MINUTES/ACTION NOTES. Members Dr Geoff Watson (GW) Medical Director (Acute) Secondary Care Doctor

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1 Name of meeting Date and time MINUTES/ACTION NOTES Governing Body meeting in public 24 January p.m. Venue Boardroom, Dominion House, Guildford Chairman Dr David Eyre-Brook (DEB) Chair Members Dr Susan Tresman (ST) Vice Chair/Lay Member Quality & Clinical Governance Dr Darren Watts (DW) Dr Sian Jones (SJ) Dr Justine Hall (JH) Dr Jonathan Inglesfield (JI) Phelim Brady (PB) Jacqui Burke (JB) Dominic Wright (DWr) Karen McDowell (KMc) Vicky Stobbart (VS) Vice Chair (Clinical)/GP Member GP Member GP Member Medical Director (Commissioning) Lay Member Patient & Public Engagement Lay Member Corporate Governance and Audit Committee Chair Chief Executive Chief Finance Officer & Deputy Chief Executive Director of Nursing, Quality and Safeguarding In attendance Elaine Newton (EN) Director of Governance & Compliance Apologies Julie George (JG) Brian Mayers (BM) Chris Head (CH) (Minute Taker) Consultant in Public Health (Surrey County Council) Area Director Guildford and Waverley, Adult Social Care (Surrey County Council) Governing Body Secretary Members Dr Geoff Watson (GW) Medical Director (Acute) Secondary Care Doctor NB: Those present at this meeting should be aware that their names will be listed in the notes of the meeting which may be released to members of the public on request under Freedom of Information requirements. 1

2 Introduction Dr David Eyre-Brook, Chair, welcomed members of the public to the meeting, advising the meeting was being recorded for minute taking purposes Apologies for absence and confirm quorum Apologies were received as noted above. As the quorum was met, the Chair declared the meeting open. Declaration of Interests Dr David Eyre-Brook (DEB), Chair, noted the register of Governing Body member interests included in the meeting papers and reported on new declarations received since the previous Governing Body meeting as follows: Sue Tresman declared on 11/01/16 that from 12/01/17 her son became Vice Principal New Barn School, Horsham, Sussex (independent specialist school) Dr. Jonathan Inglesfield declared on 13/12/16 that he is a Director of AMCS Performance Consulting - a learning and organisational development consultancy specialising in the oil and gas industry. AMCSP does not operate in the health sector. It occasionally works with other consultancy firms who may work in the health sector. Jacqui Burke, newly appointed Governing Body Lay Member Corporate Governance and Audit Chair, declared on 19/12/16 as part of the recruitment process that she is: An independent member of the Department of Health Audit Committe Part time employee providing financial management support Bells Solitors (Farnham) Was formerly Non-Executive Director at Royal Surrey County Hospital until 06/01/ DEB invited members to report any new declarations, including those relating to items on the agenda. None were received. Chair s Introduction and Opening Remarks Dr David Eyre-Brook (DEB) welcomed Jacqui Burke, Lay Member Corporate Governance and Audit Chair, to the Governing Body. Jacqui brings to the role extensive experience both within the private and public sector, including Royal Surrey County Hospital and University of Surrey. DEB reported on the following challenges, both national and local: NHS finance and performance. Locally, A&E performance has been suboptimal although data received for the previous week 2

3 indicated an improvement against the 4 hour target. A&E performance data is included in the Performance Report and Quality and Safety Report (item 3.1 and 3.2 respectively on the agenda) The financial challenge is detailed in item 4.4 on the agenda (Month 8 Finance Report). Transformation of the system is crucial to have an impact on financial positions across the health economy. The current contracting arrangements through payment by results (Pbr) does not advance transformational change and the CCG are working with RSCH and other partners to work collaboratively to resolve financial issues Surrey and Sussex County Councils are in discussion with NHS England regarding devolution, together with Surrey Heartlands STP. Devolution is deemed to offer positive opportunities to sustain the health economy. A prerequisite for devolution, from NHS E perspective, is to proceed with the appointment of a joint Accountable Officer for Guildford and Waverley, North West Surrey and Surrey Downs CCGs. Questions received from the public Dr David Eyre-Brook (DEB) advised that no questions had been received from the public. Minutes of the previous Governing Body meeting (1 November 2016) The minutes of the 1 November 2016 Governing Body meeting were agreed as an accurate record. Matters Arising Action Log Matters arising were reviewed and noted. KMc updated GB1116/4.1 Service Transformation 2016/17 Month 6 - confirming the meeting with the regulators to discuss the way forward for quarter 4 and 2017/18 had taken place on 30 November The regulators will continue to monitor the CCG and RSCH throughout the planning and subsequent mobilisation period. NHS England and NHS Improvement are informed of the CCG s position and associated risks. The Governing Body will continue to be kept updated. This item is now closed on the action log. 1.7 Chief Executive Report Dominic Wright (DWr) highlighted the following from the Chief Executive s report: Performance A&E In preparation for Winter, the CCG put plans in place to support anticipated pressures at RSCH, which were evident as predicted. 3

4 The latest available data reports 94.3% of patients were seen in A&E within the 4 hour target the previous week. Nationally, following an extensive media campaign, there was a downturn in A&E attendances, with RSCH attendances reducing by approximately 20%. DWr thanked the CCG s social care partners for their significant support in achieving this improved position, in particular with the discharge of patients. South East Coast Ambulance (SECAmb) The CCG is seeking to improve response times, particularly in the Waverley area, under the terms of the Surrey wide contract. Stroke Services Consultation A public consultation on future stroke services across the West and Border systems will be launched and run from 6 February to 30 April Interim arrangements have been put in place, following the departure of key medical staff and cessation of the hyper acute services at RSCH from 9 January Guildford and Waverley stroke patients will now be treated at hyper acute units at Ashford and St Peters and Frimley Park Hospitals, pending outcome of the consultation. Adult Community Services and Children s Community Services Work is ongoing to mobilise these services from 1 April Joint OFSTED/CQC Inspection of Services to Children with Special Educational Needs and Disabilities (SEND) VS advised the CCG were working with the Local Authority to submit a joint statement of action requested by the Department of Education, which was due by March Commissioning Elaine Jackson has been appointed as Joint Transformation Director for the CCG and RSCH. It is anticipated a joint transformation plan, which is key to achieving financial balance and sustainability in 2017/18 and beyond, will be agreed by end of January Proposed Cranleigh Village Hospital Development The CCG has been working with Cranleigh Village Hospital Trust and partners (RSCH and a private nursing home provider) to develop a proposal to provide a holistic set of health and care facilities. The proposal is in early planning stages and includes an innovative scheme to provide affordable accommodation for health and care staff to support the recruitment and retention of staff. The 4

5 Governing Body will be kept informed as the proposal develops over the next 2-3 years. Primary Care Transformation Funding Application The CCG have registered their disappointment with unsuccessful applications to the NHS England Technology and Transformation Fund. Consideration will now be given to identify alternative innovative programmes to secure key improvements in primary care and community hub working. Changes to Governing Body Membership and Staff Changes to Governing Body Membership and Staff were highlighted, as detailed in the report with congratulations to Dr Larisa Han, GP Merrow Park Practice, who has assumed the Chair of Practice Council from Dr Darren Watts, with effect from January 2017; and appreciation for their respective contributions to Dr. Hannah Marshall, standing down as clinical lead for mental health and learning disabilities, and Leah Moss, Deputy Director of Clinical Commissioning, leaving for a new role. Arrangements were being put in place to fill these roles. RECOMMENDATION: The Governing Body is recommended to Note the Chief Executive s Report The Governing Body noted the contents of the Chief Executive s Report 2. Governance and Assurance Chair s Action Appointment of Lay Member (Corporate 2.1 Governance and Audit Chair) Elaine Newton (EN) presented the Chair s Action taken to approve the appointment of the new Lay Member (Corporate Governance and Audit Chair) to enable a seamless transition, following the departure of Stephen Park. This was for ratification by the Governing Body. The Constitution requires Governing Body approval of Lay Member appointments. The Governing Body is asked to ratify the Chair s Action to approve the appointment of the Lay Member (Corporate Governance and Audit Chair) The Governing Body ratified the Chair s Action approving the appointment of the Lay Member (Corporate Governance and Audit Chair) 5

6 2.2 DISCUSSION AND NEW ACTIONS Risk Management Board Assurance (BAF) Elaine Newton, presented the risk management report, reflecting Audit Committee s review of the risk profile in December This included a deep dive of persistent quality risks and assurances associated with each risk. Audit Committee requested regular refresh of assurances to ensure they are valid, relevant and up-to-date, allowing Governing Body members to determine the extent to which mitigations are effective in controlling risks. The report presents the current risk profile, new risks around stroke and commissioning of diabetes structured education programme, with assurance of mitigation detailed. As agreed at the November 2016 Governing Body meeting, December 2016 Audit Committee reviewed the risk appetite associated with the CCG s corporate objective to innovate, lead and transform. The Governing Body is asked to approve the reduction in risk appetite level to open-high (10-12) for the reasons given in the report and in the context of the CCG s financial position. To note, for the second year in succession, the CCG has been awarded substantial assurance following internal audit of the CCG s risk management arrangements. JB requested clarification of the director s commentary in relation to risk R0148: If community health and social care capacity is insufficient, patients will not be discharged and create blocks in patient flow. JB enquired what action was required to achieve a more favourable position as the commentary relates to admission avoidance rather than discharge. VS gave assurance of many actions agreed through A&E Delivery Board with focus on patient flow, but acknowledged the mitigating action detailed relates more to admission reduction. She added the level of detail on the Magique risk management system was not reflected in the report but would revisit to address the point. ACTION: VS In relation to stroke services, EN confirmed that the Audit Committee had asked for the risk associated with the interim arrangements (R0219) to be separated from that relating to the future model of stroke care (R0210), so that there was clarity of mitigating actions. The latter reflected the increased investment required to achieve the new stroke care pathway and the narrative on page 3 focused on the financial aspect. KMc confirmed the increased costs for the interim arrangement related to transport costs; the financial modeling for the new service is currently under discussion. VS 6

7 The Governing Body is asked to: Review and note the current position with respect to risks included on the BAF, informed by the risk owners for the top rated BAF risks. Approve the change in risk appetite for the objective innovate, lead and transform the way local healthcare is delivered, fostering strong local partnerships to achieve this to open-high (10-12). 2.3 The Governing Body reviewed and noted the current position of risks included on the BAF. The Governing Body approved the change in risk appetite for the objective innovate, lead and transform the way local healthcare is delivered, fostering strong local partnerships to - achieve this to open-high (10-12) Annual Equality Report 2016/17 Elaine Newton (EN) presented the Annual Equality Report 2016/17, required to be published by end of January The report had been reviewed in detail by the January 2017 Quality and Clinical Governance Committee. EN highlighted the following from the report: the CCG s commitment to equality and diversity being embedded in the commissioning cycle, particularly evident in procurement activity, and how this has influenced specification and outcome. The diverse patient and public stakeholder group, chaired by Phelim Brady, Lay Member Patient and Public Engagement. The success of the apprenticeship role, and the work in progress to establish a work experience placement for a person with learning disabilities Patient stories featured on Governing Body agendas to facilitate reflection on patient experiences and issues. JG acknowledged the report as useful and easy to understand in terms of its equality focus. With the imminent re-launch of the Joint Strategic Needs Assessment and Health Profiles, which the report draws from, she asked to receive feedback as to the extent to which this assists delivery of the actions to address health inequalities. RECOMMENDED ACTIONS: 1. The Governing Body is asked to reaffirm their commitment to be personal, fair and diverse champions. 7

8 2.4 DISCUSSION AND NEW ACTIONS 2. To agree the Equality Objectives for 2017/18 on page 21 of the report 3. To approve the Annual Equality Report 2016/17 for publication The Governing Body reaffirmed their commitment to be personal, fair and diverse champions. The Governing Body agreed the Equality Objectives for 2017/ 18 on page 21 of the report. The Governing Body approved the Annual Equality Report 2016/17 for publication. Policies a) Standards of Business Conduct and Conflict of Interest Policy including Receipt of Gifts, Hospitality and Inducements/Commercial Sponsorship and Joint Working with the Pharmaceuticals Industry Elaine Newton (EN), presented the revised policy. Following NHS England s publication in June 2016 of revised Statutory Guidance for CCGs for managing COIs, three policies have been merged into one, to align with the guidance. The rationale for so doing is to support staff awareness, navigation and compliance, given the degree of overlap inherent in the three original policies. Whilst Guildford and Waverley CCG has led the revision of the policy, there has been a degree of collaborative working across the Surrey Heartlands footprint. Audit Committee, including internal audit and counter fraud, have also reviewed, with comments reflected in the policy, now recommended to the Governing Body for approval. Training and dissemination of the implications of the new guidance has commenced - with sessions at Team Brief, Practice Council, Governing Body and Practice Managers Forum and follow up articles in E:Brief and Practice Focus. EN highlighted the following points: (a) Thresholds for receipt of gifts and hospitality were reviewed at December 2016 Audit Committee and reflect NHS England s guidance. She advised the intention to revisit these, once the outcome of NHS England s subsequent consultation on rules and principles across NHS bodies is known, to consider how workable these limits are for the CCG s day to day business. Internal Audit had advised that the CCG can do this, with explanation of the reason for any change/variation. 8

9 (b) Clear provisions for accepting commercial sponsorship to ensure understanding by both parties. (c) Outcome of Counter-Fraud pro-active audit of the Governing Body register of interest has raised no issues of concern; this exercise will be extended to staff and practice registers. (d) The mandatory annual audit of conflicts of interest is underway. Following a question from JI related to implications of the guidance for practices working with pharmaceutical industry for the benefit of patients, EN explained the scope of the policy extends to GP partners and practice staff involved in CCG business/decision making processes. Illustrative examples (provided by the former GP Member of the Audit Committee) have been shared with practice managers, with the intention to work closely with them to determine what should be declared and a workable system for so doing. She referred to the statement of compliance in the policy for practices to declare their intention to work within CCG prescribing frameworks and an option to be considered, for a bi annual statement from each practice of pharmaceutical interactions, in support of the individual declarations which are now automated. Policy implementation will be closely monitored going forward to ensure the policy is fit for purpose and workable with regard to its expectations of what needs to be declared. The Governing Body, with recommendation from Audit Committee (and Quality and Clinical Governance Committee Section C Joint Working with the Pharmaceutical Industry only), is asked to approve the revised merged policy. The Audit Committee take responsibility for future approval of this integrated Policy, with any significant changes to Joint Working with Pharmaceuticals Industry section being reported to Medicines Optimisation Group (MOG) and Quality and Clinical Governance Committee (QCG). The Governing Body approved the revised merged policy and agreed the Audit Committee take responsibility for future approval of the integrated Policy, with any changes to Joint Working with Pharmaceuticals Industry section being reported to MOG and QCG Committee. 9

10 b) Review of HR policies Elaine Newton (EN) reminded Governing Body that the Remuneration Committee has delegated authority to review and recommend HR policies. The schedule of amendments had been reviewed in detail by the Committee in October 2016, and the Governing Body is asked to ratify these. In the light of national policy being issued, she advised that further amendments would be needed for the Raising Matters of Concerns Policy (current Whistle Blowing Policy) and the Recruitment and Selection Policy. To ensure these policies remained valid the Governing Body was asked to ratify the changes to date. In connection with the Raising Matters of Concerns Policy, the Governing Body was asked to nominate a Freedom to Speak Up Guardian role. EN proposed that this role should be allocated as part of the planned review of lay member roles which the Remuneration Committee had commissioned and was currently underway. (1) Review of HR Policies as detailed in 2017 HR Policy Review and Schedule of Recommended Changes to be ratified by the Governing Body (2) Approve amendments to date with regard to Raising Matters of Concern and Recruitment and Selection Policies, noting further amendments indicated which will come back to Governing Body for final ratification in April (3) Nominate Freedom to Speak up Guardian role. The Governing Body ratified the outcome of the review of HR policies as detailed in the paper. The Governing Body approved the amendments to date and noted the Raising Matters of Concern and Recruitment and Selection Policies required further amendments, with revised policies to be presented for final ratification at April 2017 meeting. The Governing Body agreed the nomination of the Freedom to Speak Up Guardian role would be allocated following the review of Lay Member roles, to be ratified at the April 2017 Governing Body meeting. CH Forward plan EN 10

11 c) Procurement Policy Karen McDowell (KMc), presented the revised policy, as recommended by December 2016 Audit Committee for approval by the Governing Body. KMc highlighted in the paper the detail of the areas addressed in the revision of the policy. JB* recommended an additional requirement to item 4.8 (Value for Money) of the policy to define the actions required by the CCG. JB had shared her feedback with the author, who was in agreement. The Governing Body are asked to review and approve the policy The Governing Body reviewed and approved the policy subject to the suggested refinements relating to item 4.8 (value for money). ACTION: JB to liaise with author with regard to the revisions to the policy. JB d) Review of Prime Financial Policies Karen McDowell (KMc) presented a summary of revisions to the prime financial policies, following annual review. Detailed review of these had been undertaken by December 2016 Audit Committee, now recommended to the Governing Body for approval. JB* noted minor amendments were required to ensure correct cross reference between detailed and prime financial policies. ACTION: JB to liaise with Deputy Finance Officer to make necessary amendments. *JB was not a member of Audit Committee at the time these items were considered by the Committee (December 2016). To approve the proposed changes to the policies, as recommended by the Audit Committee. The policies should continue to be formally reviewed on an annual basis to ensure they remain fit for purpose (adhoc adjustments may need to be made in-year to reflect revised guidance and/or operational developments) The Governing Body approved the changes to the policies, as recommended by Audit Committee subject to minor amendments to ensure accurate cross reference between prime and detailed policies. The Governing Body agreed approval of these revisions to be via Chair s Action to be ratified at the April 2017 Governing Body meeting. JB KMc 11

12 3. Quality and Performance Performance Report Month Karen McDowell (KMc), presented the Performance Report, acknowledging the overlap of reporting related to A&E and SECAmb with the Chief Executive s report and Quality and Safety report. KMc highlighted the following from the report: Performance metrics From month 7 to month 8 - green targets had increased significantly, red targets had decreased and amber targets had remained static. Page 1 identifies the key issues including: A&E 4 hour wait (RSCH); Cancer waits: 62 days from urgent GP referrals (RSCH); Ambulance handovers: over 30 minute breaches (SECAmb); Ambulance handovers over 60 minute breaches (SECAmb); Category A calls within 8 minutes (Red1) (SECAmb); Category A calls within 8 minutes (Red 2) (SECAmb); The report noted for each area, the provider, the issue, actions being taken to resolve and the officer responsible for progressing actions. Due to actions during the month there had been a slight increase in targets met. The Quality Premium (QP) was achieved against standards for 2015/16, resulting in a part payment of 359,800 received in the current financial year. Page 14 details monitoring of the quality premium targets for 2016/17. Due to the CCG s financial position full achievement is not anticipated. The Joint Transformation Director is working with providers to factor into the Joint Recovery Plan actions to ensure improvement in achievement against Quality Premium targets for future years. No questions were raised n the Performance Report. To note the areas of adverse performance and the actions identified to rectify The Governing Body noted the areas of adverse performance and the actions identified to rectify. 3.2 Quality and Safety Report Vicky Stobbart (VS), presented the Quality and Safety report, by exception only but also including positive indicators. VS advised the report had been presented at the 3 January 2017 Quality and Clinical Governance Committee. 12

13 VS highlighted the following from the report: Royal Surrey County Hospital (RSCH) Sustained and/or improved performance was noted in the following areas: pressure damage Grade 3 and 4 (developed in hospital); harm free care, with a slight decrease in September and October 2016; the number of cancelled operations significant reduction since quarter /16. and Friends and Family Test with maternity performing especially well. Issues flagged: workforce remains the subject of the performance notice, with a remedial action plan in place. VS highlighted the spike in staff turnover which had been raised with RSCH and has subsequently reduced; Statutory and Mandatory training also included in the remedial action plan. A slight decrease noted in medical and non-medical training, but over the last year there has been steady improvement in completion; Mortality SHMI rates highlighted as red. VS advised the latest data available was published in September 2016 and related to March RSCH s rate remains low in comparison with trusts both nationally and locally, and is the subject of regular quality monitoring, with assurance received in relation to data. South East Coast Ambulance Service (SECAmb) A follow up inspection is anticipated (to CQC inspection in May 2016 and inadequate rating published in September 2016). The quality concerns identified also relate to patient transport and the 111 service and a focus session was held at Quality and Clinical Governance Committee. The CCG have raised concerns with North West Surrey CCG (host commissioners) relating to the lower response rates for the Waverley area. The Associate Director of Quality and Improvement is leading on the ambulance summit being held on 11 February 2017, with feedback to Quality and Clinical Governance Committee and Commissioning, Finance and Performance Committee. Surrey and Borders Partnership Trust (SABP) The CCG have taken the lead on Children and Adolescent Mental Health Services (CAMHS), adult learning disabilities and adult mental health from North East Hants and Farnham CCG(NEHF CCG), with staff transferring from NEHF CCG from 1 January Page 4 as previously flagged, system 1 e-patient system difficulties in extracting information remain. This is an area identified by CQC as requiring improvement. The CCG continue to receive proxy data but have received assurance there is an action plan in place. Ashmount (residential service providing intensive support for 13

14 men with learning disabilities) a Care Quality Commission (CQC) inspection in May 2016 reported a requires improvement rating. The care home is within Surrey Downs CCG (SDCCG) area, who have reviewed progress against action plan, advising some improvement evident but further improvement required. The CCG will ensure oversight on these services. Staff issues flagged in the CQC report, in particular around services to people with learning disabilities and psychiatric intensive support services. The CCG has chaired two serious incidents panels on behalf of Surrey and lead the clinical review meetings. Virgin Care Ltd (VCL) VS flagged the performance issues in relation to continence response times, tissue viability, waiting times for completed autistic spectrum disorder diagnostic pathway, breast referral screening symptomatic (recovery plan in place with oversight by Public Health) There has been excellent improvement in therapy waiting times, in particular paediatric therapy. Care Homes There are a number of care homes within Guildford and Waverley rated requiring improvement or inadequate and work is underway with the local authority quality assurance team to ensure oversight and feedback to Quality and Clinical Governance Committee. It was noted this position had an impact on the number of care home placements available. DEB enquired the reason for the 62 day cancer wait performance (RSCH), being indicated green for the CCG and red for RSCH. SJ advised re-allocation of breaches had not yet been finalised which may have an impact. DWr advised breaches mainly relate to prostate cancer, and SJ responded the new prostate pathway should facilitate improvement. Following an enquiry from DEB on challenge to SECAMb in relation to Waverley response rates, VS advised the contract is agreed across Kent, Surrey and Sussex and allows compliance with performance targets to be achieved on the basis of aggregate rather than local response times. Discussions have taken place, as part of the recovery plan, to seek information at CCG level. The CCG have made representation to North West Surrey (commissioning CCG) requesting Guildford and Waverley CCG sign off for its contracted target response times. In response to a question from PB related to the reason for the below target performance of patient admissions to a stroke unit 14

15 within the 4 hour target, DEB advised this had been due to capacity and workforce issues, which the stroke services review has sought to address. Following a question from PB relating to the reason for the increase in reported absence without leave detailed on page 3 of the report, VS advised the issue was to be discussed at CQRM with Surrey and Borders Partnership Trust, with assurance back to March 2017 Quality and Clinical Governance Committee. ACTION: VS VS Following a question from PB on the increase in issues reported for Virgin Care Ltd, VS responded this may correlate with the increased level of granularity of the data now received by the CCG. JB asked if there were plans to populate the areas in the report that did not currently include data. VS advised where there is no national target it has been the practice to note not applicable. VS to feedback to the team for the report to be populated with information through KPIs. ACTION: VS VS ST welcomed the opportunity to ensure a consistent level of rigour across all serious incidents following adult mental health commissioning transferring to the CCG. VS advised meetings are held on a monthly basis, with reports shared with the CCGs where the incidents occurred, and their feedback received. The reviews include CCGs and public health. (1) To review quality performance. (2) To discuss additional actions required for areas of particular sub-optimal performance The Governing Body reviewed the quality performance and discussed as noted above. 4. Commissioning and Finance 4.1 Operational Plan Karen McDowell (KMc), presented the Operational Plan which was an annual requirement for the CCG. The plan had been presented to a number of clinical forums, committees and a Governing Body seminar and was subsequently signed off by the Chief Executive and submitted to NHS England (NHSE) on 23 December Feedback received from NHSE had identified minor amendments to strengthen a number of key areas. The Governing Body are asked to ratify the plan submitted on the 23 December 2016 and agree a mid year update on 2017/18. 15

16 KMc advised the detailed annexes which covered each workstream had not been included with the paper but were available on request. The Governing Body had no questions. (1) To ratify the submission made on the 23 December 2016 (2) To request a mid-year update on the 2017/18 Operational Plan The Governing Body ratified the submission made on the 23 December 2016, requesting a mid-year update on the 2017/18 Operational Plan. 4.2 Draft QIPP Programme 2017/18 Karen McDowell (KMc), presented the high level draft QIPP programme for 2017/18, which was work in progress. Each of the programmes will be clinically led with a number of the initiatives included in the programme forming part of the Joint Recovery Plan with RSCH. KMc highlighted items on page 4, item 9, reports STP unidentified equating to 4m. There is an expectation as part of the STP an element of recovery will feed through from the workstreams together with a number of unidentified schemes. Work is required over the coming months to close the gap. The QIPP Delivery Assurance Group will monitor progress and work is underway with RSCH to develop a joint recovery plan. Following a question from ST, KMc advised the interim Joint Transformation Director post was for a period of development of the recovery plan followed by a period of mobilisation (3-6 months). The Governing Body is asked to approve the 2017/18 QIPP programme noting that the STP schemes may be subject to change. The Governing Body approved the 2017/18 QIPP programme noting the STP schemes may be subject to change. 4.3 Draft Financial Planning 2017/ /19 Karen McDowell (KMc), presented the draft financial plan submitted to NHS England on 23 December KMc highlighted the key points from the paper: Page 3 the CCG has been set a deficit control total of 16

17 3.69m in 17/18 and 1.807m in 18/19, which is a challenging position going forward. Page 4 - overall planning - details the number of areas the CCG need to factor in, both national and local assumptions. A key impact for the organisation is the requirement for resolution of a national issues: the impact of the HRG 4 tariff with the CCG s main acute providers; and specialist commissioning with the change in the Identification Rules (IR). Confirmation and validation from Acute providers and confirmation from the CCG s regulators with regard to transfer of resources was awaited. The position is dependent on the outcome. Page 8 informs of the net gap to be met of c m in 2017/18 and 10.3 (estimated) in 2018/19 based on allocations notified to date, still to be confirmed. Page 9 identifies the risks for the CCG going forward, the main issue for 17/18 is the national issue of the impact of the HRG 4 and IR rules. The plan is work in progress. The 17/18 plans are dependent on the 16/17 outturn due to the transfer of recurrent costs going forward JB requested clarification that on the assumption of breakeven for 16/17, the financial plan for 17/18 is as presented and if breakeven is not achieved this will adversely affect the funding position for 17/18. KMc responded the regulators had already identified the CCG have an underlying recurrent issue hence the reason the control total set. She confirmed that any significant deterioration in this year s position will result in pressures going into 17/18. Following a question from PB related to the inclusion of provision for any increased expenditure from the stroke review, KMc advised provision had not been included as there is specific funding allocated for the service. Any increase in service costs would impact on the CCG s overall position. KMc advised modeling for 17/18 stroke review is being undertaken. To note the contents of the report The Governing Body noted the contents of the report. 4.4 Finance Report 2016/17 Month 8 Karen McDowell (KMc), presented the 2016/17 Month 8 finance report and advised the position remains challenging. The deficit at month 9 is 9.1m against a breakeven plan. The CCG continues to report delivery against forecast at outturn. There are number of financial risks reported in year, with unmitigated risks ranging between 9.3m and 13.8m as the worst case position. 17

18 The main unmitigated risk is continued over performance against Acute contracts (mainly related to non elective procedures) and slippage on some areas of the CCG s service transformation programme. There are a number of unmitigated risks against national assumptions, i.e. continuing health care increased costs. All of the CCG s contingency funds and reserves in year have been released to support the position. KMc reported the national exercise to review all commissioners month 9 positions, including unmitigated risk to identify the scale of the challenge. JB emphasised the considerable risk outlined by KMc and enquired from the Executive Team their confidence that the necessary resources were in place and engagement with providers to achieve the planned care QIPP target. KMc responded there was significant risk in the position, the worst case scenario factors in the slippage against the QIPP in the unmitigated risk. The schemes are reviewed and scrutinised with a focus on joint working with the provider to work together to deliver. Brain Mayers (BM) noted the equally challenged position in social care within Surrey, particularly around increased costs from providers and increased demand, exacerbated the position. BM reiterated the need for joint working. JI acknowledged the concerns related to slippage in planned care QIPP programme but highlighted positives, i.e. advice and guidance service. In response to a question from PB related to the detailed property overspend, KMc advised of the CCG s challenge to NHS Property Services in relation to void space costs, particularly in connection with properties that due to their current state were not attractive for renting resulting in the CCG being liable for the void space charge. The CCG are actively working with NHS Property Services to reduce this overspend. RECOMMENDED ACTION To review and note 4.5 The Governing Body reviewed and noted the report. Service Transformation 2016/17 Month 8 Karen McDowell (KMc), presented the 2016/17 Month 8 Service Transformation report highlighting planned care and delivery had been noted in previous items. KMc reported for 2016/17 the majority of the service transformation programme ( 12.7m) was linked to RSCH with a joint approach required to deliver transformation. There had been delays and 18

19 slippage on a number of schemes, particularly against planned care in the first two quarters of the year. Traction in this area is now being achieved with RSCH. The CCG is also working with other providers. KMc highlighted to the Governing Body the delivery of service transformation on all schemes with the exception of those with the main acute provider. Transformation change is required going forward to enable delivery of QIPP targets and is an area under the scrutiny of the QIPP Delivery Group. KMc advised positive reports received from the audit of the governance arrangements review, clearly demonstrated the CCG is on track, with further joint working is required to progress. PB expressed the Governing Body s gratitude for the considerable work undertaken by staff resulting in successful delivery of schemes and acknowledgement of sign up to joint working was required to progress some schemes. DWr reported an increase in contracts under planned care to BMI Mount Alvernia, which may be a reflection of waiting times at RSCH. Engagement was required with RSCH to review. RECOMMENDED ACTION To review and note 4.6 The Governing Body reviewed and noted the contents of the report Commissioning, Finance and Performance Committee Report October December 2016 Dr Darren Watts (DW), as Chair of the Commissioning, Finance and Performance Committee, presented the report giving the Governing Body oversight of the commissioning decisions taken at the October, November and December 2016 meetings. DW welcomed questions. There were no questions. RECOMMENDED ACTION To note the contents of the report The Governing Body noted the contents of the report. 5. Governing Body Sub Committee Minutes Dr David Eyre-Brook (DEB), Chair, invited Chairs of the Governing Body Committees to highlight any items with reference to the minutes circulated with the papers. There were no further items to report to the Governing Body. 19

20 5.1 GB1116/ 5.2 GB1116/ 5.3 GB1116/ 6 DISCUSSION AND NEW ACTIONS Audit Committee September 2016 The Governing Body noted the minutes Commissioning, Finance & Performance Committee September, October and November 2016 The Governing Body noted the minutes Quality and Clinical Governance Committee September and November 2016 The Governing Body noted the minutes Any Other Business There was no other business DEB invited questions from the floor. There were no questions. Meeting closed at 3.55 p.m. Date and venue of next meeting in public 25 April p.m. to 4.30 p.m. Venue: TBC Signed:. Date: 26 April 2017 Dr David Eyre-Brook, Chair 20