Sheffield Clinical Commissioning Group

Transcription

1 Sheffield Clinical Commissioning Group NHS Sheffield Clinical Commissioning Group Committee 4 October 2012 Minutes of the meeting held in public in the Boardroom at 722 Prince of Wales Road, Darnall, Sheffield, S9 4EU Present: Dr Tim Moorhead, GP Locality Representative, West (Chair (Designate)) Dr Amir Afzal, GP Locality Representative, Central Ian Atkinson, Chief Officer (Designate) Dr Margaret Ainger, GP Elected City-wide Representative Kevin Clifford, Chief Nurse (Designate) Dr Anil Gill, GP Elected City-wide Representative Mohammed Ismail, Lay Advisor Malcolm Lindley, Lay Advisor Dr Andrew McGinty, GP Locality Representative, Hallam and South Dr Zak McMurray, Joint Clinical Director Julia Newton, Chief Finance Officer (Designate) Dr Richard Oliver, Joint Clinical Director Dr Ilyes Tabani, GP Locality Representative, North (for part of the meeting) Dr Ted Turner, GP Elected City-wide Representative In Attendance: Katrina Cleary, Locality Manager, Hallam and South Rachel Dillon, Locality Manager, West Tim Furness, Chief of Business Planning and Partnerships (Designate) Idris Griffiths, Chief Operating Officer (Designate) Carol Henderson, Personal Assistant Sophie Jones, Communications Officer Simon Kirby, Locality Manager, North Mike Smith, Chair, Sheffield Local Involvement Network (LINk) Linda Tully, Company Secretary / CCG Authorisation Project Director Richard Webb, Executive Director Communities, Sheffield City Council (for part of the meeting) Dr Jeremy Wight, Director of Public Health Members of the public: Seven members of the public were in attendance. A list of members of the public who have attended CCG Committee meetings is held by the Company Secretary 232/12 Welcome ACTION The Chair (Designate) welcomed members of the NHS Sheffield Clinical Commissioning Group (CCG) Committee, those in attendance and observing, and members of the public to the meeting. The Chair (Designate) also welcomed Mr John Boyington, CBE, NHS Sheffield CCG Lay Member (Designate), and Ms Amanda Forrest NHS Sheffield CCG Lay Member (Designate), to the meeting. 1

2 233/12 Apologies for Absence Apologies for absence had been received from Dr Marion Sloan, GP Elected City-wide Representative, and Professor Malcolm Whitfield, Lay Advisor Apologies for absence from those who were normally in attendance had been received from Dr Mark Durling, Chairman, Sheffield Local Medical Committee 234/12 Declarations of Interest There were no declarations of interest. 235/12 Minutes of the CCG Committee meeting held in public on 6 September 2012 The minutes of the Committee held in public on 6 September 2012 were agreed as a true and correct record and were signed by the Chair. 236/12 Matters arising from the minutes of the meeting held in public on 6 September 2012 a) Organisational Development (OD) Strategy (minute 220/12 refers) The Chief Operating Officer (Designate) advised the Committee that the OD strategy continued to be developed and he would incorporate all comments received. He was not intending to present a further revision to the Committee. b) Audit and Integrated Governance Group (AIGG): The Talbot Trusts - Appointment of Nominated Trustees (minute 221/12 refers) The Director of Public Health advised the Committee that he would be working with the Chair of Sheffield Local Medical Committee (LMC) and the Clerk to the Talbot Trusts to raise awareness of the Trust amongst GPs. JW 237/12 Chair s Report The Chair (Designate) presented his report and offered to expand on any issues if members so wished. In addition to his report, he highlighted three further key appointments that had been made to the CCG's senior team, Tim Furness, Chief of Business Planning and Partnerships, Kevin Clifford, Chief Nurse, and Dr Richard Davidson, Secondary Care Doctor, which meant that all posts the CCG was obliged to fill by statute had been filled. He confirmed that the recruitment process had been as vigorous as it could have been, national guidance had been followed, and there had been strong 2

3 external and clinical input and assurance. He thanked GP and other colleagues for their contribution to the process. The Chair (Designate)also advised the Committee that he had been appointed as a member of the Leadership Academy Programme Board, and would be attending quarterly meetings. The Committee received and noted the report. 238/12 Chief Officer s Report The Chief Officer (Designate), informed the Committee of the following matters: As reported under minute 237/12, all statutory appointments to the CCG's Governing Body had been made. There was a national process in-train for recruitment to the Commissioning Support Unit (CSU) and Local Area Team (LAT). Discussions about the process for staff assignment to the CCG, Commissioning Support Unit (CSU) and National Commissioning Board (NCB) would take place with Staff Side the following day and with all staff over the next couple of weeks. He would provide a further update at the November meeting. Sheffield was leading on the work of the new Core Cities CCG Network, whose aim it was to improve the health outcomes of populations that live in complex city environments. An inaugural meeting of the network would take place on 31 October. A business proposal for the joint Yorkshire and Humber Academic Health Science Network (AHSN) had been completed by the end of September for submission to the Department of Health (DH). NHS Sheffield's IT service had been shortlisted for an E-Health award for the most innovative IT supported risk stratification using SystemOne. CCG and CET GPs participated in an NHS morning that had taken place at the Radio Sheffield offices on Thursday 27 September. It was received very positively. IA The Committee noted the report. 239/12 Progress in the Application Phase for Authorisation The Company Secretary / Authorisation Project Director updated the Committee as follows: The paper set out the next important phase for authorisation, including a preparatory session for the CCG site visit held earlier in the day, preparation work for Key Lines of Enquiries (KLOEs), and the CCG site visit on 18 October. She advised the Committee that only two working days had been allowed for response to the KLOE report that had been received earlier in the day. She advised the Committee that the report looked favourable and we had received less 'Red' indicators than the national average. The Committee received and noted the report. 3

4 240/12 Establishing a South Yorkshire and Bassetlaw (SY&B) CCG Commissioning Network (CCGCom) The Chief of Business Planning and Partnerships (Designate) presented this report. The report would be presented to the other SY&B CCG Governing Bodies, would be discussed further with the Chief Officers and the Local Area Team. It was proposed to present a final Memorandum of Understanding (MoU) and Terms of Reference (ToR) to the Committee in due course. The Chief Officer (Designate) commented that there was enthusiasm in the SY&B CCGs to bring clinicians together across the patch. CCGCom would need to draw on the expertise of clinical colleagues and continue to rely on the expertise, support and advice from its providers. Endorsed the establishment of a collaborative commissioning arrangement, to be known as CCGCom, Memorandum of Understanding, and Terms of Reference. Authorised the Chief Officer (Designate) to discuss the Local Area Team's potential involvement in CCGCom with the Local Area Director. 241/12 Finance Report The Chief Finance Officer (Designate) presented this paper which provided the Committee with information on the financial position to the end of August 2012 and an assessment of the possible outturn position against plan. She advised the Committee that there had been a slight reduction in the overall risk compared to Month 4 and she was reporting a position which was overall in line with plan, but with a range of risks and challenges that would need to be closely monitored and managed. She advised the Committee that nationally agreed changes to the pharmacy contract and prescribing prices would reduce expenditure by the PCT but that the impact had not been factored into the forecast yet whilst further work on the likely locally impact was completed but that it would provide additional flexibility into the financial position to manage winter pressures and the potential impact of the continuing healthcare (CHC) retrospective appeals. She advised the Committee that in line with other PCTs across the country there had been a significant number of appeals relating to CHC in the past few weeks from members of the public who believed they may have been eligible for periods of care that occurred between 1 April 2004 and 31 March 2011, following national publicity on the deadline to appeal. It was still too early to quantify how much of an impact this may have on the financial position. 4

5 She advised the Committee that there had been a slight decrease in over performance at Sheffield Teaching Hospitals NHS Foundation Trust (STHFT) and hence she had been able to hold the forecast with them to an over performance of 7 million. Noted the position at Month 5. Endorsed the ongoing actions to secure delivery of the financial plan. Approved the budget changes made at Month 5 detailed in Appendix D. 242/12 Delivery and Quality Report The Chief Operating Officer (Designate) presented the key performance issues as at Month 5. He drew the Committee's attention to the following key highlights. a) QIPP: There had been excellent delivery in some of the QIPP programmes and overall there had been an improvement this year, although there was still under delivery of 327k. b) A&E: There had been a significant improvement at STHFT in September and the Quarter 2 target had been achieved. c) 18 weeks: We were seeing a reduction in the longest wait of patients. Waiting times for children's oral health services remained challenging, which was related to staffing issues, although performance had improved since August. d) Quality The Chief Nurse (Designate) drew the Committee's attention to the following: (i) MRSA Bacteraemia There had been no further MRSA cases at STHFT. (ii) Clostridium Difficile (C.Diff) STHFT was still under the target that had been set and SCHFT had had one case in September. Meetings would take place with both trusts. (ii) Eliminating Mixed Sex Accommodation Breaches There had been no reports of breaches in any of the Sheffield Trusts to date this year. e) Other Issues Updated information on life expectancy for males and females in IG 5

6 Sheffield would be included in the November report. With regard to reporting of public health performance data, the Director of Public Health commented that it would be helpful to report the same information as was reported to the Sheffield City Council's (SCC) Cabinet and Executive Team. The Chief Operating Officer (Designate) advised the Committee that he would be developing reports on commissioning outcomes to report to the CCG's Governing Body. IG The Chief of Business Planning and Partnerships (Designate) advised the Committee that with regard to mental health referrals, Sheffield Health and Social Care NHS Foundation Trust (SHSCFT) did not recognise the number of referrals as an accurate reflection of their services, but had indicated that it reflected changes in their accounting practices. Noted the progress relating to delivery the 2012/13 QIPP. Noted the key performance issues for Month 5. Noted the contracting performance as at Month 5. Noted the key issues relating to Quality. 243/ /13 Business Plan Quarter 1 Update The Chief of Business Planning and Partnerships (Designate) presented an update on progress and risks to delivery of business plan objectives. He drew the Committee's attention to the key highlights. 76.9% of the 117 objectives were on track for completion or had been completed, and 23.1% were at risk or could not be delivered. The paper proposed prioritisation of objectives with a view to focusing managerial resource on the high priorities. Work would be undertaken to ensure resources were aligned to those priorities. Locality objectives would be reviewed, with a view to freeing up managerial and clinical time in localities for face to face work with practices. This was welcomed by the Committee. He advised the Committee that a progress report would be presented each quarter, but objectives would not be re-prioritised. Noted progress and risks to delivery of the business plan. Approved the prioritisation of business plan objectives. Tasked the Commissioning Executive Team (CET) with targeting resource on the resource identified. 244/12 NHS Sheffield CCG's Contribution to Reducing Health Inequalities in Sheffield Dr Turner, GP Elected City-wide Representative, presented this report, 6

7 which had been worked up following discussion and proposals at the Committee meeting in July. The Executive Director Communities, Sheffield City Council, commented that it was a positive statement, it talked positively about equality, was very much welcomed and would be a bespoke core offer as part of the work public health would be undertaking with the CCG. The Director of Public Health commented that inequalities could not be eliminated with the Equality Act and each area needed to be given an appropriate level of emphasis. Membership of the Equalities Action Group needed to have an optimum level of public health membership, which he would discuss with the Chief of Business Planning and Partnerships (Designate). Members suggested that each clinician in the city could help to ensure quality of access. They welcomed the ambition and asked the Equalities Action Group to give them some indication on the cost of commissioning some of the initiatives. There needed to be a quick conclusion on this and the outcomes should be reflected in the performance report. Approved the draft action plan. Tasked the Equalities Action Group with developing the detailed action plan and to give some indication of cost of commissioning some of the initiatives. 245/12 Joint Health and Wellbeing Strategy The Chief of Business Planning and Partnerships (Designate) presented this report, which had been produced following discussions between GPs, Councillors and CCG members. He advised the Committee that the small public consultation on the strategy, would be followed by a larger consultation when the Health and Wellbeing Board went 'live' in April Approved the draft strategy. Noted the requirements on the CCG to take actions to achieve the aims set out in the strategy. 246/12 Impact of the Recession on Health and Wellbeing The Director of Public Health presented this report on the effects of the economic downturn in Sheffield. He advised the Committee that it had taken a while to understand the discrepancies in the increase of mental health referrals. The evidence demonstrated no increase in the need for mental health services. He stressed that statistical evidence on access to a service should not be confused with need. He advised the Committee that there was good evidence available that showed that recessions were bad for health and, in particular, for mental 7

8 health, but assessing need for mental health services was very challenging. He commented that there was no evidence that suggested that need was changing on a month by month basis, and that an annual report should be sufficient for the CCG to base its commissioning intentions on. Received and noted the report. Requested an annual report on monitoring the health effects of the economic downturn, rather than quarterly monitoring. 247/12 Right First Time Programme Update The Joint Clinical Director presented this report. He advised the Committee that the three workstreams that formed the programme were progressing well and evidence showed that this was having a positive impact on patient flow through the system, however, there were significant risks with the financial sustainability and the impact on this year's urgent care QIPP. He advised the Committee that there were initiatives going on at SCHFT that mirrored the RFT programme. Project Updates The Joint Clinical Director advised the Committee that the commitment with STHFT to develop a 'front door' urgent care part of the system would bring a rapid change in the system. The Chief Finance Officer (Designate) advised the Committee that STHFT was seeing fewer outliers, which had led to an improvement in the number of delayed discharges. She also reported that admissions were higher than hoped, although the programme only focused on the over 65 age group. The Joint Clinical Director commented that there seemed to be a variation and link in when patients were admitted and by which clinicians. Impact of the Programme: System Flow Although there was every indication that this was bringing sustainable change, ways of capturing patient experience through the system needed to be explored. Development of Phase 2 of the Programme In addition to strengthening the governance arrangements, the team was exploring how to raise awareness across partner organisations, including how to ensure that benefits and risks were shared and distributed across the system. GP Leadership input in to the programme The Committee was asked to consider GP leadership into the development of Phase 2 of the programme and noted that this would be over and above their normal CCG work. The Joint Clinical Directors ZM/RO 8

9 would take this forward. The Chair of Sheffield LINk commented that the programme was not progressing as quickly as anticipated. The Joint Clinical Director responded that this was due to financial issues in some areas. The Chair of Sheffield LINk asked about communications issues as people needed to understand the reasoning behind the programme. The Joint Clinical Director responded that the communications programme was very clearly outlined in Phase 2 of the programme. The Executive Director Communities, Sheffield City Council, left the meeting at this stage. Other Comments Members thought that the programme should be more bold, free up the resource into the community, and concentrate on what the patient needs and what will help them. The GP Locality Representative, North, left the meeting at this stage. Noted the progress update. Noted the impact of the programme year to date in terms of system flow. Noted the impact on the current urgent care QIPP and supported the actions being taken to address this. Endorsed the development of Phase 2 of the programme, in particular the governance arrangements described in section 5 of the report. Tasked the Joint Clinical Directors in taking forward GP Leadership into the programme. 248/12 Progress towards Implementation of the new NHS111 Service in South Yorkshire and Bassetlaw The Chief Officer (Designate) presented this report. He drew the Committee's attention to the key highlights which included confirmation of the contractual position for the delivery of the service that had been signed between the Yorkshire Ambulance Service NHS Trust (YAS) and NHS Calderdale on behalf of all commissioners of the contract. A meeting would take place on 16 October to discuss the YAS Emergency Contractual relationship with CCGs. He also advised the Committee that there was a huge amount of national interest in the clinical governance side of the service, which the Chief Nurse (Designate) was leading on behalf of South Yorkshire and Bassetlaw CCGs. Received and report and noted the progress to date. Noted the outline requirements of the clinical governance assessment process. 9

10 Noted the approach suggested to the lead commissioner and contract management arrangements. 249/12 Audit and Integrated Governance Group The Chair of the AIGG updated the Committee from the meeting of the AIGG held on 27 September. Items discussed had included formal receipt of the Annual Audit letter for 2011/12, and looking at the resilience of the audit services we used. Mr Lindley, who would be retiring in November, and had attended his last meeting of the AIGG, was thanked by the Committee for his contribution to the group over the past few years. Assurance Framework 2012/13 Quarter 1 update The Company Secretary / Authorisation Project Director presented this report. She advised the Committee that there were no high level 'Red' risks and no risks had needed to be escalated to the Cluster Board. She drew the Committee's attention to appendix 2 of the report which detailed the changes that had been made since the last report, which were mainly due to transition and inclusion of the GP Portfolio leads in the framework. The Committee asked if a key to the framework could be included on future reports. LT The Committee received and noted the report. 250/12 Assurance Group The Chief Nurse advised the Committee that the next meeting of the Assurance Group would take place on 15 November /12 Commissioning Executive Team The Chair of the Commissioning Executive Team advised the Committee of the following matters: Commissioning Executive Team (CET) and Planning and Delivery Group (P&DG) Update The Chief Officer (Designate) presented this report. There were no particular items to draw to the Committee's attention this month. The Committee received and noted the report. 252/12 Locality and Practice Reports West The Locality Manager, West, advised the Committee that in addition to normal Council business discussed at the West Council meeting the previous week, they had also discussed an alcohol screening tool they were developing, and QIPP and work being done with the peer review 10

11 groups, the outcomes of which would be distributed to the CCG. Central The Locality Manager, Central, advised the Committee that Central's Council discussion had focused on the emerging elective strategy in the city, North The Locality Manager, North, would present an update to the next Committee meeting. He advised the Committee that North's next Council meeting would reflect the discussions held at the Commissioning Executive Team (CET) and at the Committee meeting. SK The Chair proposed that written reports from localities were presented to future meetings, which could include notes of Locality Executive Groups (LEG) meetings, as we needed to capture and reflect on the work that was being undertaken in localities. The Committee noted the reports. 253/12 Specialised and Collaborative Commissioning Summary Report The Chief Officer (Designate) presented this report. Cardiac Services: New Oral Anticoagulants (minute 7(a) refers) The Joint Clinical Director advised the Committee that there were helpful guidelines on the Sheffield Intranet on how GPs should implement use of the drug Dabigatran. The Committee received and noted the report. 254/12 South Yorkshire Commissioning and Business Support Services (CBSS) The Chief Operating Officer (Designate) presented the minutes of the CBSS Advisory Group meeting held on 21 August There were no particular issues to draw to the Committee s attention this month. 255/12 Feedback from GPs and Lay Advisers The Joint Clinical Director advised the Committee that the last meeting of the Clinical Reference Group had discussed weight management and GP input into weight management services in the future. He reported that the CRG had a 'virtual' wider form and encouraged GPs to get involved with this. Malcolm Lindley advised the Committee that he would forward the Chief Officer (Designate) a list of the Committees, groups and meetings he had attended during his time as a Lay Advisor, in preparation for a formal handover. 11

12 256/12 Questions from the Public There were no questions from members of the public this month. 257/12 Confidential Session The Committee resolved that representatives of the press and other members of the public be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest, section (2) Public Bodies (Admission to Meetings) Act /12 Malcolm Lindley, Lay Advisor On behalf of the Committee, the Chair thanked Mr Lindley, who was attending his last meeting of the Committee, for his invaluable advice, expertise and support to the Committee and other groups and meetings he had attended in his role as Lay Advisor. The Chair (Designate) thanked Rachel Dillon, who was attending her last meeting of the Committee, for her contribution to the CCG over the past year There was no further business to discuss this month. 231/12 Date and Time of Next Meeting The next meeting would take place on Thursday 1 November 2012 at 2.00 pm in the Boardroom, 722 Prince of Wales Road. 12