These had previously been deferred due to single item issues on agenda in March and April.

Transcription

1 Agenda Item: 5.4a PENNINE LANCASHIRE CLINICAL TRANSFORMATION BOARD M I N U T E S Of meeting held on Wednesday 1 May 2013 At 4.30pm in Walshaw House, Nelson Present In Attendance Chris Clayton BwD CCG Chair Damien Lynch ELHT Mark Brearley ELHT Jayne Mellor LCC Alan Crowther ELHT Bob Palmowski ELMS Colin Dugdale LCFT Malcolm Ridgway BwD CCG Simon Hill ELHT Rineke Schram - ELHT Mark Hindle LCFT Ian Stanley ELHT Mike Ions ELCCG Amanda Thornton LCFT Gifford Kerr PHBwD BC Stephen Tingle BwD BC Val Bertenshaw John Dean Debbie Nixon Alex Walker S Winterson ELHT ELHT BwD CCG ELCCG LCFT Judith Rice-Jones ELCCG (Note taker) Elizabeth Houghton ELCCG (Observer) Welcome and Apologies : Apologies were received from Lynn Wissett, Heather Tierney-Moore, Hazel Richards, Murthy Motupalli, Max Marshall, Jim Gardner, Dr Antonysamy, Stephen Gross, Duncan Gavan, Paul Hartley, Stephen Tingle, Warren Larkin, Maire Morton and Tim Mansfield Action By Jayne Mellor is attending on behalf of Stephen Gross; Colin Dugdale is attending on behalf of Hazel Richards; Gifford Kerr on behalf of Dominic Harrison Minutes of last meetings held: 6 February 2013 were reviewed and accepted as a true record 6 March were reviewed and accepted as a true record 3 April 2013 were reviewed and accepted as a true record These had previously been deferred due to single item issues on agenda in March and April. On all minutes please note that Damien Lynch is a Board Member and not in attendance. Minutes approved by Dr Chris Clayton (Chair) on 16 May 2013

2 Matters arising: An Action Matrix highlighting outstanding actions was reviewed. Min (5/12/12) Cardiac Network The Strategic Clinical Networks (SCNs) are being reconfigured. Chris Clayton to speak to Tim Mansfield. Vide minute Min (6/02/13) Enhanced Recovery Programmes There had been no action. Chris Clayton will review how to take this further. Min (6/02/13) Mortality this matter is now finalised C Clayton with TM C Clayton Ratification of Terms of Reference This is the first meeting of the revised membership under the new Terms of Reference: these were received and reviewed. /Re: Membership Amendments were requested to the role titles of the ELHT Representatives. These were proposed in situ, to be incorporated in a revised document and sent to Dr Rineke Schram for approval before new circulation. Corporate Support There followed further discussion about the LCC representation and attendance of Deputies eg It was agreed that Steve Gross, Director of Commissioning for LCC Social Care was a member and that anyone formally deputed by him to attend would have the same status at the meeting in this respect. Adopting Best practice would mean that clarification of members voting status would be sought whenever a matter was put to a formal vote It was requested that for future meetings an attendance list should contain the Member s name, role, and organisation and in respect of deputising members, their delegated authority/voting status should be available for clarity and record /Re:5.1 - Quoracy amended: to include provision for an Officer representative from Lancashire County Council in addition to Blackburn with Darwen (BwD) and Public Heath Lancashire Action: At the conclusion of a discussion it was proposed that the agreed amendments should be incorporated into document and that the following matters Quoracy, Voting/non-voting members, Protocol for decision making Venues for future meetings, - given a strongly expressed view that the meeting should rotate around venues in the locality, Optimal size of group ( Committee + officers is currently 26 ) Modus operandi between Board Members and Executive Group be remitted to the Executive Officers Group() for clarification and report to next meeting Pledges Working Group Update Presentation by John Dean (JD) and Malcolm Ridgway. ( MR) ( copy attached) A Workgroup of this Committee had been nominated and tasked to 6. PLCTB - Pledges Working Group.pptx Page 2 of 7

3 review and refine the 10 Pledges which had arisen from the Clinical Summit work is ongoing and progress will be reported to a future meeting MR explained that to finalise the pledges required either cultural or transformational shifts There followed discussion about the representation of the pledges following amendments were agreed: to Pledge 3 - remove from and substitute within available resources To Pledge 8: right care right place.. add - every time ( consider reliably) Action: JD will circulate underpinning ( explanatory) narrative The agreed next steps were to finalise the pledges and any accompanying narrative and then to engage LCSU Comms Team s support to review and advise how best to publish the pledges The final part of this discussion related to a recommendation from the Workgroup to run a Workshop for senior clinical leaders and officers which would assist them in o agreeing a clear family centred vision of healthcare for local people o Defining and agreeing measurable aims around outcomes quality and cost o Agree timescales ( eg 5/10 years) for implementation o Agree priorities and enablers for a transformational programme The following points were noted : It was proposed and agreed that the workshop should be arranged in late June ideally a Wednesday or Thursday evening subject to diary constraints of key people/organisations and the King s Fund partners. The summit had been held three months earlier and called for identifiable progress The CCGs and Health & Wellbeing Boards were required to publish their prospectuses/forward plans in May this may provide a timely opportunity to publicise the agreed pledges There is an imperative that the workshop should deliver sharply focussed actions and next steps for implementation. It was important that participants would have the authority to develop /determine deliverable actions Action: The Pledges Workgroup will coordinate arrangements and liaise with members Executive Officers Group() Update The Board were advised that DN: has been nominated by the to Chair meetings- this will be reviewed in 6/12 DN reported the main discussions and outcomes from the last meeting, highlighting proposed matrix style working and governances arrangements Page 3 of 7

4 Headlines from the Utilisation Management (UM) Study Presentation by Val Bertenshaw on Utilisation Management Figures. (Copy Attached) Background : The UM Team is now hosted by Greater Manchester Commissioning Unit The team had reported on a visit to ELHT (RBH Site) The Team had walked 6 wards including a number of Care of Elderly Wards 8. East Lancashire Hospitals NHS Trust P A review of in-patients on these wards against simple metrics assessed whether the patient required acute bed at this hospital and if not, then what supports were required to assist a step down to another bed or discharge. The reviewers concentrated on flow process rather than patient notes. Outcome Focussed Management Plan diagnosis to discharge Summary of Findings: Reviewed 170 patients on 6 wards concluded that 92 (54%) did not need acute hospital bed. Given the inclusion in the review of a significant proportion of care of elderly wards the team observed that there was a higher than expected occupancy norm of say 35% In a high proportion of patients social or therapy were identified as being the cause of delayed discharge In the review, patients were predominantly older Sources of admission were interesting low rate of admission from Residential Care and RNH sources often flagged as problematical Key points captured in discussion included: ELHT now has the tools to repeat the review exercise as a means of driving internal improvements; That the step-down beds commissioned by the CCG were demonstrated as being used to good effect it was emphasised that the continuing availability of them is important to improving the bed availability in the overall healthcare system; That there is a clear need to collaborate across the whole health economy to gain significant improvements in patient flow and experience within the system ( away from high cost acute beds) including ways of supporting patients at home That the ready availability of CHC funding is a significant factor and that consideration should be given to developing a fast track approach That poor performance against 4hr target and poor patient experiences through difficult winter were related to the findings Page 4 of 7

5 That providers of community services need this information to be shared LCFT is happy to share similar information with Commissioners That a similar presentation/ information has emerged in CLCCG, reference too to Blackpool and Morecambe Bay, which would indicate that the problems are not unique to East Lancashire That there are notable messages coming back about disparate community services. That there is a high level of support at this level to create a single assessment which will be undertaken wherever the patient is at a given point in an episode of care That the timing of hospital based assessments is critical pts may be very poorly at point of assessment and improve thereafter That there is an evidence base that for Patients in <75 age group which indicates that multiple moves are not necessarily effective and may be counter productive That availability of community beds may not necessarily provide the optimal solution need to get community and domiciliary support services properly aligned That there is a need to consider pre-emptive care as a means of avoiding an episode of acute care That savings made in secondary care could be allocated to an identifiable budget signposted to invest in community services. That LCFT working hard on a RAID (review agree implement demonstrate) model of enhanced care on this foot print and Central Lancs and soon to be available in hospital trust to support timely discharge and liaison model. Impact on elderly people. RCPsych report on impact on multiple moves taken into account for model That there is a need to consider developing a pathway model with clear opportunity to develop an integrated model which engages external partners - although much regulation may come from CQC who will insist on providers doing the assessment which duplicates the professionals assessment That LA budgets are running at about half the level of two/three years ago this calls for a more innovative way of working around assessment or targeted social care services and pathways. That there is a pressing need to identify the barriers to people being cared for in the most appropriate place and to identify a fix rather than wait for a whole service review. That help is needed to identify short, medium and long term strategies and the level of commitment from participating organisations Page 5 of 7

6 Agreed Actions: 1. requested to pull together a small representative task and finish group to review CHC related issues (including when and where assessments should take place) and 7 day working, whole system approach, linking with work in existing unscheduled care group, 4 Hour action plans and long term conditions/intermediate care groups. 2. Co-ordinate a combined Acute Trust, Community Health & Community Social Care response and bring back for consideration by the Board in June CAPITA Proposal for Phase 2 of Demand and Capacity Review. The CTB received an outline proposal from CAPITA Modelling Unscheduled patient flows in Pennine Lancashire (11 April 2013) copy attached A SRO group from (ELHT) had CAPITA. Page 4 summarises the requirements discussed. Page 7 et seq summarises Steps 1-4 of the proposal, timetable (11 weeks) and fees for each step (total cost 103,725.) 9. Pennine Lancs LHE discharge support pro Discussions took place regarding the cost of taking this forward. LCFT did not feel that the proposal supported mental health services The total package cost was considered to be expensive although reserved views were expressed that in the longer term, the costs could be set against cost savings which might potentially be achieved. It was also noted that each steps could be purchased individually and that it may be that other areas undertaking similar exercises are producing relevant information which may inform PLCTB planning There was organisational agreement from ELHT and commit to Step 1, subject to further clarification both CCGs to Agreed 1. Further discussion to be held outside meeting to discuss funding ( 30,200 for Step 1) 2. Subject to further clarification - Mapping to take place by mid- June 3. Bring outline report to this meeting in July 2013 Action: to clarify PLCTB mapping requirements, expected outcomes, payment terms ie the possibility of deferring an element as performance/outcome related payment, time frame and relevant assumptions ( p 15 of proposal document) Annual Work Plan This remains work outstanding AOB Role of PLCTB in Quality Monitoring Across Pennine Page 6 of 7

7 Lancashire - this would need to be addressed in the first instance outside this meeting. Delivering networks MI reported that he had attended a meeting at which the prevailing view was that there was little understanding of CCG issues he proposed that the Associate Director of the Senate be invited to a future meeting to discuss how the groups could work together MI /Corporate Admin Date and Time of next and following meetings The next meeting will be held on Wednesday 5 June and thereafter on 3 July August September 2013 All meetings commence at 4.30pm In Meeting Room 1, Walshaw House, Regent Street, Nelson. Page 7 of 7