GHCCE_mins_27.06.12-cs-RATIFIED-08.08.12

NHS KIRKLEES

Minutes of the Greater Huddersfield Clinical Commissioning Executive (CCE) Meeting held on Wednesday 27th June 2012, 2.00 – 5.00pm in the Board Room at Broad Lea House, Bradley Business Park, Huddersfield Present: Rob Millington (RM) Dr Steve Ollerton (SO) Dr Dil Ashraf (DA) Dr Karen Dean (KD) Dr Jane Ford (JF) Dr Paul Wilding (PaW) Dr Anuj Handa (AH) Carol McKenna (CM) Penny Woodhead (PeW) Julie Lawreniuk (JL)

Non-executive Associate CCG Clinical Chair CCG member CCG member CCG member CCG member CCG member Shadow Accountable Officer Head of Quality & Safety Shadow Chief Financial Officer

In attendance: Rachel Carter (RC) Jan Giles (JG) Vicky Dutchburn (VD) Nicky Hoyle (NH)

Head of Contracting Head of Practice Support & Development Head of Strategic & Business Planning Public Health Consultant

Minutes: Claire Sibbald (CS)

Commissioning Facilitator

EC/12/143

Welcome, Introductions and Apologies for Absence Apologies for absence were received from; Vanessa Stirum (VS) Mehboob Khan (MK) Dr Judith Parker (JP) Dr David Hughes (DH)

Non-executive Associate and Chair Non-executive Director CCG member CCG member

Declarations of Interest Declarations of Interest were noted from CM and JL in Agenda Item No 3 – Clinical Chair/Transitional Accountable Office update, as the roles will be discussed that they are currently working in. Both will leave the room for this section of the meeting.

SO also noted interest in Agenda Item No 7 – Election of the CCG Chair as this is a role he has applied for. SO will leave the room for this section and RM will chair.

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EC/12/143

Accuracy of Minutes of 23 May 2012 KC was thanked for putting actions in red.

An amendment was noted to page 4 of the minutes under agenda item EC/12/131. Paragraph to be added ‘Financial implications were discussed. It was recognised that if uptake is high this will have implications for the CCE budget going forward’.

Action: KC to make the amendment as noted before confirming the minutes as ratified.

Agenda item EC/12/132 to be added that KD will liaise with AP about Wells testing which will be added to the D-Dimer LES. Action: KC to make the amendment as noted before confirming the minutes as ratified. KD to speak to Andrew Parker.

NHS Transition CM confirmed that under the subject of People Transition the documents would be circulated to CCE members once confirmed.

Action: CM to provide KC with documents for circulation.

Communications Team Discussion took place about the formal mechanism for feeding items back to the Communications team. A formal process has not been agreed.

Action: CM to meet with Sarah Lindley to discuss formal process and whether she should attend meetings.

The minutes were then AGREED as accurate.

Action Log All actions complete with the exception of Item EC/12/128 – Estates.

This was discussed further at Finance and Performance and is currently a joint Kirklees document, this will be split between CCE groups and brought to the next meeting Action: JL to take this forward with Keith Geldard and to bring updated document to CCE in August.

EC/12/145

Clinical Chair/Transitional Accountable Officer Update CM gave an update on the recent appointments across the cluster.

CM asked attendees to note the appointment of the CFO for Wakefield PCT. CM also updated that although the Risk Register is not on the agenda for this meeting, work is being done on the risk management framework and this will be brought to CCE in August.

This framework needs to be agreed and signed off by CCE before Page 2 of 12

the start of the Authorisation process. Time needs to be given for Training and Development for CCE members to ensure everyone is aware.

Action: KC to add Risk Register to agenda for August CCE. JG asked for feedback from the BMA industrial action. CM confirmed that before the event data was collected about practices who would be closed and the impact of the event. No significant disruption was reported as a result of the action taken on the day.

At this point CM and JL left the room SO gave an update on the Accountable Officer position the closing date for which is 28th June at 5pm. SO stated that his details were on the advert for the job and so far no-one had contacted him. The interviews for the Accountable Officer role will take place on the 11th July with presentations in the morning and interviews in the afternoon and all GP CCG members were encouraged to attend if possible.

SO then updated on the Chief Financial Officer role which will be advertised Yorkshire and Humber wide on the 9th July. The interview panel will include external CFO, SO, Calderdale/Greater Huddersfield AO and Alan Brook.

After the discussion was brought to a close CM and JL were invited to re-join the meeting.

CM then gave an update on the recruitment of an external Consultant and Nurse to the CCE. Further guidance about these roles is due shortly. To date there have been expressions of interest from from 19 doctors and 9 nurses. Further information from Human Resources is needed before these applications can be progressed further.

CM confirmed that the previous guidance stated that the nurse can’t be employed by a member practice or the CCG, however, this has now been updated and the nurse could be employed by the CCG, although the exclusion of practice employed nurses remains. CM asked the board members to state whether they would be happy with this or whether they would still like to proceed with nurses who are external to both member practices and the CCG. The decision was taken that the nurse should be external to the CCG as this would be better for someone who is required to fulfil a governance role.

Confirmation was given that the successful applicants would be offered 1 day per month, which would include 1 CCE and preparation for that meeting. This is different to many other areas who are offering 2.5 days. However, agreement was given that all Page 3 of 12

were happy to proceed with 1 day and this could be extended at a later date if necessary.

At this point RM said that he would not be applying for role as NonExecutives when they were recruited. He thanked the board for their support and for the opportunities that he had been given. He confirmed that he would continue in his post until new members are recruited. SO thanked RM for his contributions to date.

EC/12/146

Finance and Contracting JL presented this information and explained that the report is currently joint for GHCCG and NKHA, however from September the report received will be GHCCG only. GHCCG look at £270 million of expenditure. The current report shows that they are broadly online with objectives set, but this is early in the reporting year. JL also stated that there are some areas not shown on the report including slippage.

JL asked the CCE to take note of the risks including CHFT and Leeds where they currently have a block contract which finishes at the end of 2012/13. There are also risks around prescribing as this can be highly volatile. A further risk is the re-structure of the PCT, which may effect QIPP savings, but currently on track for £4 million of £5 million projected savings and looking at the Strategic Refresh as a means of delivering QIPP in future.

There is currently £1.5 million non-recurrent money to spend and consideration will need to be given to this in the near future.

JL confirmed that issues about elective inpatients will be taken through the contracting board. RC confirmed that it’s too early in the year to identify trends at the moment, but as the issue has been flagged so early into quarter one it will be monitored more closely throughout the next few months.

RC went on to say that pressure is being put on CHFT to understand why waiting lists are going up. A task and finish group has been set up for this. PW said that 18 week performance is deteriorating nationally, but what actions could be taken at Trust level? It was noted that it is important to monitor activity levels at CHFT and ensure these do not reduce below what is expected as a consequence of the fixed value contract.

Following this JL said that the CCE need to be aware of the baseline exercise currently talking place and this may determine CCG allocation for year one. Allocation formula will be given and this will show what this means for NHS GHCCG, however, timescales for travelling to target not yet clear.

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JG asked for PPT to be removed from Management Allowance figures as this meeting has a separate budget.

Action: JL to remove PPT from future reports.

JL and RC asked if CCE were happy with the structure of this report, with the high detail report going to Finance and Performance for more in-depth discussion. All agreed happy with just an overview to be given at CCE meeting.

The CCE RECEIVED and NOTED the contents of the report and thanked RC and JL. EC/12/147

Performance Report RC provided a brief overview of the key points from the report, stating that in future CCE will see items that are identified as needing to be highlighted by Finance and Performance: There is an issue with the Cancer target which is 95% and CHFT are currently at 47%. This is a breach and there have been 3 issues already picked up.

Mixed sex accommodation – 1 known breach in May at Calderdale, this was a clinical decision and investigation showed that the process for the Matron was followed.

Infection Control – 10 cases of C-Dif reported in Apr/May, this is high as there should only be 6 across the whole year.

This is being closely monitored and CHFT have escalated the matter appropriately.

Choose and Book usage in GHCCG is still well below the 90% target. National data collection however, may not be the same as local reporting. Finance and Performance have identified specific actions relating to this and Christine Powell is aware.

CCE agreed to bring the issue of Choose and Back to later meeting to look at a more radical approach.

Action: To be added to agenda for OD day.

Action: JG to ensure Choose and book training is on the agenda for a PPT event.

RC asked for approval of this level of reporting. CCE confirmed happy with level of report given. The CCE RECEIVED and NOTED the contents of the report and thanked RC.

EC/12/148

Quality and Safety Report

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PeW provided an overview of the key points from the more detailed report that had been given to the Quality and Safety sub-group.

A breach in April had previously been discussed, however, when reviewed this was not actually a breach. The patient was suspected as having a stroke and was therefore accommodated in a mixed sex bay in the stroke unit which was considered to be best clinical practices.

Handwashing/toilet breaches in April make CHFT an outlier in Yorkshire and the Humber. This shows a high level of reporting at CHFT. PW asked if this was as a result of the operating framework and staff being more aware. PeW confirmed that 12 months ago no incidents were reported, but a lot of training has taken place and staff are now more aware.

PeW also confirmed she is speaking to lead nurses re infection/prevention control to ensure as a CCG they are meeting requirements.

The CCE had previously been asked for comments about the Quality Accounts. These comments have now been submitted to the providers and accounts will be published at the end of the week.

The accounts will first go to the quality group and will then be brought to CCE. Attachment EC/12/148 page 63 shows guidance given on handing over Quality information. PeW confirmed plan had been given to SHA last week and will be shared with Quality group. Over the next 9 months the CCE will be asked to receive documents from this.

The Quality group will also split from NKHA with effect from July.

The Terms of Reference for the GHCCG group have been drafted and will be shared with the Quality group at their next meeting, once finalised they will come to CCE for agreement. NH asked if Public Health need to be involved in this group, PeW confirmed that Julie Tolhurst attends on behalf of Public Health. JL said she will speak to Gill Galdins to clarify if Terms of Reference need to be brought for CCE sign off.

The CCE RECEIVED and NOTED the contents of the report and thanked PeW. EC/12/149

NHS Transition Election of the CCG Chair At this point SO left the room and RM took over as Chair.

RM asked JG to clarify process. JG confirmed that in order to progress with appointment of the chair, the appointment needs to be ratified. The constitution states that the chair has to self Page 6 of 12

nominate and undertake a national recruitment process which SO has done.

RM stated that all appointed board members have to vote on the appointment of the CCE Chair and that current voting is to appoint the chair until 31st October 2013. RM asked if all present were happy to proceed with just one nominee.

All present confirmed they were happy with this.

RM asked for confirmation about who the Chair is responsible to.

Action: CM/JG to get confirmation of this and report back at CCE in August.

RM asked for all to vote if they were happy to accept SO as chair.

All GPs, lay members present and PeW, JG and CM voted and all agreed. The matter was agreed as unanimous.

CM said that they may now need to consider if SO should take responsibility for chairing governing body.

Action: CM to look into this and confirm if the appointed clinical chair has to Chair the Governing Body or whether it should be an external member.

At this point RM invited SO to return to the room.

RM then formally reported to SO unanimous vote in accepting him as chair. SO thanked him and the members and also thanked RM for chairing that section of the meeting.

The CCE vote was NOTED as UNANIMOUS and SO was confirmed appointed as Chair.

CCG Structures and CSS CM confirmed that she is working with partners in the CKW cluster to look at costings of structures and CSS. Working to 19th July deadline for sharing these with CKW. The structures will then be brought to CCE for further discussion.

CM confirmed the structure had previously been brought to CSG and cost of incentive scheme had been discussed at length. A debate had taken place at CSG about whether the scheme is needed next year. It was suggested that this was discussed with member practices and they are open about how the money is allocated and spent.

AH asked for confirmation of whether Medicines Management were included in costs? JL said it would be appropriate for it to be Page 7 of 12

brought to CSG once further information on CSS costs are available. This was agreed.

KD said it was important to support engagement with practices but there may be other events that don’t need to take place. She suggested in future engagement could also be done through work given to practices through a LES. PaW said incentives need to be looked at in more detail and an OD session needs to be arranged to have more in-depth discussions.

This motion was NOTED and AGREED. Action: OD event to be arranged to discuss this further. JG to speak to Karen Gallagher about it.

Team Coaching CM had shared a paper containing a summary of discussions of functionality of CCE meeting. Some of these things can be seen through the structure of the meeting today. In SMT work has started looking at work loads which will be shared with clinicians for discussion with management lead. CM said proposal is for CCE to change to take place on 1st Wednesday of the month and so CSGwill be moved. Proposal was voted on and AGREED. Action: KC to move meetings to start at 1.30pm on the first Wednesday of the month CM asked all to consider feedback form the OD session and reflect on those areas where individual action was required. RM emphasised that it was very important that sub-committees really get into the meat of their roles and new process needs to be followed.

AH asked if documents need to be developed i.e an SLA for CSS staff to show what behaviours are acceptable when working for CCG. Discussion took place about how important this was. NH suggested that this became part of the induction process.

EC/12/150

Reablement JL said there is £2 million to spend on reablement in 2012/13. SB looking for approval for 2 schemes to the value of £470k, further work being done and will be brought back as developed.

Reablement group has representative from GHCCG. Two business cases were brought and discussed. The hospital avoidance scheme, which helps people to stay at home, being discharged earlier. This is currently running and has good feedback.

The care home response service is a scheme working with people with pendants, helping to avoid inappropriate admissions. SB Page 8 of 12

confirmed that both schemes are currently in place and continue to be evaluated. SO felt that both demonstrated encouraging figures, but figures show reduction in Ambulance activity so should YAS be funding some of the service. RC confirmed that YAS are only paid for activity so if using them less we’ll be paying them less.

Avoidance scheme has team based in A&E helping to assist patients where A&E admission isn’t appropriate, taking them home working with social care where appropriate.

PaW feels this will have effect on SR programme and needs to be developed further. RC confirmed that agreement is in place with CHFT that re-admissions within 30 days aren’t paid for.

The 2 schemes were originally put through as a business case but due to changes now need to be re-submitted.

With reference to the nursing homes LES, JF has received several letters about service and is writing responses to these. Also written to all care homes, staff, patients and relatives to review service.

SB said if goes through all sign off committees will come to CCE again for formal sign off in August.

Action: To be added to 8th August agenda for CCE.

EC/12/151

Strategic Review PaW said that the Strategic Refresh meeting on Wednesday 4th July is crucial. Final completion date for the design framework is 1 st week of August before care streams go live. The design framework needs to be shared and working draft will be shown on the 4 th July and comments on these need to be collated and managed internally.

Action: CM to agree internal process for feeding back.

PeW said from quality view there are a few gaps that need to be plugged. She feels further work needs to be done on this.

Jo Gibson (Programme Manager) has given assurance that quality and finance will be part of the process.

PaW told the group that unfortunately there was a slippage of 9 weeks. If consultation is necessary then the timing for this is April 2013. Slippage is due to failure to constitute programme office and shortage of time for all involved. A further delay as been as Mike Potts stood down as programme chair and Matt Walsh has taken over.

Action: Page 112 of document needs to reflect this.

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Again PaW emphasised that the 4th July event was very important.

All 7 other GP board members have had their names put forward to be involved. They will need time to be involved in this instead of undertaking other work. Prioritisation of work needs to be done before this starts.

EC/12/152

Staff Survey Rob Willis joined the meeting to discuss the results of the October staff survey. Rob explained he was attending as a member of the investors in people group of which he is now chair. He shared the results of the pulse questionnaire and staff survey with the meeting and explained how this could be taken forward by GHCCG. The role of the investors in people group currently is to support staff through transition and other events.

RW asked CCE to be aware of how CCG would like to support staff going forward. CM said there are positives from survey and some areas were expected to be high such as staff looking to leave due to PCT being abolished.

Action plan being managed by IIP group at the moment. CM said once staff aware where they are going a view needs to be taken about how CCG would like to take this forward. RM asked how HR thinking can be fed into this group.

Action: GHCCG will bear feedback in mind and once statutory body is in place make a decision about whether they wish to apply for investors in people.

EC/12/153

Equality and Diversity Report PeW gave overview. This is the first time this has been brought to CCE. She asked if CCE were comfortable with the objectives as these need to be taken forward. Light touch exercise done in March with public, but difficult to get an understanding of commissioning services as patients didn’t understand commissioning very well.

Report shows areas in Red, lots in Amber and a few greens. This is consistent nationally. PeW asked for agreement to run OD session on this and for a nominated GP lead to work on this.

Action: Decision to be made on the lead for this and will be fed back.

JG raised the point that there are a large number of objectives to be completed this year. The CCE reviewed the objectives and agreed them.

PeW confirmed that the equality documents have been raised and discussed at F&P when making decisions and will continue to be taken to F&P in this way.

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EC/12/154

Treatment Room LES At this point Eric Power joined the meeting. Eric said the current LES ends at the end of June and was only agreed for 6 months. A report was distributed with current activity figures on. However, to fully evaluate the service will now take considerable time. Proposal is to extend this for another 6 months and evaluate fully. Eric suggested KD could be the lead for this through her work with Medicine Management team. RC said the LES had been developed in response to concerns from practices and the point was also made that secondary care aren’t able to provide this service. There also continues to be a lot of discontent about District Nurse services. RC supports a 6 month extension of the LES but feels that long term this should be part of practice role with no additional payment. KD said this forms larger discussion about what is core practice business. CM suggested worth continuing in order to have robust information to share with practices and to make a decision based on this.

CM proposal was discussed and agreed.

Action: LES to continue for a further 6 months.

EC/12/155

Receipt of Minutes All minutes for previous meetings received and agreed. No comments made.

EC/12/156

Specialist commissioning group minutes – this is the first time these minutes have been received by the group. The issues of specialist commissioning had been considered in a recent interface meeting with CHFT it was agreed there was a need to ensure local understanding of any SCG decisions and where influence needed to be exterted from our health economy.

Any Other Business Cluster Board – CM said Shadow Accountable Officer report has been sent to board.

Communications Team – Members to know chair was ratified Action: Sarah Lindley to share this with practices.

Stroke Patients – JF had received a call from Dr Verma about options for the future configuration of stroke and vascular rehabilitation services. It was agreed that there would be merit in considering this further and we need to understand what process should be in place to support this, including links to the strategic review. Action: CM to ask for details of this process to be shared at the next meeting.

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Constitution and MOU – JG confirmed that these had been taken to the LMC, the biggest query was that the LMC felt they should have observer status of governing body in the constitution. The governing body will be public eventually and so all interested parties could attend the meetings. The CCE felt that the LMC would be able to observe meetings in the is way, and that this would be fairer than giving formal observer status to one group and not others.

Apologies for 8th August CCE – Apologies were given by JF.

EC/12/157

Date and time of the next meeting The date of the next scheduled meeting is Wednesday 8th August 2012, 2.00 – 5.00pm.

This concluded the content of the CCE meeting and the Chair declared the meeting closed at approximately 5.20pm.

Chair’s Signature:

Date: .27/6/12

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