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INTEGRATED GOVERNANCE AND
PERFORMANCE REPORT
NHS Lambeth Clinical Commissioning
March 2016
Our Mission: Our Mission is to improve the health and reduce health inequalities of Lambeth people and to commission the highest quality health services on their behalf.
Contents 1 INTRODUCTION ................................................................................................ 1
2 EXECUTIVE SUMMARIES ................................................................................ 2
2.1 CCG ASSURANCE ........................................................................................... 2
2.1.1 National CCG Assurance Framework ......................................................................... 2
2.2 COMPONENTS OF THE CCG ASSURANCE FRAMEWORK .......................... 2
2.2.1 Well-led Organisation .................................................................................................. 2
2.2.2 Delegated Functions ................................................................................................... 3
2.2.3 Financial Duties .......................................................................................................... 4
2.2.4 Performance ............................................................................................................... 5
2.3 STRATEGIC AND OPERATIONAL DELIVERY ................................................ 7
2.3.1 Programme Assurance Statements ............................................................................ 7
2.4 QUALITY ASSURANCE .................................................................................... 7
3 CCG ASSURANCE ........................................................................................... 8
3.1 National CCG Assurance Framework 2015/16 ............................................... 8
3.2 NHS Lambeth CCG Assurance 2015/16 ......................................................... 8
4 COMPONENTS OF THE CCG ASSURANCE FRAMEWORK .......................... 9
4.1 Well-led Organisation ...................................................................................... 9
4.1.1 Board Assurance Framework – ................................................................................... 9
4.2 Delegated Functions ...................................................................................... 16
4.3 Financial Management ................................................................................... 16
4.3.1 Financial Position ...................................................................................................... 16
4.3.3 QIPP ......................................................................................................................... 20
4.3.4 QIPP Performance .................................................................................................... 22
4.4 Performance ................................................................................................... 22
4.4.1 NHS England Top 8 Performance Measures and National Constitution Standards ... 23
4.4.2 RTT (Referral to Treatment Times for Lambeth Patients) ......................................... 25
4.4.3 Diagnostics (Lambeth Patients) ................................................................................ 26
4.4.4 A & E Waiting Times ................................................................................................. 27
4.4.5 Cancer Waiting Times ............................................................................................... 27
4.4.6 Ambulance Response ............................................................................................... 28
4.4.7 Health Visitors ........................................................................................................... 28
4.4.8 Improved Access to Psychological Therapies (IAPT) ................................................ 28
4.4.9 New Early Intervention In Psychosis 2 Week Standard ............................................. 29
4.4.10 Dementia Diagnosis Rate ......................................................................................... 29
4.4.11 Transforming Care .................................................................................................... 30
5 STRATEGIC AND OPERATIONAL DELIVERY – OUR PROGRAMMES ...... 33
5.1 Integrated Children and Young People (including Maternity) Programme 33
5.1.1 Programme Assurance Statement ............................................................................ 33
5.1.2 Integrated Children and Young People (including maternity) Programme Risk Register
34
5.1.3 Children and Maternity Programme Board Dashboard .............................................. 38
5.1.4 Key Deliverables ....................................................................................................... 40
5.2 Integrated Adults Programme (Elective, Long Term Conditions, Older
People, Urgent Care) ............................................................................................... 46
5.2.1 Programme Assurance Statement ............................................................................ 46
5.2.2 Integrated Adults (Elective, Long Term Conditions, Older People, Urgent Care)
Programme Risk Register .................................................................................................... 47
5.2.3 Integrated Adults Dashboard .................................................................................... 50
5.2.4 Elective ..................................................................................................................... 52
5.2.5 Long Term Conditions/Medicines Optimisation ......................................................... 55
5.2.6 Older People ............................................................................................................. 72
5.2.7 Continuing Healthcare .............................................................................................. 77
5.2.8 Urgent Care .............................................................................................................. 79
5.3 Integrated Mental Health for Adults .............................................................. 83
5.3.1 Programme Assurance Statement ............................................................................ 84
5.3.2 Integrated Mental Health for Adults Programme Risk Register ................................. 84
5.3.3 Mental Health Whole System Dashboard .................................................................. 86
5.3.4 Key Deliverables ....................................................................................................... 88
5.4 Staying Healthy (Led by London Borough of Lambeth) ............................. 90
5.4.1 Programme Assurance Statement ............................................................................ 92
5.4.2 Staying Healthy Dashboard ...................................................................................... 93
5.4.3 Risk Register ............................................................................................................ 97
5.4.4 Key Deliverables ....................................................................................................... 99
5.5 Primary Care Development ......................................................................... 103
5.5.1 Programme Assurance Statement .......................................................................... 104
5.5.2 Primary Care Development Programme Risk Register ........................................... 104
5.5.3 Primary Care Programme Dashboard ..................................................................... 108
5.5.4 Key Deliverables ..................................................................................................... 109
5.6 Enabler Programmes ................................................................................... 114
5.6.1 Governance and Development Risk Register.......................................................... 114
5.6.2 Equalities ................................................................................................................ 117
5.6.3 ICT .......................................................................................................................... 117
5.6.4 Estates.................................................................................................................... 121
5.6.5 Workforce ............................................................................................................... 124
6 QUALITY ASSURANCE ................................................................................ 127
6.1 Provider Quality Report ............................................................................... 127
6.2 Complaints and PALS .................................................................................. 127
6.3 Serious Incidents ......................................................................................... 130
6.4 Never Events ................................................................................................ 132
6.5 Quality Alerts ................................................................................................ 132
6.6 Infection Control .......................................................................................... 132
6.7 Mixed Sex Accommodation......................................................................... 133
6.8 Freedom of Information (FOI) ...................................................................... 133
6.9 Quality Premium ........................................................................................... 134
6.10 Better Care Fund ....................................................................................... 137
Acronyms
AMH Adult Mental Health
CCG Clinical Commissioning Group
CQC Care Quality Commission
CQRG Clinical Quality Review Group
CQUIN Commissioning for Quality and Innovation Payment
CSU Commissioning Support Unit
CTR Care and Treatment Review
EIP Early Intervention in Psychosis
GSTFT Guy’s and St. Thomas’ NHS Foundation Trust
IPSA Integrated Personal Support Alliance
IST Intensive Support Team
IT Information Technology
KCH Kings College Hospital NHS Foundation Trust
LCCG Lambeth Clinical Commissioning Group
LCSB Local Children’s Safeguarding Board
LWN Living Well Network
NHSE NHS England
PMO Programme Management Office
PTL Patient Tracking List
PRUH Princess Royal University Hospital, Bromley
QIPP Quality Improvement Programme
SCR Safeguarding Children Risk
SEL South East London
SLaM South London and Maudesley NHS Foundation Trust
UCC Urgent Care Centre
1
1 INTRODUCTION
NHS Lambeth Clinical Commissioning Group (CCG) comprises 47 member GP Practices organised
into three localities.
The NHS Lambeth CCG Governing Body is responsible for ensuring that the CCG has appropriate
arrangements in place to exercise its functions effectively, efficiently and economically and in
accordance with the CCG Constitution and our principles of good governance. Membership of the
Governing Body is drawn from our Member Practices, appointed individuals with statutory roles and
nominees from our key Lambeth partners.
The Governing Body is supported by the Lambeth Clinical Network. The purpose of the Clinical
Network is to provide the CCG Board members with sound clinical advice on commissioning care
services, clinical pathways and best practice. The Clinical Network consists of care and clinical
“subject matter experts” from within Lambeth including GPs, practice managers, nurses, pharmacists,
opticians and social care colleagues.
This report sets out how NHS Lambeth CCG is performing against its agreed objectives under the
leadership of the NHS Lambeth Clinical Commissioning Governing Body. It is a tool for providing
assurance to the Governing Body that objectives are being delivered or, where performance is behind
plan, that mitigating actions are in place to address performance improvement.
The 2015/16 Business Plan set out NHS Lambeth CCG’s corporate objectives. Later is this report,
NHS Lambeth CCG’s Programme Boards and Enabler Work streams report on delivery of their
2015/16 objectives. The Integrated Governance and Performance Report provides a consolidate
picture of delivery of NHS Lambeth CCG’s corporate objectives.
NHS Lambeth CCG Objectives 2015/16
CCG Corporate Objectives Quality, Safety
and Effectiveness
Sustainable Delivery & Governance
System Transformation
Involvement Equality
To improve health outcomes, address inequalities and secure a parity of esteem
To secure delivery of the NHS constitutional rights and pledges for all Lambeth residents
To commission proactive care focused upon the prevention and the early detection of illness. Improve outcomes for Lambeth patients and achieve better value, integrated care through transformation programmes delivered in partnership with stakeholders and our residents.
To ensure patients and the public play a central role in the commissioning of the services they receive
Enact the Public Sector Equality and Diversity requirements
To improve the quality and safety of local services
To ensure good governance, financial stability of the local health economy, VfM and the delivery of statutory responsibilities
To ensure the CCG’s commissioning resource and organisational capability are effectively aligned to deliver its objectives
To ensure effective involvement of member practices and other partners in commissioning decisions
2
2 EXECUTIVE SUMMARIES
2.1 CCG ASSURANCE
2.1.1 National CCG Assurance Framework
The Quarter 1 2015/16 Assurance Meeting took place on October 16th 2015. NHS Lambeth CCG is
being assessed against the revised Assurance Framework for this financial year. NHS England has
not yet advised the CCG regarding the outcome of the Meeting.
The Quarter 2 2015/16 Assurance Meeting was cancelled to allow CCGs to focus on the Operational
Plan 2016/17. However, regional teams plan to meet with CCGs to review and feedback on Operating
Plan draft submissions at the end of February 2016. NHS Lambeth CCG is meeting with NHS
England on the 23rd of February.
On the 17th of November NHS Lambeth CCG participated in the NHS England Deep Dive Review of
Safeguarding Children and Adults as part of the assurance process for 2015/16. NHS Lambeth
received an outcome as ‘Assured as Good’ on all components of the review. NHS England London
Region intends to share all areas of good practice identified as part of NHS Lambeth CCGs review in
their London overview report.
NHS Lambeth CCG is currently preparing for a deep dive into provision of Continuing Care. This will
take place on the 9th of March 2016.
2.2 COMPONENTS OF THE CCG ASSURANCE FRAMEWORK
2.2.1 Well-led Organisation
The NHS Lambeth CCG Board Assurance Framework (BAF) is included in this report, along with a
Heat Map showing the number of risks at each score for all risks recorded on Lambeth CCG’s Risk
Register not just those scoring 12 or above. The BAF and supporting Risk Register are living
documents, updated regularly.
Risk Matrix Impact
Likelihood 1 Negligible 2 Minor 3 Moderate 4 Major 5 Catastrophic
4x4=16 2C A&E Performance
4x4=16 2N RTT Performance
4x4=16 2K Cancer referral to treatment 62 days
4x4=16 2M Community Nursing Vacancy Level
4x4=16 5N SEL Strategy - inadequate workforce capacity
4x4=16 5R SEL Strategy - integrated IT systems
3x5=15 1A Safeguarding children
3x4=12 2A Community Nursing Service Improvement Plan
3x4=12 2B Safeguarding Adults
3x4=12 3C Risk to SLaM Contract
3x4=12 3M IPSA Alliance
3x4=12 3N LWN reduction in secondary care demand
3x4=12 7A Financial Planning Risk
3x4=12 7B QIPP delivery risk
3x4=12 6K CSU procurement process risk
3x4=12 PMCF07 Sustainability of Access Hubs
4x3=12 5S PMS Contract Review
1 Rare
1x1=1 1x2=2
4x5=20
5 Almost Certain
1x5=5 2x5=10 3x5=15 4x5=20 5x5=20
4 Likely
4x1=4 4x2=8 4x3=12 4x4=16
3x5=15
2 Unlikely
2x1=2 2x2=4 2x3=6 2x4=8
3 Possible
3x1=3 3x2=6 3x3=9 3x4=12
1x3=3 1x4=4
Risks scoring 12 and above
1x5=5
2x5=10
7 2
1931
1 6
1
9
6
1
1
1
3
2.2.2 Delegated Functions
NHS Lambeth CCG currently has no delegated functions. However, the general practice Out-of-
Hours service, for which the lead commissioner is NHS Southwark CCG, is a directed function. NHS
Lambeth CCG is a co-commissioner for primary care with NHS England. The CCG Assurance
Framework requires CCGs to return a quarterly self-assessment regarding delivery of these services.
Quarters one to three have been submitted. Quarter four is due on the 25th of May 2016 There has
been no formal feedback from NHS England to date.
4
2.2.3 Financial Duties
Financial performance to Month 10 is summarised below.
Performance Area Commentary
Year to
Date
Forecast
Outturn
Revenue Surplus
Lambeth CCG is reporting a surplus of £6.351 for the period to
January and forecast surplus of £7.622m for the year 2015/16. This
is in line with our target of delivering a 1% surplus
Cash Limit
Cash balances are planned to be maintained at low levels (less
than 1.25% at 31st January 2016. Lambeth CCG's cash balance at
bank as at the end of January was £663k failing to meet planned
level for January 16. The CCG expects to meet its cash limit target
for the end of the year
QIPP The CCG is forecasting full QIPP delivery of its annual QIPP target
of £8.86m.
Public Sector
Payment Policy
Public sector payment target is 95% on numbers. The CCG is
currently performing at 98.94% for NHS % overall on numbers and
at 99.88% by value. The CCG is not achieving its target for
numbers for Non NHS invoices. Performance for the first ten
months is 92.91% on numbers and 95.45% by value.
Running CostThe CCGs running cost allowance is £7.8m. The CCG is reporting
an underspend of £482k against its running cost budgets.
Key Financial Performance Duties
5
2.2.4 Performance
Key performance measures rated as Red – based on latest reported data (please refer to section 4.4 for detailed updates on all targets)
RTT NHS Lambeth CCG continues to monitor Admitted and Non-admitted performance as local Trusts have struggled to deliver this standard
guaranteed in the NHS Constitution. Admitted performance has been below the standard every month since April 2015 and non-admitted has also
been below standard apart from in May and June 2015. The Incomplete pathway standard was also narrowly missed at 91.6% as at quarter three.
Delivery of the admitted treated pathway remains a challenge across London.
52 week waiters KCH are not providing data to Unify, however the validation process has identified a number of further over 52 week waiters
finalised as 169 at the end of December, 24 of these were Lambeth patients. Recovery plans have been put in place and KCH have been asked
to produce an over 52 week trajectory. Neurosurgery makes up the largest proportion of the breaches. An additional assurance process has been
put in place for clinical review of the additional long waiters identified. This has had input from CCG clinical leads. 4 of the reported breaches were
at GSTT, two of these are no longer on the waiting list and 2 patients are awaiting TCI. One breach was at the Royal Marsden recorded under
‘other’ as a specialty.
A&E Both GSTT and Denmark Hill continue to perform below the 95% standard and this has been the case for the last three months. January’s
data has not yet been formally published but indicative figures suggest that performance will continue to be a challenge and it is unlikely to
improve until early April 2016.
Cancer Cancer targets are measured on a quarterly basis. The 62 day target was not met in quarters one and two but achieved in quarter three.
The Cancer two week (breast symptoms) was narrowly missed in quarter three.
Ambulance Response Times There has been no improvement in performance during 2015/16 to date. LAS continue to struggle to meet this
target.
Mixed Sex Accommodation Breaches have been reported throughout 2015/16 todate. However, no breaches were reported in December 2015.
Breaches occurring in October (2) and November (4) occurred at GSTT. These were critical care step down patients. The Trust is not required
nationally to report these as mixed sex accommodation breaches however GSTT has chosen to do so for internal monitoring purposes.
6
7
2.3 STRATEGIC AND OPERATIONAL DELIVERY
2.3.1 Programme Assurance Statements
Programme Status/Risks RAG Rating (Red/Amber/Green)
Integrated Children and Young People (Including
Maternity)
Integrated Adults (Elective, Long Term
Conditions, Older People, Urgent Care)
Integrated Mental Health for Adults
Staying Healthy
Primary Care Development
2.4 QUALITY ASSURANCE
The following parts of the CCG’s Quality Assurance Framework are available on a quarterly basis. Quarter 3 2015/16 data is available in this report, alongside the quarterly Provider Quality Report.
Provider Quality Reports
Complaints and PALS enquiries
Serious Incidents
Quality Alerts
NHS England published a revised Serious Incident (SI) Framework in March 2015. All SI issues are monitored.
Lambeth CCG was awarded a payment of £336k for the achievement of 2014/15 Quality Premiums. 2014/15 Quality Premiums achieved were
Avoidable Emergency Admissions and Improving the reporting of medication related safety incidents.
8
3 CCG ASSURANCE
3.1 National CCG Assurance Framework 2015/16
The CCG Assurance Framework is designed to give assurance that CCGs are operating effectively to
commission safe, high quality and sustainable services within their resources.
The components of the 2015/16 assurance framework are as follows:
Components of the NHS England CCG Assurance Framework 2015/16
In addition, the CCG Assurance Framework 2015/16 focuses on 6 CCG statutory functions which are
considered to be ‘Areas requiring a more detailed focus’, as part of the Well Led Organisation
component of the Framework. Whilst these areas will not themselves be assured, concerns around
them will trigger a review of the Well Led Organisation component of the Framework.
3.2 NHS Lambeth CCG Assurance 2015/16
NHS Lambeth CCG is being assessed against the revised Assurance Framework for this financial
year.
The Quarter 2 2015/16 Assurance Meeting was due to take place on 21st January 2016, however
regional teams are meeting with CCGs at the end of February to discuss Operating Plan submissions.
On the 17th of November NHS Lambeth CCG participated in the NHS England Deep Dive Review of
Safeguarding Children and Adults as part of the assurance process for 2015/16. NHS Lambeth
received an outcome as ‘Assured as Good’ on all components of the review. NHS England London
Region intends to share all areas of good practice identified as part of NHS Lambeth CCGs review in
their London overview report.
NHS Lambeth CCG is currently preparing for a deep dive into provision of Continuing Care. This will
take place on the 9th of March 2016.
CCGs are required to complete a quarterly self-assessment for Primary Care and the Out-of-Hours
service. Quarter 4 is due on the 25th May 2016.
9
4 COMPONENTS OF THE CCG ASSURANCE FRAMEWORK
4.1 Well-led Organisation
4.1.1 Board Assurance Framework
The NHS Lambeth CCG Board Assurance Framework (BAF) is included along with a Heat Map showing the number of risks at each score for all risks recorded on Lambeth CCG’s Risk Register not just those scoring 12 or above. The BAF and supporting Risk Register are living documents, updated regularly. The BAF includes the key mitigating actions and tracks progress of risk scores over the previous 12 months.
Risk Matrix Impact
Likelihood 1 Negligible 2 Minor 3 Moderate 4 Major 5 Catastrophic
4x4=16 2C A&E Performance
4x4=16 2N RTT Performance
4x4=16 2K Cancer referral to treatment 62 days
4x4=16 2M Community Nursing Vacancy Level
4x4=16 5N SEL Strategy - inadequate workforce capacity
4x4=16 5R SEL Strategy - integrated IT systems
3x5=15 1A Safeguarding children
3x4=12 2A Community Nursing Service Improvement Plan
3x4=12 2B Safeguarding Adults
3x4=12 3C Risk to SLaM Contract
3x4=12 3M IPSA Alliance
3x4=12 3N LWN reduction in secondary care demand
3x4=12 7A Financial Planning Risk
3x4=12 7B QIPP delivery risk
3x4=12 6K CSU procurement process risk
3x4=12 PMCF07 Sustainability of Access Hubs
4x3=12 5S PMS Contract Review
1 Rare
1x1=1 1x2=2
4x5=20
5 Almost Certain
1x5=5 2x5=10 3x5=15 4x5=20 5x5=20
4 Likely
4x1=4 4x2=8 4x3=12 4x4=16
3x5=15
2 Unlikely
2x1=2 2x2=4 2x3=6 2x4=8
3 Possible
3x1=3 3x2=6 3x3=9 3x4=12
1x3=3 1x4=4
Risks scoring 12 and above
1x5=5
2x5=10
7 2
1931
1 6
1
9
6
1
1
1
10
There are currently 17 risks rated 12 or above.
Two risks have been added to the Corporate Risk Register:
5S ‘Likely risk that the review of the PMS contract will result in changes levels of funding to GP practices impacting on service
delivery and disruption of some GP practices’
6K ‘Risk that ineffective management of commissioning support services procurement process may lead to poor quality service
procured’.
One risk has been reinstated to the Corporate Risk Register:
PMCF07 ‘Prime Ministers Challenge Fund / Access Hubs - Risk that there will be insufficient resources to continue Access Hubs
beyond March 2016’.
One risk has been removed from the Corporate Risk Register:
6G ‘Risk that insufficient governance, ownership and stakeholder/partner engagement will result in legal challenge, delays and
changes to implementation of the SEL Strategy’. This risk has been removed from the corporate risk register as the governance
arrangements are now in place.
11
UPDATED February
2016
Mar
Ap
ril
May
Ju
n
Ju
ly
Au
g
Sep
t
Oct
No
v
Dec
Jan
Feb
Risk
Rated 12
or more
Key Actions
Denis
O'Rourke3C
Risk to SLaM
Contract – possible
risk that the delivery
of AMH redesigns
fails to reduce
relapse rates and
use of beds
8 12 12 12 12 12 12 12 12 12 12 12 12 12+
Working with Southwark on AMH re-design – ongoing
Proposal to create provider/commissioner forum to monitor impact of SLaM re-design, LWN and IPSA agreed. First meeting of whole
system forum met in November 2015. Further meeting in Dec 2015 - looking at impact of the various service transformation initiatives
together.
6 monthly review being undertaken of AMH model. SLaM producing a progress report - completed.
Query regarding month 6 position suggesting substantial reduction in bed usage - Nov 2015. SLaM are undertaking a comprehensive
review of data quality and accuracy and are feeding this through the contract negotiation process for 2016/17.
Denis
O'Rourke3M
Possible risk that
the IPSA Alliance
contract fails to
deliver service and
financial outcomes
resulting in poor
outcomes for people
and financial
challenge
4 12 12 12 12 12 12 12 12 12 12 12+
1. Supporting alliance in relation to housing supply – ongoing. Meetings with housing department and agreed actions in place to
improve access to housing supply.Working to facilitate move on from supported housing working with providers.
2. Developing peer support led evaluation of outcomes from Sept 2015. Recruiting peer supporters - completed; Outcomes reports
expected Feb 2016.
3. Alliance members being interviewed by LH Alliances to support implementation of development plan agreed with existing partners at
learning event. Report received and workshop to take place in Feb 2016 to agree next stage of the development plan.
2015 Monthly Progress 2016Target
Risk Score
and
Direction
of Travel
Principal Risk
(Obstacle to
achievement of
Strategic Aim)
ASSURANCE FRAMEWORK 2015/16 – PROGRESS
SUMMARY
Strategic AimExecutive
Lead
Operation
al Lead
Corporate Objective
1.1: Quality, Safety &
Effectiveness - To
improve health
outcomes, address
inequalities and secure
a parity of esteem
Director of
Integrated
Commissioning
, Adults
Risk
Register
Ref
12
UPDATED February
2016
Mar
Ap
ril
May
Ju
n
Ju
ly
Au
g
Sep
t
Oct
No
v
Dec
Jan
Feb
Risk
Rated 12
or more
Key Actions
Director of
Integrated
Commissioning
, Children
Avis
Williams-
McKoy
1A
Zero Tolerance
Risk - Risk of failure
to safeguard children
and identify and
respond
appropriately to
abuse
5 8 8 15 15 15 15 15 15 15 15 15 15 12+
On-going review of SCR in collaboration with Lambeth Safeguarding Childrens Board and NHS England - Jan 2016.
Implement subsequent SCR recommendations as required
LSCB Executive and Sub working groups now refreshed. Learning and Improvement Sub working group developing key performance
indicators - draft indicators in progress.
Multi-agency FGM policy to be published - COMPLETED
Liz Clegg 2A
Risk of failure to
implement the
Service Improvement
Plan for Community
Nursing
8 16 16 16 12 12 12 12 12 12 12 12 12 12+
Going forward GSTT plan to:
Introduce mobile technology after the introduction of advanced care notes in September 2015
Review referral criteria
Implement a geographical system
Review community end of life roles within the district nursing with a view to creating dedicated roles. This will ensure that patients
Priorities of Care are met so they receive individual care based on their needs which is delivered with compassion and sensitivity by
our nurses
Develop action plans by continuing to measure our services through our patients’ experience
Continue to implement the recruitment strategy - 76 staff recruited in last year (to Dec 2015)
Continue to work with health and social care partners and citizens to co-produce a model of care that supports and meet the needs of
local people.
Opportunities:
Work better across the local hospitals, community and primary care to support patient pathways ensuring smooth transfers of care and
to develop a transfer of care strategy.
Ensure that our clinical strategy is underpinned by working closely with social care and voluntary sector.
Deliver 24/7 community nursing care - OOH service will be managed by GSTT from 07/12/15.
Working with citizens, clinicians, key partners to develop a new model for community nursing, including learning from elsewhere i.e.
Holland - new models of care are being tested in pilot form early 2016.
CCG: To continue to monitor improvement via CQRG and contract monitoring meetings. This was most recently discussed at the
August 2015 CQRG. Update provided at CQRG Dec 2015.
Liz Clegg 2B
Zero Tolerance
Risk - Risk of failure
to safeguard adults
and identify and
respond
appropriately to
abuse
8 12 12 12 12 12 12 12 12 12 12 12 12 12+
Implement the accountability and assurance framework for safeguarding vulnerable people - implement recommendations from NHSE
deep dive, expected Feb 2016
Influence NHSE contracts to include safeguarding training requirements - ongoing; complete a training needs analysis
Practices to nominate staff to attend 'Alerters' safeguarding training - as part of practice visits
Recruit designated doctor for adult safeguarding
Develop training strategy for primary care - March 2016
Recruit designated doctor for adult safeguarding
Liz Clegg 2M
Likely risk to
sustaining good
quality community
nursing service due
to high vacancy level
16 16 16 16 16 16 16 16 16 16
GSTFT forward plan:
Implement a geographical system
Explore more flexible working for staff
Prepare, continue to grow and support the workforce
Continue to implement the recruitment strategy - 76 staff recruited in last 12 months.
Continue to work with health and social care partners and citizens to co-produce a model of care that supports and meet the needs of
local people - new models of care being tested in pilot form at beginning of 2016.
CCG: To continue to monitor recruitment levels via CQRG, contract monitoring meetings. This was last discussed at the August 2015
CQRG. Update provided at CQRG Dec 2015.
Strategic AimExecutive
Lead
Operation
al Lead
Risk
Register
Ref
Principal Risk
(Obstacle to
achievement of
Strategic Aim)
Target
Risk Score
and
Direction
of Travel
2015 Monthly Progress 2016
Corporate Objective 1.2:
Quality, Safety &
Effectiveness - To
improve the quality and
safety of local services Director of
Integrated
Commissioning
, Adults
ASSURANCE FRAMEWORK 2015/16 – PROGRESS
SUMMARY
13
UPDATED February
2016
Mar
Ap
ril
May
Ju
n
Ju
ly
Au
g
Sep
t
Oct
No
v
Dec
Jan
Feb
12+ Key Actions
Bisi
Aiyeleso/
Sara White
2C
Likely risk of not
achieving the agreed
access performance
levels for A&E
resulting in longer
waits for patients
and failure of the
CCG to meet the
national target
12 16 16 16 16 16 16 16 16 16 16 16 16 12+
A repatriation project has commenced across SE and SW London. has delivered significant improvements; the numbers of patients
awaiting repatriation to local hospitals from Kings, for example, was regularly reported in excess of 30 and this has now reduced to
below 10 on a daily basis. Complete by end of March 2015.
A&E performance remains challenging at both GSTT and Kings. The CCG is now represented at the weekly performance meeting at
GSTT.
Winter schemes agreed to support additional capacity.
Tripartite visit made to GST ED including Lambeth CEO following significant drop in performance. Acknowledged that performance
targets will be challenging during building works/moves and consequential loss of capacity. ECIP visit scheduled for November to
assist with immediate improvements.
Jan 16 – Improvement to performance in Dec 2015 but slight dip again in January. Platinum call established bi-weekly and chaired by
the CCG to help unblock issues and facilitate faster discharge of patients (DTOCs).
Urgent care dashboard developed and will be reviewed at the UCWG at every meeting to identify trends and work through with partners
to unblock issues.
Harriet
Agyepong2K
Likely risk of not
achieving the
access performance
levels for timely
access to cancer
treatment (as
measured by the
standard for 62 days
from GP referral to
treatment) impacting
on the CCG Quality
Premium and
Assurance
Framework
12 16 16 16 16 16 16 16 16 16 16 12+
Deep dive at GST did not reveal any key reasons for difference in performance between Lambeth and Southwark CCG. A watching brief
will be kept on this.
GSTT have revised trajectories for internal and external referrals.
TCST action: Trusts being supported by TCST around patient choice and training of booking staff on PTL management.
Harriet
Agyepong2N
Ongoing risk of not
achieving the agreed
access initiative
performance levels
for RTT for
incomplete
pathways impacting
on the CCG Quality
Premium and
Assurance
Framework
12 16 16 16 16 16 16 12+
KCH outsourcing some elective activity to private providers to assist with the reduction of the backlog - ongoing
Meetings between GSTT and commissioners to develop plans to manage referrals - GST and Commissioners agreeing referral
guidelines for key specialties e.g. paediatric ENT.
KCH and GSTT working with national PMO to identify and use and spare capacity - ongoing
2015 Monthly Progress 2016
ASSURANCE FRAMEWORK 2015/16 – PROGRESS
SUMMARY
Strategic AimExecutive
Lead
Corporate Objective
2.1: Sustainable
Delivery & Governance
- To secure delivery of
the NHS constitutional
rights and pledges for
all Lambeth residents
Director of
Integrated
Commissioning
, Adults
Operation
al Lead
Risk
Register
Ref
Principal Risk
(Obstacle to
achievement of
Strategic Aim)
Target
Risk Score
and
Direction
of Travel
14
UPDATED February
2016
Mar
Ap
ril
May
Ju
n
Ju
ly
Au
g
Sep
t
Oct
No
v
Dec
Jan
Feb
12+ Key Actions
Christine
Caton7A
Risk that current
planning and
strategic approach
is not sufficiently
robust to manage
pressures and
deliver sustainable
position in the
context of potential
reduction in growth
resulting from the
implementation of
the CCG allocation
formula
8 12 12 12 12 12 12 12 12 12 12 12 12 12+
SE London CCGs are working as an SPG to deliver transformation across boroughs and providers.
The CCG is represented on each Clinical Leadership Group and Enabler work stream.
The Finance and QIPP Working Group and Governing Body have had oversight of the 2015/16 Operational Plan as it has been
developed and are responsible for in-year performance management of programme delivery - ongoing.
The CCG delivers transformation through its programmes -ongoing.
The CFO is a member of the Financial Provider, Commissioner and LA leadership group responsible for agreeing the financial and
activity assumptions that underpin the SEL Strategic Plan and
and developing business cases for service change where appropriate - Dec 2015.
The CCG and SEL Five Year Strategy Plans are being refreshed during Q2 and Q3 2015/16. Work is underway to assess in detail
savings and investment required to delivery financial sustainability - Dec 2015.
The CCG Governing Body signed off the Our Healthier South East London (OHSEL) strategic direction at its meeting on 1st July 2015.
Programme delivery plans are in place to achieve our 2015/16 commissioning intentions and these have been built into our signed
contracts.
Option appraisal and business case development is underway across SE London - Dec 2015.
CCG programmes continue to develop 2016-17 commissioning intentions including agreement of QIPP and investment. These were
discussed at the GB Meeting on 20 January and overall agreed as basis of plan subject to consultation on detailed content. Final 16/17
plan to be approved by GB on 2 March. 5 year allocations received on 8 Jan. 16/17 allocation was in line with the draft overall financial
framework which was agreed by GB on 6 January 2016.
Operational Plan due in draft Feb 2016. Final Mar 2016. SEL Five Year Strategy due June 2016.
Christine
Caton7B
Risk of failure to
deliver QIPP and
acute
overperformance
leading to CCG risk
on financial
sustainability
8 12 12 12 12 12 12 12 12 12 12 12 12 12+
We are working on plans that have impact going into 2016/17 to make sure we are in a position to meet the financial challenges that
lay ahead - Jan 2016.
The CCG continues to review its performance reporting to improve the way in which we monitor and manage delivery - ongoing
The CCG undertakes in year risk assessments and develops contingency plans to deliver variances from plan - ongoing.
Commissioning Intentions were reviewed and prioritised by programmes and GB during December 2015. The overall content and
financial framework was approved in January 2016, following confirmation of allocations and planning guidance and subject to review
in detail based on responses to sharing with public and membership. Detail of service and activity impact, investment requirements
and QIPP is being worked on to enable Operational Plan and Start Budgets to be completed by 2 March and contracts to be negotiated
by end March 2016.
Director of
Primary Care
Development
Andrew
ParkerPMCF07
Prime Ministers
Challenge Fund /
Access Hubs - Risk
that there will be
insufficient
resources to
maintain the Access
Hubs operational
capacity beyond
March 2016
4 12 12 16 16 16 4 12 12+
1. To be discussed and updated at regular contract meetings with CCG and Federations - ongoing
2. Monitoring of utilisation of Access Hubs from October 2015 - COMMENCED
3. Development of a plan for the use of the freed up capacity of General Practice, which improves care and reduces the use of other
services - 30/11/15 (TF and JC)
4. Plan the evaluation of effects on other services - results of the evaluation will inform the provision going forward.
5. Business Case to be developed for continuation of service after March 2016 - based on existing funding of £1.5million plus
additional investment - there will be some provision of access hubs from April 2016. Exact configuration is to be decided from outcome
of commissioning intentions.
Director of
Primary Care
Development
Andrew
Parker5S
Likely risk that the
review of the PMS
contract will result in
changes to levels of
funding to GP
practices impacting
on service delivery
and service
disruption
6 12 12 12+
1. Project plan to be updated and contain actions 2-3 - 31/01/16
2. Develop a detailed communications plan, especially regarding communication sessions with practices and patient and public
involvement groups - 31/01/16
3. Develop a detailed contingency plan, anticipating and mitigating the likely impacts on service delivery. Leverage new developments
e.g. GP federations, to deliver services at scale 31/01/16
4. Liaise with NHS England around logistical considerations e.g. managing and changing the PMS contracts - 31/01/2015
Corporate Objective 3.1:
System Transformation -
Commission Proactive
care focused on
prevention and early
detection of illness;
Improve outcomes for
Lambeth patients,
achieve better value,
integrated care through
transformation
programmes in
partnership
Director of
Integrated
Commissioning
, Adults
Denis
O'Rourke3N
Possible risk that
the LWN does not
reduce demand on
secondary care
resulting in the
system becoming
unsustainable and
costs in relation to
higher bed usage
8 12 12 12 12 12 12 12 12 12 12 12+
Negotiating with GP Federation becoming part of the LWN Provider Alliance Group and future alliance agreement – Jan 2016
Single LWN performance management report including service and finance from Oct 2015 - initial report received and will be
developed. 6 monthly report published and reviewed at Provider Alliance group.
Meeting held with voluntary sector providers to signal where heading and how to best organise alliance.
Working towards an alliance agreement to support the LWN – April 2016. To support this, a workshop scheduled for 10/10/15 - for
whole market providers to outline plans. Project plan agreed to take this forward, MOU in place from April and full contract from July
2016.
Complete application to GST Charity for further funding.
2015 Monthly Progress 2016
ASSURANCE FRAMEWORK 2015/16 – PROGRESS
SUMMARY
Strategic AimExecutive
Lead
Operation
al Lead
Risk
Register
Ref
Principal Risk
(Obstacle to
achievement of
Strategic Aim)
Target
Risk Score
and
Direction
of Travel
Corprate Objective 2.2:
Sustainable Delivery &
Governance - To ensure
good governance,
financial stability of the
local health economy,
VfM and the delivery of
statutory
responsibilities
Chief Financial
Officer
15
UPDATED February
2016
Mar
Ap
ril
May
Ju
n
Ju
ly
Au
g
Sep
t
Oct
No
v
Dec
Jan
Feb
12+ Key Actions
Andrew
Parker5N
Risk that inadequate
workforce
capacity/skills and a
lack of integrated
information systems
will affect the
delivery of the SEL
Strategy in providing
new models of
integrated, high
quality care
4 16 16 16 16 16 16 16 16 16 12+
Full alignment to CCG Programme Enablers - this is not yet complete and ongoing work required around workforce.
Andrew
Parker5R
Risk that a lack of
integrated
information systems
will affect the
delivery of the SEL
Strategy in providing
new models of
integrated, high
quality care
4 16 16 16 16 16 12+
Full alignment to CCG Programme Enablers
Chief Financial
Officer/Director
of Governance
and
Development
Christine
Caton/Una
Dalton
6K
Risk that ineffective
management of
commissioning
support service
procurement
process may lead to
poor quality service
procured.
8 12 12+
1. Action plan in place for management of procurement process for each service line (GP IT and CCG IT) - June 2016
2. Review of GP and CCG IT procurement process for lessons learned - June 2016
3. Begin procurement process for all other services - starting March 2016
2015 Monthly Progress 2016Principal Risk
(Obstacle to
achievement of
Strategic Aim)
Target
Risk Score
and
Direction
of Travel
Director of
Primary Care
Development
Strategic AimExecutive
Lead
Operation
al Lead
Risk
Register
Ref
Corporate Objective 3.2
System Transformation -
To ensure the CCG’s
commissioning
resource and
organisational capability
are effectively aligned to
deliver its objectives
ASSURANCE FRAMEWORK 2015/16 – PROGRESS
SUMMARY
16
4.2 Delegated Functions
NHS Lambeth CCG currently has no delegated functions. However, the CCG commissions
General Practice services jointly with NHS England and commissions General Practice Out-of-
Hours services as a directed function. All CCGs are now required, as part of the CCG Assurance
Framework, to provide NHS England with a self-certificate providing assurance around
governance and management of potential conflicts of interest for these two services. Quarters 1,
2 and 3 have been submitted and quarter 4 is due on the 25th of May 2016.
4.3 Financial Management
4.3.1 Financial Position
To deliver financial control totals for resource and cash and support the delivery of
statutory financial duties for 2015/16
The CCG is required by statute to meet certain financial duties to ensure that public funds are
used appropriately. CCGs are required not to exceed the revenue (administration and
programme) and capital resource limits in any one year and to have cash balances of no greater
than 1.25% of the main monthly drawdown for March 2016.
Lambeth CCG’s financial performance as at January 2016 is a surplus of £6.351m. The
year-end forecast is an underspend of £7.622m which in line with our planned target of
delivering a minimum 1% surplus.
Running Costs budgets are showing an underspend of £417k as at month 10. The main
reason for this underspend is due to an allocation for quality premium received as admin
and write back of 2014/15 accruals. The expenditure against this allocation is likely to be
programme spend. The CCG is within the £22.50 per head Running Cost allowance. Our
year end forecast is an underspend of £481k.
The CCG has drawn down £342.m of cash at the end of month 10. The maximum cash
drawdown limit is £409.904m for 2015/16. The cash balance at bank as the end of
January 2015 was £663k.
Revenue Resource Limit
Month 9 -
December
Changes Month 10 -
January£'000 £'000 £'000
Issued Budgets - Programme 430,458 5,501 435,959
Issued Budgets - Admin (Running Cost) 7,825 7,825
Reserves 6,120 (3,552) 2,568
Planned Surplus 7,612 7,612
Total Allocation 452,015 1,949 453,964
Summary of Budgets - January 2016
17
Performance Summary
Performance Area Commentary
Year to
Date
Forecast
Outturn
Revenue Surplus
Lambeth CCG is reporting a surplus of £6.351 for the period to
January and forecast surplus of £7.622m for the year 2015/16. This
is in line with our target of delivering a 1% surplus
Cash Limit
Cash balances are planned to be maintained at low levels (less
than 1.25% at 31st January 2016. Lambeth CCG's cash balance at
bank as at the end of January was £663k failing to meet planned
level for January 16. The CCG expects to meet its cash limit target
for the end of the year
QIPP The CCG is forecasting full QIPP delivery of its annual QIPP target
of £8.86m.
Public Sector
Payment Policy
Public sector payment target is 95% on numbers. The CCG is
currently performing at 98.94% for NHS % overall on numbers and
at 99.88% by value. The CCG is not achieving its target for
numbers for Non NHS invoices. Performance for the first ten
months is 92.91% on numbers and 95.45% by value.
Running CostThe CCGs running cost allowance is £7.8m. The CCG is reporting
an underspend of £482k against its running cost budgets.
Key Financial Performance Duties
18
Summary Budgets – Financial Position for December 2015/16
It is essential that the CCG maintains strong internal financial controls to enable it to achieve its
statutory duties, delivers value for money and have a clean bill of audit health.
Actions being taken include:
Delivery of the 2015/16 Internal Audit Plan and making sure that recommendations are
implemented promptly. This is closely monitored by the CCG’s Audit Committee.
Embed understanding across Governing Body Members/Head of Collaborative Forum of
Internal and External Audit including the use of induction for new Governing Body
Members.
Review Standing Orders, Prime Financial Policies and Scheme of Delegation under
review to make sure that they best reflect the needs of CCG and to support accountability
through programme boards.
Best Case Worst Case
Plan Actual Plan Actual
Variance
(Adv/Fav)
Variance
(Adv/Fav)
£'000 £'000 £'000 % £'000 £'000 £'000 % £'000 £'000
Resource Allocation
Programme Resource 369,815 369,815 - 0% 446,139 446,139 0 0% 0 0
Running Cost Resource 6,520 6,520.4 0 0% 7,825 7,825 0 0% 0 0
Total Resource Allocation 376,336 376,336 0 0% 453,964 453,964 0 0% 0 0
Programme Expenditure
Acute 231,147 230,915 232 0% 277,377 277,767 (390) (0%) 1,525 (2,494)
Mental Health 57,662 58,392 (730) (1%) 69,194 70,084 (889) (1%) (878) (1,270)
Community Health 16,525 16,412 112 1% 19,830 19,697 133 1% (359) (231)
Continuing Care/Free Nursing
Care 12,268 14,170 (1,902) (16%) 14,721 16,482 (1,760) (12%) (1,002) (3,240)
Primary Care 36,916 35,652 1,263 3% 44,299 42,837 1,462 3% 1,882 508
Other Programme Costs
including Corporate 8,955 8,668 287 3% 10,538 10,560 (22) (0%) 213 (159)
Total Programme Costs 363,472 364,209 (737) (0.20%) 435,959 437,426 (1,467) (0%) 1,382 (6,886)
Running Cost
Pay 3,091 3,345 (255) (8%) 3,709 4,033 (324) (9%) (324) (324)
Non Pay 3,430 2,758 672 20% 4,116 3,310 806 20% 806 806
Total Running Cost 6,520 6,104 417 6% 7,825 7,343 482 6% 482 482
Reserves including
contingency - 328- 328 0% 2,568 1,573 995 39% 995 995
Total CCG Expenditure 369,993 369,985 8 0% 446,352 446,342 10 0% 2,859 (5,409)
Surplus 6,343 6,351 8 0% 7,612 7,622 10 0% 10,424 2,156
EXECUTIVE SUMMARY - FOR THE PERIOD ENDING 31st JANUARY 2016
Variance ((Adv)/Fav)
Year to Date
Variance ((Adv)/Fav)
Forecast Outturn
19
The CCG is developing and implementing a training programme that along with the
Budgetary Framework supports effective budget management and control.
20
QIPP Lambeth CCG QIPP Delivery as at Month 10 (January 2016)
PROJECT/SCHEME
QIPP
Programme
Planned
QIPP
QIPP
Delivered
Variance
Over/(Under)
%
Delivery
QIPP
Delivered
Variance
Over/(Under)
%
Delivery
£'000 £'000 £'000 £'000 £'000 £'000
Acute 5,264 4,387 4,387 0 100% 5,264 0 100.0%
Community - Trust Led 438 365 365 0 100% 438 0 100.0%
Mental Health 2,425 2,021 1,587 (434) 79% 2,070 (355) 85.4%
Prescribing 1,296 1,080 1,080 0 100% 1,296 0 100.0%
Primary Care 208 173 173 0 100.0% 208 0 100.0%
Non Acute & Other Schemes 180 150 150 0 100% 180 0 100.0%
Total QIPP Savings 9,811 8,176 7,742 (434) 95% 9,456 (355) 96.4%
Reprovision Costs (950) (792) (358) 434 45% (595) 355 62.6%
Total Net QIPP Savings 8,861 7,384 7,384 (0) 100.0% 8,861 0 100.0%
QIPP DELIVERY FOR THE YEAR 2015/16
Year to Date - January 2016 Forecast Outturn
21
QIPP Analysis By Delivery Area
2015/16 QIPP Delivery for the year 2015/16 (Year to date/forecast outturn/underlying position)
2015/16 QIPP Annual
Plan Plan Actual Variance % Variance Actual Variance % Actual Variance %
Acute
Guys & St Thomas NHSFT
Emergency Admissions 1,569 1,308 1,308 - 100% 1,569 - 100% 1,059 (510) 68%
Outpatient redesign - news and follow ups 1,153 961 961 - 100% 1,153 - 100% 415 (738) 36%
Local Integrated Adult Savings 438 365 365 - 100% 438 - 100% - (438) 0%
Inflammatory Bowel Disease (IBD) care pathway savings 100 83 83 - 100% 100 - 100% - (100) 0%
Patient Transport Services (PTS) 100 83 83 - 100% 100 - 100% - (100) 0%
Prescribing 100 83 83 - 100% 100 - 100% - (100) 0%
GSTT NHSFT - TOTAL QIPP 3,461 2,884 2,884 - 100% 3,461 - 100% 1,474 (1,986) 43%
Kings Healthcare NHSFT
Emergency Admissions 1,449 1,207 1,207 - 100% 1,449 - 100% 623 (825) 43%
Follow-up Outpatients 472 394 394 - 100% 472 - 100% 221 (251) 47%
Shift to Non-face to Face new Outpatients 249 208 208 - 100% 249 - 100% 224 (25) 90%
Prescribing 71 59 59 - 100% 71 - 100% - (71) 0%
KINGS NHSFT - TOTAL QIPP 2,241 1,868 1,868 - 100% 2,241 - 100% 1,069 (1,172) 48%
TOTAL ACUTE QIPP 5,702 4,752 4,752 - 100% 5,702 - 100% 2,543 (3,159) 45%
Mental Health
AMH and EI inpatients beds 703 586 221 (365) 38% 431 (272) 61% 431 (272) 61%
IPSA 1,119 932 932 - 100% 1,119 100% 846 (273) 76%
EMI Beds 450 375 375 - 100% 450 - 100% 380 (70) 84%
Outpatients - Specialist 83 69 (69) 0% (83) 0% - (83) 0%
Woodlands fixed costs 70 58 58 - 100% 70 - 100% 70 0 100%
Total 2,425 2,021 1,587 (434) 79% 2,070 (355) 85% 1,727 (698) 71%
Medicines Management 1,296 1,080 1,080 - 100% 1,296 - 100% 1,296 0 100%
Primary Care Savings 208 173 173 - 100% 208 - 100% 208 0 100%
Savings from Other Non Acute 80 67 67 - 100% 80 - 100% 80 0 100%
Property Services 100 83 83 - 100% 100 - 100% 100 0 100%-
Grand Total Gross QIPP 9,811 8,176 7,742 (434) 94.69% 9,456 (355) 96% 5,954 (3,857) 61%
Investment (950) (792) (358) 434.00 45% (595) 355 63% (595) 355 63%
Net QIPP 8,861 7,384 7,384 (0) 100.00% 8,861 0 100.00% 5,359 (3,502) 60.48%
Year To Date Forecast Outturn Underlying Position
QIPP DELIVERY FOR THE YEAR 2015/16
22
4.3.2 QIPP Performance
The table below provides a summary of the current performance of the ongoing QIPP schemes for 2015-16. All other areas of QIPP were secured at the beginning of the financial year through contractual negotiations with our main providers.
QIPP Scheme Highlights
Performance currently in
line with target?
Reduce variation in outpatient referrals
The scheme is currently is in line to hit target by the end of March although YE position has been significantly impacted by month 9 performance.
MECS (Minor Eye Conditions Service)
The scheme is exceeding performing against expected activity targets. The scheme is performing within budget.
Diagnostics This project is currently in a scoping phase N/A
MSK workstream and Lambeth Integrated Musculoskeletal Service (LIMS)
This scheme is currently not performing in line with the target activity both in terms of month 8 performance and cumulative YTD. It is not expected that this scheme will meet activity reduction targets this year.
No
Redesign of GSTT UCC This scheme did not perform to target in month 8. It is not expected to perform to target for the year.
No
Paediatrics in ED Reporting not currently available. N/A
GP Diversation to Waterloo Health Centre
This scheme is not performing in line with target this month or for the year so far. Agreement reached to decoimmission the service.
No
PALS This scheme is not performing in line with target this month or for the year so far. Agreement reached to decoimmission the service.
No
Minor Ailments Scheme (GSTT Divert to GST Sainsbury’s or Lower Marsh Boots)
Performance is significantly below target. Recommendation to cease with the service will be made during M10 to the relevant decision maiking forums.
No
Integrated Adults LTC/Medicines Optimisation QIPP
Schemes in this area are performing well and delivering the required level of savings.
Lambeth Alcohol Recovery Centre (LARC)
This scheme is performing in line with target for the end of the financial year. Month 8 peformance exceeded target for the month
Adults Mental Health Redesign EI Inpatient Beds
Savings have been delivered through block contracting arrangements with SLAM, however, work continues to be undertaken to identify whether there is a corresponding reduction in activity.
Subject to review
23
4.4 Performance
4.4.1 NHS England Top 8 Performance Measures and National Constitution Standards
The performance dashboard covers the National Constitution Standards as set out in the national
2015/16 Assurance Framework and the Top 8 priorities as identified by NHS England are monitored
through the assurance process. Lambeth CCG performance for each of these measures for the financial
year 2015/16 is set out in the table on page 23.
As part of the CCG Assurance Framework, NHS England has begun monitoring CCGs against a
longstanding operational standard – Cancelled Operations Not Rescheduled Within 28 Days. NHS
Lambeth CCG is monitored against performance at Guy’s and St. Thomas’s NHS Foundation Trust. This
indicator has now been added to the performance dashboard. The data is reported on a quarterly basis
with the table detailing latest performance for Quarter 3.
24
25
4.4.2 RTT (Referral to Treatment Times for Lambeth Patients)
Note: From 01/01/2015 NHS England ceased to monitor the RTT 18 weeks admitted and non-admitted
pathways as performance measures. NHS Lambeth CCG continues to monitor them as local Trusts have
struggled to deliver this standard guaranteed in the NHS Constitution.
18 weeks RTT – admitted and non-admitted treated
Delivery of the admitted and non-admitted treated pathway remains a challenge across London.
Kings College Hospital is currently not reporting activity. GSTFT has failed the admitted standard
in every month since April 2015. The Trust recovered performance for the non-admitted standard
in May and June, but performance has fallen below the 95% target in the other months. This has
resulted in failure of the target overall during the first three quarters of 2015/16. Performance for
the first two months in quarter 3 have also been well below target.
Incomplete Pathways
GSTT Trust failed to meet the national 92% incomplete standard in December 2015. This is the
first month of the year GSTT has been below 92%. The backlog of patients waiting beyond 18
weeks has grown considerably during 2015/16, with referrals into the trust increasing by 20%
from the same period last year; there are a number of s ervices with increased demand and
limited alternative provision which are of particular concern. The Trust has contacted the national
Programme Management Office regarding additional outsourced capacity and is maximising its
own internal capacity with additional clinics and weekend working. Currently activity levels whilst
increasing from last year are not at the level required to keep pace with demand. The Trust has
been asked to complete demand and capacity modelling to assess the level of activity required to
deliver the RTT incomplete target sustainably. The Trust has predicted it will be back above 92%
from February 2016. Compliance for 2016/17 has been assumed for operating plans.
KCH - had been implementing a RTT recovery plan over quarters one and two of 15/16 with a
planned return to compliance against RTT standards from October 15/16. This included a
backlog reduction plan, alongside a waiting list validation programme. The Intensive Support
Team reviewed the position prior to reporting in October and advised against a November return
to reporting, recommending a further period of suspended national reporting whilst continued
validation takes place. A maximum suspension of a further 6 months to April was agreed by the
Trust's Board and Monitor. This was subject to 'open book accounting' over the period of
suspension, commissioners accepting the suspension, a priority focus on long waiters being
treated and a robust validation/RTT recovery plan being agreed for quarters 3 and 4. CCG
reporting will not reflect data for KCH over this period The KCH validation programme is on target
to return to reporting in April for the March position, at this point CCG figures will reflect the KCH
position. The Trust expects to have validated all over 18 week admitted patients by mid-February
and all over 18 week non admitted patients by March. In March the Trust will submit a draft return
on the February position as a test for the full return. Once these figures are available the scale of
the backlog position will be known and demand and capacity work will follow to move the Trust
26
into a sustainable RTT position. It has been stated by the Trust that the incomplete Standard will
not be met in March 2016 but until validation is completed an exact percentage cannot be given.
RTT– waiting more than 52 weeks, and still waiting (incompletes)
KCH have not been able to provide routine monitoring data for patients waiting longer than 52
weeks for most of 2015/16, however a recent validation process identified a number of long
waiters as at the end of December 2015. The Trust wide figure is 169, 24 of these were Lambeth
patients. Recovery plans have been put in place and KCH have been asked to produce an over
52 week trajectory. Neurosurgery makes up the largest proportion of the breaches. An additional
assurance process has been put in place for clinical review of the additional long waiters
identified. This has had input from CCG clinical leads. 4 of the reported breaches were at GSTT,
two of these are no longer on the waiting list and 2 patients are awaiting TCI. One breach was at
the Royal Marsden recorded under ‘other’ as a specialty.
4.4.3 Diagnostics (Lambeth Patients)
Diagnostic performance at the CCG deteriorated in December 2015. The standard was missed in
quarter one 2015/16 with 1.2% of referred patients waiting more than the operational standard,
achieved in quarter two at 0.8% but missed again for quarter three with 2.1% of patients waiting.
This deterioration in performance has been driven by both GSTT and KCH. KCH represents the
biggest proportion of the decline. The two biggest issues which came to light in December 2015
were with Neuro MRI and Ultrasound at Denmark Hill. Neuro MRI was driven by staff vacancies
reducing capacity, Inhealth was also unable to provide additional days on site. Adverts are out for
two substantive members of staff and the Trust has approached Blackheath to undertake
additional capacity. The expectation is that the backlog will be reduced by the end of March 2016.
GSTT represents a much smaller proportion of the decline being at 2% Trust wide in December.
The main cause of the problem was a booking issue in December where patients were not
booked in order. This has not been addressed. Performance should be back on track for
February and March 2016.
OP std
15/16Q1 15/16 Q2 15/16 Q3 15/16
<1% 1.2% 0.8% 2.1%
National Priorities including Top 8 Performance Measures
Diagnostic Waits >6 weeks
27
4.4.4 A & E Waiting Times
Both GSTT and Denmark Hill continue to perform below the 95% standard. GSTT expected a
deterioration in performance following planned building works in A&E which reduced capacity.
The Trust has now taken steps to create additional inpatient and A&E capacity and is working to
a rapid action improvement plan designed to improve overall efficiency, however achieving the
target will be challenging. Denmark Hill has now agreed revised trajectory to secure an
improvement in performance to 92% by March 2016. The Trust is focussing on 4 areas of
improvement: a ED recovery plan; out of hospital care services; demand and capacity plan; and
winter planning and funding. Capacity remains a significant challenge.
4.4.5 Cancer Waiting Times
Cancer 62 day Standard
Lambeth met 8 of the 9 cancer targets during quarter three including the 62 day standard.
GSTFT's performance against this target however remains challenging. The Trust’s internal
performance improvement is linked to increased robotic capacity for urology. This should lead to
a return to compliance against the target from November. A new surgical robot came online in
July and GSTFT have been working to reduce the backlog of patients with this additional
capacity, noting that it is expected that performance will deteriorate whilst this backlog is cleared.
The Trust is currently behind plan for urology recovery. Overall trust-wide performance
improvement is linked to reducing late referrals from other district general hospitals in London
and the South East of England. A system wide recovery trajectory and plan has been agreed,
which includes Lewisham & Greenwich NHS Trust and KCH. This will run to March 2016. These
actions will support a trust wide improvement for GSTFT, but are considered high risk. KCH
continues to have strong internal performance but will need to work to the agreed inter-trust
transfer trajectory in order for performance across the South East London system to improve.
NHS England have given particular focus to the cancer 62 day target in South East London,
which is seen as a key risk to London performance. Commissioners will work closely with Trusts
in South East London to monitor and track the agreed improvement trajectories and ensure
Lewisham & Greenwich NHS Trust pathways are adhered to and avoidable delays are
28
eliminated. There will be regular weekly dialogue with Trusts reviewing Patient Tracking List
reporting and addressing individual patient pathway delays/ issues.
Cancer 2 weeks (breast symptoms)
Quarter 3 Performance relates to 21 breaches. The majority of breaches were at GSTT and the
majority were due to patient choice reasons.
4.4.6 Ambulance Response
The London Ambulance Service continues to struggle to meet the national standard
response times. NHS Lambeth CCG is currently reviewing the CQC findings published in
November 2015. LAS received a rating of Inadequate.
4.4.7 Health Visitors
From October 2015, responsibility for commissioning the Health Visitor service transferred to
local authorities.
4.4.8 Improved Access to Psychological Therapies (IAPT)
The service continues to over-perform on the access target by 0.9% over the quarter as at
quarter three. Work has started on waiting list validation which and has highlighted approximately
100 clients who had completed treatment but were not properly discharged from the clinical
records system. They were all discharged in September. These un-discharged clients skewed the
recovery rate. The service has been awarded non-recurrent funding to validate waiting lists and
ensure waiting list data accuracy, and also to clear the backlog of appointments. This is in
preparation for the consistent achievement of waiting targets due to be formally initiated in April
2016. The service is working with NHSE and commissioners on data sets by which to monitor the
new targets.
29
4.4.9 New Early Intervention In Psychosis 2 Week Standard
NHS Lambeth CCG is working closely with South London and Maudsley NHS Foundation
Trust (SLaM) to deliver the Early Intervention in Psychosis (EIP) 2 Week standard from
01/04/2016.
SLaM will be running the standard in shadow form from 01/11/2015.
SLaM has carried out significant pieces of work to enable collection of data to support the
standard, including:
• A psychosis gap analysis to identify requirements to deliver the standard
• Review of the patient data collection system to confirm that it can capture
appropriate clock start and stop dates
• Development of new processes to identify ‘Suspected First Episode of
Psychosis’ in all internal and external referral forms
• Appointment of a Better Access Programme Manager
• Development and roll-out of a programme of training for staff to support
delivery of the standard
SLaM report on progress in delivery of the standard to NHS Lambeth CCG at monthly
commissioning meetings. The Trust is committed to delivery of the EIP standard from 1st
April 2016.
A joint work shop between commissioners, practitioners and managers within secondary
care and the Living Well Network (LWN) took place on the 25th November 2015. It was
recognised at that workshop that a whole system response was required in order to
effectively meet the target. It was also recognised that the interface between the LWN and
the Early Intervention Psychosis Team needs to be enhanced, as the LWN sees people in
the first instance they experience mental distress, either via GPs or through self-referrals
(SLaM) to deliver the Early Intervention in Psychosis (EIP) 2 Week standard from 1st April
2016.
SlaM and the CCG completed a NHSE self-assessment which rated Trust’s readiness in
terms of meeting the two waiting time target, IT development and the recruitment and
training of staff. SLaM has a task group which meets on a monthly basis and is in a
position to report the first extract of data in January.
4.4.10 Dementia Diagnosis Rate
The Health and Social Care Centre (HSCIC) has now published data for Dementia
Diagnosis Rate for the year to December 2015. A new methodology is being used for
2015/16 to calculate estimated dementia prevalence.
30
NHS Lambeth CCG continues
to rank 2nd in London for
recording dementia diagnoses
in primary care. NHS
Lambeth CCG achieved a rate
for recording dementia
diagnoses in primary care of
85.7% in December 2015 and
85.1% overall for quarter 3.
Data for 2014/15 is gradually
being published by the Health and Social Care Information Centre (HSCIC). The graph
shows published data for NHS Lambeth CCG’s GP practices, for the percentage of
expected dementia patients for the CCG with a dementia diagnosis recorded. The rate
would be expected to fluctuate slightly month on month as patients join and leave GP
practices.
The CCG’s Older People team have been working consistently for about 2 years to achieve
this success. Some of the things that the team did included:
• The GP with a special interest in dementia reviewed GP practice data and referrals
to the Memory Service. The GP did awareness raising and education with
practices which did not refer, or had a low rate of referral.
• Regular communications to practices about the importance of registering diagnoses
for patients with dementia.
• The Memory Service wrote to GP practices reminding them to register diagnoses
for patients they were seeing.
• All people in Lambeth care homes who are receiving nursing are given a memory
assessment as part of their regular reviews with the GP practice assigned to their
home.
• Protected Learning Time has been used to educate GPs about dementia and how
to refer.
4.4.11 Transforming Care
Since January 2015 NHS England has directed CCGs to increase the level of scrutiny to
ensure that the people placed locally in hospital settings are receiving the right care that
meets their individual needs, with discharge plans in place for those that are able to move
to a community setting.
The people with learning disabilities who are the responsibility of NHS Lambeth CCG are
placed in assessment and treatment units when there is an escalation in their need for
support in relation to their condition and/or behaviour that challenges.
The CCG is then made aware of the placement and the Transforming Care Leads and the
Commissioners for Mental Health becomes involved in the monitoring of the placement and
the commencement of discharge planning. The Transforming Care Lead organise the CTR
for the patient and reports every 2 weeks to NHSE on the progress for each individual
patient.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar% o
f E
xp
ecte
d P
reva
len
ce
wit
h
Re
co
rde
d D
iag
no
sis
% Recording by GP Practice of Dementia Diagnoses against Expected Prevalence 2015/16
31
Since that time NHS Lambeth CCG has worked to progress the discharge of the people
originally identified by the CCG and has maintained a register of all existing and new
people who are in assessment and treatment units.
At the time of writing this report the CCG has 13 people in assessment and treatment
settings who are at varying stages of their care, treatment and discharge. Of the 13 people
admitted:
There was 1 admission in 2016
7 in 2015
2 in 2014
o Of the 2 patients, 1 is scheduled to be discharged into the community by 31
March 2016
3 were admitted prior to 1 April 2014.
o Of the 3 patients, 2 are scheduled to be discharged into the community by
31 March 2016
o The 3rd patient is scheduled to be discharged into the community by August
2016
Future Service Model
A national service model, developed with the help of people with lived experience,
clinicians, providers and commissioners, sets out the range of support that should be in
place no later than March 2019.
Implementing this model, and giving people greater power over the services they use, will
result in a significantly reduced need for inpatient care. NHSE expect that as a minimum, in
three years’ time no area will need capacity for more than 10-15 inpatients per million
population in clinical commissioning group (CCG) commissioned beds (such as
assessment and treatment units), and 20-25 inpatients per million population in NHS
England-commissioned beds (such as low-, medium- or high-secure services).
These planning assumptions will mean that, at a minimum, 45 – 65% of CCG
commissioned inpatient capacity will be closed, and 25 – 40% of NHS England-
commissioned capacity will close, with the bulk of change in secure care expected to occur
in low-secure provision.
South East London Transforming Care Partnership
To achieve this systemic change, 49 transforming care partnerships (commissioning
collaborations of CCGs, NHS England’s specialised commissioners and local authorities)
are mobilising now. They will work with people who have lived experience of these
services, their families and carers, as well as key stakeholders to agree robust
implementation plans by April 2016 and then deliver on them over three years.
Lambeth is part South East London Transforming Care Partnership (SE TCP). The other
partners are, Southwark, Lewisham, Bexley, Bromley, Greenwich and NHSE Specialised
32
Commissioning. The Senior Responsible Officer for the SE TCP is Annabel Burn,
Managing Director, Greenwich Business Support Unit at NHS South East London.
The CCG and Lambeth Council are clear that locally a model of local service delivery will
be developed based on best practice models which will deliver as much within Lambeth as
possible. This will be driven by a requirement to achieve the best outcome for people in
Lambeth, minimising and potentially eliminating in-patient provision as soon as possible.
The CCG and LA will work closely with the SE TCP to allow the deployment of resources at
the community level and to meet the aspirations of the local population. Both the CCG and
the Council are committed to this and both see it as a critical success factor for effective
provision of services for people with a Learning Disability and /or Autism with behaviour
deemed to challenge.
33
5 STRATEGIC AND OPERATIONAL DELIVERY – OUR PROGRAMMES
5.1 Integrated Children and Young People (including Maternity) Programme
Responsible Director Maria Millwood, Director of Integrated Commissioning (Children & Young People, Adult Disabilities)
Clinical Lead Dr Nandini Mukhopadhyay
Programme Lead Emma Stevenson, Assistant Director Children & Maternity
Scope of business area The purpose of this business area is to lead the redesign of children’s and maternity services and disability
services to achieve quality, and value for money services. This business area has strong links with the
business areas on integrated mental health for adults, a model of integrated care and citizen participation
and empowerment.
Objectives of business area
The objectives of this business area are to:
Redesign the child and adolescent mental health services
Implement the recommended London standards across child health services
Develop and implement integrated child health pathways
Implement Maternity standards and effective local pathways
Develop an integrated commissioning strategy for a whole life disability pathway
5.1.1 Programme Assurance Statement
Assurance Status/Risks RAG Rating (Red/Amber/Green)
Is your programme delivering as planned – is it
on target?
Many objectives on target but some risks
identified.
34
5.1.2 Integrated Children and Young People (including maternity) Programme Risk Register
Please see Board Assurance Framework for risks 1A rated 12 and above.
Risk Title
Risk Register
where Risk is
managed
Current Risk
Score Approach Action Plan Summary
Unlikely risk that the Children’s and Maternity Programme will not achieve its objectives due to the dependency on the delivery of other programmes (Leap, CYPHP)
Programme Board /
Directorate Risk
Register
6 Mitigate To review and implement clear thresholds to specialist and acute services - completed To review the universal service reviews - completed To restructure targeted workforce to develop an integrated team by June 2016 To complete service re-design process for remaining LEAP interventions - completed Governance structure for Childrens Transformation Programme to be submitted to a workshop of the CFSP for discussion on 16/07/15 - completed. Corporate review in Council re key boards will determine how this is taken forward - ongoing To mitigate against delayed delivery of CYPHP: - Implement GP Delivery Scheme for Paediatric Asthma - implemented and being monitored. Worked up 2016/17 Commissioning Intentions including QIPP - awaiting approval by CCG Governing Body March 2016
Unlikely risk of failure to reduce waiting time from referral to first treatment for the CAMHS Early
Programme Board /
Directorate
6 Mitigate Complete recruitment to posts - SLAM, Oct 2015 - Completed Set up and run agreed new group work - SLAM, Oct
35
Risk Title
Risk Register
where Risk is
managed
Current Risk
Score Approach Action Plan Summary
Intervention Team resulting in poorer outcomes and increased escalation to Tier 3-4 services.
Risk Register
2015 - Completed.
Unlikely risk that babies under one year not vaccinated with the BCG vaccine during a period of non-supply will not be robustly identified and vaccinated in a timely way by the commissioned provider once supply is restored, resulting in increased risk of exposure to infection.
Programme Board /
Directorate Risk
Register
6 Mitigate Monitor implementation of provider action plan once vaccine is available
Risk of failure to improve rate of health reviews to meet local and new nationally mandated targets, resulting health issues in children potentially missed.
Programme Board /
Directorate Risk
Register
6 Mitigate Action plan to improve performance against targets – Dec 15 Data cleansing exercise by provider – Oct 2015 - completed. Documented failsafe system – Dec 15
36
Children and Maternity Dashboard – items to note MENTAL HEALTH The average wait time from referral to 1st assessment community CAHMS and average wait time from referral to 1st assessment CLAMHS both consistently have waiting times below the 18 week target. The average waiting time from referral to 1st assessment for early intervention services was over 40 weeks for three quarters in succession, but then fell back sharply to 23 weeks in quarter two. The number of young people admitted to both CAMHS tier 4 in-patients and outpatients is rising, with both current year targets having been breached by around 100%. REDUCING PAEDIATRIC A&E PRESENTATIONS & ADMISSIONS The percentage of total paediatric admissions due to asthma has remained steady at around 2% and the unplanned admissions due to asthma, diabetes and epilepsy at between 3% and 4% for the past three years. Whilst these two indicators remain within a reasonable distance of the target, the other two indicators in this group are proving more difficult to bring within range. ENHANCED HEALTHY CHILD PROGRAMME ALIGNED WITH LEAP After averaging 90.2% in the 2013-14 year, the breastfeeding initiation rate rose slightly to 91.2% in 2014-15, but in the current year has exceeded or is close to the 90% target. Meanwhile, the percentage of infants breast fed at 6-8 weeks after birth has risen steadily from an average of 78% in 2012-13 to 82% in 2014-15. The average for the two quarters of the current year is 81.5%, still 3.5% short of the annual target. Vitamin D coverage is increasing encouragingly, the latest figuring showing that 39.6% of the eligible population are engaged in the distribution scheme. With regard to childhood immunisation, coverage levels are highest for children aged 1, with the DTP/IPV/HiB (3 doses primary) immunisation averaging just under 93% this year The comparable figure for the aged 2 MMR first dose jab is just under 91%. Although coverage of the aged 5 pre-school booster has increased over the past two years, it lags behind the earlier age vaccinations, averaging around 86.0% this year. All three childhood immunisations fall short of the 95% coverage target. Data for the health review 1 and 2 indicators has only been available since the start of the 2014-15 year. In that time, coverage initially dropped, but for both increased at the end of the 2014-15. Latest figures show better coverage for the health check 1, but both are falling short of this year’s target.
37
SAFETY The number of paediatric re-admissions per quarter has fallen compared to last year but has exceeded the current year target by 100%. MATERNITY The Friends and Family test in respect of ante-natal care has now been in existence for 18 months, with St. Georges Hospital achieving the highest average satisfaction score for the 2014-15 year. In the current year the picture is mixed with GSTT having the highest rating for antenatal care at 97.4%, which is over 10% better than St. Georges. For postnatal care, St. Georges has a 2% advantage over GSTT at 90.5% compared to 88.4%. For both ante- and post-natal care, Kings has the lowest satisfaction rating, at 89.2% and 87.3% respectively.
CHILDREN & YOUNG PEOPLE'S EXPERIENCE The Friends and Family scores in respect of inpatients over the past year has revealed consistently higher levels of satisfaction at GSTT than at the other two local Trusts. Although no Trust has reached the 100% satisfaction target, GSTT has come closest to achieving it and St. Georges has consistently had the lowest satisfaction scores.
38
5.1.3 Children and Maternity Programme Board Dashboard
Lambeth Children & Maternity Programme Board Dashboard
2012 -13 2013 -14 2014 -15
Current
Year
Target
High or
Low
Target?
Full year Full year Full year Q1 Q2 Q3 Q4
New data
since prev
month?
Rating (Latest
full quarter to
current year
target)
Trend last 7 quarters
Latest quarter
2015-16 verses
2014-15
INDICATOR
LABEL
MH 1 8.1 6.1 10.1 18 Low 10.1-2.9
MH 2 32.9 42.6 23.2 18 Low 23.2-3.9
MH 3 12.6 5.4 5.7 18 Low 5.7-1.0
MH 4 not supplied 118 199 71 21 54 Low 92-8
MH 5 not supplied 35 21 9 5 6 Low 142
PAE1 4.5% 3.3% 3.6% 3.4% 2.5% 3.8% 3.6% Low 3.8%0.1%
PAE2 44.4% 31.8% 32.2% 32.8% 29.2% 31.9% 28.9% Low 31.9%1.3%
PAE4 78.6% 76.9% 74.7% 76.9% 72.9% 72.2% 65.0% Low 72.2%-2.8%
PAE5 3.0% 2.6% 2.7% 2.1% 1.9% 2.9% 2.3% Low 2.9%-0.1%
2015 -16 Quarterly Activity
Number of Young People admitted to CAMHS tier 4 in-patients
Number of Young People admitted to CAMHS tier 4 outpatients
Percentage of children and young people admitted with a length of stay of less than 24
hours
MENTAL HEALTH
Percentage of paediatric A&E attendances resulting in NFA or referred back to GP
REDUCING PAEDIATRIC A&E PRESENTATIONS & ADMISSIONS
Average waiting time from referral to 1st assessment Community CAMHS (weeks)
Relative Performance
Percentage of unplanned hospitalisations for children and young people with asthma,
diabetes and epilepsy
Average waiting time from referral to 1st assessment Early Intervention Team (weeks)
Average waiting time from referral to 1st assessment CLAMHS (weeks)
Percentage of all paediatric (0-18) admissions due to asthma
Dashboard
39
EHC 1 81.0% 67.9% 85.6% 78.8% 90.0% High 78.8%
EHC 2 92.0% 90.2% 91.2% 92.3% 90.0% 90.0% High 90.0%
EHC 3 78.0% 81.5% 82.0% 83.6% 79.8% 85.0% High 79.8%-2.5%
EHC 4 no data no data 27.2% 27.7% 34.4% 39.6% 25.0% High 39.6%24.3%
EHC 5 92.4% 92.6% 92.6% 92.7% 93.0% 95.0% High 93.0%-0.5%
EHC 6 89.6% 91.0% 90.6% 91.0% 90.3% 95.0% High 90.3%-0.2%
EHC 7 76.8% 81.9% 88.0% 85.3% 87.0% 95.0% High 87.0%-2.7%
EHC 8 not available not available 65.3% 78.9% 79.2% 85.0% High 79.2%16.7%
EHC 9 not available not available 65.6% 71.0% 70.1% 85.0% High 70.1%3.0%
SAF 1 0 0 0 0 0 0 Low 0
SAF 2 117 96 113 16 24 15 20 Low 55-15
MAT 1 N/A N/A 92.2% 97.7% 95.9% 98.3% 91.9% High 98.3%5.8%
N/A N/A 89.4% 89.4% 92.3% 79.5% 91.9% High 79.5%-9.1%
N/A N/A 93.9% 87.3% 84.3% 100.0% 91.9% High 100.0%4.3%
MAT 2 N/A N/A 84.0% 89.6% 87.5% 88.0% 89.5% High 88.0%2.9%
N/A N/A 87.7% 86.4% 89.6% 86.0% 89.5% High 86.0%1.3%
N/A N/A 93.1% 90.4% 90.9% 90.1% 89.5% High 90.1%2.1%
MAT 3 N/A N/A 99.5% 98.2% 99.8% 98.9% 100% High 98.9%-0.8%
N/A N/A 96.1% 95.1% 97.1% 98.3% 100% High 98.3%3.3%
N/A N/A 86.0% 91.4% 95.0% 95.1% 100% High 95.1%15.5%
Number of paediatric re-admissions
Percentage of health review 2 completed in line with target
Kings College - Friends & Family test (inpatients - young people)
Kings College - Friends & Family Test (ante-natal recommend score)
GSTT - Friends & Family test (post-natal recommend score)
Kings College - Friends & Family Test (post-natal recommend score)
St. George's - Maternity Friends & Family test (post-natal recommend score)
MATERNITY EXPERIENCE
St. George's - Maternity Friends & Family test (ante-natal recommend score)
GSTT - Friends & Family Test (ante-natal recommend score)
CHILDREN & YOUNG PEOPLE'S EXPERIENCE
Percentage immunisations at 1 year (DTP/IPV/HiB 3 doses primary)
Percentage immunisations at 5 years (pre-school booster)
Percentage immunisations at 2 years (MMR 1st dose)
St. George's - Friends & Family test (inpatients - young people)
GSTT - Friends & Family test (inpatients - young people)
Admission of full-term babies to neonatal care unit (without congenital abnormalities)
(GSTT)
SAFETY
Percentage of health review 1 completed in line with target
Percentage Vitamin D take-up (D-card scheme) of eligible population
Percentage breastfeeding 6-8 weeks after birth
Percentage breastfeeding initiation
Percentage of maternal bookings made within less than 12 weeks and 6 days gestation
ENHANCED HEALTHY CHILD PROGRAMME ALIGNED WITH LEAP
40
5.1.4 Key Deliverables
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref: Objective Delivery
Period
Progress update
Paediatric A&E Reduction, Admission Avoidance and Early Discharge
5.1.1 Commission a 7 day a week pilot
ambulatory care service across LSL
for general paediatrics, including
those with respiratory and sickle cell
conditions to manage winter pressure
from Oct 2015
Quarter 2-4
Recruitment for the Paediatric Hospital@Home service is progressing
across the 3 Acute Trusts. Evelina has recruited fully and start date for all
Trusts is February 2016. The service specification is complete and has
been signed off and the evaluation spec has been finalised
5.1.2 Ensure effective interface and joint
working with the CCNT
Quarter 2 This is being taken forward via the above Commissioner/Provider
meetings. Assurance of effective interface and joint working across the 3
Providers and with the pilot Paed H@H service will be received via
contract monitoring once operational from Feb 2016
5.1.4 Improve communication and
information sharing with parents and
carers of young children through
dissemination of the ‘Common
Childhood Illnesses’ Booklet
Quarter 2-4
The Common Childhood Illnesses booklets have been ordered by GSTFT
community health and are being distributed by Health Visitors and are
part of the GST Transformation Programme. Quarterly reporting on
number of books ordered, number delivered to parents and parent
satisfaction is being monitored via the GST contract monitoring meetings
Lambeth Early Action Partnership (LEAP)
5.1.6 Work with GP clinical network leads
for LEAP to ensure primary care are
Quarter 2-4
Two GP clinical network leads have now been appointed. As part of their
ongoing work they are meeting with the Practices that fall within the 4
41
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref: Objective Delivery
Period
Progress update
fully engaged with the programme
and there is effective linking with
LCN
LEAP wards and working up the detail of the GP LEAP Programme
5.1.7 Continue to work up the local
evaluation framework for LEAP and
each intervention through a
consortium of academic stakeholders
Quarter 2 -3
This is on-going. An Evaluation Lead has been appointed as part of the
core LEAP team and they continue to liaise with stakeholders including
KHP.
5.1.8 Work with London School of
economics to develop the LEAP cost
benefit analysis tool
Quarter 3 This is in progress. There has been some delay across the a Better Start
Big Lottery sites due to getting the correct data etc
Children’s Transformation Programme
5.1.10 Ensure children’s agenda is
embedded into LCN development
Quarters 2-4 Children’s issues have been discussed at the SEL LCN and plans are
being developed to ensure priorities link with and are informed by LEAP,
CYPHP, Wells Centre and Children’s GP Delivery Scheme. SW LCN has
recently prioritised Children & YP, with a focus on supporting schools with
effective emotional resilience, aligned with the CAMHS Strategy and
CYPHP.
5.1.11 Continue to roll out and monitor
enhanced vitamin D programme
Quarters 1-4 The 25% target was exceeded at the end of July 2015 with 36.9% take
up by eligible population in Q3. The Children & Maternity Programme
Board continues to monitor take up on a monthly basis
5.1.12 Scope and consult on the delivery
service model for integrated targeted
Quarter 3 The focus on has been on integrating family support services and work is
currently being developed around improved integration of HVS with
42
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref: Objective Delivery
Period
Progress update
family support, incorporating social
care, early help, health visiting,
voluntary sector etc.
Children Centre and early years model. Proposed models will be
consulted on through out early 16/17
5.1.13 Ensure the healthy child programme
is effectively delivered, focusing on
improving Child Health reviews
Quarters 1-4 The Health Reviews are below the agreed target of 85%, however
improvement has been made in HR1 increasing from 78.9% in Q1 and
79.2% in Q2. HR2 remains below target at 70.1% in Q2. Work is on-going
with GST and the Health Visiting service, with an improvement plan in
place monitored via the CMB
5.1.14 Ensure service improvement in line
with Ofsted Inspection: Initial Health
assessments of LAC completed in
timely manner and care leavers
receive and talk through their health
passports
Quarter 3 Work is ongoing to improve Health of LAC. The focus is on improving the
interface and joint working between the designated LAC health team and
spocial workers to ensure information and processes are effective
Children & Young People’s Health Partnership (CYPHP)
5.1.15 Develop comprehensive Child health
pathway , specifically for asthma,
diabetes and sickle cell
Quarter 3 There is a range of work in development around asthma pathway. A
dedicated asthma post is in place at GST through the Transformation
fund, ensuring the quality standards are effectively implemented. The
Children’s GP Delivery scheme is operational with good take up by
Lambeth Practices to improve paediatric asthma diagnostic and care
management
5.1.16 Review adolescent health
commissioning and delivery model, in
Quarter 3 This is being developed through CYPHP. Considerable co-production
work has taken place with a range of young people, identifying what
43
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref: Objective Delivery
Period
Progress update
line with learning from the Wells
Centre model
works well, gaps in service and accessibility and ideas for improvement.
This work will feed into local strategies across social care, CAMHs and
youth violence
Emotional Health & Wellbeing
5.1.17 Sign off of the Emotional Health &
wellbeing Strategy
Quarter 2 The CAMHS Transformation Plan has been approved by NHSE and
£684k has been allocated to the CCG. The detailed Transformation plan
is being implemented. Plans for regular reporting to NHSE, CMB and
H&WB are in place. In addition the CCG invested £182k recurrent
funding in 15/16 to address the long waiting times into the early
intervention CAMHS team. A detailed improvement plan is in place
monitored by the CAMHS JCG. The target is to reduce to 10% wks
waiting by Q4 16/17. Good progress is being made with waiting times
redued from 45wks end of 14/15 to 23.2wks in Q2
5.1.18 Continue to co-produce the
implementation plan to ensure
stakeholders are fully engaged in
delivery of the Strategy (3 year plan)
Quarters 1-4
& 2016/17
A part time post has been recruited to funded via the CAMHS
Transformation budget to co-produce and consult on the implemtaiton of
the Transformation Plan. Events are being planned over the next few
months with key groups of C&YP, including those known to the YOS,
LAC, CWD and certain BME groups
5.1.20 Improve service in line with Ofsted
Inspection: Timely access to CAMHS
for LAC, post adoption support
Quarter 3 As part of the CAMHSTransfotmation Plan all teams are being reviewed
to ensure the right pathwaysm, capcity, outcomes are being met. This
includes the CLAMHS team for LAC.
Perinatal Mental Health
44
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref: Objective Delivery
Period
Progress update
5.1.21 Take forward the recommendations
from the Perinatal MH pilot
Quarters 2-4 The part time perinatal MH worker has started in post and is leading on
the following specific work: scope the training needs across the children’s
workforce, review training programmes and evidence of impact, work with
service users and professionals to further develop the perinatal MH
pathway and align it with current acute model, carry out research into cost
benefit analysis of implementing an effective pathway and input into the
development of a Perinatal MH Commissioning strategy. In addition
Lambeth has been shortlisted for the RCM 2016 Awards for our work
around perinatal MH pathway and the pilot we ran earlier in the year.
Results will be announced in March 2016
Ensure LEAP peri-natal MH
interventions is effectively developed
and informed by learning from the
pilot
Quarters 2-4 Service design phase of the LEAP peri-natal MH intervention will begin in January 2016, following a logic model approach. Learning from the pilot will inform the process.
Maternity & New Born Screening
5.1.24 Maternity standards:
Working with GSTFT to ensure
workforce requirement are met
(Increasing consultancy hours cover,
supervisor ratio etc.)
Quarters 1-4 This is being looked at via the CQRG meetings for both Kings and GST
and more widely as part Our Healthier SEL work
5.1.25 Continue to reduce C-Section rates –
focus on vulnerable groups, pre-
pregnancy support and antenatal
Quarter 1-4 GSTFT has appointed a Consultant Midwife for Antenatal Care who
started in May 2015. The remit of this person is to identify and support
women and pathways of care where women may be at increased risk of
45
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref: Objective Delivery
Period
Progress update
management (i.e. through Centring
pregnancy, increasing caseload
midwifery etc.)
delivering by C-section. The Trust is liaising with those organisations with
lower C-section rates to determine any learning. They have also
commenced a small pilot testing the use of acupuncture to stimulate the
start of labour in post term pregnancies.
A KCH Maternity Group with commissioners has been set up to review a
number of maternity issues. The Trust has established a working group
to review the C-section rates and investigate possible opportunities for
reducing it.
5.1.26 Working across primary care and
maternity services to increase early
booking down to 10wks gestation
(supports better management of
sickle Cell) (on-going and reviewed
each quarter)
Quarter 1-4 Both GSTFT and KCH are committed to increasing early bookings down
to 10 weeks gestation. KCH established a new centralised antenatal
booking system at the PRUH at the start of May. This has a dedicated
phone line for easy access for women who choose to self-refer over the
phone or a simple on-line form located on the website. GSTFT is looking
at modifying the maternity website to improve access for women wishing
to self-refer.
5.1.27 Supporting the local management of
new born screening programme
commissioned by NHSE
Quarter 1-4 GSTFT are implementing the agreed action plan, following
recommendations from the EQA of new-born screening
46
5.2 Integrated Adults Programme (Elective, Long Term Conditions, Older People, Urgent Care)
Responsible Director Moira McGrath, Director of Integrated Commissioning (Older Adults)
Clinical Lead Drs. Lisa Le Roux, John Balazs, Hasnain Abbasi & Paul Heenan
Programme Lead Various – please see work streams
Scope of business area The purpose of this business area is to lead the redesign of adult’s health and social care services to
achieve quality, and value for money services, promote independence and self-care.
This business area has strong links with the business areas on integrated mental health for adults, a
modern model of integrated care, primary care and citizen participation and empowerment.
Objectives of business area
The objectives of this business area are to:
To improve integrated services to provide better health and wellbeing outcomes for patients
High quality and cost effective health and care system
Delivery of financially sustainable health care system for Lambeth
5.2.1 Programme Assurance Statement
Assurance Status/Risks RAG Rating (Red/Amber/Green)
Is your programme delivering as planned – is it
on target?
Many objectives on target but some risks
identified.
47
5.2.2 Integrated Adults (Elective, Long Term Conditions, Older People, Urgent Care) Programme Risk Register
For risks scoring 12 and above, 2A, 2B, 2M, 2C, 2K and 2N, please see the Board Assurance Framework.
Risk Title
Risk Register
where Risk is
managed
Current Risk
Score Approach Action Plan Summary
Likely risk of E-referral service not being implemented fully leading to issues for GP practices and providers around outpatient referrals
Programme Board /
Directorate Risk
Register
9 Mitigate Collaborative meetings with acute providers and HSCIC to resolve any issues raised: Issues previously occurring with the e referral system have been resolved over the last few weeks. This has included the deployment of fixes through the national team for areas previously causing issues. Most recent IT fix has further resolved technical issues. IT training plan for practices in progress. Training plan being implemented. ‘How to…’ guide distributed and has seen immediate increase in ERS utilisation in some practices. Planning to trial ERS-only access for one service in 2016/17. Priorities for 16/17 to be agreed with providers in Q4 2015/16.
48
Integrated Adults Dashboard – items to note
Plan 2015/16
The Plan for 2015/16 used in this report is the one used by the Contracting Team to monitor activity by provider Trusts. This may be the driver for the apparent large variances between activity and plan year to date (YTD). Generally while elective inpatients and emergency activity is underperforming against plan, outpatients is overperforming against plan. The report is for Pbr and Non Pbr, to negate the Shift from Pbr to non Pbr in certain trust.
Elective Activity
Elective activity is underperforming against plan. This is the case for all 3 main Trusts, with others marginally over plan.
Emergency Activity
Non-elective activity is underperforming against plan. This is the case for all 3 main Trusts. Although other Trusts are 12% over plan, the overall position is showing as 7% under.
Non-elective Other Activity
In contrast to the main categories of Non-elective activity, GSTT and St. Georges are over performing against plan, whilst Kings is underperforming. The percentage variances appear high because of the small numbers involved. Across all Trusts there is a variance of 126% over plan.
Outpatients First
Outpatient First activity is overperforming against plan by 22% overall. Overperformance against plan varies at local Trusts from 11% at GSTT to 47% at St Georges. Cardiology, gynaecology, nephrology, ophthalmology and non QIPP Specialities show over performance, other specialties are under mostly performing.
49
Outpatients Follow-up
Outpatient follow-up activity is overperforming against plan. The two main Trusts are over performing and GSTT within 10% of the plan. The contributes to 25% over-performance overall. First attendance activity impacts on follow up activity.
Outpatients Procedures
Outpatient procedures are overperforming across the board.
Accident & Emergency
Accident & Emergency activity overall is overperforming against plan by 9%. However the GSTT and St Georges Trusts are underperforming slightly and Kings is overperforming by 5% Most of the headline over-performance is attributable to the 74% over-performance at other Trusts.
Emergency Admissions for Long Term Conditions
Overall, emergency admissions for patients with long term conditions have fallen by 1%. The exceptions to this trend are diabetes and heart failure. Heart failure shows a 24% increase compared to 2014/15.
50
5.2.3 Integrated Adults Dashboard
5 2014/2015 2015/2016 5
LAMBETH YEAR MONTH
2015 Nov Nov B3
Nov activity
14/15
YTD activity @ Nov
14/15
Plan @Nov
15/16
Nov activity
15/16
Plan @Nov
YTD
YTD activity
@Nov 15/16
Comparing
YTD Plan
with YTD
Actual
Activity
% Change YTD
Actual Vs YTD Plan
Comparing Monthly
Plan with in
Monthly Actual
Activity
% Change Nov
Actual vs Plan
POD (Point of Delivery) 29,037 333,221 42,984 55,006 344,161 437,518 Up 27% p 28%
INPATIENTS TOTAL 4,558 36,242 4,742 4,356 37,953 37,080 9,777 Down -2% q -8%
Elective 2,220 17,553 2,522 2,424 20,192 19,314 2,551 Down -4% q -4%
GSTT 861 6,930 1,102 1,149 8,815 8,707 2,566 Down -1% u 4%
Kings 821 6,791 869 760 6,952 6,506 540 Down -6% q -13%
SGH 176 1,331 237 187 1,921 1,549 923 Down -19% q -21%
OTHER 362 2,501 314 328 2,505 2,552 6,808 - 2% u 4%
Emergency 1,989 15,886 2,107 1,861 16,855 15,722 124 Down -7% q -12%
GSTT 693 5,408 813 642 6,507 5,651 2,497 Down -13% q -21%
Kings 739 6,092 764 728 6,113 5,934 855 Down -3% q -5%
SGH 305 2,234 312 291 2,499 2,195 706 Down -12% q -7%
OTHER 252 2,152 217 200 1,736 1,942 6,609 Up 12% q -8%
This is excluding Maternity Non Elective_Other 349 2,803 113 71 905 2,044 7102 Up 126% q -37%
GSTT 184 1,563 34 4 270 1,207 48 Up 347% q -88%
Kings 100 890 64 56 510 470 9 Down -8% q -12%
SGH 32 186 3 - 20 163 25 Up 699% q -100%
OTHER 33 164 13 11 105 204 206 Up 94% q -16%
LAMBETH CCG INTEGRATED ADULT PROGRAMME DASHBOARD
YTD activity @ Nov15/16 vs
YTD Plan @ Nov15/16
Plan @Nov 15/16 vs
Nov Act 15/16
ALL Acute Plan and Actual Activity
2014/2015 2015/2016
November 2015 - Dashboard
51
5 2014/2015 2015/2016 5
LAMBETH YEAR MONTH
2015 Nov Nov B3
Nov activity
14/15
YTD activity @ Nov
14/15
Plan @Nov
15/16
Nov activity
15/16
Plan @Nov
YTD
YTD activity
@Nov 15/16
Comparing
YTD Plan
with YTD
Actual
Activity
% Change YTD
Actual Vs YTD Plan
Comparing Monthly
Plan with in
Monthly Actual
Activity
% Change Nov
Actual vs Plan
OUTPATIENTS TOTAL 12,990 201,052 27,359 39,214 219,158 305,887 Up 40% p 43%
First OP 9,967 82,042 8,387 10,863 67,187 82,268 19,937 Up 22% p 30%
GSTT 5,008 41,564 4,695 5,560 37,559 41,635 7,053 Up 11% p 18%
Kings 3,361 27,402 2,601 3,046 20,806 26,200 1,085 Up 26% p 17%
SGH 727 6,018 540 1,228 4,383 6,447 2,005 Up 47% p 127%
OTHER 871 7,058 552 1,029 4,439 7,986 17,245 Up 80% p 87%
Follow-Up 465 99,247 18,972 23,424 151,972 190,101 5,563 Up 25% p 23%
GSTT 11,165 95,494 11,090 12,137 88,721 94,820 13,812 - 7% u 9%
KINGS 7,579 61,648 5,337 7,174 42,696 60,041 2,935 Up 41% p 34%
SGH 1,853 15,074 1,238 1,326 10,051 13,416 5,186 Up 33% u 7%
OTHER 2,461 20,468 1,306 2,787 10,503 21,824 41,870 Up 108% p 113%
OP_Proc 2,558 19,763 - 4,927 - 33,518 120,018 Up - p -
GSTT 2,063 17,170 1,242 2,744 9,934 19,592 1,195 Up 97% p 121%
Kings 354 3,189 451 1,077 3,605 5,554 844 Up 54% p 139%
SGH 503 3,479 356 428 2,887 3,559 1,572 Up 23% p 20%
OTHER 530 3,738 324 678 2,589 4,813 9,174 Up 86% p 109%
A&E TOTAL
A&E 11,489 95,927 10,883 11,436 87,050 94,551 2,779 - 9% u 5%
GSTT 3,775 32,568 4,179 3,780 33,435 32,317 16,565 Down -3% q -10%
Kings 4,499 36,873 4,227 4,423 33,818 35,416 16,467 - 5% u 5%
SGH 1,200 9,622 1,252 1,235 10,017 9,834 5,074 Down -2% q -1%
OTHER 2,015 16,864 1,224 1,998 9,780 16,984 38,106 Up 74% p 63%
LAMBETH CCG INTEGRATED ADULT PROGRAMME DASHBOARD
YTD activity @ Nov15/16 vs Plan @Nov 15/16 vs2014/2015 2015/2016November 2015 - Dashboard
52
5.2.4 Elective
Responsible Director Moira McGrath, Director of Integrated Commissioning (Older Adults)
Clinical Lead Dr. Hasnain Abbasi
Programme Lead Bisi Aiyeleso / Sara White, Assistant Director Service Redesign
Scope of business area The Elective Care project has historically focussed on GP referred activity in outpatients, both first and follow
up. The elective programme in 2015/16 aims to reflect the changing nature of the work required to deliver
improvements across the elective pathway as a whole. Whilst there is still a focus on reduction of activity in
outpatients via appropriate referral to specialist services, the Programme also focuses on associated activity
along the elective pathway including diagnostics and pre/post-surgical elements of elective pathways.
The elective care project links into work being implemented to support the delivery of 18 week referral to
treatment targets. It cross references work to the Long Term Conditions project, the Primary Care
Development Programme including the GP delivery framework within this, Children’s Services and work
undertaken by Southwark and Lambeth Integrated Care (SLIC).
Objectives of business area
The objectives of this business area are to:
To strive to achieve an approach to create solutions for service redesign and delivery with
consistency across providers that are accessed by patients living in Lambeth
To create an outcome based approach to agreeing changes to the way in which services are
delivered across primary, social, community and secondary care
To manage and mitigate in-year risk, whilst recognising minimal material impact
To reduce the number of people inappropriately seen in outpatients
To reduce inappropriate specialty specific follow up
To agree a consistent approach across Lambeth and Southwark where possible
To reduce variation in the GP referral patterns to outpatients
53
To agree contractual levers to treating patients referred correctly within a pathway
To agree whole pathway approaches within defined areas, including outcome based approaches to
pathway management
To reduce expenditure by making people responsible for their own health
To address some of the Information Technology challenges to allow primary care clinicians to feel
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref: Objective Delivery
Period
Progress update
Reducing Variation In Referral Practices
6.1.1 Complete pilot phase of an
information workflow process (DXS)
Quarter 1 Complete. The DXS system has been implemented across all practices.
Monitoring of practice usage of the system is occurring and the use of the
system has been included as an indicator within the GP federation contract.
6.1.2 Implement DXS across all practices Quarter 2 See section 6.1.1
A new online training package is being explored as part of the drive to
increase utilisation in practices. Review currently being conducted of DXS to
provide recommendations on the future of the service and evaluation of its
use in Lambeth. This will include a visit to Camden to look at how they use
DXS. The internal review is planned to be completed by end of Feb 2016.
6.1.3 Development of checklists in key
areas and implement onto DXS
Quarter 3 There are two areas where checklists are still being finalised. The
completion of these is due in Q4.
Ophthalmology
6.1.4 Agree and sign new contracts with all Quarter 2 MECS contracts and service specifications have been signed by all 9 MECS
54
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref: Objective Delivery
Period
Progress update
MECS providers, increasing
providers to 10
providers that are currently operating. Work has progressed with recruiting
an optometrist Provider in the Streatham and Clapham area. Optometrists
in Specsavers Clapham - start date has been put back to February 2016.
Reduction In Trust Led Referrals
6.1.5 Acute contracts agreed with
reductions in trust led activity
Quarter 1 Agreed acute contracts included reductions in trusts led activity including the
areas of Follow up appointments and consultant to consultant appointments
Diagnostics
6.1.6 Implement process to identify
potential areas for improvement that
could deliver efficiencies within
2015/16
Quarter 2 Work plan identified in pathology.
Workplan to be agreed for imaging, meeting in December to agree.
Priority areas address quality issues and are unlikely to deliver financial
efficiencies during this financial year.
Implementation of e-Referrals
6.1.7 Improve functionality of e-referral advice and guidance function
Quarter 4 ERS meeting with Providers and Southwark planned for end January.
Advice and guidance plan to be discussed but unlikely to make any impact
until 16/17.
6.1.8 To understand and monopolise on
the improvements that e-referral
offers and aim to increase utilisation
of e-referral in primary care
Quarters 2-
4
Action plans to increase utilisation, which were delayed due to system
instability, are now being reinstated. Provider/CCG interface meeting on
ERS now established bi-monthly. Training plan agreed for ERS and
implementation commenced. Low utilisation practices identified and
targeted for training. ‘How to….’ guide distributed to all practices. ERS-only
access pilot for LIMS service being planned for Q3 2016/17.
55
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref: Objective Delivery
Period
Progress update
6.1.9 To devise a work plan that aims to
encourage local Trusts to further
improve their ‘Directly Bookable
Services’, ‘Named Clinician in
Service Name’ and increase their
specialty clinics
Quarter 1 See 6.1.8. Draft workplan produced to be agreed January 2016.
5.2.5 Long Term Conditions/Medicines Optimisation
Responsible Director Moira McGrath, Director of Integrated Commissioning (Older Adults)
Clinical Lead Dr. John Balazs (Long term conditions), Dr Di Aitken and Dr Sadru Kheraj (Medicines Optimisation)
Programme Lead Vanessa Burgess, Assistant Director & Chief Pharmacist.
Scope of business area The purpose of this business area is to improve the quality and length of life of people with one or more long term
conditions, to promote the clinical and population behaviours, which allow the right care to be delivered in the
right setting. We aim to do this by commissioning high value, patient-orientated outcome clinical interventions
which aim to support self-management though joint decision making with patients and importantly address parity
of esteem for mental health.
Objectives of business area
The objectives of this business area are to:
Improve quality and length of life for people with long term conditions by commissioning high value,
accessible patient-orientated outcome clinical interventions for people living with long term conditions.
Empower patients with long-term conditions through enriched clinical consultations – development of
56
coordinated care, shared decision-making, prevention, emotional support and self-management.
Focus on prevention and improve the recognition, diagnosis and interventions for improving care
specifically in respiratory and cardiovascular disease including diabetes.
Reducing the need for unscheduled care and unnecessary out-patient activity for people with long term
conditions by education and improving focus on prevention and self-management.
Work closely with clinicians and the mental health programme to ensure that mental health needs of
patients with long term conditions are incorporated into pathways.
57
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
Commissioning Integrated Services
6.2.1 Benchmarking population needs – assessment
of data for long term conditions outcomes.
Quarter
1
Complete
Data analysis with Public Health on evaluating mental health needs
of people with Long Terms conditions is underway as part of the
evaluation and mainstreaming of the 3DFD service (3 dimensions of
care for Diabetes).
6.2.2i Community management of Diabetes (via
Diabetes intermediate care team) re-
commissioned for 15/16.
Quarter
1
Complete, Diabetes Intermediate Care Team (DICT) service recommissioned until 31.3.16. Scoping of commissioning model for the DICT service for 2016/17 is undergoing evaluation of evidence base on outcomes based diabetes contracting and understanding models used in other areas – meetings with Camden CCG and Islington CCG have been completed. Darzi fellow: a workplan has been agreed covering severe mental illness (SMI) and structured education programmes; increasing the number of people with severe mental illness who attend structured education, completing service evaluations of currently commissioned structured education programmes and designing modified-structured education for people with SMI with a view to rolling this out across Lambeth practices. Complete, National Diabetes Audit (NDA) 2014-15 - 100% of practices participated.
58
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
Education for practices – peer support and learning: DICT have been commissioned to provide 2 practice events. Delegates from 38 practices attended the event on the 19 November 2015. Feedback on the presentations and case studies were very positive with all evaluations stating the sessions had improved their knowledge 'quite a lot' or 'a great deal' 57 bookings have already been received for the second learning event in March 2016. Ensure cost effective prescribing in diabetes via active promotion of QIPP projects and audit against NICE guidelines. The Lambeth Diabetes Intermediate Care Team have moved into the third phase of implementation of reviewing Blood Glucose Monitoring in people with uncomplicated type 2 diabetes. The CCG are developing plans to commission community pharmacists to co-deliver this initiative with Lambeth GP practices and Lambeth DICT. Scoping potential for a combined CVD and diabetes network to embed learning into other LTCs. Update: A focus group for leads from each LTC area, LCN leads, Federation c hairs, Acute Trusts and Healthwatch has been arranged for February, faciliaited by South London HIN. This will also plan a future workshop to be attended by a broader group of stakeholders, to scope and progress the development of a Lambeth and Southwark LTC Network. Optimising type 2 diabetes care via search and virtual clinic.
Target: patients with uncontrolled HbA1c - 64 mmol/mol or greater
59
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
(QOF) and sub-optimal medicines. Included in LTC scheme, GP
Delivery framework. 39 out of 47 practices have completed their
first virtual clinic to date.
Ten practices have been offered additional support by the DICT to
improve clinical outcomes for patients. The practices were selected
based on Quality and Outcomes Framework (QOF) clinical domain
data relating to HbA1c, blood pressure and total cholesterol as well
as expected prevalence data.
8 out the 10 practices have accepted the offer. The Diabete
Specialist Nurse linked to each practice has made contact and intial
visits are underway to meet and discuss the best way to support
each practice.
Lambeth CCG and Local Authority submitted a joint expression of
interest with CCGs/LAs in South London in October 2015 to be part
of the first wave of the NHS England Diabetes Prevention
Programme. NHS England are working towards an announcement
regarding wave 1 sites shortly.
The HeLP-Diabetes (Healthy Living for People with Diabetes)
Programme has been launched - a new online resource has been
commissioned for Lambeth people living with type 2 diabetes for
one year.It will allow people living with Type 2 diabetes to access
structured –education online.
60
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
Resources to support practices in promoting HeLP-Diabetes to
patients have been shared via emails, bulletins and webpages and
will be uploaded to DXS.
Decembers monthly report from the HeLP-Diabetes team
highlighted that 19 patients have registered on the programme and
8 practices have referred patients into the service since the team
presented at the diabetes learning event in November 2015. Thirty-
five patients were registered prior to this.
6.2.2ii Performance indicators agreed and reports
monitored for 15/16.
Quarter
1
Complete.
6.2.3i Hypertension service re-commissioned for 15/16
with updated performance indicators and
reports.
Quarter
1
Community hypertension service – GSTT outreach and virtual clinic
service recommissioned for 15/16.
Ambulatory Blood Pressure Monitoring (ABPM) - Aim to obtain
further information regarding the service and the different models
across the borough to allow evaluation of the service and design of
the future delivery model. Practice survey is complete and results
are being collated for presentation at the next CVD steering group.
Secondary care activity data has been requested in order to review
all ABPM activity since the introduction of the practice based
service. A service evaluation report and options appraisal for future
commissioning is due to be discussed at the January Integrated
Adults Programme Board.
61
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
Hypertension – optimising management. Over 15/16, identify a
target cohort of uncontrolled HT patients - BP systolic >160 or
diastolic >100mmHg for optimisation. Each practice holds a
minimum one annual CVD virtual clinic plus HT clinic referral where
needed for complex patients. Implementation plan for practice to
include learning from previous work, and action planning to optimise
patients identified. Offer lifestyle advice & stop smoking. Included in
LTC scheme, GP Delivery framework. An update from the
hypertension team was received in November at which point 37
practices have their virtual clinic booking confirmed. A further
update has been requested. Remaining practices are in the process
of being contacted by the link pharmacists.
6.2.3ii Equality objective for Hypertension delivered. Quarter
4
6.2.3iii Performance indicators for 15/16 for the
community heart failure service and reports
monitored.
Quarters
1-4
The service specification and KPIs for 16/17 are due to be ratified
at the January Integrated Adults Programme Board. Providers have
shared data relating to delivery of the currently commissioned
service. This data consists mainly of activity data rather than
outcome data due to data collection problems which have now
been resolved. Meetings are in place to plan the implementation of
the successful heart failure charity bid for 7 day working, moving
care into the community and aligning with Federations and locality
care networks. A key focus of this work will be to look at how to
integrate across other long term conditions and how to deliver
improved outcomes for our patinets and reduced heart failure
62
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
admissions across the system.
6.2.3iv Ambulatory Blood pressure monitoring service
reviewed and re-commissioned by April 2016.
Quarter
4
6.2.3v Performance Indicators developed and
monitored.
Quarters
1-4
As 6.2.3i.
6.2.4 Integrated respiratory team (based @KCH) re-
commissioned for 15/16.
Pharmacist support to enable medicines
optimisation in respiratory disease.
Quarter
1
Quarter
1-4
Complete for 15/16.
Complete
Optimise care of asthma patients via virtual clinic.
Discuss information from the Quality Asthma Review Pyramid to;
1. develop a practice specific action plan to improve asthma care
2. Implement the action plan with a progress report by March 2016
and Identify patients on high dose Inhaled corticosteroids and step
down as clinically appropriate
Included in LTC scheme, GP Delivery framework.
Optimise care of Chronic Obstructive Pulmonary Disease (COPD)
patients – in 15/16 each practice identifies cohort of patients to
discuss during IRT VC;
1. Patients on high dose inhaled corticosteroids with mild/mod
COPD.
2. COPD patients with any recent urgent care episode (A&E,
hospital admission).
63
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
Complete a review with IRT Support using the COPD review
template and CCG prescribing guidelines.
Increase referrals of people with COPD and tobacco dependency to
specialist stop smoking services via singlepoint of referral.
All clinicians to strongly consider completion of NCSCT VIncluded
in LTC scheme, GP Delivery framework.
100% of practices have booked a virtual clinic.
Education for practices – (1) PLT event with 80 in attendance,
focussing on cough, breathlessness and asthma to support delivery
of LTC scheme. (2) IRT to provide additional afternoon training
sessions, on spirometry, asthma and COPD in Q3 and Q4 – all
events have booked attendance at 80 – 100%.
Patient support – pilot project involving Self-Management UK is
being streamlined with the established Breatheasy group as an
alternative mechanism to support reluctant patients into Pulmonary
Rehab service. BA training and if already completed then Level 1
quit smoking training. Lambeth patients participating in Singing for
Better Breathing study.
Establish a SEL Responsible Respiratory Prescribing group to
report to the SEL Area Prescribing Committee. Terms of reference
have been agreed with the APC and the group is meeting in
November 2015.
The SEL Responsible Respiratory Prescribing group has met and agreed to develop a respiratory management guideline and
64
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
pathway for asthma and COPD across SEL. Discussion was held around inhaler device and drug choice, with initial agreement on some drug classes made. The guideline will be developed and further discussions will be held around remaining drugs and relevant devices.
6.2.5i Performance indicators for the IRT service for
2015/16 developed and monitored.
Quarter
1
Review underway. Final indicators to be agreed at November Core
Group meeting. Focus on holistic patient outcomes. Range of
metrics are being discussed, for example: the “Asthma pyramid”,
and a similar pyramid for COPD for accessible data from EMIS.
Also patient-reported outcome measures to ensure the patient
experience is captured.
6.2.5ii Community Spirometry service to be
commissioned for 2015/16 in line with approved
business case.
Quarter
1
The service specification is complete and has been sent to localities
for expressions of interest. Alternative models of provision including
via IRT are being explored and a paper will be taken to the
Integrated Adults Programme Board in December/January.
Implementation during Q4, anticipated start date no later than April
16.
Update to the spirometry business case:
The IRT are progressing the spirometry service via their business
planning process, and are expecting final sign off from KCH at the
end of January. Federations have been updated.
6.2.5iii Performance indicators to be developed and
monitored.
Quarters
1-4
As 6.2.5i.
6.2.7i Commission mental health support for people with Quarter
65
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
LTCs for 2016/17. 4
6.2.7ii Embed and mainstream the learning from the
3DFD pilot
Quarters
1-4
Mainstream the service over the next 12 months.
Interim funding for 15/16 agreed. The first review meeting with
KCH has taken place in June and it was agreed to pursue 2 routes
concurrently ;
1. Contribute to the Trust led amended bid to the Health
Foundation to continue the service and roll out to CVD patients
(Hypertension) – the “3DLC” proposed model. A second stage
application for funding for 3DLC has been supported by CCGs in
October on the basis that agreement on alignment with currently
commissioned pathways is agreed over the next few weeks.
2. Lambeth CCG has met with the IAPTs provider (SLAM) in
July to discuss meeting needs of patients with LTCs. To identify the
small cohort of complex patients who will need more intensive
support and how that can be provided for all patients with LTCs
using the learning from 3DFD. This will be further progressed over
Autumn.
Commissioning For Outcomes
6.2.8 Establish a steering group to scope a model of
care for enabling quality care and self-
management for patients with LTCs, possibly via
an outcomes based/year of care approach to
commissioning long term conditions services.
Quarter
2
Initial scoping underway internally.
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Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
GP Delivery Scheme 2015/16
6.2.9 Consult and agree on a scheme with General
Practice and federations to improve self-
management and optimisation for people with
LTCs and obtain best value from medicines.
Quarter
1
Promote care planning and shared decision making via
personalisation in patients with long term conditions through
incentivising enriched clinical consultations – development of
coordinated care, shared decision making, prevention, emotional
support and self-management.
CVD and diabetes virtual clinics and medicines reconciliation
ensure adoption of care plans into practice in primary care.
Included in Long Term Conditions Scheme 15-16 which has been
launched via 3 launch events with 100% attendance from
practices. The scheme has been designed to build on proven
successful interventions by the virtual clinic model of care in key
elements of CVD, Respiratory Disease and Diabetes plus
Medicines Reconciliation in primary care.
Phase 2 of the LTC scheme scoping is delayed due to lack of
system capacity. This will now be incorporated into commissioning
intentions and plans for 16/17.
6.2.10 Deliver medicines QIPP plan and financial
balance on prescribing budget.
Quarters
1-4
The Medicines Optimisation Scheme 2015-16 has successfully
been developed and fully consulted with stakeholders. The key
areas are: Cost Prescribing Efficiencies; Repeat Prescribing
Systems and Waste Reduction; Patient Safety on Antibiotics. The
scheme has been designed to progress on foundations laid from
the 2014-15 scheme for example practices will be asked to
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Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
minimise the risks identified within the Repeat Prescribing Support
Day visits.
ScriptSwitch continues to be actively managed to raise potential
savings within all practices and the profile review and rationalisation
is 80% complete
CCG commissioned high cost drugs spend is monitored and
inappropriate charges are challenged monthly.
The GSTfT and KCH High Cost Drugs Policy for 15/16 has been
agreed. Key Performance Indicators have been agreed for KHP.
Regular medicines contracting meetings are held quarterly with
Trusts and medicines/CSU teams.
Collaboration on cost effective use of high cost drugs is via pathway
development as part of SEL APC.
Lambeth CCG continues to have representation on the GSTfT
Medicines Safety Forum and the SLAM Medicines Safety
Committee to facilitate learning across organisations on medicines
errors.
The three Electronic Prescribing System (EPS) workshops for
practices took place in September and were well subscribed with
representatives from 41 practices and 9 community pharmacies
attending. Feedback from attendees was positive, with the
opportunity to obtain peer support and address questions directly to
EMIS Web/HSCIC/CSU representatives cited as particularly helpful.
Medicines Waste Campaign materials have been agreed and
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Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
circulated, commissioned alongside other SEL CCGs via the CSU.
6.2.11 Deliver effective implementation of the LTCs and
Medicines schemes – communications,
specialist support, resources and monitoring.
Quarters
1-4
Ongoing.
6.2.12 Scope phase 2 of the LTCs plan – mental health
inclusion in LTCs, shared care for medicines,
osteoarthritis.
Quarter
3
Included in the scoping and development of 2016/17
commissioning intentions
Enabling Self-management And Resilience: Allied Health Professionals
6.2.13 Support GP federation/local care network to
promote extended consultation times in primary
care for complex younger people with long term
conditions not currently included in the holistic
assessment process.
Quarters
1-4
Holistic Assessments now available for over 65 years.
Care planning for younger people via LTC virtual clinics.
6.2.14 Commission a scheme to deliver routine
pharmacist support to the frail elderly taking
complex medication regimens in the community.
Quarter
1
Complete – service business case for an Integrated Pharmacy
Service for Older People was approved by the Committee in
Common in October 2015.
A Community Pharmacy Older Peoples Support service for ongoing
medicines and support in the community is being scoped and a
business case will be submitted to the Committee in Common in
early 2016.
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Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
6.2.15 Commission a domiciliary specialist clinical
pharmacy medicines assessment service for
complex frail elderly to enable local authority
social services and primary care to support
people in their own homes.
Quarter
3
Complete
6.2.16 Scope a scheme with the older people’s team
for incentivising waste management and
increasing quality of prescribing for community
pharmacies with a care home supply contract.
Quarters
1-2
Scoping
Enabling Self-management And Well-being: Community Access to Effective Medicines
6.2.17 Review of community pharmacy common
ailments scheme – list of products available
Quarter
1
The common ailments scheme has been reviewed and approved by
the Lambeth Borough Prescribing Committee - complete
6.2.18 Integrated working with local authority
commissioners to support development and
approval of patient group directions in local
authority commissioned services, and access to
medicines to support prevention and well-being
e.g. stop smoking, contraception.
Quarters
1-4
Work has been undertaken to support the local authority to develop
and approve a range of PGDs for use by Community Pharmacists
and Brook Sexual Health Clinic nurses.
Safe Transfer of Information Between Care Settings
6.2.19 GSTFT and KCH Medicines CQUIN – develop,
monitor and embed into routine practice. CQUIN
is delivery of a robust medicines review in high
Quarters
1-4
Year 2 CQUIN on medicines review and communication from acute
trusts with GSTfT and KCH – agreed to include learning from year1.
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Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
risk polypharmacy patients admitted to hospital
which is well communicated to primary care on
discharge
6.2.20 LTCs scheme (GP Delivery Framework)
incentivised medicines reconciliation in primary
care in line with NICE NG5, March 2015.
Quarter
4
Medicines Reconciliation in primary care included in the LTC
scheme, GP Delivery Framework.
Collaboration Across South East London
6.2.21 Active engagement and leadership (hosting
function) from Lambeth CCG for the SEL Area
Prescribing Committee and work streams.
Quarters
1-4
Shared care guidelines for rheumatology are developed and
undergoing final approval via the Area Prescribing Committee.
6.2.22 Ensure that medicines related IFRs are
progressed in a timely manner in line with
current policy.
Attendance at IFR panel meetings.
IFR policy in place.
6
monthly
report
Ongoing
71
Medicines Optimisation & LTC – data element
A. Overall Performance 2015/16 (Month 7) Overall the prescribing budget underspend at Month 8 is £358,033 (1.5%, see finance
report). The North is underspent by 2.8%, the South East by 1.2% and the South West by 1.0%
Spend per ASTRO-PU (data available quarterly)
NHS England Antibiotic Quality Premium Monitoring Dashboard (12 month rolling data)
Green = target met
QIPP Savings Plan
72
5.2.6 Older People
Responsible Director Moira McGrath, Director of Integrated Commissioning Adults
Clinical Lead Dr. Lisa Le Roux
Programme Lead Liz Clegg, Assistant Director Integrated Commissioning, Older Adults
Scope of business area Lambeth CCG is one of a range of partners who form the Lambeth and Southwark Integrated Care
Programme (known as SLIC). This three-year integrated care programme has been funded by a
grant to the value of £10.2 million awarded by Guys and St Thomas’ Charity in March 2012.
Objectives of business area
The objectives of this business area are:
Older people will remain independent and are able to manage their health well with the right
level of timely support and advice when they need it to remain at home
Fewer older people will be admitted to hospital or care home
Redesign of local health and social care systems supporting the shift from bed to community
based care
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
Intermediate Care
6.3.1 Determine approximate number of
beds required for bed-based
intermediate care to inform a move
from block to tariff commissioning
Quarters 2-
4
Awaiting defined pathways and costs for bed based, double handed home
based and extended LOS in acute hospitals to support decision regarding
numbers of intermediate care beds required. Southwark CCG will commission
a small amount of Lambeth intermediate care beds on a block contract and a
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Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
position for 2016/17 proportion of other beds will potentially be used for Level 2b neuro-rehabilitation
beds.
6.3.2 Clarify pathways to intermediate care
services for improved referral
processes
Quarter 2 As per above.
6.3.3 Stimulate bed-based intermediate care
market for commissioning 2016/17
Quarters 2-
3
Commenced pilot to use of 2 extracare flats as stepdown ‘discharge to assess’
as a test
Dementia
6.3.4 To set locally agreed waiting time
targets and monitoring mechanisms.
Quarter 2
Need to agree targets with Southwark and SLaM and include in 16/17
contracting round.
6.3.5 To work with provider to ensure
efficiencies
Quarters 2-
3
Work to commence next quarter
6.3.6 To develop business case for further
resources if unable to meet waiting
time targets having exhausted all
efficiencies
Quarters 3 -
4
6.3.7 To commission co-produced post
diagnosis support service
Quarters 2-
3
Work to commence quarter 3
6.3.8 Working across LBL and CCG
modernise the older people’s day
services and to provide choice for
service users, as well as developing
Reviewer post recruited to, a number of staff meetings have taken place in
June/July and meeting with service users and carers took place over August.
Day service attendees are currently being reviewed, final report due Jan/Feb.
Second provider event with over 40 participants took place in November 2015
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Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
the local day opportunities market to
include those who wish to self-fund
to update service users and their families and carers on progress on the review
and to communicate some initial findings. Final review report due Feb, will
inform the business case for new day activites offer which will be developed in
2016/17
6.3.9 Working across LBL and CCG
modernise and commission an
assistive technology, response and call
handling service which will enable
savings to be made whilst delivering a
more targeted, responsive service.
Quarters 1-
4
Bench marking information gathered and workshop event held with local care
management staff and other boroughs to gather evidence on models of
provision.
Options appraisal document has been produced to help enable decision making
for the way forward.
Community Services
6.3.10 Roll out of Unified Point of Access for
health and social care services
Quarters 1-
4
Work being progressed and monitoring through the GSTFT contract monitoring
meeting
6.3.11 Evaluation of Neuro-rehab scale up
pilot
Quarters 2-
4
GSTFT contract monitoring meeting agreed extension of pilot based on interim
evaluation report.
6.3.12 Implementation of Pal@home and
access to 24 hour community nursing
support for patients with EOLC needs
Quarters 2-
3
Pal@home model went live in November 2015
6.3.13 Work with GSTFT to explore new and
improved ways of delivering integrated
community nursing services
Quarter 2 Task and Finish Group including commissioning representation established to
look at possible models.
Test model being developed – likely to be small scale around 2 GP practices in
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Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
Lambeth and Southwark
Integrated Care
6.3.14 Establish and develop the Committee
in Common to support progression of
BCF
Quarter 1 Committee in Common now in place, TOR and membership agreed. Forward
plan to be developed
ACTION COMPLETED
6.3.15 Refine reporting template for Better
Care Fund (BCF) for measuring and
monitoring against defined metrics for
Health and Wellbeing Board, and to
national BCF team Q1-2.
Quarters 1-
2
Reporting to BCF National Team now based on SUS. Reporting for local quality
metric being devised.
ACTION COMPLETED
6.3.16 Consider current BCF delivery
programme for extension to 2016/17,
and other services that could be
included in an integrated service
Quarters 2-
3
New national guidance issued January 2016. Health and Wellbeing Boards to
submit refreshed BCF plans for 2016/17 by mid April. Self assessment on BCF
delivery to be submitted to NHSE by beginning of February. Process and key
themes to be agreed by the Committee in Common
Reablement Service
6.3.17 To review and revise reablement
specification following market failure of
previous community support provider
GSTT have agreed to host the integrated Reablement service including
Reablement Support Workers (RSW). Project manager being recruited, adverts
out for RSWs. Business case for additional CCG investment to roll out
Reablement offer to community referrals being developed
76
Integrated Care Home Commissioning – performance management
Dulwich Care Centre (DCC)
DCC is a care home registered to provide care for older adults with physical needs and for people with dementia. DCC service is currently
suspended. Monthly meetings with commissioning and care management continue.
Collingwood Court Nursing Centre (CCNC), BUPA
CCNC is a care home registered to provide care for older adults with physical need and for people with dementia. CCNC service was suspended on
26 October 2015 and other placing boroughs and CCGs were informed of the suspension. An initial meeting between CCNC management and
Lambeth commissioning and care management was held on 18 November 2015. A comprehensive action plan has been developed to respond to
concerns raised. Monthly meetings with commissioning and care management continue.
Laurels Care Centre (LCC)
LCC is a care home register to provide accommodation for persons who require nursing or personal care. LCC service was suspended on 24
December 2015 and other placing boroughs and CCGs were informed of the suspension. In advance of the suspension, Lambeth commissioning
met with management of the home regarding concerns identified via unannounced visits. Lambeth care management and Care Home Support Team
have reviewed the home and Lambeth residents and an Investigating Officer (IO) will review specific alleged concerns relating to physical health of
one resident. Following the report from the IO, a Provider Concerns meeting will establish whether the suspension remains or can be lifted.
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5.2.7 Continuing Healthcare
Responsible Director Moira McGrath, Director Integrated Commissioning (Older People)
Clinical Lead Dr. Lisa Le Roux
Programme Lead Liz Clegg, Assistant Director, Integrated Commissioning, Older Adults
Scope of business area Evaluation of Continuing Healthcare pathways ensuring patient centred care.
Objectives of business area
The objectives of this business area are:
To continue the roll out of Personal Health Budgets for patients deemed eligible for fully funded
NHS Continuing Healthcare.
To continue with the National Retrospective Appeals work in accordance with Department of Health
guidance, ensuring continued monitoring of the impact of the appeals.
To continue working with the London Purchased Healthcare Programme (LPP) in relation to further
AQP developments.
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery Period Progress update
6.5.1 Increasing the uptake of personal health
budgets for patients identified as being
eligible for fully funded NHS Continuing
Healthcare
Quarters 1-4 There are currently 15 fully funded CHC patients receiving a PHB,
and 1 joint funded service user receiving a PHB.
6.5.2 Continue the project to assess appeals for
Previously Unassessed Periods of Care
(previously called Retrospective Continuing
Quarters 1-4 The CCG has commissioned an outside organisation to complete the
clinical reviews for the remaining claims. All of the claims have been
sent to the organisation for processing. The CCG has been holding
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Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery Period Progress update
Healthcare Appeals) appeals panels since October 2015 to consider the claims. Eight
claims have been considered at the appeals panel, two of which have
resulted in a restitution payment being agreed. NHSE requires all of
the claims to have been completed by the CCG by September 2016.
The current trajectories indicate the CCG will have completed all of
the claims by July 2016.
6.5.3i Monitor the current AQP contract for
Continuing Healthcare placements
Quarters 1-4 The CCG continues to review all CHC placements under the AQP
contract. The AQP contract service specification will be reviewed
during the year by the LPP in conjunction with all the London CCGs in
the contract, as part of the agreement to extend the contract for a
further two years
6.5.3ii Work with GSTT to develop new model of
continuing care provision at Minnie Kidd
House
Quarter 3 Work is progressing with the new model of continuing care that will be
delivered at Minnie Kidd House. Negoiations are underway with
GSTT to agree contractual arrangements for these beds for 2016/17
6.5.4 Review the CCG’s compliance with NHSE’s
Quality Assurance Framework for Continuing
Healthcare
Quarters 1-4 In late October 2015, the CCG was notified of NHSE’s proposal for a
“Deep Dive” on CHC. The CCG has collated the evidence for each
KLOE and has provided all of the information to NHSE via the on-line
CHC data collection tool. This will take place on the 9th of March
2016.
6.5.5 Work with Southwark CCG and the
Integrated Care programme to review the
‘Health Offer’ to nursing homes in Lambeth
Quarters 1-4 On-going discussions with Southwark CCG and SLIC lead regarding
contracting position.
Urgent Care Working Group funding falls training in nursing and
residential homes across Lambeth and Southwark for completion in
Q4.
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Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery Period Progress update
6.5.6 Work jointly with Lambeth Council to review
the quality of care provided in the Lambeth
nursing homes
Quarters 1-4 On-going integrated work on improved safeguarding processes.
‘Provider Concerns’ policy has been approved and is being rolled out.
Audit of LBL processes for monitoring care homes has been
completed and draft report shared with commissioners. Final report
with action plan to be ready by the end of February 2016
5.2.8 Urgent Care
Responsible Director Andrew Parker, Director Primary Care Development
Clinical Lead Dr. Paul Heenan
Programme Lead Bisi Aiyeleso / Sara White, Assistant Director Service Redesign
Scope of business area To ensure that patients can access urgent care services appropriately within Lambeth.
Objectives of business area
The objectives of this business area are to:
Enable patients to better manage their health and choose the most appropriate care settings
through the provision of comprehensive communication and self-management strategies.
Develop innovative ways to improve access to General Practice and offer patients consistent
access to urgent and unplanned care within primary care.
Develop access to alternative pathways to primary care for patients accessing the emergency
department who could be managed elsewhere
Commissioning to ensure that Urgent Care is better configured to deliver for example a front ended
co-located Urgent Care Centre within ED on the St Thomas’ site, supported by consistent communications
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and signposting of patients.
To provide sufficient pressure surge management support to the urgent care system, particularly in
winter but also at times of pressure such as heat wave or infection outbreaks.
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
Development and Implementation of Urgent Care Strategy
6.4.1 Full implementation of the community
pharmacy redirection scheme to
support redirection of appropriate
patients from St Thomas ED
Quarter 2 This scheme was raised with GSTT on the 05.01.16. GSTT advised that
patients that do not need to be seen in A&E are triaged out and referred to a
Pharmacy i.e. treatment for head lice, coughs and colds. The trust does not feel
the scheme is required as patients who require a Pharmacy are not usually
seen in A&E. Recommend through decision making forums that Pharmacy MAS
scheme specific to GSTT does not continue.
6.4.2 Maintain target for patients seen within
St Thomas ED who are managed
through the UCC
Quarters 1-
4
The UCC saw a decrease in activity for M9. The scheme has performed under
target for the year to date with activity of 39,937 for M9 against planned year to
date target of 43,200.
Lambeth CCG held meeting on the 05.01.16 with GSTT and the following were
discussed
a. GSTT advised that Phase 2 of the ED building works to be completed in
April 2016. The final phase (Phase 3) will commence further to this with
completion due in 2017. Deputy General Manager and ED Head of Nursing to
brief Lambeth and Southwark Urgent Care Working Group (UCWG) on site
changes that will occur over the next year and the mitigating actions that are
being put in place to ensure 4 hour wait performance is maintained at 95%.
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Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
b. Urgent Care service specification to be sent to GSTT to circulate the
spec internally for comments
c. Informed GSTT of the review completed on the GP diversion scheme
and the recommendation that the scheme should be decommissioned due to
the large number of non Lambeth patients being managed through the scheme
and alternative provision being available through the GP access hubs. The final
dicision will be made regarding the scheme once consultation on the
recommendation has occurred.
6.4.3 Usage of the GP Diversion scheme to
support the redirection of patients from
EDs
Quarters 1-
4
Continues to perform poorly. Following agreement at the IAB in December, it
has been recommended that this service be decommissioned, subject to
consultation as part of the CCG commissioning intentions for 2016/17. Should it
be agreed, the service will be given 6 months notice.
6.4.4 PALs officer support to unregistered
patients to register with a GP
Quarters 1-
4
This scheme has seen a decrease in activity for M9 in comparison to M8.
This scheme has not performed in line with target for the year to date falling
82% below the target
A lower number of unregistered patients are being seen in the trust compared
with when the scheme was initially started. This service may therefore not now
be needed for the future and is currently being reviewed in line with the GP
Diversion scheme.
6.4.5 Management of patients through the Lambeth Alcohol Recovery Service (LARC)
Quarter 4 Continues to perform well. The scheme has just come under target with a
cumulative year to date variation of -11. Final outurn performance is expected
to exceed the target.
6.4.6 Development of the LARC to include Quarter 2 In terms of incorporating patients under the influence of drugs in the model,
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Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
patients under the influence of drugs initial discussions with the LARC lead consultant and the GST Toxicologists
identified there is already an established toxicology pathway from ED 24/7. This
scheme will therefore not be progressed as planned given lack of added benefit.
Implementation of UCC Service Specification
6.4.7 Contractual Negotiations around
specific tariffs and agree KPIs
Quarter 4 Meeting with the CGG and GST held in January. Urgent Care service
specification to be sent to GSTT to circulate the spec internally for comments.
6.4.8 Operational changes, 24/7 model,
phased implementation of revised front
ended UCC specification
Quarter 4 The UCC service is open 24 hours a day and within a dedicated facility until
2am (this was previously unitl Midnight). Once building work is complete the
UCC service will be available within a dedicated facility 24/7.
6.4.9 Improvement of the Clinical
streaming/PALS redirection of patients
to alternative Primary Care services
pathway
Quarters 1-
4
See 6.4.3 and 6.4.4. Work in this area continues as described above. Given
the poor performance of this workstream, work is planned to review it during Q3
and Q4.
6.4.10 Minors/primary Care Pathway to be
operational 24/7
Quarters 1-
4
This element will be delivered along with the redevelopment of the GSTFT ED
department.
6.4.11 Development of the ENP role,
recruitment of additional ENP’s and
24/7 working
Quarters 1-
4
Work commenced on this area during 2014/15 with ENP trainee’s being
employed by GSTFT. Competencies for ENP staff were agreed and have been
implemented.
6.4.12 Review urgent care pathway as part of
developing extended and enhanced
primary care services, including A&E
front end UCCs and WICs.
Quarters 1-
4
Work on this area will be completed as part of the prime ministers challenge
fund work. This work is currently in progress.
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Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
Systems Resilience
6.4.13 Complete evaluation of 2014/15
systems resilience schemes
Quarter 1 Evaluation completed in Q3.
6.4.14 Work with providers to agree
underlying schemes that will be funded
through systems resilience monies
Quarter 2 For acute, social services, mental health, community and some voluntary sector
providers an allocation was made at the beginning of the financial year for the
implementation of winter resilience schemes.
10 schemes have been approved in the baseline winter funding and a further 6
via the contingency element of funding.
6.4.15 Develop monitoring process for
2015/16 systems resilience schemes
Quarter 3 The Urgent Care working Group monitor performance of the winter schemes via
an approved template.
5.3 Integrated Mental Health for Adults
Responsible Director Moira McGrath, Director of Integrated Commissioning (Older People)
Clinical Lead Drs Paul Heenan and Raj Mitra
Programme Lead Denis O’Rourke, Assistant Director
Scope of business area This business area aims to introduce three major structural changes to the system of care and support via
the new “front door” – the Living Well Network which will provide help and support much earlier than the
current system and provide a personalised and co-productive response via integrated multi-agency, multi-
disciplinary teams and ensure that secondary care services, via the SLAM AMH redesign, are focused on
early intervention and recovery and thereby reduce the “relapse” rates amongst the SMI population. The
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third element of system change relates to the proposed Integrated Personal Support Alliance which aims
to radically transform NHS/social care rehabilitation services.
Objectives of business area
The objectives of this business area are:
Improved health outcomes & experience for patients
Redesign of the local mental healthcare system supporting shift from acute to community
Strengthen individuals and communities capacity to self-manage at scale
Support a managed redirection of resources from secondary care to integrated care within primary
care/community setting.
5.3.1 Programme Assurance Statement
Assurance Status/Risks RAG Rating (Red/Amber/Green)
Is your programme delivering as planned – is it
on target?
5.3.2 Integrated Mental Health for Adults Programme Risk Register
For risks scoring 12 and above, 3C, 3N and 3M, please see the Board Assurance Framework.
Risk Title
Risk Register
where Risk is managed
Current Risk
Score Approach Action Plan Summary
Possible risk that the pathways between Programme 9 Mitigate Implement crisis care concordat plan including 24/7 crisis
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Risk Title
Risk Register
where Risk is managed
Current Risk
Score Approach Action Plan Summary
secure services (commissioned by NHSE) and community are fragmented and under-developed possibly resulting in poor quality outcomes for the population group and persists in inequality experienced by Black and Caribbean community.
Board / Directorate
Risk Register
line from Oct 2015, crisis sanctuary from May 2015. Crisis sanctuary extended to 5 days a week from January 2016. Undertake focussed engagement with young black men with experience of CJS and mental health services in partnership with Time to Change, SLaM, Police etc – Oct 2015 - June 2016 Develop 'step down and move on' strategy with key partners e.g. SLaM and Voluntary sector and Social Finance (01/10/15) and ongoing. Seek agreement with NHSE on the ‘step down and move on’ strategy including shift in resources i.e from secure to community. Meeting has taken place - a proposal is being developed. Discussion with NHSE and SLaM and other CCG's - ongoing. Social Value (Offender Management) Programme pilot - could offer an opportunity to develop integrated commissioning approach including NHSE, HP Brixton, Lambeth Council and Probation Service and MOPAC. Currently reviewing options on next steps for this project - March 2016.
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5.3.3 Mental Health Whole System Dashboard
Mental Health Whole System Dashboard 2015/16 - NOVEMBER
Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16
1 2 3 4 5 6 7 8 9 10 11 12
AMH Redesign
1 ACTUAL 1589 1956 1987 2047 2016 1786 1852 1523
TARGET 1847 1856 1797 1856 1857 1795 1857 1796 1857 1856 1736 1358
2 ACTUAL 22 60 90 123 163 195 229 260
Cumulative
TARGET35 70 105 140 175 210 245 280 315 350 385 420
3 ACTUAL 65 63 74 75 55 59 57 56
TARGET 50 50 50 50 50 50 50 50 50 50 50 50
4 ACTUAL 22 43 76 97 116 160 184 200
Cumulative
TARGET30 60 90 120 150 180 210 240 270 300 330 360
5indicator indicator
Aim is to reduce the number of
detentions that follow MHA
assessments. Currently 95%.
95 97 93 110 90 104 88 93
6
0 0This is a never never event and a key
expectation of the national crisis care
concordat.
0 0 0 0 0 0 0 0
7<7.5% <7.5%
The aim is to keep the delayed
transfers of care to an absolute
minimum. 3.4% 3.2% 2.3% 1.9% 1.8% 5.1% 11.1% 9.5%
8 ACTUAL 154 272 422 895 1216 1520 1919 2299
Cumulative
TARGET144 288 432 632 832 1032 1232 1432 1632 1832 2032 2232
9 ACTUAL 40 44 46 46 49 61 59 63
Cumulative
TARGET45 50 55 70 90 120 150 180 210 240 270 300
10 ACTUAL 319 330 326 336 327 315 339 347 354
TARGET 300 300 300 300 300 300 300 300 300 300 300 300
11 ACTUAL 52 131 224 320 385 436 496 558
Cumulative
TARGET50 100 150 200 250 300 350 400 450 500 550 600
12 ACTUAL 608 580 531 699 528 567 667 552
TARGET 552 552 552 552 552 552 552 552 552 552 552 552
13 ACTUAL 50% 50% 46.2% 49.5% 46.1% 48.3% 44.4% 50.0%
TARGET 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%
14 ACTUAL 5 10 20 26 31 36 41 45
Cumulative
TARGET0 3 6 10 14 18 22 26 30 34 38 41
ACTUAL 2 9 15 20 29 32 33 36
15Cumulative
TARGET4 7 9 22 26 30 37 42 47 58 62 69
Number of people on GP+ 40 300At the close of 14/15 there were 40
people on GP+. The target of 300 ppl on
GP+ will be reached by March 16.
Number of 'new' people accepted by
IPSA0 69 Service went live 1 April 2015
250 300
Number of people entering treatment
into Integrated Talking Therapies
Integrated Talking Therapies recovery
rate of people in treatment
Integrated Personalised Support Alliance
Number of 'legacy' people moved on 192 41
552
Service went live 1 April 2015
Comment
The aim is to reduce overall bed usage. 13571852
120 420Aim is to reduce referrals to no more
than 35 per month. The average for
14/15 60 p/m.
We want to see an increase in HTT
capacity which will contribute to a
reduction in admissions.
144
This includes those people accessing
enablement and membership of LWP.
The target is to support 300 ppl p/m
50%
The actual number of ppl who started
treatment. A provider generated figure
which is ratified by HSCIC 3 mths later.
This is the % of ppl who have entered
and completed treatment who have
achieved 50% recovery rate.
Numbers of accepted referrals to HTT
People discharged to Primary Care
(will also include those discharged
into GP+)
5040
30
Target / Indicator (I)
Baseline
starting
point
End Point
Occupied Bed Days and bed number
trajectory
Referrals to CMHTs
Number of people accessing out of
hours Peer Support (SiaC)40 600
Ppl accessing this service usual during
or following an A&E attendance. We
will review this in Sept to take account
of 24/7 crisis line. Target to support
min 50 ppl p/m
Number of people supported at Living
Well Partnership (Mosaic)
Number of people who experience a
crisis who end up being detained in
police custody
Percentage of delayed transfer of
care
2232
14/15 saw an average of 144
introductions per month. Provisional
target from July 2015 is 200 per
month.
360The aim is to discharge on average 30
people per month into primary care.
(i.e. LWN)
AMHPs assessments.
LWN including CIS
Number of introductions to the LWN.
RAG
rating
87
Mental Health Whole System Dashboard Commentary Commentary is provided below on a number of indicators of interest as highlighted in the table above. 1 OBD - Occupied Bed Days - We have discrepancies in reports from SLaM previously around OBDs. At M6 SLaM are on target with the OBD trajectory. 3. HTT (Home Treatment Team) - There were 56 referrals into HTT. 39 people did not have an admission, 7 people who then required admission, 10 taken onto caseload for early discharge from hospital. 4. Discharges to PC - There were only 16 discharges to Primary care in December. This will be addressed at the SLaM core contract meeting. 5 - AMPs - Historically the number of assessments has been high. i.e. 80+ per month. We want to reduce the overall number of assessments. Of the 93 assessments 76 lead to detention, 2 lead to informal admission, 15 did not lead to an admission, 20 S136 warrants obtained, 7 S136 warrants executed, 3 S136 used 7 - Delayed transfer of care - The target is above the target of 7.5% OBD. Previously, this has been consistently below the target. We have asked SLaM for detailed explanation for the significant increase. 8 - Introductions to the LWN - There were 380 people introdcued to the hub in September. There have been 264 closures to the hub. Of the 380 introductions 227 came from a GP, 9 from A&E, 25 from IAPT, 1 from JCP, 18 self-referrals (12 phone, 6 walk-in), 3 from MAP, 7 from Psychosis, 33 from police, 12 from LA, 2 from IPTT, 43 from other sources. The top 3 main reasons for introduction is: depression (58), psyhcosis (29), Housing (15) 9 - GP+ - There are currently 63 people who are on GP+. There have been 6 discharges from GP+ in November. 11 - SiaC - will be working with the SLaM 24/7 information/advice/crisis telephone line which goes live Dec 2015. 14 - This is the number of people who have been in either residential care or rehabilitation beds where the IPSA team have worked with them to move into the new service offer.
88
5.3.4 Key Deliverables
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
7.1.1 Finalise Section 75 agreements for
mental health alliance services
Quarter 1 Completed. Section 75 Agreement agreed and signed, commenced 1 April
2015
7.1.2 Establish governance and programme
arrangements for implementation of the
mental health alliance contract
Quarter 1 Completed. Integrated Personal Support Alliance agreement signed and went
live 1 April 2015. A committee in common, the Integrated Commissioning
Committee, has been established between Lambeth council and NHS Lambeth
CCG to provide the overarching governance for the IPSA and Better Care Fund
(BCF).
7.1.3 Increase the proportion of people
receiving brief advice in mental health
services on alcohol, smoking and
physical activity
Quarters 1-
4
The Living Well Network (LWN) was launched as a borough wide multi-agency
service from 1 July 2015 (previously operated in the north of the borough since
November 2013) with the aim of providing a holistic range of support to people
with mental health problems much earlier than was previously available via
CMHTs. The LWN has significantly contributed to a reduction in referrals to
secondary care, from an average of 120 per month in October 2014 to c25 per
month (since June 2015) and is receiving over 300 “introductions” per month
and thereby supporting a larger volume of people with early support. Most
people are seen within 10 days (target is 48 hours) compared to at least a
month previously for “non urgent” referrals to CMHTS. The LWN teams
(currently operating at 80% staff capacity) have been allocated to support the
primary care locality care networks. Development work is underway to progress
toward an alliance contract agreement to support an expanded LWN from April
2016.
89
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
7.1.4 Improve the health outcomes for
people in mental health services
Quarters 1-
4
An evaluation of the LWN outcomes is being developed through an evaluation
board chaired by Dr Sarah Corlett from Public Health together with Dr Paul
McCrone from IOP. This is being funded by the GST Charity grant and involves
qualitative and quantitative evaluation of the Collaborative big 3 outcomes. The
first (all borough) six month activity and performance report is being drafted by
the Provider Alliance Group (PAG). and will be available February 2016. The
IPSA service outcomes are being monitored by the Alliance Leadership Team
and the Integrated Commissioning Committee. The mental health dashboard
includes two core IPSA outcomes measures.
7.1.5 Work with providers to ensure robust
SDIP are in place to support delivery of
the new mental health access targets
Quarter 4 Draft action plans and trajectories are being developed between the CCG and
SLaM. Additional capacity to support delivery of the EIP target is being
negotiated as part of the 20161/17 contract.
90
5.4 Staying Healthy (Led by London Borough of Lambeth)
Responsible Director Dr Ruth Wallis, Director of Public Health, Lambeth & Southwark
Maria Millwood, Director of Integrated Commissioning (Public Health, Children & Young People, Adult Disabilities)
Clinical Lead Dr. Raj Mitra
Programme Lead London Borough Lambeth
Scope of business
area
The Staying Healthy Partnership Board (SHPB) is the lead partnership body reporting directly to the Health and
Wellbeing Board on strategy, action, investment and progress to prevent ill health, promote health and wellbeing and
reduce health inequalities of the Lambeth population. It also reports to the Lambeth CCG IGC.
The SHPB has oversight of local delivery against the Public Health Outcomes Framework, advises the Health and
Wellbeing Board on priorities for the Health and Wellbeing Strategy in line with the Joint Strategic Needs Assessment,
and has oversight of the commissioning of health services where responsibility has transferred to local government.
The group takes a strategic perspective on all staying healthy action and investment and holds other groups to
account for delivery. A number of groups with specific staying healthy responsibilities report into the Staying Healthy
Board and other groups and partnership boards in the Council and CCG report to it with respect to their specific
staying healthy commitments.
A Health Improvement Commissioning Group has recently been established to provide strategic oversight of the cross
cutting commissioning of the health improvement service portfolio that now falls within the council’s remit bringing
together commissioning and strategy around NHS Health Checks, tobacco control, substance misuse, homeless
health and related early intervention and behaviour change programmes including public mental health. This group
reports to the Staying Healthy Board.
Lambeth leads on the commissioning of sexual health services across Lambeth, Southwark and Lewisham via a tri-
borough agreement. Commissioners, partners and providers are engaged in a local transformation project to increase
the effectiveness of local sexual health pathways and services.
In summary, the main commissioning areas of work for the SHPB are:
Tobacco Control
91
Vascular Risk Prevention (NHS Health Checks)
Substance misuse and alcohol services
Healthy lifestyle services
Sexual health services
Public mental health
A number of partnership and other initiatives have links with or report to the Board including:
Lambeth Food Flagship Programme
Lambeth Tobacco Control Alliance
Lambeth Healthy Weight Taskforce
Lambeth and Southwark Mental Wellbeing Programme
Lambeth Alcohol Prevention Group
In addition the Board provides oversight and assurance of the Joint Strategic Needs Assessment process for Lambeth.
Objectives of
business area
To support the Health and Wellbeing Board to take a strategic and evidence based approach to decision making and
prioritisation in health improvement so as to improve population health and wellbeing and reduce health inequalities.
To enable the local authority, CCG and other partners to deliver coherent and strategic health improvement action and
commission health improvement services including the health services where responsibility has transferred to the local
authority so that they are effective, efficient and evidence based, meet population health needs and reduce health
inequalities.
To enable the Health and Wellbeing Board to give effective account of progress on health improvement and reducing
health inequality including commissioning action to achieve these goals and to ensure that there is appropriate
transparency, engagement and co-production in health improvement work across organisations, patients and the
public.
To oversee the management of PGDs and production of Pharmaceutical Needs Assessment.
To embed and support the achievement of staying healthy outcomes within other council and CCG programmes.
92
5.4.1 Programme Assurance Statement
Assurance Status/Risks RAG Rating
(Red/Amber/Green)
Is your programme delivering as
planned – is it on target?
Yes
What are the risks you have
identified to date and how are
you mitigating against these?
1. Financial – we have experienced a 6.2% in-year cut to PH Grant during 15/16
with the money taken by DH from the fourth quarter’s grant payment. These
savings are impossible to achieve through spend reduction in year as they have
been asked for so late in the financial year and spend is fully contracted. The
cut represents a £1.9m loss of grant income which will need to be met from
council reserves. The budget itself was forecast to be balanced (before the
6.2% cut) but there are continuing pressures around demand-led GUM spend
which seem to be being managed well currently. DH have signalled via the CSR
that PH grants will be subject to 3.9% year on year cuts between 16/17 and
19/20 and the 6.2% cut made in 15/16 has been confirmed as recurrent. This
means that to achieve a balanced budgetary position in 16/17, commissioners
need to reduce spend by £3m. A proposed refresh of the PH funding formula
(ACRA) has been consulted on and the outcome of the consultation is awaited.
If implemented fully, the new formula will see LB Lambeth lose a further £3m+
of PH grant. The CSR confirmed further cuts to LA core funding which will
create pressure for the Staying Healthy programme (directly and indirectly)
though – at this time – the council is not intending to take savings from PH
budgets. A programme of consultation about potential cuts/changes to services
– across all areas of Public Health – is underway and will determine where
savings will be realised.
2. Structural – the splitting of the PH specialist team will create uncertainty and
change which may impact on the effectiveness of the programme in meeting
outcomes, achieving savings and successfully recommissioning services as
93
intended.
3. External – continued/extended programme of welfare cuts likely to negatively
impact on housing, youth homelessness, income/poverty, mental well-being,
etc. The impact of these wider determinants of public health creates a risk to
the success of the programme in meeting intended outcomes.
4. Sexual health – continuing growth in need/demand for services, efforts to
manage costs/demand proving problematic (complicated by open access
issues, market development issues and differences in London-wide approach to
issue).
5.4.2 Staying Healthy Dashboard
The Public Health Outcomes Framework (PHOF) was used to identify the national indicators relevant to each of the three main commissioning areas
(sexual health, substance misuse, health and wellbeing). Commissioners were also consulted to identify the local priorities. Where KPIs are annual,
local data will be used where possible and appropriate to provide quarterly updates. The Staying Healthy Board is to agree which other indicators
could help to demonstrate progress against the wider determinants of health that are specifically within the Board’s remit.
94
Sexual Health Source Frequency Reporting RAG Comment
PHOF 2.4 Under 18
conceptions
PHOF Annual Date 2010 2011 2012 2013 Amber No performance data update since
last IGC report. per 1,000 pop 49.3 34.8 33.2 24.7
London 32.8 28.7 25.9 21.8
PHOF 3.2 Chlamydia
diagnoses for 15-24
PHOF Annual Date 2012 2013 2014 Green No performance data update since
last IGC report. per 100,000
pop
6348 4410 4225
London 2215 2213 2178
PHOF 3.4 HIV
presentations at late
stage
PHOF Annual Date 2009-
11
2010-12 2011-13 2012-14 Amber No performance data update since
last IGC report.
per 100,000
pop
39.7 39.3 34.7 29.9
London 46.7 44.6 40.5
% Repeat terminations
for under 25s
PHE Annual Date 2012 2013 2014 Red No performance data update since
last IGC report.
Performance red compared to national
average, but has improved for two years
running. U18 conception rates in
Lambeth started to come down from
2004, which will continue to impact on
repeat abortions to under 25s.
% 32.9 31.9 30.7
London 33 32.6 32.3
% Post-abortion LARC
uptake
Local Provider Date 2014/15
Q4
2015/16
Q1
2015/16
Q1
N/A Post-abortion LARC uptake is low at one
particular provider. The provider is
addressing this by training additional
staff to fit LARC and on contraceptive
counselling.
% 38.0 33.9 29.8
SH24 uptake by kits
ordered and received
Provider Monthly Date Jul-15 Aug-15 Sep-15 Oct-15 Green Service target is 50%. Latest
performance expected to increase with
pending returns. %
(Cumulative)
71.1 71.3 69.3 58.1
95
Substance Misuse Source Frequency Reporting RAG Comment
PHOF 2.15i Successful
completions from
treatment (Opiates)
NDTMS Monthly Date Aug-15 Sep-15 Oct-15 Nov-15 Amber Current worsening trend in performance
may be partly attributable to an identified
data input error in a large provider.
Remedial action has been taken and
should be reflected in next report.
% 9.1 8.6 7.9 7.1
PHOF 2.15ii Successful
completions from
treatment (Non-opiates)
NDTMS Monthly Date Aug-15 Sep-15 Oct-15 Nov-15 Amber Continued to improve in this key metric,
now AMBER. Performance will continue
to be monitored through provider forum
and individual contract monitoring to
ensure positive direction of travel is
maintained.
% 38.8 39.9 39.0 41.4
PHOF 2.18 Alcohol-
related hospital
admissions
PHOF Annual Date 2010/11 2011/12 2012/13 2013/14 Amber Monitoring implementation of local
initiatives, incl. alcohol care teams in
hospital settings and evaluation of IBA
Direct (targeted at key populations).
per 100,000
pop
592 658 642 626
London 587 572 554 541
Number in treatment
(adults, rolling year)
NDTMS Monthly Date Aug-15 Sep-15 Oct-15 Nov-15 N/A This indicator to be assessed and revised
to more accurately match our strategic
objectives. Performance stable, showing
efficient use of available capacity
n 2071 2073 2043 2045
PHOF 2.16 Prison
treatment starts
PHOF Annual Date 2012/13 Red New performance indicator, to be
assessed and understood as part of
recommissioning of Integrated Offender
Management. Currently awaiting latest
performance figures.
% 61.9
London 57.1
% Hepatitis B vaccine
completions
NDTMS Quarterly Date 2014/15
Q3
2014/15
Q4
2015/16
Q1
2015/16
Q2
Red Provider asked to bring forward remedial
plan to address apparent decline in
screening and vaccination rates, which
will be monitored via contract review
process.
% 22.7 20.3 20.2 18.9
London 27 26 27 27
96
Health Improvement Source Frequency Reporting RAG Comment
PHOF 2.14 Smoking
Prevalence
PHOF Annual Date 2010 2011 2012 2013 Amber No performance data update since last
IGC report. % 18.3 21.3 19.9 18.1
London 19.5 18.0 17.3 17.0
Take up of NHS Health
Checks
Local Quarterly Date 2015-16
Q1
2015-16
Q2
Amber Data errors in Q1 have been rectified
and performance will be monitored to
ensure ongoing improvements are
embedded. % 13.6 17.6
England 44.4 44.4
PHOF 2.17 Recorded
Diabetes
PHOF Annual Date 2010/11 2011/12 2012/13 2013/14 N/A No performance data update since last
IGC report. % 4.2 4.4 4.7 5.0
London 5.4 5.6 5.8 6.0
PHOF 4.04ii Mortality
from preventable CVD
PHOF Annual Date 2009-11 2010-12 2011-13 2012-14 Amber No performance data update since last
IGC report. per 100,000
pop
61 54 50.3 51.9
London 55.1 52 50.2 49.2
% successful four-week
quitterswho set a quit
date
Local Quarterly Date FY2014-15 2015-16
Q1
2015-16
Q2
Amber Local reporting mechanisms are now
established and this indicator has been
changed to quarterly, but compared to
previous annual performance. % (n) 40% 32% 33%
(1552 of
3896)
(273 of
848)
(268 of
809)
Number of smokers
setting a quit date
Local Quarterly Date 2015-16
Q1
2015-16
Q1
Amber Local reporting mechanisms are now
established and this indicator included
as quarterly. n 848 809
97
5.4.3 Risk Register
The Public Health Commissioning Risk Register is currently being reviewed and updated. Risks will be assessed and updated for the next IGC
report, including actions taken against ongoing risks.
98
99
5.4.4 Key Deliverables
100
101
102
103
5.5 Primary Care Development
Responsible Director Andrew Parker, Director Primary Care Development
Clinical Lead Dr. Hasnain Abbasi
Programme Lead Terilla Bernard, Assistant Director Primary Care
Scope of business area This business area aims to transform Primary Care across the borough of Lambeth, by developing integrated
models of primary care that are bottom-up, co-produced and clinically led.
By investing in leadership and development, Primary Care can continue to drive innovation, and collaborate in
new ways of working that take account of the local context and deliver more patient centred and integrated
models of care.
Objectives of business area
The objectives of this business area are:
Primary Care is better configured to deliver an increased range of services to patients and integrate with
other services on a population health basis
Reduces variation in access and quality for local populations
Delivers demonstrable benefits in terms of quality and value for money
Makes primary care a more attractive place to work
Drives innovation and achieves both local and national strategic objectives
Reducing inappropriate GP Referrals
Case Management of frequent users of services
104
5.5.1 Programme Assurance Statement
Assurance Status/Risks RAG Rating (Red/Amber/Green)
Is your programme delivering as planned
– is it on target?
Yes
5.5.2 Primary Care Development Programme Risk Register
For risks scoring 12 and above, 5N, 5R, 5S and PMCF07 please see the Board Assurance Framework.
Risk Title
Risk Register
where Risk is managed
Current Risk
Score Approach Action Plan Summary
Risk of failure to create a formalised and well supported Local Care Network
Programme Board /
Directorate Risk
Register
3 Mitigate 1. Appointment of 3 Locality Care Network Managers to support practices and Locality Networks by November 2014 - COMPLETED 2. Completion of Locality Development Plans to underpin Local Care Network initiative - COMPLETED - end July 2015 3. Confirmation of governance structure - to be agreed via Options Appraisal / supported by Provider Group / Enabler Group - COMPLETED 4. Recruitment of interim Chair and Admin Support to take place in October / November 2015 - for period November 2015 to March 2016 - COMPLETED 5. Development of Locality Care Network Plans - March 2016
105
Risk Title
Risk Register
where Risk is managed
Current Risk
Score Approach Action Plan Summary
Risk of increased costs if DXS installation has to be re-installed on GP computers, following Windows 7 deployment. Costs would be charged to the CCG by DXS and the CSU. If Zen Works cannot run DXS software this would result in the manual upload of DXS software to each practice PC. This would result in delays in the project which would also include a reputational risk.
Programme Board /
Directorate Risk
Register
6 Mitigate / Transfer
1. Test site to be identified and DXS installed and tested by 31/01/15 - COMPLETED 2. DXS rollout to all practices by 30/06/15 - Some practices have had the original DXS installation removed - COMPLETED 3. DXS now included in standard desktop rollout, packaged with Windows 7. Due to be rolled out by end October 2015. COMPLETED. 4. Cardiology and Diabetes to be added to DXS for monitoring of referrals - target date to be confirmed. Diabetes has been added. Cardiology delayed - awaiting confirmation from hospital.
Risk that the identified actions to support Trusts to cease faxing discharges from Oct 2015 and GP’s to cease faxing referrals from March 2016 are not fully completed against agreed timescales, resulting in a failure to meet the contractual deadlines
Programme Board /
Directorate Risk
Register
9 Mitigate 1. Trusts to update action plans to resolve any use of fax for discharge information, including any internal comms - due date 19/8/2015 (Trust leads) LC followed up with Trusts 15/9/15 - COMPLETED 2. CCGs leads to provide Trusts with an updated list of GP emails for discharge correspondence - COMPLETED 3. CCG leads to produce SOPs for GP practices re email management discharge information and ensure appropriate comms - COMPLETED 4. CSU to confirm SGH contact with Lambeth CCG - COMPLETED 5. Trusts to have appropriate NHS e-referral and NHS net emails in place for all services with appropriate internal SOP developed - due date 01/10/2015 (Trust leads) - ongoing
106
Risk Title
Risk Register
where Risk is managed
Current Risk
Score Approach Action Plan Summary
6. CCG leads to produce SOPs for GPs to refer via electronic means (first line agreed as NHS e-referral, second line via nhs.net email) - due date 01/10/2015 (Lesley Connaughton / Colin Paget / Southwark lead) - Directory of Services being compiled currently 7. CCGs to draft detailed communication plan and share with Trusts - COMPLETED
107
Primary Care Dashboard – items to note No of GP initiated 1st Outpatient attendances (QIPP Specialties) - This is currently at 89.3 at a CCG level; the benchmark is 88.7. It has worsened slightly from the last reporting period. This is due to the South west federation being outside the benchmark.
No of people supported by GP+ - More activity is being reported on this scheme as well as the important break down at practice level.
SLIC Incentive scheme – HHA and CM are progressing well and have been reporting a continual increase in number the of people participating. Case Management moved from red to Amber on a CCG level. It’s yet to meet the ambitious target but a step in the right direction none the less.
People who have set a quit date and have quit smoking YTD – The activity is still below target. The benchmark is 35% of those who sign up to have quit, more effort needed to address the shortfall.
Cervical (Cytology) screening uptake YTD & BP (Hypertension) -They are below the benchmark . They are at the risk zone (amber) and likely to turn red if action is not taken promptly.
BP <150/90mmhg (Diabetes) YTD & Cholesterol (5mmol) Diabetes – They are above benchmark . BP <150/90mmhg (Diabetes) is particularly doing well, the success can be replicated when dealing with the Hypertensive patients.
Diabetes (Hba1c) < 59 & 64 mmol/mol - They are doing badly with 59 mmol particularly lagging behind. There is a risk that Diabetes (Hba1c) < 64 mmol/mol YTD will totally miss the benchmark, if it continues on the current trajectory.
How many people with a Learning disability (LD) had an annual health check in this financial year? – The performance is well below the benchmark, more effort needed to meet the necessary criteria.
108
5.5.3 Primary Care Programme Dashboard
Locality Care Network Managers are working with practices to validate the data that is captured in the dashboard. Each practice has a Quality and Improvement Plan that supports improvement at practice level and all practices in Lambeth have signed up to this process. 5 Community Incentive Scheme (CIS) indicators for which data collection systems are currently being set up have been excluded from the dashboard.
01/04/2015
2015/16 Data at Oct-157
Patient
Safety
GP 1st
Outpatients
KPIs
(Per/
1000 P
racti
ce P
op
)
No o
f G
P initia
tied 1
st
Outp
atient attendances
(QIP
P S
pecia
ltie
s)
YT
D
No o
f people
support
ed b
y
GP
+.
The n
o o
f pra
ctices that
have r
un a
Physic
al
Assessm
ent A
udit a
nd h
as a
dem
entia r
egis
ter.
Holis
tic A
ssessem
ent
Deliv
ere
d in p
ractice o
r at
Hom
e Y
TD
Holis
tic A
ssessem
ent Y
TD
Contr
act P
lan
(Full
Year
5487)
Case M
anagem
ent (C
M)
YT
D
CM
YT
D C
ontr
act P
lan (
Full
Year
845)
People
who h
ave s
et a q
uit
date
and h
ave q
uit s
mokin
g
YT
D.
Vascula
r H
ealth C
hecks for
40-7
4 y
rs o
ld Y
TD
Bre
ast scre
enin
g u
pta
ke
Annual -(
locality
data
no
t
availab
le)
Cerv
ical (C
yto
logy)
scre
enin
g u
pta
ke Y
TD
BP
<
150/9
0m
mhg
(Hypert
ensio
n)
YT
D
BP
<
150/9
0m
mhg
(Dia
bete
s)
YT
D
Chole
ste
rol -
(5
mm
ol)
Dia
bete
s Y
TD
Dia
bete
s (
Hba1c)
< 5
9
mm
ol/m
ol Y
TD
Dia
bete
s (
Hba1c)
< 6
4
mm
ol/m
ol Y
TD
How
many p
eople
with a
Learn
ing d
isabili
ty (
LD
) had
an a
nnual health c
heck in
this
fin
ancia
l year?
Period Apr-15 -
Oct-15 Apr-15 - Oct-15 Apr-15 - Oct-15 Apr-15 - Oct-15 Apr-15 - Oct-15 Apr-15 - Oct-15 Apr-15 - Oct-15 Apr-15 - Oct-15 Apr-15 - Oct-15 Apr-15 - Oct-15 14/15 Apr-15 - Oct-15 Apr-15 - Oct-15 Apr-15 - Oct-15 Apr-15 - Oct-15 Apr-15 - Oct-15 Apr-15 - Oct-15 Apr-15 - Oct-15
Lambeth_CC
G
LAMBETH CCGtotal
88 60 45 2645 # 3201 306
494494
###193 2959 63% 79% 77% 85% 75% 59% 68.0% 154
1.1 Total Audit
CCG Practice Average 88 1.3 # 96% 56 # 68 7 11 11 #### 4.3 85 63% 79% 77% 85% 75% 59% 68.0% 3
North Locality Practice Average 86 100%1
47#
69 610
100.75
6.0 52 78% 77% 83% 75% 60% 69% 5
South East Locality Practice Average 82 94%1
51#
71 511
110.74
5.3 65 81% 77% 85% 75% 57% 66% 3
South West Locality Practice Average 90 90%1
66#
65 810
10 2.3 122 79% 77% 85% 74% 60% 70.1% 3
GREEN (Within the Benchmark) 89 >=300 100.0% >=3200 >=494 >=5425 >=70% >=80% >=78.5% >=78.5% >=73.9% >=70.9% >=70.9% >=471
AMBER (Within 10% of the Benchmark) 88.9 - 96 299 - 270 90% - 99% 3199 - 2880 493 - 444 >=4882 - ≤5424 62.1 -70% 72.1 -80% 70.7 -78.5% 70.7 -78.5% 66.5 -73.9% 63.8 -70.9% 63.8 -70.9% 470 - 424
RED (10% Outside the Benchmark) >96 <=269 <90% <=2879 <=443 <4882 <62.1% <72.1% <70.7% <70.7% <66.5% <63.8% <63.8% <=423
Annual
EMIS
Monthly
EMIS(QMS Returns from QMS)
Monthly Monthly
PHE (Cancer
commisioning
toolkit)
GP Contract KPIs
(Quality Outcome Framework -QOF)
Monthly
(QMS Returns
from QMS)
Frequency of collecting data
Monthly (with
a 2 month
lag)
SUS data
Monthly
EMIS
Monthly
Living Well
HubEMIS
Primary Care Dashboard - Published December 2015
Mental Health - The GP+ Scheme
(formerly the CIS Scheme)SLIC (South London Integrated Care) Incentive Scheme
Datasource
Preventative CareGP Delivery Framework
109
5.5.4 Key Deliverables
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress Update
9.1.1 Implement the CCG primary care
development plan and GP delivery
framework
Quarter 1 GP Delivery Framework 2015/16
Year two of the GP Delivery Framework 2015/16 has been developed with
the Lambeth GP Federations and already 44 of 47 practices have returned
their signed contract. The Delivery Framework covers:
GP Initiated First Out-Patient Referral
Long term conditions
SLIC older people’s incentive scheme
Medicines Optimisation
Mental Health Community Incentive Scheme
Children – agreed in October
Patient Participation Listening Practices – to be considered at the
Conflict of Interest Panel on 9 Dec.
9.1.2 Develop a programme to support
integrated local care networks,
including primary care, community
services, and social care. Integrated
services will be based on shared
assessment and risk stratification,
models of case management and care
co-ordination and multi-disciplinary
working.
Quarter 2 Local Care Networks (LCNs)
The arrangements for LCNs continue to be developed towards maturity, led by
an Enabler Group, and a Provider Group.
The following priority work areas have been agreed by Lambeth LCNs, and
each has an active project in place:
South West:
Community asset mapping for people with a long term condition, for
example mental health.
Children and Young People – including hoe to make practices friendlier
to younger people, and improving emotional resilience with schools.
110
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress Update
Health Living, focusing on the care navigator role.
Living with a Long Term Condition
South East:
Safe and Independent Living - enabling wider health and wellbeing
referrals.
Locality Geriatrician
Wound Dressing
North:
Portuguese community project
Primary Care Navigators, starting with diabetes
Further priority areas are being chosen by the LCNs.
Chairs have now been appointed by two of the three LCNs, with recruitment in
progress by the third.
9.1.3 Develop a programme to support the
integrated local care networks
Quarter 1
9.1.4 Commission extended access to
urgent primary care across the
borough
Quarter 2 Prime Ministers Challenge Fund Project (PMCF)
The four new GP Access Hubsprovide pre-booked and on the day
appointments 8am-8pm Monday to Friday and 10am-6pm on Saturdays
and Sundays for all patients of Lambeth practices, booked through their
practice or SELDOC.
The CCG aims to complete the due diligence process in December.
As planned, the hubs are opening at reduced capacity during the first six week
mobilisation period (one GP and one nurse, rather than two GPs and one
111
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress Update
nurse). This is planned to rise provided utilisation reaches 75%, although this
may not be uniform across all times of the week or all hubs.
It has been recognised by all involved (CCG, NHSE and three Federations) that
the cost of the first six months’ service, £2,600,000 is not sustainable on a
recurrent basis (i.e. £5,200,000 a year). There are some areas where the costs
of a recurring service will fall, as staff move from rates based on being
temporary rather than longer term arrangements, and as overheads
fall. However, the funding available for a full year remains £1,500,000 from the
CCG, with the NHSE’s PMCF funding being zero in 2016/17. This equates to
less than two hubs running at the capacity of the pilot in 2015/16.
It is expected that lessons will be learned during the six month pilot phase about
patient demand and methods of provision that will refine the service model and
the capacity to be commissioned.
A business case will be prepared for the service from 2016/17 onwards, to be
considered in January by the CCG.
A central part of the rationale for the GP Access Hubs is that they will release
capacity in general practice for them to spend additional time managing patients
with multiple long term conditions, and frail elderly patients. The CCG wishes to
agree with the Federations the ways in which this additional capacity will be
used. This, and measurement of its effectiveness, will be key to the business
case for the future of the service.
The PMCF Steering Group are exploring further initiatives to improve access,
using the remaining non-recurrent PMCF budget, and business cases will coe to
the December Primary Care Programme Board.
112
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress Update
9.1.5 Design and deliver a comprehensive
primary care leadership programme
Quarters 1-
4
GST Charity Fund – Transforming General Practice Provision
The Lambeth and Southwark Primary Care Transformation Programme, funded
by Guy’s and St Thomas’ Charity (GSTC), has been in place since January
2014 and has been delivered in two phases.
Lambeth and Southwark CCGs have made a successful application for
transitional funding to GSTC to enable continuation of the programme’s second
phase through to December 2015. This will provide continued support to the
emerging leaders in their roles leading the three GP Federations, and extend to
organisational development support within these live organisations.
The Phase three bid is being considered, to include a wider cohort and the
development of leaders for Local Care Networks
9.1.6 Engage on and develop a primary care
quality scorecard for member
practices. This would be used by
localities in the development of local
care networks with the aim of
improving quality and access and
reducing inter-practice variation
Quarters 1-
2
The updated dashboard is included in these papers.
9.1.7 Invest finance received from GSTFT
Trustees to support set up of Local
Care Networks working to improve
access to services
Quarter 1 See 9.12 above
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Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress Update
9.1.8 Define and agree estates strategy to
support Primary care development
Quarter 1 Lambeth Estates Strategy is being developed, led by Christine Caton, with a
draft plan submitted to NHSE on 31 December 2015 and will be submitted to
the Primary Care Programme Board in March.
9.1.9 Implement a programme to support
developing local care network services
Quarter 1 See 9.1.9 above
9.1.10 Commission extended access to
urgent primary care across the
borough
Quarter 1 Complete See 9.1.4 above
9.1.11 Agree and implement the GP Delivery
Framework for 2015/16
Quarter 1 See 9.1.1 above
9.1.12 Ensure regular performance reporting
to IG Committee on outcomes
Quarters 1-
4
See this report
9.1.13 Ensure that the GP delivery scheme –
includes incentives that target variation
in health outcomes
Quarter 1 Complete
9.1.14 Roll out DXS to support best practice
referrals including use of referral
management systems, single points of
referral and decision support tools.
Quarter 1 See objective 12.4.3iii in section 5.6.3 ICT below.
9.1.15 Complete inner south east London
procurement NHS 111 service from
April 2015
Quarter 1 Delayed.
114
5.6 Enabler Programmes
5.6.1 Governance and Development Risk Register
For risk 6K, scored 12, please see the Board Assurance Framework.
Risk Title
Risk Register
where Risk is managed
Current Risk
Score Approach Action Plan Summary
Possible failure of the CCG to have robust business continuity plans to ensure ongoing service delivery resulting in delay in delivery of CCG outputs, potential non-compliance with NHSE Assurance Framework and impact on relationships/loss of confidence with providers, members and NHSE.
Programme Board /
Directorate Risk
Register
6 Mitigate CSU BCPs to be obtained and reviewed – by 29/02/2016 NHS Property BCPs to be obtained and reviewed – by 29/02/2016 Undertake a Lower Marsh EPRR exercise – by 31/10/2016 Undertake LCCG Communications exercise – by 30/09/2016 Annual CCG BCM exercise to be undertaken by 01/06/2016
Equality Act Risk - Likely risk that the CCG does not currently collect information that provides assurance that they are meeting public sector equalities duties; public engagement work doesn’t systematically target groups of protected characteristic and therefore CCG cannot demonstrate how it fosters good relations. This could result in a breach of the law and loss of reputation; non
Programme Board /
Directorate Risk
Register
8 Mitigate CSU acute contract team/Business Intelligence Team need to provide acute facing equalities data - discussion with CSU to take place by March 2016. CCG Performance and Information Team to report on primary care equalities objectives from Q4 2015/16. EIA's to be carried out as a key feature of commissioning intentions process in Q4 2015/16. Programmes and enablers need to continually collect EDS evidence - March 2016
115
Risk Title
Risk Register
where Risk is managed
Current Risk
Score Approach Action Plan Summary
compliance could result in the CCG in an employment tribunal or county court.
Possible risk of non-compliance with information governance requirements relating to processing of personal confidential data on QUIC system, resulting in a breach of personal confidential information
Programme Board /
Directorate Risk
Register
6 Mitigate 1. Review of initial IG advice by CCG Chair and Director of Governance and Development - completed. 2. Review of IG advice by Caldicott Guardian and SIRO - completed. 3. Meeting with Head of Information Governance to review gaps in controls and provide assurance -completed. 4. Meeting with local CCGs and Providers to agree processing of data going forward - National GP Incident Reporting system in place and being used. Ongoing awareness raising to end of Nov 2015. 5. To agree FPN for CCG and communication plan to GP Practices - Completed. 6. To review the retention and destruction schedule to include retention of quality alert data - March 2016 7. Follow up with GP Practices completion of FPN actions - Jan 2016
Ongoing unlikely risk of staff shortage and recruitment and retention problems causing disruption to critical services/essential business functions
Programme Board /
Directorate Risk
Register
6 Mitigate Ensure all plans are ratified and implemented Ensure that, so far as is reasonably practicable, staffing levels and skill mix in critical services are protected from financial pressures.
Ongoing unlikely risk to premises resulting in denial of access/loss of use of premises causing disruption to critical
Programme Board /
Directorate
8 Mitigate Ensure all parts of the organisation have integrated arrangements for response to a major incident. Ensure all critical services and essential business
116
Risk Title
Risk Register
where Risk is managed
Current Risk
Score Approach Action Plan Summary
services/essential business functions. Risk Register
functions have business continuity plans in place which are aligned with ISO 22301. Maintain current Southwark Access list and physically test ability of a selection of staff to log in at Tooley Street
Ongoing unlikely risk to technology resulting in disruption to critical services and essential business functions.
Programme Board /
Directorate Risk
Register
8 Mitigate Assess situation against information governance toolkit Ensure plans keep pace with the introduction of new technology and the increasing dependency on technology Ensure that, so far as is reasonably practicable, that arrangements are in place with suppliers of critical systems to ensure swift replacement and commissioning into service Review CSU Disaster Recovery Plan against CCG Business Continuity recovery assumptions
117
5.6.2 Equalities
Responsible Director Una Dalton, Director Governance and Development
Clinical Lead Dr. Paul Heenan
Programme Lead Cathryn Flynn, Engagement Manager
Scope of business area This business area covers the equalities strategic priorities and is responsible for ensuring that the CCG complies with
its equalities duties as set out in the Equalities Act 2010.
Objectives of business area
The objectives of this business area are to ensure that Lambeth meets all its equalities objectives as set out in its
equalities strategy.
Legal requirements: The CCG’s 3 year equalities strategy was agreed at the July 2015 GB meeting. This sets out how we will comply with the
public sector equality duty. The Engagement, Equalities and Communications Committee meets quarterly to oversee delivery of this strategy (April,
July, September 2015 and due to meet Jan 2016).
Equalities Strategy: We are currently conducting a rapid review of our overall position and progress against our 2015-16 equalities objectives. This
will report to our January 2016 Engagement, Equalities and Communications Committee and will steer our work for Q4.
Equalities analysis of our Healthier Together strategy: as we develop 2016-17 commissioning intentions we will be testing these against our
corporate and programme equalities objectives to ensure alignment between our commissioning strategy and our equalities strategy.
NHS Equality Delivery System: review will commence in Q4. We aim to share our self-assessment against the EDS in late March 2016.
5.6.3 ICT
Responsible Director Christine Caton, Chief Financial Officer, Andrew Parker, Director of Primary Care Development
Clinical Lead Dr Adrian McLachlan
118
Programme Lead Jeremy Burden and Graham Crawford Business Intelligence & ICT (CSU) Jo Steranka, Digital and Business
Intelligence Development Manager
Scope of business area This business area covers both business information support and information systems. This business is provided to
Lambeth CCG by South East CSU.
Objectives of business area
The overall aim of the IM&T enabler work stream is to ensure that good quality clinical information is accessible in an
integrated shared clinical record and to ensure that information systems are available to support the clinical business
needs of NHS Lambeth Clinical Commissioning Group. A robust IT infrastructure needs to be in place to enable this to
happen.
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
12.4.1
ICT 5 Year Strategy development
and Implementation Plan to achieve:
Establish fully representative work
stream and detailed work plan
aligned to CCG Programmes
Quarter 1
CCG is working with the CSU to complete a local ICT Five Year Strategy. The
document is currently being redrafted in the light of new published national
expectations for delivery of digital services by 2020.
12.4.2
Ensure full alignment to existing
Lambeth and Southwark and SEL
wide initiatives including LCR (Local
Care Record).
Quarter 1
The national Digital Roadmap programme to delivery paperless care at the point of
contact with patients by 2020 has set the strategic direction for the whole NHS with
regard to digital delivery of services.
The CCG submitted an initial Digital Footprint to NHS England in October 2015.
Since then, it has been agreed that south east London CCGs collectively form a
digital footprint. The footprint is the area covered by organisations where our
patients attend for care and therefore have electronic records.
119
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
The Our Healthier South East London ICT enabler workstream, supported by the
Innovation Unit, are leading on digital development for south east London CCGs.
NHS England have also seconded a member of staff to support us with Digital
Roadmap development.
Digital Roadmaps submissions are required by the end of June 2016.
CCG works together with Southwark CCG through the vehicle of the Lambeth and
Southwark Informatics group to implement initiatives that impact across both
boroughs to make best use of resources.
Provision of GP IT services
12.4.3i
Effective commissioning and
management of GP IT support
services
Quarters
1-4
The procurement process for GP and CSU IT systems has now begun. This is a
joint procurement process between Lambeth, Southwark, Greenwich and
Lewisham CCGs.
The deadline for suppliers to return documention is 19/02/2016. Further
milestones in the process are:
Tender evaluation completed: 01/03/2016
Supplier presentations to lead evaluators: 03/03/2016
Approval of preferred supplier by Governing Body: 09/03/2016
Final award of contract: 29/03/2016
12.4.3ii Implement retendered services 2016/17 Implementation of the re-tendered service (mobilisation) will begin on 30/03/2016.
12.4.3iii Complete and maintain clinical
content management systems
Quarter 1 DXS work stream underway. Implemented in all practices. Monthly monitoring on
usage. Development of Directory of Services progressing.
It is to be expected that useage in practices will vary, so training and promotion of
the system continues.
120
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
Ensure the delivery of high quality corporate technology systems
12.4.4i
Effective commissioning and
management of ICT support services
Quarters
1-4
See item 12.4.3i above.
12.4.4ii Implement retendered services 2016/17 See item 12.4.3ii above.
Ensure the full benefit of technologies to support strategic transformation
12.4.5i Support programme to achieve
change
Quarter 1 Business Intelligence specification is being reviewed as part of the CSU re-
procurement.
The CCG submitted a number of proposals to the Prime Minister’s Challenge Fund
for development of digital approaches to patient care. These are being carried
forwards. Bits for GPIT capital allocation for 2016/17 have been submitted to NHS
England for:
Replacement of out-of-warranty equipment
Implementation of wi-fi in General Practice
Deployment of mobile devices to GPs and other practice clinical staff
Telemedicine
Improved SMS messaging
The CCG is developing a project plan for a ‘Clinicial Effectiveness Group’
approach that will drive quality using population based intelligence to support
outcomes-based commissioning.
12.4.5ii Complete and implement work plan Quarter 1 Implementation timescales will take account of outcome of CSU business
intelligence specification review and London wide interoperability programme.
121
5.6.4 Estates
Responsible Director Christine Caton, Chief Financial Officer
Clinical Lead Dr. Adrian McLachlan
Programme Lead Claire Hornick
Scope of business area This business area is responsible for ensuring maximum use of the CCG commissioned estate across Lambeth.
Objectives of business area
The purpose of the Estates enabling work stream is to make sure that we are getting value for money from the estate
we commission and that this estate supports the delivery of effective and high quality new models of healthcare
provision.
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
12.3.1 Develop NHS Lambeth CCG Estates /
Infrastructure/Services/Commissioning Strategy
during 2015/16 including work with federations,
localities and NHS England and through
programmes to review and define primary and
community estate requirements addressing
impact of such issues as population growth
including the new development led NEV related
growth
Quarters
1 -4
Community Health Partnerships (CHP) are supporting the development
of Strategic Estates Plans (SEP). Strategic leads and additional resource
are in place working with the CCG who a dedicated resource to co-
ordinate this.
Strategic Estates Workshops took place on 15th September and 26th
November to inform the Strategic Estates Plan content. The SEP is
being developed with input from primary care, LB Lambeth and local
providers and the interim plan was submitted to NHSE on 31 December
2015. The final plan is due for completed by 31 March 2016. The SEP
will identify commitments that will form the basis of bids submitted to the
Primary Care Transformation Fund in April 2016, following a revision to
the timescales. Guidance is due to be issued at the end February 2016.
122
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
12.3.2 Review CHP Centre management pilot work
stream
Quarters
1 -4
Centre Management pilot started on 1st June, KPIs have been agreed
and are being monitoring through the monthly Asset and Engagement
Meeting. Action is being taken to increase utilisation. The pilot has
been extended to 31 March 2016.
12.3.3 Work closely with Wandsworth CCG and NHS
England to support the development of OBC/FBC
for Nine Elms Vauxhall (NEV) in North Lambeth.
This will support the robust case for primary
health care facility in Battersea and case for
Community Infrastructure Levy (CIL)/Section 106
funding from Wandsworth Council. Business
case to be submitted to Wandsworth Council in
September 2015
Quarter
3
The CCG, including clinical leads are working closely with the NEV
project team, NHSE and Wandsworth CCG to support the development
of the business case. Work has been commissioned to assess the work
needed to develop existing Lambeth practices to accommodate the list
size growth to enable the CCG to access CIL/Section 106 funding.
The final version of the Infrastructure Funding Bid for CIL contributions will be submitted to the NEV Strategy Board for approval in September 2016.
12.3.4 Work with South East London CCGs to develop
the South East London Estates Strategy. To
agree longer term proposals for use of estates
across borough boundaries particularly to support
boundary issues with Southwark CCG
Quarters
1 -4
SEL Estates Strategy Workshop took place on 17th September as part of
the SEL Five Year Strategy Enabling Work steam. The SEL Enabler
group of CCGs and providers had its first meeting on 17th November.
Use of provider estate is also part of the SEL productivity workstream.
12.3.5 Work with NHS Property Services and NHS
England to assess need for GP estates
developments – on-going – this work is currently
underway through local Lambeth Estates group
and SEL wide SPG meetings
Quarters
1 -4
This work is being undertaken to inform the Lambeth Strategic Estates
Plan as outlined above. PCIF funding for practices has been approved
and practices are submitting applications for its use.
12.3.6 15 Ambleside Avenue – valuation and follow up Quarter The transfer of this property from the Department of Health to LB
123
Key Deliverables For Quarters 1 - 4 2015/16
Business
Plan Ref:
Objective Delivery
Period
Progress update
work to grant property to London Borough of
Lambeth
2 Lambeth is now being undertaken as part of a London-wide exercise
through NHSE.
12.3.7 Lambeth Strategic Infrastructure Study draft
report – review and feedback – attend
stakeholder meetings and agree way forward
Quarters
1 -4
CCG and NHSPS have provided feedback for the draft report. This will
in turn inform the Lambeth Strategic Estates Plan.
12.3.8 Section 106 – on-going review of opportunities
including the latest development opportunities at
the Stockwell Group Practice
Quarters
1 -4
CCG is working with NHSPS and Stockwell Group Practice to develop
proposal to make effective use of S106 funding to support practice
growth.
12.3.9 To commission updated review of estates
utilisation and develop and implement plan to
maximise use of the community estate. Work with
South London and Maudsley (SLAM) and the
London Borough of Lambeth (LBL) to identify and
maximise opportunities for co-location to enable
service transformation and deliver QIPP across
our commissioned services
Quarters
1 -4
Utilisation reviews are being updated as part of producing the Strategic
Estates Plan. Funding has been provided via the PCIF to undertake
estates utilisation and condition surveys across SEL CCGs. SLAM, LBL
and GSTFT attended the Estates Stakeholder Workshop. The CCG is
establishing a Local Estates Forum to oversee the implementation of the
Strategic Estates Plan in Lambeth which includes provider
representation.
The draft Lambeth SEP was completed by 31 December. This
document is being further developed and will be approved by the
Governing Body following recommendation from the Primary Care
Development Board in March 2016. This is an interim plan with a main
focus on primary and community care with next stage broader provider
engagement.
12.3.10 To monitor, review and oversee the delivery of the
Action Plan of the Sustainable Development
Management Plan
Quarters
1 -4
CCG will be working with the Sustainable Delivery Unit/NHSPS to deliver
the Action plan building on work undertaken to date.
124
5.6.5 Workforce
Responsible Director Una Dalton, Director Governance and Development
Clinical Lead Dr. Adrian McLachlan
Programme Lead Lorraine Smith , HR Business Partner, South London CSU
Scope of business area To purpose of this business area is to ensure the provision of an effective
Human Resource service to staff and managers across the organisation.
Objectives of business
area
The objectives of this business area are to ensure that managers and staff
across the CCG have access to up to date advice and support on all
matters relating to the recruitment, management and development of staff
within the CCG.
Our Human Resources services are provided by South Commissioning Support Unit and we have a
named Business Partner, Lorraine Smith, providing support to managers and staff within the CCG. Since
March 2015 payroll and pensions services is been provided by SECSU in-house team.
September 2015
Our workforce profile is as follows:
Staff turnover
125
In December there was one leavers with no leavers registered in November. This is a smaller degree of
turnover compared with periods earlier in the year.
Recruitment activity December 2015
Robust recruitment checking processes are in place to ensure all recruitment activity has finance and
director approval prior to proceeding to advert, in order to monitor and control running costs.
A summary of substantive staff appointed from between September 2015 – December 2015
Position title
Start date
Senior Business support Manager x2 21 Sept 2015
05 Oct 2015
Service Re-design Manager 01 Sep 2015
Head of Communications 01 Sep 2015
Assistant Director Governance & Quality 21-Oct-2015
Associate Lay Member 20-Nov-2015
Clinical Commissioning Pharmacist 07-Oct-2015
Commissioning Support Officer 30-Dec-2015
Senior Business Support Administrator 05-Oct-2015
Service Redesign Manager - Urgent Care 30-Nov-2015
Sickness Absence
126
The sickness absence rate for Lambeth CCG for December 2015 was 1.09%. This is a significant
reduction compared to August where absence was recorded at 3.49% and is attributed to proactive
management of a small number of cases that had met trigger points for short term absence. Cases are
being managed in accordance with the Promoting Attendance at Work Policy with appropriate support
through HR and Occupational Health. It is anticipated that the trend will continue; sickness absence will
continue to be monitored to identify any trends and changes, and to determine whether any further
action is required .This will be supported by the recently revised Promoting Attendance at Work Policy
which is now available on the intranet and which will provide a structured and more focused approach to
monitoring and managing sickness absence.
The highest figures for first day absence is a Monday. There are currently no long term sickness
absence cases. Currently the sickness absence rate is below the national target of 2.5%.
Calendar days lost/working days lost from 1/4/15- 31/12/15
Employee Relations cases
There are currently no live employee relations cases.
127
6 QUALITY ASSURANCE
6.1 Provider Quality Report
The Provider Quality Report for Quarter 3 will be in the April 2016 IGC report.
6.2 Complaints and PALS
17 PALS enquiries and five complaints were received from October to December 2015. Compared to the figures from October to December 2014, there is a 36% reduction in the number of PALS enquiries recorded, as well as a 50% decrease in the number of complaints recorded from October to December 2014. Compared to the previous Quarter in 2015 (July, August, September), there has been a 29% decrease in the number of complaints recorded. However, the number of PALS cases recorded has increased by 41%.
13
910
1211
7 7
13
67
4
13
9
4
7
43 3
11
3 32
5
2
10
21
4 4
21
3
7
3
1
4
21
4
2 21
0
2
4
6
8
10
12
14
Apr
May Jun Jul
Aug Se
p
Oct
Nov
Dec Jan
Feb
Mar
Apr
May Jun Jul
Aug Se
p
Oct
Nov
Dec
2014 2015
PALS
Complaint
0
2
4
6
8
10
12
14
Apr Jun Aug Oct Dec Feb Apr Jun Aug Oct Dec
2014 2015
PALS
Complaint
Month PALS Complaints
All PALS CCG PALS All Complaints CCG Complaints
Q1 2014/15 32 6 9 1
Q2 2014/15 30 7 13 5
128
PALS and Complaints recorded in Quarter Three 2015/16 There were 22 cases recorded between October to December 2015. 17 were PALS enquiries and five were complaints: The three complaints recorded as CCG related to:
Assessment/Eligibility (Two)
Complaint Handling (One)
There were also two non-CCG Complaints cases related to:
Access – Mental Health Services
Treatment – Lambeth Local Authority
Details of the five complaint cases recorded between October to December 2015 are as follows:
1. Complainant wants to complain about Psychiatrist referred to her by the GP. Case closed.
2. Complaint regarding NHS Continuing Healthcare assessment. Case Closed. 3. Complaint about treatment in a care home and the competency of the carers. Case Closed.
4. Letter received from Parliamentary and Health Ombudsman regarding complaint against Lambeth CCG. Case Closed
5. Complainant registering complaint regarding Retrospective Home Fees. Case Open.
Seven of the PALS cases recorded between October to December 2015 related to the CCG. Assessment/Eligibility (Two)
Commissioning Decisions (Three)
Communication (One )
Treatment (One)
There were ten non-CCG PALS cases related to:
Contact Information (Four)
Staff Attitude (Four)
Complaint Handling (One)
Other (One) - Medical Records
Number of Open Complaints and PALS cases There are currently three cases that remain open; one of which is a complaint received on 14 December 2015. The other two cases are PALS cases received on 23 October and 27 October 2015
Q3 2014/15 26 6 10 3
Q4 2014/15 24 9 11 4
Q1 2015/16 20 7 8 3
Q2 2015/16 10 4 7 4
Q3 2015/16 17 7 5 3
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The other 15 PALS cases and four complaint cases received between October to December 2015 have been dealt with and closed. Number of MP Cases There were three MP PALS cases recorded between October to December 2015 Number of Ombudsman Cases Between the months of October to December 2015, there was one Ombudsman case recorded. Mode of Receipt From October to December 2015, of the five complaints recorded, two were received by letter, two by email and one by telephone. Ten of the 17 PALS enquiries received were by telephone; six were received by letter and one by email.
Mode PALS Complaint Total
Email 1 2 3
Letter 6 2 8
Telephone 10 1 11
Total 17 5 22
Complaints responded to within 25 working days Of the five complaints received between October to December 2015, four were closed within 25 working days. One of complaint received in December 2015 currently remains open and is also currently within the 25 day timescale 15 of the 17 PALS cases were closed within 25 working days of being received. The two PALS cases that remain open have been open since October 2015. Themes There are no common themes for direct CCG complaint and PALS cases that were received between October to December 2015
Theme PALS n=3 Complaints n=4 Total n=7
Access 0 1 1
Assessment/Eligibility 2 2 4
Commissioning Decisions 3 0 3
Communication 1 0 1
Complaint Handling 1 1 2
Contact Information 4 0 4
Staff Attitude 4 0 4
Treatment 1 1 2
Other 1 0 1
Complaints Risk Grading (only complaints are risk graded)
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Formal complaints are graded accordingly on receipt using the Risk Grading Matrix below. Grading is based on the actual consequences and also the potential for future complaints on a similar issue. Grading of Complaints provides the potential to flag serious risks to the CCG. Where a complaint is graded at 15 or above, the Complaints Team will alert the CCG.
Risk Grade Count of Type
4 4
6 1
Total 5
Any complaints listed as ungraded are complaints that are not dealt with by SECSU Complaints Team but by other organisations in the area i.e. GP complaints referred to NHS England or hospital complaints. Risk Grading Matrix used in Grading Complaints
Likelihood
Consequence Negligible Minor Moderate Major Catastrophic
Rare 1 2 3 4 5
Unlikely 2 4 6 8 10
Possible 3 6 9 12 15
Likely 4 8 12 16 20
Almost certain
5 10 15 20 25
Cases of Special Interest: It is accepted that all complaints cases are of special interest to the complainant and the CCG. There are some cases which are of specific and special interest due to the complexity and nature of the complaint. There may also be a special interest in themes from complaints.
There were no cases of special interest recorded in this quarter.
6.3 Serious Incidents
NHS England published a revised Serious Incident (SI) Framework in March 2015.
Serious Incidents are defined as:
Acts and/or omissions resulting in unexpected or avoidable death of one or more people;
includes suicide/self-inflicted death and homicide by a person in receipt of mental health
care within the recent past;
Unexpected or avoidable injury to one or more people that has resulted in serious harm;
Unexpected or avoidable injury to one or more people that requires further treatment by a
healthcare professional in order to prevent the death of the service user or serious harm;
Actual or alleged abuse where healthcare did not take appropriate action/intervention to
safeguard against such abuse occurring or where abuse occurred during the provision of
NHS-funded care.
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A Never Event
An incident (or series of incidents) that prevents, or threatens to prevent, an
organisation’s ability to continue to deliver an acceptable quality of healthcare services,
including (but not limited to) failures in the security, integrity, accuracy or availability of
information; Property damage; Security breach/concern; Incidents in population-wide
healthcare activities like screening and immunisation programmes; Inappropriate
enforcement/care under the Mental Health Act (1983) and the Mental Capacity Act (2005)
including Deprivation of Liberty Safeguards (MCA DOLS); Systematic failure to provide an
acceptable standard of safe care or Activation of Major Incident Plan
Major loss of confidence in the service, including prolonged adverse media coverage or
public concern about the quality of healthcare or an organisation
Incidents Requiring Investigation
In Q3, 2015/16 a total of 31 Serious Incidents were reported on STEIS.
One of these SI’s was de-escalated by King’s College Hospital (KCH) as it was found not to meet
the SI criteria after further investigation. It is possible that SI’s reported during this period may be
de-escalated at a later date if found not to meet the criteria following further investigation.
Thirty incidents required an investigation, as noted by provider in the following table.
Table 1: Q3 2015/16 Serious Incidents requiring investigation reported by provider
Provider Oct-15 Nov-15 Dec-15
GSTFT 8 5 3
KCH 0 4 2
SLaM 3 0 4
PRUH 0 1 0 GSTFT = Guy’s and St Thomas’s NHS Foundation Trust; KCH = King’s College Hospital NHS Foundation Trust; SLaM = South London and Maudsley NHS Foundation Trust; PRUH = Princess Royal University Hospital
GSTFT reported serious incident numbers are larger than KCH and SLaM as they include all
incidents. KCH, SLaM and PRUH incidents are only for Lambeth residents.
Table 2: Serious Incident categories by Provider for SI’s requiring investigation, Q3 2015/16
STEIS CATEGORY GSTFT KCH PRUH SLaM
Surgical/invasive procedure incident meeting SI criteria 8 0 0 0
Treatment delay meeting SI criteria 3 3 0 1
Apparent/actual/suspected self-inflicted harm meeting SI criteria 0 1 0 4
Slips/trips/falls meeting SI criteria 2 0 0 1
Medication incident meeting SI criteria 2 0 0 0
Confidential information leak/IG breach meeting SI criteria 0 0 0 1
Diagnostic incident including delay meeting SI criteria 0 1 0 0
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STEIS CATEGORY GSTFT KCH PRUH SLaM
Maternity/obstetric incident meeting SI criteria: mother only 0 1 0 0
Pending review 0 0 1 0
Pressure ulcer meeting SI criteria 1 0 0 0
NOTE: GSTFT = Guy’s and St Thomas’s NHS Foundation Trust; KCH = King’s College Hospital NHS Foundation Trust; SLaM = South London and Maudsley NHS Foundation Trust; PRUH = Princess Royal University Hospital
Of the incidents reported by GSTFT, all 16 required investigation.
There was two incidents reported in the ‘Pending review’ category where it is not yet established which
category the incident falls into.
6.4 Never Events
NHS England published a revised Never Events Policy and Framework along with the revised Serious
Incident Framework in March 2015.
The definition of a Never Event has also revised:
They are wholly preventable, where guidance or safety recommendations that provide strong
systemic protective barriers are available at a national level, and should have been implemented
by all healthcare providers
Each type has potential to cause serious patient harm or death (but may not).
Evidence that never event type has occurred in the past and risk of recurrence remains.
Occurrence of the Never Event is easily recognised and clearly defined.
There were five never events reported on STEIS in Q3 by GSTFT. These included a wrong site surgery,
two mis-placed naso-gastric tubes, a retained foreign object post-procedure and a wrong route
administration of medication. These are currently being investigated. Due to the number of never events
in Q1 – Q3, a meeting was held with the Trust to discuss these events in December. The Trust will be
producing an action plan for the management of never events by the end of January, which will be
monitored via CQRG.
All serious incident issues are followed up at on-going provider Serious Incident Monitoring meetings for
each provider, this includes reviewing the progress of overdue investigation reports. These meetings are
chaired by the CCG Clinical Quality Lead. Serious incidents are closed by the CCG through the Serious
Incident Review Group, which is a sub-committee of the Integrated Governance Committee.
6.5 Quality Alerts
The Quality Alerts data for Quarter 3 2015/16 will be provided in the Q3 Quality Report, which will be an
appendix of this report in April 2016.
6.6 Infection Control
MRSA
There have been no MRSA cases so far this year.
Infection Control Target (YTD) Apr 15 May 15 Jun-15 Jul-15 Aug-15 Sep-15 YTD
MRSA 0 0 0 0 0 0 0 0
C-difficile 42 8 7 6 5 6 13 45
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C-Difficile
To Month 6, there have been 45 cases of C. difficile reported. More than 50% occurred in a non-acute
setting.
6.7 Mixed Sex Accommodation
The majority of the breaches of the MSA standard at GST have been due to critical care step down. This
is a long standing issue where patients are counted as being MSA breaches whilst in critical care step
down. Last year, there was new guidance released which outlined that Trusts do not need to record
these particular types of patients as MSA breaches.
However, GSTFT has chosen to continue reporting on this particular type of breaches in order to keep
track of the issue internally. GSTFT is aware that other Trusts across London do not report these
patients but feel it is more important to record these patients in order to understand the issue and drive
improvement. We have supported the Trust in this choice.
6.8 Freedom of Information (FOI) There were 65 FOI requests received for Q3 2015/16. Response rates (requests completed within 20 working days)
2 responses were overdue for the following reasons,
Approval was not received in time for the response to be made.
Information was supplied to South East CSU after the deadline date.
1 response was made beyond 20 working day deadline, due to a consideration of an exemption under the Freedom of Information Act 2000 (Commercial interests)
Of the 65 requests received, 52 of these were round robins, where the same request was asked of other CCGs. The following table lists the requests that were specific to NHS Lambeth CCG
Indicator National Target Apr 15 May 15 Jun 15 Jul-15 Aug-15 Sep-15 Oct-15
Mixed-sex Accommodation 0 3 0 2 0 1 3 2
FOI response rates – NHS Lambeth CCG
Qtr 4 13/14
Q1 14/15 Q2 14/15 Q3 14/15 Q4 14/15 Q1 15/16
Q2 15/16
Q3 15/16
97% 100% 98% 98% 97% 100% 100% 97%
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Individuals / Researchers made the majority of requests (43%) followed by Commercial organisations (26%) and Media organisations (12%).
6.9 Quality Premium
The ‘Quality Premium’ is intended to reward clinical commissioning groups (CCGs) for improvements in
the quality of the services that they commission and for associated improvements in health outcomes
and reducing inequalities. The Quality Premium for Lambeth CCG is agreed with the local Health and
Wellbeing Board and NHS England (London).
Quality Premium 2015/16
The 2015/16 Quality Premium will be paid to Lambeth CCG in 2016/17 in line with previous practice.
The measures have been revised as follows:
Reducing potential years of lives lost (PYLL) through causes considered amenable to
healthcare and addressing locally agreed priorities for reducing premature mortality (15% of
quality premium). This measure is being rolled forward into the current financial year. The target for
this indicator has changed this year. CCGs are now working to an average trend percentage
reduction in years of life lost of no less than 1.2% over the period 2012 – 2015 calendar years. This
measure will be worth 10% of this year’s Quality Premium.
This measure is reported annually; there is no change from the 2014/15 position reported below:
Subject of Request Type of Applicant
making the request
Referral rates between GP Practices Individual
Telehealth / Telecare services Organisation / Company
Money paid to GPs – Referral management schemes Individual
Prescribing incentive schemes Public organisation
Policies and procedures for extra contractual referrals Organisation / Company
Wound care formularies Organisation / Company
Shared data backup in surgeries Individual
Software development and testing Organisation / Company
Medicines formulary Individual
Wounds care products Organisation / Company
Communications with Advisory boards Journalist
Minor ailments service Researcher
Financial information Researcher
Main subject of FOI requests received No. of requests
Medicines Optimisation 7
Commissioning 8
ICT 5
Service provision 12
Procurement 7
Staff details 10
Mental health 4
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Reducing potential years of lives lost (PYLL) through causes considered amenable to
healthcare and addressing locally agreed priorities for reducing premature mortality (15%
of quality premium). The required reduction in mortality rate between 2012/13 and 2014/15 was
1.2%. The table below shows published data for the years 2012 – 2014. This seems to be a
very volatilie indicator as
there was a reduction of
1.3% between 2012 and
2013. However, there was
an increase of 8.6%
between 2013 and 2014.
Overall, there has therefore
been a 6.6% increase in
mortality from these causes.
This indicator is part of the
suite of 2015/16 Quality Premiums. Detailed investigation of trends in admissions and hospital
mortality for these causes is need to enable understanding of this public health issue.
Urgent and emergency care – Reducing NHS-responsible delayed transfers of care.
This measure uses the number of days patients’ discharge was delayed for reasons for which the
NHS is responsible. This is a subset of the Delayed Transfers of Care measure reported to the
Better Care Fund (see below). Delayed Transfers of Care are attributed at local authority level using
the proportion of each CCG’s registered population that are resident in each local authority. This
measure will be worth 30% of this year’s Quality Premium.
The table below shows that YTD, the number of NHS responsible Delayed Transfer Days is below
the 2014/15 level.
Mental health – Reduction in the number of people with severe mental illness who are
smokers.
This measure is calculated from the severe mental illness (SMI) registers on GP systems, based on
GP data extracted by GPES. This measure compares the percentage of smokers on 31/03/2015
against that on 31/03/2016, and will be worth 30% of this year’s Quality Premium.
Following advice from HSCIC, the table below uses the national methodology to calculate
performance. The percentage of smokers on an SMI register was slightly higher on 30/09/2015 than
on 31/03/2015.
Reducing NHS Responsible Delayed Transfers of Care ONS Mid-year Population Estimate 2014 318000
No national target Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 YTD
2014/15 No. NHS Responsible Delayed Transfers 386 294 292 285 436 384 464 334 277 256 185 254 2,077
No. of 2014/15 NHS Responsible Delayed Days per 100,000
Population 121 92 92 90 137 121 146 105 87 81 58 80 653
2015/16 No. NHS Responsible Delayed Transfers 287 200 377 390 292 411 505 341 409 3,212
No. of 2015/16 NHS Responsible Delayed Days per 100,000
Population 90 63 119 123 92 129 159 107 129 1,010
Quality Premium 2015/16
Data Source: NHSE Unify2 public data
No national target
2014/15 % Smokers
2015/16 % Smokers 57.8% 57.5% 57.7%
Data Source: EMIS Enterprise
57.8% 57.9% 57.9% 56.9%
30th June 30th September 31st December 31st March
Reduction in the percentage of people with severe mental illness who are currently smokers
Reducing potential years of lives lost (PYLL) through causes
considered amenable to healthcare and addressing locally
agreed priorities for reducing premature mortality
Target: Reduction in PYLL 2012 - 2014 2012 2013 2014
Registered patients 384096 374777 369647
Years of life lost 5047 4980 5406
Observed deaths 195 202 208
Annual % change -1.3% 8.6%
% Change 2012 - 2014 6.6%
* Data source: Health & Social Care Information Centre Indicator Portal
Quality Premium 2014/15
136
Improving antibiotic prescribing in primary and secondary care.
This is a composite Quality Premium consisting of 3 parts:
a) Reduction in the number of antibiotics prescribed in primary care – threshold >=1% from the
2013/14 position
b) Reduction in the proportion of broad spectrum antibiotics prescribed in primary care – threshold
either >= 10% from the 2013/14 position or below the 2013/14 median English CCG position of
11.3%. The table below shows that this was being achieved from June 2015 for antibacterial
items but not for Co-amoxiclav, Cephalosporins and Quinolones.
c) Secondary care providers have validate their total antibiotic prescribing data as certified by PHE
This measure will be worth 10% of this year’s Quality Premium.
This measure is reported as part of the Medicine’s Management Report earlier in this report
under Long Term Conditions.
Maternal smoking at delivery
This is a long-standing measure. This measure will be worth 10% of this year’s Quality Premium.
Performance against the standard itself is achieving the target. However, there is a risk that the
standard will not be achieved because the data validation measure - <5% of maternities should
return a status of ‘not known’. This has not been achieved for two quarters of 2015/16.
Breast-feeding delivery at 6 – 8 weeks.
This is also long-standing measure. This measure will be worth 10% of this year’s Quality Premium.
The national target for this standard is 85%. This was not achieved in 2014/15 and has not been
achieved in Quarter 1 2015/16. NHS England has ceased to collect data for this standard. As yet, and
alternative owner for the data has not been arranged. We are awaiting further information regarding this.
National Target: 11%
2014/15 % Smoking at Delivery
2015/16 Smoking at Delivery
Validation: Not Known <5% of Maternities
Data Source: Quarterly return submitted by South London Commissioning Support Unit
3.9% 3.4%
6.5% 8.5%
3.7% 4.3% 3.1% 2.5%
Quarter 1 Quarter 2 Quarter 3 Quarter 4
Smoking At Delivery
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This year, the maximum quality premium reward for Lambeth CCG is £1.6m and will be paid out in
accordance to the NHS England’s “Quality Premium: 2015/16 guidance for CCGs”. As last year, the
CCG is required to achieve financial and quality gateways before it is eligible for payment and the overall
payment is reduced for non-delivery of constitutional targets for A&E, RTT, ambulance conveyance and
cancer waits.
6.10 Better Care Fund
Non Elective Activity:
As part of the Better Care Fund there is a national expectation that local areas reduce the non elective
admissions (unplanned care) by at least 3.5% against a baseline of Q4 2013/14 to Q3 2014/15. The plan
reduction could be set at a local level and within Lambeth CCG this has been set at 2%.
Data on performance for non elective (unplanned care) activity for 2015/16 shows that we made a 4%
reduction in quarter 4 2014/15 and quarter 1 2015/16 respectively, and a 3% reduction in quarter 2
20151/6. This is based on using Secondary Uses Service (SUS)1 data available.
SUS is the recognised national dataset that is used for contracts with acute providers and, in agreement
with the BCF national team, is now being used to report non-elective admissions for BCF.
Our latest data which is quarter two for 2015 shows actual non elective admissions as 6396. These
figures have been validated internally.
Delayed Transfers of Care:
Delayed transfers of care (DTOC) is one of the metrics identified to be planned and monitored by CCGs
and local authorities as a part of the Better Care Fund. Effective collaboration between providers is
needed in order to minimise delayed transfers of care.
1 The Secondary Uses Service (SUS) is the single, comprehensive repository for healthcare data in England which enables a range of reporting and analyses to support the NHS in the delivery of healthcare services.
National Target: 85%
2014/15 Actual
2015/16 Actual
Data Source: NHSE Unify2 public data
76.1%
Breastfeeding At 6 – 8 Weeks
Quarter 1 Quarter 2 Quarter 3 Quarter 4
77.4% 74.9% 74.9% 75.4%
Reduction in non-elective admissions using SUS
Rate per 100,000 1,764 1,800 1,761 1,777 1,699 1,747 1,686 1,751
Non-elective admissions (SUS) Actual/Plan 6,525 6,710 6,608 6,725 6,395 6,576 6,476 6,591
Non-elective admissions (SUS) Actual 6,525 6,710 6,608 6,725 6,217 6,393 6,396
Variance plan vs actual (%) 4.7% 4.7% 3.2%
Population denominator (Registerd population) 369,897 372,709 375,141 378,387 376,382 376,382 384,016 376,382
SUS (Actual) SUS (Actual/Plan)
Q4
(Jan 14 - Mar 14)
Q1
(Apr 14 - Jun 14)
Q2
(Jul 14 - Sep 14)
Q3
(Oct 14 - Dec 14)
Q4
(Jan 15 - Mar 15)
Q1
(Apr 15 - Jun 15)
Q2
(Jul 15 - Sep 15)
Q3
(Oct 15 - Dec 15)
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The performance on DTOC improved during August, recording the best month in 2015/16 so far. There
were 66 days for social care delays from the four main local providers in October (GSTT, KCH, SLaM
and St George’s) with the main reasons being public funding and choice.
Performance on NHS delays deterioriated in October to 464 from 318 in the preceding month. The
main reasons are residential home placements (SLaM) and completion of assessment (GSTT)
Commissioners are currently working with senior managers at SLaM to identify trends and take the
lessons learnt from the targeted work at KCH to see what can be applied to a mental health trust.
Residential Care
Permanent Admissions for Residential and nursing care for December are 99 against a monthly target of
103. There were a total of only 7 new admissions to residential/nursing care in December. Six of these
were for EMI care and all service users 75 or above.
For the proportion of older people still living at home 91 days following discharge from hospital,
performance in December was 94%. The year to date performance is 95%. At the time of reporting data
was not available for October and November 2015. This will be reported in March 2016.