MEETING: Haringey Clinical Commissioning Group …

1 MEETING: Haringey Clinical Commissioning Group governing body DATE: Thursday, 15 March 2018 TITLE: Accountable Officer s Report LEAD DIRECTOR/ MANAGER: Helen Pettersen, Accountable Officer AUTHOR: Helen Pettersen, Accountable Officer Tony Hoolaghan, Chief Operating Officer CONTACT DETAILS: SUMMARY: This report updates the governing body on developments in the local NHS and wider policy issues. SUPPORTING PAPERS: There are no supporting papers. RECOMMENDED ACTION: The governing body is asked to: NOTE the Accountable Officer s Report, AGREE to delegate the approval of the 2017/18 Annual Report and Accounts to the Audit Committee and RATIFY the award of the Internal Audit and Counter Fraud Services contract to RSM Risk Services. Objective(s) / Plans supported by this paper: This report is for information only. Audit Trail: This report is for information only. Patient & Public Involvement (PPI): This report is for information only.

2 Equality Impact Assessment: This report is for information only. Risks: This report is for information only. Appendix 2 Resource Implications: This report is for information only. 3 Accountable Officer s Report 1. Introduction This report will focus on the key activities that the senior team and I have been involved in since the last governing body meeting. 2. Winter planning The health and care system has continued to work hard together to manage the additional activity and pressures associated with winter. During this time: Performance against the four hour Emergency Department (ED) standard at the North Middlesex University Hospital stabilised with week-on-week improvement after a difficult fortnight in the week before and after the New Year. Performance during week commencing 11 February was c. 82% with performance for quarter four at 78% to date. Performance remained consistent at Whittington Health, at 86% during quarter four to date.

3 Social Care, Continuing Healthcare and Community Health staff worked with acute trust colleagues to reduce Delayed Transfers of Care (DTOCs) at both Trusts. System partners continued to improve processes through weekly Multi-Agency Discharge Events (MADE) which focus on unblocking barriers which prevent patients being discharged home after they are medically fit. o This joint work helped the North Middlesex University Hospital achieve record lows, with a number of day s DTOC levels falling under 1% against the national target of of bed-base. o System partners are working hard to reduce delays at Whittington Health, which has continued to struggle to achieve the national DTOC target of Daily escalation calls have been instigated alongside the weekly MADE event. Haringey CCG made c. 3200 appointments a month available through extended access at primary care hubs, as well as additional hub appointments at NMUH s ED. A joint session was held between primary care, the CCG and the North Middlesex during February to agree further improvement actions to help support the 50%+ patients who attend ED with primary care needs.

4 A lessons learned session is being planned between System Partners for April 2018 which will help inform planning for next winter. 3. Planning Guidance for 2018/19 The NHS Planning Guidance for 2018/19 was released at the beginning of February. A number of items are included that will impact on local commissioners and providers, including: Expectation that above 90% is achieved against the A&E standard in the period up until September 2018 Expectation that the majority of providers achieve 95% within March 2019 4 Referral to Treatment: Reduction of 52 week waiters by 50% by March 2019 and number of incompletes ( waiting list) to be no higher at March 2019 than March 2018 level Requirement to produce a winter demand and capacity plan, with further guidance being issued in March 2018 Final governing body approved Operating Plan submitted by 30 April 2018. These issues are being taken into account during the contract negotiations that are taking place for 2018/19.

5 The national planning guidance also stipulated that final agreement on contract values should take place by 23 March 2019. 4. Delegating approval of the Annual Report and Accounts to the Audit Committee CCGs are required to submit their audited 2017/18 Annual Accounts and Annual Report to NHS England by noon on 29 May 2018 at the latest. A meeting of the Audit Committee has been provisionally arranged for either 18 May or 22 May 2018 where the CCG s 2017/18 Annual Accounts and Annual Report will be approved prior to their submission. The governing body is asked to DELEGATE approval of the 2017/18 Annual Report and Accounts to the Audit Committee. 5. 2018 NHS Staff Survey Results The NHS Staff Survey results were published on 6 March 2018. The results present an extremely positive picture of how staff view Haringey and Islington CCGs as a place to work. The 2017 results highlighted that our staff felt trusted to do their job, had been supported with training to do their job more effectively and had completed their mandatory training.

6 Staff felt that they are able to make improvements towards the work of their team and department with staff reporting they had not experienced discrimination from their manager or team leader in the last 12 months. Furthermore there has been some positive steps taken in the past six months to address the flexible working challenges across both CCGs which emerged from Haringey CCG 2016 Staff Survey. On the whole, the results were relatively good when compared to the national benchmarks, but there is still room for improvement. We have already worked with a cross section of staff from Haringey and Islington CCGs to devise an action plan in response to the results. We have recently issued guidance to staff and managers on the flexible working policy and SMART working (as these were identified as areas of improvement). The Haringey and Islington staff involvement Group (SIG) will hold the CCGs to account for the delivery of the NHS Staff Survey Action Plan, and have taken this approach to gain ownership and buy-in from all staff working in the CCGs.

7 The results flagged a number of areas that both CCGs plan to work on which will be supported by our Executive Management Team: Ensuring that staff feel valued during appraisals; Enabling staff to speak up about any bullying and harassment they experience; Strengthening health and wellbeing across both CCGs. 6. Contract Award Internal Audit and Counter-Fraud Services The procurement process has now concluded for the award of the Internal Audit and Counter Fraud Services contract. The contract award is to provide services to the CCGs 5 in North Central London (NCL), along with WELC (Waltham Forest, Newham, Tower Hamlets, City & Hackney) and BHR (Barking & Dagenham, Havering, Redbridge). The award is for a period of 3 years with an optional extension of 2 years. The evaluation criteria used in the procurement process was: Technical (Quality) 60% Commercial (Cost) 40% The procurement process was fair, transparent and conducted in accordance with legislation.

8 RSM Risk Assurance Services (the NCL CCGs current provider of internal audit and counter fraud services) presented the highest scoring bid submission and are therefore recommended for appointment. The appointment offers economies of scale to all of the CCGs in scope and represents best value for money. In order to enable RSM to commence audit planning for 2018/19 a Chair s Action under section of the Constitution was sought in February 2018 to approve the re-appointment of RSM on behalf of the governing body . The process was conducted in accordance with the provisions of the Constitution. This action was also supported by the Chair of the Audit Committee. The governing body is asked to ratify the decision taken under Chair s Action. 7. NEL Commissioning Support Unit Following agreement at the five NCL CCG governing Bodies in January 2018, we issued a notice letter to NEL Commissioning Support Unit (NEL CSU) of our intention to take in-house contract management (POD MDT) services and acute medicines management services.

9 The next step is to submit a business case to NHS England for approval. TUPE consultation with the staff who will transfer will commence once we have received approval from NHS England. We held our first governing body Sub- Group meeting on 22 February. This sub- Group is designed to give assurance to governing Bodies that the process we are following is robust. At the first meeting we reviewed the project plan and risk register. The Sub- Group agreed that we should ensure that the business case to take these services back in-house is also approved by the individual governing bodies prior to commencing TUPE consultation through an agreed sign-off process or through delegated decision-making to the sub- Group . 8. Committee Terms of Reference The Haringey and Islington CCGs governing Bodies discussed at their February seminars how to take forward through our governance structures their desire to increase working together. There was mutual agreement that in order to streamline decision-making, reduce duplication and make best use of governing body members time, committees with similar terms of reference and business should in the first instance move towards meeting in common, as a forerunner to potentially becoming joint committees of each governing body in due course where this is considered appropriate.

10 6 As there is not a seamless overlap between the two CCGs committee structures, options appraisals will be carried out to map functions and identify any necessary changes to committees responsibilities, prior to committees beginning to meet in common. These options appraisals will be reviewed by the individual committees, with a proposal being brought to the governing body for approval. In light of this direction of travel, we are not proposing to make any amendments to the existing Terms of Reference (ToRs) to our committees at this stage as part of the annual review of ToRs. (The Audit Committee ToRs have recently been updated in line with the NCL committee in common arrangements). The governing body is therefore being asked to note that the review will take place in line with the developing committee changes 9. Information Governance (IG) Update The CCG is on course to achieve its target level two IG Toolkit submission. At the time of writing, the evidence for the submission is being uploaded and quality-assured, prior to it being submitted by the 31 March 2018 deadline.