Draft Minutes of the Clinical Commissioning Executive Meeting held on 11 October 2012 in the Shibden Meeting Room, F Mill, Dean Clough Mills, Halifax Present:
Dr Alan Brook Dr Majid Azeb Dr Hazel Carsley Dr Steven Cleasby Dr Peter Davies Trevor Lake Julie Lawreniuk John Mallalieu Dr John Taylor Dr Nigel Taylor Dr Matt Walsh Dr Graham Wardman Penny Woodhead
Clinical Commissioning Group (CCG) Board Chair (Chair of the meeting) CCG Board Member CCG Board Member CCG Board Member and Assistant Clinical Chair CCG Board Member Non Executive Associate Designate Chief Finance Officer Lay Member and Deputy Chair of CCG CCG Board Member (from Item 120/12 onwards) CCG Board Member Designate Chief Officer Director of Public Health Head of Quality
Apologies for absence:
Keith Wright
Non Executive Director
Also present:
Debbie Graham
Head of Service Improvement (for items 117, 118 & 123/12) Programme Manager, Care Closer to Home (for item 123/12) Head of Commissioning for Adult Services Patient and Public Involvement Manager (for item 122/12) Head of Business Intelligence (for item117/12) Assistant Director of Workforce (for item 119/12) Corporate Governance Manager/Board Secretary
Corinne McDonald Mick Mellors Dawn Pearson Tim Shields Laura Smith Jane Brownlie Observers:
Cllr D Draycott Mike Lodge
Member of Adults, Health and Social Care Scrutiny Panel, Calderdale Metropolitan Borough Council Senior Scrutiny Support Officer, Calderdale Metropolitan Borough Council
111/12 OBSERVERS FROM THE ADULTS HEALTH AND SOCIAL CARE SCRUTINY PANEL OF CALDERDALE METROPOLITAN BOROUGH COUNCIL The Chair advised the meeting that, following a request from Calderdale Metropolitan Borough Council, it had been agreed that as part of their development, members of the Adults, Health and Social Care Scrutiny Panel could attend at any of the next three Clinical Commissioning Executive meetings as observers. The Chair welcomed Cllr Draycott and Mike Lodge to the meeting.
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112/12 DECLARATIONS OF INTEREST Trevor Lake declared an interest in Item 115/12 (Finance and Efficiency Report) due to his appointment as a Non Executive Director of Mid Yorkshire Hospitals NHS Trust. Dr Peter Davies declared an interest in item 117/12 (Operating Framework – Performance Report) due to previous difficulties in his practice’s ability to use the Choose and Book System. 113/12 MINUTES OF THE MEETING HELD ON 13 SEPTEMBER 2012 The minutes of the meeting held on 13 September 2012 were accepted as a correct record. 114/12 DESIGNATE CHIEF OFFICER’S REPORT The Designate Chief Officer presented this report which provided an update on current pertinent issues, including the CCG authorisation visit, Equitable Access, NHS 111, immunisation of staff against flu, winter planning and proposals for new arrangements for national commissioning of specialised services. The report also proposed that John Mallalieu, the Lay Member for audit and finance assume responsibility for chairing the Audit and Governance Group and with Keith Wright, the Non Executive Director providing support and remaining on the membership of the Group until 31 March 2013. The Designate Chief Officer also referred to progress in respect of the Strategic Review of Health and Social Care and advised that the first phase of the review was complete and a specification was being prepared for support of the care streams. The Designate Chief Officer advised that he would circulate a copy of the service specification to CCE members. DECISIONS 1. That the report be noted. 2. That John Mallalieu be appointed as Chair of the Audit and Governance Group. 115/12 FINANCE AND EFFICIENCY REPORT It was noted that Trevor Lake had declared an interest in this item due to his appointment as a Non Executive Director of Mid Yorkshire NHS Hospitals Trust. The Designate Chief Finance Officer presented this report which outlined the current and forecast financial position for 2012/13 including associated risks. The report forecast that the control total would be delivered and outlined the steps being taken to manage the risk of the QIPP plans not delivering the required level of savings. It was noted that there was an under-spending on some budgets. The Designate Chief Finance Officer referred to the contingency fund and the requirement for £12m to be spent non-recurrently. She advised that the Finance 2
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and Performance Group had now completed its non-recurrent spending plan so as to mitigate the risk of the monies not being spent. It was reported that bids (together with supporting business cases) had been received from/in relation to primary care development, third sector support, CHFT (mainly for integration of primary care and secondary care information), SWYPFT, the Council (in relation to care homes and equipment) and public health. Those bids had been reviewed by the Senior Management Team and CCG Board Chair and Assistant Clinical Chair and an appropriate number and cost of bids (equating to the monies available) had been approved. It was reported that each scheme had its own governance process. The CCE was asked to confirm its support of this process which involved SMT managing the delivery of the schemes and the Finance and Performance Group overseeing the governance process. Discussion took place regarding the increase in non elective activity. It was acknowledged that although QIPP schemes had been introduced, activity was still increasing. The Designate Chief Officer pointed out that this was a national issue and not just restricted to Calderdale and the Strategic Review should have an effect on this but consideration also needed to be given to how practices might be further involved in addressing this issue. Reference was made to the urgency of understanding and addressing the issue of this increased activity so as to ensure an appropriate starting point for negotiations on the 2013/14 contract with CHFT. DECISIONS 1. That the forecast financial position for 2012/13 be received. 2. That the risk rating of green for achieving the control target be noted. 3. That support for the processes involved in the preparation, implementation and monitoring of the non-recurrent spending plan be confirmed. 116/12 QUALITY AND SAFETY REPORT The Head of Quality presented this report which outlined progress in respect of quality and patient safety activities including quality performance in terms of Eliminating Mixed Sex Accommodation (EMSA); a National Patient Safety Agency (NPSA) safety alert; Healthcare Associated Infection (HCAI) performance; Venous Thromboembolism performance: an update on CQC activities; an outline of CQuINS 2012/13 Quarter 1 performance and information on a national cancer patient survey report. It was noted that all these issues had been discussed in detail by the Quality Group. With regard to the MRSA figures, it was noted that the SHA's HCAI lead had recently visited CHFT to review their internal plans. Discussion took place regarding recent CQC inspections of some of the local care homes. It was noted that reports of these inspections had been posted on the CQC website and were therefore available to the public and were not confidential. The Head of Quality advised that questions had been asked at the Quality Group about the way in which the information from CQC Inspections was acted upon. The Head of Commissioning for Adult Services advised that the 3
CQC would pursue issues itself and any safeguarding issues would also be referred in through the Gateway to Care safeguarding system and investigated further as appropriate. He also referred to the monthly monitoring meetings held between the Council's Adult Health and Social Care Directorate, NHS Calderdale and the CQC where knowledge was pooled and any response activity was coordinated to ensure issues were addressed comprehensively and care homes received one consistent message. Reference was made to the actions that could be taken where the concerns were sufficiently serious, including the CQC issuing enforcement notices and/or closing a home and the Local Authority and the Primary Care Trust suspending admissions and advising patients to move out of a home. It was pointed out that the involvement of the CQC came towards the end of the process and some of the unannounced CQC inspections were triggered by concerns raised by the PCT or the Local Authority. The Head of Commissioning for Adult Services also commented upon issues being escalated to the risk register where appropriate and he referred to the fact that that was presently the case with issues at two homes. The Head of Quality added that the Quality Group received updates on concerns on a monthly basis and where a home was engaging and being co-operative in addressing concerns the issue would not necessarily be included on the risk register. A CCG Board Member referred to concerns raised following the inspection at Pellon Lane Care Centre, which was not included on the risk register and she asked about progress on these issues. The Head of Commissioning for Adult Services advised that he would check into this issue. It was agreed that the Quality Group ACTION consider this matter further and in particular check on progress with the issues ACTION raised by the CQC. DECISIONS 1. That the CCE note the updates on Quality and Safety information including HCAI, EMSA, the Venous Thromboembolism, a NPSA safety alert, CQC activity, the CQUINs for quarter 1 and the report on the national cancer patient survey results. 2. That the Quality Group give further consideration to the issues raised by the CQC inspection of Pellon Lane Care Centre, and in particular consider progress made at the home following the inspection.
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3. That the Quality Group update the CCE on Decision 2. above.
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117/12 OPERATING FRAMEWORK – PERFORMANCE REPORT Dr Peter Davies declared an interest in this item, in relation to his practice’s use of the Choose and Book System The Head of Business Intelligence presented this report which provided an update on the achievement of headline and supporting indicators achieved in Calderdale together with benchmarking data on performance throughout the North England. With regard to the peer review of stroke services at CHFT it was noted that due to the quality of the service and improvements made in the last few years, CHFT was the only provider in West Yorkshire to which the review team had not requested a follow-up visit and it was anticipated that the CHFT stroke services 4
would receive full accreditation. Discussion took place upon the statistics on the use of Choose and Book. Dr Peter Davies declared an interest since his practice at Keighley Road had not been using the Choose and Book system. However he reported that his practice had recently received an IT upgrade and moved onto SystmOne and training had been arranged, so it was anticipated the practice would shortly begin using Choose and Book. Discussion took place as to whether the use of Choose and Book had reduced in Calderdale over the last few months or whether it had levelled off and neighbouring PCTs’ use had increased, resulting in a change to the respective benchmarking positions. The Chair referred to incidents of non-availability of appointments and commented that it would be useful to see data on the occasions when referring clinicians had attempted to use Choose and Book but had been unable to secure appointments. Following a suggestion of the Designate Chief Officer it was agreed that the Finance and Performance Group should undertake a practice level analysis. ACTION DECISIONS 1. That the progress made with the headline and supporting indictors be noted. 2. That the update on areas requiring continued focus be noted. 3. That the Finance and Performance Group undertake a practice level analysis of the use of the Choose and Book system.
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118/12 CCG COMMISSIONING PLAN 2012 – PERFORMANCE REPORT/SERVICE IMPROVEMENT UPDATE The Head of Service Improvement presented this report which provided a high level view of QIPP/Service Improvement delivery for 2012/13. It was noted that the shortfall between the QIPP plans and the target for savings in 2012/13 had reduced significantly since the start of the year and information on additional schemes to offset the outstanding shortfall of £460k was appended to the report. Reference was made to on-going concern regarding the increase in non elective activity, which was being considered in detail by the Finance and Performance Group. With regard to the long term care programme the Non Executive Associate referred to the reported increase in telephone calls to and from Gateway to Care and asked about publicity of the telephone number. It was confirmed that the telephone number was publicised on the Council’s website and the Head of Service Improvement agreed to circulate further information on the numbers involved and the marketing of the service. In respect of the planned care programme update, the Chair referred to the consultant- to- consultant referral rate being rated as red. The Head of Service Improvement reported that although the impact of these referrals was correctly rated as red, the numbers of such referrals had actually reduced year on year. It was confirmed that this issue was continuing to be treated as a high priority. 5
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DECISIONS 1. That the report be noted. 2. That further information be circulated on Gateway to Care marketing and on the volume of telephone calls received and made. 119/12 WORKFORCE REPORT The Assistant Director of Workforce presented this report which provided workforce information figures, trends and trajectories related to the directlyemployed NHS Calderdale workforce and key workforce headlines. It was noted that there had been a slight drop in the size of the workforce and in sickness absence up to 31 August 2012. The Assistant Director of Workforce advised that the staff pooling and matching process was now underway and was expected to be completed by the start of November 2012. She advised that the NHS Commissioning Board and Public Health England had begun to send through advertisements and job descriptions for posts that might be relevant to some Calderdale staff and she referred to the introduction of the West Yorkshire Workforce Transition Microsite and to additional sessions that had been arranged for staff on interview techniques etc. A CCG Board Member asked about the degree of flexibility possible in the pooling and matching process. It was acknowledged that this had been raised as an issue, but the Designate Chief Officer advised that it was essential to ensure that the approach taken was constant and consistent across the system. DECISION That the report be noted. 120/12 UPDATE ON PARTNERSHIP AGREEMENT WITH CALDERDALE METROPOLITAN BOROUGH COUNCIL The Designate Chief Finance Officer referred to discussions on the Partnership Agreement at the previous CCE meeting and at previous meetings of the Audit and Governance Group where it had been reported that the agreement was expected to be signed by 30 September 2012. She advised that the agreement had not yet been signed, but was due to be considered at a joint Senior Management Team meeting on 15 October 2012, a Local Authority Senior Management Team meeting on 16 October 2012 and was expected to be signed by 19 October 2012. The Lay Member acknowledged that the proposed agreement was much more comprehensive than originally envisaged but stressed the importance of maintaining the momentum and ensuring the agreement was finalised and signed. DECISION 6
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That the Designate Chief Finance Officer’s oral update be noted. 121/12 RISK REPORT AND HIGH LEVEL RISK LOG The Designate Chief Officer presented this report which provided an update on the current risk position in Calderdale. It was noted that the risk register had been reviewed by the Senior Management Team and the report had been considered by the Audit and Governance Group. Discussion took place upon the risk regarding commissioning support and the view was expressed that circumstances had changed, with there being better dialogue and with the Commissioning Support offer having been made and it might therefore be possible to reduce the score when the risk was next reviewed. Reference was also made to the risks relating to the delivery of care at certain care homes and it was acknowledged that, although the risks were being managed and the monitoring systems were operating appropriately, the delivery risks still remained. DECISIONS 1. That the High Level Risk Log be accepted as a true reflection of the risk position as at September 2012. 2. That the High Level Risk Log be referred to the Cluster Board with the recommendation that it be accepted as a true reflection of the risk position as at September 2012. 122/12 CONSULTATION REPORT 2011-12 The Head of Quality and the Patient and Public Involvement Manager presented this report. It was noted that Primary Care Trusts had a statutory duty to report annually on engagement activities relating to commissioning activities. This annual consultation report had therefore been presented to the Calderdale, Kirklees and Wakefield District Cluster Board but was also being presented to the CCE for information. The Patient and Public Involvement Manager commented that in 2012/13 work being undertaken in connection with Calderdale and Kirklees Strategic Review would highlight the consultation work being undertaken. The Designate Chief Officer commented upon the importance of consultation and engagement exercises as an integral part of the Strategic Review. A CCG Board Member commented that she would have liked to have seen more information about what happened following the consultation, particularly for example where the results of consultation on one issue fed into another project. The Patient and Public Involvement Manager commented that she expected there would be several examples of this in the 2012/13 report, such as consultation on children’s services being 7
used to drive service development. A CCG Board Member referred to the low response rate on the consultation on equitable access to primary care and it was acknowledged that further work was required on improving response rates. A CCG Board Member speculated on the likelihood of responses to questionnaires only being submitted by people who held strong views on a particular topic. It was reported that there was a relationship matrix group of 14,000 people regularly used for consultation purposes and those people were not merely sent questionnaires, but were also provided with background information on the topics being consulted upon, so as to facilitate informed feedback. The Head of Quality commented upon the close relationship between engagement and patient experience and the advantages of closer working and the sharing of information between those functions. It was also acknowledged that there was potential for more involvement and input from the member practices in passing on known information on patients’ experiences and views. DECISION That the report be noted. 123/12 SERVICE SPECIFICATION FOR INTERMEDIATE CARE BEDS The Programme Manager, Care Closer to Home presented this report which introduced and included at its appendix a new service specification for the intermediate care beds to be commissioned by Calderdale CCG from 1 April 2013. It was noted that preparation of the service specification had been overseen by the Intermediate Tier Project Board, it had been widely consulted upon both internally with staff and GPs and externally with patients, carers and provider staff. The service specification had also been considered in detail by the Quality Group. It was reported that it had originally been intended to insert an additional section on the location of beds, but it had subsequently been decided to simply state that the beds were to be in Calderdale or in the vicinity of Calderdale. Potential providers were also to be asked how they would support families/carers in visiting patients where the beds were not provided within Calderdale itself. In discussion, concern was expressed about the wording of some of the comments in Appendix A to the report, but it was commented that the wording had been repeated verbatim and, although that information had been taken into account in the preparation of the service specification, the appendix would not be circulated any further. Discussion took place on the wording of point 4.15 of page 21 of the specification regarding resuscitation and it was agreed that the CCG Lead would revise the wording to reflect the fact that discussions on individuals’ wishes could 8
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be undertaken with a relevant GP or other authorised physician. DECISION That, subject to an amendment to the wording of point 4.15 on page 21, the service specification be approved.
124/12 SERVICE SPECIFICATION FOR DOMICILIARY CARE AND HOME BASED RESPITE CARE The Designate Chief Finance Officer presented this report which introduced and included at its appendices a new service specification for domiciliary and home based respite care and a framework agreement. It was pointed out that at present domiciliary care was purchased on a spot purchase basis but the intention was that in future there would be a framework (umbrella) agreement setting out the terms and conditions under which individual call off contracts would then be issued. It was noted that the Quality Group had considered the service specification in detail and, following that Group’s recommendation, additional input had been included on medicines management. DECISION That the service specification for domiciliary care and home based respite care be approved. 125/12 DEVELOPMENT OF CALDERDALE CLINICAL COMMISSIONING GROUP – UPDATE REPORT The Assistant Director, Transition presented this report which provided an update on progress towards the establishment of the CCG as a statutory body by 1 April 2013. A copy of the transition risk register was appended to the report. It was noted that there had been very positive feedback following the authorisation site visit and it was agreed that copies of the site visit report and the CCG’s response be circulated to CCE members for information and that the issue be discussed at the next Practice Leads meeting. DECISION That the report be noted. 126/12 MINUTES RECEIVED The following minutes were received: (a)
Calderdale, Kirklees and Wakefield District Cluster Board – Minutes of the meeting held on 3 July 2012 9
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(b) (c) (d)
Audit and Governance Group – Draft Minutes of the meeting held on 20 September 2012 Finance and Performance Group – Minutes of the meeting held on 30 August 2012 Calderdale and Huddersfield Health and Social Care Strategic Review Programme Board – Minutes of the meeting held on 28 August 2012
127/12 ITEMS FOR THE LEGACY DOCUMENT Consultation Report 128/12 ITEMS FOR PRACTICE LEADS/KEY MESSAGES TO MEMBER PRACTICES Authorisation visit Flu immunisation
CHAIR
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Clinical Commissioning Executive action sheet 11 October 2012 Report name
Action no.
Designate Chief Officer’s Report
114/12
Quality and Safety Report
116/12
Action required
Lead
Designate Chief Officer to circulate a copy of the specification for support for the care streams of the Strategic Review
Matt Walsh
Head of Commissioning for Adult Services to check on progress in respect of CQC concerns at Pellon Lane Care Centre
Penny Woodhead
Quality Group to consider progress in respect of CQC concerns at Pellon Lane Care Centre and report back to a subsequent CCE meeting Operating Framework – Performance Report
117/12
CCG Commissioning Plan Performance Report/Service Improvement Update Service Specification for Intermediate Care Beds
118/12
123/12
Complete
Comments (include expected completion date, areas of concern etc) Completion date: 8 November 2012
Complete
Completion date: 25 October 2012
Complete
Finance and Performance Group to undertake a practice level analysis of use of Choose and Book
Tim Shields
Head of Service Improvement to circulate further information on Gateway to Care in relation to the number of telephone calls involved and the marketing of the service
Debbie Graham
CCG Lead to revise wording in relation to resuscitation section of service specification
Dr. John Taylor/ Corrine McDonald
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Current status*
On-going
Completion date: 29 November 2012
Complete
Completion date: 8 November 2012
Complete
Completion date: 16 October 2012
Report name
Development of CCG – Update Report
Action no.
125/12
Action required
Lead
Copies of authorisation site visit report and CCG’s response to be circulated to CCE and to be discussed at next Practice Leads meeting.
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Current status*
Judith Salter Complete
Comments (include expected completion date, areas of concern etc) Completion date: 8 November 2012