INTEGRATED
GOVERNANCE AND
PERFORMANCE REPORT
NHS Lambeth Clinical Commissioning
Governing Body
NOVEMBER 2013
Our Mission:
Our Mission is to improve the health and reduce
health inequalities of Lambeth people and to
commission the highest quality health services on
their behalf.
1
Contents
Table of Contents
SECTION 1
OVERVIEW
Introduction ................................................................................................................ 4
Corporate Risk Register, Heatmap and Board Assurance Framework ................. 6
1.0 Governance and Performance .......................................................................... 15
1.1 National CCG Assurance Framework 2013/14 ...................................................15
1.2 Financial Duties ..................................................................................................15
1.3 QiPP ...................................................................................................................18
1.4 Equalities ............................................................................................................26
1.5 Performance Dashboards ...................................................................................26
SECTION 2
OPERATIONAL DELIVERY
2.0 Planned Care Programme ................................................................................. 38
2.1 Long Term Conditions ........................................................................................38
2.2 Sexual Health .....................................................................................................38
2.3 South East London Community Based Care.......................................................40
3.0 Unplanned Care Programme............................................................................. 42
3.1 Urgent Care ........................................................................................................42
3.2 Lambeth & Southwark Integrated Care Programme ...........................................43
4.0 Mental Health Programme ................................................................................. 48
5.0 Staying Healthy Programme ............................................................................ 50
6.0 Children and Maternity
................................................................................... 53
7.0 Continuing Healthcare ..................................................................................... 55
8.0 Medicines Optimisation ................................................................................... 56
9.0 Cardiac and Stroke ........................................................................................... 60
10.0 Cancer ............................................................................................................... 60
11.0 Enabler Programmes ...................................................................................... 61
11.1 Primary Care Development ...................................................................... 63
2
12.0 Estates .............................................................................................................. 63
SECTION 3
ORGANISATIONAL DEVELOPMENT
12.0 Organisational Development .......................................................................... 64
12.1 Organisational Development Programme ............................................... 64
12.2 Engagement & Communications ............................................................. 67
12.3 Human Resources...................................................................................... 68
SECTION 4
QUALITY ASSURANCE
13.0 Governance and Assurance............................................................................ 71
13.2 Information Governance ........................................................................... 72
3
SECTION 1 OVERVIEW
1
Introduction
NHS Lambeth CCG comprises of 48 member Practices across three localities.
The NHS Lambeth CCG Governing Body is responsible for ensuring that the CCG has
appropriate arrangements in place to exercise its functions effectively, efficiently and
economically and in accordance with the CCG Constitution and our principles of good
governance. Membership of the Governing Body is drawn from our Member Practices,
appointed individuals with statutory roles and nominees from our key Lambeth partners.
The Governing Body is overseen by the NHS Lambeth CCG Collaborative Forum made
up of all Lambeth member practices. The Collaborative Forum held its second meeting on
Tuesday the 15th October 2013. This builds upon a range of events with Member
Practices over the past two years. Under the CCG’s agreed Constitution the Collaborative
Forum has a number of specified responsibilities, including changes to the NHS Lambeth
CCG Constitution and oversight of the CCG Commissioning vision and strategic direction.
The Governing Body is supported by the Clinical Network of clinical leads for each area of
work being taken forward. The purpose of the Clinical Network is to provide the CCG
Board members with sound clinical advice on commissioning care services, clinical
pathways and best practice. The Clinical network consists of care and clinical “subject
matter experts” from within Lambeth including GPs, practice managers, nurses,
pharmacists, opticians and social care colleagues.
This report sets out how NHS Lambeth CCG is performing against its agreed objectives under the
leadership of the NHS Lambeth Clinical Commissioning Governing Body. It is a tool for providing
assurance to the Governing Body that objectives are being delivered or, where performance is behind
plan, that mitigating actions are in place to address performance improvement.
The 2013-14 Business Plan sets out our key objectives as detailed below. This report provides an
update against each of these business areas and strategic objectives.
Area of Business
(i)
(ii)
Operational
Delivery
(SECTION 2) through our
health programmes
Organisational Development
(SECTION 3)
Strategic Objective
To deliver our agreed priority health programmes and
effective high quality and safe care with robust
operational risk and financial management.
To manage the transition of commissioning
responsibility to the Lambeth Clinical Commissioning
Group and the establishment of new Health and
Wellbeing arrangements, engaging the public and
patients and addressing equalities.
4
(iii)
Governance & Assurance
(SECTION 4)
To ensure systems and processes are in place to
support individual, team and corporate accountability
for delivering patient centred, safe, high quality care,
within our resource limits.
Performance against corporate objectives are detailed within this report to provide a consolidated
performance report.
Performance is also reviewed at quarterly Lambeth Assurance meetings with the NHS England. The
latest Assurance meeting was held on 17th October, where key delivery and performance risks were
assessed. The next meeting is on 9th January 2013. A new Assurance Framework for CCGs across
London has been developed by NHS England and the key elements are incorporated within this
report.
5
Corporate Risk Register, Heatmap and Board Assurance Framework
The NHS Lambeth CCG Board Assurance Framework (BAF) is included along with a Heat Map showing key risks. The BAF and supporting
Risk Register are living documents.
Lambeth Clinical Commissioning Group Corporate Risk Register Heat Map of current residual risks
Risk Matrix
Impact
Likelihood
Negligible
1
Minor
2
Moderate
3
Major
4
Catastrophic
5
Risk Description
SO1AA
SO1AA
Performance Levels for RTT
SO2CA
A&E Performance
SO2LB
111 Service and risk to OOH provision
SO3AA
Implementation of AMH Prgramme
SO3BA
Community Services Forensic Service Changes
SO4AA
TSA Process Impact
SO6AA
Statutory Financial Targets Delivery
SO6AB
Disaggregation of PCT Baselines
SO6AC
Financial Planning and Strategic Approach
SO6AD
QIPP and Acute Over-performance
SO6AE
Internal Financial Controls
SO7AA
Delivery of CCG Strategy [Zero Tolerance Risk]
SO7CA
SO7CA
Safeguarding Adults [Zero Tolerance Risk]
SO7CB
SO7CB
Safeguarding Children [Zero Tolerance Risk]
SO7DA
SO7DA
Emergency Planning [Zero Tolerance Risk]
SO7EA
Equality Act
SO2CA
SO2LB
Rare
1
SO3AA
SO3BA
1
2
3
4
5
SO6AA
SO7CB
SO7EA
SO4AA
SO7DA
SO6AB
SO6AC
Unlikely
2
SO6AD
SO6AE
2
4
6
8
SO2LB
SO7AA
10
SO3AA
SO4AA
SO7AA
SO6AB
Possible 3
SO6AC
SO6AD
SO7EA
SO6AE
SO7CA
3
6
9
SO2CA
12
15
16
20
SO1AA
SO3BA
Likely
4
SO6AA
4
8
12
Updated 10/10/2013
Two risks removed - as risk score reduced to 9
SO7FC
Community Forensic Services and Prison Health
Commissioning
SO7FC
Information Governance
SO3BB
Almost Certain
5
SO7FC
5
10
15
20
6
25
There are currently 12 risks rated 12 or above at at October 2013. This number has
reduced from 14 in August 2013 as two risks have been reviewed and the risk scores
reduced to 9.
These are as follows:
 Risk S03BB – ‘Risk that the resettlement pathways between the prison and
community services are fragmented and under-developed due to the changes in
the commissioning arrangements for forensic secure services from 1 April 2013
from CCG to NHS England’. The controls and action plan summary have been
updated to note meetings with HMP Brixton Partnership Board at which progress
report on re-tendering was noted - new provider arrangements should be in
place for April 2015. The prison reported the fact that there are significantly
fewer Lambeth residents in HMP Brixton due to prison service referral changes.
The risk score has been reduced to 9 (moderate and possible) from 12
(moderate and likely)

Risk S07FC – ‘Risk that Lambeth CCG may be constrained in delivery of its
statutory functions and corporate objectives as a result of non-alignment of
national guidance and interpretation of Information rights related legislation and
NHS policy with local commissioning context’. The controls and assurance
have been updated to note that in October 2013 S251 applications have been
made for continued use of SUS data and risk stratification and that S251 Invoice
validation is under consideration. The risk score has been reduced to 9
(moderate and possible) from 12 (moderate and likely)
Actions to address SO1AA, Performance Levels for RTT, graded 16 is led by the NHS
SLCSU Acute Contracts Team.
No new risks have been added to the Risk Register.
All risks over 12 have been reviewed and updated where required.
All risks have robust action plans in place to address any gaps in assurance. A
summary of key risks rated 12 and above over the following pages set out NHS
Lambeth CCG’s Board Assurance Framework. Areas that have been updated are
noted in bold.
7
Risks graded 12 or above:
Code
Risk Summary
SO1AA
(GG6.7SC)
Performance
Levels for RTT
Risk
Risk
Score
Direction
16
Risk Owner
Summary of Actions
Harriet
Agyepong
KCH outsourcing some elective activity to private providers to assist with the reduction
of the backlog. Additionally more capacity will be made available on the Denmark Hill
site and the Orpington site, which will further assist in admitted backlog reduction.
KCH are transferring some orthopaedic patients to GST for treatment – due to start August
2013
RTT Recovery Plan (March 2014)
Previously
SO2CA
(MA6.8AE)
A&E Performance
Level Risk
12
Therese
Fletcher
Delivery KCH action plan completed (March 2013)
Delivery GSTT action plan completed (March 2013)
Achievement of Target Risk Score (March 2013)
Recovery and Improvement Plan submitted to NHS England (July 2013)
Further assurances due September 2013 - to be updated on action plan 2 October 2013
Winter Capacity and Recovery Plan completed (Sept 2013)
SO2LB
(FF3.2AE/6
Implementation of
111 Service Risk
12
Therese
Fletcher
NHS SEL (Cluster) to negotiate new contract with SELDOC until March 2014 (extended from
April 2013)
Exit Strategy being discussed and agreed for NHS Direct and appropriate step in arrangements
being discussed with relevant providers (August/September 2013)
SO3AA
Transforming
Adult Mental
Health Services
via the Lambeth
Living Well
Collaborative
Programme Risk
12
Denis
O'Rourke
Launch of Living Well Network (Sept. 2013) (new front end to MH support system)
Agree provider alliance contracting framework (December 2013)
Support SLaM AMH redesign – implementation from Jan 2014.
Primary care engagement strategy developed including a community incentive scheme
from April 2014
Work is ongoing on 2014/15 Commissioning Intentions, building on 2013/14 development
SO3BA
Community
Services Forensic
Service Changes
Risk
12
Denis
O'Rourke
Sean Rigg action plan - ongoing delivery (relates to community forensic service delivery
actions)
Service specifications to be updated for 2014/15 contact period to include multiagency
response (December 2013)
Continue to deliver 'step down and move on' actions. (December 2013)
Review of CJS MH police custody service – currently being considered by LA, SLaM and
CCG
8
Code
Risk Summary
SO4AA
(SH8.9MM)
TSA Process
Impact Risk
SO6AA
(S8.1CC)
SO6AB
(SA8.2CC)
Risk
Score
Direction
Risk Owner
Summary of Actions
12
Christine
Caton
Implications of SoS decision across SEL assessed - McKinsey working with CCGs (July 2013)
Implementation through the Community Based Care strategy (March 2015)
Agree business cases for new provider configuration with TSA.NHSE approval (September
2013)
Final governance arrangements to be agreed for TSA across South London (July 2013)
Transaction business cases discussed - including negotiation of funding package - to go to
CCG Board (August 2013) to enable signoff at NHSE F&I Committee 2 September 2013.
New configuration agreed will be implemented by 1 October 2013.
Service transformation work ongoing as commissioners required to fund service transformation.
Judicial review will result in delay on aspects of service configuration
CCG signoff of commitment to funding of transition business cases to be confirmed at IGC on
28 August 2013.
CCG's contribution agreed
TSA implementation of SLHT dissolution and acquisition effective 1 October 2013
Statutory
Financial Targets
Delivery Risk
12
Christine
Caton
Deliver effective systems and financial management controls (ongoing)
Develop and implement recovery plan with emphasis on achievement of underlying financial
balance. (ongoing)
Ensure that use of 2% non recurrent investment fund is maximised (ongoing)
Work with CSU and NHSE to confirm specialised commissioning transfer value
(December 2013)
Disaggregation of
PCT Baselines
Risk
12
Christine
Caton
Timely monthly reporting arrangements to identify potential areas of risk and facilitate monthly
reporting and forecasting.
Clear process for transferring funds to mitigated risk across London CCGs/NHSE.
Agree methodology for 2014/15 to ensure smooth implementation of baseline changes and
clear resource position.
Christine
Caton
Produce new 5-year Plan, agree CCG priorities going forward in the context of changing
resource assumptions and commissioning arrangements.
Use benchmarking, other data to provide robust evidence base for decision making. Analyse
financial trend and identify additional savings needed to maintain underlying financial position.
Focus on reporting to include recurrent underlying position. This is included as part of CCG
assurance framework (ongoing)
Development of Commissioning Intentions into costed QIPP proposals and review with
Governing Body
Negotiation meetings with providers to begin October 2013
Previously
SO6AC
(SB8.3CC)
Financial
Planning and
Strategic
Approach Risk
12
9
Code
Risk Summary
SO6AD
(SG8.8CC)
QIPP and Acute
Overperformance Risk
Risk
Score
Direction
12
Risk Owner
Summary of Actions
Christine
Caton
CCG working through detailed risk management strategies/recovery plan to address projected
financial risk and strategies leading into 2014/15 for recurring impact of under delivery of QIPP
and activity over performance
Christine
Caton
Induction/Training Programme for Governing Body and staff
Regular monitoring to ensure that audit recommendations for CCG and CSU are being
implemented
Alex
McTeare
Implement the accountability and assurance framework for safeguarding vulnerable people - all
in place apart from recruitment of designated leads for adults (see below)
Recruit designated doctor and designated nurse for adult safeguarding – to be completed by
31/01/14
Influence NHSE contracts to include safeguarding training requirements – A review of current
contracts is underway to ensure that best practice and learning from Lambeth council
and London are incorporated; all contracts (current and new) will incorporate best
practice from 01/04/13 onwards
Practices to nominate staff to attend 'Alerters' safeguarding training – in place
Previously
SO6AE
Internal Financial
Controls and
Audit Health Risk
12
Previously
SO7CA
Safeguarding
(CC9.5HCM) Adults Risk [Zero
Tolerance Risk]
12
10
Zero Tolerance Risks: There are a number of areas where the Board has suggested a zero tolerance for reporting. There are currently four such
risks as per the table below. Within Lambeth CCG no ‘zero tolerance’ risk is rated as greater than 12. One risk (S07CA) is duplicated from the
previous table.
Code
Risk Summary
SO7AA
Risk re capacity and
capability in
commissioning system
to fulfil requirements
as a statutory body
and membership
organisation to deliver
the CCG strategy.
[Zero Tolerance]
Risk
Score
Direction Risk Owner
Summary of Actions
9
Janie Conlin;
Lucy Day;
Catherine
Flynn
SO7CA
Safeguarding Adults
(CC9.5HCM) Risk [Zero Tolerance
Risk]
12
Alex McTeare Implement the accountability and assurance framework for safeguarding vulnerable
people - all in place apart from recruitment of designated leads for adults (see
below)
Recruit designated doctor and designated nurse for adult safeguarding – to be
completed by 31/01/14
Influence NHSE contracts to include safeguarding training requirements – A review
of current contracts is underway to ensure that best practice and learning
from Lambeth council and London are incorporated; all contracts (current
and new) will incorporate best practice from 01/04/13 onwards
Practices to nominate staff to attend 'Alerters' safeguarding training – in place
SO7CB
(T9.1HCM)
Safeguarding Children
Risk [Zero Tolerance
Risk]
8
Avis Williams- Implement the accountability and assurance framework for safeguarding vulnerable
McKoy
people
SO7DA
(TA9.7AP)
Emergency Planning
Risk [Zero Tolerance
Risk]
8
Marion
Shipman
Previous
ly
OD plan delivery (March 2014)
Communications and Engagement action plan (March 2014)
Implementation of CCG Assurance Framework (March 2014)
Internal operational guidance updated.
LCCG Business Continuity Policy to be drafted (June 2013 amended to October
2013)
LCCG EPRR Risk Assessment (May 2013).
To update EPRR plan to fully meet assessment criteria (Oct 2013)
New surge management arrangements to be confirmed (October 2013)
11
Board Assurance Framework
Responsible
Executive:
Director of
Integrated
Commissioning
16
16
16
16
9

12
12
12
12
12
12
12
8

12
12
12
12
12
12
12
SO3AA
Risk the Adult Mental Health (AMH)
change programme won't be fully
implemented as planned impacting
negatively on patient outcomes
and financial savings targets.
9

15
15
15
15
12
12
SO3BA
Risk that the pathways between
secure services and community are
fragmented and under-developed
due to the changes in the
commissioning arrangements for
forensic secure services from 1
April 2013 from CCG to NHS
England
6

12
12
12
12
12
12
SO2CA
(MA6.8AE)
Therese
Fletcher
SO2LB
(FF3.2AE)
Denis
O'Rourke
12
Apr
16
Mar
16
Feb
16
Jan

There is a risk of not achieving the
agreed access initiative
performance levels for RTT i.e.
backlog of admitted patients
waiting more than 18 weeks and
number of patient waiting more
than 52 weeks.
There is a risk of not achieving the
agreed access performance levels
fo A&E
Risk that pilot implementation of a
111 service for SEL may negatively
affect out of hours service
provision
Dec
12
SO1AA
(GG6.7SC)
Therese
Fletcher
Denis
O'Rourke
Strategic Objective 3: To deliver good
quality mental health care services and
improve patient outcomes
Oct
Responsible
Executive: Chief
Officer Lambeth
CCG
Monthly Progress
Sep
Strategic Objective 2: To improve the
integration and quality of care for
older people and reduce the number
of avoidable hospital admissions and
readmissions
Target Risk
Score and
Direction of
Travel
Aug
Responsible
Executive:
Director of Care
Harriet
Pathway
Agyepong
Commissioning /
Chief Officer
Southwark CCG
Principal Risk (Obstacle to achievement
of Strategic Aim)
Jul
Strategic Objective 1: To develop and
deliver planned care which reduces
premature mortality and improves
quality of life, reducing reliance on
hospital services and improving the
quality of primary care
Risk Register
Ref
Jun
Operational
Lead
May
Executive Lead
Apr
Strategic Aim
UPDATED OCTOBER 2013
Nov
ASSURANCE FRAMEWORK 2013/14 – PROGRESS SUMMARY
12

12
12
12
12
12
12
12
Responsible
Executive: Head
of Finance
Christine
Caton
SO6AA
(S8.1CC)
Failure to deliver statutory financial
targets. Financial risk management
and reputational risk.
4

9
12
12
12
12
12
12
Responsible
Executive: Head
of Finance
Christine
Caton
SO6AB
(SA8.2CC)
Risk associated with the
disaggregation of PCT baselines
across new commissioning
organisations
8

12
12
12
12
12
12
12
8

12
12
12
12
12
12
12
12

12
12
12
12
12
12
12
Responsible
Executive: Head
of Finance
Christine
Caton
SO6AC
(SB8.3CC)
Risk that current planning and
strategic approach is not
sufficiently robust to manage
pressures and deliver sustainable
position in the context of potential
reduction in growth resulting from
the implementation of the CCG
allocation formula.
Responsible
Executive: Head
of Finance
Christine
Caton
SO6AD
(SG8.8CC)
There is a risk that failure to
deliver QIPP and acute
overperformance leading to CCG's
risk on financial sustainability
13
Apr
Risk of the TSA process and
outcomes negatively impacting on
provider landscape and delivery of
CCGs strategic plans to 2017-18
Mar
SO4AA
(SH8.9MM)
Feb
Christine
Caton
Jan
Responsible
Executive:
Director of Care
Pathway
Commissioning
Dec
Oct
Monthly Progress
Sep
Target Risk
Score and
Direction of
Travel
Aug
Principal Risk (Obstacle to achievement
of Strategic Aim)
Jul
Strategic Objective 6: To deliver our
annual operating and medium term
financial plans to ensure an ongoing
sustainable financial position that
delivers our strategic health goals for
the Lambeth population.
Risk Register
Ref
Jun
Strategic Objective 6: To deliver our
annual operating and medium term
financial plans to ensure an ongoing
sustainable financial position that
delivers our strategic health goals for
the Lambeth population.
Operational
Lead
May
Strategic Objective 4: To implement
the Secretary of State's (SoS) TSA
recommendations
Executive Lead
Apr
Strategic Aim
UPDATED OCTOBER 2013
Nov
ASSURANCE FRAMEWORK 2013/14 – PROGRESS SUMMARY
12
12
12
SO7AA
Ze ro T o le rance Risk - There is a
risk that there will not be capacity
and capability in the
commissioning system to fulfill
requirements as a statutory body
and membership organisation to
deliver the CCG strategy.
6

9
9
9
9
9
9
SO7CA
Alex McTeare
(CC9.5HCM)
Ze ro T o le rance Risk - Risk of
failure to safeguard adults and
identify and respond appropriately
to abuse.
4

12
12
12
12
12
12
12
Avis Williams- SO7CB
McKoy
(T9.1HCM)
Ze ro T o le rance Risk - Risk of
failure to safeguard children and
identify and respond appropriately
to abuse
4

8
8
8
8
8
8
8
6

12
8
8
8
8
8
8
4

6
6
6
6
6
6
6
Strategic Objective 7: To ensure
systems and processes are in place to
support individual, team and corporate
accountability for delivering patient
centred, safe and high quality care
Responsible
Executive:
Director of
Governance and
Development
Janie Conlin;
Lucy Day;
Catherine
Flynn
Marion
Shipman
SO7DA
(TA9.7AP)
Andrew
Parker
SO7EA
(Q7.3AP)
Ze ro T o le rance Risk - There is a
risk of inadequate response to
emergencies owing to the CCG
responsibilities changing as
category 2 responder and NHS
England as category 1 responder.
Lambeth CCG fails to comply with
the Equality Act (2010) and does
not achieve its equality objectives,
leading to negative impact on
population health and equity.
Requirements of the Equality Act
(2010) are not integrated into core
business
14
Apr
12
Mar
Oct
12
Feb
Sep
12
Jan
Aug

Dec
Jul
Monthly Progress
4
Christine
Caton
Strategic Objective 7: To ensure
systems and processes are in place to
support individual, team and corporate
accountability for delivering patient
Responsible
centred, safe and high quality care
Executive:
Director of
Governance and
Development
Target Risk
Score and
Direction of
Travel
SO6AE
Responsible
Executive: Head
of Finance
Responsible
Executive:
Director of
Governance and
Development
Principal Risk (Obstacle to achievement
of Strategic Aim)
Failure to embed and maintain
strong internal financial controls
and achieve a clean bill of audit
health
Strategic Objective 6: To deliver our
annual operating and medium term
financial plans to ensure an ongoing
sustainable financial position that
delivers our strategic health goals for
the Lambeth population.
Responsible
Executive:
Director of
Strategic Objective 7: To ensure
Governance and
systems and processes are in place to
Development
support individual, team and corporate
Responsible
accountability for delivering patient
Executive:
centred, safe and high quality care
Director of
Governance and
Development
Risk Register
Ref
Jun
Operational
Lead
May
Executive Lead
Apr
Strategic Aim
UPDATED OCTOBER 2013
Nov
ASSURANCE FRAMEWORK 2013/14 – PROGRESS SUMMARY
1.0 Governance and Performance Summary
1.1 National CCG Assurance Framework 2013/14
The CCG Assurance Framework is designed to give assurance that CCGs are
delivering quality and outcomes for patients, as well as being the basis for
assessing they are continuously improving from the start point of
authorisation.
The NHS England London region will use a CCG Assurance Balanced
Scorecard approach to monitor its performance against the framework.
NHS England published Q1 Balanced Scorecards for all London CCGs in at
the end of August. Lambeth’s Q1 position was assessed as follows:
1.2 Financial Duties
To deliver financial control totals for resource and cash and support the
delivery of statutory financial duties 2013/14
As at month 6 Lambeth CCG is reporting a surplus of £2,337k. The forecast outturn
for the year is a surplus of £4.682m which is in line with our planned target of
delivering a1% surplus.
15
Performance Area
Year to Forecast
Date
Outturn
Commentary
Commissioning
Performance
Lambeth CCG is reporting a surplus of £2,337k for the period ending
September 2013. This is in line with plan and its target of delivering a 1%
surplus £4.682m for the year.
Cash balances are planned to be maintained at low levels. (less than 5%
of cash drawn) Lambeth CCG's cash balance as at the end of
September was £86k. CCG's cash limit as at the end of September 13 is
£414m. The CCG expects to meet its cash limit target by the end of the
year.
QIPP year to date is an under delivery of £328k as at the end of
September. The forecast for the year is expected to be an underdelivery
QIPP of £422k (4%)
Performance on commissioned services as at the end of September is a
total overspend of £3.49m of which £4.3m relates to acute services and
£272k relates to primary care services. Non Acute services are
underspent £1.29m. Forecast outturn variance is £6.6m against plan.
The main issues relate to acute services (£8.3m), continuing care and
mental health.
Public Sector Payment
Policy
Public sector payment target is 95% and Lambeth CCG is not achieving
its target for Non NHS invoices (93.7%). The CCG is currently performing
at 94.1% overall.
Revenue Surplus
Cash Limit
QIPP
Capital Resource
Ensure that capital resources use does not exceed the limit set for capital
Ensure that revenue resources use on prescribed matters relating to
admin costs (i.e. not relating to healthcare services) does not exceed the
running cost allowance set by NHS England.
Running Cost
The CCG’s financial year to date and forecast position is detailed below:
SUMMARY OF YEAR TO DATE & FORECAST OUTTURN 2013/14
Year to Date
Acute
Non Acute
Primary Care
Other
Annual Budget
£'000
220,620
129,207
40,980
1,080
Budget
Actual Spend
£'000
£'000
110,310
114,618
64,603
63,316
20,643
20,915
540
747
Variance
(over)/under
spend
£'000
(4,308)
1,288
(272)
(207)
Forecast Outturn
Likely Variance
(over)/under
spend
£'000
(8,263)
2,659
(578)
(414)
Reserves
Total Programme
Total Corporate
Total Expenditure - CCG
12,859
404,746
8,280
413,026
6,429
202,526
4,138
206,664
2,934
202,530
4,138
206,668
3,496
(4)
0
(4)
6,596
0
0
0
Total Income
417,708
209,005
209,005
0
4,682
4,682
2,341
2,337
4
4,682
0
0
0
0
0
Surplus/(Deficit)
Variance Against Plan
Actions being taken to ensure delivery of financial targets and mitigate
financial risk include:
 Use of 0.5% contingency and other reserves
 Release of population and incidence reserves in year
 Manage expenditure in overspending areas back in line with budget
16
 Maximise use of 2% non recurrent investment funding
 Acceleration of QIPP plans
 Implementation of processes for demand management for activity related
budgets, e.g. mental health specialist services and continuing care.
 Undertake detailed review of all CCG budgets to identify in year flexibilities
to implement in-year recovery plan
Maintain strong internal financial controls and achieve a clean bill of
audit health
Actions being taken include:
 Deliver 2013/14 Internal Audit Plan and ensure that recommendations are
implemented. This is closely monitored by the CCG’s Audit Committee
 Embed understanding across Governing Body Members/Head of
Collaborative Forum of Internal and External Audit
 Revised Standing Orders, Prime Financial Policies and Scheme of
Delegation to best reflect needs of CCG
17
1.3 QIPP
The CCG’s 2013/14 QIPP forecast shows annual under-delivery of 4%.
QIPP Projects
Total QIPP
Annual
£
Contractual/
Forecast
Forecast
Underlying
Underlying
Guaranteed
Outturn
Outturn
Forecast
Variance
Forecast
Variance
Variance
Variance
(under)/Over
Outturn as at (under)/Over (under)/Over (under)/over
month 6
as at Month
as at month
6
6
£
£
%
£
%
CCG Led Acute Schemes
3,513,549
1,941,114
(1,572,435)
(45%)
(1,572,435)
(45%)
Trust Led Acute Schemes
2,325,000
2,325,000
0
0%
(1,162,500)
(50%)
Community Health
1,199,998
1,199,998
0
0%
(372,000)
(31%)
Mental health
2,957,000
2,807,000
(150,000)
(5%)
(568,000)
(19%)
Prescribing
1,203,000
1,203,000
0
0%
0
0%
Other client groups
322,500
322,500
0
0%
0
0%
Corporate
359,000
359,000
0
0%
0
0%
Total
11,880,047
10,157,612
(1,722,435)
(14%)
(3,674,935)
(31%)
Reprovision Cost
(1,864,000)
(564,000)
1,300,000
(70%)
1,300,000
(70%)
Total
10,016,047
9,593,612
(422,435)
(4%)
(2,374,935)
(24%)
The table shows underlying under delivery of 24% which reflects the fact that
QIPP savings are contractually secured for Trust led Acute, and Mental Health
and Community Schemes for 2013/14. It is essential that we ensure delivery
of the QIPP on an ongoing basis in order to mitigate the risk of the negative
impact of underachievement in financial and service terms on financial years
2014/15 onwards. Where a QIPP initiative is forecasting under delivery a
Recovery Plan has been drafted. Work on these plans is ongoing and
progress will be reported to the October Finance and QIPP meeting.
Lambeth CCG’s QIPP Programme is made up of Acute Trust led schemes,
CCG led admission avoidance schemes, CCG led care pathway redesign
schemes, mental health improvement, community health and prescribing.
The Acute Trust led schemes carry a total value of £2,325. These savings are
guaranteed to the CCG through contractual agreements. We do however
track the activity under these schemes to provide some assurance that the
service redesign work underpinning the required QIPP savings is having the
intended impact.
The CCG led Acute schemes are predominantly focussed on the redesign of
care pathways – typically referral into outpatients by GPs. The CCG carries
the risk for these schemes as the lever to enable the required referral change
sits outside acute and within primary care.
18
The performance reports on each initiative highlight a number of areas where
initiatives have either slipped or are not delivering the intended outcomes. The
Planned care (out patients) initiatives have been reviewed and
recommendations for action included in the recovery plan, this includes
recommendations on specific out patients specialisms for referral
management, and consideration of waiting time thresholds. This work is
ongoing. The gynaecology work stream has been scoped and
recommendations for to uro-gynae referrals are included in the recovery plan,
as are recommendations on gynaecology consultant to consultant led referrals
and triage. Practice visits are being used to give support to practices to
enable them to deliver QIPP outcomes by providing the necessary information
on referral pathways, peer support and mechanisms. These are led by CCG
locality leads working in conjunction with commissioning staff.
We are meeting with the Acute Trust teams on a fortnightly basis to ensure
delivery of both CCG led and Trust led schemes and ensure that measures
developed by Trust and CCGs schemes leads lead to QIPP gains across both
Outpatient First and Follow Ups.
The mental health and community QIPP savings are also secured through
contractual agreements with the exception of specialized mental health
services. Mental health QIPP includes the redesign of acute mental health
services which is being implemented working alongside SLaM, and the
decommissioning of MHOA continuing care bed capacity as a result of
redesign of the pathway and the development of more specialist services.
For mental health specialist services, a rigorous approach to applications to
panel has been implemented and review of consultant to consultant referrals
is being undertaken. A review of psychosexual and specialist ADHD services
is currently being carried out which is expected to positively impact on QIPP
delivery.
We are doing a detailed review of commissioning and administration cost
budgets in order to develop recovery plans in order to manage the level of
outstanding risk that exists in 2013/14 and significant financial challenges that
we face in 2014/15 and beyond. This is as outlined in Section 1.1 above.
19
20
2. Lambeth CCG QIPP Dashboard (M6)
The Lambeth CCG QIPP Dashboard provides an overview of the CCG’s performance across three QIPP programs of work: planned care,
unplanned care, and mental health. The dashboard highlights those areas where the CCG is currently on track or exceeding target (green
rated), varying from target (amber rated) or significantly varying from target (red rated). A detailed QIPP performance report is available and
reviewed at through the Finance and QIPP Group.
*RAG Status: 100% = Green, 75.99% = Amber, <50% = Red
2.1 CCG Led Schemes - Acute Dashboard
PROJECT/SCHEME
PROJECT/SCHEME
2013/14 TOTAL
Guaranteed/Not Contractual Rag Project Delivery
QIPP
Guaranteed
Rating
Rag Rating
PROGRAMMES
£'000
Plan
Year To Date
Variance
Actual
Over/(Under)
£'000
£'000
£'000
Forecast Outturn
Variance
Variance Over/(Under) Variance
%
£'000
%
Underlying Postion
Variance
Over/(Under) Variance
£'000
% Risk Rating
%
%
CCG Led Schemes
Respiratory
Non Guaranteed
47.96
23.98
-
-23.98
-100%
-35.97
-75%
-35.97
-75%
25%
Acute
CVD/Cardiology
Non Guaranteed
33.61
16.81
21.83
5.03
30%
0.00
0%
0.00
0%
100%
Ophthalmology
Non Guaranteed
155.81
77.91
-
-77.91
-100%
-116.86
-75%
-116.86
-75%
100%
Diabetes
Non Guaranteed
55.03
27.51
-
-27.51
-100%
-41.27
-75%
-41.27
-75%
100%
Gynaecology
Non Guaranteed Start - September Start - September
418.93
72.60
32.93
-39.67
-55%
-230.41
-55%
-230.41
-55%
100%
Endicronology
Non Guaranteed
72.28
36.14
-
-36.14
-100%
-43.37
-60%
-43.37
-60%
100%
Other specialities 2% reduction
Non Guaranteed
1,023.57
511.79 -
54.77
-566.55
-111%
-614.14
-60%
-614.14
-60%
50%
Urgent Care
Non Guaranteed
817.36
408.68
-
-408.68
-100%
-490.41
-60%
-490.41
-60%
50%
Guaranteed
889.00
444.50
444.50
0.00
0%
0.00
0%
0.00
0%
100%
3,513.55
1,619.91
444.50
-1,175.41
-73%
-1,572.43
-45%
-1,572.43
-45%
Guaranteed QIPP
Sub Total CCG Led Schemes - Acute
2.2 Trust Led Schemes - Acute Dashboard
21
PROJECT/SCHEME
PROJECT/SCHEME
Project 2013/14 TOTAL
Guaranteed/Not Contractual Rag Delivery Rag
QIPP
Guaranteed
Rating
Rating
PROGRAMMES
£'000
Plan
Year To Date
Variance
Actual
Over/(Under)
£'000
£'000
£'000
Forecast Outturn
Variance
Variance Over/(Under) Variance
%
£'000
Underlying Postion
Variance
Over/(Under) Variance
%
£'000
%
% Risk Rating
%
Trust Led Schemes
GSTT
Kings
Excess Bed Days
Outpatient Follow up ratios/shifts to
nurse led and non face to face
Guaranteed
236.00
118.00
118.00
0.00
0%
-
0%
-118.00
-50%
100%
Guaranteed
736.00
368.00
368.00
0.00
0%
-
0%
-368.00
-50%
100%
Patient Transport
Guaranteed
70.00
35.00
35.00
0.00
0%
-
0%
-35.00
-50%
100%
In year QIPP opportunities
Outpatient Follow up ratios/shifts to
nurse led and non face to face
Guaranteed
229.00
114.50
114.50
0.00
0%
-
0%
-114.50
-50%
100%
Guaranteed
400.00
200.00
200.00
0.00
0%
-
0%
-200.00
-50%
100%
Admission Avoidance
Guaranteed
160.00
80.00
80.00
0.00
0%
-
0%
-80.00
-50%
100%
Pharmacy Savings
Guaranteed
280.00
140.00
140.00
0.00
0%
-
0%
-140.00
-50%
100%
In year QIPP opportunities
Guaranteed
214.00
107.00
107.00
0.00
0%
-
0%
-107.00
-50%
100%
2,325.00
1,162.50
1,162.50
-
0%
-
0%
-1,162.50
-50%
Sub Total Trust Led Schemes - Acute
2.3 CCG/Trust Led Schemes – Community Dashboard
22
PROJECT/SCHEME
Project
Guaranteed/Not Contractual Rag Delivery Rag
Guaranteed
Rating
Rating
2013/14 TOTAL
QIPP
PROGRAMMES
£'000
Plan
Year To Date
Variance
Actual
Over/(Under)
£'000
£'000
£'000
Forecast Outturn
Variance
Variance Over/(Under) Variance
%
£'000
%
Underlying Postion
Variance
Over/(Under) Variance
£'000
% Risk Rating
%
%
Intermediate Care (full year effect)
Guaranteed
114.06
57.03
57.03
0.00
0%
-
0%
0.00
0%
100%
Podiatry
Guaranteed
50.39
25.20
25.20
0.00
0%
-
0%
0.00
0%
100%
Estates Rationalisation
Guaranteed
300.00
150.00
150.00
0.00
0%
-
0%
-150.00
50%
50%
Specialist Children's Services
Guaranteed
200.00
100.00
100.00
0.00
0%
-
0%
-100.00
50%
50%
Minnie Kidd House
Guaranteed
244.00
122.00
122.00
0.00
0%
-
0%
-122.00
50%
50%
Population/Incidence Growth
Guaranteed
Sub Total Trust Led Schemes - Community
291.54
1,200.00
145.77
600.00
145.77
600.00
0.00
-
0%
0%
-
0%
0%
0.00
-372.00
0%
-31%
100%
23
2.4 CCG/Trust Led Schemes – Mental Health Dashboard
PROJECT/SCHEME
Project
Guaranteed/Not Contractual Rag Delivery Rag
Guaranteed
Rating
Rating
2013/14 TOTAL
QIPP
PROGRAMMES
£'000
Plan
Year To Date
Variance
Actual
Over/(Under)
£'000
£'000
£'000
Variance
%
Forecast Outturn
Variance
Over/(Under) Variance
£'000
%
Underlying Postion
Variance
Over/(Under)
Variance
£'000
% Risk Rating
%
%
Review of Rehabilitation Services
Guaranteed
776.00
388.00
388.00
0.00
0%
-
0%
-388.00
50%
50%
Spot Placements
Guaranteed
144.00
72.00
72.00
0.00
0%
-
0%
0.00
0%
100%
Supported Housing Transfer
Guaranteed
100.00
50.00
50.00
0.00
0%
-
0%
0.00
0%
100%
Acute bed reductions
Guaranteed
500.00
250.00
250.00
0.00
0%
-
0%
0.00
0%
100%
CAMHS
Mental Health Older Adults continuing care
Mental Health Older Adults - acute
HTT
Guaranteed
200.00
100.00
100.00
0.00
0%
-
0%
-30.00
-15%
70%
Guaranteed
750.00
375.00
375.00
0.00
0%
-
0%
0.00
0%
100%
Guaranteed
200.00
100.00
100.00
0.00
0%
-
0%
0.00
0%
100%
Specialist
Non Guaranteed
150.00
75.00
-
-75.00
-100%
-100%
-150.00
-100%
50%
Prescribing
Guaranteed
137.00
68.50
68.50
0.00
0%
-
0%
0.00
0%
50%
2,957.00
1,478.50
1,403.50
-75.00
-5%
-150.00
-5%
-568.00
-19%
Sub Total Mental Health - CCG Led Schemes
24
-150.00
2.5 CCG Led Schemes – Prescribing Dashboard
PROJECT/SCHEME
Project
Guaranteed/Not Contractual Rag Delivery Rag
Guaranteed
Rating
Rating
2013/14 TOTAL
QIPP
PROGRAMMES
£'000
Repatriation of
Immunosuppressants
Non Guaranteed
Implementation of London
Respiratory Team key prescribing
messages
Non Guaranteed
Delivery of Primary Care QIPP Plan /
Scriptswitch Implementation
Non Guaranteed
Other schemes
Non Guaranteed
Sub Total Prescribing - CCG Led Schemes
Plan
Year To Date
Variance
Actual
Over/(Under)
£'000
£'000
£'000
Forecast Outturn
Variance
Variance Over/(Under) Variance
%
£'000
Underlying Postion
Variance
Over/(Under)
Variance
%
£'000
% Risk Rating
%
%
200.00
100.00
100.00
0.00
0%
-
0%
0.00
0%
100%
400.00
200.00
200.00
0.00
0%
-
0%
0.00
0%
100%
403.00
201.50
201.50
0.00
0%
-
0%
0.00
0%
100%
200.00
100.00
100.00
0.00
0%
-
0%
0.00
0%
100%
1,203.00
601.50
601.50
-
0%
-
0%
-
0%
25
2.6 CCG Led Schemes Dashboard
PROJECT/SCHEME
Project
Guaranteed/Not Contractual Rag Delivery Rag
Guaranteed
Rating
Rating
PROJECT/SCHEME
2013/14 TOTAL
QIPP
PROGRAMMES
£'000
Plan
Year To Date
Variance
Actual
Over/(Under)
£'000
£'000
Forecast Outturn
Variance
Over/(Under) Variance
Variance
£'000
%
£'000
Underlying Postion
Variance
Over/(Under)
Variance
%
£'000
% Risk Rating
%
%
CCG Led Schemes
Non Acute
Other Client Groups
Guaranteed
322.50
161.25
161.25
0.00
0%
-
0%
0.00
0%
100%
Corporate
Reduction in corporate spend
Guaranteed
359.00
179.50
179.50
0.00
0%
-
0%
0.00
0%
100%
681.50
340.75
340.75
-
0%
-
0%
-
0%
Sub Total - Non Acute & Other CCG Led Schemes
2.7 QIPP Totals Dashboard
PROJECT/SCHEME
2013/14 TOTAL
QIPP
PROGRAMMES
£'000
Total QIPP Savings
Reinvestment
Net QIPP Schemes
Plan
Year To Date
Variance
Actual
Over/(Under)
£'000
£'000
£'000
Variance
%
Forecast Outturn
Variance
Over/(Under) Variance
£'000
%
Underlying Postion
Variance
Over/(Under)
Variance
£'000
%
%
11,880.05
5,803.16
4,552.75
-1,250.41
-22%
-1,722.43
-14%
-3,674.93
-31%
-1,864.00
-932.00
-10.00
922.00
-99%
1,300.00
-70%
1,300.00
-70%
10,016.05
4,871.16
4,542.75
-328.41
-7%
-422.43
-4%
-2,374.93
-24%
26
% Risk Rating
1.4 Equalities
NHS Lambeth CCG has adopted an equality objective for each of its seven
priority health goals which are the responsibility of the respective programme
boards to drive, monitor and report on.
The CCG is placing an emphasis on its core mission of improving health and
reducing inequalities through the material being used in developing and
implementing the Big Lambeth Health Debate discussions. Themes emerging
through the debate at this stage include:






Better engagement and support for carers
Use community groups to engage ‘hard to reach’
Better use of language
Service should be more ‘ person centred’
Health Living Champions – expand into larger workforce
More joined up services
Further feedback on BLHD prompted equalities themes will be brought to and
discussed at the EEC meeting and the new strategic plan of the CCG,
prepared on the back of the BLHD will pay close attention to issues of
inequality.
1.5 Performance Dashboards
The performance dashboards cover the National Standards as set out in the
national 2013/14 Assurance Framework.
The Performance Measures are listed with a description in the performance
dashboards (with data shown for providers and on a commissioner basis)
The Report describes where performance has been below the expected
standard and highlights risks to future delivery. The actions being taken are
summarised to give the Board assurance that performance issues are being
appropriately addressed.
27
Lambeth CCG Executive Summary
Finance
The month 5 acute performance position shows a year to date over performance of 4.8% for contracted activity and an over performance of 3.9% across all acute budgets, after the release of agreed over performance reserves. The forecast
outturn is a year-end contractual over performance of 4.8%, reducing to 3.7% for all acute budgets, again after the utilisation of acute budget reserves. Over performance against plan at KCH and non local contracts (excluding STG) are the key
drivers of Lambeth’s over performance at Trust level. At service level the key drivers of the Lambeth position are non-elective admissions, new outpatients, GP direct access services and critical care, all over performing by more than 10% - this
is offset by significant YTD under performance for elective admissions and marginal under performance on outpatient follow ups. In overall terms trends have remained as set out last month and the forecast outturn position is broadly static
although there have been swings at individual provider and service level.
Key financial risks for 2013/14 are known and understood and include :
•
Expected in year increases in demand driven by population and incidence growth, waiting times pressures and case mix complexity.
•
Delivery of activity reductions in line with CCG QIPP plans and price and case mix changes.
•
The impact of new commissioning arrangements and specifically the impact of NHSE transfers
•
The impact of recording and charging related to new tariff arrangements, with particularly significant risk associated with the new maternity care pathways tariffs.
Work is on going across the CCGs and SLCSU to mitigate as far as possible these risks, with work to address allocation and tariff related risks, on going delivery of CCG service redesign and demand management initiatives and the effective
management of the acute contracts utilising appropriate contractual levers in doing so.
Demand & Activity
The demand and activity section of the report provides a comparison of activity trends against prior year activity. It therefore differs to the information provided in the Finance Section of the report, which assesses
in year performance against 2013/14 plan. The two sections of the report will not therefore reconcile but the activity section provides a helpful context against which to consider in year performance against plan
and better understand year on year trends. Once we have two quarters of 2013/14 data available we will link the finance and activity sections of this report more effectively, try to extrapolate key underlying
demand trends and distinguish between these underlying activity trends and contractual issues related to baseline or the application of agreed contract rules.
Quality
Key issues in terms of compliance with quality dashboard indicators remain as reported last month - strong performance in relation to standardised mortality, continuing required improvements in complaints
response times at KCH, low levels of serious incidents, including grade 3 and 4 pressure ulcers and some continuing challenges in meeting maternity standards and for KCH safeguarding training. A summary of the
key issues discussed at the most recent CQRGs is also included in this section of the Integrated Report.
Performance
A&E performance has improved over August 2013 with Lambeth (GST and KCH) meeting the 95% all type target. A&E Recovery Plans continue to be implemented and work is on going to finalise winter plans for
2013/14 - with Urgent Care Board focused plans, underpinned by provider specific plans and a SEL wide demand and capacity analysis having been completed. On other key performance targets the CCG position
shows breaches against a limited number of other targets, including over 52 week waiters (2 at KCH), diagnostic waits (driven primarily by GST), Mixed Sex Accommodation (KCH) and cancer 62 day waits (GST). On
infection control C Difficile performance has been strong and is within targets and there have been no further MRSA cases since the 1 GST reported case in June 2013. On RTT performance Lambeth again met key
performance thresholds, however there remains a very significant RTT backlog at KCH to be cleared over the remainder of the year and a planned RTT failure at KCH for the whole of 2013/14.
28
Commentary
Key Risks and Mitigations
NHSE transfer – there are a number of continuing risks associated with the NHSE transfer: the accuracy of start contract assumptions in relation to NHSE/CCG activity and funding splits, the accuracy of in year coding to
the correct responsible commissioner, differences between CCG allocation adjustments and provider/NHSE assessments of transfer values and the residual budget shortfall associated with CCG to NHSE transfers
following the latest adjustments made to CCG baselines. Work is on going to address these issues.
Demand, Population and Incidence Growth - 2013/14 contracts are based on the previous year’s FOT and therefore reflect underlying demand but do not include provision for in year general population and incidence
growth. The expectation therefore is that there will be over performance against start contract plans, although over performance at some providers and for some services is currently in excess of expectations in relation
to demand, population and incidence growth. CCG budgets include some funding to cover expected acute over performance, although the level of available reserves means that CCGs will need to work to manage
demand where they have the ability to do so, with delivery of CCG led QIPP initiatives vital in containing overall acute over performance over 2013/14. From a contractual perspective the CSU will continue ensure that
available contractual levers are effectively utilised – the contracts include a number of commitments providers have made to support CCG commissioning intentions and QIPP plans in 2013/14. Stocktake meetings are
taking place with providers in October to review performance YTD and QIPP delivery.
Waiting Times and Referral to Treatment Times (RTT) - 2013/14 contracts make provision for expected demand increases associated with the treatment of waiting list backlogs at KCH and the sustained delivery of RTT
targets at GST over 2013/14. The CSU will be monitoring elective performance against plan and RTT performance trajectories closely over 2013/14 to ensure the delivery of agreed plans. To date elective activity has
been less than planned with this under performance offsetting over performance in other areas. It is expected that there will be some catch up over the rest of the year, which will be important in terms of ensuring a
backlog does not develop to be addressed in 2014/15 contracts.
QIPP - CCG QIPP targets have been reflected in start acute contracts for 2013/14. Initiatives all have an agreed lead and risk holder and a contractual framework has been agreed to secure effective contractual levers and
incentives to support delivery of QIPP. Based on YTD delivery a step reduction in outpatient referrals and A&E attendances from current levels will be required to recover the QIPP position and get closer to delivering
2013/14 targets by year end. Robust monitoring of Trust led initiatives will also take place to ensure that providers are making the operational and service changes agreed with commissioners to underpin agreed
initiatives and reduce acute sector activity and cost, noting that performance YTD shows some progress in delivering QIPP associated KPI targets but with a step change required to meet annual targets.
Price/Case Mix – 2013/14 contracts have been set on the basis of historic (2012/13 case mix). There are however a number of potential risks for 2013/14, including: increased case mix complexity over 2013/14
(particularly emergency admissions) and risks associated with new tariff arrangements for maternity and unbundled imagining services. Acuity will be monitored over 2013/14 across all activity with the impact on
emergency activity mitigated through agreed winter plans and the further development of admissions avoidance schemes. The key case mix related issue YTD related to the impact of the new maternity care pathways
with a step increase in the complexity of recorded birth case mix at GST and KCH and antenatal case mix at KCH. Discussions are on going with providers to identify a mutually acceptable way of managing and mitigating
these risks for 2013/14 in line with PbR guidance.
29
Activity (Demand) Summary
This section of the Integrated Report provides a comparison of activity trends against prior year performance. It therefore differs to the information provided in Section 1 of the Integrated Report, which assesses in year performance against
2013/14 plan. The two sections of the report will not therefore reconcile but the activity section provides a helpful context against which to consider in year performance against plan and better understand year on year trends. To enable
meaningful year on year comparison historic data has been disaggregated to include 2013/14 CCG commissioned services only. As noted last month the CSU will be refining the assumptions made in our disaggregation and the year on year
comparisons should therefore be treated with a degree of caution.
Referrals
The absolute number of referrals has sharply dropped in Month 5 from the previous reporting period. GP referrals are up slightly from comparable months, but remain round about the average for the
17 month period show n above.
A&E
A&E attendances have fallen back from the peak seen in July, and are now back to similar levels to those seen earlier in the year.
Outpatients
A reduction in activity w as expected for August due to the few er number of w orking days, how ever activity is much low er than May and June w hich are comparable months.
Elective
The expected increase in elective activity to clear 18 w eek backlogs has not yet commenced, as August saw a dip in Electives. It is presumed this is linked to the traditionally low er in August clinic
capacity at Acute Trusts.
Emergency
Emergency activity remains relatively stable across the CCG.
30
Performance Summary
Commentary
Fig 1. Performance Summary
Indicator
Health Care Acquired
Infection
MRSA
C'Diff
18 weeks Referral to
Treatment Time (RTT)
Patients waiting 52+
weeks RTT
Diagnostic Waits Within 6
Weeks
1
25
19
Q2
95%
95.7%
Q2
95%
95.0%
YTD
0%
0
Aug
0
0
> 60 min
Aug
0
0
Admitted
Aug
90%
90.3%
Incomplete
Aug
0
1
Aug
99%
97.2%
Aug
0
6
All Cancer 2 week
standard
Jul
93%
95.4%
2 week standard for
Breast Symptoms
Jul
93%
95.8%
62 day standard
Jul
85%
84.2%
Mixed Sex
Accommodation Breaches
Cancer Waiting Times
Actual
YTD
Guy's & St Thomas'
A&E Waiting Time – 4 hour
King's Colllege
DTA, All types
Hospital
A&E Trolley waits over
12hrs at Guy's & St
Thomas'
Ambulance Handover Time 30-60 Min
for Guy's & St Thomas'
Reporting National
Period
Target
YTD
0
31
MRSA
There have been no further MRSA cases since June. The single case to date was a community attributable case.
A & E Waiting times – 4 hour Decision to Admit
Both GST and KCH met the Q2 performance threshold, this is despite performance below 95% at both trusts in July.
Historically trusts have met the performance targets in the first two quarters of the financial year, with performance
usually dipping in Q3 and Q4, when winter pressures can affect performance. The Lambeth and Southwark UCB have
developed a winter plan amongst the objectives is the mitigating of winter pressures and the maintenance of
performance against this target.
18 weeks RTT – admitted
Although performance in August continues above the performance threshold, it should be noted that KCH still has a
backlog of admitted patients which it will be reducing over the course of 2013/14. The trust will be using a
combination of outsourcing to private providers and additional elective capacity on the PRUH and Orpington sites. In
addition the trust is transferring some existing orthopaedic waiters, subject to patient agreement, to GST for
treatment. Consequently KCH’s performance will be below the threshold each month in 2013/14 while backlog
patients are cleared, and this could affect Lambeth’s performance for admitted in future months. The trust should be
in a sustainable position from April 2014.
RTT– waiting more than 52 weeks, and still waiting (incompletes)
The long waiter is waiting for general surgery/bariatric surgery at KCH. KCH continues to outsource bariatrics to
private providers.
Diagnostics
The main driver for this under performance is endoscopy at GST, good progress has been made with Echocardiology
at KCH which had previously been affecting Lambeth’s performance. Although GST has opened a new larger
endoscopy suite, poor staffing levels has resulted in an increase in the number of waiters over 6 weeks. The trust has
put additional sessions in place to increase staffing capacity using clinical fellows, however it anticipates it will take
until December to fully clear the backlog of long waiters.
Mixed Sex Accommodation breaches
All of the breaches were at KCH and relate to the unavailability of general beds for patients who no longer require
critical care. Recent clarification from NHSE(L) on reporting this types of breaches, is likely to result in lower reported
numbers from September.
Cancer waiting times – 62 days from GP referral to first definitive treatment
This performance relates to 6 of 38 patients not being treated within the required threshold: 4 GST ( 2 due to
complex pathways, 2 due to admin delays), 1 at KCH (patient DNAd on a number of occasions) and 1 at St Georges
(due to insufficient elective capacity). Earlier this year, GST had an external review of 62 day performance by the IST,
which focused on patients whose care starts and ends at the trust. The trust has implemented the action plan arising
from the recommendations and performance for this cohort of patients improved over the course of the quarter 1.
KCH have recently engaged the IST to review 62 days at both the Denmark Hill and PRUH sites, with the work taking
place from September to October. The CSU, on behalf of SE London Commissioners, have asked the IST to provide
an overview for this performance area, focusing on pathway issues between trusts, specifically SLHT to GST. This is
being undertaken to the same timescales as the KCH/PRUH review.
Lambeth CCG Acute Performance Scorecard
32
CCG Acute Performance Scorecard
33
Provider Performance Scorecard
34
Provider Performance Scorecard
35
36
37
SECTION 2 OPERATIONAL DELIVERY
2.0 Planned Care Programme
Clinical Lead: Dr John Balazs
Executive Lead: Moira McGrath, Director of Care Pathway Commissioning
Programme Lead: Claire Hornick Interim Acute Commissioning & Redesign Manager
2.1
Long Term Conditions
Diabetes
 ‘Living with Diabetes’ – Structured Self-Management programme has been
launched. This programme is being delivered through the Lambeth Early
Intervention Programme
 DMI developing patient portal enhancing self-management of an LTC.
An online portal that enables people living with diabetes to assess their test
results, build knowledge, confidence and understanding and improve their
ability to self-manage. So patients could receive their HbA1C test results
prior to their GP appointment, to enhance self-management and embed
care planning.
 DMI will provide proof of concept – Proof of concept (£30.5k)
 Active recruitment for 15 DUK Community Champions. Second wave of
recruiting and training care planning advocates.
 Community Clinic service is currently being evaluated and full report will be
available at the end of October so NHS Lambeth CCG can decide future
procurement for the service
 The vast majority of Lambeth practices have signed up to the CCG/DMI
Incentive Scheme and submitted their action plans for analysis.
 Practice action plans are currently being analysed to identify common
themes for packages of support
 10 practices have been identified that will benefit from a package of support
from the DMI and the DICT. These practices will be asked to commit to this
package of support.
 The 10 practices identified last year for this support have made huge
improvements during 2012/13 and continue to sustain this improvement
2.2 Sexual Health Commissioning Update
Lambeth is in the preliminary stages of developing a tri-borough needs assessment
to review service provision in line with local needs, available evidence and ensure
commissioned services are needs led and value for money. This intends to inform
the tri borough strategy, with the first draft document due in due in December 2013.
38
2.2.1 HIV Prevention
Research into MSM substance misuse and risk taking behaviour to inform a media
spec is underway and is due to be completed in January 2013. The findings will
inform a future tender specification.
The London HIV Prevention Needs assessment commissioned on behalf London
Councils is underway. The needs assessment intends to report on London wide
and local approaches to commissioning prevention services for Men who have sex
with men and black and minority groups.
The condom review (which includes the primary care condom scheme), has also
been completed along with an options appraisal. The review aimed to rationalise
the number of condom schemes across LSL and indentify where savings could be
delivered. The review had a limited evidence base, but highlighted the numerous
supplies and contracts across LSL and the potential for efficiencies. The review
recommended the phased adoption of a C card and GP scheme that will require a
retendering process.
Lambeth, Southwark and Lewisham (LSL) HIV Care and Support Review
The HIV Care and Support Working Group (HCSWG) has have met twice since
September 2013. Since, 1st of July 2013 there has been a 30% reduction applied
to CASCAID funding. Future options for the contracting Mildmay (HIV cognitive
impairment service) have been explored and an alternative provider market test is
underway.
The LSL HIV care and support services that are currently commissioned within the
South London HIV Partnership via Croydon(lead commissioner) will be continued
and contracted directly by LSL sexual health team from 2014-15. LSL local
authorities intend to extend contracts initially for one year whilst there is a local
review which will be aligned with the Pan London HIV Needs Assessment and
review of LSL African HIV Prevention services.
The peer support work stream is in progress and service specification is being
development for the local model. The project plan has been refreshed and
stakeholders will be engaged during the implementation process.
2.2.2 Sexual Health service redesign
The first draft of the Wise Up To sexual health (WUSH) Evaluation has been
completed. The initial findings will be presented at a meeting with key stake
holders followed by a discussion on the next steps and most appropriate service
model. Once this has been completed the evaluation report and findings will be
available for wider circulation.
The Guys and St Thomas’s Reproductive and Sexual Health service Evaluation, is
nearing completion. Once completed the initial findings will be presented to the
provider for accuracy. This will be followed by a meeting to discuss future service
model options.
The evaluation of the HIV testing in primary care has been completed and its initial
finding is shown in appendix 2.
The sexual health team lead will be attending a workshop on the 15th October
2013 with Lambeth and Southwark CCG to increase the uptake of LARC in general
39
practice via the gynaecology pathway. Clarity on funding streams for medical
LARC and contraceptive LARC insertions (which falls within sexual health) should
be clarified along with the recognition that there is limited capacity within the sexual
health team.
2.2.3 Tariff Implementation
A London sexual health meeting is planned for the 10th October 2013 which will
help provide a London wide direction of travel in terms of Tariff implementation.
2.2.4 Termination of Pregnancy (TOP)s
Marie Stopes International has opened a new Early Medical Abortion unit in
Lewisham without any prior discussion or engagement with commissioners. The
new unit is near an existing Early Medical Abortion service that was commissioned
last year by LSL. All the CCGs have been consulted and the SH team are awaiting
the final decision from the CCG as to whether to approve funding for the service.
There have been no Serious Incidents in the last quarter.
2.2.5 Sterilisations & Vasectomies
British Pregnancy Advisory Service will continue to provide Vasectomies for
2013/14 for Lambeth, Southwark and Lewisham. Volumes for this service continue
to be low.
2.3 South East London Community Based Care
To enable better ways of team working and consider changes in the traditional
roles of primary care practitioners, creating the opportunity to design new ways of
working which will reshape the boundaries between primary care, hospital and
other associated services.
Primary Care/Urgent Care Workstream
SEL CBC Transformation Board has approved key areas for focus and action for
delivery in the first year of the three year implementation period. It is proposed the
workstream should be understood as a 'Super Enabler' as PCC will underpin the
full ambition of CBC.
Targeted actions for 13/14
Co-ordination of borough activity with enhanced levels of collaboration and
learning:
Lambeth has submitted their baseline activity to the SEL PMO and is already
viewed as ahead of the game on this but we need to 'show case' these areas more
and spread best practice.
Addressing variation in the quality and delivery of primary care:
Lambeth CCG has already established a robust interface with NHSE and
understand our primary care providers. Lambeth CCG is currently analysing the
2012/13 QOF outcomes against the NHSE dashboard, which relates to 2011/12
40
data. Lambeth CCG is developing a direct programme of support to groups of
practices, which we've already commenced with reducing variation in diabetes and
the work with the DMI. Key areas of focus include:
 Identification of common standards
 Understanding the NHSE dashboard and approach
 Establish a framework to develop providers
 Practices will continue to receive practice packs so they are resourced to
achieve their Quality and Productivity Indicators (QP)
 Practices will also continue to have their practice visit from Locality Leads.
Localities will continue to meet for peer review of their referral rates,
emergency admissions and A&E attendance.
New and Consistently high standards models of care and delivery:


The focus here upon establishing models of best practice, engaging
providers in them and supporting the piloting or establishment of new
models of provision at scale. (This would involve direct pump priming to be
offered to groups of primary and community care providers who want to test
out new ways of working) This would be focused upon population based
delivery of services, ranging from core through to shift.
The second area of activity would focus specifically on our aspirations for
access including the design and implementation of 111 and an intelligent
interface with SEL PMO.
41
3.0 Unplanned Care Programme
Clinical Lead: Lisa LeRoux & Ray Walsh
Executive Lead: Moira McGrath, Director of Care Pathway Commissioning
Programme Lead: Therese Fletcher, AD Primary Care and Community
Commissioning/Liz Clegg, AD Older People & Client Groups
Lambeth continues to have a high number of non-elective admissions compared to
London and England and have a high level of reliance on hospital based care.
Local audits show that between 40-60% of people attending A&E could have their
care provided safely and appropriately in primary and community settings. The
major service challenge include the need to improve equitable access, quality and
capacity/capability of primary care services to manage care more effectively
including out of hours, to identify areas that require a whole system pathway
redesign.
3.1 Urgent Care
St Thomas UCC Reconfiguration - Main areas of reconfiguration in line with
the phased implementation of the revised service specification:
 Contractual Negotiations around specific tariffs and agree KPIs – December
2013
 Operational changes, 24/7 model, phased implementation of revised front
ended UCC specification – Qtr2 14/15
 Improvement of the following pathway elements:
1. Clinical streaming/PALS redirection of patients to alternative Primary
Care services – Qtr1 14/15
2. Minors/primary Care Pathway operational 24/7 - completed
3. Paediatrics – Implementation of the revised Paediatric pathway –
November 2013
4. UCC GP’s – partnership with local GP Practices – March 2014
5. Development of the ENP role – March 2014
6. OOH being based within the UCC – Jan 2014
There is a detailed project plan to support this phased implementation.
Winter Pressures Review/Planning:

The Lambeth & Southwark Winter Pressure Surge Plan has been
completed for 2013/14.
 Lambeth and Southwark Urgent Care Network has submitted the Recovery
and Improvement plan to NHSE on behalf of Lambeth and Southwark CCGs
 Key documents including recovery plans for both GST and KCH were
submitted to NHS England, on behalf of Lambeth & Southwark Urgent Care
Network.
 Continue to manage and monitor performance and ensure that proactive
steps are taken to ensure system is resilient. Teleconferences will
42
commence in November 2013, and continue during the winter period. This is
an effective mechanism to raise operational issues such as delayed
discharges or repatriations.
Implementation of NHS SEL 111 Programme






NHS Direct (NHSD) continue to deliver a clinically safe service and are
meeting their KPIs on a regular basis
London Ambulance Service (LAS) has been confirmed as step-in provider
Robust due diligence completed to ensure LAS fit for purpose; NHS LCCG
Governing Body informed and approved recommendation in September 13
Handover from NHSD to LAS will take place on 19th November 2013. LAS
will be interim provider until March 2015
Development of specification and subsequent procurement has commenced
for provider of NHS SEL 111 service beyond March 2015
NHS LCCG engaged in Gateway meetings that reassure NHSE robust
contingencies in place to manage handover of NHS SEL 111 service from
NHSD to LAS
A&E Diversion Schemes

GSTT has recruited to the PALS officer role at St. Thomas’ ED and report
on the number of patients appropriately diverted from A&E. They also report
the number of unregistered Lambeth residents who have registered with a
local GP.
Primary Care Diversion scheme operational via Waterloo Health Centre and
Lambeth Walk. NHS LCCG is currently reviewing the service to ensure maximum
utilisation of the allocated slots.
3.2 Southwark and Lambeth Integrated Care Programme (SLIC)
Southwark and Lambeth Integrated Care is a partnership between local GPs,
King’s College Hospital, Guy’s and St Thomas’ Hospitals, the South London and
Maudsley Mental Health trust, social care in both local councils, and Lambeth and
Southwark Clinical Commissioning groups, with local people.
It is funded by GSTT Charity and the first wave of the programme is focusing on
care of frail older people. The current work streams are:





Early intervention – this includes setting up GP registers, case finding, case
management and establishment of locality based Community
Multidisciplinary Care Teams (CMDTs)
Establishment of geriatrician hot lines and clinics
Admission avoidance schemes included Enhanced Rapid Response and
Homeward
Simplified discharge
Care pathway development for falls, nutrition and treatment of infections
Dementia.
43
The care home and home care workers as early alerters work streams have been
deprioritised and will now be taken forward from February 2014.
The programme applied for Pioneer Status as part of the Pioneer Programme for
health and social care integration, however the bid was unsuccessful.
44
STATUS REPORT – OLDER PEOPLE’S PROGRAMME
SEPTEMBER 2013 OPERATIONS BOARD
Main summary points from the last month
 Achieved target of 80% older people in Lambeth and Southwark, covered by signed up practices
 Significant improvement in number of registers created, with 75 % now completed.
 Following August’s Operations Board, we are in the process of re-evaluating HHAs and the process, to ensure that
deliver an acceleration in our performance.
 Recruited substantive project team for the Older People’s Programme within SLIC
 Simplified Discharge testing has begun, with testing of the referral process. Live patient testing will start in October
2013

Better proactive identification of need & intervention
45
we
An alternative urgent response
Maximising independence before long-term care is finalised
 Simplified Discharge is within the testing phase.
 Real-life testing will commence on the 7th
October and the trajectory for the testing will be signed
off by the senior leaders group in October
46
Improved clinical pathways

Papers on Infection and Dementia are being presented
within the September Operations Board, which will include the
timescale for when testing will commence
47
4.0 Mental Health Programme
Clinical Lead: Drs Ray Walsh and Raj Mitra
Executive Lead: Director of Integrated Commissioning
Programme Lead: Denis O’Rourke, AD Integrated Commissioning Mental Health/Liz
Clegg AD Older People & Client Groups.
4.1 Transforming primary care and community mental health services
Following co-design work led by Lambeth Living Well Collaborative (LLWC) plans
for the phased implementation of the Living Well Network (new front end to mental
health support system) have been worked up by the Provider Alliance Group
(PAG) for initial roll out in the North of the borough from November 2013. A range
of communications and engagement events have been held with primary care
practices to advise of service changes led by Dr Ray Walsh, CCG board member
and primary care lead within the PAG.
The rehabilitation services QIPP review has been completed in collaboration with
SLaM which included full assessments of all 52 people within (SLaM and private
sector) in-patient beds; an independent benchmarking report and two multi-agency
workshops. Next steps for radically recommissioning the rehabilitation services
provided by SLaM are being worked up including the possibility of including within
the package the social care rehabilitation spot placement provision.
The changes to the front end of the system runs alongside proposed changes to
Adult Mental Health (AMH) community and acute services provided by SLaM. The
aim is for a greater focus on early intervention and recovery and an improved
interface with primary care. These proposals were outlined to the CCG Board
seminar on 17 July 2013. Service changes will commence January 2014 and the
CCG and Lambeth Council will be represented on the programme board driving
this change.
4.2 Integrated Talking Therapy services
The initial report of the evaluation of the first six months of the integrated talking
therapy service provided by SLaM has been completed and was considered at the
CCG Board seminar on 9th October. Feedback from the seminar will be
incorporated in a final report and presentation to the CCG Board meeting in
November 2013
4.3 Criminal Justice mental health pathways
The potential for a full review of community forensic services is being discussed
with SLaM including future options for the “ward in community” service which
provides step down provision for people moving on from secure forensic beds.
48
The CCG attended the first HMP Brixton Health partnership board on 13
September 2013 since NHSE took on commissioning responsibility for prison
health care from April 2013. There was positive feedback on the quality and
effectiveness of the healthcare provision being delivered by the existing provider
consortium. NHSE advised that the healthcare tendering process at HMP Brixton
(in a package with HMP Wandsworth and Pentonville) has commenced and that a
new provider is on schedule to be in place from April 2014. The overall healthcare
budget for HMP Brixton has been reduced by 25%.
4.4 Dementia
Lambeth & Southwark Memory Service (Memory Service)
 The Task & Finish group has identified a building that could potentially be
used for outpatient appointments with the capacity to house the MDT from
SLaM, KCH and GSTT, however refurbishment required and will take
approximately 12-18 months. Alternative outpatient clinic space is being
sought in the interim.
 Monitor the affect the acute hospital CQUIN for detecting dementia is having
on referrals to the memory service, and the outcomes of these referrals.
 The Shared Care Protocol for prescribing dementia medication is currently
being reviewed by the SEL Medicines Management Committee, the
intention is for Clinicians to inform GPs of the drugs they need to initiate and
for the Clinicians to then review the patient 3 months post starting them.
 An Memory Service EMIS referral form has been circulated and uploaded
onto practice systems and referrals will be regularly monitored.
Cabinet office visit to Lambeth
Lambeth was chosen, along with five other CCGs nationally, to discuss progress in
the context of the Prime Minister’s Dementia Challenge, to inform Cabinet Office
thinking. A comprehensive programme was provided covering all aspects of
service from a person with dementia and their carer, voluntary and community
sector together with service providers and commissioners.
4.5 Specialist mental health continuing care older adults
Following joint redesign programme between commissioners and SLaM, LCCG
agreement was obtained at the September public board meeting to consolidation of
specialist mental health continuing care to the Greenvale site located in Streatham.
49
5.0 Staying Healthy
Clinical Lead: Dr John Balazs
Executive Lead: Helen Charlesworth-May, Director of Integrated Commissioning
Programme Lead: Therese Fletcher, AD Primary & Community Commissioning
5.1 Smoking quitters
 NHS Lambeth CCG achieved the 2012/13 target. 2012/13 performance
figures show 2303 smoking quitters, against the target of 2262. The target
remains the same for 2013/14 with current year to date figures at 371
quitters against a year to date trajectory of 538. Work is underway to review
the dip in performance and to work with practices and providers to chase up
the lost to follow ups.
5.2 Healthy Living Pharmacy (HLP) Project
 62 out of 64 Pharmacies signed up to HLP initiative (aim to have all
pharmacies signed up by the end of the year)
 3000 plus alcohol intervention carried out by HLC’s
 Reaccreditation of phase 1 completed and action plans agreed
 Accreditation of phase 2 pharmacies on going, planned completion end of
October 2013.
 430 NHS health checks carried out in Pharmacies as at the end of
September 2013.
5.3 NHS Vascular Health Checks
 As at Q1 9% of the eligible population were offered a Health Check against
a quarterly target of 5% for 2013/14. In Q2 1728 health checks have been
carried out across all providers.
 2nd phase of cross borders pilot started with Lewisham and Southwark.
 Dementia included within current dataset. LSL joint approach, including
marketing.
 New standardised template rolled out to all practices.
 Further work required to ensure patients take up offer
5.4 Alcohol Harm Reduction:
 2013/14 CQUINS are in place for community and acute services.
 Health Visitors and Sexual Health staff in the community have completed
training in alcohol brief intervention and are offering the interventions in line
with agreed CQUIN.
 Joint Alcohol Prevention Group (APG) is developing ‘Out of Hospital’ Bid
 Evaluation underway for Alcohol Recovery Centres that went live in
Lambeth for 8 week pilot in December 2012: Medical Model at St Thomas’
Hospital and social model at Clapham Methodist Church.
50

Pharmacies currently accredited as a HLP provide Alcohol screening
5.5 Healthy Weight
Childhood Obesity Healthy Weight Programme
The data collected for the 2012/13 academic year National Child Measurement
Programme (NCMP) was submitted in July 2013 and has been centrally validated
and final results will be published later in the year. The Specialist Obesity School
Nurse (SOSN) had a key role in supporting the implementation of the priority
interventions of the childhood obesity programme. It includes overseeing the
implementation of the NCMP, the assessment and referrals of children and families
to appropriate services as well as establishing links with key staff and practitioners
working to support health weight issues. As part of the 2012/13 NCMP, 466
overweight and obese children were identified as being eligible for the Level 2
service and their parents have been sent information on this service by the SOSN.
Likewise the parents of the 520 obese children identified as being eligible for the
Level 3 weight management services were sent information on the service. The
NCMP for 13/14 academic year will take place during November/December 2013.
Letters have been sent to parents/carers informing them of the process and asking
if they wish to opt out.
Lambeth achieved Stage 1 UNICEF Baby Friendly Initiative (BFI) accreditation in
June 2013. The national BFI team commended Lambeth on the quality of the
documents submitted. A number of recommendations were included in the
feedback report. The recommendations aim to help with the subsequent
achievement and maintenance of BFI standards and will have an impact on the
outcomes and achievement of Stages 2 and 3. Public Health are conducting a
rapid breastfeeding needs assessment which will be complete by January 2014,
findings from this work will help support the implementation of some of the
recommendations to achieve stage 2 accreditation. A BFI co-ordinator is being
recruited and will hopefully be in post by January 2014.
The Breastfeeding Peer Support Programme is being further rolled out. 15
voluntary peer supporters are being trained throughout 2013 and will support
mothers at the milk spot cafes in children Centres across the borough. Some of
these peer supporters will then undertake a yearlong training programme to
become Breastfeeding Supervisors, once they complete the training they will be
able to run Milk spots and support the community midwives.
Health child weight Programmes:
 Level 1 Children’s Health Weight training continues to be delivered to health
and non-health professionals including school staff. The school healthy
weight promotion programme has completed training in 16 primary schools
to date.
 The Level 2 weight management service – Lambeth Ready Steady Go!
Have received a total of 111 referrals in Q1 203/14. They have delivered 4
structured programmes and 2 flexible programmes and 36 children have
completed the programme.
51

The Level 3 specialist weight management service offers support for
overweight and obese children with additional medical and or complex
social needs. All children/families identified through NCMP results contacted
(520). 473 children/families provided with advice. 7 children have been
referred for level 3 interventions.
Monitoring, review and evaluation continues to be important components of the
Lambeth childhood obesity programme. These not only help to ensure that the
services are being delivered to achieve maximum outcomes but also are
contributing to the local and national evidence base around weight management.
52
6.0 Children and Maternity Improvement Programme
Clinical Lead: TBC
Executive Lead: Helen Charlesworth-May, Director of Integrated Commissioning
Programme Lead: Emma Stevenson, AD Children and Maternity
6.1 Children & Families Early Intervention & Prevention
An integrated approach to commissioning and service development continues to
be a priority for Children’s services. The Early Intervention & Prevention Integrated
Commissioning Strategy (2013-16) was signed off at the Children’s Trust Board
(CTB) in July 2013. It was informed by the Children’s JSNA and identifies 4
overarching priority outcomes:




Improve Family Stability
Reduce risk taking behaviour in adolescents
Improve educational aspiration & attainment
Reduce Health Inequalities
Work is now underway to implement this strategy through an innovative and
integrated delivery model. This is being informed by findings from the Big Lambeth
Health Debate; the Council’s outcome based budgeting work and developments
from the Big Lottery Bid – Fulfilling Lives. Lambeth has been shortlisted from 140
submissions down to a final 15. The final Big Lottery bid has to be submitted on
January 3rd 2014 and just 3 or 5 areas will be selected to receive £30m over a 10
year period to improve services for pregnancy to 3yrs.
6.2 Children’s Integrated Care Pathway
Children’s ICP is being developed through the Evelina London Child Health
Programme (ELCHP). This programme is GSTT charity funded for an initial 30
month period to look at improving both vertical (primary, secondary, tertiary) and
horizontal (health, education, social care) integration. Hilary Cass, Consultant
Paediatrician and President of the Royal college of Paediatricians is championing
the work. The first Programme board is meeting in October and has GP
representation through the clinical network and strong commissioner involvement.
The work being developed through this programme links with the work being
progressed through NHS England (London Region) Children & Maternity clinical
network
6.3 Community Child Health
New core offer to mainstream schools has been developed as part of the
Paediatric Health therapies review (SALT, OT and Physio). The proposed models
is being taken to school throughout October and November 2013 to develop and
agree an integrated commissioning approach.
6.4 Maternity
The SEL Maternity network is being reviewed and a meeting is planned in early
September to revisit terms of reference and membership. This may be superseded
by the TSA Maternity work, but ensuring effective maternity pathways are
53
established and implemented from community based children Centres, Primary
care and acute is essential. This includes looking at how and where antenatal
classes are delivered, developing effective shared care protocols with GP’s and
ensuring early identification and support is available for vulnerable pregnant
women. A clinical commissioning lead has been identified from CCG Board
working across Lambeth, Southwark and Lewisham.
6.5 Breastfeeding
Breastfeeding rates continue to improve (13/14 Q1 97% coverage and 81%
prevalence) Q2 data will be available end of October. Lambeth achieved Stage 1
UNICEF Baby Friendly Initiative (BFI) accreditation in June 2013. The National BFI
team were particularly impressed with Lambeth’s strong partnership working. The
Breastfeeding Peer Support programme is being rolled out with training for
voluntary peer supporters delivered throughout 13/14.
54
7.0 Continuing Healthcare
Clinical Lead: TBC
Executive Lead: Helen Charlesworth-May, Director of Integrated Commissioning
Programme Lead: Liz Clegg AD Older People & Client Groups.
7.1 Any Qualified Provider (AQP)
Phase 2 of the AQP process went live on 1 October 2013, with a number of additional
providers across London added to the London wide Framework contract, thus increasing
local capacity. The CCG is continuing to try to use the AQP list of providers for placements
for patients over 65 years, but on occasions needs to make placements off the contract.
Costs for non AQP providers are negotiated on a case by case basis.
7.2 NHS Lambeth CCG Continuing Healthcare Choice Policy
The draft policy was discussed at the Lambeth CCG QIPP and Finance meetings on
22nd May, and 24th July 2013. The legal advice received from Capsticks has not identified
any legal concerns, and therefore the policy is due to be presented to the Integrated
Governance Committee meeting on 23rd October 2013.
7.3 Minnie Kidd House
Discussions are continuing with GSTT regarding the options for future usage of the facility.
7.4 Personal Health Budgets
We are finalising the local operating procedures and policy for delivering Personal Health
Budgets in the CCG. We have signed up to the Department of Health’s national personal
health budgets delivery programme for CHC. We are also developing a paper which looks
at the benchmarking of hourly rates for direct payments across London, and it is
anticipated that this paper will be presented to the QIPP and Finance meeting on 30th
October 2013.
7.5 National Retrospective Appeals
All of the Responsible Commissioner issues have now been resolved, and we know the
final list of cases for which we are responsible for investigating. We have started the
protracted process of information gathering for individual cases, focusing on the shortest
claim periods first.
55
8.0 Medicines Optimisation
Clinical Lead: Dr Sadru Keraj
Executive Lead: Moira McGrath, Director of Care Pathway Commissioning
Programme Lead: Vanessa Burgess, AD Medicines Management
Current Overall Performance 2013-14 (Month 4)
 Overall the prescribing budget (year to date) is under spent at Month 4 by £175,600
(1.5%, see finance report). Both the North and the South West localities were under
spent by 1.8% and 3.9% respectively. The South East locality was overspent by 2.0%.
 Overall spend per APU at CCG level has increased to £1.92/APU in M4 (compared to
M3 £1.69/APU) which is above target (£1.77/APU per month).
 Cumulative growth (analysed monthly) on primary care prescribing is 0.1% in month 4
(compare to -0.9% in month 3). Please note the change to positive growth in
prescribing.
Quality, Innovation, Productivity and Prevention (QIPP) Performance.
2013/14 Primary Care Prescribing QIPP Plan and Dashboard.
Monthly Performance Monitoring (Month 4):
QIPP AREA
Spend per ASTRO-PU per
month
Emollient bath and shower
preparations spend per 1000
APU per month
Silver Wound Dressings Spend
per 1000 APU per month
Honey dressings Spend per
1000 APU per month
Tadalafil Spend per 1000 APU
per month
Specials Total Spend per
month
Immunosuppressants Spend
per month
2013 – 14 Scriptswitch Summary.
ScriptSwitch - Actual savings
ScriptSwitch - Potential savings
TARGET
M4 v M3
£1.77
↑ (above target)
≤ £12.55
↑ (£11.87, but still below
target)
≤ £2.42
↑ (£2.19, but still below
target)
≤ £0.54
↓ (£0.49, below target)
≤ £12.91
↑ (£11.93, but still below
target)
↓
↑
£16K/month saving
Exceeding target
April
£19,231
£62,999
May
£12,291
£57,195
June
£19,571
£46,344
July
£29,069
£56,151
August
£27,435
£54,166
Sept
£33,041
£62,539
Local, London and National Prescribing Performance:
Data source: Q1 2013/14 (Apr – June)
Full data and London/national ranking as per table overleaf.
We remain in the top
performing CCGs in London and nationally in many of these areas.
As part of the Medicines Optimisation plan for 2013-14 practices will be undertaking the
associated reviews for each comparator over the following financial year which will support
movement from AMBER (current position for the majority) to GREEN.
56
Comparator
(RAG rated against NHS Lambeth CCG Primary Care
Dashboard Q1)
Antibacterial Items/STAR PU
NSAIDs: Ibuprofen & Naproxen % Items
Antidepressants ADQ/STAR PU
Hypoglycaemic agents % Items
% Items Long acting insulin analogues
Hypnotics ADQ/STAR PU
Minocycline ADQ/1000 Patients
NSAIDs: ADQ/STAR PU
Generic Prescribing percentage
Laxatives ADQ/STAR PU
Low cost lipid modifying drugs % Items
% Metformin & Sulphonylureas items of all antidiabetic
agents
% Fentanyl items of all opioid items
3 days Trimethoprim ADQ/ITEM
Antidepressants % first choice items
% items for immediate release venlafaxine as % total
venlafaxine immediate and extended release items (tablets
and capsules)
Silver Wound Dressings Spend per 1000 APU per month
% Oxycodone items of all opioid items
Omega-3-fatty acids spend per 1000 APU per month
% items for plain prednisolone 5mg as % of all prednisolone
5mg plain & e/c items
% of Low Cost PPI items as % of all PPI items (low cost
defined as omeprazole capsules, lansoprazole capsules and
pantoprazole tablets)
Tadalafil spend per 1000 APU per month
Honey Wound Dressings Spend per 1000 APU per month
Emollients bath and shower preparations spend per 1000
APU per month
% statin items prescribed as low cost statins of all statins
including ezetimibe (and combinations) & generic
atorvastatin
Spend of Specials* per 1000 patients per month
Lipid modifying drugs: Ezetimibe % Items
Cephalosporins & Quinolones % Items
Omega-3 ADQ/STAR-PU
% items ACE inhibitors
Wound care products NIC/Item
% reduction in High dose inhaled corticosteroids as a % of all
inhaled corticosteroids (compared to Quarter 3 2012-13)
57
National
ranking
(Q1
2013/14)
Out of 211
CCGs)
6th
10th
6th
11th
17th
11th
61st
28th
20th
100th
57th
N/A
London
ranking
(July 2013;
out of 32
CCGs)
N/A
3rd
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
2nd
N/A
55th
79th
N/A
3rd
N/A
N/A
2nd
N/A
N/A
N/A
N/A
6th
5th
9th
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
128th
97th
148th
129th
195th
N/A
30th
N/A
10th
N/A
N/A
N/A
N/A
Key
GREEN (already achieved) = Locally: >75% of practices achieving comparator; London and national: CCG is in top 25th
centile
AMBER (significant improvement nearing maximum achievement) = Locally: <75% but > 50% of practices achieving
comparator; London and national: CCG is in 25th to 50th centile
RED (Further improvement required) = Locally: < 50% of practices achieving comparator; London and national: CCG is in
bottom 50th to 100th centile
The following indicators are currently rated RED:
High dose inhaled corticosteroids as a % of all inhaled corticosteroids - practices continue
to be supported to review patients with COPD and asthma by the Integrated Respiratory
Team virtual clinics. A template for practice pre-work for the virtual clinics has now been
agreed to ensure that the clinic visit can be case review based. “Step down” of high dose
inhaled steroids in stable asthma patients is being encouraged as part of asthma reviews.
Four inhaler technique training workshops are underway for practices and community
pharmacists and a PLT event on respiratory has been secured for November.
Wound care products NIC/Item – the preferred dressings request form has been relaunched with maximum ordering quantities to support evidence based prescribing and in
turn a reduction in waste on dressings. We are also about to start a targeted intervention
with 3 practices to manage spend on dressings in nursing homes.
Community District nurses who are not using the request form are being followed up on a
case by case basis.
Omega-3 ADQ/STAR-PU – this is a new national QIPP comparator introduced in quarter
1. Omega-3 prescribing is higher in the SW locality due to local acute trust use. Practices
with high prescribing have been encouraged to complete the Omega-3 fatty acids review
tool in the Medicines Optimisation plan 2013-14.
General Update
1. Medicines Optimisation & QIPP Plan for 2013-14.
All 48 annual practice prescribing visits have now been completed (May –
August)
Respiratory, hypertension and heart failure virtual clinics are now under way
with positive feedback.
Quarterly visits for overspending practices are now underway, jointly with
the medicines team and GP clinical leads where required to agree a
recovery plan for the overspend.
Individual Scriptswitch reports being received by practices quarterly and
practices are required to review and report back reasons for rejected
messages.
2. Highlights from the Lambeth and Southwark Joint Prescribing
Committee (JPC) Meeting September 2013:
Approved – Emollients prescribing guideline; SOP for COPD Rescue Pack
assessment
Deferred – Denosumab shared care guideline
3. Highlights from SEL Area Prescribing Committee (APC) meeting
58
The New Drugs panel for the APC is now meeting monthly, with a full APC
meeting scheduled for the 15th October.
4. Highlights from the APC New Drugs Panel Meeting, September 2013.
Approved:
- Dapagliflozin tablets for type 2 diabetes - specialist initiation in line with
NICE recommendations and local criteria for use, with transfer to primary
care at 6 months in line with a transfer of care agreement.
- Mirabegron prolonged release tablets for the treatment of overactive
bladder – suitable for routine use, initiation and prescribing in primary
care in line with NICE recommendations and local criteria for use.
5. Specials – a plan has been initiated with GSTfT to ensure that selected
specials are prescribed by specialists in a phased manner. This will start
with cocaine mouthwash and midodrine tablets/capsules. The GSTfT
Medicines Information Specials information helpline will be extended to all
GP practices in Lambeth following an initial pilot in three practices – this is
being provided as a free service.
59
9.0 Cardiac and stroke
Clinical Lead: Dr John Balazs
Executive Lead: Moira McGrath, Director of Care Pathway Commissioning
Programme Lead: TBC.
9.1 Stroke survivor advice, support and signposting
The Lambeth Council contract with Stroke Association for advice, support and
signposting for stroke survivors and their carers at six weeks is being extended to
31 March 2014.
The contract with Stroke Association for review of stroke survivors and their carers
at six months is jointly commissioned with Southwark CCG using admission
avoidance funding. Extension of the contract is confirmed to 31 March 2014.
The Lambeth service is currently being re-specified for a commissioning position
from 1 April 2014 with the potential to commission across Lambeth and Southwark
being considered.
CCGs have been asked to lead on the accreditation of local Hyper Acute Stroke
Units and Stroke Units. Lambeth CCG will be responsible for carrying out the site
visit at St Thomas’ Stroke Unit and this will be led by the clinical lead. Discussions
are underway with the London Clinical network and other commissioning leads
across the sector to agree the SEL approach on this.
9.2 Cardiac
The Community Arterial Fibrillation and hypertension service is now in place with
further clinics planned to commence in Autumn 2013.
10.0 Cancer services
Clinical Lead: Cathy Burton
Executive Lead: Andrew Eyres, Chief Officer
Programme Lead: Liz Clegg, Assistant Director Older People
10.1 Performance monitoring
Role of Lambeth and Southwark Cancer locality group reviewed and TOR revised
to include a focus on performance management now that the SELCN no longer
exists. Membership will include commissioning representatives from both CCGs,
the CSU and the Cancer Commissioning Team, cancer service management and
nurse leads from GSTT and KCH, voluntary service and user representatives.
10.2 Prevention
The second national programme on raising lung cancer awareness is now in place.
A further Be Clear on Cancer programme aimed at urinary symptoms is expected
later this year although no further information has been released. The bowel
60
cancer screening age extension roll out has will not go live in Lambeth and
Southwark in Q2 as expected. KCH have not yet achieved accreditation due to
colonoscopy capacity as a result of a fire in the new endoscopy suite. It is now
anticipated that the go live date will be later this year.
10.4 National cancer patient experience survey 2012/13
GSTT and KCH are static against targets compared to 2011/12, however overall
comparative performance for both Trusts is below national average.
Communication and access to Clinical Nurse Specialist advice and support are
main areas for improvement identified at both Trusts. Actions plans…
Primary care detection and support following diagnosis also identified as areas for
improvement.
10.5 Primary care
Lambeth Macmillan GP now visiting practices to support early detection of cancer,
focussing on lung, prostate, breast and colorectal. Lambeth Macmillan primary
care nurse post supporting improved patient-centred services, early diagnosis and
post-treatment support in primary care, to be advertised as an 18 month
secondment.
11.0 Enabler Programmes
11.1 Primary Care Development – ‘Super-Enabler’
NHS Lambeth CCG six high-level Primary Care objectives
1. To support primary care services in being more responsive and
accessible and provide high quality primary care services that meet
patients every day and urgent care health needs
2. To develop more effective partnership working across organisational and
professional boundaries to provide more effective and integrated team
working;
3. To facilitate more informed, proactive engagement and involvement of
people in local communities and practitioners in the use, planning and
delivery of services;
4. To put in place a robust Primary Care Education strategy that secures a
primary care workforce fit for purpose;
5. To reduce variation in the quality of Primary Care provision and reduce
health inequalities across the borough;
6. To encourage and enable patients to positively manage their own health,
in partnership with health professionals and their carers

NHS Lambeth fully engaged in Community Based Care (CBC) work
(Primary and Community Care)
o Key focus areas: Development (reducing variation) Commissioning
(at Scale) and Organisational Development (capacity)
61

Lambeth & Southwark CCGs together with two borough LMCs are
developing joint bid to GSTT Charity for Primary Care Development

This will be a two phase charity bid with opportunity to scope the
requirements across both boroughs and implementation that focuses on
integration and sustaining the highest quality General Practice for the
populations of Lambeth and Southwark

GP Delivery Scheme launched to practices with focus on increased
utilisation of CAB, Primary Care Access (focus on urgent care), Develop
patient participation in the practice (5 steps to better access)

NHS LCCG has developed matrix for 'Reducing Variation' across practices
and improving quality of primary care. Practice Data Pack updated so
variation can be mapped across practices and split by Locality. Dashboard
also includes data from GPHLI, GPOS and triangulated with EPACT data.

Primary Care Commissioning and Quality Group (NHSE represented) is
developing programme of support. Focus support on practices below agreed
threshold

During October and November each practice will be visited by a Locality
Lead and a CCG Manager to discuss their practice data pack and where
they are against budget for Out-patient GP Initiated referral, Emergency
admission and A&E attendance

Primary Care Training Programme booklet now available and has been
distributed to all our practices
62
12.0 Estates
West Norwood Health and Leisure Centre:
 Integration Manager has been appointed to achieve the benefits of
integration across Health and Leisure at the West Norwood Health and
Leisure Centre
 Draw up action plan for operational implementation for Norwood Hall
 Develop procurement strategy for GP Suite 2
 Commence procurement process
 Implement/evaluate Service Integration Plan
Nine Elms and Vauxhall (NEV)
 Joint Project Manager has been appointed
 Programme Board has been set up/TOR agreed
 GP Capacity
o Scope potential capacity in current practice sites
o Financial impact for 2014/15
o Consider medium/long term commissioning issues
(governance/funding)
 Community Services (including Mental Health)
o Use population assumptions and PACT/OOH shift to scope 14/15
o Consider financial impact for 14/15
o Consider estates rationalisation work
 Urgent Care – Walk-in/Minor Injuries Capacity
o Use population assumptions and BSBV shift to scope capacity
requirements for 14/15
o Consider Battersea Locality and potential expansion in urgent care
facilities (e.g. Clapham Junction)
o Consider financial impact for 14/15
 Public Health and Social Care Commissioning
o Health promotion, Sexual health and DAAT requirements
o Consider capacity in Vauxhall as current hub
 Submission of Health bid for CIL monies – Jan 2014
 NEV workshop between Lambeth and Wandsworth planned for September
o Create firm short 14/15 plans
o Ensure process in place for medium and long term plans for CIL
application timescales
63
SECTION 3 ORGANISATIONAL DEVELOPMENT
12.0 Organisational Development
Clinical Lead: Adrian McLachlan
Executive Lead: Andrew Parker, Director of Governance & Development
12.1 Organisational Development
Summary
Clinical Lead
Adrian
McLachlan & Raj
Mitra
CCG Director
Andrew Parker
Impacts on:
CCG objectives
Enabling
Qrt 1 milestones
Qrt 2 milestones
Qrt 3 milestones
Qrt 4 milestones
Met (Green)
6
4

In progress (Amber)
2
3

Not met (Red)
0
0



Comments on current performance – on track
64
Key Milestones and planned actions/mitigations
Month
Summary Milestone
June
Organisational development plan agreed by OD Steering Group (JC/LD)
G
Collaborative Forum Chair appointed and support provided for first
meeting (JC/LD)
G
June
Website launched and membership communications review undertaken
(JC/LD)
G
June
Development and launch of Primary Care Education and Development
Strategy (TF)
G
June
Development of GP Delivery Scheme with Member Practices and Launch
(TF)
G
June
Work and development plans for Clinical Network members established
(AS)
A
Q1
June
Achiev
ed
(RAG)
June
June
CCG successfully launched (JC/LD)
Mitigation Planned
Date
Mitigation
to be
Completed
121s with Clinical Network members
currently underway, but not yet complete
Ongoing
Governing Body membership elected and
discussions underway to develop and
agree specialist portfolio areas.
December
G
Commissioning relationships defined to inform stakeholder management
(AP)
A
65
Key Milestones and planned actions/mitigations
Month
Achiev
ed
(RAG)
Summary Milestone
Mitigation Planned
Date
Mitigation
to be
Completed
Q2
1. Governing Body selection and election process completed (JC/LD)
Sept
G
Sept
2. Relationship with Collaborative Forum Chair established and
support arrangements agreed (JC/LD)
G
Sept
3. Bespoke Leadership Development Programme for Practice
Managers (TF)
G
Sept
4. Development training for action learning set facilitation (TF)
G
Sept
Sept
Sept
5. Clinical network engagement input and relationship with Board
agreed (AS)
A
OD and administrative support agreed in
principle. Objectives agreed at Board and
key deliverables to be agreed.
End
October
A
Further reminders issued.
Training
proposal in development for wider
engagement
End
October
A
Review in line with new emergent
strategy post Big Lambeth Debate.
March
6. Objective and PDP process completed (JC/LD)
7. Action plan to manage stakeholder arrangements agreed (AP)
66
12.2 Engagement and Communications
Engagement and
communications
Clinical Lead
Executive Lead
Reports to:
Engagement,
Communication
s and Equalities
Committee
Raj Mitra
Andrew Parker
Work area
Purpose
PM
Success measure
Qtr
Implementing
Communications
and engagement
strategy
Build public and
stakeholder
confidence in
CCG and its
leadership
AP/CS
U
Accessible website for
CCG up and running
with opportunities for
feedback published
CCG has profile in local
media
Regular briefings held
with Scrutiny and
HealthWatch; presence
of and presentation by
clinical members at
Scrutiny
Engagement is part of
new Governing Body
members' PDPs and
part of development
plan for Governing Body
as a whole
CCG commissioning
areas and QIPP
programmes have
engagement and
communications plans
in place
Established cycle of
meetings/communicatio
n with Lambeth PPG
Network and with
HealthWatch Lambeth
Records of engagement
on strategic plan 201415
Engagement in strategic
planning, service
redesign and service
quality monitoring
(patient experience) has
been discussed at
Engagement, Equalities
and Communications
Committee
Media policy developed
for CCG
Board meetings held in
public
Qtr1
Achieved
(RAG)
G
Qtr2
G
Qtr3
On track
Qtr4
On track
Qtr1
G
Qtr2
A
Qtr3
On track
Qtr4
On track
Qtr1
A
Qtr2
G
AP/CS
U
CF
CF/JC
Implementing
Communications
and engagement
strategy
Systematically
involve patients,
their carers and
communities in
the
commissioning
of health
services for
local people
CF
CF
CF
CF
Implementing
Communications
and engagement
strategy
Demonstrate
open and
transparent
governance and
AP/CS
U
CF
67
Implementing
Communications
and engagement
strategy
leadership
CF
Promote
equality through
engagement
work
CF
AP/CS
U
CF
Good attendance and
range of issues raised at
stakeholder premeetings
Needs of protected
groups incorporated into
engagement plans
Equalities stories
included in stakeholder
bulletin(s) and
publications
Local communities have
been involved in
reviewing progress on
CCG's equalities
objectives and in
refreshing objectives for
2014-15
Qtr3
Qtr1
and
ongoing
Qtr3
G
Qtr4
On track
On track
12.3 Human Resources:
Workforce Report Q2 2013-14
The full CCG establishment is 45.75 whole time equivalent posts (51 posts) with
47.42 WTE currently filled (this includes agency staff). Vacancies have reduced
(from seven and then three at end of Q1) to two, both posts are currently being
covered by external secondment. Three staff are currently on maternity leave and
a further two are on career break or secondment. Turnover remains low with one
leaver for July to September (6.3% cumulative).
The workforce system was re-launched in April. Staff and managers have been
reminded of the importance of ensuring that all sickness absence must be
recorded on the system to ensure absences are recorded and the appropriate
payroll action is taken. The sickness absence rate for July to September ranged
from 1.4% to 2.5%. This amounts to 84 calendar days lost. Sickness absence will
continue to be monitored over the coming months to identify any trends and
changes, and to determine future actions. There is one long-term case of sickness
absence over the quarter.
There are no changes to occupational health services and employee assistance
programmes for NHS Lambeth CCG staff since the last report.
A revised programme of statutory and mandatory training for completion during
2013/14 has been agreed as below:
Course
Equality, Diversity & Human Rights
Health, Safety & Security
Counter Fraud & Bribery
Information Governance
Frequency required
Once
Once
Annual
Annual
68
Fire Safety
Safeguarding Children Level 1
Safeguarding Vulnerable Adults
Moving and Handling
Annual
Annual
Annual
Every three years
31 staff have completed counter fraud and bribery training but uptake on remaining
mandatory training is currently low. This may be due to electronic recording issues
and will be reviewed for next quarter.
All staff have been agreeing their objectives and personal development plans.
There was a successful CCG Awaytime on 25th September primarily aimed at staff.
Material on the content, evaluation and next steps is available on request. The
event provided a good opportunity to continue the development of the CCG living
our published values and the link to the appraisal process. This will be further
developed at the monthly staff briefing.
The Director of Integrated Commissioning has now assumed her new role in the
Local Authority and staff members have been informed of interim management
arrangements to ensure the appropriate management of all core functions at the
staff briefing on 10th October and a subsequent written communication.
Under the transfer scheme staff transferred with their existing terms and conditions
of employment, including HR policies. A timetable to review the existing policies
has now been agreed. Key policies have been identified as policies for priority
review and first drafts for consideration by the CCG will be prepared between now
and the end of the year. These include the most frequently used such as sickness
absence, grievance, flexible working and disciplinary.
CCG Employees Equalities profile as at 30th September 2013
The following tables are a profile of CCG employed staff, relating to five of the nine
protected characteristics. Monitoring will continue to identify any priority areas to
address.
Ethnicity
50.00
40.00
30.00
20.00
10.00
0.00
69
Gender
Disability
2%
20.00
2%
18%
No
Male
Not Declared
Female
Undefined
Yes
80.00
78%
Religion
3% 0%
0%
0%
4%
Age Band
Atheism
0%
2%
0%
Buddhism
3%
1%
21-25
26-30
2%
31-35
10%
17%
Christianity
20%
41-45
38%
46-50
Hinduism
42%
51-55
17%
3%
36-40
I do not wish to
disclose my
religion/belief
70
20%
56-60
61-65
18%
66-75
SECTION 4 QUALITY ASSURANCE
13.0 Governance & Assurance
Clinical Lead: Adrian McLachlan
Executive Lead: Andrew Parker, Director Governance & Development
Programme Lead: Marion Shipman, AD Governance and Quality
13.1 Quality Report
The NHS is the only healthcare system in the world with a definition of quality
enshrined in legislation. An organisation delivering high quality care will be offering
care that is clinically effective, safe and delivering as positive an experience as
possible for patients.
The Q2 Quality report and provider summary will be included in the next Integrated
Governance and Performance Report.
13.2 Lambeth Quality Summit
Challenging reports from Francis, Keogh and Berwick have put the spotlight on
quality and patient safety, and highlighted the importance of involving patients,
carers and members of the public as equal partners in the design and assessment
of their local NHS.
Following on from discussions at the Lambeth Health and Wellbeing Board NHS
Lambeth CCG, in partnership with Healthwatch Lambeth held the Lambeth Quality
Summit on 2nd October 2013. This was a multiagency event with a main purpose
of considering how we could as individuals, groups, organisations, providers and
commissioners work together better to improve the quality of health in Lambeth.
The objectives of the summit were to:
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Develop a shared understanding of what actions others are taking to
implement the Francis Inquiry recommendations and identify areas where
by working with partners there could be a greater impact.
Identify areas for working together across boundaries to co-produce high
quality health involving – individuals, groups, organisations, health providers
and commissioners and agree next steps.
Agree how we can develop and embed ongoing relationships across
organisational boundaries.
Nearly 100 participants engaged in a lively debate, exploring how primarily we can
prevent problems from happening, while equally ensuring that when issues do
occur they are detected and acted upon quickly – and that we learn from any
mistakes made across the system.
A comprehensive report of the event is currently being drafted and will be shared
widely. People were very keen to continue the dialogue and NHS Lambeth CCG
are planning to continue to work with Healthwatch Lambeth to ensure this
happens.
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13.3 Information Governance
The Information Governance Steering Group is a sub group of the Integrated
Governance Committee (IGC). An Information Governance update was provided to
the October IGC meeting. Lambeth CCG will be the first to use a new flow
mapping and information asset risk assessment tool for the control of information
risk and the identification of opportunities in the context of multiple providers and
stakeholders.
A new Information Governance Policy Suite which set out the expected standards
and controls around the use of information was approved by the IGC. These
include: Information Governance Policy; Information Governance Management;
Information Governance Quality and Information Governance Security.
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