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TRANSCRIPT
Haringey Clinical Commissioning Group Governing Body Meeting
Thursday, 13 September 2018 2.00pm – 4.30pm Cypriot Centre
Earlham Grove
London N22 5HJ
Item Title Lead Action Papers Page No. 1. INTRODUCTION
1.1 Welcome and Apologies
Chair To note Oral -
1.2 Declarations of Interest Register
Chair To note 1.2 3
1.3 Declarations of Gifts and Hospitality
Chair To note Oral l -
1.4 Draft minutes of previous Governing Body meetings on 12 July 2018
Chair For approval
1.4 12
1.5 Action Log
Chair For approval
1.5 30
1.6 Questions from the public
Chair Oral -
2. OVERVIEW REPORTS
2.1 Accountable Officer’s Report Accountable Officer
To note 2.1 30
3. DISCUSSION
3.1 Whittington Health Community Services
Chief Executive, Whittington
Health
For discussion
Present-ation
-
4. CORPORATE BUSINESS AND BUSINESS CASES
4.1 STP Programme Update
NCL Director of Strategy
For discussion
4.1 33
4.2 System Intentions for 2019/20: Haringey CCG
NCL Director of Performance, Planning and Primary Care
For discussion
4.2 54
5. FINANCE AND PERFORMANCE
5.1 Finance Report
Chief Finance Officer
For discussion
5.1 63
5.2
Performance Report
Director of Planning,
Performance and Delivery
For discussion
5.2 78
6. GOVERNANCE
6.1 6.1.1 6.1.2 6.1.3 6.1.4
Board Assurance Framework Haringey BAF Risks available here NCL Risk Register (August 2018) available here NCL Primary Care Committee in Common Risk Register (August 2018) available here NCL Joint Commissioning Committee Risk Register (August 2018) available here
Director of Planning,
Performance and Delivery
For discussion
To note
To note
To note
To note
6.1 113
7. ITEMS FOR INFORMATION AND ASSURANCE
7.1 Minutes of the Haringey and Islington CCGs Quality and Performance Committee in Common Meeting on 25 July 2018 – available here
Chair of Haringey and
Islington CCGs Quality and
Performance Committee in
Common
To note
7.2 Minutes of the Haringey & Islington CCGs Strategy & Finance Committee in Common meeting on 28 June 2018 – available here
Chair of Haringey and
Islington CCGs Strategy and
Finance Committee in
Common
To note
7.3 Minutes of the Haringey CCG Clinical Cabinet meeting on 5 July 2018 - available here
Chair of Haringey CCG
Clinical Cabinet
To note
7.4 Minutes of the NCL Joint Commissioning Committee Meeting on 7 June 2018 – available here Papers of the NCL Joint Commissioning Committee Meeting on 2 August 2018 – available here
Chair of NCL Joint
Commissioning Committee
To note
7.5 Minutes of the NCL Primary Care Commissioning Committee Meeting on 21 June 2018 – available here
Chair of NCL Primary Care
Commissioning Committee
To note
8. ANY OTHER BUSINESS
9. DATE OF NEXT MEETING - Thursday 15 November 2018
REGISTER OF INTERESTS
A register of members’ interests is available for viewing by the public. The register will be available at the meeting or during working hours within the Haringey CCG Office,
River Park House, 225 High Rd, Wood Green, London N22 8HQ.
Haringey Clinical Commissioning Group Governing Body Meeting 13 September 2018
Report Title Declaration of Interest Register
Date of report 6 September 2018
Agenda Item
1.2
Lead Director /
Manager
Peter Christian Chair, Haringey CCG
Tel/Email
GB Member Sponsor
Peter Christian Chair, Haringey CCG
Report Author
Steve Beeho, Board Secretary Tel/Email [email protected]
Report Summary
Governing Body Members and attendees are asked to review the agenda and consider whether any of the topics might present a conflict of interest, whether those interests are already included within the Register of Interest, or need to be considered for the first time due to the specific subject matter of the agenda item. A conflict of interest would arise if decisions or recommendations made by the Governing Body or its Committees could be perceived to advantage the individual holding the interest, their family, or their workplace or business interests. Such advantage might be financial or in another form, such as the ability to exert undue influence. Any such interests should be declared either before or during the meeting so that they can be managed appropriately. Effective handling of conflicts of interest is crucial to give confidence to patients, tax payers, healthcare providers and Parliament that CCG commissioning decisions are robust, fair and transparent and offer value for money. If attendees are unsure of whether or not individual interests represent a conflict, they should be declared anyway.
Recommendation The Governing Body is asked to NOTE the Register of Interests and advise the meeting / Board Secretary of any changes.
Identified Risks
and Risk
Management
Actions
The risk of failing to declare an interest may affect the validity of a decision / discussion made at this meeting and could potentially result in reputational and financial costs against the CCG.
Conflicts of Interest
The purpose of the Register is to list interests, perceived and actual, of members that may relate to the meeting.
Resource
Implications
Not applicable.
Engagement
Not applicable.
Equality Impact
Analysis
Not applicable.
Report History and
Key Decisions
The Register of Interests is a standing item presented to every Governing Body Meeting.
Next Steps The Register of Interests is reviewed monthly.
Appendices
The Register of Interests.
Haringey CCG Governing Body Declarations 6.9.18
From To Updated
Fin
an
cia
l In
tere
sts
No
n-F
inan
cia
l
Pro
fessio
nal
Inte
rests
No
n-F
inan
cia
l P
ers
on
al
Inte
rests
Morris House Group
Practice X Direct Practice Partner 17.8.17 29.6.18
The Morris House Group
Practice is a member of
Federated4Health, the
pan-Haringey federation
of GP practices.X Direct Practice Partner 17.8.17 29.6.18
The Morris House Group
Practice provides
anticoagulant care to
Haringey residents under
a contract with the CCG.
X Direct Practice Partner 17.8.17 29.6.18
The Morris House Group
Practice premises are
also used for the
provision of physiotherapy
services by Premier
Medical, who are charged
a nominal amount to
cover electricity and gas
etc.
X Direct Practice Partner 17.8.17 29.6.18
Local Medical Committee
(LMC) X Direct GP representative 17.8.17 29.6.18
NHS England
X Direct GP Trainer 17.8.17 29.6.18
Italian Medical Charity
X Direct Trustee 17.8.17 29.6.18
Fernlea Surgery X Direct Practice Partner 15.3.18 23.04.18
Fernlea Surgery is a
member of
Federated4Health, the
pan-Haringey federation
of GP practices.
X
Direct
Practice Partner 15.3.18 23.04.18
Fernlea Surgery premises
are also used for the
provision of MSK services
by Premier Health and
Sport Therapy Ltd, who
are charged a nominal
amount to cover
electricity and gas etc.
X Practice Partner 15.3.18 23.04.18
Talawa Fostering X Direct Medical adviser 15.3.18 23.04.18
Jewish Care Direct clinical governance committee
member15.3.18 23.04.18
New North London
synagogue X Direct Organiser of doctors' rota. 15.3.18 23.04.18
NHS England (London) X
Direct Senior clinical adviser 15.3.18 23.04.18
Central London
Community Healthcare
NHS Trust.
Indirect (wife)
Community paediatric
physiotherapist15.3.18 23.04.18
Action taken to mitigate risk
Nature of Interest
Declared Interest-
(Name of the
organisation and nature
of business)
Name
Current position (s) held-
i.e. Governing Body,
Member practice,
Employee or other
Date of Interest
Type of Interest
Is the interest
direct or
indirect?
Gino Amato
GP Partner, Morris House
Group Practice
North East GP Member,
Governing Body
Member, Governing Body
Member, Clinical Cabinet
Planned Care Lead,
Governing Body
Member, NMUH
Clinical Quality Review
Group
Simon Caplan
GP Partner, Fernlea
Surgery
North East
GP Member, Governing
Body
Member, Clinical Cabinet
Chair, A&E Delivery Board
(advised this had ceased
on 30.8.17)
Chair, Medicines
Management Committee
Muswell Hill Practice X Direct Practice Partner 15.3.18 25.04.18
Muswell Hill Practice is a
member of
Federated4Health, the
pan-Haringey federation
of GP practices.
X Direct Practice Partner 15.3.18 25.04.18
Muswell Hill Practice is a
member of WISH -
Urgent Care Centre
provider at Whittington
Hospital.
X Direct Practice Partner 15.3.18 25.04.18
Muswell Hill Practice
provides anticoagulant
care to Haringey residents
under a contract with the
CCG.
X Direct Practice Partner 15.3.18 25.04.18
The Hospital Saturday
Fund - a charity which
gives money to health
related issues.
X Direct Member 15.3.18 25.04.18
The Hospital Saturday
Fund - a charity which
gives money to health
related issues.
Indirect (wife) Patron 15.3.18 25.04.18
The Lost Chord Charity -
organises interactive
musical sessions for
people with dementia in
residential homes.
Indirect (wife) Patron 15.3.18 25.04.18
Federated4Health, the
pan-Haringey federation
of GP Practices
Indirect (Practice
manager ) Chair 15.3.18 25.04.18
Haringey Health
Connected, the federation
of west Haringey GP
practices
Indirect (Practice
manager )
Finance Manager 15.3.18 25.04.18
Vale Practice X Direct Practice Partner 15.3.18 27.04.18
Vale Practice is a
member of
Federated4Health, the
pan-Haringey federation
of GP practices.X Direct Practice Partner 15.3.18 27.04.18
The Vale Practice is a
member of WISH, the
Urgent Care Centre
Provider at Whittington
Health.
X Direct 15.3.18 27.04.18
WISH, the Urgent Care
Centre Provider at
Whittington Health.
XDirect
Director 15.3.18 27.04.18
NHS England X Direct GP appraiser 15.3.18 27.04.18
Frater Clinic (a private
clinic) X Direct Appraisal lead and appraiser 15.3.18 27.04.18
Vale Practice X Indirect Husband is a practice partner. 1.3.18 27.04.18
Peter Christian
CCG Chair, West GP Lead
GP Partner, Muswell Hill
Practice
Member, Strategy and
Finance Committee
Member, Clinical Cabinet
Member, Health and
Wellbeing Board
Member, Collaboration
Board
Member, Remuneration
Committee
Member, STP Clinical
Cabinet and
Transformation Board
Dina Dhorajiwala
GP Partner, Vale Practice
West GP Member,
Governing Body
Member, Strategy and
Finance Committee
Member, Clinical Cabinet
Primary Care Lead,
Governing Body
Haringey Primary Care
Lead, Co-Commissioning
Committee, NCL NHS
Member, Primary Care
Steering Group
Member, Primary Care
Transformation Group
Member, Health and
Wellbeing Board
Simon Goodwin Chief Finance OfficerEast London Foundation
Trust X Indirect
Wife is Senior Manager at the
Trust 14.6.17 23.04.18
Islington CCG X
Chief Operating Officer
Member, Governing Body
Member, Finance and
Performance Committee
21.6.17 23.04.18
Sidney Estates Tenants
and Residents
Association,
Tower Hamlets
X Chair 21.6.17 23.04.18
Will Maimaris Interim Director of Public
Health, Haringey Council No interests to declare. 30.8.18
Queenswood Practice X Direct Practice Partner 15.3.18 30.04.18
Queenswood Practice is a
member of WISH, the
Urgent Care Provider at
Whittington Hospital. X Direct Practice Partner 15.3.18 30.04.18
Queenswood Medical
Practice takes part in
various funded research
projects, including
PANDA, Kare and North
Thames CRN Primary
Care Team X Direct Practice Partner 15.3.18 30.04.18
Catherine Herman
Lay Member, Governing
Body
Chair, Primary Care Co-
Commissioning
Committee, NCL NHS
Chair, Investment
Committee
Chair, Communications
and Engagement Sub-
Committee Member,
Remuneration Committee
Member, Audit Committee
Member, Quality and
Performance Committee
Member, Health and
Wellbeing Board
Member, Primary Care
Transformation Group
Member, Organisational
Development Group
Chair, Engagement
Network
No interests to declare. 15.3.18 23.4.18
Tony Hoolaghan
Chief Operating Officer
Member, Governing Body
Member, Strategy and
Finance Committee
David Masters
GP Partner, Queenswood
Practice
West Member, Governing
Body
Clinical Lead for Children
(including CAMHS and
child safeguarding)
Member, Investment
Committee
Chair, Safeguarding
Assurance meeting
Member, Clinical Cabinet
Queenswood Practice is a
member of
Federated4Health, the
pan-Haringey federation
of GP practices.X Direct Practice Partner 15.3.18
30.04.18
Queenswood Practice
arranges education
activities with our local
hospital teams, including
the Whittinghton Hospital
and Highgate Hospital. X Direct Practice Partner 15.3.18 30.04.18
Tavistock Clinic X Direct Systemic Therapist (one day a
week) 15.3.18 30.04.18
NHS England
(Whittington Health
scheme)
X Direct GP trainer 2.3.18 30.04.18
Hornsey Heath Care Ltd
that holds the lease at
Hornsey Central Health
Care
X Direct Director 30.04.18
Arcadian Gardens
X Direct Practice Partner 6.3.18 27.6.18
Arcadian Gardens is a
member of
Federated4Health, the
pan-Haringey federation
of GP practices.
X Direct Practice Partner 6.3.18 27.6.18
Central Haringey CHIN X Direct Joint Clinical Lead 6.3.18 27.6.18
Muswell Hill Practice
(CCG member practice)X Direct Registered patient 10.5.17 23.04.18
Royal Borough of
Kensington and Chelsea
Local Authority
X Indirect
Husband is Programme
Manager for Partners in
Practice, a social work training
programme.
15.5.18
Lawrence House Surgery X Direct Practice Partner 15.3.18 25.04.18
Lawrence House Surgery
is a member of
Federated4Health, the
pan-Haringey federation
of GP practices.
X Direct Practice Partner 15.3.18 25.04.18
Lawrence House Surgery
has merged with Dowsett
Rd Surgery and
Broadwater Farm Health
Centre.
X Direct Practice Partner 15.3.18 25.04.18
Lawrence House Surgery
also runs the Tottenham
Hale practice.X Direct Practice Partner 15.3.18 25.04.18
NHS England X Direct GP Trainer: Enfield and
Haringey GP Scheme. 15.3.18 25.04.18
NHS England X Direct GP appraiser 15.3.18 25.04.18
Whittington Health Indirect (wife) Consultant (based at St Ann's
Hospital) 15.3.18 25.04.18
David Masters
GP Partner, Queenswood
Practice
West Member, Governing
Body
Clinical Lead for Children
(including CAMHS and
child safeguarding)
Member, Investment
Committee
Chair, Safeguarding
Assurance meeting
Member, Clinical Cabinet
Sheena Patel
GP Partner, Arcadian
Gardens Surgery
Clinical Director, Central
Haringey,
Governing Body
Member, Governing Body
Member, Clinical Cabinet
Women’s Health Lead,
Governing Body
Member, QIPP Delivery
Group
Member, Primary Care
Steering Group
Helen Pettersen Accountable Officer
John Rohan
CCG Deputy Clinical Chair
North East GP Lead, CCG
Governing Body
GP Partner, Lawrence
House Surgery
Member, Governing Body
Chair, Strategy and
Finance Committee
Chair, Clinical Cabinet
Member, Primary Care
Steering Group
Member, QIPP Delivery
Group
Finance, Estates and
QIPP Lead, Governing
Body
JS Medical Practice X Direct Advanced Nurse Practitioner 19.3.18 24.04.18
JS Medical Practice is a
member of
Federated4Health, the
pan-Haringey federation
of GP practices.
X Direct Advanced Nurse Practitioner 19.3.18 24.04.18
Islington COPD Steering
Group X Direct Attending Member 5.3.18 24.04.18
Camden, Islington and
Haringey Responsible
Prescribing Group
X Direct Attending Member 5.3.18 24.04.18
Money Advice Trust
(a national debt advice
charity)
X Direct Chair 01.07.16 23.04.18
Enfield CCG X Direct Member, Audit Committee 1.0114 23.04.18
Bounds Green Group
Practice X Direct Practice Partner 19.3.18 23.04.18
Bounds Green Group
Practice is a member of
the pan-Haringey GP
Federation X Direct Practice Partner 19.3.18 23.04.18
Sharon Seber
Adam Sharples
Lay Member, Governing
Body
Chair, Audit Committee
Chair, Remuneration
Committee
Member, Strategy and
Finance Committee
Member, Finance and
Performance Partnership
Board
Chair, IFR Panel
Member, NCL Joint
Commissioning
Committee
Lionel Sherman
GP Partner, Bounds Green
Practice
Member, Governing Body
Member, Clinical Cabinet
Chair, CCG CHC Funding
Panel
POLCE lead, CCG
Learning Disabilities Lead,
CCG
Member, QIPP Delivery
Group
Primary Care Health
Professional Member,
South East, Governing
Body
Advanced Nurse
Practitioner, JS Medical
Practice
Member, Quality and
Performance Committee
Member, Clinical Cabinet
Nurse Member, NCL Joint
Commissioning
Committee
Healthy Life Expectancy
Clinical Lead, Governing
Body
Chair, Increasing Healthy
Life Expectancy Group
Member, Primary Care
Steering Group
Dowsett Rd Surgery X Direct Practice Partner 18.1.17 2.7.18
Lawrence House Surgery
and Dowsett Rd Surgery
are both members of
Federated4Health, the
pan-Haringey federation
of GP practices.
X Direct Practice Partner 18.1.17 2.7.18
Whittington Health X Indirect
Husband is currently on a
Fixed Term Contract as a
Locum Consultant in
Endocrinology.
1.3.18 2.7.18
Sarah Timms
Consultancy Ltd X Direct Sole Director 19.2.18 23.04.18
Vale Practice X Direct Registered patient 19.2.18 23.04.18
Whittington Health X Indirect Daughter is employed in an
administrative role.15.8.18
Public Voice CIC (a
Community Interest
Company)
X Direct Chair of the Board 19.2.18 23.04.18
Healthwatch Haringey X Direct Chair, Steering Committee 19.2.18 23.04.18
Bernie Grant Arts Centre
Partnership X Direct Director 19.2.18 23.04.18
Nurse Member, Governing
Body
Chair, Quality and
Performance Committee
Member, Clinical Cabinet
Member, Investment
Committee
Member, Remuneration
Committee
Member, Organisational
Development Group
Member, NMUH Clinical
Quality Review Group
Member, Eligibility Panel
Chair, Primary Care
Transformation Group
Member, QIPP Delivery
Group
Sarah Timms
Sharon Grant
Chair, Healthwatch
Haringey
Haringey CCG Governing
Body Observer (With
Speaking Rights)
Dai Tan
Sessional GP Member,
Governing Body
Salaried GP, Lawrence
House Surgery
Practice Partner, Dowsett
Rd Surgery
Member, Clinical Cabinet
Member, Primary Care
Steering Group
Chair, CEPN Steering
Group
Member, Organisational
Development Group
Education and Workforce
Lead, Governing Body
Clinical Lead for Diabetes
Non-voting Governing Body attendees
Independent Advisory
Group, Metropolitan
Police Haringey
X Direct Member 19.2.18 23.04.18
Parliamentary researcher X Direct
Part-time-employment as a
Parliamentary Researcher on
Health issues for backbench
Labour MP
19.2.18 23.04.18
Consumers Association
(Which?)X Direct
Trustee and Director
(Unremunerated)19.2.18 23.04.18
Clare Henderson
Attendee of CCG
Governing Body
Director of Commissioning
Member, Strategy and
Finance Committee
Member, Clinical Cabinet
No interests declared
N/A 5.3.18 23.04.18
Will Huxter
NCL Director of Strategy
Attend any of the five
CCGs in NCL GroupN/A 23.04.18
Rachel Lissauer
Director, Wellbeing
Partnership
Attendee of CCG
Governing Body
Vale School
X Direct Co-opted Governor 13.7.17 29.6.18
Sarah Mcilwaine
Programme Director, Care
Closer to Home, North
London Partners
Non-Voting GB Member
Hillside (Islington-based
mental health charity)
X Direct Trustee 19.10.17 23.04.18
Paul Sinden
NCL Director of
Performance and Acute
Commissioning
Attend NCL Primary Care
Commissioning in
Common
Attend any of the five
CCGs in NCL Group
No interests to declare.
23.04.18
Alex Smith
Director of Performance,
Planning and Delivery
Non-Voting GB member
Member of Strategy and
Finance Committee
No interests declared
N/A 20.9.17 30.4.18
Islington CCGX Direct 10.7.17 02.05.18
Central and North West
London NHS Foundation
Trust X Indirect Husband is Director of Nursing 10.7.17 02.05.18
Whittington Health X Indirect
Son is working in
administrative post via Temp
Bank.
15.8.18
Jennie Williams
Director of Quality and
Nursing
Non-voting member,
Governing Body
Member, Quality and
Performance Committee
Sharon Grant
Chair, Healthwatch
Haringey
Haringey CCG Governing
Body Observer (With
Speaking Rights)
Draft Minutes of the
Meeting of the Haringey Clinical Commissioning Group Governing Body
Thursday 12 July 2018 at 1.30pm Cypriot Centre, Earlham Grove
Dr Peter Christian Chair of Haringey CCG, West Lead
Helen Pettersen Accountable Officer, North Central London CCGs
Dr Gino Amato GP Governing Body Member, North East Dr Simon Caplan GP Governing Body Member, North East
Dr Dina Dhorajiwala GP Governing Body Member, West
Dr David Masters GP Governing Body Member, West
Dr Sheena Patel GP Governing Body Member, Central Lead
Dr John Rohan GP Governing Body Member, North East Lead
Dr Lionel Sherman GP Governing Body Member, Central
Dr Daijun Tan GP Governing Body Member, Sessional
Sharon Seber GP Governing Body Primary Care Health Professional Member, South East
Catherine Herman Lay Member, Haringey CCG
Adam Sharples Lay Member, Haringey CCG Sarah Timms Nurse Member, Haringey CCG
Tony Hoolaghan Chief Operating Officer, Haringey CCG
Simon Goodwin Chief Finance Officer, North Central London CCGs In attendance:
Anthony Browne Deputy Chief Finance Officer, Haringey CCG
Clare Henderson Director of Commissioning, Haringey CCG
Alex Smith Director of Planning, Performance and Delivery, Haringey CCG
Sharon Grant Chair, Healthwatch Haringey (Observer with speaking rights) Will Maimaris Consultant in Public Health, Haringey Council
Steve Beeho Board Secretary, Haringey CCG (minutes)
1. INTRODUCTION
1.1 Apologies for Absence
1.1.1 Apologies were received from Jeanelle De Gruchy. Will Maimaris was attending on her behalf. As Jeanelle would shortly be beginning her secondment in Manchester, the Chair thanked her in her absence for her contribution to the achievements of the CCG.
1.2 Declarations of Interest
1.2.1 There were no additional declarations of interest.
1.3 Declarations of Gifts and Hospitality
1.3.1 There were no additional declarations of gifts or hospitality.
2
1.4 Chair’s Introduction and Opening Remarks
1.4.1 The Chair formally welcomed all present to the meeting. In addition he welcomed
Chantelle Fatania (Consultant in Medicine, Haringey Public Heath) and Lorraine Wiener (Head of Quality, Islington CCG), who were both attending the meeting as observers.
1.5 Minutes of the Previous Meeting
1.4.1 The Governing Body agreed the minutes of the Governing Body meeting held on 10 May 2018 as an accurate record, subject to section 5.2.2 being amended to state that Adam Sharples will be the Chair of the NCL Audit Committee in Common, rather than the Vice Chair.
1.6 Matters Arising
1.6.1 The Governing Body discussed the progress against the actions from the last meeting.
1.6.2 Alex Smith confirmed that an update on the Health Information Exchange would be brought to the Governing Body Seminar in October 2018.
1.6.3 Alex Smith noted that in addition to the update on the Memory Clinic included in the Performance and Quality Report, further details would also be presented at the next meeting of the Joint Commissioning Committee.
1.6.4 Adam Sharples observed that the breakdown of the charges incurred by the CCG for each private provider and the corresponding budget allocation highlighted the scale of the overspend at Highgate Hospital.
1.6.5 Assurance was given that the CCG is taking steps to control this. The CCG will be attending Clinical Quality Review Group (CQRG) meetings for this provider It was also
hoped that the MSK work would help to obviate the situation.
1.6.6 Sharon Grant confirmed that she had now received a response to the concerns raised
by the Reference Groups at the last Joint Partnership Board meeting, which she would now relay to the next meeting.
1.6.7 Jennie Williams noted the she had met with CCG colleagues to clarify the governance processes which other early e-referral adopters have in place, following on from the earlier concerns expressed about what happens when a patient referral is rejected. It was agreed that Jennie Williams would speak to Sheena Patel outside the meeting
about assurances the CCG has received regarding the volume of rejected referrals.
1.6.8 The Governing Body NOTED the action log.
1.6.9 ACTION 12/7-1: Jennie Williams to speak to Sheena Patel outside the meeting about
assurances the CCG has received regarding the volume of rejected referrals.
1.7 Questions From the Public
1.7.1 Ten questions had been submitted in advance from members of the public. The responses are appended to these minutes.
3
1.7.2 In response to a follow-up comment about the lack of notice concerning a recent consultation, it was agreed that the CCG would look into how consultations can be promoted more effectively.
1.7.3 ACTION 12/7-2: Tony Hoolaghan to arrange for consultations to be promoted more
effectively.
2. Overview Reports
2.1 Accountable Officer’s Report
2.1.1 Helen Pettersen introduced the Accountable Officer’s Report, highlighting a number of
specific items.
2.1.2 Haringey CCG’s achievement of a ‘Green’ rating for its patient and local community
engagement under a new national assessment was welcomed, although it was recognised at the same time that further progress still needs to be made. Helen Pettersen thanked in particular the contribution made by the CCG’s partners (Public Voice, Healthwatch Haringey and the Bridge Renewal Trust) and the CCG’s
Communications and Engagement Team.
2.1.3 The CCG is currently awaiting NHS England’s approval of the business case to take
back in-house the contracting support function from NEL Commissioning Support Unit but in the meantime the necessary planning work was continuing.
2.1.4 Following feedback from the engagement on the draft Primary Care Strategy, the engagement period had been extended and the final version of the strategy would now be brought to the November Governing Body meeting for approval.
2.1.5 There was then a brief discussion of the recent meeting of the STP Advisory Committee. Peter Christian observed that it had highlighted tensions between different parties which he was optimistic would be worked through.
2.1.6 In response to potential concerns about accountability in the context of the STP, Helen Pettersen said that it was important to remember that no statutory bodies had delegated
authority to the STP and it therefore does not have a formal decision-making forum. She confirmed that it had been agreed that future agenda-setting needed to allow for more discussion of strategic issues and that future meetings of the Advisory Committee would be minuted and ultimately published on the North London Partners in Health and
Care website.
2.1.7 In response to a query from Adam Sharples, Tony Hoolaghan noted that the
membership of the two newly-created Committees in Common had initially been established on a ‘lift and shift’ basis, prior to further recalibration.
2.1.8 The Governing Body NOTED the Accountable Officer’s Report.
3. Business, Quality and Integrated Performance
3.1 Finance Report
4
3.1.1 Anthony Browne provided an overview of the Finance Report, highlighting the following points:
At month 2 the CCG is reporting a £14k year to date deficit and forecasting to
plan at year end. Month 3 reporting, which had just closed, did not show a
significant variance from the Month 2 figures.
The CCG is already reporting significant pressure against its Continuing Care
spend – a more detailed report will be brought to a future meeting
The NMUH contract is projecting a material overspend – these figures will
require further examination across the patch
The 2018/19 QIPP target (£19.5m) is particularly challenging compared to
previous years, with the focus on avoiding admissions. There is currently a
financial risk around closing the £7.6m QIPP ‘gap’
A breakdown of the other financial risks and the mitigations identified to date
were set out in section 6.3.
3.1.2 Simon Goodwin then provided an overview of the summary of CCG financial variances
across NCL which would now be presented at future meetings. The summary showed £36m-£40m financial risk across NCL, with the level of Haringey risk sitting in the middle of the five CCGs.
3.1.3 He also noted that the increased NHS funding announced recently by Jeremy Hunt would be available from 2019/20, rather than the current financial year. He further cautioned that it was unclear at this stage how much of the increased funding would be
directed to CCGs and how the recent NHS staff pay awards will be funded.
3.1.4 The Governing Body then noted that Becky Booker, Director of Finance, Camden CCG
is leading on a piece of work to benchmark Continuing Care expenditure across NCL and a progress report will be brought to the Strategy and Finance Committee in due course.
3.1.5 John Rohan suggested that it would be helpful if the Governing Body could be provided with an outline of how the CCG will meet its QIPP targets in-year, in order to avoid a repetition of the pressures incurred in the previous financial year.
3.1.6 Anthony Browne confirmed that the CCG would be adopting the style of reporting modelled by Camden CCG with effect from the QIPP Delivery Group Meeting in early
August, followed by the Strategy and Finance Committee meeting later that month. The new format, combined with acute reporting data, will help the CCG to assess the level of financial risk better.
3.1.7 Adam Sharples highlighted that the CCG’s projected running costs were actually increasing, despite the recent organisational changes. Anthony Browne clarified that this was a function of the NHS reporting process and acknowledged that this ought to
be made clearer in future. More detail would be provided at the next meeting of the Strategy and Finance Committee. It was noted that the CCG is not permitted to spend its running cost budget on other areas of work.
3.1.8 Gino Amato suggested that if it would be helpful if the CCG could be notified of its financial allocation for the following financial year earlier than at present, to facilitate more effective planning.
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3.1.9 The Governing Body NOTED the financial position at Month 2.
3.2 Performance and Quality Report
3.2.1 Alex Smith provided an overview of the Performance and Quality Report, highlighting the following key points from the performance section:
The overall Referral to Treatment 18 Week Target was not met in April 2018,
although the CCG has been assured that that NMUH will soon be back on track
as their summer elective catch-up continues apace. A contract notice had been
issued to RFH as a result of their failure to meet this target since August 2017
Five of the eight targets for cancer had been met in April 2018. In light of regional
concern about NMUH’s achievement of the 62 day standard, the Cancer
Intensive Support Team has made recommendations which are to be addressed
in the Trust’s refreshed improvement plan
Urology and gastroenterology performance at NMUH remains challenging, with
endoscopy capacity a particular issue – as a result, NHS England and NHS
Improvement have asked commissioners to participate in a demand/capacity
review
The recent A&E performance at NMUH continues to improve and the provisional
figures for June place it 3% ahead of its improvement trajectory
Bed occupancy rates at NMUH remain high and are the single highest cause of
the trust’s performance breaches
The CCG will need to work closely with local trusts, Haringey Council and
Community Health Services to meet the target set by NHS England and NHS
Improvement to reduce ‘stranded patients’
The Community Health dashboard presented a mixed picture, with a significant
improvement in Child and Adolescent Mental Health Services (CAMHS)
performance off-set by a decrease in the percentage of Podiatry patients seen
within six weeks
Performance at the Memory Clinic has deteriorated, falling to 6.7% in April 2018.
The fact that the trust largely attributed this to workplace changes has led to the
CCG requesting a demand and capacity review. A new clinic specification is
being proposed by commissioners and GPs are being sought to strengthen the
clinical input to this.
3.2.2 Jennie Williams then provided a further update to the quality section of the report. A rapid review is being carried out following NMUH’s recent declaration of a new Never Event, concerning the insertion of an incorrect intraocular lens. A paper on the LUTS
(Lower Urinary Tract Symptoms) service will be presented at the Joint Overview and Scrutiny Committee meeting on 20 July 2018.
3.2.3 The Governing Body then discussed the report.
6
3.2.4 Simon Caplan welcomed the improvements being made in Community Services but sought assurance that these were not being achieved at the expense of patients who are already in the system. Rachel Lissauer also noted the concern that follow-up appointments are being spaced out to accommodate the introduction of additional
clinics for first appointments. Alex Smith welcomed this feedback and said that he would raise this at the next meeting of the Transformation Group.
3.2.5 Adam Sharples welcomed the establishment of an agreed basis for assessing performance and hoped that this would form the basis for improvements going forward. However, he observed that the general level of Community Services performance was significantly below where it ought to be and the lack of timely data undermined the value
of the dashboard. The fact that the majority of urgent targets are not being met was a particular matter of concern.
3.2.6 The Governing Body then discussed potential steps that could be taken to improve the performance of the Memory Clinic, including the use of interim staff. Simon Goodwin cautioned that the CCG needs to be clear whether the number of referrals is actually increasing, as it may be the case that the resource is not keeping up with the level of
activity. It was agreed that Alex Smith would provide an update to the Governing Body.
3.2.7 Catherine Herman queried whether there had been any data to inform the Trust and
the CCG on patient satisfaction with the call centre used by Community Services for booking appointments. Jennie Williams confirmed that this issue would be raised at the next meeting of the Whittington Health Clinical Quality Review Group. She suggested that it would also be worth tracking the average length of time it takes for patients to
get through to a receptionist. Rachel Lissauer noted that the Trust had acknowledged at the Improvement Working Group that more needs to be done to improve communications with the public.
3.2.8 Simon Caplan highlighted that Community Services are currently not accessible on the e-Referral System (eRS) and suggested that the CCG should address this in the next round of Commissioning Intentions.
3.2.9 Sharon Grant expressed concern about the backlog of radiology reporting, (predominantly x-rays), which was currently being reviewed by Whittington Health. Gino
Amato clarified that these x-rays would have been reviewed by a doctor at the trust who would have drawn their own conclusions about any action that might need to be taken, but it was nevertheless unsatisfactory that the results not been reported further.
3.2.10 Jennie Williams confirmed that the trust had reviewed the backlog and had not identified any incidents of patient harm. An internal root cause analysis had been undertaken and a report will be taken shortly to the next Trust Board meeting, after which it will be
presented to the Clinical Quality Review Group.
3.2.11 It was agreed that Jennie Williams would update Sharon Grant outside the meeting
about the action being taken by BEHMHT to improve the timeliness of its complaints management.
3.2.12 The Governing Body NOTED the Performance and Quality Report.
3.2.13 ACTION 12/7-3: Clare Henderson to provide an update on the Memory Clinic.
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3.2.14 ACTION 12/7-4: Jennie Williams to update Sharon Grant outside the meeting about
the action being taken by BEHMHT to improve the timeliness of its complaints management.
4. Strategy and Development
4.1 Strategic Risk Report
4.1.1 Alex Smith provided an overview of the report, highlighting the changes over the past
two months to the CCG, NCL Joint Commissioning Committee and NCL-wide Risk Registers. The CCG currently had five ‘open’ risks rated at 12 and above.
4.1.2 It was noted that a new risk around diagnostic endoscopy capacity would be opened during the next review period.
4.1.3 The Governing Body NOTED the Strategic Risk Report.
5. Governing Body Committee Minutes
5.1 The Governing Body NOTED the minutes of the Audit Committee meeting held on 27
February 2018, the Clinical Cabinet meeting held on 3 May 2018, the Finance and
Performance Committee meeting held on 27 April 2018, the NCL Joint Commissioning Committee meeting held on 5 April 2018 and the NCL Primary Care Committee in Common meeting held on 19 April 2018.
6. Any Other Business
6.1 Adam Sharples informed the Governing Body that Catherine Herman had agreed to be the third member of the Haringey CCG Audit Committee. As a consequence, Catherine Herman would be stepping down as the CCG’s lay member representative on the Joint Commissioning Committee with effect from September 2018 and Adam Sharples would
be taking over this role. 7. Date of Next Meeting
7.1 Thursday, 13 September 2018.
Draft Minutes of the
Part II Meeting of the Haringey Clinical Commissioning Group Governing Body
Thursday 12 July 2018 at 1.30pm
Cypriot Centre, Earlham Grove Present:
Dr Peter Christian PC Chair of Haringey CCG, West Lead
Helen Pettersen HP Accountable Officer, North Central London CCGs
Dr Gino Amato GA GP Governing Body Member, North East Dr Simon Caplan SC GP Governing Body Member, North East
Dr Dina Dhorajiwala DD GP Governing Body Member, West
Dr David Masters DM GP Governing Body Member, West
Dr Sheena Patel SP GP Governing Body Member, Central Lead
Dr John Rohan JR GP Governing Body Member, North East Lead
Dr Lionel Sherman LS GP Governing Body Member, Central
Dr Daijun Tan DT GP Governing Body Member, Sessional
Sharon Seber SS GP Governing Body Primary Care Health Professional Member, South East
Catherine Herman CHr Lay Member, Haringey CCG
Adam Sharples ASh Lay Member, Haringey CCG Sarah Timms ST Nurse Member, Haringey CCG
Tony Hoolaghan TH Chief Operating Officer, Haringey CCG
Simon Goodwin SGo Chief Finance Officer, North Central London CCGs In attendance:
Anthony Browne AB Deputy Chief Finance Officer, Haringey CCG
Clare Henderson CHn Director of Commissioning, Haringey CCG
Alex Smith ASm Director of Planning, Performance and Delivery, Haringey CCG
Will Maimaris WM Consultant in Public Health, Haringey Council
Steve Beeho SB Board Secretary, Haringey CCG (minutes)
1. INTRODUCTION Action
1.1 Apologies for Absence
1.1.1 Apologies were received from Jeanelle De Gruchy. Will Maimaris was attending on her behalf.
1.2 Declarations of Interest
1.2.1 There were no additional declarations of interest.
2. Minutes of the Previous Meeting
2.1 The Governing Body agreed the minutes of the Governing Body meeting held on 10 May 2018 as an accurate record.
2
3. Matters Arising
3.1 There were no matters arising.
4. Any Other Business
4.1 Tony Hoolaghan noted that the CCG would be undertaking a ‘refresh’ of clinical lead responsibilities using a similar approach to the one which Dominic Roberts had used in Islington.
5. Date of Next Meeting
5.1 Thursday, 13 September 2018.
Haringey CCG Governing Body meeting – Thursday 12 July 2018
Questions from the public (received in advance of the meeting)
Question 1 - 3 from Rod Wells, Haringey Keep Our NHS Public
Question 1 relates to Item 2.1 Accountable Officer’s report, section 2
Engagement assessment rating.
1. HKONP note that the CCG believe “Patient and community engagement
is vital when it comes to improving health services within Haringey.”
However the recent consultation on draft policy for primary hip and knee
arthroplasty (replacement) run by London Choosing Wisely-who London
CCGs I understand contracted- was a dire failure to engage with the public
in Haringey . Ref https://www.healthylondon.org/our-work/london-
choosing-wisely/
Haringey residents were given 4 days to respond to a long and technical
consultation (by 4/6/18) which most would not be aware of. We understand
that up to 30 May no notification was received by Haringey Healthwatch of
this.
These proposed changes in the way patients may expect to receive surgical
treatments would affect people for years. HKONP believe the rushed way
the consultation was done and manner it was carried out fails any
“community engagement” test
HKONP want any future consultation on changes in people’s health to be
carried out properly, in good time, and in clear and plain language and ask
what steps Haringey CCG are taking to ensure this happens in future.
Answer: The London Choosing Widely engagement was a London – wide
exercise led by the Healthy London Partnership.
Response provided by the London Choosing Wisely programme
From the patient perspective, the London Choosing Wisely programme has had
support from Healthwatch England in cascading information to London’s
Healthwatch networks, whom the programme has also been contacting directly.
The Steering Group has two patient representatives and each Task and Finish
Group also has a patient representative supporting the development of each draft
London policy. The programme is engaging directly with patient-facing groups for
the relevant treatment areas too. There have been some concerns raised about
the short timeline of the programme’s ‘sense check’ phase and wider
engagement with local patient groups. These concerns are being reviewed by
the London Choosing Wisely Steering Group and Programme Board.
Questions 2 - 3 relates to Item 3.1 Finance Report
2. I understand that the CCG has a financial plan to deliver a surplus of
£19k in 2018/19 from a deficit of £14 m and that this means
delivering “net efficiencies of £19.5m.” Any “efficiencies” could mean a
reduction in health services
Then the finance report states that “the net risk is £7.1m, (and )
the CCG does not have any reserves or mitigations set aside if these
risks materialise”
If so why is the CCG considering putting itself in this position? Is there
pressure from NHSE or the STP –North London Partners- to produce a
surplus of this size? If not should the CCG reduce the surplus and keep
more money for health services in Haringey?
Answer: The statutory requirement is to breakeven. CCGs typically budget
slightly better than breakeven, hence £19k in Haringey.
3. Given the above can the CCG explain in plain language what are the “STP Interventions” and how do you “stretch them”?
Can the CCG point me to how the “QIPP” will deliver the
“net savings of £11.8m.” as per para 4.1 - and will this involve cuts to
services?
Answer: STP interventions refer to the larger areas of QIPP (Quality, Innovation,
Productivity and Prevention) taking place across all Trusts in North Central
London. ‘Stretch’ is a term used to increase the level of efficiency where a
scheme has the opportunity to exceed original savings targets. We will ensure
language is clearer in future.
Focus on QIPP savings plans will be presented at future meetings. The CCG has
no plans to make cuts to services.
Question 4 from Liz Ciokajlo
Question 4 relates to Item 2.1 Accountable Officer’s Report - section 8
Osborne Grove Nursing Home
4. I am a daughter of a long standing resident of the home. We welcome Haringey Council's reverse decision to keep the home open and the seven remaining residents will stay before, during and after which future option is decided upon. My question is the CCG planning to protect the
residents and raise the standards to CQC 'good' standard now in all areas by employing Pamela Edam to advise improvement and implement this advice, officially raising the CQC standard to 'good'? Also how is the CCG planning to protect the residents in the event of building works and expansion, given in the past at OGNH residents’ health has been significantly impacted when moved from one wing to another? Answer: As a Local Authority owned residential nursing home the responsibility for employing staff at Osbourne Grove and ensuring that residents and patients are kept safe sits with Haringey Local Authority. The CCG’s care homes team is supporting the Local Authority and staff within the home to ensure continuous improvement of the care delivered. With regard to the protection of residents in the event of building works, the CCG has been advised by the Director of Adult Social Services that all decisions made by the council will be made in the best interests of the residents. There will be a risk assessment made prior to building works and the CQC in their regulatory role will make a decision about whether it is appropriate for regulated activities to be delivered.
Question 5 from Gordon Peters, Older Persons Group
Question 5 relates to Item 2.1 Accountable Officer’s Report - section 8
Osborne Grove Nursing Home
5. What does the CCG see its role as in keeping Osborne Grove as a
nursing home, now that Haringey Council has agreed to do that?
Answer: Haringey CCG is keen to take part in the co-design of new or expanded
facilities at Osborne Grove. The Council has set up a steering group and the
CCG will take an active role in this.
Questions 6- 7 from Anne Gray
Question 6 relates to Item 1.5 Minutes from previous meeting, section 4.1.3
6. a) if assessment of continuing care needs is done at home, what steps
are taken to carry out a pre-assessment to ensure before they are
discharged that the patient will have someone to provide meals,
shopping, basic housework, medical, washing and toileting needs
? What are patients advised to do if these arrangements break down
(e.g. if a friend/relative who does not normally reside with them breaks
their commitment to be available, perhaps for some unavoidable reason
to do with employer demands or other car-ees, or goes sick
themselves?)
b) How is continuing care coordinated with local authority domiciliary care?
c) Has the CCG evaluated the adequacy of the Home from Hospital service and are members aware of the misgivings of at least one local pensioners’ group about its adequacy?
Answer: a) The assessment of a patient’s needs prior to discharge is not undertaken by the continuing healthcare team so we cannot comment on the nature of that assessment. We are advised by the acute setting of the appropriate care package to meet the health and social care needs of the patient and commission a package accordingly. It is rarely, if ever, reliant on the ability of family members to provide care. Patients (and sometimes appropriately authorised family members) can decline CCG services if they wish to manage care themselves. In those circumstances a new application would have to be made to be re-referred for CHC assessment. If there is any breakdown in care arrangements for a funded care package the first point of call would be to the provider organisation for that care who would contact the appropriate commissioner of that care for advice, support or increased care provision.
b) Continuing healthcare does not involve local authority domiciliary care. In the event that a person is in receipt of local authority commissioned care, the funding responsibility for that care package is taken over by the CCG at the point the person is deemed eligible for continuing healthcare, which can only happen after a full assessment for eligibility. In those circumstances it has usually been an increase in care needs so the package of care is often recommissioned.
c) The Home from Hospital is commissioned by the London Borough of Haringey.
The Council evaluates the service via quarterly monitoring meetings which are informed by performance reporting from the provider (Bridge Renewal Trust). We evaluate patient satisfaction levels (surveyed by Bridge Renewal Trust after receiving a service), referral levels and outcomes against the terms of the contract, and we supplement this with wider stakeholder feedback. Any complaints would be shared with the commissioners during the quarterly evaluation or they may be received directly by the Council.
Where we receive any complaints about the service, these are investigated, and followed up with a quality assurance visit if required. We have not received any complaints regarding the service. In order to investigate the point raised in the question we would need further details which may be provided by emailing [email protected]
Question 7 relates to Item 3.2 Performance and Quality summary, section 3.3 and page 9 of the Performance and Quality summary report.
7. Will the senior CHC nurses overseeing discharge routinely
communicate discharge information to GPs, or whose responsibility will
it be? What proportion of people discharged have no GP
registration? (may be common given low GP registration rate of recent
arrivals in Haringey).
Answer: The responsibility to ensure GPs receive discharge summaries within
24 hours of the patient being transferred or discharged lies with Trusts. CHC
teams do not have a role in overseeing discharge information to GPs. It is
very unlikely that patients with CHC needs do not have a GP because they
often have a long history of complex care needs. In situations where people
are unregistered, Trusts take an active role in encouraging registration.
Questions 8 - 10 from Joanna Bornat, Haringey Keep Our NHS Public
Question 8 relates to Item 5.2 Clinical Cabinet Minutes, section 2.1.1 Update on
BEHMT Haringey Mental Health Services
8. Is the CCG satisfied with the current situation relating to the provision of community based mental health services, their staffing and co-ordination between primary and secondary care, and might the CCG press BEHMT Mental Health Services to consider whether the future role of the St Ann’s site might be used to improve community mental health service provision given that, at present, plans appear to be for adult acute services only?
Answer: The CCG works continuously with BEHMHT, and our other partners
including the Council, to improve community mental health services. For
example, we are pleased to be launching the Primary Care Link Workers in the
Central area of Haringey over the summer, bringing mental health nurses into
general practice to advise GPs and patients, and to liaise between primary and
secondary care.
We are also facilitating discussion between primary and secondary care to
explore opportunities for joint working in the new primary care buildings that will
be opening over the coming years in Haringey.
The St Ann’s site redevelopment is focused on improving the mental health
inpatient wards, and this has been identified as a priority. However, we note that
the Trust is also seeking to improve the other facilities on the site that will be
under their management in future, to ensure their community teams have
appropriate facilities to operate from.
Question 9 relates to Item 5.4 Joint Commissioning minutes, section 3.1 Whittington Health Lower Urinary Tract service
9. Could the CCG provide an update on the situation with the Lower Urinary Trace Service at the Whittington Hospital, given that this service
has yet to be restored after a very long period of closure and request dates for the ‘phased re-opening’ ( see minute 3.19) of this service?
Answer: Following a meeting of the Joint Commissioning Committee (JCC) of
North Central London CCGs and the Whittington Health NHS Trust Board, the
LUTS clinic has re-opened to new patients.
In order to re-open the clinic the Islington Clinical Commissioning Group (CCG)
and Whittington Health Trust Board has approved a Commissioning Service
Specification, which meets the recommendations set out in the report from the
Royal College of Physicians (RCP) Invited Review.
The RCP report says: “Based on all of the information considered by the review
team it was concluded that significant changes need to be made to ensure the
safety of patients currently being treated by the LUTS clinic.”
The Royal College of Physicians (RCP) Invited Service Review Panel
recommended that “until the future of the service has been determined by the
Trust and commissioners, no new patient referrals should be accepted into the
LUTS clinic”. In line with this recommendation the clinic has remained open to
existing patients, but the Trust has not accepted any new referrals since October
2015. Any clinician who wrote to make a referral during that time was advised
that the referral would not be accepted and that they should refer their patient
elsewhere. There is therefore no waiting list or backlog of patients for the
Whittington Health LUTS clinic.
A more detailed update on the LUTS clinic is available on Whittington Health’s
website.
Question 10 relates to Item 5.3 Finance and Performance Committee Minutes, section 2.6
10. Reference is made to the possibility of cutting down on contracts in order to prevent overspend. Could the CCG provide reassurance that this will not mean loss of provision of services or to any reduction in plans for service development for local people? And could the CCG also note that much of this important paper is not written in a way that is easily understood by members of the public?
Answer: Haringey CCG will be facing very difficult choices over the coming year
as we have a large savings programme to deliver, however, we do not have
plans in place to reduce current provision. Our focus will be on continuing to
transform services that will provide care closer to home and better value for
money. This includes continuing to focus on areas such as reducing variation in
primary care, supporting people at home, introducing new ways of working such
as tele-dermatology and working with partners to take cost out of the system.
Your second point has been noted.
Page 1 of 2
Haringey CCG Governing Body: Action Log Item 1.6
Meeting Date
No. Action Description Lead Action Taken
12.7.18 1 Action Log To speak to Sheena Patel outside the meeting regarding assurances
about the volume of rejected e-referrals.
Jennie Williams Jennie Williams has liaised with Sheena Patel and Denise Pettit outside the meeting. There have been no formal escalations regarding rejections but will be kept under review.
12.7.18 2 Matters Arising To arrange for consultations to be
promoted more effectively.
Tony Hoolaghan The CCG Communications Team is looking into ways of raising awareness of consultations via the CCG website.
12.7.18 3 Performance and Quality Summary Report To provide an update to the
Governing Body on the Memory Clinic.
Clare Henderson An update is included in section four of the Performance Report. Healthwatch and other carer representatives have been
invited to be core members of the Dementia Strategy Group. The group is multi-agency and works together to create effective partnership-working, with an emphasis on improving the experience for people with Dementia and their
carers via a dementia care delivery plan. The membership of the group has been extended in order to ensure wider engagement and support of the delivery plan.
12.7.18 4 Performance and Quality Summary
Report To provide Sharon Grant with more detail about the action being taken
by BEH MHT regarding its failure
Jennie Williams An email summarising the action taken by the Trust was
sent to Sharon Grant on 12.7.18.
Page 2 of 2
to meet its complaints management performance target.
Haringey Clinical Commissioning Group Governing Body Meeting 13 September 2018
Report Title Accountable Officer’s Report
Date of report 27 August 2018
Agenda Item
2.1
Lead Director /
Manager
Helen Pettersen Tel/Email [email protected]
GB Member Sponsor
Not applicable.
Report Author
Tony Hoolaghan Chief Operating Officer
Tel/Email [email protected]
Report Summary
This report updates the Governing Body on developments in the local NHS and wider policy issues.
Recommendation The Governing Body is asked to NOTE the Accountable Officer’s Report.
Identified Risks
and Risk
Management
Actions
Not applicable.
Conflicts of Interest
Not applicable.
Resource
Implications
Not applicable.
Engagement
Not applicable.
Equality Impact
Analysis
Not applicable.
Report History and
Key Decisions
Not applicable.
Next Steps Not applicable.
Appendices
Not applicable.
Accountable Officer’s Report
1 Introduction
1.1 This report focuses on the key activities that the senior team and I have been involved in since the
last Governing Body meeting and work progressed.
2 Haringey and Islington Wellbeing Partnership Expression of Interest to Healthy London
Partnership
2.1 In June, London areas were invited by the Healthy London Partnership (HLP) to put forward
expressions of interest to set out the ways how they might use the flexibilities of devolution in
London to progress with integration. These flexibilities include more joint regulation to support
joint working or support to enable people to work across transitional health and social care
boundaries. Haringey and Islington Wellbeing Partnership submitted a bid in which we set out an
ambition to test an expansion of our Care and Health Integrated Network (CHIN) work within two
geographical areas, one in Haringey and one in Islington. We would develop these as
'prototypes' of a holistic approach towards improving health and wellbeing within an area,
drawing on all assets and the full range of services available. Within the Welllbeing Partnership
there is an agreement that this work will be progressed locally and would be supported by , but is
not dependent on, additional resource through Healthy London Partnership.
3. Wellbeing Week
3.1 To mark our annual Health and Wellbeing week for our staff, we are hosting a range of activities
taking place from 24-28 September for all staff at Haringey CCG. The week is an opportunity to
promote the importance of staff wellbeing in the workplace. Our staff involvement group are also
taking a lead on the preparation for the week by hosting a range of activities. The week was a
huge success last year. We will also be applying for the London Workplace Charter to highlight
the work we do to support our staff wellbeing.
4. Draft Strategy for General Practice
4.1 NCL Clinical Commissioning Groups are developing a refreshed strategy focusing on general practice and which builds on previous collaborative strategies for NCL. A draft strategy has been developed through a dedicated task and finish group, which also included representation from CCGs, Healthwatch, nursing and the NCL GP federations. This group met six times between March and June 2018. We are now in the process of engaging on this draft. The timeline has been lengthened until October and November 2018, for the Primary Care Committee in Common and CCG Governing Bodies’ respective approvals.
4.2 Engagement is being clinically and locally led by each CCG through patient and public forums,
GP locality meetings, LMC meetings, primary care development meetings and letters to local
councillors. Where it is appropriate, some engagement is being done once across NCL e.g. Joint
Health Overview and Scrutiny Committee (JHOSC) and the Primary Care Committee in
Common.
4.3 Feedback to date has indicated that stakeholders would like to see greater clarity on what our
key priorities are (less is more), clearer examples of what will be different for patients, what
investment is available, stronger messages on prevention and self-care and a clearer message
on our vision for the workforce and new ways of working (e.g. using pharmacists in general
practice, portfolio working for GPs). All feedback is being considered as part of the development
of the final draft of the strategy.
5. GP Patient Survey
5.1 The results of the national GP survey have been published this month by NHS England. This
year’s survey has been extensively redesigned - the aim is to help better understand and shape
areas for improvement in people’s experiences of general practice and evolving approaches to
delivering GP services. This means the majority of questions are not comparable with previous
years, and that no comparable data will be published by NHS England. CCGs in NCL will be
reviewing their data packs to consider the findings and identify the actions needed to deliver
improvement – particularly in relation to what patients have said about access.
5.2 Haringey CCG noted the slight overall improvement in overall satisfaction, from 79% to 80%, so
closer to the national average which dropped from 85% to 84%. There is significant variation
between practices, and our focus is on working with the practices that are at the low end of
patient satisfaction. Low patient satisfaction is a potential indicator of other performance issues.
6. Haringey CCG: Maternity and Cancer CCG assessments
6.1 In August, Haringey received its 2017/18 CCG assessments for cancer and maternity. The
assessments are based on performance against the indicators in the Integrated Assurance
Framework (IAF) for CCGs for these clinical areas. Haringey received a rating of ‘good’ for
maternity and ‘requires improvement’ for cancer.
6.2 Although the cancer IAF indicator for early stage diagnosis was achieved, patient experience,
one year survival rates and the 62 day urgent referral to treatment standard were not at the level
required. The focus that is being given in primary care regarding early diagnosis will ultimately
support improvements in survival rates and there is an improvement plan in place supported by
the cancer collaborative, CCG and NHSI regarding 62 day performance. A plan to improve
patient experience of cancer services at NMUH is also in place.
6.3 Contributing to the successful maternity rating has been progress between partners to improve
women’s experience of maternity services. We would like to thank all staff from across the
system involved in delivering these improvements and will continue to work with partners to
improve cancer services and outcomes across out system.
7. St Ann’s Hospital update 7.1 Barnet, Enfield and Haringey Mental Health Trust is rapidly progressing the plans for the brand
new mental health inpatient wards and other improvements at St Ann’s Hospital in Haringey . Plans will see the proceeds from the surplus land no longer needed for healthcare, which was sold to the GLA in March 2018, reinvested into the building of the new wards and other improvements.
7.2 The Trust expects to receive final approval from NHS Improvement in September this year. It has
already received final planning approval from Haringey Council in March 2018. Initial building work is due to begin around November 2018, with completion of the new inpatient building by late 2020 and the other improvements by late 2022.
7.3 The plans have widespread support, with backing from Haringey Council, Haringey CCG and wider stakeholders following two extensive public consultations and on-going stakeholder engagement. The project is affordable and will bear no additional costs to the Trust or NHS commissioners with the new facilities being fully funded from the sale of the surplus land.
Haringey Clinical Commissioning Group Governing Body Meeting Thursday 12 September 2018
Report Title STP Programme Update
Agenda Item
4.1
Governing Body
Sponsor
Helen Pettersen Accountable Officer
Lead Director /
Manager
Will Huxter NCL Director of Strategy
Email [email protected]
Report Author
Will Huxter NCL Director of Strategy
Email [email protected]
Report Summary
The report provides an update on the work of the Sustainability and Transformation Partnership (STP) since April 2018. The aim is to ensure that Governing Body members are aware of the current and planned work being undertaken as part of the STP.
Recommendation The Governing Body is asked to NOTE the report.
Identified Risks
and Risk
Management
Actions
Not Applicable
Conflicts of Interest
Not Applicable
Resource
Implications
There are no direct resource implications arising from this report.
Engagement
Not Applicable
Equality Impact
Analysis
Not Applicable
Report History and
Key Decisions
This report is a follow-up to previous STP update reports.
Next Steps Not Applicable
Appendices Six Monthly Report
STP Programme update
Haringey CCG Governing Body 13 September 2018
Will Huxter, Director of Strategy
Barnet, Camden, Enfield, Haringey & Islington CCGs
Ambition for the STP is built on existing CCG, Local
Authority and Provider values and strategy
Improve the health and wellbeing of the
local population
Reduce health inequalities
Maximise out of hospital care and build resilient
well supported communities
Ambitions of the STP
A partnership of the NHS and local authorities, working together with the public and patients where it’s the most efficient and effective way to deliver improvements.
NLP Governance Structure
The Adult Social Care Programme runs alongside the STP workstreams
4
The STP has no formal decision-making authority, beyond management of the
agreed programme, and the delegated budget for the STP central team.
Statutory bodies retain responsibility for decisions on funding commitments and
endorsement of the STP priorities.
Increasingly, the STP is being asked by NHS England and NHS Improvement to
co-ordinate and submit NCL-wide bids for funding – e.g. for Wave 4 capital, and
for digital revenue and capital. These are formally signed off by Helen Pettersen
as STP Convenor, on recommendation from the relevant STP workstream.
The Joint Commissioning Committee has delegated authority for acute
commissioning on behalf of the 5 CCGs. The Primary Care Committee in
Common has delegated authority for primary care commissioning on behalf of
the 5 CCGs.
Key points about STP governance
5
Summary: Clincal and care workstream objectives
Workstream High level objectives
Urgent and Emergency Care • A consistent and reliable UEC service by 2021 that is accessible to the public, easy to navigate, inspires confidence, promotes consistent standards in clinical practice and leads to a reduction in variation of patient outcomes. Work focussing on Admissions avoidance, ambulatory care, end of life and discharge to assess.
Health and care closer to home
• A ‘place-based’ population health system of care base around neighbourhoods of 50-80k which draws together social, community, primary and specialist services underpinned by a systematic focus on prevention and supported self-care.
Mental Health • Working to address inequalities for those with SMI and provide consistent care. • Deliver services closer to home, reducing demand on the acute sector and mitigating the need for additional MH
inpatient beds.
Adult Social Care • Working to address care inequalities in provision and improving longer term strategic approach to workforce and care market.
Maternity • Delivery of the National Maternity Transformation programme through improved continuity and safety of perinatal care for women, working across professional and organisational boundaries to drive better patient experience and integrated care.
Children and Young people • Delivery of Health and social care services which are equitable, accessible, responsive and efficient, delivered locally wherever possible. Working closely with social care and council services to increase focus on promoting wellbeing, reducing health inequalities and improving social outcomes such as school readiness.
Cancer • Focus on the delivery of improved survival, reduced variation, improved patient experience, efficiency of service delivery including services closer to home, and, reduced costs and financial sustainability.
Planned Care • Deliver better value planned care, delivering efficiency savings and reducing unwarranted variation in planned care across providers.
• Review of orthopaedic services across providers.
Prevention • Driving system-wide approach to prevention and population health working to enable success in the overall STP strategy for care.
UEC
• One of the first areas nationally to launch the new integrated urgent care model. This means that more people in NCL ringing 111 now speak directly with a clinician to try to resolve their issue.
• ‘Star divert numbers’ enable clinical staff to get through to a clinical expert for urgent advice and support by dialling the appropriate number. For 2017/18 star l ine activity increased 42%, from 751 calls in May 2017 to 1068 calls in April 2018 with a total of 11,929 calls recorded across the period.
• Mental health patients can now ring 111, and be directly transfer to crisis team for advice and support. 16 people in April who rang 111 with mental health issues were successfully transferred to a mental health team.
• Successful bid for enhanced mental health liaison services in A&E at University College Hospital in 2017/18, and North MiddlesexUniversity Hospital in 2018/19. This will enable us to place more mental health staff in hospitals so patients’ physical and mental health needs are cared for holistically.
• We have made it faster and safer for patients to get home from hospital by agreeing standard ways of working and working moreeffectively with social care. Use of the new discharge to assess pathways has increased by 50% over the past six months.
Planned Care
• Clinical advice & guidance now live across providers in NCL in 8 specialities with further specialties going live in November 2018.
• Tele-dermatology service to go live in 2018/19 to improve patient experience and performance for waiting times.
• Review of adult elective orthopaedic care commenced in March 2018 . Our ambition is to create a comprehensive adult elective orthopaedic service for NCL, which will be seen as a centre for excellence with an international reputation for patient outco mes and experience, education and research.
Health and Care Close to Home
• Since April 2018 it has been possible for residents to access GP services 8am-8pm across the whole of NCL through extended access.
• Established the first NCL Care and Health Integrated Networks and Quality Improvement Support Teams, focusing on improving quality and reducing unnecessary variation.
Mental Health
• Our perinatal mental health service operates across the five boroughs. Our community specialist perinatal mental health service s aw an additional 400 women in 2017/18 and plans to reach an additional 600 women in 2018/19.
• A new women’s psychiatric intensive care unit at Camden and Islington NHS Foundation Trust service opened in November 2017. A l l women who require intensive care services can now be treated close to where they live. All women have been repatriated back f rom out of area placements (OAPs) and we currently have zero women in OAPs.
Tangible benefits and delivery to date:
Overview of programmes impact and leadership
Ma
jor
fin
an
ce a
nd
act
ivit
yim
pa
ct fo
r 1
8/1
9
Workstream and leads Programme Primary impact Major Independencies
UECSRO: Sarah Mansuralli C CCG
Clinical leads:Chris Laing
Shakil Alam
Integrated urgent care £, Quality & Performance Digital
Admission avoidance £, Quality & Performance Digital, Workforce
Simplified discharge £, Quality & Performance Digital, Social Care
Last Phase of life £, Quality & Performance Digital, Social Care
Planned CareSRO: Marcel Levi
Clinical leads: Debbie Frost
Richard Jennings
Using NHS money wisely (POLCE) £, Q, Learning: Enactment of policy -
Clinical Advice and Navigation £, Q, Learning: working across acute & primary care Digital
Dermatology £, Q, Perf & Learning: Use of digital pathway Digital
Urology £ & Learning: upskill primary care HCCH
Orthopaedic review Proposed reduction in variation Q and £ -
Health and Care Closer to Home
SRO: Tony Hoolaghan H&I CCG Clinical lead: Katie Coleman
CHIN/Neighbourhood development Population health and wellbeing Workforce, Estates, Digital
Quality Improvement £ & Reduction in primary care variation Workforce
Social Prescribing Reduction in primary care variation Workforce
Mental HealthSRO: Paul Jenkins
Clinical leads: Vincent Kirchner
Jonathan BindmanAlex Warner
Improve the acute care pathway Reduction in bed requirement in future HCCH, Social Care
Improvement to CAMHS Quality improvements CYP
Mental Health Liaison services Quality and £ and perf UEC
Primary Care mental health (Inc. IAPT) Q & £ and Perf HCCH
Mental Health Workforce Future workforce development
MaternityDonald Peebles
Mai Buckley
Quality and safety Quality Digital
Improving personalisation and choice Quality Digital
Single point of access £ and Quality Digital , Workforce
Community services development Quality & NHS E recommendation HCCH
NCL collaborative working £ and Quality Workforce
PreventionSRO: Julie Billett
Workforce for prevention Referrals to preventative services (inc MH) Workforce
Healthier environment Employee health and wellbeing and sickness rates Workforce
Healthier choices (maternity and Frailty) Child health outcomes, independent living Maternity, UEC
CancerSRO: Kathy Pritchard-Jones
Sustained delivery of cancer waits Quality & Performance Diagnostics capacity
Early diagnosis Quality (lives saved) HCCH, Prevention
Living with and beyond cancer Quality HCCH, Planned
Children and Young PeopleSRO: Charlotte Pomery
Paediatric surgery Quality UEC
Asthma Quality Prevention, HCCH
School readiness by 5 Child outcomes -
Paediatric admissions avoidance £, Quality and Performance UEC
EstatesSRO: Simon Goodwin
Develop NCL estates strategy Strategic priority, £, Quality improvement All
St Pancras development – C&I FT £, Quality improvement Mental Health
St Ann’s development - BEH £, Quality improvement All
Project Oriel Quality Improvement -
Reducing void spaces £, quality improvement All
DigitalSRO: David Sloman
Health Information Exchange Enabler for £ and Quality improvements Clinical Workstreams
Population Health Management Enabler for £ and Quality improvements Clinical Workstreams
WorkforceSRO: Siobhan Harrington
UEC preparation winter 2019 Performance and quality UEC, HCCH, Social
Portability (including passports, MAST) Performance and £ UEC, Maternity, Cancer
Temporary Staffing £ Provider productivity
Social & Primary care/Community/Place based Long term quality HCCH , Social Care
Analytics (workforce planning) £ enabler for new clinical models Digital
Overview of programmes impact and leadership
Provider Productivity
SRO: Tim Jaggard
Workforce £ Workforce
Procurement £ -
Facilities management £ -
Diagnostics £ and Quality Planned Care
SocialCare
SRO: Dawn Wakeling
Independent Care Sector Workforce Capacity and Quality HCCH, UEC, Workforce
Social Care Markets Increased Capacity & Quality; £; HCCH, UEC, MH, Workforce
Overview of programmes impact and leadership
Dedicated capacity now in place across majority of workstreams to facilitate working across partner organisations to deliver agreed STP initiatives.
Capacity to facilitate change
Workstream Programme lead Email Address
Adult Social Care Richard Elphick [email protected]
Cancer Nasar Turabi [email protected]
Children and Young People Sam Rostom [email protected]
Digital Interim to start in September [email protected]
Estates Dianne MacDonald [email protected]
Health and Care Closer to Home Sarah McIlwaine [email protected]
Maternity Julie Juliff [email protected]
Mental Health Chris Dzikiti [email protected]
Planned Care Donal Markey [email protected]
Prevention Mubasshir Ajaz [email protected]
Productivity Shahbaz Bhutta [email protected]
Orthopaedic review Anna Stewart [email protected]
Urgent and Emergency Care Alex Faulkes [email protected]
Workforce Sarah Young (interim) [email protected]
Digital: plan to deliver by 2020
11
Enable information to flow between all NHS providers and local authorities within NLP
Optimise spend on health and care information sharing across NLP
Enable population health management capability for NLP
Implement international IT standards to enable interoperability and support integrated care
Activate person held records (PHR) for NLP residents
Adult elective orthopaedic services review
• We think there may be opportunities to improve adult elective orthopaedic surgery in north central London by consolidating services onto fewer sites
• We are undertaking a review of these services to see if these improvements can be achieved
• The review has been established by North London Partners in Health and Care
• A review group led by local clinicians is coordinating the development of how this kind of care could be delivered in the future
• Clinical commissioners will make decisions on where and how this happens
• The review covers services in Barnet, Camden, Enfield, Haringey and Islington
12
Stages of the review
Stage 1Engage to get feedback on the draft case for change Propose a service model describing how services might be delivered in future, informed by feedbackStage 2Clinical commissioners consider the feedback from the engagement, agree a service model
Produce a pre-consultation business case
13
• Patients & residents• Providers• Clinicians• Clinical Commissioners
engagem
ent
Principles underpinning this review
• Co-production (everyone working collaboratively) • Evidence based service model (using evidence from trusted sources)• Clinically led collaborative approach which enables meaningful
engagement with all stakeholders, particularly front line clinical staff and the public (people involved in delivering and receiving care)
• Independent experts to provide challenge and advice• Sharing what we learn• Clear separation of decision-making functions • Flexible timelines to ensure we are properly engaging with
stakeholders and the public
14
Leadership and Review Group
Chair: Professor Fares Haddad (UCLH)CEO Sponsor and Project SRO: Rob Hurd (RNOH)
Review Group Members:Clinical representatives from each of the five largest providers of adult orthopaedic servicesTwo clinical commissioning representatives from NCL CCGsNHS England Specialised CommissioningTwo patient and public representatives (recruited by Healthwatch)NHS England Strategy and Reconfiguration
In attendance:Trust management leads from each of the five largest providers of adult orthopaedic servicesProgramme Director and Programme ManagerOther workstream leads as required
15
Adult elective orthopaedic services review
• We think there may be opportunities to improve adult elective orthopaedic surgery in north central London by consolidating services onto fewer sites
• We are undertaking a review of these services to see if these improvements can be achieved
• The review has been established by North London Partners in Health and Care
• A review group led by local clinicians is coordinating the development of how this kind of care could be delivered in the future
• Clinical commissioners will make decisions on where and how this happens
• The review covers services in Barnet, Camden, Enfield, Haringey and Islington
16
Ways to feed back
Seeking feed back by 19 October 2018
•Read the full case for change on our website:www.northlondonpartners.org.uk
• Email us: [email protected]
•Complete our online questionnaire
•Write to us: North London Partners in Health and Care, 5th Floor, 5 Pancras Square, London N1C 4AG
*Additional time will be allowed to hear more views if required
17
Financial benefits 2018/19:
• £35m worth of QIPP plans aligned to STP workstreams
• Successful with bid for 2 grants with Department of Health for Beyond Places of Safety worth £1.0 m and £0.8m
• £500k grant awarded from Health Education England
• £100k funding for engagement
• £100k awarded via RightCare to take forward work on Cardio Vascular Disease prevention
• NHS E funded dementia project manager
Breakdown of STP financial benefits (NCL-wide)
Supporting local QIPP plans and focus on delivery at scale
19
• Urgent and Emergency Care, Planned Care and Health and Care Close to Home workstreamsaligned to CCG QIPP plans to support in year financial delivery. This aligns to approximately £35m of acute QIPP schemes across NCL.
• Across the STP there has been close working with local CCG teams to align plans across the NCL CCGs, spread good practice and support CCGs to add to their pipeline opportunities.
• This work has resulted in a shared set of priorities across acute contracts (next slide). This will allow the opportunity for greater collaboration and implementation at pace and scale.
• STP and local teams are working through ‘local delivery teams’ at each acute site to drive changes and unblock issues. This includes directly supporting implementation of new ways of working and acceleration of local work.
• Work is underway to quantify new pipeline schemes that can feed into individual CCG QIPP plans.
NCL wide priorities delivery at scale:
Across NCL, the top schemes by value are shared across the four main acute providers. These are summarised below:
20
Number of times scheme appears within top 15
Workstream Royal Free NMUH UCLH Whitt Total
Planned Care POLCE 1 1 1 1 4Planned Care Diagnostics - Pathology 1 1 1 1 4UEC Adult Admission Avoidance - Rapid Response Services 1 1 1 1 4UEC Ambulatory Care 1 1 1 1 4UEC Simplified Discharge 1 1 1 1 4UEC IUC 1 1 1 1 4UEC Last Phase of Life 1 1 1 1 4Health and Care Closer to Home CHIN & QIST initiatives combined 1 1 1 1 4Planned Care MSK 1 1 1 1 4UEC Reducing NEL Admissions for Children 1 1 1 3UEC ED Front Door Streaming & Redirection 1 1 1 3Planned Care Gastroenterology & Colorectal Surgery 1 1 2Planned Care Clinical Advice and Navigation (CAN) 1 1 2Planned Care Gynaecology 2 2Planned Care Camden Clinical Assessment Service (CCAS) 1 1Planned Care Urology 1 1Health and Care Closer to Home Universal Offer Review 1 1Planned Care Teledermatology 1 1 1 1 4UEC HIU / LAS - Frequent Attenders 1 1Planned Care Dermatology - minor skin lesions 1 1UEC Stroke Prevention 1 1Planned Care STT Cancer Pathway 1 1
Haringey Clinical Commissioning Group
Governing Body Meeting Thursday, 13 September 2018
Report Title System Intentions for 2019/20: Haringey CCG
Date of report 30 August 2018
Agenda
Item
4.2
Lead Director /
Manager
Paul Sinden, Director of Performance, Planning and Primary Care Alex Smith, Director of Planning, Performance and Delivery Clare Henderson, Director of Commissioning
Tel/Email [email protected] [email protected] [email protected]
GB Member Sponsor
Not Applicable
Report Author
Seonaid Henderson, Head of Performance and Planning
Tel/Email [email protected] 0203 688 2785
Report Summary
This report sets out system intentions and provisional commissioning intentions for 2019/20, and the backdrop to the development of North Central London (NCL) System Intentions for 2019/20. It should be noted that these are provisional system/commissioning intentions and are subject to change as the financial impact of them is assessed.
Recommendation The Governing Body is asked to:
NOTE the report; and
COMMENT on this iteration of System Intentions and local Commissioning Intentions for 2019/20.
Identified Risks
and Risk
Management
Actions
The main risks to delivering system intentions for 2019/20 are:
The need to align CCG and provider operating plans to support a reduction in system costs; and
The need to better align system incentives to support delivery of System and Transformation Plan (NCL) priorities and reduce system costs.
Conflicts of Interest
The report was prepared in accordance with conflict of interest guidance
Resource
Implications
Plans for 2019/20 will need to be developed within CCG resource envelopes and encompass run-rates from 2018/19 adjusted for demographic growth, the impact of the NCL Sustainability and Transformation Plan (STP), local QIPP interventions, and the impact of national planning guidance.
Engagement
Intentions should reflect the priorities identified through engagement with patients and public. Local CCG engagement timelines will be built into the process for generating system intentions, as well as being informed by on-going engagement structures. Haringey CCG strives to engage with patients, partners and residents throughout the commissioning cycle to ensure that local people have a voice. We have a strategic approach which is set out in our engagement strategy to demonstrate how we involve patients and wider stakeholders in services we commission. In 2018, the CCG was rated ‘Green’ as part of a national assessment undertaken by NHS England. Haringey CCG wants to make real and sustainable improvements to the health and wellbeing of the people living in the borough. Effective engagement will help us to improve health outcomes and make the best use of public resources. We will continue to work with patients, carers, and the public to listen to their views, and we will continue to involve them in decisions about commissioning, developing, and improving health services.
Equality Impact
Analysis
The report was written in accordance with the provisions of the Equali ty Act 2010.
Report History and
Key Decisions
System Intentions for 2019/20 were considered by the Joint Commissioning
Committee Seminar held on 5 July 2018 and by the Joint Commissioning
Committee held on 2 August 2018. The System Intentions for 2019/20 were
considered at the Strategy and Finance Committee on 30 August 2018.
Next Steps System intentions and commissioning intentions for 2019/20 will be further
developed with feedback from:
CCG Strategy and Finance Committees;
The five NCL CCG Governing Bodies in September 2018;
The NCL Sustainability and Transformation Plan Chief Executives Group
(commissioners and providers) in September 2018;
The outcome of the NCL STP Integrated Care Systems workshop to be held in
October 2018;
Priorities set out in the NHS Ten-Year Plan to be published in autumn 2018.
Before 30 September 2018 all providers in North Central London will have been
sent intentions and supporting technical guidance (with notice where required) for
2019/20.
Appendices
1. Haringey CCG Notices
1. Introduction
This report sets out system intentions and provisional commissioning intentions for 2019/20, and the
backdrop to the development of North Central London System Intentions for 2019/20.
Any service changes described in this report are also subject to scrutiny via a business case at the
relevant committee or board, during the course of the commissioning cycle, which evaluate the quality,
safety, financial viability and strategic fit of any proposal. Commissioning intentions therefore do not
represent formal commitments to act, but do ensure commissioners have legally given notice on the
pipeline of activities they would like to work jointly with providers on, as notice needs to legally be given
to exit contracts or change service configurations in alignment with a strict planning timetable.
Intentions for 2019/20 will consist of the following:
1. System intentions - Following on from the after action review of the 2018/19, contract round system
intentions for 2019/20 seek to identify a few high-level priorities, agreed by all parties to the STP that
will then be translated into operating plans and provider contracts for the year;
2. Commissioning intentions – that provide a more detailed view of how system intentions will be
delivered locally, plus any local intentions for CCGs that sit outside of the STP; and
3. Supporting technical guidance – identifying any areas requiring formal contract notice to providers
for 2019/20
System intentions and commissioning intentions for 2019/20 will be further developed in response to feedback from:
CCG Strategy and Finance Committees;
The five NCL CCG Governing Bodies in September 2018;
The NCL STP Chief Executives Group (commissioners and providers) in September 2018;
The outcome of the NCL STP Care Systems workshop to be held in October 2018; and
Priorities set out in the NHS Ten-Year Plan to be published in autumn 2018.
Before 30 September 2018 all providers in North Central London will have been sent intentions and
supporting technical guidance (with notice where required) for 2019/20.
2. System Intentions
The high-level priorities for 2019/20 seek to focus on what is best required to meet the needs of the local
population, rather than taking an institutional approach. NCL will seek support for the collective
commitment to reduce system costs and to ensure that any unintended consequences of that for
individual organisations is mitigated.
To take this forward there will need to be a single local delivery plan for the year for both commissioners
and providers, with the plan developed and signed-off by combined clinical and executive leadership to
assure inclusion in operating plans and delivery during the year. Local Delivery Groups, aligned to each
provider, will lead in-year delivery.
The high-level system priorities for 2019/20 to address the strategic challenges faced by NCL are
identified below:
A focus on prevention to tackle the broader determinants of health and reduce health inequalities,
and to deliver this, extend the scope of work with the third sector and utilisation of community
assets;
Further developing integrated care systems across health and care services as part of our move to
population based health models and to better tackle the broader determinants of health;
To support our move to population based health models this means redefining community services
contracts to an outcomes based approach for future years, allowing greater flexibility in service
redesign to support the development of Care and Health Integrated Networks (CHINs), and
establishing integrated services across health and care for admission avoidance and discharge from
hospital;
Building resilience in general practice including developing primary care at scale alongside the
emerging GP Federations;
The redesign of outpatient pathways building on service models developed in 2018/19 including
Clinical Advice and Navigation;
Continuing to deliver value and reduce variations in care, building on the work to date in both
primary care and secondary care to reduce unwarranted variations in care;
Delivering investment in prevention and primary care will require historic growth in acute contract
baselines to be halted. Aligned to this, system intentions are designed to deliver off -setted cost
reductions for acute providers. This will be supported by:
Joint work on provider cost improvement plans and CCG QIPP programmes to help providers
reduce their costs; and
Joint development of system incentives as below;
Trialling new system incentives and contract forms to promote a reduction in system costs and
better align incentives to the service models being developed through the NCL STP:
In 2019/20 to support STP service developments a focus on outpatient and elective pathways,
community services outcomes, and streaming in emergency departments to support urgent
treatment centre designations and winter resilience are proposed;
CCGs will also work with providers on opportunities for whole contract form changes for adoption in
2019/20 or future years; and
In preparation for contracts for 2019/20 and onwards, CCGs would therefore like to ‘shadow-run’
alternative contract forms in 2018/19 to ensure that any changes support delivery of the STP and
balance risk equitably across the system.
The delivery of enablers for the above, including:
Roll-out of the Health Information Exchange across North Central London;
Provider collaboration initiatives including opportunities for common procurement, repatriation of
activity, and exploring further opportunities for mutual aid across providers to support delivery of
NHS Constitution targets for cancer, referral-to-treatment times, and A&E;
Delivery of the estates strategy for NCL based on the one-public estate approach to support the
development of a place-based approach to our community estate and increase operational
efficiency; and
Workforce, including the work by Community Education Provider Networks (CEPN), to develop the
workforce to support our strategic service changes with a focus on skill-mix, recruitment and
retention, collaboration across providers including “passporting”, and portfolio careers.
3. Commissioning Intentions
The information below sets out how Haringey CCG intends to achieve the priorities within the 2019/20
system intentions and any other local intentions it is required to issue. These intentions are provisional at
this stage and have been developed through the following process:
Commissioning managers in each commissioning area have collated intentions based on their
work programme, giving due to regard to the Joint Strategic Needs Assessment (JSNA), relevant
national or regional guidance/policy, patient and public feedback, contract and outcome
monitoring, value for money analysis and any available assessments of quality and safety.
The Executive Management Team (EMT) and Heads of Planning and Performance from
Haringey and Islington CCGs have undertaken a joint review taking into account fit with NCL
STP strategy and local business plans.
EMT and Heads of Planning and Performance have determined which commissioning intentions
require a formal notice (see Appendix 1) and which of those are already part of an existing
workplan which might lead to future transformation, for example, joint work to develop a new
MSK clinical model.
The next steps are for feedback to be collated on both the system intentions (Joint Commissioning
Committee (JCC), all five CCG Governing Bodies and Strategy and Finance Committees) and
commissioning intentions (Haringey and Islington CCG Governing Bodies and Strategy and Finance
Committee). This will allow intentions to be further refined ahead of formal notice being given on 30
September 2018 to all providers in NCL. It should be noted that further intentions are likely to be added
as work to agree consistent QIPP initiatives across the STP continues.
Community and Acute Commissioning Intentions:
Haringey CCG intends to achieve the priorities within the 2019/20 system intentions through the
following community health and acute intentions:
As part of the Wellbeing Partnership, commissioners and providers have agreed to collaborate in
the development of a new MSK clinical model for Haringey and Islington which will include, a
single point of clinical triage, increased community provision and a programme of provider led
improvements to existing services. This pathway redesign is aligned to national best practice and
aims to ensure more people are treated in community based care.
As part of the Well Being Partnership programme of work to improve intermediate care, Haringey
CCG intends to review and re-specify the Community Rehabilitation Teams service to deliver
improvements for Haringey service users.
As part of the Wellbeing Partnership programme of work to improve services for Children and
Young People within Haringey, a joint review of Specialist Therapies will take place with the
London Borough of Haringey which aims to agree new specifications being agreed for all
therapies. This will deliver earlier intervention and prevention of speech and language issues.
As part of the Wellbeing Programme, Islington and Haringey CCGs will review against best
practice all elements of our frailty services in order to consider the current provision and identify
any gaps or priority needs. This will be done in a way that is aligned to guidance contained in
NHS England’s ‘Frail older people – Safe, compassionate care’ practical guide for commissioners
and will ultimately aim to support people in community settings better and reduce unnecessary
hospital admissions.
Haringey CCG intends to draft a new service specification and model for children's community
nursing provided by North Middlesex University Hospital. The new model will aim to ensure more
children can be cared for in community settings, without the need for hospital
attendance/admission.
As part of NCL wide work to develop primary care at scale and strengthen care closer to home,
wound management and leg ulcer treatment services will be procured at CHIN level. This work
aims to ensure better outcomes for patients, ensuring community services are proactive and high
quality, in a way that reduces the need for hospital attendance.
As part of NCL wide work to improve Urgent and Emergency Care, Haringey CCG and Islington
CCG will be exploring opportunities to align and integrate our stroke and neuro-rehab pathways
and community and inpatient rehabilitation services in order to improve and expand access to
Early Supported Discharge (ESD). This will improve outcomes for patients and enhance their
recovery. Aligning and integrating pathways will also improve value for money.
In alignment with NCL wide work, Haringey CCG will seek to develop revised payment
mechanisms that incentivise providers to focus on overall pathway outcomes, and to shift care
from acute to primary and community settings. This is likely to be a staged process, with shadow
tariffs in place first.
Haringey CCG’s acute intentions support the redesign of pathways that build upon service models
developed in 2018/19.
As part of the London Five Point Cancer Improvement Plan, Haringey CCG will require North
Middlesex University Hospital to sustainably implement Straight to Test for upper and lower
gastro intestinal 2-week wait referrals. This will improve outcomes for patients with cancer,
contribute to improving survival rates and help enable this important constitutional target to be
delivered.
As part of NCL wide work to improve planned care pathways, new pathways will be implemented
for planned urology care, ear nose and throat, gynaecology, ophthalmology, chronic kidney
disease and physiotherapy for women’s bowel services. This will improve the effectiveness and
efficiency of pathways in line with recognised good practice.
As part of NCL wide work the recommendations from the orthopaedics planned care review will
be implemented across NCL and the pain management pathways reviewed. The aim of this work
is to improve outcomes for patients and the effectiveness of the pathway, in line with recognised
good practice.
Taking into account the outcomes of the ‘National Consultation on Evidence -Based Interventions,
July 2018’, the new sector wide Procedures of Limited Clinical Effectiveness (POLCE) policy will
be implemented by all providers.
Mental Health Commissioning Intentions
Haringey CCG intends to, subject to a positive evaluation, extend the primary care mental health
service for the whole of Haringey. The mental health link worker service, nurses and occupational
therapists, work in collaboration with secondary mental health services and primary care to
deliver a range of interventions including clinical advice and guidance and access to services to
prevent emergency admissions.
Haringey CCG will continue to support Barnet, Enfield and Haringey Mental Health Trust (BEH
MHT) to introduce mental health link workers in the ‘Central’ CHIN.
Haringey CCG intends to review and re-specify the Crisis Response and Home Treatment
Teams to strengthen the crisis and acute intervention pathways and models delivering
improvements for Haringey service users.
Haringey CCG intends to work closely with BEH MHT to improve the dementia pathway including
the memory clinic. This work aims to improve patient experience, reduce waiting times, improve
post diagnosis-support, and implement the requirements of the NICE guidelines on ‘Dementia:
assessment, management and support for people living with dementia and their carers, June
2018’.
As part of NCL wide work, and subject to a successful evaluation, Haringey CCG intends to
extend Improving Access to Psychological Therapies (IAPT) for people with long term conditions
introducing more long term physical health condition pathways, potentially in cardiology and
chronic pain. This work aims to support people to better manage their long term condition,
improving outcomes and ultimately reducing costs to the health and care system.
Haringey CCG intends to increase the non-long term conditions (LTC) psychological therapies to
meet NHS England access target requirements towards 21%. This will be achieved through the
expansion of the outreach functions providing a preventative approach to the identification and
management of mild to moderate mental health issues. Enhanced provision will also be
implemented in priority areas, which may include behavioural therapy for couples and specialist
support for 18-25 year olds not suited to Cognitive Behavioural Therapy (CBT).
In order to better support recovery and in line with NHS England policy, Haringey CCG intends to
implement improvements to the rehabilitation and accommodation pathway in-line with the BEH
MHT Out of Area Treatment reduction plan. These improvements may include step down models
such as discharge to assess or intermediate care support and treatment options for people with
complex needs requiring further assessment for safe discharge home or to a new setting.
Haringey CCG intends to recommission Tier 2 CAHMS services to further improve alignment with
national policy published in the ‘Department of Health/NHS England: Future in Mind: Promoting,
protecting and improving our children and young people’s mental health and wellbeing, 2015’ and
in line with NHS England’s ‘Model Specification for Child and Adolescent Mental Health Services:
Targeted and Specialist levels (Tiers 2/3)’.
In line with NCL STP strategy, Haringey CCG will work with partners to develop sustainable
mental health liaison services that are compliant with national Core 24 requirements (those
services that need nationally to be delivered 24/7). This will support all main emergency
departments and acute hospitals and aims to improve the responsiveness of services to people
experiencing an acute mental health crisis.
Haringey CCG intends to commission an evening crisis café service, to work with the psychiatric
liaison service and the crisis response and home treatment team service.
Haringey CCG intends to reduce the number of people with severe mental illness who are in
residential care, supported living or who are homeless by strengthening their community and at -
home care and support, using personal health budgets to personalise support across NHS and
Social Care services. This is in alignment with the NHS England’s ‘National Expansion Plan for
Personal Health Budgets, June 2017’ and will support people in primary and secondary care to
be more physically active and improve wellbeing. This initiative is informed by the good practice
developed regionally by Islington CCG, which is an NHSE Personalisation Demonstrator site.
As part of delivering the new ‘NICE guidelines for Attention Deficit Hyperactivity Disorder
(ADHD), March 2018’, mental health commissioners are working together to scope out the
service model for a specialist ADHD and Autism Spectral Disorder (ASD) neurodevelopmental
disorders (NDD) service that would cover Camden, Islington and Haringey CCGs. Processes are
underway to scope a procurement and contracting model for the three CCGs and if this goes
ahead then a procurement process will be initiated in December 2018, which could potentially
identify a new service provider by autumn 2019. The new service model will improve post
diagnosis support and include voluntary and community sector engagement.
4. Technical guidance
Acute Contracts for 2019/20 and 2020/21 (early indications point to a minimum two-year contract
process) will be consistent with national planning guidance, and an indicative timetable is set out below
that mirrors the timetable for the 2018/19 planning round. This will be updated once national planning
guidance is published in autumn 2018.
The contract round will have to account for the following:
Lessons learned from the 2018/19 contracting and planning round.
Agreement of operational planning and contracting principles to ensure a consistent approach for
planning and setting contract baselines;
Agreement of key planning assumptions for growth, the impact of QIPP and 2018/19 run -rate for
baseline setting;
The publication of tariffs for 2019/21 tariffs, following an engagement process in autumn 2018. The
report sets out early indications for 2019/21 tariffs with potential material changes to outpatient and
non-elective tariffs;
Any changes to the revised standard acute contract including any new mandated contract forms;
The approach for setting contract baselines for each individual year as part of any multi-year contract;
The approach to setting non-acute baselines;
Identification of local variations to the Standard Contract:
Local tariffs to support delivery of Sustainability and Transformation Plan (STP) initiatives;
Marginal rates;
Claims and challenges;
Penalties/sanctions;
Timetable and approach to generating 2019/20 STP and QIPP schemes and including them in
2019/20 contract baselines; and
Local escalation process where progress is slipping against the timetable above, and to avo id the
need to refer contracts to NHS England and NHS Improvement for resolution.
Appendix 1 - Haringey CCG Notices
Reference
number
Programme
Area
Commissioning
purpose and
rationale
Lead
commissioner Coverage
Commissioning
Lead (name)
inc. contact
details
System Intention detail Providers
impacted on
H&ICCG2
c/f for
19/20
Children and
Young People:
Autism
Diagnostic
Pathw ay
Recommissioning of the service to
improve quality of
care including
post-diagnostic
support in line
w ith the new
NICE guidelines
on ADHD (March
2018) and Autism
Spectrum
Disorder (2011)
Haringey
CCG
Multiple
CCGs
Michele.guimarin
@nhs.net and
Kathryn.collin1@n
hs.net
As part of delivering the new ‘NICE guidelines for
Attention Deficit Hyperactivity Disorder (ADHD),
March 2018’, mental health commissioners are
w orking together to scope out the service model for a
specialist ADHD and Autism Spectral Disorder (ASD)
neurodevelopmental disorders (NDD) service that
w ould cover Camden, Islington and Haringey CCG.
Processes are underw ay to scope a procurement and
contracting model for the three CCGs and if this goes
ahead then a procurement process w ill be initiated in
December 2018, w hich could potentially identify a new service provider by autumn 2019. The new
service model w ill improve post discharge support
and include voluntary and community sector
engagement.
All
acute
pro
vid
ers
HCCG 39
Children and
Young People
(CAMHS)
Recommissioning
service in line w ith
NHS England’s ‘Model
Specif ication for
CAMHS: Targeted
and Specialist
levels (Tiers 2/3).
NHS Haringey
CCG
NHS
Haringey
CCG
michele.guimarin
@nhs.net
Dependent on the outcomes of public
consultation/engagement requirements, Haringey
CCG intends to recommission Tier 2 CAMHS services
to further improve alignment w ith national policy
published in the ‘Department of Health/NHS England:
Future in Mind: Promoting, improving and protecting
our children and young people’s mental health and
w ellbeing (2015)’ and in line w ith NHS England’s
‘Model Specif ication for Child and Adolescent Mental
Health Services: Targeted and Specialist levels (Tiers
2/3).
NM
UH
WH
RF
L
H&ICCG3 Intermediate
care
Recommissioning
service to better
support people to
be cared for
outside of acute
hospital settings
Islington
CCG
Multiple
CCGs
Jacob Wheeler
(jacob.w heeler@
islington.gov.uk)
and Marco Inzani
(marco.inzani@
nhs.net)
The intermediate care system across Haringey and
Islington w ill be redesigned in collaboration w ith users and providers in order to improve outcomes for
patients and services users. This w ork w ill affect all
elements of Intermediate Care, and w ill be
operationally led in order to determine impact on
existing contracts.
UC
LH
WH
CN
WLF
T
NM
UH
Haringey Clinical Commissioning Group Governing Body Meeting
13 September 2018
Report Title Haringey CCG Finance Report as at 31 July 2018
Date of report 29 August 2018
Agenda
Item
5.1
Lead Director /
Manager
Anthony Browne Deputy Chief Finance Officer
Tel/Email 020 3688 1394 [email protected]
GB Member Sponsor
Simon Goodwin Chief Finance Officer
Report Author
Scott Hunn Head of Finance (HCCG)
Tel/Email 020 3688 2727 [email protected]
Report Summary
This paper sets out for the Governing Body, the Haringey CCG financial position at the end of July 2018 (month 4). The 2018/19 financial plan for the CCG is to deliver an in year surplus of £19k at the year-end. At month 4 the CCG is reporting a £514k year to date deficit and forecasting to plan at year end. Based on April to June activity and an estimate for July the financial position of the CCG’s acute contracts reports forecast over-performance of £14.0m at month 4, this has been mitigated by the release of the acute demand reserves, contingency and the impact of QIPP in the latter part of the year. In order to deliver the control target of a £19k surplus the CCG are required to deliver net efficiencies of £19.5m. The CCG has developed £15.8m of schemes and set aside investment of £3.9m to support their delivery. Work is on-going to identify additional efficiencies in-year to cover the £7.6m of unidentified efficiencies. The delivery of our planned in-year surplus of £19k is subject to a number of risks, particularly in year acute over performance, delivery of the STP Interventions & QIPP programme and increased continuing healthcare activity. The net risk is £8.1m, the CCG does not have any reserves or mitigations set aside if these risks materialise. This financial position has been reported to NHS England as part of the monthly monitoring process.
Recommendation The Governing Body is asked to NOTE the financial position at month 4.
Identified Risks
and Risk
Management
Actions
This report is one element used to monitor the Clinical Commissioning Group’s financial performance in terms of adherence to core statutory duties.
Conflicts of Interest
Not applicable.
Resource
Implications
There are no direct resource implications for this paper, as it is not a project proposal for additional internal resourcing, nor is it assuming additional external resourcing.
Engagement
Not applicable.
Equality Impact
Analysis
No Equality Impact Assessment is planned or has been undertaken for the finance report itself, though individual QIPP schemes undergo the assessment.
Report History and
Key Decisions
Not applicable.
Next Steps Updates to be provided at all Governing Body meetings.
Appendices
Financial position of all five NCL CCGs.
HARINGEY CLINICAL COMMISSIONING GROUP Finance Report for the period to 31 May 2018
1 Introduction
1.1 This paper sets out for the Governing Body, the financial position at the end of May 2018 (month 2).
2 Executive Summary
2.1 The 2018/19 financial plan for the CCG is to deliver an in year surplus of £19k at the year-end.
2.2 At month 2 the CCG is reporting a £14k year to date deficit and forecasting to plan at year end. It should be noted that the position is largely based on one month’s data, therefore it is too early in the financial year for any activity trends to emerge.
2.3 In order to deliver the control target of a £19k surplus the CCG are required to deliver net efficiencies of £19.5m. The CCG has developed £15.8m of schemes and set aside investment of £3.9m to support their delivery. Work is on-going to identify additional efficiencies in-year to
cover the £7.6m of unidentified efficiencies. 2.4 The delivery of our planned in-year surplus of £19k is subject to a number of risks, particularly in year acute over performance, delivery of the STP Interventions & QIPP programme and
increased continuing healthcare activity. The net risk is £7.1m, the CCG does not have any reserves or mitigations set aside if these risks materialise. 2.5 This financial position has been reported to NHS England as part of the monthly monitoring
process. 3 Financial Position at Month 2
3.1 Financial performance can be summarised as follows:
3.2 The 2018/19 financial plan for the CCG is to deliver an in-year surplus of £19k at the year-end.
3.3 At month 2 the CCG is reporting a year to date deficit of £14k and forecasting to plan at year end. 3.4 The most significant points to note include:
The position is based on one month’s data and therefore it is too early in the financial year for any activity trends to emerge.
Activity data provided by the main providers is reasonable however contract plans still
require correct point of delivery apportionment from Trusts ahead of Month 3 reporting.
Out of Sector provider data varies. Not all providers have submitted data and in some instances the data is incomplete.
On this basis acute contracts have been reported to plan.
The Continuing Healthcare budget is over-performing by £109k at month 2 but is forecast to be in line with plan at year-end.
Running cost budget of £6,398k is forecast to plan at month 2.
Budget Actual
£'000 £'000 £'000 £'000 £'000
Resource Allocation - 70,823 - 70,823 - - 414,519 -
Acute Contracts (In and Out of Sector) 39,620 39,620 - 227,502 -
Other Acute 3,092 3,091 1- 18,554 -
Acute Commissioning 42,712 42,711 1- 246,057 -
Mental Health 6,909 6,909 - 41,457 0-
Continuing Care 3,658 3,767 109 21,946 -
Community Services 3,130 3,130 - 18,777 0-
Primary Care Prescribing 4,849 4,849 - 29,096 0-
Primary Care 199 199 0- 1,195 0-
PRC Delegated Co-Commissioning 6,776 6,776 0- 43,231 0-
Primary Care 111 & OOH Integrated Care 408 408 - 2,450 0-
Programme Corporate Cost 814 778 35- 4,882 -
Non-Acute Commissioning 26,743 26,816 74 163,033 0-
Running Costs 1,056 1,000 55- 6,398 -
0.5% Contingency 310 310 - 1,858 -
Demand Reserve - - - 2,846- -
(Surplus) / Deficit 3- 14 17 19- 0-
YTDFOT Variance
Variance
4 QIPP Delivery
4.1 The 2018/19 QIPP plan for the CCG is a net £19.5m. The CCG has QIPP identified which are expected to delivery net savings of £11.8m. This includes £12.3m of acute schemes and £3.5m of Non Acute schemes offset by investments of £3.9m to support delivery of the QIPP schemes. £7.6m of “unidentified” QIPP remains in the plan.
4.2 In order to bridge the gap a repository of QIPP ‘work in progress’ is maintained and used to
support scheme generation. Governance and assurance is provided at Strategy and Finance Committee with the QIPP Delivery Group (QDG) responsible for operational and detailed
monitoring of each scheme.
4.3 In addition QDG is focussing on ‘stretch’ STP interventions and alignment of provider CIPs with commissioner QIPPs to achieve greater savings. The CCG is continuing to work closely with the Right Care delivery team to identify further opportunities from variation analysis. The
current ‘work in progress’ has a value of £3m and is in the process of being validated clinically and financially.
5 Financial Risks
5.1 The delivery of our planned in-year surplus of £19k is subject to a number of risks, particularly in year acute over performance, delivery of the STP Interventions & QIPP programme and increased continuing healthcare activity.
5.2 The CCG on a monthly basis makes an assessment of its key financial risks and mitigations. This is also a key element of the monthly financial report submitted to NHS England. These risks and mitigations represent the level of net risk from delivering a surplus of £7.1m.
6.3 The current assessment of financial risks and mitigations is set out below:
6.4 As highlighted above, the current assessment of net financial risk is around £7.1m. This position reflects an assessment of acute over-performance, under-delivery of QIPP/STP interventions and increased non-acute activity. It is evident from the above that the CCG does
Assessment of Risks & Mitigations - 2018/19
Full Value Probability
Adjusted
Value
Risks £m % £m
Acute Contract over-performance of 3% at a marginal rate of 50% 3.7 71% 2.600
Under delivery of QIPP/STP interventions. 23.4 21% 4.992
Increased in year CHC activity 2.0 50% 1.000
Increased in year Prescibing activity 1.0 50% 0.500
Increased activity at private providers and out of area mental health providers 1.0 50% 0.500
Pay awards @ 3% 0.2 50% 0.100
Total Risk 31.3 9.7
Mitigations
Contingency (1.9) 100% (1.9)
Delay/reduce STP investment (3.9) 20% (0.8)
Total Mitigations (5.8) (2.6)
Net Risk/(Mitigation) 25.5 7.1
not have any significant mitigations if these risks materialise. The CCG will continue to monitor these and any emerging risks closely looking to identify further mitigations where possible. 6 Recommendation The Governing Body is asked to NOTE the financial position at month 2.
Scott Hunn
June 2018
Finance Report 2018-19
Month 4 (July 2018)
Lead Director: Anthony Browne
Author: Scott Hunn
NCL CCG Summary Financial Position at
Month 4
• This table sets out the aggregate position across the five NCL CCGs.
• There is an annual plan to deliver a £0.22m surplus.
• There is a YTD adverse variance at M4 of (£3.77m) mostly at Enfield (£3.3m). Each CCG is reporting a
FOT on plan.
• There is an adverse YTD QIPP variance (£3.58m). The FOT QIPP variance is (£13.41m)
• There is an overall Net risk of (£42.13m) to the achievement of NCL CCG financial plans, a net
deterioration in the risk position by £3.1m since M3.
• The 18/19 target underlying position was for a £14.2m surplus. At M4 the forecast is for a £11.65m
deficit, a net deterioration of £3.4m since M3 (mostly at Barnet).
Bottom line QIPP Net risks Net risks Net risks Underlying position
Annual PlanYTD Var. FOT Var.
YTD Var.
YTD Var. FOT Var.FOT Var.
previous month
current month Movement 18/19 Plan
M4 Forecast
£m £m £m £m % £m % £m £m £m £m £m
Barnet 0.20 0.16 0.00 (0.15) 96% (1.35) 93% (3.55) (6.42) (2.87) 3.50 0.18
Camden 0.00 0.08 (0.00) (1.41) 79% (3.34) 87% (9.82) (9.63) 0.19 0.00 (9.60)
Enfield 0.00 (3.33) (0.00) (1.75) 74% 0.00 100% (15.77) (15.77) 0.00 1.40 (3.99)
Haringey 0.02 (0.51) (0.00) 0.00 100% (4.82) 75% (7.87) (8.11) (0.23) 1.80 1.77
Islington 0.00 (0.16) (0.00) (0.27) 92% (3.90) 75% (2.02) (2.20) (0.18) 7.50 (0.00)
Total 0.22 (3.77) 0.00 (3.58) 84% (13.41) 87% (39.03) (42.13) (3.09) 14.20 (11.65)
• Summary Financial Position: The 2018/19
financial plan for the CCG is to deliver a
surplus of £19k at the year-end. At month 4,
the CCG is reporting a £514k year to date
over-performance and forecast to plan at
year end. There continue to be significant
levels of risks that may impact on the CCGs
financial position further, these relate to
QIPP, acute activity and CHC.
• Acute: Based on April to June activity the
financial position of the CCG’s acute
contracts reports forecast over-performance
of £14.0m at month 4, this has been
mitigated by the release of the acute demand
reserves, contingency and the impact of
QIPP in the latter part of the year.
• Non Acute: The CHC budget is seeing
increased levels of activity and costs in the
first four months of the year and is currently
under review.
• QIPP: The QIPP Programme is forecast to
deliver £14.7m (75%) of the £19.5m plan.
Additional schemes are being worked
through to mitigate the current under delivery
and to provide cover against any future
deterioration in the financial position.
Executive SummarySummary financial position (£m)
Bud Actual Var Bud FOT Var
Revenue Resource Limit 143.9 143.9 - 416.6 416.6 -
Acute 86.8 87.8 1.0 243.2 245.6 2.4
Non-Acute 52.6 52.6 0.0 159.6 158.8 (0.9)
Corporate & Running Costs 3.9 3.9 0.1 11.8 12.1 0.3
Total Operational 143.3 144.4 1.1 414.7 416.5 1.9
Total Non Operational 0.6 - (0.6) 1.9 (0.0) (1.9)
Total Expenditure 143.9 144.4 0.5 416.5 416.5 0.0
Surplus / (Deficit) 0.0 (0.5) (0.5) 0.0 0.0 (0.0)
Acute performance (£m)
Bud Actual Var Bud FOT Var
North Mid 27.0 28.4 1.4 77.1 82.5 5.4
Whittington 28.9 29.3 0.4 82.4 86.4 4.0
Other Acute 30.9 30.1 (0.8) 83.7 76.7 (7.0)
Total Acute 86.8 87.8 1.0 243.2 245.6 2.4
Prior month 243.2 245.7 2.4
18/19 QIPP programme (£'m)
Bud Actual Var Bud FOT Var
Planned care 1.1 1.1 - 5.7 6.9 1.3
CC2H 0.5 0.5 - 2.0 1.8 (0.2)
UEC 0.9 0.9 - 4.1 4.9 0.8
Other Acute 0.1 0.1 - 0.5 0.7 0.2
Other Schemes (0.6) (0.6) - 7.2 0.4 (6.8)
Net QIPP 2.1 2.1 - 19.5 14.7 (4.8)
YTD Full Year
YTD Full Year
Trust / ServiceYTD Full Year
Material Changes from the prior month FOT are:
• QIPP slippage of £4.8m.
• Deterioration in acute performance of £3.5m,
partially offset by the application of the marginal
rate (£1.6m).
• Phasing of QIPP plan adjusted to reflect forecast
delivery of £6.7m in latter part of the year.
• Investment reduction of £1m withheld to offset
QIPP under delivery.
Financial Bridge – Plan to Forecast Outturn
The forecast outturn at month 4 is a surplus of £19k which is in line with the agreed
NHSE control total.
0.0 0.0
1.6
0.0 13.7 0.4
(4.8) (10.9)
(21.0)
(16.0)
(11.0)
(6.0)
(1.0)
4.0
17/18 Plan QIPP slippage Acuteperformance
Marginal rate Prior year items Mitigations Other FOT
Driven By:
• £4.5m Whittington Health
• £5.4m North Middlesex
• £1.6m Royal Free London
• £2.8m UCLH
• £0.8m Out of Sector
• £0.4m Private Providers
Applied at:
• £0.5m Whittington Health
• £1.0m Royal Free London
• £0.2m UCLH
Applied at:
• £5.0m Acute Demand Reserve
• £6.7m QIPP Delivery
• £2.0m Delay/Reduce Investment
M2 M3 M4 Var
Plan (0.1) 0.0 0.0 0.0
QIPP Slippage - 0.0 (4.8) (4.8)
Acute performance - (7.4) (10.9) (3.5)
Marginal rate - - 1.6 1.6
Prior year items - - - -
Mitigations - 6.0 13.7 7.7
Other - 1.4 0.4 (1.0)
FOT - (0.0) 0.0 0.0
• Haringey CCG is reporting breakeven but has
identified £8.7m of Risk with £0.6m of
Mitigations. This position has been reported to
NHSE.
• The Acute Risk consists of £4.8m QIPP
slippage and £2.0m of over performance on
agreed contracts.
• Community Services mitigation relates to the
potential delayed investments supporting QIPP.
• Continuing Health Care risk consists of £0.2m
QIPP slippage and £0.6m increased activity
and package of care prices.
• Primary Care Services risk of £0.3m relates to
QIPP slippage.
Risk and Mitigations
An assessment of risks and opportunities that may impact on the CCGs financial
position further has been estimated at £8.1m over and above the forecast position.
Risk and mitigations (£m)
Last Current Change Best Worst
FOT 0.0 0.0
Acute Services (6.9) (6.8) 0.0 - (6.8)
Mental Health - - - - -
Community Health 0.6 0.6 (0.0) 0.6 (0.0)
Continuing Care (1.0) (0.8) 0.2 - (0.8)
Primary Care Services (0.5) (0.3) 0.2 - (0.3)
PC Co-Commissioning - - - - -
Other Programmes - (0.7) (0.7) - (0.7)
Running Costs (0.1) (0.0) 0.1 - (0.0)
Total (7.9) (8.1) (0.2) 0.6 (8.7)
All CCGs are forecasting to hit plan. However, there is £42.13m overall net risk to the achievement of the plan, which means delivery will be challenging.
9
NCL summary Financial Position
Source: Non-ISFE return
• This table sets out the aggregate position across the f ive NCL CCGs.
• There is a annual plan to deliver a £0.22m surplus.
• There is a YTD adverse variance at M4 of (£3.77m) mostly at Enfield (£3.3m). Each CCG is reporting a FOT on plan.
• There is an adverse YTD QIPP variance (£3.58m). The FOT QIPP variance is (£13.41m)
• There is an overall Net risk of (£42.13m) to the achievement of NCL CCG financial plans, a net deterioration in the risk position by £3.1m since M3.
• The 18/19 target underlying position w as for a £14.2m surplus. At M4 the forecast is for a £11.65m deficit, a net deterioration of £3.4m since M3
(mostly at Barnet).
Bottom line QIPP Net risks Net risks Net risks Underlying position
Annual
Plan
YTD
Var.
FOT
Var.
YTD
Var.
YTD
Var.
FOT
Var.
FOT
Var.
previous
month
current
monthMovement 18/19 Plan
M4
Forecast
£m £m £m £m % £m % £m £m £m £m £m
Barnet 0.20 0.16 0.00 (0.15) 96% (1.35) 93% (3.55) (6.42) (2.87) 3.50 0.18
Camden 0.00 0.08 0.00 (1.41) 79% (3.34) 87% (9.82) (9.63) 0.19 0.00 (9.60)
Enfield 0.00 (3.33) 0.00 (1.75) 74% 0.00 100% (15.77) (15.77) 0.00 1.40 (3.99)
Haringey 0.02 (0.51) 0.00 0.00 100% (4.82) 75% (7.87) (8.11) (0.23) 1.80 1.77
Islington 0.00 (0.16) 0.00 (0.27) 92% (3.90) 75% (2.02) (2.20) (0.18) 7.50 (0.00)
Total 0.22 (3.77) 0.00 (3.58) 84% (13.41) 87% (39.03) (42.13) (3.09) 14.20 (11.65)
Table 1 - NCL CCG Summary Financial Position - Month 4 18/19
The CCG is forecasting to deliver the plan, although there is significant risk in relation to QIPP delivery and acute activity
1
Executive Summary
Summary financial position (£m)
YTD Full YearBud Actual Var Bud FOT Var
Revenue Resource Limit 129.4 129.4 - 405.7 405.7 -
Acute 76.0 78.3 2.3 226.4 230.8 4.3
Non-Acute 50.5 50.5 0.0 162.8 163.0 0.2
Programme Corporate Costs 1.2 1.1 (0.1) 6.6 6.6 (0.1)
Corporate & running costs 1.7 1.7 - 5.1 5.1 -
Total Operational 129.4 131.6 2.3 400.9 405.4 4.4
Total Non Operational - (2.1) (2.1) 4.8 0.3 (4.4)Total Expenditure 129.4 129.5 0.2 405.7 405.7 0.0Surplus / (Deficit) - (0.2) (0.2) - (0.0) (0.0)
Acute performance (£m)
Trust / Service
YTD Full YearBud Actual Var Bud FOT Var
£m £m £m £m £m £m
Whittington 33.5 34.6 1.1 99.5 101.6 2.1
UCLH 23.7 24.6 0.9 70.9 72.3 1.4
Other Acute 18.8 19.1 0.3 56.0 56.8 0.7
Total In Sector
76.0 78.3 2.3 226.4 230.7 4.3
Prior month 226.9 229.7 2.818/19 QIPP programme Gross (£'000)
YTD Full YearBud Actual Var Bud FOT Var
£m £m £m £m £m £m
CC2H 0.72 0.50 (0.22) 2.44 1.84 (0.60)
Planned Care 0.45 0.58 0.13 4.59 4.39 (0.20)
UEC 0.72 0.89 0.17 3.58 3.53 (0.05)
Other Schemes 1.46 1.10 (0.36) 6.57 3.53 (3.04)
QIPP Programme 3.34 3.07 (0.28) 17.18 13.29 (3.89)
Summary position
o Year to date the CCG is showing a £0.2m adverse variance against plan,
however maintains a breakeven forecast outturn (FOT) whilst further
analysis of QIPP and performance levels are completed.
o Acute Data - To date the CCG has only received Month 3 (flex) data and
are mindful of the risk of using a small sample to draw full year conclusions. The adverse variance of £2.3m is based on QIPP slippage and the effect of
this is offset with non recurrent items within the Acute Demand Reserve. The
Acute Demand Reserve is fully utilised to achieve the FOT position.
o Non Acute - The majority of Mental Health and Community contracts are
block arrangements but there has been notification of a £0.2m FOT cost
pressure on the Learning Disabilities pooled budget.
o Continuing Healthcare has a reported £0.1m overspend YTD but this is
expected to reduce as the work for the agreed CHC QIPP has started.
o Prescribing data has only been received for April and May and as yet, as in
all years, the full year forecast is not available until August.
o Contracts – There is a large element of QIPP that is not included within
Whittington, UCLH and RFL contracts and this represents a significant risk to delivery of the CCG control total.
The forecast outturn is breakeven – QIPP slippage and acute performance have been offset by reserves (Acute Demand and Contingency)
2
Bridge
Material changes from the prior month FOT are:
• QIPP slippage of (£1.3m);
• Acute performance has deteriorated by (£1.1m);
• Prescribing now forecasting an underspend of £0.8m; and
• Remaining contingency of £1.5m held at M3 has been
released
Total acute variance is split between QIPP slippage £0.3m and over performance £0.4m
Release of contingency
Driven by:• Prescribing of £0.8m;
partially offset by• CHC overspend of
£0.7m (above QIPP slippage of £0.8m)
Bridging items (£m)
M2 M3 M4 Var
Plan 0.2 0.2 0.2 -
QIPP Slippage - (0.0) (1.3) (1.3)
Acute performance - (0.4) (1.5) (1.1)
Mitigations - 1.3 2.8 1.5
Other - (0.9) 0.1 1.0
Movement - - - -
0.0 0.0
4.4
0.0
(3.9)
(0.5)
(5.0)
(4.0)
(3.0)
(2.0)
(1.0)
-
1.0
2.0
3.0
4.0
18/19 Plan QIPP slippage Acute performance Mitigations Other FOT
Risk & Mitigations
There is a £2.2m net risk for Islington CCG reported to NHSE. This Risk not reported in position & should it materialise will be a pressure to CCG bottom line
8
o This is the basis of the month 4 return to NHSE. Islington CCG is reporting breakeven but has identified £7.3m of Risk with £5.1m of Mitigations
o The Acute Risk consists of £1.6m QIPP slippage and £2.6m of over performance on agreed contracts.
o For the Acute Mitigations the continued levels of over performance are being challenged and data is being further analysed to ensure over performance is not linked to QIPP slippage.
o Mental health services has some over performance in Pooled budgets but this is being managed within other areas.
o Continuing Health Care Services risk relates to the delay is patient assessments that are behind the QIPP target
o Primary Care Services relates to risk on Prescribing charges (NCSO and Category M). These may be offset by underspends elsewhere in Primary Care, predominantly CCG staffing.
o Islington CCG has a ‘Stretch’ QIPP target of £3.3m. QIPP shemes are being identified but due to the time taken to initiate there is a risk that £2.3m will not be achieved in 18/19.
Table 8 - Risk & Mitigations
Risk and mitigations (£m)
Emergent risk
Best Case
Worst Case
Last month
Current month Change Mitigations
Med Case
FOT (0.0) (0.0) (0.0)
Acute Services (4.0) (4.2) (0.1) 4.0 - (0.2) (4.2)
Mental Health (0.0) - 0.0 - - - -
Community Health (0.2) (0.2) - 0.2 - 0.1 (0.2)
Continuing Care (0.2) (0.1) 0.0 - - (0.1) (0.1)
Primary Care Services (0.5) (0.5) (0.0) 0.6 - 0.1 (0.5)
PC Co-Commissioning - - - - - - -
Unidentified QIPP (2.3) (2.3) - 0.3 - (2.0) (2.3)
Running Costs (0.1) - 0.1 - - -
Total (7.2) (7.3) (0.1) 5.1 (0.0) (2.2) (7.3)
Haringey Clinical Commissioning Group Governing Body Meeting Thursday, 13 September 2018
Report Title Performance Report
Date of report: 29 August 2018
Agenda Item
5.2
Lead Director /
Manager
Alex Smith, Director of Planning, Performance and Delivery, Haringey and Islington CCGs
Tel/Email [email protected] 07712 729703
GB Member Sponsor
Not applicable.
Report Author
Seonaid Henderson, Head of Planning and Performance, Haringey CCG
Tel/Email [email protected] 0203 688 2785
Report Summary
This report provides an overview of the performance of Mental Health, Community Health Services, Ambulance services and other key non-acute standards Acute Performance information is reported at the Joint Commissioning Committee (JCC) and the papers for JCC have been made available to the Governing Body. As the Governing Body will be aware (due to reporting timetable differences) the performance report contain different months’ activity. This is stated within the relevant sections of the P&Q summary.
Recommendation The Governing Body is asked to NOTE the contents of this report.
Identified Risks
and Risk
Management
Actions
Not applicable.
Conflicts of Interest Not applicable.
Resource
Implications
Not applicable.
Engagement Not applicable.
Equality Impact
Analysis
Not applicable.
Report History and
Key Decisions
Not applicable.
Next Steps Not applicable.
Appendices Performance & Quality Report - Governing Body Summary
1. Executive Summary
The Performance and Quality Summary (P&Q) and this report provide an overview of the performance of Mental Health, Community Health Services, Ambulance services and other key non-acute standards in Haringey. Acute Performance information is reported at the Joint Commissioning Committee (JCC) and the papers for JCC have been made available to the
Governing Body. As it is widely seen as a ‘system target’, dependent on multiple agencies to deliver, this paper also provides an overview on A&E performance.
As the performance of acute services is already reported to the Governing Body via the Joint Commissioning Committee report reporting on acute services had been removed from this report to avoid duplication. The Performance and Quality Summary produced by North East
London Commissioning Support Unit (NEL CSU) will report performance of A&E (including the London Ambulance Service performance), Mental Health and Community Services. It should be noted that sections of the report contain different months’ activity, due to the
reporting timetable. This is stated as clearly as possible within the report and near-time local intelligence is also included, where relevant. 2. Accident & Emergency (A&E)
The provider level performance for the A&E four hour waiting standard for June 18 is shown below Main provider A&E performance for the A&E four hour waiting standard:
Our main provider, NMUH, achieved the standard expected within the NHS Operating Plan trajectory for NMUH for 2018/19. The target was 86% while performance for June 2018 was 89.7%. NMUH Performance Update
The A&E standard is dependent on multi-agency working to delivery, including through non-acute providers and social care.
A&E performance has continued to stablilise for the six weeks leading up to 19 August 2018. This is largely due to the implementation of the new Emergency Department (ED) operating model:
Week Provisional Performance Target (improvement
trajectory)
w/e 19th August 2018 84.81% 89%
w/c 12th August 2018 89.54% 89%
w/e 5th August 2018 87.44% 89%
w/e 29th July 2018 86.12% 86%
Provider Performance June 18
Lead commissioner
North Middlesex University Hospital 89.7% Haringey CCG
Whittington Health NHS Trust 90.6% Islington CCG
w/e 22nd July 2018 83.76% 86%
w/c 15th July 2018 86.70% 86%
Under NHS Operating Plan guidance, NMUH is planning to achieve 90% by September 2018
and 95% by March 2019. Making the step changes necessary to consistently achieve these targets continues to require collaborative and system wide efforts across all partner agencies, managed via the Safer, Faster, Better Programme and overseen by the A&E Delivery Board.
NMUH has exceeded trajectory targets in three of the last six weeks, against a number of challenges including an unprecedented heatwave and CPE infection outbreak. The Safer, Faster, Better Programme (overseen by A&E Delivery Board) has developed a number of High Impact Initiatives which aim to further support ED improvements, including through a breaches
in minors reduction plan and a multi-agency plan to tackle LOS challenges which impact on flow. The weekly breach analyses continues to show bed management (i.e. lack of available beds) to
be the main reason for breaches, accounting for approximately 40% of all breaches over the above six week period. This emphasises the importance of LOS work both within NMUH and between multi-agency partners. Delayed Transfers of Care (DToC) Performance
DToCs at NMUH have been an increasing issue in recent weeks. One of the reasons for this increase has been challenges associated with care home provision. Work is also being
undertaken in partnership with Haringey Local Authority to understand reasons behind apparent increases in social care DTOCs. Weekly multi-agency platinum command meetings attended by Executive level sponsors from
NMUH and Haringey/Enfield CCGs have been established to understand and unblock internal and external reasons for delay amongst patients who have the longest delayed discharges (21 days +). Learning from these meetings is being incorporated into system improvement plans. This approach is in line with good practice mandated within the National Length of Stay
initiative, whereby all systems must reduce the number of patients who experience the longest delays significantly by December 2018. This is because of the safety issues concerned with deconditioning and resultant impact on flow. Continuing Healthcare (CHC) in the acute setting
Haringey CCG continues to perform well with 0% of assessments taking place in an acute setting and 98%+ eligibility decisions on cases with a positive NHS CHC Checklist, being made
within 28 days of the receipt of the checklist (target 80%) in May 2018. 3. Whittington Health (WH) Community Health Services (CHS)
The full report showing the performance for each service against the maximum and average waiting time for urgent and routine appointments is shown in main performance pack. The number of patients seen in the latest month is also indicated.
The community services report shows that in June, for Haringey CCG, eight community services at Whittington Health achieved performance of 95% or above for routine appointments. This compares to ten in May 2018.
A number of areas that did not achieved their service target did however demonstrate significant improvements in performance in June 2018:
Physiotherapy (from 50% to 77.8%);
MSK – CATS (from 75.2% to 88%); and
Podiatry (from 62.9% to 74.8%)
The Community Services improvement work stream has focused mainly on podiatry, bladder and bowel, nutrition and dietetics and lymphoedema. Whittington Health and the Wellbeing Partnership identified these services for improvement based on their high waiting times, service throughput and recruitment and retention issues. The service improvement work’s focus is on
workforce, efficiency, estates and improving patient satisfaction. Each of these services have observed improvement in performance since improvement work started. The table below summarises when the reduction in waiting times is expected to be achieved by. Service improvement delivery timeline:
Service Agreed date for achievement of target
Podiatry Oct 18
Bladder and Bowel Adults Dec 18
Nutrition and Dietetics Oct 18
Lymphoedema Sept 18
Now that these work streams are well-established further areas are being added to the scope of the improvement work which are summarised in table below. Service improvement delivery timeline for extended scope Service Improvement objective Agreed date for
achievement of target
Intermediate Diabetes Service
Patients are able to expect and receive prompt and accurate assessment and care to enable them to live healthy and independent lives. Reduce the number of inappropriate referrals and support GP/Practice education of Type 2 diabetes.
Dec 18
Respiratory Service
The service will reduce the waiting times for Pulmonary Rehabilitation, in the longer term, the impact of earlier interventions will contribute to a reduction in hospital admissions.
Dec 18
Intermediate Care
The service will continue to ensure patients are seen on time according to clinical need(s) and are offered a rehab programme where necessary.
Dec 18
Community Reablement Team (CRT)
The service will continue to ensure patients are seen on time according to clinical need(s) and are offered a rehab programme where necessary.
Dec 18
Integrated Community Therapy Team (ICTT)
The service aims to improve access rates and see clients in a timely manner, preserve independence for clients living in their own home for longer and reduce the number of cancellations by the team.
Dec 18
Bladder and Bowel (Children and Adults)
The work will address capacity issues with recruitment scheduled. Performance improvement plans include a first point of access, senior team organisational development work and a focus on operational efficiencies.
Feb 19
School Nursing
The work will address capacity issues and an increase in number of referrals, particularly with safeguarding. Recruitment is planned for
Sept 18
nurses. A review of Emergency Department and Multi-Agency Safeguarding Hub referrals is underway by the safeguarding team. Improvements are expected by September 2018.
Parents & Infants Psychological Services (PIPS)
Address capacity issues (new trainee starting in October 2018) Dec 18
4. Barnet, Enfield & Haringey Mental Health Trust (BEH MHT)
Out of area placements
This relates to people being admitted to an adult acute bed out of the Barnet, Enfield and Haringey area, and is an area of particular focus with NHS England. It also has significant
impact on North Central London’s Sustainability and Transformation Partnerships’ (NCL’s STP) aim of staying within the current mental health acute bed base, and for Haringey CCG and BEH MHT in terms of quality and sustainability. Haringey’s monthly figure for June 2018 was 200 days; a reduction from an average of 325 per month over the previous six months. BEH MHT
led a Perfect Week exercise in August 2018 which has led to the agreement of a significant number of actions and changes, including opening a new acute ward in Barnet to support the trust wide position on this performance. Delayed Transfer of Care (DToC)/Length of stay on acute wards
Haringey Mental Health Delayed Transfer of Care (DToCs) were increased to 5.3% of bed days in June 2018 against a target of 2.5%. A Trust-wide DToC reduction plan has been approved
and is being implemented by the tri-borough System Resilience Lead. Memory Clinic Service (MCS)
Haringey CCG is reassured that the service meets the Memory Service National Accreditation Programme (MSNAP) standard of 12 weeks for people who require complex investigations to determine a diagnosis, standards which have been published by the Royal College of Psychiatrists. However, the service has continued to not provide referral to diagnosis within six
weeks and significant collaborative work is being undertaken between commissioners and BEH operational and clinical leads to improve the pathway. As part of the wider tri-borough and NCL commissioning arrangements, we have engaged the NCL performance and improvement manager who has undertaken an initial demand and capacity review of the service. This will
help to identify issues in relation to the future SLA and to understand current pressures. Recommendations from the demand and capacity review of the service are being shared with Haringey CCG in mid-September. Haringey CCG officers have been meeting with the memory clinic service and The Haynes
dementia hub service, launched in June this year, to create opportunities for people to be referred to post diagnostic support quicker and reduce the need for the memory clinic to offer follow on appointments routinely. This has released some capacity to offer appointments to reduce the waiting list.
Haringey CCG is also actively supporting the development of a memory clinic service Service Level Agreement for all three memory service clinics within Barnet, Enfield & Haringey Mental Health Trust that will ensure equitable standards across BEH for services from 2019.
We have agreed with our local authority colleagues and the wider dementia care strategy group to develop a co-produced action plan to ensure that all services within Haringey are working
towards the recent NICE guidance on dementia care ‘Dementia: assessment, management and support for people living with dementia and their carers’. https://www.nice.org.uk/guidance/ng97 This has significant guidance on assessment and diagnosis tools and will support more efficient
approaches that will ultimately reduce waiting times and improve quality of post diagnostic support. Membership for the dementia care strategy group includes carer representatives, NMUH, LBH and BEHMT. Membership will be extended from September this year to include increased carer representation. We will also extend an invitation to Healthwatch colleagues to
ensure that we are engaging the widest audience possible to influence the development of the pathway for both patients and their families and carers. An additional invitation has been sent to NHS England regional dementia care leads.
The demand and capacity review will offer a view on whether the current service has the resource to meet the current six week target in all cases. However, the service is MSNAP accredited and has additionally been rated as outstanding by CQC and therefore the general offer is deemed to be of a high standard. The results of the demand and capacity review will
support the consideration of a sustainable approach and it is recommended that a business case will be developed to incorporate reducing the current waits, improve the 6 week target to all applicable cases and to consider the impact of improved pathways both into the service and earlier discharge into post diagnostic support services. The business case will highlight where
efficiencies can be made and what further resource may be required. It is important to note that 32% of people require more than one assessment or diagnostic meeting – something that will require significantly longer than six weeks (dependent on
complexity). However, waiting times from referral to diagnosis for those patients with particularly complex presentations still fall within good practice guidelines. As a result of the need for a second or third appointment, which will apply to one third of all available appointment slots, the number of slots available for the initial assessment and diagnosis appointments has reduced.
The recent NICE guidance on dementia will support more efficient and timelier diagnosis times for dementia potentially reducing the number of second and third appointments. As part of the Dementia Care Strategy, we are working closely with clinical and operational
leads to ensure the service is supported, particularly post diagnosis, to be able to signpost both clients and their families to support services. This will reduce the number of follow on appointments that people may need following their diagnosis and ensure people are supported in the optimal care setting. Haringey CCG are seeking Healthwatch involvement in the dementia
care strategy group. The dementia strategy group met in July and is chaired jointly by HCCG and Haringey social services and has further membership from colleagues from BEH, NMUH, carer representation,
social services and the independent sector. This is where the collaborative work of commissioners comes together with wider stakeholders. It has been working to support the wider dementia care pathway and particularly the flows following diagnosis from the memory clinic service. With Dr Gino Amato offering to support the work of the group, we are hoping to
increase the focus on supporting the referrals into the service even more. Since July the Group has:
Re-drafted dementia care protocols and these will be signed off for wider circulation to
primary and secondary care colleagues following the next strategy meeting in September
Linked the dementia care navigators (1.5WTE) with the Haynes dementia care hub that was launched earlier this year
Agreed to update its overall action plan and focus on the ensuring a multi-agency plan to support the recently published NICE guidance.
Early Intervention Psychosis (EIP)
The Haringey service continues to meet the two-week RTT target of 50%, with performance of
75% in June 2018. Increasing Access to Psychological Therapies (IAPT)
Local June 2018 data showed the IAPT recovery rate was 58.2% (target 50%) and Haringey’s IAPT service continues to improve and exceed all targets. Both the IAPT six weeks and 18 weeks waiting time standards were achieved in June 2018 (93.4% and 100% respectively). Children and Young People Mental Health (CYPMH)
Quarter four 2017/2018 national data is now available. Prior to the data release there was a one-off special data collection by NHS Digital/NHS England for all the providers to contribute.
Local data has previously shown that performance is better than the information NHS England formally publish. This is because it captures activity from our local voluntary sector providers who were not yet able to upload their activity to the national reporting toolkit in a way that is compliant with recent information governance legislation. Therefore the non-submitting local
providers were able to submit their activity and the CCGs signed these off. Haringey CCG achieved 27.3% (2017/18) with the Mental Health Services Data Set (MHSDS) data. Once all local providers’ manual updates were included, Haringey CCG achieved 31.8% against the 30% standard.
There is a local action plan in place at BEH MHT to increase access. Commissioners have been working with NHS England/CSU representatives to develop a local way of uploading the voluntary sector activity sustainably on Haringey CCG’s behalf in accordance with General Data
Protection Regulation (GDPR) standards to the NHS Bureau Service. 5. Quality Premium (QP)
The QP award is based on measures that cover a combination of national and local priorities and reflect the quality of the health services commissioned. Quality Premium 2017/18
The total value of the Quality Premium in 2017/18 was £1,434,000. Payments are usually made in month nine (December 2018) of the financial year. The Quality Premium due in month nine
2018/19 is based on the performance for 2017/18. There were five national measures (early cancer diagnosis, GP access and experience, continuing healthcare, bloodstream infections and mental health) and two local measures (one
of which is the mental health measure and the other is the expected prevalence of people with atrial fibrillation). The indicators for these measures were:
1. For CCGs to show an improvement in early cancer diagnosis (increase proportion
diagnosed at stages 1 or 2);
2. That the GP survey indicates 85% of respondents said that they had a good experience of making an appointment or that there was a 3 percent increase
(between July 2017 and July 2018 survey results);
3. For CCGs to ensure that in more than 80% of cases with a positive NHS Continuing Health Care (CHC), assessments took place within 28 days, and that less than 15%
of all NHS Continuing Health Care assessments take place in an acute hospital;
4. For CCGs to demonstrate they are reducing Gram Negative Bloodstream Infections (GNBSIs) and inappropriate antibiotic prescribing in at risk groups; and
5. For CCGs to demonstrate a reduction in the number of out of area mental health
placements.
The final data has not yet been confirmed for 2017/18. However, early indications are that at least four of the national improvement measures have not been met (early cancer diagnosis, overall experience of making a GP appointment, CHC assessments and Out of Area Placements) and reductions in gram negative bloodstream infections and inappropriate
antibiotic prescribing will be met. The value of the quality premium paid will be reduced by 25% for each of the constitutional measures which are not met. Of the four constitutional measures, the latest data for 2017/18
shows that at least three of these standards were not met. These were A&E 4 hour waits, Cancer 62 day waits (GP referral to first definitive treatment and Category A RED 1 ambulance calls). The constitutional standard of referral to treatment within 18 weeks (92% of patients) was met. This means that the payment any of the national or local measures which were met will be
reduced by 75%. The current estimate of the likely Quality Premium payment based on the performance for 2017/18 is £93,250.
Quality Premium 2018/19
The 2018/19 Quality Premium scheme guidance published by NHS England in April 2018 has
been restructured to include an incentive on non-elective demand management. In keeping with the 2017/18 Quality Premium, the maximum payment for a CCG is expressed as £5 per head of population, calculated in the same methodology as for CCG running costs,
and made as a programme allocation (this is in addition to a CCG’s main financial allocation and its running costs allowance). Emergency Demand Management Indicators (£210M national allocation):
Indicator Rationale Weighting
Type 1 A&E
Attendances
Total number of type 1 A&E attendances for 2018/19 is no greater than their
total planned number of type 1 A&E attendances in 2018/19. These will be
measured as simply the difference between actual and plan e.g. [2018/19
actual attendances] - [2018/19 planned attendances]
Non-Elective
admissions with zero
length of stay
Total number of actual non-elective admissions with LOS =0 days in 2018/19
is no greater than their total planned number of non-elective admissions with
LOS = 0 days in 2018/19. These will be measured as simply the difference
between actual and plan e.g. [2018/19 actual attendances] - [2018/19 planned
attendances]
Non-Elective
admissions with
length of stay of 1 day
or more
Total number of actual non-elective admissions with LOS >=1 days in 2018/19
is no greater than their total planned number of non-elective admissions with
LOS >=1 days in 2018/19. This will be measured as simply the difference
between actual and plan
i.e. [2018/19 actual admissions] - [2018/19 planned admissions].
50%
50%
Quality Indicators (£68M national allocation):
*CCGs can select one local indicator which will be worth 15% of the QP for the Quality
Indicators. In 2017 Haringey CCG chose expected prevalence of people with atrial fibrillation as its local indicator for the 2017/2019 quality premium and this has been retained for the 2018/19 scheme.
Quality, Financial and Constitutional Gateways will again be core requirements for payment in 2018/19. However, given the introduction of an emergency demand management element and to remain aligned with Operating Plan guidance, NHS England have suspended the operation of the tests relating to Ambulance response times and 4 Hour A&E.
No. Simple QP Inidcator name Target BaselineYTD
PerformanceWeighting
1 Cancer diagnosed at early stage. 60% 56% 56% (2016 Q4) 17.00%
2GP Survey - patients experienceing a good service when making
an appointment.68% In July 2019 65% (August 2018) 65% (August 2018) 17.00%
NHS CHC Checklist decicsion made within 28 days. Above 80% To be Compliant 83% - Q1 2018/19
Less than 15% of NHS CHC Checklists take place in acute hospital
settingBelow 15% To be Compliant 11% - Q1 2018/19
4
Improved Access to Children & Young People’s Mental Health
Services: The increase in activity to enable children and young
people aged under 18 with a diagnosable Mental Health
condition to receive treatment in NHS funded community
services.
Above 32% 27.3% (2017/18) 27.3% (2017/18) 17.00%
The reduction target in all E coli BSI reported at CCG level below 159 155 - March 2018 155 - March 2018 5.10%
Collection and reporting of a core primary care data set for all E
coli casesNo Target No Target Ongoing 2.55%
A 30% reduction in the number of Trimethoprim items prescribed
to patients aged 70 years or greater
30% below the
June 2015-May
2016 baseline
1854 1574 (May 2018) 3.40%
(STAR-PU) must be equal to or below England 2013/14 mean
performance value of 1.161 items per STAR-PUBelow 1.161 0.645 (March 2018) 0.645 (May 2018) 1.70%
(STAR-PU) equal to or below 0.965 items per STAR-PU (A STAR-PU
(or Specific Therapeutic group Age-sex Related Prescribing Unit)
is a value calculated to reflect not only the number of patients in
a practice, but also the age and sex mix of that group)
Below 0.965 0.645 (March 2018) 0.645 (May 2018) 4.25%
6Improvement in the proportion of people with atrial fibrillation
with CHADSVASC2 score>273.53% (Oct 2017) 72.53% (Oct 2017)
Next data due Nov
201815.00%
5
3 17.00%
NHS constitution gateway indicators are therefore:
Some of the measures can be reported on monthly, some quarterly and others annually (as performance is derived from national surveys). A summary of performance for indicators, which are available to be reported on, will be included within the next Performance report. 6. London Ambulance Service (LAS)
The new national ambulance response time standards were established under the Ambulance
Response Programme Initiative (ARP) led by NHS England. The aim of the ARP is to ensure that:
• The sickest patients receive the fastest response • All patients get the best response allocated to them • No one is left waiting for an unacceptably long time for an ambulance to arrive
The new ambulance response time standards are summarised below.
Category Basic definition Response time standard
Category 1
Life threatening injuries and illness (e.g. anaphylactic shock or bee sting)
Response time with an average of 7 minutes Response before 15 minutes for 9 out of 10 calls (90th centile)
Category 2
Emergency calls (e.g. stroke) Response time with an average of 18 minutes Response before 40 minutes for 9 out of 10 calls (90th centile)
Category 3
Urgent calls (e.g. uncomplicated diabetes – some of these may be treated in patient’s own home)
Response before 120 minutes for 9 out of 10 calls (90th centile)
Category 4
Less urgent likely requiring transport or hear and treat
Response before 180 minutes for 9 out of 10 calls (90th centile)
The four new patient categories are:
Category One – Life Threatening Category Two – Emergencies Category Three – Urgent Category Four– Less Urgent
IndicatorMarch 2018
(Baseline)
% Reduction
of QP
The number of patients on an incomplete pathway
not to be higher in March 2019 than in March 2018 19,250 50%
Maximum two month (62-day) wait from urgent GP
referral to first definitive treatment for cancer81.13% 50%
The LAS performance for June 2018 against the national standards is shown in the table below:
Category Measure National
Standard April May June
1 Mean response time 7 minutes 00:06:52 00:06:54 00:07:17
90th centile 15 minutes 00:11:15 00:11:21 00:11:46
2 Mean response time 18 minutes 00:16:54 00:18:41 00:20:02
90th centile 40 minutes 00:33:16 00:38:11 00:40:52
3 Mean response time 60 minutes n/a 00:55:50 01:01:12
90th centile 120 minutes 01:49:47 02:12:40 02:22:53
4 90th centile 180 minutes 02:05:05 02:24:33 02:28:17
In June 2018, LAS achieved four out of the seven measures against the national standards
when evaluating city-wide performance. The table below shows the LAS Performance by STP for June 2018:
NCL achieved the C1 90th Centile target and the C4 90th Centile target. The LAS C4 90th centile has been well within the 3 hour standard for the eight months since ARP was implemented
The table below shows a further breakdown for Haringey CCG in June 2018: C1 Mean C1 90th
Centile
C2 Mean C2 90th
Centile
C2 Mean C3 90th
Centile
C4 90th
Centile
National
Standard
7
minutes
(00:07:00)
15
minutes
(00:15:00)
18
minutes
(00:18:00)
40
minutes
(00:40:00)
60
minutes
(01:00:00)
120
minutes
(02:00:00)
180
minutes
(03:00:00)
Haringey
CCG 00:07:33 00:11:27 00:22:43 00:48:08
01:27:35 03:15:29 01:50:38
Haringey CCG achieved C1 90th Centile and C4 90th Centile. Most other CCGs had similar performance. Drivers of underperformance included delays with handovers by Acute Trusts and increased demand for Category 1.
Hospital handovers have a direct impact on performance, particularly across non-life threatening categories as ambulances are less available for conveyances. It has been recognised by regulators nationally that Ambulance services will not be in a position
to meet ARP standards straight away and performance management against these standards comes into effect in September 2018.
Haringey CCG Governing Body
Performance and Quality Report August 2018
Contents
Item Page
Haringey CCG A&E Summary 3
Whittington Health NHS Trust Community Services Dashboards 4
Haringey CCG Mental Health Performance Dashboards 8
NMUH A&E Performance Summary 11
NMUH Quality Summary 13
Barnet, Enfield and Haringey MH Trust Dashboards and Summary
London Ambulance Service
14
17
2
Key Messages
A&EFrom April 2018 CCG level A&E Performance is no longer measured as a quality premium indicator. As with CCG Operating Plans performanceis measured at provider level with CCGs responsible for the performance of the providers for which they are lead commissioners. The mainproviders for Haringey CCG patients performed as below for June 2018 against the four hour waiting standard:
North Middlesex University Hospital 89.7%Whittington Health NHS Trust 90.6% (Lead Commissioner Islington CCG)
At North Middlesex University Hospital, the local improvement trajectory of 86% was achieved. The key issues were;
• Lower than anticipated streaming of patients via the Urgent Care Centre (approximately 46% through June 2018, against a trajectory of50%), though this is strong performance in comparison to other NCL Trusts. A training plan is place, which will run through until the end ofAugust 2018, with the intention of reducing minors breaches.
• Longer than expected waiting times in ambulatory care for triage, though this has been reducing since early May 2018, from highs of 50minutes, to 28 minutes at the end of June 2018.
• Insufficient discharges, particularly, earlier in the day and lower than expected number of patients utilising the Discharge to Assesspathways. This causes flow pressures from ED, resulting in bed management issues accounting for the majority of breaches.
The Whittington Health NHS Trust/Islington CCG System revised the Accident and Emergency Improvement Plans in May 2018 with an improvement trajectory to achieve and sustain 95% from September 2018 onwards. A Rapid Improvement Plan to support this was agreed in May 2018 and is reviewed and updated monthly at the Accident and Emergency Delivery Board.
Haringey CCGA&E Summary
3
4
Whittington Health NHS TrustCommunity Services Dashboard
Mar-18 Apr-18 May-18
8.10% 8.00% 8.30%
58994 53835 62439
96.50% 96.20% 95.90%
779 1206 1181
New birth vis i ts % within 2 weeks 90.50% 89.40% 92.70%
8 week review % within 8 weeks 40.10% 38.00% 48.20%
HR1 % within 15 months 64.50% 65.30% 74.50%
HR2 % within 30 months 60.50% 56.90% 63.60%
New birth vis i ts % within 2 weeks 96.40% 94.40% 93.00%
8 week review % within 8 weeks 66.10% 68.10% 73.50%
HR1 % within 15 months 81.50% 69.40% 80.00%
HR2 % within 30 months 76.50% 77.80% 76.70%
District nurs ing - 48 hour response time (a l l CCGs) 86.70% 83.20% 91.00%
District nurs ing - 2 hour response time (a l l CCGs) 92.50% 86.70% 88.90%
ICSU Service Name%
Threshold
Target
WeeksMar-18 Apr-18 May-18
Avg Wait
(May-18)
No of Pts
Seen
%
Threshold
Target
WeeksMar-18 Apr-18 May-18
Avg Wait
(May-18)
No of Pts
Seen
CYP CAMHS >95% 8 70.10% 66.20% 67.80% 6.6 149 >95% 2 100.00% 100.00% 0
CYP Child Development Services >95% 8 66.70% 44.20% 62.30% 1.2 53 >95% 2 0
CYP Community Children's Nursing >95% 2 78.70% 84.10% 85.70% 7.9 84 >95% 1 100.00% 100.00% 100.00% 0.2 9
CYP Community Paediatrics Services >95% 12 80.60% 59.10% 86.50% 5.1 37 >95% 1 46.30% 36.40% 43.10% 5.1 51
CYP Haematology Service >95% 12 100.00% 100.00% 100.00% 1 8 >95% 2 0
CYP Looked After Children >95% 4 55.60% 80.00% 79.20% 4.4 24 >95% 2 0
CYP Occupational Therapy >95% 8 46.40% 19.20% 30.40% 13.3 23 >95% 2 0
CYP Physiotherapy >95% 8 54.70% 55.70% 47.80% 7.5 92 >95% 2 0
CYP PIPS >95% 12 100.00% 100.00% 100.00% 4.5 18 >95% 0
CYP School Nursing >95% 12 81.70% 90.80% 88.00% 5.3 100 >95% 0
CYP Speech and Language Therapy >95% 6 33.70% 35.90% 34.60% 9.4 185 >95% 2 12.50% 0.00% 4 <5
IM Bladder and Bowel - Children >95% 12 57.10% 28.60% 37.50% 13.8 16 >95% 0
EUC Community Matron >95% 6 100.00% 100.00% 95.70% 1.1 47 >95% 2 0
IM Adult Wheelchair Service >95% 8 100.00% 87.10% 97.80% 3.7 46 >95% 2 0.00% 0
IM Cardiology Service >95% 6 93.10% 100.00% 100.00% 2.7 18 >95% 2 0.00% 0.00% 100.00% 1.3 6
IM Community Rehabilitation (CRT) >95% 12 94.40% 97.70% 95.40% 3.6 131 >95% 2 62.10% 62.90% 56.50% 2.2 23
IM Community Rehabilitation (ICTT) >95% 12 84.20% 78.10% 84.80% 5.8 349 >95% 2 42.50% 29.30% 37.90% 3.6 87
IM Diabetes Service >95% 6 66.40% 65.70% 72.20% 5.4 108 >95% 2 100.00% 100.00% 100.00% 0.5 <5
IM Intermediate Care (REACH) >95% 6 85.70% 86.30% 80.60% 5 93 >95% 2 81.40% 60.70% 41.40% 3.3 29
IM Paediatric Wheelchair Service >95% 8 83.30% 80.00% 100.00% 5.6 <5 >95% 2 0
IM Respiratory Service >95% 6 80.00% 53.20% 36.40% 6.2 107 >95% 2 15.60% 6.50% 0.00% 8.2 6
PPP Bladder and Bowel - Adult >95% 12 51.80% 44.30% 50.40% 14.7 496 >95% 2 0.00% 0.00% 0
PPP Musculoskeletal Service - CATS >95% 6 94.90% 81.60% 76.00% 4.3 119 >95% 2 0.00% 0.00% 75.00% 2 <5
PPP Musculoskeletal Service - Routine >95% 6 83.90% 89.50% 92.10% 3.5 1539 >95% 2 1.3 15
PPP Nutrition and Dietetics >95% 6 72.50% 74.60% 83.90% 3.5 211 >95% 2 72.50% 74.60% 83.90% 0
PPP Podiatry (Foot Health) >95% 6 58.20% 38.20% 59.70% 5.3 645 >95% 2 58.20% 38.20% 59.70% 3 9
PPP Lymphodema Care >95% 6 83.30% 73.30% 95.20% 3.1 21 >95% 2 0
PPP Tissue Viability Service >95% 6 0 >95% 2 81.00% 74.70% 69.40% 1.9 98
80% in 2 hours
Routine Referral Urgency Urgent Referral Urgency
Is l ington HV
reviews
95%
95% in 2 days
FFT% Pos i tive (a l l CCGs) >90%
FFT responses (a l l CCGs) >1500
Haringey HV
reviews
95%
Whittington Health - NELCSU CCGs
KPI Measure Target threshold
DNA rate% <10%
Face to Face contacts
ICSU Service Name%
Threshold
Target
WeeksApr-18 May-18 Jun-18
Avg Wait
(June-18)
No of Pts
Seen
%
Threshold
Target
WeeksApr-18 May-18 Jun-18
Avg Wait
(June-18)
No of Pts
Seen
CYP CAMHS >95% 8 66.40% 67.10% 60.90% 7.8 133 >95% 2 100.00% 100.00% 0
CYP Child Development Services >95% 8 43.40% 62.30% 56.50% 1.1 46 >95% 2 0
CYP Community Children's Nursing >95% 2 82.40% 85.20% 83.30% 10.3 77 >95% 1 100.00% 100.00% 100.00% 0.2 7
CYP Community Paediatrics Services >95% 12 59.10% 84.20% 83.30% 6.4 48 >95% 1 39.10% 44.20% 31.00% 6.4 42
CYP Haematology Service >95% 12 100.00% 100.00% 100.00% 0.8 11 >95% 2 0
CYP Looked After Children >95% 4 75.00% 78.60% 77.30% 6.9 22 >95% 2 0
CYP Occupational Therapy >95% 8 19.20% 30.40% 31.80% 16.6 22 >95% 2 0
CYP Physiotherapy >95% 8 55.70% 47.30% 54.30% 7.9 92 >95% 2 0
CYP PIPS >95% 12 100.00% 100.00% 70.00% 7.7 10 >95% 0
CYP School Nursing >95% 12 89.70% 86.50% 76.80% 7.7 95 >95% 0
CYP Speech and Language Therapy >95% 6 35.80% 35.90% 42.20% 8.8 211 >95% 2 0.00% 33.30% 5 <5
IM Bladder and Bowel - Children >95% 12 28.60% 37.50% 26.70% 11.5 15 >95% 0
EUC Community Matron >95% 6 100.00% 95.70% 100.00% 0.7 43 >95% 2 0
IM Adult Wheelchair Service >95% 8 87.10% 97.80% 85.70% 4.1 28 >95% 2 0
IM Cardiology Service >95% 6 100.00% 100.00% 100.00% 1.9 33 >95% 2 0.00% 100.00% 81.80% 1.4 11
IM Community Rehabilitation (CRT) >95% 12 96.90% 95.50% 92.60% 4.7 136 >95% 2 62.90% 56.50% 68.80% 2.1 32
IM Community Rehabilitation (ICTT) >95% 12 78.10% 84.90% 89.20% 5 296 >95% 2 29.30% 37.50% 43.40% 3 99
IM Diabetes Service >95% 6 65.70% 71.60% 67.10% 5.5 143 >95% 2 100.00% 100.00% 50.00% 6 <5
IM Intermediate Care (REACH) >95% 6 86.30% 80.60% 73.30% 6.7 165 >95% 2 60.70% 41.40% 45.80% 3.3 24
IM Paediatric Wheelchair Service >95% 8 80.00% 100.00% 66.70% 6.6 <5 >95% 2 0
IM Respiratory Service >95% 6 53.20% 36.40% 63.60% 4.9 110 >95% 2 6.50% 0.00% 100.00% 1.4 <5
PPP Bladder and Bowel - Adult >95% 12 42.20% 50.00% 60.80% 12 143 >95% 2 0.00% 0
PPP Musculoskeletal Service - CATS >95% 6 81.60% 76.00% 89.60% 3.8 469 >95% 2 0.00% 75.00% 100.00% 1.3 <5
PPP Musculoskeletal Service - Routine >95% 6 89.40% 92.10% 92.60% 3.8 1469 >95% 2 68.20% 73.30% 42.90% 2.7 7
PPP Nutrition and Dietetics >95% 6 74.30% 83.90% 89.70% 3.6 184 >95% 2 0
PPP Podiatry (Foot Health) >95% 6 38.20% 59.70% 72.80% 4.9 588 >95% 2 38.20% 59.70% 72.80% 3.6 3
PPP Lymphodema Care >95% 6 73.30% 95.20% 95.00% 2.9 20 >95% 2 0
PPP Tissue Viability Service >95% 6 96.30% 93.90% 99.00% 1.5 97 >95% 2 100.00% 0.4 <5
Routine Referral Urgency Urgent Referral Urgency
5
Whittington Health NHS TrustCommunity Services Dashboard
Mar-18 Apr-18 May-18
8.50% 8.80% 9.00%
25275 23099 26551
96.50% 96.20% 95.90%
779 1206 1181
New birth vis i ts % within 2 weeks 90.50% 89.40% 92.70%
8 week review % within 8 weeks 40.10% 38.00% 48.20%
HR1 % within 15 months 64.50% 65.30% 74.50%
HR1 % within 30 months 60.50% 56.90% 63.60%
District nurs ing - 48 hour response time (a l l CCGs) 86.70% 83.20% 91.00%
District nurs ing - 2 hour response time (a l l CCGs) 92.50% 86.70% 88.90%
ICSU Service Name%
Threshold
Target
WeeksMar-18 Apr-18 May-18
Avg Wait
(May-18)
No of Pts
Seen
%
Threshold
Target
WeeksMar-18 Apr-18 May-18
Avg Wait
(May-18)
No of Pts
Seen
CYP CAMHS >95% 8 66.70% 100.00% 75.00% 4.6 <5 >95% 2 0
CYP Child Development Services >95% 8 100.00% 80.00% 100.00% 0.9 7 >95% 2 0
CYP Community Children's Nursing >95% 2 66.70% 70.00% 83.30% 2.7 6 >95% 1 0
CYP Community Paediatrics Services >95% 12 78.90% 50.00% 93.30% 5.6 15 >95% 1 46.30% 25.70% 35.00% 5.6 40
CYP Haematology Service >95% 12 100.00% 100.00% 1 6 >95% 2 0
CYP Looked After Children >95% 4 100.00% 100.00% 84.60% 5.8 13 >95% 2 0
CYP Occupational Therapy >95% 8 50.00% 0.00% 0.00% 23.4 8 >95% 2 0
CYP Physiotherapy >95% 8 44.90% 42.90% 50.00% 8.1 36 >95% 2 0
CYP PIPS >95% 12 100.00% 100.00% 100.00% 4.8 17 >95% 0
CYP School Nursing >95% 12 73.20% 85.70% 74.30% 7.9 35 >95% 0
CYP Speech and Language Therapy >95% 6 29.10% 28.10% 31.50% 9.5 73 >95% 2 12.50% 0.00% 4 <5
IM Bladder and Bowel - Children >95% 12 0 >95% 0
EUC Community Matron >95% 6 100.00% 100.00% 92.00% 1.4 25 >95% 2 0
IM Adult Wheelchair Service >95% 8 100.00% 87.10% 97.80% 3.7 45 >95% 2 0.00% 0
IM Cardiology Service >95% 6 95.00% 100.00% 100.00% 2.9 9 >95% 2 100.00% 1.7 <5
IM Community Rehabilitation (CRT) >95% 12 83.30% 100.00% 100.00% 6 <5 >95% 2 100.00% 0.1 <5
IM Community Rehabilitation (ICTT) >95% 12 84.30% 78.30% 83.90% 6.1 329 >95% 2 42.70% 27.50% 37.20% 3.7 86
IM Diabetes Service >95% 6 59.10% 60.30% 65.50% 5.8 55 >95% 2 100.00% 100.00% 100.00% 1 <5
IM Intermediate Care (REACH) >95% 6 100.00% 0.00% 100.00% 1.3 <5 >95% 2 100.00% 100.00% 100.00% 0.9 <5
IM Paediatric Wheelchair Service >95% 8 83.30% 80.00% 100.00% 5.6 <5 >95% 2 0
IM Respiratory Service >95% 6 68.40% 33.30% 26.90% 7.1 67 >95% 2 7.10% 6.50% 0.00% 8.2 6
PPP Bladder and Bowel - Adult >95% 12 42.90% 55.30% 66.00% 12.2 286 >95% 2 0.00% 0
PPP Musculoskeletal Service - CATS >95% 6 93.70% 79.20% 75.20% 4.5 50 >95% 2 0.00% 0.00% 50.00% 2.4 <5
PPP Musculoskeletal Service - Routine >95% 6 79.00% 88.00% 90.80% 3.5 884 >95% 2 1.6 7
PPP Nutrition and Dietetics >95% 6 84.00% 79.00% 90.30% 3.1 113 >95% 2 0
PPP Podiatry (Foot Health) >95% 6 64.30% 34.70% 62.90% 5.1 340 >95% 2 64.30% 34.70% 62.90% 2.2 <5
PPP Lymphodema Care >95% 6 66.70% 81.80% 100.00% 2.6 11 >95% 2 0
PPP Tissue Viability Service >95% 6 0 >95% 2 88.00% 95.70% 66.70% 2.1 24
95% in 2 days
80% in 2 hours
Routine Referral Urgency Urgent Referral Urgency
>95%
FFT% Pos i tive (a l l CCGs) >90%
FFT responses (a l l CCGs) >1500
Haringey HV
reviews
Face to Face contacts
Whittington Health - Haringey CCG
KPI Measure Target threshold
DNA rate% <10%
ICSU Service Name%
Threshold
Target
WeeksApr-18 May-18 Jun-18
Avg Wait
(June-18)
No of Pts
Seen
%
Threshold
Target
WeeksApr-18 May-18 Jun-18
Avg Wait
(June-18)
No of Pts
Seen
CYP CAMHS >95% 8 100.00% 75.00% 66.70% 6.6 <5 >95% 2 0
CYP Child Development Services >95% 8 80.00% 100.00% 100.00% 0.2 10 >95% 2 0
CYP Community Children's Nursing >95% 2 70.00% 83.30% 100.00% 2.8 10 >95% 1 0
CYP Community Paediatrics Services >95% 12 50.00% 93.30% 90.50% 6.9 21 >95% 1 25.70% 35.00% 16.70% 6.9 30
CYP Haematology Service >95% 12 100.00% 100.00% 0.6 <5 >95% 2 0
CYP Looked After Children >95% 4 100.00% 84.60% 100.00% 3 6 >95% 2 0
CYP Occupational Therapy >95% 8 0.00% 0.00% 11.10% 27.6 9 >95% 2 0
CYP Physiotherapy >95% 8 42.90% 50.00% 77.80% 6.4 27 >95% 2 0
CYP PIPS >95% 12 100.00% 100.00% 62.50% 8.4 8 >95% 0
CYP School Nursing >95% 12 85.70% 75.00% 75.90% 7.4 58 >95% 0
CYP Speech and Language Therapy >95% 6 28.10% 31.50% 28.20% 9.9 71 >95% 2 0.00% 50.00% 5 <5
IM Bladder and Bowel - Children >95% 12 0 >95% 0
EUC Community Matron >95% 6 100.00% 92.00% 100.00% 0.8 22 >95% 2 0
IM Adult Wheelchair Service >95% 8 87.10% 97.80% 88.90% 3.9 27 >95% 2 0
IM Cardiology Service >95% 6 100.00% 100.00% 100.00% 2.1 17 >95% 2 100.00% 0.00% 2.7 <5
IM Community Rehabilitation (CRT) >95% 12 100.00% 100.00% 100.00% 5.6 <5 >95% 2 100.00% 100.00% 0.7 <5
IM Community Rehabilitation (ICTT) >95% 12 78.30% 83.90% 88.30% 5.2 274 >95% 2 27.50% 37.20% 43.60% 3 94
IM Diabetes Service >95% 6 60.30% 65.50% 63.00% 5.8 81 >95% 2 100.00% 100.00% 0.00% 11.9 <5
IM Intermediate Care (REACH) >95% 6 0.00% 100.00% 0.00% 31.4 <5 >95% 2 100.00% 100.00%
IM Paediatric Wheelchair Service >95% 8 80.00% 100.00% 66.70% 6.6 <5 >95% 2
IM Respiratory Service >95% 6 33.30% 26.90% 54.70% 5.4 75 >95% 2 6.50% 0.00%
PPP Bladder and Bowel - Adult >95% 12 55.30% 66.00% 59.30% 13.4 59 >95% 2
PPP Musculoskeletal Service - CATS >95% 6 79.20% 75.20% 88.00% 3.9 251 >95% 2 0.00% 50.00%
PPP Musculoskeletal Service - Routine >95% 6 88.00% 90.80% 92.20% 3.7 805 >95% 2 70.60% 71.40% 33.30% 2.8 <5
PPP Nutrition and Dietetics >95% 6 79.00% 90.30% 91.90% 3.4 99 >95% 2 0
PPP Podiatry (Foot Health) >95% 6 34.70% 62.90% 74.80% 5 282 >95% 2 34.70% 62.90% 74.80% 1.1 <5
PPP Lymphodema Care >95% 6 81.80% 100.00% 91.70% 3 12 >95% 2 0
PPP Tissue Viability Service >95% 6 100.00% 95.80% 100.00% 1.7 27 >95% 2
Routine Referral Urgency Urgent Referral Urgency
Key Messages
Community Services The main areas of concern within the Community Services are, Bladder and bowel, nutrition and dietetics, podiatry and lymphedema. Whilst all four areas are underperforming, there has been improvement across each over the past three months. Whittington Health NHS Trust has provided a detailed breakdown of those services not meeting current access standards, the reasons for the performance, actions to address it and anticipated dates for recovery at a service level. Anticipated dates for recovery of the waiting time positions for services range from August 2018 to March 2019.
On July 24th 2018 Islington CCG issued a contract performance notice to Whittington Health to ‘ formally raise concerns regarding on-going under performance in regards to waiting times into the CAMHs emotional health and behaviour pathways’. Discussions around a recovery plan to return the service to a reasonable waiting time position will take place in August 2018.
Haringey CCGCommunity Services Summary
6
Whittington Health NHS TrustPerformance & Quality Summary
7
Key issue Priority actions
Community Access and Waiting Times
At the July 2018 meeting of the Community Service Improvement Group it was noted that although many waiting time indicators on the community performance dashboard were red, there was an upward trajectory in terms of improvement, for each of the specific areas identified for improvement by the group:
Bladder and bowel April 50.7%, May: 57.3%, June: 68.3%.Nutrition and dieteticsApril 74.1%, May: 83.2%, June: 87.9%.PodiatryApril 37.9%, May: 59.8%, June: 69.3%.LymphedemaApril 73.3%, May: 95.2%, June: 94.1%.
Whittington Health have provided a detailed breakdown of those services not meeting current access standards, the reasons for the performance, actions to address it and anticipated dates for recovery at a service level. Anticipated dates for recovery of the waiting time positions for services range from August 2018 to March 2019.
• Update following Community Service Improvement Group in July 2018
• Formal notes from the meeting were not available at the time of writing however:
• It was agreed that children and young people services were a priority and future meetings of the Community Service Improvement Group would be split to allow distinctive time allocations for discussion of adult services and discussion of children and young people services.
• Themes from the discussion around children and young people services were:
• Data Quality for children and young people services is not as good as for adult services – particularly around urgent and routine definitions
• The need to look at the overall paediatric workforce and workload
• Assess how staff can be best utilised to support provision across services rather than based on historical departmental boundaries
• A strategic plan for community services for children and young people, based on analysis of demand and capacity, to be brought to the Community Service Improvement Group by the end of August 2018.
Haringey CCGMental Health Performance Dashboard
*Latest data is provisional and unpublishedNHS Digital data published by NHS DigitalLocal data derived from Provider reports to NHS England 8
Theme KPI/Measure SourceReporting
PeriodActual Standard
Current Month and Previous Month's Trend
Blue = Actual Red = Target
Dementia Diagnosis Rate (Age
65+)NHS Digital Jun-18 67.43% 66.7%
The percentage of RTT First
Episode Psychosis (FEP) periods
within 2 weeks of referral. *
NHS Digital Jun-18 75.00% 50%
Proportion of patients on CPA who
were followed up within 7 days after
discharge from psychiatric inpatient
care
NHS Digital 2017-18 Q4 98.77% 95%
Proportion of admissions to acute
wards that were gate kept by the
CRHT teams
NHS Digital 2017-18 Q4 97.37% 95%
Proportion of Children and Young
people with eating disorders
(routine cases) that wait 4 weeks or
less from referral to start of NICE-
approved treatment
NHS Digital 2017-18 Q4 91.67% 95%
Proportion of Children and Young
people with eating disorders (urgent
cases) that wait 1 week or less from
referral to start of NICE-approved
treatment
NHS Digital 2017-18 Q4 100.00% 95%
HARINGEY
CCG
MENTAL
HEALTH
68.60% 68.50% 67.67% 67.20% 67.82% 68.27% 67.80% 67.61% 68.50% 67.90% 67.70% 67.76% 67.43%
Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18
50.00% 62.50% 75.00% 80.00% 77.78% 62.50%100.00%
75.00% 60.00% 57.14%87.50% 92.86% 75.00%
Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18
99.28% 99.33% 100.00% 98.77%
2017-18 Q1 2017-18 Q2 2017-18 Q3 2017-18 Q4 2018-19 Q1
96.12%99.32% 100.00%
97.37%
2017-18 Q1 2017-18 Q2 2017-18 Q3 2017-18 Q4 2018-19 Q1
92.86%
100.00%
91.67%
2017-18 Q1 2017-18 Q2 2017-18 Q3 2017-18 Q4 2018-19 Q1
50.00%
100.00% 100.00%
2017-18 Q1 2017-18 Q2 2017-18 Q3 2017-18 Q4 2018-19 Q1
NHS Digital data published by NHS Digital
Local data derived from Provider reports to NHSE
9
Haringey CCGImproving Access to Psychological Therapies
Performance Dashboard
Theme KPI/Measure SourceReporting
PeriodActual Standard
Current Month and Previous Month's Trend
Blue = Actual Red = Target
% Waited less than 6 weeks for a
course of treatment (for those
finishing a course of treatment)
NHS Digital Apr-18 93.00% 75%
% Waited less than 18 weeks for a
course of treatment (for those
finishing a course of treatment)
NHS Digital Apr-18 99.00% 95%
Reliable Recovery Rate NHS Digital Apr-18 53.00%
Recovery Rate NHS Digital Apr-18 54.00% 50%
Recovery Rate - QUARTERLY NHS Digital 2017-18 Q4 53.00% 50.00%
Access Rate NHS Digital Apr-18 1.81% 1.40%
Access Rate - QUARTERLY NHS Digital 2017-18 Q4 4.29% 4.20%
BME % of Numbers Entering
Treatment - QUARTERLYNHS Digital 2017-18 Q4 56.33%
HARINGEY
CCG IAPT
96.00% 94.00% 93.00%97.00% 98.00% 95.00% 93.00% 94.00% 92.00% 92.00% 94.00% 93.00%
May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18
100.00% 99.00% 99.00% 100.00% 100.00% 100.00% 96.00% 98.00% 98.00% 99.00% 98.00% 99.00%
May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18
47.00% 52.00% 47.00% 50.00% 53.00% 49.00% 49.00% 45.00% 47.00% 45.00% 57.00% 53.00%
May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18
50.00% 55.00% 50.00% 54.00% 56.00% 51.00% 52.00% 51.00% 48.00% 50.00% 60.00% 54.00%
May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18
1.70% 1.57%1.13% 1.24%
1.56%
0.94%
1.54%
0.87%
1.49% 1.39% 1.41%1.81%
May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18
51.00% 53.00% 52.00% 53.00%
2017-18 Q1 2017-18 Q2 2017-18 Q3 2017-18 Q4
4.36%3.94%
3.34%
4.29%
2017-18 Q1 2017-18 Q2 2017-18 Q3 2017-18 Q4
55.74% 53.99% 54.27% 56.33%
2017-18 Q1 2017-18 Q2 2017-18 Q3 2017-18 Q4
10
Key Messages
Barnet Enfield and Haringey Mental Health Trust Crisis Resolution and Home Treatment TeamIn April 2018 the performance reporting changed to 95% having a “Face to face assessment within 4 hours for those triaged as Urgent - clinically
appropriate following referral to Crisis Resolution and Home Treatment Team”. This has been monitored for three months and in June 2018 Barnet Enfield and Haringey Mental Health Trust reported 26.1% (161 out of a total of 617 referrals) were assessed within four hou rs, if the clinically triaged figures are used 36.9% were assessed (82 out of 222 referrals). A three month review is required on the impact of the new clinically triaged as appropriate including a commentary on change in service outcomes as the services are seeing / assessing less clients within four hours since the changes were implemented.
Early Intervention in Psychosis Commissioners are working with Barnet Enfield and Haringey Mental Health Trust to finalise the evidence required from the Ear ly Intervention in Psychosis services in terms of the National Institute for Health and Care Excellence compliant treatments and timely access. The Early Intervention in Psychosis Network Report on the recent audit of all EIP teams in England have been received with a Trust overview and Essential Standards included in the report. It is recommended that in addition to the audit evidence a plan with traject ory on the move to using structured clinical coded recording (SNOMED CT) and outcome measures is required.
Children and Adolescent Mental Health Services There are two main priorities firstly the time waiting to first appointment (standard 13 weeks) and the Access to Treatment (second appointment). The overall waiting list for Children and Young People increased by 25 to 866 in June 2018 with 212 in June 2018 waiting over 13 weeks. The Children and Young People seen within 13 week waiting time for first appointment decreased in June 2018 to 73.8% The number of children and young people seen who waited over 13 weeks improved to 98 in June 2018. Barnet Enfield and Haringey Mental Health Trust are reporting staff shortages within the Barnet and Enfield Child and Adolescent Mental Health Services which has led to an increase in long waits.
Reporting against the Five Year Forward View Improving Access Rate to Children and Young People Mental has increased to 32% for 2018 / 2019 for the proportion of children and young people aged 0-18 with a diagnosable mental health condition who have received treatment (two attendances). Barnet Enfield and Haringey Mental Health Trust contributed cumulatively April - June 2018 3026 treatment (second) contacts to the 2018 /2019 standard, therefore achieving 14.2% against the expected 8%. The Haringey Services are showing acontribution below expected at 5.1% against 8% expected.
Haringey CCGMental Health Summary
North Middlesex University Hospital A&E Performance
11
Key issue Priority actions
A&EPerformance at North Middlesex University Hospital showed further improvement, from 85.16% in May 2018 to 89.67% in June 2018. Whilst the national standard has not been achieved, the local improvement trajectory of 86% was achieved.
The key factors impacting performance are:• Insufficient streaming of patients via
the Urgent Care Centre, though performance is strong in comparison to other NCL Trusts
• Longer than expected waiting times in ambulatory care
• Slow discharges from the wards, with insufficient patients ‘home before lunch’ and lower than expected number of patients utilising the ‘Discharge to Assess’ pathways. This causes flow pressures from ED, resulting in bed management issues accounting for the majority of breaches.
There is a recovery plan in place to help improve the 4 hour A&E performance. The main areas of focus remain the same as the previous month, namely, improving streaming, streamlining the ambulatory care pathway and greater focus on early discharge planning and admission avoidance.
Emergency Department Flow
• Continue to embed the new Emergency Departmentflow model, focussing on changes on the ‘Fit2Sit’ space and optimising processes within the model and is expected to be embedded by mid July 2018.
• Specialty visits to build relationships between specialties and the Emergency Department planned and completion on-going. Visits to be completed by mid July 2018, followed by time to test and embed the new ways of working with specialties.
• The training plan continues as part of the embedding period of the flow model; this is anticipated to continue until end of August 2018, to support a reduction in minors breaches.
Wards• Regular reviews of Red2Green are undertaken, to identify the key delays and devise specific
actions to address these. • An enhanced stranded patients review commenced on 02 July 2018 to address top delay
reasons. • There is greater focus on reducing length of stay, by implementing several initiatives:
• Optimising the number of patients utilising Discharge to Assess pathways, by undertaking a ward by ward engagement plan with clear communications.
• A ‘home first’ focus• Embedding a trusted assessor initiative• Increasing the use of NM@Home to complete acute care at home; a meeting is
scheduled for 29 July 2018 between the Trust and the community teams, to identify gaps in provision and agree appropriate use of all services.
North Middlesex University Hospital A&E Performance
12
North Middlesex University HospitalQuality Summary
13
Key issue Priority actions
Serious Incidents (SI)North Middlesex University Hospital reported three Serious Incidences in June 2018. Incidents were reported in the following categories:
• One Suboptimal Care
• Diagnostics
• Falls
At the end of June 2018 there were 20 reports overdue for submission and eight Further Information Requests made.
Haringey CCG and North Middlesex University Hospital continue to meet to support timely submission and closure of Serious Incident investigation reports and good progress is being made.
North Middlesex University Hospital has revised its Serious Incident investigation process and has introduced dedicated Serious Incident investigators for a trial period to improve the quality and timeliness of investigation reports. The revised Serious Incident process was shared with the July 2018 Clinical Quality Review Group meeting. The Trust has recruited additional staff to the Governance Team to ensure a more robust process is in place
The July 2018 Clinical Quality Review Group meeting received assurance that the Trust Serious Incident and Learning Group identify any immediate actions required in response to an Serious Incident, and ensures that the service or team is aware and addresses the issues raised. The overdue status of a report investigation is not affecting immediate action implementation.
Commissioners are continuing to work with North Middlesex University Hospital to ensure only essential further information requests require a response. Additional comments and recommendations will be submitted to the Trust but a response is not required in order to close the investigation report.
Governance and Risk Improvement Process
The June 2018 Trust Board mandated the establishment of a Trust wide Governance and Risk Improvement Process. The process gives direction to existing risk and governance initiatives to ensure delivery of the Trust strategic objectives.
The Governance and Risk Improvement Process Steering Group has met twice since the June 2018 Board. Meetings are now bi monthly to ensure momentum is maintained.
Six additional Governance Team members have been recruited.
The Serious Incident and Duty of Candour processes have been reviewed and revised. Audit plans have been aligned with Governance and Risk Improvement Process deliverables. Nine staff have been trained in to undertake Structured Judgement Reviews.
NHS Improvement has agreed to support the Trust in key areas of the process.
Barnet, Enfield and Haringey MH TrustMental Health Performance Dashboard
14
*Latest data is provisional and unpublishedNHS Digital data published by NHS DigitalLocal data derived from Provider reports to NHSE
Theme SourceReporting
PeriodActual Standard
Current Month and Previous Months' Trend
Blue = NHS Digital Green = Local Data Red = Target
NHS Digital May-18 85.71% 50%
NHS Digital 2017-18 Q4 99.52% 95%
NHS Digital 2017-18 Q4 97.86% 95%
% Assessments begun within 1
hour in A&ELocal Data Jun-18 70.00% 95%
% Assessments begun within 4
hours in AMULocal Data Jun-18 60.00% 95%
% Assessments begun within 24
hours on wardsLocal Data Jun-18 84.00% 95%
% Assessments begun within 1
hour in A&ELocal Data Jun-18 89.00% 95%
% Assessments begun within 24
hours on wardsLocal Data Jun-18 96.00% 95%
KPI/Measure
BEH MENTAL
HEALTH
TRUST
The percentage of RTT First Episode
Psychosis (FEP) periods within 2 weeks
of referral. *
Proportion of patients on CPA who were
followed up within 7 days after discharge
from psychiatric inpatient care
Proportion of admissions to acute wards
that were gate kept by the CRHT teams
North
Mid
dle
sex
Barn
et
64.29%
90.91%78.57% 73.68% 66.67% 76.47%
90.48%
62.50%84.62% 81.25% 87.50% 77.78% 85.71% 85.71%
Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18
98.74% 99.76% 99.76% 99.52%
2017-18 Q1 2017-18 Q2 2017-18 Q3 2017-18 Q4
98.72% 99.45% 98.64% 97.86%
2017-18 Q1 2017-18 Q2 2017-18 Q3 2017-18 Q4
85.0% 82.0% 76.0% 73.0% 67.0%76.0% 72.0%
82.0% 88.0% 89.0% 92.0% 86.0% 81.0%72.0% 70.0%
Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18
78.0%56.0% 52.0%
68.0% 72.0% 77.0%61.0%
85.0% 71.0% 81.0% 91.0% 81.0%64.0% 63.0% 60.0%
Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18
90.0% 93.0% 89.0% 92.0%77.0%
92.0% 87.0% 91.0% 91.0% 95.0% 97.0% 94.0% 88.0%75.0%
84.0%Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18
95.0% 95.0%89.0% 93.0% 94.0% 92.0% 92.0%
98.0% 95.0% 95.0% 95.0% 94.0% 95.0%86.0% 89.0%
Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18
100.0% 100.0%
90.0%
100.0% 100.0% 100.0%93.0%
98.0% 100.0% 98.0% 98.0% 98.0% 98.0%94.0% 96.0%
Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18
Barnet, Enfield and Haringey Mental Health Quality and Performance Summary
15
Key issue Priority actions
Care Quality Commission
Barnet Enfield and Haringey Mental Health Trust was subject to
a comprehensive Care Quality Commission inspection in
September 2017 following which the Trust was awarded an
overall rating of ‘Requires Improvement’.
Two of the Trust’s mental health services were awarded a rating
of ‘Outstanding’, three were rated as ‘Good’ and three were
rated as ‘Requires Improvement’.
Barnet, Enfield and Haringey Mental Health Trust was subject to an unannounced inspection of two additional services in quarter four 2017/18.Recommendations were made in relation to nutrition and hydration, care planning, medicines management, physical health care and consultant cover.
Barnet Enfield and Haringey Mental Health Trust has shared the Trust wide
action plan addressing the Must Do and Should Do recommendations. All
actions arising from Care Quality Commission inspections are being
incorporated into the single Trust wide plan. Barnet, Enfield and Haringey
Mental Health Trust is holding bi-monthly meetings to review service area
evidence and update the plan.
The full updated plan was shared with the July 2018 Clinical Quality Review
Group meeting; the Trust is reporting good progress with implementing and
completing actions. In addition commissioners received an exception
report outlining the closed actions and those that are behind schedule.
Commissioners received actions plans for the two wards visited during the
March 2018 unannounced inspections. Progress with implementing
actions is being monitored on a quarterly basis together with the Trust wide
plan.
16
Key issue Priority actions
Early Intervention in Psychosis - Performance
There are concerns about Barnet Enfield and Haringey Mental Health Trust evidencing compliance with the NICE Standards for Early Intervention in Psychosis. In June 2018 all three teams achieved the standard for starting NICE compliant treatments within two weeks of referrals with suspected first episode of psychosis.
Commissioners continue to invest an additional £800k for Early
Intervention in Psychosis Services. Implement agreed Cluster 10 Service
Specification when approved within CCG Governance processes.
Develop and implement a Child and Adolescent Mental Health Service specification to include the Early Intervention in Psychosis standard.
Commissioners to agree the measures for assessing the impact on access and National Institute for Health and Care Excellence compliance of the additional £800k investment.
Early Intervention in Psychosis - Data Quality and Recording
There have been issues with the assurance about reporting of the Barnet Enfield and Haringey Mental Health Trust data related to Early Intervention in Psychosis performance standards when comparing data sources i.e. Mental Health Services Data Set, Unify submissions and local data. The submissions are via SDCS from April 2018.
The EIP Network Report on the recent audit of all EIP teams in England have been received with a Trust overview and Essential Standards included in the report. It is recommended that in addition to the audit evidence a plan with trajectory on the move to using structured clinical coded recording (SNOMED CT) and outcome measures is required
A revised Data Quality Improvement Plan is being discussed for 2018/19 .
It is recommended that in addition to the audit evidence a plan with
trajectory on the move to using structured clinical coded recording
(SNOMED CT) and outcome measures is required DIALOG (quality of life
and treatment satisfaction questionnaire) and Questionnaire on the
Process of Recovery (QPR) .
Barnet, Enfield and Haringey Mental Health Quality and Performance Summary
London Wide Ambulance Service Performance (LAS)
17Data Source: LAS Monthly Performance Report
The four new patient categories are:Category One – Life Threatening Category Two – EmergenciesCategory Three – Urgent Category Four– Less Urgent
With the introduction of the new Ambulance Response Programme performance reporting is being reviewed by London Ambulance Service and commissioners. London Ambulance Service have provided both CCG and pan-London summary reports for June 2018. This gives a summary of performance against the new standards for the whole of London.
London Wide Ambulance Service Performance (LAS)
24Data Source: London Ambulance Service Performance Report
The four new patient categories are:Category One – Life Threatening Category Two – EmergenciesCategory Three – Urgent Category Four– Less Urgent
The table below shows the seven key ambulance performance measures profiled by the Sustainability Performance Programme Areas. Two areas performance achieved two out of seven ambulance measures, North Central London and North West London. North Central London performance was lower across all the unmet standards across the areas and London overall. Category One mean standard has a safety standard of nine minutes and all areas where within this.
London North Central LondonAmbulance Service Performance
19
The four new patient categories are:Category One – Life Threatening Category Two – EmergenciesCategory Three – Urgent Category Four– Less Urgent
Data Source: London Ambulance Service Performance Report
London North Central LondonAmbulance Service Performance
• London Ambulance Service previously noted the North Central London performance (which has consecutively achieved only two of the seven standards since month one) and have investigated the Category Four (less urgent) activity in Enfield specifically. Two Sustainability and Transformation Planning areas achieved two out of the seven ambulance standards the other areas achieved four out of seven ambulance standards.
• In month two, six calls were made by Acute trusts to book ambulances the evening before they were required for morning conveyances, triggering six hour dispatch waits each time. London Ambulance Service have since brought this issue to the attention of those Trusts and in month three the Category Four performance has improved accordingly.
• Within the North Central London CCGs three out of five CCG areas did not achieve four out of seven ambulance standards; Enfield CCG area achieved one (Category One 90th Centile – Emergencies), Barnet CCG area achieved two (Category One 90th
Centile – Emergencies and Category Four 90th Centile – Less Urgent) and Islington CCG area achieved two (Category One 90th
Centile – Emergencies and Category Four 90th Centile – Less Urgent).
• Within the North Central London CCG areas two out of five CCGs achieve four or more ambulance standards, Haringey CCG four out of seven and Camden CCG six out of seven
• A monthly Ambulance Acute Transformation meeting was established in July 2018 to oversee the implementation of the improvement plans, patient flow process mapping and suggested improvement. The group includes representative from each site (Barnet and Royal Free), London Ambulance Services, East of England Ambulance Services, NEL Commissioning Support Unit and Barnet CCG.
20
London NCL Ambulance Service Performance NHS Haringey CCG Area
21
Quality Assurance Sign-off
22
Section Written By
Performance Mita Joshi and Julie Starr
Quality Ros Murphy
Final Sign Off by: Richard PearsonDate: 7 August 2018
To know more
If you would like to discuss any elementof this presentation, please contact:
Mita Joshi Tel: 0203 688 1120Email: [email protected]
www.nelcsu.nhs.uk
Haringey Clinical Commissioning Group Governing Body Meeting 13 September 2018
Report Title Board Assurance Framework
Date of report 23 August 2018
Agenda Item
6.1
Lead Director /
Manager
Alex Smith, Director of Planning, Performance and Delivery
Tel/Email [email protected]
GB Member Sponsor
Adam Sharples, Lay Member for Audit and Governance
Report Author
Andrew Spicer, NCL Head of Governance and Risk
Tel/Email
Report Summary
This report is the Governing Body Board Assurance Framework (‘BAF’). It captures the most serious risks that have been identified as threatening the achievement of the CCG’s four strategic objectives. In July 2018 the NCL Audit Committee in Common approved a new style Governing Body risk report which strengthens the Governing Body’s strategic oversight and focus on the CCG’s key risks and helps to ensure a consistent approach to strategic risk reporting across NCL. This is the first report in the new style. Key risks from the NCL Primary Care Co-Commissioning Committee in Common (‘NCL PCC’) risk register, NCL Joint Commissioning Committee (‘NCL JCC’) risk register and NCL Risk Register are reported to the Governing Body to ensure visibility and oversight. Risks from the NCL JCC risk register and the NCL risk register are from an NCL perspective. However, risks from the NCL PCC risk register can be from either a local perspective or a pan-NCL perspective depending on the risk. Board Assurance Framework (‘BAF’) There are 9 risks on the risk register with 4 risks reaching the threshold of 12 or higher for inclusion on the BAF. The Governing Body-level risks on the BAF can be found here Key Highlights: Risk 10 - A failure to improve performance against the A&E target at NMUH in line with the requirements of the planning guidance for 2018/19 (Threat) : A&E at NMUH is failing to meet the national performance target but has stabilised over the summer months. Significant multi-agency planning is being undertaken as winter is expected to be challenging. There is a continued risk that A&E performance will worsen during the winter months because of the significant service pressures expected so actions are focused on effective winter planning and maintaining the current stable performance levels through a potentially difficult winter. Risk 43 - A failure to deliver a balanced Financial Plan in 2018/19 (Threat): The CCG has reviewed financial controls in place in order to control budgetary
pressures or mitigate overspending. Effective mitigation of this risk is also dependent on delivery of the CCG's QIPP and transformation programme and other long term structural changes such as new contract forms with acute providers. The CCG is focussing on QIPP delivery, enhancing financial governance, and the development of new pipeline QIPP schemes for 2019-20 onwards. Haringey CCG Risk Register- New Risk The following risk has been added to the Haringey CCG risk register: Risk 44 – Cancer performance is being affected at NMUH as a result of Insufficient endoscopy diagnostic capacity due to unfilled staff vacancies (Threat). The risk has not reached the threshold for escalation to the BAF and so will be monitored by the Executive Team and the appropriate Governing Body committee. NCL Risk Register There are 9 risks on the NCL Risk Register with 1 risk having a current risk score of 15 or higher. The full version of the NCL Risk Register can be found here. Key Highlights: NCL 9: Delivering Financial Balance Across NCL CCGs (Threat): Given the scale of the financial ask it is possible that the identified actions, even if they are all implemented, will not deliver financial balance. Future mitigations are therefore being sought. This risk links with risk 43. NCL Primary Care Co-Commissioning Committee in Common Risk Register There are 13 risks on the NCL Primary Care Co-Commissioning Committee in Common (‘NCL PCCC’) Risk Register with 1 risk having a current risk score of 15 or higher. The full version of the NCL PCCC Register can be found here. Key Highlights: Risk 18 - Primary Care Support England (Threat): NHSE do not plan to bring any aspect of the contract back in house, but are pursuing active contract management in response to the National Audit Office report and recommendations. This issue remains a standing item on the NCL PCCC’s agenda. NCL Joint Commissioning Committee Risk Register There are 24 risks on the NCL Joint Commissioning Committee (‘NCL JCC’) Risk Register with 8 risks having a current risk score of 15 or higher. The full version of the NCL Risk Register can be found here. Key Highlights: JCC 10 - Mobilisation of STP and QIPP plans (Threat) And JCC 22- CSU In-Housing of Services (Threat): The in-housing of NELCSU to provide greater support and capacity for delivery of STP interventions is underway but the full extent of the financial risk of London sector in-housing of CSU services has not yet been finalised and mitigated. This has now delayed the approval of the in -housing of CSU services by NHS England which also includes North Central London. A joint financial review by NHS England and the CSU is to be implemented by mid-September 2018.
Recommendation The Governing Body is asked to REVIEW the BAF highlight report and provide feedback on the risks.
Identified Risks
and Risk
Management
Actions
The BAF is a risk management document which highlights the most significant risks to the achievement of the CCG’s strategic objectives.
Conflicts of Interest
Conflicts of interest are managed robustly and in accordance with the CCG’s conflicts of interest policy.
Resource
Implications
Updating of the BAF is the responsibility of each risk owner and their respective directorates. The Governance Team helps to support this by providing monitoring, guidance and advice.
Engagement
The BAF report is presented to each Governing Body meeting. The Governing Body includes clinicians, lay members and representatives of patients and other key stakeholders.
Equality Impact
Analysis
This report was written in accordance with the provisions of the Equality Act 2010.
Report History and
Key Decisions
The BAF was last reviewed by the Governing Body in July 2018. Risks are kept under review by the risk owners and by the committees of the Governing Body.
Next Steps To continue to manage risk across the organisation in a robust way.
Appendices
The following documents are included:
BAF Risks Highlight Report;
Risk Scoring Key.
Risk ID Risk Title Risk Owner Strategic Update MAR MAY JUL SEP
10 A failure to improve
performance against
the A&E target at
NMUH in line with the
requirements of the
planning guidance for
2018/19 (Threat)
Tony Hoolighan, Chief
Operating Officer
A&E at NMUH is failing to meet the national performance target
but has stabilised over the summer months. Significant multi-
agency planning is being undertaken as winter is expected to
be challenging. There is a continued risk that A&E
performance will worsen during the winter months because of
the significant service pressures expected so actions are
focused on effective winter planning and maintaining the
current stable performance levels through a potentially difficult
winter.
15 15 15 15 15
26 Risk of BEH MHT failing
to deliver the required
‘must do’ and ‘should
do’ improvements
required, after the Trust
was rated as ‘requires
improvement’ following
an inspection by the
CQC in December
2015 (Threat)
Jenny Williams, Director of
Nursing and Quality
The Trust shared its Improvement Plan at the April CQRG
meeting with agreement that CQRG will receive monthly
exception reports of compliance with due actions, and quarterly
presentation of the full plan. There were two unannounced
CQC inspections during quarter four to Magnolia Unit and
Silver Birches ward. The final report is yet to be published, but
the Trust had received informal feedback at the time of the
inspection indicating that improvement is needed in providing
nutrition and hydration, care planning, medicines management
and physical health care.
12 12 12 12 8
42 Continued overspend
on the Continuing
Healthcare (CHC)
budgets, resulting in the
CCG being unable to
meet its financial duty
to deliver services
within its resources
(Threat)
Clare Henderson, Director of
Commissioning
A significant amount of work has been undertaken to
understand the causes and drivers of CHC activity and spend.
This is supported by working with partner organisations through
a comprehensive multi-agency action plan with related QIPP
schemes and a review of the entire CHC function. An SRO for
CHC has been appointed across the NCL CCGs to support an
effective and efficient CHC function and clinical leads are being
engaged.
16 16 16 16 8
43 A failure to deliver a
balanced Financial Plan
in 2018/19 (Threat)
Simon Goodwin, Chief
Finance Officer
The CCG has reviewed financial controls in place in order to
control budgetary pressures or mitigate overspending.
Effective mitigation of this risk is also dependent on delivery of
the CCG's QIPP and transformation programme and other
long term structural changes such as new contract forms with
acute providers. The CCG is focussing on QIPP delivery,
enhancing financial governance, and the development of new
pipeline QIPP schemes for 2019-20 onwards.”
20 20 20 16
Risk Key
Risk Improving
Risk Worsening
Risk neither improving nor worsening but working towards target
Risk of positon worsening so actions taken are to maintain the current level
Haringey CCG BAF Risks- Highlight Report2018/19
Movement From
Last Report
Target Risk
ScoreCurrent Risk Score
Risk Scoring Key This document sets out the key scoring methodology for risks and risk management.
1. Overall Strength of Controls in Place There are four levels of effectiveness: Level Criteria
Zero The controls have no effect on controlling the risk. Weak The controls have a 1- 60% chance of successfully controlling the risk.
Average The controls have a 61 – 79% chance of successfully controlling the risk Strong The controls have a 80%+ chance or higher of successfully controlling the risk
2. Risk Scoring
This is separated into Consequence and Likelihood. Consequence Scale: Level of Impact on the Objective
Descriptor of Level of Impact on the Objective
Consequence for the Objective
Consequence Score
0 - 5% Very low impact Very Low 1
6 - 25% Low impact Low 2 26-50% Moderate impact Medium 3
51 – 75% High impact High 4 76%+ Very high impact Very High 5
Likelihood Scale: Level of Likelihood the Risk will Occur
Descriptor of Level of Likelihood the Risk will Occur
Likelihood the Risk will Occur
Likelihood Score
0 - 5% Highly unlikely to occur
Very Low 1
6 - 25% Unlikely to occur Low 2 26-50% Fairly likely to occur Medium 3
51 – 75% More likely to occur than not
High 4
76%+ Almost certainly will occur
Very High 5
3. Level of Risk and Priority Chart
This chart shows the level of risk a risk represents and sets out the priority which should be
given to each risk:
LIKELIHOOD
CONSEQUENCE
Very Low
(1)
Low (2)
Medium (3)
High (4)
Very High
(5)
Very Low (1)
1 2 3 4 5
Low (2)
2 4 6 8 10
Medium (3)
3 6 9 12 15
High (4)
4 8 12 16 20
Very High (5)
5 10 15 20 25
1-3
Low Priority
4-6
Moderate Priority
8-12
High Priority
15-25
Very High Priority