Minutes of the North Kirklees Clinical Commissioning Executive held on Wednesday 26th September 9.00am – 12.30pm, The Barn, Northorpe Hall 1)
Present: Valerie Aguirregoicoa (VA) David Kelly (DK) Helen Shallow (HSh) Helen Severns (HS) Isle Newsome (IN) Deborah Turner Tony Gerrard (TG) Jackie Holdich (JH) Khalid Naeem (KN) Yasar Mahmood (YM) Imran Patel (IP) Sarah Muckle (SM) Steve Brennan (SB)
Non-executive Director - Chair CCG Chair Senior Finance Manager Head of Service Improvement Interim Governance Manager Head of Quality and Safety Non-executive Director Head of Practice CCG member CCG member Non Executive Director Consultant in Public Health Chief Finance Officer
In-attendance; Christina Fairhead Jen Love
Designated Nurse Safeguarding Children Authorisation and Development Manager
Minutes: Natasha Brown (NB)
Personal Assistant to NHS North Kirklees Clinical Commissioning Group
Welcome & Apologies Chris Dowse (CD) David Boothroyd (DB) Kathryn Greaves (KG) Jan Randall (JR) Ajit Mehrotra (AM) Farhad Kohi (FK)
Shadow Accountable Officer Senior Lead, Contracting and Commercial Intelligence CCG member Head of Strategic Development & Business Planning CCG member CCG member
The Chair opened the meeting by welcoming all those in attendance. 2)
Declarations of Interest All GPs and Practice members declared an interest in agenda item 7.2, Options for Governing Body Member.
3)
Accuracy of minutes from last meeting 22nd August 2012 The minutes of the Clinical Commissioning Executive meeting held 22nd August 2012 were accepted as a true and accurate record with noted amendments.
Agenda Item 8.4 Action - TG to email NB with wording that reflects a true and accurate record of what discussions took place in relation to the Governing Body Membership. Action - IN to email confirmation regarding the subcommittee structure to all Governing Body members. It was agreed that this will be brought to a future CCE for sign off. 4)
Live Action Sheet The group reviewed the action log from the previous meeting.
5)
NHS Kirklees Safeguarding Children and Young People Annual Report DT introduced Christina Fairhead to the Board. The Board noted that NHS Kirklees Safeguarding Children and Young People Annual report is still in draft format. The report is based on the previous report 2011/2012; however Christina welcomes feedback and comments. This annual report is for NKCCG as an organisation and is an overview from the last 12 months Safeguarding activity. Within the report, key goals have been highlighted and some of these goals are currently being worked on. NHS Kirklees Memorandum of Understanding is in place with Locala which specifies that their named nurses are to continue to offer training to all independent contractors as per agreement. Christina confirmed that figures for training will be broken down specifically for NKCCG. The Board noted that once the Care Quality Commission (CQC) action plan is complete, a letter of assurance will be sent to CQC. Since this report was written, a lot of work has been done around child Exploitation. The Board noted that CCGs will have the responsibility to ensure a Training Needs Analysis is carried out. Christina confirmed that letters for Training Needs Analysis have been sent out to Practices, Dentists and Opticians. The response was poor from North Kirklees. Therefore, an additional letter was sent out and the response improved. Training Needs Analysis was split into Clinical and Non-clinical. Locala are offering training for all staff in Primary Care. JH is happy to work with Christina and DT to ensure this is feedback to practices. Action – JH and Christina to have a discussion regarding training being offered from Locala to Primary Care and ensure this is communicated to all Practices. IP expressed his concerns in the rise in numbers who have a Child Protection Plan. The board noted that all employed staff, whether in a clinical or non clinical role, should have the level one, basic package training on Safeguarding.
The ongoing responsibility for Safeguarding will sit with the CCGs through Section 11 audits. The Governing Body noted that this will have implications regarding practice support and development and discussions are required regarding boundaries and where our responsibilities lie. DT stated that the Safeguarding accountability is currently been worked on. DT and Christina will be working on accessibility on training packages. This will then be brought back to a future CCE meeting. VA requested that the Ofsted and CQC report are to come back to CCE for sign off and to ensure all actions are completed. DT confirmed that this is on the agenda for the Locala meeting in October. Key Performance Indicators have been set regarding training figures and named nurse provision. This will be sent to the CCG on a quarterly basis and this is part of the MOU. Future annual reports will be specific to North Kirklees; however, part of the report will be Kirklees wide. The more detailed reports will be sent to the Quality and Safety Committee for detailed discussions. Action – DT and JH to work together on recording status in patient records. The Clinical Commissioning Executive; • Received the NHS Kirklees Safeguarding Annual Report • Approved the priorities for next year • Agreed to recommend the approval by Cluster Board
5.1
Quality & Safety Report DT presented the Quality and Safety report and highlighted the key areas. Eliminated of Mixed Sex Accommodation The performance report confirms that there have been no EMSA breaches in MYHT during July and August 2012. Healthcare Associated Infection (HCAI) MRSA MYHT had no MRSA bacteraemia cases reported in August. To date a cumulative total of 2 cases, against a trajectory of no more than 7 cases. Clostridium Difficile (C. difficile) C. difficile infections were reported in August in Kirklees residents, a cumulative total of 57 cases. The trajectory in 2012/13 is no more than 104 cases of C.difficile infection in Kirklees residents, and includes all pre and post 72 hour cases. Of the 13 C.difficile cases, 5 of these were allocated to North Kirklees. In addition 1 patient had no GP assigned therefore was not allocated to any particular Clinical Commissioning Group. The breakdown of the 13 cases is as follows by NHS Organisation – 3 MYHT; 4 CHFT; 4 GP’s, 1 LTHT; 1 Kirkwood Hospice. Of these cases, MYHT had 2 post 72 hour C.difficile infections giving cumulative total of 19 against target of no more than 78 cases.
MSSA and E.Coli 4 MSSA cases were reported and these are attributable to the following providers (2 CHFT, 1 MYHT, 1 LTHT) giving a cumulative total 26. In relation to the E. Coli bacteraemia -18 cases reported in August are attributable to - 8 CHFT, 8 MYHT, 2 LTHT. A cumulative total during April - August is 121. Serious Incidents One never event was reported by CHFT and details of this event are included in the private Quality and Safety paper later in the agenda. Care Quality Commission (CQC) CQC made an unannounced inspection to the Day Surgical Unit at Pinderfields Hospital on Wednesday 5 September 2012. The Board noted that the Day Surgical Unit was opened as a unit to care for elective non-complex surgical patients in March 2011. It provides accommodation for up to 30 patients needing noncomplex surgery across a range of specialities. The CQC issued a compliance notice and requested the Trust to take action on Thursday 13 September 2012 which the Trust complied with immediately. This action was that the Trust should not admit any further service users for a period exceeding 23 hours to the Day Surgical Unit without prior written agreement of the CQC. The Trust have now made significant improvements to the Unit to bring it up to the standard required for short stay inpatients. DT informed the Governing Body of the improvements made. The CQC found that a number of patients had stayed on the day surgery unit for over 23 hours between 19 July and 30 August 2012. The Governing Body noted that these issues have been raised at Executive Contract Board and an action plan will be produced and will be lead by the compliance Nurse. The Clinical Commissioning Executive; • Received the report on quality performance information for Healthcare Associated Infections (HCAI), Eliminating Mixed Sex Accommodation (EMSA), Venous Thromboembolism (VTE) • Received an update on recent regulatory activity published by the Care Quality Commission (CQC), the actions being undertaken and noted the changes to CQC inspections;
5.2
High Level risk log DT presented the high level risk log and highlighted the key areas. It was noted that the Board are already aware of the risks that are currently on the risk register. SB informed the Board that a programme manager will be employed to work on specific risk areas. Action – TG and DT to have a discussion regarding taking this report to the Audit and Governance meeting.
The board scrutinised this report and have noted the content. It was recommended that risks that relate to Authorisation are to be included in the Risk Register. Action – NB to inform Emma Trisconi that risks relating to authorization are to be discussed at SMT. 6)
Contracting and Finance report
SB presented the report, highlighted the key issues and fedback what was discussed at Finance and Performance Committee. The Board noted that the A&E position was discussed at Finance and Performance Committee and that poor READ coding could be leading to data inaccuracies. Non-recurrent monies The Board noted that this has been discussed in detail at Finance and Performance Committee and Senior Management Team. A list has been produced to see what potentially the £3m can be used for. Steve circulated a paper which set out a list of proposals. The Cluster Board have requested information from the CCE to give them indication on how much our CCG can spend sensibly by the end of this year. It was recommended that more proposals are to be made towards patient care. It has been requested that Locala feedback any ideas and suggestions that could improve patient care. Suggestions were made regarding a working group to be set up to work on these proposals. The Board noted that the proposal list fits well with NKCCG objectives and priorities. The proposal on the Clinical Dashboard concentrates on real time activity data. The Board noted that getting this service up and running with practices could take 2 years to implement. Action - SB confirmed that he will feed back to Cluster Board; • The CCE approved £3m that is available as non-recurrent money • A task and finish group will be implemented to work on the proposals • To have plans in place to spend £3m by Oct Summary of request for support SB circulated a summary of request for support. MYHT have requested £6M to fund redundancies as they will be reducing staffing levels by approx 28%. The proposal is, NHS North to contribute £3m, NHS Wakefield £2m, North Kirklees £1m. Action – Steve to circulate the paper explaining the figures in more detail
IN recommended that the Board require assurance from MYHT on what their future financial aims are for the long term and a review to be brought to CCE on an annually basis The Board agree to support this for one year only. Action – TG to feed back what discussion have taken place at the CCG to the cluster board meeting. 6. 1
Performance Report NA presented the Performance Report and highlighted the key areas. The Board noted that the Performance report was discussed in great detail at SMT and Finance and Performance Committee. Actions were given at Finance and Performance which relate to Children Hospitalisation and emergency admissions. NA informed the Board that numbers reported are very low. The breakdown of these reports will be taken to SMT and Finance and Performance Committee in October.
7.
Accountable Officer’s and Chairman’s report. DK presented the report to the Board. Chief Officer Designate The interviews for Chief Officer Designate took place Friday 21st September. It is recommended to approve the appointment of Chris Dowse as Chief Officer Designate for North Kirklees CCG. All CCE Board members approved and congratulated Chris on her new appointment. The CCG have held and attended multiple stakeholder meetings and events with patients and the population over the last 4 weeks. Overwhelming interest to our advertised meet and greet sessions has created the need to hold multiple events with our stakeholders. Feedback from the voluntary and charity sector 'speed dating' event 5 September, has been extremely positive and the stakeholder and patient event on the 19 September 2012, attracted over 50 members of the population who worked with the Governing Body and Senior Management Team to help shape key areas of priority and bolster the strategic plans: CCG will be taking forward these new and redefined relationships to work together towards achieving the CCG vision. A further event, with more than 40 confirmed attendees takes place on the 10 October 2012. Action – JH to request Tracey to publicise and ensures media coverage on these successful events Secondary Care Doctor for Governing Body The secondary care Doctor has not yet been appointed. This post will be re-advertised. Appointment of Lay Members Interview dates are being arranged and candidates have been notified that will be contacted in due course to confirm dates and times.
Strategic Nurse The Board were informed that following the candidate interviews, the interview panel selected Joanne Crewe, Director Harrogate and District Foundation Trust. The CCE approved the appointment and welcomed Joanne to the Governing Body. 7.1
MYHT in Year Changes – Engagement Report The clinical services strategy sets out options for how hospital services may be delivered in the future. The Governing Body noted that as part of the work to review services, some changes have been identified which could be made ahead of the development of the full clinical services strategy in order to improve care for patients and make more effective use of hospital capacity. These relate to neurological rehabilitation services, ophthalmology services and orthopaedic services. These changes have been consulted on with the public. VA stated that the Governing Body require assurance that Choose and Book enables patients to choose who they see and which location they are seen at. The Governing Body; • Accepted, noted and agreed this to be taken to the cluster board.
7.2
Options for Governing Body Member HS presented this paper and explained the recommendations. This is for half the board to go through the tenure process in November and the other half of board to go through an election process in June 2013. Board members will be asked what their preferred option is. If they go through the process in November, their contract will be for 3 years. It was agreed that 3 members will go through the tenure process in November and then 4 members will go through the election process in June 2013. DK informed board members that he and CD are currently undertaking performance reviews with Governing Body members Mandatory training was discussed and a process is needed for training.
The Governing Body noted that communication will be sent out to practices to ensure member practices are informed of any updates regarding the tenure process. Action – JH/DK to inform all practices of the tenure processes for the Board. The Board noted that the Remuneration and Terms and Conditions need to be reviewed in relation to rates of pay for Board members. It was acknowledged that the current rates of pay for board members across CCGs are much the same.
The CCE; • Accepted and noted the contents of the update and APPROVED the conditional offer to the post of Strategic Nurse. • Agreed to change the document to state that 3 members will go through tenure in November 2012 and 4 will go through the election process in 2013. 7.3
Governing Body Appointment of the Chair Jen confirmed with all possible applicants who the nominees for Chair were and it was confirmed that the only applicant for the Chair for the Governing body was Dr David Kelly. DK shared with the Governing Body the outcome of his Haygroup assessment. From the feedback from the assessment, a number of development plans have been made for DK and some already have been delivered. DK stated that the feedback confirmed he was fit to be the Chair of the Governing Body. DK has meetings set up with local councillors, Locala, MPs, MYHT, and other wide stakeholders. DK is intending being involved in the Health & Wellbeing Board and to input in the weekly blogs onto the CCG website. DK hopes to lead this organisation to a better place. A process was undertaken with an independent returning officer. Dr David Kelly left the room at this stage under conflict of interest. Board members were asked to have a discussion. Members recognised everyone has development needs, and highlighted DKs strengths. All members were in support with DKs development needs. It was also acknowledged that DKs Chairing skills have improved significantly. All Board members agreed by a show of hands to appoint Dr David Kelly as Chair to NKCCG in line with the constitution, and offered their support through the challenging times. DK welcomes feedback from all members. The independent returning officer, Jen Love, confirmed after the show of hands the appointment; Dr David Kelly has been appointed under the constitution terms agreed by members, as the Chair of the Governing Body for NHS Kirklees Clinical Commissioning Group and Executive.
7.4
Major Incident Plan – Emergency Preparedness This paper outlines changes and developments. The SMT has discussed this in detail with Phil and the CCG will be accountable for this. All Governing Body endorses this plan and awaits decision.
7.5
Priderm Evaluation This was discussed at length at the Clinical Strategy Group (CSG).
HS recommends that this service is extended to run until March 2014. This service was opened up to the whole of Kirklees. It was recommended that discussions are required with MYHT regarding the historical issues with their dermatology service and what the current position is. SB suggested that himself and HSh monitors the finances on this service on a monthly basis. Any issues will be escalated to SMT. This is part of the QOF pathways and Practices are encouraged to follow this. DB is looking at data from MYHT and is investigating which practices are still referring to MYHT. The Governing Body agreed to extend this service until March 2014 assuming this fits with all the regulations and fully support the new pathways to allow for a greater understanding of the services requiring commissioning 7.6
CAMHs Service Specification The CAMHs Service Specification was discussed in great length at the CSG meeting. This may not be the final version and may change once this has been to the Patent and Carers meeting. Amendments have been made as recommended by CSG. HS suggested that the final version will be brought back to a future CCE meeting. Action – Debi Hemingway to amend the Equality Impact assessment to state the age implications. All agreed the draft service specification with amendments made by the Patient and Carers Group on the understanding that it will be referred back should recommended changes be substantial.
8.
Communication and Engagement Strategy Kirsty Wayman and Tracey Hollis presented the Communication and Education strategy. The Governing Body noted that the PPE group recommended the strategy to the Governing Body. DK acknowledged the work that has gone into producing this document. The PPE group are recommending that an operational group will be implemented which will replace the PPE Group. ALL Board members approved the Strategy and approved that the Operational group will replace the Patient and Public Engagement group.
9.
Private Paper Deborah presented the Safeguarding Quality and Safety Report. Deborah highlighted the summary in the Adult Serious Reviews and Domestic Homicide Reviews.
The Governing Body noted that CCE have the accountability and responsibility for these areas of work. 10.
AOB •
Quoracy – DT stated that the Quality and Saftey Committee was not quorate at the last meeting. The internal audit review has picked up the issue that was noted in the CCE minutes early this year. No GPs were present at the last meeting due to annual leave. Action – SMT to discuss how we move forward with quoracy. SB raised the same issue at for the Finance and Performance Committee. It was suggested that the membership to be increased to address issues, and if lengthy discussions do take place, it would be beneficial to have more members present, which will reduce having to spend time in CCE meeting going through reports in a lengthy manner. IP stated that the last meeting was a very beneficial meeting and detail discussions took place. This has improved since the split from GHCCG.
•
11.
It was requested that the Quality and Safety minutes are included in the meeting pack for next meeting.
Matters for Escalation There were no items for escalation.
12.
Receipt of Minutes Minutes from the Finance and Performance Subgroup The minutes from the Finance and Performance Subgroup held on 15th August 2012 were RECEIVED and NOTED by the Clinical Commissioning Executive Board. Minutes from the Quality Review Group The minutes from the Quality Review Group held on 14th August 2012 were RECEIVED and NOTED by the Clinical Commissioning Executive Board. Minutes from the Audit and Governance Subgroup The minutes from the Audit and Governance Subgroup held on 26th July 2012 were RECEIVED and NOTED by the Clinical Commissioning Executive Board. Minutes from the Shadow Health and Wellbeing Board The minutes from the Shadow Health and Wellbeing Board held on 1st August 2012 were RECEIVED and NOTED by the Clinical Commissioning Executive Board. Minutes from the Joint PCT/LMC.CCG Interface Meeting The minutes from the Joint PCT/LMC.CCG Interface Meeting Group held on 10th July 2012 were RECEIVED and NOTED by the Clinical Commissioning Executive Board.
Draft minutes from the Clinical Strategy Group The draft minutes from the Clinical Strategy Group held on 5th September 2012 were RECEIVED and NOTED by the Clinical Commissioning Executive Board.
13.
Date and Time of Next Meeting Wednesday 31st October 2012 9.00am – 12.30pm The Barn, Northorpe Hall, Mirfield
This concluded the content of the CCE meeting and the Chair declared the meeting CLOSED at approximately 13.05pm.
Chairman’s Signature:
Date: Wednesday 17th October 2012