Minutes. Minutes of the Meeting held 24 May Page 1 of 9

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1 Minutes of the Welsh Health Specialised Services Committee Management Group Meeting held on 24 May 2018 at Health & Care Research Wales, Castlebridge 4, Cowbridge Road East, Cardiff, CF11 9AB Members Present Sian Lewis (SL) Managing Director, WHSSC Carole Bell (for part) (CB) Director of Nursing Quality, WHSSC Stuart Davies (SD) Director of Finance, WHSSC (Chair) Julie Keegan (JK) Assistant Director of Commissioning, CTUHB Ian Langfield (IL) Acting Director of Planning, WHSSC Clare Lines (CL) Assistant Director, Commissioning Development, PTHB Robert Mahoney (RM) Assistant Director of Finance, CVUHB Phillip Meredith (PM) Finance Business Partner, ABUHB Deputies Present Lynn Briscoe (by VC) (LB) Financial Support Manager (Planning), HDUHB Maxine Evans (ME) Head of Performance and Specialised Commissioning, ABMUHB David Eve (by VC) (DE) Assistant Director of Finance - Financial Planning & Governance, HDUHB Andrew Jones (AJ) Assistant Director of Finance, CTUHB Gill Milne (by VC) (GM) Head of Contracts - Finance, BCUHB John Morgan (JM) Senior Commissioning Manager, PTHB Claire Nelson (CN) Acting Assistant Director of Planning, WHSSC Stacey Taylor (ST) Assistant Director of Finance Planning, WHSSC In Attendance Greg Chambers (GC) Locality Finance and Performance Manager, PTHB Cathie Steele (CS) Corporate Governance Manager, WHSSC Sandy Tallon (STa) Head of Information, WHSSC Matt Taylor (MT) WHSSC Apologies Valerie Attwood (VA) Associate Director Of Contracting, BCUHB John Darlington (JD) Assistant Director, Corporate Planning, BCUHB Iolo Doull (ID) Deputy Medical Director, WHSSC Sian Jenkins (SJ) Interim Assistant Finance Director, ABMUHB Charlie McKenzie (CM) Finance Business Partner, ABMUHB Karen Miles (KM) Director of Planning, Performance & Commissioning, HDUHB Rob Nolan (RN) Finance Director - Commissioning & Strategy, BCUHB Kevin Smith (KS) Committee Secretary & Head of Corporate Services, WHSSC Jenny Thomas (JT) Medical Director, WHSSC Melanie Wilkey (MW) Head of Outcomes Based Commissioning, CVUHB Minutes Page 1 of 9

2 Michaella Henderson (MH) Interim Corporate Governance Officer, WHSSC The meeting opened at 10:00 a.m. Page 2 of 9

3 MG18/019 Welcome, Introductions and Apologies SL took the chair and opened the meeting welcoming members. Apologies were noted as above. MG18/020 Declarations of Interest There were no declarations of interest. MG18/021 Accuracy of Minutes from 26 April 2018 The minutes of the meeting held on 26 April 2018 were approved as a true and accurate record. MG18/022 Action Log and Matters Arising Members reviewed the action log and noted the following. MG001 NWIS Project on English Data Action: Formal closure report to be presented at the July meeting of Management Group (SD) MG049 BMT Investment in South Wales 2016/17 It was noted that work was ongoing, particularly with regard to understanding the complexities around funding, and that performance management meetings were about to start. IL reported that by September the team would have a better assessment of how the investment had been used and that Management Group would be updated at that time. MG052 BAHA and Cochlear: 26 Week Waiting Time Standard JT had escalated the need for a delivery plan to Steve Curry, CVUHB COO. CN reported that the financial plan had been received on 23 May but that work needed to be undertaken to understand why there was a 250k over-spend compared to the ICP. MG054 Revised Commissioning Policies for Specialised Rehabilitation This action had been rolled into MG055. Action closed. MG055 Specialised Rehabilitation This action was included in the Performance Report for the meeting. Action closed. MG056 Commissioning Policies: Approval Process It was noted that an update paper was due at the July Management Group meeting. It was acknowledged that Management Group was a key stakeholder in the policy review process and that going forward members would receive a monthly update outside the meeting, on Page 3 of 9

4 which policies were out for review and where other policies were in the process. MG063 Implementation of the WHSSC Integrated Commissioning Plan (ICP) for Specialised Services SL had consulted with Andrew Champion and it was agreed that copies of the PET meeting notes would be circulated to all MG members going forward. Action closed. MG18/023 Report from the Managing Director Members received the report and noted the following key areas: Bariatric Surgery SL reported that performance had considerably improved at ABMUHB and that it had revealed that the anticipated demand was not there. The findings were reported to the all Wales Directors of Public Heath (DoPH) forum who requested a written specification of the work WHSSC had been asked to carry out to provide them with a better understanding of issues around demand, work that in turn fits in with the DoPH work on the obesity strategy. The DoPH s view was that it was likely to be a pathway issue but that understanding of the underlying detail was needed. At their last meeting the Joint Committee had identified two possible views on the issue: No extra funding in the year in the event demand increases; An obligation to try and increase demand to cover current unmet needs. Members agreed that until they had a better understanding of demand issues no immediate solution was apparent. Cystic Fibrosis In April CVUHB submitted an addendum to the original Cystic Fibrosis business case submitted in July SL reported work was ongoing to develop the proposal outlining a phased approach to the required investment and that it would be submitted to the Management Group at the June meeting. Action: Cystic Fibrosis business case update report to be received at the June Management Group Meeting (IL) Major Trauma The Major Trauma Project Board met for the last time on 26 April 2018 and the Trauma Network Board was established and met for the first time on 23 May. It was noted that the Trauma Network Board would report directly to WHSSC Joint Committee. IL reported that as a result of an action arising from the Collaborative Executive Group, WHSSC had commenced early discussions with the NHS Health Collaborative Page 4 of 9

5 and the Critical Care and Trauma Network to identify and scope the roles and responsibilities for organisations required for Phase 2. Thrombectomy SD reported that he and IL had met with NHS England colleagues in mid-april when it was noted that NHS England had published a national tariff for thrombectomy which they intended to enforce. The tariff for North Bristol had been set at 13,942. Concerns had been raised by a number of centres around the UK, challenging the tariff on the basis that their own costs would be higher. It was noted that the tariffs were based on a 48 hour stay and did not allow for the failure of thrombectomy for 60%-70% of patients, who would then revert to the usual Stroke Management Pathway with all the associated higher costs. SD and IL attended a second meeting with NHS England to discuss the repatriation of those patients whose thrombectomy failed after the first 48 hours and confirmed that, in the event repatriation did not occur for whatever reason, WHSSC would commission the relevant Stroke Pathway from NHS England for that patient. SD reported the proposal was well received and that he and IL would be following up with NHS England. It was noted that in terms of headline numbers, England had commissioned 80 thrombectomies from North Bristol for the coming year under the national plan which meant Wales would need to scale down the original estimate of commissioning 100 thrombectomies to be commensurate with population size. Members agreed that a watching brief needed to be kept on all centres offering thrombectomy and stroke services not just North Bristol to provide an understanding of the implications of changes to stroke services in England for Welsh patients. Note the content of the report. MG18/024 Informatics Demonstration STa and MT demonstrated the data management tool and database being developed by the WHSS Team to enable efficient interrogation of specialised services data, building on work already done by NWIS on accessing English provider data. It was noted that the addition of Welsh provider data would be critical to the success of the tool. It was further noted that NHSE had built a portal giving access to outcome data that the WHSS Quality Assurance Team would be utilising and encouraging ABMUHB and CVUHB to populate with their outcome data. STa reported that the next steps included ascertaining what reports end users wanted to see to ensure the system configuration can meet those needs. STa and the team would be looking at the 208 separate Page 5 of 9

6 data sets identified, commissioning team by commissioning team, starting with Neurosciences. STa confirmed that the database would be demonstrated to the Innovation Champions meeting in June, the Head of Information in July and then consideration would be given to meetings with the Commissioning Teams. It was noted that meetings would need to be held with BCU and Powys as the Team understands they have more granular geographic use requirements than the other Health Boards. MG18/025 Integrated Performance Report Members received the report, which provided a summary of the performance of services commissioned by WHSSC for March 2018 and detailed the actions being taken to address areas of non-compliance. Members noted: the de-escalation of Bariatric surgery from Level 4 to Level 3 in April the Paediatric Surgery Commissioning Quality Re-visit took place on 16 May Action: Members to review the inclusion of the Repatriation Schedule in the report and feedback to IL. Note the March performance and the actions being undertaken to address areas of non-compliance Consider the dataset for reporting on Neuro Rehabilitation DTOCs MG18/026 Finance Report Members received the report, which set out the estimated financial position for WHSSC for the financial year 2017/18. SD reported that the year-end audit process had been completed, all targets met and no concerns raised. Note the year end and M financial position. MG18/027 Provision of Congenital Heart Disease Services following NHS England s Public Consultation Members received the paper which provided an update on the current situation with regard to the changes in delivery of care for Congenital Heart Disease services following NHS England s review of services and describing the impact for Welsh patients. Members noted that the NHS England standards describe 3 levels of CHD service provision: Page 6 of 9

7 Level 1 Specialist Surgical and Interventional CHD Centres; Level 2 Specialist Medical Cardiology Centres; Level 3 Local Cardiology Services. In addition it was noted that NHS England had identified 3 key elements to the standards, as set out in the report, that when adopted would potentially impact on the configuration of services: Surgeon working requirements; Service inter-dependencies or co-location; Interventional cardiology. IL reported that a full public consultation for the future commissioning of CHD services had been launched in February 2017, the outcome of which had been published in December The South Wales and South West CHD Network had undertaken a self-assessment against the standards in 2017 and a number of gaps and risks had been identified including: Single handed ACHD consultant; Variation in service delivery in several outreach clinics due to insufficient staffing; and Timely access to psychology. Members agreed that is was important to understand the impact of the new standards on level 2 and 3 services in Wales prior to signing up to them. Note the information presented within the report; and Support the NHS England Level 1 standards for Wales; and Undertake urgent work to understand the implications for Wales of the Level 2 and Level 3 standards prior to their approval. Action: Undertake work to understand the implications for Wales of NHS England s Level 2 and Level 3 standards MG18/028 Implementation of ICP Workplan Members received and discussed a presentation from CN, a copy of which was circulated outside the meeting for information. CN reported that the Implementation Plan had been approved by Joint Committee, that 138 work-streams had been identified to date, and that Management Group was expected to look at all 138 work-streams and provide a scrutiny and advisory function. It was noted that the work-streams were identified using the following categorisations and then weighted in terms of intensity and impact: Page 7 of 9

8 Schemes approved for funding within ICP; Two high risk schemes approved for funding within ICP; Services in Quality and Performance Escalation; Previously funded schemes; Schemes on the Risk Management Framework; Key risks emerging in year; Services identified for collective commissioning; Areas highlighted for re-commissioning value Service reviews New services New policies and service specifications required Policies and service specifications that require updating It was noted that the Performance Reports in their current format would not track progress of the 138 work-streams and that a separate report would be needed to keep Management Group up to date. MG18/029 MG18/030 Any Other Business Gender SL reported that a Letter of Direction had been issued by Andrew Goodall, Welsh Government s Director General for Health and Social Services and Chief Executive of NHS Wales, to all Welsh Local Health Board CEOs pushing for the implementation of a Gender Identity Pathway and producing funding of 500k to support that work. It was noted however that Welsh Government had already negotiated with C&VUHB to deliver the specialist end of the relevant services at a cost of 480k, leaving just 20k for the primary care end of the pathway. In addition, Welsh Government had raised expectations in the GP community through direct communication by committing 370k funding for various aspects of the pathway. SL reported that the next step was a meeting between the Health Board CEOs, WHSSC and Welsh Government to decide how to proceed and how to manage the expectations of the difference stakeholders, especially the community. Immunology SD circulated headline analysis regarding pressure that emerged throughout the last year in terms of immunology, a copy of which was attached to the minutes for information. It was noted that, despite heavy investment in both consultants and drugs, there was a substantial over-spend in the last financial year, primarily attributable to the increase in secondary immunodeficiency services, not commissioned by WHSSC. It was noted that Health Boards wanted to retain a single point of contact for patients and that secondary immunodeficiency would be prioritised in the WHSSC work plan for the coming year but until that happened, rather than cause disruption to patients, it was proposed WHSSC make the necessary arrangements and create a mechanism by which to recharge the individual Health Boards. In addition a separate Page 8 of 9

9 contract line would be created to reflect patient distribution across the Health Boards. A new risk sharing line would also be created to enable WHSSC to share actual costs to Health Boards based on real terms utilisation and to provide transparent information on equity of access. A more permanent solution would be communicated to the Health Boards as soon as possible but in the meantime Members were asked to approve the interim proposal put forward by Finance Working Group. Note the holding position for WHSSC to continue to process secondary immunodeficiency case approvals. MG18/031 MG18/032 Perinatal Mental Health CB thanked those who attended the first workshop and reported that a second workshop would take place after the July Management Group meeting. Date and Time of Next Meeting It was confirmed that the next meeting would be held on 21 June 2018 at Health & Care Research Wales, Castlebridge 4, Cowbridge Road East, Cardiff, CF11 9AB The Management Group meeting concluded at approximately 12:35 and the non- WHSSC members participated in a Corporate Values Development Session. Page 9 of 9