GOVERNING BOARD. Minutes of Other Meetings. Date of Meeting 21 March 2018 Agenda Item No 12. Title. To accept the following:

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1 GOVERNING BOARD Date of Meeting 21 March 2018 Agenda Item No 12 Title Minutes of Other Meetings To accept the following: Minutes of the Clinical Strategy Committee meetings held on 3 January 2018 and 14 February Purpose of Paper Minutes of the Audit Committee meeting held on 13 December Minutes of the Health and Wellbeing Board meeting held on 29 November Minutes of the Primary Care Commissioning Committee meeting held on 15 November Recommendations/ Actions requested Accept Engagement Activities Clinical, Stakeholder and Public/Patient N/A Item previously considered at N/A Potential Conflicts of Interests for Board Members N/A Author Various Sponsoring member Dr Elizabeth Fellows, Chair of Governing Board Date of Paper 13 March 2018

2 Minutes of a Meeting of the Clinical Strategy Committee held on Wednesday 3 January 2018 at 1.00pm pm in the Committee Room, CCG Headquarters, 1 Guildhall Square, Portsmouth PO1 2GJ Summary of Actions item: Action: Action for: Due: 8, Wheelchair Service. Results of the clinical review and future procurement paper to be brought to a future CSC meeting. 10, SHIP 8 Priorities CCGs Policy statement. Alison Edington to clarify decision for the policy statement for treatment of hydrocele & strangulated hernias. Post meeting note: A response received from Chris Ashdown Head of IFRs, has been circulated to CSC members for information via . 6 Extra Contractual Referrals (ECRs) OPMH Transformation Team Business to be brought to CSC in July. 6 ECR Revised Application Process Savings figures and funding source information to be discussed outside of this meeting. 8 Primary Care CQUIN The Primary Care Team to discuss CQUIN and transformation with PPCA 10 AOB Contact F&G/SEH CCGs for Agenda for the Joint CCGs Clinical Committee in Common on 14 February 18. S Rosenberg A Edgington/ L Foster Future Meeting Action closed D Dew/R Penlington July 2018 D Dew/ R Penlington/ M Spandley T Russell/ S McInnes Jan/Feb 2018 Jan 2018 L Foster Jan 2018 Present: Simon Cooper - Deputy Director of Medicines Optimisation Michael Drake - Director of Planning & Performance Alison Edgington - Director of Delivery SE Hampshire and Fareham & Gosport CCGs Dr Elizabeth Fellows (GP) - Clinical Executive Member & Chair of CCG Governing Board Margaret Geary - Lay Member Justina Jeffs - Head of Governance Dr Jonathan Lake(GP) (Chair) Clinical Executive Member Graham Love - Lay Member Dr Nick Moore (GP) - Clinical Executive Member Dr Jonathan Price (GP) - Clinical Commissioning Lead Innes Richens - Chief of Health and Care Portsmouth Suzannah Rosenberg - Director of Quality & Commissioning Terri Russell - Deputy Director of Primary Care Michelle Spandley - Chief Finance Officer Dr Kevin Vernon (GP) - Clinical Commissioning Lead In attendance: Linda Foster - Executive Assistant (Minutes) Chris Horan - Primary Care Improvement Facilitator (for Agenda item 8) 1. Apologies and Welcome Dr Jonathan Lake welcomed everyone to the meeting. Apologies were received from: Dr Linda Collie, Dr Jason Horsley, Jane Cole, Carly Darwin, Dr Tahwinder Upile, and Jo York.

3 2. Register and Declarations of Interest A Conflict of Interest was noted for Agenda Item 8 Primary Care CQUIN for; Dr Jonathan Lake Dr Elizabeth Fellows Dr Nick Moore Dr Jonathan Price and Dr Kevin Vernon. The achievement of CQUINs attracts additional funding for practices which presented a direct conflict for those primary care clinicians present at this meeting. 3. Items for Any Other Business There were no items raised. 4. Minutes of Previous Meeting The minutes of the Clinical Commissioning Committee held on Wednesday 6 th December 2017 were approved as an accurate record subject to the following amendments: Page 4 Agenda item 7: The last sentence of the first paragraph to be amended to read: New initiatives are planned but not joined up. Page 8 Attendance Log to be amended to reflect Dr Nick Moore s apologies. The summary of actions from the Clinical Commissioning Committee held on Wednesday 6 th November 2017 were discussed and reviewed as follows: Item Action Who By Progress 6 Autism Business Case. A discussion to be held outside of the meeting in regards to the possibility of recurrent funding for the next two quarters of the contract. 8 Wheelchair Service Suzannah Rosenberg to follow up the clinical review of the service and to look at the level of risk and to review with figures (data) and costs for the waiting list backlog. The details to be brought back to the CSC at a future meeting. 9 IAPT Options Paper Michelle Spandley to try and identify some alternative funding from NHS England. 10 SHIP 8 Priorities Clinical Commissioning Group Policy statement for Treatment of Hydrocele. Alison Edgington to clarify who made the decision for the policy statement for treatment of hydrocele in strangulated hernias. 12 AOB: Joint CCGs Clinical Committee Meetings. Justina Jeffs to clarify F&G and S E Hampshire s Scheme of Delegation and link with their Governance Lead b) Matters Arising: None. 5. Planning Update R Penlington Dec 17 R. Penlington is liaising with Finance. (Action completed) S Rosenberg/ R Penlington Ongoing Once procurement is underway a paper to be brought to CSC. M Spandley Jan 2018 No funding available through NHS England. CCG to continue with the Pilot. A Edgington Jan 2018 L Foster to follow up with Alison Edgington outside of the meeting. J Jeffs Dec 2017 Action completed. The next joint meeting is on 14 February Michael Drake spoke to this item. The planning guidance is expected mid- January. The CCG 17/18 QIPP Target of 9.2m expected year end figure, which has 2

4 been fully validated is still on track. There is an anticipated overspend due to Continuing Health Care services however, this is being managed. There are risks around several projects with regards to progress and delivery timescales. These projects; activity input at Jubilee House (6 month study), High Intensity User project, and Discharge to Assess project, will be taken to the Portsmouth Planning and Performance Board in January where prioritisation will also be discussed. Michael Drake informed members a strategic approach to planning is being adopted for 2018/19 based on demand and capacity modelling in order to focus on, and address local system challenges. Meetings will be held in January to determine how best to meet the challenges across the system. Michael Drake went on to explain that a flat cash approach is being used. This approach reflects no additional funding for the 2018/19 year and therefore prioritisation and additional scrutiny of any investment will be required Michelle Spandley stated that a more coherent plan is needed in order to meet the requirements for regulators including reducing activity and confirmed that the system Finance Board which includes representatives from all local organisations, also continue to discuss and support a local approach across the system. Following a question from Margaret Geary, Michael Drake confirmed that plans between the Aligned Incentive Contract (AIC) and the Accountable Care System (ACS) are aligned and any delay in realising the impact would be addressed. The Clinical Strategy Committee recognised the risk to delivery of some projects to be reviewed at P3B. The Committee noted the 18/19 Planning requirements and the joint System working that is being undertaken. 6. Project Plans for Review Rosie Penlington and Dominic Dew spoke to a paper outlining proposed initiatives to address the increasing costs of Extra Contractual Referrals (ECRs) in particular for Older Persons Mental Health (OPMH) placements. A team hosted by Solent NHS Trust working on processes for reviewing and appropriate management of individual placements in order to improve patient outcomes and stabilise ECR costs. The ICS is also undertaking a review of Supported Living accommodation in the city. Portsmouth City Council is developing a plan which, when realised will provide new supported lining accommodation and deliver savings for health and social care. Dominic Dew provided an overview of the three new initiatives to address the ECR budget pressures: a) Budget analysis working with CCG finance team to look at the last 3 years activity to see what changes can be made b) Investment in an OPMH Transformation Team (OPMH is the largest area of spend for ECRs) A Business Case is currently work in progress; a more detailed paper will be brought to CSC in July. Work to continue on OPMH position and costs. (Action: D. Dew /R. Penlington) 3

5 c) A revised application process Rosie Penlington presented see below * Investment in an OPMH Transformation Team The proposal for the OPMH Transformation Team is to focus on a short list of placements with complex/high cost needs/1:1 reviews (approximately 20 patients). There are four options: Option 1 Do Nothing resulting in no improvement in placement costs or care effectiveness and appropriateness, and costs may continue to rise. Option 2 Implement additional staffing for a limited period 6 months. (Small team to address high cost/complex need patients) Clinical Assessments by 1WTE Band 6 OPMH Nurse and 1WTE Band 8 (midpoint Social Worker) Option 3 Option 2 plus a Care Home Practice Educator to provide training to Care Home staff to effectively manage patients and provide a directory of services provision. Option 4 Option 3 plus development of a discharge to assess pathway (proposed by Solent) Option 2 was highlighted as the recommended option as it is believed that the core staff could progress to fulfilling the Educator role and assists the more strategic aims of the project which the ICS team would coordinate. The Committee discussed the options and the historic funding arrangements which have contributed to the current situation. Margaret Geary questioned whether the new proposed application process would challenge the high costs that some providers demand. Rosie Penlington confirmed that the new application process will provide closer scrutiny and monitoring of applications. Suzannah Rosenberg said that the ECR process has suffered as a result of having to rely on providers to assess the individual s clinical care. The ECR process is currently managed by the ICS team for the financial side (not clinical), the Solent NGS team are needed to undertake the clinical/social care review. Michelle Spandley queried whether the current team could be used to conduct these reviews and proposed that the current provider be included in determining the solution. Dominic Dew responded that expertise is needed to address the specific issues of the cohort of individuals. It is difficult for the current team to review patients and continue to deal with the current workload. Alison Edgington proposed that the level of risk being carried by the CCG might aid any decision being made and expressed her support of quality of service above costs, as confirmed by Dominic Dew. *ECR Application Process Rosie Penlington explained that all stakeholders have been involved in the application process changes to improve scrutiny and challenge. There are 4 new documents: 4

6 1) Guidance 2) Resource options for Care Coordinators (tool) 3) Framework 4) New application form (a shorter follow-up form to be completed) Addition of a 1:1 checklist; to reaffirm the level of scrutiny. Savings figures and funding source to be discussed outside of this meeting. Action: R Penlington/D Dew/M Spandley The Clinical Strategy Committee: Noted the 6 month s budget analysis and to receive a report in 6 months time. Agreed to approve Option 2 to approve 91K non-recurrent funding. Approved the changes to the ECR application process 7. Medicines Management Update Simon Cooper provided a summary report of GP practice prescribing within Portsmouth CCG to October Portsmouth CCGs prescribing budget for 17/18 and 18/19 has been set at 2.5% growth on outturn. The budget has a forecast underspend of 1.2m and the Medicines Management team are confident of achieving target growth. Benchmarking across the ten comparable CCGs show variation however Portsmouth is not an outlier. The Committee discussed Pregabalin prescribing spend costs. It was noted that previous national guidance requiring branded prescribing of Pregabalin (Lyrica) was revoked in July 17 which has resulted in savings for the CCG. Simon Cooper provided a brief update the following areas of work: No Cheaper Stock Obtainable (NCSOs) Category M medicines Rebates OptimiseRx Quality and Safety (as part of this year s CQUIN, practices have undertaken quality and safety interventions in all practices for PINCER, Asthma medications, Antibiotic, Diabetes, Discharge summaries) Antibiotic Audits Care Home Medication Reviews the cost of the technicians conducting the review of Care Home medication would be covered by cost savings. Electronic Prescribing Services (EPS) and Electronic Repeat Dispensing (erd) this will be discussed at the next Prescribing evening meeting. Dr Nick Moore asked if there was any guidance for Antibiotic prescribing easily available. Simon Cooper advised that an App is in development. Details will be circulated to practices once available. Dr Elizabeth Fellows thanked Simon and the Medicines Management Team for the update and work they have been doing. The Clinical Strategy Committee noted the Medicines Management Update. 8. Primary Care CQUIN

7 A conflict of Interest was declared for all primary care clinicians present as stated under Item 2 in these minutes. Terri Russell presented the paper which detailed the recent review of the Primary Care CQUIN undertaken with key stakeholders, and sets out broad plans for the 18/19 scheme and explained the proposed changes for 18/19 which will focus on the following areas: Engagement Programme Technology Quality Improvement Efficient and effective use of resources Health promotion, Patient Education and Self Care Following a challenge regarding health promotion, it was confirmed that this was primary care focused and therefore not in conflict with Public Health responsibilities. Whilst Collaborative Working is not included as one of the areas, due to previous work it likely to be added into the basket of Locally Commissioned Service. Michelle Spandley suggested the scheme needs to be more explicit on how it relates to the ongoing Transformation Plan and that practices need to be informed of the details. Margaret Geary commented that we need to understand why and how the scheme fits with Transformation work; she asked if the Alliance could pick up some of this work. Innes Richens stated that the paper does not address sustainability and practices working together. He suggested that a conversation is needed with the Alliance and GP practices around how best to maximise the impact CQUIN funds as they are separate to the Transformation Fund. Action: Terri Russell and team Terri Russell confirmed that F&G/SEH CCGs have a similar scheme but that it is called an LCS (Locally Commissioned Scheme). Terri Russell advised that PMS funding for the Primary Care CQUIN scheme will be taken to the Primary Care Commissioning Committee for approval. Dr Jonathan Price said that the GP Engagement evenings are a good opportunity to keep practices informed of this work and to present information on the results of good measures etc. The Clinical Strategy Committee noted the CQUIN Review work for and agreed on the proposed development of the scheme for Minutes of Other Meetings for noting: The Minutes of the SHIP 8 Priorities Committee Meeting held on the 21 st September 2017 were accepted. 10. Any Other Business Identify agenda items for the February 2018 Joint CCGs Committee in Common. Action: L Foster 6

8 11. Date of the Next Meeting: The next Clinical Strategy Committee will be held on Wednesday 7 th March 2018, from 1 3 pm in the Committee Room, Portsmouth CCG Headquarters. Clinical Strategy Committee Attendance Log Member Name Dr Linda Collie (Chair) A Berry April May June July Aug Sept Oct Nov Dec Jan Chair A A Chair A Chair A L Darby Deputy L Darby Deputy L Darby Deputy L Darby Deputy A L Darby Lyn Darby A A A Jane Cole A A A A Simon Cooper A A A Carly Darwin A A A Mike Drake Dr Elizabeth Fellows A A A Chair A Margaret Geary Katie Hovenden A Dr Jim Hogan A Dr Jonathan Lake Chair A Chair Chair Graham Love Dr Nick Moore A A A Dr Jonathan Price A A Innes Richens A Terri Russell A A A A Suzannah Rosenberg Andy Silvester A A A A Michelle Spandley D Deputy Dr Tahwinder Upile A A A A A A A A Dr Kevin Vernon A Jo York A A A A Dr Jason Horsley A A A A Justina Jeffs Alison Edgington - present A apologies Feb

9 Minutes of a Meeting of the Clinical Strategy Committee held on Wednesday 14 February 2018 at 1.00pm pm in the Committee Room, CCG Headquarters, 1 Guildhall Square, Portsmouth PO1 2GJ Summary of Actions item: Action: Action for: Due: 3 SHIP 8 Priorities Committee Policy statements: No 27 Liothyronine in hyperthyroidism It was requested that the final version is obtained for the Committee to re-consider. 3 No 28 Flash Glucose Monitoring Freestyle Libre The policy was approved, however the process needs to be worked through. The CCG Communications Team will release a statement to Social Media to this effect. 3 No 29 Pelvic Organ Prolapse surgery The Committee requested that more information is obtained from the CSU including any information related to whether Uro-gynae physios can make onward referrals to surgeons. 8 Mental Health - Acute Bed Transformation A business case to include the financial model to be brought to a future Clinical Strategy Committee Meeting 9 Due Diligence for the Integrated Primary Care Service The Urgent Care Centre Plan to be brought back to the three CCGs for further consideration. Justina Jeffs Feb 2018 Justina Jeffs/ David Barker Feb 2018 Justina Jeffs Feb 2018 Suzannah Rosenberg Jo York Future meeting Future meeting Present: Dr Linda Collie (GP) (Chair) - Chief Clinical Officer Simon Cooper - Deputy Director of Medicines Optimisation Michael Drake - Director of Planning & Performance Dr Elizabeth Fellows (GP) - Clinical Executive Member & Chair of CCG Governing Board Margaret Geary - Lay Member Justina Jeffs - Head of Governance Dr Jonathan Lake (GP) - Clinical Executive Member Graham Love - Lay Member Dr Nick Moore (GP) - Clinical Executive Member Dr Jonathan Price (GP) - Clinical Commissioning Lead Innes Richens - Chief of Health and Care Portsmouth Suzannah Rosenberg - Director of Quality & Commissioning Terri Russell - Deputy Director of Primary Care Michelle Spandley - Chief Finance Officer Dr Kevin Vernon (GP) - Clinical Commissioning Lead In attendance: Linda Foster - Executive Assistant (Minutes) 1. Apologies and Welcome Dr Linda Collie welcomed everyone to the meeting. Apologies were received from: Jane Cole, Carly Darwin, Dr Jason Horsley, Dr Tahwinder Upile and Alison Edgington.

10 2. Register and Declarations of Interest A Conflict of Interest was noted for Agenda Item 9 Due Diligence for the Integrated Primary Care Service. The Integrated Primary Care Service attracts funding for GPs working within the service, which presented a direct conflict for the GPs present at the meeting namely; Dr Linda Collie, Dr Elizabeth Fellows, Dr Jonathan Lake, Dr Nick Moore, Dr Jonathan Price, Dr Kevin Vernon all of whose partnership is a shareholder of the PPCA. As this item was brought to the Committee as an update, it was agreed that members should remain for any discussions. 3. Items for Any Other Business The Clinical Strategy Committee discussed the SHIP 8 Priorities Committee Statements as below: Policy no. 27 Liothyronine in hyperthyroidism The Committee was unclear whether the final version had been provided, therefore it was requested that the final version is obtained for the committee to re-consider. Action: J Jeffs Policy no. 28 Flash Glucose Monitoring Freestyle Libre The policy statement was approved by the Committee; however the process needs to be worked through. The CCG Communications Team will release a statement to Social Media to this effect. Action: J Jeffs/D Barker Policy no. 29 Pelvic Organ Prolapse surgery The Committee raised concern regarding the criteria and degree/stage of prolapse before surgery is considered. The Committee requested that more information is obtained from the CSU including any information related to whether Uro-gynae physio can make onward referrals to surgeons. Action: J Jeffs 4. Minutes of Previous Meeting The minutes of the Clinical Commissioning Committee held on 3 January 2018 were approved as an accurate record, The summary of actions from the Clinical Commissioning Committee held on Wednesday 3 January 2018 were discussed and reviewed as follows: Item Action Who By Progress 8, Wheelchair Service. Results of the clinical review and future procurement paper to be brought to a future CSC meeting. 10, Clarification required for the policy statement for treatment of hydrocele and strangulated hernias. Post meeting note. A response was received from C Ashdown, Head of IFRs which was circulated to CSC members via . 6 Extra Contractual Referrals (ECRs) OPMH Transformation Team Business Case to be brought to CSC in July 2018 S Rosenberg Feb 2018 On Agenda. E Edgington/ L Foster/ J Jeffs D Dew/R Penlington Jan/Feb 2018 July 2018 Action closed. To be noted for July CSC meeting agenda. 2

11 6 ECR Revised Application process. Savings figures and funding source to be discussed outside of this meeting. 8 Primary Care CQUIN The Primary Care Team to discuss CQUIN and transformation with the PPCA. 10 Contact F&G/SE Hants CCGs regarding the Agenda for the joint meeting in February. D Dew/ R Penlington/ M Spandley T Russell/ S McInnes Jan/Feb 2018 Jan/Feb 2018 M Spandley confirmed this is work in progress. T Russell confirmed discussions are taking place between the GP member practices and the PPCA. L Foster Jan 2018 Action closed. b) Matters Arising: Dr Nick Moore queried when the App for Antibiotic Prescribing would be available. Simon Cooper advised the App is still being worked on and will be available soon. 5. Planning Update Michael Drake spoke to this item. The 2018/19 Planning Guidance was published on 2 February 2018; the key messages were summarised for the Committee: Finance control totals Provider and Commissioner national control totals Commissioning Sustainability Fund (CSF) Priority and investment Mental Health (improving) Primary Care 5 year Forward View Cancer, the 8 national cancer standards Although an RTT target was not specified, waiting list reduction requirements were laid out for 2018/19. The Accountable Care System (ACS) is now called the Integrated Care System. Aligned to the STP geography of system partners, this will provide more rigour and a structured influence across the system and not duplicating the work of the STP. Michael Drake advised the timetable for the production of the Operating Plan: This will include the narrative document, financial detail, activity templates and trajectory. The first draft submission is due on 8 March Michelle Spandley stated the CCG Control Totals were included in the planning guidance. For organisations with a negative (deficit) control total, access will be given to the Commissioner Sustainability Fund if they successfully meet their required control total thereby bring their financial position to break-even at the end of the financial year. Portsmouth CCG does not have a negative control total and are therefore unable to access this Fund. Provider organisations control total information was not released at the time of this meeting. The Clinical Strategy Committee noted the update on Local Planning for and 18-19, and on the progress being made with the ACS. 6. Project Update for noting Gastro Intestinal Service Redesign Programme Michael Drake informed members that this paper was provided for information and will also be shared at the Fareham and Gosport and South Eastern Hampshire Joint Clinical Cabinet Meeting being held today. 3

12 The Clinical Strategy Committee noted the paper. 7. Wheelchair Service Procurement options briefing paper Suzannah Rosenberg confirmed that the current collaborative contract with Millbrook Healthcare for the five CCGs ends on 31 March The paper presented outlined the procurement options available for Portsmouth CCG. There have been performance and quality issues related to Millbrook Healthcare wheelchair service. However West Hampshire CSU (Lead for this Service) has undertaken work resulting in an improving waiting list position. Following quality issues raised by Solent NHS Trust, a Trend Serious Incident Requiring Investigation (SIRI) was undertaken jointly by Millbrook and Solent NHS Trust who reviewed 50 cases (children). The findings of this review did not provide sufficient clinical information and therefore a second review focussing on harm caused due to length of waiting times was carried out. No agreed conclusions were reached. The CCG Safeguarding and Quality Team commissioned an independent review of the same 50 cases by Niche Consult. The consultancy costs were shared across the CCGs with additional contribution from Solent NHS Trust. Members requested flexibility of the future arrangements to include service changes and improvements following receipt of the Niche Consult report. Suzannah Rosenberg explained that this briefing paper contains three procurement options, and that risks have been identified for all three. Fareham & Gosport and South Eastern Hampshire CCGs will be discussing these options at their upcoming Governing Body meeting. The recommendation to the Committee is to choose Option 1: to negotiate contract extension with Millbrook Healthcare for up to two years. Members questioned whether, due to the issues raised, a shorter (6 months) extension time might be possible in order for some improvement and rectification work to be undertaken rather than extending the current contract for a further 2 years. Michelle Spandley stated that the costs for such a short extension are prohibitive and would not enable sufficient time to undertake a full procurement. Suzannah Rosenberg confirmed that Millbrook are improving and are a very responsive provider. They also provide the local Equipment Service which is viewed positively and have stated their wish to continue to provide the Wheelchair Service. The Clinical Strategy Committee approved Option 1: A contract extension with Millbrook Healthcare of 1 year plus a 1 year option. With the caveat that sustained improvement is made and dependent on the outcome of the Niche Consult report. 8. Mental Health Overview Suzannah Rosenberg introduced this paper which provides an overview of the emerging plans to develop mental health services in the city and where possible, across the system. 4

13 Wellbeing House The Wellbeing House will provide a social single point of access and contact for patients who are in a self-defined crisis or just require advice or signposting to services or support from community peer networks; which, it is planned, will reduce activity in primary care. There are plans to look at other areas such as substance misuse, for individuals seeking help that do not fit into the criteria for Recovery Hub and Talking Change services. A number of engagement activities have taken place at various meetings with stakeholders and across the system and it was particularly well received by Portsmouth GPs at the Commissioning Meeting held in early February A business case is being worked up with Solent NHS Trust and Solent Mind. Mental Health Assessment Unit (MHAU) The Psychiatric Decision Unit re-named the Mental Health Assessment Unit, will be situated in the Emergency Department of QA Hospital. Suzannah Rosenberg explained the vision and core principles of the service; Right Care, Right Place, Right Time being a part of operational Emergency Department, but in a separate space, to help with the patient flow through the emergency department. A small group will meet to look at issues such as Triage, Assessment, Intervention and Discharges. The MHAU will be a blended service of psychiatric liaison function, crisis function and assessments of patients. It was noted that the Section 136 service will be considered at a later time. Capital bid news from PHT is expected by the end of February for the space in the emergency department and the plan is for the Unit to be operational by the end of November Communication to the wider public will be launched in due course for all aspects of mental health and its links with the psychiatric service but not specifically for the MHAU. Acute Bed Transformation Suzannah Rosenberg reported on the success of this project in reducing the use of acute Out of Area placements through the use of local beds in Elmleigh and Oakdene wards. A business case to include the finance model to be brought to a future Clinical Strategy Committee Meeting. Action: S Rosenberg 5

14 System Redesign Suzannah Rosenberg reported the start of Phase 1 of the system redesign process; 200 days of change management, funded by NHS Improvement and delivered by Northumberland Tyne & Wear (NTW), consists of a current state analysis triangulating Southern Health and Solent NHS Trust performance data about existing pathways of 700 patient journeys and week-long observation of each of 20 AMH and OPMH community facing teams. Phase 2 will commence in April and will be four, 5 day co-produced workshops. Portsmouth priorities continue to be focused on the local population needs as well as more broadly across the system. The Committee discussed costs and it was noted that the high costs of Section 117 extra-contractual referrals, longer lengths of stay at Southern Health Trust and higher admission rates for Solent NHS Trust all have an impact. It is part of the system redesign learning process to reduce these numbers. Dr Jonathan Price queried whether older people s OPMH will be linked into this work. (System Redesign). He also asked about individuals within learning disabilities who fall marginally outside the current criteria. Suzannah Rosenberg confirmed that all service developments are for individuals over 18 years old, however more work is required for people with learning disabilities etc. Suzannah Rosenberg highlighted positive work currently being undertaken to repatriate patients with learning disabilities who are in out of area placements back into the city. The Clinical Strategy Committee approved the direction of travel for the mental health transformation programme. 9. Due Diligence for the Integrated Primary Care Service Conflict of Interests were declared by the GP members present. Portsmouth Primary Care Alliance (PPCA) received a direct award approval from the Primary Care Commissioning Committee in July 2017 to implement an Integrated Primary Care Service (IPCS), incorporating the Acute Visiting Service, GP Enhanced Access and Out of Hours Service provision. The service commencement date is 1 June Jo York presented the business proposal submitted by the PPCA for scrutiny. The CCG has determined a two-stage due diligence approach similar to that of a formal procurement. Gateway one is to review the operating arrangements of the PPCA, including financial, corporate governance, quality and testing the proposed business model. Gateway two provides a more detailed review into how these arrangements will be carried out e.g. policy content, specific arrangements and subcontracting agreement details. 6

15 The CCG is currently working through assurance to Gateway one as there are still some activity issues and costings being worked through, however Corporate and Clinical Governance requirements have been satisfied at this stage. Once confirmation to proceed with mobilisation has been given, the PPCA will work with CCG colleagues and other organisation towards Gateway two Members expressed their support of the Business Proposal document in its level of detail and clinical model and agreed to pursue the PPCA business case. Jo York informed the Committee although plans for and Urgent Care Centre (UCC) at QA Hospital are still in motion, although uncertain, it is envisaged the IPCS will form part of the solution to establishing a UCC. The situation regarding Carillion will cause delays for the UCC at PHT. The three providers agree that a Stream and Refer Service would be better. Plans are currently being worked through but the UCC may need to consider separately a more affordable option to have two sites across the city with just one being open on a Saturday. Currently the team are concentrating on having one site at Lake Road Health Centre; there is a need to consider if Lake Road will be the final venue/site. The Urgent Care Centre plan needs to be brought back to the three CCGs for further consideration. Action: J York The Clinical Strategy Committee approved the Due Diligence Process for the Integrated Primary Care Service. 10. Minutes of Other Meetings for noting: Minutes of the Committee in Common Joint Strategic Clinical Committee Meeting held on 8 th November The Clinical Strategy Committee noted and accepted the above Minutes. 11. Any Other Business Nil. 12. Date of the Next Meeting: The next Clinical Strategy Committee will be held on Wednesday 7 March 2018, from 1 3 pm in the Committee Room, Portsmouth CCG Headquarters. 7

16 Clinical Strategy Committee Attendance Log Member Name Dr Linda Collie (Chair) A Berry April May June July Aug Sept Oct Nov Dec Jan Feb Chair A A Chair A Chair A Chair L Darby Deputy L Darby Deputy L Darby Deputy L Darby Deputy A L Darby Lyn Darby A A A Jane Cole A A A A A Simon Cooper A A A Carly Darwin A A A A Mike Drake Dr Elizabeth Fellows A A A Chair A Margaret Geary Katie Hovenden A Dr Jim Hogan A Dr Jonathan Lake Chair A Chair Chair Graham Love Dr Nick Moore A A A Dr Jonathan Price A A Innes Richens A Terri Russell A A A A Suzannah Rosenberg Andy Silvester A A A A Michelle Spandley D Deputy Dr Tahwinder Upile A A A A A A A A A Dr Kevin Vernon A Jo York A A A A Dr Jason Horsley A A A A A Justina Jeffs Alison Edgington A - present A apologies 8

17 Agenda Item Minutes of a Meeting of the Audit Committee held on Wednesday 13 December 2017, 1:00-3:00pm in the Committee Room, NHS Portsmouth CCG Headquarters, Civic Offices, 4 th Floor, 1 Guildhall Square, Portsmouth 5b (130917) 5a 6a Summary of Actions Action Who By External Audit Progress and Sector Briefing Report Iain Murray to send Justina Jeffs slides/notes from the Good Governance Institute and the World Health Innovation Summit team work for dissemination, due to the absence of a report. External Audit Progress and Sector Briefing Report Vicki Puttock to disseminate the bulletins electronically Internal Audit Update 2017/18 Justina Jeffs to circulate the final Primary Care Commissioning report 7 Local Counter Fraud Services Karen Travers to look at the availability of the e-learning course on MLE. 9b 9c Corporate Risk Register Justina Jeffs to circulate the feedback on the CCG Visit to Radiology Register of Procurement Decisions Justina Jeffs to change the Register of Procurement Decisions to include the agreed list of amendments. Iain Murray Vicki Puttock Justina Jeffs Karen Travers Justina Jeffs Justina Jeffs January 2018 January 2018 January 2018 March 2018 January 2018 March Scrutiny Item Justina Jeffs to collate list of Scrutiny Items for to be discussed at the Committee Justina Jeffs March 2018 Present: Julie Cullen Graham Love Dr Nick Moore Jackie Powell Andy Silvester - Registered Nurse Representative - Lay Member - Clinical Executive (GP) - Lay Member - Lay Member (Chair) In attendance: Will Barnard - Internal Auditor TIAA Ltd Sophia Brown - Grant Thornton, External Auditors Jane Cole - Deputy Chief Finance Officer Dr Linda Collie - Chief Clinical Officer (GP) Justina Jeffs - Head of Governance Hayley Matthews - Information Governance Manager, CSU (Item 9a) Iain Murray - External Audit (Grant Thornton Ltd) Giles Parratt - Director of Audit, TIAA Ltd Vicki Puttock - Business Development Officer (Minutes) Tracy Sanders - Managing Director Michelle Spandley - Chief Finance Officer Karen Travers - Local Counter Fraud Specialist, Hampshire & Isle of Wight Fraud & Security Management Service 1

18 1. Apologies and Welcome Following introductions apologies were received from Innes Richens. 2. Declarations of Interest No Interests were declared however Will Barnard informed the Committee that he was now also the Interim Governance Manager for the Hampshire CCG s 4 days per week. 3. Minutes of the meeting held on 13 September 2017 The minutes were agreed as an accurate record Summary of Actions The summary of actions from the last meeting were discussed and reviewed as follows: Action 5b External Audit Progress and Sector Briefing Report: Iain Murray apologised that there had been no report available to share from the Good Governance Institute and the World Health Innovation Summit and noted that he would see if there were any slides or notes that could be sent to Justina Jeffs for dissemination instead. Ongoing. Action 10 Scrutiny Item: WannaCry Cyber Incident Customer Briefing: Justina Jeffs said this had been discussed with Terri Russell and she will review how to include GP training on cyber security, fraud and general IG requirements this as part of TARGET in Deferred Items There were no deferred items. 5. External Audit a. External Audit Progress and Health Sector Briefings Report Sophia Brown presented the progress and sector briefing report. Sophia Brown confirmed that planning had started for the 2017/18 financial statements work and that interim audit had commenced with site visits in December and planned in January The interim work includes reviewing the CCG control environment, financial systems and internal audit reports, with early substantive testing taking place in January/early February Findings from the interim audit will be included in the Progress Report at the March Audit Committee. Sophia Brown confirmed that the Audit Plan was deliverable for March 2018 and would be brought to the March Audit Committee Sophia Brown informed members that an initial risk assessment to determine the approach to Value for Money would begin in January It was noted that the Hampshire and Isle of Wight CCG s Audit Committee Chair s Event was held in September 2017 and the next one is due to be held on the 19 January Also included in the report were bulletins published from a number of organisations which provided up-to-date information on a range of information of interest to the Committee and the work of the CCG. Tracy Sanders suggested it would be beneficial to have the bulletins sent electronically so that members could access the web links included in the bulletins. Michelle Spandley highlighted that these could also be accessed via the CCG Weekly Bulletin. Action Vicki Puttock to send the reports electronically. Iain Murray informed members that a handover with the previous auditors Ernst Young had taken place in September. The prior year file had been received and there were no concerns to bring to attention. 2

19 Following a question by Jackie Powell regarding the HMFA s recent briefing on Accounting for Leases (p19), Jane Cole confirmed that the CCG only has 3 leases, 2 of which were photocopiers and office space. This would be more of a presentational issue and would be put on the balance sheet as asset/liability. Jane Cole said it was more of an issue for providers due to the higher number of leases they have. In response to a question by Jackie Powell regarding the Targeted Enhanced Recruitment Scheme for GP s (p18), Michelle Spandley informed members that this was unlikely to be applicable Portsmouth but more to do with rural areas. Dr Nick Moore confirmed that the Isle of Wight was on the list but Portsmouth was not. The Committee noted the report. 6a. Internal Audit Update 2017/18 Giles Parratt presented the Progress Report and highlighted that it was Primary Care Commissioning report issued since the last meeting, not the Partnership Working final report as per the agenda. The Executive Summary was included but the final report would be disseminated to members. Action Justina Jeffs to circulate the final Primary Care Commissioning report Giles Parratt informed the committee that the Conflicts of Interest and the Information Governance toolkit internal audits were due to start and the Annual Report/Head of Internal Audit Opinion was on track. All other systems were on track for external audit. It was noted that the planning round for next year would come back to the next meeting, and would feature Cyber Security. Giles Parratt confirmed that there had been good progress on the recommendations tracker. Jackie Powell questioned why the Target Risk Score and Target Implementation dates were red and the usefulness of the target whilst there are missed scores. Giles Parratt responded this had been picked up with Justina Jeffs and would be reviewed in terms of the risk management process. Tracy Sanders highlighted to members that work would be undertaken with the CCG Board at the Development session in February 2018 to agree the approach to risk. Also included in the report were client briefings on a range of information of interest to the Committee and the work of the CCG. The Committee noted the report. 7. Local Counter Fraud Services Local Counter Fraud Anti-Fraud Bribery and Corruption Interim Report Quarter 2 Karen Travers spoke to the report. There are currently no issues of concern and no investigations have taken place. Members were informed that as of the 1 November 2017 NHS Protect ceased to exist and the LCFS produced a new Anti-Fraud, Bribery and Corruption Policy following the changes for submission to the Clinical Executive Committee meeting on the 20 December 2018 for ratification. Karen Travers informed members that the Counter Fraud Authority were issuing new standards for 2018/19, but these would not be published until January 2018, which meant that the workplan cannot be finalised until this had been seen. Karen Travers highlighted that the LCFS had developed a face-to-face training presentation which can delivered to all CCG employees and was delivered to staff at a lunch and learn session on 18 July It was noted that new e-learning course on 3

20 fraud, corruption and bribery in development and would hopefully be available in Tracy Sanders noted that the e-learning would be accessible via the Hampshire and IOW Fraud and Security Management Service website, but emphasised that staff should be able to access this via MLE directly. Action: Karen Travers to look at the availability of the e-learning course on MLE. Following a question by Jackie Powell regarding the definition of CIFAS (p9), Karen Travers responded that this stood for the Credit Industry Fraud Avoidance System. The Committee noted the Local Counter Fraud Anti-Fraud Bribery and Corruption Interim Report Quarter 2. 8 Financial Matters a Finance Report for the period to 31 st October 2017 (Month 7) Jane Cole notified members that at month 7 the CCG are on target to achieve an in-year break even position in line with its agreed control total, with a surplus of 6.1m and 0.5% non-current reserve. Jane Cole highlighted that the CCG is likely to be asked to improve its position from 6.1m to 7.5m. Jane Cole informed members that a risk had been highlighted within prescribing of cost pressures across the Hampshire and the IOW, caused by No Cheaper Stock Obtainable. The CCG was not seeing growth on prescribing that had been planned for and therefore were seeing an underspend. Michelle Spandley noted that other CCGs and providers were not fairing so well and there were large variances from original forecasted plan, however the system were trying to work as a whole in order to support partners. Jane Cole said that Winter Pressures monies were available. The CCG were reaching and bidding for the available monies and it was hopeful these would be finalised next week. Tracy Sanders noted that the approved schemes have to be ready immediately and therefore we may already be investing in these areas. Michelle Spandley updated members on other budget announcements, highlighting that STP had not been allocated. A recent letter received supporting the St James Hospital/St Mary s hospital bid, which would lead to additional work. It was noted that pharmacy reconfiguration also required an update business case to share to ensure value for money. Michelle Spandley informed members that some STP bids would fall into digital programme and may impact on our New Models of Care. Overall it was unclear where the 1.6bn for 18/19 would be allocated in the system. In response to a question raised by Jackie Powell regarding the 6.1m CCG surplus, Michelle Spandley responded that whilst it would be helpful for the CCG to use this for transformation, business rules state 1% can be used, but the CCG is well over this. There would need to be a system plan to use this in order to support the system out of deficit position. In response to Graham Love s question regarding Property Services creditors/debtors over 10%, Jane Cole informed members that regular meetings with Property Services had generated good discussions and invoices would hopefully be cleared in a couple of weeks. Jane Cole also updated that in terms of debtors, the CCG were working with PCC to overcome governance barriers. There had been issues with the invoices regarding the shared posts across both organisations, but a meeting on Monday was useful in clearing the outstanding invoices and working on a process going forward. The Audit Committee accepted the Finance Report for the period to October 2017 (Month 7) 4

21 b Audit Committee Work Programme 2018 Justina Jeffs presented the Audit Committee Work Programme 2018, noting that there would be a change to the formatting The Audit Committee accepted the Audit Committee Work Programme 2018 c Use of the NHS Portsmouth CCG Trust Seal None to report to the Committee d Record of the Chair s Actions/Single Tender Actions None to report to the Committee 9 Governance Matters a Information Governance Update Hayley Matthews (CSU IG Manager) spoke to this report. Highlights from the report include: The IG Toolkit is due to be audited by TIAA in January, this is on track and all evidence is available to the auditors. The Information Governance Framework and Policy have been reviewed and approved at the Clinical Executive Committee on 22 November 2017 No Data Subject Access Requests had been received. The action plans following the CCG s audit by NHS Digital had been finalised with the majority of the actions being completed with only minor changes to action. Two Privacy Impact Assessments had been approved by the Caldicott Guardian and CSU IG team Implementation and Utilisation of the MJog Patient Messaging Service for Portsmouth GP Practices and Access to TPP SystemOne for Enhanced Care Home Team. There had been no internal breaches and one external breach which had been reported by the CCG. Mandatory training completion figure currently stood at 53% at time of reporting, but two face to face and Governing Board training sessions would increase this. Following a questions regarding the Cyber Security Update Report, Michelle Spandley confirmed that the CCG were not being asked for additional investment. It was also noted that any actions regarding technical measures for GPs would be addressed via the last meeting action to provide GP training on cyber security, fraud and general IG requirements as part of TARGET in The Audit Committee noted the IG Update report b Corporate Risk Register Justina Jeffs introduced the Corporate Risk Register, in particular risks that are pertaining to other organisations where there is a key risk to the CCG meeting constitutional targets. Justina Jeffs informed members that the CQC report into Delayed Radiology Reporting had been included. It was noted that two risks, Transformation and Public Health Budget had been reduced and removed from the register. Following a question regarding the planned CCG visit to the Radiology department on 8 th October (pg7) Justina Jeffs informed members that the Quality Team undertake regular visits, but will ask for feedback on the visit to be circulated with the minutes. 5

22 Action Justina Jeffs to circulate the feedback on the CCG Visit to Radiology (8/10/17) The Audit Committee noted Corporate Risk Register c Register of Procurement Decisions Justina Jeffs tabled an updated Register of Procurement Decisions to the one distributed with the agenda, noting that the register only includes those decisions that are absolute and approved. The following amendments were agreed to be changed Spelling error to be changed to Manager in the CCG Contract Manager Contract title column. Column errors in 2017/ ADHD to be correct, as currently extends down all references. Amend names in CCG Clinical Lead Name and CCG Contract Manager Name to Job title only Action Justina Jeffs to change the Register of Procurement Decisions to include the agreed list of amendments. The Audit Committee approved the Register of Procurement Decisions subject the amendments being made. e NHS Audit Committee Handbook Audit Self-Assessment Checklist Justina Jeffs presented NHS Audit Committee Handbook Audit Self-Assessment Checklist informing members that as part of good governance practice, the Audit Committee undertakes a self-evaluation each year based on the Audit and Risk Assurance Committee Handbook published by HM Treasury. There had been some changes to the membership of the Committee during the 2017/18 financial year therefore some members had not attended a meeting at the time of evaluation and were unable to comment. Justina Jeffs informed members that this had been seen by Governing Board and was distributed for information. Justina Jeffs and Andy Silvester would work through any comments that had been made. Julie Cullen suggested the unable to answer column could be used for a comments column. Jackie Powell also noted it would be helpful to use the feedback to scrutinise other items, depending on appropriateness, within the meeting. The Audit Committee noted the NHS Audit Committee Handbook Audit Self- Assessment Checklist. d Register of Gifts/Hospitality Justina Jeffs presented an updated gifts and hospitality register which also forms part of the statutory guidance on managing conflicts of interests. There were no new declarations since the last meeting. The Audit Committee noted the Register of Gifts & Hospitality and approved its publication on the CCG s public website. 10. Scrutiny Item 6