nel ccg governing body

NEL CCG Governing Body 27 October 2021

Title of report Audit & Risk Committee Chair’s report

Item number 7

Author Anna McDonald, Business Manager, Governance Team

Presented by Kash Pandya, Lay Member – Governance and Chair of the

Audit & Risk Committee

Contact for further information [email protected]

Executive summary The key messages from the NEL CCG Audit & Risk Committee meeting held on 29 September 2021 are set out below:

• A very helpful overview of the key risk areas foreach ICP was provided.

• An update on digital risks was noted

• An update on ICS developments was notedtogether with an update covering due diligence andrisk management.

• An informative summary of the Better Care Fund(BCF) across each borough was noted and thecommittee supported a proposal to establish a BCFworking group.

• A comprehensive overview of Single TendersWaivers since April 2021 was noted.

• Progress updates were presented by, External andInternal Audit and the latter included a helpfulreport on assurance mapping.

• A comprehensive update from LCFS was noted.

Draft minutes of the meeting held on 29 September 2021

are attached as an appendix to this report.

Action required The Governing Body is asked to note the update and the

minutes of the meeting held in September 2021.

Where else has this paper been

discussed?

N/A

Next steps/ onward reporting A regular report on key messages from the Audit & risk

Committee will be presented at each meeting of the

Governing Body.

1

What does this mean for local

people?

How does this drive change

and reduce health inequalities?

The Committee will ensure that there is an effective internal audit function that meets mandatory Public Sector Internal Audit Standards and provides appropriate independent assurance to the Governing Body.

Conflicts of interest There are no conflicts of interest in regard to this report.

Strategic fit The Committee will review the establishment and maintenance of an effective system of integrated governance, risk management and internal control, across the whole of the CCG’s activities that support the achievement of the CCG’s objectives.

Impact on finance, performance

and quality

The Committee will work closely with other committees established by the Governing Body to ensure there are no assurance gaps.

Risks The Committee will review the adequacy and effectiveness of the risk register and defined mitigating actions, particularly relating to the most significant risks, to assure that risks are being properly reviewed and effectively managed.

Equality impact N/A

2

Draft minutes - NEL CCG Audit & Risk Committee

29 September 2021 - 9.00am - 11.30am

Via MS Teams

Members

Kash Pandya (KP) - Chair Lay Member, Governance

Charlotte Harrison (CH) Independent Secondary Care Specialist

Sue Evans (SE) Lay Member, Primary Care

Noah Curthoys (NC) Lay Member, Performance

Khalil Ali (KA) Lay Member, PPI

In attendance

Steve Collins (SC) Acting Chief Finance Officer, NEL CCG

Ahmet Koray (AK) Director of Finance (BHR)

Sunil Thakker (ST) Director of Finance (TNW)

Marie Price (MP) Director of Corporate Affairs, NEL CCG

Anna McDonald (AMc) Business Manager, ICP- BHR

Ceri Jacob (CJ) Managing Director, BHR ICP

Selina Douglas (SD) Managing Director, TNW ICP

Siobhan Harper (SH) Interim Director of Transition, C&H ICP

Rob Meaker Director of Innovation, BHR ICP

Lee Walker Contracts Manager, NEL CCG

Auditors

Dean Gibbs (DG) External Auditor, KPMG

Jessica Spencer (JS) External Auditor, KPMG

Nick Atkinson (NA) Internal Auditor, RSM

Gemma Higginson (GH) LCFS, RSM

Apologies

Henry Black (HB) Acting Accountable Officer

1.0 Welcome, introductions and apologies

The Chair welcomed everyone to the meeting and apologies were noted.

1.1 Declaration of conflicts of interest

The Chair reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of NEL CCG. No additional conflicts of interest were declared.

3

The registers of interests held for NEL CCG Governing Body members and staff are available from the Company Secretary.

1.2 Minutes of the last meeting

The minutes of the meeting held on 21 July 2021 were agreed as a correct record.

1.3 Matters arising

The actions log was reviewed and updated accordingly.

1.3.1 Digital risks update

RM advised that the cyber security risk rating has been increased to reflect concerns previously raised by the committee. A new risk has been added relating to achieving the system wide digital strategy, the main issue being the need for the CCG to link into system partner computers systems. The risk rating in regard to the corporate IT transition has been downgraded as all the data now sits on the CCG’s servers rather than the CSU servers. The chair referred to the planned independent review on cyber security risk and RM reported that the first part of the review by has been undertaken and the cyber essential plus part of the review will be undertaken in the next few weeks. RM to send the full outcome report to KP who will determine if the whole report needs to come to the Committee or just a summary. KA referred to recent guidance that included ‘what good looks like’ in relation to digital and data management and empowering patients and asked whether any internal self-analysis on that is planned. RM referred to ‘patient knows best’ which is being procured across London as a project and is likely to be deployed out to patients to allow them to interact with their medical records. SC clarified that ‘patient knows best’ was approved at the September Finance & Performance Committee and the CCG is looking at how that will be deployed over the coming months. The committee noted the update. Rob Meaker left the meeting.

RM

2.0 Directorate risk overview

2.1 ICP issues: BHR ICP – CJ advised that the three main areas of challenge within BHR ICP are:

• securing the ‘new world’ in BHR in a manner that does not lose the gains we have made but does reflect the emerging NEL ICS

• maintaining focus and progress against key areas during a period of transition

• providing clarity of direction for staff during transition. An overview of each challenge was given and CJ added that the instability in senior leadership within BHR adds to the challenge. It was noted that all the work being undertaken at a BHR ICP level has to be aligned with what is being done at a NEL level.

4

TNW ICP – SD advised that the main key areas of risk in TNW ICP are:

• recovery – elective position, delivery in primary care, health in-equalities, huge gaps in services particularly children’s services

• transition / TNW footprint – uncertainty in terms of staff and delivery

• financial balance in TNW – significant investment in Waltham Forest needed, underfunded for many years.

ST referred to the financial gap and assured the committee that work is being done to ensure there is financial stability going forward. C&H ICP – SH advised there are lots of similarities in terms of potential risks around transition and priorities and the scale of change should not be underestimated. There is more stability in C&H from a financial perspective but there is uncertainty around delivery in terms of managing the transition and moving into new ways of working. There are some partnership issues in areas such as CAMHS which has a multi-partner pathway creating pressure points in the system The capacity of the system as a whole is a concern and there is stress on the system to deliver increasing ‘asks’ as well as continuing with ‘business as usual’. KA referred to primary care and asked if the pressures relating to the lack of GPs and practice nurses can be defined in terms of what it means to people in relation to inequalities. CJ responded in her capacity as NEL CCG lead for primary care and updated the committee in regard to the new model way of working which includes the Additional Role Reimbursement Scheme (ARRS). An update in regard to work going in Redbridge was also given. In terms of inequalities, C&H and TH boroughs have the best primary and community services in NEL because they have been able to invest in those areas and CJ gave an overview of the difficulties being experienced in BHR practices in terms of the significant change in demand. KA stressed the need for a new dialogue about how to make the best use of services in the new model of care. That needs to be presented into the public domain. CJ confirmed that the NEL Communications Team is continuing to focus on the messaging. SE commented on the huge challenges faced by the system, Waltham Forest and Whipps X in particular, in regard to not having capacity in ‘out of hospital’ services whilst at the same time, needing to reduce the number of people going to hospital for treatment. SD advised that a full business case for the out of hospital model for Waltham Forest will be presented to various committees in November and there is multi-borough working going on with Redbridge in regard to Whipps Cross X as the residents relate to 30% of the activity. The Auditors’ thanked the leads for the helpful session which they felt provided a real insight of the challenges in terms of delivery. DG flagged the importance of understanding which risks are being addressed at system level and which are being addressed at ‘place-based level’. NA referred to the risks relating to staff and the need to keep staff on board. The chair thanked CJ, SD and SH on behalf of the committee and commented that risk management has to be done at ICP level and a NEL level and trying to prioritise the risks is a key challenge. Ceri Jacob, Selina Douglas and Siobhan Harper left the meeting.

5

3.0 Governance

3.1 ICS development including due diligence process update A high-level summary was provided which outlined the progress to date and specifics on the due diligence and readiness to operate requirements. The programme of work has been organised into three core areas; strategy and transformation; system design; organisational transition. Some of the work has to be completed by 31 March 2022 and some will go beyond April 2022. A number of system-wide groups have been established together with a number of working groups including governance and finance. The oversight group that was set up as part of the CCGs’ merger is being re-established in order to have lay and independent oversight and the first meeting will be held mid-end October 2021. A due diligence process will be undertaken but not on the same scale as the CCG’s merger as a lot of the information is already in place. MP explained what the ‘readiness to operate statement’ involves and reported that overall, good progress is being made. NA commented that the CCG is more advanced in terms of the detail than other CCGs that he is working with. Contracts will not novate, they will transfer and NA fed back that one of the challenges being seen in other CCGs is that strong contract registers are essential. NA also referred to the ‘closedown’ and flagged the need to give some thought to the arrangements for the new ICB to sign off the annual accounts and annual report for the outgoing NEL CCG. There is also an Internal Audit requirement to review and comment on some of the processes such as due diligence and NA said he would be happy to sit on the Oversight Group if that would help. MP to feed the helpful offer back to Henry Black and Chris Cotton. SC advised that the finance merger working group is being re-established as a similar group called the finance transition group. The group will pick up SFIs, closedown and the work that the contracts Team will be doing. KA referred to all the assurance processes and requirements such as the ‘Readiness to Operate’ statement and questioned if it can all be achieved by the end of March 2022. MP explained that the statement is a helpful checklist of all the essential task that need to be put in place. SE referred to the new responsibilities that the ICB will be taking on that do not currently sit with the CCG such as dentistry and ophthalmology and asked if the process for transferring those is known as yet. MP explained that there is a longer timescale for some of the new functions and not all of them are expected to transfer together. The Chair referred to the ‘maturity matrix’ and asked how that fits into the work that MP and her team are doing. MP referred to the what the King Fund and the Good Governance Institute have produced and the five options in regard to place base delegation. The Chair thanked MP and her team on behalf of the committee for their continued hard work. 3.2 Risk management update MP confirmed that the Governing Body Assurance Framework (GBAF) is in place and there is a process for regularly discussing risks at an ICP level and

MP

6

also at the NEL SMT. MP to provide an update on risk at the next meeting. - MP

4.0 Planning & performance

4.1 Better Care Fund (BCF) update LW presented the update and gave the key points – the legacy CCGs took slightly different approaches to BCF planning and the creation of schemes. While all Section 75 Agreements were compliant with the national BCF conditions there was discrepancy in the approach. The main differences were outlined and committee members were asked to support the establishment of a working group consisting of the CCG Better Care Fund leads in order to review the potential inequalities in the way the BCF is used, and identify good practices which could be shared across NEL. KA asked whether there is any work going on to identify and measure outcomes to assist the committee in terms of value for money. LW advised that pre-merger, it was for each local area to determine how they would meet the outcomes and submit plans for approval. Post-merger, there is not a NEL version of a set of outcomes but there is a very clear national steer on what the BCF outcomes should be on an annual basis. The BCF leads are still working in a borough-based way. Further discussion took place and the committee agreed that a ‘read-across’ by a working group would be helpful. The committee:

• Noted the report

• Supported the recommendation to establish a working group

5.0 External Audit

5.1 Progress report JS presented the report and explained that a de-brief meeting was held with management on 16 August 2021 to review the 2020/21 audit and take the lessons learnt through to the planning stage for next year. The Audit plan and Value for Money assessment will be presented to the committee in January. Attention was drawn to the technical section of the progress report and JS highlighted that the Government has tightened the approval process for special severance payments, whereby, ministerial approval is now required for exit packages over £100k and Treasury sign-off is needed. In regard to revised guidance on losses and any special payments, those with a value above £95k must be submitted to NHSEI for approval. For completeness, SC referred to the retrospective requests needed as part of KPMG’s 2020/21 audit. The two retrospective requests were turned down by the Treasury and this was shared in the year-end report and the regularity opinion was qualified. SC added that it is understood that no further action is required and JS confirmed that it has been discussed and agreed. ST added that the regulator has also confirmed that the matter is closed. The Chair brought the discussion to a close by assuring the Auditors that lessons have been learnt. The Committee noted the progress report.

6.0 Internal Audit

7

6.1 Progress report NA talked through the key points in the report and explained that the ‘new models of care’ work sets out the work that has been done and the progress made across the three ICP areas. NA confirmed there are no overdue items from the legacy CCGs. It was noted that Governing Body members would be undertaking a training session on COIs and Fraud & Bribery later in the day at the Governing Body’s OD session and NA advised he would soon be sharing a meeting invitation for the second ICS workshop on 21 October 2021. NA outlined the work completed in regard to assurance mapping work across the CCG and the chair commented that the assurance mapping will be helpful for the due diligence work that is being undertaken. The chair referred to the questions asked in the report about assurance needs and asked NA how he would like that taken forward. NA clarified that it would be helpful for a wider discussion at an executive level to take place in regard to the questions. MP confirmed she has been discussing this with John Elbake (RSM) and the intention is to share it as part of the risk discussion planned for the next SMT meeting. SC suggested it would be helpful for SMT to consider where some of the assurance mapping can be factored into rolling agendas for committees and also cross referencing it to the risk register. MP to bring an update back to the committee in March. The committee:

• noted the progress report

• noted that the following documents had been shared outside of the meeting for information:

o ICS workshop summary o NHS news briefings.

NA MP

7.0 Local Counter Fraud Specialists (LCFS)

7.1 Progress report GH presented the update and reported a positive position in terms of the number of referrals received, the type of referrals which span a range of different methodologies and the sources of the referrals. In July 2021 Disclosure UK released annual data in regard to the Association of the British Pharmaceutical Industry (ABPI) that identifies gifts, hospitality, fees etc offered by the pharmaceutical industry to healthcare organisations and individuals and GH confirmed that only there is only one entry for 2020 and it related to an individual member of staff which LCFS is verifying against local registers. GH pointed out that there has been a lower incident rate across the ABPI data for the reporting period as there have been fewer conferences and other activities that pharmaceutical companies would have been sponsoring. An overview was given in regard to work that the LCFS team has been doing in conjunction with NA and his team on CHC, personal health Budgets and procurement and contract management. GH advised that there is strong focus around awareness activity and awareness sessions are being scheduled for CCG staff, practice managers and GPs. GH updated members on a referral that has arisen since the report was produced relating to a prescription pad and also gave an update on an on-going case. In regard to CFA compliance, the requirement to have ‘counter fraud champion’ has been paused and the reasons why were explained.

8

KA asked whether the number of staff who were re-deployed during the pandemic has impacted on the fraud awareness and training programmes. GH responded that the awareness programme delivered over the past 18 months has been really positive as attendance on virtual events has been much more significant and LCFS is keen to have a blended awareness sessions going forward. The chair asked what impact the National Fraud Initiative is having and GH confirmed that the matches have been released and the team is liaising with HR to determine the action that needs to be taken. GH to provide an update at the next meeting. The committee noted the progress report. 7.2 Reactive benchmarking report This is produced on an annual basis and was shared for information. The committee noted the benchmarking report.

GH

8.0 Finance

8.1 Finance overview SC gave a verbal update on the key headlines following the presentation of the full report at the Finance & Performance Committee on 22 October 2021. The CCG is still operating a block contract arrangement and it is expected that will continue for H2. The H2 principles are broadly similar to H1 and further guidance on H2 is awaited. There are emerging volume-based pressures being seen in prescribing and CHC across some boroughs. There are also increasing significant pressures for the CCG and system partners as we move into the winter period. SC updated the committee on the changes to how the Elective Recovery Fund (ERF) is manged and advised there is a heightened approach in regard to returning to near normal productivity levels for the second half of the year. The committee noted the update. 8.2 Update on ISA260 recommendations ST recapped that the ISA260 had three actions - the first action relating to special payments has been closed as discussed earlier in the meeting under agenda item 5.1. The second action relating to the CHC programme of work in carrying out a review on the process of maintaining the various databases the CCG has specifically within the BHR ICP is on-going and the deadline for completion is 31 December 2021. In regard to the third action relating to the review of prior year accruals, ST advised that a number of workshops have been held to articulate what the accrual arrangements are and this is work in progress with a due date of 31 December 2021. KA referred to the transformation programmes and commented that it would be helpful to regenerate interest in those as a lot of hard work has been undertaken over a number of years. ST clarified that in the main, the system development funds have been deployed such as ‘aging well’, mental health and primary care relating to digital but there is still work to be done and it is very much a key priority for everyone.

9

The committee noted the update, 8.3 Single Tender Waivers An overview of the work undertaken by the NEL Procurement Group in relation to Single Tender Waivers (STWs) was provided for noting. Thirty six STWs totalling £12.56m have been endorsed by the NEL Procurement Group since it was established in April 2021 and in the main, they reflect a continuation of contractual arrangements during the pandemic. STWs will continue to be reported to the Audit & Risk committee for noting. SE commented that there is a risk in terms of having to refresh and renew where contracts are terminating rather being able to transfer because timescales keep rolling forward. SC responded that the CCG is continuing to ensure there is the right level of resource and it is likely that additional professional procurement advice and resource will be brought in when needed. The chair commented that STWs are always a concern and something that the committee needs to keep a close eye on. The committee noted the update.

9.0 Key messages to feedback to the Governing Body A short paper will be drafted for the next meeting of the Governing Body.

KP/AMc

10.0 Any other business

10.1 Work plan It was noted that the directorate risk overview scheduled for the next meeting would be on Continuing Health Care. A report on winter planning to be added to the work plan at the next meeting. The Committee noted the work plan.

11.0 Items for information

11.1 Procurement Group minutes The committee noted the minutes of the meetings held in July, August and September 2021. 11.2 Information Governance Group minutes The committee noted the minutes of the meeting held in August 2021.

Date of next meeting – 19 January 2022

10

Governing Body meeting - Wednesday 27 October 2021

Title of report Primary Care Commissioning Committee Chair’s report

Item number 7

Author Sue Evans, Deputy CCG Chair and Lay Member - Primary Care

Presented by Sue Evans, Deputy CCG Chair and Lay Member - Primary Care


Executive summary The key messages from the NEL CCG Primary Care

Commissioning Committee meeting held on 8 September are:

• the removal of the temporary arrangements for LIS/LES

income protection that put in place to support the response

to the Covid-19 Pandemic from Q3 was approved

• the proposal to implement a LIS for Safeguarding Children

and Vulnerable adults from October 2021 was approved

• the Committee ratified and approved the decision to issue

Dr Sathyajith’s Practice (Newham) with a Remedial

Breach Notice

• the Committee ratified and approved the decision to

extend the caretaking arrangements for Victoria Medical

Centre (B&D)

• the Committee ratified the decision to approve the change

of PCN for the Hainault Surgery (Redbridge)

• the proposed process for the allocation of the PCN

development funding was approved.

The approved minutes of the meeting are attached as an

appendix to this report.

Action required The Governing Body is asked to note the update.


discussed?

N/A

Next steps/ onward reporting A regular report on key messages from the Primary Care

Commissioning Committee will be presented at each meeting of

the Governing Body.


people?



In exercising its functions, the Committee must comply with the

statutory duties as set out in the NHS Act, including ensuring

quality of primary medical services, reducing inequalities, patient

involvement and patient choice, and will provide appropriate

independent assurance to the Governing Body.

Conflicts of interest None.

Strategic fit The Committee functions as the corporate decision-making body

for the management of the primary care delegated functions to

NEL CCG.

11

mailto:[email protected]


and quality

The Committee will oversee primary care services, ensuring

consistency and value for money across NEL.

Risks The Committee will review the Primary Care risks and mitigating

actions at each meeting.

Equality impact N/A

12

Primary Care Commissioning Committee meeting 2-4.30pm Wednesday 8 September 2021, Microsoft Teams

Minutes

Present

Khalil Ali Lay Member for Patient and Public Involvement, NEL CCG

Steve Collins Acting Chief Finance Officer, NEL CCG

Sue Evans (Chair) Lay Member for Primary Care and Deputy CCG Chair

Charlotte Harrison Secondary Care Consultant, NEL CCG

Ceri Jacob Managing Director, BHR ICP, NEL CCG

Kash Pandya Lay Member for Governance, NEL CCG

In attendance

Richard Bull Primary Care Director, City & Hackney ICP, NEL CCG

Greg Cairns Local Medical Committee (Londonwide)

Gohar Choudhury Assistant Head of Primary Care, NEL CCG

William Cunningham-Davis Primary Care Director, TNW ICP, NEL CCG

Angela Ezimora-West Primary Care Team, NEL CCG

Mike Fitchett Independent GP

Leornardo Greco HealthWatch, Newham

Michal Grenville Local Medical Committee (Londonwide)

Alison Goodlad Deputy Director Primary Care, NEL CCG

Rachel Halksworth Senior Consultant NEL Healthcare Consulting

Lorna Hutchinson Assistant Head Primary Care, NEL CCG

Natalie Keefe Deputy Director Primary Care, BHR ICP, NEL CCG

Chris Lovitt Deputy Director of Public Health, City of London & London Borough of

Hackney Public Health Service

Manisha Modhvadia (items 1-7) HealthWatch, Barking and Dagenham

Kate McFadden-Lewis (minutes) Board Secretary, NEL CCG

Anil Mehta Clinical Chair, Redbridge, NEL CCG

Muhammad Naqvi Clinical Chair, Newham, NEL CCG

Mark Rickets Clinical Chair, City & Hackney/ GP lead for Primary Care NEL CCG

Sarah See Primary Care Director, BHR ICP, NEL CCG

Tina Teotia Local Medical Committee (Redbridge)

Gladys Xavier Director of Public Health, London Borough of Redbridge

Apologies

Azeem Nizamuddin Independent GP

Fiona Smith Registered Nurse, NEL CCG

13

Item

1 Welcome, introductions, apologies

Sue Evans welcomed attendees to the meeting and apologies were noted.

There were no declarations of interest.

2 Minutes of the last meeting and matters arising

The minutes of the last meeting were accepted as an accurate record.

3 LIS/ LES Income Protection

Alison Goodlad presented on the proposal that the temporary arrangements for LIS/LES income

protection that were put in place to support the response to the Covid-19 Pandemic, and extended

until 30 September 2021, should cease from Q3. Where practices performance is being adversely

affected due to release of staff to the Covid-19 vaccination programme or by staff sickness,

income protection will be considered on a case by case basis. There may be some LISs that are

affected by the blood collection tube supply disruption, and these LISs will be considered for

temporary suspension until this issue is resolved.

Discussion points included:

i. concerns around the continued pressure of the pandemic, vaccination programme and

winter approaching

ii. a reminder that the LIS suspension was to address the specific and immediate issue of the

pandemic. The perennial capacity and workforce issues will need to be addressed

separately

iii. acknowledgement that reinstating these LISs is best for patients, and a lot of the services

have continued despite the suspension in line with patients’ needs, specifically around

managing long term conditions

iv. the need to ensure consistency across NEL in the approach to assessing any necessary

income protection, clearly setting out the criteria in advance and ensuring any appeals

process is easy and fair

v. the balance between recognising the pressure that the whole system is under and being

compassionate, respectful and mindful of the wellbeing of staff

vi. the need to ensure the LIS equalisation programme is well resourced so that preventative

strategies across NEL are levelled up as soon as possible

vii. that any changes are communicated to Local Authorities to be taken into consideration for

reinstating Local Authority commissioned services.

The Committee approved the suspension of LIS/ LES income protection from Q3, with the

assurance that any income protection considered on a case by case basis will be consistent

across NEL.

4 Equalisation of LISs

Rachel Halksworth updated on the LIS Equalisation programme progress, reporting that the

programme group has agreed the approach to prioritisation for the LIS review, including evaluation

criteria for each of the priority areas. The prioritisation process has been slightly delayed to mid-

October, however this will not affect the overall timeline. The financial investment required for the

levelling up approach is being explored and will be assessed for value for money by each LIS area

task and finish group. In discussion, the Committee noted:

i. the importance of being able to demonstrate the value for money for our patients

ii. that often improving quality in primary care can result in a reduced flow of patients into

secondary care

iii. the need to ensure the workforce is in place to support these schemes.

14

5 Local Incentive Scheme for Safeguarding Children and Vulnerable adults

Alison Goodlad presented on the proposed LIS as a way to ensure appropriate remuneration to

practices for completing Safeguarding Reports as required by Local Authorities. Implementation of

this arrangement was delayed across NEL, largely due to the Pandemic, and so it is proposed that

practices are paid retrospectively for reports already completed from 1 October 2019 at a price of

£35 per report. It was initially proposed that future reports were also paid at this rate on the basis

of coded activity, however subsequent engagement with LMC colleagues indicated that manual

claims per report based on time spent undertaking reports, was preferred. This change in

methodology does not impact on the financial projections.

The aim is to implement this from October and continue to work with the Local Authorities on a

standard template for use across NEL. The Tower Hamlets gold standard safeguarding scheme

has been in place for a year, and it is planned to evaluate this alongside the Safeguarding LIS

covering the rest of the NEL to inform the commissioning of a safeguarding scheme in the future

across all of NEL.

This has been approved through the BHR and TNW agreed governance process, and is due to be

discussed by City and Hackney Primary Care Commissioning Advisory Group later in September.

In discussion, the time and resource necessary to complete these reports, and the need for a

digital solution to help reduce this, was raised.

The Committee approved the proposed financial implication and the service specification, subject

to the necessary sign off by City and Hackney Primary Care Commissioning Advisory Group.

6 Duty Doctor Scheme (BHR ICP)

Sarah See presented on the proposal to pilot a duty doctor scheme to allow healthcare

professionals access to a GP during core hours, running from October 2021 to March 2022, with a

review taking place at the end of the scheme. This will support the winter plan for BHR ICP and will

be supported by current infrastructure available in the GP federation. In discussion, the Committee

noted:

i. the need for improved data sharing and shared patient records across the system

ii. that this scheme will support, and is supported by, the additional capacity that has been

commissioned separately across BHR ICP

iii. the need to develop robust outcome measures to demonstrate delivery, as well as

improved quality and patient experience

iv. the importance of collaboration and sharing the learning from similar schemes across the

system.

7 Remedial Breach Notice: Dr Sathyajith’s Practice

Lorna Hutchinson presented on the decision to issue Dr Sathyajith’s Practice with a Remedial

Breach Notice (RBN) following the ‘Requires Improvement’ rating by the Care Quality Commission.

The practice have given assurance that the patient safety issues have been addressed and new

systems are being implemented to support clinical governance. An action plan is in place and is

being closely monitored by the local primary care team.

The Committee ratified and approved the decision to issue Dr Sathyajith’s Practice with a RBN.

8

Commissioning decision: Extension of Caretaking Arrangements - Victoria Medical Centre

Gohar Choudhury presented on the recommended decision to extend the caretaking

arrangements for Victoria Medical Centre to allow further stakeholder engagement and undertake

an options appraisal for the future of the list, as due to the pandemic, a full appraisal and

engagement exercise was not undertaken.

In addition to this, the GP partner of Five Elms Health Centre has been taken ill, and there is

potential that the practice will need to hand back the contract, in which case, one option would be

to merge the lists. An extension would give more time to explore all of these options.

15

In discussion, the Committee sought assurance that four months was adequate time to undertake

the options appraisal and consultation, and was assured that the options would be presented to

the Committee in January 2022 to take the decision on the way forward.

The Committee ratified and approved the decision to extend the caretaking arrangements for

Victoria Medical Centre for four months.

9

NEL Primary Care Contractual update

Lorna Hutchinson presented on the decisions that have been made, in regards to contract

changes, through the ICP primary care groups since the last meeting, and updated the Committee

on the progress on action plans for those practices issued with remedial breach notices.

Hainault Surgery - Change of PCN

The Committee ratified the decision, through the BHR Primary Care Group, to approve the change

of PCN for the Hainault Surgery.

10 PCN Development Funding

Alison Goodlad presented on the proposed process for the allocation of the PCN development

funding, with the allocations to boroughs based on weighted capitation, as previously.

The PCNs are due to report on how last year’s funding was spent by 17 September and submit

their plans for this year’s funding by the end of September. The PCNs are asked to ensure their

plans meet at least one of four development areas: support recruitment, embedding and retention

of new staff, enhance integration, improve access and reduce health inequalities.

The Committee noted that the funding request form has been updated to include a section to

report on how the funding will be used. The Committee approved the process noting this

amendment.

11 Substructures - ICP updates

TNW - William Cunningham-Davis presented the proposed primary care governance

arrangements for TNW ICP, outlining how the structure supports the 80:20 principle with local

stakeholder input, scrutiny and decision making.

In discussion the suggestion to have Lay Chairs for some of these meetings was noted, and clarity

was given that the reporting line to the NEL PCCC is from the TNW Primary Care Transformation

Group.

The Committee approved the proposed governance structure, noting that some streamlining may

be undertaken.

BHR - Sarah See presented the BHR ICP primary care delegated governance sub-structure which

has been agreed at the BHR Primary Care Management Group. The Committee approved.

C&H - Richard Bull presented the primary care update; the Committee noted.

12 Summary of round-table discussion regarding Havering Primary Care quality issues

Sarah See presented on the round-table discussion, held with NHS England, Clinical Leads,

Primary Care and Nursing and Quality Teams and CQC leads, to discuss Havering Primary Care

quality issues and agree key areas of work to improve primary care services for the local

community and support practices. The agreed next step from discussions was to establish a BHR

wide quality improvement programme, with the potential to share the learning across NEL.

Discussion points included:

i. the importance of ensuring patient and public involvement and engagement in these plans,

as well as the borough practices and primary care staff, PCNs and LMC

16

ii. the need to ensure this programme of work is joined up with the work from the PCN

improvement fund, including around sustainability and innovation

iii. the potential for this programme, and the learning, to develop and expand across NEL.

13 Finance update

Steve Collins updated the Committee on the primary care budgets across NEL, reporting a break-

even position for delegated primary care, and a small overspend for CCG funded Primary Care.

Key discussion points included:

i. that pressures remain around the vaccine programme and urgent care. Some cost

pressures are emerging in prescribing which may a temporary charge due to increased

prescribing in the community or potentially increasing costs, including around

transportation. The team will continue to monitor

ii. the slight concern that north east London has not seen the expected high rate of

demographic growth, which could affect the primary care allocations. This may be due to a

number of reasons and is a concern across London

iii. the need to ensure investment in transformation to support the recovery journey.

14 Approach to risk

Alison Goodlad presented on the approach to managing the primary care risks across north east

London, which is in line with the NEL CCG policy and strategy. A task and finish group will be

established to take this forward. Discussion points included:

i. that a digital risk management programme would enable shared risks to be easily managed

and updated across the system. The governance team are exploring risk management

programmes, such as RLDatix

ii. the importance of ensuring consistency in the approach to risk scoring, escalation and de-

escalation and risk appetite across the system.

15 Questions from the public: None.

16 AOB

The Committee reviewed the 2021/22 meeting planner and agreed to discuss the future of primary

care governance and commissioning at the OD session planned for 13 October 2021.

17

Governing Body meeting - Wednesday 27 October 2021

Title of report Remuneration Committee Chair’s report

Item number 7

Author Noah Curthoys, Lay Member for Performance

Presented by Noah Curthoys, Lay Member for Performance


Executive summary The key messages from the meeting held on 22 September 2021 are:

• The Committee discussed the ICS OD and HR requirements

as set out in the recent guidance from NHSE/I

• The Committee noted the timeline and plan for submission of

the WRES data to NHSE/I

• The Committee approved the proposal to establish an ICS

Chief Pharmacist

• The Committee approved the increase in the number of

sessions for Governing Body Registered Nurse member.


Where else has this paper

been discussed?

N/A

Next steps/ onward reporting A regular report on key messages from the Remuneration Committee

will be presented at each meeting of the Governing Body.


people?


and reduce health

inequalities?

The Committee is in place to ensure all decisions on the

remuneration and conditions of service of CCG staff are fair,

transparent and consistent, as well as to ensure that the Governing

Body has the right balance of skills, knowledge and perspectives

required to function effectively.

Conflicts of interest None.

Strategic fit The work of the Committee will support the following corporate

objectives:

• Ensure the best use of resources

• Support our people to thrive.

Impact on finance,

performance and quality

The Committee will oversee the remuneration of all CCG staff,

ensuring consistency and value for money across NEL.

Risks The Committee will review any corporate risks as assigned by SMT

and the Governance Team as necessary

Equality impact N/A

18


NEL CCG Governing Body – 27 October 2021

Title of report Finance & Performance Chair’s report

Item number 7

Author Sophia Beckingham

Presented by Noah Curthoys – Lay Member for Performance


Executive summary Since the last Governing Body, two Finance & Performance Committees have been held on 25 August and 22September respectively.

Items discussed and reviewed at the Finance & Performance Committee are as follows:

• The committee’s discussed the performance of NEL providers against constitutional standards and H1 plans. The committee also received an update on recovery plans where NEL providers continue to work on decreasing PTL and incomplete RTT pathways, although a number of risks challenge this area of work.

• The committee noted the increased pressure in 111 and urgent care, and the solutions which had been adopted to decrease this pressure and build resilience in the emergency care system.

• The committee APPROVED the closure of the legacy CCG bank accounts.

• The committee received an update on the CSU in-housing business case.

• The committee received the month 4 finance report, which outlined that the CCG were reporting a break even position and was on plan. Deficits included in the report were due to the retrospective claim process the CCG is in engaged on with NHSE. Pressures were emerging in Acute, CHC and Prescribing Costs.

• The committee discussed and agreed the process of the strategic transfer of property to ICS or trust partners.

22 September 2021:

• The committee discussed the challenged position of elective recovery. Key highlights include an increase

19


of over 78 week waiters, outpatient activity is behind projected baselines coupled with an increase growth in the non-admitted PTL.

• The committee also discussed winter pressures and planning, noting that 111 and UEC were becoming increasingly challenged, with high call volumes and ED attendances exceeding baseline expectations. Significant planning as a system has taken place in order to mitigate key risks and meet National and Regional asks. The committee also noted the risk that Covid-19 spikes and RSV would have on a challenged ED system.

• The committee AGREED to continue funding mitigations for 111 and UEC pressures.

• The committee noted the Month 5 finance report. Key headlines: At Month 5 (period to end of August 2021), NEL CCG have achieved a break even position on the core budgets. However, delivery to the break even position is reliant of the used of non-recurrent mitigations and Covid contingency funds to offset identified budgetary pressures.

• NEL Procurement Group TOR was agreed subject to more inclusion of Quality elements.

• The committee approved and supported the business case for a Personal Health Record for NEL. NEL took part in the procurement process for the PHR in NWL and this business case is to take up the offer of the winning bidder (Patient Knows Best).

• St George’s Business case was discussed

• The committee APPROVED a contract award for Enhancing Population Awareness Services contract to Catch22.

The draft minutes of the 25 August meeting are attached as

an appendix to this report.



discussed?

Finance and Performance Committee.

Next steps/ onward reporting A regular report on key messages from the Finance &

Performance Committee will be presented at each meeting

of the Governing Body.


people?



The Committee:

• provides assurance to the public and the Governing Body on the robustness of the in-year financial strategy and financial management for the CCG and spend of public funds

• gains assurance on the longer term financial strategy and planning to ensure stability of the health services for the people of NEL

20

• scrutinises the performance of providers and of the CCG against established contractual, statutory and KPI metrics, and act based on these findings.

• Agrees and recommends business cases and contract awards


Strategic fit The Committee reviews and monitors the financial strategy

and operational financial plans of the CCG and the current

and forecast financial position of the overall CCG budget. In

addition, it approves business cases that are beneficial to

the public and fit within the CCG financial plans that are

within delegation limits.


and quality

The Committee will manage the key areas of finance and performance as outlined in this report.

Risks The Committee will review and monitor system wide operational performance in accordance with national operational planning guidance and advise on risks and mitigations. The committee will Manage system risks to the CCG’s financial performance and of plans to mitigate their impact. A risk based report shall be sent to the CCG Governing Body every 2 months; along with any necessary progress reports, recommendations and formal requests for approval in relation to contracting activity.

Equality impact N/A

21

1

NEL CCG Finance and Performance Committee Meeting

25 August 2021 from 10h00 to 11h30, Microsoft Teams

Minutes

In attendance

Name Role Committee Role

Organisation

Noah Curthoys Lay Member for Performance Chair NEL CCG

Ahmet Koray Director of Finance Attendee NEL CCG (BHR ICP)

Archna Mathur Director of Performance & Assurance

Member NEL CCG

Fiona Smith Independent Clinical Representative – Registered Nurse

Member NEL CCG

Kash Pandya Audit Chair Member NEL CCG

Sophia Beckingham Senior Governance Lead Attendee NEL CCG

Apologies:

Name Role Committee Role

Organisation

Mark Ricketts Clinical Chair City & Hackney Member NEL CCG

Sunil Thacker Director of Finance Attendee NEL CCG (C&H and TNW ICP)

Ken Aswani Clinical Chair Waltham Forest Member NEL CCG

Steve Collins Acting Chief Finance Officer Member NEL CCG

No. Agenda item and minute

1. Noah Curthoys (NC, Committee Chair and NEL CCG Lay Member for Performance) welcomed the group, noted apologies and confirmed that the meeting was quorate.

Minutes of Meeting held on 28 July 2021 were confirmed as accurate.

2. Performance Report

Archna Mathur (Director of Performance and Assurance, NEL CCG) presented the performance report, outlining that the report covered the areas of constitutional standards: elective, diagnostics and cancer, Phase 3 Operating Plan and ED Performance (weekly A&E report).

AM informed the committee that the over 104 week waiters elective position was deteriorating, largely due to the speciality of Paediatric Dentistry at NHS Barts Health. AM explained that this

22

was an area of challenge before the pandemic and the CCG had to submit trajectories for these areas to the NHS England Regional Team that outlined plans for this financial year. This submission outlined that of the 242 patients, 230 were from the paediatric dentistry specialty. AM confirmed that there is a plan to clear this backlog by June 2022 but that the CCG had to press for additional assurance from the trust that this could be achieved.

AM noted that although the over 52 week waiter position was improving, NEL was seeing a continuing rise of non-admitted PTL which is largely due to operational issues. AM noted that additional challenge, deep dives and operational groups had to be put in place regarding these issues with a detailed plan in place for NHS Barts Health who are driving the increase.

AM highlighted that the over 62 day backlog in NEL was ahead of plan in May-21 with 687 patients waiting over 63 days compared to 743 trajectory with a reducing trend, noting however that NEL had the greatest backlog in London with lower GI and gynae specialities remaining a concern. AM explained that the two week wait referrals for May were below plan at 99% BAU compared to 107% target however recent trends show this is increasing in line with awareness campaigns. The number of patients receiving their first definitive treatment within 31 days of diagnosis was at 99% just below the 100% of BAU target for May.

NC queried the approach to clearing the paediatric backlog. AM explained that a deep dive would be taking place that afternoon to discuss this matter with the hope that Barts Health would take good practice from BHRUT in holding extra clinics to clear the backlog and encourage patient equity.

Fiona Smith (FS – Registered Nurse, CCG Lay Member) queried if there was wastage in the system or staffing impacts and if there was any move to have a singular PTL across NEL. AM explained that there is more that could be done to improve theatre productivity and theatre utilisation which is being explored in the operational groups and that challenges had been reported regarding the number of nurses which was impacting a number of specialties. AM confirmed that there was work in train to review the establishment of one PTL across NEL.

Kash Pandya (KP – Audit Chair) queried what the trusts were doing to communicate with patients and if NEL was utilising the independent sector appropriately. AM explained that clinical triage is the main route of communication with patients which assesses patient’s condition whilst they are waiting and if it has worsened during that time which allows for urgent patient prioritisation and engagement. AM confirmed that other routes such as texts, calls and letters are in place. AK noted that NEL is using the independent sector and highlighted the slight overspend against independent sector spend in the financial papers.

The committee NOTED the update.

3. Finance Report

Ahmet Koray (Director of Finance, BHR ICP, NEL CCG) presented the finance report, explaining that NEL CCG reported a year to date and forecast break even position at Month 4. AK explained that there is slight overspend against independent sector and CHC spend, by which mitigations have been assigned by releasing some previsions from the previous year. AK noted that TNW has unidentified quip scheme for prescribing which the finance team were currently reviewing.

AK noted that in month 4 the CCG received £6.2m HDP funding and £2.4m non NHS ERF funding, highlighting that the CCG was still expecting further HDP and ERF funding based on the latest year to date cumulative position but in general ERF funding was declining.

NC queried if the CCG were confident that NHSE would reimburse the CCG within the financial year. AK explained that NHSE were currently conducting a validation exercise to review

23

reimbursement costs and that NHSE release 80% of the claim with the remaining 20% released as part of the validation exercise, but that this would be received in-year.

KP queried the use of reserves as mitigations, monies of which had been ear marked for transformation work and if this would impact the CCGs transformation plans. AK agreed that some of the reserves had been ear marked for transformation work but explained that other reserves had been set aside for backlog clearance, so there was balance sheet head room to cover these mitigation spends without impacting the CCGs transformation plans.

The committee NOTED the report.

4. Closure of Legacy CCG Bank Accounts

Ahmet Koray (Director of Finance, BHR ICP – NEL CCG) introduced the paper, noting the merging of the seven CCGs within north East London that took place on April 1st 2021. AK explained that each CCG had held its own bank account, all of which are required to be closed with the exception of Tower Hamlets CCG which has been renamed to North East London CCG and acts as the bank account for NEL CCG.

The committee members noted the importance of acting within NHS England Guidelines for CCG mergers and the need to complete this legacy work.

The committee AGREED the closure of the six legacy bank accounts associated with NHS City & Hackney CCG, NHS Waltham Forest CCG, NHS Newham CCG, NHS Barking and Dagenham CCG, NHS Havering CCG and NHS Redbridge CCG.

5. Strategic Property Transfers

AK explained that the paper asked for support from the committee to engage with consultants to strategically advise on the property transfer from NHS Property Services to the CCG. AK noted that the transfer of properties to the local NHS would allow the ICS to have better control over the utilisation and development of sites and would also support the system to better integrate and standardise facilities management commissioning.

FS queried the costs within the paper and if these had been factored in to the CCGs financial plans and its impact on the CCG’s estates strategy. The committee agreed to review these areas as part of a deep dive on the estates strategy.

KP voiced concerns that transfer of property to the CCG without associated funds to manage the estates would result in financial constraints. KP asked that the project leads conduct a risk analysis for the transfer, with a risk register included with any future papers.

The committee supported engagement with consultants to strategically advise on the property transfer and supported a deep dive in to the estates strategy.


6. CSU in-housing business case

Charlotte Fry noted that the CSU in-housing business case had previously visited the committee prior to its approval by NHSE and gave an update on the current position of the case.

CF explained that two areas had impacted the timelines for in-housing; the national CSU strategy published its findings regarding plans for CSUs and a decision made by NHSE.

24

The national CSU strategy review highlighted that data and analytics services would require additional review at national level, with NHS X looking into a standardised approach across the UK, in part driven by the data and analytic approaches stood up during Covid-19. The review also highlighted GP IT as an area of concern, with NHS X now looking at benefits of working at scale and standardising the GP IT support offer nationally. The review also highlighted procurement and procurement support as areas for analysis. CF explained that the reviews were currently taking place and, due to this, these areas had been taken out of the scope for the business case in the short term.

CF explained that because of the reviews, NHSE decided that London would have to in-house all CSU services rather than the services originally proposed in the business case, resulting in additional services in scope and greater degree of complexity. This change impacted the early transfer dates and the overall business case, which will need to incorporate these new elements. NHSE have proposed a plan to disentangle London and non-London services provided by the CSU, after which the HR process to prepare for in-housing will commence. It is still ambition that these staff and services will come across to the CCG on 31st March.


7. Phlebotomy Update

AK noted that the CCG have been reviewing phlebotomy costs but given the disparity in service arrangements across NEL, it was proving difficult to make reasonable comparison between service provision versus costs of services.

FS noted that discussions would need to be had with Sam Everington and Ken Aswani in order to ensure clarity in the papers that visit the F&P and the ask of the committee. KP noted the different understandings of how the services would be provided amongst the clinical chairs and that they would need to be engaged with this discussion in order to ensure they are aligned in their vision for these services.

Action: F&P – Phlebotomy to visit F&P in future meeting – SB, SC, AK Action: F&P – Finance to ensure appropriate engagement with clinical leads before paper comes to committee.

Date of next meeting: 27th October from 10.00-12.00

25

NEL CCG Governing Body

27 October 2021

Title of report Quality, Safety and Improvement Committee (QS&I) Chair’s

report

Item number 7

Author Jason Clarke, Senior Governance Manager – Corporate

Affairs, NEL CCG

Presented by Fiona Smith, Chair of QS&I Committee, and Independent

Clinical Member – Registered Nurse

Contact for further information Jason Clarke, Senior Governance Manager – Corporate Affairs, NEL CCG, [email protected]

Executive summary The last NEL CCG Quality, Safety and Improvement Committee was held on 8 September 2021.

The committee was chaired by Diane Jones, ICS Chief Nurse and Caldicott Guardian.

The Governing Body are advised that the main items discussed and reviewed were as follows:

• The committee was provided with an update on the national quality and safety framework. The committee heard that conversations had begun in NEL regarding provider collaborations and the potential inclusion of community services and ambulance providers. The approach to collaboration is aimed at developing economies of scale, effective peer support and mutual aid, particularly with regards to workforce. The committee discussed national guidance that had recently been issued to ensure the eventual safe transfer for the delivery and oversight of the statutory functions to the NEL ICS.

• The committee received an update from the Local Maternity System (LMS) as a follow up to the deep dive at the July 2021 meeting. The committee heard that BHRUT and NUH have received their initial CQC inspection reports, which they were reviewing for factual accuracy. The LMS is waiting to hear the outcomes of these reports and will support the Trust’s with their action plans and any recommendations.

These updates support the overall delivery of safe high quality maternity services in NEL.

• The committee undertook a deep dive into the delivery of CHC services across NEL. The Committee heard that CHC accounted for around 4% of the total spend for the CCGs and there is a plan in place to work with commissioning leads to improve service delivery on the 28 day assessment target, long waits backlogs and outstanding reviews.

26

• The committee received the LeDeR annual report and heard that across despite the pandemic, overall performance across NEL was above NHSE set target of 75%. The committee were informed that 84 deaths were reported to have been caused by COVID-19, or suspected to have been contributed by COVID19. The committee approved the annual report.

• The committee reviewed the NEL Quality Report and heard updates from the Quality Leads for City and Hackney, Barking, Havering and Redbridge and Tower Hamlets, Newham and Waltham Forest ICPs. The committee discussed the Becton Dickinson incident and the national requirement to reduce non-essential (non-clinical urgent) testing in acute and primary care settings.

The minutes of the meeting are attached as an appendix to this

report.



discussed?

NEL Quality, Safety and Improvement Committee.

Next steps/ onward reporting A regular report on key messages from the QS&I Committee will

be presented at each meeting of the Governing Body.


people?



The Committee:

• provides assurance of internal governance and quality standards where the CCG has responsibility for regulatory standards and statutory requirements

• Has an oversight of quality across the NEL system and works to the benefit of NEL patients

• Will oversee areas of assurance relating to patient experience.


Strategic fit The Committee is responsible for system assurance regarding quality and safety and patient experience and has a collective view of risks to quality through sharing relevant information, data and intelligence to understand emerging concerns and risks across providers and the system. It identifies themes and trends across the system and utilises its reports and data to scrutinise and assure the system that quality objectives are met and issues reviewed accordingly.


and quality

The Committee will manage the key areas of risk to quality and safety as outlined in the QS&I TOR.

Risks The Committee will review and monitor system wide quality issues in accordance with and advise on risks and mitigations. The committee is responsible for Quality and safety risks on the Board Assurance Framework and agree any action for improvement

Equality impact N/A

27

NEL Quality, Safety and Improvement Committee

8 September 2021 at 12:00pm, held on MS Teams

Minutes

Present

Khalil Ali (KA) Lay Member – Patient and Public Involvement, NEL CCG

James Chapman (JCh) Head of Integrated Care, BHR ICP

Jason Clarke (Minutes) (JCL) Senior Governance Manager – Corporate Affairs, NEL CCG

Alison de Metz Head of IFR & HPSU, NELCSU

Cindy Fischer Commissioning Programme Manager, C&H ICP

Charlotte Harrison (CH) Independent Clinical Member - Secondary Care Clinician, NEL CCG

Alison Herron (AH) SRO NEL LMS/Associate Director of Midwifery and Gynaecology - RLH

Ceri Jacobs Managing Director, BHR ICP

Diane Jones (DJ) Chief Nurse, NEL CCG

Beatrice Kivengea LeDeR Coordinator, NEL CCG

Archna Mathur (AM) Director of Performance and Assurance, NEL CCG

Daniel Monie Interim Head of CHC, BHR ICP

Dawn Newman-Cooper (DNC) Assistant Director of NEL LMS Maternity Programmes

Hilary Shananan Head of Quality and Clinical Governance, BHR ICP

Jennifer Singleton (JS) Head of Quality, C&H ICP

Peter Turner Senior Transformation Manager (CHC), TNW ICP

Chetan Vyas (CV) Director of Quality and Safety, TNW ICP

Apologies

Mark Gilbey-Cross; Fiona Smith

28


1. Diane Jones welcomed members to the meeting and introductions were made.

No conflicts of interest were declared

2. Minutes of the meeting on 14 July 2021

The committee approved the minutes from the previous meeting as accurate.

3. National Update

Justin Roper (JR) provided an update on the national publications and discussions that seek to shape statutory quality and safety functions as we transition into ICSs. From the ICS design framework we are also able to see what expectations will be placed on ICSs regarding quality.

JR noted that there had been conversations in August regarding provider collaborations and the inclusion of community services and ambulance providers. The approach to collaboration aims to develop economies of scale, effective peer support and mutual aid, particularly with regards to workforce.

Archna Mathur (AM) informed the group that a number of guidance documents had been released during the previous week. AM noted that the NEL SMT were working through the issued guidance to further develop our interpretation of how we progress as an ICS.

Khalil Ali (KA) noted the importance of reviewing how quality is supported in the community and voluntary sectors and the importance of an effective patient voice.

The committee were informed that the quality toolkit had now been published and asked the question of what this means for us. The national guidance appendix A document, as previously presented to this group, sets out many of the expectations of an ICS and the group agreed to bring to this group annotate the requirements against the ICS leads. The committee noted that it was important to ensure that this is reflected within the ToR of the group as it develops into the ICS committee and wanted to be sure there was clarity regarding how those changes were reflected.

Members heard that it was likely the new ICS organisation would be a category one responder and CQC inspected. To support this development, new roles such as Chief Pharmacist and Chief Medical Director were being developed. Additionally, the responsibility for safeguarding has been assigned to the ICS, and not NHSE and it was important to understand the implications of this change.

Action: Chetan Vyas (CV) bring back the Appendix A document to begin the mapping process.

4. Terms of reference and membership

Diane Jones (DJ) presented the terms of reference to the group, noting that it had been discussed at this meeting previously.

29

The group were keen to address the references to primary care and equality within the terms of reference to ensure that the role of the committee in providing assurance to the primary care and equalities agendas was accurately reflected.

Alison Heron (AH) queried the reference to the Maternity sub-committee in section 5.5. It was agreed that this reference was prior to the development of the Local Maternity System (LMS), and as such would be updated to reflect the current arrangements.

CV asked whether the committee would be referred to as a Quality committee or the Quality, Safety and Improvement Committee. If the later, then the terms of reference should ensure that there was reflection of the safety and improvement agenda. The Committee heard that and that there was a need to consider future proofing the terms of reference and that the ICS committee would be cover Quality, Safety and Improvement. The Committee noted that it was important not to lose sight of the assurance and statutory responsibilities and look to weave in the safety and improvement agendas.

The Committee discussed the membership and sought to ensure it had adequate representation from finance, primary care, performance and assurance.

Members agreed to circulate comments to DJ and JC initially. The Committee agreed to further review date in early 2022 to ensure that the terms of reference were fit for purpose ahead of the development of the NEL ICS Quality, Safety and Improvement Committee from April 2022.

Action: Members to send comments on the terms of reference to DJ and JC.

Action: JC to add ToR review to the November 2021 and March 2022 agendas.

5. Local Maternity System update

Alison Heron (AH) provided an update for the committee to note on progress since the last meeting and the top 3 risks currently being managed.

AH noted that the team had been working with the London Perinatal Board and Healthcare Safety Investigation Branch (HSIB) to review the still birth and neo-natal death audit and the themes were consistent with other LMS’. AH informed the committee that they had met with the HSIB to undertake a deeper dive and that University College London Hospitals will support the quality improvement programme.

AH informed the committee that BHRUT and NUH have received their initial CQC inspection reports, and were currently reviewing them for factual accuracy. The LMS is waiting to hear the outcomes and will support the Trust’s with their action plans and any recommendations.

AH updated on the development of the NEL dashboard on capacity and demand, mandatory training compliance across the area and the saving babies lives care bundle.

Khalil Ali (KA) noted the importance of effective communication and engagement and asked how this was being factored in. AH noted that communication and patient engagement has been factored into the development of the LMS. The East London

30

Health and Care Partnership (ELHCP) website contained lots of information for patients on the developments related to local maternity services. AH also highlighted the development of an app for women, which would be launched in the Autumn. AH noted that the app was bespoke, and sought to be a central point for key information relating to maternity services and the links to health visiting, social care and primary care services.

AH was asked about the metrics to support community services and noted that the staffing dashboard focused on staffing in the wards and delivery suites, and thus had an acute focus.

AH provided the committee with an update on never events, noting that there were 3 potential and 2 confirmed events currently being investigated. One incident at RLH had been given an external investigator to provide a fresh perspective. The committee heard that there was a general reduction in the number of never events at Barts Health and this had been achieved with support from NHS Resolution.

6 CHC Deep Dive

Members of the NEL CHC team introduced themselves to the committee ahead of the deep dive presentation.

The presentation gave a brief update on the CHC service, noting that CHC was for patients needing end of life care. The Committee heard that CHC care accounted for around 4% of the total spend for the CCGs.

The committee were informed there were a number differences in the CHC structures across the individual ICP areas. For example, in BHR nursing staff have been in housed, whilst City and Hackney lack support within brokerage and Waltham Forest are currently without a commissioning manager. In the interim, that role is being covered in part by the Deputy Director for CHC. The committee heard that these challenges have contributed to the number of 28 day delays that have been reported.

The committee heard that there were additional challenges in BHR and Tower Hamlets regarding the lack of social workers, but that there had been noticeable improvements as a result of meetings held with the local authorities those areas.

The committee heard that there were a number of recognised data quality issues, particularly around a lack of recording. It is understood that there is more work being undertaken than is currently recorded.

The committee were informed of a CHC system and that there was a potential risk relating to the data transfer and potentially having to run two systems in parallel.

The committee discussed the challenges of policy and procedural alignment across NEL given that there are 5 services across NEL being integrated, all currently operating under different policies and procedures. A policy harmonisation working group has been developed to recognising areas of specific need, but also ensure that there is a single aligned policy across NEL.

The committee were informed about the implementation of Liberty protection safeguarding legislation which comes into operation from 1 April 2022. Separate people being are being recruited to support with this, to ensure that the additional requirements are not absorbed by the current teams.

31

The team noted that as part of the policy and procedural alignment across NEL, there was also work being undertaken to look at the difference in costs and quality of providers within the area.

The committee were informed about the number of reviews outstanding in the table on page 32 of the meeting pack. The team were keen to highlight that across City and Hackney and TNW there are some data quality issues caused by the reliance on clinical staff to inform the CSU that a review has been completed. The in-housing of nursing staff within BHR means that is less of an issue in that area.

KA thanked the team for their presentation noting that it was one of the best reports seen in over 8 years as a lay member. KA felt that the report should go to the audit committee.

AM highlighted the need for robust winter planning, particularly in BHR and Waltham Forest given their older population demographic. AM also noted that when assessing the service gaps, whilst mitigations and actions had been presented but there was a lack of time frames associated to the risks and gaps. As such it was felt that there was a need for greater assurances given the lack of service equity, and the complexity of some of the issues and challenges presented.

The CHC team gave assurances that winter plans were in place and that as a result of those plans there were no major safety or discharge concerns, albeit there were some concerns regarding the quality of the paperwork. The team noted that discharge to assess funding was due to cease at the end of quarter 2.

DJ informed the committee that guidance had been issued the previous day confirming that discharge to assess funding was now in place until the end of March.

The committee sought assurance on the 28 day KPI for Tower Hamlets given the performance and trajectories were low in comparison to the rest of the NEL.

The committee were informed of the discussion with NHSE of how to increase this to 30%, particularly given the national requirement to move towards 80% and discussed the need for equity to achieve 80% for all Boroughs. The team noted that fast track reviews within 24 hours would still be sought where required, with a further assessment at 12 weeks to see if CHC is still required. If patients were deemed eligible for CHC then the routine 3 month and 12 month reviews would be undertaken.

CV thanked the CHC team for their presentation and work to date and asked how assured we are that the packages offered continue to be appropriate, and what mechanisms are currently in place to try and answer that question and provide assurance to the committee.

The committee heard that the increase in the number of face to face reviews had helped the teams to understand the challenges about whether the correct care packages were in place. The team believe that the quality of the face to face reviews was helping to provide greater assurances. The committee were informed that the increase in face to face reviews might identify new concerns, and the team were working this through as new issues arose. Regarding the initial question, the team felt that they were as assured as they could be that the correct packages were being offered to patients.

32

Jennifer Singleton raised a query regarding falls, pressure ulcers and the overall completeness of data. JS noted the importance of a two way quality share of information, the importance of working with local authority colleagues & the CQC to drive up improvements within CHC.

The committee considered how to bring this item back noting the particular challenges around service equity and patient/carer involvement.

7 LeDeR Annual Report

Rachel Penney and Beatrice Kivengea were in attendance to present the NEL LeDer Annual report, noting that the report covers

• LeDeR data on reported deaths locally and nationally

• NEL performance during this year and how it compares to past years.

• Key aspects of care provided to people with learning disabilities

• New LeDeR policy- Expectations and timescales

The Committee were informed that despite the pandemic, performance across NEL was above the NHSE target of 75%, ranging from 74-91%. The committee heard that twice as many cases had been reported than in the previous year, with 84 Covid related deaths and 56 of those having had a full LeDeR review.

The Committee heard that 75% of the reported deaths had severe or profound learning disabilities and the impact in residential care settings was particularly apparent given that 68% of the deaths occurred in residential settings. The committee also heard that people with mild learning disabilities or from BME background were more likely to receive poor care than their respective peers.

The Committee were told that a new LeDeR policy and process has been in place since June 2021 and had been extended to include autism. The committee were asked to approve the contents of the report.

Jenny Singleton (JS) noted that as we develop as an ICS it is still important to have access to Borough level data. As an example, in Hackney the Jewish community are particularly affected and the data from annual reports and local boroughs will enable the teams to take specific local actions where necessary.

The Committee approved the report and thanked the team for their hard work.

Action: QS2-2JC to share the LeDeR presentation from this meeting to committee members for information.

8 Individual Funding Requests

Alison de Metz was in attendance to present for this agenda item. ADM informed the Committee that the policy is intended to develop consistency across the system and less legal challenges and appeals. The policy will be going to the NEL Governing Body meeting in November and builds on the existing policy

33

JR noted the need to ensure equality impact considerations as part of the process.

The Committee were informed that as part of the Once for London process, a high level equality impact assessment had been taken and supported the local level arrangements.

The Committee agreed to circulate the IFR policy to members and feedback comments to AdM by 30 September to enable the onward reporting the NEL Governing Body.

Action: JC to share the IFR policy to members with a deadline for comments back to AdM to enable the upward reporting to the Governing Body.

Action: JC to include IFR on the next agenda to update the committee on the comments received.

9 Quality Report

The Quality leads presented the quality reports as presented in the meeting pack.

JR provided an additional update on the national Becton Dickinson (BD) incident noting the requirement GPs to halt all non-urgent testing and for acute trusts to reduce their demand by a minimum of 25%.

10 Governance and risk registers

In the interest of time, it was agreed that this agenda item would be moved to the November meeting

Action: JC to add risk registers to the November agenda meeting.

Date of the next meeting: 10 November 2021 at 12:00pm on MS Teams

34

NEL CCG Governing Body

27 October 2021

Title of report BHR Integrated Care Partnership Board (incorporating

BHR CCG Area Committee) - update

Item number 7

Author Anna McDonald, Business Manager, BHR ICP

Presented by Kash Pandya, BHR ICP Area Committee Chair


Executive summary The key messages from the BHR Integrated Care Partnership Board meeting held on 30 September 2021:-

• Noted an update on the latest ICS development

• Noted the on-going development of the BHR Integrated Care Partnership (ICP)

• Noted progress in regard to BHR ICP priority actions

• Noted an update on the BHR Borough Partnerships development

• Noted current risks to the BHR ICP, the risk management cycle and the key risks to the NEL CCG Governing Body

• Noted development of an engagement structure and approach to support the local partnership

• Noted an update on primary care development

• Approved the Integrated Sustainability Plan

• Approved the winter plan

• Noted the latest finance position and key messages

• Approved a proposal for safeguarding reporting to the ICPB.

Action required The Governing Body is asked to note the update and the

minutes of the meeting held on 30 September 2021.


discussed?

N/A

Next steps/ onward reporting A regular report on key messages from the BHR ICPB will be presented at each meeting of the Governing Body.


people?



The ICPB will seek to act in the best interest of residents in the BHR health and care system as a whole, rather than representing the individual interests of any of its members.


35


Strategic fit The ICPB provides strategic leadership for, and delivery of, the overarching strategy and outcomes framework for the BHR ICP.


and quality

The ICPB will:

• ensure the delivery of high-quality outcomes, putting patient safety and quality first

• have lead responsibility for population modelling and analysis within the ICP area, supporting the CCG to discharge its statutory duties, including those relating to equality and inequality

• Approve proposed health needs prioritisation policies ensuring that this enables the CCG to meet its statutory duties in relation to outcomes, equality and inequalities

• Receive recommendations from the ICP Finance and Performance Sub-Committee and make decisions on matters referred to it by that sub-Committee.

Risks The ICPB is developing a risk register that covers the most critical risks to the BHR ICP and will form part of the overall NEL CCG risk management process.

Equality impact N/A

36

Draft minutes – BHR Integrated Care Partnership Board

30 September 2021

1.00pm – 3.00pm

Via MS Teams

Members: Cllr Maureen Worby (MW) ICPB Chair (LBBD) Kash Pandya (KP) Lay Member, Governance & Area Committee Chair,

NEL CCG Ahmet Koray (AK) Director of Finance, BHR ICP (rep SC) Ceri Jacob (CJ) Managing Director, BHR ICP Dr Rami Hara (RH) Deputy B&D Clinical Chair Dr Atul Aggarwal (AA) Havering Clinical Chair Dr Anil Mehta (AMe) Redbridge Clinical Chair Matthew Trainer (MT) Chief Executive, BHRUT Sultan Taylor (ST) NELFT Chair representative Dr Caroline Allum (CA) Chair – Health & Care Cabinet Andrew Blake-Herbert (ABH) Chief Executive, LBH Cllr Jason Frost (JFr) LB, Havering Adrian Loades (ALo) Corporate Director of People, LB Redbridge Cllr Mark Santos (MS) LB Redbridge Dr Gurmeet Singh (GS) PCN Clinical Director, Havering Dr Sangeetha Pazhanisami (SP) PCN Clinical Director, Redbridge Attendees: Steve Rubery (SR) Director of Planning & Performance, BHR ICP Diane Jones (DJ) Chief Nurse, NEL CCG Mark Eaton (ME) BHR System Recovery Adviser Kirsty Boettcher (KB) Deputy Director, Transformation, BHR ICP Anna McDonald (AMcD) Business Manager, BHR ICP Caron Bluestone (CB) Associate Lay Member, BHR ICP Jayam Dalal (JD) Associate Lay Member, BHR ICP Sarah See (SS) Director of Primary care, BHR ICP Sophia Jaques (SJ) Member of the public Apologies: Oliver Shanley (OS) Chief Executive, NELFT Mike Bell (MB) Chair, BHRUT Mehboob Khan (MB) Non-Executive Director, BHRUT Joe Fielder (JFi) Chair, NELFT Dr Jagan John (JJ) NEL CCG Chair and B&D Clinical Chair Henry Black (HB) Acting Accountable Officer, NEL CCG Steve Collins (SC) Acting Chief Finance Officer, NEL CCG Emily Plane (EP) Programme Lead, BHR ICP

37

Tracy Welsh (TW) Director of Transformation, BHR ICP

1.0

1.0 Welcome, introductions and apologies

The Chair welcomed everyone to the meeting and apologies received were noted.

1.1 Declarations of conflicts of interest

The chair reminded everyone of their obligation to declare any interest they may have on any issues arising at the meeting. No additional conflicts of interest were declared. The register of interests was noted.

1.2 Minutes of the last meeting

The notes of the meeting held on 29 July 2021 were agreed as an accurate record.

1.3 Actions/matters arising

ICPB members noted the action taken since the last meeting.

2.0 Managing director’s report

CJ presented the update report which covered the following areas:

• Latest ICS development guidance

• BHR process to articulate our local vision for collaboration at a multi-borough level

• BHR Borough Partnership development

• Anchor Organisations – procurement workshop

• Contracting discussion

• Identification of our key priorities

• Development of a BHR System Integrated Sustainability Plan

• Development of an engagement structure and approach to support the local partnership

The chair drew particular attention to appendix 1 – BHR partnership development programme and commented that the ‘plan on a page’ provides an overview of all the different elements of work. ST said he found the information very helpful and asked whether a summary could be sent to him for onward sharing with his non-executive colleagues at NELFT. The Chair advised that in advance of each ICPB meeting a summary of the agenda items is shared with the three PCN ICPB members and suggested that ST could be included going forward. Members of the ICPB:

• Noted the update.

EP

3.0 BHR Integrated Care Partnership Risk Management

SR presented the update and advised that the current NEL level risks relate to four areas:-

• underperformance against H1 metrics, specifically elective recovery

38

• continuing healthcare

• use of resources and finance balance

• vaccine delivery Members were advised that work to refine the BHR ICP risk register is continuing and a review of the risks is being undertaken. The current key risks within BHR ICP relate to:

• Children with learning difficulties and mental health needs and access to services and discharge from inpatient beds

• Appropriate digital infrastructure

• Financial balance across the BHR system

• Adult social care provider workforce

• Risk of future waves of COVID 19

• Backlog of elective activity KP welcomed the progress made and referred to the funding issues within social care and suggested this needs to be considered as an additional risk for the system. SR confirmed that it is included as a high scoring on the System Operational Command Group (SOCG) risk register and agreed that it also needs to be added to the BHR ICP risk register. The chair suggested the increasing gap in health inequalities within the NEL system also needs to be added. RH referred to the risk relating to Covid-19 and advised members that work is being undertaken in regard to children with learning disabilities together with an additional piece of work on long-covid in children. KP confirmed that long-covid is being added to the NEL risk register as part of the recovery plans. JFr flagged that the increasing population across BHR is a risk and suggested the need to ensure population projections are built into the re-designing of pathways and any decisions around infrastructure. CJ assured the ICPB that population growth is woven into the clinical strategy, the Integrated Sustainability Plan (ISP) and estates planning. A discussion took place about funding flows and how there needs to be level of flex across the whole of the health & wellbeing system and CJ confirmed that will be taken forward as part of the ICS discussions. AK explained that as an ICS, there will be opportunities to look at how allocations are split across the boroughs going forward and as the ICS matures, there will be opportunities to do things differently. AMe expressed his view that the inequalities across NEL cannot be addressed until the low number of GPs and practice nurses in BHR is addressed. ICPB members agreed that consistency of practice across NEL is needed. SR to update the risk register with a narrative that reflects the discussion. Members of the ICPB:

• Noted the current risks to the BHR ICP, the risk management cycle and the key risks to the NEL CCG Governing Body.

SR SR

4.0 Integrated Care System Development

39

4.1 Developing our BHR partnership within the North East London integrated care system context CJ gave an overview of the key points and confirmed that the process for agreeing what Borough Partnerships will continue to collaborate on post 1 April 2022 is underway. Once all the information has been collated, a proposal will come back to the ICBP. Good progress is being made in regard to the development of the Borough Partnership Boards. Further work is needed in regard to PCN development as a lot of the work was halted due to the pandemic and clinical leads are under continued pressure. CJ suggested that going forward a more detailed update on one or two areas of the Borough Partnership areas of development could be presented rather than an overall update on all of them. CA referred to Anchor Organisations and stressed the need to use the data resulting from the Nightingale census to ensure we get people into employment within health and social care. The Chair added that the BHR Academy is the key vehicle to help address the workforce issues. The Chair referred back to the point made earlier in the meeting about the shortage of GPs and practice nurses within BHR and asked how that is affecting PCN development. AMe responded that PCN development is key as they are the foundation for addressing population health but their development is a risk due to workload, workforce and resource. SP stressed the need to not overwhelm PCNs and for the system to clearly articulate what the expectations are and prioritise the work. The Chair suggested that each Borough Partnership needs to consider what the top three ‘asks’ for their PCNs are in terms of development. KP added that each Borough Partnership could also be asked to undertake their own self-assessment to see where they need more support in order to direct the support where it is needed most. CJ agreed to take both points forward. RH endorsed everything that was said and stressed that patient education is an important element in regard to PCN development and delivery as they need to understand the new GP model. The Chair recapped on a recent discussion she had in regard to the strong impact social media messaging can have particularly if the messages are coming from GPs. JD advised she will discuss how patient education can be strengthened as part of patient and public engagement with the CCG’s Communications Team. Members of the ICPB:

• Noted the report and the next steps to further develop our local partnership within the wider context of the developing North East London Integrated Care System.

4.2 Developing our proposal for ongoing collaboration in BHR CJ recapped that members of the BHR Integrated Care Executive Group (ICEG) reviewed and endorsed the proposal in August 2021 and key meetings are being scheduled. Outputs from the discussions will be developed into a proposal which will be reviewed by ICEG in October 2021 and presented to ICPB members in November 2021. Once endorsed, the proposal will be shared with NEL colleagues in order to feed into and shape the framework that is being developed for the NEL ICS.

CJ/EP CJ/EP CJ/EP JD

40

Members of the ICPB:

• Noted the proposed process to design and articulate our proposal for ongoing collaboration in BHR.

• Endorsed the proposed process to design and articulate our proposal for ongoing collaboration in BHR.

5.0 North East London Primary Care Development

5.1 NEL integrated care system primary care collaborative CJ explained that the recent national ICS guidance requires a mental health collaborative and an acute collaborative. In addition, work is underway in NEL looking at a community collaborative and a primary care collaborative and CJ outlined their key areas of focus. The collaborations provide an opportunity to strengthen working across different areas of health. PCNs have a key role in forming the primary care collaborative in NEL so there is a need to agree how they can work together at a NEL level when necessary to drive consistency and to work together with the mental health and community collaboratives to be a strong community care voice. Views are being sought from PCNs, GP Federations, local primary care groups. Members of the ICPB:

• Noted the report. 5.1.1 BHR primary care development NEL CCG has developed a wide portfolio of development projects under the Transformation Programme with the key aim of improving both access to and the quality of services available to patients across the whole of NEL, with a key focus on reducing health inequalities for our diverse population. The aim is to develop a sustainable model for primary care as a key element of the NEL ICS. The presentation provided an update on; access and patient survey results; CQC ratings; local incentive scheme equalisation programme; workforce in regard to general practice nursing; Covid-19 and flu vaccination programme 2021/22. AMe welcomed the helpful summary and flagged that BHR has performed very well in regard to the Covid-19 and flu vaccination programmes despite having the least number of GPs and practice nurses which in turn has added to the pressures on an already exhausted workforce. A discussion took place about the increased demand for face to face appointments and the need to address the expectation of patients and recruitment issues. JFr suggested the need for GP practices to review the narrative used in recorded telephone messages that patients hear when phoning the surgery and gave his personal experience as an example adding that a much smarter approach to communicating messages to the public is needed. SP commented that a lot of remote monitoring of conditions is taking place successfully which is empowering patients and the data needs to be looked at differently. JD to discuss ways in which the advantages of having some appointments remotely can be best communicated to the public with the CCG’s Communications Team. The Chair raised concern about the uptake of the Covid-19 vaccination in the 12-15year age group in B&D. SS clarified that the issue appears to be how consent is being sought and advised it is being addressed.

JD

41

The Chair requested an update on primary care development in six months. Members of the ICPB:

• Noted the report

SS

6.0 Transformation

6.1 Integrated Sustainability Plan (ISP) ME advised that the ISP was being presented for ratification prior to it being presented for final approval at the NEL CCG Governing Body meeting in October 2021. ME reiterated that the ISP is a five-year plan designed to bring significant change to the outcomes for patients within the system. The plan redresses the historic under-investment in primary care across BHR and will bring BHR primary care investment up to the level of Tower Hamlets. Historic underfunding in mental health is also being redressed. There is significant focus on prevention and early intervention to reduce the number of non-elective presentations and also to improve longer term outcomes. ME flagged that the national guidance for 2022/23 onwards is not likely to be received until early 2022 which will mean that some of the assumptions made will need to be reviewed. KP fed back that members of the BHR Finance sub-committee were very supportive of the ISP. JFr reported that the plan received very positive comments at the Havering Health and Wellbeing Board and MT fed back that the ISP had been approved by the BHRUT Board. Members of the ICPB:

• Approved the Integrated Sustainability Plan.

7.0 Safeguarding update

DJ presented the report and recapped that the CCG’s Quality & Safeguarding Team members were asked to consider how safeguarding in BHR could be fed into the ICPB going forward to ensure members have oversight of the key issues around safeguarding. DJ outlined a proposal to submit minutes of the Integrated Safeguarding Assurance Board (ISAB) meetings to the ICPB for information and advised that the ISAB is a well-established and effective forum where detailed discussions of all safeguarding related issues, risks and mitigations are presented and discussed. The Chair gave her view that having sight of the minutes would ensure that ICPB members have oversight of safeguarding issues and the opportunity to flag any areas of concern. Members of the ICPB:

• Noted the report.

• Agreed to receive the minutes from the Integrated Safeguarding Assurance Board.

8.0 Winter plan assurance

KB presented the winter plan which highlighted the risks and action being taken to try and reduce the risks. The plan has been developed across the BHR system with involvement from all system partners.

42

ABH referred to the additional services and asked whether the £2.9m includes cover across social care. KB clarified that the £2.9m is very specific to schemes being developed in regard to admission avoidance and supporting discharge, however, other discussions are taking place in regard to financial support for other packages to support social care through the winter and discussions will be held at the Discharge Working Improvement Group (DWIG). ABH asked for children to be included as there will be pressures relating to children as well as adults that need to be addressed. The Chair flagged that flu is likely to be a huge pressure this winter. Members of the ICPB:

• Approved the winter plan.

KB

9.0 BHR Integrated Care Partnership Performance

9.1 BHR priority actions progress update SR reported that progress is being made against all four priorities. In regard to ‘recovering well’ SR asked members to note the impact of the flow of activity going into the BHR system. In regard to waiting lists, SR reported that 52 week waits are decreasing slowly but overall, the waiting list continues to increase which highlights the challenges faced by the system in addition to trying to address the backlog resulting from the pandemic. The Chair referred to the possible deterioration of health that may have occurred to patients on the waiting lists and SR clarified how the waiting lists at BHRUT operate, whereby the condition of patients on the list is regularly reviewed and prioritised accordingly. SR added that people who did not present for healthcare during the pandemic are coming forward now, with many having more complex needs. MT explained that the Trust tries to prioritise lists based on urgency and identifies the highest priority patients. It is going to take a sustained effort by the system as a whole and MT added that he will be looking to discuss with primary care colleagues, what can be done to reassure patients who are on a waiting list. AA commented that BHRUT is doing well compared to other Trusts and added that the Trust has a mechanism in place for clinical risk management. A lot of health promotion is being done in primary care and AA suggested a review of the screening programme might help. DJ referred to the clinical risk undertaken at BHRUT and questioned whether any clinical harm has been found whist undertaking the reviews. SR confirmed clinical harm reviews are carried out on an on-going basis by BHRUT and there are well-established processes in place. The BHR Quality & Performance Oversight Group (QPOG) monitor clinical harm at BHRUT and SR confirmed that no cases of significant harm have been reported. MT suggested the Chief Medical Officer at BHRUT could speak more about the clinical harm process if required and SR suggested a more detailed discussion could be held but it would be more appropriate for it to be undertaken at the QPOG meeting. DJ suggested it would be helpful to look at the demographics of the people who are on the waiting list in terms of addressing inequalities and MT responded that it would be hard to quantify the unfairness but added more people than ever are accessing private healthcare and there will be

SR

43

residents in the borough who do not feel confident to get themselves heard in the same way others might. MT also pointed out that the anxiety that comes from being on a waiting list is not captured in the harm reviews. DJ fed back that data is showing that NEL as a whole does not access the independent sector for patients as much as other areas do. CJ fed back that the BHR Public Health Directors have been working with BHRUT looking at inequalities and the Chair requested a report at the next meeting on the demographics of the people on the waiting lists and for the report to include data on the number of BHR residents being referred to the independent sector for treatment. ICPB members:

• Noted the progress made. 9.2 BHR finance report AK presented the update and reported that pressures are developing in some areas including the independent sector, prescribing and Continuing Health care (CHC). AK advised that the report was discussed in detail at the BHR Finance sub-committee held earlier in the day. Each of the NEL ICPs have reported a break-even position across core budgets. However, delivery of the break-even position is reliant on the use of non-recurrent balance sheet accruals. This has been necessary to offset budgetary pressures in the areas mentioned. KP reported that Finance sub-committee members have raised their concern about the budget gap being bridged through reserves as that means there is an underlying deficit which could get worse in the second half of the year. The sub-committee will be looking into the independent sector increase and also will be undertaking a deep dive in regard to prescription costs. ICPB members:

• Noted the report.

SR

10.0 Items for information

10.1 Minutes of relevant fora: The minutes of the following meetings were noted:

• Integrated Care Executive Group – July and August 2021

• Health & Care Cabinet – July and August 2021

• Finance sub-committee – July and August 2021

• Quality & Performance Oversight Group – July and August 2021

11.0 Any other business

There was no other business.

12.0 Questions from the public

No questions from the public were received.

Date of next meeting – 25 November 2021

44

NEL CCG Governing Body 27 October 2021

Title of report City and Hackney Area Committee update, meeting as part

of the Integrated Care Partnership Board (ICPB)

Item number 7

Author Dr Mark Rickets, City and Hackney Chair, NEL CCG

Presented by Dr Mark Rickets, City and Hackney Chair, NEL CCG


Executive summary The City and Hackney (C&H) Integrated Care Partnership Board (ICPB) met on Thursday 9 September 2021 and discussed:

• The ICPB ratified the decisions of the previous meeting, where a quorum had not been reached in July 2021

• Members were briefed on the transition work underway towards an Integrated Care System (ICS), noting that discussions on the relationships with place based partnerships were commencing and underpinned by a collaborative and co-operative culture

• The ICPB recognised that health inequalities and Covid-19 recovery remained priority work through the upcoming changes and that any structural or governance changes needed to support this work

• The City and Hackney co-production charter was received and discussed by the ICPB, noting that it would return for endorsement to a future meeting, with the feedback addressed. The members feedback included that the input and views of children and young people needed to be covered in the charter, that co-production was important to the success of the system in the future, even if each organisation working together took a slightly different approach. The ICPB noted that this iteration of the charter included a self-assessment tool to measure success and that the charter, and work undertaken under it would be reviewed on an annual basis. The ICPB asked the People and Places Group (PPG) to monitor uptake and progress

• The PPG provided an update to the ICPB, noting that the new Group was due to hold its third meeting in October 2021 after a series of development

45

sessions and that a Community Involvement Forum was also being launched

• The ICPB recognised that it needed a consistent mechanism to ensure that it heard from patients and residents regarding their experiences and outcomes and asked for a proposal to come back to a future meeting

• The ICPB received an update on the Children and Young Peoples Emotional Health and Wellbeing Strategy, noting the pivot towards focussing on resilience and prevention. The ICPB discussed and approved the strategy for publication

• The ICPB was briefed on the latest financial performance and received the monthly risk register. Members were informed that at month 4, the area remains in a break even position with small cost pressures developing in the acute budget, prescribing and continuing healthcare.

Action required The NEL Governing Body is asked to:

1. Note this update from the ICPB

2. Receive and note the ICPB minutes agreed at the

Thursday 14 October 2021 meeting.


discussed?

N/A

Next steps / onward reporting A regular report on key messages from the C&H Integrated

Care Partnership Board (ICPB) will be presented at each

meeting of the Governing Body.


people?



The City and Hackney Area Committee meets together with partners in a Committee in Common arrangement, in public to take local decisions on decisions on the functions delegated to it as the ICPB. Meeting in public promotes transparency and allows discussion and challenge in real time with members of the public.

The Committee holds specific functions related to population health management, including lead responsibility for population modelling and analysis within the ICP area, supporting the CCG to discharge its statutory duties, including those relating to equality and inequality as well as for stakeholder engagement and management, including the discharge of NEL CCGs statutory duty in relation to public involvement and consultation.


Strategic fit The Committee exercises a variety of delegated functions granted to it by the NEL GB and as such, has relevance to all of NEL CCGs Corporate Objectives.


and quality

The Committee will report to the NEL CCG Governing Body on a bi-monthly basis and a copy of its minutes are presented to the NEL CCG Governing Body, for information and assurance purposes.

46

Risks The Committee will hold and review an ICP risk register and monitor progress against defined mitigating actions, particularly relating to the most significant risks, to assure that risks are being properly reviewed and effectively managed.

Equality impact N/A

47

City & Hackney Integrated Care Partnership Board

This is also a meeting of the Integrated Commissioning Board which is a Committee in-Common meeting of the:

The London Borough of Hackney Integrated Commissioning Sub-Committee

(‘The LBH Committee)

The City of London Corporation Integrated Commissioning Sub-Committee (‘The COLC Committee’)

North East London CCG Governing Body City and Hackney ICP Area Committee (The ‘CCG Area Committee’)

Minutes of meeting held in public on 9 September 2021

Microsoft Teams

Present:

Hackney Integrated Commissioning Board

Hackney Integrated Commissioning Committee

Cllr Anntoinette Bramble

Deputy Mayor & Cabinet Member for Education, Young People & Childrens’ Social Care

London Borough of Hackney

Cllr Chris Kennedy

Cabinet Member for Health, Adult Social Care & Leisure


North East London CCG City & Hackney Area Committee

Henry Black Acting Accountable Officer NE London CCG

Dr Mark Rickets City & Hackney Clinical Chair NE London CCG / City & Hackney Integrated Care Partnership

Sunil Thakker Executive Director of Finance NE London CCG / City & Hackney Integrated Care Partnership

Steve Collins Director of Finance NE London CCG

Siobhan Harper Transition Director NE London CCG / City & Hackney Integrated Care Partnership

City Integrated Commissioning Board City Integrated Commissioning Committee Marianne Fredericks

Member, Community & Childrens’ Services Sub-Committee

City of London Corporation

Randall Anderson QC

Member, Community & Childrens’ Services Sub-Committee


48

Ruby Sayed Member, Community & Childrens’ Services Sub-Committee


Integrated Care Partnership Board Members

Ann Sanders Lay member NE London CCG

Caroline Millar Acting Chair City & Hackney GP Confederation

Catherine Pelley Chief Nurse (substitute for Homerton Chief Exec)

Homerton University Hospital NHS Foundation Trust

Haren Patel Clinical Director Primary Care Network

Honor Rhodes Associate Lay Member NE London CCG

Ian Williams Acting Chief Executive London Borough of Hackney

John Gieve Chair Homerton University Hospital NHS Foundation Trust

Jon Williams Executive Director Healthwatch Hackney

Dr Julia Simon Director of Strategic Implementation & Partnerships (substitute for Homerton Chief Exec)

Homerton University Hospital NHS Foundation Trust

Laura Sharpe CEO City & Hackney GP Confederation

Paul Calaminus Chief Executive East London NHS Foundation Trust

Paul Coles General Manager Healthwatch City of London

Dr Sandra Husbands

Director of Public Health London Borough of Hackney

Dr Stephanie Coughlin

Clinical Lead: Neighbourhoods & Covid-19 – City & Hackney

NE London CCG

Susan Masters Co-Director: Health Transformation, Policy and Neighbourhoods

Hackney Council for Voluntary Services

In attendance

Andrew Carter Director: Community & Childrens’ Services Sub-Committee


Alex Harris Integrated Commissioning Governance Manager

NE London CCG / City & Hackney Integrated Care Partnership

Amy Wilkinson Workstream Director: Children, Young People, Maternity & Families


Diana Divajeva Public Health Analyst London Borough of Hackney

49

Eeva Huoviala Head of Public Engagement: Patient & Public Involvement


Ellie Duncan Programme Manager NE London CCG / City & Hackney Integrated Care Partnership

Helen Fentimen Member, Community & Childrens’ Services Sub-Committee


Helen Woodland Group Director – Adults, Health & Integration


Jonathan McShane

Integrated Care Convenor NE London CCG / City & Hackney Integrated Care Partnership

Matthew Knell Head of Governance & Assurance NE London CCG / City & Hackney Integrated Care Partnership

Nina Griffith Workstream Director: Unplanned Care


Rachael Tomlinson

Programme Manager NE London CCG

Sally Beaven Engagement & Co-Production Manager

Healthwatch Hackney

Stella Okonkwo Integrated Commissioning Programme Manager


Apologies

Cllr Chapman

1. Welcome, Introductions and Apologies for Absence

1.1. The Chair, Randall Anderson, opened the meeting.

1.2. Apologies were noted as listed above.

2. Declarations of Interests

2.1. Susan Masters added that she was a Councillor in Newham however this did not cause

any conflicts in relation to items on the agenda.

2.2. The City Integrated Commissioning Board

● NOTED the Register of Interests.

2.3. The Hackney Integrated Commissioning Board ● NOTED the Register of Interests.

50

3. Questions from the Public

3.1. There were none. 4. Minutes of the Previous Meeting & Action Log

4.1. The City Integrated Care Partnership Board

● APPROVED the minutes of the previous meeting. ● RATIFIED the decisions of the previous meeting. ● NOTED the action log.

4.2. The Hackney Integrated Care Partnership Board ● APPROVED the minutes of the previous meeting. ● NOTED the action log.

5. ICS Update 5.1. Siobhan Harper introduced the item. Our primary objective was to establish some

coherence throughout the transition to the implementation of Integrated Care Systems (ICS) next year and the closing down of the CCG. There were still emerging discussions about how ICS would interact with local place-based partnerships and a number of fora in which this was being discussed. There was also an event upcoming on October 6th which would aim to discuss the development of ICS further.

5.2. A key piece of work would be developing a collaborative and co-operative culture as opposed to a competitive and transactional culture. Place-based partnerships would also have a strong role in connecting communities with the wider health and social care sector.

5.3. Cllr Kennedy added that health inequalities and covid recovery were the main priorities.

We needed to therefore place these first and design the governance to make sure that this fits in place. He also added that “place-based” was coterminous with borough-area. Previously the CCGs in NE London had been mergers of several boroughs. Henry Black added that we should be working through what our purpose was and then design the governance around supporting our new ways of working. The ICS would be designed to bring all partners together as equal peers to design more effective ways of doing things.

5.4. Randall Anderson added that the work would need to continue to be at a City &

Hackney level as the NEL-level governance was constrained by legislation.

5.5. Helen Fentimen added we needed clarity around what the objectives were for service transition and design. Siobhan Harper added that a lot of this had been set out in the context of the long term plan. We were also picking up issues around inequalities and needed to make sure we focused and honed-in on this from a population health perspective.

Item on service transition and design to be brought back to a future ICPB.

5.6. Mark Rickets added that the challenges were to make sure that the place-based

partnerships were working and that issues such as relationships with health and

51

wellbeing boards were ironed out. This was therefore a parallel piece of work in developing the governance.

5.7. John Gieve noted that we had received our financial settlement. The amount of money received was not the amount needed for it to catch-up on the backlog of care in the service and to simultaneously deal with other pressures. The biggest change currently taking place in terms of national legislation was the move to a more centralized allocation system. He therefore asked what the timetable was for decisions at the NE London level. Furthermore, the ICPB would not just be dealing with additional / extra funding but would be more involved in allocation of existing funding.

5.8. Helen Fentimen noted that City & Hackney was focused on health inequalities and

place-based partnerships. However the impact of covid was enormous and much had been pushed back. She was therefore not clear how we could manage old tensions whilst keeping the focus on health inequalities so that they were not merely pushed to the side.

5.9. Laura Sharpe noted that as leaders and clinicians we would need to set a series of

principles around this. We should therefore set the high-level principles that would underpin our investment. Furthermore, we would need to be agreeing on a set of prioritisations for which we would also be involving the public. The debate would therefore take a long time and should be started soon.

5.10. Henry Black responded that it was essential for us to prioritise work in a way that was

safe and fair but that we also find better and more innovative ways of reducing the burdens placed on the system in relation to the covid backlog. In terms of the financial framework going forward, this would be based on population need and the ability to allocate resources accordingly. The payment-by-results (PBR) system was designed to foster competition, and was not effective in encouraging collaboration.

5.11. The City Integrated Care Partnership Board NOTED the report.

5.12. The Hackney Integrated Care Partnership Board

NOTED the report.

6. City & Hackney Co-Production Charter

6.1. Sally Beaven introduced the item. This charter had been underpinned by a piece of work in reviewing the extant 2017 charter, which had concluded that it should be an evolving and live document. The principles of the charter remained broadly the same as in the 2017 charter however there had been updates to the elements of the charter in relation to staff training and induction and in helping organisations capture the public voice.

6.2. The charter was not something that organisations would be forced to sign up to, but the ICPB was being asked to endorse the charter and encourage organisations to agree to. Individual organisations would therefore be given the opportunity to comment on anything that was proposed. The item may therefore need to be brought back to a future ICPB.

52

6.3. Honor Rhodes added that children and young peoples’ voices should not be lost within this, as they could have valuable perspectives on how services should be designed. We needed to therefore think about how we would encourage children to co-design things with us. Sally Beaven added that we may be bringing work on system influencers to governance boards that existed within the ICS structure. Honor Rhodes added that young people need to be referenced specifically within the co-production work.

6.4. Stephanie Coughlin added that she was fully supportive of the principles, however

there could be more work in bringing all organisations on board with this work. Different organisations would have their own challenges and we needed to ensure buy-in and engagement, and that organisations were not signing up to things they could not achieve. Sally Beaven responded that the work itself was widely co-produced, however there was more we could do in bringing on board the decision-makers in the respective organisations.

6.5. Randall Anderson noted that he was happy to sign off the charter with the provision

that it be brought back to ICPB once it has been to the various partner organisations.

6.6. Jon Williams added that co-production was a very effective way of involving people in local systems because it enabled people to be involved in service production from the beginning. He also added that the backup documents were a big positive piece of this work.

6.7. Mark Rickets added that we should review this after a year. He also asked how the

self-assessment tool would be filled-in. Sally Beaven responded that this would be a co-produced part of the process and everyone would be able to discuss the self-assessment going forward.

6.8. Paul Calaminus asked how we would be able to keep an eye on how we were

progressing towards co-production. It was therefore important for us to see and learn together how we would build up towards leading, designing and learning together. Sally Beaven responded that the role of the People & Place Group was crucial and would be the primary leadership governance body supporting this work.

6.9. Cllr Kennedy also added that co-production was something that would be happening

all the time and should not just be contained within one stream of work.

6.10. Siobhan Harper offered to support this work going through the system. We all needed to support this as a way of working and think about how we would support implementation as a collective endeavor.

6.11. Ann Sanders suggested that the People & Place Group oversee the review of this work.



NOTED the report.

53

7. People & Place Group Update

7.1. Eeva Huoviala introduced the item. She noted that the People & Place Group (PPG) would operate as a sub-committee of the ICPB. There had been a series of development sessions undertaken, and the Group was due to hold its third formal meeting in October. The board would continually develop its arrangements to ensure a wide range of community insight.

7.2. Cllr Kennedy added that we often heard stories of services going badly for residents due to the emotional impact of these situations. However we also needed to understand outcomes in their full breadth. We needed a consistent mechanism to capture these outputs and the ICPB would need to decide what information it wanted to hear on a regular basis.

7.3. Stephanie Coughlin added that she would like to see this brought back to ICPB once

we had a clearer idea of how these principles would be implemented in practice, in particular how we would enable clinicians to embed these principles in the work that we do.

7.4. Eeva Huoviala responded that we would be striving towards a wide range of feedback

and we were working with Healthwatch on developing that further. We were also beginning to offer people the opportunity to have their voices heard and then to analyse and code that information better. We would therefore be building a database of community insight that could report on what people were saying about services, and a regular report would come to the PPG.

7.5. In terms of making the values & principles a reality, we were currently working on this

to make sure that the principles and values were not just abstract but were convertible into tangible work for practitioners.

7.6. Ann Sanders added that the community involvement forum was a place where people

could discuss issues in detail. If clinicians, for example, requested information from the public then this could be set up and could then feed information to the PPG.

7.7. Honor Rhodes noted that we should regularly receive reports from all groups in the

sub-committee structure.

7.8. Caroline Millar added that we should think about our agendas set out in terms of themes such as strategy, operational, for information and they should be structured as such.



NOTED the report.

8. Children & Young Peoples’ Emotional Health and Wellbeing Strategy 8.1. Amy Wilkinson introduced the item. She noted that a big focus of the next five years

was a move towards resilience and prevention.

54

8.2. Honor Rhodes thanked the team for the work that they had done in re-developing this

strategy since the previous meeting.

8.3. The City Integrated Care Partnership Board APPROVED the strategy and progression to publish and dissemination.


APPROVED the strategy and progression to publish and dissemination. 9. Monthly Finance Update 9.1. Sunil Thakker introduced the item. At M4 City & Hackney was declaring a break-even

position. There was a small cost pressure within the acute area of spend. There were however ongoing cost pressures around prescribing and Continuing Healthcare (CHC).

9.2. NE London CCG was working towards a budget just under £2bn and was forecasting a break-even position. There were cost pressures relating to actue prescribing and CHC.

9.3. Cllr Kennedy asked if there was any information about the recently-announced extra

funding for hospital discharge. Sunil Thakker said he did not have information about this yet but there was an ongoing review situation. We would also be looking at the second half of the planning cycle from October onwards.

10. Risk Management Update

10.1. Rachael Tomlinson introduced the item. She noted that the report represented a new mechanism of risk reporting and updating, which would be focused on building up a system-based risk register. Only red-rated risks were currently being reported however the ICPB may wish to have certain risks reported to the board.

10.2. Cllr Kennedy welcomed the new approach. He noted that the previous system only really highlighted red risks, and he endorsed the system-based way of reporting.

10.3. John Gieve noted that many of the risks were operational risks, however there were

also longer-term strategic risks that arose from changes in financing allocations. We therefore needed a way to balance longer-term strategic risks against the more immediate operational risks. Randall Anderson added that the longer-term strategic risks were not necessarily ones that would arise from the natural workstream reporting process. Rachael Tomlinson added that the ICPB itself could identify risks it wished to see, and we could separate the risk register into operational and strategic risks.

10.4. Siobhan Harper noted that there was further work that could be done to bring risks

together as part of a system register as opposed to having risks that would sit on organizational risk registers.


NOTED the report.


55

NOTED the report.

11. AOB & Reflections

11.1. Cllr Kennedy noted that many comments had been about the ways in which we do our work – we were very much in a state of flux at the moment as a partnership board. We needed to bear this in mind as we further developed our arrangements going forward.

11.2. Honor Rhodes added that we had been giving greater thought to how we did work and how things would be operating going forward. She added she had no current insight into how the Neighbourhood Health and Care Board (NHCB) was going. She requested an update on the NHCB for the next meeting.

Update on NHCB to be provided at next ICPB meeting.

11.3. Siobhan Harper added that we may wish to schedule in a development session for the ICPB in the next few months. Caroline Millar added that she was supportive of the principle of a development session.

11.4. Randall Anderson added that there was a possibility for us to have in-person meetings in future.

11.5. Julia Simon added that the quality of the meeting was very high-quality, as were the papers.

11.6. John Gieve added that City & Hackney was in a good position to act as a London exemplar to how we developed place-based partnerships going forward.

56

Governing Body meeting – Wednesday 27 October 2021

Title of report TNW Area Committee update

Item number 7

Author Muna Ahmed, TNW Committee Manager (Interim)

Presented by Fiona Smith, TNW Area Committee Chair


Executive summary The Area Committee met on 14 October and was run alongside

the TNW Delivery Group. The key messages were as follows:

• The Committee discussed a proposal to make permanent

the move of Dementia inpatient admission services to

Cazaubon ward, East Ham Care Centre. These services

moved on an interim basis from Columbia ward, Mile End

Hospital in August 2020. The Cazaubon ward

environment supports recovery and the interim move has

already seen improvements in patient outcomes. The

feedback from service users and carers on their

experience of the service has been positive to date. A

public consultation will be launched which will consist of 3

questions, including a new question on travel.

• Selina Douglas, Managing Director provided an update on

the implementation of Advice and Guidance in primary

care.

• The Committee noted the summary of the TNW Finance

and Performance Sub-Committee which included the

items it had considered including

o Business cases; a deep dive on long terms

conditions; a Covid-19 update; The TNW

Performance report; analysis of the TNW financial

position; proposals for funding for mental health in

Newham and Waltham Forest

• The Committee were introduced to Siobhan Harper, who

will be taking over from Selina Douglas as TNW Director

of Transition from 20 October.

• The Committee thanked Selina for all her work in

Newham and TNW over the years and wished Selina all

the best for the future and success in her new role.

Action required The Governing Body is asked to note the update and the minutes

of the meeting held on 14 October 2021.


discussed?

This is a summary paper for the Governing Body and has not

been presented anywhere else.

Next steps/ onward reporting A regular report on key messages from the TNW Area

Committee will be presented at each meeting of the

Governing Body.

57

about:blank


people?



The TNW Area Committee will seek to act in the best interest of

residents within the TNW health and care system as a whole,

rather than representing the individual interests of any of its

members.

Conflicts of interest There are no conflicts of interest concerns in relation to this

report.

Strategic fit The Area Committee retains its core accountabilities until 31

March 2022. Going forward, the Area Committee will be held in

common with the Delivery Group and as such provide strategic

leadership and delivery of the overarching strategy and

outcomes framework for the TNW ICP.


and quality

The TNW Area Committee/ICB Board will:

• ensure the delivery of high-quality outcomes, putting

patient safety and quality first.

• have lead responsibility for population modelling and

analysis within the ICP area, supporting the CCG to

discharge its statutory duties, including those

relating to equality and inequality.

• Approve proposed health needs prioritisation

policies ensuring that this enables the CCG to meet

its statutory duties in relation to outcomes, equality

and inequalities.

• Receive recommendations from the ICP Finance and

Performance Sub-Committee and make decisions

on matters referred to it by that sub-Committee.

Risks A TNW system risk register is currently in development and will

cover the key strategic and operational risks to the TNW ICP

and will form part of the overall NEL CCG risk management

process.

Equality impact The delegated functions of the Area committee include the

following:

Population health management: the Committee will have lead

responsibility for population modelling and analysis within the

TNW area, supporting the CCG to discharge its statutory

duties, including those relating to equality and inequality. This

includes exercising the following specific functions in this

context:

• ensuring appropriate arrangements are in place to

support the TNW partnership to carry-out predicative

modelling and trend analysis,

• overseeing and implementing CCG information

governance arrangements within the TNW area,

• overseeing the development and implementation of

system incentives and re-alignment in order to deliver

a responsive population health driven system.

58

Tower Hamlets, Newham and Waltham Forest (TNW) Area Committee

Thursday 14 October, 13:45 – 14:30, Microsoft Teams

Minutes

Present:

Members

Fiona Smith (FS) (Chair) NEL CCG Board Independent Nurse

Sunil Thakker (ST) TNW Executive Director of Finance (Acting), NEL CCG

Ken Aswani (KA) Borough Chair, Waltham Forest

Muhammad Naqvi (MN) Borough Chair, Newham

Selina Douglas (SD) TNW Managing Director, NEL CCG

Anna Carratt (AC) TNW Director of Strategy and System Transformation, NEL CCG

Attendees

Eugene Jones (EJ) (item 3.2) Director of Service Transformation, East London NHS Foundation Trust

Dr Waleed Fawzi (WF) (item 3.2) East London NHS Foundation Trust

Siobhan Harper (SH) TNW Director of Transition, NEL CCG

Members of the TNW Delivery Group

Muna Ahmed (MA) TNW Committee Manager (interim), NEL CCG

Apologies

Henry Black (HB) NEL CCG Accountable Officer (Acting)

Steve Collins (SC) NEL CCG Chief Finance Officer (Acting)

Sam Everington (SE) Borough Chair, Tower Hamlets

Chetan Vyas (CV) TNW Director of Quality and Safety, NEL CCG

59


3 General business

3.0 Welcome, introductions and apologies FS welcomed all members and attendees from the TNW Delivery Group to the Area Committee meeting Apologies were noted, as above.

Conflicts of interest No interests were declared.

Quoracy The meeting was declared quorate.

3.1a Minutes from the previous meeting The Committee agreed the minutes from 29 July 2021, as an accurate record of the meeting.

3.1b Action log There were no outstanding actions.

3.1c Matters Arising None raised.

Items for approval

3.2 Columbia and Cazaboun Ward proposal The proposal is to make permanent the move of Dementia inpatient admission services to Cazaubon ward, East Ham Care Centre. These services moved on an interim basis from Columbia ward, Mile End Hospital in August 2020. The move of Columbia ward to East Ham Care Centre has provided an opportunity to create a critical mass of expertise, resources and support for dementia care and the frail elderly. The Cazaubon ward environment supports recovery and the interim move has already seen improvements in patient outcomes, as evidenced in the proposal. The feedback from service users and carers on their experience of the service has been positive. Currently, EJ is in the process of engaging with key reference groups, governance committees in the CCG and overview and scrutiny committees, until the end of November, after which a public consultation will be launched which will consist of the 2 questions detailed in the proposal. EJ added that following consideration of the change to the location a third question around travel will be added. EJ advised that they will develop their travel and transport protocol which will be co-authored with public representatives, HealthWatch and other stakeholders and ask the public to comment on its robustness, ease of use of access and will be the third question. The consultation will run for 12 weeks and EJ will return with an outcome in March 2022.

60

WF stated that the ward is settled and functioning well. It has synergies with the other wards at the East Ham Care Centre. EJ noted that there has been a reduction in the length of stay in the ward, of 16 days and they can continue to make improvements.

FS reflected that the evidence in the proposal supported the case and that it was helpful to see good patient outcomes and feedback.

Clare Davison (GP, Newham), queried if this may create an opportunity to create a Barts wide approach for frailty. EJ felt there was potential to develop the benefits of the services and is happy to explore and create a centre of excellence model. WF stated that they have links to geriatricians, mainly at Royal London. A joint NEL approach to frailty with input from psychiatry and geriatrics would be ideal.

Ralph Coulbeck (Barts) felt that it is a good suggestion, and that frailty is a critical priority in Waltham Forest. Ralph supports the proposal.

FS welcomes the additional question on travel. Any further comments can be emailed to EJ.

The Committee noted the proposal and supports the consultation on the Cazaboun Ward proposal and the inclusion of the additional question on travel for the public consultation.

Other Items

3.3a TNW Managing Director Update In addition to the update in the papers, SD advised that there has been a development of an Advice and Guidance offer across TNW. At NEL level, work is in progress to support primary care with A&G.

FS advised that the Finance and Performance Committee has also requested an update on A&G, as part of the performance pack.

SD introduced Siobhan Harper, who will be taking over from SD as TNW Director of Transition on the 20th of October. SH thanked SD for a comprehensive handover.

SD advised that the development and recruitment for a Director of Delivery post for Newham has been put on hold, until we have more information on the development of the ICS.

The Committee noted the Managing Director’s update.

3.3b Summary: TNW finance and performance sub-committee

ST highlighted from the summary:

- TNW F&P Committee considered and agreed a list of headings to beconsidered and included within business cases.

- A deep dive on long terms conditions.- Covid-19 update- A paper was presented on the financial gap in TNW.- Performance report

61

- Update on the NEL Community Health submission - Proposals for funding - Financial risk in Newham and Waltham Forest, in mental health

KA felt that long term conditions is an area we need to focus on and understand the unmet need, as it drives hospital admissions. KA felt that we need to catch up strategically, as it affects all partners and see an improvement in trajectory. We also need to focus on prevention, as we have high needs, due to the demographics of the population. KA added that it is a growing area.

MN agreed that it is a growing area and that we need to include long Covid. MN felt that we need more services for LTCs in the community, i.e. for respiratory conditions. Clare Davison added that we have good examples of work in Diabetes with partners working in a coordinated way, across the system in Newham and need the same for CVD and respiratory conditions.

ST agreed with KA on working strategically. ST will link in with Kieran and bring a paper on LTCs, to a future meeting.

FS suggested adding a question for the star chamber on how a business case/scheme contributes to the prevention of ill health in the long term. ST will include it as part of the star chamber process. ST added that it needs to be a collaborative approach, across the system.

MN stated that we need to be clear on where decisions are being made. Borough discussions are important, and we also need learning between boroughs and ensure we have the same offers for each borough, with crossover.

ACTION: SH and ST to take the work on LTCs forward and bring back to a future meeting.

The Committee noted the Summary of the TNW Finance and Performance Committee.

4 Any Other Business

4.1 Any other business FS thanked SD for all her work in Newham and TNW over the years and wished SD all the best for the future and success in her new role. MN added that SD has been exceptional and has elevated Newham. SD stated that it has been a pleasure working with everyone in NEL and will still be working within the system and looks forward to working with colleagues in her new role at NELFT.

4.2 Next meeting: Thursday 2 December 2021, 1-3pm, via Microsoft Teams

62

nel ccg governing body

Documents