BRADFORD DISTRICT AND CRAVEN CCG

BRADFORD DISTRICT AND CRAVEN CCG BD&C CCG Governing Body - Public

Tuesday 8th March 2022 13:15 – 15:40

G7/G8, Scorex House

AGENDA

ATTENDEES TO NOTE: the meeting may be audio-recorded to assist with minute-taking. Whether a meeting is being recorded will be confirmed at the start of the meeting by the Chair. All recordings will be destroyed after approval of the minutes to which they relate.

Item Lead Purpose Time Mins

1. Welcome and Apologies James Thomas

Information - note

13:15 2 Verbal report

2. Declarations of Interest James Thomas

Action - as required


3. Questions from the public James Thomas

Action - discuss


4. Minutes of the previous meeting held 18 January 2022 and action log

James Thomas

Decision - approve

13:20 5 Paper

5. Chief Officer and Clinical Chair’s report

Helen Hirst James Thomas

Information - note

13:25 20 Paper

6. Performance Reports

i) Finance and performance update

ii) Patient safety and quality

improvement report

Robert Maden/Michelle Turner Michelle Turner

Information & Assurance

13:45 14:05

20 20

Paper Paper

7. Operational Planning 2022/23 update

Robert Maden Information & Assurance

14:25 15 Slides

8. i) ICS/Place Based Partnership development update ii) CCG transition iii) Transition of CCG to place-

based partnership governance arrangements

Helen Hirst Liz Allen Liz Allen

Information Information Decision

14:40 25 Verbal Slides Paper

COMFORT BREAK 15:05

9. Commissioning Assurance Framework

Carrie Haywood Assurance 15:10 10 Paper

10. High level risk report Catherine Smith Assurance 15:20 10 Paper

11. Exception reports from Committee Chairs

Bryan Millar David Richardson Neil Fell Ruby Bhatti

Information and Assurance


Items to receive and note

Item Lead Purpose Time Mins

12. Primary Care Commissioning Committee minutes: 9 November 2021

Ruby Bhatti

Assurance

15:35 4 Paper

13. System Finance and Performance Committee minutes: 27 January 2022

Neil Fell

Assurance

Paper

14. Quality Committee minutes: 7 October 2021, 4 November 2021 and 2 December 2021. System Quality Committee minutes: 13 January 2022

David Richardson

Assurance

Paper

15. Audit and Governance Committee: 1 November 2021

Bryan Millar Assurance Paper

Exclusion of the public - it is recommended that the following resolution be passed: "That representatives of the press and other members of the public be excluded from the remainder of the meeting, having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest

James Thomas

Decision - approve 15:39 1

For any queries regarding this agenda, please contact: Catherine Smith, Corporate Governance Manager, [email protected]

We are working to make our meeting papers accessible. If you need these papers in a different format, please contact Catherine Smith on the above email address.

Conflicts of Interests Check List for Meeting Chairs (Appendix C of the Conflicts of Interest and Business Conduct Policy) Meeting Chairs have responsibility for ensuring the appropriate management of conflicts of interest during the course of CCG meetings (see below for a definition and examples of ‘interests’). In particular they must ensure:

• They are familiar with the contents of the Registers of Interests as pertinent to their Group or Committee. The CCG’s Registers of Interests can be accessed here: https://www.bradfordcravenccg.nhs.uk/ccg-information/publication-scheme/lists-and-registers/

• They prepare for the meeting mindful of any actual or potential conflicts of interest that may arise relevant to the business of that meeting. Where conflicts of interest are known in advance, the individual concerned must not receive the supporting papers or minutes of the meeting which relate to the matter(s) which give rise to the conflict.

• That declarations of interest are always an item on the agenda.

• That the meeting is quorate and that this is recorded in the minutes.

• That members are asked to declare any interests that are likely to lead to a conflict or potential conflict that could impact (or has the potential to impact) on any items on the agenda. This should be repeated again at individual item(s) where it is considered a conflict is likely to or could potentially arise.

• Any declaration must be made clearly noted in the minutes both at the start of the meeting and at the relevant item. If there is any doubt as to whether or not a conflict of interest could arise, a declaration should be made and noted in the minutes.

The minutes must specify how the Chairs have decided to manage the declared interest. The appropriate course of action will depend on the particular circumstances, but could include one or more of the following:

• Where the Chair has a conflict of interest, deciding that the vice Chair (or another non-conflicted member of the meeting if the vice Chair is also conflicted) should chair all or part of the meeting;

• Requiring the individual who has a conflict of interest (including the Chair or vice Chair if necessary) not to attend the meeting;

• Ensuring that the individual concerned does not receive the supporting papers or minutes of the meeting which relate to the matter(s) which give rise to the conflict;

• Requiring the individual to leave the discussion when the relevant matter(s) are being discussed and when any decisions are being taken in relation to those matter(s). In private meetings, this could include requiring the individual to leave the room and in public meetings to either leave the room or join the audience in the public gallery;

• Allowing the individual to participate in some or all of the discussion when the relevant matter(s) are being discussed but requiring them to leave the meeting when any decisions are being taken in relation to those matter(s). This may be appropriate where, for example, the conflicted individual has important relevant knowledge and experience of the matter(s) under discussion, which it would be of benefit for the meeting to hear, but this will depend on the nature and extent of the interest which has been declared;

• Noting the interest and ensuring that all attendees are aware of the nature and extent of the interest, but allowing the individual to remain and participate in both the discussion and in any decisions. This is only likely to be the appropriate course of action where it is decided that the

https://www.bradfordcravenccg.nhs.uk/ccg-information/publication-scheme/lists-and-registers/

interest which has been declared is either immaterial or not relevant to the matter(s) under discussion. The conflicts of interest case studies include examples of material and immaterial conflicts of interest.

In making this decision the Chairs will need to consider the following points:

- the nature and materiality of the decision - the nature and materiality of the declared interest(s) - the availability of relevant expertise - as a general rule (and subject to the judgement of the Chairs), if an interest involves a

financial interest or a significant non-financial interest, the individual should be asked to leave the meeting for the whole item

• Any declaration arising during the course of a meeting / individual item must be minuted and action how to handle it agreed by the Chair and recorded in the minutes It is imperative that CCGs ensure complete transparency in their decision making processes through robust record-keeping. If any conflicts of interest are declared or otherwise arise in a meeting, the Chair must ensure the following information is recorded in the minutes:

• Who has the interest

• The nature of the interest and why it gives rise to a conflict, including the magnitude of any interest

• The items on the agenda to which the interest relates

• How the conflict was agreed to be managed, and

• Evidence that the conflict was managed as intended (for example recording the points during the meeting when particular individuals left or returned to the meeting).

• Quoracy of the meeting or for individual items must be checked if an interest is declared. If the meeting is no longer quorate (in full or for particular items) or there is insufficient relevant expertise to inform decision-making once those with conflicts of interests are excluded, the Chairs must agree how this should be managed, i.e. defer the item / meeting or refer any decisions for particular items(s) to another Committee for consideration and formal approval.

• Refer to Standard Financial Instructions for Delegated Limits Definition of Conflicts of Interest (Section 5 of the CCG Conflicts of Interest Policy)

Conflicts of interest may arise where personal interests or loyalties conflict with those of the CCG. Such conflicts may create problems such as inhibiting free discussions which could result in decisions or actions that are not in the best interests of the CCG, patients or the public and risk creating the impression that the CCG has acted improperly. NHS England defines a conflict of interest as occurring: “Where an individual’s ability to exercise judgement or act in a role is, could be, or is seen to be impaired or otherwise influenced by his or her own involvement in another role or relationship. In some circumstances, it could be reasonably considered that a conflict of interest exists even when there is no actual conflict” (i.e. a perceived conflict). The latest version of this guidance is Managing Conflicts of Interest: Revised Statutory Guidance for CCGs, June 2017. This guidance supersedes the previous version (June 2016) and has been fully aligned with the new cross-system guidance on Managing Conflicts of Interest in the NHS which was published in February 2017.

NHS England identifies four categories of conflicts of interest:

1. Financial interests: This is where an individual may get direct financial benefits from the

consequences of a commissioning decision. This could, for example, include being:

• A director, including a non-executive director or senior employee in a private company or public limited company or other organisation which is doing, or which is likely, or possibly seeking to do, business with a health or social care organisation.

• A shareholder (or similar ownership interests), a partner or owner of a private or not-for-profit company, business, partnership or consultancy which is doing, or which is likely, or possibly seeking to do business with a health or social care organisation.

• A management consultant for a provider

This could also include an individual (or their practices, in the case of GPs) being:

• In secondary employment (see Section 7.2)

• In receipt of secondary income from a provider.

• In receipt of a grant from a provider.

• In receipt of payments (for example, Honoria, one-off payments, day allowances or travel or subsistence) from a provider.

• In receipt of funding from the pharmaceutical or med-tech industry as part of a joint working arrangement.

• In receipt of research funding, including grants that may be received by the individual or any organisation in which they have an interest or role; and

• Having a pension that is funded by a provider (where the value of this might be affected by the success or failure of the provider).

2. Non-financial professional interests: This is where an individual may obtain a non-financial professional benefit from the consequences of a commissioning decision, such as increasing their professional reputation or status or promoting their professional career. This may, for example, include situations where the individual is:

• An advocate for a particular group of patients;

• A GP with a special interest(s);

• A member of a particular specialist professional body (although routine GP membership of the Royal College of General Practitioners, British Medical Association or a medical defence organisation would not usually by itself amount to an interest which needed to be declared);

• An advisor for the Care Quality Commission (CQC) or the National Institute for Health and Care Excellence (NICE);

• A medical researcher.

3. Non-financial personal interests: This is where an individual may benefit personally in ways which are not directly linked to their professional career or do not give rise to direct financial benefit. This could include, for example, where the individual is:

• A voluntary sector champion for a provider;

• A volunteer for a provider;

• A member of a voluntary sector board or has any other position of authority with a voluntary sector organisation.

• A member of a lobby or pressure group with an interest in health.

4. Indirect interests: This is where an individual has a close association with an individual who has a financial interest, a non-financial professional interest or a non-financial personal interest in a commissioning decision, for example:

• Spouse / partner

• Close relatives e.g. parent, grandparent, child, grandchild or sibling;

• Close friend;

• Business partner. A declaration for a “business partner” in a GP partnership should include all relevant collective interests of the partnership and all interests of their fellow GP partners (this could be done by cross-referring to the separate declarations made by those GP partners).

Whether an interest held by another person gives rise to a conflict of interest will depend upon the nature of the relationship between that person and the individual and the role of the individual within the CCGs. It is not possible to define all instances in which an interest may be a real or perceived conflict. If in doubt it is better to assume the existence of a conflict of interest and declare it, rather than ignore it.

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DRAFT Minutes of the Governing Body

PUBLIC Tuesday 18 January 2021, 13:15 – 16:00

Meeting held via Zoom Present: James Thomas Ruby Bhatti

Clinical Chair (Chair) Lay Member for Primary Care Commissioning and Communities

Neil Fell Lay Member for Finance and Performance Helen Hirst Chief Officer Robert Maden Chief Finance Officer Bryan Millar Lay Member for Audit and Governance David Richardson Lay Member for Quality John Young Angie Clegg Michelle Turner

Secondary Care Consultant Registered Nurse Strategic Director of Quality and Nursing (items 1-6, 9)

In Attendance: Ali Jan Haider Strategic Director of Keeping Well (items 1-6, 9) Liz Allen Pam Essler Carrie Haywood Vicki Wallace Sue Baxter Catherine Smith

Strategic Director of Organisation Effectiveness Lay Chair of the Individual Funding Request Panel Senior Governance and Resilience Manager Interim Strategic Director, Transformation and Change Strategic Head of Assurance Corporate Governance Manager (minutes)

Apologies: None received. Members of the public: 0

1 Welcome and Apologies

James Thomas, Chair, welcomed everyone to the meeting of the Governing Body of Bradford District and Craven Clinical Commissioning Group. The meeting was noted to be quorate.

2 Declarations of Interest No declarations of interest were made against any agenda items. The record of members’ register of interests can be found at:


3 Questions received from the public No questions had been received from the public ahead of the meeting.

4 Minutes of the previous meeting held 9 November 2021 and action log The minutes of the meeting held on 9 November 2021 were agreed to be a true and accurate record. There were no outstanding actions.


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RESOLVED: The Governing Body:

• Approved the minutes of the public meeting of the Governing Body held on 9 November 2021

5 Chief Officer and Clinical Chair’s report Helen Hirst provided an update on the key issues, meetings and partnership activities affecting the CCG alongside references to national guidance and, where relevant, the local impact of this guidance.

Helen referred to the report which provides updates from the West Yorkshire Partnership Board and the System Leadership Executive Group noting that work continues on the development of the ICS as well as ‘business as usual’ items within both groups. Helen provided an update on the current Covid-19 situation in the district highlighting that due to the increase in cases and impact of the Omicron variant a level 4 national incident has been declared and local command and control arrangements stepped up to ensure a robust response to the situation. An update was provided on the latest figures related to the local vaccination programme nothing that the uptake for the district is 70% with low uptake in particular wards. Helen highlighted ongoing work on encouraging uptake of the vaccine and gave credit to the whole system on their work to meet the challenge from the government to offer all adults the booster vaccine by the end of December 2021. There is continued work to ensure that issues such as access and vaccine hesitancy are addressed through communication and community work. Currently there has not been a significant increase in hospital admissions or deaths due to the Omicron variant. Helen referred to broader system pressures during the latest wave of Covid-19 with the cancellation of some elective recovery work and impact on general practice in terms of demand and issues with workforce. There has been significant work on discharge to free up capacity in the acute trusts which has been affected by issues with staffing. There has been work on redeployment to support the vaccine programme and areas in the system which have been affected by workforce challenges. Helen explained that the national planning guidance was received on 24th December 2021 and indicated a delay to the implementation of the Health and Social Care Act from 1st April 2022 for three months until 1st July 2022. The report includes a summary of the priorities and operational planning guidance for 2022/23 with further information expected on the impacts on finance and planning arrangements. In terms of delegated commissioning for primary care, arrangements will need to remain in place until 30th June as CCGs will keep delegated authority until then and the Primary Care Commissioning Committee will need to continue. The impact of the delays will be discussed with the Governing Body in the development session in February with the intention that the true shadow period will take place from April to July 2022 with the CCG maintaining its levels of assurance. In December 2021 all staff received a letter confirming their future role and reporting arrangements with board level members receiving their offer or confirmation of what their role will be in the new arrangements. Helen passed on condolences to the family, friends and colleagues of former CCG staff member Julie Archibald who passed away in December. Julie was deeply loved by colleagues. Helen congratulated Pam Essler who was recognised in the Queen’s New Year Honours list and been awarded a British Empire Medal for outstanding contributions to health services. RESOLVED: The Governing Body

• Noted the information and assurance provided by the Clinical Chair and Chief Officer’s report.

6 Performance Reports

i) Finance and performance update

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Robert Maden provided an update on the financial position of the CCG as at 30th November 2021 and the forecast financial position to 31st March 2022 using budgets which were set in line with the amounts in the H2 (October 2021 to March 2022) 2021/22 financial plan approved by the Governing Body in November 2021 as well as further in-year allocations. Robert referred to summary budget performance across the CCG’s main budget areas noting a £0.8m forecast underspend in the operational commissioning and running cost budgets due to lower than expected prescribing costs and lower levels of elective activity with independent sector providers. There are demand pressures on mental health placements and complex care packages for children which are creating a cost pressure of £0.4m in H2. There is a savings shortfall of £3m following the release of contingency reserves to offset the shortfall against expected plan savings and budget pressures and there are local discussions on how the savings shortfall will be managed. Contingency reserves of £950k will be held to manage demand pressures in H2. The CCG is expecting to meet its break-even financial plan target for both H2 and 2021/22 and all health organisations in the Bradford place are also forecasting a break-even position. Robert reported a financial risk related to the hospital discharge scheme as the expenditure cap on hospital discharge was lifted as a response to the Omicron variant to enable discharges and maintain flow, and this might mean that the costs across the ICS exceed the ICS allocation and create a local cost pressure. Another risk relates to the bringing forward of the implementation of the National Living Wage from April 2022 to December 2021, which was approved by the Governing Body outside of a meeting in order to support implementation as quickly possible to provide resilience in the care sector through the winter period, with further reports on the impacts from the resource presented to the planning and commissioning forum and the system finance and performance committee.


• Noted the forecast financial position as at Month 8 (November);

• Noted that plans for managing the savings shortfall / residual financial risk are expected to be confirmed in the Month 9 (December) finance report; and

• Formally acknowledged approval for the proposal to bring forward the implementation of the National Living Wage from April 2022 to December 2021 for care workers in domiciliary settings and residential and nursing homes.

Robert referred to the planning arrangements for 2022/23 which have indicated that CCGs will be provided with indicative allocations for Q1 in 2022/23 and three months of CCG accounts will be needed with further guidance expected on how the final accounts of the CCG will be signed off. In terms of the high level ICS draft allocation schedule there is a trajectory to get back to the resource levels in the spending review of 2020/21 and there needs to be an understanding of the place view of expenditure resource. Robert provided an update on key performance issues and recovery in the Bradford District and Craven health system noting that the district did not declare a critical incident during the recent wave of Covid-19 which is testament to the plans in place to maintain and minimise the impact on elective activity during the pandemic. It was noted that the figures in the report relate to October and November 2021 and more recent figures will be affected by the latest wave of Covid-19. Robert referred to waiting lists for elective activity, which were improving in November 2021, and ongoing focus on the elective waiting list from a clinical priority view. Capacity has been secured to treat complex bariatric patients who have been waiting for a significant amount of time. Robert referred to improvement in the waiting list for community dental noting a challenge with capacity due to Covid-19 infection prevention and control procedures and work with the acute trusts to ensure that lists are maintained and further breaches avoided. In terms of performance related to cancer – performance at ANHSFT was below the 2WW target in November 2021 due to demand in the breast service and challenges with Covid and self-isolation– additional capacity has been added into the pathway. There is similar demand on 2WW referrals in BTHFT with issues with staffing and capacity. Robert referred to pressure caused by the increase in mental health out of area placements due to infection prevention measures which are impacting on capacity in inpatient wards. There is WY system work on adult acute mental health pathways and PICU (psychiatric intensive care) pathways.

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Michelle Turner provided an update on work on discharges highlighting work in the WY discharge group focusing on reducing the number of patients that no longer meet the criteria to reside in hospital, reducing internal delays in flow in acute hospitals and reducing delays in out of hospital/community and social care. Michelle noted positive work on discharge in Bradford which has been acknowledged regionally. There will be further discussion on discharges in the system quality committee and the clinical forum where learning will be shared, as well as across the region at the WY ICS System Quality Group. Michelle updated that the system quality committee have discussed system pressures and challenges and key themes were on staffing, mental health, children and young people, midwifery, outbreaks, elective care and vaccinations, adding that programmes will pick up on the themes. Michelle referred to the information included in the presentation highlighting how local people feel about health services in Bradford district and Craven with themes being raised on staffing, contacting practices, delays with diagnosis for autism, CAMHS, accessing the vaccine and vaccine hesitancy, and summarised work to address these issues. Pam Essler referred to the need to consider support for carers as part of the work on discharge and suggested that communications, ongoing support and signposting for patients is addressed through the Act as One programmes. Michelle explained that pressure on carers is being picked up in the workforce programme and has been raised in ICS discussions and suggested that the Act as One programmes pick up on some of the learning related to communications and support from projects in Modality and other places.

ii) Patient safety and quality improvement report

Michelle Turner talked through a presentation which provided an update on patient safety and quality improvement and highlighted key messages from a number of areas. Michelle explained that following a requirement for the ICS to establish a service for the targeted deployment of Covid-19 treatments for non-hospitalised clinically vulnerable patients, a clinic in Airedale Hospital is now operational alongside other clinics in West Yorkshire. A general practice IT clinical risk summit, chaired by Helen Hirst, took place on 9th December 2021 and was attended by representatives from the CCG, NHS Digital, NHSE/I, LMC, THIS and TPP. No patient harm issues were identified but additional pressure on practices was highlighted and a partnership approach to manage the issues identified will be explored.

Michelle noted that the BDCFT has received an overall rating of ‘good’ following a CQC inspection with the rating for specialist community mental health services for children and young people has changed to ‘requires improvement’. Members congratulated the Trust and recognised the hard work that had gone in to this level of improvement. Michelle referred to discussions with lay members who are part of the quality committee and it was agreed that a development session would be arranged to understand how to use the lay members skillsets and experience to support arrangements for the ICP in terms of building independent challenge and scrutiny.


• Noted the information and assurance provided by the report, including key actions taken by the CCG to manage key quality and safety issues and risks arising from Covid-19 and non-Covid-19 issues e.g., GP IT risk summit

• Noted the excellent work from BDCT to gain a ‘Good’ CQC rating

• Noted the Government announcements on 12th and 30th December re: Covid-19 Vaccination Booster Programme and the Impact of the Omicron Variant respectively

• Noted the increasing emphasis on ‘place’/’system and collaboration to address system pressures and impact on patient harm, and poor outcomes together, rather than on an individual basis with each provider, and the increase in emphasis to address functions once across the West Yorkshire Integrated Care System.

7 ICB/Place Based Partnership development update

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CCG transition

Liz Allen provided an update on the CCG transition process noting that the dis-establishment of the CCGs has been delayed until 30th June 2022 due to the delay with the legislation needed for the Health and Care Bill to progress through Parliament. The shadow period for the CCG has been extended to a six month period with the informal shadow arrangements taking place between January to March 2022 and March to July 2022 as the formal shadow period. There is a need to consider the extension of the CCG’s statutory responsibilities and assurance mechanisms with a further discussion in the development session in February 2022. In terms of finances there will be a Q1 for the CCG with some contracts and SLAs extended to 30 June 2022. It is expected that there will be a similar Q1 period for the CCG’s annual governance statement, accounts and annual report but further national guidance will be issued.

Liz referred to work on the due diligence exercise and highlighted that CCG baseline information was submitted by the deadline of 3rd December 2021. All information has been collated into a WY due diligence checklist and a WY baseline report has been produced which provides overview and assurance on the CCG closedown process and indicates each CCG’s RAG status with no issues highlighted for Bradford District and Craven CCG.

Liz referred to the milestone plan and explained that the timescales will be amended to reflect the delay. In terms of key changes the final version of ICB constitution will be complete by the end of March 2022 with formal sign-off following royal assent of the Health and Care Bill. Delegated commissioning will remain with the CCG until 30th June 2022 and delivery points have been extended. The accounting period for 2022/23 remains as a 12 month period with three months of CCG accounts followed by nine months of ICB accounts with the audit process confirmed in due course. In terms of assurance and readiness the submissions have moved to March 2022 with the final submission in June 2022.

8 High level risk report Sue Baxter presented a paper detailing the ‘serious’ and ‘critical’ risks (those scoring 15 or more), new risks identified and risks closed during cycle four of 2021/22 (covering November and December 2021). It was noted that there were 51 open risks on the CCG corporate risk register with two risks that were closed during the cycle – quality of stroke care which has reached its target score due to there being no longer a risk to the stroke collaboration team as it is now aligned to the Healthy Hearts programme in terms of governance and oversight of stroke performance, and the management of conflicts of interest as the system register of interests has been updated and extended to cover all programmes and enablers. Two new risks have been added to the risk register during the cycle – a risk of structural deficiencies at Airedale Hospital related to construction using RAAC (reinforced, autoclaved, aerated concrete) which has a risk score of 20 making it a ‘critical’ risk and it will also be added to the commissioning assurance framework. The second new risk relates to the difficulty with the procurement and commissioning of independent care providers due to a lack of capacity within the BMDC framework and non-framework providers for adults, children and young people. This risk is classed as a ‘high’ risk with a score of 12. Two further risks have been added which were not included in the report – one relates to the delay to the ICS legislation and the extension of the CCG by three months, which was highlighted as a risk by the CCG transition programme management board and has been rated as a ‘serious’ risk with a score of 15. There is also a risk related to YAS, which has been operating at REAP level 4, the highest level due to high demand and high rates of staff absence, which has been scored as a ‘high’ risk. Robert provided a brief update on the risk related to the dual data centre resilience which is currently rated as a ‘critical’ risk – capital funding required to get the right amount of processing power in place to restore resilience has been identified with a project initiation document being developed for NHSE. It is expected that additional resilience will be in place before the end of March 2022.

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Sue noted that the corporate governance team are undertaking more detailed work on areas within the corporate risk register in order to encourage a comprehensive review of risks and this will be captured in the next cycle. RESOLVED: The Governing Body:

• Received and noted the risk report and high level risk log. 13 Exception Reports from Committee Chairs Verbal updates were provided by Committee Chairs in order to share key messages with those present. Minutes of the most recent committee meetings had also been shared as part of meeting papers and would be noted under the ‘items to receive and note’ section of the agenda.

Primary Care Commissioning Committee

Ruby Bhatti provided an update from the PCCC meeting that took place on 18 January 2022 where items included an update on the provision of primary medical care services during Covid-19 and the potential for workforce issues relating to the requirement for health and care staff to be fully vaccinated. In terms of the contract assurance and performance report it was noted that the quality assurance and CQC inspections are currently paused.

Finance and Performance Committee

Neil updated that the last meeting of the finance and performance committee took place on 2nd December 2021 with the next meeting of the system finance and performance committee taking place on 27th January 2022. Risks and issues are in hand with no new issues raised.

Quality Committee

David Richardson updated that the CCG’s quality committee has already moved into shadow form and lay and professional members have been invited to join the system quality committee where members have been aligned with executives from specialist areas.

Audit and Governance Committee

It was noted that the development session in February will consider additional meeting dates for the committee in relation to the extension of the CCG as there will need to be formal sign-off of the 2021/22 accounts. Bryan Millar suggested that the internal and external auditors are invited to the session in terms of providing opinion based on their assurance on whether the CCG continues to discharge its statutory duties. Liz Allen noted that governing body members are welcome to attend the SLT meetings where the monthly finance, performance and quality reports will be presented alongside the risk register and commissioning assurance framework in order to receive additional assurance. Robert added that in terms of finance this would be an opportunity to get a detailed view as system finance and performance committee will be high level.

14 Primary Care Commissioning Committee minutes: 14 September 2021 Noted. 15 Finance and Performance Committee minutes: 7 October and 4 November 2021 Noted. 16 Quality Committee minutes: 2 September 2021 Noted. 17 Audit and Governance Committee minutes: 5 August 2021 Noted.

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18 Exclusion of the Public

It was recommended that the following resolution be passed: “That representatives of the press and other members of the public be excluded from the remainder of the meeting, having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest”. RESOLVED: The Governing Body passed the resolution to exclude representatives of the press and other members of the public for the remainder of the meeting. 17. Date and Time of Next Meeting The date and time of the next meeting is Tuesday 8 March 2022, 1.15pm – 4.15pm. VENUE: Scorex House.

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NHS Bradford District and Craven CCG This document provides a summary and/or key discussion points and recommendations relevant to the subject of an item for consideration at the specified CCG meeting for the purpose of assurance, information, decision, or action.

Agenda item 5

Name of meeting Governing Body Meeting date 8 March 2022

Title of report Chief Officer/Clinical Chair report Report author(s) Helen Hirst, Chief Officer James Thomas, Clinical Chair

Lead(s) / SRO Helen Hirst James Thomas

Report lead(s) Helen Hirst James Thomas

Paper summary and/or key discussion points

This paper provides a brief update of the key issues, meetings and partnership activities affecting the CCG together with updates on national guidance and, where relevant, local impact of this guidance.

Appendix 1 provides a summary of the Senior Leadership Team meeting discussions and decisions.

Outline how this will help us to achieve our vision through our strategic ambitions:

• Our population – improving health and equity for local people, and/or

• Our partnerships – as the vehicle for enabling people to take more responsibility for their health, and/or

• Our people – a skilled, motivated workforce with a culture of continuous improvement, and/or

• Our leadership – assuring sustainability of our health and care system.

This report is relevant to all strategic objectives.

Purpose

assurance

information

decision

approve / recommend / support / ratify

action

review / consider / comment / discuss

Recommendation(s)

1. The Governing Body is asked to note the information and assurance provided by the report.

Appendices (or other supporting papers)

1. Summary of Senior Leadership Team meeting discussions and decisions.

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1. West Yorkshire & Harrogate Health and Care Partnership (WY&H HCP) At the System Leadership Executive Group in January, members:

• discussed the system response to the omicron surge following a move from a Level 3 NHS incident to a Level 4 incident on 13 December 2021; the impact of the delay to implementation of the health and care bill: the NHS Operational Planning Guidance 2022/23 and Place readiness reviews.

• supported a new partnership three-year digital strategy to help put communities in control of their own health and wellbeing via new technology. The strategy supports our ambitions for using digital tools to promote health and wellness, reduce inequalities and deliver safe, joined up high-quality care for all.

• Received an update from the Yorkshire & Humber Academic Health Science Network (YHAHSN) on the progress made around delivery of innovation and improvement programmes across West Yorkshire.

In February the Group received an update on the latest COVID infection rates across the area; across West Yorkshire the numbers have declined, though higher than previous peaks. The vaccine programme is also targeting eligible 5–11-year-olds, and communities where there is a lower take-up There has been a specific piece of West Yorkshire system work ‘Delivering a Medium-Term Plan through a Discharge’ and a Task and Finish Group has been established. There is work taking place across West Yorkshire to address challenges and risks associated with current discharge models and to propose new models of care. The focus is on improving patient experience and outcomes and avoiding admissions where possible. This multi-agency work stream includes all partners in the delivery of the challenge ensuring that this is not an issue solely for health or social care and is centered around having good care in our communities at the right time, in the right place. Members discussed the progress of the Integrated Care Board Constitution and Governance arrangements and received an update following the 2021/22 Planning Focus meeting held in November. There have been no meetings of the Joint Committee of CCGs.

2. ICS update

In our five places, the designate Accountable Officers/ Place Leads for each Place Partnership are as follows:

• Mel Pickup: Bradford District and Craven

• Robin Tuddenham: Calderdale

• Carol McKenna: Kirklees

• Tim Ryley: Leeds

• Jo Webster: Wakefield I am delighted to share that Dr James Thomas has been appointed as the NHS West Yorkshire Integrated Care Board (ICB) Medical Director Designate from 1 April 2022. James will also continue to fulfil his role as Clinical Chair for Bradford district and Craven until the end of June 2022. Jonathon Webb (Chief Finance Officer at NHS Wakefield CCG) has been appointed Director of finance Designate and Beverley Geary (currently Chief Nurse at Hull University Teaching Hospitals NHS Trust) has been appointed Director of Nursing Designate. Kate Sims (currently People Director for West Yorkshire Police) has been appointed as Director of People Designate. Recruitment is ongoing for the Independent Non-Executive Member (INEM) roles All these posts will be subject to parliament confirming the statutory responsibilities of ISBs as anticipated from July 2022 3. Business continuity and resilience update

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3.1 Overview of local COVID-19 figures The CCG produces a weekly COVID-19 dashboard that is shared with health and care partners across the system to enable identification of service pressures and the impact upon recovery. The City of Bradford Metropolitan District Council (CBMDC) Public Health team also produces a twice-weekly report with details of numbers of cases, hospitalisations, and outbreaks. A verbal, contemporaneous summary of the current COVID-19 position can be provided in the Governing Body meeting to include incidence, positivity rate, number of hospitalisations and number of deaths.

3.2 COVID-19 vaccination programme roll-out There is a continued focus on the delivery of the booster programme, but we are also seeing people continue to come forward to receive their first vaccines. The demand for vaccinations overall has dropped off within our place, so there is a concerted effort to promote the benefits of having the vaccination via various channels. This also includes national coverage – BBC’s The One Show covered the work we are doing at place to increase the number of pregnant women receiving the vaccine.

As per the JCVI guidance we are offering the booster and vaccines to our children and young people. We continue to have a wide-ranging offer of vaccination sites: PCNs, community pharmacies, hospital hubs and various pop-up sites. We have increased the offer via pop up sites and have a forward plan for where these will occur so conversations can be had in advance with these communities. Work will shortly be commencing on how to embed the vaccine programme as ‘business as usual’ on behalf of our partnership.

A verbal update of current numbers and cohorts vaccinated can be provided in the Governing Body meeting.

3.3 Health and care silver meeting The Bradford district and Craven health and care silver command meetings have been reduced in frequency to once weekly and are split into two sections:

• surge and escalation pressures

• COVID-19 issues

Tactical actions are developed in response to the system service delivery requirements applicable to surge and escalation pressures and in relation to COVID-19. This includes ensuring that we have a co-ordinated system response to individual sector challenges as organisations respond to varying activity, staffing and other pressures. Steps are taken collectively to mitigate any risks.

A more detailed update will be included in the separate system pressures item presented by Michelle Turner in the Governing Body today.

3.4 Other ‘control and command’ arrangements The District Health and Care Gold continues to meet weekly and is a forum to agree actions to address the ongoing demands on health and care services as well as Place developments. This group is attended by the chief (executive) officers of the three provider trusts, local authority and CCG and other senior managers. The Gold group advises if/when other command arrangements need to be set up.

An incident management team (IMT) for our Bradford district and Craven place is led by Mel Pickup and is linked into our District Gold arrangements and Health and Care Silver. The IMT was initially put in place to manage actions related to the expansion of the Covid vaccination programme. Staff across our transformation programmes and the CCG were redeployed to support the work required in delivering the national and regional asks related to the vaccination programme. We are further considering how our CCG EPRR and business continuity responsibilities are carried out through our local place and WY ICS arrangements as part of shadow running from now to the end of June.

Our Associate Leadership Team (ALT) was asked in mid-December to reinstate the CCG Bronze group to support the actions required by the IMT which included redeployment of staff to support the vaccination programme. It was subsequently agreed at Health and Care Silver that the redeployment of CCG staff would cease as of the 1st February 2022 as the providers reported a reduction in the numbers of staff absent from work due to COVID-19.

23.5 Post-EU exit period The CCG is still required to report any post-EU exit related issues by exception which may impact business critical services for any of the following areas: supply of medicines, medical devices, consumables, goods, and services; supply of blood products, transplant organs and tissues; workforce; estates and facilities;

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clinical trials; data sharing, processing and access; reciprocal healthcare and cost recovery; partner organisations that are essential to delivery of healthcare.

4. Bradford District and Craven Partnerships 3.1 Wellbeing Board (Previously Health & Wellbeing Board) At the Wellbeing Board development session in February, members:

• received a presentation on the District’s ambitions around creating a sustainable digital infrastructure to support our Clean Growth and District plan ambitions.

• were provided with an update on the Health and Care Partnership arrangements for Bradford District and Craven.

• Received the final version of the District Plan.

• Ratified the Better Care Fund proposal. 4.2 Partnership Leadership Executive In January the Executive:

• received an interim update from Mike Farrar on the Independent review of partnership leadership opportunities.

• Supported a proposal around close down arrangements for Well Bradford, with the majority of the remaining non-recurrent funding going to Living Well, specifically around healthy places and spaces and community partnerships, with a small portion for the Girlington area being set aside following engagement with elected members that represent this ward.

• discussed the annual planning process and how we will identify our partnership’s priorities.

• received a proposal around the requirements for Bradford District and Craven with regards to its People function. including the establishment of a people committee for the Bradford District and Craven Health and Care Partnership. Further consideration will be given to the proposal using the prioritisation process.

• were provided with an update on children services following the announcement that Bradford Council will be creating a council-owned children’s company as part of its ongoing commitment to improving its children’s services.

• were given the opportunity to comment on the Place based partnership website which is currently being developed

In February, the time was used as a development session for members of the the Bradford district and Craven Partnership Board.

4.3 Bradford Wellbeing Executive Group (Formally Strategic Coordination Group) /Outbreak Control

Board The Bradford Wellbeing Executive Group continue to meet monthly. The Groups primary purpose is to support the functioning and operational delivery of the Wellbeing Board through strategic alignment, responding and planning key issues and facilitating action on cross-cutting issues that affect the District such as the District Plan, Child Friendly District and enabling infrastructure for the Wellbeing Board. The Outbreak Control Board is currently meeting monthly and continues to receive updates on infection, testing and vaccinations and then determines what strategic and operational actions are required. 5. SEND Inspection CQC/Ofsted inspectors have announced they will be visiting the local area (Bradford) during the week commencing Monday 7 March 2022, the inspection will last for five days. The local area will be inspected on its effectiveness in identifying and meeting the needs of children and young people with special educational needs and disability (SEND). The inspection will focus on services delivered and commissioned in a local area for children and young people with SEND and their families by the local authority i.e., education and social services, including health services, early years settings, schools, providers and further education. The inspections will also consider how well these services work in partnership to meet the needs of children and young people and their families The CCG is working closely with Bradford Metropolitan District Council to prepare for the visit.

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5. New Chief Executive Officer of Airedale NHS Foundation Trust Foluke Ajayi has been appointed at the CEO of ANHSFT, Foluke is currently Director of Strategic Transformation at Humber Coast & Vale Health and Care Partnership, her start date is to be confirmed. 6. Bradford Children’s services The Department for Education appointed a commissioner to work with Bradford council’s children’s services after Ofsted reported a “slow pace” of improvement since its ‘inadequate’ rating three years ago. Following the independent review of services, a recommendation was made that services are placed into a Children’s Trust. The trust will be owned by Bradford Council but operate at arms-length under the control of a new independent Chair and Board of Directors. The CCG are working closely with the council to understand how we will work with and support these arrangements. 7. New Independent Chair appointed to the Bradford Partnership The Bradford Partnership – Working Together to Safeguard Children, has appointed a new Independent Chair. Janice Hawkes will take up the post in May 2022 following the retirement in January of Jane Booth, the Partnership’s previous Chair. 8. Summary of Senior Leadership Team Discussions

Please see attached a summary of the SLT meetings during the last two months at appendix 1

9 National Updates

9.1 Coronavirus (COVID‑19)

As of 24 February 2022, the government announced that: You will not be legally required to self-isolate if you test positive for COVID-19, but you should stay at home if you can and avoid contact with other people.

You will not have to take daily tests or be legally required to self-isolate following contact with someone who has tested positive for COVID-1.

Guidance still encourages vaccinations, wearing a face covering in crowded and enclosed spaces and meeting outside.

For up-to-date guidance on all aspects of Covid-19 please visit the government website https://www.gov.uk/coronavirus

https://www.gov.uk/coronavirus

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Appendix 1

SLT updates for Governing Body: 5 January 2022 – 23 February 2022

GPIT update and mail migration

It was agreed that as the issues had begun to settle SLT no longer needed a separate IT update, future updates would be incorporated into the digital update and at the weekly huddle meeting.

Extended SLT 12 January 2022 System (ICS) and place (PBP) updates Members discussed the delay in implementation of ICS legislation, it was noted that this would impact the move to meeting as a partnership leadership team (PLT). This will be delayed as it cannot connect to the future structures e.g., Partnership Board and Partnership Leadership Executive (PLE) as the governance arrangements for these are not yet in place. The plan is to move to full shadow form by April 2022, operating in the new arrangements even though the CCG will still exist until 30 June. The CCG will continue to discharge its statutory duties until the end of June 2022. Development of PLT and ALT - new ways of working Mel Pickup joined the group as Place based lead to join a conversation about the development of new ways of working, what needs to change, what has worked well and how future arrangements would work. SLT discussed the ambition for the first year, agreed to set up review points; how to engage the right people in the right discussions and move away from CCG and think partnership and system working. GPIT and infrastructure The data centre options paper has been completed. To future proof the IT system, recommendations include investing in more computing resource and building more capacity in the ‘cloud’. External assurance has been sought to ensure this will provide a fit for purpose service. A THIS service review is planned, to look at requirements for 22/23. There will be a focus on extending out of hours support. The roll out of the Oberthur software to practices continues, it is anticipated that this will resolve the performance issues. SLT 19 January 2022 Resource prioritisation / management of partnership running costs It was recognised that there is only a finite resource available, and a need to decide whether to spread our resource across every area and make steady progress or re-align some of the resource to a few priority areas to make greater progress in those areas. The draft priorities for 22/23 were shared: 1) Partnership: recovery from Covid whilst addressing health inequity, 2) People: workforce, 3) Purpose: community partnerships 4) Place: prevention. Whilst it was felt the suggestions were appropriate, they would be tested with the wider partnership and system committees for comments. It was agreed that when vacancies arise, we take the opportunity to look at the strategy to help us decide whether a vacancy needs filling – if a gap is left, to look across the system and consider if it could be approached in a different way. A proposal for a realignment of admin resource was presented. This had been prompted by several issues being raised by some teams around lack of admin resource and some admin staff advising that they were not happy with the current arrangements, believing them to be unfair and disproportionate. ALT were asked to take this forward. Individual Funding Requests (IFR) panel update It was reported that there had been a slight increase in body image/cosmetic issues coming to the IFR panel, this was likely due to clinics opening back up again as Covid restrictions ease. An update was provided around the ongoing issue of a growing number of our population choosing to have adult ADHD assessments undertaken by independent providers. If an independent provider holds a commissioning contract with a CCG, then other CCGs are obliged to enable a patient to exercise ‘choice’ in securing an appointment with that provider. This poses a problem when medication is subsequently required as there

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are no shared care arrangements in place with the independent providers. Legal advice has been sought but a clear solution could not be provided. It was noted that this is will be the responsibility of the ICS from the 1 July therefore It was agreed the IFR lead should use the time from now until 30 June to work with colleagues across the system to resolve this. Children's services monthly report

• Steve Walker, the Department of Education appointed children’s commissioner, has concluded his review on BMDC children’s services. His report has not been circulated yet, but it was noted BMDC have indicated that the report is likely to highlight several areas where the partnership could work together better.

• The first Act as One Children &Young Peoples Partnership Board was held 21st November 2021.

• Star Hobson case: It was reported that the national panel were reconsidering the review SLT 26 January 2022 Monthly finance update (Financial Position – H2 2021/22, (Month 9)

• Forecasting a budget overspend of £3.1m contingency and other uncommitted reserves of £3.1m released to offset this overspend. This includes the balance of H1 contingency reserves. Expect to achieve a break-even position for H2 and for 2021/22.

• Expected to see a forecast drop on elective activity but there has been additional capacity sourced for complex bariatrics. These patients have been waiting a long time and it was a clinical priority.

It was acknowledged this had been a strange year in finance terms due to Covid but noted that we were not in a better position financially than we were in 2019/20. Waiting lists are longer and complications from Covid need to be managed. We need to stay aligned to the priorities in our strategy and support transformation which will manage services better financially in the future.

A proposal to re-configure senior finance posts was approved. Monthly performance update

• Significant pressures during December and January because of Omicron, this impacted on urgent care, patient flow and length of stay.

• Elective care has been affected and the independent sector is being used to support recovery.

• Cancer remains a priority, targets are being achieved but there is an increased demand particularly around breast cancer.

• Mental health – seeing increased complexity in patients and have some long-term staffing issues.

• The impact of Covid on out of area placements (OAPs) for adult mental health services continues.

• As of the 31st December, almost 72k had received their booster vaccination, this was noted to be a significant achievement for our place.

CCG transition update The date for dis-establishment of CCGs has been extended from 31/03/22 to 30/06/2022. Whilst this allows more time to put plans in place for the transition, it will impact on several areas including CCG statutory responsibilities, finance, contracts, and governance. There will be some actions to take / risks to manage; gaps to identify; clarify responsibilities; and ensure comprehensive handovers. Monthly quality update

• Personalised commissioning: securing care provision for patients at home (children and adults) is becoming increasingly challenging. It was felt a system wide response was needed, a task and finish group will be convened to take the work forward.

• It was reported that BMDC are creating a council-owned children’s trust company as part of its ongoing commitment to improving its children’s services. The council will remain commissioners – the trust body will be a new strategic partner in our partnership arrangements, and we will be working with them. Safeguarding arrangements will be unchanged. A board will be set up to support the trust.

Corporate risk register

• One new risk was added to the risk register during this cycle. This risk relates to the delay of the legislation that is required to establish ICSs and dis-establish CCGs in its passage through parliament which has led to a three-month delay to the process.

• One risk has increased – this is the procurement and commissioning of independent care providers.

• It was agreed something broader around children’s services need adding.

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• It was reported that staff would be contacted to discuss vaccination as a condition of deployment (VCOD) status considering the national guidance.

SLT 2 February 2022 Planning for Partnership Leadership Team development (PLT) A discussion took place about the role of PLT. PLT will make recommendations for the partnership. PLT will have the headspace to think and will be objective and have a balanced view, keeping a population focus. PLT should be a safe space for critique and challenge, a convener of the groups above and below PLT, provide support and encourage and empower teams. It was acknowledged that this is an experiment, and it may not be right first time.

System (ICS) and place (PBP) updates It was reported the recruitment of the independent members of the West Yorkshire Partnership Board has commenced. The Director of nursing interviews have taken place and they have a preferred candidate. The director of finance and medical director interviews are been held week commencing 7 Feb followed by director of people on 22/02/22. Work is ongoing to understand how these roles will fit with place leaders.

March Governing Body draft agenda The agendas for March Governing Body were approved.

Post infection reviews – business case A post infection review (PIR) is a process that helps organisations to understand how infection cases occurred and identify actions that will prevent it recurring. PIRs were historically undertaken by some practices pre-Covid however, due to covid pressures, PIRs were paused. Practices have indicated that they do not have the capacity to undertake these reviews and currently there are no requirements in the current GP contract to complete PIR apart from the underlying obligation of providing high quality services. It was agreed there would be more value for the system if this was a place-based partnership ‘Act as One’ approach for not just this issue but infection prevention control in general. It was felt this needed some system NHS leadership and agreed it should be taken forward through the system directors of nursing.

Extended SLT 9 February 2022 ALT focus – future role and remit of ALT in our place partnership ALT were currently described as a forum where operational and tactical place-based partnership objectives and issues can be discussed and addressed. A place for input from staff groups into decision-making on staff issues, to provide collective leadership into the workstreams, secure appropriate mandates to undertake work on behalf of the partnership and accept remits to lead on ad hoc and emerging scenarios. When we move into the new arrangements, the Partnership Leadership Executive will be in a strategic and tactical space, the Partnership Leadership Team will be predominantly tactical, and ALT will be doing some of this with a role of implementation. ALT will bring back a proposal of their new ways of working.

System (ICS) and place (PBP) updates Work has been undertaken on refreshing the strategy as an ICS in terms of evolving the current strategy and the ten ambitions into the next stage and the mechanism for implementation for the ICS. An improvement methodology has been discussed as well as having a common approach. A Partnership Board development session will take place to discuss the partnership arrangements which will start in shadow form from April 2022.

Role of the Wellbeing and Able (WAA) staff network in the ICS Members of the network shared some personal experiences related to the lives of people with long term conditions/disabilities throughout the pandemic, highlighting a sense of feeling forgotten or invisible. The network was provided with a number of contacts throughout the system that could support the network and help them develop their offer to the system as we move into the new arrangements.

SLT 16 February 2022 Primary care fairer funding review SLT were presented with the primary care fairer funding review which set out a number of principles to ensure equity and fairness of funding. It is acknowledged that there are inequalities across the whole system and this needs to be addressed. The review will ensure a fairer distribution and transparency of how resources are spent and what outcomes are achieved. It is proposed that changes start from 1 April 2022 and the change should be staggered over 3 years so the practices would start receiving the final

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revised contract value in April 2024. It was clarified that no practice in 2022/23 will have a lower contract value than they have now. IAPT review update It was agreed to undertake a detailed review of all the commissioned services (from BDCFT and VCSE) covering all elements of IAPT performance. The outcome is to provide the Health and Care Partnership MHLDND board a report with what actions need to be taken to improve access to psychological therapies and evidence based talking therapies and provide proposals for improving efficiency, staff recruitment, and performance within the current financial context. It was noted that referrals reduced during the last two years of the Covid pandemic, but these are now rising steadily back to a pre-Covid position and in comparison, with other areas of the ICS, that Bradford is an outlier. From a partnership perspective any next steps need to be in line with the strategy and inequalities need to be considered SLT 23 February Monthly finance report

• The CCG is on track to deliver a balanced in year position. There have been some slight increases in month – costs which have been covered by contingency funds and uncommitted resource.

• There is increased activity in the independent sector, particularly in the Yorkshire Clinic which is helping to reduce the waiting list backlog.

• Work is ongoing around service development and system recovery funds in order to maximise spend in 2021/22.

• It was recognised that the financial plan for 22/23 will be challenging.

Monthly Quality report

• Host commissioner: Safe and wellbeing reviews – Covid 19 outbreaks are creating challenges with conducting face to face visits, plans are in place to reschedule during February.

• Work is ongoing looking at inequalities in recovery for those living with Covid 19.

• The 0-19 service contract is due for renewal and the Council has indicated that it could put these services out to tender.

• Overall projected stroke performance is reducing. Stroke services are currently addressing issues through a place-based improvement plan.

• Easements to death certification processes and cremation forms expire 24th March 2022. A meeting has been convened with LMC, Coroner etc to agree what will happen going forward. If necessary a letter will be sent to local MPs asking them to raise this nationally.

Monthly performance report

• Urgent care: although there has been slight improvement, both trusts are below the national standard in terms of waiting times; challenges continue to relate to the complexity and volume of attendances.

• Pressures relating to flow and onward admission were increasingly challenged through January and into February. This pressure impacted on length of stay and challenged flow across urgent care significantly. Both trusts have focussed on the pressure on the ambulance service and work is ongoing around how to reduce handover times.

• Covid has affected staff and patients in terms of absence and patients unable to attend because of Covid and isolation and alongside this there has been some redeployment of staff to support the vaccination programme.

• Elective recovery 52 and 104 week waits: Both acute Trusts have indicated they will achieve targets as per H2 plan.

• Work is underway through the access programme to look at DNA rates to identify where people come off the pathways and identify if any specific cohorts are linked to inequalities.

Staff survey - headlines

• The CCG was not an outlier in any area compared to other organisations.

• It was noted that whilst the percentages of people reporting harassment/bullying or discrimination were not high (between 6% and 8%) the numbers were still significant for a small organisation. It was recognised that this had been raised before in previous staff surveys and attempts have been made to get underneath the issues, but this was difficult as the feedback is anonymous. People would be asked for suggestions on how to address the issues in a way that is comfortable for them and makes them feel supported. This learning will be taken into the partnership arrangements.

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CCG corporate risk register (CRR) and commissioning assurance framework (CAF) No new risks have been added since the last cycle, 10 risks have closed, none have reduced, and one has increased to critical (failure to secure provision of independent care providers). A risk around Children’s services will be added. It was agreed the CAF provided a fair and accurate reflection of the CCG’s current strategic risk position. Future of Senior leadership Group. This was the last SLT meeting to take place. From 2 March the PLT will begin to meet. A smaller monthly assurance meeting will be convened with Helen Hirst, Liz Allen and the governing body lay and professional members until the end of June so the CCG can discharge its statutory duties.

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NHS Bradford District and Craven CCG This document provides a summary and/or key discussion points and recommendations relevant to the subject of an item for consideration at the specified CCG meeting for the purpose of assurance, information, decision or action.

Agenda item 6i

Name of meeting Governing Body Meeting date 8th March 2022

Title of report CCG Finance Report for the period to the 31st January 2022

Report author(s) Diane Lawlor – Strategic Head of Finance

Lead(s) / SRO Robert Maden – CFO Report lead(s) Robert Maden - CFO


This report provides information on the financial position of the CCG as at the 31st January 2022 and the forecast financial position for the six months through to the 31st March 2022.

For the last six months of the financial year (H2) the CCG has received a resource allocation covering the period October 2021 to March 2022. Budgets have been set in line with the amounts in the H2 2021/22 Financial Plan approved by the Governing Body in November 2021, plus further in-year allocations notified to date.

Appendix 1 contains information on summary budget performance across the CCG’s main budget areas. Key Points:

• Overall, across operational commissioning and running cost budgets there is a forecast underspend of £0.7m before taking into account the savings shortfall. This is due mainly to a continued fall in prescribing costs and higher support function savings. These have been partially offset by higher levels of elective ophthalmology activity at independent sector providers. Demand pressures on mental health placements and continuing care support remain with forecast continuing care costs increasing by a further £0.3m in H2.

• Including the savings shortfall of £4.1m, there is a forecast overspend of £3.4m. Contingency reserves (including uncommitted reserves from H1) have been released to offset this overspend and this has reduced the residual financial risk to £nil. Contingency reserves of £900k have been retained to manage further demand pressures in H2.

• From a Bradford Place perspective, each local NHS Trust is forecasting a small surplus and this is after making provision for the accelerated implementation of the National Living Wage for care staff in line with the agreed West Yorkshire ICS business case. All other West Yorkshire ICS organisations are forecasting to at least achieve their H2 plan and therefore there are no wider ICS pressures affecting the CCG’s position.

• Overall, based on commissioning budget performance to January 2022 and forecast budget performance to March 2022, the CCG expects to meet its break-even financial plan target for H2, and as a result achieve a break-even position for the whole of 2021/22.

• The underlying deficit taken forward to 2022/23 is expected to be £11.5m. Further detail is in the 2022/23 financial plan update.

• Capital funding of £1.3m to enhance data centre resilience for the GP clinical systems and CCG corporate systems has been confirmed by NHS England and Improvement and scheme completion

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is expected by the end of March 2022.






Contributes to financial sustainability and improves quality of commissioned services.

Purpose

assurance

Information

Decision


action


Recommendation(s)

The Governing Body is asked to:

1. Note the forecast financial position as at Month 10 (January);

2. Note that capital funding of £1.3m has been secured to improve data centre resilience for GP clinical and CCG corporate systems; and

3. Note the underlying deficit position that will be taken forward into 2022/23 and addressed through the operational planning process.


1. Summary CCG Financial Performance

BRADFORD DISTRICT AND CRAVEN CCG

FINANCE REPORT FOR THE PERIOD TO 31ST JANUARY 2022 (MONTH 10)

1. Introduction.

1.1 This report provides information on the financial position of the CCG as at the 31st January 2022.

1.2 For the first six months of the financial year (H1) the CCG operated within a resource allocation

covering the period April to September 2021. The CCG reported a break-even financial position

to the end of September 2021.

1.3 For the last six months of the financial year (H2) the CCG has received a resource allocation

covering the period October 2021 to March 2022 and this report concentrates on financial

performance for this period.

1.4 Financial performance for this period is based on the application of H2 Financial Planning and

Contracting guidance. Under these arrangements, block contract values for our main NHS Trusts

have been rolled forward from H1 and an uplift of 1.16% applied. A further non-recurrent uplift of

1.75% per month has been applied to cover the backdated costs of the Agenda for Change pay

award for H1.

Budgets have been set based on the uplifted block contract values and currently performance is

shown in-line with budget.

For other services, where activity information is available, this has been used to support the

assessment of financial performance. The main budget areas concerned are:

Primary Care Prescribing - November activity; and

Continuing Healthcare – activity to the 5th December 2021.

The additional costs related to responding to the pandemic are included in the relevant budget

line and continue to be highlighted on the budget report as COVID19 costs.

1.4 Additional funding continues to be available in H2 2021/22 for reimbursement of Hospital

Discharge Programme costs, elective activity costs in excess of Elective Recovery Fund

thresholds, COVID19 Vaccination Programme and the Additional Roles Reimbursement Scheme

costs for Primary Medical Care. From January 2022 claims for reimbursement of Winter Access

Fund costs over and above the initial allocation are also included. Expenditure budgets have

been shown gross of these funds.

1.5 Key points for Month 10 performance are highlighted for the Committee.

2. Changes to Resource Allocation and Budgets.

2.2 The resource allocation updated for allocations received in January is:

Full Year

Opening

allocationRRLA

(non recurrent)

RRLA

(reclaims)

Closing

allocation

Closing

allocation

Closing

allocation

To September 521,777 521,777

October 518,167 11,697 529,864 1,173 531,037

November 977 977 -55 922

December 361 361 0 361

January 705 705 0 705

Actioned to date 518,167 13,740 0 531,907 522,895 1,054,802

October - March

April -

September

Non-recurrent resource allocations of £705k include:

• £103 Primary Care On-line consultation software systems;

• £90k Primary Care Practice resilience programme;

• £219k Winter Access Fund;

• £68k Diabetes treatment and care funding (SDF);

• -£344k Redistribution of £2m ICS reserve;

• -£52k WY LD TCP discharge priorities funding transfer to Leeds and Kirklees CCG;

• £16k HSCN funding;

• £570k pension uplift @ 6.3%;

• £35k Health assessment service for Afghan families in bridging hotels.

These resource allocation changes have been reflected in budgets as appropriate with SDF

spending plans being confirmed by the relevant programme board or commissioning lead.

The pension uplift allocation represents the increased level of Employer pension scheme

contributions that are currently funded by the Department of Health & Social Care and which are

paid to the NHS Pensions Agency by the CCG.

2.3 The H2 income budget for items reimbursed outside of the fixed funding envelope comprises:

£'000

Hospital Discharge Programme -1,500

COVID-19 Vaccination Programme 0

Primary Care Additional Roles -1,878 44% of maximum allocation of £4,235k

Local Independent Sector Activity 0

-3,378

No H2 reimbursements have been received to date. Actual year to date and H2 forecast

reimbursement values are described under the Acute, Continuing Care, Primary Medical Care

and Support Function sections in Appendix 1.

3. Financial Performance at Month 10 – Key Points.

3.1 Overall Position

October -

MarchFOT

Budget BudgetOver /

(Under)

Over /

(Under)

Commissioning Budget 533,877 357,854 -753 2,474 218 3,752

Savings Target -6,018 -4,012 2,751 0 4,126 0

Contingency Reserves 1,688 1,349 -1,645 0 -3,362 0

Running Costs 5,738 4,107 -121 12 -189 17

Residual Financial Risk 0 0 0 0 0 0

Gross Expenditure 535,285 359,298 232 2,486 793 3,769

Funding to reclaim -3,378 -2,252 -232 -1,798 -793 -2,732

Net Expenditure 531,907 357,046 0 688 0 1,037

Net Summary:

Net Commissioning Budget 530,499 355,602 -1,470 676 -575 1,020

Savings Target -6,018 -4,012 2,751 0 4,126 0

Contingency Reserves 1,688 1,349 -1,160 0 -3,362 0

Running Costs 5,738 4,107 -121 12 -189 17

Residual Financial Risk 0 0 0 0 0 0

Net Expenditure 531,907 357,046 0 688 0 1,037

October 2021 - March 2022

Year to Date

Januaryof which is

COVID19

Costs

of which is

COVID19

Costs

• The forecast H2 position for commissioning costs within the fixed resource baseline shows

an underspend of £764k before taking into account the savings shortfall. This is due mainly

to a continued fall in prescribing costs and higher support function savings. These have been

partially offset by higher levels of elective ophthalmology activity at independent sector

providers. Demand pressures on mental health placements and continuing care support

remain with forecast continuing care costs increasing by a further £0.3m in H2.

• Including the savings shortfall of £4.1m, there is a forecast overspend of £3.4m. Contingency

reserves (including uncommitted reserves from H1) have been released to offset this

overspend and this has reduced the residual financial risk to £nil. Contingency reserves of

£900k have been retained to manage further demand pressures in H2.

• Underspends and overspends against budgets for which additional funding can be claimed,

i.e. the Hospital Discharge Scheme and Elective Recovery Fund, are offset by a

corresponding change in the value of the reclaim resulting in no impact on the CCG’s financial

position.

• The position includes a net £688k and £1,037k for year to date and forecast COVID-19 costs in H2.

• The underlying deficit taken forward to 2022/23 is expected to be £11.5m. Further detail is in

the 2022/23 financial plan update.

3.2 COVID19 Costs

COVID19 costs against budget are detailed in the following Table. They reflect the net position

after the reclaim of costs in support of the COVID19 Vaccination Centre.

• The overspend for the Telehealth Service is to be funded from the Ageing Well

Programme.

• The budgets for primary care Red Hubs and GP Super Rota are no longer required as

these services have now ended or are funded from other sources on a recurrent basis.

However, there has been an additional cost relating to the cleaning of Hillside Bridge.

• There are still some residual costs of admin staff support to COVID19 services and these

are showing as an overspend as no separate budget has been identified. The level of

support and associated costs may reduce but this remains dependent on any on-going

requirements.

The position for H2 will be kept under review with future COVID19 costs being dependent on the

impact of rising infection rates.

October -

MarchFOT

Budget BudgetOver /

(Under)

Over /

(Under)

Patient Transport Services 379 189 62 -3 0

Telehealth 132 66 115 142 0

Primary Care Red Hubs 80 40 -11 -50 1

Primary Care Super Rota 0 0 8 8 0

Primary Care Transport costs 0 0 0 0 0

Primary Care GP Sustainability 0 0 -10 -10 0

Primary Care Long COVID 213 107 0 0 0

Admin Support Costs 0 0 122 146 57

804 402 286 233 58

Year to Date

January


Mvt from

last month

3.3 The main factors affecting financial performance are:

• Acute – year to date and forecast overspends against budget have increased since last

month mainly due to additional activity with independent sector providers and in particular

ophthalmology activity at the Yorkshire Eye Hospital and Spamedica. Overspends relating

to activity with private providers has been partially offset by an underspend against AQP

services. The activity levels do not exceed the Elective Recovery Fund threshold and so

no additional funding can be claimed.

• Community Services – release of community services reserves offset by overspends

relating to the ACCT service, children’s sleeping aids and adult communication aids,

community equipment and patient transport services. Other services reported in-line with

budgets.

• Personalised Commissioning – activity and cost information to 5 December 2021 shows

an increase in nursing home and home support costs. The increase is partially covered

by the release of the risk reserve, but a net forecast over spend of £311k remains after

reimbursement of Hospital Discharge programme costs. The risk reserve has been fully

utilised and therefore there is a risk that any further increases with produce a further

pressure against the H2 budgets. It is assumed that all Hospital Discharge Programme

costs will be fully reimbursed.

• Mental Health – overspends against the budgets for mental health placements and

complex care for children reflect the forecast cost of the current patient cohort including

one high-cost case with costs of £24k per week. Additional costs relating to Children and

Young Peoples mental health services have been offset by slippage on the Learning

Disabilities SDF programme.

• Prescribing – information has been received for the period April to November and shows

an increase in costs of 1.41% compared to the previous year of which there is a 2.58%

increase in the number of items and a 1.17% decrease in prices. However, there have

been 3 less prescribing days in April to November when compared to last year and the

increase in cost per prescribing day is 3.14%. Whilst these are increases when compared

to the previous year the level of increase is reducing and the forecast costs in 2021/22

have reduced since last month. The H2 position is based on this information to November

and an underspend against budget has been reported. Actual costs remain volatile and

so a reserve of £258k has been maintained.

• Primary Care – the overall position is now showing a net underspend against the H2

budget of £58k due to reduced forecasts for GP locum, prescribing fees and central NHS

England recharges. The forecast costs for Additional Roles Reimbursement has

increased, but this is offset by a corresponding increase in the reclaim value. The

underspend against the reclaim budget is due to difficulties in recruitment.

• Other Primary Care – increased costs relating to the Winter Access Fund are offset by

an additional reclaim for reimbursement. There is a forecast underspend against the

COVID cost and the GP LES budgets, but all other costs are on-line with budget.

• Other Commissioning – an underspend against support function budgets due to staff

vacancies, release of uncommitted reserves and other reduced corporate costs. There

has also been slippage on the Ageing Well and Learning Disabilities SDF programmes

and this is reflected in the year to date and forecast underspend.

• Running Costs – a year to date and forecast underspend reflects staff vacancies,

confirmed external income for hosted and joint funded posts and reduced non-pay

corporate costs.

Appendix 1 shows a summarised budget position and a detailed break-down of each budget area.

4. Performance Against the Savings Target.

The national expectation of savings of 0.82% of resource baselines for H2 which equated to

£1,599k is expected to be achieved through a combination of recurrent and non-recurrent savings

as follows:

Prescribing (1%) £551k Continuing care (1%) £307k

Admin functions (non-recurrent) £450k Release of contingency reserve £291k

The savings values have been taken out of the respective budget areas and financial

performance is reported against the budget net of savings. Budget performance to date indicates

that we are on track to deliver these savings.

As described in previous reports to the Finance and Performance Committee, we are continuing

to develop further savings schemes for 2022/23 in these areas.

5. Bradford Place Financial Performance.

5.1 As at Month 10, all Health organisations in the Bradford Place are forecasting a small surplus and

this is after making provision for the accelerated implementation of the National Living Wage for

care staff in line with the agreed West Yorkshire ICS business case.

5.2 All other West Yorkshire ICS organisations are forecasting to at least achieve their H2 plan and

therefore there are no wider ICS pressures affecting the CCG’s position.

6. Financial Risk.

6.1 Current financial risks and mitigating actions are set-out in the following Table:

Risk Mitigation

Savings Target shortfall. (risk fully mitigated by the release of reserves, although this is mainly a non-recurrent measure)

- Budget performance review to identify in-year savings (recurrent and non-recurrent).

- Release of VAT provision. - Use of contingency reserves. - Use of non-recurrent balance sheet

flexibilities. - Place based risk share

arrangements.

Activity Risk – continuing healthcare (some demand risk remains for which some reserves have been retained)

- Review application of eligibility criteria and contributions to jointly funded care packages.

- Ensure appropriate costs fully claimed under the Hospital Discharge programme.

- Use of contingency reserves.

6.2 There is a risk that the CCG may move into a surplus position if further resource allocations

are received in Quarter 4 that cannot be spent by the year-end. However, at this stage no

further resource allocations have been confirmed.

7. Other Items.

7.1 Capital funding of £1.3m to enhance data centre resilience for the GP clinical systems and CCG corporate systems has been confirmed by NHS England and Improvement and scheme completion is expected by the end of March 2022.

8. Recommendations.

The Finance & Performance Committee are asked to:

a) Note the forecast financial position as at Month 10 (January);

b) Note that capital funding of £1.3m has been secured to improve data centre resilience for GP

clinical and CCG corporate systems; and

c) Note the underlying deficit position that will be taken forward into 2022/23 and addressed

through the operational planning process.

APPENDIX 1

Summary Financial Performance for the period to 31 January 2022

October -

MarchFOT

Budget BudgetOver /

(Under)

Over /

(Under)

£'000 £'000 £'000 £'000

Acute Care 243,774 163,522 256 0 568 0

Urgent Care 20,532 13,797 -42 0 -16 0

Community Services 38,071 25,893 -70 432 -34 650

Personalised Commissioning 31,897 21,264 1,065 1,778 1,509 2,698

Mental Health and LD Services 58,637 39,190 397 0 326 0

Prescribing 53,472 35,649 -637 0 -649 0

Primary Medical Care 58,206 39,590 -891 128 -631 213

Other Primary Care 5,131 3,422 -16 67 44 87

Other Commissioning 20,880 13,337 -815 69 -899 104

RIC Investments 3,277 2,190 0 0

QIPP Savings Balance -6,018 -4,012 2,751 4,126

Total Operating Costs 527,859 353,842 1,998 2,474 4,344 3,752

Contingency Reserves 1,296 864 -1,160 -2,970

Other Reserves 392 485 -485 -392

Total Reserves 1,688 1,349 -1,645 0 -3,362 0

Total Healthcare Expenditure 529,547 355,191 353 2,474 982 3,752

CCG Running Costs 5,738 4,107 -121 12 -189 17

Residual Financial Risk 0 0 0 0

Gross Expenditure 535,285 359,298 232 2,486 793 3,769

Additional funding to reclaim -3,378 -2,252 -232 -1,798 -793 -2,732

Total Net Financial Position 531,907 357,046 0 688 0 1,037

MEMORANDUM

Additional funding to reclaim:

Hospital Discharge Programme -1,500 -1,000 -778 -1,778 -1,198 -2,698

COVID-19 Vaccination Programme 0 0 -20 -20 -34 -34

Primary Care Additional Roles -1,878 -1,252 566 573

Elective Recovery Fund 0 0 0 0

Winter Access Fund 0 0 0 -134

-3,378 -2,252 -232 -1,798 -793 -2,732

of which is

COVID19

Costs

Year to Date

January of which is

COVID19

Costs


of 2


Agenda item 6

Name of meeting Governing Body Meeting date 8th March 2022

Title of report Patient Safety and Quality Improvement report

Report author(s) Michelle Turner Gill Paxton

Lead(s) / SRO

SRO Michelle Turner Strategic Director of Quality and Nursing Dr James Thomas, Clinical Chair

Report lead(s) Michelle Turner Strategic Director of Quality and Nursing


This report provides an overview and key messages of the following:

• Quality and Safety headlines

• Living with Covid-19 – impact on services for patients and local people

• Overview of system health provider quality outcomes - provider specific (including General Practice and the Care Sector)

• Overview of outcomes for Vulnerable Children including the update regrading safeguarding children, sourcing packages for children with complex health and care needs.

• Overview of Medicines Optimisation and Research and Development (hosted service WYICS)

• Host commissioner responsibilities and the Learning Disabilities Review Programme Overview

• Overview of Personalised Commissioning

Each month the CCG’s senior leadership team has also received a more detailed overview of the emerging issues and the steps taken to mitigate. The System Quality Committee and its sub groups have also received highlight reports including an overview of steps to mitigate.






The quality and safety of services is core to the CCG’s strategy. Patient feedback is included within the paper and a more detailed overview will be considered at the CCG’s Quality Committee. Equality Impact Assessments have been conducted throughout the period and the outcomes have informed the CCG’s approach to risk assessment and to mitigation.

Purpose

assurance

information

decision


action


Recommendation(s)

of 2


• Note the information and assurance provided by the report, including key actions taken by the CCG to manage key quality and safety issues and risks.

• Note the progress regarding safe and wellbeing reviews for Bradford and the responsibilities of the West Yorkshire Integrated Care System.

• Note the increasing emphasis on ‘place’/’system and collaboration to address system pressures and impact on patient harm, and poor outcomes together, rather than on an individual basis with each provider, and the increase in emphasis to address functions once across the West Yorkshire Integrated Care System.


1. Governing Body Quality Report (March 2022)

Covid-19 Quality and Safety Related Issues and Risks

Governing Body

Quality Report

Michelle Turner

March 2022

SafeguardingMedicines

Optimisation

Patient

safety

Quality Improvement

Personalised

Commissioning

Research & development

Quality Update - Headlines• The System Quality Committee (SQC) in Jan 2022 was dedicated to the recognition of the

significant system pressures and risks associated with potential patient harm – staffing, vaccination hesitancy, mental health, Children and Young people (Inc. community paediatrics and safeguarding) maternity, elective care ( health inequalities/safety), Care Sector, Covid-19 Outbreaks, timely communication to enable people to live well. The System Ethics Committee agreed one approach to requirements for encouraging staff to be doubly vaccinated in light of national policy.

• Bradford Local Authority Children's social services- voluntarily to become a Children’s Trust. • Easements to death certification processes and cremation forms expire 24th March 2022• Overall projected Stroke performance (SSNAP) as at October 2021 is likely to fall from a C to a D in

the next publication. Clinical forum to discuss and Healthy Hearts programme to have oversight• Due to challenges in sourcing care packages some children with complex needs are experiencing

delays in discharge from the Acute Provider. Families are experiencing shortfalls in care provision placing them under increased pressure.

• Child Safeguarding Practice Review - The National Panel has requested a re-write of the report; the timeline for which is not yet determined. Publication will be delayed. A communication strategy is in place.

• An ICS response is sought to the increasing pressures across the system in sourcing providers to fulfil Continuing Healthcare packages for both adults and children at home.

• Ofsted have commenced their service inspection due 3rd Feb 2022, The SEND inspection will follow

Quality and Safety Headlines February 2022

Living with COVID-19 – Impact on Services for Patients/local people

• Bradford ‘Place’ met the ask of the Government to expedite the Covid-19 Vaccination Booster programme andoffered a Covid vaccine to all adults over 18yrs by 31st Dec 2021. Over 1 million vaccinations have been delivered. As of 5th January 2022 34.4%, of children aged 12-15 years in Bradford District have had their first dose and 80.6% of those eligible for their booster/third dose have received it.

• There are currently around 150 people with COVID-19 in the Care Homes who meet the threshold for Super Rota (SR) support, this is a significant increase ; the SR has increased to meet the increasing demand.

Discharge Planning;• The National ambition to reduce the number of patients who no longer meet the criteria to reside by 30% by the

end of January 2022 is being operationalised with the support of Bradford District and Craven ‘Act as One’ (Health & Care Silver emergency planning arrangements) with West Yorkshire Acute Providers focussing on reducing internal delays in each Trust by 60%. System delays related to social care, community services and other issues should reduce by 20%.

• Actions and themes are being identified including the need for; I. Data and definitions and consistency across WY ICS ( Integrated Care Services)II. Understand key interventions that workIII. Risk appetite using Gold arrangements in ‘Places’ to manage risk in placeIV. Culture of taking a partnership approach to tackling and transforming discharge agenda at place


Overview of system provider quality outcomes (BTHFT/ANHSFT/BDCT/Primary Care/Care Homes)

• Accident and Emergency attendances continues to increase across Place. Providers are operating at Opel 3 / 4

• Covid-19 outbreaks continue to affect the cohorting of patients and bed availability

• Staff continue to be redeployed to support clinical areas, staff sickness levels continue to be a challenge

• BTHFT has seen an increase in cases of MRSA (5 to date)

• BTHFT Elective restart: Same Day Emergency Care (SDEC) unit opened 7th February. 2 Ultra Green wards opening to support orthopaedic surgery.

• ANHSFT has ongoing challenges in finding placements for patients who do not meet criteria to reside

• BDCFT has commenced a pilot of its new Quality Assurance Framework, starting with 0-19 services

• System increases in demand for mental health services, is leading to increased waiting times for CAMHS and Children’s Mental Health Therapies.

• Adult Psychiatric Intensive Care Unit out of area placements remain high



Overview of system provider quality outcomes

• BTHFT and ANHSFT - Overall projected Stroke performance (SSNAP) as at October 2021 is likely to fall from a C to a D in the next publication. Clinical forum to discuss and Healthy Hearts programme to have oversight

• British Pregnancy Advisory Service (BPAS)- concerns raised from Leeds CCG of inadequate CQC reports following some patient safety incidents in Doncaster, Teesside and Merseyside in regard to Termination of Pregnancy services (TOP). Discussion with Quality leads for WY and at QLM.

• Yorkshire Ambulance Service (YAS) – continue to report Opel 4 activity level. Significant pressures re cat 1 attendance times, call rate, workforce. Risk mitigation includes; Strategic staff being redeployed to frontline duties, help provided by Military Aid to the Civil Authority and Army personnel currently training to drive ambulances (to non-emergencies).

• A collaborative approach is in place with all system partners to support Care Home Providers of concern through data triangulation, training, action planning, consultation, joint quality site visits and sharing of best practice

Overview of system provider quality outcomes

• BTHFT saw a slight reduction and Airedale Foundation Trust (AFT) a slight increase in A&E attendances inDecember;

• 18 week performance at ANHSFT in December was 76% with an increase to 441 over 52 week waiters and 29 >104weeks. BTHFT’s 18 week performance improved to 64.2% in December from 62.69% in October.

• November diagnostics performance BTHFT was 92.58% with December performance projected to be 92.85%, whilstperformance remains a significant challenge at ANHSFT with performance reducing to 80.93%. Increase in demandand workforce pressures continue to be the main areas of issue across the modalities with the main pressuresbeing Dexa, Echocardiology and Non-obstetric Ultrasound

• Provisional Early Intervention in Psychosis performance for the 3-month period October to December is 74.3%,remaining above the 60% target.

• Improving Access to Psychological Therapy services; waiting time performance remains stable, with 6-week and18-week targets consistently being met. However, the number of referrals remains below the contractual target.Following the dip in recovery rate in October to below the 50% target it recovered to 53.5% in November and50.7% in December.

• Mental health surge modelling to quantify the impact of Covid shows expected increases in referrals (compared to2019) of 35% to 40% for the second half of 2021/22



Overview of Children’s services – Vulnerable Children

• Impact of recent changes to Education, health and care plan (EHCP) tribunals is ongoing. Consent and Data Protection Impact Assessments (DPIA) issue now resolving with therapy services identified as key areas of service gap for children in education

• A Transforming Care/SEND Lead has been appointed to over-see the Dynamic Support Register (CYPDSR) and Children’s Care education and treatment reviews. The CYPDSR will include young people with a Mental Health condition only in additional to the children with Learning Disability and/or Autism requirements of the register.

• The CYP Mental Health and Crisis Annual report was received at to Overview and Scrutiny Committee 17th November 2021

• The 1st Act as One C&YP Partnership Board held 21st November 2021. The focus is on governance, interface with other Act as One boards and production and implementation of a strategic focus forward planner. ‘Joint’ commissioning intentions are under discussion at the community of practice group (co-chaired between CCG/LA) and feeding into the Commissioning Planning forum.


Overview of Children’s services – Vulnerable Children (2)

Children’s Autism (neurodiversity)• Reducing the waiting list: Contracts have been agreed with the external providers to provide c1000 assessments. • A pilot of moving from autism diagnosis to needs assessment across 3 localities is in planning

Children Looked After • Statutory Guidance requires an Initial Health Assessment to be undertaken as soon as practicable after a child

becomes ‘Looked After’ but within 20 working days of a child entering care, this target is not currently met.

Learning Disability • Work has been identified to develop the offer for CYP with a Learning Disability, including the development of a

diagnostic pathway• Improvements to alignment and communication across the SENDSPB and the MHLDND Board in relation to decision

making for Children’s LD/ND are underway

0-19 services & Local Authority residential provision• The 0-19 service activated its Business Continuity Plan in July 2020 due to recruitment issues. The BCP will continue

until Feb 2021 , after which there is anticipated reinstatement of core contacts for universal families from January onwards beginning with the 6 week contact and moving on to the antenatal contact being reintroduced in February. Further detail covered by Public health report to system wide groups and CSIB


Overview of Safeguarding Adults

• The Department of Health and Social Care has announced that the Liberty Protection Safeguards (LPS) will now not be implemented in April 2022 with the draft code of practice and supporting resources expected in early 2022

• 3 Domestic Homicide Review’s (DHR) and 5 Safeguarding Adult Review’s (SAR) are in progress and a further DHR scoping expected.

• WY ICS to review numbers of Court of Protection applications to determine whether a WY ICS solution can be found.

• The CCG has commissioned an external support to review how best it is using its safeguarding resource (adults and children) in line with the ICS and ‘place’ based strategies, partnership working with health sector and BMDC and North Yorkshire Council.

Overview of Safeguarding Children

• WY ICS to review increasing demand on safeguarding resources and how best to develop a bank of

independent authors.

• Demand for Rapid Reviews is extraordinarily high

• Continued concerns raised re the functionality of BDCFT Strategy team and a apparent 2 tier

system of information sharing across health community


Overview of system provider quality outcomes - Primary Care Update

• Due to ongoing system pressures the CCG Contract and Quality Assurance process has been paused with a review at the end of February 2022.

• To assist General Practice with the Covid-19 booster vaccination programme, the CQC has agreed to pause all inspections across general practice unless there are serious failings in safety which pose a risk to life or serious harm. This includes the new Access inspections which were due to commence 6th December 2021. This position is due to be reviewed at the end of January 2022.

• Bradford District and Craven CCG currently has 62 practices (this has reduced due to recent practice mergers) rated as Good with 3 practices rated as Outstanding following their most recent CQC inspection.

• Bradford Care Alliance (BCA) has been rated as ‘Requires Improvement’. An action plan has been submitted to the CQC and BCA are working towards these requirements.


Overview of Research and Development (hosted service WYICS)

• Report 20 of LAMP will be sent out this month as we continue to support the Anti-Microbial Resistance work taking place across the ICS health and care partnership

• We are continuing to build place based collaborations, Wakefield, Leeds and Bradford are set up to act individually and we will be setting up Calderdale and Kirklees as a joint place for research.

• We are working with general practices to start the PANORAMIC study, this trial is designed to look at the use of antivirals in a community setting News: Ground-breaking COVID-19 antiviral treatment trial opens to recruitment | NIHR

Overview of Medicines Optimisation

▪ Warfarin supply - BTHFT continue to issue warfarin but report difficulties in doing this with the drive-through model. Regular meetings looking at Any Qualified Provider (AQP) have now restarted

▪ Covid-19 Medicines Dispensing Unit (CMDU) for nMABs and antivirals. The local CMDU on the Airedale site, is operational now for oral treatment and IV treatment. However, the guidance has very recently changed – the ICS is working on a system response.

https://www.nihr.ac.uk/news/ground-breaking-covid-19-antiviral-treatment-trial-opens-to-recruitment/29515


Host Commissioner responsibilities for people with Learning Disability and Autism in inpatient settings and the Learning Disability Mortality Review Programme (LeDeR)

• Host Commissioner Quarterly Provider meetings have been completed as per plan. Also the Placing Commissioner Provider visits continue to be undertaken on a 6-8 weekly basis.

• Host Commissioner; Safe and wellbeing reviews and subsequent oversight panels are in train. There have been some challenges with access due to Covid 19 outbreaks. The ICS model has been tasked with implementing oversight panels for safe and wellbeing views for CCG and specials commissioning putting increasing pressure on ICS teams and CCGs. All 7 Bradford cases have been assessed. The ICS will have conducted oversight panels for 59 people by mid March 2022

• Ongoing discussions regarding the long term objective to provide a single Host Commissioner service across ICS

• Learning Disability Mortality Review Programme (LeDeR) process continues there are currently 125 cases across the ICS.

• LeDeR Governance arrangements have been finalised – reporting and learning from reviews will be held by the LD Health Inequalities Challenge Group (fully operational by April 2022).


Overview of Personalised Commissioning

Continuing Healthcare• A significant performance improvement– Q3 for 28 days at 97% (target 80%) for new referrals.

All other KPI’s have been achieved

• Fastrack referrals continue to fluctuate, investigation demonstrates this is due to COVID-19 impacts.

• The commissioned service for completing the Decision Support Tool (DST) backlog following the review work is commencing with adult social care.

• The CCG and BMDC is jointly funding a review of personalised commissioning arrangements and best use of resource ( Adults and Children) at ‘place’ and in line with regional and national best practice.

Children’s Continuing Care update• Pressures across the system are leading to challenges in sourcing providers to fulfil packages of

care for complex children, this may result in delays in discharge.

• In addition some children / Young People with complex needs and their families are experiencing significant shortfalls in care provision placing them under increased pressure

Happy, healthy at home in Bradford District and Craven

INITIAL CCG FINANCIAL PLAN FOR 2022/23

LOCAL ICS SUBMISSION - 18th FEBRUARY 2022


Financial Plan - Funding Basis for 2022/23

➢ Financial plan will be for the full financial year with a split to be determined for Quarter 1 (CCG)

and the rest of the year (ICB).

➢ The NHS is spending > Spending Review 21 (SR21) settlement and needs to bring spending

back in line with the SR21 settlement.

➢ Additional non-recurrent funding of £2.3bn is available to reduce the waiting list backlog, some

of which has been included in the ICB allocation with some being retained by NHSEI.

➢ ICS level funding envelopes are based on the H2 (2021/22) funding envelope x 2,

adjusted for:

- Removal of pay award back-pay funding for H1;

- Growth funding at 3.79% on core Programme resources (£36.8m for Place)

- A ‘convergence’ adjustment that moves that NHS back to spending in line with the

SR21 settlement over the next 3 years (£(6.1)m for Place);

- An additional convergence adjustment capped at 0.25% to move Places to their target

funding share of ICB resources. For Bradford this is a negative adjustment of £2.5m;

and

- Reduction in COVID support funding of 57%. (£(32)m for Place)


H2 Expenditure Budgets - Approach

➢ Initial Financial Plans Based on the following approach:

- Roll-forward of NHS Trust block contract values + 1.7% net tariff uplift as per planning

guidance;

- Activity growth of 2.08% applied to healthcare contracts;

- Convergence adjustment of (0.84)% applied to all programme cost areas except for Mental

Health, Primary Care and Better Care Fund;

- Planning to meet MHIS investment requirements (increase of 4.42%);

- Primary Care prescribing uplift of 2%;

- Better Care Fund uplift of 5.3% in line with planning guidance;

- Continuing care fee uplift of 6.5% (average);

- Contingency reserves have been set at 0.25% of resources following the approach set in

H2 (2021/22); and

- Savings target of 1.1% of CCG budgets excluding national tariff based contracts which is

consistent with the efficiency included in the national tariff.


CCG Plan – Movement from 2021/22 Outturnto the Opening Position for 2022/23.

Surplus / (Deficit)

£'000

Forecast Outturn for 2021/22 0

Adjustments:

Non-recurrent underspends -2,296

Release of Balance Sheet provisions -4,908

Loss of Elective Recovery Fund Income -1,429

Release of Uncommitted Reserves 1,613

Full Year Effect of Increased H2 Efficiency Requirement -2,328

Underlying Deficit Taken into 2022/23 -9,348

One-off benefits used in 2021/22.

Recurrent changes


CCG Financial Plan for 2022/23.

Surplus / (Deficit)

£'000

Opening Deficit -9,348

Adjustments:

Growth funding (core, primary care, community SDF) 45,911

Total Expenditure Uplifts -48,390

Convergence Adjustment - Resource Reduction -8,475

Convergence Adjustment - Expenditure Reduction 6,600

Additional Childrens Autism Capacity -700

Increase in Yorkshire Clinic contract to 2019/20 Baseline -2,154

Estimated Impact of Ending the Hospital Discharge Programme -1,460

Reduction in COVID funding -5,839

CCG Budget Savings Target 2,291

Underlying Deficit Taken into 2022/23 -21,564


ACTIONS WE HAVE TAKEN / SHOULD TAKE

➢ Maximise Cost Savings / Cost Avoidance

Medicines Optimisation

- The Medicines Optimisation team have produced a list of cost effective prescribing opportunities

which we need to prioritise for implementation.

- Make best use of additional pharmacy roles in PCNs to support more cost effective prescribing.

- Progress the implementation of a catheter formulary across primary and secondary care.

Personalised Commissioning

- Finish the work on reviewing the application of national framework criteria on determining

eligibility for continuing healthcare support.

- Assess the potential for more cost effective care packages through personal health budgets.

Estates Rationalisation

- Carry out a review across health, social care and third sector sites to assess the savings

potential.

Support Function Savings

- We are already taking costs out of CCG support functions, but these savings will be offset by

the additional costs associated with establishing the ICB. Further work is required to streamline

support functions across Place and the ICB and to avoid duplication.

Realise the efficiencies from our transformation programmes.


INITIAL 2022/23 FINANCIAL PLAN – PLACE

➢ OVERALL POSITION

CCG DEFICIT £(21.6)m

LOCAL TRUSTS £(23.8)m

TOTAL PLACE DEFICIT £(45.4)m

➢ NEXT STEPS

- CCG and Provider Peer review processes to test plan assumptions and consistency.

- Firm up COVID cost reductions and cost improvement / waste reduction plans to reduce

spend where possible.

- Consider any other flexibilities available to us to help manage the position.

- Produce updated plan positions taking into consideration local priorities and assess

deliverability at a Place level and at an ICS level.

CCG transition update

Governing Body

8 March 2022


Impact of legislation delay

• Date for dis-establishment of CCGs now 30/06/2022

• WY due diligence programme recommendations:

• CCGs / workstreams to complete final due diligence (end of April)

• Defer holding a (x5) CCG Audit Committee in common (May)

• Establish an ICB Audit Committee (shadow – May)

• WY team to develop a template to enable CCGs to identify outstanding activities / provide assurance on planned actions / identify leads for completion – as relevant/applicable post 1st July 2022


Further proposals

• WY team to provide documentation to form appropriate level of handover/legacy information to the ICB, including:

• Decision log

• CCG Audit Committee legacy briefing

• System Oversight Framework quality of leadership report

• The above documentation to be informed by engagement with:

• WY Future Design and Transition Group (FD&TG) members

• CCG leads

• Audit Yorkshire


Milestones

• 31/01 – WY due diligence plan approved by AOs/FD&TG

• 07/03 – due diligence programme progress update to AOs

• 09/03 – due diligence programme progress update to FD&TG

• 29/04 – final due diligence completed

• 27/05 – final due diligence presented, reviewed and supported by CCG Audit Committee in common, ICB Audit Committee (shadow), AOs and FD&TG

• 01/06 – CCG AO letter confirming assurance on completed due diligence sent to ICB Chief Executive (designate), cc’ing in NHSEI regional lead

CCG Transition milestone plan – Page 1 of 2Update:

Key:

28 February 2022

Complete On trackAt risk revised deadline Issues / Conditions

Them

es a

nd

wo

rk a

reas

Co

mm

un

icat

ion

s &

En

gage

me

nt

WY

H

Tran

siti

on

Q1 2021/22 Q2 2021/22 Q3 2021/22 Q4 2021/22 Q1 2022/23 Q2 2022/23p

eo

ple

Appendix 2

Missed and will be

completed shortly

HR support for staff issues

fortnightly/ monthly clinics

exit interviews offered for

all outgoing members

ICS staff transfer scheme /

orders inc TUPE

Transfer of staff from

other service providers

Identify all staff to be committed

by NHS BDC CCG to the ICS

Identify non-CCG staff (e.g. HR)

from outsourced service (TUPE

provisions)

appointment process for filling

wider staff structures within the

PBP operating model

appointment process for filling

senior post in the PBP operating

model

Comms & engage - staff side and

involvement with TUPE

Communicate the functions within

each portfolio

General communication with all

staff impacted at place, in all

aspects of transition

CCG to notify key stakeholders

prior to 1 April 2022

Internal comms plan

and approved by TPB

Go

vern

ance

Final - GB

Due diligence and transfer

estates and liabilities

Proposals for CCG shadow

governance arrangements

Identify legacy actions - based on

CCG duties and powers,

committee Terms of Reference

and forward planners

Data security and protection

toolkit for 2021/22

Transfer of all current

records/documents to ICS or to

place (as appropriate) and create

permanent archive for NHS BDC

CCG.

share CCG policies and

procedures with relevant ICS and

ICP work streams for harmonising

across WY and at place

Dissolve the CCG on the 30

June 2022

Respond to the ICS

due diligence –

coordinate response

Support the ICS with the NHSEI

sign-off process for property

and staff Transfer Orders

CCG functions

mapping information

supplied to the

programme support

for TOF TAF

Comms on the ICS

operating model

Proposed ICS portfolios completed

Detailed

structures for

ICS portfolios

completed

Function map

updated to include

operating model

and risk

assessment of

function transfers

Complete ICS

due diligence

baseline exercise

Regional director

to sign off ICB

Constitution inc

standing orders

Agreed

due

diligence

approach

CCG agreement

of approach to ICB

constitution consultation

Complete ICS due

diligence exercise

Internal comms plan

refreshed

Identify all staff to be committed

by NHS BDC CCG to the ICS

Identify non-CCG staff (e.g. HR)

from outsourced service (TUPE

provisions)

Detailed PBP staffing structure

Baseline due diligence

submission

Final due

diligence

submission

CCG Transition milestone plan – Page 2 of 2Update:

Key:

Complete On trackMissed and will be

completed shortly

revised deadline Issues / Conditions

Them

es a

nd

wo

rk a

reas

Lega

cyAppendix 228 February 2022

At risk

Esta

blis

h P

MO Establish PMO

Establish CCG Transition PB (mthly)

Agree PMO documentationBegin drafting PMO

documentation

End TPB

Report

monthly

Report

monthly

Report

monthly

Report

monthlyReport

monthly

Report

monthly

Fin

ance

–n

ot

up

dat

ed

fo

r M

arch

Info

rmat

ics

Pri

mar

y C

are

Q1 2021/22 Q2 2021/22 Q3 2021/22 Q4 2021/22 Q1 2022/23 Q2 2022/23

PCCC agree legacy

handover docs/actions to

ICSNew gov arrangements for primary care

delegated commissioning

Agree with ICS/NHSE re; primary care

functions at place or ICS level

Working through

baseline of due

diligence checklist

Housekeeping

of ledgersWorking through final due

diligence checklist

Working through

baseline of due

diligence checklist

Working through final due

diligence checklist

Destroy seal

Handover draft Annual

Reports inc AGS for 2021/22

for NHS BDC CCG

Archive NHS BDC CCG

website & intradoc

Notify the Information

Commissioner Officer of

closure of CCG (with support

of IG team)

Records Management

(archive etc inc: Covid-19

inquiry preparation and

related legacy)

Report

monthly

Report

monthly

Report

monthly

Report

monthly

System/software

contracts review

Report

monthly

of 2


Agenda item 8iii


Title of report Transition of CCG to place-based partnership governance arrangements

Report author Liz Allen

Lead Liz Allen Report lead Liz Allen


A development session was held on 9th February 2022, its purpose being to consider and debate proposals to manage the transition from CCG to Bradford District and Craven (BDC) place-based partnership governance arrangements. (Please see Appendix 1 for the slides used that day). Invitees to the development session included the CCG Council chair, members of the Governing Body, Senior leadership team (SLT), Associate leadership team (ALT), Associate clinical directors (ACDs), and colleagues from external and internal audit organisations (KPMG and Audit Yorkshire).

Key points from the discussion related to future place-based partnership governance arrangements and leadership; the links with the West Yorkshire Integrated Care Board (ICB) in terms of mapping functions and decisions; proposals for moving from existing CCG to future BDC place-based partnership arrangements and the transfer of responsibilities; a suggested timeline for transition to the end of June 2022 culminating in new arrangements applicable from July.

Other proposals were considered in relation to specific bodies, committees and sub-committees including the CCG Council, Governing Body, SLT, Audit and Governance Committee, Finance and Performance Committee, Quality Committee and IFR Panel.

Most proposals received broad support with some amendments and the following points made:

1. The proposals should be taken to the next Audit and Governance Committee (28/02/22) for any amendments, followed by the Governing Body (08/03/22) to finalise recommendations to the CCG Council (23/03/22)

2. There should be a final Governing Body meeting held in public after 14 June (when the Audit and Governance Committee meet to receive the draft annual report and accounts) and prior to the closedown of the CCG on 30 June

3. The purpose of holding the final Governing Body in late June would be to enable and ensure a controlled closedown of all internal governance arrangements.






The responsibility for achieving the CCG’s vision via our four strategic ambitions is carried through our strategic decision making, governance arrangements and assurance mechanisms – all of which rest collectively with the CCG’s various bodies, committees, and sub-committees referenced above.

of 2

Purpose

assurance

information

decision


action


Recommendation


1. Consider the proposals outlined in the slides at Appendix 1 and the points summarised above along with any further changes proposed by the Audit and Governance Committee (which met on 28/02/22) and advise any final amendments that should be made.

2. Approve the recommendations for the transition of CCG to place-based partnership governance arrangements to the CCG Council meeting on 23/03/22.

3. Support the proposal to hold a final Governing Body meeting in late June 2022 to enable and ensure a controlled closedown of all internal governance arrangements.


1. Transitional arrangements from CCG governance to BDC partnership governance – proposals considered and debated at the development session held on 09/02/22 (slide set)


Development session

(GB / SLT / ALT / ACDs)

9th February 2022: 13.00 – 14.20

Transitional arrangements from CCG

governance to BD&C partnership governance

Helen Hirst, Robert Maden, Liz Allen, Gill Paxton, James Drury

Future BD&C Partnership governance


Key responsibilities Connects to

Wellbeing

Board

• Determines health and wellbeing needs of population

• Sets overall place strategy for health and wellbeing

• Convenes partnerships to act on needs and strategy

• ICS Partnership Board –

ensures BD&C health and

wellbeing needs recognised in

ICS

• A committee of the Council

BD&C

Partnership

Board

• Determines BD&C health and care partnership plans in

response to population needs, and in context of overall

strategy.

• Delegated responsibility for use of NHS resources and

delivery of NHS requirements.

• Leads the local partnership, taking the big decisions –

strategy, money etc. Therefore utmost probity and

transparency essential.

• Enters into s.75 agreements with Councils.

• Primary accountability to ICB –

a ‘committee of’

• Local assurance to Wellbeing

Board

• Lead connection between

place and ICS, provider

collaboratives, and individual

partner organisations.

Partnership

Leadership

Executive

• Strategic partnership delivery and operation

• Strategic connectivity with other elements of ICS

• Accountable to the BD&C

Partnership Board

• Key support for place lead

Partnership

Leadership

Team

• Leadership and management to ICS place based staff

• Day to day partnership delivery and operation

• Day to day connectivity with other elements of ICS

• PLE

• CEO sponsors

• ICS place based staff

Future BD&C Partnership leadership

Governing Body

Rem

unera

tion

Co

mm

ittee

Au

dit &

Go

ve

rna

nce

Com

mitte

e

Senior Leadership

Team

Ind

ivid

ua

l

Fu

nd

ing

Re

qu

ests

Pa

ne

l

Asso

cia

te

Le

ad

ers

hip

Te

am

CCG Council

Prim

ary

Ca

re

Co

mm

issio

nin

g

Co

mm

ittee

Co

ntra

cts

Assu

ran

ce

Gro

up

Qu

ality

Co

mm

ittee

Fin

an

ce

&

Pe

rform

an

ce

Co

mm

ittee

Current CCG governance structure

Simplified version of ‘old’ to ‘new’

Existing CCG arrangements

CCG Council

Governing Body

Senior Leadership Team

Finance and Performance

Committee

Quality Committee

Primary Care Commissioning

Committee

Future BD&C arrangements

West Yorkshire Integrated Care

Board

BD&C Partnership Board

Partnership Leadership Exec

Partnership Leadership Team

System Finance and

Performance Committee

System Quality Committee

Primary medical care function

Timeline for transition

January – March 2022 April – June 2022

Governing Body

Senior

Leadership Team

F&P Cttee

Quality Cttee

Audit Cttee

PCCC

Rem Com

Members have joined system F&P committee already and will work through it until July.

Members have joined system Quality committee already and will work through it until July.

= formal closure

Continues to operate until July.

Continues to operate until July.

Remains established until July, but will not meet unless issues arise that require it to.

Continues to operate until July.IFR Panel

Remains established until July, but will not

meet unless issues arise that require it to.Continues to meet until 23rd March

Continues to meet until 8th March. May meet

in April if formal sign off of year-end requiredRemains established until July, but will not

meet unless issues arise that require it to.

CCG Council

Continues to meet

weekly until end of FebMeets once a month until the end of June. ‘PLT’ meetings

begin on the other weeks

Commencing new arrangements

January – March 2022 April – June 2022

Partnership

Leadership Exec

Partnership

Leadership Team

BD&C F&P

Committee

BD&C Quality

Committee

BD&C People

Committee

BD&C Citizens

Forum

BD&C Clinical

Forum

HCPBs

Development sessions and Chair recruitment

Group meets monthly now – in effect in shadow form. ToRs to be revised to reflect additional

responsibilities which formally commence in July

Partnership

Board

Membership changes in

readiness for transitionWeekly ‘PLT’ meetings commence – in effect in shadow

form pending formal delegation

July

Meet bi-monthly in shadow form, plus further

development sessions in between


responsibilities which formally commence in July, when will formally meet bi-monthly


responsibilities which formally commence in July, when will formally meet bi-monthly

Groups meet monthly now. At this stage no formal delegation, so responsibilities unchanged by July

transition

Development sessions (existing

involvement arrangements continue)

Meet in shadow form, plus further



responsibilities which formally commence in July

Predecessor groups meet now. ToRs and

membership to be revised

Meet in shadow form, plus further


= formal start

Transitional proposals

• Next (and probably final) meeting will be held on 23rd

March 2022

Agenda to include:• Consider / approve proposed transitional governance

arrangements (1st April to 30th June)• Reflection on (and thanks for) primary medical care

clinical leadership into strategic commissioning• Discuss future opportunities for practice engagement

CCG Council


• Next (and probably final) meeting will be held on 8th

March 2022

Agenda to include:• Consider transitional governance arrangements (1st April

to 30th June) • Agree recommendations to be presented to following

CCG Council• Agree any requirements / circumstances that may

require GB members to meet (e.g., 2022/23 Q1 budget)

Governing Body


• SLT weekly meetings cease at end of February

Proposed transitional arrangements (1st March to 30th June):• Week 1: PLT development• Week 2: extended PLT (includes ALT, staff networks)• Week 3: PLT• Week 4: SLT (includes monthly finance, performance,

quality and CCG transition reports + CRR and CAF)• Week 5: PLT (March and June)

Senior Leadership Team

Now through to the 30th June 2022

• Normal business meeting on the 28th February – including External Audit Plan for 2021/22 audit, CCG Transition and ICS Due Diligence Update, and IG Update.

• Meeting on the 10th May - to consider the draft Annual Report and Accounts, draft Head of Internal Audit opinion, draft Annual Governance Statement and External Audit progress report.

• Meeting on the 14th June – to receive the final Head of Internal Audit opinion, to receive the External Audit Annual Report and ISA 260 Report, approve the Letter of Representation and approve the Annual Report and Accounts.

Also to receive the final CCG transition report and agree the final legacydecision log for handover to the ICB.

Audit Committee

Now through to the 30th June 2022

• CCG Finance & Performance Committee stepped down from January 2022.

- assurance on 2021/22 CCG financial and operational plan target performance through monthly SLT session.

- assurance on CCG financial and operational plan target performance seen within the context of Place through Lay Member attendance at the System Finance & Performance Committee.

- Minutes from System Finance and Performance Committee reported to the CCG’s Governing Body.


Planning for 2022/23 and CCG Plan for Quarter 1

• Planning for 2022/23 will be for the full 12 month period with Place plans being aggregated to produce a West Yorkshire ICS financial and operational plan.

• The Bradford Place plan will be considered by the System Finance and Performance Committee at a single item agenda meeting on the 14th April and a recommendation made to the Place Leadership Executive for approval of the Plan.

(need to understand timings for the Partnership Board where Plan approval will be given).

• For planning purposes, the full year plan will be split between Quarter 1 and the rest of the year to create a Quarter 1 plan for the CCG. The recommendation from the System Finance and Performance Committee will include this split and will seek approval for the full year plan for 2022/23, along with the Quarter 1 CCG element.

• In Quarter 1, the resource allocation will be matched with expenditure to give a balanced position for the CCG.


Transitional and future proposals

• CCG monthly IFR panel meets to end of June

Proposals (July onwards) from WY to the current CCGs:• Work to common set of policies• Weekly triage meetings (WY core + 5 places) to make

decisions about cases that can be resolved outside of, or do not need to come to, panel

• One (joint) monthly panel meeting to consider cases requiring shared decisions

IFR Panel


SafeguardingMedicines

Optimisation

Patient

safety

Quality Improvement

Personalised

Commissioning

Research & development

How will Quality

Oversight be

undertaken at

Bradford Place Based

Partnership?

Gill Paxton

Feb 2022

Quality Governance at the Place

Quality Governance at Place

SYSTEM QUALITY

COMMITTEE

Quality oversight

safety /

performance/

learning

Culture of Quality

Improvement and

learning

Learning from deaths

Strategic risks,

statutory duties and

oversight assurance

framework

Vulnerable children

– improving

outcomes

Adult social care

temperature check and

improving outcomes

Safeguarding Adults

and Children - health

Medicines safety

Health Protection

Health inequalities and inclusion and hard and soft intelligence

Focus on - Quality Oversight Operationally

QUALITY OVERSIGHT

MEETING

1.Quality

Oversight with

Provider

2.Patient Safety

Strategy

3.Attend

Governance and

sub groups

4.Utilise pre-

existing

Governance

meetings

5.Proactive

emerging quality

issues

6.Patient

feedback

7.Pre-scheduled

learning events /

conferences

8.Planned quality

summits

9.Reactive quality

‘task and finish’

groups

10.Quality

Oversight across

Place

How will this Quality Oversight Meeting function?

Interrogating quality and safety data to understand the status of service provision across Place.

Using intelligence from a number of sources to contextualise quality and safety data, identify emerging

issues, or assurances and prioritise areas for collective improvement activity.

Identifying and reviewing national or local guidance that will have implications for quality and safety

and, where action is required that sits outside of individual providers, commissioning activity to address the

implications through the establishment of working sets with the specific skills and knowledge to make the

necessary changes.

Identifying improvement opportunities and shared learning as a result of shared intelligence and,

where this sits outside of individual providers, commissioning activity to drive improvement through the

establishment of working sets with the specific skills and knowledge to drive the improvement identified.

Overseeing the delivery and impact of working sets commissioned by the group

Undertaking reviews of Quality Impact Assessments for system programmes of work and make

recommendations to inform business plan development

Providing assurance to the System Quality Committee and escalation of unmitigated risks to quality and

safety

Next steps • Continue to support the development of the bubble workstreams, utilising the SQC sub group to ensure

progression, effective governance and all statutory requirements are met

• Continue to build on the relationships, culture and the strength of Place

• Extend the membership of the Quality Oversight meeting function, recognising the pace of change varies

with individual organisations

• Test and evaluate the functionality of the SQC through audit, membership feedback and peer review by

system partners

• Strengthening relationships with Peoples Committee, Citizens Forum, Clinical Forum to ensure robust

governance and challenge

What is the impact of the delay in the ICS roll out? • Shadow form has been developed over the past 6 months, with attendance at Provider meetings, One to

One meetings with Provider and CCG colleagues, one version of the truth SQC slides,

• CCG Quality committee has stopped, CCG Statutory functions are being discharged through SQC

• Alignment of the lay members to the “bubbles” that feed into SQC, to utilise their expertise and ensure

the proposal for how the “bubbles” will operate is safe and effective

1

Official

Publication approval reference: B1423

To:

• Designate ICB CEOs and Chairs

• CCG Accountable Officers and Chairs 3 March 2022

Dear colleagues Change in target date for ICS implementation to 1 July 2022: next steps I am writing further to my letter of 24 December 2021 that confirmed the change in target date for ICS implementation outlined in the 2022/23 Priorities and Operational Planning Guidance. This letter and its annexes set out further details to support planning and preparations for the revised timeline. We have been working closely with DHSC to ensure that our approach to preparing for the introduction of statutory ICS arrangements, including the establishment of Integrated Care Boards (ICBs) in every system, is aligned with the legislative process. The revised target date of 1 July was agreed based on DHSC’s belief that the legislation will be in place, and that this date is operationally achievable. This remains the case, but the implementation of new statutory arrangements remains subject to the passage of the Bill through Parliamentary procedures. We have now revised the milestones for preparatory activity and have issued an updated ICB establishment timeline that reflects the new target date. This can be found on the FutureNHS platform. Thank you to colleagues who have helped inform these revised plans that support the practical actions to prepare for the new arrangements. Until the commencement of the future statutory arrangements:

• CCGs will remain in place as statutory organisations. They will retain all existing duties and functions and will conduct their business (continuing to work collaboratively in cases where there are multiple CCGs within an ICS footprint) through existing governing bodies.

• CCG leaders are asked to continue working closely with designate ICB leaders on key decisions that will affect the future ICB, notably planning, commissioning and contracting.

• NHS England and NHS Improvement (NHSEI) will retain all direct commissioning responsibilities (other than those already delegated to CCGs).

During this transition period we need to be able to operate under the existing statutory framework while making effective and appropriate preparation for the

Skipton House 80 London Road

London SE1 6LH

https://future.nhs.uk/ICSGuidance/viewdocument?docid=113833861

2

legislative changes. In Annex 1 to this letter we provide a short summary of key elements of the transition activity, including:

• Assurance of progress to establish statutory ICBs in every system

• Supporting the revised timing for people change as teams move into new organisations and as new leadership teams are established

• Arrangements for transition governance including managing joint working between CCGs and designate ICB leaders

• Implications for finance and contracting with a brief summary of wider guidance on allocations, financial planning, contracts, running costs and accounts

• Practical handling of preparations for changes to ICS boundaries

• Maintaining momentum of the Integration White Paper

• Revised timelines and process for delegation of commissioning functions from NHS England

• The details of key guidance to support ICS implementation In Annex 2a and 2b we have set out the approach to transition of Commissioning Support arrangements when ICBs are established. Our expectation is that all current services delivered to CCGs by a Commissioning Support Unit (CSU) will continue to be provided to ICSs/ICBs unless there is a clear rationale for alternative arrangements, whether that is in-house or through a different provider. The attached note asks systems to review existing support arrangements across their systems, including CSU provision and submit a summary of their intentions by 29 April 2022 using the attached template. I would like also to thank you for your ongoing flexibility in responding to the change in the ICS implementation target date, especially in view of the current operational challenges. Our NHSEI regional teams, along with the relevant national leads, will continue to support you in all the preparations for the new statutory arrangements taking effect and for the future development of your integrated care systems. We are planning to invite designate ICB Chief Executives and Chairs to come together in-person on Wednesday 6 April to share experiences and ambitions across the country to further develop our approach to system working. We will circulate more information and invites in due course, and I look forward to seeing you there and our continued work together. Best regards

Mark Cubbon Chief Delivery Officer

3

ANNEX 1: Updated arrangements for key elements of transition Please note: All elements below are subject to passage of the Health and Care Bill and may change until the Bill passes through Parliament and receives Royal Assent. Assurance of progress We have heard a strong message from system leaders that you wish to keep up the momentum towards preparation for the future arrangements for ICSs. The revised target dates in the programme plan reflect this, with existing dates maintained where possible, and a small number adjusted to reflect the extended preparatory period. Notably, systems are now asked to send in their next readiness to operate assessment and refreshed System Development Plan by 31 March 2022 describing readiness for 1 July 2022. People change

Supporting our people through change is a priority. We are supporting system

leaders to manage the transition through establishing their designate leadership

teams for the ICB as soon as is practicable and preparing for formal transfers of

CCG staff into new ICBs on the new target date of 1 July 2022. Significant progress

has been made in this regard already, signalling clear commitment to maintaining

momentum, development of leadership relationships and strong progress towards

establishment readiness for the target date.

The Planning Guidance confirmed that the employment commitment for

colleagues below Board level remains in place until 1 July. Further implications of the

change in target date are being explored with trade unions and employers, and the

HR framework and FAQs will be updated accordingly. We expect to issue these

updated documents within the next month.

We have now agreed arrangements for the ICS executive pay framework with

DHSC and further guidance on its implementation will be shared this week. Pay

discussions with prospective candidates can now be concluded with reference to the

guidance and subject to the requisite approvals from NHSEI and ministers.

We are working with colleagues to encourage diversity in senior teams and are

being actively supported in this important area by NHS Confederation. Updated

information on accessing this support and advice is available on the FutureNHS

platform.

CCGs/ICBs should also ensure that they are aware of the HM Treasury Guidance on

public sector exit payments. All special severance payments must be approved by

HMT before any payment is made. NHSEI is currently reviewing its guidance on

approval for special severance and contractual exit payments and an updated

guidance note will be issued in due course.

https://future.nhs.uk/ICSGuidance/grouphome

https://nhsengland.sharepoint.com/TeamCentre/Finance/FinancialControl/Pages/GCh23.aspx

https://nhsengland.sharepoint.com/TeamCentre/Finance/FinancialControl/Pages/GCh23.aspx

4

Transition governance We will support CCG and designate ICB leaders to ensure that the responsibility and governance for commissioning activities through the transition is clear, and that there is effective transfer of statutory responsibilities from CCGs to ICBs when they are established. While CCGs maintain their responsibilities and statutory duties through the transition period and up to the commencement date when the future arrangements become law, it will be important that designate ICB leaders take shared responsibility for the transition and the arrangements developed during the preparatory period. We recognise that CCG and designate ICB leaders will be working closely together to ensure continuity. As set out in the Planning Guidance, CCGs are asked to confirm and agree with designate ICB leaders any material decisions impacting on the future operation and commitments of ICBs. This approach also should be applied to decisions on commissioning services from CSUs (see Annex 2), where no services should transfer prior to April 2023. For very exceptional cases (where extenuating circumstances apply) regions may present cases to a panel setting out the rationale, impact and risk to the wider system of any proposed change. Finance and contracting Draft guidance on financial arrangements during the transition has been shared

through regional finance teams. This covers several processes affected by the

revised target date. In summary:

• Systems (based on future ICB footprints) continue to be the primary planning unit.

• Full-year system-level financial plans for 2022/23 will need to be set out by CCGs, so that allocations and reporting continue at this level while CCGs continue to operate. Plans and allocations will then be brought together upon ICB establishment.

• CCGs will receive an allocation from 1 April 2022, and they will need to agree contracts with providers. Upon establishment, ICBs will receive their system’s remaining allocation for the financial year and contracts will transfer to the relevant ICB through a nationally agreed transfer scheme. For ICBs established from multiple CCGs, we recommend consistent local contractual terms to ease the transition to a single ICB contract.

Further guidance to be aware of:

• Financial commitments on the mental health investment standard (MHIS) and minimum contributions to the better care fund (BCF) contributions are required and will be monitored based on the footprints of future ICBs on a full year basis.

• Capital allocations and planning continue as planned, as these are not significantly impacted by the new target date.

5

• Running cost allowances will be set for CCGs and the spending against these limits will reduce the remaining allowances for ICBs upon establishment. We’re working with regional teams to understand where the new target date may cause an unavoidable additional pressure.

• Financial accounts are required for CCGs up to ICB establishment, i.e. 3 months for CCGs and 9 months for ICBs in 2022/23. We currently expect there will be one audit process at the end of 2022/23 to cover both, but this is subject to further discussion with audit firms and NAO agreement.

• Areas affected by boundary changes need to agree the appropriate resources for Quarter 1 which will be allocated back to the current host CCG during that period. Planning templates enable this information to be captured and we will continue to work directly with those affected systems.

Changes to ICS boundaries Having engaged with the small number of CCGs affected by system boundary changes, NHSEI has taken the decision not to pursue implementation of boundary changes at CCG level on 1 April 2022. Instead, the system boundaries decided by the Secretary of State last July will come into effect when ICBs are legally established on 1 July 2022. The specifics of the operational and financial impact of this position are being managed with the seven affected CCGs and their ICSs. Integration White Paper The Government’s Health and Social Care Integration White Paper (IWP) Joining Up Care for People, Places and Population was published on 9 February. This sets out the Government’s thinking on how NHS and local government partnerships can go ‘further and faster’ across the country, building on existing legislative and policy reform including the creation of ICBs and ICPs, and our guidance on Thriving Places, that was developed jointly with the Local Government Association. The White Paper sets out policy proposals in four areas:

• Shared Outcomes

• Leadership, Oversight and Finance

• Digital and Data

• The Health and Care Workforce and Carers

As a White Paper these are policy proposals, subject to consultation. We will continue to work closely with Government as they engage on these proposals. We are meeting with system leaders, via regional teams, to hear initial feedback and we encourage colleagues to respond to the consultation directly. During this process designate ICB leaders should continue work with their local authority and other partners to progress the development of their place-based arrangements, in line with existing ambitions and the direction described in Thriving Places. We will provide further guidance if necessary, following the engagement exercise. Over the course of 2022/23 we will work with each system to support the development of their place-based partnership arrangements as required.

https://www.england.nhs.uk/wp-content/uploads/2021/06/B0660-ics-implementation-guidance-on-thriving-places.pdf

https://www.england.nhs.uk/wp-content/uploads/2021/06/B0660-ics-implementation-guidance-on-thriving-places.pdf

6

Delegation of commissioning functions from NHS England We are currently supporting those systems which are preparing for their ICB, when established, to take on delegated dental, general ophthalmic services and/or pharmaceutical services functions from the point of commencement. We expect that NHS England’s Board will be able to make a final decision over the delegation of these commissioning functions to these specific ICBs after Royal Assent of the Health and Care Bill and in advance of the 1 July target date for implementation. We expect to delegate these functions to all remaining ICBs from April 2023. NHS England will retain ownership of the commissioning allocation and functions for specialised services in 2022/23. Updated guidance to support ICS implementation All resources for ICSs to support preparation for implementation are available on the FutureNHS platform. As noted there, current references to 1 April 2022 (subject to the passage of legislation) as a date for implementation of the new arrangements should now be read as 1 July 2022 (subject to the passage of legislation). To avoid undue burden, existing guidance will not be reissued if the only significant change is in relation to this implementation target date. The key resources that are available to support systems in their development and preparation for future arrangements include:

• Integrated Care Systems: Design framework

• Interim guidance on the functions and governance of the integrated care board. This references the draft Model Constitution for ICBs with the latest amendments to ICB membership and disqualification criteria.

• Guidance on the employment commitment (to be updated to reflect new timeline)

• HR framework for developing integrated care boards (to be updated to reflect new timeline)

• Operational planning and contracting guidance 2022-23 including supporting guidance on financial arrangements for the new target date

The full suite of resources on Integrated Care Systems functions and transition is available on FutureNHS (requires a login).


https://www.england.nhs.uk/wp-content/uploads/2021/06/B0642-ics-design-framework-june-2021.pdf

https://www.england.nhs.uk/wp-content/uploads/2021/06/B0886_Interim-guidance-on-the-functions-and-governance-of-the-integrated-care-board-August-2021.pdf

https://www.england.nhs.uk/wp-content/uploads/2021/06/B0886_Interim-guidance-on-the-functions-and-governance-of-the-integrated-care-board-August-2021.pdf

https://www.england.nhs.uk/wp-content/uploads/2021/06/B0724-employment-commitment-guidance-supporting-ics-v1.pdf

https://www.england.nhs.uk/wp-content/uploads/2021/06/B0790_ICS_HR-Framework-Technical-Guidance_FINAL18Aug.pdf

https://www.england.nhs.uk/operational-planning-and-contracting/


7

ANNEX 2A and 2B - Draft Service Support Plan guidance Development of ICS Service Support Plans 2022/23 We are asking all ICSs to review existing support arrangements including CSU provision across their systems and submit a summary of their intentions by 29 April 2022. Background As progress continues towards developing integrated care systems, it is important to understand the wider support service needs across the whole system. To achieve this end, all ICSs are being asked to confirm their existing and future requirements for support services. In particular, there is a need to understand arrangements with NHS Commissioning Support Units (CSUs) ensuring they are aligned into the future needs of the ICBs and wider systems. A national and regional strategic review of CSU services during the summer of 2021 agreed that nationally delivered CSU services would continue for the next two to three years and local arrangements would remain in place until at least April 2023. This was in order to ensure continuity of support during the transition towards ICBs. The expectation from NHS England/Improvement is that all current services delivered to CCGs by a CSU will continue to be provided to ICSs/ICBs unless there is a clear rationale for alternative arrangements, whether that is in-house or through a different provider. CSUs have been asked to work with national users, regions and ICSs to understand and help plan the future requirements. The information gathered will be used to ensure CSUs continue to be able to deliver value for money, at scale high quality support services to integrated health care systems. That is why we are now asking all ICSs to review existing support arrangements including CSU provision across their systems and submit a summary of their intentions by 29 April 2022. Plans should be completed in dialogue with your nominated NHS England/Improvement regional lead and submitted to [email protected]. A template (attached) has been developed to help the development of the ICS Service Support Plan. ICSs are asked to set out the direction of travel for their future service provisioning model, including what support services are currently commissioned and any intentions for future service requirements. If there is any anticipated change to the CSU current provision, the plan should set out the rationale for that change. Where detail is available, we would ask you to include as much as possible, but in the event of little or no information yet being ready, an indication of that position would also be helpful. All ICS Service Support Plans will be considered by the Regional Team in the first instance. Consideration will be given to the impact across the region and to national delivery. Where plans identify changes to existing delivery arrangements, the ICS will be invited to submit a more detailed plan/business case. A nationally constituted

mailto:[email protected]

8

panel will be established to consider the proposed case in more detail. This approach is being put in place to ensure any transitions are effectively managed, mitigating risks and potential for destabilisation across the wider system. The plans will remain confidential and will not be shared outside of NHSE/I. Where a business case is successful the managed transition of the service will be over a minimum period (as decided by the national panel). Timeline for service transitioning: April 2022: Service support plan submission May 2022: ‘Check and challenge’ June 2022: Panel discussions July 2022: Business case submission Where there is no change to service provisioning indicated or where the region deems the service not appropriate to transition at this stage the ICS will be asked to continue with the existing CSU services. Please complete the attached template (Annex 2B) and return to [email protected] by 29 April 2022.


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Agenda item 9

Name of meeting Governing Body Meeting date 08/03/2022

Title of report Commissioning Assurance Framework (strategic risks)

Report author

Carrie Haywood Senior governance and resilience manager (with support of Bev Denton & Catherine Smith)

Lead / SRO Liz Allen, strategic director of organisation effectiveness

Report lead Carrie Haywood


Introduction

The commissioning assurance framework (CAF) focusses on the most strategic and long-term risks to the delivery of the CCGs’ strategic objectives and as such is strongly aligned to our CCG Commissioning Strategy (2020). The commissioning assurance framework was received by the Governing Body on the 9 March 2021 when it was agreed to receive it three times a year. During 2021/22 the commissioning assurance framework has been taken to Governing Body on the 13 July 2021 and 9 November 2021 and will be taken to Governing Body 8 March 2022. Background Below provides a brief description of the purpose of the CCG’s commissioning assurance framework. An assurance framework is a comprehensive method for the effective and focused management of principal risks to meeting strategic priorities as derived from our strategy. It is a high-level view of risk which sits above a corporate risk register and deals with strategic and long-term risks. In simple terms, the CCG’s commissioning assurance framework sets out our strategic objectives and the risks to achieving these.

• Risk grading A risk can be defined as “an uncertain event or series of events that, should it occur, would have an effect on the achievement of objectives” and is measured in terms of impact and likelihood. Risk scores (both current and target) are calculated by multiplying the potential impact or severity of impact by the potential likelihood or frequency level to provide a risk score using a 5 x 5 matrix scoring system which produces a range of scores from 1 to 25. [Likelihood x impact = risk score]. The risk score determines the prioritisation and allocation of resource. Higher scores have a higher priority for action, as the impact of failing to reduce the risk is greater, the risk score is assigned grades as follows: Table 1: grade of risk

Score Risk level / grade

1-3 Low

4-6 Moderate

8-12 High

15-16 Serious

20-25 Critical

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• Key controls Relate to management actions such as systems, processes, mechanisms already in place and gaps in control are where there are plans in place to a specified timeframe but are not yet in-place.

• Assurance Relates to what mechanisms are in place to provide evidence of management actions and can include but are not limited to - key performance indicators, oversight groups / committees or other reporting assurance mechanisms such as internal audit reports or reviews by regulatory bodies, etc. Gaps in assurance can occur when no mechanism in place to report on progress or performance is below target For any gaps in control or gaps in assurance associated actions are set out within the commissioning assurance framework with timeframes to redress the associated gap. Triangulation with the corporate risk register is provided whereby any related corporate risk and associated score is provided. Finally, a progress update summary of key changes is provided for each strategic risk.

• How we use the CAF As well as providing an important tool of assurance for the Governing Body, the commissioning assurance

framework is also reviewed by our senior leadership team and the associate leadership team. With the aim

of broadening out the use of this framework to facilitate and engage our leaders and decision makers with

the strategic risk management process.

• Future of the CAF The next and final CAF cycle run from 27 April 2022 which will allow all risk owners and leads to help shape the final CAF document which will be part of a suite of legacy documents in relation to the closedown of the CCG as part of the due diligence work. During this cycle the development of the Place based partnership assurance framework will run in parallel. The commissioning assurance framework update (December 2021) The commissioning assurance framework is set out within Appendix 1 and has two tables, the first provides

a summary and the second provides the detail for each of our strategic risks.

• Key changes for this cycle 3 (December 2021: including risks with increased and reduced scores and a new risk)

o 3.1 Addressing the gaps in the quality and outcomes of our health and social care: the

score has increased due to capacity within the system arising from COVID pressures and

capacity. Attrition rates and sickness absence is higher, and expressions of workforce are related

to a workforce struggling with fatigue - recommendation agree increase in risk score

o 3.3 Partnerships as the vehicle for enabling people to take more responsibility for their

health and self-care: A new risk has been developed due to the rise in RAAC incidents at

Airedale General Hospital alongside uncertainty of securing national capital funding to build a

new hospital. In the event of RAAC failure then this would ultimately result in loss of services for

the local population, should the known structural issues lead to total and permanent premises

closure. – recommendation is to review and agree new risk

o 4.1 repurposing of programmes due to COVID19: The score has decreased due to the

planned COVID19 pandemic omicron surge response in December 2021, the covid command

arrangements and hub were re-established, drawing upon the core transformation team

resource– recommendation agree reduction in score

The table below provides a summary of the strategic risks and their current scores. Table 2: Commissioning assurance framework strategic risk summary

Strategic risk Movement

since last cycle

1.1 there is a risk of failure to improve population health outcomes and to reduce health inequalities due to COVID19. Poor outcomes and health inequalities have been highlighted by the COVID19 pandemic with both direct and indirect impacts of

20 ↔

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COVID19 on the economy, education as well as the physical health and mental wellbeing of our population particularly those living in the areas of worst socioeconomic deprivation

2.1 there is a risk due to the growing financial pressures created by an increase in demand for services could result in agreed strategic and operational plans to deliver improved health and care not being realised

16 ↔

Strategic risk. continued… Movement

since last cycle

3.1 there is a risk that unwarranted variations in quality and care cannot be effectively addressed due to shortfalls in workforce capacity, capability and skills resulting in failure to close the care and quality gap (across BdC)

20

3.2 there is a risk that our efforts may not have the impact we desire due to some determinants of quality and outcomes which lie outside of the control of health and social care resulting in a failure to close the care and quality gap (Quality improvement / assurance)

16 ↔

3.3 * new There is a risk of not securing national capital funding to build a new hospital on the current Airedale General Hospital site that would ultimately result in loss of services for the local population if the known structural issues were to lead to total and permanent premises closure. This would result in a requirement to commission hospital-based services for the local population of Airedale, Wharfedale and Craven from other providers throughout West Yorkshire and beyond. This would lead to an increase in unwarranted variation impacting negatively on the quality of care, experience, and outcomes for some of the patients for whom we currently commission local hospital-based services.

20 *New risk

4.1 There is a risk that resources which would deliver transformational change are required to focus on the emergency response to Covid 19 in light of changed circumstances, resulting in limited progress with transformational goals

15

5.1 Place Based Partnership (PBP) establishment: There is a risk that we fail to put in place sufficiently robust partnership decision making and delivery arrangements to take on the responsibilities currently discharged through CCG governance for BD&C, such that the WY ICS and NHSE are unable to delegate authority to the place-based partnership from July 2022 onwards.

9 ↔

6.1 CCG transition: There is a risk of CCG staff struggling to adapt to revised system- and partnership-focussed roles as we move towards the new ICS and PBP operating models by 1 July 2022 due to the need for different organisational forms and individual CCG staff role flexibility and the normal factors associated with change, exacerbated by the impact of the Covid pandemic upon ways of working, resulting in failure to successfully transition our CCG staff.

12 ↔

7.1 there is a risk that we do not address the underlying financial deficit and establish a financially sustainable position over the medium term as we exit the pandemic

16 ↔






• Our leadership: to provide assurance regarding delivery of our commissioning strategy including our

strategic ambitions and specific outcomes.

• Each of our ambitions has at least one associated strategic objective and strategic risk, as follows:

o Our population - 1.1, 2.1

o Our partnerships - 3.1, 3.2, 3.3, 4.1 and 5.1

o Our people - 6.1

o Our leadership - 7.1

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Purpose

assurance

information

decision


action


Recommendation(s)


• review the Commissioning Assurance Framework and consider whether this provides a fair and accurate reflection of the CCG’s current strategic risk position

• note the changes to the strategic risks: o note the increase in risk scores for 3.1 up to current risk score of 20 o agree the new risk 3.3 related to the rise in RAAC incidents at Airedale General Hospital and o note the reduction in risk score for 4.1 down a current risk score of 15


1. Commissioning assurance framework (Cycle 3, December 2021)

Page | 1

Commissioning assurance framework

Introduction Brought forward from the three predecessor CCGs’ governing body assurance framework the NHS Bradford District and Craven CCG commissioning assurance framework (CAF) identifies the principal risks to the delivery of the CCG’s strategic objectives and links to how we operate within the new CCG Commissioning Strategy. It sets out the controls that are in place to manage the risks and provides the assurances that show the extent to which the controls are having the desired impact. It identifies the gaps in control and therefore the key mitigating actions required to reduce the risks towards the target risk score. It also identifies any gaps in assurance and what actions can be taken to increase assurance to the CCG.

Summary overview: The table below sets out the strategic objectives, the strategic risks that relate to them and highlights where gaps in control or assurance have been identified. Further details can be found on the supporting pages for each of the Strategic Risks.

Strategic Objective

Risk ID

Strategic Risk Summary

Risk Lead

Risk Current Score

Ris

k M

ovem

en

t

sin

ce O

ct

21

Risk Target

or Appetite

Score

Are there GAPS in control

Are there GAPS in

assurance

our Population improved health and equity for local people 1. Improving population

health and reducing health inequalities by embedding the population health management approach, identifying population needs and working collaboratively with our partners and communities to implement effective interventions. In order to improve health, to promote healthy lifestyles and by

1.1

There is a risk of failure to improve population health outcomes and to reduce health inequalities due to COVID19. Poor outcomes and health inequalities have been highlighted by the COVID19 pandemic with both direct and indirect impacts of COVID19 on the economy, education as well as the physical health and mental wellbeing of our population particularly those living in the areas of worst socioeconomic deprivation

Dr Sohail Abbas

Strategic clinical director of population health and wellbeing /

deputy clinical chair and

Kerry Weir associate director of population

20 ↔ 6 Yes Yes

Appendix 1

Our vision: by 2023 every person living in Bradford district and Craven will have

the opportunity to spend more time enjoying life in the best of health

Page | 2

Strategic Objective

Risk ID


Risk Lead

Risk Current Score

Ris

k M

ovem

en

t

sin

ce O

ct

21

Risk Target

or Appetite

Score


Are there GAPS in

assurance

ensuring access to health and care services, particularly for those in areas of greatest need

health and wellbeing

2. Building strong relationships with local authorities and Health and Wellbeing Boards to ensure local priorities for improved health and care are met by jointly planning, designing and monitoring the delivery of care

2.1

There is a risk due to the growing financial pressures created by an increase in demand for services could result in agreed strategic and operational plans to deliver improved health and care not being realised

Ali Jan Haider Strategic director of

keeping well at home

16 ↔ 6 Yes No

our Partnerships as the vehicle for enabling people to take more responsibility for their health and self care

3. Working at Bradford district and Craven place we will develop and deliver targeted programmes to address the gaps in the quality and outcomes of our health and social care. We will reduce unwarranted variations in the quality and care provided for our patients and residents. We will improve outcomes and experience for our patients and residents

3.1

There is a risk that unwarranted variations in quality and care cannot be effectively addressed due to shortfalls in workforce capacity, capability and skills resulting in failure to close the care and quality gap (across BdC)

Michelle Turner

strategic director of quality and nursing, Gill

Paxton associate director of quality and nursing and

Damien Kaye, associate

directors of transformation

and change

20 4 Yes Yes

Page | 3

Strategic Objective

Risk ID


Risk Lead

Risk Current Score

Ris

k M

ovem

en

t

sin

ce O

ct

21

Risk Target

or Appetite

Score


Are there GAPS in

assurance

3.2

There is a risk that our efforts may not have the impact we desire due to some determinants of quality and outcomes which lie outside of the control of health and social care resulting in a failure to close the care and quality gap (Quality improvement / assurance)

Michelle Turner

strategic director of quality and nursing and Gill Paxton associate director of quality and

nursing

16 ↔ 9 Yes Yes

3.3

** New: there is a risk of not securing national capital funding to build a new hospital on the current Airedale General Hospital site that would ultimately result in loss of services for the local population if the known structural issues were to lead to total and permanent premises closure. This would result in a requirement to commission hospital-based services for the local population of Airedale, Wharfedale and Craven from other providers throughout West Yorkshire and beyond. This would lead to an increase in unwarranted variation impacting negatively on the quality of care, experience, and outcomes for some of the patients for whom we currently commission local hospital-based services.

Nancy O’Neill,

chief operating

officer

20 New Risk

8 Yes Yes

Page | 4

Strategic Objective

Risk ID


Risk Lead

Risk Current Score

Ris

k M

ovem

en

t

sin

ce O

ct

21

Risk Target

or Appetite

Score


Are there GAPS in

assurance

4. Working collaboratively at Bradford district and Craven place, our ACTasONE (AAO) way of working improves health and care services whilst ensuring the clinical and financial sustainability of our partnership. This will include our programmes (Access to health and care; Respiratory; Diabetes; Healthy Hearts; Better births; Ageing Well; and Children and Young People’s mental wellbeing) and enabling strategies

4.1

There is a risk that resources which would deliver transformational change are required to focus on the emergency response to Covid 19 in light of changed circumstances, resulting in limited progress with transformational goals

Nancy O’Neill,

director of

partnership

delivery

15 8 Yes Yes

5. Develop stronger collaborative partnerships in local places between the NHS, local government and others. Including a central role for primary care, collaborative provider arrangements and incorporate strategic commissioning through systems with a focus on population health outcomes

5.1

Place Based Partnership (PBP) establishment:

There is a risk that we fail to put in place sufficiently

robust partnership decision making and delivery

arrangements to take on the responsibilities

currently discharged through CCG governance for

BD&C, such that the WY ICS and NHSE are unable

to delegate authority to the place-based partnership

from July 2022 onwards.

James Drury, director of partnership

development

9 ↔ 6 Yes Yes

our People a skilled, motivated workforce with a culture of continuous improvement

Page | 5

Strategic Objective

Risk ID


Risk Lead

Risk Current Score

Ris

k M

ovem

en

t

sin

ce O

ct

21

Risk Target

or Appetite

Score


Are there GAPS in

assurance

6. We will continue to review and develop our internal resources, structures and processes to ensure that we are able to achieve our strategic objectives as our commissioning functions transfer and, thereby, our CCG staff transition to new Integrated Care System (ICS) and Place Based Partnership (PBP) arrangements.

6.1

There is a risk of CCG staff struggling to adapt to revised system- and partnership-focussed roles as we move towards the new ICS and PBP operating models by 1 July 2022 due to the need for different organisational forms and individual CCG staff role flexibility and the normal factors associated with change, exacerbated by the impact of the Covid pandemic upon ways of working, resulting in failure to successfully transition our CCG staff.

Liz Allen Strategic director of

organisation effectiveness, Fiona Jeffrey,

associate director of

organisation effectiveness

and Sue Baxter

strategic head of assurance

12 ↔ 8 Yes Yes

our Leadership assuring the sustainability of our health and care system 7. Working at Bradford

district and Craven place, we will maximise value for money in the use of healthcare services to ensure we can make shared decisions on how to use our resources to improve population health

7.1

There is a risk that we do not address the underlying financial deficit and establish a financially sustainable position over the medium term as we exit the pandemic

Robert Maden Chief Finance

Officer

16 ↔ 8 Yes No

The following pages set out the detail the level of risk against each strategic objective the management controls in place and outstanding actions to take as well as the internal and external assurance in place and the outstanding assurances to secure.

Page | 6

Strategic Risk Log – our Population improved health and equity for local people

Strategic Objective 1: Improving population health and reducing health inequalities by embedding the population health management approach, identifying population needs and working collaboratively with our partners and communities to implement effective interventions. In order to improve health, to promote healthy lifestyles and by ensuring access to health and care services, particularly for those in areas of greatest need.

Risk Lead: Dr Sohail Abbas, strategic clinical director of population health and wellbeing / deputy clinical chair Risk Owner: Kerry Weir, associate director of population health and wellbeing

Risk rating

20

1.1 There is a risk of failure to improve population health outcomes and to reduce health inequalities due to COVID19. Poor outcomes and health inequalities have been highlighted by the COVID19 pandemic with both direct and indirect impacts of COVID19 on the economy, education as well as the physical health and mental wellbeing of our population particularly those living in the areas of worst socioeconomic deprivation.

Specific outcomes:

• Share responsibility for leading healthier lives and preventing ill health

• Create opportunities for people to take control over their own health and care

• Use population health management solutions in areas with high health inequalities (partnerships)

Risk Rating (Likelihood x Impact) Initial 4 x 4 = 16 (Sept 2017) Current 5 x 4 = 20 (Dec 21) Target 3 x 2 = 6

Rationale for current score: COVID19 has created significant waiting lists for services in acute and mental health. The long-term impact on the wider determinants of COVID19 is still not yet fully understood but we are already seeing increased demand on all sectors. The uptake in the vaccine programme varies across the district with particularly low uptake in some communities which is below the national average.

Rationale for target score (risk appetite): The planning round for 2021/22 is focussed on tackling inequalities, ACTasONE programmes are looking at how they are tackling inequalities including working with community partnerships. We are reducing the waiting list based on clinical priorities and ensuring that there are no adverse impacts on those from deprived areas and ethnicity. Reducing Inequalities in City work is focused in central Bradford to reduce inequalities in communities. We are establishing the BdC Reducing Inequalities Alliance as part of the new BdC PBP governance arrangements. Partners / stakeholders involved:

• Patients & patient groups

• Primary Care Networks and Community Partnerships

• VCS

• ACTasONE partners (Bradford district and Craven ‘place’)

• WYH ICP health inequalities network

• WYH ICP population health

0

5

10

15

20

25

Risk Score Risk Appetite

Page | 7




Risk rating

20


Specific outcomes:




Existing Controls (what are the key controls in place to prevent this risk occurring?) Gaps in Control (where are we failing to put effective controls in place and what more should

be done to manage the risk)

• ACTasONE initiative overseen via the Health and Care Executive Board / Partnership Leadership Executive

• Bradford district & Craven (BdC), strategy 'happy healthy at home'

• Health & Wellbeing Board and BdC system governance arrangements

• Primary Care Networks Direct Enhanced Service

• Looking at all initiatives from an inequalities perspective (e.g. COVID)

• Population Health Management system enabling programme has been launched

• Community Partnership work stream on health inequalities inc. public health refreshed Community Partnership profiles and CCG PHW work is focussing on analysis at CP/PCN level

• ICS Health Inequalities Academy launched February 2022 to operate from April 2022 onwards as part of the BdC Partnership/Place arrangements

• Resources at place to support include: BMDC and North Yorkshire Public Health Teams to support the implementation of the programme: BdC partnership / place population health management team structure now agreed - capacity secured

• Clear commitment to self-care and prevention by all partners

• Reducing Inequalities in Communities (RIC) programme and funding targeting the most deprived area in Bradford City

• BdC Partnership/Place Population Health Management structure implemented April 2022 – BI team aligned to ACTasONE Programmes and CP/PCNs

• Population health management is now embedded as a way of working

• Covid-19 is impacting on workload and affecting the capacity/resources needed for the full development of the work streams.

• Work is ongoing to develop a clear and credible baseline that indicates the

starting position so that any programme progress can be reliably measured –

currently we are unable to quantify the full impact that Covid-19 has had on

increasing health inequalities until national data is available on mortality and

morbidity rates etc. The data and digital work stream of BdC Place Based

Partnership (PBP) Development Programme aims to develop and deliver a

comprehensive Digital, Data and Insight proposition for BdC PBP that

maximises the opportunity to enable individuals and communities

• Clarity still needed on national data flows in light of becoming ICSs /PBPs and

whether data coding will still allow analysis of local health inequalities

• Work is needed to increase and bring together the system capacity for robust

evaluations.

• Setting up a leadership group for implementing the national core 20 plus 5 health inequalities framework for the ICS and BdC Partnership/Place

• Working with the primary care commissioning team to develop health inequalities metrics for general practices who operate within the most deprived areas of Bradford

Page | 8




Risk rating

20


Specific outcomes:




• Significant focus on reducing health inequalities in the 2022/23 operational planning guidance

Controls Action Plan (what actions are being taken to address gaps in

control) Implementati

on date Progress to date

1. Development of BDC Reducing Inequalities Alliance (from 1 April in shadow and to be fully operational from 1 July 2022)

1 April 2022 (formal

shadow)

1 July 2022

As part of the new operating model the Inequalities Alliance has been established in place from 1 January informal shadow form / from 1 April formal shadow and fully operational from 1 July 2022 as an integral part of BdC PBP

2. PBP approach to robust evaluations

3. Clear and credible baseline (need an agreed place-based set of Health Inequalities measures)

These Health Inequalities measures will be developed as part of District strategy. Inequality action plan, inequality academy, RIC dashboard and health inequalities profiles for PBP transformational programmes will contribute.

4. Leadership group to be established for Core 20 plus 5

5. GP inequalities metrics

Page | 9




Risk rating

20


Specific outcomes:




Assurance Mechanisms (where / how do we get assurance that the existing controls are

working effectively)

Assurance Details (specific evidence of positive or negative assurances)

Internal:

• Ad-hoc reporting on specific initiatives and projects as required - PHM presentation to the CCG Senior Leadership Team in 2022

• The Health Inequalities Alliance function is in shadow form from January 2022

• ACTasONE programmes focussing on health inequalities – workshop for the access programme is planned for February 2022

• The Airedale HCPB and Bradford HCPB have received focussed inequalities presentation from some of the communities across Bradford district and Craven.

• PHM Enabling Programme highlight reports to joint HCP meetings on a quarterly basis including updates on RIC

External:

• Reporting to Health & Wellbeing Board and ACTasONE Health and Care Executive Board

• Quarterly whole system review meetings: focus on tackling inequalities

• Focus on Health Inequalities in 2021/22 planning requirements and achievement of Elective Recovery Fund (ERF)

• PHM enabling programme formally in place from April 2021

• Performance reporting (not including population health management), to both the System Quality Committee and to the System Finance and Performance Committee

• Process for demonstrating that we are not widening inequalities in order to secure elective recovery fund monies (ERF), still needs to be developed

• Internal CCG audit of health inequalities draft result has been returned showing significant assurance

Gaps in Assurance & Action Plan where are we failing to gain

evidence that our controls are effective and how can we address this?

Implementation date

Progress to date

No routine reporting on health inequalities at CCG nor ACTasONE April 2022

Range of health inequalities reporting needs to be part of PBP Inequalities Academy development

A place based approach to reducing inequalities needs to be reflected in the 2022/23 operational plan

April 2022 Overall requirements published but still awaiting detailed guidance

Page | 10




Risk rating

20


Specific outcomes:




Key changes since the last review of this commissioning assurance framework (CAF) in October 2021

Related risks on the Risk Register Number, brief description, current score

• RIC being launched across WYH ICS as part of Health Inequalities Academy

• Increased national focus commitment to this area – 2021/22 planning & ERF

• Review of previous self-care and prevention programme complete.

• New Living Well Programme launched (new branding, website, resources); new Programme Board and governance structure in place.

• Additional public health staff supporting the Living Well agenda

• Reducing Inequalities in Communities launched

• PHM enabling programme workshop

• PBP Reducing Inequalities Alliance function in place and future scope being developed now established

• PHM looking at developing baseline for health inequalities metrics

• Due to redeployment of staff within COVID, system pressures and operational

issues have increased

• ICS timeline has been delayed which causes concern of a slowed momentum

• Risk 931: access to and understanding of mental health data (12)

• Risk 1098: failure against key constitutional targets (15)

• Risk 1582: increased health inequalities (COVID RR) (20)

• Risk 1495: Impact of Covid-19 pandemic (25)

Page | 11

Strategic Risk Log – our Partnerships as the vehicle for enabling people to take more responsibility for their health and self care Strategic Objective 2: Building strong relationships with local authorities and Health and Wellbeing Boards to ensure local priorities for improved health and care are met by jointly planning, designing and monitoring the delivery of care

Risk Lead: Ali Jan Haider, strategic director of keeping well at home Risk Owner: Christina Holloway, associate director of keeping well

Risk rating

16

2.1 There is a risk that an increase in demand and unmet need for services could result in agreed strategic and operational plans to deliver improved health and care not being realised on time

Specific outcomes: • Make shared decisions on how to use our resources to improve population

health

• Look beyond health to where we can make the greatest difference to the wellbeing of local people


Rationale for current score: Due to increased demand and conflicting priorities across the health and care system, pressure accrues and has an adverse impact on the achievement of operational outcomes. This could mean that some of the priorities of the ACTasONE programmes are not realised within the timescales that have been set. Anecdotal feedback from grassroots, media, VCS indicates that services are over-stretched and that increasingly service users are experiencing frustration at not being able to access support at the right time. There is also an increasing pressure relating to workforce.

Rationale for target score (risk appetite): We believe we can reduce the likelihood of the risk by focussing on the benefits to users and business benefits for partners of closer working.

Partners / stakeholders involved:

• Local Authority – education, social care, public health, housing

• VCS

• Patient Groups

Existing Controls what are the key controls in place to prevent this risk occurring?

Gaps in Control where are we failing to put effective controls in place and what more should

be done to manage the risk

• Wellbeing Board membership including non-health and social care representatives

• Joint working with CBMDC and collaboration with a wide variety of stakeholders

• Agreement on the principles of ‘no cost shunting’ is in place

• Living Well programme plan and Living Well Programme Board and collaborative

• Early help and prevention programme board

• Personalised Commissioning / Continuing Healthcare – differences in approaches and working practices identified between health and social care. Joint policy is in development

• Unpredictability of financial pressures impacting on partner organisations, particularly in the context of children looked after, children with complex needs and mental well-being

• The left-shift investment in self-care and prevention has not been realised which prevents the development of interventions at pace and scale

• Implementing prevention and early help to address pressures in both adult and children’s autism pathways.

• Process for considering shared responsibilities for children placed in educational establishments out-of-area is under review

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Risk rating

16



health


• Training for staff in motivational interviewing has been completed

• There is now closer collaboration with the Local Authority when commissioning and decommissioning

• Planning & Commissioning Forum in place to oversee s75 arrangements

• MH, LD, ND Programme Board

• Children’s Young People and Families Programme Board

• Further conversations are needed with partners to prioritise our services where an increase in demand creates high waiting times.

Controls Action Plan what actions are being taken to address

gaps in control

Implementation date Progress to date

1. Continue to influence partners and negotiate practical solutions in regard to the unpredictability of financial pressures

31 March 2022 Joined up conversations at the Health and Care Partnership Boards to tackle together the financial challenges. System conversations between Adult Social Care and the CCG regarding funding for Care Home Sector and the Better Care Fund.

2. Address the lack of transparency and openness regarding funding and decommissioning decisions At least annually by 31

March 2022

We have joint meetings to consider finances and pressures in the care home sector. The BdC System Finance and Performance Committee and the Planning and Commissioning Forum will ensure that any decommissioning decisions are taken jointly (Health & Care), in order to minimise unintended consequences.

3. Personalised commissioning and continuing health care joint policy in place

Complete

1 November 2021

Procedures have been reviewed for CHC via a CHC Operational and CHC Strategic Oversight Group. In addition, a Children’s Continuing Care Verification Group is now in place to ensure agreements between health and social care are correct, CCC process is sound with appropriate care resource being commissioned appropriately. We are currently undergoing a review of children’s CCC & PHB procedures using audit recommendations – has been completed however awaits signoff by City of Bradford Metropolitan District Council

4. Modelling demand pressures across key parts of the health and care system to identify interventions that can minimise impact

1 February 2022 Trajectories have been developed for children’s autism.

5. Action to redress the expected rise in demand following on from the pandemic

Further conversations are needed with partners to prioritise our services where an increase in demand creates high waiting times.

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Risk rating

16



health


Assurance Mechanisms where / how do we get assurance that the existing controls are

working effectively Assurance Details specific evidence of positive or negative assurances

• Reports and updates to Bradford Wellbeing Board and HOSC

• Minutes of CBMDC Executive meeting in relation to plans, funding and service changes

• Reports to the Health and Care Executive Board

• Annual BMDC budget consultation

• New PBP place based governance arrangements will strength current system committee arrangements and joint decision making will include:-

o Planning and Commissioning Forum (P&CF) o Finance Forum (a sub-group of the P&CF), which oversees section 75 o BdC PBP Finance & Performance Committee

• Reports to children’s, and young people’s programme board.

• Reports to Planning and Commissioning Forum

Planning and forecasting commissioning and decommissioning together across services to anticipate any shift of pressure or any unintended consequences.

Gaps in Assurance & Action Plan where are we failing to

gain evidence that our controls are effective and how can we address this?


No gaps in assurance N/A N/A

Key changes since the last review of this commissioning assurance framework (CAF) in Oct 2021

Related risks on the Risk Register number, brief description, current score)

We have seen a growing demand for children’s autism assessments and services. Investment that has been approved in children’s autism will address the current backlog and also increase recurrent funding to align with growth in demand. We anticipate an increase in demand both on primary care, secondary care services and tertiary care services following easing of lockdown post COVID19, leading to an impact on finances which remains challenging during this year and in the coming year(s).

Risk 1101: health input to education & care plans (SEND) (8) Risk 1094: child autism / ADHD services (16) Risk 1134: health outcomes of children looked after (12) Risk 1135: adult autism / ADHD services (16) Risk 1404: 0-19 services; impact on CCG commissioned services (15) Risk 1613: demand for mental health services outweighs capacity (25)

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Strategic Risk Log – our Partnerships as the vehicle for enabling people to take more responsibility for their health and self care Strategic Objective 3: Working at Bradford district and Craven place we will develop and deliver targeted programmes to address the gaps in the quality and outcomes of our health and social care. We will reduce unwarranted variations in the quality and care provided for our patients and residents. We will improve outcomes and experience for our patients and residents

Risk Lead: Michelle Turner, strategic director of quality and nursing Risk Owner: Gill Paxton, associate director of quality and nursing, Damien Kay, associate director of transformation and change & Dawn Clissett, senior head of strategy, change and delivery

Risk rating

20

3.1 There is a risk that unwarranted variations in quality and care cannot be effectively addressed due to shortfalls in workforce capacity, capability and skills resulting in failure to close the care and quality gap (across BdC)

Specific outcome:

• Improve our skills and knowledge to increase our personal value


Rationale for current score: Attrition rates and sickness absence is higher and feedback from staff is related to a workforce struggling with fatigue. The national drive and ambition to recruit nursing workforce has lagged in delivery. Recruitment is slower to fill the increasing workforce gaps across Bradford district and Craven. The risk score is currently reviewed to be higher than the previous score due to capacity within the system arising from sickness / contact absence due to COVID and related pressures and overall capacity.

Rationale for target score (risk appetite): Ongoing local challenges in recruitment and retention of a skilled workforce continue to be reported across BdC PBP. It is likely that this will continue, risking sustainability for some services. Due to the development of the Commissioning People Plan, a Bradford district and Craven wide primary care workforce together with acute/mental health and community provider workforce plans, we anticipate that workforce initiatives and movement across the BdC providers workforce will reduce the likelihood and impact of any shortfalls within the system. Additionally, further initiatives across primary care such as GP and Practice Nurse leadership schemes that have been held over the last year are beginning to yield strengthened leadership and therefore address variations in practice.


• GP Practices and Primary Care Networks

• Health Care Partnership Board stakeholders (AWC and Bradford HCP’s)

• Demand needs to be owned by all stakeholders in the footprint

• NHS England

• WY stakeholders. HEE

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Risk rating

20


Specific outcome:


Existing Controls (what are the key controls in place to prevent this risk occurring?) Gaps in Control where are we failing to put effective controls in place and what

more should be done to manage the risk

• BdC PBP People Committee / Integrated People Board (IPB)/ Primary care strategy – Provider led including representation from Bradford Care Alliance/ WY Workforce & Training Hub.

• West Yorkshire and Harrogate People Board and associated groups in place

• Commissioning People Plan

• Strategic Coordination Group – attended by Public Health colleagues

• An agreement /MoU underpinning the movement of staff within the Health Care Partnership

• The WYAAT trusts have signed an agreement that enables colleagues who are competent to undertake roles and are cleared to work in one of our organisations to be able to work in another WYAAT Provider Trust without the need for an honorary contract and all the associated checks.

• A lack of a consistent approach to understanding return on investment including investment of all resources (staff and money)

• Due to Health Education England (HEE) allocation in education credits to Higher Education Institution the CCGs have noted the curtailment/limitation to relevant health courses available locally, this will likely continue to impact in the short term of the availability of a local skilled workforce – outside of CCG control but we will try to influence in this area by assessing workforce plans and skill gaps to inform further discussions. We will work together at place to influence and inform this through the Bradford district and Craven learning needs assessment group.

• Challenges in enabling and facilitating free movement across the system of qualified and capable staff have resulted in little uptake from staff within the local system. No mechanism to balance the allocation of sufficient resource to local requirements due to national shortage of skilled workforce / allocations competing priorities. The new Government White Paper on ICS People function sets out clear responsibilities to help grow future and retain existing workforce including streamlining recruitment processes supported by digital passport.

• Inability to view the workforce performance of the entire pathway due to unavoidable data constraints (e.g., legal and information governance requirements). For clarity this means not all staff who deliver an entire pathway of care are employed by same organisation and therefore can’t easily or readily see the relevant workforce data across a pathway as a result. Hence if you want to transform that

https://www.england.nhs.uk/wp-content/uploads/2021/06/B0662_Building-strong-integrated-care-systems-everywhere-guidance-on-the-ICS-people-function-August-2021.pdf

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Risk rating

20


Specific outcome:


pathways of care then the workforce implications of that may well span many sectors and organisations.

• Partnership Leadership Executive engaged in the development of future People and OD function proposition

Controls Action Plan (what actions are being taken to address gaps in control)

Implementation date

Progress to date

1. A lack of a consistent approach to understanding return on investment including investment of all resources (staff and money)

2. Discussions are ongoing with HEE and HEIs to identify priority areas and agree engagement required when education credit curtailment / limitation decisions are made, to ensure sustainability of local care services.

June 2022 All additional training needs have been fed into the Transformation Training Requirements for 2021/22 for WY/HEE and for the successful bids against the Support Staff Workforce Development Fund to enable commissioning of education and training on a needs led basis. Shared understanding has now been developed across Bd&C on our top 15-20 role gaps to help inform and focus our place-based workforce planning and development

3. Raise approach to workforce challenges with the WYQSG / ICB Quality Committee and local CCGs across the HCP footprint

June 2022 Raised at WYQSG, DoN forum, primary and Community Care HCP workgroup. Challenges and workforce needs fed into the BdC Integrated People Plan and primary care has a regular place at the Integrated People Board (IPB).

4. People Plan – work together across Bradford district and Craven, and West Yorkshire where appropriate, to address and deliver against the workforce challenges, opportunities, aspirations and plans (emerging and already in place) for our current and future system wide health and care workforce

June 2022

Bd & C Integrated People Plan is being refreshed to take account of NHS planning guidance, 10 core outcomes focused functions underpinning an ICS people function and the future of NHS HR and OD and development of a health and care partnership proposition for a people and OD function is underway - aligning with WY ICS People function requirements.

5. Utilise NHSSOF dashboard – people theme From 1 July 2022

NHS SOF people theme has ## the National People Plan KPIs, utilise the tableau data for BdC PBP People Committee

6. Partnership Leadership Executive engaged in the development of future People and OD function proposition.

June 2022 The proposed People and OD function will respond to our need to move beyond our current workforce enabler programme arrangements as part of

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Risk rating

20


Specific outcome:


the evolution of our health and care partnership and strengthening of Integrated Care Systems which will be capable of contributing to the delivery our health and care strategy, connecting us through a shared purpose and accountability, as well as collaborating on workforce development across numerous footprints.

Assurance Mechanisms where / how do we get assurance that the existing controls are working effectively

Assurance Details specific evidence of positive or negative assurances

• BdC PBP People Committee / Integrated People Board discussion and reporting shared with BdC place Quality Committee and programme work streams

• Additional reporting to SLT/PLT providing additional internal assurance

• Reporting of gaps in care and workforce challenges across our providers reported monthly to the BdC place Quality Committee

• Quality assurance mechanisms of providers identify gaps and workforce challenges and agreement of actions required in place

• Quality assurance and performance monitoring to address care delivery gaps actioned via provider contractual meetings including use of CQC inspections

• Reporting against the system plan to BdC PBP People Committee / Integrated People Board (IPB), Health and Social Care Economic partnership and Joint Health and Care Partnership Board and system quarterly review focus.

Gaps in Assurance & Action Plan (where are we failing to gain evidence that

our controls are effective and how can we address this?)

Implementation date

Progress to date

1. NHS System Oversight people metrics to be reviewed in relation to development of a system dashboard.

June 2022 In relation to what is contained within the BdC system dashboard none of the metrics under the peoples plan section of the SOF (see page2 of attached), are available in the system dashboard. Therefore, if visibility of these metrics are required by the new BdC People Committee then BI report/dashboard and / or extract from the SOF dashboard will need to be carried out

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Risk rating

20


Specific outcome:



Related risks on the Risk Register number, brief description, current score

The delivery plan to underpin BdC People Plan is underway with key programme leads identified and clear priorities for the next 12 months and 1-3 years. Plan for development of health and care partnership People Committee is underway to improve assurance and align with emerging health and care partnership governance architecture. Proposition work for People and OD function includes a workforce planning and intelligence delivery group including operational planning and workforce observatory development. Bradford district and Craven Integrated People plan developed and delivery is overseen by BdC People Committee / Integrated People Board, with submission of NHS Priorities and Operational Planning 2021/22 workforce narrative including plans / data explained in terms of assumptions, actions, risks & issues for primary care, acute, community, ambulance and mental health. The plan covers the following:-

• greater connectivity with primary medical care and neighbourhoods

• system passport for care agreed for ‘place’

• greater alignment with health and care economic partnership to ‘market’ Bradford district and Craven

No related risks on the corporate risk register – Note there may be a need to align Corporate Manager to the new BdC PBP People Committee – in order to embed risk management within the committee

Page | 19

Strategic Risk Log – our Partnerships as the vehicle for enabling people to take more responsibility for their health and self care Strategic Objective 3: Working collaboratively, we will develop and deliver targeted programmes to address the gaps in the quality and outcomes of our health and social care. We will reduce unwarranted variations in the quality and care provided for our patients and residents. We will improve outcomes and experience for our patients and residents.

Risk Lead: Risk Lead: Michelle Turner, strategic director of quality and nursing Risk Owner: Gill Paxton, associate director of quality and nursing (supported by John Hartley, Head of Patient Outcomes)

Risk rating

16

3.2 There is a risk that our efforts may not have the impact we desire due to some determinants of quality and outcomes which lie outside of the control of health and social care resulting in a failure to close the care and quality gap (Quality improvement / assurance)

Specific outcome:

• Through our partnerships, reduce the variation in people’s experience of care


Rationale for current score: The impact of COVID19 on long term conditions, identification of conditions such as cancer through lack of early presentation. Rise in frailty due to long term isolation and increases in mental health issues. Waiting times for diagnostics and planned care activity have increased over the period of the pandemic. Further cooperation between partners (see below) and more joined up system wide plans for improvement i.e. ACTasONE, ICS and PBP, system performance and quality groups are working towards reducing the likelihood of the risk occurring and improved the way we mitigate the risk. Rationale for target score (risk appetite): The impact of not closing the care and quality gap will always remain high but we expect long term interventions will likely reduce the gap. NHS 10 Year Plan signals more involvement / influence of NHS bodies in the wider determinants of quality and outcomes. The clinical risk remains present; however the collaborative risk has reduced. Partners / stakeholders involved:

BDMC and NYCC Health care Partnerships x 3

BPA BCA

NHSE and NHSI VCS

BDCFT BTHFT / ANHSFT

ICS CPs / PCNs

PBP Independent Sector Partners

Existing Controls what are the key controls in place to prevent this risk occurring? Gaps in Control where are we failing to put effective controls in place and what more

should be done to manage the risk

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Risk rating

16


Specific outcome:


• Following processes: Equality, Quality Impact Assessment, Serious Incident review, patient experience process

• A more direct influence on system wide quality, performance, and outcomes through joint working; BdC signed up to the Strategic Partnering Agreement, BdC PBP governance inc: place Finance & Performance Committee, place Quality Committee, system, BdC strategy etc. and specific funding allocated to reduce inequalities through i.e. RIC

• ACTasONE system programmes and WYH ten ambitions

• Further clinical engagement with system partners via Clinical Forum at Place and ICS

• Corporate risk register and commissioning assurance framework

• ICB Quality Committee / West Yorkshire Quality Surveillance Group (includes regulators)

• CCG Finance and Performance Committee and Quality Committee has been stepped down due to transfer to BdC PBP equivalent committees, and also the stepped up SLT / PLT) 4 week of the month meetings during working in shadow form until June 2022

• Previous CCG Plans to close gap signed off by Governing Bodies is under review due to extension of CCG transition. CCG plans are signed off from March – June 2022 will be via PLT/SLT and GB s under review and to be confirmed. Operational Planning signoff will be via BdC PBP governance arrangements inc. PLE and PLT

• Work at a Community Partnership and Primary Care Network level with partner organisations to understand and look to meet more specific local need

• Focus on Population Health through the Inequalities Alliance within the BdC PBP.

• Programmes jointly undertaken with Public Health to improve wider determinants of health

• PBP development workstream: Quality and Performance (links with Inequality Alliance workstream

• BdC Partnership Board and BdC place strategy

• Long term outcomes affected by wider determinants of health, demographic and societal issues i.e. housing, debt, air quality

• BdC place quality improvement and quality improvement framework is currently in development

• System agreement on prioritisation of resources to include addressing safety issues

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Risk rating

16


Specific outcome:


Controls Action Plan what actions are being taken to address gaps in

control Implementation

date Progress to date

1. No existing agreed action plan is in place; however, we anticipate that a combination of HWB strategy, BMDC planning, Bradford district and Craven strategy and the work of the inequalities alliance to improve the health, well-being, social determinants / living standards and employability will over time impact positively to improve outcomes for the people of Bradford and Airedale localities.

1 July 2022

CCGs continue to explore how best to close the care quality gap through system partnership plans overseen by local partnership arrangements, Clinical Forum, Partnership Leadership Executive Board, Wellbeing Board.

• Health and Wellbeing Strategy

• Refer to system strategy and Inequalities Alliance.

• ACTasONE workstreams

2. System QA/QI framework for agreement by System Quality Committee Feb 2021 and then to be rolled out incrementally

1 July 2022

complete

System QI principles Agreement to be reached across all BdC place partners on the QI framework in October 2021.

• QI Framework complete – to be rolled out.

3. System agreement on prioritisation of resources to address safety issues through planning and prioritisation processes and governance protocols supported by system partners i.e. Planning & Commissioning Forum. F&PC, SQC, System Strategy Group

May 2021 (completed) Signoff by

November 21

System Planning & Commissioning Forum and System Strategy Group work focus on joined up planning processes and a consistent approach to prioritising the use of resource to maximise returns around funding, quality of service provision, and improved outcomes for the population/

Assurance Mechanisms where / how do we get assurance that the existing controls are working

effectively


Internal:

• Monthly reporting to SLT/PLT and BdC System Quality Committee

• Quality report to Governing Body (bi-monthly)

• Monthly Primary Care Contract Committee and contract assurance group (PCCC & CAG)

• Risk Register to include ongoing risk regarding the quality of service provision – reviewed as part of the bi-monthly risk cycle

• System Quality Committee will report to the BdC Partnership Committee (sub-committee of the ICB under the ICB Constitution.

• National Quality Board have released a draft dashboard. Final version is yet to be released – TBC once released. Interactive tool on Futures platform, this has been noted as difficult to access and may not still be in action.

• NHSEI business intelligence tools – to be confirmed once released.

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Risk rating

16


Specific outcome:


External:

• Assurance of plans by NHS England & Improvement

• NHS System Oversight Framework

• Regulators (CQC, NHSE/I, OFSTED, MHRA and HSE etc)

• Safeguarding Boards

• Overview and Scrutiny Committee

Gaps in Assurance & Action Plan where are we failing to gain evidence

that our controls are effective and how can we address this?

Implementation date

Progress to date

Reporting and assurance arrangements to be developed in partnership with stakeholder organisations to ensure that the health of the population is adequately measured

July 2022

The CCG Programme Office and the Deputy Director of Performance are developing a common reporting framework to provide assurance, which will include progess against outcomes. Approach to Quality assurance and reporting of quality of service provision under review via the System Quality Committee



• Sub-group of SQC in place to oversee delivery and development of the Quality & Performance work stream (including links with i.e. Inequalities Alliance)

• Ongoing updates and assurance provided to BdC System Quality Committee.

• System EQIA process utilised to highlight positive and negative impact of proposed service change and identify areas of potential focus for programmes - ongoing

• Serious Incident review process utilised to highlight areas for improvement including themes and trends – monthly reporting to Senior Leadership Team / Partnership Leadership Team as appropriate

• Patient experience process utilised to highlight areas of excellence and poor service quality – fed into programmes, Quality Committee and Senior Leadership Team / Partnership Leadership Team as appropriate. Plan to widen the scope to include partner organisation’s patient feedback and report to System Quality Committee ongoing through delivery of demonstrations

• Risk 940: BTHFT quality and safety of maternity services (16)

• Risk 943: COVID19 impact on care home quality (COVID RR Score 16)

• Risk 1312: quality of general practice (12) (previously 8)

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Risk rating

16


Specific outcome:


• Quality Improvement/ Assurance Framework being implemented on an incremental basis to provide assurance on provider service provision, taken forward via the PBP development Quality and Performance work stream

• Links made into the System Strategy delivery including the Prioritisation Toolkit development, testing and roll out with system partners

• Review of Clinical Forum deliverables and membership completed

• CQC strategy launched – awaiting details of how this will be / is being operationalised • The NHS Patient Safety Strategy 2019

• NHS England Patient safety incident response framework (PSIRF

Page | 24


Risk Lead: Nancy O’Neill, chief operating officer Risk Owner: Laura Siddall, business continuity and risk manager

Risk rating

20

3.3 There is a risk of not securing national capital funding to build a new hospital on the current Airedale General Hospital site that would ultimately result in loss of services for the local population if the known structural issues were to lead to total and permanent premises closure. AGH Closure could lead to an increase in unwarranted variation impacting negatively on the quality of care, experience, and outcomes for some of the patients for whom we currently commission local hospital-based services.

Specific outcomes: • Commit as One to our role in making our district a great place to live, work

and thrive

• Share as One the power and responsibility to make the best use of our collective assets

Risk Rating (Likelihood x Impact) Initial 4 x 5 = 20 (Dec 21) Current 4 x 5 = 20 (Dec 21) Target 2 x 4 = 8

Rationale for current score:

Whilst, in the short term, capital funding has been provided to make the site safe and maintain services, this is not sustainable in the long term. National capital funding is required to build a new hospital at the current AGH site. Estimated timescale for completing a total build is 2030. If capital funding was made available, this site or any other hospital site with RAAC would need to be free of partial or total structural failure over the next eight years in order to prevent any detrimental impact on provision of services. Therefore, in the event of a collapse in this or another NHS facility then this would result in a requirement to commission hospital-based services for the local population of Airedale, Wharfedale and Craven from other providers throughout West Yorkshire and beyond.

Rationale for target score (risk appetite): When the following desired outcomes are satisfied

• National capital funding is made available to provide a new hospital on the current Airedale General Hospital (AGH) site

• People residing in the area (Airedale, Wharfedale and Craven; East Lancashire) benefit from having access to local hospital services

Health inequalities are not exacerbated by the need for patients to travel to providers across West Yorkshire and beyond to access services that are currently commissioned from AGH

Page | 25



Risk rating

20



and thrive



• AGH CEO and team

• Regional (NEY) and system (WY) leads

• CEOs and DoFs of CCG and provider trusts in Bradford district and Craven

•

Existing Controls what are the key controls in place to prevent this risk occurring? Gaps in Control where are we failing to put effective controls in place and what more


• CCG leads regularly attend NEY and WY convened meetings to contribute to debates and influence actions relevant to the impact of structural issues caused by substantial areas of the hospital site being constructed from reinforced autoclaved aerated concrete (RAAC)

• CCG leads make strategic arguments for residents requiring access to local hospital services based on our modelling of population health needs

• CCG leads use formal and informal routes to lobby support for the case for national capital funding to build a new hospital on the AGH site

Awaiting update from NEY/WY and ANHSFT leads as to progress re: next stage of national capital funding allocation process

Controls Action Plan what actions are being taken to address

gaps in control Implementation date Progress to date

1.

2. .

3.

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Risk rating

20



and thrive



working effectively


Internal:

• CCG AO meets regularly with ANHSFT CEO and with CEOs/Chairs of Bradford district and Craven (BdC) provider trusts and other key organisations who have agreed a strategic approach to estates development within the BdC ‘place’.

External:

• CCG accountable officer and/or SRO (for acute and elective care workstreams) attend the regional RAAC risk summits. Regular meetings of the North East and Yorkshire regional RAAC steering group and working group are both attended by the CCG SRO and/or business continuity and resilience manager.

• ANHSFT report on RAAC panel breaches via the IIMARCH reports

•

• Risks summits provide information as to the latest position on potential for receipt of national capital funding as well as local reports about RAAC-related issues and updates from business continuity/emergency planning workstreams

• RAAC incident reports are generated by ANHSFT whenever structural deficiencies are detected. The reports provide assurance on the actions being taken to address each individual incident (usually an assessment by an engineer and propping the affected area) and provide additional and ongoing evidence of the requirement to address the risk of site closure as a matter of urgency




1. University-led research work is being undertaken to understand how RAAC reacts to fire, water and other pressures. This will help to provide a more accurate estimate of the longevity of RAAC and the subsequent risk of panel failure.

Unknown as this research work has

been commissioned by NHSEI.

Page | 27



Risk rating

20



and thrive




Not applicable as this is a new risk Risk 1960: RAAC at Airedale General Hospital - there is a risk of structural deficiencies at Airedale General Hospital related to construction using RAAC (reinforced, autoclaved, aerated concrete) making it necessary to undertake a full or partial evacuation of the site due to issues either at Airedale or other RAAC sites in the country. This potentially could involve injuries to patients and/or staff, disruption to patient care and increased pressure on the rest of the health and social care system across Yorkshire and the Humber.

Page | 28

Strategic risk log - our Partnerships as the vehicle for enabling people to take more responsibility for their health and self care Strategic Objective 4: Working collaboratively at Bradford district and Craven place, our ACTasONE (AAO) way of working improves health and care services whilst ensuring the clinical and financial sustainability of our partnership. This will include our transformation programmes and enabling strategies

Risk Lead: Nancy O’Neill, director of partnership delivery Risk Owner: Helen Farmer Supported by: Transformation Programme Team

Risk rating

15


Specific outcomes

• use population health management in areas experiencing high deprivation

• facilitate health and care to become more joined up and coordinated around people

• reduce unwarranted variation in people’s experience and effectiveness of care

• Create a focus on use of resources and workforce wellbeing

Risk Rating (Likelihood x Impact) Initial 4 x 4 = 16 (Oct 2021) Current 5 x 3 = 15 (Dec 21) Target 2 x 4 = 8

Rationale for current score: Due to the COVID19 pandemic ACTasONE programmes were re-purposed or put on pause to release resources. This was in order to ensure an adequate response to COVID at the peak during 2020 and to support recovery. For example the Access programme is overseeing the elective recovery fund. In December 2021 the covid command arrangements and hub were re-established, drawing upon the core transformation team resource to again pause ACTasONE programmes in order to respond to the surge in COVID cases due to omicron. This was a planned response.

Rationale for target score (risk appetite):


• All partners signed up to the SPA


Gaps in Control where are we failing to put effective controls in place and what more should

be done to manage the risk

• Programme structure in place (transformational change) with key deliverables/measures documented and SROs, Exec Champions Rob Aitchison, Mel Pickup, Therese Patten, Kersten England, Iain MacBeath and James Thomas)

• 2 Programme directors (Helen Farmer - Access and Mark Hindmarsh - all others) and project team in place

• There is a growing confidence within the partnership way of working due to additional network of developed relationships through COVID redeployment

• Recovery is taking precedence which may impact on resources needed to deliver transformational elements of the programmes resource is being focused differently due to COVID – more prevalent in Access programme work

• Gap in workforce to fully engage in programmes due to redeployment of staff and pause of programmes to support this

• Programme management documentation including e.g. project plans and risk registers may not all be in place

• Looking at how we resource the transformational programmes as part of organisational structure to support the operational model for place

0

5

10

15

20

25

Oct-21 Dec-21


Page | 29



Risk rating

15


Specific outcomes





• Clarity needed surrounding the criteria against which we will decide when to step incident management arrangements down again, so we make sure not to continue them longer than is required, resulting in undue delay to transformation work

• Clarity needed how we will ensure that positive learning and transformational change gained through the experience of operating the covid command hub, are captured and embedded.

• There is concern that PCN’s may become over reliant on redeployed staff due to ongoing workforce shortages, plans for managed withdrawal to be formulated

Controls Action Plan what actions are being taken to address gaps

in control Implementation date

Progress to date

1. Review of detailed programmes & projects documentation including risk registers

TBC Internal audit undertaking a review of PMO arrangements for ACTasONE during 2022/23

2. Complete the place-based partnership team alignment / structures

31 October 2021 First draft produced, engaged with SLT & ALT on content and engaged with the Exec Board

3. HR – Transferring staff into new PBP structure.

1 April 2022 PBP functions, leadership/sponsorship, director roles and team alignment now confirmed. Staff sent letters December 2021 with confirmation of team alignment into PBP functions, line manager and job title

4. Final structure (organogram) to be provided to Liz and Manisha as part of the due diligence and staff transfer orders

By 1 April 2022 Greater clarity of team structures to detail line management arrangements are still required for benefit of staff and the due diligence information – in time for formal shadow arrangements commencing 1 April 2022

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Risk rating

15


Specific outcomes






working effectively


Internal:

• Reporting to Health & Care Silver and Gold

• Monthly transformational programmes reporting into HCPBs and Joint HCPB and connectivity of the enabler programmes

• Reporting to SLT / PLT

• The high-level director portfolios have been signed off by Partnership Leadership Executive

• The governance structures including the sub-committee of the ICB has been designed and signed off by Health & Care Executive / Partnership Leadership Executive

• Incident Management of COVID omicron reporting to H&C Silver and Gold

• Specific reporting template used by transformational programmes and enablers.

External

• Internal audit report completed ACTasONE programme 2020/21 with all actions resolved Oct 2021.



Implementation date

Progress to date

1. Dedicated internal audit days specifically for the ACTasONE Programme Management

October – March 2022

We have agreed the scope for the next audit of ACTasONE.


Related risks on the Risk Register (number, brief description, current score):

• Current redeployment arrangements are kept under review

• Working on clarity to what the criteria would be for pausing/ resuming transformation work when faced with circumstances like a covid surge in future

1613 Demand for Mental Health Services (25) 1582 Increased health inequalities due to socio-economic and ethnicity factors (20)

Page | 31



Risk rating

15


Specific outcomes





• Due to peak of omicron surge passing, by 31 January 2022 all CCG staff on redeployment, returned to their substantive roles

• Plans in development to ensure we take the transformational learning from activities undertaken in response to covid, as well as from pre-planned transformation projects.

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Strategic Risk Log – our Partnerships as the vehicle for enabling people to take more responsibility for their health and self care Strategic Objective 5: Develop stronger collaborative partnerships in local places between the NHS, local government and others. Including a central role for primary care, collaborative provider arrangements and incorporate strategic commissioning through systems with a focus on population health outcomes

Risk Lead: James Drury (Director of Partnership Development) Risk Owner: Vicki Wallace Interim director - Partnerships

Risk rating

9

5.1 BdC PBP development: There is a risk that we fail to put in place sufficiently robust partnership decision making and delivery arrangements to take on the responsibilities currently discharged through CCG governance for BD&C, such that the WY ICS and NHSE are unable to delegate authority to the place-based partnership from July 2022 onwards.

Specific outcomes:



• reduce unwarranted variation in people’s experience of care

Risk Rating (Likelihood x Impact) Initial 4 x 3 = 12 (February 2021) 3 x 3 = 9 (Dec 21) Target 3 x 2 = 6

Rationale for current score:

• There is still work to do to progress the PBP arrangements. However, this is unlikely to stop the duties to be discharged being delegated from the ICB to the PBP

• Programme structure has been established, and work streams have been progressing throughout 2021/22

• Audit of readiness for PBP launch undertaken by Audit Yorkshire helped identify the remaining ‘must do’ requirements for each work stream in order to demonstrate that future decision-making and delivery arrangements are fit for purpose. Work streams are now refining delivery plans to ensure timely completion of the work required.

• Beyond the completion of the ‘must dos’ for authorisation, there is a need for a longer term and broader based partnership development plan. Work has commenced to scope this, informed by the self-assessment undertaken against the ‘PBP maturity matrix’

• Some uncertainty remains regarding the networked operational model across the five places, into which our local arrangements must interface and contribute

• Sub-risks are being managed in relation to possible loss of momentum due to the delay with legislation. Capacity due to pressures.

Rationale for target score (risk appetite):

• We seek to reduce the likelihood and impact Partners / stakeholders involved:

• All signatories to the SPA, plus general practices Functions need to be agreed at ICS level and dependent on the ICS programme

0

5

10

15

20

25

Feb-21 Jun-21 Oct-21 Dec-21


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Risk rating

9


Specific outcomes:





Gaps in Control where are we failing to put effective controls in place and what more


• H&C Exec Board will be assured by the PBP Establishment Programme Board

• PBP Establishment Programme Board (meeting every two weeks from the end of May is accountable to the Health & Care Exec Board.

• Regular management meetings with each work stream lead (fortnightly/monthly)

• Each work stream has refreshed it’s job card and work stream definition,

• Strategic Partnering Agreement in place, was refreshed in March 2021 with ongoing development

• WY&H ICS PBP Development Framework was used to self-assess. Process of self-assessment was in depth and multi-faceted. Used to support readiness audit submission, and the revised programme plan for Q4 21/22 Programme structure and programme management approach refined. Bi-weekly programme boards with highlight reports and mutual support between work streams. Chairs and Elected members Reference Group monthly

• Second phase of readiness audit to be undertaken in Q4 2021/22

Controls Action Plan what actions are being taken to address gaps in

control

Implementation date

Progress to date

1. Strategic Partnering Agreement update to reflect the new governance and partnership working arrangements

March 2022 Work on the update will be overseen by the governance work stream

2. PBP system development plan to be established

ongoing

PBP system development plan, will concurrently through 2021/22 (work streams: (i) leadership & behaviours and (ii) communications & engagement) (will be monitored throughout via the PBP establishment programme board) A national timeline was released in September 2021 and a new national timeline was released in January 2022 to reflect the delay to 1 July 2022. PBP workstreams have refreshed their work plans to take account of this delay

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Risk rating

9


Specific outcomes:




Assurance Mechanisms where / how do we get assurance that the existing controls are working effectively


Internal

• BD&C Strategic Partnering Agreement

• Engagement with NHS, LA and VCS partners

• Governance structure including Wellbeing Boards, Health & Care Executive Board, System Finance and Performance Committee, System Quality Committee and Health and Care Partnership Boards

• Monthly System & Place (ICS and PBP) report to the CCG Senior Leadership Team Chief Officer's Report to Governing Body which will then be received at the Partnership Board when the Governing Body is stepped down.

• Checks and balances at system not currently built in part of the Governance (system committee structures)

• ToR working group are developing key system group ToR which are due to be in draft by February 2022

• PBP Establishment Programme Board to establish progress reporting to Health & Care Executive Board

• Future design and transition group has conducted risk assessment on each workstream

External

• System Oversight including quarterly Whole System Review Meetings held at place with NHSEI and WYH ICS with partners across BdC

• Minutes of Bradford Wellbeing Board

• Attendance at Overview and Scrutiny Committees

• Internal audit have conducted readiness audit for PBP

• Shadow governance arrangements operating and the duties which will transfer (in place from January 2022)

Gaps in Assurance & Action Plan (where are we failing to gain evidence

that our controls are effective and how can we address this?)

Implementation date

Progress to date

1. No gaps in assurance N/A N/A


Related risks on the Risk Register (number, brief description, current score):

• Lead for Design and Delivery element meeting regularly with work stream leads (fortnightly)

• We have agreed PBP governance model through Exec board and PBP leadership arrangements – place-based leader

Risk 1858: CCG fails to adequately discharge its responsibilities with regard to dis-establishment (12) Risk 1857: Risk to staff wellbeing, morale and motivation due to impact of planned legislation (12)

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Risk rating

9


Specific outcomes:




• ICP self-assessment undertaken to establish baseline and inform our PBP development plan

• Works on functions underway (? Sign off date/process) and working towards shadow PBP from January 2022, informal shadow, and from 1 April 2022 formal shadow

• Internal Audit readiness baseline gave a set of actions that flows into each workstream.

Risk 1546: Member engagement in a larger CCG, impact of pandemic And ICS legislation (6) Risk 1968: legislation required to establish ICSs and dis-establish CCGs will be delayed in its passage through parliament.

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Strategic Risk Log – our People a skilled, motivated workforce with a culture of continuous improvement

Strategic Objective 6: We will continue to review and develop our internal resources, structures and processes to ensure that we are able to achieve our strategic objectives as our commissioning functions transfer and, thereby, our CCG staff transition to new Integrated Care System (ICS) and Place Based Partnership (PBP) arrangements.

Risk lead: Liz Allen, strategic director of organisation effectiveness Risk owners: Fiona Jeffrey, associate director of organisation effectiveness and Sue Baxter, strategic head of assurance

Risk rating

12

6.1 There is a risk of CCG staff struggling to adapt to revised system- and partnership-focussed roles as we move towards the new ICS and PBP operating models by 1 July 2022 due to the need for different organisational forms and individual CCG staff role flexibility and the normal factors associated with change, exacerbated by the impact of the Covid pandemic upon ways of working, resulting in failure to successfully transition our CCG staff.

Specific outcomes: • develop our inclusion and diversity as a team to better reflect and

understand our communities

• improve our skills and knowledge to increase our personal value

• be responsible, holding ourselves and each other to account

Risk Rating (Likelihood x Impact) Initial 3 x 4 = 12 (Mar 2018) Current 3 x 4 =12 (Dec 21) Target 2 x4 = 8

Rationale for current score: Score increased since January 2020 due to the impact on ways of working (due to Covid) and legislative changes that will result in the transfer of CCG statutory functions to the ICS. CCG staff will transfer employment to the WY ICB though most are expected to continue to work at place (i.e., in the BdC place-based partnership). Legislation delay has put back the transition date to 1 July 2022 which affords more preparation time in some areas but will create additional work associated with extending the change into a new financial year. Rationale for target score (risk appetite): As the impact of legislative change is clarified, and our plans to support staff are further developed, we aim to reduce the likelihood of staff not adapting to the transition. NHSE/I and the WY partnership have committed to continue to employ all CCG staff at and below board level. We will however have a number of leavers from key roles (due to retirement and resignation). There is an extension for key roles to continue to 30 June i.e., AO, Chair and lay and professional Governing Body members. Partners / stakeholders involved:

• West Yorkshire ICS and Bradford district and Craven PBP stakeholders

• CCG very senior managers and clinical leads

• CCG clinical and lay members

• CCG staff (including staff networks) and other staff affected by transfer orders

0

5

10

15

20

25

Mar 18 Sept 18 Mar-19 Jan-20 Feb-21 Jun-21 Oct-21 Dec-21


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Risk rating

12






Existing controls what are the key controls in place to prevent this risk occurring?

Gaps in control where are we failing to put effective controls in place and what more


• CCG People Plan agreed by SLT and an action plan is in place

• Commissioning workforce development framework – our learning and development (L&D) plan – aligns with our CCG People Plan and the NHS People Plan and was informed by a skills preference audit undertaken in summer 2020. This was launched in February 2021 and includes an expanded offer of blended learning and development opportunities to all staff.

• System workforce development group in place meets quarterly to oversee implementation with associated workforce update reporting monthly to SLT/PLT

• A common process for L&D applications has been put in place

• A range of learning and development offers are regularly provided and publicised

• Human resources (HR) and L&D contract is in place with BDCFT. Implications for extending the contract period to 30 June 2022 (end of transition period) are currently being worked through at West Yorkshire level.

• Documentation and guidance provided to line managers and staff to support effective annual appraisals, mid-year reviews and regular one-to-one conversations (including personal and career development, flexible working and wellbeing)

• Support for on-line access to training is available

• The CCG transition programme board has been established in order to ensure the safe and effective transfer of the CCG’s functions, people, assets and liabilities.

• Workforce Race Equality Standard (WRES) action plan agreed by SLT and has been in place since late summer 2021.

• Band 7 EDI role (funded by CCG) – this system post supports the senior EDI lead from BTHFT who, in turn, provides advice to the CCG and support to our staff networks.

• A PBP development programme board was initiated in May 2021 but requires time and resource to deliver against a broad range of work streams related to vision and strategy, leadership and behaviour, design and delivery.

• Functions that will inform future structures have been communicated but greater clarity is required as to the future operating model for the PBP in order to understand the potential impact on all current CCG staff.

• Lack of detail/clarity on PBP people structures (organogram) – more detail required for benefit of staff and to inform due diligence

• Position statement/assurance to the CCG Transition PB on key leavers and implications for organisational memory

• Out to recruitment currently for Associate Director of Partnership Delivery (people, patients and resilience) – interview 8 Feb 2022 (note: current related post holder leaves 11 February 2022)

• Due to the delay with the legislation through parliament, the due diligence timeline will be extended to align with 1 July 2022 new transition date.

• A delay in the audit and governance committee in common (bringing together WY ICB designated officers and current members of the five CCGs) which had been planned to take place in February 2022 is now more likely to meet in June 2022.

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Risk rating

12






• Race equality (RE) and WellbeingandAble (WAA) staff networks in place, representatives supported by ALT sponsors, debating items on a monthly basis. Both networks have governing body, strategic clinical director and associate director sponsors. In addition, there is work ongoing to facilitate transition to ICS.

• Workforce equality plan (developed by the RE and WAA staff networks) agreed by SLT and in place with senior staff identified to lead different elements – with regular updates taken to ALT with a handover refresh in Feb 2022

• New recruitment, selection and promotion policy developed in conjunction with RE staff network, including a strengthened recruitment manager’s checklist mandated for use in all relevant processes and requirement for all recruitment to gain approval from ALT before progressing to advertisement stage

• Engagement sessions (mandatory for all managers) have taken place – focussed on new/revised recruitment, selection and promotion policy, flexible working procedures and home-based working policy (using case studies from staff’s lived experience) in order to ensure fair and consistent implementation and promote good practice

• CCG RE staff taking part in the West Yorkshire ICS fellowship as mentors and mentees. Senior placement (Nov 2020), High potential 2 (Jul 2021) and a third tranche of high potential fellowship coming soon across WY. (Note this approach has attracted recognition – award)

• WAA staff network proposed extension to recruitment advertisement timescales – approved by SLT September 2021.

• Wellbeing task and finish group formed with input from range of staff including network representatives have undertaken mapping and audit of total wellbeing offer to staff – including gap analysis. Has completed its work and internal audit have provided significant assurance on our approach to wellbeing which is now business

Page | 39




Risk rating

12






as usual. We now have five wellbeing volunteers to work alongside our wellbeing guardians. We have ten members of staff trained as mental health first aiders.

• The national HR framework published by NHSE/I provides guidance relevant to all our staff’s future employment. In addition, the WY HR framework is now in place and supporting transition.

• Member of the WY ICS transition transfer of functions task and finish group. Terms of reference have been agreed, functions mapping work completed – provides peer support for ongoing due diligence work

• A BDC CCG due diligence task and finish group has been established and meets monthly to support coordination of the CCG response. The baseline due diligence exercise was completed by 3 Dec 2021 deadline and sense-checked by 15 December. The due diligence baseline report was taken to the CCG Transition PB in Jan 2022. The next step will be a deep dive across West Yorkshire led by Internal Audit and a position statement on due diligence will be produced by 31 Jan 2022

Controls action plan what actions are being taken to address gaps in control?

Implementation date

Progress to date

1. Functions that are expected to be carried out at ‘place’ will be translated into structures that can be shared with staff in future engagement sessions.

September 21 to 31 Dec 2021 - complete

Team alignment with the PBP functions was agreed and letters to individual staff were sent out in December 2021 in time to begin the informal shadow arrangements from 1 Jan 2022 and formal shadow arrangements from 1 April to 30 June.

2. The CCG is participating in the West Yorkshire due diligence exercise and will use the checklist provided by NHSE/I

September 21 to 30 June 22

The CCG transition programme board has overseen the completion of the baseline due diligence exercise and received the baseline report on 4 Jan 2022. Next steps will be a refresh of the timeline to align with the transition date change of 1 April 2022 to 1 July 2022

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Risk rating

12






3. Workforce assurance report (including leavers, starters and recruitment 1 Feb 2022 to June

2022

HR colleagues are supporting the production of a monthly monitoring assurance report (that outlines the leavers, starters and recruitment) which will highlight potential risks to organisational memory

4. Organogram production By 1 July 2022

Structures are developing and the production of the BdC place partnership organogram will be revisited prior to establishment of the new arrangements

5. AD Partnership Delivery (people, patients and resilience) – recruitment

8 February 2022 (interview)

The role is out to advert for the second time, with a closing date of 31 January 2022.

Assurance mechanisms where / how do we get assurance that the existing controls are working effectively?

Assurance details specific evidence of positive or negative assurances

Internal

• SLT/PLT and ALT members provide management, leadership and direction within and across the hubs and share issues, concerns, successes in CCG business and/or development meetings

• Workforce development group action plan is signed off and is business as usual. There will be a next phase to take this to WY

• 1:1 calls and development review meetings between managers and staff

• Workforce reporting to ALT including HR metrics

• Annual workforce report to Governing Body

• Reporting against WRES action plan to ALT and SLT

• EDI reporting in the CCG annual report

• Our people continue to express positive feedback in relation to the monthly staff engagement sessions we are holding.

• Use of survey tools (MENTI and MIRO) enable staff to provide anonymous and candid responses as to their views about future working in the ICS and PBP

• As a result of discussions with Strategic Director of Organisation Effectiveness, ongoing input to SLT/PLT from the staff networks and other mechanisms to raise good practice or issues has been established

• NHS staff survey results are still largely positive. Initial report for 2021 staff survey has been received and a more detailed report is due February/March 2022. Headlines are being prepared for SLT/PLT

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Risk rating

12






• Feedback from staff networks to extended SLT/PLT (includes ALT members)

• Internal auditors are part of the CCG due diligence task and finish group and

engage with the due diligence exercise providing assurance to the CCG transition

programme board and the audit and governance committee. They will also provide

assurance across WY to the accountable officer to support the AO’s written

assurance to the ICB AO and the Regional Director of NHSEI

External

• National NHS staff survey

• WRES national comparators

Gaps in assurance and action plan where are we failing to gain


Implementation date

Progress to date

No gaps in assurance N/A N/A

Key changes since the last review of this commissioning assurance framework (CAF) since October 2021


• Letters were sent out to staff in December, setting out their new team, line manager and job title

• We have taken account of the impacts upon timescales due to the delays in the legislative process. We have refreshed our programme management documents to re-align to the new target date of the 1 July 2022.

• *Risk 1857 risk to staff wellbeing, morale and motivation due to transfer of commissioning functions, people, assets and liabilities to integrated care systems (12)

• *Risk 1858 risk that the CCG fails to adequately discharge its responsibilities with regard to its own dissolution on 31 March 2022 (12)

• Key staff have agreed to extend their tenure to 30 June including AO, Chair, lay and professional Governing Body members

• We have progressed the due diligence exercise and met the required timescales. In addition, we have involved Internal Auditors with our approach at BdC and across West Yorkshire

• We have revised and updated our CCG transition internal communications action plan

• Risk 1968: risk that the legislation required to establish ICSs and dis-establish CCGs will be delayed in its passage through parliament. (15)

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Strategic Risk Log – our Leadership assuring the sustainability of our health and care system

Strategic Objective 7: Working at Bradford district and Craven place, we will maximise value for money in the use of healthcare services to ensure we can make shared decisions on how to use our resources to improve population health.

Risk Lead: Robert Maden, Chief Finance Officer Risk Owner: Diane Lawlor, Strategic Head of Finance for corporate reporting and financial control and Amy Paffett, Strategic Head of Finance for planning and transformation

Risk rating

16

7.1 There is a risk that we do not address the underlying financial deficit and establish a financially sustainable position over the medium term as we exit the pandemic

Specific outcome: • make shared decisions on how to use our resources to improve

population health

Risk Rating (Likelihood x Impact) Initial 4 x 4 = 16 (Sept 2017) Current 4 x 4 =16 (Dec 2021) Target 2 x4 = 8

Rationale for current score: The financial regime around the pandemic limited the CCG’s ability to improve the underlying financial deficit in 2020/21. This has continued into 2021/22 as we continue to operate under the COVID finance regime. For the first half of 2021/22 a break-even position is forecast, but this has been achieved mainly through non-recurrent measures. The financial plan for the second half of the year is being finalised but indicates that we will have a challenging savings target to achieve a break-even position for this period which is unlikely to be resolved on a recurrent basis prior to April 2022. Rationale for target score (risk appetite): The impact of not closing the financial gap will always remain high but we want to lower the likelihood, this still remains as we enter 2022. Partners / stakeholders involved:

• Local Health and Care Partnership stakeholders

• Demand needs to be owned by all stakeholders in the footprint

• NHS England


Gaps in Control where are we failing to put effective controls in place and what

more should be done to manage the risk

• joint planning process established across the Bradford district and Craven place

• business case process to support shared decision making on the use of resources

• expenditure controls in place to limit new expenditure commitments

• system transformation programmes established to support demand management

• Bradford Place financial risk share arrangements

• Approval for H2 plans

• waste reduction / savings programme not in place due to diversion of resources to support the pandemic

• greater clarity over local place based approvals processes

0

5

10

15

20

25

Sept 17Mar 18Sept 18Mar-19 Jan-20 Feb-21 Jun-21 Oct-21 Dec-21


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Risk rating

16



population health

• System Finance & Performance Committee oversight of Place financial position

• expect fixed income contract arrangements with main local providers implemented to continue with a focus on marginal cost changes rather than a tariff based approach

• operation of demand management initiatives (e.g. GP streaming, pathway adherence, evidence based interventions, etc.)

• quantifying the expected impact of transformation programme priorities on demand management. – this is in progress

• clarity needed surrounding financial plan 2022/23 and how sign off will work with closure of CCG

Controls Action Plan (what actions are being taken to address gaps in control) Implementation date

Progress to date

1. Finalise financial plan for H2, 2021/22 for approval by the Governing Body.

November 2021 Completed

November 2021

Planning guidance issued on the 30th September 2021 and operational and financial plan being prepared. This will be reviewed at the November Finance & Performance Committee and will be considered by the Governing Body in November.

2. Scope efficiency opportunities and expected implementation timescales in light of impact of the pandemic.

December 2021

Med Ops and Continuing Care

presented at F P & C.

QIPP opportunities being reviewed:

• Medicines Optimisation (CCG, Place and WY focus) discussions held

• Continuing care (National Framework criteria, and personalised budgets discussions held

• CCG support functions

• Estates rationalisation (CCG and Place) Feasibility work progressing. Schemes to be implemented to be confirmed long with any resource requirements. Expect main benefits to impact in 2022/23.

3. Confirm local Place based business case approvals processes

November 2021

• Place governance structure being updated in line with transition to ICB arrangements. (In progress)

• Testing a proposal for business cases to be considered by a joint meeting of representatives from the System Finance & Performance Committee and System Quality Committee as part of the new governance arrangements. Approach tested but not formalised.

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Risk rating

16



population health

• Local Finance Deputies group developing a standardised template and process for compiling business case proposals.

4. Assess the impact of the main transformation schemes on managing demand for health services.

TBC

• plan to schedule detailed reviews of transformation programme plans to confirm expected outcomes and over what timescale.

• part of new arrangements linked to work plan for Finance and Performance Committee. Schedule of transformation will be mirrored with BdC place system F P & C.

Assurance Mechanisms (where / how do we get assurance that the existing controls are working

effectively)

Assurance Details (specific evidence of positive or negative assurances)

Internal

• Involvement of SLT and Governing Body members in development of plans - relates to Q3

• Sign-off of plans by F&P Committee and Governing Body. Relates to Q3

• Monthly financial reporting (CCG and Place) to SLT, CCG F&P, Governing Body, System F&P, Bradford Place Forums and PBP Board. Relates to Q3

• Shadow governance arrangements in place for Q4 and Q1 of 2022/23 External

• Financial Plan sign off by NHSEI as part of WY&H ICB plan. Process to be agreed.

• Collaborative agreement of plans by the WY&H ICB.

• West Yorkshire & Harrogate ICB

• Role of NHSEI as regulators

• Monthly internal reports on financial performance.

• Monthly non-ISFE submission to NHSEI on year to date and forecast

financial position.

• Annual accounts submission.

• External audit opinion.

Gaps in Assurance & Action Plan (where are we failing to gain evidence that

our controls are effective and how can we address this?)

Implementation date

Progress to date

No gaps in assurance currently.

Not applicable Not applicable

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Risk rating

16



population health

Key changes since the last review of this commissioning assurance framework (CAF) in June 2021


• Break-even financial performance for H1, 2021/22 confirmed.

• H2 financial plan was completed in November 2021

• Further work has been progressed in relation to savings opportunities.

• Further work has progressed in relation to developing local Place governance arrangements.

• CCG F&P Committee has been stepped down from 1 January 2022

• Delay in CCG transition to ICB (put back from 1 April 2022 to 1 July 2022)

Risk 1862: Financial arrangements for H1 2021/22 (9) Risk 1694: Underlying financial position risk (16) Risk 1549: Loss of local financial control (10)

of 2

Agenda item 10


Title of report Risk Register Report: Cycle 5 2021-22 (January to February)

Report author(s) Catherine Smith, Corporate Governance Manager

Lead(s) / SRO Helen Hirst, Chief Officer Report lead(s) Catherine Smith, Corporate Governance Manager


The purpose of the paper is to provide the Governing Body with details of ‘serious’ and ‘critical’ risks (those scoring 15 or more), new risks identified and risks closed during the current risk review cycle. Corporate risk register (updated bi-monthly)

• There has been one new risk added to the risk register during this cycle:

o Risk 1968 - there is a risk that the legislation required to establish ICSs and dis-establish CCGs will be delayed in its passage through parliament. This would result in a hiatus to the implementation of the new arrangements and the operation of dual or hybrid arrangements in the interim. Confirmation received from NHSE/I (December 2021) that the implementation of the ICS legislation will be extended by three months - from 1 April 2022 to 1 July 2022. The risk has a score of 15 and is classed as a ‘serious’ risk.

• There are seven risks at the ‘critical’ level (scoring 20 or 25).

o Risk 1613 relates to the demand for mental health services (with a risk score of 25),

o Risk 1495 relates to the impact of the Covid-19 pandemic (with a risk score of 25).

o Risk 1960 relates to the risk of structural deficiencies at Airedale General Hospital related to construction using RAAC (reinforced, autoclaved, aerated concrete (with a risk score of 20).

o Risk 1955 relates to the difficulty in procuring and commissioning of independent care (with a risk score of 20.

o Risk 1953 relates to dual data centre resilience (with a risk score of 20).

o Risk 1739 relates to burnout amongst NHS workforce (with a risk score of 20).

o Risk 1582 relates to increased health inequalities due to socio-economic and ethnicity factors (with a risk score of 20).

• There are 11 risks classed as ‘serious’ (scoring 15 or 16), of which two risks will be reported in private.

• Ten risks have closed this cycle – two of which were classed as ‘serious’ risks.






A robust risk management framework is essential to supporting the delivery of the CCG strategy.

The CCG’s assurance framework is sets out the higher-level and longer-term risks to achievement of the CCG strategy.

of 2

The assurance framework and risk register will be closed down as part of the transition for CCGs. Some risks will transfer to the Partnership Board and some to the Integrated Care Board.

Purpose

assurance

information

decision


action


Recommendation(s)

The governing body is asked to receive and note the risk report and high level risk log.


Appendix 1: Risk report including scoring matrices Appendix 2: Risk overview diagram Appendix 3: Corporate risk register; high level risk log

1

Risk Register Report: Cycle 5 2021-22 (January - February 2022) 1.0 Purpose of the Report

1.1 To provide the Governing Body with details as at the end of Risk Cycle 5 2021-22, of:

• ‘high level’ risks – those rated as ‘serious’ or ‘critical’ risks (scoring 15 or more)

• new risks added to the risk register during the current risk cycle

• risks above the ‘serious’ level that have increased or decreased during the cycle

• risks closed during the cycle.

2.0 Risk Review and Reporting Process

2.1 There are normally six risk review cycles per annum. The process for the review and reporting of

the CCG’s corporate risk register is as follows:

• Review of individual risks by risk Owners

• Review of individual risks by allocated Senior managers

• Review of all risks by the Senior Leadership Team (SLT)

• Further report to SLT prior to Governing Body reporting by exception

• Reporting of risks scoring 15 or more, plus new and closed risks, to the Governing Body.

2.2 In addition, the corporate risk register is a standing item on the agenda of standard Audit and

Governance Committee meetings in order to provide assurance on the risk management process.

2.3 During this cycle work has continued to encourage risk owners and senior managers to undertake

comprehensive reviews of each risk in particular focusing on any risks that have remained static for

more than a year and to consider whether they are still relevant.

24. The risk register was presented to the Senior Leadership Team meeting on 26th January 2022.

3.0 Corporate Risk Cycle 5 January - February 2022

3.1 Please see Appendix 2 for the CCG risk overview diagram.

3.2 Numbers of risks and average risk scores are shown in the table below:

Numbers of risks and average risk scores

2

Total number of open risks 44

Number of open risks aligned to Finance and Performance Committee (FPC) 17

Number of open risks aligned to Quality Committee (QC) 20

Number of open risks aligned to both Finance and Performance and Quality committee 7

CCG average risk score 12.69

FPC average risk score 10.53

QC average risk score 14.40

Details of new risks

3.3 One new risk has been added to the risk register in the current risk cycle, details of which can be found in the table below. Risk scores are calculated by multiplying the impact by the likelihood.

Risk reference number

Risk summary Current risk score

1968

(Both FPC and QC)

There is a risk that the legislation required to establish ICSs and dis-establish CCGs will be delayed in its passage through parliament. This would result in a hiatus to the implementation of the new arrangements and the operation of dual or hybrid arrangements in the interim. Confirmation received from NHSE/I (December 2021) that the implementation of the ICS legislation will be extended by three months - from 1 April 2022 to 1 July 2022.

Overall score is 15

Impact is 3

Likelihood is 5

Details of critical risks

3.4 There are seven risks currently classed as ‘critical’ (scoring 20 to 25) on the risk register, details

can be found below:



1613

(QC) • Demand for mental health services – there is a risk that

demand for mental health services outweighs capacity and / or require a different focus going forwards due to increased need arising from the pandemic, including the impact on key workers (for example PTSD). The impact is inability of local people to access appropriate mental support in a timely way which would reduce their health and wellbeing.

Overall score is 25

Impact score is 5

Likelihood score is 5

1495

(QC) • COVID-19 pandemic - there is a risk that the COVID-19

pandemic will result in substantial fatal outcomes in high-risk groups and economic and societal disruption. The demand for health services may outstrip resources available.158

Overall score is 25

Impact score is 5


1960

(QC) • RAAC at Airedale Hospital - there is a risk of structural

deficiencies at Airedale General Hospital related to Overall score is 20

3



construction using RAAC (reinforced, autoclaved, aerated concrete) making it necessary to undertake a full or partial evacuation of the site due to issues either at Airedale or other RAAC sites in the country. This potentially could involve injuries to patients and/or staff, disruption to patient care and increased pressure on the rest of the health and social care system across Yorkshire and the Humber.

Impact score is 5


1955

(QC) • Independent care providers - procurement and

commissioning of independent care providers is becoming increasingly difficult due to a lack of capacity within the BDMC Framework and non-framework providers for adults, children and young people.

Overall score is 20

Impact score is 4


1953

(Both FPC and QC)

Dual data centre resilience - following the upgrade to Windows 10 there is inadequate computing resource (across our 2 Data Centres) to deliver the required level of failover / resilience required (as previously enjoyed under Windows7).

Overall score is 20

Impact score is 4


1739

(QC) • There is a risk of burnout amongst the NHS workforce as the

system continues to manage the significant acute and now longer-term demands of COVID-19, in addition to dealing with the backlog of elective care that necessarily accrued during the pandemic, which could impact negatively on staff wellbeing and on the provision of care to the population.

Overall score is 20

Impact score is 5


1582

(QC)

Increased health inequalities due to socio-economic and ethnicity factors - there is a risk of increased health inequalities due to socio-economic and ethnicity factors during the pandemic (evidence to date is that the pandemic is impacting on deprived and BAME groups more than average). The impact is failure to meet statutory duties relating to reduction of health inequalities / disproportionate suffering for certain groups.

Overall score is 20

Impact score is 5


Details of serious risks

3.5 ‘Serious’ risks are those scoring 15 or 16. The current number of ‘serious’ risks is 11 in total. Details for risk 1968 can be found in section 3.3 and two risks will be reported in private, the remaining nine serious risks are detailed below



Risk movement

Cycle 5 update

1694 (FPC)

There is a risk that the CCG will take an underlying financial deficit into 2021/22 due to the inability to deliver the original planned savings of £13.8m as a result of the disruption of activities caused by the pandemic.

Overall score is 16

Impact is 4

Likelihood is 4

Static – 7 cycles

No further update has been provided at this time.

4



Risk movement

Cycle 5 update

1135

(QC)

There is a risk of further deterioration in the service offer for adults waiting for an adult autism and/or ADHD assessment, diagnosis and immediate post-diagnostic support due to the limited capacity to address the demand for referrals, resulting in the waiting times for initial assessment and completion of the diagnostic process lengthening and increasing beyond standard wait times. This may result in delays to patient receiving appropriate care and treatment.

Overall score is 16

Impact is 4

Likelihood is 4

1

4)

Static – 16

cycles

Formal contractual routes are used but the service provider has not been able to deliver increased capacity to meet demand of referrals due to staffing shortages at the provider and model. CCG / Local Authority Councillor meeting held in December 2021 providing an update on adult autism waits and plans for resolution. The provider has agreed to the CCG proposal that BANDS deliver 110 Adult Autism assessments for the Transformation Fund (from 2022 through to 2024) sum, to support addressing the waiting list over core funding of autism service provision. Scoping of potential outsourcing arrangements are ongoing to recover the wait list to a zero baseline by end 2022. Current low monthly rate of assessments is linked to staff absences and the provider team focus on tasks. Discussions via a BANDS task and finish group with the provider, to progress improvements in triage function (now taken out of the provider team function) have been held and agreed.

1094

(QC)

There is a risk of further deterioration in the statutory duty service offer for children waiting for an autism and/or ADHD assessment, diagnosis and immediate post-diagnostic support. This results in non-compliance with the NICE (non-mandatory) standard for first appointment by 3 months, delaying any appropriately identified formal post-diagnostic support.

Overall score is 16

Impact is 4

Likelihood is 416

6

(I4XL4)

Static – 25 cycles

The risk has been reviewed and the narrative updated to reflect the current position following the additional funding for assessments identified in the business case. The risk remains at the same risk rating as the current level of funding will allow us to achieve NICE guidance in respect of referral to commencement of assessment but then, without additional investment the waiting list will rise again. There is also a concern a concern that NHS providers may not be able to recruit to posts at a level which will allow them to increase their capacity in line with the business case.

5



Risk movement

Cycle 5 update

1726 (QC)

There is a risk that unpaid carers are not identified as carers and are therefore not offered assessment and support, resulting in worse mental and physical health and increased acute care needs for both the carer and the person they look after.

Overall score is 15

Impact is 5

Likelihood is 3

15

(I15

L3)

Static – 5 cycles

Focused engagement with primary care planned through the top tips campaign . Work has commenced at WYICS level to develop a primary care resource pack to increase the unpaid carer identification across the system. Carer awareness training for health and social care staff to be developed and mobilised. CCG workstream lead will engage with PCNs to increase the identification of carers.

1713 (Both

FPC and QC)

COVID vaccinations Overall score is 15

Impact is 3

Likelihood is 5

Static -1 cycle

The risk remains the same due to decreased uptake from population in regards to boosters. Met the accelerated offer of all adults to receive booster by end of December 2021 but population did not come forward to meet the offer.

1594 (FPC)

There is a risk to the financial sustainability of the care home market due to the costs and issues arising from the pandemic.

Overall score is 15

Impact is 3

Likelihood is 5L5)


Risk remains active.

1404 (QC)

There is a risk of impact on CCG commissioned services due to redesigned health visitor, school nursing and oral health services (commissioned by CBMDC with a significantly reduced budget), resulting in pressure on other health services.

Overall score is 15

Impact is 3

Likelihood is 5

L5)


We await further updates from CBMDC on their discussions with BDCFT with regard to when they will come out of business continuity mode. The impact of a lack of early intervention and support from the HV service continues to be felt by CCG commissioned services.

1098 (FPC)

There is a risk that poor performance against the key constitutional standards will impact upon a number of CCG national performance assessments including the annual Improvement and Assessment Framework ratings and quality premium achievement.

Overall score is 15

Impact is 3

Likelihood is 5


Covid continues to impact upon recovery and the new variant is resulting in higher cases, staff absence, hospitalisations etc which will impact upon recovery of elective care, alongside increased demand on services to deliver the Covid vaccination programme. Recovery plans submitted for H2 2021

6

Increased risks 3.6 Three risks have increased in score during the current risk cycle – details for 1955 and 1739 can be found in section 3.4 as they have increased to become ‘critical’ risks. The third risk falls below the threshold of being classed as a ‘serious’ or ‘critical’ risk

Decreased risks

3.7 One risk has decreased in score during the cycle and falls below the threshold of being either a

‘serious or ‘critical risk’.

Details of closed risks

3.8 Ten risks have been marked for closure this cycle. Eight risks were below the ‘serious’ level of risk – details for the remaining two which were classed as ‘serious’ risks can be found below:

4.0 Recommendations

The Governing Body is asked to receive and note the high level risk report and risk log.

Appendices Appendix 1: Risk Scoring Matrices (from the Integrated Risk Management Framework) Appendix 2: Risk Overview Diagram Appendix 3: High Level Risk Log


Risk description Reason for closure

943

(QC)

Quality and safety in care homes

System risk to be developed.

940

(QC)

There is a potential risk that women and babies will receive unsatisfactory care within BTHFT maternity services and this may result in increased serious incidents and the potential of avoidable patient harm.

System risk to be developed.

7

Appendix 1: Risk Scoring Matrices and Risk Grading

Impact

Impact 1 Insignificant 2 Minor 3 Moderate 4 Major 5 Catastrophic

Financial £1k - £10k Up to £50k Up to £250k Up to £1M Over £1M

Harm

Minor bruises/ discomfort/

affects wellbeing.

Some minor injuries/

ill-health - minor.

<3 days absence

Many minor injuries/

ill-health – temporarily incapacitating. RIDDOR reportable.

Some major injuries/ ill-health - permanently incapacitating

Multiple injuries/infections

Unexpected Death

Clinical care No significant effect on quality of care provided

Noticeable effect on quality of care provided

Significant effect on quality of care provided

Patient care significantly impaired

Patient care impossible

Quality

Negligible negative impact on access, experience and /or outcomes for people with this protected characteristic. Negligible increase in health inequalities by widening the gap in access, experience and /or outcomes between people with this protected characteristic and the general population. Potential to result in minimal injury requiring no/minimal intervention or treatment, peripheral

Minor negative impact on access, experience and /or outcomes for people with this protected characteristic. Minor increase in health inequalities by widening the gap in access, experience and /or outcomes between people with this protected characteristic and the general population.

Potential to result in minor injury or illness, requiring minor

Moderate negative impact on access, experience and /or outcomes for people with this protected characteristic. Moderate increase in health inequalities by widening the gap in access, experience and /or outcomes between people with this protected characteristic and the general population. Potential to result in moderate injury requiring professional intervention.

Major negative impact on access, experience and /or outcomes for people with this protected characteristic. Major increase in health inequalities by widening the gap in access, experience and /or outcomes between people with this protected characteristic and the general population. Potential to lead to major injury leading to long-term incapacity/disability

Catastrophic negative impact on access, experience and /or outcomes for people with this protected characteristic. Catastrophic increase in health inequalities by widening the gap in access, experience and /or outcomes between people with this protected characteristic and the general population. Potential to result in incident leading to death, multiple permanent injuries or

8

Impact 1 Insignificant 2 Minor 3 Moderate 4 Major 5 Catastrophic

element of treatment suboptimal and/or informal complaint/inquiry

intervention and overall treatment suboptimal"

irreversible health effects, an event which impacts on a large number of patients, totally unacceptable level or effectiveness of treatment, gross failure of experience and does not meet required standards

Performance Internal Standards not achievable

Repeated failure to meet internal standards

National Performance not achievable (Intermittent)

National Performance not achievable (Continuous)

Enforcing action Audit non-conformance/advice from enforcers.

Breach of procedure/ Directive from enforcers.

Improvement Notice. Prohibition Notice. Government Investigation.

Likelihood

Level Descriptor Description

1 Rare The event may occur only in exceptional circumstances

2 Unlikely The event could occur at some time

3 Possible The event should occur at some time.

4 Likely The event will probably occur in most circumstances.

5 Almost Certain The event is expected to occur.

9

Score and risk level

Score Risk Level

1-3 Low risk

4-6 Moderate risk

8-12 High risk

15-16 Serious risk

20-25 Critical risk

10

Appendix 2: Risk Overview Diagram

Risk Overview Diagram relates to the current risk cycle

Key

FPC

QC

Both FPC and QC

New Risk

Risk Score Increasing

Closed Risk

Risk Score Decreasing

Risk Score Static

Score Risk Level

1-3 Low Risk

4-6 Moderate Risk

8-12 High Risk

15-16 Serious Risk

20-25 Critical Risk

Corporate risk register - cycle 5

Risk

ID

Dat

e Cr

eate

d

Risk

Typ

e

Risk

Ca

tego

ry

Risk

Ra

ting

Targ

et

Risk

Ra

ting

Risk

O

wne

r

Seni

or

Man

ager Principal Risk Key Controls Key Control Gaps Assurance Controls Positive Assurance Assurance Gaps GBAF Ref No(s)

Risk

St

atus

1613

19/0

6/20

20 QC

Our

Pop

ulat

ion 25

(I5xL

5) 15(I5

xL3)

Kris

tian

Farn

ell

Alija

n H

aide

r DEMAND FOR MENTAL HEALTH SERVICES

Risk that demand for mental health services outweighs capacity and / or require a different focus going forwards due to increased need arising from the pandemic, including the impact on key workers (for example PTSD).The impact is inability of local people to access appropriate mental support in a timely way which would reduce their health and wellbeing.Increased pressures on services leading to out of area placements and more people presenting in crisis. 14/01/2022 Reviewed and risk still present, workforce reduced due to increased incidence of sickness due to Covid across the systems.

~ Bereavement services set up for public, training for front line staff and Psychological support line for staff operated by BDCFT - ~ Task and finish group overseeing and have established work plan which looks at home support, discharge support and admissions avoidance.~ Communications and resource material developed and published~ Provider forum have MOU to allow swift redeployment of resources and capacity between organisations (community and trust)- Additional resource and support from Mind in Bradford and National Mind, providing vital capacity14/01/2022 Reviewed

Funding to continue Covid grief and loss support locally needs to be identified. 14/01/2022 continuation of funding through to end March2023.

* Weekly huddles in place* Monthly meeting with SRO and key partners* Escalation procedures in place* Partnership working with ICS and other WY partners and providers * Provider forum meeting monthly 14/01/2022 reviewed and to remain in place.

14.01.2022 Winter pressures funding to support VCS across both CYP and Adults, temporary Crisis house being identified until commissioned service available, continuation of Grief and Loss service funding. Crisis Alternatives Procurement underway. 09.09.21 - learning event taken place to review CYP pressures. This has resulted in an action plan with key mitigating factors that partners have agreed. 08.07.21 - additional resource from SDF input to IHTT and FRS capacity. Mobilisation of support between services made to speed up triage and waiting list growing.

14.01.2022 reviewed the below still remains a gap. System partners working on this reducing this. 17.05.21 - increase in crisis and admissions means trajectory for reducing admissions is not being met.

Stat

ic -

6 cy

cle(

s)

1495

03/0

3/20

20 QC

Our

Pop

ulat

ion 25

(I5xL

5) 12(I3

xL4)

Laur

a Si

ddal

l

Liz

Alle

n IMPACT OF COVID-19 PANDEMIC

There is a risk that the COVID-19 pandemic will result in substantial fatal outcomes in high-risk groups and economic and societal disruption. The demand for health services may outstrip resources available.

- Partial command structure in place in the CCG and across Bradford district and Craven. Some elements have been stood down, but can be stood up again if required.- Regional meetings for the NHS emergency planners once a week.- The health and care silver meetings for Bradford district and Craven have been stood up to twice weekly.- Lateral flow testing established for staff and general public.- Outbreak Control Board established. Led by BMDC and with senior system leaders on membership.- Vaccination of adults programme has been delivered and an "evergreen" offer is available. - Vaccination programme for 12-15 year olds and booster programme in place.

- Rapidly changing nature of the prevalence of COVID-19 and new variants, such as Omicron, emerging means that actions and arrangements required are constantly changing.- Lack of clarity about the threshold that must be met for further lockdown measures to be introduced nationally.

Update for SLT (05/01/22) - A significant surge is forecast for mid to late January, with high levels of staff absence. NHS organisations have been asked to prepare to stand up their command and control structures as a major incident may need to be declared. The WY System Oversight and Assurance Group has agreed a set of exceptional actions that can be taken to reduce pressure on the system during a surge. These have been reviewed by the health and care silver group, who noted that many of the actions are already being enacted. Difficulty accessing PCR and LFT tests and delays in receiving results is a significant risk to workforce. Local arrangements have been put in place so that priority health and care staff can access PCR tests through the acute trusts. Work is being done to access contingency supplies of LFTs for staff.

Update for SLT (24/11/21) - no significant changes to report

- Unknown numbers of people who are COVID-19 positive but are asymptomatic or have very mild symptoms. - Contact tracing is now more limited as under 18s, people who are double vaccinated and people who are not eligible to receive the vaccine are no longer required to isolate after contact with a positive case.- Potential for people to decline Covid testing in order to avoid the requirement to self isolate (if test positive)

- Unknown numbers of people who are COVID-19 positive but are asymptomatic or have very mild symptoms. - Contact tracing is now more limited as under 18s, people who are double vaccinated and people who are not eligible to receive the vaccine are no longer required to isolate after contact with a positive case.- Potential for people to decline Covid testing in order to avoid the requirement to self isolate (if test positive)

Stat

ic -

11 c

ycle

(s)

1960

08/1

2/20

21 QC

Our

Pop

ulat

ion 20

(I5xL

4) 9(I3

xL3)

Laur

a Si

ddal

l

Liz

Alle

n RAAC AT AIREDALE - There is a risk of structural deficiencies at Airedale General Hospital related to construction using RAAC (reinforced, autoclaved, aerated concrete) making it necessary to undertake a full or partial evacuation of the site due to issues either at Airedale or other RAAC sites in the country. This potentially could involve injuries to patients and/or staff, disruption to patient care and increased pressure on the rest of the health and social care system across Yorkshire and the Humber.

- Airedale NHSFT is taking a programme of actions to monitor and manage the risk of RAAC (regular inspections take place and, if issues are identified, actions are undertaken to ensure that the area is safe).- NHS England is leading a programme to develop plans for how the Yorkshire health and care system would manage a partial or full evacuation of the Airedale General Hospital site.- There is a national programme for NHS RAAC sites to ensure that learning and risk is shared nationally and a common approach is taken.- ANHSFT is building a number of modular wards so that patients can be decanted out of RAAC areas while repair work takes place and can be used if areas need to be evacuated.

- It remains uncertain whether the national funding required to build a new hospital for ANSHFT will be approved.- Research into the properties of RAAC, such as flammability, is still ongoing and so there are a number of unknowns as to how resilient RAAC is.

Update to SLT (5 and 10 Jan 2022) - The CCG is leading on the workstreams related to acute services and elective recovery. Liz Allen is currently the SRO for these workstreams and will shortly hand back to Nancy O'Neill (timescale TBA). Owners have been assigned to each of the actions (CCG, ANHSFT and, since 06/01, WYAAT programme director) - significant updates having taken place following discussions at a meeting chaired by Anthony Kealy on 06/01/2022. Regular meetings to monitor progress are taking place.

- ANHSFT escalates any RAAC related incidents and actions being taken to address them to NHSE and the CCG using a nationally developed reporting form.- Quarterly RAAC risk summits, chaired by Margaret Kitching, Chief Nurse for the North, are an opportunity for various stakeholders to examine RAAC risks from different perspectives.

- The trust’s monitoring programme has detected areas of weaknesses at an early stage before significant collapses have occurred.

- The risk of RAAC is difficult to quantify due to unknown information (currently, further research is being carried out into the resilience of RAAC). This makes it difficult for the CCG to balance the option of commissioning services from ANHSFT (and exposure to RAAC risk) versus the option of not commissioning services from ANHSFT (to avoid RAAC risk) and the subsequent risk to patient care by overburdening the health system across Yorkshire through reduced capacity.- It is unknown how the public and staff would react if a collapse happened at another RAAC site or part of Airedale General Hospital needed to be evacuated. The public and staff may lose confidence and choose not to attend Airedale General Hospital, putting pressure on the Yorkshire health system.

Stat

ic -

1 cy

cle(

s)

1955

22/1

1/20

21 QC

Our

Peo

ple 20

(I4xL

5) 1(I1

xL1)

Nad

ine

Culli

mor

e

Mic

helle

Tur

ner Procurement and commissioning of Independent care

providers is becoming increasingly difficult due to a lack of capacity within the BDMC Framework and non framework providers for adults, children and young people.

The situation is being monitored through the CHC Oversight Group and PCD managers are monitoring the situation on a daily basis within the PCD.Children's' CCG commissioners have been informed and they are carrying out a service review with the BTHfT community children's team.

Monthly reporting is occurring to the PCD Adult Oversight Group and PCD children Oversight Group. The children’s commissioners need to complete their service review as soon as possible with BTHfT. We are informing families that we are limited to the providers we can approach due to capacity in the system. We are offering Direct Payments to families as standard within the PCD.

Updates on the service review are being provided through the CCG's ALT/SLT and PCD Oversight Groups. PCD is linked in with the Local Authority to broaden availability of providers.

At present we have no incidents where the CCG has been unable to provide independent provider support to an individual living within the community. As a contingency, numerous agencies are contacted at the same time when staff are sourcing providers

There are no gaps in assurance

Incr

easi

ng

Risk

ID

Dat

e Cr

eate

d

Risk

Typ

e

Risk

Ca

tego

ry

Risk

Ra

ting

Targ

et

Risk

Ra

ting

Risk

O

wne

r

Seni

or

Man


Risk

St

atus

1953

22/1

0/20

21

Both

FPC

and

QC

Our

Pop

ulat

ion 20

(I4xL

5) 6(I3

xL2)

Sim

on W

ilson

Robe

rt M

aden DUAL DATA CENTRE RESILIENCE

Linked to risk 1735 (to be updated to include VDI Desktop slowness experienced)Following the upgrade to Windows 10 there is inadequate computing resource (across our 2 Data Centres) to deliver the required level of failover / resilience required (as previously enjoyed under Windows7). This means that should key equipment fail at either one of the Data Centres then the affected users will not be able to connect to another Data Centre and in turn will be unable to use their full Clinical and user desktop. It may result in a reduction in the number of people who could be seen in General Practice, introduce Clinical Risk, place additional stress on the GP workforce and in turn create pressures elsewhere in the place and potentially wider system. Patient experience could be equally impacted and current (nationwide) levels of media attention re provision of GP Services could see a focus on Bradford District and Craven, impacting on Public Relations and reputation. By way of explanation (figures are indicative but not exact - within a 10% tolerance): prior to Windows 10 both Data Centres (one in Calderdale Royal Infirmary and one in Huddersfield Royal Infirmary) provided capacity for circa 2000 users per Data Centre (so 4000 users across the 2) with the daily average number of concurrent users (the number of users logged on at any one time) across both Data Centres being circa 1900-2100. The level of resilience provided here therefore would allow almost all users from say Data Centre A to move to Data Centre B in the event that Data Centre A experienced a catastrophic failure. Data Centre B would have sufficient capacity to handle approximately 80-90% of the overall (combined) user base.Following the deployment of Windows10 each DC is now able to serve only around half the original number i.e. 1000 users per Data Centre in Windows

An Incident Management Process has been initiated and calls are held daily (internal Health Informatics Technical call @ 12noon and joint CCG and Health Informatics call @ 3pm).The Incident Management Team is headed by Rob Birkett, Dir of Ops @ THIS with Keith Redmond (Chief Technology Officer) acting as Deputy. The joint meeting at 3pm is attended by Senior THIS representatives and CCG Senior Digital Team members (and Mutaz Aldawoud as CCIO when required).A separate governance and communications workstream is being led by Michelle Turner, Director of Quality, with a particular focus on the impact on Clinical Safety and general (healthcare) system resilience; linking with the LMC and NHSE Region. Robert Maden as SIRO is linked to this workstream as is Mutaz Aldawoud and Simon Wilson - creating the link back to the Incident Management Team. General Communications re progress on resolution and interim advice and guidance re workarounds is being managed via Paul Searle, CCG Digital Programme Manager. Periodic updates (via email) are distributed to Practice Managers and via various less formal channels including the IT Reference WhatsApp Group (made up of a number of Practice Manager, GPs and PCN Clinical Directors). Paul Slater (Programme Manager and Technical Specialist) from the NHSD TSSM Team (Trust System Support Model) attends the 3pm Incident Management meeting, his role is to assure the Investigation Plan (initially) and will also assure the Resolution Plan once the investigations have completed. Paul Slater may need to bring in specific technical expertise at any point during either the Investigation or Resolution phases.Engagement with the key SystmOne Clinical System Supplier (TPP - The Phoenix Partnership) continues and escalations where appropriate are made to their Account Director to seek their advice and expertise for

The CCG has yet to source the additional 3rd Party Technical Specialist input as an added layer of governance and assurance (for potentially the Investigation Phase and also for the Resolution Phase).Escalations to TPP do not always result in a timely or required response. There is a need for a more indepth joint investigation approach including TPP, THIS, BDC CCG and NHSD.

Other than as described in the Key Controls above, a weekly Highlight Report is produced for consumption at the CCG SLT (this is effectively a continuation of the Windows10 Highlight Report but is now predominantly focussed on the status and management of this incident.Areas of escalation for resolution are noted and actioned accordingly.

The Highlight Report mechanism via SLT has enabled Michelle Turner to trigger engagement with LMC and NHSE colleagues.The Incident Management Process, and in particular the 3pm joint call, has enabled the CCG Digital Team to source input from NHSD TSSM Team, trigger escalations to TPP and provide periodic communications to the user base via various channels.The Incident Management Process has enabled the CCG Digital Team to maintain momentum and ensure THIS remain wholly focussed on completing the Investigation Phase (current phase).

As this is the initial entry@ 22/10/21 we will need to observe current approaches and identify Gaps in Assurance in the coming days/weeks.

Stat

ic -

2 cy

cle(

s)

1739

26/0

3/20

21 QC

Our

Peo

ple 20

(I5xL

4) 6(I3

xL2)

Dave

Tat

ham

Dave

Tat

ham BURNOUT AMONGST NHS WORKFORCE

There is a risk of burnout amongst the NHS workforce as the system continues to manage the significant acute and now longer-term demands of COVID-19, in addition to dealing with the backlog of elective care that necessarily accrued during the pandemic, which could impact negatively on staff wellbeing and on the provision of care to the population.

Organisational and system focus on staff wellbeing, setting and communicating realistic expectations of recovery and system transformational work to embrace and enhance new ways of working (enabled by enhanced technology) and interfacing across primary and secondary care to deliver more efficient ways of working.

No gaps in control To be confirmed Organisational and system focus on staff wellbeing, setting and communicating realistic expectations of recovery and system transformational work to embrace and enhance new ways of working (enabled by enhanced technology) and interfacing across primary and secondary care to deliver more efficient ways of working.

To be confirmed

Incr

easi

ng

1582

09/0

6/20

20 QC

Our

Pop

ulat

ion 20

(I5xL

4) 10(I5

xL2)

Polly

Mas

son

Soha

il Ab

bas INCREASED HEALTH INEQUALITIES DUE TO SOCIO-

ECONOMIC & ETHNICITY FACTORS

There is a risk of increased health inequalities due to socio-economic and ethnicity factors during the pandemic (evidence to date is that the pandemic is impacting on deprived and BAME groups more than average).

The impact is failure to meet statutory duties relating to reduction of health inequalities / disproportionate suffering for certain groups.

Recognition of need to revise strategies in light of pandemic and changes to health needs.

Some immediate mitigations are the work we are doing as health inequalities network across WY and within Bradford central locality. The community connectors funded by the RIC monies are doing great work. Recent additional comms to practices offering support with work related to vulnerable patients / high risks groups.

RIC programme is slowly gaining momentum with particular emphasis on VCS lead projects, homeless people projects, mental health, CLICS and primary care workforce development.

Two projects led by BDCFT (proactive care team and admiral nursing team) are now live and building caseloads

There is also work to support vulnerable people started by public health in Bradford and at PHE. Pippa Bird, a public health registrar is leading on the Bradford work and will report to HI network that I chair and PHE work is led by Toni Williams.

Projects that involve BTHFT (mainly maternity and children related) are on hold at the moment and will be reviewed at the next RIC steering group.

VCS alliance is holding an event to raise awareness for inequality grant funding amongst local VCS organisations with particular focus on Keighley and Bradford District deprived area

The Mental health team have a specific workstream looking at mental health inequalities and support for communities. (Sasha Bhat)

09/09/21 - All but one of the RIC projects are live now. (Advanced midwifery support currently recruiting). Concerted effort in place to promote all live projects to ensure as many eligible people are possible are able to access the support offers

08/07/21 - RIC champions have been identified in each practice and communications channels in place to promote services and engagement via this channel. Working on establishing better networks with other potential referrer groups to maximise utilisation. RIC Forums also launched to support this work. Connections made with BTHFT and AaO Ageing Well Board.

RIC approaches shared at Community Partnership workshops to help the CPs to develop their plans to reduce health inequalities.

27.01.21: Priority for January is to develop comms tools for the RIC programme and individual projects to support the launch and wider promotion of RIC services to referrers. Launch is scheduled for 4 Feb. CLICS facilitator is in post and supporting practices with embedding the service (which focusses on multiple covid risk factors). We will continue to monitor impact of covid on service delivery to determine if adjustments are required.

* NA

Stat

ic -

16 c

ycle

(s)

1694

25/1

1/20

20 FPC

Our

Lea

ders

hip 16

(I4xL

4) 12(I3

xL4)

Robe

rt M

aden

Robe

rt M

aden UNDERLYING FINANCIAL POSITION RISK.

There is is risk that the CCG will take an underlying financial deficit into 2021/22 due to the inability to deliver the original planned savings of £13.8m as a result of the disruption of activities caused by the pandemic.

- Place based integrated planning approach for 2021/22; and- Identification of savings schemes that can be progressed when it is possible to do so.

- Prioritisation framework for Bradford Place to be developed; - Clarity on financial framework for 2021/22;- Savings schemes not identified at this stage.

- Involvement of and reporting to SLT and Governing Body members on the development of the plan for 2021/22.- Confirmation of savings schemes for 2021/22.

- Integrated planning approach used effectively in 2020/21.

N/A

Stat

ic -

7 cy

cle(

s)

Risk

ID

Dat

e Cr

eate

d

Risk

Typ

e

Risk

Ca

tego

ry

Risk

Ra

ting

Targ

et

Risk

Ra

ting

Risk

O

wne

r

Seni

or

Man


Risk

St

atus

1135

03/0

1/20

18 QC

Our

Pop

ulat

ion 16

(I4xL

4) 9(I3

xL3)

Chris

tina

Hol

low

ay

Alija

n H

aide

r ADULT AUTISM and/or ADHD ASSESSMENT and DIAGNOSIS

There is a risk of further deterioration in the service offer for adults waiting for assessment, diagnosis and immediate post-diagnostic support due to the limited capacity of out local provider to address the demand for referrals, resulting in the waiting times for initial assessment and completion of the diagnostic process lengthening and increasing beyond standard wait times. This may result in delays to patient receiving appropriate care and treatment.Risk Score reviewed 06/01/2022 and remains unchanged (16) but will be reviewed late January 2022 following confirmation of provider plans and outsourcing activity agreement

Context; For Bradford the population anticipated based on trajectories diagnosed with Autism is calculated at 3,147 by 2025 (Panset data)

CCG SLT and system Finance and Performance & System Quality Committee.

Formal contractual routes are used but the service provider has not been able to deliver increased capacity to meet demand of referrals due to staffing shortages at the provider and model.06/01/2022: as at end of November 2021 there were 196 people waiting for an assessment following initial triage, with a provider estimated waiting time of 5 years based on current commissioned provider capacity.

08/07/2021: - At the end of June 2021 there are 164 people waiting for an assessment, with an estimated a waiting time of 3 years for assessment and Quarter 1 figures suggest an increase in annual referrals , which will increase waiting times further.

Minutes of the CCG SLT where regular updates are submitted.Minutes of the system Finance and Performance Committee.

Update 06/01/2022: CCG / Local Authority Councillor meeting held (AJ Haider in attendance) December 2021 providing an update on adult autism waits and plans for resolution.

Attendance and presentation at BMDC Health Overview and Scrutiny and Chair's briefing (update/presentation due end July 2021).

June 2021: Joint proposal for NHSE funding, with Leeds Autism Diagnostic Service (LADS), to develop a Leeds and Bradford Joint Autism Diagnostic service to improve quality of referrals, and triage and to offer non-clinical post diagnostic support under discussion.3 year TCP funding proposal to support people with ASD only and strengthen Autism Assessment Pathway (adults) is in progress.

Update 06/05/2022: the provider has agreed to the CCG proposal that BANDS deliver 110 Adult Autism assessments for the Transformation Fund (from 2022 through to 2024) sum, to support addressing the waiting list over core funding of autism service provision. Scoping of potential outsourcing arrangements are ongoing to recover the wait list to a zero baseline by end 2022.

08/07/2021 - specialist workforce availability in service providers is impacted due to lack of specialist training provision at national level and ability to attract and retain a specialist workforce in this field to Bradford (has been flagged with NHSE/I; as of today over 426 vacant Mental health vacancies across west Yorkshire including posts in relation to Autism).Despite additional funding, staffing levels are very low for this service and therefore there is little resilience in this provision. This has previously resulted to the closure of the service and a build of waiting lists for extended periods.Quality of referrals remains a concern though plans to improve this outlined above – incomplete and poor quality referrals result in time taken away from assessment and diagnosisCapacity and demand – BANDS is commissioned to deliver 40 assessments per year – actually delivered 48 in 20/21 and therefore current capacity needs to increase to meet demand. With additional funding, impact on wait lists within normal limits may not be achieved until early to mid 2022 (and is dependant on workforce availability).

Update 06/01/2022: Current low monthly rate of assessments is linked to staff absences and the provider team focus on tasks. Discussions via a BANDS Task & Finish group with the provider, to progress improvements in triage function (now taken out of the provider team function) have been held and agreed.

2.2; 1.1

Stat

ic -

16 c

ycle

(s)

1094

14/0

9/20

17 QC

Our

Pop

ulat

ion 16

(I4xL

4) 6(I3

xL2)

Ruth

Sha

w

Alija

n H

aide

r CHILD AUTISM and/or ADHD ASSESSMENT and DIAGNOSIS.

There is a risk of further deterioration in the statutory duty service offer for children waiting for assessment, diagnosis and immediate post-diagnostic support. This results in non-compliance with the NICE (non-mandatory) standard for first appointment by 3 months, delaying any appropriately identified formal post-diagnostic support.

Regular updates at CCG SLT.System Finance and Performance Committee.Systems Quality CommitteeCYP neurodiversity business case delivery groupCYP autism project team meetingsPatient Tracking List

A neurodiversity business case delivery group has been established - initially meeting weekly but now meeting monthly. Not all partners are attending which makes it difficult to identify progress in terms of implementation of elements of the business case.Although NHS service providers have continued to deliver assessments during the COVID period there have been issues with regard to the availability of clinical staff in some areas at certain times.

Minutes of the CCG SLT.Minutes of the System Finance and Performance Committee.Notes of the CYP neurodiversity business case delivery groupCYP Autism Project reporting.

The continued development and refinement of the Patient Tracking List (PTL) has allowed us to have oversight of the completes Autism/ADHD waiting list position.The autism project manager has oversight of the outsourcing project which is one element of implementation of the business case. Contracts have been agreed with the external providers and the transfer of children has begun.Work continues to validate the PTL, with a focus on our longest waiters, to ensure data has been recorded accurately and the waiting list resulting in the identification of a number of children who should not longer be on the PTL.

Referral rates continue to increase which are impacting on our ability to demonstrate an impact on the overall waiting list numbers. NHS service providers have not yet developed their plans for utilisation of the recurrent element of the funded business case.The capacity of the NHS providers to support the identification and review of children to be transferred to external providers had been limited at time.

2.2

Stat

ic -

25 c

ycle

(s)

1968

05/0

1/20

22

Both

FPC

and

QC

Our

Par

tner

ship

s

15(I3

xL5) 6

(I3xL

2)

Sue

Baxt

er

Liz

Alle

n DELAY TO LEGISLATION TO ESTABLISH ICSS AND DIS-ESTABLISH CCGS There is a risk that the legislation required to establish ICSs and dis-establish CCGs will be delayed in its passage through parliament. This would result in a hiatus to the implementation of the new arrangements and the operation of dual or hybrid arrangements in the interim. Confirmation received from NHSE/I (December 2021) that the implementation of the ICS legislation will be extended by three months - from 1 April 2022 to 1 July 2022.

Ongoing monitoring of legislative progress and situation.Default strategy in case of any delay would be to carry on with current preparations and revisit timelines and impacts of delay.the action log will be reviewed in light of the delay, including but not limited to: - Transition communications plans to be updated and any significant issues to be flagged and addressed. - HR TUPE will be delayed as appropriate to the new timeline. HR drop-ins will be extended to support wellbeing. - Payroll arrangements will be adjusted

Review and update of the CCG transition action log in light of the delays in the legislative process.

* Reporting to Transition Programme Board* Programme documentation* Due diligence baseline checklist* Internal audit review of CCG transitions arrangements and review of baseline due diligence exercise

The Bill has reached the House of Lords committee stage which involves detailed line by line examination of the separate parts (clauses and schedules) of a Bill. Starting from the front of the Bill, members work through to the end. Any member of the Lords can take part. This stage is listed for 11 - 26 January

Lack of direct communication between Department of Health & Social care and/or NHSEI with CCGs and emerging ICSs in regards to any further potential delay in legislative process.

5.1 and 6.1

New

- O

pen

1726

02/0

2/20

21 QC

Our

Peo

ple 15

(I5xL

3) 10(I5

xL2)

Rash

mi S

udhi

r

Alija

n H

aide

r UNPAID CARERS: IDENTIFICATION & SUPPORT

There is a risk that unpaid carers are not identified as carers and are therefore not offered assessment and support, resulting in worse mental and physical health and increased acute care needs for both the carer and the person they look after.

SystmOne template available to primary care staff including prompts to follow up health needs and identify Safeguarding concernsLocal strategy includes priority to identify unpaid carers on SystmOne recordGP Safeguarding lead and Specialist Health Practitioner - Safeguarding Adults to address needs of carers .Top Tips to identify Unpaid Carers being developed to be disseminated via GP bulletin and Social Care networks.Working with WYICS Unpaid Carers programme to develop Primary Care Resource pack.Planned engagement with PCNs, especially those with low rate of carers identified, to increase practice use of template, identify unpaid carers and identify and meet healthcare support needs.

Communications for SystmOne template may not have reached all practice staff.SystmOne template does not include prompt to refer for statutory carer's assessment.Current likelihood remains 4 as (1) local priority for practices to identify carers on S1 still not fully implemented and (2) statutory carer assessment and support not in place in Bradford

SystmOne extracts with numbers of carers recorded on clinical system.

SystmOne template reviewed December 2020 to include LTC follow up, Safeguarding and referral to social prescribers.New template for Comprehensive Geriatric Assessment (CGA) to include link to unpaid carers template

In October 2020 GP practices in Bradford district and Craven identified 19,280 people as carers on SystmOne. The true number is estimated as more than 50,000.

2.1

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5 cy

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Risk

ID

Dat

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d

Risk

Typ

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Risk

Ca

tego

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Risk

Ra

ting

Targ

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Risk

Ra

ting

Risk

O

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Seni

or

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Risk

St

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1713

24/1

2/20

20

Both

FPC

and

QC

Our

Pop

ulat

ion 15

(I3xL

5) 9(I3

xL3)

Vick

i Wal

lace

Vick

i Wal

lace COVID VACCINATIONS

There is a risk that a large proportion of our population will not receive the covid19 vaccination due to a variety of reasons including: vaccine availability; workforce to deliver; individual beliefs and sharing of misinformation.

January 2022 - risk remains same due to decreased uptake from population in regards to boosters. Met the accelerated offer of all adults to receive booster by end of December but population did not come forward to meet the offer.

December 2021 - risk has increased on changes to JVCI and government guidance as concerns around capacity to deliver to the end of January 2022 for all over 18s to receive booster. Main risks are with workforce to deliver considering focus on recovery and vaccine supply as this is now allocated to place and has moved from a pull model. Changes have been made due to Omicron variant.

The delivery of the vaccine if via hub working - making the most of estate and workforce available to deliver safely.Working with partners to ensure that any spare vaccines are utilised and not wasted.Working with national and local communications teams, community and faith leaders to ensure the right messages are shared with our populations. Using a variety of communication channels to get messages out. Governance arrangements in place across system Regular meetings in place with all partners across the system to ensure workforce, vaccine and resources are maximised: meeting with CDs on a weekly basis; part of COVID vaccine steering group which meets weekly.Continue to escalate issues nationally relating to vaccine availability and associated supply issues. Raising issues via NHSE regional colleagues and Covid SRO calls

Need national teams to help combat circulation of misinformationThe vaccine supply and associated supplies are all under national direction on which we have no influence. There continues to be a focus on delivery of all NHS services which puts pressure on availability of staff to deliver the vaccines.

Continues to be a section of our community who are not confident to accept the vaccine. National and local work underway to target specific communities which will be enhanced by national funding received via ICS (£100k at ICS and funding via local authority)Information shared regarding blood clot risk in AZ vaccine has had impact on some sections of the population wishing to accept it.

Updated January 2022Updated December 2021Updated November 2021Updated September 2021Updated July 2021Updated April 2021Updated 1.03.21Risk altered as discussed at SLT27.01.21: N/A new risk added 24.12.20.Update 28/01/2021 Discussion re likelihood. Agreed likelihood change from 4 to 3. VW/SDN/A new risk added 24.12.20

Fake news is still being circulated by anti-vax groups but main issue now appears to be apathy not hesitancy. This hasn't been helped by lifting of all restrictions on 19th July 2021.

Stat

ic -

1 cy

cle(

s)

1594

09/0

6/20

20 FPC

Our

Pop

ulat

ion 15

(I5xL

3) 8(I4

xL2)

Alija

n H

aide

r

Alija

n H

aide

r CARE HOME FINANCIAL SUSTAINABILITY

There is a risk to the financial sustainability of the care home market due to the costs and issues arising from the pandemic.

The impact is reduction in care home capacity / pressure on other parts of the health and care system.

Co-ordination of market sustainability is assumed by BDMC and we work closely with them to ensure a consistent and joined up response.Conversations ongoing re void costs and funding principle's linked to the Section 75 agreement.Further conversations taking place regarding rates of pay.

Clarification on CHC fees - working ongoing to benchmark against other CCGs

* 12/7/21: Risk remains active27.01.21: The CCG is liaising with local care home providers regarding payments for services and an analysis of the how the pandemic has impacted on their capacity and resilience.

* NA

Stat

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16 c

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(s)

1404

25/0

9/20

19 QC

Our

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(I3xL

5) 9(I3

xL3)

Ruth

Sha

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Alija

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aide

r 0-19 SERVICES: IMPACT ON CCG COMMISSIONED SERVICES

There is a risk of impact on CCG commissioned services due to redesigned health visitor, school nursing and oral health services (commissioned by CBMDC with a significantly reduced budget), resulting in pressure on other health services.

• 0-19 Partnership Group in place to oversee the implementation process and meeting months• CCG representatives on the group: Anne Connolly and Jude MacDonald provide clinical input; Ali Jan Haider and Ruth Hayward provide managerial input.• 0-19 Service Risk Register in place and monitored by the Partnership Group

Update 31/03/20 We are aware that COVID-19 national guidance for community services advised that health visiting and school nursing services stopped an element of face to face work but should continue some face to face support including: for the most vulnerable families, new-borns and safeguarding.

• The CCG neither manages or provides this service and can only influence (not direct) partners• Additional capacity to be commissioned from the VCS to support BDCFT in Year 2 of the contract.• Matrix working between CBMDC and BDCFT still in development.

• Strategic Partnership Report to Governing Body• Mobilisation Update Report to Partnership Group (verbal)• Regular analysis of data and report updates to key fora

• Assurance received via Partnership Group that BDCFT are progressing the implementation of the agreed contract.

• Lack of assurance as to the adequacy of the agreed contract to meet demand.• Lack of performance data reporting to Partnership Group currently (waiting times, etc.)

18/05/2020 The CCG is working closely with a multi-agency team to ensure that concerns raised about the redesign of the 0-19 services are addressed alongside the implementation process.

1.1 1.2 3.1 3.2

Stat

ic -

14 c

ycle

(s)

1098

19/0

9/20

17 FPC

Our

Pop

ulat

ion 15

(I3xL

5) 4(I2

xL2)

Kerr

y W

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aden PERFORMANCE AGAINST CONSTITUTIONAL

STANDARDS

There is a risk that poor performance against the key constitutional standards will impact upon a number of CCG national performance assessments including the annual Improvement and Assessment Framework ratings and quality premium achievement. The CCGs may face both financial and reputational impact alongside reduced patient care.

On-going monitoring of provider performance.

04/01/21 System F&P Committee meets monthly and planning now undertaken on a system footprint. System performance and recovery dashboards in place

Normal financial contractual levers are not currently applicable due to individual provider targets agreed with NHSI. Providers do not consistently provide up-to-date plans for delivery of improved performance

Monitoring via performance groups via providers.Monitoring of CCG constitutional performance monthly at JFPCMonitoring of provider quality performance at JQC

06/07/21 - Recovery plans submitted for H1 2021

05/01/22 - Recovery plans submitted for H2 2021

06/07/21 - Trusts continue to implement their recovery plans. However, significant increased demand being seen across all of the system

05/01/22 - Covid continues to impact upon recovery and new variant resulting in higher cases, staff absence, hospitalisations etc which will impact upon recovery of elective care, alongside increased demand on services to deliver Covid vaccination programme

3.1; 6.3

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ic -

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ycle

(s)

of 6

Minutes of the Primary Care Commissioning Committee (Public)

Tuesday 9th November 2021

Zoom meeting

Present Representing Ruby Bhatti (Chair) Lay Member for Primary Care Commissioning CCG Karen Stothers Senior Head of Strategy, Change and Delivery CCG Robert Maden Chief Finance Officer CCG Bryan Millar Lay Member for Audit & Governance CCG David Richardson Lay Member for Quality CCG Neil Fell Parveen Akhtar Ali-Jan Haider James Thomas Angie Clegg John Young

Lay Member for Finance and Performance Associate Director, Primary Care Strategic Director – Keeping Well at Home Clinical Director Registered Nurse Secondary Care Consultant

CCG CCG CCG CCG CCG CCG

In attendance Dr Val Wilson YORLMC Ltd Liaison LMC Debbie Oxley Head of Strategy Change and Delivery CCG Bev Denton Sue Wilby David D’Arcy Ali Jan Haider Neil Coulter Steve Patterson Helen Hirst Michelle Turner

Corporate Governance Manager (minutes) Strategy Change and Delivery Senior Manager Strategy Change and Delivery Senior Manager Strategic Director of Strategic Partnerships Senior Primary Care Manager YORLMC Ltd Liaison Chief Officer Director of Quality

CCG CCG CCG CCG NHSE LMC CCG CCG

Apologies None received 1. Welcome and Apologies Ruby Bhatti, Chair of the Primary Care Commissioning Committee (PCCC), welcomed everyone to the public meeting of the NHS Bradford District and Craven (BDC) PCCC and noted no apologies were received. 2. Declarations of Interest There were no declarations of interest. The CCG’s registers of interests record all interests declared and are available at: https://www.bradfordcravenccg.nhs.uk/ccg-information/publication-scheme/lists-and-registers/


of 6

3. Minutes of the meeting held on 14th September 2021. The minutes of the meeting held on the 14th September were agreed as a true record and there were no matters arising. 4. Primary Medical Care Recovery and Restoration Parveen Akhtar presented the Health and Social Care Overview and Scrutiny Committee (HOSC) report which took place on 21st October together with the slides presented to the HOSC that day. The paper gives details of the available winter access funds and Parveen highlighted Appendix F which provides a summary of the Primary Care Network (PCN) objectives for 2021/22 and 2022/23. RESOLVED: The PCCC received and noted the report. 5. Primary Care Access Review David D’Arcy, taking the paper as read, commented that some of the financial and quantative data was included in the HOSC report (Agenda Item 4). David gave a high-level overview of the report commenting on each of the services that are covered in the access review. Appointments in General Practice were reported as delivering 357,000 appointments in September 2021 which is higher that the same period in 2019 at 330,000 noting that telephone appointments have quadrupled. Parveen Akhtar highlighted the number of appointments available in primary care are almost back to pre-pandemic levels, there is no clear ratio between face to face or remote appointments or a formula on the percentage of appointments required, although some guidance is expected from the RCGP shortly. Parveen commented that the issue is not just about a GP face to face appointment, it is about accessing the most appropriate clinical role, eg Nurse Practitioner, HCA and this is the next piece of work to be undertaken as part of the Access Review. Val Wilson shared with the Committee that a practice had changed its appointment structure to enable more face-to-face appointments but these appointments could not be filled as patients did not want to face- to-face. David D’Arcy also highted the CCG Commissioned Extended Access and the PCN Extended Hours Access updates in the report. Angie Clegg commented that it is important to access any central monies available and asked if there are any identified areas where finance can help. David commented that service redesign and COVID recovery in additional to financial support may enable access initiatives but the challenge is workforce capacity. Parveen noted that for extended access the CCG is issued £6 per head which equates to £3.5m, of which £1.2m is spent on GP streaming services and the PCNs get £1.44 for extended hours and there is a need to look at how we combine these funds to provide a stable and robust service. RESOLVED: The PCCC:

1. noted the content of the report 2. noted regular updates will be presented to the PCCC as appropriate

of 6

6. Contract Assurance and Performance Report The chair took the report as read and Debbie Oxley highlighted the current CQC Inspection position. The last inspection took place in September to Ashwell Medical Practice and subsequently all the CCGs practices are rated as ‘Good’ or ‘Outstanding’. The Impact and Investment Fund report is in progress and will be shared with the Committee as soon as it is finalised. RESOLVED: The Primary Care Commissioning Committee noted the Contract Assurance and Performance report 7. PCN Workforce Karen Stothers took members through the paper commenting that the Additional Roles Reimbursement Scheme (ARRS) is in its third year and the paper provides a snapshot of the roles in place. The CCG ARRS allocation is £8,470.000. There is a projected underspend and the CCG is seeking guidance on allocation of this underspend. Karen commented on the local Primary Care Workforce Group whose remit is to support PCNs with recruitment to ARRS roles. The Group will be looking at recruitment and training. Robert Maden asked which indicative spend the CCG was working to for 2021/22 and if this has been factored into the pain management service discussed at a recent Senior Leadership Team Meeting. Karen responded that the second table in the paper shows £1,085,407. Michelle Turner welcomed the paper and commented that there is some good work going on but there is additional work to do. John Young commented that most of PCN directors are investing heavily in clinical pharmacists and social prescribers and asked if that is the right workforce personnel. Karen commented that availability of roles impacts on GP time and these were the first roles recruited to under the ARRS. David Darcy commented that support to encourage increased Nurse prescribers would be good for workforce development and Val Wilson responded that nurse prescribers need support form GPs which is a another call on their time. Parveen noted that clinical pharmacists also work at a PCN level with GPs, getting involved with structured medication reviews and supporting with care homes which releases GP time. Neil Fell commented on the indicative spend there is 10% slippage between the two indicative spend tables detailed in the paper and as we are already in month eight are the CCG able to spend the monies in year. Neil asked if this funding was recurrent to enable the CCG to address the workforce issue. Robert confirmed this is recurrent baseline funding. Parveen commented that in relation to the underspend there is a risk of an underspend this year. Nationally, last year the CCG could repurpose the underspend to cover overtime for staff providing COVID vaccinations but to date no guidance has been received for this year. Steve Patterson commented that the PCN DES was a defined role and as ICS development continues more pressures will be put on this role. Extra funding has been given for the additional management responsibilities. The ARRS funding was initially bought in to support general practice and so the roles were to cover work undertaken by GPs. Steve commented that as well as the workforce challenges there are also challenges in relation to the estate.

of 6

Val Wilson commented that PCNs have different needs and there is a requirement to look at the role of GP Partners who do not work as a salaried GP. RESOLVED: The Primary Care Commissioning Committee

1. noted the roles appointed and funded through the ARRS scheme 2. noted the current budget position 3. noted the role of the Primary Care Workforce Group

8. Legacy handover preparation / ICS transition Parveen reminded members of the Committee that it was suggested that the Committee looks at the actions/areas that will be required to handover to the ICS. Parveen commented that there will be the risk register. Bryan Millar commented that in addition there would be any financial obligations and any recurrent commitments that will handed over. Bryan stated that there is a need to understand how those issues will be signed off whilst the CCG is still in existence and internal audit, the transition programme board, the audit committee, and the governing body will have a role is the legacy handover. Karen Stothers commented that following closure of the CCG in March there will be decisions that have been made that will have not been implemented. Karen confirmed that the Contracts Assurance Group will be looking to pull together a list of decisions made by this Committee. Karen confirmed that a Contract Register currently exists. Parveen confirmed a national template is being used to pull all areas together and will be shared with this Committee in mid-December. RESOLVED: The Committee noted the update. 9. Key Messages from the Governing Body Ruby Bhatti agreed to summarise the key points from the public meeting to the Governing Body. 10. Date and time of next meeting 18h January 2022, 10:30am.

1

System Finance and Performance Committee

Zoom Meeting Thursday 27th January 2022 10.00 – 11:15

Minutes

Bradford District & Craven CCG

Robert Maden (Chair) Chief Finance Officer BD&C CCG Sue Baxter Strategic Head of Assurance BD&C CCG Theresa Birks Head of Performance BD&C CCG Neil Fell Lay Member, Finance BD&C CCG Walter O’Neill Strategic Head of Keeping Well BD&C CCG Amy Paffett Strategic Head of Finance BD&C CCG Kerry Weir Associate Director, Population Health & Wellbeing BD&C CCG Sharon Wood (minutes) PA to Chief Finance Officer BD&C CCG

Act As One

Helen Farmer Programme Director – Access to Care, Bradford District & Craven health & care system

Airedale NHS Trust Philip Driscoll Income & Contracting Finance Manager ANHST Farida Khawaja, Deputy Director of Finance ANHST

Neil Scott Head of Performance & Information ANHST Bradford District Metropolitan Council Iain MacBeath Strategic Director, Health and Wellbeing BDMC

Bradford Teaching Hospitals Trust Matthew Horner Director of Finance BTHFT Jacqui Griffin Assistant Director of Finance BTHFT Carl Stephenson Head of Performance BTHFT Apologies Mark Hindmarsh - Programme Director for Act as One (Bradford & Airedale System Programmes Rob Aitchison Chief Operating Officer ANHST Stuart Shaw Director of Strategy, Planning & Partnerships ANHST Amy Whitaker (Chair) Director of Finance ANHST Chris Balson Senior Head of Strategy Change Delivery BD&C CCG Louise Clarke Strategic Clinical Director Strategy & Planning BD&C CCG Philippa Hubbard Acting Chief Operating Officer BDCFT Susan Ince Deputy Director of Performance & Planning BDCFT Claire Risdon Deputy Director of Finance BDCFT Patrick Scott Chief Operating Officer BDCFT Mike Woodhead Director of Finance, Contracting and Estates BDCFT James Drury Programme Director Executive Board BDMC

Lyn Sowray Deputy Director of Operations BDMC Wendy Wilkinson Business Advisor – Health and Wellbeing BDMC Sajid Azeb Chief Operating Officer BTHFT Chris Smith Deputy Director of Finance BTHFT Nicholas Clarke CEO WACA Dr Danielle Hann BA Branch Vice Chair YORLMC Stephen Patterson GP YORLMC

2

1. Apologies

Apologies were noted as above. Robert introduced Neil Fell to the meeting, Neil Fell is the Lay Member for the Finance & Performance Committee for the CCG and as part of the new governance arrangements the CCG has stepped this committee down and in terms of assurance back for the CCG, Neil is in attendance to feed back on Finance and Performance to the CCGs GB.

2. Minutes of the last meeting

The minutes of the last meeting were agreed as an accurate record.

3. Action Log

See Appendix 1.

4. System Financial Position for Month 09

Robert Maden gave an update. Key points to note: Health

• As at M9, the Bradford District and Craven Health system have declared a forecast outturn surplus position of £8m. The three Trusts are each forecasting a surplus with the CCG maintaining a breakeven position. The surpluses are mainly derived from additional funding streams for winter pressures and slippage on elective recovery activity.

• The positions reported include the agreed commitments to provide non-recurrent funding to BMDC to support early implementation of an increase in the National Living Wage for care staff (£3m) and for the outsourcing of Children’s Autism assessments in order to reduce the current waiting list.

• Given the slippage on elective recovery activity, no additional elective recovery funding for Q3 or Q4 has been included within the forecast outturn position.

• There is a risk that the surplus position may increase if further resource allocations are received in Quarter 4 that cannot be spent by the year-end.

LA • After including the BMDC forecast overspend of £15.9m, the overall Place position at M9

shows a forecast deficit of £7.9m. the Bradford and Craven Place are declaring a net deficit position of £7.9m.

• BMDC’s position is mainly driven by overspends within Children’s Social Care related services (Children’s Social Care (£1.9m) and Safeguarding & Reviewing, and Commissioning & Provision (£11.8m).

• The overspend position has improved since last reported due to increases in Discharge to Assess income.

• Iain Macbeath confirmed the LA overspend is down to £3m on a net budget of £110m for adult social care, the council overall is still overspent as children’s services are overspending by more than £10m and they go into next year using reserves from the council to balance the budget of around £4m and should be ok overall.

Airedale Trust Farida gave an update At M9 Airedale have £1.68m surplus and by the year end in line with the reported position this will be £1.9m. In terms of risks this relates to the TIF funding and whether they can spend all the money and are looking at their capital programme and bringing forward any schemes. Bradford Trust Matthew gave an update In terms of the elective recovery opportunities BTHFT haven’t done any extra lists throughout January on a weekend due to the covid situation. Forecast was based on a M9 prediction and are doing everything they can to protect the organisation, place, and the wider health system in terms of support. Capital allocation process is making the TIF money difficult to spend and is a challenge.

3

CCG Robert gave an update. The CCG’s position reflects the agreement to fund the acceleration of the implementation of the national living wage for care staff and we have agreed across health partners how they will fund this non-recurrent cost for 2021/22. The outstanding issue relates to North Yorkshire but anticipating it will be a smaller number than the Bradford number and this will be resourced through the CCGs position. Guidance received around independent sector contracting and the arrangements put in place around a surge situation, unclear who pays what to the Yorkshire Clinic in Q4 and the CCGs position is based on normal operation. Amy confirmed a very brief letter came out that seemed to indicate to carry on as normal into Q4. NHSE will look at the position at the end of the year and if they think that there is a requirement to pay over to reach the thresholds to the Yorkshire Clinic, they will make that separately, the letter didn’t seem to suggest that any decision they made would impact the CCG expenditure and will carry on paying on the same premise as they have throughout the year and this risk is very small. Jacqui confirmed there is more risk with the Yorkshire Clinic as the data source is going to be sus and there may be some issues around what is covered in the national contract, the main issues for BTHFT is Bariatric and if it is the national contract no-one should be discussing tariff plus with the providers and waiting for some feedback from Caroline Wood on the situation. In relation to the waiting list backlog for Children’s’ autism assessments and additional recurrent service capacity, it was agreed that an update on the current position on the business case that had been approved by the joint meeting of System Finance & Performance Committee and System Quality Committee representatives should be presented at the February meeting. CASH

• No liquidity issues with the forecast year end cash balance continuing to increase at BTHFT.

• Forecast cash at BTHT has increased by £14.7m due to increased provisions, improved I&E surplus and increased capital payables forecast.

• Cash forecast in line with plan for AFT and BDCFT. CAPITAL

• System Capital forecasts have decreased in month at both AFT and BTHT creating an overall reduction in the forecast overspend of c.£3m.

• The capital forecast at BTHT has reduced by £2.1m due to reduced PDC TIF schemes. • Trust capital forecasts are reflected in the overall ICS capital forecast position for the year. • Whilst the CCG does not have a capital resource limit, it is able to access NHSEI primary

care capital funding and subject to approval of the business case template, additional capital funding of £1.3m has been confirmed to strengthen data centre resilience for GP clinical systems.

5. System Performance Dashboard

Kerry gave an update. Key points to note: In terms of covid at the end of December they saw daily reported cases rising above anything they had seen since the pandemic, although numbers have now started to fall there has been a significant increase in care home cases. In terms of activity for the hospitals it wasn’t as high as it had been throughout the pandemic due to the covid vaccination programme. The target set on the 13th December around everyone eligible to have their booster vaccination by the 31st December, locally this equated to 188,000 people and 72,000 did have their booster vaccination by the 31st December. Continuing to deliver the 1st, 2nd and the booster vaccinations where applicable.

4

Non-elective activity in both Trusts in December and January demand is still high and has impacted on flow and length of stay has increased. In terms of the impact this has had on elective recovery it has had an impact more at Airedale than Bradford. Both Trusts still delivering their plans around elective recovery including insourcing and independent sector. Cancer remains to be a priority although there is a challenge around the 2 weeks wait due to increased demand, particularly breast at Airedale. In terms of Mental Health, they continue to deliver that early intervention targets but still noting later presentations and increasing intensity. Also seeing increased intensity in terms of the IAPT service and the impact of staff sickness, maternity leave and are therefore, not delivering the access target around IAPT but the Trust is having a targeted recruitment campaign and there is a system wide IAPT review under way to look at how they deliver the national requirements within that service. Out of area placements continue to be a concern at the Care Trust and lots of actions ongoing to manage that the best they can with the restrictions imposed via covid on the bed capacity the Trust have. Work is ongoing on the dashboard to include some of the new metrics. If anyone has any feedback on format and what else may be useful please contact Kerry or Theresa over the next week. BTHFT Carl gave an update Covid – lower numbers in terms of occupancy. Volume of non-admitted positives which is impacting on out-patient attendance and seeing DNAs in relation to patients not been able to come in. Cancer recovery is 3 / 4 weeks behind the target for year-end but have managed to maintain day cases. Overall RTT performance is ok but is putting pressure on the one-off flow position as they haven’t been able to get in those overnight spells and is a risk in terms of year-end. ANHST Neil gave an update. High with numbers of covid and in terms of the elective recovery its only in the last week or so that they have got everything apart from orthopaedics back up and running, hopefully orthopaedics will be back up next week. The impact is on their 104s and not been able to get them booked in for a date. The surgical divisional performance meeting held yesterday confirmed they are still aiming to eliminate them by the end of the year. Carl highlighted in terms of the overall waiting list at Bradford, as a place they may want to look at the narrative and is there a referral patten. Robert confirmed this could feed into the assurance conversations. Kerry confirmed through covid A&E performance has been better at Bradford than it was before covid and it’s the impact of that transformation work as you can’t quantify necessarily but is clearly having the changes in processes, procedures and flow is making an impact.

6. System F&P Deputies update

Amy Paffett gave an update. Key points to note: Planning and how they will approach planning – weekly planning meetings will take place from February onwards pulling together a timetable, done some mapping in terms of deadlines, understanding they have to submit a week before the official deadlines and what they might want to bring forward. Starter for 10 on the funding for business cases they are aware of internally that they think should come to the system for discussion around how they fund and prioritise them.

5

Robert highlighted in terms of understanding what the asks are on place resources this will collect a number of things and the planning and commissioning forum will be another route that they need to pick up in terms of items coming through from the LA integration agenda that they need to feed into that process and need to capture everything from all parts of the system and will do this sense check when they have a better understanding of the list. There will be some things on the list where they have either made a commitment or may need to do as part of the planning ask. Robert highlighted the child and development service business case that has gone through BTHFTs internal process but needs a wider place discussion. Matthew confirmed it is going to a Children’s Board to address some of the issues highlighted. Jacqui highlighted there was an outstanding action on the finances in terms of the provider contribution and conversations are ongoing.

7. MyCare24 Pilot Update

Matthew gave an update. MyCare was discussed at local Dofs in terms of ongoing support to this programme and felt it was appropriate to support this for the next 2 years but ask for an evaluation in the first half of 23/24 to see if this will be supported recurrently moving forward. The Committee ratified the proposal to use Place resources to fund the MyCare24 (COPD) pilot for 2022/23 and 2023/24 for a caseload of 6,000 patients in line with the business case approved by the Executive Board. This was on the basis that an evaluation is carried out mid-way through 2023/24 so that they can decide whether to continue funding the service in 2024/25. The financial value approved was £441k per annum, but with the Place contribution being reduced by £105k in 2022/23 to reflect unused funds from 2021/22.

8. End of Life Care in Craven

Walter gave an update. There has been an issue in Craven for patients who are on end-of-life pathway and are eligible for a CHC fast track funding service to support their personal care needs, providers haven’t been available to deliver the support because parts of Craven are rural, and providers and staff don’t want to travel the distances and there are access issues in the winter. In order to meet those needs, costs for that support into Craven area have been between £25/ £30 per hour plus travel. The Craven Collaborative Care Team (CCCT) support people living in that area and are aware of this issue and put a proposal to us that if funding through CHC they could recruit additional support workers who would work alongside the nurses and other clinicians in their team to provide a service. The number of people needing this has increased and on average there are 8 referrals including 2 a month who are registered with GPs in the Bentham area part of Morecambe CCG. They have linked up with Morecambe CCG and agreed a service specification and level of funding that allows CCCT to recruit and retain staff and provide this service to patients in that area and service starts on the 1st February. Robert confirmed in terms of process this will result in a contract variation with the Airedale contract, however, they are doing it on the basis that from a service to the patient point of view it is a good result and from a financial point of view they are using the CHC budget in a better way. Walter confirmed they are reducing health inequalities in that area and it supports discharging people from hospital so they can end their life in their place of choice which is a better outcome for patients.

9. 2022/23 Planning - Programme Mapping / Process and Timetable

Robert & Kerry gave an update. The paper highlights a draft mapping of the specifics within the operational planning guidance to the Act as One programmes. Kerry to take through the programmes to review and identify the following to take forward the plan and deliver the required work to achieve the requirements:

• where plans are already in place, do they deliver in line with the requirements?

6

• are there areas where the priorities are not seen to be a priority for the Act as one work programmes and why?

• are there additional priorities which are currently not within scope but need to be?

Robert confirmed as it is a long list of requirements there is a need to understand where they are being picked up and this will feature as part of their planning leads meetings that they are pulling together in relation to its operational ask for 22/23. Also highlighted are the references to where additional money is expected to flow.

Kerry highlighted the whole process in terms of the templates and guidance is very much ICS focused and could create some challenges at place in building up their view. Robert confirmed there will be the national policy in terms of how they structure things that might not fit with this notional place which is a challenge for us in terms of what they send out and how we will need to adapt that in terms of making it do something for place which will then aggregate back to an ICS level plan. This will be an extra piece of work that will need to be factored into the planning timetable.

Matthew confirmed it is around having the clarity of who needs to do what and by when and the 24th February timeline is a big ask in terms of what may be required at that meeting. There is a planning forum on the 10th February as a place and can feedback at that meeting.

The planning update on the agenda at the next System F&P might be some high-level messages in relation to the planning requirements rather than a draft plan and there is a need to do what we can to present an appropriate update given the time constraints.

Carl highlighted the leads are receiving the e-mails from the ICS via Imran but there are some things not been received.

Robert highlighted the template is very much a provider template and there is a need to build that space into the timetable to construct and understand the place view that they want to put forward as this will be informing their place-based narrative to develop for the ICP.

10. Key messages Health & Care Partnerships & ICP

• Financial outturn.

• Developing a plan for 22/23.

• Performance issues around elective and in terms of understanding expectations for long waiters.

• Overall, in terms for 21/22 it is a positive message in terms of in-year financial performance and the outlook for elective recovery but noting that 2022/23 is expected to be extremely challenging from a financial perspective.

11. Any other Business

There were no items.

12. Date & time of next meeting:

Thursday 24th February 2022 between 3 – 5pm via zoom.

7

Appendix 1 - Action Log

Date of meeting & Minute Ref Action Officer Responsible Target Date Progress Update Complete

Yes/No

16.09.21

Item 4

System Programme updates

Better Births

A number of community estates issues around midwives

working from practice sites. Action Point: RM to pick up with

James Drury.

Robert confirmed he met with James and has

requested information on the sites and yet hasn’t

received any information from Operational

colleagues.

Action: Keep on the action log & follow up.

N

16.09.21

Item 6

System Performance Dashboard

It is necessary to confirm the definitions behind the indicators

which are not nationally set, to ensure a consistency of

understanding across the Trusts. Action Point: CS, NS and TB to

liaise around a common understanding of the definitions.

Carl Stephenson

Neill Scott

Theresa Birks

Carl confirmed he met with Neil to go through the

indicators proposed and the return made this

month was against the new indicators.

Action complete

Y

21/10/2021

Item 6

System F&P Deputies update

Chris to update on the contracting resource and once this is

complete will look at next steps and take to DoFs early

November. ACTION: Chris to update on timescale.

ACTION: Farida to speak to Kathryn Hooper re timescale of an

update coming to this committee

Chris Balson

DoFs

Farida Khawaja

24/02/22

Robert confirmed there was a discussion but need

to clarify the timescale when it will come back to

this committee.

Farida confirmed Kathryn Hoper & Jacqui had

been doing some work on this and are not at a

stage where they have any recommendations or

solutions but there is an indication of some of the

opportunities they have found and more work to

be done. Once they have some recommendations

they will bring to this committee.

Action keep on the agenda log.

N

21/10/2021

Item 9

BD&C Resource Principles

Build into reviewing the financial principles that are in the SPA

for example as there is some examples in terms of gain share

that could be expanded to include a set of principles around

how they deal with stranded costs. ACTION: Helen to review

the SPA and take forward.

Helen Farmer

No further update.

Action update at the next meeting.

Keep on the action log.

N

8

Deputies did some initial work on principles and the

requirement to look at actual costs rather than tariff that could

be released. ACTION: Helen to pick up with Deputies

ACTION: Helen to make the wording clearer on the strategy

25th November 2021

Item 4

System Financial Position for Month 07

update on the LA’s position at the next meeting Wendy Wilkinson 23/12/2021 This is on the agenda.

Action complete

Y

25th November 2021

Item 5

Planning Item to include winter plan

elective recovery and the finance plan

Kerry agreed to circulate the ICS submission which will include

the other organisations in terms of workforce and activity and

the generic narrative the ICS pulled together from the place-

based submissions.

Kerry Weir 25/11/2021 Kerry circulated the ICS submission.

Action complete

Y

25th November 2021

Item 6

System Performance Dashboard

Amy Whitaker confirmed she would commit to having a

conversation with Robert about the current governance and

how things should work going forward as there is a need to

capture this as part of that work to ensure they have got it

right.

Action ToR to be on the agenda at the March meeting:

Amy Whitaker

Chair

24/03/2022

Robert confirmed Kerry’s report is on the agenda

and includes some enhanced reporting.

The Governance aspects will be picked up as part

of the ToR review which will be on the agenda at

the February meeting.

Action ToR to be on the agenda at the March

meeting:

Y

25th November 2021

Item 7

System F&P Deputies update

consistent approach for calculating and charging over heads on

business cases as they move forward to build a consistent

business case process with a set of assumptions and proposals

the system work to and will bring a paper to this committee in

January.

Deputies March

2022 (?)

Date to be confirmed.

25th November 2021

Item 8

Update on the REACT business case

The business case to come back to this committee at month 9

of the 12 months to explore on an ongoing basis.

Matthew Horner tbc Robert confirmed this will need to come back

later and the need to build a forward plan for

22/23 in terms of when they are expecting things

back to this committee.

Matthew confirmed there are several business

cases that are approved and are going to be

approved going forward and should they

introduce a more formal post implementation

review process for this group.

Jacqui confirmed at this stage they don’t have a

post implementation review process agreed and

there is a bit of work to do.

On-going

9

Kerry confirmed this is an evaluation of all

outcomes and could build this into the dashboard

on a ¼ ly basis.

Robert confirmed when developing a business

case describing the various benefits and how they

will be measured is part of the standard business

case approach that is set out in the templates that

have been developed.

25th November 2021

Item 8a

Implementing a staffing model to

support an Outstanding Child

Development Service business case

The approval of business cases to be discussed with DoFs DoFs tbc Robert confirmed this is ongoing and a discussion

was held re types of business cases and the

appropriate approval routes.

Keep on the action log and update as they start to

develop.

On-going

25th November 2021

Item 10

System Programme Updates

Mark to provide a written update on programmes. Mark Hindmarsh 25/11/2021 Robert confirmed this is part of revising the

forward planner and have talked about mirroring

the schedule that was going to the Quality

Committee in terms of a deeper review of what

transformation programme are doing and what

they are achieving.

On-going

25th November 2021

Item 12

Key messages Health & Care

Partnerships & ICP

Sharon to check with Robert if key messages go to HCPB and

ICP

Sharon Wood 23/12/2021 This can be removed as the meetings have been

stepped down. Action complete.

Y

Bradford District & Craven CCG Minutes Quality Committee Meeting

Thursday 7th October 2021

13:30-16:00 hours Zoom Call

Present:- David Richardson (DR) (Chair) Lay Member, Quality Michelle Turner (MT) Strategic Director, Quality & Nursing Gill Paxton (GP) Associate Director, Quality & Nursing Helen Rushworth (HR) Manager, Healthwatch James Thomas (JT) Clinical Chair John Hartley (JH) Strategic Head, Quality Improvement Dave Tatham (DT) Strategic Clinical Director, Keeping Well in Hospital Ruby Bhatti (RB) Lay Member, Primary Care Commissioning John Young (JY) Secondary Care Consultant Fiona Jeffrey (FJ) Associate Director, Organisation Effectiveness Iram Amin (IA) Senior Manager, Project & Programme Management Jackie Haw-Wells (JHW) Head of Safety and Quality Improvement Apologies:- Peter Brunskill (PB) Secondary Care Consultant Kate Varley (KV) Senior Head, Patient Safety Jude MacDonald (JMac) Designated Nurse, Safeguarding & Children Looked

After Angie Clegg (AC) Independent Registered Nurse In Attendance:- Helen Hart (Item 9, 10, 11) Designated Nurse Safeguarding Adults Helen Hyde (Item 12) Deputy Designated Nurse, Safeguarding Childrens’

Bev Denton (Item 13) Corporate Governance Manager

Katrina Uttley (Item 12) Deputy Designated Nurse, Safeguarding Adult

Sharonjit Kaur (Minutes) PA/Senior Officer

1. Introductions and Apologies:

Apologies received as noted above.

2. Declarations of Interest: There were no declarations of interest.

3. Minutes of the last meeting:

Minutes of the previous meeting held on 2nd September 2021 were accepted as a true

record of the meeting.

4. Action Log Update: The action log was updated at the meeting.

5. Matters Arising: MT provided an update regarding the plans and alignment of governance arrangements and future plans for Lay members.

6. Patient Experience: On the Horizon. People Experience/Complaints: FJ provided an update on complaints and the different types of complaints/issues which have been received by the CCG. Details were shared of the main types of issues and concerns including waiting times, delayed or cancelled procedures and access to GPs along with problems related to vaccine timescales, recording of vaccines on the NHS app and non-compliance with PPE. Work within the comms and engagement team continues to encourage uptake of vaccinations. The staff survey is currently open for completion and details have been circulated to staff members. FJ highlighted that within the staff survey this year there is a focus on wellbeing through the Covid period. A meeting has taken place with Karen Bentley (Assistant Chief Nurse, BTHFT) to look at the next steps required to enable the reinstatement of the Grassroots system which has been static due to system pressures and resource issues within the team.

7. Quality Hub Slides:

JHW provided key highlights from the slides which were circulated prior to the meeting.

Key headlines included.

▪ Care home vaccination programme: - Intelligence indicates there are around 346

care home staff who may leave the care sector due to the requirement for front line

staff to be fully vaccinated.

▪ GP IT systems migration: - MT provided an update on the rollout of Windows 10 across primary care and the risks and issues identified. MT will meet with Steve Patterson (Chair, Bradford & Airedale Branch, YOR Local Medical Committee Limited) and Taz Aldawoud (Chief Clinical Information Officer, CCIO) to discuss short to medium term arrangements

▪ 111 Services: - Due to high demand and pressures, the service is operating at

OPEL level 4.

▪ BDCFT :- A CQC inspection is currently taking place. Formal feedback has not

been received to date but will be shared with the committee in future updates.

BTHFT:- are leading the compilation of a system wide EQIA for proposed changes

to the Bacillus Calmette-Guérin (BCG) neonatal vaccine service.

▪ ANHSFT and BTHFT: - Act as One Better Births conference focussing on safe and

personal maternity care hosted jointly by provider trusts.

8. Serious Incidents:

(Report circulated). JHW provided an outline of the current Serious Incidents for

ANHSFT, BTHFT and BDCFT and the independent sector. It was noted that there

have been some delays with the completion of incident investigations due to COVID -

19 and related concerns regarding delays in incident reporting which impacted on the

ability to understand and share learning from incidents.

The committee agreed it would be beneficial to understand immediate actions

undertaken for all incidents and where possible for these to be included in the monthly

report.

Action: JHW to include key headlines from incidents within future serious

incidents monthly reports.

MT discussed the requirement of a system to discuss SI’s Learning and sharing

outside of the QC.

Action: GP to discuss other options of reviewing and sharing learning from SI at

Quality & Performance Task and finish group and report back to QC.

9. Provider Safeguarding Assurance Report:

HH presented slides summarising the Safeguarding Provider Assurance Report 2020-

21 including the levels of safeguarding assurance received in relation to services

commissioned by the CCG.

HH reported that changes to how assurance was gained had been made due to the

impact of COVID-19 including the redeployment of staff to provide support to other

teams. It was highlighted that due to the extra workload and changes due to the

pandemic there have been delays in some providers submitting reports. As a result of

these delays agreed that further assurances will be provided to the committee in

December 2021.

Action: HH to present an updated assurance report at the December QC

meeting.

10. Team Safeguarding Assurance Report:

HH presented the Team Safeguarding Adults and Children Report 20-21 which

provides an overview of the work undertaken by the CCG Safeguarding Adults and

Children Team within the last year. The report provided details of the team structures

and activity undertaken within the previous year together with arrangements and action

plans for the forthcoming year.

During the reporting period a full reorganisation of the team structure was undertaken,

including the appointment of two designated nurses and an additional Deputy

Safeguarding nurse. Additional funding has also been approved for a specialist

practitioner role.

11. Prevent Policy:

HH presented the updated Prevent policy for ratification. The committee was advised

the committee that the policy renewal was due last year but unfortunately delayed due

to other priorities and COVID-19 workload impact.

Approval of the updated policy, including most recent guidance was provided by the

committee.

12. Children Looked After (CLA) Annual Report: KW presented the first Children Looked After annual report which has also been shared with OFSTED. The report written by KW was circulated to the group and includes an update on progress to date and details of priorities and actions to be completed as a system within the next year.

13. Risk Register: BD presented key points regarding the risk reports for cycle 3 (review period April - September). It was noted that the previous impact of backlog of CHC referrals has now been completed which has enabled the team to revert to business as usual. 1 new risk relating to the supply of blood collection tubes was reported. Due to the ongoing mitigating actions undertaken however it is proposed that this might now be reviewed with a view to being downgraded.

14. Items for escalation to Governing Body/System Quality Committee: A request was made to highlight the positive progress across the system following the work undertaken by the Safeguarding Team. Action: DR to include the progress to date in the update to Governing Body and MT to highlight at SQC.

15. Any Other Business: MT updated the committee regarding the future of QC meetings. Lay members were informed of proposed future governance arrangements and the potential for attendance at SLT and SQC as a means of providing challenge and gaining assurance regarding requirements relating to quality and patient safety. It was further noted that the intention is for QC meetings to be stood down with effect from the end of December 2021. The committee highlighted concerns regarding the arrangements in the future model for reviewing and gaining assurance regarding serious incidents Concerns were expressed around SI arrangements. Action: AC to liaise with Quality Team colleagues to review proposed arrangements for management of serious incidents and provide feedback to the December meeting.

16. Date and Time of Next Meeting: The date and time of the next meeting is Thursday 4th November 2021 @ 1.30pm via Zoom.


Thursday 4th November 2021


Present:- David Richardson (DR) (Chair) Lay Member, Quality Michelle Turner (MT) Strategic Director, Quality & Nursing James Thomas (JT) Clinical Chair John Hartley (JH) Strategic Head, Quality Improvement Dave Tatham (DT) Strategic Clinical Director, Keeping Well in Hospital Ruby Bhatti (RB) Lay Member, Primary Care Commissioning John Young (JY) Secondary Care Consultant Fiona Jeffrey (FJ) Associate Director, Organisation Effectiveness Iram Amin (IA) Senior Manager, Project & Programme Management Jackie Haw-Wells (JHW) Head of Safety and Quality Improvement Angie Clegg (AC) Independent Registered Nurse Peter Brunskill (PB) Secondary Care Consultant Apologies:- Gill Paxton (GP) Associate Director, Quality & Nursing Helen Rushworth (HR) Manager, Healthwatch Kate Varley (KV) Senior Head, Patient Safety Ruth Shaw (RS) Item 6 Senior Head, Strategy, Change and Delivery In Attendance:- Christina Holloway (CH) Item 8 Associate Director, Keeping Well Joanne Tooby (JTo) Item 8 Senior Manager, Mental Wellbeing Paul Carder (PC) Head of Research Elaine Phelps (Minutes) PA

1. Introductions and Apologies:



3. Minutes of the last meeting:

Minutes of the previous meeting held on 7th October 2021 were accepted as a true

record of the meeting.

4. Action Log Update: The action log was updated at the meeting.

5. Matters Arising: There were no further matters arising outside of the action log.

6. Maternity: As Ruth Shaw was unable to attend the meeting the item was deferred to the December meeting.

7. Quality Hub Slides:

J. Hartley (Strategic Head, Quality Improvement) provided key highlights from the slides which were circulated prior to the meeting. Key headlines included. ▪ Blood Tube supply - from 30th September 2021 primary care blood pathology

testing can resume with immediate effect for all clinically indicated reasons.

Living with COVID-19 Impact on services and patients: ▪ We are now into the 3rd vaccine booster for immunosuppressed patients, 12–15-

year-olds are being offered vaccinations via schools and the booster vaccine rollout continues.

▪ There are currently no patients in Care homes with Covid-19 who meet the threshold for Super rota support.

▪ There is pressure within the system to ensure sufficient home care provision due to increase in demand and staffing issues.

System Provider Quality Outcomes: ▪ YAS are still operating at OPEL level 4, all staff are supporting the frontline and

therefore serious incident investigations are not being prioritised. ▪ We are still awaiting formal feedback on the CQC inspection of BDCFT. ▪ ICS level meetings continue to address the reinforced autoclaved aerated concrete

(RAAC) issues at ANHSFT ▪ There has been a slight decrease in A&E attendances across acuter providers,

however numbers of patients are still high compared to pre-COVD-19. This is impacting upon delivery of the 4-hour target, patient flow, length of stay and onward admission numbers.

Primary Care: ▪ Work is ongoing to address the IT issues being experienced across practices. ▪ ANHSFT maternity services are reporting issues securing clinical premises within

primary care to undertake midwifery clinics.

Care Homes: ▪ Workforce challenges in the care home sector continue. Work is ongoing to identify

potential solutions to support this. ▪ There are currently 8 care homes in Bradford that have inadequate rating – work

continues via Bradford Metropolitan District Council to address the issues raised

Medicines Optimisation: ▪ Warfarin supply – BTHFT are issuing warfarin however they are reporting

difficulties doing this through the current ‘drive-through’ model. ▪ Oral Antiviral for COVID-19 - it has been announced this morning that a drug

called Molnupiravir has been approved as an antiviral treatment for COVID-19 MHRA. This is a tablet to be taken when a positive PCR test has been received. It is not a vaccine.

Host commissioner: ▪ A new NHSE led ‘5 eyes’ approach to safe and wellbeing reviews is commencing.

Work to understand the resource implications of delivering this process is required ▪ There are ongoing discussions regarding the long-term objective to provide a

single Host commissioner service across the ICS

LeDeR ▪ Currently hosted by BDC CCG. There are ongoing conversations regarding plans

for delivery in the future Safeguarding Children ▪ A system task and finish group has been established to proactively review, plan

and develop pathways to address the shortfall in placement provision for children with complex health and care needs

▪ 4 reviews of looked after children in residential homes admitted to the 136 suite are underway

Safeguarding Adults ▪ Support is ongoing, on behalf of Primary Care to two Court of Protection cases

pertaining to administration of COVID-19 vaccination where there are objections from family members to individual receiving a COVID-19 vaccination

▪ Liberty Protection Safeguards – publication is anticipated in April 2022, training is being proactively provided.

Children’s Services ▪ There is an ongoing system collaboration led by the Local Authority to examine the

quality of residential placements for children and young people ▪ Waiting list pressures continues to be experienced in CAMHS service areas. ▪ Agreement has been reached for a business case to strengthen the care of

children with autism

Research & Development ▪ BDC CCG team were part of a larger network who delivered the vaccine trial in

Wakefield and have won a Pharma Times Award as clinical site team of the year. ▪ The team is collaborating with medicines optimisation team on World Antibiotic

Awareness Week (18th – 24th November) which will coincide with report 19 of LAMP

▪ A QI manual developed with Leeds University is now available to all

Personalised Commissioning ▪ There are no cases reported as breaching the 28 day waiting time indicator KPI ▪ A staffing structure review is underway comparing BDCCG with other Placed

Based partnerships within the ICS ▪ The volume of Fastrack referrals continues to increase ▪ There is currently a backlog of reviews due to lack of capacity within the team

Stroke Services ▪ SNAAP data published in October is showing that as a system we are projected to

operate at Level C. ▪ Areas for concern highlighted include:

o Stroke metrics and indicators o Decrease in performance in thrombolysis o MDT working has also reduced

▪ An action plan is in place to look at underlying issues to include o Staffing

o Workforce – consultant and nursing o Therapies - including speech and language, physio and occupational

therapy. A short discussion took place on the above

8. Children & Young People Annual Report:.

J. Tooby (Senior Manager, Mental Wellbeing) provided an overview of the annual

report circulated to the meeting.

The report provided an overview of progress towards priority areas of work within the

CYP Wellbeing programme during its first year to August 2021. A jointly commissioned

system wide review of CYP Mental Health services for Bradford District & Craven has

taken place, commissioned jointly by BDCFT, CCG and the Local Authority Children’s

Social Care. The recommendations were published in July 2020.

The Vision of the programme is to provide a,

‘brighter future for children and young people to thrive and achieve their potential’

A Children and young people’s wellbeing leadership team was established with

membership across Public Health, Children’s social care, BDCFT, CAMHs, and the

voluntary sector. Also included are 8 young healthy minds apprentices, two of which

are focusing on the SEND agenda and are part of the leadership team.

The team have identified priority workstreams which will have the biggest impact on

improving mental health and emotional wellbeing of children and young people.

▪ Thrive & One Trusted Pathway – improve access to effective support by

establishing a new, multi-agency front door and referral pathway for CYP

wellbeing services

▪ Crisis Support – Strengthen our approach to preventing crisis for CYP and

ensure we have accessible, effective multi-disciplinary crisis care pathways for

CYP

▪ Models of Care – Ensure we have models of care delivered by our services

that promote integration and meet the needs of children and young people.

▪ Prevention – Develop information, campaigns and resources by children and

young people that promote good mental wellbeing, emotional resilience and

self-care

The annual report also reflects on key achievements specifically relating to the

identified workstreams. These include delivery of.

▪ Crisis protocol and daily huddles

▪ Little minds matter

▪ Bradford educations Psychology team

▪ MH support teams

▪ KCU.rap

▪ Youth in Mind

▪ CAMHs

The report summarises:

▪ The impact of COVID-19

▪ Improvements to data and insight

▪ Quality improvement work

▪ Investment in services,

▪ On Trusted Referral Pathway

▪ Acting as One

C. Holloway (Associate Director, Keeping Well) stated that we have one of the highest

percentages of young people in the country and with that comes lots of complexity,

levels of deprivation, housing, education aspiration and attainment which all impact on

children’s mental health along with Covid.

9. Serious Incidents Monthly Update:

J. HawWells (Head of Safety & Quality Improvement) provided an update on the

above. AWC have had 0 new incidents in the last month and there are currently 3

beyond deadline one of which is stop the clock

BDCT have had 0 new incidents in the last month and there are currently 4 beyond

deadline one of which is stop the clock

BTHFT reported 2 new incidents in the last month, both maternity. These will take at

least 6 months to investigate. There are currently 5 beyond deadline

YAS have reported 1 new incident and 6 beyond deadline. We are currently unable to

chase YAS for information on these incidents.

Independent providers. No new incidents have been reported in the last month and

there are no outstanding investigations.

10. Serious Incident Quarter 2 Report:

J. HawWells (Head of Safety & Quality Improvement) provided an overview of the Q2

report.

The total number of Serious Incidents reported 1st July 2020 – 30th September 2021

(Q2) = 33. Bradford District Care NHS Foundation Trust reported the majority of the

serious incidents in Q2 with a total of eleven serious incidents reported. This was

followed by Bradford Teaching hospitals NHS Foundation Trust who reported a total of

seven serious incidents.

The Quality Team continue to engage well with providers on an integrated and system

wide level within the new QA model which has been well received by the majority of

our partner providers in care. With the recommencement of the Learning Forum within

West Yorkshire, the engagement with partners will allow shared learning to support our

system wide approach.

11. ICP Update: M. Turner (Strategic Director, Quality & Nursing) has sent an email to SQC members re QC members attending the next SQC meeting in order to support subgroups in understanding how statutory functions maybe discharged.

12. Items for escalation to Governing Body/System Quality Committee: It was agreed to share the good stories from the work undertaken from Safeguarding and the Children & Young People workstream at the Governing Body.

13. Any Other Business:

The Quality Hub is currently facing challenges due to no admin support, therefore MT has requested an admin review to improve capacity within the CCG.

14. Date and Time of Next Meeting: The date and time of the next meeting is Thursday 2nd December 2021 at 1.30pm via Zoom.


Thursday 2nd December 2021


Present:- David Richardson (DR) (Chair) Lay Member, Quality Michelle Turner (MT) Strategic Director, Quality & Nursing James Thomas (JT) Clinical Chair John Hartley (JH) Strategic Head, Quality Improvement Dave Tatham (DT) Strategic Clinical Director, Keeping Well in Gill Paxton (GP) Associate Director, Quality & Nursing Hospital Fiona Jeffrey (FJ) Associate Director, Organisation Effectiveness Iram Amin (IA) Senior Manager, Project & Programme Management Jackie Haw-Wells (JHW) Head of Safety and Quality Improvement Angie Clegg (AC) Independent Registered Nurse Helen Rushworth (HR) Manager, Healthwatch Apologies:- Ruby Bhatti (RB) Lay Member, Primary Care Commissioning John Young (JY) Secondary Care Consultant Peter Brunskill (PB) Secondary Care Consultant Kate Varley (KV) Senior Head, Patient Safety Victoria Simmons (VS) Senior Head of Communications and Engagement

In Attendance:- Ruth Shaw (RS) Item 6 Senior Head, Strategy, Change and Delivery Tracey Gaston (TMG) Item 7 Head of Medicines Optimisation Helen Hart (HH) Items 8/9 Designated Nurse, Safeguarding Adults` Catherine Smith (CS) Item 13 Corporate Governance Manager Elaine Phelps (Minutes) PA 1. Introductions and Apologies:



3. Minutes of the last meeting: Minutes of the previous meeting held on 4th November 2021 were accepted as a true record of the meeting.

4. Action Log Update:

The action log was updated at the meeting.

5. Matters Arising: There were no further matters arising outside of the action log.

6. Maternity: Ruth Shaw (Senior Head, Strategy, Change and Delivery) attended to provide an update on Maternity Services. It was noted that there are concerns regarding some elements of Maternity staffing and levels of staffing within the services and this has been escalated nationally. Airedale NHS Trust have had three unit diverts mainly due to acuity and staffing levels and have decided that they will review and possibly pause continuity of carer for now. This would enable midwives to come back into the unit. It was noted that ladies who test positive for COVID-19 are being offered pulse oximetry service. Airedale NHS Trust are establishing this through their virtual ward and are liaising with Bradford Teaching Hospitals NHS Trust regarding how best to support Bradford’s ladies to access pulse oximetry There has been a poor uptake of vaccinations in pregnant women in Bradford and conversations are taking place at an ICS level to try to improve this. The Maternity Quality Oversight group are to discuss concerns about maternity services. It was noted there have been changes to the BCG service. Changes to rules mean this is no longer given on discharge and is now 4 weeks post-natal. Airedale NHS Trust are operating this system and have managed to embed well within the organisation, however BTHFT have concerns and issues around this and have escalated nationally. BTHFT have stopped administering prior to discharge but the team are waiting for confirmation around the plan for delivery at 4 weeks. This covers approx. 250 babies per month. BTHFT feel they will need to deliver in this in communities and have written a business case for a community-based model.

7. Quality Hub Slides: JH provided key highlights from the slides which were circulated prior to the meeting. Vaccinations:

• Vaccination stocks for both flu and COVID-19 are challenging. There is some concern regarding poor uptake by the clinically vulnerable and children’s cohorts.

• W/c 15th November 2021, 71.9% of people are double vaccinated at Place and 19.2% of children aged 12-15 years in Bradford District have had their first dose

• COVID-19 Infection rates have decreased in the last week (253 per 100,000). • There has been a large uptake at vaccination hubs rather than schools as

parents are wanting to be with their children. Uptake is low in schools generally. • The 18-30 age group is a concern, and we need to understand how to get

communications out to them

Care Homes Outbreak Information: • In Bradford there are 8 care homes who have had an outbreak within 0-28 days • In Craven there are two homes who have single cases and two homes with

ongoing cases and one home with ongoing multiple cases. • There are currently111 patients with COVID-19 in care homes who meet the

threshold for Super Rota support this is an increase from last month.

System Provider quality outcome: • ANHSFT, YAS and LCD are operating at Opel level 4 • Increases in A&E attendance have impacted on the delivery of the 4-hour target

• 18-week performance has increased at ANHSFT this month.

Stroke Care & Performance: • The SSNAP data report has highlighted a number of areas of potential concern

including Stroke indicators, Thrombolysis, Speech & Language, MDT and specialist assessment key indicators. Extensive plans are in place to counteract this.

Primary Care:

• A paper providing an update on the restoration of General Practice was presented to the Health & social Care Overview and Scrutiny Committee in October, including Primary Care Access, PCN development and workforce and return to business as usual for primary care to include the national core priorities.

• The light touch contract and quality assurance process continues • Winter Access funds of £10.7m have been allocated to the ICS from November

2021 to March 2022 to support increase in primary care access and enhanced support for practices that are down on primary care appointments against their pre covid levels.

Care Homes:

• All care home clients have either received or have a date booked for their Covid 18 booster to be administered.

• There are currently 7 care homes in Bradford that have inadequate rating

Medicines Optimisation: • Inclisiran – new drug (for treatment of Hypercholesterolaemia) – Bradford is likely

to be the first place to administer the drug in the country. • Warfarin supply - BTHFT continue to issue warfarin however they are continuing

to report difficulties doing this with the drive-through model

Host Commissioner: • Quarterly Provider meetings were completed in October and no concerns were

raised • The Band 7 place based Host Commissioner post has been appointed to and we

await a start date

Learning Disability Mortality Review Programme (LeDeR): • Governance arrangements have been finalised and reporting and learning form

reviews will sit with the LD Health Inequalities Challenge Group. Personalised Commissioning:

• Significant challenges within the service demonstrate the outlier position for the CCG within the ICS, pertaining to high eligibility for CHC, FastTrack and Funded Nursing Care, work is underway to address

• Fastrack referrals continue to increase, work is underway to explore this to resolve issues that are within the CCGs power

• Pressures across the system are leading to challenges in sourcing providers to fulfil packages of care for adults at home. Access to BDMC provider portal may ease this pressure

• Audit – PHB / CHC and Children's Continuing Care re-audits to commence w/c 15th November 2021

Children’s Continuing Care:

• Pressures across the system are leading to challenges in sourcing providers to fulfil packages of care for complex children, this may result in delays in discharge.

In addition, some children / YP with complex needs and their families are experiencing significant shortfalls in care provision placing them under increased pressure as we enter the winter season. There is a risk of increased admissions to hospital and potential increases in Safeguarding referrals.

Safeguarding Children:

• A system task and finish group has been established to review health resource into the Integrated Front Door and agree a model for the Bradford District.

• A system task and finish group has been established to proactively review, plan, and develop pathways to address the shortfall in placement provision for children with complex health and care needs.

• Recruitment to Child Exploitation Health Practitioner Role is underway. • Completion of ‘Grace’ Child Safeguarding Practice Review and a further 2 Child

Safeguarding Practice Reviews commenced. Safeguarding Adults:

• Meeting held with the Local Authority to discuss and consider the proposed changes under the Liberty Protection Safeguards and the role of the CCG as a responsible body.

Children’s Services:

• Paper on Children and Young People Mental Health and Crisis to be presented to Overview and Scrutiny Committee on 17th November 2021.

SEND:

• Impact of recent changes to Education, health, and care plan (EHCP) tribunals under review due to escalation of CCG attendance at tribunals (further paper to be considered by QC/SLT)

School Nurses:

• There are significant capacity issues with School Nurses across the system, with no school nurses currently in Craven

Research & Development:

• World Antibiotic Awareness Week is 18th – 24th November and this will coincide with report 19 of LAMP

• The Improving Prescribing In Renal Impairment (IPRIM) study has commenced in 2 of our PCNs addressing chronic kidney disease (CKD) management

• An anticholinergic burden project, led by Dr Andy Clegg from BTHFT, is commencing and we have engaged with the Clinical Advisory Board to discuss this and several PCN clinical directors agreed to participate

• We are continuing to build place-based collaborations; Wakefield, Leeds and Bradford are set up to act individually and we will be setting up Calderdale and Kirklees as a joint place for research

8. Safeguarding Provider Assurance:

Helen Hart (Designated Nurse, Safeguarding Adults`) provided an overview of the report circulated to members. This paper was presented to provide assurance to the Quality Committee in respect of the safeguarding children and adult reports and declarations received from provider organisations for the reporting period of 2020-21.

Following presentation at the October Quality Committee it was agreed to present an update against the reports and declarations since received. Safeguarding annual reports and a self-declaration have been received as requested. One provider has submitted a self-declaration only. Work is being undertaken to implement robust systems for future reporting cycles aligned with the approach of the Quality Team where appropriate. The safeguarding team continue to offer support to provider safeguarding leads. ANHSFT - There is a clear description of the robust governance structures in place alongside the team structures and the collaborative nature of the Trust’s working arrangements. The Trust refers to a culture of learning and improvement, which reflects the assurances provided in relation to learning from incidents and statutory reviews. Assurance is provided that the Trust meets its obligations in relation to statutory reviews. The annual report provides a good summary and level of assurance against the extensive work undertaken by the safeguarding adult and children teams. BTHFT – The annual report provides a descriptive summary of the extensive work undertaken by the safeguarding adult and children teams and indicates commitment to driving forward the safeguarding agenda. There is evidence of continued safeguarding practice improvement whilst managing the impact of COVID-19 on service provision and capacity. The Trust reports planning and preparation is underway to respond to the anticipated implementation of the Liberty Protection Safeguards, including actively working with partners. BDCFT – The report provides a descriptive summary of the extensive work undertaken by the Trust’s safeguarding team. Assurance is provided that policies and procedures are reviewed and up to date, however assurance could be strengthened through evidence of the application of outcomes in practice from audits undertaken and develop audit work further in safeguarding adults. The Trust provide assurance that they meet their obligations in relation to statutory reviews. The Trust continues to be a valued and active contributor to the range of safeguarding agendas and relevant health specific groups and the wider multi-agency partnerships, including the Bradford Safeguarding Adults Board, The Bradford Partnership and the Domestic and Sexual Violence Board, subgroups, and Prevent Channel. Assurance could be strengthened through evidence of the application of outcomes in practice from audits undertaken and develop audit work further in safeguarding adults. The Trust provide assurance that they meet their obligations in relation to statutory reviews. The Trust continues to be a valued and active contributor to the range of safeguarding agendas and relevant health specific groups and the wider multi-agency partnerships, including the Bradford Safeguarding Adults Board, The Bradford Partnership and the Domestic and Sexual Violence Board, subgroups, and Prevent Channel. Yorkshire Clinic - The report refers to an organisational and local leadership team with identified and appropriate governance arrangements with a clear reporting structure, including reference to the role of the dedicated Safeguarding lead, who has protected time to carry out safeguarding related duties. Yorkshire Clinic are committed to attending and contributing to the Health Safeguarding Adult Group.

The report confirms that safeguarding policies and procedures are up to date and reference is made to a range of relevant and related policies. The report indicates a great deal of work has been undertaken in relation to the Mental Capacity Act (2005) and application into practice. The recently appointed Matron is keen to engage with the CCG Safeguarding Team. There is evidence of commitment to further embedding the safeguarding adult agenda across the Yorkshire Clinic and the annual report and self-declaration are consistent with the CCGs safeguarding teams’ knowledge and experience of the service and contribute to an overall high level of safeguarding assurance. Optegra - Limited assurance has been received from Optegra for the reporting period of 2020-21. It is noted that there has been a recent change of personnel at Optegra. A self-declaration against the safeguarding standards has been received however no narrative has been submitted. The self-declaration is an honest account of Optegra’s current position with some standards RAG rated amber and red and a brief action plan submitted addressing these areas. Although the CCG safeguarding team are not aware of any particular concerns or risks in relation to safeguarding performance with Optegra, there is a lack of safeguarding specific assurance.

9. ICS Safeguarding adult and children standards Helen Hart (Designated Nurse, Safeguarding Adults`) provided an overview of the above. The Integrated Care System (ICS) Safeguarding Adult and Children and Mental Capacity Act Standards have been developed by the Integrated Designated Professional Network. The aim of implementing the standards into contracts for 2022-23 is to promote a consistent and ‘do it once’ approach across the ICS footprint. The intention of the standards is to strengthen the internal assurance provider organisations currently have in addition to providing assurance to the ICS safeguarding team at place.

• Working to ensure the CCG meet their Statutory requirements and discharging their responsibilities for safeguarding adults and children

• Providing leadership, governance and challenge across the health and social care economy ensuring that safeguarding systems are robust

• Facilitating innovative practice within health to meet the challenges of population safeguarding

• Fully collaborates in all aspects of safeguarding partnership working to meet agreed outcomes and drive forward service developments/improvements

• Provision of guidance and expertise through a safeguarding lens across the whole spectrum of commissioning activities

10. Serious Incidents Monthly Update:

Jackie Haw-Wells (Head of Safety & Quality improvement) provided an update on the following;

• ANHSFT have recorded two new incidents and currently have three over deadline, mainly due to systems and processes. Extensions requested are due to staff having to go back to front line work

• BDCFT have recorded three new incidents and currently have three beyond deadline

• BTHFT have reported four new incidents, one of which is going to HSIB. There are currently six beyond deadline

• YAS have report 0 new incidents and still have six beyond deadline – we are still unable to chase these.

• Independents – There has been one new incident report from a Care Home

11. Patient Experience: On the Horizon People Experience/Complaints: Fiona Jeffrey (Associate Director, Organisation Effectiveness) provided the meeting with key highlights from the report.

• There has been one new formal complaint to the CCG regarding dissatisfaction with the outcome of an appeal with Funded nursing care.

• Concerns raised included: equality, diversity and inclusion and experience of services for Trans people. PCD/continuing healthcare assessment outcomes and care packages, IFR concerns re timescales and funding.

• Complaints/concerns re Primary Care were consistent with previous months although there was as increase

• Providers issues again were consistent with previous months.

• Covid Vaccination Issues – included difficulty in accessing boosters and concerns re booster following allergic reactions.

• Communication headlines included Social media – supported self-care week, anti-bullying week and a refresh of the major IT outage communications plan

• Engagement has taken place around the transition to ICP, Keighley North Street, Keighley Health & Wellbeing Centre and Talk Cancer workshops

• GrassRoots – The team continue to work with team within the CCG as well as partners to expand the sources of public feedback of local health services.

• CLICS – following feedback from practice teams we are designing a CLICS toolkit and materials for teams to hand out to patients.

12. Shadow Governance Arrangements: - to include Item 14

MT/GP led on a discussion regarding the future of Quality Committee. A paper has been produced regarding the future of Quality Committee for Governing Body. On this there are two options for the meeting to consider. Option 1 – The CCG Quality Committee and Finance & Performance Committee step down and the equivalent system committee accept delegated responsibilities from the CCG where these relate to partnerships issues. SLT considers those responsibilities to be discharged by the CCG alone or Option 2 - The CCG and Place system committees continue to dual run. In order to ensure the discharge of committee CCG functions, duties and powers delegated to system committees and /or the CCG Senior Leadership Team have clear lines of accountability back to the Governing Body, there are certain temporary enhancements that were approved to step up as appropriate during the shadow period (1 October 2021 to 31 March 2022): Following a discussion, the meeting was happy to step down Quality Committee from 31st December 2021. Lay members who were unable to attend the meeting will be contacted by MT for their feedback.

13. Risk Register Catherine Smith (Corporate Governance Manager) updated the meeting on the current Risk Register (Cycle 4) Work continues to encourage risk owners and senior managers to undertake comprehensive reviews of each risk focusing on any risks that have remained static for more than a year and to consider whether they are still relevant.

• There are a total of 50 open risks on the corporate risk register, of which 27 align to the QC and seven risks align to both the QC and FPC (Finance and Performance Committee).

• There are currently four open ‘critical’ level risks on the register (scoring 20 or 25) and three of these align to the QC.

• One new risk was added to the register during the cycle which aligns to the QC– this is risk 1955 which relates to the procurement and commissioning of independent care providers.

• There are eight risks which are classed as ‘serious’ risks (scoring 15 or 16) which align to the QC on the risk register.

• No risks have increased during this cycle.

• One risk has closed during this cycle relating to Quality of Stroke Care (1036)

• One risk aligned to the QC has decreased this cycle relating to engagement with people and communities (risk 1545).

Following a discussion, it was felt that the risk regarding blood bottles should be updated with more narrative as should the demand for MH services.

14. Items for escalation to Governing Body/System Quality Committee: Safeguarding Vaccinations

15. Any Other Business:

Performance reports and appendices circulated for information

16. Date and Time of Next Meeting: There will be no further meeting of the Quality Committee

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Minutes of the System Quality Committee Date: Thursday 13th January 2022

Time: 15:00-16:00 Venue: Zoom Call

By Video Call: Turner, Michelle (MT) (Chair) Strategic Director, Quality & Nursing, BD&C CCG Amin, Iram (IA) Project Manager, Project & Programme Management, BD&C CCG Drury, James (JD) Director, Partnership Development, BDC HCP Elliott, Leeanne (LE) Deputy Chief Medical Officer Fearnley, Bev (BF) Deputy Director, Patient Safety, Compliance and Risk, BDCFT Freeman, Sarah (SF) Associate Director, Unplanned Care, BTHFT Haider, Ali Jan (AJH) Director of Health and Integrated Care, BD&C CCG Hubbard, Phil (PH) Director, Nursing/Professions and Care Standards DIPC, BDCFT Paxton, Gill (GP) Associate Director, Nursing & Quality, BD&C CCG Rushworth, Helen (HR) Manager Healthwatch Stanford, Amanda (AS) Chief Nurse, ANHSFT Simms, David (DS) Medical Director, BDCFT Thomas, James (JT) CCG Clinical Chair, BD&C CCG Tomes, Caroline (CT) Consultant, Public Health, CBMDC Wood, Jane (JW) Assistant Director, Commissioning & Integration, CBMDC Varley, Kate (KV) Senior Head, Patient Safety, BD&C CCG Sharonjit Kaur (SK) Note Taker, BD&C CCG In Attendance: Bhatti, Ruby Lay Member, Quality Committee, BD&C CCG Brunskill, Peter Lay Member, Quality Committee, BD&C CCG Clarke, Louise Director of Strategy, BD&C CCG Clegg, Angie Lay Member, Quality Committee, BD&C CCG Richardson, David Lay Member, Quality Committee, BD&C CCG Young, John Lay Member Quality Committee, BD&C CCG Apologies: Hartley, John (JHa) Strategic Head, Quality Improvement, BD&C CCG

1. Introductions and Apologies: -

Apologies noted as above. Attendees of the meeting were introduced. MT informed the lay

members of their role within the SQC meetings and the purpose of the meeting which is to

discuss system pressures, identify big ticket items and items pertaining to harm and safety

2. Minutes of the last meeting, matters arising and action log update: - The minutes of the last meeting were agreed as a true and accurate record. The action log and previous actions were reviewed and updated.

3. System Pressures – impact on patient safety and reducing harm:- James Thomas (CCG Clinical Chair ) presented the slides on System Response to Omnicron planning requirements which were shared with the Clinical Forum.

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The system response was developed as a result of incident escalation from Level 3 to Level 4 on 13th December 2021. Key actions were required to support the system across West Yorkshire in terms of care and recovery of services across the system.

• A significant increase in occupied beds across services including Mental Health services.

• SDU and ITU bed occupancy also increased. Several key priority actions were taken to support the system:

• Staff were unable to be tested – A task and finish group was formed across West Yorkshire led by Steve Russell (Chief Executive, Harrogate) to ensure staff testing was available. Improvements have been seen and there is now a stockpile. It was noted that due to the resources being available via a “push supply system” it is important to ensure correct reporting of tests to enable sufficient resources for future planning and use.

• NMaBS - A new treatment system has been implemented within hospital settings. Implementation of the first clinic in Leeds took place on 21st December. The Bradford Service will be a nurse led service commencing on 17th January for the delivery of antivirals and the and IVs followed by further services being provided at Airedale from 26th January. CKW site services which will provide a DV service will be implemented from 17th January.

MT thanked all colleagues who have supported with the services using an Act as One

Approach.

• Ambulance services have been under massive pressures due to the Omnicron surge. Military Services are involved in supporting YAS with patients and reprioritisation of patient transport services.

• Supporting Acute Care Pathways - Priority has been given to cancer, life and limb and surgery. A revised independent sector contract has been circulated nationally. This includes details of IPC to ensure consistency in all areas.

• Over 75% of individuals have had booster jabs within Yorkshire.

• There have been no issues as a result of Omnicron which have affected children and young people.

Work has been completed using a phased approach (see slide for full details). The committee were asked to consider the impact of:

• Inequalities and role of teams

• Impact of unvaccinated staff

• Speed of medically fit patients being discharged and locations as to where they are discharged to

• Implications of child absences from school and mental health issues

• Impact on the care sector and domiciliary care.

An organisational update of pressures, risks and high priorities was given for each area: Airedale Hospital:- Main pressures discussed for the hospital are emergency department pressures and acuity of presentations as well as workforce issues. The hospital has also seen an increase in presentations of patients experiencing mental health issues and Covid patients. It has been identified that patients are attending the hospital not reporting Covid

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which is then identified once screening is completed. Due to the number of positive cases there are also problems of managing pathways. The number of Covid positive staff has recently increased and numbers of staffing within ward areas are proving to be challenging. Robust systems are in place for risk assessments which have been changed to align with current guidance, twice daily meetings are taking place to discuss assessments, daily staffing meetings are taking place to mitigate any risks with staffing which is currently at minimum along with staff movements to cover areas of low staffing. Alongside staffing challenges there have also been added pressures of managing outbreaks within 3 ward areas, 1 of which is orthopaedics and trauma. Maternity services, community, therapies, and paediatric services are also stretched due to the current staffing pressures. BDCFT:- There are 3 main areas of concern identified within BDCFT. These include staffing, presentation of mental health patients, some of whom require psychiatric intensive care and families who have been unable to travel to children’s appointments which is reflecting concern of vulnerable children. Additionally, there are a large number of outbreaks within ward areas. BTHFT:- Main issues of concern at BTHFT include staffing which has resulted in the ability to adequately staff ward areas and increase turnaround times for ambulance admissions. The hospital currently has 104 Covid Positive patients which has resulted in the need for additional red areas. Bradford Council:- The committee were informed there are currently 76 reported outbreaks which has impacted both staff and service users within the independent care sector. Some areas are unable to take new admissions and staffing is monitored on a daily basis due to staff shortages which are critical. GP Services:- GP services have identified higher acuity of patients along with an increase in late presentations. Staffing numbers have been extremely low due to sickness with additional impact of unvaccinated staff. Healthwatch:- Healthwatch reported issues of communication and the impact of lack of communication being a problem as patients are unaware of surgeries being open, late cancellations and self-referrals. – From the discussion regarding system pressure and risks associated with potential patient harm the key themes identified were as follows:

• Staffing,

• Vaccination hesitancy,

• Mental health,

• Children and Young people (including community paediatrics and safeguarding)

• Maternity,

• Elective care (health inequalities/safety),

• Care Sector,

• Outbreaks,

• Timely communication to enable people to live well.

Identified issues have been escalated and will be discussed further:

• Midwifery has been escalated on safer staffing grounds.

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• Monitoring of patient flow issues and outbreaks will take place within Health and Care Silver calls.

• Vaccination’s discussions will take place at Ethics meetings.

4. Quality & Performance Slides from Bradford Place:- G Paxton gave a brief outline of Quality and Performance slides produced with input from providers and the wider system which were circulated to the committee. The slides are produced to look at “big ticket” items across the system and to identify approaches and what action is taken from the committee

5. SQC Terms of Reference:-

The Terms of Reference have been circulated to the committee for feedback. Feedback will

then be collated and adapted in terms of input.

6. Vulnerable Children Highlight Report:-

To note.

System F & PC paper:-

To note.

7. Any Other Business:-

8. Date and time of Next Meeting:-

Thursday 19th February at 3.00pm via Zoom.

1

Minutes of the Audit & Governance Committee

13:10 – 15:00

1st November 2021

held virtually via Zoom

Present

Bryan Millar – Lay Member for Audit & Governance (Chair)

Ruby Bhatti – Lay Member for Primary Care Commissioning

David Richardson – Lay Member for Quality

In Attendance

Liz Allen – Strategic Director of Organisation Effectiveness

Sue Baxter – Strategic Head of Assurance

Bev Denton – Corporate Governance Manager – (Minutes)

Sharron Blackburn – Deputy Head of Internal Audit, Audit Yorkshire

Rashpal Khangura – Director – Public Sector Audit, KPMG

Lee Swift – Local Counter Fraud Specialist, Audit Yorkshire

Diane Lawlor – representing Robert Maden

Iain Twedily – Information Governance Officer, THIS

Roberto Geidrojt, Health and Safety manager, BDCT (Item 7 only)

Apologies

Neil Fell – Lay Member for Finance & Performance

Robert Maden – Chief Finance Officer

1. Welcome and apologies for Absence

Bryan commented that a private meeting had been held prior to the main business meeting

with the internal and external auditors and confirmed that there were no points to raise at this

meeting.

Bryan Millar welcomed everyone to the meeting of NHS Bradford District and Craven CCG

Audit & Governance (A&G) Committee. Apologies were received from Neil Fell and Robert

Maden.

Neil Fell submitted some comments on the Committee agenda and papers prior to the

meeting and these had been shared with the Corporate Governance Team and Neil’s

comments and responses will be included in these minutes.

2. Declarations of interest

There were no declarations of interest. The CCG’s registers of interests record all interests

declared and are available at:

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https://www.bradfordcravenccg.nhs.uk/ccg-information/publication-scheme/lists-and-

registers/

3. Minutes of the meeting held on 5th July 2021

The minutes of the meeting held on 5th July were reviewed and no comments raised.

RESOLVED: The Audit & Governance Committee approved the minutes from the meeting

held on 5th July 2021.

4. Action Log

The action log was reviewed and updated as follows:

• Records management (ref: 2021/22 – 02). A post meeting note was included in the

minutes. It was noted that the responsibilities were noted incorrectly and will be

amended to Robert Maden / Sharron Blackburn. This action is closed.

• Corporate Risk and Assurance Report (ref 2021/22 – 04). Beverley Denton

confirmed the Policy Schedule had been reviewed. This action is closed.

• Health and Safety Report (ref: 2021/22 – 08. Liz Allen confirmed a contact had been

provided to Roberto Giedrojt. This action is closed.

• Annual Counter Fraud Report (ref: 2021/22 – 10). Appointment of Counter Fraud

Champion - Nomination has been received and will be submitted. A nominee has

been confirmed. This action is closed.

• Annual Counter Fraud Report (ref: 2021/22 – 10). Proposal regarding the number of

allocated days has been received. This action is closed.

RESOLVED: The Audit & Governance Committee noted the assurance provided by the

action log.

5. Records Management update report (including Information Governance)

Sue Baxter highlighted the key items noting that a Records Management Meeting was held

on 28th September. The main agenda items for this meeting related to CCG transition

preparation, Office 365 migration project and preparatory work on the COVID 19 inquiry

including the NHSE/I legal stop notice.

Sue informed the Committee that in terms of CCG transition, an IG subgroup is being

established to support and co-ordinate how the operating model will work across West

Yorkshire and the associated work programme to 31st March 2022 for example the Data

Security and Protection Toolkit (DSPT) submission.

Neil Fell submitted a query in relation to the DSPT commenting on the need to keep on top

of deadlines and actions from DSPT 2020/21. Sue responded that some of the items /

actions under the DSPT improvement plan are dependent on the completion of the Office



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365 migration/Windows 10. Part of this work involves the email migration, and this has been

rescheduled until mid-November. Colleagues in THIS are currently reviewing the DSPT

2020/21 improvement plan timescales for completion. Bryan commented that in relation to

the DSPT Improvement Plan the Committee would welcome updates on the position in light

of changes in timelines.

Iain Twedily took members through the Information Governance progress report noting the

2021/22 DSPT submission date is June 2022, and it will be an ICB submission. Iain noted

that of the 8 IG incidents none were ICO/NHS Digital reportable. All Freedom of Information

(FoI) requests had been completed within the required timescale.

Neil Fell commented on DSPT Improvement Plan deadlines and asked if the committee can

be assured on progress to get back on track. Sue commented that confirmation of dates are

outstanding from THIS colleagues.

Neil Fell had submitted a query prior to the meeting relating to the number of mental health

FoI changes and if these were general queries or are they indicative of the pressures on MH

service delivery. Neil also asked whether there is a feedback loop to SLT/Commissioning

team to prompt review and corrective action. An action was taken to update following the

meeting via email.

Action: Bev Denton to provide further details on FoIs received.

Iain updated on the Training Needs Analysis (TNA) provided as part of the IG report

confirming all members of BD&C CCG staff are required to complete online IG training.

There is a training presentation with commentary available for the SIRO and Information

Asset Owners to review. There is a requirement for the Caldicott Guardian to undertake

training every three years and is due in 2021/22. The training for the Deputy Caldicott

Guardian is up to date.

The THIS work programme has been submitted to the Committee for review and details the

service provision to the CCG. Iain highlighted to committee members the Governments

consultation on Data Protection reforms which is open for consultation until November 19th

2021. Iain will share a briefing prepared by Hill Dickinson Solicitors on the reforms.

Action: Iain Twedily to share the Data Protection reforms briefing paper.

Sue Baxter introduced the preparation underway on the COVID 19 Inquiry legal stop notice

and the draft email footer suggested for staff use. There are two considerations, the

preservation of relevant COVID data, this can also include actions / information not directly

related to COVID 19 for example elective recovery and the transfer of records to the new

organisation. Sue Baxter asked for feedback from members of the Committee on the stop

notice to be returned to [email protected].

Bryan asked the source and Sue confirmed that NHSE legal stop notice and email footer are

the source, this has been shared as good practice, with no obligation to use. Bryan asked

what the approval process for this stop notice is. Sue commented that this has yet to be

agreed and sought the committee’s view. Bryan commented that as this is a legal issue and


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as such legal advice should be sought and if agreed fit for purpose Audit & Governance

Committee would be happy to approve. Ruby echoed the comments to ensure that any

changes sit within the legal requirement and reiterated the need to share any amendments

with the Committee. Liz Allen commented that the next Audit and Governance Committee is

in February 2022 and there is a requirement to issue the stop notice prior to that date. It was

agreed to process approval of these two documents outside of committee by Audit &

Governance members.

Action: Committee members to send any comments to Sue Baxter/Catherine Smith

Action: Upon completion and legal advice, the legal stop notice and footer to be submitted

for Audit & Governance members approval outside of committee

RESOLVED: The Audit & Governance Committee reviewed and noted the:

1. Preparations for CCG Transition

2. Information Governance update report including training needs analysis and IG

work programme

3. Progress with office 365

4. COVID Inquiry legal stop notice and email footer approved in principle and agreed

to feedback any comments to Sue Baxter/Iain Twedily

6. IG Policies Approval

Information Governance Policies had been sent to the Committee members outside of this meeting. Iain Twedily confirmed the changes

• Records Management Policy, updated to reflect latest Code of Practice

• Data protection Impact Assessment Procedure. Typos have been identified and the procedure will be amended and resent for publication

• FoI/EIR Policy and FoI/EIR Procedure, updated to reflect one CCG

RESOLVED: The Audit & Governance Committee received and approved the policies

subject to amendment noted above.

Iain Twedily left the meeting. Robert Geidrojt joined the meeting for Item 7.

7. Health and Safety Update

Roberto Geidrojt updated the Committee on highlights since the last meeting and confirmed

the Health and Safety Policy remains in date. The Fire Safety site inspections remain in

date for both Scorex House and Millennium Business Park (MBP).

Roberto confirmed that one Fire Safety training session has been held and additional dates

can be arranged on request.

The Health and Safety site inspection at MBP was delayed due to COVID and the

subsequent office closure however an inspection took place on 6th October. The building

remains closed and an access procedure is in place should staff need to attend the site.

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The building itself was reviewed and it was noted that clearance of the building is currently

underway and housekeeping advice was provided to the Corporate Governance Team.

The Health and Safety site inspection of Scorex House is to be scheduled in November and

this is seen as timely considering proposals for staff to return to the office.

Roberto confirmed there are no outstanding actions for both locations. Roberto commended

the staff within the CCG for closing actions and maintaining Health and Safety standards.

There are no updates from the Health and Safety Executive to note.

Roberto updated the Committee on a Health and Safety issue within some NHS

organisations in relation to the anti-vax campaign. Individuals are attending sites, handing

out leaflets then uploading video footage onto social media platforms. Roberto asked if any

organisations are affected the inform him as he has links with the West Yorkshire Police.

Liz Allen confirmed no incidents have been experienced to date.

Liz Allen commented that the Scorex House Risk Assessment is currently being updated in

line with any changes to Government requirements.

RESOLVED: The Audit and Governance noted the report.

8. Incident Reporting Policy

The Policy was circulated outside the meeting for approval.

RESOLVED: The Committee approved the policy.

9. Internal Audit Progress Report

Sharron Blackburn talked to the paper and commented that work is progressing with the plan

and any final audit reports will be circulated to members.

The paper includes, for information, a proposal relating to how Internal Audit can support the

CCG transition to ICB.

Bryan commented that if this is a variation to the audit plan, approval would need to be

sought from this Committee and a recommendation made to the CCG Transition Programme

Board.

Sharron stated there have been some changes to the plan and highlighted the change

around System Governance, which has been updated to support around Place transition

readiness.

Bryan commented on a point raised in the private discussion with Auditors on readiness

within the CCG in relation to Shadow Governance arrangements for example joint

committees and dual running. Sharron commented that there the proposal to review

arrangements within the paper at Appendix A.

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Bryan asked if, following a previous proposal regarding the standing down of the BD&C

CCG’s Finance and Performance and Quality committees in Quarter 4, if there is a transition

plan in Quarter 3. David Richardson commented that communication has been made with

the System Quality Committee regarding BD&C CCG Quality Committees attendance at the

System Quality Meeting. David asked if considering the timescale, additional resources will

be required within the CCG’s corporate governance team to deliver the shadow governance

arrangements. Sue Baxter commented that the work of implementing the system committee

aspects of the shadow governance arrangements has transferred to the Chairs of the

System Committees sit within the BD&C CCG and confirmed that the invitation to the

System Committees would be extended to lay and professional members for attendance at

the system committees from 1 October 2021 to 31 March 2022.

Sharron referred to the audit plan and the proposed postponement of the Better Care Fund

Audit and the revaluation post transition to Place.

Bryan in Neil’s absence raised his comment on the original approach to committing funds

was flexed to accommodate Covid pressures. Neil asked if we can we still be assured that

we are getting some benefit and VFM if the audit is postponed.

Sharron commented that the reallocation of days means assurance can be given in regard to

the Personalised Health Budget, which has previously received limited assurance. Bryan

commented that this is a positive move.

Sharron highlighted that since the last meeting there has been a new Head of Audit

appointment within Audit Yorkshire has been made and Helen Higgs will commence the role

on 10th January 2022. Helen was previously Head of Audit within NHS Wales Shared

Services Partnership. Bryan confirmed he participated on the recruitment panel.

Sharron commented on the progress on outstanding audit report recommendations reducing

from 65 to 20. There are no ‘red’ actions and there has been significant movement in

closure of actions.

Neil Fell commented on the outstanding recommendations relating to IT Business Continuity

and the inadequate resource to allow ‘fall-over’ testing. The dual server installation is a

relatively new development across the two centres and asked if the CCG have

underestimated system capacity requirements and can we rectify this quickly so as not to

impair ability to function in the new arrangements.

Action: Update to be provided outside the meeting.

Sharron confirmed that any outstanding actions will be handed over to the new organisation.

Bryan asked for assurance of achievement of the plan. Sharron commented that many

audits were profiled for Q3 and there have been changes in Q2, but work is progressing and

there is capacity in Q4 for any slippage.

RESOLVED: The Committee noted the internal Audit Progress report.

10. Internal Audit Annual Report

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Sharron presented the Audit Yorkshire Annual Report 2020/21 to the Committee for

information.

RESOLVED: The Committee noted the Annual Report 2020/21

11. Internal Audit Charter

Sharron presented the Internal Audit Charter which sets out the authority of Internal Audit to

operate and provide internal audit services to the CCG. It is a requirement of the Public

Sector Internal Audit Standards (PSIAS) and is reviewed annually. Sharron noted that there

has only been one change since last year in relation to minor changes to the organisation’s

mission.

RESOLVED: The Committee approved the Internal Audit Charter.

12. Counter Fraud Progress Report

Lee Swift commented on the counter fraud progress report and took the Committee through

the highlights in relation to mandatory training and noted that participants will be asked to

feedback on the training and a report will be presented to this committee at year end.

Fraud awareness training has been undertaken with the Finance Team since the last Audit

Committee. A fraud prevention masterclass has been launched in relation to recruitment

fraud, payroll fraud and creditor payments and the option to attend has been extended to

GPs. Cyber Crime awareness training will be launched shortly.

Internal Fraud Awareness week takes place from 14th – 20th November and literature will be

sent out via the Communications team.

The Chief Finance officer has nominated Diane Lawlor (Strategic Head of Finance) to be the

CCGS Counter-Fraud champion.

Lee highlighted a new area within the report in relation to benchmarking of fraud referrals for

information.

Bryan commented on the report noting that the Counter Fraud plan and the number of days

allocated is on schedule.

RESOLVED: The Committee received and took assurance from the Counter Fraud Report.

13. External Audit Progress and Technical Report

Rashpal Khangura commented on the External Audit Progress and Technical Report and

highlighted the main technical issues currently being experienced. Rashpal commented that

the KPMG team had held their Health Planning meeting and the local planning session will

be preparing the audit plan which will be submitted to this Committee in the New Year.

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Bryan in Neil’s absence raised his comment that the BCF plan should be reported to the

CCG whether through CCG GB or F&P even if signed off via Health and Wellbeing.

Action: Bev Denton to provide an update outside the meeting via email.

Rashpal highlighted the issues raised in the report around the financial arrangements and

the senior officer disclosure. Rashpal confirmed that the focus will be on the changes that

will be required by the CCG through the transition process and to date has no concerns

around the arrangements in place.

Rashpal updated the Committee on the schedule for the audit once the plan has been

agreed. Interim work will be undertaken in February 2022, looking at systems and controls

and final work at the end of April/May 2022.

Bryan commented that Audit and Governance Committee meetings will take place in

February and March, however from April the CCG will no longer exist and asked if the Audit

will be presented to the ICB in May / June. Rashpal commented that the final guidance and

timelines have not be published.

Bryan asked how many of the five West Yorkshire CCG’s, KMPG were the external auditor

for and Rashpal confirmed the number to be four, the only one not covered by KPMG is

Calderdale.

Bryan asked if the process for appointment to audits in the ICS has been confirmed.

Rashpal commented that this has not been announced. Bryan further commented that

should a contract novation with Auditors be required then completion of planned audits will

be agreed.

Sue Baxter asked if the External Auditors had received a timeline from NHSEI in relation to

the annual report and accounts. Rashpal commented that KPMG has shared views on

timelines with the NHSEI and are awaiting final publication.

David Richardson commented that the KPMG Thought Leadership section was an

informative addition to the report and asked if the recommendations would be followed up by

KPMG. Rashpal agreed to feedback this to KPMG.

RESOLVED: The Committee received and took assurance from the External Audit Progress

Report and Technical Update.

Diane Lawlor left the meeting.

14. Corporate Risk and Assurance Report

The register of interests has been included in the report for information and if anyone has

any updates please send to the Corporate Governance Team. Bryan highlighted an

amendment to his declaration of interest as Chair of Audit Yorkshire and confirmed this a

non-financial professional interest and this has been noted.

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Action: Bev Denton to update register of interests.

Sue commented that the CCG governing documents such as the CCG’s Constitution,

standing financial instructions have been updated, with non-material changes and

have been published on the CCG website, as required. A copy has also been sent to

NHSE/I for their records.

A comprehensive review of the policies and procedures schedule has been undertaken and

now includes policies from across the hubs, in support of the transition. Neil Fell

commented) that the policies relating to Safeguarding, Prevent policy and procedures,

Safeguarding children policy and safeguarding children commissioning policy should be

identified as a priority for update.

Action: Bev Denton to follow up with the children’s safeguarding team

The Corporate Risk Register and the Commissioning Assurance Framework (CAF) has been

included in the report. The CAF will be presented to the Governing Body on 9th November

2021. Sue Baxter updated on the corporate risk register stating there are 27 risks aligned to

the Quality Committee (QC) risks on the register, 17 aligned to Finance and Performance

(F&P) and six aligned to both FPC & QC giving a total of 50 risks, including one new one

relating to performance issues of the data centres following migration to Windows 10.

Neil Fell commented on risk 1613 and asked re Mental Health services and asked if the

actions from the September learning event have commenced and is there a trajectory to

chart progress.

Action: Bev Denton agreed to contact the 1613 risk owner for an update.

The key changes to the CAF are detailed in the report (Section 6) relating to risk 4.1, engagement with act-as-one, the recommendation to Governing Body will be to close this risk. A new risk in relation to act-as-one due to the COVID19 pandemic response in that programmes were re-purposed or paused to release resources, was added. Risk 5.1 Establishing our place-based partnership has been reduced due to progress, whilst recognising the legislation is still making its way through parliament. The Corporate Governance Team Work plan is a new addition to the Corporate Assurance

Report and details the work the team is undertaking and aims to provide assurance on the

work and responsibilities of the team. Bryan commented that this was a useful and helpful

document especially around the secretariat work and the support provided to the

Committees.

Sue Baxter raised the issue of the committee effectiveness review hinging on the potential

step down of two of the Committees (QC and FPC) in Quarter 4 and therefore the need to

undertake the Committee Effectives review prior to Q4. A proposal will be sent from Carrie

Haywood outside this meeting for Committee members to review and comment. Bryan

welcomed a sensible and light touch approach and commented that the focus should be on

what Committees are required to do in the time that remains. David Richardson supported

Bryan’s view and confirmed the need to establish if Committees have discharged their

responsibilities prior to transition. Sue confirmed the need for a practical approach and the

requirement to review what will be handed over to the new organisation. Ruby commented

that it was important to close the loop and asked if there is a need to meet after 31st March to

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ensure all actions completed. Sue commented that after 31st March it will be the ICB Audit

Committee.

Rashpal Khangura recommended that the committee effectiveness review should take place

as late as possible. There is a meeting schedule for 28th March and this would be a good

date to undertake the review. However, Rashpal also commented that if a review is done

earlier then any outstanding actions can be addressed.

Action: Carrie Haywood to send proposal to be sent to members for review and comment.

RESOLVED: The Committee received the Corporate Assurance Report and agreed to

feedback on the Committee Effectiveness Review proposal which will be sent separately

after this meeting.

15. Assurance of ICS Transition

Sue Baxter gave a verbal update on progress on the CCG transition and commented that

there is work underway across West Yorkshire and our Place around the governance

structure and operating models. A workspace will be created for all West Yorkshire

workstreams and this will be where the due diligence checklists will be submitted by each

work stream on behalf of the five CCGs in West Yorkshire.

RESOLVED: The Committee noted the update.

16. Due Diligence exercise

The paper has been presented to the CCG Transition Programme Board. Sue Baxter

presented the paper, prepared by Rebecca Leahy. The work for due diligence will be co-

ordinated by West Yorkshire. Sue confirmed that from a legal perspective when an

organisation is transferring the onus is on the sending organisation.

It has been agreed to use the national due diligence checklist, although this is checklist is

not mandatory. The Corporate Governance Team will provide a coordination role and

collate submissions made by BD&C CCG. Currently there is no requirement to submit

evidence however internal links to any evidence will be recorded. The due diligence

exercise informs the Accountable Officers letter of assurance due in mid-February and will

be sent to the ICB/S Chief executive and NHSEI Regional Director.

This approach will be supported by a proposed Audit Committees to be held in Common

meeting scheduled for February, in order to sign off the draft due diligence checklist ahead

of the AOs letter of assurance.

Sue Baxter requested Liz Allen to raise a query of the West Yorkshire Transfer of Functions

Reference Group in regard to clarity and further details on the plans for the Audit Committee

meeting in common.

Bryan confirmed the proposed schedule of meetings:

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• 28th February 2022 a BD&C CCG Audit and Governance Committee business

meeting.

• 29th March 2022 a BD&C CCG Audit and Governance Committee close down

meeting

• 28th March 2022 has been set aside for a Committees in Common meeting and

clarity will be sought on the agenda.

The Committee agreed to attendance at these meeting as required.

ACTION: Liz Allen to seek further details of the proposed Audit Committees in Common

meeting scheduled for 28th March 2022.

RESOLVED: The Committee received the report and:

1. reviewed the recommended approach and framework for the West Yorkshire due

diligence exercise

2. confirmed their approval of the recommended approach and framework to West

Yorkshire transition due diligence and

3. considered Audit & Governance Committee in common approach to providing input

and assurance of due diligence process and outputs in February 2022 (Phase 4)

17. ICS Constitution – Consultation Approach

Sue Baxter took the committee through a paper submitted by Stephen Gregg on the

Integrated Care Board constitution consultation approach. The paper explains the approach

to the new organisation from 1st April 2022. A national model constitution is provided with

associated supporting documents that are then tailored to support our operating model

within West Yorkshire.

RESOLVED: The Committee approved the approach.

18. Any other business

No items of any other business were raised.

19. A&G Work Programme

The Audit and Governance Work Programme was reviewed and agreed.

RESOLVED: The Committee reviewed and approved the work programme

20. Process for review of committee effectiveness

This item was discussed under item 14 Corporate Assurance Report

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21. Key messages for Governing Body

Bryan Millar agreed to highlight the complexities of working with the Internal and External

Auditors during the transition process and to highlight the standard items in the business

meeting.

22. Date and Time of next meetings

• 28th February 2022

• 28th March 2022 – Committee in Common

• 29th March 2022 – close down meeting.

BRADFORD DISTRICT AND CRAVEN CCG

Documents

Transcript of BRADFORD DISTRICT AND CRAVEN CCG