MINUTES. Nottingham North & East Clinical Commissioning Group Governing Body Meeting Held 17 November 2015 at Gedling Civic Centre

Transcription

1 GB 16/004 MINUTES Nottingham North & East Clinical Commissioning Group Governing Body Meeting Held 17 November 2015 at Gedling Civic Centre Present Dr Paul Oliver (PO) Chair and Clinical Lead (Chair) Terry Allen (TA) Lay Member Financial Management & Audit Dr Mohammed Al-Uzri (MA) Secondary Care Consultant Jonathan Bemrose (JB) Chief Finance Officer Nichola Bramhall (NB) Registered Nurse, Director of Nursing & Quality Dr James Hopkinson (JH) Assistant Clinical Chair Dr Amelia Ndrika (AN) GP Representative Dr Paramjit Panesar (PP) Assistant Clinical Chair Stephen Storr (SS) Patient and Public Representative, Observer Sam Walters (SW) Chief Officer Mike Wilkins (MW) Lay Member Patient & Public Involvement Apologies Paul McKay (PM) Service Director, Nottinghamshire County Council In Attendance Hazel Buchanan (HB) Andy Hall (AH) Sharon Pickett (SP) Sally Seeley (SSe) Martin Whittle (MWh) Director of Operations Director of Outcomes and Information Deputy Chief Officer Director of Quality and Delivery, NHS Nottingham City CCG Martin Whittle Consultancy Ltd Agenda Items GB 15/143 GB 15/144 GB 15/145 Welcome & Apologies Dr Paul Oliver (PO) welcomed members and attendees, with apologies noted as per above. Declarations of Interest No further declarations were made relevant to the agenda. Questions from the Public relating to the Agenda No questions from the public were raised prior to the meeting. Actions

2 GB 15/146 Minutes of the Last Meeting The minutes of the meeting held on 15 September 2015 were accepted as an accurate record with the following changes: Confirmation that the Primary Care Home initiative is a multi-specialty community provider (MSCP). Decisions made through the Transformation Board will not compromise the statutory duties of individual organisations. The annual report for the Audit and Governance Committee will be considered in the November meeting. GB 15/147 Matters arising and actions from the meeting held on 15 September /121ii Andy Hall (AH) confirmed that there has not been a shift in elective activity due to a changing trend in outpatient referrals. There has been a comparative growth in elective admissions and a dissimilar trend in outpatient attendances and GP referrals. AH suggested that this could be an area of focus for Dr Emma Pooley in order to understand what changing behaviour is, clinically. AH to discuss with Dr Emma Pooley. AH confirmed that the conversion rate has shifted from weeks to closer to 18 weeks. AH highlighted the need to focus on clinical variation and specialisms that are moved from the hospital to primary care. PO challenged AH as to whether behaviour in secondary care is impacting on changes in activity. AH confirmed that there are different patterns of referrals between Clinical Commissioning Groups (CCGs) and GP practices. AH 15/124i AH confirmed that information is to be received on diagnostic rates. AH s team will analyse fully when received. 15/124ii AH confirmed that data not available yet. To be carried to next meeting. 15/124iii AH confirmed that actions are being taken forward by Arriva. 15/126 Nichola Bramhall (NB) confirmed that all information is included in the quarterly quality report. GB 15/148 Chief Officer and Chair Report Sam Walters (SW) introduced the report and highlighted the following points: Better Care Fund : SW highlighted that there will continue to be a Better Care Fund in 2016/17. Confirmation 2

3 of minimum spends to be received. SW confirmed that there will continue to be local flexibility alongside greater clarity from the centre with regards to the policy. Annual Assurance Letter 2014/15: SW confirmed that the CCG continues to be assured with support. SW referred the Governing Body to the letter received from NHS England, which was very positive. Devolution Of Specialist Wheelchairs And Neurology Outpatient Services: SW highlighted that commissioning of neurology may be devolved to CCGs. Dr James Hopkinson (JH) emphasised the risks in taking on neurology. SW emphasised that decisions on devolution have been paused and the CCG should keep sighted on this. Share Patients Direct Care Information: SW emphasised the benefits for direct patient care in defaulting to using and sharing the NHS number. SW confirmed that Social Services in Nottinghamshire are using the NHS number. Affiliated Commisioning Committee: SW confirmed the establishment of the Collaborative Commissioning Committee which includes 19 CCGs in the East Midlands. This allows CCGs to work collaboratively on areas such as Procedures of Limited Clinical Value. SW confirmed that also, through the Committee, workforce and quality issues in hospitals that will affect neighbouring hospitals will be discussed in order to pre-empt the impact and mitigate risks. The Committee is looking at all services that might be a threat and considering how to take forward as a collective. Primary Care Transformation Fund: update: SW confirmed that the infrastructure fund has to be aligned with CCG plans. The Primary Care Commissioning Committee (PCCC) will oversee and support the process. In response to a question raised by Mike Wilkins (MW) Sharon Pickett (SP) confirmed that submissions need to be made with CCG support. Terry Allen (TA) highlighted the benefits of an indicative budget for the Committee. SP confirmed that proposals are being funded from a national pot, with not indicative budget at CCG level. The PCCC will review proposals against the strategic direction and estates strategy of the CCG. Consultation On The Mandate To NHS England: SW requested that the Governing Body review and comment on the NHS England Mandate which is open for consultation. SW confirmed that NHS England have doubled the funding for the pharmacist scheme. They are looking to employ 403 new pharmacists. SW confirmed that NHS Nottingham West CCG and NHS Mansfield and Ashfield CCG have practices who are involved in the scheme. 3

4 GB 15/149 NHS Nottingham North & East CCG Governing Body Peer Review with NHS Hardwick CCG PO welcomed Martin Whittle (MWh) who thanked the team who took part in the peer review. MWh confirmed that the process used resources from the Good Governance Institute. MWh emphasised that the process of the peer review is a real opportunity to look at what and how the Governing Body are functioning in a non-judgemental environment using appreciative enquiry. MWh confirmed that a list of areas for consideration and rationale for appreciative enquiry was developed by the Governing Body team as part of the process. MWh emphasised that since links had been made with NHS Hardwick CCG it would be beneficial to maintain a process with them. TA emphasised that it was a useful process that was embraced appropriately. Both CCGs found areas where improvements could be made and new areas to investigate further. Dr Parm Panesar (PP) thanked MWh for the exercise which was very useful and sharing learning was productive. Nichola Bramhall (NB) highlighted benefits in buddying with NHS Hardwick CCG on other areas. SW confirmed that the recommendations of the peer review would be discussed in more detail at the Governing Body development session. Thanked Martin Whittle and NHS Hardwick CCG and supported on-going peer review. QUALITY GB 15/150 Transforming Care Nottinghamshire Fast Track PO welcomed Sally Seeley (SSe), Senior Responsible Officer for the Fast Track. SSe confirmed that the plan covers all of Nottinghamshire, including Bassetlaw. SSe confirmed that there are six fast track sites. SSe confirmed that funding is available on condition that CCGs match fund. Plan needs to be delivered over three years. The outcome is to transform the offer that patients have access to and to reduce beds through appropriate support. SSe confirmed that there are six workstreams constituted with individuals from across Nottinghamshire. Service user and professional reference groups will be established to support the programme. Consultation will be carried out as transforming care is about changing the service model. In response to a query raised by PO, SSe highlighted that the plan includes changing people s assumptions that the hospital is the best place to be. NB emphasised the risks in the pace, however it provides 4

5 the impetus to drive forward change. The programme will be monitored on two separate trajectories fast track and Winterbourne. One is dependent on the other. Consultation will be vital. SSe emphasised that benefits in collaborative working. MW emphasised the links with the People s Council and the proposed principles in Partners in Health. SSe also emphasised the links with Social Services and confirmed that Caroline Baria is the deputy Senior Responsible Officer. In response to a query raised by SW, SSe confirmed that the programme will provide the right bed base for the local population. A mapping process will be conducted of what currently have and what is needed. In response to a query raised by SSe, the Governing Body confirmed that they would like six monthly updates through a highlight report. To be put on forward planner. Bridget Meats : Supported the programme and governance arrangements. GB 15/151 Quality Report Q2 2015/16 NB presented the quality report and confirmed that it had been considered in detail at the Quality Risk Committee. NB highlighted that NHS Nottingham North and East (NNE) is now rated green with respect to healthcare associated infections. NB emphasised that Nottingham University Hospitals NHS Trust has not deteriorated as expected, however with winter there is the likelihood that will increase. Ongoing detail will be included on performance against cleanliness ensuring that data is contextualised. NB confirmed that the Trust Development Authority is carrying out training with matrons on cleanliness. NB has received assurance that issues are being addressed appropriately through actions that are being taken in identifying appropriate leadership and development support, restructuring nurses. NB highlighted that NNE are three cases behind trajectory. Concerns have been raised to NHS England. NB confirmed that there is a five stage process for retrospective reviews and the first three stages are very labour intensive. Reporting will be provided to break down who is at what stage in order to provide a greater level of assurance. NB emphasised the risk of another window opening up which covers from April The contract with Arden and Gem Commissioning Support Unit ends March Of the cases reviewed to date 91 per cent have been considered ineligible. Legacy funding is available. In response to a query raised by TA, NB confirmed that there has been a slight increase in pressure ulcers and 5

6 there does tend to be a spike at this time of year. Actual numbers have come down. : Acknowledged the Quality Report. GB 15/152 Patient Story NB presented the patient story which was from the perspective of a carer. It describes a disjointed experience of care, particularly in relation to how carers can access support. Recommendations are included with the story. PP supported the recommendations and the need to promote for GP practices. Hazel Buchanan (HB) outlined the role and responsibilities of Carers Champions in each member practice. HB emphasised that the role has been introduced to support member practices aligned with the recommendations, as opposed to adding any additional pressures. Acknowledged the patient story. GB 15/153 Serious Incident Annual Report 2014/15 NB presented the serious incident annual report. Acknowledged the report. GB 15/154 Quality & Risk Committee Terms of Reference Annual Review NB presented the terms of reference and no further comments were made. Approved the terms of reference. FINANCE AND PERFORMANCE GB 15/155 Finance Update Finance Position Activity Report Month 6 Jonathan Bemrose (JB) presented the finance update and position for month seven. JB confirmed that the CCG is on track to achieve the required surplus. Quality, Innovation, Productivity & Prevention (QIPP) continues to be a challenge and the Finance and Information QIPP continues 6

7 to focus on different areas to review and support progress against plans. JB highlighted the continued risk in Nottingham University Hospitals NHS Trust due to ongoing variance against plan. JB confirmed that Nottingham University Hospital is expected to recover their financial position before the end of the financial year. Discussions are ongoing to agree forecasted outturn. : Acknowledged the financial position and key points in the Activity Report. GB 15/156 Financial Deep Dive (Letter from Wendy Saviour) With reference to the letter received from Wendy Saviour, JB presented the financial deep dive to the Governing Body. JB highlighted that since the deep dive the CCG has had three good months and NHS England are more assured on the CCGs performance. Acknowledged the financial deep dive information GB 15/157 Draft Financial Plans 2016/ /19 JB presented the draft financial plans. All CCGs have been provided with base case assumptions which include net provider efficiency of 2 per cent, reduction in running costs of 5 per cent year on year, 1 per cent cumulative surplus year on year and a QIPP plan between per cent. NNE allocations are slightly different to the financial paper due to in year changes. JB highlighted that QIPP is a constant challenge. The CCGs are working with Nottingham University Hospitals NHS Trust to plan based on what money have as a system and how to deliver against defined principles. A proposal will go to Nottingham University Hospitals NHS Trust Contract Executive Board. This approach links to Greater Nottingham Health and Care. If any envelope can be agreed this will form the basis of a plan over three years. : Approved the draft financial plans and supported system based planning. GB 15/158 Finance and Information Group TA highlighted that most points have been raised through other agenda items. At the October 2015 meeting it was identified that the CCG is an outlier in 111 calls and a deep dive report was presented back at the November

8 meeting. The CCG have a high proportion of 111 calls and this will be raised for discussion in the Clinical Cabinet. : Acknowledged the minutes and discussions held. GB 15/159 Performance Report November 2015 AH presented the performance report and the following key points were made: The quarter three Nottingham University Hospitals NHS Trust emergency department position is below target. AH highlighted the importance not to lose momentum to resolve and to continue to achieve benefits through the System Resilience Group. There are a series of discussions happening at the System Resilience Group and an effort to continually re-evaluate how initiatives are working and whether people are operating in a consistent way across the community. There will be a Super Tag meeting to kick start. For the south CCGs as a community and for patients, performance is better but it is not where the CCG would like it to be. There are a series of meetings and discussions planned with Nottingham University Hospitals NHS Trust to improve services including pathway redesign and variation at GP practice level. Referral to Treatment (RTT) is on target. NNE is affected by Sherwood Forest Hospitals NHS Foundation Trust and so performance is not as high as other south CCGs. AH confirmed that RTT rules changed 01 October 2015 which introduced new risks. There is a risk at the end of the month that the CCG will have a 52 week waiter and AH has asked Nottingham University Hospitals NHS Trust to have a clear audit trail on discussions with patients. In response to a query raised by PO, AH confirmed that private providers are used to ensure delivery of the RTT target. AH highlighted that delays may be through a lack of escort for patients in prison or where have been waiting in another Trust. AH highlighted that Trusts do a very good job in managing waiting lists. AH confirmed that spines are moving into Trauma and Orthopaedics and the private sector will be utilised to balance out the risk. AH highlighted the patient transport service action plan is included in the performance report and contractual levers are being applied as relevant. PP highlighted that performance in upper and lower gastrointestinal cancer services stands out. There are a significant number of breaches. AH highlighted that audits need to be carried out with Nottingham University Hospitals NHS Trust. PP challenged that there needs to be pressure 8

9 and progress through auditing on facets of capacity and confirmation in GP Practice. Acknowledged performance. PLANNING GB 15/160 Strategic Estates Plan SP presented the draft estates plan. A local estates forum has been established and Community Health Partners have been supporting the production of the plan. SP requested approval for the plan provided with delegated authority to SW and JB for final approval. This is due to a final submission date of the end December SP confirmed that the strategy is integrated across the south and is also being considered county wide. There is a push to rationalise the estate. The strategy considers where more capacity is required due to housing developments. emphasised that the strategy is a brilliant piece of work. In response to a query raised by MW, SP confirmed that a more definitive service model is required in relation to links with primary and community care. In response to a query raised by Stephen Storr (SS), SP confirmed that the local estates forum will be opened out to include social services. Dr Amelia Ndirika (AN) highlighted that it is difficult for practices to pull together a plan and they need a steer from the CCG and a wider perspective on primary care. Approved the strategy document with final approval to SW and JB. The submitted version is to be circulated to the Governing Body. SP GB 15/161 Clinical Cabinet Update Due to time constraints this agenda item was not discussed however no comments were raised in relation to the minutes. GOVERNANCE GB 15/162 Audit & Governance Committee TA highlighted the minor change in the terms of reference in relation to counter fraud. The annual report was deferred from the last meeting and the attached version has been recommended by the Audit & Governance Committee. TA highlighted from the minutes that the external auditors need to be appointed locally from 2017/18. A 9

10 Nottinghamshire/Derbyshire process is being considered, including with providers if relevant to timescales. : Approved the terms of reference. Acknowledged the annual report and the minutes. GB 15/163 Information Governance, Management and Technology Committee Terms of Reference. AH presented the terms of reference and confirmed updates in the highlight report. Approved the terms of reference. ENGAGEMENT AND INCLUSION GB 15/164 Peoples Council Update SS highlighted the focus on community pharmacists. Partners in Health will be presented to the Clinical Cabinet. Acknowledged the discussions in the Peoples Council. DOCUMENTS GB 15/165 *Minutes a) Nottinghamshire Safeguarding Adult Board Highlight Report October 2015 b) Open Safeguarding Committee Minutes July 2015 ratified c) Open Adults & Children s Highlight Report September 2015 d) Quality & Risk Committee Minutes July 2015 ratified e) Quality & Risk Committee Highlight Report October 2015 f) IGM&T Minutes & Highlight Report g) HWB Summary September & October 2015 : Acknowledged the minutes. GB 15/166 Reports a) Primary Care Commissioning Quarterly self-certification of compliance : Acknowledged the report. 10

11 CLOSING ITEMS GB 15/167 Have the Public Questions Been Answered No questions from the public were raised. GB 15/168 Any other business No further business was raised. Date, Time and Venue of Next Meeting Tuesday: 19 January 2015, Gedling Civic Centre, Arnold. SIGNED:. (Chair) DATE:.. 11