nel joint commissioning committee meeting part 1 · welcome 1.1 12.30pm welcome, introductions,...

An alliance of North East London Clinical Commissioning Groups

City and Hackney, Newham, Tower Hamlets, Waltham Forest, Barking and Dagenham, Havering and Redbridge CCGs

NEL Joint Commissioning Committee Meeting Part 1

12.30-2pm Wednesday 8 January 2020

Committee rooms, Unex Tower

5 Station Street, Stratford, E15 1DA

1

NELCA Joint Commissioning Committee - Part 1 Date and time: 12.30-2pm Wednesday 8 January 2020

Venue: Committee Rooms, Unex Tower, 5 Station Street, Stratford, E15 1DA

Agenda

No. Time Item Page Action required Owner

1. Welcome

1.1

12.30pm

Welcome, introductions, apologies

Declarations of interestVerbal Chair

1.2 Minutes of the last meeting and matters arising

Action log

19

23

Approve

Monitor Chair

2. Patient and public engagement

2.1 12.35pm Questions from the public Verbal Discussion Chair

3. Strategy

3.1 12.55pm Medicines Optimisation strategy 24 Note Moira Coughlan

3.2 1.10pm The NHS Long Term Plan: our response and how we plan to deliver on our commitments

32 Note Simon Hall

4. Performance

4.1 1.25pm Performance report – month 7 46 Note Archna Mathur

5. Risk Register

5.1 1.35pm Approach to risk management - update 50 Note Kash Pandya

6. Forward planning/ AOB

6.1 1.45pm JCC meeting planner 53 Discussion Chair

Date of next meetings: 11 March 2020 13 May 2020

2

NELCA JCC - Acronyms List

ACRONYM MEANING

A&E Accident & Emergency

AfC Agenda for Change

AI Artificial Intelligence

APMS Alternative Provider Medical Services (a type of Primary care contract)

AQP Any qualified provider

BAF Board Assurance Framework

Bart's / BHT Barts Health NHS Trust

BHRUT Barking, Havering and Redbridge University Hospitals NHS Trust

BMA British Medical Association

CAS Clinical Assessment Service

CCG Clinical Commissioning Group

CCU Critical Care Unit

CEG Clinical Effectiveness group

CEPN Community Education Provider Network

CHP Community Health Partners

CIL Construction Industry Levy

CPD Continuing Professional Development

CQC Care Quality Commission

CQRM Clinical Quality Review Meeting

CQUINs Commissioning for Quality and Innovation (Payment Framework)

CSA Child sexual assault

CSU Commissioning Support Unit

CYP Children and Young People

DES Direct Enhanced Service

DoH/ DH Department of Health

DoPM Department of Psychological Medicine

DToC/ DToCs Delayed Transfers of Care

3


EBI Evidence Based Interventions

ED Emergency Department

ELFT East London Foundation Trust

ELHCP East London Health and Care Partnership

ELHCP ODG East London Health and Care Partnership Operational Delivery Group

EMIS web Egton Medical Information Systems (System that records patient consults)

EPCS Extended Primary Care Service

EPCT Extended Primary Care Team

EPR Electronic Patient Record

ETTF Estates and Technology Transformation Fund

FOI Freedom of Information

FRF Financial Recovery Fund

GB Governing Body

GIA Gross internal area

GLA Greater London Authority

GMC General Medical Council

GMS General Medical Services (a type of Primary care contract)

GP General Practitioner

HBPoS Health Based Places of Safety

HEE Health Education England

HLP Healthy London Partnership

HMT Her Majesty's Treasury

HUH The Homerton University Hospital NHS Foundation Trust

IAPT Increasing Access to Psychological Therapy

ICP Integrated care partnership

IG Information Governance

IMT Information Management and Technology

INEL Inner north east London

IPS Individual placement and support schemes

ITU Intensive Therapy Unit

IUC Integrated urgent care

JCC Joint Commissioning Committee

JSNA Joint Strategic Needs Assessment

KGH King George Hospital

KPI Key Performance Indicator

LAP Local Area Partnership

4


LAS London Ambulance Service

LAs Local Authorities

LBN London Borough of Newham

LBWF London Borough of Waltham Forest

LCFS Local Counter Fraud Specialist

LD SAF Learning Disability Self-Assessment Framework

LEB London Estates Board

LEDU London Estates Development Unit

LES Local enhanced service

LITA London Improvement and Transformation Architecture

LMC Local Medical Committee

LTP (NHS) Long Term Plan

MoLCV Medicines of limited clinical value

MOU Memorandum of Understanding

MPIG Minimum Practice Income Guarantee

MRET Marginal Rate Emergency Tariff or Threshold

NAFO Newham Alternative Funding Option

NCCG Newham Clinical Commissioning Group

NDPP National diabetes prevention programme

NEL North East London

NELCA North East London Commissioning Alliance

NELCSU North East London Commissioning Support Unit

NELFT North East London Foundation Trust

NHS PS NHS Property Services

NHSE NHS England

NHSI NHS Improvement

NICE National Institute of Health and Care Excellence

NUH Newham University Hospital

ONEL Outer north east London

OOH Out of hours

OPD Outpatient department

OPE One Public Estate

PALS Patient Advice and Liaison Service

PCCC Primary Care Commissioning Committee

PCT Primary Care Trusts

PHE Public Health England

5


PMS Personal Medical Services (a type of Primary care contract)

PoLCV Procedures of low clinical value

PolCE Procedures of low clinical effectiveness

PPE Patient and Public Engagement

PPG Patient and Public Group

PREM Patient Reported Experience Measure

PROM Patient Reported Outcome Measures

PSF Provider Sustainability Fund

PTL Patient Tracking List

QIPP Quality, Innovation, Productivity and Prevention

QOF Quality Outcome Framework (Assessor Validation Reports)

R&D Research & Development

RAG Red, Amber, Green

RAS Referral assessment service

RICS Royal Institute of Chartered Surveyors

RLH Royal London Hospital

ROI Return on Investment

RTT Referral to treatment

SDP Strategy Delivery Plan

SEP Strategic Estates Plan

SMI Severe mental illness

SMW Spending Money Wisely

SPA Single Point of Access

SRO Senior Responsible Officer

STP Sustainability and Transformation Plan or Partnership

6

NHS North East London Commissioning Alliance (City and Hackney, Newham, Tower Hamlets, Waltham Forest, Barking and Dagenham, Havering and Redbridge CCGs)

Voting Members

Name Title Name of organisation and nature of its business

Position Held/Nature of Interest

Type of Interest Date

Declared

Date

Updated Financial Non-financial

Professional

Non-Financial

Personal

Jane Milligan Accountable Officer –NELCA/NEL STP

NEL Commissioning Support Unit

Partner is employed substantively

X 2014 - Present

23 October 2019

NHS England Partner on secondment to Central London Community Healthcare as Director of Primary Care Development.

X April 2019 - present

Action For Stammering Children

Partner is a Trustee for Action for Stammering

Children

X Oct 2013 – Present

Stonewall Ambassador

(historical)

X Oct 2014 – September 2019

Peabody Housing Association Board

Non-Executive Director X Jan 2017 – Present

Date November 2019

Edited by Kate McFadden-Lewis, Board Secretary

Joint Commissioning Committee Register of Interests

7


Ken Aswani Chair –Chair Waltham Forest CCG

Allum medical centre

GP partner X 1990 – Present

11 September 2019

NEL RCGP faculty

Board member X 1995 – Present

CQC GP inspector X 2014 – Present

Clinical panel Member X 2015– Present

Member practice Fednet X 2014 – Present

WhippsX University Hospital Education and research fund

Trustee X May 2017 – Present

Muhammad Naqvi

Joint Chair JCC & Chair Newham CCG

Woodgrange Medical practice

GP partner X 2015-present 10 March 2019

Frenford clubs for young people (registered charity/ voluntary organisation)

Trustee X 2012-present

NHC - Newham GP Federation, Woodrange practice is a shareholder

GP partner X 2015-present

Novartis Clinical Mentor X 2018-present

Primary care APMS contract for GP caretaking – Dr Abiola’s practice

X March 2019-present

Anil Mehta Joint Chair JCC & Chair

Fullwell Cross Medical Centre

GP Partner X April 2013 – present

28 Feb 2019

8


Redbridge CCG

Metropolitan Police

Forensic examiner X November 2015 – present

The Cleaning Company

Sister-in-law is the owner

X 2013 – present

NHSE GP appraiser X February 2015 – present

Healthbridge Direct

Shareholder X September 2014 – present

Fouress Enterprises Ltd

Director X 2015 – present

Prescon Ad-hoc screening work X January 2018 – present

London Healthwise Ltd (non trading)

Director X 2009 - present

Sam Everington

Chair THCCG Bromley By Bow Partnership - based at the Bromley by Bow Centre Charity 1999

GP

X 1989-present 7 March 2019

Chair of Chairs London CCGs X 2018-present

East London Health Partnership (STP)

Clinical Lead

X 2011- present

Tower Hamlets health and wellbeing board

Deputy chair X 2016- present

BMA Council member and Vice President

X 1989- present

Queen Mary University of London.

Fellow and Honorary Professor

X 2014- present

9


Tower Hamlets CCG

Wife Linda Aldous is the practice nurse Board Member

X

Bromley by Bow partnership

Wife Linda Aldous is a Partner

X

MDDUS (insurance for the GP partnership)

As a GP partners member

X 2005- present

Queens Nursing Institute

Vice President X 2017- present

College of medicine

Vice President and Council member

X 2016- present

NHS property board

Board member X 2018- present

NHS resolution Associate Director July 2018- present

Atul Aggarwal

Chair Havering CCG

Maylands Healthcare

GP Partner X April 2013 – present

28 Feb 2019

Maylands Healthcare Ltd

Director and shareholder in

on-site pharmacy

X April 2013 – present

Parkview Dental Practice

Sister is NHS dentist within

Havering

X 1996 – present

Essex Medicare LLP

Part owner which owns

Westland Clinic,

Hornchurch. Space rented

out to Inhealth

(Diagnostic),Nuffield Health

(Brentwood), Communitas

Clinics (Dermatology &

X 2014– present

10


Gynaecology)

Havering Health Ltd.

Shareholder. X September 2014 – present

Barking, Dagenham and Havering LMC

Co-opted member 2013 – present

Westlands Clinic (Langton dental) have an outsourced contract with BHRUT for oral surgery.

Spouse is a dentist. X May 2018-present

Mark Rickets Joint Chair JCC and Chair C&H CCG

GP Confederation Nightingale Practice is a Member

X 8 November 2019

HENCEL I work as a GP appraiser in City and Hackney and Tower Hamlets for HENCEL

X

Health Systems Innovation Lab, School Health and Social Care, London South Bank University

Wife is a Visiting Fellow

X

Nightingale Practice (CCG Member Practice)

Salaried GP X

Jagan John

Chair, B&D CCG

King Edwards Medical Group

GP Partner X June 2010- present

28 Feb 2019

King Edwards Medical Group

Other GPs are family members

X June 2010-present

Proactive Care - Healthy London Partnerships NHS England

Clinical Lead X Mar 2017- present

11


North East London Foundation Trust - Barking & Dagenham Community Cardiology Service

GPWSI in Cardiology X Aug 2018- present

Together First Limited (GP Federation)

Practice is a Shareholder

X May 2014- present

Harley Fitzrovia Health Limited

Director and Shareholder

X Jan 2018- present

Monifieth Limited (Director and Shareholder)

X Mar 2018- present

Health 1000 Director

Prime Ministers Challenge Fund Lead BHR

X Dec 2014- Nov 2018

Kash Pandya Vice Chair JCC and Lay member B&D CCG

NHS Havering CCG

Lay member, Governance and Audit Chair

X 2013-19 26 June 2018

Redbridge CCG a Lay member governance and audit chair

X

University of Essex

Independent Audit Committee member

X 2013-19

Southend-on-Sea Borough Council


X 2016-18

Brentwood Citizen's Advice Bureau

General Advisor X 2009 – present

Accenture Son is employed as Legal Counsel

X 2015 – present

Historic - Hillcroft College for

Council member & honorary treasurer

X May 2017 – present

12


Women (Surbiton)

Historic - Health & Safety Executive


X May 2017 – present

Richard Coleman

Lay Member Havering CCG

BHR CCGs Brother-in-law is

Independent GP on the Primary Care

Commissioning Committee

X January 2017- present

13 March 2019

Price Waterhouse Cooper

Nephew is a partner X X August 2013 – present

Khalil Ali Lay Member Redbridge CCG

Dr Joseph GP practice, Collier Row

Family Doctor X April 2017 – present

13 March 2019

St Francis Hospice

Spouse is a regular donor


Cancer Research UK

Spouse is a regular donor


Sue Evans Lay Member C&H CCG

Loughton Youth Project (registered charity)

Trustee and Treasurer X October 2017 – Sept 2018

18 March 2019

Worshipful Company of Glass Sellers Charity Fund

Secretary to Trustees,

X October 2017 – present

St Aubyn’s School Charitable Trust/Limited Company

Trustee and Director


Essex Advisory Committee for Justices of the Peace

Lay Member

X October 2017 – July 2018

13


Barts Health Trust/BHRUT

Self and family are patients in the NELCA area.


Caroline White

Lay Member

WFCCG

Red Edge Communications Ltd - Communications/journalism/PR company

Director X 2015 - present

30 July 2019

BMJ P/T employment - Senior Media Relations Executive

X August 2017 - present

Freelance Medical Journalist

X Ongoing

Medical Journalists’ Association - Executive committee post to promote the interests of medical journalists

Co- vice chair X September 2017 - present

Women of Walthamstow

(WoWStow) - Local sexual health campaign group

Member

X 2011 - present

Linford Road, Wood Street

PPG member X 2017 - present

Labour Party Associate Member X 2015- present

Noah Curthoys

Lay Member THCCG

Bridgenor Group Ltd

Director & Owner

X June 2015 - current

11 July 2019

14


Northshott Consulting Ltd

Director & Owner

X March 2011- current

The Democratic Society (Belgian based NGO/charity)

Board member X July 2019 - current

The Democratic Society

Senior Partner X July 2016-June 2019

Phil Horwell Lay Member, Newham CCG

Deloitte Management consultant

X April 2019 - current

15


Non-Voting Members

Name Title Name of organisation and nature of its business

Position Held/Nature of Interest

Type of Interest Date Declared

Date Updated

Financial Non-financial Professional

Non-Financial Personal

Henry Black

CFO, NELCA BHRUT Wife works as Deputy Director of Income and Planning at BHRUT

X Feb 2018 - Present

12 November 2019

NHS Clinical Commissioners

Board member X 16 July 2018 - Present

East London Lift Accommodation Services Ltd

Director (historical) X Feb 2018 – 29 August 2019

East London Lift Accommodation Services No2 Ltd


East London Lift Holdco No2 Ltd






ELLAS No3 Ltd Director (historical) X Feb 2018 – 29 August 2019

ELLAS No4 Ltd Director (historical) X Feb 2018 – 29 August 2019

Infracare East London Ltd


Mark Tyson

Barking & Dagenham Local Authority

NIL

Mark Ansell

Havering Local Authority

NIL

16


Adrian Loades

Redbridge Local Authority

Redbridge Living, a company 100% owned by LB Redbridge to develop housing schemes within the Borough.

Director X October 2018 - present

29 April 2019

Ellie Ward City of London Corporation

NIL

Gareth Wall

Hackney Local Authority

NIL 21 July 2018

Heather Flinders

Waltham Forest Local Authority

NIL 30 September 2019

Colin Ansell

Newham Local Authority

Health and Care Space Newham

Director X May 2019-present

19 July 2019

Denise Radley

Tower Hamlets Local Authority

CACI Family member (Marc Radley) is a director of CACI (supplier of information and IT systems to public sector)


13 March 2019

Hertfordshire Partnership NHS Foundation Trust

Ordinary member X April 2016 – present

Fiona Smith

Chief Nurse, NELCA JCC

Director & co-owner

Honesta Partners Ltd, a LLP Healthcare Consultancy company

X 1 November 2018

Spouse is also a director

Honesta Partners Ltd, a LLP Healthcare Consultancy company

X

Registered Board Nurse

NHS Newham CCG X

Charlotte Harrison

Secondary Care Consultant, NELCA JCC

Consultant Psychiatrist and

South West London and St Georges MH NHS Trust

X May 2005 - present

13 March 2019

17


Deputy Medical Director

18

An alliance of North East London Clinical Commissioning Groups City and Hackney, Newham, Tower Hamlets, Waltham Forest, Barking and Dagenham, Havering and Redbridge CCGs

NEL Joint Commissioning Committee – part I

12.30-2.10pm Wednesday 13 November 2019

Committee Rooms, Unex Tower, 5 Station Street, Stratford, E15 1DA

Minutes

Present

Dr Atul Aggarwal Chair, NHS Havering CCG

Colin Ansell Local Authority Representative, Newham

Khalil Ali Lay Member, NHS Redbridge CCG

Dr Ken Aswani Chair, NHS Waltham Forest CCG

Henry Black Chief Finance Officer, NELCA

Richard Coleman Lay Member, NHS Havering CCG

Noah Curthoys Lay Member, NHS Tower Hamlets CCG

Sue Evans Lay Member, City & Hackney CCG

Phil Horwell Lay Member, Newham CCG

Dr Jagan John Chair, NHS Barking and Dagenham CCG

Dr Anil Mehta (Chair) Chair, NHS Redbridge CCG

Jane Milligan Accountable Officer, NELCA

Dr Muhammad Naqvi Chair, NHS Newham CCG

Kash Pandya Lay Member, NHS Barking and Dagenham CCG

Dr Mark Rickets Chair, NHS City & Hackney CCG

Gareth Wall Local Authority Representative, Hackney

Caroline White Lay Member, NHS Waltham Forest CCG

In attendance

Les Borrett Director of Strategic Commissioning, NELCA

Steve Collins (item 4.1) Executive Director of Finance, WEL CCGs

Alastair Finney (item 4.1) Whipps Cross Redevelopment Director

Tracey Fletcher (item 3.1) Chief Executive, Homerton University Hospital NHS Foundation Trust

John Flood NEL CSU

Kate McFadden-Lewis (minutes) Board Secretary, NELCA

Frances O’Callaghan

(items 1 - 4.1)

Director, Strategic Implementation and Partnership, Homerton University

Hospital NHS Foundation Trust

Dylan Jones (item 3.1) Chief Operating Officer, Homerton University Hospital NHS Foundation

Trust

Denise Tyrrell (item 4.2) Programme Director NCL CCGs, Moorfields Consultation

Apologies

Matthew Cole Local Authority Representative, Barking and Dagenham

Professor Sir Sam Everington Chair, NHS Tower Hamlets CCG

Heather Flinders Local Authority Representative, Waltham Forest

Charlotte Harrison Secondary Care Consultant, NELCA

Adrian Loades Local Authority Representative, Redbridge

Denise Radley Local Authority Representative, Tower Hamlets

Fiona Smith Chief Nurse, NELCA

19


No. Item

1.1 Welcome, introductions, apologies

Dr Anil Mehta welcomed attendees to the meeting, and apologies for absence were noted as above.

There were no declarations of interest on the agenda items, however Mark Rickets noted that his

declarations had recently changed and will be updated for the next meeting.

1.2 Minutes of the last meeting and matters arising

The minutes of the last meeting were accepted as an accurate record, and all actions are complete or in

progress.

2.1 Questions from the public

Question from Shujah Hamid, Integrated Heathcare Manager, North London Region, Thornton &

Ross Ltd:

In the fast changing NHS and the NHS Long Term Plan being towards the creation of a North East

London ICS - Integrated Care System, will the existing/future clinical treatment guidelines be shared

across a single ICS structure?

Currently there is variation in clinical guidance from one CCG area to another…

Answer:

As part of developing an integrated care system for north east London we are considering at what a

streamlined commissioning function would look like. If we move towards a single commissioning

structure across north east London, then we will need to ensure that we align our policies across this

footprint to ensure consistency for our residents. There is a NEL Clinical Senate meeting in place where

the clinical guidelines across the patch are often discussed.

Question from Meenakshi Sharma, BHR resident:

Despite having four pages of acronyms at the beginning of the NELCA November report, the meaning of

acronyms FRF, PSF, MRET, and AfC, are not given, making understanding of appendices 1 and 2 on

pages 102-108 even more impossible for the layperson. Is this a deliberate attempt to avoid scrutiny

and, if not, can the essential meaning of the tables be clarified?

Answer:

The list of acronyms is a by no means exhaustive list of commonly used acronyms in the NHS and by

our organisations, and is continually reviewed. It is additionally common practice to spell out any

acronyms in papers the first time they are used. On this occasion Financial Recovery Fund (FRF) and

Provider Sustainability Fund (PSF) were both spelled out in the accompanying letter. Apologies that

Marginal Rate Emergency Tariff (MRET) and Agenda for Change (AfC) were not. These will all be added

to the next iteration of the Acronyms list, many thanks for your feedback.

This is not a deliberate attempt to mislead people or avid scrutiny - we will pick up and explain when we

come to the item.

Question from Andy Walker, BHR resident (submitted on the day):

Does this committee agree that the principle of transparency outlined in the Francis report means that

BHRUT should disclose:

1) What the purpose of £9m for additional capital funding be disclosed?

&

2) Produce type 1 A&E stats for King George and Queens?

Answer:

1) the £9m for BHRUT is not additional capital funding, it is a loan from the Department of Health.

Michael Gilham, Deputy Director of Finance, BHRUT has said:

20


“We’re delighted to have received this loan funding, which will be spent on modernising and improving

our hospitals for our patients and staff.

It will allow us to replace and upgrade medical equipment, instruments for our theatres, as well as

provide more up-to-date birthing pools and beds for our Maternity department. We will also be

undertaking essential maintenance work particularly at King George Hospital

The money will also support the first phase of our IT strategy. This will see us modernising and

upgrading our IT system, putting in place a platform for future opportunities using digital technology to

improve our patients’ care and experience.”

2) A&E reporting for BHRUT is in line with national reporting requirements. At this point in time, BHRUT

will not be publishing data broken down into type 1 and 2, by site, although overall four hour emergency

standard data is on the Trust’s website (https://www.bhrhospitals.nhs.uk/our-performance), and is

broken down by site, and NHS England data is broken down by type. Data that has not yet been

published by NHS England cannot be provided.

3.1 Homerton University Hospital - update

Frances O’Callaghan, Tracey Fletcher and Dylan Jones joined the meeting and presented on three

strategic initiatives that the trust is working on: surgery, integration and pathology. In discussion the

Committee noted:

i. the effective primary care in City and Hackney, which helps to reduce the demand on A&E, and

the need to extend this learning across NEL

ii. the STP as an enabler to joint working across the NEL system, bringing together the five

provider Chief Executives, building relationships, and ensuring that the integration work can

happen at every level

iii. the potential for a NEL-wide solution to the workforce retention issue, such as the pathology hub

model, providing a career path by enabling training and promotion within the trust.

3.2 Specialised Commissioning – A Case for Change

Les Borrett presented on the changing arrangements for NHS England and local system management

of specialised commissioning in the future. Discussion points included:

i. that in the move to the NEL ICS, there is a need for a population health management approach

to the whole spectrum of health within the ICS

ii. the need to ensure a co-creation approach to this for NEL, working closely with patient groups

iii. the opportunity to transform and improve services across NEL

iv. the considerable financial risks and the need to ensure robust risk management of these

v. the plans for a provider-based collaborative board across the STP, which will oversee the

development of the framework for delegation of commissioning to the NEL ICS.

The Committee supported the proposals and direction of travel.

4.1 Whipps Cross redevelopment programme update

Steve Collins and Alastair Finney joined the meeting to update on progress on the Whipps Cross

redevelopment programme, highlighting the Government’s recent funding commitment to deliver a

brand new hospital, subject to business case approvals. The strategic outline case is scheduled to be

considered by the JCC early in the new year. In discussion the Committee noted:

i. the extensive clinical input, from across the system, into the design of the programme, and the

integrated care approach to the design, ensuring alignment with the local system

ii. the importance of continued communication and engagement with all stakeholders throughout

this process, particularly with the further development of ICSs, and the need to ensure that the

Whipps Cross health and care services strategy aligns with the wider NEL strategy

iii. the ambitious timescale of delivery by 2025, and therefore the need to revise the programme

plan

21

https://www.bhrhospitals.nhs.uk/our-performance


iv. the vision for the hospital as a local health and social care facility, with enhanced triage services

including specialist opinion as early as possible in the urgent care pathway

v. the design principle for the new hospital to be ‘excellent’ in terms of environmental sustainability

vi. that further funding streams will be sought, in addition to the share of the £2.7billion for six major

hospital rebuilds, to invest in the redevelopment.

4.2 Moorfields Consultation - update

Les Borrett and Denise Tyrrell updated the Committee on the progress on the formal public consultation

proposal to relocate Moorfields Eye Hospital from its site in City Road, Islington to St Pancras. Key

discussion points included:

i. the patient engagement work has identified the main areas of concern are around access to the

site from St Pancras/ King’s Cross compared to Old Street station. Once the consultation has

concluded, and if the move is confirmed to go ahead, the detailed work around the measures

that will be put in place to address these concerns

ii. a reminder that this consultation relates solely to the Moorfields City Road site relocation to St

Pancras; there are no proposed changes to the services provided at the other sites

iii. the extensive work that has been undertaken around the demand and capacity for

ophthalmology, which has fed into these plans

iv. there was a discussion around educational programmes on eye health for the public, providers

and GPs. It was agreed that this should be discussed in more detail at the NEL clinical senate

(ACTION: MN/ SH)

5.1 Performance report – month 5

David Flood presented on the month 5 performance across the STP area, highlighting that A&E

performance remains the most challenging area, the focus on 52 week waits across the patch, and that

the NEL winter plan has now been agreed. Key discussion points included:

i. the potential for extra resource for winter is being considered with NHS England and

Improvement

ii. that work continues on streamlining, and ensuring that all of the alternative urgent care

pathways in NEL are utilised, following the recently held ‘perfect day’ where these were tested

iii. the move away from financial penalties for poor performance, towards a focus on working

collaboratively to resolve.

6.1 Changes to the System Financial Framework: Financial Improvement Trajectories and Indicative

Financial Recovery Allocations

Henry Black presented on the changes to the system financial framework over the next four years from

2020/21, with particular focus on the introduction of Financial Improvement Trajectories, which have

been set out by NHS England and Improvement in the NHS Long Term Plan.

The Committee noted.

7.1 NEL JCC approach to risk management

Kash Pandya presented on the plans in place to refresh and strengthen the risk management

arrangements in preparation for NEL 2021.

The JCC risk group have recommended a shadow approach to risk management across NEL for April

2020. In preparation for this, it is proposed that a JCC Development session on the approach to risk

management is held in December. The Committee agreed the proposals.

8.1 Meeting planner: noted.

9 Any other business: none.

Date of next meeting: 12.30-2.30pm Wednesday 13 November 2019

22

ReferenceMeeting

date

Minute

referenceAction Owner

Target completion

dateComment

JCC - 24 10/07/2019 4.2

Better Care Fund next update to include:

• comparative performance across the key BCF indicators and initiatives

• sharing of good practice across the patch, such as personal health budgets, continuing healthcare and

winter planning.

Les Borrett Mar-20 In progress - on the meeting planner.

JCC - 26 10/07/2019 6.1

Risk Register:

• Ensure the national pensions issue, and the impact on capacity in primary care and workforce

retention, is addressed on the risk register.

• Include the progress being made on the BHR recovery plan as a mitigation on the financial risk, S3.

Kash Pandya/ Kate

McFadden-LewisApr-20 In progress - on the meeting planner.

JCC - 28 13/11/2019 4.2Discuss educational programmes on eye health for the public, providers and GPs, at the NEL clinical

senate.

Simon Hall/

Muhammad Naqvi May-20

NEL JCC action log 08/01/20

Highlighted items represent a recommendation to remove from register

23

Joint Commissioning Committee

8 January 2020

Title of report Medicines Optimisation and Pharmacy Transformation

Item number 3.1

Author Moira Coughlan

Presented by Moira Coughlan, Programme Director for Medicines Optimisation and Pharmacy Transformation, SRO for Antimicrobial Resistance

Contact for further information [email protected]

Executive summary This is an update on the progress and priorities of the ELHCP Medicines Optimisation Steering Group. A number of work streams are making good progress at a borough and system level but some new programmes are being developed in line with the response to the Long Term Plan. These include workforce, gram negative blood stream infections and a NEL one policy/ formulary group.

Action required Recommendation:

1. The JCC recognises the breadth of work the MO group aredelivering and ensure we are linked in to relevant programmes as they develop. In particular we ask that commissioners consider how physical and mental health are integrated and how pharmacists can support that agenda eg. as in the ELFT Community Transformation Programme

2. The JCC supports the pharmacy workforce developmentagenda by identifying opportunities to support recruitment andretention of primary care network pharmacists. This includesidentifying how new models such as cross sector rotationalposts (including general practice) can be supported

3. The JCC supports the National Action Plan for AntimicrobialResistance by ensuring best practice is incorporated incommissioned services. We ask you to consider how qualityimprovement programmes and clinical leadership in yourorganisations can support this

4. The JCC supports clinicians to implement cost effectivemedicines interventions including biosimilars and the nationalconsultations on deprescribing medicines of limited value.These require appropriate patient consultation and support forclinicians implementing the change programme

5. The JCC support a review of the management of shared careto enable better patient pathways, appropriate governancesystems and processes for prescribers and optimise use ofspecialist clinic time.

Where else has this paper been discussed?

Clinical Senate - 11 December 2019

Strategic fit

Commissioning implications

Many of the work streams highlighted in this document require engagement with health and social partners including community pharmacists and local authority. As outlined in the recommendations we ask that medicines optimisation services, pharmacists and

24


Local authority/integratedcommissioning implications

infection prevention and control processes are considered in commissioned services and at the interface between commissioned services.

What does this mean for local people?

Developing the pharmacy workforce and technology will improve access for patients to a recognised qualified medicines expert.

How does this drive change and reduce health inequalities (unwarranted variation)

Developing consistent medicines pathways and policies should reduce inequity in access. The National Action Plan for antimicrobial resistance aims to reduce the infection rates and reduce the risk of resistance to antibiotics.

Impact on finance, performance and quality

Many of the medicines optimisation work streams impact on finance expenditure and savings plans. Managing antimicrobial resistance is a critical quality programme.

Risks There are three over arching priorities for this Steering Group. Workforce development, Antimicrobial resistance and a NEL one formulary/ pathway/ policy group. We will develop risk registers and escalate through organisational and ELHCP/ NELCA processes as appropriate.

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Moira Coughlan 22/12/19

STP JCC

Introduction

This report is an update on the progress of the existing work streams managed by the ELHCP MO Steering Group and the plans to develop new working groups to address the new priorities. It is also early notice of the need for increased focus across all health and social care organisations in NEL to address antimicrobial resistance (AMR); in particular Gram Negative Blood Stream Infections (GNBI).

An earlier version of this paper was presented to Clinical Senate 11th December 2019. There was support for:

1. Development of an Antimicrobial Resistance GNBI subgroup to agree the mosteffective interventions, share best practice and develop a work plan to meet thetargets in the National Action Plan. There has been limited engagement by someorganisations in the Antimicrobial Medicines Optimisation and Stewardship group.Clinical Senate members agreed to support engagement in their organisations, at theinterface and across local authority as this requires wider system interventions.

2. Identifying the medicines pathways and policies which should be agreed at a NELlevel. This links with the ambition to have one formulary across NEL but recognisesthere are greater gains to be made in addressing variation in pathways in a fewtherapeutic areas eg rheumatology initially.

3. Endorsement to develop a NEL biologics pathway for rheumatology. This will beclinically reviewed by the ELHCP MO Steering Group and Clinical Senate andapproved at JCC. It will include a review of the financial implications as there areelements of both savings and cost pressures.

4. Development of the pharmacy work force recognising the value of a wider systemoffer to provide professional leadership and support professional development. Weneed to consider the impact of PCN pharmacists on pharmacists and pharmacytechnician roles in other services including community pharmacy and acute trusts aspharmacists may move across sectors. We recognise the need to influencerecruitment and retention across NEL.

Recommendation:

1. The JCC recognises the breadth of work the MO group are delivering and ensure weare linked in to relevant programmes as they develop. In particular we ask thatcommissioners consider how physical and mental health are integrated and howpharmacists can support that agenda eg. as in the ELFT Community TransformationProgramme.

2. The JCC supports the pharmacy workforce development agenda by identifyingopportunities to support recruitment and retention of primary care networkpharmacists. This includes identifying how new models such as cross sectorrotational posts (including general practice) can be supported.

3. The JCC supports the National Action Plan for Antimicrobial Resistance by ensuringbest practice is incorporated in commissioned services. We ask you to consider howquality improvement programmes and clinical leadership in your organisations cansupport this.

4. The JCC supports clinicians to implement cost effective medicines interventionsincluding biosimilars and the national consultations on deprescribing medicines oflimited value. These require appropriate patient consultation and support forclinicians implementing the change programme.

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5. The JCC support a review of the management of shared care to enable better patientpathways, appropriate governance systems and processes for prescribers andoptimise use of specialist clinic time.

Medicines Optimisation summary

The ELHCP MO Steering Group consists of chief pharmacists from the Acute Trusts, mental health Trusts and CCGs across NEL and is chaired by GP Dr Anwar Khan. The group has developed a number of work streams based on principles of improving medicines optimisation in pathways, improving patient outcomes and avoiding duplication and variation in prescribing practice. The shared experience and expertise as well as STP support has enabled some of these work streams to gain traction more easily.

1. Discharge to Pharmacy

This is a programme to facilitate an e referral from an Acute Trust pharmacist to a primary care pharmacist to support patients with a high need for medicines support post discharge. This programme is also nationally referred to as Transfer of Care Around Medicines (TCAM). In recent months the AHSN (UCLP) has been able to provide some support to existing business cases eg supporting training for pharmacists. The programme is being developed in the three local systems at a different pace. It was initially piloted between Waltham Forest and Whipps Cross Hospital and Newham have implemented since November. Tower Hamlets/ Royal London and the Homerton are rolling out in Q4. BHRCCG is currently working through their business case.

2. Care Homes pharmacists.

Pharmacists (2.8 wte) and a (0.4 wte) pharmacist technician are working as part of the Medicines Optimisation in Care Homes pilot in Havering and Waltham Forest CCGs. They are focusing on medicines optimisation reviews, improving patient adherence, safe storage of medicines policies and reducing medicines waste.

There have been a number of operational challenges including ensuring the pharmacists had access to the necessary IT to deliver the role. This is a 2 year programme due to report in December 2020. However, the experience and lessons will inform the expansion of the role in other care homes across the ICS sooner as it is important this work is integrated into the pcn structures as they start to evolve now.

3. Best value medicines

This is part of a national programme to ensure medicines of best value are commissioned and available to patients. It also incorporates deprescribing medicines of limited value.

Biosimilar biologics

Biosimilar biological medicines offered significant savings in Acute Trust medicines in recent years (for CCG, NHSE and hospital spend). Following support from Clinical Senate and national procurement and contracting frameworks these are being offered to patients across NEL. Barts Health is currently an outlier but under the leadership of the Medical Director

27


and Chief Pharmacist they are developing an action plan to address this and increase savings. The latest plan indicates there should be a significant change in the prescribing pattern in February.

Medicines of Limited Value

A national group identified a number of medicines considered to be of limited value. Following local consultation, organisations across NEL approved a list for implementation. The group has shared tools and pathways to support implementing the guidance.

The Steering group reviews the current prescribing practice to identify any unwarranted variation. We accept there is still some prescribing in place due to patient choice and difficulties in finding suitable alternatives. Some of the items are also disproportionately high cost per patient due to market forces.

One of the challenges is ensuring that all prescribers consistently follow the recommendation.

Flash glucose monitoring/ Freestyle libre

This is a glucose monitoring system which measures glucose levels continuously throughout the day. NHSE will fund CCGs for upto 20% of the Type 1 diabetes population for 2 years from April 2019. The device is started by specialists in the Acute Trusts and once patients are stabilised the prescribing and cost is picked up in primary care. All local organisations are offering the device to patients according to the NHSE guidelines, these were an update from the Regional Medicines Optimisation Group guidelines in 2017. The data indicates there is some variation in uptake across the NEL CCGs. The group are reviewing this to understand the reasons.

4. One Hospital Only List/ Formulary/ Policy/ Shared Care Guidelines

Barts Health are managing the latest review of the NEL wide Hospital Only List. There are two other related projects; shared care guidelines (SCG) and a one formulary/ policy group. There is variation in some of the medicines classified as suitable for shared care across the different organisations. Shared Care Guidelines are an important technical document for supporting patients prescribed specialist sometimes high risk medicines, being managed by the general practice whilst under the expertise of a specialist in the Acute Trust. The complexities often arise due to limitations in capacity in general practice to take on the additional work and differences in commissioned pathways. Where a practice is unable to take on shared care the impact of this is that a patient has to continue to attend the hospital for their ongoing prescriptions and incur hospital tariff.

This is a complex problem and will need a separate task and finish working group to identify a more acceptable model.

5. Workforce

The recruitment of pharmacists in primary care provides an opportunity to improve patient outcomes through medicines optimisation, support the development and progression of the pharmacy profession and support integration through whole system working. Pharmacy workforce development was an early working group of the MO Steering Group. The remit of this group is being reviewed and will be part of the primary care development workforce governance as we expect some of the outputs to be transferable.

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Antimicrobial resistance

The ELHCP Antimicrobial Resistance Strategy Group (AMRSG) has been operating since 2016 and is considered an exemplar across London with active representation from health and social care in ELHCP. The group provides clinical leadership and facilitates collaboration for appropriate antimicrobial stewardship. It has had a number of successes to date including:

Co-ordinated and systematic awareness campaign maintained throughout the year Antibiotic prescribing review tool to support general practice prescribing and facilitation

by prescribing advisers to share learning. NEL Management of Infection Guidance for Primary Care Care Home Resources: UTI Assessment Tool and Hydration Guidance for Care Home

Staff Reductions in primary care prescribing – see Appendices 1 and 2 for reduction in

volume and change in choice of antibiotic.

In July 2019 NHSE/I required all STPs to appoint an SRO to deliver the wider Antimicrobial Resistance programme. This is extending the focus from the antimicrobial medicines optimisation and stewardship agenda incorporated in the AMRSG above to incorporate accountability for sepsis, GNBI and ensuring appropriate diagnostics, at an ELHCP level. All healthcare organisations have a Director of Infection Prevention and Control and organisational work plans. The next step is to establish a working group to develop a strategy to address these issues across the wider system and share best practice.

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Appendix 1

30


Appendix 2

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8 January 2020

Title of report The NHS Long Term Plan. Our response and how we deliver on our commitments

Item number 3.2

Author Mark Scott, Deputy Director of Transformation PMO, ELHCP

Presented by Simon Hall, Director of Transformation, ELHCP


Executive summary We submitted a response to NHSE/I on the Long Term Plan on 15 November 2019, which is available on this web link https://www.eastlondonhcp.nhs.uk/ourplans/. In line with feedback from partners, we also produced a short, public facing version of the response, which is attached with this pack.

As we move into implementing the plan, we have developed a delivery report as part of this pack. This report sets out the high-level governance for implementing the plan and provides a short progress report based across four thematic priority areas:

1. Improving population health2. System change and integration3. Priority areas for improving outcomes4. Enablers supporting work programmes

Our submission on 15 November 2019 contained a finance and metrics submission as well as an overall narrative. We are in discussions with NHSE/I about bridging the finance triangulation gap, which will be taken forwards as part of the system operating planning for 2020/21. We are to begin actively monitoring LTP metric trajectories, and have included an update on planned trajectories in the pack for information, split across the four priority areas. It is proposed to develop a short summary bi-monthly report on delivery against LTP metrics, reporting by exception for metrics where there is variance against plan.

Action required The Committee is asked to note this update and the commitments we have made in the LTP summary document.


We will be providing a presentation on the Long Term Plan and our commitments in the plan to CCG Governing Bodies, Trust Boards, Borough Partnership Boards and Health and Wellbeing Boards during January and February.

We will also be providing an update at the INEL/ONEL Joint Scrutiny Committee on 8 February.

The short, public-facing version of the LTP response will be published week commencing 13 January, following approval by the STP Executive on 9 January.

Strategic fit

Commissioningimplications

Local authority/integrated

Much of the work to implement the plan will be taken forward at system level, and there is currently a mapping exercise, led by systems and supported by the ELHCP team, which will inform how programme information is collated and reported.

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commissioning implications


Transformation and improvement of local services.


Delivery of the NHS Long Term Plan will support collaboration across the NEL work streams and between work streams and local systems, and support consistency across the patch.


Successful implementation of the LTP response should have a positive impact on finance, performance and quality.

Risks The two main areas of risk for LTP implementation are finance and workforce.

Finance will be addressed via the 2020/21 system operating planning processes.

A detailed review on workforce will be scrutinised at the March 2020 ELHCP executive meeting, to ensure the proportionate level of oversight is given to this key enabler.

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The NHS Long Term Plan

Our response and how we plan to deliver on our

commitments

January 2020

Simon Hall

Director of Transformation

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Our governance (at high level)

Bringing together the way we work at a north east London level

Partnership

Board Clinical Senate

STP

Executive

Provider

Collaboration

Forums

Acute

Mental Health

Primary Care

Our 3 Systems:

C&H, WEL & BHR

Finance Forum (ODG)

Improving population

health

Priority areas for

improving outcomes

System change and

integration

Programmes

Enablers

NHSE/I London

London Councils

NHSE/I

National

35

Programmes of work

Improving Population Health

• Prevention

• Health inequalities

• Wider determinants ofhealth e.g. housing,poverty

• Personalised care

System Change And Integration

• Primary/community care

• Urgent and emergencycare

• Improving planned careand outpatients

• Provider collaboration

• Mental health

Priority Areas for Improving Outcomes

• Cancer

• Learning disabilitiesand autism

• Children and youngpeople

• Maternity

• Medicines optimisation

• Major LTCs

• End of life care

Enablers Supporting Work Programmes

• Workforce

• Digital

• Estates

• Demand and capacity –business intelligence

• Research and innovation

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Improving population health

Population HealthDeveloping an ELHCP approach to population health will be a priority during 2020, with the following activities planned:

• An in-depth review into how we can strategically influence the development of new infrastructure,

particularly around areas of significant re-generation, to maximise the population health impact.

This will be brought through our ELHCP forums in January, with an STP Executive discussion

planned for February

• A review and re-launch of our prevention work stream through a workshop with Directors of Public

Health during January

• We will be bringing a proposed outline approach to population health to the STP Executive in

March, taking into account best practice from national and regional work. There is also a planned

engagement event in June, at which prevention and population health will be a headline topic.

Personalisation

• A review is currently underway to align the personal health budgets (PHBs) and social prescribingelements of the programme more closely. This will result in a new personalisation group acrossELHCP from February, and there will be an event in March. We have also secured a resourcefrom NHSE/I to assist us with this alignment going forward

• A specific programme to improve the take up of PHBs in the BHR system will go live duringJanuary 2020, and it is hoped to extend learning from this initiative (with NELFT) at our stakeholderevent

• We propose an in-depth review of the personalisation programme at the April STP Executive.

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System change and integration

Primary and Community Care Developed 48 Primary Care Networks (PCNs) across NEL Support by targeted organisational development and transformation funding Digital accelerator programme for WEL system established, as well as training hub

board for PCN workforce.

Improving Planned Care and Outpatients Range of improvement actions being implemented Performance vs constitutional standards (RTT/Diagnostics) challenged at BH &

BHRUT.

Urgent and Emergency Care Current focus on managing winter pressures through funded support initiatives Ensuring grip during winter through VIPER meetings and following activities: working to

right time/right place by digital assessment, bookings & communications, expandingappropriate care pathways criteria and further UEC integration testing.

Mental Health Good progress developing LTP for mental health and transformation plans via funding

Challenges persist in achieving IAPT trajectories, CYP, out of area placements and

perinatal access across parts of NEL.

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Better start in life

Mature local maternity system meeting national trajectories; no current midwifery vacancies

Plans for ongoing CPD via cross-site rotational programmes to further support retention

Review current/future activity across sites to develop sustainable maternity/neonatal service

Children/young people’s programme managing transitions into adult services priority for 2020 together

with developing personalised care.

Living well and long term conditions management

Cancer focusing on smooth transition to new north east London operating model, but will need to

ensure performance metrics return to trajectory during Q4

Diabetes transformation funds successfully utilised, diabetes dashboard showing improvements

across NEL on key metrics

Cardiovascular prevention group in development, to share learning and support systems to prepare

for STP-level transformation funding

Medicines optimisation supported many transformation projects and plans greater links with primary

care networks to enhance recruitment/retention of pharmacy workforce in PCNs.

A better end to life

Local hospices to receive non-recurrent allocation of £875k to improve adults/children's end of life

services

ELHCP match-funding bid for children’s end of life care made to NHS E/I (awaiting outcome).

Priority areas for improving outcomes

39

Workforce, Digital and Estates: ELHCP has well developed enabler programmes, with

delivery across a range of initiatives. Main areas to highlight are:

Digital: maximising impact of ‘One London’ investment will be priority area, as well as

preparing organisations for introducing Patient Held Records

Estates: introducing infrastructure plan and phased capital pipeline key priorities. Also

ensuring development of health promoting environments at forefront of strategic planning

approaches for NEL “new town” developments

Workforce: excellent progress implementing initiatives with stakeholders but scale of the

recruitment and retention challenges remain significant with detailed STP Executive review in

March 2019 and consideration to be given on how support and progress can be monitored

on an ongoing basis given the importance of this enabler programme.

Demand and Capacity – Business Intelligence

Strategic planning currently happening individually by providers, and the Provider

Collaboration forums have identified that there is a gap at system level

A demand and capacity mapping across all of NEL has been agreed, commencing in

January 2020 initially focusing on acute services and taking into account population growth

projections for the next 10-20 years

This mapping will be expanded to mental health and community services over the next few

months.

Enablers supporting work programmes

40

Metrics Reporting

Outline of metrics by programme area

The metrics are currently based on planned trajectories, existing

baseline monitoring and tracking to begin in early 2020

41

Improving Population Health: funding and metrics

Ref Measure Area Target Compliant

EN1 Personal health budgets PHB Varies by CCG Y

EN3 Personalised care and support planning PHB Varies by CCG Y

EN2 Social prescribing referrals Social Prescribing Varies by CCG N

Enablers supporting work programmes: metrics

Ref Measure Area Target Compliant

ED21 Cybersecurity Digital 100% by Y5 Y

42

System change and integration:Primary care and acute services metrics

Ref. Measure Area Target Compliant

ED16 Proportion population with access to online consultations Pcare 75% Y

ED20 Proportion population registered to use NHSApp Pcare 30% Y

EK3 Learning Disability Registers/Annual Health Checks by GPs Pcare 75% Y


EM23 Ambulance Conveyance to ED Acute TBC N/A

EM24 Delayed Transfers of Care Acute National Level Y

EM25 Length of stay for patients in hospital for over 21 days Acute TBC Y

EM16Mental Health Liaison in general hospitals meet “core 24”

service standardAcute 70% in 23/24 Y

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System change and integration: Mental health metrics


EA3 IAPT roll-out MH 50% N

EH9 Access Children/Young People’s Mental Health Services MH Varies by CCG Y

EH12 Inappropriate adult mental health Out of Area bed days MH 0 from 2021/22 Y

EH13 Annual physical health check in severe mental illness MH 60% Y

EH15 Women accessing specialist perinatal mental health service MH TBC Y

EK1a Inpatient care learning disability/autism: CCG commissioned MH <30 Y

EK1bInpatient care learning disability/autism: Sp Com

commissionedMH <30 Y

EK1cInpatient care learning disability/autism: CCGs/NHS England

for childrenMH 15 children <30 Y

EH17 People accessing Individual Placement and Support MH TBC Y

EH18 EIP Services achieving Level 3 NICE concordance MH 95% by 23/24 Y

EH19People receiving new models integrated primary/community

care for severe mental illnessMH Varies by CCG Y

EH20 24/7 crisis provision for children and young people MH 100% by 23/24 Y

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Priority areas for improving outcomes: Metrics


ES1 Patients directly admitted to stroke unit within 4 hours Acute 80% 23/24 Y

ES2 Applicable stroke patients are assessed at 6 months Acute >60% 23/24 N

ER1 People supported by NHS Diabetes Prevention Programme Diabetes Varies by CCG Y

EP1 One Year Survival from Cancer Cancer Set by CA Y

EP2 Proportion of cancers diagnosed at stages 1 or 2 Cancer Set by CA Y

EQ1 Still birth rate LMS TBC Y

EQ2 Neo-natal mortality rate LMS TBC Y

EQ3Percentage of women placed on a maternity continuity of care

pathwayLMS TBC Y

EQ Brain Injury Rate LMS Undefined Y

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8 January 2020

Title of report Month 7 Performance Report

Item number 4.1

Author Archna Mathur, Director of Performance & Assurance, NELCA

Presented by Archna Mathur, Director of Performance & Assurance, NELCA

Contact for further information

Archna Mathur, Director of Performance & Assurance, NELCA

Executive summary The paper outlines the performance headlines as at M7 201920 (or latest position where available). Key points for JCC to note:

NEL STP level risks to delivery against NHS Constitutional standards for October (M7)

A&E Performance at Barts Health NHS Trust and BHRUT RTT performance, waiting list size and position on > 52 week

waits: Barts Health 15 (vs 13 plan) BHRUT 15 (vs 16 plan)

Diagnostics performance at Barts Health 1.82% vs < 1% standard(both BHRUT and Homerton are compliant)

Cancer performance at BHRUT 2 week wait: 86.17% vs 93% standard (improvement from

September) 62 day: 75.95% vs 85% standard (deterioration from

September)To note that work to contract for insourcing capacity across NEL for endoscopy as priority action.

NEL STP level risks to delivery of non-constitutional standard operating plan metrics:

30 minute ambulance handovers: ELHCP 83.3%, 108 x 60 minbreaches at Queens, and increasing 60 min breaches at WhippsCross.

Length of stay over 21 days for ELHCP with 412 patients waiting> 21 days vs 333 trajectory with both Barts Health and BHRUTunderperforming vs trajectory and more stretching trajectoriestowards March. ECIST support currently at RLH and due to moveto Queens in 6 weeks. C70% internal vs 30% internal delays.

NHS 111 performance for calls answered within 60s was 72.4%vs 95% standard. Whilst performance against call abandonmentwas complaint at < 4% overall, the last month has seen a severedeterioration. Work to reduce in hours demand on the 111 CAShas commenced to ensure in hour primary care is first port of callfor “contact GP” dispositions.

46


Offer of Personal Health Budgets was non compliant in all CCGsapart from Tower Hamlets. The BHR Q2 aggregate performancewas 153 vs 512 target.

Re primary care, BHR CCGs underperforming vs 75% ofpopulation to have access to online consultations. WEL and C&Hachieved this target.

NEL STP level compliant performance: Early Intervention psychosis waiting times Estimated Dementia diagnosis rate IAPT Access and recovery Adults with learning disabilities in receipt of inpatient care

Action required The JCC is asked to note this report.


This paper has been discussed at the NELCA SMT meeting on the 17 December 2019

Strategic fit


Local authority/integratedcommissioningimplications

Commissioning Implications:

Underperformance against constitutional standards creates a case for change in the way in which services are commissioned and how both elective and non elective demand is planned and managed by local integrated care partnerships.

Local Authority/integrated commissioning implications:

As above with implications specifically for integrated commissioning around urgent care, reducing lengths of stay, commissioning of care home capacity for example.


Local people will be aware of how services that are commissioned to meet their needs around quality, safety and access perform, and the processes in place to provide assurance


The performance report highlights national standard performance which means that all services across England are measured in the same way for equitable delivery.


The performance report highlights where increases in activity could be driving commissioning costs e.g. A&E attendances or unplanned admissions, with the consequence of under performance against a national standard. If a performance standard is not delivered, this could impact on patient quality e.g. waiting times for outpatient appointments or planned surgery, resulting in the need to ensure processes are in place gain assurance on patient safety and minimising the risk of clinical harm. Equally, if performance standards are met, then the impact on patient outcomes will be seen e.g. delivery of the 62 day cancer standard driving improving early diagnosis and one year survival.

Risks Current risks are insufficient improvement to consistently deliver 18 weeks, reduction in over 52 week waiters, A&E standards, diagnostic access times and consistent delivery of Mental health standards

47

Executive Summary

Sustained Improvement(>3months)

Recent Improvement Areas of Particular Concern Issues

The following metrics remained on track with sustained achievement of targets across NEL STP for three months or longer.

• Mental Health IAPT WaitingTimes and Recovery

• Mental Health Dementia• MH EIP waiting times

Metrics which showed an improvement or maintained good performance

• Minor breaches: Oct-19 sustainedsimilar performance to previous monthwith 99.3% for NEL STP. Improvedperformance at Barts Health (99.2%)driven by an improvement in UCCperformance at Whipps Cross and RLH.BHRUT reported 48 breaches in Oct-19 compared to 18 in Sep-19; 99.5% forthe month.

• Diagnostics: NEL STP achieved aperformance of 1.50% in Sep-19. A 1.32% improvement against Aug-19 performance of (2.82%). The performance improvement this monthhas been driven predominantly byBHRUT.

• IAPT Access: NEL STP access rateprovisional performance in Oct-19 was5.24%, meeting the Q2 5.01% operatingplan target. 3/7 CCGs met target.

• Cancer 62 day: NEL STP achieved aperformance of 86.70% in Sep-19 whichis an improvement of 0.35% on the previous month.

Metrics failing to reach targets and not showing improved trajectory

• LAS Handovers: In Oct-19, NEL STP 30 minute handovers was 83.3% (3.0% deterioration on Sep-19).There were 135, 60 minute breaches (compared to 72in Sep-19). Queens and King George Hospital’shandover breaches and performance remainssignificantly over trajectory; 108 of the 60 minute breaches were reported at Queens; with notedincrease in 60 minute breaches (27) at Whipps Cross.

• RTT: In Sep-19, NEL STP achieved 82.34%, adeterioration on Aug-19 (82.92%). The NEL PTL position is 389 pathways over plan driven by BHRUT.The volume of 52ww at BHRUT (16) and Barts (17)against trajectory remains a risk. Provisional data forOct-19 indicates 15 52+ww breaches at BHRUT, 15 atBarts and zero at HUH.

• A&E 4 hour: NEL STP A&E performance in Oct-19 was80.93%, 7.27% below NEL STP trajectory and adeterioration from Sep-19 (83.12%).

• LOS: NEL STP reported 412 patients waiting >21 daysagainst a trajectory of 333 in Oct-19; a continued trend of underperformance, but an improvement onthe 441 reported in Sep-19. Projections for M8onwards suggest this trend will not be sustained.

• Personal Health Budgets: For Q2 19/20, NEL STPperformance was 877, underperforming against theoverall NEL STP operating plan. Only Tower HamletsCCG achieved their Q2 operating plan target.Aggregate BHR Q2 performance was 153, 70% belowQ2 target (of 512).

• MH Inappropriate Out of AreaPlacements: NEL STP reported a total of525 days in Aug-19, compared with 770 inthe previous month. Mitigating actionshave been put in place to reduce out ofarea placements including opening of 20additional beds by end August to helpmanage demand.

• Serious Mental Illness PhysicalHealthchecks: During Q2 2019/20, 41.0%NEL STP patients on GP SMI registerreceived all six physical healthchecks, upon the 40.1% Q1 position, and above the38% Q2 operating plan target. Howeverimprovement is limited and not assuredagainst annualtarget.

• NHS 111: Performance for calls answeredwithin 60 seconds for Oct-19 deterioratedto 72.4% (-4.5% less than previous month)against 95% standard. NEL STPperformance is below the London average of 74.8% this month by (-2.4%).

• MH CYP Access: NEL STP reported aprovisional ytd performance of 23% atOct-19, marginally below Octoberindicative target of 23.8%

• DTOC: NEL STP average bed days lost toDTOCs in Sep-19 was 103, above the target of 69. The position has deterioratedfrom the 93 average bed days lost toDTOCs reported in Aug-19.

Summarises the key issues from this months NEL STP Performance Report; identifies key changes from previous month’s report including changes between the categories of performance achievement on the next slide.

Key: GREEN: Sustained Improvement >than 3mths LIGHT GREEN: Recent Improvement RED: Denotes areas of Particular Concern BURGUNDY: Denotes areas where issues persists

48

ELHCP STP Executive Performance update –M7 2019/20

Not compliant and performance trajectory deteriorating /not improving NOT IMPROVING (4)

Elective Care RTT

A&E 4 Hour Wait LAS Handovers NHS 111 LOS >21 Days

U&ECDTOC

18 - 7 - 7 - 5 - 3 - 1 q

NEL STP achieved 82.34% in Sep-19. The NEL PTL position is 389 pathways over-plan for the month (Aug; 2652 over), driven by BHRUT (4,783 pathways over-plan). Both Barts (-4,303) and HUH (-91) were below plan this month.

NEL STP A&E performance inOct-19 was 80.93% (Sept 83.12%) 7.27% below NEL STP trajectory.

NEL STP performance is driven predominantly by the 3.80% deterioration at BHRUT.

Oct-19 NEL STP 30 minutehandover performance was 83.3% (Sept 87.9%).

30 minute breaches for NEL STP was 1,591 for the month. BHRUT account for 1,463 of the total breaches.

Worsening 60 minute breach position (135), with 108 at Queens and 27 at Whipps Cross.

In Oct-19, NEL reported72.4% of calls answered within 60 seconds; (Sept 76.9%) below the 95% standard.

NEL’s % calls abandoned within 30 seconds was achieved in Oct-19 with a performance of 4.1%.

In Oct-19, NEL reported 412 patients waiting >21 days against a trajectory of 333 (Sept 441)

Homerton was the only provider in NEL to achieve their trajectory for the month.

NEL STP average bed days lost to DTOCs was 103 in Sep-19 (Aug 93) exceeding the revised NEL STP target of (69).

Performance improving but not yet on trackIMPROVING (3)

Mental Health CYP Access

Mental Health SMI Physical Healthcheck Minors Breaches

Diagnostics

4 - 1 - 6 - 5 -

NEL STP Oct-19 (provisional) performance was 23%, below cumulative indicative target of 23.8%.

During Q2 2019/20, 41.0%. NEL STP patients on GP SMI register received all six physical healthchecks, above the 38% Q1 operating plan target.

NEL STP achieved 99.3% in Oct-19 –sustainedperformance to last month.

NEL STP reported 172 breaches in Oct-19, 3 fewer breaches than lastmonth. Barts reported 33 fewer breaches and BHRUT 30 more than last month.

NEL STP achieved 1.50% in Sep-19, an improvement on the 2.82% reported the previous month. Performance remains non-compliant with the national threshold of 1%.

September’s positionwas driven by improvements in DM01 performance at BHRUT.

Issu

es

/ A

ctio

n /

M

itig

atio

n

Diagnostics Elective Care RTT Mental Health

NEL STP improved performance was driven by BHRUT (5.39% improvement in Oct-19)against the 1% Standard.

BHRUT informed BHR commissioners that DM01 compliance anticipated in Oct-19 with performance of 0.80% and in Nov-19, unvalidated position currently at 0.66%.

Barts Health is non-compliant with the Diagnostics standard for a further month, and MRI continues to be the key driver for sustained underperformance. The Trust’s position was 1.77%, a marginal deterioration on Sep-19 outturn; with performance impacted by an inflated PTL and capacity challenged in MRI due to staff sickness.

Barts forecast recovery of the DMO1 standard in January 2020.

NEL STP performance remains challenged across Barts Health and BHRUT in Sep-19. Barts Health achieved 82.11% in September, 4.39% below trajectory. The PTL was 85,247, remaining below plan for a further month. Barts reported 17 52ww, 3 higher than plan. There is significant risk in the number of waits >52ww; the Trust forecast 15 pathways vs trajectory of 13 in Oct-19.

BHRUT achieved 76.38% in Sep-19, missing the trajectory of 84.6% for the month by (-8.2%). At month end, the PTL was 41,334, down from 42,564 in Aug-19 and 4,783 above the plan of 36,551 for M6 of 19/20. Unvalidated 52+ weeks position for Oct-19 forecasts 15 against a trajectory of 16.

IAPT access and recovery rates continue to show sustained delivery at NEL STP level, although is expected to remain challenged at BHR until the latter part of the financial year. Recovery plans are in place with system level oversight provided through NEL STP MH Assurance Group.

CYP Access Rate: CYP overall NEL STP level performance at October 2019 is marginally below cumulative indicative plan. CCG level recovery plans are in place to support delivery during 2019/20.

URGENT AND EMERGENCY CARE

ELELCTIVECARE

CANCER/DIAGNOSTICS

PRIMARYCARE

MENTAL HEALTH TRANSFORMING CARE

Key: Number of consecutive months that performance is in assigned category.

Arrows denote movement between categories.qp , no change -

Performance On Track against trajectory/ performance standard ON-TRACK (1)

Mental Health EIP waiting time Mental Health IAPT recovery

8 - 7 p

NEL STP achieved the waiting times element of EIP across 7 of 7 CCGs in Sept-19 reporting 86%, delivering on the operating plan 2019/20 target of 56%.

NEL STP IAPT recovery rate performance inOct-19 (provisional) was 54.3%, above the50% standard. 7/7 CCGs achieved thestandard.

Currently compliant against trajectory/performance standard but performance at risk

AT RISK (2)

Mental Health Dementia Mental Health IAPT AccessTransforming Care

IP reduction Learning DisabilitiesPersonal Health Budgets

19 - 4 - 4 - 2 -

NEL STP performance during Sept-19 was 67.6%, delivering above the 66.7% national standard. 6/7 CCGs met target.

NEL STP’s access rate in Oct-19 (provisional) was 5.24%, meeting Q3 target of 5.01%. 3/7 CCGs met target.

NEL STP level position at Sept-19 showed 45 adults with learning disabilities (LD) in receipt of inpatient care, 9 below the NHSE target of 54.

NEL STP level performance during Q2 19/20 was 877, below Q2 target.

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Joint Commissioning Committee 8 January 2020

Title of report NEL approach to risk management

Item number 5.1

Author Kate McFadden-Lewis, Board Secretary, NELCA and Marie Price, Director of Corporate Services, BHR CCGs

Presented by Kash Pandya, Lay Member (Governance), BHR CCGs


Executive summary Good governance requires each committee to hold a risk register for its responsibilities. The NELCA JCC risk register is based on the JCC objectives and covers:

S1 Robust demand and capacity planning across NEL

S2 Improving self care and demand management and increasing care closer to home

S3 Securing the future of NEL health and social care providers and commissioners

S4 Improving the commissioning of specialised care

S5 Securing local council leadership for key NEL programmes

S6 Delivery of primary care at scale

E1-3 Enabling programmes of workforce, digital and estates

AD1 Streamlined and robust assurance on system transformation and improvement plans

AD2 Integrating CSU services into CCGs where required.

To reflect the move towards a NEL ICS from 2021, the current NELCA JCC risk register and process is under review. A small ‘task and finish’ risk group are leading the process and a number of improvements are in train. A risk workshop, held on 11 December, considered the current risks, good practice and discussed next steps – including better articulation of risks, agreement of risk appetite and clearer mitigating actions and assurances.

Action required The Committee is asked to agree to the next steps outlined in section 8 of this report, with a risk working group member paired with and SRO to take the first step of articulating the risks for finance, partnerships and workforce in light of moves to a NEL ICS.


JCC risk group December 2019 – virtually.

Strategic fit:


Local authority/integratedcommissioning implications

The risk register notes the main risks and mitigating actions to deliver the NELCA priorities. The risks should be considered and integrated into local CCG Board/Joint Committee Assurance Frameworks where required.


The risk register sets out the key actions being implemented to address any finance, performance or quality risks.


Highlighting the risks to deliver the NELCA priorities within the Scheme of Delegation, and the actions taken to minimise the impact of those risks, is part of making sure the work of the JCC is transparent and accountable to local people.

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Risks Inadequate governance arrangements, and/or failure to operate an effective approach to risk management would expose NELCA to the risk that appropriate mitigations are not able to be identified and put in place, and therefore the JCC’s stated objectives are not able to be achieved.

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Current NELCA JCC Risk Register, purpose and background

1. The Joint Commissioning Committee (JCC) has a responsibility to maintain sound risk managementprocesses and ensure that internal control systems are appropriate and effective and where necessary to take remedial action. It is a key part of good governance.

2. The purpose of the Joint Commissioning Committee risk register is to set out the key risks to theNorth East London Commissioning Alliance (NELCA) in achieving its objectives and priorities andthe actions in place to manage those risks.

3. The risk register is organised around the NELCA corporate objectives. The JCC has set out itsforward plan that includes updates on its key strategies and programmes. The risk register will beupdated each time to reflect the progress being made, as well as identifying any new risks from theconsideration of its business.

4. The current NELCA JCC risk register is under review to reflect the move towards a NEL ICS from2021. In the interim, individual NEL CCGs continue to manage risks through their own board/jointcommittee assurance framework (AF) arrangements. The NELCA JCC risk register only considersthe responsibilities delegated by the CCGs to the JCC and the progress being made to mitigate anyresultant risks.

Risk register review – preparing for NEL 2021 commissioning arrangements

5. At the previous two meetings of the JCC, members first agreed to a new template and process formanaging and reporting risks to the Committee (July) and at the last meeting (November) to a workshop focussing on the approach to risk from 2020/21.

6. A ‘task and finish’ risk group which includes two audit chairs, the JCC nurse and governance staff isin place, meeting regularly and overseeing this work. The group met to discuss the format andapproach of the workshop. A specification was produced and it was agreed to commission thesenior lead from the CCGs’ internal auditors, RSM, to design and run the workshop.

7. The workshop was held on 11 December, with the invite extended to wider SMT directors/riskowners, several of whom attended. The session involved a presentation and three groups exploringthe key risks of finance, partnerships and workforce. The following topics were covered:

Risk appetite – methodology and potential application in NEL, with initial proposals for eachof the three risk areas

Output of review of risks in other areas of London where CCGs are merging Review of NELCA risks – descriptions, mitigations and assurance

Colleagues agreed that the risks currently identified are not necessarily the right ones, or articulated in the best way in light of NEL ICS development and potential CCG merger. Some of the risks were also not assigned to the correct director following more recent appointments (e.g. workforce). Members agreed to review these and to consider risk appetite levels.

8. Following the session, the risk group met to agree next steps which are summarised below: A member of the risk group to meet with the risk owners for finance (Chief Finance Officer),

partnerships (Director of Transformation) and workforce (Director of People and OD) toagree revised clear wording for each risk and propose risk appetite levels (Jan 2020)

Advise wider members of SMT on process for risk management and their responsibilities(Jan 2020)

Identification of Strategic Delivery Plan (SDP) risks (Jan/Feb 2020) Risk owners to fully complete the new templates agreed for risk management (Feb 2020) Governance working group to propose new and consistent approach to risk management

across all NEL CCGs (March 2020) New approach begins (April 2020)

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Joint Commissioning Committee and Clinical Senate meeting plan – 2019/20

Regular items:

Minutes / Action log/ Questions from the public Performance report – tailored to the agenda items and include friends and family test Future of commissioning – 2021 vision Risk register Meeting plan

Clinical Senate Joint Commissioning Committee

Month Subject / Topic Month Items

10 April

Stroke Network – developing collaborative,system wide clinical approaches across NEL

East London Prevention Program (ELoPE) –Promoting the coordination of CVD preventionacross NEL

10 April Moorfields Hospital proposals - Pre Consultation Business

Case – part II

8 May

Neurosurgery provision/reconfiguration acrossNEL

Integrated Care System & ELHCP governanceupdate

8 May

STP refresh update

Cancer Diagnostic Hub: update on patient engagement

North East London Spending Money Wisely Programme update

12 June

Stroke – Presentation of a proposed uniformstroke care pathway for NEL – Senate tocontribute support via input, feedback and nextsteps.

Neuro-Rehab – INEL STB overview ofprogramme

Spending Money Wisely – Update paper onlycirculated (no presentation)

12 June OD session – future of commissioning

Item 6.1

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10 July Mental Health – LTP developments; senate to

input and feedback 10 July

ELFT update

Better Care Fund – update

ELHCP Transformation Programme

Update on development of LTP

o to include NELCA progress on the LTP vision

14 August LTP and London vision 14 August OD session - cancelled

11 September

Primary Care Networks – Consideration ofuniform PCN structures and governance acrossNEL that promote collaboration and integration.

NEL LTP Enabler Workstream programmeupdate: Digital Transformation.

11 September

Long Term Plan draft submission

Barts Health surgical strategy

Aligning Commissioning Policies – engagement outcome

Update on progress on the NEL child sexual abuse hubs

Mental Health Strategy- including crises intervention, suicideand veterans and Early Intervention in Psychosis

Update on LITA/HLP/CSU – part II

9 October Stroke – Strategic programme updates

Whipps Cross redevelopment progress update9 October OD session – Progress on digitalisation

13 November NEL Enabler Workstream programme update:

Workforce 13 November

HUHT update

Update on specialised commissioning

Progress on redeveloping Whipps Cross

Moorfields Consultation - update

NHS Long Term Plan sign off (part 2)

Neurosurgery (part 2)

11 December Medicines Optimisation - Strategic Programme

updates 11 December

Pathology (part 2) OD session: Approach to identifying and managing risk

8 January NEL LTP Enabler Workstream programme

update: Infrastructure (Estates)8 January

Medicines Optimisation strategy

Strategy Delivery plan update

12 February Urgent & Emergency Care - Strategic

Programme updates12 February

OD session:

Workforce strategy NEL 2021

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0 – 25 (Children’s & Young Persons) StrategicProgramme updates

Personalisation Strategic Programme updates

11 March

ELHCP Clinical Senate review:

o Terms of Reference

o Membership

o Lessons Learnt/ Future Senatedevelopments for 20/21

11 March

BHRUT update

Better Care Fund update

Neuro-Rehab Level 2b business case

WX Redevelopment - SOC

Operating Plan 2020/21

Moorfields business case

Estates Strategy update

Future of commissioning 2021 – update

JCC Review:

o Terms of Reference

o 2020/21 programme

JCC to be scheduled: Vascular Acute paediatrics Health-based places of safety NELFT update - May 2020 ICS system updates (WEL/ BHR/ C&H/ INEL) Demand management – update from demand and capacity group OD session: Primary care at scale - April OD session on Health and Wellbeing Board plans.

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nel joint commissioning committee meeting part 1 · welcome 1.1 12.30pm welcome, introductions,...

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