Meeting of the CCG Governing Body...2020/07/28 · OFFICIAL 1 Meeting of the CCG Governing Body A meeting of NHS North Tyneside Clinical Commissioning Group Governing Body is to be

OFFICIAL

1

Meeting of the CCG Governing Body

A meeting of NHS North Tyneside Clinical Commissioning Group Governing Body is to be held in Public on Tuesday 28th July 2020, 11.15 – 12.00, via MS Teams

Agenda

Item No

Item Lead Enclosure/ Verbal

Action Required

Time

1 Welcome and Introductions

Dr. R Scott Verbal 11.15

2 Apologies for Absence

Dr. R Scott Verbal

3 Confirmation of Quoracy

Dr. R Scott Verbal Confirm

4 Declarations of Interest

Dr. R Scott Enclosure Manage

5 Minutes of the Previous Meeting held on 2nd June 2020

Dr. R Scott Enclosure Agree 11.20

6 Matters Arising from the Previous Meeting held on 2nd June 2020

Dr. R Scott Verbal Respond

7 Action Log 2nd June 2020

Dr. R Scott Enclosure Update

8 Report from Chair and Chief Officer

Dr. R Scott / Mr. M Adams

Verbal Note 11.25

9 Quality & Safety

9.1 Integrated Quality and Performance Report

Mr. J Connolly / Dr. L Young-Murphy

Enclosure Note / Approval

11.35

10 Finance & Contracting

10.1 Financial Position Report Mr. J Connolly Enclosure Assurance 11.40

11 Public and Patient Involvement

11.1 Report from the Patient Forum

Dr. L Young-Murphy

Verbal Information 11.45

11.2 North Tyneside Covid-19 Outbreak Control Plan

Dr. L Young-Murphy

Enclosure Assurance

12 Governance and Assurance

12.1 Use of Seal 19/20 Mrs. I Walker Enclosure Ratification 11.50

12.2 Risk Assurance Framework Q1 2020/21 Mrs. I Walker Enclosure Assurance

12.3 Northern CCG Joint Committee - Terms of Reference

Mrs. I Walker Enclosures Approval

OFFICIAL

2

13 Items for Information

13.1 Reports / Minutes from Committees of the Governing Body for Assurance: • Primary Care Committee Public

meeting 5.3.20

Mrs. I Walker Enclosure Note 11.55

14 Date of Next Meeting

Tuesday 22nd September 2020

08.30 – 10.00 Private Governing Body Meeting 10.15 -12.00 Governing Body Meeting in Public Venue TBC

Surname Forename

Current

Position(s) held in

CCG i.e. Governing

Body member;

Committee member;

Council of Practices

member (Member

practice); CCG

employee; other

GP Practice (if

applicable)

Declared Interest (name of

organisation and nature of

business) Financial

Non

Financial

Professiona

l Interests

Non

Financial

Personal

Interests

Is the

interest

direct or

indirect? Nature of interest From To Action taken to mitigate risk

Adams Mark

Governing Body

member/

Committee

member Beverley Park Leisure Ltd

Direct

Director 2008 31/03/2020 Not relevant to CCG role

Adams Mark

Governing Body

member/

Committee

member GLSKR.com Ltd

Direct

Director 2015 Ongoing Will declare at meetings as appropriate

Adams Mark

Governing Body

member/

Committee

member

NHS Newcastle Gateshead Clinical

Commissioning Group

Direct

Accountable Officer 01/12/2016 Ongoing Will declare at meetings as appropriate

Adams Mark

Governing Body

member/

Committee

member

NHS Northumberland Clinical

Commissioing Group

Direct


Adams Mark

Governing Body

member/

Committee

member

NHS North Cumbria Clinical

Commissioing Group

Direct


AIREY GILLIAN

NECS

EMPLOYEE NA NA

NA NA NA NA NA NA NA NA

Bernardi Mario

GP IT Strategic

Manager N/A None

None None None None None N/A N/A

No Conflict

Blomfield Kathryn

Primary Care

Strategy &

Delivery Group

member

Forest Hall Medical

Group/Stephenson

Park Salaried GP at Forest Hall Medical Group/Stephenson Park

Clinical Deputy Network Director Jan-15 PresentWill comply with Standards of Business Conduct

Policy

Blomfield Kathryn

Primary Care

Strategy &

Delivery Group

member

Forest Hall Medical

Group/Stephenson

Park North West North Tyneside Primary Care Network

Clinical Deputy Network Director Apr-19 OngoingWill comply with Standards of Business Conduct

Policy

Charlton Gary CCG Employee

Uncle (Wally Charlton) works for

CCG - Head of Improvement &

Development

Non-

financial

personal

interest indirect relative working within CCG 13/05/2016 Ongoing

I will comply with standards of business conduct

policy

Charlton Walter CCG Employee

Wife is a bio medical science

technician at Freeman Hospital

Indirect

Wife is a bio medical science

technician at Freeman Hospital Circa 2001 Ongoing

Will comply with Standards of Business Conduct

Policy

Type of Interest (tick as appropriate)

Published Register of Declarations of Interests by Decision Makers v2-0 issued 11 June 2020This register lists members of Governing Body; members of Governing Body committees, and as appropriate sub committees; staff grade 8d and above if not already listed; members of new care models

joint provider/commissioner groups/committees; members of advisory groups which contributes to direct or delegated decision making on the commissioning or provision of tax payer services

Surname Forename

Current

Position(s) held in

CCG i.e. Governing

Body member;

Committee member;


member (Member

practice); CCG

employee; other

GP Practice (if

applicable)



business) Financial

Non

Financial

Professiona

l Interests

Non

Financial

Personal

Interests

Is the

interest

direct or



Daughter – in – law is employed as

District nurse with Northumbria

Healthcare Foundation Trust

Indirect

Daughter – in – law is employed as

District nurse with Northumbria

Healthcare Foundation Trust Circa 2014 Ongoing


Policy


Nephew is employed by North

Tyneside CCG as a Primary Care

development manager

Indirect

Nephew is employed by North

Tyneside CCG as a Primary Care

development manager Circa 2013 Ongoing


Policy

Charlton Walter CCG Employee Citizens Advice Bureau

Indirect Employed by CAB (Son's Partner) 01/06/2018 Ongoing


Policy

Connolly Jon

Governing Body

member/

Committee

member

NHS Northumberland Clinical

Commissioing Group

Direct

Chief Finance Officer 01/03/2019

I will comply with the Standards of Business

Conduct and Declarations of Interest Policy

Coyle Mary

Governing Body

member/

Committee

member

Newcastle University, Trustee

Member of Pension Trustee

Limited

IndirectThere may be a connection between

the University and the CCG 2011 Ongoing Not required

Coyle Mary

Governing Body

member/

Committee

member

Forum Member. Northumbrian

Water Forum

Indirect

Northumbrian Water and CCG may

have some connection 2011 Ongoing Not necessary

Coyle Mary

Governing Body

member/

Committee

member

Board Chair, Shared Interest

Society and Shared Interest

Foundation

Indirect

There may be connection between

Shared Interest and CCG 2015 Ongoing Not required

Craig Lynn

Clinical

Development

Manager CCG NA

Senior Lecturer (PT) Northumbria

university

Direct Senior Lecturer (PT) Northumbria

university 07/11/2019 ongoing I will declare at meetings as required

Craig Lynn

Clinical

Development

Manager CCG NA

Newcastle upton Tyne Hospitals

(NuTH)

Indirect

My daughter works for (NuTH) 01/10/2019 Ongoing I will declare at meetings as required

Crowther Mathew CCG Employee

Wife works for Newcastle upon

Tyne Hospitals

Wife works for Newcastle upon

Tyne Hospitals 2011 Ongoing



Crowther Mathew CCG Employee Newcastle Upon Tyne Hospitals FT

Secondment to Trust 2 days per

week Jan-20 Jul-20



Davison Keith

NHS England -

Senior Finance

Manager Gluo-Rx

IndirectDaughter in Law is a Business

Development Manager with this

company 01/09/2019 Ongoing

I will comply with the standards of business

conduct and declarations of interest policy

Surname Forename

Current

Position(s) held in

CCG i.e. Governing

Body member;

Committee member;


member (Member

practice); CCG

employee; other

GP Practice (if

applicable)



business) Financial

Non

Financial

Professiona

l Interests

Non

Financial

Personal

Interests

Is the

interest

direct or


Douglas Leanne

Primary Care

Business

Manager, NHS

England None

Evans Ruth

Council of

Practice member/

Committee

Member

CCG Employee

The Village Green

Surgery The Village Green Surgery

✓ Direct

Partner 2007 ongoing



I will declare at meetings and abide chair's

instructions

I will not participate in any CCG business relating

to the surgery

Evans Ruth

Council of

Practice member/

Committee

Member

CCG Employee

The Village Green

Surgery Tynehealth GP Federation

✓ Direct

Practice is shareholder in

Tynehealh 2015 ongoing



I will declare at meetings as required

Evans Ruth

Council of

Practice member/

Committee

Member

CCG Employee

The Village Green

Surgery

Action Foundation (charity for

refugees & asylum seekers

providing housing, language and

support)

✓ Indirect

Trustee 2006 ongoing





to this organisation

Evans Ruth

Council of

Practice member/

Committee

Member

CCG Employee

The Village Green

Surgery Wallsend Primary Care Network

✓ Direct

Practice is a member of Wallsend

Primary Care Network 01/07/2019 ongoing




Frankland Neil

MO CSU

pharmacist,

Member of MOSC N/A Nil

N/A N/A N/A N/A

N/A N/A N/A N/A

Goldthorpe Jeffrey Head of Finance Nothing to declare

Grieveson Maureen

Committee

member/

CCG employee Nothing to declare

Surname Forename

Current

Position(s) held in

CCG i.e. Governing

Body member;

Committee member;


member (Member

practice); CCG

employee; other

GP Practice (if

applicable)



business) Financial

Non

Financial

Professiona

l Interests

Non

Financial

Personal

Interests

Is the

interest

direct or


Hall Margaret

Cabinet Member

for Health and

Wellbeing North

Tyneside Council LA Employee

Cabinet Member for Health and

Wellbeing North Tyneside Council

GP

Collingwo

od

Surgery

North

Shields

Indirect

Daughter - GP Collingwood Surgery

North Shields 1998 Ongoing Compliance with CCG Conflicts of Interest policy.

Hall Margaret

Cabinet Member

for Health and

Wellbeing North

Tyneside Council LA Employee

Cabinet Member for Health and

Wellbeing North Tyneside Council

Cabinet

Member

for Health

and

Wellbeing

North

Tyneside

Council

Direct

Self - Cabinet Member for Health

and Wellbeing North Tyneside

Council May-16 Ongoing Compliance with CCG Conflicts of Interest policy.

Hayward Eleanor

Governing Body

member/

Committee

member

Suzanne Duncan - Daughter, Head

of HR at NorthTyneside Council

IndirectSuzanne Duncan - Daughter, Head

of HR at NorthTyneside Council 4 Years Ongoing Compliance with Business Standards Policy

Hemingway Jan CCG Employee None

Horsfield Philip

Committee

Member

The Village Green

Surgery NHS England CNTW

IndirectDaughter is Commissioning

Manager for NHS England Health &

Social Justice 2017 ongoing




Horsfield Philip

Committee

member

The Village Green

Surgery The Village Green Surgery

Direct

Partner 2010 ongoing




Horsfield Philip

Committee

member

The Village Green

Surgery Tynehealth GP Federation

DirectPractice is shareholder in

Tynehealh 2014 ongoing




Jones Paul

Director

HealthWatch

North Tyneside

Attends CCG

Comms

committee; PCC;

and Future Care

Programme Board None

Kent Alexandra

CCG Employee -

Clinical Director Priory Medical Group

Salaried GP Feb-18 Ongoing



Lackey Shaun

Committee

member/

CCG Employee

Woodlands Park Health Centre -

GMS GP

IndirectEmma Lackey (wife) is a GP

employee in member practice

(Woodlands Park Health Centre) 08/04/2013 Ongoing



- I will declare at meetings as required

Lackey Shaun

Committee

member/

CCG Employee

Director and share holder of

TRUSTY LTD

Direct

Director and shareholder of

TRUSTY LTD, a company which

provides GP services and

consultancy (including website

services in the near future) 09/04/2019 Ongoing



- I will declare at meetings as required

Surname Forename

Current

Position(s) held in

CCG i.e. Governing

Body member;

Committee member;


member (Member

practice); CCG

employee; other

GP Practice (if

applicable)



business) Financial

Non

Financial

Professiona

l Interests

Non

Financial

Personal

Interests

Is the

interest

direct or


Lunn Dr James

GP

Partner/Council of

Practice Member

Stephenson Park

Health Gas House Lane Surgery, Morpeth

Indirect

Spouse is GP partner approx 2016 Ongoing



Lunn Dr James

GP

Partner/Council of

Practice Member

Stephenson Park

Health Tynehealth (Provider Organisation)

Direct

Shareholder c.2014 Ongoing



Lunn Dr James

GP

Partner/Council of

Practice Member

Stephenson Park

Health Stephenson Park Health

Direct

GP Partner approx 2011 Ongoing



Lunn Dr James

GP

Partner/Council of

Practice Member

Stephenson Park

Health

North West North Tyneside

Primary Care Network

Direct

Network Director 01/07/2019 Ongoing



Martin James

Committee

member/

CCG employee

Northumberland Tyne and Wear

NHS Foundation Trust

Indirect

Wife is a Clinical Psychologist

working for NTW Mental Health

Trust 01/02/2014 Ongoing

Whilst NTW is a provider of services, the wife's

role (Clinical Psychologist) is highly unlikely to

lead to any conflict of interest. Notwithstanding

this the NTCCG Standards of Business Conduct

and Declarations of Interest Policy will be

followed.

McEntee

Kaye

Amanda

Senior Provider

Management

Lead N/A N/A N/A N/A N/A N/A N/A N/A N/A No Conflict

Murray Catherine

Salaried

GP/Council of

Practices

Representative/Pr

imary Care

Network Director 49 Marine Avenue Northumbria Primary Care

Direct

Salaried GP 01/09/2016 Current




Murray Catherine

Salaried

GP/Council of

Practices

Representative/Pr

imary Care

Network Director 49 Marine Avenue NUTH

Indirect

Husband is a consultant

neurosurgeon there 29/12/2016 Current




Murray Catherine

Salaried

GP/Council of

Practices

Representative/Pr

imary Care

Network Director 49 Marine Avenue 49 Marine Avenue

Direct

GMS Contract Holder 01/09/2018 Current




Murray Catherine

Salaried

GP/Council of

Practices

Representative/Pr

imary Care

Network Director 49 Marine Avenue Tynehealth (provider)

Direct

Member 01/09/2018 Current




Murray Catherine

Salaried

GP/Council of

Practices

Representative/Pr

imary Care

Network Director 49 Marine Avenue Whitley Bay Primary Care Network

Direct

Network Director 01/07/2019 Current




Surname Forename

Current

Position(s) held in

CCG i.e. Governing

Body member;

Committee member;


member (Member

practice); CCG

employee; other

GP Practice (if

applicable)



business) Financial

Non

Financial

Professiona

l Interests

Non

Financial

Personal

Interests

Is the

interest

direct or


Paradis Anya CCG Employee N/A Nothing to declare

Reynold Steven IM&T Member N/A N/A N/A N/A N/A N/A N/A N/A

Rice Marc CCG Employee employee None

Richardson Kirsten GP Partner & Council of Practice Representative

Bewicke Medical

Centre Bewicke Medical Centre

Direct GP Partner 01.05.2008 Ongoing





Bewicke Medical

Centre Tynehealth (Provider Organisation)

Direct Shareholder 2014/15 Ongoing





Bewicke Medical

Centre

Local Health - a non profit making

local organisation where members

can share experiences and insight

into the local health economy with

a view to improving local health

provision.

Direct Member of Local Health 30th March 2015 Ongoing





Bewicke Medical

Centre Locality Director - Wallsend

Direct CCG Role 01.04.17 Ongoing





Bewicke Medical

Centre NTW FT

Indirect

Husband is Group Medical Director

for South Locality and Trust Wide.

This includes specialist services and

neurological services. Apr-15 Ongoing



I will declare at meetings as required.


to NTW FT.


Bewicke Medical

Centre

Castleside inpatient ward at

Campus for Aging Vitality

Indirect Husband is Old Age Psychiatrist Jan-06 Ongoing





to this service.


Bewicke Medical

Centre Wallsend Primary Care Network

Direct Network Director Jul-19 Current




Rundle Steve

Committee

member/

CCG employee Sheila Rundle (Spouse)

Indirect

Works as a Public Health

Intelligence Analyst (Needs

Assessment) at Sunderland City

Council 04/01/2013 Ongoing

Unlikely to lead to any conflict of interest.

Notwithstanding this the NTCCG Standards of

Business Conduct and Declarations of Interest

Policy will be followed

Surname Forename

Current

Position(s) held in

CCG i.e. Governing

Body member;

Committee member;


member (Member

practice); CCG

employee; other

GP Practice (if

applicable)



business) Financial

Non

Financial

Professiona

l Interests

Non

Financial

Personal

Interests

Is the

interest

direct or


Rundle Steve

Committee

member/

CCG employee Dr Jan Panke (Brother in Law)

Indirect

Partner at Claypath and University

Medical Group, Durham

Director of Claypath and University

Primary Care Network

Executive GP for North Durham and

DDES CCG

Trustee for RTProject , a mental

health charity in Durham 04/01/2013 Ongoing





Rundle Steve

Committee

member/

CCG employee Dr Anna Basu (Sister in Law)

Indirect

Clinical Senior Lecturer, Newcastle

University.

Honorary Consultant Paediatric

Neurologist at The Newcastle upon

Tyne Hospitals NHS Foundation

Trust

Honorary Consultant Paediatric

Neurologist at City Hospitals

Sunderland NHS Foundation Trust 07/01/2013 Ongoing





Scott RichardClinical Chair of

CCG

Marine Avenue

Medical Centre

Marine Avenue Medical Centre,

Whitley Bay ✓ Direct

GP Partner and GP trainer;

member of CCG Council of

Practices.

2008 ongoingI will comply with the Standards of Business

Conduct & Declarations of Interest Policy


CCG

Marine Avenue

Medical Centre

Tyne Health (North Tyneside

GP Federation)✓ Direct

Partner in a GP Practice that is a

shareholder of TyneHealth.

Practice Manager is a director of

TyneHealth




CCG

Marine Avenue

Medical CentreNorthumbria Healthcare FT ✓ Indirect

Wife, Tracy Scott works as a

District Nurse for Northumbria

Healthcare FT




CCG

Marine Avenue

Medical Centre

Whitley Bay Primary Care

Network✓ Direct

Practice is a member of Whitley

Bay Primary Care Network01/07/2019 ongoing



Shabde Neela

Governing Body

Member N/A

Be Serene Limited - business of

keeping health & well Direct

Director 2015 Ongoing No conflict as not trading

Shabde Neela

Governing Body

Member N/A

Aristia Associates, UK Ltd -

Training & Development Company Direct

One of the Directors Aug-16 Ongoing



Shabde Neela

Governing Body

Member N/A

World Health Innovation Summit

(Community Interest Company) Direct

One of the Directors Mar-18 Ongoing



Shabde Neela

Governing Body

Member N/A

My daughter has a company

Ishybruce Anxiety & Weight

Management. Life coaching &

Indirect

No direct involvement 2016 Ongoing No conflict

Snowdon Hilary

Member of

Primary Care

Strategy and

Assurance

Committee;

Primary Care

Home Board

TyneHealth Limited (GP

Federation)

Yes Direct

Director of Strategy Nov-19 To date




Surname Forename

Current

Position(s) held in

CCG i.e. Governing

Body member;

Committee member;


member (Member

practice); CCG

employee; other

GP Practice (if

applicable)



business) Financial

Non

Financial

Professiona

l Interests

Non

Financial

Personal

Interests

Is the

interest

direct or


Snowdon Hilary

Member of

Primary Care

Strategy and

Assurance

Committee;

Primary Care

Home Board

Hadrian Primary Care Limited (GP

Federation in West

Northumberland)

Yes Direc

Executive Manager Jan-18 To date




Snowdon Hilary

Member of

Primary Care

Strategy and

Assurance

Committee;

Primary Care

Home Board

West Northumberland Primary

Care Network

Yes Direct

Management Lead May-19 To date




Snowdon Hilary

Member of

Primary Care

Strategy and

Assurance

Committee;

Primary Care

Home Board Mtech Access Liimited

Yes Direct

Faculty Member Nov-19 To date




Swanepoel Riaan

named GP child

and adult

safeguarding NT

CCG

See Decision

Maker Register

July 19

Care Plus (Appleby

surgery) Worktogether ltd -safeguarding

consultancy

I do this

privately indirect

private clients and work on behalf of

other CCGs since 2016 I will declare at meetings

Swanepoel Riaan

See Decision

Maker Register

July 19

Private GP Newcastle Nuffiled

Hospital

I do this

privately indirect

private clients since 2016 No conflict

Tomson Dave GP Partner

Collingwood

Surgery Collingwood Surgery

Direct

GP Partner 1992 Ongoing

no conflict - other than that which all GPs have

who are members of CCGs


Collingwood

Surgery Tynehealth (Provider Organisation)

Direct

Shareholder 2011 Ongoing

I will comply with the standards of Business

conduct and Declarations of interest policy


Collingwood

Surgery CCG

Direct

Freelance educationalist with

interests in shared decision making

and persistent pain - I sometimes

do work for CCG on these areas 2018 Ongoing

I will withdraw from decsion making at relevant

meetings.



Surname Forename

Current

Position(s) held in

CCG i.e. Governing

Body member;

Committee member;


member (Member

practice); CCG

employee; other

GP Practice (if

applicable)



business) Financial

Non

Financial

Professiona

l Interests

Non

Financial

Personal

Interests

Is the

interest

direct or



Collingwood

Surgery

North Shields Primary Care

Network

Direct Primary Care Network Director 01/07/2019 Ongoing

I will withdraw from decsion making at relevant

meetings.



Walker Irene

Committee

member None

Wardle Stephanie

Other - PCN

Project Lead

(North Shields) as

per SLA with

Northumbria

Healthcare N/A

Permanent employee of

Northumbria Healthcare Yes None None None Employment outside of CCG May-10 Ongoing




Westwood Mark

CCG - Member of

IM&T The Village Green Surgery

Direct Salaried GP Aug-19 ongoing






Westwood Mark

CCG - Member of

IM&T

Newcastle upon Tyne Hospital

Foundation Trust

Direct Clinical Assistant Neurology Trial Feb-98 ongoing






Westwood Mark

CCG - Member of

IM&T Academic Health Science Network

Direct

Primary Care lead for Connected

Health Cities (Great North Care

Project) May-17 ongoing






Westwood Mark

CCG - Member of

IM&T

Northumbria Healthcare

Foundation Trust (NHCFT)

Indirect Operational Service Manager N/K ongoing






Willis Dave

Governing Body

member/

Committee

member No conflict of interests

Young-

Murphy Lesley

Governing Body

member,

committee

member Primary

Care, CE,

commissioning, NA

Professor at Northumbria

University

Direct

Professional reputation/

research/development role 01/04/2013 Ongoing


Conduct and Declarations Policy.


Surname Forename

Current

Position(s) held in

CCG i.e. Governing

Body member;

Committee member;


member (Member

practice); CCG

employee; other

GP Practice (if

applicable)



business) Financial

Non

Financial

Professiona

l Interests

Non

Financial

Personal

Interests

Is the

interest

direct or


Young-

Murphy Lesley

Governing Body

member,

committee

member Primary

Care, CE,

commissioning, NA

HEE/ CRN Lead for NMAHP

Research and Chair of HEE/CRN

NMAHP Strategy Implmentaton

Group

Direct

Professional reputation/

research/development role 05-Feb-18 Present




Young-

Murphy Lesley

Governing Body

member,

committee

member Primary

Care, CE,

commissioning, NA

Cumbria, Northumberland, Tyne

and Wear NHS Foundation

Trust (CNTWFT)

IndirectMy daughter Hannah Murphy is an

assistant psychologist with CNTW

FT in the Specialist Eating

Disorders Service

14/10/2019 OngoingI will comply with the Standards of Business



OFFICIAL

Page 1 of 7

North Tyneside CCG Governing Body

Minutes of the North Tyneside CCG Governing Body meeting in Public held on Tuesday 2nd June 2020, 10:40 – 12:40 via MS Teams Present: Dr Richard Scott Clinical Chair (Chair) Mark Adams Chief Officer Jon Connolly Chief Finance Officer Dr Lesley Young-Murphy Executive Director of Nursing & Chief Operating Officer Mary Coyle Deputy Lay Chair Eleanor Hayward Lay Member Dr Ruth Evans Medical Director Dave Willis Lay Member Dr Neela Shabde Secondary Care Doctor In Attendance: Anya Paradis Director of Contracting & Commissioning Irene Walker Head of Governance Wendy Hume PA (Papers) Wendy Burke Director of Public Health, North Tyneside Council Michelle Anderson PA (Minutes)

Apologies: None

NTGB/20/019 Welcome & Introductions (Agenda Item 1)

Dr Scott welcomed members to the North Tyneside CCG Governing Body meeting in Public. Members were informed that this meeting was being held via MS Teams and that it was not being recorded or streamed. Dr Scott went on to say that our thoughts are with all of our residents and gave thanks to the NHS, all care workers and key workers for their work whilst in the grip of Covid-19.

NTGB/20/020 Apologies for Absence (Agenda Item 2)

No apologies received. NTGB/20/021 Confirmation of Quoracy (Agenda Item 3)

The meeting was confirmed as quorate.

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Page 2 of 7

NTGB/20/022 Declarations of Interest (Agenda Item 4)

Dr Scott asked the members:

Whether there were any declarations on the enclosed register of interests which were relevant to today’s agenda? Whether there were any additional declarations of interest, including gifts and hospitality relevant to today’s meeting? There were no additional declarations of interest.

NTGB/20/023 Minutes of the Previous Meeting held on 26 November 2019

(Agenda Item 5)

NTGB/20/010, page 5, last sentence in paragraph 1: The word “tech” changed to read “each”. NTGB/20/011, page 5, paragraph 2: “Risk 4.07” to be changed to “Risk 407” and punctuation mark usage to be checked in this paragraph. With these amendments, the minutes of the previous meeting were agreed as an accurate record.

NTGB/20/024 Matters Arising from the Previous Meeting held on 28th January 2020

(Agenda Item 6)

There were no matters arising from the previous meeting. NTGB/20/025

Action Log (Agenda Item 7)

NTGB/19/077, Action 1: Dr Young-Murphy confirmed that this piece of work is ongoing and will bring to Board once complete. NTGB/19/077, Action 2: Mrs Paradis confirmed this work had been completed.

NTGB/20/011, Action 1: Mrs Walker confirmed this work had been completed.

NTGB/20/026 Reports from the Chair and Chief Officer (Agenda Item 8)

Chair’s Report Dr Scott expressed his thanks to care and key workers, as well as the CCG and partner organisations for their work in these unchartered times, while we continue to be in the grip of the Covid-19 pandemic. Dr Scott offered congratulations to Mr Adams, who has been appointed the Accountable Officer for North Cumbria CCG and now works across 4CCGs

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Page 3 of 7

including North Tyneside, Newcastle Gateshead and Northumberland.

Chief Officer’s Report Mr Adams echoed Dr Scott’s words of thanks to all workers and advised that while we are still in Level 4 crisis, the focus is now on the legacy of Covid / lockdown, as well as planning for Winter and the future. Mr Adams congratulated Dr Scott on his reappointment as Chair for a further 2 years, until March 2022.

NTGB/20/027 Quality and Safety (Agenda Item 9)

9.1 Covid-19 Dr Young-Murphy assured members that the CCG had complied with its statutory duties, unless changed due to Covid outbreak. All discharges were safe, appropriate and timely, and all assessments were being tracked. The Local Authority and the CCG are managing funds between them, so patients are not being means-tested for CHC or Social Care at present. Dr Young-Murphy went on to give a short presentation to the Governing Body. Dr Young-Murphy confirmed that Hedley Court had re-opened and risk assessments were in place. There is a need to adapt to new ways of working for living with Covid and it is important to start activity again to ensure people are not lost in the system, but there is not a quick fix for this. Significant discussions need to take place on how the likes of schools, nurseries, offices, transport links, etc. all link up to ensure the safety of everyone and to begin operating safely. The key messages around handwashing, social distancing and respiratory spreading need to be reinforced and we cannot underestimate the economic impact on the North East. Mrs Burke confirmed the economy has been critically impacted in the North East and this won’t be fully understood just yet. In terms of the NHS Test and Trace, the 4 elements are really important in the next stage and how we begin to relax measures as we go. Dr Scott asked about the measures in place if impacted by flu and Covid in a close time period. Has thought been given on how to administer flu jabs safely? Dr Young-Murphy confirmed that plans were in place for the flu vaccine and wants to encourage the uptake of the vaccination. Winter will bring the usual difficulties faced with weather and flu, but with the addition of Covid. Dr Evans said that practices and pharmacies had already begun to place orders for the flu vaccine and regional meetings are taking place to discuss ways of delivering the vaccination. There have not been any issues reported on the availability of the flu vaccine to date. Routine checks of long-term

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conditions are being stepped up to optimise management of conditions now, in preparation for winter. Mrs Burke would encourage Primary Care Networks to think of the assets available within the community, to allow the flu jab to be administered safely. It is felt that there will be a much greater demand for the vaccination this year and it would also be interesting to see if there is a rise in the uptake of childhood vaccinations.

9.2 Integrated Performance & Quality Report Mr Connolly gave an overview of the Performance and Quality Report that

was distributed with the papers, with the information contained within the report largely relating to February:

Referral to Treatment: In February 2020, 88.2% of CCG patients on an incomplete pathway were waiting to be treated within 18 weeks; this is below the standard of 92%. Newcastle FT achieved 87% which did not meet the standard and Northumbria FT achieved 92.6% which did meet the standard. Over 52 week wait for treatment: The CCG had one patient wait over 52 weeks for treatment which was for a spinal deformity at Newcastle FT. The FT had a total of 39 patients wait over 52 weeks for treatment in 2019/20 to date. The Trust is working closely with NHSI, providing weekly tracking data and treatment dates to manage the waiting list. Ambulance response times: In December 2019, ambulance response times exceeded standards across category 2 and 3. Overall the number of ambulance handover delays has reduced from December 2019 to March 2020 across both Trusts. The proportion of an ambulance response resulting in an Emergency Department attendance has also reduced in March as part of the response to managing the coronavirus pandemic. Quality Premium: Mr Connolly noted that this had been discontinued.

9.3 Oversight Framework Report All Clinical Commissioning Groups (CCG) were previously monitored against the NHS Improvement and Assessment Framework (IAF). The CCG IAF has now been superseded by the NHS Oversight Framework for 2019/20. Mr Connolly explained the data is reported on a quarterly basis, so contains a mixture of timescales. The year-end assessment is not available as yet. There are 2 further measures in the top quartile and 4 more in the lower quartile and Mr Connolly is optimistic that the CCG can maintain its Outstanding rating. Dr Young-Murphy drew attention to Page 8 of the report headed Negative Outliers: 104a Injuries from falls in people aged 65 and over. Over 65’s and those shielding can become decommissioned, so are reminded to keep exercising, walking, etc.

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107a Antimicrobial resistance appropriate prescribing of antibiotics in primary care. The number of people presenting has decreased and this needs to be monitored closely.

NTGB/20/028 Finance & Contracting (Agenda Item 10) 10.1 Financial Position Report

Mr Connolly advised that the CCG had hit all financial targets for 2019/20 and the annual accounts were close to being concluded, with no concerns to report. Mr Connolly explained that for 2020/21, interim finance arrangements had bene put in place due to Covid-19. For the first 4 months of the financial year, the CCG would be placed as break-even. Further guidance is due to be issued w/c 8th June 2020 and Mr Connolly will update the Governing Body when the information becomes available.

NTGB/20/029 Public & Patient Involvement (Agenda Item 11)

11.1 Report from the Patient Forum Mrs Hayward gave a verbal update to the members. The Patient forum is continuing as normal via MS Teams and members remain as committed as ever. A newsletter is due to be published shortly. Mrs Hayward thanked the public for their commitment and dedication to the group, to which Dr Scott extended his thanks also.

NTGB/20/030 Governance & Assurance (Agenda Item 12) 12.1 Finance Committee Terms of Reference Mrs Walker informed the members that the Terms of Reference had been amended to include the Deputy Chief Finance Officer in the membership and as part of the quoracy in the absence of the Chief Finance Officer. The Governing Body approved the changes to the Finance Committee Terms of Reference. 12.2 Corporate Objectives 2020/21 Mrs Walker informed members that the Corporate Objectives mirror those of previous years but recommended that objectives 2 and 3 should be amended slightly to ensure appropriate focus. Mrs Walker invited questions or comments from members. Dr Evans felt that Corporate Objective 3 should relate to health and social care as a whole and not just North Tyneside. After discussion, the Governing Body agreed that Corporate Objective 3 would remain the same as in 2019/20. With this amendment, the Governing

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Body approved the Corporate Objectives for 2020/21. 12.3 Risk Assurance Framework (RAF)

Mrs Walker informed the members that the information contained within the report was up to April 2020 plus one month. Mrs Walker advised that it is standard procedure for the RAF to be reviewed by the responsible committees (i.e. Finance Committee, Quality & Safety Committee and Clinical Commissioning & Contracts Committee). However, these committees did not meet in May 2020 due to the Covid-19 response. The Audit Committee agreed the RAF at its meeting on 29th May 2020. Mrs Walker took members through the updates to the RAF: Added CV01 - Response to COVID 19 impacts on system’s ability to deliver healthcare to meet the needs of the population. CV02 - Failure to support NHS & social care system to deliver appropriate care to the residents of North Tyneside throughout the Covid-19 pandemic. CV03 - Covid-19 poses a risk to staff health and CCG operations. This risk had been added at the request of Audit Committee. Deleted Risk 306 - Impact on morgues and homes because of a delayed transfer of deceased persons to a place of rest due to the Coroner advising undertakers not to remove a body until a death certificate has been signed. Changes Residual risk score increased for: Risk 107 - Risk of adult or child safeguarding incident or other significant quality failure incident had now been moved ‘above the line’ as the risk was now at its target risk score. Risk 109 - Intermediate Care and older people’s services - level of system resilience, delayed discharges, and not realising their potential for rehabilitation. Risk 407 - Lack of operational resilience, or organisational capacity and infrastructure leading to failure to delivery against corporate objectives. The residual risk score for Risk 110 - Risk that delayed ambulance handovers impacts negatively on patient safety and patient flow, has been reduced.

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ACTION 1

Dr Young-Murphy stated she understood why Risk CV03 has been added, but having looked at the mitigations and residual risks, felt it should be ‘below the line’ (i.e. meetings its target risk score). Ms Coyle replied that she felt it was a separate risk that needed to be taken into account and that Mr Adams had given assurance at the Audit Committee about the measures put in place. Further discussions took place around the level of residual risk and if it was demonstrated enough measures were in place to bring the residual score risk down. Mrs Walker explained to members that the risk was added late Friday afternoon at the request of the Audit Committee and therefore not all mitigations had been discussed with Directors before being circulated to members on Friday evening. Mr Willis commented that he supported Ms Coyle and had asked for this risk to be added, as it was not visible and felt it was a ‘live’ risk to the organisation. Mrs Walker was correct in what she had said and had correctly identified the risk, but there was enough evidence from discussions to suggest that the residual risk score could be reduced Mrs Walker to update the RAF with the mitigations identified and in discussion with Directors.

NTGB/20/031 Items for Information (Agenda Item 13)

13.1 Reports / Minutes from Committees of the Governing Body for Assurance The Chair confirmed the Governing Body received the following minutes of Committees for assurance:

• Quality & Safety Committee: 14.01.20 • Primary Care Committee: 09.01.20 • Northern CCG Joint Committee: 09.01.20

13.2 Any Other Business

None

NTGB/20/032 Date of Next Meeting (Agenda Item 14)

The next meeting of NHS North Tyneside Clinical Commissioning Group Governing Body is to be held on: Tuesday 28th July 2020 10:15 - 11:00 AGM of Governing Body 11:15 – 12:00 NTCCG Governing Body Meeting in Public Venue: MS Teams Meeting

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Date Minute Action No. Action Resp. OfficerTarget Date Status

26.11.19 NTGB/19/077 1 Integrated Performance & Quality Report: Dr Young-Murphy to bring a report on Learning Disability beds across the region.

28/01/20 Update: Work is ongoing and a report will be brought to the Governing Body.

Dr Young-Murphy TBC Ongoing

G / / C C2.6.20 NTGB/20/030 1 Risk Assurance Framework (RAF) Mrs Walker to update the RAF with the mitigations identified and in discussion with Directors.

Mrs Walker Ongoing Completed

North Tyneside Governing Body (Public)

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Report to: Governing Body (Public) Date: 28th July 2020 Agenda item: 9.1

Title of report: Integrated Performance and Quality Report Sponsor: Jon Connolly, Chief Finance Officer and Lesley Young-Murphy, Executive Director of Nursing and Chief Operating Officer Authors: Teresa Ho, Performance and Monitoring Manager and Gillian Airey, NECS Senior Officer Clinical Quality. Purpose of the report and action required: 1. To report progress against the CCG performance and quality measures. 2. Members are asked to note the current progress in 2020/21 against the listed

measures. 3. Members are asked to approve the changes to the reported measures for 2020/21 Executive summary: The 2020/21 Integrated Performance and Quality Report show delivery against the NHS Constitution, CCG Health Outcomes, and other Quality measures. Part A of the report covers the performance indicators and Part B of the report covers the quality indicators. The CCG is held to account for the delivery of these measures by NHS England.

Part A Performance Summary In response to the COVID 19 pandemic, health services have had to prioritise areas of activity to ensure that Trusts were able to support the pandemic. In March NHSEI issued guidance changes which saw elective services cease. Generally this has impacted negatively on performance measures. The performance indicators to note identified in this report are:- NHS Constitution Referral to Treatment – In April 2020, 78.8% of CCG patients on an incomplete pathway were waiting to be treated within 18 weeks, this is below the standard of 92%. Newcastle FT achieved 74.1% and Northumbria FT achieved 86.6% which did not meet the standard. Our local FTs re-opened to referrals in mid-May / early June and are working actively to reinstate services, although activity levels are very low at present. There are numerous confounding factors including social distancing requirements, Personal Protection Equipment (PPE) shortages, non-availability of Patient Transport System, staff absence and patients being unwilling to attend hospital. Over 52 week wait for treatment – The CCG had nine patients wait over 52 weeks for treatment at Newcastle FT for specialties Trauma and Orthopaedics, Ear Nose & Throat, Ophthalmology, Urology and Other.. Newcastle FT had 72 patients wait over 52 weeks for treatment in April 2020. Newcastle FT raised with Commissioners issues

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in treating some patients at the beginning of 2020 within the 52 week target, largely due to the need for complex spinal deformity surgeries. With the national guidance to suspend elective activity as a result of the COVID-19 pandemic, this has further compounded the issues. Although the FT are working to actively reinstate services, the backlog of patients which had already waited over 48 weeks early in 2020 have now resulted in breaches. Cancer

62 days of an urgent referral for suspected cancer– Newcastle FT achieved 71.7% in April 2020 which did not meet the standard of 85%. Northumbria achieved 86.2% in April 2020 which did meet the standard. The CCG achieved 82.7% in April 2020 which did not meet the standard.

Cancer two week wait for suspected cancer – Newcastle FT achieved 82.2% and Northumbria FT achieved 88.2% in April 2020, which did not meet the standard of 93%. The CCG achieved 84.7% which did not meet the standard.

The COVID-19 pandemic has impacted both on the number of referrals made and also the capacity of Trusts to undertake referrals.

There are numerous confounding factors including social distancing requirements, PPE shortages, non-availability of Patient Transport System, staff absence and patients being unwilling to attend hospital. With social distancing and infection prevention controls in place, the number of patients which can be seen in a clinic is greatly reduced compared to pre-COVID 19 pandemic numbers.

New reported measures

Due to new planning guidance for 2020/21 a number of new measures will now be included in this report. These measures are:-

NHS Constitution 1. Cancer - % of patients waiting 28 days to be told whether or not they have

cancer after an urgent referral from GP or a cancer screening programme Other commitments

2. Improve access to Children and Young People’s Mental Health Services (CYPMH)

3. Perinatal Mental Health: number of women accessing specialist perinatal mental health services

4. Reliance on inpatient care for people with a learning disability and/or autism – adults CCG commissioned

5. Citizens facing tools: Proportion of the population registered to use NHS App

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Part B Quality Summary The quality indicators to note from this report are: Safe

• NuTHFT reported 1 (published) MRSA case in April 2020. • NHCFT reported 5 (published) C.difficile cases exceeding their monthly

trajectory of 4 in April 2020. • NHCFT and NuTHFT reported 30 and 22 (published) cases of E.coli respectively

in April 2020 and were the first and third highest reporters in the region. In May 2020 the Trusts reported 36 and 31 unconfirmed cases respectively. If these figures remain unchanged the Trusts would remain the first and third highest reporters of E.coli in the region.

• NTCCG reported 13 (published) cases of E.coli in April 2020; exceeding their monthly trajectory of 12.

• NHCFT and NuTHFT reported 1 never event each in May 2020. Neither SI related to North Tyneside patients.

• Serious Incident Reporting – During the Covid-19 pandemic the reporting of serious incidents is being closely monitored by the CCG/NECS to ensure any emerging quality issues, patterns or trends are addressed. It has been noted that:

o NuTHFT reported 9 SIs since October 2019 relating to the ophthalmology patients lost to follow up. An outpatient transformation programme is underway to ensure that positive change is captured and embedded into new ways of working. The Trust will be requested to present on this improvement work at a future QRG.

• NHCFT identified 6 significant learning events between April and May 2020 that related to North Tyneside patients.

• NuTHFT, CNTWFT and NEASFT had absence rates which exceeded the England average for January 2020 of 4.80%.

• NHCFT identified that in March 2020, 15 out of 38 areas reported a shift fill rate for Registered Nurses (RNs) of less than 80% on day shifts, of which 12 areas reported fill rates of below 80% in February 2020.

• NuTHFT reported that in March 2020, 15 wards reported a day fill rate of less than 85%.

Effective, Caring, Responsive & Well Led

• Friends and Family Tests (FFT) – Trusts have been asked to temporarily suspend FFT during the coronavirus pandemic. Therefore there will be no data submission or publication of results until further notice.

• NTCCG received 1 formal complaint and no concerns during May 2020. • NTCCG received 8 freedom of information requests in May 2020 and 1 subject

access request.

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Additional Quality Concerns

• CNTWFT reported that 67.5% of appraisals occurred below the standard of 85% in April 2020.

• CNTWFT reported that 12 courses were below their standard (85%) in April 2020, e.g., safeguarding adults training (84.8%), Prevention and Management of Violence and Aggression (PMVA) Training (basic= 57.9%, breakaway=69.6%).

• Quality Account Requirements for 2019/20 - NHSE & NHSI recommends that a revised deadline of 15 December 2020 for NHS providers would be appropriate. Draft quality accounts should be provided to stakeholders in good time to allow scrutiny and comment. For finalising quality accounts by 15 December 2020, a date of 15 October would be reasonable for this; each trust should agree this with their relevant stakeholders. NHS providers are no longer expected to obtain assurance from their external auditor on their quality account for 2019/20.

• NEASFT QRG June 2020 – The chair of the QRG highlighted the positive outcomes from the meeting, including the Trust’s analysis of performance data compared to last year. The Trust highlighted that they require urgent information from the foundation trusts (FTs) on how the FTs are restarting services so NEASFT can plan scheduled care transport.

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Governance and Compliance 1. Links to Corporate Objectives

2020/21 corporate objectives Item links to objectives √

1. Commission high quality care for patients, that is safe, value for money and in line with the NHS Constitution.

√

2. Meet the CCG’s statutory duties. √

3. Work collaboratively with partners and stakeholders to develop sustainable health and social care in North Tyneside and the wider Cumbria & North East system.

√

4. Continue to develop North Tyneside CCG as a patient focused, clinically led commissioning organisation with a continuous learning culture.

√

2. Consultation and Engagement

Not applicable 3. Resource Implications

Not applicable 4. Risks

For escalated risks, please refer to Risk Assessment Framework 5. Equality Assessment

Not applicable 6. Environment and Sustainability Assessment There are no environmental or sustainability issues arising from this report.

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Performance Report (Part A)

June 2020

Part A NHS Constitution

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Performance Area Indicator Period Threshold CCG YTD Movement NHCFT Movement NuTH Movement

% patients waiting for initial treatment on incomplete pathways within 18 weeks Apr-20 92.0% 78.8% 86.6% 74.1%

Number of patients waiting more than 52 weeks for treatment Apr-20 0 9 9 0 72

Diagnostic waits % patients waiting less than 6 weeks for the 15 diagnostic tests (including audiology) Apr-20 >99% 28.6% 28.6% 28.3% 34.7%

% patients spending 4 hours or less in A&E or minor injury unit May-20 95.0% 99.7% 94.9%

Over 12 hour trolley waits May-20 <0 0 0

Ambulance handovers 30 mins - 60 mins May-20 <0 155 65

Ambulance handovers => 60 mins May-20 <0 5 0

Ambulance handovers =>120mins May-20 <0 0 0

% of patients seen within 2 weeks of an urgent GP referral for suspected cancer Apr-20 93.0% 84.7% 84.7% 88.2% 82.2%

% of patients seen within 2 weeks of an urgent referral for breast symptoms Apr-20 93.0% 20.0% 20.0% 100.0% 45.3%

* + % of patients waiting 28 days to be told whether or not they have cancer after an urgen referral from GP or a cancer screening programme Apr-20 70.0%

% of patients treated within 62-days of an urgent GP referral for suspected cancer Apr-20 85.0% 82.7% 82.7% 86.2% 71.7%

% of patients treated within 62-days of urgent referral from an NHS Cancer Screening Service Apr-20 90.0% 88.9% 88.9% 11.1% 79.3%

% of patients treated for cancer within 62-days of consultant decision to upgrade status Apr-20 N/A 50.0% 50.0% 83.3% 35.0%

% of patients treated within 31 days of a cancer diagnosis Apr-20 96.0% 94.3% 94.3% 99.3% 90.7%

% of patients receiving subsequent treatment for cancer within 31-days - Surgery Apr-20 94.0% 88.9% 88.9% 88.9% 87.3%

% of patients receiving subsequent treatment for cancer within 31-days - Drugs Apr-20 98.0% 94.4% 94.4% 100.0% 97.1%

% of patients receiving subsequent treatment for cancer within 31-days - Radiotherapy Apr-20 94.0% 100.0% 100.0% n/a 96.8%

Mixed sex accommodation *Mixed sex accommodation - number of unjustified breaches Feb-20 0 0 0 0 0

* Cancelled operations for non-clinical reasons to be rescheduled within 28 days Q3 19/20 95.0% 94.8% 95.8%

* Urgent operations cancelled for a 2nd time Jan-20 0 0 0Care

Programme Approach

* % people followed up within 7 days of discharge from psychiatric in-patient care Q3 19/20 95.0% 92.5% 93.1%

C1 Response Time CCG (Mean time) May-20 00:07:00 00:06:01 00:05:56

C2 Response Time CCG (Mean time) May-20 00:18:00 00:17:01 00:17:14

C3 Response Time CCG (90th centile) May-20 02:00:00 01:23:14 01:31:15

C4 Response Time CCG (90th centile) May-20 03:00:00 01:48:51 01:41:20 * Delayed/postponed due to Covid-19 + New measure

Ambulance Response Times

Cancer waits

Cancelled operations

Referral to Treatment

A&E

Part A Issues to Note on Constitution Measures Official

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Constitution measure Synopsis of Issue Actions taken to resolve issue

Referral to Treatment

Level of risk: High

Risk Owner: Steve Rundle

Expected date to achieve the standard: Quarter 4 2020/21

Newcastle FT achieved 74.1% April 2020 which did not meet the standard of 92%.

Northumbria FT achieved 86.6% April 2020 which did not meet the standard.

In April 2020, 78.8% of CCG patients on an incomplete pathway were waiting to be treated within 18 weeks, this is below the standard of 92%

The CCG had 12,342 patients waiting less than 18 weeks on an incomplete pathway out of 15,666 patients. The number of patients on an incomplete pathway in February 2020 was 17,282 compared to 14,981 in April. This represents a 13% reduction in referrals from Feb 2020 to April 2020, which will be linked to the COVID 19 pandemic.

This target was not achieved due to the national instruction to suspend elective activity as a result of the COVID-19 pandemic. This position is therefore mirrored across the country, and May’s performance is expected to be worse than April’s. Our local FTs re-opened to referrals in mid-May / early June and are working actively to reinstate services, although activity levels are very low at present. There are numerous confounding factors including social distancing requirements, PPE shortages, non-availability of Patient Transport System, staff absence and patients being unwilling to attend hospital. Virtual appointments are being offered in preference to face-to-face appointments wherever possible. National planning guidance is expected in early July which will help steer the next phases of recovery.

Number of patients waiting over 52 week for treatment

Level of risk: High



Newcastle FT had 72 patients wait over 52 weeks for treatment in April 2020.

Northumbria FT had no patients wait over 52 weeks for treatment in April 2020.

The CCG had 9 patients wait over 52 weeks for treatment in April 2020.

All nine of the CCG patients which have waited more than 52 weeks for treatment are awaiting treatment at Newcastle Hospitals. The specialities which the patients are awaiting treatment include Trauma and Orthopaedics, Ear Nose & Throat, Ophthalmology, Urology and Other.

Newcastle FT raised with Commissioners issues in treating some patients at the beginning of 2020 within the 52 week, largely due to the need for complex spinal deformity surgeries. With the national guidance to suspend elective activity as a result of the COVID-19 pandemic, this has further compounded the issues. Although the FT are working to actively reinstate services, the backlog of patients which had already waited over 48 weeks early in 2020 have now resulted in a breach. The Trust has discussed with NHSEI and Commissioners the need to follow clinical guidance to ensure patients are treated according to clinical priority. The Trust have already indicated that the number of 52 week breaches will continue to increase and that they will have to manage the backlog of pre


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COVID-19 patients and new referrals which will continue along the pathway timeline.

North of Tyne commissioners have met with the Trust to agree the phased re-instating of services. This will be monitored at the Trust contract meeting and Commissioner forums.

Diagnostic waits

Level of risk: Medium



Newcastle FT achieved 34.7% in April 2020 and therefore did not achieve the standard of >99%

Northumbria FT achieved 28.3% in April 2020 and therefore did not achieve the standard.

The CCG achieved 28.6% in April 2020 and therefore did not achieve the standard.

The majority of breaches are in non-obstetric ultrasound, magnetic resonance imaging (MRI) and computerised tomography

The number of patients being referred for diagnostic tests has decreased from 7,336 in February 2020 to 2,215 in April 2020. Although this represents a significant reduction in activity levels, providers did not undertake any non-urgent diagnostics tests during the lockdown in March and April. Our local FTs re-opened to referrals in mid-May / early June and are working actively to reinstate services, although activity levels are very low at present. There are numerous confounding factors including social distancing requirements, PPE shortages, non-availability of Patient Transport System, staff absence and patients being unwilling to attend hospital. With social distancing and infection prevention controls in place, the number of patients which can be seen in a clinic is greatly reduced compared to pre-COVID 19 pandemic numbers.

The Government enforced lock down procedures across England which has affected the number of diagnostic tests being requested, but also Trusts ability to carry out those tests within the standard of over 99% undertaken within 6 weeks. Until Government guidance changes on lockdown procedures change, performance will continue to decline. The number of patients waiting over 6 weeks will grow, and the proportion of those patients waiting over 13 weeks will also increase.

The CCG will continue to monitor performance via the FT performance and contract meetings.


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4 Hours or less in A&E

Level of risk: High

Risk Owner: Tom Dunkerton


Newcastle FT achieved 94.9% in April 2020 which did not achieve the standard of 95.0%.

Northumbria FT achieved 99.7% in April 2020 and therefore achieved the standard.

Newcastle FT had 9,648 A&E attendances in May 2020 which is an increase of 1,873 on April 2020. 7,311 of the attendances (76%) were at type 1 hospital sites. The Trust missed the standard by 0.01% which equates to 10 patients.

This spike in attendances was unexpected given lockdown procedures were still in place. Activity levels did rise to pre-COVID levels of 11,786 average attendances per month in 2019/20, With social distancing and infection prevention controls in place, the number of patients which can be seen within an hour is greatly reduced compared to pre-COVID 19 pandemic numbers.

Ambulance Handovers

Level of risk: High



Newcastle FT had 65 ambulance handovers 30 – 60 mins in May 2020

Northumbria FT had 155 ambulance handovers 30 – 60 mins in May 2020.

Northumbria FT had 5 ambulance handovers =>60 mins in May 2020.

Overall the number of ambulance handover delays has reduced from December 2019 to May 2020 across both Trusts. The proportion of an ambulance response resulting in an Emergency Department attendance has also reduced in May as part of the response to managing the coronavirus pandemic.

Northumbria FT is contesting the ambulance handovers which are over 60 minutes with NEAS. The Trust have identified that the point at which the handover time starts is triggered by a beacon which is positioned outside of the NSECH site. Therefore travelling time for ambulances to go to the A&E entrance is being counted towards the handover duration which is incorrect.

The CCG will continue to monitor performance via the FT performance and contract meetings.

% of patients seen within 2 weeks of an urgent GP referral for suspected cancer

Newcastle FT achieved 82.2% for April 2020 and therefore did not achieve the standard of 93%.

Northumbria FT achieved 88.2%

The CCG had 57 out of 373 patients wait longer than two weeks for an urgent referral. The majority of breaches were within upper GI, lower GI and breast.

Newcastle FT is implementing initiatives to accelerate patients through the pathway, such as straight to testing. A Project Manager has been appointed by the Northern Cancer Alliance to work with Trusts


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Level of risk: High



for April 2020 and therefore did not achieve the standard.

The CCG achieved 84.7% in April 2020 and therefore did not achieve the standard.

across the region to improve performance. The COVID-19 pandemic has impacted both on the number of referrals made and also the capacity of Trusts to undertake referrals.


The CCG will continue to monitor patient flows within the pathway. This continues to be monitored at both FT’s contract meetings and by the Commissioning Manager and the Northern Cancer Alliance.


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% of patients seen within 2 weeks of an urgent GP referral for breast symptoms

Level of risk: High



Newcastle FT achieved 45.3% for April 2020 and therefore did not achieve the standard of 93%.

Northumbria FT achieved 100% for April 2020 and therefore achieved the standard.

The CCG achieved 20% in April 2020 and therefore did not achieve the standard.

The CCG had 4 out of 5 patients wait longer than two weeks to be seen following an urgent referral for breast symptoms.

Newcastle FT is implementing initiatives to accelerate patients through the pathway, such as straight to testing. A Project Manager has been appointed by the Northern Cancer Alliance to work with Trusts across the region to improve performance. The Trust appointed an additional Breast Radiologist (0.6 whole time equivalent) to the team to help relieve pressure within the service. The Trust is also looking to establish a breast surgeon led ultrasound service. The North ICP has also funded a Breast co-ordinator through the Northern Cancer Alliance.


% of patients treated within 62 days of an urgent GP referral for suspected cancer

Level of risk: High



Newcastle FT achieved 71.7% for April 2020 and therefore did not achieve the standard of 85%

Northumbria FT achieved 86.2% for April 2020 and therefore achieved the standard

The CCG achieved 82.7% for April 2020 and therefore did not achieve the standard.

The CCG had 9 out of 52 patients wait longer than 62 days for treatment following an urgent GP referral. The majority of breaches were within upper GI, lower GI, gynaecology and other




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% of patients treated within 62 days of an urgent referral from a Cancer Screening Service

Level of risk: Low



Newcastle FT achieved 79.3% for April 2020 and therefore did not achieve the standard of 90%

Northumbria FT achieved 11.1% for April 2020 and therefore did not achieve the standard


Northumbria FT had 1 out of 9 patients treated within 62 days of an urgent referral from a cancer screening service.

Due to the low number of patients involved, this can have a significant impact on the percentages achieved. This will be monitored as part of the contract meeting with providers to ensure there are no underlying performance issues.

Cancer % of patients treated within 31 days of a cancer diagnosis

Level of risk: Low



Newcastle FT achieved 90.7% in April 2020 and therefore did not achieve the standard of 96%.

Northumbria FT achieved 99.3% in April 2020 and therefore achieved the standard.


The CCG had 6 out of 105 patients wait longer than 31 days of a cancer diagnosis. The majority of breaches were within lower GI.

Both trusts have been working to increase the speed of diagnosis for cancer services. The planned development of rapid diagnostic and assessment centres known as 'one stop clinics' will help to streamline diagnosis for people with suspected cancer. It is hoped that these one stop clinics will be particularly useful for speeding up the diagnosis of certain cancers, including breast cancer.

The CCG will continue to monitor to check under performance is not sustained.


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Cancer % of patients receiving subsequent treatment for cancer within 31 days – surgery

Level of risk: Low




Northumbria FT achieved 88.9% in April 2020 and therefore did not achieve the standard.


During 2019/20, our local providers have undertaken significant reviews to understand what happens in each step of the cancer pathway up to treatment and surgery. This includes:

• Redesigning demand and capacity planning processes and involving key staff in implementing new ways of working.

• Integrating the Somerset IT system with the Trusts Patient Administration System (PAS), thus allowing for the tracking patients through each stage of their journey and proactively addressing potential blockages, Did Not Attend’s, etc.

• Instigating straight to test in colorectal and urology pathways. • Making best use of data intelligence to understand trajectories and trends and plan services

accordingly. • Through these improvements, our trusts are now able to demonstrate more effective ways in

streamlining pathways and performance throughout the year has improved.

However challenges remain around access to radiology and oncology resulting in a shortfall in achieving the target. Both trusts continue to make improvements in cancer pathways. The addition of lung cancer case finding and the development of Rapid Diagnostic Centres are two enablers as we move forward in 2020/21. The CCG will continue to monitor to check under performance is not sustained.

Cancer % of patients receiving subsequent treatment for cancer within 31 days – drugs

Level of risk: Low



Northumbria FT achieved 100% in April 2020 and therefore achieved the standard.

The CCG achieved 94.4% for

At Northumbria FT 1 out of 18 patients received subsequent drug treatment for cancer after 31 days.

Due to the low number of patients involved, this can have a significant impact on the percentages achieved. This will be monitored as part of the contract meeting with providers to ensure there are no underlying performance issues


15



April 2020 and therefore did not achieve the standard.

Cancelled operations for non-clinical reasons to be rescheduled within 28 days

Level of risk: Low



Newcastle FT achieved 95.8% for Qtr. 3 2019/20 and therefore achieved the standard of 95%.

Northumbria FT achieved 94.8% and therefore did not achieve the standard

The data for this measure has been delayed due to COVID-19 and has not been refreshed since Qtr. 3 2019/20.

Northumbria FT is reviewing their cancellation processes to ensure patients are contacted within 28 days. The administrative review will support an efficient patient pathway and improved patient experience.

Due to the low number of patients involved, this can have a significant impact on the percentages achieved. This will be monitored as part of the contract meeting with providers to ensure there are no underlying performance issues.


16


Care programme approach % people followed up within 7 days of discharge from psychiatric in-patient care

Level of risk: Low

Risk Owner: Janet Arris


The CCG achieved 92.5% for Qtr. 3, 2019/20 which did not meet the standard of 95%. The CCG achieved a YTD position is 93.1%

The data for this measure has been delayed due to COVID-19 and has not been refreshed since Qtr. 3 2019/20.

3 patients of 40 North Tyneside CCG patients were not followed up after 7 days after discharge from psychiatric patient care. The provider, Cumbria, Northumberland, Tyne and Wear FT attempted to follow up the patients following discharge several times to try and engage and re-arrange appointments but patients disengaged with the service. One patient was being treated by Talking Therapies North Tyneside and did not want to be seen by multiple services.

Due to the low number of patients involved, this can have a significant impact on the percentages achieved. The CCG will continue to monitor to check under performance is not sustained.

17

50%55%60%65%70%75%80%85%90%95%100%

0

5,000

10,000

15,000

20,000

25,000

Ap

r-1

7

May

-17

Jun

-17

Jul-

17

Au

g-1

7

Sep

-17

Oct

-17

No

v-1

7

Dec

-17

Jan

-18

Feb

-18

Mar

-18

Ap

r-1

8

May

-18

Jun

-18

Jul-

18

Au

g-1

8

Sep

-18

Oct

-18

No

v-1

8

Dec

-18

Jan

-19

Feb

-19

Mar

-19

Ap

r-1

9

May

-19

Jun

-19

Jul-

19

Au

g-1

9

Sep

-19

Oct

-19

No

v-1

9

Dec

-19

Jan

-20

Feb

-20

Mar

-20

Ap

r-2

0

May

-20

Jun

-20

Jul-

20

Au

g-2

0

Sep

-20

Oct

-20

No

v-2

0

Dec

-20

Jan

-21

Feb

-21

Mar

-21

RTT Incomplete Referral Pathways and 92% Target, chart showing:All Specialties; NHS North Tyneside CCG; All Trusts

Under 18 Weeks Over 18 Weeks 92% Performance

The CCG was seeing a gradual reduction in referrals numbers from November 2019. Due to the impact of the COVID 19 pandemic with all Trusts not accepting non-urgent referrals in March 2020 you can now see a marked reduction in referral numbers. The true size of the waiting list is not clear as GPs are holding referrals until guidance is changed. Until these go onto the system as non-urgent services are reintroduced, these will increase the waiting list numbers by an unknown amount. Cancer two week, urgent and emergency referrals continue to be accepted by both main providers.

The proportion of patients which are currently waiting over 18 weeks will continue to increase as services are phased back in. As patients continue to wait, more patients will continue up the timeline and potentially fall into the over 18 week wait cohort. The Trusts are anticipating two spikes in demand which will be referrals which have been on hold by GPs and a cohort of patients which have been delayed due to the COVID-19 pandemic

Our local FTs re-opened to referrals in mid-May / early June and are working actively to reinstate services, although activity levels are very low at present. There are numerous confounding factors including social distancing requirements, PPE shortages, non-availability of Patient Transport System, staff absence and patients being unwilling to attend hospital. Virtual appointments are being offered in preference to face-to-face appointments wherever possible. National planning guidance is expected in early July which will help steer the next phases of recovery.

RTT Incompletes – North Tyneside CCG

Part A Other commitments Official

18

There are 22 indicators under other commitments which warrant monitoring on behalf of the CCG. This includes 4 new indicators which are included as part of the 2020/21 planning cycle. Currently 3 indicators are flagged as a red rating and 15 flagged as a green rating. The new indicators do not currently have any published data due to delays in data collection to COVID-19 pandemic.

Area Indicator Period Threshold CCG YTD Movement

Movement to recovery Apr-20 50.0% 51.5% 51.5%IAPT Waiting times - 6 weeks Apr-20 75.0% 97.2% 97.2%IAPT Waiting times - 18 weeks Apr-20 95.0% 99.6% 99.6%

Waiting times for routine referral to CYP Eating Disorder Services - Within 4 weeks 95.0% 100.0%Waiting times for Urgent referrals to CYP Eating Disorder Services - within 1 week 95.0% 96.3%* EIP ( Services achieving Level 3 NICE concordance) Jan-20 56.0% 68.1%Dementia diagnosis rate Qtr 4 2019/20 66.7% 68.8% 70.1% + Improve access to Children and Young People’s Mental Health Services (CYPMH) Q1 20/21 18.2% + Perinatal Mental Health: Number of women accessing specialist perinatal mental health services Q1 20/21 23.2%

+ Reliance on inpatient care for people with a learning disability and/or autism – adults CCG commissioned Q1 20/21 12.23

People with a severe mental illness receiving a full annual physical health check and follow-up interventions Apri l 2019 - March 2020 50.0% 47.1%

IAPT Trainees Q3 2019/20 0 1 1

Therapists co-located in primary Care Q3 2019/20 4 54 54

Proportion of the population with access to online consultations Apr-20 19.8% 100.0% + Citizens facing tools: Proportion of the population registered to use NHSAppExtended Access Appointment Utilisation Jan-20 75.0% 86.0%Proportion of population that the urgent care system (NHS 111) can directly book appointments for in contracted extended access

Mar-20 100.0% 100.0% 100.0%

* DTOC - Total delays per day Feb-20 7.40 2.9

* Children waiting more than 18 weeks for a wheelchair Qtr 3 2019/20 92.0% 100.0% 95.1%

* Personal Health Budgets Qtr 3 2019/20 154 124 6478

AHCs delivered by GPs for patients on the Learning Disability Register Apri l 2019 - March 2020 60.0% 46.7%

* Delayed/postponed due to Covid-19 + New measure

Q1 - Q4 2019-20

Primary Care

Other

Mental Health

IAPT access rate Qtr 4 2019/20 5.50% 4.0%


19

Outcome measure Synopsis of Issue Actions taken to resolve issue

IAPT access rate

Level of risk: High



The CCG achieved 4.0% against a local trajectory of 5.5% for Qtr. 4, 2019/20.

The North Tyneside Talking Therapies service’s access rate has not achieved the local trajectory of 5.5% for Qtr. 4

The CCG has investigated referrals numbers and identified a reduction in referrals to IAPT which coincides with the start of a Community Mental Health team in North Shields and Wallsend. The CCG has met with the Community Mental health team and Talking Therapies North Tyneside to discuss pathways and referral patterns. The CCG has raised issues with the national IAPT reporting model to NHSE/I as pathways have evolved which do not follow the strict IAPT reporting criteria, leading to reduced performance. North Tyneside CCG has agreed to explore options on an ICS level to address the issue with funds from NHSEI. Events are currently being planned with providers and commissioners to map the ‘to be’ pathway. The CCG are exploring examples of best practice across England to explore different IAPT service models.

The CCG will continue to monitor performance via the contract meeting to ensure under performance is not sustained.

People with severe mental illness receiving a full annual physical health check

Level of risk: Low



The CCG achieved 47.1% of patients registered on the severe mental illness (SMI) register received an annual health check from April 2019 to March 2020 (12 month rolling period). The target for 2019/20 is to achieve at least 50% of SMI patients receives an annual health check; therefore the CCG did not achieve the standard.

Within the Five Year Forward View for Mental Health, NHSE committed to ensuring that by 2020/21, 280,000 people living with severe mental illness (SMI) have their physical health needs met by increasing early detection, and expanding access to evidence-based physical care assessment and intervention each year.

The CCG end of year position for 2018/19 was that 46.2% of SMI patients had received an annual health check (AHC) during the year. The CCG has improved its position from 46.2% in 2018/19 to 47.1% in 2019/20 which is one of the highest rates within the Cumbria and North East region.

The definition of the annual health check for 2018/19 was that six physical health checks needed to be undertaken. This included; measurement of weight, blood pressure, blood glucose, cholesterol, cholesterol, assessment of alcohol consumption and assessment of smoking status.


20

Outcome measure Synopsis of Issue Actions taken to resolve issue

Training by the NECS Primary Care Data Quality Team was rolled out across a number of practices to help identify patients which were potentially not coded correctly to count towards the target. Discussions are ongoing with the Primary Care Network Directors, NECS Primary Care Data Quality Team and the Commissioning Manager to understand what ongoing support can be provided to ensure more SMI patients receive an annual health check

The CCG will continue to monitor performance against the target and has contacted other CCGs to help identify best practice in improving performance.

Annual Health Checks delivered by GPs for patients on the Learning Disability Register

Level of risk: Medium



The CCG achieved 46.7% of patients registered on the learning disability register (LD) register received an annual health check from April 2019 to March 2020 (12 month rolling period). The target for 2019/20 is to achieve at least 60% of LD patients receives an annual health check.

The CCG have an LD action plan in place to improve performance on the LD AHC measure. The measure is to both increase the number of patients on the LD register and increase the proportion of patients which receive an AHC. The CCG has increased the number of patients on the register from April 2019 to March 2020 which has a negative impact upon the percentages achieved for the number of AHC undertaken. Trend data also shows that AHC are normally undertaken within Qtr. 4. The North Tyneside rate of AHC undertaken reduced significantly in February and March 2020, most likely as a result of the COVID 19 pandemic with patients shielding and Government guidance on lockdown and non-essential activities. GP capacity to undertake and prioritise AHC would have been limited as they responded to the pandemic.

As of October 2020 LD AHC will be included within the PCN Investment and Impact Fund (IIF) which will hopefully have a positive impact upon performance. The CCG has set up a task and finish group to establish what the patient and practice barriers are to undertaking AHC.

The CCG will continue to monitor performance against the target.

Official

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Quality Report (Part B)

June 2020

Official

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Part B – Safe

Safe Quality Indicators OverviewKey

PerformanceArea

Indicator Period Threshold CCG Actual YTD Actual Movement NHCFT Movement NuTHFT Movement CNTWFT Movement NEASFT Movement

MRSA Assignment Following PIR Process Apr-20 0 0.0 0.0 0 1

C Difficile Apr-20 4.0 1.0 1.0 5 5

C Difficile Community Cases Apr-20 N/A 0.0 0.0 N/A N/A

MSSA Apr-20 N/A 2.0 2.0 0 1

E Coli Apr-20 12.0 13.0 13.0 30 22

Never Events (i.e., number involving CCG's patients) May-20 0 0 0 1 1 0 0

Serious Incidents May-20 N/A 0 5 6 11 9 1

NHSI SI Framework: 2 Day Reporting Q4 19/20 95% 100.0% 100.0% 100.0% 100.0%

NHSI SI Framework: 60 Day Reporting Q4 19/20 95% 79.0% 31.0% 90.0% 0.0%

Safeguard Incident Risk Management (SIRMS) May-20 N/A 9 15 13 25 2 12

NRLS - Proportion of Incidents that are harmful. Feb-20 N/A 28.1% 25.0% Nil

NRLS - Potential under-reporting of death/severe harm Feb-20 N/A 0.11 0.1

NRLS - Potential under-reporting Feb-20 N/A 53.1 46.8 Nil

NRLS - Consistency of Reporting Feb-20 N/A 6 6 Nil

Staffing Absence rate Jan-20 4.80% 4.73% 4.99% 6.06% 7.88%

Alerts Patient safety alerts open past deadline Mar-20 0 0 0

Incidents

HCAINT CCG

Official

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Measure Synopsis of Issue Actions taken to resolve issue

HCAI - MRSA NuTHFT reported 1 (published) case in April 2020. The Trust noted that the post infection review meeting of this case identified some good practice. However, on 31 March 2020 the Trust agreed that MRSA screening would be suspended to enable the laboratory to prioritise COVID-19 testing, as a result this patient was not screened on arrival to the Trust and therefore admission MRSA status was unknown. MRSA screening was reintroduced on 5 May when laboratory capacity returned to a baseline level and this allowed for screens to be processed. (Source: Healthcare Associated Infections (HCAI) – DIPC Report Trust Board – 26 May 2020)

HCAI – C.Difficile NHCFT reported 5 (published) cases in April 2020 and exceeded their monthly trajectory of 4.

During April 2020 there were 5 cases of C. difficile (all hospital on-set). The Trust’s threshold for 2020-21 is to be confirmed. By default, each case is deemed to be ‘due to a lapse in care’ unless it has been through a formal appeals process. All cases continue to have root case analysis investigations carried out. Source: (Regulatory Performance Report - Trust Board 28th May, 2020)

HCAI – E.Coli NHCFT reported 30 (published) cases in April 2020 and was the highest reporter in the region. In May 2020 the Trust reported 36 actual cases; this data is unconfirmed. If these figures remain unchanged the Trust would be highest reporter of E.coli in the region.

As previously reported the Trust has undertaken analysis of all cases reported but has not identified any themes.

Official

24


HCAI – E.Coli continued NuTHFT reported 22 (published) cases in April 2020 and was the third highest reporter in the region. In May 2020 the Trust reported 31 actual cases; this data is unconfirmed. If these figures remain unchanged the Trust would be the third highest reporter of E.coli in the region.

The Trust set an internal reduction of 10% for E.coli bacteraemias which was exceeded with a total reduction of 12% from the previous year. The Trust will continue with the aim of a 10% reduction on 2019/20’s total number of cases and the objective for 2020/21 will be no more than 144 cases. (Source: Healthcare Associated Infections (HCAI) – DIPC Report Trust Board – 26 May 2020)

NTCCG reported 13 (published) cases, exceeding their monthly trajectory of 12 in April 2020.

NTCCG continues to focus on hydration, delivering this work into nursing and residential homes. Work is ongoing to develop a consistent approach to urine testing through ‘To Dip or Not to Dip’ and the ‘Skip the Dip’ campaigns. The medicines optimisation team continue to focus on antibiotic prescribing.

Never Events NHCFT reported 1 never event in May 2020 The never event reported in May 2020 related to a retained guidewire. Northumberland CCG will manage this SI as the patient was registered with a practice in their area.

NuTHFT reported 1 never event in May 2020. The never event reported in May 2020 related to a misplaced nasogastric tube. Newcastle Gateshead CCG will manage this SI as the patient was registered with a practice in their area.

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Serious Incidents (SIs) Reported

During the COVID-19 pandemic the reporting of serious incidents is being closely monitored by the CCG/NECS to ensure any emerging quality issues, patterns or trends are addressed.

NHCFT reported 6 SIs in May 2020 and all related to NCCG registered patients. This demonstrates no change on the same period last year. Of those reported in May 2020: • 1 unexpected death (occurred in April 2020) • 1 diagnostic incident (occurred in June 2014 but

only recently identified - child has cerebral palsy)

• 1 never event involving a retained guidewire • 3 falls (1 occurred in February 2020 and 2 in

May 2020)

Between 1 March - 17 June 2020 the following wards/departments reported more than 1 serious incident, as follows: • Ward 12 NSECH 3 SIs (3 falls, 1 medication) these occurred

between February and June 2020. • A&E NSECH 2 SIs (1 unexpected death occurring in April, 1

treatment delay occurring in February). • Theatres NSECH 2 SIs (1 retained guidewire never event

occurring in May, 1 treatment delay occurring in November 2019). • Ward 15 NSECH 2 SIs (1 diagnostic delay occurring in March

2020 and 1 surgical procedure occurring in December 2019).

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Serious Incidents (SIs) Reported continued

NuTHFT reported 11 serious incidents (8 involved NGCCG registered patients and 3 NCCG patients) in May 2020. This is a decrease on the same period last year (17 reported). Of those reported in May 2020:

• 4 pressure ulcers (all occurring in April and May 2020)

• 3 falls (1 occurred in April 2020) • 2 diagnostic incidents (both occurred in

November 2019) • 1 never event involving a misplaced NG

tube • 1 treatment delay (occurred in October 2019

in ophthalmology)

The following themes have been noted: Ophthalmology Department: There has been a notable increase in the number of serious incidents reported, with 9 SIs reported since October 2019. This was raised at the NGCCG SI panel and further assurance sought from the Trust. The Trust advised that they have identified a cohort of patients who were lost to follow up for surgery or clinic appointment; not all patients have come to harm. Cases have been investigated individually and as a group. An outpatient transformation programme is underway to ensure that positive change is captured and embedded into new ways of working. The Trust will be requested to present on this improvement work at a future QRG. Between 1 March - 17 June 2020 the following wards reported more than 1 serious incident, as follows: • Ward 8 Freeman Hospital 3 SIs (1 pressure ulcer, 1 fall, 1

medication – all occurring March/April) • Ward 17 Freeman Hospital 3 SIs (2 pressure ulcers both

occurring in March, 1 fall occurring in June). • Ward 15 Freeman Hospital 2 SIs (1 pressure ulcer, 1 fall – both

occurred in May ) • Ward 30 Short Stay (RVI) 2 SIs (both pressure ulcers occurring in

May/June) • Ward 32 Freeman Hospital 2 SIs (both pressure ulcers occurring

in April) No other themes were observed.

Official

27


Serious Incidents (SIs) Reported continued

CNTWFT reported 9 SIs in May 2020, this is a slight decrease compared to the same period last year (11 reported). Of the 9 SIs reported 3 involved NGCCG patients, 4 NCCG patients, 1 SCCG patient and 1 Cumbria patient. Of those reported in May 2020:

• 7 related to unexpected deaths (all occurred between April and May 2020)

• 1 related to apparent/actual homicide (occurred in April 2020).

• 1 fall

No themes were identified.

NEASFT reported 1 serious incident in May 2020 related to a treatment delay involving a South Tees patient.

No themes were identified

Significant Learning Events (SLE) Reports

NHCFT identified 6 SLEs in April 2020 and 4 in May 2020.

Of the 10 SLEs identified in April and May 2020, 6 involved patients registered in the North Tyneside area. SLEs are discussed at the CCGs SI panel.

Official

28


Absence Rate The following Trusts exceeded the England average for January 2020 of 4.80%.

NuTHFT was noted to have an absence rate of 4.99%

The Trust reported that at most, in early April, they recorded just over 640 COVID-19 related absences, which included both staff who had tested positive for COVID-19, and those who were following the Government’s guidance to self-isolate. This accounted for approximately 50% of all staff absences. However, comparatively the Trust’s noted that sickness absence rates throughout the last two months were impressively lower than many other providers. The Trust introduced a number of changes to ensure their teams were getting the support they required, particularly around their welfare, health and wellbeing. This was separate and additional to the Trust’s operational processes and procedures around staff safety. To coordinate this work, a Welfare and Wellbeing Group was commissioned The Trust noted that their ability to test staff quickly, using their own laboratory, was a huge benefit to maintain, on average, lower levels of COVID-19 related absences and gave staff certainty to return to work. (Source: Chief Executive’s Report, Trust Board – 26 May 2020)

CNTWFT was noted to have an absence rate of 6.06%.

The Trust continues to implement a number of initiatives to improve absence rates.

Official

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Absence Rate continued NEASFT was noted to have an absence rate of 7.88%.

(Source: NHS Sickness Absence Rates Jan 20 Provisional Statistics)

The Trust reported that their current staff sickness absence in April increased to 8.01% compared to 6.72% in March 2020 due to COVID19. The 12-month rolling is now 6.88%, (+1.88% above Trust target). The Trust commented that if COVID19 medical absences were discounted from the normal sickness absence rates, this would reduce to 5.61% in March 2020 and 6.45% in April 2020. When compared to last year’s monthly absence rates for the same period, this would mean sickness absence decreased by (-0.96) in March 2020, but increased by (+0.44%) in April 2020. (Source: Workforce Assurance Metric Report (as at: 30th April 2020))

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Measure Synopsis of Issue

COVID-19 – sickness absence rates Covering the period 28.03.20 to 16.06.20. Please note that this data is not validated and may therefore be subject to change

North East and Cumbria absence rates since 1 June 2020:

• clinical staff averaged around 4 to 5% and is slightly above the trend line • other staff groups averaged between 2 to 3%

Source: COVID-19 Daily Sit-Rep reports

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Staff Fill Rates NHCFT identified that in March 2020, 15 out of 38 areas reported a shift fill rate for Registered Nurses (RNs) of less than 80% on day shifts, of which 12 areas reported fill rates of below 80% in February 2020.

The Trust reported that the monthly Hard Truths return was suspended nationally. The senior team agreed that to have data on fill rates would be beneficial, therefore, as a temporary measure the data was collated from the Trust wide daily staffing reports that the Matrons complete. However, the Trust commented that the data needs to be interpreted with caution if comparing to previous months data. Also, as part of the Trust’s COVID-19 preparations ward occupancy levels were lower and some wards were temporarily closed or relocated in March 2020. The Trust noted that on review of the last twelve months data, sixteen wards triggered below 80% shift fill rate for RNs on day shifts for three consecutive months or longer. The highest number of consecutive triggers is eleven months on Ward 18, NTGH. Ward 18 recorded a shift fill rate for RNs on day shifts at 68% (CHPPD 6.54). This was due to vacancies and sickness resulting in not being able to staff to the fourth RN on the early and third RN late shift. Skill mix has been adjusted with over 100% fill in Nursing Assistants and on review there were no safety concerns. The Trust stated that despite their newly RNs coming into post in October 2019 the Trust has experienced challenges, in some areas, with long and short term absences and vacancies. However, the Trust was assured that safety was not compromised in these areas as a result of the actions taken by the Matrons; daily safe staffing assessment and close monitoring of recruitment and sickness. (Source: Nursing and Midwifery Assurance Report for the month of March 2020)

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Staff Fill Rates NuTHFT reported that in January (n=10 wards), February (n=9 wards) and March (n=15 wards) reported a day fill rate of less than 85%.

Any ward demonstrating a RN day fill rate of less than 85% is reviewed by the Nurse Staffing and Clinical Outcomes group alongside all other wards which have flagged due to a high staffing or outcome risk score; any ward requiring medium level support after review for two consecutive months will be highlighted to the Trust Board. In this period two wards were highlighted as requiring medium level support for two consecutive months. Overall this is a decrease compared to the same period last year. The highest occurrence continues to be within the Medicine and Older Peoples Medicine and is in-line with the vacancy positions and number of supernumerary staff who are in training. This should rectify in the coming months as staff start in post. (Source: Nursing and Midwifery Staffing – Annual Review Trust Board – 26 May 2020)

Vacancies NuTHFT reported that the current vacancy rate for RNs sits at approximately 8% and for Healthcare Assistants at 5%.

The Trust stated that it is evident from the nurse staffing metrics that there is a continued risk to the Trust due to the local and national shortage of registered nurses, which is being closely monitored. Although the Trust is in an extremely positive and assured position, it is unlikely that there will be significant intake of RNs until this time next year due to the changes in undergraduate training. It is therefore necessary to continue to explore mechanisms to maximise external recruitment, alongside retention strategies to reduce the total vacancy rate. Whilst this risk cannot be fully mitigated, robust professional leadership and framework is in place to actively support directorates in assuring safety and good progress across all work streams. (Source: Nursing and Midwifery Staffing – Annual Review Trust Board – 26 May 2020)

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Part B – Effective, Caring, Responsive & Well Led

Effective Quality Indicators OverviewKey

PerformanceArea

Indicator Period Threshold CCG Actual YTD Actual Movement NHCFT Movement NuTHFT Movement NTWFT Movement NEASFT Movement

Summary Hospital-level Mortality Indicator (SHMI) Sep-19 N/A 102.6 95.6

Hospital Standardised Mortalbity Ratio (HSMR) Jun-19 N/A 108.2 96.8

VTE VTE Risk Assessment Dec-19 95% 95.1% 97.4%

Caring Quality Indicators OverviewKey

PerformanceArea

Indicator Period Threshold CCG Actual YTD Actual Movement NHCFT Movement NuTHFT Movement NTWFT Movement NEASFT Movement

Patient experience of GP services - Satisfaction with the overall care received at the surgery

Jul-19 publication 83.0% 86.0%

Overall experience of making an appointment Jul-19 publication 67.0% 69.0%

Patient experience of GP out of hours services Jul-19 publication 69.0% 82.0%

Friends and Family Suspended

Responsive and Well - Led Quality Indicators OverviewKey

PerformanceArea

Indicator Period Threshold CCG Actual YTD Actual Movement

Formal Complaint May-20 N/A 1.0 1.0

Concern/Advice/Other May-20 N/A 0.0 2.0

Freedom of Information Requests May-20 N/A 8.0 13.0

Key Performance Area Indicator Period AchievementCQUIN - NHCFT Q3

CQUIN - NuTHFT Acute Q3

CQUIN - NuTHFT Community Q3

CQUIN - CNTWFT Q3

CQUIN - Ramsay Healthcare 2019/20

Mortality

Responsive

GP Survey

Well - Led

Official

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Measure Synopsis of Issue Actions taken to resolve issue Friends & Family Test (FFT)/Patient Experience

Please note that data submission and publication for the FFT has been paused during the response to Covid-19. Therefore there will be no data submission or publication of results until further notice. (Source: Publication 001559 ‘Reducing the burden and releasing capacity at NHS providers and commissioners to manage the COVID-19 pandemic’)

Formal Complaints NTCCG received 1 formal complaint during May 2020 and 1 for another provider. These related to:

CCG Complaint • MP raised concerns that a constituent who

is shielding has been unable to obtain their medication for over a month due medication shortages.

Status: Ongoing.

Provider Complaint • The complainant is raising concerns on

behalf of the Pernicious Anaemia Society. Vitamin B12 treatment has been paused due to COVID-19. The complainant is concerned that this has caused great anxiety and fear amongst patients.

Passed To Provider - Handled Informally. Status: Closed.

Concern/Advice/Other NTCCG received no concerns during May 2020.

Freedom of Information Requests

NTCCG received 8 requests in May 2020. All were acknowledged within 2 working days. 7 were responded to within the statutory 20 working days and 1 is on target to meet their deadline date. The average response time was 8 working days. 1 subject access request was received.

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Additional Quality Concerns Measure Synopsis of Issue Actions taken to resolve issue Appraisals CNTWFT reported that 67.5% of appraisals

occurred against a standard of 85% in April 2020. The Trust noted that this was a decrease on the last month (72.6%). (Source: CNTW Integrated Commissioning & Quality Assurance Report 2020-21 Month 1 (April 2020))

Training CNTWFT reported that 12 courses were below their standard (85%) in April 2020.

The courses below the 85% standard included Safeguarding Adults (84.8%), Seclusion training (81.1%), Rapid Tranquilisation training (84.0%), Medicines Management training (81.4%), Information Governance (81.6%), PMVA basic training (57.9%), PMVA Breakaway training (69.6%), MHA combined training (64.3%), MHCT Clustering Training (60.6%), Clinical Risk training (69.5%),Fire training (75.8%) and Clinical Supervision training (70.5%). (Source: CNTW Integrated Commissioning & Quality Assurance Report 2020-21 Month 1 (April 2020))

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Measure Synopsis of Issue Actions taken to resolve issue Quality Review Group Meeting

NEASFT reported, at their QRG in June 2020, their analysis of performance compared to last year and the information required from foundation trusts to enable NEASFT to plan scheduled care transport.

• There has been no statistically significant change in the number of heart attacks and strokes that the Trust dealt with compared with this time last year. However it looks like the outcomes may be worse as people have delayed calling.

• Demand for 999 ambulances has been in line with last year, but about 6% up in April.

• The Trust has 27 additional vehicles on the road per day (mainly third party, e.g., Red Cross, etc.). This brings the Trust in line with the Operations Research in Health suggested levels of vehicles.

• The Trust has hit all bar one of the conveyance targets during lockdown.

• With extra people managing the CAS stack and, for example, GPs helping out with the calls the Trust has managed well, and the number of follow up calls requesting ETA for vehicles, etc., has decreased meaning that call handling stats have improved.

• The Trust has a “review and rebuild” process rather than “recovery”; the Trust does not want to go back to previous ways of working.

• Scheduled care has been impacted as vehicles can only take one patient at a time due to social distancing. The Trust urgently needs to know from the foundation trusts how they intend to restart clinics.

• See and Treat numbers have massively increased due to patient expectation, but also due to crew confidence. Crews are supported now by registered staff in the call centre.

• It is much easier for crews to get hold of GPs who are all doing phone call/video consultations which means that NEASFT are keeping more patients at home.

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37

Measure Synopsis of Issue Update on Quality Account Requirements for 2019/20

Regulations making revisions to quality account deadlines for 2019/20 are now in force. While primary legislation continues to require providers of NHS services to prepare a quality account for each financial year, the amended regulations mean there is no fixed deadline by which providers must publish their 2019/20 quality account. NHSE & NHSI recommends that a revised deadline of 15 December 2020 for NHS providers would be appropriate, in light of pressures caused by COVID-19. Draft quality accounts should be provided to stakeholders in good time to allow scrutiny and comment. For finalising quality accounts by 15 December 2020, a date of 15 October would be reasonable for this; each trust should agree this with their relevant stakeholders. NHS providers are no longer expected to obtain assurance from their external auditor on their quality account for 2019/20.

Independent Providers

• Ramsay Healthcare (Cobalt) – No data available

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38

Glossary of Terms

A&E Accident and Emergency ASI Appointment Slot Issue BCF Better Care Fund CAS Central Alerting System CCG Clinical Commissioning Group Cdiff Clostridium Difficile CHC Continuing Health Care

CNTWFT Cumbria Northumberland Tyne and Wear Foundation Trust

CYP Children Young People DTOC Delayed Transfers of Care E.Coli Escherichia coli ECIP Emergency Care Improvement Plan ECIST Emergency Care Intensive Support Team ENT Ear, Nose and Throat FFT Friends Family Test FT Foundation Trust GNBSI Gram-Negative Bloodstream Infections GP General Practitioner HCAI Healthcare Associated Infections HSMR Hospital Standardised Mortality Ratio IAF Improvement and Assessment Framework IAPT Improving Access to Psychological Therapies LADB Local Accident and Emergency Delivery Board LocSSIPS Local Safety Standards for Invasive Procedures LOS Length of stay MRSA Meticillin-resistant Staphylococcus aureus

MSK Musculoskeletal MSSA Methicillin-sensitive Staphylococcus aureus NEASFT North East Ambulance Service Foundation Trust NECS North of England Commissioning Support Unit NHCFT Northumbria Healthcare Foundation Trust NHS National Health Service NHSE National Health Service England NHSI National Health Service Improvement NRLS National Reporting and Learning System NSECH Northumbria Specialist Emergency Care Hospital NTCCG North Tyneside Clinical Commissioning Group NuTHFT Newcastle upon Tyne Hospitals Foundation Trust OAP Out of Area Placements PIR Post Incident Review PTL Patient Tracking List QP Quality Premium QRG Quality Review Groups RCA Root Cause Analysis RTT Referral to treatment time SHMI Summary Hospital-level Mortality Indicator SI Serious Incident SIRMS Safeguard Incident Risk Management System STAR-PU Specific therapeutic group age-sex prescribing unit UTC Urgent Treatment Centre UTIs Urinary Tract Infections VTE Venous thrombosis WHO World Health Organisation YTD Year To Date

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39

North Tyneside CCG Finance Report for the 3 months

ended 30 June 2020

Working together to maximise the health and wellbeing of North Tyneside communities by making the best use of resources.

Payment by results (PbR) and operational planning process suspended All NHS Providers provided a guaranteed minimum level of income reflecting current cost

base For months 1- 4 block payments have been calculated for all NHS Providers based on

2019/20 month 9 spend and increased by an inflation rate of 2.8% Block and top up payments to fund NHS Providers to a break even position for months 1 – 4 Retrospective top up payments also put in place to fund additional direct costs arising from

Covid-19 and loss of income arising from Covid-19. Expectation that CCGs will break even during this period CCGs allocations non-recurrently adjusted to reflect expected monthly expenditure. The calculation considers: 1. Block contracting arrangements with NHS Providers 2. National contracting of acute services from independent sector CCGs will be monitored against the adjusted allocation and a retrospective non-recurrent

adjustment will be actioned for ‘reasonable variances’ between actual spend and expected monthly expenditure.

Financial Regime

2

Overview of the Financial Position

• This report provides an update on the financial performance of NHS North Tyneside CCG for the 3 months ending 30 June 2020.

• The CCG is currently reporting a break even position as at June 2020 (Month 3) and is forecasting a break even position at the end of Month 4. The CCG has not been issued a control total for the first 4 months of the year but there is an expectation that CCGs break even during this period.

• As at Month 2 (May 2020) the CCG has received additional allocations of £1.1m and is anticipating to receive a further allocation of £654k in respect of month 3.

• Due to the suspension of the financial planning process in March 2020 the CCG does not have to formally report on efficiency schemes (QIPP) for the period April to July 2020.

• Although the month end cash balance target has been suspended as a result of the temporary financial regime the CCG is predicting delivery of the target at year end (£50k).

• The CCG's financial performance continues to be monitored by the Finance Committee and NHS E/I.

3

Summary

4

Annual Budget (M1-M4) £000's

YTD Budget £000's

YTD Actual £000's

YTD Variance

£000's

Forecast Outturn (M1-M4) £000's

Forecast Variance £000's

In Year Allocation 122,636 92,248 92,248 0 122,636 0

Healthcare Commissioned ServicesAcute Services 64,997 48,748 47,877 (871) 63,836 (1,161)Mental Health Services 9,673 7,269 7,964 696 10,625 951Community Health Services 9,897 7,468 7,801 333 10,410 512Continuing Care Services 6,390 4,955 4,507 (448) 6,259 (131)Prescribing 11,406 8,555 9,403 848 12,569 1,163Primary Care 3,502 2,672 2,626 (46) 3,437 (65)Delegated Co-commissioning 10,011 7,508 7,435 (73) 9,967 (44)Better Care Fund 3,699 2,774 2,774 0 3,699 0Other Programme Services 1,897 1,422 1,349 (73) 1,847 (50)Reserves - CCG 67 50 183 133 244 177Healthcare Commissioned Services Total 121,539 91,421 91,920 499 122,892 1,354

Running Costs Total 1,097 827 982 155 1,326 229

Total Expenditure 122,636 92,248 92,902 654 124,218 1,583

In Year (Surplus) / Deficit (0) (0) 654 654 1,582 1,582

Anticipated Allocations 0 0 (654) (654) (1,582) (1,582)

Revised In Year (Surplus) / Deficit (0) (0) 0 (0) (0) 0

Allocations

5

Recurrent Non Recurrent Total

£000's £000's £000's

2019-20 Programme Allocation 350,970 350,970

2019-20 Running Cost Allocation 4,144 4,144

2019-20 Primary Care Delegated Allocation 31,590 31,590

Pace of change funding 1,313 1,313

Reduction for central indemnity scheme (907) (907)

IR PELs transfer 162 162

NHS Property Services Voids & Subs 181 181

Morbid Obesity Risk Share (63) (63)

CCG core services additional funding 254 254

Total NHS Allocation April 2019 387,644 0 387,644

Trf 8 mths allocations to central reserve (258,429) (258,429)

4 mths NR adjustment - national model (7,663) (7,663)

In-Year Allocations 1,084 1,084

Total NHS Allocation May 2020 387,644 (265,008) 122,636

Balance Sheet

6

Jun-20 May-20 Movement£000's £000's £000's

Non Current Assets Property, plant and equipment 0 0 0Intangible Assets 0 0 0Other Financial Assets 0 0 0

Total Non Current Assets 0 0 0

Current Assets Trade and other Receivables 14 79 (65)Prepayments & Accrued Income/Provision for bad debt 23,845 25,542 (1,697)Cash and cash equivalents 210 50 160

Totala Current Assets 24,069 25,671 (1,602)

Total Assets 24,069 25,671 (1,602)

Current Liabilities Trade and other payables (3,767) (6,193) 2,426Accruals (18,027) (22,241) 4,214Other liabilities 0 0 0Provisions 0 0 0Borrowings 0 0 0

Total Current Liabilities (21,794) (28,434) 6,640

Non-Current Assets plus/less Net Current Assets/Liabilities 2,275 (2,763) 5,038

Non-Current liabilities Other liabilities 0 0 0Provisions 0 0 0Borrowings 0 0 0

Total Non-Current Liabilities 0 0 0

TOTAL ASSETS EMPLOYED 2,275 (2,763) 5,038

Financed by Taxpayers Equity

Capital & Reserves General Fund 2,275 (2,763) 5,038Revaluation Reserve 0 0 0Other reserves 0 0 0

TOTAL TAXPAYERS EQUITY 2,275 (2,763) 5,038

7

Cash Forecast Actual Actual Actual ForecastApril May June March

£000's £000's £000's £000's

IncomeBalance bfwd 337 692 50 110DOH Income 49,214 26,600 32,400 4,300Supplementary /Cash Return 400 0 0 0Prescribing/Home Oxygen Therapy Charge 2,770 3,132 3,233 2,822Pension Uplift 6.3% 0 0 0 0CHC Risk Pool 0 0 0 0Better Care Fund 0 0 0 0Other Income 295 51 86 100Total Income 53,016 30,475 35,372 7,333

ExpenditurePay (316) (319) (319) (310)NHS Payments including contracts (41,938) (21,624) (22,923) (130)Other Payments - BACS/CHAPS/CHQS (4,519) (2,912) (3,017) (1,637)Prescribing/Home Oxygen Therapy (2,770) (3,132) (3,233) (2,822)Pension Uplift 6.3% 0 0 0 0Delegated Co-Commissioning (2,588) (2,245) (3,178) (2,188)Better Care Fund 0 0 (2,685) 0Other (193) (193) (204) (195)Total Expenditure (52,324) (30,425) (35,252) (7,283)

BALANCE CFWD 692 50 210 50

Variance against drawdown 1.41% 0.19% 0.65% 1.16%

BPPC

8

Better Payment Practice Code - 30 Days NUMBER £000's

Non-NHSTotal Non-NHS Trade Invoices Paid in the Year 992 20,627Total Non-NHS Trade Invoices Paid Within 30 Day Target 985 20,611Percentage of Non-NHS Trade Invoices Paid Within 30 Day Target 99.10% 99.90%

NHS Total NHS Trade Invoices Paid in the Year 384 87,014Total NHS Trade Invoices Paid Within 30 Day Target 372 85,281Percentage of NHS Trade Invoices Paid Within 30 Day Target 97.07% 99.95%

Total Total Trade Invoices Paid in the Year 1,376 107,641Total Trade Invoices Paid Within 30 Day Target 1,357 105,892Percentage of NHS Trade Invoices Paid Within 30 Day Target 98.62% 98.38%

Official

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Report to: Governing Body Date: 28th July 2020 Agenda item: 11.2

Title of report: North Tyneside Covid-19 Outbreak Control Plan Sponsor: Dr. Lesley Young- Murphy Executive Director Nursing: Chief Operating Officer Author: Wendy Burke North Tyneside Director of Public Health Purpose of the report and action required: This plan is for information and assurance. Members are asked to note the contents of the plan and the two Boards that oversee this led by the Director of Public Health. Executive summary: Objectives of the North Tyneside Covid 19 Control Plan The plan will focus on preventing and containing the transmission of Coronavirus (SARS-Cov2) and managing the consequences of incidents and local outbreaks of Covid 19. The plan will:

• Set out measures to prevent the transmission of the virus in the population. • Describe the process to provide an early identification system for local

outbreaks. • Document the steps to be taken to proactively manage local outbreaks. • Detail the coordination of local resources and capabilities.

In keeping with national guidance, the plan will be structured around the following seven key themes set out in figure 2 below. Principles Under the leadership of the Director of Public Health the plan will bring together a combination of health protection expertise and capabilities (epidemiology, surveillance, infection prevention and control techniques, contact tracing and evaluation) and multiple agencies supporting a whole system public health approach and action at scale where needed to prevent and manage outbreaks of Covid 19. The approach will be underpinned by:

• understanding the trends and patterns of infection and the needs of our communities

• evidence of what works to inform our actions • collaboration across agencies utilising expertise and capacity • sharing of data inform action, monitor outcomes • public engagement to build confidence and trust in the arrangements

Official

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Figure 2: National requirements of local outbreak control pans Prevention Preventing outbreaks from happening is a key part of our approach in North Tyneside. Proactive communication with the public across the borough promoting the measures to help people stay safe and reduce the transmission of Coronavirus will continue to be important. This includes general messages about how coronavirus spreads, key messages on social distancing and minimising contact with those who are unwell, hand and respiratory hygiene and other infection control measures across all settings. We also need to engage with communities to ensure that our communication and action is effective. Targeted work with high risk settings to reinforce the measures they should take to reduce transmission of infections is a key theme in the plan. Building on the work that has already been done with care homes and schools and identifying other high-risk settings, communities and groups. Managing and controlling outbreaks of Covid 19 It is anticipated that the next phase of the Covid 19 pandemic will be dominated by outbreaks in a range of high risk settings, principally care homes but in other settings where people are in close contact with one another and social distancing may be difficult, where infection control procedures are not well embedded and adhered to and where there is greater vulnerability to disease. Outbreak management and control is the approach to both identifying where there is a clustering of cases of Covid 19 and then putting in place measures to reduce the

Official

Page 3 of 3

spread. Key elements of the approach which are included in this plan are testing, contract tracing and isolating people who have Covid 19. This aims to slow the transmission of infection and reducing the basic reproduction number (R0) of the virus in order to reduce the likelihood of a ‘second peak’ within the pandemic.

Governance and Compliance 1. Links to corporate objectives



2. Meet the CCG’s statutory duties.

3. Work collaboratively with partners and stakeholders to develop sustainable health and social care in North Tyneside and the wider Cumbria & North East system.


2. Consultation and engagement

N/A 3. Resource implications

N/A

4. Risks N/A

5. Equality assessment

N/A 6. Environment and sustainability assessment

N/A

Page 1 of 38

North Tyneside Covid-19

Outbreak Control Plan

Date: 30.06.20 Version: 1 Author: Wendy Burke, Director of Public Health

Page 2 of 38

North Tyneside Covid 19 Outbreak Control Plan Contents Introduction .............................................................................................................. 3 Our approach to controlling outbreaks of Covid 19 .............................................. 7 Theme 1 Schools and Care Homes......................................................................... 8 Theme 2 High Risk Places, Locations and Communities ................................... 12 Theme 3 Local Testing ........................................................................................... 14 Theme 4 Contact Tracing in Complex Settings ................................................... 16 Theme 5 Data Integration ...................................................................................... 18 Theme 6 Supporting vulnerable people to self-isolate ....................................... 20 Theme 7 Governance ............................................................................................. 21 Notification and Activation .................................................................................... 25 Covid 19 Outbreak Control Process ..................................................................... 26 Communications and Engagement ...................................................................... 27 Local authority test and trace service support grant .......................................... 30 Appendix 1 Schools including early years settings ............................................ 31 Appendix 2 Care Homes ........................................................................................ 32 Appendix 3 High Risk Settings ............................................................................. 33 Appendix 4 Covid 19 Health Protection Board .................................................... 35 Appendix 5 Covid 19 Engagement Board ............................................................ 37 Table of Amendments Drafted by Wendy Burke Director of Public Health Plan date 30th June 2020 Approved by Paul Hanson Chief Executive Review date 31st July 2020 (monthly) Version 1.0

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Introduction The national NHS Test and Trace service was launched on 28th May 2020 as part of the UK Government’s strategy to respond to and recover from Coronavirus (SARS-Cov2). Figure 1: NHS Test and Trace

Directors of Public Health (DPH) in each local authority have been asked to put into place specific local arrangements to prevent local outbreaks and, where not possible to contain them locally to minimise the spread of the virus and avoid the need for escalation to a national lockdown. The arrangements for North Tyneside are set out in this Covid 19 Outbreak Control Plan and forms an important part of our recovery framework for the borough. In line with Our North Tyneside Plan the recovery framework for North Tyneside has the following strategic objectives: For our people we will:

• provide calm and resilient leadership – both within the Council and across the Borough as a whole – mitigating the deep impacts of the pandemic on the Authority, communities and the local economy

• protect the vulnerable as a priority • restore hope and confidence in future amongst communities and

creating a platform for social recovery • contain the spread of infection • protect the safety of staff, residents and visitors • address the impacts of the pandemic from an equalities point of view in

relation to protected characteristics, health, well-being education and income

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For our places we will:

• ensure Covid Secure open spaces and town centres to support confidence and to keep North Tyneside a great place to live, work and visit

For our economy we will:

• support local businesses to enable economic recovery and growth

For our organisation we will:

• ensure clear democratic oversight is in place • follow national Government guidance in all that we do and link in with

relevant plans and initiatives at a regional level Objectives of the North Tyneside Covid 19 Control Plan The plan will focus on preventing and containing the transmission of Coronavirus (SARS-Cov2) and managing the consequences of incidents and local outbreaks of Covid 19. The plan will:

• Set out measures to prevent the transmission of the virus in the population. • Describe the process to provide an early identification system for local

outbreaks. • Document the steps to be taken to proactively manage local outbreaks. • Detail the coordination of local resources and capabilities.

In keeping with national guidance, the plan will be structured around the following seven key themes set out in figure 2 below. Principles Under the leadership of the Director of Public Health the plan will bring together a combination of health protection expertise and capabilities (epidemiology, surveillance, infection prevention and control techniques, contact tracing and evaluation) and multiple agencies supporting a whole system public health approach and action at scale where needed to prevent and manage outbreaks of Covid 19. The approach will be underpinned by:

• understanding the trends and patterns of infection and the needs of our communities

• evidence of what works to inform our actions • collaboration across agencies utilising expertise and capacity • sharing of data inform action, monitor outcomes • public engagement to build confidence and trust in the arrangements

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Figure 2: National requirements of local outbreak control pans

Prevention Preventing outbreaks from happening is a key part of our approach in North Tyneside. Proactive communication with the public across the borough promoting the measures to help people stay safe and reduce the transmission of Coronavirus will continue to be important. This includes general messages about how coronavirus spreads, key messages on social distancing and minimising contact with those who are unwell, hand and respiratory hygiene and other infection control measures across all settings. We also need to engage with communities to ensure that our communication and action is effective. Targeted work with high risk settings to reinforce the measures they should take to reduce transmission of infections is a key theme in the plan. Building on the work that has already been done with care homes and schools and identifying other high-risk settings, communities and groups. Managing and controlling outbreaks of Covid 19 It is anticipated that the next phase of the Covid 19 pandemic will be dominated by outbreaks in a range of high risk settings, principally care homes but in other settings where people are in close contact with one another and social distancing may be difficult, where infection control procedures are not well embedded and adhered to and where there is greater vulnerability to disease.

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Outbreak management and control is the approach to both identifying where there is a clustering of cases of Covid 19 and then putting in place measures to reduce the spread. Key elements of the approach which are included in this plan are testing, contract tracing and isolating people who have Covid 19. This aims to slow the transmission of infection and reducing the basic reproduction number (R0) of the virus in order to reduce the likelihood of a ‘second peak’ within the pandemic.

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Our approach to controlling outbreaks of Covid 19 We will use four mechanisms to control outbreaks Covid 19 in North Tyneside described in Table 1. Table 1: Our approach to controlling outbreaks of Covid 19

Prevent Communicate Respond De-escalate • Public health advice on

respiratory and hand hygiene

• Public health advice on social distancing

• Awareness of Covid 19 symptoms and when to self-isolate

• Access to symptomatic testing

• Embedding Infection Prevention and Control (IPC) measures

• Training on when and how to use PPE

• Access to additional PPE • Covid 19 risk assessment

and Covid secure places

• Coordinated communication strategy that conveys information on the situation, who is affected and provides clear public health advice and information

• Testing of symptomatic individuals

• Identification of contacts • Exclusion and isolation advice

for confirmed cases and contacts

• Application of IPC measures and quality assuring that the right measures are being implemented

• Testing of contacts • Mutual aid and workforce

capacity • Establishing effective outbreak

control teams • Supporting vulnerable people

and communities to self isolate.

• Closing an active outbreak and providing clear communication to all stakeholders that conveys information on the closure of the outbreak and provides public health advice

• Where required ensure that there is a strategy to assist in reputational and financial recovery

• Embedding IPC and social distancing messages to prevent the spread of coronavirus and further outbreaks

Core principles to prevent, manage and recover from Covid 19 outbreaks

Data and intelligence Risk assessments Scenario testing and risk management Reflection and identifying lessons learnt to prevent further outbreaks

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Theme 1 Schools and Care Homes Schools including early years settings It is important to protect our children and young people in schools and early years settings from Covid 19. The potential for the spread of the virus is higher in institutional settings due to the shared spaces and the frequent close contact between children and young people who often find social distancing much harder. In North Tyneside Early Years provision is split into childminder (108), day nursery (48), out of school care (18), pre-School playgroups (12), plus 2, 3 and 4 year offer in some of our primary schools. In North Tyneside, we have 55 first and primary schools with a capacity of 17,779 places, 16 secondary schools with capacity of 14,081 places (this includes 4 middle schools and an academy), 6 special/alternative provision, 1 FE college and a university campus. All our early year settings and schools in the borough are supported by a School Improvement Service led by the Assistant Director of Education and Director of Children’s Services, with excellent working relationships and regular contact with all managers and head teachers. A lead officer has been identified from the membership of the Covid 19 Health Protection Board for this theme who will play a key role in the prevention and management of outbreaks in schools and early years settings working with a team of people from public health, school improvement, health and safety and human resources. A list of all schools and early years settings can be found in Appendix 1. Table 2 describes actions.

http://search3.openobjects.com/kb5/northtyneside/fsd/results.action?qt=&term=&sorttype=field&ecdtype=4





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Table 2 Our approach to controlling outbreaks in schools including early years settings

Prevent Communicate Respond De-escalate • Schools and early years

settings have undertaken a risk assessment and are Covid secure

• Application of IPC measures • Schools and early years

settings employ nationally recommended measures such as social distancing and cohorting pupils

• Regular hand washing and access to hand sanitiser

• Regular cleaning of surfaces and shared items

• Guidance on isolation when staff or pupils are symptomatic

• Guidance and access to PPE where required for AGPs, personal care and symptomatic staff/pupils)

• Clear communication to staff, students and parents that conveys information on the situation and provides public health advice and information

• Testing of symptomatic staff and pupils

• Exclusion and isolation advice for confirmed cases (staff and pupils)

• Identification of close contacts and provision of isolation and testing advice

• Application of IPC measures and quality assuring that the right measures are being implemented

• Mutual aid and workforce capacity

• Supporting vulnerable staff, pupils and their households to self-isolate

• Establishing effective outbreak control teams to include named lead officer from the Health protection Board for this theme

• Closing an active outbreak and providing clear communication to staff, students and parents that conveys information on the closure of the outbreak and provides public health advice

• Preparing for staff and students to return to school (including deep clean)


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Care Homes Care home residents are more at risk because of individual vulnerabilities to Covid 19 including age and underlying medical conditions, shared living space and frequent close contact with others who can unwittingly spread Covid 19 within and between settings. Protecting residents in care homes during the Covid 19 pandemic is an absolute key priority in North Tyneside. In North Tyneside we have 31 elderly care residential homes with capacity for 1481 residents and 14 learning disability/mental health care homes with capacity for 185 residents. The Adult Social Care Plan in England identified the additional support to be provided to care homes during the pandemic. In North Tyneside our care homes are currently supported by staff working in Adult Social Care, the Commissioning Team and the Clinical Commissioning Group and a team has been developed to offer enhanced support. There is weekly contact with each home and the capacity tracker is used to identify new positive cases of Covid 19 and prevent outbreaks. The actions in this plan build on the work that has been in place since an early stage in the pandemic. A lead officer has been identified from the membership of the Covid 19 Health Protection Board for this theme who will play a key role in preventing and managing outbreaks in care homes. A full list can be found in Appendix 2. Table 3 describes actions.

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Table 3 Our approach to controlling outbreaks in care homes

Prevent Communicate Respond De-escalate • Prevent and Protect team

provide enhanced support to care homes to embed IPC measures (hand and respiratory hygiene, use of PPE)

• Adult Social Care and Commissioning Team use the capacity tracker data to monitor and support homes to prevent outbreaks

• Awareness of coronavirus symptoms (staff and residents) and the actions required to implement isolation procedures

• Staff are trained in use/disposal of PPE and have access to required levels of PPE

• Staff are adhering to social distancing guidance in and out of work

• Only essential visitors are permitted to enter the care home

• Care homes have tested out the impact of an outbreak on staffing and resident care and have a business continuity plan in place

• Community admissions are tested for Covid 19 prior to admission

• Coordinated communication strategy that conveys information on the situation, who is affected, identifies stakeholders and provides clear public health advice and information

• Application of IPC measures and quality assuring that the right measures are being implemented – enhanced cleaning

• Cohorting residents (confirmed, suspected and contacts of a case)

• Fixed teams care for Covid 19 positive residents

• Isolation advice for residents and staff • Testing arranged for symptomatic

resident and staff • Data – monitoring (acknowledge that

care homes may experience multiple outbreaks)

• Mutual aid and workforce capacity • Restricting movement of staff between

care homes • Making provision for psychological

support for staff and residents • Testing of symptomatic individuals • Establishing effective outbreak control

teams to include named lead officer from the Health protection Board for this theme

• Supporting staff and their households to self-isolate

• Using local intelligence and data to inform decision to close an outbreak

• Deep clean of care home • Embedding IPC and

social distancing messages to prevent the spread of coronavirus and further outbreaks

• Supporting health and wellbeing including psychological support for staff and residents

• Reflecting on outbreak and identifying lessons learnt and planning to prevent further outbreaks

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Theme 2 High Risk Places, Locations and Communities There are many places, locations and communities in North Tyneside that are at higher risk of outbreaks characterised by a mix of some of the following factors:

• Close proximity of many people on one site • Confined spaces • Refrigeration • Underlying vulnerabilities of individuals which include age, medical

conditions, ethnicity • Low understanding of individuals of the risks of infection and the risks of the

disease • Inability of individuals to keep to infection prevention measures • Poor infection control measures

A full list by category is provided in Appendix 3. Each of these categories has a lead officer identified in the membership of the Covid-19 Health Protection Board who will play a key role in the prevention and management of outbreaks within the setting. Full lists with contact details are kept in the Covid 19 Operational Guidance. The four mechanisms for controlling Covid 19 shown in table 4 will also be applied in these high-risk settings and communities. Table 4 Our approach to controlling outbreaks in high-risk sites and communities Prevent Communicate Respond De-escalate • All workplaces are

Covid secure and have undertaken a Covid 19 risk assessment and have implemented the necessary measures required (IPC, social distancing and additional PPE)

• Employees are aware of the symptoms of Covid 19 and actions required isolation and accessing testing

• Workplaces are aware of how to report

• Clear communication to the public, business owners and employees that conveys information on the situation and provides public health advice and information

• Exclusion and isolation advice for confirmed cases

• Identification of close contacts and provision of isolation and testing advice

• Cleaning and sanitising measures implemented

• Workforce capacity and implementing business continuity plans (essential services)

• Closing an active outbreak and providing clear communication to the public, business owners and employees that conveys information on the closure of the outbreak and provides public health advice

• Reputational and financial recovery

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suspected/confirmed cases

• Preparing for employees to return to work and/or to reopen a closed business -including deep clean and risk assessment


Page 14 of 38

Theme 3 Local Testing Local testing capacity is essential not only for diagnosis for those who have symptoms but is also important in response to the management of a Covid 19 outbreak. The targeted deployment of local facilities alongside regional and national testing programmes will ensure that there is a swift response outbreaks as well as providing testing which is accessible to the entire population of North Tyneside. The current process involves taking a a throat and nose swab and using an antigen (PCR) test to establish if an individual is positive for Coronavirus (SARS-Cov2). Current testing arrangements Swab tests can be accessed through the local NHS Trusts and they are processed through NHS laboratories, this is referred to as Pillar 1 testing. Testing can also be accessed through the national testing programme, which is referred to as Pillar 2 testing and tests are processed through a laboratory in Milton Keynes. Pillar 1 (NHS Foundation Trusts) Eligible groups:

• NHS staff (via their employer) • GP’s and Practice Nurses • Social care staff (via North East Commissioning Support Unit (NECS).

https://nhscovidtestne.onk2.com) • Symptomatic care home residents (via GP) • Asymptomatic care home residents who are transferring from community or

other care home (via GP) • Patients being admitted overnight to hospital for overnight stay are tested

Pillar 2 (National Testing Programme) Eligible groups:

• Anyone who has symptoms of coronavirus, whatever their age • Essential workers who are self-isolating either because they or member(s) of

their household have coronavirus symptoms • Whole care home asymptomatic testing

Testing can be accessed via the national testing portals https://www.gov.uk/guidance/coronavirus-covid-19-getting-tested. Testing is currently offered:

• At the fixed drive through testing site based at Great Park and Ride Newcastle with a daily capacity of 300 tests

• At various locations across North of Tyne through a mobile testing unit (MTUs) that moves around on a weekly rota and is accessed on a drive through basis. In North Tyneside the MTU uses the overflow car park at The Parks Leisure

https://nhscovidtestne.onk2.com/

https://www.gov.uk/guidance/coronavirus-covid-19-getting-tested

Page 15 of 38

Centre as a site. The MTU has a daily capacity to undertake 300 tests. It is hoped that this will become a permanent site in North Tyneside soon

• Through ordering a postal self-test kit swabs are delivered direct the home address and returned in the post

• Care home portal for whole care home testing swabs are delivered direct to the care home

A crucial issue in relation to testing is the turnaround time of tests. The rapid turnaround for vulnerable populations and settings and fast return of results improves the effectiveness of the contact tracing and isolation system and prevents the spread of the virus. The turnaround time for Pillar 2 testing has been slower than Pillar 1 to date, with results taking longer than 24 hours. For home tests kits the built in delay due to postage means results can take as long as 5 days. Deploying targeted testing facilities The Director of Public Health can also deploy additional Mobile Testing Units (MTU) in response to an outbreak. This is activated nationally via the Council’s lead officer/SPOC and resources are deployed as appropriate to the outbreak situation. Mass testing may be an appropriate and rapid means in situations where there are a large number of people suspected of having Covid 19 in a particular setting. Testing capacity Access to Pillar 2 testing sites is dependent upon having a car as both the fixed and mobile sites operate on a drive through basis. Walk in options are required as many households in North Tyneside (around 30%) do not have access to a car which means they are reliant on postal self-test kits with much longer turnaround time for results. In terms of the daily testing capacity that is available for residents in North Tyneside, in the short term we do not anticipate that demand will exceed current availability.

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Theme 4 Contact Tracing in Complex Settings The national NHS Test and Trace (T&T) system ensures that anyone who develops symptoms of Covid 19 can quickly be tested to find out if they have the virus. The T&T system will also trace close recent contacts of anyone who tests positive for coronavirus and, if necessary, notify contacts that they must self-isolate at home to help stop the spread of the virus. There are three tiers in the tracing system:

• Tier 3 are call handlers recruited by Serco. Call handlers will call all the identified contacts and give them isolation advice which is to isolate for 14 days.

• Tier 2 are NHS professionals. They will conduct telephone interviews with the case to identify all their contacts.

• Tier 1 is the local North East Public Health England Health Protection Team (NE PHE HPT). This tier deals with contact tracing in complex settings and high-risk sites.

Complex settings are categorised in table 6. Table 6 Complex settings

Settings – attended setting while infectious

Employee Groups – at work while infectious

Complex information

• Educational and childcare

• Care homes and day care facilities for those with complex needs/ older/vulnerable people

• Homeless hostels, shelters and refuges

• Healthcare for non Covid reasons

• Healthcare workers • Emergency Services

workers • Border Force and

Immigration officers • Prison or other places

of detention • Working in special

schools

• Concerns about deductive disclosure

• Contacts can’t be identified without disclosure of name to employer or other third party

• Employers/workplaces unwilling or unable to provide information

Escalation and management of cases within complex settings and high-risk sites in the NHS Test and Trace Service Complex cases identified at ‘Tier 2’ are escalated to the ‘Tier 1’ NE PHE HPT based in Newcastle who will initially manage the case giving relevant advice and guidance. This will include undertaking all contact tracing arising from these settings. The NE PHE HPT have doubled the capacity of staff to undertake this role. Any additional capacity required for Tier 1 surge would be supported locally from the system via the North Tyneside Covid 19 Health Protection Board and also through mutual aid via the NE public health network led by Directors of Public Health via secondments to PHE from a range of different staff who already have skills in contact tracing.

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The Director of Public Health and other local authority officers will support the HPT in the contact tracing in complex setting and high-risk sites facilitating access to vulnerable individuals and communities through local knowledge and contacts, as required. Clusters or outbreaks of Covid 19 will be notified to the local authority in line with agreed joint protocols. The initial management will be undertaken via HPT led Outbreak Control Team (OCT) and will be escalated to the LA led OCT in line with joint protocols (see the later section on notification, activation and response for further details).

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Theme 5 Data Integration To date there has been limited local and national data available to local authority Directors of Public Health. Pillar 1 positive test results are notified through NHS laboratories through the Second Generation Surveillance System (SGSS) and notifies to the HPT. Pillar 2 data is also made available to the HPT. Positive results are also starting to flow in GP systems. Local authorities currently only receive aggregated data per local authority as follows:

• Daily and cumulative numbers tested through pillar 1 and 2 with a positive result

• Daily and cumulative numbers of positive cases in NHS Test and Trace • Exceedance reports for each LA for pillar 1 and 2 testing • ONS Covid 19 deaths include place of death • Daily report from PHE NE HPT on new outbreaks in care homes • Care home tracker

Data will be required to prevent and manage local outbreaks, deploy local testing capacity, deliver effective contact tracing, support vulnerable people, monitor local public confidence and also in terms of employing local restrictions. The current data flows of clinical and testing data are not yet available to local authorities and it is difficult to recognise or be able to respond to the spread of virus and the occurrence of outbreaks at a local level. With the establishment of the Joint Biosecurity Centre (JBC) to bring together expertise and analysis to inform decisions at a national, regional and local level on tackling Covid 19, it is intended that local authorities will receive positive test data at postcode level to inform local outbreak planning. The JBC will provide real-time analysis about infection outbreaks. It will look in detail to identify and respond to outbreaks of Covid-19 as they arise. The centre will collect data about the prevalence of the disease and analyse that data to understand infection rates across the country. It will also utilise the alert levels to advise on how the government should respond to spikes in infections (see figure 3 below). As part of these national proposals we have recently signed a Covid 19 Testing Rapid Data Sharing Contract between North Tyneside Council and PHE so that we can receive confidential patient information of residents who test positive for Covid 19 to support the management and mitigation of the spread and impact of the current outbreak of Covid 19. In advance of receiving this data we will ensure that we have in place an operating process for receiving, storing, access and use of the data which is compliant with information governance requirements. We are also encourage other professionals to share information with the HPT on any concerns they may have in relation to suspected cases, clusters or outbreaks. Soft intelligence can also add to the picture providing insights into perceived impacts of COVID-19 within our communities.

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Using all the data available to us, we will develop a local surveillance system to monitor the on-going incidence and prevalence of Covid 19 in North Tyneside using this data. We will analyse and interpret this data to inform the action we need to take at a community level, in a timely way, to prevent the transmission of infection and outbreaks at community level. Figure 3

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Theme 6 Supporting vulnerable people to self-isolate During the response phase of the Covid 19 pandemic, North Tyneside Council established a ‘Shielding Hub’ to coordinate effort across the council and a range of local partners. This hub distributed the national support packages and provided a range of support services to the most vulnerable residents. As part of the range of services developed by this hub and its teams, support for those self-isolating was also accessed by many residents and remains in place with the council and some local voluntary services and community groups. This support has included things like shopping services, pharmacy collections and telephone calls to combat loneliness and check on wellbeing. It is this work which will need to continue throughout the recovery phase and could be stepped up further if needed. The opening hours for the NTC Covid 19 support hub are Monday to Friday, 8am to 5pm, and is available by telephoning 0345 2000 101 or emailing [email protected]. The Volunteer Centre and the Good Neighbour Scheme both run by VODA (and accessed via the details above) as well as the NHS Volunteer scheme accessed through GP surgeries will also be an important source of support for many people. Establishing a contact tracing system in the UK will mean that people who have had close contact with a case will be contacted and advised to self-isolate. A lead officer has been identified to be part of both the Health Protection Board and the Outbreak Control Team so that early support needs can be identified and stood up at the onset of an outbreak. As well as our pre-identified high-risk communities and those clinically vulnerable groups who are being ‘shielded’, there are some people whose circumstances might make them vulnerable in a local outbreak and/or during any periods of self-isolation. These include (but are not limited to):

• Low income families • Ethnic and religious minorities whose needs might vary widely • Inclusion groups (homeless, migrants, asylum seekers, Gypsy and Roma, sex

workers) • Unemployed people • New benefit system claimants • Homeless people • People aged 70 • Households who are self-isolating and cannot access local amenities and

services The Covid 19 Operational Guidance details the activation and escalation processes to increase local support provision in the event of large local outbreaks.

mailto:[email protected]

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Theme 7 Governance The governance arrangements for outbreak control in North Tyneside are set out in figure 4 below in keeping with the national requirements for outbreak control arrangements. Two new boards have been established:

• At an operational or tactical level, a multi-agency North Tyneside Covid 19 Health Protection Board has been established to develop and implement the outbreak control plan. Terms of reference are set out in Appendix 4. A local authority led Outbreak Control Team will be stood up from the membership of this group in response to outbreaks escalated from the NE PHE Team.

• At a strategic level a member-led multi agency North Tyneside Covid 19 Engagement Board has also been established to provide oversight and assurance of the outbreak control arrangements. Terms of reference are set out in Appendix 5.

Managing risks A risk register will be compiled to identify the key risks and controls in the delivery of effective outbreak control in North Tyneside and the implementation of the plan. Key risks include compliance of the public with infection prevention and control measures and self isolation, access to testing for those people who do not have a car, turnaround time of test results and access to adequate data effective Test and Trace service with rapid data flows. Northumbria Local Resilience Forum (LRF) Some large and complex outbreaks may require a strategic multi-agency response. This might happen in the event of simultaneous outbreaks in the borough or where an outbreak has spread across local authority areas. At the time of publication of this plan, the Northumbria Strategic Coordinating Group (SCG) is being stood down as the recovery phase takes over management of the pandemic. The DPH maintains an active reporting link with the North Tyneside Recovery Coordinating Group (RCG), which feeds into the LRF RCG. The Outbreak Control Team can activate standing arrangements with the LRF when necessary. This would be done via a discussion with the Chief Executives of the ICP in the first instance. Regional oversight group As part of the national ‘Contain’ arrangements a regional oversight group has ben established comprising a lead Local Authority Chief Executive, the Chair of the North East Association of Directors of Public Health, the Regional Director of Public Health England and a former senior local authority executive. Its role will be to support the arrangements in each of the local authorities in the North East with assistance from the Joint Biosecurity Centre by providing a regional overview of new infections of COVID19 across the region, enable sharing of good practice, peer review and sector-led improvement. It will also provide intelligence and insight from the region to inform the Joint Biosecurity Centre.

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Figure 4 Governance arrangements for outbreak control in North Tyneside

Legal powers to contain the spread of Coronavirus1 The UK Government has a duty to protect the health of the public under article 11 of the European Social Charter 1961 (Council of Europe 1961). This requires measures such as the removal of the causes of ill health, education to promote health and encouragement of individual responsibility for health. To protect the population from infectious and communicable diseases and contamination additional measures are available through the Public Health (Control of Disease) Act 1984 (as amended by the Health & Social Care Act 2008) together with three sets of regulations protects the health of the public through a system of surveillance and action. Surveillance allows for the identification, investigation and confirmation of an outbreak of a disease or a case of contamination with appropriate and timely intervention to control the spread of the disease including isolation.

1 Details taken from Griffith, R. (2020) ‘Using public health law to contain the spread of COVID-19’,

British Journal of Nursing, 29(5), pp. 326–327. doi: 10.12968/bjon.2020.29.5.326 is outlined below.

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The Act also gives powers to local authorities, which can be used without approval from a court. They also give powers to magistrates to make orders specifying what action must be taken by authorities to protect the health of the public. Before the powers can be invoked, local authorities and magistrates must be satisfied that there is evidence of an infection or contamination and that it represents a significant risk to health along with the risk of the infection spreading to others and the action required to remove or reduce the risk. Under the Health Protection (Local Authority Powers) Regulations 2010 and the Health Protection (Local Authority Powers) (Wales) Regulations 2010, local authorities are able to request or require action to be taken to prevent, protect against or control a significant risk to human health for example when a person may be asked to self-isolate. A request only allows the local authority to ask a person to comply. If the person refuses, the local authority must go to court to seek an order of enforcement. The powers can also:

• Require that a child is kept away from school • Require a head teacher to provide contact details of pupils attending their

school • Request individuals or groups to cooperate for health protection purposes • Request the disinfection or decontamination of premises or articles • Restrict contact with or relocate a dead body for health protection purposes.

To further protect the health of the public the 1984 Act gives powers to Justices of the Peace (magistrates) in cases of infection and contamination. Where a magistrate is satisfied that the criteria are met, they can issue an order to protect against infection or contamination that presents a risk of significant harm to human health. The Health Protection (Coronavirus) Regulations 2020 in England regulations create additional powers to control people who may have coronavirus now the Secretary of State has declared that its transmission is a serious and imminent threat to public health. The powers apply where either:

• The Secretary of State or a public health consultant believes that a person may be infected with coronavirus and there is a risk that they might infect others; or

• The person has arrived in England on a ship, aircraft or train and has left an infected area in the previous 14 days.

The Coronavirus Act 2020 allows the police to intervene to prevent the spread of COVID-19. The Act also includes powers for a constable to return someone to detention or isolation by using reasonable force where necessary and to remove someone to a hospital or enter any premises in order to do so on the basis of reasonable suspicion that the person may be infected with coronavirus. Northumbria Police use the Engage, Explain and Encourage approach communities in relation to the current restrictions to prevent outbreaks. As the legislation is amended throughout the recovery phase, officers may enforce the law with those individuals who disregard infection prevention and control measures and put other people at risk.

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Other legislative powers include the rights accorded to the Health and Safety Executive (HSE) inspectors by the Health and Safety at Work etc. Act 1974 and also powers through the Food Safety Act 1990 (as amended) which provides the framework for all food legislation in the England, Wales and Scotland. In the event of an outbreak in a food processing plant we would use Food Safety Act powers to investigate and where necessary close the plant with colleagues from the Public Protection Team and our Environmental Health Officers.

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Notification and Activation There is a clear notification process in place to provide as early an alert as possible.

Notification

•Public Health England’s NE Health Protection Team will receive information about suspected or confirmed cases in a complex or high-risk setting and notify the NTC SPOC by email.•The NTC SPOC email address is [email protected]

Activation

•Notification emails are accessed by the Outbreak Control Team between the hours of 8am-8pm across seven days a week. •In the event of a confirmed outbreak, the HPT will lead the response convening a HPT led multiagency Outbreak Control Team to which the DPH and other local authority officers will be invited

Response

•If a local response is required through escalation from the HPT the DPH LA led OCT will be established in line with the North Tyneside Covid-19 Operational Guidance to manage the response. •Membership of the OCT will be drawn from the Lead Officers from the Health Protection Board.

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Covid 19 Outbreak Control Process Directors of Public Health in Local Authorities and Health Protection Teams within PHE have specific roles and responsibilities set out in statute, for preventing, identifying and managing outbreaks of infectious disease, including Covid 19. The arrangements are emerging in line with new regional and national structures that are being established by the JBC. In order to avoid duplication and to enhance working at a local authority level during the management of Covid 19 outbreaks, detailed joint standard operational procedures (SOPs) are being developed between the NE PHE Health Protection Team and local authority Directors of Public Health across the region. The SOPs will describe the actions required by the HPT, the DPH and local authority officers. Alongside the SOPs national activation cards are also in development for setting specific advice and actions. Table 7 below sets out the definitions that have been agreed for clusters and outbreaks and clusters that would trigger a local outbreak management response. Table 7 Definitions and triggers

Cluster non-residential settings (e.g. workplace, school) Two or more confirmed cases of Covid 19 among individuals associated with a specific setting with onset dates within 14 days Outbreak Non-residential setting (e.g. workplace, school) Two or more confirmed cases of Covid 19 among individuals associated with a specific setting with onset dates within 14 days AND ONE OF the following: Identified direct exposure between at least two of the confirmed cases in that setting (e.g. within 2 metres for >15 minutes) during the infectious period of the putative index case OR When there is no sustained community transmission or equivalent JBC risk level 1 or 2 and there is an absence of alternative source of infection outside the setting for initially identified cases Healthcare or residential setting Outpatient healthcare setting Inpatient healthcare setting Residential Setting Two or more confirmed cases of Covid 19 among individuals associated with a specific setting with onset dates within 14 days

Two or more confirmed cases of Covid 19 OR clinically suspected cases of Covid 19 among individuals associated with a specific setting with onset dates 8-14 days after admissions within the same ward or wing of a hospital.

Two or more confirmed cases of Covid 19 OR clinically suspected cases of Covid 19 among individuals associated with a specific setting with onset dates within 14 days

A single laboratory confirmed case would initiate further investigation and risk assessment for the above settings

Figure 5 below describe the joint management of Covid 19 outbreaks from prevention to declaring an outbreak or cluster closed between PHE and the local authority.

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Figure 5 Joint Management Responsibilities and Actions

1. Joint responsibility for prevention of outbreaks:

• Public Health Advice (social distancing, respiratory and hand hygiene) • Symptom awareness and self-isolation • Access to symptomatic testing • Embedding Infection Prevention and Control (IPC) measures • Access to PPE and training on when and how to use PPE • Covid 19 risk assessment and Covid secure places and settings

North East Public Health England Health Protection Team

2. Notification of confirmed or suspected cases by local settings

North Tyneside Council

DPH receives information on confirmed and suspected cases in care homes schools and high-risk settings. Early actions e.g. support into a care home

3. More than one case linked to any setting risk assessment carried out with setting and immediate control measures activated

5. Declare an outbreak/cluster, (as per national definitions) and in the context of local situational awareness

6. PHE led Multi agency OCT – collectively agree control actions, including external comms if required escalate management to DPH/LA

DPH/LA single point of contact will be informed that an outbreak has been declared

LA supports risk assessment and provides information to PHE as required

DPH will oversee/coordinate the LA response to the setting/community in terms of advice and support and where necessary enforcement.

2. Notification of confirmed cases by NHS Track and Trace

7. Outbreak is not contained and/or wider action is required at sectoral or geographic level, then the outbreak will be escalated by the HPT led OCT chair and the DPH

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8. Subsequent LA-led OCT meetings will be chaired by the DPH with members of the North Tyneside Covid 19 Health Protection Board providing support as outlined in setting specific joint outbreak management SOPs

9. Outbreak closed (No confirmed cases with onset dates in last 28 days in that setting) Cluster closed – (No confirmed cases with onset dates in the last 14 days)

4. Undertake contact tracing and provide advice to contacts on self-isolation and testing

LA facilitates access to vulnerable people and supports them to self-isolate

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Communications and Engagement A Covid 19 outbreak control communication and engagement plan will be developed to support and sit alongside this plan and will focus on three key areas:

• Preventing local outbreaks of Covid 19 and engaging people across all segments of society with the need to comply with social distancing, be alert to symptoms, access testing where needed and to self-isolate if positive or if contact traced

• Providing assurance to stakeholders and the public that plans for management and control of outbreaks are effective

• Providing the public with information in the event of outbreak scenarios Preventing local outbreaks A national campaign is being developed titled ‘People Protecting People’ which will be deployed locally. The campaign addresses the identified key barriers of low awareness of testing, low symptom knowledge and low understanding of isolation. Our local campaign will target key audiences and engage particularly with our most vulnerable groups and those who are disproportionately affected by Covid 19. Priority audiences include:

• BAME communities • Single mothers with young children • 65+ • People aged 18-24 • Workers aged 25-64

Key messages

• Limit contact with other people • Keep your distance if you go out and follow latest guidelines • Wash your hands regularly for 20 seconds • Cough or sneeze into a tissue (‘Catch it, Bin it Kill it’) • Wear a face covering on public transport and in enclosed public spaces if you

can • Got any of these symptoms? Cough, temperature, loss of taste or smell? • Get tested immediately and isolate your household • If positive, isolate your household for 14 days • If you’re told you’ve been in close contact with someone who has tested

positive, isolate for 14 days to protect others • Testing - why get tested, who can get tested, how and where to get a test, what

is a test like, • Contacts - why give your contacts, what if you are contacted, why is self-

isolation important, what support is available, what are the rules, how to spot scams

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• For further government, health information and advice please visit gov.uk or nhs.uk

We will engage with residents through a range of channels and use the resources from PHE at: https://campaignresources.phe.gov.uk/resources/campaigns The Local Outbreak Plan Our key messages for the public in relation to our plan will be that:

• It has been developed so that we are well prepared to effectively contain the virus and reduce its spread in the community.

• It is led by North Tyneside Council in conjunction with Public Health England, and supported by the NHS Test and Trace local team and is designed to enable day-to-day working and rapid escalation of actions when required with:

o Detailed governance arrangements with clear roles and responsibilities o Identified inks with key stakeholders and flow of information in case of an

outbreak o Trigger points for escalation o Communications and engagement plan o Focus on seven key themes.

Control of outbreaks There is a long history of the joint management of outbreaks between local Public Health England and including the management of both reactive and proactive communication with the public. In terms of Covid 19 outbreaks the audience for the communication will vary depending on the nature of the setting (workplace, school, care home etc), community (ensuring socio-demographics are taken into account), people who are clinically extremely vulnerable and relevant stakeholders including the Mayor, Ward Councillors, other elected members and MPs Key messages will vary depending on the nature of outbreak and response but could include some of the following:

• Alert that cases are rising and for the public to take extra care, reminder of guidance and restrictions

• Acceleration of testing • Closure of specific setting(s) • Closure of certain businesses and venues • Cancellation of organised events/ large gatherings • Closure of outdoor public areas • Working from home where possible • Limit schools to certain year groups • Close schools • Limit / close transport network • Stay at home

Central support will be available in the event of significant local outbreaks and local communications activity to be jointly agreed with council authorities to ensure appropriate tailoring.

https://campaignresources.phe.gov.uk/resources/campaigns

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Local authority test and trace service support grant All local authorities in England have received a test and trace service support grant from Government. The purpose of the grant is to provide support towards any expenditure incurred in relation to the mitigation against and management of local outbreaks of Covid 19. The grant for North Tyneside is approximately £1.1m and it will be used to support our approach to prevention, communication, responding and de-escalating outbreaks of Covid 19 across the key themes of work. This will include:

• Support to ensure robust infection prevention and control across targeted and high-risk settings

• Training to equip lead officers to support preventative action • Robust processes for local data flows and analysis to enable rapid identification

of clusters and outbreaks and action • Communication and engagement with the public and communities • Support for those who are vulnerable and need to isolate

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Appendix 1 Schools including early years settings First Schools (8) Appletree Gardens First Rockcliffe First Coquet Park First Southridge First Langley First South Wellfield First Marine Park First Whitley Lodge First

Primary Schools (47) Amberley Primary Hadrian Park Primary St Bernadette's RC Backworth Park Primary Hazlewood Primary St Columba's RC Primary Bailey Green Primary Holystone Primary St Cuthbert's RC Primary Balliol Primary Ivy Road Primary St Josephs RC Primary Battle Hill Primary King Edward Primary St Marys RC Primary (FH) Benton Dene Primary Monkhouse Primary St Marys RC Primary (NS) Burradon Primary New York Primary St Stephens RC Primary Carville Primary Percy Main Primary Star of the Sea RC Christ Church CofE Preston Grange Primary Stephenson Memorial Collingwood Primary Redesdale Primary Wallsend Jubilee Primary Cullercoats Primary Richardson Dees Primary Wallsend St Peters Denbigh Primary Riverside Primary Waterville Primary Fordley Primary Shiremoor Primary Western Primary Forest Hall Primary Spring Gardens Primary Westmoor Primary Grasmere Academy St Aidan's RC Primary Whitehouse Primary Greenfields Primary St Bartholomew's CofE

Middle Schools (4) Marden Bridge Middle Monkseaton Middle Valley Gardens Middle Wellfield Middle

Secondary Schools (11) Burnside College Monkseaton High Churchill Community College Norham High George Stephenson High North Gosforth Academy John Spence St Thomas More Longbenton High Whitley Bay High School Marden High

Special Schools (6) Beacon Hill Southlands Benton Dene School Woodlawn Silverdale Moor bridge

All through (1) Kings Priory Academy

FE College Northumbria Univeristy Tyne Metropolitan College Coach Lane Campus

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Appendix 2 Care Homes Elderly Care Homes (31) Appleby Care Home Evergreens Princes Court Ashfield Court Hadrian House Redesdale Court Charlton Court Heatherfield Risedale Residential Coble House Holmlea Rosemount Collingwood Court Howdon Care Centre Seaview Croft Dene

Kendal House

St Anne’s Residential Care Home

Earsdon Grange Kingfisher Care Home St. Peters Court Eastbourne House Lawns Residential Home West Farm Residential Care Eothen Homes (Wallsend) The Old Vicarage The Ferns Eothen Homes (Whitley Bay) Park View Care Home Primrose Lodge Windsor Court

Learning Disability Care Homes (14) Manor Lodge Parkvale Lenore Rocklyn Albany Cordingly House Falmouth Station Road Chipchase/Ferndene Melrose House Hadrian Court Queensbridge Milton Lodge Leybourne

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Appendix 3 High Risk Settings Healthcare Settings:

• A list of all 26 GP Surgeries in North Tyneside can be found here • A list of all 52 pharmacies across the borough can be found here • Dentists • North Tyneside General hospital (GP-led urgent treatment centre, diagnostic

testing, 24 wards, outpatient clinics and care of the elderly). • There is one private medical facility, the Cobalt Hospital in Cobalt Business

Park. • Renal Unit has one Dialysis Unit in Orion Business Park which is run from their

Newcastle site.

High Risk Communities:

• People who misuse drugs/dependent drinkers • Homeless people • Faith communities • Places of Worship

Temporary Homelessness Accommodation and Capacity:

• Budget Hotel (8) • Alcatraz Hotel (5) • Courtney (1) • Melrose (2) • Dorset Arms (8)

Other Residential:

• Whitley Bay Holiday Park – a number of key workers living there as of June 2020.

• Refuge • People receiving support with a learning disability across a wide provision listed

here but including residential units (9) and supported living providers (19) • Children’s Residential Facilities listed here, but including:

o Starting Point (Purley Close (5) and Edmund House (5)) o Sycamore House (6) o Riverdale (5)

Tourist Accommodation: Self-catering

Burradon Farm Houses and Cottages Seafront Apartments, Cullercoats

Dukes Holiday Cottages Southcliff Apartments, Cullercoats

Field House Tynemouth Holiday Cottages

https://www.northtynesideccg.nhs.uk/your-health/gp-practices/?showall

https://www.northtynesideccg.nhs.uk/your-health/pharmacies-map-view/

https://my.northtyneside.gov.uk/category/789/learning-disability

https://my.northtyneside.gov.uk/category/520/residential-units

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Guest Houses

Aabba Guest House, Whitley Bay

Lindsay Guest House, Whitley Bay

The Dorset Arms Inn

Aarden Grange Guest House, Whitley Bay

No.61, Tynemouth The Pines Guest House, Whitley Bay

Alcatraz Guest House Oaktree Lodge, Whitley Bay The Metropolitan, Whitley Bay

Chedburgh Hotel, Whitley Bay

Park Lodge, Whitley Bay

Windsor Hotel, Whitley Bay

Dunes Hotel, Whitley Bay Sandsides, Whitley Bay York House Hotel, Whitley Bay

Esplanade Lodge, Whitley Bay

Seacrest Hotel, Whitley Bay

Lighthouse Guesthouse, Whitley Bay

The Cara, Whitley Bay

Hotels

Grand Hotel, Tynemouth Royal Hotel, Whitley Bay

Park Hotel, Tynemouth Village Hotel Premier Inn, Whitley Bay Hotel 52, Whitley Bay

Premier Inn, North Shields Premier Inn, Holystone Food production sites Burradon Abattoir, Burradon

Fish processing plant – North Shields Fish Quay

Greggs, Quorum Business Park

Large employers BT (including EE) Concentrix Tesco Bank Smulders Accenture DXC Technologies P&G Newcastle Building Society Sitel Greggs

Large public sector employers North Tyneside Council NHS Hospitals HMRC

Transport sites Port of Tyne Metro (Nexus) Bus Operators (Arriva, Stagecoach, Nexus, Go North East)

Tourist attractions

Segedunum Blue Reef Aquarium George Stephenson Railway Museum Bars and Restaurants St Marys Lighthouse and Visitors Centre

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Appendix 4 Covid 19 Health Protection Board Strategic objectives The purpose of the board is to protect the health of the population of North Tyneside from outbreaks of Covid 19 through:

• Preventing the transmission of SARS-Cov2 in the population • Early identification of local outbreaks of Covid 19 • Proactive manage of local outbreaks • Coordinating local resources and capabilities within the local system

response Membership Wendy Burke Director of Public Health Chair

Heidi Douglas Public Health Vice Chair

Joanne Lee Public Protection Lindsey Ojomo/Victoria Crennell Resilience James Moore Communications Scott Woodhouse/Craig Nicholson Commissioning Toby Hartigan-Brown Housing Diane Buckle/Lisa Rogers Schools Ellie Anderson/Liz Hanley ASC Maureen Grieveson/Adrian Dracup CCG Anthony Laing Health and Safety David Tate/Judith Stonebridge NHFCT Felicity Shoesmith CVS/Faith/Shielding hub Dave Tomson/Kirsten Richardson Primary Care Network

Objectives The objectives of the board are:

1. To lead the development and implementation of Local Outbreak Control Plan 2. To collate a range of local data in the context of regional and national trends

and develop a dashboard to identify and monitor the risks to the population of NT

3. To identify local high-risk places, locations and communities and plan jointly with the PHE HPT how outbreaks will be managed in each

4. To receive information from PHE on the notification of local incidents and outbreaks

5. To rapidly establish an Outbreak Control Team meeting from the membership of the board in response local incidents and outbreaks

6. To manage local testing capacity with partners to ensure swift testing of those who have had contacts in local outbreaks#

7. To identify surge capacity within the local system for responding to multiple outbreaks

8. To provide training to staff who support outbreak control response

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9. To use local knowledge to support PHE HPT with contact tracing in complex settings

10. To support vulnerable local people to get help to self-isolate and ensuring services meet the needs of diverse communities

11. To escalate any resurgence in cases or outbreaks to the Recovery Coordinating Group

12. To report arrangements and progress to the Member-led North Tyneside Covid 19 Engagement Board

Governance The C-19 HPB will have tactical oversight of Covid 19 outbreaks in the local area and will direct operations to control the outbreak. The C-19 HPB will report to the Covid 19 Local Engagement Board. The C-19 HPB will need to stand up quickly in the event of an outbreak. Members should have nominated Deputies to enable this. Products and Information Sources The C-19 HPB will produce an Action and Decision Log. The C-19 HPB will also consider a Dashboard as a key information source to maintain a shared situational awareness. The C-19 HPB will deliver situation reports as required.

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Appendix 5 Covid 19 Engagement Board Role and Purpose The Covid 19 Engagement Board is responsible for the political, strategic and public oversight of the local Covid 19 outbreak control arrangements in North Tyneside, including prevention, surveillance, planning and response, to ensure they meet the needs of the population and assure residents and stakeholders that the arrangements for controlling outbreaks of Covid 19 in North Tyneside are effective.

Membership Norma Redfearn Elected Mayor Chair

Matt Wilson Councillor Vice Chair Paul Hanson Chief Executive North Tyneside Council Wendy Burke Director of Public Health

Jacqui Old Director of Children's and Adult Services

North Tyneside Council

Jackie Laughton Head of Corporate Strategy North Tyneside Council

Lesley Young Murphy

Executive Director of Nursing: Chief Operating Officer Chief

North Tyneside Clinical Commissioning Group

Paul Jones Chief Officer Healthwatch North Tyneside

Claire Riley Executive Director of Communication and Corporate Affairs

Northumbria Healthcare NHS Trust

Robin Fry Chief Executive Voluntary Organisations Development Agency (VODA)

Janice Hutton Chief Superintendent Northumbria Police

Objectives The Board will:

a) provide oversight and assurance of the local outbreak control arrangements in North Tyneside

b) agree and publish the North Tyneside Covid-19 Outbreak Control Plan; c) develop a local communication and engagement strategy in relation

to outbreaks of Covid 19 d) develop a communication and engagement plan with frequent and

consistent messaging through a range of channels, targeting multiple groups of people in order to build trust and confidence during outbreaks and increase adherence of local people to the measures which prevent the spread of infection

e) share the epidemiology of COVID-19 in North Tyneside in the context of regional and national trends

Page 38 of 38

The Covid 19 Engagement Board has no executive decision-making powers. If decisions are necessary, these will be taken in accordance with the relevant decision making processes as set out in the Council’s constitution.

Accountability The Covid 19 Engagement Board will be accountable to Cabinet and will report to the regional oversight group and LRF (Via ICP) See Appendix A.

Meetings Meetings will be held monthly. Extraordinary meetings will be arranged if necessary. When face to face meetings are not possible, they will be held using video conferencing technology. Meetings may, but are not required, to be open to the press and public. An agenda and papers will be prepared and circulated prior to each meeting. The agenda papers may, but are not required, to be published on the Council’s website. Elected members must declare any interests in accordance with the Code of Conduct. Other members should declare any conflicts of interest.

Quorum There must be at least one elected member at any meeting of the Board.

Review The terms of reference will be reviewed on a regular basis.

OFFICIAL

Page 1 of 2

Report to: Governing Body Date: 28 July 2020 Agenda item: 12.1

Title of report: Use of CCG Seal Sponsor: Dr Lesley Young-Murphy, Executive Director of Nursing & Chief Operating Officer Author: Irene Walker, Head of Governance, NT CCG Purpose of the report and action required: Governing Body is asked to ratify the use of the seal 2019/20. Executive summary: The CCG’s Standing Orders advises those persons authorised to authenticate the use of the CCG seal by their signature, i.e.

• the Accountable Officer • the Chair of the Governing Body • the Chief Finance Officer • senior managers duly authorised by the Accountable Officer

A separate Standard Operating Procedure describes the circumstances of when and how the seal may be used. The Standard Operating Procedure requires that the use of the seal is reported to Governing Body for ratification. The CCG is required to keep a register to record of all documents sealed. The seal was used on 3 occasions during 2019/2020:

i. Section 256 agreement ii. Better Care Fund agreement iii. Licence for Alterations (minor works)

Governing Body is asked to ratify the use of the official seal as detailed above for items i to iii.

OFFICIAL

Page 2 of 2




√

2. Meet the CCG’s statutory duties. √ 3. Work collaboratively with partners and stakeholders to

develop sustainable health and social care in North Tyneside and the wider Cumbria & North East system.

√


√

2. Consultation and engagement N/A

3. Resource implications

N/A 4. Risks

Unauthorised use of the CCG seal. 5. Equality assessment

N/A 6. Environment and sustainability assessment

N/A

Official

Report to: Governing Body - Public Date: 28 July 2020 Agenda item: 12.2

Title of report: Risk Assurance Framework (RAF) – Q1 2020/21 Sponsor: Dr Lesley Young-Murphy, Executive Director of Nursing & Chief Operating Officer Author: Irene Walker, Head of Governance Purpose of the report and action required: Governing Body is asked to:

1. Note that Audit Committee provides assurance to Governing Body that the RAF reflects the status of risks and that risks are being managed effectively;

2. Receive and review the Risk Assurance Framework (RAF) Q1 20/21, with a particular focus on those risks with a residual risk score of 15-25 (i.e. red);

3. Agree to close risk CV03 - Covid-19 poses a risk to staff health and CCG operations;

4. Note that Audit Committee questioned the residual risk score for risk 103 (Risk of commissioning services that are not of sufficiently high quality) – Governing Body is asked to discuss; and

5. Note that for risk 407 (Lack of operational resilience, or organisational capacity and infrastructure leading to failure to delivery against corporate objectives) Audit Committee had commented that details of the new senior officer structure was not detailed in the RAF. Governing Body has received a separate report on this.

Executive summary: The Governing Body has overall responsibility for governance, assurance and management of risk. The Governing Body has a duty to assure itself that the organisation has properly identified the risks it faces and that it has controls in place to mitigate those risks to a level consistent with the CCG’s risk appetite and that appropriate assurances are in place. It is standard procedure for the RAF to be reviewed by the responsible committees (i.e. Finance Committee, Quality & Safety Committee and Clinical Commissioning & Contracts Committee). Audit Committee then receives the RAF for review to enable it to provide assurance to Governing Body that risks are properly identified, assessed and effectively managed and that appropriate sources of assurance exist. The Chair of Audit Committee provides verbal assurance to Governing Body where the Audit Committee’s review takes place after the Governing Body papers have been issued.

Official The RAF which is aligned to the corporate objectives is attached at Annex 1. Appendix 1 below summarises risks not yet at their target risk score. Changes to the RAF since last reported to Governing Body are: Added None Deleted Risk 117: Inconsistency with the quality and timeliness of electronic discharge summaries (EDSs) to GP practices and community teams, leading to patient harm. The residual risk score is now at target and as a ‘corporate’ risk is now closed. Proposal to close risk CV03 – Covid 19 poses a risk to staff health and CCG operations (see recommendation 3).

Changes The following risks are at their target risk score and are now ’below the line’: Risk 109: Intermediate Care and older people’s services - level of system resilience, delayed discharges, and not realising their potential for rehabilitation Risk 407: Lack of operational resilience, or organisational capacity and infrastructure leading to failure to delivery against corporate objectives


2020/21corporate objectives Item links to objectives √


√

2. Meet the CCG’s statutory duties. √ 3. Work collaboratively with partners and stakeholders to

develop sustainable health and social care in North Tyneside and the wider Cumbria & North East system.

√


√

2. Consultation and engagement

The RAF is presented quarterly to Finance Committee, Quality & Safety Committee, Clinical Commissioning & Contracts Committee and Audit Committee for consideration ahead of submission to Governing Body (except when any of these committees is not scheduled or is stood down).

3. Resource implications

The management of risk is continuous and inherent within day to day management of business.

Official 4. Risks

The risk of not identifying and managing risk effectively is failure to deliver statutory requirements and the CCG’s corporate objectives. Risk 407 - Lack of operational resilience, or organisational capacity and infrastructure leading to failure to delivery against corporate objectives.

5. Equality assessment Consideration of equalities issues is inherent as part of the CCG assessing its risks.

6. Environment and sustainability assessment Consideration of environmental issues is inherent as part of the CCG assessing

its risks.

Official Appendix 1

Risk Matrix Q1 20/21 Residual Risk Score Impact score Likelihood 1 2 3 4 5 Negligible Minor Moderate Major Catastrophic 5 Almost Certain

4 Likely 101

3 Possible

103 107 110 112 CV01

CV02

2 Unlikely 304

1 Rare CV03

Target Risk Score Impact score Likelihood 1 2 3 4 5 Negligible Minor Moderate Major Catastrophic 5 Almost Certain

4 Likely

3 Possible

2 Unlikely

101 103 107 112

CV02

1 Rare

110 304 CV01 CV03

North Tyneside CCG Risk Assurance Framework

1

Date Last Updated/Reviewed

10/7/2020

Version V3-0 Quarter/Year Q1 2020/2021 Committee/Date Governing Body 28 July 2020

Date

entered

Risk Ref

Responsible Director/Risk

owner Strategic S C

orporate C

Risk Description

Consequence

Likelihood

Initial Score

Controls Detail Gaps in Controls Assurance 1 2 3 Gaps in Assurance

Actions (and date of entry or

target date)

Consequence

Likelihood

Residual Score

Consequence

Likelihood

Target Risk Score

Review Date

Corporate

Objective

Section One – Covid-19 Risks

29/4/2020 CV01

Executive Director of

Nursing and Chief operating

Officer

C

Response to COVID 19 impacts on system’s ability to deliver healthcare to meet the needs of the population

4 4 16

Preparations for recovery planning underway (entry 29/4/2020) ICP Group has been established, chaired by a FT Chief Executive, with representatives from all of the partners, to prepare phases for recovery. Commissioned time limited additional 30 beds in response to Covid (entry 29/4/20). Beds reduced to 15 and will end on 30th June 2020. Plans in place to respond to increase in surge with independent sector (entry June 19). Future Care Programme Board met 28/5/2020 and all of the organisations presented their Covid lessons and proposed next phase plans for next 6, 12, 18 months. Future Care Programme Board to have oversight of ‘Place’ based recovery.

Recovery planning ICP Group to prepare phases for recovery Action/s required to Increase the public’s confidence to access healthcare (based on clinical need) ICP planning meetings to ensure coherence across ICP representation from all organisations chaired by John Lawlor (entry June 2020)

4 3 12 4 1 4 Daily -

29/4/20 CV02



Officer

C

Failure to support NHS & social care system to deliver appropriate care to the residents of North Tyneside throughout the Covid-19 pandemic

5 4 20

SRO appointed COVID 19 generic in box set up Incident team established Incident room set up. Major Incident & Business Continuity Management Plan reviewed. Staff briefings (6/3/20, 11/3/20, 13/3/20, and 17/3/2020) and continuing virtually. Staff briefing distributed 17/3/2020 S Drive folders established Logging system established to log, distribute and monitor the clearance of COVID actions/decisions. SITREPS returned on demand Daily briefings to GP Practices

Number of outstanding actions on the Covid-19 Incident Log National Command and Control in place Reports from NuTH, NHCFT and Primary Care on capacity in the system to meet demand ONS reports of number of deaths Reports of community discharges back to the community Reports from work with LA and Public Health England (PHE) monitoring the number of outbreaks and deaths in nursing homes Reporting from nursing homes indicate PPE flow is being managed (entry June 2020)

Ongoing monitoring Set up a joint Covid BCF section with the local authority (in progress 23/6/2020) Report to Council of Practices (July 2020) A system response in relation to actions required to prevent nosocomial Covid 19 infections (entry June 2020).

5 3 15 5 2 10 Daily -


2

Date entered

Risk Ref


owner Strategic S C

orporate C

Risk Description

Consequence

Likelihood

Initial Score



target date)

Consequence

Likelihood

Residual Score

Consequence

Likelihood

Target Risk Score

Review Date

Corporate

Objective

System SIREP reports which detail overall bed occupancy including Covid specific related activity CCG is part of national ICS/ICP command and control system Direct support of the CCG, LA and wider provider services to care homes National delivery pipeline of PPE CCG has small amount of PPE supplies and can respond to urgent need whilst waiting for delivery of PPE Monitoring capacity within the system to handle Covid-19 Monitoring number of deaths Monitoring number of discharges Monitoring the number of outbreaks and deaths in nursing homes CHC Team working with LA and hospital discharge team, to track all discharges. (This will identify care packages and help to mitigate risk, post Covid) Established mechanism to monitor Covid specific spend OD plan sets out details of what is being done to manage risk at operational level (entry June 2020) Report to Board and Q&S (June 2020) Comprehensive PPE training across health and care home settings (entry June 2020).

29/5/20 CV03



Officer

C

Covid-19 poses a risk to staff health and CCG operations

4 4 20

CCG compliant with Government guidance from declaration of level 4 incidence January 2020. Implementation of Government Guidance dated 11/5/2020 titled ‘Working Safely during Covid-19 in offices and contact centre’ In response to this guidance the premises at Hedley court have been risk assessed and Government recommendations implemented, e.g. ensuring premises allow social distancing measures, provision of adequate hand washing facilities; ensuring staff work from home unless it is essential for them to work in the office.

Number of staff contracting Covid-19 (caveated that staff may contract this outside of the work environment) Evidence of implementation of Government guidance 11/5/20 % of staff that have completed an agile self-assessment Audit of premises by CCG

Audit of premises by NECS Health & Safety

Audit of premises by NECS Health & Safety scheduled for 29/6/2020

4 1 4 4 1 4 Daily N/A


3

Date entered

Risk Ref


owner Strategic S C

orporate C

Risk Description

Consequence

Likelihood

Initial Score



target date)

Consequence

Likelihood

Residual Score

Consequence

Likelihood

Target Risk Score

Review Date

Corporate

Objective

All staff have completed ‘agile’ (home-working) self-assessments for discussion and agreement with their line managers. BAME assessments completed. Instructions to all staff not to enter CCG premises without their line manager’s permission. Continued vigilance by CCG staff. Return to work in CCG premises completed (for those staff working in CCG premises). Completed the implementation of Government Guidance dated 11/5/2020 titled ‘Working Safely during Covid-19 in offices and contact centre’

Section Two – Corporate & Strategic Risks not at Target Risk Score

02/05/13 101

Chief Finance Officer/ Performance & Commissioning Manager

S

Risk of failure to clearly demonstrate compliance with NHS Constitution rights and pledges

4 4 16

CCG Constitution reflects NHS Constitution

Regular provider performance management meetings

Regular performance reports to Governing Body Monthly performance reports to Clinical Commissioning & Contracts Committee to align performance issues with contracting discussion Annual report of year-end performance against Improvement & Assessment Framework System approach (ICP/ICS) to address 62 day wait Internal CCG group established in Sept 19 to examine Referral to Treatment (RTT) Focused Task Groups on RTT; A&E Waits and Cancer 62 Days Detailed action plan with timescales & trajectories from NHCFT iro 62 day wait and RTT).

Notes of Provider performance management meetings Minutes of Governing Body Minutes of Clinical Commissioning & Contracts Committee CCG Annual Report and Annual Public Meeting Chief Executive from NuTH attended Governing Body November 19 NHCFT now achieving 62 day wait (entry December 19) NTC 05 2019-20 Contract & Performance Monitoring – Substantial

During Covid-19 pandemic, the CHOICE agenda is suspended.

NOTE: This risk is Impacted by Covid-19 ICP is planning recovery for elective capacity and cancer issues. Also see risk CV01. Awaiting planning guidance from NHSE/I (16/6/20)

4 4 16 4 2 8 30/9/20 1


4

Date entered

Risk Ref


owner Strategic S C

orporate C

Risk Description

Consequence

Likelihood

Initial Score



target date)

Consequence

Likelihood

Residual Score

Consequence

Likelihood

Target Risk Score

Review Date

Corporate

Objective

20/05/13

103


Nursing & Chief Operating

Officer/ Deputy Director of

Nursing, Quality & Safety

S

Risk of commissioning services that are not of sufficiently high quality

4 4 16

Standard NHS Contracts in place with NHS Providers - joint contract with local authority for domiciliary services & nursing homes Regular provider performance management meetings CCG is an active member of the Quality Review Groups (QRG) Specific quality issues are actively performance managed (e.g. ambulance handover delays) and reported to QRG and CCG Quality and Safety Committee, escalated as appropriate Regular quality reports to Quality and Safety Committee and to Governing Body Quality issues in Nursing Homes and other CHC care settings are actively monitored and reported to Quality and Safety Committee CCG sign off annual FT Quality Accounts Working in partnership with Local Authority to monitor and improve quality of care in Nursing Homes through joint assurance visits Working in partnership with Local Authority to monitor and improve quality of services to people with learning disabilities, including implementing the national programme of work on 'transforming services' Structured approach to capturing and acting on soft intelligence e.g. patient forum (minutes and reported to Governing Body); SIRMS (information collated and reported to Q&S committee); Practice nurse forum (notes); feedback from complaints and MP letters

Programme of commissioner assurance visits to all providers in place Tynehealth ‘ Extended Access’ Action Plan complete (June 19) Two Contract Penalty Notices issued re Urgent Care Treatment Centre (September 19) Action Plan agreed with Tynehealth & implementation is subject to ongoing monitoring via monthly contract meetings. (October 19)

Notes of contract monitoring meetings

Notes of Quality Review Groups, received by Quality and Safety Committee

Minutes of Quality and Safety Committee and Governing Body

FT Quality Accounts are published and include CCG comments

CQC inspection reports

Serious Incident (SI) review panels Internal Audit of Serious Incidents NT1617/03 substantial assurance (August 2016) Internal Audit NTC 1718 05 Delivery of Falls Strategy - Substantial assurance NTC 011 2019/20 Quality of Commissioned Services - Substantial New arrangements for Care Point agreed by Clinical Commissioning and Contracts Committee until the commencement of the new Integrated Fragility Service in April 2021 (entry June 2020)

CAMHS Action Plan developed which will be monitored through the formal contract meeting between the CCG and NHCFT. Monthly updates required. Letter sent to NHCFT on 13/12/19 requiring confirmation at the January 2020 contract meeting that the Trust’s trajectories are on track, otherwise a Contract Performance Notice (CPN) will be issued. Entry Dec 2019. Action – Outcome of contact meeting - evidence required (entry June 2020). Urgent Treatment Centre Two Contract Performance Notices (CPNs) 8 October 2019 in relation to lack of electronic clinical recording system and on 17th September 2019 in relation to performance issues. Remedial Action Plans developed for each CPN with timescales and targets. Requirement that performance data meets KPIs for 3 consecutive months before 1st CPN is lifted. Trust expected to have electronic clinical recording system in place by end of Jan 2020. NOTE: This risk is Impacted by Covid-19 The Trust has progressed implementation of an electronic clinical recording system prior to COVID-19 but had not fully implemented it prior to the COVID-19 pandemic. Meetings are being re-established from July 2020 to pick up this work again. (Entry June 2020)

4 3 12 4 2 8 30/9/20 1


5

Date entered

Risk Ref


owner Strategic S C

orporate C

Risk Description

Consequence

Likelihood

Initial Score



target date)

Consequence

Likelihood

Residual Score

Consequence

Likelihood

Target Risk Score

Review Date

Corporate

Objective

21/05/13

107



Officer/ Head of Safeguarding:

Designated Nurse

Safeguarding Children/Deputy

Director of Nursing, Quality

& Safety

S

Risk of adult or child safeguarding incident or other significant quality failure incident

4 4 16

Adult Safeguarding Board and Local Children Safeguarding Boards in place; CCG an active member

Regular performance reports to the CCG from NHS Providers to confirm and evidence that they have robust safeguarding arrangements in place Expertise of designated health professionals and named GP

Child and Adult Safeguarding Policies in place (revised 2018); CCG staff up to date with Safeguarding training

Governing Body provided with Prevent and Safeguarding training

Serious Incident Management system in place, compliant with NHS England framework

Quality and Safety Committee receive regular reports on serious incidents and safeguarding issues)

Governing Body receive regular reports on safeguarding issues Working with partners (statutory agencies) to identify further risks as a result of Covid-19 (entry 5/5/20). Report to Quality & Safety Committee 3/6/20.

Minutes of Adult & children Safeguarding Board; Minutes of LSCB

Designated Professionals Job Descriptions and work plans

Policies in place, on the CCG website and reviewed as appropriate CCG annual report and Governing Body records

SI policy documents and notes of SI closedown panels

Verbal report to Governing Body

Bi-Monthly report to Quality and Safety Committee

Internal Audit of Serious Incidents NT1617/03 substantial assurance (August 2016)

Internal Audit review of Safeguarding 2018-19 08 resulted in substantial assurance (September 2018)

Currently a national increase in reported domestic violence but no significant reported increase in North Tyneside as yet. (entry June 2020). Continued monitoring.

4 3 12 4 2 8 30/9/20 1

04/08/16

110

Director of Contracting &

Commissioning/ Commissioning

Manager

C

Risk that delayed ambulance handovers impacts negatively on patient safety and patient flow

4 5 20

Regular director level meetings with NHCFT and NEAS Local A&E Delivery Board overseeing response to ECIST report CCG working collaboratively with Northumberland CCG to reduce walk in activity at NSECH to increase capacity for ambulance conveyed patients. Sitreps from whole system during ‘winter’. CCG has regular meetings with ECIST and NHCFT Access to ambulance flight deck Winter surge – daily updates CCG Chief Officer has written out to two trusts in September 19 advising of the requirement to comply with the regional divert policy. New regional ambulances divert policy relating to handover delays in place

Regular reports to Quality & Safety Committee Daily sitreps from NEAS (1) NTC 1718/06: Performance Management and Reporting – Substantial Monthly monitoring and assurance reports from Operational and Strategic LADB meetings NHCFT/LADB Chair (Sir James Mackey) attended Governing Body 21st May 2019

Assurance on the effectiveness of the new regional ambulance divert policy relating to handover delays NHCFT internal flow issues

LADB and network to review handover policy and results will be reported back to CCG. Work continues between Trusts (updated June 2020) NOTE: This risk is Impacted by Covid-19 4 3 12 4 1 4 30/9/20 1


6

Date entered

Risk Ref


owner Strategic S C

orporate C

Risk Description

Consequence

Likelihood

Initial Score



target date)

Consequence

Likelihood

Residual Score

Consequence

Likelihood

Target Risk Score

Review Date

Corporate

Objective

(November 19). NEAS redirecting to most appropriate site as agreed at meeting November 2019 Daily updates on delays and diverts from NHSE/I Daily updates fed up to director level meetings and NHSE Local LADB winter plan 2019 in place (entry December 2019) Collaborative working between NHCFT, NuTH and NEAS to assess ambulance flows. Outputs reported to the North ICP LADB meeting (entry 16/6/20)

18/12/17 112

Executive Director of Nursing and Chief operating Officer/ Deputy Director of Nursing, Quality & Patient Safety

S

Nursing homes are rated inadequate by CQC and/or are in organisational safeguarding, resulting in reduced availability of beds in nursing homes to meet demand

4 5 20

Action plans following CQC Inspections 15 Steps review (snapshot on homes) Scheduled quality monitoring visits with LA CCG unannounced visits with LA to monitor implementation of CQC action plans CCG is part of organisational safeguarding meetings (led by LA) Joint forum meetings with providers (& LA) CCG & LA meet CQC to share intelligence Nursing home forum Alignment of GP Practices with care homes Existing quality monitoring meetings between Care homes, LA and CCG in place and continue Joint contract with LA which includes quality standards

15 Steps reports Reports from monitoring visits Quality & Safety Committee papers Minutes of meetings At the beginning of 2018 there were: 3 nursing homes rated inadequate 6 nursing homes rated as requires improvement 5 nursing homes rated as good. (As at 15/10/19 there are: 2 nursing homes that require improvement ( when the next draft report is published we will only have 1 that requires improvement)

Proactive monitoring through Quality & Safety Committee. Review March 2020. (Entry dated 15/10/19) NOTE: This risk is Impacted by Covid-19 Quality monitoring continues and we have an enhanced offer to care homes to support them during Covid (entry June 2020) 4 3 12 4 2 8 30/9/20 1

12/09/14 304



Officer/ Primary Care

Development Manager

C

Risk of not being able to implement New Models of Care to meet the needs of the population

4 4 16

Future Care Programme Board (Multi Agency)

Primary Care Committee (PCC) with oversight for Primary Care delivery

Dedicated resource in CCG to develop and lead

SDiPS agreements as part of contracts

New revised model requires testing to ensure delivery of logic outcomes

Patient Forum involved in design of New Models of Care, informing its development and enhancing understanding of and commitment to

Council of Practices briefed and involved; this discussion minuted

Future Care Programme Board Terms of Reference &

Impacted by Covid-19

4 2 8 4 1 4

30/9/20 3


7

Date entered

Risk Ref


owner Strategic S C

orporate C

Risk Description

Consequence

Likelihood

Initial Score



target date)

Consequence

Likelihood

Residual Score

Consequence

Likelihood

Target Risk Score

Review Date

Corporate

Objective

Escalation process to Future Care Executive

4 x Primary Care Networks approved by Primary Care Committee 6/6/19 Action Plan in place with multi agency leads (Oct 19 19) Scope for Integrated Frailty Service agreed with Future Care Executive (October 19) The CCG has worked with partners to coproduce reconfigured service delivery of care plus, care point, Jubilee Day and frailty services and intermediate care beds as part of system for implementation 2020/21 (Oct 19) Multi Agency Executive is place to oversee project.(Entry Dec 19) Multi Agency Project Team in place. (Entry Dec 19) Co-production event 22/1/20 and February 2020. Integrated Fragility Executive meeting 22/6/2020 in order to progress procurement.

Minutes

Future Care Executive minutes & notes

Section 3: Risks which currently meet their target score are listed below

20/05/13

102





S

Risk of inadequate procedures for Health Care Acquired Infection (HCAI) resulting in a patients contracting an avoidable infection which could prove fatal

4 4 16

NTCCG is an active member of the formal control of infection partnership, covering Gateshead and North of the Tyne

HCAI is a standard item on the work plan for Quality Review Groups

Robust arrangements evidenced in FTs including FT Infection Protection and Prevention Control meetings and HCAI Action Plans

CCG HCAI action plan in place, and reported to Quality and Safety Committee, refreshed as required

HCAI regularly reported to CCG Quality and Safety Committee, escalated to Governing Body as required

Overarching action plan in place for e-coli and gram negative blood stream infection (GNBSI) management

E-coli trajectory is developed centrally and presented annually

Public Health England (PHE) status

Agenda and notes of the Control of Infection Partnership

Agenda and notes of Quality Review Groups

Agenda and notes of CCG Quality and Safety Committee and Governing Body

Quality of Commissioned Services NTC 1718 (04) substantial assurance

PHE status update on homes & residential settings in relation to HCAI

NTCCG HCAI action plan

NTCCG GNBSI action plan Quarterly performance reports received from NHSE

Regional and local work continues to reduce the GNBSI infections (entry 5/5/2020).

This is impacted by Covid 19 (see CV02).

4 3 12 4 3 12 30/9/20 1


8

Date entered

Risk Ref


owner Strategic S C

orporate C

Risk Description

Consequence

Likelihood

Initial Score



target date)

Consequence

Likelihood

Residual Score

Consequence

Likelihood

Target Risk Score

Review Date

Corporate

Objective

update on homes & residential settings in relation to HCAI as required

Report from the Deputy Director of Nursing, Quality & Patient Safety 5/5/2020 The CCG had 49 episodes of Clostridium Difficile against an annual threshold of no more than 43 cases for 2019/20. The majority of cases reported are Community Onset Healthcare Associated (COHA) rather than Hospital Onset Healthcare Associated (HOHA) infections. C-Diff cases have been updated to show the change in reporting for the CCG which is now to include all figures, we have split these into Hospital Onset and Community Onset however the CCG figure is the addition of them all. NTCCG had no MRSA attributed infection during 2019/20

19/11/15

106





S

Risk of inadequate implementation of Liberty Protection Safeguards criteria leading to the required Court Orders not being in place as required

3 4 12

CCG employs professional staff with knowledge of DoL regulations and developing DoL case law CCG staff aware of patient group who are the responsibility of the CCG who may require a DoL assessment Process for checking which patients have had or who need a DoL assessment and who have or who need a court of protection order (including Orders that have expired or are about to expire) Process in place to ensure relevant court applications are made The financial impact on the CCG (e.g. the cost of the Court application and associated legal fees) is being monitored CCG staff has a list of CHC patients living at home within CHC IT Broadcare System Patients who require DoLs identified by case managers Medical Director has sent out guidance to GP Practices relating to DOLS sign off Reports to Quality and Safety Committee Monitor compliance within community assessments and performance manage LA Impact of the Liberty Protection

Local action plans (1) DoLs Assessments included in new CHC specification with Local Authority (1) Minutes of Safeguarding Committee Minutes of Quality and Safety Committee Status reports from Hempsons

Implementation of liberty protection plans (circa 2020)

3 3 9 3 3 9 30/9/20 1


9

Date entered

Risk Ref


owner Strategic S C

orporate C

Risk Description

Consequence

Likelihood

Initial Score



target date)

Consequence

Likelihood

Residual Score

Consequence

Likelihood

Target Risk Score

Review Date

Corporate

Objective

Safeguards proposal relating to DoLs reported to Quality & Safety Committee (Dec 18) Monitoring of liberty protection implementation plans (due 2020) All clinical team have had training i.r.o MCA DOLS and wider legislation (Nov 19)

04/08/16 109



Officer

S

Intermediate Care and older people’s services - level of system resilience, delayed discharges, and not realising their potential for rehabilitation

4 4 16

Consistent monitoring of bed use at Royal Quays and Howden (entry Dec 19). Under occupancy regularly reported.

Phase 2 Contract meetings minutes Operations meetings minutes Under occupancy provides assurance

NOTE: This risk is Impacted by Covid-19 – see risk CV01

4 2 8 4 2 8 30/9/20 1

14/07/17 111

Executive Director of Nursing and Chief Operating Officer

S

CCG IT systems at risk of cyber-attack, jeopardising day to day operations and impacting on service delivery and patient safety

4 4 16

Business Continuity Plan v4.1 approved by Quality & Safety Committee 25/9/18 Business Impact Assessment (BIA) undertaken for IT date 24/4/17 Monitoring by IM&T Sub Committee NECS IT Contingency Plan (as per BIA) NECS IT Disaster Recovery Plan (as per BIA) Anti-virus software in place to protect against malware/virus infection (assurance received via NECS) NECS proactive emergency upgrade of the core network equipment at the datacentre on Sunday 28th January 2018 Ongoing work with fire walls (added 15/1/19) NECS will close down system to protect it should a Malware threat be a strategic concern (added 15/1/19) Old stock of lap tops held by NECS have now been used. Any new ad hoc replacement of lap tops will be Windows 10 compliant. Update 25/2/19

S:\Corporate\Organisation\Emergency & Business Continuity Planning\- Business Continuity Management\IT Disaster Recovery Plan for North of England CCGs March 2019.pdf Business Continuity Plan v4.2 approved by Governing Body 23/7/19

The NECS Deputy Head of IT / Compliance has clarified that NHS organisations are unable to achieve full compliance to Cyber Essentials accreditation primarily because of the nationally procured systems such as Oracle and ESR (electronic staff record). This is due to the fact they do not operate on the latest versions of software e.g. Java.

Service Auditor Reports Monitoring of Business Continuity Planning incidents, responses and lessons learned by Quality & Safety Committee

NECS IT Director attended Audit Committee on 17/11/17 to provide update on system assurance

Assurance received from NHCFT dated 14/2/18

Assurance received from NEAS dated 20/4/18 “…. We do have a number of written policies and ‘technological’ policies/solutions in situ that mitigate and reduce the risks but it’s a constant and ever changing landscape.…. One good piece of assurance we could provide – did we get affected by WannaCry – No.” “…. In June 2017 Northumbria Trust Board commissioned an external agency to provide assurance and make specific recommendations that the organisation needed to undertake to minimise future impact of future Cyber Incidents. The Trust Board have committed significant resource and funding to improve rapidly our position.” S:\Corporate\Organisation\Emergency & Business Continuity

4 2 8 4 2 8 30/9/20 1


10

Date entered

Risk Ref


owner Strategic S C

orporate C

Risk Description

Consequence

Likelihood

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target date)

Consequence

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Consequence

Likelihood

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Objective

Planning\- Business Continuity Management\CCG Cyber Security Assurance - N Tyneside CCG May 2019.xlsx Assurance - change to Windows 10 by January 2020 NHCFT 4.2.18 Assurance from NTW 19/6/19

5/12/18 117

Executive Director of Nursing and Chief operating Officer

C

Inconsistency with the quality and timeliness of electronic discharge summaries (EDSs) to GP practices and community teams, leading to patient harm

4 4 16

IM & T agreed actions (Dec 2018) EDS is part of an NHS contract and is monitored in contract performance meeting Executive Director of Nursing & Chief Operating Officer/Deputy Director of Nursing, Quality & Patient Safety has reported concerns re EDS to the Quality and Safety Committee and Primary Care Quality Group Monitored by IM&T Sub Committee Status of ED Summaries reviewed quarterly as part of SIRMS reporting. Entry Dec 19

Process is variable due to non-standardised approach across Trusts and national interface with system providers Improvement required in how medication appears in Electronic Discharge Summaries

Minutes from Contract meetings Minutes from Quality & Safety Committee Minutes from Primary Care Quality Group Minutes from IM&T

Assurance from NHCFT Assurance from NTW (inpatient discharges) Audit with Practice Managers identified no further issues or discrepancies between EDS and the formal letter (As reported to IM&T October 19) Assurance from NuTFT

Assurance from the Northern ICP Task Group Assurance from CCG Contract Meetings

Director of Contracting and Commissioning to seek assurance via contract monitoring meetings of CNTW compliance with contract requirements in relation to EDS (community discharges are embedded) target date August 2019. Ongoing assurance will be sought through contract meetings.

4 1 4 4 1 4 Closed N/A 1

03/07/17 206

Chief Finance Officer/Deputy Chief Finance Officer

S

Fraud undermines the financial position/reputation of the CCG

3 3 9

Overall financial control environment including: specific system controls; budgetary control system; internal audit; counter fraud services; external audit review of financial statements; and CCG policies as outlined below: • HR07:Disciplinary Policy • HR35: Whistleblowing policy • CO06:Anti-Fraud Policy • CO13:Procurement Policy • CO19:Standards of Business

Conduct Fraud risk management tool used by Counter Fraud (notified 26.10.18) On 29 April 2019, the Counter Fraud Service successfully submitted the CCG’s counter fraud self-review tool (SRT) for 2018/19 to the NHS Counter Fraud Authority (NHSCFA). This self-review was approved by the CFO and audit committee chair prior to submission. The Standards of Business Conduct

Improvements arising from review by NHS Counter Fraud Authority of compliance against NHS Protect standards for commissioners 2017/18 (Fraud, Bribery and Corruption)

Counter fraud updates and annual report

External audit opinion

CCG Policies

Budget reports

Reconciliations

Review by NHS Counter Fraud Authority of compliance against NHS Protect standards for commissioners 2017/18 (Fraud, Bribery and Corruption) - overall green rating for its work in Strategic Governance and an overall amber rating for work in Inform and Involve NTC 2019-20/06: Financial and Strategic Planning - Substantial

3 1 3 3 1 3 30/9/20 2


11

Date entered

Risk Ref


owner Strategic S C

orporate C

Risk Description

Consequence

Likelihood

Initial Score



target date)

Consequence

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Consequence

Likelihood

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Corporate

Objective

and Declarations of Interest Policy v5.1 approved November 2019 took into account the tackling fraud bribery and corruption economic crime strategy 2018-2021.

1/4/19 207

Chief Finance Officer/Director of Contracts & Commissioning

S

Failure to deliver control total and to financially support services effectively because of: activity over performance; failure to make efficiency savings; and/or other factors

4 3 12

Contract management meetings with variances against planned contract activity scrutinised forecast outturn summaries updated

Finance Committee to oversee investigation into priority areas

Detailed finance and contract report and quality and performance report presented to Clinical Commissioning and Contracts Committee, Finance Committee and Governing Body to enable triangulation of information

Medicines Optimisation Services purchased from NECS - Medicines Optimisation Sub Committee in place

Robust CHC assessment processes in place, benchmarked against other CCGs nationally, robust CHC decision making processes and budget forecasts

Referral Management System (now Rapid Specialist Opinion (RSO) in place

Provision of suitable financial reserves in the plan.

PMO assurance of QIPP Projects Monthly Financial Monitoring by NHSE Refreshed financial strategy 19/20 to 23/24 ICP Finance Directors’ Group managing risk across ICP Agreement of blended tariff for non-elective work with NHCFT and NuHT National guidance for BCF contract from April 19 received (entry Oct 19) BCF contract 2019/2020 & 2020/2021 agreed by Health & Wellbeing Board and received by CCG Governing Body October 2019. BCF Plan has been submitted to national team (entry Oct 19)

Notes of contract management meetings and 14 Day reviews and actions arising from those Minutes of Finance Committee, including deep dives Finance and contract reports and quality and performance reports to Clinical Commissioning and Contracts Committee, Finance Committee and Governing Body with exceptions highlighted and actions reported Minutes of Medicines Optimisation Committee, medicine optimisation SLA with NECS and medicine optimisation QIPP schemes & QIPP Tracker to 4Cs CHC assessment processes and reports to Clinical Commissioning and Contracts Committee and Finance Committee NTC 2018-19 (07) – CHC – Substantial (3) NTC 2019-20/06: Financial and Strategic Planning – Substantial NTC 05 2019-20 Audit of Contract & Performance Monitoring – Substantial NTC 2019-20 Audit of Key Financial Controls & QIPP 2019/20 Substantial Assurance

2020/21 operational planning process has been suspended. Interim financial arrangements are in place. CCG expects to be able to deliver what is required. Entry 5/5/2020 New planning guidance is expected from NHSE/I in June/July 2020.

4 2 8 4 2 8 30/9/20 2

16/11/15

305

Chief Officer/ Head of

Governance S

Risk of insufficient clinical input into the work of the

3 4 12

CCG Committee membership includes Clinicians - Council of Practices, Quality and Safety Committee, Clinical Commissioning and Contracts

Governing Body and Committee Terms of Reference, meeting papers and minutes

3 3 9 3 3 9 30/9/20 3


12

Date entered

Risk Ref


owner Strategic S C

orporate C

Risk Description

Consequence

Likelihood

Initial Score



target date)

Consequence

Likelihood

Residual Score

Consequence

Likelihood

Target Risk Score

Review Date

Corporate

Objective

CCG if clinical leaders and member practices CCG are not effectively engaged

Committee, Audit Committee, Finance Committee CCG Chair is a GP, supported by Medical Director (GP), 3 Clinical Directors (2 x GP Directors and 1 x Nurse Director) and a range of Clinical Leads CCG Governing Body members include an experienced executive nurse and secondary care specialist doctor Practice Managers are members of Quality and Safety Committee and the Clinical Commissioning and Contracts Committee CCG Constitution sets out matters reserved to Members, enacted through a structured programme of meetings of the Council of Practices Practice Nurse Forum facilitated by CCG Quality team Monthly newsletter to all practices highlighting commissioning issues Clinical Chair and Chief Officer programme of joint practice visits 4 x Primary Care Networks approved from 1/7/19 Living Well Locally in North Tyneside Board replaces Primary Care Home Board (entry 5/5/20) Extensive comms & engagement during Covid 19 (entry June 2020)

CCG Constitution and papers and minutes of the meetings of the Council of Practices CCG annual report Practice Nurse Forum notes Monthly newsletters Internal Audit review of Clinical Engagement 2014/15 NTC4806 provided Significant Assurance with one issue of note (issued Feb 2015). Issue of note has been addressed 360° Stakeholder Survey

07/05/13 401

Executive Director of Nursing and Chief Operating Officer/ Director of Contracting & Commissioning

S

Risk of the work of the CCG and its partners not improving the health of the population in line with statutory duties

4 3 12

Commissioning Plans informed by JSNA to ensure focus on health needs and health improvement Regular reports to Clinical Commissioning and Contracts Committee, and Governing Body on progress against health outcomes data set Regular Performance Reviews with the NHS England Area Team Joint working with CCG and Local Authority Public Health department, including Consultant Public Health (Medical) working within the CCG 2 days per week Progress on health improvement reported year-on-year in CCG Annual Report ICS funding allocations for specific

Commissioning Plans developed and published Regular integrated quality and performance reports to Clinical Executive and Governing Body; minutes of those meetings and results of 'deep dives' Notes of Quarterly Performance Reviews with the NHS England Area Team Public Health work plan CCG Annual Report against CCG health outcomes data set Internal Audit of Performance Management (NTC 1718/06) substantial assurance

4 2 8 4 2 8 30/9/20 4


13

Date entered

Risk Ref


owner Strategic S C

orporate C

Risk Description

Consequence

Likelihood

Initial Score



target date)

Consequence

Likelihood

Residual Score

Consequence

Likelihood

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Review Date

Corporate

Objective

services logged, including implications for long-term funding commitment and alignment to Long Term Plan. Entry Dec 19. Services being established with Public Health, using CCG funding, via Task & Finish Group. Will be monitored (when established) according to KPIs. Entry Dec 19. BCF Partnership Board agrees and monitors BCF Plan (Entry Dec 19).

20/05/13 402

Executive Director of Nursing & Chief Operating Officer/Head of Improvement & Development

S

Partners do not work together effectively to achieve outcome identified in ICS/ICP/Place plans

3 4 12

CCG an active partner in the North Tyneside Health and Wellbeing Board

CCG attends the Overview and Scrutiny Committee, as required, to present and discuss the work of the CCG

CCG has regular formal and informal meetings with North Tyneside Council, local NHS FTs, HealthWatch, local MPs

CCG complies with formal duty to consult

There are regular communication channels between CCG and Voluntary Sector Process designed for the development of Commissioning Intentions

Communications and engagement services from NECS to support the work of the CCG

BCF agreed for 17/18 & 18/19 Formal agreement with the Community Health Care Forum

Operational Plan 19/20 complete and available of CCG website

ICS application for NE&NC approved by NHSE May 19 Implementation of refreshed Comms & engagement strategy Action Plan (Oct 19)

Implementation of action plan from 3600 survey (Oct 19) North ICP working on common issues: urgent care; 62 day cancer wait; RTT; planning; Covid 19 (entry updated 1/5/2020) Joint Board Development Session held 25/2/20

Action plan for refreshed Comms & engagement strategy

Action plan from 3600 survey

North Tyneside Health and Wellbeing Board and Overview and Scrutiny Committee meeting papers and minutes

Minutes of Urgent Care Board

Minutes of Primary Care Committee

Communications and engagement strategy refreshed 2019

Operational Plan 19/20 signed off by Clinical Commissioning and Contracts Committee, Governing Body and Council of Practices, available on CCG website

Internal Audit NTC 17-18 03 Stakeholder Engagement – substantial assurance

3600 Survey results NTC 2019-20/06: Financial and Strategic Planning - Substantial

Executive team and operational team members to continue to present positive behaviours and ways of working.

3 2 6 3 2 6 30/9/20 4


14

Date entered

Risk Ref


owner Strategic S C

orporate C

Risk Description

Consequence

Likelihood

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target date)

Consequence

Likelihood

Residual Score

Consequence

Likelihood

Target Risk Score

Review Date

Corporate

Objective

13/08/14 403

Director of Contracting and Commissioning/Commissioning Manager/Head of Governance

S

Unable to respond effectively to surges in demand leading to a failure to respond effectively to local healthcare needs

4 4 16

CCG Major Incident & Business Continuity Management Plan in place CCG complies with Emergency Planning, Resilience and Response (EPRR) requirements under Civil Contingencies Act Reported results of 18/19 EPRR self-assessment to Governing Body (full compliance) LADB and urgent and emergency care network, CCGs and other relevant key stakeholders have meetings and systems in place to monitor capacity and ensure plans (including winter plans) are in place Clinical Commissioning and Contracts Committee, reviews capacity plans as necessary; plans also subject to review by partners and by NHS England System to monitor capacity and pressure in place Daily teleconference between Commissioners, Acute Providers and NEAS to manage pressures over winter period Regular reviews of CCG capacity and authority to make decisions in business continuity situation Winter planning arrangements in place and reported to Governing Body 26 November 2019 Providers required to notify CCGs if they escalate their OPEL status

CCG(s) request written report from when OPEL status escalated Addressed in contract meeting if provider OPEL status repeatedly escalated.

Local A&E Delivery Board minutes Clinical Commissioning and Contracts Committee, papers and minutes Winter plans including documented system to monitor capacity and pressure Notes of Daily teleconference over the winter period EPRR self-assessment 18//19 completed (full compliance) Governing Body and Clinical Commissioning and Contracts Committee receipt of plans Contract meeting minutes

LADB has started winter planning round (entry June 2020). Winter planning arrangements to be reported to Governing Body circa November 2020.

4 2 8 4 2 8 30/9/20 4

19/08/14 404

Chief Officer/Head of Governance

S

Risk of a lack of confidence in the CCG as a result of reputational damage, inhibiting the CCG’s role as a system leader

4 4 16

Standards of Business Conduct policy in place, with clear conflict of Interest management arrangements in line with current guidance and good practice Robust contracting and procurement process in place CCG has access to legal advice Robust consultation and engagement processes

Standards of Business Conduct policy, quarterly review of conflict of interest declarations PMO arrangements identified as best practice Minutes of Governing Body where procurement decisions made and recorded Governing Body Meetings held in public, with papers posted in

4 2 8 4 2 8 30/9/20 4


15

Date entered

Risk Ref


owner Strategic S C

orporate C

Risk Description

Consequence

Likelihood

Initial Score



target date)

Consequence

Likelihood

Residual Score

Consequence

Likelihood

Target Risk Score

Review Date

Corporate

Objective

Partnership working ICP/ICS Constitution v16 approved by Council of Practices November 2019 Constitution v16 approved by NHSE 13/5/2020

advance of the meeting CCG Annual Reports and Annual Governance Statements published for 18/19 3600 Survey Results 18/19 NTC 19/20 (04) Primary Medical Care Commissioning – substantial assurance

16/11/15

405

Chief Officer/ Executive Director of Nursing and Chief Operating Officer

S

Risk of the CCG lacking capacity to provide system wide leadership

4 4 16

Governing Body members maintain both an external and internal focus, working with key stakeholders and partners CCG directors and senior managers participate in region wide groups and fora CCG chairs and leads meetings, acting as system wide leader ICS application for North East and North Cumbria made to NHSE May 2019 (approved)

Minutes of Health and Wellbeing Board, CCG Accountable Officers and Chairs meeting, Primary Care Commissioning Committee, Integration Board Terms of Reference, papers and minutes of Professional meetings e.g. health care acquired infection partnership Terms of reference for Urgent Care working group, practice nurse forum, QRGs, Medicines Optimisation Northern CCG Committee for the Cumbria & North East established & approved by Governing Body 28/11/17 ICS application for North East and North Cumbria approved by NHSE May 2019

4 2 8 4 2 8 30/9/20 4

06/06/17 406

Executive Director of Nursing and Chief operating Officer/ Commissioning and Performance Manager

S

Undermined capacity in Primary Care and system support for new ways of working challenges the delivery of sustainable Primary Care Services

4 3 12

Tripartite Primary Care Strategy developed and agreed by CCG GP Federation and LMC Monitoring of progress again Tripartite Primary Care Strategy by Primary Care Committee Council of Practices

CCG has a Chair, Medical Director and 2 Clinical Directors who are all Primary Care Practitioners Support from NHS England in the management of primary care issues

CCG working with NHSE (HENE) to mitigate system risks by collective workforce planning and recruitment

Appointment of 5 x GP Career Starts

Primary Care Strategy approved by Governing Body May 16 Primary Care Committee ToR and minutes to Governing Body NHS England approval of Level 3 submission Quarterly assurance meetings with NHS England Appointment of 5 x GP Career Starts Minutes of PCC approving PCNs NTC 19/20 (04) Primary Medical Care Commissioning

4 2 8 4 2 8 30/9/20 4


16

Date entered

Risk Ref


owner Strategic S C

orporate C

Risk Description

Consequence

Likelihood

Initial Score



target date)

Consequence

Likelihood

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Consequence

Likelihood

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Review Date

Corporate

Objective

Strategy in place to manage impact of changing landscape (Dec 18) Four Primary Care Networks approved from 1 July 19 Recurrent & Non-recurrent investment into GP Practices of £2.25m (£1.575m recurring / £0.675m non recurring in 18/19) Detailed strategy and operational plan developed (October 2019) 4 Primary Care Networks, developed in line with national requirements, established 1/7/19 Agreed extension of Extended Access contract with Tynehealth for a further year until April 2021 when it will transition to PCNs. Entry Dec 19.

– substantial assurance

28/9/18 407

Executive Director of Nursing & Chief Operating Officer/Head of Governance

S

Lack of operational resilience, or organisational capacity and infrastructure leading to failure to delivery against corporate objectives

4 4 16

Organisational Capacity & Capacity Rigorous recruitment process ensures the appointment of qualified and competent staff (entry 29/1/2020). Annual appraisal system identifies areas for improvement & development (entry 29/1/2020). Monitoring of staff turnover through quarterly HR reports to Q&S Committee (entry 29/1/2020). Remuneration Committee recommends remuneration for non AfC appointments taking into account complexity of role/s and benchmarking with North East CCGs (entry 29/1/2020). Deputy CFO and Deputy Director of Nursing, Quality & Patient Safety in post at North Tyneside CCG providing support for Executive Nurse role and CFO role (entry 29/1/2020). Operational Resilience Organisational Development Plan CCG Constitution in place, with Scheme of Delegation and clear governance structures Prime and Detailed Financial policies and budget monitoring Approved organisational polices (corporate, HR and IG) Service Level Agreement with

No identified deputy or succession planning for COO role (entry 29/1/2020). Role of Executive Director of Nursing & Chief Operating Officer covers: 3 functions Contingency plans in the event of long term absence are not assessed and documented (entry 29/1/2020).

Clear staff reporting arrangements; job descriptions, appraisal processes, objectives and work plans Staff statutory and mandatory training records & reports CCG Constitution is current and on CCG website; committee effectiveness and terms of reference regularly reviewed and reported in Annual Governance Statement NHS England assurance - rated ‘Outstanding’ for 18/19 NTC 2019-20 01 Governance Structure & Risk Management Arrangements - Substantial NTC 2019-20 (02) Conflicts of Interest – Substantial Benchmarking against neighbouring CCGs reported to Governing Body 23 July 2019. Updated benchmarking (February 2020) against neighbouring CCGs scheduled to report to Governing Body 19 May 2020 (now July 2020 due to Covid). Substantial assurance from Internal Audit for Data Security

4 2 8 4 2 8 30/9/20 4


17

Date entered

Risk Ref


owner Strategic S C

orporate C

Risk Description

Consequence

Likelihood

Initial Score



target date)

Consequence

Likelihood

Residual Score

Consequence

Likelihood

Target Risk Score

Review Date

Corporate

Objective

Commissioning Support Unit Risk and Assurance Framework Data Security & Protection toolkit Major Incident & Business Continuity Management Plan A new senior officer structure (which responds to strategic risk no. 407 has been approved. Implementation is in progress. (Entry June 2020)

& Protection Toolkit 2019/20

16/11/15

411

Director of Contracting &

Commissioning/ Planning &

Commissioning Manager

S

Risk that the CCG fails to focus on the needs of patients and fails to commission the right, cost effective services to meet those needs

3 4 12

Lay Member for Patient and Public Involvement in post Active Patient Forum, Chaired by Lay Member and facilitated by Community Healthcare Forum (CHCF), with programme of work and effective sub groups; Patient Forum reports to Governing Body and is attended by Executive Director of Nursing & Chief Operating Officer CCG planning predicated on Joint Strategic Needs Analysis, which documents the health needs of North Tyneside CCG population Active public and patient engagement in planning, commissioning and service review Council of Practices and Clinical Leaders bring direct experience of patient contact to CCG decision making Mechanisms in place for patients to contact the CCG formally and informally North Tyneside Health and Wellbeing Board priorities inform CCG plans HealthWatch input and feedback into CCG commissioning plans Quality Review Groups in place, joint with other CCGs, to support the delivery of high quality healthcare services Service planning and service redesign, including QIPP plans, based on clinical evidence Communication and Engagement group within Patient Forum which provides a direct link with Governing Body CCG member of Patient Forum Sub Groups as appropriate (entry 25/2/19)

Role of Lay Member for Patient and Public Involvement set out in CCG Constitution and evidenced in her work in the CCG Patient Forum work programme, meeting notes and reports to CCG Governing Body Communications and engagement strategy in place, supported by specific plans for identified work streams CCG operational plan and commissioning Plans prepared, approved by the Governing Body and Council of Practices and published Value Based Commissioning Policy on CCG website; Medical Director identified as CCG decision maker; reported at Clinical Commissioning & Contracts Committee Reports from public and patient engagement in major service reviews Committee reports and minutes show that Clinical Leaders - nurses and GPs - are involved in all aspects of CCG decision making CCG website shows a number of ways to contact the CCG including 'contact us' , complaints and compliments, opportunity to meet Governing Body members informally prior to meetings Minutes of Quality Review Groups and reports to Quality and Safety Committee

Next phase planning groups have been established to review and develop services post Covid (entry 16/6/20) Awaiting planning guidance from NHSE/I (entry 16/6/20)

3 3 9 3 3 9 30/9/20 4


18

Date entered

Risk Ref


owner Strategic S C

orporate C

Risk Description

Consequence

Likelihood

Initial Score



target date)

Consequence

Likelihood

Residual Score

Consequence

Likelihood

Target Risk Score

Review Date

Corporate

Objective

Procurement of ‘Hear my Voice’ software to ensure patient voice feeds into patient pathways Changed approach to service delivery e.g. virtual consultations during the Covid-19 pandemic Commissioned additional services in response to Covid-19 pandemic e.g. mental health services.

Internal Audit review of Mental Health Arrangements – S117 NTC 1718/02 substantial assurance NTC 1718 -14 Internal Audit review - Delivery of outsourced services substantial assurance NTC 18 19 09 Medicines Optimisation substantial assurance NTC 2019-20/06: Financial and Strategic Planning - Substantial

Heat Map

Risk Assurance Framework – Definition

Impact score Strategic Risk – is a risk that undermines the CCG’s ability to meet its statutory duties. These are defined as ‘strategic risks’ on the Risk Assurance Framework.

They will remain on the Risk Assurance Framework permanently to provide assurance the risks are effectively managed.

Likelihood 1 2 3 4 5

Negligible Minor Moderate Major Catastrophic Corporate refers to a risk that is transient in nature. These are identified as ‘corporate risks’ on the Risk Assurance Framework. Once a corporate risk is managed

to an acceptable level (and assurances are sufficient), the risk will be closed. An ‘acceptable level’ means when the residual risk score achieves the target risk score.

5 Almost Certain 5 10 15 20 25

Risk Assurance Framework is a document which consolidates the Corporate Risk Register (see corporate risks) and Assurance Framework (see strategic risks) into one document.

4 Likely 4 8 12 16 20

3 Possible 3 6 9 12 15

2 Unlikely 2 4 6 8 10

1 Rare 1 2 3 4 5

2020/21 Corporate Objectives

1. Quality& Safety Committee: Commission high quality care for patients, that is safe, value for money and in line with the NHS Constitution 2. Finance Committee: Meet the CCG’s statutory duties 3. Clinical Commissioning and Contracts Committee: Work collaboratively with partners and stakeholders to develop sustainable health and social care in North Tyneside and the wider Cumbria & North East

system 4. Clinical Commissioning and Contracts Committee: Continue to develop North Tyneside CCG as a patient focused, clinically led commissioning organisation with a continuous learning culture

Three lines of defence

1. The first line of defence – functions that own and manage risk (assurance from functions that own and manage risk) 2. The second line of defence – functions that oversee or specialise in risk management compliance (e.g. PMO, CCG financial and performance reporting, Governing Body, Audit Committee, external organisations

e.g. QRG, LSCB, A&E Board, Health and Wellbeing Board) 3. The third line of defence – functions that provide independent assurance (e.g. internal audit, external audit CQC, NHSE)

Source: Chartered Institute of Internal Auditors (brackets by CCG)

1

Northern CCG Joint Committee

Date of meeting: To be agreed via correspondence

Does paper need to be circulated before the agenda goes out (ie earlier than 10 working days prior to the meeting) (please circle): n/a

Title of report: Northern CCG Joint Committee – Terms of Reference

Purpose of report (brief description): The Committee’s Terms of Reference (ToR) have been amended to reflect changes to CCG structures effective from 1 April 2020 and these are attached. For ease of reference a copy of the ToR showing tracked changes is also attached. Members will recall discussion at the meeting of the Committee held on 12th March 2020 as to whether future voting arrangements would need to change (ie whether this should remain as unanimous and be one vote/one organisation or whether voting should be per capita to the size of the CCG population).There was general support that current voting arrangements should continue going forward – unanimous by one vote per organisation and therefore the section on voting in the ToR has not been changed. Recommendations: CCG Governing Bodies are now asked to approve the revised ToR for final ratification at the next meeting of the Committee on 9th July 2020. Is the paper for (please tick):

Decision-making Information Sharing Discussion

Actions required by Northern CCG Joint Committee: Sponsor: Jon Rush Report Author: Gillian Stanger Job Title: Business Support Manager, NECS Date: 6 May 2020

x

Official – Sensitive – Commercial

1 V3.0 Approved Northern CCG Joint Committee TOR

Northern CCG Joint Committee Terms of Reference

Version Date Comments 1.0 5.10.17 Considered at Joint CCG Committee for CNE meeting

2.0 12.10.17

4.1.18 3.5.18 5.7.18

Updates incorporated following Joint CCG Committee for CNE meeting on 5.10.17 as follows: Para.2 – Insertion re term of office: ‘The term of office will be two years’. Para.5 – Insertion of paragraph re lay members: ‘There will also be two (non-voting) lay members appointed to the Joint Committee, one of whom will be from a patient and public involvement perspective and the other from a finance and governance perspective. Where feasible, one lay member will be from the north of the patch and the other from the south of the patch’ Following the selection process on 5th January 2018, the ability to do this was not possible hence why this further addition has been made in red above. Para 15 – Insertion of sentence re decision making: ‘Decisions will be taken only by those CCGs to whom a particular issue applies’ Para 16 – amendment to paragraph re collective decisions to read: The collective decisions of the Joint Committee shall be binding on all member CCGs to whom a particular issue applies, and decisions will be published by individual CCG members on their websites. All decisions of the Joint Committee must be unanimous. Title of the Committee This has been amended to read consistently throughout as ‘Northern CCG Joint Committee’ At its meeting on 1 January 2018 (development session), the Joint Committee agreed - not to include financial limits for decision making in the terms of reference. - that the Vice-Chair would be selected from any appointed lay member Amended to note the correct title of NHS Hartlepool and Stockton-on-Tees CCG. Title of Committee confirmed as ‘Northern CCG Joint Committee’ At its meeting on 5 July 2018 the Joint Committee agreed that the Chair of the CCG Chief officer group would be invited to attend meetings of the Committee (both the public and private sessions) and would receive the papers. Terms of Reference approved.

3.0 4.7.19 7.11.19

Revised Terms of Reference agreed for submission to and approval by CCG Governing Bodies. Terms of Reference approved by Joint Committee.



TERMS OF REFERENCE

Northern CCG Joint Committee: membership and functions

1. Membership of the Northern CCG Joint Committee (hereafter referred to as ‘the Joint

Committee’) will be open to the eighttwelve undermentioned clinical commissioning groups :

• NHS Darlington CCG • NHS Durham Dales, Easington & Sedgefield CCG • NHS Hambleton, Richmondshire & Whitby CCG • NHS Hartlepool and Stockton-on-Tees CCG • NHS County Durham CCG • NHS Newcastle Gateshead CCG • NHS North Cumbria CCG • NHS North Durham CCG • NHS Northumberland CCG • NHS North Tyneside CCG • NHS South Tees CCG • NHS South Tyneside CCG • NHS Sunderland CCG • NHS Tees Valley CCG

2. Voting membership of the joint committee will comprise the Chair and Chief Officer from each member CCG, or a nominated deputy.

2.3. Where there is an issue requiring a decision to be made which will affect what was formerly NHS Hambleton, Richmondshire and Whitby CCG, NHS North Yorkshire CCG will be invited to attend meetings as an Associate Member of the Joint Committee with full voting rights in relation to the relevant issue.

3.4. The Chair and Vice Chair of this Joint Committee will be elected by the members of the Joint Committee, and must come from the eight twelve member CCGs. Both roles cannot be undertaken by members of the same CCG. The term of office will be two years.

4.5. Each CCG will be entitled to exercise one vote in the Joint Committee – this means that the two

representatives of each CCG will have to be in agreement when exercising their CCG’s vote. It will then be important for these representatives to canvas views from their nominating CCG prior to meetings and to discuss agenda matters in advance of meetings.

5.6. There will also be two (non-voting) lay members of CCGs appointed to the Joint Committee, one of whom will be from a patient and public involvement perspective and the other from a finance and governance perspective. One lay member will, where feasible, be from the north of the patch and the other from the south of the patch. One of these lay members will also perform the role of Vice-Chair.

6.7. Also attending the meeting (in a non-voting capacity and where appropriate under the conflicts

of interest policies of the CCGs) will be the Managing Director of NECS, a named Director from NHS England, the Head of Strategic CCG Development and the Chair of the CCG Chief Finance Officer Group.



7.8. The Joint Committee will be guided by the following principles:

• Subsidiarity: decisions should be made at the smallest geographical level possible, and joint decisions covering a wider geography should only be taken where this adds value.

• Securing continuous improvement to the quality of commissioned services to improve outcomes for patients with regard to clinical effectiveness, safety and patient experience

• Promoting innovation and seeking out and adopting best practice, by supporting research and adopting and diffusing transformative, innovative ideas, products, services and clinical practice within its commissioned services, which add value in relation to quality and productivity.

• Developing strong working relationships with clear aims and a shared vision putting the needs of the people we serve over and above organisational interests

• Avoiding unnecessary costs through better co-ordinated and proactive services which keep people well enough to need less acute and long term care.

8.9. The Joint CCG’s Committee’s work plan will be set annually using a decision-making flowchart

and scoring criteria set out in Appendix 1. Where this flowchart shows where there is a policy, guideline or procedure that would benefit from full Committee sign-up these should be included. This process will be overseen by nominated members (Chair and Chief Officer from each member CCG, or a nominated deputy) of the Joint Committee. This work programme will then need to be approved by the Joint Committee and then approved by each member CCG.

9.10. If urgent or exceptional issues emerge after this work programme is set that require a

collective decision then approval for this will need to be agreed unanimously by the Joint CCG Committee. And ratified by each member CCG.

10.11. The Joint Committee will also ensure compliance with the four key tests for service change

as established by the Department for Health: • Strong public and patient engagement. • Consistency with current and prospective need for patient choice. • Clear, clinical evidence base. • Support for proposals from commissioners.

11.12. In accordance with statutory powers under s.14Z3 of the NHS Act 2006, the proposed Joint

Committee will be able to make decisions on procuring services and awarding contracts, chiefly to the providers of specialised acute and ambulance services. In discharging this function the committee will: • Determine the options appraisal process for commissioning services, including agreeing the

evaluation criteria and weighting of the criteria

• Where appropriate, determine the method and scope of the consultation process, and make any necessary decisions arising from a Pre-Consultation Business Case (and the decision to go run a formal consultation process). That includes any determination on the viability of models of care pre-consultation and during formal consultation processes, as set out in s.13Q, s.14Z2 and s.242 of the NHS Act 2006 (as amended).

• Approve the formal report on the outcome of the consultation that incorporates all of the representations received in order to reach a decision, taking into account all of the information collated and representations received in relation to the consultation process.



• Make decisions to satisfy any legal requirements associated with consulting the public and

making decisions arising from it, ensuring that individual CCGs’ retained duties can be met.

Decision-making and links to individual CCG Governing Bodies 12.13. The NHS Act 2006 (as amended) enables CCGs to exercise certain functions jointly and to

take collective binding decisions as to the exercise of these functions. To be clear, this legislative permission only applies to Joint Committees of CCGs and does not apply to enable decision-making to be exercised by any alternatively constituted or wider group (for example, an STP Board or Programme Board).

13.14. Under this legal framework, the power to take commissioning decisions in respect of health services sits with CCGs (and to a more limited extent NHS England), with decisions being taken by the Governing Body or otherwise, as determined in the relevant governance documents. On this basis, all commissioning decisions must be taken by the CCGs acting independently or as a formally constituted joint CCG committee. Therefore, when functions are delegated to the Joint Committee, it will transact all the work necessary to discharge those functions. The Joint Committee will be the decision maker in relation to that work and those functions, however it is for the members of the Joint Committee to consult their own Governing Body prior to any decision being taken and for the members to report back to their relevant CCG Governing Body.

14.15. The relevant parties to whom any Joint Committee decision applies must be agreed first by

the Joint Committee itself – before any recommendations are brought back to it for decision-making (this will allow for the exclusion of certain CCGs where the geographical scope of a proposal does not apply to them or because of their current status, e.g. where legal directions prohibit them from taking the decision). Decisions will be taken only by those CCGs to whom a particular issue applies.

15.16. The collective decisions of the Joint Committee shall be binding on all member CCGs to

whom a particular issue applies, and decisions will be published by individual CCG members on their websites. All decisions of the Joint Committee must be unanimous.

16.17. The Joint Committee will have a forward plan to ensure CCG members are clear which

decisions they need to prepare for. It will be the responsibility of each member CCG to ensure that their Governing Body and/or other CCG decision making body is appropriately consulted and briefed ahead of Joint Committee meetings, and is provided with regular updates on the business of the Joint Committee so that they are clear on the implications of the decisions made.

17.18. Implementation of the decisions will be the remit of each member CCG and therefore accurate reporting back to their respective Governing Body is essential. The Joint Committee will make regular written reports to the Governing Bodies of its member CCGs, and will review its aims, objectives, strategy and progress and produce an annual report for the member Governing Bodies.

18.19. While CCGs can delegate decisions to the Joint Committee they can also agree the governing

bodies or members input on these decisions and have them provide recommendations into the Joint Committee.



19.20. It is essential that each CCG delegates the same level of authority for the same matters into the Joint Committee.

20.21. Should this joint commissioning arrangement prove to be unsatisfactory, the Governing

Body of any of the member CCGs can decide to withdraw from the arrangement and pull out of the Joint Committee.

Meetings of the Northern CCG Joint Committee: 21.22. Members of the Joint Committee have a collective responsibility for the operation of the

Joint Committee. They will participate in discussion, review evidence and provide objective expert input to the best of their knowledge and ability, and endeavor to reach a collective view.

22.23. The Joint Committee will usually meet on a bi-monthly basis but will be cancelled if there is no business to be dealt with. Additional meetings can be called as required.

23.24. The Joint Committee may call additional experts to attend meetings on an ad hoc basis to

inform discussions. 24.25. The Joint Committee has the power to establish sub groups and working groups and any

such groups will be accountable to the Joint Committee (and ultimately the member CCGs). 25.26. Para 8 of Schedule 1A of the NHS Act 2006 requires meetings of a Governing Body to be in

public unless it is not in the public interest to hold them in public. It will be for the members of the formally constituted Joint Committee to decide whether their meetings (or parts of them) are held in public to help them meet their statutory duties of transparency and public involvement.

26.27. Joint Committee meetings held in public should only occur when there is a decision to be

made or a discussion/information item of public note/concern.

27.28. The Joint Committee has shall adopted the standing orders of what was formerly known as North Durham CCG (which is one of its constituent CCGs) insofar as they relate to the: • Notice of meetings • Recording and minuting of meetings • Agendas • Circulation of papers • Conflicts of interest (together with complying with the statutory guidance issued by NHS

England) • At least one full voting member from each CCG must be present for the meeting to be

quorate. • All decisions of the Joint Committee must be unanimous (see section 165 above).

28.29. Members of the Joint Committee shall respect confidentiality requirements as set out in the

Standing Orders unless separate confidentiality requirements are set out for the Joint Committee in which event these shall be observed.

29.30. The secretariat to the Joint Committee will:

• Circulate agenda and associated documents at least ten working days prior to the meeting

Formatted: Pattern: Clear (Yellow)






• Work in collaboration with CCG and NECS communication and engagement personnel to publicise the meeting/agenda and documents on all CCG websites

• Circulate the minutes and action notes of the Joint Committee within three working days of the meeting to all members

• Present the minutes and action notes to the governing bodies of the CCGs.

30.31. These terms of reference will be formally reviewed annually by the CCGs and may be amended by mutual agreement between the CCGs at any time to reflect changes in circumstances as they may arise.

Approved by Northern CCG Joint Committee at its meeting on 7 November 2019.

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Primary Care Committee (Public)

Minutes of the Primary Care Committee Meeting held on Thursday 5 March 2020, 2.35pm-3.30pm, in Longsands North, Hedley Court Present: Mary Coyle (MC) Deputy Lay Chair, NTCCG (Chair) Jon Connolly (JC) Chief Finance Officer, NTCCG In Attendance: James Martin (JM) Commissioning & Performance Manager, NTCCG Phillip Horsfield (PH) Practice Manager, Village Green Surgery Keith Davison (KD) Senior Finance Manager, NHS England Cllr Margaret Hall (MH) Chair, Health & Wellbeing Board Paul Jones (PJ) Healthwatch North Tyneside Dianne Effard PA, NTCCG Agenda Item, Discussion & Agreed Actions

NTPCC/19/068 Welcome & Apologies for Absence: Agenda Item 01

Mrs Mary Coyle (MC) welcomed everyone to the meeting and advised that the meeting was being audio recorded for minuting purposes, and by signing to confirm attendance you were also agreeing to the proceedings being recorded. The recording would be destroyed once the final minutes have been agreed. Apologies were noted from Lesley Young-Murphy, Ruth Evans, Irene Walker and Jenny Long. James Martin (JM) advised that Jenny Long would be added to the invitation list for the meeting, and she would attend when Leanne Douglas (LD) was not available. However, neither had been available for today’s meeting.

NTPCC/19/069 Confirmation of Quoracy: Agenda Item 02

The meeting was confirmed as being quorate.

NTPCC/19/070 Declarations of Interest: Agenda Item 03

There were no declarations of interest pertinent to today’s agenda.

NTPCC/19/071 Minutes of the Previous Meeting: Agenda Item 04

The minutes of the meeting held on 9 January 2020 were agreed to be accurate.

NTPCC/19/072 Action Log: Agenda Item 05

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NTPCC/19/063, Action 6: Committee Effectiveness 2019/20 & Work Plan 2020/21: JM advised he had discussed the Terms of Reference with Ruth Evans, which were based on a standard template produced by NHS England. Issues about strategy were discussed in other committees. Jon Connolly (JC) advised the same discussion had taken place in Northumberland CCG and they had agreed procedural decisions were made in the Primary Care Committee with other issues being the broader responsibility of the CCG. It had not been clear what would have been a better way. Complete

NTPCC/19/065, Action 7: Contract Baseline Report July 2019 December 2019: JM had received feedback from LD and the number of CQC inspections noted in the report which had been presented to the last meeting should have stated one inspection, not seven. Complete

NTPCC/19/072 Operational Update: Agenda Item 06

JM advised that this was a standard item as meetings were held every two months and if items needed to be considered in between meetings, a summary of those items would be brought to the next meeting. On this occasion there were no items of business to update the Committee on.

NTPCC/19/073 Hadrian Park Pharmacy Conversion: Agenda Item 07

JM presented the report and advised that the Hadrian Park surgery had made an application to increase the amount of reimbursable rent and increase the footprint of their building as there was a pharmacy on the site which was currently not being used and they would like to use the space for clinical use.

Based on an assessment, their current space was 844m2 of net internal area compared to the guidance which would be 902m2 for their list size. Implications in terms of cost would be £2,200 per annum for an increase of 18.8m2. Even with the additional space, the practice would still have less space than recommended in the guidance. The recommendation from NHS England was to approve, which the CCG also recommended.

It was clarified that the building was owned by a landlord and privately leased to the practice, and the owner had agreed to undertake the necessary work for the practice. The Pharmacy was part of the structure of the building but had its own entrance, and had been closed for some time. There would be an extra consulting room accessed from within the building. It would be good use of the premises and made sense in terms of internal layout.

Keith Davison (KD) queried whether the lease would be extended as he was concerned the practice may be tied into a long lease. JM advised that using the empty space would benefit the practice, and there were no plans to move the practice, so the length of the lease should not be an

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issue.

The Committee approved the application.

NTPCC/19/074 Primary Care Strategy Workplan: Agenda Item 08

JM presented the Primary Care Strategy Workplan which showed the main projects being undertaken. An update would be brought on a regular basis. Items which were rated as Amber were reviewed.

Care Plus: There had been some ongoing issues around referrals and an action plan was now in place.

Car Home Nursing Team Pilot: This was in the North West and Wallsend Networks. There had been some under-delivery against the contract in North West. An action plan was now in place.

Understanding Capacity and Demand, and Workforce Planning: These were related items. Additional funding went to practices to use Apex Insight software to look at current demand and capacity of the current provision. There was a workforce scenario planning tool attached to it. There had been a delay in rolling out the system due to issues which had now been resolved, and some practices were still behind on training.

CCG Workforce Strategy: Dr Shaun Lackey (SL) had been working on this and it would be presented to the committee for sign off at next meeting.

Estates Profile: There was now a national programme to understand primary care estates. The North East was to be a pilot for this but it had been delayed. The programme had been signed off at end of February 2020 and should now move forward.

Members felt the workplan was useful to be able to see all projects, and gave a good indication of everything that had been invested in.

The Committee received the report.

Action 1: CCG Workforce Strategy to be presented to the committee for sign off at next meeting (08.04.20)

NTPCC/19/075 Update to GP Contract 2020-21: Agenda Item 09

JM presented the update to the GP contract. There have been some challenges around some of the expectations of the Primary Care Networks (PCN). In early February 2020, the five year contract had been published and the update presented outlined some of the main changes.

Funding to PCNs had increased to increase the number of additional staff from 20,000 to 26,000. For the average sized network this meant

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21 additional staff by the end of 2023-24. There had been a change to the roles which could be reimbursed and some roles normally associated with community services were now included.

Previously Networks received 70% reimbursement with the practise funding the remaining 30%, but now the full amount of 100% would be reimbursed.

There was a reduction in expectation for service specifications to be delivered in this financial year. It had previously been five but was now three: structured medication review, care homes and early cancer diagnosis.

It was felt that the overall changes around workforce would be helpful. There were issues around funding as the expected increase of 3% to the contract would now be 4%. That had created a deficit gap in other CCGs in this patch. There had been a revision to the allocations which meant that North Tyneside should be alright for the next year.

For PCNs there was a risk of over-complication about who would recruit to the posts. The CCG and PCC needed to think about how to help PCNs and practices understand what the benefits were and how they could be supported to identify that and what would help.

It was noted that some of the additional roles were already being provided so it would be important to think about what would actually make a difference. There was a finite pot of money which would grow year on year as Networks recruited additional roles. Philip Horsfield (PH) had attended a meeting where there had been discussion about how to spend the money practically. There was an issue in many practices about infrastructure and capacity. Village Green Surgery (VGS) had looked at training capacity which may have to be cut back because there was no space for the new roles. As Wallsend PCN could get 20-25 WTE extra clinicians, they were considering extending the VGS building to provide additional consulting rooms, but that would not be quick or cheap. It was a significant challenge. There was not a vast amount of space available in North Tyneside. It would be important to have the PCN roles embedded within practices and to be part of teams. Wallsend PCN would be holding a stakeholder mapping event on 10 March 2020.

Margaret Hall (MH) advised that the local authority had a lot of properties. She wanted to see health and local authority working across each other and had hoped for that from PCNs with better use of valuable expertise. There were libraries, sports centres, community buildings, YMCA and other centres available in the borough.

It was noted that people working in a clinical room will have to have access to the clinical IT network. There were infrastructure costs in moving staff out of NHS buildings into other buildings and issues about whether rooms were reimbursable. From a team building point of view staff needed to feel they are part of the Network and not just a practice.

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JM explained how Living Well Locally fitted with the PCNs, which were under the umbrella of the CCG.

Members sometimes found it difficult to keep track of what each Network was doing and it was suggested mapping that out for ease of understanding. It was important to understand how different services inter-connected with each other as a cohesive system.

PCNs would need to consider how they would spend the available funding on additional roles to identify potential gaps in service. There were a lot of different ways the money could be used, and the patients’ perspective would be different.

MC noted that at a recent meeting at a local University there was discussion about the future of further and higher education in terms of demands on campuses. The expectation was that over the next 10-20 years people would start to do virtual learning and distance learning. In practices, members of the public should be encouraged to use technology more with practitioners working from home or from a surgery.

The Committee received the report and MC thanked members for the useful discussion.

NTPCC/19/076 Finance Report: Agenda Item 10

JC presented the finance report and advised there was little change since the last meeting. There was a forecast of a small underspend against budget which was likely to go up by the end of the financial year. From a risk point of view, many of the risks related to underspending rather than overspending. The forecast underspend was £34k against a budget of £29m, which is around 0.1% of the budget.

PJ noted that he understood the report better this time and thanked JC and KD for their help with that. MC advised that it was important for lay people that the information provided was straightforward and understandable, so they could ask questions more easily.

MH noted that the Council used variances for comparison, and JC advised that people understood that but there was a need to be careful because it was about what you were understanding as a variance.

The Committee received the report.

NTPCC/19/077 Internal Audit Primary Care Commissioning 2019/20: Agenda Item 11

JM presented the Internal Audit Report which focused on the second part of the National Internal Audit Framework for Primary Care Commissioning, relating to contract levels. The Audit was on a three year cycle. NTCCG PCC had been given a full assurance rating with some low reported findings.

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It was noted that Internal Audit rarely gave a rating of full assurance but levels of assurance were specified.

MC noted that fantastic work had been done to achieve the rating, and the Committee received the report.

NTPCC/19/078 Committee Attendance 2019/20: Agenda Item 12

JM advised that the schedule of attendance had not been sent out with the report, in error, and would be sent to all members after the meeting. A paper copy was shown to members and the schedule showed there had been good attendance over the year from members and from Healthwatch and the Health & Wellbeing Board.

MC noted that the Deputy Chair was noted on the schedule but she had not attended any meeting as she was only expected to attend when the Chair was not available. As the schedule was to be included in the Annual Report it was agreed the Deputy Chair should not be included in the attendance schedule.

An issue was noted in relation to the Clinical Director or nominated GP, which was usually Dr Ruth Evans (RE). A nominated GP had not been put in place, so if RE was unable to attend there was no-one else available to attend in her place.

Action 2: DE to send schedule of attendance to all members.

Action 3: DE to advise Irene Walker (IW) of the Committees request that the Deputy Chair be taken off the attendance schedule.

Action 4: JM to follow up with IW and RE regarding a nominated GP.

NTPCC/19/079 Any Other Business: Agenda Item 13

There was no other items of business raised.

NTPCC/19/080 Date and Time of the Next Meeting: Agenda Item 14

Thursday 7 May 2020, 10.00am-11.30am

Documents

Meeting of the CCG Governing Body...2020/07/28 · OFFICIAL 1 Meeting of the CCG Governing Body A meeting of NHS North Tyneside Clinical Commissioning Group Governing Body is to be