EC-11-51-GHCC_mins_26_10_11-kjc-RATIFIED-23_11_11

NHS KIRKLEES

Minutes of the Greater Huddersfield Clinical Commissioning Executive (CCE) Meeting held on Wednesday 26th October 2011, 2.00 – 4.00pm in the Ibbotson Room at Broad Lea House, Bradley Business Park, Huddersfield Present: Vanessa Stirum (VS) Dr Judith Parker (JP) Dr David Hughes (DH) Dr Jane Ford (JF) Dr Dil Ashraf (DA) Dr Anuj Handa (AH) Dr Karen Dean (KD) Dr Paul Wilding (PW) Carol McKenna (CM) Jan Giles (JG) Sheila Dilks (SD) Nicky Hoyle (NH)

Non-executive Associate and Chair CCG member CCG member CCG member CCG member CCG member CCG member CCG member Chief Operating Officer Assistant Director of Commissioning Director of Transformation Public Health Consultant

In attendance: Rachel Carter (RC) David Boothroyd (DB) Natalie Ackroyd (NA) Theresa Fawcett (TF) Andrew Parker (AP)

Deputy Director of Commissioning - Head of Contracts Senior Contracts Manager Business Reporting Manager Finance Officer Commissioning Development Manager

Minutes: Kelly Chadwick (KC)

Personal Assistant to Greater Huddersfield CCE

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Apologies for Absence Apologies for absence were received from; Rob Millington (RM) Mehboob Khan (MK) Dr Steve Ollerton (SO) Steve Brennan (SB) Kath Woodford (KW)

Non-executive Associate Non-executive Director CCG Chair Acting Director of Finance Performance Reporting Manager

Introductions were made between Andrew Parker and the members of the group.

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Accuracy of Minutes 28 September 2011 The minutes of the CCE meeting held on 28th September 2011 were ACCEPTED as a true and accurate record with amendments as Page 1 of 6

recorded. It was AGREED that the wording of the minutes would be formatted to ensure the Shadow Board Sub Committee is now referred to as the CCE. EC/11/64

Matters Arising: Pain Business Case JG advised she had recently met with SO and Sarah Muckle (SM).

SM had advised that the specification is almost ready to go out to tender. However a question regarding medication has arisen and an answer was required from the CCE. JG asked the clinical CCE members whether the Provider should be able to prescribe medication for the patients using the service, or whether this should still sit with the GPs. Discussions took place and it was AGREED that the Provider will not prescribe any medication.

RC confirmed that Bradford has now given the 3 month notice required to finish the service. JG confirmed discussions have taken place with Locala to provide the service temporarily until a new Provider is in place.

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Transition Update Governance Update CM advised that the Terms of Reference for the CCE have been revisited and that they needed to be discussed and agreed by the CCE members. Terms of Reference for the 3 subgroups also need to be discussed and agreed. CM explained that the subgroups will initially be shared with NKHA CCE. GHCCE Terms of Reference CM explained that the SFI’s were not available yet. It was noted that the wording throughout the document would be amended to read CCE consistently.

Points 3.20 regarding Public Health Service and 3.21 regarding Primary care services, specialised services, prison and military services would be managed at Cluster level.

Point 8 regarding membership was raised. The membership consists of potentially 19 people, although the exact configuration of the group still needs to be finalised. Discussions took place about the voting rights of each member. It was AGREED that the two nonGP clinical members will not have any voting rights at this stage.

Attendance of the Kirklees Council member was discussed and it was AGREED that clarity would be sought as to whether Judith Hooper’s attendance could fulfil both this and PH role.

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It was AGREED that the Chair of the CCE would be VS and the Vice-Chair would be SO. Action: CM to raise the question of LA membership through the Cluster and review voting arrangements with a view to ensure there was a clinical majority in any vote.

SUBGROUPS Audit & Governance Group Terms of Reference CM advised of the main points from the TORs; The Chair of this group will be Tony Gerrard.

There will be one Non-Executive Associate (NEA) member from each CCE – which will either be VS or RM for GHCCE. There will be two clinical representatives from GHCCE. SB will be the Chief Finance Officer and would attend every meeting, whereas the Chief Operating Officer would only attend if required Quoracy – there will need to be the Chair (TG), one member from each CCG, two NEAs and one other member.

Meetings will be held bi-monthly.

Finance & Performance Group Terms of Reference CM advised of the main points from the TORs; The F&P group will be a subgroup of the CCE going forward.

The group will meet on a monthly basis.

Membership needs to be agreed but it will be the Chair of the CCGs plus one other member. CM advised she would discuss this further with SO. Action: CM to discuss F&P membership with SO. Quality Group Terms of Reference Membership for the group was discussed. It was agreed that CM would again discuss this with SO. Action: CM to discuss F&P membership with SO. SD advised that Quality Boards are held with all providers and there should be a quarterly report fed into this group.

Further discussion took place around the table regarding the time commitments of the GPs. It was agreed that time management and attendance needs to be revisited. CM advised that a process will be put in place regarding the format of the groups going forward including dates of meetings and the final Terms of Reference.

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Commissioning Support CM gave a brief update. Some guidance was launched mid-October which provides helpful information on structures both nationally and locally. Work continues locally on what commissioning support might look like in the future.

Self Assessment Process JG advised as to the output from the last session held on 12 October 2011. JG advised that the session went very well and that Karen Gallagher was coordinating the feedback and write-up of the papers. The next session is to be held on Wednesday 16 November 2011.

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Performance Report KW had sent apologies. NA advised of the key points; Ambulance response times – currently underachieving in Denby Dale & Kirkburton and The Valleys Cancer waits – 16 breaches; 12 at CHFT; 6 due to capacity issues.

NA advised that she was not aware of any action being taken to rectify that yet. CHFT are currently meeting the required targets so this is not an issue with them yet.

There is an issue with stroke in Q1 data around the TIA indicator.

The CQC reports on dignity and nutrition for older people were discussed. One is for CHFT and one for Barnsley. No concerns for CHFT. Improvements are needed on outcome number five for Barnsley. The contract manager is aware of this and it will be raised.

YAS performance was discussed. JG advised that she was meeting with Paul Mudd from YAS along with SO and KW to discuss the issues around performance.

RC confirmed that discussions have taken place with YAS about the length of time taken to respond to patient calls. Detailed information is currently being drafted.

The CCE RECEIVED and NOTED the contents of the performance report.

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Finance Report SB had sent apologies. TF advised of the key points; £956k currently overspent which is an improvement on previous months and this is due to Cat M savings on QIPP Plan. £760k underachieving forecast for the year end.

A meeting is to be held to develop the plans for 2012/13 and these will be shared in due course.

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There has been some movement on acute trading positions.

Elective care (MSK/Hips) is mainly responsible for this.

There is an overtrade in the independent sector with issues around BMI overtrading. Leeds are showing an undertrade, Bradford showing an overtrade – mainly in two areas; oral and ENT activity.

No further detail available on this yet. RC advised that a letter was sent out earlier this year to dentists reminding them about referral choices, Bradford being one of them. Barnsley/Sheffield – slight overtrade.

YAS PTS contract – underspend due to new contract.

Clinical engagement budget - £148k undertrade currently but forecast to spend this year.

There is a meeting taking place on 31 October to look at data flows and reviews of activity and SB will feedback to the CCE. The CCE RECEIVED and NOTED the contents of the Finance Report.

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Contracting Report DB gave advised of the key points; £530k undertrade at month 5. This has decreased from £940k last month.

Demand planning is to start in November and this will be held as a joint discussion between NHSK, CHFT and Calderdale.

There is an increase in population growth and this is showing in the changes in waiting list size.

There has been an emergency threshold adjustment. Discussions and agreement have been reached regarding how this will be progressed based on the PbR tariff. JG suggested including Locala and SWYFT data in these figures.

DB confirmed that work is ongoing with the Planned Care Board to look at first attendances in other areas in more detail. The main concern is still consultant to consultant referrals but other areas are also causing concern. Increased attendances showing in trauma & orthopaedics, ENT, obs & gynae and midwifery. Decreases are showing in ophthalmology, cardio and GUM. Discussion took place regarding the number of elective short stays being charged for on a monthly basis.

The CCE RECEIVED and NOTED the contents of the Contracting Report.

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AQP RC fed back on the recent Any Qualified Provider (AQP) work. RC advised that the priorities for GHCCG had been fed into the process.

The information also went to the Shadow Health and Wellbeing Board and there has also public engagement on it. AQP has now been discussed at the Cluster Board.

RC explained that there are three services to be identified by the Cluster. Diagnostics and the West Yorkshire Sexual Assault Referral Centre service are two options suggested. IAPT has been identified

by Calderdale but Kirklees is currently tied into a contract with SWYPFT until 2013. RC advised that Adult Hearing and Dermatology are both possibilities for the third service for Kirklees and asked for clarification from the group as to which one to choose.

It was AGREED that both should be suggested if required.

JG raised a question regarding what was included under Diagnostics. RC advised it wasn’t clear as yet and that the specification would be available from the end of November. RC advised that there could possibly be a menu of services that we choose from.

Action: RC to feedback views from the CCE to the Cluster lead.

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Any Other Business CM advised that Angela Monaghan will be in attendance for the next meeting on 23 November.

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Date and time of the next meeting The date of the next scheduled meeting is Wednesday 23rd November 2011, 2 – 4pm.

This concluded the content of the CCE meeting and the Chair declared the meeting closed at 4.00pm.

Chair’s Signature:

Date: 26/10/11

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