Barnsley CCG

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Putting Barnsley People First

A meeting of the NHS Barnsley Clinical Commissioning Group Governing Body will be held on Thursday 13 August 2015 at 9.30 am in the Boardroom, Conference Centre, Kendray Hospital. Doncaster Road, Barnsley S70 3RD.

AGENDA (Public)

Item Session GB Requested

to

Enclosure Lead

Time

1. Apologies

09.30 am

2. Patient Story

09.30 am 10 mins

3. Declarations of Interest Relevant to the Agenda

Nick Balac GB/Pu/15/08/03

09.40 am

4. Questions from the Public on Barnsley Clinical Commissioning Group Business

Nick Balac 09.40 am 10 mins

5. Minutes of the Meeting held on 9 July 2015

Approve GB/Pu/15/08/05 Nick Balac

09.50 am 5 mins

6. Matters Arising Report

Note GB/Pu/15/08/06 Nick Balac

09.55 am 5 mins

Strategy

7. Report of the Chief Officer

Information GB/Pu/15/08/07 Lesley Smith

10.00 am 10 mins

Quality Governance

8. Quality Highlights Report

Information GB/Pu/15/08/08 Brigid Reid

10.10 am 10 mins

9. Child Sexual Exploitation Update


10.20 am 10 mins

10. Commissioning of Children’s Services Quarterly Monitoring


10.30 am 10 mins

11. Workforce Race Equality Standard WRES Information & Approval

GB/Pu/15/08/11 Brigid Reid

10.40 am 10 mins

12. Security Policy & Procedure Approval GB/Pu/15/08/12 Vicky Peverelle

10.50 am 5 mins

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Signed

Dr Nick Balac – Chairman Exclusion of the Public:

13. Hospital Discharge Notifications Information GB/Pu/15/08/13 John Harban

5 mins 10.55 am

14. Terms of Reference Patient and Public Engagement Committee.

Approval GB/Pu/15/08/14 Vicky Peverelle

11.00 pm 5 mins

15. Risk and Governance Exception Report

Information & Approval

GB/Pu/15/08/15 Vicky Peverelle

11.05 am 10 mins

Finance and Performance

16. Integrated Performance Report

Information GB/Pu/15/08/16 Heather Wells Vicky Peverelle

11.15 am 15 mins

Committee Reports and Minutes

17. Minutes of the Membership Council held on 21 July 2015

Information GB/Pu/15/08/17 Nick Balac

11.30 am 5 mins

18. Minutes of the Finance and Performance Committee held on 2 July 2015

Information GB/Pu/15/08/18 Nick Balac

11.35 am 5 mins

19. Primary Care Commissioning Assurance Report

Information GB/Pu/15/08/19 Chris Millington

11.40 am 5 mins

20. Minutes of the Quality and Patient Safety Committee held on 25 June 2015

Information GB/Pu/15/08/20 Mehrban Ghani

11.45 am 5 mins

21. Minutes of the Patient and Public Engagement Committee meeting held on 16 July 2015

Information GB/Pu/15/08/21 Chris Millington

11.50 am 5 mins

22. Minutes of the Equality Steering Group held on 16 July 2015


11.55 am 5 mins

Date and Time of the Next Meeting: 10 September 2015 at 09.30 am in the Boardroom, Hillder House 49/51 Gawber Road, Barnsley S75 2PY.

12.00 am Close

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The CCG Governing Body should consider the following resolution: “That representatives of the press and other members of the public be excluded from the remainder of this meeting due to the confidential nature of the business to be transacted - publicity on which would be prejudicial to the public interest” Section 1 (2) Public Bodies (Admission to meetings) Act 1960

GB/Pu/15/08/03

1


GOVERNING BODY

13 August 2015

Declarations of Interests Report

1. PURPOSE OF THE REPORT

To provide the Governing Body with all Governing Body members declarations of interest.

2. EXECUTIVE SUMMARY

This report details all Governing Body members declared interests for members to update and to enable the Chair and members to foresee any potential conflicts of interests.

3. THE GOVERNING BODY IS ASKED TO:

Review that their individual declared interests are up to date

Receive and note the Governing Body members declarations of interest

Agenda time allocation for report:

5 minutes

Report of:

Vicky Peverelle

Designation:

Chief of Corporate Affairs

Report Prepared by:

Lynne Richards

Designation: Governance, Assurance and Engagement Facilitator.

GB/Pu/15/08/03

2

1. SUPPORTING INFORMATION

1.1 Links to the Assurance Framework

The report is especially relevant to the following risks on the Gb Assurance Framework: 2.1 and 5.2.

1.2 Links to Objectives

To have the highest quality of governance and processes to support its business

To commission high quality health care that meets the needs of individuals and groups

Wherever it makes safe clinical sense to bring care closer to home

To support a safe and sustainable local hospital, supporting them to transform the way they provide services so that they are as efficient and effective as possible for the people of Barnsley

To develop services through real partnerships with mutual accountability and strong governance that improve health and health care and effectively use the Barnsley £.

1.3 Governance Arrangements Checklist

Financial Implications

Not relevant

Contracting Implications

Not relevant

Quality

Not relevant

Consultation / Engagement

Not relevant

Equality and Diversity

Not relevant

Information Governance

Not relevant

Environmental Sustainability

Not relevant

Human Resources

Not relevant

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REGISTER OF INTERESTS

NHS Barnsley Clinical Commissioning Group

This register of interests includes all interests declared by members and employees of Barnsley Clinical Commissioning Group. In accordance

with the Clinical Commissioning Groups constitution and the Clinical Commissioning Groups Accountable Officer will be informed of any conflict

of interest that needs to be included in the register within not more than 28 days of any relevant event (e.g. appointment, change of

circumstances) and the register will be updated regularly (at no more than 3-monthly intervals)

Register: Governing Body

GOVERNING BODY

Name Position Details of interest

Nick Balac Chair of Barnsley Clinical Commissioning Group

Partner at St Georges Medical Practice (PMS)

Practice holds Barnsley Clinical Commissioning Group Vasectomy contract

Member Royal College General Practitioners

Member of the British Medical Association

Member Medical Protection Society

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GOVERNING BODY


A member of Barnsley GP Federation which may provide services to Barnsley CCG

Mehrban Ghani Medical Director for Barnsley Clinical Commissioning Group

GP Partner at White Rose Medical Practice, Cudworth, Barnsley

Directorship at SAAG Ltd, 15 Newham Road, Rotherham

A member of Barnsley Healthcare Federation which may provide services to Barnsley CCG

Madhavi Guntamukkala

GP Member Barnsley Clinical Commissioning Group

GP partner at The Grove Medical Practice

Member of British Medical Association and member of Royal College of General Practitioners


John Harban GP Member Barnsley Clinical Commissioning Group

GP Partner at Lundwood Medical Centre and The Kakoty Practice, Barnsley

Contracts with the Barnsley Clinical Commissioning Group to supply Vasectomy, Carpal Tunnels and Nerve Conduction Studies services

Owner/Director Lundwood Surgical Services

Wife is Owner/Director of Lundwood Surgical Services

Member of the Royal College of General Practitioners

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GOVERNING BODY


Member of the faculty of sports and exercise medicine (Edinburgh)


Anne Marie Hoyle Practice Manager Member Barnsley Clinical Commissioning Group

Business Manager at The Kakoty Practice, Barnsley

Cllr Alice Cave, BMBC Elected Councillor is related

Member of Yorkshire NAPC Steering Group

Director Barnsley Enterprise for Living Well (CIC)

Member of the Institute of Healthcare Management


Nick Luscombe GP Member Barnsley Clinical Commissioning Group

GP partner at Huddersfield Road Partnership

Practice lead for a small dispensing branch surgery

A fierce advocate of the adoption of first world standards of medical practice into Barnsley health care

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GOVERNING BODY


Member of the British Medical Association but not actively

Medical student and F2 tutor for University of Sheffield

Lawrence King


Salaried GP at Kingswell Surgery

Local Medical Committee Member

Sudhagar Krishnasamy


GP Partner at Royston Group Practice, Barnsley

Member of the British Medical Association

Member of the Royal College of General Practitioners

GP Appraiser for NHS England

Executive member of Barnsley Local Medical Committee

Member of the Medical Defence Union

Director of SKSJ Medicals Ltd


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GOVERNING BODY


Chris Millington

Lay Member, Barnsley Clinical Commissioning Group

Partner Governor Barnsley Hospital NHS Foundation Trust

Vicky Peverelle Chief of Corporate Affairs, Barnsley Clinical Commissioning Group

No interests to declare

Brigid Reid Chief Nurse, Barnsley Clinical Commissioning Group

Volunteer registered Nurse, St Gemma’s Hospice, 329 Harrogate Road, Moortown, Leeds LS17 6QD

Mark Smith


Senior Partner at Victoria Medical Centre also undertaking training and minor surgery roles.

Lesley Smith Chief Officer, Barnsley Clinical Commissioning Group

Husband is Director of Ben Johnson Ltd a York based business offering office interiors solutions, furniture, equipment and supplies for private and public sector clients.

Mike Simms Secondary Care Clinician, Barnsley Clinical Commissioning Group

No interests to declare

Heather Wells Chief Finance Officer, Partner holds a Senior Management position with BUPA –potential supplier of

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GOVERNING BODY


Barnsley Clinical Commissioning Group

services to the NHS.

GB/Pu/15/08/05

Page 1 of 19


Minutes of the Meeting of the BARNSLEY CLINICAL COMMISSIONING GROUP GOVERNING BODY (PUBLIC SESSION) held on Thursday 9 July 2015 at 09.30 am in the Boardroom, Hillder House, 49/51 Gawber Road, Barnsley, S75 2PY. MEMBERS PRESENT: Dr Nick Balac (in the chair) Chair Dr Mehrban Ghani Medical Director Dr Madhavi Guntamukkala Member Dr John Harban Member Ms Marie Hoyle Member Dr Lawrence King Member Dr Nick Luscombe Member Mr Chris Millington Lay Member Mrs Lesley Smith Chief Officer IN ATTENDANCE: Mr Neil Lester Deputy Chief Finance Officer Ms Kay Morgan Governing Body Secretary Ms Karen Martin Deputy Chief Nurse Mrs Vicky Peverelle Chief of Corporate Affairs APOLOGIES: Dr Sudhagar Krishnasamy Member Ms Brigid Reid Chief Nurse Dr Mark Smith Member Mr Mike Simms Secondary Care Clinician Ms Heather Wells Chief Finance Officer MEMBERS OF THE PUBLIC: Ms Donna Ardron Extended Scope Practitioner SWYPFT Mr David Brannan Member of the Public Mrs Margaret Dennison Member of the Public Healthwatch Barnsley Mrs Margaret Sheard Member of the Public Mr Trevor Smith JP Member of the Public Ms Sharon Sweeting Physiotherapy Professional Lead SWYPFT Ms Tesni Ward Member of the Public

GB/Pu/15/08/05

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Agenda Item

Action

Deadline

GB 15/150 PATIENT STORY

The Governing Body received a Patent Story which reflected the experiences of a patient who suffered with heart failure and depression. The Care Navigation and Tele Health Service provided care to the Patient which resulted in positive wide ranging benefits and outcomes for the patient and his carers.

The Chairman invited views from the Governing Body about the Patient Story. The following main points were noted:

A diagnosis of heart failure was the one single diagnosis which tended to generate the most fear and anxiety in patients.

Advice and support for the patient following initial diagnosis was important and in this case had been provided by the Care Navigation Service.

It was queried whether various support mechanisms available for patients were effectively joined up.

Cancer follow ups are now being undertaken by the Care Navigation Team and good feedback had been received from this service

The story provided a good example of care being delivered closer to home, improving and providing quality services to patients.

The Governing Body noted the Patient Story.

GB 15/151 DECLARATION OF INTERESTS RELEVANT TO THE AGENDA

The Governing Body considered the Declarations of Interest Report.

The Chairman advised that the Barnsley First Limited Liability Partnership was dissolved on 30 June 2015.

The Deputy Chief Nurse declared that she was seconded to the Care Quality Commission (CQC) as specialist adviser. This declaration was in respect of agenda item 9, Quality Highlights Report and CQC

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Agenda Item

Action

Deadline

Primary Care inspections.

The Chairman determined that it was in the best interests of the CCG for the Deputy Chief Nurse to participate in discussion relating to agenda item 9 due to her expertise in this area. In addition this item was for information purposes only and not for decision.

The Governing Body noted the Declaration of Interests Agreed Actions:

To remove the Barnsley First Limited Liability Partnership from all relevant declarations.

KM

13.08.15

GB 15/152 QUESTIONS FROM THE PUBLIC ON BARNSLEY CLINCIAL COMMISSIONING GROUP BUSINESS

The Chairman invited questions from Members of the Public on Clinical Commissioning Group business.

Funding Gap for Barnsley A member of the public requested clarity on the funding gap for health in Barnsley. The Chairman informed the meeting that the previous MP for Barnsley Mr E Illsley had made representation in parliament about the funding allocation for Barnsley. In response to the question, the Chief Officer advised that the previous representation had been in light of Barnsley PCT allocations being below target allocation. The formula had since been revised for CCGs, placing more emphasis on age rather than deprivation. In 2014/15, Barnsley CCG was therefore 10.13% above target allocation. For 2015/16, NHS England have increased the pace at which CCGs move to targets allocations and the CCG is now 8.55% above target allocation. In order to meet this reduced allocation and expected reductions in future years, the CCG must carefully manage its resource to meet the surplus required by NHS England. It was noted that an “Introduction to NHS England Finance Regime” workshop offered to Governing Body

HW

13.08.15

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Agenda Item

Action

Deadline

members and provided by the Deputy Chief Finance Officer could be extended to partner organisations in order to aid understanding of the context in which the CCG is operating.

Funding for Seven Day Services at the Barnsley Hospital NHS Foundation Trust (BHNFT) A member of the public asked about CCG funding to support 7 day services at the BHNFT in particular whether the CCG’s surplus could be used to help the deficit in required funding? In response, it was explained that:

In 2014/15 and 2015/16, BHNFT had received £1.895m and £1.700m respectively from CCG resource to support 7 day services. In the context of reduced allocations from plan, the CCG does not have the scope to find and provide any additional monies over and above that which had already been provided.

The CCG surplus is an historic surplus and is required to be maintained in line with NHS England business rules. In year the CCG is not planning delivery of any additional surplus. Access to historic surpluses can only be provided to the CCG non-recurrently on the basis of a business case approved by NHS England. The 2015/16 Financial Plan included the release of £2.2m of the historic surplus which was approved by NHS England.

The member of the public posed a further question and queried if there was a business case against surplus for additional monies to fund 7 day services and sustain services over the winter period? The Chief Officer advised that the CCG paid for all activity at the hospital on a case by case basis and contracted for sufficient activity. It was reiterated that the CCG had also invested non recurrently in transformational change in support of 7 day services, £1.895m in 2014/15 and £1.7m in 2015/16. Only one other CCG, Rotherham had provided so much financial support for 7 day services. The ability of the CCG to provide further financial support was very limited.

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Agenda Item

Action

Deadline

In respect of business cases against historic surpluses, the Deputy Chief Finance Officer clarified that the business case process takes place prior to the start of the financial year and that the possibility for further drawdown of funds was not available in 2015/16. . Dr John Harban commented that the BHNFT had received substantial amounts of additional funding from the CCG to support 7 day services. The BHNFT should deliver 7 day services within their budget allocations. It was noted that funding for 7 day services had been raised by a member of the public at the previous meeting of the Governing Body on 11 June 2015 and this discussion was fully documented in the minutes of the meeting. The Chief Officer offered a further opportunity, outside of the meeting, for members of the public to speak with her about the funding of seven day services. NB Post meeting note: The Chief Officer met with the members of the public to discuss the funding of 7 day services on 9 July 2015 at 11.30 am.

LS

09.07.15

The Governing Body noted the questions from the Member of the Public. Agreed Actions: To promote the NHS Finance Workshops across the Barnsley Health and Social Care Community.

LS

31.08.15

GB 15/153 MINUTES OF THE PREVIOUS MEETING HELD ON 11 JUNE 2015 AND AGM 25 JUNE 2014

The Minutes of the meeting held on 11 June 2015 were verified as a correct record of the proceedings subject to the following amendment:

Minute reference GB 15/124 Questions from the Public Third paragraph second and third sentences to read: 100 was considered on par and BHNFT had been

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Agenda Item

Action

Deadline

around 110. The Trust had introduced a number of measures including medical examiner system and the use of sepsis bundles as part of an action plan to reduce their Hospital Standardised Mortality Rate (HSMR).

Minute reference GB 15/126 – D1 Discharge Letters Second paragraph, first sentence to read: It was noted that information about a patient’s medication could be accessed from Patient Summary Care Records.

Minute reference GB 15/134 Integrated Performance Report First sentence to read: The Chief of Corporate Affairs presented the Integrated Performance Report to the Governing Body.

Minute reference 15/140 Primary Care Commissioning Committee Assurance Report

I Heart Programme to be depicted as I HEART

The Minutes of the Annual General Meeting (AGM) held on 25 June 2015 were verified as a correct record of the proceedings. It was noted that any pertinent issues from the informal session of the AGM, would be discussed at the Patient Council.

CM/MH

22.07.15

GB 15/154 MATTERS ARISING REPORT

The Governing Body considered the Matters Arising Report and the following main points were noted:

Minute reference GB 15/135 Budget

It was noted that budget management meetings will commence in August 2015.

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Agenda Item

Action

Deadline

Minute reference GB 14/163 Strategic Commissioning Plan

The Chief of Corporate Affairs informed the meeting that workforce would be addressed via the new models of care, with reports to the Clinical Transformation Board.

The Governing Body deemed this action complete.

Minute reference GB 15/42 Terms of Reference Clinical Senate.

It was noted that in addition to the CCG Chairman Medical Director and Chief Nurse the other clinical representative from the CCG attending the Clinical Senate will be Dr M Guntamukkala.

Minute reference GB 15/125 Customer Focussed Training

Mr C Millington reported that customer focussed training would be further discussed by the Governing Body in private session on 9 July 2015.

The Governing Body noted the Matters Arising Report.

STRATEGY

GB 15/155 REPORT OF THE CHIEF OFFICER

The Chief Officer introduced her report, which provided the Governing Body with the following update:

Five Year Forward View – Time to Deliver

The Five Year Forward View – Time to Deliver reinforced the national direction of travel for the NHS and progress against this. Members noted that Barnsley featured in the report as one of the 8 Integrated Personal Commissioning demonstrator sites and one of 57 Prime Minister’s Challenge Fund sites.

Establishment of Urgent and Emergency Care

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Page 8 of 19

Agenda Item

Action

Deadline

Networks

It was reported that Urgent and Emergency Care networks were being established on a geographic basis to have strategic oversight of urgent and emergency care on a regional footprint via an agreed Urgent and Emergency Care Strategy. The Barnsley System Resilience Group was evolving to undertake the role of operational leadership; retaining responsibility for effective delivery of urgent care in adherence with the Strategy. Dr J Harban commented that there was a huge amount of work and cost shift being transferred from the Barnsley Hospital NHS Foundation Trust and South West Yorkshire NHS Partnership Trust District Nursing Service to Primary Care. There appeared to have been no agreement by the CCG for transfer of this work and cost to Primary Care. There were also capacity issues within Primary Care to take on any additional workload. A member of the public highlighted that Nursing Homes by dispensing with their trained nurses and transferring this work to the District Nursing Service, may be putting additional pressure on the District Nursing Service. The Medical Director clarified that nursing and residential home placements were commissioned by the Barnsley Metropolitan Borough Council. It was noted that existing extended hours at Practices had not yet made a difference in terms of reducing attendance rates at the Accident and Emergency Department. The Barnsley public needed to informed about extended GP opening hours

Yorkshire and the Humber Genomic Medicine Centre

The Governing Body noted that the Yorkshire and Humber region would submit a bid for Wave 2 to establish a Genomic Medicine.

CCG Assurance Process 2015/16

Members noted the requirements of the CCG

VP

13.08.15

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Page 9 of 19

Agenda Item

Action

Deadline

Assurance Framework 2015/16. The Chief Officer was pleased to announce that the CCG’s 2014/15 Quarter 4 Assurance Meeting with NHS England had taken place on 1 July and the CCG was hopeful that it would be assured as ‘good’ by NHSE. This indicated that there were some minor concerns with the performance of the CCG, but overall the CCG is well led and in good organisational health.

The Governing Body noted the Report of the Chief Officer. Agreed actions:

The Chief of Corporate Affairs agreed to confirm position with SWYPT with regard to Commissioned workload moving from host to Primary Care and if there had been any change to provided services.

To raise transfer of work from the District Nursing Service to Primary Care at the South West Yorkshire NHS Partnership Trust Contract monitoring meeting.

To consider how best to communicate GP extended opening hours to the Barnsley Public.

VP HW VP

13.08.15

13.08.15

13.08.15

GB 15/156 COMMISSIONING STRATEGY 2014-19

The Chief of Corporate Affairs presented her report which updated the Governing Body with a refresh of the CCG Strategic Commissioning Strategy. It was noted that consultation had taken place on the final draft of the Plan and the limited comments received had been included in the final version of the Plan.

The Governing Body: Approved The publication of the ‘Strategic Commissioning Plan 2014 to 2019, Refresh – 2015 to 2019 – Putting the NHS Five Year View into Action’ and sign off by the Chair and Chief officer.

VP

13.08.15

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Agenda Item

Action

Deadline

QUALITY AND GOVERNANCE

GB 15/157 QUALITY HIGHLIGHTS REPORT

The Deputy Chief Nurse referred to her Report which provided the Governing Body with the agreed highlights of the June Quality and Patient Safety Committee meeting. The Deputy Chief Nurse drew members’ attention to the following specific issues within the Report.

The Kirkup Report – Morecombe Bay Obstetrics Investigation

The Barnsley Hospital NHS Foundation Trust (BHNFT) had produced a gap analysis against recommendations in the Kirkup Report and shared the resultant action plan with the CCG. The CCG had subsequently undertaken additional work looking at the correlation of serious incidents occurring at the BHNFT with the Kirkup Report and BHNFT action plan.

Care Quality Commission Primary Care Inspections

It was noted that following the Care Quality Commission’s (CQC) inspections of Primary Care in Barnsley two Practices were required to make improvements. The CCG was supporting and working with these practices to achieve the CQC standards. The Royal College of GPs had visited one of the Practices and initial feedback from this visit was positive.

Testosterone Shared Care Agreement

It was noted that issues with the Testosterone Shared Care Agreement had been resolved and the agreements were now in place.

Infection Prevention and Control

A new Infection prevention and Control service provided by IPC Solutions would commence at the end of September 2015. In response to a question raised the Chief Nurse confirmed that there were no

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Agenda Item

Action

Deadline

additional cost implications to the CCG for the new service. In addition it was anticipated that a more specialised service would be provided.

Adult Safeguarding A recent internal audit of the CCG’s Adult Safeguarding System determined there was significant assurance of sound systems of control in place. A number of medium and low risk recommendations were included in the Internal Audit Report. An agreed action plan was in place and being progressed by the designated Nurse Safeguarding Adults.

The Governing Body noted the Quality Highlights Report.

GB 15/158 TERMS OF REFERENCE – CCG COMMITTEES

The Chief of Corporate Affairs introduced her report which provided the Governing Body with updated terms of reference for CCG Committees. The Chief of Corporate Affairs explained that CCGs Constitution suggested an annual review of the CCG Committees terms of reference.

Five committee terms of reference were presented for review and approval by the Governing Body. It was noted that the Terms of Reference for the Clinical Transformation Board and Primary Care Commissioning Committee had recently been approved by the Governing Body. The Terms of Reference for the Patient and Public Engagement Committee would be considered at the next meeting of the Committee on 16 July 2015 and then submitted to the Governing Body for approval on 13 August 2015.

The Governing Body: Approved The following terms of reference:

Finance and Performance Committee

Remuneration Committee

Equality Steering Group

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Agenda Item

Action

Deadline

Approved The following terms of reference subject to:

Audit Committee: a change in membership – (paragraph 12.1 c) the Governing Body Member to be Dr M Guntamukkala

Quality and Patient Safety Committee: addition to the membership – inclusion of the Head of Quality for Commissioning Primary Care Medical Services.

VP

13.08.15

GB 15/159 RISK AND GOVERNANCE EXCEPTION REPORT

With reference to her report the Chief of Corporate Affairs provided the Governing Body with the Risk and Governance Report. The Governing Body noted the three risks on the Assurance Framework currently rated as ‘red’ extreme and the five extreme risks on the Risk Register. The Quality and Patient Safety Committee had recommended with rationale, two risks for removal from the Risk Register.

The Chief of Corporate Affairs drew members’ attention to risk reference CCG 14/11, the performance of Barnsley Hospital NHS Foundation Trust in relation to waiting times for diagnostic tests. She advised that performance had recently improved and the Governing Body may wish to consider reducing the score for this risk should the improved performance be sustained.

The Governing Body:

Considered and agreed that the red (extreme) risks on the Assurance Framework were appropriately scored and there was sufficient assurance that these risks are being effectively managed as at 11 June 2015

Did not identify any positive assurances relevant to the risks on the Assurance Framework.

Reviewed risks rated as extreme on the Risk Register

Reviewed the risks escalated from the Risk Register as gaps in control against risks on the Assurance Framework

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Agenda Item

Action

Deadline

Approved

The removal of the two identified risks from the Risk Register.

VP

13.08.15

FINANCE AND PERFORMANCE

GB 15/160 INTEGRATED PERFORMANCE REPORT

The Chief of Corporate Affairs and Deputy Chief Finance Officer presented the Integrated Performance Report to the Governing Body.

Performance The key performance issues highlighted in the report were considered by the Governing Body.

Yorkshire Ambulance Service

It was noted that the performance of YAS in Barnsley had continued to improve during 2015. Dr J Harban commented that performance was the same as per the previous year and sustained performance should remain on the CCGs radar.

Cancer

For the month of May there were concerns around 3 breaches where patients had waited more than 31 days for subsequent treatment. To improve performance, there was a drive to send referrals on a timelier basis.

Healthcare Associated Infections

The Chief of Corporate Affairs reported that to date there had been eight cases of healthcare associated infections (C Diff) this was above trajectory of seven cases.

In response to a question raised about staff sickness rates the Chief of Corporate Affairs advised that one person on long term sickness strongly affected the organisational staff sickness rate.

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Agenda Item

Action

Deadline

Finance The Deputy Chief Finance Officer informed the Governing Body that the CCG was forecasting to achieve all financial duties and planning guidance requirements. This included the achievement of a surplus of £8,280k in line with NHS England expectations.

The Governing Body considered the Financial Risk Assessment and noted a potential £202k risk not covered by the £4,899k target for QIPP delivery. For members of the public the Chief Officer explained that the CCG had committed £1.7m to the Barnsley Hospital NHS Foundation Trust, the CCG therefore needed to action its savings programme and was holding risk in the system. The Deputy Chief Finance Officer explained that the Financial Risk Assessment was also about meeting the challenges of financial risk, some risks were mitigated but other risks may emerge. It was important therefore that the Transformation/QIPP Programme was achieved.

In response to a question raised it was clarified that a Multidisciplinary Consistency and Performance Steering Group was in place to develop and monitor progress with the QIPP. A Transformation/QIPP Programme Monitoring Report would be submitted to the next meeting of the Governing Body on 13 August 2015. The Chairman commented that it was also important for member Practices to engage with the delivery Transformation/QIPP Programme.

The Governing Body noted the contents of the report including the 2015/16 forecast outturn and financial risk assessment. Agreed Actions:

To submit a Transformation/QIPP Programme Monitoring Report to the next meeting of the Governing Body on 13 August 2015

HW

13.08.15

COMMITTEE REPORTS AND MINUTES

GB 15/161 MINUTES OF THE AUDIT COMMITTEE HELD ON 4

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Agenda Item

Action

Deadline

JUNE 2015

The Governing Body considered the Minutes of the Audit Committee held on 4 June 2015. Mr C Millington informed the Governing Body that the main purpose of the meeting had been to tie up outstanding issues before the Lay Member for Governance and Chair of the Audit Committee left the CCG. A round of recruitment had taken place for a new Lay Member but no appointment had been made. A further round of recruitment was currently in progress.

Discussion took place and the following main point were noted:

Minute reference AC 15/130 Register of Procurement

The Chief of Corporate Affairs clarified that following delegated Co-commissioning of Primary Care the CCG was required to have additional governance measures in place relating to Conflicts of Interest and also a Register of Procurement.

Minute reference AC15/121 & AC 114/8 – CSU Service Auditors Report.

It was noted that there were some outstanding but minor actions in relation to the CSU Service Auditors Report.

The Governing Body noted the minutes of the Audit Committee.

GB 15/162 MINUTES OF THE FINANCE AND PERFORMANCE COMMITTEE HELD ON 4 JUNE 2015

The Governing Body received and noted the Minutes of the Audit Committee held on 4 June 2015.

GB 15/163 PRIMARY CARE COMMISSIONING ASSURANCE REPORT

Mr C Millington presented the Primary Care Commissioning Committee Assurance Report.

CQC Update

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Agenda Item

Action

Deadline

Mr C Millington highlighted that there was a requirement for all Practices to publish their CQC reports and actions within their Practices.

Violent Patient Scheme

In response to queries raised, it was clarified that the existing contract for the Violent Patient Scheme, provided in Doncaster will be in place until March 2016. No Barnsley patients were currently registered on the scheme. There was general consensus amongst the Governing Body that the Violent Patient Scheme should be provided in Barnsley. The Practice Manager Member commented that the specification for the Scheme required the provider to pay for security staff and a small Practice may not be able to take this kind of financial risk. The Chairman commented that the Violent Patient Scheme was a difficult area to cover from a provision of service perspective, consideration could be given to a district wide service and extending opportunities to other providers.

Lundwood and Highgate

It was noted that the Lundwood and Highgate procurement would be completed by September 2015. It was explained that currently a APMS contract was for a three year period. A new APMS contract would in future run for 15 Years with five yearly reviews. APMS Practices had previously been funded at a higher level; this was now being brought in line to similar levels of funding within other Barnsley Practices. The Chairman commented that Primary Care affected the people of Barnsley and reports submitted to the Governing Body should be in clear reader friendly format.

Brierley Practice

An update was provided regarding the Brierley

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Page 17 of 19

Agenda Item

Action

Deadline

Practice. The emergency contract provision currently provided by Sheffield Health and Social Care Trust would come to an end in September 2015. Options to sustain the service were being explored. Some recent developments had taken place affecting the Practice premises. The Shafton branch premises were no longer available to the Practice and a service was being provided from the main Brierley premises, although the Brierley premise was up for sale. The Governing Body considered the situation with the Brierley Practice it was identified that:

o The Barnsley GP Federation was providing help and support to the Brierley practice.

o A new provider would be in place by 1 December 2015

o Public consultation on Procurement of a new service was due to commence.

o The CCG had written to local MP’s about the Brierley Practice and it was thought that the MP’s may issue a media release.

o The CCG has also informed the Health and Wellbeing Board and Overview and Scrutiny Committee.

o A joint letter was being sent to all patients of the Brierley Practice informing them of the current situation. If patients were not happy there was an option for them to register with another Practice in the local area.

The CCG was assessing viable alternative premises for the Practice and to sustain a quality service for the Patients at Brierley and Shafton. This was a priority area of work for the Primary Care Commissioning Committee.

The Governing Body noted the Primary Care Commissioning Committee Assurance Report.

GB 15/164 MINUTES OF THE HEALTH AND WELLBEING BOARD HELD ON 9 JUNE 2015

The Governing Body noted the minutes of the Health and Wellbeing board held on 9 June 2015. The Chief Officer highlighted that since the Health and Wellbeing Board meeting an agreement had been reached about

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Page 18 of 19

Agenda Item

Action

Deadline

the risk share and the section 75 agreement was to be signed by the CCG and Barnsley Metropolitan Borough Council.

GB 15/165 QUESTIONS FROM THE PUBLIC

The Chairman invited further questions from the public on Barnsley CCG business. Two questions were raised Lundwood Practice A member of the public enquired about the Lundwood practice and issues with the Premises. The Chief of Corporate Affairs indicated that this was not an issue for the public domain and offered to further discuss this with the member of the public outside of the meeting. Monitoring of Nursing Homes A member of the Public asked about monitoring arrangements of nursing homes specifically in relation to patient care. The member of the public commented that Healthwatch Barnsley were undertaking some pilot work around patient experience in care homes but this was not necessarily monitoring care. The Deputy Chief Nurse provided assurance that the CCG worked very closely with the commissioners (Barnsley Metropolitan Borough Council) of nursing/residential homes placements to develop key quality indicators. The quality indicators were monitored by the BMBC in partnership with the CCG and involving the CCGs Safeguarding Adult Lead. The member of the public highlighted that some homes had received a low rating from the Care Quality Commission. She was concerned about the regular monitoring of these homes and quality of care provided to elderly patients. Relatives of patients in care homes did not feel that they could complain because of the potential effects that this may have on the care delivered to their relative. The Medical Director advised that any concerns about care homes could be reported anonymously to the Care Quality Commission. The Chairman closed the discussion indicating that the CCG would remain vigilant in the monitoring of Care

VP

09.07.15

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Page 19 of 19

Agenda Item

Action

Deadline

homes and safe quality of care provided to patients. The member of the Public was invited to speak further about care homes outside of the meeting.

GB 15/166 DATE AND TIME OF THE NEXT MEETING

The next meeting of the Governing Body will be held on:

Thursday 13 August 2015 at 09.30 am in the Boardroom, Conference Centre, Kendray Hospital, Doncaster Road, Barnsley S70 3RD

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Page 1 of 7


MATTERS ARISING REPORT TO THE GOVERNING BODY 13 August 2015

1. MATTERS ARISING

The table below provides an update on actions arising from the previous meeting of the Governing Body (public session) held on 9 July 2015.

Table 1

Minute ref Issue Action Outcome/Action

GB 15/151 Declaration of Interests To remove the Barnsley First Limited Liability Partnership from all relevant declarations.

KMo

COMPLETE

GB 15/152 Questions from the Public Barnsley Funding Gap - To promote the NHS Finance Workshops across the barnsley Health and Social Care Community BHNFT 7 day services - To discuss funding of seven services with Members of the public

NL LS

ONGOING COMPLETE

GB 15/153 Minutes of the Previous Annual General Meeting - 25 June 2015 To raise any pertinent issues from the AGM informal session at the Patient Council.

CM/MH

of 7


GB 15/155 Report of the Chief Officer – Establishment of Urgent and Emergency Care Networks

To confirm position with SWYPT with regard to Commissioned workload moving from host to Primary Care and if there had been any change to provided services.

To raise transfer of work from the District Nursing Service to Primary Care at the South West Yorkshire NHS Partnership Trust Contract monitoring meeting.

To consider how best to communicate GP extended opening hours to the Barnsley Public.

VP HW VP

COMPLETE To build into contract discussions. To pick up as part of Prime Ministers Challenge Fund Communications

GB 15/156 Commissioning Strategy The publication of the ‘Strategic Commissioning Plan 2014 to 2019, Refresh – 2015 to 2019 – Putting the NHS Five Year View into Action’

VP

COMPLETE

GB 15/158 Terms of Reference CCG Committees To amend the following terms of reference in line with the comments of the Governing Body

Audit Committee: a change in membership – (paragraph 12.1 c) the Governing Body Member to be Dr M Guntamukkala

Quality and Patient Safety Committee: addition to the membership – inclusion of the Head of Quality for Commissioning Primary Care Medical Services.

VP

COMPLETE

of 7


GB 15/158 Risk and Governance Exception Report Removal of 2 risks 14/5a and 13/2b from the CCG Risk Register

VP

COMPLETE

GB 15/165 Questions from the Public – Lundwood Practice To discuss issue with the Lundwood Practice with the member of the public outside of the Governing Body (public session) meeting.

VP

COMPLETE

2. ITEMS FROM PREVIOUS MEETINGS CARRIED FORWARD TO FUTURE MEETINGS

Table 2 provides an update/status indicator on actions arising from earlier Board meetings held in public.

Table 2

Minute Ref

Issue Action Outcome/Actions

GB 14/320 & GB

14/335

Formal Management Team To set up a meeting with IT leads, the Practice Manager Member and Chief Finance Officer to look at all issues around IT support to avoid becoming a reputational issue for the CCG.

HW

Martin Lane met with Practice Managers Group Chairman of Practice Managers Group to meet with Martin Lane to progress resolution of IT issues

GB 14/108 Report of the Chief Officer Identify the individual(s), organisation(s) responsible for ensuring that actions from the External Verification Cancer Peer Review Visit 2014 were completed. Action plan to be circulated to Governing Body Members.

VP

COMPLETE

GB 14/340 BUPP Report, Winterbourne View – Time for Change Management Team to consider the proposed savings in the significant commissioning area of Learning

Man. Team

Work to progress phase 2 has been agreed by the Management Team in July

of 7

Minute Ref


Disabilities for the CCG.

2015 and regular updates will come to JCU. COMPLETE.

GB 14/347 Minutes of the Quality and Patient Safety Committee The D1 audit and considerations of this by the Area Prescribing Committee and Quality and Patient Safety Committee discussed by Governing Body. Preferred list of D1 indicators to be submitted to the Membership Council for approval Development of an action plan to improve the quality and timeliness of DI information to Practices.

MG JH MG

The DI Audit was being considered and monitored by the Area Prescribing Committee and Quality and Patient Safety Committee. It was also included in the Quality Highlights Report and on the CCG Risk Register. Membership Council considered D1 indicators on 21.07.15 The action plan is outstanding.

GB 14/350 & GB15/35

Questions from the Public The Medicines Optimisation Team and Quality and Patient Safety Committee to explore whether the BHNFT’s Pharmacy Robot is being utilised to its full potential and reflect findings back to the BHNFT. A Report about utilisation of the Pharmacy Robot and realisation of benefits as listed in the original business case will be submitted to Contract Monitoring Meeting in March 2015 and then Governing Body. Submission of update benefits realisation report to Patient Council

MG/(CH) HW (CH) HW CM

Further reminders have been sent to the Trust and their KPI information has been received with KPIs noted as achieved. However, further details to support this achievement and the project closure report have been requested. The latest correspondence received 8 June 2015 suggested this could be received next month once approved through the Trusts governance structures.

GB 15/10 & GB 15/35

Quality Highlights Report Determine CCG levers to affect improvement in D1 letters and report

(CH) HW

Discussed at BHNFT contract meeting on 6

of 7

Minute Ref


back to next meeting of the Governing Body on 12 February 2015. Meeting being arranged to agree improvements to D1 Letters - Ms Chris Lawson Medicines Optimisation to attend the meeting

February 2015. BHNFT to produce a timeline of actions to address issues. To be taken forward by the Director of Nursing BHNFT.

GB 15/41 Child Sexual Exploitation Update

To share the Louise Casey Report and assurances about CSE activity in a supportive way with the Council.

BR

Chief Nurse to request BSCB for a ‘True for us’ review. COMPLETE

GB 15/42 Terms of Reference Clinical Senate

The Chairman to ascertain interest in the membership of the Clinical Senate from GPs.

NB

Pending – Dr M Guntamukkula to attend Clinical Senate

GB 15/43 Integrated Performance Report To press for financial penalties to be applied in respect of the YAS contract

(CH) HW

Ongoing

GB 15/66 Chief s Officers Report – Vanguard Application

To continue to progress the CCGs approach to developing a Multispecialty Community Provider model of care for Barnsley.

LS

Business case considered at Clinical Transformation Board on 04 June 2015 and supported by Governing Body on 11 June 2015. Work Ongoing.

GB 15/69 Cancer Programme Board Update Consider inclusion of monitoring and chase up mechanism for Patient Bowel Cancer Screening in the PDA with emphasis on special attention for vulnerable groups.

JH/VP

To be considered as part of the Barnsley Quality Framework Phase 3 in 2016.

GB 15/76 Contracts

Delegated authority for the Chairman and Chief Officer to

LS/NB

SWYPFT contract has been signed

of 7

Minute Ref


sign finalised contracts between the CCG and its main providers BHNFT & SWYPT

BHNFT core contract, agreed but not yet signed

GB 15/96 Summary of Lorenzo demonstration Pharmacy Robot

To submit a further benefits realisation report about the Pharmacy Robot to the Governing Body.

Patient X-rays to be made available to respective GPs

BR VP

To be picked up via contracting meeting on 16 July 2015. – Report requested Work Is ongoing to facilitate this as a pilot

GB 15/125 Customer Focussed Training To develop the customer focused training. A plan for the training to be produced by w/e 23 June 2015

CM BR MH MA AP

First Port of Call – recognising Receptionists pilot planned for October – November 2015

GB 15/140 Management Team To rearrange Management Team meetings to Wednesdays at 12.00 noon.

LS

Agreed to begin from 5 August 2015.

GB 15/131 Quality and Patient Safety Committee Annual Report

To submit the Quality and Patient Safety Annual Report to the next meeting of the Membership Council.

To produce a one page summary and video clip of the Quality and Patient Safety Annual Report for the Patient Council

BR BR

Planned for September Meeting Planned for July Meeting - COMPLETE

GB 15/135 2015/16 Budget

To identify a Clinical Lead and Executive Lead for each budget

Budget management meetings to be prioritised and timetabled in diaries for relevant budget Clinical

HW HW

Budget leads identified. Budget management meeting to commence in August 2015.

of 7

Minute Ref


and Executive Leads.

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1


GOVERNING BODY

13 August 2015

REPORT OF THE CHIEF OFFICER


To update the Governing Body on key issues and developments relevant to the strategic direction of the CCG.


This report provides an update on the following issues:

Secretary of State Speech on 16 July – Making healthcare more human-centred and not system centred

Achieving World Class Cancer Outcomes


Note the summary of the Secretary of State’s Speech on future vision for the NHS

Note the report from the Independent Cancer Taskforce on Achieving World Class Cancer Outcomes

Agenda Item – Allocation of Time

10 Minutes

Prepared by: Jade Francis-Rose

Designation: Head of Commissioning for Partnership and Integration

Report of: Lesley Smith

Designation: Chief Officer

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2



Objective 1, threat 1.1 – risk the CCG will fail to work effectively with its key providers resulting in a failure to commission high quality health care that meets the needs of individuals and groups Objective 3, threat 1.5 – failure to align operational planning with long term objectives Objective 4, threat 4.1 – failure to deliver joined up services for the people of Barnsley


Highest quality governance and processes.

X

Commission high quality health care that meets the needs of individuals and groups.

X

Bring care closer to home.

X

To support safe, sustainable and accessible local hospital services.

X

To develop services through real partnerships with mutual accountability and strong governance.

X

1.3

Links to NHS Constitution

Comprehensive service to all.

X

Based on clinical need, not ability to pay.

X

Highest standards of excellence.

X

Reflect the needs and preferences of patient’s families and carers.

X

The NHS works in partnership with other organisations.

X

Best value for taxpayers’ money.

X

Accountable to the public and patients that it serves.

X

1.4

Equality and Diversity N/A Report for information only

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3

2. DISCUSSION / ISSUES

2.1 Secretary of State Speech 16 July 2015

Health Secretary, Jeremy Hunt, set out the direction of reform for the future NHS in his speech ‘Making healthcare more human-centred and not system-centred’ on the 16 July 2015. The SoS reinforced the 5 year plan for the NHS which the government is willing to support financially on the back of a strong economy. The major announcements include:

- Supporting development of a ‘culture of continuous improvement’ - Focus on safety and quality

- Jointly led Monitor/TDA organization called ‘NHS Improvement’ to be

chaired by Ed Smith (Current Deputy Chair of NHS England) and Ara Darzi has been appointed as a Non-Exec Director. CEO post to be advertised with immediate effect. The patient safety function is to be transferred out of NHS England to NHS Improvement by the end of March 2016.

- Leadership development, including the NHS Leadership Academy will

become the responsibility of Health Education England (HEE). The speech centred on the importance of:

- Leadership

- Improvement

- Innovation

- Patient safety

- 7-day services The SoS reaffirmed the commitment to the 5 year plan but that alongside this a vision is needed. That vision moves away from a narrow focus on access targets to a broader view of what high quality care entails; a change towards holistic integrated care; a move towards prevention with a bigger focus on public health and more personal responsibility for our wellbeing. It was announced that the intention is by March 2016, England will become the first country in the world to publish avoidable deaths by hospital trust and with the help of the King’s Fund, publish ratings on the overall quality of care provided to different patient groups in every local health economy. The SoS went on to state that with smart metrics there can be less prescription about models of care, allowing more space for local ingenuity and innovation.

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4

There is a need to move further and faster towards population-level commissioning with accountable care organisations or integrated care provision. The SoS confirmed a commitment to 7-day care. The consultant contract will be reformed to remove the opt-out from weekend working for newly qualified doctors. No doctors currently in service will be forced to move onto the new contracts. Negotiations are ongoing with BMA union representatives but if negotiation is not successful, a new contract will be imposed. This element of Mr Hunt’s speech has gained much social media interest and comment. The SoS also stated that within the next 5 years electronic health records will be available seamlessly in every care setting. It was announced that as part of the new electronic booking service that has replaced Choose and Book, all GPs will be asked to tell patients not just which hospital they can be referred to but the relevant CQC rating and waiting time as well so patients will be able to make a truly informed choice about which local service is best for them. Patients also need to be able to make a meaningful choice about which GP surgery is most appropriate for their needs recognising there is a lack of capacity. This will be addressed through the New Deal for General Practice which will boost GP provision in under-doctored areas. The full speech can be found at: https://www.gov.uk/government/speeches/making-healthcare-more-human-centred-and-not-system-centred

2.2 Achieving World Class Cancer Outcomes

The Independent Cancer Taskforce released its report, Achieving World Class Cancer Outcomes on Sunday 19 July, which set out recommendations for a new cancer strategy for England and includes a series of initiatives across the patient pathway. The Independent Cancer Taskforce has consulted widely to determine how the NHS can deliver a step-change in outcomes. The report encompasses a large number of recommendations. However the six strategic priorities over the next five years are to: Spearhead a radical upgrade in prevention and public health: The NHS should work with Government to drive improvements in public health, including a new tobacco control strategy within the next 12 months, and a national action plan on obesity. We should aim to reduce adult smoking prevalence to less than 13% by 2020 and less than 5% by 2035. Smoking prevalence in Barnsley currently sits at 25%. Drive a national ambition to achieve earlier diagnosis: This will require a shift towards faster and less restrictive investigative testing Establish patient experience as being on a par with clinical effectiveness and safety: the report outlines that we have the opportunity to revolutionise the way we communicate with and the information we provide to cancer patients, using digital technologies. From the point of cancer diagnosis

https://www.gov.uk/government/speeches/making-healthcare-more-human-centred-and-not-system-centred

https://www.gov.uk/government/speeches/making-healthcare-more-human-centred-and-not-system-centred

GB/Pu/15/08/07

5

onwards, it is recommended we give all consenting patients online access to all test results and other communications involving secondary or tertiary care providers by 2020. Transform our approach to support people living with and beyond cancer: accelerating the roll-out of stratified follow up pathways and the “Recovery Package”. Make the necessary investments required to deliver a modern high-quality service, including:

Implementing a rolling plan to replace linear accelerators (linacs)

Working to define and implement a sustainable solution for access to new cancer treatments, building from the Cancer Drugs Fund;

Overhaul processes for commissioning, accountability and provision. The report recommends setting clearer expectations, by the end of 2015, for how cancer services should be commissioned. For example, most treatment would be commissioned at population sizes above CCG level. By 2016, we should establish Cancer Alliances across the country, bringing together key partners at a sub-regional level, including commissioners, providers and patients. These Alliances should drive and support improvement and integrate care pathways, using a dashboard of key metrics to understand variation and support service redesign. We should also pilot new models of care and commissioning. For example, the entire cancer pathway in at least one area should have a fully devolved budget over multiple years, based on achieving a pre-specified set of outcomes. The National Audit Office has estimated cancer services cost the NHS approximately £6.7bn per annum in 2012/13. The Five Year Forward View projections indicate that this will grow by about 9% a year, implying a total of £13bn by 2020/21. The recommendations set out in the report will cost an estimated £400m per annum, of which it is estimated that approximately £300m per annum may already be included within the FYFV baseline projections. However, in the medium term, implementation of the recommendations is expected to contribute substantially in excess of £400m per annum to the projected £22bn funding gap.

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Quality Highlights Report to August Governing Body Page 1 of 2


GOVERNING BODY

13 August 2015

Quality Highlights Report


T0 provide the August Governing Body with the agreed highlights of the July Quality & Patient Safety Committee meeting.


The information provided in this report is in addition to that already provided within the monthly performance report and the ongoing risk management work through the Assurance Framework and Risk Register. The format agreed highlights quality issues considered at each Quality & Patient Safety Committee which includes key points discussed, relevant actions and a narrative summary.


Note the Quality Highlights identified.


10 minutes.

Report of: Brigid Reid

Designation: Chief Nurse

Report Prepared by:

Amanda Lindley

Designation: Quality Manager

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Quality Highlights Report to August Governing Body Page 2 of 2



This report links to risks on the current Assurance Framework as follows: 1.1 If the CCG is unable effectively to manage the tension between BHNFT, SWPPFT, and BMBC's roles as both partners and providers of services to the CCG, there is a risk that the CCG will fail to work effectively with its key providers, resulting in failure to commission high quality health care that meets the needs of individuals and groups. 1.5 If (with support where appropriate from the CCG) our providers cannot effectively manage the financial pressures they are facing, there is a risk that those pressures will lead to a deterioration in the quality and safety of services provided, resulting in failure to commission high quality health care that meets the needs of individuals and groups. 5.1 If the CCG does not appropriately identify and assess client need in relation to safeguarding there is a risk of failure to commission services that safeguard vulnerable clients; AND if the CCG does not ensure our support to direct commissioning of care homes (BMBC) with professional advice is effectively acted upon there is a risk of failure to deliver our vulnerable adult safeguarding responsibilities to people in Care Homes.










Quality





Human Resources

As this report is for information only, all areas within the governance arrangements checklist are not relevant.

QUALITY HIGHLIGHTS

Governing Body Highlights Report following July 2015 QPSC Page 1 of 1

MONTHLY UPDATE TO THE AUGUST 2015 GOVERNING BODY FOLLOWING THE

JULY QUALITY & PATIENT SAFETY COMMITTEE This paper highlights significant quality issues or foci that the Quality & Patient Safety Committee judge important for the Governing Body to be sighted on in addition to the information provided in the monthly performance report or ongoing risk management through the Assurance Framework and Risk Register.

Issue Consideration

Action

Unannounced AMU Quality Assurance Visit Report

In April 2015 a team of CCG reviewers visited the AMU unit from 18:00 – 20:00. This was a follow up visit to the announced visit in November 2014. Whilst there had been improvements with some care issues, it was concerning that Consultant cover up until 20:00 was still reported as not consistently in place. BHNFT have seen the report and have not had any queries regarding factual inaccuracies. The report was tabled at the July QPSC.

The Committee received and noted the content. It was felt that the best approach to pursuing the recommendations would be to discuss them at the inaugural Clinical Quality Board.

Risk Register review

All the risks allocated to the QPSC have recently been fully reviewed by the Chief Nurse, Medical Director, Head of Assurance and Quality Manager. This process ensured that that the wording of the risks reflected accurately the current position, that mitigating actions are sufficient and up to date and that the scores were appropriate.

The Committee received and noted the content of the report. The wording and scores were agreed following only minor amendments, two risks were transferred to Primary Care Commissioning. One risk was closed relating to CHC retrospective claims relating to living patients as all of these have now had their current needs assessed. Two new risks were proposed and approved, one relating to the Medicines Optimisation QIPP scheme and one relating to ongoing work to develop Health Care support to an educational facility. The Head of Assurance was thanked for his work with the review.

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1


GOVERNING BODY

13 August 2015

Child Sexual Exploitation


This report is to update the Governing Body with regard to Child Sexual Exploitation (CSE) in Barnsley since the initial report presented in December 2014.


As identified to the Governing Body in previous meetings Barnsley is not exempt from CSE activity and so, the Governing Body requested that they receive bi-monthly reports. This report updates the Governing Body on the work being progressed through the Barnsley Safeguarding Children Board (BSCB) and offers a more detailed overview of the recently publicised repeat inspection by Her Majesty’s Inspectorate of Constabulary (HMIC) of South Yorkshire Police in relation to their handling of Child Protection.


Note the information provided in the report and its implications for the CCG as a partner agency of the Barnsley Safeguarding Children Board.


10 minutes



Report Prepared by:

Sharon Galvin

Designation:

Designated Nurse Safeguarding Children/LAC

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2


1.1 Links to Assurance Framework

The report is relevant to risk 5.1 as this relates to the Safeguarding of vulnerable young people and children.



√


√




√



Not relevant


Not relevant

Quality

Yes


Yes


Yes


Not relevant


Not relevant

Human Resources

Not relevant

GB/Pu/15/08/09

3

2. INTRODUCTION

As a result of the Jay report (August 2014) and the HMIC report findings which were released one month later (September 2014), there was rightly grave concern with regard to the announced failings of South Yorkshire Police. Since then there has been a significant increase in the number of Police Officers and staff in the public protection Units specifically to tackle Child sexual Exploitation as a result of the initial inspection. The HMIC re-inspected in April of this year and focussed on staff interviews and the examination of 28 case files to determine if the Police had made sufficient progress in addressing Child protection issues.

3. DISCUSSION

Subsequent to the update shared with the Governing Body in June 2015 the HMIC have published their re-inspection report (July 15). Whilst this inspection was portrayed negatively in the Media, who focused on the further progress required, the detail of the findings bears further review. As identified in the introduction the inspection focussed on staff interviews and examination of case files, unfortunately some of the files examined pre-dated the recommendations that came from the HMIC in September 2014, therefore those files would not demonstrate progress. There was however a positive acknowledgement of progress in relation to the Police’s initial response to referrals, their determination to improve and evidence that investigations were being handled well. It was evident to the inspectors that there was enhanced joint working to improve consistency across South Yorkshire. The Inspectors also obtained evidence from victims of CSE who confirmed that the service they received from the Police had improved and that they were well supported. It was acknowledged by South Yorkshire Police that there is still more to do to continue improving and they have identified a series of recommendations for improvement that go beyond those provided by HMIC. South Yorkshire Police stated that they are committed to achieving justice, stopping harm and preventing future offending and that the wellbeing of vulnerable children is paramount to them. The CSE Strategic Group met on the 13 July and they discussed:

Therapeutic support-existing resource and identified gaps in Provision.

The Casey Report: Benchmarking Response

BMBC Licensing response to the Casey report.

Training updates and gap analysis including frontline staff awareness of CSE.

Updating the Terms of Reference for this group and developing a Work programme.

Update from the Regional Data Intelligence meeting.

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4

South Yorkshire Police have also been influential in establishing Multi-agency Safeguarding Hubs (MASH’s) across South Yorkshire on a rolling programme Barnsley MASH is scheduled to commence September 2015. All notifications relating to safeguarding and promoting the welfare of children go through the Hub, there is co-location of professionals from core agencies to research, interpret and determine what is proportionate and relevant to share. This encourages understanding of each other’s roles and enhances and develops knowledge and expertise. There is an agreed process for analysing and assessing risk, based on the fullest information picture and dissemination of suitable information to the most appropriate agency for action. The MASH enables the early identification of risk and harm. The CCG’s Designated Nurse (Nurse Safeguarding Children/LAC) has been involved in its development and plans to sample practice there on a monthly basis.

The commissioning of Return Interviews for children missing has recently changed the previous provider was Safe at Last, the interviews are now been undertaken by the Targeted Youth Support Service.

The largest volume of CSE reports in Barnsley still relate to inappropriate sexual relationships. Many of the Barnsley cases reported to the Police and Social Care thought to be CSE by the referrer are actually identified as sexually harmful behavior; BSCB is to develop a policy to advice staff how to help young people that are engaging in sexually harmful behavior.

CSE is included in the Barnsley Safeguarding Children Board Continuous Service Improvement plan. Another BSCB multi-agency audit is scheduled for 15 September 2015 to ensure that there is improvement in the management of CSE in Barnsley across all the agencies.

4. IMPLICATIONS

As a partner agency of the BSCB the CCG has a role to ensure that we are part of the robust assurance process, through effective interagency challenge and escalation if necessary, to ensure that children and young people’s safety and welfare is paramount and maximised in Barnsley.

5. RISKS TO THE CLINICAL COMMISSIONING GROUP

The CCG are rightly concerned that any evidence of CSE activity in the Borough is appropriately managed. Through our membership of the BSCB, our scrutiny of providers and our support to Primary Care, our agency to maximise mitigation of risks is strong though clearly reliant upon open and transparent information shared by other agencies.

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5

6. CONCLUSION

It is evident that the programme of work being undertaken by BMBC and South Yorkshire Police is ongoing and there is some evidence that improvements are being made. The BSCB will continue to seek assurance that local intelligence is appropriately handled including escalation to resolution where necessary. The multi-agency CSE audits are ongoing on behalf of BSCB to ensure that identified cases of CSE are being managed appropriately. Whilst the recognition of CSE is improving, this will continue to be monitored by the BSCB. There is still no evidence to suggest that any CSE related Organised Crime Groups are operational in Barnsley.

GB/Pu/15/08/10

1


GOVERNING BODY

13 August 2015

COMMISSIONING OF CHILDRENS HEALTH SERVICES

QUARTERLY UPDATE


This report aims to update the Governing Body on the work that has been undertaken since the April 2015 update in relation to the commissioning of Children’s Health Services in Barnsley.


Key issues in relation to the commissioning of Children’s Health Services in Barnsley are centred on the remediation of CAMHS Performance, pursuing the Emotional Wellbeing offer for Children & Young People and the commissioning of Community Paediatric Nursing support to schools who have students with complex health care needs requiring medication/treatments in school hours. In addition the process and progress of the re-procurement of the 0-19 pathway is shared.


NOTE the progress made and the risks highlighted


Time required 10 minutes.

Report of: Brigid Reid, Chief Nurse

Report Prepared by:

Brigid Reid, Chief Nurse

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2

1 SUPPORTING INFORMATION


The update on Commissioning of Childrens Health Services provides assurances to the Governing Body against the following risks on the CCG’s Assurance Framework:

1.1, 1.4, 1.5, 4.1 & 5.1






To develop services through real partnerships with mutual accountability and strong governance that improve health and health care and effectively use the Barnsley £. These partnerships will be with: Patients, the public, Practices, Providers, the Local Authority, the local voluntary sector and other stakeholders as required

1.3

Links to NHS Constitution

The NHS provides a comprehensive service available to all.

Access to NHS Services is based on clinical need, not an individual’s ability to pay.

The NHS aspires to the highest standards of excellence and professionalism

The NHS services must reflect the needs and preferences of patients their families and their carers.

The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population

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

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

1.4 Equality and Diversity

This section should seek to check that an Equality Impact Assessment has taken place. If completed, please add as Appendix.

NA – reporting progress against plan

GB/Pu/15/08/10

3

2 INTRODUCTION

Subsequent to the arrangements described in the April 2015 paper to the Governing Body the following updates are provided:-

CAMHS Remediation work

The Emotional Wellbeing of Children and Young People

The role of Lead Nurse for Children with Complex Health Care Needs (Continuing Health Care, Special Educational Needs and the development of a specification for Community Paediatric Nursing support to schools in Barnsley)

CQC inspection of Looked After Children (LAC) and Children’s Safeguarding services report was received in April 2015 and shared with the June Quality & Patient Safety Committee

The 0-19 pathway re procurement commenced in the middle of April

Support to Education Staff in relation to children requiring medications/treatments during school hours

Due to capacity issues previously identified the Chief Nurse’s role in relation to the commissioning of Children’s Services is now supported by the Head of Commissioning (Mental Health, Children & Specialised Services).

3 AREAS OF SIGNIFICANT FOCUS

3.1 CAMHS Remediation Work This continues to be a major focus and has the oversight of the Children & Young People’s Trust Executive Commissioning Group (ECG). South West Yorkshire Partnerships NHS Foundation Trust (SWYPFT) have now asked their Interim BDU Director for CAMHS to directly support the local team following her leadership of the remediation work undertaken in Calderdale & Kirklees. Alongside the service’s work to ensure effective and timely data is utilised to monitor trends a revised action plan has been requested by the end of August and particular consideration is being given to how to reduce DNAs (current DNA rate is approximately 27% (national benchmark is around 12%)). As referrals are often sensitive in nature recourse to seeking universal services to reinforce/assist attendance needs further consideration but this is being pursued as in addition to the impact on the child referred it is imperative to reduce the loss of capacity such non use of appointments causes (hard to bring forward the rest of the clinic or others at short notice). In the meantime crisis intervention continues to challenge the service’s ability to undertake its planned work and the effect is compounding. The national monies associated with ‘Future in Mind’ were only announced on 3 August (guidance) and we have until 9 October to develop and submit our Local Transformation Plan. The intention is to utilise them in 2 ways, to deliver the non-medicalised counselling part of the emotional well being offer (3.2) to prevent need for referral into CAMHS and to support those currently waiting for treatment (post assessment).

http://www.england.nhs.uk/wp-content/uploads/2015/07/local-transformation-plans-cyp-mh-guidance.pdf

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4

3.2 Emotional Wellbeing of Children and Young People As identified above in 3.1 the element of the offer developed in October 2014 is the priority to deliver via accessing national monies. As part of the 365 in 30 initiative the pilot the CCG supported in Barnsley College has been captured on video (CHILIPEP) and Governing Body members are urged to view this to understand the powerful nature of the work that is key to building a resilient legacy.

3.3 Lead Nurse for Children with Complex Health Care Needs (Continuing Health Care, Special Educational Needs and the development of a specification for Community Paediatric Nursing support to schools in Barnsley) As identified in the April 2015 update this is currently being covered by an interim secondee from Sheffield Children’s Hospital Trust. Given the positive benefits of expertise that is associated to a tertiary centre and thus reduces the risk of professional isolation or reliance on one individual a joint appointment with SCHT is being pursued. 3.4 Community Paediatric Nursing support to schools in Barnsley Although it has not yet been possible to secure the proposed long term solution (See Appendix A) the time taken to ensure all parties understand the needs and aims has been invaluable and a revised interim position has been secured to commence in September 2015. To support the new interim providers work is being undertaken during the summer by the Lead Nurse and the CCGs medicine’s management team. Once Schools recommence Healthwatch will facilitate the consultation process with the parents and carers of children attending relevant schools. 3.5 Procurement of the 0-19 year old pathway (Health Visiting and School Nursing) Led by Public Health as the responsible commissioner (School Nursing transferred in April 2013 and Health Visiting transfers in October 2015) this process began on 14 April 2015 and its governance is through the ECG of which the Chief Nurse is a member. The stakeholder feedback closed on 29 July and following discussion at the Membership Council on 21 July a formal response on behalf of the CCG and the Local Medical Council was submitted (Appendix B). ECG met on 3 August to review the specification in light of stakeholder feedback. The tendering process will commence on 2 September and end on the 20 November, there will be GP representation on the panel. Contract mobilisation is planned over 6 months with the new service to commence on 1 June 2016. 3.6 Looked After Children (LAC)/Children in Care (CIC) Following the receipt of the CQC report of the inspection of Looked After Children (LAC) and Children’s Safeguarding services (which took place in November 2014) on 28 April 2015 an action plan was developed with relevant providers and submitted to the Quality & Patient Safety Committee (Q&PS) in June 2015 (Appendix C). This action plan is being monitored by the Children & Young People’s Trust Continuous Service Improvement work and progress will be reported at regular intervals to Q&PS. The CCG’s Designated Nurse set up and Chairs a group focusing on the Health of Children in Care and these minutes go to Q&PS.

https://www.youtube.com/watch?v=BWg1VMcq364

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4 IMPLICATIONS

This report as presented potentially has the following implications for the CCG as follows:

Securing a joint appointment with SCHT for the Lead Nurse role (the ability to recruit and retain to a CCG part time senior post has been judged high risk)

The need to secure resourcing of the non-medicalised counselling element of the emotional wellbeing offer is dependent on ‘Future in Mind’ identifying additional resources to reduce the demand on CAMHS

The progression of a new service specification to support to schools with students who require medication/treatment when at school is behind schedule but the delay has been essential to ensure stakeholder engagement, the revised interim provision reduces the cost pressure inherited and transition risks are being managed by close involvement of the Lead Nurse and the CCGs Medicines Management Team.

There have been concerns expressed by GPs that the 0-19 pathway re-procurement will reduce provision at a time when neither outcomes nor engagement with fellow health professionals can afford to deteriorate in any way. These concerns have been fed into the consultation process.

5

RISKS TO THE CLINICAL COMMISSIONING GROUP

Risk to realising benefits or reducing risk in relation to CAMHS remediation due to delayed progression of the emotional wellbeing offer remains.

In relation to the work to progress the service to support to schools with students who require medication/treatment when at school, Q&PS are sighted on the associated risks through their risk register 15/09 Greenacre.

With regard to the re-procurement of the 0-19 pathway in addition to the Chief Nurse and the Head of Commissioning input via ECG the Director for Public Health has indicated that she will make the draft specification available to GPs once it is further developed and the CCG Chair or Medical Director will participate in reviewing the bids submitted in November 2015.

6 APPENDICES

Appendix A SAFEMED draft spec Appendix B CCG & LMC response to 0-19 pathway stakeholder feedback request Appendix C CQC action plan for LAC and Children’s Safeguarding

7 CONCLUSION

Further to the April 2015 report to the Governing Body further action has been taken by the CCG to strengthen its capacity to ensure the key remediation required is pursued and associated supporting work is progressed.

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6

Appendix A Meeting the needs of Children with

Complex Health Needs in Education Draft Service Specification

May 2015 National Guidance states that:

“The aim is to ensure that all children with medical conditions, in terms of both physical and mental health, are properly supported in school so that they can play a full and active role in school life” (DfE, September 2014)

In 2014 Barnsley Clinical Commissioning Group (BCCG) took over the responsibility from Public Health to provide health care support to children with complex needs in education (responsibility remains with Public Health for the provision of the School Nursing service i.e. delivery of the 5 – 19 Healthy Child Programme).

The CCG compared the current service model with the National Guidance and the existing processes were assessed by our clinical lead.

The outcome of this is that the CCG are now proposing a model in which the service will:

Provide effective training to all education based staff involved in medication or treatment

Provide training and support to education based staff which allows them to undertake

health related tasks for children and young people in their care

Provide clinical supervision (in an accessible and appropriate way) to all staff involved in

medication or treatment and provide professional advice in emergency situations

Provide clinical advice to make sure rescue medications are stored safely and accessibly

Support education staff to manage medicine and feed administration in ways that support

the child / young persons’ learning

Draft Individual Health care plans for each child and young person attending the school

Ensure up-to-date, comprehensive medication plans for each child and young person are

held at school

Act as liaison to enable specialist clinics to be held in schools (where this is appropriate)

Provide support to coordinate health appointments and help share information between

services

Develop working links with GP’s and Consultants to help deliver person centred care

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7

In undertaking the above the following principles will be adhered to:

Child / Young person and family centred

Supportive of the child / young person’s learning needs

Integrated responsibility for the safety and wellbeing of the child across parents, schools

and health / social care services, enabling it to be person centred

Respectfully enable best interest decisions and appropriate use of Mental Capacity Act

Ensure that resilience and business continuity plans are built into service provision, taking a

collaborative team approach (does not then rely on individuals to ‘go that extra mile’)

The service will work closely with existing specialist paediatric nurses and community paediatric nursing teams; the Public Health funded School Nursing service, primary, community and acute teams as well as making links with wider stakeholders in education, health, social care and voluntary sectors. The service that the CCG are proposing will NOT undertake the following:

Preparation and administration of medicines

Preparation and administration of feeds

First aid tasks

It is proposed that the following acronym is adopted to best describe this service:- SAFE (M) ED (Supporting Administration oF routine and emergency healthcare treatments Effectively (M) Every Day in schools).

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8

Appendix B 0–19 PATHWAY PROCUREMENT FEEDBACK FROM BARNSLEY CCG AND BARNSLEY LMC As GP membership organisations the CCG and Local Medical Committee recognises the vital role of the Health Visiting service and 0–19 Pathway in optimising health outcomes and safeguarding for children and young adults. In anticipation of the reprocurement of the 0–19 service there have been CCG Governing Body discussions which concluded that the current Health Visiting service was suboptimal. The Healthy Child programme was discussed at the CCG Membership Council on Tuesday 19 May and reprocurement of the 0-19 Pathway was discussed at the Membership Council meeting of 21 July 2015 following a presentation from Penny Greenwood. From these discussions a number of concerns were highlighted by member practices around the current quality of health visiting and school nurse services. In any re-procurement process we would anticipate an opportunity for these issues to be addressed successfully. 1. Access to Health Visitor colleagues was deemed to be a major problem. This was evidenced

at a Governing Body meeting where only one member of the Governing Body knew the name of their practice Health Visitor. Access is a major problem including timeliness of response.

2. There was a strong view that Health Visitors should once again become an integral part of the practice team, with named individuals for each practice population.

3. Following access, communication was seen as another area of concern. To some extent

computer systems have helped with this for example SystmOne, however the timeliness, content including actions, and relevance of communications is very variable. Views were expressed that some issues are probably better communicated with face to face or by telephone conversation than sending messages or tasks.

4. Continuity of Children’s Services was identified. The current system is perceived as being too

fragmented. 5. Following the age of 5 child health issues are passed to the School Nursing Service. There

was some confusion over what this service intended to provide. It was noted that the response to parents on many occasions was “to see the GP”. Another issue was unclear communication for example School Nurses can refer directly to CAMHS but there is little evidence of this.

6. Skill mix within Health Visiting teams and the willingness to take on responsibility was

highlighted. Contributory factors to this might be the lack of support that Health Visitors receive and the variation in case load numbers.

7. In areas where there were significant safeguarding issues this clearly impacts upon the Health

Visitor workload. With the need to prioritise safeguarding issues there is perception that there is not the residual capacity in the current system to deal adequately with the non-safeguarding health related issues. There was a clear view that any new service could not afford to be less effective than the current one without introducing significant risk.

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9

STRATEGIC CONCERNS REGARDING THE 0-19 PATHWAY REPROCUREMENT 1. Financial Modelling

Concern was expressed about the financial modelling and that the reprocurement would resort in savings being made at the expense of the quality of the service. Penny Greenwood told the Membership Council that benchmarking had identified higher costs than comparative neighbours. She also stated that any cost savings would be reinvested in the system.

2. Alternative Models In an under doctored area such as Barnsley with significant healthcare professional recruitment and retention issues there is a clear concern that any reduction in numbers of staff will compound already stretched resources. The exploration of alternative skill mix models was a concern for three reasons;

(i) Dilution of accountability and professionalism, (ii) Capacity which is already stretched and (iii) The evidence for other models working effectively in similarly under doctored and under

nursed areas would need rigorous evaluation. 3. Transition Period

The time needed for major change for a reprocurement of this size and importance is likely to take 18 to 24 months, so significant focus has to be addressed to this transitional period so that gaps in service and decreasing quality do not appear.

4. Service Specification

The re-procurement process to date (consultation and engagement) was perceived as focusing on the process whereas the detail of the content ie service specification and an opportunity to comment on a draft was thought to be clinically of more importance. Therefore the CCG and LMC request that we have an opportunity to comment on the draft specification and key performance indicators before the service specification is finalised.

5. Quality Monitoring

Monitoring and evaluation of the quality of a new service would have to be vigorous and convincing to healthcare professions.

The CCG and LMC would expect that all the above issues are taken into account. Our view is that this service is a priority and an opportunity to increase the quality of care and support we give to children, young people and their families. We are strongly committed to working with you to make this happen. Nick Balac Chair Barnsley CCG Dr John Wood Chair Barnsley LMC 23 July 2015

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CQC Health Improvement Plan as at 17.5.15 Appendix C

NHS Action Plan to address areas identified for improvement following CQC CLAS Review Inspection November 2015.

Recommendations

Rag Rating

GREEN – Action Complete

AMBER – Action Underway and on target for completion within the deadline

RED – Action yet to

commence or

behind deadline

target

Ref Recommendations Process measures Timescale Progress against process

measures RAG Rated

Outcome measures Progress

against

outcome

measures RAG rated

Lead

agency/person

Within months

NHS Barnsley CCG

CQC Review the effectiveness of the electronic form used The CCG to incentivise GPs to use the Jun-15 GP reports to Child Protection Continuous monitoring of the 20.7.15 Designated 1.1 by GPs to inform child protection conferences by electronic form. Conference have been added number of forms returned The Nurse/Named Dr

way of audit and GP consultation. to the Practice Delivery completed against the number Designated CCG

agreement so non returns requested. This will enable Nurse

could have financial audits to be undertaken to receives all

implications for GP practices. access the quality of the CP

The Designated Nurse to be information provided. conference

copied in when completed reports

form returned to the completed

Conference Chair at BMBC by GP's

audit to be

undertaken

September

2015

CQC

1.2

Continue to work with providers to ensure

appropriate care and support is provided to

expectant mothers who require lower levels of

mental health support with reduced waiting times.

Work has commenced to review the

Maternal Health Pathway to ensure

compliant with NICE Guidance.

Specialist Midwife for Maternal Mental

Health in post (BHNFT).

Dec-15 The CCG will receive reports

from BHNFT regarding

progress

pregnant women will receive

appropriate mental health

support.

Head of

Midwifery/Chief

Nurse CCG

CQC

1.3

Ensure all available information is used to inform

initial health assessments(IHA) including parental

histories where known.

Review of current practice and

determine how this can be improved.

Aug-15 A review will be completed. All relevant information will be

collated to inform the IHA. Designated Dr, LAC

CQC

1.4

Consider methods to include SDQ scores to inform

Review Health Assessment processes and planning.

SDQ,s tasked on SystmOne to the

HV/SN prior to review health

assessment. Journey of LAC through

the system training being delivered to

all Health Visitors, School Nurses and

Family Nurses.

Jun-15 SystmOne tasking in place,

Named Nurse LAC monitoring

all review HA's to ensure SDQ

results used appropriately.

LAC training ongoing.

SDQ,s will be routinely used to

inform RHA's and the Health

Care Plan.

Designated Nurse (CCG) Named Nurse LAC (SWYPFT)

10

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measures RAG Rated


against

outcome

measures RAG rated

Lead

agency/person

CQC

1.5

Work with providers across Barnsley to ensure

practitioner involvement across disciplines is

included in the Initial Health Assessment process.

Journey of LAC through the system

delivered to Community Paediatrics

undertaking IHAs to remind of the

importance of gathering all appropriate

health information to inform IHA.

Sep-15 This will be audited as part of

the Quality of IHA's. Designated Doctor

LAC

CQC

1.6

Consider methods to better involve GP contribution

to Initial and Review Health Assessment processes.

Journey of LAC through the system

delivered to Community Paediatrics

undertaking IHAs and HV,s/SN,s/FNP

undertaking review HA's to remind of

the importance of gathering all

appropriate health information to

inform the assessment.

Sep-15 This will be audited as part of

the Quality of IHA's.

Gp information will be routinely

used in LAC Health

Assessments.

Updated

20.7.15 Designated Nurse has emailed all practice managers

Designated Dr/Nurse

LAC

CQC

1.7

Consider the role of the Named Doctor for

safeguarding to assure themselves that contracted

hours account for the responsibilities of the role and

that children’s safeguarding responsibilities are

sufficiently accounted for.

the current Named Dr is retiring, this

will be considered in line with the

Intercollegiate Document when the

replacement Named GP post is

advertised.

Jun-15 Post will be in line with

Intercollegiate

recommendations.

Updated

20.7.15

The

current

postholder

Chief

Nurse/Designated

Nurse

CQC

3.1

Consider methods for improving tier two CAMHS

support to young people in need of emotional care

and support.

Review of current practice and

services undertaken.

Jun-15 An Emotional Well Being

Offer has been developed and

the first priority in resourcing it

is to secure pre CAMHS non

medicalised counselling/peer

group activity. There is also

parallel work to remediate

access to CAMHS tier 2.

children receive early help-level

4 services. Increased access to

CAMHS and Pre- CAMHS

service leads to improved

assessment, diagnosis and

ongoing care for children and

young people.

Chief Nurse

Barnsley Hospital NHS Foundation Trust CQC

2.1

Assure themselves that all health practitioners

providing care and support to children and young

people within the ED have received appropriate

specialist training and that this is recorded

electronically for reference.

The Paediatric Lead Nurse will produce

a training package to be used by those

providing cover in the paediatric area.

Jun-15 Training pack will be in place

and being used for those

covering paediatrics.

Children will be seen by either a

paediatric nurse or a generic

nurse who has undertaken

additional training in paediatrics.

The E roster will evidence this.

Emergency

Department Lead

Nurses

Additionally 3 generic staff have

received further training in Paediatrics

and these staff will provide the core

cover for Paediatrics wherever

possible. It is also planned to train 4

more.

Jul-15 Core cover for paediatrics will

be provided by staff with

additional appropriate training

this will be evidenced through

the e rostering system.

Emergency

Department Lead

Nurses

11

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measures RAG Rated


against

outcome

measures RAG rated

Lead

agency/person

The current e- rostering system will be

amended to add this competency. The

Trust is also currently trying to appoint

to the paediatric roles.

Jul-15 Core cover for paediatrics will be

provided by staff with additional

appropriate training - this will be

evidenced through the e

rostering system.

Emergency

Department Lead

Nurses

The Trust is also currently trying to

appoint to the paediatric roles.

Sep-15 The department will have

appointed into the vacant

positions in paediatrics.

The department will have

appointed into the vacant

positions in paediatrics

Emergency

Department Lead

Nurses

CQC

2.2

Ensure children and young people's ethnicity is

carried across to all documentation used whilst they

are present at Barnsley hospital so that all staff can

be alerted to any cultural sensitivities.

Ethnicity to be requested when

booking at reception. Information to

be recorded electronically and printed

on the Emergency Department card

that goes through to nursing and

medical staff.

Jun-15 Ethnicity will be recorded on

all documentation.

This will be evidenced by

random spot checks on a

monthly basis by the

receptionist manager until we

are assured that this is

happening in 100% of cases.

Ethnicity will be recorded on all

documentation.

This will be evidenced by

random spot checks on a

monthly basis by the receptionist

manager until we are assured

that this is happening in 100% of

cases.

Emergency

Department

Receptionis

t Manager

CQC

2.3

Review documentation used by midwifery

practitioners so that when planning the care of

expectant mothers the process is SMART and

person centred.

Record keeping in maternity will

transfer to electronic recording in June

15 (making the system partly

paperless) and in the process of

making this change the documentation

has been reviewed. This will be

progressed and further developed over

the next twelve months as the system

is used and tested.

Next safeguarding record keeping

audit will incorporate these records to

assure standards are being met and

record keeping is person centred.

Review completed

Transfer to

electronic records

June 15

On-going work

next twelve months

Maternity documentation has

been reviewed in line with the

recommendations. Record

keeping audits will evidence

care that is more person

centred.

Records are reviewed and make

it easier to deliver person

centred care.

Named Midwife

Head of Midwifery

12

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measures RAG Rated


against

outcome

measures RAG rated

Lead

agency/person

CQC

2.4

Improve the IT system to make alerts (codes) more

specific rather than generic, such as when in relation

to child protection alerts, self-harm or regular

attenders.

The new IT system allows for more

detail to be recorded under the alert

and this feature is being used by the

Safeguarding Department to make the

alerts more specific.

Sep-15 New IT system is allowing

more detail to be recorded

and safeguarding department

when registering alerts are

ensuring there is enough

detail for staff to make an

informed assessment.

No datix incidents or feedback

from staff re lack of details re

alerts. All front sheets will

have alert information on

them.

Safeguarding alerts will be

visible and easy to access and

will contain enough detail to help

inform any assessment.

Business Manager

CBU 6

CQC

2.5

Ensure staff awareness is improved in relation to the

recording of children in the care of parents or adults

who attend Barnsley ED and that this is effectively

monitored.

Promote through training, memo, CBU

governance structure, raise with Lead

Nurses.

Aug-15 Random audit will ensure

improvement. Audit to be

held August 15

It will be routine practice to

record details of any children

when adults attend the

Emergency Department.

Lead Nurses

Emergency

Department

CQC

2.6

Review methods to make it easier for other health

practitioners to make contact or make arrangements

to make contact with midwifery team members

Community Midwifery Administration

Centre to commence from 8/6/15, with

an administrator available Mon – Fri 8 -

4 which can be used to leave

messages for midwives.

These will be tracked via a data base.

Additionally all midwives are available

via e mails which are checked on a

regular basis.

Jun-15 Administrator will be in place

and be a central source for /

leaving messages for

midwives. Data base will

provide audit trail.

No further negative feedback

from other professionals.

Other health colleagues will find

it easier to communicate with

community midwives and

communication is improved.

Head of Midwifery

CQC

2.7

Implement more formal scheduled safeguarding

supervision outside of clinical supervision in line with

the latest intercollegiate guidance.

Safeguarding guidelines amended Feb

15 with need for 1-1 supervision to be

provided to Emergency Department

Staff, Children’s Community Nursing

team and Community Midwives.

Database created to record compliance

and supervision being undertaken.

Nov-15 Qualitative audit of

supervision to assess

effectiveness. Quantative

audit will demonstrate

supervision is being

undertaken and formally

recorded in notes

Staff will feel supported in

safeguarding work and ultimately

children and families will benefit

from staff receiving formal

supervision.

Safeguarding

Department

13

GB/Pu/15/08/10


measures RAG Rated


against

outcome

measures RAG rated

Lead

agency/person

CQC

2.8

Ensure that the outcomes of any safeguarding

supervision in relation to patients are recorded in

those patient notes in line with the latest

intercollegiate guidance.

Safeguarding guidelines amended Feb

15.

Guidelines and contract clearly state

need to record when cases discussed

in notes.

Audit to take place to ensure

compliance.

Nov-15 Audit will demonstrate that

cases discussed in

supervision are being

recorded.

The records of families

discussed in supervision will

clearly demonstrate that this

discussion has taken place and

the outcomes.

Safeguarding

Department

CQC

5.4

Ensure paediatricians undertaking initial health

assessments use the substance misuse screening

tool (or equivalent) as part of the process whether

disclosure has been made in relation to substance or

alcohol misuse or not

Disseminate and train paediatricians in

use of tool so they are fully aware of

the process.

Representative from Addaction has

met with paediatricians to explain the

service.

Build into audit to assess quality of

assessments

Jun-15 Audits will demonstrate

pathway is being used.

Young people will be screened

re alcohol and substance misuse

as part of the LAC initial medical

and will be offered a referral to

appropriate services as per

pathway.

Designated Doctor

LAC

CQC

5.6

Initiate quality assurance processes to oversee the

quality of initial health assessments to refine and

improve quality. This should include oversight of the

quality of health plans following initial health

assessments to ensure they are consistently

SMART, appropriately reviewed, actioned and

completed.

Agree audit tool and methodology.

Conduct twice yearly audit.

Designated Dr will undertake regular

monitoring.

Aug-15 On-going monitoring and

Audit will demonstrate

standards are being met.

Initial assessments and health

plans undertaken will be of a

sufficient standard.

Safeguarding

Department and

Designated Dr for

LAC

CQC

5.7

Consider contingency planning to ensure where

important lead health professionals are unable to

undertake their responsibilities at short notice that

alternative arrangements can be made at short

notice and replacement suitably qualified staff be

found with the minimum of delay.

To work with Human Resources to

establish what measures can be put in

place.

Sep-15 Policy/procedure in place. Agreement of a policy/procedure

that will be followed for

contingency planning.

Deputy Director of

Nursing

South West Yorkshire Partnership NHS

Foundation Trust

CQC

3.2

Consider better use of chronologies by CAMHS

practitioners, especially when working with complex

families.

Practice Governance Coach to

facilitate and develop the use of

Chronologies in supervision and case

meetings.

01 August 2015 Chronologies will have been

developed.

Chronologies used in case

discussion and interagency

consultation meetings.

SWYPFT CAMHS

Practice Governance

Coach

CQC

3.3

Consider methods to reduce waiting times to access

CAMHS support to kinship carers, foster carers and

adoptees to reduce the risk of placement

breakdown.

CAMHS Transformation plans to

improve where possible within current

capacity.

01 August 2015 Waiting times monitored for

this group.

Waiting time improved. SWYPFT Nette

Carder /

David

Ramsay

14

GB/Pu/15/08/10


measures RAG Rated


against

outcome

measures RAG rated

Lead

agency/person

CQC

3.4

Ensure attendance at child protection conferences

and the submission of reports to inform conference

is appropriately monitored to drive continued

improvement where necessary. This should include

a formal audit process of patient cases.

For the safeguarding children team to

monitor the attendance at conferences

and that the reports are submitted to

the conference chair within the

allocated standard timeframe.

With immediate

effect. Audit this

process after 3

months -

September 2015

Safeguarding Children’s Team

will monitor CP Conference

attendance.

Satisfactory level of attendance

at Child Protection Conference

by SWYPFT staff and an Audit

of compliance.

SWYPFT

Safeguarding

Children team

CQC

3.5

Ensure oversight of CAMHS safeguarding

supervision and decisions arising from those

discussions to ensure client electronic records are

updated in line with the latest intercollegiate

guidance.


revise the current provision of child

protection supervision offered to the

CAMHS service to reflect the changes

within the 2014 intercollegiate guidance

about roles and responsibilities of

health professionals .

For this to be

completed

September 2015

Client records will reflect

discussions and decisions

that take place during

Safeguarding Children

supervision.

Supervision will be clearly

documented in the Client record. SWYPFT

Safeguarding

Children team

CQC

3.6

Maintain oversight of individual CAMHS practitioner

attendance at safeguarding supervision to ensure

regular attendance.


monitor the attendance of relevant

CAMHS staff for safeguarding children

supervision.

For this process to

be implemented

and be reflective of

the changes to the

provision of

supervision as per

action 3.5.

September 2015.

Audit December

2015

A data base of supervision

delivered to CAMHS staff will

be commenced and

monitored.

CAMHS staff will access

supervision and this will be

monitored.

SWYPFT

Safeguarding

Children team

CQC

3.7

Monitor electronic systems, including RiO to ensure

appropriate 'flags' are in place to alert all staff as to

children and young people's current and previous

safeguarding concerns.


ensure that safeguarding concerns are

identified appropriately within all

electronic systems used by SWYPFT

staff.

Work with the 'RIO'

system - version 7

is currently

underway to

address this.

When this system is

launched the 'flagging' of

safeguarding will be audited

within 12 weeks from the

launch of this system.

Appropriate Flags will be in

place. SWYPFT Nette

Carder/ David

Ramsay

15

GB/Pu/15/08/10


measures RAG Rated


against

outcome

measures RAG rated

Lead

agency/person

NHS Barnsley CCG and Barnsley Hospital NHS

Foundation Trust

CQC

4.1

Consider ways to ensure perinatal mental health

pathway for women in Barnsley is compliant with

NICE guidance and to reduce waiting times for

priority pregnant women.

Maternal mental health pathway in

place. Post-natal part currently being

updated. Direct questions are asked at

booking and postnatally and screening

tools are used for anxiety, depression

and suicide as per NICE guidelines.

Women are referred directly to mental

health teams with an agreement that

they are prioritised. A direct link with a

Psychiatrist has now been made.

Dec-15 Specialist Midwife for Mental

Health in post and will develop

the work in the weekly

Perinatal Health Clinic.

Perinatal Mental health Pathway

is Compliant with Nice

Guidance. Waiting times are

reduced for priority pregnant

women.

BHNFT Sue Gibson/

Chief Nurse CCG

CQC Improve quality assurance processes to assure All referrals to come via the May-15 The quality of all referrals are Assurance report provided to BHNFT Safeguarding 4.2 themselves that referrals made to children’s Social safeguarding team for quality checking monitored. Designated Nurse November 15. Department/

Care are of sufficient quality and meet current with the exception of section 47 Designated Nurse

thresholds, sufficiently articulating risk. referrals – this process commenced Safeguarding

post the inspection. Children

NHS Barnsley CCG and South West Yorkshire

Partnership NHS Foundation Trust

CQC Consider methods to improve information sharing Review models of working as part of Jul-15

Work ongoing as part of the Service model policies and SWYPFT/ Children’s 5.1 between GPs and health visitors to better promote phase 2 transformation to ensure transformation programme. guidance in place assure Transformation

an integrated approach to supporting vulnerable communication and information communication and information Group Anita

families. sharing takes place. Ensure relevant sharing between GP and health McCrum Professional

standards for communication are visitors. Early intervention and Lead 0 to 19,

audited and action plans complete.

Discussion to take place to develop a

single point of access for

support for vulnerable families. Michele Tudor

Community Services

Manager

communications i.e. Admin hub.

CQC

5.2

Consider methods to ensure health visitors are

routinely notified of incidences of domestic violence

by Police at the earliest opportunity after the alleged

incident.

Review current processes for

notification of incidences of domestic

violence by police. Build on good

practice and learning from the stronger

families model. Raise at relevant

partnership meetings.

Jul-15

Work in progress

Timely notification of domestic

violence incidences received

from police to health visiting

teams. Increased opportunity

for early help and support for

individuals experiencing

domestic abuse.

Anita McCrum

Professional Lead 0

to 19,

Michele Tudor

Community Services

Manager

16

GB/Pu/15/08/10


measures RAG Rated


against

outcome

measures RAG rated

Lead

agency/person

CQC

5.3

Review the methods used to record client contact

and general record keeping ensuring safe pracrice is

maintained across CAMHS in Barnsley, including

methods to routinely update the trust's safeguarding

team when referrals are made to children's social

care. This should include quality assurance

processes being put in place to continually review

practice.

● Review Record Keeping process.

● Deliver additional Record Keeping

Training.

● CAMHS clinicians to update

Safeguarding Team of referrals to

Children’s Social Care.

Sep-15 Record keeping process

reviewed. Training delivered

and routine notification of

referrals to Social Care to

SWYPFT Safeguarding Team

by CAMHS professionals.

● Record Keeping Audit result.

● Record Keeping Action Plan.

CAMHS Service

Manager/

Named Nurse

CQC

5.5

Review CAMHS service provision to children looked

after to include regular, routine audit of the number

of looked after children waiting to access services

and that CAMHS practitioners are routinely asked to

contribute to initial and review health assessments

● Review care pathway of LAC in

CAMHS.

● Regular audit of number of LAC in

receipt of CAMHS input (direct and

indirect).

● Review CAMHS input into initial and

Health Assessment reviews.

Sep-15 Clear pathway in place.

Audit results

CAMHS clinicians involved in

assessments and reviews

This will be monitored via the

Health of Children in Care and

Care leavers meeting

Named Nurse CIC

(SWYPFT)

Designated Nurse

LAC (CCG),

CAMHS/

Local

Authority

NHS Barnsley CCG, Barnsley Hospital NHS

Foundation Trust and South West Yorkshire

Partnership NHS Foundation Trust

CQC

6.1

Ensure all partner health providers proactively

monitor and report on attendance at child protection

conferences from within their own organisation.

Appropriate attendance at CP

conference is in provider contracts and

is also reported as a Key Performance

Indicator to the CCG.

Apr-15

CP conference attendance

monitored and reported to the

CCG.

Attendance at CP conference

continually monitored.

Named

Nurses/Designated

Nurse

CQC

6.2

Consider methods to ensure the use of

chronologies of significant events are effectively

authored and used to support practitioners in

maintaining accurate and effective oversight of

cases where children and young people are

considered at risk.


assess whether the use of the current

significant incident template is fit for

purpose.

Sep-15 The Safeguarding Children

Team to conduct an audit of

the current Significant

Incident template in order to

determine its relevance.

CCG will be assured that

chronologies of significant

events are being used.

Safeguarding Team

17

GB/Pu/15/08/11

1


Governing Body

13 August 2015

Workforce Race Equality Standard


The purpose of this report is to update the Governing Body on the Workforce Race Equality Standard (WRES) which has been introduced by NHS England.


WRES requires NHS organisations to show progress in identifying and eliminate discrimination in the treatment of Black Minority Ethnic (BME) staff. This report highlights the initial data for Barnsley CCG and considers further work to progress in relation to this.

3. THE BOARD IS ASKED TO:

Note BCCG Workforce Race Equality Standard baseline data and associated actions.


10 minutes.



Report Prepared by:

Elaine Barnes

Designation: Equality & Diversity Manager

GB/Pu/15/08/11

2



5.2 If the CCG fails to deliver its statutory duties, due to weaknesses in its corporate governance and control arrangements, it will result in legal, financial, and /or reputational risks to the CCG and its employees.








Financial Implications No

Contracting Implications Yes

Quality No

Consultation / Engagement No


EIA not required, this

is for information.

Information Governance No

Environmental Sustainability No

Human Resources Yes

GB/Pu/15/08/11

3

2. BACKGROUND INFORMATION

The Workforce Race Equality Standard is a set of metrics which requires all NHS organisations to demonstrate progress against a number of indicators of race equality, including a specific indicator to address the low levels of BME Board representation. Seven metrics have been proposed within which the differences between the treatment and experience of white and BME staff are expected to be the same. Despite Black and Minority Ethnic staff contributions to the NHS, their treatment has been consistently worse than the treatment of other NHS staff. Black and minority ethnic staff are disproportionally absent from NHS Trust Board and leadership positions. The metrics focuses upon bullying and harassment, access to promotion and career development, and experience of discrimination, as well as local workforce measures – including the likelihood of being recruited from shortlisting.

3. DISCUSSION

The WRES was discussed at the Equality Steering Group Committee on Thursday 16 July 2015 and it was noted that Barnsley CCG had a very small number of BME staff which was reflective of the local population. It was agreed that the Values Based Recruitment training focuses on non-discriminatory practices, a further piece of work to consider might be a survey work to identify the views of potential BME candidates as to the attractive of working for the CCG. The providers have shared their WRES with the CCG in line with their contractual agreement.

4. IMPLICATIONS

The WRES will form part of CCG assurance frameworks, the NHS standard contract and the CQC inspection regime.

5.

CONSULTATION

The baseline WRES data is relatively new and has been collected from the CCG Electronic Staff Record (ESR) and the National Staff Survey.

6. APPENDICES TO THE REPORT

Appendix A - Workforce Race Equality Standard which was reported to the Equality Steering Group Committee.

GB/Pu/15/08/11

4

7. CONCLUSION

The Governing Body are asked to :

Note the Workforce Race Equality Standard and associated considerations and actions.

GB/Pu/15/08/11.1

1

NHS Barnsley CCG - Workforce Race Equality Standard

NHS Barnsley Clinical Commissioning Group welcomes the introduction of the NHS Workforce Race Equality Standard (WRES) as a useful tool to identify and reduce any disparities in experience and outcomes for NHS employees and job applicants of different ethnicities. This is important work as research evidence shows that improving workforce race equality within the NHS will lead to improved healthcare for everyone and better use of NHS resources. The Workforce Race Equality Standard requires NHS organisations to demonstrate progress against a number of indicators of workforce equality in relation to race. The Standard will be used by organisations to track progress to identify and help eliminate discrimination in the treatment of Black and Minority Ethnic (BME) employees. 3 NHS Staff Survey indicators

KF19 (difference between % white staff and % BME staff experiencing harassment, bullying or abuse ( HBA ) from staff in last 12 months)

o 84%, had never experienced HBA in last 12 months compared to 83% for CCGs nationally

o 15% had experienced HBA between 1 and 10 times compared to 16% nationally

o No breakdown in report between white and BME staff

KF27 (difference between % white staff and % BME staff believing the trust provides equal opportunities for career progression or promotion)

o 89% believed CCG acts fairly with regards to career progression which mirrors the figure of 89% nationally

o 11% believed CCG does not act fairly which again reflects the figure of 11%

nationally

o No breakdown in report between white and BME staff

o

KF 28 (difference between % white staff and % BME staff experiencing discrimination at work in last 12 months)

o 2% had personally experienced discrimination at work compared to 3% nationally

o 98% had not personally experienced discrimination at work compared to 97% nationally

o 0% had personally experienced discrimination at work because of their ethnic background compared to 9% nationally


GB/Pu/15/08/11.1

2

4 Workforce Indicators

98% of staff describe their ethnic origin as white British compared to 86% nationally o 2% Black/Black British compared to 2% nationally.

Ratio of proportion of BME staff on grades 8C-9 to the ratio of BME staff in all grades o 0% BME staff on grades 8c-9 o 2% BME staff on all grades

Likelihood of shortlisted BME applicants being appointed compared to white applicants

o BME Applications – 78 – 15.4% o BME applicants shortlisted 7.4% o BME Applicants appointed - 0%

Likelihood of BME staff entering disciplinary process compared to white staff o 2% of staff entering disciplinary process were from a white British background o 0% of staff entering disciplinary process were from a BME.

Access to non-mandatory training and CPD o 78% staff reported having a development review in last 12 months compared

to 80% nationally o 86% stated appraisal helped agree clear objectives for their work which

equates to 86% nationally o 74% agreed appraisal identified training, learning or development needs

compared to 79% o 96% staff received job relevant training in last 12 months compared to 83%

nationally o 86% staff received E&D training in last 12 months compared to 73%

nationally o No breakdown provided for BME staff

Additionally, the extent to which Board composition reflects local population would be an additional element.

14 members – 10 White British, 4 Asian British

Provider organisations will be expected to ensure they have this data, share it with their staff and commissioners, and then consider and act upon the differences between the white and BME staff experience and survey responses so that year on year the differences are seen to reduce. The smaller the differences between the BME and white workplace experience indicators and survey responses, the more likely it is that discrimination is declining.

GB/Pu/15/08/11.1

3

Summary

The organisation is committed to:

Learning from and sharing best practice with other organisations including comparison of data, addressing issues and in representation at a senior leadership level.

Listening to BME employees about their experiences to help understand the data.

Addressing gaps and challenges in reporting data due to low workforce numbers.

Ensuring robust systems for collecting and analysing data.

Ensuring the Workforce Race Equality Standard is embedded within talent management, succession and development planning.

Monitoring and supporting provider organisations in meeting the Workforce Race Equality Standard.

30 June 2015

GB/Pu/15/08/12

1


GOVERNING BODY

13 August 2015

Security Policy and Procedure


This report is provided as a covering paper for the new Security Policy and Procedure which has been developed for NHS Barnsley CCG.


NHS Barnsley Clinical Commissioning Group (CCG) is committed to a safe and secure environment that protects staff, patients and visitors, and their property and the physical assets of the CCG, in accordance with Health and Safety legislation, Department of Health Policy and the common law duty of care. The Security Policy and Procedure appended to this report sets out the CCG’s security arrangements, and helps to ensure that we are compliant with the NHS Protect Security Standards. The Policy has been developed by the CCG’s nominated Local Security Management Specialist (LSMS), who is the Head of Specialist Advice, Health and Safety (Yorkshire & Humber Commissioning Support). The LSMS works on behalf of Barnsley CCG to deliver an environment that is safe and secure. The Policy has also been reviewed during its development by the Head of Assurance and Management Team.


Note the contents of this report

Approve the Security Policy and Procedure.


10 minutes

Report of: Vicky Peverelle

Designation: Chief of Corporate Affairs

Report Prepared by:

Richard Walker

Designation: Head of Assurance

GB/Pu/15/08/12

2



Links to GBAF risk reference 5.2



Y






Yes


N/A


N/A

Quality

N/A


N/A


Yes – EIA completed


N/A


N/A

Human Resources

Yes

1


Barnsley CCG’s


Version: Draft 0.2

Approved By:

Date Approved:

Name of originator / author: Richard Walker/Ruth Nutbrown

Name of responsible committee/ individual: Health & Safety Group

Name of executive lead: Vicky Peverelle

Date issued:

Review Date: 2 years from date of approval

Target Audience: All CCG Staff

2


DOCUMENT CONTROL

Version No Type of Change

Date Description of change

v0.1 Document developed

April 2015 New document

V0.2 Drafting changes

July 2015 Minor changes following review of the original draft by Head of Assurance and Management Team

3

BARNSLEY CLINICAL COMMISSIONING GROUP


Contents

1. Introduction 2. Purpose 3. The risks of not having this policy in place 4. Principles 5. Roles and responsibilities 6. Procedure 7. Monitoring the Compliance and Effectiveness of this Policy 8. References 9. Review of the Policy Appendix 1 – Definitions Appendix 2 – Reporting of Crime/Security Incidents Appendix 3 – Lone Worker Procedure Appendix 4 – Lone Worker Risk Assessment Appendix 5 – Equality Impact Assessment 2013

4 4 5 5 5 9 14 14 14 15 17 19 27 30

4

1. Introduction

1.1 NHS Barnsley Clinical Commissioning Group (CCG) is committed to a safe and secure environment that protects staff, patients and visitors, and their property and the physical assets of the CCG, via Health and Safety legislation, by Department of Health Policy and by common law duty of care. This policy aims to deal proactively with the CCG’s security arrangements.

1.1.1 The CCG acknowledges its responsibility for the safety of people within the organisation and wider, and the requirement to have a written statement of general policy under the statutory requirements of: ● the Health and Safety at Work Act 1974 ● NHS Protect guidance “Standards for Commissioners”

1.1.2 The Security policy has been developed in accordance with the CCG’s Policy on the Development and Management of Policies and Procedures

1.1.3 This policy needs to be read in conjunction with the:

Corporate Manual

Fraud, Corruption and Bribery Policy

Fire Safety Policy

Health and Safety Policy 2. Purpose

2.1 The CCG recognises its responsibilities to ensure that

reasonable precautions are taken to provide a safe and secure working environment and that steps are taken to prevent issues in relation to security management, in compliance with relevant statutes and codes of practice (as identified above).

2.1.1 In pursuance of this aim, the CCG will:

Protect the safety, security and welfare of staff, patients and the general public whilst on CCG premises

Provide systems and safeguards against crime, loss, damage or theft of property and equipment

Minimise disruption or loss of service to patients/clients

Ensure Risk Assessment and security audits are implemented to comply with statute.

2.1.2 The CCG recognises that this Policy Statement is

implemented in pursuance of these aims.

5

3. The Risks of not having this Policy in place

3.1 Not having this policy in place exposes the CCG to increased risk of failure to meet its legal responsibility to provide a safe and secure environment that protects staff, patients and visitors, and their property and the physical assets of the CCG.

4. Principles

4.1 It is the CCG’s intention to take all reasonable practicable steps to reduce the associated risks from security issues.

4.1.1 The CCG will also ensure, so far as is reasonably practical, that all employees who are required to work alone for significant periods of time are protected from risks to their health and safety.

5. Roles and Responsibilities

5.1

Security is a management responsibility and the provision of a security service in no way relieves management at any level of its obligations to fulfill the stated purpose of security in the CCG. Managers are required not only to exercise preventative aspects but also to take appropriate action where necessary in respect of those who offend against the law, commit misconduct or other breach of security in contravention of the policies of the CCG.

5.2 Overall accountability for ensuring that there are systems and processes to effectively manage security lies with the Chief Officer who takes the risks to the CCG from breaches of security seriously and seeks to reduce the numbers of incidents occurring as a direct result. Responsibility is also delegated to the following individuals:

5.2.1

The Chief of Corporate Affairs functions as the Security Management Director and has lead responsibility for the development and strategic review of security within Barnsley CCG, in line with the Secretary of State’s Directions of November 2003. The Security Management Director is responsible for: The formulation, implementation and maintenance of an effective Security Policy, (following NHS Protect guidance) in consultation with staff representatives, and ensuring that Managers co-ordinate and implement the Policy in their respective areas

Reviewing and amending this policy to ensure compliance with any current guidance

Instituting regular campaigns to highlight the importance of security and the responsibilities of all CCG staff

Leading Security Management within the CCG and

6

identifying security initiatives for improving the security across the CCG

Advising the CCG of any requirements, statutory or other, by the preparation of procedures for dealing with crime prevention, supply of security systems and maintenance

Monitoring the performance of the CCG with regard to the implementation of this policy.

5.2.2

The nominated Local Security Management Specialist (LSMS) for the CCG is the Head of Specialist Advice, Health and Safety (Yorkshire & Humber Commissioning Support). The overall objective of the LSMS will be to work on behalf of Barnsley CCG to deliver an environment that is safe and secure. This objective will be achieved by working in close partnership with stakeholders within Barnsley CCG, NHS Protect and external organisations such as the police, professional representative bodies and trade unions. The LSMS will aim to provide comprehensive, inclusive and professional security management services for Barnsley CCG and work towards the creation of a pro-security culture within the NHS. The LSMS will:

Report to Barnsley CCG Security Management Director (SMD) on security management work locally

Lead on the day to day work within Barnsley CCG to tackle violence against staff and professionals in accordance with national guidance

Ensure that lessons are learned from security incidents, and that these incidents are assessed and the impact on the CCG reported to appropriate authorities in accordance with guidelines issued by the NHS SMS

Investigate security incidents/breaches in a fair, objective and professional manner so that the appropriate sanctions (and allow consideration of preventative action to be taken)

Ensure that the security management policy addresses all the organisations identified risks and contains all the required elements from NHS Protect guidance

Ensure that the security management policy is reviewed or evaluated to establish its effectiveness

Ensure that any corrective or preventative actions identified as a result of the policy review or evaluation are implemented, to ensure that the

7

security management policy continues to address the CCG’s identified risks.

5.2.3

Other Chiefs of Service, on behalf of the Chief Officer are responsible for ensuring that the CCG’s Security Policy is implemented within the organisation. This will include responsibility for:

Planning any capital investment required to address matters arising from risk assessments

Security risk assessment within their areas and for ensuring that staff for whom they are responsible are aware of these risks

Preventative measures and appropriate action in respect of persons who are suspected of committing a criminal offence, misconduct or other breach of security in contravention of the policies of the CCG

Ensuring staff awareness of and how to access this policy and other relevant documents and their responsibilities and also ensure that staff (including temporary staff) receive training appropriate to the risks involved

Ensuring that security arrangements within their area are being observed and that deficiencies are reported

Ensuring that any particular security problems known to them are reported accordingly

Actively reviewing the security arrangements within their area by carrying out routine audits themselves with the co-operation of staff organisations, in line with CCG risk assessment procedures

Ensuring that every member of staff obtains a security ID Badge and that the badge is worn and visible at all times whilst the staff member is on CCG premises or on CCG business

An ongoing commitment to staff training, carrying out risk assessments, identifying areas at greatest risk and eliminating or controlling these risks.

5.2.4

Line Managers are responsible for:

Ensuring compliance with CCG Security Policy requirements in the areas for which they are responsible

The completion of any risk assessments required in relation to security of staff or premises

Ensuring that any security problems known to them are reported accordingly

8

5.2.5

Responsibilities of Staff (including all employees, whether full / part time, agency, bank or volunteers) are:

To co-operate with management to achieve the aims and objectives of the Security Policy. Great emphasis is placed on the importance of co-operation of all staff in observing security and combating crime.

The protection and safe keeping of their private property. Any loss of private property must be reported without delay. If private property has been stolen, then it is the owner’s responsibility, not the CCG’s responsibility to contact the Police.

To familiarise themselves with o any special security requirements relating to

their place of work or work practices o the action to take in the event of a security

incident.

To safeguard themselves, colleagues, visitors, patients/clients etc., so far as is reasonably practicable, and ensure that neither equipment nor property are put in jeopardy by their actions or omissions, either by instruction, example or behaviour.

To follow prescribed working methods and security procedures at all times.

To co-operate with managers to achieve the aims of the Security Policy.

To comply with all training requirements concerning security issues.

To ensure that the CCG ID is worn and visible whenever on CCG premises or on CCG business.

To notify their line manager of any potential security problems and report all incidents involving criminal activity to the appropriate manager.

To report any crime/breach of security. This procedure is documented as Appendix 2.

All staff are reminded that it is an offence to remove property belonging to the CCG without written authority. Failure to seek authority from their line manager could result in disciplinary action or criminal proceedings being taken. NHS Barnsley CCG will not accept liability for the loss of, or damage to private property including motor vehicles or other modes of transport. Motor vehicles are brought onto the sites entirely at the owner’s risk. NHS Barnsley CCG will take reasonable steps to safeguard vehicles on their property.

9

6. Procedure

6.1

Employment

6.1.1 All persons applying for a post within the CCG must have completed the section on the application form entitled Rehabilitation of Offenders Act 1974. This section states that ‘because of the nature of the work for which you are applying, this post is exempt from provisions of Section 4(2) of the Rehabilitation of Offenders Act, 1974 (Exemption) Order, 1975.’ Applicants are therefore, not entitled to withhold information about convictions which for purposes are ‘spent’ under the provisions of the Act, and in the event of employment, any failure to disclose such convictions could result in dismissal or disciplinary action by the CCG.

6.1.2 This application form also requests details of any convictions, adult cautions or bind-overs, and requires the applicant to sign the statement confirming that the information given is correct. For more information refer to the Recruitment & Selection Policy.

6.1.3 In accordance with the provisions of the Children’s Act 1989, the CCG must ensure that, staff who occupy certain positions that brings them regularly in contact with children have Disclosure & Barring Service check which will be requested as appropriate following appointment of the staff member by the Human Resources Department.

6.2

Personal Security

6.2.1 Specific procedures for local needs such as domiciliary visits (e.g. lone workers), staff in other premises, reception staff, agile workers etc. are to be developed and implemented by individual departments. All staff must follow existing Health & Safety policies and guidelines.

6.2.2 The requirement for security personnel (e.g. static or mobile guards) should be assessed by local managers and managed within each Department. The Local Security Management Specialist (LSMS) can advise and help manage arrangements if so required.

6.3

Staff Identification

6.3.1 Every employee, including bank staff, will be issued with an identification badge on commencement of employment which must be worn at all times whilst on

10

CCG premises or on official business.

6.3.2

Each member of staff is personally responsible for their badge, and to ensure that the badge is up to date and that there are no radical changes in physical appearance, title or department. All staff should wear an official CCG identification badge and it is the responsibility of each departmental manager to ensure that this is implemented. The identity badge will state the employee name and job title and must be clearly visible to other staff, and visitors.

6.3.3 Identification badges must be returned to the Human

Resources Department when a member of staff leaves the employment of the CCG. It is the responsibility of the line manager to recover the identity badge from the member of staff concerned and return it to the HR Department.

6.3.4 For the Management of Contractors please refer to the Control of Contractors Procedure.

6.4

Cash Movement/Handling

6.4.1 Only the Finance Team should hold cash, which will be managed in accordance with the Petty Cash Procedure.

6.5

Funding

6.5.1 Each Department must take into account security issues including cost implications when:

Developing schemes for minor improvements

Developing schemes for new premises, major upgrading etc

Introducing new services or changes to existing services, which may have implications for staff security.

6.6

Key Holding

6.6.1

The responsibility for the arrangements for daily opening / closing of premises rests with the Security Management Director (SMD). This includes the maintenance of a key register which identifies the location of all keys. The register should detail the individuals in receipt of keys and signatures should be obtained.

11

6.7 Access and Egress

6.7.1 Access to NHS Barnsley CCG premises will be

restricted. The responsibility for the arrangements for daily opening / closing of premises and individual departments rests with the SMD.

6.7.2 Where appropriate, access will be controlled by the use of digital locks, electronic alarm systems and access to keys.

6.7.3 All windows at ground level, where appropriate, will be fitted with security devices or restrictors limiting the extent to which they can be opened.

6.7.4

The Security Management Director will put in place measures to ensure that locking systems and alarm codes are reviewed on a regular basis.

6.8

Security of Goods

6.8.1

Goods received into the organisation must be checked against delivery notes prior to signing for acceptance. The organisation will provide secure accommodation for goods awaiting distribution.

6.8.2 Some CCG goods are received by South and West Yorkshire Partnership Foundation Trust (SWYPFT). These goods will remain the responsibility of SWYPFT until signed for by a CCG staff member.

6.8.3 All CCG departments receiving goods must ensure there are procedures in place to monitor the receipt of goods and safe/ secure systems are in place to protect goods from theft or inappropriate use.

6.9

Security of Personal Belongings

6.9.1 All staff should ensure that personal belongings are stored in a secure location e.g. locked in cupboards, lockers or desk drawers. NHS Barnsley CCG cannot be held responsible for theft of personal items.

6.10

Fraud

6.10.1 The responsibilities for fraud prevention are described in the CCG Fraud, Corruption, and Bribery Policy. The Local Security Management Specialist will liaise regularly with the Local Counter Fraud Specialist to ensure a direct and close relationship is maintained.

12

6.11

Fire

6.11.1 The overlapping interests of security and fire safety policies are fully recognised and there is full co-operation between fire and security staff.

6.12

Information Security

6.12.1 Information security risk is inherent in all administrative and business activities and everyone working for or on behalf of NHS Barnsley CCG continuously manages information security risk. The aim of information security risk management is not to eliminate risk, but rather to provide the structural means to identify, prioritise and manage the risks involved in all our organisational activities. It requires a balance between the cost of managing and treating information security risks with the anticipated benefits that will be derived.

6.12.2 All information is held in accordance with the CCG’s Information Governance Strategy Framework, Policy and associated procedures. Further information can be found in the organisation’s Information Security Management Statement and Assurance Plan.

6.13

Violence and Aggression

6.13.1 Any member of the public, patients or otherwise who are violent towards CCG staff may have sanctions taken against them, be refused treatment, or taken to court by the CCG in line with NHS Protect Guidance.

6.14

Emergency Preparedness, Resilience & Response

6.14.1 A significant incident or emergency can be described as any event that cannot be managed within routine service arrangements. Each requires the implementation of special procedures and may involve one or more of the emergency services, the wider NHS or a local authority. Please refer to the Emergency Preparedness, Resilience & Response Policy for further details.

6.15

Risk Assessment

6.15.1 The Management (Health, Safety and Welfare)

Regulations 1999 (Regulation 3) require that suitable and sufficient risk assessments be undertaken, so that the significance of a hazard can be identified, assessed and controlled. Guidance on Assessing risks to safety and health can be found in the CCG’s

13

guidance document – Risk Assessment Matrix. Please refer to the Integrated Risk Management Framework, Strategy, Policy and Procedure for further information.

6.15.2 Risks associated with security should be reported to

the Local Security Management Specialist (LSMS).

6.15.3 Risk Assessments should be completed for all security hazards including physical (buildings, equipment etc.) and people. These risk assessments are the responsibility of the department involved, with support from the Local Security Management Specialist (LSMS) where required.

6.15.4 Risks relating to security are identified on an ongoing basis through incident reports, complaints and claims procedures, and the risk assessment procedure.

6.15.5 It is important that all staff within the CCG are aware of the security risks involved within their work. They must also be aware of formal risk assessments that apply to them, the actions identified to control the risks and the measures to be taken by them personally to reduce the risks to themselves and others.

6.15.6 When working arrangements are agreed with an individual which result in that person working alone for regular / significant periods, then the manager will be responsible for ensuring that a risk assessment is undertaken and that a related safe system of work is put in place. This will take into account the capability of the individual. The employee will be required to conform to these arrangements, to safeguard both themselves and NHS Barnsley CCG.

6.15.7 Working alone is not illegal, but it can bring additional risks to a work activity. The CCG has developed policies and procedures to control the risks and protect employees, and employees should know and follow them. Apart from the employee being capable of undertaking the work / detail the three most important aspects to be certain of are that:

The lone worker has full knowledge of the hazards and risks to which they are exposed.

The lone worker knows what to do if something goes wrong.

Someone else knows the whereabouts of the lone worker and what he/she is doing

14

7. Monitoring the Compliance and Effectiveness of this Policy

7.1 The Health and Safety Group will be responsible for monitoring compliance with, and the effectiveness of, this policy. In discharging this responsibility the Health and Safety Group will take into account:

Any security incident reported via the CCG’s incident reporting system

The results of the annual security audit

Self-assessments against NHS Protect’s security standards.

8. References

8.1 The following legislation and guidance has been taken into consideration in the development of this procedural document:

8.1.1 The Private Security Industry Act 2001

The Regulation of Investigatory Powers Act 2000

Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) 1995.

Data Protection Act 1998

The Protection from Harassment Act 1997

Control of Substances Hazardous to Health 2004 Approved Codes of Practice

The Health and Safety at Work Act 1974

Human Rights Act 1998

Criminal Procedure and Investigation Act 1996

Police and Criminal Evidence Act 1984

Criminal Justice and Public Order Act 1994

CCTV Code of Practice 2000

Standards for Commissioners 2015-16 NHS Protect.

9. Review of the Policy

9.1 The policy will be approved by the Governing Body and reviewed at

least every 2 years. The Health and Safety Group will monitor the policy on an ongoing basis. The procedural document will be reviewed every two years, and in accordance with the following on an as and when required basis:

9.1.1 Legislatives changes

Good practice guidelines

Case Law

Significant incidents reported

New vulnerabilities identified

Changes to organisational infrastructure

Changes in practice

15

Appendix 1 Definitions

1. NHS Protect

The NHS Counter Fraud Service was established in 1998 as a specialist organisation with the commitment to protect the NHS by ensuring that resources made available to patient care and services are not lost to fraud and corruption. The much larger CFSMS was officially inaugurated as a Special Health Authority on 1st April 2003. Since 1st April 2006 it has been a division of the NHS Business Services Authority, and is strategically placed with its operational and policy roles to effectively counter fraud and, with a wide remit to manage healthcare security arrangements within the NHS. The organisation changed its name to NHS Protect in 2011 and continues to lead on work to identify and tackle crime across the health service.

2. Local Security Management Specialist (LSMS) The Local Security Management Specialist (LSMS) is highly trained by NHS Protect and will be involved in performing a wide range of security-related tasks:

Creating a ‘pro-security’ culture amongst staff, professionals and the public

Deterring those who may be minded to breach security

Preventing security incidents or breaches from occurring

Detecting security incidents and reporting them to NHS Protect

Investigating security incidents in a fair, objective and professional manner

Applying a wide range of sanctions against those responsible for security incidents, involving a combination of procedural, disciplinary, civil and criminal action as appropriate

Seeking redress through the criminal and civil justice systems against those whose actions lead to loss of NHS resources

To deter Criminal activities where possible by putting in place essential security control systems and other counter measures

To deny the criminal opportunity, not only through physical barriers, but by putting in place effective systems of loss prevention and property control

To detect the criminal act. The earlier the criminal act is detected and reported the greater the chances of

16

preventing the offenders getting away. Raised awareness of security at all levels will both detect and reduce the risk of crime

To respond effectively to security issues and problems with workable counter measures

To review the strategy after every incident, also after counter measures have been put in place to evaluate their effectiveness

To liaise with the local police and the local authority to achieve partnership working towards a safe and secure environment

The Local Security Management Specialist will work closely with the Local Counter Fraud Services Officer to prevent and detect crime and fraudulent activities.

3. Property Can be defined as the physical buildings in which NHS staff and professionals work, where patients are treated and from where the business of the NHS is delivered. Ref: A Professional Approach to Managing Security in the NHS, NHS Counter Fraud and Security Management Service (2003) http://www.nhsbsa.nhs.uk/Documents/sms_strategy.pdf

4. Assets Assets, irrespective of their value can be defined as the materials and equipment used to deliver NHS healthcare. In respect of staff, professionals and patient sit can also mean the personal possessions they retain whilst working in, using or providing services to the NHS. A Professional Approach to Managing Security in the NHS, NHS Counter Fraud and Security Management Service (2003) http://www.nhsbsa.nhs.uk/Documents/sms_strategy.pdf

5. Premises Premises are land and buildings together considered as a property. This usage arose from property owners finding the word in their title deeds, where it originally correctly meant "the aforementioned; what this document is about", from Latin prae-missus = "placed before". Wikipedia (2015) http://en.wikipedia.org/wiki/Premises

http://www.nhsbsa.nhs.uk/Documents/sms_strategy.pdf

http://www.nhsbsa.nhs.uk/Documents/sms_strategy.pdf

http://en.wikipedia.org/wiki/Premises

17

Appendix 2

Reporting of Crime / Security Incidents All staff have a responsibility to report any crime / breach of security. This reporting falls into the following categories: NHS Barnsley CCG Premises - Hillder House

Where a crime/security incident of a serious nature occurs and is happening there and then, dial 999 and report to police, and then the Security Management Director or their Deputy should be informed.

Where a security/criminal incident is discovered, the information should be passed to the Security Management Director or their Deputy and the Local Security Management Specialist as soon as practicable.

Completion of an Incident Reporting Form (as per Incident Policy) and a copy should be forwarded to the Local Security Management Specialist.

External Locations

Where a crime / security incident of a serious nature occurs and is happening there and then, you should call the police immediately by telephoning 999.

Where a security incident is discovered, the information should be passed to the Security Management Director or their Deputy as soon as practicable.

Completion of an Incident Report Form (as per Incident Policy) and a copy should be forwarded to the Local Security Management Specialist.

Out of Hours

Where a crime / security incident of a serious nature occurs and is happening there and then, you should call the police immediately by telephoning 999.

Following this the incident should be reported to the Security Management Director or their Deputy as soon as possible.

Suspicious (suspect) packages

A suspect package is a package believed to contain a potentially harmful device or substance.

Any suspect package (postal item, e.g. letter / package) when received must immediately be placed in isolation (and not moved again) and away from water, chemicals, heated surfaces, naked flames and gaseous substances. It is more likely to be an incendiary device than a bomb; i.e. it is designed to start a fire.

Do not shake it, squeeze, or open the letter or package.

Turn off all air conditioners, fans, photocopiers, printers, computers and heaters within the room where the letter / package is located. Close all windows and evacuate the room, lock all doors and leave the key in the lock. Place a clearly visible warning on the door.

Any suspicious packages (other items e.g. bags, boxes that have appeared) should NOT be moved and its position should be reported to the Security Management Director or their Deputy or a member of the Senior Management Team. Undertake initial investigation (without touching or moving the package) identifying:

o The listed owner of the package o Visible wires or electrical components showing from the package,

especially where the wrapping has been damaged

18

o Any greasy marks on the envelope or package o If an unknown powder or liquid substance is leaking from the package o Distinctive smells from the package e.g. almonds / marzipan or machine

oil o If the package when delivered was heavy for its size or has an uneven

distribution of weight or has excessive wrapping o If the package was delivered by hand from an unknown source or posted

from an unusual place

If in doubt, dial 999 and report to police and evacuate the building without sounding the fire alarm and closing doors and windows behind you.

Do not use mobile telephones near suspect packages.

If you feel you may have been contaminated, go to an isolated room and avoid other people if you can. It is vitally important that you segregate yourself and others who may have come into contact with the suspicious package. It is unlikely that you have been contaminated and you will get medical treatment if required. Signs that people may have been exposed to a chemical incident are streaming eyes, coughs and irritated skin. Do not rub your eyes; touch your face or other people. Thoroughly wash your hands in soap and water as soon as possible.

Where convenient, fire assembly points can be utilised for the purpose of evacuation, but only if they are located at a distance of at least 400 metres from the suspected bomb site. Safe assembly points are best situated behind a solid building at a distance away from the blast site.

Bomb threats

A bomb threat is a threat to detonate an explosive or incendiary device to cause property damage or injuries, whether or not such a device actually exists. Bomb threats are usually made verbally over the phone.

Notification of a bomb threat can be made at any time and can be made and delivered by several means, usually anonymous, but all must be considered seriously.

Any member of staff receiving a telephone threat regarding a suspect package or explosive device should obtain as must detail as possible from the caller. The police need to be informed immediately - dial 999 and report to police and evacuate the building without sounding the fire alarm and closing doors and windows behind you. Report the situation to the Security Management Director or their Deputy or a member of the Senior Management Team who will decide whether an emergency should be declared in line with the Emergency Preparedness, Resilience & Response Policy.

19

Appendix 3


BARNSLEY CCG’s

LONE WORKER PROCEDURE

Version: 1.0

Approved By: Health & Safety Group

Date Approved: October 2014

Name of originator / author: Ian Plummer, Ruth Nutbrown & Richard Walker

Name of responsible committee/ individual: Health & Safety Group

Name of executive lead: Vicky Peverelle

Date issued: October 2014

Review Date: 2 years from approval

Target Audience: All Barnsley CCG staff

20

LONE WORKER PROCEDURE Amendment Log

Version No Type of Change

Date Description of change

V0.1 First Draft September 2014

V1.0 Final October 2014

Finalised following H&S Group approval on 6.10.2014

21

CONTENTS PAGE

1. Introduction

22

2. Purpose

22

3. The Risks of not having this procedure in place

22

4. Definitions

22

5. Principles

22-23


23

7. Development, Approval and Implementation

23

8. Procedure

23-26

9. Monitoring the Compliance and Effectiveness of this Procedure

26

10. References

26

11. Review of this Procedure 26

22

BARNSLEY CLINICAL COMMISSIONING GROUP

LONE WORKER PROCEDURE

1. Introduction

1.1 This procedure sets out the steps the CCG will take to keep lone

workers healthy and safe. The procedure has been developed in accordance with the CCG’s Policy on the Development and Management of Policies and Procedures.

2. Purpose

2.1 Working alone is not in itself against the law and it will often be safe to do so. However, the law requires employers to consider carefully, and then deal with, any health and safety risks for people working alone.

3. The risks of not having this procedure in place

3.1 In the absence of this procedure there is an increased risk that the CCG will not effectively discharge it’s responsibility to address the health and safety risks for people working alone.

4. Definitions

4.1 4.2

The Health and Safety Executive (HSE) defines lone workers as: “Those who work by themselves without close or direct supervision” Further HSE definition examples include lone workers who work by themselves without close or direct supervision such as:

only one employee works on the premises

employees work separately from others

employees work outside normal hours It is recognised that any employee may spend a limited amount of their working time ‘alone’.

5. Principles

5.1 Lone workers should not be put at more risk than other employees. Establishing a healthy and safe working environment for lone workers can be different from organising the health and safety of other employees. Employers should take account of normal work and foreseeable emergencies, eg fire, equipment failure, illness and accidents. Employers should identify situations where people work alone and consider the following:

23

Does the workplace present a specific risk to the lone worker?

Is there a safe way in and out for one person, eg for a lone person working out of hours where the workplace could be locked up?

Is there a risk of violence and/or aggression?

Are there any reasons why the individual might be more vulnerable than others and be particularly at risk if they work alone (for example if they are young, pregnant, disabled or a trainee)?

If the lone worker’s first language is not English, are suitable arrangements in place to ensure clear communications, especially in an emergency?


6.1

6.2 6.3

The CCG is responsible for the health, safety and welfare at work of all its workers including any contractors or self-employed people doing work for the CCG. These responsibilities cannot be transferred to any other person, including those people who work alone. Line managers are responsible for knowing the whereabouts of their staff; discussing potential risks to their staff arising from lone working; and putting in place appropriate, pragmatic actions to mitigate those risks (see procedure below). All staff have responsibilities to take reasonable care of themselves and other people affected by their work activities and to co-operate with their employers in meeting their legal obligations.

7. Development, approval, and implementation

7.1

This procedure will be:

Developed by the Head of Assurance with the support and expert input of the CSU’s Health & Safety specialist

Approved by the Health & Safety Group, which reports to the Audit Committee

Disseminated to all CCG staff via email, staff bulletins, and the intranet.

8. Procedure

8.1 Staff working alone in Hillder House

8.1.1

Staff working alone are at greater risk for a number of reasons:

Persons attending work early in the morning are potentially at risk because they are the first to enter the site or building, which could expose them to either danger from a fault such as gas leak or electrical fault which has developed over night

24

There is increased threat of personal attack from unauthorised persons on site

If a lone worker suffered an accident while working alone in the building there is a possibility that they would not be discovered for some time.

8.1.2

In order to mitigate these threats the following steps should be taken:

The worker should obtain their line manager’s agreement before working outside their normal hours

The worker and their line manager should agree a procedure to allow the lone worker to be able to contact their line manager or a colleague in the case of an emergency

When working late, the worker should inform their line manager beforehand if possible, and also when they leave the premises

If the line manager is not available, the worker should inform another manager or colleague of what time they expect to finish work and inform them if there are any changes to those plans. When the worker has finished and is outside the building, they should inform their contact that they are done for the day.

8.1.3 Lone workers should always ensure they will be able to leave

the office safely after working late. There have been instances where the building has been locked and people have been locked in.

8.2 Staff working alone at other locations

8.2.1

Lone workers must always ensure that CCG manager or appropriate colleague is aware of their planned movements. This means providing them with the address of where they will be working, details of the people they will be working with or visiting, telephone numbers if known and expected arrival and departure times.

8.2.2

Arrangements must be in place to ensure that if a colleague with whom details have been left leaves work, they will pass the details to another colleague who will check that the lone worker arrives back at their office/base or has safely completed their duties. Procedures must also be in place to ensure that the lone worker is in regular contact with their manager or relevant colleague, particularly if they are delayed or have to cancel an appointment.

8.2.3 When working at other sites lone workers should ensure they understand the local procedures for locking up, times etc. They should always ensure that they sign out of the building.

25

If they must work late they should ensure that their presence is reported to the proper person and that security (if applicable) is aware of the arrangements.

8.3 Lone working and vehicles

8.3.1

Before setting out, lone workers should ensure that they have adequate fuel for their journey and give themselves enough time for the journey to avoid rushing or taking unnecessary risks.

8.3.2

Items such as bags or cases should never be left visible in the car. These should be out of sight, preferably stored in the boot of the vehicle.

8.3.3 Lone workers should always try to park close to the location that they are visiting and should never take short cuts to save time. At night or in poor weather conditions, they should park in a well-lit area and facing the direction in which they will leave. They should ensure that all the vehicle’s windows are closed and the doors locked.

8.3.4 In case of vehicle breakdown or accident, lone workers should contact their manager or colleague immediately. If they need to leave the vehicle to use an emergency telephone, they should put their hazard lights on, lock their vehicle and ensure that they are visible to passing traffic.

8.4 Escalation Procedure

8.4.1

Line managers must discuss with their lone worker staff what actions they should take in the event of an incident.

8.4.2

Where there is genuine concern, as a result of a lone worker failing to attend a visit or an arranged meeting within an agreed time, or to make contact as agreed, the manager should use the information provided to locate them and ascertain whether they turned up for previous appointments that day. Depending on the circumstances and whether contact through normal means can be made, the manager or colleague should involve the police, if necessary.

8.4.3 If it is thought that the lone worker may be at risk, it is important that matters are dealt with quickly, after considering all the available facts. If police involvement is needed, they must be given full access to information held and personnel who may hold it, that information might help trace the lone worker and provide a fuller assessment of any risks they may be facing.

26

8.4.4 It is important that contact arrangements, once in place, are adhered to. Many such procedures fail simply because staff forget to make the necessary call when they finish their work. The result is unnecessary escalation and expense, which undermines the integrity of the process.

9. Monitoring the Compliance and Effectiveness of this Procedure

9.1 Compliance with, and effectiveness of, this procedure will be monitored by:

Regular discussion and review by the Health & Safety Group

Ongoing monitoring and review of incidents reported through the Safeguard incident reporting system.

10. References

10.1 The Health & Safety Executive has provided guidance related to lone

working in the following publication:

Working Alone: Health and Safety Guidance on the Risks of Lone Working (http://www.hse.gov.uk/pubns/indg73.pdf).

11. Review of the Procedure

11.1 The procedure will be reviewed at least every 2 years by the Health & Safety Group.

http://www.hse.gov.uk/pubns/indg73.pdf

27

Appendix 4

Lone Worker Risk Assessment

The Health and Safety Executive (HSE) defines lone workers as:

“Those who work by themselves without close or direct supervision”

Further HSE definition examples include. Only one employee works on the premises, employees work separately from others and employees work outside normal hours

Area/Task: Lone working risk assessment for NHS Barnsley CCG staff

Date: October 2014 Persons Assessing the Risks: IP

Ref No:

Activity/Task/

Area

Hazard Identified

Likelih

ood 1 – 5

Consequence 1 – 5

Risk

Rating

Controls in place (including PPE as

a last resort)

Recommended Additional Controls

Post Risk

Rating

Note: You should rate the risks on the basis of the current controls in place

1

Working outside normal office hours within Hillder house

There is a lone working risk of not receiving help in the event of an injury while working alone. Any injuries suffered could be exacerbated due to no first aide cover. This could result in litigation.

1

3

3

Low

Lone Worker procedure Mobile phone

Ensure lines of communication are available to lone workers who work outside office hours, line managers / colleagues are aware that the building is occupied, mobile phone numbers provided in the case of an emergency Lone worker to phone colleague when leaving the building at night.

3

28

2

Evening work within Hillder house

There is a risk of setting off the burglar alarm and not being able to reset it, which could result in the police visiting the site due to staff being locked in the premises after hours.

1

2

2

Low

Lone Worker procedure Mobile phone

Ensure reception are aware that work is to be carried on after office hours, ensure the lone worker is aware of the procedure to set the alarm Ensure that a manager / colleague is aware the person will be on site

2

3

Working off site, within another building

There is a risk of staff being locked in with potentially no safe available means of escape due to late working at other sites, which could result in litigation.

1

2

2

Low

Meeting in diary, diary open to other staff Signing visitors sheets, Mobile phone

Advise staff to inform reception/ security that they plan to remain late if permitted. Ensure that a manager / colleague is aware the person will be on site

2

4

Travelling to and from meetings

There is a risk of injury to staff and others due to car incidents while travelling to and from other premises, which could result in litigation.

2

3

6

Med

Meetings in diary on outlook. Lone Worker Procedure. Mobile phone. Escalation procedure.

Conduct driving risk assessment and the development of a driving procedure. Be aware of your surroundings when driving, ensure your car is maintained and windows clean to aid visibility

3

5

There is a risk of injury due to Inclement weather while travelling to and from other premises, which could result in litigation.

2

3

6

Med

Check the weather forecast before travelling, if travel is required, it is advisable for warm clothes, food and a shovel is taken, ensure colleagues are aware, if there is an issue ensure your mobile phone is fully charged.

3

6

Walking from vehicle to meeting

There is a risk of injury due to slips, trips & falls while walking to or from a meeting, which could result in litigation.

2

2

4

Low

None

Ensure footwear is suitable when travelling. Always take your time, do not rush, park in well-lit areas were possible

2

7

There is a potential risk of physical / verbal aggression from members of the public while walking to or from a meeting, which could result in litigation and absence due to stress.

1

2

2

Low

None

Ensure personal items are not on show. Always park in well-lit areas were possible. Conflict resolution training could be delivered to front line staff

2

8

There is a risk of personal injury/suffering due to Inclement weather while walking to and from a meeting

1

2

2

Low

None

Check weather forecast before travelling, ensure clothing and footwear is suitable.

2

There is a risk of staff suffering from musculoskeletal issues from incorrect manual handling techniques due to

1

3

3

Low

e-learning & practical manual handling training

Plan your meeting/journey ensure only work required is carried.

3

29

9 carrying heavy bags for meetings which could result in long term illness and potential medical/legal costs to the business

30

APPENDIX 5

Equality Impact Assessment 2013

Title of policy or service Security Policy and Procedure

Name and role of officers completing the assessment

Richard Walker / Ruth Nutbrown

Date assessment started/completed 28/04/15

1. Outline Give a brief summary of your policy or service

Aims

Objectives

Links to other policies, including partners, national or regional

To protect staff, property and assets from a security threat. Produced in line with NHS Protect guidance. The policy should be read alongside the CCG’s Corporate Manual; Fraud, Corruption, and Bribery Policy; Fire safety Policy; Health and Safety Policy; and Lone Worker Procedure.

31

2. Gathering of Information This is the core of the analysis; what information do you have that might impact on protected groups, with consideration of the General Equality Duty.

What key impact have you identified?

What action do you need to take to address these issues?

What difference will this make?

Positive Impact

Neutral impact

Negative impact

Human rights Nil Nil Nil N/A No anticipated detrimental impact has been identified on any equality group. The policy is applicable to all employees and adheres to NHSLA Standards, statutory requirements and best practice and makes all reasonable provision to ensure equity of access to all staff.

Age Nil Nil Nil

Nil Nil Nil

Nil Nil Nil

N/A

Carers Nil Nil Nil

Nil Nil Nil

Nil Nil Nil

N/A

Disability Nil Nil Nil

Nil Nil Nil

Nil Nil Nil

N/A

Sex Nil Nil Nil

Nil Nil Nil

Nil Nil Nil

N/A

Race Nil Nil Nil

Nil Nil Nil

Nil Nil Nil

N/A

Religion or belief

Nil Nil Nil

Nil Nil Nil

Nil Nil Nil

N/A

Sexual orientation

Nil Nil Nil

Nil Nil Nil

Nil Nil Nil

N/A

Gender reassignment

Nil Nil Nil

Nil Nil Nil

Nil Nil Nil

N/A

Pregnancy and maternity

Nil Nil Nil

Nil Nil Nil

Nil Nil Nil

N/A

Marriage and civil partnership (only eliminating discrimination)

Nil Nil Nil

Nil Nil Nil

Nil Nil Nil

N/A

Other relevant groups

Nil Nil Nil

Nil Nil Nil

Nil Nil Nil

N/A

32

Having detailed the actions you need to take please transfer them to onto the action plan below.

3. Action plan

Issues identified Actions required How will you measure

impact/progress Timescale

Officer responsible

No anticipated detrimental impact has been identified on any equality group. The policy is applicable to all employees and adheres to NHSLA Standards, statutory requirements and best practice and makes all reasonable provision to ensure equity of access to all staff.

There are no statements, conditions or requirements that disadvantage any particular group of people with a protected characteristic – therefore there is no required action identified.

The policy will be consulted on widely and will be monitored via the Equality and Diversity Steering Group/Management Team.

4. Monitoring, Review and Publication

When will the proposal be reviewed and by whom?

The policy will be reviewed 2 years after its implementation date.

Lead Officer Richard Walker Review date: tbc

Once complete please forward to your Equality lead Elaine Barnes via email [email protected]

mailto:[email protected]

GB/Pu/15/08/13

1


GOVERNING BODY

13 August 2015

HOSPITAL DISCHARGE NOTIFICATIONS (D1’s)


To inform the Governing Body about the Hospital Discharge Notifications required from the Barnsley Hospital NHS Foundation Trust.


On 21 July the Membership Council reviewed the Barnsley Hospital NHS Foundation Trust (BHNFT) Discharge information received by GP practices. The aim of the review is to improve the quality and efficiency of the discharge information received by GP practices. The content of the Hospital Discharge Notifications has been updated with comments received at the Membership Council and is appended to this report for information.


Note the content of the Hospital Discharge Notifications


5 minutes.

Report of: John Harban

Designation: Elected Member

Report Prepared by:

Kay Morgan

Designation: Governing Body Secretary

GB/Pu/15/08/13

2



This report links to and provides some control against Assurance Framework risk reference 1.4

1.2 Links to Objectives – As a Membership Organisation


√


√


√


√


√



Not relevant


Yes

Quality

Yes


Not relevant

Equality and Diversity – All Patients treated equally

Yes


Not relevant


Not relevant

Human Resources

Not relevant

SUGGESTED DEATH NOTIFICATION - with comments

DEATH NOTIFICATION

Gawber Road, Barnsley, S75 2EP

Telephone (Main Switchboard) 01226 730000

Reason for Admission

Summary of Inpatient Management (Events , Complications, Operations)

Date and time of death

Suspected Cause of death - confirmation and further information (where appropriate) will be sent later

Coroner Involvement YES/NO

Verified by a consultant

PLEASE NOTE SUBSEQUENT INFORMATION MAY LEAD TO A REVISION

SUGGESTED DAY CASE/SHORT STAY DISCHARGE SUMMARY - with comments (Red)

DAY CASE/SHORT STAY DISCHARGE SUMMARY



Primary diagnosis (main condition treated)

Operations and procedures (specify dates where possible)

Operation findings

Follow up plans - hospital and actioned (including trauma rehabilitation)

Follow up plans - GP & community or hospital - must not include GP to chase up results if done in hospital

Information given to patient and/or authorised representative

Presenting complaint(s) Should be Diagnosis on admission and Diagnosis on discharge and where from ie A/E. GP Direct referral etc… Drop down Box

All other diagnoses/injuries

Complications

Allergies

Relevant investigations and results Blood results not required GP can get these from ICE if required

Relevant inpatient treatments and progress

Discharge destination

Is DNACPR in place? Please select yes or no dropdown and if yes select additional required dropdowns and ensure copy accompanies patient out of hospital

Has patient had a blood transfusion during this admission?

Results awaited

Medication on Admission section – complete list of reconciled medicines on admission

Medication changes (differences between drugs on admission and on discharge) Must include reasons for change Drop down box with options of ‘no changes’ or ‘changes to medicines – document in this box’ or such like should clarify this. The reason for the change should also be documented within this section.

Medication on Discharge – what medicines have been prescribed at discharge (list in alphabetical order & highlight change)

Pharmacy information

Prescribers bleep

Cause of death - please note that confirmation and further information where appropriate will be sent by the Bereavement Service Separate notification for death not needed here?

Date and time of death (full information from the Bereavement Office will follow) Separate notification for death not needed here?

NAME AND SIGNATURE OF RESPONSIBLE CONSULTANT


SUGGESTED INPATIENT DISCHARGE SUMMARY - with comments

INPATIENT DISCHARGE SUMMARY



Presenting complaint(s) Should Include Diagnosis on admission and diagnosis on discharge and where from ie A/E. GP Direct referral etc….Drop down Box

Primary diagnosis (main condition treated)

All other diagnoses/injuries

Complications

Allergies

Relevant investigations and results Blood results not required GP can get these from ICE if required

Relevant inpatient treatments and progress

Operations and procedures (specify dates where possible)

Measures of physical and cognitive function at discharge

Discharge destination

Is DNACPR in place? Please select yes or no dropdown and if yes select additional required dropdowns and ensure copy accompanies patient out of hospital

Has patient had a blood transfusion during this admission?

Results awaited

Follow up plans - hospital and actioned (including trauma rehabilitation) Follow up plans - GP & community or hospital - must not include GP to chase up results if done in hospital

Follow up plans - GP & community

Medication on Admission section - complete list of reconciled medicines on admission

Medication changes (differences between drugs on admission and on discharge) Must include reasons for change Drop down box with options of ‘no changes’ or ‘changes to medicines – document in this box’ or such like should clarify this. The reason for the change should also be documented within this section.

Medication on Discharge - what medicines have been prescribed at discharge (list in alphabetical order & highlight change)

Information given to patient and/or authorised representative

Pharmacy information

Prescribers bleep

Cause of death - please note that confirmation and further information where appropriate will be sent by the Bereavement Service Separate notification for death not needed here?

Date and time of death (full information from the Bereavement Office will follow) Separate notification for death

not needed here?

NAME AND SIGNATURE OF RESPONSIBLE CONSULTANT


GB/Pu/15/08/14

1


GOVERNING BODY

9 July 2015

TERMS OF REFERENCE PATIENT AND PUBLIC ENGAGEMENT COMMITTEE


The purpose of this report is to provide the Governing Body with updated Terms of Reference for the Patient and Public Engagement Committee.


The Terms of Reference for CCG Committees are reviewed on an annual basis to ensure that the Terms of Reference:

remain current and fit for purpose

accurately reflect the Committee’s duties and responsibilities

adhere to any Internal Audit recommendations.

The Terms of Reference have been reviewed and are recommended by the Patient and Public Engagement Committee to the Governing Body for approval.


Approve the Terms of Reference for the Patient and Public Engagement Committee

Agenda time allocation for report: 5 minutes.



Report Prepared by:

Richard Walker


GB/Pu/15/08/14

2



The Patient and Public Engagement Committee Terms of reference link to risk reference 5.2 on the CCGs Assurance Framework

“If the CCG fails to deliver its statutory duties, due to weaknesses in its corporate governance and control arrangements, it will result in legal, financial, and / or reputational risks to the CCG and its employees”.









Not relevant – report for information


As above

Quality

As above


As above


As above


As above


As above

Human Resources

As above


Patient and Public Engagement Committee

Terms of Reference

NHS Barnsley Clinical Commissioning Group Patient and Public Engagement Committee

Terms of Reference

1. Introduction

1.1 The Clinical Commissioning Group has established a committee reporting to the Governing Body known as the Patient and Public Engagement Committee.

1.2 The Committee is established in accordance with Barnsley Clinical Commissioning Group’s Constitution, Standing Orders and Scheme of Delegation.

1.3 These terms of reference set out the membership, remit responsibilities and reporting arrangements of the group and shall have effect as if incorporated into the Clinical Commissioning Group’s constitution.

2. 1. Purpose

2.1 The Patient and Public Engagement Committee will provide assurance to the Governing Body on communication and patient, carers and public engagement. The duties of the Patient and Public Engagement Committee will be driven by the priorities of the Clinical Commissioning Group and will be flexible and responsive to new and emerging priorities.

3. Responsibilities The Patient and Public Engagement Committee will:

3.1 Ensure that Patient and Public Engagement is central to the business of the Clinical Commissioning Group, and that is embedded in all decision making processes adopted by the Clinical Commissioning Group

3.2 Secure continuous improvement in the quality or engagement and communication.

3.3 Advise the Governing Body and as necessary the Membership Council on all matters relating to overview and scrutiny and where needed the process of formal consultation.

3.4 Design the specification and quality standards relating to the process and policies relating to engagement, communication and consultation that will be used by all members of the Clinical Commissioning Group and by its staff, in particular that which will be used in the process of service transformation.

3.5 To review the CCGs Assurance Framework and Risk Register at each meeting of the Committee in particular:

Assurance Framework

Review the risks on the Assurance Framework for which the Committee are responsible

Note and approve the risks assigned to the Committee

Review the risk assessment scores for risks

Identify any new risks that present a gap in control for inclusion on the Assurance Framework

Agree actions to reduce impact of extreme and high risks

Risk Register

Review those risks on the Risk Register for which the Committee are responsible for completeness and accuracy

Note and approve the risks assigned to the Committee

Review the risk assessment scores for risks

Identify any new risks for inclusion on the Risk Register

Agree actions to reduce impact of extreme and high risks Consider and agreed whether risks are being effectively

managed

4. Membership

4.1 The core members of the Patient and Public Engagement Committee;

a) The Chair of the Governing Body b) The Chief Officer c) Chief Nurse d) The Elected Clinical Lead(s) for Public and Patient Engagement e) The Lay Member championing Patient and Public Engagement (to

Chair the Committee) f) Communications and Engagement Lead Officer g) Governing body Practice Manager Member h) Chief of Corporate Affairs i) Membership Council Representative

4.2 The Committee may co-opt expert members as it sees fit to deliver its

responsibilities with the approval of the Clinical Commissioners Governing Body.

5. Quorum

5.1 A quorum shall be at least 5 members, including the Lay Member for Patient and Public Engagement or the Clinical Lead for Patient and Public Involvement.

5.2 A decision put to a vote at the meeting shall be determined by a majority of the votes of members present. In the case of an equal vote,

the Chair of the Committee on that occasion shall have a second and casting vote or retain the option to refer the decision to the Governing Body.

5.3 Deputies are not permitted except in exceptional circumstances, and only with the agreement of the Chair

6. Reporting Arrangements

6.1 The Patient and Public Engagement Committee will report to the Governing Body.

6.2 The minutes of the Patient and Public Engagement Committee shall be recorded and submitted to the Clinical Commissioning Group Governing Body on a monthly basis, highlighting, with a written summary, decisions taken on behalf of the Clinical Commissioning Group.

6.3 The Chair of the Patient and Public Engagement Committee will feed back to the Governing Body.

6.4 A PPE Committee Annual Report will be produced for submission to the Governing Body.

7. Administration

7.1 The Chief of Corporate Affairs will oversee the management of the Committee supported by the Public and Patient Engagement Manager Governance, Assurance, and Engagement Facilitator will provide the direct support to the committee.

7.2 The Communications and Public Engagement Manager will be responsible for supporting the chair in the management of the business.

8. Frequency

8.1 The Patient and Public Engagement Committee will meet bi-monthly on a fixed schedule with extraordinary meetings arranged as necessary.

8.2 The agenda and papers will be made available at least one week in advance of the meeting.

9. Code of Conduct

9.1 The Committee shall conduct its business in accordance with national guidance, relevant codes of practice including the Nolan Principles and the Standards of Business Conduct, Managing Conflicts of Interest, and Acceptance of Sponsorship, Gifts, and Hospitality Policy.

10. Review

10.1 The Patient and Public Engagement Committee will review its performance, membership and terms of reference at least annually, or whenever new guidance or circumstances require it.

10.2 Any resulting changes to the terms of reference will be presented for approval to the Governing Body.

Review date July 2016

GB/Pu/15/08/15

1


GOVERNING BODY

13 August 2015

RISK AND GOVERNANCE EXCEPTION REPORT


To provide the Governing Body with the Risk and Governance Exception Report.


The CCG’s Assurance Framework and Risk Register provide the Governing Body with an overarching framework to manage all organisational risk:

the Governing Body Assurance Framework (GBAF) facilitates the Governing Body in assuring the delivery of the CCG’s annual strategic objectives

the Risk Register is a mechanism to effectively manage the current risks to the organisation.

Governing Body Assurance Framework A summary of the GBAF is appended to this report, along with details of the three risks on the GBAF currently rated as red (extreme) which are:

1.1 If the CCG is unable effectively to manage the competing interests and priorities of our partners and providers, there is a risk that the CCG will fail to work effectively to commission high quality health care.

3.1 If the CCG and wider health care system is not sufficiently clear on where it wants to be after 5 years, there is a risk that its operational business planning will not be appropriately integrated with or aligned to its long term objectives, resulting in a failure to support safe and sustainable local hospital services, whilst transforming the way services are provided so that they are as efficient and effective as possible for the people of Barnsley.

4.1 If the CCG and its partners on the Health & Wellbeing Board do not articulate a clear ‘sense of place’ (strategy for Barnsley) or develop a strong sense of mutual accountability (eg for the Better Care Fund), there is a risk that the Board will not deliver more joined up, higher quality, efficient and effective services for the people of Barnsley which address the priority areas in the JSNA.

GB/Pu/15/08/15

2

The Governing Body should consider whether these risks continue to be managed and scored appropriately, and that any relevant positive assurances are identified for inclusion on the GBAF. Corporate Risk Register This exception report provides the Governing Body with the extreme risks faced by the organisation; that is those risks that impact on the Assurance Framework and which could potentially impact on the achievement of the CCG’s strategic objectives. There are currently four extreme risks on the CCG’s Risk Register which have been escalated to the Assurance Framework as gaps in assurance against risks on the Assurance Framework. The risks are:

Ref CCG 14/5b (rated score 20 ‘extreme’) – Contractual and reputational risks relating to Yorkshire Ambulance Service (YAS) under achieving against the Category A response standard of 75% within 8 minutes

Ref CCG 14/11 (rated score 15 ‘extreme’) - BHNFT under performance in respect of people waiting > 6 weeks for diagnostic tests (eg due to lack of ultrasound capacity)

Ref CCG 14/15 (rated score 16 ‘extreme’) – Potential impact on quality & patient safety of incomplete D1 discharge letters

Ref CCG 15/07 (rated score 15 ‘extreme’) – Quality & patient safety risks relating to Yorkshire Ambulance Service (YAS) under achieving against the Category A response standard of 75% within 8 minutes.

Risk owners continue to review and refresh of all the risks allocated to them to ensure the risk register is complete and up to date. Since the last meeting of the Governing Body the Quality and Patient Safety Committee has concluded a detailed review of all the risks it is responsible for as a result of which it is proposing the following changes:

Risk 13/1 (infection control) has been fully reworded and it is proposed to reduce the residual risk score from 16 (extreme) to 12 (high) reflecting the CCG’s recent success in delivering HCAI trajectories

Risk ref 15/07 (YAS response times) has been reworded and re-scored following discussion at the Governing Body in June 2015

Risk 14/7 (Stroke) has been fully reworded

Risk 13/2b (CHC retrospective close) has been removed (this was reported to the Governing Body in July 2015)

Risks 14/10 (lack of GPs) and 13/17 (clinical accreditation requirements) are proposed to be re-allocated to the Primary Care Commissioning Committee.

Quality and Patient Safety Committee also identified two new risks for inclusion in the risk register, the first relating to the Medicines Optimisation QIPP scheme and the second to Goldthorpe School. Although neither of these is rated as red (‘extreme’) they are included on the enclosed extract for the Governing Body’s information.

GB/Pu/15/08/15

3

The CCG’s Committees continue to review and manage all the risks identified.


Consider and agree whether the red (extreme) risks on the GBAF are appropriately scored and whether there is sufficient assurance that they are being effectively managed as at 13 August 2015

Identify any positive assurances relevant to the risks on the GBAF

Review risks rated as extreme on the Risk Register

Review the risks escalated from the Risk Register as gaps in control against risks on the Assurance Framework.


10 minutes.



Report Prepared by:

Richard Walker


GB/Pu/15/08/15

4



The requirement for the CCG to have an Assurance framework and Risk Register is documented in the Integrated Risk Management Framework 2013/14.








Has the area been considered (yes / no / not relevant)?


Not relevant – report for information


As above

Quality

As above


As above


As above


As above


As above

Human Resources

As above

MG, BR

QPSC

Risk rating Likelihood Consequence Total

Initial 4 4 16

Current 3 5 15

Appetite 3 4 12

Approach

Real time assurance via Clinically Led Quality Assurance visits to main providers Reports received and considered by QPSC

CCG to work with Healthwatch to develop a grass roots report to understand public perceptions of the quality of

services

To be included in Integrated Performance Reports to F&PC

Gaps in assurance Actions being taken to address gaps in control / assurance

Potential for harm to patients if the quality and completeness of D1 discharge letters is not improved. (RR

14/15)

Risk register: Extreme - 13/1, 13/3/ 13/10, 13/35,

14/5a, 14/13, 14/15; High - 13/15, 13/17, 14/6, 14/7,

14/8.

CCG represented at Quality Surveillance Group

Quality Team reviews incident reports

Gaps in control

Audit undertaken, results shared with Trust, action plan requested. Follow up audit to be carried out.

Issue raised with Trust's medical director. D1 completion included within the core contract for

2015/16 with financial penalties if not met.

Rationale: Historic poor performance by BHNFT & SWYPFT against

some key quality measures means likelihood of failure is possible.

Consequence of failure catastrophic owing to impact on patient care.

Contract monitoring meetings with BHNFT & SWPFT

Quality & Performance Group meetings with BHNFT & SWYPFT

Self assessment for NHSE assurance process Delivery dashboard; NHSE assurance letters taken to GB

Minutes of Joint Commissioning meetings

Minutes received and considered by QPSC

Updates received and considered by QPSC

Monthly assurance to QPSC via Patient Safety Reports

CQUINs built into contracts & monitored through Quality & Performance Meetings

Clinical / Lay Lead

Executive lead

Committee

Objective 1: To commission high quality health care that meets the needs

of individuals and groups

NHSE Domains: 1, 3, 4, 6

What would success look like? Principal threat(s) to delivery of the objective

Improved outcomes for patients.

Improved performance by providers in delivery of all key performance measures

inc A&E waits, HCAI, ambulance response times and the quality of D1 discharge

letters.

1.1 If the CCG is unable effectively to manage the competing interests and priorities of our partners and providers, there is a risk

that the CCG will fail to work effectively to commission high quality health care.

Treat

Key controls to mitigate threat: Sources of assurance

YAS is currently under achieving against the Category A response standard of 75% within 8 minutes for

Barnsley residents, with potential impacts on the quality of care for Barnsley residents (RR 14/5a).

Ongoing work with YAS to better understand and mitigate impact of under performance on the

quality and safety of care for Barnsley residents, through breach analysis, review of serious

incidents etc. Detailed reports have been received and reviewed by the GB. YAS senior managers

met with the CCG Governing Body on 26 March in light of ongoing poor performance. Issues have

also been raised directly with NHSE.

Jul-15

Positive assurances received

QPSC minutes and Quality Highlights Reports to Gov Body every month; annual QPSC report is

presented to GB; ad hoc reports to GB on specific issues.

Minutes received and considered by FPC

Regular reports on Quality to Governing Body

Joint commissioning arrangements with BMBC

Quality & Performance Group minutes received and considered by QPSC

Date reviewed

0

10

20

A M J J A S O N D J F M

NB

LJS

FPC


Initial 3 4 12

Current 4 5 20

Appetite 3 4 12

Approach


Gaps in assurance Actions being taken to address gaps in control / assurance

CCG represented by Chair & CO. Working Together & CCG COM reports to GB.

Start of the Year Conference with main providers and BMBC

As above

Plan approved by GB, signed off by membership Council. Revised plan approved by GB June

2014.

5 year plan includes performance measures and trajectories

Working Together Programme - supporting acute providers across South Yorkshire to

work more effectively together to ensure safe effective and sustainable local services.

NHSE provides challenge & sign off over long term ambitions and trajectories. NHSE

assurance letters taken to GB.

Mid Year 'refresh' of Start The Year Conference

5 year plan included in CCG Commissioning Plan based on the Health & Wellbeing

Strategy. Refreshed strategic plan now reflects the ambitions for new models of care

set out in the NHS Five Year Forward View.

Objective 3: To support safe and sustainable local hospital

services, supporting them to transform the way they provide

services so that they are as efficient and effective as possible

for the people of Barnsley.

What would success look like?

Less ‘short termism’ in the way investment decisions are made (fewer reactive business cases,

better /earlier planning for winter pressures etc)

Greater clarity within the CCG about our long term objectives and how these are to be measured /

quantified so that we know whether we’re on track

Deeper understanding of how our objectives link (or conflict?) with BHNFT’s transformation

Strategy in order to deliver ‘win / win’ solutions

3.1 If the CCG and wider health care system is not sufficiently clear on where it

wants to be after 5 years, there is a risk that its operational business planning will

not be appropriately integrated with or aligned to its long term objectives, resulting

in a failure to support safe and sustainable local hospital services, whilst

transforming the way services are provided so that they are as efficient and

effective as possible for the people of Barnsley.

Clinical / Lay Lead

Risk register: High - 14/4. Executive lead

The CCG's Strategic Vision and 5 Year Narrative has been refreshed and presented to

Membership Council and Governing Body in May 2015 prior to submission to NHSE.

Health & Wellbeing Board provider Forum

Cross system economic modelling of impact of CCG Commissioning Plans on key

system stakeholders

CCG representation on Senior Strategic Development Group (SSDG), reporting to Health &

Wellbeing Board and to CCG via Chief Officer Reports to the Governing Body

BHNFT - 5 year Plan, including financial sustainability submitted to Monitor May 2015 CCG Governing Body members to gain assurances via Monitor and NHSE re ongoing financial

sustainability of BHNFT.

Gaps in control

Sources of assurance

Date reviewed Jul-15

Rationale: Likelihood is likely as we are currently developing plans

across the system & wider SY&B footprint to reconfigure services.

Consequence catastrophic given serious impact on quality, finance, &

reputation.

Treat

1, 3, 4, 5, 6

CCG reps at meetings, minutes produced

Principal threat(s) to delivery of the objective

Core contract agreed 20 April 2015. In addition to the core contract for 2015/16 the CCG has

offered £1.7m non-recurrent support to BHNFT for transformation of services to deliver 7 day

working

Contract with BHNFT

Committee

NHSE Domains:

Actions agreed and to be monitored via GB

Improvement in unplanned care performance (A&E waits etc)

Key controls to mitigate threat:

0

10

20

30


NB

LJS

FPC


Initial 3 4 12

Current 4 4 16

Appetite 3 4 12

Approach

Delivery of shared objectives is via Joint Programme Boards, CTB and HWBB all of

which have senior membership, and transformational support.

CCG Chair & Chief Officer sit on Health & Wellbeing Board, and development work

underway on H&WB management arrangements

CCG representation on Senior Strategic Development Group (SSDG), reporting to Health

& Wellbeing Board and to CCG via Chief Officer Reports to the Governing Body

Contracts in place with key providers and delivery monitored (see 1.4)

Projects monitored by CTB via highlights reports; and regular reports to GB

Cross system economic modelling of impact of CCG Commissioning Plans on key

system stakeholders


Plan approved by GB & membership Council and reviewed / challenged by NHSE

DoH assessment of the plan - assurance has now been received that the BCF Plan is

fully approved (Dec-14).

Minutes & Reports to Governing Body

Sources of assurance

Rationale: Likelihood is likely as H&WB remains immature and

partnerships are developing across the system. Consequence

major given significance of partnerships to delivery of CCG

priorities.

What would success look like?

4.1 If the CCG and its partners on the Health & Wellbeing Board do not articulate a clear ‘sense of place’

(strategy for Barnsley) or develop a strong sense of mutual accountability (eg for the Better Care Fund), there is

a risk that the Board will not deliver more joined up, higher quality, efficient and effective services for the people

of Barnsley which address the priority areas in the JSNA.

Jul-15

NHSE quarterly assurance process considers effectiveness of partnership working.

Actions being taken to address gaps in control / assurance

BCF submission fully approved (Dec-14).

Report received & reviewed by GB (Jun-14)

Gaps in assurance

Gaps in control

NHSE assurance received and reviewed by GB.

H&WB developing a Medium Term Financial Strategy

Governance arrangements re Better Care Fund still need to fully implemented BCF submission fully approved as of December 2014. Section 75 agreement and

underpinning risk share agreement under development and will go live from 30 June

2015.

All service developments now under the remit of a single Clinical Transformation Board

which include commissioner and provider partners.

Monitored via FPC

Risk register: High - 13/7;

Moderate - 13/25,

13/35.

Key controls to mitigate threat:

Better Care Fund Plan approved November 2014. Section 75 agreement and

underpinning risk share agreement under development and will go live from 1 April

2015.

Objective 4: To develop services through real partnerships with

mutual accountability and strong governance that improve

health and health care and effectively use the Barnsley £.

Priority areas in JSNA reflected in H&W Strategy and CCG Commissioning Plan

Treat

Executive lead

Principal threat(s) to delivery of the objective

NHSE Domains: 1, 3, 4, 5, 6 Clinical / Lay Lead

Date reviewed

Committee

A highly effective health & wellbeing board.

Seamless services – service users are unaware which part of

the system is delivering their services.

0

10

20


1

Initial Risk

Score

Residual Risk Score

Ref

Do

main

Risk Description

Lik

elih

oo

d

Co

nseq

uen

ce

Sco

re

Mitigation/Treatment Lead Owner of the risk

Source of Risk

Lik

elih

oo

d

Co

nseq

uen

ce

Sco

re

Date

Ris

k

Asse

ssed

Pro

gre

ss/

Up

date

Date

fo

r re

-

asse

ssm

en

t

CCG 14/5b

5,6 If improvement in Yorkshire Ambulance Service (YAS) performance against the Category A response standard ( 75% within 8 minutes for Barnsley residents) is not secured and sustained, there is a risk that the reputation of the CCG with its stakeholders could be damaged.

3 4 12 YAS management invited to a ‘confirm and challenge’ meeting. Progress will be monitored through the CCG’s Integrated Performance Report The CCG will work through lead commissioner should performance not be maintained

VP

(Finance & Performance Committee)

Risk Assessment

5 4 20 05/15 May 2015 Performance has improved in March and April ongoing monitoring will continue through FPC March 2015 Considerable discussions were held at the February GB, and in light of significant media interest in ambulance performance and the fact that Ba.

06/15

Domains 1. Adverse publicity/ reputation 2. Business Objectives/ Projects 3. Finance including claims 4. Human Resources/ Organisational Development/ Staffing/

Competence 5. Impact on the safety of patients, staff or public

(phys/psych) 6. Quality/ Complaints/ Audit 7. Service/Business Interruption/ Environmental Impact 8. Statutory Duties/ Inspections

Likelihood Consequence Scoring Description Current Risk No’s

Review

Almost Certain 5 Catastrophic 5 Red Extreme Risk (15-25) 5 Monthly

Likely 4 Major 4 Amber High Risk (8- 12) 26 3 mthly

Possible 3 Moderate 3 Yellow Moderate Risk (4 -6) 11 6 mthly

Unlikely 2 Minor 2 Green Low Risk (1-3) 1 Yearly

Rare 1 Negligible 1 Total = Likelihood x Consequence

The initial risk rating is what the risk would score if no mitigation was in place. The residual/current risk score is the likelihood/consequence (impact) of the risk sits when mitigation plans are in place

Risk Register Escalation to GB Assurance Framework

RISK REGISTER – GB August 2015

2

Initial Risk

Score

Residual Risk Score

Ref

Do

main

Risk Description

Lik

elih

oo

d

Co

nseq

uen

ce

Sco

re


Source of Risk

Lik

elih

oo

d

Co

nseq

uen

ce

Sco

re

Date

Ris

k

Asse

ssed

Pro

gre

ss/

Up

date

Date

fo

r re

-

asse

ssm

en

t

14/15 1, 5, 6

If the quality and completeness of D1 medication information on discharge is not improved there is a risk that patients may not be prescribed the correct ongoing medication by primary care following hospital discharge thereby increasing the risk of harm (An audit of 355 D1 discharge letters from BHNFT undertaken by the medicines management team identified that in 55% of cases the TTO section had not been completed or was incorrect).

4 4 16 The results of the audit have been shared with BHNFT and raised with the Trust’s medical director.

The BHNFT Medical

Director is now leading on the development of a BHNFT Action Plan to address the D1 medicines issues raised and which will, when completed, be received by the Area Prescribing Committee. Work to streamline the information required to ensure effective and timely completion for all discharged patients is being progressed between BHNFT’s Clinical Director for General and Specialist Medicine, the CCG’s Clinical Lead for the BHNFT Contract, and members of the Medicines Optimisation team. Work is undertaken in primary care to reconcile pre- and post-hospitalisation medication.

MG

(Quality &Patient Safety

Committee)

Risk Assessment

& audit of discharge

letters

4 4 16 07/15 July 2015 The Membership Council at its 21 July meeting, endorsed D1 templates which contain three Medicines sections: Medicines on Admission (full reconciled list), Medication Changes (detail of any change including reason for the change) and Medication at discharge (full list of medicines dispensed/supplied to the patient ). June 2015 Following discussion at the CCG’s Governing Body the Chief Officer wrote to the Chief Executive of the Barnsley Hospital NHS Foundation

08/15

3

Initial Risk

Score

Residual Risk Score

Ref

Do

main

Risk Description

Lik

elih

oo

d

Co

nseq

uen

ce

Sco

re


Source of Risk

Lik

elih

oo

d

Co

nseq

uen

ce

Sco

re

Date

Ris

k

Asse

ssed

Pro

gre

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Up

date

Date

fo

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asse

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en

t

D1 completion included within the BHNFT contract for 2015/16 with financial penalties if not met. A follow up audit will be undertaken in due course.

Trust to expedite matters around D1 letters.

CCG 15/07

1,5,6

If improvement in Yorkshire Ambulance Service (YAS) performance against the Category A response standard (75% within 8 minutes for Barnsley residents) is not secured and sustained, there is a risk that the quality and safety of care for some patients could be adversely affected.

4 5 20 Regular meetings between CCG and YAS senior management to assess actual and potential harm in relation to delayed response times and understand YAS actions to mitigate the risk of harm. Meeting of CCG Governing Body and YAS Executive Team 26 March 2015 to discuss ways of achieving sustainable improvements in performance and safety of the service. Further meeting planned. CCG action plan in place covering safety, performance, and sustainability. Regular consideration of YAS incident reporting by QPSC and GB to understand the frequency and severity of

BR

(Quality & Patient Safety Committee)

Risk Assessment

3 5 15 06/15 June 2015 Following discussion of a detailed paper at the June 2015 Governing Body it was agreed to reword the YAS quality risk and to rebase the score. GB agreed that the consequence score should be 5, as there is a theoretical risk of death(s) associated with delays in ambulance response times, but the likelihood score should be 3 (‘possible’) as on the basis of the evidence to date significant harm is

07/15

4

Initial Risk

Score

Residual Risk Score

Ref

Do

main

Risk Description

Lik

elih

oo

d

Co

nseq

uen

ce

Sco

re


Source of Risk

Lik

elih

oo

d

Co

nseq

uen

ce

Sco

re

Date

Ris

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Pro

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Date

fo

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t

incidents associated with ambulance response.

not likely to occur on more than an occasional (monthly) basis.

CCG 14/11 (Inc CCG 14/9 merged Sep-14)

1, 2, 5, 6

If BHNFT does not improve its performance in respect of people waiting > 6 weeks for diagnostic tests (eg due to lack of ultrasound capacity) there is a risk to the reputation of the CCG and the quality of care provided to the people of Barnsley in respect of this service.

4 3 12 The CCG provided additional funding during 2013/14 to support additional clinics and increased capacity to address the issue. Diagnostic performance is monitored as part of contract performance. Contracting team is working with the Trust on options to increase capacity and performance, with a view to bringing a business case to Governing Body later in the year. An action plan is in place at BHNFT to increase capacity to address non - obstetric ultrasound waiting time pressures. Performance to be monitored through quality and performance meetings and contract monitoring.

VP

(Finance & performance Committee)

Risk assessment

5 3 15 05/15 May 2015 In April only 2 patients (0.1%) breached the 6 week target. This reflects a trend which has seen the target achieved consistently since February 2015. March 2015 Performance continues to be inconsistent although assurance has been received that it is the reporting rather than performance that is the problem and that an improvement should be seen by next month.

06/15

5

Initial Risk

Score

Residual Risk Score

Ref

Do

main

Risk Description

Lik

elih

oo

d

Co

nseq

uen

ce

Sco

re


Source of Risk

Lik

elih

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d

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Sco

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Date

Ris

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CCG 13/1

1,5, 6, 8

If the reprocurement of the infection control commissioning advisory service does not deliver the required specification there is a risk that the recent success in achieving HCAI trajectories in 2014/15 will not be sustained for the more stringent 2015/16 trajectories.

5 4 20 There is a monthly PIR Review Group meeting which was informed by the review in 2013/14. The CCG is a member of the Health Protection Board which is chaired by the Director of Public Health. The board reports into the Health & Wellbeing Board, and assurances are obtained from providers in relation to IPC, Public Health and Environmental Health. Minutes of the HPB will be sent to the QPSC. The infection control service is being reprocured with a view to a new service going live from September 2015 for a period of 18 months. SWYPFT will continue to provide the service in the interim. Monthly reports re the incidence of HCAI are taken to QPSC and quarterly ‘deep dives’ are provided via the Patient Safety Report.

BR


Risk Assessment

3 4 12 06/15

June 2015 No successful bids were received in response to the April tender. Discussions are underway potential providers and SWYPFT will continue to deliver the service until September.

07/15

6

NEW RISKS AUGUST 2015 15/08 1,

3, 5, 6

If the significant changes to the medications prescribed to individuals in accordance with the CCG’s ambitious medicines QIPP programme are not effectively implemented, this could lead to stock shortages, inconvenience, and delays in the receipt of prescribed medication, resulting in a risk to the reputation of the CCG and the quality of care provided to patients. (Note: financial risks relating to the QIPP programme are covered by risk 13/31 and managed by F&PC).

4 4 16 About a third of CCG’s have already made the changes so products have a high national use. The CCG is seeking assurances from companiesfor any medication changes it recommends. Advice and support is being provided to Practices. If there was an out of stock situation then the CCG would advise generic scripts are written until supplies come back in. Medicines Management Team is working with community pharmacies to identify and manage any issues. APC has received briefings on the proposed changes. The Quality & Cost Effectiveness Group and the QIPP group are overseeing the implementation of the programme. Proposed changes are in line with accepted good practice and evidence from elsewhere.

MG


Area prescribing Committee

3 4 12 07/15 10/15

15/09 5, 6 If the CCG is unable to secure a new service specification

4 4 16 CCG is working with the school to clarify the rationale for a specification which

BR

(Quality &

Originally raised at SWYPFT

3 4 12 07/15 10/15

7

to provide health care support to children with complex needs at Greenacre School, either due to inability to reach agreement with the school over the care model to be provided or due to an inability to find a suitable service provider, there is a risk that the service to this vulnerable group will not comply with statutory guidance.

meets statutory guidance and ensures a safe, child centred approach to the administration of medicines and feeds to pupils during school hours Service as currently provided by SWYPFT will continue in the interim whilst other interim provision is sought. Proposed service specification ensures each child’s health care plan is up to date and minimises interventions at school and that staff there receive the appropriate clinical supervision, training & support to undertake this. CCG working with school to ensure safe transition from existing to new model

Patient Safety Committee)

Contract Meeting

June 2015

1


GOVERNING BODY

13 August 2015

Integrated Performance Report


1.1 To provide the Governing Body with:

The headline Performance Dashboard including performance against key performance indicators, along with an update on key performance issues by exception.

An overview of the key risks or challenges in achieving performance indicators along with any actions being taken to improve performance.

An update on workforce information and performance.

The financial position for the period ending 30 June 2015, together with forecasts for the full year to 31 March 2016.


2.1 The Governing Body Integrated Performance Report aims to provide an overview of the performance of NHS Barnsley Clinical Commissioning Group (BCCG) up to the end of June 2015.

2.2 The performance report attached at Appendix 1 provides a high level dashboard and an exception report which covers the NHS constitution standards, quality indicators, key performance indicators linked to local priorities and financial performance. This is supplemented by finance appendices A and B which provide details of achievement of financial duties and an executive summary of the financial position for the month.

2.3 The report also highlights the financial performance of the CCG up to 30 June 2015, together with forecasts for the year end.

2.4 The Finance and Performance Committee usually receive a more detailed report containing all indicators monitored by the CCG and detailed financial analysis to enable them to maintain an oversight of performance and finance and provide assurance to the Governing Body. This has not happened this month as there was no Finance and Performance Committee scheduled for August.

2.5 There are a number of performance measures which are currently rated at ‘Red’ or ‘Amber’ for the month of June 2015. Where these are new ratings or where new data has become available since the last report and performance continues to be a concern, a narrative is provided in the performance report attached at appendix 1.

GB/Pu/15/08/16

2

A number of the measures which are currently flagged red are annual targets and therefore no narrative is included.

2.6 Key issues which are identified within the report are :

Yorkshire Ambulance Service performance for category R1 and R2 calls, ambulance handover times and crew clear delays. (Red)

Avoidable Emergency Admissions (composite measure) – Quarter 3 data is showing that 3 of the 4 measures are showing increases in the number of admissions. These are:

o Unplanned hospitalisation for chronic ambulatory care sensitive conditions (Amber)

o Emergency admissions for children with Lower Respiratory Tract Infections (Red)

o Emergency admissions for acute conditions that should not usually require hospital admission (Amber)

The proportion of people waiting 6 weeks or less from referral to entering a course of IAPT treatment (Amber)

The proportion of people with long term conditions feeling supported to manage the condition (Amber)

The incidence of healthcare associated infections (C.Diff). (Red)

Cancer – The percentage of patients seen with 62 days of referral from a GP. (Amber)

Cancer – The % of patients referred with breast symptoms seen within 2 weeks of referral (Amber)

Patient experience of primary care - GP Services (Amber)

Patient experience of access to GP services (Amber)

2.7 The Barnsley CCG May 2015 workforce information is currently showing that:

The CCG workforce has 98 employees (80.4 full time equivalents) an increase of 2 from May.

The sickness rate in June increased to 2.2% (from 1% in April and 2.1% in May) however this remains below the 2.5%. The year to date rate is below the target at 1.8%.

2.8 The CCG is forecasting to achieve delivery of a £8,280k surplus, in line with NHS England expectations, together with other financial duties and targets.

2.9 The Finance and Contracting Report, starting at paragraph 3.4, provides detail underpinning this projected performance and identifies key emerging financial risks to delivery of the required surplus, plus the mitigating actions that are being taken to off-set this risk. The financial risk assessment is at paragraph 3.10. The “most likely” assessed position is that the CCG will achieve its financial duties including delivery of the required level of surplus, on the assumption that:

Risks crystallise at the level assessed as most likely.

The 0.5% contingency is available for mitigation.

Those QIPP schemes identified as Green and Amber (within Appendix D) are delivered and to the level identified.

Income estimated as recoverable from other CCGs is secured.

3

No further net risk emerges during the financial year in excess of that identified within this scenario.

It is recommended that we as a Governing Body pursue full delivery of the £4,966k QIPP target to manage any adverse fluctuations which may impact the position considered “most likely”. Should risks fail to crystallise at a level that utilises the QIPP delivery in full, the CCG will have the ability to invest further in its priorities.


Note the contents of the report including:

2015/16 performance to date

forecast year end financial outturn and financial risk assessment

projected delivery of all financial duties, preciated on successful delivery of an in-year QIPP programme to mitigate in-year risks

continue to pursue full delivery of the £4,966k QIPP target


15 minutes.

Report of: Vicky Peverelle/Heather Wells

Designation: Chief of Corporate Affairs/Chief Finance Officer

Report Prepared by:

Jamie Wike/Neil Lester/Roxanna Naylor

Designation: Head of Planning & Performance/ Deputy Chief Finance Officer/Head of Finance - Contracting

4



This report provides assurance to the Committee against risks 1.1, 1.3, 1.4, 3.1 and 4.1 of the Governing Body Assurance Framework. Performance reporting is a key tool in providing assurance that both the risks currently identified within the Assurance Framework are being addressed and that any emerging performance risks are escalated as appropriate.








Has the area been considered

Financial Implications Yes

Contracting Implications Yes

Quality Yes

Consultation / Engagement N/A

Equality and Diversity N/A

Information Governance N/A

Environmental Sustainability N/A

Human Resources N/A

5

2. INTRODUCTION/ BACKGROUND INFORMATION

2.1 This monthly integrated performance report consists of a progress update against key performance indicators, details the CCG performance against its statutory and other financial duties and assesses the risks of achievement by the year end.

2.2 The headline performance report (attached at Appendix 1) covers the NHS constitution standards, quality indicators, key performance indicators linked to local priorities, workforce indicators and financial performance. The report contains, by exception, a narrative on any key performance issues escalated by Finance and Performance Committee along with details of any actions being taken to address under performance.

2.3 Work will continue on developing and refining the performance reporting framework, in consultation with Governing Body members and lead officers across the CCG to ensure it is fit for purpose and contains the right information to provide the Governing Body with assurance of performance against the Commissioning Plan 2014/19 priorities and outcome ambitions.

2.4

The finance and contracting narrative details the financial performance of the CCG up to 30 June 2015, together with forecasts for the year end and a financial risk assessment.

3. DISCUSSION/ISSUES

3.1 Performance Report – Progress against Key Performance Indicators by Exception

3.2 There are a large number of performance indicators which are monitored by the CCG to provide assurance and measure performance in delivering improved outcomes. These are reviewed on a monthly basis by the Finance and Performance Committee with key indicators reported on a monthly basis to Governing Body.

3.3 The key issues identified for consideration by the Governing Body are:

Yorkshire Ambulance Service performance in Barnsley has dipped in June with performance for Red 1 (the most urgent) calls in Barnsley now below the 75% target at 70.9%, down from 81% in May. Year to date performance to the end of June was 74.4%. For R2 calls, Barnsley performance for June is also below the 75% target at 71.2% and remains below the target for the year to date at 72.1%. YAS overall remain below the target for both Red 1 and Red 2. Further performance information for YAS is included in appendix 2. (Red)

Ambulance turnaround efficiency measures continue to be below targeted expectations in June:-

o Ambulance handover times over 30 minutes, recording 29 breaches, up slightly from 28 breaches in May. 1 of these was over 60 minutes. (Red)

o Ambulance crew clear delays over 30 minutes recorded 7 breaches, up 2 from 5 in May. (Red)

6

Unplanned hospitalisations for chronic ambulatory care sensitive conditions have increased by 2.1% in Quarter 3 (latest reported data). when compared to Quarter 2 and are 4.1% higher than in 2013/14. (Amber)

Emergency admissions for children with Lower Respiratory Tract Infections (LRTI) have increased by 9.1% in Quarter 3 (latest reported data) when compared to Quarter 2 and are 19% higher than in 2013/14. (Red)

Emergency admissions for acute conditions that should not usually require hospital admission have increased by 2.5% in Quarter 3 (latest reported data) when compared to Quarter 2 and are 4% higher than in 2013/14. (Amber)

The proportion of people with a long term condition feeling supported to manage their condition, based upon the January to March 2015 GP patient survey results is 67.31% against a target of 69.9%. Performance also remains below the England average which is 67.54%, however, compared to the July to September 2014 results Barnsley’s performance improved by 1.16% against a national decline of 0.5%. (Amber)

The proportion of people waiting 6 weeks or less from referral to entering a course of IAPT treatment dipped below the 75% standard to 71.81% June as a result of increasing waiting lists due to staff absence and vacancies. Vacant posts have now been recruited to and performance is improving and waiting lists reducing. (Amber)

The incidence of healthcare associated infections (C.Diff) was above the trajectory in June with 4 cases recorded for Barnsley patients. (Red)

Cancer - The percentage of patients seen with 62 days of referral from a GP was below the standard for June with 9 patients out of 50 waiting more than 62 days.

Cancer - The % of patients referred with breast symptoms seen within 2 weeks of referral was below the standard for May with 7 patients out of 95 waiting more than 2 weeks. All of the 7 breaches were due to patient choice. (Amber)

Patient experience of primary care - GP Services is lower than the national average and below the target at 84.69% based on the January to March 2015 GP Survey. Satisfaction has dipped by 0.2% in Barnsley from the previous survey period. Nationally satisfaction has reduced by 0.6% (Amber)

Patient experience of access to GP services is also lower than the national average and the local target at 70.59% based on the January to March 2015 GP Survey. Satisfaction has dipped by 1.49% in Barnsley from the previous survey period, a bigger reduction than seen nationally where satisfaction fell by 1.02%.(Amber)

7

3.4 Finance and Contracting Report for the period ending 30 June 2015

The following narrative details the financial performance of the CCG for the period ending 30 June 2015, together with a projected year end position. The report also includes a financial risk assessment at paragraph 3.10.

3.5 Headline Messages

As shown at Appendix A, the CCG is forecasting to achieve all financial duties and planning guidance requirements. In line with NHS England expectations, the CCG is forecasting delivery of a surplus of £8,280k (2.2% of opening Programme and Running Costs allocations). The financial statements (see appendices) have been prepared utilising projected expenditure against resource allocations received up to 30 June 2015. This includes 3 new allocations received in June, as detailed in paragraph 3.6. The Executive Summary at Appendix B shows the position before assessment of risk and mitigations, a pressure of £426k. The financial positon shown in the Executive Summary is based on limited data, particularly in relation to contracts with providers, where early data suggests that levels are broadly in line with plan. However, it has been assumed that the nationally mandated 0.5% contingency will be utilised to support achievement of financial duties. A risk adjusted position is outlined at paragraph 3.10, detailing emerging financial risks and the impact of mitigations to support the achievement of financial duties. This recommends that the we as a Governing Body continue to pursue full delivery of the £4,966k QIPP target to manage any adverse fluctuations which impact erode the position considered “most likely”. Should risks fail to crystallise at a level that utilises the QIPP delivery in full, the CCG will have the ability to invest further in its priorities.

3.6 Resource Allocation Movements During month 3, three additional resource allocations were made to the CCG.

£’000s

Prime Ministers Challenge Fund 2,266

GPIT Transition Funding 100

GPIT main allocation 652

Total Month 3 additional allocations 3,018

The CCG total available allocation is now £412,519k.

3.7 Budget Movements Budget movements reflect forecast expenditure against the increased resource allocation noted in 3.6 above. It is projected that the full value of these allocations will be utilised in the financial year.

8

3.8 Programme Expenditure At Month 3, all programme budgets are projected to deliver to planned levels. Contract data and PPA forecasts for months 1 and 2 are still subject to validation. It is not considered that the information for each of these areas is sufficiently robust to build a meaningful forecast. However, the financial risk assessment at paragraph 3.10 considers the level of potential financial risk to the CCG and mitigating actions being undertaken to ensure delivery of financial duties.

3.9 Running Costs There is very limited flexibility in this budget. Current information indicates that there is headroom in the order of £100k. It should be noted that the CCG has a financial duty not to exceed this allocation, therefore the position will need to be tightly managed to ensure that cost pressures are contained.

3.10 Financial Risk Assessment From the outset of financial planning, the financial position of the CCG has been subject to ongoing proactive assessment of risk and development of mitigating actions in order to ensure that the CCG can deliver its financial duties. Opening Financial Pressures and Mitigations During the financial planning process the CCG identified a financial pressure of £7,132k as a result of demographic and non-demographic growth in programme expenditure and the requirement to deliver running costs against an allocation reduced by 10%. Through restricting running costs growth and agreement of contracts designed to deliver efficiencies, the CCG had a balanced financial plan at the outset of 2015/16. Budget-setting and Risk Horizon-scanning During the budget-setting process, a pro-active horizon-scanning of emerging risk was undertaken in order to identify the level of financial risk the CCG could face in-year. This also identified the requirement for additional mitigating actions should these risks crystallise. The initial assessment of financial risk was:

£’000s

Over-commitment of investment plans 929

Emerging risks not covered by 0.5% contingency

4,520

Total Risk 5,449

In order to manage this financial risk, the CCG agreed to contain Prescribing budget growth, reducing budgets by £550k to off-set over-commitment against investment plans. In addition, the CCG set a requirement of £4,899k Transformation/QIPP to off-set the total potential risk.

9

Month 3 assessment of Financial Risk and Mitigations (see Appendix C) Each month the CCG undertakes a re-evaluation of the likelihood that emerging risks may crystallise alongside the likely success of delivering the proposed mitigations. The approach to risk assessment and reporting is being developed and will be considered further by the Finance and Performance Committee. Appendix C outlines the “worst case” and “most likely” level of risk, along with mitigations and the impact on delivery of the required surplus. “Worst Case” and “Most Likely Case” The “worst case” scenario indicates a pressure of £5,819k against the delivery of the required surplus. This case has been developed utilising the following assumptions:

All emerging risks identified crystallise at their full value.


Only those QIPP schemes identified as Green (within Appendix D) are delivered.

The “most likely” scenario indicates at this stage that the CCG will achieve the required surplus. However this position is predicated on the following assumptions:

Risks crystallise at the level assessed as most likely.


Those QIPP schemes identified as Green and Amber (within Appendix D) are delivered and to the level identified.

Income estimated as recoverable from other CCGs is secured.

No further net risk emerges during the financial year in excess of that identified within this scenario.

Financial Risk Assessment Conclusion

Although the “most likely” scenario suggests that the CCG will achieve the required surplus, this is on the assumptions outlined above. It should be noted that risks and their likely impact will continue to fluctuate throughout the year and will be robustly monitored and reported. Therefore, it is recommended that the Governing Body continue to pursue full delivery of the £4,966k QIPP target to manage any adverse fluctuations which impact erode the position considered “most likely”. Should risks fail to crystallise at a level that utilises the QIPP delivery in full, the CCG will have the ability to invest further in its priorities.

4. IMPLICATIONS

4.1 Any implications of current levels of performance are included within the commentary in section 3.

10

4.2 It is recommended that we as a Governing Body note the contents of this report.

5. RISKS TO THE CLINICAL COMMISSIONING GROUP

5.1 Financial risks and proposed mitigation have been identified throughout this report.

6.

CONSULTATION

6.1 All relevant functions and departments within the Clinical Commissioning Group are engaged in the development of the integrated performance report and all relevant documents or approaches have been provided to Governing Body, Management Team, the Audit Committee or Clinical Transformation Board prior to this paper.

7. APPENDICES TO THE REPORT

Performance Section

Appendix 1 – Barnsley CCG (InPhase) Monthly Performance Report to June 2015

Appendix 2 – YAS Performance Assurance report June 2015

Finance Section

Appendix A – Performance against Key Financial Duties

Appendix B – Financial Performance : Executive Summary

Appendix C – Financial Risk Assessment Month 3

Appendix D – QIPP Assessment – Cash releasing schemes 2015/16

8. CONCLUSION

8.1 The Governing Body are asked to note the contents of the report including:

2015/16 performance to date

forecast year end financial outturn and financial risk assessment

projected delivery of all financial duties, preciated on successful delivery of an in-year QIPP programme to mitigate in-year risks

continue to pursue full delivery of the £4,966k QIPP target

NHS Barnsley Clinical Commissioning Group

Performance Report

CCGs are accountable to their local populations and to NHS England for planning and delivering comprehensive and high quality

care that meets the needs of their local community.

We have created within InPhase the tools that you need to ensure that your activities and operations are compliant with the targets

set within the CCG Assurance Framework.

Governing Body Dashboard 2015/16

'?' = Awaiting DataPotential Years of Life Lost (PYLL) from causes considered amendable to healthcare, per 100,000

2,471.30 2,445.30 2,445.30December

2013

Improved Access to Psychological Services-IAPT: People entering treatment against level of need

3.75 % 1.25 % 3.81 % June 2015

Improved Access to Psychological Services-IAPT: People who complete treatment, moving to recovery

50.00 % 50.00 % 52.04 % June 2015

Estimated diagnosis rate for people with dementia 67.04 % 64.09 % 64.09 % March 2015

Unplanned hospitalisation for chronic ambulatory care sensitive conditions 1,164.60 1,193.70 1,193.70December

2014

Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s 363.30 325.10 325.10December

2014

Emergency admissions for acute conditions that should not usually require hospital admission

1,649.60 1,687.20 1,687.20December

2014

Emergency admissions for children with Lower Respiratory Tract Infections (LRTI) 1,440.60 651.40 1,747.00December

2014

The proportion of older people (65+)still at home 91 days after discharge into rehabilitation

85.00 % 80.40 % 80.40 % March 2015

% Patient experience of primary care - GP Services 84.82 % 83.93 % 83.93 % March 2015

% Patient experience of primary care - GP Out of Hours services 68.60 % 73.10 % 73.10 % March 2015

% Admitted patients to start treatment within a maximum of 18 weeks from referral (Commissioner)

90.00 % 92.45 % 92.88 % June 2015

% Non-admitted patients to start treatment within a maximum of 18 weeks from referral (Commissioner)

95.00 % 98.01 % 97.65 % June 2015

% Patients on incomplete non-emergency pathways waiting no more than 18 weeks (Commissioner)

92.00 % 94.31 % 92.93 % June 2015

Number of 52 week Referral to Treatment Pathways Incomplete (Commissioner) 0 0 0 June 2015

% Patients waiting for diagnostic test waiting > than 6 wks from referral (Commissioner)

1.00 % 0.20 % 0.40 % June 2015

% 4 hour A&E waiting times - seen within 4 hours (CCG) 95.00 % 97.71 % 94.92 % June 2015

Cancer - % Patients seen within 2wks referred urgently by a GP 93.00 % 97.61 % 98.37 % May 2015

Cancer - % Patients referred with breast symptoms seen within 2 wks of referral 93.00 % 92.63 % 94.76 % May 2015

Cancer - % Patients seen within 31 days from referral to treatment 96.00 % 100.00 % 99.57 % May 2015

Cancer - % Patients seen within 31 days for subsequent treatment (Surgery) 94.00 % 96.00 % 91.11 % May 2015

Cancer - % Patients seen within 31 days for subsequent treatment (Drugs) 98.00 % 100.00 % 100.00 % May 2015

Cancer - % Patients seen within 31 days for subsequent treatment (Radiotherapy) 94.00 % 100.00 % 100.00 % May 2015

Cancer - % Patients seen within 62 days of referral from GP 85.00 % 82.00 % 83.93 % May 2015

Cancer - % Patients seen from referral within 62 days (Screening Service: Breast, Bowel & Cervical)

90.00 % 100.00 % 100.00 % May 2015

Cancer - % Patients being seen within 62 days (ref. Consultant) 85.00 % 91.67 % 95.24 % May 2015

CatA (Red 1) 8 min response time (Yorkshire Ambulance Service - YAS) 75.00 % 69.41 % 72.69 % June 2015

CatA (Red 2) 8 min response time (Yorkshire Ambulance Service - YAS) 75.00 % 70.42 % 72.19 % June 2015

CatA 19min response time (Yorkshire Ambulance Service - YAS) 95.00 % 95.26 % 95.26 % June 2015

Cancelled operations rebooked within 28 days 0 0 0 May 2015

Proportion of people on Care Programme Approach (CPA) who were followed upwithin 7 days of discharge

100.00 % 100.00 % 100.00 % June 2015

Trolley waits in A&E 0 0 0 June 2015

Urgent operations cancelled for a second time 0 0 0 May 2015

Ambulance handover delays of over 30 mins 0 29 106 June 2015

Ambulance handover delays of over 1 hour 0 1 7 June 2015

Reduction in the proportion of broad spectrum antibiotics as a total of all antibiotics in 14/15

10.81 8.71 8.49September

2014

Has your local acute trust validated their total antibiotic prescription data Yes Yes Yes June 2015

Satisfaction with accessing primary care 73.8 % 72.4 % 72.4 %December

2014

Satisfaction with the quality of consultation at the GP practice 437.30 436.10 436.10December

2014

Satisfaction with the overall care received at the surgery 85.2 % 84.9 % 84.9 %December

2014

Number of patients admitted to hospital for non-elective reasons discharged at weekends/bank holiday

23.85 % 25.82 % 25.82 % April 2015

Proportion of people waiting 6 weeks or less from referral to first IAPT treatment appointment

75.00 % 74.00 % 74.00 % June 2015

Proportion of people waiting 18 weeks or less from referral to first IAPT treatment appointment

95.00 % 98.00 % 98.00 % June 2015

Performance

Outcomes TargetActual Period

Actual YTD

Period End Date

Patient experience of hospital care 76.90 % 77.30 % 77.30 %March 2014

Incidence of healthcare associated infection (HCAI) - MRSA (Commissioner)

0 0 0 June 2015

Incidence of healthcare associated infection (HCAI) - MRSA (Provider) - BHFT

0 0 0 June 2015

Incidence of healthcare associated infection (HCAI) - C.Diff (Commissioner)

11 4 12 June 2015

Incidence of healthcare associated infection (HCAI) - C.Diff (Provider) - BHFT

3 1 2 June 2015

Number of mixed sex accomodation breaches (Commissioner) 0 0 0 June 2015

Quality


Actual YTD

Period End Date

Underlying Recurrent Surplus (FORECAST) 2.01% 2.19 % 2.19 % June 2015

Surplus - full year forecast £8,280,000 £8,200,000 £8,200,000 June 2015

Quality, Innovation, Productivity and Prevention (QIPP) - year to date delivery

£1,224,847

Plans for delivery -excluding £2m to be planned

Plans for delivery -excluding £2m to be planned

June 2015

Running Costs (FORECAST) £5,480,000 £5,480,000 £5,480,000 June 2015

BCCG Headcount 98 96 June 2015

BCCG Monthly sickness rate 2.5% 2.20 % 1.93 % June 2015

Resources


Actual YTD

Period End Date

BMBC: Better Care Fund

The Better Care Fund provides an opportunity to improve the lives of some of the most vulnerable people in our society, giving them control, placing them at the centre

of their own care and support, and, in doing so, providing them with a better service and better quality of life.

Below is the Dashboard to support Barnsley MBC Better Care Fund for 2015/16.

Non-elective FFCEs (First Finished

Consultant Episode)

Actual 2,764 2,779 2,547 2,883 2,961 2,854

Target 2,748 2,857 2,592 2,465 2,733 2,805 2,682 2,778 2,513

Performance

Actual (YTD) 24,353 27,132 29,679 32,562 2,961 5,815

Target (YTD) 23,411 26,268 28,860 31,325 2,733 5,538 8,220 10,998 13,511

Performance (YTD)

Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-

15

Permanent admissions of older

people (aged 65+) to residential & nursing care homes, per 100,000

Actual 700.2

Target 640.9

Performance

Baseline 2013/14 736.5 736.5 736.5 736.5 736.5

Direction of Change

Mar-15 Jun-15 Sep-15 Dec-15 Mar-16

The proportion of older people

(65+)still at home 91 days after

discharge into rehabilitation

Actual 80.40

Target 85.00 80.00 84.50 80.00 80.40

Performance

Baseline 2013/14 77.20 77.20 77.20 77.20 77.20

Mar-15 Jun-15 Sep-15 Dec-15 Mar-16

Delayed transfers of care from

hospital per 100,000 population

(number of days delayed)

Actual 38.20 39.79

Target 61.20 61.20 61.20 75.00 75.00 75.00 18.00 18.00 18.00 42.30 42.30 42.30

Performance

Baseline 2013/14

Quarterly Actual

Quarterly Plan

Apr-15 May-15 Jun-15 Jul-

15

Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16

Patient/service user experience

Actual

Target 5.20 5.20

Performance

Actual YTD (YTD)

Target (YTD) 5.20 5.20

Baseline: 2012/13 5.30 5.30

Sep-14 Mar-15

Proportion of people feeling

supported to manage their

condition

Actual 67.19 % 67.73 %

Target 67.54 % 69.99 %

Performance

Baseline 2013 67.70 %

30/09/2014 30/03/2015

CatA (Red 1) 8 min response time (Barnsley) 75.00 % 70.93 %

Yorkshire Ambulance Service performance in Barnsley dropped

dramatically in June 2015.

Performance for Red 1 (the most urgent) calls in Barnsley remains

below the target at 70.9% in June 2015 (May 81%) with a YTD of

74.4% against a target of 75%. Red 2 calls in Barnsley was 71.2% in

June (May 75.1%) with a YTD position of 72.1%

YAS Performance also remains under the national standard of 75%,

with Red 1 at 69.4% in June from 73.7% in May. Red 2 has also

dropped in June to 70.4% from 73.5% in May

30/06/2015

CatA (Red 2) 8 min response time (Barnsley) 75.00 % 71.20 %See Above Commentary against CatA Red1

30/06/2015

CatA (Red 1) 8 min response time (Yorkshire Ambulance Service - YAS)

75.00 % 69.41 % See Above Commentary against CatA Red1 30/06/2015

Emergency admissions for children with Lower Respiratory Tract Infections (LRTI)

480.20 651.40

The overarching Avoidable Emergency Admissions measure forms part

of Barnsley Quality Premium. This is made up of 4 measures, of which 3

are noted as underperforming in this report. The target for all these

measures is the 2013/14 outturn.

The latest provisional data (qtr 3) for this measure shows an increase in

admissions by 9.1% when compared to qtr 2 of 2014/15, with Barnsley

CCG reporting a 19% increase when compared to the 2013/14 outturn.

31/12/2014

Unplanned hospitalisation for chronic ambulatory care sensitive conditions

1,164.60 1,193.70

This is one of the composite measures, with qtr 3 data showing an increase of 2.1% in unplanned admissions when compared to qtr 2 2014/15. Barnsley CCG are reporting a 4.1% increase when compared to the 2013/14 outturn.

31/12/2014

Emergency admissions for acute conditions that should not usually require hospital admission

1,649.60 1,687.20

This is another one of the composite measures, that is showing an increase of 2.5% when comparing qtr 3 to qtr 2 2014/15. Barnsley CCG are reporting a 4% increase when compared to the 2013/14 outturn.

31/12/2014

Proportion of people waiting 6 weeks or less from referral to entering a course of IAPT treatment

75.00 % 71.81 %

This measure has only become mandatory from April 2015.

Due to staff sickness and annual leave, SWYFT have failed to achieve

the qtr 1 target of 75%. Staff have now been recruited and performance

is improving.

30/06/2015

Proportion of people feeling supported to manage their condition 69.99 % 67.73 %

The 2014/15 GP Patients survey results have been published showing

Barnsley CCG performance (67.73%) is better than England (67.31%).

Looking at the January - March 2014 data England performance

dropped by -0.5% where as Barnsley have improved by 1.16%.

This is Barnsley CCG chosen Quality Premium, local measure, of which

a plan was submitted to NHS England to achieve 69.9% for 2014/15.

Barnsley CCG have not achieved the Quality Premium, and therefore

will not receive the money that was attached to this measure.

30/03/2015

Incidence of healthcare associated infection (HCAI) - C.Diff (Commissioner)

4 4

At commissioner level, the number of cases of C.difficile for June is 4, of

which 1 case was at Sheffield Teaching Hospital and the remaining 3

are attributable to BHNFT. Of the 3 cases for BHNFT only 1 was at the

hospital the other 2 are community acquired.

YTD the number of cases of C.diff is higher than the plan, and is

currently reporting 12 cases against the target of 11.

30/06/2015

Key Performance Indicators by Exception

Indicator Target Actual RAGPerformance Direction

Period Performance Period

Cancer - % Patients seen within 62 days of referral from GP 85.00 % 82.00 %

For the month of May 41 out of 50 patients were seen and treated within

62 days, achieving the target of 85% The remaining 9 patients

breached due to:

1 Inter Trust Referral (ITR) being received late in the pathway (73 days),

3 ITR being received late due to a delay in dignostic test (91, 98 and

126 days)

1 delay due to medical reasons (66 days)

1 unexceptional pathway (70 days)

1 breach is still being investigated ( 64 days)

1 delay to diagnostic test (78 days)

1 delay, as the tumour was thought to be non cancerous, and also

patient was away for 10 days. (74 days)

31/05/2015

Cancer - % Patients referred with breast symptoms seen within 2 wks of referral

93.00 % 92.63 %For the month of May, 88 out of 95 patients were seen within two weeks

(92.63%). The 7 breaches were all due to patient choice. 31/05/2015

% Patient experience of primary care - GP Services 84.82 % 83.93 %

The 2014/15 GP Patients survey results have been published, and

show Barnsley CCG performance (84.69%) is lower than England

(85.18%). Comparing July to September (2014) against January to

March (2015), performance has dropped by -0.6% for

England compared to Barnsley -0.2%.

30/03/2015

Ambulance handover delays of over 30 mins 0 29

Ambulance handovers for BCCG, has seen an improvement in

performance with the number of delays going from 49 patients in April

to 29 in June.

There was 1 delay over 60 minutes.

There is a financial penalty for the Ambulance handover measure that

has been applied since April 2014.

An improvement plan will be agreed with YAS and monitored, and

monies retained by commissioners as a result of the implementation.

30/06/2015

Crew Clear delays of over 30 mins 0 7

There has been no improvement in performance for crew clear delays of

over 30 minutes, with June 2015, reporting 7 cases compared to

the 5 cases in April and May against a target of zero.

Zero patients waited over 60 minutes.

The narrative in the Ambulance Handover delays reported above is

applicable to this measure also.

30/06/2015

Breastfeeding prevalence at 6-8 weeks 31.50 % 26.60 %Qtr 4 2014/15 data has been published, showing that for the fourth consecutive quarter Barnsleys breastfeeding prevalence has dipped again going from 29.1% in qtr 1 to 26.6%. in qtr 4.

31/03/2015

Access to GP Services 73.29 % 70.59 %

This data comes from the GP Patients survey, and show Barnsley

Access to GP services, (70.97%) is worse than England (73.84%).

Comparing July to September against January to March, performance

has dropped by -0.6% for England compared to Barnsley -0.2%.

Looking at the January - March 2015 data England performance

dropped by -1.02% compared to Barnsley -1.49%.

30/03/2015

Other Key Performance Indicators by Exception (not included on dashboard)

Indicator Target Actual RAGPerformance Direction

Period Performance Period

Contracts

04/08/2015 Paul Harding

YAS Performance Report – June 2015

Activity Vs Plan

2015/16 RED Ambulance System Indicators (ASI’s) Achievement

Red 1 = 70.9% Red 2 = 71.2% Red 1 & 2 = 71.2%

Tail of Performance: Minute in which 75% ASI was reached (to nearest minute)

NB. Some months where 8 minutes are reported did not meet the target due to the achievement being >8 minutes target requires 75% in =

to or < 8 minutes.

Tail of Performance: Analysis of patients who did not hit the ASI target of 8 minutes in June 2015

100% Achieved at 45 minutes in June 2015

Red 1 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Total Trend

Plan 81 78 76 88 95 79 84 96 105 90 96 91 1059

Actual 92 77 85 254

Diff. 11 -1 9 -88 -95 -79 -84 -96 -105 -90 -96 -91 -805

Red 1 & 2 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Total Trend

Plan 1200 1146 1198 1144 1153 1102 1138 1181 1398 1239 1070 1151 14120

Actual 1145 1138 1095 3378

Diff. -55 -8 -103 -1144 -1153 -1102 -1138 -1181 -1398 -1239 -1070 -1151 -10742

Red 1 & 2 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Total Trend

Plan (%) 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00%

Actual 70.00% 75.50% 71.20% 18.06%

Diff. -0.05 0.01 -0.04 -0.75 -0.75 -0.75 -0.75 -0.75 -0.75 -0.75 -0.75 -0.75 -57%

Month Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15

Target 8 8 8 8 8 8 8

Point Target Reached (Min) 12 10 9 9 9 8 9

Minutes 9 10 11 12 13 14 15 16 17 18 19 20 - 110

Feb 2015 - Misses 80 62 45 32 29 25 14 15 4 1 6 15

Mar 2015 - Misses 70 59 58 44 25 21 14 15 6 7 3 12

Apr 2015 - Misses 88 60 52 35 33 21 11 14 8 7 2 12

May 2015 - Misses 69 71 47 15 19 9 13 3 6 8 5 15

June 2015 - Misses 66 61 57 32 35 23 13 7 3 5 3 10

Contracts

04/08/2015 Paul Harding

Additional Context

Red Combined Performance

Annual Activity Analysis

Analysis of Under/Over Performance (Activity) by year (0.0 =Planned Activity)

R1&R2 Trend APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Total

2012/13 76.7 77.4 78.2 76.6 76.1 76 75.5 75.2 73.6 73.4 73.1 73 75.4

2013/14 73.3 72.1 73.9 70.1 74.6 70.2 72.7 69.9 67.5 70.5 64.1 71.2 70.8

2014/15 65.5 67.7 61.2 59.7 60.8 68.3 71.1 70.3 51.6 66.0 69.3 71.1 65.2

2015/16 70.0 75.5 71.2

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

Actual 2011/12 2371 2404 2387 2493 2347 2362 2416 2425 2724 2639 2456 2691 29715

Actual 2012/13 2454 2715 2538 2718 2598 2587 2643 2605 2946 2778 2527 2878 31987

Actual 2013/14 2760 2784 2729 2932 2692 2665 2836 2771 3023 2922 2559 2700 33373

Actual 2014/15 2793 2808 2845 2905 2814 2766 2868 2898 3203 3097 2637 2902 34536

Actual 2015/16 2896 2791 2622 8309

>/< Activity APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Total

2013/14 12.5 2.5 7.6 7.8 3.8 3.1 7.4 5.9 3.2 5.5 1.7 -6.0 4.6

2014/15 0.6 0.7 3.4 -1.5 3.6 2.4 -0.3 3.2 4.5 4.7 1.5 6.1 2.4

2015/16 -0.2 -4.3 -11.3

APPENDIX A

PLANNED ACTUAL VARIANCE CURRENT PLANNED ACTUAL ACTUAL CURRENT

YEAR TO

DATE TO DATE TO DATE STATUS OUTTURN OUTTURN VARIANCE STATUS

£'000 £'000 £'000 £'000 £'000 £'000

REMAIN WITHIN TOTAL REVENUE RESOURCE LIMIT 101,732 101,288 (444) 404,239 404,239 0

REQUIRED SURPLUS (AS PER PLAN) (2,114) (2,114) 0 (8,280) (8,280) 0

REMAIN WITHIN CAPITAL RESOURCE LIMIT 0 0 0 N/A 0 0 0 N/A

REMAIN WITHIN RUNNING COST ENVELOPE 1,395 1,314 (81) 5,480 5,480 0

REMAIN WITHIN MAXIMUM CASH DRAWDOWN * 0 0 0 0 0 0

PLANNING GUIDANCE REQUIREMENTS

UTILISATION OF 1.0.% RESOURCES NON RECURRENTLY 1,018 0 (1,018) 4,070 12,195 8,125

0.5% CONTINGENCY RESERVE 471 0 (471) 1,884 1,884 0

2015-16 2015-16 CURRENT 2015-16 2015-16 CURRENT

BETTER PAYMENT PRACTICE CODE NUMBER £'000 STATUS NUMBER £'000 STATUS

NON-NHS PAYABLES: CCG

TOTAL NON NHS TRADE INVOICES PAID IN THE YEAR 2,086 8,787 8,344 35,148

TOTAL NON NHS TRADE INVOICES PAID WITHIN THE TARGET 2,078 8,746 8,312 34,984

PERCENTAGE OF NON-NHS TRADE INVOICES PAID WITHIN TARGET 99.62% 99.53% 99.62% 99.53%

NHS PAYABLES: CCG

TOTAL NHS TRADE INVOICES PAID IN THE YEAR 525 64,575 2,100 258,300

TOTAL NHS TRADE INVOICES PAID WITHIN THE TARGET 522 64,454 2,088 257,816

PERCENTAGE OF NHS TRADE INVOICES PAID WITHIN TARGET 99.43% 99.81% 99.43% 99.81%

* Currently no Maximum Cash Drawdown figure provided from NHSE, Indicative figure to be provided by month 4

YEAR TO DATE FORECAST OUTTURN

NHS BARNSLEY CLINICAL COMMISSIONING GROUP

MONTHLY FINANCE MONITORING STATEMENT - KEY FINANCIAL DUTIES

FOR THE PERIOD ENDING 30 JUNE 2015

YEAR TO DATE FORECAST OUTTURN

Financial Duties

APPENDIX B

AREA

RECURRENT NON

RECURRENT

TOTAL

BUDGET

(£'000)

BUDGET ACTUAL

VARIANCE

OVER /

(UNDER)

FORECAST

OUTTURN

VARIANCE

OVER /

(UNDER)

VARIANCE

AS % OF

TOTAL

BUDGET

MOVEMENT

FROM

PREVIOUS

MONTH

RESOURCE ALLOCATION FOR CCG

PROGRAMME RESOURCE B5 (392,794) (14,245) (407,039) (102,451) (102,088) 363 (407,039) 0 0.0% 0

RUNNING COST RESOURCE B5 (5,480) 0 (5,480) (1,395) (1,314) 81 (5,480) 0 0.0% 0

TOTAL RESOURCE ALLOCATION B5 (398,274) (14,245) (412,519) (103,846) (103,402) 444 (412,519) 0 0.0% 0

PROGRAMME EXPENDITURE

ACUTE B1 191,614 1,153 192,767 48,192 47,939 (253) 192,767 0 0.0% 0

MENTAL HEALTH B1 31,467 47 31,514 7,878 7,878 0 31,514 0 0.0% 0

COMMUNITY HEALTH B1 35,923 405 36,328 9,082 9,082 0 36,328 0 0.0% 0

PRIMARY MEDICAL SERVICES (CO-COMMISSIONING) B2 33,409 0 33,409 8,352 8,220 (132) 33,409 0 0.0% 0

PRIMARY CARE B2 51,488 4,255 55,743 13,936 13,936 0 55,743 0 0.0% 0

CONTINUING CARE / FREE NURSING CARE B2 16,840 2,444 19,284 6,572 6,572 0 19,284 0 0.0% 0

OTHER PROGRAMME COSTS B2 19,806 3,090 22,896 5,810 5,821 11 22,896 0 0.0% 0

TOTAL COMMISSIONING SERVICES (EXCLUDING RESERVES) 380,547 11,394 391,941 99,822 99,448 (374) 391,941 0 0.0% 0

CORPORATE COSTS (NON RUNNING COSTS) 827 69 896 224 235 11 896 0 0.0% 0

DEPRECIATION / PROPERTY CHARGES 493 0 493 123 123 0 493 0 0.0% 0

CSU RECHARGE 672 0 672 168 168 0 672 0 0.0% 0

TOTAL PROGRAMME COSTS (EXCLUDING RESERVES) 382,539 11,463 394,002 100,337 99,974 (363) 394,002 0 0.0% 0

RUNNING COSTS

PAY COSTS B4 2,905 71 2,976 756 714 (42) 2,976 0 0.0% 0

NON PAY COSTS B4 2,806 (17) 2,789 710 667 (43) 2,789 0 0.0% 0

INCOME B4 (231) (54) (285) (71) (67) 4 (285) 0 0.0% 0

RUNNING COSTS TOTAL 5,480 0 5,480 1,395 1,314 (81) 5,480 0 0.0% 0

TOTAL CCG EXPENDITURE (EXCLUDING RESERVES) 388,019 11,463 399,482 101,732 101,288 (444) 399,482 0 0.0% 0

COMMITTED PROGRAMME RESERVE / QIPP REQUIREMENT B3 4,025 (1,152) 2,873 0 0 0 3,299 426 14.8% 73

TOTAL CCG EXPENDITURE BEFORE 0.5% CONTINGENY RESERVE 392,044 10,311 402,355 101,732 101,288 (444) 402,781 426 0.1% 73

APPLICATION OF 0.5% CONTINGENCY RESERVE 0 1,884 1,884 0 0 0 1,884 0 0.0% 0

TOTAL AFTER APPLICATION OF CONTINGENCY 392,044 12,195 404,239 101,732 101,288 (444) 404,665 426 0.11% 73

FURTHER SAVINGS REQUIRED TO ACHIEVE PLANNED SURPLUS (426) (426)

TOTAL REQUIRED SURPLUS (6,230) (2,050) (8,280) (2,114) (2,114) 0 (8,280) 0


MONTHLY FINANCE MONITORING STATEMENT - EXECUTIVE SUMMARY

FOR THE PERIOD ENDING 30 JUNE 2015

YEAR TO DATE (£'000)TOTAL ANNUAL BUDGET (£'000)Ap

pen

dix

FORECAST OUTTURN (£'000)

Exec Summary

APPENDIX C

"Worst Case" "Most Likely"

£'000 £'000

RISKS

Risk identified in base position See Appendix B 426 426

Potential overtrade on contract positions 1,884 1,884

Emerging Risks identifed to Month 3 6,304 2,124

Total risk assessed at Month 3 8,614 4,434

MITIGATIONS

0.5% nationally required contingency -1,884 -1,884

Delivery of transformation/QIPP schemes -911 -1,636

Realisation of income streams from other CCGS - -914

Total mitigations assessed at Month 3 -2,795 -4,434

Unmitigated Risk 5,819 0


Financial Risk Assessment - Month 3

APPENDIX D

QIPP area Scheme Description Lead Full year GREEN rated AMBER rated RED rated

£'000 £'000 £'000 £'000

Medicines Management

A number of schemes looking at Primary Care medicines

optimisation and review of commercial contracts. Medical Director

996 532 464

Substance misuse - recharge of Drugs to

LA

Recharging of Substance Misuse drugs spend to the LA,

at approx £130k per annum. Back dated to 2013-14. Medical Director

390 130 260

RightCare Barnsley Reduction in Acute hospital admissions Chief Nurse -

Out Patients activity

Reduction in the level of out patient referrals that are

discharged at first appointmentDr Guntamukala

175 175

COPD pathway

Reduce hospital admissions by developing a temporary

pathway on an interim basis whilst the whole pathway

review is taking place and subsequent new service put in

place.Chair

243 243

Non pay budgets Further underspends within non pay budgets Chief Finance Officer224 224

DVT Implementation of new pathway

Dr Krishnaswamy25 25

TeledermatologyPilot virtual clinics to reduce face to face consultations in

hospital -

Review pathway -

Review hospital services for heart failure to reduce

demand for inpatient beds while also maintaining and

improving quality of care and clinical effectiveness.

-

Stroke unbundling

Review of potential areas to unbundle tariff. Contractual

issue therefore any savings will not materialise until 1st

April 2016 -

Other unbundling

Review of potential areas to unbundle tariff. Contractual

issue therefore any savings will not materialise until 1st

April 2016 -

Reinstate Referral management meetings to roll out to

GP practices 3rd August 2015 -

Review referral criteria for Hip and Knee joint

replacements -

Explore potential for Primary Care to Primary Care

referrals to help manage secondary care referrals.

-

Develop a short 60 seconds information video and leaflet

for hip and knee joint replacements to better inform and

prepare patients psychologically about the procedures

-

GP forums - Possibly on BEST WebsiteSet up a web based GP forum for sharing best practice

and for obtaining peer advice and support. -

AMAC Tariff

Clinical review of activity going through AMAC to be

undertaken to ascertain if current local tariff is set

appropriately. Contractual issue therefore any savings

will not materialise until 1st April 2016

-

PEARS Scheme

Primary Eye-care Assessment and referral service. Local

opticians offering a free assessment and treatment for a

recent eye condition

-

Diabetes pathway Review of pathway. -

Use of CDU in A+EClinical Decision Unit in BHNFT A&E department to help

manage the level of admissions from A&E. -

Clinical Coding audits

National Audit Office have confirmed that a coding audit

has not been completed within the last 2 years. Currently

establishing who is responsible for arranging an audit.

-

Procedures of low clinical effectiveness (POLCE)

-

The CCG to speak with Bob Kirton from the acute trust

regarding services that are running at a loss for BHNFT

which the CCG are paying for. Need to consider service

decommissioning implications. -

Pre-Assessment clinics

Transfer activity from secondary care to Primary Care

where safe and appropriate.

-

Pre-Assessment clinics

Transfer activity from secondary care to Primary Care

where safe and appropriate.

-

BQF- LUTS (Lower Uninary Tract

Symptoms in Men)

Introduction of new pathway for LUTS patients which

results in fewer referrals to secondary care.

-

BQF - Stroke prevention in people with AF/

Flutter

-

QOF Exploring changing the offer in Primary Care with

flexibility in QOF. -

ProcurementReview of contracts and non clinical spend to identify

potential areas for procurement efficiencies -

Diagnostic equipment in primary care ECG /Blood pressure monitors for AF-

Barnsley Participation Funding

Review of historical payment arrangement to BMBC of

£141k per annum. This is being queried with BMBC as it

is not clear what we are paying for.

-

GRAND TOTAL 2,054 911 724 418

Expected Requirement 4,966

QIPP still to be identified 2,912

Heart Failure diagnostics

Referral Management

Services which are running at a loss at

BHNFT


QIPP ASSESSMENT : Cash-releasing schemes 2015/16

Workstreams implemented / ready to be implemented

Workstreams under development

GB/Pu/15/08/17

Page 1 of 10


Minutes of the Meeting of the Membership Council held on Tuesday 21 July 2015 at 7 pm in the Boardroom Hillder House, 49/51 Gawber Road, Barnsley S75 1EY. PRESENT: Dr N Balac Chairman Elected Member (St Georges Medical Practice) Dr Ali Elected Member (Woodland Drive Medical Centre) Dr S Ball Elected Member (Penistone Group Practice) Dr R Farmer Elected Member (Hoyland First PMS Practice) Dr M Ghani Elected Member (The Rose Tree PMS Practice) Dr J Harban Elected Member (Lundwood Medical Centre) Dr N Luscombe Elected Member ( Huddersfield Road Surgery) Dr P C Kakoty Elected Member (The Kakoty Practice) Dr J MacInnes Elected Member (Dove Valley Practice) Dr S Krishnasamy Elected Member (Royston Group Surgery) Mr J Logan Elected Member (Ashville Medical Practice) Dr M Smith Elected Member (Victoria Medical Centre) Dr A Walker Elected Member (Hoyland Medical Practice) IN ATTENDANCE: Mr M Austin Practice Managers Group Chair Mr J Barker Lead Service Development Manager Ms A Capper Service Development Manager Ms Penny Greenwood Head of Public Health – Health Protection Mr J Holliday Lead Commissioning and Transformation Manager Ms M Hoyle Governing Body Practice Manager Member Ms K Morgan Governing Body Secretary Ms K Martin Head of Quality for Primary Care Commissioning General

Medical Services Mr C Millington Governing Body Lay Member Ms B Reid Chief Nurse Ms K Roebuck Operational Development Manager Ms H Wells Chief Finance Officer APOLOGIES: Dr E Czepulkowski Elected Member (Royston High Street)

Dr M Guntamukkala Elected Member (The Grove Practice)

Dr Tom Heyes Brierley Medical Centre Dr L King Kingswell Surgery Mrs C Lawson Head of Medicines Optimisation Mrs V Peverelle Chief of Corporate Affairs Dr M Simms Governing Body Secondary Care Doctor Mrs L Smith Interim Chief Officer

GB/Pu/15/08/17

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Mr Jamie Wike Head of Planning and performance The Chairman welcomed everyone to the Meeting of the Membership Council and introductions took place. The Chairman informed the meeting that agenda item 6; Re-procurement of 0-19 pathway would be taken as the first item of business.

Agenda Item

Note Action Deadline

MC 15/07/01

MINUTES OF THE PREVIOUS MEETING

The minutes of the previous meeting held on 24 March 2015 were verified as a correct record of the proceedings. The Governing Body Secretary noted that she had received some points of clarification from the Chief Finance Officer prior to the meeting in relation to section 15/05/03 Financial Plan.

MC 15/07/02

MATTERS ARISING REPORT

The Membership Council considered the Matters Arising Report.

Minute Reference 15/05/04 Member Practice Visits

Elected Members confirmed that they had received a letter about the forthcoming practice visits by CCG officers. It was noted however that it may take time to visit all Practices.

MC 15/07/03

RE PROCUREMENT OF 0-19 PATHWAY

The Head of Public Health – Health Protection introduced her report, updating and engaging with the Membership Council about the 0-19 Healthy Child Programme. She explained that from 1 October 2015 the responsibility for commissioning public health services for children aged 0-5 will transfer from NHS England to local authorities. As agreed by the BMBC Cabinet, Public Health were currently working with key stakeholders to develop an integrated Healthy Child Programme 0-19 years based on national guidance and in consideration of local need.

The Head of Public Health reported that Public and Stakeholder Consultation on the 0-19 Pathway had commenced at the end of May 2015 and will finish on 27 July 2015. The consultation was being promoted across the borough with specific engagement being undertaken with young people. Comments positive or otherwise from all

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Agenda Item


stakeholders were extremely important.

A lengthy discussion took place and the following main points noted:

The CCG and LMC would provide a joint response to the consultation reflecting the comments of all GPs.

A benchmark for the numbers of responses received from the consultation was queried. It was clarified that the consultation had exceeded the defined limit for expected responses and a good strong evaluation was anticipated.

A Communications Strategy was in place to promote the consultation.

In response to a question raised about the cost difference of re modelling the service the Nurse Consultant Public Health indicated that the 0-19 pathway would commission better outcomes for Children. The future allocation for the 0-19 services would be determined by the Children & Young People’s Trust Executive Group (ECG) The cost envelope, including national and geographical averages would be considered. The cost difference as yet was not known.

From a clinical practice perspective it was felt there were deficiencies in the current health visiting model with variable gaps in availability, accountability and communication. Given that the numbers of health visitors may be reduced in the new pathway this, in real terms will reduce productivity and quality of service provision. The Head of Public Health commented that the future service may be innovative in approach and delivered differently. The Medical Director advised that in reality the current provider of the Health Visiting Service was not going to change overnight, the management and leadership of this service was vitally important to bring about an improved service. It would take invested time and energy to change the service which could take up to 18 months.

The 0-19 pathway must recognise transition issues to ensure that a quality service was delivered with no gaps in service

It was clarified that named health visitors and school nurses for Practices was included as an indicator in the specification.

From a stakeholder perspective there was no indication about the kind of service that was being sought and the detail of the specification was required. The Head of Public Health stated that the governance around the

NB/BR & JW

Complete 22.08.15

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Agenda Item


programme was very strict; the specification would be shaped following the evaluation process. This was the standard way to produce a specification; once all feedback had been received from stakeholders.

The CCG’s Chief Nurse identified she was a member of the ECG which would make decision on the specification, following which the documents would be made available to bidders.

The Chief Nurse reported that draft performance indicators were available and she would seek that they could be shared with the Membership Council.

The Membership Council requested that the CCG and LMC would wish to see the specification before providing a final response. The current 390 response’s to the consultation was not a lot when compared to how many people would be affected by the 0-19 Pathway. The timelines set for the Programme appeared quite rapid.

It was confirmed that the Care Quality Commission would regulate the 0-19 service.

The Head of Public Health commented that that a key BMBC corporate objective was for every child in Barnsley to have the best start in life, the re-procurement was not about budget but rather how would the service be maximised and re-profiled.

The Chairman concluded discussion indicating that:

It was important to get the consultation process correct leading to an appropriate specification. Despite remodelling options for a new pathway the numbers of Heath Visitors should not decrease. It would be helpful to have evidence of where other operating models had worked well, particularly in under doctored areas.

The rapid process for procurement of the 0-19 pathway could be perceived as a weakness.

A model which reduced professionals in favour of Family Co-workers was not appropriate. Professionalism and accountability were important to ensure patients received the appropriate care.

The Local Authority were under cost pressures and assurance was required that the primary aim of the re-procurement was not a cost saving issue.

The CCG should have an opportunity to see and comment upon the specification. If the specification did

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Agenda Item


not take serious account of the CCG and LMC then this would be a difficult position.

Agreed Actions: To Circulate the draft performance indicators for the 0-19 Healthy Child Programme. To ask the Chair of the Executive Decision Making Group when a window of opportunity may be available for the CCG and LMC to review the specification.

BR BR

31.07.15 31.07.15

MC 15/07/04

CCG COMMISSIONING PLAN

The Chairman introduced the report updating the Membership Council on progress made in finalising the refresh of the CCG Strategic Commissioning Strategy and confirmed publication of the final Strategy on the CCG Website. The Chairman drew the Membership Council’s attention to the main changes of the refreshed Strategy.

Mr C Millington highlighted that there had been limited response to consultation on the Strategy and enquired as to whether this could be quantified. The Chairman advised that the Strategy had been circulated to all Practices, however not all GPs were engaged with regard to strategic type of working, clinical practice was their priority.

The Membership Council noted the changes made to the ‘Strategic Commissioning Plan 2014 to 2019, Refresh – 2015 to 2019 – Putting the NHS Five Year View into Action.

MC 15/07/05

UPDATE REPORT – FINANCIAL CHALLENGES THROUGH REDESIGN

The Chief Finance Officer introduced her Report and gave a presentation to the Membership Council about the Transformation/QIPP Programme. The Chief Finance Officer explained that the CCG was faced with emerging financial risks which presented a significant challenge to delivery of the CCG’s financial duties. Prior to the presentation the Chair requested an explanation of “Why we are in this position”

The Chief Finance Officer’s report and presentation detailed progress in the development of a Transformation/QIPP Programme designed to deliver £4.9m to mitigate the impact

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Agenda Item


of these emerging risks. Specifically the presentation provided to the Membership Council included: A definition and meaning of QIPP (Quality, Innovation, Productivity and Prevention) NHS Barnsley CCG Context 2015-2016 QIPP It was noted that the Dr M Guntamukkala was the Governing Body Lead for QIPP

The Membership Council and considered the proposed areas of QIPP focus:

Medicines Management

Consistency in Performance and Delivery/Referral Management

Procedures of low Clinical Effectiveness

RightCare Barnsley

Diabetes and Respiratory Pathways The Chairman advised that it was important for the Membership Council to understand the financial position as represented by the Chief Finance Officer and that the presentation provided practical steps to achieve savings. It was noted that whilst work is ongoing, the current position indicates that firm plans are still required to address £4.1m of target savings.

Discussion took place:

In response to a question raised about plans for savings in secondary care the Chief Finance Officer explained that expected efficiency savings were defined in contracts.

It was suggested that the CCG should look at the causes of over performance in providers such as referrals. The Practice Manager Member commented that issues around data quality had prevented reconciliation of referral data to activity for previous referral schemes. The Chief Finance Officer highlighted benchmarking of CCG data against peers which indicated there was scope for improvement in terms of GP referrals into secondary care. The meeting was informed that Dr M Guntamukkala had some innovative ideas around

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Agenda Item


referrals which would be shared with GP colleagues. The Chief Finance Officer referenced the significant investment in Primary Care in 2015/16.

A review of restricted procedures could be undertaken. From a comms perspective the Medical Director advised that any new restricted procedures would need evidence to demonstrate the lack of clinical effectiveness. Patients had a right to referral and second opinion.

With regard to the Respiratory review Dr R farmer commented that putting more money into Primary Care may be the answer but investing in secondary care would lead to additional doctors in secondary care and more work for Primary Care. There had been a 23% increase in Hospital doctors.

Restrictions on referrals may increase demand in future years.

With regard to Medicines Management, it was noted that consultants changed patients medication and this impacted on Practice costs.

The Governing Body Lay Member expressed concern about the remaining £4.1m savings target at month 5 of financial year

The Chairman advised that although it was now the fifth month of the financial year, the proposed schemes would achieve savings. However if the QIPP schemes were not developed and progressed this may affect the investment monies available to the CCG including Primary Care. Some schemes could be undertaken by the Multispecialty Community Provider. It was noted that a regional QIPP Leads Group would share ideas and evaluate performance of schemes.

The Membership Council noted the contents of the Report and agreed to:

Support further development of the proposed transformation/QIPP Programme.

To participate in the actions required to secure delivery.

Dr J MacInnes agreed to help on the QIPP workstreams.

MC 15/07/06

BHNFT HOSPITAL DISCHARGE FORM D1 LETTERS

Dr Harban introduced a report and tabled templates about Hospital Discharge Letters (D1’s). He requested the

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Page 8 of 10

Agenda Item


Membership Council to review the content of D1’s.

The Membership Council Agreed the following amendments: Death Notification:

Added Coroner Involvement YES/NO Day Case/Short Stay Discharge Summary

Removed – Patient is on oxygen at home/home ventilation (yes/No) The rationale for removal, oxygen should be included on TTO

Amended - Follow up plans to read - & actioned at Hospital

Removed – measures of physical and cognitive function at discharge

Amended - Medication on Discharge – added list in alpha order and highlight changes

Agreed that ‘Verified by Consultant’ to remain In Patient Discharge Summary

Removed – Patient is on oxygen at home/home ventilation (yes/No) The rationale for removal was that oxygen should be included on TTO

Amended - Follow up plans to read - & actioned at Hospital

Amended Medication on Discharge – added list in alpha order and highlight changes

Agreed that ‘Verified by Consultant’ to remain

MC 15/07/07

MEDICAL INTEROPERABILTY GATEWAY (MIG)

The Lead Service Development Manager introduced his report and gave a presentation about the Medical Interoperability Gateway (MIG). The Membership Council were informed about the benefits of the MIG, information to be shared and who with, safeguards in place to ensure information is shared safely and how patients will be informed of this.

Members were assured that all information shared would be on a read only basis. However, comments could be sent back to Practice for the records if required. Information would not be shared with the BMBC because the council did

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Page 9 of 10

Agenda Item


not have secure clinical systems. Dr N Luscombe informed the Membership Council about other areas where a MIG was operational. The MIG allowed people in other organisations to see real time patient records. In Leeds 98% of Practices had signed up to the MIG. The Medical Director commented that from a legal perspective it was better to be in a majority and this was easier from a defence angle.

The Chief Nurse explained about access and consent to records via the MIG. Once Practices had signed up to the MIG, the clinician seeing the Patient would ask permission to view the records at the point of access. The MIG provided an auditable trail of access to patient records.

Discussion took place and the following point were noted:

The CCG would get the latest version of the M<IG (version2)

Major alerts would be included on records

Other professions wishing to add to the records will be sent to the GP as a task.

Community Pharmacists will only be able to access summary care records

Dr S Ball indicated that he would like to ask his Patient Reference Group for their comments on the MIG and sharing of information.

The Lead Service Development Manager explained that it was intended to launch the MIG as part of the I HEART Barnsley launch in 6 weeks’ time. The MIG would require sign off by all Practice Caldicott Guardians. He agreed to email information about the MIG to all practices with a request for all comments to be returned by 31 August 2015.

JB

31.08.15

The Membership Council Agreed:

The proposed data fields to be included in the Detailed Care Record

The proposed list of consuming organisations

The Draft Information Sharing Agreement

MIG documents be circulated to all Practices for information and approval by Practice Caldicott Guardians.

The Membership Council

JB

31.07.15

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Page 10 of 10

Agenda Item


Did not agreed to delegate authority to the CCG to add additional providers to the list of consuming organisations in future (subject to appropriate consultation and engagement with Practices). The Membership Council agreed that they wished to see and agree additional Providers before they were added to the list of consuming organisations.

MC 15/07/08

PRACTICE PRESENTATIONS – HOW CCG DECISIONS AND THE STRATEGIC PLAN IMPACT AT PRACTICE LEVEL

The Chairman extended an opportunity for Practices to show case themselves, present on a common issue, share best practice, innovations, perceptions and or concerns at future meetings of the Membership Council. It was suggested that a brief round the table session – ‘Checking in putting baggage down’ would provide an opportunity for Elected Members to air any issues. These were not to be resolved at the meeting but recorded in the minutes and acted upon accordingly by the CCG outside of the meeting. The BEST Forum as opposed to the Membership Council was also suggested for this purpose.

The Chairman agreed to reflect and maybe trial some of the suggestions.

NB 22.09.15

MC 15/07/09

ANY OTHER BUSINESS

09.1 MENTAL HEALTH COMMISSIONG STRATEGY

The Chief Nurse advised the Membership Council that Practice that all Practice would receive an invitation consultation portal for the Mental Health Commissioning Strategy.

MC 15/07/10

DATE AND TIME OF NEXT MEETING

The next meeting of the Membership Council will be held on Tuesday 22 September 2015 at 7.00 pm in the Boardroom Hillder House, 49/51 Gawber Road, Barnsley, S75 2PY

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Page 1 of 7 S:\BarnsleyCCGLive\CCG Corporate Documentation\Meetings\Governing Body\2015\Public\Meetings\13 Aug\18 - FP Minutes 02 07 15 v3.doc


Minutes of the Meeting of the NHS Barnsley Clinical Commissioning Group FINANCE &

PERFORMANCE COMMITTEE held on Thursday 2 July 2015 at 10.00am in the

Boardroom, Hillder House, 49 – 51 Gawber Road, Barnsley S75 2PY.

PRESENT:

Dr Nick Balac (Chairman) - Chairman of Barnsley CCG

Dr Madhavi Guntamukkala - Elected Member Governing Body

Dr Nick Luscombe - Elected Member Governing Body

Ms Lesley Smith - Chief Officer

Dr John Harban - Elected Member Governing Body

Mr Jim Logan - Membership Council

Mrs Vicky Peverelle - Chief of Corporate Affairs

IN ATTENDANCE:

Mr Neil Lester - Deputy Chief Finance Officer/Finance

Mr Jamie Wike - Head of Planning & Performance

Miss Leanne Burgin (Minutes) - PA to Chief Finance Officer

APOLOGIES:

Miss Heather Wells - Chief Finance Officer

Agenda Item

Note Action

Deadline

FPC15/84 DECLARATIONS OF INTEREST

The declarations of interest report was received and noted by the Committee.

FPC15/85 MINUTES OF THE PREVIOUS MEETING

The minutes of the meeting held on the 4 June 2015 were agreed as a true record of proceedings. Discussion took place in relation to Lorenzo data inputting system at BHNFT and whether data was considered robust. The Head of Planning and Performance reported that BHNFT had now put in place arrangements to validate all information inputs. It was expected that all validation would be complete by the by the end of September. Mr J Logan asked when assurance would be given to the CCG in respect of data quality. The Deputy Chief Finance

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Officer referred to the timeline outlined by the Head of Planning and Performance in respect of the BHNFT Lorenzo system and further stated that the CCG had identified time within the Internal Audit plan for review of data received from all providers which would provide additional assurance. The Chief Officer reported she had recently met with Andrew Liley (CEO of the Academic Health and Science Network) This organisation can offer services to the CCG to reconcile D1 and national data data sources, which the Chief Officer felt would be a very useful piece of work. The costs for the work would be £20,000 but the Academic Health and Science Network would pay £15,000 towards it so would leave a cost of £5,000 for the CCG to pick up. The Committee were in agreement for the Chief Officer to explore this option. Dr J Harban raised the Hospice Grant as there was no longer a Cancer Board for this to feed into. The Chief Officer reported that the CCG were exploring possibilities with the Hospice, to move towards contractual arrangements in line with the NHS Standard Contract instead of a Grant. It was agreed that hospice arrangements should be reported to the Clinical Transformation Board. The Chief Officer indicated that the Hospice was on the agenda for discussion at the September meeting of the Clinical Transformation Board. It was agreed to include an update in September’s report of the Update on Contracting Cycle to the Finance and Performance Committee in relation to the Hospice contractual arrangements.

LS

HW

September

FPC15/86 MATTERS ARISING REPORT

FPC15/61 Integrated Performance Report The Chief of Corporate Affairs reported that discussion had been held with Karen Kelly in regards to Urology Services, including the issue was surrounding clinical support and resilience. The Trust is working with Mid Yorkshire Hospitals NHS Trust and exploring a new arrangement between Barnsley, Sheffield Teaching NHS FT and Mid Yorkshire Hospitals NHS Trust. Assurance on this would be provided to the Quality and Patient Safety Committee. FPC14/181 Any Other Business The Chief Officer reported that a meeting was scheduled with Rotherham CCG for the 12 August.

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FPC15/73 Update on Recent Published and Expected Guidance A question was raised by Dr Harban in respect of provision of support to practices to understand and reconcile payments made to them from NHS England and Barnsley CCG. The Deputy Chief Officer reported that initial discussions with a Practice Manager representative were due to take place in July to develop a response to this issue. It is expected that work would be ongoing over the summer as highlighted by the Chief Finance Officer at the June Committee. FPC15/74 Update on Contracting Cycle The Chief Officer reported she had written to BHNFT Chief Executive outlining the payments related to the core contract and 7 day services and ask how the Trust would deploy the 7 day services transformation support. No report had been received at this point. It was noted that BHNFT were due to meet with NHS England on the 7 July. FPC15/14 Minutes of Children’s and Adults Executive Committee The Chief of Corporate Affairs gave a brief update on the CAMHS review and reported national funding was awaited and this was ongoing transformation work. It was agreed to have a discussion at a future Governing Body Development Session to understand the clinical issues as it was felt there was inconsistencies between practices along with a remedial overview report for CAMHS to understand the clinical issues. FPC/14/118 Major Review – Primary Care Development Group The Chief of Corporate Affairs reported that the tender had been won by Capital Simmons and a written report was expected by September which would then be shared.

NL

BR

VP

July

September

FPC15/87 UPDATE ON RECENT PUBLISHED GUIDANCE

The Deputy Chief Finance Officer presented the report to the Committee updating on recent guidance. It was reported that guidance had been received on how the CCG reported primary care co-commissioning budgets (delegated by NHS England) and the key points to note

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were:

The allocation would be part of the CCG Programme Allocation

However there would not be a requirement to generate an additional surplus relating to this delegated funding. Therefore the CCG required surplus for 2015/16 remains at £8.2m as planned.

In addition the Deputy Chief Finance Officer presented guidance received from Department of Health and NHS England in respect of financial control. These covered, Very Senior Managers Pay, NHS Consultancy spending controls and Month 3 reporting guidance. In relation to the requirements set out in guidance received in relation to Very Senior Managers Pay, it was reported that the Chief of Corporate Affairs would be presenting a paper to the Remuneration Committee later that week for discussion. In relation to NHS Consultancy spending controls, the Chief Officer reported that her paper to the Governing on the 9 July would contain information further information in respect to this. The Deputy Chief Finance Officer highlighted that requirements within month 3 reporting guidance indicated an increased scrutiny across the NHS on consultancy spending.

FPC15/88 UPDATE ON CONTRACTING CYCLE

The Deputy Chief Finance Officer presented a report to the Committee updating them on the contracting cycle. The Chief Officer gave an update in relation to the BHNFT Contract. It was reported that the Trust had contacted NHS England in respect to the contract. NHS England had directed the Trust to the Centre for Effective Dispute Resolution (CEDR), should the Trust deem arbitration to be required. NHS England, however had agreed to meet with the Trust on the 7 July for discussion and an update following this meeting would be given to the CCG which would be picked up at the Governing Body meeting on the 9 July. The Chief Officer clarified that if the Trust considered that a process via CEDR was required, the Trust would need to instigate this, as at present the Chief Officer stated that the CCG considers it has an agreed core contract with the Trust and are fulfilling its obligations by commissioning efficient

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activity and paying for it. In addition, the Chief Officer stated that in respect of 7 day services, the CCG is not considered an outlier in terms of the funding offered. Discussion took place in relation to BMBC re-procuring Weight Management Services. The CCG has requested a funding transfer from BMBC in order to secure procurement of Tier 3 Weight Management Services. Work is ongoing between BMBC and CCG to resolve these issues. The Chief Officer reported on the current position in respect of Assistive Technology and highlighted that agreement with NHS England had been reached in relation to funding £85,000 initially, to enable NHS England to agree a contract with BHNFT. A response from BHNFT to NHS England’s offer was not known at the meeting.

FPC15/89 INTEGRATED PERFORMANCE REPORT

The Deputy Chief Finance Officer gave an update from the IPR report in terms of finance and it was noted that the CCG projected delivery of all financial duties, preciated on successful delivery of an in-year QIPP programme to mitigate in-year risks Mr J Logan questioned how the CCG could be assured on the QIPP programme and how we will meet this requirement. The Chair indicated that the CCG had a workstream around QIPP surrounding 5 areas. The approach is clinically-led and supported via the Service Development Team. The programme will be closely monitored through Management Team on a weekly basis and reporting on delivery would form part of the Integrated Performance Report in future. The Head of Planning and Performance gave an update in relation to performance on the IPR and it was reported that RTT standards had been achieved for May. A&E 4 hour target had improved to 95.01% and the Red 1 for YAS was achieving 76.6% for the year to date and 81% in May which is above the target 75% target for year to date. There had been significant numbers in delays in ambulance handovers and discussions were being held between BHNFT and YAS relating to this issue. It was noted that cancer had fallen below target for April with 3 out of 20 patients waiting more than 31 days for diagnosis. It was reported that CDiff was also above the trajectory for May with 6 patients recorded for Barnsley and this would be followed up through the Quality and Patient Safety Committee.

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The Chief of Corporate Affairs reported that 52 weeks had been breached due to 1 patient waiting in excess of this time and further information on this had been requested.

FPC15/90 ASSURANCE FRAMEWORK

The Chief of Corporate Affairs reported that there were 2 Red risks relating to the Finance and Performance Committee and indicated that all had been reworded and increased how these risks would be monitored.

FPC15/91 RISK REGISTER

The Chief of Corporate Affairs reported that herself and the Chief Finance Officer had done a review of the Risk Register and indicated a number of risks that it was recommending could be removed. The Committee approved the risks to be removed. It was noted that there were currently 2 red risks on the register, YAS and 6 weeks diagnostics. It had been previously agreed to leave the 6 weeks diagnostics on the register until a sustained improvement was made. The Chief of Corporate Affairs felt that the risk could be lowered after 3 months of sustained improvements. The Head of Planning and Performance reported that 3 months of data had now been reviewed and performance had been sustained for this period. It was suggested that if performance was achieved for June the scoring be changed to a 3 by 3. The Committee were in agreement with this approach.

VP

FPC15/92 MINUTES OF THE BHNFT CONTRACT MANAGEMENT BOARD

There had been no meetings held.

FPC15/93 MINUTES OF THE CCG & SWYPFT 2015/16 CONTRACT NEGOTIATION MEETING


FPC15/94 MINUTES OF THE SWYPFT CONTRACT MANAGEMENT BOARD


FPC15/95 JOINT COMMISSIONING MINUTES

The notes of the adult Joint Commissioning Group Meetings held on the 28 April and 16 June were received and noted

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by the Committee.

FPC15/96 FINANCE AND PERFORMANCE COMMITTEE TERMS OF REFERENCE

The Terms of Reference for the Finance and Performance Committee were agreed by the Committee.

FPC15/9 ANY OTHER BUSINESS

There was no other business.

FPC15/97 DATE AND TIME OF NEXT MEETING

The next meeting of the Finance and Performance Committee will be held at 10.00am on Thursday 3 September 2015 in the Boardroom at Hillder House.

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Page 1 of 4


GOVERNING BODY

13 August 2015

Primary Care Commissioning Committee Assurance Report


Provide the Governing Body with the highlights of the July Primary Care Commissioning Committee meeting.


ASSURANCE FRAMEWORK & RISK REGISTER The Committee were informed that the risk register had been updated to reflect the risks relating to the Brierley and Shafton Practice. It was also proposed and agreed that the risks associated if the Barnsley area continues to experience a lack of GPs in comparison with the national average, due to GP retirements, inability to recruit etc. should be transferred to the Governing Body risk register. FRIENDS AND FAMILY TEST (FFT) The Committee received a report updating on the Friends and Family Test which has been undertaken in GP Practices for the last 6 months. The requirements are for GP practices, to give all patients the opportunity to feedback, to submit the data nationally and to publish the data locally. There have been a number of issues including no submission of data, concerns about data quality and incorrect data submitted. As a consequence a number of remedial breach notices have been issued to practices in South Yorkshire and Bassetlaw including 3 in Barnsley. The FFT data collection is required from all GP practices on an on-going monthly basis and the results will be analysed for compliance and trends. Practices will be supported to ensure FFT is embedded however remedial action will be taken if there is a failure to comply. PROCUREMENT UPDATE Lundwood and Highgate The Lundwood and Highgate procurement were progressing although timescales had slipped as a result of approval processes within NHS England which had just been received. It was proposed and agreed that the existing contract be extended to 31 March 2016 to allow sufficient time for the contract to be re-procured at a reasonable pace. It was acknowledged that the contract extension

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Page 2 of 4

value would need to be at the current rate otherwise it would be deemed to be a new contract under procurement law. Brierley Practice The Committee were updated on the provision of GP services at Brierley Medical Centre practice premises in Shafton and Brierley. Following the 24-hour notice period provided to the occupants of Shafton Health Centre, the CCG has been working with colleagues in NHS England and the service providers Sheffield Health and Social Care NHS Foundation Trust, to ensure there is a there is a continuation of healthcare services for patients. Services have continued to be offered to all patients from the main practice site in Brierley. The team has been monitoring clinic capacity and whilst they have seen an increase, there are still clinics with available appointments and the service continues to run as before. The team are continuing to collect patient feedback during this time and are responding accordingly. Following the first letter to patients, approximately 100 patients have chosen to register with the other local GP practices including the one in Shafton. The Committee were informed that the premises at the Brierley site had been put up for sale by receivers and as part of this process a closing date for bids had been set at the 30 July. The CCG wait to hear the outcome of this process and until that detail is clarified we are unable to consider next steps. Independent of the premises issue, the contract for GP services was due to be reviewed. The CCG/NHSE has now written to patients, as part of the contract review process, to gain their views on three commissioning options. These are:

a. Commission (or purchase) services in Brierley and Shafton to ensure that services continue to be provided in both localities

b. Commission services at Brierley only and permanently close the provision at Shafton

c. Patients register with neighbouring practices and the practices at Brierley

and Shafton close People are able to feedback via a questionnaire, online or paper version and three drop-in sessions have also been arranged, one in Shafton and two in Brierley, for people to feedback on a 1-1 basis. CQC UPDATE The Committee received a report detailing progress with the two practices receiving inadequate reports from the CQC. Follow up visits were undertaken to both practices on the 2 July by the Contract Manager at NHS England and the Head of Quality for Primary Care Commissioning at the CCG and both practices had subsequently been sent a detailed letter outlining progress and further action required.

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The Committee noted that the CQC final follow up visits will be undertaken after 6 months and requested proposals through the primary care workstream on how the CCG would offer on-going support and assurance to practices once the practices are “signed-off” by CQC.


Note the report


5 minutes.

Report of: Chris Millington

Designation: Chair of the Primary Care Commissioning Committee

Report Prepared by:

Jon Holliday

Designation: Lead Commissioning and Transformation Manager

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The report is particularly relevant to risks 1.2, 1.4, 2.1 and 5.2










Quality





Human Resources

As this report is for information only, all areas within the governance arrangements checklist are not relevant.

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QPSC Minutes 2015.06.25 Page 1 of 10


Minutes of a Meeting of the NHS Barnsley Clinical Commissioning Group

QUALITY & PATIENT SAFETY COMMITTEE Thursday 25 June 2015, 11:30

Room 1, Hillder House

PRESENT:

Dr Mehrban Ghani (Chair) - Medical Director Dr Mark Smith - Elected Practice Member Representative

Contracting Lead from the Governing Body Karen Martin Chris Millington Mike Simms

- - -

Head of Patient Safety/Deputy Chief Nurse Lay Member for Public and Patient Engagement Secondary Care Doctor

Brigid Reid Chris Lawson

- -

Chief Nurse & Caldicott Guardian Head of Medicines Optimisation

IN ATTENDANCE:

Gill Pepper Sharon Galvin Andrea Parkin

- - -

Designated Nurse Adult Safeguarding & Patient Experience Designated Nurse Safeguarding Children Nurse Fellow ANP

Richard Walker - Head of Assurance Amanda Lindley (minutes)

-

Quality Manager

APOLOGIES:

Dr Mohammed Kadarsha Dr Mohammed Ali

- -

Membership Council Elected Practice Member Representative Membership Council Member as clinical advisor

Dr Sudhagar Krishnasamy Richard Staniforth

- -

Secondary Care Doctor, Governing Body Elected Practice Member Representative Commissioning Lead from the Governing Body Lead Pharmacist

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Agenda Item

Note

Action

Deadline

QPSC 25/06/01

INTRODUCTIONS & APOLOGIES

The Chief Nurse opened and chaired the meeting in the temporary absence of the Medical Director. Introductions were made and apologies were noted.

QPSC 25/06/02

DECLARATIONS OF INTEREST RELEVANT TO THE AGENDA

There were no declarations of interest relevant to the agenda.

QPSC 25/06/03

PATIENT STORY

A patient story was presented. The story described the experience of a lady whose elderly mother had utilised the Pharmacy First Service. They had been advised of the service by their GP Practice when asking for a GP appointment. They had found the service to be positive. The location was accessible, the local Chemist was very helpful and they received the required medication free of charge. Views and thoughts were shared by the Committee. It was felt the scheme is very positive. It was agreed further improvements can be made in relation to brokering the relationships between the GP Practices and Chemists. Strategies were discussed, particularly where Locum Pharmacists are being used. The Designated Nurse Safeguarding Adults & Patient Experience is to further progress the brokerage between GP Practices and Pharmacists.

GP

13/8/15

QPSC 25/06/04

MINUTES OF THE PREVIOUS MEETING 30/4/15

The minutes of the previous meeting were agreed as a true and accurate record.

QPSC 25/06/05

MATTERS ARISING REPORT FROM 30/4/15

Report tabled and actions all populated prior to the meeting. Items by exception are;

30/04/13 – Violent Patient Scheme The Committee requested an update on the Violent Patient Scheme. KM to provide an update at the July’s QPSC meeting

KM

10/7/15

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Agenda Item

Note

Action

Deadline

30/04/17 – JAG site Accreditation – Private Hospital NHS England are to be made aware.

KM

10/7/15

QUALITY AND GOVERNANCE

QPSC 25/06/10

CCG ANNOUNCED CLINICAL VISTS

The Committee noted the schedule for quality assurance visits for 2015/16. The Medical Director discussed the recent serious incidents involving Radiology. It was agreed to use a pathway approach when undertaking the General Surgery announced visit, which would cover Radiological aspects of the patient pathway. In respect of SWYPFT Terms of Reference (TOR), the Quality Manager confirmed that the SWYPFT Deputy Director of Nursing, has verbally agreed the TOR. However SWYPFT to escalate TOR via their governance arrangements. The Committee approved the SWYPFT TOR. Post Meeting Note See Appendix A – Letter from SWYPFT, Director of Nursing regarding SWYPFT’s quality assurance visits.

The Medical Director joined and chaired the meeting from this point and the Deputy Chief Nurse also joined the meeting at this point.

QPSC 25/06/07

KIRKUP REPORT – MORECAMBE BAY INVESTIGATION

The Chief Nurse gave the background to the report and summarised the findings. The CCG visited the Barnsley Maternity Unit in December 2013. The visit was positive and since then a new Birthing Suite has opened with excellent facilities. Healthwatch have shared with the CCG the positive comments regarding the Birthing Suite.

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Agenda Item

Note

Action

Deadline

Over the past year there has been one serious incident declared relating to the Birthing Unit. The serious incident investigation found no areas reflected in the incident that were identified in the Kirkup Report. A more recent serious incident has been logged but the full serious incident report and root cause analysis are awaited. The Chair confirmed that he felt re-assured by the gap analysis provided by BHNFT following the Kirkup Report. The Chair is to correspond with the BHNFT Medical Director regarding the working relationships between the Medical Team and Midwives. The Chief Nurse agreed to request and review a sample of incidents (not classed as serious) reports from BHNFT. Health Education England are to undertake routine quality monitoring at BHNFT in October 2015. Obstetrics & Gynaecology is one of the specialist areas to be visited.

Post meeting update.

The Chair has contacted the BHNFT Medical Director and discussed the relationship between Midwifes and Medical Staff at the Birthing Centre and there are no concerns in relation to this working relationship.

MG BR

10/7/15

10/7/15

The Designated Nurse for Safeguarding Children joined the meeting at this point

QPSC 25/06/06

CQC CHILDRENS SERVICE INSPECTION – HEALTH IMPROVEMENT PLAN

The paper was presented. It was explained that the CCG actions within the report will be reported by exception to the QPSC. The Chief Nurse drew attention to the positive comments within the report. The Chair identified that there is a need to raise the School Nurse Public Health profile. The Chief Nurse confirmed there is a review of the School Nursing Service (0-19 pathway re procurement) and stakeholders are encouraged to give feedback.

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Agenda Item

Note

Action

Deadline

The Safeguarding Children Designated Nurse explained her involvement in the 0-19 Pathway Procurement. The Children and Young People Trust Executive Commissioning Group have oversight of this process. Public Health are the commissioners. The Chief Nurse confirmed the CCG will also be doing a formal response to the review.

SG

BR

10/7/15

27/7/15

The Head of Medicines Optimisation joined the meeting at this point.

QPSC 25/06/08

SAFEGUARDING ADULTS – INTERNAL AUDIT REPORT

The paper was presented. It was identified that there are broader safeguarding considerations relating to partners and input is needed to galvanise actions. This is around thresholds for safeguarding referrals. The Chief Nurse expanded that the CCG Safeguarding Adults & Patient Experience role is having a positive impact.

QPSC 25/06/11

INFECTION PREVENTION AND CONTROL (IPC) UPDATE

The Deputy Chief Nurse confirmed that discussions are progressing well with Infection Prevention Solutions (IPS). They already provide an IPC service to three CCG’s in the south. The Chief Nurse confirmed they had met with IPS on the 24 June 2015 and good progress had been made. The Chief Nurse was assured that IPS were able to deliver the CCG’s vision for Infection Prevention and Control. SWYPFT are covering the service until 30 September 2015 and discussions are ongoing with SWYPFT regarding extended cover if required.

QPSC 25/06/09

MONTHLY PATIENT SAFETY REPORT

The Deputy Chief Nurse presented the report, which included an Infection Control deep dive. The performance on achieving no MRSA bacteraemia cases was commended.

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Agenda Item

Note

Action

Deadline

The TB Service is to be tied into the review of the Respiratory Service and the Lead Service Development Manager is taking this forward in the CCG. Prescribing issues are to be taken forward by the Local Pharmacy Committee. The CCG has met with contracting leads at SWYT and agreed the specification; concerns have been raised in relation to prescriptions for TB medications, blood tests and associated costs. A secondary concern has been raised as patients who have TB should be obtaining drugs free of charge. Discussions are going through the Area Prescribing Committee. A meeting will be arranged with CCG Commissioners, Public health, LA, Public Health England, SWYT and BHNFT to discuss future service delivery.

QPSC 25/06/12

IPC ANNUAL REPORT 2014-15

The Deputy Chief Nurse presented the report. The Chief Nurse commended her work in this area.

QPSC 25/06/13

PRIMARY CARE CO-COMMISSIONING – HIGHLIGHT REPORT ( STANDING ITEM )

The background to this new committee was given. The two poor CQC rated GP practices were discussed. A remedial breach to the GMS contract has been issued and NHS England are aware. CCG support is being provided and the Royal College of GP’s are also supporting these Practices. The committee commended the two practices that have been rated as outstanding and the other thirteen out of fifteen which were rated good.

QPSC 25/06/14

QUALITY SURVIELANCE GROUP -SUMMARY

The Chief Nurse provided an overview of key areas covered at Quality Surveillance Group (QSG). The Kirkup report was covered. Transforming Care – this work stream resulted from the Winterbourne report. It involves the review of people with complex Learning Disabilities and their place of care. Barnsley has four people placed in care settings that this work relates to. There is national work ongoing regarding the availability of appropriate step up and step down services.

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Agenda Item

Note

Action

Deadline

Female Genital Mutilation – work is ongoing within the CCG led by the Designated Nurse for Safeguarding Children.

QPSC 25/06/15

RISK REGISTER & ASSURANCE FRAMEWORK (STANDING ITEM)

The Head of Assurance explained that a meeting had been held with the Chief Nurse and Quality Manager and a review of the existing risks had been undertaken. The Committee agreed in light of this, to consider the proposed amended risks at the July QPSC.

COMMITTEE REPORTS AND MINUTES GENERAL

QPSC 25/06/16

MINUTES OF THE AREA PRESCRIBING COMMITTEE 11/3/15 & 15/4/15

The minutes were received and noted by the Committee. Two areas of note were highlighted, these were good progress on anti-microbials and in relation to testosterone all are now on shared care protocols. The success was noted.

QPSC 25/06/17

MINUTES OF THE QUALITY & COST EFFECTIVE PRESCRIBING GROUP - 7/05/15

The minutes were received and noted by the Committee.

QPSC 25/06/18

MINUTES OF THE QUALITY & PERFORMANCE MEETINGS (BHNFT & SWYPFT) 3/3/15 & 27/3/15


QPSC 25/06/19

MINUTES OF THE CQUINS MEETING 25/3/15


QPSC 25/06/20

MINUTES OF THE CLINICAL ACCREDITATION PANEL 30/4/15


GB/Pu/15/08/20


Agenda Item

Note

Action

Deadline

QPSC 25/06/21

MINUTES OF THE POST INFECTION REVIEW GROUP (PIR) MEETING 3/3/15 & 7/4/15


QPSC 25/06/22

MINUTES OF THE OUT OF HOURS CONTRACT MEETING 28/4/15


GENERAL

QPSC 15/03/23

ISSUES FOR ESCALATION TO THE GOVERNING BODY AND ITEMS TO BE COVERED IN THE HIGHLIGHT REPORT

The Committee agreed the following areas for inclusion in the Quality Highlights Report to the July Governing Body:

Kirkup Report - Amber

CQC Primary Care - Amber

Safeguarding Adults – Green

IPC Annual Report – Green

Testosterone Shared care – Green.

BR/AL

30/6/15

QPSC 15/03/24

ANY OTHER BUSINESS

No any other business items were raised.

QPSC 15/03/25

DATE AND TIME OF THE NEXT MEETING

The next meeting is scheduled for Thursday 23 July 2015, 13:00 – 15:00, Hillder House, Boardroom.

GB/Pu/15/08/20


Appendix A Tim Breedon

Director of Nursing,

Clinical Governance & Safety

Fieldhead Hospital

Ouchthorpe Lane

Wakefield

WF1 3SP

Tel: 01924 327017

3rd July 2015 Email: [email protected]

Dear Amanda,

Clinically Led Quality Assurance Visits to South West Yorkshire Partnership NHS Foundation Trust (SWYPFT)

Thank you for sending me the above guidelines for comment.

As you will know SWYPT prides itself on being honest, open and transparent and we are committed to working effectively with our CCG partners to ensure continual quality improvement.

Therefore, in principle we welcome the proposal for clinically led quality visits. As mentioned I did share with the Trust EMT and senior staff for comments and suggestions and I would like to share with you some of our existing processes for quality assurance visits.

In addition to external CQC and MHA visits, we currently have an internal process of mock CQC inspections, where a team of senior internal staff (external to the service being inspected) assess our services against both the CQC essential standards and the Trust’s seven quality priorities. Visits cover both wards/units and community teams and we conducted 49 such inspections in 2014-15 highlighting examples of outstanding practice and some areas requiring development. Commissioners from partner CCGs have joined these inspections and gained a detailed insight into the services we provide and the quality of care and treatment delivered. Likewise we would be happy for commissioners from Barnsley CCG to join any of the 10 visits planned for our Barnsley services in 2015-16.

GB/Pu/15/08/20


The Trust also implemented the 15 Step Programme across all wards in 2014/15. This is a more open and less intensive approach than the mock CQC visits and is based on the first impressions given by our services. The 15 steps challenge was developed by the NHS Institute for Development and Improvement and not only did this help us to identify some really positive practices in our services - but also some areas that we can and will be building on in the future. The 15 steps challenge is not intended to evaluate the quality of care provided - rather it is an opportunity to take a step back and look at what impressions our services give to people when they first visit.

Commissioners from partner CCGs have participated in the challenges and again Barnsley CCG commissioners would be very welcome to join us in the future.

In summary, we welcome your proposals for quality visits but we also wondered if you would like to participate in our mock CQC visits and/or 15-step challenges as an alternative or in addition to planned quality visits. Please let me know.

Please do not hesitate to contact me if you wish to discuss further and I look forward to hear more about your plans going forward.

Yours sincerely

Tim Breedon

Director of Nursing, Clinical Governance & Safety

GB/Pu/15/08/21 q

Page 1 of 9


Minutes of the Meeting of the PATIENT AND PUBLIC ENGAGEMENT COMMITTEE held on Thursday 16 July 2015 at 12:30pm in Boardroom, Hillder House, Gawber Road, Barnsley, S75 2PY. PRESENT: Mr Chris Millington Lay Member for Patient and Public Engagement Ms Marie Hoyle Practice Manager Governing Body Member Dr Lawrence King Elected Member Ms Brigid Reid Chief Nurse Dr Mike Simms Secondary Care Clinician Ms Kirsty Waknell Communications and Engagement Manager (from

minute reference PPE 15/07/04) IN ATTENDANCE: Mrs Emma Bradshaw Engagement Manager CSU Ms Kay Morgan Governing Body Secretary Mr Richard Walker Head of Assurance APOLOGIES: Dr Nick Balac Chairman Ms Vicky Peverelle Chief of Corporate Affairs Mrs Lesley Smith Chief Officer

Agenda Item

Note

Action

Deadline

PPE 15/07/01

DECLARATIONS OF INTEREST RELEVANT TO THE AGENDA

The Committee considered the Declarations of Interest Report. No further declarations interests were received.

PPE 15/07/02

MINUTES OF THE PREVIOUS MEETING HELD ON 19 MARCH 2015

The minutes of the previous meeting held on 19 March 2015 were verified as a correct record of the proceedings subject to the following amendment:

Meeting Attendance/Apologies Ms Brigid Reid, Chief Nurse tendered her apologies for the meeting.

Minute reference PPE 15/03/03 – Minutes of the

GB/Pu/15/08/21 q

Page 2 of 9

Agenda Item

Note

Action

Deadline

Previous Meeting Second sentence – typographical error removal of the word ‘the’.

Minute reference PPE 15/03/04 & PPE 15/01/12 – Federation and Patient Groups

Typographical error correction of spelling to Mr Jon Holliday.

PPE 15/07/03

MATTERS ARISING REPORT

The Committee noted the Matters Arising Report and actions denoted as complete. The following issues were raised :

Minute Reference PPE 15/03/04 & PPE 15/01/12 – Federation and Patient Reference Groups It was reported that the Federation were to undertake engagement work with the PRG’s in relation the I HEART Barnsley service ‘Hubs’. It was noted that a PRG event had been held on 3 June 2015 including a workshop on I HEART Barnsley. The event had been inclusive of all PRGs on a borough wide basis.

Minute Reference PPE 15/03/05 – Minutes of the Patient Council Meetings The Communications and Engagement Manager reported that an action to provide information to practices about Sound Doctor was complete.

Minute Reference PPE 15/03/07 – PPE Annual Report

The Committee Chair commented that the next challenge for PPE would be around I HEART Barnsley. The Engagement Manager CSU agreed to provide feedback from an initial Report about I HEART Barnsley (by Mr James Barker Lead Service Development Manager) to the next meeting of the Committee on 3 September 2015.

EB

03.09.15

COMMITTEE REPORTS AND MINUTES

GB/Pu/15/08/21 q

Page 3 of 9

Agenda Item

Note

Action

Deadline

PPE 15/07/04

MINUTES OF THE PATIENT COUNCIL MEETINGS

The Committee considered the Minutes of the Patient Council held on 25 March 2015, 29 April 2015 and 20 May 2015. Discussion took place and the following main points were noted:

The Charter for the Patient Council is under review. It was suggested that the remit and function of the Patient Council would be as a patient listening mechanism.

The Chief Nurse commented that it was important to triangulate intelligence and establish linkages between information. Engagement is ‘an active process when the CCG decided that it required information’, generally a formal engagement process

10 to 15 members attended each meeting of the Patient Council and members fed back information to other related groups.

The Chief Nurse would provide input to the Patient Council Charter.

It was noted the Chief Nurse will attend the next meeting of Patient Council 19 July 2015 to present an update on Quality.

The Committee noted the Minutes of the Patient Council.

ENGAGEMENT ITEMS

PPE 15/07/05

TERMS OF REFERENCE

The Committee considered and approved the Terms of Reference for the Patient and Public Engagement Committee subject to the following amendment:

Section 7 Administration

7.1 – replace Public and Engagement Manager with Governance Assurance and Engagement Facilitator.

Section 9 Code of Conduct

KM/LR

03.09.15

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Page 4 of 9

Agenda Item

Note

Action

Deadline

9.1 replace Conflicts of Interests Policy with Standards of Business Conduct, Managing Conflicts of Interest and the Acceptance of Gifts and Hospitality Policy.

KM/LR

03.09.15

PPE 15/07/06

PRG PROJECT REPORT

The Communications and Engagement Manager introduced her report providing assurance to the Committee on the results and conclusions of the Patient Reference Group Development Project. The overall picture was positive, new PRG groups had been formed and where no groups existed Practices were promoting alternative ways of engagement.

Members attention was drawn to appendix 1 of the report, a table showing Practice sign up to the DES in 2013/14 and 2014/15 and also Practice establishment of a PRG in 2013/14. The requirement for Practices to establish a PRG Group was included in the Practice Delivery Agreement (PDA). It was noted that the Care Quality Commission were now including questions on PRGs during Practice Inspections.

The Engagement Manager CSU informed the meeting that a PRG event held in National Patient Participation Week on 3 June 2015 had been well attended. It was noted that there was a huge potential for the PRG Groups to deliver something collectively on borough wide issues.

The Communications and Engagement Manager highlighted that the CCG had invested in the PRG project and accompanying workload. She stressed that going forward there was still plenty of scope for further development with PRGs and it was important for this work not to be tagged onto a member of staffs day job. Practice Managers were currently being supported with PRGs by the CCGs Governance Assurance and Engagement Facilitator but that this member of staff did not have capacity to allocate a significant amount of time to develop the PRG Project. .

Discussion took place and the following points were noted:

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Page 5 of 9

Agenda Item

Note

Action

Deadline

The Chief Nurse put forward that a vibrant PRG would wish to the attend Patient Council which provided a route for PRGs to operate more widely. A further piece of work was required to unlock barriers and progress this work. The Engagement Manager CSU commented that people attending the PRG event had indicated their willingness to attend similar events/meetings.

It was suggested that there may be a duplication of work between the Patient Council and PRGs. PRGS appeared to be relatively active groups in comparison to the role of the Patient Council.

Where practices were unable to have actual PRG meetings then virtual meetings could be created with support from the CCG.

In response to questions raised about diversity in PRGs it was reported that one particular Group, supported by a Practice Manager had worked hard to attract all age groups using social media in particular face book. It was important to get demographic diversity on PRGS groups

The Committee noted the PRG Project Report and agreed the following actions:

To consider including a role to develop PRG Groups in a CCG Officers job description.

The development of PRG Groups to be added to the PPE Action Plan.

The action plan from the PRG event to be finalised and sent to the PPE Committee Chair for approval

The Head of Quality for Commissioning Primary Care Medical Services to inform Practices that the Care Quality Commission would ask questions on PRGs when undertaking Practice Inspection Visits.

CM

KW

EB

BR (KM)

03.09.15

03.09.15

03.09.15

PPE 15/07/07

2015/16 ENGAGEMENT ACTION PLAN

The Committee considered the 2015/16 Engagement Action Plan. The Engagement Manager CSU explained that the action plan was a live document and therefore subject to frequent change. The action plan included

GB/Pu/15/08/21 q

Page 6 of 9

Agenda Item

Note

Action

Deadline

individual engagement activities that were over and above the structure work and provided assurance to the Committee about the range of engagement work being undertaken. A top line update will be submitted to the next meeting of the PPE Committee on 3 September 2015.

It was noted that action plan did not capture:

The Mental Health Integrated Personalised Commissioning

Engagement that the CCG was contributing to but not leading such as 0.19 Healthy Child Pathway.

The Practice Delivery Agreement (PDA) and commissioning of Primary Care.

It was suggested that the action plan be submitted to the Clinical Transformation Board to ensure triangulation of work.

The Communications and Engagement Manager reported that Chief of Corporate Affairs was to discuss Engagement Hubs with Wendy Lowder, Directorate of Communities BMBC. It was also queried if the PPE Strategy mapped to the themes in the Engagement Action Plan and suggested that internal audit be commissioned to review and measure engagement against the Strategy.

The Committee noted the 2015/16 Engagement Action Plan. Agreed Actions:

The 2015/16 Engagement Action Plan to be a standing agenda item at each meeting of the Committee.

To circulate the updated Engagement Action Plan to members of the PPE Committee for comment on content and format

LR

EB

03.09.15

31.08.15

PPE 15/07/08

DRAFT SELF ASSESSMENT CHECKLIST

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Page 7 of 9

Agenda Item

Note

Action

Deadline

The Head of Assurance introduced his report which provided the Committee with a self-assessment checklist in order for members to assess their effectiveness as a Committee. The Head of Assurance explained that it was good practice for committees to reflect on their effectiveness. As a starting point, the draft check list provided in his report had been taken from the Audit Committee Checklist.

The Committee consider the self-assessment and concluded that the content should be tailored to the PPE Committee, be simple language and fit for purpose.

The Chief Nurse advised that the Committee had new members and had not met for a while, she further suggested that it may be more appropriate for the self-assessment to be completed in a couple of more meetings time. The Communications and Engagement Manager indicated that she was happy to induct any new members to the PPE Committee.

The Committee noted the Draft Self-Assessment Checklist: Agreed actions:

To amend the checklist to reflect the comments provided by the Committee

To circulate and request completion of the self-assessment to PPE Committee members

PPE Committee members to complete the self-assessment

Submit results of self-assessment to the next meeting of the PPE Committee on 3 September 2015.

KW/RW

KW/RW

ALL

KW/RW

31.07.15

31.07.15

03.09.15

03.09.15

QUALITY GOVERNANCE

PPE 15/07/09

CCG RISK REGISTER AND ASSURANCE FRAMEWORK

The Head of Assurance presented the Corporate Risk Register and Assurance Framework. The Committee noted the one risk on each of the CCG’s Assurance Framework and Risk Register for which the Committee are responsible for managing. The Communications and Engagement Manager indicated that now the CCG

GB/Pu/15/08/21 q

Page 8 of 9

Agenda Item

Note

Action

Deadline

was undertaking delegated Primary Care Commissioning of General Medical Services there would be risks associated with this for PPE.

The Committee noted the Risk Register and Assurance Framework Report. Agreed Actions

To consider the risks for PPE in relation to the CCG and Primary Care Commissioning.

RW/KW

PPE 15/07/10

ANY OTHER BUSINESS

10.1 CQC Inspection BHNFT

The Chief Nurse expressed concern that although the CQC inspection visit to the BHNFT was promoted and members of the public invited to join consultation, only 6 members of the public attended the consultation event.

10.2 OPEN

The Committee Chair reported that he had set a personal target to increase the numbers of OPEN members from approximately 180 to 500 members. The Engagement Manager CSU advised that adequate resources in terms of staffing, capacity and funding would be required to make this a reality.

The objective of the OPEN network was queried as the currently this resource was not being utilised to its full potential and or developed as originally intended. The Engagement Manager CSU commented that other CCGs produced reports on engagement activity and that she would share this with the Committee.

EB

The Chief Nurse commented that there were 3 things to address in terms of OPEN:

What information was being sent out to the OPEN Network

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Page 9 of 9

Agenda Item

Note

Action

Deadline

Ask OPEN members what information they would like to see more or less of

Determine and ask if PRG members were in OPEN and if not why not.

10.3 Patient Partner System

The Committee Chair indicated that although substantial investment had been made in the Patient Partner System, Patients did not appear happy with the system. It was noted that from initial evaluation when practices embraced Patient Partner the system worked well. The system had help reduce DNA’s in some Practices.

The Practice Manager commented that the system could be used to address capacity if promoted and signposted corporately. In terms of actions by the Committee, the Communications and Engagement Manager advised that plans were in place to for Practices and patients to engage with the system.

At present there was nothing to base a positive view on the investment return, outcomes and benefits from the Patient Partner System; this had also been noted by the Clinical Transformation Board.

Agreed Actions

To include engagement around the Patient Partner System on the 2015/16 Engagement Action Plan.

KW

PPE 15/07/11

DATE AND TIME OF THE NEXT MEETING

The next meeting of the Patient and Public Engagement Committee will be held on 3 September 2015 at 2.00pm in the Boardroom, Hillder House.

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1

Minutes of a Meeting of the NHS Barnsley Clinical Commissioning Group

EQUALITY STEERING GROUP held on Thursday 16 July 2015 3 pm to 5pm

Boardroom at Hillder House, Barnsley PRESENT: Brigid Reid - Chief Nurse, Barnsley CCG (Chair)

Marie Hoyle - Governing Body Member, Practice Manager (Deputy

Chair)

Dr Lawrence King

- Governing Body Member, Barnsley CCG

Elaine Barnes - Equality & Diversity Manager , Yorkshire and Humber

Commissioning Support

Dr Saxena - Membership Council Member

Kirsty Waknell

- Communication and Engagement Manager, Yorkshire

and Humber Commissioning Support

Mike Smith - HR Manager, Yorkshire and Humber Commissioning

Support

Carrianne Stones - Health Watch Barnsley

Patrick Otway - Commissioning Manager, Mental Health, Children’s and Specialised Services, Barnsley CCG

Richard Walker - Head of Assurance, Barnsley CCG

IN ATTENDANCE Carol Williams

- Executive PA to Brigid Reid, Chief Nurse (Minute Taker)

APOLOGIES: Chris Millington - Governing Body Lay Member for Public & Patient

Engagement, Barnsley CCG

GB/Pu/15/08/22


2

Agenda

Item

Note

Action

Deadline

ESG 15/07/01

WELCOME/APOLOGIES/QUORACY/ DECLARATIONS OF INTEREST

Apologies received as above. The Chair invited declarations of interest relevant to the agenda. The Chair thanked the Deputy Chair for covering during their absence and welcomed new members from the Governing Body and Y&H Commissioning Unit. The new Governing Body Lay Member for Public & Patient Engagement had sent apologies. For the benefit of new committee members The Chair confirmed the Equality Steering Group is a sub-committee of the Governing Body which provides the Governing Body with the Annual Report and assurance that Barnsley CCG complied with Equality legislations. The Chair reminded the committee of the core values of the CCG.

ESG 15/07/02

PATIENT STORY

The patient story was about the experience of a patient with impaired hearing when a BSL interpreter was not booked for their GP consultation Discussions took place around the story and the issues that it raised

An interpreter not being booked is a single point of failure.

Practices do not offer similar services due to different resources and time constraints

BSL interpreters costs are met, so this should not be a barrier for practices

Opportunity for Practices to learn from each other.

GB/Pu/15/08/22


3

Agenda

Item

Note

Action

Deadline

Deputy Chair to speak to Practice Managers (PM) Group about reasonable adjustments that if a BSL interpreter is required a double appointment slot is automatically booked. Equality & Diversity Manager to link Deputy Chair with Healthdeafinitions for additional support.

The Chair highlighted the proposal of the ‘This is Me’ document which allows patients to share information about them in a dignified way. Communications and Engagement Manager to link with Gill Pepper to check local progress with providers of ‘This is Me’ for this to come alive for the BSL community.

Equality & Diversity Manager to work with the HR Manager to write up an employee story for the next meeting.

MH

MH/EB

KW

EB/MS

Next PM meeting

31.8.15

29.10.15

29.10.15

ESG 15/07/03

MINUTES FROM THE PREVIOUS MEETING HELD ON 8 JANUARY 2015

The minutes of the previous meeting held on 8 January 2015 were agreed as an accurate record.

ESG 15/07/04

MATTERS ARISING REPORT FROM 8 JANUARY AND 16 APRIL 2015 MEETING

EDSG 14/37 Provider Reporting KPIs – A&E Attendance

The Commissioning Manager stated that the EDS2 end of year report from BHNFT will be reviewed with the Equality & Diversity Manager to note any improvement.

PO/EB

29.10.15

EDSG 15/01/05 British Sign Language (BSL) Interpreting Contract

KPIs in relation to Primary Care access now incorporated in the SWYPFT contract.

GB/Pu/15/08/22


4

Agenda

Item

Note

Action

Deadline

Commissioning Manager to receive interim report after 6 months to assess any improvement from current base line. The Commissioning Manager and Equality & Diversity Manager to provide brief summary to re-clarify to Practices how to book an interpreter. Deputy Chair to agree document prior to circulation. The Communication and Engagement Manager is to ensure that I HEART Barnsley have considered interpreter access in their delivery model.

PO

PO/EB/MH

KW

Jan 16

31.8.15

31.8.15

15/01/13 Mutual Patient & Public Involvement

GP’s were advising patients from the Immigrant, Asylum Seeker and Refugee communities to access treatment at the Kakoty practice, when they could have registered at any of the practices in their local area instead of having to travel. The Healthwatch representative stated that there was a need to gather more evidence that this was still the case and 360 Engagement would do this once their contract was finalised. Health Integration Team was next door to the Kakoty Practice and reminded patients that they had the choice to register elsewhere and were assisting in making this a smooth process. The Deputy Chair stated that patients were still registering with them but moving onto other practices after 1-2 weeks.

15/01/16 Accessible Information Standard

The Accessible Information Standard has now been implemented and circulated to GP’s. There is 12 months to comply with the standards. Deputy Chair to share at the Practice Managers meeting.

MH

Next PM meeting

GB/Pu/15/08/22


5

Agenda

Item

Note

Action

Deadline

The Communications and Engagement had already shared the information with NHS provider and Local Authority communications leads and will bring an update to next meeting.

KW

29.10.15

ESG 15/07/05

BEHAVIOUR CHAMPION

The Equality & Diversity Manager presented feedback received from staff following discussions around the qualities a Behaviour Champion should portray. The feedback received was similar to the Behavioural Framework used during staff appraisals and PDR training. The Chair stated that a Behavioural Champion was to uphold the Core Behaviours of the CCG, challenge staff when they were not meeting them, be an accessible and neutral person to advise staff when they struggling with others behaviours in an informal way. The Chair noted that approximately 50% of staff had received the Appraisal and PDR Training which includes Core Behaviours of the CCG. MS stated that further sessions will be planned in September 2015 and will feedback the dates The Chair to ensure Behavioural Champion roles promoted in the Staff Briefing before and after the training. Staff are to self nominate and Managers to utilise appraisals to identify staff that uphold the core behaviours and suggest they become a Behavioural Champion to promote the role as a valued one The Chair and the Equality & Diversity Manager to develop the role/duties. The Communication and Engagement Manager to include details of the role in Friday Round Up once complete.

MS

BR

BR/EB

KW

31.8.15 31.8.15 31.8.15 31.8.15

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6

Agenda

Item

Note

Action

Deadline

ESG 15/07/06

RISK REGISTER & ASSURANCE FRAMEWORK

The Head of Assurance stated that there was one risk on the risk register associated with the Committee which had been added in January 2015. The Head of Assurance sought agreement from the Committee that the risk was suitably rated and mitigated. The Chair asked that the work around values based interviewing and the Appraisal training be added as evidence to mitigate the risk.

The Chair asked that Values Based Recruitment be added to the October meeting agenda.

RW

CW

31.8.15 29.10.15

ESG 15/07/07

EQUALITY DELIVERY SYSTEM (EDS2)

The Equality & Diversity Manager informed the Committee that the EDS2, which is a toolkit to support NHS organisation to meet its Equality duties was now mandatory in the NHS Standard Contract. The providers are implementing the EDS 2 as part of their contractual agreement.

ESG 15/07/08

EQUALITY OBJECTIVES ACTION PLAN 2014/16

The Equality& Diversity Manager gave a brief overview of the plan and the updated evidence against the agreed actions which had been added as appendices.

EB

29.10.15

ESG 15/07/09

HR POLICY UPDATE/WORKFORCE RACE EQUALITY STANDARD

The Head of Assurance explained to the Committee that HR policies were now being reviewed on a rolling programme.

Five policies had been reviewed:

Acceptable Standards of Behaviour

Disciplinary

Grievance

GB/Pu/15/08/22


7

Agenda

Item

Note

Action

Deadline

Maternity, Adoption, Maternity Support (Paternity) and Parental and Carers Leave

Recruitment and Selection

The Committee agreed the minor changes made in line with new legislation.

RW

13.8.15

The Equality& Diversity Manager explained that the Workforce Race Equality Standard (WRES) requires NHS organisations to show progress in identifying and eliminating discrimination in the treatment of Black Minority Ethnic (BME) staff.

Barnsley CCG had a very small number of BME staff which was reflective of the local population.

It was agreed that the Valued Based Recruitment training will focuses on non-discriminatory practices, a further piece of work to consider might be a survey work to identify the views of potential BME candidates as to the attractive of working for the CCG.

The Equality & Diversity Manager stated that she has received the WRES from both service providers.

ESG 15/07/10

ASSESS OUR EFFECTIVENESS AS A COMMITTEE

The Equality & Diversity Manager gave an overview of the process involved in assessing the effectiveness of the Committee. The Equality & Diversity Manager thanked past and present Committee members for their participation in what had been a good process to go through. As the Equality & Diversity Manager was also part of the process a colleague had evaluated the Committees responses to the questionnaire.

The Deputy Chair and the Equality & Diversity Manager presented their findings to the Committee which overall were very positive with some key areas for improvement as detailed in the report.

GB/Pu/15/08/22


8

Agenda

Item

Note

Action

Deadline

The Chair proposed that an anonymous voting system be used at the beginning of the next meeting (re this meeting) and at the end of each meeting asking Committee’s members to reflect on the questions below

Have we been focussed?

How comfortable do I feel contributing?

Clarify of actions agreed

How did the Patient story contributed to the agenda?

CW

29.10.15

ESG 15/07/11

MUTUTAL PATIENT AND PUBLIC INVOLVEMENT

The Chair stated they had feedback to the CCG AGM on the LGBT work that has begun to highlight the needs within Primary Care. A LBGT video has been made as part of the 365 in 30 project. The Equality and Diversity Manager will continue to work with the LBGT Forum.

EB

Ongoing

ESG 15/07/12

WORK PLAN/AGENDA TIMETABLE

The work plan/agenda timetable was circulated for information only.

ESG 15/07/13

ANY OTHER BUSINESS

The Committee had no other business to discuss.

ESG 15/01/17

DATE AND TIME OF NEXT MEETING Thursday 29 October 2015 12pm to 2pm Hillder House Boardroom

Barnsley CCG

Documents

Transcript of Barnsley CCG