/CKWCB-12-171b_GHCCE_mins_28.03.

NHS KIRKLEES

Minutes of the Greater Huddersfield Clinical Commissioning Executive (CCE) Meeting held on Wednesday 28th March 2012, 2.00 – 5.00pm in the Board Room at Broad Lea House, Bradley Business Park, Huddersfield Present: Vanessa Stirum (VS) Rob Millington (RM) Mehboob Khan (MK) Dr Steve Ollerton (SO) Dr Judith Parker (JP) Dr David Hughes (DH) Dr Dil Ashraf (DA) Dr Karen Dean (KD) Dr Jane Ford (JF) Carol McKenna (CM) Penny Woodhead (PeW)

Non-executive Associate and Chair Non-executive Associate Non-executive Director CCG Clinical Chair CCG member CCG member CCG member CCG member CCG member Chief Operating Officer Deputy Director of Quality & Professional Development

In attendance: Merran McRae (MM) Rachel Carter (RC) Joanne Crewe (JC) Nicky Hoyle (NH) Steve Brennan (SB) David Boothroyd (DB) Kath Woodford (KW) Sue Richardson (SR) Helen Severns (HS)

Director of Wellbeing, Kirklees Council Deputy Director of Commissioning/Head of Contracts Head of Wellbeing & Integration Public Health Consultant Deputy Director of Finance Senior Contracts Manager Performance Reporting Manager Programme Manager Assistant Director of Commissioning (Children’s)

Minutes: Kelly Chadwick (KC)

Personal Assistant to Greater Huddersfield CCE

EC/12/96

Welcome, Introductions and Apologies for Absence VS welcomed PeW to the CCE and introductions were made from CCE members.

Apologies for absence were received from; Jan Giles (JG) Vicky Dutchburn (VD) Dr Anuj Handa (AH) Dr Paul Wilding (PaW) Sheila Dilks (SD)

Assistant Director of Commissioning Assistant Director of Commissioning (MH) CCG member CCG member Director of Transformation

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Declarations of Interest Declarations of Interest were noted from both Judith Parker and David Hughes with respect to Agenda Item No 11 - Ophthalmology Business Case.

EC/12/97

Accuracy of Minutes of 22 February 2012 The minutes were confirmed as accurate with an amendment to page 10, item EC/12/89, Any Other Business - Flu Epidemic.

Action: KC to make the amendment before confirming minutes as ratified.

Action: Minutes from extra CCE held on 14 March 2012 to be added to April agenda.

Estates It was agreed that this would be added to the May agenda for an update.

External Nurse/Consultant CM advised she had raised this at the Cluster Leadership Team meeting. Advice has been taken from the HR Cluster Director to hold on this until the final job specification is made available. This can then be progressed to recruitment stage.

Action: Any suggestions for suitable applicants who could be encouraged to apply for the roles to be fed back to CM/SO. Action: Add to April agenda for update.

EC/12/98

Clinical Chair/Chief Operating Officer update It was noted that Sheila Dilks has now retired from NHS Kirklees and the CCE would like to formally thank Sheila for all her hard work and wish her well in her retirement.

CM advised that the NHS constitution has been slightly revised and the update has been shared with the CCE members.

The CCE members NOTED the contents of the report and thanked CM/SO.

EC/12/99

Performance Report KW gave a brief overview of the performance report.

KW advised that a feedback paper has been received from YAS on 28 March 2012. The issues with YAS have been discussed previously at the Finance & Performance Committee.

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KW highlighted the main issues as being ambulance response times for Denby Dale, Kirkburton and The Valleys. The report is showing South Kirklees as a whole but KW has asked for further information specific to the Valleys.

Further discussions took place about the contract for this service.

RC confirmed that payment was withheld until performance improved. YAS will receive payment as they have reached their targets overall.

CQUINS was discussed. It was noted that Denby Dale and Kirkburton do not qualify as a rural area under the YAS target areas.

It was AGREED that KW would request further information from YAS regarding certain rural areas.

Action: KW to look at cross border performance for comparison and feedback at the next CCE. Further discussion took place regarding the most suitable group to receive this information. It was AGREED that a Task & Finish group would be organised and would involve Pat Andrewartha, Kath Woodford, Steve Ollerton, David Hughes and representation from YAS. Action: Pat Andrewartha to be asked to arrange a Task & Finish Group to look at the issues highlighted and feedback to CCE in due course.

KW highlighted key areas of concern: Mixed sex accommodation Critical care KW advised that new guidance has been published for CDiff and suggested CCE members contact KW directly should they wish to receive a copy of this guidance.

JP highlighted that she had offered to be the GHCCG rep to work with CHFT to review Stroke pathways but had not yet had any contact from Hayley Haycock. KW agreed to look into this.

Action: KW to speak with HH and ask her to make contact with JP regarding representation on Stroke pathways group.

It was reported from the Finance & Performance Committee that the following items had been added to the Risk Register; IAPT YAS Healthchecks The CCE RECEIVED and NOTED the contents of the report and thanked KW for her attendance.

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EC/12/100

Finance Report SB briefed the CCE on the overall financial position.

Very little movement across budgets overall Budgets for 2012/13 were discussed at F&P on 18/03/12 and have been approved by Cluster Board on 27/03/12.

The level of contingency was discussed. Its significantly less at £1.5million instead of £5million.

SB advised the reason for this is because the contingency used on in-year acute activity. 2012-13 has fixed contracts in this area which fixes the financial risk.

Non-recurrent spend £2.5 million for CHFT and £5million for MYHT. There is still some of this money to be committed and SHA approval is still awaited. £1million is still available for GHCCG .

SB advised that the importance of the next QIPP target is crucial.

Targets need to be maintained to ensure contingency isn’t required to be used.

Healthchecks money was discussed and SB explained the plans for the money.

JP questioned the finance report from the Cluster Board minutes and asked for clarification regarding the surplus monies. SB confirmed they were true figures.

SB confirmed that initial discussions have taken place regarding Bolton Dashboard and Pathfinder. SB also confirmed that there have been some slight amendments for the use of 2% non-recurrent money but all had been approved.

The CCE RECEIVED and NOTED the contents of the report and thanked SB for his attendance.

EC/12/101

Contracting Report DB gave a brief overview of the current position; CHFT at month 10 - £662K undertrade Figures showing reduction Contract challenge process is bringing money back to the PCT via the demand plan. This year it is about £380k.

Contracts not signed yet.

The pressures on some contract areas were discussed. This should clear up a little in 2012-13 due to fixed points in the contract.

Discussions took place regarding private providers. The figures have increased due to patient choice.

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Discussion took place regarding patient choice on Choose & Book and whether CHFT would accommodate patient appointments quicker than a private provider.

RC confirmed that a fixed value contract has been agreed for 2012/13 with CHFT. This would mean no floor and ceiling but a fixed figure for all services. £138.3 million for Kirklees including £1million reinvestment.

RC explained the background to the contract negotiations. A clinically led review has taken place and been shared between commissioner and provider, although does need to be commissioner lead. A certain element of QIPP savings have been included in the financial report. Monitoring of services will continue in the normal manner but figures will remain fixed.

DH questioned how CHFT would be affected if levels in activity changed. RC explained that it would a benefit this year but will need to be looked into further next year.

RC advised that Keith Griffiths, the Director of Finance will be invited to attend to explain this in more detail. RC confirmed that the next steps would be some pre-work to take place before meeting with Keith Griffiths.

It was AGREED that Keith to be invited to either April/May Clinical Strategy Group and that a pre-meeting be organised in advance of this. It was AGREED that CM would lead the pre-meeting.

Action: RC to organise date with Keith Griffiths.

Action: KC to look at attendance for pre-meeting. CM to lead.

The CCE RECEIVED and NOTED the contents of the report and thanked DB for his attendance.

EC/12/102

Quality & Safety Report PeW advised that this report covered the CKW Cluster and that the Quality & Safety Subgroup will be working up reports to come to the individual CCE’s as a standing agenda item going forward.

The reports will include CQUINS, National Quality Indicators, Serious Incidents and CQC. Current updates include; Mixed sex accommodation – no breaches MRSA – no breaches CQC – Foxview inspection – the Mental Health Quality Board have received an action plan. CQC will be visiting again after implementation of the plan.

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The CCE RECEIVED and NOTED the contents of the report and thanked PeW. EC/12/103

NHS Transition CSS Update/Memorandum of Understanding CM explained the letter and Memorandum of Understanding recently sent to Ann Ballarini.

Alison Hughes has recently been appointed as Director of the CSS. It was agreed that Alison Hughes should be invited to attend the CCE in April.

Action: KC to invite Alison Hughes in April and add to agenda.

There has been a development day on the CSS held today, 28/03/12, and PaW has attended on behalf of GHCCG. MM asked for the information regarding the structures to be fed back to the SHWB at some stage. CM agreed and advised that integrated commissioning is vital. We need to be consistent with communication between the CCG’s and the Local Authority.

NH advised that a draft MoU for the Public Health offer should be available mid-April. Draft guidance is currently in development. NH suggested this be brought to the CCE for further discussion once available.

People Transition CM explained the next steps on the structure and the recent assignments. DH raised a question regarding sharing a Chief Financial Officer with another CCG. It was agreed that this should be put to Mike Potts for a response, as he is attending the Clinical Strategy Group on 11 April to discuss the structure developments.

CM advised that the Clinical Chair, Chief Financial Officer and Accountable Officer will all have to go through an assessment process as of mid-April. Carol highlighted that nominations for the assessment process for these roles are being forwarded to the SHA now, and that if any GP other than SO wished to be considered for assessment, then they should make this known straight way.

Action: CM to confirm with PaW and AH that they do not wish to be considered for the assessment centre.

EC/12/104

Plenary Update SO gave a brief update regarding the recent plenary. SO confirmed the results are as follows; All eligible practices voted for the current 8 GPs to stay in post for a further 18 months.

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All eligible practices voted for that 8 members was an acceptable number.

All eligible practices voted for the members to be GPs only at this stage.

All eligible practices voted for half of the members to be in post for 2 years and the other half for 3 years, once a new Board was chosen.

The constitution and Memorandum of Understanding was also explained at the plenary. The Board are proposing to go for wave 2 authorisation which would mean application on 1st September 2012.

There would be a 360° survey of stakeholders, including member practices, commencing in July 2012.

The Board members payment arrangements going forward was discussed and CM agreed to raise this with the Cluster HR Director.

Action: CM to discuss payments of GPs on the Board with June Goodson-Moore.

It was agreed that both practices and the CCE members should be informed of the changes to be made to the number of sessions the GPs would have from April 2012 onwards. NH advised that this has been previously discussed and that it needs picking up through the Communications team to agree a strategy.

Action: Formal report to be drafted by SO regarding the changes to the number of sessions per GP and brought to the next CCE meeting.

EC/12/105

Calderdale & Huddersfield Clinical Strategy Refresh CM gave a brief high level presentation. CM explained the examples of sectors on the slides and the integration needed between each. QIPP links across the Health and Social Care Economy.

CM advised that the Transformation Board have taken a lead on this. The first meeting was in March and the Terms of Reference are currently being agreed. A full time programme director is to be recruited and a programme office will be organised.

MM advised that we need to be aware of clear links between the 2 CCG’s. NH suggested also linking into the SHWB and JSNA. JC confirmed there is a link across Kirklees via the two Transformation Boards. JC advised that Joe Gibson has been recruited as an interim director and has been impressed with the work developed so far.

Action: KC to send out copies of the presentation by CM.

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EC/12/106

Ophthalmology Business Case SR explained the three business cases; Primary Eyecare Acute Referral Scheme (PEARS) Ocular Hypertension long-term Follow-Up Cataract Referral Refinement & Post Operative Follow-up Both Wakefield and Calderdale PCTs have schemes in place and this would enable the whole of the CHFT/CKW footprint to be covered.

SR explained that the business cases had been submitted through the Finance & Performance Committee and agreed to be brought to CCE for approval. It was AGREED that option 1 would be the most suitable.

Discussions took place regarding the use if the GOS18s pathway.

The scheme would be commencing in July. Patients can still be referred to optometrists for minor eye ailments instead of to A&E or GP surgeries. No additional investment will be used it will all fall within the current targets and it will be performance monitored.

It was AGREED that the CCE APPROVED the business cases and thanked SR for her attendance.

EC/12/107

CAMHs Tier 3 Service

Helen Severns gave a brief explanation on the options and next steps for the procurement of a new service model for Tier 3 CAMHS following the market sounding exercise undertaken in February 2012.

Options are: A. Do nothing B. Continue to work with CHFT to improve the Tier 3 CAMH service with the newly developed service specification C. Proceed to a formal tender D. Any qualified provider Helen informed the CCE that this paper has already been to Finance and Performance Subgroup, and they support option C. All CCE members supported the recommendation and agreed with option C.

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EC/12/108

Risk Register CM advised that the group that the risks that have been flagged are currently being followed up. It was noted that work continues on the implementation of the risk management system, and in particular the creation of CCG specific risk registers in Kirklees.

The CCE RECEIVED and NOTED the contents of the report.

EC/12/109

Receipt of Minutes The CCE RECEIVED and NOTED the minutes of the following meetings; Cluster Board meeting Shadow Health & Wellbeing Board OD & Authorisation Subgroup Audit & Governance Subgroup Clinical Strategy Group

EC/12/110

Any Other Business LMC/CCG/PCT Interface Meeting - Terms of Reference It was AGREED that JG/SO/JP would be the representation on the group.

The terms of reference were AGREED by the CCE.

EC/12/111

Date and time of the next meeting The date of the next scheduled meeting is Wednesday 25th April 2012, 2.00 – 5.00pm.

This concluded the content of the CCE meeting and the Chair declared the meeting closed at approximately 5.20pm.

Chair’s Signature: ........................................................ Date: ..................................

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