NHS Greater Huddersfield Clinical Commissioning Group
Minutes of the NHS Greater Huddersfield Clinical Commissioning Executive (CCE) Meeting held on Wednesday 5th September 2012, 1.30 – 4.30pm, Board Room, Broad Lea House, Bradley, Huddersfield Present: Dr Steve Ollerton (SO) Dr Dil Ashraf (DA) Dr Karen Dean (KD) Dr Judith Parker (JP) Dr David Hughes (DH) Dr Paul Wilding (PaW) Dr Jane Ford (JF) Carol McKenna (CM) Julie Lawreniuk (JL) Penny Woodhead (PeW) Dr Irving Cobden (IC) Angela Monaghan (AM) Vanessa Stirum (VS) Rob Millington (RM)
CCG Clinical Leader and Chair CCG member CCG member CCG member CCG member CCG member CCG member Designate Chief Officer Chief Financial Officer Head of Quality & Safety Secondary Care Consultant Registered Nurse Non-executive Associate Non-executive Associate
In attendance: Rachel Carter (RC) Kath Woodford (KW) Lynsey Warwick Giles (LWG) Christina Fairhead (CF) Esther Silva (ES) Ilse Newsome (IN) Tony Gerrard (TG) Carol Pickering (CP) Karen Gallagher (KG) Dasa Farmer (DF)
Head of Contracting Business Reporting Manager Research Analyst Safeguarding Nurse Graduate Management Trainee Corporate Governance Manager Audit & Governance Subgroup Chair Organisational & Leadership Development Consultant Assistant Director of Organisational Development Engagement Officer
Minutes: Kelly Chadwick (KC)
Personal Assistant to Greater Huddersfield CCE
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Welcome, Introductions and Apologies for Absence SO welcomed the CCE members and opened the meeting. Apologies for absence were received from; Dr Anuj Handa (AH) Nicky Hoyle (NH) Mehboob Khan (MK) Jan Giles (JG) Vicky Dutchburn (VD)
CCG member Public Health Consultant Non-executive Director Head of Practice Support & Development Head of Strategic & Business Planning Page 1 of 13
Sarah Cowman (SC) Merran McRae (MM)
Head of Communications Director of Wellbeing, Kirklees Council
Declarations of Interest All the GP’s present declared an interest in Agenda Item No 11 – Estates. EC/12/169
Accuracy of Minutes of 8 August 2012 It was noted that the title for Charlotte Parker was inaccurate and that Sarah Lindley is now Sarah Cowman. Action: KC to make amendments as noted. The minutes were AGREED as accurate with the amendments as noted above. Action Log CCE 27 June 2012 - EC/12/149 – NHS Transition (Election of CCG Chair) CM clarified that discussions were still ongoing regarding the accountability of the Chair. CM to feedback once further information is available. EC/12/159 - Accuracy of Minutes of 27 June 2012 – Stroke Rehab Patients CM confirmed that she will be attending a meeting on Friday 7 September and will provide further feedback at the next meeting. EC/12/162 - Quality & Safety Report CM confirmed that mapping of the subgroups has been picked up Ilse Newsome. Ilse is developing a paper that will be presented to a future CCE. EC/12/165 - Any Other Business - Health Checks SO advised that Sarah Muckle was unable to attend but had provided a brief update. 33 practices have signed up for the LES to date. No training has been requested yet for GHCCG. Locala have been served notice and the service will end in November. RC advised that the Locala budget is still included within our finances and this will need to be discussed. Action: RC to provide further information on the figures for the Locala budget for this service. All other actions were confirmed as complete.
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Annual Safeguarding Children’s Report PeW introduced Christina Fairhead, Designated Safeguarding Nurse for NHS Kirklees. PeW explained the background to the report. PeW informed the CCE members that a local safeguarding children’s report will be presented to the CCE in the future. This particular report covers the details from 2011-12 and also informs of plans for 2012-13. PeW advised that the terminology of the report will also change in the future to reflect the CCG rather than NHS Kirklees. JP asked if the rise in numbers of looked after children was causing capacity pressures. CF confirmed this hasn’t been raised as an issue to date but could potentially be in the future. Children require health needs assessments and the Local Authority undertake this but haven’t reported any added pressures. Discussion took place about awareness and knowledge of safeguarding and CF confirmed that the first session was given on 29 August to CCE members and this will continue to happen in the future. PeW advised that all future reports will specifically note that Board members and member practices are included in the awareness and learning where appropriate. RM asked how the information was fed back to CCE. PeW advised that the minutes of the Quality & Safety Subgroup would include any information relating to safeguarding. A quarterly report will also be submitted to the subgroup, some of which PeW will feed into her Quality & Safety Report for the CCE VS asked what the position was regarding safeguarding adults. PeW confirmed that this has been identified as an area that requires strengthening and this will be picked up through the filling of posts in the structures over the coming months. PeW confirmed that annual reports for safeguarding adults will be submitted to CCE in the same way as the children’s reports. JP asked how the lead roles will work in the future in the new organisation. PeW confirmed that she will have this responsibility and will work alongside CF (designated nurse) and JF and their teams. A further question was raised by JP about primary care training for safeguarding. PeW confirmed that this has been discussed but at the moment it’s unclear as to who will provide this. The CCE NOTED and ENDORSED the contents of the report and thanked CF for her attendance. Page 3 of 13
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Audit & Governance Annual Report TG was in attendance and presented the report in his capacity as the Chair of the joint Audit & Governance Subgroup. TG explained that the report has recently been presented to the Audit & Governance Subgroup for information. The report is being presented to the CCE to provide assurance that the activities of the subgroup have been reviewed and discharged appropriately. Assurances also come from external parties such as internal/external audit. TG advised that the report would normally be based upon the financial year, April – March. However this report is based upon January to July due to the unique circumstances at the moment. IN highlighted the value of corporate governance being involved in this group and its report and advised that this shouldn’t be underestimated. CM asked TG what his thoughts were for the Audit Committee from April onwards. TG responded that the Committee structure would be the main method of ensuring that assurance can be given to the CCE for various items. RM advised that continuity and experience will be very beneficial to the CCE going forward. TG agreed. TG suggested that the other subgroups should provide an annual report to CCE and suggested that workplans are also very useful. PeW confirmed that a workplan is being developed for the Quality & Safety Subgroup. The CCE members AGREED that this would be useful. The CCE NOTED and ENDORSED the contents of the report and thanked TG for his attendance.
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Clinical Leader/Designate Chief Officer Report CM highlighted the key points from the report. Structures CM gave an update on the current structures. Consultation had been extended for a further week but this has now closed. The final refinements are now complete. This was shared with staff on the 4th September and pooling and matching will begin week commencing 10th September. CM informed the CCE members that the main comments from staff on the structures were around banding which have since been included. Page 4 of 13
West Yorkshire LAT An advert has gone out for the West Yorkshire LAT Director. Mike Potts is working with the team to get the senior team of the LAT established quickly. Maternity Triage SO advised that this is predominantly a service used by midwives. IC asked what the service was. SO explained how the service was used to the CCE members. SO explained the new protocol that has recently been designed. Discussion took place about the next steps relating to the protocol and the service itself. DA AGREED to raise this at the Children’s Carestream. It was AGREED that GHCCG were happy to let the service continue in its new form. Action: SO to inform CHFT that GHCCG were happy to let the service continue in its new form. Mid Yorkshire update CM advised that a meeting has recently taken place that involved herself, JL, PaW and Neil Goodwin. The intention of the meeting was to discuss our strategic interest in MYHT. CM informed the CCE that the meeting has given the message to MYHT that GHCCG do want to remain involved. JL questioned how we ensure we keep the conversations flowing. CM advised that it would depend on if there is a formal mechanism for this. CM informed the CCE that she was involved in a weekly teleconference with Chris Dowse, Mike Potts, Jo Webster and Matt Walsh and this could be used to highlight key points if necessary. Public Meetings CM advised that Ilse Newsome (IN) was observing the meeting from a governance point of view and will be making notes on the Board’s conduct. CM informed the CCE that it was proposed that the first public meeting is in November or December. It is intended that October’s agenda will be split into public and private sections as a test run. The CCE RECEIVED and NOTED the contents of the report and thanked SO/CM. EC/12/173
Finance, Contracting & QIPP Report JL presented the report and explained that the report will still continue to show some NHS Kirklees budget information. Finance NHS Kirklees are forecast to meet their control total of £280 million. There is a need to understand the reserve budgets in more detail, as part of the splitting of the Kirklees budget into two CCGs . Page 5 of 13
CHFT are currently overtrading and plans are in place to look at non-elective activity in future CSG meetings. There is a financial risk involved, particularly in relation to next year if this level of activity is recurrent. JL confirmed that the first GHCCG only Finance & Performance Subgroup will take place in September. Information relating to QIPP will be brought into the meeting for discussion. The QIPP information shows all GHCCG schemes with approximately £5.3 million savings. VD is working with Natalie Ackroyd to provide a detailed paper on QIPP and this will be presented to a future CCE. JL advised that the QIPP plans for 2013-14 onwards will be focussing very much on the SR to bring in the savings. RM asked if the F&P and Q&S Subgroups will both be looking at QIPP. JL confirmed that F&P will have responsibility for delivering QIPP but it does include Q&S as well. QIPP is on the agenda for SMT once a month for an update before being further discussed at F&P then reported to CCE. Contracting It was noted that the Pain Management Service has now reopened but not the Neurology service. It was also noted that the new Tier 2 Pain Service starts in November. Any Qualified Provider RC provided an update. Stage 2 assessment has been carried out locally. Adult Services – the procurement has now finished. The contracts are being finalised. The list of suppliers has not been made public as yet but this will go onto Choose & Book. Referrals cannot take place unless the supplier is on Choose & Book. There could be some difficulties with this process as not all suppliers will want to be on C&B. Diagnostics – this is ongoing. The financial risk has been managed in year. This is up to a 3 year period for the contract. The contracts start out at zero figures but could be as high as £2.5 million. JP advised that practices are starting to ask questions during practice visits about AQP and asked for guidance on what can be fed back. Discussions took place about the thresholds and how this will work. RC advised that a standard contract will be in place with all providers so the standard quality reporting will be included. RC explained that as soon as referral forms are agreed then practices will be informed. Page 6 of 13
The need for an electronic referral directory was discussed. It was noted that both Calderdale CCG and GHCCG are keen to establish this system but it would need to be procured due to the likely value. Liz Lawlor is now leading on developing a business case. SO confirmed both him and AH are also involved. CM questioned how to build into this report information about other contracts and not just CHFT. JL confirmed this was being discussed and will pick it up further with Rachel/Martin. Action: JL to discuss future reporting of all providers contracts with RC/MP. The CCE RECEIVED and NOTED the contents of the report and thanked JL. EC/12/174
Performance Report KW presented the report and advised that a more detailed report will now go to Finance & Performance and only the high level key information will be presented at CCE. They key points are; •
• •
Mental health – there has been a drop in performance due to a small number of patients not being followed up after 7 days of discharge. This was due to a clash of annual leave. This has now been picked up by SWYFT. Ambulatory conditions – number of areas being looked into and they will be discussed further at both F&P and CSG. KD advised that the manager for this area is currently on leave. Smoking – the performance figures are repeatedly low at this time of year and this is due to how the figures are actually reported. KW confirmed this does not mean the actual performance is any worse.
It was noted that there is a potential error with the figures in section PSH13. RC agreed to check the accuracy and confirm if the increase is 5.5% as opposed to 19%. SO confirmed that all practices except one will be on SystmOne or EMIS by the end of the year. JP congratulated KW and RC on the quality of report provided. The CCE RECEIVED and NOTED the contents of the report and thanked KW for her attendance. EC/12/175
Quality & Safety Report PeW explained the background to the report. A range of issues are picked up via the Quality & Safety Subgroup including national indicators. The key points to note are; Page 7 of 13
• •
Mixed sex accommodation – no breaches at present Performance update from HCAI agenda – CHFT are holding an independent review of the CDI plan.
PeW explained that the CQC Ofsted Action Plan was inspected in November 2011.. The action plan was planned to close in June but some of the issues have overrun. PeW advised that Christina Fairhead has informed her that these issues have now been rectified although she is still awaiting the actual evidence. PeW advised that the latest guidance from the national Quality Board has come out and a brief update will be provided at the next CCE after further discussions at the next Quality & Safety Subgroup. AM asked if all the providers are covered within the Quality & safety report. PeW informed the CCE that if there are any major issues then these are included but the main focus is CHFT. Locala, SWYFT and Leeds are also included. The CCE RECEIVED and NOTED the contents of the report and thanked PeW. EC/12/176
Risk Register CM advised that this has been discussed at SMT recently and a piece of work will be carried out with SMT to look at the risk management system and how to use it. Our system is based on the Kirklees PCT system and it will need to split into 2 CCG systems. It was AGREED that this needs to be on the agenda next month for further discussion. Action: Risk register to be added to October agenda VS asked if this was linked to authorisation and if a deadline needs to be put in place. CM advised this wasn’t a requirement but we do need to be cited on any outstanding risks/action plans.
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High Performing Membership Organisations KG explained the project and introduced Carol Pickering, Organisational & Leadership Development Consultant. CP thanked GHCCG for showing interest in this project. Discussion took place about what sort of organisation GHCCG aspire to be. The tender specification was discussed and CP confirmed that the potential tenderers have been asked to come up with a model to bridge any gaps of engagements. This project is currently out to tender to 7 companies, mainly academic institutions.
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There has been limited response to date. CP advised she is in discussions with other companies. KG advised that both herself and JG could potentially be involved in the tendering selection process. KG explained that this needs to be developed in such a way that GHCCG practices will want to engage further with us. CM suggested using some of the feedback from the recent 360 survey. KG advised this would be useful as part of the desktop research. CP informed the CCE members that there are 3 workshops planned along with drop in surgeries – both by phone and in person. There will also be some form of Board observation included. SO suggested this could be linked with the Commissioning Readiness Scheme. IC asked how an evaluation will take place and what sort of information will be sought from the provider. CP confirmed that part of the brief for the winning provider will be around providing an evaluation. PeW informed the CCE she had previously worked on a scheme involving a co-creating competency framework and this model could potentially be used. CP confirmed that this will offer will be opened up to other organisations to gather any new interest. VS questioned timescales for the scheme. CP confirmed that this is moving fairly quickly and that evaluation is planned for January 2013. The CCE AGREED to support the project and thanked KG/CP for their attendance. EC/12/178
Estates JL explained the background of the item and advised that this had initially been discussed at the joint Finance & Performance Subgroup. This report is a position statement on where we are with estates at present. There is a working group looking at the service need and a list of estates has been tabled and is included within the report. JL confirmed that the highest priority area is Huddersfield town centre. Discussions took place regarding the estates prioritisation list and questions were put forward regarding other areas of estates not mentioned in this report. JL confirmed that some of these areas would be picked up by the Strategic Review and we will need to feed into this at some point. It was highlighted by JF that this is high Page 9 of 13
on the agenda of local councillors and local communities and that it should be higher in our list of priorities. RM agreed and suggested some of the work should begin where possible. JL informed the CCE that this report had been produced for information purposes at this stage. JL noted that there were some comments raised regarding the need to progress this as much as possible at this stage. JL agreed to feed the comments back to the working group. Action: JL to feedback comments provided by CCE members. It was AGREED that a report will be provided to the Finance & Performance on a 6 monthly basis showing any progress/actions to date. Action: JL to arrange for a 6 monthly progress report to be provided to Finance & Performance. The CCE RECEIVED and NOTED the contents of the report and thanked JL. EC/12/179
Public Health MoU CM presented the report on behalf of Nicky Hoyle, who has sent apologies to the meeting. The Public Health Memorandum of Understanding has recently been presented at the Clinical Strategy Group to allow further comments to be received. These have now been incorporated and the CCE are now asked to endorse the MoU in its current format. It will be reviewed in January or February 2013 before implementation in April 2013. The CCE AGREED to endorse the MoU in its current format.
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Strategic Review update PaW gave an update on the Strategic Review. PaW advised that the Carestream launch event had taken place on the 4th July and this had been very well received. The feedback slides have been included within the CCE papers for information.
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There are 4 Carestreams; Planned Care Unplanned Care Children’s Care Long Term Care Each Carestream has managerial and clinical representation from across the 7 partners involved in the Strategic Review. A central Programme Management Office has now been set up and the Programme Board meetings monthly. SO is one of the two ViceChair of the Board. The Steering Group meet weekly and PaW advised he is the Chair of this group. PaW informed the CCE that a risk register for the programme has been produced and will be considered by the Programme Board. . It was AGREED that the SR would be a regular standing agenda item and a report would be provided to inform the CCE of progress. It was also AGREED that minutes of the Programme Board and Steering Group would be included for information. Action: KC to add SR as standing agenda item and seek copies of minutes for information. DH gave a brief update on the Unplanned Care workstream and asked if the CCE were happy with the direction of travel. All AGREED. The CCE RECEIVED and NOTED the progress and thanked PaW for the update. EC/12/181
Patient and Public Engagement – progress to date DF explained the report and advised that this was to show progress to date around Patient and Public Engagement for GHCCG. The report shows information relating to the PPE Operational Group, the Patient Reference Network and some information relating to the Strategic Review PPE work that has been taking place. DF confirmed that the 4 Carestreams leads have been contacted in relation to carry out further work to support PPE. DF informed the CCE that the next steps are developing the PPE operational group for implementation post April and looking at how this will fit with future governance arrangements. PPE is expected to be a Key Line of Enquiry (KLOE) during the site visit. This will be discussed further at the Quality & Safety Subgroup to agree a course of action. The CCE RECEIVED and NOTED the contents of the report and thanked DF for her attendance.
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NHS Transition Structures/Running Costs JL presented a paper to the CCE regarding the current thoughts around running costs and the GHCCG structure. JL advised that “Buy, Build, Share” is the strapline and this involves buying in from CSS where appropriate, building a team within our CCG and sharing posts where appropriate i.e. across the CHFT footprint. JL explained the report provides a brief for each of the functions within the structure and this had been written by the current transitional Head of the function. JL informed CCE that the financial modelling shows what is affordable and what we can buy from CSS. Further discussions took place regarding the structure and the CCE were advised that pooling and matching of staff is expected to commence w/c 10 September. Authorisation CM advised that the final application was submitted on the 3rd of September. CM formally thanked everyone that had been involved for their hard work and efforts. In particular, Carol thanked Kelly Chadwick for the considerable effort involved in pulling the submission together and the additional time commitment this had entailed. CM advised CCE members of 2 key dates over the coming weeks; • Wed 26 September – Mock Panel Day. This will involve a run through of our site visit day to prepare us for the actual visit. • Friday 19 October - Site Visit Day. An external panel of around 11 people will be in attendance for the visit and CM informed CCE members it is expected that attendance from everyone will be required for the full day. A briefing pack will be supplied before the panel visit.
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Receipt of Minutes The CCE RECEIVED and NOTED the minutes of the following meetings; • Shadow Health & Wellbeing Board (01/08/12 – draft only) • Finance & Performance Subgroup (20/06/12 – ratified) • Quality & Safety Subgroup (15/08/12 – draft) • Audit & Governance Subgroup (26/07/12 – draft) • Specialist Commissioning Group (27/08/12 – ratified)
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SCG Minutes Discussion took place regarding the minutes received from the SCG and in particular the Clinical Standards Group which looks at the Quality aspect. PeW confirmed that work is in progress to look at how quality will fit during the transitional period as well as the delivery of engagement work as it isn’t clear yet how that will be incorporated in the future. Further comments were raised regarding WYCOM and how this should be used to ensure CCGs could influence the specialist commissioning agenda. . Audit & Governance Minutes It was noted that Serious Incidents had been discussed at the last meeting and it has been AGREED that these will be reported to the Quality & Safety Subgroup in future. The Complaints Report was also discussed and it was AGREED that this needs to be reviewed and presented again in more detail. PeW will undertake this. Action: PeW to review Complaints Report and present in more detail at future Audit & Governance Subgroup. EC/12/184
Any Other Business Matters to escalate to Cluster Board CM confirmed that the deadline for any items to be included in her report to Cluster Board is 11 September. YAS Report CM informed the CCE members that this has been discussed again recently at F&P and it had been AGREED that the performance figures for YAS at overall and locality level would be kept under review through F&P. Given that detailed consideration had been given to the performance shortfalls in some localities, and a number of actions taken, this level of detail would not need to be reported to the CCE on a regular basis as had previously been the case.
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Date and time of the next meeting The date of the next scheduled meeting is Wednesday 3 October 2012, 1.30 – 4.30pm.
This concluded the content of the CCE meeting and the Chair declared the meeting closed at approximately 4.45pm.
Chair’s Signature: ........................................................ Date: .................................. Page 13 of 13