MINUTES. NHS Scarborough & Ryedale Clinical Commissioning Group Governing Body, held in public

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1 Item 2 MINUTES NHS Scarborough & Ryedale Clinical Commissioning Group Governing Body, held in public Wednesday 29 th January 2014, 9.30am Council Chambers, Scarborough Borough Council, St Nicholas Street, Scarborough Chair: Philip Hewitson Present: Dr Greg Black GP Board Member Mr Simon Cox Chief Officer Dr Clive Diggory GP Board Member Dr Kath Halloran GP Board Member Mr Tom Hall Consultant in Public Health Dr Omnia Hefni GP Board Member Mr Philip Hewitson Lay Member Dr Ian Holland Secondary Care Doctor Mrs Carolyn Liddle Primary Care Manager to the Board Dr Douglas Lumb Co-opted LMC Representative Mrs Carrie Wollerton Executive Nurse In Attendance: Mrs Sally Brown Head of Programme Management Miss Stacey Mabbott Executive Assistant Mr Richard Mellor Chief Finance Officer (Designate) Apologies: Dr Peter Billingsley GP Board Member Dr Phil Garnett Chair Mr Andy Hudson Lay Member Mrs Anne Marie Lubanski Co-opted Local Authority Representative Mr Alan Wittrick Interim Chief Finance Officer Minutes Agenda Item 1 Welcome and Apologies Philip Hewitson opened the meeting and welcomed members of the public. A member of the public reported that he had submitted a question prior to today s meeting but unfortunately this hadn t been received. Stacey Mabbott will contact this person and ask for a copy of his question and provide a written response below. Action SM Question: What progress has the CCG made in identifying the causes of high diabetic amputations rates? with the comment hoping that one of the actions has been to learn from the North East Diabetes Footcare Network to see how they resolved the very same problem that they identified in 2012 Answer: The CCG does not hold specific data on the number of amputations but has commissioned a piece of work to better understand any variances of outcomes for our patients. This work will involve the Public Health Page 1 of 11

2 Observatory, members of the Vascular Clinical network and Consultants in Vascular surgery at York Foundation Trust who will be able to assist with the analysis of data. We will look to establish when a formal response can be shared. 2 Minutes of the Previous Meeting It was noted that under item 8.1 on the second line of the second to last paragraph should read how to provide translation services and not transformational services The Governing Body accepted the minutes of the previous meeting as a true record with the above amendment. 3 Matters Arising Item 7.1a, Whistleblowing Policy: Sally Brown reported that an amendment has been made to the policy to make reference to Lay membership Sally Brown reported that at the last Governing Body it was suggested it would be useful to include a short summary of key points in policies for staff. She has discussed this with HR who has advised that this was not recommended as the wording could be taken out of context. Sally Brown recommended that members accept the advice from HR. Policies will be put onto the intranet and it will be the responsibility of staff to be aware of the policies and to read them. Item 7.4, Report from the Audit & Governance Committee: Sally Brown reported that the operational scheme of delegation reflected the overarching scheme of delegation in the CCG s constitution. A good deal of progress had been made and it will be reviewed at the next Audit & Governance Committee where it will be signed off. The terms of reference of the Strategic Collaborative Committee had been circulated to members of the Governing Body and the Council of Clinical representatives (CoCR). Item 8.1, Exception and Progress Report: Sally Brown reported that she had been in discussion with North Yorkshire and the Humber Commissioning Support Unit (CSU) regarding translation services. Work was being done to review translation services in both Primary and Secondary Care and of suitable providers of the service. A report would be available within the month. 4 Declarations of Interest None raised 5 Chair s Report Philip Hewitson advised the Governing Body that Phil Garnett was currently on leave and had indicated that anything he would like to raise was already on the agenda. Philip Hewitson reported that he attended a seminar on the Care Bill earlier this month and suggested it might be useful to have a briefing on the Care Bill at the next meeting. Page 2 of 11

3 6 Accountable Officer s Report 6.1 Authorisation Conditions Simon Cox reported that there had been a Quarter 2 review of our performance with the Area Team on 10 th December Following this the CCG submitted evidence for consideration by NHS England and the formal results of this would be released during the following week. He anticipated that this would mean the release of the remaining 4 conditions and that the CCG would be fully authorised. Philip Hewitson said that in anticipation of this he would like to congratulate Simon Cox and the rest of the Executive Team for their hard work in getting the CCG to this point. 6.2 Workforce Structure Simon Cox reported that the workforce structure was now complete. Richard Mellor would be starting with the CCG in early February as the new Chief Finance Officer. There were a couple of existing posts which were currently going through re-banding and review and it was anticipated that this work would be complete shortly. 6.3 Everyone Counts Planning Guidance Simon Cox reported on the latest planning guidance, which was circulated and covered a longer time scale than earlier guidance. There were some overall principles about the various outcomes and frameworks to work within, including the vision for NHS England and its constituent CCGs; the 5 domains were the same as those in the existing outcomes framework: Domain 1 Preventing people from dying prematurely Domain 2 Enhancing quality of life for people with long-term conditions Domain 3 Helping people recover from episodes of ill health or following injury Domain 4 Ensuring people have a positive experience of care Domain 5 Treating and caring for people in a safe environment and protecting them from avoidable harm Simon Cox reported that the next key date was the submission of an early planning template which was due by 14 th February Documents would be circulated to the Governing Body for review prior to submission. The deadline to have contracts signed was 28 th February 2014, which would be challenging. Barbara Buckley, Head of Service Development was currently co-ordinating the process. Sally Brown reported that the Communications and Engagement Committee were developing a plan on public and stakeholder engagement. Work with focus groups, the voluntary sector, patient representative groups and the Council of Clinical Representatives had been fed into this plan. Public events would be held at the end of March/beginning of April with the final dates published as soon as possible. 7 Better Care Fund 7.1 Better Care Fund Overview Page 3 of 11

4 Simon Cox reported that one of the major elements coming out of the NHS planning guidance was the establishment of the Better Care Fund (previously referred to as the Integration and Transformation fund). The Better Care Fund would create a resource targeted at the elements of care, particularly for the vulnerable elderly. The fund will take effect in formal terms from but will be working in a shadow form in Simon Cox reported that there were elements of new resource which would be created to support this but to a large extent, the fund would come from current health care resources. The CCG would need to work with North Yorkshire County Council on how to create the fund, what it will be used for and how it will work differently from current arrangements. Greg Black said that it would depend on what the other neighbouring CCGs did, as the Local Authority covered a larger area than just Scarborough and Ryedale. The local authority would want a uniform service, which might be a threat to local individuality and need as more services were put into the fund. 7.2 Better Care Fund update on delivering community programmes Simon Cox reported that the paper summarised the current position in developing the strategy for Community Services and there was a discussion needed about developing and strengthening community services during the coming year. Carrie Wollerton reported that discussions had centred on community nursing, looking at how nursing services worked closely across the whole sector and how this integrated with primary care. The Neighbourhood Care Team model centred services on the patient and GP practices; the aim should be to build on this model and improve it. The current specification was limited, but it did provide a platform to work through what could be provided in the future. There was more work to be done and she confirmed that she had been developing key performance indicators. Sally Brown suggested that the CCG needed to build on regular communications with the Foundation Trust so that there was a mutual understanding of any proposed changes. Carrie Wollerton reported on work with the Locality Manager for Adult Community Services and Simon Cox referred to discussions with the Local Authority at the Integrated Care Delivery Board. Simon Cox reported that within the paper a set of overarching principles were mentioned and asked the Governing Body to formally support the major project areas and objectives. These were: Intervention to improve lifestyle choices and overall health; Strengthening the community system to support the elderly population in their main place of residence as much as possible; Developing community hubs to support care outside of hospital, rapid assessment and diagnosis of the frail elderly; Improved access to mental health liaison services, supporting urgent and emergency care, and those patients with dementia; Page 4 of 11

5 Developing care for patients at the end of life in the most appropriate setting. The Governing Body agreed these principles and agreed that there was a need for an emphasis on long term conditions, which should be referenced in one of the above areas. 7.3 Proposals for Item covered above. 8 Corporate 8.1 SRCCG Policies a) Conflicts of interest Sally Brown indicated that this policy was included in the SRCCG Constitution and therefore the Council of Clinical Representatives (CoCR) would need to approve this policy. The current register of interests of all staff would be updated at least annually and when required. The policy will also need to be referred to when going through tender processes. It was noted that there was as yet no register of interest from the CoCR and the policy proposed the collection and recording of the representatives interests. The Governing Body confirmed its agreement for this policy to go to CoCR for approval b) Business Conduct Sally Brown reported that this was very similar process to the previous item as it was also included in the SRCCG constitution. The policy supported one of the organisational values of being transparent, open and honest in how the CCG conducted its business. She highlighted the section on receiving gifts. There was currently a limit of 20 with a register of any gifts exceeding this amount, which the Audit & Governance Committee would periodically review. The policy had been circulated to members and would need to go to CoCR for approval. The Governing Body discussed 7.16 of the policy, Intellectual Property Rights. Carrie Wollerton noted that when working in collaboration with the Commissioning Support Unit (CSU) any work was branded as CSU copyright rather than copyrighted to the CCG. She said it was important that the CCG s contribution was properly recognised. Sally Brown agreed to look into this. The Governing Body confirmed its agreement for the 20 limit on reporting gifts to continue and for the policy to go to the COCR for approval SB Sponsorship Sally Brown reported that the policy provided guidance on working relationships with the pharmaceutical industry. The Governing Body discussed section 8.3 of the policy Approval of Commercial Sponsorship. The policy stated that all arrangements for Page 5 of 11

6 commercial sponsorship must be approved by the Governing Body; however it was queried whether the Governing Body might consider delegating some of the sponsorship to a committee or individual. The example quoted was for small sponsorship where there was the provision of a small stand for a company at an educational event. Larger commercial sponsorship would need to be agreed by the Governing Body and it was suggested that a sponsorship threshold should be agreed. Previously, for a Chronic Obstructive Pulmonary Disease (COPD) education event, a sponsorship of 200 had been agreed, above which approval was needed from the Governing Body. Kath Halloran suggested that it was not always the amount of money and time, but the impact of the sponsorship that was important. The Governing Body agreed that a 200 threshold be set as a starting point and Sally Brown would check with legal services on a form of words to clarify an education limit. SB 8.2 Report from the Audit & Governance Committee held 3 rd December 2013 Philip Hewitson reported that there was an error on the agenda; the agenda should read Report form the Audit & Governance Committee held on 3 rd December and not 11 th October Philip Hewitson asked the Governing Body to note progress. Key financial policies were nearing completion along with the scheme of delegation. CSU assurance was limited and there were still some performance issues; more clarity on the Strategic partnerships arrangements was required. He reported that the CSUs were being audited nationally by Deloittes and Janice Sunderland, Relationship Manager, had been invited to attend the next Audit & Governance Committee to update it on progress and the Deloitte readiness assessment. Governance and risk; progress on the risk registers had been slow. There was a measure of assurance that the full Corporate Risk Register would be available for next meeting and that processes would be in place during February to facilitate the committee registers to be drawn together. He reported that the Assurance Framework would be presented to the Audit & Governance Committee in draft and then brought to the Governing Body meeting in March. 8.3 Corporate Risk Register Item covered above. 9 Report from Communication and Engagement Committee 9.1 Exception and Progress Report Clive Diggory reported on the Communications and Engagement Committee s progress and highlighted the following points: Engagement around Urgent Care was ongoing; Omnia Hefni had done fantastic work highlighting this in the media. There were four upcoming meetings for the public and written consultations forms were on the Page 6 of 11

7 internet; There is now a webpage on the SR CCG website, which had a feedback area for members of the public; A series of events with voluntary sector organisations had now been completed and a report was being written highlighting the key themes raised by organisations; Discussions had taken place with Seachange and the Scarborough Urban Area Forum regarding a directory of services for people in the Scarborough and Ryedale area. This work was continuing; Education events were continuing with the most recent being a Dementia educational event the previous evening; The SRCCG Intranet has been launched and was now available to all staff and practices; Work towards the Customer Service Excellence Model (CSE) had been progressing positively. A self assessment had been undertaken by the Communications and Engagement Committee to determine whether the committee should apply for the award. Members of the committee met with the assessor where it was agreed that the CCG should hold off applying for the award until it could demonstrate how a service had been commissioned as a result of consultation. This being the case and due to the positive feedback from the assessor the Committee recommended going for the award as the CCG organisation rather than just as the Communications and Engagement Committee. Carolyn Liddle reported that Andy Hudson had recently attended an event in London to share best practice and came away feeling that SR CCG was ahead of the rest of the country. She said that this reflected great credit on the team and all the hard work that had been done. The Governing Body agreed that the Communications and Engagement Committee should go ahead and prepare the whole CCG for the CSE. 10 Service Developments 10.1 Urgent Care Services update Omnia Hefni reported that he engagement process, beginning in January had been successful so far. A majority of the time has been spent dealing with media enquiries. She reported that the non-formal feedback was positive and that it was felt to be a long awaited review. A majority of the concerns raised were around the closure of the walk in centre at Castle Health Centre. Omnia Hefni explained the importance of stressing that the service was not being cancelled, but enhanced to make for a more equal access and service across the patch. She hoped the public events would be a useful place to address this. It was noted that the CSU and Project Management Team were collecting and reviewing evidence of activity which would be analysed and fed back into the specification of the service for the future. Sally Brown reported that the Communication and Engagement Committee was looking at the hard to reach groups, especially people that may use the Page 7 of 11

8 Castle Health Centre. Engagement would continue through March. She reported on work that was being done to encourage young people to attend the consultation meetings; Questionnaires had been circulated to nurseries, schools, sports teams and clubs. She was asked to ensure that people with learning disabilities were included in the hard to reach groups. SB 10.2 Medicine Management Commissioning recommendations Greg Black reported on the new Medicines Management Committee. The Committee was a joint project between SRCCG and the Vale of York CCG (VoYCCG) as an attempt to rationalise decision making on which drugs to commission. He suggested that it would be useful if the Governing Body agreed to delegate some authority to the Business Committee which will allow the decision to be made more quickly; also to delegate authority for the adoption of NICE approved drugs. The Governing Body agreed to give Greg Black delegated authority for NICE approved drugs and to also delegate authority to the Business Committee for drugs approval Musculoskeletal (MSK) Service Delivery options Omnia Hefni presented the paper with a request that the Governing Body agree an option for the future development of the MSK service. She reported that the service was reviewed and a proposal redesign was prepared at the beginning of The idea of the review was to have a more streamlined pathway into MSK. This was to improve the way the service was delivered by reducing the time patients were waiting and provide consultant triage at the first point of entry into the pathway ensuring patients get the most appropriate management plan from the beginning. Negotiations had taken place throughout 2013 with York Foundation Trust on how to implement the pathways. She emphasised that this did not affect the orthopaedic area just the triage service. She explained the 4 options for the future of the MSK service: Option 1 Do Nothing: MSK service remains. GPs do not have an option to refer directly for an orthopaedic opinion. Option 2 De-commission the MSK service: GP referrals for an orthopaedic opinion are sent straight to the secondary care orthopaedic service. Physiotherapy referrals direct to physiotherapy department. Option 3 Commence LOTTS service in March/April 2014 as currently planned. Initial triage of patients is undertaken by Consultant Orthopaedic team. Option 4 Page 8 of 11

9 Decommission MSK service. Commission primary care triage service. She explained that the first 3 options had been presented to the Council of Clinical Representatives (CoCR) and it was this group that had suggested the fourth option. It was reported that the MSK service was set up to save money and to reduce orthopaedic referrals, however, there is no evidence it has saved money, partly because investigation costs had risen and come out of the service budget. Simon Cox suggested that the only options that could potentially be implemented in the forthcoming year were options 1 or 3; the other options would require a 12 month notice period. It was suggested that option 3 could be used as a pilot and notice given to YFT to go to the market for some solution. Option 4 would need to be tested through a formal tender process. Simon Cox said that the right clinical model needed to be developed and establishing this would clarify the decision on whether to give notice on the current model. The Governing Body agreed to adopt option 3 to test the market, while exploring option 4 and to give notice on this basis. 11 Report from Quality and Performance Committee 11.1 Quality and Performance Report Carrie Wollerton reported that a much fuller set of indicators had been provided reflecting the position against the outcomes framework. She reported on the following areas: 18 weeks and referral to treatment continued to be a problem especially at speciality level. Problems arose when YFT merged their computer data across the York and Scarborough sites which threw up some anomalies and the CCG had asked the intensive support team to do an audit of the FT s waiting list management; A&E there were fragile signs of improvement; Ambulance handover times there is a little improvement here and YFT were trying to speed up patient flow through the hospital and making discharges more effective; Cancer waiting times There had been some breaches including those arising from patient choice. Some patients were choosing to wait for Scarborough appointments rather than attending available appointments in York. Clive Diggory suggested that if there was a clinical need for these patients to be seen sooner we needed to ensure they were aware of this; Clostridium Difficile (C.diff) This had been taken up with Alastair Turnbull, YFT Medical Director, setting out the CCG s expectations and requesting that the FT review its internal procedures. An analysis of Scarborough and Ryedale cases was in hand; Page 9 of 11

10 Paediatrics YFT had done a good deal of work on standards of care and safeguarding and had paused routine surgery on the children s ward at Scarborough with patients going to York or Hull pending the outcome of a review. Carrie Wollerton reported that she had done some observations the previous day and that she felt positive about the way the children s ward was working and had improved. Simon Cox reported that this had been discussed at YFT s Contract Management Board on 28 th January where he had been advised those children who were referred and expecting a Scarborough appointment had been held on a waiting list. There was no plan for restarting Paediatric Surgery in Scarborough soon and he had written formally to YFT to say that the CCG would only agree to restart when Scarborough services were fully compliant with the standards. It had been agreed that the CCG and YFT would write jointly to patients advising them that there was currently no option for surgery in Scarborough and that they could instead go to York or Hull or be referred back to their GPs. It was noted that this was only for routine surgery and not for emergencies Update on Winter Pressures Carrie Wollerton reported the on the allocation of winter pressures money. The system had not been tested by severe weather because of the mild winter, but the plans and processes in place appeared to be robust; the most recent test concerned a potentially serious ferry incident. Omnia Hefni reported that YFT had been implementing their resilience plan and had been on amber alert as opposed to red alert as in previous years. Carrie Wollerton reported that there were MIND workers in A&E who had been sitting with patients while they are waiting their turn and giving general support. They had also taken people home when they had been discharged. This has been helpful in that the MIND workers were picking up and listening to what was happening in A&E and had been able to provide feedback to the hospital. 12 Report from the Finance and Contracting Committee Financial Report Simon Cox reported that the overall financial position was increasingly tight in terms of delivering financial targets although the forecast predicted that the CCG would achieve the 1% surplus required. There were a number of challenges and risks. He referred to the potential financial pressures arising from NHS Property Services charged to CCGs, which were not in the financial plan and related to property liabilities transferred from the former PCT. Simon Cox reported that the Hull and East Yorkshire Hospital NHS trust contract had not been finalised in respect of specialised services, the commissioning for which was undertaken by NHS England. Simon Cox reported that the YFT contract showed an overtrading position of just have 0.5m. There were a number of financial penalties the CCG may impose for failing to hit targets, including those for Clostridium Difficile (C.diff) and 18 weeks. There was a meeting arranged during February with YFT to go Page 10 of 11

11 through this Resources and Planning for Simon Cox reported that the paper was a local assessment of resources. For 2014/15 and 2015/16the CCG s allocation would grow, but to deliver planned services and achieve targets required a QIPP plan to deliver 4% savings annually. A further paper would be brought to the next Governing Body on proposals to deliver QIPP savings of 6m in 2014/15. He pointed out that a more ambitious QIPP programme would develop funding for new services. National guidance encouraged CCGs to develop a fund of 5 per head of population for service development and transformation. GPs views would be sought on what schemes could be used to generate such resource. The March Governing Body meeting would receive a finalised financial plan for approval. The work that had been done so far provided a strong position for agreeing service contracts with providers by the end of February It was agreed that in finalising any submissions for this be delegated to the Finance and Contract Committee meeting on 12 th February. 13 AOB Simon Cox reported that on Monday 27 th January the 136 suite at Cross Lane Hospital opened and was now fully operational. There was now a 24/7 service for people detained under the section 136 Mental Health Act. This was the first unit in North Yorkshire and was really good news. It was suggested that reports on the new service should be included in the Quality Report and should include details of the number of patients that were from outside the Scarborough and Ryedale area. 14 Date and Time of next meetings: Wednesday 26 th March 2014 ( am) at the Council Chambers, Scarborough Borough Council Page 11 of 11