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20170823 UC JLEB Agenda

Clinicians commissioning healthcare for the people of Northumberland

Joint Locality Executive Board

This meeting will be held at 09.00 on 23 August 2017 Committee Room 1, County Hall

AGENDA

Time Item Topic Decision Required

Enc. PDF Page

Sponsor

09.00 1 Administration

1.1 Apologies for absence 1.2 Declarations of conflicts of interest 1.3 Quoracy * 1.4 Minutes of the previous meeting 1.5 Review of actions register

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09.10 2 Business Matters

2.1 ACO Update 2.2 Finance report 2.3 Performance report 2.4 Quality report 2.5 Emergency Planning Assurance

Report 2.6 Assurance Framework and Risk

Register 2.7 Engagement Report 2.8 Medicines Optimisation Group

Minutes – July 2017

6 21 32

V Bainbridge M Robson S Brown A Topping S Brown

S Young

S Young

10.40 3 Locality meeting assurance/key points S Young

10.45 4 Any other business (items submitted prior to meeting only)

5 Date and time of next meeting: 27 September 2017, 0900 Corn Exchange, Town Hall, Morpeth

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Minutes of the Joint Locality Executive Board Meeting Wednesday 26 July 2017, 11.00am Committee Room 2, County Hall

Present Vanessa Bainbridge (VB) Accountable Officer (Chair) Alistair Blair (AB) Clinical Chair Siobhan Brown (SB) Transformation Director David Shovlin (DS) Locality Director - West Hilary Brown (HB) Locality Director - North John Warrington (JW) Locality Director - Central Frances Naylor (FN) Locality Director - Blyth Annie Topping (AT) Director of Nursing, Quality and Patient Safety Mike Robson (MR) Chief Finance Officer In Attendance Stephen Young (SY) Strategic Head of Corporate Affairs Janet Guy (JG) Lay Chair Karen Bower (KB) Lay Member - Resources and Performance and Patient and

Public Involvement Paul Crook (PC) Governing Body Secondary Care Doctor John Unsworth (JU) Governing Body Nurse Steve Brazier (SBr) Lay Member – Audit Committee Rachel Mitcheson (RM) Head of Commissioning Andy Johnson (AJ) Director of Education and Skills Northumberland County

Council Fiona Rogerson (FR) Business Support (minutes) JLEB/17/96 Agenda Item 1.1 Apologies There were no apologies received. JLEB/17/97 Agenda Item 1.2 Declarations of Conflicts of Interest There were no declarations of interest JLEB/17/98 Agenda Item 1.3 Quoracy The meeting was quorate. JLEB/17/99 Agenda Item 1.4 Minutes of the Previous Meeting The minutes of the previous meeting were agreed as a true and accurate record, pending the following amendment:

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• Page 5, JLEB/17/92 Agenda Item 2.5 Revised Governance Proposals: To be

amended to ‘The finance assurance function previously undertaken by Resource and Performance (R&P) function would be performed by the Finance Group with the remaining functions being undertaken by CEC and GB as normal business. The work of the Engagement, Public Health and Quality would be undertaken as core business in other groups and committees’.

JLEB/17/100 Agenda Item 1.5 Action Log The actions register was reviewed and the following updates given: JLEB/17/61/10 Session to be arranged with Andy Johnson regarding SEND. This item is on the agenda, to be removed from action log. Complete. JLEB/17/74/02 VB/SB/AB/DS to discuss ECIP workstream progress DS to present an update to JLEB. DS in process of updating. Ongoing. JLEB/17/76/01 VB to confirm that the ‘red line letter’ will be circulated. To be removed from action log. Complete. JLEB/17/89/01 VB to produce a note to JLEB once the NHSE CCG Improvement and Assessment Framework Report is received. To be removed from action log. Complete. JLEB/17/90/01 AT to update the Commissioner Assurance Visit Report for Woodhorn Ward with the relevant safeguarding findings. To be removed from action log. Complete. JLEB/19/94/01 SY to bring CCG ‘lessons learnt’ cyber attack briefing back to JLEB. Ongoing. JLEB/17/101 Agenda Item 2.1 Finance report

The report was considered for comment by exception. No exceptions were raised.

JLEB/17/102 Agenda Item 2.2 Performance report


JLEB/17/103 Agenda Item 2.3 Summary Quality report


JLEB/17/104 Agenda Item 2.4 Ambulance Performance report (commercially sensitive)

This report was discussed in the private JLEB meeting. JLEB/17/105 Agenda Item 2.5 Quarterly SEND Update A Johnson presented a report on the new SEND reforms and explained how the statement process has changed since the introduction of the Children and Families Act 2014. The families’ views are now more central and collaboration is key; the previous system was thought to be too concentrated on education funding. The new strategy now focusses on one stream including education and health and care. Children now get assessed through an

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Education Health and Care plan (EHC) which has replaced statements of special education need (SEN). The option of a personal budget for families and young people with an EHC plan is a key aspect. AJ asked the JLEB to consider the published local offer and said that he would welcome feedback. He further outlined the process of the SEND inspection, which will involve the CCG, saying that further improvements are required across Northumberland to provide evidence of collaboration. The results to date of the new inspection regime that commenced in 2016 are outlined in a published letter of key priorities. An action plan needs to be produced for any areas of concern and this is re-inspected at a later date. The SEND strategy and Inclusion strategy are currently in draft format and they both need to have agreed documentation by September 2017. AT/RM/VB are working on these documents and JU suggested that due to the short timescale and the amount of documentation to be agreed before September, delegation should be given to AB/VB to help speed things along. Action JLEB/17/105/01: RM/VB/AT to consider the draft revised SEND ‘offer’ and feedback to AJ. Action JLEB/17/105/02: AT and AJ to meet to discuss next steps for the SEND inspection. Action JLEB/17/105/03: AT to maintain quarterly SEND reporting to JLEB. JLEB/17/106 Agenda Item 2.6 Quality Intelligence Group Minutes – June 2017 The minutes were considered for comment by exception. No exceptions were raised. JLEB/17/107 Agenda Item 2.7 Governance Group Minutes – June 2017 The minutes were considered for comment by exception. No exceptions were raised. JLEB/17/108 Agenda Item 3 Locality meeting assurance/key points There were no key points discussed to feedback to localities. JLEB/17/109 Agenda Item 4 Any other business There were no items for discussion. JLEB/17/110 Agenda Item 5 Date and time of next meeting 23 August 2017, 09.00, Management Meeting Room, County Hall

JLEB/17/74/02 24/05/2017 26/07/2017 VB/SB/AB/DS to meet to discuss ECIP workstream Progress DS to present an update to JLEB

David Shovlin In Progress DS will report to October JLEB

JLEB/19/94/01 28/06/2017 26/07/2017 SY to bring CCG ‘lessons learnt’ cyber attack briefing to JLEB.

Stephen Young In Progress

JLEB/17/105/01 26/07/2017 23/08/2017 RM/VB/AT to consider the draft revised SEND ‘offer’ and feedback to AJ.

Annie Topping In Progress

JLEB/17/105/02 26/07/2017 23/08/2017 AT and AJ to meet to discuss next steps for the SEND inspection.

Annie Topping Complete

Meeting booked.

Joint Locality Executive BoardDATE: August 2017

NHS Northumberland Clinical Commissioning Group Joint Locality Executive Board Meeting - REGISTER OF ACTIONSLog owner: JLEB Chair

Description and Comments Owner Status CommentNumber Date Identified

Target Completion

Date

Joint Locality Executive Board 23 August 2017 Agenda Item: 2.2 Financial Performance Report, July 2017 (Month 4) Sponsor: Chief Finance Officer

Clinicians commissioning healthcare for the people of Northumberland 20170823 UC Agenda Item 2.2 Finance Report

1

Members of the Joint Locality Executive Board are asked to: 1. Consider the CCG financial position as at 31 July 2017. 2. Note the forecast outturn and key risks to delivery.

1 Purpose

1.1 Outlines the draft financial position for the period to 31 July 2017. 1.2 Appendix 1 shows the financial allocation of NHS Northumberland Clinical

Commissioning Group (CCG) broken down across the relevant areas of expenditure. The CCG’s main contracts, prescribing and running costs are identified separately, as they cross all domains, with delegated domain budgets also shown.

1.3 Appendix 7 shows the CCG level performance for medical (GP) primary care. 2 Financial Position Overview 2.1 Appendix 1 shows the financial performance of the CCG for the year to date to July

2017. At month 4, the CCG is forecasting an in year planned deficit of £4.5m and a total cumulative reported deficit of £44.9m. Reported performance against acute contracts has been amended to reflect the impact of the cyber-attack in May on both clinical activity and completeness of reporting.

2.2 Appendix 2 shows the total confirmed 2017-18 allocation for programme and running

costs as at July is £470.6m. This month the table in appendix 2 has been expanded to provide more information about each of the individual allocations, who the lead is and whether it has been approved to be committed. The in-month allocations received in July are as follows (all are non-recurrent except for PM Challenge fund and Lothian transfer to specialised commissioning);

JULY ALLOCATIONS £000's

Lothian Adjustment (120) Diabetes transformation bid 62 Acute hospital urgent and emergency liaison mental health services 62 ACC - Northumbria NCM vanguard Q2 funding 487 PACS - Northumberland NCM vanguard Q2 funding 1,072 Northumbria ACC Q1&Q2 Local evaluation funding 62

20170823 UC Agenda Item 2.2 Finance Report 2

PM Challenge Fund - GP Access Fund and TA Improving Access Allocations 481 Cancer 62 days wait support 10 TOTAL JULY ALLOCATIONS 2,116

2.3 The CCG shows the individual budget line positions on appendix 1 net of their QIPP

target. Any risk associated with under delivery of these QIPP targets at Month 4 is reported at summary level through the QIPP summary in appendix 8. Appendix 6a and 6b show forecasts for year end for the two main acute contracts. Risks of over performance within the acute contracts and failure to meet QIPP targets are reported as part of the in-year risk adjusted position to NHS England via the monthly non ISFE return submitted on working day 8 of each month.

3 Financial Position Detail 3.1 Northumbria Healthcare NHS Foundation Trust (NHCFT)

The cyber-attack in May 2017 impacted upon both the capacity of the Trust to deliver healthcare and the quality of reported data. This has resulted in a number of estimates and assumptions included within the forecast modelling based on this abnormal month. A prudent view has therefore been taken and a breakeven position reported. The SLAM data received from the North of England Commissioning Support Unit (NECS) has been included in appendix 6a for information and shows the detailed breakdown to point of delivery level for finance and activity. At Month 3 the reported performance from SLAM data identifies an underspend of £1.5m before the application of QIPP (£5.1m at month 3 straight line profile).

3.2 Newcastle upon Tyne Hospitals NHS Foundation Trust (NUTHFT)

The cyber-attack in May 2017 had a similar impact in that explained at NHCFT. A further issue in the NUTHFT contract concerns the correct application of identification rules in the submitted data. A similarly prudent approach to NUHCFT has therefore been taken. The SLAM data received from NECS has been included in appendix 6b for information and shows the detailed breakdown to point of delivery level for finance and activity. At Month 3 the reported performance from SLAM data identifies an underspend of £1.1m.

3.3 Acute Contracts NHS

Acute Contracts NHS reports the position on the smaller NHS contracts the CCG has, these include Gateshead Healthcare NHS Foundation Trust (£1.4m), North Cumbria University Hospitals Foundation Trust (£1.2m) and County Durham and Darlington Foundation Trust (£0.3m). Month 3 data received shows a forecast overspend of 4k for these providers. The remaining over spend of £74k reported in appendix 1 for this line relates to non-contract expenditure for NHCFT and NUTHFT that are reported outside of the main contract lines.

3.4 Acute Contracts Non NHS


Non NHS acute contracts are made up of Scottish providers NHS Borders (£2.2m) and NHS Lothian (£0.2m), and include private providers Ramsey Healthcare (£0.8m) and Nuffield Health (£0.3m), Better Care Fund (BCF) payment to the local authority re admissions avoidance (£2.2m), and a number of smaller AQP providers (£0.9m). Month 3 data supports the breakeven position for these providers for Month 4 reporting.

3.5 Northumberland Tyne and Wear NHS Foundation Trust (NTW)

The contract with NTW is a block contract and is therefore shown breakeven for Month 4 reporting.

3.6 North East Ambulance Service

This is the main ambulance contract held with the North East Ambulance Service. It also includes the 111 service contract with the same provider. Both are mainly block contracts and are reported breakeven for Month 4.

3.7 Other Acute NCA

Other Acute NCA (Non Contracted Activity) covers other NHS and non NHS providers where CCG patients are treated outside of Northumberland. Also included in this line are exceptional treatment and Private Patient Transport Service (PTS) payments. As this expenditure is ad hoc and immaterial by nature the CCG is showing breakeven for Month 4 reporting until more months data is available.

3.8 Community Contracts The CCG holds one main community block contract with NHCFT (£28.7m) and a

smaller one with NUTHFT (£0.3m). This line also contains the Joint Equipment Loan Store (JELS) contract with the Local Authority (£1.4m), continence products payments to NHCFT (£0.8m) and St Oswald’s palliative care contract (£0.3m). These are all block payments except for the continence products which and have been reported breakeven for Month 4 reporting.

3.9 Prescribing The Prescribing line includes prescribing and oxygen forecasts from data provided by

the Business Service Authority (BSA), and wound care payments to NHCFT. The Prescribing data runs two months in arrears so only month 2 was available at time of reporting. Given the volatility of the prescribing data, this is a forecast that can vary until the BSA have enough information through the year to provide a realistic profile of spending for 2017/18. The CCG has factored in QIPP achievement from the QIPP tracker and an increased drugs pressure for Olanzapine potential risk of 1.7m into the position. There is further risk regarding the Pregabalin QIPP scheme in that given the price drop in the drug there may be a shortage of supply later in the year, and


alternative drugs will be used at a higher cost. The CCG has reported this as potential risk through the monthly non ISFE return to NHS England.

3.10 Out of Hours The Out of Hours contract is with Northern Doctors Urgent Care. The contract is

currently in line with expectations and reported to breakeven for Month 4 reporting. 3.11 Commissioning Schemes Commissioning schemes includes the local enhanced services within primary care.

Currently underspending due to the final achievement payments for the practice activity scheme being less than what was originally planned as outturn.

3.12 Continuing Healthcare Continuing Healthcare (CHC) includes the main CHC contract with the Local Authority

for adult continuing healthcare. It also includes children personal health budgets, short break care with St Oswald’s, nurse assessor payments to NHCFT and estimated costs for previously unrecognised period of care (PUPoC) restitution claims. £55k underspend reported at Month 4 relates to children’s personal health budgets.

3.13 Mental Health and Learning Disabilities Mental Health and Learning Disabilities includes three main contracts: Section 117

(£5.5m) and Mental Health Pooled Budget (£2.7m) with the Local Authority, and Improving Access to Psychological therapies (IAPT) contract with Mental Health Matters (£3.9m). There are other smaller contracts included the British Pregnancy and Advice Service (BPAS) and bereavement and sexual health counselling from Barnardo’s. All reported breakeven position for Month 4 reporting except for an agreed Barnardo’s bereavement contract reduction of 3k.

3.14 Primary Care Commissioning

The delegated Primary Care Commissioning budgets are reported under this heading. The further breakdown of the expenditure within this line can be found in appendix 7.

3.15 Other Programme services Other Programme services includes social care funding that is passed through to the

Local Authority (£7.2m) and GP IT expenditure (£0.8m) with NECS for maintaining the GP IT infrastructure. GP IT is currently shown as an over spend but this is planned and is due to be offset by a corresponding under spend within the running costs allocation.

3.16 Commissioning Reserves


Commissioning reserves contains the business rules the CCG is required to set during

2017-18 planning. These include 0.5% national system reserve, 0.5% headroom and 0.5% contingency. Remaining reserves outside of the business rules are non-recurrent allocations received (as in appendix 2) that are yet to be committed, along with general reserves held to repay non recurrent legacy payments to NHCFT.

3.17 Running Costs

Running costs includes the CCG Establishment expenditure for its staff pay and non-pay plus the cost of outsourced services to NECS and NHCFT, along with contributions into regional support networks, audit fees, legal fees and depreciation. Running costs is showing as an under spend of £0.3m in Month 4 reporting to support the planned over spend in GP IT shown in other programmed services.

4 Statement of Financial Position and Cash flow. 4.1 The Statement of Financial Position (appendix 3) shows the closing positions at the end

of July 2017 in comparison to the previous months reported position. The main movements in month are in creditors and are due to the CCG part paying NHCFT acute contract payments (Trust invoicing gross value, CCG paying based on net of QIPP contract value), and re-profiling of the legacy payment made to NHCFT.

4.2 The CCG is expected by NHS England to proactively manage the cash it draws down

each month and the amount it actually spends. The target is to have no more than 1.25% of the monthly drawdown of cash left in the main bank account each month. The cash balance at the end of July 2017 was £0.013m (appendix 5) which equates to 0.32% of the July draw down, and meets the target level.

5 Better Payment Practice Code for year to 30 June 2017 5.1 The Better Payment Practice Code requires that all valid invoices should be paid by

their due date or within 30 days of receipt, whichever is later. The CCG is measured against a target of 95% achievement.

5.2 Appendix 4 shows the cumulative value of NHS invoices paid within 30 days at 31 July was 99.99% as a percentage of invoice value and 99.87% by invoice count. The cumulative value of Non NHS invoices paid within 30 days at 30 June was 99.93% as a percentage of invoice value and 99.35% by invoice count. Appendix 1: Year to date income and expenditure report and forecast outturn Appendix 2: Allocation breakdown Appendix 3: Statement of financial position

Appendix 4: Better payment practice code Appendix 5: Cash flow forecast


Appendix 6: Contract monitoring statements Appendix 7: Primary care expenditure Appendix 8: QIPP Summary

APPENDIX 1Northumberland Clinical Commissioning Group

YTD Budget YTD Actual

YTD Variance (Under)/

Overspend


Overspend 2017-18 BudgetForecast Outturn

Forecast Variance (Under)/

Overspend


Overspend£000's £000's £000's % £000's £000's £000's %

Commissioned Services

Northumbria Healthcare NHS FT 53,676 53,676 0 0.0% 161,027 161,027 0 0.0%Newcastle Upon Tyne Hospitals NHS FT 21,188 21,188 0 0.0% 63,563 63,563 0 0.0%Acute Contracts NHS 1,034 1,060 26 2.5% 3,103 3,181 79 2.5%Acute Contracts Non NHS 2,202 2,187 (16) -0.7% 6,607 6,560 (47) -0.7%Northumberland Tyne & Wear NHS Foundation Trust 14,698 14,698 0 0.0% 44,093 44,093 0 0.0%North East Ambulance Service 4,887 4,892 6 0.1% 14,660 14,677 18 0.1%Other Acute NCA 1,153 1,153 (0) 0.0% 3,460 3,459 (1) 0.0%

Community Services 10,475 10,509 35 0.3% 31,424 31,528 105 0.3%

Prescribing 19,020 19,024 4 0.0% 57,060 57,073 13 0.0%

OOH 931 931 0 0.0% 2,793 2,793 0 0.0%

Commissioning Schemes 813 748 (65) -8.0% 2,441 2,245 (195) -8.0%

Continuing Care Services 12,787 12,769 (18) -0.1% 38,362 38,308 (55) -0.1%

Mental Health & LD 4,174 4,173 (1) 0.0% 12,522 12,519 (3) 0.0%

Primary Care Co Commissioning 14,196 14,164 (32) -0.2% 43,768 43,768 0 0.0%

Other Programme Services 2,549 2,689 139 5.5% 7,648 8,066 418 5.5%

Commissioning Reserves 7,901 7,917 16 0.2% 15,991 15,947 (44) -0.3%

Total Commissioned Services 171,684 171,779 95 508,522 508,808 286

Running Costs 2,333 2,238 (95) -4.1% 7,001 6,715 (286) -4.1%

Total Running Costs 2,333 2,238 (95) 7,001 6,715 (286)

TOTAL EXPENDITURE 174,018 174,017 (0) 515,523 515,522 (0)

ResourceNotified Allocation (159,038) (159,038) 0 (470,582) (470,582) 0

TOTAL RESOURCE (159,038) (159,038) 0 (470,582) (470,582) 0

Planned Deficit Adjustments to Notified AllocationIn Year Deficit (1,493) 0 1,493 (4,481) 0 4,481

Cumulative Historic Deficit (13,487) 0 13,487 (40,461) 0 40,461

TOTAL PLANNED & HISTORIC DEFICIT (14,980) 0 14,980 (44,941) 0 44,941

TOTAL CUMULATIVE REPORTED DEFICIT (0) 14,980 14,980 0 44,941 44,941

INCOME & EXPENDITURE REPORT - YTD & FOT POSITION AS AT 31 JULY 2017

Acute Services (inc Ambulance Services)

APPENDIX 2

Northumberland Clinical Commissioning Group

Recurrent Non Recurrent Total£000's £000's £000's

April Initial CCG Programme Allocation 457,342 0 457,342 N/A Initial allocation - Programme YInitial CCG Running Cost Allocation 6,996 0 6,996 N/A Initial allocation - Running Costs YPrimary Care Co-Commissioning Funding 44,017 0 44,017 N/A Initial allocation - Primary Care Co Commissioning YRTD - Paed NEL Zero LoS to Ambulatory Recoding 71 0 71 N/A Baseline Adjustment YRTD - block drugs disaggregation 674 0 674 N/A Baseline Adjustment YAllocation adjustments of the drugs block in the Newcastle contract 2017-18 (204) 0 (204) N/A Baseline Adjustment YIR Changes 0 (1,581) (1,581) N/A Technical Adjustment YHRG4+ changes 0 (1,871) (1,871) N/A Technical Adjustment Y

Total NHS England Allocation April 2017 508,896 (3,452) 505,444May

Deficit Carry Forward - Planned 0 (31,041) (31,041) N/A Technical Adjustment Y

Total NHS England Allocation May 2017 0 (31,041) (31,041)June

Surplus/Deficit Carry Forward - 1617 Final Outturn (9,420) (9,420) N/A Technical Adjustment YInterpreters and Clinical waste transfer (249) (249) Primary care co-commissioning Transferred service to NHSE, agreed 16-17 YReception and clerical training - (Training Care Navigators and Medical Assistants) 55 55 Pamlea LevenyNHS WiFi 147 147 Brian Moulder/ Alan BellPHB Champion Funding Mar - Oct 17 funding 35 35 Paul TurnerMarket Rents - Admin adjustment 5 5 Mike Robson Move to Market rent funding for HQ County HallMarket rents adjustment 634 634 Mike Robson Move to Market rent funding for Community sitesParamedic Rebanding Additional Funding 2017-18 65 65 Pamela Leveny NHSE have advised to hold this allocation until further notice.HSCN Funding 147 147 Brian Moulder/ Alan Bell CoIN FundingCYPT IAPT Trainee staff support costs 3 3 Kate O'BrienAcute hospital urgent & emergency liaison mental health services 62 62 Kate O'BrienQ1 vanguard funding - Northumbria Foundation Group 488 488 Siobhan Brown Pass through allocation to Northumbria HC FTQ1 vanguard funding - Northumberland ACO PACS 1,073 1,073 Siobhan Brown Pass through allocation to Northumbria HC FTHelpforce Funding for Northumbria Healthcare FT 51 51 Paul TurnerResilience Ambulance Funding 2017/18 966 966 Pamela Leveny Winter resilience funding foe NEAS

Total NHS England Allocation June 2017 (249) (5,689) (5,938)July

Lothian Adjustment (120) (120) Mike Robson / Brian MoulderDiabetes transformation bid 62 62 David LeaAcute hospital urgent and emergency liaison mental health services 62 62 Kate O'BrienACC - Northumbria NCM vanguard Q2 funding 487 487 Siobhan Brown Pass through allocation to Northumbria HC FTPACS - Northumberland NCM vanguard Q2 funding 1,072 1,072 Siobhan Brown Pass through allocation to Northumbria HC FTNorthumbria ACC Q1&Q2 Local evaluation funding 62 62 Siobhan Brown Pass through allocation to Northumbria HC FTPM Challenge Fund - GP Access Fund and TA Improving Access Allocations 481 481 Pamela LevenyCancer 62 days wait support 10 10 Hilary Brown / Susan Boyd

Total NHS England Allocation July 2017 361 1,755 2,116Total YTD Confirmed NHS England Allocation 2017-18 509,008 (38,427) 470,582

NHS ENGLAND IN YEAR ALLOCATIONS

Commissioning Manager Lead Narrative

Board Approval

(Y/N)

APPENDIX 3


July 2017 June 2017 Movement£000's £000's £000's

Non Current Assets Property, plant and equipment 1,488 1,509 (21)Intangible Assets 0 0 0Other Financial Assets 0 0 0

Total Non Current Assets 1,488 1,509 (21)

Current Assets Trade and other Receivables 3,890 3,476 414Cash and cash equivalents 126 453 (327)

Total Current Assets 4,016 3,929 87

Total Assets 5,504 5,438 65

Current Liabilities Trade and other payables (23,138) (19,784) (3,355)Other liabilities 0 0Provisions 0 0Borrowings 0 0

Total Current Liabilities (23,138) (19,784) (3,355)

Non-Current Assets plus/less Net Current Assets/Liabilities (17,635) (14,345) (3,289)

Non-Current liabilities Other liabilities 0 0Provisions 0 0Borrowings 0 0

Total Non-Current Liabilities 0 0 0

TOTAL ASSETS EMPLOYED (17,635) (14,345) (3,289)

Financed by Taxpayers Equity

Capital & Reserves General Fund (17,635) (14,345) (3,289)Revaluation Reserve 0 0Other reserves 0 0

TOTAL TAXPAYERS EQUITY (17,635) (14,345) (3,289)

STATEMENT OF FINANCIAL POSITION

APPENDIX 4


Better Payment Practice Code - 30 Days NUMBER £000's

Non-NHSTotal Non-NHS Trade Invoices Paid in the Year 2,323 47,153 Total Non-NHS Trade Invoices Paid Within 30 Day Target 2,308 47,121 Percentage of Non-NHS Trade Invoices Paid Within 30 Day Target 99.35% 99.93%

NHS Total NHS Trade Invoices Paid in the Year 771 116,615 Total NHS Trade Invoices Paid Within 30 Day Target 770 116,614 Percentage of NHS Trade Invoices Paid Within 30 Day Target 99.87% 100.00%

BETTER PAYMENT PRACTICE CODEFOR THE FOUR MONTHS TO 31 JULY 2017

APPENDIX 5


Actual Actual Actual Actual Forecast Forecast Forecast Forecast Forecast Forecast Forecast ForecastApril May June July August September October November December January February March

£000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's

IncomeBalance bfwd 21 416 138 453 126 118 131 196 155 107 142 144DOH Income 38,300 39,900 46,300 38,900 37,700 37,700 37,000 37,000 37,000 37,000 37,000 44,000Supplementary /Cash Return 0 0 0 0 0 0 0 0 0 0 0 0Prescribing Charge to Cash Limit 3,823 4,367 4,033 4,342 4,394 4,243 4,237 4,266 4,154 4,310 4,566 4,451CHC Risk Pool 0 0 0 0 0 0 0 0 0 0 0 0Better Care Fund 0 0 0 0 0 0 0 0 0 0 0 0Other Income 1,103 106 879 454 450 505 450 450 450 450 450 450Total Income 43,247 44,789 51,350 44,149 42,670 42,566 41,818 41,912 41,759 41,867 42,158 49,045

ExpenditurePay (209) (214) (207) (206) (207) (207) (207) (207) (207) (207) (207) (207)NHS Payments including contracts (26,928) (28,509) (32,271) (29,018) (28,004) (27,804) (27,204) (27,204) (27,204) (27,204) (27,204) (27,303)Other Payments - BACS/CHAPS/CHQS (11,682) (9,761) (13,370) (9,635) (8,748) (8,982) (8,775) (8,881) (8,888) (8,805) (8,838) (15,828)Prescribing/Home Oxygen Therapy (3,823) (4,367) (4,033) (4,342) (4,394) (4,243) (4,237) (4,266) (4,154) (4,310) (4,566) (4,451)CHC Risk Share 0 0 0 0 0 0 0 0 0 0 0 0Better Care Fund (1,611) (827) (602) (1,010) (1,010) (1,010) (1,010) (1,010) (1,010) (1,010) (1,017)Other (189) (189) (189) (220) (189) (189) (189) (189) (189) (189) (189) (189)Total Expenditure (42,831) (44,651) (50,897) (44,023) (42,552) (42,435) (41,622) (41,757) (41,652) (41,725) (42,014) (48,995)

BALANCE CFWD 416 138 453 126 118 131 196 155 107 142 144 50

CASHFLOW FORECAST

APPENDIX 6a


Summary Bottom Line Position £'000

The position below is based on month 3 Service Level Agreement Monitoring (SLAM) data produced via NECS for forecasting for the Full year effect.

£000'sSLA Value 17-18 160,774 SLAM Forecast Outturn 17-18 179,127 SLAM Forecast Contract Variance 17-18 18,353 Board report Variance (appendix 1) 0 Difference to Board report 18,353

POD CATEGORIESYEAR TO DATE

PLANYEAR TO DATE

ACTUALYEAR TO DATE

VARIANCE ANNUAL PLANFORECAST OUTTURN

FORECAST OUTTURN VARIANCE

NON ELECTIVE ADMISSIONS INCLUDING EXCESS BEDDAYS 15,453 14,518 (935) 61,814 59,156 (2,658)ELECTIVE INCLUDING EXCESS BEDDAYS 4,210 3,940 (270) 16,839 16,392 (447)DAY CASES 4,880 4,486 (394) 19,521 17,943 (1,578)ACCIDENT & EMERGENCY 3,777 3,221 (556) 15,107 12,882 (2,225)AMBULATORY CARE 2,360 2,914 554 9,442 11,656 2,214 OUTPATIENT FIRST ATTENDANCE INCLUDING NF2F 2,527 2,318 (209) 10,109 9,846 (263)OUTPATIENT FOLLOW UP ATTENDANCE INCLUDING NF2F 2,969 2,831 (137) 11,874 11,606 (269)HIGH COST DRUGS 1,337 1,250 (87) 5,346 5,259 (87)DEVICES 52 55 3 208 221 13 MATERNITY PATHWAY 1,386 1,322 (64) 5,544 5,287 (256)BLOCK 3,514 3,514 0 14,057 14,057 0 READMISSIONS, EM THRESHOLD, BEST PRACTICE 126 44 (82) 505 175 (330)OTHER 2,665 3,536 871 10,660 15,058 4,398 PENALTIES 0 (61) (61) 0 (245) (245)DATA CHALLENGES 0 (166) (166) 0 (166) (166)QIPP (5,063) 0 5,063 (20,252) 0 20,252 Grand Total 40,193 43,722 3,528 160,774 179,127 18,353

Without QIPP 45,256 43,722 (1,535) 181,026 179,127 (1,899)

* Without QIPP reduction the forecast is under plan by 1.5m.* QIPP relating to Demand management, Right Care, Ambulatory care, LoS reductions, and contract block reductions are yet to be applied to the above forecast at PoD level detail in SLAM.


PLANYEAR TO DATE

ACTUALYEAR TO DATE



NON ELECTIVE ADMISSIONS INCLUDING EXCESS BEDDAYS 8,865 7,896 (969) 35,459 31,583 (3,876)ELECTIVE INCLUDING EXCESS BEDDAYS 1,130 1,095 (35) 4,518 4,380 (138)DAY CASES 6,099 5,592 (507) 24,396 22,368 (2,028)ACCIDENT & EMERGENCY 31,264 30,767 (497) 125,058 123,068 (1,990)AMBULATORY CARE 8,029 9,690 1,661 32,117 38,760 6,643 OUTPATIENT FIRST ATTENDANCE INCLUDING NF2F 19,384 19,069 (315) 77,536 76,276 (1,260)OUTPATIENT FOLLOW UP ATTENDANCE INCLUDING NF2F 45,495 46,407 912 181,981 185,628 3,647 HIGH COST DRUGS 0 0 0 0 0 0 DEVICES 0 0 0 0 0 0 MATERNITY PATHWAY 1,474 1,349 (125) 5,897 5,396 (501)BLOCK 0 0 0 0 0 0 READMISSIONS, EM THRESHOLD, BEST PRACTICE 0 0 0 0 0 0 OTHER 425,392 390,398 (34,994) 1,701,568 1,561,592 (139,976)PENALTIES 0 0 0 0 0 0 DATA CHALLENGES 0 0 0 0 0 0 QIPP 0 0 0 0 0 0 Grand Total 547,132 512,263 (34,869) 2,188,529 2,049,050 (139,479)

Month 3 data position £000's Full Year forecast £000's

ACTIVITY OVERVIEW

Month 3 data position Full Year forecast

* Month 3 flex data in SLAM (below) shows the YTD position of £3.5m over plan for Quarter 1. The expectation in the forecast is that cancelled appointments and operations will be caught up with over the up coming months, along with a Winter period with potential pressures ergo a forecast of £18.3m above contract is predicted in the SLAM model.

FINANCE OVERVIEW

* Due to the cyber attacks effect on cancelled operations in May, the CCG has reported in board report (appendix 1) a breakeven position for Northumbria Healthcare, rather than using the SLAM Forecast due to the nature of the estimates include in that model, i.e. no QIPP delivery.

CONTRACT SUMMARY

Northumbria Hospitals NHS FT

* The latest SLAM data (Month 3) used in the tables below is made available after the financial ledger closes, therefore there are differences between what is reported in the board report (appendix 1) and what the SLAM data forecast for Northumbria Healthcare shows, however to provide the most up to date information the latest data available at board report close is used.

* Risks associated with QIPP under delivery have been reported through the non ISFE monthly reporting to NHS England.

APPENDIX 6b


Summary Bottom Line Position £'000

The position below is based on month 3 Service Level Agreement Monitoring (SLAM) data produced via NECS for forecasting for the Full year effect.

£000'sSLA Value 17-18 63,563 SLAM Forecast Outturn 17-18 64,052 SLAM Forecast Contract Variance 17-18 489 Board report Variance (appendix 1) 0 Difference to Board report 489


PLANYEAR TO DATE

ACTUALYEAR TO DATE



NON ELECTIVE ADMISSIONS INCLUDING EXCESS BEDDAYS 3,964 3,424 (540) 15,856 13,698 (2,159)ELECTIVE INCLUDING EXCESS BEDDAYS 2,069 2,114 45 8,276 8,454 178 DAY CASES 2,510 2,565 56 10,038 10,260 222 ACCIDENT & EMERGENCY 461 389 (72) 1,844 1,557 (287)AMBULATORY CARE 204 177 (27) 814 708 (106)OUTPATIENT FIRST ATTENDANCE INCLUDING NF2F 1,331 1,094 (237) 5,324 4,376 (948)OUTPATIENT FOLLOW UP ATTENDANCE INCLUDING NF2F 1,567 1,440 (127) 6,266 5,759 (508)OUTPATIENT PROCEDURES 1,267 1,250 (17) 5,066 4,999 (68)HIGH COST DRUGS 1,536 1,553 17 6,145 6,212 66 DEVICES 87 74 (14) 350 296 (54)MATERNITY PATHWAY 6 11 5 24 45 21 BLOCK 383 383 0 1,530 1,530 0 READMISSIONS, EM THRESHOLD, BEST PRACTICE (925) (557) 369 (3,701) 618 4,319 OTHER 1,432 1,560 127 5,729 6,220 492 DATA CHALLENGES 0 (680) (680) 0 (680) (680)Grand Total 15,891 14,796 (1,095) 63,563 64,052 489


PLANYEAR TO DATE

ACTUALYEAR TO DATE



NON ELECTIVE ADMISSIONS INCLUDING EXCESS BEDDAYS 2,422 1,948 (474) 9,688 7,792 (1,897)ELECTIVE INCLUDING EXCESS BEDDAYS 4,027 3,644 (383) 16,109 14,576 (1,533)DAY CASES 391 339 (52) 1,564 1,356 (208)ACCIDENT & EMERGENCY 3,652 3,806 154 14,608 15,224 616 AMBULATORY CARE 0 0 0 0 0 0 OUTPATIENT FIRST ATTENDANCE INCLUDING NF2F 1,129 1,007 (122) 4,516 4,028 (489)OUTPATIENT FOLLOW UP ATTENDANCE INCLUDING NF2F 0 0 0 0 0 0 OUTPATIENT PROCEDURES 8,013 6,697 (1,316) 32,050 26,788 (5,262)HIGH COST DRUGS 20,254 18,480 (1,774) 81,017 73,920 (7,098)DEVICES 9,197 8,610 (587) 36,789 34,440 (2,349)MATERNITY PATHWAY 16 21 5 65 84 19 BLOCK 0 0 0 0 0 0 READMISSIONS, EM THRESHOLD, BEST PRACTICE 0 0 0 0 0 0 OTHER 51,538 51,422 (116) 206,153 205,688 (466)DATA CHALLENGES 0 0 0 0 0 0 Grand Total 100,640 95,974 (4,666) 402,561 383,894 (18,666)

* Month 3 flex data in SLAM (below) shows the YTD position of £1.1m underspend which is due to Easter in April and the Cyber-attack in May. The expectation in the forecast outturn of £0.5m over spend is that cancelled appointments and operations will be caught up with over the up coming months, and it includes a manual adjustment added by NECS for the impact of the Identification rules.

Month 3 data position £000's Full Year forecast £000's

ACTIVITY OVERVIEW

Month 3 data position Full Year forecast

FINANCE OVERVIEW

CONTRACT SUMMARY

Newcastle Upon Tyne Hospitals NHS FT

* The latest SLAM data (Month 3) used in the tables below is made available after the financial ledger closes, therefore there are differences between what is reported in the board report (appendix 1) and what the SLAM data forecast for Newcastle Hospitals NHS FT shows, however to provide the most up to date information the latest data available at board report close is used.* Due to the cyber attacks effect on cancelled operations in May, the CCG has reported in board report (appendix 1) a breakeven position for Newcastle Hospitals, rather than using the SLAM Forecast due to the nature of the estimates include in that model. For Newcastle Hospitals the data received from the trust and used in the SLAM model does not include the full effect of the identification rules adjustment.* Risks associated with QIPP under delivery have been reported through the non ISFE monthly reporting to NHSE.

Appendix 7


2017-18 Annual Budget YTD Budget YTD Actual


OverspendForecast Outturn


Overspend

This Month Forecast

MovementNHS NORTHUMBERLAND CCGGeneral Practice - GMS 6,943,403 2,314,445 2,326,710 12,265 6,962,242 18,839 -26,833General Practice - PMS 22,537,230 7,512,337 7,552,306 39,969 22,696,483 159,253 59,346QOF 5,035,158 1,678,265 1,652,720 -25,545 5,011,760 -23,398 0Enhanced Services 1,952,113 650,481 597,075 -53,406 1,905,180 -46,933 0Premises Cost Reimbursement 3,901,816 1,300,427 1,291,602 -8,825 3,964,697 62,881 -27,901Other Premises Cost 0 0 0 0 0 0 0Dispensing/Prescribing Drs 1,644,554 548,094 490,564 -57,530 1,587,016 -57,538 4,914Other GP Services 766,094 255,295 313,403 58,108 884,847 118,753 6,686CCG Prescribing -190,597 -63,503 -60,050 3,453 -187,115 3,482 0LEVY - Other GP Services 0 0 0 0 0 0 0Superannuation 0 0 0 0 0 0 0Reserves 1,178,229 0 0 0 942,890 -235,339 -16,212Grand Total 43,768,000 14,195,841 14,164,330 -31,511 43,768,000 0 0

Medical - Monthly Budget Monitoring Report Month 4

Appendix 8

Northumberland Clinical Commissioning GroupNORTHUMBERLAND CCG QIPP PLAN HIGH LEVEL SUMMARY 2017-18Version 140817 - Month 4 board report

Scheme Area b 2017-18 £'s CommentsRight Care 2,416,668 All Amber Rated Community 1,520,000 All Amber RatedMental Health 3,123,000 Green rated £0.8m, £1.0m Amber rated, £1.3m Red ratedCHC 3,800,000 All Grey rated (delivered)Prescribing 2,928,000 Green rated £2.8m, Amber rated £0.1mOther Acute Schemes 5,073,389 Green rated £2.1m, Amber rated £2.2m, Red Rated £0.7mEstates 200,000 All Red RatedSub Total 19,061,057Still to be indentified 10,958,943 Balance of QIPP target not identifiedPlanned QIPP target 30,020,000

RAG Rating TotalsRAG Rating £'s Comments

Green 5,911,000£2.8m Prescribing, £1.5m Demand Management, £0.8m Mental Health (NTW), £0.2m Avastin, £0.6m A&E block to PbR (half).

Amber 7,165,057£2.4m Right Care, £1.5m Bed Utilisation, £1.3m ED Streaming, £0.6m A&E Block to PbR (half), £1.0m Mental Health (TMN & NTW), £0.1m Prescribing stretch, £0.2mOutpaitent Follow ups

Red 2,185,000 £1.3m Mental Health, £0.7m Ambulatory care, £0.2m Estates.

Grey 3,800,000 £3.8m CHC Delivered and transacted through agreed contract.

Yellow 0 No Pipeline schemes to report.

Total from Identified schemes 19,061,057

Joint Locality Executive Board 23 August 2017 Agenda Item: 2.3 Summary performance report Sponsor: Chief Operating Officer

Clinicians commissioning healthcare For the people of Northumberland 20170823 UC Agenda Item 2.3 Performance Report

Members of the Joint Locality Executive Board are asked to: 1. Consider the June 2017 key performance indicators. 2. Agree the actions identified to improve future performance. Purpose This report details the June 2017 and the year to date position for the key performance indicators where the information is available in relation to the NHS Northumberland Clinical Commissioning Group (CCG) and the key Northumberland providers. The monthly data is for June 2017 unless otherwise stated.

CCG and provider key performance indicators 2017/18

Ambulance Cat A

Ap

Ambulance Cat A

A

----------------------

Key: Achieved or exceeded target Underachieved <3% Underachieved >3%

RTT 18 weeks June 17

Diagnostic Waits

June 17

Dementia diagnosis

July 17

Mental Health

April 17

Ambulance June 17

Cancer June 17 CCG Overall

Northumberland

RTT 18 weeks

June 17

Diagnostic Waits

June 17

Dementia diagnosis

July 17

Mental Health April 17

Ambulance June 17

Cancer June 17 TRUST Overall

The Newcastle upon Tyne Hospitals NHS Foundation Trust

Northumbria Healthcare NHS Foundation Trust

Northumberland Tyne and Wear NHS Foundation Mental Health Trust

North East Ambulance Service NHS Foundation Trust

Talking Matters Northumberland

England average

A&E Waits

July 17

A&E Waits July 17

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The provider and the overall England performance captured in the above table and throughout the report relate to the treatment of all patients from all CCGs and not exclusively to Northumberland residents. This will partially account for the variations in performance ratings compared to the CCG. CCG summary of performance

• The NHS Constitution standard for the dementia screening continues to be achieved.

• 18 weeks referral to treatment time performance remains strong across all specialties except trauma and orthopaedics where the 92% threshold has been consistently breached across the local health economy.

• Diagnostic waiting times’ performance was achieved within the CCG. • The CCG also achieved the 50% NHS Constitution target for early intervention in

psychosis. The performance was reported at 100% for the third month running. • The percentage of patients moving to recovery achieved the NHS Constitution

standard within the mental health Improving Access to Psychological Therapies (IAPT) service. More recent provisional data also indicates that performance continues to improve.

• Both the main acute providers achieved the accident and emergency 4 hour waiting time target during June and July.

There are three areas of performance concern:

• Ambulance response times remain significantly below the constitutional performance standards and continue to deteriorate. This remains the most significant risk for the CCG and the North East health economy.

• Excessive handover delays at Northumbria Healthcare NHS Foundation Trust (NHCFT) continue to impact upon ambulance response times. Performance during July had deteriorated when compared with the previous month.

• The CCG failed to achieve the 62 day cancer target.

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Accident and Emergency The Accident and Emergency performance during June and July 2017 improved to enable NHCFT and NUTHFT to achieve the 95% threshold.

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Ambulance response times The eight minutes’ response time performance for the CCG against the 75% target continues to be underachieved with a continued deterioration in performance in June reported at 58.0% compared to 58.8% in May. The 19 minutes’ response time target of 95% was also underachieved at CCG level with a performance of 82.8% representing a slight improvement when compared to the 82.3% performance reported in May. The North East Ambulance Service (NEAS) provider level performance also failed to achieve the response time targets with a further deterioration in performance being observed when compared with the previous months. The 8 minutes’ response time performance was reported at 58.0%, the same as reported in May. The 19 minutes’ response time performance was reported at 87.4% compared with 87.6% reported in May. Outlined below is the overall NEAS performance compared against the organisation’s recovery trajectory for 2017/18 and the performance during 2016/17. The data for July as yet is provisional but is not expected to change significantly.

Whilst it is encouraging to note that the actual performance for 2017/18 is above the recovery trajectory, red 1 calls only represent 6% of the total emergency response volumes. The high volume of activity relates to red 2 calls – see below.

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The major concern is that the red 2 actual performance is below the recovery trajectory and last year’s performance by around 10% month on month during 2017/18. As a part of the ECIP programme, the Ambulance service is undertaking a rapid improvement workshop during October to review focussing on the management of the frail elderly patients. In the future it is intended to offer this group of patients’ alternative places of treatment as opposed to transporting them into hospital. Other work streams are being proposed as part of the programme that also considers alternatives to transporting patients into hospital. Handover delays

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Whilst still remaining an outlier, in July the total time lost at the Northumbria Specialist Care Emergency Hospital (NSECH) was 163 hours compared to 127 hours in June, an increase of 36 hours. NSECH continues to contribute to the largest proportion of handover delays however the proportion has increased partially due to the deterioration outlined above and also to reductions in delays within other trusts across the North East. The delays at NSECH represented 50% of the total delays across the health economy in July compared to 37% in June. This compares to NSECH receiving 19% of the total ambulance activity across the region. The four work streams within the Emergency Care Intensive Programme Board (ECIP) continue to focus on activities to improve urgent care performance including the reduction of handover delays at NSECH. Cancer performance The 62 day target was breached by the CCG with 15 out of 87 patients being treated outside the threshold time. The reported performance was 82.8% against an 85% target. NHCFT breached the same target with a performance of 81.8%. NHCFT has been successfully awarded £10,000 from NHS England to focus on improving processes to track patients on the cancer pathway. The expectation is to enable the trust to achieve the 62 day standard by October 2017. The trust’s improvement in performance is expected to have a direct impact on the CCG’s cancer 62 day performance.

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NHS Constitution

NHS Northumberland CCG Performance Indicators

`

The above chart now incorporates the end of year risk for performance of the CCG.

In terms of the current outliers, the Ambulance response times pose the greatest risk for the CCG due to the continued under performance of the service against the recovery trajectory for red 2, which represents the highest volume of activity.

Based upon the planned investment in cancer pathway tracking processes at NHCFT, it is expected that the cancer performance will recover in year. Accident and Emergency performance continues to improve month on month which is expected to reduce the end of year risk.

Threshold Actual YTD End of year risk Actual

% patients waiting for initial treatment on incomplete pathways within 18 weeks 92.0% 94.5% 94.4% 90.3%

Number of patients waiting more than 52 weeks for treatment 0 0 0 1,544

Diagnostic waits % patients waiting more than 6 weeks for the 15 diagnostics tests (including audiology) Jun-17 1.0% 0.5% 0.5% 1.9%

A&E waits % patients spending 4 hrs or less in A&E or minor injury unit Jul-17 95.0% 95.1% 94.0% 90.3%

% of patients seen within 2 weeks of an urgent GP referral for suspected cancer 93.0% 95.0% 94.0% 94.1%

% of patients seen within 2 weeks of an urgent referral for breast symptoms 93.0% 94.8% 94.6% 91.6%

% of patients treated within 62 days of an urgent GP referral for suspected cancer 85.0% 82.8% 82.6% 80.2%

% of patients treated within 62 days of an urgent GP referral from an NHS Cancer Screening Service

90.0% 100.0% 95.0% 91.1%

% of patients treated for cancer within 62 days of consultant decision to upgrade status N/A 100.0% 71.43% 86.8%

% of patients treated within 31 days of a cancer diagnosis 96.0% 98.2% 98.3% 97.5%

% of patients receiving subsequent treatment for cancer within 31 days - surgery 94.0% 97.4% 97.2% 96.5%

% of patients receiving subsequent treatment for cancer within 31 days - drugs 98.0% 97.5% 99.0% 99.3%

% of patients receiving subsequent treatment for cancer within 31 days - radiotherapy 94.0% 100.0% 100.0% 96.7%

Category A (Red 1) 8 minute response time 63.5% 65.2% 68.8%

Category A (Red 2) 8 minute response time 57.7% 59.0% 61.8%

Category A (Red 1 & 2 combined) 8 minute response time 75.0% 58.0% 59.4% 62.2%

Category A 19 minute transportation time 95.0% 82.8% 84.0% 90.0%

Mixed Sex accommodation

Mixed Sex accommodation - number of unjustified breaches Jun-17 0 0 0 776 (47.6%)

Cancelled operations Cancelled operations for non-clinical reasons to be rescheduled within 28 days Q1 2017/18 92.7%

Care Programme Approach

% people followed up within 7 days of discharge from psychiatric in patient care Q4 2016/17 95.0% 98.0% 97.9% 96.7%

6 Week wait IAPT treatment (People Entering Therapy) Apr-17 75.0% 98.0% 89.6%

6 Week wait IAPT treatment (People Completing Therapy) Apr-17 75.0% 97.3%

18 Week wait IAPT treatment (People Entering Therapy) Apr-17 95.0% 100.0% 99.1%

18 Week wait IAPT treatment (People Completing Therapy) Apr-17 95.0% 98.6%

Early intervention in psychosis - % with 1st episode treated within 2 weeks Jun-17 50.0% 100.0% 100.0% 77.5%

% people with anxiety disorders and depression who access psychological therapies (IAPT) Apr-17 1.25% 1.48% 1.48%

% complete treatment who are moving to recovery Apr-17 50% 50.7% 50.7% 51.1%

Improve diagnosis rate for people with dementia Jul-17 66.7% 69.2% 68.0%

Referral to treatment access times Jun-17

Mental Health

Category A Ambulance Jun-17

Cancer Waits Jun-17

CCG

Indicators Indicator Description Latest Data Period

Monthly trend

England BenchmarkNHS Northumberland CCG

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Residents within Northumberland not receiving care within NHS Constitution pledge Indicator

Sub indicator

June 2017 Patients 2017/18 YTD

Cancer

2 week wait for referral

54

(48 due to patient choice)

179


31 days for diagnosis

3 (0 due to patient

choice)

8 (1 due to patient

choice)

62 days for treatment 15


41 (5 due to patient

choice) Accident and Emergency (maximum 4 hour wait)

473 1,889

Referral to treatment - incomplete (18 weeks)

1,138 3,447

6 Weeks for a diagnostic test

27 69

TOTAL

1,710 5,633

The NHS Constitution states that every patient should be treated safely and receives care within a reasonable period of time. The table above summarises the total number of patients across Northumberland whose NHS constitutional rights were breached due to one of the key access waiting time targets not being achieved.

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Update on performance indicators included in the improvement assessment framework. As reported to JLEB members at last month’s meeting, the CCG received an overall rating of “inadequate” in the NHS England’s assessment of the 2016/17 performance. Although only representing 25% of the assessment criteria, a considerable influence on this overall rating related to the financial position of the CCG. This in turn influenced the leadership rating - representing another 25% of the assessment. This section of the performance report outlines the progress and changes made within the CCG since 2016/17 upon which the assessment was based. Financial position

In recent months the CCG has identified a clear £10 million worth of savings which is considered to be clearly achievable in this financial year (green rated). It is also working on a series of other schemes where potential savings can be realised but as yet need further work to ensure delivery during the year (amber and red rated).

Leadership

The management structure has been reviewed and some staff in senior posts have been replaced with a new team. This includes the replacement of the Accountable Officer, Chief Operating Officer and the Chief Finance Officer. Additional people including personnel recommended by NHS England are now in post to support the staff currently within the CCG.

Non-financial performance

Although a brief summary was provided last month, outlined below is an update on the performance of some of the key indicators that provided a 50% contribution to the overall assessment of the CCG’s performance.

High quality of care – across a range of indicators the performance of the CCG was placed in the upper quartile. Out of a total of 209 CCGs across the country:

• Within acute care the CCG was placed first • Primary care placed 5th (based on strong CQC performance). • 14th for cancer patient experience.

The three main local providers also received an “outstanding” rating for the delivery of services - NUTHFT, NHCFT and NTW.

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Access – The CCG has continued to perform well in terms of accessing services.

• During 2017/18 all children who need early intervention in psychosis have accessed the service within two weeks. (100% performance against a 50% target)

• Despite a dip in performance over the winter months, 95% or more of the Northumberland patients now are being seen or admitted within 4 hours arrival at accident and emergency departments. This level of performance continues to exceed the national average.

• IAPT performance has improved month on month resulting in the achievement of the 50% recovery threshold during 2017/18.

• The waiting time performance against the 18 weeks 92% threshold has consistently exceeded month on month by in excess of 2% (94.4% performance year to date).

• Diagnostic waiting times in excess of 6 weeks performance continue to be delivered well below the 1% national threshold. (0.5% performance year to date).

Cancer – outstanding rating

Despite the performance of the CCG deteriorating slightly below the 62 day threshold for treatment, the CCG has a recovery plan in place. As outlined above in the performance section, NHCFT has received an investment to develop the tracking of patients on the pathway. The CCG, in line with the provider, is expecting to be achieving this target by October 2017.

To support the recovery in performance, the CCG is also reviewing the pathway with the providers in order to detect patients with cancer earlier in the pathway by reviewing access to screening and diagnostic tests.

Since 2012 the CCG has improved its performance in detecting cancers at an early stage. The performance has improved year on year and now exceeds the England average. Although the CCG performance is slightly below the England average, the CCG has also improved its performance year on year for one year survival after the diagnosis of cancer.

Health inequalities

The CCG was placed in the lowest quartile in relation to the indicators associated with this topic – unplanned hospitalisation of chronic ambulatory care sensitive conditions and inequality in avoidable admissions.

The CCG is addressing the improvement through a variety of streams of work including ECIP and Right Care.

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ECIP

Based upon a recent audit of length of stay, the focus is upon the management of frail elderly patients in an attempt to provide support and treatment outside the hospital environment. A series of work streams are in place to review the pathways as many of the patients appear to be within this category. The actions include extending the proportion of alternative dispositions for the ambulance service, reviewing the family choice policy and its enforcement for follow on support after treatment in hospital and providing further support within social care.

Right care

Four streams of work are underway relating to MSK, gastroenterology, cardiology and respiratory to reduce lengths of stay in hospital. This will be achieved by either alternative treatment outside hospital either in the community or within primary care. Alternative pathways to treatment are also being explored relating to the hospital based treatment that will involve shorter stays in hospital – potentially as a day patient as an alternative to longer periods of hospitalisation.

Periodic updates on progress against the integrated assessment framework will be provided periodically, however many of the indicators are produced either quarterly or annually so updates cannot necessarily be provided as frequently as the range of indicators associated with the NHS Constitution framework.

Summary of key actions to improve current performance

Issue Action Lead Date

Ambulance performance Reduce handover delays

NEAS and NHCFT to implement ECIST action plan including reduced conveyance rates and greater use of alternative dispositions. Actions to be overseen by ECIP working group and A&E delivery board

A&E Clinical Director/

Director of Transformation

Ongoing actions

until March 2018

Cancer Performance to consistently exceed minimum target thresholds

Review and implement access policy to enable an offer of earlier appointments including within first week of a referral , collect and monitor median waits (average waiting times)

Cancer Clinical lead and

Performance lead

September

2017

Joint Locality Executive Board 23 August 2017 Agenda Item: 2.4 Quality Report Sponsor: Director of Nursing, Quality and Patient Safety

1 20170823-UC-Item 2.4 Quality Report


Members of the Joint Locality Executive Board are asked to: 1. Consider the latest position regarding key quality indicators for both the CCG and key providers. 2. Consider the actions taken in response to the highlighted exception areas.

Purpose This report details the position regarding the key quality issues for NHS Northumberland Clinical Commissioning Group (CCG) and key Northumberland providers for July 2017. The full quality dashboard has been provided for further information. Strategic Headlines

• The C.Difficile rates are within both monthly and year to date trajectories for the CCG as well as Northumbria Healthcare NHS Foundation Trust (NHCFT) and Newcastle upon Tyne Hospitals NHS Foundation Trust (NUTHFT).

• 10 SIs were reported in May 2017 relating to Northumberland CCG patients, with an increase in incidents reported by NHCFT, with seven Slips/Trips/Falls reported. The number of Slips/Trips/Falls reported has increased each month since April 2017.

• NUTHFT and NTWFT have improved their compliance rates in both two day reporting and 60 day reporting in July 2017, however NHCFT and NEAS remain non-compliant.

• The rate of incidents reported on SIRMS has doubled compared to June 2017, with 77 incidents reported in July 2017.

• Response rates remain below the national and regional average for A&E and inpatients Friends & Family Test (FFT) for both NHCFT and NUTHFT, however A&E response rates have improved for both Trusts.

• North East Ambulance Service (NEAS) sickness absence has increased slightly to 6.49%.

Healthcare Associated Infections (HCAIs) Headlines:

• Provisional figures show that six C.Difficile cases have been reported for May 2017 for the CCG (against a trajectory of seven) bringing the total year to date to 24 against a trajectory of 26.

• C.Difficile cases reported in the year to date are above the number reported at the same

20170823-UC-Item 2.4 Quality Report 2

time last year (an increase of six).

• 18 community cases of C.Difficile have been reported YTD, an increase on last year when 14 had been reported.

• The CCG now has a monthly trajectory for E-Coli cases of 22 and whilst the CCG stayed within trajectory in July, it has breached the year to date trajectory.

• There have been no cases of MRSA reported relating to the CCG. Key Actions:

• All Glutamate Dehydrogenase positive (GDH+) cases have been passed to the appropriate practices in order to add a read code to the patient record.

• The community root cause analysis (RCAs) reports for all of the community C.Difficile cases reported in the year to date are currently being analysed to assess whether there are any themes or trends.

• Given the national ambition to reduce Gram negative bloodstream infections by 50% by March 2021, the CCG has provided initial assurances to both NHS England and NHS Improvement regarding organisational readiness.

• The first HCAI quarterly report for 2017/18 has been included as appendix 2.

C. Difficile The C.Difficile reporting rates remain within the year to date trajectory with 24 cases reported, however the numbers reported in-month have increased slightly from last year. 18 cases of C.Difficile have been reported in the community, with six reported by Providers.

The graphs below also show that the C.Difficile rates per 100,000 for community cases place the CCG below the North East Aggregate year to date.


GDH testing is an initial screening test used to determine the presence of the C.difficile bacteria in the large intestine. Each month, the CCG is informed of any patients who have been tested GDH+ in order that the patients practice can be informed and appropriate action taken. There were 10 GDH+ cases reported in June, two in the Blyth Valley locality, three in Central, four in North and one in the West. MRSA There have been no MRSA cases involving Northumberland CCG patients reported. E.Coli A monthly trajectory has been set for the CCG which currently stands at 22 cases per month. In July, 21 cases of E.Coli were reported for the CCG, however year to date the CCG has breached the trajectory of 88 with 93 cases reported.

Serious Incident Management Headlines:

• In July 2017, the number of SIs reported relating to Northumberland CCG patients increased. An increased SI reporting rate was also seen at NHCFT and NEAS.

• NUTHFT and NTW achieved the 100% compliance in the two day reporting of SIs and also improved in the compliance with 60 day reports. NHCFT and NEAS reported below the compliance rate in both areas in July 2017.

• Slips/Trips/Falls incidents were the most reported SI for the CCG in July 2017, all of which were reported by NHCFT (n=7). The number of Slips/Trips/Falls incidents reported has increased each month from April 2017.

• A further never event was reported by NUTHFT and related to a Newcastle Gateshead CCG patient involving a retained foreign object.


• On 18 July 2017, the National Reporting & Learning System (NRLS) published rolling data to show the number of patient safety incidents reported by Providers. This information will be published each month.

Key Actions:

• As detailed in the June 2017 quality report, NHCFT were requested via the Quality Review Group (QRG) to provide an action plan detailing how they intend to improve compliance rates with the 60 day reporting target. An action plan focussing on processes for falls incidents, which make up the bulk of the Trust SIs, was brought to the July QRG. The Trust informed the group that improvements in management processes had been seen in June 2017 and early July 2017 and therefore performance should show an improvement from the previous quarter. Actions undertaken by the Trust include pieces of work to understand the reasons for the backlog, review of the current process for completion and possible widening of the cohort of root cause analysis (RCA) investigators.

• The decline in reporting compliance for NEAS will be raised at the next SI caseload meeting.

Serious Incidents (SIs) The graph below details the number of SIs reported by the four main providers since July 2016.

The graph below details the total number of SIs reported by the four main providers per month and the number of those reported SIs that were for NCCG to manage.


The table below details the number of reports received in July 2017 for the four main providers. The NECS Clinical Quality Team has regular meetings with the Trust to discuss the open SI caseload.

Reporting Organisation

Reports Received 72 hour Final Actual No. of

Reports Received Relevant to NCCG

Due Received within Deadline

Due Received within Deadline

NUTHFT 2 1 7 5 1

NEASFT 4 3 6 2 0

NTWFT 1 0 10 6 1

NHCFT 13 10 8 3 9


Northumberland CCG SI Caseload The graph below demonstrates the status, as at 11 August 2017, of ongoing SIs that require NCCG sign off by provider.

50 SIs are currently ongoing, of these:

• 22 root cause analysis (RCA) investigation reports are awaited, this includes six which are overdue. The six overdue reports include:

o four RCAs where the reason for the delay is not known. o one RCA that is delayed due to police involvement. o one RCA has been requested and been granted an extension on two occasions.

• 15 SIs are awaiting further information from the Trust • two RCAs are awaiting review prior to listing for panel • 11 are listed for SI panel.

New SIs Received There were 10 new serious incidents reported in July 2017 relating to Northumberland CCG patients:

• NHCFT reported nine SIs, including: o seven falls, two at ward 7 and within general medicine at NSECH, the remaining

five falls occurred on Ward 02 (Blyth Community Hospital), Ward 04 (HGH), Ward 15 (NTGH), Ward 04 (Wansbeck) and Geriatric Medicine (Whalton Unit).

o one pressure ulcer at Ward 1 (NSECH). o one maternity/obstetric incident at the Birthing Centre (NSECH).

• NTW reported one Unexpected/Avoidable Death in Community Services.


The new incidents will be investigated by the reporting Trust and will be considered for closure by the CCG SI Panel on receipt of the root cause analysis investigation report; they will then be reported to JLEB in due course. SI Performance Trust performance against the requirements of the NHS England SI Framework is monitored on a monthly and quarterly basis and is included in the Local Quality Requirements (LQR) of the provider contract. Performance against these measures is discussed at each Trust QRG and at the 1:1 caseload meetings with Trust operational clinical quality teams. Providers are expected to ensure that:

• 100% of SIs are reported within two days of identification, and; • 100% of SI RCA final investigation reports are submitted to commissioners within 60

days of reporting. The table below highlights the Trust performance in July 2017 and is compared to June 2017. Trust 2-Day Reporting % 60 Day Reporting % NuTHFT 100% 71% NEASFT 25% 33%

NTWFT 100% 60%

NHCFT 85% 38% Never Events One never event was reported in July 2017 by NUTH involving a retained foreign object. SIRMS Incident Reporting Headlines:

• The reporting of incidents on SIRMS increased in July 2017, with 77 incidents reported compared to 39 in June 2017.

• Incidents regarding 2 week wait referrals, particularly into Hexham General Hospital Plastic Surgery have increased in June 2017.

• The number of discharge issue incidents increased significantly including incidents where discharge had been delayed as there was no sufficient care provision for patients in the community.

Key Actions:

• The quality team is currently working with the Service Development Manager to review the incidents regarding the 2 week wait referrals.

• The GP practices who have reported discharge issues at Alnwick Infirmary have been contacted for further information to aid investigation.


• Following liaison with social care colleagues, in particular the Head of Service - Care Management, incidents relating to the delayed discharge of patients who required care provision were reviewed by the Senior Manager of Transformation. Lessons learned were identified in these incidents particularly around communication and responsibilities within Social Care and the Hospital to Home teams. Senior Managers are now implementing an action plan to ensure communication improvements moving forward.

The graph below demonstrates the level of reporting by Northumberland practices; 583 incidents were reported between July 2016 and July 2017. The data detailed in the graph is divided in to internal (practice) and external (provider) incidents. When comparing the data from July 2017 with the same month last year there is a 57% increase in the number of incidents reported. The increase in SIRMS incidents is mainly due to the 2 week wait referral issues relating to Plastic Surgery at Hexham General Hospital and an increased number of discharge issues reported. The discharge issues highlighted an increase in incidents reported at Alnwick Infirmary.

The top incident types reported by Northumberland practices between July 2016 and July 2017 are detailed in the graph below.


In Q1 2017/18:

• 129 incidents were reported by Northumberland GP Practices; this demonstrates a very slight decrease from Q4 2016/17 when 132 incidents were reported.

• When compared to Q1 2016/17 there has been a 17% decrease in the number of incidents reported.

• The number of incidents reported by locality are; Blyth Valley (n=28), Central (n=15), North (n=41) and West (n=45).

• 27 internal GP practice incidents were reported. • 51% of provider incidents related to NHCFT.

National Reporting & Learning System (NRLS) Monthly Reports In response to a number of requests for more public NRLS data, from 18 July 2017, NRLS has begun to publish monthly data by reporting organisation on the number of incidents reported to NRLS. This report provides timely organisational data on reporting to NRLS, promotes data transparency, encourages changes in reporting patterns and supports organisations to monitor potential under-reporting of incidents. These reports will be triangulated alongside other intelligence such as Safety Thermometer. Any issues with falling rates of reporting will be raised at the Trusts’ QRGs. NHCFT


NUTHFT

NTW

NEAS

Please note, the NEAS report shows that no incidents were reported in June 2017 to NRLS by the Trust. The Head of Clinical Care and Patient Safety at NEAS has confirmed that the Trust has encountered problems with the link failing at the receiving end when incidents are being reported. The Trust is liaising with NRLS to find a solution. Mortality The latest reporting period (January 2017 – Provisional) shows:

• NHCFT and NUTHFT were both reported as being more than two standard deviations away from their expected rate for the Hospital Standardised Mortality Ration (HSMR),


although this is not deemed to be statistically significant. There were no immediate issues reported for either trust.

Key Actions:

• Mortality is a standing agenda item at the Quality Surveillance Group (QSG) and the Quality Review Groups (QRG) of each provider.

Safety Thermometer Headlines:

• NHCFT has risen to above national average for all pressure ulcers. An upward trend in reporting of these types of incidents has been seen in the last 12 months.

• NHCFT gave an update on pressure ulcers at the QRG in May 2017 which was included in the June 2017 quality report. Further assurance will be given at the next QRG in September 2017.

• NUTHFT remain above the national average in reported new pressure ulcers, however the numbers have reduced from May 2017.

Key Actions:

• Performance exceptions on the Safety Thermometer continue to be challenged at the respective providers QRGs.

• Data on pressure ulcers and falls is triangulated between safety thermometer performance and SIRMS/SI reporting to determine whether there are any areas on which the CCG should focus for further assurance.

The NHS Safety Thermometer allows teams to measure harm and the proportion of patients that are ‘harm free’ from pressure ulcers, falls, urine infections (UTI) and venous thromboembolism (VTE) during their working day. This is a point of care survey carried out on 100% of patients on the last Thursday of each month. NHCFT survey an average of 1766 patient per month, NUTH survey an average of 2721 patients per month and NTW survey significantly less than the acute trusts – around 275 per month. Pressure Ulcers


Falls with Harm Venous Thromboembolism (VTE)

Urinary Tract Infections (UTIs) Maternity Safety Thermometer (NHCFT)

Friends & Family Test (FFT) Headlines:

• Response rates remain well below the national and regional average inpatients for both NHCFT and NUTHFT.

• Although the A&E responses rates remain below the national average for both Trusts, there has been an improvement reported in June 2017.

• NTW has continued to improve its percentage recommended for Mental Health and reported on par with the national average of 88% in June 2017.

• NEAS continue to achieve higher than the national average for both Patient Transport Services (PTS) and See & Treat.

Action on FFT:

• The CCG continue to request and receive robust assurances of the quality of the overall patient experience programmes in place across providers.

• Performance exceptions on the patient and staff FFT continue to be challenged at the respective providers QRGs.

NHCFT The following exceptions were reported for NHCFT:


• Inpatient response rate: Overall the Trust’s combined score of 19.2% continues to remain below the England average of 26%, however this has improved since April 2017.

• A&E percentage response rate: In April 2017, the Trust’s score improved to 7.3%. • Outpatient percentage recommended rate: The Trust has fallen very slightly below

the national average with 93%.

NUTHFT The following exceptions were reported for at NUTHFT:

• Inpatient response rate: The Trust reported a score of 15.2 which remains below the England average of 26%.

• A&E percentage response rates: The Trust score has improved to 10.9%. This is the highest reported response rate from the Trust in the last 12 months.

Workforce Headlines:

• Work continues at NEAS to recruit qualified paramedics to fill the additional 42 WTE.

Actions:

• A recent ‘Speed Dating’ exercise resulted in conditional offers being made to 41 students.

• Recruitment of sessional GPs to the Clinical Hub continues to be challenging and a range of approaches are being taken to attract colleagues.

Safer Staffing Each provider QRG regularly receives information on safer staffing strategies and performance. This information is also used to triangulate with incident data. NHCFT The Trust Q1 Safer Staffing report has been requested for the QRG in September 2017. An update has also been requested which describes the progress being made on any work currently underway to triangulate any identified staffing issues with indicators of potential quality concerns. NEAS The most recent sickness absence figures (June 2017) for NEAS show that the Trust sickness rate has increased slightly to 6.49%. As this is still above the 5% target set by the Trust, all managers along with advice and guidance from the HR team have been asked to prioritise all aspects of absence management in an effort to bring the absence rate much closer to the target rate during the next 12 months.


A detailed action plan has been agreed which will be monitored over the year at Executive Team level. Alerts NHCFT has been asked to provide details of its CAS alerts implementation process and compliance status (with the focus on the alerts with which the Trust is non-compliant) at the next QRG in September 2017. In particular, an update is requested for an alert which the Trust was due to be compliant with by June 2017 – Restricted use of open systems for injectable medication (NHS/PSA/D/2016/008). Commissioner Assurance Visit – Ingram Ward Following a number of concerns raised by a patient’s family regarding the environment on Ingram ward, a visit was conducted on 24 July 2017. The CCG recommended a number of actions to NTW in relation to patient experience, facilities and the environment. The CCG has written to the family regarding the summary of the findings and the conversation with and recommendations made to NTW. The Trust will be considering what reasonable measures could be taken to improve the environment of this temporary accommodation, and involved the family in the plan. Safeguarding (Adults, Children and Looked After Children) Headlines

• The CCG safeguarding team continues to work with partner agencies to provide hospital based Health Domestic Abuse Advocates across the Northumbria Police Force area with funding provided by the Police and Crime Commissioner (PCC). Northumberland and North Tyneside are working jointly to place the posts within Northumbria Specialist Emergency Care Hospital’s (NSECH) A&E, gynaecology and maternity services. NHCFT has agreed for a safeguarding team member to be seconded in to the position in order to begin to roll out the project while the recruitment process is on-going.

• A multi-agency audit of neglect cases is underway. The designated nurse and named GP are reviewing five cases with GP practices.

Case Reviews

• The CCG is currently participating with two on-going Domestic Homicide Reviews (DHRs). There has been no change since last report.

• The ‘Molly’ Serious Case Review was published on Northumberland Safeguarding Children Board’s website on the 10 August 2017. It is planned for an alert to be circulated in the weekly bulletin following publication containing a brief presentation, a hyperlink to the report and the recommendations for primary care. The designated nurse


will undertake a follow up audit to ensure the recommendations have been actioned and evidence learning has taken place.

Assurance CCG NHS England has sought assurance from CCGs that there is a statement in place regarding modern slavery and trafficking. This is a legislative requirement under The Modern Slavery Act 2015. The statement has been prepared and displayed on the CCG’s website. To seek further assurance, the designated nurse has approached both NHCFT and NTW regarding the same issue and has received assurance and evidence from both that this has been actioned.

Looked After Children (LAC) Annual Report Action Plan The LAC annual report was discussed at the request of the Corporate Parenting Committee Advisory Group at the meeting held 9 August 2017. Providers The Quality and Patient Safety Team have been actively involved in seeking quarterly assurance from Providers. This is received using an agreed template. Organisation leads are invited to present these at the CCG Safeguarding Work Stream. This provides an opportunity for the CCG to challenge any concerns identified and allows the provider to seek appropriate support from the CCG. To date, NHCFT and NTW have presented their reports. It has been agreed to accept NEAS assurance via the NEAS Strategic Safeguarding Committee which the designated nurse is invited to attend. The NEAS assurance report has also been received. NHCFT The Designated Nurse is a member of the internal safeguarding committee. Assurance reports for adult safeguarding are presented there and any areas for concern added to the NHCFT’s risk register. The Q1 report for 2017/18 has been received, with no major areas of concern identified via the safeguarding assurance template. The Trust is monitoring its safeguarding children training figures (Level 2 and Level 3) closely. NTW The Q1 report for 2017/18 has been received. No areas of concern have been identified via the safeguarding assurance template. NEAS The Q1 report for 2017/18 has been received. The new safeguarding posts will be in place September 2017 and interim arrangements remain in place until that time. Appendix 1: Northumberland CCG Quality Dashboard August 2017 (June/July Data) Appendix 2: Healthcare Associated Infections (HCAI) Q1 2017-2018

Joint Locality Executive Board 23 August 2017 Agenda Item: 2.6 Assurance Framework and Risk Register Sponsor: Strategic Head of Corporate Affairs

1 20170823 Item 2.6 Assurance Framework and Corporate Risk Register


Members of the Joint Locality Executive Board are asked to: 1. Undertake the quarterly review of the CCG’s assurance framework and

corporate risk register. 2. Approve new Strategic Risk 1894. Purpose This report constitutes the Joint Locality Executive Board (JLEB) quarterly risk update. Introduction This report provides the current risk status of NHS Northumberland Clinical Commissioning Group (CCG) and outlines risk management progress since the last report taken by JLEB in May 2017. Joint Locality Executive Board responsibility JLEB is responsible for assuring the CCG that risks are appropriately managed and consequently consider the assurance framework and corporate risk register on a quarterly basis (it is also a standing agenda item at the bi-monthly Governance Group). Members are required to consider all strategic risks on the assurance framework, together with operational risks on the corporate risk register above the JLEB Risk Tolerance Line (RTL) (set at a risk rating of 12 and above). A risk distribution matrix (Appendix 1) will be presented by the Strategic Head of Corporate Affairs to focus JLEB risk discussions on the most important areas of strategic and operational risk. As a guide to assessing CCG risk, the risk matrix, as detailed in the approved Risk Management Policy, is reproduced below:


Likelihood score Consequence score 1 2 3 4 5

Rare Unlikely Possible Likely Almost certain

5 Catastrophic 5 10 15 20 25

4 Major 4 8 12 16 20 3 Moderate 3 6 9 12 15 2 Minor 2 4 6 8 10 1 Negligible 1 2 3 4 5

Scoring = Consequence x Likelihood (C x L) Audit Committee responsibility The Audit Committee is required, under its terms of reference, to report to the Governing Body annually on its work in support of the Annual Governance Statement, specifically commenting on the fitness for purpose of the Assurance Framework, the completeness and embeddedness of risk management in the organisation and the integration of governance arrangements. The Audit committee consider risk quarterly after JLEB and are presented with the JLEB paper and minutes for assurance purposes. Development of Assurance Framework and Risk Register SIRMS has been updated as follows:

• Full audit of outstanding actions. • Recent leadership changes reflected.

Assurance Framework The assurance framework for 2017-18 (Appendix 2) incorporates the CCG’s strategic plan and corporate objectives. Its purpose is to:

• Identify the strategic risks to the delivery of the CCG’s corporate objectives. • Identify the controls and assurances in place. • Identify and manage any gaps in controls and assurance.

The assurance framework drives the internal audit plan and associated outcomes are detailed in the relevant section of both the assurance framework and the corporate risk register.


The assurance framework has been regularly reviewed by the risk owners and the Strategic Head of Corporate Affairs. There are 16 risks above the RTL (no overall change since May 2017) with the following key movements: Risk No Title Movement 1801 ACO – Additional mitigation - ACO

transition plan to be fully implemented

1506 Strategic Partnerships – ACO delays impacting on contracting relationship with NHCFT and NTW

1800 Strategic Commissioning – Robust governance structure – JLEB have approved the proposed governance – constitution to be amended

399 CHC Cost Growth – Reduced budget agreed for 2017/18 resulting in QIPP savings – further work being undertaken to highlight additional integration opportunities

1191 Commissioning Support Services – Improved performance overall

Although the assurance framework printout is in current risk rating descending order, JLEB should note that the inherent risk (the initial risk rating) is equally important on the assurance framework and therefore should consider all risks in this respect. All risks and associated actions are in date for review. Risk Register The corporate risk register (Appendix 3) lists operational risks above the JLEB RTL and has been regularly reviewed by the risk owners. The complete risk register is reviewed by the Strategic Head of Corporate Affairs and risk owners as required, on a monthly basis. There are now 10 risks (an overall increase of one) identified on the corporate risk register that are above the JLEB RTL with the following key movements:


Risk No Title Movement 405 Staffing Levels – Staff leaving the CCG.

Mitigations remain in place – regular staff briefings on ACO and strategic CCG progress and daily line management.

1504 PCCC – Conflicts of Interest (COI) – Committee members do not register all COIs – additional guidance circulated

1447 Low Acuity Activity – Non elective activity results in cost pressures – Whole system action plan being implemented

All risks and associated actions are in date for review. New Risks/Closed Risks There is one new strategic risk (Appendix 4 refers) and no new operational risks above the JLEB RTL. No risks have been closed. There are now 42 risks experienced by the CCG (an increase of one overall since February 2017). Further Work The next quarter will see the Strategic Head of Corporate Affairs working closely with the Director of Finance and the PMO construct to ensure that there is an appropriate risk escalation route from the CCG’s QIPP tracker to the corporate risk register. Recommendation JLEB is asked to review the Assurance Framework and Corporate Risk Register and, approve the new strategic risk. Appendix 1 – Risk Distribution Matrix Appendix 2 – Assurance Framework Appendix 3 – Operational risks above the JLEB RTL Appendix 4 - New Risks

Northumberland CCG - Risk Analysis on a page

Consequence/ Severity

Rare 1

Unlikely 2

Possible 3

Likely 4

Almost Certain 5

Likelihood

Catastrophic 5

Major 4

Moderate 3

Minor 2

Negligble 1

744, 1190

1064, 1374, 1800, 1470, 399

1181, 1492, 1797, 1798, 1446, 451, 407, 401, 1504, 1385, 1447, 1856, 403, 1503, 1435, 1506, 1894

1799, 1505, 1801, 405

1444, 1390, 1178, 946, 945

1027, 1191, 1507

1332, 733, 805, 1508

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Assurance Framework 17/08/2017

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1178

David Shovlin

System Resilienceand EscalationPlanning

There is a risk that alack of robustplanning for surges indemand for frontlineservices throughoutthe year, mean thaturgent andemergency carepressures increase,resulting in rises inA&E activity andmultiple demands onambulance,community, acute andprimary care services

This could lead toinsufficient resourcebeing available,potentially resultingin increased CCGcosts due toduplication of servicedelivery andinsufficient capacityto meet demand andan inability to meetnational targets (4hour A&E, 18 weeksRTT and ambulanceperformance). Thiswill lead to impact onorganisationalperformance atprovider level andreputational impacton the CCG

5 5 25 Emergency careindependent reviewactions delivered bySystem wide ChiefOfficer group withindependent chair

JLEB reportingR&P reporting

A&E DeliveryBoardUrgent andEmergencyCare network

Although ChiefOfficer levelmeetings held andactions agreed,performancepressures remain.

Internal Audit onEmergency Planningand BusinessContinuityManagement -Significant AssuranceOctober 2016

Internal Audit

A&E Delivery Boardchaired by NHCFTCEO - delivering 5mandated areas

All CCG boardsreceive regularupdates.

Urgent andEmergencyCare NetworkRegional A&EDelivery BoardChairs GroupHWBB scrutinyOSC scrutiny

Unprecendenteddemand hasresulted in higherescalation levelsunable to be fullymitigated.

NHCFT and NEASlack of ECIPprogresse

NHS I and NHS Einvolvement insystem wide deliveryplans

System wideaction plandelivery

10/12/2017SiobhanBrown

Low acuity activitymanagementaction plan beingdeveloped.


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Mike Robson

Contract overperformance

There is a risk ofover-activity, beyondthe CCG's control, onacute/secondary carecontracts, whichcould ultimately leadto the provision ofinadequate patientcare pathways whichwould necessitatecorrective actionbeing taken.

This would result inincreased CCGfinancial pressureand reputationaldamage to the CCG.

5 5 25 Monthly monitoring ofcontracts in year andraising any issueswith the FT's inaccordance with ouragreed timetable -orvia commissioningarrangements asassociate.

Minutes ofcontractmeetings andissue logsmaintainedR&P reportingJLEB reporting

ContractMonitoring IAJanuary 2017 -SignificantAssuranceKey FinancialControls IAApril 2017-SignificantAssurance)

Decreased CCGleverage to imposepenalities causedby STP and STFsign up.

Internal auditreview on contractmonitoringscheduled for2017/18QIPP Internal AuditScheduled for2017/18, QualityInternal Auditscheduled for2017/18

Monthly internalcontract reviewmeetings invovlingfinance team andheads ofcommissioning,quality team, andlocality managers.Outcome of whichfeeds into providercontract monitoringmeetings.

Issue logmaintained

NHSI requirementfor FT to meetsignificant controltotal negatespotential to workwith CCG toreduce activity.

Signed Service LevelAgreements in placewith all providerswhich specify financeand activity plans.

Report oncontractsoverviewpresented toResource &PerformanceCommittee inMay 2016

NHSI requirementfor FT to meetsignificant controltotal negatespotential to workwith CCG toreduce activity.

Monthly monitoringmethods set up:Finance Groupmeeting, Activity

Finance groupreview offinancialpressures and

/ /

Development ofan alternativecommissioningarrangement toACO development(Plan B)


Fully introduceand embed newgovernancestructure forfinance review.

30/09/2017Mike Robson

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PlanningAssumptions,NSECH workinggoup, contractanalysis of larger andsmaller contracts tofeed into 14 workingday meeting

QIPP delivery

Finance groupintroduced to reviewfinancial performanceincluding QIPPdelivery.

Action log sentout to allattendees andmaintained.

Finance group notfully operationalwith risks identifiedand escalated.

System wideFinancial recoverydeveloped to movethe CCG from 1%deficit back intosurplus in futureyears.

FRP discussed,reviewed andchangedapprovedthroughGoverning body.

NHS EnglandArea teamexternalassurance overRecovery plan.PWC Externalreviewhighlightedgoodgovernanaceand financialstewardship.

The FRP has beendeveloped it nowneed to bedelivered.

Project managementoffice put in place tohelp monitor andimplement financialrecovery plan. Reporton risks andmitigation to NHSEngland.

CCG financegroup along withPMO board toimplement QIPPschemes

NHSEreviewing risksand mitigationsof the CCG ona monthlybasis.

Activity ManagementReview - Agreeingover performingareas with the maintrust and agreeing aplan to targetreductions inidentified areas.

Targeted areasare monitored toensure that weare seeing theactivitymanagementeffect comingthrough thesource data.

946

Mike Robson

Financial Balance ACO does notprogress and there isa risk that themedium termfinancial plan(including delivery ofQIPP) will beadversely affected bycontract performanceleading to a failure toachieve financialbalance and a breachof statutory duty. Thiswould result inreduced funds forfuture improvementsto patient outcomesand NHS Englandrevoking the CCG'scommissioning

Leading to increasedfinancial pressureand reputationaldamage to the CCG

5 5 25 1. Monthly financialclose down withreview of positionagainst budgets andmonthly board report.

Detailed reviewof financialposition andforecasts takenplace with CFO,every month.YTD ledger andpurchase ordershave beencorrected,detailed work onledger has beenundertaken andwill be ongoing.Working papersupdated eachmonth in detail.

Internal Auditreview -contractmonitoring(March 16 -significantassurance).Internal Auditreview -medicinesmanagement(Mar 15 -significantassurance)

Lack of detailedimplementationplans andsignificantunidentified QIPPs.

QIPP internal auditscheduled for2017/18

2. Procedure noteswritten and

Internal Auditreview - key

Lack of detailedimplementation

Joint QIPP/CIP tobe developed withTrust.

31/08/2017RichardTurnbull

PMO reviewInitiated, Highintensityworkshopscommenced todetailimplementationplans.

31/08/2017Mike Robson

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authority. month-end checklistis used each month.

financialcontrols (Apr16 - significantassurance)

plans andsignificantunidentified QIPPs.

3. Detailed review ofgeneral ledger andupdate workingpapers

Updated reviewof general ledger- transactionsand trial balance.This in ongoingand undertakenon a regularbasis andreviewed in detailat month end.Working paperscompleted aspart ofmonth-endclosedown.


4. Issue of monthlybudget reports viaBusiness Intelligenceand discussion withbudget managers

Regulardiscussions withbudget managerson financeposition withintheir domains.


QIPP delivery planbeing developedjointly with FT as partof ACO development.Project managementoffice establishedafter recommendationin PWC report,tasked with deliveringthe recovery plan.

FRP discussed,reviewed andapprovedthroughgoverning body.

NHS EnglandArea teamexternalassurance overRecovery plan.PwC externalassurancereport.

FRP still needs tobe delivered inorder for the CCGto return to mediumterm financialbalance within theCCG allocation.

Key FinancialControls InternalAudit

NOR 1516/15Key FinancialControlsInternal Auditreport -significantassurance withno issues ofnote

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Siobhan Brown

ServiceCommissioning

There is a risk thatthe CCG fails tocommission the righthigh quality, costeffective services tomeet the needs of thepopulation it serves.

This could result inpoor healthoutcomes, increasedpressure across theNorthumberlandhealth economy andassociated financialpressure andreputational damageto the CCG.

5 4 20 Adherence to theNHS ConstitutionalStandards

JLEBPerformanceReport andminutes

NHS Englandassurance

Adherence to the '9must do principles'

JLEBperformancereport andminutes


2017/18 operationalplan - incorporatingthe joint FRP withNHCFT

JLEB andGoverning Body

NHS Englandquarterlyassurance andlegal directionsmeetings,StrategicPlanningInternal Audit

Implement ACOtransition plan


Develop 2018/19CommissioningStrategy


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New ACOorganisational form


ACOdevelopmentboardNHS E, NHS Inew models ofcare team

Transition periodcontinues with finaldecisionsoutstanding. Tightcontracting rounddeadlines

IntegratedAssessmentFramework


NHS EnglandQuarterlyassurancemeetings

SystemTransformation Board


Health andWellbeingBoardNHS England

CommissioningStrategy 2018/19

JLEB Internal AuditNHS E

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Siobhan Brown

ACO There is a risk thatthe transfer ofdesignatedresponsibilities to theACO is not supportedby a comprehensivetransition plan. Thiscould result inperiods of uncertaintyfor CCG and NHCFTstaff, disengagementof CCG memberpractices and aninability to conductareas of normal CCGbusiness effectively.

Leading to anineffective ACO onstart-up, CCGmember lack ofconfidence in theACO construct andreputational damageto the CCG.

4 5 20 ACO transition plan JLEB reportingGB reportingACO stakeholderboard

NHS EnglandNHSImprovement

ACO transitionplan to be fullyimplemented


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1181

Graham Syers

Prescribing There is a risk thatpoor qualityprescribing or drugshortages could leadto patient safety andexperience issuesand unnecessaryprecribing costs.

This could ultimatelyresult in reputationaldamage, legalchallenge andunsustainableprescribing costgrowth to the CCG.

4 4 16 NECS horizonscanning documentsand cost growthprojections.

The MedicinesOptimisationGroup evaluatesregular NECSreports andaction plans areproduced asnecessary.

Internal auditreview onmedicinesmanagement(16/17 -significantassurance).Service AuditorReport fromPwC on NHSBSAPrescriptionsPaymentsProcess2016/17.

The Department ofHealth sometimesconsults with thePharmaceuticalServicesNegotiatingCommittee toadjust the amountcommissioners payto pharmacies.This can result inadjustment ofCategory M(generic drugs)prices the CCGpay which cannegatively impactdrug spend. Thesechanges aredifficult toanticipate.

QIPP precribingplanning.

MOG membersmonitor of QIPPaction planprogressmonthly.CCG 14 daymeeting monitors

JLEB monitorQIPP progressmonthly

NHSE monitorQIPP progresswith COO andCFO.

NECS MedicineManagementFunction

MedicinesOptimisationGroup

Proposed introductionof OptimiseRx - thissystem suggest themost cost and qualityeffective drug at thepoint of prescription.This allowsalternative medicationto be suggested whenthere are knownshortages.

The system willbe monitoredquarterly by theMedicinesOptimisationGroup

OptimiseRxintroduced Jun 16and data monitoredon a monthly basis

MedicinesOptimisationGroup (MOG)consider monthlydata. MOG minutesconsidered byJLEB

Internal Audit onMedicinesOptimisationNovember 2016

SubstantialAssurance

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Siobhan Brown

Provider Delivery There is a risk thatproviders fail to meetkey performanceoutcomes and ceaseoperations leading tocompromised patientcare and the CCGhaving to introducepotentially expensiveshort term measuresin response. NHSEngland couldrevoke the CCG'scommissioningauthority if foundnegligent.

This could lead toincreased financialpressure andreputational damageto the CCG

4 4 16 Signed contracts inplace with allproviders.NECS provide amonthly report forsmaller providerscovering finance andperformance.

R&P reportingJLEB reporting

Non FinancialPerformanceManagement IAMarch 2016 -SignificantAssurance.QualityMonitoring andImprovement IAMarch 2016 -SignificantAssuranceNHS EnglandQuarterlyRview updates

Currentperformanceissues with NEASand CYPS. Not allprovider contractssigned

Monthly performancereports to JLEB

NHS Englandquarterly assurancemeetings & monthlyfinancial recoverypack, highlightingrisks the CCG isfacing.

Minutes of AreaTeam meetings

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Mike Robson

National and localagreed outcomes

There is a risk thatthe CCG falls belowthe IntegratedAssessmentFramework targetsand fails to identifyand address qualityissues in services orproviders or providersfail to provide therequisite informationto enable effectivemonitoring ofperformance, leadingto compromisedpatient care and aloss of income fromthe CCG's qualitypremium

This could result inderogated patientcare, increasedreputational risk andfinancial pressure tothe CCG andultimately NHSEngland revoking theCCG'scommissioningauthority.

4 4 16 Signed contracts inplace with allproviders with paperdetailing all signedcontracts presentedon an annual basis toResource &PerformanceCommittee

Minutes ofResources &PerformanceCommittee.Minutes of JLEB.

ContractMonitoring IA(Jan 17) -SignificantAssurancewith no issuesof note.Key FinancialControls IA(Apr 17) -SignificantAssurance withno issues ofnote.Qualitymonitoring &improvement IA- SignificantAssurance withno issues ofnote.

Contracts withNHFT and NTWaren't yet signeddue to the ACOprocess.

Regional escalationprocess if requredwhere outcomes notbeing met

Minutes ofResources &PerformanceCommitteeMinutes of JLEB

RegionalQualitySurveillanceGroup.

Action Plan in placewith NEAS.

Exceptionreporting isprovided to JLEBvia the QualityReport.

Progressagainst actionplan ismonitored byNEAS 999contract reviewmeeting andQRG (qualityimpact).

Monthly performance Minutes of

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reports to Resource& PerformanceCommittee

Resource andPerformanceCommittee

Bi-monthly domainspecific report toResource &PerformanceCommittee

Minutes ofResource &PerformanceCommittee

Area Team quarterlyassurance meetings

Minutes ofResource &PerformanceCommitteeMinutes of JLEB

QRGs in place Minutes ofResource &PerformanceCommittee

Programme ofunannounced visits toproviders, theoutcome of which arereported to QualityIntelligence Group.

Minutes ofQualityIntelligenceGroup

HCAI root causeanalysis undertakenmonthly by HCAIclinical domain lead

HCAI bi monthlyworkstreammeetingconsiders rootcause analysis

HCAI recovery plan HCAI workstreammeeting

CCG quarterlyassurancemeeting.

RAIDR informationvalidated by NECS.

ECIP action plan CCG boardupdates

A&E deliveryboardHWBBUrgent andEmergencyCare network

Integrated AssuranceFramework

Monthly report toJLEB

Progressreviewmeetings withNHSE localarea team.

401

Siobhan Brown

StakeholderEngagement

There is a risk that alack of appropriateengagement with keystakeholders,including the publicand patients, willmean that the CCGwill fail to takefeedback andevidence intoaccount whendesigning andcommissioning newservices.

This could result inpotential legalchallenge, deliveredservices not meetingpatient expectationsand diminishing carequality that ultimatelyaffects the CCG'sreputation.

4 4 16 Locality patientgroups in place toreview and informCCG work.

Notes frompatient groups.

PatientExperience IAApril 2017SubstantialAssurance

Participation in Healthand Wellbeing Boardincluding theengagementsub-group.

Communications andengagement strategy.

JLEB provideassurance thatthe CCG has an

Internal auditreviews: Patient

EPC action planto include VCDFreplacementproposal

29/09/2017StephenYoung

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appropriatestrategy Evaluation ofengagementevents.Comms andengagementaction plan.JLEBreview thecomms andengagementstrategy workplanon a regularbasis

ExperienceInternal AuditApril 2017 -SubstantialAssurance

Internal Audit onHealth and WellbeingBoard

Internal Auditreport onHealth andWellbeingBoard

FRP engagementrequirementsassessed as projectsdevelop in 2017/18

JLEB monitoring Internal Auditon patientexperience inApril 2017 -SubstantialAssurance

CCG Wide PatientForums take placeevery 6 months

Reports frompatient forumengagementsessions

Internal Auditon ClinicalEngagement2016/17significantassurance,Internal Auditon Patient andPublicInvolvement2015/16Significantassurance

Vanguard Co DesignForums

Notes andReports fromMeetings

STP and ACOcontinuedengagement

JLEB reporting Internal Audit

2016/17 patientexperience IASubstantialAssurance

SystemTransformationengagement

SystemTransformationBoard

Internal Audit VCDF replacementforum yet to befully determined

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1385

Annie Topping

Deprivation of LibertySafeguards (DOLS).

Due to a SupremeCourt ruling that hassignificantly loweredthe threshold fordeprivation of libertythere is a risk thatmany people whonow receive healthfunded care at homewill needauthorisation from thecourt of protectionwhich the CCG arerequired to consider.The CCG couldeither fail to considerand deprive libertyunlawfully or makean incorrectjudgement.

This could lead to arisk of legalchallenge resulting inboth reputational andfinancial damage tothe CCG andincreased care costsoverall.

4 4 16 Training package toraise staff awarenessof the Supreme CourtRuling 'CheshireWest' implications,provided by theLearningDevelopement UnitNorthumbria.Training attendancesheets completed andforwarded to thequality and patientsafety team followingall bespoke singleagency MCA/DOL'Straining delivered bythe LDU to CCG andPrimary Care staff.

Annual CCGtraining auditreported to QIG.Exceptionreporting toJLEB.

Potentially staffunwilling to engagewith training.

lA/CHC team toidentify potentialcases which need tobe referred torelevant SupervisoryBody for DOL'S, andestablish baseline.

LA DOL'sDashoard reportdiscussed at theSafeguardingWorkstream.

Quarterly CHCreports andcommissioningteammonitoring andassurance. DOL'SDashboardreported toNSAB/Performanceand Govenancesub group.

Baseline yet to bedetermined

LA/CHC team toidentify potentialcases of deprivationof liberty that needauthorisation from theCourt of Protection.

Assurancesought from LA atthe NSABPerformance andGovenance subgroup Sept 2016re currentposition ofjudicial DOL's.

Quarterly CHCreports andcommissioningteammonitoring andassurance.LA to providefurther trainingto social carestaff and raiseawareness.

Baseline yet to bedetermined

LA/CHC Team toreview care packagesof ContinuingHealthcare fundedpatients within theirown homes,independantsupported living orfoster/adultplacements.

To reviewcases andpackages ofcare to exploreless restrictiveways ofdelivering careto negate therisk of adeprivation ofliberty occuring.

Not sure that thisis happening at thepresent time.

CCG Deprivation ofLiberty Safeguards(DOL'S) Policy

GovenanceGroup policyapproval.DOL'S Policy willgive clearguidance andinstruction to

Internal Audit -Deprivation ofLiberty -2016/17Substantialassurance

CCG staff will workwith the LA toaddress gaps indata provision anddevelop a plan ofaction. This will

To undertake anaudit ofMCA/DOL'Straining accessedby CCG andPrimary Care staff

30/09/2017Fiona Kane

LA/ContinuingHealthcare Teamto review theircaselaod toidentify whichpatients meet 'theacid test' andtherefore requirereferral to relevantSupervisory Bodyfor DOL'S orauthorisation fromthe Court ofProtection.


LA /ContinuingHealthcare Teamto review carepackages of CHCfunded patients,independantsupported living orfoster/adultplacements. Toexplore lessrestrictive ways ofdelivering care tonegate the risk ofa deprivation ofliberty occurring.


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CCG staff. involveunderstanding anybarriers to datacollection/provisionand agreeingactions to resolvethis.It is theresponsibility of theLocal Authority toreport on thenumber of patientsfor whom DoLSwere not put inplace in line withrequiredtimescales. Thisinformation isprovided in theDoLS quarterlyassurance report tothe Performanceand GovernanceNSAB sub group.

1856

Siobhan Brown

Conflict of Interest There is a risk thatthe CCG fails toadequately manageconflicts of interests.This could result inthe inability to deliverCCG objectives in acost effective, openand transparent way.

This would lead topotential legalchallenges andreputational damageto the CCG.

4 5 20 CCG Policy C019Standards ofBusiness Conductand Declarations ofInterest

Audit Committee Internal Audit

Declarations ofConflict of Interest

Audit Committeereviews thedeclarations ofinterestsregisters on a 6monthly basis

There may besome gaps if not allinterests havebeen declared

Conflicts of interestself assurancereturns to NHSEngland on a 6monthly basis


Conflicts of InterestGuardian in place

Conflicts of InterestInternal Audit

Internal AuditReport

COI register updatedto reflect revisedguidance (morecomprehensive)

Audit Committee Internal Audit

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Alistair Blair

CCG memberengagement

There is a risk that afailure to engage theCCG's membershipmeans that vitalintelligence is nottaken into accountwhen developingfuture deliverystrategy.

This could result inservices not beingevidence based ormeeting patientneeds, legalchallenge,reputational damageand memberpractices leaving theCCG, ultimatelyleading to the breakup of the CCG.

4 4 16 Communications andengagement strategy.

JLEB monitoringof CCG strategy

Stakeholder360 Survey.Internal auditreport onstrategicplanning(2016/17 -significantassurance)

CCG centrallyco-ordinates LocalityDirector briefingnotes to ensurecommon messagingfrom the JLEB andfrom members backto JLEB

Locality Meetingminutes

Monthly localitymeetings with CCGdirectorrepresentation

Locality meetingkey pointsdiscussed atBMM andadditionalguidance/feedback provided asrequired.

Bi-annual membersmeeting

Governing BodymemberengagementAttendancelevels monitoredAgenda agreedby CCO andCOO

Member engagementscheme

COO annualoversight of thescheme

ClinicalEngagement IAJuly 2016 -SubstantialAssurance

CCG 360 Feedbackreport

JLEB monitoring ClinicalEngagement IAJuly 2016 -

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Internal Audit ofClinical Engagement

SignificantAssurance inthe InternalAudit on clinicalengagementJuly 2016

Internal Audit ofClinical EngagementJuly 2016

Internal Audit ofClinicalEngagement -substantialassurance

Weekly Directorstelecom to ensurethat information iscurrent andconsistent

Followed up byemail Directors briefingnotes from JLEBWeekly BusinessManagementmeeting actionsand updates

Primary CareLeadership Group

JLEB reporting NHS EnglandNew Models ofCare teamquarterlyreviews

Regular ACO updatesin both member's andlocality meetings and

Weekly bulletinprovides currentupdates

1503

Siobhan Brown

Primary CareDelegatedCommissioning

There is a risk thatworkforce shortagesand increasingdemand combine atpractice level andresult in practiceclosures, patientsbeing dispersed andadditional pressuresbeing experienced byother practices. Thiscould lead to anunsustainablenumber of practiceclosures andultimately an inabilityto deliver primarycare at scale inNorthumberland.

This will result aderogation of patientcare at the primarycare level, additionalpressures beingexperienced acrossthe wider healtheconomy and theassociatedreputational damageto the CCG.

4 4 16 NorthumberlandPrimary CareCommissioningCommittee

Governing Bodyreceive minutes

NHS England,LMC, HWB andHealthWatchare committeemember.

IA on PCCo-CommissioningSignificantAssurance Noissues of note(Apr 16)

Additional CCGcapacity allocated tosupport COO and theStrategic Head ofCorporate Affairs

CCG LineManagement

NHS England

PACS primary careworkforcedevelopment scheme

PACS monthlysteering groupdirection andguidance

Vanguard NewCare Modelsteam oversight

PACS investmentprogramme

PACS steeringgroup directionand guidance

Vanguard NewCare Modelsoversight

Capacity and Demandfunding delivered to

Primary CareLeadership

New CareModels Team

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all practicesdelivering new orimproved accessmodels.

Group

GP Forward Viewoperational plansupported byTransformationFunding

PCCC NHS England

Merger ApprovalProcess

Process testedand fit forpurpose

NorthumberlandPrimary CareBusiness Model

In place withsupport familypractices

Delivery of locumagency, communityeducation providernetwork and carenavigation

JLEB and PCCC NHS EnglandLMC

Primary CareDevelopment ActionPlan

PCCC Internal Audit

Clinical Leadership JLEBGoverning Body

Stretch caused byadditional clinicalleadership beingrequired by boththe strategic CCGand ACO(Federation)

1435

Siobhan Brown

CCG OperatingResilience

There is a risk thatexternal or internalevents could occurwhich could impacton the CCG's abilityto conduct routinebusiness (property orIT infrastructure,staffing levels) whichlead to capacity oroperational deliverygaps.

This could result inreduced operationaloutput, a potentialreduction in quality ofclinical services, andultimately damage tothe CCG's reputation.

4 3 12 The CCG has abusiness continuityplan in place,approved by JLEB

Internal auditreview onbusinesscontinuity andemergencyplanning October2016 (substantialassurance)

EPRR returnsare submittedto NHS Englandfor assuranceon an annualbasis

The CCG has anabsence managementpolicy in place,approved by JLEB

Monthly HRanalysis reportprovided byNECS,includingsicknessabsence data,is reported toResource andPerformanceCommittee.

NECS IT servicesmanage the ITsystem and telephonesystem and areresponsible forbacking upinformation

CCG staff undertakestatutory andmandatory training

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Ensure adequatesufficient staff levelswho are qualified andcompetent toundertake daily CCGtasks.

R&P HR reportsJLEB reports

Internal AuditsNHS Englandquarterlyreviews

Internal Audit onEmergency Planningand BusinessContinuity Planning -SubstantialAssurance

Internal Auditon EmergencyPlanning andBusinessContinuityPlanning -SubstantialAssurance

Regional IT resiliencegroup set up asrequired.

PWCRecommendation ofstaff augmentation isfinance and PMO hasbeen addressed,additional financestaff have beenrecruited, a PMO leadand project managerswere recruited.

Single IT domain JLEB Internal Audit Yet to beimplemented

ACO TUPE process CCG linemanagement

TUPE process yetto start

1506

Siobhan Brown

StrategicPartnerships

There is a risk thatthe CCG's strategicpartnerships failleading to abreakdown inrelationships andassociated short termcapability gapsemerging.

This could lead to aderogation of patientcare and an impacton patient safety andthe CCG futurefinancial plansleading toreputational damageto the CCG

4 3 12 ACO transitionagreement signedand transitionmanaged by weeklymeetings of ACOtransition group

Governing BodyJLEB

NHS EnglandNHSImprovement

ACO decisiondelays impactingon contractingrelationship withNHCFT and NTW

HWBB formalsub-reportingstructure fromSystemTransformation Boardand ACO StakeholderBoard


HWBB

Register ofPartnershipAgreement

Formal S75agreements in placeas necessary

Partnershiparrangements/BCF IA Dec2015 -SignificantAssurance

Internal Audit ofStrategic Planning

Substantialassurance forthe InternalAudit ofStrategicPlanning July

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Internal Audit ofStrategic Planning -July 2016

SubstantialAssurance

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Alistair Blair

Federation There is a risk thatthe CCG fails toensure that theFederation issufficiently engagedand offered ODsupport meaning thatthe Federationoperates at asub-optimal level

This could result inreputational damageto the Federation andPrimary Care with theconsequent impacton ACO developmentand implementation

4 5 20 Federation Agreement ACO TransitionGroup

Not signed by allpractices

CCG managementsupport

ACO TransitionBoard

Governancearrangements

Weekly updatesprovided on CCGstrategic andoperational issues

Developcomprehensivegovernancearrangements

29/09/2017PamelaLeveny

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Siobhan Brown

MentalHealthTransformationProgramme

There is a risk thatthe programme failsto deliver the requiredreduction in themental health bedbase resulting infinances unable to bereleased to improvecommunity services.This will lead toadditionalnon-elective activity.

This will resultderogated patientcare, variations inquality by locality andincreased financialpressure on the CCG.

3 4 12 Monthly contractsmanagement meetingwith NTW

PACS New Models ofCare

ACO ProgrammeBoard

National NewCare Modelsteam

ACO MH workstream ACO stakeholderboardJLEB andGoverning Body

HWBBNHS Englandquarterlyassurancemeeting

MH TransformationPlan

SystemTransformationBoard

Internal AuditOSC

TransformationPlan requiresfurtherdevelopment

Completedevelopment ofMHTransformationPlan

31/10/2017Kate Brundle

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Annie Topping

SafeguardingVulnerable People

There is a risk thatfailure to comply withgood clinical practice,policies andprocedures,ineffectivemulti-agency andmulti-disciplinaryworking and notimplementing CaseReview action planswill result invulnerable people'ssafety beingcompromised andnon-compliance withstatutory regulations.

This could result in aderogation of patientcare with associatedreputational damageto the CCG andlitigation financialpressures.

4 4 16 SafeguardingChildren/adultPolicies andProcedures ofproviderorganisations andother agencies.

AnnualsafeguardingChildren andadult reports, Bi-monthlysafeguardingreports to EPHQ,Safeguardingupdates includedin the monthlyquality report toJLEB

Quarterlyperformancedashboard fromproviders.

Representation ofCCG on LSCB/NSABCase Review groupto monitorimplementation ofrecommendationsand actions fromCase Reviews andquality assure theimplementation of theactions. Action planson agenda forsafeguardingworkstreammeetings.

Safeguardingcase reviews area standingagenda item onthe CCG'ssafeguardingworkstreammeetings.

Regularupdates on theprogress ofimplementationofrecommendations from seniorleads fromproviders andalso evidencethatrecommendations have beenimplementedand embeddede.g. adults.Regular reportsfrom Chair ofgroup to JLEBregarding theprogres andany issues. Allof NHCFTs andNTWsrecommendations in relationto the threemanagement.Reviews havebeen completedand signed offby the LSCBCase ReviewSub-group.

CCG's own internalarrangements forsafeguarding whichinclude appointmentof appropriateSafeguarding leadsand Designatedprofessionals andalso commissioningarrangements thatensure providerorganisations haverobust safeguardingmeasures in place.

1. QIG minutesare nowpresented toJLEB as a matterof routine.Safeguardingchildren/adultspolicies updated.2. Briefingsdelivered 4. Bi-monthlyreport to EPHQ5. Monthlyupdate forsafeguardingincluded in thequality report for

IAsafeguarding/qualityimprovementNOR1516-10April 2016.Significantassurance withno issues ofnote.CNE NHSEngland CCGassurance toolcompleted May2016IA Safeguarding

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JLEB.6. Learning fromSerious Casereviews andDomesticHomicideReviews isincorporated intosingle agencymandatorytraining for GP's.

Children, LACand AdultsNOR1617-04/05 November2016 Significantassurance.

1800

Siobhan Brown

StrategicCommissioning

There is a risk thatthe revised CCGStrategicCommissioninggovernance structurelacks the robustnessrequired to effectivelymonitor andchallenge theoperational businessof the ACO. Thiscould mean that theCCG is unable toexercise the fullrange of its statutoryfunctions and monitorthe long term healthand wellbeingoutcomes it set theACO.

This would result aloss of confidencefrom memberpractices,reputational damageto the CCG andultimately NHSEngland revoking theCCG'scommissioningauthority.

4 5 20 ACO Full BusinessCase - robust CCGstructure articulated.

JLEB reporting.Governing Bodyreporting.

NHS England

Effective CCGGovernanceStructure

Governancechangesapproved byJLEB and, inoutline, bylocality meetings

Internal Audit Constitutionalchanges required

Constitutionalchanges to beagreed bymembership andNHS E

29/09/2017StephenYoung

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Siobhan Brown

PACS There is a risk thatacute and communityintegration fails,leading to acontinued lack ofintegration in someareas ofNorthumberland'shealth economy.

This could result inhealthcare beinguncoordinated, afragmented patientpathway which hasno link with primarycare and outcomesbeing derogated,potentially leading toincreased financialpressure andreputational damageto the CCG. It couldalso undermine theinception of the ACOand risk long termsystem-wide financialrecovery.

4 3 12 Monthly PACS teammeetingRegular PACSSteering Group

ACO programmeboard

National NewCare ModelsTeam quarterlyassuranceprocess

PACS internalupdates to JLEB,R&P, Primary CareDelegatedCommissioningCommittee andGoverning Body

Governing Body Internal Audit

Funding confirmed for2017/18

ACO ProgrammeBoard

National NewCare Modelsteam quarterlyassuranceNationalVanguardDashboardsLocalevaluation to beprocured

Quarterly reporting tothe national NewModels of Care Team

NCM teamsupport to theVanguard

Deliver amendedPACS programmein line withnational fundingof £4.3M for2017/18


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ACO Roadmapworking groupAcceleratedsites workinggroupRegionalEvaluation tobe procured byend September2016

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Frances Naylor

Continuing HealthCare (CHC)

There is a risk thatincreasing CHCcosts impact on theability of the CCG todeliver broadercommissioning plans.It may also provedifficult to measurethe quality and safetyof the services andthe assessment andreview process andreviews could resultin gaps in servicedelivery to patients,potentially resultingin an adverse effecton patient safetyrestitution orders.

The consequenceswould be an adverseaffect on patient care,increased financialpressures andassociatedreputational damage.

4 4 16 Partnershipagreement NCC tomanage the CHCprocess. 2017/18budget of £36Magreed whichrepresents a £3.8MQIPP saving.

CCG financeteam and JLEBmonitoring

Budget reports.CHC outcomemetrics.IA CHC ReportMay 16 -Significantassurance withno issues ofnote.

Further integrationand potentialsavings yet to beidentified

Nursing careassessment teamsundertaking review ofall potential CHCpatients.

Keyperformanceindicators.

Announced andunannounced visits toproviders by both thelocal authority andCCG.

Visit reports.

Review of complaintsand incident data viathe QualityIntelligence Group.

QualityIntelligenceGroup minutes.Quality reports.

Improved CHCreporting from LA

R&P reportingJLEB reporting

Internal Audit

StrategicCommissioningdelivered by a


Internal Audit

AT and FNconducting CHCreview

31/10/2017AnnieTopping

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partnership betweenthe CCG and the LA

Workplan agreed withthe Local Authoritywill include newactions: 1. NHSEngland has beenasked to supportbenchmarking ofeligibility decisions 2.An audit of spend onlow cost packages

Workplan yet to beagreed, will bedependent on NHSEngland deliveringsupport

1191

Mike Robson

CommissioningSupport Services

There is a risk thatNECS fail to deliverSLA business criticalsupport services orthat inadequate KPIsfail to identifyproblem areas. Thiscould impact on theCCG's ability todeliver against itscorporate objectivesif additional tasking isrequired by a leanCCG workforce.

This could result inreputational damageto the CCG andhigher absencelevels leading tounsustainable staffchurn and increasedfinancial pressure ofemploying additionalagency staff.

3 4 12 Signed Service levelAgreement in placebetween CCG &NECS with monthlySLA review meetingsheld between bothparties

Contract reviewmeeting minuteswith issues logmaintained.

SLA delivery IAMay 2016 -SignificantAssuranceDeloitte serviceauditor reportsfor period2016/17MedicinesManagement IAMarch 2016/17- SignificantAssurance.

Key PerformanceIndicators in placewhich are routinelyreported andreviewed at eachmonthly SLA reviewmeeting

Regularmeetings heldwith NECSaccount managerby CCG CFO.

NECS AccountManager for SLAqueries.

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1507

Annie Topping

Learning DisabilitiesTransformationProgramme

There is a risk thatthere is insufficientsystem capacity tocare for patients whoare transferred to thecommunity setting asa result of thenational requirementto deliver the bedclosure trajectory.This could result indelayed transfers ofcare,over-commissionedcare packages andpatient's care beingtransferred out ofNorthumberland.

This could result inderogated patientcare and pooroutcomes, increasedfinancial pressure onthe CCG andreputational damage.

3 3 9 Community care andtreatment reviews

TransformingCare Meeting

Audited by NHSEngland

In-patient trackingsystem

TransformingCare Group

Regional LDTransformationBoard

Enhanced Models ofCare delivery

TransformingCare Meeting

OSC Business Casedevelopment

Developenhanced modelof care businesscase

31/10/2017Kate Brundle

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744

Mike Robson

Anti-FraudArrangements

There is a risk thatineffective anti-fraudarrangements, orstaff failing to adhereto comprehensiveinstructions orundertake mandatorytraining, will notprevent bribery andcorruption leading toa breach of nationalstandards and CCGliability under theBribery Act 2010.

This would result inreputational damageto the CCG.

4 3 12 Standards ofBusiness ConductPolicy - March 2015.

Standards ofBusinessConduct Policyhas beenupdated toinclude referenceto the Bribery Act2010

Internal Auditreview ondeclarations ofinterest -1617-03 - May17 providedassurance thatthe CCG isgenerallycompliant withtherequirements ofthe Health &Social Care Act2012 in relationto declarationsof interest.

Procurementprocedures in placewithin NECS.

ISAE Reportissued byDeloitte onoperation ofNECS incertain areasfor the period1/4/16 to31/3/17.

Inclusion in CCGAnnual Accounts ofrelated third partytransactions.

. IndependentAuditors Reportissued byMazars LLPMay 2017.Included withinthe annualreport.

Annual Review ofDeclaration ofInterests Register bythe CCG AuditCommittee.

Minutes of theAudit Committeemeeting.

Anti-fraudarrangements inplace which include:Local Counter FraudSpecialist in place Approved Anti-fraudpolicyAnnual anti-fraud planapproved by AuditCommitteeCounter fraudawareness mandatorytraining

Audit CommitteeminutesBi-monthlytraining report toGovernanceGroupAnnual staffsurvery containsspecific questionon anti-fraudawarenessAssessment ofanti-fraudarrangementsundertaken.

Regular updatereports fromLCFS to AuditCommittee.Annual Reporton anti-fraudawarenessreport to AuditCommittee.Carried out byCity hospitalsSunderland,Paul Bevan.SRT inattachments.

Assessment ofanti-fraudarrangementsreport gaps to beclarified by theCounter FraudLead nationally andaddressed withCCG leads.

With Primary Caredelegatedcommissioning nowwith the CCG post31st March 2016, theCFO's have agreed

The primary carefinance teamdon't haveaccess to theOracle paymentsystem, No useraccess has

Systems thatare to be usedhave been usedby NHSE for anumber of yearwhere they

The CCG wouldstill need to ensurefor itself that thesystems andcontrols in placeare suitable for

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an assurance reportthat outlines thegovernance in placeto remove anyconflicts of interestthe system maycause.

changed intaking on Primarycare cocommissioning.

would havebeen part oftheir auditedaccounts andcontrols.

Delegated primarycarecommissioning.Which is theassurance reportthat the CFO's arecurrently reviewing.

1190

Mike Robson

InformationGovernance

A failure to embedinformation riskmanagement intoCCG business and tocomply withinformationgovernance policiescould lead toinformationinefficiences andrisks not beingidentified andassessed.

This could result inconfidentialitybreaches or a failureto embrace a spirit ofopenness andhonesty which maylead to litigation andconsequent financialand reputational riskto the CCG.

4 3 12 InformationGovernanceFramework in placewhich includespolicies andInformationGovernance Strategy

Connecting forHealthInformationGovernanceSelfAssessmentToolkit.Deloitte ServiceAuditor 2016/17report.Governanceassurancereport for 16/17provided byNECS andpresented toGovernanceGroup.IG Toolkit IAApril 2017 -SignificantAssurance

InformationGovernancemandatory training forall CCG staffCompliance is beingmonitored throughout2016/17. 100%completion ratesachieved for IG.

Compliance withIG training ismonitored by theGoveranceGroup

Caldicott Guardianand SIRO in place inCCG. Both requiredto undertake annualtraining specific totheir roles.

Completion ofannual trainingmonitored byGovernanceGroup

No patient identifiabledata is handled by theCCG - patient dataprovided by NECS isroutinelypseudonymised.

Deloitte serviceauditor reportcovering period1/4/16 -31/03/17.

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24/11/2015

1444

MikeRobson

MikeRobson

NSECH (StrategicRisk 945 refers)

There is a risk thatfinancial modelunderpinningNSECH becomesunsustainable forlocal healtheconomy.

This could result ina financial pressureon the CCG and arisk to servicedelivery resulting inreputational damageand a failure toachieve financebalance.

4 5 20Monthly monitoring of NSECHperformance and activity, NECS providingdetailed analysis and variations in patienttrends from the impact of the opening ofNSECH so that actions can be taking toensure that NSECH activity remainssustainable within the financial resourcesavailable.

Provider doesn't accept thatfinancial pressure is due toNSECH but rather generaldemand, and maintains levels ofactivity in order to meet theirfinancial control total for STP.

Looking at Tariff options and other ways todrive cost out of the system.

Provider doesn't want to entertaintariff options as it looks tomaximise income to hit their ownfinancial control total

Contract challengesunderway

Paul Turner

31/08/2017

ECIP action plandelivery

SiobhanBrown

25/12/2017

QIPP scheme EDStreamingimplementation tohelp address demandmanagement issuesat NSECH

SiobhanBrown

31/08/2017

4 1 454 201. AssureDelivery OfSafety,Quality &Performance

18/08/2015

1390

DavidShovlin

PamelaLeveny

North EastAmbulance Service(NEAS) (StrategicRisk 407 refers)

There is a risk thatNEAS contractunder performanceand the impact ofincreased activity onthe PatientTransport Serviceassociated with 7day working, willlead to a failure todeliver keyoutcomes, whichwould result inpatient care beingcompromised and arequirement foradditionalcommissioningaction.

This could result inreputational damageto the CCG andincreased financialpressure.

4 5 20Signed contractMediation complete and contract signed

Monitoring NEAS performance targets

Regional contract managed by NECS.There is an improved minimum dataset foremergency cost per case element andPTS block. CCG is one of four regionalleads with Head of Commissioningactively involved at a regional level.Non contracted elements of NEAS service- PTS, ECR and impact of 7 day workingcreating a financial risk - addressed incontract

As per Strategic Risk 451. NEAScontinues to perform below KPI's,Unlikely to improve to desired levelby end of the year. revisingambulance protocols to other basesites, ambulance crews ringingahead to discuss whetherappropriate to take into UCC

ECIP action plan delivery

ECIP IndependentReview -reporthighlightsrecommendations forNSECH and NEAS.To ensurerecommendations areactioned, OversightProgramme Boardinplace in Feb 17 .

PamelaLeveny

30/03/2018

Contract leversestablished to shiftactivity fromconveyance togreater proportions ofsee/hear and treat.

PamelaLeveny

30/03/2018

UCC dispositionsrevised with NEASand Northumbria andcommunicated toparamedics. This willincrease the numbersthat can be taken toUCC and avoidNSECH ED.

PamelaLeveny

30/03/2018

Paramedics continueto call ED ahead ofconveyance todeterminealternatives.

PamelaLeveny

30/03/2018


18/01/2017

1799

MikeRobson

MikeRobson

QIPP (Strategic Risk946 refers)

There is a risk thatthe lack of acomprehensiveQIPP or a failure toensure that there areappropriatemonitoring anddeliverymechanisms willlead to the 17/18QIPP target beingunachieved.

This will result inincreased financialpressure andreputational damageto the CCG.

4 4 16QIPP tracker monitoring reported to thefinance group and programmemanagement board.

Escalation route from QIPP trackerto corporate risk register not fullyimplemented.

Development of detailed QIPP includingproject milestones.

Full QIPP not established.

Finance Group

Further develop PMOfunction and QIPPescalation policy

MikeRobson

31/08/2017

Joint QIPP/CIPdeveloped with Trustas part of ACOdevelopment.

RichardTurnbull

31/08/2017


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09/07/2013

405

SiobhanBrown

StephenYoung

Staffing Levels(Strategic Risk 1435refers)

There is a risk thatstaff leaving at shortnotice, sicknesslevels and Interimappointments leadto unsustainablestaff churn and aloss of corporateknowledge.

This could result inreduced operationaloutput, consequentdamage to theCCG's professionalreputation andincreased costs ofemployment(agency staff).

4 4 16Absence Management Policy

HR Policies including:Recuritment & Selection,Flexible Working,Other leave,Appraisal.

Unable to control ACO TUPEtimeline

Business continuing and emergencyplanning arrangements

Managementagreement to bescoped ahead ofTUPE

SiobhanBrown

29/09/2017


01/03/2016

1492

AnnieTopping

AnnieTopping

Maternity staffshortages atNESCH and MLUs.(Strategic Risk 407refers)

High levels ofsickness andvacancy at NESCHmaternity serviceshave resulted in alarge number ofunfilled shifts andunable to meet theincreasing demand. Ongoing recruitmentissues at MLUshave impacted onthe ability to releasemidwives onto therotation programmeto NESCH to keepup skills andcompetencies, andmaintain the currentlevel of service.

Adverse impact onpatient safety andquality of services.Reputationaldamage to the CCG.Litigation andfinancial loss.

4 3 12Trust has put in place maternity escalationplan if there is an increase in demand orstaffing issues. Actions are in place tomitigate by drawing in staffing frommidwifery management / matrons roles andspecialist midwifery posts to support theunit and ensure safe standards of care aremaintained.

Trust is recruiting an additional 6.3 wteband 6 staff to meet with increasingdemand.

Review and reconfigurate maternityservices at MLUs to ensure patient safety.

The Trust has implemented temporaryovernight closure at Alnwick MLU as fromNov 2016 to reduce overall staffingrequirement.


19/01/2017

1802

SiobhanBrown

StephenYoung

ACO (Strategic Risk1801 refers)

There is a risk that a'soft launch' of theACO and continuedCCG staffuncertainty abouthow current stafflevels will be splitbetween theStrategicCommissioner andthe ACO will lead tostaff disengagementand staff looking foralternativeemployment.

This will result ininsufficient staffinglevels and aninability to conductdaily CCG business.This risk is linked tooperational risk 405

3 4 12ACO transition plan Still in development - Action Planin strategic risk 1801

3 2 643 122. CreateJoined UpPathwaysAcrossOrganisations ToDeliver seamless Care

18/01/2017

1797

SiobhanBrown

StephenYoung

Conflicts of Interest There is a risk thatthe revised CCGStrategicCommissioninggovernancestructure (whichincludes a numberof shared rolesbetween the CCGand the LA) willresult in additionalConflicts of Interestbeing declared.This could result inthe CCG's decisionmaking processbeing adverselyaffected.

Leading tosub-optimalstrategiccommissioningdecisions andresultantreputational damageto the CCG.

4 3 12CCG Policy CO19 Standards of BusinessConduct and Declarations of Interest

Policy requires updating to reflectthe revised New Care Models COIinput - Revised guidance soon tobe subject to consultation fromNHS E.

Declarations of Conflicts of Interest There may be some gaps if not allinterests have been declared

Conflicts of Interest Self AssuranceReturns to NHS England

Conflicts of Interest Guardian

Register of Conflicts


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JohnWarrington

BrianMoulder

RightCareProgramme(Strategic Risk 946refers)

There is a risk thatthe financial andoutcomeopportunitiesidentified byRightCare are notdelivered. Thiswould result inpotential contractoverperformanceand the continuedvariation fromnationalbenchmarkingleading tosub-optimal patienttreatment levels.

Leading toderogated patientcare, increasedfinancial pressureand reputationaldamage to the CCG

4 3 12RightCare programme deployment anddelivery partner identified.

Data disputes.Constructive and comprehensiveclinical engagement.

4 clinical areasidentified which areCVD, respiratory,MSK and gastro.Monthly meetings arebeing held with CCGand Trust clinicianand managementteams to identifiyareas to improvepatient pathway

BrianMoulder

29/09/2017

4 2 844 163. DeliverClinically LedHealthServicesThat AreFocused OnThe PatientAnd BasedOn Evidence

24/11/2015

1446

SiobhanBrown

StephenYoung

ACO (Strategic Risk1801 refers)

There is a risk thatthe CCG will fail toappropriatelyengage memberpractices during thedevelopment of theACO leading topractices beingprovided insufficientinformation onwhich to make aninformed decision.

This could ultimatelylead to an ACOmandate not beingachieved andconsequently thepotential failure todeliver the fulleffects of PACSwhich would resultin reputationaldamage to the CCG.

4 3 12Regular updates via the LMC forum

Locality and Members meetings

Weekly bulletin providing current updates.

Northumberland Federation constructformed.

ACO Transition Plan Transition plan to be delivered

Regular ACO updates via members andlocality meetings.

ACO Business Case members meetingMay 2017 to provide full backgroundahead of the member's ACO vote ascommissioners.

4 2 834 122. CreateJoined UpPathwaysAcrossOrganisations ToDeliver seamless Care

14/03/2016

1504

SiobhanBrown

StephenYoung

Primary CareDelegatedCommissioning

There is a risk thatconflicts of interestare not declared, oronce they are, theyreach a level thatprecludes thedelivery of theoperationalbusiness of theNorthumberlandPrimary CareCommissioningCommittee.

This could lead todelays in decisionmaking, potentialderogation to patientcare and a lack ofconfidence in theCCG by memberpractices leading toreputational damageto the CCG

4 3 12CCG Business Conduct Policy

Separate COI declarations by committeemembers

Committee members do notregister all potential COIs

Internal COI governance routine - egagenda circulated prior to papers to ask forearly declarations of any potential COI

Revised COI business conduct policyreflecting revised national guidance


24/11/2015

1447

DavidShovlin

PamelaLeveny

Low AcuityActivity(StrategicRisk 945 refers)

There is a risk thatincreasednon-elective activitywhich results inadditional resourcebeing requiredeither to fundNHCFT (above thecurrent cap) orNUFT

This could result inunsustainable costpressures, therelated failure todeliver othercommissioning planobjectives, with theassociated patientcare derogation, andreputational damageto the CCG.(Strategic Risk 945refers).

4 3 12Chief Officer level meetings to identifysystem wide actions.STP and FRP actions include redesign ofemergency care post-NSECH.Contract negotiated for blocks on urgentcare centres and reclassification to type 3.

ECIP action plan

Phased approach:Develop andimplementambulance protocolsDirect admissions tobase sitesPlans for reducingwalk insEnforcenon-commissioningof Cat 2&3

PamelaLeveny

09/10/2017

Asked for FTresponse in 10 daysto address significantpressure and alsoplan to holdpayments to plancommensurate withundue financialpressure

SiobhanBrown

30/11/2017

4 2 854 203. DeliverClinically LedHealthServicesThat AreFocused OnThe PatientAnd BasedOn Evidence

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17/08/2017

1894

Alistair Blair

PamelaLeveny

Federation There is a risk thatthe CCG fails toensure that theFederation issufficiently engagedand offered ODsupport meaningthat the Federationoperates at asub-optimal level

This could result inreputational damageto the Federationand Primary Carewith the consequentimpact on ACOdevelopment andimplementation

4 3 12 Federation Agreement Not signed by all practices

CCG management support Governance arrangements

Weekly updates provided on CCG strategic andoperational issues

Develop comprehensivegovernancearrangements

PamelaLeveny

29/09/2017

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Strategic -

Page 1

Joint Locality Executive Board 23 August 2017 Agenda Item: 2.7 Communication and Engagement Report Sponsor: Strategic Head of Corporate Affairs

1 20170823-UC-Item 2.7 Engagement Report


Members of the Joint Locality Executive Board are asked to: 1. Consider the contents of the report. 2. Agree to consider quarterly communication and engagement reports.

Purpose This report outlines NHS Northumberland Clinical Commissioning Group’s (CCG) communications and engagement activity since the last report to the Engagement, Public Health and Quality Committee in March 2017. A quarterly report will now be presented to JLEB. Headline Activity The following work has recently been undertaken: Risk 401 Stakeholder Engagement – There is a risk that a lack of appropriate engagement with key stakeholders including the public and patients, will mean that the CCG will fail to take feedback and evidence into account when designing and commissioning new services. (Risk Rating 12)

• Vanguard Co-Design Forum (VCDF) – The final meeting took place on 27 July 2017. The work previously undertaken by this forum will now be subsumed into joint working arrangements with Northumbria Healthcare NHS Foundation Trust under the umbrella of the Empowering People and Communities vanguard. This work is in the early stages of development and future JLEB reports will include progress reports in this respect.

• PACS Vanguard Evaluation – A thorough evaluation is being carried out to assess how the new models of care models are working. Research is needed to gather feedback on how the models have impacted on staff, patients and carers. Explain Market Research has been commissioned to conduct the evaluation and have adopted the following methodology:

o Online survey o Tele-depth interviews o Focus groups o Online community

As of July, Explain began the tele-depth interviews with GPs, practice managers and nurses and the first focus group took place with carers earlier this month. The online

20170823-UC-Item 2.7 Engagement Report 2

survey launched last week (w/c 14 August) and the link was shared with stakeholders and partners for onward distribution. It is hoped the online community will launch the following week.

• Rothbury Community Hospital – The public consultation which proposed to permanently close the inpatient ward and shape services around a Health and Wellbeing Centre closed on 25 April 2017. A copy of the consultation feedback document considered by JLEB in June 2017 has been circulated to stakeholders and attendees of public events and also made available online in August. JLEB will consider the final decision making business case in the September meeting, which will be held in public.

• Assurance Ratings – A comprehensive communications plan and stakeholder briefings were prepared and followed to announce the annual CCG assessment.

• Harbottle – An agreement was reached with the Rothbury Practice regarding the provision of a branch surgery in Harbottle. All patients of the Rothbury Practice and former patients of the Harbottle Surgery were written to on 21 July to inform them of the decision and provide details of how GP services will be delivered in future.

• Cambois – Gables Medical Group in Bedlington temporarily closed their branch surgery urgently at the start of July following a Northumberland County Council (NCC) surveyor declaring the building as unsafe. The CCG supported practice patient engagement.

• Riversdale – The CCG is supporting Riversdale Surgery with media relations as part of the engagement process on the proposed closure of the Wylam branch surgery.

• STP engagement – A feedback report following the initial period of engagement on the draft STP was published on the CCG’s website in August.

• Patient Engagement – The North locality patient forum took place in June which discussed the ACO and the cyber attack.

• Press Releases – The CCG issued a press release on 7 July on the publication of the GP Patient Survey results, in which 87% of the people in Northumberland rated their experiences as ‘good’. The Clinical Chair was also quoted in a Public Health press release issued by the council on 30 June encouraging uptake of the MMR vaccine.

• Patient Forum – The sixth CCG Patient Forum event took place on 29 March 2017 in the Blyth Valley locality. The event was fairly well attended with approximately 18 patients, 10 CCG staff and six service provider colleagues. A copy of the feedback report is at Appendix 1. Recruitment to increase the membership of the Patient Forum Steering Group is currently ongoing. It is hoped the group will meet again later this month to plan the next forum in September/October.

Risk 403 CCG Member Engagement. There is a risk that a failure to engage the CCG’s membership means that vital intelligence is not taken into account when developing future delivery strategy.

• ACO Q&A Sessions – The key ACO partners attended a Question and Answer (Q&A) session following the Members’ Meeting on 8 March 2017. The panel included leaders from NHCFT, NTW, NEAS, the Council and the CCG. The meeting was filmed and a video was shared via the locality bulletin in April. A further Q&A session was held for members on 25 May 2017.


• ACO Vote and Federation Sign-up – The ACO vote and the opportunity to sign up to the Northumberland GP Federation ran from 13 July to 14 August 2017. Practices were emailed a briefing pack with a link to the online survey and a Q&A page was set up on GPTeamNet. 76% of the votes cast by practices using the CCG constitution’s process (1 vote per 500 registered practices) were, in principle, in favour of the ACO. 34 of the 42 practices also took the opportunity to sign up to the Federation. ACO development work continues and practices will be given a further opportunity to voice their opinion when the final ACO vote is conducted. The CCG supported the Federation in announcing their launch.

• Senior Management Changes – Following changes in the CCG senior management in May/June, two separate briefings from the Clinical Chair were emailed to all members to ensure they were kept informed.

• Cyber Attack – Following the Cyber Attack on 12 May 2017 a multitude of communications activities were undertaken to ensure all member practices were supported and to assist them in the process of getting their ITC systems up and running.

• Primary Care Event – Considerable planning took place to organise a large scale primary care event in June to share best practice of the work occurring through the Vanguard programme. However, the event was cancelled at the end of May owing to an insufficient number of delegates registered. It is hoped to disseminate the learning from the vanguard programme through other methods including the locality meetings.

• Locality Meetings – Locality meetings continue to take place at the start of each month.

• Locality Bulletin – The CCG’s weekly bulletin continues to be well received by practices as the figures below indicate and the usage of GPTeamNet remains high (Appendix 2 refers).

Locality Bulletin Issue Readership Figure 50, 6 June 447 51, 13 June 292 52, 20 June 361 53, 27 June 356 54, 5 July 422 55, 12 July 318 56, 19 July 322 57, 26 July 361

Conclusion This has been a busy period of both communication and engagement and the Corporate Affairs team fully recognises the need to retain the impetus in this area of operation particularly concerning membership engagement at such a period of transition.


Recommendation JLEB are asked to consider the communication and engagement activity undertaken since March 2017 and agree to receive quarterly reports in this respect Appendix 1: March 2017 Patient Forum Feedback Report Appendix 2: GP TeamNet monthly statistics – July Appendix 3: NECS social media evaluation – July

Feedback from County-wide Patient Forum 29 March 2017 Isabella Community Centre, Blyth

Feedback from County-wide Patient Forum Introduction The sixth CCG Patient Forum event took place on the afternoon of Wednesday, 29 March 2017. The event was fairly well attended with approximately 18 patients, 10 CCG staff and six service provider colleagues. The patient forum steering group were involved in the planning process and a decision was made to hold the event in the Blyth Valley Locality as the previous event had been held in the West. Isabella Community Centre was chosen as the venue because of its central location within Blyth and the good transport links. Service providers represented at the event included Northumbria Healthcare NHS Foundation Trust (NHCFT), Carers Northumberland, Healthwatch Northumberland and Age UK who all brought materials for an information stand. The format of the event included a range of brief presentations regarding relevant CCG updates, in particular the work of the Northumberland Vanguard programme and how we are empowering our communities to live long and healthy lives at home. Cynthia Atkin, the departing Healthwatch Northumberland Chair also presented an update which focused on their annual survey. Following the presentations two workshops were held around the vanguard programme: empowering people and communities and the feedback will be used to inform the development and design of services. The workshops discussed:

• Developing healthy and resilient communities • Creating community health and wellbeing centres

To enable a wider discussion each group were given a set of case studies (appendix 1) to focus their attention before answering questions (appendix 2) on the above themes. Notes were taken by facilitators at each of the table discussions and additionally attendees were asked to complete evaluation forms about the event. Summary of Workshops Engaging with patients is an important way of obtaining feedback relating to the quality of services commissioned by the CCG as well as gaining useful insight for the design and development of future services. Below is a summary of the key themes that were raised in the two workshops, a full transcript of the feedback can be found in appendix 2. Developing healthy and resilient communities

The case study allowed lengthy discussions to take place among all groups who were able to identify the issues that were affecting the family described, such as

Feedback from County-wide Patient Forum 29 March 2017 Isabella Community Centre, Blyth financial pressures, childcare, weight loss and mental health worries. Consequently, when asked what would enable the family to stay well and healthy, all groups focused on the support that can be provided in the community, education on healthy eating and exercise in schools and the importance of self-care. Suggestions from the groups on what they would wish for the case study, included:

• Organisations going into schools to educate children in health lifestyles • Health visitors roles to be expanded to give advice to the rest of the family • Companion support for those who need it e.g. buddy scheme.

Creating community health and wellbeing centres In workshop two all groups kept their focus on the first case study and used their own experiences to discuss community health and wellbeing centres. The first question generated a lot of discussion about what a health and wellbeing centre is, how they could be run and where they could be located, while the second question led the groups to discuss what services they would want to be provided. This included suggestions for annual health reviews, advice on minor ailments, well man and woman checks, chronic disease monitoring, while also addressing physical and mental health needs. Better accessibility was raised, and it was considered important that appointments should be flexible and available 24/7. Involving pharmacists in the provision of services was also recommended. Summary of Evaluation Forms Of the 18 attendees only 14 completed an evaluation form but some very positive feedback was obtained nevertheless, a full analysis of the evaluation forms can be found in appendix 3. By combining the responses to ‘strongly agree’ and ‘agree’: all attendees agreed that the organisation, planning and communication of the event were well executed; 79% of attendees agreed that the event was held at a convenient venue and all agreed it was at a convenient time; the presentations were clear and 79% of attendees were able to follow them; similarly 79% of attendees found the materials helpful but only 64% found the information stands informative; and finally, it was pleasing that all attendees agreed that they were able to actively contribute in the workshops and felt they were listened to. The evaluation form also gave attendees the option to leave their own comments. The majority of attendees indicated their overall view of the event was either ‘excellent’, ‘good’ or ‘or useful’ and four others felt the forum was informative. Seven responses indicated that the most enjoyable part of the event was the workshop discussions, the exchange of ideas and listening to information from other patients. Conclusion The March 2017 patient forum was a successful event, which generated wide-ranging discussions and included many useful suggestions for the future design of services. Although it would have been preferable to have a higher number of

Feedback from County-wide Patient Forum 29 March 2017 Isabella Community Centre, Blyth attendees, all of those that did attend were well informed and willing, engaging participants. The level of discussion was undoubtedly aided by the use of case studies in the workshops and this view was clearly reflected by attendees who found them to be the most enjoyable part of the day. It is interesting to note that all agreed that the time of the meeting was convenient, with this being the first time the forum was held in the afternoon during the week. It is also worthy of note that not many attendees visited the provider stalls, with only two-thirds saying they valued the materials. It may be worth reconsidering inviting service providers to attend future events. A copy of this report will be sent directly to attendees of the event and the patient forum steering group. Information from the event will also be shared with GP Practices via the CCG Locality Managers to enable Practices to benefit from the information obtained and to consider the feedback at future PPG meetings.

Feedback from County-wide Patient Forum 29 March 2017 Isabella Community Centre, Blyth Appendix 1: Case Studies Four case studies were provided for the workshop discussions but only the first and second case studies were reviewed, with the second case study only reviewed by one group. Case Study 1 • John Robinson (44) and Kelly Jones (36) have two children Chloe (6 years) and

George (3 years). • Chloe was born six weeks prematurely and is small for her age. Through a

school hearing test she has been identified as needing further assessment and has been referred to her GP.

• George has started pre-school nursery attending two days a week. • John Robinson has been out of work for two years but has recently been

employed on a zero hours contract for a supermarket chain as a driver. • Kelly works full time as a receptionist in the local school her children use. • Kelly’s mum lives locally and is now providing some child care as John has

returned to work. • Kelly and her mum are keen to lose weight and attend slimming world weekly. • Last year John gave up fishing with a neighbour due to financial pressures. • Chloe loves dancing and has requested going to classes with her best friend from

school. Case Study 2 • Mrs Rose Johnson (53) lives alone following the death of her husband from lung

cancer six months ago. They have two sons, one lives in New Zealand and the other in London.

• She works as a paid carer full time. • She has recently been diagnosed with diabetes and has started medication within

the last few weeks. • She has looked up the condition on line and is concerned about how the

condition will affect her. • She has several appointments in the diary for checks, tests and some education

sessions. She is very worried how to fit these appointments into her working day and to date has missed three appointments.

• Rose and her husband have a caravan and enjoyed holidays by the coast with friends. Rose’s sons are helping her to sell the caravan as she feels unable to join her friends on holidays on her own.

Feedback from County-wide Patient Forum 29 March 2017 Isabella Community Centre, Blyth Appendix 2: Workshop Discussions All groups reviewed the case studies and then provided the following feedback in the two workshops: Workshop 1: Developing healthy and resilient communities

1. What matters to the people in the case studies? 2. What needs can you identify which would enable them to stay well and healthy? 3. Who or what can help with those identified needs? 4. If you had a magic wand with one wish, what would it be for the case study?

1. What matters to the people in the case studies? - Finances - Childcare - Zero hours contract – unpredictable - Could lose weight without attending slimming world - Could be referred by a GP to a dietician - Education about health eating - Chloe gets a good start in life to improve her quality of life - Start as young as possible. Focus on good childhood. Best future available. - Safety at school, worries about bullying. Improved opportunities. - The father could use going fishing as a relaxing pastime to ease the pressure

from financial issues. - Lose of money results in the inability to do things people like and therefore

people are depressed. - Stress due to financial pressures can bring on mental health issues. 2. What needs can you identify which would enable them to stay well and

healthy? - Education about healthy foods - Not having access to fast food/ready meals - Important for the grandmother to stay healthy and would need more support if

became unwell, and she helps with childcare - The hearing difficulty could be a problem - Dancing classes cost money - More security – reliable employment. Dad’s mental health and impact on family

life. Limits self-care due to financial pressures e.g. being able to go fishing. Community club / subsidised, shared. Everyone needs an outlet

- Societal – taxation, close the loops, everyone should pay tax. - Voluntary/ Community Leaders/Champions – Development into ‘formal’ roles,

payment/ reward. Social investment - Community Centres – Place/venue. Community anchor. Shouldn’t need to rely on

volunteers. Flexible working, encourage employers. Still needs value. - How do we address isolation? Prevention. How can we appeal to everyone? - Parents need to reduce weight and therefore need assistance and help early in

process.

Feedback from County-wide Patient Forum 29 March 2017 Isabella Community Centre, Blyth - Obesity – if weight problems are sorted an added benefit is that this reduces cost

to NHS. 3. Who or what can help with those identified needs? - School – education in healthy eating and exercise - Nursery also has a role to play in education - More employment opportunities other than a zero hours contract - Citizens advice for financial issues - Weight loss advice from the GP or nurse - Northumbria FT has healthcare trainers – providing lifestyle advice and social

prescribing - Voluntary sector - Transport could be an issue if the family live in a rural area - Signposting is difficult as services change - Local Authority employ support planners who have an in depth knowledge of

services available - Patient Forums for contacts - Employer - School - Volunteers - Carers ‘unpaid’ (families/ spouse) - Communication. Myth busting. Debunk historical message. Quality maintenance

of care. - Diabetes. Motivation to self-care. Incentives. Punitive. - Mental health - Self-worth - Flexible employment - Shared responsibility for health and wellbeing - Support group. Allocated support staff. - Apps - Holistic view of people, self and self-care - Grandparents could look after the children – supported by possible pay allocation

by Government - Work to be valued – support employment by Government. - Support to release pressure e.g. minders. - Improve education on nutrition and cooking methods. - Prevention not Cure” - Health Navigators to help families – system to be developed 4. If you had a magic wand with one wish, what would it be for the case

study? - Win the lottery! - Proper job, not zero hours - Organisations going into schools to educate children in health lifestyles - Health visitor role to be expanded give advice to the rest of the family - Companion support for those who need it. Buddy scheme. Expert patient

scheme. Sociable care. One group briefly reviewed case study 2 and made the following observations:

Feedback from County-wide Patient Forum 29 March 2017 Isabella Community Centre, Blyth - Offer optional evening appointments. - Local appointments would result in avoiding travelling. - Increased use of technology would help to ease communications. - However it must be noted that Wi-Fi is not good in all areas in Northumberland. - Education on diagnosed condition is needed by patient to understand the

implications. Use of ‘iPad’ by clinician could aid to resolve issues with other providers

Workshop 2: Creating community health and wellbeing centres Thinking about your community and health and wellbeing services you have used or know about could you tell us: 1. What works well / what do you most value from these services? 2. What do you think are missing or where are there gaps? 3. If you had a magic wand with one wish for your community health services, what

would it be? 1. What works well/what do you most value from these services? - Knowing what services are available and how to get to them - Who will be running the centres? - There used to be a centre in Bedlington which closed due to lack of funding, it

provided fitness training, cookery classes - Are there areas that could be used in community hospitals for the new centres? - Community centres would be a good base to provide advice on NHS services - School halls could be used, also churches and Salvation Army - The name could be a problem, people may think that the health and wellbeing

centres may just be for people who are ill, could they be called ‘Health and Welfare’ centres instead?

- Enterprise centres have been set up in some schools, they have a bank of students who are ambassadors

- Community Wellbeing Centre. Who will host this? Health or social care? - Multi-purpose centres - It was suggested that the name of the centre should not replicate “education” as

people do not like to be educated. - Directory of services/signposting – to be included for reference. - Make up of Centre will be different for each community/locality e.g. rural/urban. - Using everything we have better:

• Community groups / venues • People • Technology • Use the physical space venue better

2. What do you think is missing or where are there gaps? - There needs to be someone to link in with a knowledge of all available services,

across all ages - Bedlington has a help hub, run by the church, which gives advice on CVs for the

unemployed, and also advice for those in financial difficulty, it would also be possible for them to signpost other services

Feedback from County-wide Patient Forum 29 March 2017 Isabella Community Centre, Blyth - Being able to communicate to all age groups is important - Need to have the ability to communicate to people what services they might need - There is a lack of knowledge about available services - Proactive/preventative vaccinations. Practice contacts patients. Holistic health

review to plan long term healthcare - NHS annual health check to be more readily available to everyone. Well man.

Well woman. Annual health review for chronic disease monitoring. Balance with those who have long term health needs.

- Flexible appointments. Better access. Early and late. Ideally 24/7 e.g. Samaritans etc Crisis Team.

- Appropriate Venue. Doesn’t need to be at a GP surgery. ‘Men in Sheds’. ‘Knit and Natter’. Social venue, professional free.

- Needs to address physical and mental health - Use the right people for the right thing. Best use of people and skills. Role of

pharmacist. First port of call? - Possibly include education on cooking/nutrition for the public. - Publicise good examples of working in other areas sharing good practice. - In order to encourage attendance at the centre, the public need to enjoy the

services being provided. - Increase access and availability at the centre especially in rural areas. - It would be beneficial to subsidise activities to help keep the population healthy

and thereby resulting in prevention. 3. If you had a magic wand with one wish for your community health services,

what would it be? - Get people more involved, including young people - Health and social care MOT for everyone - Access to own record. - Availability of advice and discussion on minor ailments. - One patient described a centre in Belfast which included swimming pool; gym

and function rooms. A medical was required to enrol with annual medicals ongoing. Minimum cost per year for membership.

Feedback from County-wide Patient Forum 29 March 2017 Isabella Community Centre, Blyth Appendix 3: Evaluation Forms Question 1: The organisations, planning and communication of the event were well executed

Question 2: The event was held at a convenient venue

Question 3: The event was held at a convenient time

57%

43%

Strongly Agree

Agree

29%

50%

7%

14%

Strongly Agree

Agree

Neutral

Disagree

43%

57%

Strongly Agree

Agree

Feedback from County-wide Patient Forum 29 March 2017 Isabella Community Centre, Blyth Question 4: The presentations were clear and I was able to follow them

Question 5: I found the materials/information provided helpful

Question 6: The information available on the ‘stands’ was informative

50%

29%

7%

7% 7%

Strongly Agree

Agree

Neutral

Strongly Disagree

No Answer

50%

29%

14%

7%

Strongly Agree

Agree

Neutral

Disagree

36%

28%

29%

7%

Strongly Agree

Agree

Neutral

No Answer

Feedback from County-wide Patient Forum 29 March 2017 Isabella Community Centre, Blyth Questions 7: I was able to actively contribute in the workshops and feel my views were listened to

Free Text Overall – what did you think of today’s event? - Went very well, very useful. - Excellent - Some good ideas from fellow workshop participants - Very good - Thank goodness we are starting to consider these improvements - Extremely useful - Good - Excellent - Interesting to me as an individual but not sure how useful it will be to the CCG - Good - Too much jargon - Reasonable on the whole The most enjoyable part of the event for me was: - All - Exchange of ideas - All except getting to the venue - Participation - The information from other patients - The workshops - Meeting and talking to other Northumbrians - Workshops - The workshops - Discussions – a very lively group! I would have liked to have heard more about: - Practical examples of ACO development - All agenda issues covered - Specific criteria related to what makes an improvement - Success stories across the communities

71%

29%

Strongly Agree

Agree

Feedback from County-wide Patient Forum 29 March 2017 Isabella Community Centre, Blyth - What progress has been made - Goings on with healthcare locally e.g. why is Northumbria NHS selling part of the

car park at Wansbeck Hospital? It would be helpful for the next Patient Forum Event to take place at (locality area): - Anywhere - Alnwick - West Northumberland - Bedlington Salvation Army - Not too far away from Ashington - Blyth - Bedlington Do you have any comments about how we might improve events in the future: - Just be yourselves - Keep consulting - Agenda - All ok - Not at the moment - Show us the criteria (see above) and ask how we meet/miss them - Get some young people involved. Average age today had to be 60+. Seems to be

some excellent initiatives on the go but little coordination or cross pollination of them.

- Not early in the morning

NorthumberlandHighest to date at the time

MonthCCG hits

CCG views

CCG attachments

CCG searches

Practice hits

Practice views

Practice attachments

Practice searches

Blyth Valley hits

Central hits

North hits West hits

N'land CSI clicks

NT CSI clicks

Overall hits

Jul-17 411 103 41 50 4182 2106 1633 1312 668 2639 356 519 11 63 4593Jun-17 591 90 33 42 4710 1085 680 530 658 3032 465 555 22 416 5301

May-17 618 90 25 32 4601 2463 1812 1417 647 2961 404 589 34 402 5219Apr-17 522 118 45 46 3994 2081 1594 1270 609 2555 408 422 19 516 4516

Mar-17 590 107 34 38 4854 2544 1933 1550 759 3087 412 596 24 439 5444Feb-17 537 91 43 48 4411 2494 2020 1573 872 2736 218 585 23 271 4948Jan-17 527 82 33 33 4807 2811 2271 1683 915 3061 232 599 33 209 5334Dec-16 438 74 47 19 3543 1896 1530 1173 647 2357 137 402 11 180 3981Nov-16 552 95 47 28 4660 2648 2183 1684 825 3078 212 545 20 313 5212Oct-16 450 100 45 44 4093 2353 1914 1422 739 2653 191 510 14 290 4543Sep-16 592 110 55 43 4300 2439 2040 1447 660 2954 227 459 3 298 4892Aug-16 513 123 67 39 3862 2221 1800 1380 680 2768 173 241 12 236 4375

Jul-16 504 109 39 47 3763 2136 1748 1312 484 2890 162 227 21 262 4267Jun-16 526 105 41 20 4217 2444 1996 1560 480 3379 98 260 35 228 4743

May-16 480 67 31 21 1027 518 296 320 505 398 81 32 n/a 141 1507Apr-16 565 61 24 17 681 262 186 183 469 143 64 5 n/a 1 1246

Mar-16 547 56 26 8 770 340 238 209 478 144 123 25 1317Feb-16 578 65 42 5 994 481 300 119 625 174 172 23 1572Jan-16 591 95 57 20 808 361 262 197 520 153 110 25 1399Dec-15 518 61 32 19 641 285 207 172 421 133 73 14 1159Nov-15 714 123 79 19 738 319 218 213 505 159 67 7 1452Oct-15 592 125 80 22 756 297 209 196 471 198 84 3 1348Sep-15 529 70 46 13 785 338 222 196 505 196 76 8 1314Aug-15 524 91 57 19 562 242 155 129 370 112 76 4 1086

Jul-15 610 85 55 24 772 338 244 206 446 179 147 0 1382Jun-15 612 99 72 14 719 318 233 203 375 152 187 5 1331

May-15 469 48 27 10 566 203 132 141 298 151 104 13 1035Apr-15 570 77 56 8 545 202 144 147 280 147 105 13 1115


Jul-14 542 84 75 25 1035 193 228 205 458 261 282 34 1577Jun-14 479 78 84 32 997 153 181 180 417 223 307 50 1476

May-14 428 60 53 24 1287 386 269 267 523 310 257 197 1715Apr-14 511 91 89 20 1160 238 245 169 532 246 323 59 1671


Northumberland CCG metrics report for July 2017

MP enquiries

None received

Media handling

None

Media evaluation (July)

• 5 x mentions o GP patient survey o Rothbury Community Hospital o Overnight closure at Hexham hospital o Delays to rebuilding Berwick Infirmary o Importance of MMR vaccination

Value: £9,048 Reach: 104,464

Twitter

Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Followers 1.4K 1.5K 1.5K 1.5K 1.6K 1.6k 1.6k 1.7k 1.7 1.8 1.8 1.8 Reach 138.2K 224.2K 200K 126.6K 93.6K 18.4k 228k 155k 209k 235K 3.1k 125k Klout 42 43 45 45 44 42 46 46 44 45 45 45

Facebook

Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17

Likes 281 290 292 292 296 320 324 334 338 338 340 349

Website (rolling statistics)

agenda - nhs northumberland ccgnorthumberland ccg€¦ · 1.5 review of actions register ......

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