boardroom, hilldale, wigan road, ormskirk, l39 2jw · 2018-05-16 · nhs west lancashire clinical...

NHS WEST LANCASHIRE CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING

22 May 2018, 10.00 – 12.00 pm

Boardroom, Hilldale, Wigan Road, Ormskirk, L39 2JW

15 minutes to be allocated for questions from members of the public based on agenda items.

Item WLCCGB

Time Agenda item Action Presenter

05/18/1 10.00 Welcome Chair

05/18/2 1 10.05 Declaration of Interests All

05/18/3 10.10 Minutes of previous meeting held on 27 March 2018 DR Chair

05/18/4 1 10.15 Matters arising - Action sheet DR Chair

Annual Accounts

05/18/5 10.25 • Annual report

• Annual governance statement (contained in the annual report)

• Financial statements

• External Audit findings report for the annual accounts

• Management representation letter

DR Paul Kingan Papers to follow

Communication

05/18/6 1 10.40 Chair’s update – paper to follow I Chair

05/18/7 1 10.50 Chief Officer’s update – paper to follow I Mike Maguire

Governance

05/18/8 11.00 Risk management report I Paul Kingan

Operational Management Section

05/18/9 11.15 Integrated business report D Paul Kingan

05/18/10 11.30 Equality and Inclusion annual report DR Catherine Bentley

05/18/11 11.40 Bomb threat policy DR Paul Kingan

05/18/12 11.50 Extended access DR Jackie Moran

05/18/13 11.55 Integrated delivery framework DR Jackie Moran

05/18/14 12.05 Enhanced care homes DR Chair

Consent items

05/18/15 1 12.15 Minutes of sub-committees: - Audit Committee – April 2018 - Finance and QIPP – March 2018 - Executive Committee – 7 March – 2 May 2017

Other minutes/action notes: - West Lancashire Community Safety Partnership -

January 2018

I

Chair

Other Business

05/18/16 12.00 Any other business I Chair

Date and Time of Next Meeting – 24 July 2018, 9.30 – 11.30 am, Boardroom, Hilldale

I – Information D-Discussion DR – Decision Required Members of the governing body will be available after the close of the meeting for

informal discussion, time permitting

West Lancashire Clinical Commissioning Group Governing Body meeting – 24 April 2018 Page 1 of 9

Minutes D R A F T

Meeting Title: West Lancashire Clinical Commissioning Governing Body Meeting

Date: 27 March 2018

Time: 9.30 – 11.30 am Venue: Boardroom, Hilldale, Ormskirk

Present: Dr John Caine, Chair Mike Maguire, Chief Officer Dr Adam Robinson, Secondary Care Consultant Claire Heneghan, Chief Nurse Douglas Soper, Lay Member Greg Mitten, Vice-Chair / Lay Member Steve Gross, Lay Member Dr Bapi Biswas, GP Executive Lead Dr Peter Gregory, GP Executive Lead Dr Rakesh Jaidka, GP Executive Lead Dr Vikul Mittal, GP Executive Lead

In attendance: Cathy Ashcroft, Executive Assistant Jackie Moran, Head of Quality, Performance and Contracting Gail Godson, Director, Healthwatch Lancashire Chris Brown, Interim Project Support (item 7) Paul Jones, Head of Finance (item 8 & 9) Nic Baxter, Head of Medicines Optimisation (item 11) Dawn Threlfall, Medicines Optimisation Project Support Manager (item 11) Smita Shetty, Service Redesign Manager (item 12) Charlotte McAllister, Urgent Care Commissioning Lead (item 16)

Apologies: Paul Kingan, Chief Officer/Deputy Chief Officer Dr John (Jack) Kinsey, GP Executive Lead

Agenda

Item WLCCGB/

Summary of Discussion Action

03/18/01 Welcome and apologies for absence The meeting of the West Lancashire Clinical Commissioning Group Governing Body was opened by Dr John Caine. There was one member of the public present and no questions had been received from the public in respect of the agenda.

03/18/02 Declarations of interests Dr John Caine reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of West Lancashire CCG. Declarations declared by governing body members are listed in the CCG’s Register of Interests. The register is available either via the secretary to the governing body or the CCG website at the following link: http://www.westlancashireccg.nhs.uk/wp-content/uploads/Register-of-interests-Governing-Body-November-2017.pdf

Declarations of interest from sub committees. None declared

Declarations declared for this meeting included: Greg Mitten declared an interest in respect of Item 14, as he is the chief officer of the CVS, which has a relationship with many VCFS organisations. The chair deemed the interest to be fundamental and Greg will leave the room for the entire item. All GPs present declared at interest in respect of Item 15, as they have an interest in the primary care levels. However, the paper has been deferred. Dr Mittal declared an interest in Item 14, due to his connection with social

http://www.westlancashireccg.nhs.uk/wp-content/uploads/Register-of-interests-Governing-Body-November-2017.pdf



prescribing. It was felt that this connection was only significant and no action would be taken.

Gail Godson had a working relationship with the Birchwood Centre and declared an interest in Item 14. This was deemed to be a fundamental interest and Gail will leave the room for the item.

03/18/03 Minutes of previous meeting held on 23 January 2018 The minutes of the meeting held on 23 January were approved as a correct record.

03/18/04 Matters arising The action sheet was updated.

COMMUNICATION

03/18/05 Chair’s update The report provided members with an update on both strategic and operational issues since the last meeting. John Caine highlighted key areas of interest: Urgent care - discharge events had taken place at Southport and Ormskirk Hospital NHS Trust (the Trust) in January to assist with patient flows and discharge. Subsequenty, Emergency Care Improvement Programme and NHS Improvement are supporting the Trust on several improvements, including SAFER flow bundle, site management processes and development of protocols. The Trust was awarded £800k of winter pressure monies which will in part be used for a modular extension to A&E. Primary care -

• Viran Medical Centre – the centre is located in a medical grade portacabin with the service provided by a local practice. A long-term solution is being pursued and engagement with the patients group is taking place. An estates option appraisal has been undertaken and the service model reflects the requirements of the NHS England APMS contract.

• International GP Recruitment – the North West is taking part in a national recruitment programme. The CCG is part of the Lancashire and South Cumbria applications. The programme is expected to commence in November 2018.

Ophthalmology – In May 2017, the two new providers were announced as iSIGHT to provide triage and tier 2 ophthalmology services and SpaMedica to provide community macular services. Both providers will deliver services locally. iSIGHT will commence 1 April 2018, whereas SpaMedica will commence on 1 June 2018. Medicines optimisation – the ‘Don’t be a Waster’ project has been relaunched. A report highlighting the effectiveness of the CCG’s medicines waste programme has been published. The Prescribing Ordering Direct (POD) service will be expanded across West Lancashire and a further POD will open in Skelmersdale and Burscough. A Lancashire-wide policy development review is taking place on Freestyle Libre. Therefore, prescribing this drug has ceased until completion of the review. The public consultation will commence following the local elections, under Purdah guidance. Mental health – a new Primary Care Mental Health model of care is being developed, with specialist mental health practitioners being based in GP practices. The CCG has recently commissioned medical support for West Lancashire Eating Disorder service. A safe area in children’s A&E has been commissioned. In line with work across Lancashire to transform children’s mental health services, a Primary Mental Health worker has been commissioned to form links between schools and primary care colleagues to offer help at an early stage to prevent children needing specialist mental health services. A new service commissioned by the CCG provides psychological support to people with long-term physical health conditions, via Lancashire Care Foundation Trust, Mindsmatter service.


RightCare – since the submission of RightCare’s three priorities last year, the CCG continues to deliver against them: MSK, chronic pain and respiratory. The CCG is also scoping additional opportunities which include gastroenterology. Greg Mitten provided the VCFS acknowledgement to CCG staff on the medical waste programme. Greg feels that engagement with the public has led to positive opportunities including; Healthwatch Lancashire’s work on a needs assessment on pharmacies and access for the public and the new service of support for patients with long-term conditions. This shows that much work is taking place in supporting diabetes along with the national diabetes programme. It would be beneficial to draw all parts of this work together in patients engagement. This can be raised at a meeting with Southport and Formby CCG, to establish what work is taking place in the national programme in their area. The benefits of technologies for patients such as digital prescribing and healthcare apps and Better Points are currently not in an overall plan. Jackie Moran confirmed that the community provider has progressed in engaging with patients about their care and the VCFS will be included going forward. The governing body: Noted the contents of the report

03/18/06 Chief Officer’s update The report provided members with an update on both strategic and operational issues since the last meeting. Mike Maguire highlighted key areas of interest: Quality update – Ann Farrar is the interim chief executive at the Trust until Silas Nicholls commences in the permanent role in April. Dr Mahajan will be in the medical director role until June 2018. The Southport and Ormskirk Improvement Board will be chaired by NHS Improvement with NHS England. It will have oversight of the improvement action plan submitted over the last few months and it is hoped to support patients through hospital for discharge. The CCG is working with the CSU to ensure no more that 15% of people receive assessment in an acute setting. Currently 100% of people are being assessed in the community which is a significant achievement, supported by the commissioning of discharge to assess beds, an initiative supported via Improved Better Care Fund monies. A care home in Banks will close on 23 April. The CCG is confident that new homes will be found for all residents and there has been a collaborative approach to managing the process to ensure minimal impact on residents. Another home causing concern has been closed to all new admissions due to on-going investigations, again with full systems collaboration and CQC investment. Social prescribing – Owls CIC and West Lancashire CVS were awarded the contract to provide a social prescribing pilot in Skelmersdale, commencing on 4 April. The programme will provide a process where wider social and lifestyle issues that impact health are addressed. STP update - this is now called the Integrated Care System. Their board has approved the Primary Care Delivery Plan, which sets out the package of investment and reform for primary care through to 2020. Discharge to assess beds - Claire Heneghan confirmed that there have been few occasions when assessing patients in the funded community beds has resulted in an extended stay. This is a 28-day process and by day 14 it has been established where patients need to transfer to. There are no issues in moving patients and local authority social care teams and CSU are fully engaged in the process which is robustly managed. The CCG has achieved 100% delivery by the end of March of all CHC assessments being undertaken in the mandated timeframe, again a significant collaborative achievement. The support of the CSU and local authority in respect of multi-disciplinary teams was noted.


It is known that currently there are many organisations in West Lancashire who are providing some form of social prescribing, including the integrated Wellness service commissioned by Lancashire County Council and other services such as the Power of Music provided by third sector organisaions. In order to try to bring cohesion a meeting is to be arranged by Kathryn Kavanagh with all of these organisaions to draw them together into our pilot across West Lancashire. Feedback will be provided through the Executive Committee. The governing body: noted the content of the report

GOVERNANCE

03/18/07 Risk Management Process Chris Brown stated that the risk register process will be reviewed and a workshop has been arranged in April. The latest risk report was presented. There are 23 risks including four extreme risks. The extreme risks relate to staffing and finance issues at the Trust and one deprivation of liberty risk. Two new risks include: Risk 64, loss of care home beds and Risk 65, timeliness of healthcare assessments, specifically the initial assessments. Three risks closed: Risks 33, 34 and 36. Risk 34, has been incorporated in Risk 65. Risk 64 – pandemic flu, the risk score had reduced as we are now ‘out of season’ for flu. Risk 08 – lack of engagement from providers in the quality agenda. The score has reduced from 16 to 12. This is due to the Southport and Ormskirk Improvement Board now being led by NHS Improvement and a direct report regarding quality outcomes to the Improvement Board. Only chief officers attend the Improvement Board from the CCG in order to maintain high level decision making and momentum. The CQC report rated leadership of the Trust as ‘inadequate’, but a positive change is the permanent role of chief executive and the speedy recruitment to the recently vacated director of nursing post. Progress had been made in recruiting to the required areas with greater engagement apparent. The report was commended for the more up to date information. Risk 32, CHC requests – the CSU are supporting the CCG in processing. The delays in the system are being resolved as additional support is being provided to the CHC team. The governing body: noted the content.

OPERATIONAL MANAGEMENT SECTION

03/18/08 Peter Gregory left the meeting.

Integrated Business Report (IBR) The report provided summary information on the financial position and activity performance of the CCG to January and the financial position for February 2018. It also included quality and performance analysis for community-based targets for Southport and Ormskirk Hospital NHS Trust. Paul Jones highlighted some key areas within the report:

• The CCG forecast position surplus is £2.997m.

• Quantified net risks are £750k, which have been reported to NHS England. Producing a risk adjusted surplus of £2.247m.

• The largest financial pressure relates to secondary care contracts.

• A contract dispute is currently with expert determination, with the results


due in early April.

• Individual packages of care – 25 packages are funded with an annual cost in excess of £100k.

• These pressures are off-set by the prescribing budget, QIPP savings, the reserves of 0.5% (contingency) and £1m received for the transformation fund from NHS England.

• Better Payments Practice is still being achieved.

• QIPP has achieved 83% of expected savings, an improvement on last year and in line with other CCGs.

• Individual Patient activity – the increase in spend refers to an increase in price/complexity rather than level of activity.

Jackie Moran reported on the quality and performance section of the IBR:

• The levels of GP referrals has plateaued, with consultant to consultant referrals remaining high. This will be looked into to ensure all referrals are necessary and addressed in the contract intensions.

• Planned care is underspent at the Trust and patient flows have moved to other providers.

• Outpatient procedures have increased and this will be explored.

• 18 weeks RTT has been achieved at 93.1%, with sufficient capacity in secondary care being commissioned.

• Diagnostics appears to be an issue. Some providers do not publish their figures electronically and so these figures may be distorted. The CCG is exploring how to include these numbers in the reported figures.

• The CT scanner at the Trust was out of commission recently and patients were transferred to other hospital providers. This has had an impact on our diagnostic performance figures.

• Cancer 62 days waiting remains an issue. There are a small number of patients and no common theme for missing the target.

• Prescribing is performing well with an underspend of £370k.

• Unplanned care is overperforming mostly due to A&E activity, which is common nationally.

• Four-hour waiting at Southport A&E has achieved 40-50% in the last month. The Trust four-hour waiting for both A&E and the West Lancashire Walk In Centre is approximately 80%. More intermediate care beds have been made available in the community to discharge and patient flow has improved.

• Ambulance response times will now be measured by the average response time, by NWAS. The CCG will seek ways to improve the times through discussions with Wigan CCG. The modular extension to the Trust’s A&E department should increase its capacity.

• Memory services performance seems to fluctuate, however the CCG continues discussion with the provider to monitor this situation.

• IAPT is performing well, as noted by NHS England recently.

• Quality – Friends and family testing and the safety thermometer were referred to. There are 26 serious incidents open, including 15 from the Trust. Regular meetings take place to monitor progress. The mortality rate is still an issue and regular meetings have been arranged to include GPs to understand the patient journey. NHS England and NHS Improvement are involved.

• The improvement and assessment framework shows that the CCG is performing well specifically in diabetes and mental health. Improvement is required in offering a choice of home birth, however the demand is low and it is not cost effective.

There are currently six patients receiving IV therapy at home this is an increase


from the previous maximum capacity of three patients at any one time. This service, which is increasing in scope and use, was felt to be cost-effective and the range of treatments could be expanded to cover other conditions which could be treated in the community such as cellulitis. The intention is to enhance the capacity of the team by a shared care approach with district nursing service.

The governing body: noted the content of the IBR.

03/18/09 Financial Plan 2018-19 Paul Jones presented the draft paper, with the final paper being presented to the Governing Body meeting in July. The executive summary shows the challenging financial position for 2018-19, however the CCG expect to deliver their statutory financial duties. The CCG’s funding allocation for running costs is £2.34m and the total recurrent allocation is £169.049m. In the formulation of the comprehensive financial plan for 2018-19, submitted to NHS England, each current budget has been adjusted: known cost pressures; anticipated increase in demand; impact of QIPP schemes; provider inflation and efficiency requirements; and the outcome of commissioning intensions / contract negotiations. The level of unmitigated risk is £1.582m. If the current disputed issues are found in favour of the provider, this will increase the level of financial pressure. The governing body agreed to:

• Note the challenging nature of the financial plan for 2017/18 in particular the requirement to deliver a QIPP plan totalling £5m.

• Note the requirement to identify and develop additional QIPP schemes early in 2018/19 to guard against the significant financial risks that exist over the next 12 months.

• Note the requirement to use Right Care approach to identify ongoing savings to mitigate uncovered financial risk.

• Note that the financial plan is based on the best available knowledge of allocations and financial commitments at the present time. Budget assumptions may change during the year based on final contractual agreements and revisions to financial assumptions.

• Note the direction of travel to wider working across STP areas and the development of associated financial arrangements

• Approve the initial 2018/19 revenue income and expenditure plan for NHS West Lancashire CCG.

• Acknowledge the Draft Activity Plan (page 9) that has been submitted NHS England.

The financial plan was felt to be very comprehensive. Concern was expressed that the current risk in achieving QIPP scheme savings could increase. The budget for suicide prevention is contained in other budgets, which cover this ongoing work. Paul Jones will discuss the location of this spend with Greg Mitten. As the business rules have changed, the 0.5% retention for NHS England is not required in 2018-19, however another provisional 0.5% for sustainability in Lancashire has been committed. The governing body: approved the financial plan and the recommendations.

PJ/GM

03/18/10

Lancashire Safeguarding Boards annual report 2016-17 The annual report has been issued to share with Governing Bodies. Claire Heneghan outlined the key points as follows: The Boards have come together as much as possible to form a single business unit for children and adults, the lead nurses for children and adults attend on behalf of West Lancashire;


considerable work has taken place since the SEND report and the OFSTED findings were published. The CCG has commissioned Sarah Derbyshire to lead on these areas to include eating disorders, learning disability, ADHD and autism. The Boards are proactive in using media campaigns to raise awareness, looking at suicides in children and adults and the CCG must ensure it contributes to this agenda. New guidance for children is expected for 2018-19. The governing body: approved the annual report.

03/18/11 Gluten-free decision This paper was returning to the Governing Body, following national consultation on gluten-free products, which had resulted in a different view to that of the CCG. Based on the results of the national consultation, the CCG were asked to agree one of the following options: 1. To reverse the CCG decision and prescribe all gluten-free products 2. continue to prescribe as agreed (no gluten-free products to be prescribed,

unless the GP feels it is necessary) 3. add certain gluten-free items back onto prescription. Many other CCGs have agreed to continue with the original decision to cease prescribing gluten-free products, but allows the GP to prescribe if clinically indicated. The governing body: agreed to continue with the current policy (Option 2)

03/18/12 Rakesh Jaidka left the meeting.

Information Governance (IG) annual report Smita Shetty presented the annual report, which outlines the work completed in 2017-18. The IG Toolkit has been completed to achieve an overall compliance level of 91%. One requirement of the IG Toolkit is that IG policies and procedures are in place. The annual review of the IG Handbook was delayed to wait for the national guidance release for the General Data Protection Regulation. Online IG training was complete with one exception. One IG incident had been reported in human resources and lessons learned and recommendations had been recorded. Privacy Impact Assessments are being completed as appropriate and no subject access requests have been received. The Clinical Executive Committee had reviewed the annual report and approval was sought. The governing body: approved the report.

03/18/13 SEND report This item was deferred along with the action plan following review by Sarah Derbyshire, who is new in post.

03/18/14 Third Sector Procurement decisions Greg Mitten and Gail Godson left the meeting for the item, as detailed in item 03/18/2. Jackie Moran thanked Joanna Rimmer for her work in visiting the third sector providers to review the quality and delivery of the contracts. The following third sector contracts were discussed: Carers support service – the services provides support across West Lancashire. It has access in outpatients and will be moving into Walk In Centres. This service could have a conflict with social prescribing. Vik Mittal declared an indirect interest as a director of OWLS. The declaration was felt to be significant and he remained in the meeting, but did not vote.


The governing body: agreed to extend the contract for 12 months. Palliative care sitting services – the service provided by Crossroads was given additional funding at the end of the year and has overspent this and requested an increase in their original allocation. The increase in activity could relate to the increase in discharge numbers. The service can improve the quality of end of life for patients. An end of life review is due to take place and there is a need to ensure the service is provided to all and not cancer patients only. The governing body: agreed to extend the contract for 12 months with no increase. Dementia adviser service – Phil Winnard is working on this and understands how the service links in to work in Lancashire Care Foundation Trust. It could form part of the social prescribing in mental health. The CCG is an associate with the contract. The governing body: agreed to extend the contract for 12 months and Jackie Moran will bring back more detailed information on the service provided for a future review. Queenscourt hospice – in 2017-18 the CCG provided a grant of £100k. The hospice is also funded via the community contract. A good service is provided but no definition of where the funding is used is available. The governing body: agreed to extend the contract for 12 months Greg Mitten and Gail Godson re-joined the meeting.

JM

03/18/15 Primary Care Levels This item was deferred

03/18/16 Proposal for Patients Flow Team for Southport and Ormskirk Hospital NHS Trust The business case had been presented at the Clinical Executive Committee on 6 March to support Southport and Ormskirk Hospital NHS Trust with patient flow. The proposal lists options of which Southport and Formby CCG have chosen option 4A - to allocate one Band 4 to multiple wards for a six-day service, would provide funding for 3 – 6 months only with a caveat that the staff are additional to the current staffing levels. It was felt that this reverted to the original Emergency Care and Improvement Programme review and that the wards have lost their ability to effectively manage the discharge process without a pathway review and additional short-term funding. The realistic benefits to the Trust, in providing a role for such a limited period were discussed in addition to the Trust’s duty to provide the discharge service. The governing body: agreed to fund in line with the decision reached by Southport and Formby CCG with the CCG funding up to £60k and up to a 6-month period

03/18/17 Register of interests The current register of declarations of interest for Governing Body members was presented. This will be available in the CCG’s annual report for 2017-18. The governing body: noted the declaration of interests register.

CONSENT ITEMS

03/18/18 Minutes of sub-committees: - Finance and QIPP Committee – February 2018 - Audit Committee – February 2018 - Executive Committee – 30 January – 6 March 2018


- Quality and Safety Committee – January 2018

Other minutes/action notes: - Health and Well Being Board – November 2017 and January 2018 (draft)

Joint Committee of CCGs – November 2017 The governing body: noted the papers and comments above.

Other business

03/18/19 Any other business Doug Soper reminded governing body members that online Conflict of Interest training was required to be completed (Modules 1 and 3) Gail Godson informed the group that Healthwatch Lancashire had not been successful in winning the contract from Lancashire County Council. People First will be commencing the contract from 1 May and some Healthwatch staff will be transferred to the provider. Gail felt confident that People First will continue to deliver the excellent work Healthwatch had done and thanked the governing body for its support. On behalf of the governing body and West Lancashire, John Caine thanked Gail for the input from Healthwatch. The governing body will write to People First to highlight the importance of having a local representation at meetings.

Meeting closed at 12.00 noon

Date and time to next meeting: 29 May 2018, 10.00 – 12.00 noon, Boardroom, Hilldale, Wigan Road, Ormskirk

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Agenda item no: WLCCGB

West Lancashire CCG Governing Body meeting Action sheet

Action Lead Date required by Action completed

03/18/09 Financial Plan 2018-19 The budget for suicide prevention is contained within other budgets, which cover this ongoing work. Paul Jones will discuss the location of this spend with Greg Mitten.

Paul Jones / Greg Mitten

22 May 2018

01/18/05 Chair’s update The suggestions of an oxygen register in practices and sending safety guidance to patients will be discussed in an executive committee, with the outcomes shared with the MDTs.

Rakesh Jaidka / Claire Heneghan

22 May 2018 The community respiratory team have undertaken safety checks on all patients except one. This had not been raised at

the respiratory meeting, but will be discussed with the respiratory team to

take forward at a meeting with Air Liquide UK. The fire service has the list

of patients using oxygen.

01/18/05 Chair’s update The Quit Squad, a Lancashire County Council stop smoking campaign, through Public Health England, offers to encourage patients to stop smoking and is available within 24 hours. This will be raised at Membership Council.

John Caine 22 May 2018

There will be an updated for the next Membership Council

01/18/07 Risk Management Process The Pan-Lancashire issue of deprivation of liberty (DoL), where no clear case management for individuals subject to a domestic DoL is in place, may result in safeguarding issues. The safeguarding team will report on the CSU data for West Lancashire at the next meeting to inform on the possible numbers in West Lancashire.

Claire Heneghan 22 May 2018

The figures are difficult to disaggregate. The safeguarding team will meet with

the CSU to gain a better idea of accurate numbers for West Lancashire.

01/18/07 Risk Management Process The CCG will attend the Sefton Health and Care

Paul Kingan 22 May 2018

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Transformation Programme Board tomorrow, which is a key meeting relating to Southport and Ormskirk Hospital, and the North Mersey Hospitals Transformation Joint Committee, which cover the other hospitals. An update to the governing body will be available for the March meeting.

01/18/08 Integrated Business Report (IBR) The Virgin Care contract monitoring is included in the IBR to provide assurance to governing body members and an update will be provided to the Membership Council.

Paul Kingan 22 May 2018 A&E data feeds into the IBR. Data from Walk In Centres will be available from

June via the community services.

01/18/08 Integrated Business Report (IBR) A report will be presented to the Executive Committee to provide an update on the national diabetes project and how it is working here compared to Sefton

Claire Heneghan 22 May 2018 A greater number of patients have signed up to the project in Sefton. A meeting with Southport and Formby

CCG will take place to ascertain what they are doing. It has been raised with

NHS England at the assurance meeting. The CVS would like to meet with the

team.

New action: It was suggested that January was a busy time for GP practices to respond to QoF requests, due to the effect of winter pressures. This will be raised at the STP.


Defer

New action: The lack of representation from LCC was raised. A presence is essential to provide high-level input.

Paul Kingan/ Sakthi Karunanithi

27 March 2018 Tony Pounder will be the new

representative from LCC from April 2018.

11/17/08 Integrated Business Report (IBR) Social care costs are split 50:50 between LCC and the CCG. The value of the 50%, which has not been paid by LCC, will be calculated.


LCC have started to pay invoices for some transforming care costs.

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11/17/08 Integrated Business Report (IBR) It was commented that a solution in the long-term would be for all agencies to be part of the same system, eg care homes, LD homes etc. This will be discussed in detail at a future Executive Committee / Board Development meeting.

Mike Maguire 27 March 2018 The Advanced Care Plan was discussed at the Board Development Session to

work on bringing neighbourhoods together. This will return to the

executive committee. One neighbourhood is doing something different and this item will return.

Charlotte McAllister is looking at care homes and the scheme is part of the

Frailty Group work.

11/17/06 Chief Officer’s update Quality: A breakdown to identify the specific areas where outpatient appointments are outstanding (RTT backlog), will be requested from the Trust. There will be a trajectory and a record of improvement.

Claire Heneghan 22 May 2018 NHS Improvement are leading this process with the Trust. There are

regular updates and discussions with the CCGs and there has been progress

to date, however certain specialities remain difficult to address as rapidly as anticipated. The report will be shared

with the executives for information.

09/17/16 Integrated Business Report (IBR) GP Assessment Unit is focussing on follow-up activity and not initial admission to hospital wards. The CCG business analyst is working on this issue and sharing data with Sefton. Paul Kingan will report back at the next meeting.

Paul Kingan 27 March 2018

This is part of expert determination. The result of this will determine if notice is given and PbR is used in the future.

WLCCGB 05/18/8

WEST LANCASHIRE CLINICAL COMMISSIONING GROUP GOVERNING BODY REPORT

DATE OF BOARD MEETING: 22 May 2018 TITLE OF REPORT: Risk Report BRIEFING POINTS:

Amendments to our Corporate Risk Register and Risk Report: Reviewed and updated our current risks

Does this report / its recommendations have implications and impact with regard to the following:

A. Commissioning Board’s Aims and Objectives

1. Quality (including patient safety, clinical effectiveness and patient experience) – please outline impact

No

2. Commissioning of hospital and community services – please outline impact

No

3. Commissioning and performance management of GP Prescribing – please outline impact

No

4. Delivering Financial Balance – please outline impact No

5. Development of the commissioning group as a commissioning organisation – please outline impact

No

B. Governance – please outline impact

1. Does this report:

• provide the Commissioning Board with assurance against any of the risks identified in the assurance framework (identify risk number)

• have any legal implications

• promote effective governance practice

Yes (positive impact) as it strengthens our governance practice and helps us identify opportunities to put relevant controls and measures in place

2. Additional resource implications (either financial or staffing resources)

Yes

3. Health Inequalities N/A

4. Equality and Inclusion and Human Rights Requirements – Has an Equality Impact and Risk Assessment been carried out?

N/A

5. Clinical Engagement Yes (through our GP leads

and Chief Nurse)

6. Patient and Public Engagement N/A

PAPER PREPARED BY: PAPER PRESENTED BY:

Smita Shetty, Service Redesign Manager (Corporate) Paul Kingan, Chief Finance Officer

Risk Report West Lancashire Clinical Commissioning Group Governing Body Meeting – 22 May 2018

Risk Register & Governing Board Assurance Framework Introduction This month’s report contains two aspects. Firstly it updates members on reviews which have taken place to further develop the risk management function within the CCG. Secondly, it fulfils its usual purpose of updating members on changes in the CCG’s risk profile, in terms of new and emerging risks, closed risks, and updates on actions taken to mitigate risks. The format has changed in certain respects as a result of the reviews, which are explained below.

Development Reviews Firstly an internal audit review of the Assurance Framework was undertaken. This recommended that the report to Governing Body should include a description of assurances (previously the Governing Body has just seen gaps in assurances, but members can now see the assurances themselves as well as any gaps. The report also listed several best practice suggestions that were considered as part of an in-house development review. The in-house development review was also held including the Chief Finance Officer, Service Redesign Manager, Quality Assurance Manager, Interim Project Support, CSU Risk Manager for Midlands and Lancashire, and CSU Senior Risk Officer. The actions thus determined were issued to all Executive Leads and Risk Leads and amended to reflect their input. Actions agreed were:

• Chief Finance Officer to speak to Chief Officer about means of raising the profile of risk management. This is to be consistent with the risk management strategy which deems risk to be ‘everyone’s business’.

• Align the Assurance Framework with corporate objectives. Chief Finance Officer to advise Interim Project Support on what corporate objectives to use pending a potential refresh of the strategic plan. Note that the attached appendix places risks under 4 categories to ensure adequate coverage of strategic and operational risks, again in accordance with the CCG’s risk management strategy. Three strategic themes have been adopted, based on themes used by NHS England. – these are Improving Health, Transforming Care, and Controlling Costs and Enabling Change. A fourth category of Managing Operations has been added to cover operational risks.

• Chief Finance Officer to discuss with Chief Officer a potential refresh of the strategic plan, to take account of Integrated Care Partnership work across organisational boundaries. This could then produce new corporate objectives to replace the 4 categories used in the interim.

• Develop target risk scores for each risk, to recognise that risk can be mitigated but never eliminated. These have been introduced in this report.

• Implement a chart showing movements in corporate risk scores over time ‘at a glance’. This has been introduced in this report.

• Taking the report to Quality and Safety Committee in future. It has been agreed that this report will go to each Quality and Safety Committee, to be presented by the Chief Nurse.

• Only risks scoring 12 or more to be reported to the Governing Body, in line with the risk management strategy. This has been implemented in this report.

• Clearly articulate assurances to be clear on scope, frequency, and reporting arrangements. Consider using the '3 lines of defence model', to consider assurances in 3 categories - management assurances, risk and compliance functions and independent internal audit. Further work is required on this with Risk Leads.

• Separate the GBAF (strategic risks to the achievement of corporate objectives) from the risk register (operational risks relating to ability to provide a service). This has been achieved in this report by the use of 3 strategic categories of risk and an operational category for operational risks.

• Consider the best means of handling project risks, so that the corporate risk register is not cluttered with numerous detailed project-specific risks, but it does include key higher-level risks related to projects and the Gov Body also has assurance that detailed project level risks are being managed appropriately. The Chief Finance Officer will give this further thought and make a recommendation to Clinical Executive Committee.

• Implement a cloud-based system for managing risk to give Execs and Risk Leads greater ownership of risk management and to streamline it. A group has been established to produce a risk

module of the project management toolkit used by the Programme Management Office (PMO). An initial meeting of this group has been established for Monday 14 May

Recommendations

• Members are required to comment on the helpfulness of the changes in this month’s report, specifically on a) the newly categorised corporative objectives b) the Risk Score Movement Chart (Appendix A) and the Heat Map (see Appendix B)

• Approve the recommended target risk score

• Receive (for information) the latest updates on corporate risks

Assurance Framework/ Risk Register Update The Board Assurance Framework (BAF) is a key part of the CCG’s governance arrangements. It is the principal way by which the CCG holds itself to account; it helps to clarify and quantify risks that could compromise delivery of our strategic objectives. The CCG Risk Register has been reviewed to reflect the up to date position as at May 2018. The CCG Risk Register has 22 risks (out of which 14 risks with a score of 12 and above) categorised as follows:

0 Low Risk Unlikely to cause problems 3 Moderate Risk Needs to be resolved or accepted at Departmental level

14 High Risk Needs to be resolved or accepted at Departmental level

5 Extreme Risk To be resolved or accepted at CCG Level There have been no emerging risks as at May 2018.

UPDATED RISKS Risk 35 Risk score 12 The CSU are currently scoping out using a desk top exercise as to how many patients may need screening against the ACID test criteria Risk 42 - Risk score 12 Continuous monitoring of financial position and take mitigating action when budgetary variances arise. Successful implementation of QIPP schemes - scrutiny via PMO system. Risk 50 - Risk score 16 Cases which require a Court of Protection (CoP) application are now being carefully measured against the Court of Protection prioritisation tool by the CSU. COP prioritisation tool developed to identify priority cases and agreed across Lancashire CCGs and the LA. This has resulted in an applied approach where known cases can be progressed through the court of protection based on presenting issues and urgency as well as available capacity. This should reduce some of the Section 21a challenges being managed within the CSU where patients are objecting to their placements or conditions that form part of their placements. Court of Protection (CoP) working group in place with CCG, CSU and LCC as core members. Risk 55 – this risk has also reduced in score now at Risk score 8 from 12. Work on Acute Sustainability Programme is ensuring that West Lancs patient flows are taken into account of. Risk 56 - NHS Digital have been tasked to roll out Windows 10 in practices. However, there is some conflict identified between the versions that CSU were rolling out and the one NHS Digital have at hand. Although staffing has been arranged for this project work, CSU are now carrying out an assessment this week; to identify whether the version that NHS Digital have a greater/lower level of security. Risk score has now gone down from 12 to 9 as NHS Digital are now looking into strengthening the IT security arrangements. Risk 58 - Risk score 16 Serious incident issue of backlog of outpatients has just been closed. Risk 62 – Risk score 12 The CCG needs to make arrangements for provision of prophylaxis in Care homes in the event of an outbreak. Policy and Procedure for provision of Anti-virals in the event of an outbreak at a Care home • Service provision to prescribe Anti-virals in the event of an outbreak at a Care Home. The CoP Coordinator has introduced a pilot process with the local authority DoLs manager to routinely screen CHC DoLS authorisations where there are conditions or recommendations identified.

NEW RISK

None

EMERGING RISKS

None CLOSED RISK Risk 63 - Winter reporting has been stood down by NHS England and therefore the system is returning to normal operations following the winter period. The Trust escalation level has returned to lower levels. The New CEO at S&O has outlined his priority areas for the summer and this includes an increase in medical staffing levels, therefore it is anticipated that plans to manage winter in 2018/19 will be in place by September 2018 at the latest.

APPENDIX A

APPENDIX B

Ris

k ID

Dat

e A

dd

ed

Description of Risk

Init

ial R

isk

Sco

re

Controls to Mitigate Risk

Cu

rren

t R

isk

Sco

re

Gaps in Control Measures

Assurance Source Gaps in Assurance

Sources Actions Required

Last

Rev

iew

Dat

e

Targ

et R

isk

Sco

re

Targ

et D

ate

Risk Lead Executive

Lead

Assurance

Status

CORPORATE OBJECTIVE 1 - IMPROVING HEALTH

CC

G6

2

15

.01

.20

18

Potential flu pandemic - Have sufficient service availability due to pressures caused by increased demand and reduced staff due to outbreak

16 • Flu plan in place including stocks of prophylaxis • Flu vaccine immunisation programme (high risk groups) • Staff immunisation • MOU with PHE • Escalation policy

12 Current staff shortages at local Trust which would be further impacted in the event of a pandemic The CCG needs to make arrangements for provision of prophylaxisis in Care homes in the event of an outbreak.

• Promote immunisation programme to increase uptake in both staff and at risk groups • Maintain communication links with local trust and PHE • System wide actions being discussed between North Mersey Acute hospitals which includes Southport & Ormskirk NHS Trust • Escalation policy Policy and Procedure for provision of Anti-virals in the event of an outbreak at a Care home • Service provision to prescribe Anti-virals in the event of an outbreak at a Care Home

04

.05

.18

6

31

.07

.18

Charlotte McAllister

Chief Nurse

CC

G6

5

22

.02

.18

IHAs not being consistently carried out within timescales will impact on a looked after child’s health needs not being identified, assessed and met in a timely manner.

16 Service specification in place with Community provider LCFT, which requires them to co-ordinate the health assessment process and to quality assure assessments. Exception reporting and case tracking meetings are being held monthly. Quarterly reporting based upon the quality and performance of KPI’s within the service specification.

12 Interdependencies with the Local Authority and the IHA process for example: health are dependent on LCC’s timely notification of child looked after

Permanence and Corporate

Parenting Board and CCG

safeguarding team

IHA are not consistently completed within statutory timescales

Monitoring exception reporting undertake audits to identify delays in the IHA process. Lancashire multi agency recovery action plan has been dissolved and functions and outstanding actions have been merged under the Permanence and Corporate Parenting Board which sits under LCC internal structures to strengthen accountability and governance. This development should mitigate against the gap in controls identified in respect to interdependencies between IHA and LCC.

02

.05

.18

9

01

.09

.20

18

Louise Burton

Ch

ief

Nu

rse

APPENDIX C

CORPORATE OBJECTIVE 2 - TRANSFORMING CARE C

CG

00

8

01

.04

.15

Lack of engagement of providers in the quality agenda leading to a lack of understanding and consistency between partners regarding outcomes of specific schemes.

16 CQPG has been reinvigorated but Trust Executive engagement from the Trust has been poor joint CQC action plan and risk summit and Executive Improvement Board has focussed the trust on more strategic quality issues

12

Significant issues are still regularly arising from the trust which are

causing the Quality Committee

concern

COPQ/EIB/Sefton transformation

board EIB main focus

quality issues with CHC/NHSE/NHS

and CCGs in attendance

Engagement of trust staff with GPs in our

membership. GP members at

CQPG

GP forum is no longer functioning GPS and CCG concerns are represented through the quality and contracting process Updates still continue to be given at membership via the Chairman's update Engagement of the trust staff and GPs is via the LDS discussions. Now escalated Quality Committee concerns formally to lead CCG for their onward transmission to CQC, NHSE and NHSi

04

.05

.18

8

01

/09

/20

18

Jackie Moran

Chief Nurse

CC

G6

4

23

.02

.18

The impact of quality issues and financial concerns resulting in home closures will impact the wider health care system in terms of loss of community beds required for identified groups of individuals. This is likely to result in delayed discharges, out of area home placements for West Lancashire residents and more costly placements.

15 The CCG current provide support to care homes in respect of quality; providing advice and guidance and some training. A quarterly forum has been established which promotes peer support, best practice, education and closer working. The CCG is working closely with LCC in respect of the Care Home agenda and involved in STP workstreams related to this area. Radar and QIP continue to be in place but the number of Homes subject to QIP is increasing. Implementation of the Enhanced Health in Care Homes (EHCH) framework is progressing.

15 The implementation of the EHCH framework is only partially implemented as at 23.02.18 Capacity to support increased numbers of QIPs may be limited.

Quality Committee The decision to close a home it outside the CCG’s control, however impacts residents and families. The CCG supports resident's and families to find new placements. Homes can decide to close for business reasons and quality issues may not be a factor, meaning the loss of beds from the system which are CQC rated as 'Good'.

• Full implementation of the EHCH framework • More visible executive support for the care home forum • Continue to build relationships with the care home sectors • Continue to work with partners to support Homes on Radar and QIP

03

.05

.18

12

01/

06/2

018

Alison Lumley

Chief Nurse

CORPORATE OBJECTIVE 3 - CONTROLLING COSTS AND ENABLING CHANGE

C

CG

29

31

.07

.14

IPA process - financial instability, increasing costs, and assurances on quality of assessments

16 Reviews of high cost complex cases. Examining the information MLCSU sends to CCG. Undertaking further training for GPs on process. Participation at IPA Programme Board meetings

12

None identified at present

The CCG participates in the Individual Patient

Activity (IPA) programme board which is a forum for raising issues

and scrutinising the CSU's service

delivery

Undertake reviews and complete training for GPs on process. CCG scrutinising the accuracy of the financial forecast and patient data produced by the CSU Developing new commissioning processes in partnership with CSU. The CCG accepted the CSU's QIPP proposal - this increased the capacity of the CSU IPA team and the frequency of case reviews but consideration needs to be given to how this scheme develops in 2018/19. The CCG is participating in a detailed review of the Detailed Service Offer (DSO) aimed at developing a new SLA to replace the 2013 DSO including prioritisation of what matters most to CCGs in delivering the programme within available budgets. This risk is considered at the Lancashire wide Collaborative Commissioning Board (CCB)

08

.05

.18

6

01

.09

.20

18

Paul Jones

Chief Nurse

CC

G4

2

30

.06

.15

Failure to Achieve Financial Balance 2018/19.

16 Robust financial controls (ledger) and budget setting. Finance Recovery plan in operation to bolster initial financial and QIPP plan.

12

Maintain an on-going review of

financial position. Monthly reporting

of position via Integrated Business

Report. Finance and QIPP

Committee.

Planned Care Budgets need careful

monitoring due to potential impact on

CCG financial position.

Continuous monitoring of financial position and take mitigating action when budgetary variances arise. Successful implementation of QIPP schemes - scrutiny via PMO system

08

.05

.18

31

.03

.19

Paul Jones

Chief Finance Officer

CC

G5

7

07

.09

.20

17

Inability to deliver corporate objectives as a result of budget cuts in Local Authorities (including £4M reduction in Public Health funding). This has impacted on the CCG in terms of services provided by the Local Authorities; reduction in capacity and knowledge and relationships with key stakeholders; thereby increasing demand and strain on NHS services. Consolidation of two WLCCG risks (38 and 43)

16 Chair of Health Well Being Board has written to the Secretary of State on behalf of the Board. Regular meetings with Public Health. There is joint work across Lancashire as part of the Healthier Lancashire STP plan to work towards better health and social care integration by 2020. This currently includes work as part of the Better Care Fund and also Learning Disability.

12 Implications of revised Lancashire County Council budget setting.

Clinical Executive Committee & Governing Body

None identified The Lancashire CCG's are developing their relationship with the Council, particularly in relation to the Better Care fund and the Delayed Transfers of Care Agenda. There is also much greater joint working as part of the Lancashire and South Cumbria STP which will is exploring new ways and opportunities of delivering the health and social care agenda in an integrated way. 14.03.18 - LCC have been providing financial support to CCG BCF schemes. 02.05.18 In addition to the BCF we are also working on the following workstreams - Population Health, Learning Disability, Children’s mental health, digital and regulated care.

02

.05

.18

9

On

goin

g

Paul Kingan

Chief Officer

CORPORATE OBJECTIVE 4 - MANAGING OPERATIONS C

CG

35

31

.10

.14

Services users are potentially at risk of harm due to unlawful deprivation of liberty within hospital care home and supported living following the Cheshire West judgement in March 2014.This is due to the backlog of referrals and limited resource available to deal with the increased demand due to the lowered threshold of the DoLS criteria. This is a national problem and legislation is not due to be reviewed until after 2019

12 LSAB MCA subgroup in place to ensure practice is consistent across Lancashire footprint. MCA/adult leads of CCGs providing expert advice and support around management of individual complex cases. Collaborative working with LCC around the use of the ADASS prioritisation tool. Collaborative working with CSU, CCG and LCC to develop COP prioritisation tool to identify potential domiciliary DoL's.

12 Timely notification and management of cases where application to Court of Protection may be required. The current CHC screening tool does not include a Promt to screen patients against the Acid Test criteria. The Adam system does not currently have a prompt to flag patients requiring DoLs authorisation.

CCG to determine which service is best placed to be commissioned to case manage CHC patients residing in their own homes and supported tenancy to ensure compliance with Cheshire West recommendations. There is no assurance currently around total number of patients who are unlawfully deprived of their liberty in care homes or Domicillary care settings

Close working relationships with CSU in the management Broadcare Reports. Seek assurance that the care and treatment plans for CHC commissioned packages of care have been reviewed and where a DoLS is identified least restrictive measures are in place. Work streams continue and the overall performance continues to be monitored. 05.03.18 Monthly meetings planned with CSU CoP Coordinator to scope out total number of domiciliary patients requiring an assessment against the Acid Test criteria 11.05.18 The CSU are currently scoping out using a desk top exercise as to how many patients may need screening against the ACID test criteria

02

.05

.18

6

01

.09

.18

Louise Burton

Chief Nurse

CC

G4

4

11

.08

.15

Risk of main acute provider failing to meet required levels of delivery and performance due to a number of issues including service quality, financial outlook and senior staff changes.

16 Discussions at Quality Committee Discussions with hospital chair and Board to Board meetings and Executive Improvement Board meetings. There is also a new governance structure for the health economy group working that facilitates better joint working for clinicians across sectors. NHSE & NHSI is now orchestrating more joint discussions and joint working to focus on a limited number of priorities to drive improved performance.

16

Performance data often retrospective and time lag exists. Queries and letters not responded to

on time.

CCG continues to meet regularly with

the Trust at a number of

meetings (around quality and contractual

performance), as well as a dedicated

health economy wide group which

meets regularly and looks at clinical

and financial sustainability of services going forward. This

includes NHSI, NHS England, the TDA and fellow CCG commissioners.

This work has been given a high

priority in each organisation.

As part of new arrangements, the

health economy has a new

governance structure for cross-

organisational working that

focusses on the key issues such as

frailty, urgent care and planned care

specialties.

Assurance around the impact of

solutions on West Lancs population

patient flows.

In addition to the regular formal meetings in respect of quality and contract performance, the CCG will continue to maintain involvement in the Executive Improvement Board which oversees a number of improvement actions including recommendations from the latest CQC report. The CCG will also ensure it can influence any future STP-wide work programmes in relation to acute care and associated formal decision-making.

04

.05

.18

12

31

.03

.18

Jackie Moran


CC

G5

0

16

.06

.16

There are no clear case management arrangements for those individuals who may be subject to a domestic DoL There is no oversight of individuals resulting in potential safeguarding risks and people being subject to an unauthorised DoL. There has been a reported increase of Section 21 A challenges ( challenge of a DoLs authorisation) across Lancashire which could be preventable and may result in increased costs to the CCG

16 The CSU have appointed a lead for quality and safeguarding to oversee arrangements for these individuals. CCG Safeguarding team are sited on identified cases and provide expert advise and signposting to legal team for Court of Protection referral. CSU have process in place to inform CCG as domestic DoL cases are identified. CHC documentation requires auditing to establish if it reflects robust screening against the Acid Test Criteria. Court of Protection (CoP) working group in place with CCG, CSU and LCC as core members. COP prioritisation tool developed to identify priority cases and agreed across Lancashire CCGs and LA. 08/05/18 Cases which require a Court of Protection (CoP) application are now being carefully measured against the Court of Protection prioritisation tool by the CSU. COP prioritisation tool developed to identify priority cases and agreed across Lancashire CCGs and the LA. This has resulted in an applied approach where known cases can be progressed through the court of protection based on presenting issues and urgency as well as available capacity. This should reduce some of the Section 21a challenges being managed within

16 No clear documented case

management. CSU System

requires strengthening in the identification

and communication of potential domestic

DoLS to the CCG CoP prioritisation

tool needs agreement from

WL CCG prior to its use CHC

documentation requires auditing /

amending to establish if it

reflects robust screening against

the Acid Test Criteria.

CSU have process in place to inform CCG as domestic

DoL cases are identified. CHC documentation

amended to reflect screening against

the Acid Test Criteria.

Need to determine if there are any Section

21 A challenges for WL CCG Resource

requirements need to be established. and await update

from CSU . The CCG resource

requirements need to be established.

CSU to establish resource requirements and determine if additional resource is required to reflect workload. Case management arrangements not yet agreed. Designated Lead Nurse for Safeguarding has requested an update from the CSU around total number of cases outstanding 22.12.17. No update provided as yet 22.02.18 No update provided as year. A meeting is arranged for 6 April between the CSU lead and CCG safeguarding leads to seek to improve information on potential DoLs. The risk may reduce following that meeting.

09

.05

.18

8

01

.09

.20

18

Lorraine Elliott

Chief Nurse

the CSU where patients are objecting to their placements or conditions that form part of their placements. Court of Protection (CoP) working group in place with CCG, CSU and LCC as core members. The CoP Coordinator has introduced a pilot process with the local authority DoLs manager to routinely screen CHC DoLS authorisations where there are conditions or recommendations identified

CC

G5

1

16

.06

.16

There are no quality assurance arrangements or contracts in place for individuals in receipt of a CHC funded domiciliary health package of care. The risk is a commissioning gap resulting in a lack of governance arrangements impacting from a safeguarding perspective. There is an increased risk of harm to individuals due to a lack of quality assurance.

20 Following the submission of a paper to the CCB July 2016 the work stream has been allocated to the Healthier Lancashire Group. Safeguarding team work closely with multi agency partners where there are identified safeguarding risks. CSU complex cases team sign off individual packages of care once a care plan has been presented and meets needs. CSU Safeguarding team work closely with multi agency partners. Quest 4 Care proposal trialled Pan Lancashire - joint health and social care contract management system trialled with a domiciliary care provider in collaboration with local provider. Intelligence available from Local Authority where there are safeguarding alerts raised. The pan Lancashire CCGs have agreed to fund the web-based quality monitoring tool for care homes in collaboration with the Local Authority. It is expected that the tool will be rolled out in the future to all domiciliary care providers. The CCGs will need to ensure there is a robust process in place for reviewing future quality submissions and determine who will be best placed to review them. It is anticipated that increased resources will be

16

Lack of governance arrangements when monitoring the ongoing packages of care or when an individual needs change. No obligation for Providers to submit quality data returns to the CSU or to provide assurance to Commissioners Progress update to be considered by CCG representative on the Collaborative Commissioning Board to determine further action

CSU Safeguarding team work closely with multi agency partners.

Limited resource available to provide the ongoing review of packages from the complex cases team.

Safeguarding team are sited on complex cases. Safeguarding team become involved when safeguarding risks become apparent. CCG representative on the Healthier Lancashire Work stream. Quest 4 Care will enable significant improvement in assurance regarding the service delivery. A senior clinical CCG representative will be engaged in the development of Quest for care and its application. 06.03.18 A case management pilot is being introduced in other CCGs with the CHC team to determine how risks can be managed more effectively. Progress of this to be reported and considered if appropriate for WL CCG

09

.05

.18

12

01

.09

.18

Lorraine Elliott

Chief Nurse

required to support this work.

CC

G5

8

07

.09

.20

17

Fragility of Hospital services relating to workforce recruitment and retention issues at the Trust. This includes Patient safety issues in relation to the Maternity Services, Cardiology, Radiology & Dermatology services at Southport and Ormskirk Trust and issues in respect of backlog of follow up patients.

20 Through Suitability & Transformation Plans, working practices are being reviewed and are encouraged to work strategically within their local health economy. Resource management, planning eventualities shared organisational actions, etc. are being drawn through these plans. Alternative providers being proposed to S&OHT to increase capacity with which to ameliorate position.

16 Timely recruitment and resource planning.

CCF discussions Contract meeting Information sub-group discussions Activity data received Serious incident issue of backlog of outpatients has just been closed.

Urgent cases have appointments scheduled. Alternative provider expanding services in Cardiology and diagnostics. Senior Service S&OHT Redesign Manager will update monthly. Operational Services Manager has been contacted with regards to monthly updates. Maternity Services issues being led by Cheshire & Mersey women's and children's Vanguard. Additional Heart Failure specialist nurse support has been provided by Mersey & Cheshire. Heart Failure Community service are struggling to in reach into the hospital

04

.05

.18

12

Jackie Moran

Chief Nurse

CC

G5

9

16

.11

.20

17

There is a risk of a gap in service for paediatric audiology due to the current provider serving notice on the service and the negotiated extension coming to an end.

16 Managerial discussions to extend the contract with S&OHT AO discussion with new provider CEO about expediting the negotiation and mobilisation of the new service Managerial discussion with peers at new provider to make this shift happen Letter to alternative provider's Executive to increase focus on this issue.

12 Dependent on capacity at the new provider who is currently mobilising another new service for another provider

Discussions with Provider Executives

Written confirmation of agreement ro provider service within financial envelope

Managerial discussions to extend the contract with S&OHT AO discussion with new provider CEO about expediting the negotiation and mobilisation of the new service Managerial discussion with peers at new provider to make this shift happen Letters to alternative providers executive to increase focus on this issue.

04

.05

.18

12

Jackie Moran


C

CG

60

17

.11

.20

17

There is a risk of a gap in some paediatric services as a result of due diligence undertaken by the Trust during procurement of community services which did not raise issues with the delivery of some paediatric service provision, these are now coming to light as patients present.

16 Urgent short term cover for these services are being put in place

12 Dependent on available skills and capacity of provider to respond to these gaps in service and cover these as quickly as required.

Agreement from alternative providers to provide service

We don’t know currently in what services there might also be a problem until they arise so the mapping of services must be undertaken urgently

Discussions with local providers to understand these gaps, how they have arisen and about how to cover these gaps in the short term Longer term mapping, modelling and re-procurement or paediatric services is urgently necessary to reduce this risk

03

.05

.18

8

Jackie Moran


Integrated Business Report West Lancashire Clinical Commissioning Group Governing Body – 22 May 2018

Agenda item no: WLCCGB 05/18/9

WEST LANCASHIRE CLINICAL COMMISSIONING GROUP GOVERING BODY REPORT

DATE OF BOARD MEETING: 22 May 2018 TITLE OF REPORT: Integrated Business Report BRIEFING POINTS: This report provides summary information on the financial

and activity performance of West Lancashire Clinical Commissioning Group for March 2018 and a financial position for April 2018. Quality and performance analysis is also provided for community based targets and for the Southport and Ormskirk Hospitals.




Yes

The report outlines quality and performance issues relevant to the CCG and describes key actions to address these.


Yes

The report includes financial and activity information in relation to commissioned services and highlights areas of risk and actions.


No

4. Delivering Financial Balance – please outline impact Yes

The report summarises the financial position of the CCG and highlights areas of financial risk.


Yes

This report will support the CCG in developing clear and credible plans.



• provide the Commissioning Board with assurance against any of the risks identified in the assurance framework



Yes

Links to financial risks.


No

3. Health Inequalities Yes

Links to health outcomes framework (all five domains)

4. Human Rights, Equality and Diversity Requirements No

5. Clinical Engagement No

6. Patient and Public Engagement No

REPORT PREPARED BY: Paul Jones, Head of finance REPORT PRESENTED BY: Paul Kingan, Chief finance officer

1 | P a g e

West Lancashire Clinical Commissioning Group Integrated Business Report

May 2018 (Reporting Period March 2018)

2 | P a g e

TABLE OF CONTENTS

1 Executive Summary 3

2 Financial Position 4

3 QIPP 7

4 Individual Patient Activity 8

5 Learning Disability and Transforming Care 9

6 Right Care 10

7 Planned Care: Referrals 12

8 Planned Care: eReferrals Service 14

9 Planned Care: Acute Contract 15

10 Unplanned Care: Acute Contract 17

11 Prescribing 19

12 Mental Health 21

13 Quality and Performance

a West Lancashire CCG Performance Dashboard 25

b Southport and Ormskirk Hospitals NHS Trust Integrated Performance Dashboard 29

c Areas of Under-Performance 30

d Patients Waiting by Weeks 34

f Friends and Family Test 36

g Safety Thermometer

37

14 Complaints

GP Comments, Concerns and Issues with Healthcare Providers 38

15 Serious and Untoward Incident Reporting

38

3 | P a g e

1. Executive Summary This report provides summary information on the activity performance of West Lancashire Clinical Commissioning Group for March 2018 and a financial position up to the March 2018 financial year end. Quality and performance analysis is also provided for community based targets and for Southport and Ormskirk Hospitals NHS Trust.

CCG Position Highlights

FINANCIAL PERFORMANCE Value

CCG Forecast Position (Surplus) £3.930m

Quantified Net Risks n/a

Risk Adjusted Forecast (Surplus) n/a

Better Payments Practice Code >95%

QIPP Forecast Savings (Plan £5.063m) £4.139m

DEMAND Footprint

GP referrals CCG Other referrals CCG

PLANNED CARE Total planned care PBR CCG UNPLANNED CARE Total unplanned care PBR CCG PRESCRIBING Prescribing Budget CCG

CCG Key Performance Indicators YTD

NHS Constitution indicators Footprint

RTT 18 Weeks wait (admitted) CCG

Accident and Emergency 4 hours CCG

Cancer Waits 62 days CCG

Ambulance Category a Calls CCG

Other key targets

Friends and Family CCG

MRSA attributable to CCG CCG

C. difficile CCG

Cancer 14-day urgent target –breast CCG

Key information from this report NHS West Lancashire CCG For the 2017/18 financial year the CCG has delivered a surplus of £3.930m, in line with that required by NHS England. The unaudited 2017/18 position is presented in this report. Indicative performance to the end of March 2018 against the planned care element of all contracts is under plan by £1215k. The performance over the same period against the planned care element of the Southport and Ormskirk Hospitals NHS Trust contract only is under plan by £1890k. Indicative performance to the end of March 2018 against the unplanned care element of all contracts is over plan by £3351k. Unplanned care performance for the same period against the Southport and Ormskirk Hospitals NHS Trust contract is over plan by £1720k.

Performance issues

The 4-hour Accident and Emergency target continues to be an issue with Southport and Ormskirk, Wrightington, Wigan and Leigh and Lancashire Teaching Hospitals NHS Trusts all failing the 95% target. The 12-hour Accident and Emergency Trolley Waits target has been exceeded at Southport and Ormskirk Hospitals NHS Trust – the main cause in December and January being insufficient bed availability. North West Ambulance Service have failed to meet the new ARP response time targets between August and January 2017/18.

Hospital Mortality measured by both SHMI and HSMR at Southport and Ormskirk Hospitals NHS Trust remains significantly above expected levels.

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2. Financial Position

For the 2017/18 financial year the CCG has delivered a surplus of £3.930m, £1k in excess of the target surplus

(£3.929m) required by NHS England.

Budget Expenditure Variance

£000 £000 £000

Acute services

Acute 73,758 77,587 3,829

Ambulance services 3,206 3,194 (12)

Sub-total Acute Services 76,964 80,781 3,817

Mental Health Services

Mental Health 11,442 11,228 (214)

Learning Difficulties 1,804 2,033 229

Sub-total Mental Health Services 13,246 13,261 15

Community Health Services

Community 17,105 16,201 (904)

Sub-total Community Services 17,105 16,201 (904)

Continuing Care Services

Individual Packages 8,202 9,428 1,226

Funded Nursing Care 1,332 1,218 (114)

Sub-total Continuing Care Services 9,534 10,646 1,112

Primary Care Services

Enhanced & Tier 2 Services 1,274 1,109 (165)

GP IT 658 640 (18)

Prescribing 19,163 18,555 (608)

Primary Care Co-Commissioning 13,675 13,101 (574)

Sub-total Primary Care Services 34,770 33,405 (1,365)

Other Budgets/Reserves

Running Costs 2,383 2,218 (165)

NHS Property Services 1,361 782 (579)

Urgent Care 3,851 4,044 193

Other Corporate Costs 1,027 881 (146)

Other Programme Services 1,512 1,921 409

Seasonal Resilience 0 0 0

Reserves (0.5% Non-recurrent) 751 0 (751)

Reserves (0.5% Contingency) 751 0 (751)

Reserves (Other) 1,819 0 (1,819)

Sub-total Other Programme Services 13,455 9,846 (3,609)

Total - Commissioning services 165,074 164,140 (933)

Planned Surplus 2,997 0 (2,997)

Grand Total 168,071 164,140 (3,930)

NHS West Lancashire CCG

Financial Position as at Month 12 (March) 2017/18

Full Year

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Key points to note are:

Acute Services – The year end position is based on Month 11 activity monitoring information. Consistent with

previous iterations it reveals significant overperformance with certain providers including Wrightington, Wigan and

Leigh NHS Trust (forecast £1.548m above budget), Aintree Hospitals NHS Trust (£833k) and St Helens & Knowsley

NHS Trust (£441k). It is probable that these variances represent a continuation of a shift in market share away from

Southport and Ormskirk Hospitals NHS Trust. For example Dermatology activity previously undertaken at Ormskirk

is now contributing to the overperformance at St Helens & Knowsley NHS Trust.

The monthly value of activity at Southport & Ormskirk Trust has been increasing in recent months, reducing the

underspend that was helping to offset the pressures on other contracts. As the Trust did not agree a 2017/18

financial control total with NHS Improvement, the CCG is however mandated to apply contractual sanctions for

non-delivery of certain performance targets. These amounted to be £1.141m for the entire financial year.

Alongside other local commissioners, the CCG disputed various charges (both historic and relating to the current

year) with Southport & Ormskirk Hospitals NHS Trust. For West Lancashire CCG, the total value of the disputes is

£2.378m. Though every effort has been made to resolve these issues locally, it has not been possible to reach

agreement. To ensure these issues are resolved, the disputes progressed to a process called ‘expert determination’.

At the time of producing a financial position for the unaudited accounts the outcome of this process was not known

and the CCG had to make asssumptions regarding this issue. The CCG is now in receipt of the outcome which is

largely consistent with the assumptions made for the unuadited accounts and therefore does not expect to have

to restate this position when the external audit concludes.

Individual Packages – The CCG is now forecasting a pressure of £1.226m. The CCG now funds 25 packages of care

with annualised costs in excess of £100k pa. The trend of the overall number of packages is slightly down over the

last 18 months – this would suggest that the average cost of a package has increased, potentially through

inflationary pressures and/or greater complexity of packages.

Funded Nursing Care – Expenditure for April to March is approximately 9% lower than budgeted; if this trend is

maintained this will deliver an underspend of £114k.

Prescribing – The CCG is reporting a surplus of £608k, based on data for the period from April to January. CCGs

nationally experienced a material and volatile financial pressure resulting from shortages of many generic

medications, with the impact to West Lancashire CCG estimated to be £597k. However, the encouraging

performance of the Prescribing QIPP has meant that this pressure has been absorbed within budgeted resources.

More detailed analysis of Prescribing expenditure is provided in Section 11.

Reserves 0.5% (Non-recurrent) – Consistent with NHS England’s planning guidance the CCG has set aside 0.5% of

its allocation as a contribution towards a national risk reserve of £830m. As happened in 2016/17, the CCG was

advised to release these funds in March resulting in an improvement to its financial position (compared to that

reported in February) of £0.752m.

Reserves 0.5% (Contingency) - As was the case for 2016/17 and previous years, the CCG created a 0.5% contingency

to manage in-year pressures and risks. Given the financial pressures that arose, the entire contingency was

deployed and the resultant underspend factored into the CCG’s forecast.

Reserves (Other) – This surplus, helping to offset the various financial pressures above, partly relates to a market

rent allocation the CCG has received. The CCG had already prudently budgeted for the associated costs. Additionally

£1m of transformation funding received from NHS England has been factored into this line.

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Allocated Resources The CCG’s annual budget for 2017/18 is £168.071m. This is derived as follows:

In addition to its duty on delivering a £3.930m surplus the CCG has other financial responsibilities: Better Payment Practice Code (BPPC)

The Better Payment Practice Code requires the CCG to pay valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later. The CCG’s target is for 95% of invoices (both by value and volume) to be paid within this criteria. Below is the 2017/18 cumulative performance against these requirements:

Cash Management

The CCG must not utilise more cash than it has available, both on a monthly and annual basis. It must manage its cash flow accordingly whilst ensuring there are sufficient funds available to pay suppliers and meet the BPPC targets listed above. NHS England issued the CCG with a Maximum Cash Drawdown (MCD) for 2017/18 of £164.709m. The CCG was instructed not to hold excess funds (i.e. a balance of over £138k) in its bank account at the end of the financial year. The actual balance was £7k.

£000

Initial CCG Programme Allocation 150,017

Initial CCG Running Cost Allocation 2,355

Business Rules - Co Commissioning 160

Winter Resilience 117

IR Changes (338)

HRG4+ changes (2,131)

2017-18 Primary Care Delegated budget 13,675

2016/17 Surplus/Deficit Carry Forward 1,584

Care Navigators and Medical Assistants Training 19

NHS WiFi 74

Market Rent Adjustment 862

Paramedic Rebanding Additional Funding 2017-18 22

HSCN - GP Funding 2

Transfer 17/18 for Minor Ailment Scheme (Pharmacy) 25

GP Access 2017/18 300

2017/18 Working at scale 113

CYP Crisis Acceleration Funding - North 162

Charge Exempt Overseas Visitor (CEOV) Adj (199)

Additional Winter Funding - (GP Winter Access Bid etc. ) 148

GPFV Online consultations - North cohort 1 28

Tranformation Funding 1,000

CYP IAPT trainee staff support costs 76

Total Resources (as at Month 12) 168,071

TargetCumulative

Performance to date

On Target for

Year End

Value 95% 99.80

Volume 95% 99.70

Value 95% 99.55

Volume 95% 99.35

NHS

Non-NHS

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3. QIPP Each year the CCG is required to balance the continually increasing demand for services with a finite amount of resources. Therefore, the CCG seeks to negotiate the best value for money it can achieve from its contracts, whilst also seeking to achieve Quality, Innovation, Productivity and Performance (QIPP) gains. These savings may be either cash releasing or non-cash releasing but need to have a recurrent effect if the CCG is to derive a sustainable financial benefit.

The CCG’s Financial Plan identified 8 QIPP schemes for 2017/2018. These had an aggregate value of £4.684m, with a further £0.379m being classed as ‘unidentified’, giving a total savings target of £5.063m. Two additional schemes (Ophthalmology and Estates) have been subsequently added to the Programme, but it is probable that some schemes will not deliver all planned savings. The CCG must therefore continue to devise schemes that drive efficiencies to enable it to deliver services within its allocated resources. A description, scheme leads, financial performance (expected savings compared to planned levels) and project status for each are shown in the table below.

Planned

Savings

Forecast

Savings

£k £k

1Community Procurement -

Impact on emergency activity

Redesigned community services will reduce

emergency admissions and A&E attendancesC Heneghan C Heneghan 1,000 500

New provider in period of 'safe transfer' prior to

transformation initiatives

2 PrescribingSavings from more efficient and effective

prescribing of medicinesN Baxter P Gregory 900 1,881

Medicines waste campaign operational in addition to

Prescribing for Clinical Need. Prescribing Ordering Direct

(POD) initiative commenced in Skelmersdale.

3Musculoskeletal Redesign

Project

Savings from avoided inpatient and outpatient

activityP Kingan P Gregory 982 982

Joint Health service operational & producing marked

reduction in elective activity. Oversight from Joint Health

Programme Board

4 Right Care

Savings identified from the Right Care

opportunities analysis (additional to schemes

separately identified)

J Moran C Heneghan 515 0Right Care data has been analysed. Potential

opportunities are being considered

5 Individual Patient Activity Reduction in CHC placement costs P Jones C Heneghan 470 200MLCSU have recruited staff and 48 patient reviews have

been completed.

6 Pain Management Redesign of service M Maguire V Mittal 377 0Procurement ongoing, financial impact now expected to

be in 2018/19

7 Discharge to AssessA greater proportion of assessments to be

undertaken in community based settings M Maguire C Heneghan 350 50 Scheme will require additional capacity

8 Contract ReviewReview of grants made to non-NHS organisations

to ensure alignment with CCG strategy

J Moran

J Rimmer90 90 Review completed

9 Ophthalmology

The CCG will be commissioning a community

Ophthalmology triage and treatment service

alongside re-commissioning macular services

M Greene

J Rimmer

V Mittal

R Jaidka0 0

Procurement process has concluded - the CCG has

awarded contract to 2 providers. Service to commence

April 2018.

10 EstatesRationalisation of CCG Estate to reduce charges

levied by NHS Property ServicesP Kingan J Caine 0 436

Cost reductions resulting from a review of NHS Property

Services charges

11 UnidentifiedSchemes must be identified in year in order to

bridge this financial gap in the QIPP plan379 0

Total 5,063 4,139

% Delivery

Update/Actions Pending

82%

Full Year

ID Scheme Name DescriptionManagerial

LeadClinical Lead

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4. Individual Patient Activity

Current Activity

Midlands and Lancashire CSU (MLCSU) provides commissioning support services on behalf of the CCG for Individual Patient Activity (IPA). The graph below itemises the spend for 2017/18 by categories of care and compares the spend to 2016/17. To the end of March 2018 total spend on Individual Patient Activity exceeds 2016/17 spend by 17.2%.

The largest spend by category is Continuing Healthcare, the table below illustrates the number and type of packages the CCG has been responsible for over the 12 months to March 2018. At March 2018, this amounted to 154 packages.

Retrospective Cases

On 15 March 2012, the Department of Health announced the introduction of deadlines for individuals to request an assessment of eligibility for NHS Continuing Healthcare (NHS CHC) funding, for previously unassessed cases during the period 1 April 2004 - 31 March 2012. Lancashire CCGs received almost 2,000 initial applications. In early 2015, NHSE instructed CCGs to provide an eligibility outcome on all cases received by March 2017, which was revised soon after to an earlier deadline of 30 September 2016. Because of this requirement the CCGs commissioned MLCSU to provide additional support to manage this caseload.

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MLCSU completed all 148 reviews relating to West Lancashire CCG by the 30 September deadline. However, work continues on disputes, complaints and Subject Access Requests received in relation to eligibility decisions.

5. Learning Disability and Transforming Care West Lancashire CCG commissions a range of learning disability care from various providers in different settings. There is a national effort to ensure individuals with learning disabilities can be cared for in the community rather than in hospitals. This work is driven by 48 Transforming Care Partnerships (TCP) which are made up of groups of Clinical Commissioning Groups. West Lancashire CCG is part of the Lancashire and South Cumbria TCP. West Lancashire CCG Transforming Care efforts are focused on 9 individuals. The information below reflects the situation as at 31/03/2018:

Learning Disability is an area of high cost for West Lancashire CCG:

Other IPA refers to individuals whose primary diagnosis is Learning Disability and have a funded package of care but these individuals are not covered by the Transforming Care Programme.

West Lancashire CCG contributes to a Learning Disability Pooled Budget operated by Lancashire County Council. This pooled budget purchases a range of services for residents with a Learning Disability in West Lancashire. Other community services contain elements of community Learning Disability services which are not included in the pooled budget – this is mainly children’s services.

Whalley Site Deficit Funding Mersey Care Whalley Site (formerly Calderstones) is now operated by Mersey Care NHS FT. As patients are being discharged, Mersey Care receives less income but cannot immediately reduce costs. This results in a budget deficit for the Mersey Care Whalley Site. Commissioners have agreed to fund this deficit each financial year (Heads if Terms Agreement). The total deficit value is divided by the number of CCG discharges in a year to calculate a ‘cost per discharge’. Each CCG then pays the product of the number of patients discharged in the financial year for which they are the responsible commissioner and the ‘cost per discharge’. In 2017/18, a total of 5 patients have been discharged by all commissioners. WLCCG has discharged 2 patients therefore resulting in a charge of c. £150k (ie 40% of the total cost). This cost has been offset with the CCGs share of national income to help manage the deficit.

Dowry Funding From November 2017, West Lancashire CCG became the responsible commissioner for a transforming care patient who no longer required services commissioned by the NHS Specialist Commissioning Team. As this individual had been

TC Patients Inpatient Community Discharged 2017/18

9 3 6 3

Description Inpatient Transition Community Various Dowry Total

TC Patients £1,415,439 £129,175 £397,436 £0 -£38,270 £1,903,780

Other IPA £0 £0 £0 £257,285 £0 £257,285

LD Pool £0 £0 £0 £944,868 £0 £944,868

Other Community Services £0 £0 £168,824 £0 £0 £168,824

Whalley Site Deficit Share £0 £0 £0 £0 £0 £0

Total £1,415,439 £129,175 £566,260 £1,202,153 -£38,270 £3,274,756

Financial Year 2017/18

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an inpatient for more than 5 years, a Dowry is applicable. A Dowry involves funding transferring from specialist commissioning to West Lancashire CCG to help cover the costs of this patient’s care. Dowry funding is recurrent. The pro-rata dowry funding applicable to the 2017/18 financial year has now been included in the table above.

6. Right Care RightCare is a national NHS supported programme, committed to delivering the best care to patients, ensuring NHS resources go as far as possible and improving patient outcomes. Ensuring patients access to the right care, in the right place and at the right time enables the NHS to treat patients more effectively, now and in the future. The central principle of RightCare is that it is unacceptable for there to be inconsistencies across the country in the types of care patients receive. By comparing the performance of an individual CCG with a group of ‘peer’ CCGs it is possible to identify the areas of care where a CCG is spending more than anticipated or that patient outcomes are inferior given their population demographics. Although RightCare can identify areas of inefficiency in commissioning by a CCG its findings are not definitive. Using leading edge medical evidence and delivering practical support helps local health economies understand how resources are allocated to deliver the best care across England. NHS West Lancashire CCG is in the second wave of RightCare rollout to Clinical Commissioning Groups. For NHS West Lancashire CCG, RightCare has allocated 10 CCGs regarded as peers based upon similar size and population demographic (see table below). This peer group is can change year on year, and NHS West Lancashire CCG have encountered significant changes between 2015/16 and 2017/18 financial years. The RightCare algorithm then aligns CCG spend using Programme Budget Categories and identifies areas where NHS West Lancashire CCG could potentially improve patient outcomes or reduce spend significantly. NHS West Lancashire CCG has been allocated a RightCare Delivery Partner, whose role is to support the CCG throughout the RightCare process.

Aligned with national requirements and informed by intelligence provided by the RightCare programme, CCG’s were initially asked to focus on 3 areas which are listed below. NHS West Lancashire CCG already were engaged in service developments in all three areas.

• Musculo Skeletal System – Elective Spend

• Neurological Problems – Primary Care Prescribing Spend

• Problems of the Respiratory System – Elective Spend and Primary Care Prescribing Spend

NHS West Lancashire CCG has been commended on its efforts in the progress it has made against the main RightCare priorities listed above and has since been looking into what additional opportunities there may be. Four areas were highlighted as potential opportunities to improve outcomes and/or reduce spend. They are as follows:

2015/16 Financial Year 2016/17 Financial Year

NHS Bassetlaw CCG NHS Bassetlaw CCG

NHS Newark and Sherwood CCG NHS Newark and Sherwood CCG

NHS South Cheshire CCG NHS South Cheshire CCG

NHS West Cheshire CCG NHS West Cheshire CCG

NHS Warwickshire North CCG NHS South Kent Coast CCG

NHS Vale Royal CCG NHS North Staffordshire CCG

NHS North East Lincolnshire CCG NHS Lincolnshire West CCG

NHS Thanet CCG NHS Hardwick CCG

NHS St Helens CCG NHS North Lincolnshire CCG

NHS South Sefton CCG NHS Hastings and Rother CCG

NHS West Lancashire CCG RightCare Peers

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• Gastrointestinal – we know there are opportunities, specifically around admissions but further analysis of appropriate data is required. The original Commissioning for Value packs were based on 14/15 data and the new Gastrointestinal focus pack is due to be received from the NHS England RightCare team at the end of May 2018. However, steps have been taken to improve services through the adoption of the Sefton dyspepsia pathway, led by clinical executive Dr Jack Kinsey.

• CVD – Non-Elective spend. When looking at the practice level data pack, the extent of opportunity in this area appears minimal. Further analysis of this will allow us to discover if there are any worthwhile opportunities which can be explored further.

• Excessive Menstruation/Total abdominal hysterectomy – the GP Federation are increasing the number of clinics (through the extended hours contract) to meet the needs of our local population. Southport and Ormskirk Hospitals NHS Trust have employed a specialist consultant to deliver menopause advice and treatment, which could help improve outcomes and reduce costs through utilising treatment options other than surgery where appropriate.

• Under 5’s Accident and Emergency attendances – a review of children’s services is underway. An initial scoping report on current services has been written and is currently being reviewed before agreeing next steps.

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7. Planned Care: Referrals

The following section provides an overview of referrals to Secondary Care up to the end of March 2018 comparing referrals activity for financial years 2016/17 and 2017/18. In all IBRs produced since November 2017 West Lancashire CCG have disregarded referrals to Physiotherapy from this analysis. Because this data is no longer being returned by Southport and Ormskirk Hospitals it will distort the overall picture. This approach is consistent with the referrals counting methodology (only measuring consultant led services) used by NHS England to monitor CCG performance. The clart below shows numbers of referrals for West Lancashire CCG across all Lancashire providers and Merseyside providers. Overall, there has been an increase of 1278 (2.35%) in all sources of referrals year to date compared to the same period last financial year.

GP referrals have reduced by 4.93%, a decrease of 1504 when comparing the same period 2016/17 to 2017/18. Significant in this reduction are the effects of Joint Health MCAS service and a requirement that all Orthopaedic Referrals to Secondary Care received after 30 October 2016 are triaged by this service. Across all providers GP referrals to Trauma and Orthopaedics have fallen by 39.51% (1121 referrals) when comparing April-March 2017/18 with the same period in 2016/17. If the effects of the Joint Health MCAS service are removed from GP referrals data, GP referrals have decreased by 383 across all providers. Hospital referrals have increased by 16.55% (2569 referrals). This considerable increase can be ascribed to Southport and Ormskirk Hospitals. This increase is of concern and additional work is required to identify the source of these referrals, and any activity and cost pressures caused by this activity. Other referrals have increased by 2.57% (213 referrals) which is not significant. It should be noted that NHS England monitors CCG Performance against GP written referrals made as recorded in the Monthly Activity Report (MAR) rather than using a local return (to MLCSU) for Lancashire and Merseyside providers. As of March 2018, the MAR Position for GP referrals for 2017/18 shows a 9.21% decrease compared to the same period 2016/17. The principal reason for this difference is that MAR only reports on referrals to consultant led services. An additional issue identified is that Ramsay Operations does not supply correct numbers of referrals to MAR and typically understates referrals by 30%. Ramsay has confirmed that their MAR return is incorrect and have explained the source of the error but have not indicated how they intend to correct this. Work is ongoing to align the two data sources to ensure consistent reporting in future reports. The remainder of comments in this section relate to data supplied by the MLCSU local return.

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West Lancashire CCGs’ main secondary care provider, Southport and Ormskirk Hospitals NHS Trust, has seen referrals decrease by 0.16% in all sources (526 referrals); GP referrals have decreased by 3081 (17.22%) compared to the same period last financial year. The overall market share in total referrals for Southport and Ormskirk Hospitals NHS Trust has decreased by 2.32% compared to the same period last year, while the market share for GP referrals has decreased by 7.59%.

The specialties with the most significant decreases in GP referrals at Southport and Ormskirk Hospitals are: Dermatology 59.0% decrease (1713 referrals); Ophthalmology 14.4% decrease (337 referrals); Midwife Episodes 61.3% decrease (184 referrals); General Surgery 14.3% decrease (162 referrals); Respiratory Medicine 26.3% decrease (159 referrals); Cardiology 18.1% decrease (129 referrals); Rheumatology 24.7% decrease (114 referrals); Trauma and Orthopaedics 14.4% decrease (82 referrals) and Urology 8.2% decrease (68 referrals). The decline in Dermatology referrals is related to restrictions being placed on the use of the eReferrals system for this specialty. Significant increases in GP Referrals at Southport and Ormskirk Hospitals are Clinical Physiology 20.2% increase (173 referrals) and Audiological Medicine 15.1% increase (72 referrals). Our second main provider, Wrightington, Wigan and Leigh NHS Foundation Trust, has seen an 3.14% decrease in GP referrals (85) from 2016/17 to 2017/18. The most significant decreases in GP referrals have been in Trauma and Orthopaedics 40.2% decrease (359 referrals); Oral Surgery 84.7% decrease (83 referrals) and Nephrology 95.0% decrease (19 referrals). The most significant increases were: Rheumatology 152.1% increase (108 referrals); Cardiology 72.7% increase (88 referrals); ENT 42.2% increase (57 referrals); Dermatology 95.2% increase (40 referrals); and Clinical Haematology 62.7% increase (37 referrals). Overall market share for Wrightington, Wigan and Leigh NHS Foundation Trust total referrals increased by 0.07% compared to same period 2016/17.

University Hospitals Aintree Trust has seen an increase in GP Referrals of 365 (28.1%) when compared to same period 2016/17. This is mostly attributed to Breast Surgery an increase of 43.9% (183 referrals); Cardiology an increase of 54.2% (45 referrals); Respiratory Medicine with an increase of 77.2% (44 referrals); Gastroenterology an increase of 70.6% (36 referrals); ENT with an increase of 34.9% (29 referrals); Clinical Haematology with a decrease of 53.3% (24 referrals); General Medicine with a decrease of 34.2% (13 referrals) and Endocrinology with a decrease of 7.9% (5 referrals). Overall market share for University Hospitals Aintree total referrals increased by 0.99% compared to the same period last year.

St Helens and Knowsley NHS Trust has seen an increase of 951 GP Referrals (100.7%) when compared to the same period last year. This is mainly attributed to Dermatology with 829 additional GP Referrals (355.8%); Breast Surgery with 40 additional GP Referrals (51.3%) and Gastroenterology an increase of 25 GP Referrals (192.3%). It is assumed that the increase in Dermatology referrals is related to the restrictions on GP referrals to the Dermatology service at Southport and Ormskirk Hospitals NHS Trust that became effective in February 2017. Overall market share for St Helens and Knowsley total referrals increased by 1.89% compared to same period 2016/17.

Ramsay Healthcare (mainly Renacres Hospital) has seen a decrease of 578 GP referrals (11.3%) for April-March 2017/18 compared to the same period in 2016/17. These decreases in referrals occurred mainly in Trauma and Orthopaedics with a reduction of 632 referrals (58.8%); General Surgery with a reduction of 125 referrals (21.5%) and ENT with a reduction of 42 referrals (10.5%). This is partially offset by an increase of 119 referrals in Pain Management (27.5%). Overall market share of total referrals for Ramsey Healthcare decreased by 1.26% compared to same period in 2016/17.

Referral Source 2016-17 2017-18 Variance Variance %

All 54302 55580 1278 2.35%

GP 30496 28992 -1504 -4.93%

Hospital 15519 18088 2569 16.55%

Other 8287 8500 213 2.57%

Comparison of Referrals Financial Year to Date 2016/17 to 2017/18 -March 2018

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8. Planned Care: eReferrals Service (previously Choose and Book) Performance for March 2018 shows a slight decline to 76.9% compared to the achievement of 81.6% in December 2018. This figure is below the 80% target which West Lancashire CCG were supposed to achieve by March 2017 to be eligible for the eReferral Quality Premium. For 2017/18 there is no financial incentive for West Lancashire CCG to achieve 80% of all GP Referrals being made via the eReferrals service. However, achievement of the target is still expected. The March 2018 figure for eReferrals is based upon weekly bookings data up to 31 December 2017 and monthly data for the period 01 January 2018 to 31 March 2018. It would appear that NHS Digital have stopped publishing weekly bookings data, intending to move over to a Power BI Solution. Because weekly data is subject to additional data cleansing it is possible that these Janaury to March positions will change – most probably downwards. The move to weekly data for November 2017 witnessed a fall of 3% from that measured using monthly data.

The eReferral Quality Premium for 2016/17 was designed to increase the proportion of GP Referrals made by eReferrals. The referral Quality Premium (QP) was worth £1 per head of patient population approximately £112k, and to be eligible NHS West Lancashire CCG had to meet a level of 80% by March 2017 (March 2017 performance only). The failure of West Lancashire CCG to achieve a 1% financial surplus for 2016/17 meant that Quality Premium payments were not appropriate. The 80% eReferrals target is to be measured by comparing all new eReferrals for outpatient attendances in a month (numerator) with the number of GP referrals (denominator) reported via the UNIFY Monthly Activity Report (MAR). To allow for dental activity the MAR GP Referrals in the denominator are reduced by 5.2%. eReferrals performance using these measures is shown as series 2015/16 and 2016/17 on the graph above. Work to meet the overall aims of improving the efficiency of referral processes for practices and local providers has continued. Input from the Health and Social Care Information Centre (HSCIC) has commenced and they are in the process of compiling reports to identify problem areas that can be addressed to improve eReferrals utilisation as reported using Monthly Activity Return (MAR).

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9. Planned Care: Acute Contract

All Providers

Performance up to the end of March 2018 against the planned care element of the contract is shown below. This shows the planned care element of the contracts is under plan by £1215k. The greatest variance is seen in Daycases (under plan by £750k), and Outpatient First Attendances (under plan by £463k). The greatest specialty level variance is Trauma and Orthopaedics with an underperformance of £913k across all providers.

Southport and Ormskirk Hospitals NHS Trust

Performance up to the end of March 2018 against the Planned Care element of the contract is shown below. This shows that the Planned Care element of the contract is under plan by £1890k, the most significant variance being in Daycases. The most significant variances within Daycases are Trauma and Orthopaedics with an underperformance of £240k; General Surgery with an underperformance of £214k and Pain Management with an underperformance of £213k.

All Other Providers

Performance up to the end of March 2018 against the Planned Care element of the contract is shown below. This shows the Planned Care element of the contract is over plan by £675k. The largest performance differences within this are Outpatient Procedures (overperformance of £303k) and Daycases (overperformance of £148k).

Plan Actual Variance Plan Actual Variance

Daycase 15365 14679 -686 £10,589,510 £9,839,850 -£749,660

Elective 2464 2282 -182 £7,008,924 £6,690,039 -£318,885

Elective Excess Bed Days 756 607 -149 £191,341 £146,367 -£44,974

Outpatient First Attendance 28804 25839 -2965 £4,829,110 £4,365,833 -£463,277

Outpatient Follow Up Attendance 67378 64022 -3355 £5,298,883 £5,032,262 -£266,621

Outpatient Procedure 29164 33898 4734 £3,973,534 £4,459,729 £486,195

Diagnostic Imaging 14245 15118 873 £1,253,971 £1,396,218 £142,247

Grand Total 158177 156445 -1732 £33,145,273 £31,930,298 -£1,214,975

Activity Cost

Point of Delivery (POD)

Planned Care to Month 12 (March) 2017/18 - All Providers


Daycase 8652 7698 -954 £4,844,170 £3,946,468 -£897,702

Elective 1091 972 -119 £2,667,527 £2,252,866 -£414,661

Elective Excess Bed Days 280 200 -80 £74,557 £48,417 -£26,140

Outpatient First Attendance 12763 10079 -2684 £2,169,623 £1,729,895 -£439,727

Outpatient Follow Up Attendance 33739 28818 -4921 £2,738,645 £2,354,359 -£384,286

Outpatient Procedure 20121 22350 2229 £2,693,662 £2,876,407 £182,745

Diagnostic Imaging 6688 7087 399 £557,609 £647,526 £89,917

Grand Total 83334 77204 -6130 £15,745,792 £13,855,938 -£1,889,854

Planned Care to Month 12 (March) 2017/18 - Southport and Ormskirk Hospitals


Activity Cost


Wrightington, Wigan and Leigh NHSFT 20220 20901 681 £4,647,942 £5,003,425 £355,483

Ramsay Operations (UK) 12463 12724 261 £3,611,251 £3,654,993 £43,742

Aintree University Hospitals NHSFT 12288 13472 1184 £2,249,632 £2,392,353 £142,721

Royal Liverpool and Broadgreen Hospitals NHSFT 7678 7905 227 £1,576,880 £1,459,774 -£117,106

St Helen's and Knowsley Hospitals NHSFT 6072 7554 1481 £1,242,920 £1,474,304 £231,384

Lancashire Teaching Hospitals NHSFT 4438 4968 530 £732,658 £910,547 £177,889

Other 11683 11717 34 £3,338,199 £3,178,964 -£159,234

Grand Total 74843 79241 4398 £17,399,481 £18,074,360 £674,879

Planned Care to Month 12 (March) 2017/18 - All Other Providers

Provider

Activity Cost

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Key Risks and Actions Although Planned Care is significantly below target at the end of March 2018 it should be noted that this saving is primarily at Southport and Ormskirk Hospitals with other providers overperforming significantly. Southport and Ormskirk Hospitals are under pressure to increase planned activity market-share, which may be a cost pressure in 2018/19. Concerns have been raised with Southport and Ormskirk Hospitals regarding the overperformance in Outpatient Procedures and Diagnostic Imaging combined with an underperformance in Outpatient First and Follow Up Attendances. Some issues have been identified with the planning process for 2017/18 which could have contributed towards this imbalance, while some changes to clinical practice have resulted in an increase in Outpatient Procedures. It should be noted that the structure of the 2017/18 tariff means that these movements between Outpatient Attendances and Outpatient Procedures are not financially significant. The overperformance at Wrightington, Wigan and Leigh Hospitals NHSFT is identified as occurring mainly in Trauma and Orthopaedics Elective activity, although there is a corresponding decrease in Daycase activity in this specialty. It is assumed this is a result of patient choice following patient assessment by the Joint Health MCAS service, it being assumed that patients requiring more complex procedures are choosing the specialist Orthopaedics Hospital. There appears to be a reduction in waiting times for patients being treated electively in this specialty. Both Wigan Borough CCG and Wrightington, Wigan and Leigh Hospitals NHSFT have been notified by letter of the requirement that all Orthopaedic referrals must be triaged and authorised by the Joint Health MCAS service.

The continuing overperformance at Lancashire Teaching Hospitals NHSFT is a concern and currently unexplained, the only suggestion from the host CCG being that planned Care has been overperforming as the Trust attempts to improve its RTT performance. The majority of this overperformance can be attributed to three specialties: Trauma and Orthopaedics; Breast Surgery and Plastic Surgery. Investigation should be carried out to ensure that all planned Trauma and Orthopaedic activity is being triaged by the Joint Health MCAS service. Overperformance at St Helens and Knowsley Hospitals NHSFT is in line with the increase in GP referrals over the previous 12 months and represents a market share shift from Southport and Ormskirk Hospitals NHS Trust mainly in Dermatology. Ramsay Operations are currently indicating a planned care overperformance. Analysis shows that this is occurring at the Fulwood and Euxton sites while there is an underperformance at Renacres Hospital. The activity growth at Euxton occurs mainly in Gastroenterology/General Surgery and has occurred since the planning period, it is suspected that prior to 2016/17 GPs were unable to refer Gastroenterology activity to Ramsay (although some came through as General Surgery). Combined with the additional activity there is evidence of a change to outpatient clinical coding which is driving additional Outpatient Procedure costs at Euxton and Fulwood. The overperformance issues have been raised with the host commissioner for Fulwood and Euxton (NHS Chorley and South Ribble CCG/ NHS Greater Preston CCG) with regard to a number of evident coding and counting changes.

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10. Unplanned Care: Acute Contract

All Providers

Performance up to the end of March 2018 against the Unplanned Care element of the contract is shown below. Overall, the unplanned care element of the contract is over plan by £3351k. This is caused by significant overperformance from Non-Elective Spells at £1990k over plan; the GP Assessment Unit at £818k over plan and Accident and Emergency which is £433K above plan. See below for variances for Southport and Ormskirk Hospitals NHS Trust.

Southport and Ormskirk Hospitals NHS Trust Performance up to the end of March 2018 against the Unplanned Care element of the contract is shown below. Overall, the unplanned care element of the contract is over plan by £1720k. The main cause of this overperformance is the GP Assessment Unit at £818k over plan and Non-Elective spells at £624k over plan.

The GP Assessment Unit began operating as part of the Accident and Emergency Department at Southport and Ormskirk Hospitals in April 2015. It is used by the Trust to assess patients and partly to manage the 4-hour waiting target in Accident and Emergency. Prior to implementation of this scheme, the Trust suggests that patients would have incurred both an Accident and Emergency attendance and a Non-Elective spell. Growth in GP Assessment Unit activity during 2016/17 and 2017/18 is primarily caused by the Trust chosing to categorise follow-up attendances as GPAU attendances (costing £625 each) rather than as Ward Attendances costing on average £60 each.


Accident and Emergency 32025 34601 2576 £4,238,493 £4,671,763 £433,270

GP Assessment Unit 721 2029 1308 £451,309 £1,269,414 £818,105

Non-Elective 9025 9060 35 £15,975,420 £17,965,390 £1,989,970

Non-Elective Short Stay 1002 1089 87 £730,092 £804,189 £74,097

Non-Elective Same Day Emergency Care 773 818 45 £576,713 £619,578 £42,865

Non-Elective Excess Bed Days 4734 4225 -509 £1,139,281 £998,924 -£140,358

Non-Elective Non-Emergency 1310 1386 76 £3,058,015 £3,190,916 £132,901

Non-Elective Non-Emergency Excess Bed Days 113 176 63 £39,236 £47,317 £8,081

Grand Total 49590 53208 3618 £26,169,322 £29,520,173 £3,350,851

Unplanned Care to Month 12 (March) 2017/18 - All Providers


Activity Cost


Accident and Emergency 24814 26345 1531 £3,314,363 £3,620,599 £306,236

GP Assessment Unit 721 2029 1308 £451,309 £1,269,414 £818,105

Non-Elective 7059 6550 -509 £11,743,766 £12,367,628 £623,862

Non-Elective Short Stay 644 628 -16 £442,985 £449,803 £6,818

Non-Elective Same Day Emergency Care 549 485 -64 £411,828 £378,062 -£33,766

Non-Elective Excess Bed Days 3940 3605 -335 £944,470 £850,561 -£93,909

Non-Elective Non-Emergency 1115 1180 65 £2,558,675 £2,647,391 £88,716

Non-Elective Non-Emergency Excess Bed Days 105 152 47 £36,320 £40,696 £4,375

Grand Total 38947 40974 2027 £19,903,716 £21,624,154 £1,720,438

Unplanned Care to Month 12 (March) 2017/18 - Southport and Ormskirk Hospitals


Activity Cost

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All Other Providers Performance up to the end of March 2018 against the Unplanned Care element of the contract is shown below. Overall, the Unplanned Care element of the contract is over plan by £1630k. The most significant variance amongst the major providers is general overperformance at Wrightington, Wigan and Leigh NHSFT which is £884k over plan. Aintree University Hospitals NHSFT are over plan by £363k and St Helens and Knowsley Hospitals NHSFT are over plan by £185k.


Wrightington, Wigan and Leigh NHSFT 5190 6071 881 £2,732,432 £3,616,110 £883,678

Aintree University Hospitals NHSFT 1629 2261 632 £1,063,964 £1,426,963 £362,998

Lancashire Teaching Hospitals NHSFT 916 840 -76 £581,701 £581,139 -£562

Royal Liverpool and Broadgreen Hospitals NHSFT 866 783 -83 £492,464 £570,581 £78,117

St Helen's and Knowsley Hospitals NHSFT 487 786 299 £234,770 £419,278 £184,508

Other 1669 1669 -0 £1,165,316 £1,286,162 £120,846

Grand Total 10756 12410 1654 £6,270,646 £7,900,231 £1,629,585

Unplanned Care to Month 12 (March) 2017/18 - All Other Providers

Provider

Activity Cost

*Includes points-of-delivery as per Tables 3a and 3b

Key Risks and Actions

The overperformance recorded for the GP Assessment Unit at Southport and Ormskirk Hospitals was part of the ‘Expert Determination’ dispute resolution exercise, the finding being predominantly in favour of the commissioners The financial position in this IBR reflects the Trust position prior to the expert determination findings. NHS West Lancashire CCG believe the value of actual GP Assesment Unit activity should be reduced by £648k to take account of these findings. Although the current issue of follow-up attendances has been resolved, care must be taken regarding 2018/19 contract setting and monitoring to ensure that the Trust do not attempt to use the reconfiguration of Accident and Emergency services to move further PbR activity onto a higher Non-PbR tariff. In March 2017 NHS England mandated changes to the coding of hospital spells where sepsis occurred, this coding change being adopted by the majority or acute providers has resulted in an increase in HRG severity and concequent increase in income for Acute Trusts. Following a request for clarification from CCGs, England mandated that this change should be treated as a Code of Conduct change and be cost neutral for 2017/18. NHS West Lancashire CCG have agreed with Southport and Ormskirk Hospitals that the cost implication of these changes will be £90k for 2017/18; however, the Trust are reluctant to adjust the contract monitoring figures. There are smaller adjustments regarding other providers, although these are still not agreed with the providers or the host commissioners. The overperformance in Unplanned Care activity at Wrightington, Wigan and Leigh Hospitals is of concern and should be investigated in detail. The cost of emergency admissions at this Trust is overperforming by 37.2% while Accident and Emergency attendances at this Trust have only increased by 9.8%. Basic analysis of the overperforming HRGs indicates that sepsis could be a partial factor in this. The overperformance at Aintree Hospitals NHS Trust appears to be driven by an increase of 26% in Accident and Emergency attendances, and a corresponding increase in emergency admissions. The cause of the increase in Accident and Emergency attendances should be investigated further, as this is a significant increase over plan. Stroke care is significant amongst the conditions with an emergency overperformance, and this may be driven by the diversion of stroke patients from Southport Hospital Accident and Emergency to Aintree during periods when the Trust is unable to provide appropriate care. It would seem reasonable to infer that Unplanned Acute Care is migrating from Southport and Ormskirk Hospitals to neighbouring trusts and the reasons for this should be investigated further. .

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11. Prescribing

To address the West Lancashire CCG Medicines Management duties as defined by the National Prescribing Centre’s Medicines Management Competency Framework, West Lancashire CCG has set up a Medicines Management Committee (MMC). The MMC’s remit encompasses all systems, policies and procedures designed to ensure the safe, secure and cost-effective use of medicines.

For financial year 2017/18 West Lancashire CCG prescribing spend is £611k below budget (3.58%). This is based upon an annual budget of £18,661,414 which has been phased to correspond with dispensing days in each calendar month. This budget includes a £900k QIPP reduction.

West Lancashire CCGs’ prescribing spend to the end of February 2017/18 is significantly lower, £546k (3.21%), than the corresponding period in 2016/17.

A national reduction in the costs of medicines covered by Category M has been announced from August 2017. The CCG was initially informed that the benefit of these price reductions would be retained nationally by NHS England rather than reducing costs to CCGs to create a ‘system risk reserve’. However a change in policy late in the financial year meant that CCG’s would indeed reflect the impact of these cost reductions in their financial position. Further to this, the CCG is being adversely affected by shortages of multiple generic medications. The shortage of generic versions results in the CCG paying a higher price for these medicines. It is estimated that the financial pressure to the CCG in 2017/18 arising from generic shortages is £597k higher than the financial pressure in the previous year.

Budget Spend Variance Variance %

Blackburn with Darwen £21,667,615 £23,477,935 £1,810,320 8.35%

Blackpool £30,160,650 £29,138,584 -£1,022,066 -3.39%

Chorley and South Ribble £24,562,823 £25,016,511 £453,688 1.85%

East Lancashire £58,293,299 £54,809,350 -£3,483,948 -5.98%

Fylde and Wyre £25,581,931 £25,140,025 -£441,906 -1.73%

Greater Preston £28,608,186 £29,168,569 £560,383 1.96%

Morecambe Bay £50,148,977

West Lancashire £17,065,372 £16,453,941 -£611,431 -3.58%

Grand Total £205,939,875 £253,353,893 -£2,734,959 -1.33%

CCG Spend Year to Date - February 2017/18

CCG

Morecambe Bay excluded from variance calculations owing to absence of a budget

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The Medicines Waste Campaign continues to progress, repeat prescription review services are being introduced (PODS) and the prescribing of ‘self-care’ medicines is being limited. The CCG has also benefited from a significant price reduction in Pregabalin effective from August. The combination of the medicines management team’s efforts and the windfall Pregabalin saving mean that the CCG can more than offset the cost pressures discussed. The CCG is forecasting a prescribing underspend of £498k in 2017/18. The table below shows the average prescribing cost year to date per APU (Astro Prescribing Unit – a weighted population to take account of the differing prescribing costs with age and gender) for Lancashire CCGs. West Lancashire CCG has the third lowest cost per APU of the eight Lancashire CCGs and has also demonstrated the third smallest increase in spend per APU across the region.

The table below details the total spend and spend per APU for each GP Practice up to February 2018 along with comparative figures for the same period 2016/17.

2016-17 2017-18 Variance

Blackburn with Darwen £43.85 £41.69 -4.92%

Blackpool £45.14 £44.01 -2.50%

Chorley and South Ribble £38.31 £36.37 -5.07%

East Lancashire £43.01 £40.19 -6.55%

Fylde and Wyre £39.41 £38.17 -3.15%

Greater Preston £41.32 £39.31 -4.86%

Morecambe Bay £38.88 £34.78 -10.54%

West Lancashire £39.70 £37.37 -5.86%

Spend per APU Year to Date - February 2017/18

CCG

Spend

Spend

per APU Budget* Spend Variance

Spend

per APU

P81201 Ashurst Primary Care £602,238 £37.44 £606,275 £639,071 £32,796 £39.52

P81695 Aughton Surgery £803,954 £33.46 £806,986 £804,226 -£2,760 £33.24

P81112 Beacon Primary Care £2,223,456 £55.11 £1,988,442 £2,177,905 £189,463 £53.58

P81138 Burscough Family Practice £422,455 £34.86 £426,471 £421,702 -£4,770 £34.89

P81727 County Road Surgery £367,052 £46.09 £368,578 £387,681 £19,104 £49.02

P81136 Dr A Bisarya £373,529 £37.12 £377,671 £377,700 £29 £37.25

P81084 Hall Green Surgery £1,212,398 £39.49 £1,219,707 £1,169,362 -£50,345 £38.27

P81646 Lathom House Surgery £761,121 £42.40 £764,794 £747,230 -£17,563 £41.63

P81039 Manor Primary Care £629,065 £39.75 £636,240 £672,402 £36,162 £41.54

P81758 Matthew Ryder Clinic £357,645 £35.31 £361,478 £352,023 -£9,455 £33.02

P81772 North Meols Medical Centre £429,666 £30.63 £669,256 £282,458 -£386,798 £20.65

P81014 Ormskirk Medical Practice £1,535,068 £40.23 £1,539,225 £1,485,355 -£53,870 £38.59

P81096 Parbold Surgery £996,605 £33.71 £1,012,195 £1,019,593 £7,398 £34.24

P81041 Parkgate Surgery £966,455 £33.58 £977,590 £990,375 £12,785 £33.96

P81208 Skelmersdale Practice £2,017,561 £39.97 £2,039,216 £1,934,332 -£104,884 £38.72

P81674 Stanley Court Surgery £824,254 £38.21 £834,636 £814,195 -£20,441 £37.16

P81710 Tarleton Group Practice £1,147,645 £35.18 £1,156,586 £1,162,343 £5,756 £34.33

P81045 The Elms Practice £781,948 £31.92 £784,044 £684,268 -£99,776 £30.19

P81177 Viran Medical Centre £356,297 £32.48 £356,426 £232,932 -£123,494 £23.69

West Lancashire CCG Prescribing Performance 2017/18 to February 2018

'*Budget to February 2018 is calculated as 91.45% of the 2017/18 annual budget for Prescriber - Based upon number of prescribing days.

Table does not include all prescribing spend and budget - only active GP Practices are included.

2016/17 2017/18

Prescriber NameCode

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12. Mental Health Lancashire Care Foundation Trust The contract value for Lancashire Care Foundation Trust (LCFT) mental health services is £10.0m. The LCFT contract is for a range of mental health services such as rehabilitation; community mental health teams; hospital liaison; memory assessment; CAMHS child psychology and prison in-reach. Below is activity for 2017/18 by month up to the end of March 2018.

Dementia

For 2016/17 the Dementia Diagnostic Rate Target was monitored against a fixed estimate of the number of patients with dementia (Prevalence), this figure is based upon population profile. For 2016/17 this figure was estimated at 1483 patients. For 2017/18 a planning figure of 1426 patients was used. However, rather than monitoring against this figure, NHS Digital is monitoring against an estimate of Prevalence based on the current CCG registered population. The CCG Diagnostic Rate Target is that at least 67% of patients with dementia have been diagnosed. Because the population with dementia suffers significant mortality it is necessary to maintain referrals to the Memory Assessment Service (MAS) to ensure that the CCG Diagnostic Rate Target is maintained. The table below shows performance against the CCG Dementia Diagnostic Rate Target.

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

ADHD Contacts 55 39 37 51 51 16 37 49 41 62 31 35 504

Adult Ward Occupied Bed Days 307 290 236 274 220 312 338 307 240 175 155 266 3,120

Adult/PICU Ward Admissions 6 12 6 9 9 6 9 1 4 10 3 8 83

Adult/PICU Ward Discharges 5 14 7 7 7 7 5 4 6 10 3 6 81

CMHT - Older Adult Referrals 1 9 4 1 6 0 6 0 4 3 3 7 44

CMHT - Older Adult Contacts 128 157 138 165 121 134 141 114 117 161 130 133 1,639

CMHT - Adult Contacts 703 921 918 898 992 900 863 909 755 979 830 776 10,444

CMHT - Adult Referrals 13 7 4 11 11 14 2 10 8 11 7 8 106

Community Restart Teams - Accepted Referrals 0 0 0 0 0 0 0 1 1 0 0 0 2

CRHT Face to Face Contacts - 18 to 65 207 154 206 201 247 226 184 234 162 187 132 160 2,300

CRHT Face to Face Contacts - Below 18 3 6 3 4 1 9 6 2 7 1 2 4 48

CRHT Face to Face Contacts - Over 65 24 25 13 6 13 0 8 13 0 0 1 2 105

CRHT Teams - Referrals 34 40 43 31 35 38 45 36 30 48 32 40 452

CRHT Telephone Contacts - 18 to 65 99 101 91 122 107 101 77 97 100 87 92 111 1,185

CRHT Telephone Contacts - Below 18 2 7 3 2 4 3 1 1 2 1 1 1 28

CRHT Telephone Contacts - Over 65 9 18 5 1 2 2 0 0 0 0 0 3 40

Criminal Justice Liaison - Contacts 17 24 27 27 9 8 20 13 16 19 14 25 219

Eating Disorder Service - Contacts 28 19 40 51 26 23 30 25 21 51 37 41 392

Eating Disorder Service - Referrals 3 8 8 9 5 6 9 5 11 9 9 12 94

Eating Disorder Service DNAs - Follow Up Contacts 1 1 2 1 0 1 3 2 0 4 1 4 20

Eating Disorder Service DNAs - New Contacts 0 0 0 1 2 0 0 1 2 0 4 1 11

Hospital Liaison Contacts 0 0 1 0 3 0 2 5 0 0 2 0 13

Hospital Liaison Referrals 0 0 0 0 1 0 1 1 0 0 1 0 4

MAS Teams - Contacts 512 758 472 397 436 352 354 446 307 483 456 444 5,417

MAS Teams - Referrals 29 45 54 42 52 33 28 47 28 46 37 49 490

Older Adult (Dementia) Inpatient Ward Discharges 1 0 0 0 0 0 1 2 1 0 0 1 6

Older Adult (Dementia) Ward Occupied Bed Days 23 32 63 62 55 86 91 72 13 20 28 21 566

Older Adult (Dementia) Inpatient 90 Day ReAdmissions 0 1 0 0 0 0 0 0 0 0 0 0 1

Older Adult (Dementia) Inpatient Ward Admissions 0 2 1 0 1 1 0 0 0 1 0 1 7

Older Adult (Functional) Inpatient Ward Discharges 0 1 1 0 3 1 1 0 0 0 2 1 10

Older Adult (Functional) Ward Occupied Bed Days 94 64 81 93 108 55 37 30 31 58 65 88 804

Older Adult (Functional) Inpatient Ward Admissions 0 0 1 0 1 0 1 0 0 0 1 0 4

PICU Ward Occupied Bed Days 60 72 66 44 52 30 13 49 72 56 43 557

PICU Wards - Transfers In 0 3 3 1 0 0 0 1 2 1 0 0 11

RITT Contacts 12 5 4 491 617 542 496 513 463 574 556 569 4,842

RITT Referrals 2 2 0 0 2 1 4 9 1 0 2 1 24

Year to

DateMetric

Quarter 1 Quarter 2 Quarter 3 Quarter 4


Diagnosed Patients 1039 1053 1070 1065 1063 1056 1060 1074 1080 1072 1094 1066

Estimated Prevalence 1426.6 1432.7 1438.9 1405.6 1409 1415 1415 1423.8 1426.3 1428 1465.2 1459

Demantia Diagnosis Rate 72.81% 73.50% 74.36% 75.77% 75.44% 74.63% 74.91% 75.43% 75.72% 75.07% 74.67% 73.06%

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West Lancashire CCG is holding a strong position against the target of 67% for Dementia Diagnosis Rate. It should be noted that these numbers are from the NHS Digital web site and are adjusted for any GP Practices where monthly diagnosis data is not available. To obtain a diagnosis of dementia for a patient it is necessary for GP practices to refer patients to the Memory Assessment Service (MAS) operated by Lancashire Care Foundation Trust. For West Lancashire CCG MAS waits have begun to reduce dramatically recently due to the older adult service stopping unnecessary annual reviews and, as of week commencing 8 May, anyone referred to the MAS will be offered an appointment within two weeks. This will be the best performance in Lancashire. The table below summarises MAS performance for West Lancashire CCG patients in 2017/18.

Practice Level Information

Practice level diagnosis rates are no longer produced by NHS Digital but provide a useful guide to progress against target. They indicate practices where the diagnostic rate is lower than anticipated which could indicate a lower than normal rate of referral to the MAS. To carry out this analysis the percentage of the CCG over-65 population registered with each practice is used to factor the CCG level of prevalence.

Memory Assesment Service Metric Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Number of referrals to MAS 29 42 54 42 52 33 28 47 28 45 37 49

Number of referrals accepted by MAS 26 42 50 40 51 33 24 46 27 45 35 46

Number of referrals rejected by MAS 3 0 4 2 1 0 4 1 1 0 2 3

Number of assesments by MAS 20 33 30 36 37 36 26 26 28 46 27 29

Average (mean) wait to assesment (weeks) 3.4 2.3 2.6 2.9 2.8 2.9 2.6 3.0 3.4 3.9 3.1 2.9

Waiting list at month end 19 20 36 31 36 30 23 30 30 33 24 39

Average (mean) wait to diagnosis (Weeks) 20.3 21.3 17.3 21 21 26.2 16.4 17.4 23.4 20.6 18.2 12.3

Number diagnosed 20 35 29 23 14 19 16 30 32 27 27 21

Number diagnosed with dementia 17 24 24 18 10 11 14 21 19 15 18 11


Patients

Aged 65 Yr+

% of CCG

Patients 65+

Share of CCG

Prevalence

Diagnosis

Rate %

Beacon Primary Care 140 137 138 138 142 185 188 194 191 186 181 172 2500 11.04% 161.03 106.81%

Parkgate Surgery 120 122 121 125 123 126 125 128 131 128 126 122 1790 7.90% 115.30 105.81%

Ormskirk Medical Practice 124 124 131 131 132 132 131 134 136 134 137 138 2290 10.11% 147.50 93.56%

Lathom House Surgery 48 49 48 49 46 48 48 50 49 50 51 50 1004 4.43% 64.67 77.32%

Aughton Surgery 64 67 66 68 67 67 68 67 66 65 64 64 1311 5.79% 84.44 75.79%

The Elms Practice 56 57 56 58 57 58 59 58 58 60 61 60 1261 5.57% 81.22 73.87%

Hall Green Surgery 80 82 82 84 86 83 81 82 83 81 83 78 1744 7.70% 112.33 69.44%

Ashurst Primary Care 26 28 29 29 0 26 27 28 30 30 30 28 643 2.84% 41.42 67.61%

Burscough Family Practice 33 33 32 32 33 34 33 35 35 33 34 32 736 3.25% 47.41 67.50%

Dr A Bisarya 0 0 0 0 0 0 0 0 0 0 20 22 539 2.38% 34.72 63.37%

Skelmersdale Practice 79 78 79 85 84 84 88 89 92 89 90 84 2061 9.10% 132.75 63.28%

County Road Surgery 14 14 15 14 14 14 15 16 16 15 14 14 377 1.66% 24.28 57.65%

Stanley Court Surgery 42 43 44 45 45 42 41 39 41 42 42 42 1177 5.20% 75.81 55.40%

Matthew Ryder Clinic 14 13 16 16 16 16 17 17 16 16 17 17 483 2.13% 31.11 54.64%

Parbold Surgery 56 61 60 56 56 57 56 54 54 55 55 53 1681 7.42% 108.28 48.95%

Viran Medical Centre 18 20 21 21 21 20 19 19 18 18 18 18 588 2.60% 37.87 47.53%

Tarleton Group Practice 41 40 44 45 46 46 46 46 48 54 55 56 1839 8.12% 118.45 47.28%

Manor Primary Care 21 21 20 21 19 18 18 18 16 16 16 16 627 2.77% 40.39 39.62%

Number of Registered over 65 Patients with a Dementia Diagnosis 2017/18 Performance as of March 2018

GP Practice

GP List Size as of March 2018

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Care Programme Approach (CPA) follow-up within 7 days

Research demonstrates that patients are more likely to commit suicide in the immediate days following discharge from a Mental Health Acute bed. Therefore, discharge is followed up with a meeting with a Mental Health Professional within 7 days of discharge to reduce this risk. (LCFT have a desirable 48-hour target). The national target is that 95% of all discharged patients are seen within 7 days. The table below summarises Lancashire Care Foundation Trust activity for West Lancashire CCG patients during 2017/18. West Lancashire CCG failed the 95% target in June, July, November and December 2017 due to a single person not receiving follow-up within 7 days. The low numbers being discharged will mean that even one fail will mean NHS West Lancashire CCG will fail the national target.

Adult Psychological Therapy (Mindsmatter) For Adult Psychological Therapy, the number of patients with a need (Prevalence) is estimated at 13908. This is defined as the number of West Lancashire CCG patients who have depression and/or anxiety disorders. This is a local estimate based upon the Psychiatric Morbidity Survey.

The table below summarises the year to date performance for West Lancashire CCG patients with the Lancashire Care Foundation Trust IAPT service.

The Access Rate national target is for 15% of patients with a need to have been referred to the Lancashire Care IAPT service during the financial year – this equates to 174 patients per month.

The Recovery target is that at least 50% of patients completing treatment with the APT service will be considered ‘recovered’. This is calculated as:

(Number moved to Recovery)/ (Number Completed Treatment – Number not at Caseness)

Patients not at Caseness are defined as patients who on entry to the service were below the clinical cut off point for psychometric scoring measures for both depression and anxiety. Because recovery is measured against these criteria these patients are excluded from the recovery calculation.

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Target

Eligible Current Month 7 15 10 11 11 10 7 9 9 11 7 8

Sucessful Current Month 7 15 9 10 11 10 7 8 8 11 7 8

Current Month 100.0% 100.0% 90.0% 90.9% 100.0% 100.0% 100.0% 88.9% 88.9% 100.0% 100.0% 100.0% 95%

Year to Date 100.0% 100.0% 96.9% 95.3% 96.3% 96.9% 97.2% 96.3% 95.5% 96.0% 96.3% 96.5% 95%

Sucessful Rate

Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Target

Current Month 157 210 187 150 206 169 185 232 155 211 148 229 174

Year to Date 157 367 554 704 910 1079 1264 1496 1651 1862 2010 2239

Current Month 13.5% 18.1% 16.1% 12.9% 17.8% 14.6% 15.9% 20.0% 13.4% 18.2% 12.8% 19.7% 15.0%

Year to Date 13.5% 15.8% 15.9% 15.2% 15.7% 15.5% 15.6% 16.1% 15.8% 16.1% 15.8% 16.1% 15.0%

Completed Treatment 68 68 75 66 72 82 68 49 44 84 59 66

Moved to recovery 34 35 47 34 42 41 34 23 20 43 28 40

Not at Caseness 5 2 5 3 8 5 6 5 4 4 4 2

Current Month 54.0% 53.0% 67.1% 54.0% 65.6% 53.2% 54.8% 52.3% 50.0% 53.8% 50.9% 62.5% 50.0%

Year to Date 54.0% 53.5% 58.3% 57.3% 58.9% 57.8% 57.4% 57.0% 56.5% 56.1% 55.7% 56.3% 50.0%

Reliable Improvement 53 61 53 57 50 65 42 33 29 56 40 51

6 weeks or less 67 212 183 144 199 162 172 196 152 204 148 223

7 to 18 weeks 0 3 4 4 7 5 9 11 7 3 4 9

Greater than 18 weeks 1 0 0 0 0 0 2 0 0 0 0 0

Current Month < 6 weeks 98.5% 98.6% 97.9% 97.3% 96.6% 97.0% 94.0% 94.7% 95.6% 98.6% 97.4% 96.1% 75.0%

Year to Date < 6 weeks 98.5% 98.6% 98.3% 98.1% 97.7% 97.6% 97.0% 96.7% 96.6% 96.8% 96.8% 96.8% 75.0%



6 weeks or less 67 64 73 62 71 76 67 46 45 77 55 65

7 to 18 weeks 0 4 2 4 1 6 1 3 1 6 2 1

Greater than 18 weeks 1 0 0 0 0 0 0 0 0 1 2 0





Referrals

Access Rate

Recovery

Referral to receipt of

welcome call from

Service

Referral to Discharge

from Treatment

24 | P a g e

Reliable Improvement is defined as patients who demonstrate a statistically significant improvement in psychometric scoring measures for either depression or anxiety between the beginning of treatment and being discharged by the IAPT service. Referral to Treatment times in the preceding table relate to the wait between referral to the IAPT service and the welcome call made by the service to the client. These are the waits that patients often refer to when speaking to their GP. Following the welcome call, patients are allocated to one of three waiting lists. The time between allocation and the start of treatment Is shown in the table below.


Less than 6 Weeks 139 128 105 135 162 133 133 174 124 185 151 1646 to 17 weeks 24 18 5 6 12 30 45 26 89 78 96 10018 Weeks and Over 2 0 0 0 0 0 0 0 1 0 1 1Current Month < 6 Weeks 84.2% 87.7% 95.5% 95.7% 93.1% 81.6% 74.7% 87.0% 57.9% 70.3% 60.9% 61.9% 75.0%Year to Date < 6 Weeks 84.2% 85.9% 88.4% 90.2% 90.9% 89.2% 86.8% 86.8% 82.7% 80.8% 78.4% 76.4% 75.0%Current Month < 18 weeks 98.8% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 99.5% 100.0% 99.6% 99.6% 95.0%

Year to Date < 18 Weeks 98.8% 99.4% 99.5% 99.6% 99.7% 99.8% 99.8% 99.8% 99.8% 99.8% 99.8% 99.8% 95.0%

Waiting List Profile













Psychological Wellbeing Practitioners

Cognitive Behavioral Therapists

Counsellors

All Services

25 | P a g e

13. Quality and Performance 13a West Lancashire CCG Performance Dashboard

YTD


RAG G R G G G G G G G G G G G

Actual 96.23% 92.45% 96.21% 95.42% 96.26% 97.63% 95.92% 95.87% 98.03% 94.56% 97.60% 95.33% 95.97%

Target 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00%

RAG R R R G G R G R G R G R G

Actual 91.84% 92.11% 89.74% 95.00% 96.30% 92.00% 100.00% 92.31% 95.00% 89.29% 100.00% 91.53% 93.68%

Target 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00%

RAG G G G G G G G G G R R G G

Actual 100.00% 98.11% 100.00% 98.21% 98.21% 97.56% 97.78% 100.00% 98.21% 93.75% 95.38% 98.18% 97.85%

Target 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00%

RAG G R G G G G G R G G R G G

Actual 100.00% 85.71% 100.00% 100.00% 100.00% 100.00% 100.00% 88.89% 100.00% 100.00% 87.50% 100.00% 96.88%

Target 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00%

RAG R R G G G G G G G G G G G

Actual 93.75% 96.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 99.08%

Target 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00%

RAG G G G G G R G G G G R G G

Actual 100.00% 100.00% 100.00% 100.00% 100.00% 93.33% 100.00% 100.00% 100.00% 100.00% 91.67% 100.00% 98.97%

Target 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00%

RAG G G R R G R R R R R R R R

Actual 86.36% 86.96% 77.78% 72.00% 86.21% 79.17% 74.07% 79.17% 84.00% 75.76% 80.00% 70.00% 79.32%

Target 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00%

RAG G G G R R G G G G G G

Actual 100.00% 100.00% 100.00% 75.00% 50.00% 100.00% 100.00% 100.00% 100.00% 100.00% 96.43%

Target 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00%

RAG

Actual 88.24% 77.78% 80.00% 90.00% 100.00% 100.00% 100.00% 89.47% 100.00% 100.00% 83.33% 92.86% 91.10%

Target

MetricReporting

Level

2017/18

Q1 Q2 Q3 Q4

Preventing People from Dying Prematurely

% Patients seen within two weeks for an urgent GP referral for suspected cancer.

West Lancashire CCG

% of patients seen within 2 weeks for an urgent referral for breast symptoms.

West Lancashire CCG

% of patients receiving definitive treatment w ithin 1 month of a cancer diagnosis.

West Lancashire CCG

Cancer Waiting Times

% of patients receiving 1st definitive treatment for cancer w ithin 2 months (62

days).West Lancashire CCG

% of patients receiving treatment for cancer w ithin 62 days from an NHS Cancer

Screening Service.West Lancashire CCG

% of patients receiving treatment for cancer w ithin 62 days upgrade their priority.

West Lancashire CCG

% of patients receiving subsequent treatment for cancer w ithin 31 days (Surgery).

West Lancashire CCG

% of patients receiving subsequent treatment for cancer w ithin 31 days (Drug

Treatments).West Lancashire CCG

% of patients receiving subsequent treatment for cancer w ithin 31 days

(Radiotherapy Treatments).West Lancashire CCG

26 | P a g e

YTD


RAG R R R R R

Actual 53.13% 50.00% 32.60% 55.56% 46.98%

Target 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00%

RAG R R R R R

Actual 70.08% 65.92% 62.53% 64.67% 65.77%

Target 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00%

RAG R R R R R

Actual 53.57% 54.18% 46.90% 44.32% 49.70%

Target 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00%

RAG R R R R R

Actual 68.94% 64.43% 64.68% 64.17% 65.51%

Target 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00%

RAG R R R R R

Actual 85.05% 83.61% 73.30% 74.41% 79.00%

Target 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%

RAG R R R R R

Actual 92.54% 90.08% 89.39% 89.80% 90.43%

Target 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%

RAG R R R R R R R R

Actual 13:06 13:31 11:21 12:26 13:19 11:37 11:21 12:20

Target 07:00 07:00 07:00 07:00 07:00 07:00 07:00 07:00

RAG R R R R R R R R

Actual 11:13 10:29 09:57 10:14 11:27 09:40 09:06 10:16

Target 07:00 07:00 07:00 07:00 07:00 07:00 07:00 07:00

RAG R R R R R R R R

Actual 33:17 33:38 35:49 43:59 47:38 49:51 36:03 40:45

Target 18:00 18:00 18:00 18:00 18:00 18:00 18:00 18:00

RAG R R R R R R R R

Actual 35:55 25:26 26:15 31:20 38:40 35:09 27:28 30:25

Target 18:00 18:00 18:00 18:00 18:00 18:00 18:00 18:00

MetricReporting

Level

2017/18

Q1 Q2 Q3 Q4

Category A Calls Response Time (Red1).

West Lancashire CCG

North West

Ambulance Service

NHS Trust

Category A (Red 2) 8 Minute Response Time.

West Lancashire CCG

North West

Ambulance Service

NHS Trust

Ambulance

Category A calls responded to w ithin 19 minutes.

West Lancashire CCG

North West

Ambulance Service

NHS Trust

Ambulance - New ARP Targets - Effective from November 2017

Category 1 calls - Average (mean) response time

West Lancashire CCG

North West

Ambulance Service

NHS Trust

Category 2 calls - Average (mean) response time

West Lancashire CCG

North West

Ambulance Service

NHS Trust

27 | P a g e

RTT and Diagnostics targets not updated because of issues with the transition from Unify2 to the Strategic Data Collection service. This is a national issue.

YTD


RAG R R R R R R R R R R R R R

Actual 1 3 4 13 4 4 6 1 7 3 3 9 58

Target 0 0 0 0 0 0 0 0 0 0 0 0 0


Actual 0.32 0.92 1.20 3.89 1.20 1.23 1.71 0.29 2.19 0.87 0.93 2.75 1.46

Target 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

RAG G G G G G G G G G G G G

Actual 95.75% 94.96% 95.15% 94.88% 94.96% 95.10% 94.63% 94.46% 93.78% 93.54% 92.91% 94.57%

Target 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00%

RAG G G G G G G G G G R G R

Actual 0 0 0 0 0 0 0 0 0 2 0 2

Target 0 0 0 0 0 0 0 0 0 0 0 0 0

RAG R R R R R R R R R R R R

Actual 3.13% 3.83% 1.56% 1.22% 2.39% 2.01% 2.58% 3.77% 3.65% 4.29% 2.17% 2.78%

Target 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00%

Ensuring that People Have a Positive Experience of Care

MetricReporting

Level

2017/18

Q1 Q2 Q3

Mixed sex accommodation breaches - All Providers.

West Lancashire CCG

Mixed Sex Accommodation - MSA Breach Rate.

West Lancashire CCG

Q4

EMSA

Referral to Treatment RTT - No of Incomplete Pathways Waiting >52 weeks.

West Lancashire CCG

% of patients waiting 6 weeks or more for a diagnostic test.

West Lancashire CCG

Referral to Treatment (RTT) & Diagnostics

% of all Incomplete RTT pathways within 18 weeks.

West Lancashire CCG

28 | P a g e

YTD


RAG G G G G G R R R R R R R R

YTD 0 0 0 0 0 1 1 1 1 1 1 1 1

Target 0 0 0 0 0 0 0 0 0 0 0 0 0

RAG G G G G G G G G G G G G G

YTD 2 4 8 9 12 14 18 27 32 34 36 40 40

Target 4 8 11 15 19 23 27 31 34 38 42 46 46


Actual 91.17% 89.48% 90.07% 88.32% 88.14% 85.69% 85.50% 80.31% 80.32% 80.68% 80.56% 78.20% 84.89%

Target 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00%

RAG

Actual 6,177 6,720 6,368 6,714 6,018 6,195 6,918 6,575 6,270 6,117 5,816 6,778 76,666

Target

RAG

Actual 7,250 7,706 7,737 7,796 7,212 7,320 7,222 6,959 6,810 6,332 6,073 6,882 85,299

Target

RAG

Actual 5,639 5,895 5,352 5,758 5,495 5,501 5,898 5,727 5,661 5,530 5,201 6,120 67,777

Target

RAG G

Actual 69,696

Target 77,939

RAG R

Actual 52,695

Target 89,300

RAG R

Actual 86,381

Target 77,143

RAG R R G R G G G R R R R R R

Actual 3 9 0 2 0 0 0 16 65 63 3 8 169

Target 0 0 0 0 0 0 0 0 0 0 0 0 0

RAG G G G G G G G G G G G G G

Actual 0 0 0 0 0 0 0 0 0 0 0 0 0

Target 0 0 0 0 0 0 0 0 0 0 0 0 0

RAG G G G G G R G G R R G R R

Actual 0 0 0 0 0 2 0 0 1 10 0 7 20

Target 0 0 0 0 0 0 0 0 0 0 0 0 0

HCAI

Treating and Caring for People in a Safe Environment and Protect them from Avoidable Harm

MetricReporting

Level

2017/18

Q1 Q2 Q3 Q4

Accident & Emergency

4-Hour A&E Waiting Time Target (Monthly Aggregate based on HES 15/16 ratio).

West Lancashire CCG

Number of MRSA Bacteraemias.

West Lancashire CCG

Number of C.Difficile infections.

West Lancashire CCG

12 Hour Trolley waits in A&E. Southport and

Ormskirk Hospitals

NHS Trust

Wrightington Wigan

and Leigh NHS

Foundation Trust

Lancashire Teaching

Hospitals NHS

Foundation Trust

A&E Attendances: Type 1. Southport and

Ormskirk Hospitals

NHS Trust

Wrightington Wigan

and Leigh NHS

Foundation Trust

Lancashire Teaching

Hospitals NHS

Foundation Trust

A&E Attendances: All Types. Southport and

Ormskirk Hospitals

NHS Trust

Wrightington Wigan

and Leigh NHS

Foundation Trust

Lancashire Teaching

Hospitals NHS

Foundation Trust

29 | P a g e

13b Southport and Ormskirk Hospitals NHS Trust Integrated Performance Dashboard

2016/17 2017/18 2016/17

Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Q4 Q1 Q2 Q3 Q4 YTD Target

18 Weeks - Ongoing - % <18 Weeks - Trust 94.1 % 94.1 % 93.4 % 94.0 % 94.0 % 93.7 % 94.2 % 94.4 % 95.1 % 94.2 % 93.6 % 93.3 % 93.4 % 92.9 % 94.0 % 94.2 % 94.2 % 93.4 % 93.4 % 92.0%

A&E - Left Department Without Being Seen Rate (LWBS) - Trust 2.14 % 1.60 % 1.70 % 1.60 % 2.40 % 2.10 % 2.50 % 2.50 % 2.90 % 2.60 % 2.30 % 2.90 % 3.00 % N/A N/A N/A N/A N/A N/A 5.00%

A&E - Time to Initial Assessment - 95th Percentile - Trust 12 7 10 7 7 8 10 11 11 9 6 10 20 N/A N/A N/A N/A N/A N/A 15

A&E - Time to Treatment - Median - Trust 48 49 52 63 74 68 69 77 97 83 89 85 101 N/A N/A N/A N/A N/A N/A 60

A&E - Total Time - 95th Percentile - Trust 415 336 585 571 676 640 838 784 946 1093 1010 1004 1027 N/A N/A N/A N/A N/A N/A 240

A&E - Total Time in A&E - 4 Hour % - Trust Overall 88.12 % 91.15 % 89.50 % 90.30 % 88.10 % 88.70 % 85.50 % 85.60 % 80.70 % 80.30 % 80.98 % 80.78 % 79.32 % 90.30 % 87.50 % 82.30 % 80.20 % 85.60 % 100.0%

A&E - Total Time in A&E - 4 Hour % - RVY01 66.33 % 76.00 % 77.80 % 77.60 % 73.30 % 75.80 % 66.70 % 65.90 % 53.20 % 52.80 % 54.00 % 56.41 % 53.14 % 77.00 % 72.10 % 57.50 % 54.20 % 66.30 % 100.0%

A&E - Unplanned Re-attendance Rate (within 7 days) - Trust 5.98 % 6.28 % 5.81 % 4.96 % 5.20 % 4.82 % 5.04 % 5.50 % 5.10 % 4.55 % 4.66 % 4.79 % 4.95 % N/A N/A N/A N/A N/A N/A 5.00%

ALOS - Elective - Trust 0.34 0.39 0.36 0.29 0.28 0.31 0.33 0.31 0.25 0.31 0.23 0.28 0.35 0.31 0.34 0.28 0.29 0.29 0.30 0.37

ALOS - Non-Elective - Trust 5.48 5.34 5.05 5.05 4.93 5.61 5.29 5.07 5.46 6.26 6.11 5.42 5.79 5.07 5.14 4.93 5.58 5.78 5.53 4.3

ALOS - Overall - Trust 2.65 2.79 2.65 2.33 2.41 2.68 2.63 2.55 2.61 3.02 2.88 2.62 3.00 2.51 2.58 2.57 2.72 2.84 2.64 2

Cancelled Operations - % of Total Electives in Month 0.62 % 1.42 % 0.55 % 0.50 % 0.47 % 0.52 % 0.70 % 0.80 % 0.72 % 0.51 % 0.33 % 0.25 % 0.79 % 0.50 % 0.79 % 0.56 % 0.68 % 0.45 % 0.62 % 0.60%

Cancer 14 Day - Urgent GP Referral Suspected Cancer 94.2 % 94.9 % 91.9 % 95.8 % 95.0 % 96.3 % 96.2 % 96.1 % 96.2 % 96.0 % 94.6 % 95.4 % 94.4 % 95.8 % 96.1 % 95.0 % 93.0%

Cancer 31 Day - Decision to Treatment 100.0 % 100.0 % 98.3 % 98.1 % 100.0 % 96.0 % 100.0 % 98.2 % 100.0 % 100.0 % 96.7 % 100.0 % 98.9 % 98.8 % 99.4 % 98.2 % 96.0%

Cancer 31 Day - Subsequent Treatment - Drug Therapy 100.0 % NTR 100.0 % 100.0 % NTR 100.0 % 100.0 % 100.0 % 100.0 % 100.0 % 100.0 % 100.0 % 100.0 % 100.0 % 100.0 % 100.0 % 100.0 % 98.0%

Cancer 31 Day - Subsequent Treatment - Surgery 100.0 % 80.0 % 100.0 % 100.0 % 100.0 % 100.0 % 100.0 % 100.0 % 100.0 % 100.0 % 100.0 % 100.0 % 87.5 % 100.0 % 100.0 % 100.0 % 94.0%

Cancer 62 Day - GP Referral to Treatment 78.6 % 86.7 % 84.3 % 76.1 % 77.9 % 77.4 % 88.0 % 87.2 % 85.4 % 87.8 % 75.9 % 82.6 % 82.1 % 81.0 % 87.0 % 78.9 % 85.0%

Cancer 62 Day - Screening Referral to Treatment 100.0 % 100.0 % NTR NTR 100.0 % NTR NTR NTR 100.0 % NTR NTR 100.0 % 100.0 % 100.0 % 100.0 % 100.0 % 90.0%

Diagnostics waiting time: percentage >= 6 weeks - All Tests 1.26 % 4.55 % 5.88 % 1.89 % 1.50 % 2.35 % 2.23 % 1.18 % 3.20 % 2.83 % 3.72 % 1.95 % 3.53 % N/A N/A N/A N/A N/A N/A 0.01

DSSA Breaches - Trust 17 4 6 8 18 12 18 16 11 15 7 11 15 26 18 48 42 33 141 0

HR - Agency Staff Costs 7.19 % 5.22 % 5.44 % 4.77 % 4.76 % 5.25 % 5.58 % 5.80 % 5.91 % 6.18 % 5.70 % 4.10 % 5.60 % N/A N/A N/A N/A N/A N/A 4.00%

HR - Sickness Absence Rate - Trust 5.13 % 4.80 % 4.75 % 5.14 % 5.31 % 4.80 % 5.12 % 5.32 % 5.10 % 5.83 % 7.01 % 6.45 % 5.81 % 5.63 % 4.89 % 5.08 % 5.42 % 6.42 % 5.44 % 4.00%

IC - Clostridium Difficile - Trust 3 2 0 0 0 1 1 2 4 2 1 3 5 3 2 2 8 9 21 36

IC - Incidence of MRSA - Trust 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 1 27

IC - MRSA Screening - Elective Admissions - Trust 99.5 % 100.0 % 98.2 % 96.0 % 97.0 % 99.6 % 100.0 % 97.0 % 100.0 % 98.0 % 99.5 % 99.0 % 99.0 % N/A N/A N/A N/A N/A N/A 100.0%

IC - MRSA Screening - Emergency Admissions - Trust 89.0 % 90.0 % 87.0 % 86.0 % 88.0 % 88.0 % 90.0 % 90.0 % 88.0 % 85.0 % 89.0 % 80.0 % 84.0 % N/A N/A N/A N/A N/A N/A 100.0%

Mortality - HSMR 12 Month Rolling Total - Trust 116.86 120.60 120.26 119.46 121.65 120.13 120.10 117.00 114.40 114.40 119.46 120.10 113.20 113.20 90

Mortality - HSMR Monthly - Trust 106.81 134.93 130.44 115.60 118.30 115.39 112.20 96.80 91.40 109.10 N/A N/A N/A N/A 90

RM - Never Events - Trust 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 1 0 1 0

RM - Patient Falls - by 1,000 bed days 5.0 4.4 4.4 4.1 3.9 4.8 3.8 5.4 4.2 4.2 5.2 4.4 4.7 5.7 4.3 4.3 4.6 4.8

RM - Steis Reportable Incidents - Trust 13 2 5 4 2 5 8 9 4 5 11 5 2 7 11 15 18 18 62 0

Stroke/TIA - Stroke 90% Stay on ASU 53.9 % 43.6 % 54.3 % 42.9 % 48.7 % 52.8 % 51.4 % 60.0 % 56.0 % 50.0 % 28.6 % 69.6 % 63.3 % 56.6 % 47.1 % 50.9 % 55.4 % 55.4 % 51.8 % 80.0%

Stroke/TIA - TIA - High Risk Treated within 24Hrs 26.7 % 33.3 % 0.0 % 0.0 % 0.0 % 9.1 % 4.8 % 14.3 % 0.0 % 9.1 % 0.0 % 0.0 % 0.0 % 4.8 % 6.3 % 5.0 % 8.8 % 0.0 % 5.4 % 60.0%

TV - Hospital Acquired Grade 2 Pressure Sores 12 4 3 3 7 6 3 2 9 13 15 10 8 13 10 16 24 33 83 18



TV - Hospital Acquired Pressure Sores - Grades 2-4 14 5 3 5 7 6 4 5 10 14 16 12 10 20 13 17 29 38 97 28

VTE Prophylaxis Assessment - Trust 98.1 % 98.8 % 98.1 % 97.7 % 99.1 % 98.5 % 97.3 % 98.8 % 98.6 % 97.4 % 98.4 % 97.5 % 95.3 % N/A N/A N/A N/A N/A N/A

2017/18

30 | P a g e

13c Areas of Under-Performance for West Lancashire CCG The year to date performance of several indicators are failing to meet the national targets at the end January 2018. The detail below is presented by indicator for each of these areas with actions identified as required and ongoing, seeking to improve performance. For each indicator which is underperforming Year to Date to January 2018 there is a sparkline graph which shows the monthly performance of the indicator over the previous 12 months. Months where the indicator achieved target are represented by a green line, underperformance by a red line and the target by a blue line. The vertical amber line represents the division between 2016/17 and 2017/18 financial years. West Lancashire CCG Business Intelligence is investigating local areas of underperformance and how this compares to the performance of our local peer CCGs. Cancer Waiting Times

% of patients receiving 1st definitive treatment for cancer within 2 months (62 days).

12

Mo

nth

s A

ctiv

ity

Target: 85% Current Performance YTD: 79.32%

Current Issues: April, May and August performance met the target; however, underperformance in the remaining nine months means the Year to Date Target of 85% is not being met.

Improvement Plans: Low activity levels mean a single case is sufficient to cause a breach of this target in month. No further action has been initiated.

Ambulance

Indicator: Ambulance Response Times CCG 1

2 M

on

ths

Act

ivit

y

Target: 7 Minutes < Category 1 18 minutes < Category 2

Current Performance YTD: 12:20 Category 1 40:45 Category 2

Current Issues: Issues with Ambulance Turnarounds have impacted on Ambulance response times. Turnaround target performance continues to be challenging due to bed pressures and lack of flow within Acute Trusts. During 2016/17, the North West Ambulance Service have experienced increases in call volumes. However, the main impact on response times continues to be delays with patient handover at Accident and Emergency. In February 2017 handover delays at Southport and Ormskirk Hospitals NHS Trust increased to 24.5% of ambulances waiting 30 minutes or more.

Prior to August 2017 the measure was the percentage of Category A Red1 and Red 2 calls responded to within a set time. For the period April to July 2017 NWAS failed to meet these targets for all months both for West Lancashire CCG patients and on a Lancashire wide basis.

Beginning August 2017 new ARP response targets were introduced, the measures being the mean response time for Category 1 (Time critical and life-threatening events) with a target of 7 minutes and mean response time for Category 2 (Potentially serious conditions) with a target of 18 minutes. There are also targets for lower priority categories of calls.

For Category 1 calls performance to January 2018 failed to meet the 7-minute target with an average response time of 12:31 for West Lancashire CCG, the secondary target of 90% of all calls being met within 15 minutes was also not met. WAS performance also failed to meet both these targets.

For Category 2 calls performance to January 2018 failed to meet the 18-minute target with an average response time of 41:30 for West Lancashire CCG, the secondary target of 90% of all calls being met within 40 minutes was also not met. NWAS performance also failed to meet both these targets.

Improvement Plans: With Commissioner support, NWAS are undertaking analysis of the additional factors affecting performance, which may be added to the existing monitoring dashboard that is discussed at the weekly performance meetings, the NWAS Contracting Group and the Strategic Partnership Board. Some of the additional actions being considered include:

• Identification of how the red/green code set has changed following AMPDS v.13 being implemented

• Use of ‘Auto Dispatch’ within the existing NWAS CAD system

• Recruitment of an additional 23 call handlers to specifically manage outbound calls

• Analysis of the effect on performance of delays in call pickups

31 | P a g e

EMSA

Mixed Sex Accommodation Breaches – All Providers

12

Mo

nth

s A

ctiv

ity

Target: 0 Current Performance YTD: 58

Current Issues: There have been Mixed Sex Accommodation Breaches at Southport and Ormskirk Hospitals in all months of the 2017/18 financial year. This means the annual target of 0 breaches cannot be met.

Improvement Plans: This activity relates to Critical Care and Stroke patients at Southport and Ormskirk Hospitals. The Trusts are in the process of reconfiguring the Stroke Care facilities to minimise these issues.

Referral to Treatment (RTT) and Diagnostics

% of patients waiting 6 weeks or more for a diagnostic test.

12

Mo

nth

s A

ctiv

ity

Target: 1.0% Current Performance YTD: 2.78%

Current Issues: This is an issue at Southport and Ormskirk Hospitals, primarily within Cardiology concerning echocardiography and ultrasound tests. Underperformance increased steadily since initially breaching the 1% target in December 2016, peaking at 5.88% of patients waiting over 6 weeks for a diagnostic test in May 2017. A major factor in the large number of breaches in May 2017 was the cyber-attack which resulted in the cancellation of a significant number of diagnostic tests. The deterioration in performance in between August 2017 and January 2018 has been attributed to staffing issues within echocardiography with 50% of departmental staff being unavailable. Although this target was not updated nationally in March 2018 it should be noted the Southport and Ormskirk Hospitals IPD report shows another significant deterioration in this measure in month.

Improvement Plans: Southport and Ormskirk Hospitals have improved performance significantly in June and July and are organising additional radiology sessions to bring this indicator back on track. No plans have been identified to deal with the echocardiography staff shortfall.

Treating and Caring for People in a Safe Environment and Protect them from Avoidable Harm

Number of MRSA Bacteraemias.

12

Mo

nth

s A

ctiv

ity


Current Issues: A case of MRSA Bacteraemia was detected in a West Lancashire patient while an inpatient at Southport and Ormskirk NHS Trust on 26th September 2017. Following the post-infection review, the case of MRSA was attributed to the Trust with poor cannula care identified as the root cause. The review also identified issues with documentation and observations as well as delays in reporting on the specimen and delays in receiving appropriate treatment.

Improvement Plans: Southport and Ormskirk Hospitals carried out a full review of this case. The Action Plan produced has been shared with the CCG.

32 | P a g e

Accident and Emergency

4-Hour Accident and Emergency Waiting Time Target

12

Mo

nth

s A

ctiv

ity

Target: 95.0% Current Performance YTD: 84.89%

Current Issues: Performance is consistently below the 95% target. It should be noted that the actual performance of the Accident and Emergency department at Southport Hospital is considerably worst than this figure and is flattered by the inclusion of performance figures from the Children’s Accident and Emergency Department at Ormskirk Hospital and the Ormskirk Walk in Centre.

Improvement Plans: A&E continues to experience pressures. The A&E Delivery Board, Southport Subgroup held a Winter planning workshop on 31st August 2017. Plans include:

• Development of a clinical design group to have an action learning set/solution focused approach

• Providers to identify procedures and processes of low priority which ‘we don’t need to do’ in January to release capacity in the system

• Development of ‘winter flying squad’ team

• Development of daily multi-agency discharge huddle which joins all flow critical providers

• Development of internal and external communications protocol to identify ‘go to person’ at time of escalation.

• Work up schemes to test out as PDSAs during October

12-Hour Trolley Waits in Accident and Emergency

12

Mo

nth

s A

ctiv

ity


Current Issues: One hundred and sixty nine 12-hour trolley waits at Southport and Ormskirk Hospitals during 2017/18. Activity prior to November 2017 mainly related to the admission of mental health patients. The 155 waits between November 2017 and March 2018 indicate the Trust that did not plan properly for winter pressures. Commissioners have noted that despite instructions from NHS England to cancel all non-urgent elective activity in January 2018 consultants were frequently unavailable because of elective clinics.

There were two 12-hour trolley waits at Lancashire Teaching Hospitals NHSFT in September 2017; one in December, ten in January 2018 and seven in March 2018. However, none of this activity related to a West Lancashire CCG patient.

Improvement Plans: West Lancashire CCG met with Mersey Care and Southport and Ormskirk Hospitals Accident and Emergency representatives to discuss Mental Health 12-hour breaches. A Task and Finish Group will be established to improve escalation processes; interaction between Mersey Care and Lancashire Care FT Mental Health Services and to explore reciprocal arrangements for West Lancashire patients who attend Mersey Trust Accident and Emergency but require Lancashire Care FT Mental Health Services.

Average Length of Stay

Average Length of Stay (ALOS) Non-Elective Southport and Ormskirk Hospitals

12

Mo

nth

s A

ctiv

ity

Target: 4.3 Current Performance YTD: 5.53

Current Issues: Southport and Ormskirk Hospitals NHS Trust currently exceed the national target of 4.3 days for average (mean) Non-Elective Length of Stay. This is mainly due to an ageing population and difficulties finding suitable post discharge accommodation.

Improvement Plans: ECIP has highlighted to Southport and Ormskirk Hospitals NHS Trust that Non-Elective Length of Stay is significantly higher than other Trusts and needs to be improved. Urology moved to Ormskirk on 14 December to make way for the expanded 15a Ward which will become an integrated discharge hub; this will include a discharge lounge. Work on improving discharge processes is also part of the ECIP work as mentioned under Accident and Emergency performance.

33 | P a g e

Hospital Mortality

Hospital Mortality – HSMR 12 Month Rolling Total - Southport and Ormskirk Hospitals

12

Mo

nth

s A

ctiv

ity

Target: 100 Current Performance : 114.4

Current Issues: Southport and Ormskirk Hospitals NHS Trust is significantly above the expected level of 100. This has also been confirmed by the publication of Standardised Hospital Mortality Index figures for the 12 months to December 2016 where Southport and Ormskirk Hospitals Trust had the second worst Mortality Index for an English Acute Trust (116). Up until late 2016 a combination of data processing issues with the Southport and Ormskirk Hospitals Patient Administration System and the data cleansing process used by NHS Digital for HES data resulted in the mortality at the Trust being significantly underestimated in these statistics. After several months of reporting with these errors corrected it is evident that mortality is a major concern and no longer a data issue.

Improvement Plans: Southport and Ormskirk Hospitals have established a Mortality Review Group. However, this activity has been assumed by the Hospital Senior Management Team and as a result they feel that CCG participation in this review is inappropriate. To date no explanation for the high rates has been provided.

34 | P a g e

13d West Lancashire CCG Patients Waiting

To understand how many patients were still waiting for procedures or outpatient appointments, the numbers of patients waiting for all incomplete pathways for all Trusts have been included in the graph below. More detailed reports on RTT waiters are available via Aristotle spotlight reports. The reports in this IBR relate to February 2018 as March data is unavailable owing to issues with the transition between Unify2 and the Strategic Data Collection service. This is a national issue. Given the high rate of RTT achievement between April 2017 and February 2018, it is impossible for NHS West Lancashire CCG to fall below the 92% target for the complete financial year.

For West Lancashire CCG patients: in February 2018, there were 6237 patients in total with an Incomplete Pathway. Of these, 5795 (92.9%) are under 18 Weeks and 442 over 18 Weeks.

The table below shows the providers with the highest number of incomplete patient pathways for West Lancashire CCG patients in February 2018. Of these providers four have achieved the 92% target. The best performer is Ramsay Operations (UK) (mainly Renacres Hospital) with 99.4%. Southport and Ormskirk Hospitals NHS Trust, the most significant Secondary Care provider for West Lancashire CCG, achieved 93.5%.

Although West Lancashire CCG experienced a decline in 18-week Referrals to Treatment performance during 2016/17 and 2017/18, this pattern is reflected both nationally and for other local CCGs. The table below shows West Lancashire CCG performance for 2017/18 compared to other local CCGs.

Trust

Under 18

Weeks

Over 18

Weeks Total

% Under

18 Weeks RAG

Southport and Ormskirk Hospitals NHS Trust 3041 213 3254 93.5% G

Ramsay Operations (UK) 504 3 507 99.4% G

Wrightington, Wigan and Leigh NHSFT 470 30 500 94.0% G

St Helens and Knowsley Hospital Services NHS Trust 380 25 405 93.8% G

Aintree University Hospital NHS Foundation Trust 316 36 352 89.8% R

Lancashire Teaching Hospitals NHSFT 264 48 312 84.6% R

Royal Liverpool and Broadgreen University Hospitals NHS Trust 238 44 282 84.4% R

CCG Name Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD

Chorley and South Ribble CCG 89.9% 90.6% 91.1% 89.4% 89.7% 89.8% 90.5% 90.2% 90.2% 89.3% 88.5% -100.0% 89.9%

Greater Preston CCG 90.3% 90.5% 90.8% 89.1% 89.1% 88.8% 89.2% 89.4% 88.8% 87.7% 87.3% -100.0% 89.2%

Liverpool CCG 91.4% 91.2% 90.5% 90.3% 89.9% 89.3% 89.6% 89.3% 88.5% 87.9% 87.4% -100.0% 89.6%

South Sefton CCG 93.7% 94.2% 93.6% 92.6% 92.4% 92.3% 92.2% 92.2% 91.3% 90.8% 90.3% -100.0% 92.3%

Southport and Formby CCG 94.3% 93.6% 93.9% 93.6% 93.4% 93.4% 93.1% 93.5% 93.2% 92.8% 92.5% -100.0% 93.4%

West Lancashire CCG 95.8% 95.0% 95.1% 94.9% 95.0% 95.1% 94.6% 94.5% 93.8% 93.5% 92.9% -100.0% 94.6%

35 | P a g e

The table below shows the specialties at the main providers where the 92% target was not achieved for West Lancashire CCG patients in February 2018.

The chart below indicates the number of patient pathways by which the major providers for West Lancashire CCG overperform or underperform the 92% Referral to Treatment target in February 2018. Theoretically any provider with a significant positive difference could delay treatment of patients without impacting the 92% target, although West Lancashire CCG do acknowledge this would be difficult to manage as a commissioner.

Rheumatology 78.4% General Surgery 81.9% Ophthalmology 91.2%

Gynaecology 88.9% Trauma & Orthopaedics 90.8%

General Surgery 70.6% Gynaecology 80.0% Plastic Surgery 83.3%

ENT 83.3%

Gastroenterology 78.3% Ophthalmology 80.4% Respiratory Medicine 85.7%

ENT 86.2% Trauma & Orthopaedics 90.9%

Gastroenterology 42.9% Neurology 63.6% Cardiology 66.7%

Trauma & Orthopaedics 75.0% Dermatology 84.2% General Medicine 85.0%

Urology 85.7% ENT 87.0% General Surgery 88.9%

Plastic Surgery 88.9%

Trauma & Orthopaedics 66.7% Dermatology 81.8% General Surgery 82.4%

Ophthalmology 83.7% Gastroenterology 87.5% Other 88.7%

Rheumatology 90.9% Urology 91.7%

Southport and Ormskirk Hospitals NHS Trust

Wrightington, Wigan and Leigh NHSFT

St Helens and Knowsley Hospital Services NHS Trust

Aintree University Hospital NHS Foundation Trust

Lancashire Teaching Hospitals NHSFT

Royal Liverpool and Broadgreen University Hospitals NHS Trust

36 | P a g e

13e Friends and Family Test

It should be noted that although the proportion of positive responses to the Friends and Family Test at Southport and Ormskirk Hospitals NHST are high the actual response rates are significantly below the National Average. For example, the National Response Rate for Inpatients is 26.4% whereas at Southport and Ormskirk Hospitals NHST only 14.4% of discharged patients responded.

37 | P a g e

13f Safety Thermometer On one day each month, hospital Trusts are required to check to see how many of their patients suffered certain types of harm whilst in their care. This measure is known as the Safety Thermometer. The Safety Thermometer looks at four harms: pressure ulcers, falls, blood clots and urine infections for those patients who have a urinary catheter in place. This helps Trusts to understand where they need to make improvements. The graph and table below indicate the percentage of patients at each trust who did not suffer harm in any of the four categories.

38 | P a g e

14. Complaints

In March 2018, there were two issues raised by GPs, both related to patient discharge letters/summaries not having been received by the GP . Most of the issues regarding patient discharge letters during 2017/18 seem to be related to the ‘red book’ not being completed for new-borns. All issues raised by GPs during 2017/18 concern two providers, Southport and Ormskirk Hospitals NHS Trust and St Helens and Knowsley Hospitals NHS Trust. The main issues are Information Governance related with reports being sent to the wrong GP practice. The high percentage of issues relating to Southport and Ormskirk Hospitals are because this is the main provider for West Lancashire CCG while St Helens and Knowsley Hospitals NHS Trust are the main provider of Direct Access Pathology.

15. Serious Untoward Incidents

During 2017/18 there have been 30 incidents involving NHS West Lancashire CCG patients reported on StEIS. This is a significant decrease (38.78%) compared to 2016/17 when there were 49 incidents reported. The decrease experienced by NHS West Lancashire CCG does not reflect the experience across all Lancashire CCGs where an increase of 18.9% has occurred. It has been suggested that the increase of activity for other Lancashire CCGs may be related to Lancashire Providers reporting 12 hour Accident and Emergency Trolley waits as StEIS incidents while Southport and Ormskirk Hospitals are not recording these events.

Of the 30 recorded StEIS incidents 18 (60%) were reported within the two working day target. Of the 20 recorded StEIS incidents at Southport and Ormskirk Hospitals only 8 (40%) were reported within two working days. All StEIS incidents for NHS west Lancashire CCG patients that were reported outside the two working days target occurred at Southport and Ormskirk Hospitals.

In accordance with the Serious Incident Framework implemented on 1 April 2015 the Provider is obliged to carry out a review within three working days of the incident being identified. Of the 30 recorded StEIS incidents in 2017/18 a 72-hour update was received in 6 cases (20%), no 72-hour update was received in 20 cases (66.7%) and in 4 cases (13.3%) the status of the 72-hour update is unknown. For the 20 StEIS incidents reported by Southport and Ormskirk Hospitals for NHS West Lancashire CCG patients, no 72-hour reviews are recorded as being carried out. NHS Southport and Formby CCG as host commissioner for Southport and Ormskirk Hospitals do not insist on 72-hour reviews being completed.

Internal investigations of a StEIS incident must be completed within 60 working days of the incident being reported, or alternatively given exceptional circumstances the Provider may agree an extension to this deadline with the CCG. During 2017/18, 21 final reports were submitted by Providers for West Lancashire CCG to review. Of these 21 final reports 9 (42.9%) were received within the deadline (or extension thereof) and 12 (57.1%) were received outside the deadline. Of the 9 reports received from Southport and Ormskirk Hospitals 6 (66%) were received outside the deadline.

Equality and Inclusion Annual Report 2017/2018 West Lancashire Clinical Commissioning Group Governing Body Meeting – 22 May 2018

1

WLCCGB 05/18/10


DATE OF BOARD MEETING: 22 May 2018 TITLE OF REPORT: Equality and Inclusion Annual Report 2017/2018 BRIEFING POINTS:




Yes

From an Equality and Inclusion perspective




No

4. Delivering Financial Balance – please outline impact No


Yes







Yes

Meeting the Public Sector Equality Duties


N/A

3. Health Inequalities Yes


4. Human Rights, Equality and Diversity Requirements Yes


5. Clinical Engagement No

6. Patient and Public Engagement Yes


REPORT PREPARED BY: REPORT PRESENTED BY:

Catherine Bentley, Equality & Inclusion Business Partner (North) Catherine Bentley, Equality & Inclusion Business Partner (North)

1

NHS West Lancashire Equality and Inclusion Annual Report

2017/2018

2

Contents Page

Accessibility Statement 3 Executive Summary 4

Introduction 5

The CCG’s Strengths in Terms of Equality and Inclusion

5

The CCG’s Areas for Improvement for Equality and Inclusion

6

Legal Duties Equality and Inclusion 7

Our Organisation 10

Our Workforce 12

Our Communities 20 Our Equality Objectives – 2017 to 2021 20

Equality Impact and Risk Assessments 21

Equality Delivery System Grading Assessment 2017 24

Involving Local People 27

Customer Care 32

Quality and Performance 32

Equality Performance of Our Main Providers 32

Conclusion 33

Appendix 1: Equality Objectives Progress and Actions 35

Appendix 2: Overview of West Lancashire CCG Grading Results 2017 to 2021

49

3

Accessibility Statement

To request information or any of our key documents in

an alternative format such as larger print, audio or any

other format please email: [email protected]

Or call 01695 588 000 quoting your address, telephone

number along with the title and date of the publication

plus the format you require.

Or you can access our website by this link to get in

touch: http://www.westlancashireccg.nhs.uk/get-in-

touch/

mailto:[email protected]

http://www.westlancashireccg.nhs.uk/get-in-touch/

http://www.westlancashireccg.nhs.uk/get-in-touch/

4

Executive Summary

NHS West Lancashire Clinical Commissioning Group (CCG) believes that equality and inclusion

include addressing health inequalities and should be embedded into all commissioning

activity.

It is our over-riding aim to provide equality of opportunity to all our patients, their families

and carers and to proactively attempt to eliminate discrimination of any kind to the services

we commission (buy).

The CCG is keen to involve local people in the continuing development and monitoring of this

aim to ensure that we commission the right health care services, provide well trained staff to

deliver and ensure our providers meet the equality duties set out in the Equality Act 2010.

This is our fifth Equality and Inclusion Annual Report and the report shows how we have met

our equality duties and also how we are achieving our equality objectives.

Mike Maguire, Chief Officer Dr John Caine, Chair

“We will make

equality core to

our business

planning”

“By working with local people

with our stakeholders in West

Lancashire and making

effective use of resources, we

will strive for the best possible

care for our local population

and to empower people to be

in control of their own health

and health care services”

5

Introduction

West Lancashire Clinical Commissioning Group (CCG) became a Statutory Body in April 2013

when it became responsible for commissioning high quality health services and improving the

health of the population of West Lancashire. The equalities information presented in this

report represents the CCG’s progress during its fifth year of operation and outlines the CCG’s

progress to incorporate Equality and Inclusion in all its work. The CCG is making this annual

report publicly available so that the organisation complies with the Specific Duty of the

Public-Sector Equality Duty to publish equality information annually.

This report sets out:

• Our commitment to Equality and Inclusion

• Our ‘due regard’ to the Public-Sector Equality Duty

• Equality Impact and Risk Assessments completed by the CCG in 2017/18

• Our NHS Equality Delivery System grading assessment in 2017

• Progress against the CCG’s Equality Objectives set in 2017/2018

The CCG’s Strengths in Terms of Equality and Inclusion • The CCG has a clear commitment to equality and inclusion which is described our

Equality and Inclusion Strategy 2017/2021. This strategy was ratified by the Governing

Body in May 2017 and sets out the CCG’s strategic approach to embed equality and

inclusion in its core commissioning and quality improvement work. This will be

achieved by being a flexible framework for our equality and inclusion activity which is

an integral part of the way we do business.

• The Equality impact and Risk Assessments process is embedded in all aspects of the

CCG’s work through our Project Management System and is included as a requirement

in the commissioning planning processes for 2018/2019. We have undertaken a

number of Equality Impact and Risk Assessment during the last 12 months, more detail

can be found on page 21 of this report.

6

• The CCG’s patient and public engagement continues to be improved by providing a

range of ways in which our local population can stay informed and be involved in the

work of the CCG.

• In 2016, the Lancashire and South Cumbria CCGs with Public Health Lancashire

Consultants decided to undertake a review of a range of clinical policies that were

termed as ‘low clinical value’. The review work has continued into 2017/2018 with a

number of Equality Impact and Risk Assessments being completed.

• In October 2017 the CCG maintained their Equality Delivery System grade as

‘Achieving’ for Goal 4 Inclusive Leadership, further information can be found on page

24 of this report.

• All staff will have the opportunity to attend an Equality Impact and Risk Assessment

(EIRA) workshop to refresh existing staff or to ensure that all members of staff

understand the EIRA process. This was an action identified from the staff EDS Grading

Assessment in October 2017

The CCG’s Areas for Improvement for Equality and Inclusion

The CCG will focus on Goal 1 Better Health Outcomes for their EDS Grading Assessment for

2018. An area for improvement for this goal identified from the 2016 EDS Grading

Assessment was to show evidence of how services are delivered in an equitable way to

people from protected groups. The EDS Grading Assessment is planned for later in 2018 and

is still in the early stages of planning. The West Lancashire Council for Voluntary Service

(WLCVS) will be assessing the CCG this year.

See below diagram of the CCG’s EDS Grading Assessment Cycle:

7

Legal Duties for Equality and Inclusion

This section outlines the various legal requirements and NHS Mandated Standards relating to

Equality and Inclusion. Please view our Equality and Inclusion Strategy on our website:

http://www.westlancashireccg.nhs.uk/about-us/equality-and-inclusion/

The Equality Act 2010

The Equality Act 2010 came into force in October 2010. The Equality Act combines over 116

separate pieces of legislation into one single

Act, combined, they make up an Act that

provides a legal framework to protect the

rights of individuals and advance equality of

opportunity for all. The Act simplifies,

strengthens and harmonises the current legislation to provide with a discrimination law

which protects individuals from unfair treatment and promotes a fair and more equality

society.

The Act protects people from unfavourable treatment and this refers particularly to people

from the following categories known as protected characteristics:

West Lancashire CCG’s

EDS Grading Assessment

Cycle


8

We additionally pay ‘due regard’ to the needs of carers, homeless, and military veterans and

deprived areas when making commissioning decisions. ‘Due regard’ means that the CCG

have given advance deliberate consideration to issues of equality and discrimination before

making any key healthcare decisions.

Public Sector Equality General Duty 2011

Section 149 of the Equality Act

2010 requires us to demonstrate

compliance with the ‘Public

Sector Equality Duty’ which

places a statutory duty on the CCG to address:

• Eliminating unlawful discrimination, harassment, victimisation and any other conduct

prohibited by the Equality Act 2010

• Advance equality of opportunity between people who share a protected

characteristic and people who do not share it

• Foster good relations between people who share a protected characteristics and

people who do not

9

Specific Duty

• Publish information to demonstrate their compliance with the Equality Duties, at least

annually

• Set equality objectives, at least every 4 years

Human Rights Act 1998

The Human Rights Act 1998 came into

effect in the United Kingdom in October

2000. The CCG must ensure that their

commissioning decisions safeguard

vulnerable people, and do not put people’s

lives at risk or expose them to inhumane

and degrading treatment.

The Health and Social Care Act 2012

The Health and Social Care Act, states that each Clinical Commissioning Group must in the

exercise of its functions, have regard to the need to:

• Reduce inequalities between

patients with respect to their

ability to access health services;

• Reduce inequalities between

patients with respect to the

outcomes achieved for them by

the provision of health services;

• Promote the involvement of

patients and their carers in decisions about provision of the health services to them;

• Enable patients to make choices with patients to make choices with respect to

aspects of health services provided to them

10

NHS Constitution 2015

This Constitution sets out rights for patients, the public and

staff. It outlines NHS commitments to patients and staff,

and the responsibilities that the public, patients and staff

owe to one another to ensure that the NHS operates fairly

and effectively. NHS Constitution targets are monitored

via the CCG’s Quality and Performance Team and

assurance is provided to the Governing Body via the Quality and Performance Committee’s.

NHS Mandated Equality Standards

Equality Delivery System 2013

The Equality Delivery System (EDS)

helps NHS organisations improve the

services they provide for their local

communities and provide better

working environments, free of

discrimination, for those who work

in the NHS, while meeting the

requirements of the Equality Act

201. The main purpose of the EDS is to help organisations, in discussion with local partners

including local populations, review and improve their performance for people with

characteristics protected by the Equality Act 2010.

Accessible Information Standard 2016

The aim of the Accessible Information Standard is to make sure that people who have a

disability, impairment or sensory loss receive information that they can access and

understand and any communication support that they need.

Commissioners of NHS services must have a regard to this standard, in so much as they must

ensure that they enable and support compliance through their relationships with provider

11

organisations. This standard is in all the CCG’s NHS Standard Contracts and is monitored by

Quality and Performance Key Performance Indicators.

Workforce Race Equality Standard 2015

The NHS Workforce Race Equality Standard (WRES) is a useful tool to identify and reduce any

disparities in experience and outcomes for NHS employees and job applicants of different

ethnicities. The Standard is used by organisations to track progress to identify and help

eliminate discrimination in the treatment of Black and Minority (BME) employees. The CCG

published their WRES report in 2017: http://www.westlancashireccg.nhs.uk/about-

us/equality-and-inclusion/

Workforce Disability Equality Standard 2018

The Workforce Disability Equality Standard (WDES) is a set of specific measure (metrics) that

will enable NHS organisations to compare the experiences of disabled and non-disabled staff.

All NHS Standard Contracts for 2018 set out

that NHS Trust and NHS Foundation Trusts

will have to implement the WDES in the first

year. This information will then be used by

the relevant organisations to develop a local

action plan and enable then to demonstrate

progress against the indicators of disability

equality.

Modern Day Slavery Act 2015

All public authorities are required to co-operate with the police commissioner under the

Modern-Day Slavery Act 2015. This means that police and health care services, together with

voluntary organisations, are legally required to work together to support people who have

experienced slavery. The CCG has a zero tolerance for modern day slavery and breaches of

human rights, and ensure this protection is built into the processes and business practices

that we, our partners and providers use.



12

Our Workforce

We have professional external Human Resources, NHS Midlands and Lancashire

Commissioning Support Unit MLCSU advice and support available for all our staff. We use

NHS jobs website to recruit new members of staff this is supported by the Recruitment Team

at (MLCSU). We also provide PAM Assist which is an employee assistance programme where

our staff can access clinical and professional expertise, giving them the opportunity to talk

about all kinds of work and personal issues that are affecting them. These might include;

health advice, work issues, domestic abuse, drug/alcohol addiction, family care or

bereavement.

Workforce Representation

As a CCG we aim to be representative of the local community as we continue to commission

health services, we have a small workforce of 49 members of staff including 3 embedded

MLCSU staff, as a consequence we are not able to report on age, race, religion or belief,

gender reassignment, sexual orientation, pregnancy and maternity, marriage or civil

partnership as this may identify an individual employee.

Sex (Gender) – In West Lancashire the population has nearly the same number of males 48%

as females at 52%. The CCG consists of 41% males and 59% females.

Disability – The CCG has a low number of staff who have declared that they have a disability.

However, there are a number of staff who have required ‘reasonable adjustments’ in the

workplace due to a disability or long-term conditions. On a yearly basis West Lancashire CCG

send out a Display Screen Equipment (DSE) assessment form for each employee to complete,

this is where any reasonable adjustments that maybe required can be identified.

Training and Development Opportunities

Staff have the opportunity to agree learning and development opportunities with their

manager during their appraisal process. Some of these relate to specific courses, or

13

attending conferences and other events, while some have related to on-the-job

development. These have included –

• Lunch and learn sessions

• Prince 2

• PMO training

• Secondment opportunities

Governing Body Members

All the Governing Body Members participate in an Equality and Inclusion development

session each year, as part of a bi-monthly programme of development briefing sessions. The

session in April 2018 focused on recapping on the drivers for Equality and Inclusion within the

CCG and meeting the challenges of transforming services within the Sustainable

Transformation Partnership (STPs).

Staff Training

Mandatory training for staff is monitored via Electronic Staff Records (ESR). Equality and

Diversity Training is mandatory for all CCG employees and is completed every three years.

Additional Equality Training

An Equality Impact and Risk Assessment Workshop was held in October 2017. This took place

at the CCG’s Team Brief, a weekly meeting which all staff are expected to attend. The

workshop was to raise staff’s awareness of the PSED focusing on the Brown and Gunning

Principles and due regard to the Equality Act 2010, and how to document and evidence

potential impact relating to protected characteristics and other vulnerable groups.

Lancashire LGBT Awareness Session

Travis Peters, from Lancashire LGBT attended a staff team brief in December 2017 to raise

staff’s awareness of the LGBT issues in Lancashire, to advise staff how they can ensure groups

of people from LGBT can be best considered when commissioning services and how

Lancashire LGBT can support the CCG.

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Project Management Office

NHS West Lancashire Clinical Commissioning Group (WLCCG) procure and design healthcare

services for the people of West Lancashire. As a result, the organisation is required to

manage and deliver several high-quality healthcare projects on time and on budget.

WLCCG had invested in a project management solution to provide oversight in terms of

helping to manage and monitor projects. However, since the implementation of the online

solution, there were a few issues identified through staff engagement and performance

reporting. Some of the issues were also around governance and accountability. Taking staff

issues onboard, our IT Consultant, devised a solution based on PRINCE 2 Project

Management model as well as integrating a consulting capacity into the project management

process. The consulting aspect involved setting up a Project Management Office (PMO)

function (comprising of WLCCG’s Service Redesign Manager and Project Support Officer)

providing project managers with training, guidance and best practice tools. The PMO function

facilitates project prioritisation and governance as it ensures project managers follow a

stringent approval process for their business cases/proposals; thus, establishing discipline

and best practice.

The solution allows the CCG’s Senior Management Team (SMT) to view real time data

through bespoke online Dashboards. This empowers the CCG’s (SMT) to make informed

decisions and enforces governance and ultimate accountability amongst staff. Our business

priorities are embedded within the solution which allows SMT to release and/or deploy

capacity where appropriate and focus on business-critical activities. The tool also allows

information sharing between partner agencies and stakeholders and the sharing capability

can be controlled with different levels of access rights which in fact lends itself well with

Information Governance compliance. The solution also prompts project managers to

complete the cost management activities, risk logs and other project related activities in a

standardised & consistent format.

Besides having held workshops on Project Management, the PMO are currently delivering

individually tailored support surgeries and one to one sessions for staff who manage projects

(or who are involved as a specialist resource in projects). The feedback from staff who have

had an opportunity to explore and work on the toolkit has been very positive.

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Workforce Race Equality Standard (WRES)

Following the introduction of the WRES in 2015, West Lancashire CCG submitted its third

WRES return to NHS England in August (using data from 2016/2017). The WRES report

which is published on our website (to view the WRES report access this link

http://www.westlancashireccg.nhs.uk/wp-content/uploads/WLCCG-WRES-Report-

2017_FINAL.pdf ). The WRES report sets out the CCG performance information profile and

Board composition, by ethnicity. The CCG is working towards collecting data that will make it

possible to fully compare all 9 metrics in 2018.

Communicating with Our Staff

A range of communication options are regularly viewed by our staff via the following

methods:

• Fortnightly staff e-bulletins

• Staff intranet (this is regularly reviewed and updated)

• Social media (Facebook and Twitter)

• Newsletter for GP Practice Staff – CCG staff

• Weekly Team Briefs which are chaired by the CCG’s Chief Officer

Staff Forum

The CCG Staff Forum continues to be held once a month. This is a working group which will

identify best ways to share the work of the CCG even wider.

The purpose of the Staff Forum is to do the following:

• Share awareness and campaign days that staff are encouraged to support and get

involved in, as well as being the point of contact for any member for any member of

staff to nominate or suggest a campaign that they would like the CCG to support.

• Be a neutral port of call for anyone to share an issue that they are not comfortable

raising with their line manager or Senior Management Team (SMT), that the Staff

Forum can then raise at the meeting before deciding the best way forward.

• Highlight and suggest educational visits and away days – suggestions are escalated to

the SMT

http://www.westlancashireccg.nhs.uk/wp-content/uploads/WLCCG-WRES-Report-2017_FINAL.pdf

http://www.westlancashireccg.nhs.uk/wp-content/uploads/WLCCG-WRES-Report-2017_FINAL.pdf

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• Draft corporate policies are sent to the Forum for comment and to engage with staff

Staff Awards 2017/2018

The CCG won two prestigious national awards during 2017/18 for digital and telehealth

projects implemented successfully the awards were:

NHS Sustainability Award 2017 and the Laing Buisson Award 2017 – Innovation in technology

As a CCG we will continue to design bespoke digital

solutions to reduce unnecessary hospital

admissions and travel. We have implemented

various digital health care projects that has seen

reduction in travel, patient-clinician contact time

and some of the solutions have even acted as

timely interventions that have minimised the need

for hospital treatment(s). We collaborated with

Liverpool Community Health and Southport and

Ormskirk NHS Hospitals Trust to introduce a SMS

Telehealth System called FLO to help improve how

care is delivered and to help citizens suffering with Heart Failure, improve their overall Health

and Wellbeing. The pilot supported by the Innovation Agency for the North-West Coast went

Live last year and has been used to remotely support and monitor patients with Heart Failure.

The system works by asking patients to send in readings such as their weight, blood pressure,

pulse, and oxygen saturation levels via their own mobile phone. These reading are then

monitored by the Specialist Heart Failure Team and the local Community Matrons and are

responded to accordingly.

We have empowered patients to self-care and self-manage their health conditions. Patients

have also told us that they feel more confident in managing their condition and would rather

submit the reading than attend clinic where this can be avoided. It alerts clinicians when

there are risks or concerns at an early stage, and on occasions has sent alerts that if gone

unnoticed, it could have possibly led to an avoidable admission to hospital.

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By 2020 we expect to see significant increase in patient access with the delivery of Shared

Care Records which will underpin - avoidable deaths, enhanced patient experience, New

Models of care, Health and Social care integration amongst others.

Equality and Inclusion Team, NHS Midlands and Lancashire Commissioning

Support Unit (MLCSU)

Catherine Bentley, Equality and Inclusion Business

Partner, supports us to ensure that our engagement,

and commissioning decisions are made in line with

the Equality Act 2010 and the Public-Sector Equality

Duty (2011).

In December 2017, Catherine won a MLCSU Michel

Kongolo-Mankou staff award. The Michel Kongolo-

Mankou Award is awarded to an individual who has

demonstrated outstanding achievement in promoting

equality and issues which contribute to making a fair

society.

West Lancashire CCG and the NHS Management Graduate Training Scheme

This scheme aims to train graduates to become the future leaders of the NHS. The process

aims to select the organisations that can teach best practice, not just in day to day tasks but

in leadership, teamwork and collaboration. It is a very competitive process, yielding over 100

applications from organisations in the North West alone, with only 16 trainees to fill them.

WLCCG have been praised by the North-West Leadership Academy, which is responsible for

selecting host organisations as they worked extremely hard to show what an innovative,

driven and inclusive organisation WLCCG is and how committed they are to deliver the best

experience for trainees. This commitment stems from an ambition to invest in the future of

the NHS through moulding its future leaders to also be innovative, driven and inclusive.

Laura Anton, Project Manager: “I feel very lucky to have been selected to undertake my first

placement at WLCCG as the whole workforce is welcoming, honest and approachable. I was

made to feel part of the team from day one and staff made it clear they were there to help

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whenever I needed it. By the very nature of the scheme, trainees start in the thick of it, and

with limited or no experience will need support,

mentoring and guidance from their host

organisations, and WLCCG has gone above and

beyond to ensure I receive this.

Working at WLCCG is like a breath of fresh air. The

organisation provides space to think, improve,

monitor and evaluate services, quality and care,

patient experiences and staff satisfaction. No voice

goes unheard and every member of staff is treated

fairly. Patients are at the heart of everything they

do, with a focus on ensuring every member of the

local community has access to high quality, cost

effective and safe health care services. During my

first few weeks I asked if I could get involved in

working on some Equality Impact Risk Assessments

for upcoming projects.

The culture of the CCG is positive and inclusive, and this reflects in the services it procures,

contracts and buys. I became aware of this very early in my journey and wanted to gain a

deeper understanding of how organisations ensure health and care services are inclusive of

the entire population they serve. Through completing these reports, I was able to liaise with

representatives and groups of protected characteristics. This was an invaluable project, it

helped me understand the importance of including, consulting and listening to different

groups within the population when designing and improving services. It is difficult to

understand the potential impact of a project or service on the local population if you do not

engage with a wide range of different people and act on their concerns and advice.”

Our Communities

The boundary of West Lancashire CCG is aligned to the West Lancashire district boundary.

• The CCG is made up of 18 GP practices and covers a population of approximately

112,000 people in Ormskirk, Skelmersdale and surrounding communities

• Southport and Ormskirk Hospital NHS Trust is the main provider of secondary health

care for the area operating two main sites: Southport and Formby District General

Hospital and Ormskirk District General Hospital, which includes the West Lancashire

Health Partnership. There is also a walk-in centre in Skelmersdale.

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• Lancashire Care Foundation Trust is the main provider of inpatient and specialist

community mental health and Learning and disability services

• 21% of registered patients are aged 65 or over, with 16% aged 15 or under

• Census 2011 found 2% of resident population of West Lancashire to be from black

and non-white minority ethnic groups

• 33% of the registered population live within LSOAs considered to amongst the 40%

most deprived LSOAs nationally.

• The aged 65+ resident population of West Lancashire CCG is estimated to increase by

14% over the next 10 years

Demographic breakdown of West Lancashire

West Lancashire is one of 12 districts in Lancashire and stretches from the outskirts of

Liverpool to the south of the River Ribble, with Southport to the West and Wigan and Chorley

to the east. In 2012, the district had a population of 110,600 and is made up of a number of

small towns, villages and rural farmland.

West Lancashire has a diverse population in terms of age with some communities having a

markedly older population (Aughton, Parbold/Newburgh, Tarleton) with others being the

home to households with younger children (Skelmersdale). The borough is also home to

Edge Hill University which has more than 22,350 students most of whom live in the area – the

population of Ormskirk has a high level of 18-24-year olds. The 2011 census has shown that

West Lancashire has a generally ageing population – a 23% rise in those over 65 in a ten-year

period.

The ethnicity of residents is almost entirely White British – around 5% of the population in

Skelmersdale declared themselves to be White Other which could reflect the Eastern

European community living and working in the area. There are very small numbers of

residents who have other ethnicities (less than one half of one percent) and these live across

the borough. Less than 1% of residents have a mixed ethnicity (866). In the most recent

census, 76% of residents declared themselves to be Christian with 17% stating that they do

not follow a religion. The remaining 7% of the population have beliefs that include Buddhism,

Hinduism, Judaism, Islam and Sikhism.

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The gender of the borough is relatively balanced overall with 52% of the population

identifying as female. Data on the numbers of our population that are transgender is not

available to us but, based on a national estimate of 20 per 100,000 head of population, we

might expect to have around 20 residents who had a different gender at birth.

More than 20% of the population of West Lancashire consider that their day-to-day activities

are limited by health which is significantly higher than the national average. Almost 12,000

residents have a hearing impairment and just short of 2,000 adults have a visual impairment.

More than 2,000 resident adults have a learning disability. 12% of the population (12,682)

are found to have a common mental health disorder including depression and anxiety.

Data on the sexual orientation of the residents of West Lancashire is not available. Estimates

at a national level vary from 1.5% to 5% which would mean between 1,700 and 5,600

residents of our borough are lesbian, gay or bisexual.

Data source: West Lancashire Borough Council

Our Equality Objectives 2017/18 to 2021/22

Equality Objective 1: Better health outcomes

Equality Objective 2: Improved patient access and experience

Equality Objective 3: A representative and supported workforce

Equality Objective 4: Inclusive leadership

See Appendix 1 for progress on our Equality Objectives

Showing ‘Due Regard’ to the Public-Sector Equality Duty

In order to deliver high quality inclusive health services, we aim to ensure that groups

protected by the Equality Act 2010 have the same access, experiences and outcomes as the

general population. In this regard, we recognise that there are many things that influence

this that we may not have complete control over, but we are committed to working with the

community and our partners to influence our decisions.

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Equality Impact and Risk Assessments

The CCG has implemented the Equality Impact and Risk Assessment (EIRA) Toolkit from the

Equality and Inclusion Team, NHS Midlands and Lancashire Commissioning Support Unit

(MLCSU). The EIRA provides a framework for undertaking Equality Impact and Risk

Assessments. This tool combines two assessments consisting of Equality and Human Rights.

This enables the CCG to show ‘due regard’ to the Public-Sector Equality Duty and ensures

that consideration is given prior to any policy or commissioning decisions made by the

Governing Body or the Executive Team that may affect equality and human rights.

The CCG has continued to embed equality impact and risk assessments into policy

development and the commissioning cycle and also our Equality and Inclusion Business

Partner regularly updates the EIRA logging system and reports on the progress of the EIRA’s

regularly through reports that are submitted to the Executive Team.

Equality Impact and Risk Assessments undertaken by the CCG in 2017/2018 are:

• Ophthalmology Service

• Maternity Policy

• Grievance Policy

• Quality Strategy

• GP Enhanced Care Homes

• Social Prescribing

• Conflict of Interest Policy

• Disciplinary Policy

• Audiology Service for Paediatrics

• Paediatric Continence

• Project Management System

• Gluten Free Products

• Self-Care

• Prescribing Hubs

• Fall Car Service

• Risk Management Strategy

• Adoption Policy

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• Constitution Updated

• Better Points

• Career Break Policy

• Red Bag Scheme

• Pod

• Special Leave Policy

• IT Strategy 2020 Vision

• Sustainability Development Plan

• Organisations for the Review of Care and Health Applications: ORCHA

• Operational Plan 2018/2019

Equality Impact and Risk Assessments – Review of Pan Lancashire and South

Cumbria CCG’s Clinical Policies

In 2016 it was identified that current policies of low clinical value were in need of a review.

These policies had been previously adopted from Primary Care Trusts (PCTs) and some were

outdated in terms on NICE guidance and changing technologies, this work has continued into

2017/2018.

The Lancashire CCG’s represented on the policy review are:

• Fylde and Wyre CCG

• Lancaster North CCG

• Blackpool CCG

• Blackburn with Darwen CCG

• Chorley and South Ribble CCG

• Greater Preston CCG

• East Lancashire CCG

• West Lancashire CCG

Pan Lancashire Policies EIRA that have been undertaken:

• Process of Managing IFR Requests

• The Collaborative Individual Funding Requests Process for Lancashire Clinical

Commissioning Groups

• General Policy for Individual Funding Request Decision Making

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• Statement of Principles

• Policy for Considering Applications for Exceptionality to Commissioning Policies

• Assisted Conception and Surgical Fertility Services: Stage 2 EIRA and Human Rights

Assessment completed

• Carpal Tunnel

• Endoscopic Knee

• Cosmetics: Stage 2 EIRA

• Alternative Therapies

• Tonsillectomy

• Trigger Finger

• Insulin Pumps and Glucose Monitors

• Functional Electrical Stimulation

• Male Circumcision Policy

• Hip Arthroscopy

• Spinal Cord Stimulation

• Reversal of Sterilisation for Men and Woman

• Lumbar Spine Procedures

• The collaborative Individual Funding Request process for Lancashire Clinical

Commissioning Groups

• General Policy for Individual Funding Request Decision Making

• Statement of Principles

• Policy for Considering Applications for Exceptionality to Commissioning Policies

• Policy for Assisted Conception and Surgical Fertility Services

• Policy for the Commissioning of Cosmetic Procedures

Key Changes Influenced by Equality Work Included:

• Targeted engagement work including full equality monitoring forms for the

participants

• Changes were made to the age criteria for some policies when indirect discrimination

was identified

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• Changes were made to some policies wording regarding people gender reassignment

• Clarification on policy criteria relating to NICE Guidance

• Glossary added to policies to help and/or support people to understand clinical

wording

• Policy development group members have increased their awareness of the equality

agenda and the Brown and Gunning Principles

Pan Lancashire and South Cumbria Additional Equality Impact and Risk

Assessment Work

The following services under review have undertaken or are in process of undertaking an

EIRA:

• Child and Adolescent Mental Health Services (CAHMS)

• Improving Access to Psychological Therapies (IAPT) for Long Term Conditions

• Audiology Review (Adults)

• Stoke Services

Equality Delivery System Grading Assessment 2017

The Equality Delivery System (EDS) grading assessment was carried out by the CCG in October

2017 to CCG and CSU embedded staff. The purpose of the EDS grading is to help NHS

organisations, in discussion with local people, review and improve their performance for

people with characteristics protected by the Equality Act 2010.

EDS Grading Assessment for 2017

The CCG decided to focus on the EDS Goal 4 and the 3 outcomes outlined in the table below

for this year’s grading assessment. The desired outcome from this EDS exercise was to show

significant improvements in terms of Inclusive Leadership that the CCG has made since their

authorisation in 2012.

EDS Goal Outcome 2014/15 Grade

2017 Grade

Goal 4 Inclusive Leadership

4.1 The Governing Body Members and Senior

Leaders routinely demonstrate their

Achieving Achieving

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commitment to promoting equality within and

beyond their organisation

4.2 Papers that come before the Governing

Body and other major committees identify

equality related impacts including risks, and say

how these risks are managed

Achieving Achieving

4.3 Managers support their staff to work in

culturally competent ways within a work

environment free from discrimination

Achieving Achieving

EDS Grading Outcomes

The CCG maintained their overall grade of ‘Achieving’ for Goal 4 Inclusive Leadership received

in 2014/2015. The graphs below show the percentages of the staff who attended the event

and how staff voted for each outcome:

EDS Outcome 4.1: Boards and Senior Leaders routinely demonstrate their commitment to

promoting equality within and beyond their organisation

• 70% of staff graded the CCG as Achieving

EDS Outcome 4.2: Papers that come before the Governing Body and other major committees

identify equality related impact including risk and say how these risks are managed

• 65% of staff graded the CCG as Achieving

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EDS Outcome 4.3: Managers support their staff to work in culturally competent ways within a work

environment free from discrimination

• 35% of staff graded the CCG as Achieving, however 30% of staff felt that the CCG was

Excelling so an agreed grade of Achieving was awarded

EDS Grading Feedback from CCG Staff

Staff reported that they enjoyed the grading assessment and found it accessible. Staff also

found the session factual, informative and interactive. There was a general feeling that the

CCG is very inclusive and does accommodate needs of all staff.

You can view our full EDS grading assessment report on our website by accessing the

following link: http://www.westlancashireccg.nhs.uk/about-us/equality-and-inclusion/


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Involving Local People

We continue to rely on our existing communication channels to engage with various groups

and individuals and reach out to those who are less engaged in our work. These channels

include our annual drop in public listening events, our My View group, online and face to face

surveys, events, involvement in visioning events and focus groups. We also continue to value

those local groups we work regularly with such as long-term condition support groups, U3A,

disability groups and pensioner forums.

As a reminder, all CCGs across the country are required to by law to:

• Involve the public in the planning and development of services

• Consult on commissioning (buying) plans

• Act with a view to secure the involvement of patients in decisions about their care

• Promote choice

• Ensure efficient, cost-effective services are available

There are some examples of involvement included which will be included in both our Annual

Report 2017/18 and Duty to Involve Report 2017/18, which will both be available later this

year. In the meantime, here is a flavour of just some of the work we have done this year:

• Continuing to involve local public, patients and carers in the development of our

vision for joined up care.

• Publishing all materials available to the public regarding our procurement process

around community health services and urgent care services.

• Welcoming views from patients on any areas of service redesign such as

musculoskeletal, chronic pain and ophthalmology services.

• Delivering regular drop in public listening events, this time focusing on several draft

clinical policies which we, along with the other CCGs in Lancashire are proposing

several changes too.

• Further developing our newly formed Patient Participation Group (PPG) Forum. The

purpose of this group being to bring together the PPGs across West Lancashire to help

share best practice and work collaboratively to discuss and resolve matters affecting

patients in West Lancashire.

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• Extensive engagement with patients was conducted throughout the process of

moving the Viran Medical Centre to a temporary unit at the Tarleton Health Centre.

This has also resulted in the formation of a Viran PPG and a sub-group.

• Continuing to promote our My View group across West Lancashire.

• Supporting engagement with the third sector through participation in West

Lancashire CVS Health Network events.

• Involving the voluntary, community and faith sector in our vision for joined up care

and other service plans/discussions.

• Involving partners such as Healthwatch, CVS and primary care colleagues in sharing

patient experience allowing the CCG to identify any emerging themes.

• The introduction of our Prescription Ordering Direct Service (POD) across West

Lancashire has been complimented with extensive opportunities for patients to share

their views with us.

• The CCG has also been listening to its own staff having recently conducted a survey

focussing on internal communications and employee engagement and looking at what

works well and what staff would like to see improved/introduced.

• The CCG has recently set up the Staff Forum. This group has been established to help

further enforce the CCG’s culture of promoting health and wellbeing amongst its staff

and is a forum for staff to report any concerns/issues affecting them, that they may

not feel comfortable speaking to a senior manager about.

Pan Lancashire and South Cumbria CCG Policy Harmonisation

The CCG has continued to work in partnership with the other seven CCGs in Lancashire and

South Cumbria to review clinical policies across the region.

All of the CCG’s have all agreed that there is a need to review their policies in order to:

• Ensure a consistent and fair approach.

• Develop a set of principles and policies against which decisions about care and

treatment can be made.

• Update current policies in accordance with National Guidelines and best clinical

practice.

• Develop collaborative policies across the eight CCGs in Lancashire and South Cumbria.

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These clinical policies, inherited from Primary Care Trusts, although broadly similar, have

offered different approaches and rules. The CCGs recognise that this can lead to confusion

and potentially unintended differences in services across the area.

In 2017 and in early 2018 the CCG hosted a number of consultation events to go through the

policies. These were held around Blackpool at various times (including evenings) to provide

an opportunity for more people to attend in person. Surveys and other methods of providing

feedback were also offered.

Results from Blackpool’s engagement have been collated by the Midlands and Central

Lancashire Commissioning Support Unit along with the results from the other seven CCGs

involved.

For more examples of involvement, please read our Duty to Involve Report 2017/18. This will

be available via our website http://www.westlancashireccg.nhs.uk/ later in the year.

Community Voluntary Development

West Lancashire CVS continues to work in partnership with its members and with various

organisations on supporting health improvements. West Lancashire CCG recently seconded

a member of staff for a period to aid the further mapping of community assets, amongst

other work. Outlined below are some examples of work undertaken:

Gifts of Tanhouse:

The below word art illustrates the exploration of participants gifts of the head, heart, hand

and human connections: all community building starts with the individual.

http://www.westlancashireccg.nhs.uk/

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Other Projects:

Mental Health – Using the Ketso ABCD engagement tool, connections were made with a

variety of community groups and 5 mental health consultation workshops were held. The

results were fed back to the service redesign team to inform the mental health all age service

specification in West Lancashire.

Tawd Valley – This project involved designing methodologies to engage with the communities

around improving the Tawd Valley project. A Ketso workshop was designed and the team

involved was trained to utilise the tool to engage with a variety of audiences. Great feedback

and thoughts were received on the engagement process.

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Mutual Gain – Provided a learning platform and re-visited some learning and methods around

building social capital. This was a Lancashire police led initiative with a desire to work with

communities differently to embed early intervention. Support was offered and there were

great mutual benefits achieved from the involvement. Knowledge was gained, new

relationships were formed, and learning was shared and captured in a creative way and a

world café event, ‘Let’s eat cake and talk about our community’ was organised for the

Digmoor community to explore the following menu of questions: What is good about living

here? What are the biggest risks/issues here? What can we do about this? Table cloths were

used to capture the comments, and this felt very natural.

As part of the Community Development mapping project, Hajra Sardar, our Service Redesign

Manager, organised a session on 13 July 2017 with Souls Kitchen call the ‘Tanhouse Soup

Dragon’. The aim of the event was to mobilise communities’ ideas into action following the

exploration of, 3 asset questions, identified by Cormac Russell: What can you do for yourself?

What can we do together? What do you need services to do for you?

Outcomes of the Soup Dragon event:

• Residents who submitted pitches have been empowered by the event

• Building social capital through the connections

• New relationships and networks have been formed

• Sustainability of community project as ideas/solutions are supported created by the

community

• Participatory appraisal evaluation evidence improved well-being

• SPICE Time Credits – People’s voluntary attendance was valued

• Positive feedback was given by the Community

• Financial savings for the organisation were identified

Approximately 110 people attended the Soup Dragon event. 82% of the people who

attended live or work in Tanhouse, 15% of these included attendees with varied ethnic

backgrounds including Eastern European, Syrian and the Portuguese community. The event

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was also intergenerational including older residents from Fenney Court (sheltered housing)

and young pupils from the youth group and Hillside Primary School.

On the night of the event there was a great atmosphere and an amazing sense of community

spirit and people connecting and engaging that would normally do so, allowing inter-

generational and cross-cultural connections to form.

Customer Care and Complaints

Midlands and Lancashire Commissioning Support Unit (MLCSU) manage complaints on our

behalf and also offer a Patient Advice and Liaison Service (PALS). We are committed to

working with MLCSU to provide the best service for patients, their families and carers. The

CCG receive monthly reports from the Customer Care Team, MLCSU. These reports are

presented to the CCG’s Executive Team.

Quality and Performance

The CCG has continued to use the Quality Impact Assessment (QIA) process over the last

year. A QIA is a continuous process to ensure that potential projects/service changes are

assessed in terms of possible consequences and impacts on quality of care in terms of clinical

effectiveness, safety and patient experience. Any factors that can mitigate any negative

impact on quality will be identified as part of the assessment. NHS West Lancashire CCG is

committed to ensuring that commissioning decisions, business cases and policy changes are

evaluated for their impact on quality.

Equality Performance of Our Main Providers

All NHS Providers which the CCG contracts with undertake the annual equality performance

review using the NHS Equality Delivery System (EDS). The table below provides a snap shot

view of the current position of each of main NHS providers for West Lancashire CCG following

a review of their websites.

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CCG commissions services from the following providers

Equality Objectives

Published Equality Information in 2017/18

Undertaken EDS grading in 2017/18

Published WRES report in 2017

Accessible Information Standard

Southport and Ormskirk NHS Trust

Lancashire Care Foundation Trust

Merseycare NHS Foundation Trust

North West Ambulance Service

Wrightington, Wigan and Leigh NHS Foundation Trust

Aintree University Hospitals Foundation Trust

Conclusion

The evidence set out in this annual report demonstrates that the CCG continues to make

good progress towards its responsibilities showing ‘due regard’ to the way healthcare

services are commissioned and delivered. West Lancashire CCG is committed to making

continuous improvements as a commissioner of services.

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As an employer the CCG will continue to monitor progress against the Equality Act 2010, the

Public-Sector Equality Duty and the CCG’s new Equality Objectives. During 2017 we will need

to consider new services and functions on a bigger footprint across West Lancashire and in

some area Pan Lancashire across the Sustainable Transformation (STP) footprint from 2018

onwards.

Recommendations for action

1. The CCG is requested to discuss and note the report.

2. Escalate the report to the Governing Body to approve the report for publication on

the CCG’s website.

This report has been produced by the:

Equality and Inclusion Team, Midlands and Lancashire Commissioning Support

Unit

Date: May 2018

35

Appendix 1: Equality Objectives Progress and Actions 2017/18 – 2021/22

Equality Objectives & EDS Goal

EDS Outcome Progress in 2017/2018 Actions for 2018/2019 EDS Grade

Equality objective 1: To reduce unacceptable differences in the health inequalities of all people who live within West Lancashire. The evidence base suggests that healthcare contributes approximately 10% towards preventing premature death, how we live our lives offers the greatest opportunity for improving health. We recognise that an ever-increasing proportion of presentations in Primary Care are primarily related to non-medical issues that are impacting upon health. In response to this we have commissioned a Social Prescribing pilot initially focused on the neighbourhood of Skelmersdale. At the core of this work will be creating connectivity across primary care to a plethora of community-led projects that are able to provide the support, advice and guidance needed to tackle the key issues impacting on people’s lives.

36

Better health outcomes

1.1 Services are commissioned, procured, designed and delivered to meet the health needs of local communities

Our Commissioning Cycle and Activity There are four stages to our commissioning cycle. They are analysing, planning doing and reviewing. Patient involvement and patient feedback is integral to our commissioning cycle and supports us to buy the health services to meet the need of our local people. Commissioned: We have robust systems in place to ensure the services we commission are appropriate, effective and cost effective. This ensures that the services we buy are the best services for people in our local communities. Procurement: We buy our procurement service from NHS Midlands and Lancashire Commissioning Support Unit. Within this process there are Equality questions asked of potential providers. This ensures that we are buying services that meet the needs of all the people in our local communities. Designed: We involved our local communities, our patient groups and providers of our services when we are designing services, this ensures that we can make informed commissioning decisions. Delivered: We monitor how the services we commission are delivered. This ensures that any issues are reported, and lessons are learned to improve health outcomes, and improve patient access and experience.

EDS grading assessment 2018

Achieving 2015

37

Equality Impact and Risk Assessments (EIRA’s): We undertake EIRA’s on any services we are commissioning, which includes any changes to service or justifications in policy to mitigate the risk of inequality. EIRA’s undertaken by the CCG within 2017/18 are outlined on page xx of this report

1.2 Individual peoples’ health needs are assessed and met in appropriate and effective ways

Equality objective 1: To reduce unacceptable differences in the health inequalities of all people who live within West Lancashire The evidence base suggests that healthcare contributes approximately 10% towards preventing premature death, how we live our lives offers the greatest opportunity for improving health. We recognise that an ever-increasing proportion of presentations in Primary Care are primarily related to non-medical issues that are impacting upon health. In response to this we have commissioned a Social Prescribing pilot initially focused on the neighbourhood of Skelmersdale. At the core of


Developing 2015

38

this work will be creating connectivity across primary care to a plethora of community-led projects that are able to provide the support, advice and guidance needed to tackle the key issues impacting on people’s lives. Since the inception of Well Skelmersdale it has been recognised that the neighbourhood of Skelmersdale is awash with entrepreneurial spirit that is limited by low-level mental health problems that impact of confidence and self-esteem. We have identified the School of Social Entrepreneurs as a vehicle through which individuals can get the training and structure they need to take them on a journey to launching a Social Business. We recognise the growth of Social Business as a key contributor to growing a local and inclusive economy, taking people who are furthest away from the labour market to employment. To support this growth, we will be networking existing award-winning Skelmersdale-based Social Businesses to provide greater synergy for the town, with the ultimate ambition to secure ‘Social Enterprise Town’ status. We have been working with other Lancashire CCG’s to review a number of clinical policies, this work started in 2016 and has continued into 2018, with the aim of reducing inequalities in access or treatment across Lancashire and to ensure

39

limited NHS resources are used appropriately and effectively. We undertake equality impact and risk assessments and include the changes or justifications in the policy reviews to mitigate the risk of inequality. Engagement is targeted at groups identified via the initial Stage 1 Equality Impact and Risk Assessment We commission an Individual Funding Request (IFR) and the Continuing Health Services from NHS Midlands and Lancashire Commissioning Support Unit. The MLCSU review IFR’s for people who have been to their GP, but their condition does not meet the criteria of the associated Clinical Policy to enable them to receive treatment. We use a range of methods to gain views including online and paper questionnaires, patient forums, listening cafes to ensure all

1.3 Transitions from one service to another, for people on care pathways, are made smoothly with everyone well-informed

Stroke Services This project is being completed by the Service Redesign Team, MLCSU: Review of Lancashire and South Cumbria’s Hyper Acute Stroke Units – this EIRA is still in its early having – the Stage 1 EIRA identified that a Stage 2 EIRA will be completed. The next steps are to obtain the Communications and Engagement plan for this workstream and carry out a Stage 1 the on plan. The Service Redesign Team will ensure

EDS Grading Assessment 2018

Developing 2015

40

that engagement is carried out in the areas where most impact is expected, and record and monitor the demographic details of those involved to evidence that the engagement has been appropriate and meaningful. The insight obtained from the consultation and engagement will then be used to inform and complete a Stage 2 EIRA and ascertain any impacts perceived by the protected characteristic groups. Any negative impacts that are identified can be considered and steps taken to minimise the effects of them. Improving Access to Psychological Therapies (IAPT) (IAPT): In March 2017, the non-Pennine CCGs across the pan-Lancashire and South Cumbria footprint secured funding as part of wave 2 of the national programme, to roll out implementation of IAPT for people with long terms conditions. This will involve identifying staff within existing IAPT services to undergo training re: LTCs who will then work alongside physical health teams to treat people with LTCs who have co-morbid mental health needs. It will also involve recruiting new IAPT trainees to the IAPT teams to grow capacity and provide backfill. Child and Adolescent Mental Health Services. (CAMHS): In February 2017, the Collaborative Commissioning Board (CCB) received the 2017/18 Business Plan for the Children and

41

Young People’s Emotional Wellbeing and Mental Health (CYPEWMH) Transformation Programme. Listed below are a snapshot of some of the aims of this project are:

• To design and commission children and

young people’s emotional wellbeing

and mental health (CYPEWMH) services

across Lancashire and South Cumbria

which:

• Offer quality services that result in

positive patient experiences and deliver

positive outcomes for children, young

people and families

• Reflect the THRIVE model including

• Take referrals from birth up to 18th

birthday and continue to support up to

19th birthday, as needed

• Offer 7-day CAMHS crisis response with

access to out of hours on call services

and places of safety

• Meet expectations of MHS (mental

health services) dataset

Ensure that young people receive prompt access to urgent care, with young person-specific services working

42

collaboratively with all-age urgent care service

1.4 When people use NHS services their safety is prioritised, and they are free from mistakes, mistreatment and abuse

As a Clinical Commissioning Group, we have a duty to keep children and adults safe by safeguarding and promoting the welfare of children and young people and protecting adults who may be vulnerable to abuse. We seek assurances from all health providers from which we buy services on your behalf that they have safeguarding policies and procedures in place. We ask them to provide evidence of how they are meeting essential safeguarding standards and the services provided are monitored regularly. Serious Untoward Incidents (SUI’s): We have a Serious Incident and Management Policy in place this policy has had an EIRA completed. The Strategic Executive Information System (STEIS) captures all Serious Incidents. Serious Incidents (as defined in the Serious Incident Framework)


Achieving 2013

1.5 Screening, vaccination and other health promotion services reach and benefit all local communities

We have a range of communication channels please see page of this report for more details.


Developing 2014

Improved Patient Access and Experience

2.1 People, carers and communities can readily access hospital, community health or primary care services and should not be denied access on unreasonable grounds

Equality Impact and Risk Assessments have been completed on a range of services which have shown evidence, see page xx of this report for more detail.


Achieving 2016

43

2.2 People are informed and supported to be involved as they wish to be in decisions about their care

Involvement and Engagement see page xx of this report


Achieving 2016

2.3 People’s report positive experiences of the NHS

We use patient feedback in the form of concerns, compliments, complaints, patient’s stories, workshops, surveys, listening cafes and provider performance data to gather the experiences of the people in our locality who use our provider services, we use this information to help us make informed decisions on how we commission health services.


Developing 2015

2.4 Peoples’ complaints about services are handled respectfully and efficiently

All the complaints that we receive are handled in a fair and equitable manner, we have details on our website to help simplify the complaints process for people. Customer Care Team, MLCSU produce a report every quarter, each report summarises all correspondence with the customer care team, which is reported by trend and themes.


Achieving 2014

A Represented and Supported Workforce

3.1 Fair NHS recruitment and selection processes lead to a more representative workforce at all levels

The CCG uses NHS Jobs for their recruitment and selection process, which means that the shortlisting process is confidential. Our interviewing process is competency based and band appropriate, which means that candidates are fairly assessed again the key competencies that the CCG is looking for We have also continued to run the Apprentice Scheme.


Achieving 2014

44

3.2 The NHS is committed to equal pay for work of equal value and expects employers to use equal pay audits to help fulfil their legal obligations

Agenda for Change PayScale’s have fixed pay scales and pay points. When a position is within the NHS Pay Review Body (NHSPRB) is advertised, it is allocated on of the pay bands based on job weight as measures by the NHS job evaluation scheme. Any changes to job descriptions are subject to job evaluation. Job evaluation is carried out on behalf of the CCG by the CSU and job descriptions are reviewed against the Agenda for Change (AfC) national role profiles. Job descriptions are reviewed as part of the appraisals process.


Achieving 2014

3.3 Training and development opportunities are taken up and positively evaluated by all staff

Staff and Governing Body Members are mandated to complete a range of core training, and the CCG has good compliance rate in the area. A formal appraisal process is in place at the CCG, which allows staff to plan appropriate development for their role and career with their line manager. See page xxx of this report


Achieving 2014

3.4 When at work, staff are free from abuse, harassment, bullying and violence form any source

The CCG has a range of HR policies in place, which have all recently been reviewed and have had an Equality Impact and Risk Assessment completed on them.


Achieving 2014

45

3.5 Flexible working options are available to all staff consistent with the needs of the service and the way people lead their lives

Our employees are on a mixture of permanent and fixed term contracts. All individuals can undertake flexible working to amend their contracts to provide a different working pattern. This can include a change in days or hours and some members of staff work a nine-day fortnight.


Achieving 2014

3.6 Staff report positive experiences of their membership of the workforce

One to One’s Appraisals


Achieving 2014

Inclusive Leadership

4.1 Boards and senior leaders routinely demonstrate their commitment to promoting equality within and beyond their organisations

The CCG’s Equality and Inclusion Strategy 2017/2021

• Equality Impact and Risk Assessment

Toolkit

• Equality and Inclusion Annual Report

• Equality and Diversity included in job

descriptions

• Organisational Plan 2018/2019

• Project Management Office

• Appraisal process

• 360◦ Stakeholder Annual Survey

• Governing Body Meetings

• Patient online surveys

• CCG’s NHS England Improvement and

Assessment Framework

• NHS Standard Contracts

• Quality and Performance Key Indicators

relating to Equality


Achieving 2017

46

4.2 Papers that come before the Board and other major Committees identify equality related impacts including risks, and say how these risks are managed

• All papers submitted to the Governing

Body Meetings include a front cover

sheet – this requires the author to

demonstrate how their paper has

proportionally considered Equality and

Inclusion by stating if an EIRA has been

completed.

• The Equality Impact and Risk

Assessment Toolkit has a section on

risks and an action plan section to state

how the equality risks will be managed.

• A list of the EIRA’s completed by the

CCG in the last 12 months can be found

on page xx of this report. The CCG

recognises that it will face all manner of

risks. To ensure that the CCG manages

the challenges to it business, the

Governing Body has approved a Risk

Management Framework, which

provides an over-arching summary of

the CCG’s Risk policy, strategy and

accountability, and procedure guidance.

• All identified risks are included on the

CCG’s Risk Register and assigned a Risk

Owner. The full Risk Register is


Achieving 2017

47

reviewed monthly by the CCG’s Senior

Management Team and bi-monthly by

the Audit Committee, with an extract of

the high-level risk (those rated 12 or

above) taken to each Governing Body

Meeting.

4.3 Middle managers and other line managers support their staff to work in culturally competent ways within a work environment free from discrimination

• Equality and Diversity Mandatory

Training

• Extra Equality and Inclusion Training

• Equality Impact and Risk Assessment

Workshops

• Workforce Race Equality Standard

Reporting

• Induction

• One to one’s

• Appraisals – Personal Development

Plans

• Staff development

• Team meetings

• Executive Team Open Door Policy

• EIRA’s on all Human Resources Policies

• Equality and Diversity Policies

o Flexible Working

o Bullying and Harassment

o Whistleblowing


Excelling 2017

48

o Maternity

o Special Leave

o Safeguarding

o Zero Tolerance

o Adoption

o Grievance

o Appraisal Policy

• Team Briefs (Weekly)

• Staff Communication updates by email

(monthly)

• CCG Equality Objective - EDS Goal 3: A

represented and supported workforce

(6 outcomes)

• ‘Two ticks’ disability symbol

49

Appendix 2: Overview of West Lancashire CCG Grading Results 2012 to 2017

Objective Narrative Outcome 2012 2013 2014 2015 2016 2017 1. Better

health outcomes

The NHS should achieve improvements in patient health, public health and patient safety for all, based on comprehensive evidence of needs and results

1.1 Services are commissioned, procured, designed and delivered to meet the health needs of local communities

Developing Achieving Not graded in 2014

Achieving Not graded in 2016

Not graded in 2017

1.2 Individual people’s health needs are assessed and met in appropriate and effective ways

Developing Developing Developing +

Developing Not graded in 2016

Not graded in 2017

1.3 Transitions from one service to another, for people on care pathways, are made smoothly with everyone well-informed

Developing Developing Developing + Developing Not graded in 2016

Not graded in 2017

1.4 When people use NHS services their safety is prioritised, and they are free from mistakes, mistreatment and abuse

Developing Achieving Not graded in 2014

Not graded in 2015

Not graded in 2016

Not graded in 2017

1.5 Screening, vaccination and other health promotion services reach and benefit all local communities

Developing Developing Developing + Not graded in 2015

Not graded 2016

Not graded in 2017

2. Improved patient access and experience

The NHS should improve accessibility and information, and deliver the right services that are targeted, useful, useable and used to improve patient experience

2.1 People, carers and communities can readily access hospital, community health or primary care services and should not be denied access on unreasonable grounds

Developing Developing Achieving + Not graded in 2015


2.2 People are informed and supported to be as involved as they wish to be in decisions about their care

Developing Developing Achieving Not graded in 2015


2.3 People report positive experiences of the NHS

Developing Developing Developing + Developing + Not graded in 2016

Not graded in 2017

2.4 People’s complaints about services are handled respectfully and efficiently


Not graded 2016

Not graded in 2017

50

3. A representative and supported workforce

The NHS should increase the diversity and quality of the working lives of the paid and non-paid workforce, supporting all staff to better respond to patients’ and communities’ needs

3.1 Fair NHS recruitment and selection processes lead to a more representative workforce at all levels

Developing Staff Grading Staff Grading Not graded in 2015

Not in graded 2016

Not graded in 2017

Achieving Achieving Not graded in 2015

Not graded 2016

Not graded in 2017

3.2 The NHS is committed to equal pay for work of equal value and expects employers to use equal pay audits to help fulfil their legal obligations

Developing Achieving Achieving Not graded in 2015

Not graded Not graded in 2017

3.3 Training and development opportunities are taken up and positively evaluated by all staff


Not graded in 2016

Not graded in 2017

3.4 When at work, staff are free from abuse, harassment, bullying and violence from any source

Achieving Achieving Achieving Not graded in 2015

Not graded in 2016

Not graded in 2017

3.5 Flexible working options are available to all staff consistent with the needs of the service and the way people lead their lives

Developing Achieving Achieving Not graded in 2015

Not graded in 2016

Not graded in 2017

3.6 Staff report positive experiences of their membership of the workforce

Achieving Developing Achieving Not graded in 2015

Not graded in 2016

Not graded in 2017

4. Inclusive leadership

NHS organisations should ensure that equality is everyone’s business, and everyone is expected to take an active part, supported by the work of specialist equality leaders and champions

4.1 Boards and senior leaders routinely demonstrate their commitment to promoting equality within and beyond their organisations

Achieving Developing Achieving Not graded in 2015

Not graded in 2016

Achieving

4.2 Papers that come before the Board and other major Committees identify equality-related impacts including risks, and say how these risks are managed


Not graded in 2016

Achieving

2012 - 4.3 The organisation used the NHS Equality & Diversity Competency Framework to recruit, develop and

4.3 Middle managers and other line managers support their staff to work in culturally

Underdeveloped


Not graded in 2015

Not graded 2016

Achieving

51

support strategic leaders to advance equality outcomes

competent ways within a work environment free from discrimination

Bomb Threat Policy West Lancashire Clinical Commissioning Group Governing Body Meeting – 22 May 2018

1

WLCCGB 05/18/11


DATE OF BOARD MEETING: 22 May 2018 TITLE OF REPORT: Bomb Threat Policy BRIEFING POINTS:

No change in content. Inserted logo and updated review date




The policy will have a positive impact on staff and patients as it advises and supports them and creates create a pro-security culture.


N/A


N/A

4. Delivering Financial Balance – please outline impact N/A


N/A






Yes. Fulfils legal obligations and promotes governance practice


N/A

3. Health Inequalities

4. Equality and Inclusion and Human Rights Requirements – Has an Equality Impact and Risk Assessment been carried out?

Yes. Approved on 17 April

2018

5. Clinical Engagement N/A

6. Patient and Public Engagement N/A

PAPER PREPARED BY: PAPER PRESENTED BY:

Smita Shetty, service redesign manager Paul Kingan, chief finance officer

1

Reference number V2 Apr 2018

Version V 2.0

EIA Approval Approved on 17 Apr 18

Approving Committee Clinical Executive Committee 25 Apr 2018

Governing Body TBC

Review Date Apr 2019

2

West Lancashire CCG is committed to ensuring that, as far as it is reasonably practicable, the way we provide services to the public and the way we treat our staff reflects their individual needs and does not discriminate against individuals or groups on the basis of their age, disability, gender, race, religion/belief or sexual orientation.

Should a member of staff or any other person require access to this policy in another language or format (such as Braille or large print) they can do so by contacting the West Lancashire CCG who will do its utmost to support and develop equitable access to all policies.

Senior managers within the CCG have a responsibility for ensuring that a system is in place for their area of responsibility that keeps staff up to date with new policy changes.

It is the responsibility of all staff employed directly or indirectly by the CCG to make themselves aware of the policies and procedures of that CCG.

3

CONTENTS

PAGE

1. Introduction 4

2. Definitions 5

3. Principles 5

4. Duties and Responsibilities 7

5. Procedural Guidelines 8

6. Implementation, Compliance, Training 13

7. Monitoring, Review and Equality 13

Appendix A Aide Memoir for a Bomb Threat 15

4

1. INTRODUCTION

West Lancashire Clinical Commissioning Group (CCG) is committed to providing a

safe working environment for its patients, staff, professionals and property. West

Lancashire CCG will work with NHS Protect, the police, the Crown Prosecution

Service, West Lancashire Borough Council, the National Security Services and other

partners to create and safe and secure environment so that the highest standards of

clinical care can be made available to patients.

Bombs have been a popular terrorist weapon from the 19th century, but even during

periods of heightened terrorism, the chances of any given individual being affected

by a bomb attack are low. However, some locations, organisations and individuals

remain more likely than others to be the target of terrorist attack. Terrorists do not

always target specific organisations when they plant bombs. They may well plant

them at random, so the organisation may be affected simply because of where it is

situated.

Threats more recently have come from terrorists who act in an extreme way following

a cult or religion. Their focus is mainly on public areas and mass casualties so that

their act has a greater impact. These acts are based on extremist views and following

an extreme ideology or religion. The Government’s strategy CONTEST is the UK’s

counter terrorism strategy that aims to reduce the risk we face from terrorism. It is

made up of four work streams;

Protect – strengthening our borders, infrastructure, buildings and public spaces from

an attack.

Prepare – where an attack cannot be stopped, to reduce its impact by ensuring we

can respond effectively.

Pursue – to disrupt or stop terrorist attacks.

Prevent – to stop people becoming terrorists or supporting terrorism.

West Lancashire CCG will support the CONTEST strategy by providing Prevent

workshops for all staff and monitor providers contractual obligation to deliver the

Prevent strategy. West Lancashire CCG will support this strategy by running Prevent

workshops for all its staff.

1.1 Aim

The purpose of this policy is to advise and support staff of the on bomb threats and

to seek their support and commitment to create a pro-security culture.

This document contains information on the structure required and defines the roles

and responsibilities to implement the bomb threat policy.

This policy aims to integrate security awareness into the general working environment of West Lancashire CCG and to reduce the risk of a bomb threat/attack.

• To support the personal safety, at all times, of patients, staff and visitors.

• To protect West Lancashire CCG office building from malicious acts, criminal

damage and trespass.

• To protect West Lancashire CCG assets and information from theft, damage or

fraud.

5

• To protect personal property belongings of staff and visitors whilst on West

Lancashire CCG premises.

• To support the uninterrupted delivery of health and community care.

1.2 Scope

This policy applies to all staff employed by the CCG, either directly or indirectly, and to

any other person or organisation that uses CCG’s premises for any purpose. All staff

have a responsibility to ensure that security measures and procedures are observed

at all times. Managers should take a lead role in promoting and developing a security

conscious environment.

2. DEFINITIONS

NHS Protect - Is an independent division of the NHS Business Services Authority

(NHSBSA) and has responsibility for all policy and operational

matters relating to the management of security in the National Health

Service.

ACPO - Association of Chief Police Officers

Counter Terrorism Security Advisor (CTSA) - Contactable through the Lancashire

Constabulary. This officer can advise on physical security.

CBRN Material - Chemical, biological, radiological or nuclear materials

3.0 Principles

The bomb threat policy establishes the following principles:

The delivery of a bomb threat response locally to national standards.

The creation of a pro-security culture - the promotion of a culture where

security is the responsibility of every member of staff and anyone granted

permission to use CCG premises. Where the actions of the minority who breach

security are not tolerated.

To deter offenders from committing offences - deterring those who may be

minded to breach security – using publicity to raise awareness of what the

consequences of their intended actions could be, both personally and to the NHS.

To prevent offenders from committing offences - preventing security incidents

or breaches from occurring whenever possible or minimising the risk of them

occurring by learning from operational experience about previous incidents, using

technology wisely and sharing best practice.

6

Detecting security incidents or breaches - and ensuring these are reported in

a simple, consistent manner within the CCG, so that trends and risks can be

analysed, allowing this data to properly inform the development of preventative

measures or the revision of policies and procedures.

Investigating security incidents or breaches - in a fair, objective and

professional manner, to ensure those responsible for such incidents are held to

account for their actions, and that the causes of such incidents or breaches are

fully examined and fed into prevention work to minimises the risk of them

occurring again.

To put in place sanctions against those who breach this security policy -

involving a combination of procedural, disciplinary, civil and criminal action as

appropriate.

To apply for redress against offenders - through the criminal and civil justice

systems against those whose actions lead to loss of NHS resources, through

security breaches or incidents. Also ensuring that those who are the victims within

the NHS environment are supported to seek appropriate compensation from

offenders for loss of earnings or for the effects of injuries sustained.

3.1 The Law

The vast majority of bomb threats are hoaxes. Making such malicious calls is an offence contrary to Section 51 of the Criminal Law Act 1977 and should always be reported to the police.

3.1.1 Section 51(1) It is an offence for any person to place any article in any place or to despatch an article by post, rail or other means with the intention of inducing in another person a belief that it is likely to explode or ignite and, therefore, causing personal injury or damage to property.

3.1.2 Section 51(2) It is an offence for any person to communicate any information, which he knows to be false, to another person with the intention of inducing in him or another person a false belief that a bomb or other thing likely to explode or ignite is present in any place or location.

3.1.3 Section 51(3) For a person to be guilty of any of the foregoing offences, it is not necessary for him to have any particular person in mind as the person in whom he intends to induce the belief that is mentioned in either of the offences.

3.2 Legal Duty

While the risk of an individual being caught up in a bomb-related incident is low, each health body has a responsibility under the Health and Safety at Work Regulations 1992 to minimise that risk. These regulations provide that:

• all employers owe their staff and visitors a duty of care; the responsibility for

safety on their premises rests with employers, not the police

appropriate procedures must be in place to deal with serious, imminent

7

danger

• there should be people competent to implement the procedures

• employees must be informed of the hazards, and the steps to be taken in the

event of an emergency

• in the case of serious, imminent danger, work must be stopped immediately

and people moved to a place of safety

• access must be restricted, and resumption of normal work prevented, while

the serious and imminent danger persists

• in the event of an emergency, plans are disclosable and may be subject to

scrutiny in any enquiries or court proceedings.

4. DUTIES AND RESPONSIBILITIES

4.1 Security Management Lead (SML)

The CCG executive responsible for security management is the Chief Finance Officer. The Chief Finance Officer as security management lead (SML) will lead and communicate at senior level on strategies to deal with bomb threats of any kind. This will assist the CCG in meeting its responsibilities for safeguarding the health and safety of staff.

The SML should work with CCG staff to promote and champion strategies to terrorism

at governing body level.

Final responsibility for security management matters, including strategies to deal with bomb threats, remains with the SML regardless of whether or not the Local Security Management Specialist (LSMS) and/or security staff are directly employed by the CSU or provided by an external contractor.

4.2 Local Security Management Specialist (LSMS)

The CCG has commissioned Midlands and Lancashire Commissioning Support Unit (CSU) to provide security services including the role of local security management specialist.

• The LSMS will:

• Ensure that appropriate and adequate risk assessments of security arrangements are in place based on site visits, historical information and intelligence received and were necessary, changes made in agreement with the organisation to reduce or eliminate the risk of bomb threats towards staff or the organisation.

8

Provide clear advice and guidance to all staff on how to deal with situations

where a bomb threat has been made or is suspected.

• Ensure support is provided, as and when required, to West Lancashire CCG,

where an incident has taken place.

• Assist in the action following any adverse incidents involving a bomb threat or

real life situation, including liaison with the police as appropriate;

• Ensure that any significant areas of concern are reported to the Chief Finance

Officer who is the CCG’s nominated Security Management Director.

• Liaise with necessary authorities e.g. police, NHS Protect to impose sanctions

on those who commit an offence under Section 51 (1) (2) (3) of the Criminal

Law Act 1977, where appropriate.

4.3 All Managers

All managers must ensure they understand how this policy is enacted, when it should

be enacted and their role within this structure.

4.4 All Staff

Staff are responsible for keeping themselves informed and up to date about changes

to the procedural documents, particularly policy changes. Updates will be provided by

the staff newsletter.

5.0 PROCEDURAL GUIDELINES

Most bomb threats are made over the phone but could also come from other media

devices. The overwhelming majority are hoaxes, often the work of malicious

pranksters, although terrorists also make hoax calls. Any such hoax is a crime and, no

matter how ridiculous or unconvincing, should be reported to the police and reported

on an incident report.

• The police MUST be contacted immediately whenever a bomb threat is

received by calling 999 or 112.

• West Lancashire CCG Security Management Lead (SML) (the Chief Finance

Officer) or deputy MUST be informed of any bomb threat. The SML or deputy

will manage the implementation and compliance with this policy and should

consider search of premises

• All evidence and/or crime scenes must be left undisturbed until the police

forensics have carried out their duties and the Police have said it is ok to do

so.

9

• The CSU’s Local Security Management Specialist (LSMS) should be

contacted as soon as possible (by phone or email) to inform him/her of the

incident regardless of whether it was a hoax or not.

10

• An incident report MUST be completed as soon as reasonably possible. A

copy should be sent to West Lancashire CCG LSMS and SML.

• West Lancashire CCG Business Continuity Plan should be implemented, if

required.

5.1 Suspicious and/or Unattended Bag/Parcel

A bag or parcel is required to be easily portable, such bombs are unlikely to weigh

more than 25kg, although even an ordinary sized briefcase can contain about 12kg

of explosive. This type of explosive could cause serious damage to buildings and

fatal to people nearby or in the blast radius.

A suspicious and/or unattended bag/parcel is one that is out of place from the norm.

In a small office environment is easier to spot as staff should be familiar with their

surroundings.

• Do not touch or attempt to move the bag/parcel under any circumstances until it

is safe to do so.

• Speak to the senior manager on duty about your suspicions of the bag/parcel

• Try to quickly identify if it belongs to a member of staff, quietly and calmly.

Especially reception staff as they may have seen its owner brings in the bag and

if they have left.

• Review CCTV to see if you can establish the carrier of the bag/parcel.

• Consider a controlled evacuation of the immediate area and contact the police

immediately.

• Follow police advice.

• If the device is making strange noises or smoking, evacuate immediately without

delay.

5.2 Telephone Bomb Threats

Bomb threats made by phone are usually to hide the identity of the caller and to allow

people to evacuate the area of the possible bomb threat. The callers will usually

spend some time on the phone describing the location of the bomb. The expected

impact of the caller is to cause disruption rather than loss of life. Quick callers are

usually hoaxers but should not be ignored as such. Staff should consider the

following when taking a call like this and follow these guidelines.

Staff receiving a bomb threat telephone call should follow these instructions:

• Remain calm and listen

11

Obtain as much information as possible – try to get the caller to be precise about

the location and timing of the alleged bomb and try to establish whom they

represent. If possible keep the caller talking

• If voice recording equipment is available switch it on

• When the caller rings off, dial 1471 (if that facility operates and you have no

automatic number display) to see if you can get their number

• Follow 5.0 Procedural Guidelines

• If you have not been able to record the call, make notes for the security

management lead (SML) and police. Do not leave your post unless ordered to

evacuate or until the police or the SML or deputy advises. Refer to the appendix

one for the full and comprehensive bomb threat action checklist.

• All staff must comply with the following the instructions:

Do not touch suspicious items

Move away to a safe distance

Prevent others from approaching

Communicate safely to staff, patients and visitors

Do not use hand-held radios or mobiles phones in immediate vicinity of a

suspect item or at a distance of less than 15 metres.

Notify the police (in an emergency dial 999 or 112, non-emergency dial

101)

Ensure that whoever found the item or witnessed the incident remains on

hand to brief the police.

5.3 Letter Bombs

• Letter bombs, which include parcels, packages and anything delivered by post

or courier, have previously been a commonly used terrorist act.

• Letter bombs may be explosive or incendiary (the two most likely types) or

conceivably chemical, biological or radiological. Anyone receiving a suspicious

delivery is unlikely to know which type it is, so procedures should cater for every

eventuality.

• A letter bomb will probably have received fairly rough handling in the post and

so is unlikely to detonate through being moved, but any attempt at opening it

may set it off. Unless delivered by a courier, it is unlikely to contain a timing

device.

• Letter bombs come in a variety of shapes and sizes: a well-made one will look

innocuous but there may be tell-tale signs.

• Good housekeeping is essential for safe guarding staff. Ensuring that parcels,

boxes and other similar objects are stowed away safely and as soon as possible

is a good crime / bomb threat prevention practice.

Indicators of a letter bomb

• It is unexpected or of unusual origin or from an unfamiliar sender.

12

• There is no return address or the address cannot be verified.

• It is poorly or inaccurately addressed, e.g. incorrect title, spelt wrongly, title but

no name or addressed to an individual no longer with the CCG.

• The address has been printed unevenly or in an unusual way.

The writing is in an unfamiliar foreign style.

• There are unusual postmarks or postage paid marks.

• A jiffy bag or similar padded envelope has been used.

• It seems unusually heavy for its size. Most letters weigh up to about 30 grams,

whereas most effective letter bombs weigh 50-100 grams and are 5mm or more

thick.

• It has more than the appropriate value of stamps for its size and weight.

• It is marked ‘personal’ or ‘confidential’.

• It is oddly shaped or lopsided.

• The envelope flap is stuck down completely (a normal letter usually has an un

gummed gap of 35mm at the corners).

• There is a pin-sized hole in the envelope or package wrapping.

• There is an unusual smell, including but not restricted to, almonds, ammonia or

marzipan.

• Has a greasy or oily stain on the envelope.

• There is an additional inner envelope and it is tightly taped or tied (however, in some organisations sensitive material is sent in double envelopes as standard procedure).

Staff need to be aware of the usual pattern of deliveries and to be briefed of unusual

deliveries. The best practice is to open letters with letter openers (and with minimum

movement) to keep hands away from noses and mouths and always wash your

hands afterwards. Staff should not blow into envelopes or shake them. Packages

suspected of containing chemical, biological, radiological (CBR) material should

ideally be placed in a double-sealed bag.

5.4 Vehicle Bombs / Vehicle Borne Improvised Explosive Devices (VBIEDs)

Vehicle bombs are one of the most effective weapons in the terrorist’s arsenal. They

are capable of delivering a large quantity of explosives to a target and can cause a

great deal of damage.

If a vehicle is suspected or identified, staff should remain in their offices until the

police arrive. If that is not deemed to be safe senior management should consider

exiting safely from the building to a safer area. The use of an alternative exit should

be considered if usual exit is close to suspect vehicle and leave in an orderly fashion.

5.5 Person-Borne Bombs

Person-borne bombs are usually, as their name implies, explosive devices carried by

an individual. These are usually carried in containers such as rucksacks or

briefcases, which are chosen to blend in easily with the target surroundings.

Suicide bombers have previously used this method in order to hide their explosive

device. Poorly made devices can detonate prior to set off at the intended time. Some

may start smoking which is an indication something is not right and should be treated

as a real life incident flowing the evacuation process.

13

5.6 Chemical, biological and radioactive (CBR) Incidents

Responses to CBR incidents will vary more than those involving conventional or

incendiary devices, but the following general points should be noted:

• The exact nature of an incident may not be immediately apparent. For example,

an Improvised Explosive Devices (IED) might also involve the release of CBR

material.

• In the event of a suspect CBR incident within the building, switch off all air

conditioning, ventilation and other systems or items that circulate air (e.g. fans

and personal computers).

• Do not allow anyone, whether exposed or not, to leave evacuation areas before

the emergency services have given medical advice, assessments or treatment.

• If an incident occurs outside the building, close all doors and windows and switch

off any systems that draw air into the building.

• Remember to let the police know what action you are taking during any incident.

• Building managers should ensure that they have a working knowledge of the

heating, ventilation and air condition (HVAC) systems and how these may

contribute to the spread of CBR materials within the building.

5.7 Search plans

• Appoint a search co-ordinator (usually the most senior manager on site) to

produce and maintain a search plan. He or she should initiate any searches and

liaise with other searches.

• All staff should search their immediate area without disturbing anything to see if

there is anything unusual. Staff will be familiar with their areas and so best to

identify a parcel or bag or box is out of place or not seen before.

• Staff should be careful not to evacuate the area until advised to do so. This could

be a ploy by the caller to move people into an area e.g. the car park, where the

real device is situated.

• Prioritise the important areas that need to be searched; particularly those areas

open to the public, other vulnerable areas such as cloakrooms, stairs, corridors

and lifts, as well as evacuation points and routes, car parks and other outside

areas such as goods or loading bays.

• The search should be started calmly to prevent hysteria. The search can be

initiated by talking to staff in groups or individually.

• Any object found that is identified as suspect; staff should move away and inform

the search co-ordinator and leave for police to investigate further.

14

5.8 Evacuation Plans

The purpose of evacuation is to move people from an area where they might be

at risk to a place of lesser risk. The premises may need to evacuate because of:

15

• A threat aimed directly at the building.

• A threat received elsewhere and passed on to the CCG by the police.

• Discovery of a suspicious item in the building (perhaps a postal package, an

unclaimed hold-all or rucksack).

• Discovery of a suspicious item or vehicle outside the building.

• An incident to which the police have alerted West Lancashire CCG.

A risk assessment should be done in conjunction with the Landlord to identify safe

routes of egress and co-ordinating this information to other stakeholders on site.

This should be done in advance of an incident occurring. The CSU’s Local Security

Management Specialist will provide assistance in developing such plans. The

plans should include:

• Full evacuation outside the building

• Evacuation of part of the building, if the device is small and thought to be

confined to one location (e.g. a letter bomb found in the post room).

• Full or partial evacuation to an internal safe area, such as a protected space,

if available.

• Evacuation of all staff apart from designated searchers.

• Maybe achieved by external evacuation or internal sheltering.

• Assembly areas should be at least 500 metres away from the incident

• Any evacuation point should be searched and should not be near to secondary

hazards i.e. glass (windows etc.) or petrol supplies / sources (vehicles).

5.9 Re-occupancy

Re-occupancy must always be discussed with the police and as necessary the other

emergency services. Safety remains paramount, and allowance must be made for

secondary devices (bomb) vagueness of descriptions of location of suspected

devices. If an explosion occurs the building structure may be unsound and damage

to power and gas may make the environment unsafe. Where a crime has been

committed, the building itself will be a crime scene.

6. IMPLEMENTATION, COMPLIANCE, TRAINING

Information about this policy will be cascaded to all staff via the staff newsletter.

The policy will be placed on the CCG’s website. Bomb threat awareness

training/information will also be provided.

16

7. MONITORING, REVIEW & Equality Impact Assessment

7.1 Monitoring

The Head of Corporate Affairs will monitor the effectiveness of this policy through

incident reporting and evacuation drills. The Clinical Executive Committee will

receive reports on any incidents.

7.2 Review

Changes made to this policy will be based on legislation, lessons learned and new

information from Department of Health, NHS Protect and/or Governments Home

Office.

All changes to this policy must be ratified by West Lancashire CCG’s Clinical

Executive Committee.

7.3 Equality Analysis Assessment

An equality and diversity impact assessment has been carried out on this policy and is

embedded in this document.

EIRA Bomb Threat

Policy_V1.xlsm

17

APPENDIX ONE

AIDE MEMOIRE FOR A BOMB THREAT Immediately alert someone else if possible so that they can inform the police.

DO NOT PUT DOWN THE HANDSET OR CUT OFF THE CALLER. Obtain as much information as you can. Complete this form as you go along, asking questions in sequence as necessary.

THREAT MESSAGE (Exact words)

…………………………………………………………………………………………………………… …………………………………………………………………………………………………………… …………………………………………………………………………………………………………… ……………………………………………………………………………………………………………

WHERE IS IT?

WHAT TIME WILL IT GO

OFF?

WHAT DOES IT LOOK

LIKE?

WHAT KIND OF BOMB IS IT? (Type of explosive)

WHAT WILL CAUSE IT TO

GO OFF?

DID YOU PLACE THE

BOMB?

WHY ARE YOU DOING

THIS?

WHO DO YOU

REPRESENT?

WHAT IS YOUR NAME?

WHAT IS YOUR ADDRESS?

TELEPHONE No?

18

If the threat relates to another site or location, contact the police at once by dialling 999.

(Continued)

COMPLETE THE FOLLOWING AS SOON AS PRACTICABLE

Extension number at

which call received

Date of call

Time of call

Length of call

DETAILS OF CALLER

Man Woman Child Old/young Approx age:

THREAT LANGUAGE

Well-spoken (educated) Foul Irrational

Taped Incoherent Message obviously being read

CALLER’S VOICE

Calm Angry Excited Slow

Soft Rapid Loud Laughter

Crying Normal Distinct Slurred

Nasal Stutter Lisp Raspy

Deep Ragged Clearing throat Deep breathing

Cracking voice Disguised Accent Familiar

If voice is familiar,

who did it sound like?

BACKGROUND SOUNDS

Interruptions Someone CCin

background? Street noises Crockery

Voices PA system Music House noises

19

Motors Office machinery Booth Factory machinery

Animal noises Clear Static Local

Long distance Aircraft Children Others

REMARKS

DETAILS OF PERSON RECEIVING CALL

Name: Unit/ward/dept:

Extension no: Has the call been taped at your end?

SIGNATURE:

Extended Access West Lancashire Clinical Commissioning Group Governing Body Meeting – 22 May 2018

1

WLCCGB 05/18/12


DATE OF BOARD MEETING: 22 May 2018 TITLE OF REPORT: Extended Access




√

This scheme extends access for patients to additional booked GP appointments across West Lancashire.



4. Delivering Financial Balance – please outline impact √

This scheme is expected to reduce attendance at OOH, Walk in Centres and A&E.








√

3. Health Inequalities √

4. Human Rights, Equality and Diversity Requirements

5. Clinical Engagement √

6. Patient and Public Engagement √

PAPER PRESENTED BY: Jackie Moran, Head of quality, performance and

contracting

June 2017

Report Title Extended Access Pilot

Author Jan Charnock

Meeting West Lancashire CCG Primary Care Commissioning Committee

Meeting date Tuesday 8th May 2018

Purpose of the Paper

To outline a proposal to run the extended hours pilot for 12 months whilst a service specification is drawn up to go out to procurement.

West Lancashire CCG were not due to provide to 7 core requirements until 19/20, but NHSE have just issued notice that all CCGs are to provide the 7 core requirements by October 2018.

This will mean that we will need to go out to procurement much earlier than initially planned.

A PIN notice will need to be issued to the market to advise that we are looking at the extended access specification with a view to going out to procurement. As the value pushes us over the OJEU threshold.

Background

Extended access to general practice was launched in response to the government’s mandate to NHS England which sets out:

“To ensure everyone has easier and more convenient access to GP services, including appointments at evenings and weekends”.

Public satisfaction with general practice remains high, but in recent years patients have increasingly reported, through the GP Patient Survey, more difficulty in accessing services including a decline in good overall experience of making an appointment in general practice.

However, good access is not just about getting an appointment when patients need it. It is also about access to the right person, providing the right care, in the right place at the right time.

NHSE have issued guidance around extended access and the 7 core requirements that CCG’s must ensure are met.

Funding has been provided nationally to CCG’s for the service.

OWLS’s have been providing the service for the last 12 months as a pilot scheme, shaping the service to meet patient demand and requirements.

A financial proposal has been received from OWLS to offer the service for a further 12 months whilst the specification is finalised to go out to procurement.

Appointments are booked via the patients GP practice via EMIS and are routine GP pre-bookable appointments.

June 2017

Summary Agreement is required that a 12 months contract with OWLS can continue for the extended hours service until a specification can be drawn up to enable us to go out to procurement. A quote for the service of £417,907.90 has been received from OWLS which will offer: Monday – Friday 6.30pm – 8pm at various practices across West Lancashire Saturday: Burscough Health Centre – 10am – 4pm appointments available with GP, Nurse and HCA (for bloods) Sandy Lane, Skelmersdale – 10am – 4pm appointments available with GP, Nurse and Blood clinic Ormskirk Medical Practice – 10am- 4pm appointments available with GP and Nurse Sunday: Burscough Health Centre – 10am – 2pm appointments available with GP & Nurse Sandy Lane, Skelmersdale – 10am – 2pm appointments available with GP & Nurse Ormskirk Medical Practice – 10am- 2pm appointments available with GP & Nurse Additional hours will also be provided over bank holidays. The only day the service will not operate is Christmas day. The timeline for procurement is attached at the end of the document.

Key Points

• Decision required regarding the bid from OWLS to continue with the extended hours service for 12 months.

• OWLS have been provided with the 7 core requirements that the service must achieve from NHSE.

• Delivering 40 minutes per 1000 population which is over and above the minimum criteria set by NHSE of 30 minutes per 1000 population.

June 2017

Additional Information

Purpose / Actions Required

To agree that the quote received from OWLS of £417,907.90 can be approved to continue with the extended access service for the next 12 months.

Agreement that a PIN notice can be issued to the market prior to the procurement process commencing for the service.

Documents to be prepared to start the procurement process

In order to inform the specification, undertake a patient engagement.

Confirm the timeline for procurement.

June 2017

Project Name: Extended Access Procurement

Ref:

Project Start Date: 26/04/2018

Phase Activity

Ref Activity Start Date

Duration (Days)

End Date

Pre

-Pro

cu

rem

ent

1 Initiate Project Group 08/05/2018 1 08/05/2018

2 Terms of Reference for Project Group 08/05/2018 1 08/05/2018

3 Complete Project Initiation Document (PID) 14/05/2018 7 21/05/2018

4 Develop Specification 14/05/2018 42 25/06/2018

5 Issue Prior Information Notice 01/06/2018 1 01/06/2018

6 Develop Procurement and Evaluation Strategy 25/06/2018 69 02/09/2018

7 Develop Financial Template Model (FMT) & financial methodology 25/06/2018 69 02/09/2018

9 Finalise Specification 25/06/2018 1 02/09/2018

10 Finalise Evaluation Panel 25/06/2018 1 25/06/2018

11 Develop Evaluation Questions 25/06/2018 1 02/09/2018

12 Develop Capability and Capacity Assessment 25/06/2018 1 02/09/2018

13 Develop Evaluation Criteria/Weightings 25/06/2018 1 02/09/2018

14 Finalise Financial Methodology/FMT 25/06/2018 1 02/09/2018

15 Populate Contract Documents 25/06/2018 69 02/09/2018

16 Finalise Procurement and Evaluation Strategy 03/09/2018 7 10/09/2018

17 Submit Procurement & Evaluation Strategy to PCCC for Approval 11/09/2018 1 11/09/2018

18 Approval Obtained 25/09/2018 1 25/09/2018

Pro

cu

re

me

nt 19 Publish advert on e-tendering/Contracts Finder/OJEU 26/09/2018 1 26/09/2018

20 Tender Submission Deadline 24/10/2018 1 24/10/2018

21 Evaluation Period 25/10/2018 11 01/11/2018

June 2017

22 Consensus Meetings (TBC- location/times) 01/11/2018 3 06/11/2018

Po

st

Pro

cu

rem

ent

23 Draft Recommended Bidder Report 01/11/2018 5 06/11/2018

24 Submit Recommended Bidder Report for approval 13/11/2018 1 13/11/2018

25 Obtain approval of Recommended Bidder Report 27/11/2018 1 27/11/2018

26 Send Successful/Unsuccessful Bidder Letters 03/12/2018 1 03/12/2018

27 10-Day Standstill Period 04/12/2018 1 04/12/2018

28 Send Contract Award Letters to Bidders 14/12/2018 1 14/12/2018

29 Mobilisation/Transition Phase 15/12/2018 90 01/04/2019

30 Contract Commencement 01/04/2019 1 01/04/2019

Integrated Delivery Framework West Lancashire Clinical Commissioning Group Governing Body Meeting – 22 May 2018

1

WLCCGB 05/18/13


DATE OF BOARD MEETING: 22 May 2018 TITLE OF REPORT: IDF (Integrated Delivery Framework) Document




√

This scheme will focus on improving quality and range of services in primary care.



√

This scheme will focus GP’s on reviewing prescribing data and reducing variances

4. Delivering Financial Balance – please outline impact √


√

This scheme will move the CCG towards an integrated care organisation by encouraging collaborative working.







√


4. Human Rights, Equality and Diversity Requirements

5. Clinical Engagement √

6. Patient and Public Engagement

PAPER PRESENTED BY: Jackie Moran, Head of quality, performance and

contracting

Integrated Delivery Framework

Local Quality Premium to primary care providers – April 2018 – March 2019

Integrated Delivery Framework Strong and effective primary care is acknowledged to be a critical aspect of a high-performing health care system, given that 90% of public contact is recognised to go on in primary care. This is predicated on the basis that high quality primary care improves health outcomes and helps contain health care costs. In recent years, there has been renewed interest in the nature of primary care service delivery, and in particular what needs to be done from primary care to scale up to meet the challenges of increasing demand from older and frail patients living with complex and multiple chronic diseases, and other vulnerable groups such as those with mental health problems, and families living in poverty. Opportunities to commission new primary care contracts are outlined in the national documents, Improving General Practice – A Call for Action (August 2013), The Five Year Forward View (October 2014) and General Practice Forward View (April 2016). To meet the challenges of the future, it is recognised that Primary Care needs to transform, this provides opportunities for groups of practices coming together to work collaboratively. Patients across West Lancashire should have access to consistent GP services which are delivered to an agreed level of quality and to ensure that patients are treated outside of hospital whenever appropriate. It is well recognised that investment into Primary Care has fallen in recent years, as a percentage of UK health care spending, despite an ever-increasing demand for services and strong evidence that such investment improves health outcomes.

National Context NHS Operational Planning and Contracting Guidance 2017-2019 West Lancashire CCG is committed to implementing the NHS priorities and nine must do’s. This Integrated Framework has been designed to focus attention on some of these ‘must do’s’ around Primary Care, Urgent and Emergency Care and Quality improvement. Specifically, the framework is focussed on Primary Care and the Integrated Framework supports the following elements:

• Practice Transformational Support

• The Ten High Impact Changes

• Local Investment

• Workload Issues

• Stimulating the use of online consultation systems

• Extending and Improving Access

• Supporting General Practice at scale

Quality Improvement

There is a challenge for General Practice to improve the effectiveness and efficiency of the services they offer in a systematic and standardised way across all providers. West Lancashire CCG recognise that shared Quality Improvement is a very valuable process and want to support all General Practices to plan, implement, evaluate, and embed new approaches more effectively and efficiently into practice. The evidence it generates, through your work and shared experience, will provide support for improvements in your neighbourhoods, localities and across West Lancashire as a whole. The standards contained in the framework focus on improving access, quality of services, improving efficiency and keeping people out of hospital, whilst at the same time, concentrating on prevention and appropriate treatment of existing disease. Data from various sources will be used to determine individual practice performance. Data sources include;

• Practice submissions

• Quality and Outcomes Framework (QOF)

• CCG information

• Service Level Agreement Monitoring (SLAM)

• Secondary Uses Service (SUS)

• Aristotle

• ImmForm

• Other partners e.g. NHS England Public Health



Initiative Requirement Outcome Achievement Criteria

Access

(required as part of GMS)

All practices to be open 8am – 6.30pm in line with GMS contract

requirements:

The General Medical Services (GMS) and Personal Medical Services (PMS)

Regulations require general practice contractors to provide essential and

additional services at such times within core hours, “as are appropriate to

meet the reasonable needs of patients,” and require the contractor to have

in place arrangements for its patients to access those services throughout

core hours in case of emergency. Core hours for GMS practices are 8:00 –

18:30, Monday – Friday, excluding weekends and bank holidays. PMS terms

are applied in the same manner following national negotiation and the

definition ‘core hours’ is in the contract and in the underpinning

regulations. Schedule 2 of the PMS contract allows local commissioners

the flexibility to agree alternative opening hours ‘normal hours’ and this

should be specified in the contract where they have been agreed

Opening hours for APMS practices are set out in their contract and largely

mirror GMS opening hours or longer.

The Public Accounts Committee (PAC) report into GP access held in March

2017 set out a number of recommendations. One was to ensure that no

practice that was closed weekly for half a day should be in receipt of

additional funds to provide ‘extended hours’ i.e. outside ‘core hours’ and

secondly that patients should know what they can ‘reasonably’ expect of

their GP practice during core hours

This Guidance has been drafted to help commissioners to work with their

providers of general practice in respect of the services that they offer to

patients during ‘core hours’ as well as the conditions that should govern

the commissioning of extended hours

Specifically, it considers the issues surrounding the subcontracting of

services during core hours.

All practices to remain open during the core GMS contract

hours of 08.00 to 18.30.

The practice must not close for lunch or divert the telephone

to answer machine.

Patients should be able to access the practice during these

times in person or by telephone.

The doors to the practice should be open the public should be

able to speak to a member of staff and book appointments,

request prescriptions or access other admin processes during

this time.

Patients have physical access during the core contracted hours to their registered practice within West Lancashire. They have the ability to enter the building and speak to a member of staff during the contractual opening hours.

The practice remains open during the core

contracted hours to patients which is between

08.00 and 18.30 hours.

This standard

must be met in

order to access

any of the other

funding available

within this

document.



Managing Need

Initiative Requirement Outcome Achievement Criteria Payment

Clinical Peer Review

(GPFV & Building for the future)

Clinical peer review - GP groupings will review evidence and conduct peer

review to support best practice and embed change of practice for future

sustainability

There is still unwarranted variation in clinical practice across West

Lancashire.

1. Clinicians' will embed peer review within the GP locality on

issues pertinent to that locality. Review data at least on a

quarterly basis.

2. GP localities will work together to establish a robust process

for peer review, developing lessons learnt and embedding

new processes and review impact.

3. Understanding baseline data, undertaking audit as

necessary and challenging peers as appropriate.

This metric comes from the

requirement to reduce variation in

primary care.

GP groupings may want ot consider the

following as areas for peer review: -

1) Referrals into secondary care will

be appropriate and timely

2) Standardised use of urgent a

planned care services

3) Reducing waiting times for

primary care.

4) Standardise the number of urgent

appointments in primary care.

Report initially by GP groupings to include:

1. Chosen area of focus

2. Agreed approach across the GP locality for peer review.

3. Document the findings of the review and any findings

baseline

4. Agreed actions to be taken

5. Idea of the metrics to be measured to demonstrate impact

Quarterly Report showing:

6. Evidence of dates of meetings, practices involved including %

attendance across the GP grouping

7. Quantified impact of process change/evidence of lessons

learnt & changes embedded.

Prescribing

(National & CCG)

Prescribing achievement of medicines optimisation strategy and action

plan as developed by Medicines Management committee from a

variety of measures such as QIPP and agreed by each practice or

neighborhoods with the Medicine Optimisation team by March 2019

1. GP grouping will work to the medicines optimization

action plan that each practice or neighborhood has agreed,

to develop an overall plan, using a range of measure such

as QIPP and individualized OptimiseRx prescribing reports

2. GP Practices will work with medicines optimisation team

and peers within the GP group to achieve the overall plan using a range of measure such as QIPP and individualized

OptimiseRx prescribing reports

Reduce prescribing variations and promote and share best practice

Submission, by GP groupings, of: Initial action plan produced in conjunction with the Meds Management team. Updated action plan on a quarterly basis to be submitted to the CCG to monitor progress to full achievement by 31st March 2019 To assist quarterly reports will be produced by the CCG for GP groupings based on the overall plan.

Community

Frailty

Initiative

Requirement

Outcome

Achievement Criteria Payment

Integrated care

planning for frail

patients

(GMS, National,

Local)

This initiative is expected to address the following isssues:-

1. Reduce inappropriate admission to hospital through proactive

anticipatory planning

2. GPs will utilise the eFI and guidance on a monthly basis to case find

severely frail patients

3. GP’s will actively participate in the review and evaluation of the

integrated care plan as part of a structured process

4. Find and case manage frail patients and where possible to keep

them out of hospital.

5. Reduce variation of care across West Lancashire and meet health

care needs of patients.

Current requirements under GMS:

1. Use appropriate tool (e.g. eFI) to identify patients from

their practice 65 and over living with moderate and

severe frailty.

2. Severe frailty patients to get clinical review providing

annual medication review and where clinically

appropriate discuss whether the patient has fallen in last

12 months and provide any other clinically relevant

interventions.

3. Code clinical interventions appropriately

4. Collect data on

• Number of patients recorded with moderate frailty

• No. with severe frailty

• No with severe frailty and annual medication review

• No. with severe frailty as having fall in preceding 12

months

New Requirements:

1. Verify moderate and severe frailty eFI score with

Clinical Frailty Scale (CFS) e.g. Rockwood

2. All patients identified as severely frail will be have

an individualised plan from April 2019.

Reduce variation of care across West

Lancashire and meet health care needs

of severely frail elderly patients

1. Identify a lead on behalf of the GP Grouping to participate

within the project and communicate with GP practices to

review any best practice that can be consistently

implemented across the GP Grouping with evidence of

discussions.

2. Evidence from GP clinical system

• Frailty register of patients – number of patients on

frailty register as a % of practice total population

• READ codes and flags applied (READ codes to be

agreed)

• % of patients on the frailty register with an eFI

template (expectation is approximately 80%)



Resilience

Initiative

Requirement

Outcome


Business

Continuity Plan

NHS Act

requirements post

Cyber Attack

It is a contractual responsibility for practices to have robust business

continuity plans in place which are reviewed at least annually Practices are expected to:

• Have an adequate, up to date Business Continuity

Plan in place to include loss of premises, staff,

utilities and processes to manage surges in activity

etc. These plans should be reviewed regularly, as a

minimum annually. Plans should also include

support arrangements with local practices which

will support the practice in the event of an

incident.

• Support local Emergency Preparedness Resilience and Response (EPRR) by actively engaging with CCG/NHSE when required

• Provide support to rest centres, if and when

required, i.e. prescriptions for medications to

displaced people who have run out of regular

supplies or been unable to bring them in due to

evacuation process. In such circumstances support

required would be short term, routine and likely to

be within the geography of the GPs surgery.

All practices to have a robust business

continuity plan in place which has been

reviewed within the previous 12 months

Copy of the business plan (which must include last date of

review) to be submitted to CCG by the 31st December 2018.

The plan must include, as a minimum:

• evidence of arrangements with another local practice(s)

which will support the practice in the event of an

incident requiring re-location or mutual aide

• evaluation of Business-Critical activities and systems and

priority for re-instating/applying a contingency for each

one

Incident Reporting

NHS England

CQC

To embed the process for identification and reporting of serious

incidents. The West Lancashire process for primary care should be

followed and adopted.

• Undertake training on serious incidents

• Report Sis and undertake Root Cause analysis

investigations as required.

• Review numbers of serious incidents

• Engage with external colleagues as required

Increase of incidents reported

Review of RCAs undertaken

Evidence of meetings undertaken with minutes, identifying

lessons learnt and report identifying the changes in process

to be implemented as a result.

Named clinical practice lead for Incident Reporting

Safeguarding

NHS Act

GPFV

Variations

WLCCG is dedicated in ensuring that the principles and duties of

safeguarding adults and children are holistically, consistently and

conscientiously applied with the wellbeing of all, at the heart of what

we do.

Practices are expected to:

Comply with the standards for safeguarding as detailed in the

CCG safeguarding policy.

Pan-Lancashire safeguarding children policies and procedures

can be accessed at:

http://panlancashirescb.proceduresonline.com/index.htm

Pan-Lancashire safeguarding adult policies and procedures can

be accessed at:

http://plcsab.proceduresonline.com/chapters/contents.html

The principles and duties of safeguarding

adults and children are consistently and

holistically applied.

Submission of a safeguarding self-assessment to evidence

practice arrangements to be submitted to the CCG by 31

December 2018

Submission of a completed CCG safeguarding standards

audit document on an annual basis

Action plans detailing progression to full compliance for

those areas of non-compliance

Evidence that each GP in the practice has attended the

Annual Safeguarding event once every 3 years, as a

minimum

Evidence that someone from the practice has attended the

Annual Safeguarding Learning Event each year

Evidence that each practice has discussed at practice

meeting, the learning arising from attendance at the Annual

Safeguarding Learning event and has identified any

additional points for clarification / learning needs for their

wider workforce in the practice.

Named clinical practice lead for Incident Reporting

MDT

(GPFV, CCG)

GP participation and representation in a minimum of 3 MDT’s per

annum to focus on moderate and severely frail patients

GP groupings will evidence active engagement in monthly

interdisciplinary review of patients were identified as

requiring an integrated support, follow up plans and clinical

care coordination.

Increase the number of patients

managed in community via MDT and

learning from admissions where the

attendance at hospital could have

been avoided.

Baseline data will be collated as at

the end of May 2018 in relation to

non-elective admissions and then

collated again as at the end of March

2019.

Evidence from GP clinical system of MDTs - reporting

from READ codes to be agreed

Minutes to be provided from the meetings along with

attendees and details of active participation within

the meeting.

http://panlancashirescb.proceduresonline.com/index.htm

http://plcsab.proceduresonline.com/chapters/contents.html



Post Infection

Review

Public Health

The CCG reviews all cases of non-acute acquired infections (e.g.

MRSA, C. diff, -coli) and deem them to be either avoidable (lapse in

care) or unavoidable. Input from primary and community

colleagues required to help assess the root cause of the infection

in addition, they work with acute colleagues where it is considered

learning can be gained from the community. In both circumstances

learning is identified and shared with the aim to improve the

management and reduce infections rates. It is a national

requirement to report this information


• Participate in post infection reviews order to aid the

decision-making process.

• Take on board any learning outcomes shared by the

CCG following the review post infection reviews

In order to assist GPs with this process an Infection

Control Nurse from Lancashire County Council will make

contact with the GP to gain the relevant information for

the case and complete the Post Infection Review

document on the GPs behalf

Improved patient outcomes by the

reduction in the number of infections

All requested reviewed are completed within the individual specified deadline Evidence of dissemination of any identified learning e.g. meeting notes etc. Practice representation at PIR meetings upon invitation (MRSA only)

Diagnostics

Initiative

Requirement

Outcome


Tackling Stroke / AF

NHSE Primary Care Strategy, STP

Atrial Fibrillation (AF) is the most common sustained adult cardiac

arrhythmia. There are currently over 1 million people diagnosed with

AF in the UK, with many more (25-30%) who are thought to have the

condition without it being diagnosed yet. The prevalence of AF

increases with age, and to more than 15% in those aged 75 years and

over. AF increases the risk of death, stroke, thromboembolic events,

heart failure, vascular dementia, hospitalisations, reduced quality of

life and diminished exercise capacity.

AF is costly in terms of increased mortality, morbidity and reduced

quality of life. Within the UK, it is a condition that is not always

managed well, with patients reporting inadequate explanations of

their condition and treatment options.

GRASP-AF is an easy to use tool that assists GP practices to interrogate

their clinical data enabling them to improve the management and care

of patients with atrial fibrillation and to reduce their risk of stroke

through appropriate intervention with anticoagulation. The tool also

assists with case finding activity, helping practices to establish more

accurate prevalence rates within the practice population.

This tool can be made available to practices should they want to use it

to help them to deliver this initiative. The Data Quality team can help

practices to run this search and interrogate the results. The Data

Quality team and the CCG business analysts are available to help

produce data associated with this initiative should the practice / GP

network choose to use them.

1) To implement a robust protocol for the

identification, diagnosis and appropriate

management of people with AF.

2) Review appropriate benchmark data where

available.

3) Opportunistic screening of patients aged 65 or over,

to be undertaken in practice through clinics eg flu,

GP or practice nurse visits.

4) A code is entered to capture the activity and a READ

code will be specified.

5) Ensure that all patients found to have an irregular

pulse are offered a 12 lead ECG.

6) Ensure patients are offered an explanation as to

why their pulse rate and rhythm are checked.

7) Patients identified to have AF to be assessed using

CHAD2DS2-VASc risk tool and appropriate therapy

initiated in line with NICE guidance.

Increase in the diagnosis of AF and

receiving appropriate treatment

To improve the detection rate of Atrial

fibrillation in General Practice, to

produce an accurate record of AF

prevalence across West Lancashire.

Codes and Templates/Guides will be issued by the Data

Quality Team,

The practice shall monitor and provide, as requested, the

following information as a minimum:

• Names of the clinical and administrative leads

responsible for AF

• Number of patients recorded as having AF on the

GP Clinical System (EMIS)

• Number of patients aged over 65 not already

diagnosed with AF with a recording of pulse, both

rate and rhythm, in the last 12 months

• Number of patients found to have an irregular pulse

who have been offered a 12 lead ECG

• % of patients reporting having been told why their

rate and rhythm is checked regularly

• Number of patients referred to or offered anti-coag

services as per the QOF requirements



Integrated Working


Neighbourhood

Engagement

NAPC Primary Care Home, GPFV, National primary care strategy, STP

As part of the implementation and the further development of the integrated delivery framework, it is vital that there are resources made available for the Neighbourhoods and their constituent GP’s and Practices, to engage, develop and facilitate the implementation of the challenging New Models of Care (NMoC), Multispecialty Community Provider and the NHS transformational agenda. Practices work together to coordinate health and social care for people in their local area and consider how to make the best and most effective use of local services. Neighbourhoods are ideally placed to respond to the challenges facing the health economy and to be at the heart of re-designing, coordinating and integrating services. The monthly membership events will be adapted to enable both CCG

and Neighbourhoods to utilise the events in supporting effective delivery

of the Multispecialty Community Provider and influence changes to

service provision.

To Support the CCG through development and engagement activities in and across neighbourhoods, GP Practices will be required to:

1. Support the CCG in developing a population health and care model focused on proactive and preventative care tailored around the needs of the individual.

2. Assisting in discussions around how new models of care can to be implemented within West Lancashire from the national agenda.

3. Each Neighbourhood should have a set of priorities

based on the health and social needs of their particular area. There should also a strong focus on preventing ill health, reducing unnecessary hospital admissions and supporting people to gain control of their own health and wellbeing.

Each neighbourhood develops a set of priorities based on the health and social needs of their patient population to allow the development of place-based care. This will allow for the development of a neighbourhood workforce strategy and new models of care.

Practices will engage at a neighbourhood level and actively

participate in creating the strategy for that patient

population.

Monthly locality meetings are to be attended by at least one

practice representative which must be a GP.

Evidence of completion of actions in a timely manner for delivery of progress. Where actions have slipped, mitigations and/or recovery should be outlined.

Upon reviewing data and initiatives from the national team

assist the CCG in how best this can be developed and

implemented to change and improve services for the patient

population of West Lancashire.

Workforce

GPFV, National primary care strategy, STP

To be assured that the practice has the skills and capacity needed given the strategic drive for delivering more high-quality care closer to home Analysing data obtained from the workforce planning tool and looking not just at practice level, but at neighbourhood level what the future workforce demand needs are. Standardising training across practices to ensure standardization in the delivery of care and advice to patients. As part of the GPFV care navigation training will be delivered to practice staff across West Lancashire in order to standardise our delivery to the patient population.

• Complete annual data capture exercise via HENW

• Undertake training needs analysis for the practice staffing establishment and consider neighbourhood footprint training where appropriate to promote economies of scale and financial efficiencies.

• Release staff for statutory and mandatory training

• Promote and support further professional development

• Annual appraisal process in place for all staff and record training/matrix log

• Ensure systems are in place to support compliance with nurse revalidation/GP revalidation

• Contribute to developing/sharing new roles aligned with new models of care

• Working in neighbourhoods to review the workforce data and ensure plans are in place to address the workforce needs going forward.

• GP Practices to be required to have Whistleblowing Policy by September 2018

A workforce strategy is in place to address any long or short-term staffing shortages within Primary care in West Lancashire. Staff will be supported to continually develop their skills and experience. Improved resilience of the workforce Opportunities for sharing skills and knowledge will be encouraged

• Submission of a workforce strategy that will assist in addressing any long and short-term workforce issues and that there is an associated action plan in place, for example providing work-based placements from school age up, covering clinical posts, allied health professionals and admin posts based on the following:-

o Completed HENW annual submission (to be

shared with the CCG once completed)

o Completed PA consulting data workforce tool including Apex as nationally mandated by NHSE. (to be shared with the CCG once completed)

o Initiatives from the “Grow your Own”

strategy which are relevant o the practice.

• Provide the practice Whistleblowing Policy by End Sept 2018



Appendix 1

Suggested Long Term

Conditions Opportunities


Respiratory

Example

Better management of people with Long Term Conditions requires

transformational change, both within the system and to the cultures

and behaviours of NHS staff and patients themselves (DH 2010).

In England, more than 15 million people have a long-term condition – a

health problem that can’t be cured but can be controlled by

medication or other therapies. This figure is set to increase over the

next 10 years, particularly those people with three or more conditions

at once. (DH 2010 to 2015 government policy: long term health

conditions, updated May 2015)

Long term conditions can affect many parts of a person’s life, from

their ability to work and have relationships to housing and education

opportunities. Care of people with long term conditions accounts for

70% of the money we spend on health and social care in England. (DH

2010 to 2015 government policy: long term health conditions, updated

May 2015)

Due to an ageing population it is estimated that by 2025 there will be

42% more people in England ages 65 years and over. This will mean

that the number of people with at least one long term condition will

rise to 18 million (DH 2010).

Management of care for people with long term conditions should be

proactive, holistic, preventative and patient centred. There should be

an active role for patients with collaborative personalized care

planning and shared decision making (The Kings Fund, 2013).


• Annual reviews - Have a structure in place to ensure that

people with COPD are invited to participate in an annual

care planning process which includes review of the person’s

individualised comprehensive management plan, including

provision of high-quality information and educational

material about the condition and its management, relevant

to the stage of disease. (NICE Quality Standard 10, -

statement 2).

• People who are admitted to hospital with an exacerbation of

COPD are reviewed within 2 weeks of discharge. (NICE

Quality Standard 10).

• Pulmonary Rehabilitation – Offer people with COPD, who

consider themselves functionally disabled by COPD, (usually

MRC grade 3 and above) or who have had a recent

hospitalisation for an acute exacerbation a referral to

pulmonary rehabilitation.

N.B. NICE CG 101 recommendation 1.2.8.2 highlights that

pulmonary rehabilitation is not suitable for those who are

unable to walk, have unstable angina or who have had a

recent myocardial infarction.

• National COPD Audit

Join the National COPD audit when the primary care element

opens

Improve diagnosis of COPD and treatment management plans Standardised use of READ codes. COPD register codes as per QOF spec: Review and Breathlessness 66YM COPD annual review 66YB0 COPD 3 monthly review 66YB1 COPD 6 monthly review AND 173H – LMRC breathlessness score Patients with COPD and MRC scale >=3 and an oxygen saturation value in the last 12 months 44YA0 Oxygen saturation at periphery 44YA1 Peripheral blood oxygen sats on room air at rest 44YA3 Peripheral blood oxygen sats supplemental at rest 44YA5 Baseline SpO2 (oxygen saturation at periphery) 8H7v Referral to pulmonary rehabilitation

Dependant on Business Case submitted

Asthma Checks - Implementation of regular reviews and

assessments ensuring compliance with Nice guidance. 1. GP groupings will review all asthma patients to

manage their condition ensuring compliance with nice

guidelines.

Improve patient outcomes and share

learning


Spirometry checks - Evidence of regular reviews and assessment for

community in primary care • GP grouping will provide support to patients to manage their

condition within a primary care / community setting for

COPD - focusing on the cohort of smokers recorded on the

practice clinical system

• Each grouping will propose a plan to routinely review COPD

patients including a spirometry check - to be agreed by the

integrated delivery central tea

Increase the number of Respiratory

patients being supported in a

community setting

Reduction in mis-diagnosis of

respiratory illness


Opportunities Initiative Requirement Outcome Achievement Criteria

Payment

Opportunities

available for

selection

Practices should consider one or more opportunity which is relevant to the Neighbourhood for development and improvement. Groups of Practices should agree an approach and action plan with the CCG. Practices are invited to offer business cases for options specific to their population demograohics

See suggestions in Appendix 1

Review of demographics, admissions, prevalence and local

issues

Improve management of patients with Long Term conditions in the community Reduce unnecessary admissions Improve prescribing Improve pathways and processes for long term conditions

Evidence of condition review for the locality and agreed business

case and workplan for delivery of improvements. The workplan

should be agreed with the CCG prior to the commencement of any

delivery. Review of progress will also be agreed between practices

and CCG dependent on the business case and outputs.

Evaluated by Quarterly submissions

Enhanced Care Home Scheme West Lancashire Clinical Commissioning Group Governing Body Meeting – 22 May 2018

1

WLCCGB 05/18/14


DATE OF BOARD MEETING: 22 May 2018 TITLE OF REPORT: Enhanced Care Home Scheme BRIEFING POINTS:

Primary Care Scheme to support Care Home Patients and part of the National Enhanced Care Home Framework



1. Quality (including patient safety, clinical effectiveness and patient experience) – please outline impact Proactive care for Care home Residents

x



4. Delivering Financial Balance – please outline impact








x


4. Human Rights, Equality and Diversity Requirements x

5. Clinical Engagement

6. Patient and Public Engagement

PAPER PREPARED BY: Charlotte McAllister, Urgent care commissioning lead PAPER PRESENTED BY: Charlotte McAllister, Urgent care commissioning lead

1

Options for a West Lancashire Enhanced Care Home Scheme

Primary Care Paper 8th May 2018

Background

Most care home residents have a mix of co-morbidities and are affected by physical and mental

health issues, with dementia and depression being common. Single disease/condition models of

care don’t address the needs of this complex population. Access to GP services is often difficult with

homes having residents registered with a range of practices leading to responsive care and often

high usage of ambulance and A&E services. To address these issues a co-ordinated proactive

approach is required to support care home residents more effectively.

Introduction In September 2016, an NHS framework for Enhanced Health in Care Homes (EHCH) was published,

which summaries the findings from the 6 National Vanguards for Care Home support and sets out a

framework and key findings as a guide for other CCGs to adopt locally. The framework consolidates

evidence from interventions that have been shown to make a difference to Care Home residents and

to support people in their own home for as long as possible. The principles of the framework are:

• Person-centred change; putting the person at the centre including carers and families

• Co-production; integrating sectors to co-design and co-deliver the model of care

• Quality; focus on quality and clinical evidence to support change

• Leadership; to drive a joint vision of better care

The Framework sets out ‘Seven Care Elements’ have been developed from the Vanguards and are

shown in the table below. The framework is a mandated framework for CCGs and implementation

will be monitored by NHS England.

2

Enhanced Care Home Model Each of the Vanguards has an enhanced care home model, and other areas have adopted similar

models throughout the country. The framework sets out that an enhanced care model should offer

co-ordinated preventative care and support to those at risk of losing their independence or having

unplanned admissions to hospital. Some key findings from the Vanguards are:

1. Wherever possible there should be a one-to-one mapping of GP practices to care homes to

simplify care delivery.

2. Each resident should have a comprehensive assessment and care planning.

3. A weekly ‘home round’ should be held at each home which is pro-active and should include

the MDT and Pharmacy, and were appropriate this could be virtual. The ‘home round’

should include nutrition and hydration support.

4. Each resident should have a comprehensive geriatric assessment (CGA) which is reviewed at

least twice a year. It is good practice to include the family in this assessment. This should

also include a medicine’s review.

5. A functional assessment of residents when they are well should be available to hospital on

transfer to hospital to facilitate timely discharge. This may be in paper form until a digital

solution can be found.

Multi-disciplinary Teams (MDTs)

As part of the Building for the Future vision for community and primary care, there will be MDTs

running frequently with Practices, Social Care and Community teams, to discuss high risk patients

and wrap care around individuals to help support them at home for as long as possible. It is

proposed that support is given to GP Practices to allow them to participate in MDTs. The national

enhanced care framework advocates MDTs and proactive care for people at home, wherever that

may be. It is therefore proposed that supporting Practices to participate in the MDTs would fulfil the

MDT element of the Enhanced Health in Care Homes Framework. This element of the Framework

will be covered as part of the Primary care levels framework being developed by the CCG and will

not need to be added to this service.

Options for a West Lancashire Model In West Lancashire, it will be important that an Enhanced Care home model is integrated with the

Community Neighbourhood Teams and takes account of the MDT process commissioned as part of

the Community Services contract. The Enhanced Care Home Scheme services would provide the

remaining proactive ward round element of the EHCH care home framework on page 1.

The CCG would also need to set out the requirements from Care homes to support the model and

provide a framework of expectations from homes and practices. The CCG may also need to consider

funding a community Geriatrician to help support Practices to deliver this service.

The enhanced care home service will be commissioned by the CCG for all care home residents and

there for must include as a minimum:

• A weekly proactive ‘home round’

• 6-monthly medication review

• A comprehensive geriatric assessment (CGA) which is reviewed at least twice a year. With

Family involvement and which is shared with partners to improve care in all settings

3

This approach has been broadly welcomed. However, how the funding and delivery is to be

offered needs to be further considered. The options for consideration are:

Option 1

Offer the service to the GP Federation to be delivered across West Lancashire

Pros

• One consistent service, with economies of scale

• Affordable within CCG budget

• Ability for practices to appoint a resilient team across the whole CCG

• Opportunity to facilitate working at scale

• MDT approach

• Equity of service provision across WL

Cons

• How would the funding be allocated for this option?

• Would need co-ordination across localities

Option 2

Offer the service to Primary Care homes to allow practices to develop the service in their local area

and offer funding to localities, ensuring all localities involved

Pros

• Localities could appoint a team to deliver the service

• Joint locality working

• Enables some scale which practices alone may not be able to afford

• MDT approach

• Some Equity of service provision across WL

Cons

• Funding by locality would mean practices need to agree costs and arrangements for delivery

e.g. HR

• May not be enough scale to make this affordable within the current CCG budget

Option 3

Offer the service to Primary Care homes to allow practices to develop the service in their local area

and offer funding by practice, allowing localities to jointly opt in or out

Pros

• Localities could appoint a team to deliver the service

• Joint locality working

• MDT approach

4

Cons

• Funding by locality would mean practices need to agree costs and arrangements for delivery

e.g. HR

• May not be enough scale to make this affordable within the current CCG budget

• May lead to inequity of service with some localities opting in and some out

• CCG would still need to consider localities without a service to meet the NHS England

framework expectations

Option 4

Offer service to individual practices and allow them to design the delivery model

Pros

• Could be offered to those practices with an interest in delivering the service

Cons

• No joint working unless practices take the initiative to deliver in that way

• May lead to inequity with different provision across the CCG

• May not lead to alignment of Practices and Homes if there are disputes between practices

about which homes they work with

• Would be difficult for individual practices to afford an MDT – they would need to group

together to get economies of scale

Conclusion The Primary Care Group are asked to discuss the options presented in this paper and decide on an

approach for a local scheme.

Specification to follow.

SCHEDULE 2 – THE SERVICES

A. Service Specifications Mandatory headings 1 – 4: mandatory but detail for local determination and agreement Optional headings 5-7: optional to use, detail for local determination and agreement. All subheadings for local determination and agreement

Service Specification

No.

Service Enhanced Care Home Scheme

Commissioner Lead

Provider Lead

Period

Date of Review

1. Population Needs

1.1 National/local context and evidence base

In September 2016, the NHS framework for Enhanced Health in Care Homes (EHCH) was published using information from the 6 National Vanguards for Care Home support. The framework summarises key findings as a guide for other CCGs to adopt locally. The framework consolidates evidence from interventions that have been shown to make a difference to Care Home residents.

Each of the Vanguards has an enhanced care home model, and some other areas have adopted similar models throughout the country. The EHCH sets out that an enhanced care model should offer co-ordinated preventative care based around 4 themes

• Person-centred change; putting the person at the centre including carers and families

• Co-production; integrating sectors to co-design and co-deliver the model of care

• Quality; focus on quality and clinical evidence to support change • Leadership; to drive a joint vision of better care • Multi-disciplinary approach

A growing body of evidence suggests that adopting a more proactive, rather than a reactive, approach to treatment of care home residents can improve outcomes for both residents themselves and for the wider health and social care system. Adopting a more proactive approach to the treatment of care and nursing home residents means developing ways to improve access to specialist medical or nursing care and support within care homes with Specialist nursing and gerontology. This would primarily prevent issues escalating as a medical emergency, and ensure that care was provided is in accordance with an individual’s needs.

People living in care homes should also expect to receive services broadly in line with those available to the wider population. The care provided by GPs is often restricted to a more reactive approach rather than proactive. Care home staff often have many different general practices to communicate with – each with different systems and processes. Having a pro-active approach will allow relationships to develop between practices and care homes and foster positive working practices and improve outcomes for residents.

2. Outcomes

2.1 NHS Outcomes Framework Domains & Indicators

Domain 1 Preventing people from dying prematurely ✓

Domain 2 Enhancing quality of life for people with long-term

conditions

✓

Domain 3 Helping people to recover from episodes of ill-health

or following injury

✓

Domain 4 Ensuring people have a positive experience of care ✓

Domain 5 Treating and caring for people in safe environment

and protecting them from avoidable harm

✓

2.2 Local defined outcomes

• Facilitate primary care practitioners to take a proactive approach to caring for people registered with their practice currently living in care homes. This would be by using a multi-disciplinary approach in collaboration with the care home staff and other agencies to offer consistency, efficiency and a higher quality of service to this element of our population, with support from specialist community services.

• Encourage the effective use of agreed local care pathways and local health economy resources to improve the experience for the resident and to reduce avoidable admissions to secondary care.

• Support GP practices in implementing a programme of assessment and regular review of the mental and physical health of their care home population, to include, advanced care planning and where appropriate end of life care planning supported by prognostic indicators, and the review of anti-psychotic prescribing in residents with dementia, in line with national and local guidance.

• To ensure a 6-monthly medicine’s review is completed

• To reduce the risk and adverse consequences of falls in collaboration with the home

• To deliver appropriate long term conditions management to this population

• To pro-actively target appropriate vaccinations e.g. influenza and shingles

• To improve professional relationships between care home staff and GP practices by the alignment of care homes to practices whilst respecting that choice will be available to individual residents within a home. This would enable strong continuous relationships to be developed.

• To support the CCG ambition to continue to care for patients closer to home and in their place of residence.

• Awareness of Mental Capacity Act and DOLs

3. Scope

3.1 Aims and objectives of service

Most care home residents have a mix of co-morbidities and are affected by physical and mental health issues, with dementia and depression being common. Single disease/condition models of care often don’t address the needs of this complex population. Access to GP services is often difficult with homes having residents registered with a range of practices leading to reactive and episodic care and often high usage of ambulance and A&E services. The aim of this Enhanced Service is to address these issues and provide a coordinated proactive approach to support care home residents more effectively. This scheme will reduce confusion for Care Homes, who currently have residents from multiple GP Practices. It will simplify arrangements for support. Due to pro-active home rounds there will be a reduced reliance on urgent/ad-hoc call outs to homes and practice workload will shift from reactive to a more planned approach. Residents will have improved proactive care, care planning, and regular medication reviews. Care Homes and practices will develop a close working relationship and practices will support the development of care home staff. The service should help support the education and professional development of the home staff.

3.2 Service description/care pathway

Primary Care Homes will nominate a Team to work with a Care Home or Care Homes. It is the ambition of the CCG that there will be one GP Practice/or one Team working with each Home to simplify process for Homes. Residents have the right to choose which practice they are registered with, and so can remain registered with their preferred practice. The CCG will work with Care Homes to promote the service and explain the benefits of re-registering with the Practice working with the Home where this is appropriate. Primary Care homes should provide the service to all West Lancashire registered patients in homes where they are responsible for delivering this Enhanced Service. Requirements of the service are:

1. Identify a nominated Care Home Lead(s) for the provision of medical advice and

support to Care Homes serviced by the Practice - This would be one or more GP

lead within the practice

2. Practices may deliver the service utilising, where appropriate, a GP or an

alternative healthcare professional - This could be an Advanced Nurse

Practitioner (ANP), or qualified practice nurse with support from pharmacy, to

provide the appropriate support to the Care Homes. The professional should

have the relevant skills and competencies to meet the outcomes of the service

specification.

3. Agree protocol with Care Homes to facilitate and respond to requests for

assistance from care home staff during core practice hours Practices need to

ensure and agree the capacity and timescales to visit at times other than the

weekly ward round (see below)

4. Work closely with home and encourage awareness of service with residents –

work with the home to promote the service to residents for their awareness to

support their decision on their registration with a GP practice.

5. Ensure Care home awareness of services available in and out of core hours - The practice will work with care home staff to ensure that staff are aware

of the range of health services available to their residents within core and out of hours.

6. Hold a regular ‘ward round(s)’ on a fixed day of the week - The practitioner would need to consider having face to face contact with residents via a ward round. The regularity of these would need to be determined by size of home and patient need, but should be weekly as a minimum. This should be determined in collaboration with the home to ensure the timings are able to be supported by the home. An annual review or new resident check including medications which should include:

• A review of medical issues and current problems

• A review of the patient’s medications every 6 months.

• Dementia screening* using Abbreviated Mental Test (or The General Practitioner assessment of Cognition (GPCOG) for higher functioning care home residents).

• Ensure there is a Falls plan in place were appropriate. 7. Urinary Tract Infections

• To support care home staff to identify and report signs of UTI in care home residents and in preventing UTI in the first place

• To be alert to recurrent episodes of UTI in residents and establish the underlying cause and treatment/care required

8. Advance Care planning*

• With the support staff at the care home, instigate discussions where appropriate with residents on their end of life wishes

• Ensuring practice patient notes and palliative care registers are updated

• Ensuring Special Patient Notes and the Electronic Palliative Care Coordinating System (EPACCS) are kept up to date with pertinent information that Out of Hours service providers can utilise to manage the patients out of hours

9. A functional assessment of residents when they are well should be available

to hospital on transfer to hospital to facilitate timely discharge. Ensuring the

home is updating the ‘Red Bag Scheme documents’ for hospital transfer.

*In the Learning Disability home these elements should be replaced by Care

planning, screening for long term conditions and routine cancer screening.

Dementia screening may be applicable and should be considered due to early

presentation of dementia in people with learning disabilities.

The CCG will work with Primary Care to ensure that the roles, responsibilities,

accountability and expectations of the service and home are established.

Processes for raising safeguarding concerns need to be understood by all staff

involved.

Outcomes and Measurement

Practices will be required to collate and submit data to support this Enhanced Service.

Data will also be collected centrally by the Data Quality Facilitators, where possible, to

reduce the workload for practices. This will include:

Responsible for maintaining records

Responsible for reporting to CCG

Action Read Code

Target

Practice Practice Submit name of nominated care home lead/s

N/A N/A

Practice Practice Provide copy of agreed care home protocol

N/A N/A

Practice Practice Advise frequency of ward rounds

N/A N/A

Practice Data quality facilitators

Flag care home residents in EMIS

TBC 100%


Comprehensive geriatric assessment

TBC 90%


Medicines review in last 6 months

TBC 95%


Baseline assessment in place

TBC 90%


Falls assessment TBC 90%


Dementia screen TBC 75%


End of Life Plan N/A


Do Not Attempt Resuscitation in place

N/A

Payment Arrangements Funding per Care home should be calculated at the beginning of each year based on the Nursing and residential beds occupied. Re-calculations could occur in year where there are exceptional circumstances i.e. were a Care Home opens beds after a

period of suspension. Payments for the Enhanced service will be made monthly at 1/12th total contract value. In the case of Care Homes which are embargoed due to quality concerns and which will be closed to new admissions, practices will still receive payment, however will be expected to contribute to the QIPP and RADAR action planning processes to improve the quality of care delivered in the home. Funding per Care home is provided in Appendix 2. Payment will be for each primary care home will be apportioned by individual Practice list size and paid directly to those practices. The practices may then determine how to collectively provide the service. Please see Appendix 3.

3.3 Population covered

The population served is any West Lancashire GP registered patient residing in a West Lancashire CQC registered Care Home. There are 31 Care homes in West Lancashire, however one doesn’t have any residents registered in West Lancashire due to its location, that leave 30 Homes. There are a mixture of nursing and residential homes, with some homes being dual registered. A map of care home locations is given in Appendix 1.

3.4 Any acceptance and exclusion criteria and thresholds

Care Home residents not registered with a West Lancashire GP will be excluded. 3.5 Interdependence with other services/providers

As part of the CCGs Building for the Future vision care homes are part of our health care community. The same level of care and support will be offered regardless of care environment to both residents and staff. For the residents, this will mean equal access to specialist services and care planning. For staff this means an invitation to be part of the neighbourhood network with access to development opportunities, clinical networks and local service planning. There will be dedicated clinical and therapeutic support for care home residents, with all residents having clinical care plans including advanced care plans addressing end of life wishes as part of the MDT process. Care plans will also include anticipatory management of long term conditions such as dementia, frailty, chronic obstructive pulmonary disease (COPD) and heart failure should there be deterioration. This will include Care Home residents. Virgin Care Limited will deliver the CCGs vision for community and out of hospital urgent care as part of their mobilisation and transformation plans. It is important to understand this context and that MDTs and Care co-ordination of high risk patients will form part of Virgin Care’s contractual responsibility. Therefore, an Enhanced Health for Care Homes scheme in West Lancashire is interdependent with the Community Services in West Lancashire.

4. Applicable Service Standards

4.1 Applicable national standards (eg NICE)

NICE Guidance; Multi-morbidity: clinical assessment and management https://www.nice.org.uk/guidance/ng56 NICE Guidance; Falls in older people: assessing risk and prevention https://www.nice.org.uk/guidance/cg161 British Geriatrics Society: Comprehensive Geriatric Assessment http://www.bgs.org.uk/cga-toolkit/cga-toolkit-category/what-is-cga/cga-what British Geriatrics Society: Personalised Care and Support planning http://www.bgs.org.uk/care-and-support-planning/cga-toolkit-category/cga-personal-care-plan-full Implement appropriate DH, NICE, MHRA and any other relevant guidance (as amended from time to time) that apply to the provision of this service. NHS Accessible information standard; https://www.england.nhs.uk/ourwork/accessibleinfo/ Health Professionals working with Care Homes should be aware of their responsibilities under Safeguarding policies. Concerns should be made to the LCC Safeguarding Lead and ‘soft intelligence’ can be raised with XXXXX to be discussed at RADAR meetings.

4.2 Applicable standards set out in Guidance and/or issued by a competent

body (eg Royal Colleges) 4.3 Applicable local standards

5. Applicable quality requirements and CQUIN goals

5.1 Applicable Quality Requirements (See Schedule 4A-D)

5.2 Applicable CQUIN goals (See Schedule 4E)

6. Location of Provider Premises

The Provider’s Premises are located at:

7. Individual Service User Placement

https://www.nice.org.uk/guidance/ng56

https://www.nice.org.uk/guidance/cg161

http://www.bgs.org.uk/cga-toolkit/cga-toolkit-category/what-is-cga/cga-what

http://www.bgs.org.uk/care-and-support-planning/cga-toolkit-category/cga-personal-care-plan-full

http://www.bgs.org.uk/care-and-support-planning/cga-toolkit-category/cga-personal-care-plan-full

https://www.england.nhs.uk/ourwork/accessibleinfo/

Appendix 1

West Lancashire Clinical Commissioning Group Audit Committee – 17 April 2018 Page 1 of 5

Minutes DRAFT

Meeting Title: West Lancashire Clinical Commissioning Group Audit Committee

Date: Tuesday 17 April 2018

Time: 1.30 – 3.30 pm Venue: Boardroom, Hilldale, Wigan Road, Ormskirk

Present: Douglas Soper, Lay Member (Chair) Claire Heneghan, Chief Nurse Dr Jack Kinsey, GP Executive Lead Greg Mitten, Lay Member

In attendance Paul Kingan, Chief Finance Officer Paul Jones, Head of Finance Tommy Rooney, External Audit, Grant Thornton Michelle Moss, Anti-Fraud Specialist, MIAA Liz Squires, Internal Audit, MIAA Cathy Ashcroft, Executive Assistant

Apologies: Andrew Smith, External Audit, Grant Thornton (in attendance) Ann Gregory, Anti-Fraud, MIAA (in attendance) Dr Bapi Biswas, GP Executive Lead Dr Adam Robinson, Secondary Care Doctor

Agenda

Item Summary of Discussion Action

1. Welcome, Introductions and apologies for absence Doug Soper welcomed all present to the meeting of the Audit Committee. Apologies were noted as above.

2. Declarations of interests Doug Soper reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of West Lancashire CCG. Declarations declared by governing body members are listed in the CCG’s Register of Interests. The register is available either via the secretary to the governing body or the CCG website at the following link: http://www.westlancashireccg.nhs.uk/wp-content/uploads/Register-of-interests-Governing-Body-November-2017.pdf

The following declarations of interests were raised at the meeting: Liz Squires declared an interest in item 10, Single Tender Waivers, due to her role in MIAA. The chair deemed the interest to be significant but not fundamental as the item was for noting only and Liz would remain in the meeting.

3. Minutes from the previous meeting The minutes of the meeting held on 13 February were approved as a correct representation of the discussions.

4. Matters arising The action sheet was updated.

5.

Board Assurance and Risk register The latest risk report, which had been presented at the Governing Body




meeting in March, was presented. There are 23 risks including four extreme risks. Three of the extreme risks relate to staffing, performance, quality, finance and resilience at Southport and Ormskirk Hospital NHS Trust (the Trust). The fourth concerns a deprivation of liberty (DoL) pan-Lancashire risk. A meeting has taken place around the DoL risk and an outcome is awaited. Two new risks are Risk 64 - loss of care home beds which raises concern around patient discharge from the Trust with a reduced number of beds available in care homes. This is due to a number of care home closures and one home which has suspended admissions. The CCG is working closely with Lancashire County Council, the Commissioning Support Unit and the safeguarding team. Risk 65 –concerns inconsistency/delays regarding health assessments for Looked After Children. This will be updated after liaison with the safeguarding team. It also relates to SEND and the CCG is involved in three of five pertinent workstreams. It was confirmed that the risk to the workforce in care homes, due to the living wage and exit of European workers, had been recognised in the global risk as part of the Lancashire and South Cumbria work. The review on the Assurance Framework raised issues around needing a specific section for assurances achieved. Also, the risks shared wider with other committees eg Quality and Safety Committee. The same core team attend most meetings and challenges raised are shared in the remaining meetings. It was agreed that the risk register will be included on the agenda for future Quality and Safety Committee meetings. The audit committee: noted the content of the risk register.

Internal Control

6. Internal Audit

• Progress report Since the previous meeting, the following five reports have been completed: ▪ Assurance Framework (requires improvement) ▪ Conflicts of Interest (Fully/partially compliant) ▪ Financial Systems and Reporting (Significant assurance) ▪ Prescribing (not applicable) ▪ Primary Care Commissioning Committee Risk Management Workshop

(not applicable) The following work is at draft stage: ▪ Information Governance Toolkit ▪ Specialist Commissioning (Clinical coding): Pain Management, Renacres Dave Garnett joined the meeting to discuss the draft specialist coding review. The committee were informed the issue relates to growth of activity, there is overperformance as the plans were light for pain management due to historical coding issues. Also, a consultant from the Trust has moved to Renacres on a permanent basis, which has reduced the capacity at the Trust and increased activity at Renacres. The review did not show anything abnormal outside expected limits and it is not felt to be a coding issue. Dave Garnett will confirm the details with Liz Squires. This will determine if the review achieved is limited or significant assurance, which will reflect on the Director of Audit Opinion. The Conflict of Interest review showed one item as amber. This was due to the delayed national rollout of the online training, with a completion deadline of 31 May. Recommendations included some issues around unidentified gifts


and hospitality and incomplete declarations which require follow up. These were discussed and measures will be put in place. The Audit Committee noted the significant assurance received regarding financial systems and reporting. Thanks were passed to Paul Jones and his team regarding this. ▪ The committee noted the comments reported by internal audit concerning ▪ Prescribing ▪ Primary Care Commissioning Committee Risk Management Workshop

• Audit Plan 20-18-19 The final plan, which was agreed at the previous meeting, was presented. Fees remain unchanged and no comments were made.

• Draft Director of Internal Audit Opinion The purpose of the opinion is to contribute to the assurances of the accountable officer and governing body and informs the annual governance statement. The work undertaken and assurance opinions of reviews during the year are examined. The key work was undertaken around the assurance framework and financial systems and overall the CCG was achieving moderate assurance although with the finalisation of the coding/pain audit this could improve to substantial. (The Committee felt that the CCG had performed better financially than last year, as the financial targets had been achieved this year and felt that a higher significant level of assurance could be achieved). Consistency across all organisations is checked. Positive feedback around the Project Management Office and QIPP management had been received and will be reported to NHS England. This will be added to the director of internal audit opinion. The MIAA events handbook will be available soon. Praise was given to recent events attended.

The audit committee: noted the content of the reports

7. Local Counter Fraud

• Annual report 2017-18 The annual report’s executive summary lists the key work delivered during the year. The completion of the Standards for Commissioners self-review tool achieved Green status, demonstrating a high level of compliance. Compliance from the community services provider will be sought. The CCG achieved amber for demonstrating work with external organisations and investigations regarding anti-fraud cases. A green rating is not possible as no cases have been referred, therefore there is no way to improve this outcome, unless investigations are required. No referrals have been brought forward. The general performance indicators are all Green. The workplan is written to address how to improve on any findings in the annual report. The CCG is scored Amber, as it is not a lead commissioner for a provider. Anti-fraud awareness campaigns have taken place with information circulated to the CCG via the communications manager. The audit committee: received and supported the annual report

• Annual workplan 2018-19 The executive summary outlines the purpose of the document. Fees remain the same as the previous year. The anti-fraud plan priorities and risk assessment are built from considering the national priorities of the NHS


Counter Fraud Authority, requirements from the Standards for Commissioners, place-based developments and the local strategic risk assessment. Local Enhanced Services will also be included in the workplan this year. The audit committee: approved the workplan.

8. External Audit

• Progress report Tommy Rooney presented the progress report, providing updates on the current position against the workplan. Most of the early testing of the annual accounts is complete, with no significant issues arising. The audit deliverables outline the fee for 2017-18, an accounts audit plan, interim audit findings and final report, an auditors report on the financial statements, annual governance statement and value for money conclusion. Paul Kingan mentioned the Integrated Care Partnership (ICP). The CCG’s strategy refers to a prevention and community perspective, where some ICPs provide greater focus to the acute. Acute services sustainability work continues with Southport and Formby CCG. It had been generally agreed that Lancashire CCGs would work at level 3 in the Integrated Care System (ICS).This reflected more joined up working in Health communities but not full CCG integration/merger. This, will require resources from CCGs to support the ICS. Further resources are required for the ICS, in additional to the existing sum already received. It will be necessary for CCGs to provide staff or finance resources to establish the ICS. The recommendation of the audited accounts will be brought to the next Audit Committee in May. The audit committee: noted the content of the reports

9. Losses and special payments There were no losses and special payments to note.

10. Single tender waivers One waiver was presented which related to MIAA. Liz Squires had declared an interest in this item, but no decision was required and Liz Squires remained in the meeting. The performance of MIAA had been discussed and the decision was supported. The audit committee – noted the single tender waiver

11. Gifts and hospitality – March 2018 The current gifts and hospitality register was presented. Once the collection of the GP Partners’ conflicts of interests had been completed, the register will be updated. Register of interests – March 2018 Paul Kingan presented the register, which had been to the Governing Body listing the Governing Body members’ declarations of interests, which will be included in the annual report. The full list of interests will be updated once the outstanding GP Partners responses are received. The audit committee: noted the report

12. Draft annual report The draft annual report has been to the executive committee for comments.


Chris Brown and John Barbour are working on the report to ensure it is in plain English. NHS England want to introduce a different reporting technique for finance. The surplus which is brought forward should be available to use in the future. Ways to use this surplus under current rules for the benefit of sustainability were discussed.

13. Financial position update Paul Kingan confirmed there had been no change in the financial position since reporting to the Governing Body meeting in March. The CCG had achieved its control totals this year. It had to take a view on expert determination, as the outcome will only be due on 19 April, after the financial ledger closes. Therefore, an estimate had been made of the financial outcome and a reasonable value had been included in the annual accounts. Should the outcome result in a different figure consideration of any action required would depend upon the level of materiality of the difference.

Any other business

14. Date and time of next meetings Tuesday 22 May 2018, from 9 – 10 am, in the Boardroom, Hilldale. The meeting will consider the annual report and accounts, prior to the Governing Body at 10 am. The next full Audit Committee will take place on 4 September at 1.30 pm.

Finance & QIPP Notes and Actions 6 March 2018

`Item Discussion and decisions Actions Responsible officer

Due Date

Attendees In Attendance

Chair - Mike Maguire – Chief Officer Bapi Biswas – GP Executive Lead Doug Soper – Lay Member Paul Kingan – Chief Finance Officer Peter Gregory – GP Executive Lead Rakesh Jaidka - GP Executive Lead Jack Kinsey – GP Executive Lead Vikul Mittal – GP Executive Lead Pauline Webster – Administration Officer Greg Mitten – Lay Member Adam Robinson – Secondary Care Consultant Nicola Baxter, Head of Medicine’s Optimisation Jackie Moran – Head of Contracting, Performance and Quality Paul Jones – Head of Finance Item 4 Matthew Greene, Senior Finance Manager Item 6 Karen Tordoff – Lead Manager, Service Redesign Item 6 Laura Anton – Management Trainee

Apologies John Caine – Chair Claire Heneghan – Chief Nurse Stephen Gross – Lay Member

Declaration of Interest

Declarations declared by governing body members are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the governing body or the CCG website at the following link:

Declaration of Interest Declarations of interest from sub committees; None declared. Declarations of interest from today’s meeting; Peter Gregory GP Exec is a Director West Lancashire GP Federation – OWLS CIC and all GP Execs declared an interest in: Item 5 - Procedures of limited clinical value (PLCV) in Primary Care as they are either current or potential providers. The Chair deemed this as significant but not fundamental but as a decision is not being made, Peter and all GP Execs were allowed to take part in the discussion.

Item 3 – Notes from previous meeting 6 February 2018 / matters arising / summary of actions

The notes from the previous meeting were approved. Matter arising/summary of actions

• Recruit new post Head of Integration of Health & Social Care Sarah Derbyshire, Learning Disabilities Manager commenced in post on 19 February 2018 initially on an 3 month interim contract. Sarah has a social work background and experience in special education and SEND.

Greg Mitten informed the committee that going forward Sarah may support the work of a local West Lancs partnership facilitated by the local constabulary around early intervention children’s to stop early offenders

• Acute Visiting Service ➢ John to feedback from meeting he attended on 6 February

2018 – John Caine has sent apologies ➢ AVS Activity data monitoring - Karen Tordoff was not present

for this agenda item to give an update

• Estates – Mike and Paul have met up with George Hurst outside this meeting. George is presenting the Estates Strategy in a Clinical Executive meeting in March 2018.

Update at next meeting

John Caine Karen Tordoff

1.5.18

http://www.westlancashireccg.nhs.uk/wp-content/uploads/Register-of-interests-Governing-Body-October-2016-003.pdf

Child Development Centre at S&O Trust – potential savings of £160k is reported by the Finance Team due to Propco allocating costs to Lancashire Care FT as they have been using the building for 2 years.

• PLCV in Primary Care – see agenda item 5

• CHC/IPA issues – PHBs In response to an action from the last meeting Paul Jones circulated an email and document to the Committee Members. The document details the numbers of PHBs in West Lancs. The numbers are stable with a rate of increase are incremental showing 7% last year and 10% this year. There’s also a national FAQ section on the NHS England website the link to which is below: https://www.england.nhs.uk/personal-health-budgets/what-are-personal-health-budgets-phbs/frequently-asked-questions-about-phbs/

• NHS Rightcare – see agenda item 6

• PMO – see agenda item 7

Item 4 – QIPP Plan Overview and recovery plan update

2018/19 QIPP Reviews - Paul Kingan has received a letter from Elaine Collier Director of Finance regarding NHSE North Phase 3 of the National QIPP Support Programme. This is an opportunity to test the planning and readiness for delivery of the 2018/19 programme across all CCGs in the north region and will be used to identify and shape the Phase 4 programme of bespoke CCG/system support. CCG have to deliver significant savings next year. QIPP is £4.8m next year and Paul raised concerns around Risk/deliverables – could be £2m / £3m This is a compulsory assurance process All CCG’s are to be reviewed by independent auditors.

https://www.england.nhs.uk/personal-health-budgets/what-are-personal-health-budgets-phbs/frequently-asked-questions-about-phbs/



• Timescales are tight – with a final output of a completed workbook per CCG to be completed by the end of March in order to quickly move to the bespoke support phase. The programme has been designed to minimise the impact on CCGs with just 2 days site presence from providers and a limited data submission. There will be an ICS alignment at the end specifically looking at QIPP and ICS plans alignment

• MIAA is WLCCG’s provider and is leading on the review

• CCG to submit data to the provider who will analyse the information returns and prepopulate the workbook template

• Top 10 QIPP schemes to be reviewed - Jackie Moran, Matt Greene and Paul Jones have already started the process

• An introductory meeting has been arranged for 15 March 2018 for an MIAA associate to meet with key contacts at the CCG, thereafter they will meet with the QIPP scheme leads and a feedback meeting will then be arranged with Paul Kingan and Jackie Moran. The workbook is then completed by the provider and sent back to the CCG for sign off which is expected 3 working days after the feedback meeting. Signed work book goes to DCO lead for sign off.

• Paul will feedback at the next meeting

Financial Plan 2018/19 Matt Greene has incorporated the planning guidance for the Financial Plan 2018/19 which will support the paper going to the Governing Body 27 March 2018 which will be available to the public. Matt gave a brief presentation of the Financial Plan 2018/19 for the purposes of this meeting only: Matt talked through the following slides with more emphasis on Slide 4 QIPP Plan for this meeting.

• Slide 1 – Financial plan 2018/19

• Slide 2 – Growth assumptions

• Slide 3 - Investment Requirements – STP/ICS commitment funding £0.5 – CCG may need to submit monies/transformation

Phase 3 QIPP Review feedback at next meeting

Paul Kingan

1.5.18

money expected - Paul Kingan to discuss further with Gary Raphael.

• Slide 4 – QIPP Plan – RAG ratings show that non-electives have not gone through as quickly as anticipated. QIPP scheme total savings £4,826

• Slide 5 – Summary slide listed final points ➢ Possible pressure from 2017/18 not factored into the

above ➢ Adverse expert determination would worsen position –

Paul Kingan commented that he is liaising with NHSE re transformation money – early signs £0.5m to £1m

➢ Risk of over performance in year ➢ Specific risk around property – no confirmation of

allocation for market rent

Item 5 – Procedures of Limited Clinical Value (PLCV) in Primary Care – Draft Scheme Proposal/ concept feedback from working group

The PLCV working group met on 27 February 2018. Peter Gregory described the concept which is to make savings in PLCV by creating a supported co-ordinated training programme which is a NHSE top ten for Peer Review. There could be potential finance support for this. The working group suggested that Peer Review education meetings could take place Membership Council meeting alternating every other month. Jackie Moran will further discuss this with John Caine and Mike Maguire. For the 3 Neighbourhoods - Terms of Reference will be drafted up and issued with a contract which will enable the Neighbourhoods to work independently as their requirements differ. Support from other teams was discussed i.e. Medicines Optimisation with regards to prescribing. The general concensus from discussions regarding the education aspect and the challenge of getting Practices to work together and due to the conflicts of interests involved that this should be taken to the Primary Care Committee for clarification.

Membership Council meetings with alternating Peer Review education sessions to be further discussed with John Caine and Mike Maguire Clarification sought – to take to Primary Care Committee meeting 8 May 2018

Jackie Moran Jackie Moran

6.3.18 8.5.18

Item 6 – NHS Rightcare • Gastro data

analysis

Laura Anton gave a brief presentation of the progress of the NHS Rightcare journey so far and mentioned that further news had just been received which hadn’t been included in the slides.

Gastro – potential savings opportunity of £500k which is challenging due to processes in place. The CCG are still awaiting the practice level packs 14/15 for Gastro (alcohol) which is now due in May. There are issues around analysing the GI data. Laura talked about the difficulties in getting data and support and has been working with Dave Garnett, business analyst looking at figures, Charlotte McAllister who has been looking at data via Aristotle and the Public Health observatory and the Data Quality Team to look at ways they can link secondary care data with EMIS. Next steps –

• Scoping exercise around alcohol related admissions, GI Bleeds and medication – Laura sought clarification/advice from GP Executives re procedures and data around GI scopes. NICE guidance on Gastroscopes was discussed. A Dyspepsia pathway is to be finalised and will be taken to the Clinical Executives committee meeting for decision on 13 March. Mersey also have a Dyspepsia pathway and Jackie will make contact with Sefton to get a copy. Thoughts are to share the Mersey Dyspepsia pathway with the Membership Council for Peer Review. Laura asked for clinical support from the GP Execs and Vikul Mittal agreed to work with Laura.

A&E attendance rate for under 5’s – the CCG are doing a piece of work to pull a data pack together. Jackie is attending a review of children services meeting on 8 March 2018. Activity and Finance data is broken down into providers. Once data queries have been addressed it will be shared with the Executive Committee in April. Jackie to update the committee in May. Excessive Menstruation / abdominal hysterectomy –

• Contraception service - Laura is currently scoping where patients are using services. Family planning clinics do not routinely fit coils for excessive menstruation. LCFT deliver contraception services for <25 years and Blackpool >25 years across the whole patch. LCC mid contract review of sexual health services with a focus on increasing provision in West Lancashire. Most patients are going out of area which could be contributing to high spend.

GI procedures/data – update at next meeting Clinical Executives agenda item for April 2018

Vikul Mittal Laura Anton

Jackie Moran

1.5.18 1.5.18

➢ Doctor recruited in WL – complex patients could be seen sooner and locally

➢ Practice nurse has just completed training for coil fittings – 2 ‘coil fitters’ are retiring.

➢ New policy for Hysterectomy Sept 2017 may impact the number of surgical interventions

More information/data is required before doing a procurement/ business case. Rakesh Jaidka has agreed to support Laura.

Procurement/ Business case update at next meeting

Rakesh Jaidka Laura Anton

1.5.18

Item 7 – PMO projects – Financial data

Chris Russ has made a few changes to the appearance of the QIPP Dashboard for 2017/18, and has included some charts for greater visibility. Work is in progress to put projects and figures in for 2018/19 QIPP schemes and changes have been made to the smart sheets to capture 2018/19 for reporting purposes and to create a separate Dashboard for 2018/19 QIPP. Paul Jones presented and talked through the QIPP Schemes Dashboard 2017/18. Headline figure 83% on target; 86% forecast which is slightly higher than last month. Potential savings of £160k from S&O Child Development Centre Building maintenance that LCFT have been using. QIPP scheme leads are required to complete the data weekly/reminders are going out every Thursday and currently 70% is being updated. SMT are monitoring this.

Item 8 - AOB There was no any other business discussed

Next Meeting The next meeting will take place on Tuesday 1 May 2018.

1

West Lancashire CCG Clinical Executive Committee Action and Notes – 13/03/18

Key

Attendance

Non-Attendance (sickness, holiday, unknown)

Attended meeting/course on behalf of CCG

Record of Attendance

Member 05.12.17 12.12.17 19.12.17 09.01.18 16.01.18 30.01.18 06.02.18 13.02.18 20.02.18 27.02.18 06.03.18 13.03.18

Adam Robinson Board Development

Board Development H

Bapi Biswas Board Development

Board Development H

Claire Heneghan H Board Development

Board Development H H

Debbie Dobson Resigned Resigned Resigned Resigned Resigned Resigned Resigned Resigned Board Development

Board Development

Resigned Resigned

Doug Soper Board Development

Board Development

Greg Mitten H H Board Development

Board Development

Jack Kinsey Board Development

Board Development

Jackie Moran Board Development

Board Development

Jo Debacker H Board Development

Board Development

John Caine Board Development

Board Development H

Mike Maguire H Board Development

Board Development

Paul Kingan Board Development

Board Development

Peter Gregory Board Development

Board Development H

Rakesh Jaidka Board Development

Board Development

Vikul Mittal Board Development

Board Development

Steve Gross Board Development

Board Development

2

Item Discussion and decisions Actions Officer Due Date

Attendees In attendance

Chair –– John Caine – Chair Doug Soper – Lay Member Jo Debacker – Practice Manager Stephen Gross – Lay Member Vikul Mittal – GP Executive Lead Pauline Webster – Administration Officer Jackie Moran - Head of Quality, Performance and Contracting Mike Maguire – Chief Officer Greg Mitten – Lay Member Jack Kinsey – GP Executive Lead Rakesh Jaidka - GP Executive Lead Nicky Baxter – Head of Medicines Optimisation Agenda item 7 - Karen Tordoff, Becky Cope

Apologies. Roles & Descriptions

Apologies were received from: Claire Heneghan – Chief Nurse Adam Robinson – Secondary Care Consultant Paul Kingan – Chief Finance Officer Bapi Biswas – GP Executive Lead Peter Gregory – GP Executive Lead Role and Descriptions were reviewed and changes in roles were made verbally due to apologies received.


The Chair reminded committee members of their obligation to declare any interest they may have on any issues arising at Clinical Executive Committee meetings which might conflict with the business of NHS West Lancashire Clinical Commissioning Group. Declarations declared by governing body members are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the governing body or the CCG website at the following link:

3

Declaration of Interest Declarations of interest from sub committees: None declared. Declarations of interest from today’s meeting: Rakesh Jaidka and Vikul Mittal who are Directors of OWLS CIC declared an interest in item 7 – Community & Urgent Care Update. The Chair deemed this fundamental and Rakesh and Vikul will be asked to leave the meeting for this agenda item as OWLs is sub- contracted to Virgin Care.

E-meeting

Item 3 – Continuous Glucose Monitoring and Insulin Pumps

An agenda item 28/18 Insulin Pump and Glucose Monitoring Devices Financial Analysis and Outcome of Stage 3 in the minutes from the Lancashire Commissioning Policy and implementation working group on 15 February 2018 was circulated to the Execs. An action in the minutes ask for CCG’s to decide whether this should be managed through the Prior Approval process to ensure that the policy is adhered to and that there may be cost implications. The Execs reviewed the minutes and discussions were around the financial implications and the benefits of the IFR panel and the need for clinical input. Information on lifestyles and self caring from the Medicine’s Optimisation Team that has been circulated to all GP’s was also discussed. It was agreed by the Execs that it is appropriate that Continuous Glucose Monitoring and Insulin pumps are managed through the Prior Approval Process to ensure that the policy is adhered to. There was an Action to take this to a future membership meeting to give GP’s guidance around the criteria regarding the referral process for IFR.

Membership agenda item

John Caine / Jackie Moran

April 2018


4

Item 4 – Notes from previous meeting – 6 March 2018

The notes from 6 March 2018 were approved as a correct record.

Item 5 – Draft Membership

The draft Membership Agenda 22 March was reviewed. A number of changes were made to the agenda which will now be circulated. Each agenda item including for this next meeting to give a brief explanation as to why this is important. John Caine and Jackie Moran will bring suggested changes to the format of the Membership meeting to the Clinical Executive committee meetings for the future.

Future Membership Agenda items to have a brief explanation. Suggested changes to be brought to future meeting.

John Caine / Jackie Moran John Caine / Jackie Moran

March 2018 April 2018

Strategic & Service Redesign

Item 6 - Dyspepsia Pathway

Jack Kinsey lead a discussion on the proposal for West Lancashire CCG to adopt the Sefton Dyspepsia Care Pathway 2016 which had been circulated to the Execs for review and comment. The pathway is a graphical representation and is in line with NICE guidance. The Pathway has been adopted across all Merseyside. The Execs reviewed the pathway and the clinicians talked about the local processes currently in place in terms of medication, procedures i.e. Gastroscopes, breath tests etc. and referrals to secondary care. More information was requested around gastro data collection and financial implications. Jackie Moran and Nicola Baxter have agreed to work with Matthew Greene to get financial data on gastro procedures and present the data at the Membership Council on 22 March. The Sefton Irritable Bowel syndrome pathway 2016 was circulated for information only and not for discussion.

Gastro Financial data to be presented at Membership

Jackie Moran / Nicola Baxter / Matt Greene

22.3.18

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Item 8 – AOB This item was discussed before item 7.

Southport and Ormskirk NHS Trust CQC inspection report

A press release was issued on 12 March with an embargo of 00.01 Tuesday 13 March 2018.

The Report is now available and a key summary of the report was discussed briefly.

Inspectors visited the trust between 20 November and 7 December 2017.

NHS England’s Chief Inspector of Hospitals has rated services provided by Southport and Ormskirk NHS Trust as unchanged at Requires Improvement overall.

At Southport and Formby District General Hospital the ratings for services stayed the same - Requires Improvement.

John Barbour, Interim Head of Communications is currently preparing a response on behalf of NHS West Lancashire CCG.

The report will be discussed further at next week’s Executive meeting.

Agenda item next meeting

John Caine

20.03.18

Operational

Item 7 – Community & Urgent Care Update

All GP Executive’s were given the opportunity to raise any additional issues which included Podiatry waiting times, Single Point of Access telephone number and IT challenges. Rakesh Jaidka and Vikul Mittal then left the meeting due to the declaration of interest noted above. Following a ‘business as usual’ / safe transfer period and the first 6 months of this contract being operational, an internal commissioner ‘stocktake’ workshop took place on Thursday 8 March 2018 which considered various documentation and intelligence. The purpose of the

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event was to prepare a CCG view on progress of the contract to date. The purpose of this subsequent session with the Clinical Executive, was to feedback the outputs from the workshop to generate discussion and collectively agree next steps. It was acknowledged that there were some areas of concern in terms of timescales and delivery. However, there were also many positives in the system such as recruitments to new roles e.g. IV Therapy and the impact which these could have and investment in IT infrastructure to help modernise service provision. Following a lengthy discussion and considering the impending end of year 1 for this contract, 2 main actions were agreed –

1. That an Executive to Executive meeting take place between both the provider and the commissioner in April / May 2018 where further discussions could be had.

2. That the CCG Officers produce a report outlining the current position and priority areas for the coming year for discussion at this meeting.

Jackie Moran and Karen Tordoff agreed to reference the requirements above at the Transition and Transformation Board scheduled for 15

March 2018 so both parties were aware and suitable arrangements could be made.

Report to be brought to Execs

Jackie Moran / Karen Tordoff

April / May 2018

Next Meeting The next meeting will take place on Tuesday 20 March 2018.

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Key

Attendance




Member 12.12.17 19.12.17 09.01.18 16.01.18 30.01.18 06.02.18 13.02.18 20.02.18 27.02.18 06.03.18 13.03.18 20.03.18


Board Development H


Board Development H

Claire Heneghan Board Development

Board Development H H

Debbie Dobson Resigned Resigned Resigned Resigned Resigned Resigned Resigned Board Development

Board Development

Resigned Resigned Resigned


Board Development

Greg Mitten H H Board Development

Board Development


Board Development


Board Development

Jo Debacker Board Development

Board Development H


Board Development H

Mike Maguire H Board Development

Board Development

Paul Kingan Board Development

Board Development

Peter Gregory Board Development

Board Development H


Board Development


Board Development


Board Development

2


Attendees In attendance for Agenda item 3

Chair –– John Caine – Chair Doug Soper – Lay Member Stephen Gross – Lay Member – joined the meeting 9.45am Vikul Mittal – GP Executive Lead Pauline Webster – Administration Officer Jackie Moran - Head of Quality, Performance and Contracting – left the meeting after agenda item 3 Mike Maguire – Chief Officer Jack Kinsey – GP Executive Lead Rakesh Jaidka - GP Executive Lead Nicola Baxter – Head of Medicines Optimisation Claire Heneghan – Chief Nurse Adam Robinson – Secondary Care Consultant Peter Gregory – GP Executive Lead Joanna Rimmer – Contracts Manager Jan Charnock – Primary Care Development Manager George Hurst – Estates Strategy Contractor

Simon Burnett – West Lancashire Health and Wellbeing Partnership Darren Lamb – Director of Consultancy, FMG Consulting Sheldon Walsh – Healthcare Director, AFL Architects

Apologies, Roles & Descriptions

Apologies were received from: Paul Kingan – Chief Finance Officer Jo DeBacker – Practice Manager Bapi Biswas – GP Executive Lead Role and Descriptions were reviewed and changes in roles were made verbally due to apologies received.


The Chair reminded committee members of their obligation to declare any interest they may have on any issues arising at Clinical Executive Committee meetings which might conflict with the business of NHS West Lancashire Clinical Commissioning Group.

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Declarations declared by governing body members are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the governing body or the CCG website at the following link:

Declaration of Interest Declarations of interest from sub committees: None declared. Declarations of interest from today’s meeting: All GP Executives declared an interest in agenda item 3 – Estates Strategy, due to Ormskirk and Skelmersdale individual GP Practices to be consulted as part of the concept of the Skelmersdale and Ormskirk combined model of provision working in partnership with West Lancashire Borough Council’s Project Vision. The Chair deemed this interest significant at this stage. The GP’s were allowed to remain in the meeting to take part in the discussions as this was an update and discussion, no decisions to be made at this stage.

Operational

Item 3 – Estates Strategy Key Principles

The Council’s Project Vision ‘helping communities lead Active, Fun and Sociable lives in partnership to build and run leisure centres that people love’ was presented to Execs. The presentation covered:

• Introductions - George Hurst introduced the ‘design team’ Simon Burnett, Darren Lamb and Sheldon Walsh. The purpose of presenting the concept of the combined model of provision to the Execs is to agree the key principles of the project and work in partnership with the council. Individual GP Practices in Ormskirk and Skelmersdale will be consulted if want to be involved in ‘doing this together’ or not.

• Summary of Stage 1 Viability Appraisal (Oct 2017) - the Execs were given an update on progress to date of the investment in the new leisure provision in Skelmersdale and Ormskirk. There are a series of milestones set out by NHSE for the CCG and the Council to work in alignment on this project. The vision is to help


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communities work with the NHS and Council to run health and leisure facilities. There are direct and indirect economic benefits.

• Stage 2 Project Development (Jan 2018) – the ‘design team’ talked in detail around the Design deliverables of this stage of the project covering 8 weeks from 15 January to 9 March 2018. There were slides on the site options and accommodation diagrams on Ormskirk and Skelmersdale facilities.

• Project Delivery (Management, Cost, Procurement, Risk) – the ‘design team’ discussed a slide showing a list of key considerations, actions and risks in more detail with the Execs.

• Next Steps and Key Dates ➢ To complete stage 2 work by mid May 2018: Development

of design, cost and business case, soft market testing – feedback on proposals, appraisal of future options in the context of future leisure management procurement opportunities and service provision

➢ Key decision maker group /Heads of Terms discussion ➢ Progress to RIBA 2/3 - Sheldon Walsh talked through a slide

showing the RIBA 2/3 plan of work ➢ Overall assessment by July 2018 – decision to proceed –

George gave a separate presentation on the CCG Leisure/Health key tasks and talked through and a set of slides of the timeline of CCG key tasks and decision points. An enhanced PID process/Procurement route to go to NSE by the end of May 2018 for approval. By July overall assessment of procurement/finance/feasibility/affordability/cost plan for approval by CCG/NHSE to commence detailed OBC production (decision to proceed). The last slide showed a list of organisation group and project meetings that currently take place which are part of the STP recommended process. A further progress update and summary of the of the meetings will be brought back to Execs in May 2018. A report will thereafter be presented at the Governing Body meeting in July for decision to proceed.

➢ Earliest date for completion – October 2020

Update on progress to be brought back to Execs Report to be presented to Governing Body for decision to proceed

George Hurst Governing Body

May 2018 24 July 2018

Item 4 – Gluten Free The CCG previously approved a recommendation and launched a policy to cease the funding of items to be considered of low clinical

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value, this included prescribing Gluten free products. Gluten free products were no longer available on prescription in West Lancashire from Monday 4 September 2017. This affects 1% of the local population.

Nicola Baxter referred to the national public consultation ‘Availability of Gluten Free Food on Prescription in Primary Care’ published January 2018 on whether or not to make any changes to the availability of gluten free products on prescription. The consultation presented respondents with 3 options. The majority of respondents preferred option 3: To only allow the prescribing of certain Gluten free foods (e.g. bread and flour) in primary care. The government stated that is for CCGs to decide how they commission local services to best meet the needs of their populations and may wish to undertake a review of their position and as a consequence they may or may not wish to adapt their position. Following discussion, the Clinical Executive Committee made a recommendation to the Governing Body not to adapt the position and to continue with the current CCG policy which is not to recommend prescribing Gluten free products including bread and flour.

Gluten Free recommendation to be taken to next Governing Body meeting

Governing Body

27 March 2018

Item 5 – S&O NHS Trust CQC Report

The CQC Southport and Ormskirk Hospital NHS Trust Inspection Report published 13 March 2018 was circulated to the Execs for information. Inspectors visited the Trust between 20 November and 7 December 2017. The Trust was rated Requires Improvement. NHS Improvement (NHSI) will be monitoring an action plan that was discussed at the NHSI Board meeting 19 March 2018. The new CEO Silas Nicholls commences in post at the Trust on 3 April 2018. The Execs then discussed issues raised by GP Practices over the last few days. There were several issues raised around perceived

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increase in GP workload. In particular, there was a discussion about beds in the community and what service should be covered by GMS and what is outside of the national contract. John Caine and Claire agreed to get this information as well as details around the different types of community beds, how each of them are commissioned and by which agency.

Community Beds - Information to be brought back to Execs

John Caine Claire Heneghan

April 2018

E-meeting

Item 6 - IG Annual Report

The Execs approved the NHS West Lancashire Information Governance (IG) Annual report dated 16 March 2018 and IG Toolkit submission for v14.1 (2017-18). The CSU IG Team will publish the IG toolkit return on behalf of the CCG by 31 March 2018.

IG toolkit return to be published

CSU IG Team

31 March 2018

Item 7 – Finance Report

The Execs approved the Financial Plan for 2018/19. This will be taken to the next Governing Body meeting.

Financial Plan 2018/19 to be taken to next Governing Body meeting

Governing Body

27 March 2018

Item 8 – Risk register The Execs approved the Risk Register Report to go to the next Governing Body meeting

Risk Report to be taken to next Governing Body meeting

Governing Body

27 March 2018

Item 7 – Notes from previous meeting

The notes from 13 March 2018 were approved as a correct record.

Item 9 – Integrated Business Report (IBR)

The West Lancashire Clinical Commissioning Group - Integrated Business Report - March 2018 (Reporting Period January 2018) previously circulated - all to email comments to Jackie Moran before next Governing Body meeting

IBR - email comments to Jackie Moran

All 27 March 2018

Next Meeting The next meeting will take place on Tuesday 3 April 2018.

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Key

Attendance




Member 03/04/18 10/04/18 17/04/18 24/04/18 01/05/18 08/05/18 15/05/18 29/05/18 05/06/18 12/06/18 19/06/18 26/06/18



Claire Heneghan Board Development


Greg Mitten Board Development



Jo Debacker Board Development


Mike Maguire Board Development

Paul Kingan H Board Development

Peter Gregory H Board Development




2


Attendees In attendance for Agenda item 4

Chair –– Bapi Biswas – GP Executive Lead Adam Robinson – Secondary Care Consultant Doug Soper – Lay Member Claire Heneghan – Chief Nurse Jack Kinsey – GP Executive Lead Jackie Moran - Head of Quality, Performance and Contracting Jo DeBacker – Practice Manager John Caine – Chair Mike Maguire – Chief Officer Rakesh Jaidka - GP Executive Lead Stephen Gross – Lay Member Vikul Mittal – GP Executive Lead Anne-Marie Bridge – Administration Officer Kathryn Kavanagh – Lead Manager Health Inequalities Smita Shetty – Service Redesign Manager (Corporate)


Apologies were received from: Peter Gregory – GP Executive Lead Paul Kingan – Chief Finance Officer


The Chair reminded committee members of their obligation to declare any interest they may have on any issues arising at Clinical Executive Committee meetings which might conflict with the business of NHS West Lancashire Clinical Commissioning Group. Declarations declared by governing body members are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the governing body or the CCG website at the following link: Declaration of Interest Declarations of interest from sub committees: None declared.


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Declarations of interest from today’s meeting: None declared.

Strategic & Service redesign

Item 3 – Integrated Care System Proposition

Doug reminded the Executive Committee that he and Paul would be representing the CCG at the Joint committee of CCGs meeting on 12 April 2018. The paper outlines the proposition to establish a shadow Integrated Care System for Lancashire and South Cumbria. Doug explained that the paper has been developed following on from consultation with the CCGs in Lancashire and Cumbria and them choosing this option. Concern was expressed at the meeting about the proposal in the paper for CCGs to put 0.5 percent of their allocation into a transformation fund for Lancashire. It was agreed that this would be a problem for WLCCG as it needed to work across 2 STPs and funding this could jeopardise local schemes of high importance. Doug agreed to express these concerns at the JCCCG meeting.

Item 4 - Well Skelmersdale – Elemental/School for Social Entrepreneurs

Kathryn Kavanagh attended the meeting to present 2 papers in relation developments within Skelmersdale. The first paper focused on Asset Based Development and the social wellbeing benefits associated with the use of directory of services. In order to identify and support this the paper proposed the purchase of Elemental Software which will provide an easy to use, cloud-based platform to enable community referrals to be implemented and measure outcomes of non-medical support in the community. The system connects with EMIS and the system would be purchased for a 2-year period to run alongside the social prescribing pilot. The paper identified the £30,000 coming from monies awarded by Lancashire Constabulary in 2017 and the remaining £5,750 would need to be found by the CCG. Discussion followed, and it was confirmed that the system would be available to other services ie, iHelp pain service and that the directory would be maintained by the provider. It was agreed that the software would be purchased for a 2-year period with review at 18 months. The remaining cost of £5,750 would be recouped from the Well Skelmersdale budget. The second paper focused on creating a social enterprise town in Skelmersdale. West Lancashire Borough Council’s economic strategy focuses on private business growth and there are already large

4

businesses based within the area. The School for Social Entrepreneurs focuses on encouraging small social businesses and developing local success. This is a 12-month programme and following a rigorous application process 12 successful candidates will be enrolled on the programme. Doug expressed his concerns about the lateness of this request to the Clinical Executive Committee and requested that such a situation doesn’t arise in future. The paper also highlighted partnering with the Centre for Local Economic Strategies (CLES) to explore where the CCGs annual procurement spend goes in the area. Mike explained the Preston Model and how this could be replicated locally. The process would look firstly at where current procurement spend is directed and then identify how this can be diverted towards local resources. The cost from both proposal will be met via the Well Skelmersdale budget and the committee agreed to the commencement of all the schemes.

Item 5 – Dermatology Transformation

Mike highlighted that the dermatology procurement through Cheshire and Merseyside does not seem to be progressing with pace, there seems to little evidence to date of an appetite for the type of transformation that the CCG had envisaged at a recent development day and there is still uncertainty over which CCGs have signed up or who were planning to do their own procurements. A representative from the procurement team will be in attendance at next week’s executive committee to outline the procurement process and current state. Doug raised concerns over the capacity of the CCG to deliver an independent procurement, it was noted however that a number of current procurements were reaching conclusions which should free up staff time. It was agreed that a further discussion would take place after the presentation by the procurement team at next week’s meeting to consider whether to continue with the C&M procurement or to work up

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a local scheme either instead of the C&M scheme or in parallel as a contingency.

E-meeting

Item 6 – Membership Agenda – 19 April 2018

The membership agenda was considered and changes to item timings were noted. A discussion arose from the content of the neighbourhood working section and it was felt that further work needed to be considered around the care home annual funding and the differences within the neighbourhoods.


1


Key

Attendance




Member 03/04/18 10/04/18 17/04/18 24/04/18 1/05/18 8/05/18 15/05/18 29/05/18 05/06/18 12/06/18 19/06/18 26/06/18

Adam Robinson

Bapi Biswas

Claire Heneghan

Doug Soper

Greg Mitten

Jack Kinsey

Jackie Moran

Jo Debacker

John Caine

Mike Maguire

Paul Kingan H

Peter Gregory H

Rakesh Jaidka

Vikul Mittal

Steve Gross

2


Attendees In attendance for Agenda Item 3 Agenda item 4 Agenda Item 5

Chair –– John Caine – Chair Adam Robinson – Secondary Care Consultant Bapi Biswas – GP Executive Lead Doug Soper – Lay Member Claire Heneghan – Chief Nurse Jack Kinsey – GP Executive Lead Jackie Moran - Head of Quality, Performance and Contracting Joanne Kane – Administration Officer Jo DeBacker – Practice Manager Mike Maguire – Chief Officer Nicola Baxter – Head of Medicines Management Paul Kingan – Chief Finance Officer Peter Gregory – GP Executive Lead Stephen Gross – Lay Member Vikul Mittal – GP Executive Lead Silas Nicholls Southport & Ormskirk CEO Helen Graham – Procurement Manager MLCSU Carol McCabrey – Senior Service Redesign Manager Melanie Reardon – Clinical Lead Macmillan Move More Carol McCabrey – Senior Service Redesign


Apologies were received from: Rakesh Jaidka - GP Executive Lead


The Chair reminded committee members of their obligation to declare any interest they may have on any issues arising at Clinical Executive Committee meetings which might conflict with the business of NHS West Lancashire Clinical Commissioning Group.

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Declarations declared by governing body members are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the governing body or the CCG website at the following link: Declaration of Interest Declarations of interest from sub committees: None declared. Declarations of interest from today’s meeting: None declared.


Item 3 – Silas Nicholls -Southport & Ormskirk Hospital Chief Executive

Silas Nicholls the new CEO of S&O Trust attended the Exec Committee. John welcomed Silas to the meeting and introductions were made around the room. Silas gave a brief overview of his background, starting as a graduate management trainee in 1993. He then held a range of management posts, moving from his last post as Group Deputy Chief Executive at Manchester University NHS Foundation Trust, to take up his new role at S&O. Following the introductions an open conversation took place. This briefly touched on the past relationship between S&O Trust and WLCCG management. The focused then turned to what Silas’s hopes to achieve in his role. It was noted that WLCCG welcomed Silas’s new approach and both organisations now hope to work closely together during a period of managerial stability, to provide the best care for the West Lancashire population.

Item 4 - Dermatology Procurement

Helen Graham and Carol McCabrey attended to present on progress with the Dermatology Procurement process. The Case for Change was originally presented at an earlier Exec Committee meeting on 19 September by Karl McCluskey. Helen reminded the Exec that the procurement was proposed due to a shortage of dermatologists, this is both national and local. The Model of Care aims to increase flexibility in the service by making use of alternative skill sets and technology. Questions were raised about the draft Service Spec, the sub groups and how innovation is being utilised. It was acknowledged at this point


4

the spec does not yet introduce a great deal of innovation or technology. Helen was asked what was being done to strengthen this aspect. Helen stated that the desire for transformation had not been a key feature of the provider workshop. There was a short discussion on TELEDerm. Providers felt that face to face was preferable to use of images. Discussion then turned to which CCGs have signed up. St Helens and Knowsley will not be part of the procurement and Liverpool CCG is thinking of staying with their existing providers, so have not committed at this stage. The timeline for the whole process is 18 months, due to the time scale there is also an operational clinical dermatology group running separately to deal with immediate issues while the procurement continues. At the end of the discussion it was agreed that further consideration was required on the item, so this will be returned to a future Executive.

Item 5 – Macmillan Move More – Physical Activity

Melanie Reardon and Carol McCabrey attended to present on the Macmillan Move More Programme. Jack Kinsey gave a brief overview of the pilot so far. Originally this was funded by Macmillan, the purpose of bringing this item today is to request approval to continue funding the programme. The papers set out the proposal and options. The Exec Committee discussed the information presented and asked questions about the number of referrals, the sites used for delivery. The preventative and quality of life aspects were highlighted. Greg Mitten reported that feedback from the community was positive. It was noted that such a programme would provide benefits for the wider population. The discussion also turned to how this fits into the wider context of rehab service provision. After a full discussion it was agreed unanimously to fund the project for non-recurrently for one year. There will be further investigation into the current rehab provision and consideration of widening access to such a programme for a wider section of the West Lancashire Population.

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AOB John Caine informed the Exec Committee of the results of the GP Election. Jack and Peter have retained their position but Bapi will be stepping down. Dr Dheraj Bisarya has accepted the position as the new GP Exec, a start date will be agreed and then a formal hand over process will begin. A meeting will be arranged between John, Bapi and Dheraj. John and the Exec Members thanked Bapi for his contribution over the past 10 years from PBC to PCT and then to CCG.

E-meeting

Item 6a – WLCCG Annual Report 2017

The draft WLCCG Annual Report was presented for comment. The Exec Committee discussed the draft, it was agreed that there were several changes required to make sure the terminology is appropriate. Paul Kingan gave an update on WLCCG financial position, a draft set of accounts has been produced that delivers on targets, however there remains some risk from the dispute resolution process. The deadline for an outcome is 19 April, following this the final position will be determined. It was noted that Paul and Doug wanted to thank the finance team for all their work to get the accounts to their current position.

Item 6b Notes from Previous Meeting

The notes from the 3 April were agreed as correct record. The notes from 10 April were also agreed as a correct record. Doug Soper reminded Exec members that the Conflict of Interest Training should be completed by all members.


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Key

Attendance




Member 03/04/18 10/04/18 17/04/18 24/04/18 1/05/18 8/05/18 15/05/18 29/05/18 05/06/18 12/06/18 19/06/18 26/06/18

Adam Robinson

Bapi Biswas End of

Tenure

Claire Heneghan

Doug Soper

Greg Mitten

Jack Kinsey

Jackie Moran

Jo Debacker

John Caine

Mike Maguire

Paul Kingan H

Peter Gregory H

Rakesh Jaidka

Vikul Mittal

Steve Gross

2


Attendees In Attendance For Item 6 - Dermatology

Chair –– Rakesh Jaidka – GP Executive Lead Doug Soper – Lay Member Claire Heneghan – Chief Nurse Greg Mitten – Lay Member Jack Kinsey – GP Executive Lead Jackie Moran - Head of Quality, Performance and Contracting Jo DeBacker – Practice Manager John Caine – Chair Karen Tordoff – Head of Service Re-design Mike Maguire – Chief Officer Nicola Baxter – Head of Medicines Management Pauline Webster – Administration Officer Paul Kingan – Chief Finance Officer Peter Gregory – GP Executive Lead Stephen Gross – Lay Member Vikul Mittal – GP Executive Lead Carol McCabrey – Lead Service Re-design Manager


Apologies were received from: Adam Robinson – Secondary Care Consultant Roles & Descriptions – Herder role was changed to John Caine


The Chair reminded committee members of their obligation to declare any interest they may have on any issues arising at Clinical Executive Committee meetings which might conflict with the business of NHS West Lancashire Clinical Commissioning Group. Declarations declared by governing body members are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the governing body or the CCG website at the following link: Declaration of Interest


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Declarations of interest from sub committees: None declared. Declarations of interest from today’s meeting: GP Execs Peter Gregory, Vikul Mittal, Rakesh Jaidka declared an interest in item 4 Commissioning Report VC due to being Directors of OWLs. The Chair was passed to Mike Maguire to make a decision. The Chair deemed this fundamental due to OWLs subcontract to provide Out of Hours services to Virgin Care in year 1. Peter, Vikul and Rakesh will be asked to leave the meeting for this item but will have the opportunity to give their general feedback from year 1 before this item is discussed. GP Exec Jack Kinsey also declared an interest in item 4 as an employee of OWLs. The Chair deemed this significant but as there was no decision to be made Jack can remain in the meeting to take part in the discussion. The Chair was then passed back to Rakesh Jaidka. The Chair suggested that they discuss item 4 at the end of the meeting to allow other items to be discussed with all GP Execs present and this was agreed. The order of the agenda items to be discussed to be rearranged to accommodate this.

Operational

Item 3 – Joint Committee of CCG’s update from meeting 12 April 2018

Paul Kingan and Doug Soper provided an update. Paul Kingan lead a discussion and gave the history of the Joint Committee of CCGs which has been in place for nearly 2 years. The key agenda items from the last meeting included:

• Organisational development and new arrangements for Lancashire

• CCG Option paper – All CCGs have opted for Option 3, Consolidate leadership at ICP level. CCG leadership teams would consolidate their functions and resources at ICP level, to enable CCG leadership teams to operate in an integrated way within ICPs.

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• Paul referred to ICS Board approval on 4 April, based upon the Strategic Framework a review of the existing programme workstream structure, 12 refreshed portfolios area will be adopted, mobilise and lead the work across the whole system which will be challenging financially and in terms of staff capacity. The need to find a way of supporting the system and also support and understand local issues.

Lucinda McArthur will be leading a discussion around the ICS proposition and ICP/ICS plans at the next Exec and this can be discussed further at a future Board Development if required.


Item 6 – Dermatology At the last meeting it was agreed that further consideration by the Execs was required around the proposed MLCSU Dermatology procurement process and draft service spec that was presented by Helen Graham. The Execs were asked to provide feedback from that meeting. It was agreed that the information provided to date was poor and that the MLCSU procurement service was not able to answer the questions asked to make a decision. Following discussion it was agreed that Jackie Moran would speak to MLCSU about the Cheshire and Mersey procurement and the process to be followed if the CCG undertook it’s own light touch procurement. The Execs also discussed:

➢ Current Trust ‘Waiting lists’ time scales for West Lancashire patient referrals. Lack of Dermatologists in Trusts. Mike will contact Silas Nicholls CEO, S&O Trust for his views around the future of Dermatology in S & O Trust.

➢ GPSI’s – concerns around mentorship to develop those roles

Contact MLCSU Contact CEO S&O re future of Dermatology

Jackie Moran Mike Maguire

May 2018 May 2018

Operational continued

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Item 5 – Quality Premium 2018/19

NHSE have published the Quality Premium guidance for CCGS 2018/19 (updated April 2018). The Quality Premium is intended to reward CCGs for improvements in the quality of the services that they commission and for associated improvements in health outcomes and reducing inequalities.

CCGs are being asked to select 2 local indicators – 1 Mental Health and 1 RightCare. However, the Mental Health indicator selected for 2017/18 was for a 2 year period so still remains. With regard to the RightCare measure, CCGs are to agree one local measure worth 15% of the total Quality Indicators. Karen Tordoff confirmed that she is still awaiting clarity from NHSE on a few queries in relation to this particular measure. Considering the tight timescale involved, Execs agreed to delegate the decision of the measure to Mike Maguire, John Caine and Paul Kingan as submission is required by 30 April 2018.

E-meeting

Item 7– H & S Bomb Threat Policy

The Health & Safety – Bomb Threat Policy was reviewed and approved by the Execs. The policy will be reviewed again April 2019.

Operational continued

Item 4 – Commissioning Report VC

• Year 1 delivery

• Year 2 proposals

The Chair was passed to Mike Maguire. Before leaving the meeting the GP Executives who are Directors of OWLs CIC were given the opportunity to feedback the OWLs CIC Out of Hours subcontract to Virgin Care in year 1. The subcontract will expire on 30 April 2018. Virgin Care has sub-contracted Vocare Limited for a 4 year period to deliver the service from Tuesday 1 May 2018. Services will continue to operate the same way and provide access to GP appointments from 6.30pm until 8.00am week days and 24 hours at weekends. Feedback of the OWLs out-of-hours service subcontract to VC year 1 included:

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➢ General discussion around the relationship/communication between OWLs and VC in the last year

➢ Capacity issues in covering shifts and difficulty of managing workloads

➢ Some issues with data, clinical governance and audit have been ongoing

➢ IT issues – mostly resolved but still had one outstanding issue with a printer

➢ Medicines management changes made by VC ➢ Finance – uplift request was not agreed

Discussions then turned to Vocare Limited from OWLs by VC, relating to TUPE of staff and the proposed changes to the operational model which could potentially impact on staff availability.

Rakesh Jaidka, Vikul Mittal and Peter Gregory left the meeting. Karen Tordoff and Jackie Moran tabled a Commissioner’s Report on the Review of Community and Urgent Care Services contract (Year 1). Due to the report being draft and the content being commercially sensitive, all papers were collected and counted back in at the end of the discussion. The purpose of this report is to provide West Lancashire CCG Executives with a written review of year 1 of the Community Services and Urgent Care service contract. The report has been written at a point of time amid the end of year review process for both parties (WLCCG & VC). The appendices to the report tabled contain the detail. Karen talked through the background and context of the report. Karen also explained the governance process underpinning the contract. Achievements to date were then highlighted and discussed (General and Specific). The report also contains

• Year 2 contract – initial proposals for discussion – this was a ‘snap shot’ for year 2

• Next steps – timescale for the year 1 contract end of year process

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➢ 23 April 2018 – Commissioner and Provider session took place

➢ 24 April 2018 – WLCCG Exec discussion today ➢ 25 April 2018 – VC Exec discussion ➢ 26 April 2018 – Transition and Transformation Board (TTB)

– the CCG will share the report with VC ➢ 27 April 2018 – Year 2 contract draft – commissioner only ➢ 30 April 2018 – Deadline for VC to submit evidence with

regards evidence to year 1 performance / delivery requirements

➢ 1 May 2018 – Year 2 contract draft – WLCCG & VC ➢ 4 May 2018 - Exec to Exec meeting (WLCCG & VC) end of

year review

• Recommendations – the Exec Committee were asked to note the content of the report and discuss the current position to feed into the TTB discussion on 26 April and the subsequent Exec to Exec meeting on 1 May 2018. As the report is written at a point in time in terms of end of year process and further information may be made available in respect of provider delivery until the deadline date for all evidence (30 April 2018).

Mike Maguire summed up discussions around the Vocare Limited contract and the following issues were noted:

• Out-of-Hours rota cover

• GP educational training and induction – need to check there is a Trainer for GP trainees

• Need to add in the contract Care Homes/Hospice aspect

• Discharge issues

• Proposed changes to the Out-of-Hours operational model

• Greg Mitten wanted it noted from a patient & public perspective that they appreciate the extent of the report and the staff involved in the procurement

• Phlebotomy – variation in community services

• GP satisfaction survey – to be re-run by CG via Survey Monkey

• Expedite the adoption of a lower limb service

E-meeting continued

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Item 8 Notes from Previous Meeting

The notes from the 17 April were agreed as correct record.

Doug Soper reminded all Exec committee members to complete the

Conflict of Interest Training by 31 May 2018.


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Key

Attendance




Member 03/04/18 10/04/18 17/04/18 24/04/18 1/05/18 8/05/18 15/05/18 29/05/18 05/06/18 12/06/18 19/06/18 26/06/18

Adam Robinson

Bapi Biswas End of

Tenure End of Tenure

Claire Heneghan

Doug Soper

Greg Mitten

Jack Kinsey

Jackie Moran

Jo Debacker

John Caine

Mike Maguire

Paul Kingan H

Peter Gregory H

Rakesh Jaidka

Vikul Mittal

Steve Gross

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Attendees In Attendance For Item 3 – Integrated Care Partnership Item 4 - Estates

Chair - Peter Gregory – GP Executive Lead Adam Robinson – Secondary Care Consultant Anne-Marie Bridge – Administration Officer Doug Soper – Lay Member Claire Heneghan – Chief Nurse Jack Kinsey – GP Executive Lead Jackie Moran - Head of Quality, Performance and Contracting Jo DeBacker – Practice Manager John Caine – Chair Mike Maguire – Chief Officer Nicola Baxter – Head of Medicines Management Paul Kingan – Chief Finance Officer Rakesh Jaidka – GP Executive Lead Stephen Gross – Lay Member Vikul Mittal – GP Executive Lead Lucinda McArthur – Senior Advisor George Hurst – Estates Lead


Greg Mitten – Lay Member


The Chair reminded committee members of their obligation to declare any interest they may have on any issues arising at Clinical Executive Committee meetings which might conflict with the business of NHS West Lancashire Clinical Commissioning Group. Declarations declared by governing body members are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the governing body or the CCG website at the following link: Declaration of Interest


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Declarations of interest from sub committees: None declared. Declarations of interest from today’s meeting: GP Execs Peter Gregory, Vikul Mittal, Rakesh Jaidka declared an interest in Item 3 Integrated Care Partnership due to being Directors of OWLs. The Chair was passed to Mike Maguire to make a decision. The Chair deemed this significant not fundamental as this item is only for discussion at this stage. Mike Maguire also declared an interested in Item 3 due to the potential changes to his employment role and passed the Chair to Jack Kinsey. The Chair deemed this significant not fundamental as this item is only for discussion at this stage. GP Execs Peter Gregory, Vikul Mittal, Rakesh Jaidka declared an interest in Item 4 Estates due to their individual practices moving into the new premises under discussion. The Chair was passed to Mike Maguire. The Chair deemed this significant not fundamental as this item is only for discussion at this stage.


Item 3 – Integrated Care Partnership

The Chair was passed to Mike Maguire who also declared an interest in this item, therefore the Chair was passed to Jack Kinsey. Following on from a recent board development session, Mike explained to the group that he had asked Lucinda McArthur to write a paper and lead a discussion around an Integrated Care Partnership (ICP). Lucinda started the discussion by handing out a question sheet and a deck of words. The question sheet asked the exec for their vision for a West Lancashire Integrated Care Partnership and their Top 3 underpinning behaviours in a West Lancashire Integrated Care Partnership. She also asked them to choose 3 words that described their top 3 priorities from a personal perspective. She explained that shew would collate their responses to examine the similarities.

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Lucinda then gave a presentation which focused around a place-based approach. The presentation highlighted how an ICP could be developed within West Lancashire as the ongoing development of neighbours and partnership working was already underway. It also highlighted how the culture of trust and other key behaviours among partners would need to be challenged to bring about a collectively driven partnership with no one body being responsible. A lengthy discussion followed the presentation with many of the committee thinking that it was a positive and mature outlook of how to move forward. The discussion did highlight the need to work more collaboratively with existing partners and identifying new ones. They also discussed how there is need to work with the acute trust to encourage sharing the vision. Lucinda was asked to begin the work to flesh out the practical steps needed to operationalise the proposals in the paper. The Chair was passed back to Peter Gregory.

Item 4 – Estates The Chair was passed to Mike Maguire. George Hurst attended the meeting to present an update on the status of the estates strategy. George gave an over of the progress around Ormskirk and that this is moving forward. The progress in Skelmersdale is still dependent on the movement of GP practices and the future of the current health centres. A consultation should take place as to gather the views of the public and GPs. There is a neighbourhood meeting taking place on Thursday 3 May 2018 and it was suggested that George attend to gather comments from the GPs present. A Birleywood project team has been set up and they will start to work through the proposals for this centre. Design teams have been appointed to the work on the redesign of both Burscough and Tarleton health centres.

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The PID is near completion and George will return to the committee later in May 2018 for approval of this before submission. The Chair was passed back to Peter Gregory.

E-meeting

Item 8 - Notes from Previous Meeting

The notes from the 24 April 2018 were agreed as correct record.


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WEST LANCASHIRE COMMUNITY SAFETY PARTNERSHIP HELD: 24th January 2018 Commenced: 6.00 pm Finished: 7.45 pm

PRESENT: Heidi McDougall - WLBC (CSP Chair) Andrew Hill - WLBC Cliff Owens - WLBC Steve Mahon - WLBC Inspector June Chessell - Lancashire Constabulary Rebecca Eckersley - Lancashire Constabulary Bill Hancox - Edge Hill University Matt Hamer - Lancashire Fire and Rescue Michele Dacre - Cumbria and Lancashire CRC Alex Carver - Lancashire Wellbeing Service Neal Atkinson - Lancashire Wellbeing Service Conrad Jones - EHSU Abdul Kheratkar - LCC Elizabeth-Anne Broad - Lancashire Magistrates Bench Fay Sherrington - EHU Councillor Wright - WLBC Councillor Furey - WLBC Steff Hull - OPCC Tim Grose - Children and Family Wellbeing Service Gwen Bleasdale - Liberty Centre Martin Dillon - LF&RS 1. APPOINTMENT OF NEW WLCSP CHAIRPERSON

Andrew Hill opened the meeting by requesting that thanks be noted to the retired Chairman of the CSP, Dave Tilleray for his contribution to the Partnership over the past six years. Andrew noted that Dave received a Divisional Commanders Commendation from Lancashire Constabulary and a letter thanking him for his contribution to community safety from Lancashire Fire and Rescue Service. Andrew Hill advised the Partnership that the CSP had received one nomination for the role of Chairperson and as such asked the Partnership to dispense with the proposed vote and endorse Heidi McDougall, WLBC's director of Leisure and Environment as the new Chairperson. Heidi provided a comprehensive overview of her extensive experience working in different areas of local government and in depth knowledge of community safety issues. Heidi's nomination as the new Chairperson for West Lancashire CSP was endorsed by all members of the CSP, present at the meeting.

2. WELCOME AND INTRODUCTIONS

The Chairperson welcomed colleagues to the meeting and introductions were made. 3. APOLOGIES

Apologies for absence were received from:

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C.I. Jill Halliwell, Lisa Sloan, Greg Mitten, Kathryn Kavanagh, Gareth Dykes, Alan Carr

4. MINUTES OF LAST MEETING/MATTERS ARISING

The minutes of the last meeting were agreed as a true and accurate record. Andrew advised that in relation to item 9 on Welcome Week, he had recently attended the Edge Hill Forum meeting were the CSP were thanked for the delivery of the successful multi-agency Welcome Week plan.

5. PERFORMANCE MONITORING

The Chairperson, Heidi McDougall, invited partner agencies to provide a verbal overview of current performance.

Performance updates were received from Inspector June Chessell, Lancashire Constabulary, Steve Mahon, ASB Team, Matt Hamer, Lancashire Fire and Rescue, Gwen Bleasdale, Liberty Centre and Alex Carver, LWBS. Discover Drug and Alcohol Services provided performance information only. No exception reporting issues were raised and copies of the performance data were contained in members meeting packs. It was noted in the report received from Inspector Chessell that a lot of proactive work has been undertaken in response to cross border crime and high value burglaries and thefts of high value cars. This has led to a significant decline in this category of offences in West Lancashire and arrests have been against offenders who have been operating across the North West and this will lead to detecting up to 18 offences in West Lancashire. Proactive work continues to be carried out with crime prevention information provided to residents with high value cars.

Councillor Furey raised for discussion the ongoing issue of ASB in and around the Concourse and particularly at McDonalds. It was noted that the Concourse Management Team have been proactive in helping to address ASB issues but McDonalds does not engage as well. ASB at this location is indicative of a national issue with young people congregating near McDonald's outlets, encouraged by free Wi-Fi. Inspector Chessell confirmed that the police continue to monitor and take action as and when appropriate and Rebecca Eckersley advised that at a County level this issue continues to be monitored.

It was further noted that the introduction of new and changing formats for categorising crime is leading to more crime being recorded while overall crime in the borough feels quite low. Gwen Bleasdale advised that she was not confident with regards to the stats presented through the Liberty Centre and would review the figures and format with her team. In addition to the performance information received from Lancashire Wellbeing Service, Neal Atkinson provided a brief update on the Social Return on Investment project recently undertaken with NEF Consulting which highlighted that for every £1 invested in the LWBS, £7 of value is created.

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Councillor Furey raised for the attention of the group a recent consultation document sent to WLBC regarding proposals to close further Magistrates Courts, including Chorley Magistrates Court. He advised this could have a detrimental impact on West Lancashire services and residents. It was agreed that Cliff would share a copy of the consultation document with the Partnership and individual agencies could respond as appropriate.

The Chair thanked colleagues for providing an update against their performance information.

6. CSP FUNDING UPDATE

Andrew Hill provided the Partnership with an update against the CSP’s funding allocation for 2017/18. Andrew provided a breakdown of the allocation to date advising that of the £10,000 available from the OPCC, the CSP has spent its full allocation and commissioned a number of initiatives including Freedom Personal Safety (£5,183), the World Café event (£950) and a community engagement initiative delivered by the Children and Family Wellbeing Service (£1,250) to support the Bright Sparx plan. Further initiatives funded by the CSP include £2,000 towards Fresher's, £3,000 for the Go4It Event and 12 Community Action and Engagement events. Andrew advised the Partnership that a copy of the CSP Funding Plan was contained in members meeting packs.

7. WEST LANCASHIRE INTEGRATED WORKING TEAM PILOT

Tim Grose provided the CSP with an update regarding the development of the Integrated Working Team in West Lancashire. Tim advised that a training event for staff is scheduled for 9th February and this is currently being promoted on behalf of the CSP by Cliff Owens. The IWT will be made up of multi-agency professionals who will work together to jointly deliver an early help response. The Integrated team will be based at the Youth Zone in Skelmersdale and will work across the borough, jointly allocating and sharing information on cases where their pooled effort and skills/expertise will benefit service users. The team will include professionals from: CFWS (Key Workers), Police Early Action Officers, the local Council, Lancashire Fire and Rescue and the Integrated (Adult) Wellbeing Service together with other identified local services.

8. NEMESIS

Inspector June Chessell provided the Partnership with an overview of the current issues relating to Operation Nemesis. The main focus is Skelmersdale which continues to suffer from cross county class A drug activity which is almost exclusively driven from Merseyside. The tactic employed by these OCGs is to send young males into Skelmersdale to supply the local drug users and the males will often stay in Skelmersdale for days at a time. It is difficult to tie them to known OCGs, even when arrested and the risk posed, other than the obvious effects of class A drug use, is normally low. However, historically they have been prepared to resort to violence to maintain a grip on the drug market in Skelmersdale. There are often two or even three separate groups operating in Skelmersdale at any time.

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There are also local OCGs operating in Skelmersdale, made up of individuals who are resident in the town. The current picture is that they tend to be less high profile than Merseyside groups, but they frequently become embroiled in ‘turf wars’ with groups from out of the area. The risk then is obviously much escalated and the Police will focus on preventative work to stop these issues before they happen. As a commitment to address the issues posed by these groups, Operation Nemesis staff continue to be dedicated to targeting and disrupting OCGs operating in West Lancashire. Inspector Chessell emphasised the continued excellent partnership working in dealing with serious and organised crime and provided an overview of successful outcomes achieved by the Nemesis Team.

9. BRIGHT SPARX DRAFT EVALUATION

Cliff Owens advised the Partnership that the Bright Sparx plan is one of the best examples of multi-agency working in West Lancashire. It deals with a very real threat to community safety and involves valued engagement from all statutory partners. The raw data collected to inform the 2017 evaluation shows the plan was very successful and Cliff proceeded by providing an overview of key highlights including: -

• 500 people attended the excellent 2 day GO4IT Event

• Fire and Rescue were not required to attend a single ASB fire during the Go4It Event.

• Very effective pre-emptive work carried out by the police before mischief night – visiting 36 identified nominals and delivering the message that bad behaviour will not be tolerated.

• 150 tons of combustible materials removed during the Community Action Days and Community Payback Offenders carried out 105 hours of community service.

• Enhanced services provided by the Council's Street Scene Team over the bonfire weekend and all debris cleared within 4 days following bonfire night.

• The number of arsons in October and November was down by 54% compared with 2016 and ASB was lower than expected.

Cliff advised that the data has been shared with Rebecca who will produce an objective evaluation report which will inform the 2018 Bright Sparx plan.

10. DOMESTIC ABUSE SERVICES PROVIDED BY THE LIBERTY CENTRE

Gwen Bleasdale provided the Partnership with an overview of services provided by the Liberty Centre which include: -

• A confidential personal service for families experiencing domestic violence & abuse providing emotional & practical support.

• Short term temporary emergency accommodation for women & their children who have suffered from domestic violence.

• Children & Young People Support while living in refuge

• Outreach and settlement Worker for those families who are being rehoused.

• Confidential Counselling and advocacy service for people who have suffered from domestic violence.

• Group Recovery Programme

• 24 Hour Emergency Telephone Helpline

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Gwen advised the Partnership that a key priority for the Liberty Centre is that no victim slips through the net. Gwen highlighted the importance of promoting the service and joint initiatives including the 'Don't Be a Bystander' campaign developed in partnership with the Community Safety Team and Edge Hill Students Union. Further work to develop and promote this campaign will take place once the Safe Teens Project Worker is in place. Gwen advised that partnership working is of critical importance to the Liberty Centre and the relaunch of the West Lancashire Domestic Abuse forum will build on existing positive partnership working in the borough.

11. LANCASHIRE HATE CRIME STRATEGY

Andrew Hill provided the Partnership with an update against the Lancashire Hate Crime Strategy and referred members to the copy of the West Lancashire 'Hate Crime Plan on a Page' which the Partnership was asked to endorse. Andrew advised that the Hate Crime strategy has been approved by the Lancashire Public Service Board and links with the wider Safer Lancashire Community Safety Agreement and sets out how we will work together to address the Hate Crime priorities for Lancashire. Andrew advised that whilst hate crime reported figures are generally low, this is not necessarily perceived as a good indicator, with the recognised potential for underreporting. This is being addressed through the development of third party reporting centres to make it easier for people for reporting hate crime. Andrew continued by providing a definition of Hate Crime which was included within the West Lancashire 'Hate Crime Plan on a Page', produced by Rebecca Eckersley and sent out with the CSP papers. The Partnership agreed to endorse the West Lancashire 'Hate Crime Plan on a Page'.

12. MODERN SLAVERY EVENT

Steff Hull advised that the Office of the Police and Crime Commissioner has organised a Human Trafficking and Modern Day Slavery Training Session on Tuesday 6th March at the Evermoor HUB, Skelmersdale. The event will be delivered by Hope for Justice, a national Charity which seeks to end modern day slavery. Steff advised that the event will enable attendees to improve their understanding of Modern Slavery and recognise the signs and what to do if they suspect that someone is a victim. Steff highlighted the importance of key frontline practitioners being trained across Lancashire in order to ensure victims get the best possible support and that where possible, perpetrators are brought to justice.

13. STRATEGIC ASSESSMENT PROCESS 2018

Rebecca Eckersley provided an overview of the Strategic Assessment process and advised that invitations have been sent to CSP leads for attendance at the Pan-Lancashire conference, which will be followed by a series of local workshops to develop local ideas and inputs into process.

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This event will present current findings from the recent partnership intelligence assessments and JSNA work. There will be a series of short workshop sessions in which the team will be seeking ideas and views, along with local requirements for the forthcoming strategic assessment district profiles. The current schedule will involve local district profiles being presented around June 2018 as part of the consultation process with a draft Lancashire plan ready by September 2018. The Strategic Assessment finalised document will inform local CSP Plans scheduled for refresh by April 2019.

14. ANY OTHER BUSINESS

Councillor Wright advised the Partnership that the Lancashire PCC Panel met to consider the budget for Lancashire Constabulary. Councillor Wright provided an overview of savings that have had to be made by the Police and Crime Commissioner and advised that as we enter 2018/19 the Constabulary have identified £84.6m of savings that will take them to the end of 2021/22 with an extra £18m still to find. The panel have taken the decision to increase the council tax precept this year by £12 for a Band D property after more than 78 per cent of residents consulted responded they were willing to pay more for the police through this local payment. The increase is equivalent to 23p per week for the average band D property in Lancashire, but it will raise an extra £5.11m to help offset the financial pressures the Constabulary will face this year. Steff Hull confirmed to the Partnership that there will be no change to funding provided for the CSP's for 2018/19. Councillor Furey raised for discussion the Tawd Valley Park masterplan and the need to ensure consultation takes place with the Council and Police to address underlying concerns regarding ASB at this location and its possible impact on the project. Cliff agreed to discuss Councillor Furey's concerns with the Council's Leisure Team and would, if required, ensure appropriate links were made with Leisure and the Police. It was noted that this was Matt Hamer's last CSP meeting as he was changing roles within Lancashire Fire and Rescue with Martin Dillon taking over as the Local Service Delivery Manager for West Lancashire. On behalf of the Chair, Andrew thanked Matt for his work in West Lancashire and his valued contribution to the CSP.

15. DATE OF NEXT MEETING

The next meeting of the West Lancashire CSP will be held on 9.30AM at the

Evermoor Hub, 1 Birleywood, Skelmersdale WN8 9HR on Wednesday the

18th April 2018.