations TWR Two-week referral U UCC Urgent Care Centre UCLH University College London Hospital UCLH UMC UCLH - Use of Medicines Committee UTC Urgent Treatment Centre V VBC Values Based Commissioning VSNAG Voluntary Sector National Advisory Group VTE Venous Thromboembolism W WEMWMS Warwick-Edinburgh Mental Health Wellbeing Scale WHO World Health Organisation

WRAP An interactive workshop undertaken by healthcare staff to raise awareness of PREVENT

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http://www.haringeyccg.nhs.uk/downloads/policies/Incident%20and%20Serious%20Incident%20Policy.pdf

http://www.ntda.nhs.uk/

http://www.haringeyccg.nhs.uk/talk-to-us/Value%20based%20commissioning%20presentation%20for%20CCG%20engagement%20network.pdf

http://www.connectingforhealth.nhs.uk/engagement/public/voluntary

Carolyn Cullen Board Secretary

Dr Neel Gupta Chair

Helen Pettersen Accountable Officer

Sarah Mansuralli Chief Operating Officer

Kathy Elliott Vice Chair

Simon Goodwin Chief Finance Officer

Ian Porter NCL Director Corporate

Services

Dr Birgit Curtis GP

Dr Matthew Clark Secondary Care Clinician

Dr Martin Abbas GP

Dr Kevan Ritchie GP Dr Jonathan Levy GP

Richard Strang Lay Member

Glenys Thornton Lay Member

Jonathan Duffy Practice Manager

Dr Sarah Morgan GP

Jane Davis OBE Registered Nurse

Dr Philip Taylor GP

Charlotte Cooley Practice Nurse

Julie Billett Director of Public Health

Neeshma Shah Director Quality & Clinical

Effectiveness

Richard Lewin LA Representative

Saloni Thakrar Healthwatch

Representative

Hilary Lance Patient Representative

Simone Hensby Voluntary Action Camden

Dr Farah Jameel LMC Observer

Jennifer Murray Roberts Commissioning and Contracting Director

Charlotte Mullins Director of Sustainable

Insights

Sally MacKinnon Transformation

Programme Director

Rebecca Booker Deputy Chief Finance

Officer

Table Plan - January 2018 Meeting

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