1. health and fitness

North West London collaboration of
clinical commissioning groups
Collaboration board meeting 28 August 2014
Summary update to NWL CCGs’ governing bodies
Author: Emma Taylor, collaboration governance manager, NWL CCGs
The collaboration board met on 28 August 2014 to consider strategic issues for discussion at the
future governing body meetings that our CCGs have a shared interest in.
This update is designed to provide an overview of the key discussions within their wider context and
to let governing bodies know what is expected to be discussed at subsequent meetings. Its
objectives are to safeguard transparency and to give some colour to the way in which we are
working together across our individually sovereign CCGs.
Commissioning support services transition
The board reviewed the progress made since it last met on 17 July 2014. Significantly, the staff
consultation for bringing commissioning support services in-house would be drawing to a close by 5
September 2014. After this date, role matching into the finalised post-transition structures will be
undertaken for all staff affected by change (i.e. permanent staff employed by NWL’s Commissioning
Support Unit until the contract ends on 30 September 2014). A finance working group has been set
up to oversee the relevant payroll changes. Any unfilled vacancies will be recruited to once role
matching has been completed. It was noted that expressions of interest for post-transition roles
have been received in response to online advertising with HSJ jobs in advance of this.
Giving space to strategic organisational development has been recognised as a top priority. As part
of this a special welcome event will be held in October to mark the new chapter of shared services
being brought in-house.
Business intelligence data hosting
NHS England has provided a letter of support endorsing proposed contractual arrangements with
SECSU for the hosting of NWL CCGs’ business intelligence data. The arrangements will recognise the
mutual benefits to be carried over to the Hitachi business intelligence (BI) platform, plus the strong
synergies that will come into play when McKinsey’s whole system data warehouse is brought in.
It was noted that BI staffing and testing plans were being reviewed. The board agreed that first and
foremost our CCGs’ GP leads for the joint management and development of BI will need to bring to
bear their strategic thinking as well as being IT-savvy technicians, in order to steer how the
intelligence is developed to align with and support the strategic agenda. A working group of GPs will
therefore be engaged to give direction to the way in which the platform should evolve. One
objective will be to demonstrate functionality regarding specific patient information tracking before
it is scaled up.
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Consideration was given to the shared delivery resource between all the parties; weekly meetings
were being held on Fridays. The outcome of ASH accreditation for Brent would not impact staff
operationally as secondment to SECSU would be one way of protecting the model. The board agreed
that the costing proposal from the CSU for this was too high and further negotiation was needed. It
was agreed that the Hitachi contract would be managed on behalf of NHSE with SE CSU. Chairs
actions were taken to delegate authority to the director of informatics to proceed to agreement of a
contract with SE CSU which reflects the conditions of the main contract that is based on the agreed
Heads of Terms.
Primary care co-commissioning progress
NWL CCGs had responded to the offer by NHSE earlier in the year to pursue options for primary
care-commissioning. A joint expression of interest was submitted in May 2014 which incorporated
stakeholder engagement and support from the LMC. Every other CCG in London had similarly
expressed an interest to explore collaborative arrangements for co-commissioning.
It is anticipated that shadow arrangements for co-commissioning could begin as early as November
2014 and go live in April 2015. Summary proposals will be discussed at CCGs governing bodies’ public
meetings which set the stage for developing the detailed governance arrangements that will
underpin it, including appropriate means to avoid conflicts of interest. This important item will also
be discussed at our next round of our councils of members.
The board reflected on how primary care co-commissioning will open up new opportunities to
strengthen the delivery of CCGs’ out-of-hospital strategies and considered how it would relate to
whole systems integrated care. There is high level agreement in the health care economy as to what
the key problems and challenges are, and co-commissioning will allow us to develop solutions jointly
with CCGs’ partners. It was clear that effective co-commissioning will have to be multilateral and
inclusive in ethos and structure. The board was supportive of the direction of travel described.
Strategy and transformation programmes update
A comprehensive report was presented on the key support contracts let against the outcomes
achieved. This was in response to the request to see demonstrable value for money vis-à-vis
consultancy spend based on outcomes. The purpose of the exercise was to understand the typical
sequence of resource utilisation relative to the core skillsets in place. The board requested further
analysis is distilled and summary context provided.
National clinical standards for 7-day services
A detailed baseline self-assessment has been completed across NWL against the clinical standards.
The next step is to agree the sequence by which outstanding standards can be met to against the
core criteria of impact, achievability and affordability, in addition to the 2014/15 commissioning
priorities set (e.g. diagnostics and consultant cover).
Specialist commissioning
The board considered specialist commissioning (a responsibility and function of NHS England) and
where further alignment is required to support Shaping a Healthier Future. It was noted that NHSE is
seeking to ensure the right influences are in place to inform and shape specialist commissioning
decisions. In future this is likely to see increased external engagement and a strategic approach to
common large providers and understanding the drivers for annual growth (5-7%) in specialist spend.
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Month 4 budget report – financial strategy / Shaping a Healthier Future
In-year funding pressures required an over-commitment of budget by a total of £1.75m in respect of
three areas: further resilience support in respect of service reconfiguration transition following NHSE
review (£0.35m); maternity transition – workforce support to enable transition (£0.83m) and
Imperial emergency surgery (£0.25m). The board noted the contents of the report which would be
presented in detail to governing bodies in September for their approval.
Recommendations of NWL’s Policy Development Group
The newly established group that has been approved by each CCG’s governing body has now met
three times to review detailed proposals. It brought three recommendations for approval to the
collaboration board regarding cryopreservation, varicose veins and knee replacement surgery. It was
agreed that the process of developing recommendations needed to be refined to include earlier
consultation with finance colleagues to take into account affordability constraints of changing or
removing specific eligibility criteria for certain courses of treatment. To achieve this, a finance
representative will join the group’s membership. The board agreed that before a final decision is
taken regarding the proposed removal of BMI>40 for knee replacement surgery the NICE guidelines
will be reviewed and the affordability of the proposal in the 2014/15 year will be considered. The
board supported the updated policy on cryopreservation, including ovarian stimulation, egg
harvesting and storage for up to 5 years to patients undergoing treatment likely to permanently
affect their fertility. Re-implantation will be provided in line with the IVF policy. For the treatment of
varicose veins, the board supported the removal of the requirement for patients for try six months’
conservative treatment prior to surgical intervention, whilst maintaining the other existing criteria.
Service transformation update
The A&Es at Central Middlesex and Hammersmith Hospital are scheduled to close on 10 September
2014, with 24/7 urgent care centres and other services retained on both sites. An update was given
on the detailed assurance that services can be transitioned safely and the arrangements for close
monitoring in the run up to and post-transition of services were discussed. The board was satisfied
that the assurance process for safe service transition on 10 September 2014 remains robust.
The expected changes to maternity and neonatal services in NWL would be a major item for
discussion and decision at the public sessions of CCGs’ governing body meetings in
October/November, with the process to be led by Ealing CCG.
NWL financial strategy
It was reported that NHSE had formally signed off the 5-year strategy and the detailed plans for
2014/15 adopted by respective governing bodies. The planning assumptions for 2015/16 still hold
and the detail will be returned to by governing bodies later in the year. The board noted that the
necessary financial commitments to enable the mergers between North West London
Hospitals/Ealing Hospital NHS Trust and Chelsea and Westminster/West Middlesex would be made
by NWL CCGs. The board was supportive of Shaping a Healthier Future hub business cases being
brought to CCGs’ governing bodies in due course.
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Procurement service (private)
The procurement Task & Finish group recommended to the board the contracting of SBS to supply
clinical and non-clinical procurement services to NWL CCGs after 1 October 2014 subject to further
negotiations on price. The collaboration board’s views were sought. Negotiations would proceed to
develop Heads of Terms.
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North West London collaboration of
clinical commissioning groups
Collaboration board meeting 25 September 2014
Summary update to NWL CCGs’ governing bodies (private)
Author: Emma Taylor, collaboration governance manager, NWL CCGs
The collaboration board met on 25 September 2014 to consider strategic issues for discussion at the
future governing body meetings that our CCGs have a shared interest in.
This update provides an overview of the key discussions within their wider context. Its objectives are
to safeguard transparency and to give some colour to the way in which we are working together
across our individually sovereign CCGs.
Primary care standards
A paper on primary care standards was being prepared and would be discussed at CCG governing
body meetings to help formulate a response to the letter that all NWL CCGs had recently received
from NHS England on primary care standards. A top-level response summarising the position of the
CCGs following clinical consultation would be led by Thirza Sawtell, director of strategy and
transformation.
Commissioning support services transition
At the time of reporting the matching and slotting in process was substantially complete for CSU
staff being re-deployed into roles within CCGs’ respective operational management structures. The
next phase to support CCGs’ organisational development and effectiveness is to ensure a strong
recruitment drive of substantive staff to the remaining vacancies and a steady reduction of the level
of interim staff. Organisational development and on-boarding to welcome CSU staff into the CCGs
continues to be a key focus especially over our first 100 days of in-housing support services on 1
October 2014. This would include a Day One welcome letter and an all-staff Launch Event on 9
October with interactive presentations from the leadership teams across the CCGs and an opening
talk from lay member on patient care.
It was reported that Andrew Burgess, an experienced commissioning colleague, had been appointed
as the interim director of contracts and performance, reporting to Rob Larkman, chief officer for
BHH. Andrew’s first set of priorities are to oversee the setting up of the annual contracting process
for 2015/16 which will gather momentum over the coming months. The contract steering group had
begun planning and development together with managing directors / chief operating officers.
Practical implications of in-housing were being managed. This included ensuring that a lead CCG
(Brent) receives Assured Safe Haven (ASH) formal accreditation on behalf of all NWL CCGs, in line
with data protection requirements, as per the same provisions that the CSU has had in place. Other
implications involved office moves to ensure the best configuration to accommodate new structures.
It was noted that the Transition Management Group (TMG) would continue to meet regularly for a
further six months to oversee and refine the necessary detailed operating processes relating to
shared support services and to work together to manage the associated shared running costs.
Finally, a new procurement service had been jointly procured under the CCGs’ procurement steering
group.
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Transformation programmes
1. Business intelligence and informatics: (A) data warehouse and (B) interoperability
Two papers were presented for discussion. The first examined the request for data and analytical
access to the NWL CCGs’ Hitachi data warehouse (which CCGs are the guardians of) and the second
explored key principles that would underpin a business case for interoperability for clinical notes to
be established across NWL.
On the first paper, the board asked for the NWL CCGs/Hitachi programme board to review the
requirement alongside the existing programme to estimate the scope of the work, given the greatest
priority is to deliver effectively the system for NWL’s CCGs. The driver behind the request was the
opportunity to understand more about healthcare patterns in NWL through the analysis of
anonymised data. More information about this would be brought to a future collaboration meeting
and patient leadership would be sought.
On the second paper, it was agreed that to inform debate a detailed specification needs to be
developed that also demonstrates the relevant information governance (IG) considerations including
informed patient consent have been managed in the appropriate CCG forums. Members discussed
how in the longer term it is anticipated that a greater degree of interoperability will enable new
ways of working together to deliver whole systems integrated care (which in turn will inform the
informatics needs). Significantly, there is a real spectrum of views in NWL between advocates of
single systems and advocates of interoperability between existing different systems. As a
consequence there is no clear consensus as to which system may ultimately become a designated
platform for a single system (which could be 4-5 years away). In the meantime, mapping the flows of
patient information will inform the strategic approach to be considered by CCGs, and this mapping
work is underway. A detailed proposal would be brought in due course to a future collaboration
meeting and to CCGs’ governing bodies.
2. Embedding partnerships
A presentation was given on Embedding Partnerships; a key work stream of whole systems
integrated care (WSIC). At its heart it supports lay people to come together with professionals as
equal partners and to co-produce policies for integrated care that are fully patient-centred. It has
nurtured an exciting arena through which patients are becoming intrinsically involved in the
development of Integrated Care Pathways (ICP) which has naturally extended into WSIC and which
has focused on achieving joined up care that is closer to home. The board was supportive of this
important work being consolidated and further developed so that it helps to shape and guide the
work of a range of transformation programmes. It recognised the real value in bringing together all
the parts of the healthcare system from acute providers to GPs through patients’ diverse voices and
experiences. Mohini Parmar (Chair, Ealing CCG) and Fiona Butler (Chair, West London CCG) both
agreed to champion the collaboration board’s relationship with Embedding Partnerships on behalf of
NWL CCGs.
3. Mental Health and Wellbeing strategic plan and project initiation document
A paper was presented by Fiona Butler (Chair, West CCG). Members considered how reform of
mental health nationally is long overdue. Furthermore, the imperative to increase investment in
mental health and to bring it higher up the national agenda has cross-party political support. The
paper highlighted major themes in priorities for mental health, with an emphasis on the promotion
of resilience and wellbeing and on the prevention of mental health issues. In planning for 2015/16,
the onus will be on CCGs to put their weight behind mental health through the NWL CCGs’ Shaping a
Healthier Future budget, with an estimated pooled funding of £3–5M per annum to deliver a major
new programme.
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It is clear that mental health is a core part of succeeding with whole systems integrated care, which
mental health cannot be divorced from. There was strong consensus, together with lay member
counsel, that funding of mental health transformation will not only improve the quality of
individuals’ lives but will also bring tangible socio-economic benefits to local communities. As such
the collaboration board lent its broad support to the principles outlining the case for change. The
collaboration board supported the project initiation document and the invitation to tender. A paper
will be presented to governing bodies for consideration regarding programme initiation and
commencement arrangements.
Healthwatch and interpreting services
A letter to the chief officers had been received from Healthwatch requesting funding of £60k to
assist with a review of the quality and performance of interpreting services in NWL in order for
recommendations to be made to provision to contribute to improved patient experience and
outcomes. There was some appetite to hear more about this proposal and a suggestion that a
presentation could be invited at a subsequent meeting. A question was raised as to whether or not
the proposed work already represents a core statutory responsibility of Healthwatch. It was
suggested that an externally commissioned approach may support impartiality in the way in which
such as review is set up and conducted by Healthwatch. The board concluded that more information
was required before the request is taken further.
Primary care transformation board
The collaboration board noted that the primary care transformation board (which has chair
membership) would be re-convened given the considerable work taking place in the transformation
of primary care.
Shaping a Healthier Future – maternity and paediatrics
NWL’s CCGs are continuing to lead the process for maternity transition in NWL and its interrelated
services including neonatal transition, given the planned closure of maternity services at Ealing
Hospital. An assurance process is to take place between 26 November 2014 and early January 2015
when Ealing CCG’s governing body will formally consider the assurance put into place. This will
follow prior consultation with other NWL CCGs and include the use of deep dive, clinically-led
workshops, in particular with the most affected neighbouring CCGs. This will be used to test whether
it is sufficiently robust to proceed with the planned date for transition (which at the time of
reporting has yet to be set). The collaboration board was reminded that neonatal transition is not a
decision for the CCGs but for NHS England.
It was noted that some CCGs may need to hold additional governing body meetings to accommodate
all the necessary elements of the assurance process for maternity transition. All CCGs need to fully
engage in the process and to be individually assured that services are safe to be transitioned. A
detailed assurance process is being taken to CCGs’ governing bodies for discussion designed to
ensure there is robust assurance around the timing of transition. The high degree of public interest
in this area was well understood and as such a clear communications strategy would be developed
to align closely with the assurance process being followed by the CCGs.
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