NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1 Minutes

Transcription

1 NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1 Minutes Date: Wednesday 22 March 2017 Time: Venue: Chair: 12:00 noon to 2:00pm Boardrooms A, B and C, Kirkdale House, Leytonstone, E11 1HP Dr Anwar Khan, Chairman Attendees Members Name Initials Title Dr Anwar Khan (part time) AK Chairman Alan Wells, OBE AW Deputy Chairman Terry Huff TH Chief Officer Les Borrett LB Director of Financial Strategy Dr Ken Aswani KA Clinical Director, Leyton and Leytonstone Dr Syed Ali SA Clinical Director Leyton/Leytonstone Dr A Q Sheikh AS Clinical Director Walthamstow Dr Dinesh Kapoor DK Clinical Director Leyton/Leytonstone Dr Tonia Myers TM Clinical Director Chingford Dr Rizwan Hasan RH Secondary Care Consultant Dr Ravi Gupta RGu Clinical Director Walthamstow Helen Davenport HD Director of Nursing, Quality & Governance Linzi Roberts-Egan (part time) LRE Deputy Chief Executive, London Borough of Waltham Forest Joe McDonnell JMc Acting Director Public Health, London Borough of Waltham Forest ` Page 1 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

2 In Attendance Name Initials Title Jane Mehta JM Director of Strategic Commissioning David Pearce DP Head of Governance Apologies Name Initials Title Richard Griffin, MBE RG Lay Member Public and Patient Engagement Althea Bart AB Healthwatch Manager Vineeta Manchanda VM Lay Member, Chair Audit Committee Dr Mayank Shah MS Clinical Director Walthamstow Members of the Public in Attendance Name Initials Title Jon Hanlon JH Communications (WFCCG) Rebecca Waters RW Communications and Engagement Manager (WFCCG) Paul Rosenbloom PR Save Our NHS Brian Steedman BS Save Our NHS Noel Hayes NH Save Our NHS Hayley Ward HW Area Healthcare Lead, Merck Sharpe and Dohme Ltd (MSD) Page 2 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

3 1. General Business 044/17 Apologies and Announcements AW Apologies were noted as above. AW provided the role of Chair until the arrival of AK who assumed the role of Chair from agenda item 4.1 onwards There were no announcements. 045/17 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 / 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. 046/17 Draft minutes from February 2017 Governing Body AW The minutes of the Governing Body meeting held 22 February 2017 were agreed. There were no amendments. 047/17 Matters Arising AK There were no outstanding Matters Arising. 048/17 Chair s Update AK AW provided an update on behalf of AK in 2 areas: 1. Annual Staff Conference The annual staff conference will be held on Wednesday 26 April at the Leyton Great Hall. This year s conference will include staff award presentations for which 40 nominations have been received. 2. Joint Board to Board meeting There will be a joint CCG s Board to Board meeting on 29 March with Newham CCG, Tower Hamlets CCG, and Waltham Forest CCG. The meeting is aimed at getting to know each other and to seek ways in which we can better work together collaboratively. Page 3 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

4 049 /17 Questions from the Public AW Q1 A1 Q2 WFCCG, in its Annual Report published in May 2016, announced the development of the accountable care system and in July 2016 WF Council published a Market Position Statement, developed by them with WFCCG, part of which states that: - by Autumn 2016 Waltham Forest will have 'designed an accountable care system involving care homes.' Could the CCG clarify how far the above plans have developed, and which services have been covered? Does the budget specify which treatments can be bought and how costs per head are determined? What consultation has taken place thus far on the proposals? WFCCG and Waltham Forest Local Authority (WFLA) have continued to meet with statutory partners across the local system to continue dialogue and the development of the accountable care system. The current plan is focusing the development of an accountable care system that includes services for older adults which includes acute hospital beds, community health and social care services (community rehab and reablement), bedded rehabilitation and continuing care. The model of care is currently in development and recent workshops have been held with statutory partners to further this work. The plan is to have a draft model of care by April 2017 that can then be tested with stakeholders from across the system including patient involvement. Once the model of care has been agreed work will commence on the development of how the system contract and finance will operate to support the system. The current aim will be to start testing the accountable care system for older adults from July The accountable care system programme is aligning to the registered care market work to ensure a coherent approach across the CCG and LA. Between 2011 and 2016, around half a million hospital letters giving patients results were not delivered to GPs. Instead the correspondence was stored in a warehouse by NHS Shared Business Services. It has been reported that North East London was one of the areas affected by this blunder. Does the CCG know whether any Waltham Forest patients were affected, and how many? Also, how many are likely to have suffered harm because their results were not appropriately processed? Were these patients followed up, and how many have in fact suffered harm? Bearing in mind a clear right for the public to be informed, has the CCG any information as to why this Page 4 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

5 failure by a private company was not widely publicised at the time of discovery? Apparently, GP practices are being financially compensated for the work of reviewing and processing the missing items. As NHS Shared Business Services was a partnership between the Department of Health and the company Sopra Steria, does the CCG know who is accountable for the scandal, and who will be funding the compensation? A2 8,603 items of correspondence have been returned to registered GPs in the CCG area of NHS Waltham Forest and 6 cases of potential patient harm have been identified. These cases will now be subject to further clinical assessment. To date there are no cases of confirmed harm due to the delay. The incident was reported by NHS England, following its notification by NHS Shared Business Services who have expressed regret over the incident, to the appropriate authorities and in the 2015/16 NHS England Annual Report. GP practices have received payments for the additional work required to review and assess this delayed correspondence, on a basis agreed with the British Medical Association GP Committee. NHS England is managing the resolution of the incident and commercial discussions. The NHS England Customer Contact Centre can be contacted via the details below: Telephone: england.contactus@nhs.net Q3 A3 The CCG reported to the May 2016 Board on the findings of Healthwatch and CCG reviews into the community phlebotomy service in Waltham Forest, and outlined a number of actions which could be implemented in order to improve the service and deliver a better patient experience during 2016/17, prior to the procurement of a new service to begin in April It would appear from newspaper reports, to which CCG has responded, that problems persist, particularly in relation to Langthorne and Silverthorn, the latter due to a downgrading of the rooms available. In its response, CCG noted that it had recently redesigned the specification for the phlebotomy service with the aim of reducing waiting times, and this will take effect from summer Can the CCG clarify what steps will be taken by the new provider in order to assure patients that the service will improve? The CCG has been working to implement the new phlebotomy specification since last year; however, despite undertaking both a tender exercise and a more targeted mini-competition with local providers, it has not yet been possible to identify a suitable Page 5 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

6 provider. Discussions are ongoing with a number of prospective providers at the moment. Funding was approved during 2016 to make some changes to improve the service in the short term, but Barts Health have been unable to implement the planned changes as originally agreed. However, some of the funding has been invested in increasing the amount of domiciliary blood testing available, with home visits now available on two days per week. The main change in the new specification which we expect to impact positively on waiting times is the introduction of booked blood testing appointments for patients with a particular need to be seen at a specified time. This is based on feedback from the Healthwatch report, which found that patients would most like a mix of pre-booked and walk-in appointments for blood tests. A proportion of patients receiving a dedicated time slot should reduce the high level of demand that the blood testing clinics often experience at opening time. We are also exploring in discussions with providers options around longer hours for phlebotomy services; we cannot confirm exactly what this will entail until a provider is identified, but this may include extending clinics into the afternoons or running a Saturday morning clinic. NH sought clarity on the timescale for the appointment of an alternative provider and the subsequent implementation of the service from that provider. JM confirmed that the intention was to have a new provider in place to commence delivery of services effective from June /July 2017 against the revised service specification. JM acknowledged the challenges being faced by the CCG in order to secure a provider against the revised specification and that further work was required in order to improve service delivery against the high standard that the CCG had set. TH noted the risk to the planned timescales. NH advised that concerns relating to the service were being expressed through the PPG groups including those concerns raised by service users including diabetic patients. TM, supported by SA, clarified the non- fasting requirements for diabetic patients, whilst 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. Page 6 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

7 2 Governance 050/17 Board Assurance Framework HD HD presented the Board Assurance Framework (BAF) to the Governing Body. HD advised that the BAF was presented for discussion. HD further advised that of the 5 reported risks, 4 were red (extreme) risk rated and 1 was orange (high) risk rated. HD noted that since the last report to the Governing Body; o The risk relating to the CCG failing to manage its commissioning budget within plan, due to increased costs of acute Service Level Agreements (SLAs) leading to an overspend had been removed from the BAF as a result of a reduction in the risk to the overall financial position to year end leading to achievement of the target risk rating of risk score 8 (medium risk). o The risk rating of the risk relating to the CCG not meeting the required deadlines for review of Primary Medical Services (Risk 3 of the main BAF report) had reduced from risk score 20 to risk score 16 following provision of a timetable for financial equalisation between GMS / PMS practices, draft KPIs for premium payment and a timetable for contract signing and implementation. o The risk relating to Whipps Cross Hospital (WXH) being found to be non-compliant with eight standards of care and being placed into special measures had been replaced with the risk that WFCCG are unable to demonstrate compliance with the Improvement Assessment Framework required to provide assurance to NHS England (Risk 4 of the main BAF report). This reflects the ongoing patient safety concerns at WXH. HD drew attention to the risk relating to the performance of the London Ambulance Service (LAS), (Risk 5). HD advised that that the Care Quality Commission (CQC) had recently conducted an inspection of the LAS and that the details relating to the risk actions would be updated following publication of the report. SA drew attention to the risk relating to achievement of the A&E 4 hour waiting time. SA, noting the continuing risk rating score, enquired as to how, given the actions that the CCG had undertaken, performance could be improved. KA advised that a number of actions had been put in place to support operational resilience plans at Whipps Cross Hospital (WXH). This Page 7 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

8 included a WXH improvement plan and increased staffing levels. KA further advised that the CCG, whilst content with the actions being taken, continued to monitor their impacts through the urgent care board which provided a focus towards achievement of consistency in the programme improvements. KA further emphasised the good work being undertaken and the need to translate this work to improved performance outcomes. TH, supporting KA, acknowledged the increases in staffing levels within the Emergency Department noting that this was realising positive improvements, including the increased use of specialist clinical resources, along with the utilisation of the urgent care centre. TH further noted that the Secretary of State for Health was showing a personal interest in the issue and that this was also leading to positive actions being taken. KA drew further attention to the positive impact within primary care referrals as result of changes within the system that had led to improved access for GPs. TM noted the associated paediatric peer review and the positive outcomes from the review which had had a quality focus. JM noted the positive feedback that had been received in respect to the urgent care centre. JM further noted that risks associated with the provision of phlebotomy services had not at this point been escalated to the BAF. JM further advised that if current actions did not yield positive outcomes then an escalation to the BAF would take place. JM confirmed that risks relating to the provision of phlebotomy services continued to be managed through the Strategic Commissioning directorate. KA, noting the use of Contract Performance Notices (CPNs) as a response to poor performance, enquired as to what happened following their issue. HD advised, as exemplars, updates on the current status of serious incidents, duty of candour, and complaints following issue of related CPNs. AW drew attention to the reporting framework for the BAF and noted the importance of differentiating between those mitigation actions over which the CCG had direct control, compared to those mitigation actions over which the CCG had indirect control. AW further suggested that the BAF be amended to reflect both the target risk rating against individual reported BAF risks (as is currently presented) versus the risk rating that the CCG sought to maintain. AW, supported by TH, noted that such an addition provided for yet further improvements to the CCG s BAF reporting process. Action: Add risk maintenance score to BAF reporting template. The Governing Body approved the report. HD Page 8 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

9 3. Performance and Quality 051/17 Performance and Quality Report (CCG Scorecard) LB & HD LB presented the Governing Body with an overview of the Performance Report as at end January LB advised that there was no significant change against achievement of performance targets since the last report to the Governing Body at its meeting 22 February LB clarified that there were unlikely to be any material changes to current performance levels reported at year end. LB further clarified the 26 performance targets were rated as; 5 high rated risk 4 medium rated risk 17 low rated risk LB advised that the 4 medium rated risks all represented an improvement against the 2015/16 achieved performance levels albeit that there remained a possibility of them not achieving their targets by the end of the year. LB further noted that performance against the GP Friends and Family Test performance had been below target for three consecutive months and that, recognising the volatility in performance of this particular target, it was unlikely that the target would be for the year. LB confirmed that 81% of the indicators had shown improvement from the previous year. LB drew attention to: Palliative Care January performance is on trajectory at 456 patients on the register. The CCG has developed an action plan to provide an updated plan to meet the 2016/17 target. The plan focuses on developing a process to enable Fast Track patients to be flagged to GP practices by the Continuing Healthcare Team in NEL CSU. The target is being supported by the Macmillan GP visiting GP practices. CCG GP Referral to Treatment (62 Days) Performance The target measures the proportion of people with cancer who start treatment within 62 days of their referral from GP. Barts Health overall has achieved all cancer targets for the last four months. The CCG met the target for December. Performance YTD is at 84% which is just below the target for the year (85%). Page 9 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

10 LB advised that the draft score card for 2017/18 had been developed and had been discussed at the March 2017 Performance and Quality Committee with the aim of presenting to the Governing Body at its meeting, May HD provided an overview of the Quality Dashboard and Exception Report: HD advised that the purpose of the report is to inform the Governing Body of the quality provided to the patients of Waltham Forest at its Provider Organisations, indicating by exception where quality does not meet agreed targets. HD further advised that targets were linked to standards of care which in turn were aligned to the CQC s 5 domains of care, namely, Effective, Safe, Well- led, Caring, and Responsive. HD drew attention to the Areas of Good Practice and the Areas for Improvement which provided for a balanced assessment against the performance at both the North East London Foundation Trust, (NELFT), and Whipps Cross Hospital (WXH). HD drew further attention to the exception reporting against individual indicators that identified for both NELFT and WXH: RAG rating of performance Areas of further intelligence Actions being taken by the CCG and / or Trust HD drew attention to the compliance with basic life support training and infection control training for clinical staff at levels 1 and 2 at WXH. HD advised that following non compliance in these areas over a period of time improvements in staff training on wards had been acknowledged. HD further advised that the CCG were seeking comparable improvements in statutory training requirements. HD drew attention to the quality review visit undertaken at the Waltham Forest Integrated Community Team Hawkwell Court, Chingford on 13 December HD advised that the Deputy Nurse Director Quality and Clinical Governance, assisted by the Director of Nursing, had undertaken an Internal Care Quality Commission (CQC) Inspection Audit in light of concerns relating to the high use of agency staff. HD advised that following the inspection recommendations had been made and that these would be followed up through the CQRM mechanisms. HD drew attention to the Care Home report. HD advised that details relating to Aston Grange Care Home were not reported as the care home had been inspected by the CQC and rated as inadequate and the details subsequently archived. HD further advised that where a care home received a poor rating, and in line with local authority arrangements, patients and carers were approached to confirm if an alternative placement was required. RH noted the continuation of the red rating against safeguarding training compliance at WXH. RH, further noting that safeguarding training sat within the Well Led domain of the CQC inspection regime, enquired as to whether the management at WXH had relevant actions in place to address the issue. HD confirmed the existence of evidence to support that staff providing 24/7 care were indeed trained to the required standard. Page 10 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

11 TM, further noting the issue of non-compliance against safeguarding training enquired if sufficient management time was being made available to undertake the necessary training, and if that training was linked to the appraisal process. TM further sought assurance that agency staff were appropriately trained prior to commencement of employment. HD advised of the actions that were in place whilst recognising the need for clarification in respect to agency staff. HD further acknowledged the pressures on resources and their release for training.tm requested that WXH clarify the appraisal rates being achieved. Action: Confirm appraisal rates being achieved at WXH and link to safeguarding training. HD advised that both WXH and NELFT had confirmed that relevant actions had been put in place in respect to achievement of compliance against safeguarding training requirements. HD acknowledged the importance for such confirmation from the organisations executive management teams. LRE, noting the responsibilities of Safeguarding Boards, offered to clarify their responsibilities in respect to ensuring training compliance. HD Action: Clarify Safeguarding Boards responsibilities in respect to safeguarding training compliance HD, responding to SA s enquiry in regard to the lack of improvement numbers of complaints not responded to, advised that there was evidence to support performance improvement and that this was reported through the CQRM mechanism. JM further noted the importance of the management of complaints that related specifically to primary care. LRE AW noted that all the necessary actions that the CCG could reasonably be expected to undertake were being done. The Governing Body approved the contents of the report. Page 11 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

12 052 /17 Draft Patient Participation Group Local Standard RW RW presented the Governing Body with a draft version of the Patient Participation Group s (PPG) Local Standard. RW advised that drafting of the standard arose from actions relating to Strengthening how NHS Waltham Forest Clinical Commissioning Group involves and engages with patients and the public in Waltham Forest: the CCG s Patient Reference Group and GP Practice Patient Participation Groups report, published November RW further advised that assurance was being sought from the Governing Body of their support and engagement with the draft local standard. DK enquired as to the success of recruiting new members to the PPG. RW reported that, following a recruitment process, 6 new members, taking a voluntary role as PPG Locality Representatives, had recently been recruited to the PRG. AW, noting equality and diversity needs, enquired if PPGs were representative of the local patients groups. AW further enquired as to whether this was an area explored during the recruitment process.rw said that we could recommend that practices look at their demographics in order to be representative. SA, in support of AW, enquired as to what actions were being taken to further encourage younger people to join PPGs. RW advised that steps were being taken to re-establish links to local schools and other young people and family groups. That later in 2017 a Children s and Young People s Community Participation Plan will need to be co-designed. TH, noting the good work that was taking place, further stressed the importance of seeking involvement from associated groups that represent wide communities rather than individuals. The Governing Body approved the report. 053 /17 Stroke Quality Assurance Visit, Whipps Cross Hospital, January 2017 HD presented the Governing Body with a report on the findings of the quality assurance visit to the Whipps Cross Hospital (WXH) Stroke Unit, 20 January HD advised that the quality assurance visit was conducted by Professor Rudd the National Clinical Director for Stroke and Chair of the London Stroke Network with representation including the North East London Stroke Operations Lead, the Deputy Nurse Director Quality and Clinical Governance WFCCG, and members of the medical and allied health professional teams at Whipps Cross Hospital Site. Page 12 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

13 HD further advised that the review team assessed achievement against the previous action plan from the November 2015 review, noting the improvements made against the report s recommendations with all issues raised having been addressed. HD drew attention to the work undertaken by the CCG, through the CQRM mechanisms, in supporting WXH to achieve a successful outcome. HD advised that the quality assurance review visit had demonstrated that there had been significant progress since the last review held November 2015 and that the actions identified had been taken forward and completed with areas of particular note being: 1. The reduction in length of stay 2. Band 6 nurse appointments 3. Consistent swallow screen assessment service 4. Recruitment to the team. HD further advised that the visit had provided assurance that the care and treatment provided was overall safe and effective with four recommendations made within the report to further improve the standard and experience of the stroke patients who use the service. HD noted that the Stroke Unit Team would use the recommendations to formulate an action plan and that progress against the plan would be reviewed and shared with the CCG as part of an internal assurance process utilising the CQRM. KA advised that, in respect to the Transient Ischaemic Attack (TIA), it would be necessary to follow up, through an audit process, as to what steps had been taken following the identification of a TIA occurrence. TH, in support of KA, stressed the importance of the undertaking of a clinical outcomes review to better understand effectiveness of any actions taken. TM, noting recommendation 2 of the report (review the recording of patients requiring psychological support as reported on SSNAP (Sentinel Stroke Audit Programme Data)) advised that the correct terminology was now referred to as Talking Therapies and further noted the importance of selfreferrals and the communications to support this. HD advised that this would be taken up through the Performance and Quality Committee with feedback to the Governing Body at a later date SA, whilst acknowledging comments in respect to TIA, observed that the report was very positive. HD further noted the importance of primary care involvement with achievement of the stroke unit performance emphasised the need of not viewing its performance in isolation. The Governing Body noted the report. Page 13 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

14 4. Finance and QIPP 054 /17 Finance Report LB LB gave an overview of the finance report as at the end of February LB reported that as a result of the information available to date the CCG was forecasting that it would achieve the planned surplus of 8.6 million for 2016/17 with no material changes since the last report to the Governing Body at its meeting 22 February LB advised that the CCG s 1% headroom reserve would be left unspent at year end in order to off-set NHS providers (acute trust) overspends as part of the CCG s commitment to support the balancing of the wider NHS budget. LB further advised that the CCG s established non recurrent headroom of 3.8 million within the 2016/17 budget would be pooled with other NEL CCGs to meet a combined surplus target given a significant overspend within Barking, Havering and Redbridge (BHR) CCGs. LB advised that a formal risk pooling agreement had been developed and that the CCG had actioned the transfer of 3.8 million to the BHR CCGs which would be transacted by NHSE through month 12. AW enquired as to whether the CCG was including any conditions in respect to the risk pooling (risk share) agreement. LB confirmed that this was indeed the case and drew attention to the relevant details. TH noted the success of the CCG in managing its budget throughout 2016/17. The Governing Body approved the report. 055/ /18 Budget Update LB presented an update on the development of the CCG s 2017/18 budget. LB advised that the budget had been reviewed by the Finance and QIPP Committee. LB further advised that budget, for which approval was sought, is based on rolling forward the CCG financial projections at month 8, reflecting operating framework planning assumptions, agreed contract values and the confirmed allocations for CCG commissioned services and delegated primary care. LB drew attention to the planning context, clarifying that CCGs are required to submit plans reflecting Department of Health financial rules that assure the delivery of the CCG s commissioning objectives, including the key NHS constitution targets of: Maximum referral to treatment waiting times Access to cancer services, including reduced diagnostic waits Page 14 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

15 Maximum wait to be seen in A&E Meeting the targets set out in the Mental Health Five Year Forward View LB drew further attention to the increased planning surplus requirement of 8.9 million, representing a 0.3 million increase against the 2016/17 surplus. LB, noting that the CCG was moving towards 3 difficult years, drew further attention to the key risk including the continuation of risks to the Barts Health contract in to 2017/18 and the presence of a significant risk in respect to QIPP delivery. LB emphasised that the CCG had a good reputation for financial management and that this would need to continue. LB further noted that the plan identified some contingencies albeit that the position was significantly more risky than had been the case in the previous three financial years and that further contract reviews and QIPP plans would be developed during Q1 to mitigate risks. DK, in respect to the QIPP plan, enquired as to the details supporting service areas and specifically in regard to DVT services. KA provided a comprehensive response in respect to DVT whilst LB provided details across a number of other QIPP programme areas. TH noted the general increase in activity in the acute areas, whilst further noting ring fenced budgets relating to the primary care and mental health services. TH further noted the importance of the achievement of acute specialities, with the added emphasis on the various transformation projects and initiatives in which the CCG were involved. The Governing Body approved the 2017/18 Budget. 5. Strategy and Planning 056 /17 Planning for Delivery JM JM presented the Governing Body with a report that sought to demonstrate how much progress the CCG had made in its strategic planning and subsequent implementation. JM advised that the report; Summarised the strategic direction of the organisation highlighting strategies developed since establishment, progress on implementation and next key steps Reviewed the Delivery Plan 2016/17, updating members on the significant progress made in achieving the Delivery Plan milestones during the past year Presented the two year Operating Plan 2017/19 for final approval JM requested the Governing Body to; Page 15 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

16 Note the considerable progress made to date on achieving milestones as set out in the delivery plan over the previous 12 months Approve the two year operating plan, 2017/ /19 Agree that in the event of a further Operating Plan submission authority be delegated to the Director of Financial Strategy to agree any amendments and approve the plan on behalf of the organisation JM drew attention to the strategic context noting the CCG s recognition that due to the complexity of the NHS environment, its precarious financial situation and the need to respond to national strategic directives, there needs to be agile organisational thinking. JM noted that this meant that agreed strategies may be implemented and progressed in a different way, providing as an example, the community nursing strategies evolution into an accountable care system. JM drew further attention to the details in respect to the delivery highlights, whilst further noting those areas which required further focus, for example the provision of phlebotomy services. JM drew attention to the operating plan, 2017/ /19, advising that detail of the plan had been discussed at previous Governing Body meetings. JM drew further attention to the operating plan highlights, presented at para 5.1 of the report and the details in respect to the local quality premium, presented at para 5.2 of the report. JM drew attention to para 6 of the report, detailing the required next steps, including; Development of the 2017/18 Delivery Plan supported by joint meetings between programme leads and Clinical Directors and Clinical Leads, April 2017 Refreshment of the Transformation Grid for approval by the Governing Body May 2017 Agreement of Clinical Director and Clinical Lead Work Plans that support strategic objectives and Operating Plan targets The Governing Body approved the operating plan, 2017/ /19. The Governing Body further agreed that in the event of a further Operating Plan submission authority be delegated to the Director of Financial Strategy to agree any amendments and approve the plan on behalf of the organisation Page 16 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

17 057/17 Healthy London Partnership TH TH presented the Governing Body with an update of the continued progress of the Healthy London Partnership (HLP) programme and of HLP planning for 2017/18. TH reminded the Governing Body that during the 2016/17 planning round it had confirmed two years of funding for HLP, recognising the programme design remained subject to continuous review. TH advised the Governing Body that following an extensive review process over the past six months involving CCGs, STP and Programme leads refreshed proposals had been developed. TH further advised that the review had been overseen by the London Transformation Group where, at its meeting on 14 February 2017, it considered and supported programme proposal with a clear recommendation to CCG Governing Bodies and NHS England for approval. TH drew attention to the scaling back of the overall programme budget for 2017/18 by around 24% as a consequence of a more challenged financial position. TM drew attention to the good work that had been achieved through the children s and young people work stream and raised concerns over the impact of any reduced funding in this area. AK advised that a review of individual schemes would direct decisions where any programme funding could be reduced. TH further advised that a detailed program review had been undertaken which had highlighted scope creep in some programme areas. SA drew attention to the issues associated with obesity and enquired as to how such issues would be taken forward. JMc advised of the actions being undertaken jointly through the local authority with the support of the Health and Wellbeing Board. JM, noting a reduction in the primary care budget sought assurance that the budget would be used for its intended purpose and not be deflected to support any assurance purposes. TH confirmed that this was the intention. TH further clarified that the funding was provided by the CCG and not by NHS England and as such any concerns in relation to inappropriate utilisation of funds should be made known to the CCG s accountable officer. TH further advised that a news-letter had been circulated to all GB members outlining the details of the HLP programme. TH agreed to resend the letter. Action: Resend letter outlining details of the HLP agreement to all Governing Body members TH The Governing Body approved the report and the London Transformation Group recommendations contained within. Page 17 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

18 058/17 Better Care Together Programme Plans for KA KA presented the Governing Body with an overview report of the Better Care Together programme. KA advised that the report summarised the CCG s approach for the planning round for the period 2017/19. KA drew attention to the reports detail in respect to; Delivering Joined Up Care and Support with the aim to deliver improvements in four key areas: - improved information - increased focus on prevention and early intervention - integrated care pathways - engaging communities Summary of the Planning Approach; - context - programme refresh - planning approach - engagement plan KA described the 3 levels at which the programme would operate, noting the development of support and care hubs and the links with the CCG s future strategy in respect to accountable care systems. KA further noted that the programme was designed to look across all related areas in order to ensure achievement of value from the joint budget. The Governing Body approved the report. 059/17 Planning and Innovation Committee Annual Report 2016/17 JM JM presented the Governing Body with the first annual review of the Planning & Innovation Committee s activity and contribution to the commissioning system. JM advised that the report provided the Governing Body with an opportunity to both reflect on and formally document the Committee s performance over the past year. JM further advised that the focus of the annual review was on pathway redesign and the progress made since decisions on clinical models, pathways and transformation were agreed by members and their impact on patient outcomes. JM further clarified that the report did not concentrate on the financial aspect unless where relevant, as financial decision making is outside the scope of the Committee. JM, acknowledging the value created through the generation of the report, suggested that other committees of the Governing Body consider the adoption of a similar process. LB noted the need to provide feedback on the progress being made following approval of funding arrangements. LB further suggested that such Page 18 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

19 a mechanism could be implemented on an annual basis and would provide a vehicle for closing the loop in order to measure the success of agreed funding levels against planned outcomes. AW drew attention to some possible misinterpretations within the presented Terms of Reference for the Planning and Innovation Committee. JM, acknowledging the areas in need of greater clarity agreed to address the concerns raised and re-present the terms of reference to the Governing Body at its meeting, May Action: Present updated terms of reference for the Planning and Innovation Committee to the Governing Body meeting, May 2017 The Governing Body approved the Planning and Innovation Committee Annual Report, 2016/17, noting the requirement to update the committee s terms of reference. JM 6. For Information 060 /17 Minutes of Performance and Quality Committee February 2017 HD There were no comments. 061/ 17 Minutes of Medicines Optimisation Committee February 2017 HD There were no comments. 062 /17 Minutes of Planning and Innovation Committee February 2017 JM There were no comments. 063 /17 Minutes of Patient Reference Group February 2017 HD There were no comments 064 /17 Minutes of Finance and QIPP Committee February 2017 LB There were no comments. 065 /17 Minutes of IT Committee February 2017 LB There were no comments. 066/17 Actions from Leyton / Leytonstone; Chingford; JM Page 19 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

20 and Walthamstow Locality Meetings February 2017 There were no comments. 067/17 Forward Plan TH Phlebotomy update to Governing Body meeting, 24 May Terms of Reference for the Planning and Innovation Committee, to Governing Body meeting, 24 May 2017 A.O.B. No items. Signature Date Next meeting Date: 24 May 2017 Time: Venue: Boardrooms A,B and C, Ground Floor, Kirkdale House, Leytonstone, E11 1HP Page 20 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1