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DUDLEY CLINICAL COMMISSIONING GROUP

PUBLIC AGENDA

Thursday, 10 May 2018

1.00pm – 4.30pm Boardroom, 3rd Floor, Brierley Hill Health & Social Care Centre,

Venture Way, DY5 1RU

QUORACY Meetings of the governing body will be quorate when four elected GP clinical members and two other governing body members (one from the lay members or secondary care doctor and one from the Chief Executive Officer, Chief Operating and Finance Officer or Chief Nurse are present, (provided that if the Chair is not present, then either the Chief Executive Officer or Chief Operating and Finance Officer must be present).

Agenda Item Attachment Presented By

1.00pm 1. Apologies

1.00pm

2. Declarations of Interest 2.1 To request members to disclose any interest they have, direct or indirect, in any items to be

considered during the course of the meeting and to note that those members declaring an interest would not be allowed to take part in the consideration for discussion or vote on any questions relating to that item. (Enclosed)

2.2 This meeting will be held in public and will be recorded purely as an aide memoir for the minute taker to ensure an accurate transcript of the meeting, decisions and actions. Once the minutes have been approved the recording will be destroyed. All care is taken to maintain your privacy; however, as a visitor in the public gallery, your presence may be recorded. Should you contribute to the meeting during questions from the public, you agree to being recorded.

1.05pm 3. Minutes

3.1 Minutes from Board held on 8 March and the 29 March 2018 3.2 Matters Arising

Enclosed Enclosed

Mr S Wellings Mr S Wellings

1.10pm 1.15pm 1.25pm

4. Public Voice 4.1 Questions from the Public To respond to questions from members of the public received

prior to the Board, in writing, on the provision of health care to the population served by the CCG.

4.2 Feet on the Street: Urgent Treatment Centre at Russell’s Hall Hospital 4.3 Public Update

Verbal Presentation

Enclosed

Mrs J Jasper Mrs L Broster

Mrs L Broster

1.35pm 5. Chairman & Chief Executive Officer Report Verbal Mr P Maubach

1.45pm 1.55pm 2.05pm

6. Strategy 6.1 Report from the Partnership Board 6.2 Corporate Objectives 2018/19 6.3 Black Country Joint Commissioning Committee Assurance

Reports and Minutes

Enclosed Enclosed Enclosed

Dr C Handy Mr P Maubach Mr P Maubach

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Time Agenda Item Attachment Presented By 2.15pm

7. Quality & Safety 7.1 Quality and Safety Committee Report

Enclosed

Mrs C Brunt

2.25pm 2.35pm 2.45pm 2.55pm 3.05pm

8. Governance 8.1 Report from Audit & Governance Committee (Including

Committee Annual Report) 8.2 Risk Register and Board Assurance Framework 8.3 Statement of Disclosure to Auditors 8.4 Report from Remuneration & HR Committee 8.5 Stakeholder Survey Feedback

Enclosed Enclosed Enclosed Enclosed Enclosed

Mrs J Jasper Mrs J Jasper Mr M Hartland Mrs S Cartwright Mrs S Cartwright

BREAK

3.20pm

9. Finance, Performance and Business Intelligence 9.1 Report from Finance, Performance & Business Intelligence Committee

Enclosed

Dr R Tapparo

3.30pm 3.40pm 3.50pm 4.00pm

10. Acute & Community Commissioning 10.1 Commissioning Development Committee Report 10.2 Health & Wellbeing Board Report 10.3 Integrated Commissioning Executive Report 10.4 MCP Procurement Process - Progress Report

Enclosed Enclosed Enclosed Enclosed

Dr J Darby Mr N Bucktin Mr N Bucktin Mr N Bucktin

4.10pm

11. Primary Care Commissioning 11.1 Report from Primary Care Commissioning Committee

Enclosed

Mrs C Brunt

4.20pm 12. Reflection Time

4.25pm

13. Exclusion of the Press and Public That under the Public Bodies (Admission to Meetings) Act 1960, the public and representatives of

the press and broadcast media be excluded from the meeting during the consideration of the following items of business as publicity would be prejudicial to the public interest because of the confidential nature of the business to be transacted.

14. Date and Time of Next Meeting

Thursday 12 July 2018 1pm – 4pm 3rd Floor Boardroom, Brierley Hill Health and Social Care Centre

A Glossary of terms is included at the end of the papers

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Title First Name Surname Job Title Declarations of Interest

Mrs Laura Broster Director of Communications & Public Insight Director of Shrops Hire Solutions Ltd

Mrs Caroline Brunt Chief Nurse None

Mr Neill Bucktin Director of Commissioning

Chairman of the Corporation, Heart of Worcestershire College (A general further education college which provides services for young people with special educational needs and disabilities of the sort commissioned from time to time by the CCG.) Member of Managers in Partnership Director - North East Worcestershire Enterprises Ltd.

Mrs Stephanie Cartwright Director of Organisational Development & Human Resources

In a personal relationship with Chief Executive Officer

Dr Jonathan Darby Clinical Executive for Acute & Community Commissioning

Salaried GP at St Margaret’s Well Surgery BBC Drama, Birmingham Director Manor Abbey Investments Non-Executive Director for the Royal Wolverhampton Hospitals NHS Trust Shareholder, Future Proof Health Limited (via practice shareholding)

Dr Ruth Edwards

Board Member Kingswinford, Amblecote & Brierley Hill Locality / Clinical Executive for Quality & Safety

GP Partner - AW Surgeries Shareholder, Future Proof Health Limited (via practice shareholding)

Ms Jayne Emery Chief Officer of Dudley Healthwatch None

Dr Richard Gee GP Engagement Lead Appointed member of Dudley Group Foundation Trust Council of Governors

Dr Purshotam Das Gupta Board Member Dudley &

Netherton Locality

GP Partner at Links Medical Practice Member of Labour Party Shareholder, Future Proof Health Limited (via practice shareholding)

Dr Christopher Handy Lay Member for Quality & Safety

Chief Executive, Accord Group Visiting Professor at Birmingham City University Board Member of: - Black Country LEP Board - Matrix - Redditch Co-operative Homes - Black Country Consortium - Walsall Housing Regeneration Agency - Direct Health - Eurohnet

Mrs Deborah Harkins Chief Officer for Health & Wellbeing (Director of Public Health)

None

Mr Matthew Hartland Chief Operating & Finance Officer

Director of Dudley Infracare Lift LTD Director of Whitbrook Management Company Member of Chartered Institute of Public Finance and Accountancy Interim Chief Strategic Finance Officer, Walsall CCG Interim Chief Strategic Finance Officer, Wolverhampton CCG

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Title First Name Surname Job Title Declarations of Interest

Dr David Hegarty CCG Chair / Board Member Stourbridge, Wollescote & Lye Locality

GP Partner - Wychbury Medical Group Chairman of Black Country STP Clinical Leadership Group Partner is Director of Strategy at Worcestershire CCG Shareholder, Future Proof Health Limited (via practice shareholding) Shareholder with D C Corporation Ltd Council member- West Midlands Clinical Senate Member of LMC Member of BMA

Dr Tim Horsburgh Clinical Executive for Primary Care & LMC Representative

Sessional GP - Netherton Health Centre. Member of the Local Medical Committee Clinical Lead for Partners in Paediatrics

Mrs Julie Jasper Lay Member – Patient & Public Involvement

Lay Member - Sandwell and West Birmingham CCG Managing Director of Westland’s Associates Ltd Member of CIPFA

Ms Sue Johnson Deputy Chief Finance Officer None

Mr Daniel King Director of Membership Development & Primary Care None

Dr Rebecca Lewis Board Member Halesowen & Quarry Bank Locality

GP Partner – Feldon Practice Surgery Shareholder, Future Proof Health Limited (via practice shareholding)

Dr Mohit Mandiratta Board Member Halesowen & Quarry Bank Locality Salaried GP at Feldon Road Practice

Dr Steve Mann Board Member Stourbridge, Wollescote & Lye Locality / Clinical Executive for MCP

GP Partner - Lion Health. Sister provides the Paediatric Triage Service Shareholder, Future Proof Health Limited (via practice shareholding)

Mr Paul Maubach Chief Executive Officer

Member of Dudley Health & Wellbeing Board Member of CIPFA Member of Managers in Partnership In a personal relationship with Director of OD & HR Interim Chief Executive Officer, Walsall CCG

Dr Kiranmaya Penumaka GP Board Member, Dudley & Netherton Locality GP Partner – Quarry Bank Medical Practice

Dr Matthew Read Board Member Sedgley, Coseley & Gornal

GP Woodsetton Medical Practice Shareholder, Future Proof Health Limited (via practice shareholding)

Dr Fiona Rose Board Member Sedgley, Coseley & Gornal

GP Castle Meadows Surgery Providing Educational Support to Effective Consulting Ltd on a consultancy basis Husband works for Birmingham City Council via Service Birmingham IT.

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Title First Name Surname Job Title Declarations of Interest

Dr Ruth Tapparo GP Board Member and Clinical Executive Finance, Performance & Business Intelligence

GP Partner - Three Villages Medical Practice Shareholder, Future Proof Health Limited (via practice shareholding)

Mr Steve Wellings Lay Member - Governance

Wife employed by Dudley MBC Housing Department One Niece employed by DGFT as a nurse Member of CIPFA

Updated 18/04/2018

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD PUBLIC MINUTES

MINUTES OF THE MEETING HELD IN PUBLIC ON THURSDAY 8 MARCH 2018

AT BRIERLEY HILL HEALTH AND SOCIAL CARE CENTRE Members: Mr S Wellings Lay Member for Governance/Vice Chair – Dudley CCG (Vice Chair) Mrs C Brunt Chief Nurse – Dudley CCG Dr R Edwards Clinical Executive – Dudley CCG Dr P D Gupta GP Board Member – Dudley CCG Prof C Handy Lay Member for Quality and Safety – Dudley CCG Mr M Hartland Chief Operating and Finance Officer – Dudley CCG Dr T Horsburgh Clinical Executive – Dudley CCG (LMC Representative) * Mrs J Jasper Lay Member for Patient and Public Engagement – Dudley CCG Dr R Lewis GP Board Member – Dudley CCG Dr M Read GP Board Member – Dudley CCG Dr F Rose GP Board Member – Dudley CCG Dr R Tapparo Clinical Executive – Dudley CCG Non-Voting Members: Mr M Bowsher Chief Officer/Deputy Director Adult Social Care – Dudley MBC Mrs L Broster Director of Communications and Public Insight – Dudley CCG Mr N Bucktin Director of Commissioning – Dudley CCG Mrs S Cartwright Director of Organisational Development and Human Resources – Dudley CCG Ms J Emery Chief Executive – Healthwatch Ms K Jackson Deputy Director of Public Health – Dudley MBC (for Ms D Harkins) Mr D King Director of Membership Development and Primary Care – Dudley CCG * Dr Horsburgh is also the LMC representative on the Board which is a non-voting role. In Attendance: Dr R Gee GP Engagement Lead – Dudley CCG Mrs E Smith Governance Support Manager – Dudley CCG Minute Taker: Ms C Flavell PA to Chief Finance and Operating Officer – Dudley CCG CCG022/2018 APOLOGIES Apologies were received from: Dr J Darby Clinical Executive – Dudley CCG Dr D Hegarty Chair and GP Board Member – Dudley CCG Ms D Harkins Chief Officer, Health and Wellbeing (Director of Public Health) – Dudley MBC Ms S Johnson Deputy Chief Finance Officer – Dudley CCG Dr M Mandiratta GP Board Member – Dudley CCG Dr S Mann Clinical Executive – Dudley CCG Mr P Maubach Chief Executive Officer – Dudley CCG

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CCG023/2018 DECLARATIONS OF INTEREST Members were asked to disclose any interest they may have, direct or indirect, in any of the items to be considered during the course of the meeting and to note that those Members declaring an interest would not be allowed to take part in the consideration or discussion or vote on any questions relating to that item. In addition to the declarations included in the agenda, Dr Rose had notified Mrs Smith of changes to her declaration last month and this would be reflected in the next agenda, and Mrs Jasper declared an interest in item 6.3 the Black Country Commissioning Committee assurance report. Mrs Jasper also confirmed her declaration as a Lay Member on the Sandwell and West Birmingham CCG Board. CCG024/2018 MINUTES FROM BOARD HELD ON 11 JANUARY 2018 The minutes of the Board meeting held on 11 January 2018 were accepted as a true and accurate record. Resolved: 1) The Board accepted the minutes from 11 January 2018 as a true and accurate record. CCG025/2018 MATTERS ARISING CCG009/2018 Report from Partnership Board The Partnership Board attendance schedule for the last 12 months had been produced, however, it had not been circulated as it wasyet to be shared with the Partnership Board. A copy was available from Mrs Cartwright if required. This action was closed. CCG014/2018 Risk Register and Board Assurance Framework (BAF) Risk 112 had been developed and was included in the BAF report on the agenda. This action was closed. CCG05/2018 Staff Transfer The staff would transfer from the Local Authority to the CCG on 1 April 2018. The Board thanked Ms Harkins for her help in resolving this issue and the action was closed. CCG20/2018 EMIS/IT Issues Mrs Brunt had raised with Mr Corner the risk associated with EMIS and the impact in primary care. At its next meeting the IT Strategy Sub-Committee would be discussing the creation of a risk around this, which would be added to the corporate risk register. The IT team had also raised the issues identified with EMIS. The IT Strategy Sub-Committee reports to the Finance, Performance and Business Intelligence Committee which had oversight of the issues. This action was closed. Resolved:

1) The Board noted the updates to all the Matters Outstanding

PUBLIC VOICE CCG026/2018 QUESTIONS FROM THE PUBLIC Questions to the Board from the public were tabled. Question asked: As prostate cancer deaths are now exceeding breast cancer deaths I strongly ask that the CCG should start a publicity campaign via local newspapers, media, GP screens, etc. The campaign should recommend all men over a certain age with any urinary irregularities to arrange a PSA test with their GPs. Response provided by Mrs Laura Broster, Director of Communications and Patient Insight Prostate cancer deaths are now exceeding breast cancer deaths nationally. However, although deaths from prostate cancer have been rising over the past few years, the mortality rate or the proportion of men dying from the disease has fallen by 6% between 2010 and 2015. In Dudley I can confirm that the current prostate cancer rate is below the national average (Dudley: 169 per 100,000 compared national 1:76 per 100,000. With regards to a campaign, this is the responsibility of Public Health England (PHE) who plan each year for the national cancer campaigns. PHE have confirmed that they are planning two Be Clear on Cancer Campaigns for 2018/19. The types of cancer have not yet been confirmed.

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Once we are aware what the national plans are we will work with Dudley Public Health colleagues to decide the best route for Dudley promotion. The national screening committee’s advice is essentially to say that, at present, we simply don’t have a good enough test to reliably screen the population for prostate. Rolling out PSA screening has challenges too, with many believing that this could result in just as much harm to people who either don’t have cancer or who have a very slow growing form of the disease as the amount of benefit to people found to have the disease. That said, there is always a place for promoting people to visit their GP if they have lower urinary tract symptoms and to discuss options for investigation of those symptoms. The challenges with the PSA the test were briefly discussed, though this was not to discourage patients from visiting their GP. The message therefore continued to be that patients experiencing any symptoms should arrange to see their GP. It was noted that the Prostate Cancer UK website offered a balance view on the usefulness of the PSA test and this would be used in any local publicity campaign. Question asked: In the light of the outcry about the inherent dangers of accountable care organisations (ACOs) and Jeremy Hunt having to await the outcome of public consultation conceding that he would not ‘lay down’ statutory (secondary) legislation and the NHS Chief Executive Simon Stevens making it clear he wants STPs to overcome the ‘veto power’ of hospital trusts and local CCGs. Is there any evidence in the Dudley CCG scenario that supporting STP measures: 1. Might be against local interests – if, for example, a hospital closure means patients have to travel

further? 2. Will privatisation of elements of care or treatment undermine other NHS provision? 3. Cause widespread public concern in Dudley that as the partnerships function in secret and do not

publish minutes – STPs offer no democratic accountability? 4. As STPs lack any legal status or power to compel Dudley CCG or other ‘partners’ to comply with

majority STP board decisions does this mean that Dudley council, Dudley CCG and partners who have acquiesced in STP plans so far will be reformulating to resist the combined power of STPs to drive through unpopular cuts, reconfiguration and service changes?

5. What form would this reformulation take in Dudley?

The written response was provided by Mr Maubach. This would be discussed later in the meeting when Mr Maubach joined the meeting. The Black Country STP has no statutory decision making powers as it is a partnership between the 4 Councils, 4 CCGs and provider organisations. It is not a separate legal entity. So any decisions about NHS services in Dudley for Dudley people will be made by the Dudley CCG Governing Body, which meets in public. However, the Black Country STP partnership does enable collaboration across the Black Country where Dudley people might need to go to access care. It can share expertise and ideas about how to improve services, and it can assist in understanding how decisions in neighbouring boroughs might impact on Dudley people. Resolved: 1) The Board received questions from the public. CCG027/2018 FEET ON THE STREET Mrs Broster reported that the filming has not been completed in time for the meeting given the delay in the opening of the urgent treatment centre and the adverse weather conditions which had prevented the crew from getting to the site. Filming had, however, been completed the previous day where positive feedback had been received from both service users and clinicians about the benefit of the facility. The video would be shown at the May meeting. Resolved: 1) The video on the Urgent Treatment Centre to be shown at the May meeting.

CCG028/2018 PUBLIC UPDATE Mrs Broster spoke to this item highlighting that the main area of public interest was the proposal around the application from Stourside Medical Practice to close both branch surgeries at Tenlands Road and

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Coombswood. The CCG had been informed that a 600 signature petition was due to have been posted during the consultation period which closed on Monday, 5 March 2018, however, the petition had not been received and it was suggested that it may be presented in person at the Primary Care Commissioning Committee (PCCC) on 23 March. Mrs Broster highlighted that there had been a lot of media coverage since the beginning of the year, with a significant proportion of this attributed to the negative coverage relating to the criminal trial of a Dudley GP. Ms Emery noted that the first MCP People’s Network had taken place the previous evening and was well attended. She and her colleagues would be attending a variety of forums to capture conversations around the MCP and provide an independent report on these. Dr Lewis highlighted the impact of the closures on surrounding practices, including her own, noting that some patients were already choosing to register with other practices. Although her practice had not responded formally to the consultation, her comment would be noted. The Primary Care Operational Group (PCOG), at its meeting the previous day, considered the implications of the practice proposal and would be making a recommendation to the PCCC on 16 March 2018. It was noted that the final decision rested with that Committee. The PCCC would consider the rationale for the branch closures and the impact on the patients and the public as identified during the consultation. From the CCG’s perspective as well as the impact on patients and the public, the sustainability of the configuration of the practices would also be a consideration. Moving forward Mrs Broster proposed a more open conversation with the public about the sustainability of primary care across Dudley as a totality. It was commented that the debate would need to be led by the primary care operating model as defined by the MCP and not the infrastructure of the current buildings. The idea of a healthcare forum or larger public event on this was supported. Resolved: 1) The Board received the report for assurance CHAIRMAN AND CHIEF EXECUTIVE OFFICER REPORT CCG029/2018 REPORT Mr Wellings spoke to the Chairman and Chief Executive’s Briefing, which was tabled. Dr Ruth Edwards and Dr Ruth Tapparo were congratulated on their re-election as Board members and it was noted that nominations for the election of the CCG Chair would be circulated shortly. Recent and Upcoming Events Joint Consultative Executive Away Day The development session with the Black Country management teams reviewed where collaborative working had been successful and also the barriers to this. The session noted that the amount of collaborative work already being undertaken was positive. NHS England (NHSE) had also produced a document which identified that further collaborative work was required across the Black Country STP. Vanguard Conference Unfortunately, due to the adverse weather conditions the previous week the Vanguard Conference had been cancelled and would be rearranged in June. King’s Fund In February, Mr Bucktin and Mrs Cartwright gave a presentation at the King’s Fund on the development of the new model of care. This went very well and the King’s Fund would be visiting Dudley on 14 March to look at the development of integrated care systems. Ministry of Health in Vancouver In February 2018 Mrs Cartwright presented to the Ministry of Health via video link on the new care model and in particular the development of primary care in an MCP. This was the first request from an international organisation.

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Visitors In January 2018 the CCG welcomed Professor Steve Field, Chairman of the Care Quality Commission (CQC) and Mr Ed Scully, Deputy Director of General Practice at the Department of Health. Mr Michael Macdonnell, Director of Health System Transformation had also visited to find out more about the work around the MCP and how it could help with the development of national policy. Health Select Committee On Tuesday, 6 March 2018 Mr Maubach, along with representatives from Manchester and Staffordshire attended the Health Select Committee to take questions about the Accountable Care Organisation contract. Winter Pressures Mr Wellings, on behalf of the Board, thanked all those staff who had continued to deliver services to patients during the very difficult weather conditions. The conditions had impacted on the four hour A&E access target at Dudley Group NHS Foundation Trust (DGFT). A Remedial Action Plan was in development with the Trust with the aim of achieving the 95% standard. Oversight Meeting The Care Quality Commission (CQC) had recently inspected DGFT where concerns were raised relating to quality and safety within the Emergency Department. As summarised in the Quality and Safety Report, the areas of concern were paediatrics and safeguarding, sepsis and rescuing the deteriorating patient. Although the focus of the visit was on the Emergency Department, there was concern that the pressures were compounded by flow issues in the hospital. Following the visit, a Dudley System Oversight and Assurance Group met on 22 February. At that meeting the CCG was assured by DGFT’s team that a recovery plan was in place. The meeting was also reported as positive by the regulators. The Board noted that Dudley delayed transfers of care (DTOC) were at their lowest level for a very long time, which was credit to the hard work of the Local Authority and Intermediate Care team. However, there remained an issue in respect of DTOC in neighbouring CCGs. GP Practice Closures On 16 February 2018 the PCCC approved the decision to merge Norton medical practice with Lion Health. Coombswood and Tenlands Road had been discussed earlier in the meeting. Resolved:

1) The Board noted the report for assurance.

STRATEGY CCG030/2018 REPORT FROM PARTNERSHIP BOARD Dr Handy and Mrs Cartwright spoke to this item highlighting the key areas discussed at the Partnership Board on 24 January 2018 and 28 February 2018. The issue of attendance by WMAS at the Partnership Board had been raised with their Trust. In view of demands on the service and the fact their Board met on the same day as the Partnership Board, WMAS had asked if they could be invited to attend to address specific agenda items. It was noted that WMAS had attended the February meeting and their presence was valued particularly as the discussion focussed on system pressures. Their representative took away some actions and agreed to look into specific cases raised by the GPs. The value in WMAS attending every meeting of the Partnership Board regardless of the agenda was recognised. It was, therefore, agreed that the CCG would write to WMAS inviting them to attend each meeting. The Vanguard programme and Value Proposition funding ceased at the end of March 2018 and discussions would continue with the New Care Model Team on a transition strategy, given that the CCG had 12 months in which to deliver the new model of care. The Partnership Board would continue beyond the end of March 2018 and the intention would be to open up attendance to previous CCG attendees. The Board was also keen for Dr Handy to continue as Chair. Resolved: 1) The Board noted the report for assurance

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2) The CCG would write to WMAS inviting them to attend each meeting of the Partnership Board. CCG031/2018 CORPORATE OBJECTIVES 2017/18 Mr Hartland spoke to this item which showed the current status of the CCG’s objectives. However, he believed that a lot of the areas were closer to green than amber and this would be reflected in the year-end report to the May Board. Resolved: 1) The Board noted the report for assurance CCG032/2018 BLACK COUNTRY JOINT COMMISSIONING COMMITTEE (JCC) UPDATE Mr Hartland spoke to this item providing updates from the JCC meetings held in January 2018 and February 2018 and also the revised Terms of Reference for the JCC Governance Group. The Board noted progress against the Transforming Care Partnerships (TCP) Black Country learning disability model. Currently the Black Country was not assured by NHSE based on the rate of progress. A business case for a community model was produced for agreement at the last JCC, but in view of the late circulation of the report the JCC did not feel able to make an informed decision. It did, however, support the principles of the community model, but with further work required on the business case. The original agreement was that that funds would transfer with the patients. However, this process had been halted by NHSE and there was now an expectation that CCGs would accept patients without guaranteed funding to support them. It was therefore important for everyone in the system to take responsibility for their part of the process. Mrs Brunt provided an update from the TCP Board that had taken place that morning where concerns were raised again about future and retrospective funding; the way in which the programme was being managed and the unreasonable data requests which were distracting members of the team away from the clinical priorities. The Board did not feel that NHSE was providing the support needed and Mrs Sarah Norman, Local Authority Chief Executive and Chair of that Board, agreed to write to the national team with the concerns raised. The CCG was participating in a 12-week development programme to support the evolution into integrated care systems. The West Birmingham CCG position in the context of geography and population size was discussed. A revised governance structure had been agreed following the decision by the current STP Chair to step down from the role at the end of June. Three roles had been developed – an independent chair and discussions were continuing whether this should be an Executive or Non-Executive Director; a full-time programme director, which would be a CCG appointed post and the appointment of a Senior Responsible Officer, which could be an existing Chief Executive Officer with a CCG or provider organisation. Appointments were expected to be made by the summer. The CCG had been requested by NHSE to be a national demonstrator site for self-care and personalisation funding, which has been supported by the JCC. The implications of this were currently being worked through. CCGs had challenged the terminology in reports about the decision making authority of the JCC. The last JCC confirmed that CCGs and the JCC could recommend, but could not make decisions that impacted on other CCGs without their prior consent. Dr Horsburgh reported that he and Dr Tapparo had attended an STP clinical leadership team meeting and they were disappointed about the lack of progress from a clinical perspective. Dr Tapparo noted that since that meeting, progress had been made in identifying clinical leads against a range of projects. Resolved: 1) The Board noted the report for assurance QUALITY AND SAFETY CCG033/2018 REPORT FROM QUALITY AND SAFETY COMMITTEE

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Dr Edwards spoke to this item summarising the key issues discussed at the Quality and Safety Committee in January 2018. The CQC had carried out a number of inspections, both announced and unannounced at DGFT. The Trust had been advised by the CQC that the quality of healthcare being delivered by the Trust required significant improvement. As mentioned earlier in the meeting, areas for improvement included the Emergency Department, paediatric services, management of sepsis and rescuing the deteriorating patient. There had been an increase in the number of grade 4 pressure ulcers at DGFT. This was a clinical priority for the Trust and there was an action plan in place to reduce these to zero. There had been a never event which featured a retained object post-surgery. Discussions had taken place with Dudley and Walsall Mental Health Partnership Trust (DWMHPT) on the actions required to achieving the target relating to Improving Access to Psychological Therapies (IAPT) and positive work had also taken place on developing a Suicide Prevention Strategy. Performance issues at Black Country Partnership Foundation Trust (BCPFT) had been discussed between the CCG’s Chief Nurse and the Director of Nursing at the Trust. Key areas raised included staffing, engagement and evidence of learning from events. The Trust agreed to demonstrate commitment to meeting the CCG’s requirements, which would be closely monitored by the CCG. In terms of infection prevention and control, the CCG would end the year below the C.Difficile threshold. While DGFT was expected to breach the threshold by a small number of cases, it was noted that some of the breaches were unavoidable. TCP had been discussed briefly earlier in the meeting. It was noted that the TCP Board had asked NHSE to provide additional scrutiny for 14 patients who had been identified as not suitable for discharge prior to the end of the programme in March 2019. TCP was included in the Quality and Safety Committee risk register. The summary of the latest CQC primary care inspections was noted. This identified that there were no practices subject to special measures and that only one practice was green across all measures. The meeting noted there was a sense that during the re-inspection the CQC was expecting improvement in the areas previously highlighted and not to maintain the status quo. Mrs Brunt updated on the visits to Pedmore Medical Practice and Castle Meadows surgery. Pedmore had been rated as good and the focussed visit to Castle Meadows on two domains had identified both as requiring improvement. The Waterfront Surgery was noted as requiring improvement. The practice had appointed a new Practice Manager who was focussed on the failures in the CQC report. It was hoped that her focus would produce better inspection results next time. The Quality and Safety team would continue to provide targeted support on specific issues, but ultimately it was the practice’s responsibility. Mr Hartland noted that in 2016/17 Ramsay healthcare were identified as requiring improvement and Mrs Brunt understood that this remained their current status. Resolved: 1) The Board received the report for assurance GOVERNANCE CCG034/2018 REPORT FROM AUDIT AND GOVERNANCE COMMITTEE Mrs Jasper spoke to this item, highlighting the key areas that were considered at the Audit and Governance Committee on 8 February 2018. The items received for assurance were the information governance (IG) performance report; the Board Assurance Framework (BAF) and Risk Register; progress on the Annual Report and Accounts; external audit plan progress report; internal audit progress report; anti-fraud progress report, update on National Audit Office Cyber Security, and Information Risk and Conflict of Interest on-line training to be completed by 31 May 2018. The Board noted that an internal audit report on Financial and Performance Reporting had been given full assurance. Mrs Jasper, as Chair of the Audit and Governance Committee thanked Mr Hartland and his team

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for this significant achievement. Two other reports, Commissioning Arrangements for Continuing Care for Children and Financial Systems had been given significant assurance. Resolved: 1) The Board received the report for assurance

CCG035/2018 RISK REGISTER AND BOARD ASSURANCE FRAMEWORK Mrs Jasper spoke to this item providing the Board with an update on the combined BAF and Risk Register as at 12 January 2018. On 8 February 2018 the Audit and Governance Committee considered the changes recommended by the Board in January and these would be reflected in the next iteration of the BAF and Risk Register. On this occasion there were no risks (16 or over) proposed for closure by the Board. However, the Board was asked to consider whether any updates were required to risks 13, 112 and 150. It was agreed that no further amendments at this stage were required to these risks. Resolved: 1) The Board received the report for assurance 2) The Board agreed no further amendments were required to risks 13, 112 and 150. CCG036/2018 REPORT FROM REMUNERATION AND HR COMMITTEE The GPs, Directors and Non-Executive Directors declared an interest in this item on the basis that the topics had an impact of all of them. Mrs Cartwright spoke to this item and reported a high level compliance in respect of mandatory training and the completion of personal development reviews, but that there had been an increase in the sickness rate to 3.22% which was above the CCG target of 3%. The Committee had discussed the future structure of the CCG and the transfer of functions and posts to the MCP and agreed the creation of a task and finish group to take the issue forward, which had met for the first time. Staff engagement sessions had been arranged on the MCP proposals. Mrs Cartwright, on behalf of the Board, thanked Ms Harkins for her involvement in resolving the issue of the transfer of staff from the Local Authority to the CCG. Work was progressing on the GP contract and a final report would be presented to the Committee in April. Dr Horsburgh regularly received feedback from GP members regarding the lack of clarity on contracts and job descriptions. It was agreed that, as soon as possible after this meeting, Mrs Cartwright would provide an update to the clinical members. The extension of the tenure of the Lay Members was clarified. The Lay Members for Governance and Patient Engagement had been extended until March 2019 and the Lay Member for Quality until July 2019. It was noted that a final report on the pay review of CCG Directors would be presented to the April Committee. A review of Directors salaries had also been concluded and identified an anomaly which was being resolved. The Committee had approved the recommended changes to the Staff Side and CCG Recognition Agreement. This would be signed by the Chief Executive Officer and the Staff Side representative. The Committee had considered and approved a recommendation in relation to the permanent appointment of the Dudley CCG Chief Finance and Operating Officer as Strategic Finance Officer to Walsall. This followed the recent permanent appointment of the Dudley CCG Chief Executive Officer to the Accountable Officer post in Walsall. The Board was asked to approve this recommendation. At the last meeting Dr Horsburgh expressed concern about the impact on this CCG with the split of the Accountable Officer across two organisations. He also shared this concern in respect of the Chief Finance Officer appointment. Mr Wellings acknowledged his concerns, but highlighted that there were also benefits to the Chief Finance Officer working across both organisations. Resolved: 1) The Board received the report for assurance

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2) The Director of HR and OD to provide an update to clinical members on the review of GP contracts.

3) The Board approved the recommendation of the permanent appointment of the Dudley CCG Chief Finance and Operating Officer as Strategic Finance Officer to Walsall

CCG037/2018 2017 STAFF SURVEY RESULTS Mrs Cartwright spoke to this item summarising the results of the staff survey undertaken in December 2017 and the proposed actions to be taken forward. It was noted that 80% of staff had completed the survey, which was a fantastic achievement and there were a number of highlights identified in the report, including 95% understood the CCG values; 90% received constructive feedback; 90% had the skills to do their job; 92% felt that the CCG respected and valued its employees; 92% felt proud to tell people they worked for the CCG and 90% recommended the CCG as a place to work. The results were a credit to the staff, management team and the Board. An action plan had been developed to address the areas of concern, which had been discussed and agreed at the Remuneration and HR Committee. The results had been shared at the staff team brief that day when a couple of further actions were agreed. These were around emphasising the role of the staff side representative; looking at email etiquette and diary management; more work around bullying and harassment, specifically perception and subjectivity; extended team sessions where each team would present on what they did and agreement to carry out a follow-up questionnaire specifically looking at stress levels. Mrs Jasper acknowledged the extremely positive response and noted that some of the comments were based on the unknown in terms of the STP and JCC and reflected the feelings of staff in other organisations. In terms of perceptions around bullying and harassment, Dr Lewis suggested that work should be undertaken to identify those conditions/illnesses where staff should not come into work, which was agreed. It was, however, pointed out that the sickness policy would be applied irrespective of whether the illnesses were short term or a long term condition. On the basis that many of the questions were the same as in the last survey, it was agreed that a comparison of the results would be undertaken and Mrs Cartwright agreed to take this forward. Resolved:

1) The Board noted the extremely positive results of the staff survey and approved the action plan with the additional items identified by the staff and Dr Lewis.

2) The results of the survey to be compared with those from the previous year and to be discussed further at Remuneration & HR Committee.

CCG038/2018 REVIEW OF DUDLEY CCG CONSITUTION Mrs Jasper spoke to this item summarising the recommended changes to the Constitution arising from those proposed by NHSE following a submission made by the CCG in November 2017. It was noted that there were a number of amendments proposed by NHSE where further work was required by the Governance Team. Further proposed amendments would be presented to a future meeting for approval. In respect of 2.2.10, Mr Hartland noted that the recruitment process for the Accountable Officer was carried out locally by the CCG and that the appointment was ratified by NHSE, and in respect of 7.12 regarding joint appointments with other organisations, that the Accountable Officer and Chief Finance Officer were not joint appointments between Dudley and Walsall CCGs. Resolved:

1) The proposed changes to the Constitution outlined in the report and those discussed were agreed for submission to NHSE for approval.

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FINANCE, PERFORMANCE & BUSINESS INTELLIGENCE CCG039/2018 REPORT FROM FINANCE, PERFORMANCE & BUSINESS INTELLIGENCE COMMITTEE Dr Tapparo spoke to this item summarising the key issues discussed by the Finance, Performance and Business Intelligence Committees on 21 December 2017 and 25 January 2018. The Committee also met on 1 March 2018 and Dr Tapparo provided an update on the position reported at that meeting. It was noted that a year to date underspend of £9,156,506 was reported; the CCG expected to achieve its revised control total of £10,964,000 agreed with NHSE, which included the additional £5.6m carried forward from 2016/17 and the budget had increased to just below £492m. Significant over-performances continued to be reported in respect of acute services and there were increased costs associated with learning disability and mental health placements and CCG funded continuing health care. The financial risks were closely monitored and plans were continually assessed. It was noted that DGFT failed to achieve the A&E 4-hour standard in January 2018 with performance of 81.8% and a Remedial Action Plan was in development with the Trust with the aim of achieving the 95% standard. The Trust continued to meet the 62-day cancer standard and had also achieved the headline diagnostic standard in December 2018. The improved performance was expected to be sustained with the new imaging suite at The Guest Hospital. The CCG was also keen to understand how to improve the position even further. DWMHPT continued to under-perform against the IAPT access target. A contract performance notice had been issued and a Remedial Action Plan was in development with the Trust. Both 45 and 60 minute WMAS handover breaches improved in January 2018, however they remained significantly above target. In respect of QIPP, the 2016/17 plan was on target to deliver the target of £14.4m and also a small surplus. Next year’s target was just below £17m and schemes had been developed from the Right Care analysis, professional best practice, from within existing services and discussions at the Clinical Forum. The governance process had been assured by NHSE. Mr Wellings, on behalf of the Board, thanked all those involved with the achievement of the 2016/17 QIPP target. As a result of a national problem of stock shortages in a number of drugs the CCG’s prescribing forecast had increased by approximately £2m. Although recent changes in Category M drug prices had reduced prescribing costs, the benefit had been retained centrally by NHSE. Overall, however, the prescribing budget was expected to underspend. Currently the CCG was holding a 1% reserve and Mr Hartland was expecting to be told by NHSE to release this into the control total. The impact could be to increase the control total to around £15m. Mr Bowsher stated that the sustainability of current Better Care Fund (BCF) schemes would need to be considered when the non-recurrent monies ended. On this basis he asked at what stage it would be possible to understand the impact on the CCG’s financial position. Mr Hartland responded that this was a consideration in next year’s financial plan. Resolved: 1) The Board received the report for assurance ACUTE AND COMMUNITY COMMISSIONING CCG040/2018 REPORT FROM INTEGRATED COMMISSIONING EXECUTIVE (ICE) Mr Bucktin spoke to this item summarising the main issues considered at Integrated Commissioning Executive meetings on 10 January 2018 and 7 February 2018. It was noted that the next Executive would be focussing on the evaluation process for all the BCF schemes as there was a need to understand the impact of these on the wider health and social care system, given that the resources supporting them were non-recurrent and tapered off over three years.

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Mr Bowsher confirmed that the Cabinet had confirmed to carry forward the underspend from 2017/18 into 2018/19. This was due to schemes not commencing fully until September 2017. Resolved: 1) The Board received the report for assurance CCG041/2018 MCP PROCUREMENT PROCESS – PROGRESS REPORT Mr Bucktin spoke to this item summarising progress with the MCP procurement process. It was noted that the dialogue phase of the procurement was nearing conclusion and would finish at the end of March 2018; the bidder was invited to submit proposals by late April 2018 and there would then be an evaluation process with the outcome being reported to special meetings of the CCG Board and the Local Authority on 19 June 2018. Work was also progressing with the regulatory bodies on the assurance processes. A meeting was held on 22 March 2018 to ensure that everyone was clear in terms of the requirements for the integrated support and assurance process, the transaction review to be carried out in establishing the MCP contract and the separation process for a new Foundation Trust. NHSE would be commencing a consultation process for the proposed Accountable Care Organisation contract which the CCG would be using with the MCP. The consultation process would run for 12 weeks and until it had been concluded it would not be possible to formally enter into contract negotiations. At this stage it was not expected to impact directly on the local timetable. Two judicial reviews were taking place during April 2018 and May 2018 and the outcomes were expected in June 2018. It was noted that as the bidder was not expected to propose any significant service changes this did not require public consultation. However, the bidder was keen to actively involve both the public and staff before the construction of the final bid and the CCG communications team were supporting them in this. Resolved: 1) The Board received the report for assurance PRIMARY CARE COMMISSIONING CCG042/2018 REPORT FROM PRIMARY CARE COMMISSIONING COMMITTEE (PCCC) Mrs Brunt spoke to this item summarising the key issues discussed at the meetings of the PCCC on 19 January 2018 and 16 February 2018. She highlighted that the Committee had approved the mergers of Norton Medical Practice and Lion Health; that their next consideration would be the proposals around the closure of Tenlands Road and Coombswood Branch Surgeries and the two CQC inspections carried out at Pedmore Road and Castle Meadows, which were discussed under the Quality and Safety Report. Resolved: 1) The Board received the report for assurance CCG043/2018 ANY OTHER BUSINESS CCG043.1/2018 Transforming Care Together (TCT) Mr Wellings asked for an update on the TCT agenda. Mr Hartland informed the Board that the three Governing Bodies of Black Country Partnership Trust (BCPT), Dudley and Walsall Mental Health Partnership Trust (DWMHPT) and Birmingham Community Health had agreed, after careful consideration, that the integration of the three Trusts into one would not now happen. The reasons were that financially the integration did not meet the transaction guidance; there was a lack of clinical assurance and strategically on the basis that it crossed two different STPs. Contractually the risk to this CCG was very low as next year as the decision had been taken to contract independently with BCPT and DWMHPT and it did not have a contract with Birmingham Community Health. However, through the dialogue phase there was a need to understand the impact on the MCP. Any emerging financial issues would be taken through the Finance, Performance and Business Intelligence Committee and quality concerns through the Quality and Safety Committee.

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In the light of this development a Board development session on the CCG’s strategic position in respect of mental health services was proposed and agreed. Dr Horsburgh was extremely disappointed about the lateness of the decision and the impact on staff and also the MCP. The Board also reflected its disappointment that the decision not to proceed had not been taken earlier. Mr Bowsher noted that the Chair of the Adult and Social Care Scrutiny Committee also wanted to understand the impact on the wider health and social care economy. Resolved:

1) A Board Development Session on the CCG’s strategy in respect of mental health services to be arranged.

CCG044/2018 QUESTIONS FROM THE PUBLIC (continued) The meeting returned to the item on questions from the public and specifically that relating to the STP. As Mr Maubach had still not joined the meeting Mr Hartland confirmed his response that the STP did not have any decision making authority and that all decisions were taken through the governance structure of each organisation. He added that there were benefits from collaborative working across the Black Country, though acknowledging Mr Wellings’ point that decisions about services in Dudley remained with this CCG. In relation to the first question, Mrs Broster pointed out that the STP did not present any threat of any hospital closures in Dudley. Resolved:

1) The Board received questions from the public.

CCG045/2018 REFLECTION TIME No areas were covered under this item. EXCLUSION OF THE PRESS AND PUBLIC That under the Public Bodies (Admission to Meetings) Act 1960, the public and representatives of the press and broadcast media be excluded from the meeting during the consideration of the following items of business as publicity would be prejudicial to the public interest because of the confidential nature of the business to be transacted. DATE AND TIME OF NEXT MEETING Thursday 10 May 2018 1pm – 5pm Boardroom, Brierley Hill Health and Social Care Centre MINUTES ACCEPTED AS A TRUE AND CORRECT RECORD Main

Name Title

Signed Date

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD PUBLIC MINUTES

MINUTES OF THE MEETING HELD IN PUBLIC ON THURSDAY 29 MARCH 2018

AT BRIERLEY HILL HEALTH AND SOCIAL CARE CENTRE Members: Mr S Wellings Lay Member for Governance/Vice Chair – Dudley CCG (Vice Chair) Mrs C Brunt Chief Nurse – Dudley CCG Dr J Darby Clinical Executive – Dudley CCG Dr R Edwards Clinical Executive – Dudley CCG Dr P D Gupta GP Board Member – Dudley CCG Prof C Handy Lay Member for Quality and Safety – Dudley CCG Mr M Hartland Chief Operating and Finance Officer – Dudley CCG Dr T Horsburgh Clinical Executive – Dudley CCG (LMC Representative) * Mrs J Jasper Lay Member for Patient and Public Engagement – Dudley CCG Dr R Lewis GP Board Member – Dudley CCG Dr M Mandiratta GP Board Member – Dudley CCG Mr P Maubach Chief Executive Officer – Dudley CCG Dr F Rose GP Board Member – Dudley CCG Dr R Tapparo Clinical Executive – Dudley CCG Non-Voting Members: Mrs L Broster Director of Communications and Public Insight – Dudley CCG Mr N Bucktin Director of Commissioning – Dudley CCG Mrs S Cartwright Director of Organisational Development and Human Resources – Dudley CCG Ms J Emery Chief Executive – Healthwatch Ms D Harkins Chief Officer, Health and Wellbeing (Director of Public Health) – Dudley MBC Mr D King Director of Membership Development and Primary Care – Dudley CCG * Dr Horsburgh is also the LMC representative on the Board which is a non-voting role. In Attendance: Dr R Gee GP Engagement Lead – Dudley CCG Ms S Johnson Deputy Chief Finance Officer – Dudley CCG Minute Taker: Ms C Flavell PA to Chief Finance and Operating Officer – Dudley CCG CCG022/2018 APOLOGIES Apologies were received from: Dr D Hegarty Chair and GP Board Member – Dudley CCG Dr S Mann Clinical Executive – Dudley CCG Dr K Penumaka GP Board Member – Dudley CCG CCG023/2018 DECLARATIONS OF INTEREST Members were asked to disclose any interest they may have, direct or indirect, in any of the items to be considered during the course of the meeting and to note that those Members declaring an interest would not be allowed to take part in the consideration or discussion or vote on any questions relating to that item. In

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January Dr Rose had notified the Governance Support Manager of a change to her declaration which was not yet reflected in the agenda. There were no other declarations of interest. PUBLIC VOICE CCG026/2018 PUBLIC UPDATE The meeting noted that Moss Grove Surgery in Kingswinford also had a surgery in Kinver. Mrs Broster informed the Board that the practice had written to the CCG stating that it was making an application for the Kinver surgery to join Dudley CCG from South East Staffordshire and Seisdon Peninsula (SES&SP) CCG and to simultaneously merge the two surgeries. The key reasons identified for the merger were improving access and choice for their patients; improving the continuity of care; the ability to offer clinics currently available to Kingswinford patients to the Kinver site and significant economies of scale from not having to report to two CCGs and two NHS England (NHSE) regions. This would require two processes to be followed which were intrinsically linked and it was therefore proposed that a single conversation took place with patients and the public. There would need to be an application from the CCG to NHSE to change the Constitution and the border of the CCG. This would require the CCG to take views from the Local Authority, Member practices, other stakeholders and be assured that patient and public views had been sought. The second element would be a merger application from the practice to the CCG, which would be subject to NHSE approval to a change to the CCG Constitution. Patients and the public would also be engaged in this. The deadline for the Constitutional change application was 1 June 2018. The Board’s views were sought on the CCG obtaining the views of stakeholders; supporting the practices in seeking the views of patients and the public, which had already started; for permission to add text to the CCG website that it was seeking views on the proposals and for an extraordinary Board on 31 May 2018 to consider the application to be made to NHSE. Mrs Broster responded to Dr Gupta that the Kinver practice had a list size of around 5,000 patients with the vast majority of these resident in SES&SP. However, Kinver patients were directed to Dudley hospitals for their hospital care so patient flow mirrored that of other Dudley Practices. Dr Gee asked whether the Local Authority would be able to veto the decision and if this were the case to seek their views first before engaging with stakeholders and the public. Mrs Brunt responded that the process of engagement with patients and stakeholders needs to be undertaken concurrently. Early discussions with SES&SP suggested that the transfer would not be supported. It was noted that the position of NHSE was that SES&SP CCG would retain the financial deficit, which may pose an issue for that organisation. A seven weeks’ engagement period was proposed and the Local Authority’s Health and Adult Social Care Scrutiny Committee had been asked if they wished to consider the engagement plan, but were unable to do so at their April meeting. The views of the chair of the Health and Adult Social Care Scrutiny Committee would be sought in this process and it was noted that a final decision would be based on the collective views received during this time. The capacity within both the primary care and communications and engagement teams to undertake this had been considered. Their reflection was that although this would create additional pressure, a lot of work had already taken place and they were particularly assured by the level of enthusiasm and commitment by the practice to take this forward. The practice was clear that it wanted the opportunity to follow this process even if the decision were rejected. The CCG felt it had a duty to support them in this in the same way that it supported applications from other practices to merge their branch surgeries. Ms Harkins raised the issue of the impact on Dudley public health services of the potential 4,000 increase in the population. She was informed that the merger would not impact on Dudley services as South Staffordshire Council would continue to provide services to the existing Kinver patients based on the resident population. She was further assured that her views would be sought formally during the engagement period. Dr Horsburgh raised the implications of the merger for the MCP and the integration of health and social care services. Mr Maubach responded that the CCG was already in that same position, for example Wychbury had a practice sitting outside the Dudley boundary in Sandwell. These issues would need to be considered in the context of the MCP. Mrs Broster clarified for the meeting the purpose of the Board meeting on 31 May. This would be to review the totality of the application which would include the due diligence carried out by the Commissioning Development Committee on the clinical model; the Primary Care Commissioning Committee on the merger

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application and the Finance, Performance and Business Intelligence Committee on the financial position and performance targets. The report would also include the merits and disadvantages of the merger. Dr Horsburgh raised that Moss Grove would be moving into the new Kingswinford hub and the impact on that facility if the application to merge were approved. Mr Hartland responded that it might be necessary to change the footprint of that facility, though Mrs Brunt noted that the intention was to retain the Kinver surgery. The operational issues of operating across two sites was also raised. It was noted that if the deadline of 1 June 2018 was not met the practice would need to wait a further 12 months to submit an application. Some 12 months’ ago the practice had asked for permission to follow this course of action. However, at that stage it was not possible to reach agreement with South Staffs on a joint process. The expectation was that both CCGs were unlikely to make the same recommendation to their Boards. NHSE would therefore need to weigh up the evidence and determine whether the proposal should proceed. Based on the current reporting structure the CCGs were responsible to two different regional teams. The assessment therefore would be carried out by two different teams. Mr Wellings noted that when this had previously been discussed by the Board it was agreed that under no circumstances would the CCG take on the deficit of the other organisation. This agreement was restated. The CCG had sought legal advice on the engagement plan. Their advice was that the plan was sufficiently robust on the basis that there would be no reduction in services and no changes in relation to existing contracts, and that the CCG was involving patients rather than consulting on the provision of primary care services. Legal advice had also been obtained on purdah and the pre-election guidance. The guidance did not apply directly to local NHS organisations, though the CCG was encouraged to follow its principles not to be seen to be influencing the election and its outcomes. No consultations should be launched during the pre-election period but ongoing consultations could continue, but not be promoted. Mrs Broster informed the meeting that practice involvement with the patients and the public had started on 26 March, prior to the pre-election period which started on 27 March. Practice conversations with local Councillors and the local MP, also pre-dated the start of the pre-election period. The involvement had been extended to after the election. The CCG would not mention the proposals at any public meeting until the Healthcare Forum on 17 May. Ms Harkins added that it was not a general election or a Local Authority led consultation, but it was important to make sure that the process did not provide a platform for individual members to be seen to be influencing the election. Mr Wellings stressed the importance of ensuring that the report to the Board carefully set out the process followed and all the issues identified during the consultation, particularly on the basis that South Staffs were not supportive of the proposal. Following the discussion Mr Wellings summarised that the Board supported the engagement proposal. It was also important for the CCG not to be seen to be endorsing the proposal and emphasised the CCG’s role as supporting the practice with their patient involvement. A detailed report on the outcome of the engagement, including the merits and disadvantages to be presented to the extraordinary Board on 31 May 2018. Resolution 1) The Board supported the engagement proposals 2) A detailed report on the merits and disadvantages to be presented to the Extraordinary Board

on 31 May 2018. CCG FINANCIAL PLAN 2018/19 Mr Hartland spoke to this item detailing the baseline budgets for the financial year 2018/19 and providing a forward look to the following four years to 2022/23. The financial plan had been submitted and approved by NHSE. It met all planning guidance; the CCG’s operational plan requirements; Constitution targets; parity of esteem for mental health services; and NHSE assurance targets. The planned budget for 2018/19 had been approved by the Finance, Performance and Business Intelligence Committee at its meeting on 29 March 2018 following considerable debate on the issues identified in the plan. The Committee agreed to review their risk register at the next meeting in the light of the conversation at the Board.

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The budget identified a balanced financial plan for 2018/19 with plans to achieve a surplus of £10m in 2018/19. This was in line with the control total set by NHSE. The budget next year was £489.2m which was broken down into CCG core funding, running costs and delegated primary care budgets. However, planned spend was currently in excess of the allocation by £17m which was the level of the QIPP target. The achievement of the QIPP target and an additional stretch target was necessary to meet the financial plan requirements and create recurrent headroom to fund future growth in activity and investment in new services. As 2018/19 would be financially challenging, there would be greater emphasis on performance management of QIPP across the organisation, including the Governing Body. Following the publication of the planning guidance the CCG had received an unexpected additional allocation of £3.5m. The conditions around this were that it must be used to commission additional activity from providers. The level of activity was identified in the report, which was in addition to the projected forecast outturn on this year’s activity. This was an additional 2.3% in emergency admissions, 3.6% in electives and 4.9% in outpatients. In the light of this the contract agreed with Dudley Group NHS Foundation Trust (DGFT) next year was on a payment by results basis, meaning that the CCG would only pay for activity used. It was, therefore, in the CCG’s interests to ensure that growth was met at that level, even to underspend, and that the QIPP target was achieved. It was positive that the CCG had agreed a contract with DGFT, though there were risks on both sides. This required greater collaboration between both organisations to manage the position. The discussion at the Finance, Performance and Business Intelligence Committee was that the additional investment in activity was contradictory to the CCG’s plans on how it expected activity to flow over the next 12 months. However, it was recognised that the CCG had no option but to follow this approach which was mandated by NHSE. It was noted that historically the CCG had to retain and not commit its non-recurrent funds. In 2018/19 the CCG was no longer required to retain the non-recurrent spend reserve and this had been built into the financial plan to fund investments and create a risk reserve. Over the last three years the CCG had benefited from Value Proposition (VP) funding, which ceased at the end of March 2018. Items previously funded from the VP had been included in the financial plan where appropriate to continue some of the investments recurrently to fund the implementation of the care model, in addition to non-recurrent funding to continue with the MCP procurement exercise. The plan did not include funding in respect of the transaction costs of separating DGFT into two Foundation Trusts, the second being the MCP. The CCG was in discussion with the MCP bidder team and NHSE and NHS Improvement on this issue. The QIPP plan of £16.99m equated to 3.5% of the CCG’s budget and was the maximum allowable by NHSE. Additional schemes totalling £3m had also been identified to mitigate risks within the plan. Commissioners, budget holders and clinical leads were responsible, and would be accountable for the delivery of all the schemes. There would be increased focus on QIPP delivery as the target must be met in full to achieve the financial plan. The scope of the current QIPP challenge was also being expanded to cover the additional £3m QIPP risk and routine budget management. There would also be a weekly QIPP update at the Clinical Executive. On the basis a lot of spend was driven by referrals and activity in general practice, the CCG would be reinforcing the role of GP practices and localities in assisting with the position. There had already been positive discussions at the last couple of meetings of the Clinical Forum. Mr Hartland responded to Prof Handy that the biggest risk in relation to QIPP was the MSK scheme which had a savings target of £2.8m. Performance of this was managed through Mr Bucktin and the Commissioning Development Committee. Dr Horsburgh noted that while growth of 1.93% had been applied to the 2017/18 primary care co-commissioning allocation other areas, for example, continuing healthcare, were receiving considerably more. He was informed that where this was the case the growth uplift was based on demand. Dr Horsburgh asked what would happen to the surplus at the year-end. Mr Hartland informed the Board that the CCG had a surplus of £11m to achieve at the end of 2017/18 to be carried forward to 2018/19. However, the CCG had been instructed by NHSE to uplift this by at least £2.5m, increasing the surplus to around £13.5m. This funding was not available for use by the CCG.

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Mr Wellings raised two issues of concern relating to the financial impact of the pay award if this were not fully funded by NHSE and the suggestion of an NHS dowry for the NHS 70th birthday. In respect of the pay award, the CCG had identified 1%, but the greater challenge would be for local providers. Mr Maubach responded to the comment regarding the dowry, noting that NHSE and NHS Improvement had generated a culture of organisations having to bid for funding. The work involved in bidding opportunities could be significant and he suggested that the CCG and local providers should consider working together to be more effective in benefiting from these. There would also be opportunities for CCGs to work together on this. This approach was supported by the Board and Mr Maubach indicated that the CCG might need to consider investment in a development team focus. Mrs Cartwright wished to pay credit to Mr Hartland and his team for their hard work in producing the plan and the fact that it had been possible to continue to fund schemes previously supported from the VP. The need for clinical ownership and support was again emphasised. Mr Maubach added that it had been raised at the Members’ event that week that the CCG would be more proactive with practices and through localities in highlighting where there were variances in performance and understanding the inconsistencies with a view to collectively reducing demand for hospital services. The CCG might need to consider investing further in this area. An example used was paediatric triage which was not currently being used by every practice and getting to a position where everyone was accessing the service. It had therefore been agreed at Clinical Forum that Paediatric Triage would be the only route for paediatric referrals. It was noted that a lot of work had already taken place with practices on their performance, which had produced some excellent outcomes. However, there remained considerable inconsistencies between practices. Referring to paediatric triage, Dr Gupta commented that it was important to ensure that the service was properly resourced to manage the referrals from general practice. Dr Tapparo added that the GP Board members had a role in leading by example, while recognising that a significant risk was getting practices on board with the changes as there were no contractual levers to enforce these. Dr Horsburgh commented that all the clinicians in the local health system, not just GPs, had to take their share of responsibility in changing behaviour and to do this they need to be much better sighted on the financial issues and the influence they had over these. Mr Wellings responded that the Clinical Strategic Group had a vital role in this and he had raised with the Chair of the Trust the importance of this meeting taking place. Resolution

1) The Board approved the CCG financial budgets for 2018/19.

DUDLEY CCG CONSTITUTION – FINAL CHANGES Mr Hartland spoke to this item summarising the recommended changes to the Constitution following NHSE’s review of the submission made in November 2017. At the 8 March meeting the Board received and agreed the first amendments arising from the review by NHSE. For consistency it was agreed that the references in 6.9.2 and 7.10.3 should identify that the Vice-Chair was also the Lay Member for Governance. The Board discussed the proposed change in relation to 2.2.10 and the appointment of the Accountable Officer. At the 8 March meeting it was noted that the recruitment process for the Accountable Officer was carried out locally not by NHSE and the Board disagreed with the feedback from NHSE. Mrs Cartwright noted that when Mr Maubach was appointed the CCG had challenged NHSE because they wanted to carry out the process. The recruitment process was carried out locally and the appointment was authorised by NHSE. Following the discussion, it was agreed that Ms Johnson would reinforce to NHSE the comment made previously and that the CCG remained firm on this position. If NHSE were not willing to move on this the Board delegated authority to the Chair and Accountable Officer to have discussions on this if required. Resolved:

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1) The proposed changes to the Constitution outlined in the report were agreed with the exception of that relating to the recruitment process for the Accountable Officer, for approval by NHSE

2) NHSE to be informed of the CCG’s position in respect of this process

ANY OTHER BUSINESS CCG Chair Dr Hegarty’s tenure as Chair had come to an end and it had been agreed to formally extend this to the May 2018 Board meeting. In the meantime, the Chair’s election would be organised and this would be open to all the GP Board members. The process for the May Board would be for Mr Wellings, as Acting Chair, to open the meeting and then handover to the successful candidate. Dr Hegarty had advised that he would be back at work week beginning 2 April on a phased basis and would reapply for the position. Legal Action – Human Rights Commission Mr Bucktin referred to the recent press coverage around the legal action mounted by the Human Rights Commission against a number of CCGs, including Dudley. This centred around the CCGs’ policies in relation to continuing healthcare (CHC) expenditure, specifically the ceiling set at which they were prepared to pay for a patient to be cared for in their own home. Dudley’s ceiling was 20% above residential care costs. The challenge was based on three different statutory areas; (i) Human Rights Act and Article 8 of the European Convention on Human Rights, (ii) Public Sector Equality Duty under the Equalities Act and (iii) application of the NHS CHC National Framework. The CCG, in conjunction with the other CCGs, had taken advice from Mr David Locke, QC. He had informed that the position of the CCGs was legally defensible but had advised that the CCGs write to the Commission indicating that they were prepared to review their policies, particularly the application of the ceiling. The CCG had agreed to review its policy and the guidelines on how the 20% ceiling was applied. To ensure the proper process was followed the intention would also be to undertake an equalities impact assessment. The revised CHC policy would be presented to the Board for approval. Dr Horsburgh’s dissatisfaction that public money was having to be spent on this legal action was acknowledged. However, the action was seen as necessary to ensure that the CCG did not get involved in a High Court legal battle. Resolution

1) The Board approved the action outlined 2) The revised CHC policy would be presented to the Board for approval in due course.

DATE AND TIME OF NEXT MEETING Thursday 10 May 2018 1pm – 5pm Boardroom, Brierley Hill Health and Social Care Centre MINUTES ACCEPTED AS A TRUE AND CORRECT RECORD Main

Name Title

Signed Date

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD

MATTERS OUTSTANDING

FROM MARCH 2018 – PUBLIC BOARD MEETING

ITEM NO AGENDA ITEM ACTION TO BE TAKEN ACTION FOR UPDATE COMPLETED

CCG030/2018 Report from Partnership Board

The CCG would write to West Midlands Ambulance Service (WMAS) inviting them to attend each meeting of the Partnership Board.

Mrs S Cartwright/Dr C Handy

A letter has been send to WMAS COMPLETE

CCG037/2018 Staff Survey Results 2017 The results of the survey to be compared with those from the previous year and to be discussed further at a future Board Development Session

Mrs S Cartwright This has been included in the Board Development Schedule

COMPLETE

CCG043/2018 Any Other Business A Board Development Session on the CCG’s strategy in respect of mental health services to be arranged.

Mrs S Cartwright This has been included in the Board Development Schedule

COMPLETE

1

Introduction This report is presented with the aim of keeping Board Members up to date with important Communications and Engagement issues and ‘hot topics’. It is also produced with the specific aim of further strenghtening the patient voice at our board meetings by including sections dedicated to feedback from our Patient Participation Groups, Patient Opportunity Panel (POPs) and Healthwatch.

This month Feet on the Street ventured into the new Urgent Treatment Centre at Russells Hall Hospital to see what it looked like, how local people thought it would make a difference and to see what staff and patients thought of it.

Patient Opportunity Panel (POP) Meeting POPs in April was an opportunity to meet Diane Wake, Chief Executive of Dudley Group NHS Foundation Trust and hear more about how the Trust works and an opportunity to ask questions. The group were appreciative of the time that Diane spent with them and thoroughly enjoyed the presentation and chat. The group have been promised a visit to the hospital to see some of the changes that have taken place. Dudley Borough Healthcare Forum (HCF) The Healthcare Forum will take place on the 17th May and we will be focusing on self-care with public health and Healthwatch as part of the plans for personalised care and support. Neuro Café The team visited the Neuro Café at Queens Cross Network to let the group know who and what Dudley CCG were and different ways to get involved. The group meet informally and are always keen to find out more and to support each other. Moss Grove Kinver and Kingswinford Moss Grove Kinver and Kingswinford surgeries began a public consultation on merging their 2 practices on 26th March. Both practices share the same team and if successful, would retain their separate sites. The CCG commenced an involvement exercise on the 3rd April around a constitutional change to the boundary. This is running concurrently with the practice consultation

Public Update

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based around the issue of the Kinver practice moving from South East Staffordshire & Seisdon Peninsula CCG into Dudley CCG if the merger is accepted. Whose Shoes On 27th March a ‘Whose Shoes’ event took place at Dudley Canal Trust. This event focused on developing maternity services across the Black Country. This event was organised as part of the commitment by the Local Maternity System under the Black Country STP to engage with women and their families in the transformation of maternity services across the Black Country. Women across the Black Country were invited along with stakeholders to listen to the voices of women and explore potential options and solutions in the design and development of services. The event was well attended with a large number of stakeholders attending and 20 women playing the board game of ‘whose shoes’ to provide first-hand the experiences of maternity services. Many women reiterated similar themes to other ‘Whose Shoes’ events including support, women’s choice, continuity and communication of services. The conversations were captured by a graphic facilitator and will support shaping local services as part of the engagement and advisory work stream within the Black Country LMS.

Yemeni Ladies Group The team spent some time with the Yemeni Ladies Group and were made to feel very welcome. The group discussed their perceptions around access to primary care and shared their experiences. We were also joined by a local pharmacist who explained to the group about the Minor Ailment Scheme. Dying Matters As part of Dying Matters week in May, the team are planning a Feet on the Street and a focus group with Dr Lucy Martin around dying well in Dudley. Lion Health Drop in Sessions With the merger of Norton Medical Practice and Lion Health going ahead, the team hosted 3 drop in sessions at different times of the day in Lion Health so that new patients could familiarise themselves with a new practice and register for patient online. Approximately 500 patients attended over the three sessions and the team were supported by staff at Lion Health. Personalised Care Programme Conversations are continuing across the STP sites about the possibility of becoming a demonstrator site for the Personalised Care Programmes with NHSE. Early conversations involve linking in with wider sites with a focus on personal health budgets, health coaching, personalised care and support plans and self-management. Deaf Cards We will soon see the launch of Deaf cards. This is collaboration between us, the Deaf Café, Dudley Council, Dudley Group NHS Foundation Trust and Healthwatch, Dudley. The cards are able to be shown to any public service and notify that the person presenting the card is either deaf or has a hearing impairment and also advises on what their communication needs are. We will be promoting the cards widely. The Takeover Challenge The Takeover Challenge sees organisations across England opening their doors to children and young people to take over adult roles and promote and encourage youth participation. It puts children and young people into decision-making positions and encourages organisations and businesses to hear their views. In Dudley borough we are committed to building an infrastructure for all young people to have opportunities to participate, share their views and influence decisions that affect their lives regardless of their backgrounds, experiences or abilities.

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Dudley CCG supported takeover day by creating an opportunity for a young person to take over the CCG Social Media for the day. We have been thanked for our support in a report by DCVS and DMBC and we look forward to creating more opportunities for young people in the future.

We continue to work with our providers to monitor the experience of patients using services. The infographic below illustrates a summary of the key indicators of experience at The Dudley Group NHS FT.

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The People’s Network The May Peoples Network will look at innovations in pharmacy and ask people, ‘how are they working for you?’

There will be a focus on seeking the views of people on Practice-Based Pharmacy and Prescription Ordering Direct. Any views expressed will help the CCG team to shape how these services operate.

Winter The Black Country social marketing campaign for 2017/18, developed by Arden & Gem CSU to support the national ‘Stay Well This Winter’ campaign has now come to an end. Over the final month the team have focused on promoting the correct use of services including pharmacies and promoting extended access. We also held our final two outreach events at the Merry Hill shopping centre. We are now awaiting the evaluation for winter from the CSU which will be finalised by the end of the April 2018. NHS70 - The team continue to plan for the NHS 70th birthday party taking place on the 5th July 2018. Brierley Hill Civic Hall has been booked for the whole day where the CCG AGM will take place in the morning (9.30am) and staff awards will also take place in the evening. Vamos will be performing on the day, Healthwatch Dudley and the Young Health Champions, Dudley Group NHS Foundation NHS Trust, Dudley Council Public Health colleagues, West Midlands Ambulance Service NHS Foundation Trust and Dudley and Walsall Mental Health Partnership Trust will all be helping out on the day with different activities. Local people and communities will be able to drop in and have a drink and light refreshments and take part in the celebrations. A soft promotion of the event has commenced to get the date in diaries whilst plans for the day await confirmation. In addition a letter to all local schools inviting them to take part in the ‘NHS of the future’ drawing competition was sent at the end of April. To ensure promotion of the event is as effective as possible, invitations and other promotional materials will be developed and shared by all partners in order to align local activity. Proactive and Reactive Media Activity- The table in Appendix 1 gives a breakdown and hyperlinks to recent media activity for the CCG. The Advertising total has been calculated as £34,069.05 with £5,134.35 of this relating to negative coverage relating to the Equality and Human Rights Commission (EHRC) legal action.

A range of Healthwatch Dudley evidence based reports are available to download at www.healthwatchdudley.co.uk/reports

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APPENDIX 1 Communications and Engagement – Media Monitoring – March & April 2018

Title/weblink Summary Release

Date Coverage (with links where available)

Public Invited to Dudley CCG’s Primary Care Commissioning Committee Meeting

Press Release

05.03.2018 Release

MCP Consortium Media Enquiry

06.03.2018 HSJ – Rebecca Thomas Response

GP Resilience Media Enquiry

13.03.2018 Pulse – Paul Maubach telephone Interview

34,000 patients left without a fixed GP as practices 'sucked into black hole'

Coverage of Media Enquiry

16.03.2018 Pulse Article

Daily Insight: One hit wonders

Media Story

16.03.2018 HSJ Article

CHC funding - EHRC letter

Media Enquiry

19.03.2018 HSJ – Sharon Brennan Response

CHC Funding – EHRC Letter

Media Enquiry

Healthcare Leader Magazine - Lea Legraien Response

THIRTEEN NHS BODIES FACE LEGAL ACTION OVER 'FORCED' RESIDENTIAL CARE POLICIES

Media Story

19.03.2018 Care Appointments https://www.careappointments.co.uk/care-news/england/item/43594-thirteen-nhs-bodies-face-legal-action-over-forced-residential-care-policies[/sourcelink

NHS organisations facing court action over unlawful policies

Media Story

20.03.2018 Ekkliesia Article

Equalities watchdog threatens legal action against health bodies over discrimination

Media Story

21.03.2018 Local Government Lawyer Article

This is why you could be forced into a care home

Media Story

21.03.2018 Coventry Telegraph Article

NHS facing court action over unlawful policies

Media Story

21.03.2018 WiredGov Article

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MCP Contract & Scope

Media Enquiry

21.03.2018 HSJ – Rebecca Thomas Response

NHS Continuing Healthcare

Media Enquiry

21.03.2018 Dudley News – Kelly Harris Response

Aspiring ACO will not ''fully integrate'' vast majority of its GPs

Media Story

23.03.2018 HSJ Article

Dudley Pharmacy Opening Times over Easter Bank Holiday Weekend

Press Release

26.03.2018 Release

Dudley Clinical Commissioning Group accused of forcing patients into care homes to save money

Coverage of Media Enquiry

27.03.2018 Halesowen News, Dudley News Stourbridge News Article

Stourside Medical Practice – Branch Closures

Media Enquiry

28.03.2018 Stourbridge News – Dan Sharpe Response

IVF Policy – E-cigarettes

Media Enquiry

28.03.2018 Mail On Sunday – Jake Hurfurt Response

Solving the integration puzzle

Media Story

29.03.2018 Healthcare Finance Article

Equality group in court action threat over care

Media Story

29.03.2018 Dudley News Article

Halesowen GP surgeries to close in September

Coverage of Media Enquiry

29.03.2018 Halesowen News Worcester News Stourbridge News, Dudley News Evesham Journal, Kidderminster Shuttle Bromsgrove Advertiser, Droitwich Spa Advertiser, Cotswold Journal Hereford Times, Ludlow Advertiser Tewkesbury Admag, Redditch Advertiser, Ledbury Reporter Article

GP Surgeries to Close

Coverage of Media Enquiry

29.03.2018 Halesowen News Article

Legal Threat Over Care Homes Policy

Coverage of Media Enquiry

29.03.2018 Halesowen News Article

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Title/weblink Summary Release

Date Coverage (with links where available)

GP surgeries closure plan gets go-ahead

Coverage of Media Enquiry

02.04.2018 Express & Star (Dudley) Article

GP surgeries set to close

Coverage of Media Enquiry

02.04.2018 Express & Star (Sandwell) Article

Surgeries to dose Coverage of Media Enquiry

05.04.2018 Halesowen Chronicle, Stourbridge Chronicle, Dudley Chronicle Article

Divided views rule implementation of integrated care

Media Story

13.04.2018 British Medical Journal (Web) Article

Thousands of patients left waiting too long at A&E

Media Story

13.04.2018 Halesowen Chronicle , Dudley Chronicle, Stourbridge Chronicle Article

Public Invite to Healthcare Forum Meeting

Press Release

19.04.2018 Release

Patients in Dudley benefit from Diabetes Prevention Programme

Press Release

20.04.2018 Release

ACCOUNTABLE CARE Integrated care, fragmented opinion

Media Story

21.04.2018 British Medical Journal (BMJ) Article

DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Report: 10 May 2018 Report: Partnership Board Report

Agenda item No: 6.1

TITLE OF REPORT: Partnership Board Report

PURPOSE OF REPORT: To update the Board on the developments of the Partnership Board.

AUTHOR OF REPORT: Mrs Stephanie Cartwright, Director of Organisational Development and Human Resources

MANAGEMENT LEAD: Mrs Stephanie Cartwright, Director of Organisational Development and Human Resources

CLINICAL LEAD: Dr David Hegarty, Chair

KEY POINTS:

• Since the last report the Partnership Board has met twice (28 March and 25 April 2018)

• The Partnership Board includes invitees from all organisations involved in the health and social care system in Dudley.

• The development of the MCP in Dudley continues to receive very positive national support.

• Governance arrangements continue to reflect the separation of procurement of the MCP from development of the MCP.

RECOMMENDATION: That the CCG Board notes the progress of the Partnership Board to date.

FINANCIAL IMPLICATIONS: None

WHAT ENGAGEMENT HAS TAKEN PLACE:

There is a specific workstream dedicated solely to communications and engagement on the new models of care that includes representation from all organisations involved. This workstream has undertaken an extensive piece of work undertaking listening exercises out in the community which was presented to the Partnership Board in April 2017. The workstream is also currently undertaking another engagement exercise with the public and staff on the new model of care.

ACTION REQUIRED: Decision Approval Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 10 MAY2018 PARTNERSHIP BOARD REPORT 1.0 INTRODUCTION 1.1 The Dudley New Model of Care Partnership Board includes invitees from all organisations included

in developing the Dudley Multi-speciality Community Provider. These organisations are as follows:

• Dudley Clinical Commissioning Group (lead organisation) • Dudley Metropolitan Borough Council • Dudley Group NHS Foundation NHS Trust • Dudley and Walsall Mental Health Partnership NHS Trust • Dudley Council for Voluntary Service • Black Country Partnership NHS Foundation Trust • Dudley Primary Care Providers • West Midlands Ambulance Service NHS Foundation Trust

2.0 REPORT 2.1 The Partnership Board has continued to meet on a monthly basis to lead the implementation of the

core components of the MCP, the implementation of the value proposition, to review the progress in the implementation of the new model of care and to provide the opportunity to raise robust challenge and to air issues that require partnership debate and discussion. The Partnership Board has met twice since the last report to the Board, on 28 March 2018 and 25 April 2018.

2.2 The Partnership Board in March was the final Partnership Board meeting to formally review the

development of the vanguard as the vanguard programme officially ended on 31st March 2018. The Partnership Board therefore reviewed the final programme report and the final statement on spend against the value proposition monies. Partnership Board heard that of the 80 components of an MCP new care model, 58 had been implemented and received assurance that the remaining 22 components would be implemented on commencement of the MCP contract.

2.3 The Partnership Board also heard that the value proposition monies would be spent in full by the

end of March with a very slight overspend. The Board also received the evaluation on the Patient Activation Measures pilot that had been taking place at Lion Health and an update on the Local Digital Roadmap (LDR) and Interoperability Proof of Concept.

2.4 The Partnership Board agreed that it would continue beyond the end of the Vanguard programme.

This decision was made during a workshop that took place in January where all members agreed that the Partnership Board had a role in overseeing the implementation of the MCP in the system. A revised Terms of Reference for Partnership Board were agreed and are attached as an Appendix.

2.5 In April the Partnership Board received an update on the single point of access team that is being

implemented to reduce care home admissions and were informed that this service would replace the service that had recently been decommissioned from Airedale NHS Foundation Trust. The Partnership Board also received a presentation on the development of the Integration Agreement and how all of the 80 components of the MCP new care model are incorporated into the Integration Agreement and primary care operating model. The Board discussed the timescales for implementation of the MCP and submission of the bid and requested a summary of the proposed model of care at the next meeting.

3.0 RECOMMENDATION 3.1 The Board is asked to note the contents of this report for assurance. Stephanie Cartwright Director of Organisational Development and Human Resources April 2018

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 10 May 2018 Report: Corporate Objectives Update 2018/19

Agenda item No: 6.2

TITLE OF REPORT: Corporate Objectives for 2018/19

PURPOSE OF REPORT: To present to the Board the headline Corporate Objectives for 2018/19

AUTHOR OF REPORT: Mr P Maubach, Chief Executive Officer

MANAGEMENT LEAD: Mr P Maubach, Chief Executive Officer

CLINICAL LEAD: Dr D Hegarty, Chair

KEY POINTS:

1. This paper sets out the headline corporate objectives for the coming year, including key lead responsible executives for each objective and high level milestones for the end of Q1, Q2 and the year-end.

2. This is presented in the attached schedule (Appendix 1)

3. The next paper for assurance will be presented at the July 2018 Board.

RECOMMENDATION: 1. The Governing Body is asked to approve these high-level corporate objectives with the expectation that they will be used to form the objectives for all staff in the CCG.

FINANCIAL IMPLICATIONS: None

WHAT ENGAGEMENT HAS TAKEN PLACE:

None

ACTION REQUIRED:

Decision Approval Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 10 MAY 2018 CORPORATE OBJECTIVES UPDATE 2018/19

1.0 INTRODUCTION

1.1 This paper sets out the headline corporate objectives for the coming year, including key lead

responsible executives for each objective and high level milestones for the end of Q1, Q2 and the year-end.

1.2 This year is going to be a year of significant transition – both in preparing for the creation of the

MCP as a new legal entity and the consequential impact this will have on both the system and the CCG; and in enhancing our arrangements with our partners across the Black Country to develop a more large-scale integrated care system with more robust joint commissioning arrangements.

1.3 So we will need to ensure that we can apply the focus that we need to these agendas; whilst also

maintaining our diligence and continuing oversight on the quality, performance and improvement of the Dudley Health and Care system.

1.4 During the course of this year we will be redesigning the way our CCG works; how it is organised

and governed; and how it conducts its statutory duties. This will need to accommodate both the plans for the MCP as well as the plans for developing more robust Black Country commissioning arrangements leading to a Black Country Integrated Care System.

1.5 These high-level corporate objectives will be translated into specific more detailed objectives for

each executive director and then cascaded through the organisation to all staff during the first quarter.

2.0 SEPARATION OF DUTIES 2.1 The CCG governing body previously categorised the corporate objectives into 3 – category A

relating to the MCP procurement; category B relating to normal business and category C relating to MCP bid development – and stipulated that no member of the CCG could participate in both categories A and C in order to ensure appropriate separation of duties.

2.2 It is important to be clear that by the date of this governing body, no employed CCG member of staff

(with the exception of come GPs) will be participating in category C activities, as they will have all returned to their substantive roles. Also, there is no longer a need for the CCG to act in any official capacity to support the development of the MCP bid as the bid will have been submitted to the CCG. Once/if the preferred bidder status has been approved then the CCG will necessarily have to engage with the MCP partnership to address the transition of staff and activities to the MCP; as well as continue with the procurement process – but neither of these activities are category C activities.

2.3 The MCP partnership will be putting in place transition arrangements for managing the creation of

the MCP. This arrangement is for the MCP partnership (as a provider) to determine and does not require CCG input. However it may be that the partnership will have interim job opportunities that CCG staff may wish to apply for – so the mechanism by which this will need to be managed will have to be determined by the Remuneration and HR committee. Also the basis upon which the CCG will engage with the transition arrangements will be set out in a MOU between the CCG and DGFT.

3.0 MCP PROCUREMENT 3.1 We should conclude the MCP ITPD assessment and determine our preferred bidder for the MCP by

the end of Q1. Assuming that this reaches a successful outcome we will then need to engage in the second and third checkpoints of the ISAP with NHSE and NHSI and we have agreed an indicative timetable with the regulators for this. However it is important to note that whilst the sequence of events have been determined, the precise timing may still be subject to change as, for example, there are external factors such as the two judicial reviews and national public consultation on the

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ACO contract which may affect the overall timing. 3.2 One of the most significant phases of the assurance process on the creation of the MCP will be the

financial assurance requirements by NHS Improvement. Whilst a substantial part of the responsibility for this will rest with DGFT, our CCG also has a very important role to ensure that the system financial model is robust and that the new arrangements with both the MCP and DGFT support a sustainable future for both organisations.

4.0 RECOMMENDATION 1) The Governing Body is asked to approve these high-level corporate objectives with the expectation

that they will be used to form the objectives for all staff in the CCG. Mr P Maubach Chief Executive Officer May 2018

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Aim 1 To effectively commission services which will improve the health and wellbeing for Dudley people

Objective Q1 measure Q2 measure Year-end measure

Lead Committee Cat

1. Conclude the procurement of the MCP Conclude ITPD assessment and update case for change for joint consideration by CCG GB and DMBC Cabinet

Completed ISAP documentation with regulators including independent clinical review.

ISAP concluded and MCP contract award in place

Neill Procurement Board

A

2. Ensure a sustainable overall Dudley system model which maintains financial sustainability – including MCP model, risk/gain share and new acute financial model

Update the system financial sustainability model including system risk gain share with the MCP and DGFT. Updated financial case for change.

Agree new contract model for acute services with DGFT. Completed financial assurance requirements for ISAP

ISAP and MCP financial regulatory requirements met

Matt Procurement Board / F&P

A

3. To establish new commissioning arrangements for MH and LD in collaboration with the BC STP

Determine which MH services should be delivered locally vs Black Country. Finalise TCP plan including financial model

Public and clinical engagement on proposals. Develop commissioning plan.

New BC contract in place for BC services; separate local contract for Dudley services (through MCP).

Neill / Caroline / Laura

Commissioning / JCC

B

4. To establish new commissioning arrangements for Acute service in collaboration with the BC STP

Agree plan for18/19 BC priorities (eg: cancer). Complete service-by-service modelling with DGFT to establish which services would benefit from collaboration. Develop new public engagement plan on acute services

Determine future commissioning arrangements for priority areas. Plan with DGFT and BC partners on how collaboration will be developed.

New BC contract arrangement in place for priority services. Public views on the criteria for redesigning acute services established for future reviews.

Neill / Laura

Commissioning / JCC

B

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Aim 2 To comply with our statutory duties and responsibilities and keep people safe Objective Q1 measure Q2 measure Year-end

measure Lead Committee Cat

5. To maintain financial sustainability and ensure delivery of the QIPP programme (For 18/19 and plan for 19/20)

Evidence that 18/19 QIPP is in place and/or mitigations are established

19/20 QIPP plans prepared, clinical and public engagement undertaken

18/19 QIPP and financial targets delivery. 19/20 plans and contracts agreed.

Matt F&P B

6. To deliver the CCG quality and safety responsibilities to improve the incident reporting, assurance and service delivery of all providers

Evidence of improvement in ED services. Complete review of current SI governance processes including primary care

Improving SI Reporting in Primary Care. Refresh provider QA Schedules.

Evidence of improvement in processes and delivery across all providers.

Caroline Q&S B

7. To ensure effective performance across the system to deliver the locally agreed targets – both key measures such as A&E but also improvement in all measures, especially ones in the lower quartile

Clear agreement and evidence of progress on all plans for improvement with providers.

Trajectory of improvement on all measures in line with plan.

Overall net CCG improvement on key measures. Clear plans built into 19/20 contracts for any required changes.

Matt / Neill

F&P B

8. To improve the communication and engagement of GPs in the delivery of QIPP and system pathway improvements

Engagement with primary care through localities on their role in system improvement and production of GP practice plans. Engagement with stakeholders on priorities for system improvement.

Evidence of enhanced role of localities in enabling both Primary Care and wider system improvement with clearer 2-way line of sight to CCG GB

Evidence of improvement in engagement through 360 results. New structure of our relationship with members taking account of MCP

Caroline / Dan

PCC B

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Aim 3 To ensure strong leadership and governance arrangements Objective Q1 measure Q2 measure Year-end

measure Lead Committee Cat

9. Continuing organisational development of both system and CCG to ensure ongoing resilience and effectiveness

Route map in place for establishing revised CCG arrangements. Partnership Board has clear plan for system improvement. Newly updated OD plan for both CCG board, CCG staff and wider system.

Detailed plan established for CCG activities that will form part of the MCP; and for new CCG commissioning arrangements. New governance proposal agreed

Redesign of CCG completed with new structure, agreement with MCP in place on oversight of transferred activities

Steph / Neill

A&G / R&OD / Governing Body

B

10. Supporting the evolution of the Black Country STP towards a Black Country Integrated Care System (this has clear links to objective 9)

Established shared PMO with other BC CCGs Progressed plans for BC STP / JCC / ICS arrangements

New arrangements in place to support MH and Acute BC strategic commissioning. Clear plan for BC ICS

Outcome of ICS plans on trajectory for implementation supported by new CCG BC arrangements

Paul JCC / Governing Body

B

Aim 4 To support the development of the MCP Objective Q1 measure Q2 measure Year-end

measure Lead Committee Cat

11. Assist in the transition arrangements required to manage the MCP care model and create the new MCP (particularly in relation to CCG activities)

CCG joins transition board (subject to preferred bidder status) and agrees MOU with DGFT

Shadow arrangements in place with DGFT to emulate future state when MCP is a separate legal entity

Staff successfully TUPE to MCP, CCG activities transferred to MCP in fit-for-purpose state

Paul Transition Board / Governing Body

B

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 10 May 2018 Report: Black Country Joint Commissioning Committee Assurance Report

Agenda item No: 6.3

TITLE OF REPORT: Black Country Joint Commissioning Committee Assurance Report

PURPOSE OF REPORT: To provide the Board with the Joint Commissioning Committee (JCC)

ratified minutes of the 14 December 2017, 10 January 2018 and 15 February 2018 meetings for assurance.

AUTHOR OF REPORT: Mr P Maubach, Chief Executive Officer

MANAGEMENT LEAD: Mr P Maubach, Chief Executive Officer

CLINICAL LEAD: Dr D Hegarty, Chair

KEY POINTS:

This paper includes:

• Black Country JCC Assurance Report – 22 March 2018

• Ratified minutes of the Black Country Joint Commissioning Committee 14 December 2017 meeting

• Ratified minutes of the Black Country Joint Commissioning Committee 10 January 2018 meeting

• Ratified minutes of the Black Country Joint Commissioning Committee 15 February 2018 meeting

RECOMMENDATION: 1. That the Board receive the JCC Assurance report & minutes for

assurance

FINANCIAL IMPLICATIONS: None

WHAT ENGAGEMENT HAS TAKEN PLACE:

None

ACTION REQUIRED:

Decision Approval Assurance

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BLACK COUNTRY JOINT COMMISSIONING COMMITTEE

Date of committee meeting: 22 March 2018 Agenda Item No:

TITLE OF REPORT: Black Country Joint Commissioning Committee (BCJCC)

Assurance Report EXECUTIVE SUMMARY:

This report provides a summary of business considered at the Black Country Joint Commissioning Committee meeting on 22nd March 2018, for assurance.

IMPLICATIONS RECOMMENDATION TO THE COMMITTEE:

To note the contents of the report for update on activity and assurance

CONFLICT OF INTEREST MANAGEMENT:

None identified

COMMITTEE ACTION REQUIRED:

Assurance

REPORT WRITTEN BY:

Angela Poulton, JCC Programme Director

REPORT PRESENTED BY:

Paul Maubach, Accountable Officer

REPORT SIGNED OFF BY:

Dr Anand Rischie, Chair – Walsall CCG/Chair Black Country JCC

CONSENT AGENDA: Suitable for consent agenda PREVIOUS COMMITTEES, DISCUSSION OR CIRCULATION

This report has not been to any other committee

The CCG has a duty to promote the NHS Constitution. Principles of the NHS Constitution this report supports: The NHS provides a comprehensive service available to all Yes Access to NHS services is based on clinical need, not an individual’s ability to pay

Yes

The NHS aspires to the highest standards of excellence and professionalism Yes The NHS aspires to put patients at the heart of everything it does Yes The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population

Yes

The NHS is committed to providing best value for taxpayers’ money and the most effective, fair and sustainable use of finite resources

Yes

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Positive general duties - Equality Act 2010 The CCG is committed to fulfilling its duty under the Equality Act 2010 and to ensure its commissioned services are non-discriminatory. This report is intended to support delivery of our duty to have a continuing positive impact on equality and diversity The CCG will work with providers, communities of interest and service users to ensure that any issues relating to equality of service within this report have been identified and addressed Please indicate if there have been any equality of service issues identified in this

report No

All papers are subject to the Freedom of Information Act. All papers marked as ‘in confidence, not for publication or dissemination’ are sent securely to named individuals and they cannot be distributed further without the written permission of the Chair. Exemption 41, Information provided in confidence, applies.

The NHS is accountable to the public, communities and patients that it serves Yes

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1.0 Action Log and Matters Arising

1.1 There had been satisfactory progress on all items with the exception of establishing working ‘seat at the table’ arrangements for specialised services. Simon Collings to be asked to attend the next meeting and Black Country performance information to be obtained via National Commissioning Data Repository (NCDR) for NHS England Direct Commissioning currently hosted by Arden and Gem Commissioning Support Unit.

1.2 For joint commissioning purposes, it was confirmed that no CCG will take any decision on behalf of the other Black Country CCGs without the Executive Director responsible in the lead CCG:

• clarifying the operational scheme of delegation so that their delivery team are clear

about their remit and scope of autonomy; • ensuring his/her counterparts in the other CCGs concerned are consulted (and as a

minimum the Chief Financial Officer) and organisational support is confirmed.

2.0 STP Update

2.1 The Committee discussed the STP governance arrangements going forward which have been approved by both the Partnership and Regulators. The process will now start to appoint to the new arrangements which include an Independent Chair along with a Senior Responsible Officer and a Director level Project/ Portfolio Support post. It was agreed that how best to position the BCJCC needs careful consideration.

3.0 Clinical Leadership Group (CLG) Update

3.1 Professor Nick Harding shared that work is now progressing and a refreshed clinical strategy was being produced for the STP footprint. Prof Harding also updated on the recent CLG meeting where a proposal to prevent 133 heart attacks and 167 strokes across the Black Country was presented. In order for CLG to be ‘clinically led, managerially supported’ there is the commitment now for STP and JCC partners to consider the management resources required to enable implementation of the Group’s plans. It was agreed at there is the need to triangulate the clinical strategy with finance and performance.

4.0 Local Place Based Commissioning Update

4.1 The Accountable Officer (AO) from each CCG shared progress being made on local place based models and implications on STP partner organisations. It was agreed that regular updates should be provided at future JCC meetings as well as at Joint Executive Development Sessions to allow individual CCGs to understand each other’s organisational stories and identify synergies. The opportunity to share good practice and learning in

4

relation to commissioning alliance models was agreed to be an item for a future Joint Executive Development Session.

5.0 Mental Health and Learning Disabilities Update

5.1 Dr Helen Hibbs provided an update on status and progress:

• The Black Country Perinatal Mental Health bid has been submitted, the outcome of which is anticipated to be confirmed by the end of March;

• A second Individual Placement Support bid has been submitted; • Agreement has been reached to develop a shared Mental Health strategy for the

Black Country; • Transforming Care Together is not proceeding but the two Mental Health provider

Trusts are continuing to work in an aligned way • A Mental Health Summit is scheduled for 16th May, bringing secondary care

clinicians, GPs and other professionals to relaunch the Black Country vision for Mental Health services and to agree how to work together to achieve

• Commissioning leads from all 4 CCGs have agreed which services should be commissioned as one, supported by the providers

• A Black Country STP Mental Health Delivery ‘plan on a page’ is being produced for submission to NHSE on 26th March.

5.2 There was discussion about being clear for each of the services identified as being appropriate for commissioning as one which services should be delivered once and those to be commissioned four times to a common standard.

5.3 Dr Helen Hibbs shared that the Transforming Care Partnership trajectories were not being met owing to patient admissions sectioned into Mental Health beds. The focus needs to be on commissioning the new community services as this provides the best chance to achieve the outcomes required. NHSE continue to be dissatisfied with Black Country performance and a refreshed plan is required for the Regional Board. There was agreement by the Committee that there is the need to safeguard clinical safety as the people involved are seriously ill and some with forensic problems, and recognised the work Dr Hibbs was investing to deliver this Programme.

6.0 Acute Contracts 2018/19 Update

6.1 The AO for each CCG provided a status update regarding 2018/19 contracts with acute providers. The contracting position appears positive across the Black Country with the BCJCC acknowledging the work individual organisational teams have undertaken to secure the best possible care within the resources for the population served. The urgency of resolving construction of the Midland Metropolitan Hospital arising from Carillion’s collapse into liquidation was acknowledged.

5

7.0 Priority Programme Status

7.1 Further to the acute contracts update, Mr Paul Maubach led the discussion regarding the need to develop the Black Country narrative for acute services that sets out the joint vision for future configuration of services. Reference was made to the need for data to identify issues that need to be address collectively to agree priorities. Mrs Angela Poulton reminded the Committee that joint commissioning priorities had been identified with Commissioning leads from all four CCGs last summer, and that former Black Country reviews had been considered as part of that exercise, which had informed in part the recommendation made by CLG regarding the priorities presented to this Committee last September. The Programme Briefs for five of those priority areas were included in the papers, and the summary schedule identifies gaps in terms of clinical leads, mechanisms to deliver and people assigned to do the work.

7.2 The Committee agreed to review and confirm priorities for joint commissioning and the associated workforce to deliver once the refreshed Black Country Clinical Strategy has been produced.

8.0 Personalised Care Demonstrator site Memorandum of Understanding

8.1 The committee supported the Black Country becoming a Personalised Care Demonstrator Site, subject to each CCG agreeing the position on the Personalised Health Budget position. On approval the Black Country would receive £300,000 to progress creating opportunities for more personalised care in the form of Health Coaching, Peer to Peer support, Self-Care and Personal Care Plans. The JCC recognises the important role that people play in managing their own health and were supportive of any initiatives which bring in investment in this area. An appropriate lead and resources to coordinate the work need to be identified.

8.0 Black Country Joint Procedures of Limited Clinical Value Policy (POLCV)

8.1 Mrs Angela Poulton presented the SPH proposal to Birmingham and Solihull (BSOL) and Black Country CCGs for the provision of evidence review to support policy development in relation to 3 policy areas:

• Arthroscopic sub acromial decompression including arthroscopic lavage, debridement, labral resurfacing;

• Image guided therapeutic intra-articular joint injections with corticosteroids with/without local anaesthetic;

• Image guided high volume intra-articular injections (40mls+) of saline with or without corticosteroid and/or local anaesthetic.

8.2 Further to the decision taken at the February BCJCC to proceed to develop a shared policy in relation to sub acromial decompression, the commissioning lead from all four Black Country CCGs met to consider joining in with the BSOL evidence review being actively commissioned in order to obtain independent evidence to support any policy

6

development and to share costs for this intervention in addition to the image guided procedures detailed above. Participation would require each CCG to invest approximately £7,000.

8.3 Mrs Angela Poulton confirmed that all four CCGs have confirmed their agreement to participate and the associated funding. Mr Paul Tulley, Director of Commissioning – Walsall CCG, has offered to lead and co-ordinate this work across the CCGs and to provide progress updates for the JCC.

9.0 JCC Executive Development Sessions

9.1 It was agreed at the joint JCC Executive Development Session in February to hold a visioning event to enable the four CCGs to develop shared understanding each individual CCG’s story in addition to quarterly development sessions. The dates are as follows:

• Tuesday 1st May 2018 13:00-17:00 (Visioning) • Thursday 21st June 2018 09:00-13:00 • Thursday 20th September 2018 09:00-13:00 • Thursday 17th January 2019 13:00-17:00 • Thursday 28th March 2019

10.0 Risk Register

10.1 Mr Jim Oatridge explained that the Governance Sub Group had been tasked by the Black Country Joint Commissioning Governance Group to review the risk registers of all four CCGs to identify items of commonality and shared strategies for management to report back at a future JCC.

12.0 Consent Agenda Reports

12.1 Reports included:

• Infrastructure Sub Group • Communications and Engagement Sub Group • Governance Sub Group • January & February Governing Body Assurance Reports • Feedback from Governing Bodies • February Executive Development Session Summary • NHSE Collaborative Working Submission

12.2 The reports were noted, and no issues/questions raised.

Black Country and West Birmingham Joint Commissioning Committee (JCC)

Minutes of Meeting dated 14th December 2017

Members: Prof. Nick Harding – Chairman, Sandwell & West Birmingham CCG Jim Oatridge – Interim Chair, Wolverhampton CCG (Chair) Helen Hibbs – Accountable Officer, Wolverhampton CCG Paul Maubach – Accountable Officer, Dudley CCG & Walsall CCG James Green – Chief Finance Officer, Sandwell & West Birmingham CCG Angela Poulton - Programme Director – Joint Commissioning Committee Matthew Hartland – Chief Finance and Operating Officer, Dudley CCG; Strategic Chief Finance Officer Walsall and Wolverhampton CCG’s Mike Abel – Lay Member, Walsall CCG Andy Williams – Accountable Officer, Sandwell & West Birmingham CCG Salma Reehana – Chair, Wolverhampton CCG Dr Ruth Tapparo, GP/Board Member, Dudley CCG representing Dr Hegarty Dr Anand Rischie – Chairman, Walsall CCG In Attendance: Helen Cook, Communications, Wolverhampton CCG Jackie Eades – Executive Assistant Note taker Apologies: Julie Jasper – Lay Member, Dudley CCG and Sandwell and West Birmingham CCG Simon Collings – Assistant Director of Specialised Commissioning, NHS England Dr David Hegarty – Chairman, Dudley CCG Peter Price – Lay Member, Wolverhampton CCG Jim Oatridge – Lay Member, Wolverhampton CCG Paula Furnival, Director of Adult Social Care, Walsall MBC 1. Welcome and Apologies 1.1 Welcome and apologies as above. 2. Declarations of Interest 2.1 The majority of declarations have been provided Angela Poulton is collating all declarations

of interest and a reminder given to members to return as soon as possible.

3. Minutes & Actions from the last Meeting 3.1 Minutes from the meeting held on 19th October 2017 were agreed as an accurate record of

the meeting. 3.2 The action register was reviewed (see action table at end of notes). Actions delivered were

confirmed and others taken within the agenda. 3.3 Update on action 061 in relation to cancer performance - Helen Hibbs confirmed that work is

progressing with the Chief Executive at Royal Wolverhampton Hospital Trust (RWHT) to sign up to a Breach Policy. The Recovery plan is being updated for presentation to

Wolverhampton CCG for assurance. RWHT are currently on weekly performance monitoring phone calls with NHS England (NHSE) and Improvement.

3.4 Update on action 062 in relation to Transforming Care Together, Matt Hartland and James

Green stated that they had discussed modelling assumptions in the business case with Peter Axon which were considered reasonable. This work at the moment is stalled due to the issues around TCT’s clinical model. It was noted that the delay in developing the clinical model does impact on the Black Country ACO plans. Dr Harding suggested a small working group to look at this further to ensure that there is alignment with the work that the CCGs are doing with their Place Based Models and how this fits with the suggest clinical model for Mental Health services for the future. This action would take place outside the JCC. Paul Maubach stressed to Andy Williams that in any further discussions Walsall’s and Dudley’s position must be discussed. This was agreed.

4. Sustainability & Transformation Plan (STP) Update 4.1 Andy Williams gave an update from the Stocktake meeting that had taken place earlier that

day. NHSE had fed back their view that the Black Country STP is neither cohesive nor operating as a system. The STP is not demonstrate how it is working together to achieve improvements against key trajectories. At the STP Meeting on Monday 18th December, STP members must have open and honest conversation about how we can work collaboratively and make some meaningful progress to evidence to the regulators. The barriers and strengths of working together must be drawn out at the meeting. It was suggested that STP members need to organise themselves differently to address the priority areas with focussed teams created with a common purpose i.e. actions are undertaken just once, and the emergent arrangements shared with the Regulators for assurance.

4.2 Paul Maubach asked if we knew how many other STP’s have 18 different organisations

within their membership and pointed out that he felt that collaboration between the 4 CCG’s within the Black Country was good but did state that the Council members are mainly interested in the place based work.

4.3 Andy Williams stated that the STP needs to demonstrate the actions being taken collectively

and at pace against the five priority areas, namely urgent care, cancer, mental health, learning disabilities and maternity. The part Councils will play needs to be clarified as they are not signed up to the STP at this stage. Furthermore, the plan needs to incorporate the contribution the JCC will make and ensure that the 7 priorities for joint commissioning recommended by the Clinical Leadership Group in September are fully delegated to the JCC so work can commence. Mike Abel reiterated the point that the pace of JCC delivery needs to be increased and progress made.

4.4 Angela Poulton stated that establishing the JCC as a commissioning vehicle will remain

challenging if staff continue to see joint commissioning as optional add-on’ rather than the way we do business. Consistent with the idea that commissioning teams could be mobilised to drive forward NHSE-mandated priority areas for the STP, Angela Poulton shared that she had initiated an exploratory discussion with Alice McGee about setting up virtual cross-CCG teams to take the work streams forward under the direction of a single Executive Director to deliver the agreed strategy. This is possible without changing the organisation employing staff involved and preserving existing terms and conditions.

5. Update from Clinical Leadership Group

5.1 No report as the November meeting was cancelled owing to the unplanned absence of the Chair.

6. JCC Executive Development Day 6.1 It was agreed to re-schedule the session to ensure all Accountable Officers are available to

participate. Dates will be canvassed in the New Year.

7. Reports from Subgroups (formerly Task & Finish Groups) 7.1 Reports submitted were noted for assurance that work is continuing. 8. Specialised Commissioning

8.1 Deferred until next meeting.

9. Mental Health & Transforming Care Partnership (Learning Disabilities & Autism)

9.1 Angela Poulton gave a brief overview of the reports enclosed and provided an update on the Mental Health reconciliation exercise being led by Tony Gallagher, Chief Finance Officer for Walsall and Wolverhampton CCGs. Each CCG had undertaken an individual analysis of their Mental Health spend using a common framework and were now working to establish the financial opportunities that exist if services are commissioned using different tariffs. Indicative timescales suggest that this work will be complete by March 2018.

9.2 Angela Poulton explained that the successful award of NHSE funds (circa £100K) to commission the Black Country Mental Health Crisis and Intensive Community Support for Children and Young People requires a decision regarding the preferred option for delegated decision making and how this work might be supported. All options identified in the paper received from the Governance Subgroup were discussed, and it was explained that each describe a different stage of the development in governance arrangements for joint commissioning that can accommodate growth in the delegated remit. 9.3 It was confirmed that the JCC had been given delegated authority to act on behalf of the four CCGs in relation to the submission of Black Country mental health bids for new funding and subsequently how new funding secured is spent. Angela Poulton stated that Wolverhampton CCG had coordinated bid development and made the submission on behalf of the four CCGs. On this basis the Committee agreed option 2 with Wolverhampton as the lead coordinating CCG. 9.4 James Green stated that option is akin to host commissioner arrangements already used for other services such as WMAS and 111. Matt Hartland proposed that going forward the options should be considered for any additional service(s) for which the JCC has commissioning responsibilities transferred to it. This was agreed. 9.5 Angela Poulton explained that in the very near future the four CCGs would need to agree the future model of care for people with Learning Disabilities and Autism and the associated four services specifications that has been co-developed. The Committee acknowledged that Sandwell & West Birmingham CCG were providing a significant proportion of the operational support to TCP, and agreed that this should continue and that governance option 2 should apply. Matt Hartland pointed out that this option is only for any new money that is secured as part of a bid and that it does not apply to existing financial budget arrangements that require sign off by each CCG.

9.6 Members agreed that the wording in section 4.3 of the report could not be accepted in its current form but did agree the sentiment in principle. It was agreed that existing practice would continue where one CCG takes decisions and implements actions on behalf of other CCGs in the Black Country where the pace of decision making and delivery will not allow a fully collaborative approach. In such instances, the leading CCG will ensure that the Director level officer clarifies the operational scheme of delegation so that the delivery team are clear about their remit and scope of autonomy. Matt Hartland pointed out that for on-going performance management there is the need to ensure appropriate activity modelling. 9.7 In response to the clarification that the JCC now has delegated responsibilities Mike Abel asked when this meeting will be held in public. Angela Poulton confirmed that this is included in the Terms of Reference. Discussion followed considering how other CCG statutory committees operated and it was concluded that as the minutes of this Committee included in the publicly available Governing Body meeting papers for each CCG that this meets public accountability requirements. 10. AOB

10.1 Angela Poulton asked the Committee to verify that the agreed quoracy set out in the Terms of Reference was still appropriate. It was confirmed that the JCC is quorate where the following make-up of those attending each meeting is as follows:

• Chair or Vice Chair • One member from each CCG • One Accountable Officer • One Chief Finance Officer • One lay member

It was agreed that no changes were required. Angela Poulton stated that all future meetings will proceed on this basis.

Date and Time of Next Meeting Wednesday 10th January, 10.30am – 12 noon at Kingston House.

JCC Action Log

No. Date Action Lead Status Update 051 17

August 2017

Simon Collings to confirm in writing to Kiran Patel that Specialised Services position have no concerns regarding current Vascular Services delivery

Simon Collings

To confirm status at October meeting

056 28 Sept 2017

David Hegarty to request via the Clinical Leadership Group that all clinicians take the opportunity to discuss A & E issues at forums in which they participate

David Hegarty

Meeting was cancelled therefore still outstanding

066 19th Oct 2017

Angela Poulton to contact Simon Collings for an update on Specialised Commissioning and to progress the ambition for delegation where appropriate

Angela Poulton

Meeting scheduled 3rd January

068 19th Oct 2017

Jim Oatridge to present the ratified Joint Governance Group Terms of Reference at the next appropriate JCC meeting

Jim Oatridge

Black Country and West Birmingham Joint Commissioning Committee (JCC)

Minutes of Meeting dated 10th January 2018

Members: Prof. Nick Harding – Chairman, Sandwell & West Birmingham CCG Paul Maubach – Accountable Officer, Dudley CCG & Walsall CCG James Green – Chief Finance Officer, Sandwell & West Birmingham CCG Angela Poulton - Programme Director – Joint Commissioning Committee Matthew Hartland – Chief Finance and Operating Officer, Dudley CCG; Strategic Chief Finance Officer Walsall and Wolverhampton CCG’s Mike Abel – Lay Member, Walsall CCG Salma Reehana – Chair, Wolverhampton CCG Dr Anand Rischie – Chairman, Walsall CCG Julie Jasper – Lay Member, Dudley CCG and Sandwell and West Birmingham CCG Simon Collings – Assistant Director of Specialised Commissioning, NHS England Peter Price – Lay Member, Wolverhampton CCG Jim Oatridge – Lay Member, Wolverhampton CCG In Attendance: Charlotte Harris – Note Taker, NHS England Laura Broster – Director of Communications and Public Insight Sarah Fellows - Mental Health Commissioning Manager Ali Shaukat – Programme Manager Apologies: Helen Hibbs – Accountable Officer, Wolverhampton CCG Andy Williams – Accountable Officer, Sandwell & West Birmingham CCG Dr David Hegarty – Chairman, Dudley CCG Dr Ruth Tapparo, GP/Board Member, Dudley CCG. Paula Furnival, Director of Adult Social Care, Walsall MBC 1. INTRODUCTION 1.1 Nick Harding welcomed members, introduced Charlotte Harris and thanked Jackie Eades for

her support to the JCC.

1.2 Apologies noted as above.

1.3 There are four members who have not submitted their signed declarations of interest forms, and the request was made for them to be provided by the end of the month. Nick Harding asked the committee if anyone had any declarations of interest they wished to declare in relation to the agenda for the meeting. None were given. Action: Outstanding declaration of interest forms to be provided to Charlotte Harris by the end of January.

1.4 The minutes of the meeting held on 14th December were agreed as an accurate record of the

meeting with the following exceptions: • Section 4.4 ‘option’ should be ‘optional’

• Section 9.7 ‘public’ should be ‘publicly’

1.5 Paul Maubach referred to section 9.6 in the previous minutes and section 4.3 of the corresponding report, informing members that Walsall CCG’s Governing Body felt that the wording relating to the matter in the update paper (section 1.2.6c) presented to them did not reflect the nature of the discussion. Walsall’s Governing Body did not support the lead CCG acting in isolation. It was confirmed that this is not an issue with the minutes but the JCC Update paper which is in the process of being presented to Governing Bodies. Angela Poulton reminded members that when this matter was discussed, it had been agreed that the lead CCG at the very least should speak to an Exec level manager in all the other CCGs before proceeding. James Green stated that agreement is being sought for the continuation of existing practice where one CCG takes decisions and implements actions on behalf of other CCGs in the Black Country where the pace of decision making and delivery will not allow a fully collaborative approach, subject to a locally determined operational scheme of delegation and the lead CCG specifically gaining approval from a Director level officer of the other CCGs.

Action: Angela Poulton to circulate the revised wording in relation to 1.2.6c to Governance leads and Chief Financial Officers to ensure consistency of agreement by all CCG Governing Bodies.

1.6 With reference to the minutes to the meeting held on 28th September 2017, Angela Poulton informed members that section 4.4 of the September JCC minutes stated that Walsall CCG were “locating a GP surgery onto the Manor site” when this should read had “suggested GP triage at the Manor”.

1.7 The action register was reviewed (see action table at end of the notes). Actions delivered

were confirmed and other taken within the agenda. Regarding action 051, Simon Collings confirmed that the Specialised Services Commissioners have no concerns with Vascular Services delivery and that Dudley Group of Hospitals NHS Trust are not on the list of providers not compliant with the 7-day standard. An overview of Specialised Services Commissioning Strategy was given and emphasised that any changes to where services will be provided will not be made without public consultation. In response to Laura Broster, Simon Collings confirmed that public and patient involvement support was being provided at a regional level by Jessamy Kinghorn.

2. CORE BUSINESS 2.1 Nick Harding informed that the STP had not met since the last meeting. Paul Maubach had

attended the West Midlands meeting of Accountable Officers the day before and fed back that NHSE are increasingly channelling commissioning requests on an STP basis, including future operating plans. Paul Maubach stated that this is pertinent to the discussion in establishing joint commissioning capability later on the agenda. Angela Poulton added there is likely to be greater scrutiny regarding mental health and potentially at STP level going forward, with a particular focus on compliance with the Mental Health investment standard.

2.2 Nick Harding confirmed that the Clinical Leadership Group is meeting on the 25th January and the agenda will cover Respiratory, Hypertension and Urgent Care. NHSE are increasingly asking for STP leads for specific areas and a recent request had been for a Black Country Stroke lead to participate in the West Midlands review that includes Thrombectomy. Dr Anand Rischie referred to the request for expressions of interest in August and asked for a progress update. Angela Poulton reported that the level of interest from GPs had been good but there had been concerns that no secondary care expressions had been received as a mix of both was considered important. The decision taken at the

September Clinical Leadership Group was to identify appropriate candidates through clinical networks and leads, and to approach individuals when there was definitive pieces of work to be undertaken.

2.3 Nick Harding stated that nominated clinical leads for the STP were now needed, and that as the lead for Urgent Care is a much larger job than perhaps other lead roles individual consideration will need to be given prior to making appointments. There was discussion regarding the link between JCC progress and governance arrangements, and a view shared that STP clinical leads might benefit from being plugged into a CCG-led programme management approach for delivery. Paul Maubach shared the CCG lead process being used in Worcester. Nick Harding suggested a discussion be held between Paul Maubach, Andy Williams and Helen Hibbs to explore how leads can be appointed and agreed with Simon Collings suggestion to include Specialised Services. Paul Maubach stated that this could be an opportunity to speak to Alison Tonge to see what resources NHSE have to assist. Action: Paul Maubach, Andy Williams and Helen Hibbs to meet to explore the appointment process to STP Clinical Lead roles before the February JCC.

2.4 Angela Poulton provided a verbal update on progress made in relation to commissioning

responsibilities delegated to the JCC. In relation to commissioning the Black Country Mental Health Crisis, Intensive Community Support and Paediatric Liaison Service for Children and Young People, the specification is near completion and discussions underway with mental health providers. Regarding Transforming Care Partnership Learning Disabilities and Autism services, this Committee has responsibility for ensuring patient reviews are undertaken and the non-recurrent development funding is spent according to the agreed plan. Sandwell and West Birmingham CCG are acting as the lead coordinating CCG, and the lead Senior Commissioning Manager is preparing a timeline from approval of proposed clinical model to operational commencement date. There are indications that the proposed future community model and the associated shared view of the financial implications for each CCG should be ready for presentation to the JCC at the February meeting.

Angela Poulton left the meeting to collect Sarah Fellows and Shaukat Ali. 2.5 Nick Harding referred members to the current risk register. There was a discussion about

the format and on the suggestion of Jim Oatridge it was agreed that the risk registers of all four CCGs will be reviewed by the Joint Governance Forum and a recommendation made regarding a shared template for all four CCGs and the JCC to use going forward.

Action: Risk registers be reviewed by the joint governance forum with a view to recommending a standard template at Feb JCC to be used by all CCGs and the JCC.

Angela Poulton re-joins the meeting. 3. DECISIONS REQUIRED 3.1 Establishing Joint Commissioning Capability for the Black Country

3.1.1 Angela Poulton referred members to the paper. There are currently two issues: the need for

clarity in relation to commissioning for West Birmingham as Governing Bodies approved to remove responsibility for this geography in December and the need to strengthen the contribution of this committee to STP performance. The JCC needs to agree how to establish the capability to provide a united commissioning response to performance issues. In addition the relationship between the JCC/CCGs and a future Accountable Care System (ACS) arrangement, and associated risks and opportunities need to be determined. Angela Poulton informed the committee that Helen Hibbs had shared that Alison Tonge is delivering

ACS development workshops and the need to ensure there is no overlap in the work plan arising out of today’s discussion.

3.1.2 There was a discussion about the impact of having the right governance arrangements to

enable the JCC to take a definitive view on matters and ensure the appropriate actions take place. Nick Harding shared that the experiences in other parts of the country, with Manchester cited as a specific example, highlight that waiting to achieve the right governance arrangements will delay progress and delivery. Manchester are on their fourth governance arrangement so far.

3.1.3 Paul Maubach shared the discussion held by the STP Sponsor Group, describing the three strands of the STP: the Partnership agenda with its focus on the wider determinants of health, the local place-based agenda with associated structures and the NHS agenda requiring the implementation of a robust financial and strategic plan. The JCC represents a single forum out of which clear processes and schemes of delegation to drive through implementation of the plan relating to the NHS strand, and this agenda should be the focus for this Committee. Paul Maubach shared that through discussions with other Accountable Officers in the West Midlands the approach to delivering the NHS agenda is through joint commissioning committee Programme Management Office (PMO) arrangements being established. The view was expressed that establishing a PMO would not be sufficient by itself. A discussion had been held regarding establishing a chief executives group within the STP, who would do the NHS workload.

3.1.4 There was discussion about the current remit CCGs have in relation to leading strategy development, performance management and service redesign and the option to replicate this for the STP via the JCC with identified resources. Paul Maubach shared that the resources will have to come from CCGs and the consideration now needed regarding how the STP is structured to deliver its priorities and how CCGs reorganise, aligning existing staff to create teams focussing on lead areas. A view is needed on what the shared capacity between the four CCGs is to do this, and the associated commitment to do this. It was acknowledged that to date STP leads were doing the STP element of their work in addition to their substantive job, and that CCGs need to create performance and commissioning capacity that is properly resourced. Simon Collings suggested that if the JCC is seen as a tangible STP vehicle then other resources could be assigned to it.

3.1.5 Jim Oatridge stated that there was still the need to clarify the purpose and remit of the JCC, and what needs to be achieved by it. Nick Harding shared that increasingly NHSE will want to work at STP level rather than with individual CCGs. Mike Abel referred members to the need to be careful about the language being used in relation to identifying resources to ensure it is clear that it is not new resources that are being created but the redistribution and realignment of existing staff resources. Paul Maubach stated that there are some key performance issues that need performance management and/or service reviews, and referred members to the seven clinical priorities recommended to this Committee by the Clinical Leadership Group in September 2017.

3.1.6 Paul Maubach raised the disconnect that exists between the JCC and the STP as the JCC does not include West Birmingham, and shared that Andy Williams will be taking a paper to Sandwell and West Birmingham CCG’s Governing Body regarding the future relationship Sandwell has with West Birmingham. West Birmingham currently sits across two systems, and attending to the NHS agenda was felt to need the JCC to be aligned to the STP. It was agreed that it needs to be clear where decisions relating to both parts of Sandwell and West Birmingham’s geography will be taken so the JCC can work out what it needs to operate

effectively going forward. Nick Harding confirmed that Sandwell and West Birmingham will confirm the arrangements in due course.

Action: Nick Harding to confirm the West Birmingham position in due course.

3.1.7 Nick Harding referred to the key decisions required in the paper. It was confirmed that the

JCC is committed to taking effective control of service reviews and performance reviews, and now needs to agree how it will do this. Paul Maubach suggested the Accountable Officers (AOs), Chief Finance Officers (CFOs) and Angela Poulton meet to decide where the CCGs will get best value from doing things once, what to resource jointly and to agree actions to resource properly before the next JCC. The different perspectives that exist regarding the relationship the JCC has to the future ACS was agreed will require a further meeting after the February JCC to allow for a wider strategic debate with Chairs and lay representatives. Actions:

• Charlotte Harris to arrange a meeting between AO’s, CFO’s and Angela Poulton to discuss where the CCGs will get best value from doing things once, what to resource jointly and to agree actions to resource properly before the next JCC meeting.

• Charlotte Harris to arrange a meeting between AOs/CFOs/Chairs/Lay representatives for a wider strategic debate regarding the relationship the JCC has to the future ACS to be scheduled between the February and March JCC meetings.

3.1.8 There was a discussion regarding the difference between the STP and the future ACS is and

the need for due diligence to understand the risks involved in developing into the ACS with a shared control total. Paul Maubach requested that James Green and Matthew Hartland to develop a plan for the next committee meeting setting out the plan to undertaking the necessary due diligence and how to involve providers. Action: James Green and Matthew Hartland to develop a plan for the next committee meeting on how to undertake the necessary diligence to support the Black Country STP becoming an ACS in the future.

3.2 Specialised Commissioning

3.2.1 Simon Collings explained that there had been a number of issues with cancer services in

Sandwell and West Birmingham, and the three core elements are Chemotherapy, Specialist Gynaecology Oncology surgery and Acute Oncology. In October 2017 it became clear that there were insufficient enough consultants to deliver the service safely at Sandwell and West Birmingham NHS Trust and the decision taken to transfer services to University Hospital Birmingham commencing end March 2018 a temporary arrangement for 12 months. The patient and public involvement was confirmed and the Joint Overview and Scrutiny Committee briefed, with a further briefing on the 25th January. The Trust gave notice to cease providing Gynaecology Oncology and owing to the complexity of surgery patients require other providers are unable to develop services to accommodate this change in six

months. Services will be delivered by other providers from July 2018 to ensure safe provision.

3.2.2 There was a discussion about the long term development plan for specialised services in the Black Country. NHS England must be accountable for commissioning Specialised Services as it is written into the Health and Social Care Act. In the West Midlands there was a move to try to devolve some services (dialysis, allergies, chemotherapy, HIV) to be commissioned by CCGs and the JCC seen as a good vehicle with which to engage for this purpose. This effectively stopped in July 2017, with ‘seat at the table’ continuing via the JCC but largely delivered through the Specialised Commissioning Oversight Board. There is a paper on devolution going to the Oversight Board Group on 12th January. Paul Maubach requested finance and activity data for Specialised Services for the Black Country.

Action: Simon Collings to provide the finance and activity data for Specialised Services provided for Black Country registered patients at future JCC meetings.

3.3 Perinatal Mental Health (Pilot Clinical Proposal)

3.3.1 Sarah Fellows and Ali Shaukat summarised the paper presented and requested approval to proceed with submitting a joint bid for new transformation funding and to set perinatal mental health clinics in all Black Country acute hospitals (only Sandwell and West Birmingham Hospitals NHS Trust currently has a clinic). Matthew Hartland raised concerns as there is no guarantee of securing the additional money and the need to ensure Directors of Commissioning and CFO’s sign off the clinical model and financial implications. This would ensure lessons have been learnt from the joint CAMHS bid in the autumn last year. Laura Broster offered communications and engagement support. There was discussion regarding the need to be able to evaluate the impact of developing the services with the new funding.

3.3.2 Nick Harding stated that it would be good to be able to report in a few years’ time the

number of lives saved as a result of this service development and associated investment. The JCC confirmed support to establish clinics in all acute hospitals subject to the costed clinical model being signed off by appropriate officers in all CCGs and the evaluation approach being agreed.

Actions: • Shaukat Ali to circulate the current version of the bid. • The clinical model and financial implications for the perinatal mental service to be

signed off by the Director of Commissioning and CFO for each CCG before the final draft of the bid is produced.

• Sarah Fellows/Shaukat Ali to include a clear evaluation methodology with outcome measures prior to and for inclusion in the bid document submitted.

• The final bid document to be circulated and agreed by each CCG prior to submission to NHSE.

5. Subgroup Updates (Consent Agenda)

4.1 Reports were noted by members. With regard to the Systems Design & Contractual Frameworks Subgroup, Paul Maubach indicated that its current work should be completed by June 2018.

4.2 Laura Broster informed the committee that there was a decision not to do an all-staff

communications as the majority of the meeting discussed the STP position. It was agreed that the communications that will be sent after today’s meeting will reflect main items from both meetings. In drafting staff communications care is needed to ensure items are presented as recommendations where further approval to proposals are required.

5. Summary of Actions and Any Other Business 5.1 Angela Poulton informed the Committee that Mike Hastings had suggested the

establishment of a workgroup that he will lead to develop a way to enable Cancer Multi-disciplinary Teams to access electronic patient records. The benefits of this include shortening the care pathway (62 day target), and informing the clinicians of the range of co-morbidities patients have and unnecessary repeat diagnostics. The JCC supported the work to be done.

5.2 Mike Abel suggested the format of papers need to be reviewed as there are missing items.

Action: Angela Poulton to review the format of JCC papers and use of templates.

6. Date of Next Meeting – please note time of meeting

Thursday 15th February 2018, 15.30-17.30, Dudley CCG, Orange Room, 2nd Floor, BHHSCC, DY5 1RU

JCC Action Log

No. Date Action Lead Status Update 068 19th Oct

2017 Jim Oatridge to present the ratified Joint Governance Group Terms of Reference at the next appropriate JCC meeting

Jim Oatridge

Meeting on 29th January

069 10th Jan 2018

Outstanding declaration of interest forms to be provided to Charlotte Harris by the end of January

JCC members

070 10th Jan 2018

Angela Poulton to circulate the revised wording in relation to 1.2.6c to Governance leads and Chief Financial Officers to ensure consistency of agreement by all CCG Governing Bodies

Angela Poulton

071 10th Jan 2018

Paul Maubach, Andy Williams and Helen Hibbs to meet to explore the appointment process to STP Clinical Lead roles before the February JCC.

Paul Maubach

072 10th Jan 2018

Risk registers be reviewed by the joint governance forum with a view to recommending a standard template at Feb JCC to be used by all CCGs and the JCC.

Jim Oatridge

073 10th Jan 2018

Nick Harding to confirm the West Birmingham position in due course.

Nick Harding

074 10th Jan 2018

Charlotte Harris to arrange a meeting between AO’s, CFO’s and Angela Poulton to discuss where the CCGs will get best value from doing things once, what to resource jointly and to agree actions to resource properly before the next JCC meeting.

Charlotte Harris

075 10th Jan 2018

Charlotte Harris to arrange a meeting between AOs/CFOs/Chairs/Lay representatives for a wider strategic debate regarding the relationship the JCC has to the future ACS to be scheduled between the February and March JCC meetings

Charlotte Harris

076 10th Jan 2018

James Green and Matthew Hartland to develop a plan for the next committee meeting on how to undertake the necessary diligence to support the Black Country STP becoming an ACS in the future.

James Green and Matthew Hartland

077 10th Jan 2018

Simon Collings to provide the finance and activity data for Specialised Services provided for Black Country registered patients at future JCC meetings.

Simon Collings

078 10th Jan 2018

Perinatal Mental Health Joint Bid (Pilot Clinics) • Shaukat Ali to circulate the current version of the bid • The clinical model and financial implications for the

perinatal mental service to be signed off by the Director of Commissioning and CFO for each CCG before the final draft of the bid is produced

• Sarah Fellows/Shaukat Ali to include a clear evaluation methodology with outcome measures prior to and for inclusion in the bid document submitted

• The final bid document to be circulated and agreed by each CCG prior to submission to NHSE

•

Sarah Fellows/Shaukat Ali

No. Date Action Lead Status Update 079 10th

Jan 2018

Angela Poulton to review the format of JCC papers and use of templates

Angela Poulton

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Black Country and West Birmingham Joint Commissioning Committee (JCC)

Minutes of Meeting dated 15th February 2018

Members: Prof. Nick Harding – Chairman, Sandwell & West Birmingham CCG Paul Maubach – Accountable Officer, Dudley CCG & Walsall CCG Helen Hibbs – Accountable Officer, Wolverhampton CCG Andy Williams – Accountable Officer, Sandwell & West Birmingham CCG Dr Salma Reehana – Chair, Wolverhampton CCG Dr Anand Rischie – Chairman, Walsall CCG Matthew Hartland – Chief Finance and Operating Officer, Dudley CCG; Strategic Chief Finance Officer Walsall and Wolverhampton CCG’s James Green – Chief Finance Officer, Sandwell & West Birmingham CCG Angela Poulton - Programme Director – Joint Commissioning Committee Mike Abel – Lay Member, Walsall CCG Julie Jasper – Lay Member, Dudley CCG and Sandwell and West Birmingham CCG In Attendance: Charlotte Harris – Note Taker, NHS England Laura Broster – Director of Communications and Public Insight Dr Ruth Tapparo – GP/Board Member, Dudley CCG Paula Furnival, Director of Adult Social Care, Walsall MBC Claire Parker – Chief Officer – Quality, SRO TCP Apologies: Dr David Hegarty – Chairman, Dudley CCG Peter Price – Lay Member, Wolverhampton CCG Jim Oatridge – Lay Member, Wolverhampton CCG Simon Collings – Assistant Director of Specialised Commissioning, NHS England 1. INTRODUCTION 1.1 Nick Harding welcomed members. 1.2 Apologies as noted above 1.3 All Declaration of Interest forms have been submitted. Nick Harding asked the committee if

anyone had any declarations of interest they wished to declare in relation to the agenda of the meeting. None were given.

1.4 The minutes of the meeting held on the 10th January were agreed as an accurate record of

the meeting with the following exceptions:

• Paul Maubach requested that his reference to the establishment of a Chief Executives sponsor group to deliver the NHS element of the STP agenda be added to section 3.1.3

• Action in relation to clarifying the West Birmingham position to be added on page 6, section 3.1.6

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1.5 The action register was reviewed (see table at the end of the notes). Actions delivered were confirmed and others taken within the agenda.

1.6 Regarding action 068, Angela Poulton provided the group with an updated draft of the Joint

Governance Group Terms of Reference to remove West Birmingham from the remit. 1.7 Regarding action 070, Angela Poulton confirmed she had sent the revised working to the

governance leads. Matt Hartland stated that he had not seen the revised wording in relation to 1.2.6c. Action: Angela Poulton to send the revised wording in relation to 1.2.6c to the Chief Financial Officers.

1.8 Regarding action 071, the Accountable Officers have met but have not fully covered the

appointment process to STP Clinical Lead roles. There will be a clearer idea after the meeting scheduled on 19th February. Nick Harding is undertaking identifying what is needed to make the Clinical Leadership Group work so the case for resources can be made.

1.9 Regarding action 072, Angela Poulton reported that discussion at the Joint Governance

Group had identified a reluctance to move to a single Risk Register template. Julie Jasper added that the Governance Subgroup had been tasked with reviewing the risk registers for all four CCGs to review commonalities and strategies and to report back to a future meeting.

1.10 Regarding action 075, Matt Hartland tabled a proposal for the due diligence for review and

comment. The proposal sets out a desktop exercise to be undertaken by each CCG, driven by Chief Financial Officers (CFOs). It will develop the STP modelling undertaken, building on the current planning round and Sustainability and Transformation Partnership (STP) plan but also take account of other potential occurrences such as the opening of the Midland Metropolitan Hospital based on the knowledge of projected activity flows. It is proposed that on completion of phase one there will be a discussion with providers. No timeline agreed but the work could not be finalised until after the 18/19 contracts are agreed. James Green suggested the proposal be discussed with CFOs for further joint development. Paul Maubach suggested that the exercise needs to inform the risk sharing process that organisations might be party to in the future. There was discussion regarding the benefits of signing up to a system control total and the importance of being clear that the benefits outweigh the risks. Members agreed the approach was good practice but greater provider openness is essential. James Green stated that for the exercise to be meaningful, action was required at Chief Executive level to achieve greater openness by providers before phase 2 of the work. Helen Hibbs emphasised the importance of greater openness and transparency in becoming an Integrated Care System (ICS).

1.11 Regarding action 077, Angela Poulton stated that a performance information had not been

made available and that Simon Collings had indicated that the situation was changing. Simon Collings to provide an update at the next meeting.

1.12 Regarding action 078, the final bid document needs to be submitted by 9th March. The pre-

final draft is due to be finished and circulated to CFOs by close of play on 16th February.

2. CORE BUSINESS – DECISIONS REQUIRED 2.1 Black Country Transforming Care Partnership (TCP) Community Model 2.1.1 Helen Hibbs discussed assurance concerns raised in the letter from the Director of

Commissioning Operations (DCO) team regarding Black Country delivery of the TCP

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programme. Helen Hibbs stated that whilst the Black Country STP is going to miss its trajectory, it has been made clear that patients will only be discharged from the hospital if it is clinically safe to do so. There are some delayed transfers of care about which greater understanding is needed. NHSE need assurance that the new community is being commissioned creating increased urgency for the four CCGs to agree to and implement the proposed future model.

2.1.2 Claire Parker explained that TCP is seeking to reduce beds and increase community

services in each place i.e. intensive and forensic support across the Black Country. Transition funding has been made available and the provider needs to be authorised to proceed to implementation. The business case, including the clinical model and financial implications, have been produced by the TCP Operations Group involving the provider. The model will be implemented on a pilot basis for 12 months, and further discussions are required regarding the potential for a longer contract in the future. Claire confirmed that Laura Broster had been involved in developing the engagement plan, and parallel engagement will need to be undertaken. By not doing this there are implications on the patients and the trajectory. Helen Hibbs stated that whilst there are some risks in proceeding to implement the new community model, there are greater risks by not going ahead. This Committee and the four CCG Governing Bodies need to agree the model and authorise its implementation with urgency.

2.1.3 Paul Maubach acknowledged that in the context of bed reductions and suggested that the

only change in the existing and future community model lies in Tier 3 - Intensive Community Support and Forensic Community Support. Helen Hibbs confirmed this, emphasising the importance of ensuring there is a community forensic psychiatrist across the patch going forward but also the necessary upskilling of existing staff in the community teams to establish a safe and resilient service. Paul Maubach initiated a discussion about providers, Helen Hibbs confirming that the Black Country Partnership Foundation Trust (BCPFT) is currently the only provider in the Black Country who can provide this. National TCP delivery requirements will not allow the delay a full procurement at this stage would require, hence the proposal to proceed to implementation via a contract variation for 12 months.

2.1.4 Claire Parker confirmed that the business case excludes West Birmingham. Paul Maubach

noted that the level of investment by CCG differs and implementation of the model would have differential impacts on each CCG. Helen Hibbs explained that the business case is based upon current funding abilities, and shared that Wolverhampton have already implemented the model resulting in lower spending on beds so there is the potential for reduced costs in the longer term. Going forward the provider needs to be to be held accountable for delivery of work and greater understanding of the financial implications for each CCG as the service is established. Matt Hartland shared that the CFO’s are meeting on 16th February to discuss financial aspects of the model.

2.1.5 Laura Broster confirmed the engagement plan to be proportionate and that it allows for co-

production and future influence. However, Laura raised that she felt there is a risk of legal challenge owing to the proposed changes involving reductions in the number of inpatient beds with reference made to the commitment made in Dudley with the Local Authority in relation to Ridge Hill. Helen Hibbs shared the process undertaken in Wolverhampton and that as patients and carers wanted the new model there were no problems. Claire Parker confirmed that Sarah Norman, Executive Sponsor for the Black Country TCP, is reasonably comfortable that the plan is proportionate and no issues are anticipated where empty beds are closing.

2.1.6 Dr Anand Rischie shared that many Learning Disabilities patients are looked after in the

community by GPs and the proposed clinical model does not describe how community team

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will work with primary care. All four place based teams are different and the model will need to allow for this. Helen Hibbs confirmed that this can be added to the model description.

Action: Claire Parker to ensure the clinical model includes details about how the Community Learning Disability Team will work with primary care.

2.1.7 Helen Hibbs emphasised the focus for the TCP programme is getting patients out of the

secure hospitals and moving them into community settings. Paul Maubach agreed that this is the right thing to do for patients but raised concerns about ensuring the changes do not lead to placements outside the system. Helen Hibbs explained that this model with BCPPT is about assessment and treatment beds but agreed the need for commissioning focus and ensuring the provider is held to account for delivery and continues to work co-productively through the pilot year. Nick Harding noted that this is a national requirement and if the change is better for patients it will be supported.

2.1.8 Nick Harding referred member to the acute problem relating to delivering the trajectory and

delayed discharge for which Alison Tonge is seeking assurance. Helen Hibbs shared that whilst commitment continues to achieving the trajectory set by NHSE it was potentially not achievable at the outset owing to the impact of St Margaret’s on the population base as well as other factors including step down from Specialised Commissioning and new patients requiring admission as well as some readmissions. However, there are still some unnecessary delays occurring.

2.1.9 Paul Maubach suggested that TCP programme performance reports should be reported to

the JCC every month which was agreed. Nick Harding asked how the STP assurance and Andy Williams shared that this was the function of the TCP team working with the providers. Anand Rischie asked for clarification regarding whether the new model will be commissioned jointly or by each CCG. Helen Hibbs confirmed that the TCP Board take a joint lead role and that individual CCG in governance terms is acting independently but are commissioning one model across the four geographical areas that best fits with local arrangements.

2.1.10 Claire Parker referred member to the TCP programme relates to learning difficulties and

autism, and that commissioning for autism has yet to commence. Paul Maubach asked whether there were clinical interventions for autism, Helen Hibbs explaining that whilst it is unusual there are some patients without a learning disability diagnosis that have severe autism and behavioural difficulties, requiring behavioural management interventions funded by health.

2.1.11 Angela Poulton asked whether the difficulty in getting activity levels impacting upon the

ability to identifying staffing levels and related costs referred to in page 4 of the clinical model paper presents a risk. Claire Parker noted some are being addressed by the transition funding for recruiting and retaining staff and confirmed that the main risk remains the Funding Transfer Agreements.

2.1.12 Nick Harding noted concerns regarding resources and whether more would be needed.

Helen Hibbs stated that there is enough resource as long as we are working in the right way. Angela Poulton confirmed that the business case had been shared with Commissioning Directors/Chief Officers. The JCC approved the business case subject to the agreed changes to the clinical model (refer to 2.1.6 above). It was agreed that a briefing paper setting out the recommendations would be provided by Claire Parker for presentation to all four CCG’s Governing Bodies in March. Action: Claire Parker to supply a briefing of recommendations, including the clinical model, around the TCP Community Model to presented to all Governing Bodies.

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2.2 Integrated Care System (ICS) Development Programme 2.2.1 Helen Hibbs referred members to the papers sent out and stated that the language had now

changed from Accountable Care Systems (ACS) to Integrated Care Systems, with the ambition that systems will be integrated by 2020. This fits in with the Five Year Forward View as the STP is about working in an integrated way. The DCO team have created a development programme across the West Midlands to support this transition with support from the national team.

2.2.2 The STP is early on the journey, and there needs to be evidence of clear financial stability

and open accounting with the providers to become an ICS. It is more about the journey than the destination. It is voluntary but all other STP’s are participating in it. There is also a national commissioning capability programme which the STP has been asked to take part in. Helen Hibbs does not have the full details of this but believes it is an NHS funded programme that is looking at how commissioners can become more strategic commissioners going forward. Referring to the paper entitled “What good looks like”, this sets out the core capabilities required to be an ICS.

2.2.3 The programme is designed to support the STP in becoming an ICS. To be an ICS, the

population footprint needs to be over one million. Helen Hibbs believes the model of the programme works well with the place based work already occurring. The vision is for GP practices to come together in groupings on 30,000-50,000 patients, which a lot of areas are already doing. The next layer is the integrated place based layer which fits well with the MCP model and what is being done in Wolverhampton and Walsall. The ICS is the overarching system for providers linked and working together and the strategic commissioning layer. Helen Hibbs shared her view that the system should continue on the journey to becoming an ICS.

2.2.4 Andy Williams suggested that at the system leadership session on 19th February it would be

useful to use the ‘What good looks like” checklist as part of the agenda and have a discussion about where the system currently is. Helen Hibbs confirmed that ICS is included on the agenda for the JCC Executive Day on the 16th February. Andy Williams described the programme to become an ICS to be an integrating process that is a means by which the end can be achieved.

2.2.5 Helen Hibbs confirmed that the first part of the process is a self-assessment on readiness at

a workshop scheduled in March, the results of which will inform any additional support that NHSE will provide.

2.2.6 Paul Maubach noted that the population requirements have doubled from the ACS plans to

the ICS plans, and that the Black Country still have over one million population should West Birmingham not be included. Paul Maubach stated the issue of West Birmingham needs to be resolved to understand the development into an ICS. Andy Williams informed that there is a West Birmingham Commissioning Committee that will be nested in other systems as it is not over one million in population. It will need to rest in another ICS, but there is a question as to which one. Helen Hibbs suggested there could eventually be a bigger layer above the ICS and that the ICS number could fluctuate. Andy Williams noted that it is not about the destination but the journey of working on relationships. Ruth Taparro questioned whether the change from accountable to integrated in itself would deliver greater success in system working. Helen Hibbs responded by stating that there needs to be more clarity on the workstreams and their work in addition to how we are working collaboratively. This will enable there to be focus on both the place and the system as a whole.

2.2.7 There was a discussion regarding the benefits of having a single control total system, the

benefits being identified as increased freedoms and less regulation and the consensus view

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that needs to be certainty that the benefits outweigh the risks being picked up by the CFOs as discussed earlier in the meeting.

2.3 Governance Update 2.3.1 Andy Williams stated that the STP has three distinct accountabilities and to date the system

has attempted to deliver all three in one process. There is the agenda to have place-based partnerships that make sense to primary and social care and there needs to be a way to deliver this. There is the NHS agenda requiring STP partners with a health focus to be working collaboratively, and managing upwards to secure delegated resources. The third accountability is the need to work at a greater scale to deliver whole system change with a focus on the wider determinants of health involving working with the West Midlands Combined Health Authority.

2.3.2 To progress, different governance arrangements are needed. Members were referred to the

paper which suggests the appointment to three posts: an Independent Chair, a Programme Director, and an NHS Lead/SRO. The independent Chair was described as a key role that would be an ambassador for the organisation and would hold the partners to account. To ensure independence there is an argument that a person not in the NHS should be appointed, and the post holder needs to possess a specific set of qualities and gravitas to be effective. The STP needs more robust infrastructure, with current resources being provided largely by one CCG in addition to their substantive roles. The recommendation is to have a full-time Programme Director, a joint appointment resourced by all CCGs to reflect an essentially ‘commissioner’ contribution. The NHS Lead suggested acts as a co-ordinator for the system as a whole, either a part time or full time role when other systems are considered. For independence, the suggestion is that this role is full-time. Andy Williams is consulting on these proposed successor arrangements including meetings with Chief Executives and Councils, and sought the view of the committee. All the discussions will be correlated for decisions to be made at the March STP meeting.

2.3.3 Helen Hibbs stated that in her view the CCGs should hole the Programme Director role as work the post holder will deliver is currently the remit of CCGs, and only CCG’s have the capacity and capability to manage the work programmes. Paul Maubach agreed that work should sit with the CCG’s as most of the issues to review are NHS issues. The structure supporting that resource would need to be equally accountable to all four CCG’s, essentially sitting above CCGs. The issues relating to what the PMO structure looks needs sorting, and ICS self-assessment should help with this as it needs to be aligned to the future ICS. Paul Maubach confirmed he agreed the principle but felt the structure supporting the role should be reviewed after the ICS workshop.

2.3.4 There was discussion about the number of days per week required for the independent

Chair and that the number of days finally agreed was dependent upon whether the incumbent would be required as a coordinating figurehead or an executive Chair. Paul Maubach suggested the SRO could be a part time role and part of their current job. Nick Harding advised that other STP leaders who are SRO’s have found that it has become a full time role. Paul Maubach suggested that there could be benefit from feedback from other SRO’s and how it worked for them. Andy Williams said the amount of work will determine how much emphasis is put on each of the roles.

2.3.5 Paula Furnival stated that the appointment of an independent Chair was both important and

symbolic, and supported a non-NHS appointment which she felt would be received positively by all Local Authorities. The STP areas that have positive narratives around their partnership working have non-NHS chairs. It needs to be very clear about the areas that are joined, such as the place-based health and care and referred to existing governance

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mechanisms that can progress the wider determinants accountability. Paula Furnival felt that the proposed governance arrangement presents an opportunity to reset some of the negativity and work more jointly. Andy Williams agreed that this structure offers potential for some success rather than the current negativity, and the system needs to demonstrate where it matches ‘what good looks like’. Nick Harding noted it would be good for local authorities to see that health and social care are working collaboratively across the system. Paula Furnival confirmed the pre-briefing had been done with the chief executives. The measure of success is moving on from the discussions on governance and leadership structure, and to actually proceeding to put it in place.

2.3.6 Nick Harding noted that the next version needed to include work time commitments required

for all positions and not just the independent chair. Andy Williams will feed the comments from this committee into the revised proposal, and the role of the independent Chair needs further discussion.

2.3.7 Nick Harding stated that to be a fully developed ICS the voice of primary care has to be ‘at

the top table’ and whilst acknowledging the challenges in achieving this he felt it would help to show that GPs are being included early on. Andy Williams requested feedback and support from the Chairs on who to invite from Primary Care to have this conversation, indicating that the meeting needs to take place in the next 2-3 weeks.

2.3.8 It was noted that financial implications need further consideration and agreed that the

revised governance proposal to be brought back to the March JCC meeting

Actions: - CCG Chairs to supply a list of potential attendees to Andy Williams for a meeting

with Primary Care representatives to discuss the suggested STP governance structure in the next few days.

- Andy Williams to present the revised costed STP governance structure at the March JCC meeting.

2.4 GP Forward View Workforce Plan 2.4.1 Paul Maubach presented the latest iteration of the GPFV workforce plan which he was

confident would achieve NHSE assurance. The target increase in GPs to more than 800 set out in the plan was considered extremely challenging. A formula for recruiting additional GP’s has been developed including retaining GPs and international recruitment but financial support is needed to do this. Work is underway to submit an application to participate in the national programme for international recruitment. Andy Williams stated that he was unsure whether CCGs could underwrite the costs for any GPs recruited overseas as CCGs cannot provide employment. Paul Maubach agreed that commissioners should not underwrite finding jobs for GPs recruited but could determine an appropriate phrase to include in the proposal that reflects CCG commitment to finding appropriate employers.

2.4.2 There was discussion about the agenda being how to create new models of care to alleviate

the current pressure on GPs and the need to develop a primary care workforce agenda, properly resourced. The JCC agreed the GPFV workforce plan.

2.4.3 Mr Maubach led the discussion on the paper presented setting out a proposal for the Black

Country to undertake primary care workforce planning going forward. There was a discussion about there being neither the capacity nor the capability to develop plans within current arrangements and there the need to resource properly. Andy Williams acknowledged the immense work involved to develop credible plans and asked whether CCGs could work differently to free up the necessary resources without adding to costs. Helen Hibbs stated

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that CCGs do not have the funding to recruit to new posts and supported this suggestion. It was agreed that the activities currently undertaken by primary care commissioning staff needs to be identified with a view to considering which to stop to potentially create the necessary resource to fulfil primary care workforce planning in the future.

Actions: - Paul Maubach to meet with Primary Care teams leads to agree the phrase to

include in the international recruitment proposal that reflects CCGs commitment to find appropriate employers

- Paul Maubach to lead the work to assess current work undertaken by CCG primary care staff and identify how to create capacity for primary care workforce planning.

2.5 JCC Executive Development Session 2.5.1 Angela Poulton referred members to the agenda. The purpose of the session was to update

Executives on the collaborative work underway, understand the ICS vision and journey and suggest ways to better collaborate moving forward. The agenda was agreed.

2.6 STP Funding for Self-care and Personalisation 2.6.1 Laura Broster referred members to the paper, and explained that Dudley CCG has been an

intensive support for empowering people and communities for the last 12 months. NHSE would like this to continue on a Black Country scale and escalate it to be a national demonstrator site for personalised care. STP support is required. There are some targets and trajectories that are happening already around the Black Country for personal health budgets and best practice. These can be used to justify an income stream that could come from an agreed Memorandum of Understanding (MOU).

2.6.2 The JCC supported the proposal and it was agreed that a completed MOU would be brought

back to the March JCC meeting, and it was noted that this would then require STP sign off. It was agreed that AOs would confirm a lead officer for their CCG with responsibilities for personalised care to work with Laura Broster.

Actions: - AOs to confirm named leads for the personalised care demonstrator site initiative

in the next few days - Laura Broster to present the personalised care demonstrator site MOU for

approval at the March JCC 3. CORE BUSINESS – FOR INFORMATION 3.1 Clinical Leadership Group Update 3.1.1 Prof Nick Harding reported that the Clinical Leadership Group (CLG) meeting on the 25th

January was a success and that he sensed real momentum behind the Group despite the tensions existing between the work to be done and resources available to do it. Much work is being undertaken on cardiovascular disease, with the team reviewing what actions will make the real difference. There is a respiratory group led by Helen Ward that will report into the CLG in the future. There was discussion regarding the work programme and whether frailty should be added. It was noted that clinical leads will need to be appointed. There are two West Midland reviews occurring; stroke and end of life care. Updates were provided regarding the Local Maternity Strategy and how it will be implemented. There were questions raised over whether other groups should be added such as frailty and some clinical leads

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need to be appointed. Dr Ruth Tapparo suggested it would be good to learn from other clinical leads in other areas.

3.1.2 Dr Anand Rischie, Chair – Walsall CCG, added that there had been a good discussion on

urgent care performance. The biggest challenge for urgent care will be working across the network as a whole. Paul Maubach suggested there should be some work on air quality for the respiratory group as this is a big issue for the Black Country.

3.2 Feedback from Governing Bodies 3.2.1 Angela Poulton informed all recommendations had been sent to the governing bodies except

for the section on 1.2.6c, where if a decision is required quickly, one CCG could make it. At the last JCC meeting, it was agreed that it should be that all four CCG’s are party to the decision making. One of the lay members had suggested a phone call to the chief officer to ensure that there was a robust response if a quick decision is needed. Each CCG is still responsible for making sure their duties are fulfilled. Previously, the governing bodies, other than Wolverhampton, had met to have the discussion. Helen Hibbs confirmed that it was a way of focussing everyone on a matter when a decision is needed quickly.

4. SUBGROUPS UPDATE (CONSENT AGENDA) 4.1 No update reports provided.

5. SUMMARY OF ACTIONS AND ANY OTHER BUSINESS 5.1 Nick Harding referred members to the opportunity to include subacromial decompression, a

shoulder operation, as a procedure of limited clinical value (POLCV). Anand Rischie stated that the procedure is ineffective it is done at the wrong time and that there are triaging measures in place at Walsall now to ensure recommendations for surgery are appropriate. Issues in Walsall arose from private providers recommending surgery too soon. Mike Abel noted the feedback from Walsall CCG would be good. Nick Harding said it is way of saving money as the procedure can be done at the wrong time resulting in no affect.

5.2 Angela Poulton advised that Paul Tulley has suggested this, and has identified that £1.8m

was spent last year in the Black Country on the procedure. Shropshire CCG have already reviewed and established this as a POLCV. Angela Poulton asked the JCC to support the policy to be developed for the Black Country, pointing out that Sandwell and West Birmingham currently work with Birmingham and Solihull to develop such policies. Joint policy development was agreed, and the final POLCV to be presented at a future JCC meeting.

5.3 Dr Anand Rischie suggested reviews need to be done on clinical coders as he felt there may

be double coding, and this could be done collaboratively. Helen Hibbs advised they had had several in depth clinical coding reviews and Royal Wolverhampton Trust, and there had been no evidence of inaccuracies. Matt Hartland confirmed that providers are also audited independently.

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Action: Angela Poulton to confirm POLCV for subacromial decompression to be developed for the Black Country to commissioning leads, and to present to policy at a future meeting.

6. DATE OF NEXT MEETING – please note time of meeting

Thursday 22nd March, 13:30-15:30, Room 1, Jubilee House, Bloxwich Lane, Walsall, WS2 7JL

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JCC Action Log

No. Date Action Lead Status Update 070 10th

Jan 2018

Angela Poulton to circulate the revised wording in relation to 1.2.6c to Governance leads and Chief Financial Officers to ensure consistency of agreement by all CCG Governing Bodies

Angela Poulton

071 10th Jan 2018

Paul Maubach, Andy Williams and Helen Hibbs to meet to explore the appointment process to STP Clinical Lead roles before the February JCC.

Paul Maubach

072 10th Jan 2018

Risk registers be reviewed by the joint governance forum with a view to recommending a standard template at Feb JCC to be used by all CCGs and the JCC.

Jim Oatridge

073 10th Jan 2018

Nick Harding to confirm the West Birmingham position in due course

Nick Harding

074 10th Jan 2018

Charlotte Harris to arrange a meeting between AOs/CFOs/Chairs/Lay representatives for a wider strategic debate regarding the relationship the JCC has to the future ACS to be scheduled between the February and March JCC meetings

Charlotte Harris

075 10th Jan 2018

James Green and Matthew Hartland to develop a plan for the next committee meeting on how to undertake the necessary diligence to support the Black Country STP becoming an ACS in the future.

James Green and Matthew Hartland

076 10th Jan 2018

Simon Collings to provide the finance and activity data for Specialised Services provided for Black Country registered patients at future JCC meetings.

Simon Collings

077 10th Jan 2018

Perinatal Mental Health Joint Bid (Pilot Clinics) • Shaukat Ali to circulate the current version of the bid • The clinical model and financial implications for the

perinatal mental service to be signed off by the Director of Commissioning and CFO for each CCG before the final draft of the bid is produced

• Sarah Fellows/Shaukat Ali to include a clear evaluation methodology with outcome measures prior to and for inclusion in the bid document submitted

• The final bid document to be circulated and agreed by each CCG prior to submission to NHSE

Sarah Fellows/Shaukat Ali

078 10th Jan 2018

Angela Poulton to review the format of JCC papers and use of templates

Angela Poulton

079 15th Feb 2018

Claire Parker to ensure the clinical model includes details about how the Community Learning Disability Team will work with primary care.

Claire Parker

080 15th Feb 2018

Claire Parker to supply a briefing of recommendations, including the clinical model, around the TCP Community Model to presented to all Governing Bodies.

Claire Parker

081 15th Feb 2018

CCG Chairs to supply a list of potential attendees to Andy Williams for a meeting with Primary Care representatives to discuss the suggested STP

Nick Harding/Dr Salma

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No. Date Action Lead Status Update governance structure in the next few days. Reehana/Dr

Anand Rischie

082 15th Feb 2018

Andy Williams to present the revised costed STP governance structure at the March JCC meeting.

Andy Williams

083 15th Feb 2018

Paul Maubach to meet with Primary Care teams leads to agree the phrase to include in the international recruitment proposal that reflects CCGs commitment to find appropriate employers

Paul Maubach

084 15th Feb 2018

Paul Maubach to lead the work to assess current work undertaken by CCG primary care staff and identify how to create capacity for primary care workforce planning.

Paul Maubach

085 15th Feb 2018

AOs to confirm named leads for the personalised care demonstrator site initiative in the next few days

Paul Maubach/ Andy Williams/ Helen Hibbs

086 15th Feb 2018

Laura Broster to present the personalised care demonstrator site MOU for approval at the March JCC

Laura Broster

087 15th Feb 2018

Angela Poulton to confirm POLCV for subacromial decompression to be developed for the Black Country to commissioning leads, and to present to policy at a future meeting.

Angela Poulton

DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 10 May 2018 Report: Quality & Safety Committee Report

Agenda item No: 7.1

TITLE OF REPORT:

Quality & Safety Committee Report

PURPOSE OF REPORT: To provide on-going assurance to the Governing Body regarding quality

and safety in accordance with the CCG’s statutory duties.

AUTHOR(s) OF REPORT: Mrs Caroline Brunt, Chief Nurse Ms Marcia Minott, Head of Quality & Safety

MANAGEMENT LEAD: Mrs Caroline Brunt, Chief Nurse

CLINICAL LEAD: Dr Ruth Edwards, Clinical Executive Lead for Quality

KEY POINTS:

Dudley Group NHS Foundation Trust (DGFT) • CQC Inspection Visits March 2018 and report publication April

2018 • Maternity Performance Assurance Group (MPAG) • Serious Incident Management and KPI’s update

Dudley Walsall Mental HealthTrust (D&WMHT)

• Serious Incidents Review & Management Black Country Partnership Foundation Trust (BCPFT)

• Quality issues - update Primary Care

• Care Quality Commission (CQC) update (Appendix 1)

Infection Prevention & Control (IPC) Safeguarding Update

Black Country Local Maternity Systems (LMS) Transforming Care Programme (TCP) Risk Register Review CQUINS

RECOMMENDATION:

1) Accept this report as a source of ongoing assurance that the CCG Quality & Safety Committee continues to maintain rigorous oversight of all clinical quality standards in line with the CCG’s statutory duties.

FINANCIAL IMPLICATIONS: None to report

WHAT ENGAGEMENT HAS TAKEN PLACE:

User experience is an essential component of quality assurance and surveillance and as such public views and feedback form part of the triangulation of hard and soft intelligence.

ACTION REQUIRED:

Decision Approval

Assurance

DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 10 MAY 2018 QUALITY & SAFETY COMMITTEE REPORT

1. INTRODUCTION

1.1 The CCG Quality & Safety Committee meets bi-monthly and was chaired on March 20

2018 by Dr. Ruth Edwards, Clinical Lead for Quality & Safety. This report is a material summation of the Committee’s meeting and contains details of activity being carried out by the Quality and Safety team. The report also contains information on key activities since the last meeting was held.

1.2 The Governing Body will be briefed on any contemporaneous matters of consequence arising after submission of this report at its meeting.

2. KEY ISSUES DISCUSSED

2.1 Dudley Group NHS Foundation Trust (DGFT)

2.1.1 CQC Inspection visits to DGFT DGFT has been the subject of a further inspection to the emergency department and medical escalation areas by the CQC on March 15 2018. Further areas of concern were identified. These included poor governance, high use of agency staff, failure to identify patients at risk of sepsis, and poor management of the deteriorating patient. The Trust was able to set out immediate actions in response to findings to include two additional physicians in the Emergency Department (ED) and a walkabout by senior members of the Trust to ensure effective monitoring and escalation of patients ahead of a new system planned for implementation 28 April 2018. Clinical leads from the CCG Quality and Safety team and the Trust joined colleagues from NHS Improvement, NHS England (NHSE), Dudley MBC Office of Public Health and carried out a further assurance and monitoring visit on 22 March following the CQC findings.

The CQC inspections have been completed with the final report now produced and published. The Trust has been rated overall as ‘requiring improvement’ with the A&E department deemed ‘inadequate’. The CQC cited a number of systems and processes within the A&E department which required immediate improvement. The Trust achieved a rating of ‘good’ for caring with the CQC identifying outstanding practice in the maternity and community services. Following the CQC report, the Trust executive team recognised that there was still work to do to ensure a robust safety culture across the whole organisation. The CCG continue to be involved in the Dudley System Oversight & Assurance Group meetings together with NHSE, NHSI and CQC. These meetings provide assurance on the action plans being implemented to address the CQC findings and focus on both specific operational improvements as well as broader actions regarding governance. The next meeting is planned for Thursday 3 May.

2.1.2 Maternity Performance Assurance Group (MPAG)

Following previous concerns raised, MPAG meetings have now taken place. Dates have been agreed and there is appropriate representation from senior members of DGFT management at MPAG.

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2.1.3 Serious Incident (SI) Action Plan and updated Key Performance Indicators (KPIs) Details presented to the Committee outlined the efforts being made by the Trust to achieve the agreed KPIs. Performance remains challenging with the Trust identifying actions required to meet the targets and to improve. Additional resources have now been provided to support the work of the governance team.

2.2 Dudley & Walsall Mental Health (D&WMHT) A letter outlining areas of concerns in respect of quality issues has been forwarded to the Trust. A response has been received by the CCG which provides details of the work being done by the Trust to address the concerns.

2.2.1 Management of Serious Incidents Dudley CCG continues to work collaboratively with Walsall CCG to improve the management of serious incidents within D&WMHT with a particular focus on suicide avoidance.

2.3 Black Country Partnership Foundation Trust (BCPFT)

A monthly escalation call has been held with the Director of Nursing BCPFT and the Dudley CCG Chief Nurse to discuss quality issues at BCPFT. Key areas such as safeguarding and timeliness of CQRM required actions have been raised: the Trust has been requested to provide evidence of greater rigour in the assurance process during clinical quality review meetings (CQRM) Specific issues have been raised regarding care to patients with learning disabilities and these have been followed up by a series of visits by the CQC and the CCG. Areas for improvement have been identified to improve safety and the quality of care. A focus on the assessment and clinical treatment is a priority to evidence progress for patients.

2.4 Primary Care

2.4.1 An updated summary of CQC Primary Care inspections is provided in Appendix 1:

• AW Surgeries have been inspected as part of the CQC’s 10% re-inspection of good or outstanding practices. The report is awaited.

• Castle Meadows Surgery have been rated as requires improvement for the safe and well-led domains following a focused inspection. They will be subject to a full inspection within the next 12 months as a result of the registration change

• Pedmore Medical Practice have been rated on re-inspection as good overall and for all domains following a previous requires improvement rating overall and for the safe, effective and well-led domains

2.4.2 Incident Management There are no open RCA’s being reviewed by the CCG.

2.5 Infection Prevention & Control Dudley CCG ended the 2017/18 year with 64 cases of C. difficile, below the threshold of 76

cases. DGFT ended the 2017/18 year with 30 cases of C. difficile, breaching the threshold of 29

cases, Of the 29 cases, 18 were deemed to have been avoidable. This is an encouraging result and demonstrates a continued improvement on last year.

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2.6 Safeguarding Update

2.6.1 Safeguarding Children and Looked After Children Annual report.

The report has been completed and will be presented to the next Q&S Committee

2.6.2 Child Death Overview Panel (CDOP) The Designated Nurses, Safeguarding Children from Dudley and Sandwell CCGs are working with the Chairs of the respective Safeguarding Boards and CDOPs to merge the two panels. The future plan is to bring together the four panels that cover the Black Country STP on a bi-annual basis to discuss emerging themes and to share learning.

2.6.3. Commissioning and Procurement safeguarding standards. The CCG Safeguarding Team have completed a set of safeguarding standards which will be included in all future procurement process to ensure that providers are fulfilling their statutory responsibilities with regards to safeguarding adults and children.

2.6.4 NHSE Safeguarding Assessment Tool (SAT). The CCG safeguarding team has completed the self-assessment tool as directed by NHSE. An action plan has been developed and forwarded to the NHSE Head of Safeguarding.

2.7 Black Country Local Maternity Systems (LMS) The LMS work streams are continuing to hold regular meetings with CCG representatives attending where appropriate. The LMS is currently awaiting the outcome for the Wave 2 Perinatal Mental Health bid which was submitted on the 9 March 2018, to support and implement the much needed perinatal mental health services to women in the Black Country STP.

2.8 Transforming Care Programme (TCP)

Dudley and the wider Black Country remain on escalation as a result of the ongoing delays in meeting the defined trajectory. An outline of plans being introduced by NHSE to support the Black Country to achieve the defined trajectory has been shared. Additional resource from NHSE has been identified to support local activity.

The Black Country TCP Board has requested that NHSE provide additional scrutiny of the patients who are unlikely to be discharged during the life of the programme. Local scrutiny has taken place led by all four CCG’s.

2.9 Risk Register

The risk register was reviewed in full during the last meeting, a number of risks have been closed following discussion.

2.10 CQUINS

All Dudley CCG Providers have provided evidence of CQUIN delivery during quarter 4. Reviews and progress taking place has been discussed during all provider CQRMs.

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3.0 RECOMMENDATIONS

The Board is asked to accept this report as a source of ongoing assurance that the CCG Quality & Safety Committee continues to maintain rigorous oversight of all clinical quality standards in line with the CCG’s statutory duties.

Marcia Minott, Head of Quality & Safety 24 April 2018 Enc: Appendix 1 – Primary Care – Care Quality Commission (CQC) Ratings Summary

All other practices not listed above are rated as good or outstanding for all domains and therefore not due for re-inspection unless chosen as part of the 10% re-inspection schedule.

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 10 May 2018 Report: Audit & Governance Committee Report

Agenda item No: 8.1

TITLE OF REPORT: Audit & Governance Committee Report

PURPOSE OF REPORT: To advise the Board of the key issues discussed and agreed at the Audit & Governance Committee meetings on 22 March and 3 May 2018

AUTHOR OF REPORT: Mr M Hartland, Chief Operating and Finance Officer

MANAGEMENT LEAD: Mr M Hartland, Chief Operating and Finance Officer Mrs J Jasper, Chair – Audit & Governance Committee.

CLINICAL LEAD: Dr R Tapparo, Clinical Executive Finance, Performance & Business Intelligence

KEY POINTS:

Items received for assurance or approved under delegated authority at meetings held on 22 March and 3 May 2018: • IG – End of Year Report on the IG Toolkit approved for submission

at 92%. 2018/19 GDPR work-plan received. • BAF & RR – Update presented under separate agenda item. Risks

132 and 145 approved for closure. • Annual Report & Accounts 2017/18 – Update on draft Annual

Report, Annual Governance Statement & Accounts submissions. • Audit & Governance Committee Annual Report 2017/18 –

approved included as Appendix 1 for assurance. • External Audit – Progress report received for assurance. • Internal Audit – Head of Internal Audit Report received; Progress

report and recommendation tracker received for assurance; 5 reports received; Internal Audit Strategy 2018-21 approved; Internal Audit Plan 2018/19 approved; Briefing received.

• Anti-Fraud – Progress report received for assurance; Counter Fraud work-plan 2018/19 approved; Annual Report including Self Review Tool submission and Staff Survey results received for assurance.

• Local Security Management – Security Management Progress report received for assurance; Security Management Policy approved; Security Management Strategy approved; Security Management work-plan 2018/19 approved.

• Conflict of Interest Training – On-line training requirements agreed; Conflicts of Interest Policy approved.

• Committee Terms of Reference – Revised Terms of Reference approved and included as Appendix 2 for assurance.

• Operational Scheme of Delegation – Updated operational Scheme of Delegation approved.

Other updates and assurances received – Consultancy Spend; Monitoring compliance with prime financial policies; Governance Improvement Plan; FOIs; Declarations of Interest; CCG Policies Update

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RECOMMENDATION: The Board is asked to:

1) Receive this report for assurance 2) Note the decisions made under delegated authority

FINANCIAL IMPLICATIONS: None

WHAT ENGAGEMENT HAS TAKEN PLACE: Extensive engagement around the Annual Report & Accounts

ACTION REQUIRED: Decision Approval Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 10 MAY 2018 AUDIT & GOVERNANCE COMMITTEE REPORT 1.0 INTRODUCTION

The report summarises the key issues discussed at the Audit & Governance Committee meetings on 22 March and 3 May 2018.

2.0 KEY INDICATOR SUMMARY The following items are indicators of the current position in relation to the main responsibilities and obligations of the Committee as defined in the CCG’s Constitution and the Committee’s Terms of Reference. Indicator Position RAG 1. Regulation and Control Good progress

CCG Governance Arrangements – Constitution Updated Constitution submitted to NHSE and approved August 2016. Currently under review - initial updates for approval March 2018 Board.

Scheme of Delegation Revised Operational Scheme of Delegation approved 22 March 2018.

Compliance with Prime Financial Policies No issues Board & Committee Effectiveness Continued progress against

Governance Improvement Plan.

2. Annual Report and Accounts (ARA) 2017/18 NHSE & External Audit training events attended. Draft ARA submitted in line with timetable & NHSE requirements.

3. Operational & Risk Management Good Progress Anti-Fraud and Security Anti- Fraud and Local Security

Management Specialist Work-plans 2018/19 approved. Progress reports being received.

Risk Management Arrangements – Combined BAF & Risk Register in place; Chairs/Management Leads of committees attending & updating Audit & Governance Committee;

BAF & Risk Register updated monthly and actively managed. BAF & Risk Register critically reviewed and updated at Committee level.

Report newly commissioned services Procurement Strategy & reporting updated to reflect new managing conflicts of interest guidance.

External Audit Submitted draft ARA currently being audited.

Internal Audit Audit Plan 2018/19 approved March 2018. All audits complete-overall assurance rating currently significant.

Other Policies Polices being reviewed and updated routinely.

Other Policies – Business Continuity Policy Revised Business Continuity Plan and Policy approved. Desk-top exercises being undertaken.

4. Information Governance CSU IG staff on-site regularly progressing IG Work-plan and supporting CCG officers. Toolkit rated Green by Internal Audit.

Information Governance Group established IG Steering Group meetings scheduled throughout 2018/19

Compliance with Information Governance toolkit Toolkit 2017/18 IG Toolkit submitted with 92%

Information Asset Management structure to be established with IAOs and IAAs identified from CCG staff

IG working with IAOs & IAAs to take forward information asset register update.

IG Policy Revised Policy approved May 2017. Freedom of Information requests (FOIs) All responded to within required

timescale

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3.0 ITEMS DISCUSSED 3.1 Information Governance The Committee received the Information Governance (IG) End of Year Report on the IG Toolkit

(TK) Submission from its Commissioning Support Unit (CSU) IG officer. This gave an overview of the performance in relation to IG TK version 14.1 and summarised the information that had been presented to previous meetings. The report provided assurance that the IG TK evidence was present and compliant for a successful version 14.1 level 2 submission on or before 31 March 2018 at a score of 92%. It was noted that 66% was required for a level 2 submission and any score above that meant the CCG had achieved level 3 in the majority of areas. The score of 92% was an increase of 3% on last year’s score of 89%. The Committee approved its submission with a score of 92%.

The 2018/19 General Data Protection Regulations (GDPR) work-plan was received for assurance.

3.2 Board Assurance Framework & Risk Register The Committee received the Board Assurance Framework & Risk Registers as at 14 March and 10 April. It approved the closure of risks 132 and 145 as well as a number of changes to risk descriptions and scores under its delegated powers. It also agreed to recommend the closure of risk 6 and the creation of new risk 152 to the Board. At its latest meeting it was also agreed that an additional risk should be developed recognising the serious implications of failing to comply with GDPR.

3.3 Annual Report & Accounts 2017/18 The Committee received the draft Annual Report and Annual Governance Statement and the

latest draft version of the full Annual Report & Accounts for assurance. The Committee noted that all deadlines had been met, amendments had been made following an assurance process led by the local NHS England team and a number of non-material amendments were still to be made would be made to rr.

3.4 Audit & Governance Committee Annual Report 2017/18 The Committee received and approved the Audit & Governance Committee Draft Annual Report

for 2017/18 (Included as an Appendix 1). 3.5 External Audit The Committee received the External Audit progress report highlighting a slight change in

materiality levels. The treatment of the reporting arrangements for the Chief Executive Officer and Chief Finance & Operating Officer between Dudley and Walsall CCGs was discussed to ensure consistent treatment in the respective Annual Reports.

3.6 Internal Audit The Committee received the Draft then the Updated Annual Report and Head of Internal Audit

Opinion on the effectiveness of the system of internal control for the year ended 31 March 2018. This gave an overall opinion of significant assurance, noting that no significant internal control issues (as defined by HM Treasury) were required to be reported in the CCG’s Annual Governance Statement.

The Committee noted that during 2017/18 the CCG’s Internal Audit provider completed an extensive

self-assessment against the Public Sector Internal Audit Standards (PSIAS) and this was assessed by a suitably qualified and experienced external assessor. The CCG’s Internal Auditor gained the highest rating that can be achieved under the guidance.

The Committee also received for assurance:

• Audit Report - Financial Management & QIPP - full & significant assurance respectively • Audit Report - Conflicts of Interest Management - significant assurance • Audit Review - MCP Development – significant assurance • Audit Report - IG Toolkit confirming score of 92% - rated Green, evidence greater than 85% • Assessment of Assurance Framework 2017/18 - A Rated

The Committee received updates on the recommendation tracking report for assurance and

expressed concern about delays in implementing recommendations by certain teams. It was agreed this would be taken forward internally.

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The Committee received and approved the 3-year Internal Audit Strategy 2018-21 The Committee received and approved the Internal Audit Plan for 2018/19 and also received the

Internal Audit Charter for information. The Committee received the NHS Key Developments Briefing Updates for February and March

2018 for information. 3.7 Anti-Fraud The Committee received an Anti-Fraud Progress Report for assurance noting that there had been

one new referral and an update would be provided at the appropriate stage. The Committee received and approved the Counter Fraud Work-plan for 2018/19. The Committee received the Annual Report, including Annual Self Review Tool submission to

NHS Counter Fraud Authority for assurance. The Committee received the Anti-Fraud Awareness CCG Staff Survey Results for assurance and

the Standards for Commissioners 2018/19 for information. It was disappointed to note that the response to the staff survey was low and it was agreed that a different approach would be taken in 2018/19.

3.8 Local Security Management The Committee received a Security Management Progress report for assurance noting a number of minor issues. The Committee received and approved a revised Security Management Policy and Security Management Strategy. The Committee received and approved Security Management Work-plan for 2018/19. 3.9 Conflicts of Interest The Committee received an update on the nationally mandated Conflicts of Interest On-line

Training. The Committee agreed that all members of staff and Board Members should complete module 1 by the end of May, with other groups, in particular Board Members and those involved in procurements, completing modules 2 and/or 3 later in the year.

The revised Conflicts of Interest Policy was received and approved subject to some minor changes

that were agreed. 3.10 Committee Term of Reference The Committee received and approved the revised committee Terms of Reference that had been

updated in line with NHS England’s recommendations. (Included as an Appendix 2) 3.11 Operational Scheme of Delegation The Committee received and approved an updated Operational Scheme of Delegation. 3.12 Other Issues

The Audit & Governance Committee considered and received updates and assurance in respect of:

• Consultancy Spend • Monitoring compliance with prime financial policies • Update on Governance Improvement Plan received for assurance • Freedom of Information report for the period 1 January – 13 March 2018 • Declarations of Interest Register for Board members for the period 1 April 2017 – 31 March

2018 • CCG Policies Update

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4.0 DECISIONS TAKEN UNDER DELEGATED POWERS • Approved submission of End of Year Report on the IG Toolkit at 92% • Approved closure of Risks132 and 145 • Approved the 3-year Internal Audit Strategy 2018-21 • Approved the Internal Audit Plan 2018/19 • Approved the Counter Fraud work-plan 2018/19 • Approved revised Security Management Policy • Approved revised Security Management Strategy • Approved Security Management Work-plan 2018/19 • Approved revised Conflicts of Interest Policy • Approved revised Audit & Governance Committee Terms of Reference (Appendix 1) • Approved revised Operational Scheme of Delegation and Security

5.0 DECISIONS REFERRED TO THE BOARD

• Separate report to Board on BAF & Risk Register.

6.0 RECOMMENDATIONS The Board is asked to:

1) Receive this report for assurance 2) Note the decisions taken under delegated authority

Mr M Hartland Chief Operating and Finance Officer May 2018 Appendix 1 – Audit & Governance Committee Annual Report 2017/18 Appendix 2 – Terms of Reference for the Audit & Governance Committee – Version 6.1

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Appendix 1 NHS DUDLEY CLINICAL COMMISSIONING GROUP (CCG) Audit & Governance Committee Annual Report 2017/18

Background The Audit & Governance Committee is established under Governing Body delegation with approved terms of reference that are aligned with the NHS Audit Committee Handbook published by HFMA in June 2014. These terms of reference were reviewed and updated by the Committee with formal approval by the Board in May 2018. The CCG Governing Body has delegated specific responsibilities to the Audit & Governance Committee in it’s Constitution, as follows:

- Approve the group’s operational scheme of delegation that underpins the group’s ‘overarching scheme of reservation and delegation’ as set out in its constitution.

- Approve the group’s annual report and annual accounts. - Approve the group’s counter fraud and security management arrangements. - Approve the group’s risk management arrangements. - Approve a comprehensive system of internal control, including budgetary control, which underpins

the effective, efficient and economic operation of the group. - Approve the group’s arrangements for business continuity - Approve arrangements for ensuring appropriate safekeeping and confidentiality of records and for

the storage, management and transfer of information and data. The Committee consists of three lay members (one of whom is chair) and the secondary care doctor. It has met seven times during the financial year 2017/18 and has discharged its responsibilities for scrutinising the management of risk and controls which affect all aspects of the organisation’s business. Principal review areas Governance, risk management and internal control The Committee has reviewed the Annual Governance Statement to ensure it reflects the committee’s view on the CCG’s system of internal control. It has sought assurance from the Head of Internal Audit Opinion, has received regular updates during the year from external audit and received other appropriate independent assurances in order to gain a view of the CCG’s system of internal control. The Committee considers that the governance statement is consistent with the Committee’s view on the CCG’s system of internal control and can be supported by the Board. The CCG has continued to actively manage its Board Assurance Framework and Risk Register in accordance with the revised Risk Management Strategy and Policy approved by the Board in January 2017. During 2017/18 CCG committee members have critically evaluated the risks assigned to their Committee. The outcome of this has meant a greater understanding of the individual risks and clarity about how the risks are being managed. Since the review there has been increased engagement by Governing Body members and more focused debate. As the CCG’s Board Assurance Framework (BAF) and Risk Register are combined the Board receives assurance on all red risks of 16 and over (BAF) as well as those risks for which it is directly accountable. The Committee believes that while adequate systems for risk management are in place, there needs to be a continued focus on risk in 2018/19 given the challenges the Clinical Commissioning Group faces, in particular the QIPP requirement and procurement of the Multi-Specialty Community Provider (MCP). Internal Audit’s assessment of the Assurance Framework 2017/18 confirms that an Assurance Framework has been established which is designed and operating to meet the requirements of the 2017/18 Annual Governance Statement (AGS) and provide reasonable assurance that there is an effective system of internal control to manage the principal risks identified by the organisation.

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Information Governance (IG) Under its delegated responsibility for information governance (IG), the Committee has received reports and updates from Arden & Greater East Midlands CSU information governance team. The Committee has been assured throughout the year about progress to meet the IG toolkit submission requirements. The Committee was pleased to note that this was submitted at the end of the year with a score of 92%. The local presence of both the Information Governance Manager and Information Governance Support Officer has greatly enhanced the support and advice to the Committee throughout 2017/18. This has included input into business case privacy impact assessments and development of data sharing agreements for new services. The Committee was disappointed to learn that the Manager would be moving to a new organisation in 2018/19 but was assured by the CSU that plans were in place for her replacement. IG development sessions were delivered to Board members and staff within the CCG and this included the changes that would be happening as a consequence of General Data Protection Regulation (GDPR) coming into force from 25 May 2018. The CCG’s governance team, supported by its IG Service provider, continue to be involved in identifying solutions to allow the sharing of data across organisational boundaries to support the integration of services. This work has increased as more integrated working is undertaken. Internal Audit Throughout the year the Committee has worked effectively with CW Audit Services as its internal audit service provider. A total of 230 days were included in the plan and no additional days were required during 2017/18. In total 13 audits were undertaken, with 2 providing full assurance, 9 significant assurance the Assurance Framework being rated A and the IG Toolkit being rated Green. The Committee has placed great emphasis on the findings of internal audit and timely implementation by management of actions to address these findings. It has requested that any delays in management responses or implementation of recommendations be brought to its attention so that it can seek assurances from management. External Audit The Committee received the report from Grant Thornton as its external auditor on its audit findings for the year ended 31 March 2017 at its meeting on 23 May 2017. The auditors issued an Unqualified Regularity Opinion and confirmed that the CCG had proper arrangements in place to secure economy, efficiency and effectiveness in its use of resources (Value for Money Conclusion) noting there were no internal control weaknesses to report, no adjusted misstatements, no unadjusted misstatements or misclassifications. The Committee has reviewed and agreed the external audit plan for 2017/18. Financial Reporting The Committee was advised by Internal Audit that it was able to report full assurance following its review of Financial Management and Financial & Performance Reporting, and significant assurance for Financial Systems and QIPP Delivery. The Committee received regular assurances in respect of the Annual Report and Accounts preparation. This included a detailed timetable and progress report; consideration of the content of the Annual Report; update and approval of the Accounting Policies; and progress on audit matters. The Committee has reviewed the draft Annual Report and Accounts for 2017/18 and will receive the audited Annual Report and Accounts for consideration and approval at its meeting on the 24 May 2018. Management The Committee has continued to challenge the assurance process during the year and has requested and received assurance reports from CCG management and various other sources both internally and

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externally throughout the year. As a consequence of the CCG’s current agenda and the pressure on senior manager time, it has not always been possible for them to attend to provide assurance in person. Attendance in 2018/19 is being scheduled well in advance. Other matters worthy of note Within its wide remit, the Audit & Governance Committee’s agenda is considerable. Some of the matters it has considered routinely or as required by circumstances are listed below: • Agreed the anti-fraud plan 2017/18 and received updates throughout the year. It was advised of the

outcome of the National Fraud Initiative and received the results of the NHS Protect Self Review Tool 2017/18. There were no significant issues to raise in this context.

• Regularly monitored compliance with the prime financial policies including monitoring consultancy spend and approving changes to the operational Scheme of Delegation.

• Received regular reports on Freedom of Information Requests (FOIs). • Considered and recommended changes to the CCG’s Constitution. • Received a regular policies update and approved relevant policies such as: Conflicts of Interest

Policy; Business Continuity Plan & Policy; Health & Safety Audit Policy; Sanctions & Redress Policy; and Counter Fraud, Bribery & Corruption Policy.

• Continued to assess the implications of the Statutory Guidance from NHS England with regards Conflicts of Interest and ensuring it is implemented. This has included the appointment of the Conflicts of Interest Guardian; enhancing the reporting of declarations of interest and mandatory training for all staff and board members.

Effectiveness of the Audit Committee The Committee has been active during the year in carrying out its duty in providing the CCG Board with assurance that it is an effective committee with regular reports to Board outlining matters considered and approved under delegated authority. This has included updating its terms of reference for approval and providing an annual report of its work. A Governance Improvement Plan has been developed building on previous reviews, national guidance and new requirements. This is reviewed and updated at each meeting and progress noted. Value for Money An assessment has been made of the cost of the operation and administration of the Committee throughout the year. This is based upon the attendance of individuals as shown in the attached appendix. The cost is calculated based on the average hourly cost of each individual at an estimated 3 hours per Committee (CSU and external organisations are excluded). The notional cost for 2017/18 is £8,230 and based upon the outcomes achieved by the Committee as described above, this has been viewed as an effective use of public funds. Looking Forward In looking forward to 2018/19 and developing its work-plan, the Audit & Governance Committee will build on the good progress that has been made since the CCG was established. It recognises that some of its key priorities will include embedding the management of conflicts of interest; working across the Black Country on the governance implications of the Sustainability & Transformation Plan (STP); and providing governance input into the Multi-Specialty Community Provider (MCP). However there are a number of existing responsibilities where further progress and action will be required including continued management of the process in place for Business Continuity; working with the Human Resources and Organisational Development team to further develop the Board Member induction and development programmes; and assessing the implications for the CCG of delivering its statutotry duties and its future governance structure as a consequence of the procurement of the MCP. These and other areas of work are set out in the Governance Improvement Plan. Conclusion In conclusion, the Committee is of the opinion that this annual report is consistent with the draft governance statement, Head of Internal Audit opinion, and that there are no matters that the Committee is aware of at this time that have not been disclosed appropriately.

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AUDIT & GOVERNANCE COMMITTEE ATTENDANCE 2017/18

NAME ROLE

28/0

4/20

17

23/0

5/20

17

20/0

7/20

17

21/0

9/20

17

14/1

2/20

17

08/0

2/20

18

22/0

3/20

18

VOTING MEMBERS Mrs Julie Jasper Non-Executive Director & Chair Mr Steve Wellings Non-Executive Director & Vice-Chair - - - Mr Chris Handy Non-Executive Director - - Vacancy Secondary Care Doctor (Lay Member) - - - - - - -

IN ATTENDANCE Mr Steve Wellings Non-Executive Director & Vice-Chair Mr Matthew Hartland Chief Operating & Finance Officer - - - -

Dr J Darby Interim Clinical Executive for Finance, Performance & Business Intelligence - - -

Dr Ruth Tapparo Clinical Executive for Finance, Performance & Business Intelligence - - -

Mrs Caroline Brunt Chief Nurse - - - - - -

Ms Sue Johnson Deputy Chief Finance Officer - - Mr Brendan Forde Senior Finance Manager – Accounting & Control

Mrs Emma Smith Governance Support Manager

Mr Paul Maubach Chief Accountable Officer - - - - - - Mrs L Broster Head of Communications & Public Insight - - - - - Communications & Public Insight representative - - - - - Information Governance External Audit Internal Audit - Local Counter Fraud - - - - CCG Chair - - - - - - -

Note: The attendance in respect of Mr Wellings reflects that for the period of November 2017 – April 2018 he was Acting Chair of the CCG and therefore unable to be a voting member of the Audit and Governance Committee.

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Appendix 2

Governing Body’s

Audit & Governance Committee

Terms of Reference – Version 6.1

AMENDMENT HISTORY VERSION DATE AMENDMENT HISTORY V1 June 2012 Initial version created V2 September 2013 Review carried out to incorporate new committee members V3 September 2014 Changes reflective against the HFMA Example Terms of

Reference V4 September 2015 Addition of ‘Approval of Annual Report and Annual Accounts’ and

delegated responsibility V5 November 2016 Refreshed in line with COI guidance and formatting in line with

organisation standard V5.1 December 2016 Audit Committee proposed changes to the layout of membership

and revision of 2.1. V6 November 2017 Inclusion of EPRR responsibilities in section 7.13 and amendment

to Clinical Executive role. V6.1 February 2018 Amendments to name changes of NHS protect to NHS Counter

Fraud Authority and also NHS Litigation Authority to NHS Resolution. Amendments to change of reference in Constitution

REVIEWERS This document has been reviewed by: NAME DATE TITLE/RESPONSIBILITY VERSION Matthew Hartland June 2012 Chief Finance Officer V1 Sue Johnson April 2013 Deputy Chief Finance Officer V2 Sue Johnson September 2014 Deputy Chief Finance Officer V3 Sue Johnson September 2015 Deputy Chief Finance Officer V4 Emma Smith November 2016 Governance Support Manager V5 Sue Johnson November 2016 Deputy Chief Finance Officer V5 Emma Smith December 2016 Governance Support Manager V5.1 Emma Smith November 2017 Governance Support Manager V6 Emma Smith February 2018 Governance Support Manager V6.1

APPROVALS This document has been approved by: VERSION BOARD/COMMITTEE DATE V2 Audit Committee September 2014 V3 Audit Committee 26 September 2014 V4 Governing Body 10 September 2015 V4 Audit Committee 1 October 2015 V5 Audit & Governance Committee 1 December 2016 V6 Audit & Governance Committee 14 November 2017

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V6.1 Audit & Governance Committee 22 March 2018 NB: The version of this policy posted on the intranet must be a PDF copy of the approved version. Please note that any changes to these Terms of Reference must be done in line with the Terms of Reference Development Guidance. Changes must be agreed at Committee and ratified through the Governing Body. The Governance Team must be included in any revision to ensure that the statutory duties are unaffected and in line with the CCGs Constitution.

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Audit & Governance Committee – Terms of Reference 1. Introduction & Purpose 1.1 The Audit & Governance Committee (the ‘Committee’) is established in accordance with

paragraph 6.7.1(a) of NHS Dudley Clinical Commissioning Group’s constitution. These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the Committee and will have effect as if incorporated into the constitution. The Committee will review its own performance and terms of reference annually. Any resulting changes to the terms of reference will be approved by the governing body or the group if they relate to the membership of the committee (Standing Order 4.1) before becoming part of an application for change to be approved by the group and submitted to the NHS Commissioning Board (constitution 1.4).

2. Membership

2.1 The lay member of the governing body (appointed under Standing Order 2.2.4) for Patient &

Public Engagement and by virtue of the qualifications, expertise or experience enabling them to express informed views about financial management and audit matters will also fulfil the role of the Chair of the Audit & Governance Committee for as long as they hold that position.

2.2 In the event of the Chair of the Committee being unable to attend all or part of a meeting, they

will nominate a replacement from within the membership to deputise for that meeting.

2.3 The other members of the Committee will be appointed by the group such that the Committee has at least three members, of whom at least two, including the Chair, are members of the governing body. The second lay member will be appointed as Vice-Chair of the Committee.

2.4 The chair of the governing body, GP governing body members, the Chief Accountable Officer,

the Chief Operating & Finance Officer and any employees of the group (including the Chief Quality & Nursing Officer) will not be eligible for membership of the Committee.

2.5 No individual who could not be a member of the group’s governing body by virtue of Schedule 5

of the 2012 Regulations (SI 2012/1631) will be eligible to be a non-governing body member of the Committee

2.6 Provided that they remain eligible as described above, other members of the Committee will

hold office for a term of three years and will only be eligible to serve two consecutive terms. Voting Members

2.7 The members of the Committee will be appointed by the group such that the Committee has at least five members from its governing body, which will be made up of: • Lay Member for Patient & Public Engagement (Chair) • Lay Member for Governance (Vice Chair) • Lay Member for Quality & Safety • Secondary Care Clinician In Attendance

2.8 The non-voting members of the Committee will be appointed by the group and will be made up of:

• Chief Operating & Finance Officer • Deputy Chief Finance Officer & Governance Lead • Chief Accountable Officer • Clinical Executive for Finance, Performance & Business Intelligence • Appointed External Auditor • Head of Internal Audit

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2.9 At least once a year the members should meet privately with the external and internal auditors. 2.10 The Accountable Officer will be invited to attend meetings and should discuss at least annually

with the Audit & Governance Committee the process for assurance that supports the governance statement. They will also attend when the committee considers the draft annual governance statement and the annual report and accounts.

2.11 Other employees of the group or persons providing services to it may be invited to attend when

the Committee is discussing areas of risk or operation that are the responsibility of that person. 2.12 Representatives from other organisations (for example, NHS Counter Fraud Authority and other

individuals may be invited to attend on occasion. The local counter fraud specialist should attend at least two meetings a year. The chair of the governing body may also be invited to attend one meeting each year in order to have an understanding of, the committee’s business, as well as the meeting at which the Committee considers the annual accounts.

2.13 The Head of Internal Audit, representative of external audit and counter fraud specialist have a right of direct access to the Chair of the Committee.

3. Secretary 3.1 A named individual will be responsible for supporting the Chair in the management of the

Committee’s business and for drawing members’ attention to best practice, national guidance and other relevant documents as appropriate.

4. Quorum 4.1 A meeting of the Committee will be quorate provided that two members are present, of which:

• Chair or Vice Chair of the Committee • One other member

5. Frequency and notice of meetings 5.1 The Committee must consider the frequency and timing of meetings needed to allow it to

discharge all of its responsibilities. 5.2 The Committee will meet at least four times per annum with meeting dates scheduled in

advance for at least 12 months. No unscheduled or rescheduled meetings will take place without members having at least one week’s notice of the date. The agenda and supporting papers will be circulated to all members at least five working days before the date the meeting will take place.

5.3 The Governing Body, Accountable Officer, external auditors or Head of Internal Audit can

request a meeting in addition to those scheduled if they consider that one is necessary. 6. Authority 6.1 The Committee is authorised by the Governing body to investigate any activity within its terms

of reference. This includes specific responsibilities that have been delegated to the Audit & Governance Committee by the Governing Body in its Constitution. It is authorised to seek any information it requires from any employee and all employees are directed to co-operate with any request made by the Committee. The Committee is authorised by the Governing Body to obtain outside legal or independent professional advice and to secure the attendance of outsiders with relevant experience and expertise if it considers this necessary.

7. Remit, duties and responsibilities

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7.1 The Committee is accountable to the group’s governing body and its remit is to provide the

governing body with an independent and objective view of the group’s systems, information and compliance with laws, regulations and directions governing the group. It will deliver this remit in the context of the group’s priorities, as they emerge and develop, and the risks associated with achieving them. It’s responsibilities are categorised as follows: Integrated governance, risk management and internal control

7.2 The Committee shall review the establishment and maintenance of an effective system of integrated governance, risk management and internal control, across the whole of the organisation’s activities (clinical and non-clinical), that supports the achievement of the organisation’s objectives.

7.3 In particular, the Committee will review the adequacy and effectiveness of:

• All risk and control related disclosure statements (in particular the governance statement), together with any accompanying Head of Internal Audit Opinion, external audit opinion or other appropriate independent assurances, prior to submission to the governing body

• The underlying assurance processes that indicate the degree of achievement of the organisation's objectives, the effectiveness of the management of principal risks and the appropriateness of the above disclosure statements

• The policies for ensuring compliance with relevant regulatory, legal and code of conduct requirements and related reporting and self-certifications

• The policies and procedures for all work related to counter fraud and security as required by NHS Counter Fraud Authority.

7.4 In carrying out this work the Committee will primarily utilise the work of internal audit, external audit and other assurance functions, but will not be limited to these sources. It will also seek reports and assurances from directors and managers as appropriate, concentrating on the over-arching systems of integrated governance, risk management and internal control, together with indicators of their effectiveness.

7.5 This will be evidenced through the Committee’s use of an effective assurance framework to

guide its work and the audit and assurance functions that report to it. 7.6 As part of its integrated approach, the Committee will have effective relationships with other key

committees (for example, the Quality & Safety Committee) so that it understands processes and linkages. However, these other committees must not usurp the Committee's role.

Internal audit

7.7 The Committee shall ensure that there is an effective internal audit function that meets the Public Sector Internal Audit Standards 2013 and provides appropriate independent assurance to the Committee, Accountable Officer and Governing Body. This will be achieved by:

• Considering the provision of the internal audit service and the costs involved • Reviewing and approving the annual internal audit plan and more detailed programme of

work, ensuring that this is consistent with the audit needs of the organisation as identified in the assurance framework

• Considering the major findings of internal audit work (and management’s response), and ensuring co-ordination between the internal and external auditors to optimise audit resources

• Ensuring that the internal audit function is adequately resourced and has appropriate standing within the organisation

• Monitoring the effectiveness of internal audit and carrying out an annual review. External audit

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7.8 The Committee shall review and monitor the external auditors' independence and objectivity and the effectiveness of the audit process. In particular, the Committee will review the work and findings of the external auditors and consider the implications and management’s responses to their work. This will be achieved by:

• Considering the appointment and performance of the external auditors, as far as the rules

governing the appointment permit (and make recommendations to the governing body when appropriate).

• Discussing and agreeing with the external audit, before the audit commences, the nature and scope of the audit as set out in the annual plan, and ensuring co-ordination, as appropriate, with other external auditors in the local health economy.

• Discussing with the external auditors their evaluation of audit risks and assessment of the organisation and the impact on the audit fee

• Reviewing all external audit reports, including the report to those charged with governance (before its submission to the governing body) and any work undertaken outside the annual audit plan, together with the appropriateness of management responses.

• Ensuring that there is a clear policy for the engagement of external auditors to supply non audit services.

Other assurance functions

7.9 The Committee shall review the findings of other significant assurance functions, both internal and external to the organisation, and consider the implications for the governance of the organisation. The Committee will approve any changes to the provision or delivery of assurance services to the group.

7.10 These will include, but will not be limited to, any reviews by Department of Health arm's length bodies or regulators/inspectors (for example, the Care Quality Commission, NHS Resolution, etc.) and professional bodies with responsibility for the performance of staff or functions (for example, Royal Colleges, accreditation bodies, etc.)

7.11 In addition, the Committee will review the work of other committees within the organisation,

whose work can provide relevant assurance to the Committee’s own areas of responsibility. In particular, this will include the Quality & Safety Committee in fulfilling its role in respect of clinical governance, risk management and quality.

7.12 In reviewing the work of the Quality & Safety Committee, and issues around clinical risk

management, the Committee will wish to satisfy itself on the assurance that can be gained from the clinical audit function.

7.13 The Committee will also undertake the following governance-related duties:

• Review and approval of the write-off of bad debt • Monitor compliance with Standing Orders and Prime Financial Duties • Review (and where required approval) of schedules of losses and special payments • Review (and where required receive reports on) the appointment of consultancy support • Monitor compliance with the group’s Registering Interests & Managing Conflicts of Interest

Policy and Hospitality Policy, including review of the group’s registers of interest and hospitality register.

• Review of any suspension of Standing Orders • Approve the group’s Operational Scheme of Delegation • Approve the group’s Annual Report and Annual Accounts • Approve the group’s arrangements for Business Continuity • Approve the groups Emergency Preparedness Resilience & Response (EPRR) work

priorities and oversee the delivery of the organisation's EPRR function. The Accountable Emergency Officer will be required to attend at least 50% of the meetings over the year.

• Approve the group’s arrangements in respect of Information Governance • Approve policies identified as the responsibility of the Audit & Governance Committee

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• Approves changes to the CCGs Constitution to be submitted to NHS England

Counter fraud 7.14 The Committee shall satisfy itself that the organisation has adequate arrangements in place for

counter fraud and security that meet NHS Counter Fraud Authority standards and shall review the outcomes of work in these areas.

Management

7.15 The Committee shall request and review reports, evidence and assurances from directors and managers on the overall arrangements for governance, risk management and internal control. The Committee may also request specific reports from individual functions within the organisation. Financial reporting

7.16 The Committee shall monitor the integrity of the financial statements of the organisation and any formal announcements relating to its financial performance.

7.17 The Committee should ensure that the systems for financial reporting to the governing body, including those of budgetary control, are subject to review as to completeness and accuracy of the information provided.

7.18 The Committee shall review the annual report and financial statements before submission to the

governing body, focusing particularly on:

• The wording in the annual governance statement and other disclosures relevant to the terms of reference of the Committee

• Changes in, and compliance with, accounting policies, practices and estimation techniques • Unadjusted mis-statements in the financial statements • Significant judgements in preparation of the financial statements • Significant adjustments resulting from the audit • Letters of representation • Explanations for significant variances. Whistle blowing

7.19 The Committee shall review the effectiveness of the arrangements in place for allowing staff to raise (in confidence) concerns about possible improprieties in financial, clinical or safety matters and ensure such concerns are investigated proportionately and independently.

Reporting

7.20 For the next meeting of the governing body following each meeting of the Committee, the Chair of the Committee will provide a written summary of the key matters covered by the meeting, including any actions or decisions reserved for the governing body.

7.21 The minutes of each meeting of the Committee, as agreed at the subsequent meeting, will be presented to the next meeting of the governing body for information.

7.22 The Chair of the Committee shall draw to the attention of the governing body any issues that require disclosure to the full governing body, or require executive action.

7.23 The Committee will report to the governing body at least annually on its work in support of the annual governance statement, specifically commenting on:

• The fitness for purpose of the assurance framework • The completeness and 'embeddedness' of risk management in the organisation • The integration of governance arrangements • The appropriateness of evidence that shows the organisation is fulfilling regulatory

requirements relating to its existence as a functioning business

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7.24 This annual report should also describe how the Committee has fulfilled its terms of reference and give details of any significant issues that the Committee considered in relation to the financial statements and how they were addressed.

7.25 These terms of reference will be reviewed at least annually to ensure they remain fit for

purpose. 8. Managing Conflicts of Interest

8.1 Conflicts of interest are a common and sometimes unavoidable part of the delivery of

healthcare. The CCG is required to manage any conflicts of interest through a transparent and robust system. Members of the Committee are encouraged to be open and honest in identifying any potential conflicts during the meeting. The Chair of the Committee will be provided with the latest Declaration of Interest schedule at each meeting and will be required to recognise any potential conflicts that may arise from themselves or a member of the meeting.

8.2 It is imperative that CCGs ensures complete transparency in any decision-making processes

through robust record-keeping. If any conflicts of interest are declared or otherwise arise in a meeting, the chair must ensure the following information is recorded in the minutes; who has the interest, the nature of the interest and why it give rise to a conflict; the items on the agenda to which the interest relates; how the conflict was agreed to be managed and evidence that the conflict was managed as intended.

9. Administrative Support

9.1 The Committee shall be supported by the organisation's governance lead (GL) with appropriate

secretarial support (PA). The duties in this respect will include: • Agreement of agendas with the Chair and attendees (GL) • Preparation, collation and circulation of papers in good time (GL/PA) • Ensuring that those invited to the meeting attend (PA) • Taking the minutes and helping the Chair to prepare reports to the governing body (GL/PA) • Keeping a record of matters arising and issues to be carried forward (PA) • Arranging meetings for the Chair-for example, with the internal/external auditors or local

counter fraud specialists (PA) • Maintaining records of members' appointments and renewal dates etc (GL/PA) • Advising the Committee on pertinent issues/areas of interest/policy developments (GL) • Ensuring that action points are taken forward between meetings (GL/PA) • Ensuring that Committee members receive the development and training they need (GL)

10. Relationship with the governing body 10.1 For the next meeting of the governing body following each meeting of the Committee, the Chair

of the Committee will provide a written summary of the key matters covered by the meeting, including any action or decisions reserved for the governing body.

11. Review of Committee effectiveness 11.1 The Committee will annually self-assess and report to the governing body on its performance in

delivery of these terms of reference. 11.2 These terms of reference will be reviewed at least annually to ensure they remain fit for

purpose.

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 10 May 2018 Report: Combined Board Assurance Framework and Risk Register

Agenda item No: 8.2

TITLE OF REPORT: Combined Board Assurance Framework and Risk Register

PURPOSE OF REPORT: To update the Board on the combined Board Assurance Framework (BAF) and Risk Register and present it as at 10 April 2018

AUTHOR OF REPORT: Mr M Hartland, Chief Operating and Finance Officer

MANAGEMENT LEAD: Mr M Hartland, Chief Operating and Finance Officer

CLINICAL LEAD: Dr D Hegarty, Chair

KEY POINTS:

• Update on the combined BAF & Risk Register as at the 10 April 2018.

• Audit & Governance Committee met on the 3 May 2018 and considered the proposed changes recommended following the Board meeting held on the 11 January.

• To consider Risks 13, 112, 150, 151 and 152 as a standing item • To note the increase in the residual risk score of Risk 84 due to the

increase probability of delivering an increased programme. • To approve new Risk 152 around patient and public engagement • To approve the closure of Risk 6 following recommendation from

the Finance, Performance and Business Intelligence Committee. • These changes are outlined in the paper and will be reflected in the

next iteration of the BAF & Risk Register.

RECOMMENDATION:

1) The Board is asked to receive the report for assurance and approve any recommendations made by the Audit & Governance Committee.

2) The Board is asked to consider whether any updates to risks 13, 112, 150, 151 and 152 are required

3) The Board is asked to accept new risk 152 as its responsibility 4) The Board is asked to approve the closure of risk 6

FINANCIAL IMPLICATIONS: None direct. Potential consequence if risks materialise

WHAT ENGAGEMENT HAS TAKEN PLACE: None

ACTION REQUIRED: Decision Approval Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 10 MAY 2018 COMBINED BOARD ASSURANCE FRAMEWORK (BAF) AND RISK REGISTER 1.0 INTRODUCTION

In accordance with the CCG’s Risk Management Strategy, an extract of the combined BAF and Risk Register for those risks scored 16 and over (which comprise the Board Assurance Framework) plus any risks less than 16 assigned to the Board is presented to the CCG Board. This is based on the position as at 10 April 2018.

2.0 COMBINED BOARD ASSURANCE FRAMEWORK (BAF) & RISK REGISTER Those risks with an initial or residual score (after actions having been taken and controls implemented) of 16 or higher and any others assigned directly to the Board are presented in detail at Appendix 1. These risks are also summarised in the table below: Risks 16 or higher (plus risks assigned to Governing Body) as at the 10 April 2018

Initial Risk

Residual Risk

Accountable Committee

6. Failure of a main provider (for example Dudley Group NHS FT, BCPT and other Providers) due to financial pressures will result in inadequate care for the local population

PROPOSED FOR CLOSURE

20 16

Finance, Performance &

Business Intelligence

10. There is a risk that the health and social care economy will fail to engage and work together to implement required service changes

16 12 Commissioning Development

13. Failure of the governing body to demonstrate appropriate leadership/ clinical leadership may result in poor strategy and implementation, and thereby fail to meet statutory and regulatory responsibilities.

12 12 Governing Body

36. There is a risk that key performance indicator will not be met resulting in the loss of the Quality Premium.

16 12 Commissioning Development

77. Failure to realise financial savings outlined in the value proposition because the MCP care model is not implemented.

16 9 Commissioning Development

84. There is a risk that failure to control costs and deliver significant QIPP savings will put the future sustainability of the CCG at risk. INCREASED RESIDUAL

16 16

Finance, Performance &

Business Intelligence

98. Future shape of the CCG and consequential impact on staff and delivery.

16 12 Remuneration &

HR

104. There is a risk that there will be a lack of suitable bidders providers to enter in to a contract with the MCP

16 4 Commissioning Development

112. Potential Lack of alignment between STP & MCP Strategies 16 8 Governing

Body

116. There is potential to destabilise the health system both clinically and financially as a result of MCP implementation

16 12 Commissioning Development

129. Lack of effective management of waiting list within the ophthalmology department which results in poor patient outcome. Lack of follow up appointment due to process failure.

16 12 Quality & Safety

136. There is a risk that the provision of Primary Care Medical Services are adversely affected partially or fully due to insufficient workforce

16 6 Primary Care Commissioning

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Risks 16 or higher (plus risks assigned to Governing Body) as at the 10 April 2018

Initial Risk

Residual Risk

Accountable Committee

148. There is a risk that the financial pressure on local providers will put pressure on the CCG in delivering its financial & performance targets.

20 12

Finance, Performance &

Business Intelligence

150. There is a risk that change of leadership in local system organisations will impact on system delivery, particularly in relation to loss of local knowledge

8 8 Governing Body

151. There is a risk that the CCG fails to meet its statutory duties in respect of the delivery of high quality care to the population of Dudley.

15 12 Governing Body

152. There is a risk that significant transformation of the system does not take into account the views of Dudley People. This may result in services which do not meet the needs of local people, the possibility of Judicial Reviews, and ultimately a loss of trust in health service commissioning through inadequate involvement, openness and transparency. NEW

12 8 Governing Body

3.0 RECENT AMENDMENTS TO THE BAF AND RISK REGISTER

The following amendments to risks 16 and over have been made since the Board received the BAF and Risk Register as at 10 January 2018 at its meeting on 22 March 2018. Review & Updates – Updates were received from the leads for the Primary Care Commissioning Committee; Quality & Safety Committee; Commissioning Development Committee; Finance, Performance & Business Intelligence Committee and Remuneration & HR Committee. The Board is requested to review Risks 13, 112, 150 and 151 for which it is directly responsible and update as appropriate.

3.1 Risk Description, related controls, assurances, actions and comments Exceptionally changes are made to the initial risk scores and description, particularly when an identified risk is new and additional information leads to a reassessment of the overall risk. None

3.2 Changes to the Residual Risk Scores Risk 84 – “There is a risk that failure to control costs and deliver significant QIPP savings will put the future sustainability of the CCG at risk.” The Finance, Performance and Business Intelligence Committee have increased the residual risk score from (3x4) 12 to (4x4) 16 due to the increased probability associated with delivering an increased QIPP programme.

3.3 New Risks

Risk 152 – “There is a risk that significant transformation of the system does not take into account the views of Dudley People. This may result in services which do not meet the needs of local people, the possibility of Judicial Reviews, and ultimately a loss of trust in health service commissioning through inadequate involvement, openness and transparency.” An assessment of the CCG’s BAF & Risk Register against the Merseyside Internal Audit Agency (MIAA) Clinical Commissioning Group Assurance Framework Benchmarking report was presented to the Audit & Governance Committee. This highlighted that there was limited recognition in the Assurance Framework of the risks around failure to engage. The

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Audit & Governance Committee therefore proposed that a risk be developed encompassing patient and public engagement. As this risk is organisation and function wide it was agreed that this should be a Governing Body risk. This risk is presented for approval.

3.4 Risks Proposed for Closure (Requiring Board approval)

Risk 6 – “Failure of a main provider (for example Dudley Group NHS FT, BCPT and other Providers) due to financial pressures will result in inadequate care for the local population.” The Finance, Performance and Business Intelligence Committee have asked the Board to approve the closure of this risk as the financial elements are now captured in Risk 148 and the Quality and Safety Committee capture the quality elements in the risks for which they are responsible.

4.0 RECOMMENDATIONS

1) The Board is asked to receive the report for assurance 2) The Board is asked to consider whether any updates to risks 13 , 112, 150 and 151 are required 3) The Board is asked to accept new risk 152 as its responsibility 4) The Board is asked to approve the closure of risk 6

5.0 APPENDICES Appendix 1 – Combined BAF & Risk Register as at 10 April 2018 (risks 16 and over & Risks 13, 112, 150, 151 & 152) M Hartland Chief Operating and Finance Officer April 2018

Dudley CCG Combined Board Assurance Framework and Corporate Risk Register 2017/18

10-Apr-18 MASTER Document with full Risk Review Information

ID Original Date Last Review (Committee

Date)

Last Update (Risk

Amended)

LIN

K T

O

CO

RPO

RA

TE

OB

JEC

TIVE

(SEE

K

EY A

BO

VE)

Risk Description Accountable Committee

Accountability Sponsor & Owner

Management Lead

P I

Initial Risk Score (PxI)Score

before any controls are

in place.

Key ControlsWhat controls/systems are in place to assist in securing delivery of ourobjective. Such as strategies, policies and procedures

Gaps in ControlWhere are we failing to put controls/ systems in place / Where are we failing in making them effective. For example lack of training or no regular review of performance

Internal AssurancesBoard Reports, Minutes of meetings

External AssurancesInternal and External Audit Reports, CQC Reports

Gaps in Assurance Where are we failing to gain evidence that our controls/ systems, on which we place reliance, are effective. Such as no assurance a strategy or policy is effective

(R) P (R) I

Residual Risk Score

(PxI)Score

following controls put

in place

Risk Trend ActionsTo improve control, ensure delivery of principal objectives, gain assurance

TimescalesDate action will be completed

COMMENTS

6 01/05/2013 26/03/2018 30/11/2017 2

Failure of a main provider (for example Dudley Group NHS FT, BCPT and other Providers) due to financial pressures will result in inadequate care for the local population

F&P Dr Ruth Tapparo Matt Hartland 4 5 20

Robust contract management via contract review meetings, performance management, joint strategic planning.Financial Plan and contracts agreed with providers.Financial Assurance KPIs reported to Board.Joint monthly payment reconciliation process including validation of activity.

Review of methods to mitigate financial risk to provider and CCG.

Reports to F&P & Q&S, Board reports - minutes of CRM and QRM meetings.Performance report across a range of KPIs.Monthly meetings between CCG and DG FT Senior Manager Teams now being held.Board to Board (including lay member only) meetings being held.Monthly finance meetings between both organisations.

AT review,Monitor financial rating-under formal review due to deficit position in financial plansInternal Audit review.Regular CLT meetings Formation and representation of CCG and DGFT on Vanguard Partnership Board

4 4 16 =

Ensure contracts are compliant with PbR;Review of health economy financial position;Financial Modelling of vanguard programme Incentivise Quality

Dec-17

Risk to be removed from FP&BI (included in Risk 148) once risk has been created on Q&S risk register for the quality aspect. Audit Committee approved reccommendation to Board for closure - 10 May.

10 01/05/2013 21/03/2018 21/02/2018 2

There is a risk that the health and social care economy will fail to engage and work together to implement required service changes

CDC Neill Bucktin Neill Bucktin 4 4 16

QIPP plan and implementation. Joint approach to QIPP development with Dudley Group. Service Improvement Delivery Plans in place with providers. Collaborative Leadership Teams - DGFT and DWMHPT Health and Social Care Leadership Group (A&E Delivery Board). BCF Section 75 Agreement.

Development of Commissioning Plan subject to endorsement by Health and Wellbeing Board. Series of joint strategies beneath JSNA overseen by Partnership Bodies/Boards BCF Section 75 Agreement.

Memorandum of Understanding with Public Health, membership of H&W Board, contribution to JSNA

Commissioning intentions, Change Meetings with providers

None

QIPP reporting to CDC and governing body.

Report to Board on CCG contribution to HWB activity. CCG compliance with JHWS

Internal and external audit reviews

Review of Performance with Health and Wellbeing Board, Internal Audit review

Regular updates to CCG governing body on wider stakeholder engagement as appropriate

4 3 12 =

1.Develop and implement service improvement development plans with JHWS External peer plans with all providers.2. Health and Social Care Leadership Group to be responsible for major system change: - Urgent Care- Service Integration3. Reporting mechanism on Better Care Fund implementation to be agreed.4. Reports to be made to CDC along with Outcome Ambitions and Better Care Fund.5. Establishment of Partnership Board to oversee system and new care model development. 6. Additional spending DMBC to report ot Board

To be reviewed monthly

Apr-18

13 01/05/2013 08/03/2017 08/03/2017 2

Failure of the governing body to demonstrate appropriate leadership/ clinical leadership may result in poor strategy and implementation, and thereby fail to meet statutory and regulatory responsibilities

GOVERNING BODY Dr David Hegarty Paul Maubach 3 4 12 Organisational Development plan. Governing body development events

Clinical leadership structure is being reviewed None OD plan delivery is not being

reported upon yet 2 4 8 = Implement OD plan delivery reporting to Remuneration Committee May-18

36 16/05/2013 21/03/2018 21/02/2018 3There is a risk that key performance indicators will not be met resulting in the loss of the Quality Premium

CDC Neill Bucktin Neill Bucktin 4 4 16

Plans for local targets mostly in place and on track, but still significant risk of not achieving national domains 1 and 5 (PYLL and HCAI)

Successful plans for domain 1 and 5 need to be put in place

Quality Premier achievement reporting to CDC and governing body None None 3 4 12 =

Regular report on actions and performance to CDC linked to Outcome Ambitions and Better Care Fund.Review monthly

Apr-18

77 22/07/2015 21/03/2018 21/02/2018 1, 2, 3, 4

There is a risk that failure to realise financial savings outlined in the value proposition because the MCP care model is not implemented.

CDC Dr R Tapparo Neil Bucktin 4 4 16Accountability framework including its Terms of Reference agreed by Partnership Board

None Reports to Board Performance Monitoring NCM Team Confirmation of external performance management arrangements 3 3 9 = Approval of the economic case across

the Local Health EconomyApr-18

84 07/12/2015 26/03/2018 26/03/2018 3

There is a risk that failure to control costs and deliver significant QIPP savings will put the future sustainability of the CCG at risk

F&P Dr Ruth Tapparo Matt Hartland 4 4 16

The QIPP challenge process is robust and the CCG has a history of delivery.

Internal audit recommendations have been reflected in the processes and QIPP challenge days focus on the entire commissioner portfolio which includes both financial and performance elements.

Joint ownership of QIPP Scheme/PID between commissioner and provider.

Greater accountability is placed on the commissioner to ensure delivery following the new financial framework.

Meeting actions are fully minuted and are attended by the head of financial management – commissioning and head of commissioning and representation from the provider.

Business Case/PID - Check MG

Failure to critically assess the viability of a scheme

Clearer exit strategies when schemes do not deliver

Inconsistency in following the appropriate process and challeneing the Business Case/PID

Failure to monitor plans and take timely action

Development of future year schemes

Monthly QIPP challenge process. Challenge meetings with commissioners actions are logged.

Monthly reporting to FP&BI committee

CDC oversight of QIPP delivery, and is a stanidng item of the CDC agenda

QIPP day to focus on the savings for the programme have taken place.

Intial PID documents for 2018/19 have been completed by commissioners.

2 year QIPP programme has been developed from reviewing NHSE Menu of Opportunities and Right Care Packs.

The QIPP programme is being managed by a senior programme manager.

Routine position updates are provided to FP&BI including recurrent status of schemes over 2 years.

Plan and monthly reporting to NHS England.

Forms part of annual internal audit review

Commissioner accountability

Inadequate contingency plans for additional schemes

4 4 16

PID Documents and project plans to be commenced in line with key dates to ensure delivery.

Business cases to be completed and approval sort from the releavnt committee

Commissioners to be held to account.

Jun-17

Are there any additional actions that could mitigate the risk further? Residual score to remain the same given additional assurnances that have been completed?

Residual risk increased due to the increased probability of delivering an increased programme

98 12/07/2016 07/02/2018 06/12/2017NEW 4 - Develop the CCG

Future shape of the CCG and consequential impact on staff and delivery.

REM Steve Wellings Stephanie Cartwright 4 4 16

Focus of Executive and Senior Management Team. Active involvement in the development of the STP and implementation of the MCP.Regular item on Remuneration Committee agenda.

Risk is currently being managed as one of the objectives for the Director of Organisational Development and HR.

Assurance gained from intensive support from the NCM team and leadership in the development of the STP.

National drivers may be out of control of local management. 4 3 12 =

Regular item on Remuneration Committee.Focus of quarterly reflection by the Executive Team.

May-18

Conversations have been held with current provider of primary care interventions to review plans to register patients virtually in a separate primary care setting. –

ID Original Date Last Review (Committee

Date)

Last Update (Risk

Amended)

LIN

K T

O

CO

RPO

RA

TE

OB

JEC

TIVE

(SEE

K

EY A

BO

VE)

Risk Description Accountable Committee

Accountability Sponsor & Owner

Management Lead

P I

Initial Risk Score (PxI)Score

before any controls are

in place.

Key ControlsWhat controls/systems are in place to assist in securing delivery of ourobjective. Such as strategies, policies and procedures

Gaps in ControlWhere are we failing to put controls/ systems in place / Where are we failing in making them effective. For example lack of training or no regular review of performance

Internal AssurancesBoard Reports, Minutes of meetings

External AssurancesInternal and External Audit Reports, CQC Reports

Gaps in Assurance Where are we failing to gain evidence that our controls/ systems, on which we place reliance, are effective. Such as no assurance a strategy or policy is effective

(R) P (R) I

Residual Risk Score

(PxI)Score

following controls put

in place

Risk Trend ActionsTo improve control, ensure delivery of principal objectives, gain assurance

TimescalesDate action will be completed

COMMENTS

104 08/06/2016 21/03/2018 21/03/2018 4AThere is a risk that there will be a lack of suitable bidders to enter into a contract for the MCP

CDC Dr R Tapparo Neill Bucktin 4 4 16Early publication of Prior Information Notice (PIN) to stimulate market and engage with prospective providers

None MCP Procurement Project Board None 2 2 4 = Market engagement event Jun-18

112 08/06/2016 08/03/2017 08/03/2017 4C

There is a risk that Governance arrangements between organisations (that are party to the STP) are either insufficient or inconsistent. This may lead to inadequate governance and insufficient transparency which could create unintended financial risk, inconsistent decision making or misalignment of strategic direction and implementation.

GOVERNING BODY Dr David Hegarty Paul Maubach 4 4 16

CCG membership of STP sponsor group and Dudley CCG leadership of place based component of the STP model

JCC Committee in place to support joint working across

STP is a partnership of 18 organisations, both provider and commissioner and there isn't a collective commissioning perspective on the STP. 4 CCGs need to agree a common process

Routine updates from senior managers on capacity of teams to be presented to operations meeting.

Senior Managers have received 1:1 PDR's with managers within the CCG during December 16 to understand capacity. Paul Maubach will followed up in January with additional 1:1's

Senior Manager meetings held monthly

N/A None identified to date 4 4 16 =

To seek clarity and consistency of partner governance arrangements on all areas where we need collective arrangements (both STP and JCC)

To ensure due diligence of any shared governance or planning arrangements (both financial, clinical and overall governance arrangements)

May-18

116 08/06/2016 21/03/2018 21/02/2018 4C

There is potential to destabilise the health system both clinically and financially as a result of MCP implementation

CDC Dr R Tapparo Neill Bucktin 4 4 16Internal assessments and Integrated Support and Assurance Process (ISAP)

NoneReports to Procurement Project Board and CCG Board at each stage of the process

ISAP None 4 3 12 = Enter ISAP Checkpoint 2 Jul-18

129 21/03/2017 20/03/2018 16/01/2018 2

Lack of effective management of waiting list within the ophthalmology department which results in poor patient outcome. Lack of follow up appointment due to process failure.

Q&S Dr Ruth Edwards Caroline Brunt 4 4 16

DGFT are aware of the root cause of these incidents and has put in place a parallel waiting list to support a prioritisation exercise.Lack of process when ophthalmology moved to the partial booking model. DGFT have since put in place extra follow up clinics, developed a process to record when a patient is required to attend a follow up clinic.

Red Amber Green flag system in place, however this system does not alert DGFT to all patients within the system who may have been subject to delayed follow up

Reporting of serious incidents to Quality and Safety committee.Incident s reviewed at Weekly Team meetings. Actions resulting from RCA investigations have been reviewed

DGFT are fully sighted and have requested WMQRS carry out an audit of the service.Quality and Safety team to be kept updated.

Further S.I’s have been reported which suggests that the system is failing.

3 4 12 =

Learning following serious incidents being shared across the ophthalmology directorate.

Up to 3 months for review / audit of waiting list to be completed.

Feb-18

Quality team are involved with review of investigations and ensure duty of candour takes place for all affected patients. April CQRM will provide us with an updated action plan

NB: TO BE PORPOSED FOR CLOSURE ONCE ASSURANCE RECIEVED AT OCTOBER CQRM

136 21/07/2017 16/03/2018 29/09/2017 4B

There is a risk that the provision of Primary Care Medical Services are adversely affected partially or fully due to insufficient workforce

PCC Steve Wellings Caroline Brunt 4 4 16

Annual Workforce Audit for clinical and non-clinical staff carried out

Recruitment Fayres/ Joint working and raising profiles in Primary Care

Training needs and skills set assessment

Primary Care Team visits with practice to obtain soft intelligence

Engagement with NHS England, Health Education England and Local Workforce Advisory Board committed to training and professional development.

Joint working with local Community Provider Education Network (CPEN) to maximise opportunities for Primary Care Workforce development

Enabling practices to improve and change (EPIC Programme)

Workforce plan to be developed

No current model of care available to address the workforce gaps

Report to PCCC regarding training needs and workforce analysis

Feedback from individual practices is reported through PCOG

Report to PCC regarding EPIC Programme progress

Gaps in reporting to Committee needs to be clarified as some of the soft intelligence is not suitable for a public meeting.

CCG do not currently receive notification from NHSE in respect of outstanding appraisals

2 3 6 =

1) Develop and implement the new model of care - Dudley Multispecialty Community Provider (MCP). As part of the new model, developing and investing in the clinical and non clinical workforce

2) Develop a joint action plan with external partners (eg. HEE) to establish future workforce needs moving into an MCP provider.

May-18 risk discussed

148 02/11/2017 26/03/2018 26/03/2018

There is a risk that the financial pressure on local providers will put pressure on the CCG in delivering its financial & performance targets

F&P Dr Ruth Tapparo Matt Hartland 5 4 20

Robust contract management via contract review meetings, performance management, joint strategic planning. Financial Plan and contracts agreed with providers. Financial Assurance KPIs reported to Board. Joint monthly payment reconciliation process including validation of activity.

Triangulation report submitted to NHSE for assurance

Lack of transparency and understanding of pressures on local providers.

Reports to F&P & Q&S, Board reportsMinutes of CRM and QRM meetings. Performance report across a range of KPIs. Regular meetings between CCG and DG FT & DWMH Senior Manager Teams now being held. Board to Board meetings take placeMonthly finance meetings with NHS Providers.Partnership Board established Control total was accepted by DGFT and contract has been agreed

NHS Improvement Reports

CQC Reports

Deloittes - deep dive report

Transparency between local organisations. 3 4 12 =

To determine how transparency and openess within the health economy can be improved.

Oct-18

Risk was reviewed and DGFT have a plan in place to achieve a balanced finanical position that was signed off by DGFT board.therefore committee agreed for risk to remain at 12

150 09/11/2017 08/03/2017 08/03/2017

There is a risk that change of leadership in local system organisations will impact on system delivery, particularly in relation to loss of local knowledge.

GOVERNING BODY Dr David Hegarty Paul Maubach 4 2 8

Strategic CLT meetings held with provider organisations on a monthly basisSenior managers in constant conversation and regular meetings held with provider leadership teams

The CCG clinical and management team are aware of the gap of knowledge and are managing it effectively through building new relationships and sharing intelligence.

The mitigation of this is risk is that the CCG will lead on developing new relationships with new leadership that is in place

Regular discussion with partner organisations concerned.

Obtaining regular assurance from providers that leadership is stable within organisation

4 2 8 =

From January 2018 quarterly meetings between the leadership organisations (MCP, TCT and STP) will be implemented to encourage the development of relationships.

May-18

151 08/02/2018 08/03/2017 08/03/2017

There is a risk that the CCG fails to meet its statutory duties in respect of the delivery of high quality care to the population of Dudley.

GOVERNING BODY Dr David Hegarty Paul Maubach 5 3 15

Statutory duties are managed through the scheme of delegation which is allocated to each of the CCG’s committees (FP&BI, CDC, REM, PCCC, Q&S and AG)

Regular Board Development sessions are in place to ensure the Board is up to date with the challenges and duties of the GB

TOR for Committees are regularly reviewed to ensure in line with current legislation

Board Member inductions need to be strengthened to ensure that new members are familiar with the issues the CCG faces

Capacity to deliver the statutory requirements of the organisation need to be understood further

Work Plans and Committee Annual Reports provide assurance that the committee is meeting its duties.

Regulatory inspections

NHS England outcomes framework

Health & Wellbeing Board

Overview & Scrutiny Committee

Formal reporting on plans and performance no comprehensive 4 3 12 =

1) Board member incudctions to be formalised

2) Review of workforce to be carried outMay-18

ID Original Date Last Review (Committee

Date)

Last Update (Risk

Amended)

LIN

K T

O

CO

RPO

RA

TE

OB

JEC

TIVE

(SEE

K

EY A

BO

VE)

Risk Description Accountable Committee

Accountability Sponsor & Owner

Management Lead

P I

Initial Risk Score (PxI)Score

before any controls are

in place.

Key ControlsWhat controls/systems are in place to assist in securing delivery of ourobjective. Such as strategies, policies and procedures

Gaps in ControlWhere are we failing to put controls/ systems in place / Where are we failing in making them effective. For example lack of training or no regular review of performance

Internal AssurancesBoard Reports, Minutes of meetings

External AssurancesInternal and External Audit Reports, CQC Reports

Gaps in Assurance Where are we failing to gain evidence that our controls/ systems, on which we place reliance, are effective. Such as no assurance a strategy or policy is effective

(R) P (R) I

Residual Risk Score

(PxI)Score

following controls put

in place

Risk Trend ActionsTo improve control, ensure delivery of principal objectives, gain assurance

TimescalesDate action will be completed

COMMENTS

152 14/03/2018 2

There is a risk that significant transformation of the system doesn’t take into account the views of Dudley People. This may result in services which don’t meet needs of local people, the possibility of Judicial Reviews, and ultimately a loss of trust in health service commissioning through inadequate involvement, openness and transparency.

GOVERNING BODY Dr David Hegarty Laura Broster 3 4 12

• Comms and Eng Strategy• Approach to engagement set out in constitution• Director of Comms signs off each business case• Good relationships with Health and Adult Social Care Scrutiny Committee• Significant assurance in recent internal audit• Goods rating in this domain from NHSE

External factors impacting on timeliness of decision making and availability of adequate information

need to increase officer awareness of patient and public engagement requirements when ie, commissioning services

Internal Audit Reports have been Full Assurance

Director and Lay Member in place responsible for Patient and Public Insight

IAF - NHS England rated Green

The Board can not be fully assured that adequate patient and public involvement has taken place prior to making the decision

2 4 8 NEWTraining sessions for officers involved in service delivery/change about stages of patient and public involvement.

Oct-18

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 10 May 2018 Report: Statement of Disclosure to Auditors

Agenda item No: 8.3

TITLE OF REPORT: Statement of Disclosure to Auditors

PURPOSE OF REPORT: To seek assurances from the Board to support the approval of the Annual Report & Accounts 2017/18

AUTHOR OF REPORT: Mr M Hartland, Chief Operating & Finance Officer

MANAGEMENT LEAD: Mr M Hartland, Chief Operating & Finance Officer

CLINICAL LEAD: Dr D Hegarty, Chair

KEY POINTS: • Annual Report & Accounts 2017/18 approval process outlined • Assurances sort from the Board to allow the Audit & Governance

Committee to approve the audited Annual Report & Accounts on Thursday, 24 May 2018

RECOMMENDATION:

• To recognise that authority to approve the Annual Report & Accounts is already delegated to the Audit & Governance Committee in the CCG’s Constitution

• Confirm that so far as the members are aware, there is no relevant audit information of which the clinical commissioning group’s external auditor is unaware

• Confirm that the members have taken all the steps that they ought to have taken as a member in order to make themselves aware of any relevant audit information and to establish that the clinical commissioning group’s auditor is aware of that information

FINANCIAL IMPLICATIONS: None

WHAT ENGAGEMENT HAS TAKEN PLACE: None

ACTION REQUIRED: Decision Approval Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 10 MAY 2018 STATEMENT OF DISCLOSURE TO AUDITORS 1.0 INTRODUCTION

1.1 The draft Annual Report & Accounts for 2017/18 were prepared and submitted to NHS England

before the national deadline of midday 26 April 2018 and are currently being audited by the CCG’s external auditors.

1.2 The Audit & Governance Committee meeting on Thursday 24 May will receive the auditor’s report and other supporting items in order for it to approve the final Annual Report & Accounts under its authority delegated by the CCG Board.

1.3 The approved Annual Report & Accounts will be submitted to NHS England on or before the national deadline of 9am Tuesday 29 May and will be formally presented at the CCG’s Annual General Meeting on Thursday 5 July 2018.

1.4 For the Audit & Governance Committee to fulfil its responsibilities, it requires a number of assurances from the Board as detailed in the next section.

2.0 ANNUAL REPORT & ACCOUNTS APPROVAL-ASSURANCES 2.1 In order that the Audit & Governance Committee can approve the audited Annual Report &

Accounts on 24 May, the Board is requested to provide the following assurances: 1. To formally confirm and minute that authority to approve the Annual Report & Accounts is

already delegated to the Audit Committee in the CCG’s Constitution (Appendix D, Scheme of Delegation).

2. The Members Report section of the Corporate Governance Report within the Annual Report includes the following statement: Statement of Disclosure to Auditors “At the time this Annual Report was approved, each Governing Body member declared the following: • so far as they were aware, there was no relevant audit information of which the CCG’s auditor was unaware that would be relevant for the purposes of their audit report, and • they had taken all the steps that they ought to have taken as a member in order to make

themselves aware of any relevant audit information and to establish that the CCG’s auditor was aware of that information.”

Each member of the CCG Board (Governing Body) is requested to confirm that this statement is accurate and applies to them. In addition, should a member of the Board become aware of any relevant matters up until the signing off of the Annual Report & Accounts on 24 May, they should make the CCG’s auditors aware of this.

3.0 RATIONALE 3.1 The reasons for such a statement in the accounts/annual report are various, but include:

• It is the role of external auditors to audit the accounts presented to them • With a budget of £470 million, no-one in the organisation, including the Chief Operating &

Finance Officer, will know every transaction that has occurred during the year that has contributed to the overall values included in the accounts in arriving at the year-end values

• The auditors will therefore review the financial system, and many working papers provided to

them for general and particular items (where requested) and test the financial transactions and assumptions made in the presentation of the figures. The auditors have the ability and authority

3 | P a g e

to review every detail of the accounts and have free will to question the finance team on everything in the accounts.

• Ultimately, responsibility for the accuracy of the accounts sits with the Chief Operating &

Finance Officer as this is a statutory duty of that role. In addition, Paul Maubach has responsibility as Accountable Officer.

• In addition, this is a way auditors protect themselves against any liability relating to the

accounts. 3.2 However, as Board members in an NHS organisation (as in a private company), all Board members

also have a responsibility in relation to the accounts. This relates mainly to the confidence and assurance that you have regarding the financial management and associated systems/assurance processes of the CCG.

3.3 In deciding whether you have such assurance, you could ask yourself the following questions:

• Do you believe the Finance Department fulfil their duty in producing robust finance statements? • Do you believe the Chief Operating & Finance Officer and Chief Accountable Officer fulfil their

duties in terms of managing the finances of the CCG? • Do you believe the Clinical Executive for Finance, Performance & Business Intelligence fulfils

their duty in terms of managing the finances of the CCG? • Do you believe the Finance, Performance & Business Intelligence Committee adequately

challenges and manages the finances of the CCG? • Do you believe the Audit & Governance Committee (including all lay members) holds the Chief

Operating & Finance Officer to account for financial issues within the CCG and ensures that all relevant systems and processes are adequate and robust?

• Do you believe as a Board member you receive adequate assurance from the Finance, Performance & Business Intelligence Committee and Audit & Governance Committee regarding the management of finance in the CCG?

3.4 Other items of assurance you could take are:

• We have received full assurance regarding our financial management and significant assurance regarding our financial systems and QIPP from our internal auditors

• We have received assurance from NHS England that the CCG has excellent financial management

• Audit & Governance Committee (including External and Internal Audit) have approved our Annual Governance Statement

• We have a counter fraud officer that supports the CCG 3.5 The reason for the statement in the Members statement discussed at Board is for the External

Auditors to assure themselves and question, once taking all of the above into account – i.e. accurate set of accounts, full assurance from internal audit in terms of processes, no material issues found – is there anything that Board members are aware of that should change External Audit’s opinion of approving the accounts?

4.0 RECOMMENDATIONS 4.1 The Board is asked to:

• To recognise that authority to approve the Annual Report & Accounts is already delegated to the Audit & Governance Committee in the CCG’s Constitution

• Confirm that so far as the members are aware, there is no relevant audit information of which the clinical commissioning group’s external auditor is unaware

• Confirm that the members have taken all the steps that they ought to have taken as a member in order to make themselves aware of any relevant audit information and to establish that the clinical commissioning group’s auditor is aware of that information

M Hartland Chief Operating & Finance Officer - May 2018

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 10 May 2018 Report: Remuneration & HR Committee Report

Agenda item No: 8.4

TITLE OF REPORT: Remuneration & HR Committee Report

PURPOSE OF REPORT: To provide assurance to the Board regarding key issues discussed and approved by the Remuneration & HR Committee held on 4 April 2018.

AUTHOR OF REPORT: Mrs S Cartwright, Director of Organisational Development, Transformation and Human Resources

MANAGEMENT LEAD: Mrs S Cartwright, Director of Organisational Development, Transformation and Human Resources

CLINICAL LEAD/LAY MEMBER: Dr David Hegarty, Chair and Mr S Wellings, Lay Member for Governance

KEY POINTS:

• Workforce dashboard reviewed noting a decrease in sickness

absence to a rate of 1.37% which is below the CCG target of 3%. Mandatory training is showing compliance of 93% and the PDR rate is 77.48%. Headcount is currently at 111 employees.

• Black Country and West Birmingham joint commissioning work was discussed and the committee updated.

• An update on the work of primary care development in the MCP was provided and actions taken to minimise any conflicts of interest during the current dialogue phase.

• A continued discussion regarding a pay review of Directors salaries was concluded.

• An update on the Committee Risk Register. • Discussion and agreed action plan on GP board member, clinical

executive and clinical lead contracts. • An update on the staff survey action plan. • Ratification of the revised terms of reference for Staff Forum • A verbal update on the review of the Sickness Policy • A verbal update on the national pay deal for agenda for change staff

RECOMMENDATION: The Board to receive the report for assurance and note the decisions taken under delegated powers.

FINANCIAL IMPLICATIONS: Within financial plan

WHAT ENGAGEMENT HAS TAKEN PLACE: n/a

ACTION REQUIRED: Decision Approval Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 10 MAY 2018 REMUNERATION & HR COMMITTEE REPORT 1.0 INTRODUCTION 1.1 This report provides assurance to the Board with regard to key issues discussed and approved by

the Remuneration & HR Committee on 4 April 2018. The following items are a description of the current position in relation to the main responsibilities and obligations of the Committee as defined by the CCG Constitution and Terms of Reference.

1.2 Due to the nature of the Committee, there is no set of key indicators to report to Board. 2.0 ITEMS DISCUSSED

2.1 Quarterly Workforce Dashboard The Committee receives regular updates on HR and workforce metrics applicable to the CCG. This includes analysis of vacancies, banding/skill-mix ratios, sickness, Personal Development Review completion and mandatory training compliance. In April, the Committee noted a slight decrease in the sickness absence rate which is now 1.37% and has returned to below the CCG target rate of 3%. The Committee was assured that there is currently one long term sickness absence and were also assured that sickness is being managed appropriately. The Committee reviewed mandatory training and PDR compliance. Mandatory training compliance had increased to 93% and CCG staff were commended for this excellent figure. The only outstanding mandatory training is for staff who are either on sick leave or maternity leave. PDR compliance had reduced slightly to 77.48% and the Committee was informed that the CCG is about to enter it’s PDR cycle (April – June 2018) and therefore by the end of June should be nearly 100%. The Committee was also informed that headcount is currently 111.

2.2 Risk Register The Committee reviewed the current Risk Register and noted their satisfaction with the current risks

and scores on the register with slight amendments to risk 98 to include the establishment of the Task and Finish Group on future shape of CCG.

2.3 Update on MCP Primary Care Development, STP and Black Country Joint Commissioning The Committee received an update with regards to the timeline for submission of the MCP bid which

was 25 April 2018. Arrangements with regard to conflicts of interest and staff separation between procurement and development will continue until this point. The Committee was also updated on the Black Country CCGs Executive Teams Away Day that had taken place on 16 February and advised that the away days will now take place on a quarterly basis. With regards to STP developments, the Committee was updated that the STP Board had agreed to the appointment process for an independent STP Chair, an SRO from one of the STP health organisations and a Programme Director to oversee progress of STP workstreams.

. 2.4 Staff Survey Action Plan The Committee received an update on the implementation of the action plan that was agreed as a

result of the Staff Survey. The Committee will continue to receive these updates until the action plan has been completed.

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2.5 Staff Forum Terms of Reference The Committee ratified the revised terms of reference for the CCG Staff Forum. The main change

was changing the co-chairing arrangement between the CCG staff side representative and the Director of OD & HR to sole chairing by the CCG staff side representative. The Committee was informed that in the absence of the CCG staff side representative another member of staff forum would step into the chair role.

2.6 GP Contracts

The Committee received a detailed paper on the variation of contracting approaches for CCG clinical leads and elected members. Within the paper, the clinical leads and elected members were categorised in four groups:

• Office Holders (elected Board members) • Employees (those who had been appointed following decision by Remuneration & HR

Committee in June 2016 to offer employment contracts) • Historical office holders (those who were appointed prior to June 2016 and therefore have a

historical office holder arrangement) • Office holders who transferred from Dudley PCT

The Committee decided to undertake a desktop audit of processes that were undertaken during transfer of posts from Dudley PCT to Dudley CCG and to consult with those clinical leads who were appointed prior to the change to employment contracts concluded by the end of May.

2.7 Sickness Policy

The Committee was provided with a verbal update about the review of the sickness policy following questions raised by staff side. This is currently ongoing and is anticipated to be concluded by the next Committee meeting.

2.8 National Pay Deal Update

The Committee received a verbal update to say that the pay deal for NHS staff on agenda for change contracts had been agreed as 6% over the next three financial years (2018/19 – 2021/22). Further detail of the spread and impact of the pay deal would be shared at the next Committee meeting.

2.9 Director Pay Review

The Committee received a report summarising the actions taken since December 2016 to consider Director Terms and Conditions. The Committee approved a change in Agenda for Change job evaluation banding for the Director of Commissioning and approved the conclusion of the remaining Directors pay review with no change to pay, pay band or terms and conditions.

3. RECOMMENDATION 1. The Board is asked to note the update received from the Remuneration & HR Committee for

assurance.

Mrs S Cartwright Director of Organisational Development and Human Resources May 2018

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 10 May 2018 Report: Dudley CCG 360 Degree Stakeholder Survey 2017-18 Report

Agenda item No: 8.5

TITLE OF REPORT: Dudley CCG 360 Degree Stakeholder Survey 2017-18 Report

PURPOSE OF REPORT: To provide a summary to the Board on the results of the CCG Stakeholder Survey 2017-18.

AUTHOR OF REPORT: Mrs S Cartwright, Director of Organisational Development, Transformation and Human Resources

MANAGEMENT LEAD: Mrs S Cartwright, Director of Organisational Development, Transformation and Human Resources

CLINICAL LEAD/LAY MEMBER: Dr David Hegarty, Chair and Mr S Wellings, Lay Member for Governance

KEY POINTS:

• The CCG has a higher score in every area compared to CCGs nationally and locally

• The CCG rates above the national, cluster and DCO average on every single measure

• The CCG had a higher level of responders than the national average

• The majority of areas have an improved rating compared to the last three years

• A consistent theme has been identified with regards to improving wider membership and GP practice engagement

RECOMMENDATION: The Board to receive the report for assurance and to note the action plan to address issues identified.

FINANCIAL IMPLICATIONS: Within financial plan

WHAT ENGAGEMENT HAS TAKEN PLACE: n/a

ACTION REQUIRED: Decision Approval Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 10 MAY 2018 DUDLEY CCG 360 DEGREE STAKEHOLDER SURVEY 2017-18 REPORT 1.0 INTRODUCTION 1.1 All CCGs participate in an annual stakeholder survey. Stakeholders include our GP member

practices; the Health and Wellbeing Board; Healthwatch; our patient representatives; our main NHS providers; other local CCGs; the Local Authority and any wider stakeholders the CCG may want to include (for example Dudley CVS, the New Business Models team etc).

1.2 All responses are categorised by the group within which they fall (i.e. GP member practice or NHS

provider) but are anonymous within the group (i.e. not identifiable by practice or provider). 1.3 Responders are also invited to provide comments on how Dudley CCG can improve. These are not

shared in the public domain as consent has not been obtained from the contributors. These comments have however been shared with members of the Board through the Board Development process.

1.4 The results of the Stakeholder Survey are shared with the CCG in the format attached (please see

Appendix 1) and are used to inform the organisational development plans and are also discussed with NHS England in the assurance reviews.

2. RESULTS 2.1 Dudley CCG has received excellent feedback from the survey this year. Dudley CCG rates above

the national, cluster and DCO average on every single measure.

2.2 The response rate from this year’s survey is as follows: GP Member Practices 63% Health and Wellbeing Boards 0% Local Healthwatch/Patient Groups 71% NHS Providers 50% Other CCGs 100% Local Authority 14% Wider Stakeholders 100%

2.3 The overall response rate was 62% which was higher than previous years and also higher than the average rate across the country which is 55%.

2.4 As you can see from the summary below, the survey results show an overall improvement in the majority of areas. A summary of where we have improved compared to last year’s survey are as follows: • The CCG involves the right individuals and organisations when commissioning/decommissioning

services increased by 1% to 81% • Effectiveness as a system leader increased by 1% to 93% • Leadership of the CCG has the necessary blend of skills and experience increased by 3% to

87% • Confidence in the CCG to deliver its plans and priorities increased by 1% to 85% • Confidence that the CCG monitors the quality of the services it commissions in an effective

manner increased by 7% to 83% • Ability to raise concerns with the CCG regarding the quality of local services increased by 3% to

91% • Confidence in the CCG to act on feedback it receives about the quality of services increased by

7% to 83% • Comments on the CCG plans and priorities are considered increased by 7% to 67% • CCG has effectively communicated its plans and priorities increased by 1% to 91%

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2.5 A summary of where the CCG has a decline compared to last year’s survey are as follows:

• Effectiveness of working relationship with the CCG has decreased by 3% to 87% • Clear and visible leadership of the CCG has decreased by 9% to 87% • Confidence in the CCG to deliver improved outcomes to patients has decreased by 2% to 80% • Opportunity to influence the CCGs plans and priorities has decreased by 4% to 70%

2.6 The survey included local questions produced and put forward by Dudley CCG. These questions

and their results are as follows:

• 87% feel opportunity has been given for stakeholders to shape the MCP plans in Dudley • 85% feel CCG plans to improve access, continuity and co-ordination for Dudley people are

good or very good • 77% feel the CCG is good or very good at managing relationships across the health and

social care system • 87% feel the CCG’s ability to develop plans to improve the quality of lives for Dudley people

is good or very good • 87% feel that the CCG’s understanding of the primary care landscape is good or very good

2.7 The responses will be discussed in detail at an upcoming development session with the Board.

Overall the improvement in responses to the survey, the high level of scores and the recognition that the CCG has been rated higher than other CCGs both nationally and locally should be congratulated whilst recognising areas for improvement.

2.8 The comments that have been received through the survey have shown a particular theme of

improvement that is required in the way that the CCG engages with its member practices through individual visits, locality meetings, membership meetings and general communications. This has been discussed by our board at the recent development session in April 2018 and has also been discussed at the Members Meeting also in April 2018. Further discussion and feedback is being sought through locality meetings, but meanwhile an action plan has been produced that highlights the areas of concerns and identifies various actions to address the issues raised. A copy of the action plan can be found as Appendix 2.

3. RECOMMENDATION 1. The Board is asked to note the results of the CCG Stakeholder Survey 2017/18. 2. The Board is asked to ratify the attached action plan (Appendix 2) to address issues regarding

membership engagement and communications.

Mrs S Cartwright Director of Organisational Development and Human Resources

Mr D King Director of Primary Care

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Findings

Dudley CCG CCG 360o Stakeholder Survey 2017-18

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Slide 3 Summary

Slide 6 Introduction

Slide 7 Background and objectives

Slide 8 Methodology and technical details

Slide 10 Interpreting the results

Slide 11 Using the results

Slide 13 Combined stakeholder findings

Slide 36 Upper tier and unitary local authorities

Slide 40 Healthwatch and voluntary/patient groups

Slide 43 GP member practices

Slide 55 NHS providers

Slide 62 CCG’s local questions

Slide 68 Appendix – CCG cluster

Table of contents

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Summary

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Base = all stakeholders except CQC (2018; 54, 2017; 50, 2016; 42) unless otherwise stated

Overall Engagement 2018 2017 2016

Overall, how would you rate the effectiveness of your working relationship with the CCG? 87% 90% 88%

How satisfied or dissatisfied are you with how the CCG involves patients and the public?* 91% - -

Commissioning services 2018 2017 2016

The CCG involves the right individuals and organisations when commissioning/decommissioning services 81% 80% 74%

The CCG provides adequate information to explain the reasons for the decisions it makes when commissioning/decommissioning services 80% - -

I have confidence the CCG’s plans will deliver high quality services that demonstrate value for money

81% - -

I have confidence in the CCG to commission/decommission services appropriately 83% - -

The CCG demonstrates it has considered the views of patients and the public when making commissioning decisions*

89% - -

% very/fairly good

% very/fairly satisfied

% strongly/tend to agree

% strongly/tend to agree

% strongly/tend to agree

% strongly/tend to agree

% strongly/tend to agree

Fieldwork: 15th January - 28th February

Summary This report presents the results from Dudley CCG’s 360° Stakeholder Survey 2017-18. The annual CCG 360° Stakeholder Survey, which has been conducted online and by telephone since 2014, allows a range of key stakeholders to provide feedback on working relationships with their CCG. The results are used to support CCGs’ ongoing development and feed into improvement and assessment conversations with NHS England. The following chart presents the summary findings across the CCG for the questions asked of all stakeholders. This provides the percentage of stakeholders responding positively to the key questions, including year-on-year comparisons where the question was also asked in 2017 and 2016.

Dudley CCG *Base = all stakeholders (2018; 54, 2017; 50, 2016; 42)

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Base = all stakeholders except CQC (2018; 54, 2017; 50, 2016; 42) unless otherwise stated

Leadership of the CCG 2018 2017 2016

How effective, if at all, do you feel your CCG is as a local system leader? 93% 92% 93%

The leadership of the CCG has the necessary blend of skills and experience* 87% 84% 71%

There is clear and visible leadership of the CCG* 87% 96% 83%

I have confidence in the leadership of the CCG to deliver its plans and priorities* 85% 84% 76%

The leadership of CCG is delivering high quality services within the available resources* 87% - -

I have confidence in the leadership of the CCG to deliver improved outcomes for patients* 80% 82% 81%

The leadership of the CCG is contributing effectively to local partnership arrangements (including Sustainability Transformation Partnerships (STPs), Accountable Care Systems (ACSs) where

applicable and/or other local partnership arrangements)* 85% - -

Monitoring and reviewing services 2018 2017 2016

I have confidence that the CCG monitors the quality of the services it commissions in an effective manner

83% 76% 57%

If I had concerns about the quality of local services I would feel able to raise my concerns within the CCG 91% 88% 83%

I have confidence in the CCG to act on feedback it receives about the quality of services 83% 76% 76%

Plans and priorities 2018 2017 2016

How much would you say you know about the CCG’s plans and priorities? 89% 88% 93%

I have been given the opportunity to influence the CCG’s plans and priorities 70% 74% 71%

When I have commented on the CCG’s plans and priorities I feel that my comments have been considered (even if the CCG has not been able to act on them) 67% 60% 60%

The CCG has effectively communicated its plans and priorities to me 91% 90% 76%

% very/fairly effective

% strongly/tend to agree

% strongly/tend to agree

% strongly/tend to agree

% strongly/tend to agree

% strongly/tend to agree

% strongly/tend to agree

% strongly/tend to agree

% strongly/tend to agree

% strongly/tend to agree

% a great deal/fair amount

% strongly/tend to agree

% strongly/tend to agree

% strongly/tend to agree

Fieldwork: 15th January - 28th February

Dudley CCG

Summary cont.

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Introduction

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Background and objectives

Clinical Commissioning Groups (CCGs) need to have strong relationships with a range of stakeholders in order to be successful commissioners within their local health and care systems. These relationships provide CCGs with valuable intelligence to help them make the effective commissioning decisions for their local populations. The CCG 360o Stakeholder Survey enables stakeholders to provide feedback about their CCGs. The results of the survey serve two purposes: 1. To provide a wealth of data for CCGs to help with their ongoing organisational development,

supporting them to build strong and productive relationships with stakeholders. The findings can provide a valuable tool for all CCGs to evaluate their progress, and inform the way that they work and make decisions.

2. To help NHS England to assess CCGs’ stakeholder relationships and leadership within their local health and care systems, and how effectively they commission services to improve service quality and health outcomes.

Dudley CCG

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Methodology and technical details • It was the responsibility of each CCG to provide the list of stakeholders to invite to take part in the CCG

360o stakeholder survey.

• CCGs were provided with a specification of core stakeholder organisations to be included in their stakeholder list. Beyond this, however, CCGs had the flexibility to determine which individual within each organisation was the most appropriate to nominate.

• CCGs were also given the opportunity to add up to ten additional stakeholders they wanted to include locally (they are referred to in this report as ‘wider stakeholders’). These included: Commissioning Support Units, Health Education England, lower tier local authorities, MPs, private providers, Public Health England, local care homes, GP out-of-hours providers and others.

• Stakeholders were sent an email inviting them to complete the survey online. Stakeholders who did not respond to the email invitation, and stakeholders for whom an email address was not provided, were telephoned by an Ipsos MORI interviewer who encouraged response and offered the opportunity to complete the survey by telephone.

Dudley CCG

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Stakeholder group Invited to take part in survey

Completed survey Response rate

GP member practices One from every member practice* 46 29 63%

Health and wellbeing boards Up to two per HWB* 1 0 0%

Local Healthwatch/voluntary patient groups Up to three per local Healthwatch*

14 10 71%

NHS providers Up to two from each acute, mental health and community health providers*

6 3 50%

Other CCGs Up to five* 4 4 100%

Upper tier or unitary local authorities Up to five per LA* 7 1 14%

Wider stakeholders 9 7 78%

Methodology and technical details

• Within the survey, stakeholders were asked a series of questions about their working relationship with the CCG. In addition, to reflect each core stakeholder group’s different area of expertise and knowledge, they were presented with a short section of questions specific to the stakeholder group they represented.

• Fieldwork was conducted between 15th January and 28th February.

• 54 of the CCG’s stakeholders completed the survey. The overall response rate was 62%, which varied across the stakeholder groups as shown in the table opposite.

*Specification from the core stakeholder framework Dudley CCG

Survey response rates for Dudley CCG

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Interpreting the results

• For each question, the response to each answer is presented as both a percentage (%) and as a number (n). The total number of stakeholders who answered each question (the base size) is also stated at the bottom of each chart and in every table. For questions with fewer than 30 stakeholders answering, we strongly recommend that you look at the number of stakeholders giving each response rather than the percentage, as the percentage can be misleading when based on so few stakeholders.

• This report presents the results from Dudley CCG’s stakeholder survey. Throughout the report, ‘the CCG/your CCG’ refers to Dudley CCG.

• Where results do not sum to 100%, or where individual responses (e.g. tend to agree; strongly agree) do not sum to combined responses (e.g. strongly/tend to agree) this is due to rounding.

Dudley CCG

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Using the results – the reports

• This report contains a summary section, a section on overall views of relationships and a section for each of the main stakeholder groups who were invited to complete the survey.

• The overall summary slides show the results at CCG level for the questions asked of all stakeholders (i.e. only those in section 1 of the questionnaire).

• This provides CCGs with an ‘at a glance’ visual summary of the results for the key questions, including direction of travel comparisons where appropriate.

• The stakeholder specific sections of the report contain those questions which were targeted at individual groups of stakeholders only. • These questions were often around specific issues which were only relevant to the specific group

of stakeholders.

• The remainder of the report shows the results for all questions in the survey including any local questions where CCGs included them. The results for each question are provided at CCG level with a breakdown also shown for each of the core stakeholder groups where relevant.

• This allows CCGs to interrogate the data in more detail.

Dudley CCG

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Using the results – comparisons The comparisons are included to provide an indication of differences only and should be treated with caution due to the low numbers of respondents and differences in stakeholder lists.

• Any differences are not necessarily statistically significant differences; a higher score than the

cluster average does not always equate to ‘better ’ performance, and a higher score than in 2017 does not necessarily mean the CCG has improved.

• The comparisons offer a starting point to inform wider discussions about the CCG’s ongoing

organisational development and its relationships with stakeholders. For example, they may indicate areas in which stakeholders think the CCG is performing relatively less well, for the CCG to discuss internally and externally to identify what improvements can be made in this area, if any.

Dudley CCG

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Combined stakeholder findings

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CCG change across time Regional and cluster comparisons

Number of respondents: CCG 2018 (54), National (7881), Cluster (650), DCO (643).

Number of respondents: 2018 (54), 2017 (50), 2016 (42)

56% 31%

7% 6%

30 17

4 3

Very good Fairly good Neither good nor poor

Fairly poor Very poor Don't know

Stakeholder group No. of respondents

Very good/ Fairly good

Fairly poor/ Very poor

GP member practices 29 83% (24) 7% (2)

Health & wellbeing boards 0 - -

Healthwatch and voluntary/patient groups 10 100% (10) -

NHS providers 3 33% (1) 33% (1)

Other CCGs 4 100% (4) -

Upper tier/unitary LA 1 100% (1) -

Wider stakeholders 7 100% (7) -

88% 90%

87%

2016 2017 2018

69% 76% 76%

87%

DCO**Cluster*National

CCG 2018

Overall, how would you rate the effectiveness of your working relationship with the CCG?

By stakeholder group All stakeholders

Fieldwork: 15th January - 28th February Dudley CCG

Percentage of stakeholders saying very good/fairly good

Percentage of stakeholders saying very good/fairly good

*A cluster is the group of CCGs that are most similar to the CCG based on several population characteristics..

**The DCO is the group of local CCGs that fall under the same Director of Commissioning Operations as the CCG.

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CCG change across time Regional and cluster comparisons

Number of respondents: CCG 2018 (54), National (7881), Cluster (650), DCO (643).

Number of respondents: 2018 (54), 2017 (50), 2016 (42)

37%

44%

13% 6%

20

24

7

3

Strongly agree Tend to agree Neither agree nor disagree

Tend to disagree Strongly disagree Don't know

Stakeholder group No. of respondents

Strongly/Tend to agree

Strongly/Tend to disagree

GP member practices 29 76% (22) 7% (2)

Health & wellbeing boards 0 - -

Healthwatch and voluntary/patient groups 10 90% (9) -

NHS providers 3 33% (1) 33% (1)

Other CCGs 4 100% (4) -

Upper tier/unitary LA 1 100% (1) -

Wider stakeholders 7 100% (7) -

74% 80% 81%

2016 2017 2018

51% 53%

57% 81%

DCO**Cluster*National

CCG 2018

To what extent do you agree or disagree with the following statements about the way in which the CCG commissions/decommissions services…?

The CCG involves the right individuals and organisations when commissioning/decommissioning services By stakeholder group All stakeholders

Dudley CCG Fieldwork: 15th January - 28th February

Percentage of stakeholders saying strongly agree/tend to agree

Percentage of stakeholders saying strongly agree/tend to agree

*A cluster is the group of CCGs that are most similar to the CCG based on several population characteristics.

**The DCO is the group of local CCGs that fall under the same Director of Commissioning Operations as the CCG.

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CCG change across time Regional and cluster comparisons

Number of respondents: CCG 2018 (54), National (7881), Cluster (650), DCO (643).

39%

41%

11%

9%

21

22

6

5

Strongly agree Tend to agree Neither agree nor disagree

Tend to disagree Strongly disagree Don't know

Stakeholder group No. of respondents

Strongly/Tend to agree

Strongly/Tend to disagree

GP member practices 29 66% (19) 14% (4)

Health & wellbeing boards 0 - -

Healthwatch and voluntary/patient groups 10 100% (10) -

NHS providers 3 67% (2) 33% (1)

Other CCGs 4 100% (4) -

Upper tier/unitary LA 1 100% (1) -

Wider stakeholders 7 100% (7) -

48% 52%

55% 80%

DCO**Cluster*National

CCG 2018

To what extent do you agree or disagree with the following statements about the way in which the CCG commissions/decommissions services…? The CCG provides adequate information to explain the reasons for the decisions it makes when commissioning/decommissioning services All stakeholders By stakeholder group

Dudley CCG Fieldwork: 15th January - 28th February

Percentage of stakeholders saying strongly agree/tend to agree

Percentage of stakeholders saying strongly agree/tend to agree

There is no trend data available for this question, as it was asked for the first time in 2018.

*A cluster is the group of CCGs that are most similar to the CCG based on several population characteristics.

**The DCO is the group of local CCGs that fall under the same Director of Commissioning Operations as the CCG.

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CCG change across time Regional and cluster comparisons

Number of respondents: CCG 2018 (54), National (7881), Cluster (650), DCO (643).

35%

46%

17% 2%

19

25

9 1

Strongly agree Tend to agree Neither agree nor disagree

Tend to disagree Strongly disagree Don't know

Stakeholder group No. of respondents

Strongly/Tend to agree

Strongly/Tend to disagree

GP member practices 29 79% (23) -

Health & wellbeing boards 0 - -

Healthwatch and voluntary/patient groups 10 100% (10) -

NHS providers 3 33% (1) 33% (1)

Other CCGs 4 50% (2) -

Upper tier/unitary LA 1 100% (1) -

Wider stakeholders 7 100% (7) -

53% 57% 59%

81%

DCO**Cluster*National

CCG 2018

To what extent do you agree or disagree with the following statements about the way in which the CCG commissions/decommissions services…?

I have confidence the CCG’s plans will deliver high quality services that demonstrate value for money By stakeholder group All stakeholders

Fieldwork: 15th January - 28th February Dudley CCG

Percentage of stakeholders saying strongly agree/tend to agree

Percentage of stakeholders saying strongly agree/tend to agree

There is no trend data available for this question, as it was asked for the first time in 2018.

*A cluster is the group of CCGs that are most similar to the CCG based on several population characteristics..

**The DCO is the group of local CCGs that fall under the same Director of Commissioning Operations as the CCG.

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CCG change across time Regional and cluster comparisons

39%

44%

13% 4%

21

24

7 2

Strongly agree Tend to agree Neither agree nor disagree

Tend to disagree Strongly disagree Don't know

Stakeholder group No. of respondents

Strongly/Tend to agree

Strongly/Tend to disagree

GP member practices 29 76% (22) 7% (2)

Health & wellbeing boards 0 - -

Healthwatch and voluntary/patient groups 10 90% (9) -

NHS providers 3 67% (2) -

Other CCGs 4 100% (4) -

Upper tier/unitary LA 1 100% (1) -

Wider stakeholders 7 100% (7) -

55% 58% 60%

83%

DCO**Cluster*National

CCG 2018

To what extent do you agree or disagree with the following statements about the way in which the CCG commissions/decommissions services…?

I have confidence in the CCG to commission/decommission services appropriately By stakeholder group All stakeholders

Fieldwork: 15th January - 28th February Dudley CCG

Percentage of stakeholders saying strongly agree/tend to agree

Percentage of stakeholders saying strongly agree/tend to agree

There is no trend data available for this question, as it was asked for the first time in 2018.

*A cluster is the group of CCGs that are most similar to the CCG based on several population characteristics..

**The DCO is the group of local CCGs that fall under the same Director of Commissioning Operations as the CCG.

Number of respondents: CCG 2018 (54), National (7881), Cluster (650), DCO (643).

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CCG change across time Regional and cluster comparisons

Number of respondents: CCG 2018 (54), National (7884), Cluster (651), DCO (643).

Number of respondents: 2018 (54), 2017 (50), 2016 (42)

44%

43%

11% 2%

24

23

6 1

Strongly agree Tend to agree Neither agree nor disagree

Tend to disagree Strongly disagree Don't know

Stakeholder group No. of respondents

Strongly/Tend to agree

Strongly/Tend to disagree

GP member practices 29 79% (23) 3% (1)

Health & wellbeing boards 0 - -

Healthwatch and voluntary/patient groups 10 100% (10) -

NHS providers 3 67% (2) -

Other CCGs 4 100% (4) -

Upper tier/unitary LA 1 100% (1) -

Wider stakeholders 7 100% (7) -

71% 84% 87%

2016 2017 2018

55% 57% 59%

87%

DCO**Cluster*National

CCG 2018

To what extent do you agree or disagree with the following statements about the leadership of the CCG…?

The leadership of the CCG has the necessary blend of skills and experience By stakeholder group All stakeholders

Dudley CCG Fieldwork: 15th January - 28th February

Percentage of stakeholders saying strongly agree/tend to agree

Percentage of stakeholders saying strongly agree/tend to agree

*A cluster is the group of CCGs that are most similar to the CCG based on several population characteristics.

**The DCO is the group of local CCGs that fall under the same Director of Commissioning Operations as the CCG.

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CCG change across time Regional and cluster comparisons

Number of respondents: CCG 2018 (54), National (7884), Cluster (651), DCO (643).

Number of respondents: 2018 (54), 2017 (50), 2016 (42)

61% 26%

11% 2%

33

14

6 1

Strongly agree Tend to agree Neither agree nor disagree

Tend to disagree Strongly disagree Don't know

Stakeholder group No. of respondents

Strongly/Tend to agree

Strongly/Tend to disagree

GP member practices 29 79% (23) 3% (1)

Health & wellbeing boards 0 - -

Healthwatch and voluntary/patient groups 10 100% (10) -

NHS providers 3 67% (2) -

Other CCGs 4 100% (4) -

Upper tier/unitary LA 1 100% (1) -

Wider stakeholders 7 100% (7) -

83% 96% 87%

2016 2017 2018

61% 65%

69% 87%

DCO**Cluster*National

CCG 2018

To what extent do you agree or disagree with the following statements about the overall leadership of the CCG…? There is clear and visible leadership of the CCG

By stakeholder group All stakeholders

Dudley CCG Fieldwork: 15th January - 28th February

Percentage of stakeholders saying strongly agree/tend to agree

Percentage of stakeholders saying strongly agree/tend to agree

*A cluster is the group of CCGs that are most similar to the CCG based on several population characteristics..

**The DCO is the group of local CCGs that fall under the same Director of Commissioning Operations as the CCG.

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CCG change across time Regional and cluster comparisons

Number of respondents: CCG 2018 (54), National (7884), Cluster (651), DCO (643).

Number of respondents: 2018 (54), 2017 (50), 2016 (42)

46%

39%

9% 6%

25

21

5 3

Strongly agree Tend to agree Neither agree nor disagree

Tend to disagree Strongly disagree Don't know

Stakeholder group No. of respondents

Strongly/Tend to agree

Strongly/Tend to disagree

GP member practices 29 79% (23) 7% (2)

Health & wellbeing boards 0 - -

Healthwatch and voluntary/patient groups 10 100% (10) -

NHS providers 3 67% (2) -

Other CCGs 4 75% (3) 25% (1)

Upper tier/unitary LA 1 100% (1) -

Wider stakeholders 7 100% (7) -

76% 84% 85%

2016 2017 2018

56% 60% 62%

85%

DCO**Cluster*National

CCG 2018

To what extent do you agree or disagree with the following statements about the clinical leadership of the CCG…?

I have confidence in the leadership of the CCG to deliver its plans and priorities By stakeholder group All stakeholders

Dudley CCG Fieldwork: 15th January - 28th February

Percentage of stakeholders saying strongly agree/tend to agree

Percentage of stakeholders saying strongly agree/tend to agree

*A cluster is the group of CCGs that are most similar to the CCG based on several population characteristics..

**The DCO is the group of local CCGs that fall under the same Director of Commissioning Operations as the CCG.

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CCG change across time Regional and cluster comparisons

Number of respondents: CCG 2018 (54), National (7884), Cluster (651), DCO (643).

44%

43%

9% 4%

24

23

5 2

Strongly agree Tend to agree Neither agree nor disagree

Tend to disagree Strongly disagree Don't know

Stakeholder group No. of respondents

Strongly/Tend to agree

Strongly/Tend to disagree

GP member practices 29 83% (24) 7% (2)

Health & wellbeing boards 0 - -

Healthwatch and voluntary/patient groups 10 100% (10) -

NHS providers 3 33% (1) -

Other CCGs 4 100% (4) -

Upper tier/unitary LA 1 100% (1) -

Wider stakeholders 7 100% (7) -

55% 59%

63% 87%

DCO**Cluster*National

CCG 2018

To what extent do you agree or disagree with the following statements about the leadership of the CCG…?

The leadership of the CCG is delivering high quality services within the available resources By stakeholder group All stakeholders

Dudley CCG Fieldwork: 15th January - 28th February

Percentage of stakeholders saying strongly agree/tend to agree

Percentage of stakeholders saying strongly agree/tend to agree

There is no trend data available for this question, as it was asked for the first time in 2018.

*A cluster is the group of CCGs that are most similar to the CCG based on several population characteristics..

**The DCO is the group of local CCGs that fall under the same Director of Commissioning Operations as the CCG.

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CCG change across time Regional and cluster comparisons

Number of respondents: CCG 2018 (54), National (7884), Cluster (651), DCO (643).

Number of respondents: 2018 (54), 2017 (50), 2016 (42)

50%

30%

15% 6%

27

16

8

3

Strongly agree Tend to agree Neither agree nor disagree

Tend to disagree Strongly disagree Don't know

Stakeholder group No. of respondents

Strongly/Tend to agree

Strongly/Tend to disagree

GP member practices 29 69% (20) 3% (1)

Health & wellbeing boards 0 - -

Healthwatch and voluntary/patient groups 10 100% (10) -

NHS providers 3 33% (1) 67% (2)

Other CCGs 4 100% (4) -

Upper tier/unitary LA 1 100% (1) -

Wider stakeholders 7 100% (7) -

81% 82% 80%

2016 2017 2018

56% 59% 61%

80%

DCO**Cluster*National

CCG 2018

To what extent do you agree or disagree with the following statements about the leadership of the CCG…?

I have confidence in the leadership of the CCG to deliver improved outcomes for patients By stakeholder group All stakeholders

Dudley CCG Fieldwork: 15th January - 28th February

Percentage of stakeholders saying strongly agree/tend to agree

Percentage of stakeholders saying strongly agree/tend to agree

*A cluster is the group of CCGs that are most similar to the CCG based on several population characteristics..

**The DCO is the group of local CCGs that fall under the same Director of Commissioning Operations as the CCG.

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CCG change across time Regional and cluster comparisons

Number of respondents: CCG 2018 (54), National (7884), Cluster (651), DCO (643).

48%

37%

9% 4%

2%

26

20

5 2 1

Strongly agree Tend to agree Neither agree nor disagree

Tend to disagree Strongly disagree Don't know

Stakeholder group No. of respondents

Strongly/Tend to agree

Strongly/Tend to disagree

GP member practices 29 76% (22) 7% (2)

Health & wellbeing boards 0 - -

Healthwatch and voluntary/patient groups 10 100% (10) -

NHS providers 3 100% (3) -

Other CCGs 4 75% (3) 25% (1)

Upper tier/unitary LA 1 100% (1) -

Wider stakeholders 7 100% (7) -

54% 61% 62%

85%

DCO**Cluster*National

CCG 2018

To what extent do you agree or disagree with the following statements about the leadership of the CCG…?

The leadership of the CCG is contributing effectively to local partnership arrangements (including Sustainability Transformation Partnerships (STPs), Accountable Care Systems (ACSs) where applicable and/or other local partnership arrangements).

By stakeholder group All stakeholders

Dudley CCG Fieldwork: 15th January - 28th February

Percentage of stakeholders saying strongly agree/tend to agree

Percentage of stakeholders saying strongly agree/tend to agree

There is no trend data available for this question, as it was asked for the first time in 2018.

*A cluster is the group of CCGs that are most similar to the CCG based on several population characteristics.

**The DCO is the group of local CCGs that fall under the same Director of Commissioning Operations as the CCG.

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CCG change across time Regional and cluster comparisons

Number of respondents: CCG 2018 (54), National (7881), Cluster (650), DCO (643).

Number of respondents: 2018 (54), 2017 (50), 2016 (42)

33%

50%

7% 4%

2% 4%

18

27

4 2 1 2

Strongly agree Tend to agree Neither agree nor disagree

Tend to disagree Strongly disagree Don't know

Stakeholder group No. of respondents

Strongly/Tend to agree

Strongly/Tend to disagree

GP member practices 29 76% (22) 10% (3)

Health & wellbeing boards 0 - -

Healthwatch and voluntary/patient groups 10 100% (10) -

NHS providers 3 67% (2) -

Other CCGs 4 75% (3) -

Upper tier/unitary LA 1 100% (1) -

Wider stakeholders 7 100% (7) -

57% 76% 83%

2016 2017 2018

59% 60%

63% 83%

DCO**Cluster*National

CCG 2018

To what extent do you agree or disagree with the following statements about the way in which the CCG monitors and reviews the quality of the services it commissions…?

I have confidence that the CCG monitors the quality of the services it commissions in an effective manner By stakeholder group All stakeholders

Percentage of stakeholders saying strongly agree/tend to agree

Percentage of stakeholders saying strongly agree/tend to agree

Dudley CCG Fieldwork: 15th January - 28th February

*A cluster is the group of CCGs that are most similar to the CCG based on several population characteristics.

**The DCO is the group of local CCGs that fall under the same Director of Commissioning Operations as the CCG.

26 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

CCG change across time Regional and cluster comparisons

Number of respondents: CCG 2018 (54), National (7881), Cluster (650), DCO (643).

Number of respondents: 2018 (54), 2017 (50), 2016 (42)

56% 35%

6% 4%

30 19

3 2

Strongly agree Tend to agree Neither agree nor disagree

Tend to disagree Strongly disagree Don't know

Stakeholder group No. of respondents

Strongly/Tend to agree

Strongly/Tend to disagree

GP member practices 29 83% (24) 7% (2)

Health & wellbeing boards 0 - -

Healthwatch and voluntary/patient groups 10 100% (10) -

NHS providers 3 100% (3) -

Other CCGs 4 100% (4) -

Upper tier/unitary LA 1 100% (1) -

Wider stakeholders 7 100% (7) -

83% 88% 91%

2016 2017 2018

76% 82% 83%

91%

DCO**Cluster*National

CCG 2018

To what extent do you agree or disagree with the following statements about the way in which the CCG monitors and reviews the quality of the services it commissions…? If I had concerns about the quality of local services I would feel able to raise my concerns within the CCG

By stakeholder group All stakeholders

Percentage of stakeholders saying strongly agree/tend to agree

Percentage of stakeholders saying strongly agree/tend to agree

Dudley CCG Fieldwork: 15th January - 28th February

*A cluster is the group of CCGs that are most similar to the CCG based on several population characteristics..

**The DCO is the group of local CCGs that fall under the same Director of Commissioning Operations as the CCG.

27 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

CCG change across time Regional and cluster comparisons

Number of respondents: CCG 2018 (54), National (7881), Cluster (650), DCO (643).

Number of respondents: 2018 (54), 2017 (50), 2016 (42)

43%

41%

11% 4%

2%

23

22

6 2 1

Strongly agree Tend to agree Neither agree nor disagree

Tend to disagree Strongly disagree Don't know

Stakeholder group No. of respondents

Strongly/Tend to agree

Strongly/Tend to disagree

GP member practices 29 76% (22) 7% (2)

Health & wellbeing boards 0 - -

Healthwatch and voluntary/patient groups 10 100% (10) -

NHS providers 3 67% (2) 33% (1)

Other CCGs 4 75% (3) -

Upper tier/unitary LA 1 100% (1) -

Wider stakeholders 7 100% (7) -

76% 76% 83%

2016 2017 2018

56% 63% 64%

83%

DCO**Cluster*National

CCG 2018

To what extent do you agree or disagree with the following statements about the way in which the CCG monitors and reviews the quality of the services it commissions…?

I have confidence in the CCG to act on feedback it receives about the quality of services By stakeholder group All stakeholders

Percentage of stakeholders saying strongly agree/tend to agree

Percentage of stakeholders saying strongly agree/tend to agree

Dudley CCG Fieldwork: 15th January - 28th February

*A cluster is the group of CCGs that are most similar to the CCG based on several population characteristics.

**The DCO is the group of local CCGs that fall under the same Director of Commissioning Operations as the CCG.

28 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

CCG change across time Regional and cluster comparisons

Number of respondents: CCG 2018 (54), National (7881), Cluster (650), DCO (643).

Number of respondents: 2018 (54), 2017 (50), 2016 (42)

26%

63%

11% 14

34

6

A great deal A fair amount Not very much Nothing at all

Stakeholder group No. of respondents

A great deal/ a fair amount

Not very much/ nothing at all

GP member practices 29 83% (24) 17% (5)

Health & wellbeing boards 0 - -

Healthwatch and voluntary/patient groups 10 100% (10) -

NHS providers 3 100% (3) -

Other CCGs 4 75% (3) 25% (1)

Upper tier/unitary LA 1 100% (1) -

Wider stakeholders 7 100% (7) -

93%

88% 89%

2016 2017 2018

67% 74%

78% 89%

DCO**Cluster*National

CCG 2018

How much would you say you know about the CCG’s plans and priorities?

All stakeholders By stakeholder group

Percentage of stakeholders saying a great deal/a fair amount

Percentage of stakeholders saying a great deal/a fair amount

Dudley CCG Fieldwork: 15th January - 28th February

*A cluster is the group of CCGs that are most similar to the CCG based on several population characteristics..

**The DCO is the group of local CCGs that fall under the same Director of Commissioning Operations as the CCG.

29 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

CCG change across time Regional and cluster comparisons

Number of respondents: CCG 2018 (54), National (7881), Cluster (650), DCO (643).

Number of respondents: 2018 (54), 2017 (50), 2016 (42)

33%

37%

24%

4% 2%

18

20

13

2 1

Strongly agree Tend to agree Neither agree nor disagree

Tend to disagree Strongly disagree Don't know

Stakeholder group No. of respondents

Strongly/ Tend to agree

Strongly/ Tend to disagree

GP member practices 29 59% (17) 10% (3)

Health & wellbeing boards 0 - -

Healthwatch and voluntary/patient groups 10 100% (10) -

NHS providers 3 67% (2) -

Other CCGs 4 25% (1) -

Upper tier/unitary LA 1 100% (1) -

Wider stakeholders 7 100% (7) -

71% 74% 70%

2016 2017 2018

44% 51% 53%

70%

DCO**Cluster*National

CCG 2018

To what extent do you agree or disagree with each of the following statements about the CCG’s plans and priorities?

I have been given the opportunity to influence the CCG’s plans and priorities All stakeholders By stakeholder group

Dudley CCG Fieldwork: 15th January - 28th February

Percentage of stakeholders saying strongly agree/tend to agree

Percentage of stakeholders saying strongly agree/tend to agree

*A cluster is the group of CCGs that are most similar to the CCG based on several population characteristics.

**The DCO is the group of local CCGs that fall under the same Director of Commissioning Operations as the CCG.

30 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

CCG change across time Regional and cluster comparisons

Number of respondents: CCG 2018 (54), National (7881), Cluster (650), DCO (643).

Number of respondents: 2018 (54), 2017 (50), 2016 (42)

31%

35%

26%

2% 2% 4%

17

19

14

1 1 2

Strongly agree Tend to agree Neither agree nor disagree

Tend to disagree Strongly disagree Don't know

Stakeholder group No. of respondents

Strongly/ Tend to agree

Strongly/ Tend to disagree

GP member practices 29 45% (13) 3% (1)

Health & wellbeing boards 0 - -

Healthwatch and voluntary/patient groups 10 100% (10) -

NHS providers 3 67% (2) 33% (1)

Other CCGs 4 75% (3) -

Upper tier/unitary LA 1 100% (1) -

Wider stakeholders 7 100% (7) -

60% 60% 67%

2016 2017 2018

44% 51% 53%

67%

DCO**Cluster*National

CCG 2018

To what extent do you agree or disagree with each of the following statements about the CCG’s plans and priorities?

When I have commented on the CCG’s plans and priorities I feel that my comments have been considered (even if the CCG has not been able to act on them) All stakeholders By stakeholder group

Dudley CCG Fieldwork: 15th January - 28th February

Percentage of stakeholders saying strongly agree/tend to agree

Percentage of stakeholders saying strongly agree/tend to agree

*A cluster is the group of CCGs that are most similar to the CCG based on several population characteristics..

**The DCO is the group of local CCGs that fall under the same Director of Commissioning Operations as the CCG.

31 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

CCG change across time Regional and cluster comparisons

Number of respondents: CCG 2018 (54), National (7881), Cluster (650), DCO (643).

Number of respondents: 2018 (54), 2017 (50), 2016 (42)

37%

54%

9%

20

29

5

Strongly agree Tend to agree Neither agree nor disagree

Tend to disagree Strongly disagree Don't know

Stakeholder group No. of respondents

Strongly/ Tend to agree

Strongly/ Tend to disagree

GP member practices 29 83% (24) -

Health & wellbeing boards 0 - -

Healthwatch and voluntary/patient groups 10 100% (10) -

NHS providers 3 100% (3) -

Other CCGs 4 100% (4) -

Upper tier/unitary LA 1 100% (1) -

Wider stakeholders 7 100% (7) -

76% 90% 91%

2016 2017 2018

50% 59%

62% 91%

DCO**Cluster*National

CCG 2018

To what extent do you agree or disagree with each of the following statements about the CCG’s plans and priorities…?

The CCG has effectively communicated its plans and priorities to me All stakeholders By stakeholder group

Percentage of stakeholders saying strongly agree/tend to agree

Percentage of stakeholders saying strongly agree/tend to agree

Dudley CCG Fieldwork: 15th January - 28th February

*A cluster is the group of CCGs that are most similar to the CCG based on several population characteristics.

**The DCO is the group of local CCGs that fall under the same Director of Commissioning Operations as the CCG.

32 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

CCG change across time Regional and cluster comparisons

Number of respondents: CCG 2018 (54), National (7881), Cluster (650), DCO (643).

Number of respondents: 2018 (54), 2017 (50), 2016 (42)

44%

48%

4% 4%

24

26

2 2

Very effective Fairly effective Not very effective Not at all effective Don't know

Stakeholder group No. of respondents

Very/fairly effective

Not very/ not at all effective

GP member practices 29 90% (26) 3% (1)

Health & wellbeing boards 0 - -

Healthwatch and voluntary/patient groups 10 100% (10) -

NHS providers 3 100% (3) -

Other CCGs 4 75% (3) 25% (1)

Upper tier/unitary LA 1 100% (1) -

Wider stakeholders 7 100% (7) -

93% 92% 93%

2016 2017 2018

65% 72% 72%

93%

DCO**Cluster*National

CCG 2018

How effective, if at all, do you feel the CCG is as a local system leader? By ‘local system leader’ we mean that the CCG works proactively and constructively with the other partners in its local health and care economy, prioritising tasks-in-common over formal organisational boundaries, for example as part of an STP/ACS/other local partnership. All stakeholders By stakeholder group

Percentage of stakeholders saying very/fairly effective

Percentage of stakeholders saying very/fairly effective

Dudley CCG Fieldwork: 15th January - 28th February

*A cluster is the group of CCGs that are most similar to the CCG based on several population characteristics.

**The DCO is the group of local CCGs that fall under the same Director of Commissioning Operations as the CCG.

33 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

CCG change across time Regional and cluster comparisons

Number of respondents: CCG 2018 (54), National (7884), Cluster (651), DCO (643).

44%

46%

4% 2% 4%

24

25

2 1 2

Very satisfied Fairly satisfiedNeither satisfied nor dissatisfied Fairly dissatisfiedVery dissatisfied Don't know

Stakeholder group No. of respondents

Very/fairly satisfied

Fairly/very dissatisfied

GP member practices 29 86% (25) -

Health & wellbeing boards 0 - -

Healthwatch and voluntary/patient groups 10 100% (10) -

NHS providers 3 67% (2) 33% (1)

Other CCGs 4 100% (4) -

Upper tier/unitary LA 1 100% (1) -

Wider stakeholders 7 100% (7) -

60% 64% 64%

91%

DCO**Cluster*National

CCG 2018

How satisfied or dissatisfied are you with how the CCG involves patients and the public? This may be done in various ways, for example through public meetings, focus groups, working with Patient Participation Groups (PPGs), voluntary organisations and local Healthwatch, and through the CCG’s website, newsletters, and communications in GP surgeries.

By stakeholder group All stakeholders

Percentage of stakeholders saying very/fairly satisfied

Percentage of stakeholders saying very/fairly satisfied

Dudley CCG Fieldwork: 15th January - 28th February

There is no trend data available for this question, as it was asked for the first time in 2018.

*A cluster is the group of CCGs that are most similar to the CCG based on several population characteristics..

**The DCO is the group of local CCGs that fall under the same Director of Commissioning Operations as the CCG.

34 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

CCG change across time Regional and cluster comparisons

Number of respondents: CCG 2018 (54), National (7884), Cluster (651), DCO (643).

33%

56%

6% 6%

18

30

3 3

Strongly agree Tend to agree Neither agree nor disagree

Tend to disagree Strongly disagree Don't know

Stakeholder group No. of respondents

Strongly/Tend to agree

Strongly/Tend to disagree

GP member practices 29 83% (24) -

Health & wellbeing boards 0 - -

Healthwatch and voluntary/patient groups 10 100% (10) -

NHS providers 3 67% (2) -

Other CCGs 4 100% (4) -

Upper tier/unitary LA 1 100% (1) -

Wider stakeholders 7 100% (7) -

51% 53%

56% 89%

DCO**Cluster*National

CCG 2018

To what extent do you agree or disagree that the CCG demonstrates it has considered the views of patients and the public when making commissioning decisions?

By stakeholder group All stakeholders

Percentage of stakeholders saying strongly agree/tend to agree

Percentage of stakeholders saying strongly agree/tend to agree

Dudley CCG Fieldwork: 15th January - 28th February

There is no trend data available for this question, as it was asked for the first time in 2018.

*A cluster is the group of CCGs that are most similar to the CCG based on several population characteristics.

**The DCO is the group of local CCGs that fall under the same Director of Commissioning Operations as the CCG.

35 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

CCG change across time Regional and cluster comparisons

Number of respondents: CCG 2018 (54), National (7884), Cluster (651), DCO (643).

30%

63%

4% 4% 16

34

2 2

Very effective Fairly effective Not very effective Not at all effective Don't know

Stakeholder group No. of respondents

Very/fairly effective

Not very/at all effective

GP member practices 29 90% (26) 3% (1)

Health & wellbeing boards 0 - -

Healthwatch and voluntary/patient groups 10 100% (10) -

NHS providers 3 67% (2) 33% (1)

Other CCGs 4 100% (4) -

Upper tier/unitary LA 1 100% (1) -

Wider stakeholders 7 100% (7) -

67% 73% 74%

93%

DCO**Cluster*National

CCG 2018

To what extent do you agree or disagree with the following statement…? How effective is the CCG at working with others to improve health outcomes? All stakeholders By stakeholder group

Percentage of stakeholders saying very/fairly effective

Percentage of stakeholders saying very/fairly effective

Dudley CCG Fieldwork: 15th January - 28th February

There is no trend data available for this question, as it was asked for the first time in 2018.

*A cluster is the group of CCGs that are most similar to the CCG based on several population characteristics.

**The DCO is the group of local CCGs that fall under the same Director of Commissioning Operations as the CCG.

36 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public 36 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Upper tier and unitary local authorities

37 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Total responses: All upper tier / unitary local authority stakeholders (1)

Dudley CCG

100%

1

Very well Fairly well Not very well Not at all well Don't know

How well, if at all, would you say the CCG and your local authority are working together to plan and deliver integrated commissioning? All upper tier/unitary local authority stakeholders

Fieldwork: 15th January - 28th February

38 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Total responses: All upper tier / unitary local authority stakeholders (1)

Dudley CCG

100%

1

Very effective Fairly effective Not very effective Not at all effective Don't know

How effective, if at all, has the CCG been as part of the Local Safeguarding Children Board? All upper tier/unitary local authority stakeholders

Fieldwork: 15th January - 28th February

39 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Total responses: All upper tier / unitary local authority stakeholders (1)

Dudley CCG

100%

1

Very effective Fairly effective Not very effective Not at all effective Don't know

How effective, if at all, has the CCG been as part of the Safeguarding Adults Board?

All upper tier/unitary local authority stakeholders

Fieldwork: 15th January - 28th February

40 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public 40 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Healthwatch and voluntary/patient groups

41 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Total responses: All healthwatch and voluntary/ patient groups (10)

Dudley CCG

10%

10%

40%

40%

1

1

4

4

A great deal A fair amount Just a little Not at all Don't know

‘Hard to reach’ groups are those who may experience barriers to accessing services or who are under-represented in healthcare decision making, for example, black and minority ethnic (BME) groups, Gypsies and Travellers, lesbian, gay, bisexual and trans (LGBT) people, asylum seekers, and young carers.

To what extent, if at all, do you feel that the CCG has engaged with ‘hard to reach’ groups?

All Healthwatch and voluntary/patient group stakeholders

Fieldwork: 15th January - 28th February

42 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Total responses: All healthwatch and patient group stakeholders (10)

Dudley CCG

40%

40%

20%

4

4

2

Strongly agree Tend to agree Neither agree nor disagree Tend to disagree Strongly disagree Don't know

To what extent do you agree or disagree that the CCG demonstrates that it considers and acts appropriately in response to concerns, complaints or issues raised by patients and the public?

All Healthwatch and voluntary/patient group stakeholders

Fieldwork: 15th January - 28th February

43 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public 43 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

GP member practices

44 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Total responses: All member practices (2018: 29; 2017: 26; 2016: 17)

Dudley CCG

7%

28%

52%

14%

2

8

15

4

A great deal A fair amount Just a little Not at all Don't know

34% (10)

A great deal/Fair amount 2018

31% (8) A great deal/Fair amount 2017

29% (5) A great deal/Fair amount 2016

To what extent, if at all, do you feel able to influence the CCG’s decision-making process? All member practices

Fieldwork: 15th January - 28th February

45 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Total responses: All member practices (2018: 29; 2017: 26; 2016: 17)

Dudley CCG

17%

62%

17%

3%

5

18

5

1

Strongly agree Tend to agree Neither agree nor disagree Tend to disagree Strongly disagree Don't know

79% (23)

Strongly/Tend to agree 2018

81% (21)

Strongly/Tend to agree 2017

82% (14)

Strongly/Tend to agree 2016

To what extent do you agree or disagree with the following statements about the clinical leadership of your CCG/CCG…? I have confidence in the clinical leadership of the CCG All member practices

Fieldwork: 15th January - 28th February

46 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Total responses: All member practices (2018: 29)

Dudley CCG

21%

62%

14% 3%

6

18

4

1

Strongly agree Tend to agree Neither agree nor disagree Tend to disagree Strongly disagree Don't know

83% (24)

Strongly/Tend to agree 2018

To what extent do you agree or disagree with the following statements about the clinical leadership of your CCG/CCG…? There is clear and visible clinical leadership of the CCG All member practices

Fieldwork: 15th January - 28th February

47 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Total responses: All member practices (2018: 29)

Dudley CCG

17%

55%

14%

3% 10%

5

16

4

1

3

Strongly agree Tend to agree Neither agree nor disagree Tend to disagree Strongly disagree Don't know

72% (21)

Strongly/Tend to agree 2018

To what extent do you agree or disagree with the following statements about the clinical leadership of your CCG/CCG…? The clinical leadership of my CCG has effective influence within local partnerships (STPs/ACSs/other) All member practices

Fieldwork: 15th January - 28th February

48 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Total responses: All member practices (2018: 29; 2017: 26; 2016: 17)

Dudley CCG

10%

48%

31%

3% 7%

3

14

9

1 2

Very well Fairly well Not very well Not at all well Don't know

59% (17)

Very/Fairly well 2018

62% (16)

Very/Fairly well 2017

59% (10)

Very/Fairly well 2016

How well, if at all, would you say that you understand…?

All member practices The financial implications of the CCG’s plans

Fieldwork: 15th January - 28th February

49 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Total responses: All member practices (2018: 29; 2017: 26; 2016: 17)

Dudley CCG

7%

79%

7% 7%

2

23

2

2

Very well Fairly well Not very well Not at all well Don't know

86% (25)

Very/Fairly well 2018

77% (20)

Very/Fairly well 2017

59% (10)

Very/Fairly well 2016

How well, if at all, would you say that you understand…?

All member practices The implications of the CCG’s plans for service improvement

Fieldwork: 15th January - 28th February

50 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Total responses: All member practices (2018: 29; 2017: 26; 2016: 17)

Dudley CCG

7%

66%

21%

7%

2

19

6

2

Very well Fairly well Not very well Not at all well Don't know

72% (21)

Very/Fairly well 2018

65% (17)

Very/Fairly well 2017

65% (11)

Very/Fairly well 2016

How well, if at all, would you say that you understand…?

All member practices The referral and activity implications of the CCG’s plans

Fieldwork: 15th January - 28th February

51 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Total responses: All member practices (2018: 29)

Dudley CCG

10%

62%

21%

7%

3

18

6

2

Very well Fairly well Not very well Not at all well Don't know

72% (21)

Very/Fairly well 2018

How well, if at all, would you say that you understand…?

All member practices

The CCG’s plans to improve the health of the local population and reduce health inequalities

Fieldwork: 15th January - 28th February

52 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Total responses: All member practices (2018: 29; 2017: 26; 2016: 17)

Dudley CCG

38%

34%

17%

3% 7%

11

10

5

1 2

Strongly agree Tend to agree Neither agree nor disagree Tend to disagree Strongly disagree Don’t know

72% (21)

Strongly/Tend to agree 2018

69% (18)

Strongly/Tend to agree 2017

82% (14)

Strongly/Tend to agree 2016

To what extent do you agree or disagree that value for money is a key factor in decision-making when formulating the CCG’s plans and priorities? All member practices

Fieldwork: 15th January - 28th February

53 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Total responses: All member practices (2018: 29; 2017: 26; 2016: 17)

Dudley CCG

7%

31%

55%

3% 3%

2

9

16

1 1

Very familiar Fairly familiar Not very familiar Not at all familiar Don’t know

38% (11)

Very/Fairly familiar 2018

46% (12)

Very/Fairly familiar 2017

41% (7) Very/Fairly familiar 2016

How familiar are you, if at all, with the financial position of the CCG?

All member practices

Fieldwork: 15th January - 28th February

54 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Total responses: All member practices (2018: 29; 2017: 26; 2016: 17)

Dudley CCG

24%

48%

17%

3% 3% 3% 7

14

5

1 1 1

Strongly agree Tend to agree Neither agree nor disagree Tend to disagree Strongly disagree Don’t know

72% (21)

Strongly/Tend to agree 2018

77% (20)

Strongly/Tend to agree 2017

71% (12)

Strongly/Tend to agree 2016

To what extent do you agree or disagree that representatives from member practices are able to take a leadership role within the CCG if they want to? All member practices

Fieldwork: 15th January - 28th February

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NHS Providers

56 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Total responses: All NHS providers (3)

Dudley CCG

33%

67%

1

2

Very well Fairly well Not very well Not at all well Don't know

How well, if at all, would you say the CCG and your organisation are working together to develop long-term strategies and plans? All NHS providers

Fieldwork: 15th January - 28th February

57 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Total responses: All NHS providers (3)

Dudley CCG

33%

33%

33%

1

1

1

Too much About right Too little Don't know

Would you say that the amount of monitoring the CCG carries out on the quality of your services is too much, too little or about right? All NHS providers

Fieldwork: 15th January - 28th February

58 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Total responses: All NHS providers (3)

Dudley CCG

100%

3

Strongly agree Tend to agreeNeither agree nor disagree Tend to disagreeStrongly disagree Don't knowThere has never been an issue with the quality of services

To what extent do you agree or disagree that when there is an issue with the quality of services, the response of the CCG is proportionate and fair?

All NHS providers

Fieldwork: 15th January - 28th February

59 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Total responses: All NHS providers (3)

Dudley CCG

33%

67%

1

2

Very involved Fairly involved Not very involved Not at all involved Don't know

How involved, if at all, would you say clinicians from the CCG are in discussions with your organisation about:

All NHS providers

Quality

Fieldwork: 15th January - 28th February

60 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Total responses: All NHS providers (3)

Dudley CCG

33%

33%

33%

1

1

1

Very involved Fairly involved Not very involved Not at all involved Don't know

How involved, if at all, would you say clinicians from the CCG are in discussions with your organisation about:

All NHS providers

Service redesign

Fieldwork: 15th January - 28th February

61 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Total responses: All NHS providers (3)

Dudley CCG

33%

67%

1

2

Very well Fairly well Not very well Not at all well Don't know

How well, if at all, would you say the CCG understands the challenges facing your provider organisation? All NHS providers

Fieldwork: 15th January - 28th February

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Dudley CCG’s local questions

63 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Total responses: All stakeholders (54)

Dudley CCG

The opportunity it has given for stakeholders to shape the MCP plans in Dudley

43%

44%

9% 4%

23

24

5 2

Very good Fairly goodNeither good nor poor Fairly poorVery poor Don't knowNot relevant

Stakeholder group Base Very/Fairly good

Very/Fairly poor

GP member practices 29 83% (24) -

Health and wellbeing boards 0 - -

Local Healthwatch/patient groups 10 100% (10) -

NHS providers 3 33% (1) 67% (2)

Other CCGs 4 100% (4) -

Upper tier/unitary local authorities 1 100% (1) -

Wider stakeholders 7 100% (7) -

How would you rate the CCG on each of the following…?

All stakeholders By stakeholder group

Fieldwork: 15th January - 28th February

64 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Total responses: All stakeholders (54)

Dudley CCG

It's plans to improve access, continuity and co-ordination for Dudley people

46%

39%

9% 2% 4%

25

21

5 1 2

Very good Fairly goodNeither good nor poor Fairly poorVery poor Don't knowNot relevant

Stakeholder group Base Very/Fairly good

Very/Fairly poor

GP member practices 29 83% (24) 3% (1)

Health and wellbeing boards 0 - -

Local Healthwatch/patient groups 10 100% (10) -

NHS providers 3 33% (1) -

Other CCGs 4 75% (3) -

Upper tier/unitary local authorities 1 100% (1) -

Wider stakeholders 7 100% (7) -

All stakeholders By stakeholder group

How would you rate the CCG on each of the following…?

Fieldwork: 15th January - 28th February

65 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Total responses: All stakeholders (54)

Dudley CCG

Managing relationships across the health and social care system

31%

46%

11%

7% 4% 17

25

6

4 2

Very good Fairly goodNeither good nor poor Fairly poorVery poor Don't knowNot relevant

Stakeholder group Base Very/Fairly good

Very/Fairly poor

GP member practices 29 69% (20) 7% (2)

Health and wellbeing boards 0 - -

Local Healthwatch/patient groups 10 100% (10) -

NHS providers 3 33% (1) 67% (2)

Other CCGs 4 75% (3) -

Upper tier/unitary local authorities 1 100% (1) -

Wider stakeholders 7 100% (7) -

All stakeholders By stakeholder group

How would you rate the CCG on each of the following…?

Fieldwork: 15th January - 28th February

66 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Total responses: All stakeholders (54)

Dudley CCG

Developing plans to improve the quality of lives for Dudley people

48%

39%

9% 4%

26

21

5 2

Very good Fairly goodNeither good nor poor Fairly poorVery poor Don't knowNot relevant

Stakeholder group Base Very/Fairly good

Very/Fairly poor

GP member practices 29 83% (24) -

Health and wellbeing boards 0 - -

Local Healthwatch/patient groups 10 100% (10) -

NHS providers 3 67% (2) -

Other CCGs 4 75% (3) -

Upper tier/unitary local authorities 1 100% (1) -

Wider stakeholders 7 100% (7) -

How would you rate the CCG on each of the following…?

All stakeholders By stakeholder group

Fieldwork: 15th January - 28th February

67 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Total responses: All stakeholders (54)

Dudley CCG

It’s understanding of the primary care landscape

59% 28%

7% 2%

4%

32 15

4 1 2

Very good Fairly goodNeither good nor poor Fairly poorVery poor Don't knowNot relevant

Stakeholder group Base

Very/Fairly good

Very/Fairly poor

GP member practices 29 76% (22) 3% (1)

Health and wellbeing boards 0 - -

Local Healthwatch/patient groups 10 100% (10) -

NHS providers 3 100% (3) -

Other CCGs 4 100% (4) -

Upper tier/unitary local authorities 1 100% (1) -

Wider stakeholders 7 100% (7) -

All stakeholders By stakeholder group

How would you rate the CCG on each of the following…?

Fieldwork: 15th January - 28th February

68 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public 68 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Appendix

69 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Fieldwork: 15th January - 28th February

Each CCG is compared to a cluster of the other CCGs to which they are most similar. The clusters are based on the following variables:

Warrington CCG Southend CCG

Trafford CCG Wigan Borough CCG

Wirral CCG Havering CCG

Fareham and Gosport CCG Nottingham North & East CCG

Cannock Chase CCG Mansfield and Ashfield CCG

Stockport CCG Erewash CCG

Rotherham CCG North East Lincolnshire CCG

Basildon and Brentwood CCG Medway CCG

Hartlepool and Stockton-on-Tees CCG Doncaster CCG

North Tyneside CCG

Dudley CCG

• Index of Multiple Deprivation averages (overall and health domain)

• Population registered with practices

• Age of population • Population density

• Ethnicity

• Ratio of registered population to overall population

Based on these variables, the following CCGs form the CCG cluster for Dudley CCG

CCG clusters

70 CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public CCG 360 Stakeholder Survey 2018 - Report | April 2018 | Public

Version 1 | Internal Use Only

For more information

ccg360stakeholder@ipsos-mori.com

This work was carried out in accordance with the requirements of the international quality standard for market research, ISO 20252:2006 and with the Ipsos MORI Terms and Conditions which can be found here

APPENDIX 2 – MEMBERSHIP ENGAGEMENT ACTION PLAN

FEEDBACK

ACTION OWNER TIMESCALE STATUS

Not enough commissioning – too much focus on MDT and MCP

Each locality to discuss feedback and adjust agenda accordingly

Daniel King April/May 2018 In progress

More information of performance provided to locality meetings on monthly basis

Each locality to receive Primary Care Analysis Tool (PCAT) summary report along with Prescribing Performance Report

Richard Gee/Rob Franklin

April/May 2018 In progress

Need to see minutes and action tables being produced for locality meetings

Each locality to discuss feedback and agree format for notes/minutes/actions

Daniel King April/May 2018 In progress

Allow time on agenda to discuss practice issues, best practice and ‘any other business’

Agenda’s changed for April locality meetings Daniel King April 2018 Complete

Locality feedback directly into CCG Governing body

360 feedback and members’ feedback to be discussed at locality meetings, action plan to be produced and shared with localities.

Daniel King April 2018 In progress

Agenda’s changed for April locality meetings to include member practice feedback to elected GP members to feedback to CCG Governing Body

Daniel King April 2018 Complete

Development session with GP Elected members to discuss 360 survey results and member practice feedback on relationship between localities and CCG Governing Body

Daniel King/Stephanie Cartwright

May 2018 In progress

Better communication on who does what in the CCG

CCG to produce updated phone book and directory of staff, and useful numbers for common queries associated with General Practice.

Laura Broster April/May 2018 In progress

Better engagement with the Dudley Practice Managers Association

CCG communications team to engage with practice managers via the Dudley Practice Management Alliance to establish what information would help member practices. Meet with DPMA to discuss feedback from 360 survey.

Laura Broster/Daniel King

May 2018 In progress

FEEDBACK

ACTION OWNER TIMESCALE STATUS

Clear plan agreed with the CCG and each practice on contributing and delivering the QIPP agenda – direct instructions to practices

CCG to produce a plan with each practice and locality for delivering QIPP – will include top 3 priorities for each practice

Ruth Tapparo/Neill Bucktin/Anthony Nicholls

May 2018 In progress

More regular reporting for individual practices on performance

CCG to produce performance reports for practices and localities reporting on QIPP

Anthony Nicholls/Rob Franklin

May 2018 In progress

Greater clinical lead/commissioning manager involvement and reporting to locality meetings

Localities to invite clinical leads and commissioners into locality meetings for specific items related to the delivery of the QIPP

Elected members April 2018 In progress

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 10 May 2018 Report: Finance, Performance and Business Intelligence Committee Report

Agenda item No: 9.1

TITLE OF REPORT: Finance, Performance and Business Intelligence Committee Report

PURPOSE OF REPORT: To advise the Board of key issues discussed at the Finance, Performance and Business Intelligence Committees on 1 March 2018 and 29 March 2018

AUTHOR OF REPORT: Mr M Hartland, Chief Finance and Operating Officer

MANAGEMENT LEAD: Mr M Hartland, Chief Finance and Operating Officer

CLINICAL LEAD: Dr R Tapparo, Clinical Executive for Finance, Performance and Business Intelligence

KEY POINTS:

• The CCG expects to meet all financial duties in 2017/18 • The CCG is reporting a year to date underspend of £10,373,690

and expects to achieve its revised year end control total of £10,964,000 as agreed with NHS England.

• NHS England financial assurance indicators were met. • NHS Constitution standards are being achieved at headline level

with the exception of A&E. There are also performance exceptions to note in relation to Ambulance Handovers; Mixed Sex Accommodation; IAPT Access; Dementia; and BCF.

• The Commissioning Development Committee (CDC) is forecast to overspend its delegated budget by £6.1m

• The Committee received updates on the Board Assurance Framework (BAF) and Risk Register.

• Reports from the IT Strategy Group and Estates Strategy Group were received.

• The Committee was presented with and approved the Financial Plan 2018/19 on 29 March 2018.

• The Committee endorsed & approved the revised Terms of Reference for Finance, Performance and Business Intelligence Committee with the agreed amendments proposed by NHS England

• The Committee approved the write off of aged payables debit balances with a financial implication of £3,716.22

Note: Following the committee of 1 & 28 March reflected in this report, the CCG has submitted its draft annual accounts confirming that the CCG achieved its 2017/18 financial control total, further detail will be provided to the next Governing Body meeting when the accounts have been audited.

RECOMMENDATION:

The Board is asked to: • Receive the report for assurance noting the decisions taken under

delegated authority. • Receive the revised Terms of Reference (Appendix 1) approved by

the Committee for assurance.

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FINANCIAL IMPLICATIONS: As outlined in report and key points above

WHAT ENGAGEMENT HAS TAKEN PLACE:

None

ACTION REQUIRED: Decision Approval Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 10 MAY 2018 FINANCE, PERFORMANCE AND BUSINESS INTELLIGENCE COMMITTEE REPORT 1.0 INTRODUCTION

The report summarises the key issues discussed by the Finance, Performance and Business

Intelligence Committees at its meeting on 1 March and 29 March 2018. 2.0 KEY INDICATOR SUMMARY

The table below identifies the CCG’s performance against key financial and performance indicators for 2017/18. This represents January performance information and February financial information. It is followed by exception reporting and an explanation of key issues where required.

Indicator FrequencyTarget/

ThresholdLatest Period

Direction YTD FOT

Revenue Resource Limit Control Total (£000's) M (5,278)Annual

(10,374) (10,374) (10,964)

Capital Resource Limit (£000's) M 0 0 0 0

Running Costs (£000's) M 0 (177) (177) 0

Cash Limit (£000's) M 0 352 352 40

Cash Limit (%) M <1.25% 1.04% 1.04% 0.11%

Better Payment Practice: NHS (£000's) M >95% 99.96% 99.95% 99%

Better Payment Practice: Non-NHS (£000's) M >95% 100% 100% 99%

Patients on incomplete non-emergency pathways (yet to start treatment) should have been waiting no more than 18 weeks from referral

M >92% 93.53% 94.11% 93.74%

Zero tolerance of over 52 week waiters M 0 0 0 0

Patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral

M <1% 0.71% 2.43% 2.19%

Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E department

M >95% 80.60% 87.03% 87.90%

Patients should be admitted, transferred or discharged within 12 hours of their arrival at an A&E department (zero tolerance)

M 0 2 9 9

Statutory Finance

Referral to Treatment

Diagnostics

A&E Waits

Indicator FrequencyTarget/

ThresholdLatest Period

Direction YTD FOT

Maximum two-week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP

M >93% 96.27% 94.89% 94.63%

Maximum two-week wait for first outpatient appointment for patients referred urgently with breast symptoms (where cancer was not initially suspected)

M >93% 96.69% 97.60% 96.89%

Maximum one month (31-day) wait from diagnosis to first definitive treatment for all cancers

M >96% 98.61% 98.76% 98.48%

Maximum 31-day wait for subsequent treatment where that treatment is surgery

M >94% 100% 99.17% 98.15%

Maximum 31-day wait for subsequent treatment where that treatment is a anti-cancer drug regimen

M >98% 100% 100% 100.00%

Maximum two months (62-day) wait from urgent GP referral to first definitive treatment for cancer

M >85% 89.16% 85.47% 85.46%

Maximum 62-day wait from referral from an NHS screening service to first definitive treatment for all cancers

M >90% 100% 98.18% 98.37%

Maximum 62-day wait for first definitive treatment following a consultant's decision to upgrade the priority of the patient

M NoTarget

91.46% 93.43% 93.28%

Change in national reporting from Sept-17 - Red ambulance calls resulting in an emergency response must have a mean average <7 mins

M <7mins 5mins 41s 6mins 10s 7mins

Ambulance Handovers: Breaches over 45 mins and less than 60 mins M 0 93 1,043 1,252

Ambulance Handovers: Breaches over 60 mins M 0 56 685 822

Cancer Waits (62 Days)

Ambulance

Cancer Waits (2 Weeks)

Cancer Waits (31 Days)NHS

Con

stitu

tion

/ Sta

tuto

ry F

inan

ce

4 | P a g e

Indicator FrequencyTarget/

ThresholdLatest Period

Direction YTD FOT

Underlying Recurrent Surplus M (6,518)YTD (4,795) (4,795) (4,866)

Programme Spend M 433,311YTD 421,914 421,914 465,224

Running Cost Spend M 6,210YTD 6,033 6,033 6,775

Programme Surplus M (10,046)YTD (10,197) (10,197) (10,966)

Running Costs Surplus M 0 (177) (177) 0

QIPP M (13,206)YTD (13,313) (13,313) (14,444)

Minimise breaches - zero tolerance target M 0 5 35 35

All patients who have operations cancelled , on or after the day of admission, for non-clinical reasons to be offered another binding date within 28 days

M 0 6 14 14

No urgent operation should be cancelled for a second time M 0 0 1 1

Care Programme Approach (CPA): patients followed up within 7 days Q >95% 95.65% 96.17% 96.17%

IAPT Access: Number of people who receive psychological therapiesM(A)

>1.40%(>16.8%) 0.82% 8.52% 14.13%

IAPT Recovery: Pts completing treatment who are moving to recovery M >50% 46.67% 54.10% 53.12%

Early Intervention Psychosis (EIP): Maximum 2 week wait M >50% 100% 100% 86.00%

C.Difficile (DGFT): Reported monthly but measured annually M <29 5 28 34

MRSA (DGFT): Zero tolerance M 0 0 0 0

Mixed Sex Accommodation Breaches

Cancelled Operations

Finance

Healthcare Associated Infections (HCAI)

Mental Health

Indicator FrequencyTarget/

ThresholdLatest Period

Direction YTD FOT

Dementia Diagnosis Rate: Number of people diagnosed with dementia (65 and over) expressed as a % of the estimated dementia prevalence

M >66.7% 65.48% 65.48% 66.70%

Delayed Transfer Of Care (DTOC): Number of delayed bed days (Dudley Local Authority Population)

M <803 690 9,564 10,979

Non-Elective Admissions: Total non-elective admissions to hospital (G&A), all age

M <3,698 2,651 31,522 38,449

Residential Admissions: Permanent admissions of older people (aged 65 and over) to residential and nursing care homes, per 100,000 population

Q <129 111 339 465

Re-Ablement: Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into re-ablement/ rehabilitation services

Q >87% 84.44% 87.41% 87.77%

Cancer: 17% of QP (£000's) A 262

CHC: 17% of QP (£000's) Q 262 131 131 131

GP Access & Experience: 17% of QP (£000's) A 262

Mental Health: 17% of QP (£000's) Q 262

Bloodstream Infections: 17% of QP (£000's) Q 262 144 144 144

Local Priority (RightCare): 15% of QP (£000's) M 231 0 0 0

Annual dataset - data not yet available

Annual dataset - data not yet available

Quarterly Indicator - data not yet published for 2017/18

Better Care Fund

Quality Premium

Oth

er K

ey F

inan

ce &

Per

form

ance

Indi

cato

rs

Loca

l Ind

icat

ors

5 | P a g e

3.0 STATUTORY FINANCIAL DUTIES

The Committee was advised that the CCG had an annual budget at February 2018 of £483.0m. This reflected the notified allocation from NHS England and CCG anticipated allocations. At this point in time, the CCG was underspent by £10.4m and is forecast to achieve a surplus on its Revenue Resource Limit of £10.96m in line with its financial plan and meeting the control total agreed with NHS England.

Capital budgets, cash limits and the CCG’s programme and administration expenditure targets are all expected to be achieved.

At a summary level there are three distinct areas of expenditure within the CCG, for which budget responsibility has been delegated to appropriate Committees. These are commissioning expenditure (Commissioning Development Committee - CDC), running/staffing costs and reserves (Finance, Performance and Business Intelligence Committee) and primary care commissioning/membership development (Primary Care Commissioning Committee). Whilst the Finance, Performance and Business Intelligence Committee retains oversight of the financial position of the organisation and advises the Board regarding any mitigating actions that may need to be taken, the clinical and management leads of appropriate Committees are responsible and accountable for financial performance of their delegated portfolio. The table below identifies the financial position to date by Committee;

Annual Budget

£m

Year to date

Budget £m

Year to date

Actual £m

Year to date

Variance £m

Forecast Variance

£m

Clinical Development Committee 403.3m 370.1m 375.1m 5.0m 6.1m Finance, Performance & BI Committee 24.4m 18.6m 13.3m (5.3m) (6.1m) Primary Care Commissioning Committee 44.3m 39.5m 39.5m - - Surplus 11.0m 10.1m - (10.1m) (11.0m) Total 483.0m 438.3m 427.9m (10.4m) (11.0m)

Based on month 11, the Clinical Development Committee (CDC) is forecast to overspend its delegated budget by £6.1m.

Performance Criteria Target/Threshold

Period Dudley CCG Black Country CCG Rank

Sandwell & W.B'Ham CCG

WalsallCCG

W'HamptonCCG

RTT Incompletes <18 week waits >92% Jan-18 92.70% 1 91.81% 84.36% 91.04%

RTT 52+ week waits 0 Jan-18 1 1 11 5 1

Diagnostics >6 week waits <1% Jan-18 0.78% 4 0.75% 0.67% 0.69%

A&E <4 hour waits >95% Jan-18 80.60% 2 79.81% 76.85% 86.27%

A&E >12 hour trolley waits 0 Jan-18 2 4 0 0 0

Cancer: 2 Week Wait >93% Jan-18 96.43% 1 96.23% 94.67% 91.36%

Cancer: Breast Symptoms 2 week wait >93% Jan-18 96.71% 3 97.97% 90.00% 96.88%

Cancer: 31 day first definitive treatment >96% Jan-18 98.57% 1 97.67% 98.21% 96.52%

Cancer: 31 day sub treatment - surgery >94% Jan-18 88.89% 3 100.00% 86.96% 89.29%

Cancer: 31 day sub treatment - drug >98% Jan-18 100% 1 100% 100% 100%

Cancer: 31 day sub treatment - radiotherapy >94% Jan-18 97.30% 2 100.00% 97.06% 97.30%

Cancer: 62 day standard >85% Jan-18 86.77% 1 79.27% 82.22% 71.43%

Cancer: 62 day screening >90% Jan-18 90.91% 3 100.00% 100.00% 53.85%

Cancer: 62 day upgrade N/A Jan-18 85.71% 4 90.91% 86.79% 89.74%

Ambulance Handovers between 45 & 60 mins 0 Feb-18 93 4 16 25 19

Ambulance Handovers over 60 mins 0 Feb-18 56 4 3 27 39

Mixed Sex Accommodation Breaches 0 Jan-18 5 4 0 3 1

DTOCs as a % of occupied beds <3.5% Dec-17 3.18% 4 3.12% 3.11% 2.54%

E-Referrals utilisation >80% Dec-17 55.26% 1 44.40% 42.72% 52.58%

Dementia Diagnosis >66.7% Jan-18 64.47% 3 63.00% 70.97% 74.07%

IAPT Access >4.2% 17/18 Q2 3.36% 3 4.47% 3.17% 3.42%

IAPT Recovery >50% 17/18 Q2 53.57% 3 57.81% 57.81% 52.27%

Early Intervention in Psychosis <2 week waits >50% Jan-18 100% 1 40.00% 86% 60.00%

MRSA 0 Jan-18 0 1 0 0 0

C. Difficile Varies per CCG Dec-17 4 1 4 2 1

Cancer - 62 day

RTT

Diagnostics

A&E

Cancer - 2 week

Cancer - 31 day

Ambulance

MSA

DTOCs

HCAI

Mental Health

E-Referrals

Perfo

rman

ce B

ench

mar

king

6 | P a g e

The table below illustrates the main areas contributing to the forecast overspend being reported against CDC.

Annual

Budget £m

Year to date

Budget £m

Year to date

Actual £m

Year to date

Variance £m

Forecast Variance

£m

Non-Electives 73.0m 66.9m 64.8m (2.1m) (2.3m) Electives 44.6m 40.9m 41.2m 0.3m 0.3m Rehabilitation 1.0m 0.9m 2.5m 1.6m 2.2m Outpatients 37.3m 34.2m 37.6m 3.4m 3.7m Continuing Healthcare (CHC) 16.7m 15.3m 16.1m 0.8m 1.2m Learning Disabilities (LD), Adult Mental Health (MH) 7.8m 7.2m 8.6m 1.4m 1.6m Funded Nursing Care (FNC) 4.5m 4.1m 3.8m (0.3m) (0.5m) Other, including Prescribing 218.4m 200.6m 200.5m (0.1m) (0.1m) Total 403.3m 370.1m 375.1m 5.0m 6.1m

The latest position has been discussed at the CDC and Finance, Performance and Business Intelligence Committees and rectification plans are being monitored and reviewed for each of the overspending items above (excluding FNC where the rate is nationally agreed).

The forecast overspending described above at this point does not result in a breach of the CCG’s financial duties. To mitigate the over-performance the CCG is required to utilise its uncommitted reserves.

The overspend was robustly managed in the last few months of the financial year in order to meet the CCGs duty to achieve the control total set by NHS England.

This is being achieved by:-

• Development of rectification plans in relation to main overspending areas should they arise. • Continual reviews of all discretionary spend. • Continued adoption of robust financial governance measures. • Progress with the achievement of 2017/18 QIPP schemes and develop additional schemes to

mitigate the risk of any shortfall in achievement of original plans. 4.0 NHS CONSTITUTION STANDARDS/CCG ASSURANCE

The CCG has met all but one of the NHS Constitution standards in February 2018, the exception being A&E 4 hour waits.

4.1 A&E 4 Hour Waits

A&E waits failed to achieve the 95% national standard in February 2018, with 80.36% of patients admitted, transferred or discharged within 4 hours. At the time of reporting a remedial action plan had not been agreed with the trust. The CCG proposed recovery trajectory aims to recover the 95% by March 2019 in line with national guidance.

5.0 PERFORMANCE EXCEPTION REPORTING 5.1 Ambulance Handovers

Both 45 and 60 minute handover breaches improved in February to 93 and 56 respectively. Ambulance handovers form part of the system wide Urgent Care Action plan, which is overseen by the A&E Delivery Board. It is expected that the number of handover breaches will continue to reduce now the new Emergency Treatment Centre is operational.

5.2 IAPT Access IAPT Access continues to underperform against the national standard. Provisional data for Q3

suggests a deteriorating performance against the required access target; contractual management is in place with the CCG working with the Trust to agree a remedial action plan.

5.3 Dementia Diagnosis The dementia diagnosis rate declined in January to 65.48%. Dudley is now below the recovery

trajectory as outlined in the Dementia Improvement Plan.

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6.0 QIPP 2017/18 AND 2018/19

The CCG QIPP target for 2017/18 stands at £14.4m, equating to 3.1% of the CCG’s resource allocation. The latest forecast achievement against these plans is £14.4m which is on track to achieve the target for 2017/18. The gross QIPP target for 2018/19 is £16.99m. Recurrent savings of £19.1m have been identified in the latest QIPP programme. It is anticipated that these schemes will deliver the in-year target of £16.99m with the balance of £2.11m contributing to the 2019/20 QIPP programme.

7.0 LOCAL INDICATORS 7.1 Better Care Fund (BCF)

There are a number of conditions the health economy must meet to achieve performance within the Better Care Fund (BCF) plan; • Non-elective admissions; • Admissions to residential and care homes; • Effectiveness of reablement; • Delayed transfers of care. The BCF plan is managed on a quarterly basis, with the CCG meeting 2 of the 4 indicators in 2017/18 Quarter 3. The 2 exceptions were: Reablement with performance of 84.44% against an 87% target, and Delayed Transfers of Care with actual delayed days of 2,682 against a planned threshold of 2,306.

8.0 OTHER ITEMS DISCUSSED 8.1 Combined Board Assurance Framework and Risk Register

The risks assigned to the Committee were reviewed and accepted. 8.2 FINANCIAL PLAN 2018/19

The Committee agreed the CCG’s Financial Budgets 2018/19, which were subsequently approved by the Board on 29 March 2018. Total funding delegated to the CCG to be spent in 2018/19 is £489.2m. In addition, a notional allocation of £86.2m has been identified for Dudley for specialised services commissioning. The budgets identified a balanced financial position. However, planned spend was currently in excess of the allocation and therefore the achievement of the QIPP target (£16.99m), and an additional stretch target (£3m), was approved to meet the financial plan requirements and create recurrent headroom to fund future growth in activity and investment in new services. Plans reported are set to achieve the reduced surplus of £10,004,000 in line with the control total set by NHS England; £1m of the historic surplus would be available to the CCG next year, and financial risk of up to £5,550,000 across CCG managed budgets for which mitigations have been identified.

8.3 Care Homes & Frailty Pathway

A report was presented to the Committee on the proposal of the redesign of services for care homes in line with the frailty pathway. The report would have been presented to the Commissioning Development Committee (CDC) but the Committee did not take place and therefore it was agreed it would be presented to this Committee for review. The Committee approved in principle the direction of travel and for the production of a full business case back to the CDC. The business case would be developed in two sections: the proactive team and the Single Point of Access as they both had different requirements. The proposal was discussed at length and the Committee raised various points to be addressed in the full business case to be presented to CDC.

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8.4 Write Off of Aged Payables Debit Balances The Committee approved the write off of aged payables debit balances with a financial implication of £3,716.22.

8.5 Revised Terms of Reference

The revised terms of reference, that included the amendments to reflect NHS England’s comments following the proposed Constitution submitted in November were presented and approved by the Committee.

9.0 REPORTS FROM GROUPS ACCOUNTABLE TO THE COMMITTEE 9.1 IT Strategy Sub-Committee

The Committee received an update on the issues discussed by the IT Strategy Group and noted good progress on implementing projects within the strategy. The main issues for the Board to note were the current position regarding the use of the Estates, Technology and Transformation Funding (ETTF) for interoperability with DGFT. ETTF funding of £597,000 had been secured and passed to DGFT where a programme board was being established to manage the delivery of the programme within the funding envelope; some of the work areas identified by the Sub-Committee were dependent on dialogue with the MCP to identify their requirements, it was deemed counter-intuitive to progress schemes that may not align with MCP strategies; the performance of TeraFirma specifically the lack of resources and support in delivering CCG developments; and BT roll out of patient Wi-Fi was progressing well.

9.2 Estates Strategy/Operational Group The Committee received an update on the issues discussed by the Estates Operational Group and

discussed a number of items in relation to the current year work programme as part of the Health Infrastructure Strategy. The main issues for the Board to note are progress of work nearing completion at Netherton Health Centre; continual review of space utilisation across the Dudley Health Economy; and the continued development of outline business cases for Kingswinford and Lye.

The economy wide group also approved schemes to be included in the draft STP Estate Strategy.

Committee also received updates in respect of a number of ongoing premises projects, including Central Clinic, Wordsley Green and Ridge Hill.

10.0 DECISIONS TAKEN UNDER DELEGATED POWERS

The Committee endorsed and approved the following under delegated powers:-

• The Committee approved the Financial Plan 2018/19. • The Committee endorsed and approved the revised Terms of Reference for Finance,

Performance and Business Intelligence committee with the agreed amendments proposed by NHS England (Appendix 1).

• The Committee approved the write off of aged payables debit balances with a financial implication of £3,716.22.

11.0 RECOMMENDATION The Board is asked to:

• Receive the report for assurance noting the decisions taken under delegated authority. • Receive the revised Terms of Reference (Appendix 1) approved by the Committee for

assurance. Mr M Hartland Chief Finance and Operating and Officer May 2018

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 10 May 2018 Report: Commissioning Development Committee Report

Agenda item No: 10.1

TITLE OF REPORT: Commissioning Development Committee Report

PURPOSE OF REPORT: To note matters considered by the Commissioning Development Committee

AUTHOR OF REPORT: Mr N Bucktin – Director of Commissioning

MANAGEMENT LEAD: Mr N Bucktin – Director of Commissioning

CLINICAL LEAD: Dr J Darby – Clinical Executive

KEY POINTS:

1. QIPP plan for 2018/20 approved and performance in relation to 2017/18 Plan noted.

2. Plan for future development of the Repeat Prescribing POD approved.

3. Local Government Association Peer Review report on Special

Educational Needs and Disabilities (SEN/D) noted.

4. Proposals in relation to personalised care and support approved.

5. Engagement activities relating to the CCG’s duty to involve patients and the public noted for inclusion in the CCG’s Annual Report.

6. Revision to the policy for Children’s Continuing Care approved.

7. Procurement process for AQP for Ophthalmology to be re-launched.

RECOMMENDATION:

1. That the matters considered by the Commissioning Development Committee be noted for assurance.

2. That the business case for enhanced support to care homes be

approved.

FINANCIAL IMPLICATIONS: None arising directly from this report.

WHAT ENGAGEMENT HAS TAKEN PLACE: None

ACTION REQUIRED: Decision Approval Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 10 MAY 2018 COMMISSIONING DEVELOPMENT COMMITTEE REPORT 1.0 PURPOSE OF REPORT 1.1 To note matters considered by the Commissioning Development Committee. 2.0 BACKGROUND 2.1 The Commissioning Development Committee met on 21 March, 2018 and 18 April, 2018. This

report sets out the matters considered at these meetings. 3.0 QIPP 3.1 The Committee has noted that the QIPP Plan for 2017/18 has been delivered. 3.2 The QIPP Plan for 2018/19 has now been approved and included within the CCG’s Financial

Plan. The Committee has noted that there are some areas of the Plan where there are risks in relation to delivery. The Committee will be receiving reports on a monthly basis and clinical leads will be expected to report to Clinical Executives on an exception basis if schemes are not progressing.

3.3 Work will now begin on the development of the 2019/20 QIPP Plan, 3.0 REPEAT PRESCRIPTION ORDERING DIRECT (POD) 3.1 The Committee has now approved a plan to support the roll out of the POD development

following its successful evaluation. This now forms a key element of the QIPP Plan. Members of the Committee will be visiting the POD after their next meeting on 16 May, 2018.

4.0 SPECIAL EDUCATIONAL NEEDS AND DISABILITIES (SEN/D) – LOCAL

GOVERNMENT ASSOCIATION PEER REVIEW 4.1 The Committee has considered a report on the findings of this review which had looked at issues

relating to both the CCG and the Council. 4.2 The main aspects requiring further attention included joint commissioning arrangements; the

quality of education, health and care plans; and the role of the District Medical Officer. The CCGs existing SEN/D action plan will be updated in response to these findings.

5.0 PERSONALISED CARE AND SUPPORT 5.1 The Committee has approved a proposal to become a demonstrator site for personalised care

and support plans. This involves the availability of non-recurrent resources to a number of activities including support for health coaching, social prescribing and personal health budgets.

5.2 The proposed target for personal health budgets is the subject of further discussions with NHS

England.

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6.0 SUPPORT TO CARE HOMES 6.1 The Committee has approved a proposal to provide enhanced support to care homes, with the

intention of reducing unnecessary emergency admissions. 6.2 The proposal involves:-

• enhancing the existing Community Response Team (CRT) to provide proactive support to homes with a high rate of non-elective admissions;

• a local bespoke telemedicine solution using tablets;

• extending EMIS access to staff in the CRT and the Community Single Point of Access

(SPA);

• increasing the capacity of the Community SPA to triage calls from care homes.

6.3 The anticipated net saving arising from the proposal is £580,080. 5.0 DUTY TO REPORT 5.1 The Committee has reviewed engagement activities carried out by the CCG to fulfil its statutory

duty to involve patients and the public. These will be included in the CCG’s Annual Report. 6.0 CHILDREN AND YOUNG PEOPLE’S CONTINUING CARE POLICY - REVISION 6.1 The Committee has approved a revision to this policy relating to the eligibility of children with

breathing needs. 6.0 OPHTHALMOLOGY – ANY QUALIFIED PROVIDER (AQP) 6.1 The Committee has agreed to begin a further AQP procurement process for ophthalmology

following the receipt of bids which did not meet the evaluation criteria. 7.0 RECOMMENDATION 7.1 That the report of the Commissioning Development Committee be noted for assurance. 7.2 That the proposals for enhanced support to care homes be approved. Mr. N. Bucktin Director of Commissioning April 2018

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 10 May 2018 Report: Report of the Health and Wellbeing Board

Agenda item No: 10.2

TITLE OF REPORT: Report of the Health and Wellbeing Board

PURPOSE OF REPORT: To note matters considered by the Health and Wellbeing Board

AUTHOR OF REPORT: Mr N Bucktin – Director of Commissioning

MANAGEMENT LEAD: Mr N Bucktin – Director of Commissioning

CLINICAL LEAD: Dr D Hegarty

KEY POINTS:

1. Updates received form main partnership bodies and West Midlands Combined Authority.

2. Transforming Care engagement strategy noted. 3. Updates received on the Multi-Specialty Community Provider

(MCP) and the Better Care Fund (BCF).

RECOMMENDATION: That the matters considered by the Health and Wellbeing Board be noted.

FINANCIAL IMPLICATIONS: None arising directly from this report

WHAT ENGAGEMENT HAS TAKEN PLACE:

Engagement with various stakeholders by partnership bodies as necessary.

ACTION REQUIRED: Decision Approval Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 10 MAY 2018 HEALTH AND WELLBEING BOARD REPORT 1.0 PURPOSE OF REPORT 1.1 To note items considered by the Health and Wellbeing Board 2.0 BACKGROUND 2.1 This report sets out those matters considered by the Health and Wellbeing Board at its meeting

on 22 March 2018. 3.0 STRATEGIC ISSUES 3.1 The Board has considered reports from its main partnership bodies on progress with strategic

priorities including:-

• Safe and Sound Board • Adults Alliance • Children’s and Young People’s Alliance

In addition it has considered a report on activities undertaken by the West Midlands Combined Authority’s Wellbeing Board.

3.2 As a result of this it has identified the following emerging trends:-

• Safe and Sound - an increase in all types of crime in Dudley. Resources are to be targeted to reduce crimes that have the most significant impact on individuals, families and communities and protect the most vulnerable;

• Adults - in the context of social isolation, local communities have shared stories in

relation to the issues that are important to them – sense of belonging; relationships and connections; sense of purpose; sense of autonomy and control; being active; opportunities to learn; ability to contribute and give back;

• Children and Young People - cross cutting themes impacting on multiple aspects of the

lives of children and young people including Adverse Childhood Experiences, emotional health and wellbeing skills and parenting.

3.3 The Board has noted progress made by the Combined Authority in relation to cardiovascular

disease and diabetes; supporting people with mental health problems back into work (Thrive); and health and transport. In addition, the Board has supported a proposal for work to address health equity and health inequalities. This will now be the subject of further discussion at STP level with clinical leads.

3.4 The Board has held a separate development session with representatives of the Combined

Authority and the STP and identified those areas of commonality between the work programmes of the Board itself, the STP and the Combined Authority.

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4.0 TRANSFORMING CARE 4.1 The Board has noted the proposed engagement plan for the proposed community based care

model for people with disabilities. 5.0 MULTISPECIALTY COMMUNITY PROVIDER (MCP) DEVELOPMENT AND BETTER CARE

FUND (BCF) 5.1 The Board has received updates on both the MCP development and the BCF. These are both the

subject of separate reports on this agenda. 6.0 RECOMMENDATION 6.1 That the matters considered by the Health and Wellbeing Board be noted.

Neill Bucktin Director of Commissioning April 2018

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 10 May 2018 Report: Report of the Integrated Commissioning Executive

Agenda item No: 10.3

TITLE OF REPORT: Report of the Integrated Commissioning Executive

PURPOSE OF REPORT: To note matters considered by the Integrated Commissioning Executive

AUTHOR OF REPORT: Mr. N. Bucktin – Director of Commissioning

MANAGEMENT LEAD: Mr. N. Bucktin – Director of Commissioning

CLINICAL LEAD: Dr. J. Darby – Clinical Executive

KEY POINTS:

1. iBCF scheme evaluation methodology reviewed. 2. Improved performance in relation to non-emergency admissions

and delayed transfers of care (DToC) noted. 3. Continued challenges in relation to the DToC performance of

neighbouring Councils. 4. Proposed reactive and proactive support to care homes

approved. 5. QIPP Plans and relationship to BCF reviewed.

RECOMMENDATION: That the report of the Integrated Commissioning Executive be noted.

FINANCIAL IMPLICATIONS: None arising directly from this report.

WHAT ENGAGEMENT HAS TAKEN PLACE: None

ACTION REQUIRED: Decision Approval Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 10 MAY 2018 REPORT OF THE INTEGRATED COMMISSIONING EXECUTIVE 1.0 PURPOSE OF REPORT 1.1 To note matters considered by the Integrated Commissioning Executive. 2.0 BACKGROUND 2.1 The Integrated Commissioning Executive was established to provide oversight of the Better Care

Fund (BCF). 2.2 It met on 7 March and 11 April 2018. This report sets out the main issues considered by the

Executive. 2.0 BCF 2018/19 2.1 The Executive has noted the level of resource available for 2018/19 which has increased from

£72.46m to £75.91m. The availability of funding prospectively is dependent upon the evaluation process described below.

3.0 EVALUATION OF iBCF SSCHEMES 3.1 The Executive has approved a methodology for reviewing those schemes currently funded on a

non-recurrent basis from the iBCF. These reviews will now commence so that decisions can be made on the potential recurrent funding of the schemes, based upon their impact within the wider health and care system. This will then feed into the planning processes of the CCG and the Council.

3.2 Whilst this is the immediate priority, a similar approach will be taken to the entirety of the BCF

Plan. 4.0 PERFORMANCE AND FINANCE 4.1 The Executive has noted the significant improvement in performance in relation to non-

emergency admissions and delayed transfers of care. With regard to the latter, the performance of neighbouring Councils and its impact on the position of the local system is a growing area of concern and has been raised with NHS England and other regional bodies.

4.2 The Executive has also noted the performance of the iBCF schemes referred to above which

appears to have had an impact since their implementation in September 2018. 4.3 Financial performance at month 11 shows an overspend on the CCG elements. The risk in

relation to this will be borne by the CCG.

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5.0 PROPOSED SUPPORT FOR CARE HOMES 5.1 The proposals developed by the CCG to provide both proactive and reactive support to care

homes have been reviewed by the Executive and if agreed will have an impact on the integration of health and social care. These proposals are the subject of a separate report on this agenda.

6.0 QIPP 6.1 The Executive have been briefed on those elements of the CCG’s QIPP Plan which have an

impact on the BCF and its performance metrics. The performance of these schemes will now be the subject of a regular report to the Executive, recognising the interdependencies between the two programmes.

7.0 RECOMMENDATION 7.1 That the report of the Integrated Commissioning Executive be noted for assurance. Mr. N. Bucktin Director of Commissioning April 2018

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 10 May 2018 Report: MCP Procurement Process – Progress Report

Agenda item No: 10.4

TITLE OF REPORT: MCP Procurement Process – Progress Report

PURPOSE OF REPORT: To advise the Board of progress with the MCP procurement process

AUTHOR OF REPORT: Mr N Bucktin – Director of Commissioning

MANAGEMENT LEAD: Mr N Bucktin – Director of Commissioning

CLINICAL LEAD: Dr D Hegarty, Chair

KEY POINTS:

1. The dialogue stage of the procurement process concluded on 23 March 2018. Final bids were due to be received on 8 May 2018.

2. The outcome of the evaluation process will be reported to special meetings of this Board and the Council Cabinet on 19 June 2018.

3. Two judicial reviews are due to be considered in relation to the

proposed contract that will be used for the MCP. The anticipated consultation process for the Accountable Care Organisation (ACO) Contract is yet to begin.

4. An initial submission for the Integrated Support and Assurance Process (ISAP) will be made in July, 2018.

5. The MCP Procurement Project Board has reviewed its position in relation to the recommendations arising from reports into the collapse of the Uniting Care contract and noted the register of interests.

RECOMMENDATION:

1. That progress with the MCP procurement process be noted.

2. That the CCG’s position in relation to the recommendations arising from the Uniting Care contract collapse be noted.

3. That the MCP Procurement Project Board’s register of interests be

noted.

FINANCIAL IMPLICATIONS: None

WHAT ENGAGEMENT HAS TAKEN PLACE: None

ACTION REQUIRED: Decision Approval Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 10 MAY 2018 MCP PROCUREMENT PROCESS – PROGRESS REPORT 1.0 PURPOSE OF REPORT

1.1 To advise the Board of progress with the MCP procurement process. 2.0 BACKGROUND 2.1 The Board will recall that the dialogue phase of the procurement process has continued

since September 2018. This report updates the Board on the conclusion of the dialogue phase and the next steps.

3.0 DIALOGUE PROCESS 3.1 The MCP Procurement Project Board agreed that the dialogue process could conclude on

23 March 2018 and the Invitation to Submit Final Tenders (ISFT) was issued on that date as well.

3.2 The original deadline for submission of the response to this was originally scheduled for 25

April, 2018. However, following a request from the bidder, this was extended to 8 May 2018 in order to enable the final submission to go through the necessary governance processes. This submission is in the process of being evaluated and meetings to carry out a moderation process are scheduled to take place from 17 May 2018.

4.0 DECISION-MAKING PROCESS 4.2 A report on the evaluation of the final proposals will be submitted to meetings of this Board

and the Council Cabinet on 19 June 2018. Both bodies will jointly receive the report on the outcome of the evaluation and a supporting presentation. They will then hold separate meetings to take their respective decisions.

5.0 JUDICIAL REVIEWS AND PROPOSED ACCOUNTABLE CARE ORGANISATION (ACO)

CONTRACT 5.1 The first judicial review hearing took place on 23 April 2018. The second is due to take place

on 23 and 24 May 2018. Judgements are expected in June 2018. 5.2 At the time of writing this report, the planned national consultation on the ACO contract had

not begun. A further update will be provided at the meeting. 6.0 REGULATORY PROCESSES 6.1 Following a presentation by the Chief Executive Officer to the Clinical Senate, arrangements

are being made for the Senate to review the proposed MCP clinical model. 6.2 Discussions have taken place with NHS England regarding the Integrated Support and

Assurance Process (ISAP). It is anticipated that an initial submission for ISAP Checkpoint 2 will be made in early July 2018, with the final submission being made in September 2018. Prior to the initial submission, it is proposed that a development session of this Board considers in depth the initial submission with the Board considering this fully at its meeting on 12 July 2018. The final submission will go through a similar process, prior to the Board considering this at its meeting on 13 September 2018.

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7.0 REPORTS INTO UNITING CARE CONTRACT COLLAPSE - RECOMMENDATIONS 7.1 The Board will recall that it has previously reviewed the recommendations arising from

reports into the failure of the Uniting Care contract and the CCG’s position in relation to these. The Procurement Project Board has reviewed and updated this in the light of the current stage of the procurement and this is attached as Appendix 1. The updated elements are highlighted in red text.

8.2 REGISTER OF INTERESTS 8.3 The Procurement Project Board has reviewed the register of interests and this is attached as

Appendix 2. 9.0 RECOMMENDATION 9.1 That progress with the MCP procurement be noted. 9.2 That the CCG’s position in relation to the recommendations arising from the Uniting

Care reports be noted. 9.3 That the MCP Procurement Project Board’s register of interests be noted. Neill Bucktin Director of Commissioning April 2018

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UNITING CARE PARTNERSHIPS CONTRACT REVIEW REPORTS – RECOMMENDATIONS AND ACTIONS

AS NOTED BY DUDLEY MCP PROCUREMENT BOARD – 9 APRIL 2018 RECOMMENDATION ACTION TAKEN 1. Design the service properly from the outset with stakeholders.

Articulate the service model and ensure it is costed realistically. Clear service model articulated as part of procurement documentation.

2. Insist on transparency from legacy providers including open book access to cost data.

Cost data requested and risk assessed by Deloitte. Cost data reviewed during dialogue process.

3. Increase the NHS’s commercial capability so that basic mistakes are avoided. External advice in place.

4. Obtain complete clarity about the role of external advisers and how their individual inputs should be brought together into coherent advice.

All advice channelled through Project Board with advisers in attendance.

5. Do not change the terms of the procurement part way through the process.

Integrated Support and Assurance Process (ISAP) Checkpoint (CP) 2 addresses this.

6. Do not go live until all issues between commissioners and providers are resolved and fully understood. ISAP CP 3 addresses this.

7. Consider the proposed level of “risk transfer” carefully. Allocate the risk proportionate to the organisation’s ability to manage it.

Financial modelling being prepared. To be included in CP 2 submission

8. Ensure that bidders are assessed for capacity, capability, economic and financial standing and that they are re-assessed if the structure of their bid, or corporate form changes during the procurement process.

Assessment to be conducted through Pre-Qualification Questionnaire (PQQ). PQQ to be retested due to change in organisational form.

9. Ensure that contracts with LLPs or Special Purpose Vehicles have parent guarantees.

Parent guarantees will be sought as necessary, through PQQ. No longer relevant – entity will be an FT.

10. Establish an accurate financial envelope for the new service model from the outset and before the procurement commences. Being established and will be submitted for CP1.

11. Be open with bidders around the calculation of the financial envelope so that they can be comfortable that the envelope reconciles to current expenditure levels even if the CCG requires additional efficiency savings.

As 10 and 2 above.

12. Ensure that NHS providers have included the additional cost of VAT in their bid submission if they are utilising a relevant model such as a LLP.

Advice already sought. VAT liability to be verified. No longer relevant. Entity will be an FT.

Appendix 1

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13. Avoid a situation where the new contract is still not agreed or ready to go live but notice has been given to providers to terminate existing contracts and TUPE notices have been issued to staff.

Procurement timetable to accommodate this. CP3 addresses this.

14. Ensure that the contract value is absolutely clear before the contract commences and is not a provisional figure based on historical or estimated data which needs to be updated for the previous year’s expenditure levels and other issues.

Procurement timeline to accommodate this. Rules in relation to updating this in place.

15. Ensure that there is a way of coping with the risk of inadvertently omitting key service delivery needs from the service specification. This may be achieved by not spending all of the agreed contract savings until the contract has bedded down later in the year.

Contract design to address this.

16. Escalate disputes to NHS England at an early stage and keep them informed. Escalation process noted.

17. CCG ownership of decisions should be retained despite outsourcing procurement functions and/or obtaining independent advice. Decision making responsibility remains with CCG.

18. The CCG needs to ensure it is able to evaluate and challenge the quality of the advice received and outputs delivered. CCG assessed as “well led” by NHSE.

19. The whole of the Governing Body should be provided with full information in an accessible way. This means that summaries should contain a clear articulation of risks, issues and potential consequences so that decisions are made with full knowledge and understanding of the associated risks.

Reporting process to reflect this. Regular reports submitted to CCG Board by Procurement Project Board.

20. The Governing Body should ensure it has assurance that it is making fully informed decisions, both through the written information it receives from internal and external sources and through the opportunities it has to challenge and test this information. In particular, the Governing Body and oversight committees/boards should consider having advisers present their findings and articulate the risks and implications.

External advisers to be in attendance as necessary.

21. Relationships with advisors should be held by the members of the CCG Executive team rather than through another adviser.

Arrangements managed by Chief Operating & Finance Officer and Director of Commissioning.

22. A governance structure that enables effective scrutiny and decision making should be established. The Procurement Project Board should not be too large a forum and should have sufficient skills to scrutinise on

Project Board considered appropriate. Chief Operating & Finance Officer is a member.

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behalf of the Governing Body, including the involvement of the CFO. It should focus on the whole project risks to ensure these are brought together and mitigated.

23. The CCG should ensure that is has adequate risk management and assurance processes in place to holistically oversee and mitigate risks during the procurement process. Project risk management needs to take place throughout the entire project lifecycle. Risk registers should be used to capture strategic and operational commissioner, provider and shared risks.

Full risk register in place. Reviewed monthly by Project Board.

24. Due weight needs to be given to the non-clinical aspects of procurement and specifically to the clinical risks arising from unidentified non-clinical risks.

Risk assessment process to take account of this.

25. Where decision makers are unaccustomed to evaluating financial/legal/clinical information then training should be given in advance. Advisors should be invited to attend meetings of the decision makers to present their advice and answer questions.

Training to be provided as appropriate. Advisers in attendance at Project Board meetings. Attendance at Governing Body as necessary.

26. Regulators and NHS England should be approached at an early stage in relation to large scale procurements.

ISAP Early Engagement meeting and Checkpoint 1 Panel has taken place and completed satisfactorily. Further follow up meetings have taken place. Further stages of ISAP to be completed and ongoing dialogue maintained with New Care Models Team and Regulators.

27. Comprehensive commercial advice and support should be commissioned in addition to procurement, legal and financial advice where the commissioner does not have these skills in-house.

Additional advice to be sought as appropriate.

28. Governing body members need to understand the corporate element of their role and consider decisions from a broader perspective rather than their own area of expertise.

Board assessed as “well led” by NHSE.

29. A formal Senior Responsible Officer should be sufficiently experienced and senior for a project of this nature. Appointing an Executive as SRO would allow for increased access to decision makers.

Project Board chaired by Chief Executive Officer. Project Team led by Director of Commissioning.

30. The CFO or a lead finance manager should be embedded in core team/oversight committee.

CFO is a member of the Project Board. Finance Manager – Commissioning is a member of the Project Team.

31. The CCG needs to ensure it understands the provider/bidder economics and be able to quantify the financial risks associated with the proposed

To be assessed at PQQ stage. External advice to be sought as appropriate.

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contract. This will also help inform non-clinical risks.

32. The scope of work commissioned from advisors should cover all areas where the CCG does not have the experience, expertise or capacity in-house to address a risk area without external support. The scopes of work for advisors should be fit for purpose and comprehensive.

Procurement, legal and financial advice in place. Further advice to be sought as appropriate.

33. Advisors should not be kept at arms’ length and should be retained throughout the whole process beyond the preferred bidder stage, to provide support through mobilisation.

See above. Advisers have been retained throughout process.

34. Advisors should not be managed in silos. Where a workstream structure is used advisors need to consider their assessment of impact of risks on other areas.

Advice is through Project Team and Project Board. No separation of work streams

35. The scope of work commissioned from advisors should be reviewed in response to emerging risks and, where appropriate, extended to address these.

See above.

36. Local commissioners should take responsibility for designing more integrated systems of healthcare themselves, drawing on skills from within the NHS. They must not abdicate commissioning responsibilities to a body which is clearly not accountable to the taxpayer.

Noted.

Amendments in red font

APPENDIX 2

MCP PROCUREMENT REGISTER OF INTERESTS – as at 12.04.2018 MCP PROCUREMENT PROJECT BOARD Name Organisation Date of

Declaration Interest Declared

Voting Members Bowsher, Matt Dudley MBC 06.06.2016 None Broster, Laura Dudley CCG 17.05.2016

and confirmed on 9.04.2018

Close friendship with an employee of Dudley Group of Hospitals NHS Foundation Trust. Director – Shrops Hire Solutions Ltd

Bucktin, Neill Dudley CCG 10.04.2018

Chairman of the Corporation, Heart of Worcestershire College Member of Managers in Partnership Director - North East Worcestershire Enterprises Ltd.

Corbett – Nolan, Andrew

Good Governance Institute

06.09.2017 None

Evans, Karen Patient Rep 17.05.2016 None Garry, Karen Patient Rep 17.05.2016 Healthwatch Dudley Board member - can't

be involved in actual procurement process.

Harkins, Deborah Dudley MBC 09.01.2017 None Hartland, Matthew Dudley CCG 26.08.2017 None Jasper, Julie Dudley CCG 08.05.2017 Lay member of Sandwell and West

Birmingham CCG and their New Care Models Programme Board Chair.

Maubach, Paul Dudley CCG 01.07.2017 Member of Dudley Health & Wellbeing Board Member of CIPFA Member of Managers in Partnership In a personal relationship with Director of OD and HR since April 2016 Interim Chief Executive Officer, Walsall CCG

Samuels, Martin Dudley MBC 04.06.2018 None Vandrill, Rhian Mills and Reeve 17.06.2016 None

MCP PROCUREMENT PROJECT TEAM Name Organisation Date of

Declaration Interest Declared

AbuAffan, Mayada Dudley MBC 25.01.2017 None Carter, Stacey Dudley MBC 15.03.2017 None Codd, Helen Dudley CCG 05.05.2016 None Rachel Cooper Dudley MBC 12.02.2018 None Gamage, Matthew Dudley CCG 17.05.2016 None Grayson, Darren Good Governance

Institute 30.11.2016 None

Jackson, Karen Dudley MBC 15.11.2016 None Jenkins, Dr Duncan

Dudley CCG 18.05.2016 06.02.2018

Managing Director Morph Consultancy Ltd (a healthcare consultancy), Director of Free Radical Ltd (a subsidiary of Morph Consultancy, specialising in providing rebates); my wife is a major shareholder of both the above companies; I am an honorary senior lecturer at the University of Worcester; I am a consultant to the Pharmacists' Defence Association (a trade union and provider of indemnity insurance to pharmacists); personal adhoc consultancy work for the pharmaceutical and devices industry; my post is a joint appointment with the Office of Public Health Dudley MBC, who contribute to my salary. Director of Ethical Decision Making Ltd.

Jolly, Fiona Dudley CCG 21.07.2016 Daughter is a nurse in the GI Unit at Dudley Group of Hospitals NHS Foundation Trust.

Jones, Barry Dudley MBC 15.11.2016 None Kaur, Bal Dudley MBC 21.08.2017 None Mtemachani, Taps Dudley CCG 17.05.2016 None Nicholls, Anthony Dudley CCG 17.05.2016 None Obholzer, Anton NHS England 05.08.2016 None Owen, Georgina Red Quadrant 14.08.2017 None Pearson, Cathy Arden GEM CSU 26.05.2017 None Vaughan, Joanne Dudley MBC 23.11.2016 None Ward, Richard Arden GEM CSU 17.05.2016 Wife is a community nurse - Dudley Group

of Hospitals NHS Foundation Trust. Young, James Dudley CCG 26.07.2017 Wife works as a phlebotomist at Dudley

Group of Hospitals NHS Foundation Trust

DIALOGUE/ EVALUATION SESSIONS – not included above Name Organisation Date of

Declaration Interest Declared

Argentieri, Julia Dudley CCG 12.12.2017 None Atkinson, Jane Dudley CCG 12.04.2018 None Barbosa, Greg Dudley MBC 13.07.2017 None Bourne, Lewis Dudley MBC 15.03.2018 None Brunt, Caroline Dudley CCG 13.04.2017 None Burgess, Nickie Dudley CCG 01.06.2016 None Cooper, Steve Dudley MBC 03.10.2017 None Corner, Richard Dudley CCG 29.08.2017 Employee of Alscient Services who supply

services to the CCG Cowley, Phil Dudley CCG 15.08.2016 None Dean, Heather Dudley MBC 04.09.2017 None Eaves, Kelly Dudley CCG 04.09.2017 None Fawlk, Catherine Mills & Reeve 06.09.2017 None Grayson, Darren GGI 30.11.2016 None Gee, Richard Dudley CCG 10.05.2017 Member of Council of Governors Dudley

Group of Hospitals Foundation Trust. Grainger, Louise Dudley MBC 08.03.2018 None Harris, Alison Dudley MBC 16.03.2018 None Hayes, Lucy Dudley CCG 25.09.2017 None Hicks, Nicholas R Cobic 08.05.2017 Cobic has formed a joint venture with

Optimedis AG called Optimedis-Cobic UK to support the development of service integration function. Optimedis-Cobic UK is not bidding for this contract.

McHale, John Dudley MBC 04.09.2017 None Mitchell, Simon Your Health

Partnership 08.05.2017 None

Payne, Fiona Mills & Reeve 04.12.2017 None Pleydell, Alex Mills & Reeve 22.03.2018 None Smith, James Dudley CCG 07.09.2017 Wife works in Finance Dept at DMBC Smith, Andrew Cobic 08.05.2017 None Vaughan, Joanne Dudley MBC 23.11.16 None Su Vincent Dudley CCG 12.04.18 None Yates, Rebecca Dudley MBC 15.03.2017 None

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD

Date of Board: 10 May 2018 Report: Primary Care Commissioning Committee Report

Agenda Item No: 11.1

TITLE OF REPORT: Primary Care Commissioning Committee Report

PURPOSE OF REPORT: To advise the Board on key issues discussed at the meetings of the Primary Care Commissioning Committee on 16 March 2018 and 20 April 2018

AUTHOR OF REPORT: Mrs J Robinson, Primary Care Contracts Manager

MANAGEMENT LEAD: Mrs C Brunt, Chief Nurse

CLINICAL LEAD: Dr T Horsburgh, Clinical Executive for Primary Care

KEY POINTS:

The Committee: • Received assurance from the Primary Care Operational Group that

there were no contractual breaches to be issued • Approved contractual variations in respect of partnership and

boundary changes recommended by the Primary Care Operational Group

• Approved the closure of both branch surgeries of Stourside Medical Practice and subsequent contract variation

• Received an update on an application from Moss Grove Surgery Kinver to join Dudley CCG and then merge with Moss Grove Kingswinford and approved the draft engagement plan

• Noted GMS Contract changes for 2018/19 • Approved the final DQOFH draft business rules for 2018/19, the end

of year process and process for the 2019/20 review of the framework • Approved a proposal for a new Care Home Local Improvement

Scheme (LIS) subject to minor clarifications • Received assurance from the Primary Care Steering Group in

relation to delivery of the General Practice Forward View • Received for assurance the Quality and Safety Report and full

dataset in private • Deferred the decision relating to a Phased Return to Work Following

Sickness for GPs Reimbursement Policy • Noted the reported financial position • Approved in principle changes to the Terms of Reference • Considered and accepted the current risk register ratings

RECOMMENDATIONS: • The Board is asked to note for assurance the issues discussed, and

decisions taken by the Primary Care Commissioning Committee • Receive the revised Terms of Reference (Appendix 1) approved by

the Committee for assurance. FINANCIAL IMPLICATIONS: • The budget delegated to the Committee is £44.3m

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WHAT ENGAGEMENT HAS TAKEN PLACE:

• NHS England • CQC • Member practices • Local Medical Committee

ACTION REQUIRED: Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 10 MAY 2018 PRIMARY CARE COMMISSIONING COMMITTEE REPORT 1.0 INTRODUCTION

1.1 This report summarises the key issues discussed at the Primary Care Commissioning Committees

held on 16 March 2018 and 20 April 2018.

PRIMARY CARE CONTRACTING 1.2 Committee received assurance from the Primary Care Operational Group (PCOG) that there are no

contractual breach notices to be issued against any Dudley practices. 1.3 Committee accepted a recommendation from PCOG and approved one contractual change for the

addition of a new partner.

Stourside Medical Practice – branch closures at Tenlands Road and Coombswood Road 1.4 Committee received the application from Stourside Medical Practice to close both branch surgeries at

Tenlands Road and Coombs Road. 1.5 To provide a greater opportunity for patients to attend, the meeting was held at The Cornbow Hall,

Halesowen. There were approximately 25 members of the public and public representatives in attendance.

1.6 Committee reviewed the comprehensive application and business plan and the practice presented the

rationale for consolidating the 3 sites and bringing all of the services together at Halesowen Health Centre.

1.7 The Governing body has previously been advised that Committee approved a move from a practice

led engagement to a CCG led engagement process. The Director of Communications & Public Insight provided details of the engagement process, the outcomes and the health inequalities and equality assessments.

1.8 The full plan for the engagement was approved by the Health & Adult Social Care Scrutiny Committee

(HASC). A letter was issued to the head of each household for all registered patients of Stourside Medical Practice, correspondence was also sent to neighbouring practices and CCG’s and the Health & Wellbeing Board. The CCG attended several community forums and to ensure that patients were adequately informed of the change in leadership for the public engagements, a number of meetings and drop in sessions were also arranged including discussions with the local Yemeni group.

1.9 There were two petitions, one opposing the closures, signed by 600 people and one supporting the

closure, signed by 270 people. 1.10 The key points from the engagement included lack of suitable local transport, perceived lack of parking at

Halesowen Health Centre, concerns of the stability of the local Pharmacy at Coombs Road, ease of obtaining appointments, patients unsure as to whether this would actually improve and that the proposal was perceived as financially driven.

1.11 Stourside Medical Practice representatives provided Committee with responses to the engagement

exercise. 1.12 The Chair gave members of the public and local councillor the opportunity to ask questions that had not

already been covered.

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1.13 Committee considered the application and all documentation in accordance with the delegation

agreement, NHS Regulations and NHS England policy and unanimously formally approved the branch closures application.

1.14 Comprehensive papers including the Public Consultation and Equality Impact Assessment Report and

Health Inequalities Report can be found on the CCG public website at http://www.dudleyccg.nhs.uk/primary-care-commissioning-committee-meeting-dates-and-papers/

1.15 The Contractor has given the required notice to the landlord of Tenlands Road and a lease renewal

by reference is agreed with the landlords of Coombswood Surgery. Tenlands Road Surgery is scheduled to close on 7th September 2018 and Coombswood Surgery on 14th September 2018. A letter has been drafted and patients will be notified accordingly.

Branch Closures

1.16 Committee accepted a recommendation from PCOG who had reflected on the recent branch closure

applications and agreed that before any further requests are considered, the existing Dudley CCG branch closure procedure document should be reviewed and then ratified by Committee and HASC. The review will reflect the recent launch of the NHS England, Primary Medical Care Policy and Guidance Manual.

Lower Gornal Medical Practice 1.17 Committee approved an application from Lower Gornal Medical Practice to change their practice

boundary. This was considered to be an exceptional circumstance following the boundary inherited from surgeries at Masefield Road and Clifton Street – both since closed. The decision was based on this circumstance and was not related to workforce issues.

Moss Grove Surgery 1.18 Committee received an update on an application by Moss Grove Surgery Kinver to join Dudley CCG

and then merge with Moss Grove Kinver. 1.19 Committee discussed the application and approved the draft engagement plan. The public and key

stakeholder engagement will run through until 11 May 2018. 1.20 Committee will consider the merger request in principle at May’s meeting and will make a

recommendation to the Governing Body in respect of the change in CCG boundary and list of members.

GMS Contract changes for 2018/19 1.21 Committee noted changes to the GMS Contract, agreed between NHS Employers, on behalf of NHSE

and the BMA GP’s committee. 2.0 PRIMARY CARE COMMISSIONING

Dudley Quality Outcomes for Health (DQOFH) 2.1 Committee discussed and approved the final draft business rules for 2018/19, the end of year process

and process for the 2019/20 review of the DQOFH framework. Dudley Care Home Local Improvement Scheme (LIS) 2018-19

2.2 Previously it was agreed that the Care Home indicators and related finances should be removed from

DQOFH and commissioned separately as a Care Home Local Improvement Scheme in 2018/19.

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2.3 The new Care Home LIS has been developed and enhanced with the objective of improving quality of care, supporting more people to be cared for in their preferred place of care and reducing unnecessary admissions to hospital.

2.4 Subject to clarification of some points and minor revision of the specification, Committee approved the

proposal for the new Care Home Local Improvement Scheme.

3.0 GENERAL PRACTICE FORWARD VIEW (GPFV) – UPDATE FROM THE PRIMARY CARE STRATEGY GROUP (PCSG)

3.1 The PCSG is already established to oversee the implementation of the GPFV.

3.2 Committee received an update relating to the delivery of the GPFV and was assured that there are no significant risks. The update included the following work streams:

• Black Country STP leads • Workforce • Enabling Practices to Improve and Change (EPIC) • Clinical correspondence management training • Patient on-line • Telephone consultation training • IT utilisation audit of IT systems in primary care • Care navigation / Active signposting • GP resilience programme • Extended primary care access • PM development training programme • On-line consultation

4.0 QUALITY 4.1 Committee received the full dataset in private. The Quality and Safety report to the Board will set out

in more detail those areas pertinent to primary care. 5.0 FINANCE 5.1 There has been one change to the budget, with funding of £5,000 for GP Retainer Scheme costs

being received from NHS England. 5.2 Although the year-end accounts had not been finalised, the interim position reported to NHS England

on 11 April was noted by Committee as follows: • Primary Care Co-Commissioning - £17,000 underspend • Core CCG Budgets - £4,000 overspend • Net Committee position - £13,000 underspend

5.3 A report on the final financial position submitted as part of the overall CCG accounts will be

presented to Committee in May. 5.4 Committee noted the reported financial position.

Phased Return to Work Following Sickness for GPs Reimbursement Policy

5.5 Committee received and discussed a policy that supports GP’s to return to work from sickness and allows a phased return over a 4 week period, with any locum costs incurred in respect of sessions that the GP does not cover being reimbursed up to the rate in the current Statement of Financial Entitlements (SFE).

5.6 Committee was supportive in principle however deferred a decision until receiving clarity on the

budgeted position for 2018/19 and wider consideration of issues surrounding locum reimbursement.

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6.0 TERMS OF REFERENCE (TOR)

6.1 In January 2018, NHS England returned the Constitution with proposed amends which included the

revision to all Committees’ TOR. 6.2 Committee discussed the minor changes and approved the revised TOR Version 2.5 (Appendix 1)

7.0 RISK REGISTER 7.1 The risks assigned to Committee were considered and the updates accepted. 8.0 RECOMMENDATIONS 8.1 The Board is asked to note for assurance the issues discussed, and decisions taken by the Primary

Care Commissioning Committees on 16 March 2018 and 20 April 2018. 8.2 Receive the revised Terms of Reference (Appendix 1) for assurance. Julie Robinson Primary Care Contracts Manager April 2018

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Governing Body’s

Primary Care Commissioning Committee

Terms of Reference – Version 2.5

AMENDMENT HISTORY VERSION DATE AMENDMENT HISTORY V1.0 December 2014 First Draft of PCC TOR V1.0 May 2015 Presented to Board for approval V2.0 October 2016 Governance Team reviewed with PC Team V2.1 November 2016 Further changes made to the nominated representatives &

quoracy V2.2 November 2016 Further changes made in relation to referencing – move to V2.3 V2.3 December 2016 Further changes made following Committee in November. V2.4 May 2017 Lay Member for Patient & Public Engagement made a Voting

Member of the Committee V2.5 February 2018 Slight amends following NHS England review REVIEWERS This document has been reviewed by: NAME DATE TITLE/RESPONSIBILITY VERSION Paul Lewis-Grundy May 2015 Governance Manager V1.0 Emma Smith October 2016 Governance Support Manager V2.0 Julie Robinson October 2016 Primary Care Contracts Manager V2.0 Daniel King November 2016 Director Membership Development &

Primary Care V2.1

Sue Johnson November 2016 Deputy CFO V2.2 Emma Smith December 2016 Governance Support Manager V2.3 Emma Smith May 2017 Governance Support Manager V2.4 Emma Smith February 2018 Governance Support Manager V2.5 APPROVALS This document has been approved by: VERSION BOARD/COMMITTEE DATE V1.0 Dudley CCG Board May 2015 V2.0 Primary Care Commissioning Committee 21 October 2016 V2.1 Dudley CCG Board 10 November 2016 V2.3 Primary Care Commissioning Committee 16 December 2016 V2.4 Primary Care Commissioning Committee 26 May 2017 V2.5 Primary Care Commissioning Committee 20 April 2018

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NB: The version of this policy posted on the intranet must be a PDF copy of the approved version. Please note that any changes to these Terms of Reference must be done in line with the Terms of Reference Development Guidance. Changes must be agreed at Committee and ratified through the Governing Body. The Governance Team must be included in any revision to ensure that the statutory duties are unaffected and in line with the CCGs Constitution.

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Primary Care Commissioning Committee – Terms of Reference 1. Introduction & Purpose 1.1. The Primary Care Commissioning Committee (the ‘Committee’) is established in

accordance with paragraph 6.7.1(f) of NHS Dudley Clinical Commissioning Group’s (CCG) constitution. These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the Committee and will have effect as if incorporated into the constitution. The Committee terms of reference will be reviewed annually. Any changes to the terms of reference will be approved by the Governing Body.

1.2. The Chief Executive of NHS England, announced on 1 May 2014 that NHS England

was inviting CCGs to expand their role in primary care commissioning and to submit expressions of interest setting out the CCG’s preference for how it would like to exercise expanded primary medical care commissioning functions. One option available was that NHS England would delegate the exercise of certain specified primary care commissioning functions to a CCG.

1.3. In accordance with its statutory powers under section 13Z of the National Health Service

Act 2006 (as amended). NHS England has delegated the exercise of the functions specified in Schedule 2 to these terms of reference to NHS Dudley CCG. The delegation is set out in Schedule 1.

1.4. The CCG has established the NHS Dudley CCG Primary Care

Commissioning Committee (“Committee”). The Committee will function as a corporate decision- making body for the management of the delegated functions and the exercise of the delegated powers.

1.5. It is a committee comprising representatives of the following organisations:

• NHS Dudley CCG; and • The Office of Public Health, Dudley Metropolitan Borough Council • A representative from NHS England will also be in attendance

2. Membership

2.1 Each member of the Committee as defined in Schedule 3 shall have one vote. The

Committee shall reach decisions by a simple majority of members present, but with the Chair having a second and deciding vote, if necessary. The aim of the Committee will be to achieve consensus decision-making wherever possible.

2.2 The voting membership will include all independent members of the governing body except

the Chief Officers excluding the Chief Accountable Officer; and the Public Health representative. That is:

• Lay member for Governance (Chair) • Lay member for Quality & Safety (Vice Chair) • Lay member for Patient & Public Engagement • Secondary Care Specialist Doctor • Chief Operating & Finance Officer (or their nominated representative the Deputy Chief

Finance Officer) • Chief Nurse (or their nominated representative the Head of Quality Assurance) • Public Health representative

2.3 The Chair of the Committee will be appointed by the Governing Body. Unless there are

any material reasons for not doing so this person will be the Governing Body lay member responsible for governance matters. Where the latter is not the case the material reasons

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must be documented. 2.4 The Vice Chair of the Committee will be appointed by the Committee members. 2.5 Other people that will normally be in attendance (members but non-voting) will include a:

• HealthWatch representative • Health and Wellbeing Board representative • Patient Opportunity Panel representative • LMC representative • LPC representative • GP Lay Member • Director of Membership Development & Primary Care

2.6 Governing Body elected GPs, Clinical Executives, NHS England representation, other GP

members or employees of the CCG (not already listed in the membership) will be in attendance for those agenda items that the Committee membership has deemed appropriate for their input. This will be in an advisory and non-voting capacity. The CCG’s “Registering Interests and Managing Conflicts of Interest Policy” will be observed and complied with at all times.

3. Secretary 3.1 A named individual will be responsible for supporting the Chair in the management of the

Committee’s business and for drawing members’ attention to best practice, national guidance and other relevant documents as appropriate.

4. Quorum 4.1 A meeting of the Committee will be quorate provided that at least 4 vot ing members are

present of which:

• One must be either the Chair or Vice-Chair of the Committee • One must be the Chief Operating & Finance Officer or Chief Nurse or their nominated

representatives as stated in the membership section 5. Frequency of meetings 5.1 The Committee will formally meet on a monthly basis. There may be a need for the

Committee to meet informally from time to time. Any informal meetings will support the work of the Committee and will have no delegated decision-making authority.

5.2 Meetings of the Committee shall:

a. Be held in public, subject to the application of section 2.1 b. the Committee may resolve to exclude the public from a meeting that is open to the public

(whether during the whole or part of the proceedings) whenever publicity would be prejudicial to the public interest be reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution and arising from the nature of that business or of the proceedings or for any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as amended or succeeded from time to time.

6. Authority & Statutory Framework 6.1 The Committee will be directly accountable for the commitment of the resources /

budget delegated to the CCG by NHS England for the purpose of commissioning primary

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care medical services. This includes accountability for determining appropriate arrangements for the assessment and procurement of primary care medical services, and ensuring that the CCG’s responsibilities for consulting with its GP members and the public are properly accounted for as part of the established commissioning arrangements.

6.2 For the avoidance of doubt, the CCG’s Scheme of Reservation & Delegation, Standing

Orders and Prime Financial Policies will prevail in the event of any conflict between these terms of reference and the aforementioned documents.

Statutory Framework 6.3 NHS England has delegated to the CCG authority to exercise the primary care

commissioning functions set out in Schedule 2 in accordance with section 13Z of the NHS Act.

6.4 Arrangements made under section 13Z may be on such terms and conditions (including

terms as to payment) as may be agreed between NHS England and the CCG. 6.5 Arrangements made under section 13Z do not affect the liability of NHS England for the

exercise of a ny of its functions. However, the CCG acknowledges that in exercising its functions (including those delegated to it), it must comply with the statutory duties set out in Chapter A2 of the NHS Act, including:

a) Management of conflicts of interest (section 14O); b) Duty to promote the NHS Constitution (section 14P); c) Duty to exercise its functions effectively, efficiently and economically (section 14Q); d) Duty as to improvement in quality of services (section 14R); e) Duty in relation to quality of primary medical services (section 14S); f) Duties as to reducing inequalities (section 14T); g) Duty to promote the involvement of each patient (section 14U); h) Duty as to patient choice (section 14V); i) Duty as to promoting integration (section 14Z1); j) Public involvement and consultation (section 14Z2).

6.6 The CCG will also need to specifically, in respect of the delegated functions from NHS

England, exercise those functions set out below:

• Duty to have regard to impact on services in certain areas (section 13O); • Duty as respects variation in provision of health services (section 13P).

6.7 The Committee is established as a committee of the Governing Body of NHS Dudley CCG in

accordance with Schedule 1A of the “NHS Act”. 6.8 The CCG (and Committee) is subject to directions made by NHS England or by the

Secretary of State for Health. 7. Remit Duties and Responsibilities Operation of the Committee 7.1 The Committee will operate in accordance with the CCG’s Standing Orders and “Registering

Interests and Managing Conflicts of Interest Policy”. The Secretary to the Committee will be responsible for giving notice of meetings. This will be accompanied by an agenda and supporting papers and sent to each member representative no later than 5 working days before the date of the meeting. When the Chair of the Committee deems it necessary in light of the urgent circumstances to call a meeting at short notice, the notice period shall be such as s/he shall specify. The reasons for calling a meeting at short notice will be recorded in the minutes of the meeting.

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7.2 GPs and patients are represented in the committee through the inclusion of non-voting members from the LMC; Healthwatch and the Patient Opportunity Panel.

7.3 Members of the Committee have a collective responsibility for the operation of the Committee. 7.4 The Committee may delegate tasks to such people, sub-committees or individual members

as it shall see fit, provided that any such delegations are consistent with the CCG’s relevant governance arrangements, are recorded in a scheme of delegation, are governed by terms of reference as appropriate and reflect appropriate arrangements for the management of conflicts of interest.

7.5 The Committee may call experts, as required, to attend meetings and inform discussions. 7.6 Members of the Committee shall respect confidentiality requirements as set out in the CCG’s

Constitution, and comply with Section 8 of the Constitution: Standards of Business Conduct and Managing Conflicts of Interest.

7.7 Following each meeting, the Committee will present its minutes to NHS England and

report to the governing body of the CCG (including the minutes of any sub- committees to which tasks have been delegated under paragraph 7.4 above).

7.8 The Committee will also comply with any reporting requirements set out in the

CCG Constitution. Procurement of Agreed Services 7.9 The procurement arrangements will be set out in the delegation agreement (Schedule 1 and

Schedule 2 to this Terms of Reference) between NHS Dudley CCG and NHS England. Decisions 7.10 The Committee will make decisions within the bounds of its terms of reference. 7.11 The decisions of the Committee shall be binding on NHS England and NHS Dudley CCG

where they are within the bounds of the terms of reference. Role of the Committee 7.12 The Committee has been established in accordance with the above statutory provisions

to enable decisions on the review, planning and procurement of primary care services in Dudley, under delegated authority from NHS England.

7.13 In performing its role the Committee will exercise its management of the functions

in accordance with the agreement between NHS England and NHS Dudley CCG. 7.14 The functions of the Committee are undertaken in the context of continually improving

the quality of care provided to patients within the resources available. This is underpinned by equality of access to services, increased efficiency, productivity, value for money and to minimise bureaucracy.

7.15 The Committee will have at its heart three key principles, of shared ownership,

shared responsibility and shared benefits to create jointly the best healthcare for the registered patients of Dudley.

7.16 The role of the Committee shall be to carry out the functions relating to the commissioning

of primary medical services under section 83 of the NHS Act. 7.17 This includes the following:

• GMS, PMS and APMS contracts (including the design of PMS and APMS contracts,

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monitoring of contracts, taking contractual action such as issuing branch/remedial notices, and removing a contract);

• Newly designed enhanced services (“Local Improvement Schemes” and “Directed Enhanced Services”);

• Design of local incentive schemes as an alternative to the Quality Outcomes Framework (QOF);

• Decision making on whether to establish new GP practices in an area; • Approving practice mergers; and • Making decisions on ‘discretionary’ payment (e.g., returner/retainer schemes).

7.18 The CCG will also carry out the following activities:

a) To plan for sustainable primary medical care services in Dudley; b) To review primary medical care services in Dudley with the aim of further improving the

care provided to patients c) To co-ordinate the approach to the commissioning of primary care services generally; d) To manage the budget for commissioning of primary medical care services in Dudley.

Geographical Coverage 7.19 The Committee will be responsible for commissioning primary care medical

services coterminous with the geographical boundaries of NHS Dudley CCG. Partnership 7.20 The Committee will be responsible for working with other statutory and voluntary agencies

to maximise the benefits from investment in primary care services for the people served by the CCG.

8. Managing Conflicts of Interest 8.1 Conflicts of interest are a common and sometimes unavoidable part of the delivery of

healthcare. The CCG is required to manage any conflicts of interest through a transparent and robust system. Members of the Committee are encouraged to be open and honest in identifying any potential conflicts during the meeting. The Chair of the Committee will be provided with the latest Declaration of Interest register at each meeting and will be required to recognise any potential conflicts that may arise from themselves or a member of the meeting.

8.2 It is imperative that CCGs ensures complete transparency in any decision-making processes

through robust record-keeping. If any conflicts of interest are declared or otherwise arise in a meeting, the chair must ensure the following information is recorded in the minutes; who has the interest, the nature of the interest and why it give rise to a conflict; the items on the agenda to which the interest relates; how the conflict was agreed to be managed and evidence that the conflict was managed as intended.

9. Relationship with the Governing Body

9.1 The Committee is accountable to the governing body to ensure that it is effectively

discharging its functions.

9.2 For the next meeting of the governing body following each meeting of the Committee, the Chair of the Committee will provide a written summary of the key matters covered by the meeting, including any action or decisions reserved for the governing body.

9.3 A report from of each meeting of the Committee will be presented to the next meeting of the

governing body for information by the Chair of the Committee.

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10. Review of Committee Effectiveness 10.1 The Committee will annually self-assess and report to the governing body and NHS England

on its performance in the delivery of its objectives. 10.2 The Committee’s terms of reference will be reviewed annually. 10.3 Any changes to the terms of reference will be approved by the governing body.

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Schedule 1 – Scheme of Delegation Appendix D - Scheme of Reservation and Delegation of the CCG Constitution Schedule 2 – Delegated Commissioning Functions The role of the Committee shall be to carry out the functions relating to the commissioning of primary medical services under section 83 of the NHS Act. This includes the following:

• GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing branch/remedial notices, and removing a contract);

• Newly designed enhanced services (“Local Improvement Scheme” and “Directed Enhanced Services”);

• Design of local incentive schemes as an alternative to the Quality Outcomes Framework (QOF);

• Decision making on whether to establish new GP practices in an area; • Approving practice mergers; and • Making decisions on ‘discretionary’ payment (e.g., returner/retainer schemes).

Delegated commissioning arrangements exclude individual GP performance management (medical performers’ list for GPs, appraisal and revalidation). NHS England will retain responsibility for the administration of payments and list management.

1

GLOSSARY

ABBREVIATIONS

Abbreviation Meaning

#NOF Fractured Neck of Femur

£K £1,000 equivalent

A&E Accident and Emergency

ABC / ABCD Above and Beyond the Call of Duty (Local surveys which include praise for

nominated staff members as well as assessment of services)

ACSs Accountable Care Systems

ACS Acute Coronary Syndrome

ACO Accountable Care Organisation

AD Assistant Director

AfC Agenda for Change

AGM Annual General Meeting

AHSN Academic Health Science Networks

ALE Auditors Local Evaluation

ALOS Average Length of Stay (in hospital)

AMI Acute Myocardial Infarction

AMMC Area Medicines Management Committee

Anti-D An antibody occurring in pregnancy

Anti-TNF Drugs used in the treatment of rheumatoid arthritis and Crohn’s disease

AQP Any Qualified Provider

ARIF Aggressive Research Intelligence Facility

ASAP As soon as possible

AVE Advertising Value equivalent

BACs Bank Automated Credit

BAF Board Assurance Framework

BCC Black Country Cluster

BCF Better Care Fund

BCPFT Black Country Partnership NHS Foundation Trust

BFT Behavioural Family Therapy

BMA British Medical Association

BME Black Minority Ethnic

BMJ British Medical Journal

2

BPAS British Pregnancy Advisory Board

BSCCP British Society of Colposcopy and Cervical Pathology

CAB Citizens Advise Bureau

CAO Chief Accountable Officer

CAMHS Children and Adolescent Mental Health Service

CASH Contraception and Sexual Health

CCBT (CBT) Computerised Cognitive Behavioural Therapy

CCG Clinical Commissioning Group

CCRN Comprehensive Clinical Research Networks

CDC Commissioning Development Committee

CDiff Clostridium difficile

CEO Chief Executive Officer

CFO Chief Finance Officer

CHADD The Churches Housing Association of Dudley & District Ltd

CHC Continuing Healthcare

CHD Coronary Heart Disease

CIP Cost Improvement Plan

CLT Collaborative Leadership Team

CMO Chief Medical Officer

CNST Clinical Negligence Scheme for Trusts

CNT Community Nursing Team

COSHH Control of Substances Hazardous to Health Regulations 2002

CPA Care Programme Approach

CPN Community Psychiatric Nurse

CRL Capital Resource Limit

CRRT Community Rapid Response Team

CSU Commissioning Support Unit

CT scan Computer Topography

CQC Care Quality Commission

CQNO Chief Quality and Nursing Officer

CQUIN Commissioning for Quality and Innovation

CQRM Clinical Quality Review Meeting

CSG Clinical Strategic Group

CVD Cardio Vascular Disease

D&N Dudley and Netherton (Locality)

DACHS Directorate of Adult Children and Housing Services

DCS Dudley Community Services

DCVS Dudley Community Voluntary Service

DES Directed Enhanced Service

DfES Department for Education and Skills

3

DGFT Dudley Group Foundation Trust

DMO Designated Medical Officer

DNA Did not attend

DoH Department of Health

DoLS Deprivation of Liberty Safeguards

DoS Directory of Service

DPMA Dudley Practice Managers Alliance

DSCB Dudley Safeguarding Children’s Board

DTC Diagnostic and Treatment Centre

DToC Delayed Transfer of Care

DWMHPT Dudley and Walsall Mental Health Partnership Trust

DXA Dual X-ray Absorptiometry (measures bone density)

E&D Equality and Diversity

EAU Emergency Assessment Unit

ECA Extra Care Area

ECM Every Child Matters

ECT Electroconvulsive Therapy

ED Emergency Department

EI Early Implementer

EI Early Intervention

EMI Elderly Mentally Ill

EMIS Education Management Information System

EoL End of Life

EPC Empowering People and Communities

EPP Expert Patients Programme

EPR Electronic Patient Record

EPRR Emergency, Preparedness, Resilence, Response

ERT Enzyme Replacement Therapy

ESR Electronic Staff Record

FCEs Finished Consultant Episodes

FED Forum for Education and Development

FFT Friends and Family Test

FHS Family Health Services

FMC Facility Management Centre

FOI Freedom of Information

FYE Full Year Effect

FYFV Five Year Forward View

GGI Good Governance Institute

GMS General Medical Services

GOWM Government Office for the West Midlands

4

GP General Practitioner

GPAQ General Practice Assessment of Quality

GPwSI GP with Special Interest

GU Genito-urinary

GUM Genito-urinary Medicine

H&QB Halesowen and Quarry Bank (Locality)

HCAI Healthcare Associated Infections

HCF Healthcare Forum

HEE Health Education England

HENIG Health Economy NICE Implementation Group

HF Heart Failure

HIC Health Improvement Centre

HIV Human Immunodeficiency Virus

HIS Health Infrastructure Strategy

HPA Health Protection Agency

HPS/S Health Promoting Schools / Service

HPU Health Protection Unit

HR Human Resources

HSC Health and Safety Commission

HSCQC Health and Social Care Quality Centre

HSE Health and Safety Executive

HSMC Health Services Management Centre

HT Home Treatment

HV Health Visitor

HWBB Health and Well-being Board

IAPT Improved Access to Psychological Therapies

IC Infection Control

ICAS Independent Complaints Advocacy Service

ICE Integrated Commissioning Executive

ICNA Infection Control Nurses Association

ICP Integrated Care Pathway

IFR Individual Funding Request

IG Information Governance

IOSH Institute of Occupational Safety and Health

ISAP Integrated Support Assurance Process

IT Information Technology

IUCD Intrauterine Contraceptive Device

JCAB Joint Clinical Advisory Board

JCC Joint Commissioning Committee

JD Job Description

5

JSA Joint Strategic Assessment

KAB Kingswinford, Amblecote and Brierley Hill (Locality)

KLOE Key Lines of Enquiry

KPI Key Performance Indicators

LAA Local Area Agreement

LAC Looked After Children

LAT Local Area Team

LD Learning Disability

LDP Local Delivery Plan

LDR Local Digital Roadmap

LEA Local Education Authority

LIFT Local Improvement Finance Trust

LIG Local Implementation Group

LIT Local Implementation Team

LMC Local Medical Committee

LNG Local Negotiating Committee

LPS Local Pharmaceutical Scheme

LRF Local Resilience Forum

LSCB Local Safeguarding Children’s Board

LTC Long Term Conditions

LVD Left Ventricular Dysfunction

LVSD Left Ventricular Systolic Dysfunction

MAPA Management of Actual and Potential Aggression

MASH Multi-Agency Safeguarding Hub

MAU Medical Assessment Unit

MBC Metropolitan Borough Council

MCP Multi-speciality Community Provider

MDT Multi Disciplinary Team

MIMT Major Incident Management Team

MIRE Major Incident Response Executive

MLSOs Medical Laboratory Scientific Officers

MOU Memorandum of Understanding

MRSA Methicillin Resistant Staphylococcus Aureus

MSS Medium Secure Service

NCA Non contract activity

NCB National Commissioning Board

NCM New Care Model

NCRS National Care Record System

NELHI National Electronic Library for Health Information

NFI National Fraud Initiative

6

NICE National Institute for Clinical Excellence

NGMS New General Medical Services

NHS National Health Service

NHSCPT NHS Community Practice Teacher

NHSCSP NHS Cancer Screening Programme

NHSE NHS England

NHSLA NHS Litigation Authority

NHSP National Healthy Schools Programme

NICE National Institute for Clinical Excellence

NMC New Model of Care/Nursing and Midwifery Council

NOF New Opportunities Fund

NPfIT National Programme for IT

NPSA National Patient Safety Agency

NRF Neighbourhood Renewal Fund

NRLS National Reporting and Learning System

NSF National Service Framework

OAT Out of Area Treatment

OBD Occupied Bed Day

OD Organisational Development

ODM Oesophageal Doppler Monitoring

OJEU Official Journal of the European Union

OOH Out of Hours

OPH Office of Public Health

OSC Overview and Scrutiny Committee

OT Occupational Therapist

PACS Primary and Acute Care Systems

PALS Patient Advice and Liaison Service

PAF Positive Assurance Framework

PAS Patient Administration System

PAU Paediatric Assessment Unit

PbR Payment by Results

PC Personal Computer

PCCC Primary Care Commissioning Committee

PCDSG Primary Care Development Steering Group

PCOG Primary Care Operational Group

PDF Portable Document Format

PDR Personal Development Review

PDS Personal Dental Services

PDSA Plan, Do, Study, Act

PDU Professional Development Unit

7

PE Pulmonary Embolism

PEAK Database holding the main registered details of patients and associated referral,

contact, caseload, outpatient, inpatient, MH Act and clinic information.

PEAT Patient Environment Action Team

PEPP Pooled Budget External Placement Panel

PFI Private Finance Initiative

PGD Patient Group Directives

PHE Public Health England

PICU Psychiatric Intensive Care Unit

PID Project Initiation Document

PIN Prior Information Notice

PMLD Profound and Multiple Learning Difficulties

PMS Primary Medical Services

PNA Pharmaceutical Needs Assessment

POD Prescription Ordering Direct

POPs Patient Opportunity Panels

PPA Prescription Pricing Authority

PPG Patient Participation Group

PSA Public Service Agreement

PSHE Personal and Social Health Education

PSIAMS Personal Social Impact Action Measurement System

PTCA Percutaneous Transluminary Coronary Angioplasty

Q&A Questions and Answers

Q&S Quality & Safety

QA Quality Assurance

QIB Quality Improvement Board

QIPP Quality, Innovation, Productivity and Prevention

QMAS Quality Management and Analysis System

QOF Quality and Outcome Framework

QPDT Quality and Practice Development Teams

PQQ Pre-Qualification Questionnaire

RACPC Rapid Access Chest Pain Clinic

RAG Red, Amber Green (rating)

RAS Respiratory Assessment Service

RCA Root Cause Analysis

RCGP Royal College of General Practitioners

RES Race Equality Scheme

RHH Russells Hall Hospital

RIDDOR Reporting of Injuries, Diseases and Dangerous Occurrences Regulations

RMO Responsible Medical Officer

8

RRL Revenue Resource Limit

RTT Referral to Treatment

SAP Single Assessment Process

SCG Sedgley, Coseley and Gornal (Locality)

SCIE Social Care Institute for Excellence

SCR Serious Case Review

SEPIA Mental health computer system

SFBH Standards for Better Health

SFI Standing Financial Instructions

SI Serious Incident

SIC Statement of Internal Control

SLA Service Level Agreement

SPA Single Point of Access

SRE Sex and Relationship Education

SRG System Resilience Group

SSD Social Services Department

SSDP Strategic Services Development Plan

STI Sexually Transmitted Disease

STP Sustainability and Transformation Plan

STRW Support, Time & Recovery Worker

SWL Stourbridge, Wollescote and Lye (Locality)

SWOT Strength, Weakness, Opportunity and Threat

TB Tuberculosis

TIA Transient Ischaemic Attack

TP Teenage Pregnancy

TCT Transforming Care Together

TPT Teenage Pregnancy Team

TTO To Take Out

UCC Urgent Care Centre

UHBT University Hospital Birmingham Trust

Vaccs & Imms Vaccinations and Immunisations

WAN Wide Area Network

WCC World Class Commissioning

WIC Walk in Centre

WMAS West Midlands Ambulance Service

WMCA West Midlands Combined Authority

WMHTAC West Midlands Health Technology Advisory Committee

WMSCG West Midlands Strategic Commissioning Group

WMSSA West Midlands Specialised Services Agency

WTE Whole Time Equivalent

9

YHC Young Health Champion