NHS Scarborough and Ryedale Clinical Commissioning Group Response to recommendations in the Capacity and Capability Review May 2018

Recommendations Definitions of keys used in the report Priority Appendices Executive report Recommendations At a glance Introduction Contents Recommendations Definitions of keys used in the report Priority The actions have been given a ‘Priority’ rating, from high to low. This reflects the degree of urgency with which we believe the actions should be addressed. High This is critical to the CCG’s progress Medium This is important to the CCG’s progress Low This may not have a significant impact on the CCG’s progress but should still be taken forward Implementation Risk The ‘Implementation Risk’ rating in the final column indicates the extent to which we believe the CCG will be capable of achieving the recommended action in the recommended timeframe, taking into account any work the CCG have already undertaken. High Significant concerns and/or the action is difficult to implement. Little progress has been made to date. The CCG is unlikely to implement the recommendations effectively within the necessary timeframe without external support or additional resource. Medium Some progress has been made. The CCG should consider seeking advice or support to ensure recommendation is implemented effectively. Low Low level of concern. Plans are already well advanced, or the action will be straightforward to implement. NHS Scarborough and Ryedale Clinical Commissioning Group 10

Impact assessments already conducted Ref Area Recommendation Priority By when Implementation risk SRCCG Response 1 Quality, Equality, Privacy Impact Assessments The CCG should implement a quality, equality and privacy impact assessment approach as soon as possible. All schemes require Quality, Equality, Privacy Impact Assessments, which should be signed off by clinical leads and the PMO. High 30 Apr 2018 Medium Impact assessments already conducted Quality team has picked this up and is implementing a more robust and consistent approach 2 QIPP governance The QIPP development and oversight process should be documented with clarity provided around the gateway stages, reporting governance, levels of delegated approval responsibility to different groups/individuals, project roles and responsibilities. Low QIPP governance strengthened through turnaround director and joint working with VOY Through the turnaround director we have already started to strengthen the approach to QIPP planning and monitoring. More detail around QIPP needs to go to governing body (key actions report) . Overview report needs to go to business committee. Where relevant to primary care would go through the PCCC Internal audit has also reviewed QIPP processes 3 PMO (document access) Access to certain QIPP documents is made difficult by access rights to files within the shared server. Documenting a standard filing structure and specifying where project documents should be stored will support the PMO to retain grip and oversight of the programme. 31 May 2018 Not recognised as an internal issue There is a shared folder on the Y drive so that where cross CCG working (VOY and SRCCG ) can see all relevant documents 4 QIPP project closure A project closure/review should be added to the project lifecycle. This should include capture of insights/lessons learned from successful and unsuccessful projects. 30 June 2018 Accepted and project closure documents will be introduced to the project management methodology. 5 QIPP programme development The FY18/19 QIPP programme development appears to have started too late to have had a chance of being well worked up in advance of the start of the financial year. The PMO should document an annual cycle of identifying, planning and monitoring and start planning in advance. 31 Jul 2018 Annual cycle of QIPP planning in place. Needs strengthened process to reflect joint working and longer term planning 6 QIPP detailed planning The CCG is currently behind schedule in developing financial plans, as they currently have a list of ideas with high level targets. These ideas need detailed plans and timelines to determine when the benefits will be recognised. Immediate action is required to develop detailed plans for all schemes, including detailed milestones for implementation and financial phasing. A review point at 30 April 2018 is recommended for assurance to deliver targets. Full review and updated financial recovery plan will be complete by May 31 NHS Scarborough and Ryedale Clinical Commissioning Group 11

Framework has been agreed. AIC will be agreed by May 31. Ref Area Recommendation Priority By when Implementation risk SRCCG Response 7 QIPP phasing On completing detailed plans, the CCG needs to assess the ability to deliver savings against each scheme, within the financial year. These values need to be quantified as quickly as possible to ensure there is sufficient time to close any unidentified QIPP gaps. High 30 Apr 2018 Medium Full review and updated financial recovery plan will be complete by May 31. Capacity issues in regard to the ability to forward plan future QIPP schemes need addressing & operationalising 8 QIPP risk identification All schemes should have a thorough risk assessment and mitigation plan. As above 9 Aligned incentive contract As part of the agreement of the aligned incentive contract, the CCG should: Confirm the value locked into the contract; Consider joint governance arrangements to agree scheme delivery oversight and approach to benefits sharing where costs are taken out. Consider approach to managing risk of leakage of activity to private sector/out of area providers and approach to driving activity in to YTHFT. Push existing demand management schemes through PMO gateway process as quickly as possible to ensure underlying position does not deteriorate Framework has been agreed. AIC will be agreed by May 31. 10 Residual gap Following the worked up plans for QIPP schemes, the CCG needs to validate the size of the residual gap. 31 May 2018 Low Full review and updated financial recovery plan will be complete by May 31 within that we will be clear on what residual gap is. 11 It is likely that there will be a significant residual gap in the CCG’s financial plan. The CCG should invest in developing further pipeline schemes in parallel with working up existing pipeline in detail. Sources to consider are MOO, schemes underway at other Y&H CCGs, and holding multi-disciplinary workshops to identify further in-year opportunities. Full review and updated financial recovery plan will be complete by May 31 NHS Scarborough and Ryedale Clinical Commissioning Group 12

Priority Implementation risk Ref Area Recommendation Priority By when Implementation risk SRCCG Response 12 Finance and Contracting Committee We recommend that the Finance & Contracting Committee is chaired by a Lay Member, to ensure additional independent scrutiny of the financial position. High 30 May 2018 Low Proposal will be put to the Governing Body and CoCR to amend current arrangements 13 Scrutiny of financial position There must be an even greater level of scrutiny of the financial position at the Governing Body and its subcommittees. In particular, this should consider the links between QIPP, demand and activity levels, to seek assurance that QIPP schemes are delivering genuine reductions in costs to the system as a whole. The Governing Body should consider how it gets assurance over the delivery of the system recovery plan as well as CCG specific QIPP. Medium 30 Jun 2018 Financial Recovery Board in place and will report to Finance committee and Governing Body. In part this will be addressed through new approach to strengthening QIPP 14 Meeting agendas Meeting agendas could be enhanced by including timings; this will help the Chair to run the Governing Body meeting to time. 30 Apr 2018 May be helpful as an indication and will be introduced and reviewed over coming year. Chair does currently have timings on personal copies 15 Escalation from subcommittees The CCG could create more consistency in the escalation of risks from subcommittees by using a template for subcommittee chairs to escalate matters from th recent meeting. This should include: Key issues discussed; Risks identified; and Mitigating actions. Financial Recovery Board in place and will report to Finance committee and Governing Body The CCG has a process of reporting from committees to governing body. The formats are bespoke to each committee. We will ensure that each of those three points are included 16 Finance Report Given the level of financial risk associated with the FY19 plan, the Governing Body Finance Report should be supplemented by a dashboard setting out the major areas of QIPP, and their status. The QIPP report is circulated to the Governing Body members as part of the financial report. CCG will add in additional issues as set out previously NHS Scarborough and Ryedale Clinical Commissioning Group 13

This process is already underway Ref Area Recommendation Priority By when Implementation risk SRCCG Response 17 Collaboration The CCGs’ leadership must urgently meet with NHS England to agree the optimum approach to ensure the right capacity across the North Yorkshire CCGs, and how leadership should evolve to maximise the benefits of collaboration at scale. This should include exploration of the potential for a single leadership team. High 30 Apr 2018 This process is already underway CCG will work with partners to develop option appraisal and business case in order to consider all options within an appropriate governance framework for decision making 18 The CCG should continue to develop its transformation structure with local partners and build on their learning from the Scarborough locality Ambition for Health programme, to embed transformation structures that promote “place” based planning including local authority, mental health and primary care. 31 Dec 2018 19 Determine the overall operating model for the provision of health and social care across North Yorkshire and York, allowing enabling services such as business intelligence, digital interventions, app development etc. to be commissioned once. 20 Share QIPP schemes across the patch to facilitate spread and scaling. Medium 30 Jun 2018 We have already shared all QIPP programmes by the end of Q1 and embed the process as part of the annual QIPP planning cycle. NHS Scarborough and Ryedale Clinical Commissioning Group 14