Governance and Performance Report - Welcome to NHS Lambeth … · NHSE NHS England PMO Programme Management Office PTL Patient Tracking List PRUH Princess Royal University Hospital,

INTEGRATED GOVERNANCE AND

PERFORMANCE REPORT

NHS Lambeth Clinical Commissioning

March 2016

Our Mission: Our Mission is to improve the health and reduce health inequalities of Lambeth people and to commission the highest quality health services on their behalf.

Contents 1 INTRODUCTION ................................................................................................ 1

2 EXECUTIVE SUMMARIES ................................................................................ 2

2.1 CCG ASSURANCE ........................................................................................... 2

2.1.1 National CCG Assurance Framework ......................................................................... 2

2.2 COMPONENTS OF THE CCG ASSURANCE FRAMEWORK .......................... 2

2.2.1 Well-led Organisation .................................................................................................. 2

2.2.2 Delegated Functions ................................................................................................... 3

2.2.3 Financial Duties .......................................................................................................... 4

2.2.4 Performance ............................................................................................................... 5

2.3 STRATEGIC AND OPERATIONAL DELIVERY ................................................ 7

2.3.1 Programme Assurance Statements ............................................................................ 7

2.4 QUALITY ASSURANCE .................................................................................... 7

3 CCG ASSURANCE ........................................................................................... 8

3.1 National CCG Assurance Framework 2015/16 ............................................... 8

3.2 NHS Lambeth CCG Assurance 2015/16 ......................................................... 8

4 COMPONENTS OF THE CCG ASSURANCE FRAMEWORK .......................... 9

4.1 Well-led Organisation ...................................................................................... 9

4.1.1 Board Assurance Framework – ................................................................................... 9

4.2 Delegated Functions ...................................................................................... 16

4.3 Financial Management ................................................................................... 16

4.3.1 Financial Position ...................................................................................................... 16

4.3.3 QIPP ......................................................................................................................... 20

4.3.4 QIPP Performance .................................................................................................... 22

4.4 Performance ................................................................................................... 22

4.4.1 NHS England Top 8 Performance Measures and National Constitution Standards ... 23

4.4.2 RTT (Referral to Treatment Times for Lambeth Patients) ......................................... 25

4.4.3 Diagnostics (Lambeth Patients) ................................................................................ 26

4.4.4 A & E Waiting Times ................................................................................................. 27

4.4.5 Cancer Waiting Times ............................................................................................... 27

4.4.6 Ambulance Response ............................................................................................... 28

4.4.7 Health Visitors ........................................................................................................... 28

4.4.8 Improved Access to Psychological Therapies (IAPT) ................................................ 28

4.4.9 New Early Intervention In Psychosis 2 Week Standard ............................................. 29

4.4.10 Dementia Diagnosis Rate ......................................................................................... 29

4.4.11 Transforming Care .................................................................................................... 30

5 STRATEGIC AND OPERATIONAL DELIVERY – OUR PROGRAMMES ...... 33

5.1 Integrated Children and Young People (including Maternity) Programme 33

5.1.1 Programme Assurance Statement ............................................................................ 33

5.1.2 Integrated Children and Young People (including maternity) Programme Risk Register

34

5.1.3 Children and Maternity Programme Board Dashboard .............................................. 38

5.1.4 Key Deliverables ....................................................................................................... 40

5.2 Integrated Adults Programme (Elective, Long Term Conditions, Older

People, Urgent Care) ............................................................................................... 46


5.2.2 Integrated Adults (Elective, Long Term Conditions, Older People, Urgent Care)

Programme Risk Register .................................................................................................... 47

5.2.3 Integrated Adults Dashboard .................................................................................... 50

5.2.4 Elective ..................................................................................................................... 52

5.2.5 Long Term Conditions/Medicines Optimisation ......................................................... 55

5.2.6 Older People ............................................................................................................. 72

5.2.7 Continuing Healthcare .............................................................................................. 77

5.2.8 Urgent Care .............................................................................................................. 79

5.3 Integrated Mental Health for Adults .............................................................. 83


5.3.2 Integrated Mental Health for Adults Programme Risk Register ................................. 84

5.3.3 Mental Health Whole System Dashboard .................................................................. 86


5.4 Staying Healthy (Led by London Borough of Lambeth) ............................. 90


5.4.2 Staying Healthy Dashboard ...................................................................................... 93

5.4.3 Risk Register ............................................................................................................ 97


5.5 Primary Care Development ......................................................................... 103

5.5.1 Programme Assurance Statement .......................................................................... 104

5.5.2 Primary Care Development Programme Risk Register ........................................... 104

5.5.3 Primary Care Programme Dashboard ..................................................................... 108

5.5.4 Key Deliverables ..................................................................................................... 109

5.6 Enabler Programmes ................................................................................... 114

5.6.1 Governance and Development Risk Register.......................................................... 114

5.6.2 Equalities ................................................................................................................ 117

5.6.3 ICT .......................................................................................................................... 117

5.6.4 Estates.................................................................................................................... 121

5.6.5 Workforce ............................................................................................................... 124

6 QUALITY ASSURANCE ................................................................................ 127

6.1 Provider Quality Report ............................................................................... 127

6.2 Complaints and PALS .................................................................................. 127

6.3 Serious Incidents ......................................................................................... 130

6.4 Never Events ................................................................................................ 132

6.5 Quality Alerts ................................................................................................ 132

6.6 Infection Control .......................................................................................... 132

6.7 Mixed Sex Accommodation......................................................................... 133

6.8 Freedom of Information (FOI) ...................................................................... 133

6.9 Quality Premium ........................................................................................... 134

6.10 Better Care Fund ....................................................................................... 137

Acronyms

AMH Adult Mental Health

CCG Clinical Commissioning Group

CQC Care Quality Commission

CQRG Clinical Quality Review Group

CQUIN Commissioning for Quality and Innovation Payment

CSU Commissioning Support Unit

CTR Care and Treatment Review

EIP Early Intervention in Psychosis

GSTFT Guy’s and St. Thomas’ NHS Foundation Trust

IPSA Integrated Personal Support Alliance

IST Intensive Support Team

IT Information Technology

KCH Kings College Hospital NHS Foundation Trust

LCCG Lambeth Clinical Commissioning Group

LCSB Local Children’s Safeguarding Board

LWN Living Well Network

NHSE NHS England

PMO Programme Management Office

PTL Patient Tracking List

PRUH Princess Royal University Hospital, Bromley

QIPP Quality Improvement Programme

SCR Safeguarding Children Risk

SEL South East London

SLaM South London and Maudesley NHS Foundation Trust

UCC Urgent Care Centre

1

1 INTRODUCTION

NHS Lambeth Clinical Commissioning Group (CCG) comprises 47 member GP Practices organised

into three localities.

The NHS Lambeth CCG Governing Body is responsible for ensuring that the CCG has appropriate

arrangements in place to exercise its functions effectively, efficiently and economically and in

accordance with the CCG Constitution and our principles of good governance. Membership of the

Governing Body is drawn from our Member Practices, appointed individuals with statutory roles and

nominees from our key Lambeth partners.

The Governing Body is supported by the Lambeth Clinical Network. The purpose of the Clinical

Network is to provide the CCG Board members with sound clinical advice on commissioning care

services, clinical pathways and best practice. The Clinical Network consists of care and clinical

“subject matter experts” from within Lambeth including GPs, practice managers, nurses, pharmacists,

opticians and social care colleagues.

This report sets out how NHS Lambeth CCG is performing against its agreed objectives under the

leadership of the NHS Lambeth Clinical Commissioning Governing Body. It is a tool for providing

assurance to the Governing Body that objectives are being delivered or, where performance is behind

plan, that mitigating actions are in place to address performance improvement.

The 2015/16 Business Plan set out NHS Lambeth CCG’s corporate objectives. Later is this report,

NHS Lambeth CCG’s Programme Boards and Enabler Work streams report on delivery of their

2015/16 objectives. The Integrated Governance and Performance Report provides a consolidate

picture of delivery of NHS Lambeth CCG’s corporate objectives.

NHS Lambeth CCG Objectives 2015/16

CCG Corporate Objectives Quality, Safety

and Effectiveness

Sustainable Delivery & Governance

System Transformation

Involvement Equality

To improve health outcomes, address inequalities and secure a parity of esteem

To secure delivery of the NHS constitutional rights and pledges for all Lambeth residents

To commission proactive care focused upon the prevention and the early detection of illness. Improve outcomes for Lambeth patients and achieve better value, integrated care through transformation programmes delivered in partnership with stakeholders and our residents.

To ensure patients and the public play a central role in the commissioning of the services they receive

Enact the Public Sector Equality and Diversity requirements

To improve the quality and safety of local services

To ensure good governance, financial stability of the local health economy, VfM and the delivery of statutory responsibilities

To ensure the CCG’s commissioning resource and organisational capability are effectively aligned to deliver its objectives

To ensure effective involvement of member practices and other partners in commissioning decisions

2

2 EXECUTIVE SUMMARIES

2.1 CCG ASSURANCE

2.1.1 National CCG Assurance Framework

The Quarter 1 2015/16 Assurance Meeting took place on October 16th 2015. NHS Lambeth CCG is

being assessed against the revised Assurance Framework for this financial year. NHS England has

not yet advised the CCG regarding the outcome of the Meeting.

The Quarter 2 2015/16 Assurance Meeting was cancelled to allow CCGs to focus on the Operational

Plan 2016/17. However, regional teams plan to meet with CCGs to review and feedback on Operating

Plan draft submissions at the end of February 2016. NHS Lambeth CCG is meeting with NHS

England on the 23rd of February.

On the 17th of November NHS Lambeth CCG participated in the NHS England Deep Dive Review of

Safeguarding Children and Adults as part of the assurance process for 2015/16. NHS Lambeth

received an outcome as ‘Assured as Good’ on all components of the review. NHS England London

Region intends to share all areas of good practice identified as part of NHS Lambeth CCGs review in

their London overview report.

NHS Lambeth CCG is currently preparing for a deep dive into provision of Continuing Care. This will

take place on the 9th of March 2016.

2.2 COMPONENTS OF THE CCG ASSURANCE FRAMEWORK

2.2.1 Well-led Organisation

The NHS Lambeth CCG Board Assurance Framework (BAF) is included in this report, along with a

Heat Map showing the number of risks at each score for all risks recorded on Lambeth CCG’s Risk

Register not just those scoring 12 or above. The BAF and supporting Risk Register are living

documents, updated regularly.

Risk Matrix Impact

Likelihood 1 Negligible 2 Minor 3 Moderate 4 Major 5 Catastrophic

4x4=16 2C A&E Performance

4x4=16 2N RTT Performance

4x4=16 2K Cancer referral to treatment 62 days

4x4=16 2M Community Nursing Vacancy Level

4x4=16 5N SEL Strategy - inadequate workforce capacity

4x4=16 5R SEL Strategy - integrated IT systems

3x5=15 1A Safeguarding children

3x4=12 2A Community Nursing Service Improvement Plan

3x4=12 2B Safeguarding Adults

3x4=12 3C Risk to SLaM Contract

3x4=12 3M IPSA Alliance

3x4=12 3N LWN reduction in secondary care demand

3x4=12 7A Financial Planning Risk

3x4=12 7B QIPP delivery risk

3x4=12 6K CSU procurement process risk

3x4=12 PMCF07 Sustainability of Access Hubs

4x3=12 5S PMS Contract Review

1 Rare

1x1=1 1x2=2

4x5=20

5 Almost Certain

1x5=5 2x5=10 3x5=15 4x5=20 5x5=20

4 Likely

4x1=4 4x2=8 4x3=12 4x4=16

3x5=15

2 Unlikely

2x1=2 2x2=4 2x3=6 2x4=8

3 Possible

3x1=3 3x2=6 3x3=9 3x4=12

1x3=3 1x4=4

Risks scoring 12 and above

1x5=5

2x5=10

7 2

1931

1 6

1

9

6

1

1

1

3

2.2.2 Delegated Functions

NHS Lambeth CCG currently has no delegated functions. However, the general practice Out-of-

Hours service, for which the lead commissioner is NHS Southwark CCG, is a directed function. NHS

Lambeth CCG is a co-commissioner for primary care with NHS England. The CCG Assurance

Framework requires CCGs to return a quarterly self-assessment regarding delivery of these services.

Quarters one to three have been submitted. Quarter four is due on the 25th of May 2016 There has

been no formal feedback from NHS England to date.

4

2.2.3 Financial Duties

Financial performance to Month 10 is summarised below.

Performance Area Commentary

Year to

Date

Forecast

Outturn

Revenue Surplus

Lambeth CCG is reporting a surplus of £6.351 for the period to

January and forecast surplus of £7.622m for the year 2015/16. This

is in line with our target of delivering a 1% surplus

Cash Limit

Cash balances are planned to be maintained at low levels (less

than 1.25% at 31st January 2016. Lambeth CCG's cash balance at

bank as at the end of January was £663k failing to meet planned

level for January 16. The CCG expects to meet its cash limit target

for the end of the year

QIPP The CCG is forecasting full QIPP delivery of its annual QIPP target

of £8.86m.

Public Sector

Payment Policy

Public sector payment target is 95% on numbers. The CCG is

currently performing at 98.94% for NHS % overall on numbers and

at 99.88% by value. The CCG is not achieving its target for

numbers for Non NHS invoices. Performance for the first ten

months is 92.91% on numbers and 95.45% by value.

Running CostThe CCGs running cost allowance is £7.8m. The CCG is reporting

an underspend of £482k against its running cost budgets.

Key Financial Performance Duties

5

2.2.4 Performance

Key performance measures rated as Red – based on latest reported data (please refer to section 4.4 for detailed updates on all targets)

RTT NHS Lambeth CCG continues to monitor Admitted and Non-admitted performance as local Trusts have struggled to deliver this standard

guaranteed in the NHS Constitution. Admitted performance has been below the standard every month since April 2015 and non-admitted has also

been below standard apart from in May and June 2015. The Incomplete pathway standard was also narrowly missed at 91.6% as at quarter three.

Delivery of the admitted treated pathway remains a challenge across London.

52 week waiters KCH are not providing data to Unify, however the validation process has identified a number of further over 52 week waiters

finalised as 169 at the end of December, 24 of these were Lambeth patients. Recovery plans have been put in place and KCH have been asked

to produce an over 52 week trajectory. Neurosurgery makes up the largest proportion of the breaches. An additional assurance process has been

put in place for clinical review of the additional long waiters identified. This has had input from CCG clinical leads. 4 of the reported breaches were

at GSTT, two of these are no longer on the waiting list and 2 patients are awaiting TCI. One breach was at the Royal Marsden recorded under

‘other’ as a specialty.

A&E Both GSTT and Denmark Hill continue to perform below the 95% standard and this has been the case for the last three months. January’s

data has not yet been formally published but indicative figures suggest that performance will continue to be a challenge and it is unlikely to

improve until early April 2016.

Cancer Cancer targets are measured on a quarterly basis. The 62 day target was not met in quarters one and two but achieved in quarter three.

The Cancer two week (breast symptoms) was narrowly missed in quarter three.

Ambulance Response Times There has been no improvement in performance during 2015/16 to date. LAS continue to struggle to meet this

target.

Mixed Sex Accommodation Breaches have been reported throughout 2015/16 todate. However, no breaches were reported in December 2015.

Breaches occurring in October (2) and November (4) occurred at GSTT. These were critical care step down patients. The Trust is not required

nationally to report these as mixed sex accommodation breaches however GSTT has chosen to do so for internal monitoring purposes.

6

7

2.3 STRATEGIC AND OPERATIONAL DELIVERY

2.3.1 Programme Assurance Statements

Programme Status/Risks RAG Rating (Red/Amber/Green)

Integrated Children and Young People (Including

Maternity)

Integrated Adults (Elective, Long Term

Conditions, Older People, Urgent Care)

Integrated Mental Health for Adults

Staying Healthy

Primary Care Development

2.4 QUALITY ASSURANCE

The following parts of the CCG’s Quality Assurance Framework are available on a quarterly basis. Quarter 3 2015/16 data is available in this report, alongside the quarterly Provider Quality Report.

Provider Quality Reports

Complaints and PALS enquiries

Serious Incidents

Quality Alerts

NHS England published a revised Serious Incident (SI) Framework in March 2015. All SI issues are monitored.

Lambeth CCG was awarded a payment of £336k for the achievement of 2014/15 Quality Premiums. 2014/15 Quality Premiums achieved were

Avoidable Emergency Admissions and Improving the reporting of medication related safety incidents.

8

3 CCG ASSURANCE

3.1 National CCG Assurance Framework 2015/16

The CCG Assurance Framework is designed to give assurance that CCGs are operating effectively to

commission safe, high quality and sustainable services within their resources.

The components of the 2015/16 assurance framework are as follows:

Components of the NHS England CCG Assurance Framework 2015/16

In addition, the CCG Assurance Framework 2015/16 focuses on 6 CCG statutory functions which are

considered to be ‘Areas requiring a more detailed focus’, as part of the Well Led Organisation

component of the Framework. Whilst these areas will not themselves be assured, concerns around

them will trigger a review of the Well Led Organisation component of the Framework.

3.2 NHS Lambeth CCG Assurance 2015/16

NHS Lambeth CCG is being assessed against the revised Assurance Framework for this financial

year.

The Quarter 2 2015/16 Assurance Meeting was due to take place on 21st January 2016, however

regional teams are meeting with CCGs at the end of February to discuss Operating Plan submissions.

On the 17th of November NHS Lambeth CCG participated in the NHS England Deep Dive Review of

Safeguarding Children and Adults as part of the assurance process for 2015/16. NHS Lambeth

received an outcome as ‘Assured as Good’ on all components of the review. NHS England London

Region intends to share all areas of good practice identified as part of NHS Lambeth CCGs review in

their London overview report.

NHS Lambeth CCG is currently preparing for a deep dive into provision of Continuing Care. This will

take place on the 9th of March 2016.

CCGs are required to complete a quarterly self-assessment for Primary Care and the Out-of-Hours

service. Quarter 4 is due on the 25th May 2016.

9

4 COMPONENTS OF THE CCG ASSURANCE FRAMEWORK

4.1 Well-led Organisation

4.1.1 Board Assurance Framework

The NHS Lambeth CCG Board Assurance Framework (BAF) is included along with a Heat Map showing the number of risks at each score for all risks recorded on Lambeth CCG’s Risk Register not just those scoring 12 or above. The BAF and supporting Risk Register are living documents, updated regularly. The BAF includes the key mitigating actions and tracks progress of risk scores over the previous 12 months.

Risk Matrix Impact

Likelihood 1 Negligible 2 Minor 3 Moderate 4 Major 5 Catastrophic

4x4=16 2C A&E Performance

4x4=16 2N RTT Performance

4x4=16 2K Cancer referral to treatment 62 days

4x4=16 2M Community Nursing Vacancy Level

4x4=16 5N SEL Strategy - inadequate workforce capacity

4x4=16 5R SEL Strategy - integrated IT systems

3x5=15 1A Safeguarding children

3x4=12 2A Community Nursing Service Improvement Plan

3x4=12 2B Safeguarding Adults

3x4=12 3C Risk to SLaM Contract

3x4=12 3M IPSA Alliance

3x4=12 3N LWN reduction in secondary care demand

3x4=12 7A Financial Planning Risk

3x4=12 7B QIPP delivery risk

3x4=12 6K CSU procurement process risk

3x4=12 PMCF07 Sustainability of Access Hubs

4x3=12 5S PMS Contract Review

1 Rare

1x1=1 1x2=2

4x5=20

5 Almost Certain

1x5=5 2x5=10 3x5=15 4x5=20 5x5=20

4 Likely

4x1=4 4x2=8 4x3=12 4x4=16

3x5=15

2 Unlikely

2x1=2 2x2=4 2x3=6 2x4=8

3 Possible

3x1=3 3x2=6 3x3=9 3x4=12

1x3=3 1x4=4

Risks scoring 12 and above

1x5=5

2x5=10

7 2

1931

1 6

1

9

6

1

1

1

10

There are currently 17 risks rated 12 or above.

Two risks have been added to the Corporate Risk Register:

5S ‘Likely risk that the review of the PMS contract will result in changes levels of funding to GP practices impacting on service

delivery and disruption of some GP practices’

6K ‘Risk that ineffective management of commissioning support services procurement process may lead to poor quality service

procured’.

One risk has been reinstated to the Corporate Risk Register:

PMCF07 ‘Prime Ministers Challenge Fund / Access Hubs - Risk that there will be insufficient resources to continue Access Hubs

beyond March 2016’.

One risk has been removed from the Corporate Risk Register:

6G ‘Risk that insufficient governance, ownership and stakeholder/partner engagement will result in legal challenge, delays and

changes to implementation of the SEL Strategy’. This risk has been removed from the corporate risk register as the governance

arrangements are now in place.

11

UPDATED February

2016

Mar

Ap

ril

May

Ju

n

Ju

ly

Au

g

Sep

t

Oct

No

v

Dec

Jan

Feb

Risk

Rated 12

or more

Key Actions

Denis

O'Rourke3C

Risk to SLaM

Contract – possible

risk that the delivery

of AMH redesigns

fails to reduce

relapse rates and

use of beds

8 12 12 12 12 12 12 12 12 12 12 12 12 12+

Working with Southwark on AMH re-design – ongoing

Proposal to create provider/commissioner forum to monitor impact of SLaM re-design, LWN and IPSA agreed. First meeting of whole

system forum met in November 2015. Further meeting in Dec 2015 - looking at impact of the various service transformation initiatives

together.

6 monthly review being undertaken of AMH model. SLaM producing a progress report - completed.

Query regarding month 6 position suggesting substantial reduction in bed usage - Nov 2015. SLaM are undertaking a comprehensive

review of data quality and accuracy and are feeding this through the contract negotiation process for 2016/17.

Denis

O'Rourke3M

Possible risk that

the IPSA Alliance

contract fails to

deliver service and

financial outcomes

resulting in poor

outcomes for people

and financial

challenge

4 12 12 12 12 12 12 12 12 12 12 12+

1. Supporting alliance in relation to housing supply – ongoing. Meetings with housing department and agreed actions in place to

improve access to housing supply.Working to facilitate move on from supported housing working with providers.

2. Developing peer support led evaluation of outcomes from Sept 2015. Recruiting peer supporters - completed; Outcomes reports

expected Feb 2016.

3. Alliance members being interviewed by LH Alliances to support implementation of development plan agreed with existing partners at

learning event. Report received and workshop to take place in Feb 2016 to agree next stage of the development plan.

2015 Monthly Progress 2016Target

Risk Score

and

Direction

of Travel

Principal Risk

(Obstacle to

achievement of

Strategic Aim)

ASSURANCE FRAMEWORK 2015/16 – PROGRESS

SUMMARY

Strategic AimExecutive

Lead

Operation

al Lead

Corporate Objective

1.1: Quality, Safety &

Effectiveness - To

improve health

outcomes, address

inequalities and secure

a parity of esteem

Director of

Integrated

Commissioning

, Adults

Risk

Register

Ref

12

UPDATED February

2016

Mar

Ap

ril

May

Ju

n

Ju

ly

Au

g

Sep

t

Oct

No

v

Dec

Jan

Feb

Risk

Rated 12

or more

Key Actions

Director of

Integrated

Commissioning

, Children

Avis

Williams-

McKoy

1A

Zero Tolerance

Risk - Risk of failure

to safeguard children

and identify and

respond

appropriately to

abuse

5 8 8 15 15 15 15 15 15 15 15 15 15 12+

On-going review of SCR in collaboration with Lambeth Safeguarding Childrens Board and NHS England - Jan 2016.

Implement subsequent SCR recommendations as required

LSCB Executive and Sub working groups now refreshed. Learning and Improvement Sub working group developing key performance

indicators - draft indicators in progress.

Multi-agency FGM policy to be published - COMPLETED

Liz Clegg 2A

Risk of failure to

implement the

Service Improvement

Plan for Community

Nursing

8 16 16 16 12 12 12 12 12 12 12 12 12 12+

Going forward GSTT plan to:

Introduce mobile technology after the introduction of advanced care notes in September 2015

Review referral criteria

Implement a geographical system

Review community end of life roles within the district nursing with a view to creating dedicated roles. This will ensure that patients

Priorities of Care are met so they receive individual care based on their needs which is delivered with compassion and sensitivity by

our nurses

Develop action plans by continuing to measure our services through our patients’ experience

Continue to implement the recruitment strategy - 76 staff recruited in last year (to Dec 2015)

Continue to work with health and social care partners and citizens to co-produce a model of care that supports and meet the needs of

local people.

Opportunities:

Work better across the local hospitals, community and primary care to support patient pathways ensuring smooth transfers of care and

to develop a transfer of care strategy.

Ensure that our clinical strategy is underpinned by working closely with social care and voluntary sector.

Deliver 24/7 community nursing care - OOH service will be managed by GSTT from 07/12/15.

Working with citizens, clinicians, key partners to develop a new model for community nursing, including learning from elsewhere i.e.

Holland - new models of care are being tested in pilot form early 2016.

CCG: To continue to monitor improvement via CQRG and contract monitoring meetings. This was most recently discussed at the

August 2015 CQRG. Update provided at CQRG Dec 2015.

Liz Clegg 2B

Zero Tolerance

Risk - Risk of failure

to safeguard adults

and identify and

respond

appropriately to

abuse

8 12 12 12 12 12 12 12 12 12 12 12 12 12+

Implement the accountability and assurance framework for safeguarding vulnerable people - implement recommendations from NHSE

deep dive, expected Feb 2016

Influence NHSE contracts to include safeguarding training requirements - ongoing; complete a training needs analysis

Practices to nominate staff to attend 'Alerters' safeguarding training - as part of practice visits

Recruit designated doctor for adult safeguarding

Develop training strategy for primary care - March 2016

Recruit designated doctor for adult safeguarding

Liz Clegg 2M

Likely risk to

sustaining good

quality community

nursing service due

to high vacancy level

16 16 16 16 16 16 16 16 16 16

GSTFT forward plan:

Implement a geographical system

Explore more flexible working for staff

Prepare, continue to grow and support the workforce

Continue to implement the recruitment strategy - 76 staff recruited in last 12 months.

Continue to work with health and social care partners and citizens to co-produce a model of care that supports and meet the needs of

local people - new models of care being tested in pilot form at beginning of 2016.

CCG: To continue to monitor recruitment levels via CQRG, contract monitoring meetings. This was last discussed at the August 2015

CQRG. Update provided at CQRG Dec 2015.


Lead

Operation

al Lead

Risk

Register

Ref

Principal Risk

(Obstacle to

achievement of

Strategic Aim)

Target

Risk Score

and

Direction

of Travel

2015 Monthly Progress 2016

Corporate Objective 1.2:

Quality, Safety &

Effectiveness - To

improve the quality and

safety of local services Director of

Integrated

Commissioning

, Adults


SUMMARY

13

UPDATED February

2016

Mar

Ap

ril

May

Ju

n

Ju

ly

Au

g

Sep

t

Oct

No

v

Dec

Jan

Feb

12+ Key Actions

Bisi

Aiyeleso/

Sara White

2C

Likely risk of not

achieving the agreed

access performance

levels for A&E

resulting in longer

waits for patients

and failure of the

CCG to meet the

national target

12 16 16 16 16 16 16 16 16 16 16 16 16 12+

A repatriation project has commenced across SE and SW London. has delivered significant improvements; the numbers of patients

awaiting repatriation to local hospitals from Kings, for example, was regularly reported in excess of 30 and this has now reduced to

below 10 on a daily basis. Complete by end of March 2015.

A&E performance remains challenging at both GSTT and Kings. The CCG is now represented at the weekly performance meeting at

GSTT.

Winter schemes agreed to support additional capacity.

Tripartite visit made to GST ED including Lambeth CEO following significant drop in performance. Acknowledged that performance

targets will be challenging during building works/moves and consequential loss of capacity. ECIP visit scheduled for November to

assist with immediate improvements.

Jan 16 – Improvement to performance in Dec 2015 but slight dip again in January. Platinum call established bi-weekly and chaired by

the CCG to help unblock issues and facilitate faster discharge of patients (DTOCs).

Urgent care dashboard developed and will be reviewed at the UCWG at every meeting to identify trends and work through with partners

to unblock issues.

Harriet

Agyepong2K

Likely risk of not

achieving the

access performance

levels for timely

access to cancer

treatment (as

measured by the

standard for 62 days

from GP referral to

treatment) impacting

on the CCG Quality

Premium and

Assurance

Framework

12 16 16 16 16 16 16 16 16 16 16 12+

Deep dive at GST did not reveal any key reasons for difference in performance between Lambeth and Southwark CCG. A watching brief

will be kept on this.

GSTT have revised trajectories for internal and external referrals.

TCST action: Trusts being supported by TCST around patient choice and training of booking staff on PTL management.

Harriet

Agyepong2N

Ongoing risk of not

achieving the agreed

access initiative

performance levels

for RTT for

incomplete

pathways impacting

on the CCG Quality

Premium and

Assurance

Framework

12 16 16 16 16 16 16 12+

KCH outsourcing some elective activity to private providers to assist with the reduction of the backlog - ongoing

Meetings between GSTT and commissioners to develop plans to manage referrals - GST and Commissioners agreeing referral

guidelines for key specialties e.g. paediatric ENT.

KCH and GSTT working with national PMO to identify and use and spare capacity - ongoing



SUMMARY


Lead

Corporate Objective

2.1: Sustainable

Delivery & Governance

- To secure delivery of

the NHS constitutional

rights and pledges for

all Lambeth residents

Director of

Integrated

Commissioning

, Adults

Operation

al Lead

Risk

Register

Ref

Principal Risk

(Obstacle to

achievement of

Strategic Aim)

Target

Risk Score

and

Direction

of Travel

14

UPDATED February

2016

Mar

Ap

ril

May

Ju

n

Ju

ly

Au

g

Sep

t

Oct

No

v

Dec

Jan

Feb

12+ Key Actions

Christine

Caton7A

Risk that current

planning and

strategic approach

is not sufficiently

robust to manage

pressures and

deliver sustainable

position in the

context of potential

reduction in growth

resulting from the

implementation of

the CCG allocation

formula

8 12 12 12 12 12 12 12 12 12 12 12 12 12+

SE London CCGs are working as an SPG to deliver transformation across boroughs and providers.

The CCG is represented on each Clinical Leadership Group and Enabler work stream.

The Finance and QIPP Working Group and Governing Body have had oversight of the 2015/16 Operational Plan as it has been

developed and are responsible for in-year performance management of programme delivery - ongoing.

The CCG delivers transformation through its programmes -ongoing.

The CFO is a member of the Financial Provider, Commissioner and LA leadership group responsible for agreeing the financial and

activity assumptions that underpin the SEL Strategic Plan and

and developing business cases for service change where appropriate - Dec 2015.

The CCG and SEL Five Year Strategy Plans are being refreshed during Q2 and Q3 2015/16. Work is underway to assess in detail

savings and investment required to delivery financial sustainability - Dec 2015.

The CCG Governing Body signed off the Our Healthier South East London (OHSEL) strategic direction at its meeting on 1st July 2015.

Programme delivery plans are in place to achieve our 2015/16 commissioning intentions and these have been built into our signed

contracts.

Option appraisal and business case development is underway across SE London - Dec 2015.

CCG programmes continue to develop 2016-17 commissioning intentions including agreement of QIPP and investment. These were

discussed at the GB Meeting on 20 January and overall agreed as basis of plan subject to consultation on detailed content. Final 16/17

plan to be approved by GB on 2 March. 5 year allocations received on 8 Jan. 16/17 allocation was in line with the draft overall financial

framework which was agreed by GB on 6 January 2016.

Operational Plan due in draft Feb 2016. Final Mar 2016. SEL Five Year Strategy due June 2016.

Christine

Caton7B

Risk of failure to

deliver QIPP and

acute

overperformance

leading to CCG risk

on financial

sustainability

8 12 12 12 12 12 12 12 12 12 12 12 12 12+

We are working on plans that have impact going into 2016/17 to make sure we are in a position to meet the financial challenges that

lay ahead - Jan 2016.

The CCG continues to review its performance reporting to improve the way in which we monitor and manage delivery - ongoing

The CCG undertakes in year risk assessments and develops contingency plans to deliver variances from plan - ongoing.

Commissioning Intentions were reviewed and prioritised by programmes and GB during December 2015. The overall content and

financial framework was approved in January 2016, following confirmation of allocations and planning guidance and subject to review

in detail based on responses to sharing with public and membership. Detail of service and activity impact, investment requirements

and QIPP is being worked on to enable Operational Plan and Start Budgets to be completed by 2 March and contracts to be negotiated

by end March 2016.

Director of

Primary Care

Development

Andrew

ParkerPMCF07

Prime Ministers

Challenge Fund /

Access Hubs - Risk

that there will be

insufficient

resources to

maintain the Access

Hubs operational

capacity beyond

March 2016

4 12 12 16 16 16 4 12 12+

1. To be discussed and updated at regular contract meetings with CCG and Federations - ongoing

2. Monitoring of utilisation of Access Hubs from October 2015 - COMMENCED

3. Development of a plan for the use of the freed up capacity of General Practice, which improves care and reduces the use of other

services - 30/11/15 (TF and JC)

4. Plan the evaluation of effects on other services - results of the evaluation will inform the provision going forward.

5. Business Case to be developed for continuation of service after March 2016 - based on existing funding of £1.5million plus

additional investment - there will be some provision of access hubs from April 2016. Exact configuration is to be decided from outcome

of commissioning intentions.

Director of

Primary Care

Development

Andrew

Parker5S

Likely risk that the

review of the PMS

contract will result in

changes to levels of

funding to GP

practices impacting

on service delivery

and service

disruption

6 12 12 12+

1. Project plan to be updated and contain actions 2-3 - 31/01/16

2. Develop a detailed communications plan, especially regarding communication sessions with practices and patient and public

involvement groups - 31/01/16

3. Develop a detailed contingency plan, anticipating and mitigating the likely impacts on service delivery. Leverage new developments

e.g. GP federations, to deliver services at scale 31/01/16

4. Liaise with NHS England around logistical considerations e.g. managing and changing the PMS contracts - 31/01/2015

Corporate Objective 3.1:

System Transformation -

Commission Proactive

care focused on

prevention and early

detection of illness;

Improve outcomes for

Lambeth patients,

achieve better value,

integrated care through

transformation

programmes in

partnership

Director of

Integrated

Commissioning

, Adults

Denis

O'Rourke3N

Possible risk that

the LWN does not

reduce demand on

secondary care

resulting in the

system becoming

unsustainable and

costs in relation to

higher bed usage

8 12 12 12 12 12 12 12 12 12 12 12+

Negotiating with GP Federation becoming part of the LWN Provider Alliance Group and future alliance agreement – Jan 2016

Single LWN performance management report including service and finance from Oct 2015 - initial report received and will be

developed. 6 monthly report published and reviewed at Provider Alliance group.

Meeting held with voluntary sector providers to signal where heading and how to best organise alliance.

Working towards an alliance agreement to support the LWN – April 2016. To support this, a workshop scheduled for 10/10/15 - for

whole market providers to outline plans. Project plan agreed to take this forward, MOU in place from April and full contract from July

2016.

Complete application to GST Charity for further funding.



SUMMARY


Lead

Operation

al Lead

Risk

Register

Ref

Principal Risk

(Obstacle to

achievement of

Strategic Aim)

Target

Risk Score

and

Direction

of Travel

Corprate Objective 2.2:

Sustainable Delivery &

Governance - To ensure

good governance,

financial stability of the

local health economy,

VfM and the delivery of

statutory

responsibilities

Chief Financial

Officer

15

UPDATED February

2016

Mar

Ap

ril

May

Ju

n

Ju

ly

Au

g

Sep

t

Oct

No

v

Dec

Jan

Feb

12+ Key Actions

Andrew

Parker5N

Risk that inadequate

workforce

capacity/skills and a

lack of integrated

information systems

will affect the

delivery of the SEL

Strategy in providing

new models of

integrated, high

quality care

4 16 16 16 16 16 16 16 16 16 12+

Full alignment to CCG Programme Enablers - this is not yet complete and ongoing work required around workforce.

Andrew

Parker5R

Risk that a lack of

integrated

information systems

will affect the

delivery of the SEL

Strategy in providing

new models of

integrated, high

quality care

4 16 16 16 16 16 12+

Full alignment to CCG Programme Enablers

Chief Financial

Officer/Director

of Governance

and

Development

Christine

Caton/Una

Dalton

6K

Risk that ineffective

management of

commissioning

support service

procurement

process may lead to

poor quality service

procured.

8 12 12+

1. Action plan in place for management of procurement process for each service line (GP IT and CCG IT) - June 2016

2. Review of GP and CCG IT procurement process for lessons learned - June 2016

3. Begin procurement process for all other services - starting March 2016

2015 Monthly Progress 2016Principal Risk

(Obstacle to

achievement of

Strategic Aim)

Target

Risk Score

and

Direction

of Travel

Director of

Primary Care

Development


Lead

Operation

al Lead

Risk

Register

Ref

Corporate Objective 3.2

System Transformation -

To ensure the CCG’s

commissioning

resource and

organisational capability

are effectively aligned to

deliver its objectives


SUMMARY

16

4.2 Delegated Functions

NHS Lambeth CCG currently has no delegated functions. However, the CCG commissions

General Practice services jointly with NHS England and commissions General Practice Out-of-

Hours services as a directed function. All CCGs are now required, as part of the CCG Assurance

Framework, to provide NHS England with a self-certificate providing assurance around

governance and management of potential conflicts of interest for these two services. Quarters 1,

2 and 3 have been submitted and quarter 4 is due on the 25th of May 2016.

4.3 Financial Management

4.3.1 Financial Position

To deliver financial control totals for resource and cash and support the delivery of

statutory financial duties for 2015/16

The CCG is required by statute to meet certain financial duties to ensure that public funds are

used appropriately. CCGs are required not to exceed the revenue (administration and

programme) and capital resource limits in any one year and to have cash balances of no greater

than 1.25% of the main monthly drawdown for March 2016.

Lambeth CCG’s financial performance as at January 2016 is a surplus of £6.351m. The

year-end forecast is an underspend of £7.622m which in line with our planned target of

delivering a minimum 1% surplus.

Running Costs budgets are showing an underspend of £417k as at month 10. The main

reason for this underspend is due to an allocation for quality premium received as admin

and write back of 2014/15 accruals. The expenditure against this allocation is likely to be

programme spend. The CCG is within the £22.50 per head Running Cost allowance. Our

year end forecast is an underspend of £481k.

The CCG has drawn down £342.m of cash at the end of month 10. The maximum cash

drawdown limit is £409.904m for 2015/16. The cash balance at bank as the end of

January 2015 was £663k.

Revenue Resource Limit

Month 9 -

December

Changes Month 10 -

January£'000 £'000 £'000

Issued Budgets - Programme 430,458 5,501 435,959

Issued Budgets - Admin (Running Cost) 7,825 7,825

Reserves 6,120 (3,552) 2,568

Planned Surplus 7,612 7,612

Total Allocation 452,015 1,949 453,964

Summary of Budgets - January 2016

17

Performance Summary

Performance Area Commentary

Year to

Date

Forecast

Outturn

Revenue Surplus

Lambeth CCG is reporting a surplus of £6.351 for the period to

January and forecast surplus of £7.622m for the year 2015/16. This

is in line with our target of delivering a 1% surplus

Cash Limit

Cash balances are planned to be maintained at low levels (less

than 1.25% at 31st January 2016. Lambeth CCG's cash balance at

bank as at the end of January was £663k failing to meet planned

level for January 16. The CCG expects to meet its cash limit target

for the end of the year

QIPP The CCG is forecasting full QIPP delivery of its annual QIPP target

of £8.86m.

Public Sector

Payment Policy

Public sector payment target is 95% on numbers. The CCG is

currently performing at 98.94% for NHS % overall on numbers and

at 99.88% by value. The CCG is not achieving its target for

numbers for Non NHS invoices. Performance for the first ten

months is 92.91% on numbers and 95.45% by value.

Running CostThe CCGs running cost allowance is £7.8m. The CCG is reporting

an underspend of £482k against its running cost budgets.

Key Financial Performance Duties

18

Summary Budgets – Financial Position for December 2015/16

It is essential that the CCG maintains strong internal financial controls to enable it to achieve its

statutory duties, delivers value for money and have a clean bill of audit health.

Actions being taken include:

Delivery of the 2015/16 Internal Audit Plan and making sure that recommendations are

implemented promptly. This is closely monitored by the CCG’s Audit Committee.

Embed understanding across Governing Body Members/Head of Collaborative Forum of

Internal and External Audit including the use of induction for new Governing Body

Members.

Review Standing Orders, Prime Financial Policies and Scheme of Delegation under

review to make sure that they best reflect the needs of CCG and to support accountability

through programme boards.

Best Case Worst Case

Plan Actual Plan Actual

Variance

(Adv/Fav)

Variance

(Adv/Fav)

£'000 £'000 £'000 % £'000 £'000 £'000 % £'000 £'000

Resource Allocation

Programme Resource 369,815 369,815 - 0% 446,139 446,139 0 0% 0 0

Running Cost Resource 6,520 6,520.4 0 0% 7,825 7,825 0 0% 0 0

Total Resource Allocation 376,336 376,336 0 0% 453,964 453,964 0 0% 0 0

Programme Expenditure

Acute 231,147 230,915 232 0% 277,377 277,767 (390) (0%) 1,525 (2,494)

Mental Health 57,662 58,392 (730) (1%) 69,194 70,084 (889) (1%) (878) (1,270)

Community Health 16,525 16,412 112 1% 19,830 19,697 133 1% (359) (231)

Continuing Care/Free Nursing

Care 12,268 14,170 (1,902) (16%) 14,721 16,482 (1,760) (12%) (1,002) (3,240)

Primary Care 36,916 35,652 1,263 3% 44,299 42,837 1,462 3% 1,882 508

Other Programme Costs

including Corporate 8,955 8,668 287 3% 10,538 10,560 (22) (0%) 213 (159)

Total Programme Costs 363,472 364,209 (737) (0.20%) 435,959 437,426 (1,467) (0%) 1,382 (6,886)

Running Cost

Pay 3,091 3,345 (255) (8%) 3,709 4,033 (324) (9%) (324) (324)

Non Pay 3,430 2,758 672 20% 4,116 3,310 806 20% 806 806

Total Running Cost 6,520 6,104 417 6% 7,825 7,343 482 6% 482 482

Reserves including

contingency - 328- 328 0% 2,568 1,573 995 39% 995 995

Total CCG Expenditure 369,993 369,985 8 0% 446,352 446,342 10 0% 2,859 (5,409)

Surplus 6,343 6,351 8 0% 7,612 7,622 10 0% 10,424 2,156

EXECUTIVE SUMMARY - FOR THE PERIOD ENDING 31st JANUARY 2016

Variance ((Adv)/Fav)

Year to Date

Variance ((Adv)/Fav)

Forecast Outturn

19

The CCG is developing and implementing a training programme that along with the

Budgetary Framework supports effective budget management and control.

20

QIPP Lambeth CCG QIPP Delivery as at Month 10 (January 2016)

PROJECT/SCHEME

QIPP

Programme

Planned

QIPP

QIPP

Delivered

Variance

Over/(Under)

%

Delivery

QIPP

Delivered

Variance

Over/(Under)

%

Delivery

£'000 £'000 £'000 £'000 £'000 £'000

Acute 5,264 4,387 4,387 0 100% 5,264 0 100.0%

Community - Trust Led 438 365 365 0 100% 438 0 100.0%

Mental Health 2,425 2,021 1,587 (434) 79% 2,070 (355) 85.4%

Prescribing 1,296 1,080 1,080 0 100% 1,296 0 100.0%

Primary Care 208 173 173 0 100.0% 208 0 100.0%

Non Acute & Other Schemes 180 150 150 0 100% 180 0 100.0%

Total QIPP Savings 9,811 8,176 7,742 (434) 95% 9,456 (355) 96.4%

Reprovision Costs (950) (792) (358) 434 45% (595) 355 62.6%

Total Net QIPP Savings 8,861 7,384 7,384 (0) 100.0% 8,861 0 100.0%

QIPP DELIVERY FOR THE YEAR 2015/16

Year to Date - January 2016 Forecast Outturn

21

QIPP Analysis By Delivery Area

2015/16 QIPP Delivery for the year 2015/16 (Year to date/forecast outturn/underlying position)

2015/16 QIPP Annual

Plan Plan Actual Variance % Variance Actual Variance % Actual Variance %

Acute

Guys & St Thomas NHSFT

Emergency Admissions 1,569 1,308 1,308 - 100% 1,569 - 100% 1,059 (510) 68%

Outpatient redesign - news and follow ups 1,153 961 961 - 100% 1,153 - 100% 415 (738) 36%

Local Integrated Adult Savings 438 365 365 - 100% 438 - 100% - (438) 0%

Inflammatory Bowel Disease (IBD) care pathway savings 100 83 83 - 100% 100 - 100% - (100) 0%

Patient Transport Services (PTS) 100 83 83 - 100% 100 - 100% - (100) 0%

Prescribing 100 83 83 - 100% 100 - 100% - (100) 0%

GSTT NHSFT - TOTAL QIPP 3,461 2,884 2,884 - 100% 3,461 - 100% 1,474 (1,986) 43%

Kings Healthcare NHSFT

Emergency Admissions 1,449 1,207 1,207 - 100% 1,449 - 100% 623 (825) 43%

Follow-up Outpatients 472 394 394 - 100% 472 - 100% 221 (251) 47%

Shift to Non-face to Face new Outpatients 249 208 208 - 100% 249 - 100% 224 (25) 90%

Prescribing 71 59 59 - 100% 71 - 100% - (71) 0%

KINGS NHSFT - TOTAL QIPP 2,241 1,868 1,868 - 100% 2,241 - 100% 1,069 (1,172) 48%

TOTAL ACUTE QIPP 5,702 4,752 4,752 - 100% 5,702 - 100% 2,543 (3,159) 45%

Mental Health

AMH and EI inpatients beds 703 586 221 (365) 38% 431 (272) 61% 431 (272) 61%

IPSA 1,119 932 932 - 100% 1,119 100% 846 (273) 76%

EMI Beds 450 375 375 - 100% 450 - 100% 380 (70) 84%

Outpatients - Specialist 83 69 (69) 0% (83) 0% - (83) 0%

Woodlands fixed costs 70 58 58 - 100% 70 - 100% 70 0 100%

Total 2,425 2,021 1,587 (434) 79% 2,070 (355) 85% 1,727 (698) 71%

Medicines Management 1,296 1,080 1,080 - 100% 1,296 - 100% 1,296 0 100%

Primary Care Savings 208 173 173 - 100% 208 - 100% 208 0 100%

Savings from Other Non Acute 80 67 67 - 100% 80 - 100% 80 0 100%

Property Services 100 83 83 - 100% 100 - 100% 100 0 100%-

Grand Total Gross QIPP 9,811 8,176 7,742 (434) 94.69% 9,456 (355) 96% 5,954 (3,857) 61%

Investment (950) (792) (358) 434.00 45% (595) 355 63% (595) 355 63%

Net QIPP 8,861 7,384 7,384 (0) 100.00% 8,861 0 100.00% 5,359 (3,502) 60.48%

Year To Date Forecast Outturn Underlying Position

QIPP DELIVERY FOR THE YEAR 2015/16

22

4.3.2 QIPP Performance

The table below provides a summary of the current performance of the ongoing QIPP schemes for 2015-16. All other areas of QIPP were secured at the beginning of the financial year through contractual negotiations with our main providers.

QIPP Scheme Highlights

Performance currently in

line with target?

Reduce variation in outpatient referrals

The scheme is currently is in line to hit target by the end of March although YE position has been significantly impacted by month 9 performance.

MECS (Minor Eye Conditions Service)

The scheme is exceeding performing against expected activity targets. The scheme is performing within budget.

Diagnostics This project is currently in a scoping phase N/A

MSK workstream and Lambeth Integrated Musculoskeletal Service (LIMS)

This scheme is currently not performing in line with the target activity both in terms of month 8 performance and cumulative YTD. It is not expected that this scheme will meet activity reduction targets this year.

No

Redesign of GSTT UCC This scheme did not perform to target in month 8. It is not expected to perform to target for the year.

No

Paediatrics in ED Reporting not currently available. N/A

GP Diversation to Waterloo Health Centre

This scheme is not performing in line with target this month or for the year so far. Agreement reached to decoimmission the service.

No

PALS This scheme is not performing in line with target this month or for the year so far. Agreement reached to decoimmission the service.

No

Minor Ailments Scheme (GSTT Divert to GST Sainsbury’s or Lower Marsh Boots)

Performance is significantly below target. Recommendation to cease with the service will be made during M10 to the relevant decision maiking forums.

No

Integrated Adults LTC/Medicines Optimisation QIPP

Schemes in this area are performing well and delivering the required level of savings.

Lambeth Alcohol Recovery Centre (LARC)

This scheme is performing in line with target for the end of the financial year. Month 8 peformance exceeded target for the month

Adults Mental Health Redesign EI Inpatient Beds

Savings have been delivered through block contracting arrangements with SLAM, however, work continues to be undertaken to identify whether there is a corresponding reduction in activity.

Subject to review

23

4.4 Performance

4.4.1 NHS England Top 8 Performance Measures and National Constitution Standards

The performance dashboard covers the National Constitution Standards as set out in the national

2015/16 Assurance Framework and the Top 8 priorities as identified by NHS England are monitored

through the assurance process. Lambeth CCG performance for each of these measures for the financial

year 2015/16 is set out in the table on page 23.

As part of the CCG Assurance Framework, NHS England has begun monitoring CCGs against a

longstanding operational standard – Cancelled Operations Not Rescheduled Within 28 Days. NHS

Lambeth CCG is monitored against performance at Guy’s and St. Thomas’s NHS Foundation Trust. This

indicator has now been added to the performance dashboard. The data is reported on a quarterly basis

with the table detailing latest performance for Quarter 3.

24

25

4.4.2 RTT (Referral to Treatment Times for Lambeth Patients)

Note: From 01/01/2015 NHS England ceased to monitor the RTT 18 weeks admitted and non-admitted

pathways as performance measures. NHS Lambeth CCG continues to monitor them as local Trusts have

struggled to deliver this standard guaranteed in the NHS Constitution.

18 weeks RTT – admitted and non-admitted treated

Delivery of the admitted and non-admitted treated pathway remains a challenge across London.

Kings College Hospital is currently not reporting activity. GSTFT has failed the admitted standard

in every month since April 2015. The Trust recovered performance for the non-admitted standard

in May and June, but performance has fallen below the 95% target in the other months. This has

resulted in failure of the target overall during the first three quarters of 2015/16. Performance for

the first two months in quarter 3 have also been well below target.

Incomplete Pathways

GSTT Trust failed to meet the national 92% incomplete standard in December 2015. This is the

first month of the year GSTT has been below 92%. The backlog of patients waiting beyond 18

weeks has grown considerably during 2015/16, with referrals into the trust increasing by 20%

from the same period last year; there are a number of s ervices with increased demand and

limited alternative provision which are of particular concern. The Trust has contacted the national

Programme Management Office regarding additional outsourced capacity and is maximising its

own internal capacity with additional clinics and weekend working. Currently activity levels whilst

increasing from last year are not at the level required to keep pace with demand. The Trust has

been asked to complete demand and capacity modelling to assess the level of activity required to

deliver the RTT incomplete target sustainably. The Trust has predicted it will be back above 92%

from February 2016. Compliance for 2016/17 has been assumed for operating plans.

KCH - had been implementing a RTT recovery plan over quarters one and two of 15/16 with a

planned return to compliance against RTT standards from October 15/16. This included a

backlog reduction plan, alongside a waiting list validation programme. The Intensive Support

Team reviewed the position prior to reporting in October and advised against a November return

to reporting, recommending a further period of suspended national reporting whilst continued

validation takes place. A maximum suspension of a further 6 months to April was agreed by the

Trust's Board and Monitor. This was subject to 'open book accounting' over the period of

suspension, commissioners accepting the suspension, a priority focus on long waiters being

treated and a robust validation/RTT recovery plan being agreed for quarters 3 and 4. CCG

reporting will not reflect data for KCH over this period The KCH validation programme is on target

to return to reporting in April for the March position, at this point CCG figures will reflect the KCH

position. The Trust expects to have validated all over 18 week admitted patients by mid-February

and all over 18 week non admitted patients by March. In March the Trust will submit a draft return

on the February position as a test for the full return. Once these figures are available the scale of

the backlog position will be known and demand and capacity work will follow to move the Trust

26

into a sustainable RTT position. It has been stated by the Trust that the incomplete Standard will

not be met in March 2016 but until validation is completed an exact percentage cannot be given.

RTT– waiting more than 52 weeks, and still waiting (incompletes)

KCH have not been able to provide routine monitoring data for patients waiting longer than 52

weeks for most of 2015/16, however a recent validation process identified a number of long

waiters as at the end of December 2015. The Trust wide figure is 169, 24 of these were Lambeth

patients. Recovery plans have been put in place and KCH have been asked to produce an over

52 week trajectory. Neurosurgery makes up the largest proportion of the breaches. An additional

assurance process has been put in place for clinical review of the additional long waiters

identified. This has had input from CCG clinical leads. 4 of the reported breaches were at GSTT,

two of these are no longer on the waiting list and 2 patients are awaiting TCI. One breach was at

the Royal Marsden recorded under ‘other’ as a specialty.

4.4.3 Diagnostics (Lambeth Patients)

Diagnostic performance at the CCG deteriorated in December 2015. The standard was missed in

quarter one 2015/16 with 1.2% of referred patients waiting more than the operational standard,

achieved in quarter two at 0.8% but missed again for quarter three with 2.1% of patients waiting.

This deterioration in performance has been driven by both GSTT and KCH. KCH represents the

biggest proportion of the decline. The two biggest issues which came to light in December 2015

were with Neuro MRI and Ultrasound at Denmark Hill. Neuro MRI was driven by staff vacancies

reducing capacity, Inhealth was also unable to provide additional days on site. Adverts are out for

two substantive members of staff and the Trust has approached Blackheath to undertake

additional capacity. The expectation is that the backlog will be reduced by the end of March 2016.

GSTT represents a much smaller proportion of the decline being at 2% Trust wide in December.

The main cause of the problem was a booking issue in December where patients were not

booked in order. This has not been addressed. Performance should be back on track for

February and March 2016.

OP std

15/16Q1 15/16 Q2 15/16 Q3 15/16

<1% 1.2% 0.8% 2.1%

National Priorities including Top 8 Performance Measures

Diagnostic Waits >6 weeks

27

4.4.4 A & E Waiting Times

Both GSTT and Denmark Hill continue to perform below the 95% standard. GSTT expected a

deterioration in performance following planned building works in A&E which reduced capacity.

The Trust has now taken steps to create additional inpatient and A&E capacity and is working to

a rapid action improvement plan designed to improve overall efficiency, however achieving the

target will be challenging. Denmark Hill has now agreed revised trajectory to secure an

improvement in performance to 92% by March 2016. The Trust is focussing on 4 areas of

improvement: a ED recovery plan; out of hospital care services; demand and capacity plan; and

winter planning and funding. Capacity remains a significant challenge.

4.4.5 Cancer Waiting Times

Cancer 62 day Standard

Lambeth met 8 of the 9 cancer targets during quarter three including the 62 day standard.

GSTFT's performance against this target however remains challenging. The Trust’s internal

performance improvement is linked to increased robotic capacity for urology. This should lead to

a return to compliance against the target from November. A new surgical robot came online in

July and GSTFT have been working to reduce the backlog of patients with this additional

capacity, noting that it is expected that performance will deteriorate whilst this backlog is cleared.

The Trust is currently behind plan for urology recovery. Overall trust-wide performance

improvement is linked to reducing late referrals from other district general hospitals in London

and the South East of England. A system wide recovery trajectory and plan has been agreed,

which includes Lewisham & Greenwich NHS Trust and KCH. This will run to March 2016. These

actions will support a trust wide improvement for GSTFT, but are considered high risk. KCH

continues to have strong internal performance but will need to work to the agreed inter-trust

transfer trajectory in order for performance across the South East London system to improve.

NHS England have given particular focus to the cancer 62 day target in South East London,

which is seen as a key risk to London performance. Commissioners will work closely with Trusts

in South East London to monitor and track the agreed improvement trajectories and ensure

Lewisham & Greenwich NHS Trust pathways are adhered to and avoidable delays are

28

eliminated. There will be regular weekly dialogue with Trusts reviewing Patient Tracking List

reporting and addressing individual patient pathway delays/ issues.

Cancer 2 weeks (breast symptoms)

Quarter 3 Performance relates to 21 breaches. The majority of breaches were at GSTT and the

majority were due to patient choice reasons.

4.4.6 Ambulance Response

The London Ambulance Service continues to struggle to meet the national standard

response times. NHS Lambeth CCG is currently reviewing the CQC findings published in

November 2015. LAS received a rating of Inadequate.

4.4.7 Health Visitors

From October 2015, responsibility for commissioning the Health Visitor service transferred to

local authorities.

4.4.8 Improved Access to Psychological Therapies (IAPT)

The service continues to over-perform on the access target by 0.9% over the quarter as at

quarter three. Work has started on waiting list validation which and has highlighted approximately

100 clients who had completed treatment but were not properly discharged from the clinical

records system. They were all discharged in September. These un-discharged clients skewed the

recovery rate. The service has been awarded non-recurrent funding to validate waiting lists and

ensure waiting list data accuracy, and also to clear the backlog of appointments. This is in

preparation for the consistent achievement of waiting targets due to be formally initiated in April

2016. The service is working with NHSE and commissioners on data sets by which to monitor the

new targets.

29

4.4.9 New Early Intervention In Psychosis 2 Week Standard

NHS Lambeth CCG is working closely with South London and Maudsley NHS Foundation

Trust (SLaM) to deliver the Early Intervention in Psychosis (EIP) 2 Week standard from

01/04/2016.

SLaM will be running the standard in shadow form from 01/11/2015.

SLaM has carried out significant pieces of work to enable collection of data to support the

standard, including:

• A psychosis gap analysis to identify requirements to deliver the standard

• Review of the patient data collection system to confirm that it can capture

appropriate clock start and stop dates

• Development of new processes to identify ‘Suspected First Episode of

Psychosis’ in all internal and external referral forms

• Appointment of a Better Access Programme Manager

• Development and roll-out of a programme of training for staff to support

delivery of the standard

SLaM report on progress in delivery of the standard to NHS Lambeth CCG at monthly

commissioning meetings. The Trust is committed to delivery of the EIP standard from 1st

April 2016.

A joint work shop between commissioners, practitioners and managers within secondary

care and the Living Well Network (LWN) took place on the 25th November 2015. It was

recognised at that workshop that a whole system response was required in order to

effectively meet the target. It was also recognised that the interface between the LWN and

the Early Intervention Psychosis Team needs to be enhanced, as the LWN sees people in

the first instance they experience mental distress, either via GPs or through self-referrals

(SLaM) to deliver the Early Intervention in Psychosis (EIP) 2 Week standard from 1st April

2016.

SlaM and the CCG completed a NHSE self-assessment which rated Trust’s readiness in

terms of meeting the two waiting time target, IT development and the recruitment and

training of staff. SLaM has a task group which meets on a monthly basis and is in a

position to report the first extract of data in January.

4.4.10 Dementia Diagnosis Rate

The Health and Social Care Centre (HSCIC) has now published data for Dementia

Diagnosis Rate for the year to December 2015. A new methodology is being used for

2015/16 to calculate estimated dementia prevalence.

30

NHS Lambeth CCG continues

to rank 2nd in London for

recording dementia diagnoses

in primary care. NHS

Lambeth CCG achieved a rate

for recording dementia

diagnoses in primary care of

85.7% in December 2015 and

85.1% overall for quarter 3.

Data for 2014/15 is gradually

being published by the Health and Social Care Information Centre (HSCIC). The graph

shows published data for NHS Lambeth CCG’s GP practices, for the percentage of

expected dementia patients for the CCG with a dementia diagnosis recorded. The rate

would be expected to fluctuate slightly month on month as patients join and leave GP

practices.

The CCG’s Older People team have been working consistently for about 2 years to achieve

this success. Some of the things that the team did included:

• The GP with a special interest in dementia reviewed GP practice data and referrals

to the Memory Service. The GP did awareness raising and education with

practices which did not refer, or had a low rate of referral.

• Regular communications to practices about the importance of registering diagnoses

for patients with dementia.

• The Memory Service wrote to GP practices reminding them to register diagnoses

for patients they were seeing.

• All people in Lambeth care homes who are receiving nursing are given a memory

assessment as part of their regular reviews with the GP practice assigned to their

home.

• Protected Learning Time has been used to educate GPs about dementia and how

to refer.

4.4.11 Transforming Care

Since January 2015 NHS England has directed CCGs to increase the level of scrutiny to

ensure that the people placed locally in hospital settings are receiving the right care that

meets their individual needs, with discharge plans in place for those that are able to move

to a community setting.

The people with learning disabilities who are the responsibility of NHS Lambeth CCG are

placed in assessment and treatment units when there is an escalation in their need for

support in relation to their condition and/or behaviour that challenges.

The CCG is then made aware of the placement and the Transforming Care Leads and the

Commissioners for Mental Health becomes involved in the monitoring of the placement and

the commencement of discharge planning. The Transforming Care Lead organise the CTR

for the patient and reports every 2 weeks to NHSE on the progress for each individual

patient.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

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

f E

xp

ecte

d P

reva

len

ce

wit

h

Re

co

rde

d D

iag

no

sis

% Recording by GP Practice of Dementia Diagnoses against Expected Prevalence 2015/16

31

Since that time NHS Lambeth CCG has worked to progress the discharge of the people

originally identified by the CCG and has maintained a register of all existing and new

people who are in assessment and treatment units.

At the time of writing this report the CCG has 13 people in assessment and treatment

settings who are at varying stages of their care, treatment and discharge. Of the 13 people

admitted:

There was 1 admission in 2016

7 in 2015

2 in 2014

o Of the 2 patients, 1 is scheduled to be discharged into the community by 31

March 2016

3 were admitted prior to 1 April 2014.

o Of the 3 patients, 2 are scheduled to be discharged into the community by

31 March 2016

o The 3rd patient is scheduled to be discharged into the community by August

2016

Future Service Model

A national service model, developed with the help of people with lived experience,

clinicians, providers and commissioners, sets out the range of support that should be in

place no later than March 2019.

Implementing this model, and giving people greater power over the services they use, will

result in a significantly reduced need for inpatient care. NHSE expect that as a minimum, in

three years’ time no area will need capacity for more than 10-15 inpatients per million

population in clinical commissioning group (CCG) commissioned beds (such as

assessment and treatment units), and 20-25 inpatients per million population in NHS

England-commissioned beds (such as low-, medium- or high-secure services).

These planning assumptions will mean that, at a minimum, 45 – 65% of CCG

commissioned inpatient capacity will be closed, and 25 – 40% of NHS England-

commissioned capacity will close, with the bulk of change in secure care expected to occur

in low-secure provision.

South East London Transforming Care Partnership

To achieve this systemic change, 49 transforming care partnerships (commissioning

collaborations of CCGs, NHS England’s specialised commissioners and local authorities)

are mobilising now. They will work with people who have lived experience of these

services, their families and carers, as well as key stakeholders to agree robust

implementation plans by April 2016 and then deliver on them over three years.

Lambeth is part South East London Transforming Care Partnership (SE TCP). The other

partners are, Southwark, Lewisham, Bexley, Bromley, Greenwich and NHSE Specialised

32

Commissioning. The Senior Responsible Officer for the SE TCP is Annabel Burn,

Managing Director, Greenwich Business Support Unit at NHS South East London.

The CCG and Lambeth Council are clear that locally a model of local service delivery will

be developed based on best practice models which will deliver as much within Lambeth as

possible. This will be driven by a requirement to achieve the best outcome for people in

Lambeth, minimising and potentially eliminating in-patient provision as soon as possible.

The CCG and LA will work closely with the SE TCP to allow the deployment of resources at

the community level and to meet the aspirations of the local population. Both the CCG and

the Council are committed to this and both see it as a critical success factor for effective

provision of services for people with a Learning Disability and /or Autism with behaviour

deemed to challenge.

33

5 STRATEGIC AND OPERATIONAL DELIVERY – OUR PROGRAMMES

5.1 Integrated Children and Young People (including Maternity) Programme

Responsible Director Maria Millwood, Director of Integrated Commissioning (Children & Young People, Adult Disabilities)

Clinical Lead Dr Nandini Mukhopadhyay

Programme Lead Emma Stevenson, Assistant Director Children & Maternity

Scope of business area The purpose of this business area is to lead the redesign of children’s and maternity services and disability

services to achieve quality, and value for money services. This business area has strong links with the

business areas on integrated mental health for adults, a model of integrated care and citizen participation

and empowerment.

Objectives of business area

The objectives of this business area are to:

Redesign the child and adolescent mental health services

Implement the recommended London standards across child health services

Develop and implement integrated child health pathways

Implement Maternity standards and effective local pathways

Develop an integrated commissioning strategy for a whole life disability pathway

5.1.1 Programme Assurance Statement

Assurance Status/Risks RAG Rating (Red/Amber/Green)

Is your programme delivering as planned – is it

on target?

Many objectives on target but some risks

identified.

34

5.1.2 Integrated Children and Young People (including maternity) Programme Risk Register

Please see Board Assurance Framework for risks 1A rated 12 and above.

Risk Title

Risk Register

where Risk is

managed

Current Risk

Score Approach Action Plan Summary

Unlikely risk that the Children’s and Maternity Programme will not achieve its objectives due to the dependency on the delivery of other programmes (Leap, CYPHP)

Programme Board /

Directorate Risk

Register

6 Mitigate To review and implement clear thresholds to specialist and acute services - completed To review the universal service reviews - completed To restructure targeted workforce to develop an integrated team by June 2016 To complete service re-design process for remaining LEAP interventions - completed Governance structure for Childrens Transformation Programme to be submitted to a workshop of the CFSP for discussion on 16/07/15 - completed. Corporate review in Council re key boards will determine how this is taken forward - ongoing To mitigate against delayed delivery of CYPHP: - Implement GP Delivery Scheme for Paediatric Asthma - implemented and being monitored. Worked up 2016/17 Commissioning Intentions including QIPP - awaiting approval by CCG Governing Body March 2016

Unlikely risk of failure to reduce waiting time from referral to first treatment for the CAMHS Early

Programme Board /

Directorate

6 Mitigate Complete recruitment to posts - SLAM, Oct 2015 - Completed Set up and run agreed new group work - SLAM, Oct

35

Risk Title

Risk Register

where Risk is

managed

Current Risk


Intervention Team resulting in poorer outcomes and increased escalation to Tier 3-4 services.

Risk Register

2015 - Completed.

Unlikely risk that babies under one year not vaccinated with the BCG vaccine during a period of non-supply will not be robustly identified and vaccinated in a timely way by the commissioned provider once supply is restored, resulting in increased risk of exposure to infection.

Programme Board /

Directorate Risk

Register

6 Mitigate Monitor implementation of provider action plan once vaccine is available

Risk of failure to improve rate of health reviews to meet local and new nationally mandated targets, resulting health issues in children potentially missed.

Programme Board /

Directorate Risk

Register

6 Mitigate Action plan to improve performance against targets – Dec 15 Data cleansing exercise by provider – Oct 2015 - completed. Documented failsafe system – Dec 15

36

Children and Maternity Dashboard – items to note MENTAL HEALTH The average wait time from referral to 1st assessment community CAHMS and average wait time from referral to 1st assessment CLAMHS both consistently have waiting times below the 18 week target. The average waiting time from referral to 1st assessment for early intervention services was over 40 weeks for three quarters in succession, but then fell back sharply to 23 weeks in quarter two. The number of young people admitted to both CAMHS tier 4 in-patients and outpatients is rising, with both current year targets having been breached by around 100%. REDUCING PAEDIATRIC A&E PRESENTATIONS & ADMISSIONS The percentage of total paediatric admissions due to asthma has remained steady at around 2% and the unplanned admissions due to asthma, diabetes and epilepsy at between 3% and 4% for the past three years. Whilst these two indicators remain within a reasonable distance of the target, the other two indicators in this group are proving more difficult to bring within range. ENHANCED HEALTHY CHILD PROGRAMME ALIGNED WITH LEAP After averaging 90.2% in the 2013-14 year, the breastfeeding initiation rate rose slightly to 91.2% in 2014-15, but in the current year has exceeded or is close to the 90% target. Meanwhile, the percentage of infants breast fed at 6-8 weeks after birth has risen steadily from an average of 78% in 2012-13 to 82% in 2014-15. The average for the two quarters of the current year is 81.5%, still 3.5% short of the annual target. Vitamin D coverage is increasing encouragingly, the latest figuring showing that 39.6% of the eligible population are engaged in the distribution scheme. With regard to childhood immunisation, coverage levels are highest for children aged 1, with the DTP/IPV/HiB (3 doses primary) immunisation averaging just under 93% this year The comparable figure for the aged 2 MMR first dose jab is just under 91%. Although coverage of the aged 5 pre-school booster has increased over the past two years, it lags behind the earlier age vaccinations, averaging around 86.0% this year. All three childhood immunisations fall short of the 95% coverage target. Data for the health review 1 and 2 indicators has only been available since the start of the 2014-15 year. In that time, coverage initially dropped, but for both increased at the end of the 2014-15. Latest figures show better coverage for the health check 1, but both are falling short of this year’s target.

37

SAFETY The number of paediatric re-admissions per quarter has fallen compared to last year but has exceeded the current year target by 100%. MATERNITY The Friends and Family test in respect of ante-natal care has now been in existence for 18 months, with St. Georges Hospital achieving the highest average satisfaction score for the 2014-15 year. In the current year the picture is mixed with GSTT having the highest rating for antenatal care at 97.4%, which is over 10% better than St. Georges. For postnatal care, St. Georges has a 2% advantage over GSTT at 90.5% compared to 88.4%. For both ante- and post-natal care, Kings has the lowest satisfaction rating, at 89.2% and 87.3% respectively.

CHILDREN & YOUNG PEOPLE'S EXPERIENCE The Friends and Family scores in respect of inpatients over the past year has revealed consistently higher levels of satisfaction at GSTT than at the other two local Trusts. Although no Trust has reached the 100% satisfaction target, GSTT has come closest to achieving it and St. Georges has consistently had the lowest satisfaction scores.

38

5.1.3 Children and Maternity Programme Board Dashboard

Lambeth Children & Maternity Programme Board Dashboard

2012 -13 2013 -14 2014 -15

Current

Year

Target

High or

Low

Target?

Full year Full year Full year Q1 Q2 Q3 Q4

New data

since prev

month?

Rating (Latest

full quarter to

current year

target)

Trend last 7 quarters

Latest quarter

2015-16 verses

2014-15

INDICATOR

LABEL

MH 1 8.1 6.1 10.1 18 Low 10.1-2.9

MH 2 32.9 42.6 23.2 18 Low 23.2-3.9

MH 3 12.6 5.4 5.7 18 Low 5.7-1.0

MH 4 not supplied 118 199 71 21 54 Low 92-8

MH 5 not supplied 35 21 9 5 6 Low 142

PAE1 4.5% 3.3% 3.6% 3.4% 2.5% 3.8% 3.6% Low 3.8%0.1%

PAE2 44.4% 31.8% 32.2% 32.8% 29.2% 31.9% 28.9% Low 31.9%1.3%

PAE4 78.6% 76.9% 74.7% 76.9% 72.9% 72.2% 65.0% Low 72.2%-2.8%

PAE5 3.0% 2.6% 2.7% 2.1% 1.9% 2.9% 2.3% Low 2.9%-0.1%

2015 -16 Quarterly Activity

Number of Young People admitted to CAMHS tier 4 in-patients

Number of Young People admitted to CAMHS tier 4 outpatients

Percentage of children and young people admitted with a length of stay of less than 24

hours

MENTAL HEALTH

Percentage of paediatric A&E attendances resulting in NFA or referred back to GP

REDUCING PAEDIATRIC A&E PRESENTATIONS & ADMISSIONS

Average waiting time from referral to 1st assessment Community CAMHS (weeks)

Relative Performance

Percentage of unplanned hospitalisations for children and young people with asthma,

diabetes and epilepsy

Average waiting time from referral to 1st assessment Early Intervention Team (weeks)

Average waiting time from referral to 1st assessment CLAMHS (weeks)

Percentage of all paediatric (0-18) admissions due to asthma

Dashboard

39

EHC 1 81.0% 67.9% 85.6% 78.8% 90.0% High 78.8%

EHC 2 92.0% 90.2% 91.2% 92.3% 90.0% 90.0% High 90.0%

EHC 3 78.0% 81.5% 82.0% 83.6% 79.8% 85.0% High 79.8%-2.5%

EHC 4 no data no data 27.2% 27.7% 34.4% 39.6% 25.0% High 39.6%24.3%

EHC 5 92.4% 92.6% 92.6% 92.7% 93.0% 95.0% High 93.0%-0.5%

EHC 6 89.6% 91.0% 90.6% 91.0% 90.3% 95.0% High 90.3%-0.2%

EHC 7 76.8% 81.9% 88.0% 85.3% 87.0% 95.0% High 87.0%-2.7%

EHC 8 not available not available 65.3% 78.9% 79.2% 85.0% High 79.2%16.7%

EHC 9 not available not available 65.6% 71.0% 70.1% 85.0% High 70.1%3.0%

SAF 1 0 0 0 0 0 0 Low 0

SAF 2 117 96 113 16 24 15 20 Low 55-15

MAT 1 N/A N/A 92.2% 97.7% 95.9% 98.3% 91.9% High 98.3%5.8%

N/A N/A 89.4% 89.4% 92.3% 79.5% 91.9% High 79.5%-9.1%

N/A N/A 93.9% 87.3% 84.3% 100.0% 91.9% High 100.0%4.3%

MAT 2 N/A N/A 84.0% 89.6% 87.5% 88.0% 89.5% High 88.0%2.9%

N/A N/A 87.7% 86.4% 89.6% 86.0% 89.5% High 86.0%1.3%

N/A N/A 93.1% 90.4% 90.9% 90.1% 89.5% High 90.1%2.1%

MAT 3 N/A N/A 99.5% 98.2% 99.8% 98.9% 100% High 98.9%-0.8%

N/A N/A 96.1% 95.1% 97.1% 98.3% 100% High 98.3%3.3%

N/A N/A 86.0% 91.4% 95.0% 95.1% 100% High 95.1%15.5%

Number of paediatric re-admissions

Percentage of health review 2 completed in line with target

Kings College - Friends & Family test (inpatients - young people)

Kings College - Friends & Family Test (ante-natal recommend score)

GSTT - Friends & Family test (post-natal recommend score)

Kings College - Friends & Family Test (post-natal recommend score)

St. George's - Maternity Friends & Family test (post-natal recommend score)

MATERNITY EXPERIENCE

St. George's - Maternity Friends & Family test (ante-natal recommend score)

GSTT - Friends & Family Test (ante-natal recommend score)

CHILDREN & YOUNG PEOPLE'S EXPERIENCE

Percentage immunisations at 1 year (DTP/IPV/HiB 3 doses primary)

Percentage immunisations at 5 years (pre-school booster)

Percentage immunisations at 2 years (MMR 1st dose)

St. George's - Friends & Family test (inpatients - young people)

GSTT - Friends & Family test (inpatients - young people)

Admission of full-term babies to neonatal care unit (without congenital abnormalities)

(GSTT)

SAFETY

Percentage of health review 1 completed in line with target

Percentage Vitamin D take-up (D-card scheme) of eligible population

Percentage breastfeeding 6-8 weeks after birth

Percentage breastfeeding initiation

Percentage of maternal bookings made within less than 12 weeks and 6 days gestation

ENHANCED HEALTHY CHILD PROGRAMME ALIGNED WITH LEAP

40

5.1.4 Key Deliverables

Key Deliverables For Quarters 1 - 4 2015/16

Business

Plan Ref: Objective Delivery

Period

Progress update

Paediatric A&E Reduction, Admission Avoidance and Early Discharge

5.1.1 Commission a 7 day a week pilot

ambulatory care service across LSL

for general paediatrics, including

those with respiratory and sickle cell

conditions to manage winter pressure

from Oct 2015

Quarter 2-4

Recruitment for the Paediatric Hospital@Home service is progressing

across the 3 Acute Trusts. Evelina has recruited fully and start date for all

Trusts is February 2016. The service specification is complete and has

been signed off and the evaluation spec has been finalised

5.1.2 Ensure effective interface and joint

working with the CCNT

Quarter 2 This is being taken forward via the above Commissioner/Provider

meetings. Assurance of effective interface and joint working across the 3

Providers and with the pilot Paed H@H service will be received via

contract monitoring once operational from Feb 2016

5.1.4 Improve communication and

information sharing with parents and

carers of young children through

dissemination of the ‘Common

Childhood Illnesses’ Booklet

Quarter 2-4

The Common Childhood Illnesses booklets have been ordered by GSTFT

community health and are being distributed by Health Visitors and are

part of the GST Transformation Programme. Quarterly reporting on

number of books ordered, number delivered to parents and parent

satisfaction is being monitored via the GST contract monitoring meetings

Lambeth Early Action Partnership (LEAP)

5.1.6 Work with GP clinical network leads

for LEAP to ensure primary care are

Quarter 2-4

Two GP clinical network leads have now been appointed. As part of their

ongoing work they are meeting with the Practices that fall within the 4

41


Business


Period

Progress update

fully engaged with the programme

and there is effective linking with

LCN

LEAP wards and working up the detail of the GP LEAP Programme

5.1.7 Continue to work up the local

evaluation framework for LEAP and

each intervention through a

consortium of academic stakeholders

Quarter 2 -3

This is on-going. An Evaluation Lead has been appointed as part of the

core LEAP team and they continue to liaise with stakeholders including

KHP.

5.1.8 Work with London School of

economics to develop the LEAP cost

benefit analysis tool

Quarter 3 This is in progress. There has been some delay across the a Better Start

Big Lottery sites due to getting the correct data etc

Children’s Transformation Programme

5.1.10 Ensure children’s agenda is

embedded into LCN development

Quarters 2-4 Children’s issues have been discussed at the SEL LCN and plans are

being developed to ensure priorities link with and are informed by LEAP,

CYPHP, Wells Centre and Children’s GP Delivery Scheme. SW LCN has

recently prioritised Children & YP, with a focus on supporting schools with

effective emotional resilience, aligned with the CAMHS Strategy and

CYPHP.

5.1.11 Continue to roll out and monitor

enhanced vitamin D programme

Quarters 1-4 The 25% target was exceeded at the end of July 2015 with 36.9% take

up by eligible population in Q3. The Children & Maternity Programme

Board continues to monitor take up on a monthly basis

5.1.12 Scope and consult on the delivery

service model for integrated targeted

Quarter 3 The focus on has been on integrating family support services and work is

currently being developed around improved integration of HVS with

42


Business


Period

Progress update

family support, incorporating social

care, early help, health visiting,

voluntary sector etc.

Children Centre and early years model. Proposed models will be

consulted on through out early 16/17

5.1.13 Ensure the healthy child programme

is effectively delivered, focusing on

improving Child Health reviews

Quarters 1-4 The Health Reviews are below the agreed target of 85%, however

improvement has been made in HR1 increasing from 78.9% in Q1 and

79.2% in Q2. HR2 remains below target at 70.1% in Q2. Work is on-going

with GST and the Health Visiting service, with an improvement plan in

place monitored via the CMB

5.1.14 Ensure service improvement in line

with Ofsted Inspection: Initial Health

assessments of LAC completed in

timely manner and care leavers

receive and talk through their health

passports

Quarter 3 Work is ongoing to improve Health of LAC. The focus is on improving the

interface and joint working between the designated LAC health team and

spocial workers to ensure information and processes are effective

Children & Young People’s Health Partnership (CYPHP)

5.1.15 Develop comprehensive Child health

pathway , specifically for asthma,

diabetes and sickle cell

Quarter 3 There is a range of work in development around asthma pathway. A

dedicated asthma post is in place at GST through the Transformation

fund, ensuring the quality standards are effectively implemented. The

Children’s GP Delivery scheme is operational with good take up by

Lambeth Practices to improve paediatric asthma diagnostic and care

management

5.1.16 Review adolescent health

commissioning and delivery model, in

Quarter 3 This is being developed through CYPHP. Considerable co-production

work has taken place with a range of young people, identifying what

43


Business


Period

Progress update

line with learning from the Wells

Centre model

works well, gaps in service and accessibility and ideas for improvement.

This work will feed into local strategies across social care, CAMHs and

youth violence

Emotional Health & Wellbeing

5.1.17 Sign off of the Emotional Health &

wellbeing Strategy

Quarter 2 The CAMHS Transformation Plan has been approved by NHSE and

£684k has been allocated to the CCG. The detailed Transformation plan

is being implemented. Plans for regular reporting to NHSE, CMB and

H&WB are in place. In addition the CCG invested £182k recurrent

funding in 15/16 to address the long waiting times into the early

intervention CAMHS team. A detailed improvement plan is in place

monitored by the CAMHS JCG. The target is to reduce to 10% wks

waiting by Q4 16/17. Good progress is being made with waiting times

redued from 45wks end of 14/15 to 23.2wks in Q2

5.1.18 Continue to co-produce the

implementation plan to ensure

stakeholders are fully engaged in

delivery of the Strategy (3 year plan)

Quarters 1-4

& 2016/17

A part time post has been recruited to funded via the CAMHS

Transformation budget to co-produce and consult on the implemtaiton of

the Transformation Plan. Events are being planned over the next few

months with key groups of C&YP, including those known to the YOS,

LAC, CWD and certain BME groups

5.1.20 Improve service in line with Ofsted

Inspection: Timely access to CAMHS

for LAC, post adoption support

Quarter 3 As part of the CAMHSTransfotmation Plan all teams are being reviewed

to ensure the right pathwaysm, capcity, outcomes are being met. This

includes the CLAMHS team for LAC.

Perinatal Mental Health

44


Business


Period

Progress update

5.1.21 Take forward the recommendations

from the Perinatal MH pilot

Quarters 2-4 The part time perinatal MH worker has started in post and is leading on

the following specific work: scope the training needs across the children’s

workforce, review training programmes and evidence of impact, work with

service users and professionals to further develop the perinatal MH

pathway and align it with current acute model, carry out research into cost

benefit analysis of implementing an effective pathway and input into the

development of a Perinatal MH Commissioning strategy. In addition

Lambeth has been shortlisted for the RCM 2016 Awards for our work

around perinatal MH pathway and the pilot we ran earlier in the year.

Results will be announced in March 2016

Ensure LEAP peri-natal MH

interventions is effectively developed

and informed by learning from the

pilot

Quarters 2-4 Service design phase of the LEAP peri-natal MH intervention will begin in January 2016, following a logic model approach. Learning from the pilot will inform the process.

Maternity & New Born Screening

5.1.24 Maternity standards:

Working with GSTFT to ensure

workforce requirement are met

(Increasing consultancy hours cover,

supervisor ratio etc.)

Quarters 1-4 This is being looked at via the CQRG meetings for both Kings and GST

and more widely as part Our Healthier SEL work

5.1.25 Continue to reduce C-Section rates –

focus on vulnerable groups, pre-

pregnancy support and antenatal

Quarter 1-4 GSTFT has appointed a Consultant Midwife for Antenatal Care who

started in May 2015. The remit of this person is to identify and support

women and pathways of care where women may be at increased risk of

45


Business


Period

Progress update

management (i.e. through Centring

pregnancy, increasing caseload

midwifery etc.)

delivering by C-section. The Trust is liaising with those organisations with

lower C-section rates to determine any learning. They have also

commenced a small pilot testing the use of acupuncture to stimulate the

start of labour in post term pregnancies.

A KCH Maternity Group with commissioners has been set up to review a

number of maternity issues. The Trust has established a working group

to review the C-section rates and investigate possible opportunities for

reducing it.

5.1.26 Working across primary care and

maternity services to increase early

booking down to 10wks gestation

(supports better management of

sickle Cell) (on-going and reviewed

each quarter)

Quarter 1-4 Both GSTFT and KCH are committed to increasing early bookings down

to 10 weeks gestation. KCH established a new centralised antenatal

booking system at the PRUH at the start of May. This has a dedicated

phone line for easy access for women who choose to self-refer over the

phone or a simple on-line form located on the website. GSTFT is looking

at modifying the maternity website to improve access for women wishing

to self-refer.

5.1.27 Supporting the local management of

new born screening programme

commissioned by NHSE

Quarter 1-4 GSTFT are implementing the agreed action plan, following

recommendations from the EQA of new-born screening

46

5.2 Integrated Adults Programme (Elective, Long Term Conditions, Older People, Urgent Care)

Responsible Director Moira McGrath, Director of Integrated Commissioning (Older Adults)

Clinical Lead Drs. Lisa Le Roux, John Balazs, Hasnain Abbasi & Paul Heenan

Programme Lead Various – please see work streams

Scope of business area The purpose of this business area is to lead the redesign of adult’s health and social care services to

achieve quality, and value for money services, promote independence and self-care.

This business area has strong links with the business areas on integrated mental health for adults, a

modern model of integrated care, primary care and citizen participation and empowerment.



To improve integrated services to provide better health and wellbeing outcomes for patients

High quality and cost effective health and care system

Delivery of financially sustainable health care system for Lambeth




on target?

Many objectives on target but some risks

identified.

47

5.2.2 Integrated Adults (Elective, Long Term Conditions, Older People, Urgent Care) Programme Risk Register

For risks scoring 12 and above, 2A, 2B, 2M, 2C, 2K and 2N, please see the Board Assurance Framework.

Risk Title

Risk Register

where Risk is

managed

Current Risk


Likely risk of E-referral service not being implemented fully leading to issues for GP practices and providers around outpatient referrals

Programme Board /

Directorate Risk

Register

9 Mitigate Collaborative meetings with acute providers and HSCIC to resolve any issues raised: Issues previously occurring with the e referral system have been resolved over the last few weeks. This has included the deployment of fixes through the national team for areas previously causing issues. Most recent IT fix has further resolved technical issues. IT training plan for practices in progress. Training plan being implemented. ‘How to…’ guide distributed and has seen immediate increase in ERS utilisation in some practices. Planning to trial ERS-only access for one service in 2016/17. Priorities for 16/17 to be agreed with providers in Q4 2015/16.

48

Integrated Adults Dashboard – items to note

Plan 2015/16

The Plan for 2015/16 used in this report is the one used by the Contracting Team to monitor activity by provider Trusts. This may be the driver for the apparent large variances between activity and plan year to date (YTD). Generally while elective inpatients and emergency activity is underperforming against plan, outpatients is overperforming against plan. The report is for Pbr and Non Pbr, to negate the Shift from Pbr to non Pbr in certain trust.

Elective Activity

Elective activity is underperforming against plan. This is the case for all 3 main Trusts, with others marginally over plan.

Emergency Activity

Non-elective activity is underperforming against plan. This is the case for all 3 main Trusts. Although other Trusts are 12% over plan, the overall position is showing as 7% under.

Non-elective Other Activity

In contrast to the main categories of Non-elective activity, GSTT and St. Georges are over performing against plan, whilst Kings is underperforming. The percentage variances appear high because of the small numbers involved. Across all Trusts there is a variance of 126% over plan.

Outpatients First

Outpatient First activity is overperforming against plan by 22% overall. Overperformance against plan varies at local Trusts from 11% at GSTT to 47% at St Georges. Cardiology, gynaecology, nephrology, ophthalmology and non QIPP Specialities show over performance, other specialties are under mostly performing.

49

Outpatients Follow-up

Outpatient follow-up activity is overperforming against plan. The two main Trusts are over performing and GSTT within 10% of the plan. The contributes to 25% over-performance overall. First attendance activity impacts on follow up activity.

Outpatients Procedures

Outpatient procedures are overperforming across the board.

Accident & Emergency

Accident & Emergency activity overall is overperforming against plan by 9%. However the GSTT and St Georges Trusts are underperforming slightly and Kings is overperforming by 5% Most of the headline over-performance is attributable to the 74% over-performance at other Trusts.

Emergency Admissions for Long Term Conditions

Overall, emergency admissions for patients with long term conditions have fallen by 1%. The exceptions to this trend are diabetes and heart failure. Heart failure shows a 24% increase compared to 2014/15.

50

5.2.3 Integrated Adults Dashboard

5 2014/2015 2015/2016 5

LAMBETH YEAR MONTH

2015 Nov Nov B3

Nov activity

14/15

YTD activity @ Nov

14/15

Plan @Nov

15/16

Nov activity

15/16

Plan @Nov

YTD

YTD activity

@Nov 15/16

Comparing

YTD Plan

with YTD

Actual

Activity

% Change YTD

Actual Vs YTD Plan

Comparing Monthly

Plan with in

Monthly Actual

Activity

% Change Nov

Actual vs Plan

POD (Point of Delivery) 29,037 333,221 42,984 55,006 344,161 437,518 Up 27% p 28%

INPATIENTS TOTAL 4,558 36,242 4,742 4,356 37,953 37,080 9,777 Down -2% q -8%

Elective 2,220 17,553 2,522 2,424 20,192 19,314 2,551 Down -4% q -4%

GSTT 861 6,930 1,102 1,149 8,815 8,707 2,566 Down -1% u 4%

Kings 821 6,791 869 760 6,952 6,506 540 Down -6% q -13%

SGH 176 1,331 237 187 1,921 1,549 923 Down -19% q -21%

OTHER 362 2,501 314 328 2,505 2,552 6,808 - 2% u 4%

Emergency 1,989 15,886 2,107 1,861 16,855 15,722 124 Down -7% q -12%

GSTT 693 5,408 813 642 6,507 5,651 2,497 Down -13% q -21%

Kings 739 6,092 764 728 6,113 5,934 855 Down -3% q -5%

SGH 305 2,234 312 291 2,499 2,195 706 Down -12% q -7%

OTHER 252 2,152 217 200 1,736 1,942 6,609 Up 12% q -8%

This is excluding Maternity Non Elective_Other 349 2,803 113 71 905 2,044 7102 Up 126% q -37%

GSTT 184 1,563 34 4 270 1,207 48 Up 347% q -88%

Kings 100 890 64 56 510 470 9 Down -8% q -12%

SGH 32 186 3 - 20 163 25 Up 699% q -100%

OTHER 33 164 13 11 105 204 206 Up 94% q -16%

LAMBETH CCG INTEGRATED ADULT PROGRAMME DASHBOARD

YTD activity @ Nov15/16 vs

YTD Plan @ Nov15/16

Plan @Nov 15/16 vs

Nov Act 15/16

ALL Acute Plan and Actual Activity

2014/2015 2015/2016

November 2015 - Dashboard

51

5 2014/2015 2015/2016 5

LAMBETH YEAR MONTH

2015 Nov Nov B3

Nov activity

14/15

YTD activity @ Nov

14/15

Plan @Nov

15/16

Nov activity

15/16

Plan @Nov

YTD

YTD activity

@Nov 15/16

Comparing

YTD Plan

with YTD

Actual

Activity

% Change YTD

Actual Vs YTD Plan

Comparing Monthly

Plan with in

Monthly Actual

Activity

% Change Nov

Actual vs Plan

OUTPATIENTS TOTAL 12,990 201,052 27,359 39,214 219,158 305,887 Up 40% p 43%

First OP 9,967 82,042 8,387 10,863 67,187 82,268 19,937 Up 22% p 30%

GSTT 5,008 41,564 4,695 5,560 37,559 41,635 7,053 Up 11% p 18%

Kings 3,361 27,402 2,601 3,046 20,806 26,200 1,085 Up 26% p 17%

SGH 727 6,018 540 1,228 4,383 6,447 2,005 Up 47% p 127%

OTHER 871 7,058 552 1,029 4,439 7,986 17,245 Up 80% p 87%

Follow-Up 465 99,247 18,972 23,424 151,972 190,101 5,563 Up 25% p 23%

GSTT 11,165 95,494 11,090 12,137 88,721 94,820 13,812 - 7% u 9%

KINGS 7,579 61,648 5,337 7,174 42,696 60,041 2,935 Up 41% p 34%

SGH 1,853 15,074 1,238 1,326 10,051 13,416 5,186 Up 33% u 7%

OTHER 2,461 20,468 1,306 2,787 10,503 21,824 41,870 Up 108% p 113%

OP_Proc 2,558 19,763 - 4,927 - 33,518 120,018 Up - p -

GSTT 2,063 17,170 1,242 2,744 9,934 19,592 1,195 Up 97% p 121%

Kings 354 3,189 451 1,077 3,605 5,554 844 Up 54% p 139%

SGH 503 3,479 356 428 2,887 3,559 1,572 Up 23% p 20%

OTHER 530 3,738 324 678 2,589 4,813 9,174 Up 86% p 109%

A&E TOTAL

A&E 11,489 95,927 10,883 11,436 87,050 94,551 2,779 - 9% u 5%

GSTT 3,775 32,568 4,179 3,780 33,435 32,317 16,565 Down -3% q -10%

Kings 4,499 36,873 4,227 4,423 33,818 35,416 16,467 - 5% u 5%

SGH 1,200 9,622 1,252 1,235 10,017 9,834 5,074 Down -2% q -1%

OTHER 2,015 16,864 1,224 1,998 9,780 16,984 38,106 Up 74% p 63%

LAMBETH CCG INTEGRATED ADULT PROGRAMME DASHBOARD

YTD activity @ Nov15/16 vs Plan @Nov 15/16 vs2014/2015 2015/2016November 2015 - Dashboard

52

5.2.4 Elective


Clinical Lead Dr. Hasnain Abbasi

Programme Lead Bisi Aiyeleso / Sara White, Assistant Director Service Redesign

Scope of business area The Elective Care project has historically focussed on GP referred activity in outpatients, both first and follow

up. The elective programme in 2015/16 aims to reflect the changing nature of the work required to deliver

improvements across the elective pathway as a whole. Whilst there is still a focus on reduction of activity in

outpatients via appropriate referral to specialist services, the Programme also focuses on associated activity

along the elective pathway including diagnostics and pre/post-surgical elements of elective pathways.

The elective care project links into work being implemented to support the delivery of 18 week referral to

treatment targets. It cross references work to the Long Term Conditions project, the Primary Care

Development Programme including the GP delivery framework within this, Children’s Services and work

undertaken by Southwark and Lambeth Integrated Care (SLIC).



To strive to achieve an approach to create solutions for service redesign and delivery with

consistency across providers that are accessed by patients living in Lambeth

To create an outcome based approach to agreeing changes to the way in which services are

delivered across primary, social, community and secondary care

To manage and mitigate in-year risk, whilst recognising minimal material impact

To reduce the number of people inappropriately seen in outpatients

To reduce inappropriate specialty specific follow up

To agree a consistent approach across Lambeth and Southwark where possible

To reduce variation in the GP referral patterns to outpatients

53

To agree contractual levers to treating patients referred correctly within a pathway

To agree whole pathway approaches within defined areas, including outcome based approaches to

pathway management

To reduce expenditure by making people responsible for their own health

To address some of the Information Technology challenges to allow primary care clinicians to feel


Business


Period

Progress update

Reducing Variation In Referral Practices

6.1.1 Complete pilot phase of an

information workflow process (DXS)

Quarter 1 Complete. The DXS system has been implemented across all practices.

Monitoring of practice usage of the system is occurring and the use of the

system has been included as an indicator within the GP federation contract.

6.1.2 Implement DXS across all practices Quarter 2 See section 6.1.1

A new online training package is being explored as part of the drive to

increase utilisation in practices. Review currently being conducted of DXS to

provide recommendations on the future of the service and evaluation of its

use in Lambeth. This will include a visit to Camden to look at how they use

DXS. The internal review is planned to be completed by end of Feb 2016.

6.1.3 Development of checklists in key

areas and implement onto DXS

Quarter 3 There are two areas where checklists are still being finalised. The

completion of these is due in Q4.

Ophthalmology

6.1.4 Agree and sign new contracts with all Quarter 2 MECS contracts and service specifications have been signed by all 9 MECS

54


Business


Period

Progress update

MECS providers, increasing

providers to 10

providers that are currently operating. Work has progressed with recruiting

an optometrist Provider in the Streatham and Clapham area. Optometrists

in Specsavers Clapham - start date has been put back to February 2016.

Reduction In Trust Led Referrals

6.1.5 Acute contracts agreed with

reductions in trust led activity

Quarter 1 Agreed acute contracts included reductions in trusts led activity including the

areas of Follow up appointments and consultant to consultant appointments

Diagnostics

6.1.6 Implement process to identify

potential areas for improvement that

could deliver efficiencies within

2015/16

Quarter 2 Work plan identified in pathology.

Workplan to be agreed for imaging, meeting in December to agree.

Priority areas address quality issues and are unlikely to deliver financial

efficiencies during this financial year.

Implementation of e-Referrals

6.1.7 Improve functionality of e-referral advice and guidance function

Quarter 4 ERS meeting with Providers and Southwark planned for end January.

Advice and guidance plan to be discussed but unlikely to make any impact

until 16/17.

6.1.8 To understand and monopolise on

the improvements that e-referral

offers and aim to increase utilisation

of e-referral in primary care

Quarters 2-

4

Action plans to increase utilisation, which were delayed due to system

instability, are now being reinstated. Provider/CCG interface meeting on

ERS now established bi-monthly. Training plan agreed for ERS and

implementation commenced. Low utilisation practices identified and

targeted for training. ‘How to….’ guide distributed to all practices. ERS-only

access pilot for LIMS service being planned for Q3 2016/17.

55


Business


Period

Progress update

6.1.9 To devise a work plan that aims to

encourage local Trusts to further

improve their ‘Directly Bookable

Services’, ‘Named Clinician in

Service Name’ and increase their

specialty clinics

Quarter 1 See 6.1.8. Draft workplan produced to be agreed January 2016.

5.2.5 Long Term Conditions/Medicines Optimisation


Clinical Lead Dr. John Balazs (Long term conditions), Dr Di Aitken and Dr Sadru Kheraj (Medicines Optimisation)

Programme Lead Vanessa Burgess, Assistant Director & Chief Pharmacist.

Scope of business area The purpose of this business area is to improve the quality and length of life of people with one or more long term

conditions, to promote the clinical and population behaviours, which allow the right care to be delivered in the

right setting. We aim to do this by commissioning high value, patient-orientated outcome clinical interventions

which aim to support self-management though joint decision making with patients and importantly address parity

of esteem for mental health.



Improve quality and length of life for people with long term conditions by commissioning high value,

accessible patient-orientated outcome clinical interventions for people living with long term conditions.

Empower patients with long-term conditions through enriched clinical consultations – development of

56

coordinated care, shared decision-making, prevention, emotional support and self-management.

Focus on prevention and improve the recognition, diagnosis and interventions for improving care

specifically in respiratory and cardiovascular disease including diabetes.

Reducing the need for unscheduled care and unnecessary out-patient activity for people with long term

conditions by education and improving focus on prevention and self-management.

Work closely with clinicians and the mental health programme to ensure that mental health needs of

patients with long term conditions are incorporated into pathways.

57


Business

Plan Ref:

Objective Delivery

Period

Progress update

Commissioning Integrated Services

6.2.1 Benchmarking population needs – assessment

of data for long term conditions outcomes.

Quarter

1

Complete

Data analysis with Public Health on evaluating mental health needs

of people with Long Terms conditions is underway as part of the

evaluation and mainstreaming of the 3DFD service (3 dimensions of

care for Diabetes).

6.2.2i Community management of Diabetes (via

Diabetes intermediate care team) re-

commissioned for 15/16.

Quarter

1

Complete, Diabetes Intermediate Care Team (DICT) service recommissioned until 31.3.16. Scoping of commissioning model for the DICT service for 2016/17 is undergoing evaluation of evidence base on outcomes based diabetes contracting and understanding models used in other areas – meetings with Camden CCG and Islington CCG have been completed. Darzi fellow: a workplan has been agreed covering severe mental illness (SMI) and structured education programmes; increasing the number of people with severe mental illness who attend structured education, completing service evaluations of currently commissioned structured education programmes and designing modified-structured education for people with SMI with a view to rolling this out across Lambeth practices. Complete, National Diabetes Audit (NDA) 2014-15 - 100% of practices participated.

58


Business

Plan Ref:

Objective Delivery

Period

Progress update

Education for practices – peer support and learning: DICT have been commissioned to provide 2 practice events. Delegates from 38 practices attended the event on the 19 November 2015. Feedback on the presentations and case studies were very positive with all evaluations stating the sessions had improved their knowledge 'quite a lot' or 'a great deal' 57 bookings have already been received for the second learning event in March 2016. Ensure cost effective prescribing in diabetes via active promotion of QIPP projects and audit against NICE guidelines. The Lambeth Diabetes Intermediate Care Team have moved into the third phase of implementation of reviewing Blood Glucose Monitoring in people with uncomplicated type 2 diabetes. The CCG are developing plans to commission community pharmacists to co-deliver this initiative with Lambeth GP practices and Lambeth DICT. Scoping potential for a combined CVD and diabetes network to embed learning into other LTCs. Update: A focus group for leads from each LTC area, LCN leads, Federation c hairs, Acute Trusts and Healthwatch has been arranged for February, faciliaited by South London HIN. This will also plan a future workshop to be attended by a broader group of stakeholders, to scope and progress the development of a Lambeth and Southwark LTC Network. Optimising type 2 diabetes care via search and virtual clinic.

Target: patients with uncontrolled HbA1c - 64 mmol/mol or greater

59


Business

Plan Ref:

Objective Delivery

Period

Progress update

(QOF) and sub-optimal medicines. Included in LTC scheme, GP

Delivery framework. 39 out of 47 practices have completed their

first virtual clinic to date.

Ten practices have been offered additional support by the DICT to

improve clinical outcomes for patients. The practices were selected

based on Quality and Outcomes Framework (QOF) clinical domain

data relating to HbA1c, blood pressure and total cholesterol as well

as expected prevalence data.

8 out the 10 practices have accepted the offer. The Diabete

Specialist Nurse linked to each practice has made contact and intial

visits are underway to meet and discuss the best way to support

each practice.

Lambeth CCG and Local Authority submitted a joint expression of

interest with CCGs/LAs in South London in October 2015 to be part

of the first wave of the NHS England Diabetes Prevention

Programme. NHS England are working towards an announcement

regarding wave 1 sites shortly.

The HeLP-Diabetes (Healthy Living for People with Diabetes)

Programme has been launched - a new online resource has been

commissioned for Lambeth people living with type 2 diabetes for

one year.It will allow people living with Type 2 diabetes to access

structured –education online.

60


Business

Plan Ref:

Objective Delivery

Period

Progress update

Resources to support practices in promoting HeLP-Diabetes to

patients have been shared via emails, bulletins and webpages and

will be uploaded to DXS.

Decembers monthly report from the HeLP-Diabetes team

highlighted that 19 patients have registered on the programme and

8 practices have referred patients into the service since the team

presented at the diabetes learning event in November 2015. Thirty-

five patients were registered prior to this.

6.2.2ii Performance indicators agreed and reports

monitored for 15/16.

Quarter

1

Complete.

6.2.3i Hypertension service re-commissioned for 15/16

with updated performance indicators and

reports.

Quarter

1

Community hypertension service – GSTT outreach and virtual clinic

service recommissioned for 15/16.

Ambulatory Blood Pressure Monitoring (ABPM) - Aim to obtain

further information regarding the service and the different models

across the borough to allow evaluation of the service and design of

the future delivery model. Practice survey is complete and results

are being collated for presentation at the next CVD steering group.

Secondary care activity data has been requested in order to review

all ABPM activity since the introduction of the practice based

service. A service evaluation report and options appraisal for future

commissioning is due to be discussed at the January Integrated

Adults Programme Board.

61


Business

Plan Ref:

Objective Delivery

Period

Progress update

Hypertension – optimising management. Over 15/16, identify a

target cohort of uncontrolled HT patients - BP systolic >160 or

diastolic >100mmHg for optimisation. Each practice holds a

minimum one annual CVD virtual clinic plus HT clinic referral where

needed for complex patients. Implementation plan for practice to

include learning from previous work, and action planning to optimise

patients identified. Offer lifestyle advice & stop smoking. Included in

LTC scheme, GP Delivery framework. An update from the

hypertension team was received in November at which point 37

practices have their virtual clinic booking confirmed. A further

update has been requested. Remaining practices are in the process

of being contacted by the link pharmacists.

6.2.3ii Equality objective for Hypertension delivered. Quarter

4

6.2.3iii Performance indicators for 15/16 for the

community heart failure service and reports

monitored.

Quarters

1-4

The service specification and KPIs for 16/17 are due to be ratified

at the January Integrated Adults Programme Board. Providers have

shared data relating to delivery of the currently commissioned

service. This data consists mainly of activity data rather than

outcome data due to data collection problems which have now

been resolved. Meetings are in place to plan the implementation of

the successful heart failure charity bid for 7 day working, moving

care into the community and aligning with Federations and locality

care networks. A key focus of this work will be to look at how to

integrate across other long term conditions and how to deliver

improved outcomes for our patinets and reduced heart failure

62


Business

Plan Ref:

Objective Delivery

Period

Progress update

admissions across the system.

6.2.3iv Ambulatory Blood pressure monitoring service

reviewed and re-commissioned by April 2016.

Quarter

4

6.2.3v Performance Indicators developed and

monitored.

Quarters

1-4

As 6.2.3i.

6.2.4 Integrated respiratory team (based @KCH) re-

commissioned for 15/16.

Pharmacist support to enable medicines

optimisation in respiratory disease.

Quarter

1

Quarter

1-4

Complete for 15/16.

Complete

Optimise care of asthma patients via virtual clinic.

Discuss information from the Quality Asthma Review Pyramid to;

1. develop a practice specific action plan to improve asthma care

2. Implement the action plan with a progress report by March 2016

and Identify patients on high dose Inhaled corticosteroids and step

down as clinically appropriate

Included in LTC scheme, GP Delivery framework.

Optimise care of Chronic Obstructive Pulmonary Disease (COPD)

patients – in 15/16 each practice identifies cohort of patients to

discuss during IRT VC;

1. Patients on high dose inhaled corticosteroids with mild/mod

COPD.

2. COPD patients with any recent urgent care episode (A&E,

hospital admission).

63


Business

Plan Ref:

Objective Delivery

Period

Progress update

Complete a review with IRT Support using the COPD review

template and CCG prescribing guidelines.

Increase referrals of people with COPD and tobacco dependency to

specialist stop smoking services via singlepoint of referral.

All clinicians to strongly consider completion of NCSCT VIncluded

in LTC scheme, GP Delivery framework.

100% of practices have booked a virtual clinic.

Education for practices – (1) PLT event with 80 in attendance,

focussing on cough, breathlessness and asthma to support delivery

of LTC scheme. (2) IRT to provide additional afternoon training

sessions, on spirometry, asthma and COPD in Q3 and Q4 – all

events have booked attendance at 80 – 100%.

Patient support – pilot project involving Self-Management UK is

being streamlined with the established Breatheasy group as an

alternative mechanism to support reluctant patients into Pulmonary

Rehab service. BA training and if already completed then Level 1

quit smoking training. Lambeth patients participating in Singing for

Better Breathing study.

Establish a SEL Responsible Respiratory Prescribing group to

report to the SEL Area Prescribing Committee. Terms of reference

have been agreed with the APC and the group is meeting in

November 2015.

The SEL Responsible Respiratory Prescribing group has met and agreed to develop a respiratory management guideline and

64


Business

Plan Ref:

Objective Delivery

Period

Progress update

pathway for asthma and COPD across SEL. Discussion was held around inhaler device and drug choice, with initial agreement on some drug classes made. The guideline will be developed and further discussions will be held around remaining drugs and relevant devices.

6.2.5i Performance indicators for the IRT service for

2015/16 developed and monitored.

Quarter

1

Review underway. Final indicators to be agreed at November Core

Group meeting. Focus on holistic patient outcomes. Range of

metrics are being discussed, for example: the “Asthma pyramid”,

and a similar pyramid for COPD for accessible data from EMIS.

Also patient-reported outcome measures to ensure the patient

experience is captured.

6.2.5ii Community Spirometry service to be

commissioned for 2015/16 in line with approved

business case.

Quarter

1

The service specification is complete and has been sent to localities

for expressions of interest. Alternative models of provision including

via IRT are being explored and a paper will be taken to the

Integrated Adults Programme Board in December/January.

Implementation during Q4, anticipated start date no later than April

16.

Update to the spirometry business case:

The IRT are progressing the spirometry service via their business

planning process, and are expecting final sign off from KCH at the

end of January. Federations have been updated.

6.2.5iii Performance indicators to be developed and

monitored.

Quarters

1-4

As 6.2.5i.

6.2.7i Commission mental health support for people with Quarter

65


Business

Plan Ref:

Objective Delivery

Period

Progress update

LTCs for 2016/17. 4

6.2.7ii Embed and mainstream the learning from the

3DFD pilot

Quarters

1-4

Mainstream the service over the next 12 months.

Interim funding for 15/16 agreed. The first review meeting with

KCH has taken place in June and it was agreed to pursue 2 routes

concurrently ;

1. Contribute to the Trust led amended bid to the Health

Foundation to continue the service and roll out to CVD patients

(Hypertension) – the “3DLC” proposed model. A second stage

application for funding for 3DLC has been supported by CCGs in

October on the basis that agreement on alignment with currently

commissioned pathways is agreed over the next few weeks.

2. Lambeth CCG has met with the IAPTs provider (SLAM) in

July to discuss meeting needs of patients with LTCs. To identify the

small cohort of complex patients who will need more intensive

support and how that can be provided for all patients with LTCs

using the learning from 3DFD. This will be further progressed over

Autumn.

Commissioning For Outcomes

6.2.8 Establish a steering group to scope a model of

care for enabling quality care and self-

management for patients with LTCs, possibly via

an outcomes based/year of care approach to

commissioning long term conditions services.

Quarter

2

Initial scoping underway internally.

66


Business

Plan Ref:

Objective Delivery

Period

Progress update

GP Delivery Scheme 2015/16

6.2.9 Consult and agree on a scheme with General

Practice and federations to improve self-

management and optimisation for people with

LTCs and obtain best value from medicines.

Quarter

1

Promote care planning and shared decision making via

personalisation in patients with long term conditions through

incentivising enriched clinical consultations – development of

coordinated care, shared decision making, prevention, emotional

support and self-management.

CVD and diabetes virtual clinics and medicines reconciliation

ensure adoption of care plans into practice in primary care.

Included in Long Term Conditions Scheme 15-16 which has been

launched via 3 launch events with 100% attendance from

practices. The scheme has been designed to build on proven

successful interventions by the virtual clinic model of care in key

elements of CVD, Respiratory Disease and Diabetes plus

Medicines Reconciliation in primary care.

Phase 2 of the LTC scheme scoping is delayed due to lack of

system capacity. This will now be incorporated into commissioning

intentions and plans for 16/17.

6.2.10 Deliver medicines QIPP plan and financial

balance on prescribing budget.

Quarters

1-4

The Medicines Optimisation Scheme 2015-16 has successfully

been developed and fully consulted with stakeholders. The key

areas are: Cost Prescribing Efficiencies; Repeat Prescribing

Systems and Waste Reduction; Patient Safety on Antibiotics. The

scheme has been designed to progress on foundations laid from

the 2014-15 scheme for example practices will be asked to

67


Business

Plan Ref:

Objective Delivery

Period

Progress update

minimise the risks identified within the Repeat Prescribing Support

Day visits.

ScriptSwitch continues to be actively managed to raise potential

savings within all practices and the profile review and rationalisation

is 80% complete

CCG commissioned high cost drugs spend is monitored and

inappropriate charges are challenged monthly.

The GSTfT and KCH High Cost Drugs Policy for 15/16 has been

agreed. Key Performance Indicators have been agreed for KHP.

Regular medicines contracting meetings are held quarterly with

Trusts and medicines/CSU teams.

Collaboration on cost effective use of high cost drugs is via pathway

development as part of SEL APC.

Lambeth CCG continues to have representation on the GSTfT

Medicines Safety Forum and the SLAM Medicines Safety

Committee to facilitate learning across organisations on medicines

errors.

The three Electronic Prescribing System (EPS) workshops for

practices took place in September and were well subscribed with

representatives from 41 practices and 9 community pharmacies

attending. Feedback from attendees was positive, with the

opportunity to obtain peer support and address questions directly to

EMIS Web/HSCIC/CSU representatives cited as particularly helpful.

Medicines Waste Campaign materials have been agreed and

68


Business

Plan Ref:

Objective Delivery

Period

Progress update

circulated, commissioned alongside other SEL CCGs via the CSU.

6.2.11 Deliver effective implementation of the LTCs and

Medicines schemes – communications,

specialist support, resources and monitoring.

Quarters

1-4

Ongoing.

6.2.12 Scope phase 2 of the LTCs plan – mental health

inclusion in LTCs, shared care for medicines,

osteoarthritis.

Quarter

3

Included in the scoping and development of 2016/17

commissioning intentions

Enabling Self-management And Resilience: Allied Health Professionals

6.2.13 Support GP federation/local care network to

promote extended consultation times in primary

care for complex younger people with long term

conditions not currently included in the holistic

assessment process.

Quarters

1-4

Holistic Assessments now available for over 65 years.

Care planning for younger people via LTC virtual clinics.

6.2.14 Commission a scheme to deliver routine

pharmacist support to the frail elderly taking

complex medication regimens in the community.

Quarter

1

Complete – service business case for an Integrated Pharmacy

Service for Older People was approved by the Committee in

Common in October 2015.

A Community Pharmacy Older Peoples Support service for ongoing

medicines and support in the community is being scoped and a

business case will be submitted to the Committee in Common in

early 2016.

69


Business

Plan Ref:

Objective Delivery

Period

Progress update

6.2.15 Commission a domiciliary specialist clinical

pharmacy medicines assessment service for

complex frail elderly to enable local authority

social services and primary care to support

people in their own homes.

Quarter

3

Complete

6.2.16 Scope a scheme with the older people’s team

for incentivising waste management and

increasing quality of prescribing for community

pharmacies with a care home supply contract.

Quarters

1-2

Scoping

Enabling Self-management And Well-being: Community Access to Effective Medicines

6.2.17 Review of community pharmacy common

ailments scheme – list of products available

Quarter

1

The common ailments scheme has been reviewed and approved by

the Lambeth Borough Prescribing Committee - complete

6.2.18 Integrated working with local authority

commissioners to support development and

approval of patient group directions in local

authority commissioned services, and access to

medicines to support prevention and well-being

e.g. stop smoking, contraception.

Quarters

1-4

Work has been undertaken to support the local authority to develop

and approve a range of PGDs for use by Community Pharmacists

and Brook Sexual Health Clinic nurses.

Safe Transfer of Information Between Care Settings

6.2.19 GSTFT and KCH Medicines CQUIN – develop,

monitor and embed into routine practice. CQUIN

is delivery of a robust medicines review in high

Quarters

1-4

Year 2 CQUIN on medicines review and communication from acute

trusts with GSTfT and KCH – agreed to include learning from year1.

70


Business

Plan Ref:

Objective Delivery

Period

Progress update

risk polypharmacy patients admitted to hospital

which is well communicated to primary care on

discharge

6.2.20 LTCs scheme (GP Delivery Framework)

incentivised medicines reconciliation in primary

care in line with NICE NG5, March 2015.

Quarter

4

Medicines Reconciliation in primary care included in the LTC

scheme, GP Delivery Framework.

Collaboration Across South East London

6.2.21 Active engagement and leadership (hosting

function) from Lambeth CCG for the SEL Area

Prescribing Committee and work streams.

Quarters

1-4

Shared care guidelines for rheumatology are developed and

undergoing final approval via the Area Prescribing Committee.

6.2.22 Ensure that medicines related IFRs are

progressed in a timely manner in line with

current policy.

Attendance at IFR panel meetings.

IFR policy in place.

6

monthly

report

Ongoing

71

Medicines Optimisation & LTC – data element

A. Overall Performance 2015/16 (Month 7) Overall the prescribing budget underspend at Month 8 is £358,033 (1.5%, see finance

report). The North is underspent by 2.8%, the South East by 1.2% and the South West by 1.0%

Spend per ASTRO-PU (data available quarterly)

NHS England Antibiotic Quality Premium Monitoring Dashboard (12 month rolling data)

Green = target met

QIPP Savings Plan

72

5.2.6 Older People

Responsible Director Moira McGrath, Director of Integrated Commissioning Adults

Clinical Lead Dr. Lisa Le Roux

Programme Lead Liz Clegg, Assistant Director Integrated Commissioning, Older Adults

Scope of business area Lambeth CCG is one of a range of partners who form the Lambeth and Southwark Integrated Care

Programme (known as SLIC). This three-year integrated care programme has been funded by a

grant to the value of £10.2 million awarded by Guys and St Thomas’ Charity in March 2012.


The objectives of this business area are:

Older people will remain independent and are able to manage their health well with the right

level of timely support and advice when they need it to remain at home

Fewer older people will be admitted to hospital or care home

Redesign of local health and social care systems supporting the shift from bed to community

based care


Business

Plan Ref:

Objective Delivery

Period

Progress update

Intermediate Care

6.3.1 Determine approximate number of

beds required for bed-based

intermediate care to inform a move

from block to tariff commissioning

Quarters 2-

4

Awaiting defined pathways and costs for bed based, double handed home

based and extended LOS in acute hospitals to support decision regarding

numbers of intermediate care beds required. Southwark CCG will commission

a small amount of Lambeth intermediate care beds on a block contract and a

73


Business

Plan Ref:

Objective Delivery

Period

Progress update

position for 2016/17 proportion of other beds will potentially be used for Level 2b neuro-rehabilitation

beds.

6.3.2 Clarify pathways to intermediate care

services for improved referral

processes

Quarter 2 As per above.

6.3.3 Stimulate bed-based intermediate care

market for commissioning 2016/17

Quarters 2-

3

Commenced pilot to use of 2 extracare flats as stepdown ‘discharge to assess’

as a test

Dementia

6.3.4 To set locally agreed waiting time

targets and monitoring mechanisms.

Quarter 2

Need to agree targets with Southwark and SLaM and include in 16/17

contracting round.

6.3.5 To work with provider to ensure

efficiencies

Quarters 2-

3

Work to commence next quarter

6.3.6 To develop business case for further

resources if unable to meet waiting

time targets having exhausted all

efficiencies

Quarters 3 -

4

6.3.7 To commission co-produced post

diagnosis support service

Quarters 2-

3

Work to commence quarter 3

6.3.8 Working across LBL and CCG

modernise the older people’s day

services and to provide choice for

service users, as well as developing

Reviewer post recruited to, a number of staff meetings have taken place in

June/July and meeting with service users and carers took place over August.

Day service attendees are currently being reviewed, final report due Jan/Feb.

Second provider event with over 40 participants took place in November 2015

74


Business

Plan Ref:

Objective Delivery

Period

Progress update

the local day opportunities market to

include those who wish to self-fund

to update service users and their families and carers on progress on the review

and to communicate some initial findings. Final review report due Feb, will

inform the business case for new day activites offer which will be developed in

2016/17

6.3.9 Working across LBL and CCG

modernise and commission an

assistive technology, response and call

handling service which will enable

savings to be made whilst delivering a

more targeted, responsive service.

Quarters 1-

4

Bench marking information gathered and workshop event held with local care

management staff and other boroughs to gather evidence on models of

provision.

Options appraisal document has been produced to help enable decision making

for the way forward.

Community Services

6.3.10 Roll out of Unified Point of Access for

health and social care services

Quarters 1-

4

Work being progressed and monitoring through the GSTFT contract monitoring

meeting

6.3.11 Evaluation of Neuro-rehab scale up

pilot

Quarters 2-

4

GSTFT contract monitoring meeting agreed extension of pilot based on interim

evaluation report.

6.3.12 Implementation of Pal@home and

access to 24 hour community nursing

support for patients with EOLC needs

Quarters 2-

3

Pal@home model went live in November 2015

6.3.13 Work with GSTFT to explore new and

improved ways of delivering integrated

community nursing services

Quarter 2 Task and Finish Group including commissioning representation established to

look at possible models.

Test model being developed – likely to be small scale around 2 GP practices in

75


Business

Plan Ref:

Objective Delivery

Period

Progress update

Lambeth and Southwark

Integrated Care

6.3.14 Establish and develop the Committee

in Common to support progression of

BCF

Quarter 1 Committee in Common now in place, TOR and membership agreed. Forward

plan to be developed

ACTION COMPLETED

6.3.15 Refine reporting template for Better

Care Fund (BCF) for measuring and

monitoring against defined metrics for

Health and Wellbeing Board, and to

national BCF team Q1-2.

Quarters 1-

2

Reporting to BCF National Team now based on SUS. Reporting for local quality

metric being devised.

ACTION COMPLETED

6.3.16 Consider current BCF delivery

programme for extension to 2016/17,

and other services that could be

included in an integrated service

Quarters 2-

3

New national guidance issued January 2016. Health and Wellbeing Boards to

submit refreshed BCF plans for 2016/17 by mid April. Self assessment on BCF

delivery to be submitted to NHSE by beginning of February. Process and key

themes to be agreed by the Committee in Common

Reablement Service

6.3.17 To review and revise reablement

specification following market failure of

previous community support provider

GSTT have agreed to host the integrated Reablement service including

Reablement Support Workers (RSW). Project manager being recruited, adverts

out for RSWs. Business case for additional CCG investment to roll out

Reablement offer to community referrals being developed

76

Integrated Care Home Commissioning – performance management

Dulwich Care Centre (DCC)

DCC is a care home registered to provide care for older adults with physical needs and for people with dementia. DCC service is currently

suspended. Monthly meetings with commissioning and care management continue.

Collingwood Court Nursing Centre (CCNC), BUPA

CCNC is a care home registered to provide care for older adults with physical need and for people with dementia. CCNC service was suspended on

26 October 2015 and other placing boroughs and CCGs were informed of the suspension. An initial meeting between CCNC management and

Lambeth commissioning and care management was held on 18 November 2015. A comprehensive action plan has been developed to respond to

concerns raised. Monthly meetings with commissioning and care management continue.

Laurels Care Centre (LCC)

LCC is a care home register to provide accommodation for persons who require nursing or personal care. LCC service was suspended on 24

December 2015 and other placing boroughs and CCGs were informed of the suspension. In advance of the suspension, Lambeth commissioning

met with management of the home regarding concerns identified via unannounced visits. Lambeth care management and Care Home Support Team

have reviewed the home and Lambeth residents and an Investigating Officer (IO) will review specific alleged concerns relating to physical health of

one resident. Following the report from the IO, a Provider Concerns meeting will establish whether the suspension remains or can be lifted.

77

5.2.7 Continuing Healthcare

Responsible Director Moira McGrath, Director Integrated Commissioning (Older People)

Clinical Lead Dr. Lisa Le Roux

Programme Lead Liz Clegg, Assistant Director, Integrated Commissioning, Older Adults

Scope of business area Evaluation of Continuing Healthcare pathways ensuring patient centred care.



To continue the roll out of Personal Health Budgets for patients deemed eligible for fully funded

NHS Continuing Healthcare.

To continue with the National Retrospective Appeals work in accordance with Department of Health

guidance, ensuring continued monitoring of the impact of the appeals.

To continue working with the London Purchased Healthcare Programme (LPP) in relation to further

AQP developments.


Business

Plan Ref:

Objective Delivery Period Progress update

6.5.1 Increasing the uptake of personal health

budgets for patients identified as being

eligible for fully funded NHS Continuing

Healthcare

Quarters 1-4 There are currently 15 fully funded CHC patients receiving a PHB,

and 1 joint funded service user receiving a PHB.

6.5.2 Continue the project to assess appeals for

Previously Unassessed Periods of Care

(previously called Retrospective Continuing

Quarters 1-4 The CCG has commissioned an outside organisation to complete the

clinical reviews for the remaining claims. All of the claims have been

sent to the organisation for processing. The CCG has been holding

78


Business

Plan Ref:


Healthcare Appeals) appeals panels since October 2015 to consider the claims. Eight

claims have been considered at the appeals panel, two of which have

resulted in a restitution payment being agreed. NHSE requires all of

the claims to have been completed by the CCG by September 2016.

The current trajectories indicate the CCG will have completed all of

the claims by July 2016.

6.5.3i Monitor the current AQP contract for

Continuing Healthcare placements

Quarters 1-4 The CCG continues to review all CHC placements under the AQP

contract. The AQP contract service specification will be reviewed

during the year by the LPP in conjunction with all the London CCGs in

the contract, as part of the agreement to extend the contract for a

further two years

6.5.3ii Work with GSTT to develop new model of

continuing care provision at Minnie Kidd

House

Quarter 3 Work is progressing with the new model of continuing care that will be

delivered at Minnie Kidd House. Negoiations are underway with

GSTT to agree contractual arrangements for these beds for 2016/17

6.5.4 Review the CCG’s compliance with NHSE’s

Quality Assurance Framework for Continuing

Healthcare

Quarters 1-4 In late October 2015, the CCG was notified of NHSE’s proposal for a

“Deep Dive” on CHC. The CCG has collated the evidence for each

KLOE and has provided all of the information to NHSE via the on-line

CHC data collection tool. This will take place on the 9th of March

2016.

6.5.5 Work with Southwark CCG and the

Integrated Care programme to review the

‘Health Offer’ to nursing homes in Lambeth

Quarters 1-4 On-going discussions with Southwark CCG and SLIC lead regarding

contracting position.

Urgent Care Working Group funding falls training in nursing and

residential homes across Lambeth and Southwark for completion in

Q4.

79


Business

Plan Ref:


6.5.6 Work jointly with Lambeth Council to review

the quality of care provided in the Lambeth

nursing homes

Quarters 1-4 On-going integrated work on improved safeguarding processes.

‘Provider Concerns’ policy has been approved and is being rolled out.

Audit of LBL processes for monitoring care homes has been

completed and draft report shared with commissioners. Final report

with action plan to be ready by the end of February 2016

5.2.8 Urgent Care

Responsible Director Andrew Parker, Director Primary Care Development

Clinical Lead Dr. Paul Heenan

Programme Lead Bisi Aiyeleso / Sara White, Assistant Director Service Redesign

Scope of business area To ensure that patients can access urgent care services appropriately within Lambeth.



Enable patients to better manage their health and choose the most appropriate care settings

through the provision of comprehensive communication and self-management strategies.

Develop innovative ways to improve access to General Practice and offer patients consistent

access to urgent and unplanned care within primary care.

Develop access to alternative pathways to primary care for patients accessing the emergency

department who could be managed elsewhere

Commissioning to ensure that Urgent Care is better configured to deliver for example a front ended

co-located Urgent Care Centre within ED on the St Thomas’ site, supported by consistent communications

80

and signposting of patients.

To provide sufficient pressure surge management support to the urgent care system, particularly in

winter but also at times of pressure such as heat wave or infection outbreaks.


Business

Plan Ref:

Objective Delivery

Period

Progress update

Development and Implementation of Urgent Care Strategy

6.4.1 Full implementation of the community

pharmacy redirection scheme to

support redirection of appropriate

patients from St Thomas ED

Quarter 2 This scheme was raised with GSTT on the 05.01.16. GSTT advised that

patients that do not need to be seen in A&E are triaged out and referred to a

Pharmacy i.e. treatment for head lice, coughs and colds. The trust does not feel

the scheme is required as patients who require a Pharmacy are not usually

seen in A&E. Recommend through decision making forums that Pharmacy MAS

scheme specific to GSTT does not continue.

6.4.2 Maintain target for patients seen within

St Thomas ED who are managed

through the UCC

Quarters 1-

4

The UCC saw a decrease in activity for M9. The scheme has performed under

target for the year to date with activity of 39,937 for M9 against planned year to

date target of 43,200.

Lambeth CCG held meeting on the 05.01.16 with GSTT and the following were

discussed

a. GSTT advised that Phase 2 of the ED building works to be completed in

April 2016. The final phase (Phase 3) will commence further to this with

completion due in 2017. Deputy General Manager and ED Head of Nursing to

brief Lambeth and Southwark Urgent Care Working Group (UCWG) on site

changes that will occur over the next year and the mitigating actions that are

being put in place to ensure 4 hour wait performance is maintained at 95%.

81


Business

Plan Ref:

Objective Delivery

Period

Progress update

b. Urgent Care service specification to be sent to GSTT to circulate the

spec internally for comments

c. Informed GSTT of the review completed on the GP diversion scheme

and the recommendation that the scheme should be decommissioned due to

the large number of non Lambeth patients being managed through the scheme

and alternative provision being available through the GP access hubs. The final

dicision will be made regarding the scheme once consultation on the

recommendation has occurred.

6.4.3 Usage of the GP Diversion scheme to

support the redirection of patients from

EDs

Quarters 1-

4

Continues to perform poorly. Following agreement at the IAB in December, it

has been recommended that this service be decommissioned, subject to

consultation as part of the CCG commissioning intentions for 2016/17. Should it

be agreed, the service will be given 6 months notice.

6.4.4 PALs officer support to unregistered

patients to register with a GP

Quarters 1-

4

This scheme has seen a decrease in activity for M9 in comparison to M8.

This scheme has not performed in line with target for the year to date falling

82% below the target

A lower number of unregistered patients are being seen in the trust compared

with when the scheme was initially started. This service may therefore not now

be needed for the future and is currently being reviewed in line with the GP

Diversion scheme.

6.4.5 Management of patients through the Lambeth Alcohol Recovery Service (LARC)

Quarter 4 Continues to perform well. The scheme has just come under target with a

cumulative year to date variation of -11. Final outurn performance is expected

to exceed the target.

6.4.6 Development of the LARC to include Quarter 2 In terms of incorporating patients under the influence of drugs in the model,

82


Business

Plan Ref:

Objective Delivery

Period

Progress update

patients under the influence of drugs initial discussions with the LARC lead consultant and the GST Toxicologists

identified there is already an established toxicology pathway from ED 24/7. This

scheme will therefore not be progressed as planned given lack of added benefit.

Implementation of UCC Service Specification

6.4.7 Contractual Negotiations around

specific tariffs and agree KPIs

Quarter 4 Meeting with the CGG and GST held in January. Urgent Care service

specification to be sent to GSTT to circulate the spec internally for comments.

6.4.8 Operational changes, 24/7 model,

phased implementation of revised front

ended UCC specification

Quarter 4 The UCC service is open 24 hours a day and within a dedicated facility until

2am (this was previously unitl Midnight). Once building work is complete the

UCC service will be available within a dedicated facility 24/7.

6.4.9 Improvement of the Clinical

streaming/PALS redirection of patients

to alternative Primary Care services

pathway

Quarters 1-

4

See 6.4.3 and 6.4.4. Work in this area continues as described above. Given

the poor performance of this workstream, work is planned to review it during Q3

and Q4.

6.4.10 Minors/primary Care Pathway to be

operational 24/7

Quarters 1-

4

This element will be delivered along with the redevelopment of the GSTFT ED

department.

6.4.11 Development of the ENP role,

recruitment of additional ENP’s and

24/7 working

Quarters 1-

4

Work commenced on this area during 2014/15 with ENP trainee’s being

employed by GSTFT. Competencies for ENP staff were agreed and have been

implemented.

6.4.12 Review urgent care pathway as part of

developing extended and enhanced

primary care services, including A&E

front end UCCs and WICs.

Quarters 1-

4

Work on this area will be completed as part of the prime ministers challenge

fund work. This work is currently in progress.

83


Business

Plan Ref:

Objective Delivery

Period

Progress update

Systems Resilience

6.4.13 Complete evaluation of 2014/15

systems resilience schemes

Quarter 1 Evaluation completed in Q3.

6.4.14 Work with providers to agree

underlying schemes that will be funded

through systems resilience monies

Quarter 2 For acute, social services, mental health, community and some voluntary sector

providers an allocation was made at the beginning of the financial year for the

implementation of winter resilience schemes.

10 schemes have been approved in the baseline winter funding and a further 6

via the contingency element of funding.

6.4.15 Develop monitoring process for

2015/16 systems resilience schemes

Quarter 3 The Urgent Care working Group monitor performance of the winter schemes via

an approved template.

5.3 Integrated Mental Health for Adults

Responsible Director Moira McGrath, Director of Integrated Commissioning (Older People)

Clinical Lead Drs Paul Heenan and Raj Mitra

Programme Lead Denis O’Rourke, Assistant Director

Scope of business area This business area aims to introduce three major structural changes to the system of care and support via

the new “front door” – the Living Well Network which will provide help and support much earlier than the

current system and provide a personalised and co-productive response via integrated multi-agency, multi-

disciplinary teams and ensure that secondary care services, via the SLAM AMH redesign, are focused on

early intervention and recovery and thereby reduce the “relapse” rates amongst the SMI population. The

84

third element of system change relates to the proposed Integrated Personal Support Alliance which aims

to radically transform NHS/social care rehabilitation services.



Improved health outcomes & experience for patients

Redesign of the local mental healthcare system supporting shift from acute to community

Strengthen individuals and communities capacity to self-manage at scale

Support a managed redirection of resources from secondary care to integrated care within primary

care/community setting.




on target?

5.3.2 Integrated Mental Health for Adults Programme Risk Register

For risks scoring 12 and above, 3C, 3N and 3M, please see the Board Assurance Framework.

Risk Title

Risk Register

where Risk is managed

Current Risk


Possible risk that the pathways between Programme 9 Mitigate Implement crisis care concordat plan including 24/7 crisis

85

Risk Title

Risk Register


Current Risk


secure services (commissioned by NHSE) and community are fragmented and under-developed possibly resulting in poor quality outcomes for the population group and persists in inequality experienced by Black and Caribbean community.

Board / Directorate

Risk Register

line from Oct 2015, crisis sanctuary from May 2015. Crisis sanctuary extended to 5 days a week from January 2016. Undertake focussed engagement with young black men with experience of CJS and mental health services in partnership with Time to Change, SLaM, Police etc – Oct 2015 - June 2016 Develop 'step down and move on' strategy with key partners e.g. SLaM and Voluntary sector and Social Finance (01/10/15) and ongoing. Seek agreement with NHSE on the ‘step down and move on’ strategy including shift in resources i.e from secure to community. Meeting has taken place - a proposal is being developed. Discussion with NHSE and SLaM and other CCG's - ongoing. Social Value (Offender Management) Programme pilot - could offer an opportunity to develop integrated commissioning approach including NHSE, HP Brixton, Lambeth Council and Probation Service and MOPAC. Currently reviewing options on next steps for this project - March 2016.

86

5.3.3 Mental Health Whole System Dashboard

Mental Health Whole System Dashboard 2015/16 - NOVEMBER

Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16

1 2 3 4 5 6 7 8 9 10 11 12

AMH Redesign

1 ACTUAL 1589 1956 1987 2047 2016 1786 1852 1523

TARGET 1847 1856 1797 1856 1857 1795 1857 1796 1857 1856 1736 1358

2 ACTUAL 22 60 90 123 163 195 229 260

Cumulative

TARGET35 70 105 140 175 210 245 280 315 350 385 420

3 ACTUAL 65 63 74 75 55 59 57 56

TARGET 50 50 50 50 50 50 50 50 50 50 50 50

4 ACTUAL 22 43 76 97 116 160 184 200

Cumulative

TARGET30 60 90 120 150 180 210 240 270 300 330 360

5indicator indicator

Aim is to reduce the number of

detentions that follow MHA

assessments. Currently 95%.

95 97 93 110 90 104 88 93

6

0 0This is a never never event and a key

expectation of the national crisis care

concordat.

0 0 0 0 0 0 0 0

7<7.5% <7.5%

The aim is to keep the delayed

transfers of care to an absolute

minimum. 3.4% 3.2% 2.3% 1.9% 1.8% 5.1% 11.1% 9.5%

8 ACTUAL 154 272 422 895 1216 1520 1919 2299

Cumulative

TARGET144 288 432 632 832 1032 1232 1432 1632 1832 2032 2232

9 ACTUAL 40 44 46 46 49 61 59 63

Cumulative

TARGET45 50 55 70 90 120 150 180 210 240 270 300

10 ACTUAL 319 330 326 336 327 315 339 347 354

TARGET 300 300 300 300 300 300 300 300 300 300 300 300

11 ACTUAL 52 131 224 320 385 436 496 558

Cumulative

TARGET50 100 150 200 250 300 350 400 450 500 550 600

12 ACTUAL 608 580 531 699 528 567 667 552

TARGET 552 552 552 552 552 552 552 552 552 552 552 552

13 ACTUAL 50% 50% 46.2% 49.5% 46.1% 48.3% 44.4% 50.0%

TARGET 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%

14 ACTUAL 5 10 20 26 31 36 41 45

Cumulative

TARGET0 3 6 10 14 18 22 26 30 34 38 41

ACTUAL 2 9 15 20 29 32 33 36

15Cumulative

TARGET4 7 9 22 26 30 37 42 47 58 62 69

Number of people on GP+ 40 300At the close of 14/15 there were 40

people on GP+. The target of 300 ppl on

GP+ will be reached by March 16.

Number of 'new' people accepted by

IPSA0 69 Service went live 1 April 2015

250 300

Number of people entering treatment

into Integrated Talking Therapies

Integrated Talking Therapies recovery

rate of people in treatment

Integrated Personalised Support Alliance

Number of 'legacy' people moved on 192 41

552

Service went live 1 April 2015

Comment

The aim is to reduce overall bed usage. 13571852

120 420Aim is to reduce referrals to no more

than 35 per month. The average for

14/15 60 p/m.

We want to see an increase in HTT

capacity which will contribute to a

reduction in admissions.

144

This includes those people accessing

enablement and membership of LWP.

The target is to support 300 ppl p/m

50%

The actual number of ppl who started

treatment. A provider generated figure

which is ratified by HSCIC 3 mths later.

This is the % of ppl who have entered

and completed treatment who have

achieved 50% recovery rate.

Numbers of accepted referrals to HTT

People discharged to Primary Care

(will also include those discharged

into GP+)

5040

30

Target / Indicator (I)

Baseline

starting

point

End Point

Occupied Bed Days and bed number

trajectory

Referrals to CMHTs

Number of people accessing out of

hours Peer Support (SiaC)40 600

Ppl accessing this service usual during

or following an A&E attendance. We

will review this in Sept to take account

of 24/7 crisis line. Target to support

min 50 ppl p/m

Number of people supported at Living

Well Partnership (Mosaic)

Number of people who experience a

crisis who end up being detained in

police custody

Percentage of delayed transfer of

care

2232

14/15 saw an average of 144

introductions per month. Provisional

target from July 2015 is 200 per

month.

360The aim is to discharge on average 30

people per month into primary care.

(i.e. LWN)

AMHPs assessments.

LWN including CIS

Number of introductions to the LWN.

RAG

rating

87

Mental Health Whole System Dashboard Commentary Commentary is provided below on a number of indicators of interest as highlighted in the table above. 1 OBD - Occupied Bed Days - We have discrepancies in reports from SLaM previously around OBDs. At M6 SLaM are on target with the OBD trajectory. 3. HTT (Home Treatment Team) - There were 56 referrals into HTT. 39 people did not have an admission, 7 people who then required admission, 10 taken onto caseload for early discharge from hospital. 4. Discharges to PC - There were only 16 discharges to Primary care in December. This will be addressed at the SLaM core contract meeting. 5 - AMPs - Historically the number of assessments has been high. i.e. 80+ per month. We want to reduce the overall number of assessments. Of the 93 assessments 76 lead to detention, 2 lead to informal admission, 15 did not lead to an admission, 20 S136 warrants obtained, 7 S136 warrants executed, 3 S136 used 7 - Delayed transfer of care - The target is above the target of 7.5% OBD. Previously, this has been consistently below the target. We have asked SLaM for detailed explanation for the significant increase. 8 - Introductions to the LWN - There were 380 people introdcued to the hub in September. There have been 264 closures to the hub. Of the 380 introductions 227 came from a GP, 9 from A&E, 25 from IAPT, 1 from JCP, 18 self-referrals (12 phone, 6 walk-in), 3 from MAP, 7 from Psychosis, 33 from police, 12 from LA, 2 from IPTT, 43 from other sources. The top 3 main reasons for introduction is: depression (58), psyhcosis (29), Housing (15) 9 - GP+ - There are currently 63 people who are on GP+. There have been 6 discharges from GP+ in November. 11 - SiaC - will be working with the SLaM 24/7 information/advice/crisis telephone line which goes live Dec 2015. 14 - This is the number of people who have been in either residential care or rehabilitation beds where the IPSA team have worked with them to move into the new service offer.

88



Business

Plan Ref:

Objective Delivery

Period

Progress update

7.1.1 Finalise Section 75 agreements for

mental health alliance services

Quarter 1 Completed. Section 75 Agreement agreed and signed, commenced 1 April

2015

7.1.2 Establish governance and programme

arrangements for implementation of the

mental health alliance contract

Quarter 1 Completed. Integrated Personal Support Alliance agreement signed and went

live 1 April 2015. A committee in common, the Integrated Commissioning

Committee, has been established between Lambeth council and NHS Lambeth

CCG to provide the overarching governance for the IPSA and Better Care Fund

(BCF).

7.1.3 Increase the proportion of people

receiving brief advice in mental health

services on alcohol, smoking and

physical activity

Quarters 1-

4

The Living Well Network (LWN) was launched as a borough wide multi-agency

service from 1 July 2015 (previously operated in the north of the borough since

November 2013) with the aim of providing a holistic range of support to people

with mental health problems much earlier than was previously available via

CMHTs. The LWN has significantly contributed to a reduction in referrals to

secondary care, from an average of 120 per month in October 2014 to c25 per

month (since June 2015) and is receiving over 300 “introductions” per month

and thereby supporting a larger volume of people with early support. Most

people are seen within 10 days (target is 48 hours) compared to at least a

month previously for “non urgent” referrals to CMHTS. The LWN teams

(currently operating at 80% staff capacity) have been allocated to support the

primary care locality care networks. Development work is underway to progress

toward an alliance contract agreement to support an expanded LWN from April

2016.

89


Business

Plan Ref:

Objective Delivery

Period

Progress update

7.1.4 Improve the health outcomes for

people in mental health services

Quarters 1-

4

An evaluation of the LWN outcomes is being developed through an evaluation

board chaired by Dr Sarah Corlett from Public Health together with Dr Paul

McCrone from IOP. This is being funded by the GST Charity grant and involves

qualitative and quantitative evaluation of the Collaborative big 3 outcomes. The

first (all borough) six month activity and performance report is being drafted by

the Provider Alliance Group (PAG). and will be available February 2016. The

IPSA service outcomes are being monitored by the Alliance Leadership Team

and the Integrated Commissioning Committee. The mental health dashboard

includes two core IPSA outcomes measures.

7.1.5 Work with providers to ensure robust

SDIP are in place to support delivery of

the new mental health access targets

Quarter 4 Draft action plans and trajectories are being developed between the CCG and

SLaM. Additional capacity to support delivery of the EIP target is being

negotiated as part of the 20161/17 contract.

90

5.4 Staying Healthy (Led by London Borough of Lambeth)

Responsible Director Dr Ruth Wallis, Director of Public Health, Lambeth & Southwark

Maria Millwood, Director of Integrated Commissioning (Public Health, Children & Young People, Adult Disabilities)

Clinical Lead Dr. Raj Mitra

Programme Lead London Borough Lambeth

Scope of business

area

The Staying Healthy Partnership Board (SHPB) is the lead partnership body reporting directly to the Health and

Wellbeing Board on strategy, action, investment and progress to prevent ill health, promote health and wellbeing and

reduce health inequalities of the Lambeth population. It also reports to the Lambeth CCG IGC.

The SHPB has oversight of local delivery against the Public Health Outcomes Framework, advises the Health and

Wellbeing Board on priorities for the Health and Wellbeing Strategy in line with the Joint Strategic Needs Assessment,

and has oversight of the commissioning of health services where responsibility has transferred to local government.

The group takes a strategic perspective on all staying healthy action and investment and holds other groups to

account for delivery. A number of groups with specific staying healthy responsibilities report into the Staying Healthy

Board and other groups and partnership boards in the Council and CCG report to it with respect to their specific

staying healthy commitments.

A Health Improvement Commissioning Group has recently been established to provide strategic oversight of the cross

cutting commissioning of the health improvement service portfolio that now falls within the council’s remit bringing

together commissioning and strategy around NHS Health Checks, tobacco control, substance misuse, homeless

health and related early intervention and behaviour change programmes including public mental health. This group

reports to the Staying Healthy Board.

Lambeth leads on the commissioning of sexual health services across Lambeth, Southwark and Lewisham via a tri-

borough agreement. Commissioners, partners and providers are engaged in a local transformation project to increase

the effectiveness of local sexual health pathways and services.

In summary, the main commissioning areas of work for the SHPB are:

Tobacco Control

91

Vascular Risk Prevention (NHS Health Checks)

Substance misuse and alcohol services

Healthy lifestyle services

Sexual health services

Public mental health

A number of partnership and other initiatives have links with or report to the Board including:

Lambeth Food Flagship Programme

Lambeth Tobacco Control Alliance

Lambeth Healthy Weight Taskforce

Lambeth and Southwark Mental Wellbeing Programme

Lambeth Alcohol Prevention Group

In addition the Board provides oversight and assurance of the Joint Strategic Needs Assessment process for Lambeth.

Objectives of

business area

To support the Health and Wellbeing Board to take a strategic and evidence based approach to decision making and

prioritisation in health improvement so as to improve population health and wellbeing and reduce health inequalities.

To enable the local authority, CCG and other partners to deliver coherent and strategic health improvement action and

commission health improvement services including the health services where responsibility has transferred to the local

authority so that they are effective, efficient and evidence based, meet population health needs and reduce health

inequalities.

To enable the Health and Wellbeing Board to give effective account of progress on health improvement and reducing

health inequality including commissioning action to achieve these goals and to ensure that there is appropriate

transparency, engagement and co-production in health improvement work across organisations, patients and the

public.

To oversee the management of PGDs and production of Pharmaceutical Needs Assessment.

To embed and support the achievement of staying healthy outcomes within other council and CCG programmes.

92


Assurance Status/Risks RAG Rating

(Red/Amber/Green)

Is your programme delivering as

planned – is it on target?

Yes

What are the risks you have

identified to date and how are

you mitigating against these?

1. Financial – we have experienced a 6.2% in-year cut to PH Grant during 15/16

with the money taken by DH from the fourth quarter’s grant payment. These

savings are impossible to achieve through spend reduction in year as they have

been asked for so late in the financial year and spend is fully contracted. The

cut represents a £1.9m loss of grant income which will need to be met from

council reserves. The budget itself was forecast to be balanced (before the

6.2% cut) but there are continuing pressures around demand-led GUM spend

which seem to be being managed well currently. DH have signalled via the CSR

that PH grants will be subject to 3.9% year on year cuts between 16/17 and

19/20 and the 6.2% cut made in 15/16 has been confirmed as recurrent. This

means that to achieve a balanced budgetary position in 16/17, commissioners

need to reduce spend by £3m. A proposed refresh of the PH funding formula

(ACRA) has been consulted on and the outcome of the consultation is awaited.

If implemented fully, the new formula will see LB Lambeth lose a further £3m+

of PH grant. The CSR confirmed further cuts to LA core funding which will

create pressure for the Staying Healthy programme (directly and indirectly)

though – at this time – the council is not intending to take savings from PH

budgets. A programme of consultation about potential cuts/changes to services

– across all areas of Public Health – is underway and will determine where

savings will be realised.

2. Structural – the splitting of the PH specialist team will create uncertainty and

change which may impact on the effectiveness of the programme in meeting

outcomes, achieving savings and successfully recommissioning services as

93

intended.

3. External – continued/extended programme of welfare cuts likely to negatively

impact on housing, youth homelessness, income/poverty, mental well-being,

etc. The impact of these wider determinants of public health creates a risk to

the success of the programme in meeting intended outcomes.

4. Sexual health – continuing growth in need/demand for services, efforts to

manage costs/demand proving problematic (complicated by open access

issues, market development issues and differences in London-wide approach to

issue).

5.4.2 Staying Healthy Dashboard

The Public Health Outcomes Framework (PHOF) was used to identify the national indicators relevant to each of the three main commissioning areas

(sexual health, substance misuse, health and wellbeing). Commissioners were also consulted to identify the local priorities. Where KPIs are annual,

local data will be used where possible and appropriate to provide quarterly updates. The Staying Healthy Board is to agree which other indicators

could help to demonstrate progress against the wider determinants of health that are specifically within the Board’s remit.

94

Sexual Health Source Frequency Reporting RAG Comment

PHOF 2.4 Under 18

conceptions

PHOF Annual Date 2010 2011 2012 2013 Amber No performance data update since

last IGC report. per 1,000 pop 49.3 34.8 33.2 24.7

London 32.8 28.7 25.9 21.8

PHOF 3.2 Chlamydia

diagnoses for 15-24

PHOF Annual Date 2012 2013 2014 Green No performance data update since

last IGC report. per 100,000

pop

6348 4410 4225

London 2215 2213 2178

PHOF 3.4 HIV

presentations at late

stage

PHOF Annual Date 2009-

11

2010-12 2011-13 2012-14 Amber No performance data update since

last IGC report.

per 100,000

pop

39.7 39.3 34.7 29.9

London 46.7 44.6 40.5

% Repeat terminations

for under 25s

PHE Annual Date 2012 2013 2014 Red No performance data update since

last IGC report.

Performance red compared to national

average, but has improved for two years

running. U18 conception rates in

Lambeth started to come down from

2004, which will continue to impact on

repeat abortions to under 25s.

% 32.9 31.9 30.7

London 33 32.6 32.3

% Post-abortion LARC

uptake

Local Provider Date 2014/15

Q4

2015/16

Q1

2015/16

Q1

N/A Post-abortion LARC uptake is low at one

particular provider. The provider is

addressing this by training additional

staff to fit LARC and on contraceptive

counselling.

% 38.0 33.9 29.8

SH24 uptake by kits

ordered and received

Provider Monthly Date Jul-15 Aug-15 Sep-15 Oct-15 Green Service target is 50%. Latest

performance expected to increase with

pending returns. %

(Cumulative)

71.1 71.3 69.3 58.1

95

Substance Misuse Source Frequency Reporting RAG Comment

PHOF 2.15i Successful

completions from

treatment (Opiates)

NDTMS Monthly Date Aug-15 Sep-15 Oct-15 Nov-15 Amber Current worsening trend in performance

may be partly attributable to an identified

data input error in a large provider.

Remedial action has been taken and

should be reflected in next report.

% 9.1 8.6 7.9 7.1

PHOF 2.15ii Successful

completions from

treatment (Non-opiates)

NDTMS Monthly Date Aug-15 Sep-15 Oct-15 Nov-15 Amber Continued to improve in this key metric,

now AMBER. Performance will continue

to be monitored through provider forum

and individual contract monitoring to

ensure positive direction of travel is

maintained.

% 38.8 39.9 39.0 41.4

PHOF 2.18 Alcohol-

related hospital

admissions

PHOF Annual Date 2010/11 2011/12 2012/13 2013/14 Amber Monitoring implementation of local

initiatives, incl. alcohol care teams in

hospital settings and evaluation of IBA

Direct (targeted at key populations).

per 100,000

pop

592 658 642 626

London 587 572 554 541

Number in treatment

(adults, rolling year)

NDTMS Monthly Date Aug-15 Sep-15 Oct-15 Nov-15 N/A This indicator to be assessed and revised

to more accurately match our strategic

objectives. Performance stable, showing

efficient use of available capacity

n 2071 2073 2043 2045

PHOF 2.16 Prison

treatment starts

PHOF Annual Date 2012/13 Red New performance indicator, to be

assessed and understood as part of

recommissioning of Integrated Offender

Management. Currently awaiting latest

performance figures.

% 61.9

London 57.1

% Hepatitis B vaccine

completions

NDTMS Quarterly Date 2014/15

Q3

2014/15

Q4

2015/16

Q1

2015/16

Q2

Red Provider asked to bring forward remedial

plan to address apparent decline in

screening and vaccination rates, which

will be monitored via contract review

process.

% 22.7 20.3 20.2 18.9

London 27 26 27 27

96

Health Improvement Source Frequency Reporting RAG Comment

PHOF 2.14 Smoking

Prevalence

PHOF Annual Date 2010 2011 2012 2013 Amber No performance data update since last

IGC report. % 18.3 21.3 19.9 18.1

London 19.5 18.0 17.3 17.0

Take up of NHS Health

Checks

Local Quarterly Date 2015-16

Q1

2015-16

Q2

Amber Data errors in Q1 have been rectified

and performance will be monitored to

ensure ongoing improvements are

embedded. % 13.6 17.6

England 44.4 44.4

PHOF 2.17 Recorded

Diabetes

PHOF Annual Date 2010/11 2011/12 2012/13 2013/14 N/A No performance data update since last

IGC report. % 4.2 4.4 4.7 5.0

London 5.4 5.6 5.8 6.0

PHOF 4.04ii Mortality

from preventable CVD

PHOF Annual Date 2009-11 2010-12 2011-13 2012-14 Amber No performance data update since last

IGC report. per 100,000

pop

61 54 50.3 51.9

London 55.1 52 50.2 49.2

% successful four-week

quitterswho set a quit

date

Local Quarterly Date FY2014-15 2015-16

Q1

2015-16

Q2

Amber Local reporting mechanisms are now

established and this indicator has been

changed to quarterly, but compared to

previous annual performance. % (n) 40% 32% 33%

(1552 of

3896)

(273 of

848)

(268 of

809)

Number of smokers

setting a quit date

Local Quarterly Date 2015-16

Q1

2015-16

Q1

Amber Local reporting mechanisms are now

established and this indicator included

as quarterly. n 848 809

97

5.4.3 Risk Register

The Public Health Commissioning Risk Register is currently being reviewed and updated. Risks will be assessed and updated for the next IGC

report, including actions taken against ongoing risks.

98

99


100

101

102

103

5.5 Primary Care Development

Responsible Director Andrew Parker, Director Primary Care Development

Clinical Lead Dr. Hasnain Abbasi

Programme Lead Terilla Bernard, Assistant Director Primary Care

Scope of business area This business area aims to transform Primary Care across the borough of Lambeth, by developing integrated

models of primary care that are bottom-up, co-produced and clinically led.

By investing in leadership and development, Primary Care can continue to drive innovation, and collaborate in

new ways of working that take account of the local context and deliver more patient centred and integrated

models of care.



Primary Care is better configured to deliver an increased range of services to patients and integrate with

other services on a population health basis

Reduces variation in access and quality for local populations

Delivers demonstrable benefits in terms of quality and value for money

Makes primary care a more attractive place to work

Drives innovation and achieves both local and national strategic objectives

Reducing inappropriate GP Referrals

Case Management of frequent users of services

104



Is your programme delivering as planned

– is it on target?

Yes

5.5.2 Primary Care Development Programme Risk Register

For risks scoring 12 and above, 5N, 5R, 5S and PMCF07 please see the Board Assurance Framework.

Risk Title

Risk Register


Current Risk


Risk of failure to create a formalised and well supported Local Care Network

Programme Board /

Directorate Risk

Register

3 Mitigate 1. Appointment of 3 Locality Care Network Managers to support practices and Locality Networks by November 2014 - COMPLETED 2. Completion of Locality Development Plans to underpin Local Care Network initiative - COMPLETED - end July 2015 3. Confirmation of governance structure - to be agreed via Options Appraisal / supported by Provider Group / Enabler Group - COMPLETED 4. Recruitment of interim Chair and Admin Support to take place in October / November 2015 - for period November 2015 to March 2016 - COMPLETED 5. Development of Locality Care Network Plans - March 2016

105

Risk Title

Risk Register


Current Risk


Risk of increased costs if DXS installation has to be re-installed on GP computers, following Windows 7 deployment. Costs would be charged to the CCG by DXS and the CSU. If Zen Works cannot run DXS software this would result in the manual upload of DXS software to each practice PC. This would result in delays in the project which would also include a reputational risk.

Programme Board /

Directorate Risk

Register

6 Mitigate / Transfer

1. Test site to be identified and DXS installed and tested by 31/01/15 - COMPLETED 2. DXS rollout to all practices by 30/06/15 - Some practices have had the original DXS installation removed - COMPLETED 3. DXS now included in standard desktop rollout, packaged with Windows 7. Due to be rolled out by end October 2015. COMPLETED. 4. Cardiology and Diabetes to be added to DXS for monitoring of referrals - target date to be confirmed. Diabetes has been added. Cardiology delayed - awaiting confirmation from hospital.

Risk that the identified actions to support Trusts to cease faxing discharges from Oct 2015 and GP’s to cease faxing referrals from March 2016 are not fully completed against agreed timescales, resulting in a failure to meet the contractual deadlines

Programme Board /

Directorate Risk

Register

9 Mitigate 1. Trusts to update action plans to resolve any use of fax for discharge information, including any internal comms - due date 19/8/2015 (Trust leads) LC followed up with Trusts 15/9/15 - COMPLETED 2. CCGs leads to provide Trusts with an updated list of GP emails for discharge correspondence - COMPLETED 3. CCG leads to produce SOPs for GP practices re email management discharge information and ensure appropriate comms - COMPLETED 4. CSU to confirm SGH contact with Lambeth CCG - COMPLETED 5. Trusts to have appropriate NHS e-referral and NHS net emails in place for all services with appropriate internal SOP developed - due date 01/10/2015 (Trust leads) - ongoing

106

Risk Title

Risk Register


Current Risk


6. CCG leads to produce SOPs for GPs to refer via electronic means (first line agreed as NHS e-referral, second line via nhs.net email) - due date 01/10/2015 (Lesley Connaughton / Colin Paget / Southwark lead) - Directory of Services being compiled currently 7. CCGs to draft detailed communication plan and share with Trusts - COMPLETED

107

Primary Care Dashboard – items to note No of GP initiated 1st Outpatient attendances (QIPP Specialties) - This is currently at 89.3 at a CCG level; the benchmark is 88.7. It has worsened slightly from the last reporting period. This is due to the South west federation being outside the benchmark.

No of people supported by GP+ - More activity is being reported on this scheme as well as the important break down at practice level.

SLIC Incentive scheme – HHA and CM are progressing well and have been reporting a continual increase in number the of people participating. Case Management moved from red to Amber on a CCG level. It’s yet to meet the ambitious target but a step in the right direction none the less.

People who have set a quit date and have quit smoking YTD – The activity is still below target. The benchmark is 35% of those who sign up to have quit, more effort needed to address the shortfall.

Cervical (Cytology) screening uptake YTD & BP (Hypertension) -They are below the benchmark . They are at the risk zone (amber) and likely to turn red if action is not taken promptly.

BP <150/90mmhg (Diabetes) YTD & Cholesterol (5mmol) Diabetes – They are above benchmark . BP <150/90mmhg (Diabetes) is particularly doing well, the success can be replicated when dealing with the Hypertensive patients.

Diabetes (Hba1c) < 59 & 64 mmol/mol - They are doing badly with 59 mmol particularly lagging behind. There is a risk that Diabetes (Hba1c) < 64 mmol/mol YTD will totally miss the benchmark, if it continues on the current trajectory.

How many people with a Learning disability (LD) had an annual health check in this financial year? – The performance is well below the benchmark, more effort needed to meet the necessary criteria.

108

5.5.3 Primary Care Programme Dashboard

Locality Care Network Managers are working with practices to validate the data that is captured in the dashboard. Each practice has a Quality and Improvement Plan that supports improvement at practice level and all practices in Lambeth have signed up to this process. 5 Community Incentive Scheme (CIS) indicators for which data collection systems are currently being set up have been excluded from the dashboard.

01/04/2015

2015/16 Data at Oct-157

Patient

Safety

GP 1st

Outpatients

KPIs

(Per/

1000 P

racti

ce P

op

)

No o

f G

P initia

tied 1

st

Outp

atient attendances

(QIP

P S

pecia

ltie

s)

YT

D

No o

f people

support

ed b

y

GP

+.

The n

o o

f pra

ctices that

have r

un a

Physic

al

Assessm

ent A

udit a

nd h

as a

dem

entia r

egis

ter.

Holis

tic A

ssessem

ent

Deliv

ere

d in p

ractice o

r at

Hom

e Y

TD

Holis

tic A

ssessem

ent Y

TD

Contr

act P

lan

(Full

Year

5487)

Case M

anagem

ent (C

M)

YT

D

CM

YT

D C

ontr

act P

lan (

Full

Year

845)

People

who h

ave s

et a q

uit

date

and h

ave q

uit s

mokin

g

YT

D.

Vascula

r H

ealth C

hecks for

40-7

4 y

rs o

ld Y

TD

Bre

ast scre

enin

g u

pta

ke

Annual -(

locality

data

no

t

availab

le)

Cerv

ical (C

yto

logy)

scre

enin

g u

pta

ke Y

TD

BP

<

150/9

0m

mhg

(Hypert

ensio

n)

YT

D

BP

<

150/9

0m

mhg

(Dia

bete

s)

YT

D

Chole

ste

rol -

(5

mm

ol)

Dia

bete

s Y

TD

Dia

bete

s (

Hba1c)

< 5

9

mm

ol/m

ol Y

TD

Dia

bete

s (

Hba1c)

< 6

4

mm

ol/m

ol Y

TD

How

many p

eople

with a

Learn

ing d

isabili

ty (

LD

) had

an a

nnual health c

heck in

this

fin

ancia

l year?

Period Apr-15 -

Oct-15 Apr-15 - Oct-15 Apr-15 - Oct-15 Apr-15 - Oct-15 Apr-15 - Oct-15 Apr-15 - Oct-15 Apr-15 - Oct-15 Apr-15 - Oct-15 Apr-15 - Oct-15 Apr-15 - Oct-15 14/15 Apr-15 - Oct-15 Apr-15 - Oct-15 Apr-15 - Oct-15 Apr-15 - Oct-15 Apr-15 - Oct-15 Apr-15 - Oct-15 Apr-15 - Oct-15

Lambeth_CC

G

LAMBETH CCGtotal

88 60 45 2645 # 3201 306

494494

###193 2959 63% 79% 77% 85% 75% 59% 68.0% 154

1.1 Total Audit

CCG Practice Average 88 1.3 # 96% 56 # 68 7 11 11 #### 4.3 85 63% 79% 77% 85% 75% 59% 68.0% 3

North Locality Practice Average 86 100%1

47#

69 610

100.75

6.0 52 78% 77% 83% 75% 60% 69% 5

South East Locality Practice Average 82 94%1

51#

71 511

110.74

5.3 65 81% 77% 85% 75% 57% 66% 3

South West Locality Practice Average 90 90%1

66#

65 810

10 2.3 122 79% 77% 85% 74% 60% 70.1% 3

GREEN (Within the Benchmark) 89 >=300 100.0% >=3200 >=494 >=5425 >=70% >=80% >=78.5% >=78.5% >=73.9% >=70.9% >=70.9% >=471

AMBER (Within 10% of the Benchmark) 88.9 - 96 299 - 270 90% - 99% 3199 - 2880 493 - 444 >=4882 - ≤5424 62.1 -70% 72.1 -80% 70.7 -78.5% 70.7 -78.5% 66.5 -73.9% 63.8 -70.9% 63.8 -70.9% 470 - 424

RED (10% Outside the Benchmark) >96 <=269 <90% <=2879 <=443 <4882 <62.1% <72.1% <70.7% <70.7% <66.5% <63.8% <63.8% <=423

Annual

EMIS

Monthly

EMIS(QMS Returns from QMS)

Monthly Monthly

PHE (Cancer

commisioning

toolkit)

GP Contract KPIs

(Quality Outcome Framework -QOF)

Monthly

(QMS Returns

from QMS)

Frequency of collecting data

Monthly (with

a 2 month

lag)

SUS data

Monthly

EMIS

Monthly

Living Well

HubEMIS

Primary Care Dashboard - Published December 2015

Mental Health - The GP+ Scheme

(formerly the CIS Scheme)SLIC (South London Integrated Care) Incentive Scheme

Datasource

Preventative CareGP Delivery Framework

109



Business

Plan Ref:

Objective Delivery

Period

Progress Update

9.1.1 Implement the CCG primary care

development plan and GP delivery

framework

Quarter 1 GP Delivery Framework 2015/16

Year two of the GP Delivery Framework 2015/16 has been developed with

the Lambeth GP Federations and already 44 of 47 practices have returned

their signed contract. The Delivery Framework covers:

GP Initiated First Out-Patient Referral

Long term conditions

SLIC older people’s incentive scheme

Medicines Optimisation

Mental Health Community Incentive Scheme

Children – agreed in October

Patient Participation Listening Practices – to be considered at the

Conflict of Interest Panel on 9 Dec.

9.1.2 Develop a programme to support

integrated local care networks,

including primary care, community

services, and social care. Integrated

services will be based on shared

assessment and risk stratification,

models of case management and care

co-ordination and multi-disciplinary

working.

Quarter 2 Local Care Networks (LCNs)

The arrangements for LCNs continue to be developed towards maturity, led by

an Enabler Group, and a Provider Group.

The following priority work areas have been agreed by Lambeth LCNs, and

each has an active project in place:

South West:

Community asset mapping for people with a long term condition, for

example mental health.

Children and Young People – including hoe to make practices friendlier

to younger people, and improving emotional resilience with schools.

110


Business

Plan Ref:

Objective Delivery

Period

Progress Update

Health Living, focusing on the care navigator role.

Living with a Long Term Condition

South East:

Safe and Independent Living - enabling wider health and wellbeing

referrals.

Locality Geriatrician

Wound Dressing

North:

Portuguese community project

Primary Care Navigators, starting with diabetes

Further priority areas are being chosen by the LCNs.

Chairs have now been appointed by two of the three LCNs, with recruitment in

progress by the third.

9.1.3 Develop a programme to support the

integrated local care networks

Quarter 1

9.1.4 Commission extended access to

urgent primary care across the

borough

Quarter 2 Prime Ministers Challenge Fund Project (PMCF)

The four new GP Access Hubsprovide pre-booked and on the day

appointments 8am-8pm Monday to Friday and 10am-6pm on Saturdays

and Sundays for all patients of Lambeth practices, booked through their

practice or SELDOC.

The CCG aims to complete the due diligence process in December.

As planned, the hubs are opening at reduced capacity during the first six week

mobilisation period (one GP and one nurse, rather than two GPs and one

111


Business

Plan Ref:

Objective Delivery

Period

Progress Update

nurse). This is planned to rise provided utilisation reaches 75%, although this

may not be uniform across all times of the week or all hubs.

It has been recognised by all involved (CCG, NHSE and three Federations) that

the cost of the first six months’ service, £2,600,000 is not sustainable on a

recurrent basis (i.e. £5,200,000 a year). There are some areas where the costs

of a recurring service will fall, as staff move from rates based on being

temporary rather than longer term arrangements, and as overheads

fall. However, the funding available for a full year remains £1,500,000 from the

CCG, with the NHSE’s PMCF funding being zero in 2016/17. This equates to

less than two hubs running at the capacity of the pilot in 2015/16.

It is expected that lessons will be learned during the six month pilot phase about

patient demand and methods of provision that will refine the service model and

the capacity to be commissioned.

A business case will be prepared for the service from 2016/17 onwards, to be

considered in January by the CCG.

A central part of the rationale for the GP Access Hubs is that they will release

capacity in general practice for them to spend additional time managing patients

with multiple long term conditions, and frail elderly patients. The CCG wishes to

agree with the Federations the ways in which this additional capacity will be

used. This, and measurement of its effectiveness, will be key to the business

case for the future of the service.

The PMCF Steering Group are exploring further initiatives to improve access,

using the remaining non-recurrent PMCF budget, and business cases will coe to

the December Primary Care Programme Board.

112


Business

Plan Ref:

Objective Delivery

Period

Progress Update

9.1.5 Design and deliver a comprehensive

primary care leadership programme

Quarters 1-

4

GST Charity Fund – Transforming General Practice Provision

The Lambeth and Southwark Primary Care Transformation Programme, funded

by Guy’s and St Thomas’ Charity (GSTC), has been in place since January

2014 and has been delivered in two phases.

Lambeth and Southwark CCGs have made a successful application for

transitional funding to GSTC to enable continuation of the programme’s second

phase through to December 2015. This will provide continued support to the

emerging leaders in their roles leading the three GP Federations, and extend to

organisational development support within these live organisations.

The Phase three bid is being considered, to include a wider cohort and the

development of leaders for Local Care Networks

9.1.6 Engage on and develop a primary care

quality scorecard for member

practices. This would be used by

localities in the development of local

care networks with the aim of

improving quality and access and

reducing inter-practice variation

Quarters 1-

2

The updated dashboard is included in these papers.

9.1.7 Invest finance received from GSTFT

Trustees to support set up of Local

Care Networks working to improve

access to services

Quarter 1 See 9.12 above

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Business

Plan Ref:

Objective Delivery

Period

Progress Update

9.1.8 Define and agree estates strategy to

support Primary care development

Quarter 1 Lambeth Estates Strategy is being developed, led by Christine Caton, with a

draft plan submitted to NHSE on 31 December 2015 and will be submitted to

the Primary Care Programme Board in March.

9.1.9 Implement a programme to support

developing local care network services

Quarter 1 See 9.1.9 above

9.1.10 Commission extended access to

urgent primary care across the

borough

Quarter 1 Complete See 9.1.4 above

9.1.11 Agree and implement the GP Delivery

Framework for 2015/16

Quarter 1 See 9.1.1 above

9.1.12 Ensure regular performance reporting

to IG Committee on outcomes

Quarters 1-

4

See this report

9.1.13 Ensure that the GP delivery scheme –

includes incentives that target variation

in health outcomes

Quarter 1 Complete

9.1.14 Roll out DXS to support best practice

referrals including use of referral

management systems, single points of

referral and decision support tools.

Quarter 1 See objective 12.4.3iii in section 5.6.3 ICT below.

9.1.15 Complete inner south east London

procurement NHS 111 service from

April 2015

Quarter 1 Delayed.

114

5.6 Enabler Programmes

5.6.1 Governance and Development Risk Register

For risk 6K, scored 12, please see the Board Assurance Framework.

Risk Title

Risk Register


Current Risk


Possible failure of the CCG to have robust business continuity plans to ensure ongoing service delivery resulting in delay in delivery of CCG outputs, potential non-compliance with NHSE Assurance Framework and impact on relationships/loss of confidence with providers, members and NHSE.

Programme Board /

Directorate Risk

Register

6 Mitigate CSU BCPs to be obtained and reviewed – by 29/02/2016 NHS Property BCPs to be obtained and reviewed – by 29/02/2016 Undertake a Lower Marsh EPRR exercise – by 31/10/2016 Undertake LCCG Communications exercise – by 30/09/2016 Annual CCG BCM exercise to be undertaken by 01/06/2016

Equality Act Risk - Likely risk that the CCG does not currently collect information that provides assurance that they are meeting public sector equalities duties; public engagement work doesn’t systematically target groups of protected characteristic and therefore CCG cannot demonstrate how it fosters good relations. This could result in a breach of the law and loss of reputation; non

Programme Board /

Directorate Risk

Register

8 Mitigate CSU acute contract team/Business Intelligence Team need to provide acute facing equalities data - discussion with CSU to take place by March 2016. CCG Performance and Information Team to report on primary care equalities objectives from Q4 2015/16. EIA's to be carried out as a key feature of commissioning intentions process in Q4 2015/16. Programmes and enablers need to continually collect EDS evidence - March 2016

115

Risk Title

Risk Register


Current Risk


compliance could result in the CCG in an employment tribunal or county court.

Possible risk of non-compliance with information governance requirements relating to processing of personal confidential data on QUIC system, resulting in a breach of personal confidential information

Programme Board /

Directorate Risk

Register

6 Mitigate 1. Review of initial IG advice by CCG Chair and Director of Governance and Development - completed. 2. Review of IG advice by Caldicott Guardian and SIRO - completed. 3. Meeting with Head of Information Governance to review gaps in controls and provide assurance -completed. 4. Meeting with local CCGs and Providers to agree processing of data going forward - National GP Incident Reporting system in place and being used. Ongoing awareness raising to end of Nov 2015. 5. To agree FPN for CCG and communication plan to GP Practices - Completed. 6. To review the retention and destruction schedule to include retention of quality alert data - March 2016 7. Follow up with GP Practices completion of FPN actions - Jan 2016

Ongoing unlikely risk of staff shortage and recruitment and retention problems causing disruption to critical services/essential business functions

Programme Board /

Directorate Risk

Register

6 Mitigate Ensure all plans are ratified and implemented Ensure that, so far as is reasonably practicable, staffing levels and skill mix in critical services are protected from financial pressures.

Ongoing unlikely risk to premises resulting in denial of access/loss of use of premises causing disruption to critical

Programme Board /

Directorate

8 Mitigate Ensure all parts of the organisation have integrated arrangements for response to a major incident. Ensure all critical services and essential business

116

Risk Title

Risk Register


Current Risk


services/essential business functions. Risk Register

functions have business continuity plans in place which are aligned with ISO 22301. Maintain current Southwark Access list and physically test ability of a selection of staff to log in at Tooley Street

Ongoing unlikely risk to technology resulting in disruption to critical services and essential business functions.

Programme Board /

Directorate Risk

Register

8 Mitigate Assess situation against information governance toolkit Ensure plans keep pace with the introduction of new technology and the increasing dependency on technology Ensure that, so far as is reasonably practicable, that arrangements are in place with suppliers of critical systems to ensure swift replacement and commissioning into service Review CSU Disaster Recovery Plan against CCG Business Continuity recovery assumptions

117

5.6.2 Equalities

Responsible Director Una Dalton, Director Governance and Development

Clinical Lead Dr. Paul Heenan

Programme Lead Cathryn Flynn, Engagement Manager

Scope of business area This business area covers the equalities strategic priorities and is responsible for ensuring that the CCG complies with

its equalities duties as set out in the Equalities Act 2010.


The objectives of this business area are to ensure that Lambeth meets all its equalities objectives as set out in its

equalities strategy.

Legal requirements: The CCG’s 3 year equalities strategy was agreed at the July 2015 GB meeting. This sets out how we will comply with the

public sector equality duty. The Engagement, Equalities and Communications Committee meets quarterly to oversee delivery of this strategy (April,

July, September 2015 and due to meet Jan 2016).

Equalities Strategy: We are currently conducting a rapid review of our overall position and progress against our 2015-16 equalities objectives. This

will report to our January 2016 Engagement, Equalities and Communications Committee and will steer our work for Q4.

Equalities analysis of our Healthier Together strategy: as we develop 2016-17 commissioning intentions we will be testing these against our

corporate and programme equalities objectives to ensure alignment between our commissioning strategy and our equalities strategy.

NHS Equality Delivery System: review will commence in Q4. We aim to share our self-assessment against the EDS in late March 2016.

5.6.3 ICT

Responsible Director Christine Caton, Chief Financial Officer, Andrew Parker, Director of Primary Care Development

Clinical Lead Dr Adrian McLachlan

118

Programme Lead Jeremy Burden and Graham Crawford Business Intelligence & ICT (CSU) Jo Steranka, Digital and Business

Intelligence Development Manager

Scope of business area This business area covers both business information support and information systems. This business is provided to

Lambeth CCG by South East CSU.


The overall aim of the IM&T enabler work stream is to ensure that good quality clinical information is accessible in an

integrated shared clinical record and to ensure that information systems are available to support the clinical business

needs of NHS Lambeth Clinical Commissioning Group. A robust IT infrastructure needs to be in place to enable this to

happen.


Business

Plan Ref:

Objective Delivery

Period

Progress update

12.4.1

ICT 5 Year Strategy development

and Implementation Plan to achieve:

Establish fully representative work

stream and detailed work plan

aligned to CCG Programmes

Quarter 1

CCG is working with the CSU to complete a local ICT Five Year Strategy. The

document is currently being redrafted in the light of new published national

expectations for delivery of digital services by 2020.

12.4.2

Ensure full alignment to existing

Lambeth and Southwark and SEL

wide initiatives including LCR (Local

Care Record).

Quarter 1

The national Digital Roadmap programme to delivery paperless care at the point of

contact with patients by 2020 has set the strategic direction for the whole NHS with

regard to digital delivery of services.

The CCG submitted an initial Digital Footprint to NHS England in October 2015.

Since then, it has been agreed that south east London CCGs collectively form a

digital footprint. The footprint is the area covered by organisations where our

patients attend for care and therefore have electronic records.

119


Business

Plan Ref:

Objective Delivery

Period

Progress update

The Our Healthier South East London ICT enabler workstream, supported by the

Innovation Unit, are leading on digital development for south east London CCGs.

NHS England have also seconded a member of staff to support us with Digital

Roadmap development.

Digital Roadmaps submissions are required by the end of June 2016.

CCG works together with Southwark CCG through the vehicle of the Lambeth and

Southwark Informatics group to implement initiatives that impact across both

boroughs to make best use of resources.

Provision of GP IT services

12.4.3i

Effective commissioning and

management of GP IT support

services

Quarters

1-4

The procurement process for GP and CSU IT systems has now begun. This is a

joint procurement process between Lambeth, Southwark, Greenwich and

Lewisham CCGs.

The deadline for suppliers to return documention is 19/02/2016. Further

milestones in the process are:

Tender evaluation completed: 01/03/2016

Supplier presentations to lead evaluators: 03/03/2016

Approval of preferred supplier by Governing Body: 09/03/2016

Final award of contract: 29/03/2016

12.4.3ii Implement retendered services 2016/17 Implementation of the re-tendered service (mobilisation) will begin on 30/03/2016.

12.4.3iii Complete and maintain clinical

content management systems

Quarter 1 DXS work stream underway. Implemented in all practices. Monthly monitoring on

usage. Development of Directory of Services progressing.

It is to be expected that useage in practices will vary, so training and promotion of

the system continues.

120


Business

Plan Ref:

Objective Delivery

Period

Progress update

Ensure the delivery of high quality corporate technology systems

12.4.4i

Effective commissioning and

management of ICT support services

Quarters

1-4

See item 12.4.3i above.

12.4.4ii Implement retendered services 2016/17 See item 12.4.3ii above.

Ensure the full benefit of technologies to support strategic transformation

12.4.5i Support programme to achieve

change

Quarter 1 Business Intelligence specification is being reviewed as part of the CSU re-

procurement.

The CCG submitted a number of proposals to the Prime Minister’s Challenge Fund

for development of digital approaches to patient care. These are being carried

forwards. Bits for GPIT capital allocation for 2016/17 have been submitted to NHS

England for:

Replacement of out-of-warranty equipment

Implementation of wi-fi in General Practice

Deployment of mobile devices to GPs and other practice clinical staff

Telemedicine

Improved SMS messaging

The CCG is developing a project plan for a ‘Clinicial Effectiveness Group’

approach that will drive quality using population based intelligence to support

outcomes-based commissioning.

12.4.5ii Complete and implement work plan Quarter 1 Implementation timescales will take account of outcome of CSU business

intelligence specification review and London wide interoperability programme.

121

5.6.4 Estates

Responsible Director Christine Caton, Chief Financial Officer

Clinical Lead Dr. Adrian McLachlan

Programme Lead Claire Hornick

Scope of business area This business area is responsible for ensuring maximum use of the CCG commissioned estate across Lambeth.


The purpose of the Estates enabling work stream is to make sure that we are getting value for money from the estate

we commission and that this estate supports the delivery of effective and high quality new models of healthcare

provision.


Business

Plan Ref:

Objective Delivery

Period

Progress update

12.3.1 Develop NHS Lambeth CCG Estates /

Infrastructure/Services/Commissioning Strategy

during 2015/16 including work with federations,

localities and NHS England and through

programmes to review and define primary and

community estate requirements addressing

impact of such issues as population growth

including the new development led NEV related

growth

Quarters

1 -4

Community Health Partnerships (CHP) are supporting the development

of Strategic Estates Plans (SEP). Strategic leads and additional resource

are in place working with the CCG who a dedicated resource to co-

ordinate this.

Strategic Estates Workshops took place on 15th September and 26th

November to inform the Strategic Estates Plan content. The SEP is

being developed with input from primary care, LB Lambeth and local

providers and the interim plan was submitted to NHSE on 31 December

2015. The final plan is due for completed by 31 March 2016. The SEP

will identify commitments that will form the basis of bids submitted to the

Primary Care Transformation Fund in April 2016, following a revision to

the timescales. Guidance is due to be issued at the end February 2016.

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Business

Plan Ref:

Objective Delivery

Period

Progress update

12.3.2 Review CHP Centre management pilot work

stream

Quarters

1 -4

Centre Management pilot started on 1st June, KPIs have been agreed

and are being monitoring through the monthly Asset and Engagement

Meeting. Action is being taken to increase utilisation. The pilot has

been extended to 31 March 2016.

12.3.3 Work closely with Wandsworth CCG and NHS

England to support the development of OBC/FBC

for Nine Elms Vauxhall (NEV) in North Lambeth.

This will support the robust case for primary

health care facility in Battersea and case for

Community Infrastructure Levy (CIL)/Section 106

funding from Wandsworth Council. Business

case to be submitted to Wandsworth Council in

September 2015

Quarter

3

The CCG, including clinical leads are working closely with the NEV

project team, NHSE and Wandsworth CCG to support the development

of the business case. Work has been commissioned to assess the work

needed to develop existing Lambeth practices to accommodate the list

size growth to enable the CCG to access CIL/Section 106 funding.

The final version of the Infrastructure Funding Bid for CIL contributions will be submitted to the NEV Strategy Board for approval in September 2016.

12.3.4 Work with South East London CCGs to develop

the South East London Estates Strategy. To

agree longer term proposals for use of estates

across borough boundaries particularly to support

boundary issues with Southwark CCG

Quarters

1 -4

SEL Estates Strategy Workshop took place on 17th September as part of

the SEL Five Year Strategy Enabling Work steam. The SEL Enabler

group of CCGs and providers had its first meeting on 17th November.

Use of provider estate is also part of the SEL productivity workstream.

12.3.5 Work with NHS Property Services and NHS

England to assess need for GP estates

developments – on-going – this work is currently

underway through local Lambeth Estates group

and SEL wide SPG meetings

Quarters

1 -4

This work is being undertaken to inform the Lambeth Strategic Estates

Plan as outlined above. PCIF funding for practices has been approved

and practices are submitting applications for its use.

12.3.6 15 Ambleside Avenue – valuation and follow up Quarter The transfer of this property from the Department of Health to LB

123


Business

Plan Ref:

Objective Delivery

Period

Progress update

work to grant property to London Borough of

Lambeth

2 Lambeth is now being undertaken as part of a London-wide exercise

through NHSE.

12.3.7 Lambeth Strategic Infrastructure Study draft

report – review and feedback – attend

stakeholder meetings and agree way forward

Quarters

1 -4

CCG and NHSPS have provided feedback for the draft report. This will

in turn inform the Lambeth Strategic Estates Plan.

12.3.8 Section 106 – on-going review of opportunities

including the latest development opportunities at

the Stockwell Group Practice

Quarters

1 -4

CCG is working with NHSPS and Stockwell Group Practice to develop

proposal to make effective use of S106 funding to support practice

growth.

12.3.9 To commission updated review of estates

utilisation and develop and implement plan to

maximise use of the community estate. Work with

South London and Maudsley (SLAM) and the

London Borough of Lambeth (LBL) to identify and

maximise opportunities for co-location to enable

service transformation and deliver QIPP across

our commissioned services

Quarters

1 -4

Utilisation reviews are being updated as part of producing the Strategic

Estates Plan. Funding has been provided via the PCIF to undertake

estates utilisation and condition surveys across SEL CCGs. SLAM, LBL

and GSTFT attended the Estates Stakeholder Workshop. The CCG is

establishing a Local Estates Forum to oversee the implementation of the

Strategic Estates Plan in Lambeth which includes provider

representation.

The draft Lambeth SEP was completed by 31 December. This

document is being further developed and will be approved by the

Governing Body following recommendation from the Primary Care

Development Board in March 2016. This is an interim plan with a main

focus on primary and community care with next stage broader provider

engagement.

12.3.10 To monitor, review and oversee the delivery of the

Action Plan of the Sustainable Development

Management Plan

Quarters

1 -4

CCG will be working with the Sustainable Delivery Unit/NHSPS to deliver

the Action plan building on work undertaken to date.

124

5.6.5 Workforce

Responsible Director Una Dalton, Director Governance and Development

Clinical Lead Dr. Adrian McLachlan

Programme Lead Lorraine Smith , HR Business Partner, South London CSU

Scope of business area To purpose of this business area is to ensure the provision of an effective

Human Resource service to staff and managers across the organisation.

Objectives of business

area

The objectives of this business area are to ensure that managers and staff

across the CCG have access to up to date advice and support on all

matters relating to the recruitment, management and development of staff

within the CCG.

Our Human Resources services are provided by South Commissioning Support Unit and we have a

named Business Partner, Lorraine Smith, providing support to managers and staff within the CCG. Since

March 2015 payroll and pensions services is been provided by SECSU in-house team.

September 2015

Our workforce profile is as follows:

Staff turnover

125

In December there was one leavers with no leavers registered in November. This is a smaller degree of

turnover compared with periods earlier in the year.

Recruitment activity December 2015

Robust recruitment checking processes are in place to ensure all recruitment activity has finance and

director approval prior to proceeding to advert, in order to monitor and control running costs.

A summary of substantive staff appointed from between September 2015 – December 2015

Position title

Start date

Senior Business support Manager x2 21 Sept 2015

05 Oct 2015

Service Re-design Manager 01 Sep 2015

Head of Communications 01 Sep 2015

Assistant Director Governance & Quality 21-Oct-2015

Associate Lay Member 20-Nov-2015

Clinical Commissioning Pharmacist 07-Oct-2015

Commissioning Support Officer 30-Dec-2015

Senior Business Support Administrator 05-Oct-2015

Service Redesign Manager - Urgent Care 30-Nov-2015

Sickness Absence

126

The sickness absence rate for Lambeth CCG for December 2015 was 1.09%. This is a significant

reduction compared to August where absence was recorded at 3.49% and is attributed to proactive

management of a small number of cases that had met trigger points for short term absence. Cases are

being managed in accordance with the Promoting Attendance at Work Policy with appropriate support

through HR and Occupational Health. It is anticipated that the trend will continue; sickness absence will

continue to be monitored to identify any trends and changes, and to determine whether any further

action is required .This will be supported by the recently revised Promoting Attendance at Work Policy

which is now available on the intranet and which will provide a structured and more focused approach to

monitoring and managing sickness absence.

The highest figures for first day absence is a Monday. There are currently no long term sickness

absence cases. Currently the sickness absence rate is below the national target of 2.5%.

Calendar days lost/working days lost from 1/4/15- 31/12/15

Employee Relations cases

There are currently no live employee relations cases.

127

6 QUALITY ASSURANCE

6.1 Provider Quality Report

The Provider Quality Report for Quarter 3 will be in the April 2016 IGC report.

6.2 Complaints and PALS

17 PALS enquiries and five complaints were received from October to December 2015. Compared to the figures from October to December 2014, there is a 36% reduction in the number of PALS enquiries recorded, as well as a 50% decrease in the number of complaints recorded from October to December 2014. Compared to the previous Quarter in 2015 (July, August, September), there has been a 29% decrease in the number of complaints recorded. However, the number of PALS cases recorded has increased by 41%.

13

910

1211

7 7

13

67

4

13

9

4

7

43 3

11

3 32

5

2

10

21

4 4

21

3

7

3

1

4

21

4

2 21

0

2

4

6

8

10

12

14

Apr

May Jun Jul

Aug Se

p

Oct

Nov

Dec Jan

Feb

Mar

Apr

May Jun Jul

Aug Se

p

Oct

Nov

Dec

2014 2015

PALS

Complaint

0

2

4

6

8

10

12

14

Apr Jun Aug Oct Dec Feb Apr Jun Aug Oct Dec

2014 2015

PALS

Complaint

Month PALS Complaints

All PALS CCG PALS All Complaints CCG Complaints

Q1 2014/15 32 6 9 1

Q2 2014/15 30 7 13 5

128

PALS and Complaints recorded in Quarter Three 2015/16 There were 22 cases recorded between October to December 2015. 17 were PALS enquiries and five were complaints: The three complaints recorded as CCG related to:

Assessment/Eligibility (Two)

Complaint Handling (One)

There were also two non-CCG Complaints cases related to:

Access – Mental Health Services

Treatment – Lambeth Local Authority

Details of the five complaint cases recorded between October to December 2015 are as follows:

1. Complainant wants to complain about Psychiatrist referred to her by the GP. Case closed.

2. Complaint regarding NHS Continuing Healthcare assessment. Case Closed. 3. Complaint about treatment in a care home and the competency of the carers. Case Closed.

4. Letter received from Parliamentary and Health Ombudsman regarding complaint against Lambeth CCG. Case Closed

5. Complainant registering complaint regarding Retrospective Home Fees. Case Open.

Seven of the PALS cases recorded between October to December 2015 related to the CCG. Assessment/Eligibility (Two)

Commissioning Decisions (Three)

Communication (One )

Treatment (One)

There were ten non-CCG PALS cases related to:

Contact Information (Four)

Staff Attitude (Four)

Complaint Handling (One)

Other (One) - Medical Records

Number of Open Complaints and PALS cases There are currently three cases that remain open; one of which is a complaint received on 14 December 2015. The other two cases are PALS cases received on 23 October and 27 October 2015

Q3 2014/15 26 6 10 3

Q4 2014/15 24 9 11 4

Q1 2015/16 20 7 8 3

Q2 2015/16 10 4 7 4

Q3 2015/16 17 7 5 3

129

The other 15 PALS cases and four complaint cases received between October to December 2015 have been dealt with and closed. Number of MP Cases There were three MP PALS cases recorded between October to December 2015 Number of Ombudsman Cases Between the months of October to December 2015, there was one Ombudsman case recorded. Mode of Receipt From October to December 2015, of the five complaints recorded, two were received by letter, two by email and one by telephone. Ten of the 17 PALS enquiries received were by telephone; six were received by letter and one by email.

Mode PALS Complaint Total

Email 1 2 3

Letter 6 2 8

Telephone 10 1 11

Total 17 5 22

Complaints responded to within 25 working days Of the five complaints received between October to December 2015, four were closed within 25 working days. One of complaint received in December 2015 currently remains open and is also currently within the 25 day timescale 15 of the 17 PALS cases were closed within 25 working days of being received. The two PALS cases that remain open have been open since October 2015. Themes There are no common themes for direct CCG complaint and PALS cases that were received between October to December 2015

Theme PALS n=3 Complaints n=4 Total n=7

Access 0 1 1

Assessment/Eligibility 2 2 4

Commissioning Decisions 3 0 3

Communication 1 0 1

Complaint Handling 1 1 2

Contact Information 4 0 4

Staff Attitude 4 0 4

Treatment 1 1 2

Other 1 0 1

Complaints Risk Grading (only complaints are risk graded)

130

Formal complaints are graded accordingly on receipt using the Risk Grading Matrix below. Grading is based on the actual consequences and also the potential for future complaints on a similar issue. Grading of Complaints provides the potential to flag serious risks to the CCG. Where a complaint is graded at 15 or above, the Complaints Team will alert the CCG.

Risk Grade Count of Type

4 4

6 1

Total 5

Any complaints listed as ungraded are complaints that are not dealt with by SECSU Complaints Team but by other organisations in the area i.e. GP complaints referred to NHS England or hospital complaints. Risk Grading Matrix used in Grading Complaints

Likelihood

Consequence Negligible Minor Moderate Major Catastrophic

Rare 1 2 3 4 5

Unlikely 2 4 6 8 10

Possible 3 6 9 12 15

Likely 4 8 12 16 20

Almost certain

5 10 15 20 25

Cases of Special Interest: It is accepted that all complaints cases are of special interest to the complainant and the CCG. There are some cases which are of specific and special interest due to the complexity and nature of the complaint. There may also be a special interest in themes from complaints.

There were no cases of special interest recorded in this quarter.

6.3 Serious Incidents

NHS England published a revised Serious Incident (SI) Framework in March 2015.

Serious Incidents are defined as:

Acts and/or omissions resulting in unexpected or avoidable death of one or more people;

includes suicide/self-inflicted death and homicide by a person in receipt of mental health

care within the recent past;

Unexpected or avoidable injury to one or more people that has resulted in serious harm;

Unexpected or avoidable injury to one or more people that requires further treatment by a

healthcare professional in order to prevent the death of the service user or serious harm;

Actual or alleged abuse where healthcare did not take appropriate action/intervention to

safeguard against such abuse occurring or where abuse occurred during the provision of

NHS-funded care.

131

A Never Event

An incident (or series of incidents) that prevents, or threatens to prevent, an

organisation’s ability to continue to deliver an acceptable quality of healthcare services,

including (but not limited to) failures in the security, integrity, accuracy or availability of

information; Property damage; Security breach/concern; Incidents in population-wide

healthcare activities like screening and immunisation programmes; Inappropriate

enforcement/care under the Mental Health Act (1983) and the Mental Capacity Act (2005)

including Deprivation of Liberty Safeguards (MCA DOLS); Systematic failure to provide an

acceptable standard of safe care or Activation of Major Incident Plan

Major loss of confidence in the service, including prolonged adverse media coverage or

public concern about the quality of healthcare or an organisation

Incidents Requiring Investigation

In Q3, 2015/16 a total of 31 Serious Incidents were reported on STEIS.

One of these SI’s was de-escalated by King’s College Hospital (KCH) as it was found not to meet

the SI criteria after further investigation. It is possible that SI’s reported during this period may be

de-escalated at a later date if found not to meet the criteria following further investigation.

Thirty incidents required an investigation, as noted by provider in the following table.

Table 1: Q3 2015/16 Serious Incidents requiring investigation reported by provider

Provider Oct-15 Nov-15 Dec-15

GSTFT 8 5 3

KCH 0 4 2

SLaM 3 0 4

PRUH 0 1 0 GSTFT = Guy’s and St Thomas’s NHS Foundation Trust; KCH = King’s College Hospital NHS Foundation Trust; SLaM = South London and Maudsley NHS Foundation Trust; PRUH = Princess Royal University Hospital

GSTFT reported serious incident numbers are larger than KCH and SLaM as they include all

incidents. KCH, SLaM and PRUH incidents are only for Lambeth residents.

Table 2: Serious Incident categories by Provider for SI’s requiring investigation, Q3 2015/16

STEIS CATEGORY GSTFT KCH PRUH SLaM

Surgical/invasive procedure incident meeting SI criteria 8 0 0 0

Treatment delay meeting SI criteria 3 3 0 1

Apparent/actual/suspected self-inflicted harm meeting SI criteria 0 1 0 4

Slips/trips/falls meeting SI criteria 2 0 0 1

Medication incident meeting SI criteria 2 0 0 0

Confidential information leak/IG breach meeting SI criteria 0 0 0 1

Diagnostic incident including delay meeting SI criteria 0 1 0 0

132

STEIS CATEGORY GSTFT KCH PRUH SLaM

Maternity/obstetric incident meeting SI criteria: mother only 0 1 0 0

Pending review 0 0 1 0

Pressure ulcer meeting SI criteria 1 0 0 0

NOTE: GSTFT = Guy’s and St Thomas’s NHS Foundation Trust; KCH = King’s College Hospital NHS Foundation Trust; SLaM = South London and Maudsley NHS Foundation Trust; PRUH = Princess Royal University Hospital

Of the incidents reported by GSTFT, all 16 required investigation.

There was two incidents reported in the ‘Pending review’ category where it is not yet established which

category the incident falls into.

6.4 Never Events

NHS England published a revised Never Events Policy and Framework along with the revised Serious

Incident Framework in March 2015.

The definition of a Never Event has also revised:

They are wholly preventable, where guidance or safety recommendations that provide strong

systemic protective barriers are available at a national level, and should have been implemented

by all healthcare providers

Each type has potential to cause serious patient harm or death (but may not).

Evidence that never event type has occurred in the past and risk of recurrence remains.

Occurrence of the Never Event is easily recognised and clearly defined.

There were five never events reported on STEIS in Q3 by GSTFT. These included a wrong site surgery,

two mis-placed naso-gastric tubes, a retained foreign object post-procedure and a wrong route

administration of medication. These are currently being investigated. Due to the number of never events

in Q1 – Q3, a meeting was held with the Trust to discuss these events in December. The Trust will be

producing an action plan for the management of never events by the end of January, which will be

monitored via CQRG.

All serious incident issues are followed up at on-going provider Serious Incident Monitoring meetings for

each provider, this includes reviewing the progress of overdue investigation reports. These meetings are

chaired by the CCG Clinical Quality Lead. Serious incidents are closed by the CCG through the Serious

Incident Review Group, which is a sub-committee of the Integrated Governance Committee.

6.5 Quality Alerts

The Quality Alerts data for Quarter 3 2015/16 will be provided in the Q3 Quality Report, which will be an

appendix of this report in April 2016.

6.6 Infection Control

MRSA

There have been no MRSA cases so far this year.

Infection Control Target (YTD) Apr 15 May 15 Jun-15 Jul-15 Aug-15 Sep-15 YTD

MRSA 0 0 0 0 0 0 0 0

C-difficile 42 8 7 6 5 6 13 45

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C-Difficile

To Month 6, there have been 45 cases of C. difficile reported. More than 50% occurred in a non-acute

setting.

6.7 Mixed Sex Accommodation

The majority of the breaches of the MSA standard at GST have been due to critical care step down. This

is a long standing issue where patients are counted as being MSA breaches whilst in critical care step

down. Last year, there was new guidance released which outlined that Trusts do not need to record

these particular types of patients as MSA breaches.

However, GSTFT has chosen to continue reporting on this particular type of breaches in order to keep

track of the issue internally. GSTFT is aware that other Trusts across London do not report these

patients but feel it is more important to record these patients in order to understand the issue and drive

improvement. We have supported the Trust in this choice.

6.8 Freedom of Information (FOI) There were 65 FOI requests received for Q3 2015/16. Response rates (requests completed within 20 working days)

2 responses were overdue for the following reasons,

Approval was not received in time for the response to be made.

Information was supplied to South East CSU after the deadline date.

1 response was made beyond 20 working day deadline, due to a consideration of an exemption under the Freedom of Information Act 2000 (Commercial interests)

Of the 65 requests received, 52 of these were round robins, where the same request was asked of other CCGs. The following table lists the requests that were specific to NHS Lambeth CCG

Indicator National Target Apr 15 May 15 Jun 15 Jul-15 Aug-15 Sep-15 Oct-15

Mixed-sex Accommodation 0 3 0 2 0 1 3 2

FOI response rates – NHS Lambeth CCG

Qtr 4 13/14

Q1 14/15 Q2 14/15 Q3 14/15 Q4 14/15 Q1 15/16

Q2 15/16

Q3 15/16

97% 100% 98% 98% 97% 100% 100% 97%

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Individuals / Researchers made the majority of requests (43%) followed by Commercial organisations (26%) and Media organisations (12%).

6.9 Quality Premium

The ‘Quality Premium’ is intended to reward clinical commissioning groups (CCGs) for improvements in

the quality of the services that they commission and for associated improvements in health outcomes

and reducing inequalities. The Quality Premium for Lambeth CCG is agreed with the local Health and

Wellbeing Board and NHS England (London).

Quality Premium 2015/16

The 2015/16 Quality Premium will be paid to Lambeth CCG in 2016/17 in line with previous practice.

The measures have been revised as follows:

Reducing potential years of lives lost (PYLL) through causes considered amenable to

healthcare and addressing locally agreed priorities for reducing premature mortality (15% of

quality premium). This measure is being rolled forward into the current financial year. The target for

this indicator has changed this year. CCGs are now working to an average trend percentage

reduction in years of life lost of no less than 1.2% over the period 2012 – 2015 calendar years. This

measure will be worth 10% of this year’s Quality Premium.

This measure is reported annually; there is no change from the 2014/15 position reported below:

Subject of Request Type of Applicant

making the request

Referral rates between GP Practices Individual

Telehealth / Telecare services Organisation / Company

Money paid to GPs – Referral management schemes Individual

Prescribing incentive schemes Public organisation

Policies and procedures for extra contractual referrals Organisation / Company

Wound care formularies Organisation / Company

Shared data backup in surgeries Individual

Software development and testing Organisation / Company

Medicines formulary Individual

Wounds care products Organisation / Company

Communications with Advisory boards Journalist

Minor ailments service Researcher

Financial information Researcher

Main subject of FOI requests received No. of requests

Medicines Optimisation 7

Commissioning 8

ICT 5

Service provision 12

Procurement 7

Staff details 10

Mental health 4

135

Reducing potential years of lives lost (PYLL) through causes considered amenable to

healthcare and addressing locally agreed priorities for reducing premature mortality (15%

of quality premium). The required reduction in mortality rate between 2012/13 and 2014/15 was

1.2%. The table below shows published data for the years 2012 – 2014. This seems to be a

very volatilie indicator as

there was a reduction of

1.3% between 2012 and

2013. However, there was

an increase of 8.6%

between 2013 and 2014.

Overall, there has therefore

been a 6.6% increase in

mortality from these causes.

This indicator is part of the

suite of 2015/16 Quality Premiums. Detailed investigation of trends in admissions and hospital

mortality for these causes is need to enable understanding of this public health issue.

Urgent and emergency care – Reducing NHS-responsible delayed transfers of care.

This measure uses the number of days patients’ discharge was delayed for reasons for which the

NHS is responsible. This is a subset of the Delayed Transfers of Care measure reported to the

Better Care Fund (see below). Delayed Transfers of Care are attributed at local authority level using

the proportion of each CCG’s registered population that are resident in each local authority. This

measure will be worth 30% of this year’s Quality Premium.

The table below shows that YTD, the number of NHS responsible Delayed Transfer Days is below

the 2014/15 level.

Mental health – Reduction in the number of people with severe mental illness who are

smokers.

This measure is calculated from the severe mental illness (SMI) registers on GP systems, based on

GP data extracted by GPES. This measure compares the percentage of smokers on 31/03/2015

against that on 31/03/2016, and will be worth 30% of this year’s Quality Premium.

Following advice from HSCIC, the table below uses the national methodology to calculate

performance. The percentage of smokers on an SMI register was slightly higher on 30/09/2015 than

on 31/03/2015.

Reducing NHS Responsible Delayed Transfers of Care ONS Mid-year Population Estimate 2014 318000

No national target Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 YTD

2014/15 No. NHS Responsible Delayed Transfers 386 294 292 285 436 384 464 334 277 256 185 254 2,077

No. of 2014/15 NHS Responsible Delayed Days per 100,000

Population 121 92 92 90 137 121 146 105 87 81 58 80 653

2015/16 No. NHS Responsible Delayed Transfers 287 200 377 390 292 411 505 341 409 3,212

No. of 2015/16 NHS Responsible Delayed Days per 100,000

Population 90 63 119 123 92 129 159 107 129 1,010


Data Source: NHSE Unify2 public data

No national target

2014/15 % Smokers

2015/16 % Smokers 57.8% 57.5% 57.7%

Data Source: EMIS Enterprise

57.8% 57.9% 57.9% 56.9%

30th June 30th September 31st December 31st March

Reduction in the percentage of people with severe mental illness who are currently smokers

Reducing potential years of lives lost (PYLL) through causes

considered amenable to healthcare and addressing locally

agreed priorities for reducing premature mortality

Target: Reduction in PYLL 2012 - 2014 2012 2013 2014

Registered patients 384096 374777 369647

Years of life lost 5047 4980 5406

Observed deaths 195 202 208

Annual % change -1.3% 8.6%

% Change 2012 - 2014 6.6%

* Data source: Health & Social Care Information Centre Indicator Portal


136

Improving antibiotic prescribing in primary and secondary care.

This is a composite Quality Premium consisting of 3 parts:

a) Reduction in the number of antibiotics prescribed in primary care – threshold >=1% from the

2013/14 position

b) Reduction in the proportion of broad spectrum antibiotics prescribed in primary care – threshold

either >= 10% from the 2013/14 position or below the 2013/14 median English CCG position of

11.3%. The table below shows that this was being achieved from June 2015 for antibacterial

items but not for Co-amoxiclav, Cephalosporins and Quinolones.

c) Secondary care providers have validate their total antibiotic prescribing data as certified by PHE

This measure will be worth 10% of this year’s Quality Premium.

This measure is reported as part of the Medicine’s Management Report earlier in this report

under Long Term Conditions.

Maternal smoking at delivery

This is a long-standing measure. This measure will be worth 10% of this year’s Quality Premium.

Performance against the standard itself is achieving the target. However, there is a risk that the

standard will not be achieved because the data validation measure - <5% of maternities should

return a status of ‘not known’. This has not been achieved for two quarters of 2015/16.

Breast-feeding delivery at 6 – 8 weeks.

This is also long-standing measure. This measure will be worth 10% of this year’s Quality Premium.

The national target for this standard is 85%. This was not achieved in 2014/15 and has not been

achieved in Quarter 1 2015/16. NHS England has ceased to collect data for this standard. As yet, and

alternative owner for the data has not been arranged. We are awaiting further information regarding this.

National Target: 11%

2014/15 % Smoking at Delivery

2015/16 Smoking at Delivery

Validation: Not Known <5% of Maternities

Data Source: Quarterly return submitted by South London Commissioning Support Unit

3.9% 3.4%

6.5% 8.5%

3.7% 4.3% 3.1% 2.5%

Quarter 1 Quarter 2 Quarter 3 Quarter 4

Smoking At Delivery

137

This year, the maximum quality premium reward for Lambeth CCG is £1.6m and will be paid out in

accordance to the NHS England’s “Quality Premium: 2015/16 guidance for CCGs”. As last year, the

CCG is required to achieve financial and quality gateways before it is eligible for payment and the overall

payment is reduced for non-delivery of constitutional targets for A&E, RTT, ambulance conveyance and

cancer waits.

6.10 Better Care Fund

Non Elective Activity:

As part of the Better Care Fund there is a national expectation that local areas reduce the non elective

admissions (unplanned care) by at least 3.5% against a baseline of Q4 2013/14 to Q3 2014/15. The plan

reduction could be set at a local level and within Lambeth CCG this has been set at 2%.

Data on performance for non elective (unplanned care) activity for 2015/16 shows that we made a 4%

reduction in quarter 4 2014/15 and quarter 1 2015/16 respectively, and a 3% reduction in quarter 2

20151/6. This is based on using Secondary Uses Service (SUS)1 data available.

SUS is the recognised national dataset that is used for contracts with acute providers and, in agreement

with the BCF national team, is now being used to report non-elective admissions for BCF.

Our latest data which is quarter two for 2015 shows actual non elective admissions as 6396. These

figures have been validated internally.

Delayed Transfers of Care:

Delayed transfers of care (DTOC) is one of the metrics identified to be planned and monitored by CCGs

and local authorities as a part of the Better Care Fund. Effective collaboration between providers is

needed in order to minimise delayed transfers of care.

1 The Secondary Uses Service (SUS) is the single, comprehensive repository for healthcare data in England which enables a range of reporting and analyses to support the NHS in the delivery of healthcare services.

National Target: 85%

2014/15 Actual

2015/16 Actual

Data Source: NHSE Unify2 public data

76.1%

Breastfeeding At 6 – 8 Weeks

Quarter 1 Quarter 2 Quarter 3 Quarter 4

77.4% 74.9% 74.9% 75.4%

Reduction in non-elective admissions using SUS

Rate per 100,000 1,764 1,800 1,761 1,777 1,699 1,747 1,686 1,751

Non-elective admissions (SUS) Actual/Plan 6,525 6,710 6,608 6,725 6,395 6,576 6,476 6,591

Non-elective admissions (SUS) Actual 6,525 6,710 6,608 6,725 6,217 6,393 6,396

Variance plan vs actual (%) 4.7% 4.7% 3.2%

Population denominator (Registerd population) 369,897 372,709 375,141 378,387 376,382 376,382 384,016 376,382

SUS (Actual) SUS (Actual/Plan)

Q4

(Jan 14 - Mar 14)

Q1

(Apr 14 - Jun 14)

Q2

(Jul 14 - Sep 14)

Q3

(Oct 14 - Dec 14)

Q4

(Jan 15 - Mar 15)

Q1

(Apr 15 - Jun 15)

Q2

(Jul 15 - Sep 15)

Q3

(Oct 15 - Dec 15)

138

The performance on DTOC improved during August, recording the best month in 2015/16 so far. There

were 66 days for social care delays from the four main local providers in October (GSTT, KCH, SLaM

and St George’s) with the main reasons being public funding and choice.

Performance on NHS delays deterioriated in October to 464 from 318 in the preceding month. The

main reasons are residential home placements (SLaM) and completion of assessment (GSTT)

Commissioners are currently working with senior managers at SLaM to identify trends and take the

lessons learnt from the targeted work at KCH to see what can be applied to a mental health trust.

Residential Care

Permanent Admissions for Residential and nursing care for December are 99 against a monthly target of

103. There were a total of only 7 new admissions to residential/nursing care in December. Six of these

were for EMI care and all service users 75 or above.

For the proportion of older people still living at home 91 days following discharge from hospital,

performance in December was 94%. The year to date performance is 95%. At the time of reporting data

was not available for October and November 2015. This will be reported in March 2016.

Documents

Governance and Performance Report - Welcome to NHS Lambeth … · NHSE NHS England PMO Programme Management Office PTL Patient Tracking List PRUH Princess Royal University Hospital,