Present: Also in Attendance: Mrs Karen Ball (Minute taker) LR PA to the Chief Finance Officer Welcome

Transcription

1 Telford and Wrekin Clinical Commissioning Group Governance Board Minutes of the Meeting held on Tuesday 9 th June 2015 The Temperton Room, Harper Adams University, Edgmond, Newport, TF10 8NB Present: Dr Mike Innes (Chair) MI CCG Chair Dr Jim Hudson JH GP CCG Board Member Dr Jo Leahy JL GP CCG Board Member Dr Andy Inglis AI GP CCG Board Member Mr David Evans DE Chief Officer Mr Andrew Nash AN Chief Finance Officer Mrs Fran Beck FB Executive Lead for Commissioning Mrs Christine Morris CM Executive Lead for Nursing, Quality and Safety Mr Geoff Braden GB Lay Member for Governance Mr Dylan Harrison DH Lay Member for PPI Dr Martin Allen MA Secondary Care Clinician Mrs Carol Wall CW Practice Manager Mrs Liz Noakes LN Assistant Director Health & Wellbeing and Statutory Director of Public Health Mr Paul Taylor PT Director of Health, Wellbeing and Care Also in Attendance: Mrs Karen Ball (Minute taker) LR PA to the Chief Finance Officer Welcome Dr Innes opened the meeting and welcomed Board members and members of the Public to the meeting. Dr Innes also welcomed two new CCG employees, Anna Hammond, Deputy Executive for Commissioning and Planning, Integrated Care, and Paul Gibara, who takes up the post of Deputy Executive for Commissioning and Planning, Secondary Care as from 15 th June NHS Confederation Conference Having recently attended the NHS Confederation Conference Dr Innes continued by giving a brief overview of the NHS and where it is currently going. The following key points were highlighted: It was recognised that NHS organisations are operating in an extremely challenging environment. Jeremy Hunt MP, Secretary of State for Health, asked delegates to pass the message of thanks down to all those within their organisations for what they are achieving for the NHS. 1

2 The main message of the conference was that NHS organisations now need to deliver. The NHS has been guaranteed 10bn additional funding, which includes the 2bn highlighted in the autumn statement for winter pressures. The NHS however, needs to find 22bn of efficiency savings in return. Jeremy Hunt announced several measures to help: The CQC will soon rate hospitals on efficiency as well as quality. Trusts will be given procurement saving targets. Each Trust will be rated on its efficiency and this is an area which will need monitoring. NHS England (NHSE) Chief Executive, Simon Stevens, announced that the National Institute for Health and Care Excellence (NICE) will stop work on safe staffing guidelines. Mr Stevens made it clear that an area he was serious about is the reduction of spend on the hiring of agency staff. The prediction made was that by 2020 there would be savings of 40bn in staff costs and 1bn per annum procurement savings. There will be an overhaul of cancer care payments. Struggling CCGs could be taken over by neighbouring CCGs, councils or provider organisations. Two key waiting times for elective care; elective admissions and non-elective admissions have been abolished. The remaining elective standard is covers incomplete pathways ; people who are still waiting to complete their treatment. Other targets will remain in place; however they are subject to further review. There will be a traffic light rating system for CCGs. This will focus on five groups older people, long-term conditions, mums and children, mental health and generally healthy. The rating system will look at elements of access, quality and preventing, resilience and transformation. These areas will be monitored by NHSE at their quarterly meetings with CCGs. There was considerable discussion around new ways of working which included Devolution Manchester. Also discussed was the need for regulatory bodies to work together more and how they are developing whole system regulation as a solution. It has recently been announced that there would be a 200m in-year cut to council held public health budgets. The impact of this will mean that Telford and Wrekin Council will be required to find a further 700k cost reductions this year. The Royal College of GPs is offering academic support to CCGs looking at alternatives to QOF. Values based behaviour was mentioned with the need to promote it from the Board to the floor Apologies: Miss A Smith, Dr L Warburton, Mrs C Choudhary Members Declaration of Interest The following declarations of interest were noted: Dr Mike Innes GP Partner at Stirchley Medical Practice Dr Jim Hudson GP Partner at Donnington Medical Practice Dr Andy Inglis GP Partner at Sutton Hill Medical Practice Dr Jo Leahy Her son is an employee of Shropshire Doctors Cooperative Ltd (Shropdoc) Minutes of the Governance Board Meeting Held on 12 th May 2015 The minutes of the previous Board meeting were approved as a correct record subject to the following amendments: Page 1 Dr Leahy did not attend the meeting, therefore her name is to be place 2

3 under apologies Matters Arising Chief Officer s Report Dr Innes agreed to write to Mr Herring, on behalf of the Board, to thank him for his work. Members agreed that Dr Innes would write to Mr Herring nearer to the time of his retirement. Dr Innes to send an invitation to the New Chief Executive of SaTH Dr Innes highlighted that Mr Herring is due to leave his post of Chief Executive of SaTH at the end of July The new Chief Executive, Mr Simon Wright, will take up the post in September Members therefore agreed to invite Mr Wright to the October 2015 CCG Board meeting Quality and Performance Planning, Performance & Quality Committee Chair s Report for meeting held on 24 th February 2015 Patients waiting over 52 weeks SaTH to be requested to attend the April 2015 CCG Board meeting to report on possible harm to the patients involved and potential risks of anything similar happening within other specialities. Members were informed that Mr Herring had agreed to attend the May 2015 CCG Board meeting. Mr Evans advised that due to the winter pressures Mr Peter Herring was not able to attend the May Board Meeting and Mr Evans would follow this invite up Discussions continue to take place with SaTH regarding an assurance process. Members agreed that a report will be presented at the July 2015 CCG Board meeting Review of Pain Management Solutions ltd a community pain management service Members agreed that a report on trading accounts for pain management QIPP would be brought to the April 2015 CCG Board meeting. Mr Nash asked that the report be deferred to the May 2015 Board meeting as further information was required. The report on trading accounts for pain management QIPP was still being reviewed by Commissioners therefore it was agreed that this matter be deferred to June Board Members noted that this item was an agenda item on the confidential Board agenda Pilot Community Paediatric Phlebotomy Service Report A further report will be presented at the June 2015 CCG Board meeting Members noted that this item was an agenda item at the meeting Medium Term Financial Strategy 2015/16 to 2019/20 The CCG Board agreed to receive an updated summary of the strategy at the June 2015 CCG Board meeting to reflect any potential changes in the case of a change in Government following the general election Further advice is awaited therefore this item was deferred to the July 2015 Board meeting. 3

4 Governance Mr Braden to provide Board with an update following the submission of the Draft Annual report and Annual Governance Statement for 2014/ Mr Braden highlighted that the Annual Report 2014/15 was available on the CCG website for Members to view. Mr Braden was pleased to report that the CCG had finished the financial year with a small surplus of 45k. The CCG s external auditors had rated the CCG as green for value for money and Mr Braden noted that not many CCGs had been rated as green Items Raised by Members of the Public Mrs Gill Stewart, raised an issue regarding personal healthcare budgets and questioned why a carer s funding is stopped, whilst the person they cared for is in hospital. Mrs Stewart highlighted the case of a dementia sufferer. Mrs Stewart questioned whether the carer could continue to care for their patient, whilst in hospital, therefore allowing for continuity of care and asked if this is something which could be considered. Mrs Morris responded by saying that each case needed to be looked at on its own merit. If a patient was resident in a care home their place would continue to be funded, to some level, to allow them to return to the care home that they know. Members recognised that continuity of care was extremely important to the patient. Mr Taylor said that this is an issue, which was not easily resolved as there may be a number of factors relating to employment and liability law. Following discussion members agreed that this is something that could be looked at by the health economy steering group for dementia Chief Officers Report The Board received a verbal updated from Mr Evans and the following key points were highlighted: The Serious Case Review into the death of Oliver Sargent had recently been published by the Telford and Wrekin Safeguarding Children Board. It was clear from the review that Oliver had come into contact with a number of health professionals and possible chances to save his life had been missed. A comprehensive action plan had been produced, which had been taken on board by all the organisations involved. Mr Evans thanked the Safeguarding Board, and Mrs Morris, Safeguarding Board member, for the production of such a robust Action Plan. Planning Round 2015/16 Mr Evans reported that the CCG s action plan had received significant scrutiny and had been agreed at a local level. This had not been the case for all CCGs who had been advised to revise their plans further to increase the level of activity for elective and non-electives. Mr Evans highlighted that there will be a considerable cost pressure to the CCG of 1.2m this financial year, which may prove to be a significant risk pressure. However every effort will be made to manage this risk. Mr Nash said that the CCG was paying 70p in the pound for activity this financial year, which is the opposite of last year. Mr Harrison said that as the CCG will be required to invest additional funding would they be able to direct this to particular specialities? Mr Evans said that despite the CCG having additional cost pressures they can not break business rules and will still be expect to make a 1% surplus this financial year. Draft data for month one is showing a significant increase in emergency activity. It was also noted that for the last quarter of 2014/15 emergency activity, when compared to the previous year s activity had increased. A deep dive into the data for the last quarter is currently taking place. In relation to providers who may struggle to achieve Referral to Treatment (RTT) targets NHSE would tentatively expect CCGs to access other providers to allow for extra capacity. 4

5 Winter Monies, which is included within the base line allocation, is approximately 50% of the funding provided last year. It is unknown as to whether further funding will be made available later in the year. FutureFit a meeting of the clinical reference group had recently been held looking at the community fit programme. A good level of debate had taken place and a further meeting will be held in the next three to four months. The Programme Board are looking at delaying the public consultation on the three options to be considered. Monthly assurance meetings with the NHSE local team had recently been implemented. Areas highlighted in the June meeting including the failing of the RTT target, incomplete pathways, however are slightly above target. Work still to do around dementia, which will be picked up when the new mental health commissioner takes up their post in July A small number of cancer breaches had been reported. A robust action plan will be developed by the cancer working group. Mr Evans highlighted the Breaking the Cycle initiative, which was held in SaTH during the first week of June. Mr Evans noted that for the week of the initiative the A&E performance target for the Princess Royal Hospital was over 90%. Following discussion the Board Noted the contents of the Chief Officer s Report Assurance Quality and Performance Planning, Performance & Quality Committee Chair s Report for meeting held on 26 th May 2015 The Board received an outline of the report and a summary performance report for month 11 and the following key points were highlighted: The Committee were encouraged by developments in working with the local authority on CHC and noted that jointly funded packages of care were now in place. Performance issues, particularly in relationship to trauma and orthopaedics, were discussed and further information had been requested for the next meeting. The Committee were, however assured that contingency planning had commenced. The Committee agreed a change to the two week Cancer Referral Pathway, which now sees these referrals routed through the CCG s TRAQS service, which follows a successful pilot. The Committee agreed the service specification for Maternity Services and for Advice and Guidance. Members discussed cancer targets. It was noted that the CCG was 6 th in the country for meeting cancer targets. However, members highlighted the decrease in the 31 day and 62 day cancer targets. This is an area that is currently being looked at. Members continued by discussing follow-up appointments and questioned whether patients are facing delays in receiving their appointments. Members noted that this is an area that could be looked at by the planned care working group. Members noted an improvement in ambulance response times. Following discussion the CCG Board: Noted the content of the report Members Engagement The Clinical Commissioning Group Practice Forum Chair s Report for meeting held on 19 th May 2015 The Board received a summary of the report and the following key points were highlighted: Dr Nawaid Ahmad, Consultant Chest Physician, attended the meeting and gave a very informative presentation on end of life care relating to COPD. 5

6 73.15 Strategy Mr Andrew Mason, Chair of the recently revised Adult Safeguarding Board attended the meeting and update members on the progress of the Board. The proposed Anticoagulant LES was discussed further and it was agreed, by a process of open voting, that the LES would be adopted by the CCG. It was also recommended that the CCG undertake a period of up to three months negotiation with GP practices as providers; a process that the CCG undergoes with other providers already. Following discussion the Board: Noted the content of the report Governance Audit Committee Chair s Report for meeting held on 19 th May 2015 The Board received a summary of the report and the following key points were highlighted: The Audit Committee had an extraordinary meeting on the 26 th May 2015 to approve the final accounts and annual report. The Committee received a health and safety report from the Lancashire and Staffordshire Commissioning Support Unit. It was noted that a new Health and Safety Officer had been appointed and was due to start in June Currently there is only one Health and Safety Officer who covers Lancashire, Staffordshire and Shropshire. There had been inconsistency between the accidents and incidents that the CCG were reporting and those picked up in the Health and Safety report. It was also noted that the fire risk assessment was overdue and this will be addressed. The Committee received the updated Complaints and Compliments Policy and Procedure. The key point was to note that executive responsibility is transferring from the Executive Lead for Nursing, Safety and Quality to the Executive Lead for Governance and Engagement. Mrs Angie Porter had recently taken up the role of Patient Experience Lead and will have responsibility for complaints. Members discussed the policy and highlighted that the paragraph on compliments needed to be strengthened. Mr Braden agreed that this would be done. In line with recent internal audit recommendations, there had been a formal review of the effectiveness of the Audit Committee. This included working through the Audit Committee handbook checklist and looking at areas of effectiveness. This highlighted some minor areas of process that will be included in future meetings. Following discussion the Board: Noted the content of the report. Approved the Complaints and Compliments Policy and Procedure with the caveat the paragraph on compliments would be strengthened The Patients Voice Health Roundtable Committee Chair s Report of the meeting held on 4 th June 2015 Members noted that there was no report to present at the meeting Pilot Community Paediatric Phlebotomy Services Mrs Beck informed members that the pilot had proved to be extremely successful and the danger is that it may not be able to meet demand. It had therefore been decided to revisit the services that are currently commissioned and develop a business case for future provision. 6

7 Following discussion the Board: It was agreed that a report on Paediatric Phlebotomy Services would be presented at the June 2015 PPQ Committee meeting and the July 2015 CCG Governance Board meeting CCG Assurance 360 degree Stakeholder Survey and Action Plan The Board received a brief outline of the report and the following key points were highlighted: The stakeholder survey is commissioned by NHSE and is undertaken by IPSOS Mori on behalf of all CCGs annually. Overall the response rate for the CCG was 72%. The survey produced some interesting results, and generally showed a positive picture of the CCG s relationship with its stakeholders. Members recognised that due to the small number of stakeholders answering the questions this means that the percentage figures can be misleading. Mr Evans highlighted the areas where the CCG performed well in comparison with last years survey results and against other CCGs in its cluster or nationally and those areas where it had not performed as well. Members acknowledged it was a process of learning and how to move forward. It was noted that leadership of the CCG was rated in the top quartile. The CCG had developed an action plan to explore those areas where the CCG did not perform as well in comparison with last year s results or against other CCGs in its cluster or nationally. Members were asked to share any comments they might have, regarding the action plan, with Miss Smith. One area that members discussed was the CCGs working relationship with member GP Practices and highlighted the related actions in the action plan. Members discussed the actions related to innovation. Mrs Beck highlighted an innovation course two employees are currently undertaking and agreed that it could also be directed to other staff. Following discussion the Board: Noted Survey Results. Approved the Action Plan for addressing the areas where the CCG are in the bottom third of CCGs either in our cluster or nationally. Agreed that a report on progress of the Action Plan would be presented at the December 2015 CCG Board meeting For Information Only NHS Telford and Wrekin Annual Report 2014/15 The CCG Board noted the content of the Annual Report Minutes of the Strategic Resilience Group Meeting held on 20 th March Any Other Business The CCG Board noted the content of the minutes. There was no further business to report Date and Time of Next Meeting 7

8 1.30pm Tuesday, 14 th July 2015, Telford Hotel & Golf Resort, Great Hay Drive, Sutton Heights, Telford, TF7 4DT 8