CCG Board Date of meeting 1 October 2015 Agenda Item 4 Paper No WHCCG15/078 Chief Officer s Report (September 2015) Key issues Attached is the Chief Officer s Report, which covers the following matters: Devolution in the South Financial Pressures CCG Assurance Organisation Structure Care.data Pathfinder Programme Recent Undercover Media Activity Local Digital Media Roadmaps Directorate Quarterly Assurance Meetings Staff Recognition Awards Actions requested / Recommendation Principal risk(s) relating to this paper Other committees / groups where evidence supporting this paper has been considered. Financial and resource implications / impact Legal implications / impact Public involvement activity taken or planned Equality and Diversity implications / impact Report Author The West Hampshire Clinical Commissioning Group Board is being asked to note the Chief Officer s Report (September 2015) This briefing together a number of strategic issues relevant to the wider health sector which impact on the work of the CCG. Executive and Senior Management Team Corporate Governance Committee Hampshire 5 Commissioning Group There are no financial implications arising from this paper at this stage. Not applicable. Public involvement is embedded as part of all ongoing commissioning and service reviews. The commissioning team regularly analyses data and patient feedback to identify any potential issues impacting on equality and diversity such as access to services. Heather Hauschild, Chief Officer Compassionate Inclusive Honest Ambitious Fair
Sponsoring Director Heather Hauschild, Chief Officer Date 23 September 2015 2/2
CHIEF OFFICER S REPORT September 2015 1. INTRODUCTION 1.1 The purpose of this paper is to highlight key issues of strategic importance which underpin all our work programmes and to provide the Board with a reflection on the key issues locally for the CCG. 1.2 Since our last meeting the national focus is clearly on the accelerated implementation of the Five Year Forward View, including new models of care and the integration of Health and Social Care. 1.3 Locally the CCG focus has been on translating national strategy into delivery with our Vanguard programme in the New Forest, the continuation of the development of the out of hospital strategy and the Better Care Fund Programme, the delivery of the NHS Constitutional Standards through strengthened system resilience groups for the North and South West and taking forward our financial programme. 2. DEVOLUTION IN THE SOUTH 2.1 The Government have announced plans to devolve more power to local regions. Plans have already been initiated in Greater Manchester, where local authorities are coming together with NHS England and local CCGs to take over a budget of 6 billion. The scope of the agreement includes the entire health and social care system in the area, including adult, primary and social care, mental health community services and public health. 2.2 A similar devolution deal has been proposed for Hampshire, the Isle of Wight, Portsmouth and Southampton. The plans, which involve all 15 local authorities working with the area s two local enterprise partnerships, the private sector and health partners to deliver greater economic growth and better public services, are outlined in a letter from all local authority leaders to the Government. 2.3 The letter marked the start of formal negotiations with government to agree a devolution deal, with more detailed plans expected to be submitted in the autumn. It is hoped that the plans will give local people more influence over how the region s share of national spending is spent. We will update the Board with more information as it comes to light. 1
3. FINANCIAL PRESSURES 3.1 Financial results released during the summer, and outlined in more detail in the Chief Finance Officer s report show that we are not delivering our financial plan, which was to achieve a 2 million underspend for the year in line with our planned target. Our expenditure continues to increase particularly for planned care, continuing healthcare, and also for excess bed-days for patients who are staying in hospital longer than expected, planned care at independent sector providers, and patient transport. 3.2 We have appointed additional senior finance support to provide us with additional capacity to deliver our financial recovery programme and we are reporting on progress on a very regular basis to NHS England. 4. CCG ASSURANCE UPDATE 4.1 The formal Quarter 1 Assurance meeting took place with NHS England on 24 September 2015 and we will communicate the outcome of assurance ratings to the board as soon as we receive them. 4.2 Whilst the CCG faces several challenges, there is recognition that we have a sound foundation and our clear priority now is to accelerate the next steps during 2015/16, including Strengthening member practice engagement across the CCG, focussing on involving practices in developing plans and priorities and ensuring visibility of leadership thorough our organisational restructure. Exploring the longer term health economy strategy with health and social care partners. Continuing to work closely with partners at both system resilience groups to ensure credible work programmes for 2015/16 are developed and are backed by robust governance arrangements. Exploring how the further QIPP opportunities identified can be progressed. 4.3 Last month, NHS England published the CCG assurance operating manual, including details of the new special measures regime and a CCG quarterly self-certification for delegated functions. 5. ORGANISATION STRUCTURE 5.1 As mentioned at the July meeting there have been a number of changes over recent months led us to think that the way we are currently organised needed to be adapted. This is to ensure that the CCG can continue to fulfil its obligations and support the extensive developments that are taking place in our local communities, such as: The Vanguard programme in the south west of the New Forest. 2
Signals we are receiving that GP federations across our patch would like to follow on quickly. The focus nationally on system working and the need to be even more engaged with our partner CCGs around commons areas of work. 5.2 A consultation regarding proposed structures within West Hampshire CCG took place throughout August and ended on 2 September 2015. We received 60 responses providing a range of feedback, which has been very helpful in refining our plans, and we plan to hold a special all-staff meeting on 6 October in Eastleigh to discuss the next steps. 5.3 Our intention through these proposed changes is to: Focus on more support to our localities and systems balancing the central requirements of the CCG with the imperative to ensure local service development shaped around the needs of local communities Ensure CCG running costs are affordable and sustainable. Improve service delivery. 6. CARE.DATA PATHFINDER PROGRAMME 6.1 The Secretary of State for Health made a speech at the NHS Innovation Expo on 2 September that has implications for the care.data pathfinder programme. He announced that Dame Fiona Caldicott, the National Data Guardian, would provide advice on the wording for a new model of consents and opt-outs to be used by the care.data programme. 6.2 West Hampshire CCG was announced as one of four CCG pathfinder areas for the NHS England care.data programme in October 2014. Since then, 30 of our 51 practices have signed up as pathfinders, representing nearly 60% of the CCG s membership and covering more than 335,000 people in West Hampshire. 6.3 The programme has been working towards a planned go live in late September 2015 for all four pathfinder areas, when patients of pathfinder practices would be sent the introductory letter and supporting information. It would also mark the start of a comprehensive publicity programme locally to raise awareness of the mailing across West Hampshire. 6.4 The Secretary of State s announcement means that we cannot proceed with this communication in pathfinder areas until the implications of Dame Fiona s work are fully understood. At this stage the scope and details of Dame Fiona s review are still to be agreed, so we are not in position to fully understand the implications for the programme. 6.5 Mr Hunt also announced that Dame Fiona's advice will contribute to a review of standards of data security for patients confidential data across the NHS to be carried out by the Care Quality Commission by the end of January 2016. These new measures are designed to strengthen the public s confidence in the security of their data. 3
6.6 NHS England remains completely committed to rolling out the care.data programme and to the importance and value of testing plans through our pathfinder practices. It's likely that, as pathfinders, we will have the opportunity both to contribute to and test Dame Fiona's new recommendations on consent and opt-outs as part of our pathfinder programme. 7. RECENT UNDERCOVER MEDIA ACTIVITY 7.1 There have been a number of occasions recently when journalists have been undercover to gain stories about the NHS. This has happened locally for South Central Ambulance Service and the Isle of Wight CCG, which has resulted in national media coverage. 7.2 By the end of August all CCG Accountable Officers in the country were asked to provide assurance regarding the operation of their policies and procedures to manage conflicts of interests, following the recent media allegations. While we are confident that our policies meet statutory guidance, we are conducting a review, reporting to the audit committee, to check that they are working satisfactorily and will also raise awareness of policy requirements for all staff via the staff intranet, induction, team/directorate briefings, and Board / Committee / locality meetings. 7.3 We expect all staff (clinical and non-clinical) to behave appropriately and to be aware of their own responsibilities as an employee of the CCG. This includes not disclosing confidential or inappropriate information, declaring and managing any conflicts of interest or outside activities which may impact on their role at the CCG and reporting any suspicious or inappropriate behaviour they may observe. 7.4 The standards of business conduct and declarations of interest policy, the concerns and whistle blowing policy and the local anti-fraud, corruption and bribery policy have been highlighted again to staff. 8. LOCAL DIGITAL ROADMAPS 8.1 The Five Year Forward View identified harnessing the information revolution as a key enabler to securing a sustainable NHS and made a commitment that, by 2020, all electronic health records would be fully interoperable so that patient records are paperless. This vision was supported by the establishment of the National Information Board and its ambition to transform the health and care digital landscape outlined in Personalised Health and Care 2020 A Framework for Action. 8.2 A key proposal outlined in this document, and later adopted as government policy, was to invite local areas to produce digital roadmaps detailing the steps they will take, and when, in their progress towards a fully interoperable way of working. Local digital roadmaps will generate momentum across a 4
local health economy, inform local investment prioritisation and support local benefit realisation strategies. 8.3 By April 2016, every local area is expected to submit their local digital roadmap detailing how they will achieve the ambition of being paper-free at the point of care by 2020. In the first concrete step towards this goal, CCGs are required to establish the footprint of their local digital roadmap. The footprint for a roadmap will cover either a single CCG area or multiple CCG areas. This means that individual CCGs will be able to decide whether or not to cluster together with neighbouring CCGs resulting in Lead and Partner CCGs in the development of a single roadmap. 8.4 Detailed guidance produced by the National Information Board, and endorsed by the Five Year Forward View members has been published to support CCGs with the development of their roadmaps. Each and every CCG is required to complete and return a footprint and governance template by 30 October 2015. 9. DIRECTORATE QUARTERLY ASSURANCE MEETINGS 9.1 The second round of Directorate Quarterly Assurance meetings were completed over the summer, and highlighted the very significant amount of work that is being undertaken by our teams who are committed to improving services for patients. 9.2 A range of issues were identified by the directorates for further review by the senior management team: The implications of the Five Year Forward View, new models of care, delegated commissioning on the CCG need to be clarified as information is still emerging on the implications of these transformation projects. The Senior Management Team commit to keeping staff informed of latest developments. Ensure that the resources in the organisation are best placed to match demand the CCG had already decided to restructure two years into its existence. There was already an appreciation that some areas were under resourced and the proposed new structure of the CCG is designed to address this, as well as improve its locality focus. Review reporting demands internally and externally an internal review of reporting is being carried out by the Chief Finance Officer to understand the full extent of the reporting requirements and identify opportunities to reduce duplication and streamline reporting. 10. STAFF RECOGNITION AWARDS 10.1 Continuing the previous theme we have a number of staff who have been recognised by their peers for outstanding work and this is an opportunity to formally highlight to the Board specific individuals who were nominated last month. A big well done and thank you to: 5
Jo Clifford, Quality Manager (Clinical Effectiveness) Jo has led a collaborative piece of work across various CCG teams and providers to create and agree a variation on the national Urgent and Emergency Care CQUIN for 2015/16. This has involved weeks of tireless negotiation and adjustment to ensure that the CQUIN has the design to deliver real improvements in experience and management for patients with mental health conditions in the A&E department. Jo also proactively put herself forward to work on a project with our Children s team and our colleagues at North Hampshire CCG (who had no quality lead in post) to improve care for women during labour in HHFT s maternity units. She built on recommendations of an internal report following significant events and negotiated with North Hampshire CCG to jointly work on a CQUIN. By working collaboratively with clinicians, an ambitious project was formed which will significantly improve safety for women in labour and allow for services currently only provided in Basingstoke and Winchester to be accessed safely in Andover too. Finance Services team Our finance team, led by Andrew Short, have undertaken excellent work to prepare the annual accounts for 2014/15. Thanks to the team, the CCG submitted our accounts on time and with no major issues or audit concerns. Emma Barnard, Interim Commissioning Manager Emma has a very good, engaging manner with patients and clinicians, a committed and passionate style which people respond to warmly. She has worked in partnership with others to deliver the MSK programme, spending many hours with Southern Health training teams and doing one-to-one visits with our practices. Emma is a key member of the Acute Commissioning team who looks out for others wellbeing, always willing to help and offer support to the wider CCG. Pippa Brown, Business Planning Manager Pippa has been extremely supportive of the CCG s innovation programme and a key player in its development. In her role as an Innovation Agent she has shown support and commitment to our projects, even when she was the only agent assessing innovation projects. Her ongoing support for the project has been recognised both inside and outside of the organisation, by Oxford Innovations Janet Hutchings, Service Improvement Manager, Long Term Conditions Janet has been nominated for her innovative project using pharmacies to teach awareness of foot care to Diabetic patients coming to pick up a prescription. In a fiercely competitive process, Janet gained a grant from the Wessex Academic Health Science Network (AHSN), with the local pharmacy committee (LPC) lead as a partner. She chairs the project meetings with sensitivity, flexibility, knowledge and authority 6
and we are able to make a lot of decisions in a short space of time. The project includes at least four agencies and different disciplines within the CCG. To date the pharmacy training has been delivered and the project has recruited 26 pharmacies. In just the first two weeks of running the project, 67 people had talked to their pharmacist about their feet and over 15 onward referrals were made. Tom Sheppard, Media and Public Affairs Officer Tom has been nominated for his work in refreshing our website and creating our intranet, which has included collecting and developing content with their teams. The new website went live in May and the intranet followed in July. Heather Hauschild Chief Officer 23 September 2015 7
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