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The WEL Collaboration: NHS Newham CCG, NHS Tower Hamlets CCG and NHS Waltham Forest CCG
WEL CCGs
Governing Body Meeting Part I
Wednesday 24 July 2019, 14:00 – 15:30
1
The WEL Collaboration: NHS Newham CCG, NHS Tower Hamlets CCG and NHS Waltham Forest CCG
WEL CCGs
Governing Body Meeting Part I
Wednesday 24 July 2019, 14:00 – 15:30
Committee Rooms, Unex Tower, 5 Station Street, Stratford, E15 1DA
Agenda
1.0 General Business
Action Presenter Enc. Time Page
1.1 Welcome, Introductions and Apologies
SAO/MD
14:00 (5 mins)
1.2 Chair’s appointment
1.3 Declarations of Interests & Register of Interests
Chair
1.4 Patient Story 14.05
(10 mins)
1.5 Single Accountable Officer (SAO)/Managing Director’s (MD) Report
To note SAO/MD Attached 14:15 (10 mins)
7
2.0 Governance
Action Presenter Enc. Time Page
2.1 Governance Report To note Satbinder Sanghera
Attached 14:25 (5 mins)
11
3.0 Performance, Quality and Finance
Action Presenter Enc. Time Page
2
3.1 Healthwatch report To note Selina Rodrigues
Attached 14:30
(10 mins)
36
3.2 INEL Outpatients Transformation Programme
Update
For discussion
Shane DeGaris/ Chris Neil
Attached 14:40 (15mins)
65
3.3 WEL Diabetes Update For discussion
Selina Douglas
Attached 14:55 (15
mins)
71
4.0 Strategy and Planning
Action Presenter Enc. Time Page
4.1 Barts Health Surgical Strategy
For discussion
To follow 15:10 (20 mins)
5.0 Other
Action Presenter Enc. Time Page
5.1 Public Question Time For
discussion 15:25
(5 mins)
3
Acronyms List
ACRONYM MEANING
A&E Accident & Emergency
ACS Accountable Care System
APMS Alternative Provider Medical Services (a type of Primary care contract)
AQP Any qualified provider
BAF Board Assurance Framework
Bart's / BHT Barts Health NHS Trust
BAU Business as usual
BCP Business continuity plan
BHRUT Barking, Havering and Redbridge University Hospitals NHS Trust
BMA British Medical Association
CAS Clinical Assessment Service
CCG Clinical Commissioning Group
CCG IAF Clinical Commissioning Group Improvement and Assessment Framework
CCU Critical Care Unit
CEG Clinical Effectiveness group
CEPN Community Education Provider Network
CHN Community Health Newham Directorate
CHP Community Health Partners
CHS Community Health Systems
CIL Construction Industry Levy
CPD Continuing Professional Development
CQC Care Quality Commission
CQRM Clinical Quality Review Meeting
CQUINs Commissioning for Quality and Innovation (Payment Framework)
CSU Commissioning Support Unit
CYP Children and Young People
DASL Drug and Alcohol Service in London
DES Direct Enhanced Service
DoH/ DH Department of Health
DRSS Diabetes Retinopathy Screening Service
DToC Delayed Transfers of Care
ED Emergency Department
ELFT East London Foundation Trust
ELHCP East London Health and Care Partnership
EMIS web Egton Medical Information Systems (System that records patient consults)
EPCS Extended Primary Care Service
EPCT Extended Primary Care Team
EPR Electronic Patient Record
ETTF Estates and Technology Transformation Fund
FOI Freedom of Information
GB Governing Body
GIA Gross internal area
GLA Greater London Authority
4
Acronyms List
GMC General Medical Council
GMS General Medical Services (a type of Primary care contract)
GP General Practitioner
HBPoS Health Based Places of Safety
HEE Health Education England
HLP Healthy London Partnership
HMT Her Majesty's Treasury
HoT Heads of Terms (Contract Summary)
HUH The Homerton University Hospital NHS Foundation Trust
IAPT Increasing Access to Psychological Therapy
ICC Integrated Care Committee
ICP Integrated care partnership
ICS Integrated Care System
IG Information Governance
IMCA Independent Mental Capacity Advocate
IMT Information Management and Technology
INEL Inner North East London
IPS Individual placement and support schemes
ITT Invitation to Tender
ITU Intensive Therapy Unit
IUC Integrated urgent care
JCC Joint Commissioning Committee
JSNA Joint Strategic Needs Assessment
KGH King George Hospital
KPI Key Performance Indicator
LAP Local Area Partnership
LAS London Ambulance Service
LAs Local Authorities
LBN London Borough of Newham
LBWF London Borough of Waltham Forest
LCFS Local Counter Fraud Specialist
LD Learning Disability
LD SAF Learning Disability Self-Assessment Framework
LEB London Estates Board
LEDU London Estates Development Unit
LES Local enhanced service
LMC Local Medical Committee
MHCC Mental Health Commissioning Committee
MM Medicines management
MoLCV Medicines of limited clinical value
MOU Memorandum of understanding
MPIG Minimum Practice Income Guarantee
MSK Musculoskeletal
NAFO Newham Alternative Funding Option
NCCG Newham Clinical Commissioning Group
NDPP National diabetes prevention programme
NEL North East London
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Acronyms List
NELCA North East London Commissioning Alliance
NELCSU North East London Commissioning Support Unit
NELFT North East London Foundation Trust
NHC Newham Health Collaborative
NHS PS NHS Property Services
NHSE NHS England
NHSI NHS Improvement
NICE National Institute of Health and Care Excellence
NUH Newham University Hospital
NWP Newham Wellbeing Partnership
OOH Out of hours
OPD Outpatient department
OPE One Public Estate
PALS Patient Advice and Liaison Service
PCCC Primary Care Commissioning Committee
PCH Primary Care Home
PCT Primary Care Trusts
PHE Public Health England
PMS Personal Medical Services (a type of Primary care contract)
PPE Patient and Public Engagement
PPG Patient and Public Group
PREM Patient Reported Experience Measure
PROM Patient Reported Outcome Measures
QIPP Quality, Innovation, Productivity and Prevention
QOF Quality Outcome Framework (Assessor Validation Reports)
R&D Research & Development
RAG Red, Amber, Green
RICS Royal Institute of Chartered Surveyors
RLH Royal London Hospital
ROI Return on Investment
RTT Referral to treatment
SEP Strategic Estates Plan
SMI Severe mental illness
SPA Single Point of Access
SPR Service Program Review
STP Sustainability and Transformation Plan or Partnership
THCCG Tower Hamlets Clinical Commissioning Group
TOR Terms of reference
TSCL Transforming Services Changing Lives
TST Transforming Services Together
UCC Urgent Care Centre
UCLP UCLPartners/ University College London Partners
UCWG Urgent Care Working Group
UEC Urgent and Emergency Care
UTC Urgent Treatment Centre
WELC Waltham Forest, East London and City (Integrated Care Programme)
WFCCG Waltham Forest Clinical Commissioning Group
Whipps X / WX Whipps Cross Hospital
WTE Whole Time Equivalent
6
WEL Board – part I
Date: 24 July 2019
Title of report Accountable Officer and Managing Director update
Item number 1.5
Author Jane Milligan, Accountable Officer / Selina Douglas, Managing
Director
Presented by Jane Milligan, Accountable Officer / Selina Douglas, Managing
Director
Contact for further information Selina Douglas, Managing Director [email protected]
Executive summary This report provides an update on the activities of the Accountable
Officer and Managing Director since the last Board meeting,
highlighting items of interest to Governing Body members and the
public.
Action required Note
Where else has this paper been
discussed?
No previous presentation to any previous meetings/forums.
Next steps/ onward reporting None
Strategic fit N/A
What does this mean for local
people?
N/A
How does this drive change and
reduce health inequalities?
N/A
Financial Implications None
Risks None
Equality impact None
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Accountable Officer’s update
1.
1.1 1.1.1
1.1.2
1.1.3
Aligning Commissioning Policies across north east London The Aligning Commissioning Policies engagement launched on 22 May and closed at the beginning of July. Over 100 responses were received which are now being analysed and will form part of the evidence clinical leads will use before making a recommendation to go to Governing Bodies.
The document proposed creating one commissioning policy for north east London, which would mean that:
all patients living in north east London would have access to the same types of care
the care patients would receive would be in line with the latest clinical guidance
hospitals and GPs would be clear about what policy to refer to, reducing confusion
patients would not have treatments that don’t work or aren’t the best option for them.
NHS funds would be spent paying for procedures that people need, and that would givethem a better quality of life.
This work follows a national consultation held by NHS England last year. Engagement is targeted to specifically engage with patients related to the procedures, for example people who suffer from back pain (via a hospital pain clinic) parents of young children (grommets, ear pinning) as well as GPs and hospital consultants. Any suggestions to help make sure we reach the right people are most welcome.
2.
2.1 2.1.1
2.1.2
2.1.3
Update on the LTP submission The national guidance for the Long Term Plan (LTP) submission has been published outlining what we need to do to deliver our five-year strategic delivery plan by November 2019. This plan, covering 2019/20 to 2023/24, will need to outline delivery against the LTP commitments. An initial plan has to be submitted by 27 September 2019 and the final submission is required by 15 November 2019
Key characteristics of the proposed strategic plan are that it is clinically-led, locally owned, involves realistic workforce planning, is financially balanced, delivers all commitments in the Long Term Plan and national access standards, and is phased based on local need.
We will now work up our plan over the next two months, building on engagement and input from key stakeholders and ensuring we work with health and wellbeing boards ahead of the submission date.
3.
3.1 3.1.1
3.1.2
Joint Commissioning Committee The Joint Commissioning Committee met in public in July and discussed performance and activity across north east London. The committee also heard from Navina Evans, Chief Executive of East London Foundation Trust about their strategy and also received an update on the next steps on the Better Care Fund. Questions were received from the public on the future of King George Hospital and the Better Care Fund.
We will now work up our plan over the next two months, building on engagement and input from key stakeholders and ensuring we work with health and wellbeing boards ahead of the submission date.
4.
4.1 4.1.1
East London Health and Care Partnership (ELHCP) update We held a successful stakeholder event for the East London Health and Care Partnership in June. We were joined by our partners from health and social care including council leaders and representatives from voluntary and community organisations to discuss health and care services
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4.1.2
4.1.3
for local people in north east London and help develop our response to the NHS Long Term Plan (LTP). There were also roundtable discussions on how the priorities outlined in the LTP – such as cancer, maternity and mental health care – could be best delivered by working together in partnership. This provided an opportunity for partners to make proposals and feed in ideas about how to deliver the NHS LTP locally. The national Long Term Plan sets out how the NHS will improve the quality of patient care and health outcomes. The ELHCP is leading the development of the local LTP which will be submitted in the autumn. For more information visit: www.eastlondonhcp.nhs.uk
This month I convened a roundtable of HR and workforce leads from across north east London to discuss how we can work together to address the issue of the future workforce across health and social care in light of the Long Term Plan requirements and the Interim People Plan which has just been published by NHS England. We had a really valuable discussion about the current picture, the work already underway and the existing gaps and how to address these. A number of actions came out of the roundtable and we are committed to working collaboratively across north east London on this important area of work, which will be vital for our response to the long term plan.
I joined the ELHCP digital team at their recent event which brought together Social Care and NHS leaders across north east London to take stock and share plans and experiences in the digital sphere, especially in the light of the NHS Long Term Plan and the One London Health and Care Record known as LHCRE. Workshops included gathering thoughts on the Digital Enablement workstream for the STP’s LTP response due this autumn as well as exploring options for developing Person Held Records that could span multiple STPs. The output from this event included practical suggestions to explore further work, especially in conjunction with the LTP response, an assessment of local feeling towards a collaborative approach to the development of Person Held Records and renewed enthusiasm for further expansion of the east London Patient Record and its place in the One London Local Health and Care Record Exemplar.
Managing Director’s update
1.
1.1 1.1.1
1.1.2
1.1.3
1.1.4
1.1.5
Annual Improvement and Assessment Framework 2018/19 NHS England has recently published the CCG annual assessment results for 2018/19. This assesses each CCG against the indicators in the CCG Improvement and Assessment Framework (CCG IAF).
Across the seven North East London CCGs the picture is a positive one with NHS England highlighting our overall improvement and for the work we have undertaken with provider partners and NHS England/NHS Improvement during what has been a challenging year. We are also praised for our significant improvement in delivering quality services and for working collaboratively with system partners to maximise opportunities to develop the Integrated Care Partnership.
Our three CCGs have all been rated as ‘Good’. For Newham and Waltham Forest this is the same rating as the previous year. For Tower Hamlets this is a change from last year’s ‘Outstanding’ rating but this is primarily down to the scoring methodology and QIPP targets.
Quality of leadership continues to be rated as green star, as does patient and community engagement. All three CCGs are performing above the standards required in adult mental health. Newham and Tower Hamlets maintained their green star rating for patient and community engagement with Waltham Forest maintaining their green rating.
Both the Accountable Officer and Managing Director would like to acknowledge and thank the CCG Boards and the staff working across the CCGs for their commitment and hard work over the last year.
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2.
2.1 2.1.1
2.1.2
2.1.3
WEL transition programme As part of the transition to closer working across the 3 CCGs, a single Joint Management Team structure for WEL was established in May. All posts have been permanently appointed to except for the Director of Integrated Commissioning for Newham, which is in progress.
On 16 July we launched a staff consultation on an organisational restructure and reducing from two office locations to three. The 30 day consultation is due to end on 14 August.
There has been a number of opportunities for engagement with staff in advance of the launch and we have put in place a range of support to help staff through the changes ahead, including a series of HR surgeries for staff to have a confidential discussion and to seek any support and advice on the process.
3.
3.1 3.1.1
3.1.2
Implementation of safeguarding arrangements Under the Children and Social Work Act 2017, three safeguarding partners (local authorities, chief officers of police, and clinical commissioning groups) must make arrangements to work together with relevant agencies to safeguard and protect the welfare of children in the area. The new multiagency safeguarding arrangements were published ahead of the nationally set timescales and are published on both CCG and Local authority websites. These arrangements are due for implementation in September 2019.
The Children and Social Work Act 2017, Working Together (2018)[1]and the subsequent Child Death Review Statutory and Operational Guidance (2019)[2] outline how local authorities and clinical commissioning groups (CCGs) are required to work together as Child Death Review(CDR) Partners. Inner North East London CDR Partners published details of their new arrangements ahead of the nationally set deadline. These arrangements are due for implementation in September 2019
4.
4.1 4.1.1
Continuing Healthcare review A review of Continuing Healthcare across Inner North East London is in currently in progress. A report is due to be ready by the end of July and an update will be provided in my next report.
5.
5.1 5.11
5.12
Mental Health Transformation Funding East London Health and Care Partnership submitted a bid for wave 1 community mental health transformation funding – up to £8m across 2019/20 and 20/21. We have been successful so this funding will be available to Newham and Tower Hamlets, in partnership with City & Hackney, to support a major redesign of mental health services around Primary Care Networks.
A further £4.6m has also been made available to North East London across 2019/20 and 20/21 to support crisis transformation.
[1] https://www.gov.uk/government/consultations/working-together-to-safeguard-children-revisions-to-statutory-guidance [2] https://www.gov.uk/government/publications/child-death-review-statutory-and-operational-guidance-england
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WEL Board – part I
Date: 24 July 2019
Title of report Governance Report
Item number 2.1
Author Satbinder Sanghera, Director of Corporate Services
Presented by Satbinder Sanghera, Director of Corporate Services
Contact for further information Satbinder Sanghera, Director of Corporate Services;
[email protected]; 020 3688 2388
Executive summary This report sets out the governance arrangements for the WEL
CCGs Board including attaching relevant documents, such as the
terms of reference, standing orders and conflicts of interest policy.
Action required Note the WEL CCGs Board Terms of Reference and Standing
Orders and Conflict of Interest Policy
Where else has this paper been
discussed?
All documents have been considered and agreed by Newham CCG
Board, Tower Hamlets CCG Board and Waltham Forest CCG Board
Next steps/ onward reporting For the CCG Boards to consider Standing Financial Instructions, Scheme of Reservation and Delegation and Committees Terms of Reference.
Strategic fit N/A
What does this mean for local
people?
This will mean the establishment of a WEL Board that is able to reduce unwarranted variation in the range and quality of services available to people living in the three WEL boroughs by improving outcomes in areas that are below average and driving up outcomes overall. It will also enable a joined-up approach to the commissioning of health services, enabling the CCGs to work collectively and effectively with providers to improve the experience and outcomes of care.
How does this drive change and
reduce health inequalities?
The ability to better tackle unwarranted variation in the range of
quality of services will support the drive to reduce health inequalities.
Financial Implications This paper presents plans that may have financial consequences. These are yet to be fully determined but if not already embedded in budgets or reserve provision, a further decision would be required to release any additional expenditure commitment.
Risks The WEL Board will have a potentially wide remit and it is important
that it is able to priorities where it can make the most difference.
There is also a risk that the Board does not work within the new
partnership and collaborative approach required within the Long
Term Plan. The mitigation to both risks will be for board development
sessions that are able to continuously addressing these points.
Equality impact The terms of reference of the Board require this Board to take account of the Joint Strategic Needs Assessment for each borough and to be accountable to the people in those boroughs.
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1. Introduction and background
1.1 This reports sets out the progress made to date and the basis on which this Board is meeting and to set out the future work required to complete the governance arrangements.
It should be noted that this Board is accountable and responsible to each CCG board as that remains the statutory body. The constitutions of each CCG Board permit the creation of joint committees (boards) to undertake delegated business on their behalf.
2. Membership
2.1
2.1.1
The proposed membership is as follows:
CCG Newham Tower Hamlets Waltham Forest
All CCGs
Chair M Naqvi Sam Everington Ken Aswani
Other GP Board Member
Rima Vaid Victoria Tzortziou-Brown
Johra Alam
General Practice representative
Clare Davison Virginia Patania Thaven Chetty
Lay Member Ellie Robinson Mariette Davis Vineeta Manchanda
Local Authority Representative
Colin Ansell TBC Heather Flinders
Two Board Nurses (Quality and Safeguarding)
Fiona Smith and Maggie Buckell
Secondary Care representative
Barts Trust representative
Executive Members
Jane Milligan Selina Douglas Henry Black Steve Collins
Public Health (Non Voting)
TBC
The terms of reference allows for named deputies if the Board Member is not able to attend.
3. Terms of Reference
3.1 The three CCG Boards have agreed the following:
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Terms of Reference
Standing Orders
Conflicts of Interest Policy
The next stage is for the CCG Boards to consider the following:
Scheme of Delegation with Standing Financial Instructions
Committees Terms of Reference
These are currently being developed and it is planned to consider these within each CCG in September.
Alongside this will be development of a Governance Handbook to set out how the new arrangements will work and a calendar of meetings.
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1
The WEL Collaboration of CCGs
Joint Board: draft terms of reference
Version: 5.0
Date: 10 July 2019
1. Purpose The purpose of the joint board is to bring together the leadership of the three WEL CCGs to:
reduce unwarranted variation in the range and quality of servicesavailable to people living in the three WEL boroughs by improvingoutcomes in areas that are below average and driving up outcomesoverall;
provide a joined-up approach to the commissioning of health services,enabling the CCGs to work collectively and effectively with providers toimprove the experience and outcomes of care;
to provide a collective mechanism for agreeing and monitoring theCCGs’ delivery of relevant components of the North East LondonSustainability and Transformation Programme; and
enable the CCGs to manage financial and other risks collectively whileeliminating any unnecessary duplication of functions.
Work collaboratively with all key partners, including patients, healthproviders, local authorities and community groups/organisations
The joint board’s duties will:
be undertaken in the best interests of the residents of the threeboroughs;
take proper account of each CCG’s sovereign duties, responsibilities,and Joint Strategic Needs Assessments; and
be accountable to the CCGs’ governing bodies and the populations theyrepresent.
2. Geographicalcoverage
The joint board comprises representatives from the three CCGs that together make up the WEL Collaboration:
NHS Newham CCG;
NHS Tower Hamlets CCG; and
NHS Waltham Forest CCG.
3. Statutoryframework
The joint board will carry out the functions delegated to it by any of the CCGs and/or NHS England and in accordance with the NHS Act 2006 (as amended), the key clauses being sections 14Z3, 13Z, and 14Z9.
Section 14Z3 provides that:
two or more CCGs may exercise any of their commissioning functionsjointly, including by a joint committee of those CCGs; and
for the purposes of any arrangements made under this section a CCGmay make payments, make the services of its employees or any otherresources available to another CCG.
Section 13Z provides that:
NHS England’s functions may be exercised jointly with a CCG or CCGs;
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2
functions exercised jointly in accordance with section 13Z may beexercised by a joint committee of NHS England and the CCG or CCGs;and
arrangements made under section 13Z may be on such terms andconditions as may be agreed between NHS England the CCG or CCGs.
Section 14Z9 provides that:
NHS England and one or more CCGs may make arrangements for anyof the functions of the CCG under section 3 or 3A of the NHS Act or forany functions of the CCG(s) which are related to the exercise of thosefunctions, to be exercised jointly by NHS England and the CCG(s);
functions exercised jointly in accordance with the section may beexercised by a joint committee of NHS England and the CCG(s); and
arrangements under that section may be on such terms and conditionsas may be agreed between NHS England and the CCG.
4. Duties: decisionmaking (remit)
The three participating CCGs’ governing bodies have delegated authority to this board to:
decide matters relating to the strategic direction of the CCGs, wheresuch decisions are in line with the North East London Sustainability andTransformation Programme (which has already been agreed by theCCGs’ governing bodies);
contribution to the development of the North East London Sustainabilityand Transformation Programme;
agree multi-borough commissioning strategies and plans;
commission services in the WEL footprint:
o acute services, including approaches to payment;
o community services (not in integrated commissioning);
o mental health services (not in integrated commissioning);
o other services common to the WEL CCGs;
o specialist services not commissioned by NHS England; and
o agree the decommissioning of services in the WEL footprint;
lead system and market development:
o development of the WEL Integrated Care System;
o strategic development of primary care, including GP federationsand primary care networks;
o developing the provider landscape;
o service change and reconfiguration; and
o workforce development;
agree a joint financial strategy across the three CCGs;
monitoring the CCGs’ budget and financial performance; and
along with the ELHCP board, be the primary forum for communicationfor NHS England on critical areas of system performance and changeand the delivery of the Five-Year Forward View and Long-Term Planwithin WEL.
Have oversight of the quality of commissioned services for the residentpopulations of Newham, Tower Hamlets and Waltham Forest
Individual CCG Boards will continue to:
Approve annual accounts
Approve annual report
Set annual budgets
Commission borough based services, such as Adults andChildren’s Out of Hospital services relating to DTOC andAdmissions avoidance
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3
Commission Mental Health Services (other than the ELFTCollaborative contract for Newham and tower Hamlets)
Commission Learning Disability Services
Jointly commissioned services with local authorities relating to LongTerm Conditions
For the duties listed above, the work of the joint board spans the full commissioning cycle:
needs assessment across WEL
planning service requirements
approval of business cases and change requests
developing the provider landscape
service change and reconfiguration
contracting and contract management
setting and monitoring outcomes for providers
aligning incentives across the system
procurement outcomes
across the cycle, engagement with the public and key stakeholders
Subject to any restrictions set out in relevant legislation, the joint board is authorised to determine any matter within its terms of reference.
The joint board will take proper account of national agreements and guidance in reaching its decisions.
Refer to sections 8 and 9 of the standing orders for more detail on the decision-making process.
5. Duties: monitoring The joint board will be responsible for monitoring the outputs and outcomes of the services over which it has been given delegated responsibility. This includes the performance and quality of the acute and core community and mental health contracts.
6. Membership andattendance
The joint board will bring together the senior leadership from across the WEL CCGs and consists of the membership listed below.
The members comprise a blend of representatives of individual CCGs and those who represent the three CCGs or boroughs collectively.
all three WEL CCGs’ chairs;
one additional GP representative from each CCG
a secondary care clinician;
a board nurse for Quality and a Board Nurse for Safeguarding;
three lay members, one from each CCG and representing a range of layportfolios;
one additional general practice representative from the governing bodyof each CCG (each CCG to decide who that should be and can bePractice Manager/Practice Nurse or GP);
the WEL CCGs’:
o accountable officer;
o managing director; and
o chief finance officer or in his absence WEL Executive Director ofFinance;
three local authority representatives, one from each borough andcollectively representing relevant areas of professional expertise suchas adult social care and children’s social care; and
a public health representative (non voting)
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4
The joint board’s lay members will be selected from the three CCGs’ existing cohort of lay members for a term that matches their existing tenure as a governing body member. Selection will be proposed by the WEL managing director following consultation with the CCG chairs and with regard to the needs of representation and the best mix of skills, and then agreed by each board.
Members will act on behalf of the whole WEL footprint in their decision-making.
In the event that a member of the joint board is unable to attend a meeting, a named deputy will be permitted to attend with the prior approval of the chair. The named deputy must be an additional person from outside of the joint board’s membership.
The public health representative will be agreed by the three local authorities. This may include an arrangement to rotate representation, by agreement with the chair.
7. Voting rights Role Number Voting rights?
CCG chair 3 Yes
Additional GP representative 3 Yes
Secondary care clinician 1 Yes
Board nurse 2 Yes
Lay member 3 Yes
Additional primary care governing body representative
3 Yes
CCG executives 3 Yes
Local authority representative 3 Yes
Public health representative 1 No
total number of votes 21
8. Quorum
The quorum of the joint board is seven voting members, which must include:
at least one member from each CCG from amongst the CCG chairs and additional governing body primary care representatives;
the accountable officer, managing director, or chief finance officer; and
one lay member.
In the event that all GPs are excluded due to conflicts of interest, the quorum will be four members which must include:
at least one lay member; and
at least one clinician
at least one from the CCGs’ accountable officer, managing director, and chief finance officer.
Members’ deputies are included within the quoracy. The meeting will be chaired by the lay Vice Chair.
Refer to section 7 of the standing orders for more detail on the quorum.
9. Approach to voting Members of the joint board have a collective responsibility for its successful operation. They will participate in discussion, review evidence, provide objective expert input to the best of their knowledge and ability, and endeavour to reach a collective view on the issues put before the joint board.
When making decisions, members of the joint board should consider themselves acting on the behalf of the WEL Collaboration to the benefit of all patients and staff members across the areas. Those appearing as
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representatives of the individual CCGs (the CCG chairs and additional governing body representatives) should provide insight into the circumstances of their respective CCGs to the joint board, so that fully-informed decisions can be made by all members of the joint board.
The voting rights of each member have been set out in section 7. Each member has one vote.
The secretariat (see below) will hold the register of voting members, which will include a record of any nominated deputies.
Failure to inform the chair and secretariat of a nominated deputy in advance of a joint board meeting will mean that the board member’s vote will not be transferred. This can, however, be remedied by a simple majority vote of the remaining joint board members present to confer the vote to the proposed deputy. A note of the decision will be recorded in the minutes.
10. Chair and deputy chair
The chair of the joint board will be appointed by all board members from amongst the CCG chairs.
The Deputy Chair will be a GP appointed by all joint board members from amongst the remaining two Chairs on the joint board.
The lay vice chair will be appointed by all board members from amongst the lay members on the joint board. The lay vice chair will chair meetings (or particular agenda items) when the chair and deputy chair are unavailable or unable to participate due to conflicts of interests.
Refer to sections 5 and 6 of the standing orders for more detail on the chair and the chair’s rulings.
11. Advisors (in attendance)
Only joint board members have the right to attend meetings. Key staff members and external advisors may be invited to attend for all or part of any meeting as appropriate, at the discretion of the chair.
12. Meetings in public
The joint board will meet every two months, in public, except as otherwise agreed by members and the chair. For more details on the meetings of the joint board, including for when members of the public may be excluded from meetings, see sections 1 and 14 of the standing orders.
13. Location and accessibility
The joint board will:
ensure that, where an issue disproportionately affects one CCG, the joint board should be held in that CCG to enable access and demonstrate openness;
live-stream meetings, so people can access the meeting from a greater range of locations; and
make arrangements to enable those with physical disabilities to access the meeting and its supporting materials.
14. Secretariat The secretariat function of the joint board will be provided by the WEL corporate services team.
15. Operation of the joint board
Refer to sections 2 and 13 of the standing orders for detail on operation of the joint board.
16. Conflicts of interest
The joint board will hold and publish a register of interests. This register will record all relevant and material, personal or business, interests as set out in the CCGs’ conflict of interest and standards for business conduct policies.
Each member and attendee of the joint board will be under a duty to declare any such interests in advance and where relevant appoint an alternative, non-conflicted deputy to attend with the vote (where applicable), notifying the chair and secretariat accordingly.
Any change to interests should be notified to the chair and secretariat.
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Failure to disclose an interest, whether intentional or otherwise, will be treated in line with the CCGs’ conflicts of interest policy and may result in suspension from the joint board and disciplinary proceedings.
Any interest relating to an agenda item should be brought to the attention of the chair and secretariat in advance of the meeting, or notified as soon as the interest arises, and recorded in the minutes.
All members of the joint board and participants in its meetings will comply with, and are bound by, the requirements of the relevant CCG’s or CCGs’ constitutions, policies, standards of business conduct for NHS staff (where applicable), and the NHS code of conduct. The chair (or deputy chair in his or her absence or where the chair is conflicted) will make a determination regarding the arrangements for management of conflicts of interest, in consultation with the secretariat and relevant CCG conflicts of interest guardian.
For clarity:
representatives of individual CCGs will adhere to that CCG’s policies and procedures; and
those who represent the three CCGs collectively must adhere to each CCG’s policies and procedures.
17. Accountability The joint board is accountable to each of the WEL CCGs’ governing bodies.
18. Reporting
The joint board is accountable to each of the WEL CCGs’ governing bodies and must ensure effective communication with, and reporting to, them. Members of the joint board will be expected to provide verbal feedback to their local governing body, as required. In addition to this, reports of the joint board will be a standing agenda item on all governing body meetings.
The joint board will demonstrate its accountability to its member CCGs, local people, stakeholders, and NHS England in a number of ways, including through:
local representation at the joint board;
active local engagement and reporting on key decisions;
public reporting of outcomes;
publication of a work programme and forward planner of future agenda items; and
complying with NHS England guidance and with generally accepted principles of good governance.
19. Standing orders
The joint board will operate in accordance with its standing orders.
Members of, and any attendees at, the joint board will respect the requirements of these standing orders.
20. Sub-committees
The joint board may not delegate any of its decision-making powers to a sub-committee. However, it may appoint sub-committees to advise and assist the joint board in carrying out its role. Refer to section 10 of the standing orders for more detail on sub-committees.
21. Conduct of the joint board and self-evaluation
These terms of reference will be kept under review by the joint board to ensure that they meet its needs and the needs of the WEL CCGs.
Any changes to the terms of reference must be agreed by the governing bodies of the WEL CCGs.
CCG staff feedback on the operation of the joint board should be fed to the joint board through any of its members.
In addition, the joint board should undertake a formal review of its operation and performance at least twice per year for the first two years of operation and thereafter at least annually, the results of which will be tabled at each of the governing bodies.
22. Withdrawal from the joint board
Any CCG may withdraw from the joint board with six months’ notice.
A withdrawal from the joint board should be considered a withdrawal from broader collaborative working arrangements, at both WEL and NEL level,
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and should be consistent with the process outlined in relevant governing documents of those arrangements.
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1
The WEL Collaboration of CCGs
Joint Board: standing orders
Version: 6.0
Date: 10 July 2019
These standing orders regulate the proceedings of the WEL CCGs’ joint board so that it can support
the three CCGs (NHS Newham CCG, NHS Tower Hamlets CCG, NHS Waltham Forest CCG) to fulfil
their statutory obligations, as set out largely in the National Health Service (NHS) Act (2006) and
amended by the Health and Social Care Act (2012) and related regulations.
They are effective from their approval by the three CCGs’ governing bodies in July 2019.
1. Meetings of the Joint Board
1.1. Ordinary meetings of the joint board will take place at least every two months, in public, except
as otherwise agreed by members and the chair.
1.2. Extraordinary meetings may be called by the chair of the joint board, the single accountable
officer, and the managing director.
2. Agenda, supporting papers, business to be transacted
2.1. Items of business to be included on the agenda of a joint board meeting should be notified to
the chair of the meeting and the secretariat at least ten working days before the meeting takes
place. The secretariat will prepare an agenda with the chair and make papers available to those
required to be at the meeting no less than five working days before the meeting.
2.2. Supporting papers for these items need to be submitted at least seven working days before the
meeting takes place. Late papers will be accepted only with the agreement of the chair and
managing director.
2.3. The agenda and supporting papers will be circulated to all members of a meeting by the
secretariat at least five working days before the meeting takes place.
2.4. Late papers will be accepted only with the agreement of the chair and managing director.
2.5. Agendas and public papers for the joint board, including meeting dates, times and venues, will
be published on the websites of the three WEL CCGs (www.newhamccg.nhs.uk,
www.towerhamletsccg.nhs.uk, http://www.walthamforestccg.nhs.uk/).
3. Petitions
3.1. Where a petition is received by any of the WEL CCGs on a subject that falls within the remit of
the joint board, the chair and secretariat will include the petition as an item for the agenda of
the next meeting of the joint board.
3.2. Where a petition is received by any of the WEL CCGs on a subject that falls outside the remit of
the joint board, it will be heard by the receiving CCG’s governing body in accordance with
current practice. The Joint Board will note the petition before referring to CCG Board.
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4. Motions
4.1. Members of the three WEL CCGS may move motions at the joint board by sending a written
notice to single accountable officer or managing director at least ten working days prior to a
meeting of the joint board. Motions will be formally proposed by the chair and must be
seconded by another member of the joint board. A decision of the joint board to carry a motion
requires a simple majority vote in favour.
5. Chairing the joint board
5.1. Section 10 of the joint board’s terms of reference describe how the chair and deputy chair will
be appointed.
5.2. At any meeting of the joint board, the chair of the joint board shall preside.
5.3. If the chair is absent from the meeting, the deputy chair will preside.
5.4. In the event of conflicts of interest for the chair and deputy chair, the meeting will be chaired by
the remaining CCG chair or, failing that, the meeting will appoint a chair from the remaining
GPs. In the event that all GPs are excluded due to conflicts of interest, the meeting will be
chaired by the Lay Vice Chair for the item(s) excluding all GPs
6. Chair’s rulings
6.1. The decision of the chair of the board on questions of order, relevancy and regularity, and
interpretation of these standing orders and the joint board’s terms of reference, shall be final.
The chair will rule only following consultation with the lay member for audit and governance on
the joint board.
7. Quorum
7.1. The quorum of the joint board is set out in sections 8 and 10 of the joint board’s terms of
reference.
7.2. Members’ deputies are included within the quoracy.
7.3. Each person at the meeting can count to towards the quoracy only once.
7.4. Where no quorum exists, no decision can be made by the meeting. In this situation, and where
an urgent decision is required, the accountable officer and joint board chair may use the
powers described in section 9 below.
8. Decision making (process)
8.1. Decisions of the joint board require a simple majority in favour.
8.2. All members of the joint board (or their deputies, when present) have one vote.
8.3. Generally, it is expected that at the joint board will reach decisions by consensus, without
formal voting. Should it be clear that consensus on an issue does not exist, the chair will call a
vote of members. This will allow members to cast their votes and have their positions recorded.
8.4. Any member not attending a meeting can be asked to vote by email where a decision is
required.
8.5. All votes will be recorded in the minutes.
9. Urgent decisions (process)
9.1. The decision-making powers of the joint board, as set out in its terms of reference and these
standing orders, may where an urgent decision is required be exercised collectively by the
accountable officer and joint board chair, after having consulted at least two lay members from
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the joint board membership (including the lay member for audit and governance) and if it is not
possible to call an extraordinary meeting of the Board.
9.2. The exercise of such powers shall be reported to the next formal meeting of the joint board in
public for formal ratification. The instances when this occurs should also be reported annually
to the Audit Committees in Common to consider the use of this power and it was deemed
appropriate.
10. Committees and sub-committees
10.1. The joint board may not delegate any of its decision-making powers to a sub-committee.
However, it may appoint sub-committees to advise and assist the joint board in carrying out its
role.
10.2. The joint board may also establish working groups, reporting to it.
10.3. The terms of reference for any sub-committee or working group will be agreed by the board and
included as an annex to this document.
10.4. The joint board may receive reports and recommendations from relevant experts and from any
sub-committees or working groups established by it.
11. Suspension of standing orders
11.1. Except where it would contravene any statutory provision or any direction made by the
Secretary of State for Health or NHS England, any part of these standing orders may be
suspended at any meeting of the joint board, provided a minimum of two-thirds of the members
present are in agreement.
11.2. A decision to suspend standing orders, together with the reasons for doing so, shall be
recorded in the minutes of the meeting. The instances when this occurs should also be
reported annually to the Audit Committees in Common to consider the use of this power and it
was deemed appropriate.
11.3. A separate record of matters discussed during the suspension shall be kept by the joint board’s
secretariat. These records shall be made available to the CCGs’ audit committees for review of
the reasonableness of the decision to suspend standing orders.
12. Record of attendance
12.1. The names of all members and attendees present at each meeting shall be recorded in the
minutes.
12.2. Any member not attending two or more meetings of the joint board within a full year will discuss
the reasons with the chair of the joint board, who may ask the member to stand down.
13. Minutes and summaries
13.1. The secretariat will draft minutes of each meeting, for approval by the chair, within five working
days of the meeting. Once approved by the chair, minutes will be circulated to members for
information. Minutes will be ratified at the following meeting and signed by the chair.
13.2. The secretariat will also produce a high-level summary of each meeting, which outlines
discussion points and decisions taken. This will be agreed with the chair, circulated to
governing body members, and published on the CCGs’ websites within five working days of the
meeting.
13.3. Meeting papers will be cascaded by local governance leads to governing body members, for
information and comment.
14. Admission of public and the press
14.1. The joint board has a duty to promote public engagement in, and awareness of, its activities.
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14.2. The joint board will meet in public, except as otherwise agreed by members and the chair. The
joint board may resolve to exclude the public from a meeting, either in part or in whole, if it is
judged that publicity would be prejudicial to the public interest by reason of any of the following:
the confidential nature of the business to be transacted – relating to patient, employee, or
commercial confidentiality;
where public disclosure could prejudice an on-going investigation, internal disciplinary
actions, or legal case;
where discussion in public would inhibit free and frank exchange of views between joint
board members or cause public concern and prejudice CCG’s ability to offer an effective
service;
other special reason stated in the resolution and arising from the nature of that business or
of the proceedings;
any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as
amended or succeeded from time to time; or
general disturbance.
14.3. Questions from the public regarding items on the agenda may be lodged in advance with the
secretariat or raised in person at the meeting when the public is invited to do so.
14.4. The press will be permitted to join all meetings held in public.
14.5. If any member of the public, press, or board is deemed to be disruptive, the chair may exclude
them from the meeting, with the reason for exclusion being recorded in the minutes.
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The WEL Collaboration of CCGs
Joint Board: conflict of interest policy
Version: 0.3
Date: 10 July 2019
Content
1 Purpose
2 Scope
3 Policy statement
4 Responsibilities
5 Declarations
6 The process – registering declarations of interest
7 Declarations of interests at meetings of the joint board
8 Interests and gifts
9 Advice, training, monitoring compliance, effectiveness of the policy
Appendix
1 Conflicts of interest declaration form
(for any joint board members who is not a member of a WEL CCG governing body)
1. Purpose
i. This policy sets out how the three WEL CCGs – Newham CCG, Tower Hamlets CCG, and
Waltham Forest CCG – will manage conflicts of interest relevant to the operation of their new
joint board. The aim of this policy is to protect members of the joint board from any appearance
of impropriety and to demonstrate transparency in the workings of the joint board and to give
confidence to the public and partners that decision-making is fair and transparent.
ii. The policy sits alongside the three CCGs’ individual conflicts of interest policies. It has been
devised to:
reflect the fact that the CCGs’ legal obligation to avoid potential conflicts of interest includes
the workings of the new joint board;
demonstrate awareness that the joint board’s management of conflicts of interest requires
additional explanation beyond the three CCGs’ individual policies; and
minimise the additional administrative requirements of managing conflicts of interest, on
top of the processes already in place in each CCG.
iii. The three CCGs’ governing bodies are responsible for the actions of the joint board. This
includes the joint board’s stewardship of significant public resources and commissioning of
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effective healthcare services for the three boroughs. The governing bodies will therefore ensure
that the working of the joint board inspires confidence and trust amongst patients, staff,
partners, funders and suppliers by demonstrating integrity and avoiding any potential or real
situations of undue bias or influence in its decision making.
iv. The joint board, through this policy, will respect the seven principles of public life articulated by
the Nolan Committee: selflessness, integrity, objectivity, accountability, openness, honesty, and
leadership.
2. Scope
i. This policy applies to all members of the WEL CCGs’ joint board, as well as members of any sub-
committees established by the joint board to advise and assist to in carrying out its role.
ii. It is additional to the CCGs’ current conflicts of interest policies in that it requires joint board
members to declare interests relevant to all of the WEL CCGs rather than a single CCG.
iii. For the full context of this policy, it should be read alongside the following documents, which
set out generic guidelines and responsibilities for NHS organisations and general practitioners in
relation to conflicts of interest:
the WEL CCGs’ constitutions, standing orders, schemes of reservation and delegation, and
standing financial instructions;
the WEL CCGs’ conflicts of interest policies;
Code of conduct for NHS managers;
Appointments Commission: Code of Conduct and Code of Accountability;
The Healthy NHS Board: Principles for Good Governance;
General Medical Council: Good Medical Practice;
National Health Service (Procurement, Patient Choice and Competition) (No 2) Regulations;
National Health Service Act 2006 (as amended by the Health & Social Care Act 2012);
NHSE Guidance issued in December 2014; and
NHSE Revised Statutory Guidance issued in July 2017.
iv. The WEL CCGs will make sure that all members of the joint board, and all staff and others
involved in the working of the joint board, are aware of the existence of this policy.
v. Joint board members should also refer to their respective professional codes of conduct relating
to the declaration of conflicts of interest.
3. Policy Statement
i. This policy supports a culture of openness and transparency in the work of the joint board.
ii. All joint board members, as well as CCG staff and others involved in the working of the joint
board, are required to:
ensure that the interests of local patients and residents remain paramount at all times;
be impartial and honest in the conduct of their official business;
use public funds in a way that secures best value for money;
ensure that they do not abuse their official position for personal gain or the benefit of their
family or friends; and
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ensure that they do not seek to advantage or further private or other interests in the course
of their official duties.
iii. The CCGs recognise that:
a perception of wrongdoing, impaired judgement or undue influence can be as detrimental
as any of them actually occurring;
if in doubt, it is better to assume the existence of a conflict of interest and mange it
appropriately rather than ignore it; and
for a conflict of interest to exist, financial gain is not necessary.
iv. The three CCGs will view instances where this policy is not followed as serious and may take
disciplinary action against individuals as appropriate.
4. Responsibilities
i. It is the responsibility of members of the joint board, as well as all staff and others involved in the
working of the joint board, to ensure that they are not placed in a position which creates a
potential conflict between their private interests and their duties on the joint board.
ii. The three WEL CCGs all need to be aware of all situations where a joint board member has
interests outside of his or her role on the joint board, where that interest has potential to result
in a conflict of interest between the individual’s private interests and their role on the joint
board.
iii. All joint board members must therefore declare relevant and material interests to the secretariat
of the joint board upon appointment, when a new conflict of interest arises, or upon becoming
aware that any of the three CCGs has entered into or proposes entering into a contract in which
they or any person connected with them has any financial interest, either direct or indirect.
iv. Additional attendees at the joint board are responsible for making relevant declarations at
meetings in which they participate.
v. Board members and attendees should not use confidential information acquired in the execution
of their role to benefit themselves or another person.
5. Declarations
i. All members of the joint board are required to declare any relevant and material interests, as
well as any gifts or hospitality offered and received in connection with their role on the joint
board.
ii. Through the secretariat of the joint board, the CCGs have arrangements to ensure that members
of the joint board declare any conflict or potential conflict as soon as they become aware of it,
and in any event within 28 days. The secretariat will record the interest in the joint board register
as soon as it is informed.
iii. Interests that may impact on the work of the joint board and should be declared include
(including a family member, spouse or partner):
No member of the joint board may have a material interest (e.g. shareholder of more than
5% of the nominal share capital) in that provider organisation. This would not exclude their
practice from joining a primary care network/federation/provider, or another member of
their practice team having a leadership role within the network/federation/provider. No
member of the joint board may be an office holder of the Local Medical Committee
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Any directorships, including non-executive directorships, held in private companies or public
limited companies (with the exception of those of dormant companies) of companies likely
to be engaged with the business of any of the WEL CCGs
Ownership or part ownership of companies, businesses, or consultancies which may seek to
do business with any of the WEL CCGs
Previous or current employment or consultancy positions
Voluntary or remunerated positions, such as trusteeship, local authority positions, other
public positions
Membership of professional bodies, mutual support organisations, or positions of trust in a
charity or voluntary organisation in the field of health and social care
Investments in unlisted companies, partnerships, and other forms of business, major
shareholdings (more than £25,000 or 1% of the nominal share capital) and beneficial
interests
Gifts or hospitality offered by external bodies in the last twelve months, and whether they
were declined or accepted
Receipt of research funding or grants from any of the WEL CCGs or related parties
Interests in pooled funds that are under separate management (any relevant company
included in this fund that has a potential relationship with any of the WEL CCGs must be
declared)
Formal interest with a position of influence in a political party or organisation
Current contracts with any of the WEL CCGs in which the individual has a beneficial interest
Any other employment, business involvement or relationship or that of a spouse or partner
that conflicts, or may potentially conflict with the interests of any of the WEL CCGs
Any other conflicts or potential conflicts that are not covered by the above
iv. Where joint board members are unsure whether a situation falling outside of the above
categories may give potential for a conflict of interest, they should seek advice from the WEL
CCGs’ Director of Corporate Services.
v. The secretariat of the joint board will prompt members when their declarations must be
updated.
6. The process – registering declarations of interests
i. Members of the joint board might will generally – though not necessarily – be members of the
WEL CCGs’ individual governing bodies.
ii. Where a member of the joint board is a member of a CCG governing body and has made a
declaration of interests to that CCG, he or she should update the existing declaration to ensure
that it covers all the requirements set out in section 5 above. This updated declaration should be
submitted to the joint board secretariat.
iii. Where a member of the joint board is not a member of a WEL CCG governing body, he or she
should complete the form in appendix 1 and submit this declaration to the joint board
secretariat.
iv. Where there are no interests to declare, a nil return is required.
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v. The secretariat will collate the declarations of all joint board members, which will then be
available for inspection as a combined register on each of the WEL CCGs’ websites.
vi. This combined register will be published within the CCGs’ annual report(s) and reported annually
to a meeting of the CCGs’ Audit Committees in common.
vii. The secretariat of the joint board will work with the WEL CCGs’ governance team to ensure that,
as a matter of course, declarations of interest are made and regularly confirmed or updated. This
includes the following circumstances:
On appointment to the joint board: when an appointment is made, a formal declaration of
interests (either updated or new, as detailed above) is required;
At meetings of the joint board and any of its sub-committees: all joint board members and
attendees must declare any interest in any agenda item before it is discussed or as soon as the
interest becomes apparent. Even if an interest is declared in the register of interests, it should
be declared in meetings where matters relating to that interest are discussed. Declarations of
interests are recorded in minutes of meetings;
Six-monthly: the secretariat of the joint board will ask all board members to update their
declarations of interest on a six-monthly basis so that the declarations remains accurate; and
Any change of circumstances: wherever an individual’s circumstances change in a way that
affects the individual’s interests (e.g. where an individual takes on a new role outside of the
joint board or sets up a new business or relationship), a further declaration should be made to
reflect the change in circumstances. This could involve a conflict of interest ceasing to exist or
a new one materialising.
6. Declarations of interests at meetings of the joint board
i. The agenda (both public and confidential agenda) for meetings of the joint board and its sub-
committees will contain a standing item at the commencement of each meeting, requiring
members to declare any interests relating specifically to the agenda items being considered. If
during the course of a meeting, an interest not previously declared is identified, this shall be
declared. The minutes of the meeting should detail all declarations made and any relevant
responses and/or action taken.
ii. The secretariat of the joint board shall endeavour to ensure that reports for consideration by the
joint board identify potential conflicts of interest and that these are managed proactively with
joint board members.
iii. Joint board members must be specific when declaring interests. They should state which agenda
the potential conflict of interest relates to and the nature of that conflict. Where an interest is
significant or when the individual or a connected person has a direct financial interest in a
decision, the chair will direct the individual not to take part in the discussion or vote on the item.
The chair of the meeting may ask that a member leave the room if they have a significant interest
or a direct financial interest in a matter under discussion. Where the chair has made a declaration
of interest relevant to an item, they should not chair the meeting for that particular item.
iv. All agendas of joint board and sub-committee meetings will include the following paragraphs
under the declaration of interest item:
Financial interests: If you have a direct financial interest in any matter on the agenda you
must not participate in any discussion or vote on that matter. If you do so, you may be
committing a criminal offence, as well as a breach of the joint board’s conflict of interest
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policy. The individual should leave the meeting (including any public seating area) during
consideration of the matter.
Non-financial professional interests: The joint board conflicts of interest policy requires you
to make a verbal declaration of the existence and nature of any non-financial professional
interests. Any member who does not declare these interests in any matter when they apply
may be in breach of the policy. A decision in relation to that business might reasonably be
regarded as affecting your well-being or financial standing, or that of a member of your
family, or a person with whom you have a close association, with to a greater extent than it
would affect the majority of the GPs or other joint board members.
Non-financial personal interests: The joint board conflicts of interest policy requires you to
make a verbal declaration of the existence and nature of any non-financial personal
interests. Any member who does not declare these interests in any matter when they apply
may be in breach of the policy. A decision in relation to that business might reasonably be
regarded as affecting your well-being or financial standing, or that of a member of your
family, or a person with whom you have a close association, with to a greater extent than it
would affect the majority of the GPs or other joint board members.
Indirect interests: The joint board conflicts of interest policy requires you to make a verbal
declaration of the existence and nature of any indirect interests. Any member who does not
declare these interests in any matter when they apply may be in breach of the policy.
8. Interests and gifts
i. Interests and gifts received by joint board members will be:
where the joint board member is a member of a WEL CCG governing body, recorded on the
CCG’s register of gifts and hospitality (as already required) and communicated to the
secretariat of the joint board for inclusion on a combined joint board register of gifts and
hospitality; and
where the joint board member is not a member of a WEL CCG governing body,
communicated to the secretariat of the joint board for inclusion on a combined joint board
register of gifts and hospitality.
ii. The combined register of gifts and hospitality will be accessible by the public on the WEL CCGs’
websites.
9. Advice, training, monitoring compliance, effectiveness of the policy
i. This policy will be reviewed annually by the WEL CCGs’ Audit Committees to ensure it remains fit
for purpose.
ii. All those required to comply with the policy will be required to undertake mandatory conflicts
management training, as directed by NHS England, as well as being reminded of the policy and
associated management process at least annually by the joint board secretariat.
iii. The chairs of the CCGs’ Audit Committees act as the CCGs’ conflicts of interest guardians. They
will support the WEL CCGs’ Director of Corporate Services in respect of providing advice on
conflicts of interest cases, overall conflicts of interest management, and training relevant to the
operation of the joint board.
iv. The WEL CCGs’ Director of Corporate Services and the CCGs’ Audit Committee Chair will review
register entries on a regular basis and take any action necessary. They will also review the
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combined declarations of interest register at least annually to consider if further advice should be
offered to any or all members of the joint board.
10. RAISING CONCERNS & BREACHES
10.1 It is the duty of every WELCCG employee, governing body member, committee or sub-
committee member and GP practice member to speak up about genuine concerns in relation to the
administration of the CCG’s policy on conflicts of interest management, and to report these
concerns. These individuals should not ignore their suspicions or investigate themselves, but rather
speak to WELCCG Director of Corporate Services or to the Conflicts of Interest Guardian point of
contact for these matters.
10.2 Any non-compliance with WELCCG’s conflicts of interest policy should be reported in
accordance with the terms of this policy, and the CCG’s whistleblowing policy (where the breach is
being reported by an employee or worker of WELCCG) or with the whistleblowing policy of the
relevant employer organisation (where the breach is being reported by an employee or worker of
another organisation).
10.3 Effective management of conflicts of interest requires an environment and culture where
individuals feel supported and confident in declaring relevant information, including notifying any
actual or suspected breaches of the rules. WELCCG’s Director of Corporate Services or the Conflicts
of Interest Guardian should be able to provide advice, support, and guidance on how conflicts of
interest should be managed, should ensure that organisational policies are clear about the support
available for individuals who wish to come forward to notify an actual or suspected breach of the
rules, and of the sanctions and consequences for any failure to declare an interest or to notify an
actual or suspected breach at the earliest possible opportunity.
10.4 Anonymised details of breaches should be published on WELCCG’s website for the purpose of
learning and development.
10.5 Failure to comply with the CCG’s policies on conflicts of interest management, pursuant to this
statutory guidance, can have serious implications for the CCG and any individuals concerned. The
CCG’s Managing Director will ensure that individuals who fail to disclose any relevant interests or
who otherwise breach the CCG’s rules and policies relating to the management of conflicts of
interest are subject to investigation and, where appropriate, to disciplinary action or to refer to the
relevant regulatory body by the Managing Director.
It is the duty of every CCG employee, governing body member, committee or sub-committee
member and GP practice member to speak up about genuine concerns in relation to the
administration of the CCG’s policy on conflicts of interest management, and to report these
concerns. These individuals should not ignore their suspicions or investigate themselves, but rather
speak to the Conflicts of Interest Guardian or the CCG Director of Corporate Services in the first
instance. In the event that there is a concern regarding the Conflicts of Interest Guardian, this should
be raised with the Governing Body Chair and Managing Director in the first instance. The CCG Head
of Governance will maintain a Register of Breaches which sets out:
How it has been investigated;
The governance arrangements and reporting mechanisms;
How this policy links to whistleblowing and HR policies;
Who to notify at NHS England and when to do so;
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All breaches will be reported to the CCG’s Audit Committees in Common, and will be reported to the
WEL CCGs Joint Board through a Standing Item in the Audit Committee Overview Report.
Anonymised details of breaches will be published on the CCG’s website for the purpose of learning
and development. Statutorily regulated healthcare professionals who work for, or are engaged by,
CCGs are under professional duties imposed by their relevant regulator to act appropriately with
regard to conflicts of interest. The CCG will report statutorily regulated healthcare professionals to
their regulator if they believe that they have acted improperly, so that these concerns can be
investigated. Statutorily regulated healthcare professionals should be made aware that the
consequences for inappropriate action could include fitness to practise proceedings being brought
against them, and that they could, if appropriate, be struck off by their professional regulator as a
result.
10.6 WEL CCGs will ensure that employees, governing body members, committee or sub-committee
members and GP practice members are aware of how they can report suspected or known breaches
of the CCG’s conflicts of interest policies, including ensuring that all such individuals are made aware
that they should generally contact the CCG’s designated Conflicts of Interest Guardian or the Head of
Governance in the first instance to raise any concern. They should also be advised of the
arrangements in place to ensure that they are able to contact the Conflicts of Interest Guardian on a
strictly confidential basis.
10.7 It is WELCCG policy that anyone who wishes to report a suspected or known breach of the
policy, who is not an employee or worker of the CCG, should also ensure that they comply with their
own organisation’s whistleblowing policy, since most such policies should provide protection against
detriment or dismissal.
10.8 WELCCG’s Conflicts of Interest Guardian is in a position to cross refer to and comply with other
policies within the CCG on raising concerns, counter fraud, or similar as and when appropriate.
10.9 All such notifications should be treated with appropriate confidentiality at all times in
accordance with WELCCG’s policies, (Whistleblowing) and applicable laws, and the person making
such disclosures should expect an appropriate explanation of any decisions taken as a result of any
investigation.
10.10 Furthermore, providers, patients and other third parties can make a complaint to NHS
Improvement in relation to WELCCG’s conduct under the Procurement Patient Choice and
Competition Regulations. The regulations are designed as an accessible and effective alternative to
challenging decisions in the courts.
32
Declaration of interests for CCG members and employees
Please complete the form and return to the address below:
Name:
Position within, or relationship with, NELCA or a NEL CCG [please state which CCG]:
Detail of interests held (complete all that are applicable):
Type of Interest* *See reverse of form for details
Description of Interest (including for indirect Interests, details of the relationship with the person who has the interest)
Date interest relates From & To
Actions to be taken to mitigate risk
(to be agreed with line manager or a senior CCG manager. Please confirm arrangements with the Governance Team.)
The information submitted will be held by the NEL CCGs for personnel or other reasons specified on this form and
to comply with the organisation’s policies. This information may be held in both manual and electronic form in
accordance with the Data Protection Act 2018. Information may be disclosed to third parties in accordance with
the Freedom of Information Act 2000 and published in registers that the NEL CCGs hold.
I confirm that the information provided above is complete and correct. I acknowledge that any changes in these
declarations must be notified to the CCG as soon as practicable and no later than 28 days after the interest arises.
I am aware that if I do not make full, accurate and timely declarations then civil, criminal, or internal disciplinary
action may result.
I do / do not [delete as applicable] give my consent for this information to published on registers that
the CCG holds. If consent is NOT given please give reasons:
Signed: Date: Signed: Position: Date: (Line Manager or Senior CCG Manager) Return to: NELCA Board Secretary, 4th Floor, Unex Tower, 5 Station Street, London E15 1DA [email protected]
33
Guidance Note for Completion of the declaration form This form must be completed by all NELCA/CCG members on appointment and updated as interests change or new interests are identified. Decision making staff should be aware that the information provided in this form will be added to the CCG’s registers which are held in hardcopy for inspection by the public and published on the CCG’s website. Decision making staff must make any third party whose personal data they are providing in this form aware that the personal data will held in hardcopy for inspection by the public and published on the CCG’s website and must inform the third party that the CCG’s privacy policy is available on the CCG’s website. If you are not sure whether you are a ‘decision making’ member of staff, please speak to your line manager before completing this form. It should also be completed by any employees, persons serving on all committees and other decision-making groups and as soon as a potential conflict of interest is identified or if requested by the Accountable Officer as part of the annual review of interests. “Relevant and material interests” are defined as:
any directorships including non-executive directorships held in private companies or public
limited companies (with the exception of those of dormant companies) of companies likely to be engaged with the business of the clinical commissioning group
ownership or part ownership of companies, businesses or consultancies which may seek to do business with NELCA
previous or current employment or consultancy positions
voluntary or remunerated positions, such as trusteeship, local authority positions, other public positions
membership of professional bodies, mutual support organisations or a position of trust in a charity or voluntary organisation in the field of health and social care
investments in unlisted companies, partnerships and other forms of business, shareholdings and beneficial interests
gifts or hospitality offered to you by external bodies and whether this was declined or accepted in the last twelve months
receipt of research funding / grants from NELCA or related parties
interests in pooled funds that are under separate management (any relevant company included in this fund that has a potential relationship with the CCG must be declared)
formal interest with a position of influence in a political party or organisation
current contracts with NELCA in which the individual has a beneficial interest
any other employment, business involvement or relationship or that of a spouse or partner that conflicts, or may potentially conflict with the interests of NELCA
any other conflicts that are not covered by the above. Where individuals are unsure whether a situation falling outside of the above categories may give potential for a conflict of interest they should seek advice from the Accountable Officer.
34
Types of interest:
Type of Interest Description
Financial Interests This is where an individual may get direct financial benefits from the consequences
of a commissioning decision. This could, for example, include being:
• A director, including a non-executive director, or senior employee in a private
company or public limited company or other organisation which is doing, or which is
likely, or possibly seeking to do, business with health or social care organisations
• A shareholder (or similar owner interests), a partner or owner of a private or not-
for-profit company, business, partnership or consultancy which is doing, or which is
likely, or possibly seeking to do, business with health or social care organisations
• A management consultant for a provider
• In secondary employment
• In receipt of secondary income from a provider
• In receipt of a grant from a provider
• In receipt of any payments (for example honoraria, one off payments, day
allowances or travel or subsistence) from a provider
• In receipt of research funding, including grants that may be received by the
individual or any organisation in which they have an interest or role
• Having a pension that is funded by a provider (where the value of this might be
affected by the success or failure of the provider).
Non-Financial
Professional
Interests
This is where an individual may obtain a non-financial professional benefit from the
consequences of a commissioning decision, such as increasing their professional
reputation or status or promoting their professional career. This may, for example,
include situations where the individual is:
• An advocate for a particular group of patients
• A GP with special interests e.g., in dermatology, acupuncture etc.
• A member of a particular specialist professional body (although routine GP
membership of the RCGP, BMA or a medical defence organisation would not
usually by itself amount to an interest which needed to be declared)
• An advisor for Care Quality Commission (CQC) or National Institute for Health and
Care Excellence (NICE)
• A medical researcher.
Non-Financial
Personal Interests
This is where an individual may benefit personally in ways which are not directly
linked to their professional career and do not give rise to a direct financial benefit.
This could include, for example, where the individual is:
• A voluntary sector champion for a provider
• A volunteer for a provider
• A member of a voluntary sector board or has any other position of authority in or
connection with a voluntary sector organisation
• Suffering from a particular condition requiring individually funded treatment
• A member of a lobby or pressure groups with an interest in health.
Indirect Interests This is where an individual has a close association with an individual who has a
financial interest, a non-financial professional interest or a non-financial personal
interest in a commissioning decision (as those categories are described above). For
example, this should include:
• Spouse / partner
• Close relative e.g., parent, grandparent, child, grandchild or sibling
• Close friend
• Business partner.
35
WEL Board – part I
Date: 24 July 2019
Title of report Healthwatch Report
Item number 3.1
Author Selina Rodrigues, Head of Healthwatch Newham
Presented by Selina Rodrigues
Contact for further information Selina Rodrigues selina.
Executive summary An evaluation of the NHS Healthier You Diabetes programme in
Newham.
Action required Note
Where else has this paper been
discussed?
No previous presentation to any previous meetings/forums.
Next steps/ onward reporting None
Strategic fit N/A
What does this mean for local
people?
N/A
How does this drive change and
reduce health inequalities?
N/A
Financial Implications None
Risks None
Equality impact None
36
1
Healthwatch Newham, Tower Hamlets and Waltham Forest Briefing on Diabetes and Outpatients
WEL CCG Board Wednesday 24th July 2019
Introduction Healthwatch Newham, Tower Hamlets and Waltham Forest will present a report to each WEL CCG Board, ensuring that the local residents’ voice is heard at the Board.
This report
Requests that Healtwatch having a standing Agenda item at each WEL CCG Board and
that a key part of our role is in supporting the WEL Board to make informed
commissioning decisions that put patients/residents at the centre of those decisions, is
formally noted in the minutes.
Requests that a Board Forward Plan is produced to enable Healthwatch to present
papers that are of relevance and use to the items on the Agenda and to the Board.
Requests that first-hand patient stories are also presented to the Board, to ensure that
patient voice is heard at this forum.
Provides the key findings from Newham and Tower Hamlets residents’ feedback on theirawareness of and experience of diabetes conditions, support and patient care
Provides Tower Hamlets’ review of feedback on outpatient care and appointments
(attached). The report is a good representation of RLH and WXH, with the possibility of
adding NUH (sample data included). The report is useful for comparing hospital trends
and also good at identifying potential problems at departments - RLH Fracture Clinic
(Page 9, figure 7.1) or WXH Ophthalmology (Page 9, figure 7.2).
Please note that this report was produced at short notice so it has not been able to include all the current insight from the different Healthwatch.
Key Findings on Diabetes Although the engagement ranges from 2016 to 2019, we find the trends are consistent across this timescale and the different Boroughs.
Residents are generally positive about the quality of care, once diagnosed. However,there is some variability with some GPs proactively offering health checks and for somepatients, there was confusion about whether this was in place.
Residents trusted the guidance given to them by NHS staff at the pre-diabetes anddiagnosed diabetes stage.
Young people said that ‘fast-food’ is chosen, because it is cheaper than ‘healthy food’.
Young people tended to think that diabetes was something to think about ‘in the future’.
Participants were positive about Newham’s pilot of the national model of the DiabetesPrevention Programmme, particularly the skills of the facilitator but had some concerns(see the point below).
Residents repeatedly requested support and guidance that was specific to their age, orculture or could be adapted or implemented for people with disabilities. For example, thisincludes age-specific exercise, accessible venues and equipment and support fordisabled people and language interpretation services and culturally specific guidance onfood for different communities.
37
2
Evaluation of the NHS Healthier You Diabetes Prevention Programme in Newham (Extract from full report)
Introduction Between January and June 2018, Healthwatch Newham was commissioned to carry out structured surveys with Newham residents who had been referred to the then-pilot NHS Healthier You programme. We met with Reed Momenta the provider at that time of the community sessions, engaged participants at 4 GPs through 5 sessions of phone calls surveys and attended five programme sessions.
The questions followed the patient journey from the referral at their GP practice, to the provider/reed contact and finally experience of the programme content and logistics. Demographic information was also collected to allow comparisons, by different characteristics, to be made.
Findings Patients said they found the information useful, particularly on how to adapt their diet and about different types of exercise. Some had not understood about diabetes at first, some had to wait a long time for their referral to the programme and for others, the lack of information in different community languages meant they could not participate in sessions.
Benefits The findings showed that for people undertaking the programme there were benefits, particularly those who have come to the end of it.
There had been many benefits for participants including: meeting other people withdiabetes, lowering their risk and continuing with the lifestyle changes;
The groups of participants we spoke with were diverse in terms of their age, ethnicity andbackground, showing that the programme can work for a wide range of communities;
Similarities between these participants were based around their willingness to improvetheir health, and as a result commit to the programme whatever their circumstances.
Challenges We discovered that in Newham, there were some challenges.
Difficulties in accessing and understanding the programme for non-English speakers
Participants were likely to miss sessions during the holiday seasons and this was alsoconfirmed by the programme coach
There were currently a number of issues with the referral process, including ineligible,delayed and forgotten referrals
Numbers of people who said they had not been referred, despite being classified asreferred by the GP. This pointed towards potential difficulties with either: the onlinesystem and referral pathway; the quality of the information provided by GP practice staff;or patient understanding (as a result of language barriers)
Post Report Note This report was presented to NCCG which has now taken action to improve the process for patients and to make sure there is clear information about diabetes, including communicating with different communities across Newham.
38
3
health
According to a 2017 Diabetes UK survey, 6.8% of the borough’s population suffers from
diabetes; a percentage slightly higher than the national average of 6.5%. The survey,
carried out across the UK, found that 66 per cent of adults eat three or fewer portions of
fruit and/or vegetables a day with 46 per cent not eating any fruit for at least three days
a week.
A 2018 NHS survey found that child obesity levels in Tower Hamlets are among the highest
in London, with nearly a quarter of Year 6 Pupils being classed as obese.
Healthwatch Tower Hamlets has been engaging with patients
suffering from diabetes on their use of specialist NHS services,
as well as with local residents in general on preventing
diabetes and promoting healthy lifestyles.
In 2018 and 2019, we received comments from 57 diabetes
patients on the services they used.
We also:
- Engaged online with 16 diabetes patients in March 2019,
including four mothers with gestational diabetes, ten people
aged 50+ suffering from Type 2 diabetes and two people suffering
from Type 1 diabetes.
- Conducted semi-structured interviews with 28 young people on
their eating habits and their perceived risk of diabetes in
November 2018.
- Engaged with various groups of residents on health promotion
strategy as part of various engagement events in 2016, 2017 and
2018.
Healthwatch
Diabetes Briefing paper
39
4
Out of the 16 patients we have engaged with in March 2016, a majority were
diagnosed more than two years ago.
Seven out of the ten people suffering from Type 2
diabetes were diagnosed by their GP. One person
mentions being diagnosed by a hospital specialist
and one reports receiving the diagnosis after
presenting to A&E with complications including a
chest infection. One person claims to have self-
diagnosed.
One out of the four mothers diagnosed with
gestational diabetes says that it was found during
routine screening; one was diagnosed by her GP and two by hospital-based
specialists.
I have been told that I have diabetes, but I am not on any medication for it at the
moment. Six months ago, I visited my GP, my cholesterol was a bit high, he told me
that my blood results showed that I have diabetes. About one year ago I was warned
by my GP that I was on the base level of getting diabetes. I am an active person and I
look after my diet. My dad had diabetes, I was told my genes played a part. The GP
said I could reverse my diabetes if I looked after my diet and exercised. I do not
smoke or drink.
Based on all feedback received by Healthwatch
in 2018 and 2019, patient opinion of diabetes
services in the borough is broadly positive.
Patients are happy both with the care they
receive from hospital specialist services and
from their own GPs.
Diagnosis of diabetes
6%
19%
31%
44%
When were you diagnosed?
This year
Last year
2-5 years ago
More than 5 yearsago
NHS services for diabetes patients- treatment and management
63%
6%
31%
Positive
Neutral
Negative
020406080
100120
positive neutral negative
40
5
Medical staff in GP surgeries are perceived as professional and efficient and
pleasant. Patients feel involved in their care and empowered to make personalised
care plans.
A few weeks ago, I had an assessment and blood test as part of my diabetic care plan
carried out by your excellent HCA. I had noticed her before in her previous occupation
at the reception desk and had noted her lovely manner on the telephone and in face
to face communication with patients.
Less than a month ago I booked an appointment with a diabetic expert within the
practice. I booked it over the phone. I was seen within two-three days. I think that
was entirely reasonable. My experience booking the appointment was good.
My doctor listens to me and give me enough time to explain my problem. I am a
diabetic patient and they look after me so well. Overall, I am happy about my
treatment plan.
My GP in Bromley by Bow always provide excellent community health service [for
diabetes screening]. I think they are the best.
In terms of hospital care, the community clinic based at the Mile End Hospital is
praised by patients. On the other hand, several patients who used services at the
Royal London Hospital found it to be inefficient.
0102030405060708090
positive neutral negative
41
6
Patients find that the Mile End clinic is a valuable resource in terms of information
and advice on how to manage their diabetes. In particular, classes and group
activities are praised.
The doctors are very helpful and informative. I have been diagnosed a long time ago.
The letters from the doctors are very helpful.
At the diabetes clinic they explain everything really well, and how to do things to
help ourselves. They advise us regarding our diet and exercise. We had classes which
were really helpful. The advice they gave us in the classes I tried to implement them
into my life. They have been very beneficial. At the diabetes clinic they are
understanding and helpful.
The first class [at the Diabetes Centre] was very useful; there was some follow-up and
there’s a psychologist who started to run courses for people with diabetes- that was
very useful. They’re setting up a support group for diabetics and I plan on attending.
Diabetes clinic at Mile End Hospital- Best place to go the professor is great - listens
and understands the difficulties of being 62 and over weight.
The clinic is efficiently organised, and patients feel they understand what to
expect from their appointments; appointments letters are used to communicate
efficiently.
I receive regular injections and I am also checked on a regularly for different health
issues. The appointment letters have information on them about what the
appointment will be about. I really like the experience in this hospital as they provide
me the care I need.
I was diagnosed with diabetes 4 years ago. The appointment letters had a lot
information and there have been no complications and there have been no
complications with my diabetes.
The hospital sent a message before my appointment, which was helpful.
The staff and receptionist were really nice and friendly. They were well-organised,
and I knew where to go.
I took me about five minutes to be seen and waited for about another fifteen minutes
to be seen again. The service providers are very efficient with their time
management. I didn’t know how I would be seeing today for my appointment, as it
was for an eye screening. As I entered the hospital, the receptionist was very
welcoming and caring. I knew how to get may way around with the help of the
hospital leaflets that were on the counter, and there were directions on the wall.
This is why the hospital is very organised.
42
7
On the other hand, patients who used the Royal London Hospital found it less
efficient and more poorly organised.
Patient was sent two appointment letters despite the fact that she had contact the
appointment team to informed of her unavailability. Patient is upset that the
department is blaming her for not attending her appointment.
Complaint regarding treatment received when patient attended an outpatient’s
appointment. His test results were not available, and he felt the doctor didn't know
why he was there.
I have come for my diabetes check-up. The staff here are friendly. To improve I think
the service needs to run quicker.
Out of the 16 people whom we engaged with online, most received advice from
their GP and nearly half received advice from a community diabetic or dietetics
service.
Most people trusted the competence of professionals that they received advice
from. However, only a minority thought that the advice they receive was bespoke/
personalised in relation to their medical needs, circumstances and lifestyle.
0
1
2
3
4
5
6
7
8
9
10
My GP Hospital consultant (diabetics)
Midwife or meternity consultant Community diabetic/ dietetics service
Group education session Charity (ex Diabetes UK)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Advice came fromcompetent/ trustworthy
professional
Advice took into accountmy culture, needs and
beliefs
Advice was bespoke/personalised
I was able to create plan tomy needs
Strongly agree Agree Neither/nor Disagree Strongly disagree
43
8
The online engagement we have carried out with 16 respondents shows a good
level of screening uptake.
All 16 had had their blood pressure checked at least once in the last 12
months.
All 10 respondents with type 2 diabetes, one of the four mothers with
gestational diabetes and one of the two respondents with type one diabetes
had an eye test in the last 12 months.
All respondents with type 1 or type 2 diabetes had had a cholesterol check
in the last 12 months; as did two of the four mothers diagnosed with
gestational diabetes.
All respondents with type 1 and type 2 diabetes were aware of the fact that
they should check their feet regularly. All but one of them did it.
All but one of the 16 respondents had a flu jab in the last flu season. The
vast majority got it from their GP; only one person got it from a pharmacy
instead.
Only one respondent out of 10 was currently a smoker. Seven had never smoked,
five gave up before they were diagnosed with diabetes and three after they were
diagnosed.
With one exception (a lifelong non-smoker) all respondents were aware that
smoking cessation services are available in Tower Hamlets. However, use of the
service was low: out of the eight people who reported giving up smoking at some
point in their life, only four used smoking cessation services and only one found
them useful.
Screening; preventing complications
44
9
Discussions we have had with local residents seem to indicate that Tower Hamlets
is a food swamp: a place where, while healthy food options are not generally
unavailable, unhealthy food is plentiful and difficult to avoid.
Another aspect that came up was that unhealthy food is likely to be cheaper
than healthy food. Therefore, wealth inequality in the borough is likely to
translate into health inequality, with the poorest residents having the highest risk
of diabetes.
In November 2019, we have engaged with 28 young people, on their dietary
choices, including consumption of fast food, sweets and fizzy drinks. We have
found that:
Half of respondents ate fast food at least weekly. Nearly two thirds of respondents
ate sweets daily and just under half preferred water to other soft drinks.
Prevention and the wider picture
“I eat fast food probably once a week, almost every
Saturday. My mum has work Friday night, she gets
tired and no one can be bothered to cook.”
(Young person, November 2018 interviews)
“Eating out at, say, a pub at lunchtime is
almost always demanding. Places that have
options for vegan, vegetarian or various
intolerances rarely offer anything to address
my needs, notably low carb. The diabetes
"message" is rarely understood. At home, I am
very privileged to have a very supportive
partner who is an excellent cook but I think
this is pretty rare.”
(Older person diagnosed with Type 2
diabetes, March 2019 online engagement)
“At almost every local PFC there are no healthy
options such as salads, it’s just fatty foods. I
don't really care about options as I do order the
same thing every time anyway.”
(Young person, November 2018 interviews)
46%
25%
25%
4%
Fast food
61%
4%
18%
18%
Sweets
Every day Three-six times/week
Once-twice/week Less than weekly
43%
11%
29%
14%
4%
Preferred drink
Water Water and juiceFizzy drink JuiceCoffee
45
10
Girls had somewhat better diets than boys: they ate fast food and sweets less
often, and they drank more water.
The cost of food was the chief influencing factor for respondents: fast food is
more affordable than healthier options, which makes young people more likely to
choose it.
Around a quarter of respondents mentioned peer pressure/socialising as a factor
that influences their fast food consumption; slightly less brought up the
availability of food at home.
Said the cost of food
influenced their
behaviour.
0%
20%
40%
60%
80%
100%
Girls Boys
Fast food
Not sure/varies Three-four times/week
Once-twice/week Less than once a week
0%
20%
40%
60%
80%
100%
Girls Boys
Sweets
Every day 3-6 days/week
Once-twice week Less than weekly
0%
20%
40%
60%
80%
100%
Girls Boys
Drink of choice
Water Water and juiceJuice Fizzy drinksCoffee
Said convenience
/speed influenced their
behaviour.
Said easy access
influenced their
behaviour.
“The price of PFC is just
so low that it is really
hard for you to choose
anything else over it. Nothing beats the amount
you get for a pound.”
“Timing matters especially
during school hours, you
cannot wait very long for your lunch, otherwise you
get late.”
64%
47%
% 39%
“It’s easy to get and so easy for
me to get done with school and
walk over to the PFC shop in the
direction of my home.”
46
11
Around half of respondents thought they were prone to diabetes. Most of those
who thought they were prone to it attributed it to a family history; most of those
who thought they were not attributed it to a healthy diet.
While most respondents had at least some awareness of how to prevent diabetes,
only a minority were actively taking steps to improve their diet and lifestyle. Most
thought this is something they may need to do in the future rather than a current
priority.
Half of respondents thought that they eat a balanced diet. Surprisingly, those who
thought their diet was balanced were more likely to eat fast food weekly or more
(but less likely to eat sweets daily). Those who thought they ate a balanced diet
and those who did not were equally likely to think they are prone to diabetes.
This is consistent with findings from previous research we have conducted in 2014
with 40 young Bangladeshi people, which finds that:
Most respondents associated diabetes with excessive consumption of sweets
and sugar
They associated diabetes with middle or old age and remarked upon how
the issue is not “on the radar” for young people.
They felt like young people in their community are not preoccupied with
preventing diabetes through a healthy diet, at least not at this point in their
lives.
They felt, however, that they know more about healthy eating than previous
generations and that they exercise more, as well as eating a more varied/
less traditional diet (but also more fast food).
Home-cooked traditional food, which can have a high fat content, was
identified as a risk factor alongside fast food.
They found that healthy food was expensive and less convenient to access
than unhealthy fast food.
They remarked upon the fact that healthy food is not advertised in the way
unhealthy food is.
They suggested information sessions in schools and subsidised gym
memberships as potential interventions to promote healthy living and
reduce the risk of diabetes.
47
12
In March 2019, we have also engaged online with 16 diabetes patients online on
food availability and peer interactions. The group included four new mothers
who had been diagnosed with gestational diabetes, ten older people diagnosed
with Type 2 Diabetes, and two Type 1 Diabetes sufferers.
Most respondents thought it was easy to find the types of food they need in their
local area. Affording financially to eat healthy and avoiding unhealthy food, on the
other hand, were seen as trickier.
Thinking about getting meals appropriate for their diet, respondents found it
slightly easier to shop in their local area for ingredients to cook at home than to
eat out.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Finding the types of food I need Avoiding unhealthy foods Affording the kind of food I need
Very easy Easy Difficult Very difficult/ impossible
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Easy to shop for healthy ingredients Easy to eat healthy out
Strongly agree Agree Neither agree not disagree Disagree Strongly disagree
48
13
They were broadly happy with the level of provision of spaces for physical activity.
Even though their own knowledge about diabetes was limited before they were
diagnosed, they believed that a good level of information is available locally.
In terms of socialising with family and friends, respondents were likely to eat
home-cooked meals and engage in light physical activity.
This points towards a potential of promoting light physical activity such as walks or
simple exercise as a social activity.
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
There are a lot of places where people like me can take part in physical activiy
Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
People like me have access to a good level of info
Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
My level of knowledge before diagnosis
Good Fair Poor
49
14
It would also be worth investigating patters of home cooking for eating alone/ with
household members only vs. cooking for guests.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
We go out toeat at a fastfood place
We go out toeat in a
restaurant
We eat sweets,such as cake or
biscuits
One of us cooksa light, healthy
meal
One of us cooksa large meal
We take part inlight physicalactivity (ex:
walking dogs inthe park)
We take part inmore strenuousphysical activity
(ex: we playfootball)
At least some ofus smoke
When socialising with family and friends...
Very often Often Sometimes Rarely Never
50
15
As part of our locality events in 2016, 2017 and 2018 we have engaged with local
residents through multiple tools and facilitation devices, in order to understand
how we can better promote healthy living.
Based on our research activities, we have found out:
For everyone
Walking is a popular way of staying physically active among many groups of
residents, including parents with children and older people.
Tower Hamlets residents think of walking as a leisure activity. They are
unlikely to walk to work or appointments, but more likely to walk for
pleasure- either for the enjoyment of walking/ being outdoors in green
space itself, or in order to visit local attractions and amenities such as
museums, shopping malls, cafes/restaurants or community events.
Respondents did not think of walking as a solitary activity; they prefer
walking with family members, children or friends.
Parks, natural areas and the canal/ waterfront were the top locations
mentioned as good places for walking.
Leisure centres are used by some residents but need better promotion.
The Better website is not user-friendly for people looking up information on
physical activity opportunities in the borough.
For children and young people
Play areas for children and families tend to be clustered around the King
Edward Memorial Park/ Shadwell Basin, Victoria Park, Stepney Green and
Mile End Park.
The neighbourhoods on the West of the borough (particularly the areas of
Bethnal Green, Spitalfields& Banglatown, St Katherine’s and Wapping) are
better-served by playgrounds, leisure centres and green spaces. The East of
the borough appears to have less play spaces, particularly the areas around
Bromley-by-Bow, Poplar and Blackwall. The wards with the highest
concentration of play areas are not necessarily the ones where the most
children live. Poor provision of play areas is associated with the more
deprived wards.
For families with children, a weekly family outing travelling by foot to local
amenities or community events can be a good occasion to walk.
Swimming, dancing and team sports were popular ways of engaging in
physical activity for children and teenagers.
Teenage girls are interested in having some girl-only activities.
Physical activity- possible interventions
51
16
For older people
Active seniors in Tower Hamlets are still interested in being engaged in
physical activity, according to their ability level; a lot of what is currently
available tends to be either too strenuous or too light for many people.
Provision of age and level appropriate exercise classes/ leisure centre
activity for older people who still work is poor.
Older residents we engaged with in 2018 expressed interest in walking
groups/ guided walks and tai chi classes.
The provision of specialist or adapted facilities for disabled people in leisure
centres is poor; more can be done to make leisure centres more inclusive
(including addition of specialist equipment, better guidance and training for
leisure centre staff, slightly increasing the temperature of water in
swimming pools to make it more suitable for arthritis sufferers, providing
charging points for mobility scooters and better provision of first aid in case
of emergency).
Leisure centres are not always welcoming to older people, in terms of
marketing, staff attitude and general presentation.
52
Disclaimer: The trends within this report are based on service user comments we have obtained from sources outlined on Page 2. Comments obtained from these sources may not be representative of all service users experiences or opinions.
Report compiled on 16 July 2019, to cover the period 1 July 2018 - 30 June 2019.
Experience of Barts Health Outpatients
Healthwatch is the official consumer champion for users of health and social care services. We listen to people's stories, good and bad, and report on their collective experience.
In this report, we examine the service user experience of outpatients.
Pages 2 - 3 Data Source
Healthwatch talks to people across the community, week in, week out.
This section shows where we collected the feedback that underpins this report.
Pages 3 - 8 Top Trends
We review all the feedback we collect.
This enables us to find out what people think of their services.
This section reveals the tops trends, and how people feel overall.
Pages 9 - 10 Departments
In this section, we focus on the experience of A&E, maternity and other popular hospital departments.
Page 11 Data Table
The numbers that matter.
53
1.1 Royal London Hospital 1.2 Whipps Cross University Hospital
Sources providing the most comments overall Sources providing the most comments overall
1.3 St. Newham University Hospital
Sources providing the most comments overall
1. Data Source: Where did we collect the feedback?
3%
49%
8%
33%
2% 5%
Office Outreach
Provider Report Provider Website
Social Media Telephone
0 50
100 150 200 250 300 350
# Issues Positive Neutral Negative
2% 1%
32%
2%
58%
5%
Information & Signposting
Outreach
Post
Provider Website
Social Media
0 50
100 150 200 250 300 350 400
# Issues Positive Neutral Negative
59%
41%
Provider Website Social Media
0 5
10 15 20 25 30 35 40 45
# Issues Positive Neutral Negative
54
2. Top Trends: Which service aspects are people most commenting on?
2.1 Royal London Hospital: 1281 issues from 231 people
Issues receiving the most comments overall
2.2 Whipps Cross University Hospital: 932 issues from 148 people
Issues receiving the most comments overall
0 20 40 60 80
100 120 140 160 180 200
# Issues Positive Neutral Negative
14%
5%
4%
6%
3%
2%
3% 11%
3%
8% 4%
2%
16%
19%
Advice/Information General Comment
User Involvement Administration
Booking Cancellations
Planning Support
Telephone Timing
Waiting List Choice
Quality Staff Attitude
0 20 40 60 80
100 120 140 160
# Issues Positive Neutral Negative
11%
10%
6% 1%
1%
1%
1% 15%
1%
7%
2%
20%
3%
21%
Advice/Information User Involvement
Administration Booking
Cancellations Referral
Planning Support
Telephone Timing
Waiting List Quality
Environment/Layout Staff Attitude
355
2. Top Trends: Which service aspects are people most commenting on?
2.3 St. Newham University Hospital: 83 issues from 16 people
Issues receiving the most comments overall
0 1 2 3 4 5 6 7 8
# Issues Positive Neutral Negative
9%
7%
11%
3%
3% 11%
8%
3% 3%
17%
4%
18%
3% Advice/Information General Comment
User Involvement Administration
Cancellations Support
Timing Waiting List
Choice Quality
Environment/Layout Staff Attitude
Complaints
56
3.1 Sentiment, Royal London Hospital 3.2 Sentiment, Whipps Cross University Hospital
3.3 Sentiment, Newham University Hospital
Average sentiment (all hospitals combined) is 49% positive
3. Sentiment: How do people feel as a whole?
56%
5%
39%
Positive
Neutral
Negative
0 100 200 300 400 500 600 700 800
# Issues Positive Neutral Negative
66% 6%
28%
Positive
Neutral
Negative
0 100 200 300 400 500 600 700
# Issues Positive Neutral Negative
25%
1%
74%
Positive
Neutral
Negative
0 10 20 30 40 50 60 70
# Issues Positive Neutral Negative
57
4. Sentiment: How well informed, involved and supported do people feel?
4.1 Sentiment, Royal London Hospital 4.2 Sentiment, Whipps Cross University Hospital
4.3 Sentiment, Newham University Hospital
Average sentiment (all hospitals combined) is 50% positive
62%
5%
33%
Positive
Neutral
Negative
0
50
100
150
200
250
# Issues Positive Neutral Negative
71%
6%
23%
Positive
Neutral
Negative
0
50
100
150
200
250
# Issues Positive Neutral Negative
17% 0%
83%
Positive
Neutral
Negative
0 2 4 6 8
10 12 14 16 18 20
# Issues Positive Neutral Negative
58
5. Sentiment: How do people feel about general quality and empathy?
5.1 Sentiment, Royal London Hospital 5.2 Sentiment, Whipps Cross University Hospital
5.3 Sentiment, Newham University Hospital
Average sentiment (all hospitals combined) is 72% positive
83%
4% 13%
Positive
Neutral
Negative
0 50
100 150 200 250 300 350
# Issues Positive Neutral Negative
82%
4% 14%
Positive
Neutral
Negative
0 50
100 150 200 250 300 350
# Issues Positive Neutral Negative
52%
0%
48%
Positive
Neutral
Negative
0 2 4 6 8
10 12 14
# Issues Positive Neutral Negative
59
6. Sentiment: How do people feel about general access to services?
6.1 Sentiment, Royal London Hospital 6.2 Sentiment, Whipps Cross University Hospital
6.3 Sentiment, Newham University Hospital
Average sentiment (all hospitals combined) is 18% positive
17%
10%
73%
Positive
Neutral
Negative
0 20 40 60 80
100 120 140 160 180
# Issues Positive Neutral Negative 36%
8%
56%
Positive
Neutral
Negative
0 10 20 30 40 50 60 70
# Issues Positive Neutral Negative
0% 0%
100%
Positive
Neutral
Negative
0 2 4 6 8
10 12
# Issues Positive Neutral Negative
60
7.1 Royal London Hospital: 1281 issues from 231 people
Departments receiving the most comments overall
7.2 Whipps Cross University Hospital: 932 issues from 148 people
Departments receiving the most comments overall
7. Trends: Which departments are people most commenting on?
0 20 40 60 80
100 120 140 160
# Issues Positive Neutral Negative
5% 5%
3%
4%
5%
26%
3%
15%
5%
4%
4%
5%
1% 13%
2% Cancer Services
Cardiology
Dentistry
Dermatology
Ear, Nose and Throat
Fracture Clinic
Gastroenterology
General Outpatients
Obstetrics and Gynaecology
Orthopaedics
Physiotherapy
Renal Medicine
Respiratory Medicine
Surgical Clinic
Urology
0 10 20 30 40 50 60 70 80 90
100
# Issues Positive Neutral Negative
8% 2%
6%
9%
5%
8%
3% 7%
3%
11%
19%
3%
4% 10%
2% Cardiology
Dentistry
Dermatology
Ear, Nose and Throat
Endoscopy
Fracture Clinic
Gastroenterology
General Outpatients
Obstetrics and Gynaecology
Ophthalmology
Orthopaedics
Phlebotomy
Rheumatology
Surgical Clinic
Urology
61
7.3 Newham University Hospital: 83 issues from 16 people
Departments receiving the most comments overall
7. Trends: Which departments are people most commenting on?
0 5
10 15 20 25 30
# Issues Positive Neutral Negative
5% 7%
12%
2%
7%
15%
52%
Cardiology
Ear, Nose and Throat
Endoscopy
General Outpatients
Obstetrics and Gynaecology
Phlebotomy
Surgical Clinic
62
8. Data Table: Number of issues
Positive Neutral Negative Total
Communication, including access to advice and information. 150 22 83 255
Involvement of carers, friends or family members. 17 0 4 21
A generalised statement (ie; "The doctor was good.") 45 4 16 65
Involvement of the service user. 102 5 36 143
Administrative processes and delivery. 44 15 62 121
Physical admission to a hospital ward, or other service. 2 0 2 4
Ability to book, reschedule or cancel appointments. 3 3 34 40
Cancellation of appointment by the service provider. 0 0 33 33
General data protection (including GDPR). 0 0 4 4
Referral to a service. 14 0 16 30
Management of medical records. 1 0 14 15
Prescription and management of medicines. 8 0 10 18
Opening times of a service. 1 0 0 1
Leadership and general organisation. 26 1 17 44
Ability to register for a service. 0 0 1 1
Levels of support provided. 170 11 78 259
Ability to contact a service by telephone. 2 4 35 41
Physical timing (ie; length of wait at appointments). 57 19 77 153
Length of wait while on a list. 12 4 47 63
General choice. 9 1 15 25
General cost. 0 0 5 5
Language, including terminology. 2 1 2 5
Provision of sustainance. 6 1 8 15
Privacy, personal space and property. 3 1 7 11
General quality of a service, or staff. 290 12 60 362
Deaf/blind or other sensory issues. 1 0 4 5
General stimulation, including access to activities. 5 1 3 9
Planning Registration
Support Telephone
Timing
Choice Cost
Language Nutrition Privacy Quality
Sensory
General Comment
Advice/Information Carer Involvement
Issue Name Descriptor # Issues
User Involvement
Waiting List
Stimulation
Referral Medical Records
Medication Opening Times
Administration Admission
Booking Cancellations
Data Protection
Pa
tie
nts
/Ca
rers
S
ys
tem
s
Va
lues
63
8. Data Table: Number of issues
Positive Neutral Negative Total
Distance to a service (and catchment area for eligability). 1 0 3 4
Physical environment of a service. 23 9 17 49
General equipment issues. 3 0 9 12
General hazard to safety (ie; a hospital wide infection). 1 0 5 6
Levels of hygiene and general cleanliness. 11 0 8 19
Physical mobility to, from and within services. 0 1 2 3
Ability to travel or park. 0 1 4 5
General omission (ie; transport did not arrive). 0 0 7 7
General security of a service, including conduct of staff. 0 0 3 3
Attitude, compassion and empathy of staff. 332 16 55 403
Ability to log and resolve a complaint. 2 1 7 10
Training of staff. 2 0 6 8
General availability of staff. 0 0 19 19
Total: 1345 133 818 2296
CommunityInsight CRM
Staffing Levels
Catchment/Distance
Issue Name
Equipment
Travel/Parking
Environment/Layout
Staff Training
Omission Security/Conduct
Staff Attitude Complaints
Hazard Hygiene Mobility
Descriptor # Issues
En
vir
on
me
nt
Sta
ff
64
WEL Board – part I
Date: 24th July 2019
Title of report INEL Outpatients Transformation Programme Update
Item number 3.2
Author Stephanie Good
Presented by Shane DeGaris
Contact for further information [email protected]
Executive summary The INEL Outpatients Transformation Programme has been set up
to work across the four CCGs and two acute providers in Inner North
East London to respond to the ongoing challenge of growing demand
for outpatient services and the challenge set by the NHS Long Term
Plan to reduce the number of face to face outpatient appointments
undertaken.
The programme is focused on four key workstreams: clinical
pathway redesign, improving diagnostics quality and efficiency,
improving e-RS referrals and triaging and developing a learning
system. Workstream and programme leads are drawn from across
the INEL system, and the work is overseen by the INEL Outpatients
Transformation Strategy Board.
The programme aims to: ensure that outpatient interactions add
value to patient care; promote the use of new technologies and ways
of working; reduce journeys to hospital; provide more flexibility and
choice about how patients are managed, and improve advice and
education processes between secondary and primary care.
Action required The board is asked to note the joint system working now taking place
in the outpatients transformation programme and that further updates
will be provided periodically as required.
Where else has this paper been
discussed?
N/A
Next steps/ onward reporting The programme reports to the INEL System Transformation Board and will also bring further updates to the WEL joint board as required.
Strategic fit This programme is focused on delivering outpatient transformation,
which has been identified as a strategic priority for the WEL and
INEL systems.
What does this mean for local
people?
Transforming outpatient services will enable more flexibility and
choice in how patients’ interactions with local health services take
place. The programme aims to put in place pathways and services
that will enable patients to be managed more effectively outside of
hospital, and offer alternatives to face to face appointments for those
patients who do need treatment from a consultant.
How does this drive change and
reduce health inequalities?
The programme will promote and enable the use of new
technologies to deliver care and advice to patients and GPs in new
65
and innovative ways. GPs will be able to access advice about
patient care in a more timely and effective way, reducing the need for
patients to attend hospital appointments and helping them to stay
well outside of hospital.
Financial Implications There will be a cost associated with further rollout of the A&G tariff to
additional specialties, which should be offset by some reduction in
referrals for an outpatient appointment (further modelling to be
undertaken as part of A&G tariff pilot evaluation). Some funding
needs may be identified to support the introduction of new pathways,
particularly where there is a need to introduce new technologies.
The NELCA CFO attends the INEL Outpatients Transformation
Strategy Board.
Risks The main risks for this programme relate to resourcing to support the
scale of the ambition to be delivered, both in terms of commissioner
and provider (clinical and operational) resources to support
programme delivery.
Equality impact To be undertaken as required for individual projects within the programme.
66
1. Introduction and background
1.1
1.1.1
1.1.2
1.1.3
1.1.4
1.2
1.2.1
1.2.2
1.2.3
1.2.4
1.2.5
Demand for outpatient services is growing…
Outpatient activity is growing every year: outpatient attendances at Barts Health hospitals and Homerton University Hospital increased by over 15% between 2015 and 2019
Across Inner North East London (INEL) there were around 7 follow-up appointments for every new referral; this means patients are making multiple visits to hospital.
Although new referrals make up a small proportion of total outpatient activity, they have increased by almost 30% in four years
The population of east London is also growing: the population of the five INEL boroughs (City of London, Hackney, Newham, Tower Hamlets and Waltham Forest) is predicted to increase by over 1.2 million by 2029. This means more people requiring hospital services, particularly those with long term conditions who need the most ongoing care.
…But attending a hospital appointment isn’t best for everyone.
85% of all UK hospital-based activity, excluding A&E, is accounted for by outpatient appointments, whilst 5% of road traffic in England is accounted for by journeys related to the NHS.
New technologies mean that it isn’t always necessary for a patient to physically attend a hospital appointment to get the care they need; 28% of hospital consultants believe up to 20% of their patients could have follow-up appointments via a method other than a face to face appointment.
The NHS Long Term Plan has set the challenge to reduce face to face outpatient attendances by one third over five years, and encourages the use of digital technologies to find ways to avoid patients making unnecessary trips to hospital.
Advice & Guidance (A&G) services provide advice electronically to GPs to help them to better manage their patients within primary care.
We want to help patients to stay healthier for longer without their conditions needing to be managed in an acute setting.
0
100000
200000
300000
400000
500000
600000
700000
800000
2015/16 2016/17 2017/18 2018/19 FOT*
INEL Outpatient Activity - Barts Health and Homerton Hospital
OP Follow Ups
New OP referrals
67
1.2.6 25% of hospital consultants believe that up to 20% of their new patients might not need to come to hospital at all.
2. The INEL Outpatients Transformation Programme
2.1
2.1.1
2.1.2
2.1.3
2.2
2.2.1
2.2.2
In INEL we are transforming outpatient services…
Commissioner and provider organisations across INEL are working in partnership to develop new outpatient pathways and devise innovative ways of managing patients to reduce the need for face to face appointments, in response to the challenge set in the NHS Long Term Plan of reducing face to face outpatients activity, and the rising population and demand for outpatient services in east London. The collaboration involves the WEL CCGs, City & Hackney CCG, Barts Health NHS Trust and Homerton University Hospital NHS Foundation Trust.
The programme is being led by Shane DeGaris as SRO, with programme and workstream leads from a range of commissioner and provider organisations. Clinical input and oversight is being provided by the WEL CCG Chairs, Alistair Chesser on behalf of Barts Health, local GPs and secondary care consultants.
There are four key workstreams in the programme: Clinical pathway redesign Improving diagnostics quality and efficiency Improving e-RS referrals and triaging
Developing a learning system
…To give patients a better experience…
Our work aims to ensure that every interaction that a patient has with the hospital adds value to their care. This means:
Only bringing them in for a face to face appointment when it is really needed
Giving patients more choice and flexibility about how they receive their care
We are embracing new technologies and ways of working to: Help patients stay well at home Enable patients to access the advice and support that they need in a way that is
68
2.2.3
2.3
2.3.1
2.3.2
2.3.3
convenient for them Support our local GPs in managing patients within primary care
Fewer face to face appointments also means less need for patients to make journeys to hospital. This means:
Reduced worry and stress for patients about attending a hospital appointment Patients will need to take less time out of their busy lives to attend appointments Fewer journeys to hospital required, helping to reduce traffic on the roads in east London
…And to reduce pressure on our hospitals.
By moving away from face to face appointments as the default option, our hospitals can: Be more flexible about how they manage their patients, particularly those with routine
needs Improve the management of their clinics for those patients who do need to be seen face to
face
Improving our advice and education processes will: Build stronger relationships between primary and secondary care providers, providing GPs
with a way to access specialist advice safely and quickly Support GPs to build the skills and confidence to look after more complex patients in
primary care, enabling their patients to stay well at home Reduce the overall number of referrals that GPs need to make to hospital services
Designing new pathways and introducing new technologies in the hospital will enable clinical staff to:
Offer patients the type of care that works best for them Provide reassurance and advice to patients without needing to bring them in for a face to
face appointment
3. Immediate focus areas and next steps
3.1
3.1.1
3.2
3.2.1
We are currently focusing on a number of key projects.
Key pieces of work which are under way at the moment include:
Initiation of hepatology pathway redesign, working with the consultant and operational leads at Barts Health to review the current pathway
Scoping of new virtual blood testing follow-up clinics to enable patients to access blood tests and results without the need to attend a hospital appointment
Development of plans to maximise use of Advice & Guidance through increasing availability within secondary care and working with primary care to understand the impact of A&G on their workload and what influences their decisions on whether or not to use it
Evaluation of a recent pilot with Barts Health which introduced a payment for responding to A&G requests in four specialties (haematology, cardiology, endocrinology, dermatology), to assess whether this has led to quicker responses and a reduced number of referrals to the hospital
Expansion of the payment tariff for A&G services to four further specialties by October: paediatrics, hepatology, rheumatology, gynaecology
Working with NHS Digital on system developments to the NHS e-Referral Service to improve integration with hospital systems
We will continue to update on our progress.
The work of the INEL Outpatients Transformation Programme is overseen by the INEL Outpatients Transformation Strategy Board, which is co-chaired by Sam Everington and Alistair Chesser.
69
3.2.2 The programme reports to the INEL System Transformation Board (STB); a detailed presentation on the delivery plan and progress of the Outpatients Transformation Programme will be going to the INEL STB in September. Jane Milligan is the programme’s sponsor sitting on the STB.
70
WEL Board – part I
Date: 24th July 2019
Title of report WEL diabetes update
Item number 3.3
Author Anne-Marie Maher-Vyas
Presented by Selina Douglas
Contact for further information Anne-Marie Maher-Vyas
Executive summary 63,473 people are living with diabetes across the WEL footprint.
There are an additional 17,675 people diagnosed with pre-diabetes.
All 3 CCGs have a higher than the London average rate of diabetes; with Newham reporting double the observed London rate per 1,000 population.
Outcomes for people living with diabetes has continued to improve across WEL; however there is an observed variation in outcomes.
This report provides:-
- A summary of the key components of the current diabetes models in place across the WEL CCG’s
- An overview of outcomes for people living with diabetes
- An outline of a WEL diabetes plan for 2019-2021 delivery for discussion
Action required Note/ Decision/ Discussion and consideration of the following
questions
:- What clinical leadership arrangements need to be in place to drive forward 2019.20 delivery?
:- Are there any areas outside of those outlined in the
delivery plan proposals that the board would like to
consider?
Where else has this paper been
discussed?
This paper has been discussed with clinical and commissioning
leads across the WEL CCGs.
Next steps/ onward reporting Development of a WEL diabetes delivery plan approved at the WEL commissioning committee
Strategic fit
What does this mean for local
people?
The plans detailed in the paper support:-
Increased awareness of a long term condition
Improved access to services and specialist support
Increased life expectancy
Improved quality of life
How does this drive change and
reduce health inequalities?
The plans detailed in the paper supports the identification of health
inequalities and provides a plan of delivery to address the identified
variation of service access.
71
Financial Implications This paper presents plans that may have financial consequences. These are yet to be fully determined but if not already embedded in budgets or reserve provision, a further decision would be required to release any additional expenditure commitment.
Risks
Equality impact This document relates to all WEL residents in the 9 protected characteristics that are covered by the Equality Act 2010 and our Equality Duties.
72
1.0 Introduction and context
1.1
1.1.1
Following commissioning priorities that have been discussed and agreed at each CCG board; diabetes has been identified as a WEL clinical priority.
This report looks to provide a ‘state of play’ of diabetes care across the WEL footprint; including models of care, KPI achievement and a proposed delivery plan for 2019-2021.
2.0 Diabetes as a long term condition
2.1
2.2
2.3
2.4
2.5
2.6
Diabetes is a progressive disease. Life expectancy is reduced on average by 10 years in those with Type 1 diabetes and up to 5 year in Type 2 diabetes. 3.4 million people are known to be living with diabetes in the UK with 12.3 million at high risk.
Type 2 diabetes is up to six times more common in people of South Asian descent and up to three times more common among people of African and African-Caribbean origin.
Diabetes prevalence is higher in areas experiencing deprivation. People living in the 20% most deprived neighbourhoods in England are 56% more likely to have diabetes than those living in the least deprived areas.
The risk of developing Type 2 diabetes increase by up to ten times in people with a BMI of more than 30.
People with diabetes are two to three times more likely to have a stroke compared to those without the condition. Diabetes is the leading cause of blindness in people of working age in the UK. The rate of lower limb amputation in people with diabetes is 15 times higher than in people without diabetes. Up to 70 percent of people die within five years if having an amputation as a Result of diabetes. 20% of people living with a Serious Mental Illness also have a diagnosis of Type 2 diabetes. The number of diabetics is set to double in the next 10 years.
3.0 Diabetes & at risk populations in WEL
3.1
3.2
3.3
There are currently 63,473 people living with diabetes across the WEL CCG footprint. There are 17,675 people living with Non Diabetic hyperglycaemia (NDH). NDH also known as pre-diabetes or impaired glucose regulation, refers to raised blood glucose levels; that are not in the diabetic range. NDH is confirmed via a HbA1c (HbA1c is your average blood glucose (sugar) levels for the last two to three months) within 42-47mmols.
In 2018 NEL CSU were commissioned to provide an overview of clinical outcomes, rates of complications associated with diabetes and the variation of care provided to people living with diabetes in NEL. The summary of the outcomes of this review can be seen below.
Rates of diabetes - Figure 1 shows the rates of diabetes in London, STP and the 3 WEL CCGs. All 3 CCGs have higher than the London average with Newham reporting double the observed London rate per 1,000 population.
73
3.4
3.5
3.6
Deprivation & ethnicity. Figure 2 shows the links between highest deprivation and Type 2 diabetes prevalence. Tower Hamlets have the highest proportion of people with Type 2 diabetes in the most deprived IMD. This is more than twice the London average. Figure 2:-
Figure 3: shows the rates of emergency admissions for diabetes complications, amputations and renal. Figure 3:-
74
3.7
3.8
3.9
Diabetes annual reviews include eight care processes (9 including retinal screening which is undertaken separately by the retinal screening service). There are 3 key clinical outcomes for people living with diabetes, commonly known as the ‘treatment targets’ CCGs are rated on their diabetes care by treatement outcomes and uptake of structured education programmes. Figure 4 shows the most recent nationally validated available NDA (National Diabetes Audit) 2017.2018. Outcomes for all WEL CCGs have either improved or been maintained when compared to 2016.2017 NDA data. Figure 4:-
5 QOF reporting
Key Stats QOF - 8 care processes
No evidence of a relationship between QOF reporting and improved patient outcomes across CCGs
C&H is
highest
C&H CCG has the highest proportion of
patients receiving all 8 QOF care
processes in London. There is large
variation across NEL CCGs. WF has
less than half the rate of C&H.
NullM eeting all 3 treatment targets is fairly
consistent across NEL CCGs but has
no relationship with meeting all 8 care
processes.
75
4.0 Diabetes models of care in WEL – primary prevention
4.1
4.2
4.3
4.4
The primary prevention agenda aims to support people to prevent or delay the development of Type 2 diabetes. Patients are identified as pre-diabetic / Non Diabetic Hyperglycaemic (NDH) through opportunistic reviews or through targeted NHS health check screening. The National Diabetes Prevention Programme (NDPP) is commissioned by NHS-England and intends to deliver at scale provision of evidence based lifestyle change programme, based on proven UK and international models focused on lowering weight, increasing physical activity and improving diet in those individuals who are identified at high risk of developing Type 2 diabetes.
WEL CCGs form part of the NEL partnership for the delivery of the NDPP (the partnership has been in place for 2 years). There is one contract in place in NEL and CCGs are tracked against their referral profile and IA (initial assessment) uptake. The current allocation for WEL is being met. The Long Term Plan seeks to double the numbers of spaces available for the NDPP. WEL CCGs will be required to re-profile their referral numbers to meet the new targets. Newham CCG are the only CCG in WEL to formally commission an enhanced service for identifying and reviewing patients with pre-diabetes / NDH or history of GDM (Gestational Diabetes Mellitus). All 3 CCGs have developed registers of people with NDH and provide additional support through structured education and social prescribing initiatives.
5.0 Diabetes models of care in WEL – established disease
5.1
5.2
Diabetes pathways for established disease have seen ongoing redesign within WEL CCGs. The models support the four tiers of care approach with the majority of care provided in tier 1 & tier 2.
Tower Hamlets and Newham provide similar models of care. The Tower Hamlets model has been in place for over 10 years and within Newham for the last 5 years. The models include :-
Clear pathways for referral for specialist diabetes care including Type 1 diabetes, pumps and transitioning patients; renal disease (chronic kidney disease stage 3b or lower with problematic diabetes control), active foot disease, pregnancy or pre-pregnancy counselling and in-patients with diabetes.
Utilization of GP networks /clusters with resourcing through a NES (Network Enhanced Service) / EPCS (Enhanced Primary Care Services). Supporting care planning and achievement of treatment targets.
Educational support for primary care: All health professionals delivering diabetes care in the area are expected to have attended a diabetes approved course.
Educational support for patients: Structured diabetes education for patients in English and community languages for Type 1 and Type 2 diabetes
IAPT services: available for pre-diabetics and diabetes
Specialist support for primary care:
Network / cluster multidisciplinary team meetings (MDTs): a consultant in diabetes attends each network /cluster to undertake MDTs with GPs, practice nurses, dietitians, DSNs and diabetes psychologists. These two-hour meetings offer an opportunity for review of the KPIs for the diabetes care package, an update on clinical issues, guidelines, treatments and the opportunity for primary care clinicians to discuss difficult clinical cases.
Community-based DSN clinics: poor glucose control, insulin or other injectable treatment commencement, problem solving clinics.
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5.2.1
5.3
5.4
Email advice / telephone advice: consultant offers rapid email advice for all health professionals. Rapid access to telephone advice in hours via the diabetes nurse team or consultant and out of hours via the diabetes registrar on call.
Over 90% of diabetes care is provided in primary care in Newham and Tower Hamlets.
Waltham Forest CCG have recently undertaken a review of their clinical pathway moving to:
Clear pathways for referral for specialist care including renal disease, active foot disease, Type 1 diabetes, insulin pumps, pregnancy
Utilization of GPSwi service for increased diabetes complexity
Educational support for primary care: Delivery of diabetes education to general practice staff
Educational support for patients: Structured diabetes education for patients for Type 1 & Type 2 diabetes
IAPT services: available for diabetes
WEL CCGs have utilized the NHS right care pathway, identifying opportunities and reviewing any potential gaps in commissioned services.
6.0 WEL diabetes achievements
6.1
6.1.1
All WEL CCGs have been party to the delivery of the diabetes treatement and care bid. The bid brings together all 7 CCGs, 3 acute trusts (BARTS, BHRUT & Homerton), 2 community trusts (ELFT & NELFT) and The Clinical Effectiveness Group (CEG) as part Queen Mary University. The transformation bid has provided the opportunity for commissioners, providers and an academic institution to form a partnership to support the improvement of outcomes for people living with diabetes. The partnership has supported the development of strong relationships within the sector which has allowed for sharing of best practice and has supported a reduction in variation that has been historically observed across NEL. 77
6.1.2
6.1.3
The treatment and care bid in NEL focuses on 4 interventions namely Type 1 & young people, pre-conception support for women living with diabetes, clinical diabetes dashboard & virtual patient reviews (see appendix 1) High level achievements are listed below:
Additional DAFNE (Dose Adjustment For Normal Eating) accredited Type 1 education
courses commissioned once across all WEL CCGs, courses delivered in a more flexible
way. Opportunity to access courses outside of the borough patients reside in.
Type 1 events for patients to provide feedback on commissioned services and receive
support in managing their diabetes.
Youth worker recruitment to support people living with diabetes through peers support.
Development of a true MDT approach to supporting people living with Type 1 diabetes
including mental health support with the recruitment of clinical psychologists and a
psychiatrist.
An audit of over 1500 Type 1 patient records in general practice to ensure patients are
accessing care and to support those who are not.
Standardized clinical templates for preconception rolled out in all practices in WEL, enabling
robust clinical audit
Freestyle Libre guidance developed for WEL CCGs
A dashboard available at STP/ CCG & practice level allowing effective benchmarking and
support call and recall of patients on diabetes registers
BARTS successful in bid to provide services for people living with Type 1 and diabulimia
Clinical outcomes improved for patients living with diabetes – CCG IAF rated ‘outstanding’ in
2 of the 3 WEL CCGs.
Reduced out patient referrals for patients that can be managed in a primary care setting.
Specialist support provided in GP practices – care closer to home.
Timely access to specialist advice via MDT approach.
7.0 Diabetes challenges within WEL
7.1.
7.2
7.3
7.4
7.5
7.6
As outlined above diabetes is a complex multi organ disease. Patients generally present with one or more LTCs which is turn means people require a more holistic approach to providing care rather than a disease specific approach. There are significant rates of both NDH and diabetes in WEL CCGs
Uptake of structured education varies across the WEL CCGs, there is a lack of auditable robust data to objectively review uptake of courses. Two of the WEL CCGs were rated as outstanding in the 2017-18 IAF however there remains a level of variation with those CCGs. There is continuing work to be done to improve the IAF rating in one CCG. Type 1 outcomes remain poorer than Type 2 outcomes in all WEL CCGs with longer length of stay within BARTS sites. Long term complications in diabetes renal disease and amputations are on the rise in WEL and require further integration with renal services and a robust MdFT (Multi-disciplinary Foot Team) across BARTS sites. These two areas were identified as key areas of enquiry at the recent (July 2019) GIRFT (Getting It Right First Time) visit. There is significant overlap between serious and common mental health issues and diabetes, which require further integration of mental and physical health services.
8.0 Diabetes 2019-2021 delivery proposals
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8.1
8.2
8.3
8.4
8.5
Diabetes delivery plans have been developed at a London wide level by the London Diabetes Clinical Network in collaboration with STPs. NEL has developed a ‘plan on a page’ which is in line with the London wide plans; it has also drawn its priorities from the INEL and BHR systems. The NEL diabetes partnership which includes WEL CCGs has agreed 4 main objectives for 2019.2021 delivery (see appendix 2).
- Delay or prevent high risk populations developing diabetes through provision of NDPP,
VLCD (Very Low Calorie Diets), other lifestyle programmes. Utilization of digital technology
- Improve clinical outcomes for people living with diabetes and reduce unwarranted variation
- Reduction in potentially avoidable hospital admissions e.g. hypoglycaemia
- Improve outcomes relating to long term complications of diabetes including foot care
pathway and renal disease which is in-line with GIRFT BARTS feedback received in July
2019. GIRFT identified priorities will be delivered through the BARTS diabetes clinical
network.
- Deliver personalized care for Mental health, Type 1 patients
The LTP offers additional opportunities to improve diabetes care. In line with NEL objectives a bid will be developed to access transformation funds to improve foot health services which in turn will support the reduction of amputations across WEL. WEL CCG specific delivery plans (see appendix 3) look to include the development of supplementary network services to support the annual review of people living with NDH and the rollout of existing services into Waltham Forest CCG in line with NICE guidance.
9.0 Recommendations
9.1
The Board are asked to NOTE the WEL CCGs achievements in the delivery of diabetes care and delivery plans for 2019-2021
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Executive Summary in 500 words or less
Bid reference: DTCL02
Summary of model
The NELSTP proposal offers 4 interventions covering significant numbers of the
diabetic population including those most at risk of complications:
1. Type 1 (all ages)
a. NEL wide Diabetes Network to:
i.) Manage a risk register for intensive service users
ii.) Coordinate a care pathway including insulin pump/CGMS service
iii.) Provide an integrated multi-agency service for young people
b. Local multi-disciplinary specialist teams that:
i.) Supports the updating of primary care registers including care plans
and named nurse
ii.) Provide meetings with regular dedicated case conferences for high
risk, difficult to engage individuals.
iii.) Strengthen inpatient care through 7 day working to support A&E
iv.) Development of primary care through an education programme
c. Improving engagement and self-management:
i.) Increase uptake of patient education programmes
ii.) Strengthen peer support groups and support for patients and carers
iii.) Increase the use of digital technology and remote consultations.
iv.) On-line tools for clinical care.
2. Pre-conception interventions for diabetic women of child bearing age
Within the STP CCGs there are large numbers of women with diabetes and of
child-bearing age who can be difficult to engage in preconception
interventions.
The proposal would:
Enable the roll out of a successful initiative which identifies women
with established diabetes and HbA1c >6.5 % at risk of unplanned
pregnancy who are provided with:
o annual care planning, to discuss diabetes and
preconception/reproductive health.
o women considering pregnancy will be referred to local pre-
conception service
o access to DSN service
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3. Type 1 & Type 2 Development of primary care clinical templates &
dashboards / virtual patient reviews
3.1 Clinical templates & dashboards
All CCGs are supported by the CEG who support improvements in general
practice with clinical audit and practice based facilitation.
The proposal would allow the:
Development of a monthly STP diabetes dashboard to allow feedback
to GP practices to support improvements in clinical care,
Use of the dashboard to reduce variation at CCG & STP level by
identifying underperformance or improved performance early.
Use of clinical templates to allow standard data entry which would
ensure robust auditable data.
The above support all of the proposals outlined in the 3TT bid
3.2 Virtual patient record reviews
CEG can run audits to identify patients who are not achieving their clinical
outcomes.
Patient records will be reviewed by a DSN to provide patient action
plans (including optimisation of medicines), available to the practice at
the next patient review. The tools and approach could be shared with
general practice to make the model sustainable
4 Young people (16-25 years) with diabetes:
Diabetes self-management and engagement is traditionally poor among
young people.
The proposal will:
develop an integrated service for young people based in specialist
hubs, that deals with complex health and social care issues faced by
young people.
create an innovative model of care in collaboration with e.g. schools,
education institutions, local employers and other Council-funded
organisations
The model will be developed by the local user groups with cost-benefit
modelling to ensure sustainability and spread.
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Main deliverable and expected outcomes:-
Year 1: Clinical network established, dashboard developed and rolled out, primary
care registers updated, education programme developed, engagement strategy for
Type 1 & <25yrs developed, pre-conception clinical template aide rolled out, virtual
patient reviews undertaken, improved clinical outcomes, increased uptake in
education
Year 2: reduction in DNA rates, A&E attendance, DKAs & admissions, continued
improvement in clinical outcomes, peer support group developed, virtual patient
reviews undertaken, education programme developed
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Diabetes (plan on a page)
By 2020/21 we will deliver:
National target for uptake of National
Diabetes Prevention Programme
(NDPP)
Improved clinical outcomes for
people living with diabetes.
Reduction in potentially avoidable
diabetes admissions e.g.
amputations, hypoglycaemia,
HONC, DKA
Integrated Mental Health and
diabetes care pathways – in line with
One London improvements project
2019/20 Objectives:
Increase awareness of NDPP with public and healthcare professionals
Implement the rollout of NEL wide admission avoidance initiatives
Reduce unwarranted variation in diabetes outcomes
All NEL CCGs move to ‘outstanding’ rating in CCG IAF
Test models for delivering personalised care for people living with diabetes *complex common mental health
problem
Key Initiatives:
Initiative 2 (i2)) - Admissions
Hypoglycaemia
• Standardised LAS communication protocol and
referral pathways for post-hypoglycaemic
episodes implemented in NEL
Foot care
• Establish NEL diabetes footcare network
• Subject to transformation funding recruit to NEL
to support establishing pathway coordinator
roles, HCP footcare training programme &
support to renal dialysis units.
DKA Diabetes Keto-acidosis
• Delivery of Type 1 and young people
transformation MDT intervention programme
Renal care
• Use of trigger tool and HCP education
Initiative 3 (i3)- Reducing Variation
• Improve uptake of diabetes education
programmes to promote self care /
management both f2f and via digital technology
• Utilisation of NEL diabetes dashboard to
provide insight on networks to support
• Rollout of online HCP diabetes training
programme across NEL
• Develop systematic approach to track impact of
treatment and care bid
• Continued delivery of the diabetes treatment
and care interventions
• Review right care, value based approach data
packs to understand commissioning gaps in
NEL.
• Completion and evaluation of NEL type 1
delivery of care audit in general practice.
Initiative 4 (i4)- Personalised care
• Scope proactive models of care for people living with
diabetes and severe and enduring mental illness as a
means of improving outcomes and reducing
unscheduled care.
• Development of an integrated diabetes and common
mental health problems pathway in partnership with
IAPT
• Improving the understanding of the level of need for
people with complex common mental health problems in
diabetes with a view to developing an improved
definition and pathways for complex cases
Initiative 1 (i1) - Prevention
• Undertake deep dive to understand uptake and
attendance rates against NDH (non-diabetic
hypoglycaemia) demographic
• Improve participation of BME populations via targeted
campaigning.
• Working with public health to engage local systems
• Continued quality review of referrals into NDPP and
practice based facilitation programme
• Pilot VLCD (very low calorie diet) as a means to
support patients into diabetes remission
• Rollout of online diabetes training programme across
NEL and local delivery of education
• Develop prospectus for NEL procurement for NDPP
provider procurement – delivery from 2020/21
• Continue to deliver enhanced services to support the
delivery against the referral profile
* ‘complex common mental health problems’ refers to people with complications relating to one or more of the following factors: social deprivation, trauma & adversity, substance misuse, personality and interpersonal difficulties and eating disorders.
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2019/20 Highlights:
Q1 Highlights:
• MOUs signed off by 14 (3 acute, 2 community trusts, 7 CCGS, 1 GP federation & CEG) partner organisations under the Diabetes transformation bid for 19.20 delivery
• Completion of deep dive into NDPP uptake in BME population and engagement strategy developed
• Launch of online diabetes training programme across NEL
Q2 Highlights:
• Completion of NDPP uptake and IA utilisation report following quality review programme.
• Establishment of NEL diabetes foot care network
• ROI tool developed for diabetes transformation interventions
Q3 Highlights:
• EOI to use NEL as test bed for VLCD submitted
• MDfT transformation bid submitted
• NEL NDPP ‘procurement’ prospectus submitted
Q4 Highlights:
• Draft pathways developed
2019/20 Key Milestones:
Q1• (i1) Undertake deep dive to understand uptake
and attendance rates against NDH (non-diabetic
hypoglycaemia) demographic – in progress
• (i1) Establish a working group to oversee NEL
engagement with local public health teams to
engage local systems active travel, schools,
environment – not started
• (i1) Pilot VLCD as a means to support patients into
diabetes remission – in progress C&H only
• (i1 & 13) Re-launch of online diabetes training
programme across NEL and local delivery of
education – in progress
• (i2)Continue to deliver enhanced services to
support the delivery against the referral profile – in
progress
• (i3) Utilisation of NEL diabetes dashboard to
provide insight on networks to support - in
progress
• (i3)Coordinate delivery of the diabetes treatment
and care interventions – in progress
Q2
• (i2) Standardised LAS communication protocol
and referral pathways for post-hypoglycaemic
episodes implemented in NEL – not started
• (i2) Governance and reporting arrangements
agreed for NEL diabetes footcare network – in
progress
• (i3) Develop systematic approach to track
impact of treatment and care bid – in
progress
• (i3)Completion and evaluation of NEL type 1
delivery of care audit in general practice – in
progress
• (i1)Quality review of referrals into NDPP and
practice based facilitation programme
evaluated– in progress
• (i4) Scope proactive care for people living with
diabetes and severe and enduring mental illness
as a means of reducing unscheduled care – in
progress
Q3
• (i1) Manage the development of the EOI for VLCD as a means to support patients into diabetes remission – not started
• (I1) Manage the development of the NEL NDPP prospectus for NEL procurement for NDPP provider procurement – delivery from 2020/21 – not started
• (I2) Develop business case to bid for MDfT (MDT foot team) transformation funding with input from all key NEL stakeholders CCG, primary, community and acute acre – not started
• (I3) Improve uptake of diabetes education programmes to promote self care / management both f2f and via digital technology – in progress
Q4
• (i4) Development of an integrated diabetes and
common mental health problems pathway in
partnership with IAPT – not started
• (i4) Scope proactive models of care for people
living with diabetes and severe and enduring
mental illness as a means of improving
outcomes and reducing unscheduled care- In
progress
• (i4) Scope opportunities for people with severe
and enduring mental illness to efficiently
access physical health and mental health as a
means of improving outcomes
Workstream x Milestones 19/20
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1
DRAFT: Diabetes
Aim Primary Drivers Secondary Drivers Change Idea 19/20
To prevent or delay
patients from developing
type 2 diabetes.
Measures:
• Uptake and
completion of NDPP
and VLCD.
• 3% Improvement of
treatment targets
• HbA1c
• Blood
pressure
• Cholesterol
• 10% reduction in
avoidable admissions
Very Low Calorie Diet (VLCD)
NDPP (National Diabetes
Prevention Programme)
Healthy lifestyle/ Weight
management
Clinical protocols, triage and
infrastructure in diabetes
services.
Supplementary network
services for NDH annual review
of patients
Raise awareness of NDPP with
public and HCP.
Risk detection- e.g. health
checks.
Tier 1 and Tier 2 services
Develop business case for Q2,
to fund pilot and submit to
NHSE in Q3
Development of NDPP
prospectus
Develop business case to
support SNS delivery in all WEL
CCGs by Q2
Provide a series of HCP
workshops
Improve utilisation of PPE and
PPG groups to raise awareness
and receive feedback to
patients and public.
Review of uptake of BME
population-undertake deep dive
to understand uptake and
attendance rates against NDH
demographic.
Undertake needs analysis to
understand the needs of the
population to inform
commissioning of healthy
lifestyle programmes.
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2
DRAFT: Diabetes
Aim Primary Drivers Secondary Drivers Change Idea 19/20
Improving outcomes for
people living with diabetes
Measures:
• Uptake and
completion of NDPP
and VLCD.
• 3% Improvement of
treatment targets
• HbA1c
• Blood
pressure
• Cholesterol
• 10% reduction in
avoidable admissions
Utilisation of technology
WEL wide admission
avoidance and complication
initiatives.
Education
Digital platform for patients:
• Online platform for HCP
• Rolling programme of F2F
education
Re-establishment of foot care
network
Foot protection team in place
Structured education for
patients and education for
HCP.
Increase utilisation/relaunch
online diabetes training platform
for HCP.
Develop business case to bid for
transformation funding for MDT
foot teams.
Agree rollout timetable for LAS for
hypoglycaemic episodes.
Delivery of Type 1 in young people
intervention programme.
Personalised Care for
vulnerable groups
Reduction in variation
Standardised protocol
hypoglycaemic episodes, renal
interventions
MDTs- piloted for type 1
patients
Proactive models if care for
following groups:
• SMI type 1
• CMI
Social prescribing
Targeted interventions at PCN
level.
Go out for competitive process fro
online platform.
Iplato/AccuRX roll out for tailored
messages to patients.
Increase uptake and completion
rates for structured education
Develop engagement plans for
PCNs around diabetes
dashboard
Undertake clinical audits to
understand population need.
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