BOARD AGENDA
Venue:
Date:
Time:
Members:
The Conference Rooms, Warehouse K
Tuesday 18th January 2011
14.00 – 16.30
Non-Officer Members: Millie Banerjee, Wayne Farah (Vice-Chair, Provider Services),
Marie Gabriel (Chair), Paul Hendrick (Audit Chair), John Lock (Vice-Chair, Strategic
Commissioning), Andrea Lippett, Cllr Conor McAuley.
Officer Members: Dr Philip Abiola, Rachel Flowers (Interim Director of Public Health),
Charles McNair (Director of Resources), Robert Moore (Director of Quality & Primary
Care Commissioning), Dr Ashwin Shah MBE (Interim Chair of Executive Committee),
Melanie Walker (Chief Executive).
Associate Member:
Secretary:
Cllr Clive Furness, LBN Mayoral Advisor on Health.
Dawn Bowes
In Attendance: Dr Kate Corlett (Medical Director), David Cryer (Director of Strategic Development),
Paul Gocke (Director of Provider Services), Derek Greening (Company Secretary),
Carol Hill (Director of Commissioning), Chetan Vyas,(Deputy Director of Quality).
1:
Apologies, Announcements, Declarations of Interest
14.30-14.32
2:
Minutes of the previous Meeting held on the 9th November 2010
14.32-14.40
3:
Feedback for Sub-Committee Chairs
14.40-14.50
STRATEGIC
4:
Single Management Team Update
5:
Pharmaceutical Needs Assessment
Verbal Update
14.50-15.00
(RM)
15.00-15.15
PERFORMANCE
6:
Flu Update
Verbal Update
(RF)
15.15-15.30
7:
Chief Executive’s Report
To Follow
(MW)
15.30-15.45
8:
Performance Report
(DC)
15.45-15.55
9:
Finance Report
(CMcN) 15.55-16.05
10:
Board Assurance Framework
(DG)
11:
Any Other Business
16.05-16.25
16.25-16.30
1
2
BOARD PAPER - COVER SHEET
AGENDA ITEM:
2
DATE OF MEETING: 18th January 2011
AUTHOR OF PAPER:
TITLE OF PAPER:
Dawn Bowes
Minutes of meeting of 9th November 2010
SUMMARY OF RECOMMENDATIONS:
To agree the minutes and note matters arising
3
4
Minutes of a Meeting of the Board
Held on
Tuesday 9th November 2010 at 14.00
In the Conference Rooms, Warehouse K
Members Present:
Marie Gabriel, Chair (MG)
Dr Philip Abiola, GP PEC Member (PA)
Millie Banerjee, Non-Executive Director (MB)
Wayne Farah, Vice-Chair Provider Services (WF)
Rachel Flowers, Interim Director of Public Health (RF)
Cllr Clive Furness, Associate Member (CF)
Paul Hendrick, Audit Chair & Non-Executive Director (PH)
Andrea Lippett, Non-Executive Director (AL)
John Lock, Vice-Chair Strategic Commissioning (JL)
Cllr Conor McAuley, Non-Executive Director (CMcA)
Charles McNair, Director of Resources (CMcN)
Dr Ashwin Shah, MBE, PEC Chair (AS)
Melanie Walker, Chief Executive (MW)
In Attendance:
Dawn Bowes, Corporate Services Manager (DB)
Dr Kate Corlett, Medical Director (KC)
David Cryer, Director of Strategic Development (DC)
Franco Lafaci, Newham Health Partnerships [NHP] (FL)
Paul Gocke, Director of Provider Services (PG)
Derek Greening, Company Secretary (DG)
Carol Hill, Director of Commissioning (CH)
Dr Jim Lawrie, NHP (JL)
Robert Moore, Director of Quality & Primary Care Commissioning (RM)
Dr Hardip Nandra, Newham Commissioning Group [NCG] (HN)
Chetan Vyas, Deputy Director of Quality (CV)
10/B06/01
Announcements; Declarations of Interests.
The Chair welcomed everyone to the Board meeting and expressed her pleasure at seeing the
staff presence at the meeting.
1.1
The Chair stated that with Wendy Thomas on Secondment there is a an Executive Director
vacancy on the Board; she proposed that under section 3.12 (VI) of the Standing Orders,
that Robert Moore is appointed to act up to this position until such time as a formal nursing
PEC member replacement is appointed. The Board approved that Robert Moore fill the
vacant executive member post. A PEC Nurse member will be appointed in due course.
5
1.2
The Chair declared her interest as Sector Chair and AS declared his interest as the Chair of
the Newham Health Partnership.
10/B06/02
Minutes of the meeting held on the 7th September 2010 & Matters Arising.
2.1
Minutes were agreed as a true record.
2.2
Matters Arising
2.2.1
In relation to 10/B05/02 - MW confirmed the Boards concerns had been raised at the last
meeting of the JCPCT in relation to the establishment agreement as well as the ELCA
budget; however it was an extra-ordinary meeting they had agreed to take this to the next
formal meeting of the JCPCT. PH was still concerned about ELCA being managed though
a different establishment agreement to the one that the Board approved. The Chair
reiterated that NHS Newham Board would be adhering and holding ELCA to the
Establishment Agreement that it had approved.
2.2.2
In relation to 10/B05/03 childhood obesity investment would be coming back to the Board
and would be placed on the forward planner. DB/DG
2.2.3
In relation to 10/B05/06 MW/CH confirmed that discussions were still underway in relation
to finance and the UCC it was also confirmed that this was being discussed at ET
performance meetings and with SACU.
2.2.4
Under 10/B05/07 for cancer mortality MW confirmed a meeting had been held which
involved CEO, NEDS and the medical college and it has been proposed to undertake a
research project into cancer and more detail proposal would be presented at a future Board
meeting.
2.2.5
SACU report had been finalised and circulated as agreed. It was agreed to discuss the out
of Borough over performance as part of the financial report.
2.2.6
In relation to 10/B05/08 Ophthalmic would now be managed at a sector level as was the
performance framework.
2.2.7
In relation to 10/B05/09 to clarify whether it was 4 or 5 practices not achieving national
targets. RM confirm that it was 4 not 5 practices.
2.2.8
RM confirmed that Primary Care would be inviting the NEDs to undertake some practice
visits (10/B05/09). RM
2.2.9
DAT report was taken to the Audit & Governance Committee; they noted that there were
risks in relation to changes to ways of working and provider committee approve.
(10/B05/12)
2.2.10 Items relating to the BAF and the risk register had been completed.(10/B05/13)
2.2.11 In relation to reviewing the top 5 administrative tasks that were time consuming and that
maybe could be stopped or reduce as part of the overall response to the white paper. The
background work was continuing and an assessment of the volume and responses in
relation to FOI was continuing. External deadlines for reporting process were being
reviewed as well as a review of use of resources audit.
6
10/B06/03:
Feedback from the Committee Chairs
3.1
PEC-QSI nothing to add to the report submitted.
3.2
Audit & Governance – external forward plan from PWC had been presented and
assessment had been very good and was included in the Governance paper. Whistle
blowing policy needs to be up dated the Board agreed that this is an extremely important
policy.
3.3
PIC – the Chair’s feedback was that there was a need to review the PIC structure to ensure
the committee is relevant. Once it had been completed a fuller report will be submitted to
the Board.
3.4
Joint Transition Board - feedback had been included in the Chief Executive report.
3.5
Shadow Provider Board; WF had nothing to add to the report but stated that a discussion
had been held on the issue of updating the whistle blowing policy in relation to the EHCC
SUI and relevant action plan which will be taken forward. There had been discussions
about planning a celebration for provider move to ELFT. MW said an event will be
organised and asked everyone to keep 27th January 2011 clear in their diary.
3.6
SPIIC had agreed to continue with the committee for the rest of this year and review the
Commissioning Strategy Plan and Business Case for the current financial year. But need
to review what kinds of processes are required for 2011/12 NHS Newham is responsible for
the ensuring that next 2 years financial allocations are spent.
10/B06/04:
Sector Single Management Team
4.1
The Board received a presentation from Dr Jim Lawrie & Franco Lafaci on behalf of
Newham Health Partnership (NHP)
4.1.1
The Board Noted:

NHP represents 48 practices within Newham.

NHP are committed to improving health in Newham

NHP have an agreed constitution.

NHP are dedicated to developing patient focused care.

NHP share NHS Newham’s vision.

NHP understand the need to develop skill mix and innovative ways of working.

They are committed to encouraging Patients to taking the lead in their own health care.

NHP recognise the need to work with the local authority and all primary care providers.

They acknowledge they need help to identify, utilise and develop existing support within
NHS Newham and the rest of the health economy.

NHP are encouraging young clinicians to help with the development of better health
outcomes.

NHP have aspirations to be a pathfinder from the 1st April 2011.

This proposal was being proposed as an alternative to the sector’s single management
team proposal.
7
4.1.2

That NHP want to work with Newham Commissioning Group.

That NHP want to work with NHS Newham’s Board to make the transition from NHS
Newham to GP Commissioning a success.

That NHP had been working with an external company to develop their proposals.

NHP believes that the resources should remain in Newham.
The Board Agreed:
 To support NHP in the transition to GP Commissioning.
The Chair wanted to express her thanks to Dr Prakash Chandra from the LMC for his
support to NHP in development of this proposal.
4.2
The Board received a presentation from Dr Hardip Nandra on behalf of Newham
Commissioning Group (NCG).
4.2.1
The Board Noted:
4.2.2

It currently has 10 practice members with pledges from more to join them.

NCG are keen for resources to remain in Newham, which includes both clinical and
management resources.

NCG values are about improving patient’s access to health, the patient experience and
health inequalities.

NCG wish to ensure primary care capacity and capability is adequately resourced.

NCG are clear that local decisions need to be made locally.

They recognise the need for a single management team and the Commissioning
Support Service (CSS).

They have concerns the sector’s proposals are not in the spirit of the health reforms
from the bottom up and clinically led.

The Consortia are clear that they want to keep local talent within Newham.

They ask the Board to set up a local Transition Board.

This proposal is complementary to the sector proposals and want to work the with them
to develop local solutions.
The Board Agreed:
 To support the Consortia in its development.
 To set up a Transition Board with NED representatives.
 WF & AL agreed to be the NED members on the Transition Board.
MG expressed her thanks to Dr Prakash Chandra, the Chair of Newham LMC for his
leadership and support of GPs in the development of the consortia.
AS expressed his thanks to the Board for its support.
8
4.3
The Chief Executive presented the Single Management Team Proposal.
4.3.1
The Board Noted:

The outline of the Government’s Health proposals.

The need for 51% management cost savings to be made.

That the Boards of Newham, City & Hackney had met and identify an option on how to
manage NHS London’s request for management costs savings.

Staff had been consulted and they wanted a transparent, equitable and fair process.

To need to build on Newham expertise and good practice.

That staff wanted support though the change.

City & Hackney had approved the proposal subject to caveats at their Board meeting on
the 5th November 2010.

Tower Hamlets Board would be meeting on 11th November 2010 to discuss the paper.

The importance to build in local solutions that support the GP Consortia’s.

At the NHS London Chairs meeting a discussion was held in relation to management
cost savings and how they would be redistributed to GP Consortia, NHS
Commissioning Boards and Local Authorities would be to assist with set up costs.

NHS Newham’s ability to remain viable without the sector proposals would be
challenging.

The need to ensure the retention of NHS Newham’s organisational memory.

Concerns were expressed that there as significant financial risks because of Newham’s
outer London borough status when compared to City & Hackney and Tower Hamlets
status as inner London boroughs, which had been included on the Sector’s risk register.

The majority of Newham’s GP community do not support this proposal in its current
format because it does not fully support Newham residents.

The need to retain Newham’s talent and resources locally.

That there were concerns that the governance process could not give assurance to
three Boards in the current proposal.

That Newham needs differ from the other two organisations.

That having separate boards and managements does not exclude the possibility of
sharing Corporate Functions.

Whilst the GP proposal was in the spirit of the Government’s White Paper in putting
patient experience and the GPs at the heart of the process. There were concerns that
the sector proposal did not reflect this.
9

That the sector proposal does not address the need to develop closer working
relationships with the local authorities.

Newham’s two GP Consortia’s have outlined their proposals but there is still significant
work to be developed particularly in business plans.

That the sector proposal needs further work in conjunction with our local authorities and
primary care partners.

That a decision would be required by the 22nd November 2010 to ensure the reduction
on the impact of staff.

In relation to the sector proposal, if the Board and Consortia’s wanted something
different then it had to be absolutely clear what criteria this alternative proposal had to
meet.
The Board asked that the two consortia’s and the Chief Executive meet to discuss
comments made by the Board. The Chair stated that this was essential for further
discussions of the Board and she requested a break in the Board meeting for appropriately
20 minutes to allow the Consortia’s and the Chief Executive to draw up the criteria and
during the break the Chair would hold discussions with staff and members of the public on
a one to one basis.
The Board agreed to the break and the meeting was suspended at 3.50 and was
reconvened at 4.16
4.3.2
The Chair reported back on questions that she had received from staff and the public
during the interval stating that they could all be grouped under four main topics. The chair
asked the Chief Executive to take these on board when replying on behalf of the GP
Consortia’s. The questions were:

If the proposal was approved how do we ensure that the caveats are delivered?

Why does the proposal show that more staff from lower grades will be lost than high
grades.

How were the numbers arrived at?

A concern over the GP Consortia’s working with external companies rather than internal
staff.
Members of the Board replied to the questions: in relation to the grading and on how
the numbers were arrived at CMcN reported that the proposal was based upon average
salaries this meant, for instance, that if higher level post were lost then the overall
numbers would be reduced and vice a versa for lower graded posts; the final number
relied on the proposed structure, once agreed, when a more detailed piece of work will
be undertaken
In relation to the question relating to how caveats were to be met the Chief Executive
stated that they would need to be clearly defined, with clear outcomes which are
specific, time limited and deliverable.
In relation to the GP consortia using external agencies the CE reported that this had
been discussed and both consortia were committed to using the talent within NHS
Newham.
10
4.3.3
The CE feedback on the discussion with the GP Consortia’s and their agreed caveats for
discussion on any sector proposal as required by the Board; these were:

Both Consortia’s are keen to retain Newham’s talent.

They are committed to a Newham focus solution recognising they have different
approaches to this.

That resources stay in Newham.

That they wish to work closely with the local authority to develop a Newham based
proposal.

That they recognise that management cost savings need to be made but they need to
understand them.

Willingness to work with the sector to support the GP Consortia’s aspirations.

They have concerns with the current proposals for the sector.

Willingness to enter negotiations with the sector to identify a better solution for
Newham.
The Board Agreed:
 It wanted to develop a proposal that was in conjunction with our local authority, GPs
and Board members and that this was a borough centic and in line with the White
Paper.
 That MW would organise a staff meeting to feedback the Board’s decision as soon as
possible.
 They could not approve the current proposal as it is drafted and requested that the
Executive Team take on board the Board’s comments and the feedback by the
Consortia’s and submit a response from the Board to the Sector as soon as possible
requesting a revised proposal. The Executive Team is to circulate a draft response to
the members for comments and call an extra-ordinary Board meeting on or before the
22nd November 2010 to consider the Sectors response and revised proposal.
10/B06/05
Planning 2011/12 Update
5.1
The Director of Strategic Development delivered his presentation.
5.2
The Board Noted:
5.3

That work was underway to validate transformation savings, CSP initiatives

There was a review assessing commissioning efficiencies

That our CSP was being aligned to the Sector CSP due to the Sector’s assumptions
being different to NHS Newham’s.

There is a projected deficit for the next two years followed by a period of surplus.

The planning proposals need to be signed by NHS London by the 17th December 2010.

The need to involve the GP Consortia’s in the process.
The Board Agreed:
11
 The Financial position for 2011/12
 The process for finalising the plan.
5.4
Action:
 CH agreed to meet with the two GP Consortia’s urgently to involve them in the CSP
process.
10/B06/06:
Finance Report
6.1
The Director of Resources delivered his report.
6.2
The Board Noted:
6.3

The Capital allocation and plan for approval.

The plan for Westfield had been rejected as the rent and rates were excessively high.

The finance report was forecasting NHS Newham achieving financial balance at year
end.

The significant risk identified was the over performance at BLT. SACU was in
negotiations with the BLT for a risk sharing agreement. However, it was noted that this
was different to the one reached with NUHT.

Early indications were that Whipps Cross over performance was being generated from
referrals by GPs in Newham. Patient choice would not account for the scale of over
performance.

The Chair had been contact by Man Patel in relation to the concerns with UDA
allocations.
The Board Agreed:
 The Capital allocation and plan were approved.
 Will Huxter and Alwen Williams would be asked to submit a paper and invited to attend
the Board to inform the Board on what SACU have done to resolve the over
performance of BLTs out of sectors contracts i.e. Whipps Cross.
 RM agreed to prepare a briefing to the Board on UDAs.
10/B06/07:
Performance Report
7.1
The Director of Strategic Development delivered his report.
7.2
The Board Noted:

That the performance report had been submitted to both the Executive Team and
Performance Committee meetings.

Key risks were highlighted within the report.

PIC had noted that the action plans are more robust than previous plans.

The Chair of the PIC stated some targets still may not be achieved.

RF stated that data will be submitted to NHS Newham every month for All Age, All
Cause Mortality which will show us the rates quarterly.

RM stated that the data cleansing would not impact on the quality aspects for GPs.
12
7.3
The Board expressed its appreciation to everyone who had helped to improve the
screening uptake rates.
10/B06/08:
Chief Executives Report.
8.1
The Chief Executive delivered her report.
8.2
The Board Noted:

That the Board Nurse advice will in future be provided by Mary Clarke and Caroline
Alexander and the agreement was that they would attend alternate meetings. They are
not voting members of the Board.

The need to identify a solution to the 5 borough legacy programmes once the PCTs
come to an end.

That the Mental Health needs assessment will be included in the programme of work
which comes from the review of recommendations and they will be shared with the
Borough.

The changes to the Programmes and work streams.
10/B06/09:
Assurance Update
9.1
The Company Secretary delivered his report.
9.2
The Board Noted:
9.3

The Board Assurance Framework (BAF) had been updated to include the Boards
requested improvements.

Each Committee had collated and included their identified risks.

The risks identified by the auditors in relation to the changes in NHS Newham had been
included.

That the Shadow Provider Board needed to be formally closed by the Board.

The Scheme of Delegation proposal to reflect the need for the On-call Director to sign
off emergency expenditure up to £50,000 in relation to Winter Planning.

CMcN had been nominated at Caldicott Guardian.

There needed to be a Board Member on the Prescribing sub-committee.
The Board Agreed:
 The amended Scheme of Delegation.
 CMcN as the Caldicott Guardian.
 The future of the SPB
 To have a presentation in relation to risk management at a future meeting on the Board.
Meeting concluded at 6.04
13
14
BOARD MEETING
18th JANUARY 20111
Agenda Item:
5
Title of Paper: NHS Newham Pharmaceutical Needs Assessment
Responsible Director/Lead:
Director: Robert Moore, Director of Primary Care Commissioning and Quality
Lead: Mona Sood, Head of Medicines Management
CSP Goals:
The PNA support the CSP by meeting the needs identified by the Joint Strategic Needs
Assessment, particularly:
 Improving access to primary and community based services
 Improving sexual health
 Early identification and treatment of cardiovascular disease
Other CSP target areas are being addressed within the essential service element of the
pharmacy contract (health promotion)
World Class Commissioning Competencies:
1. Locally lead the NHS – in managing the PCT pharmaceutical list, innovation in
commissioning and developing the community pharmacy workforce
2. Work with community partners – membership of the PNA steering group was
sought from a wide range of both internal and external stakeholders.
3. Engage with public and patients – a patient representative has been involved;
additionally the PCT complied with the statutory requirement to consult with patients.
4. Collaborate with clinicians – there has been considerable engagement with
community pharmacists during the production of this document.
5. Manage knowledge and assess needs – the document is a needs assessment to
support the effective commissioning of services form community pharmacy.
6. Prioritise investment – the health intelligence within the PNA enables the resources
to be invested effectively to deliver outcomes in the areas of unmet health need.
7. Stimulate market – post publication, expressions of interest will be sought from
existing contractors to meet the needs identified.
8. Promote improvement and innovation – the document encourages a create
approach to meeting the gaps in health provision by community pharmacies.
10. Manage the local health system – by supporting community pharmacy
commissioning.
11. Finance responsibility – It should be noted that the PNA has required considerable
resource (both from an external agency, and within the Medicines Management Team) to
create. Updating this document following significant changes to local commissioning
arrangements will be significant.
Summary:
The Health Act 2009 amended the National Health Service Act 2006 to include provisions for
regulations to set out the minimum standards for PNAs. The Regulations, which come into
force on 24 May 2010, include the statutory duty that PCTs develop and publish their first
pharmaceutical needs assessment by 1st February 2011. The PNA Regulations set out the
minimum requirements for the first PNA produced under this duty, covering data on the health
needs of the PCT’s population, current provision of pharmaceutical services, gaps in current
provision and how the PCT proposes to close these gaps.
This paper outlines the purpose, process and findings of the NHS Newham PNA.
15
Revenue/Resource implications:
The PNA cost £25k to produce; additionally, significant senior management and
administrative capacity was released from within the Medicines Management Team in
managing this document. However this is an investment, given that the document will support
the effective commissioning of preventative services from community pharmacists with both
clinical and financial benefits as follows:







Minor ailments scheme (MAS) – reducing the impact of consultations usually sought
from GP services
Stop smoking service – improving health outcomes and the morbidity and mortality
costs associated with the smoking
Sexual health services – prevention of teenage pregnancies, TOPs, infection control
Drug misuse services – ensuring that substance misuse treatment is not
misappropriated into the community and reducing the spread of blood-bourne
infections by providing needle exchange facilities
Anticoagulation service – the community anti-coagulation service, mainly provided by
community pharmacies, has saved NHS Newham over £1.1 million in acute
commissioning costs
NHS Health Checks (cardiovascular risk assessments) – early detection reducing the
morbidity and mortality costs associated with myocardial infarction and stroke
Supervised administration of TB medication – reducing the morbidity and mortality
costs associated with the TB
Board Action Required:
The Board is asked to: approve the PNA. As PCTs are under a statutory duty to prepare
and publish a PNA by 1st February 2011, the guidance to the Regulations states that PCTs
should ensure that their PNA is signed off by the Board in the open section of a meeting.
Health Inequalities (evidence of how these are addressed in the paper):
The PNA assimilates the data published within the JSNA (which identifies health needs and
inequalities) to provide a solution from community pharmacy.
Statutory Equality issues (evidence to show how the paper addresses the need to
avoid unfair discrimination on the grounds of age, disability, gender reassignment,
marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, or
sexual orientation):
An equality impact assessment is being undertaken, but is not expected to suggest any
evidence of inequality and or discriminatory practice, given that the analysis is largely based
on the published Joint Strategic Needs Assessment.
As part of the process, a patient survey was sent to a random sample of the population, which
will have captured the views of respondents from settled communities.
Summary of Patient and Public Involvement and/or feedback (scope and how feedback
was incorporated/actioned):
 The PNA Steering Group has included patient representation
 The PNA Regulations list as a statutory requirement to consult with “any relevant local
involvement network, and any other patient, consumer or community group in its area
which in the opinion of the PCT has an interest in the provision of pharmaceutical services
in its area”
Evidence of Best Practice nationally/internationally:
The PCT had a statutory duty to publish a PNA on by the 1st February 2011, as mandated by
the updated PNA regulations.
16
NHS Newham Pharmaceutical Needs Assessment (PNA)
Purpose of the paper: This paper outlines the purpose, process and findings of the NHS Newham
PNA, and seeks ratification from the PCT Board.
Introduction
Community pharmacy services have historically been primarily commissioned to provide safe
access to medicines, and other ancillary medicines support services. The innovation and potential
within community pharmacy to deliver a far wider range of services has been recognised through
the publication of successive Department of Health policies over the past 10 years, and the
introduction of a new NHS contract in April 2005 allowed PCTs flexibility in commissioning from
pharmacy contractors. In Newham, patients have benefited from the skill set and resources within
community pharmacies, by accessing a number of enhanced services in both domains previously
supported by a medical model, and new areas of care.
Nationally, there has been no requirement to commission additional services from pharmacies,
leading to considerable variations in the professional development of the pharmacy workforce
within different PCTs, as highlighted by national surveys 1. PCTs have however been required to
publish a PNA since the introduction of the new contract in 2005, in order to provide an objective
measure against which they commission pharmaceutical services, and manage prospective
entrants to the pharmaceutical list.
The White Paper Pharmacy in England: Building on
published by the Department of Health in April 2008. It
and data requirements of PCT PNAs and confirmed
strengthening to ensure they are an effective and robust
decisions.
strengths – delivering the future2 was
highlighted the variation in the structure
that they required further review and
commissioning tool which supports PCT
The duty on the PCT
The Health Act 2009 amended the National Health Service Act 2006 to include provisions for
regulations to set out the minimum standards for PNAs. The Regulations2, which come into force
on 24 May 2010, include the statutory duty that PCTs develop and publish their first
pharmaceutical needs assessment by 1st February 2011. The PNA Regulations3 set out the
minimum requirements for the first PNA produced under this duty, covering data on the health
needs of the PCT’s population, current provision of pharmaceutical services, gaps in current
provision and how the PCT proposes to close these gaps.
The PNA will also consider the future needs for services, supporting both the PCT in
commissioning pharmaceutical services to meet the health needs of its population and community
pharmacy contractors with business planning. It is expected that PNAs will eventually be used to
determine market entry, replacing the current “control of entry” system, which is currently dictated
by regulation4, whereby the PCT decides if it is necessary or expedient to approve an application in
order to secure access to pharmaceutical services in a particular area. It is therefore important that
the PNA is a robust document and that it links to the PCT’s JSNA.
Failure to meet this duty could lead to a judicial review.
Process
A PCT PNA steering group was convened in November 2009, involving a wide range of internal
and external stakeholders, including local pharmacy contractors, the Local Pharmaceutical
Committee (LPC), and patient involvement. This steering group met regularly in the subsequent
months to direct the content oversee the timeline of publication of a final PNA, which was
commissioned from and written by Webstar Health. The final analysis identifies pharmaceutical
service provision and unmet needs through the assimilation of a number of strands of existing
health intelligence (primarily the Newham JSNA, and primary care service mapping exercises),
with patient and pharmacy contractor surveys.
17
The draft PNA underwent a consultation period of sixty days (between 7th October – 6th December
2010), in line with the minimum period mandated by regulation. The statutory consultee list
included dispensing contractors within the PCT, the LPC and LMC, patient representatives, the
local authority and acute trust, and neighbouring PCTs. Respondents to the consultation will
receive an acknowledgement letter, and response to the specific point raised.
The final draft of the PNA, with amendments post-consultation, can be found here:
http://npctweb/services/medicines%20and%20prescribing/docs/pna2010/pna2010.pdf
It should be noted that at the time of writing the PNA and consultation, there were 63 pharmacies.
The PCT now has 64 pharmacies, the most recent of which being a 100hr pharmacy which opened
on the 24th December 2010 (post-consultation). It should be noted that a further contract has been
awarded but not as yet operational. Consequently these two additional contracts were not
surveyed as part of the PNA.
Key findings
The provision of essential services is a mandatory requirement for all pharmacy contractors.
Current pharmaceutical services meet the need for essential pharmaceutical services within
Newham, and there is no gap in the provision of these services.
It should be noted that the primary care strategy is moving towards increasing access to medical
services through extended hours. In the North West locality, there is a GP walk-in service between
8am-8pm for 365 days a year in the form of a walk-in centre. Although there is pharmaceutical
provision until 8pm on weekdays, it is noted that there is a walking distance of approximately 0.5
miles between the 2 sites, which means that patients accessing the walk-in centre towards the very
end of the day may not be able to have their prescriptions within the locality directly after the
consultation. Provision at the weekends is reduced further, as pharmaceutical services within the
locality close at 7pm on Saturdays, and 5pm on Sundays.
It is understood that currently activity within the 8am-8pm service has the potential to increase
significantly, and that the majority of evening consultations at to the GP walk-in service do not
indicate urgency in pharmaceutical need, but convenience of access to a medical service.
However, if a dispensing service is required during the times identified, there are at present a
number of options available outside of the current provision within the North West locality, as noted
overleaf:




Woodgrange Road, Newham - 100 hour pharmacy, open until 10.30pm Monday to
Saturday, 9pm on Sunday (distance from site: approximately 1 mile)
Leyton Mills, Waltham Forest – open until 10pm Monday to Saturday (distance from site:
less than 2.5 miles)
Leyton Orient Pharmacy, Waltham Forest – open until 10pm on all days (distance from site:
less than 2.5 miles)
Beckton, Newham – 100 hour pharmacy, open until 11pm on weekdays and 10pm on
Saturday (distance from site: approximately 3.5 miles)
It should be noted that where out-of-hours services are sought, the local out-of-hours medical
provider is able to supply those medications required urgently.
The PCT does therefore not consider an inclusion to the pharmaceutical list to be
necessary at the present time.
Advanced services are nationally commissioned. Provision is optional for contractors, and subject
to the accreditation of both the provider pharmacist and premises. The current service
commissioned is Medicines Usage Review (MUR), which is considered to be a necessary service
by the PCT is provided the majority of, but not all pharmacies. Additionally, the pharmacies
providing the service have capacity to undertake more reviews. The PCT is seeking to assess the
18
value of these reviews to the patient, prescriber, pharmacy and PCT in a multi-disciplinary audit
this year.
Enhanced services may be commissioned from pharmacies meeting prescribed criteria, subject to
the satisfactory delivery of all essential services. The enhanced services currently commissioned
by the PCT are:
 Minor ailments scheme (MAS)
 Stop smoking service
 Sexual health services which include:
o C CARD
o Chlamydia / Gonorrhoea Testing
o Emergency hormonal contraception (EHC)
 Drug misuse services which include:
o Supervised administration of methadone
o Needle exchange scheme
 Anticoagulation service
 NHS Health Checks (cardiovascular risk assessments)
 Supervised administration of TB medication
All these enhanced services are considered to be necessary. MAS and Stop Smoking Services are
commissioned from all pharmacies in Newham where essential services are provided; however
there is a gap in the commissioning of sexual health services in the North East locality, and TB
services in the North West locality.
One of the key findings of the patient survey is that non-adherence to prescribed medication may
be as high as 60% (compared to WHO estimates of 30-50%). Commissioning new services to
address this and maximise the productivity of the primary care prescribing budget through
pharmacists will be conducive to delivering the Quality, Innovation, Productivity and Prevention
(QIPP) agenda.
Consultation Responses
A number of key themes emerged from the responses to the consultation as follows:





Definition of terms: the definition of the terms “necessary” and “relevant” - which feature
heavily in the PNA - have been in the updated document, and the services referred to
labelled appropriately
Patient survey: one of the most frequent comments noted was that the number of
respondents to the patient survey was too low to be statistically significant, and therefore
should not be seen to be representative of the population. There has also been the
suggestion that some comments be removed. Although the response rate to any nonincentivised population survey can be expected to be low, the results should not be
discounted. A wide range of comments have been published within the PNA – both positive
and negative – reflecting the diversity of views of patients within the borough.
Adequacy of essential service provision within the North West locality. The draft PNA
suggested that the local pharmaceutical service match commissioned medical services and
that this would be sough from existing contractors: this view has been revised following
comments from contractors as outlined in p3 (“essential services”)
Locality view: it was noted that the PNA looked at service provision across localities, and
did not consider access issues to individual pharmacies. Given that Newham is
geographically very compact, and that pharmacies are sited within relatively close proximity
of others, viewing services across the localities provided a pragmatic approach to
assessing the needs of the population for individual localities.
Gaps in the provision of sexual health and TB services in the North East and North West
localities respectively. The PCT will be commissioning from existing pharmacy contractors
to meet these needs.
19



Clarity around the process of awarding contracts: currently, this is managed by the PCT
Pharmacy Contracts Group, which operates under the delegated responsibility of the Board
to make decisions on changes to the pharmaceutical list in line with the Regulations4. The
process will require revision when there is a change to the Regulations.
Transparency of commissioning decisions: the PNA is a commissioning tool, that will guide
the commissioning of enhanced services from providers on the existing pharmaceutical list,
and further unmet need for which new services may be commissioned. Contractors are
able to see where the gaps in provision are from the PNA, which once published, will be in
accessible within public domain.
Legality of the document: with an impending change in legislation allowing PCTs greater
freedom in managing the pharmaceutical list, pharmacy contractors noted concerns that the
document may be subject to legal challenge. Although the PCT has a statutory duty to
publish the PNA, it is not a legal document but a statement of need. PNAs published under
the revised Regulations have not had the opportunity to be tested legally, and professional
advice taken indicates that legal scrutiny of the document is not necessary.
In particular, it should be noted that the LPC has acknowledged that the PCT has done enough to
have a robust system in place to decide on applications for market entry in future.
Actions
The PNA is a working document, which will be used as a commissioning tool, and be seeking to
increase provision of enhanced services from the current contractor list where gaps exist.
Following the publication of the document, expressions of interest to provide the service will be
sought from contractors within the localities where appropriate.
The PNA will be updated using the process outlined, in response to developments within the
borough, for example:
 primary care strategy – such as the development of the practice based commissioning
integrated service pathway
 strategic planning
 public health needs and JSNA revisions
 Olympic development
 validated local intelligence, such as patient and provider identification of need
The PNA will require review at least every 3 years, or within 10 months of the organisational
boundary changing.
Recommendation:
In summary, the PCT is not seeking to increase it’s pharmaceutical list, but to ensure that where a
gap is perceived in the provision of existing enhanced services, this is met from within the current
complement of pharmacy contractors. The resilience demonstrated by local pharmacy contractors
in the provision of a robust anti-viral collection service during the H1N1 pandemic (2009/10)
indicates the view that the willingness, capability and capacity to meet the pharmaceutical health
needs of the population can be successfully met from within existing contractor group.
The PCT Board is asked to approve the publication of the draft PNA as a final version, with a view
to publication on the PCT internet.
Mona Sood
Head of Medicines Management
20
BOARD MEETING
18th January 2010
Agenda Item:
8
Title of Paper: Performance Brief
Responsible Director/Lead: David Cryer
Potential Conflicts of Interest:
I hereby certify that the matters stated above represent the totality of potential conflicts of
Board member interests in respect of this item, or that if nothing is stated this is because I
have been unable, after full investigation, to identify any.
Signed:
NB: NO PAPER MAY BE ACCEPTED UNLESS THIS SECTION IS COMPLETED AND
SIGNED
This paper supports:
CSP Goals:
Reduce Heart disease and stroke mortality by 40%; Reduce Infant mortality; Reduce adult
smoking prevalence; Halt the increase in childhood obesity; Halt the increase from current
STI; Improve the early detection and treatment of diabetes; Improve cancer survival rates;
Improve the quality of Primary Care Premises; Improve the Patient Experience; Improve
Primary care clinical outcomes; Improve access to Urgent Care Services; Staff will feel
valued.
World Class Commissioning Competencies:
Competency 10 - Effectively manage systems and work in partnership with providers to
ensure contract compliance and continuous improvement in quality and outcomes and value
for money.
Use of performance information:
 The PCT maintains a ‘live’ dashboard of information on key performance indicators,
including quality and outcomes, and ensures it is readily available to support
performance management
 The PCT can demonstrate data is used to drive fact-based continuous improvement in
quality and outcomes
Summary:
This paper scrutinises performance through the performance dashboard, which looks at
month by month actual performance of Existing Commitments and Vital Signs. The following
indicators have been updated since the dashboard was last presented to the Board:





LAS Category A & B
A&E
18 weeks RTT
All cancer data
MRSA
21







C.difficile
Breast screening
Cervical screening
Dental access
4 week smoking quitters
GUM
Chlamydia
We are currently producing Q3 Vital Sign figures through our statistical returns, and these will
be available in 2 weeks.
These will be added to the dashboard and presented in the next performance paper for the
Board.
Revenue/Resource implications:
N/A
Board Action Required:
The Board is asked to:

Note current performance.
Health Inequalities (evidence of how these are addressed in the paper):
Statutory Equality issues (evidence to show how the paper addresses the need to
avoid unfair discrimination on the grounds of age, disability, gender reassignment,
marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, or
sexual orientation):
Summary of Patient and Public Involvement and/or feedback (scope and how feedback
was incorporated/actioned):
Evidence of Best Practice nationally/internationally:
22
BOARD MEETING
18th January 2011
Agenda Item:
9
Title of Paper: Finance Report as at 30 November 2010
Responsible Director/Lead: Director of Resources
Potential Conflicts of Interest:
Explanatory note: The author of the paper, taking advice from NHS Newham Governance
department if necessary, must take all reasonable steps to indentify and state any potential
conflict of interest that any Board members might have in connection with the proposals
contained in this paper and sign the declaration below.
I hereby certify that the matters stated above represent the totality of potential conflicts of
Board member interests in respect of this item, or that if nothing is stated this is because I
have been unable, after full investigation, to identify any.
Signed:
NB: NO PAPER MAY BE ACCEPTED UNLESS THIS SECTION IS COMPLETED AND SIGNED
This paper supports:
CSP Goals:
To achieve statutory financial requirements prescribed by the DH
To underpin the delivery of the CSP with a financially balanced plan.
World Class Commissioning Competencies:
Primarily 11
Summary:
The paper sets out the financial position as at 30 November and provides updates on:
 Delivery of statutory duties
 Capital programme
 Risks and risk management
 Details of the Better Payment policy
Revenue/Resource implications:
Board Action Required:
The Board is asked to:
The Board is asked to consider the contents and not the improved financial position.
23
Health Inequalities (evidence of how these are addressed in the paper):
This report reflects delivery of the annual Operating Plan
Statutory Equality issues (evidence to show how the paper addresses the need to
avoid unfair discrimination on the grounds of age, disability, gender reassignment,
marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, or
sexual orientation):
No specific reference
Summary of Patient and Public Involvement and/or feedback (scope and how feedback
was incorporated/actioned):
The paper is made available for public access.
Evidence of Best Practice nationally/internationally:
The financial forecasts are prepared in line with NHS London planning guidance.
24
To:
From:
NHS Newham Board
Charles McNair, Director of Resources
Date:
30 December 2010
Subject:
Finance Report as at 30 November 2010
1
Introduction
The purpose of this report is to advise the Board on a number of key financial reporting areas. The
report covers the accounting period up to 30 November 2010 (month 8), and comprises the
following sections:







2
Overall Position (Forecast Year End Outturn)
Financial Performance to 30 November 2010
Risks and Mitigations
Capital
Other Performance Targets
Balance Sheet
Recommendation
Overall Position (Forecast Year End Outturn)
The table below sets out the assessment of the forecast year end position after taking into account
all factors that have a financial impact:
Overall position
Net
Position
surplus/(Deficit)
Less Revised Surplus (NHS London)
Distance from target
Contingency for shortfall on Transformation
savings
Revised Forecast shortfall against Plan
£'000
7,456
6,770
686
-686
0
The year end forecast of devolved budgets indicates that there will be a small overachievement of
£686k. However, a provision of £686k is retained which is a modest reserve to cover for a potential
shortfall against the Transformation savings / additional acute over performance. Our financial
position has improved by £1.4m largely as a result of a sector wide agreement with BLT, and as a
consequence of this improvement, PCT has now increased its planned surplus by £1.4m to a new
revised surplus of £6,770k. The benefit of the additional surplus will be felt in 2011/12, as the
higher surplus will be carried forward as a source of income.
The table indicates that the PCT will achieve a surplus of £6,770k, £1,400k in excess of the
required surplus (control total) by end of the year. This is after taking into account of a provision of
£1,230k for cost pressures, and £1,832k for management cost savings.
The sector and SACU have now reached an agreement with BLT on behalf of all three PCTs.
Under this agreement BLT has now agreed to a fixed price contract of SLA plus £9.2 million overperformance, for the three PCT’s combined. As a result of this agreement, NHS Newham forecast
over performance has now been reduced from £6.1m at month 7 position to our new fixed over
performance of £4.7m, resulting in an improvement of £1.4m. The improvement is reflected in the
overall financial position.
25
We also have significant recorded over-performance with providers external to our sector i.e.
UCLH, Royal Free and Whipps Cross. SACU continues to validate the activity for accuracy.
I have commissioned a final trawl of reserves, budgets and slippage on investments to determine
what further scope, if any, will be available to hedge against unspecified cost pressures. We have
been asked by the sector to contribute to cover the anticipated deficit at NHS City and Hackney,
although the resources will remain within Newham. The object is to deliver the combined, three
PCT required surplus across the sector.
3
Financial Performance to end of November 2010
At the end of November (month 8), the PCT recorded a net surplus of £124k. We have thus far
received seven months of activity for Acute, Specialist commissioning and Prescribing. A more
detailed review of the financial position is attached at appendices 2, 3, and 4.
4
Risks and Mitigations
There are a number of risks that will need to be managed in order to avoid any significant
movement of the PCT’s financial performance. The key ones are:

Through risk share agreements with NUHT and BLT, all bar a small sum for out of area
providers, transformation savings have been delivered.

The position with regard to the Specialist Commissioning budget, which is managed by
SCG (Specialist Commissioning Group) and covers mainly low volume and high cost
activities such as NICU, PICU and Mental Health Forensic, could worsen. To date we have
received seven months information and based on this data, it is expected that this budget
will over spend by £218k by the year end. A provision of £218k has been set aside for this
expected over performance.

We are still not absolutely confident that sufficient resources have been set aside for the
prescribing budget, and this leaves the Primary Care budget at risk. To date, we have
received seven months information. Based on this data, it is expected that this budget will
over spend by £501k by the year end. We have set aside an estimated £501k as a hedge
against this over performance. The position has slightly worsened by £66k compared to last
month.

The Forecast overspend for the APMS contracts has improved by £379k due to sanctions
as a result of performance measures imposed as part of contract monitoring by the Primary
Care Directorate. However, some performance indicators are being disputed to the AMPS
contractors. There is a risk of the position worsening if the final indicators need revision.

GP Practices temporarily staffed by Agency/locum are also presenting an over spend of
£175k. This position could worsen if agency/locum staff increases above the current plan.

The Dental budget is currently forecast to break-even. The forecast includes £0.3m for
Dental projects due to start shortly and risk slippage, should they not go ahead as planned.

Even though the Ophthalmic services budget is currently showing an under spend of £63k,
this is based on payments to date. As this budget has been devolved to the PCT from
2010-11, the current trends may not be reliable in the absence of historical data.
26
5

Management costs are currently under review in order to achieve the required 2010-11
management cost reduction of 15% against 2009/10 outturn reported in the final accounts.
We have subsequently been advised that certain sector and NHS London costs are
required to be presented. For 2010/11 reporting, the PCT forecast management cost is
circa £300,000 above the NHS London ceiling. However, this position is likely to improve
further as we approach the financial year.

Provider services are currently still in negotiation with NUHT for the annual SLA with a
value of approximately £4m. With the transfer of the Community Services planned for Feb
2011, there is a growing risk that on transfer, the PCT will be left with outstanding debtors
from NUHT in relation to community services, SLA disputes and potential bad debts. Steps
have been taken to escalate resolution of this matter. We are involving ELFT in this process
and have signalled to them that NHS Newham are not prepared to retain SLA debts on the
balance sheet, unless they are supported by clear agreements with NUHT. We are also
making preparations to go to arbitration with NUHT, over the dispute, if necessary.
Capital
The PCT has an operating capital allocation of £3,220m, following the approval of the capital
programme, there is a forecast outturn of approx £887k under spend. As reported in last months
report, the Dental Outreach - Westfield project is no longer going ahead, an alternative scheme at
Carpenter Road is currently been considered, with full costing proposals been awaited for the
scheme, meaning the current outturn position is likely to change once the full costings are received
and the lead times confirmed for the projects.
ICT schemes are on track to be delivered by the end of the financial year.
Backlog and compliance schemes are also on track to be delivered, though the
sustainability/carbon reduction programmes are not likely to be delivered in full due to capacity
issues in the Estates department and the late notification of the allocation this year, efforts are
currently geared towards delivering the compliance and backlog programmes. We may also
accelerated some projects, on areas identified through the due diligence process for the planned
transfer of CHS services to ELFT (buildings occupied by CHS)
The capital allocation for the development of the Olympic Village Polyclinic of £16m was over two
years, £7,224m in 2010-11 and £8,792m in 2011-12. This funding is to be passed on to the
Olympic Delivery Authority (ODA) for the construction of the polyclinic, to date £3,795m has been
paid over to the ODA, with the balance due to be paid over in Jan and Feb next year.
27
Below is a schedule of the scheme progress to date:
Capital Programme 2010/11
Scheme Description
Britannia Village –
Development
Dental
Outreach
Scheme - Carpenters
Rd
Primary
Care
Improvement Capital
Strategic
Development
&
Planning
Approved
Allocation
Sept 2010
Actual
Spend @
Nov 2010
770
90
Forecast
Outturn
770
Comments
Guarrantee
maximum
(GMP) at final stage
Alternative
Scheme
currently
considered
Focusing on Church Rd and
Vicarage Lane reconfiguration
450
188
11
170
1,408
101
940
IT Business Continuity
124
26
124
GP IT Replacement
Upgarde
of
core
network,
including
EDGE sites
150
7
150
290
59
200
PCT IT Replacement
Wireless installation to
various sites
50
15.5
50
110.5
544
ICT - Total
20
634
20
Backlog Maintenance
210
23
210
Statutory Compliance
236
19
236
Sustainability/Carbon
Reduction Prog
148
Estates - Total
594
Equipment Allocation
50
42
On track to be delivered by March
2011
On track to be delivered by March
2011
Likely slippage due to PCT sites
reconfiguration and CHS move
On track to be delivered by March
2011
On track to be delivered by Feb
2011
Survey & design completed with
quote receieved for most of the
projects
Survey
& risk assessment
completed, with designs in
progress
Behind schedule due to staffing
capacity and late notification of
allocation
496
50
50
Dental Service
303
303
Other Projects
231
0
Other Projects
Total
Planned
Operational
Programme
NHS London Capital
Allocation
Under/(Over) spend
on Capital Allocation
584
0
3,220
254
353
2,333
3,220
3,220
0
887
28
price
Equipment for Provider Services
Mobile Unit & Adaption works to
Appleby & Shrewsbury
6
Other Performance Targets
 Better Payment Policy:
The PCT is required to the meet and publish is Better Payment Policy. The target is to pay
95% of it’s suppliers within 30 days. This is monitored based on the number and value of
invoices paid each month. The PCT has achieved a cumulative position as at Nov 2010, of
94% for the number of invoices and 96% for the value of invoice paid within target, compared
to the same level of 94% and 96% in Oct. The PCT is working closely with NHS Shared
Business Service (SBS) to maintain the current levels and improve on the number of invoices
paid within 30 Days.
Better Payment Practice Code - Measure of
Compliance
Number
Total Trade Invoices Paid in the Year
Total Trade Invoices Paid Within Target
Percentage of Trade Invoices Paid Within Target
£000s
18,744
17,611
94%
335,992
321,821
96%
The performance reflects a stepped improvement on last year’s performance and complies with
statutory requirements. We will continue to be vigilant.
 Cash Limit Target:
The PCT is set an annual cash limit target, which is the amount of cash it is allowed to draw down
from the Dept of Health. The cash limit as at August 2010 is £573,491m, including capital cash
allocation; the schedule below highlights the PCT’s performance against this limit. The PCT is
currently over its planned cash limit, by 25k, with more certainty around the capital cash allocation
and the Prescribing Pricing Authority (PPA) cash funding, the PCT is forecasting a breakeven
position on the utilisation of its cash allocation by the end of the financial year.
Over/Under spend Against Cash
Limit
Cash Drawn Down from DH
PPA Recharges
Dentistry Recharges
Total Charge to Cash Limit
Cash Limit Oct 2010
Under/(Over)spend Against Cash
Limit
Plan
YTD
£000s
354,087
29,077
9,952
393,116
393,116
Current
YTD
£000s
354,100
29,138
9,903
393,141
393,116
YTD
Variance
£000s
13
61
(49)
25
0
Full Year
Plan
£000s
510,175
39,533
15,162
564,870
564,870
Forecast
Outturn
£000s
508,100
41,996
15,644
565,740
565,740
Full Year
Variance
£000s
(2,075)
2,463
482
870
870
0
(25)
0
0
0
0
29
Balance Sheet
The Balance Sheet and movements from the 1 April is provided below. Significant changes, should
they occur, will be reported in future Board meetings:
NHS Newham
Statement of Financial Position as at
31 November 2010
1 April
2010
£000
Non-current assets:
Property, plant and equipment
Intangible assets
Other financial assets
Trade and other receivables
Total non-current assets
Movements
£000
Nov 2010
£000
73,680
124
900
4,300
79,004
(1,957)
(44)
(2,001)
71,723
80
900
4,300
77,003
9,857
180
10,037
(409)
58
(351)
9,448
238
9,686
5,750
15,787
94,791
(351)
(2,352)
5,750
15,436
92,439
(45,186)
(875)
(386)
(46,447)
3,799
180
0
3,979
(41,387)
(695)
(386)
(42,468)
48,344
48,344
1,627
Non-current liabilities
Provisions
Borrowings
Total non-current liabilities
Total Assets Employed:
(2,719)
(35,121)
(37,840)
10,504
(4)
0
(4)
1,623
(2,723)
(35,121)
(37,844)
12,127
FINANCED BY:
TAXPAYERS' EQUITY
General fund
Revaluation reserve
Government grant reserve
Total Taxpayers' Equity:
(19,135)
28,999
640
10,504
1,623
(17,512)
28,999
640
12,127
Current assets:
Trade and other receivables
Cash and cash equivalents
Non-current assets classified "Held for
Sale"
Total current assets
Total assets
Current liabilities
Trade and other payables
Provisions
Borrowings
Total current liabilities
Non-current assets plus/less net current
assets/liabilities
7
1,623
Recommendation
This report is for information, The Board is asked to consider the contents and note the improved
financial position.
30
Appendix 1
Detailed Review of Budgets
The summary of the financial position by directorates at the end of November is as follows:
YTD
YTD
YTD
Full
year
Full year
Full year
Nov-10
Budget
£k
370,615
272,634
Nov-10
Actual
£k
370,615
276,973
Nov-10
Variance
£k
0
-4,339
Budget
£k
560,238
411,710
Forecast
£k
560,238
417,558
Variance
£k
0
-5,848
0
-183
183
0
-130
130
&
75,335
75,585
-250
113,047
113,359
-312
Health
4,101
3,709
392
6,712
6,305
407
&
1,825
1,829
-5
2,737
2,740
-3
Costs – Chief Executive
Costs – Medical Director
Costs – Strategy &
Planning
1,100
288
896
980
263
863
120
25
32
1,649
1,344
1,344
1,458
1,289
1,289
192
55
55
Costs - development
Costs - Resources
Costs – Contingency
Reserves
0
6,111
3,633
0
5,778
0
0
333
3,633
0
10,406
5,000
0
9,812
0
0
594
5,000
Total costs
Required Surplus - NHS
London Target
365,922
4,693
365,797
4,693
124
0
553,035
5,370
552,782
6,770
254
-1,400
Required
Management
cost savings
0
0
0
1,832
0
1,832
Net
surplus/(Deficit)
0
124
124
0
686
686
Income
Costs - Performance &
Commissioning
improvement
Costs – Providing (net)
Costs – Primary
Community
Costs
–
Improvement
Costs –
Quality
Assurance
Position
Key variances from budget
Performance & Commissioning Improvement
Acute Commissioning
The acute commissioning budget of £266.6m includes £4.4m demand management savings
against the SLAs. Based on activity information received which mainly covers seven months data,
and is currently being reviewed for accuracy, the position as at end of November is expected to be
£5,395k over spent, with a year-end forecasted position of £7,557k over spend.
31
Year to date Year to date Year to date
budget
actual
variances
£k
NUHT
BLT
Barking, Havering
and Redbridge
Whipps Cross
Moorfields
Homerton
Great Ormond St.
Royal Free
RNOH
Royal Brompton
Kings
Royal Marsden
UCLH
LAS
Guys & St
Thomas
Imperial
Mid Essex
Chelsea &
Westminster
North Middlesex
Basildon and
Thurrock
St George’s
Healthcare
Whittington Hospital
North West
London
Other SLAs
Total
£k
£k
Annual
budget
£k
Forecast
year end
position
£k
Forecast
year end
variance
£k
84,519
40,569
84,727 43,697 -
208
3,128
126,778
60,854
127,090 65,545 -
312
4,692
3,021
7,521
2,318
2,305
3,325 8,453 2,299
2,664 -
304
932
19
359
4,531
11,281
3,477
3,457
4,987 12,634 3,448
3,996 -
456
1,352
29
539
2,813
1,086
411
372
558
113
2,688
6,371
2,882
1,396
389
476
558
145
2,971
6,371
69
309
22
104
0
31
283
-
4,220
1,629
616
558
837
170
4,033
9,556
4,323
2,021
583
709
803
217
4,309
9,556
1,903
843
259
1,679
851 260 -
224
8
1
2,854
1,265
388
2,518
1,196
343
335
69
46
449
184
426
180
24
4
674
276
624
270
50
6
110
224 -
113
166
336 -
170
173
243 -
69
260
319 -
59
131
134 -
4
196
201 -
5
160
18,184
177,061
174 17,934
182,456 -
14
249
5,395
240
28,340
266,656
261 27,923
274,213 -
21
417
7,557
-
-
103
391
33
151
34
47
277
-
A cash envelope deal with NUHT in respect of the three local PCTs has been agreed by SACU.
For NHS Newham, the agreement covers an in-year risk share which provides fixed payments
based on the SLA value plus £312k, providing activity remains within ± 5% of the SLA value. All
existing claims management processes will remain in place.
The sector has now reached an agreement with BLT as explained above. The over performance at
BLT to end of November is £3.1m, with a year end forecast of £4.7m over performance. This over
performance is mainly due to Non-Elective, Elective, day case and out patients.
The other area with significant year end forecast of over spends are:

Whipps with £1,352k. The position worsened by £207k compared to last month’s reported
position. The main areas of over performance are in out patients and day case admissions.
32


UCLH with £277k. The position has improved by £293k compared to last month’s reported
position. The main areas of over performance are in Non-Elective, Elective and High cost
drugs & devices.
Royal Free with £391k. The position has improved by £206k compared to last month’s
reported position. The main areas of over performance are in the Critical care unit and
renal programme.
The overall position for acute services based on seven months data has improved by £1.5m
compared to last month, which is mainly due to BLT’s agreed fixed over performance. Further work
is underway by SACU to review the data for accuracy and to also account for the impact of
successful challenges to date made with regard to certain aspects of the clinical activity data. This
may yield additional savings.
The Clinicenta element of this budget is forecasted to be under spending by £477k which is mainly
due to the delayed mobilisation of services.
Integrated Commissioning
The Mental Health part of this budget (MHT complex care risk share) is forecast to be over spent
by £656k by the end of the year. This is mainly due to an increase in the number of patients in
adult complex care placements during the first eight months of this year. At the start of the year, a
provision of £561k was set aside for this and after taking into account this provision, this budget is
expected to be over spent by £95k which is a slight improvement of £6k to the reported position of
last month.
The budget for Mental Health – Forensic element is expected to be over spending by £367k by
year end. The position has worsened by £52k when compared to last month. The over
performance is mainly due to the number of patients receiving treatments, which are currently in
independent sector placements. Some of these patients must remain in independent sector
placements for legal reasons, but the SCG (Specialist Commissioning Group) is working closely
with the Trust (East London Foundation Trust) and expects to have most of the patients currently in
independent sector placements returned to the NHS as soon as possible. This has been reflected
in the forecast out-turn position.
Expenditure for Learning Disability clients receiving long-term care packages is over spent by
£198k at the end of November. At the start of the year, a provision of £202k was set aside and
after taking into account this provision, this budget is forecasted to be £298k over budget by the
year-end. The position has slightly worsened by £62k when compared to last month which is due
to the addition in the number of patients receiving treatments.
The overall position for this budget is £173k under spent to end of November with a forecast for the
year end of a £390k under spend.
Specialist Commissioning
The Specialist Commissioning budget is managed by SCG (Specialist Commissioning Group) and
covers mainly low volume and high cost activities such as NICU, PICU and Mental Health
Forensic. To date we have received seven months information and based on this data, it is
expected that this budget will over spend by £218k by the year end. The position has slightly
improved by £28k compared to last month’s reported position. A more detailed review of the
financial position is attached at appendix 4.
33
YPD
The placement budget for YPD (Young Physical Disabilities) is £350k under spent as at end of
November, and the expected year end forecast is a £524k under spend. The position has slightly
improved by £39k compared to last month which is mainly due to a reduction in the number of
packages.
Children Services
At the end of November this budget is showing a £59k under spend. The expected year end
forecast is a £89k under spend which is mainly due to slippage in the programmes.
PBC
This budget is forecasted to be under spending by £300k by the end of the year. This is mainly due
to reduced number of projects funded this year.
Provider Services
The budget currently shows a net under spend of £183k, compared to 109k in Oct 2010. Adult
Services is under spent by £361k, and this is without taking into account the likely impact following
the contract negotiation regarding the Urgent Care Centre(UCC), with final agreement still to be
reached on, risk share agreement with regards to UCC non Newham resident income, x-ray
charges from NUHT and agreement of space utilisation and costing from NUHT.
Children’s Service is under by £163k. The directorate has been successful in recruiting to the full
compliment of Health Visitor posts, and has reached agreement with NUHT for the costs of the
Paediatric Consultants and medical staff whose services are provided through a service level
agreement. It should be noted that the variance is non recurrent and reflects the medical staff
vacancies from April to August.
The Support service is £17k over spent, due to the Integration budget been part year funded and
given the revised transfer date the budget will over spend.
It is planned that the small reserve £275k remains intact, in addition to the forecast surplus to cover
future risk and FT surplus requirement for February and March 2011. Of the reserve £207k is non
recurrent.
Management Costs
At the end of November, this budget showed an under spend of £210k, which was primarily due to
staff vacancies. The expected year end position will be an under spend of £274k.
8
Primary and Community Services Commissioning Care
Management Costs
The expected year end position for this budget is an under spend of £115k, which is primarily due
to staff vacancies
Primary Care Budget
At the end of November, this budget is under spent by £16k. The forecast year-end position is an
under spend of £11k. The forecast includes an over spend of £106k on the APMS contracts as well
as an over spend of £175k for practices temporarily staffed by Agency/locum staff.
34
Ophthalmic
The responsibility for this budget has been devolved to the PCT from 2010-11. This budget is
expected to under spend by £63k by the year-end. The forecast is based on monthly payments to
date.
Dental
This budget is currently showing break even. The £1.4m set aside for commissioning additional
activity has now been finalised. Additional activity of £1m has now been actioned to practices and
£0.4m will be utilised for additional dental projects.
Prescribing
The PCT has now received seven months prescribing data. Based on this data, the overall
Prescribing budget is over spent by £334k at the end of November. It is expected that this budget
will over spend by £501k by the year end, which is £66k worse compared to last month’s reported
position.
Health Improvement
The overall position for this directorate is an under spend of £392k at end of November. This is
mainly due to staff vacancies. The year end forecast position for this directorate is a £407k under
spend which is mainly due to staff vacancies as well as the slippage of new initiatives.
Assurance and Quality
The overall position for this directorate is an over spend of £5k at end of November. The year end
forecast position is a £3k over spend. This is mainly due to vacant posts covered by agencies.
Chief Executive
The overall position for this directorate is an under spend of £120k at end of November, which is
mainly due to NEL TB & Board budgets. The year end forecast position for this directorate is a
£192k under spend.
Medical Directorate
The overall position for this directorate is an under spend of £25k at end of November, which is
mainly due to staff vacancies. The year end forecast position is a £40k under spend.
Strategy & Planning
At end of November, this budget is showing a £32k under spend, which is mainly due to staff
vacancies. The expected year end position is a £55k under spend.
Resources
The overall budget position for this directorate is currently an under spend of £333k and the
expected year end position is a £594k under spend. This is mainly due to staff vacancies and an
under spend in the Estates budget.
35
36
BOARD MEETING
18th January 2011
10
Agenda Item:
Title of Paper: Governance Update
Responsible Director/Lead: Derek Greening
This paper supports:
CSP Goals:
This paper reports to the Board on the key assurances, as required by the Statement of
Internal Control, that the Goals within the CSP will be delivered or if there are significant risks
to that delivery then suitable control measures are in place. This includes all mandatory and
statutory internal and external sources of assurance that the Board uses to gain full
assurance that suitable control mechanisms are in place.
(please list the relevant goals and explain how they are supported)
World Class Commissioning Competencies:
The WCC process is supported, as is the CSP, by the underlying and integral requirements of
the Statement of Internal control to have systems in place to give the Board assurance that all
risks to the delivery of the competencies and their products are managed so as to ensure
delivery.
(please list the relevant competencies and explain how they are supported)
Summary: The Board is asked to receive and to note:

An update on the policies signed of in its name;

An update on the management of strategic risks to its objectives or its existence
and operational risks - by exception

Statutory or Mandatory reports – Updates on Serious Untoward Events (SUIs)

External assurance reports

Alterations’ to the Governance arrangements in particular SFI, So or Scheme of
Delegation.
Revenue/Resource implications:
None specifically
Board Action Required:
 With relation to the policies signed off in its name the board are asked to note and
approve these.

The board is asked to approve the suspension of the PSG until a new Governance
model is approved.

2009/10 the BAF the Board are asked to note its contents.

Provider BAF the Board are asked to receive this update and to note its contents

The Board is asked to note the Serious Incidents that have occurred since the last
meeting.
37

To note Information Governance and Caldicott Meeting Minutes

To note the Sealing of Documents undertaken.

To note the Safeguarding Children’s report

To approve the adoption of the current Risk Management Strategy until a new sector
strategy is developed.
Health Inequalities (evidence of how these are addressed in the paper):
The process supports all Health Inequalities processes.
Statutory Equality issues (evidence to show how the paper addresses the need to
avoid unfair discrimination on the grounds of age, disability, gender reassignment,
marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, or
sexual orientation):
The process supports all equality issues.
Summary of Patient and Public Involvement and/or feedback (scope and how feedback
was incorporated/actioned):
Through the various governance arrangements set up to deal with each area.
Evidence of Best Practice nationally/internationally:
NA
38
To:
From:
The Board
Derek Greening, Company Secretary
Date:
18th January 2011
Subject:
Governance Update
1.
Introduction
This report informs the Board about the current status and key issues relating to the
assurance framework within the organisation as required by the Statement of Internal
Control. The Board will receive at each meeting updates on the following areas even if
there is nothing to report.
This paper specifically updates the Board as to:
 The policies signed of in its name;
 The strategic risks to its objectives or its existence (operational risks - by exception)
 Statutory or Mandatory reports
 External assurance reports
 Internal assurance process
 Updated Governance arrangements
2.
Policy Sign of Group
Since the last meeting in November the PSG has met and approved the following policies
on the Boards behalf;
Policies (NHS Newham):








Dignity at Work Policy
Alcohol and Substance Misuse Policy
HR Change Management Principles
Equal Opportunities Policy
Decommissioning Policy
Market Management Strategy
Procurement Strategy
Information Governance Policy
Policies (Newham Community Health and Care Services):






Fridge Policy
Health of Children in Care Policy
Legal Procedures relating to Safeguarding Children
Pressure Ulcer Policy
District Nursing operational policy
CDC Key Worker Procedure
It should be noted that it is proposed that the PSG now be formally round up until the sector
arrangements have been clarified.
A new Whistle blowing policy has been approved by the Audit and Governance committee
and will be rolled out as soon as possible.
39
The Board are asked to note the policies that have been signed off in its name and to
approve that until such time as the sector governance arrangements have been confirmed
that the PSG should not meet.
3.
The strategic risks to the Boards objectives or its existence (operational risks - by
exception) (Board Assurance Framework)
3.1
Commissioner Risks
31
Attached as appendix 1 is the BAF, it should be noted that the BAF has been drawn from
the risks arising from the committee’s of the Board see section seven and there are new
risks from the Executive Team.
2.2
Sections 1-6 are from the PMO and have been created from the report they are preparing
for the Board following their biweekly risk and issues reviews with the programmes. It
should be noted that the BAF only includes the highest risks arising from these reviews, as
per the auditors requirements, where as the PMO Board report identifies those areas that
the programmes feel are important and these may include low risks. It should be noted
that this report went to the Alignment Group and then to the Programme Steering Board
(PSB) as agreed by the Board.
2.3
it should be noted that for the strategic risks five have been downgraded and no longer
appear but details of these are available if requested and three new risks have been
added.
3.2
Provider Risks
The Shadow Provider Board received a new format for the BAF in December which merged
the high risk register into the objectives in a similar way as to the commissioning , BAF and
in a similar format to that used by ELFT. The updated BAF is attached as appendix 2 and
was approved by the SPB at their meeting in December.
4.
Statutory or Mandatory reports.
4.1
The Board is asked to receive an update on the Serious Untoward Incidents that occurred
in the last two months this attached as appendix three.
4.2
Information Governance and Caldicott Meeting Minutes
The minutes of the last meeting are attached as appendix 5.
4.3
Documents Sealed under the requirements of the Standing Orders.







10/006: Transfer of Whole of registered title, Day Hospital First Avenue Plaistow & 115121 Balaam Street E13 from NHS Newham to ELFT. Date 21/12/10
10/007: Lease by Reference of premises at First Avenue resource centre between ELFT
and NHS Newham. Date 10/01/11
10/008: Counterpart lease for part ground and first floor, Francis House, 760-762
Barking Road E13. Date 10/01/11
10/009: Counterpart lease for third floor, Francis House, 760-762 Barking Road E13.
Date 10/01/11
10/010: Counterpart lease for fourth floor, Francis House, 760-762 Barking Road E13.
Date 10/01/11
10/011: Licence to underlet – units 2,3,4 Warehouse K E16. Date 10/01/11
10/012: Sublease by reference – units 2,3,4 Warehouse K E16. Date 10/01/11
40
4.4
Safeguarding Children Bi-annual report
PCT’s have to receive at least two reports a year in relation to safeguarding (Working
Together 2010). This is the second 6 monthly safeguarding report for this year and has
been added as appendix 4 to this governance report. This report is for information and
approval
5
External Assurance
There has been no formal response to the organisation in the mean time.
6
Updated Governance arrangements
6.1
It is a requirement at this time of year for the Board to receive and approve an updated Risk
Management Strategy so that it is in place for the full year and this can be reflected within
the Statement of Internal Control. It is proposed that as there will be a sector Risk
Management Strategy that we agree to continue with the current strategy until the sector
one is available.
7
Recommendations
7.1
With relation to the policies signed off in its name the board are asked to note and approve
these.
7.2
The board is asked to approve the suspension of the PSG until a new Governance model is
approved.
7.3
2009/10 the BAF the Board are asked to note its contents.
7.4
Provider BAF the Board are asked to receive this update and to note its contents
7.5
The Board is asked to note the Serious Incidents that have occurred since the last meeting.
7.6
To note Information Governance and Caldicott Meeting Minutes
7.7
To note the Sealing of Documents undertaken.
7.8
To note the Safeguarding Children’s report
7.9
To approve the adoption of the current Risk Management Strategy until a new sector
strategy is developed.
Derek Greening
Company Secretary
41
Appendix 1;
Board Assurance Framework 2010-11
Seven High Level Objectives from the 2010-11 in the NHS Newham Operating Plan
1. Improve primary and community services
2. Implement Polysystems
3. Deliver improved care pathways and care packages
4. Invest in prevention
5. Achieving financial sustainability
6. Work with our partners to bring about change
7. Develop NHS Newham and our providers
Prevention
Chetan Vyas / Suzanne Wood (Seven Amber, and no green)
2
Long
Term
Conditions
Rachel Flowers / Janet Tucker ( plus 4 Amber and no greens)
2.3
Health and Social
Care Teams
Paul Mullin
5
2.4
Health and Social
Care Teams
Paul Mullin
4
Lack of NUHT support
for VW / community
rehab service
Lack
of
GP
commissioning
&
provider support for the
Virtual Ward
R
Discussing audit results and
clinical pathways and impact
on bed base with CHS /
ELFT and NUHT clinicians
and managers.
R
Working with CHS and GPs
to ensure engagement as
providers of care and
support
from
3
Assurance
Programme
Steering
Board
Performance
Reports and
Programme
meetings.
Programme
Steering
Board
Performance
Reports and
Gaps in controls
or assurance,
including action
plans for
mitigation with
lead and
completion date.
Date of last
review.
1
5
Mitigating Controls (Actions)
including completion date
and lead officer
Residual Risk
rating
Principle Risk to
Delivery of objective.
(DESCRIPTION)
Risk Rating
Director /
Programme /
Work stream
Leads
(OWNER)
PROBABILITY
Objective/
Programme /
work stream/ Risk
type
(ORIGINATOR)
IMPACT
identifier
These are to be delivered by:
7
A
5x
2
No Gaps identified
at this time
11/01
No Gaps identified
at this time
11/01
Assurance
Commissioning Groups and
LMC.
Programme
meetings.
3.0
4.0
4.2
(n)
Productivity
Personalisation
Programme Risks
Robert Moore / Mejero Uwejeyah (nine Amber, two green)
Carol Hill / William Roberts (Six amber, no greens)
William
There is a significant
4
4 R See risk 7.23
Roberts
risk that we are not
going to achieve the
immunisation targets.
4.3
Programme Risks
Thara Raj
Missing Chlamydia
target – Jan update
this is still under
target.
4
5
R
We are monitoring weekly
performance
and
have
commissioned a range of
services
to
increase
screening uptake.
Jan Update – the latest data
will be reviewed week
beginning 17h January and
if target can be achieved
before
deadline
using
additional resources these
will be deployed.
4.14
Maternity
William
Roberts
There is a risk that
financial control will
be lost related to
NZ0
non-delivery
attendances
5.0
Enablers
Charles McNair / Mary Clegg (removed)
5
4
R
Asking SACU to manage
contract and monitor NZ0
non-delivery
attendances
and challenge NUHT
43
Gaps in controls
or assurance,
including action
plans for
mitigation with
lead and
completion date.
Date of last
review.
Mitigating Controls (Actions)
including completion date
and lead officer
Residual Risk
rating
Risk Rating
Principle Risk to
Delivery of objective.
(DESCRIPTION)
PROBABILITY
Director /
Programme /
Work stream
Leads
(OWNER)
IMPACT
identifier
Objective/
Programme /
work stream/ Risk
type
(ORIGINATOR)
Regular
reports to the
performance
section of the
Executive
Team.
This
is
reported via
performance
reports
at
each
relevant
executive
team
meeting.
0
11/01
9
We are not yet
sure that controls
that are proposed
will deal with the
short fall until the
latest data has
been analysed.
11/01
Programme
Steering
Board
Performance
Reports
5
We do not hold
the contract and
are reliant on
SACU
enacting
the
contractual
controls
11/01
6.0
6.1
Transition
Clinical networks
David Cryer (one amber, No greens)
Strong
clinical
leadership
and
engagement
is
required to deliver of
care outside hospital.
5
3
R
Develop operating plan at
GP consortia level; one
consortium is already a
pathfinder
with
shadow
responsibility for budgets
and we will try to get other
consortia to the same
position.
Programme
Steering
Board
Performance
Reports and
Programme
meetings &
GP
commissioni
ng Board.
6
No gaps identified
at this time
11/01
1
0
The mitigation strategy is:
• CIP
• Regular Performance
Review
GP list cleansing
Executive
Team
on
behalf
of
Board; PEC
& LMC
6
None
11/01
Jan update – the GP
Consortia are not
engaging with the
CSP or the operating
plan and the delivery
of these through the
clinical networks.
7.0
7.1
Other
Strategic
Risks
Strategic Risk
Executive Team
Executive
Team
on
behalf of the
Board
Derived from
master class
Feb 2010
Population Growth
• Population growth
will different to the
current model
• Growth in funding
does not allow or
factor population
growth.
5
3
November Update - Working
with LBN/ Clinicians and Les
Meyhew to establish more
robust population figures;
The impact of which
will be…
Being looked at by sector in
CSP modelling.
• Funding and cost
challenges.
January update – we are
working with the borough to
review our practice patient
data with that obtained via
the Census in March 2011
to
see
the
level of
discrepancy between the
two so that additional
funding can be sought
based
upon
robust
Finance balance at
risk.
44
7.2
Strategic Risk
Executive
Team
on
behalf of the
Board
Derived from
master class
Feb 2010
Magnitude
Complexity
Change
and
of
5
5
1
0
To Focus on:
There is a risk that…
• Risk of Slippage in
delivery (DR)
• Urgent care &
community
transformation.
• Health4NEL
implementation
faces delays..(DR)
7.3
Strategic Risk
Executive
Team
on
behalf of the
Board
Derived from
master class
Feb 2010
• Competing
demands will
cause conflicts,
e.g. sector demand
for money
• We can’t influence
Executive
Team
on
behalf
of
Board
6
None
11/01
Executive
Team
on
behalf
of
Board
6
None
29th
Oct
2010
• PMO mitigates the risk by
identifying progress
against objectives;
managing risks in a timely
way; Monitoring
Performance (DC) — at
PCT and sector level (DR)
• Partnership
• Sector
• Governance
The impact of which
will be…
We won’t get: • Reduction in acute
activity
• Activity in Primary
Care
• Access to care
January update single management
structure may add to
capacity issues
when trying to
deliver this complex
agenda.
Reliance on Complex
Partnerships
population figures.
The mitigation strategy is:
January update – The
transition
process
is
reviewing these issues and
we are also drawing up a list
of actions to be taken in the
last quarter.
5
5
1
0
The
is…
mitigation
strategy
• Robust implementation of
Strategic aims (DC)
• Get clarity of
requirements, structures
we shape
• Have a leading role in e.g.
45
partners to do what
we want and
NUHT becomes
unviable due to
lack of
synchronisation
between NPCT
objectives and
partners objectives
sector
• Transparency and
dialogue around
transformation.
January update – we are
continuing with detailed
debates at the Board with
other parties such as LBN,
consortium
on
differing
governance models.
The impact of which
will be…
• A delay and impact
on delivery
January update – the
possible merger of
BLT,
Whipps
&
NUHT may lead to
deterioration in the
performance of the
organisations as their
focus moves from
performance.
7.4
Strategic Risk
Derived from
master class
Feb 2010
Capacity in Primary
Care
There is a risk that…
• Despite
improvements in
quality there is
variability
The impact of which
will be…
5
5
1
0
The
is…
mitigation
strategy
• Performance
Management Framework
– as per the PMO
processes of identifying
progress against
objectives; managing risks
in a timely way and
monitoring performance”
• Inability to deliver
our plans
Clinical Networks
• Contract review
• Data review
46
PEC-QSI
Executive
Team
on
behalf
of
Board
6
None
11/01
• Benchmarking
January update.
Mitigating Actions---we have
developed a suite of quality
performance reports which
is regularly reviewed by
PEC-QSI and action plans
will be developed to address
the
poorest
performing
practices.
GP
consortia
have
welcomed this approach
and have agreed to work
with us to take this forward.
7.5
Strategic Risk
Executive
Team
on
behalf of the
Board
Clinical / Public signup
Derived from
master class
Feb 2010
• A lack of support
and understanding
for implementation
The impact of which
will be…
There is a risk that…
• Affect on the pace
of change
5
5
1
0
The
is…
mitigation
strategy
• Implementing the Board
agreed approach from the
Communication and
Engagement Board
Development day on 20th
April 2010. (CV)
• We are already good at
engagement.
• Clinical networks boards
• Systematic approach
• Build on clinical
leadership
• Secondary care clinicians
January Update – The
transitional programme will
need
to
develop
a
communication strategy.
•
47
Executive
Team
on
behalf
of
Board
7
None
11/01
7.6
Strategic Risk
7.7
Members of the
Audit
&
Governance
Committee
PWC
via
the
A&GC
14th
October 2010
7.11
Chief
Executive
and Chair
Executive
Team
Executive
Team
This
has
been
merged into 7.22
This
has
been
merged into 7.22
5
3
January
update
–
Mitigation
is
the
Commissioning
Support
services
and
outward
facing work with consortia,
including clinical network
support.
8
The impact of the
White paper – ‘Equity
and
excellence:
liberating the NHS
The
proposed
transfer
of
commissioning
responsibilities from
PCTs
to
GP
consortia and the
newly created “NHS
Commissioning
Board” by 2013 will
require
significant
management focus
in 2010/11 and could
result in the PCT
Board
and
management team
having less capacity
to monitor continuing
services
and
arrangements. There
is also a risk of loss
of local strategic
focus as the PCT
cooperates with its
sector partners at the
East
London
Commissioning
Alliance,
(“ELCA”),
which could conflict
48
GP
Commissioni
ng
Board
Executive
Team
feedback
and
Board
discussion.
6
None
11/01
7.13
PWC
via
the
A&GC
14th
October 2010
Executive
Team
with the PCT‟s local
strategy
if
not
managed well
Transfer of Provider
Services
5
5
1
0
Through regular reports to
the Executive Team and
the PIC and then to the
Board via the A&GC.
The PCT‟s provider
services (Newham
Community Health
and Care Services,
“NCHCS”) has
transferred from the
PCT on 1 October
2010 to East London
NHS Foundation
Trust. It has already
been operating at
arms length from the
PCT and there is a
separate ledger from
the commissioning
arm.
The transfer of the
provider services to
East London FT
represents a
„machinery of
government (MoG)
change‟ as it is
between NHS
organisations. The
Treasury IFRS
Financial Reporting
Manual (iFReM) sets
out that any such
change should be
accounted for by
applying merger
accounting. Merger
accounting requires
that the PCT account
Please note that the new
date for transfer is 1st of
February
and therefore
the risk of not meeting the
October deadline has been
realised.
January Update - the audit
plan includes appropriate
treatment of the transfer
(Demerger)
49
PWC
0
None
11/01
7.16
PWC
via
the
A&GC
14th
October 2010
Executive
Team
for NCHCS as if they
had always been
under the control of
East London FT.
The
financial
statements of the
PCT for the year
ending 31 March
2011 will therefore
not
include
the
income
and
expenditure,
and
year end assets and
liabilities of NCHCS
and it will accounted
for as a provider
contract. NCHCS will
no
longer
be
reportable to the
Board of the PCT
and their results will
be reported within
East London FT‟s
accounts
Financial
Reporting.
5
2
7
January
Update
1)
Bringing
in
additional
resource short term.
In the past two years
it has been noted in
our report to those
charged with
governance that we
have experienced
issues regarding the
efficiency and
effectiveness of the
PCT‟s accounts
preparation process.
We understand that
management has put
in place a plan to
2) Audit plan in place and
reviewed with PWC
50
To
be
discussed
and noted by
the PIC and
A&GC
in
December
6
None
11/01
improve the year end
financial reporting
process with
sufficient resources
to improve the quality
of the accounts and
working paper.
Given the focus on
management
cost
efficiencies
and
increased
cooperation with ECLA,
there is a continuing
risk that the PCT will
not have sufficient
resource to meet the
required
financial
reporting deadlines,
remain
compliant
with IFRS and keep
up to date on any
changes in technical
guidance
7.18
PWC
via
the
A&GC
14th
October 2010
Executive
Team
Olympics
5
5
1
0
January Update - We need
to carry out a review of this
to see what affect the
Grant process has on
overall capitalisation.
As Newham is the
focus of the London
2012 Olympics, the
population
will
benefit
from
the
investment
in
infrastructure in the
local
area.
We
understand that the
healthcare centre for
the Olympic site will
be handed over to
the PCT following the
event.
Whilst
negotiations on the
51
To
be
discussed
and noted by
the ET and
the SPii with
reports to the
Board
6
There is a gap in
the
control
mechanism as we
do not know what
affect the grant
process has.
11/01
arrangement are not
yet complete, the
transaction may have
to be accounted for
in
the
PCT‟s
financial statements
from 2010/11
7.19
7.20
7.21
Executive
team
meeting – 27th
October 2009
Executive
team
meeting – 27th
October 2009
Executive
team
meeting – 27th
October 2009
Charles
McNair
Charles
McNair
Executive
Team
BLT are currently
over performing on
their contract by
11.8%
if
not
sufficiently managed
this will have a
potential impact on
our budget forecasts.
5
Some out of sector
Trusts are currently
over performing on
their
contract
in
particular,
RFH,
UCLH and Whipp’s
Cross;
if
not
sufficiently managed
this will have a
potential impact on
our budget forecasts.
5
There is a range of
risks relating to the
transitional phase of
the
process
in
5
5
1
0
SACU has responsibility
for
managing
acute
performance, close liaison
is therefore ongoing to
ensure that all necessary
actions are taken
Through PIC
to the Board
6
Action plan from
SACU
to
be
brought to PIC.
11/01
Through PIC
to the Board
6
Action plan from
SACU
to
be
brought to PIC.
11/01
Through ET
&PSB to the
Board
6
.Needs
to
be
picked by sector.
11/01
January update – Risk
share agreed which limits
the
cost
of
over
performance
and
the
current cost is built into
next year’s OP.
5
1
0
SACU has responsibility
for liaising the relevant
SACU for these trusts to
managing
acute
performance, close liaison
is therefore ongoing with
our sector SACU
to
ensure that all necessary
actions are taken
January update – SCU
needs to follow claims
management process with
other sectors.
5
1
0
This needs
carefully
organisation
the sector
52
to monitored
within
the
and across
to limit the
7.22
One to Ones with
directors NEW
Executive
Team
developing a single
sector management
team. There is a risk
that staff identified at
risk may leave early
the organisation or
the NHS with a loss
of
capacity
and
organisational
memory ahead of
planned processes.
Conflict of priorities if
staff have work for
the sector and for the
Trust.
This risk merges
risks 7.6 & 7.7 with
additional risks from
the directors.
impact
with
impact
assessments undertaken
on any staff changes.
January update – this
needs to be brought to the
attention of the Chief
Executive (designate)
5
5
1
0
The management structure
has now been rolled out
and
the
recruitment
process has commenced.
There are concerns
over
the
current
restructuring process
in
particular
the
uncertainty that staff
are feeling may lead
to high quality staff
leaving
the
east
London
health
economy. There is a
risk that in the time
leading up to a fully
working sector team
that key objectives
may not be achieved.
There are continuing to be
staff awareness meetings.
There has been some
discussions about “golden
handcuff “guidance coming
from the DOH but this is
not yet in place
Some staff may be
feeling demoralised
and this may lead to
fall in productivity.
53
Through ET
to the Board
8
This
is
a
considerable risk
that will roll out
over the next
three weeks and
needs full Board
and
ET
engagement.
11/01
Some
staff
may
apply for a position
they do not really
want as a holding
exercise whilst they
look for positions
elsewhere
which
may lead to future
gaps in key services
or objective delivery.
7.23
One to Ones with
directors
and
executive team NEW
Executive
Team
The Surge planning
(winter
Pressures)
contingency plan has
been initiated and
there
has
been
significant additional
activity due to the
weather
and
seasonal flu etc.
5
5
1
0
The contingency plan has
been initiated.
Regular NHS London,
conference call lead by
NHS London DOPH.
Regular
reporting to
Board,
Sector and
NHS
London.
8
None at this time.
11/01
PIC
&
Executive
team
to
Board
8
The
mitigations
have not all been
identified as the
gaps
are
unknown as data
is
not
yet
available
11/01
SCU leading on bringing
together local actions.
There is a risk
therefore
that
patient’s are at risk,
targets may not be
met or that additional
unplanned funding is
required.
IPC is meeting on a
regular basis and to also
plan for a possible second
wave of the H1N1 virus.
Additional
internal
resource identified.
Control re-activated.
7.24
One to Ones with
directors
and
executive team NEW
Executive
Team
There is a risk that a
range
of
targets
including screening,
obesity,
smoking
breast feeding may
not be met
5
3
Additional
resources
supplied to UCC.
The executive team leads
are going to review the
latest data the week
beginning the 17th January
and if the target can be
reached with additional
resources they will take a
proposal to DC & CM and
8
54
if
approved
additional
resources will be released.
8.0
Operational Risks
55
56
Appendix 2
NCHCS Provider Risk Register
57
58
Appendix 3
NHS London issued a new policy in November 2010. Serious Untoward Incidents (SUIs) are now referred to as Serious Incidents (SIs)
Commissioning SIs
SUI No.
STEIS Ref.
Service
20-10
2010/15293
Notified by
NUHT
21-10
2010/15375
Notified by
NUHT
22-10
2010/15376
Notified by
NUHT
23-10
2010/15378
Notified by
NUHT
25-10
2010/16367
ICT
01-11
2011/304
Notified by
NUHT
02-11
2011/312
Notified by
NUHT
Date of
incident
Incident Description
Patient was admitted from Mornington hall nursing home with 4, Grade 2
pressure ulcers on sacrum 1cm x1,5cm , right heel grade 4 black
necrotic. Patient is bedbound, with urinary catheter, incontinent of
faeces.
Patient admitted from home with sacral sore grade2 measuring
3cmx3cm,left heel grade 3-4,measuring 5cmx3cm.she lives with her
husband, carers x4 times daily, patient is chair bound, needs two to
transfer, hoisted indoors. She is doubly incontinent.
Patient has sacral pressure sore, grade 2-3 surrounding, and grade 3-4
3 x measuring 0.5cm x 0.5 cm. not broken. Patient admitted from own
home, no care package, admitted with the pressure sore, immobile and
double incontinent.
Patient has a grade 3 pressure sore on the sacrum. It measures 2.5cm
by 2cm. Patient was admitted from own home but has developed the
pressure ulcer in Grenada 4 weeks ago. Sore was present on
admission. She is bedbound and doubly incontinent
Various files on the network (N: Drive) went missing, IT technicians were
unable to recover the files.
Patient has grade 4 right foot & right heel grade 4. Both wounds
measuring at 5cms x 5cms necrotic grade 4 pressure ulcers. Patient
was admitted from nursing home.. WESTGATE nursing home.
Pressure ulcer present on admission. Patient is bed bound. Patient is
doubly incontinent.
Patient was admitted to ward with grade 4 sacral sores. Patient lives in
the Nursing home. Patient is bedbound and she is doubly incontinent
wearing pads.
Date SUI
was
notified
Deadline date
31/10/2010 03/11/2010
02/02/2011
04/10/2010 04/11/2010
02/02/2011
04/10/2010 04/11/2010
02/02/2011
04/10/2010 04/11/2010
02/02/2011
29/10/2010 19/11/2010
20/01/2011
12/12/2010 07/01/2011
09/03/2011
25/12/2010 07/01/2011
09/03/2011
The new NHSL guidelines state all Grade 3 and 4 pressure ulcers must be reported as SUIs. According to the European Pressure Ulcer
Advisory Panel newly acquired pressure ulcers in a clinical setting should include all patients who have developed a pressure ulcer after 72
hours of admission/transfer in a healthcare setting. Thus, any pressure ulcers occurring within 72 hours of admission to an acute trust would be
assumed to be acquired in the community and must be reported by PCT.
The services shown as0 ‘Notified by NUHT’ are being investigated by the Safeguarding Adults Team as per procedure for dealing with
safeguarding or reporting/learning alerts received from the Safeguarding Team, London Borough of Newham (LBN) or Newham University
Hospital Trust (NUHT).
59
Provider SIs
SUI No.
STEIS Ref.
24-10
2010/16380
26-10
2010/16616
Service
School
Nursing
and
Health
Visiting
Bed and
Day
Services
Incident Description
Date of
incident
Date SUI
was
Deadline
notified
on STEIS
Merlin form was accidentally sent to Wheelchair Service instead of school
nurse via e-mail. The email was opened by recipient on the group email list
referred to above and flagged to named nurse on 09/11/2010at 10.00
09/11/2010 19/11/2010 20/01/2011
Email was sent in error to the Blood Transfusion Committee at NUHT
28/10/2010 23/11/2010 25/01/2011
Both Provider SIs are Information Governance related.
60
NUHT SIs
STEIS REF:
Incident Date
2010/15745
19/10/10
2010/15910
06/11/10
2010/16149
11/05/10
2010/16159
11/10/10
2010/16188
13/11/10
2010/16167
13/11/10
2010/15966
14/10/10
2010/16632
22/11/10
2010/17157
23/11/10
2010/17727
12/06/10
2010/18894
14/12/10
2011/80
21/12/10
Brief detail
Patient developed a grade 3 Pressure Ulcer.
Patient brought to the Emergency Department by the police following an alleged assault.
Patient was xrayed and discharged. He was found dead at home the next day by his
family.
Patient was admitted from itu with grade 4 pressure sores on the top of her nose from
the bipap.Patient was referred to the tissue viability nurse
C. Diff related incident. Patient died on 10/11/10 at 11:30. The cause of death after
discussion with the Coroner's Office was 1a Acute Renal Failure, 1b Urosepsis and
Clostridium Difficile Diarrhoea, II Dementia, Hypertension, Aortic Stenosis.
Patient was induced for GDM on insulin and suspicious CTG at 00.30hrs.. There was a
delay in bringing patient to the labour ward as very busy with emergency clients.
Patient had grade 1 c/section at 1054 hrs due to pathological ctg and failure to progress.
Patient was stable in recovery until 1305 hrs when she collapsed.
Clinical Area
Type of Incident
Surgical Trauma
Pressure ulcer
Grade 3
Other
Unexpected Death
(general
Medical Thoracic
Medicine
Pressure Sore (Grade 3 or 4)
Medical Rehabilitation
C.Diff
Obstetric\Gyna
Maternity Services
ecology - Intrapartum
Obstetrics
Obstetric\Gyna
ecology Obstetrics
Maternity Services
- Maternal
unplanned
admission to ITU
Patient seen by A&E staff on 14 October following a fall. Referred to on-call surgical SpR
because of right upper quadrant abdominal pain. CT abdomen and pelvis requested as
Surgical Failure to act upon
per surgical advice. Scan confirmed fluid collections within the abdomen the radiologist
General
test
makes a point of stating that these collections do not look like haematomas: given the
Surgery
fact that the patient had signs of sepsis.
Two members of staff attacked in separate incidents by 11 year old patient on the
Assault by
Paediatric Ward, who may have behavioural problems. One member of staff was struck
Medical Inpatient (not in
across the face and shoulder and the other was struck across the face and suffered a
Paediatrics
receipt)
swollen cheek.
On 23/11/2010. client was in 2nd stage and pushing with contraction, vertex visable with Obstetric\Gyna
pushes. At 2030, noted client was having PV bleed when pushing. PV bleed +++.
ecology Emergency buzzer pulled. Decision made for kiwi delivery in view of APH. Kiwi delivery of Obstetrics for
Maternity service
live male infant 2037 hrs. client continued to bleed and emergency buzzer was pulled
patients using
again. Decison made for EUA and repair of episiotomy in main theatre after several
bed/ delivery
attempts to stop bleeding.
facilities
2 emergency ambulances waited just over an hour for their patients to be brought into
Hospital Transfer
the Emergency Department (This is deemed a SUI) Patients were subsequently brought
Other
Issue
into the Department.
29 year olod male attended Emergency Department with RIF on 12th December 2010
referred to surgeons with suspected appendicitis. On 14th patient quite sick taken to
Other
Delayed diagnosis
theatre ruptured appendix.
Attended MDC @ 26+3/40 with reduced FM.Fetal heart was heard via sonicaid for
Obstetric\Gyna
2mins. Had BP of 132/90 asymptomatic. PET bloods taken and client sent home and to
ecology call for results (later found to be normal). Growth scan @ 27+4 with no FH heard or
Obstetrics for Failure to act upon
seen.
patients using
test results
bed/ delivery
facilities
NHS Newham only receive notifications from STEIS regarding SUIs at NUHT, as NUHT is not a foundation trust we do not receive the final
reports for SIs.
61
East London Foundation Trust (Mental Health)
STEIS Ref.
Date
2010/14648
15/10/2010
2010/16462
12/11/2010
Brief summary
Service involved
CR151010 During the 0400hrs security check, staff observed
that patient seemed to be not breathing as there were no
chest movement. Staff went into the room to check to make
sure she was breathing. Observing staff pulled her alarm as
she noticed that patient appears to be unconscious and not
breathing.
Care Coordinator received telephone call from service user's
brother on 15/11/2010 informing that perpetrator has been
arrested and detained at HMP Pentonville Prison. Brother was
not clear on the reason for arrest. Unconfirmed reports
suggest that the incident may have taken place following an
attempted robbery – patient alleged to have punched the
home occupier who subsequently died.
Deadline
date
Psychiatry Mental Illness
09/01/2011
Not Stated
31/03/2011
Two new SIs form ELFT. As ELFT is a Foundation Trust the PCT agree closure of the SI. All reports are reviewed by the Mental Health
Commissioning Manager and SI Coordinator.
62
Appendix 4
9
BOARD MEETING 18th January 2011
Agenda Item:
Title of Paper: Safeguarding Children Half Year Report
Responsible Director/Lead: Mary Clarke
This paper supports:
CSP Goals:
Adding Years to life and life to years: By improving life chances for vulnerable children we are
improving both the quality of life and their longevity
Transforming the way we work: There is an action plan in place which is reviewed with provider
directors and through the Safeguarding Health Strategy Group
World Class Commissioning Competencies:
Work closely with community partners: NHS Newham participates at strategic and operational level
with all aspects of LSCB work
Engage with public and patients: Provide training for voluntary groups, support LSCB work with parents
and children, involve parents in serious case review process
Collaborate with clinicians: Work with clinicians to improve client care
Summary:
Health bodies’ responsibilities in relation to safeguarding children are clearly documented within the
Children Act 2004, Working Together 2010 (DCSF) Care Matters 2007 and the National Service
Framework core standard 5.
PCT Chief Executives have responsibility for ensuring that the health contribution to safeguarding and
promoting the welfare of children is discharged effectively across the whole health economy through
the PCT commissioning arrangements (including PBC). This paper provides the twice yearly board
report on safeguarding as required to comply with the 2004 Children Act. It reflects the work of NHS
Newham as a commissioning organisation and will report on any deficits identified within both the
commissioning and provider organisations. This report identifies the work carried out over the last six
months, future work required and the resources required to carry this out.
Revenue/Resource implications: There are some resource/revenue implications in relation to the
funding of the LSCB function. NHS Newham currently provides £10k and is being asked to provide
£130k. Health Funding for the Child Death Overview panel, a statutory requirement of the LSCB has
been mainstreamed. Local authority funding has yet to be confirmed post April 2011.
Board Action Required:
The Board is asked to: To note and agree the paper.
Health Inequalities (evidence of how these are addressed in the paper):
Children who require safeguarding are by definition those who are most vulnerable within society and
have often not accessed health services in a way that there peers have been able to. Whilst not
addressed specifically within this paper all children with a child protection plan have as part of their
assessment had an assessment of their health and development with an action plan which ensures any
health needs are addressed. In addition there is a dedicated service available for children who need
acute medical intervention as a result of abuse or neglect.
Statutory Equality issues (evidence to show how the paper addresses the need to avoid unfair
discrimination on the grounds of age, disability, gender reassignment, marriage and civil partnership,
pregnancy and maternity, race, religion or belief, sex, or sexual orientation):
This report follows the paramouncy principle in relation to the welfare of children (Children Act 1989)
which addresses the above issues
Summary of Patient and Public Involvement and/or feedback (scope and how feedback was
incorporated/actioned):
Both parental and young people’s involvement has been via the LSCB
Evidence of Best Practice nationally/internationally:
Health representation on the Domestic Violence multi agency risk assessment committee and (Multi
agency public protection panel (MAPPP).
63
To:
From:
The Board
Mary Clarke, Acting Director of Quality and Anne Morgan Nurse Consultant
for Vulnerable Children
Date:
18th January 2011
Subject:
Safeguarding Children - six monthly report
1
Introduction
1.1
This is the fifth of the six monthly reports to the Trust Board, as agreed in January 2009. It
is the second in its current format and reflects the commissioning aspect of safeguarding.
The report specifically highlights the activity of provider organisations. This approach
ensures compliance with Government legislation and protects Newham’s children by
ensuring safe systems are in place.
1.2
The report provides information relating to safeguarding and identifies the key priorities for
NHS Newham over the next year.
1.3
Newham currently has 367 children with a Child Protection (CP) Plan (December 2010).
This is 18 more than the same period last year (349), and an increase on the numbers six
months ago (345). The number of children with a CP Plan in Newham averaged at around
341 in the year 2009/10 and currently at 351 in the year 2010/11. Overall, the number of
children with a CP Plan in Newham has been rising since April 2010.
1.4
1.3.1
DfE published the final CP data from the 2009/10 Children in Need (CIN) census at
the end of November 2010. Of its statistical neighbours, Newham has the second
highest numbers of children with CP Plan (337), only Ealing with more (378) as at
the end of 2009/10; however Brent and Hackney did not provide data.
1.3.2
At the end of Quarter 4 - 2009/10, Newham had 51.0 CP per 10,000 under 18
population compared to 40.1 CP per 10,000 for London and 35.5 CP per 10,000 for
England as a whole. Of the statistical neighbour group, Waltham Forest recorded
the lowest with 31.3 and Southwark the highest with 60.9, Brent and Hackney did
not provide data.
1.3.3
This high level of child protection work continues to impact on the work of all health
professionals commissioned by NHS Newham. In particular, some staff needed
additional support following the traumatic death of a young person over the
Christmas period. This highlighted the real need to have support and supervision
systems in place to ensure staff are adequately debriefed.
With regard to ethnicity, it is difficult to accurately analyse whether children are adequately
protected across all ethnic and racial groups due to the mobility of population since the last
64
census and concerns that census figures were in-accurate. To be as statistically accurate
as possible it was agreed that RIO figures were going to be used for under fives and the
school database for the five to sixteen year olds as these are considered to be the most
accurate and complete data bases for Newham’s children. The Provider Service is
continuing to improve its input of ethnicity data to RiO and the information should be
available for the March statistics.
2
Governance and Accountability
2.1
The PCT continues to comply with its overall responsibilities in relation to the Local
Safeguarding Children Board (LSCB) and its sub-groups. Within Newham the lead Director
and Designated Professionals represent the Trust on the LSCB executive group as well as
the provider lead directors or their deputies thus ensuring the availability of appropriate
expertise and support. There is a health sub-group of the LSCB chaired by NHS Newham’s
lead director which co-ordinates and monitors the work of health in relation to the LSCB,
CQC NHS London and NHS Newham’s responsibilities and ensures appropriate
representation at the varying LSCB sub-groups.
2.2
NHS Newham has a responsibility to ensure adequate funding is provided to ensure the
LSCB carries out its functions effectively i.e independent chair’s salary, training and
carrying out of Serious Case Reviews. A request for additional funding was made in
December 2009 and this request was included in January 2010’s board report as an
identified cost pressure, however no clarity regarding amount was available at that time.
Since that time an independent review of the LSCB has identified additional resource
requirements to ensure compliance with its statutory function and the July Board report
identified a request for £190k. It was agreed at the time with the LSCB that no additional
funding could be provided for 2010/2011 as this should have been agreed as part of the
CSP for this year but there was an agreement that funding would be found if required for
any SCRs that occurred. Funding request for this year is £130k and a separate business
plan is attached. This suggests that the money is top sliced from budgets, with a suggested
breakdown per provider.
3
Monitoring and Evaluation/Quality Assurance Activity
3.1
Considerable achievements have been made in recruiting to health visitor vacancies and in
improving performance in the Service. The Service is less than 1 wte of full recruitment to
the funded establishment (there are further interviews during w/c 10th January). The
average size of health visitor caseloads in Newham continue to be significantly higher than
many other areas in London (when benchmarked using under 5s population against
numbers of trained Health Visitors). Health visiting capacity currently remains high on the
corporate risk register. Work is now in place within NCHCS, following a small audit of
health visiting records, to improve the quality of the family assessments and to ensure RiO
(child health information system) is used effectively. There are 2 wte vacancies for school
nurses who remain under pressure. A third Consultant Community Paediatrician has been
appointed to a vacancy. However, plans for funding a 4th community paediatrician have not
progressed and this is unlikely to occur. These issues will continue to be monitored at the
Safeguarding Health Strategy group (LSCB), and the Children’s Trust Board.
3.2
Over the last six months the LSCB completed a multi-agency audit of case files. These
identified both good and bad practice; in particular the supervision records within NCHCS
were identified as good practice. The audit identified the need to do more work with GPs
around the filing of CP conference minutes and recording children had a CP plan. Actions
in relation to health will be picked up as part of the work of the Safeguarding Health
Strategy Group. Additional audits were carried out in relation to SCRs actions and remedial
action plans have been put in place deficits were identified. A format for carrying out a
Section11audit has been agreed by LSCB members and this will be taking place over the
next few months. Results should be available for the next board report.
65
3.3
Both commissioning and provider organisations are compliant with CRB checking and
having a lead Director for safeguarding.
3.4
The Named Doctor post will be filled from 1st February by the Community Consultant
Paediatrician who is currently the Designated Doctor. He will formally relinquish his role as
Designated Doctor from that date but continue to provide cover in the short term until a
replacement is recruited. This dual responsibility is not ideal as the Designated Doctor’s
remit is to hold the Named Doctor to account and safeguard standards. The lead director
for safeguarding is in discussion with the Designated Doctors in City and Hackney and
Tower Hamlets to see if they would be willing to take on additional sessions. If not, this will
be a clinical risk for NHS Newham/ELCA.
3.5
ELFT currently has no Named Nurse, the post being filled by a Social Worker and a Named
Doctor who is not a Paediatrician. This arrangement, whilst not complying with Working
Together 2010 ensures that the training support and supervision required is taking place.
This arrangement will be reviewed with ELFT in the summer, once the transition period has
occurred (following them taking responsibility for NCHCS in February).
3.6
Targets for training at the appropriate levels have been reached by NHS Newham and all
providers (i.e 80% of staff trained at the appropriate level as identified in the Intercollegiate
document1) apart from NUHT. They are being monitored two monthly to ensure their action
plan in relation to this is on target. The safeguarding team are awaiting figure for
independent contractors to ensure compliance in relation to GP practices, dentists and
pharmacists. A small number of Opticians have been trained. They are however resisting
being trained, as there is nothing in their national or local contract to compel them to do so.
NHS Newham has written to the CQC to this respect, as this is a national problem. Their
response was helpful in identifying the need for opticians to be trained and the Director of
Primary Care commissioning is working with the lead director for safeguarding to forward
this locally.
3.3
The Child Death Overview Panel
3.3.1 This is now chaired by the Acting Director of Public Health. Additional funding was
provided in September by LBN to appoint a designated CDOP doctor and additional
funding for a co-ordinator. This finishes in March 2011 and a business plan has
been put to LBN to continue the funding. The health funding has been
mainstreamed. The backlog of cases previously reported on is being reduced and
an annual report for 2009/2010 can be accessed on the Intranet.
3.3.2 A meeting was held in December 2010 between Newham, Tower Hamlets and City
and Hackney to discuss how the three boroughs could work more closely together
in relation to the CDOP. Further meetings were agreed and will take place following
the publication of the Monro review when we will be clearer around the future shape
of safeguarding.
3.3.3 Neonates continue to be a high proportion of the children who die in Newham, and
the panel is looking at ways of streamlining the service by working with NUHT’s
infant mortality review group to avoid duplication of work. There is not enough
information available to identify specific issues, and the opportunity to do more in
depth work has not been possible, hopefully this will be able to be progressed in
future. Concerns relating to co-sleeping continue to be a feature of the sudden
unexpected deaths in infancy and the message relating to this remains part of the
health visiting and midwifery service advice to parents.
1
Safeguarding children and young people: roles and competences for health care staff
(Intercollegiate Document) 2010
66
3.4
The number of MERLINS (police come to notice forms) has continued to increase, however
the backlog has been cleared and they are now managed on a daily basis via a multidisciplinary/ agency triage team comprising the local authority, health and the police. The
aim of the triage system is to ensure that the most appropriate agency manages particular
cases and that those children and families receive a more co-ordinated response. It is too
early to fully assess the system but it does appear to be a more efficient method of using
social care and health professional resource. One full-time health professional is allocated
to the triage team on a daily basis and there is currently an additional resource from the
Safeguarding Team while the system is still in the development phase.
3.5
There have been no SCRs since the last report. Most actions from previous SCRs have
now been completed and where they haven’t this is being addressed with the lead
Directors.
3.6
Wendy Thomas’ secondment left a gap in lead director for safeguarding. This has been
filled in the interim by Mary Clarke the Director of Community Health Services/Deputy CEO
(Provider) NHS City and Hackney Community Health Services, and will continue until the
sector arrangements come into place. It is important during this time that safeguarding
maintains its profile and that the role of the designated professionals’ remains borough
based. This will feed into the work of both the LSCB and the GP consortia.
4
Progress on Priority Areas
4.1
Progress in relation to the Safeguarding review, CQC requirements and David Nicholson’s
letter are addressed above under point 3 Monitoring and evaluation/quality assurance
activity
4.2
Violence against Women and Children: The closure of the Family Justice Centre in
November has in the short term left a gap in the services provided to women and children
in Newham. Hopefully the new arrangements once in place and embedded will ensure
women and children are protected and that the previous good practice and effectiveness of
the Multi-agency Risk Assessment Panel (MARAC) will continue. The PCTs responsibility
in relation to government policy around trafficking forced marriage and Female Genital
Mutilation; all areas relevant to Newham need to be progressed over the next year, and the
work carried out by the domestic violence forum continued in within another work stream.
4.3
The violent crime and disorder sub-group has recently been disbanded and whilst the need
to provide services to young perpetrators of crime has been addressed (within the Youth
offending tams work); male victims of domestic violence will need to be picked up either
within other sub-groups or by the PCT as part of its public health agenda.
4.4
Common Assessment Framework (CAF) was introduced in the Children Act 2004 to
provide a structured assessment and provision of co-ordinated services to those families
with additional needs but who did not require social work intervention. CAF training was
reintroduced following LBNs reorganisation, however it is not embedded in practice,
particularly in relation to children with health needs and this will need to be a priority for all
children’s services to ensure those children not requiring social care input receive
appropriate packages of care. The multi-agency tracking group now in place will need to
work closely with the CAF co-ordinators to take this forward. There remain however
capacity issues within the school health service that will effect implementation.
4.6
The annual report relating to the Looked after Children Service was presented to the board
in May 2010, with the next one being due May 2011.
4.6.1
There are currently 500 looked after children. The majority continue to come from
the 14 to 18 year olds age group. This is a slight decrease on the situation in May at
the time of the last annual report when the number was 550. This decrease may be
67
explained on the change in policy in relation to providing intensive support to
keeping the child at home. The ethnic mix continues to reflect the boroughs
population. More than half the children are placed outside of borough, this may
change in the future as there has been a sustained effort to recruit Newham Foster
carers and this will hopefully be reflected in the number of children based in
borough.
4.6.2 An independent management review carried out following the injury to a pre-adoptive
child highlighted some issues relating to the process, the health related ones have
been actioned and signed of by the Safeguarding health strategy group.
4.6.3
Actions outstanding are completion of an SLA between provider and commissioners
regarding the Designated Nurse for Looked after Children’s time work within
commissioning. This need to be completed prior NCHCS becoming part of the
ELFT.
5
Priorities for 2011
5.1
To ensure that the move of NCHCS transfers safely across to ELFT with clear managerial
lines of accountability regarding safeguarding in place.
5.2
To ensure that the mergers required across the three East London PCTs keep
safeguarding embedded within all commissioning arrangements so that children remain the
focus of all decisions made that affect children.
5.3
To work with the prospective GP consortia to advise regarding their safeguarding
responsibilities (currently government thinking is that the designated professional roles will
be part of the remit of the GP consortia)
5.4
To ensure the LSCB links are maintained and strengthened at this time of change
5.5
To implement any changes initiated by the Monro review (April 2011)
5.6
To ensure that CAF training has taken place and that the number of CAFs in place has
increased in relation to children with health needs
6
Risks to Safeguarding.
These have all been addressed within the report with the main 5 identified below
6.1
LSCB not able to function adequately due to lack of resources to comply with statutory
requirements
6.2
Workload of front line staff, whilst progress has been made there is still a way to got and
the implementation of RIO needs embedding.
6.3
The triage system for managing the MERLINs is new and requires audit to ensure all
children identified as requiring a service receive one that appropriately meets their needs.
6.4
Ongoing funding needs to be agreed to ensure the workload of the CDOP continues once
the backlog is completed. Whilst there may well be changes following the Monro review and
there may be efficiencies to be made by working across East London, work does need to
continue until legislation changes in order to comply with current legislation.
6.5
The lack of Designated doctor post will need to be addressed, to: comply with CQC
requirements, ensure that safeguarding children’s needs will be incorporated into all
68
aspects of commissioning, that the LSCB receive ongoing clinical advice and support and
that the named doctors receive support and supervision.
7
Conclusion
7.1
Safeguarding Children continues to have been focused on by both Government and media
over the last year, particularly in London, and the PCT will continue to be called to account
re safeguarding as will the LSCB. The changes that have started to occur with the increase
in governance performance and scrutiny will continue and it is important that both
commissioning and provider services keep safeguarding on their agenda when prioritising
need, in particular the resource required to fund the LSCB and CDOP. This is particularly
important over the next few months; with the changes occurring in both provider and
commissioning organisations as well as any changes required following the publication of
the Monro review. As at all times of change safeguarding must be kept in focus to ensure
Newham’s children are kept safe.
8
Recommendation
7.1
The Board is asked to note the progress made in the area of safeguarding children and
agree the priorities for the coming six months
69
Appendix 5
Information Governance & Caldicott Steering Group
Minutes of the Meeting
Held on Thursday 21 October 2010
Present:
Derek Greening – [DG] Chair
Nesan Thirunesan [NT]
Patrick Mwondela [PM]
Charnjeet Sanghera [CS]
Nasim Patel [NP]
Helen Anderson [HA]
Eleanor Garnys [EG]
Helena Jenkins [HJ]
Company Secretary
Deputy Chief Information Officer and Deputy
SIRO
Information Manager & Data Protection Officer
Business Manager, IT Shared Service
Child Health Information Manager
Head of Occupational Therapy Services
Deputy Head of Foot Health
Manager of SLT for Schools
Minute Taker:
Rahima Begum [RB]
Information Governance Officer
Agenda
No.
1
Agenda Item
2
Minutes [08/07/10]
Action
Apologies
Apologies were received from Charles McNair, Alam
Kashem, Amina Nasim, Pravin Bhalsod, Veta Gordon.
Derek Greenings job title changed to Company Secretary.
With this amendment, the minutes were agreed as an
accurate record.
3
Matters Arising
(a)
Wendy Thomas has left the trust therefore the
responsibility of the Caldicott Guardian will go to Charles
McNair – Director of Resources.
DG will now chair the IG & CSG meeting.
(b)
(c)
(d)
NT assigned responsibility for the Business Continuity Plan
update.
Catherine Gulliford’s (Former ICT Shared Service Security
Manager) job has been split between 10 people. CS will
check with Sam Maddigan regarding this.
The incident with the security of locking cupboards when
not in use was highlighted to all staff on the staff brief as a
reminder to be more vigilant and lock cupboards when not
in use.
70
NT
(e)
(f)
(g)
DG raised concerns about the usage of photocopiers. DG
found sensitive documents (i.e. Business case for a GP,
Credit card statements) left on the photocopiers as staff
are forgetting to pick these up once they send the request.
One issue regarding this may be due to photocopiers
placing these documents on standby and process the
printouts on a later occasion hence staff forgetting to
collect these.
HJ raised concerns that they are finding it difficult to use
encrypted memory sticks because some machines do not
accept the contents of the stick. When the sticks are
plugged in, they require software downloads in order to
operate and most school computers disallow any software
downloads.
DG mentioned services can nominate one stick for one
purpose only available to all the staff in the department that
has non-identifiable information i.e. training materials.
However, this should be clearly labelled. HJ thought this
would be very helpful. DG suggested we should purchase
sticks that differentiate to those we have already.
NT/DG
4.
Information Governance Update - NT
(a)
NT stated that the Information Governance baseline scores
for this year (2010-2011) may be different to last year.
Version 7 (2009-2010) we scored up to 70%, version 8
however is likely to be a few scores lower.
NT also said we need to maintain the level 2’s and work
towards achieving level 3’s against the requirements.
(b)
(c)
DG mentioned that we were given a rating of Amber for our
CQC report. Half of the requirements were based on
Information Governance.
NT will bring and up to date baseline report against the IG
requirements for next meeting.
Data flow mappings should be done ideally every 6 months
or at least every year.
Updates on Asset Registers from all departments.
Template requested to be forwarded to all departments.
DG suggested that Caldicott Angels are nominated in each
team to carry on working together after the provider arm
merge.
(d)
PM mentioned Pascal Roper is leading on the
Pseudonymisation Implementation and was unable to get
an update for this meeting. PM mentioned they have a
deadline of March 2011 to complete this project. Currently
looking at controlling access to PID information by looking
at software solutions. This has not escalated to IT
department yet as investigations are still being carried out
71
NT/RB
ALL
internally.
(e)
Scott Sweeney to be placed on the IG & CSG group and to
be invited to the next meeting to give an update on the
Summary Care Record as many are confused regarding
the ‘opt out’ option.
5.
Caldicott Guardian Update
(a)
Charles McNair has taken the responsibility of the Caldicott
Guardian after the departure of Wendy Thomas. Charles
need to complete the modules on the Information
Governance Training Tool.
(b)
Chris Kitchener and Mason Fitzgerald from ELFT to be
invited to the next IG & CSG meeting.
AN
AN
(c)
RA update: PM will meet with RA manager next week to
discuss updates.
(d)
Commissioning contracts: we need to know how many third
party agreements we have apart from the agreement
between LBN and NUHT.
ALL
(e)
E-Learning training has been communicated to all staff via
staff brief and intranet. This includes how to complete the
e-learning module(s), facilitated sessions available for staff
who need the extra support. Only 66 staff have completed
at least one module. Each department to draw up a list of
staff that have completed the e-learning. We have a target
of 95% of staff to complete this by February 2011.
ALL
6.
Policies for review or awareness
The Terms of Reference and Membership of the IG & CSG
needs to be reviewed and updated before 31st October.
NT
7.
IT Shared Service
(a)
No update given regarding the IMT Shared Service
Quarterly Management Group as no meetings have taken
place since June. Next meeting is scheduled for
November, all issues should be raised before this meeting
so update can be given for next IG & CSG meeting.
(b)
(c)
Issues regarding contracts between two NHS services
should be discussed with Andrew Skinner (Head of
Procurement at Tower Hamlets)
Calls are still not being given priority status after problems
logged to ICT helpdesk. CS to query again.
CS
HJ indicated that user accounts are not being set-up within
72
(d)
(e)
the time frame given (3 working days). This has caused
problems for new staff joining. HJ would prefer to send new
user request form via email and not fax as this may be the
problem of delay. CS will look in to this.
CS
When emails are sent to group emails, a message should
prompt the user to reflect their decision on sending the
email as previously emails to group members have been
sent in error containing sensitive information.
CS
8.
Records/Incidents since last meeting
If future incidents takes place, this must be reported
promptly on Datix.
9.
Any Other Business
No other business brought forward.
10.
Date of Next Meeting
To note date of the next meeting scheduled for Thursday
16th December 2010 at the Appleby Centre at 1.15pm.
73