NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1 Minutes Date: Wednesday 28 February 2018 Time: Venue: Chair:

Transcription

1 NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1 Minutes Date: Wednesday 28 February 2018 Time: Venue: Chair: Attendees Members 12:00 noon to 2:00pm Boardrooms A, B and C, Kirkdale House, Leytonstone, E11 1HP Dr Anwar Khan, Chairman Name Initials Title Dr Anwar Khan AK Chair Alan Wells, OBE AW Lay Member, Deputy Chair Jane Milligan JMi Accountable Officer North East London Henry Black HB Chief Financial Officer Dr Ken Aswani KA Clinical Director, Leyton and Leytonstone Dr Dinesh Kapoor DK Clinical Director Leyton/Leytonstone Dr Ravi Gupta RGu Clinical Director Walthamstow Dr Mayank Shah MS Clinical Director Walthamstow Helen Davenport HD Director of Nursing, Quality & Governance Dr Tonia Myers TM Clinical Director Chingford Jane Mehta JMe Interim Managing Director Joe McDonnell JMc Acting Director Public Health, London Borough of Waltham Forest Linzi Roberts-Egan LRE Deputy Chief Executive, London Borough of Waltham Forest Althea Bart AB Healthwatch Manager Caroline White CW Lay Member ` Page 1 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

2 In Attendance Name Initials Title Caoimhe Garland CG Business Manager Apologies Name Initials Title Vineeta Manchanda VM Lay Member, Chair Audit Committee Dr Rizwan Hasan RH Secondary Care Consultant Dr Abdul Sheikh AS Clinical Director, Walthamstow Members of the Public in Attendance Name Initials Title Carl Edmonds CE Associate Director Strategic Commissioning Paul Rosenbloom PR Waltham Forest Save Our NHS Brian Steedman BS Waltham Forest Save Our NHS Noel Hayes NH Waltham Forest Save Our NHS Page 2 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

3 1. General Business 1.1 Apologies and Announcements AK Apologies were noted as above. 1.2 Declarations of Interest ALL In line with statutory guidance a declarations of interest checklist was reviewed by the Chair ahead of the meeting in order to identify any conflicts or potential conflicts of interest relative to the meeting agenda. There were no declarations or potential declarations of interest identified and none declared. The Governing Body Declaration of Interest Register is available on the NHS Waltham Forest Clinical Commissioning Group (WFCCG) website. A copy of the register was available to the Governing Body for this meeting. 1.3 Draft minutes from January s Board AK The minutes were approved with one amendment to 4.1 Finance and QIPP Report. However the CCG have yet to agree to a year end settlement with Barts Health. 1.4 Matters Arising AK JMe to send Terms of Reference for the newly merged Finance and QIPP Committee and Planning and Innovation Committee to the Governing Body members for comment and agreement. The final version will be brought to the Governing Body in March. Action: Chair s action to follow. JMe/HD 1.5 Chair and Accountable Officer Update AW/JMi Chair s Update AK noted that the first formal meeting of the Joint Commissioning Committee would take place in March AK informed the Governing Body that Waltham Forest were named as London s first Borough of Culture by the Mayor of London, Sadiq Khan. The London Borough of Culture is an award that will put culture at the heart of the community, celebrate the unique and distinctive creativity, character and diversity of Waltham Forest. Page 3 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

4 AK wished to express the CCG s sincere thanks and congratulations to the Borough of Culture team who have worked tirelessly over the past eight months. 1.6 Accountable Officer Update A further session to help establish the North East London Joint Commissioning Committee was held on 14 th February. This was run as an OD session however part of the session was simulating a Joint Commissioning Committee and considering a number of reports around the planning guidance, maternity and risk register. The session was successful and showed good participation from all members taking a North East London approach to issues with a strong focus on improving services and outcomes and making a difference. Some areas for improving services were highlighted including layout for the room, the overall format of papers and having sharper, more action focused reports that are presented jointly by the lead Joint Commissioning member and officers. The stocktake of arrangements across North East London CCGs is coming to the end of phase one and JMi will be discussing with the CCG chairs the particular areas to focus on to improve collaboration across North East London. JMi continues to meet stakeholders and staff across North East London as a key part of the Accountable Officer role. In the last few weeks a meeting has taken place with London Medical Council chairs and JMi has also attended the Outer North East London Joint Overview and Scrutiny Committee. Meetings have also taken place with a number of patient experience groups with the view to forming a network of patient experience leads across North East London to learn from each other and share good practice. JMi has also attended workshops for Sustainability and Transformation Programme leads across London to consider implications for London now that the planning guidance has been released and how this can help promote our ambitions around integrated care partnerships. Work continues on recruitment. Managing Directors posts were due to be advertised by the end of February. However this has been delayed and JMi will follow up with Human Resources to establish the go live date. Proposals for the Financial management arrangements will further be discussed at the Governing Body. AW asked for a timeline on when the Managing Director posts would be advertised as this was the last day of February and nothing had yet been confirmed. Action 03/18: JMi agreed to go back to HR and find out what the timeline would be. JMi Page 4 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

5 1.7 Questions from the Public AK Q1 The January Board noted, under the Board Assurance Framework Recommendations, that the risk element in relation to a structural reorganisation of the CCG s specific responsibilities remains and at this point in time is being managed and recorded through the directorate risk register processes. Has this risk now increased following the recent announcement by Jeremy Hunt of a pause in the implementation of Accountable Care Systems until further consultation has taken place? We understand the pause is a result of two areas wishing to set themselves up as a single accountable care organisation with a new accountable care contract to provide services. They have been challenged saying this new type of contract should not be used until the public has been consulted. A concern has been raised that this could be NHS privatisation of provision of services through the back door. Regarding local integration of services our proposals relate to integrated care systems. At this point in time we and our provider partners are not interested in forming a single accountable care organisation and delivering services through a single contract. We are working within the existing contracting framework available to us with our current providers we are working more with integrating services rather than organisations. Our structural change discussed under the BAF relates to the commissioning functions of the NHS and the risk in the main related to the loss of our local accountable officer. Q2 Newham CCG and Newham Council are to run a borough based Accountable Care System with Barts Health. Waltham Forest and Tower Hamlets will presumably do the same. Will Barts Health end up offering three levels of care to three separate borough ACSs? How would this be operated? How would it be equitable? We agree there is a risk that three separate integrated care systems will deliver different services and we are working with providers and other commissioners to mitigate that risk. In Waltham Forest we want to establish an integrated system around Whipps Cross Hospital because we don t want to form differential pathways for patients using Whipps Cross hospital from Waltham Forest or our neighbours in Redbridge and West Essex. We are therefore working very closely with Newham and Tower Hamlets CCGs and Barts Health in order to make sure that the end point for each integrated system is the same and is contracted for in the same way. We are also working with NELFT and ELFT and our local authority providers who have an equal part to play in an alliance of providers integrating their services. At this stage we cannot say how such a system will be operated as we work through how integration will take place we are clear that we need to make sure that the system remains equitable for all patients no matter where they live or access services from. We are attempting to test out how systems might work with our work in end of life care and urgent care and will use what we learn to inform our work in integrated systems as we progress. Page 5 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

6 Q3 Re Phlebotomy services: There still seems to be some confusion regarding the necessity or otherwise of fasting. In the Board minutes in March 2017 we find: However, NHS choices online still confirm that fasting is necessary for a blood glucose test (for diabetes) and an iron blood test (for iron deficiency anaemia). They do confirm that no fasting is needed for a cholesterol test. GPs should already be ensuring that they give patients correct advice on whether or not they need to fast prior to a blood test, although we recognise that there may be occasions where this is not clear for the patient. We are looking at what further information we can provide to our GPs via the practice portal and will be discussing and agreeing this with our clinical directors. We are also going to discuss with NELFT, the service provider, what information they can host on the blood testing page of their website to support patients who need information on fasting tests. At the meeting it was felt that question three was not answered in enough detail. The Governing Body therefore provided some clarity. AK advised that the general trend is for non-fasting however there will be some specific occasions when fasting will be required. TM advised that the routine primary care testing usually requires non fasting tests however there is an option on the online from that GPs should tick if fasting is required therefore making it clear for patients. DK stressed the importance of completing this form correctly. JM advised that the associated guidance would be re-issued. AW emphasised the importance of ensuring that the correct information was made readily available to the general public and patients. HD noted that differing advice on various websites was causing some confusion for patients and agreed to take an action to ensure that advise on websites across the patch were in line allaying any confusion for patients HD will also work with the Transforming Services Together team to ensure this is completed. Action 04/18: HD to work with the Transforming Services Together team to ensure that all websites are providing the same advice for patients relating to fasting before blood tests. HD Q4 In relation to the impact of The Mall housing development on local GP services, Stella Creasy reports the Council as stating: Page 6 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

7 The Waltham Forest CCG were also consulted and have advised that there are sufficient doctors surgeries within the local area to cater for future residents within The Mall development. In these respects, there would not be a strain on public services. Could the CCG confirm that this is also taking into account other developments in the market area eg near Sainsburys? To address the housing developments in Walthamstow, investments have been made in the local health services to ensure that the health care needs are met. Queens Road Medical Centre have been successful in securing NHS Infrastructure Grants which will see improved access and increase capacity. The St James Medical Centre development, will be a large purpose built facility of approximately 1500m2. It will help meet the expected population growth in the area. The new St James Medical Centre will operate as a health hub, offering multiple health services by delivering a fit for purpose build. Currently, we are developing an Outline Business Case and once approved will lead to a Full Business Case the development needs to undergo this process before it can be built. The build is expected to be completed by August As per the Estates Strategy we are working towards adopting a new model of care across the borough to develop Hubs and Networks which will encourage practices to work more collaboratively and can offer better access to patients. 2 Governance 2.1 Joint Commissioning Committee AW presented the North East London Commissioning Arrangements Report to the Governing Body. The report asked for the Governing Body to support proposals for new commissioning and governance arrangements across North East London. The paper set out the membership and leadership of the shadow Joint Commissioning Committee, the proposed arrangements for establishing the Joint Commissioning Committee including the Scheme of Reservation and Delegation and set out the constitutional changes required by North East London CCGs to establish the Joint Commissioning Committee and ensure it operates effectively. Membership/Leadership Each of the seven North East London CCGs will be represented by their Chair and a designated Lay Member. There will also be a Local Authority Page 7 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

8 non-voting member for each borough. Recruitment of the Nurse and secondary care consultant will commence in March The Chair of the committee will be selected and elected by the CCG chairs only. A deputy chair will be selected by the Chair from the CCG chairs. The vice Chair must be a Lay Member and will undertake chairing any meetings where the Chair/Deputy has a conflict of interest or a perceived conflict of interest. The Vice Chair will be selected and elected by the Lay Members only. Governance The terms of reference for the Joint Commissioning Committee were approved in shadow form at the December Governing Body meeting. The final terms of reference will be submitted to the Governing Body for March in time for the go live date in April Constitutional changes To establish the new joint commissioning arrangements requires changes to some CCG constitutions. The changes required enable the Joint Commissioning Committee and the Single Accountable Officer to operate within the framework agreed by the seven CCGs are set out below. The proposed changes reflect the advice given by each Governing Body when making the original decision to increase collaborative working in 2017 plus advice received from Capsticks and Beachcroft. The Scheme of Reservation and Delegation sets out the services and functions that the North East London Governing Bodies wish to delegate to the newly established Joint Commissioning Committee. These align to the outlie scheme of delegation proposed in the September 2017 Governing Body. AW noted that the members council were required to agree any constitutional change and that NHS England had previously issued guidance for all CCGs which they were required to follow. CW sought clarity relating to committees in common. AW clarified that the only committee that had taken place in common was Remuneration Committee. AW stated that there was a need to look at a system rather than set up new committees in common across the seven as this had not proved possible. JMi noted that Remuneration Committee in common could be utilised to discuss matters relating to Transforming Services Together. Common meetings will be required and emphasised that the only meeting in common currently taking place was Remuneration Committee. DK asked if any sessions were planned to look at what meetings were taking place and if these could be reduced. Page 8 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

9 JMi stated that there was a stocktake of meetings taking place and also of tenures relating to clinical director and clinical leads and that the outcome will be presented to the Governing Body. JMi stressed the importance of these reviews and the importance of getting the best value from people s time. MS requested clarity on what the conflicts of interest in relation to the constitution were JMe stated that this only impacts some CCGs and not all. Following the guidance issued by NHS England Waltham Forest CCG has already put in place guidance in its constitution by appointing a Conflicts of Interest Guardian and a terms of reference for the Primary Care Commissioning Committee. Barking Havering Redbridge did not do this and that is the reason for the statement in the report. LRE requested that the Governing Body recognised the importance of local leadership at borough level and of local accountability. AK agreed that this was very important and referenced medicines optimisation as an important example of local working. AK also noted that it was vital not to lose what was important about CCGs and that strategic alignment and feedback was required at a North East London level. AW noted that the Governing Body should not take the view that there will be no changes to the CCG. Although it was clear that the CCG should keep what is working well and look at where things can improve across a larger footprint the CCG cannot continue as it is because the Governing Body has voted for change and change will take place. TM agreed with AW s idea of working at scale and looking at sharing good practice however the test will be getting the balance right, looking at gaps and how we fill them without losing local interest. AW noted that in relation to a committee in common one CCG is unable to overrule another and requested that some of the wording on the report under Committees in Common was reworded, particularly section 20. Agreed that AW/AS would work on this. Action 05/18: AW/AS to work on wording and clarity in the committees in common section of the North East London Commissioning Arrangements report. The Governing Body approved the report pending slight changes to the committees in common section. AW/AS Page 9 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

10 3. Performance and Quality JMe/HD 3.1 Performance Report JMe presented the performance report to the Governing Body for approval. JMe The CCG currently has eight high risks, five medium risks and 14 low risks. 17 indicators are currently meeting their target on the latest performance data. High risk indicators Eight targets are considered high risk to delivery. These are: Cervical Cancer Screening Diabetes Structured Education Renal CHC Assessments in 28 days E-referrals A&E Performance at Whipps Cross Pressure ulcers at Whipps Cross Delayed Transfers of Care Based on the latest data the CCG does not expect to meet these targets for 2017/18. The Governing Body was requested to note that all but three indicators have shown improvement in 2017/18 including Home Births, Cervical, CHC, Pressure Ulcers, and Delayed Transfers of Care. The most challenged targets have been; Diabetes the CCG continues to focus on patient engagement and referrals to both the face to face and the online training services. The CCG is also raising awareness with GPs. Structured Education is recommended for both new and existing diabetes patients. Renal - The performance of the renal target is being investigated due to potential data errors from the Barts Health submissions. The CCG is continuing to work with GPs to make referrals to the virtual clinic rather than to Whipps Cross outpatients. Presentations have been made at the locality meetings to support referrals and performance has improved in the latest month. A&E Performance - A&E performance is below the target, but showing improved performance compared to last year. Recent improvement is attributed to improved bed availability, reduced numbers of patients with long lengths-of-stay, and the expansion of ambulatory care. Emergency Department attendances have not seen any increase in 17/18 and Delayed Transfers of Care are low compared to recent periods. Continuing Healthcare Performance performance against the 28 day target has improved and the target was met in December. However, there remains a risk related to the proportion of Continuing Healthcare assessments completed out of hospital. This is an additional target that NHS England has asked CCGs to monitor in 2017/18. In quarter four 55% of Page 10 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

11 Continuing Healthcare assessments were completed in hospital against a national target of 15%. The CCG plans to meet this target by the end of the year and has increased the capacity of the community team. E-referrals whilst performance is below target it was recognised at the start of the year that the national target was extremely challenging. Waltham Forest CCG s performance is above the London average performance and has improved from 46% at the start of the year. JMe updated that the London Ambulance Service have implemented the Ambulance Response Programme (ARP) in November This replaced the national response time standards and put in place a new call prioritisation system which sets the standards for all 999 calls to ambulance services including those passed to ambulance services via 111. As part of the new system call handlers will be given more time to assess the caller s symptoms and this is expected to ensure better identification of the sickest patients. CCG-level reporting is currently unavailable. There remains a risk for WFCCG as performance in the borough has historically been significantly lower than the London level. This will be monitored as soon as results are available. The ARP is expected to have a beneficial impact on patients as it improves the prioritisation of calls and ensures good response times for the sickest patients. London Ambulance Service are working with commissioners to review and design the appropriate suite of reports to capture the new range of metrics TM stated that NELFT had an adequate resource to meet the IAPT target. JMe noted that the CCG is currently working with NELFT to meet the IAPT targets and that NELFT had struggled with recruitment. TM requested some clarity on the number of patients accepted into the IAPT service. Action 06/18: NA to request clarity on the number of patients accepted into the IAPT service. November data for GP Family and Friends Test showed an influx of data from one particular practice. The data shows that the percentage of patients to recommend their GP practice dramatically decreased in November 2017 and the number of response rates has also increased. One practice submitted a high number of responses compared to previous months, adding up to more than the entire borough. CW asked if there was evidence that the diabetes structured education worked? The Clinical Directors felt that it was positive. DK noted that there was a good dietitian service via NELFT. However TM noted that it is only Page 11 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

12 successful for patients who engage and follow the course to the end and that there was currently a large drop out level. HD noted that the diabetes structured education programme had been discussed at the Medicines Optimisation Committee in relation to prevention and public health. MS stated that the structured education ran for six weeks which precluded people who were working and that there were also language barriers. TM felt that there was also a need to resolve the issue of language barriers for the programme. Action 07/18: JMe to look into the Friends and Family Test to see why there was such an increased level of response from one particular practice for November. JMe This has been queried with the practice and they have reported that this is due to a bulk upload of backdated Friends and Family Test data that has now been rectified. Action 08/18: JMe to look into language options for structured education. JMe Quality HD presented the quality report to the Governing Body for approval. Whipps Cross Hospital Barts Health NHS Trust have been out to procurement for a new patient experience solution to collate the Friends and Family Test (FFT). From 1 st March Membership Engagement Services are the new provider. Friends and Family Test response rate in the Emergency Department (ED) did not achieve the 20% response rate target in December, reaching 16%. There were four overdue serious incidents (SIs). There was one grade four pressure ulcer reported in November and seven grade three pressure ulcers were reported. HD noted that there was an improvement in pressure ulcers and that the majority of pressures ulcers were acquired in the patient s home rather than at Whipps Cross. The CCG is working with Whipps Cross to address this issue. One case of MRSA was reported in November. There were no Never Events reported. 38 complaints were received in December and 56% of complaints were responded to within the agreed timeframe. Work is ongoing with Whipps Cross to move away from the restrictive time frames and to have more engagement with families. The contract performance notice is currently still active. Page 12 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

13 North East London Foundation Trust (NELFT) Currently non-compliant with 85% target for Safeguarding Children Level 2 and life support training. No complaints were open more than 90 days and 100% of complaints were responded to within the agreed timeframe. 0 cases of MRSA and Clostridium Difficile (C.Diff). 0 overdue SIs. Percentage of staff sickness is reported above the 4% target at 4.20%. Care Home Care Quality Commission (CQC) reports CQC published reports on five residential homes in November Four were rated good overall however Kestrel House was rated required improvement. The Governing Body had no questions and the report was approved. 4.1 Finance Report HB HB presented the finance report to the Governing Body for approval. The report provided the financial position for Month 10, January and provided projections of income and expenditure to year end. The Governing Body was asked to note that CCG s have been instructed by NHS England to move to reporting in year surplus rather than total surplus in order to be consistent with provider reporting. This removes the return of the prior year surplus from our headline reporting and changes the planning surplus for 2017/18 to 0.27 million. Financial pressures have meant that at month 10 the CCG reverted to the original control total of 0.27 million and in addition are now reporting an in year deficit of 1.46 million. This follows discussion with NHS England regarding the treatment of pressures on non-stock medicines where the full overspend has been included in Month 10 forecast. However it is expected that this will revert to plan at Month 12 when the currently uncommitted nonrecurrent headroom of 1.7m is released. It should be noted that there remain significant risks to the achievement of this position. HB requested that the Governing Body noted the key points: The CCG was reporting breakeven against our plan year to date and is now forecasting to deliver a deficit of 1.46 million at year end after the application of all reserves and excluding the impact of the return of prior year surplus. At month nine the CCG had a forecast to deliver a control total of 0.37 million which generated a small contribution to offsetting financial pressures within the BHR health economy. The deterioration in the forecast position in month 10 reflects national tariff pressures on non-stock medicines. The CCG expects Page 13 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

14 an improvement at month 12 when the non-recurrent headroom of 1.7 million is released. In line with planning guidance for 2017/18 at month 10 there have been no commitments made against the 1.7 million non-recurrent headroom reserve. Barts Health have submitted SLAM data for month 9 and based on freeze data for April to November and December flex data we are now projecting a 4.8 million deficit against plan at year end. There has been a significant increase in the flow of patients to mental health services outside of North East London. At month 10 the CCG are projecting that QIPP savings of 95% of the plan will be achieved. The CCG is projecting a breakeven position against the 38.8 million primary care budget. HB stressed that the CCG were in a difficult financial situation and it could not be over emphasised how strained finances are and will continue to be next year. The Governing Body were informed that this year, 2017/18, the CCG would just about manage a break even position however next year, 2018/19, would be incredibly difficult. CW asked for clarity on what the projected financial position means and how it will impact on Waltham Forest going forward with the alliance. HB clarified that it does not mean the CCG will break our statutory duty but stressed the fact that until the CCG QIPP plan is rated green the CCG will not be able to agree a balanced 2018/2019 budget. HB noted that it would be challenging but not impossible. KA stated that he did not feel as though the level of referrals had increased however he did feel that there had been an increase in the number of letters to say that patients have been admitted in the acute and that this needed challenge. KA requested that the CSU conduct an audit on this. Action 09/18: CSU to have audit regarding the number of letters received by GPs to state that patients have been admitted to Whipps Cross. HD AK also noted that there had been an increase in A&E attendance. MS requested clarity on the referral to pathway for two week cancer where GPs were encouraged to refer and would this affect the referral target. AK emphasised that the two week referral for cancer should stay as a standard referral and should not be reviewed. TM noted that she had never thought about the two week wait in relation to pushing up the number of referrals and that it would be interesting to unpick the numbers and resource used for this. Action 10/18: HD agreed to investigate procedures relating to referrals for two week wait and normal referrals. HD MS emphasised that community care was equally important and should not be cut because it is easy. MS also felt that there was a need for real Page 14 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

15 discussions on decommissioning services in all areas and not just easy areas. AK agreed that creative thinking was required. JMi stated that she felt the outpatient s piece of work was key to transformation and that looking across the system and working with Barts Health and NELFT/ELFT at the system delivery board would help. JMi also stated that there was a need to start to look at post 2019/2020 and recognise resource is tight while also recognising that there is a lot of waste in the system. MS believed that the patients flowing out of East London with specialist requirements did not explain the increase in the level of referrals. JMe noted that there were some expensive packages of care for a variety of patients which are adding to the strain on finances and that there was a need to look at details. Action 11/18: HB agreed to conduct some analysis on number of specialist referrals. HB HD explained that the CCG would need to review all high cost Continuing Health Care packages as many are no longer sustainable. The Governing Body agreed that it was important to consider what can be done at Primary Care to avoid acute admissions. HD noted that it may be difficult for members to be familiar with the new models of care because they have not been directly involved with Transforming Services Together. TM asked if there was scope for CCGs who have surplus to support those with deficits. JMi explained that Waltham Forest had previously benefited from support from other CCGs and that CCGs are still statutorily responsible for their own financial position. There is an expectation for the CCG to manage their own resource. However there was a risk share arrangement in place and this would be utilised to support transformation across North East London. TM requested clarity on the medicines issue. HB informed the Governing Body that the issue had been a national issue with unavailability of generic drugs throughout the year and because of this more expensive ones had to be used in their place. JMi noted that the STP for 2017/18 across North East London was worse than plan for all CCGs apart from City and Hackney and BHR were already in deficit for 20m and expected to be 25m by year end. LRE stated that adult social services were projected to be 1.9m overspent. She noted that there cannot be a system response without understanding the system pressure with concern for the whole of North East London. LRE also emphasised the importance of value for money from providers both Page 15 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

16 locally and across the seven. She also requested that the Governing Body note the distance travelled by Waltham Forest and how issues are not necessarily being managed as well in other areas and that this was a cause for concern given the potential impact on Waltham Forest. The Governing Body approved the report 6. Strategy and Planning JMi 6.1 North East London Transformation (NEL Commissioning Alliance and East London Health & Care Partnership) JMi presented the report to the Governing Body for review. The plan is to bring an update report to each Governing Body meeting. The report updated the Governing Body on the progress made by the East London Health and Social Care Partnership to deliver the North East London Sustainability and Transformation Plan. A review of the current North East London Sustainability and Transformation Plan has started. This is to take account of the updates to the Five Year Forward View, the latest Planning Guidance issued by NHSE and the information of the North East London Commissioning Alliance. This will set out the key decisions and deliverables for 2018/19. A further update will come to the March Governing Body. In addition to this a review of the organisational development plan is also taking place. This will build on the early success of the programme in securing support from staff college to support medicines optimisation end of life care and diabetes work and with the Dartmouth Institute to support Integrated Care partnerships. JMi 6.2 Planning for the Future JMi JMe presented the paper planning for the future outlining The rationale for integrating our commissioning functions and the benefits of service integration. Summarised the various discussions we have been having in the last 12 months about the future of commissioning and provision within local health services and how this links with the national and East London health and care partnership proposals. Made recommendations on the key priorities and resource requirements for 2018/19 support. Sought agreement for in year funding in region of 250K to support the further development of integrated care systems in Waltham Forest and the Whipps Cross Hospital footprint. JMe noted that the new terminology is integrated care systems rather than accountable care systems. Page 16 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

17 The Governing Body agreed the recommendations laid out in the paper and endorsed in principle the formal establishment of a Whipps Cross Alliance with fellow commissioners and providers as well as agreeing to earmark for 2018/19 ongoing funding to support the alliance work programmes and agreed that a detailed work-plan and associated resource allocation would be submitted to the March Governing Body for approval. The Governing Body also agreed that the development sessions would be used to agree key priorities for 2018/2019 and to explore how members and the CCG workforce will need to adapt and reprioritise their work programmes to deliver integrated system working. JMe requested that working as part of an alliance it would be useful to share learning and legal advice where possible and therefore eliminating the need to pay for this twice. HB queried use of the funding. JMe noted that some of the CCG funding would support the jointly funded ICS senior post NELFT, WX and the council had been discussing. This might be on an interim basis whilst the permanent post JD and associated work plan was developed and agreed between partner. Other uses of the funding might be to bring in expert advice, run workshops for staff and stakeholders and for development sessions. KA noted that the Better Care Together Board had a lot more engagement at director level with attendance at meetings increasing. AK noted the importance of the alliance with workstreams such as end of life where there was an opportunity for all to work in partnership. HB noted that the CCG had made a positive decision to combine the Planning and Innovation and the Finance and QIPP Committee. JMe stated that combining both committees will help with transformation. AB stated her concern that there was nothing relating to the patient voice in the report. AK and JMe clarified that patient participation had been referenced in the report where the CCG would require support to ensure this was done correctly. JMe confirmed that a more formal report would come to Governing Body in March with a localised agreement and MOU with providers. The Governing Body approved the report and the specific recommendation regarding funding. Page 17 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

18 7. For Information 7.1 Minutes of the Audit Committee HB There were no comments. 7.2 Minutes of the Performance and Quality Committee HD There were no comments. 7.3 Minutes of the Planning and Innovation, Finance and QIPP Committee JM There were no comments. 7.4 Minutes of the IT Committee HB There were no comments. 7.5 Minutes of the Primary Care Commissioning Committee JM There were no comments. 7.6 Minutes of the Patient Reference Group HD There were no comments. 7.7 Actions from Leyton/Leytonstone, Chingford and Walthamstow Locality Meetings There were no comments. All CDs 8 Forward Plan N/A A.O.B. TM raised the issue of the minutes of the CCG committees no longer coming to Governing Body in hard copy and felt that a cover sheet would be helpful to ensure that no important issues were missed. JMe/AK emphasised that it was the responsibility of the Governing Body members to read the minutes and keep themselves updated. Action 12/18: HD suggested that there could be an item added to Governing Body similar to the Performance and Quality Committee titled items for escalation rather than have an executive summary and that Chairs for the individual committees will take responsibility for taking this forward to Governing Body. AW stated that at the end of each meeting the Chair will confirm items for escalation to the Governing Body. AK Signature Date Page 18 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

19 Next meeting Date: 21 March 2018 Time: Venue: Boardrooms A,B and C, Ground Floor, Kirkdale House, Leytonstone, E11 1HP Page 19 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1