MILTON KEYNES & NORTHAMPTONSHIRE PRIMARY CARE TRUSTS CLUSTER BOARD PUBLIC MEETING

Transcription

1 MILTON KEYNES & NORTHAMPTONSHIRE PRIMARY CARE TRUSTS CLUSTER BOARD PUBLIC MEETING Minutes of the Cluster Board Meeting held on Tuesday, 29 th November 2011, 08:30 at Francis Crick House, Moulton Park These are the minutes of Milton Keynes and Northamptonshire Cluster Board and the constituent PCT Boards Present: Will Pope, (WP) Chairman Paul Bevan, (PB) Non Executive Director Felicity Cox, (FC) Commissioning Development Director John Eaton, (JE) Non Executive Director Alan Hastings, (AH) LINk MK Susan Hills, (SHi) Non Executive Director Stephen Horsley, (SH) NHSN Director of Public Health Peter Kara, (PK) Non Executive Director Jan Norman, (JN) Director of Nursing John Parkes, (JP) Chief Executive Darin Seiger, Chairman, Nene Commissioning Des Savage, (DS) LINk Northampton (from item C68/11) Gill Scoular, (GS) Director of Finance Sarah Whiteman, (SW) Medical Director Peter Wilczynski, Chairman, Corby Healthcare Commissioning Group In Attendance Jeannie Ablett, (JA) Chief Operating Officer PremierMK Jackie Archer, Minute Taker Graham Ball, (GVB) Managing Director, Commissioning Suppory Hub Luke James, (LJ) on behalf of PremierMK for Nicola Smith and Darren Moore Helen Jennings, Observer C60/11 Apologies for Absence WP welcomed everybody to the 3rd NHS Northamptonshire & NHS Milton Keynes Cluster Board meeting which is also the meeting of the statutory Boards of both PCTs. Apologies were received from Malcolm Brighton MB), Marvelle Brown (MBro), Philip Dearing (PD), Nicholas Hicks (NH), and Nicola Smith (NS). C61/11 Matters Arising not covered elsewhere on the Agenda Ref 11/11 SW is working with Jim Connolly to look at Quality Reporting. C62/11 Minutes of Previous Meeting The minutes of the previous meeting were approved as an accurate record of the meeting. C63/11 Declaration of Interests There were no declarations of interest. C64/11 Chairman s Report WP gave a brief update on meetings and events which had taken place since the last Board Meeting January 2012 Page 1 of 8

2 WP thanked all those that took part in the successful ASR U-Collaborate event on 4 th October. On 5 th October a meeting took place for Chairs & CEOs to meet with Neil McKay and Sarah Boulton, the recently appointed CEO and Chair of Midlands and East Cluster. The Cluster SHA Mission: Capacity Building, Support for the Transition and Delivering for Today is closely aligned with that of the Cluster PCT. An update on ASR was provided for the Non Executive Team at the Cluster-wide NEDs Meeting which took place on 14 th November. WP attended a PCT Cluster Chairs Meeting on 28 th November where he received a briefing on the nationally specified 111 Service which will become mandatory across England by April The launch of this service will require workshops involving the entire health economy, WP charged the Executive Team with taking this forward. WP to circulate 111 presentation to Board members JN to organise workshops to promote 111 launch across the entire health economy. C65/11 Chief Executive s Update JP reported on the MK Community Foundation meeting which he and Will had attended on 28 th November, and thanked Peter Kara for the invitation. JP extended his congratulations to the Northamptonshire Comms Team who have won an IVCA Clarion Award for the best social marketing campaign Another Night Wasted. Comms will be moving to a nationally run shared service. JP mentioned the public sector industrial action proposed for 30 th November and asked that the Executive Team gather system management information from all providers detailing how the action is impacting on them. The Operating Framework was published on 24 th November; this is to be covered in a later agenda item. JN reported on the recent opening of The Princess Royal Trust Northamptonshire Carers Centre by Princess Anne. JN congratulated all those involved. C66/11 Process for Delegation of Commissioning Responsibilities to Corby Commissioning Group FC presented this paper which detailed the process for delegation of commissioning responsibilities to Corby Healthcare Clinical Commissioning Group. The budget of 40 million is to be delegated from 1 st January There was one amendment to the paper on page 5, paragraph 3 the CCG will be required to submit monthly reports to the Finance Director and bimonthly reports to the Cluster Board s Finance, Resources and Performance sub-committee. The SHA have undertaken their 1 st risk assessment (a configuration assessment) which received an Amber rating. This is the most common rating. In addition, the CCG has completed the diagnostic tool kit, produced a constitution and has signed agreements from member practices. They are now seeking the assignment of a Non Executive from the Cluster Board. With regard to performance reporting, the CCG will share the Cluster KPIs for their areas of responsibility but will also be developing their own internal KPIs in preparation for the next assessment, due in March. SH expressed concern that responsibilities of the CCG, Hub and Cluster are not clearly defined within the paper, which, it was agreed, will be reviewed at the Board workshop being held in the new year January 2012 Page 2 of 8

3 This workshop will also include a presentation by GVB in regards to the NHS Milton Keynes and NHS Northamptonshire Hub. PK queried whether the demand management figure of 0.5 million in 3 months was achievable. PW confirmed that they had already achieved savings of 700,000 and were currently underspending against their budget. Clarification was sought on the reference to Project Orchid this is a reporting tool currently in development which will produce reports at locality and practice level. The tool is being demonstrated to CCGs later today. JN to organise a Board Workshop (subject: CCGs Responsibilities) in the new year. The Board approved the delegation of budgets and recommended approval to the SHA. The only issue outstanding is to identify a CFO, the Board delegated responsibility to the Finance Director and CEO to action this. C67/11 SEM Acute Services Review JP presented the paper which is being presented to the Boards of the two Cluster PCTs, five hospitals and five CCGs involved in the project. The paper outlined the progress made in Phase One and the proposed governance arrangements, process and timescale for Phase Two. In addition it quantified the cost of ASR over a two year period and presented the case for change at the end of Phase One. JP commented that with a growing and ageing population, we need to determine how to best use ASR to promote quality, patient safety and improving patient outcomes. This led to a discussion about the recent press coverage of the Dr Foster report detailing the higher than expected mortality rates at Northampton General Hospital. It was agreed that urgent work was required with NGH to understand why their outcomes are, apparently, below standard; and with Dr Foster with regard to the methodology used in the report. See items C73/11 and C71/11 for further discussion on this subject, and C71/11 for the agreed actions. Returning to the ASR paper, there was discussion around the need to find the right engagement strategy for comms and the need to create a clear, concise story for the general public. As CCGs develop, more chronic disease areas will need to be dealt with locally and more specialised conditions will require patients to travel further afield. AH commented that it might be useful to tell the public how much travelling patients already do, and for patient representatives to be used alongside clinicians to promote the story. Mention could also be made of the improvements in home technology for disease management. It is proposed that in 15 months, the Health and Wellbeing Boards will be responsible for leading the health economy. Consideration needs to be given to their focus and interest in ASR and the strategic planning role they will play. The review may need to be widened to include community care. It was agreed that a clearer set of goals is required; these are to be set out in a series of separate papers in the future. A target date of May 2012 has been agreed for public consultation. Post consultation, a number of programmes will be rolled out, leading to completion in January 2012 Page 3 of 8

4 It was agreed that a short Board workshop should be organised prior to the public consultation. With regard to resources, the Board required assurance that resources will be sufficient to get the continuity of clinicians in the right place to support the programme ie. is the cost correct in terms of clinical time and engagement with partners. JN to organise Board workshop prior to ASR public consultation. The Board noted the paper and appendixes The Board endorsed the approach with the above suggestions for focus and refinement. The Board confirmed their continuing commitment to the Review programme. C68/11 Governance Suite of Documents JN presented the paper which details the interdependence of the three organisations Cluster/Hub/CCGs during this period of transition. The governance and structure is likely to evolve over time and therefore there may be a need to bring a revised paper to the Board at some point in the future. The figure on page 3 reflects the increasing level or responsibility moving to the CCGs and reducing level at the Cluster. The documents provide assurance that the Board can hold the CCGs and Hub to account. Appendix 1 captures key linkages and interrelationships. This suite of documents needs to be endorsed by the Board before the CCGs are constituted. It was agreed that Figure 2, page 5 should be updated to reflect that Solutions for Public Health and Specialist Commissioning Groups are sub-committees of the Board. JP/WP will produce a refreshed document of sub-committee members. It was agreed that both WP and JP should be entitled to attend any of the sub-committees on an ad hoc basis. The definition of the Audit Committee needs to be amended. The delegated limits were discussed and it was confirmed that these were originally derived from a national set of figures. The following was agreed: The SFIs would be reviewed by the Audit Committee on 9 th December and also by the internal auditors. The wording in section 2.2 (Committee Structure document) with regard to assurance needs to be strengthened. Reference to the Hub and their responsibilities needs to be made explicit. A paper will be presented to the Board in January detailing the material changes to the documents, not the entire documents. The revised membership of committees will be circulated to the Board electronically A series of training events should be organised for staff to remind them of the SFIs. FC/JN to discuss governance mechanism for ASR Actions: Audit Committee to review SFIs JN to amend Cluster documents as detailed above JN to present a paper to the Board in January 2012, detailing only the material changes JN to organise staff training events for SFIs The Board accepted the assurance framework and business reporting cycle January 2012 Page 4 of 8

5 The Board accepted the revised Standing Financial Instructions, Standing Orders and Scheme of Delegation subject to review and refinement of the SFIs by the Audit Committee, and reporting back to the Board in January C69/11 TCT Divestment of MKCHS and Changing Minds Partnership Correction to paper: Northampton Hospitals NHS Foundation Trust should read Northampton Healthcare Foundation Trust. JN presented the paper which reported on the successful transfer of MKCHS to Bedford Hospitals NHS Trust on 3rd November 2011, and the divestment of Changing Minds Partnership to Northampton Healthcare Foundation Trust on 31 st October The Board noted the content of the paper. C70/11 Charitable Funds The Board was asked to review and comment on the proposed direction of travel. Due to the divestment of both NHSN and NHSMK Community Health Services, arrangements for the transfer of their charitable funds need to be made. The transactions will require Department of Health approval. Currently the next available date for this approval is 1 st July 2012, however if there is a substantial number of these requests from other organisations there may be an exceptional consideration by the DH earlier than the July date. For Milton Keynes, a suitable trustee needs to be identified before the transfer documentation can be drawn up. It was agreed that the investment strategy would be reviewed. For Northampton, Cransley Hospice should become an independent charity and manage their own funds while the remainder of the funds will be transferred to Northampton General Hospital as the first step towards a county-wide charity. Ideally this needs to be completed in March The Board agreed the direction of travel outlined in the paper. C71/11 Board Assurance Framework JN presented the BAF report, now in an amended format with RAG rated risks. The principal risks have been aligned to the new strategic objectives and updated accordingly. There is only one risk with a residual score above 15 - clinical care/mortality at NGH. This is a very current issue, particularly in light of the recent Dr Foster report, and it was agreed that forensic analysis would be conducted as a matter of urgency. Further discussion can also be found under items C67/11 and C73/11. It was agreed that ASR would be added as a key risk. Actions: JN/FC to conduct forensic analysis of mortality rates at NGH, and to include outcomes in report to next Board ASR to be added as a key risk to the BAF The Board accepted the revised Board Assurance Framework C72/11 Finance Report GS presented the Finance Report for NHSN and NHSMK. The reports are now presented in a standardised format. Future papers will also include CCG reporting. Milton Keynes is on plan using contingency funds, but is not without risks. Further work is required on demand management. Figures are currently being offset by a significant under January 2012 Page 5 of 8

6 spend in primary care. The mitigation plan is being closely monitored. LJ reported that planned care carries the biggest risk and is challenged with capacity issues. Unplanned care is helped by the block contract with the FT, but they are unlikely to agree a similar contract going forward. The year end forecast is to achieve balance, MKHFT are working with us due to their Monitor restrictions which gives assurance of their co-operation. Northamptonshire is on plan using some contingency funds. The PBR contracts are being partially offset by an under spend in primary care. The recovery plan is in place for the final six months of the year. Demand needs to be managed and reduced. Whilst a reduction in referrals can be demonstrated, activity is increasing. The Board noted the financial position of NHSMK and NHSN at month 7, which reflects the challenging environment in which we find ourselves. The Board required and empowered the Executive Team to do whatever is required to deliver financial balance. C73/11 Performance & Quality Report FC presented the report, now in a new dashboard format. Future reports will be increased to include mental health and community services for Northamptonshire. There was discussion about the HSMR data (page 8) and why we are using data which shows an amber position for NGH, when according to the recent Dr Foster report, the position should be red. It was agreed that the data requires an interpretation, not just the colour. Future reports will move entirely to SHMI data (Summary Hospital Level Mortality Indicators) Further discussion on this subject can be found under items C67/11 and C71/11. JN confirmed that a comprehensive action plan is in place at KGH to address the issues with pressure ulcers, and reported that the CQC made a comprehensive visit in August which went very well. Future reports will move entirely to SHMI data (Summary Hospital Level Mortality Indicators) FC confirmed that work is underway to address the Ambulance Service performance (p22). Infection control data could only be provided for Northamptonshire, as Milton Keyne s (MK) reporting is still via South Central HPA. It was confirmed however that MK is on trajectory for MRSA bacteraemia and CDiff, although the CDiff target is tight. All data for all organisations will be available for the next Board meeting. FC will ensure future dashboard reports will include mental health and community services for Northamptonshire, and work currently underway will address the Ambulance Service Performance. The Board noted the contents of the report. C74/11 Directorate Reports (by exception) There were no exceptions to report. The executive directors confirmed that they were unaware of any other health, safety, environment, quality or risk issues of which the board needs to be aware. C75/11 Bribery Act Mark Trevallion, Counter Fraud Manager at RSM Tenon gave a presentation on the Bribery Act, highlighting the key differences in the new act January 2012 Page 6 of 8

7 Senior Compliance Officers need to be assigned for both NHSMK and NHSN. It was agreed that risks from the Bribery Act should be included as an additional item in the Board Assurance Framework. It was agreed that the Boards of Nene, Corby and Milton Keynes CCGs should receive the same presentation. FC to pass RSM Tenon contact details to CCGs, to arrange presentation to CCGs C76/11 Operating Framework JP drew the Board s attention to two recent publications, The Commonwealth Fund Annual Report and the OECD Health Indicator Comparator Report, copies of which will be placed in the library. Both publications compare the UK health services to other countries. JP provided a summary of the key points in the Operating Framework and key tasks over the next 12 months. Three areas in particular being addressed are: dementia and care of older people, military and veterans health, and mental health services. The integration agenda will be led by the Health and Wellbeing Boards, which will require adequate resourcing in order to achieve what has been set out for them. With regard to finance, the tariff price adjuster will be a reduction of at least 1.5%, new best practice tariffs are to be introduced; CQUIN premiums will move from 1.5% to 2.5%, and providers will face a 4% efficiency challenge. These developments in the system are aimed at increasing the links with quality of care, driving integration of services and incentivising delivery of the QIPP challenge. C77/11 Quality Update Following the quality priorities agreed at the recent Board Event, JN is continuing to work on a Quality paper which will be presented to the Board in January. This paper will also include the outcomes of the Mid Staffs Enquiry and the impact of the recently published Operating Framework. JN to submit a Quality paper to the Board in January, which will include the outcomes of the Mid Staffs Enquiry and the impact of the recently published Operating Framework. C78/11 Cluster Audit Committee Minutes 26 th August 2011 C79/11 PremierMK Board Minutes 27 th September 2011 C80/11 GPHealthcareMK Board Minutes 15 th September & 6 th October 2011 C81/11 Corby Healthcare Commissioning Group Board Minutes 19 th July 2011 Items C78/11 to C81/11 inclusive were noted C82/11 Nene Commissioning Board Minutes 18 th October 2011 It was noted (p3) that Philip Dearing has been appointed as a Non Executive Director for Nene Commissioning. Since PD will be resigning from the Cluster Board on 31 st December 2011, it will be necessary to assign another Cluster NED to Nene Commissioning in line with the scheme of delegation January 2012 Page 7 of 8

8 C83/11 Any other Business WP reminded Board members that both Malcolm Brighton and Philip Dearing would be retiring from the Board on 31 st December WP thanked them for their long service to the Board and wished them well for the future. JE requested that the January Board receives a paper on the Workforce Review, including an understanding of what has happened to both the organisation and to people during the restructure. Raffelina Huber (RH) will be asked to prepare a Workforce Review paper for submission to the Cluster Board meeting in January RH to prepare Workforce paper for January Board Meeting. C84/11 Date of Next Meeting Tuesday, 31 st January 2012 at 08:30 in the Boardroom, Sherwood Place, Bletchley Endorsed as an accurate record of the Cluster Board meeting held on 29 th November William Pope Chairman Date January 2012 Page 8 of 8