virtual governing body · 2020-07-31 · l devanney presented the staff survey 2019 summary report...

Virtual Governing Body

To be held on Thursday 6 August 2020

From 1pm until 3pm

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VIRTUAL GOVERNING BODY To be held on Thursday, 6 August 2020 at 1pm

A G E N D A

Ref Item Enclosure Led By

Action Required

1. Apologies for Absence

Verbal Dr Crichton

For noting

2. Declarations of Interest

Verbal All For noting

3. Minutes of the meeting held on 2 July 2020

Enc A Dr Crichton

For approval

4. Matters Arising not on the Agenda

Verbal Dr Crichton

For discussion

5. Notification of Any Other Business

Verbal Dr Crichton

For discussion

6. Questions from Members of the Public (See our website for how to submit questions – required in advance)

Verbal Dr Crichton

For discussion

7. Patient Story Verbal Dr Crichton

For discussion

Strategy

8. Healthwatch Annual Report

Enc B A Goodall For noting

Assurance

9. Quality & Performance Report • Spotlight Report on Living Well

Enc C A Fitzgerald & A Russell

For noting

10. Finance Report

Enc D H Tingle For noting

11. Chair and Chief Officers Report

Enc E Dr Crichton

For noting

Items to Note

12.

Integrated Care System CEO Report

Enc F

Dr Crichton

For noting

Receipt of Minutes

13. Receipt of Minutes

Enc G Dr Crichton

For noting

http://www.doncasterccg.nhs.uk/about-us/public-meetings/

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Ref Item Enclosure Led By

Action Required

• Engagement & Experience Committee – Minutes of the meetings held on 4 June 2020.

• Primary Care Commissioning Committee – Minutes of the meeting held on 11 June 2020.

14. Any Other Business

Verbal Dr Crichton

For discussion

15. Date and Time of Next Meeting Thursday 3 September 2020 at 1pm

For noting

Governing Body Quorum is 6 Members: Chair or Vice Chair, at least 3 Clinical Members and Chief Officer or Chief Finance Officer

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Minutes of the Virtual Governing Body

Thursday 2 July 2020 at 1pm

Members Present: Formal Attendees Present:

Dr D Crichton NHS Doncaster Clinical Commissioning Group (CCG) Chairman (Chair)

J Pederson Chief Officer, CCG H Tingle Chief Finance Officer, CCG A Russell Chief Nurse Dr E Jones Secondary Care Doctor L Tully Lay Member P Wilkin Lay Member S Whittle Lay Member Dr M Khan Locality Lead, Central Locality Dr R Kolusu Locality Lead, East Locality Dr M Pieri Locality Lead, North Locality Dr M Pande Locality Lead, South Locality A Fitzgerald Director of Strategy and Delivery, CCG L Devanney Associate Director of HR and Corporate

Services, CCG A Goodall

Healthwatch Doncaster Representative

In attendance:

J Satterthwaite PA to Chair and Chief Officer (Minute Taker)

P Hemingway Head of Communications A Harrington Interim Head of Strategic Commissioning

and Transformation (Item 12 Quality and Performance Report

G Wood Deputy Designated Nurse LAC and Safeguarding Children (Item 12 Quality and Performance report)

Action

1. Apologies for Absence

Apologies were noted from :

• Dr R Suckling, Director of Public Health • P Holmes, Doncaster Council Representative

2. Declarations of Interest The Chair reminded Governing Body members of their obligation to declare any interest they may have on any issues arising at Governing Body meetings

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which might conflict with the business of NHS Doncaster Clinical Commissioning Group (CCG). Declarations declared by members of the Governing Body are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link: www.doncasterccg.nhs.uk The meeting was noted as quorate. Declarations of interest from sub committees / working groups: None declared. Declarations of interest from today’s meeting: None declared.

3. Minutes From the Previous Meetings held on 4 June 2020 The minutes of the meetings held on 4 June 2020 were approved as a correct record.

4. Matters Arising not on the Agenda

Primary Care Commissioning Committee Terms of Reference There were minor formatting changes to the Terms of Reference and it was deemed unnecessary for them to be presented to the Governing Body again.

5. Notification of Any other Business There was no notification of further business to discuss.

6. Questions from Members of the Public The following questions was received from a Member of the Public: There has been an increase in Paramedics in Primary Care due to their skills and training making them ideally suited providing recruitment and a fresh approach to care management and same day urgent care. Are there any plans to utilise / increase or increase the number of paramedics in primary care across the Doncaster CCG area? 1 NHS England, 2017. Next Steps on the Five-Year Forward View. 2 NHS England, 2016. General Practice Forward View. 3 NHS England, 2019. Investment and Evolution. A Fitzgerald gave the following response:

http://www.doncasterccg.nhs.uk/

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Thank you for your question relating to the number of paramedics based in primary care services in Doncaster. NHS Doncaster CCG commissions an Emergency Care Practitioner (ECP) service which uses very similar skill sets to those of paramedics. We recently reviewed our ECP service as part of our work to scope out and agree a new model of urgent and emergency care that will go live in October 2020. This model will maintain the number of ECPs that we have already. In addition, Primary Care Networks (PCNs) are currently developing their workforce plans to ensure that primary care services continue to develop in line with the NHS Long Term Plan, the General Practice Forward View and the wider NHS Investment and Evolution document, as identified in your question. Paramedics form one of a number of additional roles that PCNs can recruit to and receive funding for however the funding for these roles will not be released until 21/22. PCNs will want to ensure that any additional paramedics they recruit will not duplicate roles that already exist across Doncaster, but instead will work with our existing ECPs to provide services for patients in Doncaster.

7. Patient Story The Patient Story featured Sophie who became a first time Mum in October 2019. Sophie has pre-existing health conditions and is a shielded patient and she has a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). Sophie encountered the following difficulties: • Journey described as ‘chaotic and hectic’ • Repeated visits due to health problems and lost samples • Lack of consistency, communication and responsiveness to needs and

wants (not knowing what is happening/birthing plan) • Delayed discharge from maternity ward’23.30pm discharge not ideal when it

is cold and raining’ What worked well for Sophie: • Nurses at the induction visit ‘good experience’ • Support from nurses post-delivery at the hospital ‘brilliant night staff’ ‘lovely

male midwife’ • Routine post-natal support in the community – Midwife What needs to change: • Consistency of staff • Communication • To be more informed Dr Crichton explained that there were elements of Sophie’s story which allowed her to undertake a more formal process which required further discussion and

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action. The Head of Midwifery at Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust (DBTHFT) has reported that they are working with the Maternity Voices Partnerships of which Sophie is a member and environmental improvements have been made and staff training in new mothers implemented and an invitation has been extended to Sophie to re-visit the Maternity unit. G Wood, Deputy Designated Nurse Looked After Children and Safeguarding Children NHS Doncaster CCG advised that it was timely to re-visit improvements in Maternity Services. J Pederson queried where progress will be formally reported and was advised that the CCG has a Clinical Quality Review Group (CQRG) Sub-Group for Maternity, Neo-natal and Paediatric care and the Quality and Patient Safety Committee receives reports from the group as part of a check and challenge process. Dr Crichton informed the Governing Body that Healthwatch Doncaster has commenced a consultation with the public regarding their experiences accessing appointments via video or telephone which will run for a period of one month.

8. Primary Care Commissioning Committee Annual Report L Tully presented the Primary Care Commissioning Committee Annual Report to the Governing Body for endorsement prior to submission to NHS England. It provides assurance to NHS Doncaster CCG Governing Body and NHS England with regard to the delivery of the Primary Care Commissioning Committee work programme for the period 1 February 2019 to 31 January 2020. Dr Crichton observed inconsistency between the cover sheet and the report in that the Governing Body was asked to endorse the Report and not approve it. The Governing Body endorsed the Primary Care Commissioning Annual Report prior to submission to NHS England.

9. Policy for Commissioning Cryopreservation A Russell presented the Policy for Commissioning Cryopreservation to the Governing Body and explained that the policy and has previously been presented to the Clinical Reference Group for discussion. The proposed policy sets out the commissioning position on the provision of cryopreservation for a patient about to undergo a medically necessary procedure or intervention which may permanently impair their future fertility, for example chemotherapy, radiotherapy or gender dysphoria treatment. This policy follows the available national clinical guidelines including those published by NICE (CG156 Fertility problems: assessment and management). The revised policy outlines the commission criteria and specifies that the CCG will only fund storage of gametes and embryos for an initial 10 year period. If

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storage is desired for longer than 10 years then a funding application should be made by the Individual Funding Request (IFR) panel. The policy also states that: • For females; the CCG will fund one cycle of egg retrieval, with or without

fertilisation. If fewer than ten eggs are retrieved then one further cycle can be offered.

• For Males; The CCG will commission a maximum of three semen samples. The changes to the proposed policy are not in relation to the commissioning criteria, but more to offer clarity around the scope, definitions, monitoring arrangements and policy review considerations. It is important to note that approval of cryopreservation does NOT guarantee future funding of assisted conception or fertility treatment. Should the patient wish to pursue NHS funded fertility treatment, the local eligibility criteria will apply at that stage. In line with equality and diversity it is imperative NHS Doncaster CCG has this policy in place to support those who require cryopreservation, as a result of a protected characteristic. A Russell requested that the Governing Body approve the Policy for Commissioning Cryopreservation which will replace the existing policy. S Whittle queried if there had been public consultation regarding the policy. A Russell stated that it has been drafted by the Individual Funding Request (IFR) Team however would seek clarification with the Team. The Governing Body approved the Policy for Commissioning Cryopreservation.

A Russell

10. Staff Survey Results L Devanney presented the Staff Survey 2019 Summary Report for noting by the Governing Body. It details the key findings from the results of the 2019 staff survey. The report details the scores and highlights some of the key areas against the themes within the staff survey. The scores are summarised as follows: Equality, Diversity and Inclusion: 9.7 Health and Wellbeing: 7.6 Immediate Managers: 7.8 Morale: 6.9 Quality of Appraisals: 6.5 Quality of Care: 7.5 Safe Environment – Bullying and Harassment: 9.6 Safe Environment – Violence: 9.9 Safety Culture: 7.4 Staff Engagement: 8.5 Teamwork: 7.3

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NHS Doncaster CCG rated above the national average across 10 of the themes and just below with 1 theme (Safe Environment – Violence). L Devanney explained that under normal circumstances the CCG would have worked with Staff Side and the Colleague Engagement Group on a detailed action plan however due to the COVID-19 pandemic we have concentrated on the Health and Wellbeing of our staff and alternative ways of working. Line Managers have been asked to hold Personal Development Reviews (PDRs) with their staff with the view to ensuring that last year’s objectives have been met. It was considered that now is not the appropriate time to set new objectives for the forthcoming year. A detailed staff survey report is available on the CCG website. The Governing Body noted the Staff Survey 2019 Summary Report.

11. Doncaster Place Recovery & Reset A Fitzgerald explained that in March 2020 NHS England set out four phases to the national COVID-19 recovery and transformation programme as follows: Phase 1- COVID-19 level 4 incident response Phase 2 - COVID-19 level 4 incident response and critical services switch on Phase 3 - Ongoing COVID-19 management and NHS open for business Phase 4 - New NHS Phase 2 work has commenced at organisational and Doncaster Place level to evaluate changes made in response to COVID-19, and determine which of those changes we plan to now maintain across the Health and Social Care system in Doncaster. Similarly work is taking place across the South Yorkshire and Bassetlaw Integrated Care System (SYB ICS) to also determine areas where collaboration across the wider patch can bring benefit for our respective local places. There is a commitment that as a Place partnership we take every opportunity to ensure that the learning from and improvements made through the COVID-19 response are evaluated and maintained as part of the recovery and reset process. The Principles agreed to support this were: • All recovery and reset should be undertaken in a prioritised and safe

fashion. • Where appropriate “Digital First” should be considered. • We should adopt a locality approach to all recovery and reset where

appropriate. • Our approach should be guided by innovation and the engagement and

leadership of the front line.

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• We should learn from workforce and estate changes made during the COVID-19 response.

• Our recovery and reset should be sustainable and based upon a future demand model.

A small, multi-organisational task and finish group is now taking forward the partnership process to review recovery and reset at a Place level, linking in with the work also taking place across Team Doncaster. A list of priority areas for partnership focus is in development, shaped by the local drive to have a limited number of key focus areas. The priority areas have also been reviewed in the context of the Doncaster Place Plan and the original Areas of Opportunity – a number of these have now been accelerated, whilst others have been paused. Each of the priority areas listed will be reviewed using a locally developed rapid review methodology, tested out on the discharge pathways review. The ICS has been part of a regional recovery cell with NHS England North East Yorkshire reviewing approached across cells related to: • Mental Health and Learning Disabilities • Procurement (in particular personal protective equipment) • Workforce • Critical Care • Hospital Elective Care • Ambulance This work has been played into the South Yorkshire ICS governance and Doncaster Place. In June 2020 an exercise has taken place to analyse and cost recovery for rest of 2020/2021. In particular the need to demonstrate: • Baseline capacity - the level of capacity available/activity possible during the

remainder of the financial year (without further investment) utilising our current resources (beds, workforce etc) adjusted for COVID-19 IPC compliance requirements

• The resource/investment requirements (capital, revenue, workforce) to address the capacity gap arising from the above – secondary acute care, step down/discharge, mental health, community & primary care

• The aim is to understand what resources the system would need to deliver: o Baseline capacity plus 20%, and o Critical care capacity (based on pre-COVID-19 baseline) plus 50%

This work currently continues for the CCG in collaboration with providers. Plans will be further informed by Stage 3 NHS Guidance (and further national financial clarifications) expected in July 2020. A SYB ICS “Stress Testing” event will also take place on 1 July 2020 which will test the Doncaster systems ability to respond to a second COVID-19 surge in infection rate.

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The ICS has also commissioned the South Yorkshire Academic Health Science Network (AHSN) to lead work across the ICS evaluating respective system responses and developing a suite of best practice for potential spread across the ICS. The Governing Body was asked to: • Note the approach taken to recovery and reset in Doncaster. • Note the approach taken to recovery and reset across the South Yorkshire

and Bassetlaw ICS. Dr Pieri highlighted that the provision of Out of Hours and Urgent Care at Mexborough Montagu Hospital was halted due to COVID-19 and queried when this would be re-instated. A Fitzgerald responded that there is currently no definitive timescale for the services to be re-instated however it will be part of the recovery and reset process. Dr Pieri enquired how we can ensure that a robust system and process is in place regarding Test and Trace. L Devanney informed the Governing Body that the Infection Prevention and Testing Cell meet every Thursday. Dr Joseph, Public Health is confident that Doncaster is doing better than expected. We have a governance process in place in response to any infection rates which is chaired by Dr Suckling, Director Public Health. The Data Cell has produced some impressive work on locating ‘hot spots’. Dr Crichton advised that Dr Suckling has populated a video on YouTube which advises that it is not currently considered appropriate for Doncaster to go in local lockdown however continuous monitoring is taking place. P Hemingway agreed to share the link to the video to Governing Body members. Dr Jones stated that there has been increased pressure on Mental Health and Learning Disabilities (LD) services due to COVID-19 and will continue for the foreseeable future. We must make sure that we make use of the structures in place to pro-actively monitor Mental Health and LD patients if we note an increased trend. J Pederson reported that the CCG is looking into Mental Health in detail and we need to continue with the health checks for LD patients in Primary Care. It would be beneficial to focus on LD in a future Strategy & Organisational Development Forum meeting and in the Living Well Spotlight Report in August 2020. The Governing Body: • Noted the approach taken to recovery and reset in Doncaster. • Noted the approach taken to recovery and reset across the South Yorkshire

and Bassetlaw ICS.

P Hemingway

12. Quality and Performance Report

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A Fitzgerald presented the Quality & Performance Report for noting by the Governing Body. The following key areas were highlighted: Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust (DBTHFT) • Accident and Emergency – Performance improved in May 2020 to 94.7%

but remained below the 95% target. This is the highest performance since June 2018. This is due to a collective response from partners. There has been a reduced demand in A&E during COVID-19.

Rotherham, Doncaster & South Humber NHS Foundation Trust (RDASH) • Improving Access to Psychological Therapies (IAPT) – The proportion of

people accessing the service was below the April 2020 1.58%% target at 1.55%.

• IAPT 6 weeks RTT – Performance for DCCG patients in RDASH services decreased to 39.3% during April against the 75% target. Phases 1 and 2 have made an impact on waiting lists.

• IAPT recovery rate – Performance fell below the 50% target in April to 45.6%.

A Fitzgerald informed the Governing Body that NHS Doncaster CCG is in constant dialogue with DBTHFT regarding services being brought back on line however there will be significant changes in the approach particularly in the use of more digital appointments. P Wilkin highlighted 52 week waits and asked if the CCG has assurance from DBTHFT that patients are continuing to be cared for. He was advised that DBTHFT approach is not how long patients are on the waiting lists but on clinical prioritisation. J Pederson added that we need to be mindful that this may take some time to resolve as there are limitations on DBTHFT due to specific COVID-19 areas within the hospital. S Whittle asked how we compare to other CCGs in SY&B and was advised that we are in a similar position however we have been successful in being able to access the Independent Sector. There are challenges across the region and we are working through the re-installation of services. Dr Pande queried the progress and performance of the CCHUB and if the CCHUB would verify the death of a patient due to COVID-19 between the hours of 9pm and 6am. A Fitzgerald reported that it responded well to the pandemic. There has been a significant decrease in demand and therefore it has become more of an advice and guidance service however there is flexibility to step up the service is there is a second wave of COVID-19 later in the year. A Fitzgerald agreed to liaise with the Clinical Lead of the CCHUB regarding the verification of death query.

A Fitzgerald

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Spotlight Report – Starting Well A Harrington, Interim Head of Strategic Commissioning and Transformation at Doncaster Council attended the Governing Body to give a presentation on Children and Maternity which gave an update on the outcomes within the Starting Well delivery plan for both health and social care outcomes which included the work being carried out as part of the Localities Outcome with an update on the current position and next steps. The areas of focus were: • Maternity key milestones and future projects • Reduce Neuro-developmental Pathway Waiting times key milestones • Development of a new Service Specification for Children’s Community

Nursing • Care and Education • Localities Commissioning • Long term solutions to COV)D-19 response • Medium Term COVID-19 Recovery Plan • Next steps to recovery S Whittle queried the percentage of smoking in pregnancy and how this cohort of patient is dealt with. The Governing Body was informed that for Quarter 4, the percentage is 15.2% and they are prioritised by the midwives as to what pathway they will follow and signposted to smoking cessation services. Dr Kolusu highlighted perinatal mental health and asked of patients are seen by mental health nurses of mental health midwives. He was advised that they are seen by the perinatal team who are midwives trained in mental health. G Wood agreed to circulate information on the perinatal service to Governing Body members. S Whittle asked how we ensure that those children with Special Educational Needs and Disability (SEND) are not forgotten. A Harrington stated that they have able to continue at school throughout the pandemic. A Multi-disciplinary Team (MDT) approach is taken for those patients who are of concern. G Wood added that a group has been established for children who attend A&E and are in a mental health crisis. There is still a lot of work to be undertaken as not going to school and poverty can impact on a child’s mental health. Dr Crichton thanked a Harrington and G Wood for attending the Governing Body. The Governing Body noted the Quality and Performance Report.

G Wood

13. Finance Report H Tingle presented the Finance Report for noting by the Governing Body. The report sets out the financial position as at the end of May 2020. The CCG is currently working with an interim financial regime for April – July (Month 1-4) only due to the Covid-19 pandemic. Therefore at this time there are

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no set financial targets for the CCG to meet and no QIPP expectations. The financial regime for the remainder of the year is not yet known. Due to the coronavirus outbreak the 2020/21 planning and contracting round was suspended in mid-March. NHS England and Improvement have issued guidance on how CCG’s need to work with providers during the interim period. The following summarises some of the current arrangements – • The CCG’s main NHS providers are being paid on a block basis, the value

of which was determined centrally by NHS England. This is only for contracts that exceed a set value. No other payments will be made to any other NHS providers by the CCG at this time.

• CCG’s are reimbursing their main acute provider for all other contractual activity that they would usually receive from their smaller contracts. For Doncaster CCG this is Doncaster and Bassetlaw Hospital NHS Foundation Trust.

• Primary Care income streams are being protected at 2019/20 levels as a minimum including national Direct Enhanced Service (DES) and Local Enhanced Service (LES) payments.

• Individual placement costs are still being reimbursed and the CCG is working closely with numerous providers who are having to be flexible in terms of their delivery of care at this time.

• Non NHS providers are being reviewed on an individual basis. Income streams are not guaranteed for this cohort of providers and depend upon the levels of service being provided at this time, and whether they are deemed critical to the Covid-19 response. Providers are being encouraged to seek other government support where necessary.

• Additional funding is available to support the Covid-19 response and returns are being regularly submitted to NHS England on additional costs incurred that are in line with the guidance. Governance around the agreement of additional costs is being maintained in line with usual processes.

• The new Discharge Protocols are also being centrally funded by NHS England including funding for any new packages of care that are initiated during this period in order to safely discharge a patient from hospital or avoid a hospital admission.

The above regime is currently in place until the end of July 2020 and further guidance is expected shortly to inform the regime for the remainder of the financial year. Further guidance is awaited regarding the financial regime for the remainder of the year, however it has been confirmed that the block arrangements for NHS providers will continue. It is anticipated that additional allocations will be on a prospective basis and not retrospective, however it is not clear if the additional allocations will be given to the ICS, place, or direct to CCG’s and providers. This is clearly a risk to the CCG’s financial position this year if we are expected to break-even. CCG’s and providers have been asked to submit high level revenue and capital plans for the remainder of the year to aid discussions at the Treasury. These

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have been based on a number of scenarios including that current activity levels continue and also that additional activity will start to take place as the year progresses. It is anticipated that a detailed plan will be required and the guidance around this is expected in mid-July. There are a number of risks facing the CCG. The CCG has transformation and delivery plans and it is not clear how some of this can be progressed as there is uncertainty around investment and additional funding. It is not clear if the CCG will be expected to make any Quality Innovation Productivity and Prevention (QIPP) savings in year or if these will be offset by additional top ups. It is not known what activity and capacity providers will be able to deliver in year and what the impact of this will be on the underlying demand for future years. It is not clear if the regime for 2021/2022 will revert back to the original position and therefore what the impact of the current regime will have on the CCG’s recurrent underlying position moving into next year. Clear guidance around the Mental Health Investment Standard is awaited as it is uncertain if this is a requirement for 2020/2021 and how CCG’s can progress this under the current regime when investments are not allowed. Further guidance is awaited on this. The Governing Body was asked to note the current financial position and the expectation around additional allocations so that the CCG breaks even. It was also asked to note the restrictions currently in place around investments, the uncertainty around efficiency savings and delivery of the Mental Health Investment Standard. J Pederson stated that the CCG is currently documenting innovation for this year and how we would have released funds. We acknowledged there are some barriers to transformation however the use of non-face to face appointments via digital means will help to drive some. Dr Jones highlighted that Payment by Results (PbR) was meant to incentivise and reduce demand but the implementation of the block contract is counter- productive and asked how the CCG is to manage this and free the Acute Trust of deficit. H Tingle advised that the cash in the system is not enough to pay for activity but we are trying to secure a position where a perspective top up may make them financially viable for the rest of the year. H Tingle reported that the CCG is keen to reach a break even position. It is anticipating that the COVID-19 costs will be funded and there are justifiable reasons for an overspend. The CCG remains optimistic that it will receive allocations and will bid for the top up fund. There are still savings to be made from a prescribing perspective and an outlineof an incentive scheme is being developed with the view to be implemented later this year.

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The Governing Body noted the current financial position and the expectation around additional allocations so that the CCG breaks even. It also noted the restrictions currently in place around investments, the uncertainty around efficiency savings and delivery of the Mental Health Investment Standard.

14. Integrated Care System CEO Report The Governing Body noted the Integrated Care System CEO Report.

15. Receipt of Minutes The following minutes were received and noted by the Governing Body: • Engagement & Experience Committee – Minutes of the meetings held on 7

May 2020. • Primary Care Commissioning Committee – Minutes of the meeting held on

14 May 2020.

16. Any Other Business There was no other business discussed.

17. Date and Time of Next Meeting Thursday 6 August 2020 from 1.00pm.

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Meeting name Governing Body Meeting date 6 August 2020

Title of paper

Healthwatch Doncaster Annual Report 2019-20

Executive / Clinical Lead(s) Anthony Fitzgerald – Director of Strategy and Delivery

Author(s) Andrew Goodall – Chief Operating Officer – Healthwatch Doncaster

Status of the Report To approve To consider / discuss To note Purpose of Paper - Executive Summary Healthwatch Doncaster are the independent champion for people using local health and social care services. We listen to what people like about services and what could be improved. We share their views with those with the power to make change happen. People can also speak to us to find information about health and social care services available locally.

Our sole purpose is to help make care better for people.

Healthwatch Doncaster produce an Annual Report every year that details the work of the team and the outcomes that have been achieved. In 2019-20 Healthwatch Doncaster heard from over 5,400 people about their experiences of health and care locally. We have published 12 reports on a range of topics including the NHS Long Term Plan, Emotional Health and Wellbeing, Access to GP services, the Respect forms and process, Urgent and Emergency Care Services and Enter and View reports from local care home providers. As a local Healthwatch organisation, we were recognised by Healthwatch England by being awarded for National Outstanding Achievement for the work on the NHS Long Term Plan that we led and co-ordinated across the South Yorkshire and Bassetlaw Integrated Care System. We continued to support the development of engagement and involvement in community groups and organisations by investing over £10,000 in our Micro-Grants programme and we have supported 29 volunteers and 20 students on placements to contribute over 1000 hours to projects, meetings and working with the Healthwatch Doncaster Team. Healthwatch Doncaster has agreed a 2-year extension to the current contract with

X

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Doncaster Council. The extension to the contract will be a joint contract with Doncaster Council and NHS Doncaster CCG. The contract will be extended from 1 August 2020 – 31 July 2022. Healthwatch Doncaster has set out its priorities for 2020-22 and they include: • Covid-19 – the experiences and impact of the Covid-19 pandemic and lockdown

on local people • Cancer – a qualitative report based on people’s stories of the cancer pathway in

Doncaster • Mental Health Services – how do people access mental health services locally

and have there been changes as a result of Covid-19 • Missed Appointments – revisiting the Missed Appointments project to review the

implementation recommendations of our first report • Care and Support at Home – how has domiciliary care changed since our last

report • Re-imagining engagement and involvement – learning lessons from lockdown

about using digital tools to support engagement Healthwatch Doncaster’s full 2019-20 Annual Report can be downloaded here:

https://www.healthwatchdoncaster.org.uk/wp-content/uploads/2020/06/FINAL-Healthwatch-Doncaster-Annual-Report-2019-20.pdf Recommendation(s) NHS Doncaster CCG’s Governing Body is asked to: • Note the contents of the report • Recognise the development and achievements of Healthwatch Doncaster as a

key local partner Report Exempt from Public Disclosure Yes No If yes, detail grounds for exemption: Impact analysis Quality impact The Healthwatch Doncaster Annual Report 2019-20 is for information and

noting

Equality impact

The Healthwatch Doncaster Annual Report 2019-20 is for information and

noting

Tick relevant box

An Equality Impact Analysis/Assessment is not required for this report. x

X

https://www.healthwatchdoncaster.org.uk/wp-content/uploads/2020/06/FINAL-Healthwatch-Doncaster-Annual-Report-2019-20.pdf

https://www.healthwatchdoncaster.org.uk/wp-content/uploads/2020/06/FINAL-Healthwatch-Doncaster-Annual-Report-2019-20.pdf

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An Equality Impact Analysis/Assessment has been completed and approved by the lead Head of Corporate Governance / Corporate Governance Manager. As a result of performing the analysis/assessment there are no actions arising from the analysis/assessment.

An Equality Impact Analysis/Assessment has been completed and there are actions arising from the analysis/assessment and these are included in section xx in the enclosed report.

Sustainability impact

The Healthwatch Doncaster Annual Report 2019-20 is for information and noting

Financial implications NONE

Legal implications NONE

Management of Conflicts of

Interest NONE

Consultation / Engagement

(internal departments,

clinical, stakeholder and public/patient)


Report previously

presented at NONE

Risk analysis


Corporative Objective / Assurance Framework

NONE

ContentsMessage from our Chair 3

About Us 4

Our Vision 5

Highlights from our year 6

What were our priorities in 2019-20? 7

Asking local people about the NHS Long Term Plan 8

Sharing our learning at the National Healthwatch England Conference 9

People tell us about their access to GP services 11

Helping improve Urgent and Emergency Care provision 12

Hearing how local people look after their emotional health 14

Healthwatch Doncaster’s Micro-Grants 15

Young Healthwatch Champions 16 & 17

Michael Smith’s story 18

Covid-19 19

Facing A Pandemic 20

Our Volunteers 21

Volunteers’ influence 22

Enter and View 23

Patient Stories 24

Thank You 25

Signposting and Information 26

Social Media 27

Choice for All Doncaster 28

Doncaster Keeping Safe Forum 29

Patient Participation Network 30

Health Ambassadors 31

Our Finances 32

Priorities for 2020-21 34

Message from our Chief Operating Officer 35

Thanking our partners 36

Contact Us 37

Annual Report 2019-20 | Healthwatch Doncaster 2

Message from our Chair

It is impossible to write anything about our last year at

Healthwatch Doncaster without mentioning the ongoing

effect of the Covid-19 virus on the whole world. My

thoughts and sympathies go out to everyone who has

been affected by this insidious disease and to the

families and friends of the many who have lost their

lives.

Because of our place in the public life of the Borough,

Healthwatch Doncaster has seen at first hand the incredible

efforts of our local hospitals, GPs and other medical and care

services in treating citizens. We add our heartfelt thanks to

those of everyone else. I would also like to acknowledge the

sterling work of Doncaster Council as personified by the

Director of Public Health, Dr Rupert Suckling.

We were quick to react to the situation by moving our staff to

home working in March and adapted with team discussions and

interaction with stakeholders through online meetings.

There is plenty about our efforts during 2019-20 in this report

and I would like to thank staff, volunteers and Board members,

who have helped us become more successful in our

endeavours.

Linda Crundell left her position on the Board and I’d like to

thank her for her contribution, including being involved in our

Enter and View Planning Group.

At the time of publication, our Vice-Chair Debbie Hilditch left

her role and I would like to thank her for her help and support.

Her part in the organisation’s move to a independent

Community Interest Company was crucial, alongside her

strategic and project leadership.

Steve Shore

Healthwatch Doncaster Chair


My thoughts and sympathies go out to everyone who has been affected by this Covid-19 disease

About us

Here to make care betterThe network’s collaborative effort around the NHS Long Term Plan shows the power of the Healthwatch network in giving people that find it hardest to be heard a chance to speak up. The #WhatWouldYouDo campaign saw national movement, engaging with people all over the country to see how the Long Term Plan should be implemented locally. Thanks to the thousands of views shared with Healthwatch we were also able to highlight the issue of patient transport not being included in the NHS Long Term Plan review – sparking a national review of patient transport from NHS England.

We simply could not do this without the dedicated work and efforts from our staff and volunteers and, of course, we couldn’t have done it without you. Whether it’s working with your local Healthwatch to raise awareness of local issues, or sharing your views and experiences, I’d like to thank you all. It’s important that services continue to listen, so please do keep talking to your local Healthwatch. Let’s strive to make the NHS and social care services the best that they can be.


I’ve now been Chair of Healthwatch England for over a year and I’m extremely proud to see it go from strength to strength, highlighting the importance of listening to people’s views to decision makers at a national and local level.

Sir Robert Francis, Healthwatch England Chair

Our vision is simple Engage

Healthwatch Doncaster will engage you in conversations about your experiences of local health and care services.

Inform

You will inform us about what is important to you and what changes and improvements you want to see in Doncaster.

InfluenceWe will use your stories, experiences, voices and opinions

that have been shared with us to influence change and improvement in local health and care services in Doncaster.


Photograph Credit: John Burke

Photograph Credit: Irene

29 volunteershelped to carry out our work, contributing over 745 hours of their time

20 studentsundertook a placement to support their studies and develop their career pathways

£10,200 sharedwith local community groups as part of the Micro-Grants scheme


Highlights of our year

5,405 commentsreceived about health and social care through our online feedback centre, or through a survey focusing on a specific topic

294 people contacted Healthwatch Doncaster for advice and information or questions about local support

12 reports publishedincluding our projects on the NHS Long Term Plan, emotional health, access to GP services and outcomes from Enter and View visits

What were our priorities in 2019-20?


NHS Long Term Plan

The views of local people were shared with the South

Yorkshire and Bassetlaw Integrated Care System and

helped shape their system-wide response to the NHS

Long Term Plan

What’s YOUR story?

We were aware that a lot of people had stories about how

they managed their own emotional health needs or

helped others with their emotional health needs. We

listened and shared their voices with local services so that

improvements can be made

Access to GP services

When we are out and about talking and listening to people,

access to GP services is often a topic of conversation. We

talked to over 1500 people with a focus on the working

age population. The outcomes and recommendations from

this report have been shared with our local CCG

Urgent and Emergency Care

The Healthwatch Doncaster volunteers wanted to spend

24 hours in Urgent and Emergency Care. Our strong

working relationship with our local Acute Trust enabled us to

get access across the Urgent and Emergency Care system

and to talk to people at various stages of their

care and treatment

Micro-Grants

We have continued to support the development of

community groups and organisations through our

innovative Micro-Grant programme. Developing

networks of support was a focus for us this year.

Young People

Healthwatch Doncaster loves to support and develop

the skills of students and young people. We have

continued to develop Young Healthwatch

and student placement opportunities

Asking local people about the NHS Long Term Plan

Healthwatch Doncaster were the co-

ordinating Healthwatch for analysing

the feedback, surveys and focus group

responses from across the South

Yorkshire and Bassetlaw Integrated

Care System (ICS) – Barnsley,

Bassetlaw, Doncaster, Rotherham and

Sheffield – about the NHS Long Term

Plan.

Over 1,300 people shared their views and

told us what they would do to improve the

NHS as part of the Long Term Plan and there

were 15 local focus groups that had more in-

depth conversations with people about their

thoughts and feelings about the NHS.

The report findings showed:

• 88% of people who completed the survey

told us they agreed with the Plan’s

commitment towards ‘prevention, choice

and control and promoting independence

and self-care’

• A third of survey respondents said they or

someone they cared for had used local

services and support to manage their

mental wellbeing and emotional health

• People told us that digital proposals were

important, including having access to

services using a phone or computer;

making appointments online; having

results communicated quickly and talking

to their doctor when they can.

Healthwatch Doncaster analysed all the data

and information, leading to a detailed report

shared with the ICS and presented to the

collaborative partnership of strategic leaders.

The report was used by the ICS to develop

and write their local response to the NHS

Long Term Plan based on what they have

heard from local people.

Healthwatch Doncaster were invited to help

facilitate workshop discussions at the NHS

Expo in September 2019 along with other co-

ordinating Healthwatch organisations. The

discussions were helpful and formed part of

the NHS Assembly’s engagement and

response to the NHS Long Term Plan.

At the Healthwatch National Awards in

Birmingham in October 2019, local

Healthwatch from South Yorkshire and

Bassetlaw were announced as the winners of

the Outstanding Achievement Award for their

collective work on the NHS Long Term Plan.

There was particular mention of the work

that had been done to engage with a wide

range of people and the focus groups that

had engaged groups of people whose voices

are not often heard or listened to.


Picture: from left to right - Healthwatch Doncaster Chief Operating Officer Andrew Goodall and Sir Robert Francis, Healthwatch England Chair alongside colleagues from Healthwatch Nottingham and Nottinghamshire

http://bit.ly/NHSLTPRpt

Sharing our learning at the National Healthwatch England conferenceSandie Hodson – Volunteer Co-

ordinator and Engagement Officer – and

Andrew Goodall – Chief Operating

Officer – developed a workshop

presentation in two parts. Sandie

shared her knowledge about recruiting

and supporting volunteers and Andrew

talked about supporting student

placements in Healthwatch Doncaster.

“I had an extremely positive response from

attendees especially local Healthwatch who

do not have the structures and processes in

place to fully support a robust volunteer

programme.”

“It was very gratifying to be able to share

knowledge gained through many years

working with volunteers and, more recently,

from my volunteer management studies to

make a contribution to the development of

the wider network,” said Sandie (pictured

below).

Healthwatch Doncaster has supported a

number of students on placements over the

last three years with great success. Young

people have learned and developed and the

organisation has benefited from their skills

and enthusiasm.

Healthwatch Doncaster are clear that when

students come in to the organisation that

they are treated like a member of the team

and supported to complete work that will

benefit local people.


10

Hampole, Doncaster Photo Credit: Healthwatch volunteer

People tell us about their access to GP services

Access to GP services has been a common theme from patient feedback to Healthwatch Doncaster and we have heard many stories from patients about their experiences.

In the summer of 2019, we engaged with over 1500 local people to gather their experiences with findings shared with service providers and published in a report.

The findings show there is a variation in the services that people of Doncaster experience in relation to accessing GP services. 55% of respondents were not satisfied with the service they received for a number of reasons.

Difficulty in telephone access, patients waiting a long period to get an appointment and lack of awareness of other health care services were common themes.

The following recommendations were proposed to help improve experiences:

• Make patients aware of other healthcare provision• Inform patients about signposting to appropriate clinicians or services• Encourage the use of digital and online services to book appointments/request prescriptions

Service providers including the Local Medical Council, NHS Doncaster Clinical Commissioning Group (CCG) and Primary Care Doncaster were receptive to the findings and recommendations and

recognised that “there is more to be done to continue to improve access and experiences of care received”.

In October 2019, NHS Doncaster CCG launched a campaign, which aims to raise awareness of the wide range of services that exist in Primary Care and encourage the use of IT to access services in order to enhance the experience of accessing GP services for local people.


Over two months, Healthwatch Doncaster gathered feedback and comments by talking to local people


Helping improve Urgent and Emergency Care provision

In September 2019, Healthwatch Doncaster undertook a project to gather people’s experiences of Urgent and Emergency Care services in Doncaster.

The services that were involved in this were:

• The Emergency Department at Doncaster Royal Infirmary: staff and volunteers visited the department during a busy night shift and spoke to patients, relatives and staff• Minor Injury Departments at Doncaster Royal Infirmary and Mexborough Montagu Hospital

• Urgent Treatment Centre at Doncaster Royal Infirmary

• Same Day Health Centre

As a result of our involvement in the 24 Hours in Urgent and Emergency Care project, our Volunteer Co-ordinator and two of our volunteers have been involved in the following:

• Sitting on a grants panel to consider bids to the South Yorkshire and Bassetlaw Integrated Care System Innovation Fund for Urgent and Emergency Care Services• Bringing the patient perspective to the commissioning process for Same Day Health Centre services in Doncaster

This has ensured that the patient voice is heard in the commissioning process.

The project report can be viewed at: www.healthwatchdoncaster.org.uk/urgentandemergencycarereport

Sue, Healthwatch Doncaster volunteer, shares her experience

of the Emergency Department at Doncaster Royal Infirmary

”When I went to A&E at 9pm, I was humbled by what I saw. The professionalism and the care given by the staff was wonderful. It didn’t matter what their job title was, the Sister fetching a bed, changing a bed; everyone just got on with it. They were all pleasant and introduced themselves to the patient, I thought they did a wonderful job”

Healthwatch Doncaster staff and volunteers visited urgent and emergency care services in the Borough

http://www.healthwatchdoncaster.org.uk/urgentandemergencycarereport


Hearing how local people look after their emotional health

In August 2019, we attended the Recovery Games and the Doncaster Pride event to gain views on how people support others to stay emotionally well. The project focussed on our qualitative themed approach “What’s YOUR Story” to gather extended narratives via audio recordings.

Our aim was to identify the main themes and gaps in support for people with emotional difficulties, particularly those in recovery and the LGBTQ+ community, to influence local services.

The receptiveness of 13 people who were willing to tell their own stories or stories of how they supported others was inspiring.

The importance of the support that family and friends provide was a key theme.However, it was recognised that they themselves need support to fulfil this role.

Talking to others who have been through similar experiences, hobbies and physical and practical help were also key findings.

Barriers included social stigma and individuals themselves accepting that they

need help.

The need for appropriate and timely referrals from GPs and timely appointments from specialist services was a feature of views received and some people reported accessing private therapies due to long waiting times.

A number of individuals told us about the lack of mental health resources, the need for a holistic approach where an individual has physical and emotional difficulties and the need for integrated working particular between health and social care services.

There was a gap identified for Youth Gender Identity Services locally.

A number of recommendations for organisations across Doncaster were made within the report and shared with services.

From left to right: Natalie, Sophie, Elle and Jill at the Doncaster Pride celebration event

The team at the Recovery Games


Healthwatch Doncaster’s Micro-Grants

We’ve been able to support 21

community groups in 2019-20 and

we have allocated £27,000 in Micro-

Grant funding over the past three

years.

A launch event was held to help generate

new and recurring interest, which

featured some of our previous recipients,

such as Doncaster Alcohol Services and

Doncaster Central Learning Centre. It

offered the opportunity for questions to

be answered prior to the funding round

being opened for applications.

Our annual celebration event, delivered at

the newly renovated Doncaster Wool

Market (pictured above), had the pleasure

of hearing from some of the projects,

which were funded as part of the 2018

programme.

Attendees were able enjoy some

spellbinding stage magic from Magi-Cal.

We have invited every organisation who

has worked with us throughout the

duration of our micro-grant programme to

reconnect with us and explore the

possibilities of bringing organisations

together to create a mutually beneficially

network of Voluntary, Community and

Faith Sector organisations.

It will also provide an opportunity for

organisations to skill share, help support

each other through crucial times and

celebrate each other’s successes.

Our vision for this network is what

grassroots organisations are all about:

people helping people. As we move

into the next phase of establishing this

network, we invite any community

organisation who believes they can bring

additional value and benefit to get in

touch with us and get involved.


Young Healthwatch Champions

At Healthwatch Doncaster, we want

young people to have their voices heard

and to gain insight on how the Health

and Social Care sector works. We want

to support young people who will be the

leaders of tomorrow.

With this in mind, we developed our Young

Healthwatch programme to help health and

social care students who required a provider

placement to complete their educational

qualifications. They also gain awareness and

skills needed to develop their careers. Our

programme developed into the ‘Young

Healthwatch Champions’.

This opportunity enabled us to build on

existing connections with Doncaster College to

create a strong partnership of directing

students to apply for our placement

opportunities. Once we had interviewed and

selected students for placements, sessions

were delivered in two 4-hour weekly

segments. Young people were mentored and

supported throughout their placement.

Sessions included: visits to organisations

within our existing networks so that students

were able to see how services were delivered.

For example, community space ‘Sober Social’,

delivered by Doncaster Alcohol Services, gave

the students opportunity to meet people in

recovery from substance misuse whilst also

speaking with the community professionals.

In addition to this, a representative from a

local learning disability peer support group

delivered a presentation to help raise the

young people’s awareness of the learning

disability community. Furthermore, the

students were able to access in-house

safeguarding awareness training to help boost

their understanding of safeguarding and how

to identify people at risk.

Alongside our student placement

opportunities, we also launched our monthly

meet up sessions which offer a safe space for

young people to meet and discuss relevant

issues. Topics included mental health support

for young people, where do I go for sexual

health issues, gender identity, visible vs

invisible health conditions and many more.

Future plans will see Young Healthwatch have

a stronger digital presence utilising social

media platforms and video calling will be used

as a way of supporting more young people

through the peaks and pitfalls of everyday life.

Activities during the meet-ups always involve creativity!

A huge thank you to students Amber C, Amber M, Beth, Bethany, Caitlin, Chloe, Cameron, Elisha, Holly, Janine, Jessica D, Jessica W, Jenani, Kacey, Kacie-Lea, Lauren, Leah, Mara, Melissa, Natalia, Sharni for their contribution to the work of Healthwatch Doncaster during vocational placements.

Read how Natalia, Mara, and Holly found their placement experience..


What did you enjoy the most?

Mara: I enjoyed all the activities I took part in and the support I have been given. I

appreciated the way I have been treated by the Healthwatch Doncaster team

Natalia: I really have enjoy the fact that I got to take part in the Micro-Grant project and I

got to directly take part in what it means to work for them

Holly: I enjoyed learning about Clinical Commissioning Groups and completing the suicide

awareness course.

Did the placement enhance your learning?

Mara: I feel more than confident to say that Healthwatch Doncaster provided me with the

opportunity of improving my knowledge and skills

Natalia: The placement definitely enhanced my learning as I got to listen to a lot of people

with much more knowledge than I have and I picked up interesting things and facts

Holly: I learnt a wide range of things to do with health and social care which will be useful

for my course

Did you feel the team supported you appropriately?

Mara: The team provided me with the best support. They asked me to get involved in their

project, which made me feel worthy and helpful

Natalia: Always listened to what I had to say and made sure I was pleased and comfortable

with the environment and with the tasks.

Holly: No one was impatient with me when I had questions or when I did not fully

understood the task.


Michael Smith’s storyJoining us originally on a student placement in 2018, Michael shares his reflections on creating videos, films and animations Healthwatch Doncaster as he embarks on his new college course in 2020

Michael holding the trophy for Healthwatch Doncaster’s input at a video editing course

What is the piece of work you are most

proud of?

“The introduction video because it gave

me new skills as I hadn’t tried a first

person perspective before. The more I did

it the more I felt comfortable. I felt so

proud of the video.”

How would you describe your personal

development from when you joined us in

February 2018 to February 2020?

“It has been positive as I’ve grown in

confidence due to the people I’ve met

during projects. When I started my new

course, it helped me to deal with new

surroundings and adapt quicker.”

How would you describe the support you

received from our staff team, our

volunteers and our Board?

“They would always ask me how things

were going. As time went on, I asked for

more support when I needed it. For

example with Sandie, I did a video for the

homecare and support project and she

was very helpful, giving me ideas on how

she wanted it.”

Is there any training you’ve enjoyed?

I learnt about software to create videos

using my phone at training I attended

with Akhlaq in Leeds. Plus, we came home

with a trophy for our group work!

What would you say to prospective

students considering a placement with

Healthwatch Doncaster?

“I highly recommend it to anyone looking

for experience, it’s a good work

environment. The people are nice and

made me feel welcome.”

Michael did some video workinvolving the volunteer group.

He was very professional.

He put interviewees at theirease which minimised theiranxiety about being on camera.

A testimonial from Healthwatch Doncaster’s volunteers on Michael

Covid-19

Our Chief Operating Officer Andrew

Goodall explains how Healthwatch

Doncaster reacted to the Covid-19

pandemic..

Covid-19 did not take us by surprise –

there were lots of reports from Italy and

Spain about the impact and scale of

changes need to defeat it – but national

changes did happen very quickly.

I am proud to say that Healthwatch

Doncaster, as a team and an organisation,

were able to react quickly and effectively

in response to the pandemic and the

national ‘lockdown’.

The Healthwatch Doncaster team were up

and running on Zoom and using remote

working immediately and we were able to

provide accurate and up to date

information through our website and

through our social media channels.

Home working and engagement through

digital channels is now part of the new

normal. The team have developed new

services and ways of engagement through

the Reaching Out project and the Daily

Dose of Healthwatch Doncaster.

All of our meeting and support

conversations take place through Zoom or

Facebook Live and it has given us all the

opportunity to become more efficient and

streamlined in our approach to agile and

remote working.

Our journey through the Covid-19

pandemic and into recovery and renewal

will be a steady one and one that we will

use to maintain our presence in

communities and our support for local

people and groups through digital tools.

Healthwatch Doncaster will still be

listening to local people about their

experiences of health and care and we

will still be championing the voice of local

people to improve the quality of health

and care services.


Healthwatch Doncaster – Facing A Pandemicwritten by Jill Telford

A dedicated team where do I start,Each one passionate about playing their part.Covid-19 came our way,And in our house we had to stay!

Not to be beat,We took our seat!Engagement with others remained in our heart,But in a Pandemic where do we start?

Talking to people from our room,Using a new platform known as Zoom.Passing on information, keeping people up to date,For sharing with others, not forgetting your mate.

Reaching Out became a must,We had to get the situation sussed.Tell us what you think, talk to usREGISTER online, don’t get the bus

When we have your details, we’ll pick up the phone,Whilst you sit on the couch in your own home.So to pass the timeand have a chat,Complete the registrationit’s as easy as that

Another addition Daily Dose, Monday to Friday,Download Zoom, Call at 11.00 I’d sayYou’ll need a code to enter the meeting,Find it on Facebook or Twitter then get comfy seating.

Make a Difference Monday starts the week,On Tuesday people talking, is what we seek.On Wednesday stories of health and social care we want to hear,Whilst Thursday we offer “Tech” support - no fear.

Reaching Out and Daily Dose, what we offer to aid,To all of you who in your homes you have stayed.Covid-19 how has it been for you?Talk to us, tell us your view.

Our Volunteers


Volunteers’ influence

Some of the work that the Healthwatch

Doncaster Volunteers have been

involved in during the period covered by

this report are:

• Regularly attending volunteer meetings

where we discuss issues relating to health and

social care both locally and nationally: These

enable us to identify areas of work that our

Healthwatch may want to develop.

• Planning and implementation of our Enter

and View programme: Our Enter and View

Planning Group have been instrumental in

helping to develop our Enter and View

programme and supporting our Authorised

Representatives.

• Representing the patient’s voice in focus

groups, grants panels and as part of the

commissioning process. One example is the

Urgent and Emergency Care project, here’s

what one of our volunteers had to say about

being involved in the tendering process for a

local service: “Our role was to score and

moderate parts of the bids from a service

user’s perspective. It’s wonderful to know that

the patient’s view is taken into account

alongside the financial and clinical parts of the

process.”

• Taking part in engagement activities to

promote Healthwatch Doncaster

“Being part of the Healthwatch

Doncaster team on the day of the

Recovery Games was great fun even

though it was rather wet. We spoke

to loads of people about how to

maintain good emotional health and

gathered feedback on services.”

Words from Healthwatch Doncaster

Volunteer Sue

Healthwatch Doncaster team at the Recovery Games in August 2019

Want to volunteer with Healthwatch Doncaster?

If you want to join our enthusiastic volunteer team, then contact us today!

Website: www.healthwatchdoncaster.org.uk/getinvolved

Telephone: 01302 965450

Email: [email protected]

Enter and View

During the period covered in this report our Authorised Representatives have

undertaken the following visits to local care homes (scheduled visits for March 2020

were postponed due to the Covid-19 pandemic):

The reports from these visits can be found here:

https://www.healthwatchdoncaster.org.uk/reports/

We carry out follow up visits 3-6 months after our original visit to see which, if any, of our

recommendations have been taken on board by the providers. This enables us to measure the

impact of our Enter and View programme in terms of improved experience for the recipients of

the service, to date this has been mostly positive.

The services that we visit appreciate our input and tell us that it is useful to have an independent

opinion on where service delivery can be improved.


It is great to see things through fresh eyes, we are here every day caring for people and sometimes it’s hard to see the bigger picture. We appreciate your input because if we can improve things even further we are happy to do it

Care Home Date Reason for visit Recommendations

Woodlea, Doncaster 17.4.19 Proactive Yes - minor

Stenson Court, Balby 15.5.19 Proactive Yes - minor

Roman Court, Mexborough

23.5.19 Proactive Yes - minor

The Old Rectory, Armthorpe


Headingly Court, Edlington


Headingly Park, Edlington


Thorndene,Doncaster


A quote from a Care Home manager aboutHealthwatch Doncaster Enter and View visits

https://www.healthwatchdoncaster.org.uk/reports/

Patient Stories

NHS Doncaster Clinical Commissioning Group

have monthly Governing Body meetings.

Patient stories are scheduled at each meeting

for members of the public to share their

experiences of local health and care services.

Since June 2019, Healthwatch Doncaster have facilitated the patient stories for the Governing

Body and we have supported local people to share their experiences of health and care services.

It was agreed that use of the Life Stages – Starting Well, Living Well and Ageing Well – would be

a good approach for the focus of each meeting.

This initiative has been very successful and feedback from the Governing

Body members and participants has been very positive. The Governing

Body have assured those attending that the information they have

received will be used to influence future service delivery.


Stories so far have included:

Lower back pain management

Work of the Young Advisors

Frailty services

Support for young people with Autism

Mental Health services

Life in a care home

Support for Children and Young People with additional health needs

Primary care services

Signposting and Information

This year we helped 294 people get the advice and information they need by: • Providing advice and information articles on our website• Answering people’s queries about services through a variety of different ways• Talking to people at community events• Promoting services and information that can help people on our social media channels


35%

16%

34%

8%

6%

Telephone Email Website Social Media Office

How did people contact Healthwatch Doncaster?


Twitter Facebook Instagram

1,974 Number of posts

739,398Total reach

1,850Video views

4,206Post engagements

Our Facebook post sharing information about the NHS Long Term Plan reached over 25,000

people across April and May

Choice for All Doncaster (ChAD)


ChAD were contacted by Joanne Blockley (Patient Advice and Liaison Team leader) from the local AcuteTrust to see if they could give their opinions on proposed feedback forms for the Friends and Family Test. Many simplified amendments were proposed and fed back to Joanne, who thanked ChAD for their prompt, detailed and constructive response.

In December, ChAD and RossingtonSMILE members took part in a photo shoot and filming at Diamond Activity and Therapeutic Services (formally The Solar Centre). All involved will feature in a short film and brochure to promote the service and activities available.

Find out more about us and the work we do

Telephone: 07834 686858

Email: [email protected]

Facebook: www.facebook.com/chadoncaster

Website: www.chadindoncaster.com

ChAD and Rossington SMILE were successful in receiving a micro-grant from Healthwatch Doncaster to put together a package about scams/social media. This enabled us to visit Lifewiseto find out more information to create three short video clips on different scenarios and write a song working with Mark Coley, from Rotherham Doncaster and South Humber NHS Foundation Trust

Following the work which ChAD had been involved in on the All Age Learning Disability and Autism Strategy, they were invited to attend the Scrutiny Panel at the Civic building where Doncaster Councillors and commissioners asked questions about difficulties people with a Learning Disability encounter.

mailto:[email protected]

http://www.facebook.com/chadoncaster

http://www.chadindoncaster.com/

The Forum’s main purpose

is to help

keep

people in

Doncaster safe

and well.

We achieve this in multiple ways, which

include hosting a bi-monthly Forum,

developing social media platforms and an

annual event highlighting the great

achievements of keeping people safe and

well throughout the year.

Our Forum has grown with membership

extended to people and professionals who

have an active interest in safeguarding

children, because we felt there was a

crossover of relevant issues and a need

for greater awareness.

Naturally, this influenced the variety of

guest speakers who attended the Forum.

We received information from South

Yorkshire Fire and Rescue, Voiceability,

Victim Support and Doncaster Culture and

Leisure Trust, to name a few.

Special thanks goes to Ian Walker –

Gamblers Anonymous – who shared his

personal journey about struggling with a

gambling addiction. He also shared how

gambling can affect anyone at any age

from school children to older people.

The Forum has identified a representative

to attend the local Keeping Safe sub-

group of Joint Safeguarding Boards to

share insight and ideas on local

campaigns and development of greater

partnership working between

organisations who work with adults and

children.

Our annual Keeping Safe event (pictured

below) was a festive feast. It was opened

by John Woodhouse, Chair of the Joint

Adults and Children Safeguarding Board.

Dr Alan Billings, South Yorkshire Police

Commissioner, then shared details of the

newly established Violence Reduction

Unit.

Highlights also included Jodie Keegans’

Survivors Story about domestic violence

and a showcase of how local groups are

helping to contribute to a safer Doncaster.

A local Primary School choir, who joined

us midway through the event, sang

modern Christmas songs which added a

special sparkle and festive feel to an

informative and enjoyable day.


Doncaster Keeping Safe Forum

Patient Participation Group Network


Our Patient Participation Group

Network (PPG) supports local PPG

members to come together from

across the localities and

communities in Doncaster and share

knowledge and insight.

The PPG Network enables Healthwatch

Doncaster to act as a conduit between

local patients and the local Clinical

Commissioning Group. This enhances

communication channels and helps

influence service development at a

strategic level.

Our PPG network have seen a range of

developments in Primary Care. A series of

Primary Care networks have developed

across the localities within the local area

of Doncaster with a Locality Co-ordinator

supporting community participation.

Patient Participation Groups have been

invited to be actively involved within their

own localities.

This includes bringing the Primary Care

Network representatives together with

our Patient Participation Group

representatives to discuss and support a

way forward for positive community

change.

The NHS Digital app was been trialled

and tested with a small number of

practices during the autumn and winter

months, which then saw a Borough wide

roll out of digital services enabling

patients to book appointments and order

repeat prescriptions through the NHS

App. The PPG Network were shown how

the new mobile application could benefit

patients during the trial phase so they

were able to share this information with

their own patient groups prior to the

Borough wide release.

Over the previous year, network speakers

have included: Tina Hope and Liz Leggott

from Primary Care Doncaster who shared

relevant updates on the extended access

service, which is now branded ‘More

Choice, More Appointments’; Clinical

Director Ben Scott shared his vision about

how his locality will be moving forward

and Julie Magee, the Neighbourhood Co-

ordinator for the South locality. The PPG

Network’s own carer representative

shared new information on carers and the

new ‘jointly’ app that connects everyone

who is involved with an individual’s care.

Finally, ‘Sharing Best Practice’ has been

reintroduced and consolidated into an

informative resource to help support the

on-going development of Patient

Participation Groups.

Showcasing the Network at an outreach event in Doncaster with this informative display board

Health Ambassadors


People with seldom heard voices are

not often listened to but our Health

Ambassadors initiative helps the

more marginalised communities

within Doncaster have an

opportunity to speak up and have

their say on local health and social

care services.

We have representatives from the

following communities:

• Transgender

• BAME

• Deaf

• LGBTQ+

• Asylum seekers

Every meeting, each Ambassador offers

an update on their community with

regards to what struggles they are

currently facing and any positive changes

that are happening. This provides a

supportive space where Ambassadors can

offer to help each other.

Topics of discussions throughout the year

have highlighted: video relay service – is

it being utilised enough in health settings

such as GP or hospital appointments?,

barriers faced by asylum seekers when

they wish to access GP and dental

appointments, concerns around access

and communication to and from the local

sensory team and issues regarding

prescribing medication for transgender

individuals.

All issues raised have been appropriately

addressed with the local Clinical

Commissioning Group and discussions are

ongoing to find solutions where possible.

This year we have recruited

representatives from the veteran’s

community, the deaf community, the

mental health community and young

people with autism. Moving forward,

future plans include recruiting a

Dementia representative and a young

carers representative.

Meetings have seen guest speakers from

Doncaster Council’s Equality and Diversity

team, the Voluntary, Community and

Faith Sector support team, a

representative from Healthwatch

Sheffield and colleagues from NHS

Doncaster Clinical Commissioning Group.

Trans Mission - representatives of the transgender community - at Doncaster Pride 2019

Our Finances

We are funded by our Local Authority under the Health and Social Care Act (2012).

Our core contract value is £216,360. We also received income from other services

that we delivered.


72%

9%

19%

Staffing costs

Premisescosts

Running costs £276,745

78%

7%

10%

5%

83% funding receivedfrom Doncaster Council

8% funding received fromNHS Doncaster CCG

10% additional incomefrom other work

5% income from ourreserves

£276,745

Hooton Pagnell

Photo Credit: Healthwatch volunteerPhoto Credit: Irene

Lound Hill

Photo Credit: Healthwatch volunteerPhoto Credit: John Burke

Hill Farm

Photo Credit: Healthwatch volunteer

Our Doncaster

Our priorities for 2020-21


Missed Appointments: Revisiting the project that we completed in 2017 to evaluate the impact of the changes to hospital appointments, based on our recommendations from our original report

Re-imaging engagement and involvement: We want to continue to deliver creative and innovative ways of engagement, involving local people and service providers to co-produce projects using online tools during the Covid-19 Pandemic.

Covid-19: How will people access health and social care services? What will be their experience of how services operate in the ‘new normal’.

Healthwatch Doncaster’s priorities and projects are influenced by what

we hear from local people and partners from across the Borough.

Cancer: The lived experience of people going through the cancer pathway in Doncaster.

Care and Support at Home: Talking to people about their experiences of care and support at home in the local community. Have things changed and improved since our last report in 2018?

Mental Health services: How do people access Mental Health support services in Doncaster, in light of the increase in demand relating to the Covid-19 pandemic?


Message from our Chief Operating Officer

The year started off with active

engagement in local communities across

a number of key projects and then

finished off with the Covid-19 pandemic.

The pandemic did not knock us off our

stride – it enabled us to finish the year

off by engaging with people over Zoom

and Facebook Live.

In 2019-20, Healthwatch Doncaster reinforced

our commitment to Engage, Inform and

Influence.

Engage: Healthwatch Doncaster set up and

delivered another successful Micro-Grants

programme and we supported all the

organisations that we have funded over the

last 3 years to come together as a network.

We led on a key piece of work across South

Yorkshire and Bassetlaw talking to people

about the NHS Long Term Plan and we

received national recognition for our work

locally and regionally.

Inform: Healthwatch Doncaster have

continued to provide high quality and

signposting information and support to local

people. We have developed the ‘What’s Your

Story’ approach to engagement in community

events and used this to listen to people’s

experience of emotional and mental health

support services in Doncaster. Healthwatch

Doncaster have worked closely with local

partners to deliver a key piece of work finding

out about people’s experience of accessing GP

services locally.

Influence: Healthwatch Doncaster continue to

be a loud voice for the views of local people

at the Health and Wellbeing Board,

Safeguarding Boards, Governing Bodies and

Committees. Not only are we a loud voice but

the voices of local people come through in the

reports that we write and the

recommendations that we make. We continue

to work with partners to influence an

improvement in the quality of local health and

care services

Andrew Goodall

Chief Operating Officer

Healthwatch Doncaster

The Healthwatch Doncaster team with the trophy as a result of the work around the Long Term Plan

Thanking our partners

Healthwatch Doncaster has really positive strategic and operational partnerships and relationships across health and social care in Doncaster. It is through these networks and relationships that we can overcome barriers and support local people’s voices to continue to shape and influence local services.

Healthwatch Doncaster focussed on a number of key projects in 2019-20 and we were able to deliver these to our usual high standards by working closely with all of our partners. Without these strong, local relationships we would not be able talk to as many people receiving care and support from the great services in Doncaster.

Healthwatch Doncaster are only as successful and effective as the partnerships that we have forged locally and for us these partnerships are strong and long-standing.

We would like to thank our key local partners for all their help, support and challenge over the last 12 months: • NHS Doncaster CCG• Doncaster Council• Doncaster and Bassetlaw Teaching

Hospitals NHS Foundation Trust (DBTH)• Rotherham, Doncaster and South Humber

NHS Foundation Trust (RDaSH)• Primary Care Doncaster• Local Medical Committee• Local Pharmaceutical Committee• South Yorkshire and Bassetlaw Integrated

Care System

Our local networks and relationships enable local people’s voices and opinions to make a difference and improve local services.

We have only been able to deliver the high quality reports and recommendations by working in partnership with local groups and

community organisations – without your support we would not have been able to hear as many voices and listen to as many stories and experiences of local health and care services.

Healthwatch Doncaster supports some specific networks and groups. You will have heard about the work of these groups and the voices of group members throughout this report.

Thank you to Choice for All Doncaster for speaking up on behalf of people with a Learning Disability.

Thank you to the Keeping Safe Forum for sharing messages and information to keep local people safe.

Thank you to the Health Ambassadors for supporting people, whose voices are not often heard, to speak up and speak out.

Thank you to the Healthwatch Doncaster Volunteers for getting involved in our engagement work, for leading on Enter and View and for coming up with new ideas for projects and pieces of work.

Finally, thank you to the Patient Participation Group (PPG) Network for speaking up on behalf of your individual PPG and patients so that we can support continued improvement in Primary Care. Norma Carr – Chair of the PPG Network – is stepping down as Chair from June 2020 onward. Thank you for your passion, motivation and contributions Norma. You have supported the PPG Network to grow and develop through challenge, learning and reflection. The PPG Network will continue to grow and maintain the support for local PPGs.


Contact usHealthwatch Doncaster

Cavendish CourtSouth Parade

DoncasterDN1 2DJ

01302 965450

[email protected]

www.healthwatchdoncaster.org.uk

@hwdoncaster/hwdoncaster

/healthwatchdoncaster


We confirm that we are using the Healthwatch Trademark (which covers the logo and Healthwatch brand) when undertaking work on our statutory activities as

covered by the licence agreement.

If you need this in an alternative format please contact us.

Company Number: 10158147© Copyright Healthwatch Doncaster 2020

mailto:[email protected]

http://www.healthwatchdoncaster.org.uk/

1

Meeting name Governing Body

Meeting date 6th August 2020

Title of paper

Quality & Performance Report

Executive / Clinical Lead(s)

Mr Andrew Russell, Chief Nurse

Mr Anthony Fitzgerald, Director of Strategy & Delivery

Author(s) Performance and Intelligence Team

Quality Team

Status of the Report

To approve To consider / discuss To note

Purpose of Paper - Executive Summary

This report sets out the key quality and performance issues to be noted by the NHS Doncaster Clinical Commissioning Group (DCCG) Governing Body which due to reporting restrictions or information potentially identifiable to a patient level have not been included within the main report. This report reflects 2019/20 and 2020/21 performance and includes a focus on 2020/21’s Living Well SDP. Due to the COVID-19 pandemic NHS England and NHS Improvement have reduced routine reporting requirements on NHS Organisations to release capacity and manage responses. Further details on the reporting ceased which have been agreed with DCCG’s main providers can be found here: https://www.england.nhs.uk/coronavirus/publication/reducing-burden-and-releasing-capacity-at-nhs-providers-and-commissioners-to-manage-the-covid-19-pandemic/. As detailed in May, August’s report continues to adopt the national reporting

approach with Phase 3 recovery plans awaited. Organisations are now in discussion

with NHS England and producing recovery plans to recover baseline positions pre-

Covid-19.

Please note all data is validated and quality checked internally within DCCG and with Providers as necessary. Where there is a data quality concern on any of the data or metrics presented in the following report, this will be stated in the narrative accompanying the data. Measures which also form part of the NHS Oversight Framework have been identified as (OF) within this report. The overall response will impact a number of measures, and the ability of providers to report information, in the coming which will be detailed in future reports.

x

2

The key areas of change, both positive and negative, to note since the last report are: NHS Doncaster Clinical Commissioning Group (DCCG)

Patients on incomplete non-emergency referral to treatment (RTT) pathways (yet to start treatment) should have been waiting no more than 18 weeks – Performance decreased to 61.4% during June and remains below the 92% target (Page 5). The total waiting list size remains within target.

52 week waits – There were 49 DCCG patients waiting over 52 weeks for treatment at the end of June (Page 10).

Patients waiting less than 6 weeks for a diagnostic test – Performance in June failed to meet the 99% target at 36.0% (Page 11)

Cancer 2 week waits – Performance during May 2020 met the 93% target at 97.9% (Page 15).

Cancer breast symptoms – Performance during May 2020 failed to meet the 93% target at 87.5% (Page 17).

New measure: Cancer 28 days faster diagnosis standard – Performance during May 2020 was 85.5% (Page 17)

Cancer 31 day waits – Performance during April 2020 failed to meet the 96% target at 92.9% (Page 18).

Cancer 62 day waits – Performance during April 2020 failed to meet the 85% target at 72.5% (Page 20).

Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust (DBTHFT)

Patients on incomplete non-emergency referral to treatment (RTT) pathways (yet to start treatment) should have been waiting no more than 18 weeks – Performance deteriorated to 58.8% in June below the 92% recovery trajectory (Page 5).

52 week waits – There were 52 patients at the Trust waiting over 52 weeks for treatment at the end of June 2020 (Page 10).

Patients waiting less than 6 weeks for a diagnostic test – Performance improved in June to 35.5% below the 99% target (Page 12).

Accident and Emergency – Performance decreased in June 2020 to 93.2% remaining below the 95% target (Page 13).

Cancer 31 day waits – Performance during May 2020 met the 96% target at 97.9% (Page 18).

Cancer 62 day waits – Performance during May 2020 failed to meet the 85% target at 81.6% (Page 20).

Rotherham, Doncaster & South Humber NHS Foundation Trust (RDASH)

Improving Access to Psychological Therapies (IAPT) – The proportion of people accessing the service was below the May 2020 target (3.2%) at 2.95% (Page 24)

IAPT 6 weeks RTT – Performance for DCCG patients in RDASH services increased to 59.2% during May against the 75% target (Page 24)

IAPT recovery rate – Performance remained below the 50% target in May at 44.3% (Page 25)

Other Commissioned Services

3

Yorkshire Ambulance Service – All categories met their respective targets (Page 22). Delivery Plan Reporting Full summary of 2019/20 reporting and Living well May 2020 position (Page 29)

Recommendation(s)

The Governing Body is asked to:

Note the Quality and Performance Report

Report Exempt from Public Disclosure

If yes, detail grounds for exemption: Yes No

Impact analysis

Quality impact Positive quality impact from a consistent focus on quality outcomes.

Specific quality impact as identified in the report.

Equality Impact

Tick relevant box

An Equality Impact Analysis/Assessment is not required for this report. x

An Equality Impact Analysis/Assessment has been completed and approved by the lead Head of Corporate Governance / Corporate Governance Manager. As a result of performing the analysis/assessment there are no actions arising from the analysis/assessment.



Nil

Financial implications

Nil

Legal Implications

Nil


Interest

The report is for information – no conflicts of interest identified. It should be noted that some Governing Body members may be

employed in secondary employment by organisations referenced in this

report: please see Register of Interests for details.




N/A

Report previously

presented at N/A

Risk Analysis

Risks are captured in the Executive Summary.

x

4

Assurance Framework

2.1, 2.2, 2.3, 2.4, 3.1

5

Section 1: National Frameworks and Measures 1.1: NHS Constitution Measures

1.1.1 Referral To Treatment (RTT) Performance (Oversight Framework Measure - OF)

Patients on incomplete non-emergency pathways (yet to start treatment) should have been waiting no more than 18 weeks

Commissioner Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 June-20

Doncaster CCG 86.8% 87.1% 86.5% 87.0% 87.6% 87.7% 87.5% 89.2% 90.5% 89.7% 82.6% 73.5% 61.4%

Rightcare Peer Group 88.6% 88.5% 88.0% 87.8% 87.7% 87.3% 86.4% 86.5% 86.4% 83.5% 75.5% 65.3%

Doncaster and Bassetlaw Teaching

Hospitals Foundation Trust (DBTHFT)

86.6% 86.7% 85.7% 86.4% 87.1% 87.2% 86.8% 88.8% 90.4% 90.1% 82.2% 72.3% 58.8%

England 86.2% 85.7% 84.9% 84.7% 84.6% 84.3% 83.6% 83.4% 83.1% 79.6% 70.6% 61.6%

Standard 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92%

6

Performance for Doncaster Clinical Commissioning Group (DCCG) patients at all Trusts was 61.4% in June 2020, below the 92% target. Performance was below control limits suggesting performance is under expected levels for the service. The chart above shows that RTT performance has deteriorated over the last 2 years with 3 clear stages of continual deterioration. Latest performance is below the normal range of the service, affected adversely during the Covid-19 pandemic. The DBTHFT waiting list is validated down to 12 weeks which may have a negative impact on reported performance. Eighteen specialties are failing to meet the 92% standard for DCCG:

Cardiology (63.1%)

Cardiothoracic surgery (57.7%)

Dermatology (80.5%)

Ear, Nose & Throat (52.5%)

Gastroenterology (77.8%)

General Medicine (72.1%)

General Surgery (63.5%)

Geriatric Medicine (74.2%)

Gynaecology (69.6%)

7

Neurology (68.2%)

Neurosurgery (72.0%)

Ophthalmology (59.3%)

Other (68.5%)

Plastic Surgery (69.7%)

Rheumatology (71.0%)

Thoracic Medicine (65.4%)

Trauma and Orthopaedics (T&O) (50.3%)

Urology (55.6%) The waiting list shape for Doncaster CCG patients at any provider is shown below, highlighting that the majority of patients are waiting less than 18 weeks. The CCG monitors the waiting list weekly and is in regular contact with DBTHFT and North Lincolnshire and Goole Foundation Trust for the most up to date position on patients waiting over 38 weeks in order to try to reduce long waiters, including those who may breach 52 weeks.

DBTHFT’s June 2020 position deteriorated from 72.3% in May to 58.8% in June. The additional recovery actions planned in April were compromised by the impact of Covid19.

8

Twenty Four specialties failed to meet the standard at DBTHFT in June:

Breast Surgery (89.8%)

Cardiology (64.0%)

Dermatology (77.9%)

Diabetic Medicine (63.6%)

ENT (52.4%)

General Medicine (71.8%)

General Surgery (62,2%)

Geriatric Medicine (76.1%)

Gynaecology (73.6%)

Medical Opthalmology (64.0%)

Nephrology (73.6%)

Ophthalmology (57.9%)

Oral Surgery (33.0%)

Orthodontics (36.4%)

Paediatric Cardiology (54.4%)

Paediatrics (84.5%)

Pain Management (83.4%)

Podiatry (32.0%)

Respiratory Medicine (69.2%)

Rheumatology (61.4%)

T&O (48.9%)

Upper Gastrointestinal Surgery (45.4%)

Urology (55.8%)

Vascular Surgery (73.2%) During June 2020, in line with the Trust’s Stabilisation and Recovery Plan, some routine outpatient activity has resumed. In line with national guidance no routine elective activity has taken place due to the limitations on theatre utilisation and elective bed capacity. The Trust continues to see a reduction in referrals affecting the RTT position by reducing the overall denominator of the waiting list.

9

Numerous services are already working at 100% clinic capacity using all mediums available including telephone and video consultations. Face to face consultations remain limited due to social distancing requirements. A small number of specialties will be unable to provide 100% of their clinic capacity for the foreseeable future due to the nature of the specialty e.g. Head & Neck where the majority of patients need to be seen on a face to face basis and the necessity for both medics & surgeons to cover new ‘post Covid-19’ rota's to support provision of in patient care. Remaining services are working on plans to deliver 100% of outpatient clinic capacity by using alternative methods of service delivery and extended delivery to accommodate social distancing regulations. Although activity is stepped up, there will not be a direct correlation with performance improvement as some of the prioritised patients will not be 18 weeks+. As previously reported and following national guidance all elective in patient activity is being prioritised by clinical need and routine patients are not yet being seen. 1.1.2 Waiting List Size (OF)

The expectation nationally has been revised to ensure that the number of patients on incomplete pathways is maintained below or at the

waiting list size at the end of January 2020 by March 2021. The number of DCCG patients on incomplete RTT pathways increased in June

10

2020 by 1176 patients to 19476, however continues to achieve target (22206). The Trust is aiming to maintain validation of patients at 12

weeks on the Patient Tracking List (PTL) going forwards.

1.1.3 52 Week Breaches (OF)

52 Week Waits –Incomplete Pathways

Provider Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20

Doncaster CCG 1 0 0 1 0 0 1 1 0 0 6 20 49

DBTHFT 0 0 0 3 1 1 1 1 1 1 10 27 52

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

The number of breaches has increased since April 2020 primarily due to Covid-19. The number of DCCG patients waiting over 52 weeks rose to 49 in June 2020. DBTHFT are currently reporting 52 people waiting 52 week or longer for treatment at the end of June 2020. Twenty-five of these patients were reported breaches in May. Twenty-six of these patients are DCCG patients with 15 breaches in T&O, 4 breaches in ENT, and 2 breaches in urology. The 5 other breaches that DBTHFT are reporting are in vascular, respiratory, ophthalmology, general surgery and gynaecology. RTT training and improved administrative systems will mitigate against further similar breaches. With routine elective work currently on hold the CCG anticipate that there will be 52 week breaches until routine work resumes and the backlog is addressed. As part of DBTHFT recovery plan, the Trust now needs to move urgently to reinstate work to improve underpinning administrative and validation processes, building on progress made before COVID-19. Full breach reports from DBTHFT will be sent to DCCG once completed.

11

1.1.4 Diagnostics (OF)

Patients waiting less than 6 weeks for a Diagnostic test

Commissioner Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20

Doncaster CCG 98.7% 99.3% 98.6% 99.3% 99.2% 98.7% 95.8% 94.6% 99.2% 90.0% 38.2% 29.2% 36.0%

Rightcare Peer Group 97.3% 97.0% 96.0% 95.8% 96.9% 97.0% 95.2% 95.3% 97.3% 91.8% 38.9% 37.7%

DBTHFT 98.7% 99.1% 98.7% 99.3% 99.3% 98.6% 96.2% 95.4% 99.1% 89.9% 36.9% 28.4% 35.5%

England 96.5% 96.8% 96.0% 96.5% 97.1% 97.2% 95.8% 95.6% 97.2% 89.8% 44.6% 41.5%

Standard 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99% 99%

12

Performance for DCCG in June 2020 increased to 36% of patients waiting less than 6 weeks for a test (5669 breaches) below the 99% target. Performance is below the statistical process control limits on the chart above which indicates performance is outside the normal variation expected for the service. Since March performance has been severely impacted by the COVID-19 situation. DBTHFT’s June 2020 position improved to 35.53% against a standard of 99%. The table below shows the diagnostic modalities that were impacted by Covid-19. Due to the National and Local response to the pandemic from 18th March 2020, the majority of the Trust’s routine activity ceased, limiting their ability to see patients already in the system and those referred in within the 6 week timeframe.

Diagnostic services for ‘two week waits (suspected cancer)’ and urgent patients continues with primary care being urged to continue referring patients through these pathways. Teams continue to assess all request cards to ensure urgent patients are seen in order of clinical priority. There is a robust process in place to ensure that no urgent patients are missed, with an internal Standard Operating Procedure in place for clinical triage.

Exam Type <6W >=6W Total Performance

Longest Breach (weeks)

MRI 533 1199 1732 30.77% 24

CT 1067 1235 2302 46.35% 27

Non-Obstetric Ultrasound 1786 3327 5113 34.93% 31

DEXA 209 353 562 37.19% 24

Audiology 0 265 265 0.00% 24

Echo 245 430 675 36.30% 15

Nerve Conduction 27 125 152 17.76% 21

Sleep Study 30 33 63 47.62% 15

Urodynamic 2 91 93 2.15% 27

Colonoscopy 218 377 595 36.64% 23

Flexible Sigmoidoscopy 65 138 203 32.02% 19

Cystoscopy 125 145 270 46.30% 25

Gastroscopy 225 505 730 30.82% 26

Total 4532 8223 12755 35.53%

13

Due to national guidelines & social distancing measures all diagnostic modalities will only be able to offer a percentage of their pre-Covid capacity and as with other elective services patients will be seen in order of clinical priority and not longest waits so any increase in activity will not have a direct correlation with an improvement in performance. Recovery plans for all diagnostic modalities have now been submitted and agreed with the majority of modalities now offering routine capacity. Social distancing and patient flow have been a priority to ensure all patients and staff remain safe while providing increased levels of access to diagnostics. Waiting patients continue to be reviewed & risk stratified, with patients being booked in order of clinical need. Communication continues with the Integrated Care System to ensure an equitable approach across the region and to take advantage of capacity offered from other parts of the region. 1.1.5 A&E attendance to admission, transfer or discharge (OF)

A&E attendances under 4 hours from arrival to admission, transfer or discharge

Provider Jun-19 Jul-19 Aug-

19 Sept-19 Oct-19 Nov-19 Dec-19 Jan-20

Feb-

20 Mar-20 Apr-20

May-

20 June-20

DBTHFT (all

attendances, based on

daily reported figures)

91.4% 90.4% 88.1% 88.7% 90.3% 85.9% 82.3% 84.8% 85.4% 88.0% 90.9% 94.7% 93.2%

DBTHFT (Type 1

attendances) 88.4% 87.7% 84.2% 83.8% 87.8% 82.5% 76.8% 79.4% 80.4% 84.4% 92.5% 93.9% 91.7%

England (all

attendances) 86.4% 86.5% 96.3% 85.4% 83.6% 81.4% 79.8% 81.7% 82.8% 84.2% 90.4% 93.5% 92.8%

Standard 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

14

Covid-19 has continued to impact on both EDs with departments split into 2 areas to manage 2 simultaneous pathways (yellow & blue patients). Compared to June 2019, the Trust saw 17% fewer attendances. This mainly consisted of a reduction in ‘minors’ patients at Doncaster Royal Infirmary (DRI) and a significant reduction in paediatric patients across all sites. DRI has continued to see high acuity of type 1 presentations and there has been a continued increase in non-Covid related presentations. Throughout June 2020 a review of the split of Covid and non-Covid patients has taken place and resulted in a paper being presented to the Executive Team to seek approval to increase non-Covid capacity within the Departments. This was authorised with implementation taking place from 1st July 2020. Earlier Senior Assessment, ‘Super-tracking’ of patients by a Senior Doctor and Emergency Assessment Unit continue to deliver improvements in flow particularly on the DRI site. Ongoing work continues with the teams to build and embed relationships and foster more effective patient pathways both within the Division and in the wider Trust.

15

1.1.6 Cancer Measures DBTHFT are participating in the testing phase of the Clinically-led Review of Standards (CRS) for cancer as 1 of 13 sites nationally. As part of the testing there will be a change in reporting with 2 week wait for breast symptomatic reporting no longer available for the Trust to be benchmarked. An additional Faster Diagnosis Standard will be trialed during this period and is defined as a ‘Maximum four weeks (28 days) from receipt of urgent General Medical Practitioner, General Dental Practitioner or Optometrist referral for suspected cancer, breast symptomatic referral or urgent screening referral, to the point at which the patient is told they have cancer, or cancer is definitely excluded’. Work has been completed across intelligence teams within the Integrated Care System to ensure that the impact of Covid-19 can robustly be monitored in relation to cancer treatment. From April 2020 onwards Trusts have been requested to assign Covid-19 related 2 week wait breaches under ‘Other Reason’. For all other measures ‘Other reasons’ relate to all miscellaneous reasons.

2 week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP

Commissioner Aug-

19

Sep-

19

Q2

19/20

Oct-

19

Nov-

19

Dec-

19

Q3

19/20

Jan-

20

Feb-

20

Mar-

20

Q4

19/20

Apr-

20

May-

20

Doncaster CCG 95.8% 96.7% 95.0% 94.8% 94.7% 94.2% 94.6% 92.8% 95.8% 94.6% 94.4% 92.5% 97.9%

Rightcare Peer Group 93.7% 94.5% 94.1% 94.9% 95.2% 95.4% 95.2% 94.5% 94.7% 95.3% 94.8% 83.8% 96.5%

Cancer Alliance 94.6% 94.9% 93.7% 93.9% 94.0% 94.6% 94.2% 93.5% 95.3% 94.9% 94.6% 89.1% 98.0%

England 89.3% 90.1% 90.2% 91.4% 91.3% 91.9% 91.5% 90.1% 92.8% 91.9% 91.6% 88.0% 94.2%

Target 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93%

16

Performance in May of 97.9% was above the target of 93% with only 11 breaches within the month. The 11 breaches were categorised as followed: Administrative Delay (1), Patient Choice (1) and 'Other Reasons' (9), which has been used to identify where Covid-19 has impacted the pathway. Urology was the only tumour group to perform below the desired 93% performance at 85.7%, 5 breaches from 35 patients seen, all of which were delayed as a result of Covid-19 breach reasons. The remaining breaches were distributed across the following tumour groups; Breast (2), Gynaecology (2), Skin (1) and Lower GI (1). The longest an individual had to wait to be first seen was 59 days, in the Urological Tumour Group due to a Covid-19 related breach. Local intelligence from within the Cancer Team at DBTHFT indicates that there has been a reduction of 53% in the number two week wait patients seen in April and May. The decreasing number of referrals has been highlighted at Cancer Programme Board and a recovery plan is being developed. The Performance Intelligence Team are working closely with the Cancer Team at DBTHFT monitoring cancer referrals, showing that referrals and booked appointments are starting to recover to normal average amounts from the first week of June. The numbers of referrals have increased in the first two weeks in July where eight of the nine major tracked tumour groups have shown an increase of 20% above the pre-covid19 average referral numbers.

17

2 week wait for first outpatient appointment for patients referred urgently with breast symptoms (where cancer was not initially

suspected)

Commissioner Aug-

19

Sep-

19

Q2

19/20

Oct-

19

Nov-

19

Dec-

19

Q3

19/20

Jan-

20

Feb-

20

Mar-

20

Q4

19/20

Apr-

20

May-

20

Doncaster CCG 98.1% 100% 95.8% 98.5% 95.1% 92.2% 95.2% 92.1% 100% 97.6% 96.5% 100% 87.5%


Cancer Alliance 93.3% 97.6% 91.1% 94.6% 93.9% 90.4% 93.0% 90.8% 93.5% 89.9% 91.3% 90.9% 97.4%

England 85.9% 88.0% 85.3% 89.9% 87.5% 84.3% 87.3% 83.6% 87.3% 86.1% 85.6% 80.9% 93.7%

Target 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93%

Performance in May 2020 was below the target of 93% at 87.5% due to the 1 breach within the month. The breach was due to ' Other

reasons' meaning it was a Covid-19 related breach. The patient had to wait 15 days to be first seen from referral.

Maximum four weeks (28 days) from receipt of urgent General Practice (General Medical Practitioner, General Dental Practitioner or Optometrist) referral for suspected cancer, breast symptomatic referral or urgent screening referral, to point at which patient is told

they have cancer, or cancer is definitely excluded

Commissioner Aug-19

Sep-19

Q2 19/20

Oct-19

Nov-19

Dec-19

Q3 19/20

Jan-20

Feb-20 Mar-20

Q4 19/20

Apr-20 May-

20

Doncaster CCG 80.6% 73.7% 79.1% 79.5% 80.9% 82.8% 81.0% 78.9% 83.3% 81.0%

81.2% 72.1% 85.5%

The standard operating contract for the 2020/21 financial year has indicated that the 28 Day Faster Diagnosis Standard (FDS) performance target will be held at 75%. However, after discussions with local services, it has been agreed to maintain the local target of 80%. During the Covid-19 pandemic the national pilot period for 28 Day FDS has been paused but Trusts are still required to report against performance.

18

Both Upper GI and Urology were the 2 lowest performing tumour groups at 69.5% and 51.9% respectively. When breaking down into Confirmed and ruling out of Cancer, the performance was 85.7% and 86.5%.

31-day wait from diagnosis to first definitive treatment for all cancers

Commissioner Aug-

19 Sep-19

Q2

19/20 Oct-19 Nov-19 Dec-19

Q3

19/20 Jan-20 Feb-20 Mar-20

Q4

19/20 Apr-20

May-

20

Doncaster CCG 96.4% 95.9% 96.1% 96.9% 96.2% 98.4% 97.1% 95.2% 94.1% 95.6% 95.0% 92.9% 92.9%


Cancer Alliance 96.8% 97.2% 97.1% 97.1% 97.8% 96.9% 97.3% 96.1% 96.7% 96.9% 96.5% 95.7% 94.2%

DBTHFT 100% 100% 98.8% 100% 100% 100% 100% 97.8% 99.2% 100% 99.1% 98.5% 97.9%

England 96.1% 95.5% 96.0% 96.2% 95.9% 96.0 96.0% 94.6% 96.3% 96.7% 95.9% 96.3% 93.9%

Target 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96% 96%

19

There were 7 breaches within May 2020, resulting in performance of 92.9% compared to the 96% target. The 7 breaches were in the

following tumour groups; Head & Neck (1), Lower GI (2), Lung (2), Skin (1) and Upper GI (1). The breaches were as a result of the

following reasons; Other Reasons (4), Patient initiated delay (2) and Treatment delayed for medical reasons (1). There were a total of 3

treatment pathways that were delayed as a result of Covid-19, 2 in Lower GI and 1 in Skin. The longest an individual had to wait from

Decision to Treat was 63 days, in the Lower GI tumour group and was a Covid-19 related breach requiring Surgery.

It has been noted that although the total number of treatments has decreased during the pandemic, the total that has had a surgical

treatment has increased compared the first 2 months of the previous year. The Performance and Intelligence Team is working with the

Cancer Team at DBHT to monitor the split of both first and subsequent treatment modalities compared to previous years.

It is expected that the impact of the Covid-19 pandemic on treatments will be seen in the coming months as the total number of patients

requiring a first treatment increases as capacity is reducing.

31 day wait for subsequent treatment

Commissioner Aug-

19 Sep-19

Q2

19/20 Oct-19 Nov-19 Dec-19

Q3

19/20 Jan-20 Feb-20 Mar-20

Q4

19/20 Apr-20

May-

20

Surgery - Doncaster

CCG 95.2% 94.7% 97.0% 96.0% 91.7% 100% 96.5% 92.3% 100% 73.9% 90.2% 100% 90.3%

Radiotherapy -

Doncaster CCG 92.0% 90.5% 92.8% 93.0% 89.6% 84.6% 89.1% 81.8% 100% 93.0% 91.4% 95.4% 93.3%

Target 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94% 94%

Drug Regimen -

Doncaster CCG 100% 100% 100% 100% 100% 100% 100% 97.6% 100% 100% 99.0% 100% 87.0%

Target 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98%

In May 2020 all 3 of the treatment modalities for subsequent treatments failed to meet performance targets. Surgery and Radiotherapy both achieved 90.3% and 93.9% respectively against the 94% target. Drug Regimens achieved 87% against the 98% target. All 3 of the treatment modalities had 3 breaches for the month. 6 of the breaches had the breach reason 'other reason' associated to them whilst the other breaches were due to capacity issues. Of the 'other reason' breaches, 1 associated to a Covid-19 breach. The longest an individual had to wait was 79 Days for Drug treatment with the delay reason being 'other reason'.

20

62-day wait from urgent GP referral to first definitive treatment for cancer (OF)

Commissioner Aug-

19 Sep-19

Q2

19/20 Oct-19 Nov-19 Dec-19

Q3

19/20 Jan-20 Feb-20 Mar-20

Q4

19/20 Apr-20

May-

20

Doncaster CCG 83.3% 88.7% 85.0% 81.8% 76.9% 78.8% 79.4% 80.8% 65.0% 88.5% 79.2% 72.6% 72.5%

Rightcare Peer Group 78.1% 76.6% 77.7% 77.1% 75.7 77.0% 76.6% 75.0% 73.4% 81.7% 77.0% 78.7% 73.5%

Cancer Alliance 79.1% 80.3% 79.7% 77.0% 77.9% 79.7% 78.2% 75.5% 73.7% 81.2% 77.0% 77.6% 71.7%

DBTHFT 87.0% 95.0% 87.3% 83.9% 87.8% 85.0% 85.5% 82.5% 72.7% 88.2% 82.0% 79.3% 81.6%

Sheffield Teaching

Hospitals Foundation

Trust (STHFT)

74.0% 68.0% 73.4% 73.8% 76.8% 74.3% 72.6% 69.8% 70.5% 77.5% 72.9% 67.2% 70.1%

England 78.5% 76.9% 77.7% 77.2% 77.4% 78.0% 77.5% 73.6% 73.8% 78.9% 75.6% 74.3% 69.9%

Target 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85% 85%

21

Doncaster CCG performed at 72.5% against the 85% target. There were a total of 11 breaches within the following tumour groups; Lower GI (4), Head and Neck (3), Skin (1), Urological (1), Gynaecological (1) and Lung (1). 8 of the breaches were associated to 'other reasons’, 5 of which were Covid-19 related breach pathways. The 2 local Covid-19 related breaches were delays to diagnostic testing. The remaining 3 breaches were associated to complex diagnostic pathway (2) and Patient initiated delay to diagnostic testing (1). Of the 11 breaches, 9 of those were as STH as treating provider, 6 of which were 'other reasons'. There were 2 104+ day breaches in May, one at 128 days in the Lower GI and the other at 116 in the Skin tumour group. For the lower GI breach, the reason was patient initiated delay to diagnostic testing. The 104+ day breaches are being monitored by Cancer Programme Board and assurances will be provided by the Cancer Leads and will continue to be presented at Clinical Quality Review Group on a quarterly basis. The Performance and Intelligence Team has been in discussion with the Cancer Team at DBHT regarding the 62 Day Patient Tracking List (PTL) and current referral numbers within the system. The details below provide assurance that DBTHFT are capturing the required patients. The PTL shows the number of patients that have had a first appointment but are still on the pathway without a decision to treat date and therefore can be awaiting diagnostics etc. for either a conformation or ruling out of cancer. As of 19th July, there are 405 patients waiting to be seen and 666 patients who have had their first appointment and are awaiting further diagnostics. 26 of those are considered to be waiting between 63 and 103 days and 52 patients have been waiting beyond 104 days. This is a reduction of 6 from the previous week. 12 of the patients are to be reviewed and have diagnostic tests within the next 10 days and a further 18 patients are aged 70+ and have been potentially been under isolation or have stated they won’t be attending hospital at the current time. Demographics of patients has largely attributed to increased patient tracking lists within Trusts. This will be continued to be monitored within the team.

62-day wait from referral from an NHS screening service or Consultant Upgrade to first definitive treatment for all cancers

Commissioner Aug-

19 Sep-19

Q2

19/20 Oct-19 Nov-19 Dec-19

Q3

19/20 Jan-20 Feb-20 Mar-20

Q4

19/20 Apr-20

May-

20

Doncaster CCG –

screening service 75.0% 78.6% 80.0% 100% 100% 75.0% 95.5% 77.8% 100% 90% 88.9% 100% 0%

Target 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90%

Doncaster CCG –

consultant upgrade 73.3% 40.0% 67.4% 96.9% 60.0% 85.7% 67.9% 78.6% 70.0% 66.7% 71.8% 60.0% 50.0%

22

There was 1 breach within the month resulting in performance of 0% against the 90% target. The single breach was in the lower GI

tumour group, completing the pathway on day 103 with the breach reason 'other reason' associated to it. The full breach reason was that

the pathway was impacted by Covid-19, there was a clinical pause to the pathway as the treatment modality was surgery.

There were a total of 4 breaches in May 2020 resulting in performance of 50% against the 85% target. The breaches were within the Lung

(3) and Urological (1) Tumour Groups. The breach reasons associated are as follows; 'Other reasons' (2), Out-patient Capacity

inadequate (1) and Complex Diagnostic Pathway (1). There was 1 breach related to Covid-19, the treatment had to change due to

guidance/risk stratification.

1.2 NHS National Contract Key Performance Indicators

1.2.1 Yorkshire Ambulance Service (YAS)

Oct 19 Nov 19 Dec 19 Jan 20 Feb 20 Mar 20 Apr 20 May 20 June 20

Category 1 (Life threatening injuries and illness) target of average time less than 7min

00:07:18 00:07:28 00:07:46 00:06:53 00:07:10 00:08:01 00:07:17 00:07:10 00:06:59

Category 1 target 90% of times less than 15 min

00:12:30 00:12:46 00:13:15 00:11:54 00:12:32 00:13:25 00:12:32 00:12:16 00:12:15

Category 2 (Emergency) target of average time less than 18

min 00:21:50 00:23:11 00:27:11 00:17:55 00:18:50 00:23:53 00:15:16 00:12:23 00:13:37

Category 2 target 90% of times less than 40 min

0:45:14 00:49:02 00:58:00 00:36:39 00:38:27 00:48:52 00:29:18 00:22:37 00:25:32

Category 3 (Urgent) target 90% of times below 2 hours

02:09:54 02:18:58 02:56:47 01:31:24 01:45:19 02:15:01 00:59:40 00:45:58 00:56:44

Category 4 (Less urgent) target 90% of times below 3 hours 02:59:54 02:39:07 03:18:01 02:15:22 02:19:00 02:56:35 01:55:44 01:36:37 01:45:33

Category 5 (Lowest acuity) target 90

th centile Target TBC 01:29:49 01:21:09 01:49:08 01:04:35 01:28:13 01:41:53 00:55:55 00:25:16 00:40:19

All measures met target during June 2020. Representatives from YAS continue to attend meetings around joint pathways in Doncaster to ensure that any issues can be addressed and continue to work closely with DBTHFT.

23

During May a ‘halo’ YAS staff member was based at Doncaster Royal Infirmary to help reduce the time between handover to the hospital and turnaround time for ambulances at the site. This was stopped in June but with the option to call staff into this role as required. Section 2: Provider Exception Report The following section of the report details performance by exception (those measures either rated Red or have deteriorated outside of normal range) for each main local provider, namely DBTHFT and RDASH and other commissioned services. Performance is across a range of agreed quality and more traditional “performance” measures. As such the report includes performance as a whole for DBTHFT and Doncaster sites for RDASH, and does not simply relate to services provided to DCCG. Due to the COVID-19 pandemic NHS England and NHS Improvement have directed NHS organisations to reduce routine reporting requirements to free up capacity and manage responses. Some areas agreed with Providers are included below. 2.1 Doncaster and Bassetlaw Teaching Hospitals Foundation Trust (DBTHFT) This section only includes measures in the DBTHFT contract currently not meeting target which are not included in the constitution measures in Section 1. No DBTHFT measures have been identified for reporting during the month.

24

2.2 Rotherham, Doncaster and South Humber NHS Foundation Trust (RDASH) This section only includes measures in the RDASH contract currently not meeting target which are not included in the constitution measures in Section 1.

Measure Month Latest

performance Target Update

Improving Access to Psychological Therapies (IAPT) – Cumulative percentage of people entering treatment as a proportion of people with anxiety or depression (OF) (RDASH specific DCCG data)

May 2020

2.95% 3.2%

DCCG and RDASH continue to hold monthly meetings to discuss ongoing issues with the service with a focus on the workforce required to meet the target. A recovery plan is in place and will be reviewed within these meetings. The impact of Covid-19 will also be discussed with the service offering additional telephone and digital interventions. Face to face treatment has been ceased.

IAPT – People referred will receive treatment within 6 weeks (RDASH specific DCCG data)

May 2020

59.2% 75%

Performance improved to 59.2% in May 2020 but remains below the 75% target. Staffing issues have impacted on the response time of the service. As previously identified performance should continue to improve from May onwards.

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

IAPT Access Target

25

IAPT Recovery – At least 50% of people will achieve recovery by end of treatment (RDASH specific DCCG data)

May 2020

44.3% 50%

Performance fell again during May to 44.3%. The impact of Covid-19 in new ways of working along with the staffing issues set out above both contributed to the poorer outcomes. Additional staff have been recruited and unvalidated performance data for May shows improvement.

2.3 Other Quality Elements for Inclusion Primary Care During the current COVID-19 pandemic, all patients contacting their practice continue to be triaged remotely. This is to assess clinical need and identify any symptoms of COVID-19. Consultations are still being carried out remotely where possible however; face to face consultations with non-symptomatic patients are being carried out if clinically necessary. Practices are focussing on the restoration of routine services, including screening, in ways that are safe for both patients and staff, taking into consideration social distancing PPE requirements and decontamination. Patients who are diagnosed and/or symptomatic of COVID-19, or those who are self-isolating due to living in a household with someone who is diagnosed and/or symptomatic, continue to be assessed remotely by a clinician if they have primary care needs. If a face to face consultation is deemed to be clinically necessary, they are referred to the COVID-19 Coordination Hub (CCHubb) which although currently is receiving very low numbers of calls is an expert advice and guidance service for General Practice and relevant others in managing difficult suspected or confirmed Covid-19 patients. Where a direct assessment of the patient by the CCHub is required, there are a number of options available; remote telephone or video assessment, home visits and access to the roving oxygen saturation assessment service. Plans for the influenza vaccination programme are underway and new ways of working are being explored by the Primary Care Networks with support from the CCG and NHS England. The latest influenza immunisation guidance from NHS England is due imminently and this will clarify the requirements from Primary Care and other providers.

26

National Reporting and Learning System During the current COIVD19 pandemic, NRLS reporting has continued and collated and logged for identification of any local patterns and trends no patterns or trends have been identified. Practices do have the ability to submit reports without sharing them with us, or to submit reports anonymously; however they are strongly encouraged to share their reports with us to enable any local trends to be highlighted and learning shared. Continuing Healthcare Following nationally published guidance in March 2020 all Continuing Healthcare Decision Support Tools were stood down and the Continuing Healthcare Team was redeployed to support with the COVID19 discharge pathway. The team are continuing to work 7 days a week as part of the multi-disciplinary team. The team are overseeing the management, of nursing bed based discharges and are continuing to do their case management, with main focus being hospital avoidance. Care Homes The current status of the pandemic across the borough improves week on week. The number of deaths of care home residents currently stands at 111, with 41 dying in hospital and 70 dying in homes. Please note that this data is as of the 23rd July 2020. The exact numbers of infected and symptomatic people fluctuates each day, but care home residents currently account for 41% of the Doncaster deaths (111 out of 273). We continue to collect and collate data on each care home on a daily basis, with a continued positive trend in both staff and patient infection rates. As of the 23rd July 2020 there were no COVID cases with care homes. Safeguarding Safeguarding Adult Reviews / Serious Case Reviews There have been one new Safeguarding Adult Reviews commissioned during this reporting period. Doncaster CCG is supporting the review from a Primary Care perspective with records secured and chronology developed.

27

Lessons Learnt Reviews There have been no new Lessons Learnt Reviews commissioned by the Doncaster Safeguarding Adults Board during this reporting period. Domestic Homicide Reviews During quarter three the Domestic Homicide Review Panel met to consider a case for review. At the time of the meeting the cause of death for the victim had not been confirmed therefore; it has been agreed that the panel would reconvene for consideration following the cause of death being confirmed. The cause of death remains outstanding therefore; the group are yet to reconvene.

The CCG received notification of a further two incidents which took place in June 2020. One of the Domestic Homicide Review has also been logged on the STIES system as a Serious Incident. The Domestic Homicide Review Panel are yet to convene to discuss these cases however; the CCG have secured the patient records and developed chronologies. Child Death The child death which was reported in January 2020 remains open to the partnership. The Doncaster Safeguarding Children’s Partnership (DSCP) has identified all relevant children that may inform and / or form part of the review. The Rapid Review has now commenced with two independent reviews in post. The health partnership have worked together in order to develop all key chronologies to support this review. During this reporting period there has been a further child death with initial meetings taken place. The Deputy Designated Nurse and Chief Nurse have been involved within these meetings and are supporting the process accordingly. It is yet to be established whether a Safeguarding Practice Review / Lessons Learnt Review will take place. Social, Emotional and Mental Health Proactive Monitoring and Support As previously reported, following an increasing number of children and young people presenting at the Emergency Department with suicidal ideation or having taken an overdose, the Social Emotional Mental Health Proactive Monitoring and Support Group was established.

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The group are currently meeting on a fortnightly basis to ensure a timely response to all children and young person. The group is working well with key representation and information sharing from all agencies taking place. Shielded Children The CCG, RDaSH and Local Authority continue to work closely to ensure the management of the shielded children and children living with a shielded adult are receiving the support they require during the COVID19 pandemic. The systems and processes established continue to work well with positive joint working. Section 3: NHS Oversight Framework (no update available) Due to the COVID-19 pandemic NHS England and NHS Improvement have reduced routine reporting requirements on NHS Organisations to release capacity and manage responses. Due to this, national reporting on the NHS Oversight Framework has been suspended.

Section 4: South Yorkshire and Bassetlaw Integrated Care System Assurance Report (no update available) Due to the COVID-19 pandemic NHS England and NHS Improvement have reduced routine reporting requirements on NHS Organisations to release capacity and manage responses. Due to this further updates on the Integrated Care System are not available at this time.

29

Meeting name Governing Body

Meeting date 6th August 2020

Title of paper Living Well Life Stage Report


Ailsa Leighton, Deputy Director, Strategy & Delivery

Author(s) Performance and Intelligence Team

Status of the Report

To approve To consider / discuss To note

Purpose of Paper - Executive Summary This report sets out the key quality and performance updates to be noted by the Governing

Body from the quarterly updates provided by DCCG and Doncaster Council staff in relation

to the 2020/21 Living Well Life Stage Strategic Delivery Plan.

Please note all data is validated and quality checked internally within DCCG and with

Providers as necessary. Where there is a data quality concern on any of the data or metrics

presented in the following report, this will be stated in the narrative accompanying the data.

Living Well 2020/21 – Due to reporting restrictions or capacity issues linked to the Covid-19

pandemic some of the 11 actions and associated outcomes have not been started or are

unavailable at time of writing.

Recommendation(s) The Governing Body is asked to:

Note the key quality performance areas for attention.

Report Exempt from Public Disclosure

If yes, detail grounds for exemption: Yes No

Impact analysis

Quality impact

Positive quality impact from a consistent focus on quality outcomes. Specific quality impact as identified in the report.

Equality impact

Tick

relevan

x

x

30

t box

An Equality Impact Analysis/Assessment is not required for

this report.

x

An Equality Impact Analysis/Assessment has been

completed and approved by the lead Head of Corporate

Governance / Corporate Governance Manager. As a result

of performing the analysis/assessment there are no actions

arising from the analysis/assessment.

An Equality Impact Analysis/Assessment has been

completed and there are actions arising from the

analysis/assessment and these are included in section xx in

the enclosed report.


Nil


Nil

Legal implications

Nil

Management of Conflicts of Interest

The report is for information – no conflicts of interest identified. It should be noted that some Governing Body members may be

employed in secondary employment by organisations referenced in this

report: please see Register of Interests for details.

Consultation /

Engagement (internal

departments, clinical,

stakeholder and

public/patient)

N/A

Report previously

presented at N/A

Risk analysis

Risks are captured in the Executive Summary.

Assurance Framework

2.1, 2.2, 2.3, 2.4, 3.1

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Section 1: Living Well Delivery Plan 2020/21

1:1 Actions

Action Due Date

Completion (%)

Update

Low level interventions, based in our neighbourhoods

Work closely with system partners on Cancer prevention and awareness rising including improvement in rates of smoking/alcohol, diet, obesity, exercise - linking too hard to reach groups. Continue to monitor impact on Be Clear on Cancer campaign recruiting community champions to share messages of awareness raising with the population

31/03/21 75% Work continues virtually with partners of this agenda and culminates in a quarterly meeting with partners across place and system level including; Commissioners, Local Authority, Cancer charities and Public Health England. Recent reporting published by Cancer Research United Kingdom (CRUK) has deemed Doncaster at place level at outlier when focusing on; deprivation score, number of new cases treated, persons screened for bowel cancer, two week wait referrals resulting in a diagnosis and two week wait referrals. Be Clear on Cancer update to be provided September 2020.

Deliver suicide bereavement service across Doncaster Borough

31/03/21 100% Complete.

Develop a delivery plan for whole systems 'Prevention' strand of the homelessness strategy

31/03/21 Action lead for Prevention strand of strategy identified. Prevention workshop had been planned but did not take place due to COVID19 lockdown (to be rearranged). A draft strategy implementation plan has been developed and submitted to Directors for feedback.

Develop the neighbourhood delivery model, including "local solutions", ensuring that primary care networks (PCNs) are embedded into the approach, recognising

31/03/21 25% PCNs have been fully engaged in the primary care cell COVID response which engages with all partners. The Neighbourhood Co-ordinators employed by PCD are involved in the locality cell work established by Doncaster Council. The covid response to care homes as an example has ensured that PCNs are fully embedded in the locality response to multi-disciplinary team working.

32

that this action cuts across Starting, Living and Ageing Well. Once developed, deliver the actions agreed, with a focussed approach on the agreed neighbourhood outcome for Living Well.

Increase opportunities offered by technology, exploring technologies such as Brain in Hand

31/03/21 25% Update – July 2020

Technology Enabled Independence Board established – core membership of the board has been refreshed and now includes Principle Occupational Therapist (DMBC) and Head of Service for Adult Social Care & Support (DMBC). Board requested a Task & Finish Group to scope out current assistive technology offer and gap analysis.

Assistive technology champions identified in every adult social care team.

Case example scenarios have been provided by broad range of adult social care teams – to look at identifying areas of opportunity where technology could be part of a solution to improving someone’s independence, meeting a need or improving overall quality of life.

Project in LD Services – ‘Brain in Hand’

Targeted assistive technology project in learning disability services agreed as an opportunity to take forward.

The project will focus on use of assistive technology to support individuals with a learning disability to be more independent, live life to full potential and become less reliant on formal care. The project will focus on the cohort of individuals with a LD living in supported living, who receive support with a range of daily living tasks.

Through scoping technology solutions available - Brain in Hand (assistive technology application) identified as piece of technology that could be utilised to support individuals with LD to develop daily living skills, meet need and ultimately lead to less reliance on formal care.

33

Contact made with business manager for Brain in Hand. Presentation on use and benefits of brain in hand delivered to social care colleagues.

Project plan to be drawn up to look at introduction of brain in hand.

Reduce social isolation through the further development of the Social Isolation Alliance

31/03/21 60% Building on the good practice carried out during Covid-19 a briefing paper/proposal on a SIA Community Hub/Helpline was tabled at the Community Cell Supported in principle however waiting on a final decision.

Co-ordinated access to services when needed

Reduce follow-up appointments, encompassing patient initiated follow-up as alternatives to conventional face to face follow-ups.

31/03/21 50% A digital focus through telephone/video/patient ed follow up (PLFU). Through the Elective step-down (Phase 1) digital consultation now introduced.

Collaborate across SYB to implement e-RS Capacity Alerts to offer choice at the point of referral, facilitating improved access to elective services thereby reducing the need to offer choice to patients at 26 weeks.

31/03/21 0% e-RS Capacity Alerts work stream led by South Yorkshire and Bassetlaw (STB) Integrated Care System (ICS). Proposed to commence with Ear, Nose and Throat and Gynaecology. Start date awaited from SYB ICS.

Expand IAPT (Improving Access to Psychological Therapy) capacity in line with national mandated prevalence trajectories. Continue expansion of IAPT regarding Long Term Condition offers and lowering age (<18) and increasing age (>75) offer and uptake.

31/03/21 50% Expansion investment decisions made. Additional Health Education England training capacity being accessed for expansion and workforce retention / resilience. Long Term Condition and Core condition / demographic focus areas progressing but some natural COVID related hesitancy and engagement issues.

34

Maximise use of alternatives to urgent care through: - Increasing the availability and use of primary care appointments, through provision of and communication about extended access, on line consultations and direct booking from NHS 111 - Reducing ambulance conveyance rates to A&E and increasing see & treat or use of alternative conveyance pathways - Developing the Doncaster CAS (Community Assessment Service) to respond to NHS 111 calls and provide local clinical advice to either resolve the call or direct patients to the most appropriate local alternatives - Ensuring 2 hour home response appointments made available to ambulance services and other locally identified services for appropriate patients in the community

31/03/21 10% Update July Due to the Covid-19 pandemic face to face primary care appointments have been converted to remote triage and telephone/video consultations. There is willingness across Primary Care to continue with these models of delivery post COVID. The Extended Access hubs have also been stood down and work is underway on the future model for Extended Access when it is re-instated. Direct Booking has been temporarily switched off for the SDHC and OOH services, due to the Covid-19 pandemic. However FCMS is currently in discussions with Adastra to turn their direct booking face-to-face appointments in to triage appointments. GP Practices were required to provide telephone appointments for 111 to book directly into for patient triage until the end of June however locally a decision has been made to continue with these slots being available to 111. As part of the response to the COVID Pandemic, YAS changed their triage model and redeployed a cohort of Clinical staff into their “hear and treat” model. At the same time there was also an increase in the use of the “see and treat” model and both of these actions have seen a significant reduction in conveyance rates between April and June. However numbers have started to increase again therefore discussions are taking place with YAS to understand this and ascertain whether they are able to sustain the increase in their “hear and treat” model (due to staff capacity). The UEC procurement has been complete and the Provider Alliance is now in the mobilisation stages. A Project Group has been established and the key focus will be the development of the CAS and in particular looking at how we can develop the CCHUB model as part of the CAS. Due to the Covid-19 pandemic and the requirement to implement the Rapid Discharge pathway, all resources have been focused on this pathway to ensure timely discharge into the community. Rapid Response has seen a recent decline in referrals and further comms have been sent out to Primary Care on this.

Optimise the take up of 31/03/21 40% National flu guidance was released in May and this identified the eligibility groups to be

35

population screening and immunisation programmes, including flu

the same as last year but with the possible inclusion of Year 7 children. A 2nd set of guidance is expected in mid July and it is anticipated that this may also include the over 50 year age group. A local Flu planning group has been established and is meeting on the weekly basis. There are been a commitment to work collaboratively across Primary Care with Primary Care Network Directors and the LPC expressing an interest to work together to agree on cohorts of patients for their services. Recent guidance on the administering of vaccines has meant that the vaccinations can now be delivery at PCN level and plans are in place to move this forward. Due to the complexities with delivering the flu vaccination this year, alternative methods of delivery are being explored such as the Health Bus and Drive through clinics. The draft flu plan will be complete by the end of July.

Increase in integrated Doncaster Care Record (iDCR) usage

31/03/21 25% 50 more council users added since April, increased usage in RDASH to support the updated discharge pathway. Stakeholder engagement activity to relaunch the integrated Doncaster Care Record (iDCR) was paused due to the Covid-19 response. Usage stats to be provided via RDASH, but we expect usage will continue to grow across settings.

Holistic delivery of care and support

Fully implement the Macmillan LWABC Programme including: e-holistic needs assessment (eHNA) and care plan; e-treatment summaries shared with patients and GP; Cancer Care Review by GP or practice Cancer Champion for 100% applicable patients; "Right By You" programme

31/03/21 75% The second interim report of the LWABC Programme was published April 2020 and is available for review, as required. However work continues on all areas of the Recovery Package. Electronic Holistic Needs Assessment (eHNA) or paper HNA logged through the Macmillan system via the use of tablets from within DBTH, Aurora and Macmillan Living Well service. Further work continues to increase assessments across all specialities and to train the Cancer Care Co-ordinators (non-qualified) to fully implement the use of eHNAs. The patient is able to complete their eHNA at home, in the waiting room or with their nurse specialist in clinic, or where appropriate with a Cancer Care Co-ordinator. If not electronic, all HNAs carried out paper-based and all to be logged onto the Macmillan System. 60% of all e-HNAs carried out within DBTH are undertaken at the End of Treatment and therefore work continues to bring this forward to Initial diagnosis or Start of Treatment, being repeated as appropriate

36

throughout the treatment pathway and beyond. Out of the 3 LWABC tumour sites; Breast HNAs are predominantly an end of treatment exercise, while Colorectal HNAs primarily occur at initial diagnosis. In Urology, HNAs tend to be completed at the start of, or during treatment. The development of e-Treatment summaries is progressing, and continue to be shared in a hard copy format awaiting electronic development. Collaboration with primary care continues to integrate care through both treatment summaries and the cancer care review (CCR) (currently out to consultation Nationally). Regarding the CCR (and wider front-end objectives around Early Diagnosis), engagement has occurred with PCN Leads to identify cancer champions in order to take forward this work. The aim for the CCR is to design and implement a revised template to enable a collaborative approach to encourage buy-in at the appropriate time for patient review. Regarding general Health & Well-being, a number of projects have been identified to support H&WB, all of which are in the preliminary stages. The focus will likely focus on nutrition and exercise initially, by creating nutrition-focused sessions for during treatment and developing an exercise programme with Doncaster Culture Leisure Trust. This element of work in addition to the Primary Care Macmillan ‘Right By You’ has stalled due to COVID-19.

Full review of current adult and older adult Community Mental Health models to prepare and align with both LTP expectations and local requirements from 2021.

31/03/21 0% Strategic Transformation Lead start date delayed. Living Well Lead not being pursued by joint commissioners. It should be noted that Community delivery has significantly modified due to COVID, with this presenting potential accelerated gain opportunities.

Develop all age adaptive models for functional MH - including ADHD, Eating Disorder proposals, At Risk Mental State (EIP), IAPT, Adult Crisis reach and equity

31/03/21 15% Development opportunity impacted by COVID. Some COVID informed learning on Crisis models particularly. IAPT <16 progressing.

Review of floating support 30/09/20 A draft implementation plan has been developed for the Care and Support strand of the

37

offer including mapping of existing provision (commissioned, non-commissioned, St Leger Homes, Complex Lives Alliance), where they are delivering it, identifying duplications and gaps to develop commissioning intentions

Homelessness and Rough Sleeping strategy and submitted to Directors for feedback. Draft implementation plan will be reviewed to reflect learning from the delivery of services during COVID19. Desktop review of provision has been undertaken.

Increase personalised care and support planning, personal health budgets and consider the future development of Social Prescribing, linking in with local Primary Care Networks

31/03/21 100% Rights to personalised care and support is now enshrined by the law, by virtue of the Care Act. In Doncaster there is a strong commitment to self-directed support and strength based practice when carrying out such assessments and support planning. Adult Social Care in Doncaster are committed to and have embedded strength based practice in assessment and support planning. In September last year (2019) the Strength Based Practice framework was launched. The practice framework in Doncaster around self-directed support and support planning is deep rooted in core principles of personalisation. The position in Doncaster is that for everyone who requires care and support, consideration must firstly be given to a direct payment. Individuals are actively encouraged by Social Workers to take up direct payments. Social Prescribing Link Workers Link In year 6 link workers have been appointed and are aligned to and embed within the PCN’s. The post are funded until 31 March 2024 Personal health Budgets continue to be offered to new and existing VHC Cases. Each case is afforded a case manager who works with the individual to identify their care needs and how best these can be delivered. This is manifested in the development of care/support plan that recognises the individual needs of the service user and the different approaches available.

Build on the work started in 2019/20 across the health

31/03/21 10% New discharge pathway put in place following national guidance; a review is now underway to determine how to lock in the opportunities from this change and determine

38

and social care system (including the High Impact Change Model) to reduce length of stay, work towards 92% bed occupancy rates and reduce delayed transfers of care

the model moving forwards. Note due to the impact of Covid-19 expectations regarding bed occupancy levels many change.

Develop Physical Disability accommodation offer and wrap round care and support services

31/03/21 60% Work on hold from a commissioning perspective during Covid-19, this is due to the lead officer overseeing Domiciliary Care, plans will be developed during recovery to ensure move back to BAU. Prior to lockdown presentation to portfolio holders (Racheal Blake and Glyn Jones) had taken place and next steps discussed. Overview of work to date shared with Karen Lythe as new chair of the Homes for All Board.

Develop the place based workforce strategy, to include future workforce requirements and the design/ delivery of training and education to reskill existing staff and train new staff

31/03/21 15% Whole Systems Partnerships (WSP) have been commissioned to undertaken the work that will inform the strategy. Work had been stalled due to COVID-19 however has now recommenced. A proposal is being produced to all 5 CCGs across South Yorkshire and Bassetlaw and the scope will be extended to include primary care workforce. The next step is a piece of engagement work to progress with the plan and it is likely that this will take place during August and September.

Deliver identified actions against the priority areas set out within the Learning Disability and Autism Strategy: - Diagnosis - education and inclusion - employment - family and carers - housing and support (including short breaks)

31/03/21 15% Adult ASD diagnosis April to June 2020; ASD service partially stopped • Continuing support with people on their caseload. • New diagnostics on hold • Case by case review for priority • Requires face to face appointments • Can work with clinic with PPE. • Referral list to review for priorities. • Need to understand future investment and funding

39

- health inequalities - transitions

Previous work started with RDaSH around the ASD diagnosis service to address the waiting times and after diagnosis support. Business case reviewed by CCG late summer 2019 which was at quite a high cost increase for the service and it had some crisis support added into it. CCG and RDaSH reviewed this business case and agreed to keep the crisis support separate, instead RDASH to use the already established Crisis and Intensive Support (CAIS) team. One of the forensic nurses had just left her post in the CAIS team which left a vacancy in the team. We agreed this vacancy should be filled with an ASD specialist nurse because the Forensic Liaison Service (FOLS) could support where any forensic knowledge gaps appear. In November the ASD specialist nurse was appointed to the CAIS team and so far is working really well. RDaSH and CCG met in September to discuss what we needed from the ASD service again. It was identified the waiting list to the service continued to rise so asked RDaSH to present in the business case on what they needed as a non-recurrent resource to bring the waiting times down to fit with NICE guidance and then what resource they would need following the reduction in waiting times to retain within NICE guidelines. Received an addition to the original business case in December, comments added by CCG and fed back to RDaSH as noted in FPIG however. This business case has not been received as yet from RDaSH and is on the agenda for FPIG. A task and finish group was set up for 25.03.2020 but was cancelled due to COVID responses. June 2020 Commissioning and contracting from DCCG met via MS Teams to discuss the business case. Contracting advice was that under the current block payment funding arrangements/guidance from NSHE we are currently unable to make any new investment decisions therefore would not be in a position to approve a business case. CCG finance and contracts are waiting for further guidance around what the payment arrangements will be for the rest of the year and whether the CCG will be able to make any investment decisions.

40

DCCG commissioning and RDaSH service manager met to request an update to the business case with patient waiting numbers and to ascertain what the service is currently financially receiving to understand the full cost of the investment and staffing model. RDaSH Adult ASD diagnosis service added to agenda on the contracting board for beginning of July. During Experience and Engagement Committee it was requested Primary care be involved in the understanding of referral route for the service. Housing and Support – In Jan / Feb the project plans were revised and refreshed, with further detail to be agreed against timelines and allocation of actions at the next meeting, prior to approval by the LD and Autism Partnership Boards. The workstream is due to meet again in August 2020 (first meeting since start of Covid).

1. The Strategic Housing Needs Assessment is underway, (Campbell Tickell on behalf of South Yorkshire ICS). Report due Sept 2020.

2. Travis Gardens SLS development, Residential care contract extended for further 6 months from July 20, to enable the development works to be carried out and the Landlord to be appointed prior to development as Supported Living Service.

3. Management of voids agreement shared with existing landlords, with final negotiations / signatures nearing completion.

4. Stocktake of current provision is underway, with ongoing negotiation with SYHA to increase SLS capacity across existing properties.

5. Options appraisal for In house residential service underway to be completed by end July 20.

6. See also update of Shared Lives below.

Short Breaks – The All Age Delivery Plan for Short Breaks has been developed, including the key areas 1) engaging with carers and individuals who currently access short breaks - what they

41

feel currently works well and what improvements they would like to see. 2) Analysis of the data to complete strategic needs assessment. 3) Development of current in house bed based respite service, to use this differently. 4) re-fresh of short breaks offer - exploring other opportunities for a more blended approach to short breaks (not solely focused on bed based) 5) Enhancing the Shared Lives offer to include short breaks (see update below) 6) Producing easily accessible information in regards to short breaks offer Next meeting to be held in July 2020. Shared Lives - Monthly working group meetings due to be re-established from July 2020.

1. Significant progress been made in communication and working relationships between key stakeholders.

2. Communication & Engagement plans have been aligned between the provider and the Council Communications teams. To be signed at end of July.

3. The referral process has been reviewed, revised and signed off. 4. The payment banding tool developed and to be signed off at next

meeting. 5. A service review of Shared Lives was undertaken and a report

summarising the findings to be completed and shared with the Housing and Short Breaks work-streams.

Responsive and accessible care in a crisis

Embed new statutory & third sector assets for Crisis Resolution / Home Treatment / Alternative Places / Acute Psychiatric Liaison / Suicide Prevention & Response Support.

31/03/21 20% Recruitment largely complete and delivering gain. Active acute liaison pathway and liaison model design temporarily suspended due to COVID. Good progress on partnership development as a consequence of COVID, and commitment to further pathway mapping for UEC connected agencies – tying together CCG, RDaSH, SYP, YAS, Adult Social Care, PH. Alternative third sector models progressing – with full operation of Safe Space and gradual but delayed mobilisation of High Intensity User and Suicide Attempt Response & Prevention programmes.

Implement the Homeless and Rough Sleeping Strategy, with a focus on:

31/03/21 A draft implementation plan has been developed for the Accommodation strand of the Homelessness and Rough Sleeping strategy and submitted to Directors for feedback. Draft implementation plan will be reviewed to reflect learning from the delivery of

42

- rapid re-housing - hostel re-modelling including assessment hub - substance misuse accommodation and support - expansion of Housing First

services during COVID19. Hostel re-modelling:-

Liaised with legal re: lease arrangements with landlords.

Liaised with both hostel landlords seeking views of reducing capacity in hostels and impact.

Liaised with current support provider on a similar basis.

Updated hostel briefing paper and meeting scheduled for 8 July 2020 to feedback and obtain a steer.

Approval to extend current homelessness contract for a further 12 months as a result of COVID19 impact to support re-modelling work

Expansion of Housing First:

Currently engaging with additional providers of Housing First accommodation

Linked in Complex Lives to draw up a list of 21 individuals as potential tenants of Housing First.

Proposals made to MHCLG re: re-purposing Rough Sleeper Initiative funding allocation to support pump priming of Housing First

Substance Misuse Accommodation & Support:

Approval to extend current contract for a further 12 months during which time the contract is intended to be subsumed into the wider Aspire treatment contract in order to test out local delivery of an integrated treatment and accommodation model. This will inform joint commissioning potential in the future.

COVID19 local response to homelessness informed by the “Everyone In” government directive to find emergency accommodation for those who were rough sleeping by 27 March 2020 followed by a requirement to accommodate individuals presenting as homeless during the pandemic. This has involved the use of existing capacity of the current homelessness pathway along with additional emergency accommodation within two hotels in the borough. As at 30 June 2020, 84 individuals were accommodated in

43

hotel accommodation. Personal housing plans are in place for the majority with a preferred move on destination (e.g. private rented sector, supported housing, hostel) identified. Lessons learned from COVID19 to inform the content and deliver of the strategy implementation plans.

Person centred support for people with complex needs

Review of forensic LD pathway aligning to regional and national inpatient trajectory with a focus on building appropriate and sustainable community provision

31/03/21 60% June 2020 South Yorkshire Police requested a meeting with representatives from the ICS to build and implement prevention and diversion training. This is aimed at individuals with a forensic risk to understand consent around sex and staying safe to as a proactive measure to avoid individuals becoming criminalised. Doncaster to pilot through PMSR MDT approach involving FOLS, ASD diagnosis services, RDaSH service manager, CCG commissioning and quality members and the CAIS team. Springwell lane closed which has resulted in a reduced step up/down community forensic provision for the local area need. Danescourt remain in service but not as a flow through step up/down provision. Firshill rise block booking 1 bed for Doncaster remains on hold due to current block payment funding arrangements/guidance from NSHE we are currently unable to make any new investment decisions. Agreed in principle by CCG SMT in March. This will be reviewed again when able to do so. Enhanced Provider Framework review is required to assess the measures and outcomes however due to COVID planning and responses this has reduced the capacity to carry out. Mobilisation meetings continue to progress community discharge for those patients already referred and accepted to the framework. Funding of care packages not yet agreed in panel due to no destination of discharge set at this time. LD pathway subgroup to Clinical Quality Review Group re-established on 23rd June. Action to set up patient flow meetings between CCG and RDaSH to highlight upcoming needs of service provision and case review of current needs for patients placed out of area.

44

Work alongside the Mental Health Alliance to undertake a distinct piece of work linked to Mental Health & Housing to understand issues, barriers and develop action plan as appropriate

31/03/21 10% Mental Health Alliance meetings and planned housing workshop not progressed due to COVID-19. Mental Health Alliance Meetings are taking place again virtually so moving forward it will be through this route the work will progress.

The DCCG and Council Performance Teams will work to provide a more advanced experience based approach for reporting against delivery plan key identifiable priorities

31/12/20 25% This work progressed between the two teams but stalled as a technical development due to other emergency work (e.g. Flood, Covid etc.). Future joint work between DCCG and DMBC in this field is likely to be more influenced by the legacy of the joint working established through the Covid data cell – e.g. flow models, population segmentation.

1.2 Performance measures and outcomes A number of information and outcome lines are currently unavailable due to continuing prioritisation due to the Covid-19 pandemic. These lines will be developed and reported as workflows return to normal.

0

200

400

600

Qtr 1 Qtr 2 Qtr 3 Qtr 4

Ensure at least 450 Doncaster patients are receiving a Personal Health Budget

Target

2019/20

2020/21

45

0%

50%

100%


Ensure that at least 60% of Doncaster patients on a GP SMI register receive Physical Health checks

Target

2019/20

2020/21

0.0

200.0

400.0

600.0

800.0

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

Reduce the number of Delayed Discharges of care for Doncaster patients

Target

2019/20

2020/21

5.0%

5.5%

6.0%

6.5%


Increase the amount of Doncaster patients accessing IAPT services against estimated need

Target

2020/21

46

75%

80%

85%

90%


Cancer 62 day standard for Doncaster patients

Target

2019/20

2020/21

0

500

1,000

1,500


Reduce out of area inappropriate MH out of area placements to zero

Target

2019/20

2020/21

0

5

10


Reduce the number of out of Area placements for LD patients

Target

2019/20

2020/21

47

0

2

4

6

8


Increase Social Prescribing per 1000 population 2019/20referralsper 1,000population

Target

0

200

400


Increase Personalised care and support planning

Target

2020/21

0%

5%

10%

15%

20%

Qtr1 Qtr2 Qtr3 Qtr4

Decrease the percentage of Doncaster patients that are smokers

Target

20/21

48

0

5

10

15

2012-14 2013-15 2014-16 2015-17 2016-18 2017-19 2018-20 2019-21

Reduce the Suicide rate per 100,000 using 3 year rolling average

Actual

Target

0

20

40

60

80

2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18

Increase the Life Expectancy in Males (years)

0

20

40

60

80

2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18

Increase the life expectancy in females (years)

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Title of paper

Finance Report June 2020 (Month 3)

Executive / Clinical Lead(s) Hayley Tingle, Chief Finance Officer

Author(s) Tracy Wyatt, Deputy Chief Finance Officer Status of the Report To approve To consider / discuss To note Purpose of Paper - Executive Summary This report sets out the financial position as at the end of June 2020 for consideration by the Governing Body. The CCG is currently working with an interim financial regime for April – July (Month 1-4) only due to the Covid-19 pandemic. Therefore at this time there are no set financial targets for the CCG to meet and no QIPP expectations. The financial regime for the remainder of the year is not yet known. The report also outlines:

• The risks that the CCG is currently facing • Details around the rest of the financial year • The CCG’s Financial Summary (Appendix 1) • The CCG’s current spend related to Covid-19 (Appendix 2)

Recommendation(s) The Governing Body is asked to:

• Receive the report and note any risks and issues as highlighted in the report.

Report Exempt from Public Disclosure Yes No If yes, detail grounds for exemption:

X

X

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Impact analysis Quality impact N/A

Equality impact

Tick relevant box

An Equality Impact Analysis/Assessment is not required for this report. x An Equality Impact Analysis/Assessment has been completed and approved by the lead Head of Corporate Governance / Corporate Governance Manager. As a result of performing the analysis/assessment there are no actions arising from the analysis/assessment.


Sustainability impact NIL


At the time of writing any additional allocations for non-Covid related overspends have not been confirmed. The CCG has however received an

allocation for the Covid Spend as at the end of May but not for June as yet. There is therefore a risk of overspend which the CCG may be asked

to manage. Legal

implications NIL


Interest N/A




N/A

Report previously

presented at None

Risk analysis

Risk of NHSE not funding the additional costs being incurred above the defined allocation and not funding costs associated with Covid-19.Risk of

the current regime around investment, QIPP and MHIS. Corporative Objective / Assurance Framework

CO4 - maintain spend within allocations overall.

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NHS DONCASTER CCG 2020/21 FINANCE REPORT MONTH 3 – JUNE 2020 1. Introduction

This report provides the financial position for NHS Doncaster CCG for 2020/21 as at the end of June 2020 (Month 3). Due to the interim financial regime the CCG does not have any specific targets to achieve. The CCG has been notified of its allocation based on expenditure as at Month 11 2019/20 adjusted for inflation and a few other minor adjustments. 2. Current Position Due to the coronavirus outbreak the 2020/21 planning and contracting round was suspended in mid-March. NHS England and Improvement have issued guidance on how CCG’s need to work with providers during the interim period. The following summarises some of the current arrangements –

• The CCG’s main NHS providers are being paid on a block basis, the value of which was determined centrally by NHS England. This is only for contracts that exceed a set value. No other payments will be made to any other NHS providers by the CCG at this time.

• CCG’s are reimbursing their main acute provider for all other contractual activity that they would usually receive from their smaller contracts. For Doncaster CCG this is Doncaster and Bassetlaw Hospital NHS Foundation Trust.

• Primary Care income streams are being protected at 2019/20 levels as a minimum including national DES and LES payments.

• Individual placement costs are still being reimbursed and the CCG is working closely with numerous providers who are having to be flexible in terms of their delivery of care at this time.

• Non NHS providers are being reviewed on an individual basis. Income streams are not guaranteed for this cohort of providers and depend upon the levels of service being provided at this time, and whether they are deemed critical to the Covid-19 response. Providers are being encouraged to seek other government support where necessary.

• Additional funding is available to support the Covid-19 response and returns are being regularly submitted to NHS England on additional costs incurred that are in line with the guidance. Governance around the agreement of additional costs is being maintained in line with usual processes.

• The new Discharge Protocols are also being centrally funded by NHS England including funding for any new packages of care that are initiated during this period in order to safely discharge a patient from hospital or avoid a hospital admission.

The above regime is currently in place until the end of July 2020 and further guidance is expected shortly to inform the regime for the remainder of the financial year. The CCG was showing an over spend at Month 3 of £1,038k of which £793K

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relates to costs directly incurred as a result of Covid-19. The forecast position is £3,392k which includes a forecast of £1,347k overspend on Covid-19 costs. The CCG has received an allocation in Month 3 to cover the cost of Covid-19 incurred to the end of May. Attached at Appendix 1 is a summary of the financial position that was submitted to NHS England for Month 3. It is anticipated that retrospective allocations will be provided for the Covid costs for June and the additional expenditure above allocation that is being incurred. A summary of the position is as follows Area of spend Variance

£’000’s Detail

Acute services -1,068 Underspend on Non NHS Acute contracts CHC 584 Cost of placements Prescribing 485 Under accrual from 19.20 and increased costs in

year Delegated Co-Commisioning

459 Shortfall in allocation – increased PCN costs

Other Programme 549 Mainly PTS costs related to Covid-19 Running Costs 210 Reduced Allocation Other minor -181 Total 1,038 The CCG, along with all other CCG’s, have been asked to provide additional information regarding the current variances to NHS England together with further information to support the Covid-19 costs being incurred. It should be noted that the NHSE model used to calculate the allocation, has resulted in some of the allocations not being sufficient. For example the Delegated Co-Commissioning budget is lower than the allocation received last year and is therefore not sufficient to fund the additional investments in primary care that are required as per the Forward Plan. Also the running costs budget is less than the notified allocation, it has been advised that this has been reduced as some CCG’s utilise running cost underspends to offset programme costs so nationally they have top sliced the running costs budget. All of these issues are not just affecting Doncaster CCG and have been flagged to NHSE. 3. Month 5 – Month 12 Further guidance is awaited regarding the financial regime for the remainder of the year, however it has been confirmed that the block arrangements for NHS providers will continue. It is anticipated that additional allocations will be on a prospective basis and not retrospective, however it is not clear if the additional allocations will be given to the ICS, place, or direct to CCG’s and providers. This is clearly a risk to the CCG’s financial position this year if we are expected to break-even. CCG’s and providers have been asked to submit high level revenue and capital plans for the remainder of the year to aid discussions at the Treasury. These have

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been based on a number of scenarios including that current activity levels continue and also that additional activity will start to take place as the year progresses. It is anticipated that a detailed plan will be required and the guidance around this is expected in mid-July. 4. Risks There are a number of risks facing the CCG at the moment that the Governing Body need to be made aware of. The CCG has transformation and delivery plans and it is not clear how some of this can be progressed as there is uncertainty around investment and additional funding. It is not clear if the CCG will be expected to make any QIPP savings in year or if these will be offset by additional top ups. It is not known what activity and capacity providers will be able to deliver in year and what the impact of this will be on the underlying demand for future years. It is not clear if the regime for 2021/22 will revert back to the original position and therefore what the impact of the current regime will have on the CCG’s recurrent underlying position moving into next year. Clear guidance around the Mental Health Investment standard is awaited although it has been signalled that this will be a requirement for 20/21.It is not clear how CCG’s can progress this under the current regime when investments are not allowed and NHS providers are on block arrangements. 5. Conclusion The Governing Body are asked to note the current financial position and the expectation around additional allocations so that the CCG breaks even. They are also asked to note the restrictions currently in place around investments, the uncertainty around efficiency savings and delivery of the MHIS.

NHS DONCASTER CCG - SUMMARY FINANCIAL POSITION MONTH 3 2020/21 APPENDIX 1

Budget Actual Variance Budget Actual Variance Budget Actual Variance Budget Actual Variance£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000

Revenue Resource Limit (in year) 134,501 134,501 0 179,012 179,012 0

Acute services - NHS (Block) 63,993 64,013 20 0 0 0 85,324 85,351 27 0 0 0Acute services - Independent/commercial sector (outside of Nationally procured) 2,890 1,806 -1,084 0 0 0 3,853 2,587 -1,266 0 0 0Acute services - Other non-NHS -6 0 6 0 0 0 -8 0 8 0 0 0Acute Services - Other Net Expenditure -17 -27 -10 0 0 0 -23 -40 -17 0 0 0Acute Services 66,859 65,791 -1,068 0 0 0 89,145 87,898 -1,248 0 0 0

MH Services - NHS (Block) 10,416 10,367 -48 0 0 0 13,888 13,901 13 0 0 0MH Services - Independent / Commercial Sector (outside of Nationally procured) 5,199 5,309 109 0 0 0 6,932 8,021 1,089 0 0 0MH Services - Other non-NHS 189 131 -58 0 0 0 252 241 -11 0 0 0MH Services - Other net expenditure -141 -235 -94 0 0 0 -188 -514 -325 0 0 0Mental Health Services 15,663 15,572 -91 0 0 0 20,883 21,649 766 0 0 0

Community Health Services (ISFE) 11,346 11,357 11 72 104 32 15,104 15,116 12 72 123 51

Continuing Care Services (ISFE) 9,701 10,286 584 300 633 333 12,835 13,712 876 300 786 486

Prescribing 14,892 15,377 485 0 0 0 19,856 20,742 886 0 0 0Community Base Services 1,310 1,211 -99 0 0 0 1,746 1,707 -40 0 0 0Out of Hours 0 0 0 0 0 0 0 0 0 0 0 0£1.50 per head PCN Development Investment 122 115 -6 0 0 0 162 162 0 0 0 0GP IT Costs 339 399 60 90 104 14 422 437 15 90 104 14PC - Other 341 285 -56 0 0 0 454 343 -111 0 0 0Primary Care Services (ISFE) 17,004 17,388 384 90 104 14 22,642 23,392 750 90 104 14

General Practice - GMS 6,428 6,614 186 0 0 0 8,571 8,821 250 0 0 0General Practice - PMS 1,201 1,425 224 0 0 0 1,601 1,900 299 0 0 0Other List-Based Services (APMS incl.) 598 554 -44 0 0 0 798 702 -96 0 0 0Premises cost reimbursements 1,508 1,621 113 0 0 0 2,010 2,171 161 0 0 0Primary Care NHS property Services Costs - GP 0 0 0 0 0 0 0 0 0 0 0 0Other Premises costs 14 17 3 0 0 0 19 23 4 0 0 0Enhanced services 254 443 190 0 0 0 338 607 269 0 0 0QOF 806 525 -281 0 0 0 1,075 1,033 -42 0 0 0Other - GP services 70 139 68 52 123 71 76 151 75 52 123 71Primary Care Co-Commissioning (ISFE) 10,879 11,337 459 52 123 71 14,488 15,407 919 52 123 71

Other Programme Services (ISFE) 1,928 2,477 549 455 798 343 2,419 3,242 823 455 1,179 724

Total Commissioning Services 133,379 134,207 828 969 1,762 793 177,516 180,415 2,899 969 2,315 1,346

Running Costs (ISFE) 1,122 1,331 210 0 0 0 1,496 1,989 493 0 1 1

Total CCG Net Expenditure 134,501 135,539 1,038 969 1,762 793 179,012 182,404 3,392 969 2,316 1,347

Month 3 Total incl Covid Month 4 Forecast TotalCovid Costs Covid Costs Forecast

NHS DONCASTER CCG - SUMMARY OF COVID COSTS MONTH 3 APPENDIX 2

OOH capacity/CHUB * 0 122 38 160 203PPE (scrubs) 25 9 0 34 34Hospital Discharge Programme 124 332 432 888 1,307Daycare Support 0 0 83 83 83Care Home Digital Support 0 0 79 79 79Sickness Cover 0 10 1 11 11Renal Transport Costs (bulk heads and additional resources) 87 80 57 224 315GP Bank Holiday Cover 52 0 0 52 52Primary Care Additional Costs 0 0 86 86 86Community Equipment Costs 0 38 18 56 56SMS costs 0 89 0 89 89Minor costs incl. comms 0 1 0 1 1Total costs 288 681 794 1,763 2,316

Note * OOH/CHUB costs in May include £55k from April omitted in error

Total YTD £000

Category April £000

FOT to M4 20/21 £000

May £000

June £000

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Title of paper

Chair and Chief Officer Report


Dr David Crichton, Clinical Chair Jackie Pederson, Chief Officer

Author(s) Cheryl Rollinson, Head of Corporate Governance Paul Hemingway, Head of Communications and Engagement

Status of the Report To approve To consider / discuss To note Purpose of Paper - Executive Summary 1. Introduction The purpose of this report is to update the Governing Body on issues relating to the activity of the Doncaster Clinical Commissioning Group (DCCG) of which the Governing Body needs to be aware, but which do not themselves warrant a full Governing Body paper. 2. This month the paper includes updates on the following areas: CCG Update:

• 2019/20 Annual Report and Accounts • NHS 72nd Birthday • South Yorkshire & Bassetlaw (SYB) System Reset • Healthwatch Doncaster Survey

National Update:

• GP Patient Survey 2020 • NHS Reset Campaign • NHS Parliamentary Awards 2020

Recommendation(s) The Governing Body is asked to note the report. Report Exempt from Public Disclosure Yes No If yes, detail grounds for exemption:

X

X

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Impact analysis Quality impact Neutral

Equality impact

Neutral

Tick relevant box

An Equality Impact Analysis/Assessment is not required for this report. X An Equality Impact Analysis/Assessment has been completed and approved by the lead Head of Corporate Governance / Corporate Governance Manager. As a result of performing the analysis/assessment there are no actions arising from the analysis/assessment.


Sustainability impact Nil

Financial implications Nil

Legal implications Nil


Interest Paper is for information. No relevant interests.



clinical, stakeholder & public/patient)

N/A

Report previously

presented at None

Risk analysis Nil

Assurance Framework CO1 - 1.1

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Chair and Chief Officer Report 6 August 2020

1. CCG Update

1.1 2019/20 Annual Report and Accounts Our Governing Body formally approved the CCG’s 2019/20 Annual Report and Accounts at its extra-ordinary meeting held 24 June 2020. A shorter, interactive version of the report will be available later this year and our Annual General Meeting (AGM) will take place on the 2nd September 2020. Further details will be made available on our website https://www.doncasterccg.nhs.uk/.

1.2 NHS 72nd Birthday On 5 July 2020 the NHS celebrated its 72nd anniversary. Whilst the health service has seen many changes over the years and faced many challenges, the coronavirus pandemic has presented the greatest challenge yet. We would like to take this opportunity to say ‘Thank You’ to our employees, partners and members of the public for their continued support and response during these unprecedented circumstances.

1.3 South Yorkshire & Bassetlaw (SYB) System Reset

A SYB workshop, led by the Army, was held in July to consider contingency planning as part of the plans to manage potential coronavirus outbreaks. Participants included senior leaders from across Health and Social Care organisations, the learning from working through different scenarios will be built into local plans as they are revisited. Planning for Phase Three of the SYB coronavirus pandemic response continues. Guidance from NHS England and NHS Improvement to inform the process is expected imminently.

1.4 Healthwatch Doncaster Survey

We are working closely with Healthwatch Doncaster, Primary Care Doncaster and our GP Practices to gain feedback from Doncaster patients who have accessed healthcare appointments from their local practice via video or telephone calls during the Coronavirus pandemic. Feedback from these experiences will inform and shape the development of future services provided in the local community. The survey can be accessed here.

https://www.doncasterccg.nhs.uk/full-nhs-doncaster-ccg-2019-20-annual-report-published/

https://www.doncasterccg.nhs.uk/full-nhs-doncaster-ccg-2019-20-annual-report-published/

https://www.doncasterccg.nhs.uk/

https://www.surveymonkey.co.uk/r/GPServices

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2. National Update

2.1 GP Patient Survey 2020 Results from the latest GP patient survey 2020 are now available on the NHS England and NHS Improvement website; the survey ran from between 2nd January 2020 and 6th April 2020.

2.2 NHS Reset Campaign This is a new campaign led by the NHS Confederation focussing on how the health and care system should look like in the aftermath of the coronavirus pandemic. ‘The role of health and care in the local economy: A five-point plan for every system’ is a helpful strategy for local NHS and social care organisations to consider in their approach to local place-based economic and social recovery and reset.

2.3 NHS Parliamentary Awards 2020 NHS England and NHS Improvement have launched their annual

parliamentary awards for 2020. This award is designed to encourage health and care organisations to engage with local MPs and recognise the successful work which happens locally. Deadline for nominations is Friday 7 August 2020.

https://www.gp-patient.co.uk/surveysandreports

https://www.nhsconfed.org/-/media/Confederation/The-role-of-health-and-care-in-the-economy.pdf

https://www.nhsconfed.org/-/media/Confederation/The-role-of-health-and-care-in-the-economy.pdf

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Enclosure C

CHIEF EXECUTIVE REPORT

July 2020

Author(s) Andrew Cash, Chief Executive Officer

Sponsor Andrew Cash, Chief Executive Officer

Is your report for Approval / Consideration / Noting For noting and discussion Links to the STP (please tick)

Reduce inequalities

Join up health and care

Invest and grow primary and community care

Treat the whole person, mental and physical

Standardise acute hospital care

Simplify urgent and emergency care

Develop our workforce

Use the best technology

Create financial sustainability

Work with patients and the public to do

Are there any resource implications (including Financial, Staffing etc)? N/A Summary of key issues This monthly paper from the System Lead of the South Yorkshire and Bassetlaw Integrated Care System (SYB ICS) provides a summary update on the work of the SYB ICS for the month of June 2020. Recommendations The SYB ICS Health Executive Group (HEG) partners are asked to note the update and Chief Executives and Accountable Officers are asked to share the paper with their individual Boards, Governing Bodies and Committees.

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South Yorkshire and Bassetlaw Integrated Care System

CHIEF EXECUTIVE REPORT

July 2020 1. Purpose

This paper from the South Yorkshire and Bassetlaw Integrated Care System System Lead provides an update on the work of the South Yorkshire and Bassetlaw Integrated Care System for the month of June 2020. 2. Summary update for activity during June 2020 2.1 Coronavirus (Covid-19): The South Yorkshire and Bassetlaw position There continues to be an ongoing decline in new cases, including the number of Covid-19 cases in South Yorkshire and Bassetlaw. This sustained reduction in new cases allows the system to firmly look ahead towards Phase Three from August 2020 to April 2021 - resetting the NHS. There are a number of key concerns for health leaders as the NHS recovery process looks to restore services. Issues raised include restoring the NHS amidst workforce challenges, potential lengthening of waiting lists, and strict infection control measures – all of which will significantly impede capacity. Supplies of Personal Protective Equipment (PPE) have improved significantly, particularly sterile gowns and sterile gloves and alternative suppliers through the support of Heads of Procurement have been sourced. General PPE continues to improve though there remain some concerns about the supply of PPE in Primary Care, and this remains a high priority. PCR testing (testing of swabs to see if people have the virus) continues to be in a strong position. SYB labs have capacity to undertake testing of NHS and social care patients and staff. In addition, members of the public with symptoms have access to swabbing via the regional testing sites at Doncaster Airport and Meadowhall as well as via the mobile testing units (MTUs) that are sited most days at Barnsley County Way, Rotherham AESSEAL stadium and Dearne Valley Leisure Centre. The MTU at Meadowhall continues to be one of the five busiest in England, typically undertaking more than 400 swabs per day. For antibody testing, approximately 50% of all NHS staff in SYB have now been tested (up to 22nd June) although this varies between each of SYB's five Places; Doncaster and Bassetlaw were first to have the analytical capacity in the lab and most staff there have been tested. With regards to the NHS reset, there is now a very strong case being considered for returning to fewer hospital Covid treatment sites in SYB. This would see the scale-down of the Covid surge capacity response, mirroring the original scaling up in March. At the same time, partners are now resuming some services, focusing on clinical priorities for those who most urgently require treatment. Cancer care continues to be one of the main priorities in SYB’s system recovery plans and partners are working to review and reprioritise patients. The System also has a role in supporting reset in the community. Working with partners in primary care and the community there is a need to ensure that population health and the needs of our communities post-Covid are understood and supported. This includes the plans that are underway for how to manage the follow-up and rehabilitation needs of patients who have had Covid. Each of SYB’s Local Authorities has a robust Local Outbreak Plan which is supported by a regular flow of data and led by Directors of Public Health. With the recent further easing of lockdown

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measures at the beginning of July, partners’ Plans took into account the potential for increase in demand, particularly in relation to urgent and emergency services. 2.2 National update On June 9th, there was a joint session between ICS and STP Independent Chairs and Executive leaders with senior colleagues at NHSE where the future of system working was discussed. The event was one of a broader conversation on the future of systems, alongside further opportunities to be involved in the coming months. 2.3 Regional Update

The North East and Humber Regional ICS Leaders continue to meet weekly with the NHS England and Improvement Regional Director to discuss where support during Covid-19 should be focused. Discussions during June focused on improving BAME inclusion, outbreak management arrangements, support for care homes, supporting urgent and emergency care as public confidence returns and planning for Phase Three. 2.4 Planning for Phase 3 and Phase 4

Further NHS planning guidance and a financial framework are expected in mid-July. A first draft SYB System Plan, which is an amalgamation of all five Place Plans, is currently in development. It takes into account constraints such as workforce, estates management, infection control and PPE while also incorporating examples of best practice in SYB and nationally. There will be a final submission at the end of July. To support the planning process, a workshop to stress test the restoration of broader health and sustainment of care services in a COVID environment with partners took place on June 1st. This valuable exercise explored four possible scenarios across Places, offering opportunities for colleagues across health and care to analyse local plans in order to make improvements. Feedback from the session was very positive, with the learning now being built into local plans. 2.5 Identifying and embedding transformational change across SYB and capturing

learning from the Covid-19 crisis The ICS Programme Management Office is working with the Yorkshire and Humber Academic Health Science Network to capture views of senior leaders and colleagues from across SYB's health and social care organisations to feed into the joint project: ‘Identifying and embedding transformational change across SYB and capturing learning from the Covid-19 crisis’. To accurately capture and understand the innovation that is emerging, views are being gathered from those directly involved in the implementation of the rapid changes through an extensive consultation exercise. 2.6 Cancer update Cancer care continues to be one of the main priorities in SYB’s system recovery plans. Partners are working to review and reprioritise patients who have previously been on waiting lists. Those patients who have waited for a long time already and are a priority clinically are very much at the forefront of efforts to receive fast-track diagnostic and treatment services. The results of the recently published NHS England and Improvement commissioned National Cancer Patient Experience Survey saw SYB 2% above the national average in the areas of patients thinking they were seen ‘as soon as necessary’ (86%) and the length of time ‘waiting for tests to be done being about right’ (90%). The survey monitors national progress on the patient’s experience of cancer care and acts as a driver to improve quality at local level. This is strong evidence of the excellent work taking place across SYB.

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2.7 Planning for Flu Modelling for influenza infections in the UK is now starting to take place as preparations for winter get underway, with a recognition that this could occur alongside a further Covid-19 peak. This is firmly on the radar of SYB’s testing cell which has started to devise a winter testing strategy to support the system level planning. Supporting this work will be a system level flu strategy, which will be made up of five Place plans and a SYB Flu Board. 2.8 Accelerating NHS progress on health inequalities during the next stage of COVID

recovery The disproportionate impact on people from Black, Asian and minority ethnic communities, people living in areas of high deprivation and inclusion health groups shows starkly the health inequalities which persist in England today. The NHS Long-Term Plan commits the NHS to addressing health inequalities and much excellent work is underway already, particularly focused on medium and long-term action. But progress needs to be accelerated; responding to and recovering from COVID calls for more focused, additional and immediate actions. To address this, NHS England and Improvement have established a Task and Finish Group, composed of a range of system leaders and voluntary sector partners, to focus on what specific, measurable actions should be taken by the NHS in the next few months. The Group will take account of feedback and ideas already received from BAME organisations, the VCSE sector, local systems and others. This work is distinct from but complementary to the dedicated work on the NHS as an employer being led by the Chief People Officer on supporting our BAME NHS staff and implementing the NHS Workforce Race Equality Standard. In SYB, the response to health inequalities is being taken forward by Workforce Leads, Kevan Taylor and Dean Royles. 2.9 Support for the Centre for Child Health Technology (CCHT) The Sheffield MPs wrote to the Government to outline their support for a new world class research and innovation facility in Sheffield. The Sheffield Children’s Hospital sponsored Centre for Child Health Technology (CCHT) at the Sheffield Olympic Legacy Park would be a multi-million transformational project supported by regional partners and international businesses including IBM Watson Health, Cannon Medical, Phillips and the South Yorkshire and Bassetlaw Integrated Care System. The site would span over 51,000 square metres, delivering world-class clinical and technical innovations to support children’s health and wellbeing in SYB and beyond. 2.10 Sheffield City Region devolution deal agreed South Yorkshire’s devolution deal has finally been agreed and brought to the House of Commons. This is a significant step forward for South Yorkshire’s economy and our congratulations go to Dan Jarvis, Mayor of the Sheffield City Region, and his team on this fantastic achievement. Once passed into law, an additional £30million pounds will be allocated to Sheffield City Region for regeneration projects supporting local growth and transformation. This is a great example of partnership working and its long-term impact is likely to shape the lives of the population for years to come. 2.11 Volunteers and Carers Partners recognised the thousands of carers in SYB during Carers Week (8-14 June). Many of the patients who visit GP surgeries or go into hospital are cared for by a relative or have caring responsibilities themselves. Carers Week was a timely opportunity to thank them for all they do and particularly for their vital role in helping vulnerable people manage their health and care needs during the coronavirus outbreak.

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It was also National Volunteers Week 1-7 June. Likewise, volunteers bring significant added value to health and care organisations with their experience and talent and the week was a great opportunity to thank the many thousands of volunteers in South Yorkshire and Bassetlaw for all they do. 3. Finance update A new national financial framework is being developed to cover the period from August 2020 to March 2021 which is built upon the financial framework adopted for the period from April 2020 to July 2020. This will form part of the planning guidance is due to be released shortly. The system has submitted capital plans to the region which total £47.1m which cover both the ‘base case’ and ‘stepped up case’ planning assumptions provided for this exercise. Further work is being undertaken to prioritise these schemes if the system is provided with a cash limited financial envelope to cover such expenditure. From March to July 2020, commissioners and providers have been funded at actual cost to enable a break even position each month. From August 2020 to March 2021 this will be replaced with a cash limited sum which will replace the retrospective top-ups to commissioners and providers to allow them to break even and to reimburse costs associated with COVID 19. The intention is to provide systems rather than organisations with a financial envelope. Andrew Cash System Lead, South Yorkshire and Bassetlaw Integrated Care System Date: 6 July 2020

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Engagement & Experience Committee (EEC) Meeting Thursday 4th June 2020 from 10am – 11am

via Microsoft Teams

Present : In attendance:

S Whittle (Chair) Lay Member for Patient & Public Involvement, NHS Doncaster Clinical Commissioning Group (CCG)

P Hemingway R Mather A Smith H Joerning A Edwards

Head of Communications & Engagement, CCG Senior Communications & Engagement Officer, CCG Senior Communications & Engagement Officer, CCG Patient Experience Manager, CCG Corporate Governance Manager, CCG

Dr M Pande G.P, South Locality Lead A Goodall Chief Operating Officer, Healthwatch Doncaster K Connolly

Senior Corporate Services Support Officer (Minute Taker), CCG

Agenda Ref

Subject Action Required By

1. Welcome and Introductions S Whittle welcomed everyone to the virtual meeting.

2. Apologies for Absence S Whittle noted apologies of absence from the following :

• A Fitzgerald - Director of Strategy and Delivery, CCG • L Robson - Public Health Theme Lead • A Coggan - Head of Performance and Intelligence, CCG • D Atkin - Doncaster Health Ambassador Group Chair • Dr V Joseph - Public Health Representative

3. Declarations of Interest S Whittle reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group (CCG). Declarations declared by members of the committee are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link: www.doncasterccg.nhs.uk


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The meeting was noted as quorate. Declarations of interest from sub committees / working groups: None declared Declarations of interest from today’s meeting: None declared

4. Minutes From Previous Meeting The minutes from the previous EEC meeting, held on 5th March 2020, were approved as a correct record with the following amendment: Item 9 - Healthwatch Monthly Update ‘Dr Pande commented that long term video consultations are not always appropriate as they take longer. She asked if there is any option to send photos i.e. a lesion.’ Amended to … ‘Dr Pande commented that long term video consultations are not always appropriate as they take longer. Photo options were also discussed and can be included in clinicians’ feedback.’

K Connolly

5. Action Log Update Both the open & closed action logs were updated :

• 2 actions closed • 3 actions remain open • 2 new actions

The updated open action log will be circulated with the minutes of this meeting.

6. Notification of Any Other Business There was one item of notification of further business for discussion.

7. Complaints Update Quarterly Report H Joerning provided the following answers to questions raised by Committee members from May’s Complaints Report: Annual Comparison Data Why such a huge jump to 422 contacts received for 2019/2020? We have been supporting the Medicine Management Team with

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triaging enquiries due to medication switches, If you look at the change in their numbers from approx. 13 per quarter to aprox 50 per quarter this provides a spike in numbers of +150 on top of any other hot spots such as the PLCV (procedures of low clinical value) letters. If you look at the figures in section 5 you will be able to see exactly what enquiries are coming in and the area they link to. We had planned a piece of work to look at why people were contacting CCG in the first instance rather than going to the provider – however with C-19 we are all working together to ensure issues are dealt with so this piece of work has been paused at the moment. Concerns - Website accessibility issues for the deaf community

What issues?

This was escalated to A. Russell on 18.03.2020, as there have been discussions around using Browsealoud for our site along with the Easy Read documents I am working on. P Hemingway updated the Committee to confirm that work is taking place with the DCCG web provider, RDaSH to look at options. Browsealoud is very costly and was used by RDaSH for a period of two years with very little use. P Hemingway confirmed that once the options had arrived and preferred option chosen, the committee would be informed. Compliments The Committee members asked if compliments could be shared with appropriate teams.

K McGuire will send these direct to you on a separate email as they may have gone to the generic email last time.

H Joerning advised Committee members there has been a significant drop in complaints this year, 20 in total. There is a stringent process in place and this has played a huge part in complaints dropping quarter after quarter. The Engagement and Experience Committee noted the update.

8. Healthwatch Monthly Update A Goodall provided Committee members with a verbal update on Healthwatch Doncaster, the following areas were highlighted:

• Online engagement is continuing throughout the Doncaster community

• Recovery and renewal plan • Telephone support is accessible if required to help reduce

isolation and loneliness • Looking at shielded list for extra support if required

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• Integrated Facebook into Zoom meetings, also using Facebook Live

• DBTH happy with survey results S Whittle asked if Healthwatch Doncaster are working with any other Volantary Care organisations? A Goodall advised they are not but will look into and assist if they are struggling with capacity. The Committee members noted the informative update and thanked A Goodall.

9. AGM Update P Hemingway advised Committee members a virtual Annual General Meeting via Microsoft Teams has been arranged for Wednesday, 2nd September 2020 from 3.30pm – 5.30pm. Confirmation to be sent out soon. The Committee members noted the AGM update.

10. ‘Draft’ 2019-20 NHS Doncaster CCG Annual Report P Hemingway presented the Final ‘Draft’ 2019-20 NHS Doncaster CCG Annual Report to Committee members. S Whittle commented on how comprehensive the report is. Dr Pande requested her full name is used for the report. A Edwards to request L Devanney to amend. The Committee members noted the report.

A Edwards

11. Review of Engagement Activities during the Coronavirus Outbreak R Mather updated Committee members on Engagement Activities during the Coronavirus Outbreak. Work is continuing with ICS across South Yorkshire and Bassetlaw (SYB). Looking at engagement across the whole system. Information has been provided for a paper ICS is putting together. The Committee members thanked R Mather for the update.

12. Any Other Business A Goodall requested clarification for focus areas for EEC and Governing Body as patient stories are resuming from July. P Hemingway advised Living Well will come to EEC in July. K Connolly to update the EEC forward plan.

K Connolly

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13. Date & Time of Next Meeting:

Thursday 2nd July 2020 from 10am – 11am via MS Teams

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Minutes of the Primary Care Commissioning Committee (Public)

Held on Thursday 11 June 2020 at 12.30 pm Via Microsoft Teams

Voting Members Present:

L Tully Lay Member (Chair) S Whittle Lay Member H Tingle Chief Finance Officer A Fitzgerald Director of Strategy and Delivery J Pederson Chief Officer

A Russell Chief Nurse, CCG

Non-Voting Members Present:

C Ogle Associate Director of Primary Care & Commissioning

K Roberts Primary Care Manager A Russell Head of Quality- Vulnerable People Z Head Lead Nurse Primary Care Quality Dr D Eggitt Local Medical Committee (LMC)

Representative P Barringer NHS England Representative Informatics Programme Manager Dr N Alsindi Clinical Lead for Primary Care & Long

Term Conditions J Telford Healthwatch Representative Dr M Pande Locality Lead GP

In Attendance:

M Gibbons K Smith C Empson

Primary Care Support Officer (Minutes) Senior Officer, Digital Primary Care Informatics Programme Manager

Meeting Start 12.30 pm

Action 1. Apologies for Absence

None Received

2. Declarations of Interest The Chair reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of NHS Doncaster Clinical Commissioning Group (CCG). Declarations declared by members of the committee are listed in the CCG’s Register of Interests. The Register is available either via the secretary to the Governing Body or the CCG website at the following link: www.doncasterccg.nhs.uk


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The meeting was noted as quorate. Declarations of interest from sub committees / working groups: None declared. Declarations of interest from today’s meeting: None declared.

3. Notifications of Any Other Business No items were raised.

4. Minutes From Previous Meeting held 14 May 2020 The minutes of the last meeting held on 14 May 2020 were approved as an accurate record.

5. Matters Arising not on the Agenda No matters arising.

6. Action Tracker The Committee discussed and updated each item on the Action Tracker. The latest updates can be viewed on the Action Tracker.

7. Finance & Contracting 7.1 Interim Exception Report H Tingle gave a verbal Finance update. Finance submitted a final 2019-2020 year end summary to the last committee. The Finance team have sent out a template to practices giving them an opportunity to apply for COVID related costs, which were related to the pandemic. They are expecting this to come back by the end of the week they will then have a review and submit this onto the national template. 7.2 Primary Care Estates Strategy Implementation Plan Update The Doncaster Primary Care Estate Strategy Implementation and Improvement Plan was published in May 2019 and progress has now commenced delivering the plan. The following sets out activities that have been undertaken in month and will be progressed in the following month. S Barnes is meeting the PCN’s regarding developing their own estates strategies. C Ogle and S Barnes met with the CCG Programme Board and ICS Capital Programme Board. The CCG Programme Board was an opportunity to update on local schemes with the wider partnership as the

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board includes property services, CHP and the local authority. It was useful to ensure that we were all on the same page, as our plans have implications for all of those stake holders. At the ICS meeting there is still a lot of work ongoing to manage the programme. It is anticipated that the programme business case will need to be submitted by the end of September, which means that the PCCC will need to approve it as a draft in our September meeting. This will be entered on to the forward planner for that meeting

M Gibbons S Barnes is attending a commercial workshop on 16 June. C Ogle and S Barnes will attend a Stage Gate Review in July to assure the national team that the individual projects are progressing well. The main outstanding issue (to split down the PCN project into the separate component parts) is now complete. It is expected that the national team will require information on the following:

• Task and finish groups have now been set up for each project. • To agree a timeline and identify the critical path we are following. • To look at the clinical model for each of the schemes, provide

assurance that what will be delivered in the premises is critical to the space that we need, and look at the COVID response and how this has impacted.

• We will be expected to have looked at the impact of digital working on space on know how we are refreshing the model in light of this knowledge.

• They must provide assurance that as we get closer to the financial implications, where the commitment is signed off at a CCG level, that we have considered procurement and commercial implications. We must demonstrate how we engage with the clinicians and patients around ongoing developments.

The Project Management Office (PMO) is looking into how we can access development moneys to fund architects and design. New for Old is a national programme for designing integrated hubs within a national plan for redevelopment. The intention is to streamline the process to have a nationally agreed model for an integrated hub. NHS England have asked for bids for premises improvement grants with priority on Infection, Prevention and Control to manage the safety of staff and patients. The CCG has asked for the proposals by the end of June The money has to be spent by the end of March 2021. C Ogle then gave a brief update on two of the projects: Bentley Proposal: Is to use the library building just around the corner from the Bentley Surgery. There is some ongoing work to look at the land around the library and to

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confirm the space requirements. Funding has been secured for One Public Estate to progress the next steps of this development. Mexborough: Is probably the next furthest along, working with a third party developer around the plans for a new surgery, which would incorporate the new surgery and Mexborough Health Centre. They are having further discussions with the PCN around the implications for the PCN footprint.

8. Quality

8.1 Interim Exception Report

Z Head gave a verbal report. COVID-19 work is continuing with practices. The new guidance came out on 29 May version 3 of the Standard Operating Procedure (SOP) is asking practices to consider how they will re-start services again. NHS England is now sending out cytology appointments.

TARGET will resume in July, with virtual training on Infection, Prevention and Control with a special focus on COVID-19.

There have been no more CQC reports published since the last Committee meeting. CQC inspections are currently suspended unless there are exceptional concerns.

J Pederson advised the Committee that COVID-19 Test and Trace strategy has begun. Practices and the CCG will be informed if a COVID patient has been in a Practice. It has been confirmed that individuals wearing PPE and adhering to social distancing rules at the time are not classed as a contact. It is important this message is highlighted to Primary Care.

9. Strategy & Planning

9.1 Delivery Plan 2020/21

K Roberts and C Empson gave a Presentation on the current year’s delivery plan.

Delivery Plan milestones are split into 4 key areas, identified by national guidance and local priorities. There are 39 key milestones identified across General Practice, inequalities and risk management.

The digital work stream has a bigger priority in this current work plan.

Integration and use of the NHS app is awaiting further guidance.

COVID-19 has expedited some online consultation conversations with increasing interest from practices.

Primary care Estates forms a larger part of the Delivery Plan this year with

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reduction in void space, new builds, delivery of the strategy being key areas.

PCN, working priorities include workforce, the national DES and care homes work.

It is important to note that we are in June and the delivery plan should have been in place from April. Milestone updates will be brought to the committee in the near future. Some actions have been completed and significant work has been undertaken.

C Empson then gave a presentation on Measurable Outcomes

The measures would cover improving access, improving digital uptake and ensuring care is in the right place.

Financial savings metrics are still under development.

9.2 Evaluation & Recovery

K Roberts talked to the evaluation and recovery plan shared with the agenda papers. He thanked E Serfozo for his support in developing this document. The document covered all national and local areas affected, stood down or reduced as a result of the covid-19 pandemic. The actions have been discussed at the primary care cell, exploring the clinical criteria, evaluations and risk assessments in terms of how we stand these services back up and when. With particular reference to Primary Care Commissioning Committee there are particular actions that fall under the committees remit. The Primary Care Delivery Group and the Information Sub Group both feed up into this committee and were stood down initially until 30 June. We are obliged to review when these meetings are stood back up and when they come into effect.

We recommend at the moment that a lot of the conversations happening in Delivery Group and Information Sub Group are happening via the current cells in place such as the Health Cell, Primary Care Cell and Data Cell we would like The Committees permission for these services to remain stood down until the end of July and for The Committee to review again at a later date.

The membership of the Primary Care Cell was discussed and it was confirmed that other colleagues are invited to join the Cell as and when required, similar to that of the Primary Care Delivery Group.

The Committee discussed the governance of the Primary Care Cell, and noted that the discussions are not currently held in a public arena or shared into a public arena. The Committee acknowledged that the Cells were set up quickly in response to the COVID-19 pandemic to allow timely responsive. The Committee agreed that all decisions made at the Primary Care Cell must be documented and then reported at the Primary Care Commissioning Committee. The importance of independent challenge

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during any decision making process was also discussed and noted.

The Primary Care Commissioning Committee approved the extension of the review date for the Primary Care Delivery Group and Primary Care Information Sub Group until 31 July 2020. K Roberts agreed to present a further paper detailing governance arrangements of the Primary Care Cell at the July 2020 meeting. K Roberts

9.3 Primary Care Network Update

The paper was circulated prior to the meeting. Doncaster achieved 100% coverage by our practices into PCN’s, on the same footprint as previously agreed last year. There will be some changes to the Clinical Directors, as B Scott is leaving at the end of June and we have now been formerly notified that he will be replaced by 3 GPs Dr K Singh, Dr D Coleman and Dr M Boon on a job share basis. All 3 GP’s will do one session each. C Ogle has asked for clarity regarding who is going to cover what.

K Mansfield and Dr Shah from East respectively have been re-elected for a further 12 months.

For the North Dr V Kumar and S Teanby-Clark have been extended for 3 months until 1 September, when this leadership will be reviewed.

C Ogle confirmed that the appointment of clinical directors is the role of the PCN and the CCG does not have a role in the appointments..

As part of the next steps all PCNs are required to sign a Network Agreement by the end of June 2020. The PCN’s have to develop workforce plans by the end of August 2020.

All the PCN’s have been asked for confirmation of how they spent the £1.50 per head monies in 19/20 with a deadline of 30 June.

The Committee noted the update.

10. Forward Planner The Committee noted the Forward Planner. It was agreed to discuss the Primary Care, Care Home response at the July or August 2020 Meeting. All other additions as discussed in the meeting will be added to the planner as agreed. M Gibbons It was noted that a Development Session is due, L Tully agreed to explore this further outside of the meeting. L Tully

11. Any New Potential Risks No new risks were identified at today’s meetings.

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12. Any Other Business No items were raised.

13. Date and Time of Next Meeting Thursday 9 July 2020 at 12.30 pm

Meeting Closed 13:38 pm

virtual governing body · 2020-07-31 · l devanney presented the staff survey 2019 summary report...

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