INTEGRATED
GOVERNANCE AND
PERFORMANCE REPORT
NHS Lambeth Clinical Commissioning
Governing Body
JULY 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
Executive Summary ..................................................................................... 4
Board Assurance Framework ..................................................................... 5
Governance and Assurance ....................................................................... 9
Finance ......................................................................................................................9
Quality Assurance.....................................................................................................10
Performance Dashboards ......................................................................... 15
NHS Lambeth’s Performance against National Standards .......................................15
NHS Lambeth’s CCG Dashboard .............................................................................16
NHS Lambeth’s Local Performance issues ...............................................................17
National Performance Measures Dashboard ............................................................22
Operational Delivery .................................................................................. 25
Planned Care Programme .........................................................................................25
Reduction in Outpatient Attendances........................................................................25
Improve Health Outcomes for Long Term Conditions ...............................................26
Improve Effectiveness of Care Pathways across sexual health ................................32
Norwood Hall Neighbourhood Resource Centre .......................................................33
Akerman Road Neighbourhood Resource Centre.....................................................33
Outpatient attendance data by practice ....................................................................34
Unplanned Care Programme .....................................................................................40
Admission Avoidance Schemes................................................................................40
Integrated Care Programme .....................................................................................41
End of Life Care ........................................................................................................41
Reablement ..............................................................................................................42
Intermediate Care .....................................................................................................43
A&E ..........................................................................................................................43
Emergency Admission rates by practice ...................................................................46
2
Mental Health Programme .........................................................................................53
Transforming Primary and Community Mental Health Services ................................53
Criminal Health Mental Health ..................................................................................54
Payments by Results ................................................................................................54
Integrated Talking Therapy Services ........................................................................54
Dementia ..................................................................................................................55
Staying Healthy Programme ......................................................................................56
Reduce Health Inequalities .......................................................................................56
Tobacco Control/Smoking Quitters ...........................................................................56
Alcohol Prevention ....................................................................................................56
Healthy Living Pharmacy ..........................................................................................57
Childhood Obesity ....................................................................................................58
Healthy Weight School Nurse ...................................................................................58
National Child Measurement Programme .................................................................58
School Healthy Weight Promotion Programme .........................................................58
Weight Management Services ..................................................................................58
Evaluation .................................................................................................................59
Teenage Pregnancy .................................................................................................59
Provider Integrated Performance Dashboards ....................................... 61
Guy’s & St Thomas’ Acute Provider ..........................................................................61
Kings Acute Provider ................................................................................................61
SLaM Mental Health Provider ...................................................................................61
Guy’s & St Thomas’ Community Provider .................................................................61
Medicines Management ............................................................................ 62
Organisational Development .................................................................... 66
Organisational Development update .........................................................................66
Equality and Diversity ...............................................................................................67
Appendices................................................................................................. 68
Appendix 1 Board Assurance Framework .................................................................69
Appendix 2 Acute Contract Monitoring Month 12 ......................................................73
Appendix 3 Supporting Quality Information ...............................................................87
3
1
Executive Summary
This report sets out how NHS Lambeth CCG has delivered against its agreed objectives under the
leadership of the 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 2012-13 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) Operational Delivery (pg 25)
(ii) Organisational Development (pg
58)
(iii) Governance & Assurance (pg 8)
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.
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 11th April, where key delivery and performance risks were
assessed. The next meeting is on 21st June 2013.
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, reviewed monthly.
4
Board Assurance Framework and Risk Register
There are fifteen risks rated 12 or above in May 2013.
Actions to address SO1AA (GG6.7SC), Performance Levels for RTT, graded 16 is led by the NHS
SLCSU Acute Contracts Team.
Five new risks have been added to the Risk Register in May 2013 – SO3AA “Implementation of AMH
Programme Risk” (12), SO3BA “Community Services Forensic Service Changes Risk” (12), SO3BB
“Community Forensic Services and Prison Health Commissioning Risk” (12), SO6AE “Internal Financial
Controls and Audit Health Risk” (12) and SO7AA “Delivery of CCG Strategy Risk [Zero Tolerance Risk]”
(9). SO7AA replaces previous risk ref RA7.6.
Descriptions for existing risks have been reviewed, updated and reworded 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 is set out below and the following pages set out NHS Lambeth CCG’s Board
Assurance Framework. The full Lambeth CCG BAF and Risk Register, updated monthly can be
requested from Marion.Shipman@nhs.net or GHennighan@nhs.net
From July 2013 the Risk Registers for the CCG will include a additional field of ‘Risk Appetite’
Code
Risk
Summary
Risk
Direction Risk Owner
Score
Key Actions
SO1AA
(GG6.7SC)
Performance
Levels for RTT
Risk
16

Harriet Agyepong
RTT Recovery Plan (March 2014)
SO2CA
(MA6.8AE)
A&E
Performance
Level Risk
12

Therese Fletcher
Delivery KCH action plan (March 2013)
Delivery GSTT action plan (March 2013)
Achievement of Target Risk Score (March
2013)
SO2LB
(FF3.2AE/6
Implementation
of 111 Service
Risk
12

Therese Fletcher
NHS SEL (Cluster) to negotiate new contract
with SELDOC until April 2013
SO3AA (new) Implementation
of AMH
Programme
Risk
15

Denis O'Rourke
Relaunch of Living Well Network (July 2013)
Agree provider alliance contracting framework
(December 2013)
CCG as part of Lambeth, Southwark,
Lewisham and Croydon CCGs responding to
SLaM
SO3BA (new) 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)
5
Code
Risk
Summary
Risk
Direction Risk Owner
Score
Key Actions
SO3BB (new) Community
Forensic
Services and
Prison Health
Commissioning
Risk
12

Denis O'Rourke
Lambeth CCG to meet with NHSE to agree
required actions.
SO4AA
(SH8.9MM)
TSA Process
Impact Risk
12

Christine Caton
Implications of SoS decision across SEL being
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 (March
2014)
Final governance arrangements to be agreed
for TSA across South London (July 2013)
SO6AA
(S8.1CC)
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)
SO6AB
(SA8.2CC)
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.
SO6AC
(SB8.3CC)
Financial
Planning and
Strategic
Approach Risk
12

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)
SO6AD
(SG8.8CC)
QIPP and
Acute Overperformance
Risk
12

Christine Caton
CCG working through detailed risk
management strategies/recovery plan to
address projected financial risk and strategies
leading into 203/14 for recurring impact of
under delivery of QIPP and activity over
performance
6
Risk
Summary
Code
Risk
Direction Risk Owner
Score
Key Actions
SO6AE (new) Internal
Financial
Controls and
Audit Health
Risk
12

Christine Caton
Internal Audit Charter - agreed confirm Audit
assurance arrangements across CCG and
CSU
Induction/Training Programme for Governing
Body and Staff
Completed Anti-Bribery Risk Tool
SO7CA
Safeguarding
(CC9.5HCM) Adults Risk
[Zero
Tolerance
Risk]
12

Alex McTeare
Implement the accountability and assurance
framework for safeguarding vulnerable people
Recruit designated doctor and designated
nurse for adult safeguarding
Influence NHSE contracts to include
safeguarding training requirements
Practices to nominate staff to attend 'Alerters'
safeguarding training
SO7FA
(SC8.4CC)
Data Protection
Risk
12

Zeb Allam
Lambeth CCG IG workplan ongoing. Work
underway on fair processing notices for CCG
(June 2013)
Guidance on lawful processing agreed for
continuing care cases to be agreed (June
2013)
Update main IG policies (June 2013)
IG risk assessment of data flows (June 2013)
Staff IG training implemented (Sept 2013)
SO7FB
(SI8.10AE)
Person
Identifiable
Data Risk
12

Zeb Allam
Await final decision announcement expected
re; arrangements being made for CSU data
handling arrangements of PID (Feb 2013).
Expected to be covered under IC wing who
have current legal basis. Teams advised at
London workshop 30th Jan 2013 to consider
how best to work with current data whilst legal
arrangements are being clarified. CSU/CCG
IG leads wrote to NCB lead to consider
application of section 251 - await response
Zero Tolerance Risks: There are a number of areas where the Joint Board has suggested a
zero tolerance for reporting. There are currently four such risks which are highlighted below.
Within Lambeth no ‘zero tolerance’ risk is rated as greater than 12. Risks are duplicated from the
previous table.
Code
Risk
Summary
SO7AA (new) Delivery of
CCG Strategy
Risk [Zero
Tolerance
Risk]
Risk
Direction Risk Owner
Score
9

Janie Conlin; Lucy Day;
Catherine Flynn
7
Key Actions
OD plan delivery (March 2014)
Communications and Engagement action plan
(March 2014)
Implementation CCG Assurance Framework
(March 2014)
Code
Risk
Summary
Risk
Direction Risk Owner
Score
SO7CA
Safeguarding
(CC9.5HCM) Adults Risk
[Zero
Tolerance
Risk]
12

SO7CB
(T9.1HCM)
Safeguarding
Children Risk
[Zero
Tolerance
Risk]
8
SO7DA
(TA9.7AP)
Emergency
Planning Risk
[Zero
Tolerance
Risk]
8
Key Actions
Alex McTeare
Implement the accountability and assurance
framework for safeguarding vulnerable people
Recruit designated doctor and designated
nurse for adult safeguarding
Influence NHSE contracts to include
safeguarding training requirements
Practices to nominate staff to attend 'Alerters'
safeguarding training

Avis Williams-McKoy
Implement the accountability and assurance
framework for safeguarding vulnerable people

Marion Shipman
Internal operational guidance updated.
LCCG Business Continuity Policy to be
drafted (June 2013)
LCCG EPRR Risk Assessment (May 2013).
8
NHS Lambeth Clinical Commissioning Collaborative Board Assurance Framework 2013/14 - Heat Map of Current Residual Risks
Risk Matrix
Likelihood
Impact
Negligible
1
Minor
2
Moderate
3
Major
4
Catastrophic
5
Risk Description
SO1AA
SO2CA
SO2LB
Rare
1
SO3AA
SO3BA
SO1AA
Performance Levels for RTT
SO2CA
A&E Performance
SO2LB
111 monies
SO3AA
Implementation of AMH Prgramme
SO3BA
SO3BB
Community Services Forensic Service Changes
Community Forensic Services and Prison Health
Commissioning
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
Safeguarding Adults [Zero Tolerance Risk]
SO7CB
Safeguarding Children [Zero Tolerance Risk]
SO7DA
Emergency Planning [Zero Tolerance Risk]
SO7EA
Equality Act
SO7FA
Data Protection
SO7FB
Person Identifiable Data
SO3BB
1
2
3
SO7EA
4
5
SO4AA
SO6AA
SO7CB
SO7DA
SO6AB
SO6AC
Unlikely
2
SO6AD
SO6AE
SO7AA
2
4
6
8
10
SO7CB
SO2LB
SO7AA
SO7CA
SO3BB
SO7DA
SO4AA
SO3AA
SO6AB
SO7EA
SO6AC
Possible 3
SO7FA
SO6AD
SO7FB
SO6AE
SO7CA
SO7FA
3
6
SO7FB
9
12
15
16
20
SO2CA
SO3BA
SO1AA
SO6AA
Likely
4
4
8
12
Updated 11/6/2013
Five new risks added:
SO3AA
Almost Certain
5
SO3BA
SO3AA
Implementation of AMH Prgramme
SO3BA
SO3BB
Community Services Forensic Service Changes
Community Forensic Services and Prison Health
Commissioning
SO6AE
Internal Financial Controls
SO7AA
Delivery of CCG Strategy [Zero Tolerance Risk]
SO3BB
SO6AE
5
10
15
20
9
25
SO7AA
Governance and Assurance
Finance To deliver the financial plan in order to
ensure ongoing strategic health goals are met
Objective
Update
Statu
s
To deliver financial Finance
control totals for
 Lambeth PCT achieved a
resource and cash
year end revenue surplus of
and support the
£7.093m against a forecast
delivery of
surplus of £7.0m.
statutory financial
 The PCT has delivered QIPP
duties 2012/13
savings of £14.2m compared
to planned savings of
£15.244m.
 The PCT underspent by
£0.305m against its Capital
Resource Limit in 2012/13
The PCT drew down

Expenditure Position
Acute
Client Groups
Primary Care
Prescribing
Corporate/Hosted
Surplus and Reserves
Total
To deliver financial
control totals for
resource and cash
and support the
delivery of
statutory financial
duties 2013/14
Month 12
Budget
£'000
356,312
193,189
80,337
38,428
33,844
10,159
712,269
Finance
 Lambeth CCG’s financial
performance as at the end of
May 2013 is a surplus of
£780k. This is in line with the
CCGs plan. The month 2
position is shown as break
even for most areas as at this
stage of the year , the data
available is not robust enough
to rely upon. The year end
forecast outturn position for
acute is an overspend of
£6.9m and for non acute an
overspend of £1.4m. The
CCG is still expecting to
10

Action
 Use of 0.5% contingency to address
overspend across acute services, mental
health specialist services and continuing care
 Release of population and incidence reserves
in year
 Implement processes for demand
management of mental health specialist and
continuing care.
 Undertake detailed review of across all areas
of activity to identify in year flexibilities to
implement in-year recovery plan.
 Transition risks managed through application
of 2% fund and agreement and delivery of
transition plan working closely with the SE
London
Month 12
Expenditure
£'000
363,314
194,877
80,287
35,098
32,149
(549)
705,176

Month 12
(Over)/
Underspend
£'000
(7,002)
(1,688)
50
3,330
1,695
10,708
7,093
Month 11
Forecast
(Over)/
Underspend
£'000
(7,422)
(1,051)
904
3,400
2,424
8,745
7,000
 Use of 0.5% contingency to address
overspend across acute services, mental
health specialist services and continuing
care
 Release of population and incidence
reserves in year
 Implement processes for demand
management of mental health specialist and
continuing care.
 Undertake detailed review of across all areas
of activity to identify in year flexibilities to
implement in-year recovery plan.
 Transition risks managed through application
of 2% fund and agreement and delivery of
transition plan working closely with the SE
London Cluster/CSU.



Maintain strong
internal financial
controls
throughout
transition and
beyond and
achieve a clean
bill of audit health
achieve a surplus of
£4..682m. This is in line with
achieving a 1% surplus
target.
The CCGs QIPP savings
target for 2013/14 is
£11.880m gross. As at
month 2 we are expecting an
underdelivery of QIPP of
£1.387m against this target .
.
The CCG’s Capital Resource
limit has not yet been
confirmed.
The CCGs cash limit as at
month 2 is £403.709m.. Cash
drawn down is in line with
plan.

Internal Audit
 Internal Audit plan for
2012/13 is being
delivered




Deliver 2012/13 Internal Audit Plan and
ensure that recommendations are
implemented
Embed understanding across Clinical
Board Members of Internal and
External Audit
Revised Standing Orders, Prime
Financial Policies and Scheme of
Delegation to reflect needs of transition
and CCG
Authorisation
Implementation of NHSCB Finance
Governance Toolkit
Quality Assurance (To ensure systems and processes are in place to
support individual, team and corporate accountability for delivering patient
centred, safe and high quality care)
Objective
To ensure clinical
board receives
appropriate
information to
obtain assurance
on issues of
patient safety
Update
 Development of the risk
approach across the
CCG under discussion
 To work with all staff to
embed implications of
risk appetite beyond
Board level .
Status
Action







11

Develop risk approach across the
CCG.
Ongoing Quality and Serious Incident
monitoring Provider / Commissioner
meetings
Annual provider LCCB seminar
sessions to review and discuss quality
issues.
Ongoing commissioner review of
provider quality issues – triangulation
from numerous sources.
LSL Integrated Governance Committee
- commissioner quality reports for each
provider.
Integrated Governance and
Performance Report continue for LCCB
and Integrated Governance Committee.
GP Quality Alerts
Quality Alerts are now
reported in the Quarterly
Lambeth CCG Quality
Report.
Compliance for
safeguarding
children





Compliance for
safeguarding
adults

To ensure PALs,
complaints and
incident
information is
used to develop

Governance
arrangements for
Safeguarding children
are in place, with the
CCG Children’s
Safeguarding Group
reporting to the IGC.
The remit of the group
has been broadened to
include Looked After
Children (LAC).
Clinical lead and
Executive lead for
safeguarding children
are in place and the
designated doctor and
nurse are embedded in
the CCG structure.
Ann Baxtor is the newly
appointed Lambeth
LSCB independent
chair
Recommendations
following the NSPCC’s
health check of services
for 0-2year olds are
being taken forward and
the national report will
be available end of April
2013.
Adult safeguarding elearning training tool
secured
Contract monitoring of
independent contractors
for adult safeguarding
issues established
SLCSU are commissioned by
the CCG to manage PALS
and Complaints for nonPrimary Care Services.
Management reports are
12


CP training for GP’s is good with good
attendance across Lambeth. However
further work is required with NHS
England in relation to how best to
ensure other independent contractors
comply with safeguarding training
Discussions with NHS England on how
London commissioning will link with
local safeguarding processes are
ongoing





Additional assurance measures to
ensure that dental, pharmacy and
optometry teams within NHS SEL
establish a robust way for monitoring
safeguarding adults training to be
established by September 2013.
Currently there are no contractual
levers to ensure independent
contractors within NHS SEL to
complete safeguarding training.
quality services
National Reporting
and Learning
System (NRLS)
data
received monthly and
Quarterly activity and
analysis will be included in
this report. The Q1 2013/14
report will be included in the
August 2013 Integrated
Governance Performance
Report
 The CCG are in conversation
with NWLCSU regarding
quarterly Complaint and
PALS report relating to
Primary Care and NHSE for
prison health and specialist
commissioning complaint
and incident information.
Activity and Performance
 NRLS Patient Safety Incident
Reports data for NHS
organisations in England and
Wales was published on 20
March 2013 covering
incidents between 1 April
2012 and 30 September
2012
 GSTFT has increased their
reporting over the six months
covered by this report. KCH
and SLaM have reduced
their incident reporting over
the dame period
 GSTFT and KCH saw a
decrease in the percentage
of medication incidents.
GSTFT saw a significant
increase in the percentage of
treatment/procedure
incidents.
 The most significant increase
for KCH was in the category
of patient accidents.
 SLaM reported an increased
percentage in disruptive,
aggressive behaviour
incidents Action to reduce
violence and aggression in
inpatients is within the NHS
Quality Accounts for SLaM.
 SLaM saw a significant
decrease in the number of
incidents reported as ‘no
harm’ or ‘low harm from the
previous reporting period of
94.1% to a much lower
percentage of 79.3% for this
13




Discussions through provider /
commissioner quality and serious incident
meetings
Review of provider risk management /
incident reports.
The next NRLS will be published in
September 2013 and will be included in the
December 2013 Integrated Performance
Report.
Comply with
Freedom of
Information
requests
To ensure the
provision of
effective infection
control
latest report. The national
average percentage for all
mental health organisations
is 90.5%.
Activity and Performance:
 The Q1 2013/14 FOI report
will be included in the August
Integrated Governance and
Performance Report


MRSA : There is a zero
tolerance approach to MRSA
this year. For each MRSA
bacteraemia, a Post Infection
Review investigation panel
meets and reports back to
PHE within 7 working days.
To date, GSTT have had one
case assigned to them, Kings
have had two and Lambeth
none.
CDifficile targets and current
figures for 2013/14 are:
GSTT – 8 to date (target 47)
Kings – 9 to date (target 49)
14

Governance Directorate working with
relevant information providers to improve
response compliance rates further.



The statutory infection control committee is
continues jointly across Lambeth,
Southwark and Lewisham.
 Lambeth and Southwark shared PH service
are providing CCGs with expert IC advice.

On 17th May, a very successful CDI event
was held and an LSL action plan is being
developed.
Performance dashboards
Lambeth Performance against key National Standards
The performance dashboards cover the National Standards as set out in the national
2012/13 Operating Framework. This suite of metrics replaces and builds on the Vital
Signs indicators in use for the previous three years.
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.
Key performance challenges during 2012/13 related to:





A&E 4 hour wait
Diagnostic waits at GSTT and Kings
Mixed sex accommodation at Kings
Achievement of QiPP initiatives
Increasing the uptake in percentage of people receiving NHS healthchecks
15
Lambeth Performance 2012/13
16
NHS Lambeth’s local performance issues 2012/13
Lambeth CCG
March 2013
Outturn 2012/13
Key quality, performance, finance and delivery areas

A&E 4 hour wait: Nationally, over quarter 4 2012/13 and into April 2013/14,
the urgent and emergency care system has been experiencing pressure.
KCH exceeded the target, achieving 96.3% in April. GSTT marginally failed
the target in April achieving 94.6%. The Lambeth and Southwark Urgent
Care Network has undertaken a winter review which will reflect on the
drivers for performance in the last winter, this will be in the context of
service provision across all providers acute, community, primary and
social and the additional funds that were put in place across the system.
NHS England has written to commissioning organisations setting out
national plans to review recent performance and develop plans to recover
performance. Local network plans are expected to feed into this process.

At month 12, NHS Lambeth, NHS Lambeth is underspent by £7.093m against a
planned surplus of £7.0m. QiPP savings initiative plans total £15.255m. The
month 12 performance against QiPP shows a slippage of £1.041m (6.8%).

Referral to Treatment Times: Performance for Lambeth patients across
the last quarter of 2012/13 for the RTT Performance targets were met,
apart from the slight dip in performance in February on admitted care
caused by the backlog reduction at Kings. Over the course of 2012/13
issues have arisen with the number of patients awaiting elective
admission. A plan and trajectory was agreed with Kings to reduce the
number of waiters over the course of the year. This was being delivered
through a combination of extended working on-site and outsourcing to
private providers. Although initial progress was good, the impact of winter
means that the backlog reduction was lower than the agreed plan.

52 week waiters: Over the course of the year both GST and KCH have
reduced the number of long waiters on their list, By March, GST were
reporting 1 urology long waiters for Lambeth, and this reflects a significant
reduction trust wide. The 8 reported in March by KCH were predominately
waiting for Bariatric surgery and orthopaedics. As at the end of April there
were 4 52 week waiters. 1 of these was at GSTT and 3 at Kings.

Diagnostics: By the end of the financial year, Lambeth were marginally
above the required performance threshold. Lambeth’s performance is
mainly driven by performance issues at GST ad KCH. During 2011/12
problems with waits for some diagnostic procedures emerged, as demand
has outstripped available diagnostic capacity. Both KCH and GST have
used a combination of additional in-house capacity, mobile units, and
17
outsourcing to independent providers to redress the imbalance between
capacity and demand.

Waiting times across all interventions are now within more acceptable
limits, largely due to the efforts of providers: new staff have been
deployed; new Saturday workshops and more groups are being offered,
with a new group for people with diabetes and/or depression. The current
average waiting time for counselling is 7 weeks. SLaM, the lead provider,
has begun contract monitoring with the provider of counselling services,
The Awareness Centre, and will discuss the waiting times at their meeting
later this month.
A stakeholder Board has had its first meeting and has begun organising
the 6 month evaluation of the service. Expressions of interest in tendering
for the service will be circulated/advertised, shortly.
Waiting times are still affected by the previous backlog but are slightly
improved. Additional CBT therapists have been mobilised and the service
will be meeting contracted waiting standards by April. The initial contract
monitoring meeting is planned for March.

Mixed sex accommodation: All SEL acute trusts declared compliance with
the single sex accommodation requirements at the start of 2012/13. The
expectation is that there would be no breaches of single sex
accommodation compliance. Although a separate statement of
compliance was required for 2013/14, elimination of mixed sex
accommodation is a NHS constitution requirement.
This requirement is also included in acute contracts, with financial
penalties for all breaches of single sex requirements. The current FT
Compliance Framework does not include any measures for breaches of
single sex accommodation.

MRSA and CDI: For 2012/13, the DH set challenging targets for both
MRSA and CDI reduction with separate targets set for PCTs and acute
trusts. As at the end of March 2013 4 cases of MRSA were reported
against an annual target of 4. For Clostridium Difficile, 59 cases were
reported against a target of 73.

Cancer 62 day waits. Lambeth CCG met this target for Lambeth residents
in 2012/13. However, GSTT did not achieve the 62 day waits for first
definitive treatment. The Trust has invited the Intensive support unit to
review the pathways for 62 days, with particular focus on urology and
lower GI.
The 62 days from screening breach relates to 1.5 of the 11 patients at
GST waiting longer than 62 days. In Quarter 4 the trust was marginally
below the performance threshold (86.4%) for internal patients.
18
Summary of successes arising this period

Smoking quitters: NHS Lambeth CCG has achieved the 2012/13 target.
Latest performance figures show 2269 smoking quitters, against a
2012/13 target of 2262. Further activity is due to be as a number of
practices are yet to report Q4 figures. Final outturn figures for 2012-13 will
be published at the end of June 2013.

Breastfeeding at 6-8weeks: During 2011/12 Lambeth improved its
Breastfeeding prevalence from 44% to 68%. Strong performance has
continued in 2012/13, with Q4 performance the highest ever at 98.61%
coverage and 80.26% prevalence. Work is ongoing with Health Visitors
and through the Baby Friendly Initiative to work with the small number of
women not breastfeeding to ensure they are supported.

Teenage conceptions: Latest Under 18 conception figures (second quarter for
2011) published on the 27th of November 2012 show the quarterly rate was 34.7
per 1000 girls aged 15-17. This is the lowest quarterly rate recorded since data
collection began in 1998. The rate is a 35.1% decrease since the same quarter in
2010. The number of under 18 conceptions was 37 which represents 10 fewer
conceptions than the same quarter in 2010. The rolling quarterly average for
Lambeth is 39 per 1000 girls aged 15-17, again the lowest quarterly average rate
for Lambeth since data collection began.

GSTT achieved 18 week waits in aggregate in line with targets.

NHS Health Checks target exceeded. As at Q4 8% of the eligible population were
offered a Health Check against a quarterly target of 5% for 2012/13.

Chlamydia Screening. Lambeth continues to be ranked first in England as highest
PCT achieving 49.5%.

Breastfeeding:

Access to NHS Dental Care. The 2012/13 target of 156 804 was exceeded with
161 264 patients accessing NHS Dental Care. Lambeth continues to perform well
in this area.

CDiff: Lambeth achieved its 2012/13 C.Diff target reporting 59 cases against a
trajectory of 73.
Summary of risks and issues this period, plus actions taken to address or
mitigate each
Performance
Risk or Issue
Finance
Details / Cause
Action being taken and by
when
19
Over performance
on acute contracts
Acute sector over performance at
month 12 of £7.002m
Active management of the contract
– monthly validation of activity,
robust claims management and
query process, application of
agreed contract terms related to
risk share, contractual KPIs and
penalties.
Action to manage emergency
pressures – Whole systems work
to manage emergency pressures.
Implementation of agreed whole
systems actions to manage acute
emergency pressures agreed with
both GST and KCH.
Monitoring and management of
RTT performance: Monthly
meetings with GST and KCH to
review in detail RTT delivery
against agreed action plans and
performance trajectories.
Active implementation of CCG led
QIPP: work to review and ensure
action is implemented to support
the delivery of CCG led QIPP
initiatives over the next year.
Performance
18 week wait and Underachievement of some The DoH and SEL Sector
Diagnostics
RTT Standards at GSTT and continue to monitor these
Kings
targets and programme for bimonthly
review
by
the
intensive
support
team
agreed with the Trust.
A&E 4 hour
Challenging
performance Both GSTT and KCH met the
across SEL during 2012/13
2012/13 target of 95%,
however performance against
this measure continues to be
challenging. Weekly
conference calls continue to
take place and performance
closely monitored. For April
GSTT narrowly missed the
target achieving 94.6%. KCH
achieved the target at 96.3%.
Healthcare
Challenging targets were set GSTT CDI Action Group has
Acquired
for C.Diff reduction due to been established and an
Infection: CDiff
increased sensitivity of tests at action
plan
has
been
GSTT.
developed and is being
implemented.
Other current stocktake actions (if not included above)
Action
Status / Change this period
20
Diagnostics
This continues to be challenging. A penalty
clause has been included in the contract for
2013/14 for failure to meet this target.
21
National Performance Measures
22
National Performance Measures
23
National Performance Measures
24
Operational Delivery

Planned Care Programme
To develop and deliver an outpatient strategy, which reduces the risk
of premature mortality and improve the quality of life by: sustaining
the control of long term conditions (including HIV) and preventing risk
of acute events in people with long term conditions
Senior Responsible Officer: Moira McGrath Director
Commissioning
Clinical Leads: John Balazs/Ruth Jeffery/Adrian MacLachan
Objective
Update
Status Action
To deliver
reductions in
outpatient
attendances
(referral
management
and practice
based work)
Engagement in GP Delivery
scheme
2013/14 Scheme
The new scheme is currently
being agreed with key
stakeholders including member
practices and LINKs/PPG
Networks.
2013/14 Scheme will focus on
quality of care for our patients.
Steering Group met recently and
the following areas were
discussed:
i) Increased utilisation of Choose
and Book
ii) Urgent Care access
(capacity/demand/action plan)
iii) Develop PPG within the
practices (focus on hard to reach
patients who don’t ordinarily
access care within general
practice
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.
25
of
Care
Pathways
Deadline for sign off of the
scheme is 30th June 2013.
Choose & Book
London CAB Dashboard
indicates 29% CAB utilisation in
Lambeth in April 2013. Utilisation
has increased steadily from 23%
in December 2012.
Focused work on Trust DOS
continues. CQUIN for CAB
agreed at KCH for 50% of
services to be directly
bookable by Q4.
Lambeth and Southwark have
developed their local activity
dashboards to help to identify
areas of improvement.
Rolling programme of training
sessions continues.
Ongoing training sessions being
carried out with Clinical Facilitator
Team
To improve
health
outcomes for
people with
diabetes and
COPD/Asthma
To design,
implement and
monitor
appropriate
pathways for
defined
elective and
LTC areas
Diabetes
Community clinics are running
across three sites in Lambeth;
Gracefield Gardens, Springfield
Medical Centre and the Akerman
Health Centre. Strong integrated
working with GSTT, and an
improvement with integration at
KCH due to the commencement
of fortnightly clinics at Akerman
Health Centre.
DMI developing patient portal
enhancing self-management of
an LTC.
An online portal that enables
people living with diabetes to
26
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 selfmanagement and embed care
planning.
More activated patients
Better diabetic control
Increased goal attainment
Reduced complications
Better access of health
services
Developed requests from the
patient forum, linked to DH
Mandate: patient records
available online by 2015
SLAM has developed their
patient portal – currently piloting
and using myhealthlocker with
patients. KHP preferred patient
portal of choice. Opportunity to
use myhealthlocker –compatibility
with local clinical systems and
has IG clearance
DMI aims to provide proof of
concept – 5 practices. Proof of
concept (£30.5k)
Early indications from QOF 12/13
– Additional 1200 patients
diagnosed in Lambeth during
12/13
Patients controlled with
cholesterol <5% 11/12 – 72%
12/13- 73%
We need to look at DESMOND or
alternative structured education
as Lambeth has dipped slightly in
12/13. Could be because of cook
and eat offered in Lambeth but
need to drill down.
Active recruitment for 15 DUK
Community Champions. Second
wave of recruiting and training
care planning advocates.
24% of patients in L&S have a
collaboratively produced care
27
plan – results from 12/13 DMI
Incentive Scheme (survey
monkey)
The community diabetes service
in Lambeth has been shortlisted
for a HSJ/Nursing Times award
for service integration. The
interview with the panel took
place in May and the outcome
will be announced on the 9th July
2013.
DMI incentive scheme for
practices to enable reduction in
primary care provision is now
ready to roll out.
Diabetes will continue to be a
focus area for 2013/14.
Cardiovascular
Community service –
Community service start up
confirmed and clinics will be live
from June 2013. Performance
against QIPP to be evaluated in
the light of delayed start up.
Providers have attended one
Locality meeting and plan to
attend the other two.
Ambulatory BP – Operational
and maintenance issues have
arisen and a communique will be
sent out to all practices to cover
common queries and issues.
VSCan – review meeting has
been organised for June 2013.
Community heart failure
service – ongoing review of the
service and the education
component.
Respiratory
Respiratory
Modelling of revised QIPP targets and
28
Single point of referral for COPD
referrals to be commissioned
jointly across Lambeth and
Southwark to support practices in
referral management.
expected performance; mitigating actions
across other areas to be agreed.
QIPP performance targets
revised in the light of learning
from first quarter of new
Integrated Respiratory Team.
Risk that QIPP against new
outpatient attendances will not be
realised. However, QIPP savings
in emergency admissions,
readmissions, length of stay and
medicines management likely to
be significantly more than
projected.
MSK
Work commenced on review of
back pain pathway. Impact
projected for 14/15 QIPP.
MSK tender
Report made to IGC in April
2013. Agreed to bring back the
results of the engagement work
to a future IGC meeting. This will
delay the original tendering
timetable.
Communique sent to all potential
bidders regarding the delay in the
tendering timetable.
Workstreams progressing as per
project plan in the meantime
around estates, IT and HR.
Planned visits to all GP Practices
providing a LES Physiotherapy
and Osteopathy service are on
track to be completed with 8 0ut
of 11 visits completed to date
(88%).
TUPE questionnaires have been
distributed to incumbent
providers and are being returned.
29
MSK tender
Further report to be made to IGC following
completion of engagement work.
Focus on engagement work and progress with
project plan.
Second patient event focussed
on users of GP Practice Based
Services and direct access
physiotherapy to be organised for
July 2013.
Gynaecology
Following a redesign event in
May the key areas for immediate
implementation are:
1. Review AQP for continence
services and direct community
access to urogynae
physiotherapy
2. Review Practice LES
arrangements to increase
practice based fitting of coils
for menorrhagia
3. Review and re-launch
gynaecology checklists along
with a comprehensive
programme of consultant led
GP education (as per model for
dermatology) to support peer
to peer review
4. Review pathway for 2WW
referrals and review and relaunch checklist for ultrasound
scans. Consider expansion of
direct access to scans in place
of 2WW and gynaecology
outpatient referrals where
further treatment is not
anticipated.
The above anticipated to be
implemented during Q2 to realise
QIPP savings in quarter 3 and for
the remainder of the year. Further
work on potential for community
service development is
underway.
Pain
30
Gynaecology
Progress with prioritised actions across
Lambeth and Southwark.
Progression of Charity bid for a
multidisciplinary community
based pain service is being
developed. Proposal for 14/15
implementation.
Ophthalmology
Review performance at Eye Group in June
2013.
Ophthalmology
MECS service currently on track
against QIPP targets. 6
optomotrists practices currently
participating in Lambeth.
Issue of patient information being
submitted with invoices reported
and process amended to ensure
no future incident.
First quarter performance to be
discussed at Eye Group in June
2013.
Dermatology
A full evaluation of the eczema
education service has been
submitted to the CCG. The CCG
has now indicated to the Trust
that the service will not be
recommissioned until a review of
the service specification has
been completed. Several issues
were raised on the review of the
evaluation by the CCG in relation
to source of referrals to the
service and actual activity. This
will be reviewed and discussed
with the Provider with a view to
agreeing a revised specification.
Gastro
Launch of mandatory use of
referral checklists for main
symptom driven reason for
referrals across Lambeth and
Southwark from 1st July.
Projected impact to achieve QIPP
target. It is hoped that
implementation of gastro
checklists can then be used as
an exemplar for checklists in
31
Agree timescales for evaluation.
other specialty areas.
Neurology
Service evaluation of the
Headache service was completed
in March 2013. A
recommendation will go to the
new primary care commissioning
and quality group for a final
decision on the recommissioning
(or otherwise) of this service at
this meeting. The contract for the
current service was temporality
extended pending a decision.
To improve the
quality and
effectiveness
of care
pathways
across and HIV
provision
Activity & Performance
For period Aug to Feb 2013, 11
Lambeth practices involved in the
HIV new patient testing pilot
registered 11372 16-59 years
olds of these 860 were tested for
HIV.
Sexual Health in Practice (SHIP)
primary care training: 3 Lambeth
GP/ nurse peer trainers recruited;
May/June training (3rd LSL round)
being advertised

Transition plan for
implementation of HIV
care and support service
model in draft
Finance
 Confirmed Risk to 2012-13
QIPP from Lambeth &
Southwark RSH service as
tariff implementation in
12/13 has stalled as will
require LA sign off across
all 31 LA’s. review of
options underway
Performance/Process
 Pan London HIV Prevention
Contracts have transferred
successfully to Lambeth
32

HIV evaluation being finalised and audit of
positive cases is in progress

2013/14 SHIP LSL training rounds (3)
to be administered locally by SEL SH
& HIV Network - contractual
arrangements to be developed, and
peer trainer resource strengthened





Work programme has been
initiated with specialist Mental
Health provider (CASCAID) to
support 30% activity and finance
shift from CASCAID/SLaM to
various community based
providers. This change will be
implemented from July2013.
Evaluation of African HIV
Prevention Programme delayed in
view of PH transition and contract
novation
Review of Pan London HIV
prevention has started..
Responsibility of LSL, with Lambeth
Council hosting, for Pan London
HIV Prevention Programme
commenced on April 1st and a
working group has been
established.
Council, as the host from
April 1st.
Norwood Hall – Activity
Implement
 Financial close
business case
achieved.
and secure
 Governance process
services
for Norwood Hall agree
including
with LBL – joint project
procurement of
Board.
GP Suite 2.
 Review proposed
Due to open
service strategy
Spring 2014
 Develop Service
Specification for GP
Suite 2
Akerman Road Activity:
– Develop an
 This flagship site is a
integrated
key enabler for
Neighbourhood
implementation of NHS
Resource
Lambeth Strategic
Centre.
Plan.
 Review governance
process for building
board
 Opening event was
held and well attended
by stakeholders and
patients
33



Develop procurement strategy for
GP Suite 2
Draw up action plan for operational
implementation for Norwood Hall
Commence procurement process

Action:
 Review utilisation matrix for new
premises.
 Implement/evaluate Service
Integration Plan.

Outpatient attendances - Practice Benchmarking Data
North Lambeth Locality First Attd Rates Per 1000 Oct 12 - Mar 13
20.0
BECKETT HOUSE PRACTICE
18.0
BINFIELD ROAD SURGERY
16.0
DR IRANI
DR IVOR FERREIRA
14.0
Rates Per 1000
DR WICKREMESINGHE SSG
12.0
HURLEY CLINIC
LAMBETH WALK GROUP PRACTICE
10.0
MAWBEY GROUP PRACTICE
8.0
RIVERSIDE MEDICAL PRACTICE
SPRINGFIELD PRIMARY CARE CENTRE
6.0
STOCKWELL GROUP PRACTICE
4.0
THE SOUTH LAMBETH RD PRACTICE
2.0
THE VAUXHALL SURGERY
WATERLOO HEALTH CENTRE
0.0
NORTH LAMBETH
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
LAMBETH
Month
North Lambeth Locality First Attd Rates Per 1000 Oct 11 - Mar 12
25.0
BECKETT HOUSE PRACTICE
BINFIELD ROAD SURGERY
20.0
DR IRANI
DR IVOR FERREIRA
Rates Per 1000
DR WICKREMESINGHE SSG
15.0
HURLEY CLINIC
LAMBETH WALK GROUP PRACTICE
MAWBEY GROUP PRACTICE
10.0
RIVERSIDE MEDICAL PRACTICE
SPRINGFIELD PRIMARY CARE CENTRE
STOCKWELL GROUP PRACTICE
5.0
THE SOUTH LAMBETH RD PRACTICE
THE VAUXHALL SURGERY
WATERLOO HEALTH CENTRE
0.0
Oct-11
Nov-11
Dec-11
Jan-12
Month
34
Feb-12
Mar-12
NORTH LAMBETH
LAMBETH
North Lambeth Locality F/UP Attd Rates Per 1000 Oct 12 - Mar 13
50.0
BECKETT HOUSE PRACTICE
45.0
BINFIELD ROAD SURGERY
40.0
DR IRANI
DR IVOR FERREIRA
35.0
Rates Per 1000
DR WICKREMESINGHE SSG
30.0
HURLEY CLINIC
LAMBETH WALK GROUP PRACTICE
25.0
MAWBEY GROUP PRACTICE
20.0
RIVERSIDE MEDICAL PRACTICE
15.0
SPRINGFIELD PRIMARY CARE CENTRE
STOCKWELL GROUP PRACTICE
10.0
THE SOUTH LAMBETH RD PRACTICE
THE VAUXHALL SURGERY
5.0
WATERLOO HEALTH CENTRE
0.0
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
NORTH LAMBETH
LAMBETH
Month
North Lambeth Locality F/UP Attd Rates Per 1000 Oct 11 - Mar 12
40.0
BECKETT HOUSE PRACTICE
35.0
BINFIELD ROAD SURGERY
DR IRANI
Rates Per 1000
30.0
DR IVOR FERREIRA
DR WICKREMESINGHE SSG
25.0
HURLEY CLINIC
LAMBETH WALK GROUP PRACTICE
20.0
MAWBEY GROUP PRACTICE
RIVERSIDE MEDICAL PRACTICE
15.0
SPRINGFIELD PRIMARY CARE CENTRE
STOCKWELL GROUP PRACTICE
10.0
THE SOUTH LAMBETH RD PRACTICE
5.0
THE VAUXHALL SURGERY
WATERLOO HEALTH CENTRE
0.0
NORTH LAMBETH
Oct-11
Nov-11
Dec-11
Jan-12
Month
35
Feb-12
Mar-12
LAMBETH
South East Locality First Attd Rates Per 1000 Oct 12 - Mar 13
30.0
APMS SOLUTIONS LTD
BRIXTON WATER LANE PRACTICE
25.0
BROCKWELL PARK SURGERY
CROWN DALE MEDICAL CENTRE
DRS PATEL & CRESSWELL
20.0
Rates Per 1000
HERNE HILL GROUP PRACTICE
HERNE HILL ROAD MEDICAL PRACTICE
IVEAGH HOUSE SURGERY
15.0
MYATTS FIELD HEALTH CENTRE
NORWOOD SURGERY
PAXTON GREEN GROUP PRACTICE
10.0
THE CORNER SURGERY
THE DEERBROOK SURGERY
THE KNIGHTS HILL SURGERY
5.0
THE ROSENDALE SURGERY
THE TULSE HILL PRACTICE
South East
0.0
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
LAMBETH
Month
South East Locality First Attd Rates Per 1000 Oct 11 - Mar 12
25.0
APMS SOLUTIONS LTD
BRIXTON WATER LANE PRACTICE
BROCKWELL PARK SURGERY
20.0
CROWN DALE MEDICAL CENTRE
DRS PATEL & CRESSWELL
Rates Per 1000
HERNE HILL GROUP PRACTICE
15.0
HERNE HILL ROAD MEDICAL PRACTICE
IVEAGH HOUSE SURGERY
MYATTS FIELD HEALTH CENTRE
NORWOOD SURGERY
10.0
PAXTON GREEN GROUP PRACTICE
THE CORNER SURGERY
THE DEERBROOK SURGERY
5.0
THE KNIGHTS HILL SURGERY
THE ROSENDALE SURGERY
THE TULSE HILL PRACTICE
South East
0.0
Oct-11
Nov-11
Dec-11
Jan-12
Month
36
Feb-12
Mar-12
LAMBETH
South East Locality F/UP Attd Rates Per 1000 Oct 12 - Mar 13
50.0
APMS SOLUTIONS LTD
45.0
BRIXTON WATER LANE PRACTICE
BROCKWELL PARK SURGERY
40.0
CROWN DALE MEDICAL CENTRE
35.0
DRS PATEL & CRESSWELL
Rates Per 1000
HERNE HILL GROUP PRACTICE
30.0
HERNE HILL ROAD MEDICAL PRACTICE
IVEAGH HOUSE SURGERY
25.0
MYATTS FIELD HEALTH CENTRE
NORWOOD SURGERY
20.0
PAXTON GREEN GROUP PRACTICE
15.0
THE CORNER SURGERY
THE DEERBROOK SURGERY
10.0
THE KNIGHTS HILL SURGERY
THE ROSENDALE SURGERY
5.0
THE TULSE HILL PRACTICE
South East
0.0
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
LAMBETH
Month
South East Locality F/UP Attd Rates Per 1000 Oct 11 - Mar 12
45.0
APMS SOLUTIONS LTD
40.0
BRIXTON WATER LANE PRACTICE
BROCKWELL PARK SURGERY
35.0
CROWN DALE MEDICAL CENTRE
DRS PATEL & CRESSWELL
30.0
Rates Per 1000
HERNE HILL GROUP PRACTICE
HERNE HILL ROAD MEDICAL PRACTICE
25.0
IVEAGH HOUSE SURGERY
MYATTS FIELD HEALTH CENTRE
20.0
NORWOOD SURGERY
PAXTON GREEN GROUP PRACTICE
15.0
THE CORNER SURGERY
THE DEERBROOK SURGERY
10.0
THE KNIGHTS HILL SURGERY
THE ROSENDALE SURGERY
5.0
THE TULSE HILL PRACTICE
South East
0.0
Oct-11
Nov-11
Dec-11
Jan-12
Month
37
Feb-12
Mar-12
LAMBETH
South West Locality First Attd Rates Per 1000 Oct 12 - Mar 13
25.0
BALDRY GARDENS FAMILY PRACTICE
BRIXTON HILL GROUP PRACTICE
CLAPHAM FAMILY PRACTICE
20.0
CLAPHAM PARK GROUP PRACTICE
DR ALA'S SURGERY
DR CURRAN & PARTNERS
DR SHEILA SANTAMARIA
DR. GUNASUNTHARAM SURGERY
15.0
Rates Per 1000
DR. MASTERTON'S SURGERY
EDITH CAVELL PRACTICE
HETHERINGTON AT THE PAVILION
HETHERINGTON GROUP PRACTICE
PALACE ROAD SURGERY
10.0
SANDMERE ROAD PRACTICE
STREATHAM COMMON GROUP PRACTICE
STREATHAM HIGH PRACTICE
STREATHAM PLACE SURGERY
THE COURTYARD SURGERY
5.0
THE EXCHANGE SURGERY
THE STREATHAM HILL GROUP PRACTICE
THE VALE SURGERY
VALLEY ROAD SURGERY
South West
0.0
Lambeth
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
Month
South West Locality First Attd Rates Per 1000 Oct 11 - Mar 12
25.0
BALDRY GARDENS FAMILY PRACTICE
BRIXTON HILL GROUP PRACTICE
CLAPHAM FAMILY PRACTICE
20.0
CLAPHAM PARK GROUP PRACTICE
DR ALA'S SURGERY
DR CURRAN & PARTNERS
DR SHEILA SANTAMARIA
DR. GUNASUNTHARAM SURGERY
15.0
Rates Per 1000
DR. MASTERTON'S SURGERY
EDITH CAVELL PRACTICE
HETHERINGTON AT THE PAVILION
HETHERINGTON GROUP PRACTICE
PALACE ROAD SURGERY
10.0
SANDMERE ROAD PRACTICE
STREATHAM COMMON GROUP PRACTICE
STREATHAM HIGH PRACTICE
STREATHAM PLACE SURGERY
THE COURTYARD SURGERY
5.0
THE EXCHANGE SURGERY
THE STREATHAM HILL GROUP PRACTICE
THE VALE SURGERY
VALLEY ROAD SURGERY
South West
0.0
Lambeth
Oct-11
Nov-11
Dec-11
Jan-12
Month
38
Feb-12
Mar-12
South West Locality F/UP Attd Rates Per 1000 Oct 12 - Mar 13
50.0
BALDRY GARDENS FAMILY PRACTICE
45.0
BRIXTON HILL GROUP PRACTICE
CLAPHAM FAMILY PRACTICE
40.0
CLAPHAM PARK GROUP PRACTICE
DR ALA'S SURGERY
DR CURRAN & PARTNERS
35.0
DR SHEILA SANTAMARIA
DR. GUNASUNTHARAM SURGERY
Rates Per 1000
30.0
DR. MASTERTON'S SURGERY
EDITH CAVELL PRACTICE
HETHERINGTON AT THE PAVILION
25.0
HETHERINGTON GROUP PRACTICE
PALACE ROAD SURGERY
20.0
SANDMERE ROAD PRACTICE
STREATHAM COMMON GROUP PRACTICE
STREATHAM HIGH PRACTICE
15.0
STREATHAM PLACE SURGERY
THE COURTYARD SURGERY
10.0
THE EXCHANGE SURGERY
THE STREATHAM HILL GROUP PRACTICE
THE VALE SURGERY
5.0
VALLEY ROAD SURGERY
South West
0.0
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
Lambeth
Month
South West Locality F/UP Attd Rates Per 1000 Oct 11 - Mar 12
45.0
BALDRY GARDENS FAMILY PRACTICE
40.0
BRIXTON HILL GROUP PRACTICE
CLAPHAM FAMILY PRACTICE
CLAPHAM PARK GROUP PRACTICE
35.0
DR ALA'S SURGERY
DR CURRAN & PARTNERS
DR SHEILA SANTAMARIA
30.0
DR. GUNASUNTHARAM SURGERY
Rates Per 1000
DR. MASTERTON'S SURGERY
25.0
EDITH CAVELL PRACTICE
HETHERINGTON AT THE PAVILION
HETHERINGTON GROUP PRACTICE
20.0
PALACE ROAD SURGERY
SANDMERE ROAD PRACTICE
STREATHAM COMMON GROUP PRACTICE
15.0
STREATHAM HIGH PRACTICE
STREATHAM PLACE SURGERY
THE COURTYARD SURGERY
10.0
THE EXCHANGE SURGERY
THE STREATHAM HILL GROUP PRACTICE
5.0
THE VALE SURGERY
VALLEY ROAD SURGERY
South West
0.0
Oct-11
Nov-11
Dec-11
Jan-12
Month
39
Feb-12
Mar-12
Lambeth

Unplanned Care Programme
Operates across two main work streams:

Frail Older People - To improve the quality of care for and
reduce the number of avoidable hospital admissions and
readmissions for frail older people

Urgent Care - Design and implement improved unplanned
care services across the two boroughs that support improved
health outcomes through greater planned and co-ordinated
care. (Urgent Care Centres, OOHs and 111)
Senior Responsible Officer: Andrew Eyres Managing Director
Clinical Leads: Gillian Ellsbury/Patricia Kirkman
Objective
Update
Status Action
Development of
Activity

admission avoidance
 Total activity from Jan
schemes
2012 to end May 2013
was 560 referrals with
numbers of referrals

varying from a peak of 82
in February 2013 to a low
of 22 in Dec 2012

This is reflective of the
demographic for those
practices

Reason for referral
Admission avoidance 42%
Advanced discharge 27%
Case management 23%
Triage 8%

Referrals to the ERR team
from Dec 2010 to May
2013 were 824 of which
714 (86%) have been
accepted. Continue to
average 55 referrals per
month
Referral source
A&E – 278


Details of the patient
registration for the top 5
are:Crown Dale – 112
Paxton Green – 109
Rosendale – 64
Tulse Hill – 63
Herne Hill - 43
40




Business case for Homeward roll out
completed and to be presented at
June Admission Avoidance
Programme Board.
Funding for the Lambeth and
Southwark schemes has been
agreed during contract negotiations
with GSTT and KCH – total £5.6
million
Readmission audits due to take
place June/July
Meeting with LMC to take place
June/July to agree the CCG
approach on commissioning the
medical model of Homeward
Review of other schemes funded by
admission avoidance money
Ongoing monitoring of KPIs and
adjustment of model as required
GP – 212
Hosp discharge – 99
Social care - 88
Nearly 90% of the referrals are
for people over 60 with the
highest being in the 80-89 age
bracket (38%)
Integrated Care
Programme

Activity

Targeting actions to improve
performance as many of the targets
have slipped
 SLIC time out session at end of May
identified the following 4 priority
areas:Primary care
Simplified Discharge Process
Dementia
Proactive identification of need by home
care worker
Registers
45% of GP practices across
L&S have signed up (target
100%)
% of OP on a register 24%
(target 50%0

Health needs
assessments
HHNA completed in May 13 –
180 (target 1164) 17% of target


Integrated care managers
47% in place (target 100%)
End of life care

All CMDTs in place –
averaging discussion on
10 patients per meeting
against target of 14

Hot clinics and geriatric
hotlines in place

Activity





CMC register went live
February 2013
Over 75% of GP practices
have received training on
‘Co-ordinate my Care’ the
new EOLC Register
The new Macmillan GP
post has been filled
The Macmillan practice
nurse course still running
CCG Macmillan nurse
post will be advertised
again more widely as poor
response to previous
41







Establishment of trainer role within
providers to ensure new staff
receive CMC training
Dissemination of and training on
new resus policy in
Recruit to new Macmillan Nurse
Continued work with nursing homes
and roll out of care home GSF
Mainstream community health
CQUIN requirements
Continue to monitor the impact on
recent publicity on the use of LCP


Reablement
practice nurse adverts
St Christopher’s Hospice
inpatient unit remains
closed until later in the
summer for urgent building
works. Alternative
arrangements have been
put in place which are 24/7
Hospice at Home and
inpatient beds on the
Lewisham Hospital site.
Other services including
day and outpatient and
homecare will continue to
operate as normal.
Lambeth CCG also has a
contract with Trinity
Hospice.
Work with LSL Care
Homes undertaken
following Southwark
Coroner’s Rule 43 ruling
re: use of DNACRP and
LCP in care homes
Discussions are at an advanced
stage between Lambeth Adult and
Community Services and GSTT
Community Health Services to
develop a reablement service
integrated
with
the
GSTT
intermediate care service.
LBL will commission GSTT to
provide the service. GSTT will
provide management, supervision,
and therapy support and will subcontract home care workers and
office functions via an external
provider.

Monitor the impact of inpatient bed
closure at St Christopher’s Hospice

Response to Rule 43 issued by
Southwark Coroner’s Court

Continue with short term
arrangement and monitor closely
Finalise service specification and
award contract
GSTT to commence tender process
for subcontracted services
Link into work being done as part of
KHP ICP




It is anticipated that the contract will
go live in October 2013 and be for a
3 year period.
Intermediate care
A service co-ordinator has been
appointed to oversee the current
arrangements and to ensure
reassessments are carried out and
duplication is reduced.
 Building work on the
LCCC has now been
completed and the ground
floor is now fully
operational
42


Actions complete – will be removed
from future reports



To carry out review to
better understand the
reasons for increased
pressure on A&E
during 2012/13
Winter Planning
Go live date for Amputee
Rehabilitation Unit is 17th
June 2013. Staff in place,
orientation week 10th June
prior to unit opening
Work continues with the
Friends of the LCCC who
are broadly positive with
regards to setting up a
new membership to
support all the services on
the site
New service model for
inpatient intermediate care
now in place including 7/7
therapy support
Activity
 Adjust programme for
2013/14 depending on
outcome of review.
 Submit Winter Pressure
Management Review
Template was submitted
mid April 2013.
 In response to the
guidance issued by NHS
England on 31st May 2013
on the delivery of the A&E
4 hour operational
standard – Recovery &
Improvement Plan. Key
documents including
recovery plans for both
GST and KCH were
submitted were submitted
to NHS England, on behalf
of Lambeth & Southwark
Urgent Care Network.

Activity
 Winter Pressure
Teleconferences for
2012/13 were extended
until the end on May 2013.
The teleconferences have
now been stood down,
however performance
continues to be monitored.

A Winter Pressures Review
Framework has been developed in
partnership with Southwark.

Continue to manage and monitor
performance and ensure that
proactive steps are taken to ensure
system is resilient
Both GSTT and KCH have
reported that they have found the
teleconferences to be supportive,
and an effective mechanism to
raise operational issues such as
delayed discharges or
repatriations.
Both KCH and GSTT have
achieved their annual target:
GSTT 95.12% and KCH 95.40
%(All types).



43
To re-commission
urgent care centres



Implementation of
the 111 programme
for non-emergency
healthcare needs

GSTT UCC
Specification finalised.
Case for Change was
presented at the
Unplanned Care
Programme Board in
March 2013. Further
options regarding the
new service are being
explored at present and
an option appraisal has
been was presented at
the Unplanned Care
Programme Board in
May 2013. This
document has now
been distributed to the
clinical at leads at
Southwark CCG,
deadline for comments
is Friday 7th June. The
recommendation will
then be signed off via
chairs action via
Unplanned Care
Programme Board.
New service will
commence autumn
2013.
The 111 service has
now been launched in
Bexley, Bromley and
Greenwich (BBG). Due
to some capacity issues
the service across
Lambeth. Lewisham
and Southwark (LSL)
has not yet gone live. A
soft launch date has yet
to be agreed. This will
require comprehensive
sign off from NHS
England before this can
be agreed. There
continues to be
considerable
improvements with call
back times and the
provider has shared
capacity modelling with
commissioners to offer
44




Explore pilot co-location of
GP OOH in A&E
Draft Procurement timeline.
Reconfiguration of St
Thomas’ ED and UCC is due
to commence – Autumn
2013.
Anticipated completion of St
Thomas’ ED refurbishment is
currently February 2015.






Population of the DoS is
complete
The DoS has been checked
and tested in liaison with
clinical commissioners and
providers
There has been a series of
111 events to ensure that all
stakeholders are sufficiently
briefed on the role and remit
of 111 and to ensure that it
sufficiently meets the needs of
local people.
Robust risk register has been
shared with commissioners
across SEL.



Set up and review
schemes to divert
patients away from
A&E to Primary
Care


further reassurance.
Lambeth CCG have been
heavily involved in the
population of the
Directory of Services
(DoS), and in the process
of conducting rigorous
‘break the system’ tests
to ensure that the data is
accurate and that
appropriate advice is
given to all patients for all
conditions.
The ranking strategy has
been agreed which
determines which
services are suggested
to patients depending
upon their condition. For
example, should a
patient have symptoms
which suggest an ear
infection, a GP would be
ranked higher than an
A&E or UCC and thus a
patient would be likely to
seek treatment at their
home GP rather than
attending A&E.
NHS SEL PMO is now
responsible for the
ongoing governance of
the 111 Programme as of
1st April 2013.
The funding for the
PALS officer at St.
Thomas’ ED remains to
be funded by Lambeth
CCG. However this
funding is to be
transferred to GSTT so
that they can recruit into
the role, and be
responsible for the line
management.
Primary Care Diversion
scheme operational via
Waterloo Health Centre
and Lambeth Walk (All
slots utilised)
45



Scheme reviewed and found
to be successful in
redirecting patients, and
have significant impact in
terms of encouraging the use
of Primary Care.
Recommissioned until
November 2013.
Emergency Admission Rates by Practice
South West Locality Oct 11 - Mar 12
BALDRY GARDENS FAMILY PRACTICE
BRIXTON HILL GROUP PRACTICE
12.0
CLAPHAM FAMILY PRACTICE
CLAPHAM PARK GROUP PRACTICE
DR ALA'S SURGERY
10.0
DR CURRAN & PARTNERS
DR SHEILA SANTAMARIA
DR. GUNASUNTHARAM SURGERY
DR. MASTERTON'S SURGERY
8.0
EDITH CAVELL PRACTICE
rates Per 1000
HETHERINGTON AT THE PAVILION
HETHERINGTON GROUP PRACTICE
6.0
PALACE ROAD SURGERY
SANDMERE ROAD PRACTICE
STREATHAM COMMON GROUP
PRACTICE
STREATHAM HIGH PRACTICE
4.0
STREATHAM PLACE SURGERY
THE COURTYARD SURGERY
THE EXCHANGE SURGERY
2.0
THE STREATHAM HILL GROUP
PRACTICE
THE VALE SURGERY
VALLEY ROAD SURGERY
SOUTH WEST
0.0
Oct 2011
Nov 2011
Dec 2011
Jan 2012
Feb 2012
Mar 2012
South West Locality Oct 12 - Mar 13
LAMBETH
BALDRY GARDENS FAMILY PRACTICE
BRIXTON HILL GROUP PRACTICE
16.0
CLAPHAM FAMILY PRACTICE
CLAPHAM PARK GROUP PRACTICE
14.0
DR ALA'S SURGERY
DR CURRAN & PARTNERS
DR SHEILA SANTAMARIA
12.0
DR. GUNASUNTHARAM SURGERY
DR. MASTERTON'S SURGERY
EDITH CAVELL PRACTICE
10.0
rates Per 1000
HETHERINGTON AT THE PAVILION
HETHERINGTON GROUP PRACTICE
8.0
PALACE ROAD SURGERY
SANDMERE ROAD PRACTICE
STREATHAM COMMON GROUP PRACTICE
6.0
STREATHAM HIGH PRACTICE
STREATHAM PLACE SURGERY
THE COURTYARD SURGERY
4.0
THE EXCHANGE SURGERY
THE STREATHAM HILL GROUP PRACTICE
2.0
THE VALE SURGERY
VALLEY ROAD SURGERY
SOUTH WEST
0.0
Oct 2012
Nov 2012
Dec 2012
Jan 2013
46
Feb 2013
Mar 2013
LAMBETH
South East Locality Oct 11 - Mar 12
APMS SOLUTIONS LTD
16.0
BRIXTON WATER LANE PRACTICE
BROCKWELL PARK SURGERY
14.0
CROWN DALE MEDICAL CENTRE
DRS PATEL & CRESSWELL
12.0
HERNE HILL GROUP PRACTICE
HERNE HILL ROAD MEDICAL PRACTICE
Rates Per 1000
10.0
IVEAGH HOUSE SURGERY
MYATTS FIELD HEALTH CENTRE
8.0
NORWOOD SURGERY
PAXTON GREEN GROUP PRACTICE
6.0
THE CORNER SURGERY
THE DEERBROOK SURGERY
4.0
THE KNIGHTS HILL SURGERY
THE ROSENDALE SURGERY
2.0
THE TULSE HILL PRACTICE
SOUTH EAST
0.0
LAMBETH
Oct 2011
Nov 2011
Dec 2011
Jan 2012
Feb 2012
Mar 2012
South East Locality Oct 12 - Mar 13
APMS SOLUTIONS LTD
BRIXTON WATER LANE PRACTICE
16.0
BROCKWELL PARK SURGERY
CROWN DALE MEDICAL CENTRE
14.0
DRS PATEL & CRESSWELL
HERNE HILL GROUP PRACTICE
12.0
HERNE HILL ROAD MEDICAL
PRACTICE
IVEAGH HOUSE SURGERY
Rates Per 1000
10.0
MYATTS FIELD HEALTH CENTRE
NORWOOD SURGERY
8.0
PAXTON GREEN GROUP PRACTICE
THE CORNER SURGERY
6.0
THE DEERBROOK SURGERY
THE KNIGHTS HILL SURGERY
4.0
THE ROSENDALE SURGERY
THE TULSE HILL PRACTICE
2.0
SOUTH EAST
LAMBETH
0.0
Oct 2012
Nov 2012
Dec 2012
Jan 2013
Feb 2013
47
Mar 2013
North Lambeth Locality Oct 11 - Mar 12
BECKETT HOUSE PRACTICE
14.0
BINFIELD ROAD SURGERY
DR IRANI
12.0
DR WICKREMESINGHE SSG
HURLEY CLINIC
10.0
Rates Per 1000
LAMBETH WALK GROUP PRACTICE
MAWBEY GROUP PRACTICE
8.0
RIVERSIDE MEDICAL PRACTICE
SPRINGFIELD PRIMARY CARE CENTRE
6.0
STOCKWELL GROUP PRACTICE
4.0
THE SOUTH LAMBETH RD PRACTICE
THE VAUXHALL SURGERY
2.0
WATERLOO HEALTH CENTRE
NORTH LAMBETH
0.0
Oct 2011
Nov 2011
Dec 2011
Jan 2012
Feb 2012
Mar 2012
North Lambeth Locality Oct 12 - Mar 13
14.0
LAMBETH
BECKETT HOUSE PRACTICE
BINFIELD ROAD SURGERY
DR IRANI
12.0
DR WICKREMESINGHE SSG
HURLEY CLINIC
10.0
Rates Per 1000
LAMBETH WALK GROUP PRACTICE
MAWBEY GROUP PRACTICE
8.0
RIVERSIDE MEDICAL PRACTICE
SPRINGFIELD PRIMARY CARE CENTRE
6.0
STOCKWELL GROUP PRACTICE
THE SOUTH LAMBETH RD PRACTICE
4.0
THE VAUXHALL SURGERY
2.0
WATERLOO HEALTH CENTRE
NORTH LAMBETH
0.0
LAMBETH
Oct 2012
Nov 2012
Dec 2012
Jan 2013
Feb 2013
48
Mar 2013
A&E Attendance Rates per 1000 by Practice
49
South East Locality Oct 11 - Mar 12
50.0
45.0
APMS SOLUTIONS LTD
BRIXTON WATER LANE PRACTICE
40.0
BROCKWELL PARK SURGERY
CROWN DALE MEDICAL CENTRE
35.0
DRS PATEL & CRESSWELL
HERNE HILL GROUP PRACTICE
Rates Per 1000
30.0
HERNE HILL ROAD MEDICAL PRACTICE
IVEAGH HOUSE SURGERY
25.0
MYATTS FIELD HEALTH CENTRE
NORWOOD SURGERY
PAXTON GREEN GROUP PRACTICE
20.0
THE CORNER SURGERY
THE DEERBROOK SURGERY
15.0
THE KNIGHTS HILL SURGERY
THE ROSENDALE SURGERY
10.0
THE TULSE HILL PRACTICE
SOUTH EAST
5.0
LAMBETH
0.0
Oct 2011
Nov 2011
Dec 2011
Jan 2012
Feb 2012
Mar 2012
South East Locality Oct 12 - Mar 13
45.0
40.0
APMS SOLUTIONS LTD
BRIXTON WATER LANE PRACTICE
35.0
BROCKWELL PARK SURGERY
CROWN DALE MEDICAL CENTRE
DRS PATEL & CRESSWELL
30.0
Rates Per 1000
HERNE HILL GROUP PRACTICE
HERNE HILL ROAD MEDICAL PRACTICE
25.0
IVEAGH HOUSE SURGERY
MYATTS FIELD HEALTH CENTRE
NORWOOD SURGERY
20.0
PAXTON GREEN GROUP PRACTICE
THE CORNER SURGERY
15.0
THE DEERBROOK SURGERY
THE KNIGHTS HILL SURGERY
THE ROSENDALE SURGERY
10.0
THE TULSE HILL PRACTICE
SOUTH EAST
5.0
LAMBETH
0.0
Oct 2012
Nov 2012
Dec 2012
Jan 2013
Feb 2013
50
Mar 2013
North Lambeth Locality Oct 11 - Mar 12
45.0
40.0
BECKETT HOUSE PRACTICE
BINFIELD ROAD SURGERY
35.0
DR IRANI
DR IVOR FERREIRA
Rates per 1000
30.0
DR WICKREMESINGHE SSG
HURLEY CLINIC
25.0
LAMBETH WALK GROUP PRACTICE
MAWBEY GROUP PRACTICE
20.0
RIVERSIDE MEDICAL PRACTICE
SPRINGFIELD PRIMARY CARE CENTRE
15.0
STOCKWELL GROUP PRACTICE
THE SOUTH LAMBETH RD PRACTICE
10.0
THE VAUXHALL SURGERY
WATERLOO HEALTH CENTRE
5.0
NORTH LAMBETH
LAMBETH
0.0
Oct 2011
Nov 2011
Dec 2011
Jan 2012
Feb 2012
Mar 2012
North Lambeth Locality Oct 12 - Mar 13
45.0
40.0
BECKETT HOUSE PRACTICE
BINFIELD ROAD SURGERY
35.0
DR IRANI
DR WICKREMESINGHE SSG
30.0
Rates Per 1000
HURLEY CLINIC
LAMBETH WALK GROUP PRACTICE
25.0
MAWBEY GROUP PRACTICE
RIVERSIDE MEDICAL PRACTICE
20.0
SPRINGFIELD PRIMARY CARE CENTRE
STOCKWELL GROUP PRACTICE
15.0
THE SOUTH LAMBETH RD PRACTICE
THE VAUXHALL SURGERY
10.0
WATERLOO HEALTH CENTRE
NORTH LAMBETH
5.0
LAMBETH
0.0
Oct 2012
Nov 2012
Dec 2012
Jan 2013
Feb 2013
51
Mar 2013

Mental Health Programme
To redesign mental health care pathways in order to improve patient
outcomes
Senior Reporting Officer: Helen Charlesworth-May
Commissioning
Clinical Leads: Raj Mitra/Ray Walsh/Adrian McLachlan
Objective
Update
Status Action
Transforming Activity

primary and
 Position at Month 12
community
c390 people in total
mental health
supported via the Primary
services (for
care support service & via
people with
Community Options
severe mental
Team. Resulted in

illness)
diversion of (estimated
via SLaM) c300 people
from CMHT during
2012/13. Qtr 1 report due
July 2013.
 Acute overspill in

Lambeth – 19 beds as at
31 May 2013. (ongoing
dispute about

transparency of
report/activity from SLaM)
 Increase in delayed

transfers of care – Month
1 report indicates 7
people delayed, SLaM
feeding back on causes.

 35 people accessed
Personal health Budget
15 in pipeline)
Finance
 QIPP delivery plan 13/14
agreed – £3m - 9

initiatives – monitored at
core contract meetings
and MHIP board
Performance/Process

 Project manager
appointed to support
delivery of Living Well

Network (LWN) (June
2013)
 Specification for LWN
agreed and multi agency
operational group formed
to lead implementation. .
 Provider Alliance Group /

52
Director of Integrated
Evaluation (via NIHR/IOP)
commissioned to determine impact of
new service offer – will link up multiple
data sets – secondary care, primary
care and social care. Includes
qualitative and quantitative elements.
Suite of reports from NESTA PPH
programme in process of being
published highlighting the need for
system transformation and economic
benefits of co-production c 7-25%
savings potential.
Living Well Partnership information
resource hub opened at Effra Rd – May
2013.
Peer support growth strategy plan
being developed – completion July
2013.
LLWC strategy / QIPP fully integrated
into SLaM contract 2013/14 – ambitious
remodelling of Adult Mental health
services within secondary care.
SLaM has commenced consultation on
proposed AMH redesign – piloting
initially in Lambeth and Lewisham. The
CCG and other partners have signalled
to SLaM that this needs be undertaken
collaboratively i.e. via LLWC.
Connected communities framework
agreed and roll out of community
connectors project via Certitude has
commenced.
Primary care engagement plan
developed - being tested out with a
sample of GP practices.
VCS mobilisation meeting arranged for
2 July 2013.
Criminal
Justice
mental health
Payment by
Results
Integrated
Talking
Therapy
Services
Commissioners.meeting
taking place on a monthly
basis.
Activity and finance
 Revised reporting
arrangements being
developed by SLaM with
CCG in light of NHSE
now being responsible for
forensic secure services.
The baseline is yet to be
signed off.
Performance/Process
 Fairmount service
reprovision agreed across
two sites
 Range of step down /
move on supply options
being developed with
three VCS providers.
 CCG and NHSE met
NHS Lambeth /
Lewisham met with
SCG/NCB March 2013 in
order to address interface
and plans for QIPP 13/13.
Activity
 Acute overspill – 19 beds
as at 31 May 2013
Finance
 PbyR workshop
(CCGs/SLaM) being held
June 2013 to work
through future reporting
on activity etc.
Performance/Process
 Fortnightly LSL meetings
(facilitated by NHS
Lambeth) taking place to
progress planning work.
 SLaM contract value
2013/14 agreed plus a
CQUIN to support PbyR
development.
Activity
 IAPT target for nos into
treatment met
 Waiting list for TT service
reduced following
application of recovery
plan.
Performance/Process
 CCG Board agreed award
53







Activity schedules for Slam contract
(AMH services) – will require
substantial revision following proposed
AMH remodelling and roll out of LWN.
Assumptions have been built into the
CCG business plan but these will need
further testing as the change
programme progresses.

CCG will need to consider what
levers/incentives it introduces to ensure
demand reduction plans are effective in
relation to secondary care services
when PbyR goes live April 2014. This
includes agreeing how we manage
gatekeeping to secondary care
services.
.



CCG have agreed to work with NHSE
on development/business case for
development of community pathways
out of secure services.
CCG in discussion with SLaM
concerning quality of community
forensic service in response to user
feedback and in light of proposed
support offered to VCS provided
services.
HWBB have requested that a
workstream be established to examine
MH issues and the BME community,
focusing especially on the action
following SR inquest.
CJS mental health service (police
custody/courts) - review of pilot
commissioned (due to concerns over
pilot deliverables.) to report Sept 2013.

New service commenced Nov 2012
Talking Therapy board chaired by
clinical network lead monitoring
activity and performance
Evaluation of service to commence
June 2013 – completion September
2013.

Mental
Health Older
Adults:
of contract to consortium
led by SLaM Nov 2012.
Following invite to tender,
ten submissions received,
panel agreed preferred
provider 4 June 2013.
QIPP 2013/14 - £750k provisionally
agreed for continuing care, joint
risk share with SLaM/CCG
Consolidation
of SLaM
continuing
care provision
Joint Governance Group established with agreed
terms of reference, reporting to MHIP
Identified leads for:
 Engagement and communication
 Project management
 Clinical

Meeting monthly
Initiated 3 month engagement process regarding
consolidation of service on 14 May 2013 with
carers/families affected
Assessment against nationally mandated
continuing care criteria ongoing.
Mental
Health Older
Adults:
QIPP 2013/14 - £200k provisionally
agreed for reduction in acute
utilisation as a consequence of
HTT interventions
Pilot Home
Treatment
Team (HTT)
Mental
Health Older
Adults:
Improve
diagnosis and
care of
people with
Dementia
Quarterly meeting with pilot HTT to review
monitoring data.
evaluation October-December 2013 to
Full
inform commissioning 2014/15 and confirmation
of QIPP
Clinical Network Lead for Dementia
(CNLD) to support practices who
are low/not referring to Memory
Service
Introduction of shared care for antidementia drugs
54
CNLD visited four practices
CNLD review of Lambeth practice diagnostic
data using national dementia tool to support
practice visits

CNLD supported Medicines Management
discussions. Decision re shared care for antidementia drugs to be agreed at SE London Joint
Prescribing Committee June 2013

Staying Healthy Programme
Improve health outcomes for Lambeth residents through the
commissioning of systematic health promotion and prevention
services that have the effect of improving mortality rates, reducing
morbidity and reducing the prevalence of key risk factors
Clinical Leads: John Balazs/Raj Mitra/Adrian McLachan
Objective
To reduce health
inequalities and
improve health,
identifying the
need for
interventions
that improve
population
health
Tobacco
control/Smoking
quitters
Alcohol
Prevention
Update
Activity
 Further develop the
Staying Healthy Group
with local government to
support transfer of public
health and
organisational
knowledge and expertise
to local government.
Activity
 DH has set challenging
target for 2012/13 which
will require focus on
current providers.
 Latest figures show
performance of 2269
quitters against a final
year end target of 2262.
A number of practices
are still yet to report Q4
figures. Final 2012/13
figures will be published
in July 2013.




CQUINS are in place for
community and acute
services. In principal
agreement for
Community CQUIN
2013/14.
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) have
discussed ‘Out of
Hospital’ Bid
Alcohol Recovery Centre
55
Status
Action













Agree way forward with LBL
Agree new Terms of Reference for
the Programme Board
Identify revised membership
Support providers to systematically
improve success rates and the
recording of socio-economic status,
reinforcing this through SLA with
providers
QUIT Manager rolled out to all
pharmacies
Offer refresher training to all current
providers.
Set CQUINs with Acute and
Community trusts
Scope charity bid with joint APG.
Evaluate Lambeth Alcohol and
Recovery Centres at St Thomas’
Hospital and Clapham Common
Methodist Church.
Evaluation of pilot models
completed, financial modelling
being undertaken
went live in Lambeth for
8 week pilot: Medical
Model at St Thomas’
Hospital and social
model at Clapham
Methodist Church.
Healthy Living
Pharmacy
NHS Health
Checks
Activity
 2635 alcohol
intervention carried out
by HLC’s
 Self assessment on
Quality standards
completed
 85 NHS health checks
carried out in
Pharmacies by end of
May
 44 pharmacies now
involved in the HLP
initiative.
 Phase 3 being rolled
out
Activity
 Qtr 4 target exceeded
for NHS Vascular Health
Checks offered.


Q4 8% of the eligible
population were offered
a Health Check against
a quarterly target of 5%
for 2012/13.
Qtr 1 1320, Qtr 2 1705,
Q3 1625, Q4 1732












Childhood
Obesity


The results of the
National Child
Measurement
Programme (NCMP) for
the 11/12 academic
year were published in
Dec 2012 and showed
a narrowing of the gap
between Lambeth and
London
The measuring of
Reception and Yr 6
pupils for the NCMP
2012/13 academic year
is complete and the
result letters to
parents/carers were
sent out in Feb 2013.
56




NHS Vascular Health Checks training
for 10 new pharmacies has
commenced
Re accreditation of phase 1 and
accreditation of phase 2 to start
Local EHC training to be carried out
23 Healthy Living Champions
received their certificates of
accreditation in February 2013.
This brings the total to 64 Healthy
Living Champions in Lambeth.
Work with QMS to improve reporting
and data capture from practices
2nd phase of cross borders pilot
started with Lewisham and
Southwark.
Dementia guidelines to be included
within current dataset. LSL joint
approach, including marketing.
New standardised template rolled out
in all practices
Further work required to ensure
people take up offer.
Key documents were submitted to
UNICEF for assessment of Level 1
Baby Friendly Initiative
accreditation. Formal notification of
accreditation will be given in Late
July. Once achieved the more
challenging task of achieving stage
2 accreditation begins, which
involves site visits and interviews
with staff across the partnership.
The BFI Co-ordinator post is being
advertised and will hopefully be
recruited to begin work in
September 2013
The Breastfeeding Peer Support
Programme is being rolled out with
2 ‘helpers’ training courses and 1
Healthy Weight
School Nurse

Breastfeeding at 68wks strong
performance: 12/13 Q4
coverage 98.6% and
prevalence 80.26%.
Effective partnership
working to achieve
Baby Friendly Initiation
(BFI) accreditation is
ongoing through the
Breastfeeding strategy
group and operational
group.

There is a new
specialist school nurse
in post leading on this
work and a more robust
monitoring process in
place.
‘Supporters’ training course planned
over the next year. Once the
volunteers have been trained they
will support and roll out more
breastfeeding Milk spots, targeting
vulnerable women, which have
been cited by UNICEF as good
practice. The recruitment of the
Breastfeeding peer support coordinator is underway.



School Healthy
Weight
Promotion
Programme
Weight
Management
Services

Healthy Weight training
for primary school staff
is being offered as part
of the Lambeth Schools
Health and Wellbeing
work.
Level 2 – Lambeth
Ready Steady Go!: 4
Structured (4-6yrs & 712yrs ) and 2 Flexible
(4-6yrs & 7-12yrs)
programmes were
delivered during Q3.
Over that 37 families
participated in the
flexible programmes
57







The Motivational Interviewing
training in line with the obesity
CQUIN has been planned and will
be rolled out or school nurses with
GSTT.
The Specialist SN post is coordinating the capacity and skilling
up of the SN service and ensuring
really hard to reach families are
properly engaged.
The specialist post is developing
effective ways of linking and
improving communication between
key stakeholders including the SN
service and the Levels 2&3 healthy
weight services, which in turn will
improve referral pathways and
outcomes
Training sessions are ongoing and
the model of engaging schools by
including governors and senior
management staff has been
effective.
Plans to roll this model out to other
projects in the Lambeth school
programme are in place.
Level 2: Changes to the delivery of
the flexible programme on a
Saturday has been changed to after
school activity based on feedback
form parents
Level 3: presenting health,
emotional and social issues to this
service is extremely complex and
requires intensive engagement with
the families and child/children.


Evaluation
Teenage
Pregnancy –
under 18
conceptions


and 23participants in
the 7-12yr old
structured programme
and 11 in the 4-6yr old
structured programme.
Level 3 - The service is
delivered using a family
centered approach and
to date has engaged
well with the targeted
families. 9 new referrals
were made to the
service during the Q3
and 42 sessions were
delivered.
Level 2 and 3 services
are being monitored
through quarterly
Healthy Weight
performance Monitoring
meetings. Public Health
has scoped out the
detail of the Evaluation
programme. Actions
are listed opposite.
The downward trend of the
under-18 conception rate in
Lambeth continues as
evidenced by the
conception data for 2011
(released by ONS on the
26th of February 2013). The
rate of under-18
conceptions for Lambeth
was 34.8 per 1000 girls
aged 15-17. This is the
lowest annual rate
recorded since data
collection began in 1998.
The rate is a 40.1%
decrease since the final
2010 data.
There has also been a
sustained decline in
London which had a 22.6%
reduction and in England
which had a 10.2%
reduction since 2010.
58
Engagement of families with the
service is working well and those on
the programme appear committed
to the process. The Level 3 project
team's experience is that tackling
obesity is a complex affair with
these families and often engenders
a sense of hopelessness and
sometimes shame for those
involved. Some of the positive
results being observed is an
increase in self-esteem and
motivation.





VAGA and Associates and Partner
Solutions have evaluated the Level
1 Health Weight training and the
Breastfeeding BFI (UNICEF) and
the training for Early Years Staff in
Children Centres, respectively and
findings are informing future
commissioning.
Public Health have scoped out the
detail of the evaluation of the whole
Lambeth childhood obesity
programme and are in discussion
with KCL and Imperial college to
further discuss how the evaluation
should be conducted.
The prevention of under-18
conceptions and support to teenage
parents is led by a strategic
partnership with a remit for broad
adolescent health.
Funding has now been confirmed
for 2013/14 and the strategic
partnership elected to recommission the Lambeth Health
and Wellbeing Programme for the
new academic year (September
2013 – July 2014). This
programme includes education on
sex and relationships, substance
misuse, emotional wellbeing,
healthy eating and the prevention of
violence. The programme is offered
to all Lambeth schools and targeted
youth settings. Schools and settings
are responding well to the offer with
all 14 secondary schools, 50
primary schools and 10 youth
settings taking up the programme in


59
2012/13.
Support to young parents continues
via the Sure Start Programme
which is delivered by St Michaels
Fellowship who are commissioned
in collaboration with Lambeth
CYPS.
Family Nurse Partnership (FNP)
has also continued in Lambeth as
part of the wave 3 clinical trial and
commissioning responsibility is
transferred to NHS England until
2015 when it moves to LBL. Plans
to continue and grow the service
are underway.
Provider Integrated Performance Dashboards
These dashboards are currently being reviewed. Q1 will be reported in the next Integrated
Governance and Performance Report in September 2013.
Guy’s & St Thomas’ Acute Provider
Kings Acute Provider
SLaM Mental Heath Provider
Guy’s & St Thomas’s Community Provider
60
Medicines Management
A. Current Overall Performance 2012-13 (Month 12)
 Overall the prescribing budget (year to date) is under spent at Month 12 by
£3,822,535 (10.3% see finance report). All localities were under spent: North locality
by 11.5%, South West locality by 11.4% and South East locality by 7.7%.
 Overall spend per APU at CCG level has increased to £1.61/APU in M12
(compared to M11 £1.51/APU) and is still well below target (£1.91/APU per month).
 Cumulative growth (analysed monthly) on primary care prescribing continues to be
low (averaging between -3 to -7% during months 1-12).
B. Quality, Innovation, Productivity and Prevention (QIPP) Performance.
Highlights from 2012-13 Primary care prescribing QIPP plan and dashboard.
At December 2012*, we remained in the top performing CCGs in London (L) and
nationally (N) in many of the QIPP medicines management areas including:
- Antibacterial items/STAR-PU (N)
- Antidepressants ADQ/STAR-PU (N)
- Hypnotics ADQ/STAR-PU (N)
- Hypoglycaemic agents % items (N)
- Minocycline ADQ/1000 patients (N)
- NSAIDS ADQ/STAR-PU (N)
- NSAIDs Ibuprofen & Naproxen % items (N+L)
- Long/intermediate insulin analogues % items (N + L)
- Glucosamine spend per 1000 APU per month (L)
- % metformin & Sulphonylurea items of all antidiabetic agents (L)
- Fentanyl spend per 1000 APU per month (L)
- Oxycodone spend per 1000 APU per month (L)
- % items for plain prednisolone 5mg as % of all prednisolone 5mg plain & e/c
items (L)
*At the time of writing this report Q4 January to March 2013 National prescribing data
had not been published on the NHS Business Services Authority Information Services
portal.
61
Over 2012 -13 we have made significant improvements in the following areas:
→ Minocycline prescribing
NHS Lambeth CCG Minocycline Average Daily Quantity (ADQ) prescribed per
1000 patients per quarter
70.000
60.000
Medicines Management LES
2012-13 Launched
ADQ per 1000 patients
50.000
40.000
30.000
20.000
10.000
Minocycline is a tetracycline antibiotic used in the treatment of acne.
However, there are concerns regarding its place in therapy:
- there is no clear evidence that minocycline is more effective or better
tolerated than other tetracyclines
- safety concerns specific to minocycline due to its association with
hypersensitivity reactions, autoimmune disorders and early-onset doserelated toxicity reactions resulting in single organ dysfunction
- alternative once-daily treatments such as doxycycline are available
- minocycline has a relatively high acquisition cost.
Therefore prescribers have been asked to review and, if appropriate, revise
prescribing of minocycline.
0.000
Financial Quarter
→ Phosphodiesterase type-5 (PD-5) inhibitor drug
NHS Lambeth CCG PD-5 inhibitor drug Spend per quarter
£160,000.00
Medicines Management
LES 2011-12 launched
£155,000.00
£150,000.00
Medicines Management
LES 2012-13 launched
Spend (£) per quarter
£145,000.00
£140,000.00
£135,000.00
£130,000.00
£125,000.00
£120,000.00
The DH Health Service Circular 1999/148 states that from the 1 July 1999, the
prescribing of these drugs for the treatment of erectile dysfunction (ED) under
pharmaceutical services by GPs should only be for those men whom in their clinical
judgement are suffering from ED and have one of the twelve DH stated medical
conditions. Therefore prescribers in Lambeth have been asked to review prescribing
in line with these DH criteria.
£115,000.00
Financial Quarter
2013-14 Primary Care Prescribing QIPP Plan and Dashboard.
62
Local and London Prescribing Performance: Data source: Q4 2012/13 (Jan –
Mar)
At the time of writing this report Q4 January to March 2013 National prescribing data
had not been published on the NHS Business Services Authority Information Services
portal and so we are unable to provide an update on all the comparators.
The Medicines Optimisation plan for 2013-14 has just been launched. 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. Management of “specials” is RED rated and a new plan is about to be
launched which is an integrated approach with secondary care.
Comparator
(RAG rated against NHS Lambeth CCG Primary Care Dashboard)
% reduction in High dose inhaled corticosteroids as a % of all inhaled
corticosteroids (compared to Quarter 3 2012-13)
Generic Prescribing percentage – national data unavailable
% 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)
% items for immediate release venlafaxine as % total venlafaxine
immediate and extended release items (tablets and capsules)
Spend of Specials* per 1000 patients per month
Tadalafil spend per 1000 APU per month
Silver Wound Dressings 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 – data unavailable
% Fentanyl items of all opioid items
% Oxycodone items of all opioid items
% Metformin & Sulphonylureas items of all antidiabetic agents
% statin items prescribed as low cost statins of all statins including
ezetimibe (and combinations) & generic atorvastatin
Omega-3-fatty acids spend per 1000 APU
3 days Trimethoprim ADQ/ITEM – national data unavailable
Cephalosporins & Quinolones % Items - national data unavailable
London
ranking
(March 2013;
out of 31
PCTs**)
N/A
N/A
4th
N/A
N/A
24th
N/A
13th
N/A
N/A
1st
1st
2nd
N/A
N/A
N/A
N/A
Key
GREEN (already achieved) = Locally: >75% of practices achieving comparator; London: CCG is in top 25th centile
AMBER (significant improvement nearing maximum achievement) = Locally: <75% but > 50% of practices achieving
comparator; London: CCG is in 25th to 50th centile
RED (Further improvement required) = Locally: < 50% of practices achieving comparator; London: CCG is in bottom
50th to 100th centile
** Data taken from the London Procurement Project (LPP) QIPP Dashboard March 2013, which refers to PCTs rather
than CCGs
63
C. General Update
1. Highlights from the Lambeth and Southwark Joint Prescribing Committee
(JPC) Meeting 15 May 2013:
Approved – sign up to the NOACs (dabigatran and rivaroxaban) rebate
scheme subject to negotiation over data provision timing; Sativex Shared Care
Guideline; Vitamin D prescribing guideline (including patient screening criteria);
insulin passport, continuation of current antimalarial policy.
Deferred - cow’s milk protein allergy/intolerance management guidelines; KCH
growth hormone shared care guideline.
2. The SEL New Drugs Panel, a subgroup of the SEL Area Prescribing
Committee (APC) has now been established, jointly chaired by the APC ViceChairs Dr Arun Gupta (Lewisham CCG) and Dr Mark Kinirons (GSTfT). This
will meet for the first time in July and give recommendations to the APC
regarding priorities for investing in medicines.
3. Medicines Optimisation & QIPP Plan for 2013-14.
The Medicines Optimisation Plan was launched in April. Three successful
launch events are underway at the time of writing (May/June), with 83% of
practices attended or planned to attend.
The plan focuses on medicines optimisation in the key long term conditions of
COPD and asthma (implementing the London Respiratory team responsible
prescribing messages), hypertension, and heart failure. Building on the good
feedback from the heart failure virtual clinic last year, we aim to repeat this
model across more therapeutic areas. It also includes key QIPP areas where
cost effective prescribing can be achieved via acceptance of ScriptSwitch
messages or formulary adherence (e.g. the wound formulary). There are also
key options to work on antibiotic stewardship and anticoagulant prescribing.
4. Specials – discussions have been underway with GSTfT and KCH on an
integrated approach to managing patients on a selected list of specially
manufactured products. Many specials are initiated by secondary care, are
short term and some have little evidence to support use. Costing work with
GSTfT involving 15-20 “specials” calculated a cost saving of £200,000 on a
total spend of £250,000 over a period of one year. As a result of the
discussions a “do not prescribe” list of specials with actions for GPs has been
produced. Medicines Information at GSTT has offered to host an information
line that GPs could contact for advice on alternatives to specials.
64
Organisational Development
Organisational Development Plan workstream update
A year end review of the OD Plan delivery in 2012/13 is currently in development for
consideration at the OD Steering Group. Key highlights from 2012/13 and reported
in-year include












Achievement of CCG authorisation without conditions
Coaching offered to all members of the Board/Governing Body
Board development through review and reflection on lessons learned from
challenging commissioning decisions
All member practice engagement and sign off of the NHS Lambeth CCG
Constitution
Establishment of action learning sets within localities and facilitation skills
training
Influencing change workshops provided to each locality
Membership resource pack developed
Two successful all practice events
Establishment of the Engagement, Equalities and Communications
Committee
Practice information packs refined through practice feedback
Infrastructure of commissioning support established including agreement of
service provision of formal commissioning and public health support
Establishment of CCG website and development of CCG branding
The OD plan for 2013/14 has been developed as detailed in the Lambeth Business
plan. The content has been informed by learning from 2012/13, members of the OD
Steering Group and national guidance including the outline CCG Assurance
Framework for 2013/14 (a process to ensure CCG fitness for purpose beyond
authorisation) published on the 7th May 2013.
65
Equality and Diversity
The previous report identified proposed gradings against the six CCG equality
objectives, graded using the NHS equality delivery scheme. The report identified the
process through which these grades had been derived, explained comprehensively
within a report produced by The Participation Agency: ‘Equality in NHS Lambeth’ –
engagement report March 2013.
At the CCG Governing Body meeting in May, the proposed equality objective grading
was agreed.
The next steps are to build on the recommendations contained within the above
report, which identified issues/areas for improvement, to finalise the 2013/14 plan. It
is expected that this will be completed by the end of June 2013.
This approach was disseminated and endorsed at the Equalities, Engagement and
Communications Committee meeting held on 7th June 2013. A more detailed
progress report will be made available at the next meeting.
66
Appendices
Appendix 1
Assurance Framework
Appendix 2
Acute Contracts Month 12
Appendix 3
Supporting Quality Information: Quality, PALS,
Complaints, Serious Incidents. Never Events,
Freedom of Information. Q1 to be reported in
September.
67
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
Responsible
Executive:
Director of Care
Pathway
Commissioning /
Chief Officer
Southwark CCG
Strategic Objective 2: To improve the
integration and quality of care for older
people and reduce the number of
avoidable hospital admissions and
readmissions
Responsible
Executive: Chief
Officer Lambeth
CCG
Responsible
Strategic Objective 3: To deliver good Executive:
quality mental health care services and Director of
improve patient outcomes
Integrated
Commissioning
Harriet
Agyepong
SO1AA
(GG6.7SC)
Therese
Fletcher
SO2CA
(MA6.8AE)
Therese
Fletcher
SO2LB
(FF3.2AE)
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
12

16 16
9

12 12
8

12 12
Denis
O'Rourke
Risk the Adult Mental Health (AMH)
change programme won't be fully
SO3AA (new) implemented as planned impacting 9
negatively on patient outcomes and
financial savings targets.

15
Denis
O'Rourke
Risk that community forensic
service changes involving voluntary
SO3BA (new) sector and social care liaison will
not be fully implemented leading
to poor patient care

12

6
KEY:
= risk unchanged; = risk reducing i.e. improving;  = risk increasing
Risk ratings: low risk (green) 1-3; moderate risk (yellow) 4-6; significant risk (amber) 8-12; high risk (red) 15-25
68
Apr
Mar
Feb
Jan
Dec
Nov
Oct
Sep
Monthly Progress
Aug
Target Risk
Score and
Direction of
Travel
Jul
Principal Risk (Obstacle to
achievem ent of Strategic Aim )
Jun
Executive Lead
Risk Register
Ref
May
Strategic Aim
Operational
Lead
UPDATED MAY 2013
Apr
ASSURANCE FRAMEWORK 2013/14 – PROGRESS SUMMARY

9 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
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.
8

12 12
Responsible
Executive: Head
of Finance
Christine
Caton

KEY:
= risk unchanged; = risk reducing i.e. improving;  = risk increasing
Risk ratings: low risk (green) 1-3; moderate risk (yellow) 4-6; significant risk (amber) 8-12; high risk (red) 15-25
69
Apr
4
Mar
Failure to deliver statutory financial
targets. Financial risk management
and reputational risk.
Feb
SO6AA
(S8.1CC)
Jan
Christine
Caton
12 12
Dec
Responsible
Executive: Head
of Finance

Nov
Risk of the TSA process and
outcomes negatively impacting on
12
provider landscape and delivery of
CCGs strategic plans to 2017-18
12
Oct
SO4AA
(SH8.9MM)

Sep
Christine
Caton
6
Aug
SO3BB (new)
May
Denis
O'Rourke
Risk to community forensic services
being able to deliver timely
services due to the impact of
prison health commissioning
issues.
Responsible
Strategic Objective 3: To deliver good Executive:
quality mental health care services and Director of
improve patient outcomes
Integrated
Commissioning
Responsible
Strategic Objective 4: To implement
Executive:
the Secretary of State's (SoS) TSA
Director of Care
recommendations
Pathway
Commissioning
Jul
Monthly Progress
Principal Risk (Obstacle to
achievem ent of Strategic Aim )
Executive Lead
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.
Target Risk
Score and
Direction of
Travel
Risk Register
Ref
Apr
Strategic Aim
Operational
Lead
UPDATED MAY 2013
Jun
ASSURANCE FRAMEWORK 2013/14 – PROGRESS SUMMARY
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: Head
of Finance
Christine
Caton
SO6AD
(SG8.8CC)
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: Head
of Finance
Christine
Caton
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
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
There is a risk that failure to
deliver QIPP and acute
overperformance leading to CCG's
risk on financial sustainability
12

Failure to embed and maintain
strong internal financial controls
SO6AE (new)
and achieve a clean bill of audit
health
4

12
Ze ro T ole ra nce R isk - There is
a risk that there will not be
capacity and capability in the
SO7AA (new) commissioning system to fulfill
requirements as a statutory body
and membership organisation to
deliver the CCG strategy.
6

9
SO7CA
Alex McTeare
(CC9.5HCM)
Ze ro T ole ra nce R isk - Risk of
failure to safeguard adults and
identify and respond appropriately
to abuse.
4

Avis Williams- SO7CB
McKoy
(T9.1HCM)
Ze ro T ole ra nce R isk - Risk of
failure to safeguard children and
identify and respond appropriately
to abuse
4


12 12
12 12
8
8
KEY:
= risk unchanged; = risk reducing i.e. improving;  = risk increasing
Risk ratings: low risk (green) 1-3; moderate risk (yellow) 4-6; significant risk (amber) 8-12; high risk (red) 15-25
70
Apr
Mar
Feb
Jan
Dec
Nov
Oct
Sep
Monthly Progress
Aug
Target Risk
Score and
Direction of
Travel
Jul
Principal Risk (Obstacle to
achievem ent of Strategic Aim )
Jun
Executive Lead
Risk Register
Ref
May
Strategic Aim
Operational
Lead
UPDATED MAY 2013
Apr
ASSURANCE FRAMEWORK 2013/14 – PROGRESS SUMMARY
Responsible
Executive:
Director of
Governance and
Development
Strategic Objective 7: To ensure
Responsible
systems and processes are in place to
Executive:
support individual, team and corporate
Director of
accountability for delivering patient
Governance and
centred, safe and high quality care
Development
Ze ro T ole ra nce R isk - There is
Marion
Shipman
SO7DA
(TA9.7AP)
a risk of inadequate response to
emergencies owing to the CCG
responsibilities changing as
category 2 responder and NHS
6

12
8
4

6
6
4

England as category 1 responder.
Lambeth CCG fails to comply with
the Equality Act (2010) and does
not achieve its equality objectives,
Sarah Corlett
SO7EA
(Q7.3AP)
leading to negative impact on
population health and equity.
Requirements of the Equality Act
(2010) are not integrated into core
business
Responsible
Executive:
Director of
Governance and
Development
Risk that Lambeth CCG will breach
Zeb Allam
SO7FA
(SC8.4CC)
the Data Protection Act resulting in
fines, reputational damage and
patient civil action

12 12
KEY:
= risk unchanged; = risk reducing i.e. improving;  = risk increasing
Risk ratings: low risk (green) 1-3; moderate risk (yellow) 4-6; significant risk (amber) 8-12; high risk (red) 15-25
71
Apr
Mar
Feb
Jan
Dec
Nov
Oct
Sep
Monthly Progress
Aug
Target Risk
Score and
Direction of
Travel
Jul
Principal Risk (Obstacle to
achievem ent of Strategic Aim )
Jun
Executive Lead
Risk Register
Ref
May
Strategic Aim
Operational
Lead
UPDATED MAY 2013
Apr
ASSURANCE FRAMEWORK 2013/14 – PROGRESS SUMMARY
Risk that the lack of access to
patient identifiable and confidential
data in some instances for certain
Strategic Objective 7: To ensure
Responsible
systems and processes are in place to Executive:
support individual, team and corporate Director of
accountability for delivering patient
centred, safe and high quality care
secondary use purposes by
Lambeth CCG and Public Health
Governance and
Development
Zeb Allam
SO7FB
(SI8.10AE)
teams in LA will negatively impact
on the ability of Lambeth CCG to
robustly commission and monitor
health services. CCGs can access
2

12 12
limited Personal Identifiable Data
where they are directly
providing/involved in the care of
patients/users and where there is
a lawful basis to do so.

KEY:
= risk unchanged; = risk reducing i.e. improving;  = risk increasing
Risk ratings: low risk (green) 1-3; moderate risk (yellow) 4-6; significant risk (amber) 8-12; high risk (red) 15-25
72
Apr
Mar
Feb
Jan
Dec
Nov
Oct
Sep
Monthly Progress
Aug
Target Risk
Score and
Direction of
Travel
Jul
Principal Risk (Obstacle to
achievem ent of Strategic Aim )
Jun
Executive Lead
Risk Register
Ref
May
Strategic Aim
Operational
Lead
UPDATED MAY 2013
Apr
ASSURANCE FRAMEWORK 2013/14 – PROGRESS SUMMARY
Appendix 2
Acute Contract Monitoring Month 12 Report
Overall Performance – Year to Date
Overview (£000, %) over/ (under)spend
Contract Monitoring
Full Year
Plan
YTD Plan
YTD Variance
over / (under)
spend
YTD Actual
M12 Finance
YTD Variance over / (under) FOT over /
%
spend
(under) spend FOT %
King's College Hospital
86,436
79,233
87,000
7,767
10%
8,008
8,008
9%
Guy's and St. Thomas'
116,924
107,181
110,126
2,946
3%
2,798
2,798
2%
St. George's Hospital
23,276
21,336
22,626
1,289
6%
1,407
1,407
6%
Subtotal Primary SLAs
226,636
207,750
219,752
12,002
6%
12,212
12,212
5%
1,824
1,672
1,344
-328
-20%
-358
-358
-20%
Other Local Trusts
Externals
34,440
31,570
32,716
1,146
4%
1,250
1,250
4%
262,901
240,993
253,812
12,819
5%
13,104
13,104
5%
Specialist Services Consortia
Non-Contracted - Cost Per Case &
Exclusions to Contracts
47,642
43,672
43,688
16
0%
18
18
0%
4,883
4,476
5,861
1,385
31%
1,511
1,511
31%
Other earmarked acute budgets
12,818
11,749
9,518
-2,231
-19%
-2,434
-2,434
-19%
Contracted Acute SLAs
2012/13 Commissioning Reserves
TOTAL Budget 2012/13
28,068
25,729
20,965
-4,764
-19%
-5,197
-5,197
-19%
356,312
326,619
333,844
7,225
2%
7,001
7,001
2%
Drivers by POD Heat map (£000) GSTT & KCH Total - over/ (under)spend YTD
88
Total
226
Other
1,639
Drugs &
Devices
1,083
88
Direct
Access
-18
Critical
Care
245
12
OP Proc
1,627
901
OP FU
182
Non-PbR
Total
OP 1st
A&E
NonElective
Emergency
Elective
PbR
2,000
327
472
-122
4,819
-10
123
-20
1,122
-93
1,349
1,240
4,605
1,991
451
452
1,122
-93
1,349
1,117
9,424
Drivers by POD YTD Overspend (%) GSTT & KCH Total - over/ (under)spend YTD
Financial variances reflect expcted payments of trusts and have been adjusted for uncoded estimates, QIPP agreements, contractual arrangements and trust
challenges. Activity variances are unadjusted.
73
QIPP Delivery Summary (£000) over/ (under) achievement
QIPP Initiative
YTD Planned QIPP
performance
YTD Actual QIPP
performance
YTD Variance
FYE Saving
FYE Variance
Outpatients
CCG Led
2,332
97
-2,235
106
Trust Led
1,236
1,233
-3
1,345
-3
3,568
1,330
-2,238
1,451
-2,441
Sub-Total Outpatients
-2,438
Emergency Care Pathway
CCG Led
Trust Led
Sub-Total - Emergency Care
Pathway
675
5
-669
6
-730
1,022
1,021
-1
1,114
-1
1,697
1,026
-670
1,119
-731
-1,333
0
1,333
0
1,455
882
885
4
966
4
-452
885
1,337
966
1,458
-1,714
Other
CCG Led
Trust Led
Sub-Total - Other
Total
CCG Led
1,673
103
-1,571
112
Trust Led
3,140
3,139
-1
3,424
-1
4,813
3,241
-1,572
3,536
-1,715
Grand Total
Further Details attached to appendix 2.
Key Risks
Demand, Population and Incidence Growth –
Waiting Times and RTT –
QIPP –
Price / Case Mix –
74
Forecast Outturn (£000)
Commentary
Overview
activity/costs associated with backlog clearance.
QIPP – significant deductions made to start plans.
Actions
75
King’s College Hospital – Year to Date
Overview (£000, %) over/ (under)spend
Contract Monitoring
Full Year
Plan
YTD Plan
YTD Variance
M12 Finance
over / (under) YTD Variance over / (under) FOT over /
spend
%
spend
(under) spend FOT %
YTD Actual
King's College Hospital
86,446
79,242
87,009
7,767
TOTAL
86,446
79,242
87,009
7,767
10%
7,781
7,781
9%
10%
7,781
7,781
9%
Drivers by POD Heat map (£000) over/ (under)spend
145
Total
96
Other
1,835
Drugs &
Devices
1,378
145
Direct
Access
-8
Critical
Care
104
108
OP Proc
1,727
976
OP FU
402
Non-PbR
Total
OP 1st
A&E
NonElective
Emergency
Elective
PbR
928
420
373
0
4,098
33
135
-39
852
1
1,028
583
3,669
960
555
334
852
1
1,028
583
7,767
Drivers by POD YTD Overspend (%) over/ (under)spend
Financial variances reflect expcted payments of trusts and have been adjusted for uncoded estimates, QIPP agreements, contractual arrangements and trust
challenges. Activity variances are unadjusted.
76
QIPP Delivery Summary (£000) over/ (under) achievement
Contractual Position
QIPP Initiative
Riskholder
YTD Planned YTD Actual YTD
QIPP
QIPP
Variance
performance performance
Underlying Position
FYE Saving
FYE Variance
YTD Actual
YTD
Variance
Outpatients
New Outpatients
CCG Led
839
0
-839
0
-916
0
C2Cs
Trust Led
18
18
0
20
0
-8
-26
Outpatient Follow Ups
Trust Led
507
507
0
554
0
0
-507
1,365
526
-839
573
-916
-8
-1,373
Sub-Total Outpatients
-839
Emergency Care Pathway
UCC activity
CCG Led
0
0
0
0
0
0
0
UCC tariff
Trust Led
65
65
0
71
0
36
-29
A&E attendances
CCG Led
61
0
-61
0
-66
0
-61
A&E conversion rates
Trust Led
155
155
0
170
0
-8
-163
Admission Avoidance
CCG Led
211
0
-211
0
-231
0
-211
492
220
-272
240
-297
0
-464
Sub-Total - Emergency Care Pathway
Other
Schedule 3 KPIs
Trust Led
99
99
0
108
0
26
-73
Acute Prescribing
Trust Led
92
92
0
100
0
82
-10
Excess Bed Days
Trust Led
169
169
0
185
0
148
-22
PoLCE/ TAP
CCG Led
182
0
-182
0
-199
0
-182
Maternity
Trust Led
Sub-Total - Other
11
11
0
12
0
39
28
553
371
-182
405
-199
294
-260
-1,294
Total
Total CCG led Risk
CCG Led
1,294
0
-1,294
0
-1,411
0
Total Trust led Risk
Trust Led
1,117
1,117
0
1,218
0
313
-804
2,411
1,117
-1,294
1,218
-1,411
313
-2,097
Grand Total
Further Details attached to appendix 2.
77
Guy’s and St. Thomas’– Year to Date
Overview (£000, %) over/ (under)spend
Contract Monitoring
Full Year
Plan
Guy's & St. Thomas' (Contractual Position)
YTD Plan
116,924
YTD Variance
M12 Finance
over / (under) YTD Variance over / (under) FOT over /
spend
%
spend
(under) spend FOT %
YTD Actual
107,180
110,126
2,946
3%
3,214
3,214
3%
GSTT Underlying Position
112,924
103,513
114,683
11,170
12,814
11%
We have shown both the contractual position, reflecting the contractual agreement in 2012/13 and the underlying position, reflecting actual performance.
11%
Drivers by POD Heat map (£000) over/ (under)spend
63
691
3,903
967
0
0
0
691
3,903
967
Total
199
Other
294
144
Drugs &
Devices
0
Direct
Access
63
0
Critical
Care
199
0
OP Proc
294
OP FU
Total
OP 1st
Non-PbR
A&E
PbR
NonElective
Emergency
Elective
Contractual
1,268
0
149
0
0
0
-31
0
321
539
0
2,117
829
144
1,268
0
149
-31
0
321
539
2,946
144
1,403
1,015
1,243
0
9,367
0
0
0
-258
0
328
1,732
1,803
1,403
1,015
1,243
-258
0
328
1,732
11,170
Underlying
PbR
Non-PbR
Total
144
Drivers by POD YTD Overspend (%) over/ (under)spend
Financial variances reflect expcted payments of trusts and have been adjusted for uncoded estimates, QIPP agreements, contractual arrangements and trust
challenges. Activity variances are unadjusted.
78
QIPP Delivery Summary (£000) over/ (under) achievement
Contractual Position
QIPP Initiative
Riskholder
YTD Planned YTD Actual YTD
QIPP
QIPP
Variance
performance performance
Underlying Position
FYE Saving
FYE Variance
YTD Actual
YTD
Variance
Outpatients
New Outpatients
CCG Led
1,064
97
-967
106
-1,055
97
-967
C2Cs
Trust Led
171
171
0
186
0
14
-156
Outpatient Follow Ups
Trust Led
536
536
0
585
0
0
-536
1,771
804
-967
877
-1,055
111
-1,659
0
0
0
0
0
0
0
Sub-Total Outpatients
Emergency Care Pathway
UCC activity
CCG Led
UCC Tariff
Trust Led
70
70
0
76
0
70
0
A&E attendances
CCG Led
136
0
-136
0
-148
0
-136
A&E conversion rates
Trust Led
731
731
0
797
0
0
-731
Admission Avoidance
CCG Led
199
0
-199
0
-217
0
-199
1,135
801
-335
873
-365
70
-1,066
-129
Sub-Total - Emergency Care Pathway
Other
Schedule 3 KPIs
Trust Led
129
129
0
140
0
0
Acute Prescribing
Trust Led
137
137
0
150
0
137
0
Excess Bed Days
Trust Led
195
195
0
213
0
0
-195
PoLCE/ TAP
CCG Led
208
0
-208
0
-227
0
-208
Maternity
Trust Led
43
43
0
47
0
43
0
712
504
-208
550
-227
180
-532
Sub-Total - Other
Total
Total CCG led Risk
CCG Led
1,606
97
-1,509
106
-1,647
97
-1,509
Total Trust led Risk
Trust Led
2,012
2,012
0
2,195
0
264
-1,748
3,619
2,109
-1,509
2,301
-1,647
361
-3,257
Grand Total
Further Details attached to appendix 2.
79
St. George’s Hospital – Year to Date
Overview (£000, %) over/ (under)spend
Contract Monitoring
Full Year
Plan
YTD Plan
YTD Variance
M12 Finance
over / (under) YTD Variance over / (under) FOT over /
spend
%
spend
(under) spend FOT %
YTD Actual
St. George's Hospital
23,276
21,336
22,626
1,289
6%
1,407
1,407
6%
TOTAL
23276
21336
22626
1289
6.0%
1,407
1,407
6%
Drivers by POD Heat map (£000) over/ (under)spend
-50
Total
67
Other
-10
Drugs &
Devices
-96
-395
Direct
Access
-75
-589
-92
Critical
Care
77
OP Proc
-299
OP FU
OP 1st
Total
A&E
Non-PbR
-514
NonElective
Emergency
Elective
PbR
-201
-195
-122
-43
-12
19
300
-94
0
118
108
-201
-238
-104
-31
300
-94
0
-4
-1,289
Drivers by POD YTD Overspend (%) over/ (under)spend
Financial variances reflect expcted payments of trusts and have been adjusted for uncoded estimates, QIPP agreements, contractual arrangements and trust
challenges. Activity variances are unadjusted.
80
-1,397
Key External Trusts over/ (under)spend
Contract
Annual
Value
Trust
£’000s
YTD
Over/(Under)
Performance
& RAG
£’000s
Chelsea and Westminster Hospital NHS
Foundation Trust
Croydon Health Services NHS Trust
University College London Hospitals NHS
Foundation Trust
Imperial College Healthcare NHS Trust
Other Externals:
( including London Ambulance Service,
£10,989k)
81
Commentary / Actions
Appendix 3
NOTE: Publication of the Lambeth PCT 2011-12 Complaints and Incident Report can be
requested from Marion.Shipman@nhs.net or Ghennighan@nhs.net
Q1, 2013/14 PALS, Complaints and Incident reports will be included in the August
2013 Integrated Performance Report.
April 13 – quarterly, complaint incident report,
82