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Performance and assurance

What are our overall aims by 2028?

To develop a robust oversight approach which not only provides assurance to ICB and ICS partners on system delivery against the four aims of the ICS but, most importantly, instils patients and our population with confidence in respect of local NHS services. 

To embed a mature assurance model rooted in the principles of mutual accountability, which brings system partners together to identify, assess and evaluate risks, issues and support needs, and facilitates collective action to tackle challenged performance areas.

To establish robust reporting and monitoring processes to track system, ICB, Care Collaborative and Place-based progress against the delivery of the key priorities, metrics and deliverables set out in this plan, the NHS Constitution, the NHS Long Term Plan and NHS Operational Planning Guidance.  

To be instrumental in tackling health inequalities ensuring that performance and outcomes can be monitored at a granular geographical level, to highlight unequal outcomes in the local context for the Coventry and Warwickshire geography, enabling priority areas to be identified and improvements to be tailored to local population needs.     

To transition to an outcomes based Performance and Assurance Framework to facilitate achievement of the priorities and commitments and address the changing needs of our population.


What’s our starting point?

Our Memorandum of Understanding with NHS England sets out the system assurance arrangements in place to monitor delivery of the national NHS Oversight Framework (NOF), which measures ICS delivery against five domains of performance, quality, workforce, finance and leadership.

Like the majority of ICBs nationally recovering from the impacts of the Covid pandemic, in 2022/23 Coventry and Warwickshire ICB received a NOF segmentation 3 rating, meaning significant support is required for 1 or more NOF domains. Moving into 2023/24, we are focused on improving this position.   

The System Review Group was established in 2021/22 and is based on and reflects the NOF. The group is chaired by the ICB Chief Performance and Delivery Officer and brings together system partners to focus on performance improvement.

There is already regular and integrated system-level reporting in place across the key NHS Constitution Rights, Pledges and Standards, and NHS Long Term Plan and NHS Operational Planning Guidance priorities, metrics and deliverables to support the system to drive improved outcomes. 

Operational activity, finance, workforce and performance plans and corresponding trajectories have already been agreed with Providers for 2023/24.


What are some of the key links to other parts of the plan?

Performance and assurance will link to all other parts of the plan.  Work has commenced to embed the priorities, metrics and deliverables in the plan as a central component of a broader discussion on performance and all organisations will be held to account and monitored against these, with any risks to delivery highlighted and mitigations identified. 

What will we be focusing on in the next 2 years?

Delivering the statutory duties of the ICB, including to ensure that people living in Coventry and Warwickshire have access to high quality, equitable health and care services, through the continued application and on-going development of a range of assurance tools to monitor delivery and target progress, alongside routine reporting that is accurate and clearly highlights areas of challenge, with benchmarking and special cause variation provided for contextual insight.

In exercising our functions, continuing to act in a way that promotes the NHS Constitution, including by ensuring that the delivery of the NHS Constitution Rights, Pledges and Standards is included within all relevant Provider contracts and that these are robustly monitored and performance managed.  Where challenged areas of performance are identified, working with relevant Providers to agree remedial action plans and associated recovery trajectories.  

Continuing to hold ourselves to account through the governance structure described in the ICB Constitution.  

Developing a system-level Performance and Assurance Framework which uses the priorities in this plan as an organising structure and monitors performance against the NOF and the plan, including through triangulation of a range of metrics and deliverables aligned to the NHS Long Term Plan and NHS Operational Planning Guidance.

Setting and monitoring Provider Operational Delivery Plans and trajectories on an annual basis to secure system-level delivery of NHS Long Term Plan priorities, metrics and deliverables. 

Setting out local performance priorities each year based on the findings identified through the Population Health Management data (quantitative and qualitative) to ensure that we are driving performance improvements which are important to our population. 

Building our outcome based assurance capability, scoping out the relevant data requirements with our Providers to develop a baseline position allowing us to begin to gradually transition to a more outcome based approach by the end of 2023/24 and beyond.

Reviewing our suite of reports to ensure that they enable:
- The ICB and ICS partners to understand the progress of system delivery against the four aims of the ICS;
- With a particular focus on ensuring that health inequality intelligence is reported at a granular level, wherever possible and appropriate, to ensure that transformation strategies, plans and programmes are consistently targeted to tackle unequal outcomes for our patients. 

Developing a Care Collaborative assurance reporting model for service areas within the Phase 1 scope of the two geographic Care Collaboratives to support the Collaboratives in undertaking their commissioning functions (see Collaboratives section).

Commencing shadow Care Collaborative, Place and PCN reporting across all programme areas to build commissioning intelligence to support service delivery and targeting interventions to improve overall system performance.    

Establishing robust tracking processes that enable early detection of challenged areas and identify variation across the system. This should be available for all geographical levels as organisations develop and mature (for example, Place and Care Collaborative levels).

Continually reviewing the effectiveness of our governance arrangements in overseeing and supporting the delivery of the four aims of the ICS and the priorities shared across the Integrated Care Strategy and this plan, including:

Supporting collaboration and mutual accountability through Committee and Board composition/membership;
Engaging and working collaboratively with system partners to support the delivery of shared objectives and mutual accountability. 


Key Challenges

Data accessibility at geographical level and timeliness, in addition to data quality issues.

Information Governance constraints in relation to data sharing.

Performance recovery is challenged due to the significant impact of the pandemic with regards to multiple factors, including the impact on wider determinants.

Constrained resources in terms of finance and workforce which impact on transformational activities and innovative ways of working.

Responding to the new Care Quality Commission approach to assessing ICSs. 


Key Metrics and Deliverables

Existence and development of a comprehensive system-level Performance and Assurance Framework available at varying geographic levels with organisational accountability.

Evidence of delivery against the four aims of the ICS, and the priorities, metrics and deliverables set out in this plan, the NHS Constitution, the NHS Long Term Plan and NHS Operational Planning Guidance.  

Through the above:
- Demonstrable improvement to patient outcomes and experience;
- Reduction in health inequalities and unwarranted variation. 

NHS Oversight Framework – improvement of current segmentation rating during 2023/24.