Minutes of the Clinical Commissioning Executive Meeting held on 8 November 2012 in the Shibden Meeting Room, F Mill, Dean Clough Mills, Halifax Present:
Dr Alan Brook Dr Majid Azeb Jackie Bird Dr Hazel Carsley Dr Steven Cleasby Dr Peter Davies Trevor Lake Julie Lawreniuk John Mallalieu Dr Sanjay Suri Dr John Taylor Dr Matt Walsh Dr Graham Wardman Penny Woodhead Keith Wright
Clinical Commissioning Group (CCG) Board Chair (Chair of the meeting) GP Member Registered Nurse GP Member GP Member and Assistant Clinical Chair GP Member Non Executive Associate Designate Chief Finance Officer Lay Member and Deputy Chair Secondary Care Practitioner GP Member Designate Chief Officer Director of Public Health Head of Quality Non Executive Director
Apologies for absence:
Dr Nigel Taylor
GP Member
Also present:
Debbie Graham
Head of Service Improvement (for items 137/12, 141/12, 143/12 & 144/12) Independent Chair of Calderdale Safeguarding Adults Board (for item 142/12) Senior Human Resources Manager (for item 138/12) Programme Manager, Care Closer to Home (for item 141/12) Assistant Director (Quality Improvement, Safeguarding Adults (for item 142/12) Commissioning and Strategy Manager, Calderdale Metropolitan Borough Council (for item 141/12) Head of Contracting and Procurement (for item 146/12) Head of Business Intelligence (for item 136/12) Communications Manager Corporate Governance Manager/Board Secretary
Bill Hodson Rebecca Jenkins Corinne McDonald Ann McPherson Karen Midgley Martin Pursey Tim Shields Peta Wolstencroft Jane Brownlie
129/12 NEW MEMBERS OF THE CLINICAL COMMISSIONING EXECUTIVE & CLINICAL COMMISSIONING GROUP The Chair welcomed Jackie Bird, the newly appointed Registered Nurse and Dr Sanjay Suri the newly appointed secondary care practitioner to this their first meeting of the CCE. 1
130/12 DECLARATIONS OF INTEREST There were no declarations of interest. 131/12 MINUTES OF THE MEETING HELD ON 11 OCTOBER 2012 The minutes of the meeting held on 11 October 2012 were accepted as a correct record subject to the second line of minute 112/12 on declarations of interests and the note referring to this at the start of Minute 115/12 being amended to read that Trevor Lake had declared an interest due to his appointment as a Non Executive Director and not a Lay Member of Mid Yorkshire NHS Hospitals Trust. 132/12 MATTER ARISING FROM THE MINUTES UPDATE ON PARTNERSHIP AGREEMENT WITH CALDERDALE METROPOLITAN BOROUGH COUNCIL The Designate Chief Finance Officer reported that Calderdale Metropolitan Borough Council had given assurances that the Agreement would be signed by 9 November 2012. It was noted that the issue was to be discussed at the Audit and Governance Group meeting on 15 November 2012. 133/12 DESIGNATE CHIEF OFFICER’S REPORT The Designate Chief Officer presented this report which provided an update on current pertinent issues not covered elsewhere on the Agenda. Discussion took place upon the formal feedback received from the NHS Commissioning Board Moderation Panel following the CCG authorisation visit in September 2012. The Designate Chief Officer reported on progress in addressing the three issues upon which a red rating had been received and he commented that he believed two of these issues (appointment of a Registered Nurse to the CCG Board and website publicity on learning from complaints) had already been appropriately addressed. The remaining issue on commissioning plans would be addressed when the CCG adopted its 2013/14 Commissioning Plan, which was expected to occur by March 2013. In respect of the NHS 111 initiative, it was noted that a recent learning event had been very well attended by local practices and that further discussions were expected over the next few weeks on how the initiative would be supported locally. Reference was made to recent developments in the Health and Social Care Strategic Review with the first phase now having been completed; CCE members having been circulated with a specification for additional support for the review and its care streams; the Cluster Board having agreed to the use of non recurrent monies for such support and a Cluster Board Procurement SubCommittee having recently met and accepted a tender for the provision of that support. It was agreed that an update report on the Strategic Review be included on future CCE meeting Agendas. 2
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DECISIONS 1. That the report be noted. 2. That update reports on the Health and Social Care Strategic Review be included on future CCE meeting Agendas. 134/12 FINANCE AND EFFICIENCY REPORT 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 and all the other key statutory financial duties would be delivered. It was noted that a similar report had been considered in detail by the Finance and Performance Group. The Designate Chief Finance Officer reported that along with other PCTs, Calderdale had been receiving continuing care restitution claims and following an estimate of the potential cost of these claims it had been decided to increase provision for them from £1m to £2.2m. With regard to budget variances it was noted that the main areas of underspending were continuing care and prescribing, but that the under-spending balanced out with increased activity elsewhere. Reference was made to the financial risks, the main one being that the QIPP plans would not deliver the required level of savings. It was noted that, in view of the fixed price contracts in place with the main providers, this was not a risk for 2012/13 but could impact on the 2013/14 contract negotiations. The Designate Chief Finance Officer also referred to the risks concerning full use of the reserves/non recurrent monies by the end of the financial year. The detailed spending plan prepared by the Finance and Performance Group had been presented to the previous CCE meeting and it was reported that in view of the financial limits in Standing Orders this had been subject to ratification by the Cluster Board. Discussion took place on the running costs and a proposal to increase depreciation on certain assets. It was noted that this issue was to be considered at the next Audit and Governance Group meeting. Reference was also made to a £800,000 clinical negligence claim inherited from a preceding organisation which was now being charged to NHS Calderdale by the SHA and was to be included in the running costs. In discussion reference was also made to the Specialised Commissioning Group overtrade and it was acknowledged that this would continue to be a significant risk. 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. 135/12 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 Care Quality Commission (CQC) regulatory activity (including an update on Pellon Lane Care 3
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Centre), information on the national patient experience initiative “the Friends and Family Test” and local progress in implementing the formal quality handover arrangements between the SHAs, PCTs and the successor organisations. The Head of Quality reported that the peer review regarding the children’s social care services Improvement Notice was scheduled to take place during the week commencing 26 November 2012 and she agreed to circulate a high level briefing note to CCE members. A further update would also be provided at the next CCE meeting.
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The Designate Chief Officer asked about feedback following the visit of the SHA’s Healthcare Associated Infection lead officer to CHFT. It was reported that to date there had only been informal feedback, which had been positive and that further formal feedback would be presented to the Quality Group. Discussion took place regarding the Friends and Family Test. It was noted that, in addition to the mandatory questions, there was provision for the inclusion of supplementary local questions. The Assistant Clinical Chair raised the issue of obtaining feedback from patients’ carers and families and the Head of Quality agreed to pursue with CHFT the possibility of including a question to cover this issue. The Registered Nurse referred to the variety of modes of communication to be used, with personal letters (including pictures as well as text) and text messaging and she understood that the initiative was expected to be extended into community services in the future. In response to a question from a GP Member, it was reported that the Friends and Family Test was not intended to replace existing patient monitoring practices and it was anticipated, for example, that the real time feedback system currently in place at CHFT would continue. DECISIONS 1. That the updates on quality and patient safety performance, CQC regulatory activity (including measures at Pellon Lane Care Centre), patient experience information (including the Friends and Family Test), the forthcoming peer review following the children’s social care Improvement Notice and the formal quality handover arrangements be noted. 2. That the Head of Quality circulate the high level briefing note on the peer review on children’s social care services to CCE members and to provide an update to the next meeting.
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3. That the Head of Quality pursue with CHFT the possibility of including a question in the Friends and Family Test to incorporate feedback from patients’ carers and family members.
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136/12 OPERATING FRAMEWORK – PERFORMANCE REPORT 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. It was noted that the Finance and Performance Group had considered a similar report in detail. 4
Discussion took place regarding the reduction in the achievement in terms of the four hour Accident and Emergency treatment target since September 2012. The Head of Business Intelligence reported that an audit of the coding of patients in Accident and Emergency had commenced and the early indications were that attendances and admissions through Accident and Emergency had not increased. The Designate Chief Officer commented that the Strategic Review was focusing on improving control of non-elective activity with the intention of moving towards more planned interventions. A GP Member asked about the preparation work for winter and she was advised that steps had been taken to improve health and social care partners’ participation in the winter pressures teleconferencing processes. 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. 137/12 CCG COMMISSIONING PLAN 2012 – PERFORMANCE REPORT/QIPP UPDATE The Head of Service Improvement presented this report which provided a high level view of QIPP/Service Improvement delivery for 2012/13 aligned to the emerging transformational change agendas within the Strategic Review. The report referred to a key area of concern being the delivery of the QIPP schemes’ target and the current and forecast year end shortfall. The report also outlined a detailed study of non-elective activity undertaken by the Finance and Performance Group at its meeting in October 2012. This was to be considered further at the Group’s November meeting and it was noted that a similar detailed study of elective activity was to be undertaken at the Group’s December meeting. The Head of Service Improvement advised that it had been agreed with Kirklees and CHFT to compile some high level activity data which would then be used to ensure that business cases and further discussions were based on agreed and accurate activity data. The Head of Service Improvement commented upon assertions from CHFT of a large increase in demand which was not borne out by the data produced by the Business Intelligence Unit. The Designate Chief Finance Officer commented that the Audit Commission had carried out work on auditing the Trust’s coding system which provided some assurance on coding accuracy. DECISIONS 1. That the report be noted. 2. That the actions taken by the Finance and Performance Group in respect of the detailed review of non elective activity be noted. 5
138/12 WORKFORCE REPORT The Senior Human Resources Manager 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 the sickness absence levels had increased slightly in September 2012 but were still below the agreed target. An update was provided on the filling of posts at Calderdale CCG and the West Yorkshire Commissioning Support Unit, with the pooling and matching process being due to be completed by the middle of November and the redeployment stage being expected to start at the end of November 2012. It was reported that the NHS Commissioning Board was taking a lead on the filling of its own posts and those of Public Health England, but the precise timescales for that exercise was not known. With regard to Calderdale public health staff it was confirmed that there was now clarity as to which staff were to continue to be employed by the NHS and which were to transfer to the Local Authority. Discussions were on going in respect of the arrangements for staff employed by the Local Authority to deliver services to the NHS. DECISION That the report be noted. 139/12 DIRECTOR OF PUBLIC HEALTH’S ANNUAL REPORT FOR CALDERDALE FOR 2012 The Director of Public Health gave a presentation on his Annual Health Report which identified progress made on health issues in Calderdale since the PCT was formed in 2002 and the remaining challenges for the CCG and Calderdale Metropolitan Borough Council. The Director of Public Health referred to key improvements achieved including increased life expectancy, reduced death rates for cancer, heart disease and strokes and reductions in smoking, teenage pregnancy and suicides. However he reported that there had also been increases in obesity and alcohol rates, no reduction in infant mortality rates and the health inequalities gap had increased in some areas. Reference was made to the on-going transfer of the majority of the PCT’s public health functions to the Local Authority. It was noted that each local authority was being charged with taking such steps as were considered appropriate for improving the health of the people in its area. The Local Authority’s public health responsibilities were outlined and were noted to include a wide range of issues including community safety, violence prevention, the public health impacts of environmental risks, road safety and public health aspects of social exclusion as well as the former health service public health functions. Information was provided on the social determinants of wellbeing and the Director of Public Health commented upon the wide range of factors that influenced behaviour and the importance of encouraging healthy lifestyles and thereby reduce future demand for treatment of ill health. 6
DECISIONS That the Annual Health Report be received and that its content be borne in mind in the determination of future CCG priorities and business planning. 140/12 DRAFT JOINT WELLBEING STRATEGY 2012 – 2022 The Director of Public Health presented this report which included at its appendix the draft Joint Wellbeing Strategy for 2012 – 2022. A questionnaire was also appended to the report and was aimed at partner organisations and sought commitments/responses on the way in which those organisations would contribute towards the achievement of six strategic priority outcomes identified within the Strategy. Discussion took place with particular regard to the Priority Outcome 1 “Calderdale is a place where people have good health” and the associated subset of “calls for action” aimed at helping to achieve this. There was discussion as to whether it would be appropriate for Calderdale CCG to lead on this priority outcome. Although it was acknowledged that the CCG should make a major contribution and play an active role in pursuing this outcome reference was made to the distinctions between the role of emerging CCGs and that of the disbanding Primary Care Trusts. Reference was made to the importance of investment in health promotion and prevention work so as to reduce the need to treat ill-health. The close relationship between health and poverty, housing and social care was also commented upon. In discussion it was accepted that there would be overlaps and consistencies between the CCG’s own strategies and the Joint Wellbeing Strategy and that the six strategic priority outcomes needed to be taken into account in the CCG’s business planning and addressed in Business Cases for development. DECISIONS 1. That the Draft Joint Wellbeing Strategy be received. 2. That the Chair and the Designate Chief Officer submit a response to the Health and Wellbeing Board on the ways in which Calderdale CCG would support the delivery of the Strategy and its six priorities. 141/12 CARERS STRATEGY 2012 - 2015 The Programme Manager, Care Closer to Home presented this report which introduced and included at its appendices the Calderdale Carers Strategy and its accompanying Equality Impact Assessment. It was reported that Calderdale Metropolitan Borough Council had taken the lead in the development of the strategy and it had been approved by the Council’s Directorate Management Team subject to some drafting amendments, the inclusion of 2011 census data when it became available and provision for it to be signed by the Council’s Cabinet Member for Adults, Health and Social Care as well as the Chair of Calderdale CCG. In discussion, the importance of supporting carers was acknowledged and support was expressed for the direction of travel proposed within the strategy. 7
However, it was noted that the strategy referred to additional resource requirements but did not quantify them or indicate where they were to come from. It was stressed that any additional funding request would need to be submitted and considered through the Business Planning prioritisation process. The Director of Adults, Health and Social Care, Calderdale Metropolitan Borough Council commented that there was a similar situation in respect of funding from the Council. The Assistant Clinical Chair (who was also the clinical lead on the carers strategy) commented upon support for carers and military veterans being listed as a priority in the 2012/13 Business Plan. The Head of Quality referred to the fact that the Equality Impact Assessment had been undertaken by the Council and it was agreed that the Equality and Diversity Manager be asked to check that this satisfied NHS Calderdale’s equality impact assessment requirements.
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DECISIONS 1. That the Carers Strategy 2012-15 be approved, subject to a requirement for any additional funding requests being submitted and determined through the Business Planning process. 2. That the Draft version of the Strategy be published on the PCT website with a note stating that the final version would be posted by an agreed date. 142/12 CALDERDALE SAFEGUARDING ADULTS BOARD ANNUAL REPORT 201112 The Independent Chair of Calderdale Safeguarding Adults Board (SAB) presented this report which provided an update on the achievements of the Board in 2011-12. He reported that external assessments of safeguarding were no longer carried out, but advised that national templates were now used for assessment purposes. Reference was also made to auditing and quality assurance processes for safeguarding adults and the SAB Chair commented that the assurance processes had recently become more formalised following the Serious Case Review on incidents at Winterbourne View in Gloucestershire. The SAB Chair also referred to an audit of local safeguarding cases undertaken in 2011 which had concluded that practices were sound but that IT issues had resulted in inadequate data being produced from the Council’s Client Information System. Reference was also made to the agreement to develop West Yorkshire-wide safeguarding procedures by April 2013. Reference was made to an Adult Safeguarding Serious Case Review recently carried out in Calderdale and it was noted that the review report had not yet been published due to two on-going criminal prosecutions. The review had particularly investigated why this safeguarding issue had not come to light sooner and it had considered the effectiveness of the response once the issue was known. It was reported that some issues had arisen on the need to strengthen liaison/partnership working arrangements. The Safeguarding Adults Board Chair reported that although safeguarding 8
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adults’ boards were presently not statutory bodies, this was expected to change next year and he understood they might be granted additional powers such as rights of entry to individuals’ homes. In respect of the on-going re-organisation in the NHS the SAB Chair commented that meetings had been arranged to discuss/clarify future arrangements for the delivery of safeguarding responsibilities. The Safeguarding Adults Board Chair concluded that he believed the overall adult safeguarding situation in Calderdale was good and that it was in a strong position for moving forward. Discussion took place regarding quality surveillance on care homes. The Head of Quality advised that any concerns regarding care homes were considered by the Quality Group and that Group also monitored any necessary local health service action. She added that a Joint Health Action Plan on the on-going adult Serious Case Review was due to be presented to a forthcoming Quality Group meeting. DECISION That the Calderdale Safeguarding Adults Board Annual report 2011-12 be received. 143/12 CALDERDALE AND HUDDERSFIELD FOUNDATION TRUST AND UPPER VALLEY COLPOSCOPY UNITS SERVICE SPECIFICATION The Director of Public Health presented this report which introduced and included at its appendix a service specification for the CHFT and Upper Valley Colposcopy Units. The Head of Quality confirmed that this specification had been considered at the Quality Group and that it had been confirmed that the specification described the services currently being provided (but for which there had previously not been a service specification). In response to questions from the Chair, GP Members confirmed that they were satisfied with the present service provision and believed this specification was accurate. DECISION That the CHFT and Upper Valley Colposcopy Units Service Specification be approved. 144/12 WHEELCHAIR SERVICES SPECIFICATION The Programme Manager for Disabled Children presented this report which introduced and included at its appendix a wheelchair services specification. It was noted that this specification had been considered by the Quality Group. Discussion took place regarding the financial implications of implementing this specification. It was noted that there had been difficulties in the past in meeting demand within the funding allocated to the current block contract and nonrecurrent funding had been committed on several occasions in the past. The 9
Designate Chief Finance Officer expressed concern at the proposal for approval of a service specification involving an increased level of service which had not been costed and for which the source of additional funding had not been agreed or prioritised against other competing funding requests as part of the usual business management process. In discussion it was agreed that this service specification was acceptable from a clinical point of view, but that the anticipated additional funding would need to be quantified and included in a business case submission for consideration in the business planning process. DECISION That the wheelchair services specification be approved, subject to a business case submission in respect of the funding in excess of the current wheelchair provision budget being approved through the business planning process. 145/12 MEDICINES MANAGEMENT COMMISSIONING POLICIES The Designate Chief Officer presented this report which sought approval of a number of medicines management commissioning policies developed or endorsed by the South West Yorkshire Area Prescribing Committee. DECISION That the following South West Yorkshire Area Prescribing Committee policies be approved for use across Calderdale: a) b) c) d) e) f) g)
Dexamethasone Anagrelide Antifungal therapies Botulinium toxin type A Fluenz Atomoxetine Methylphenidate
146/12 WEST YORKSHIRE COMMISSIONING SUPPORT UNIT SERVICE LEVEL AGREEMENT The Head of Contracting and Procurement presented this report which provided an update on the work to agree and document future working arrangements with the emerging West Yorkshire Commissioning Support Unit (CSU). It was reported that a Service Level Agreement between the CCG and the CSU needed to be signed by 30 November 2012 but that discussions on its content had not yet been concluded. It was also confirmed that the Service Level Agreement would not come into effect until 1 April 2013 and that there were likely to be changes in the detail up to that date. The Chair commented upon there still being a risk on the risk register regarding the timely development of the CSU and its ability to provide the required support but it was acknowledged that these risks were now frequently changing. 10
A GP Member asked about provision of programme support and staffing levels. It was explained that the CCG would be commissioning on the basis of outcomes required rather than specified staffing levels. In discussion it was acknowledged that a considerable amount of development work still needed to be done with the CSU. DECISIONS 1. That the progress made in developing the Service Level Agreement between the CCG and the CSU be noted. 2. That the CCG’s authorised officer (the Designate Chief Officer) be authorised to sign the Service Level Agreement by 30 November 2012. 147/12 CLINICAL COMMISSIONING GROUP ACCOMMODATION PLAN The Designate Chief Finance Officer presented this report which outlined a number of options on the location of CCG office accommodation from 1 April 2013 onwards. The report suggested that, subject to satisfactory lease negotiations, the most appropriate option would be for the CCG to remain in its present location at F Mill, Dean Clough, but with only the “office” side of the fifth floor being retained and the lease on the fourth floor and control of the “meeting room” side of the floor being surrendered. Existing fifth floor meeting rooms could then be hired as and when required and/or the fifth floor office accommodation could be remodelled to incorporate some additional meeting rooms. Reference was made to the existing lease arrangements and to the risks associated with the preferred option in terms of access to meeting rooms and the lease costs from 1 April 2013 and, in the longer term, upon the expiry of the existing head lease. DECISIONS 1. That the location of the CCG offices on the 5th Floor of F Mill, Dean Clough be approved. 2. That the Designate Chief Finance Officer be authorised to negotiate with NHS Property Services for the CCG to remain at Dean Clough. 3. That the risks associated with the expiry of the lease arrangements at Dean Clough be noted. 148/12 MINUTES RECEIVED The following minutes were received: (a) (b) (c) (d)
Finance and Performance Group – Minutes of the meeting held on 27 September 2012 Quality Group – Minutes of the meeting held on 27 September 2012 Calderdale and Huddersfield Health and Social Care Strategic Review Programme Board – Minutes of the meeting held on 2 October 2012 Yorkshire and the Humber Specialised Commissioning Operational Group 11
– Minutes of the meeting held on 28 September 2012 149/12 ITEMS FOR THE LEGACY DOCUMENT Joint Wellbeing Strategy Carers Strategy Annual Report of the Director of Public Health 150/12 ITEMS FOR PRACTICE LEADS/KEY MESSAGES TO MEMBER PRACTICES Carers Strategy Joint Wellbeing Strategy and in particular the 6 priority areas Annual Report of the Director of Public Health Friends and Family Test
CHAIR
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Clinical Commissioning Executive action sheet 8 November 2012 Report name
Action no.
Designate Chief Officer’s Report
133/12
Quality and Safety Report
135/12
Action required
Lead
Current status*
Comments (include expected completion date, areas of concern etc) Completion date: 13 December 2012
Update reports on the Health and Social Care Strategic Review to be included on future CCE meeting Agendas
Jane Brownlie
1. High level briefing note to be circulated to CCE members and a further update to be provided to the next meeting on the peer review regarding Children’s Social Care Improvement Notice
Penny Woodhead
Complete
Completion date: 13 December 2012
1. Equality and Diversity Manager to check that the Council’s Equality Impact Assessment satisfies NHS Calderdale’s equality impact requirements
Sarah MackensieCooper
Complete
Completion date: 13 December 2012
2. Draft version of the Carers Strategy to be published on the PCT website with a note stating that the final version would be posted by an agreed date.
Corinne McDonald
Complete
Complete
2. Head of Quality to pursue with
CHFT the possibility of including a question in the Friends and Family Test to incorporate feedback from patients’ carers and family members Carers Strategy
141/12
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