WEL CCGs Joint Board

Part I - Public Meeting

Wednesday 19 February 2020

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WEL CCGs Joint BoardPart I, Public Meeting

14:00 – 16:00 on Wednesday 19 February 2020

Committee Rooms, Level 4, Unex Tower, 5 Station Street, Stratford E15 1DA

AgendaChair: Ken Aswani

No Item Lead Action Page Time1.0 GENERAL BUSINESS 1400

1.1 Welcome, introductions and apologies Chair Information Verbal

1.2 Conflicts of Interests Register(accuracy of register and anydeclarations of conflict particular to theagenda)

Chair Approve 11-13

1.3 Quoracy

1. Will be seven voting members,which must include: at least onemember from each CCG fromamongst the CCG Chairs andadditional governing body primarycare representatives; theaccountable officer, the managingdirector, or the chief financeofficer; and one lay member.

Or, in the event that all GPs are excluded due to a conflict of interest;

2. Will be four members, which mustinclude: at least one lay member;and at least one clinician; and atleast one of a CCG accountableofficer, managing director, andchief finance officer.

Member’s deputies are included within quoracy.

Chair Approve Verbal

1.4 Minutes from the previous meeting Chair Approve

1.5 Action Log Chair Discuss

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14-25

26

1.6 Matters Arising

(notified to the Chair in advance of the meeting by email to newccg.welgoverningbody@nhe.net no later than 14:00 on the Friday before the meeting on the Wednesday including urgent agenda items)

Chair Discuss Verbal

2.0 UPDATES 1410

2.1 Accountable Officer and ManagingDirector

Jane MilliganSelina Douglas

Discuss

2.2 Chairs Chair Discuss Verbal

2.3 ELHCP - update Mark Scott Information

3.0 ASSURANCE 1440

3.1 BAF Report Sab Sanghera Discuss

3.2 Finance Report M9 with a verbal updatefor M10

Steve Collins Approve

3.3 Quality and Safety Report M9 Chetan Vyas Approve

4.0 FOR INFORMATION 1540

4.1 Quality & Safety Committee(summary of meeting 23/01/20)

Chetan Vyas Information

4.2 Finance & Performance Committee(summary of meeting 29/01/20)

Steve Collins Information

4.3 Audit Committee in Common(summary of meeting 22/01/20)

Steve Collins Information

5.0 PUBLIC QUESTIONS (notified 48 hoursin advance)

1545

5.1 Questions to the WEL Governing Bodycan be asked at any time, however toallow full responses to be given on theday of the meeting, we ask that anyquestions are submitted in advance tonewccg.welgoverningbody@nhs.net. by2PM on the Friday before theWednesday meeting.

Chair Discuss

6.0 NEXT MEETING 1555

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mailto:newccg.welgoverningbody@nhe.netmailto:newccg.welgoverningbody@nhs.net

6.1 DRAFT agenda 18 March 2020 Chair Discuss

6.2 Date of Next Meeting – 18 March 2020

Committee RoomsLevel 4 Unex Tower5 Station StreetStratford E15 1DA

Chair Information Verbal

7.0 MEETING CLOSES 1600

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101-103

WEL ACRONYMS

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

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GIA Gross internal area GLA Greater London Authority 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

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NDPP National diabetes prevention programme NEL North East London 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

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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

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WEL Joint Board Part 1 meeting attendance log 2019/20

MEMBER’S NAME JUL-19 SEPT-19 OCT-19 NOV-19 cancelled DEC-19 cancelled

JAN-20 FEB-20 MAR-20

Johra Alam X X Ken Aswani X X Henry Black X X Thaven Chetty X X

Colin Ansell Sarah

Garner - substitute

X X

Alistair Chesser X X Steve Collins X X Mariette Davis X X Clare Davison X X Selina Douglas X X Sam Everington X X Heather Flinders X X Jenny Mazarelo X X Jane Milligan X X Vineeta Manchanda X X Maggie Buckell X X Muhammad Naqvi X X Virgina Patania X X Denise Radley X X

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Ellie Robinson X X Fiona Smith X X Victoria Tzortziou-Brown X X Rima Vaid X X Director of Public Health X X

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MITIGATION TAKEN DPA

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From To (Action/s taken to mitigate risk - list of possible actions on DOI form)

(Permissionto publish)

Colin Ansell Form sent WEL CCGs Joint Board Director (London Borough of Newham) Voting member Yes Health and Social Care SpaceNewham Ltd - director

X 2019 Current YES

Alum Medical Practice - GP Partner X 1990 CurrentNorth East London Royal College of General Pratitioners Faculty - BoardMember

X1995 Current

Care Quality Commission - GPInspector X

2014 Current

Clinical Panel - Member X 2015 CurrentNHS Alliance - Member X 2000 CurrentFedNet - Member Practice X 2014 CurrentWhipps Cross University Medical Hospital Educaiton and Reserch Fund - Trustee

X2017 Current

BHRUT - Wife works as Deputy Director of Income and Planning at BRUT

X2018 Current

East London Lift Accommodation Services Ltd - Director

X 2018 2019

East London Lift Accommodation Services No.2 Ltd - Director

X 2018 2019

East London Lift Holdco No2 Ltd - Director

X 2018 2019

East London Lift Holdco No3Ltd - Director

X 2018 2019

East London Lift Holdco No4 Ltd - Director

X 2018 2019

East London Lift Accommodation Services No. 3 Ltd - Director

X 2018 2019

East London Lift Accommodation Services No 4 Ltd - Director

X 2018 2019

Infracare East London Ltd - BoardMember

X 2018 Current

Deborah Mangement Ltd (Property Mnagement) - Director / Company Secretary.

X2020 Current

NHS Greenwich CCG - Registers Nurse Member X

2020 12-Jul-05

Alistair Chesser Form sent WEL Joint Board Voting memberLeyton Healthcare X 2013British Society of Allergy and Clnical Immunology (BSAC)

X 2018

Trisett Limited - Director X 2003 CurrentSevenoaks Primary School - Chair of Governors

X 2002 Current

Fegans (a Children's Mental Health Charity) - Wife is Chair of Trustees

X 2017 Current

PwC Consulting - Daughter is a junior associate

X 2019 Current

WEL CCG JB - committee member

X

2019 Current

City & Hackney CCG - Audit Chair &Lay Member

X 2013 2019

Newham CCG - Lay Member X 2019 CurrentWaltham Forest - Lay Member X 2019 CurrentAudit Committee WF - Member X 2019 Current

Clare Davidson Form sent WEL Joint Board GP Representative Voting member Yes Lantern Health - Director X 2019 Current YESSelina Douglas February 2020 WEL Joint Board

WEL Strategy &Transformation Committee

Managing DirectorCommittee members

Voting member No YES

Bromley-By-Bow Health Partnership X CurrentBromley-By-Bow Centre Charity - GP X Current

CG Care Group CIC X CurrentTower Hamlets surgeries (x4) - (NAMES of the four surgeries) - partner GP

XCurrent

Community Health Partnership - Director

X Current

King Fund - Trustee X CurrentNew Mocels of Care NHS England - National Advisor

X Current

BMA Council - member X 1898 CurrentBMA Council - Vice President X CurrentQueens Nursing Institute - VicePresident

X Current

Queen Mary University London - Fellow and Honorary Professor

X Current

Bromley-By-Bow Charity - ROLEREQUIRED

X Current

Community Health Partnership (NHSLift) - director

X Current

ELHP (East London Health Partnership) (STP) - Chair and Clinical Lead

X2011 Current

NHS Property Board - member X 2018 CurrentCM (Colleague of Medicine) - VicePresident and Council member

X Current

Voting member

Voting member Yes

Yes

Voting member

YES

YES

YES

YES

YES

YES

YES

Voting member Yes

YesVoting member

DATE INTEREST BEING DECLARED

Register of Interests (updated March 2020) previous conflicts notified but no longer active are kept on the register for 6 months from their inactive dateTYPES OF INTERESTNAME DATE of declaration COMMITTEE/s attended POSITION/s held on CCG

committees attended:(Governing Body member;Committee member; Member practice;CCG employee;Other.)

STATUS held on committee/s(voting or non-voting member, staff)

DECLARED INTERESTS:Do you have any interests todeclare?(Y or N)

INTEREST BEING DECLARED(Name of the organisation andnature of business)

COMMITTEES listed below:DPA(permission to publish)

Henry Black February 2020 WEL CCGs Joint Board Chief Financial Officer (NELCA CCGs)

Ken Aswani Form sent WEL CCGs Joint BoardWaltham Forest CCG BoardWEL Strategy &Transformation Committee

Chair (WEL CCGs)Chair (Waltham Forest CCG)Committee MemberClinical Director (Waltham Forest CCG)

February 2020Sam Everington Chair (rotating)Chair -Tower Hamlets CCGChair - Chairs for London CCG (names of the London CCG?)

Yes

Thaven Chetty Form sent WEL CCGS Joint Board GP RepresentativeClinical Director

Voting member Yes

Steve Collins February 2020 WEL Joint BoardFinance & PerformanceCommitteeStrategy & Transformation Committee

Maggie Buckell February 2020 WEL CCGs Joint BoardQuality & Safety CommitteePrimary Care CommissioningCommitteeRemuneration Committee

Board Member (Safeguarding Nurse)Committee MemberCommittee Member

Committee Member

WEL Joint BoardWEL Strategy &Transformation CommitteeTower Hamlets CCG Board

Board MemberCommittee Member

Committee Member

Mariette Davis February 2020 WEL CCGs Joint BoardCity & Hackney CCGNewham CCGWaltham Forest CCGAudit Committee - Waltham Forest CCG

Committee MemberAudit Chair & Lay MemberLay MemberLay MemberCommittee Member

Voting memberVoting memberVoting memberVoting memberVoting member

Yes

YES

YES

YES

YES

YES

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From To (Action/s taken to mitigate risk - list of possible actions on DOI form)

(Permissionto publish)

NAME DATE of declaration COMMITTEE/s attended POSITION/s held on CCG committees attended:(Governing Body member;Committee member; Member practice;CCG employee;Other.)

STATUS held on committee/s(voting or non-voting member, staff)

DECLARED INTERESTS:Do you have any interests todeclare?(Y or N)

INTEREST BEING DECLARED(Name of the organisation andnature of business)

DPA(permission to publish)

Royal College of GPs - member X CurrentH&WB (Health & Wellbeing Board) (LBTH & THCCG) - Deputy Chair

X Current

NHS Resolution - Associate Non-Executive

X 2018 Current

ELFT (East London Foundation Trust) - Non Executive Director

X 2020 Current

MDDUS (Insurance for GP Partnership) - member

X Current

Bromley-By-Bow Partnership - wife aCCG Practice Nurse

X X Current

Tower Hamlets CCG - Wife a member of the Board

X X

Nesta Advisory Board - member X 2018Tower Hamlets Health and WellbeingBoard

X 2016 Current

North & East Londno CSU - partner is the Business Development Director (currently on secondment to NHSW as the London Regional Director for Primary Care)

X

2014 Current

Action for Stammering Children - partner is a Trustee

X 2013 Current

Family Mosiac Housing Association - non-executive Director

X 2014 Current

Peabody Housing Association Board - non-executive Director

X 2017 Current

Chartererd Physiotherapist (non-practising)

X 1987 Current

NHS North East London Commissioning Alliance (City & Hackney, Newham, Tower Hamlets, Waltham Forest, Barking and Dagenham, Havering and RedbridgeCCGs) - Accountable Officer

X

2017 Current

House of St Barnabas - member X 2018 CurrentCentral London Community Healthcare - partner is on secondment as Director of Primary Care Development X X

2019 Current

Vineeta Manchanda Form sent WEL CCGs Joint Board Lay Member Chair of Audit Committee

Voting member Yes IBMDS - Director of the company which is owned with her husband

X X 2011 Current YES

Woodgrange Medical Practice X 2015 CurrentFrenford Clu bs for Young People(registerd charity / voluntary organisaiton)

X2012 Current

NHC - Newham GP Federation (Woodrange Practice is a shareholder) X

2015 Current

Novartis X 2018 CurrentPrimary Care APMS contract for GPcaretaking - Dr Abiola's practice

X 2019 Current

Jubillee Street Practice - transformation partner X

2017 Current

GP Care Group Board - non-votingmember X

2018 Current

KPMG - Partner is Managing Director of KPMG London. (main insterest - transformation & insurance) X

X

2002 Current

NHS England - works with NHSE on project including Transformation Primarcy Care Healthy London Partnership, taskforce, vulnerablepractices pilot, the Perfect Week in General Practice.

X

2012 Current

CACI - Marc Radley (family member) is a director. CACI supply information andIT system to the public sector)

X X

2016 Current

London Borough of Tower Hamlets - Corporate Director, (Health, Adults &Community)

X2016 Current

Hertfordshire Partnership NHSFoundation Trust - ordinary member

X 2016 Current

Greater London Authority X 2019 CurrentMaidstone & Tunbridge Wells NHSTrust - Spouse is a Director

X X 2019 Current

Labour Part - Member X 2019 CurrentHonesta Partners Ltd (a healthcaremanagement consultancy) director andco-wner

X2019 Current

Honesta Partners Ltd (a health management consultancy)spoue is adirector and co-owner

X X2019 Current

North East London Joint Commissioning Committee

X 2019 Current

First Community Health and Care - non-executive Director

X 2019 Current

NELCA - Chief Nurse Member NELJCC

X 2020 Current

Waltham Forest CCG - registeredNurse Board Member

X 2020 Current

Newham CCG - registered NurseBoard Member

X 2020 Current

YES

YES

YES

YES

YES

YES

YesVoting member

Chair of Newham CCGCommittee Member

WEL Joint BoardWEL Strategy &Transformation Committee

Form sent Muhammad Naqvi

Denise Radley WEL Joint Board Board Member

February 2020Sam Everington Chair (rotating)Chair -Tower Hamlets CCGChair - Chairs for London CCG(names of the London CCG?)

Voting member Yes

Virginia Patania Form sent WEL Joint Board Board Member Voting member Yes

WEL Joint BoardWEL Strategy &Transformation CommitteeTower Hamlets CCG Board

WEL Joint BoardFebruary 2020

Voting member Yes

Ellie Robinson Form sent WEL Joint Board Newham CCG Board Member - Lay Member Patient & Public Engagement

Voting member

Form sent

Jane Milligan Voting member YesBoard Member & CCG employee

YES

YES

YESVoting memberCommittee MemberCommittee MemberCommittee MemberChair

Committee Member

Committee Member

WEL Joint CCGs BoardNewham CCG BoardWaltham Forest CCG BaordWEL Quality & Safety CommitteeWEL Finance & PerformanceCommitteeNewham Primary CareCommissioning Committee

February 2020Fional Smith

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(Permissionto publish)

NAME DATE of declaration COMMITTEE/s attended POSITION/s held on CCG committees attended:(Governing Body member;Committee member; Member practice;CCG employee;Other.)

STATUS held on committee/s(voting or non-voting member, staff)

DECLARED INTERESTS:Do you have any interests todeclare?(Y or N)

INTEREST BEING DECLARED(Name of the organisation andnature of business)

DPA(permission to publish)

All Sainst Practice - salaried GP(practice is a member of the GPprovider group- GP Care CIC)

XCurrent

Royal College of General Practitioners Council - member and Chair of NW RCGP London Faculty and RCGPLondon)

X

Current

HealthCare Quality Improvement Partnership (HQIP) - Trustee & Boardmember

XCurrent

NHS England Allocations SteeringGroup - member X

Current

Barts Health MSK IMAPs (IntegratedMusculoskeletal and Pain Service) X

Current

QMUL - NIHR Clinical Fellow X CurrentRima Vaid Form sent WEL Joint Board

WEL Strategy &Transformation Committee

Board MemberCommittee Member

Voting member Essex Lodge Surgery - salatied GPX

2019 Current

Somen Banerjee Form sent WEL CCGs Joint Board Board Member Voting member London Borough of Tower Hamlets - Director of Public Health X

Current

Joe McDonnell Form sent WEL CCGs Joint Board Board Member Voting member London Borough of Waltham Forest - Director of Public Health X

Current

Jason Strelitz Form sent WEL CCGs Joint Board Board Member Voting member London Borough of Newham - Director of Public Health

X Current

Jenny Mazarelo Form sent WEL CCGs Joint BoardWEL Strategy &Transformation Committee

CCG EmployeeCommittee member

Non-voting attendeeNon-voting attendee

Chris Neill Form sent WEL CCGs Joint BoardWEL Strategy &Transformation Committee

CCG EmployeeCommittee member

Non-voting attendeeNon-voting attendee

Satbinder Sanghera Form sent WEL CCGs Joint BoardWEL Strategy &Transformation Committee

CCG EmployeeCommittee member

Non-voting attendeeNon-voting attendee

East Village Trust X

2013 Current

Chetan Vyas Form sent WEL CCGs Joint BoardWEL Strategy &Transformation Committee

CCG EmployeeCommittee member

Non-voting attendeeNon-voting attendee

Newham CCG - wife a substantiveemployee X

Dianne Barham Form sent WEL CCGs Joint BoardAlthea Bart Form Sent WEL CCGs Joint Board Attendee Not a voting member NoLeonardo Greco Form Sent WEL CCGs Joint BoardHeather Flinders Form sent WEL CCGs Joint BoardJohra Alam Form Sent WEL CCGs Joint BoardLee Eborall Form Sent WEL CCGs Joint BoardMark Scott Form Sent WEL CCGs Joint Board

Victoria Tzortziou-Brown Form sent WEL Joint Board Board Member Voting member

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WEL CCGs Joint Board - Part 114:00 – 16:00, Wednesday 15 January 2020Committee Rooms, Level 4, Unex Tower, 5 Station Street, Stratford, E15 1DA

MINUTESCHAIR: Ken Aswani

NAME TITLE ITEMMEMBERSDr Ken Aswani WFCCG ChairDr Johra Alam WFCCG Elected GP RepresentativeHenry Black WEL CCG Executive Member - Chief Finance OfficerMaggie Buckell CCG (All) Registered NurseSteve Collins WEL CCG Executive Director FinanceSelina Douglas WEL CCG Executive Member - Managing DirectorHeather Flinders LBTH Divisional Director – Children and FamiliesVineeta Manchanda WFCCG Lay MemberJane Milligan WEL CCG Executive Member - Accountable OfficerDr Muhammad Naqvi NCCG ChairVirginia Patania THCCG Practice Manager RepresentativeFiona Smith WEL CCG Registered Nurse - QualityAlistair Chesser Barts Health Trust, Group Chief Medical OfficerDr Victoria Tzrotziou Brown THCCG Elected GP RepresentativeMariette Davis THCCG Lay MemberJoe McDonnell LBWF Director of Public Health (non-voting member)Dr Thaven Chetty WFCC Elected GP RepresentativeDr Clare Davison NCCG Elected GP RepresentativeDenis Radley LBTH Director Health, Adults & CommunityEllie Robinson NCCG, Lay Member – Patient and Public EngagementRiam Vaid NCCG GP RepresentativeShalini Kawar WFCCG Clinical Director (an observer)OFFICERSChetan Vyas WEL CCG Director of Quality and SafetySatbinder Sanghera WEL CCG Director of Corporate ServicesChris Neil WEL CCG Director of Commissioning and PerformanceAPOLOGIESColin Ansell LBN RepresentativeDr Sam Everington THCCG ChairJenny Mazarelo WEL CCG Director of Primary CareATTENDEESJohn Flood Deputy Director Contracts, NEL CSU Item 4.1Raana Ali Assistant Director – Tower Hamlets Medicines

ManagementItem 5.2

No. ITEM ACTION

1.0 GENERAL BUSINESS

1.1 Welcome, introductions and apologies.

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The Chair welcomed members, introductions were made and apologies notedas above.

The Chair on behalf of the WEL Joint Board members offered congratulations toDr Tzrotziou Brown who was awarded an OBE in the Queens’ New Year’s Honours List 2020.

1.2 Declarations of Interest and Register of Interests

The members confirmed, that the Conflicts of Interest Register was accuratesubject to the following amendments:

1. Steve Collins – duplicates to be remedied.2. Alistair Chesser – declaration form to be completed.3. Chris Neill – declaration form to be completed4. Jason Strelitz – declaration form to be completed5. Somen Banerjee – declaration form to be completed6. Heath Flinders – declaration form to be completed7. Joe McDonnell – declaration form to be completed

No additional interests, not already on the register, were declared.

Post meeting note – A WEL DOI Register is being created and will be submitted to the WEL Joint Board in April 2020.

1.3 Quoracy

1. Will be seven voting members, which must include: at least one memberfrom each CCG from amongst the CCG Chairs and additional governingbody primary care representatives; the accountable officer, the managingdirector, or the chief finance officer; and one lay member.

Or, in the event that all GPs are excluded due to a conflict of interest;

2. Will be four members, which must include: at least one lay member; andat least one clinician; and at least one of a CCG accountable officer,managing director, and chief finance officer.

Member’s deputies are included within quoracy

The Chair declared the meeting quorate.

1.4 Minutes of the previous meeting.

The members acknowledged the paper as read.

DECISION: The minutes of the previous meeting were approved as an accuraterecord.

1.5 Action Log

The members acknowledged the paper as read.

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The following actions were discussed and comments noted:

1. CLOSED – Public questions on Whipps Cross as a centre of excellencefor surgery relevant to the care of the elderly – engagement plan (formingpart of the Surgical Strategy) across the Barts footprint including details ofmeeting held is to be published on the three websites (Newham, WalthamForest and Tower Hamlets).

The Barts engagement plan has been published on all three CCGwebsites. This action has now been closed.

1.6 Matters Arising (items not already covered in the agenda and notified to theChair no later than 24 hours in advance of the meeting by email includingurgent agenda items).

No matters were raised.

1.7 Patient’s Story

No patient story was provided at this meeting.

2.0 UPDATES

2.1 BAF Development

The members acknowledged the paper as read.

Presented by Satbinder Sanghera.

The members were asked to agree the process as described [in the paper] andthe timeframe for adoption.

SS confirmed, that the new governance structure for WEL is now in place (5 WELsub-committees and 10 WEL priority areas) and, that one approach to the BAF isbeing implemented across all CCGs.

A BAF report outlining the development process for the WEL BAF will besubmitted to the WEL Audit Committees in Common on 22/01/20 for approval.The WEL CCGs BAF will be submitted to the WEL JB on 19/02/20.

Risks from providers / primary care colleagues associated with work being undertaken in integrated care will be captured by ensuring the NELCA framework (keyobjectives etc.) is followed when creating the WEL CCGs BAF. In addition, allcommittees will be required to feed into the BAF process. Finally, as the WELworking model is developed, thought will be given to the way in which provider /primary care risks feed into the WEL CCGs BAF.

DECISION: the members agreed with the process as described in the paperand the timeframe for adoption.

2.2 Accountable Officer and Managing Director

The members acknowledged the papers as read.

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Presented by Jane Milligan.

The members were asked to - note the report.

JM brought to the members’ attention the following points:

Planning for 2020/21 – the final operating plan including the narrative is due tobe submitted to NHSE/I on 17 April 2020. An update will be brought back to WEL.

Moorfields Eye Hospital – the business case will be discussed at the CiC on12/02/20. Decision making for the three CCGs for this piece of work has beendelegated to Ken Aswani (Waltham Forest CCG), Noah Curthoys (Tower HamletsCCG) and Nadeem Faruq (Newham CCG).

CCG Leadership quarterly review – Tower Hamlets has been rated green star;Newham and Waltham Forest have been rated green; BHR has moved from‘amber’ to green; and City and Hackney has moved to green star.

The Chair congratulated everyone involved in successfully achieving the greenrating.

SD brought to the members’ attention the following key points:

Out of Hospital Strategy – WEL is continuing to work with boroughs to share thestrategy, in particular prioritising delivery.

DECISION: the members noted both reports.

2.3 Chairs

The Chair mentioned, that work was being undertaken on the development offuture Clinical Leadership.

2.4 NHS LTP response across ELHCP

The members acknowledged the paper as read.

Presented by Selina Douglas.

The members were asked to note the next steps in developing the WEL CCGsresponse to the LTP and, to note the ELHCP LTP Implementation Update.

SD brought to the members’ attention the following points:

Easy read guide – a short (4 page) document is being developed of the LTP[Long Term Plan]. This will be published on the WEL CCGS website on a datein the future together with a full version of the LTP.

WEL System (page 47 of meeting papers) – SD confirmed, work is underwaywith Simon Hall from ELHCP to consider a suitable reporting process to WELCCGs on the work being undertaken on priority areas, programmes of work andtheir link to the WEL Plan mitigating any gaps between the LTP and the WELPlan.

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Matrix and Reporting (page 53 of meeting papers) – there are currentlydifferences in reporting across the areas and the CCGs. A process ofstandardisation is being developed at both NEL and at a local level to ensure italigns to the Operating Plan and trajectories are in place for delivery.

Local input - local input to the WEL CCGs’ response to the LTP is important.Input from WEL members will be sought on the first draft when produced.

Appropriate metrics - thought would need to be given to the adoption of asuitable metrics that would provide members with the necessary assurance thatimprovements implemented have been effective.

Modelling – in order to determine demand and capacity, the CCG is workingthrough existing models able to support both Acute and Primary Communitydemand and capacity mapping. At some point in the future another model maybe selected.

DECISION: the members noted the next steps in the process of responding tothe LTP and the implementation update.

2.5 Better Care Fund

The members acknowledged the paper as read.

Presented by Selina Douglas.

The members were asked to note the paper.

SD provided an overview of the three CCG reports and brought to the members’ attention the following points:

Newham – has a good performance for delayed transfers of care. Goodrelationships are in place between Newham and the Local Authority. Onechallenge in Newham are the limited residential care homes due to ongoingquality monitoring of this service is being carried out.

Waltham Forest – the priorities have been promoting wellbeing, ageing well,mental health and improving life chances for people with learning disabilities.The focus is on the out of hospital approach including complex care needs andprimary prevention – urgent needs and LTC. Waltham Forest has receivedsocial investment to look closely at improving end of life care.

Tower Hamlets – there is a good relationship within the governance structure inTower Hamlets. The borough based partnership (Tower Hamlets Together) andthe Tower Hamlets voluntary sector. They take responsibility for the BCFtemplate. There is a renewed focus has been on implementing changes to non-elective admissions at Royal London and, ensuring that the hospital to homemodel is embedded. There is limited nursing bed capacity in Tower Hamlets.

The note, the mention in the paper submitted at the meeting, that it has notbeen signed off by the Tower Hamlets Director of Social Care related to a timingissue. The paper had to be released for the WEL JB.

DR confirmed, that Tower Hamlets, did meet their target for 2019/20.

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DECISION: the members noted the report.

3.0 COMMISSIONING

3.1 Barts Health Surgery Change

Chris Neill joined the meeting.

The members acknowledged the paper as read.

Presented by Chris Neill.

The members were asked to:

1. Note the status of the Barts Health Surgery Change Programme in thecontext of partnership working across the STP;

2. Agree the approach to public consultation, in line with the relevantguidance;

3. Review the proposed governance arrangements; and4. Agree to the creation of the Strategy Change Programme Board.

CN provided an overview of the papers and brought to the members’ attention the following points:

Service change – the detail as to service changes will be provided at a futuredate. The paper submitted dealt with the governance, systems and processes.

Whipps Cross – the business case for the redevelopment is currently beingdrafted. It will take into account a variety of local factors, including any impactdemand, capacity and a shift to out of hospital services will have on activitynumbers.

DECISION: the members noted the status of the change programme, agreed theapproach to the public consultation and agreed the creation of a Strategy ChangeProgramme Board.

Chris Neill left the meeting.

4.0 ASSURANCE

4.1 Integrated Performance Report (M7)

John Flood joined the meeting

The members acknowledged the paper as read.

Presented by John Flood.

The members were asked to review the report and to:1. Note the actions that are being taken; and2. Seek any further assurances they require in respect of risks and their

management.

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JF provided an overview of the paper and brought to the members’ attention the following points:

Planned Care – (referral for treatment) the patient numbers waiting over 52 weekfor treatment has increased. There is an ASI (appointment slot issue) at Bartsarising from patients being referred into the trust and then moving onto the trustpatient record system for treatment. As a result, a number of patients wereidentified as having slipped off the system records. This is now being addressed.Over the next few months the impact of this backlog will be to increase the 52week wait position. There is also pressure on ‘business as usual’ waits which remain high with an increasing number of long waits over 52 weeks.Commissioners are working closely with the Trust to deal with these problems.

OPEL [Operational Escalation Levels] - whilst most trusts sit at OPEL 2, therehave been a number of occasions when Whipps Cross has moved into OPEL 3.Measures are in place to remedy any move into OPEL 3.

Mental Health – the issue with out-of-area placements, involving patients beingmoved out of their area due to insufficient in-area beds / services, has started toreduce. NELFT has introduced more capacity for home treatments.

CN thanked the members who had responded to some of the pressures.

DECISION: the members noted the actions being taken.

4.2 Finance Report (M8) – with a verbal update for M9

The members acknowledged the paper as read.

Presented by Steve Collins.

The members were asked to note the report.

SC provided an overview of the paper and brought to the members’ attention the following points:

Financial Pressure – there remains financial pressure on the WEL CCGs in threekey areas. Acute performance is still high; Prescribing costs are under pressure;and growth continues to be seen in CHC expenditure. Discussion continues onthe allocation adjustment for costs incurred by patients who have moved to GPat Hand. Including acute and out of area mental and community healthexpenditure.

Year to date position – the year to date position shows a shortfall of c.£2m, whilstthe full year figure shows a breakeven position. The full year figure allows for useof the risk pooling mechanism used in previous years to bring the WEL CCGsback to an in year control total in line with the plan.

Contract performance – a full year agreement has been reached with BartsHealth and with LAS for the 999 and 111 services. The volume based volatility inthe financial position for the remainder of the year is reducing.

QIPP performance – the WEL CCGs are behind in QIPP for 2020/21. Although itwill be monitored, it is unlikely to change over this financial year. The areas where

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change could have been implemented are now fixed as part of the year end dealagreed with Barts Heatlh.

Acute – £2.5m over performance is anticipated with the Homerton, substantiallyfrom growth in Newham.

Reduced corporate costs 20/20 – the WEL CCGS are now predicting, due tochanges in the WEL structure, that running costs for 20/21 are expected to be£1.5m below the 19/20 allowance. The current planning will put the CCGs ontrack to deliver the target on a full year basis in 20/21.

Better Payment Practice Code – the CCGs continue to meet the code.

DECISION: the members noted the report.

4.3 Quality and Safety Report (M8)

Presented by Fiona Smith.

The members acknowledged the paper as read.

The members were asked to note the report.

The report submitted to the WEL Joint Board meeting was the first aggregatedreport for the WEL CCGs on Quality & Safety.

FS provided an overview of the paper and brought to the members’ attention the following points:

Report format - the committee will consider over the coming months how thecommittee reports to the WEL Joint Board, the format of the report and how thecommittee escalates matters to the WEL Joint Board, in the future. The ambitionis to have a WEL system Quality & Safety report.

Clinical Quality Review – collaborative discussions are under way with providersto revise how the WEL CCGs will gain assurance on quality and safety fromprovider colleagues.

CQC inspection reports – following recent inspections by the CQC, the ratings forNELFT, Whipps Cross Hospital Maternity and Newham University HospitalDiagnostics have remained the same.

Tower Hamlets Alliance Children’s Single Point of Access – Barts HealthChildren’s Services noticed that if a referral was received and rejected, the EMISsystem was not alerting the referrer of the rejection. A manual process has beenput in place to remedy this issue whilst the IT system specialists find a digitalsolution. FS confirmed that no patients have been missed as a result of this ITsystem issue.

NELFT Paediatric OT 18 week waits - the 52 week wait position is improving. Theaverage wait is currently between 31 – 38 weeks. NELFT has employed locumsto add capacity. Clinical Harm Reviews have been carried out on patients affectedby the long waits. FS confirmed that no clinical harm have been found from thesereviews.

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Level of Detail in Q&SC Report to WEL JB – the members discussed the amountof detail which should characteristically be included in the report submitted toWEL Joint Board to ensure transparency of performance at site level. The viewof the Q&SC was that detail should be discussed in the WEL Q&SC and not atthe WEL Joint Board, with the function of the sub-committee being to provide theappropriate level of assurance to the WEL Joint Board.

DECISION: the members noted the report.

5.0 NEXT MEETING

5.1 WEL Governance Arrangements

The members acknowledged the paper as read.

Presented by Satbinder Sanghera.

The members were asked to note the WEL CCGs Joint Board Terms ofReference, Standing Orders and Conflicts of Interest Policy for information.

SS provided an overview of the paper and brought to the members’ attention the following points:

Summary of Sub-Committee meetings - the members discussed, the level ofdetail that should be submitted to the WEL CCGs Joint Board from the WEL Sub-Committees. They agreed, that a summary of the key points following eachcommittee’s meetings should be submitted on a monthly basis.

Standing Financial Instructions (page 261) – a disconnect exists in the ‘cascade of approvals’ as the values increase, as stated in the paper.

ACTION: SS to amend the wording of the cascade to ensure it can be practicallyapplied.

Clinical leadership of Sub-committees – SS confirmed, that all sub-committeesnow have clinical leadership (clinical leads / directors) in the membership.

DECISION: the members noted the paper

SS

5.2 WEL Medicines Optimisation – approval of WEL Medicines Optimisationand Commissioning Committee to become decision making [WEL MOCC]

The members acknowledged the paper as read.

Presented by Raana Ali.

The members were asked to approve the Terms of Reference for the delegateddecision making at WEL MOCC from the WEL Strategy and TransformationCommittee for oversight of the various Medicines Optimisation functions.

RA provided an overview of the paper and brought to the members’ attention the following points:

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The committee will be the single point of entry for new medicines or newindications for medicines and associated pathways across WEL CCGs.

Membership and quoracy for WEL MOCC was explained.

Public and Patient Engagement – there will be a lay member (patientrepresentative) & patient representation will be included via patient engagementto be undertaken in working groups as needed.

Delegated Authority for decision making – comes from the WEL Joint Board tothe WEL Strategy & Transformation sub-committee [S&TC] and then to WELMOCC with accountability back to the S&TC and then the WEL Joint Board. Anydecisions with a financial implication, where appropriate, will be ratified at theFinance & Performance Committee [F&PC].

The Chair asked that the Terms of Reference be clear as to what in MedicinesOptimisation is not part of the WEL MOCC.

ACTION: RA to clarify in Term of Reference, what in Medicines Optimisation isnot part of the WEL MOCC.

Impact of governance on Primary Care – GP / Clinical representatives from TowerHamlets, Waltham Forest and Newham are members of WEL MOCC. TheChairing rotates across the three GPs. This will ensure that consideration is givento the impact on Primary Care of decisions made at WEL MOCC across WEL.

Prescribing representative/link on the Joint Board - RA suggested, that there isthe need for the Heads of Medicines Management to have a Prescribingrepresentative/Link on the joint Board including for relevant discussions/decisionsat WEL MOCC or key prescribing priorities for the attention of the Joint Board.

ACTION: SS to look into appointing a Prescribing representative on the WELJoint Board.

DECISION: the members approved the Terms of Reference for the decisionmaking WEL MOCC.

RA

SS

6.0 PUBLIC QUESTIONS

6.1 No public questions were notified in advance of the meeting.

Two complaints were raised at the meeting. SS suggested to both complainantsthat complaints, as outlined in the Complaints Policy published on each CCG’s website, should be dealt with through the CCGs’ complaints process.

The Chair reiterated the information published on each website, that questionsto the WEL Joint Board can be asked at any time, however to allow fullresponses to be given on the day of the meeting, the CCG asks that questionsbe submitted in advance by 2PM on the Friday before the Wednesday meeting.

ACTION: CV to contact both complainants and discuss their needs. CV

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A question was raised by Mary Logan [SONHS] which was subsequentlyconfirmed by CN to be similar to an FOI request previously received by theWEL CCGs. This question will be dealt with through the FOI process:

WEL CCGs website – Mary Logan suggested, that the information about publicquestions on the CCG website was confusing.

Post meeting note - the following guidelines for public questions, consistent with NELCA guidelines for public questions, are published on each of the WEL CCG websites:

“We want to be open and transparent about the way we do business. We want to ensure local people and groups have the opportunity to ask questions about our work.

At each meeting of the WEL CCGs, we will allow approximately 10-15 minutes for questions from the public.

Questions for the board can be asked at any time, however to allow for a full response to be given on the day of the meeting, we ask that questions are submitted in advance, by 2pm on the Friday before the Wednesday meeting when the answer will be provided. A follow up question may be allowed at the meeting at the Chair’s discretion and if time allows.

Questions should be sent to newccg.welgoverningbody@nhs.net or sent by post to:

WEL Joint Board Secretary 4th Floor Unex Tower 5 Station Street, London E15 1DA

A question may be rejected if it:

is not about a matter for which the WEL JB is responsible

is defamatory, frivolous or offensive

is substantially the same as a question asked within the lastsix months

requests the disclosure of information which is confidential orexempt

names, or clearly identifies, a member of staff or any otherindividual

relates solely to an issue for a single CCG.

We request, for any questions asked in person at the meeting, or by a representative, that if a reply cannot conveniently be given orally, the time allocated for questions has elapsed or the questioner is not present in the chamber, a written reply will be sent, providing contact information has been provided, within a month of the meeting.

The question, the name of the questioner and the reply given will be included in the WEL minutes and published on the CCGs’ websites.

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7.0 NEXT MEETING

7.1 DRAFT Agenda WEL Joint Board Part 1 – for information.

7.2 The date of the next meeting is Wednesday 19 February 2020 – for information

8.0 MEETING CLOSED 1545

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Date Minute Ref Action Description Responsible Officer Target Completion Date Update Status CCG Committee Type15/01/2020 5.1 WEL Governance Arrangements - Standing Financial

Instructions - a disconnect exists in the 'cascade of approvals' as the values increase, as stated in the paper. SS to amend the wording of the cascade to ensure it can be practically applied.

Satbinder Sanghera 18/02/2020 Open WEL WEL Joint Board Action

15/01/2020 5.2 WEL Medicines Optimistaion - information of a WEL Medicines Optimistiaon prescribing Committee (WEL MOCC) - Terms of Reference - The Chair asked, that the ToR be clear as to what in Medicines Optimiation is not part of the WEL MOCC. RA to clarity in ToR what in Medicines Optimisation is not part of the WEL MOCC

Raana Ali 18/02/2020 The potential exclusions in the Terms of Reference were discussed with members at the January WEL MOCC (29/01/20). Board members agreed that WEL MOCC should retain oversight for all medicines related matters. This will be clarified in the ToR. There will therefore be no exclusions with regard to medicines.

Open WEL WEL Joint Board Action

15/01/2020 5.2 WEL Medicines Optimistaion - information of a WEL Medicines Optimistiaon prescribing Committee (WEL MOCC) - Prescribing representative on the Joint Board - RA suggested, it would be useful, for when discussions take plac eon decision made at MOCC, to have a prescribing representatiave on the Joint Board.SS to ldiscuss with Jenny Mazarelo establishing a link between the WEL JB and MOCC.

Satbinder Sanghera 19/02/2020 Open WEL WEL Joint Board Action

15/01/2020 6.1 Public Questions - Two complaints were raised at the meeting. SS suggested to both complainants that complaints, as outlined in the Complaints Policy published on each CCGs website, should be dealt with through the CCGs' complaints process.CV - to contact both complainants and discuss their needs.

Chetan Vyas 19/02/2020 Open WEL WEL Joint Board Question

ACTION LOG - Part 1 meetings

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WEL Board – Part IDate: 19 February 2020

Title of report Accountable Officer and Managing Director update

Item number 2.1

Author Jane Milligan, Accountable Officer / Selina Douglas, ManagingDirector

Presented by Jane Milligan, Accountable Officer / Selina Douglas, ManagingDirector

Contact for further information Selina Douglas, Managing Director selina.douglas@nhs.net

Executive summary This report provides an update on the activities of the AccountableOfficer and Managing Director since the last Board meeting,highlighting items of interest to Governing Body members and thepublic.

Action required Note

Where else has this paper beendiscussed?

No previous presentation to any previous meetings/forums.

Next steps/ onward reporting NoneStrategic fit N/A

What does this mean for localpeople?

N/A

How does this drive change andreduce health inequalities?

N/A

Financial Implications None

Risks None

Equality impact None

Accountable Officer’s update

1.

1.11.1.1

1.1.2

Operating Plan guidanceNHS England and Improvement have published the operating plan guidance for 2020/21. It islargely as expected and outlines some key guidance on development of Integrated CareSystems as well as the main deliverables for areas such as mental health, workforce, primarycare and finance.

We will now be working through our system plan with our partners across health and care intime for the draft submission in March and final submission at the end of April.

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mailto:selina.douglas@nhs.net

2.

2.12.1.1

2.1.2

Primary Care Network (PCN) Expo eventEarlier this month we held our first Primary Care Expo, showcasing the support on offeracross north east London in developing Primary Care Networks (PCNs). It was a hugesuccess, attracting over 200 attendees, including our north east London PCN clinicaldirectors and their member GP practice teams. There were presentations on a range ofareas including social prescribing, workforce and integrated care, and attendees wereencouraged to network and visit stalls for more information. The next north east LondonPCN development event is planned for June 2020.

Primary Care Networks (PCNs) are a key part of the NHS Long Term Plan, typically covering30,000 – 50,000 patients, and consisting of groups of GP surgeries working together with arange of local health and care providers, including across primary care, community services,social care and the voluntary sector. There are 48 primary care networks in north eastLondon.

3.

3.13.1.1

3.1.2

North East London Integrated Care System Chair appointedI am delighted to announce that Marie Gabriel has been appointed as the new Chair for ouremerging NEL ICS. Marie will be known to many through her current role as Chair of EastLondon Foundation Trust as well as her wealth of experience across health and care innorth east London over the last twenty years.

Marie will start with us officially from 1 April and undertake an induction and transition to therole over February and March. As part of this process Marie is already looking at how best todevelop our governance across the ICS and is bringing together CCG lay members andTrust non-executive directors for a discussion on this.

4.

4.14.1.1

4.1.2

4.1.3

YouTube live broadcast to staffAs part of our internal communications with staff across north east London I undertook my firstyoutube live broadcast this month, alongside Rachel Patterson the NELCA Director of Peopleand OD.

Using the live stream we were able to update staff across all of our offices at the same timeon a range of issues including the operating plan, ICS development and our HR and OD work.

During the broadcast staff could ask questions via the interactive platform Sli.do. This was anefficient and effective way of sharing consistent messaging with staff.

5.

5.1

5.1.1

Inner North East London/Outer North East London Joint Health Overview and ScrutinyCommitteeThe first joint JHOSC of the year took place in Stratford in February. I attended alongsideother members of the team including CCG chairs as well as colleagues from our Trusts. Wepresented an update on the north east London response to the Long Term Plan and

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answered a range of questions on the development of our ICS. The slides can be accessedhere.

Managing Director’s update

1.

1.11.1.1

Barts System Oversight and Assurance Review (SOAR) meeting – 13 FebruaryThe purpose of the meeting is to provide assurance to NHS England that as a system we areworking together to address issues in performance, quality, finance and workforce. Feedbackfrom the meeting will be provided in next month’s update.

2.2.12.1.1

2.1.2

2.1.3

Organisational DevelopmentTo support the WEL plan and as we move forward working in new ways across a widerfootprint, my Joint Management Team (JMT) spent some time together to think about how wework effectively as a team to support everybody to make the greatest impact on improvingcare in WEL. We created a starting point for the development of our shared purpose, role andvision, which will guide our work for the next year and beyond.

The grid below is both a culmination of many conversations over the past year and startingpoint for us all to create a shared purpose, role, and vision for WEL.

The next step is to involve all of the CCGs’ staff in developing these statements. This is because we want everyone to be confident in the new ways of working and for people to be

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https://mgov.newham.gov.uk/ieListDocuments.aspx?CId=1204&MId=12903&Ver=4

2.1.4

2.1.5

able to clearly articulate what we want to achieve across the WEL system and how we will besuccessful.

We will shortly be setting out details of an OD offer and opportunities for learning anddevelopment that will begin with each directorate taking a day to work through the CCGs’ purpose, role, and vison, and to make the direct link to each directorate’s objectives. As a joint Management Team, we also committed to five standards about the way we functionand support the organisation. These are:

Working together to deliver the final agreed vision, purpose and objectives Building on this strong start – by refining, using and owning the objectives, purpose,

vision and role Communicating openly and clearly with staff and stakeholders and to invite discussion

and people’s contributions

To work together more to focus on our joint leadership role Focusing on the next steps to maintain momentum – as set out above in terms of

development and focusing more on ways of working and personal purpose.

3.3.13.1.1

3.1.2

Staff engagement updateAs part of the strategy to ensure all staff voices are heard I now host a small group of staffeach month for breakfast, with the first one held on 27 January. This is an informal sessionfor staff to raise any issues/concerns, share good news stories and get to know one another.

Our staff engagement group (SEGway) meet on a monthly basis and has representativesfrom all teams. At the most recent meeting on 10 February, discussions focused on contentfor staff induction, the OD plans mentioned above and ICS development.

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WEL Board – Part IDate: 19th February

Title of report ELHCP Update

Item number 2.3

Director Simon Hall, Director of Transformation

Author Mark Scott, Deputy Director of Transformation

Presented by Simon Hall, Director of Transformation

Contact for furtherinformation

Simon Hall, Director of Transformation

Executive summary This paper provides an update on:• Background to the Long Term Plan• Summary of implementation approach• Operational planning for 2020/2021It flags to the WEL board key strategic aspects of the NEL LTPresponse, including the principles of how the system will worktogether to enable integrated care. It focuses on some of the keyimplementation aspects, including how accountability will beestablished. Finally, it focuses on the operational planningprocess for 2020/2021.

Action required (approve/ note / discuss)

To Note

Conflicts None

Where else has thispaper been discussed

None

Confidentiality No

Next steps/ onwardreporting

We will be providing a programme update and 20/21 milestoneplans during March 2020, which will be shared with the WEL Board

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Strategic fit The LTP response provides strategic direction across ELHCP andfor local systems.

What does this mean forlocal people?

Local implementation of the LTP should provide the followingbenefits for local people:

don’t notice organisational boundaries – it is all one healthand care system working together to provide the best care

are supported to stay well can access the best care possible in modern, fit for purpose

facilities can view their patient record online, and are confident it is

stored securely access care provide by skilled, motivated, kind staff with a

culture of continuous improvement benefit from world class research and innovation which

means earlier diagnosis and more effective treatments.

How does this drivechange and reducehealth inequalities?

We currently have an unbalanced delivery system– we are set upto respond to illness. A key part of our LTP response is to refocustowards prevention and population wellness, and a component ofour population health approach will be to address healthinequalities and wider determinants of health.

Financial Implications Overall, it is a key strategic priority for all our partner organisationsto manage financial risk in a different way, given the projectedincreases in demand for services and the available resources andcapacity.

There are components of transformation funding across the LTP,which will be used to drive improvements and delivery of keymetrics.

Risks The two main areas of risk for LTP implementation are finance andworkforce.

Finance will be addressed via the 2020/21 system operatingplanning processes.

Workforce will be addressed via the people plan

Equality impact There will is an equality impact assessment undertaken of the LTPresponse in collaboration with other London STPs.

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ELHCP Update

February 2020

Simon HallDirector of Transformation

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This presentation covers:

•Background to the Long Term Plan

•Summary of implementation approach

•Operational planning for 2020/2021

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Context – Long Term Plan• Final draft of north east London’s response to the NHS Long Term Plan was

submitted to NHS England on 15 November 2019 with the following text:Note: this final draft document is being submitted to NHS England during a pre-election period, when the ELHCP is bound by purdah conventions. This has meant that we have been unable to discuss the document in public forums as originally planned. As such, this is a ‘final draft’ and will be shared with partners, but not published when it is submitted on 15 November 2019.

• Final draft is now on our website: www.eastlondonhcp.nhs.uk• We are presenting on the LTP at partner meetings –trust boards, health and

wellbeing boards, joint health overview and scrutiny meetings etc –forreview and discussion before the LTP is finalised.

• Intend to publish the final LTP after March 2020 budget, subject to NHSEngland/Improvement approval.

• Marie Gabriel has been appointed as our new chair, and starts on 1 April2020.

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http://www.eastlondonhcp.nhs.uk/

Reminder: our challenges

• Substantial population growth (from 2.02m to 2.28m by 2028,13% growth over the next 10 years).

• Significant variations in clinical quality and outcomes across ourhealth and care economy that need to be tackled in order tomake a real impact on health inequalities.

• Significant workforce challenge across health and care servicesand our population growth will exacerbate demand for services ifwe continue to deliver them in the same way.

• Demand is projected to outstrip our resources and capacity whichmeans we need to look at how we provide care and our financialmodels and systems. These challenges span both health andsocial care, and mean we need to agree a different way across allour partner organisations to manage financial risk.

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How we work together

Our basic principle is that decisions about health and care take place closest to local people as possible, and only where there is good reason to do so will programmes operate at NEL level.

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Moving Towards Implementation, Headlines

• ELHCP is undertaking regular bi-monthly programme-level reportingto the STP Executive, the next report will be available in March andwill be shared with the WEL Joint Board.

• There is currently a programme of deep dives across all LTPprogrammes with the Accountable Officer/ELHCP SRO and theDirector of Transformation (and involving programme teams), toprovide an overall review of programmes as well as 2020/2021delivery plans

• ELHCP programme leads are developing 2020/2021 delivery andmilestone plans, which will be available in March and will be sharedwith the WEL Joint Board

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Programmes of work

Improving Population Health

• Prevention• Health inequalities• Wider determinants of

health e.g. housing,poverty

• Personalised care

System Change And Integration

• Primary/community care• Urgent and emergency

care• Improving planned care

and outpatients• Provider collaboration• Mental health

Priority Areas for Improving Outcomes• Cancer• Learning disabilities

and autism• Children and young

people• Maternity• Medicines optimisation• Major LTCs• End of life care

Enablers Supporting Work Programmes

• Workforce• Digital• Estates

• Demand and capacity –business intelligence

• Research and innovation

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Focus on population health management

• Population health management is an approach that aims to improvephysical and mental health outcomes, promote wellbeing and reducehealth inequalities across an entire population

• Our health and care needs are changing: we are living longer andincreased incidence of multiple long term conditions. Much of this isdown to lifestyle factors and where we live rather than the health andcare services treating us. Population health management can help usbetter understand and predict future health and care needs. This willallow improved targeted support, making better use of resources andreducing health inequalities.

• Providers will not just be responsible for the people they treat buthave a collective responsibility for the whole population’s healthalongside commissioners

• Underpinning PHM is the accompanying cultural shift required to putpopulation health data at the heart of decision making across an ICS.

• There is a key role for directors of public health to drive this forward.

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Ensuring accountability• NEL ICS will operate a “federated” approach to organisation, with

most of the activity and delivery being carried out within localsystems.

• We need ensure good governance and decision-making isstrengthened locally and across NEL. NEL ICS will be the vehiclefor transformation funding, and therefore need a governanceprocess to reflect this going forward.

• This is not about bolting on an additional layer of bureaucracy toexisting arrangements, but an opportunity to redesign how we dothings so that we are more agile, productive and effective.

• The ICS recognises the individual statutory responsibilities of itsconstituent members, but seeks to build a common set of goalsand objectives that compliment individual responsibilities and acollaborative approach to delivery that focuses on deliveringoutcomes and solution and shares the risks and benefits so thatwe optimise our collective achievement.

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System Operating Plans For 20/21

Submission to comprise forms & templates across commissioners and providers as well as a narrative plan, with the following deadlines:

• Draft – noon on 5 March 2020• Final – noon on 29 April 2020

Supporting tools to be provided to support submission, which can be completed with regional support.

16th March onwards – series of formal meetings with STPs to agree key risks of each System Operating Plan and how to manage

ELHCP to lead on provider engagement as part of planning process.

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WEL Board – Part I Date: 19 February 2020

Title of report WEL Board Assurance Framework

Item number 3.1

Director Satbinder Sanghera – Director of Corporate Services Author Frazer Tams – Head of Governance

Presented by Satbinder Sanghera – Director of Corporate Services

Contact for further information Frazer Tams frazer.tams@nhs.net

Executive summary This is the first iteration of a WEL Board Assurance Framework (BAF) for discussion and adoption by the Joint Board.

The first iteration of the BAF has been built up through consideration of existing legacy risks within the CCG system, discussions with Directors and also consideration of key papers to committees.

The criteria for risks to be included is that all have been assessed as having an inherent risk score of 15 or above therefore ensuring the focus of the Board is on the individual risks most likely to impact on the delivery of the WEL programme.

This version of the BAF has where appropriate, mapped risks against the existing NEL objectives and individual WEL plan areas. It is expected that the structure of the BAF will be further refined once corporate objectives for the WEL system are agreed so the risks are mapped against these objectives.

Key areas for the Joint Board to focus on: • The completeness of the BAF in terms of risks

included• The effectiveness and quality of key controls

recorded against each risk• The effectiveness of assurances available and

received and whether further assurance is soughtto bridge gaps.

In conjunction with the development of the BAF, existing work is taking place to reassess the operational risks within the system that sit underneath the BAF.

The risk management strategy will also be revisited to reflect the system across WEL and also ensure aligned with the wider NEL risk management system. A key part

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mailto:frazer.tams@nhs.net

of this will include defining the key accountabilities for risk at each level within the structure.

Action required (approve / note / discuss)

The Joint Board are asked to: • Consider the content within the BAF for

completeness• Discuss further developments to the level of

control or adequacy of assurances received.• Consider how the BAF can be developed and

used by the Board to help inform agendas andpapers presented.

Conflicts It is not anticipated that there will be any significant conflicts when considering this paper.

Where else has this paper been discussed

The BAF process was discussed at the previous Joint board meeting and further at the Audit Committees in Common meeting. The draft BAF was discussed with the Audit Committees chairs outside of the Audit Committees meeting for feedback.

Confidentiality N/A Next steps/ onward reporting The BAF will continue to evolve taking on Board comments

received from the Joint Board. The BAF is then proposed to be discussed at length by the Audit Committees in Common in March.

Strategic fit The report is mapped where applicable to the WEL plan project areas and will eventually map to WEL objectives once finalised.

What does this mean for local people?

N/A

How does this drive change and reduce health inequalities?

N/A

Financial Implications Financial risks and their implications are included in the BAF.

Risks The paper specifically focusses on key risks.

Equality impact N/A

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2019/20 WEL Board Assurance Framework

1. Introduction

The purpose of the paper is to present the WEL CCGs’ 2019/20 Board Assurance Framework for scrutiny and comment. This is designed to build a position across WEL that addresses the principal risk that may impact on delivery of key strategic elements of the WEL plan and statutory responsibilities of the WEL CCGs. The Board Assurance Framework as it evolves will further map to WEL strategic objectives once finalised

2. The role of the Board Assurance Framework

The purpose of the Board Assurance Framework is to provide the Joint Board with confidence that the WEL CCGs’ have identified their collective strategic risks and have robust systems, policies and processes in place (controls) that are effective and driving the delivery of the WEL plan. This confidence should be underpinned by assurances that provide the board with evidence that ‘what needs to be happening is actually happening in practice’.

The Board Assurance Framework is key in informing the production of the CCGs’ Annual Governance Statements and is the main tool that Joint Board should use in discharging their overall responsibility for ensuring that an effective system of internal control is in place.

3. Roles and Responsibilities

The Joint Board as part of their delegated role have ultimate responsibility for risk management and as such, need to utilise the BAF to be satisfied that internal control systems are functioning effectively.

The Audit Committees in Common provide scrutiny and oversight over the risk management system across the WEL CCGs including the effectiveness and content of the BAF. They specifically comment on the fitness for purpose of the BAF and have a role in securing required independent assurances.

The Executive Directors as owners of the risks within the BAF are responsible for ensuring a robust control framework is in place to mitigate their respective strategic risks to drive delivery and performance.

The risk management framework across NEL will be reviewed as part of the move towards the one CCG and further accountabilities including escalation and de-escalation process for risk will be defined. Further work will also be undertaken to determine how risk will be collectively identified, recorded and managed across the wider WEL and ICS systems.

4. BAF Development to date

Robustness of the Control framework This is the first iteration of a WEL BAF and it is recognised there has been a significant amount of transition during the year. This will continue for the next 12 months and as such the control environment will also change and evolve in to the new system. The BAF will therefore need to remain live throughout this process receiving regular refresh to ensure changes and developments are effectively documented. The BAF presented today provides a baseline

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position for controls and assurances against key strategic risks. Work will continue to further enhance the control environment and to provide greater assurance over these risks as we progress through the next 12 months. The rolling 12 month summary showing the movement in risk should therefore support this development by reporting an anticipated fall in the residual risk levels reported.

Receipt and Recording of Assurances Assurances document are there to support the control framework recorded. They should demonstrate what information has been received that confirms the existence of controls in practice and the extent they are delivering the required outcomes and as such helping to mitigate the risk. The BAF document defines assurances by whether they come from an internal or external sources, with external independent sources being classifies as stronger forms of assurance than those received internally. As the BAF develops an assessment of the balance between internal and external sources of assurances along with the frequency of assurances received will be undertaken to help understand the relative strength of the supporting information being received over the control environment.

How do we address ‘gaps’? Each individual risk should clearly map the movement from inherent risk position through to its current residual risk by way of implementing controls and receipt of assurances. Where the residual risk status concludes that further work is need to mitigate the risk then there is a need to identify what those gaps are (controls or assurance). Further controls proposed will need to be rational and in context with the overall system, especially where there is a cost to implementing the control proposed.

5. Head of Internal Audit Opinion

Strategic risk management, including the Board Assurance Framework, is a key component of the WEL CCGs’ year-end Head of Internal Audit Opinions, provided by RSM (Internal Audit Provider).

The annual Internal Audit review of the Board Assurance Framework and supporting risk management process is now due and will take place during February. The output from this review once finalised will be presented and discussed at the March Audit Committee in Common along with a draft Head of Internal Audit Opinion.

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CCG Risk Ref Description Risk Owner Lead Committee Inherent RiskScore Q1 Q2 Q3

CurrentRiskscore Risk Movement

WEL PCCC4 Failure to improve the quality of primary care service provision and ensure safe services are deliveredto patients could result in the closure of practices and potential access concerns for patients.

Jenny MazareloPrimary Care CommissioningCommittee (both In commonand CCG Specific)

20 16

WEL PCCC5 Failure to secure adequate estates to deliver the primary care strategy could result in significantfinancial and contractual implications potentially resulting in service issues for patients.

Jenny Mazarelo

Primary Care CommissioningCommittee / Primary CareCommissioning Committees inCommon

16 16

WEL F001Financial pressures within individual CCGs across WEL could result in a failure to meet specifiedfinancial control totals for 2019/20 or 2020/21. This could significantly impact on the overall stability ofthe WEL health economy.

Steve Collins WEL Finance andPerformance Committee 16 4

WEL F002Continued financial shortfalls within providers reported positions places further pressure on WELCCGs to support the delivery of system wide financial control totals which could impact on the overallstability of the WEL local health economy.

Steve Collins WEL Finance andPerformance Committee 16 9

WEL F003 Activity based provider risks to the CCGs (including CHC costs and medicines management) couldlead to a failure to achieve year-end financial balance. Steve CollinsFinance and PerformanceCommittee 16 12

WEL C001

If the WEL CCGs fail to effectively engage with providers over proposals included within the WEL Planand identify the required staff resource and capabilities needed, the delivery of the plan will be placeda risk. This inturn will lead to poorer patient outcomes, the failure to deliver care closer to home andongoing unsustainable pressures on existing acute services.

Chris Neill WEL Strategy andTransformation Committee 20 6

WEL Q001A failure to effectively monitor the quality of commissioned services to ensure the delivery of betterclinical outcomes, will compromise patient safety, patient experience and the provision of quality ofcare

Chetan Vyas

Provider quality and safety monitored through the CQRGmeetings and reported back tothe CCGs through the monthlyWEL Quality and SafetyCommittee.

16 8

WEL G001

The UK’s withdrawal from the European Union could present varied and significant risks specifically if

no deal is reached. This will impact on providers, workforce and the maintenance of quality healthcareprovision across WEL and could lead to any of the following:

(1) The potential of a health and social care workforce crisis(2) Unclear financial and logistical arrangements of reciprocal healthcare coverage and cross-borderhealthcare(3) Disruption and procurement of medicines, products, medical devices, clinical trials and wider healthresearch which are procured via the EU(4) Damage to joint working regarding public health, including environmental protections andcommunicable diseases(5) The discontinuation of resources, including EU agencies, funding programmes, networks andhealth(6) Lack of clarity regarding the continuity of legislation regarding key areas of business such asProcurement, Health & Safety, Human Resources, Trade Unions, Information Governance etc.

Selina Douglas WEL Strategy andTransformation Committee 16 9 9 9 9

WEL SD001There is a risk that the delivery of the WEL transformation programme could detract energy andattention from delivery of the WEL plan and BAU activities and, particularly in the shadow phase fromApril 2020, lead to confused accountabilities and a sub-optimal deployment of resources

Selina Douglas WEL Leadership Group 16 6

Residual Risk Score2019/20

WEL CCGs BOARD ASSURANCE FRAMEWORKSUMMARY

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Date RiskAdded:

Risk Ref:

27/01/2020 PCCC4Impact Likelihood Total Impact Likelihood Total

Control Ref:

Strength1=red2=amber3=green

Frequency

Strength1=red2=amber3=green

Internal /External

C1 1 1 Internal

C2 2 every 2weeks 3 External

C3 2 3 Internal

Cross Ref: Ref:

C1/G1 G1

C3/G2 G2

Evidencewhat was received and where was it presented

Minutes of previous PQIG meetings.Practice Quality Improvement Group (PQIG) for Newham CCG (bi-monthly meetings)

ControlsSpecific tasks and measure implemented to mitigate the effect of the pricipal risks.

This group has not been routinely meeting and has not had historicrepresentation from the Quality and Safety Team.

AssurancesReports/information received that confirms controls listed are

working effectively

Minutes/ record of meetings.Action plans resulting from meetings.

copy of the NEL Primary Care Strategy

CCG/NHSE review meetings (fortnightly) held for each CCG seperately.

NEL Primary Care Strategy

Record of meetings held

Strategy lays down the requirement for practices to be rated as outstandingor good by April 2021.

Delivery Date

Gaps In Control / AssuranceAread requiring improvement where we lack control or assurance

01/04/2020 The PQIG currently only covers Newham CCG and equivalent provision is required forWaltham Forest and Tower Hamlets.

Date

Assurance

Type Owner

Jenny Mazarelo

Dr Osman BhattiJenny Mazarelo

Delivery of primary care at scale

WEL 4 20 16

NEL Objective

Failure to improve the quality of primary care service provision and ensure safe services are deliveredto patients could result in the closure of practices and potential access concerns for patients.

Risk Owner

Jenny Mazarelo

Risk Lead(if different from above)

N/A5

Inherent risk scorebefore we consider any

mitigation

4

Residual Risk scoreRisk after consideration of

controls

4

Integrated primary and community servicesWEL Project

CCG

Further mitigation of risk is required to bring the risk within accepted tolerance levelsRisk Conclusion

Review Committee Primary Care Commissioning Committee (both In common and CCG Specific)

This risk has been previously been presented and discussed at the Newham PCCC where the issue of Quality representation on the PQIG was raised.The risk now needs to be escalated to the Waltham Forest and Tower Hamlet PCCCs.Additionally the development of the quality dashboard will be reviewed at the NEL PCCCs in Common.

The Clinical Lead for Digital is undertaking a piece of work to develop a WEL Quality dashboard to provideconsistency and facilitate comparison. 01/04/2020 Current dashboard reporting is inconsistent and differs across each CCG.

Control

Committee Feedback

The Practice Quality Improvement Group will be widened to incorporate all WEL practices and the membership willbe reconsidered to ensure effective representation from the Quality and Safety Team.

Actionsactions taken to directly improve the effectiveness of controls or assurances received

Apr-20

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Date RiskAdded:

Risk Ref:

27/01/2020 PCCC5Impact Likelihood Total Impact Likelihood Total

Control Ref:

Strength1=red2=amber3=green Date

Strength1=red2=amber3=green

Internal /External

C1 3 quarterly 2 Internal

C2 2 N/A 3 External

C3 2 Bi-monthly 3 Internal

Cross Ref: Ref:

C2 G1

C3/G1 G2

C3/G2

NEL Objective

Currently there is an ongoing issues over practices not paying services charges onpremises as a result of significant increases in the rates charged. This is a NEL wide issuesbut there has yet to be a NEL approach to tackling the problem.

Deadlines to be issued to practices for them to pay the outstanding debt based on previous service charges whilstthe increase is being contested. Control

Actionsactions taken to directly improve the effectiveness of controls or assurances received Type Delivery Date Owner

Gaps In Control / AssuranceAread requiring improvement where we lack control or assurance

Enabling programmes of workforce, digital and estates

WEL Project Capital - improving our estate

Failure to secure adequate estates to deliver the primary care strategy could result in significantfinancial and contractual implications potentially resulting in service issues for patients.

Risk Owner Inherent risk scorebefore we consider any

mitigation

Residual Risk scoreRisk after consideration of

controls

Committee Feedback

Agree to consolidate the existing Primary Care estate strategy plans in to a single WEL plan and ensure thiseffectively covers the approach to management of service charge increases. Control 30/06/2020 Jenny Mazarelo

Clarity is required from NEL PCCC in Common as to how this issue is to be taken forward to ensure a consistent approach.

Jenny Mazarelo

WEL

Risk Lead(if different from above)

4 4 16 4 4 16N/A

ControlsSpecific tasks and measure implemented to mitigate the effect of the pricipal risks.

AssurancesReports/information received that confirms controls listed are

working effectively Evidencewhat was received and where was it presented

Alternative Financial Organisation (Newham CCG specific)Joint venture with London Borough of Newham, ELFT and the GP Federation to plan and build new

premises.

newly established but will report on progress to the PCCC. PCCC papers will provide record of decisions andprogress

Primary Care Committee review status with ongoing practice estate issues and debt. Reports are only received at the local PCCC meetings currently. Meeting papers and minutes

Each WEL CCG has an exisitng Primary Care Estates Strategy in place. The existing strategies don't specifically consider the current issue aroundservice charge payment increases and historic practice debt.

Risk Conclusion Further mitigation of risk is required to bring the risk within accepted tolerance levels

CCG

A report on the position in relation to outstanding service charge debt across NEL should be compiled andpresented to the NEL PCCCs in common so a unified response can be agreed to manage this. Assurance 30/06/2020 Alison Goodlad

30/06/2020 Jenny Mazarelo There is a need to work closely with CHP and Propoerty Services in order to understand thecurrent position and then report back on what that understanding is.

Review Committee Primary Care Commissioning Committee / Primary Care Commissioning Committees in Common Date 27/11/2019

Copy of strategy documents

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Date RiskAdded:

Risk Ref:

31/01/2020 F001Impact Likelihood Total Impact Likelihood Total

Control Ref:

Strength1=red2=amber3=green

Frequency

Strength1=red2=amber3=green

Internal /External

C1 3 TBC 3 Internal

C2 2 Monthly 2 Internal

C3 3 Annually 3 Internal

C4 3 Monthly 2 Internal

Cross Ref: Ref:

C2/G1 G1

Risk share agreement has substantially reduced the risk score. Finance committee continue to monitor the ongoing position.

Risk Conclusion The risk is being managed within accepted tolerance levels.

Review Committee W