DRAFT Minutes of the Trafford Clinical Commissioning Group Governing Body Part 1 Held on Tuesday 5 September, 2017, 9.30 am at Crossgate House

Transcription

1 PRESENT: DRAFT Minutes of the Trafford Clinical Commissioning Group Governing Body Part 1 Held on Tuesday 5 September, 2017, 9.30 am at Crossgate House Dr K Clark (KC) Dr L Clarke (LC) M Colledge (MC) A Foster (AF) Dr N Guest (NG) Dr A Harrison (AH) Dr M Jarvis (MJ) J McGuigan (JM) M Moore (MM) P Nkwenti (PN) S Sherrington (SS) Dr C Tower (CT) Secondary Care Clinician GP Member Governing Body Chair Lay Member for Governance, Audit and Finance Medical Officer GP Member Clinical Director of Quality and Performance Chief Finance Officer Chief Nurse Lay Member for Patient and Public Engagement Governing Body Nurse Member Council of Members Chair IN ATTENDANCE: T Clarke (TC) J Colbert (JC) L Collins (LCo) E Donelon (ED) H Fairfield (HF) Councillor J Lamb (JL) J Lancaster (JLa) A Linfield (AL) S Marshall (SM) R Riddell (RR) E Roaf (ER) M Taylor (MT) Communications and Engagement Specialist (for agenda item 1718/89), CCG Corporate Director, Children, Families and Wellbeing Communications and Engagement Specialist, CCG Local Medical Committee Representative Healthwatch Representative Executive Member for Health and Wellbeing Governance and Support Services Officer (Minutes) Pride in Practice Co-ordinator, LGBT Foundation (for agenda item 1718/89) Performance and Quality Improvement Manager (for agenda item 1718/94) Risk and Planning Manager (from agenda item 1718/92), CCG Interim Director of Public Health, Trafford MBC Associate Director of Corporate Services OBSERVERS / PUBLIC MEMBERS M Armstrong (MA) J Collins (JCo) Public Member Public Member Page 1 of 17 Governing Body Part 1 Minutes Date of Destruction: September, 2017

2 1718/84 APOLOGIES FOR ABSENCE Apologies were noted from M Irvine, Director of Performance & Quality Improvement, J Liggett, Lay Member for Partnerships and Integration, and C Ward, Interim Accountable Officer. At this point in the meeting, the Chair welcomed everybody and introductions were made. 1718/85 DECLARATIONS OF MEMBERS' INTERESTS CONCERNING AGENDA ITEMS No declarations were made in conjunction with section 8 of the CCG s constitution. 1718/86 MINUTES (PART 1) AND ACTION LOG OF THE NHS TRAFFORD CLINICAL COMMISSIONING GROUP GOVERNING BODY HELD ON THE 27 JUNE, 2017 The Chair presented the minutes of the NHS Trafford Clinical Commissioning Group Governing Body held on the 27 June 2017 for members information and approval. JLa advised members that all actions listed within the action log were now complete. ED referred to action 10 and stated she had not been invited to the influenza task and finish group. JLa stated she would liaise with the primary care team. 1) The NHS Trafford Clinical Commissioning Group Governing Body approved the minutes of the meeting held on 27 June ) JLa to liaise with the primary care team in relation to inviting ED to attend the influenza task and finish group. 1718/87 MATTERS ARISING There were no matters arising. 1718/88 MINUTES OF MEETINGS Members received the minutes from various CCG committee meetings as follows: Page 2 of 17

3 Minutes of the Public Reference and Advisory Panel held on the 6 July 2017 PN presented the minutes from the Public Reference and Advisory Panel held on the 6 July PN advised members the PRAP had a key focus on ensuring commissioners collated ethnicity data of patients in terms of accessing the services that were available. It was suggested this data was key in being able to measure the effectiveness of services and ensuring any inequalities could be identified and addressed. ER stated an analyst had now been recruited to join the public health team and would support the Joint Strategic Needs Assessment work stream. Members were also advised the PRAP had a keen interest in the intermediate care service being provided at Ascot House. 1) The NHS Trafford Clinical Commissioning Group Governing Body noted the minutes from the Public Reference and Advisory Panel held on the 6 July Minutes of the Clinical, Commissioning and Finance Committee held on the 27 July 2017 NG presented the minutes from the Clinical Commissioning and Finance Committee held on the 27 July 2017 for members information. 2) The NHS Trafford Clinical Commissioning Group Governing Body noted the minutes from the Clinical, Commissioning and Finance Committee held on the 27 July Clinical Committee 15 August 2017 CT provided a verbal update from the meeting of the Clinical Committee held on 15 August Members were advised the committee (i) approved the commissioning approvals policy, (ii) supported the next steps moving forward to implement the QIPP commissioning scheme and development of 4 task and finish groups, and (iii) reviewed the contract for Ascot House and agreed a review of the business case would be carried out by CT, LC and MM and feedback presented to the Clinical Committee in September. Page 3 of 17

4 3) The NHS Trafford Clinical Commissioning Group Governing Body noted the update 1718/89 PATIENT STORY MM introduced the patient story and expressed the importance of patient stories to understand patient pathways and experiences and to identify any areas for improvement. TC advised members following a review of the equality delivery system approximately 1 year ago, a number of areas for improvement were highlighted in terms of meeting the needs of LGBT patients and as a result work had commenced with the LGBT foundation. AL introduced herself and explained she was the pride in practice co-ordinator. AL delivered a presentation and members were advised of number of issues experienced by LGBT patients which included: Whilst experiences with GPs had been positive, it was suggested there was a lack of understanding amongst GPs of the needs of LGBT patients and in particular, transgender patients. Confusion with regards to prescribing in terms of the role of GPs and the gender identity clinic (GIC). Access to treatment required by a transgender patient is a lot longer compared to other health conditions such as physiotherapy. The impact the delay in receiving treatment/medication had on transgender patients for example depression and anxiety. Financial and structural restrictions which could lead to patients purchasing prescriptions online. AL advised members of the pride in practice programme which was a quality assurance support service that strengthened and developed relationships with LGBT patients. It was noted 6 GP practices were currently trained and supported within Trafford and the service helped staff be more aware of LGBT patients and more knowledge to enable them to provide support. Members were informed the service provided training which led to an accredited award in LGBT healthcare. It was noted the service was free to GP practices as it was funded by NHS England and the GM H&SCP. AL added Bolton CCG had included the service as part of their contract with practices. AL stated there were talks across GM in terms of encouraging GPs with special interests to specialise in LGBT care with the right level of knowledge and Page 4 of 17

5 expertise. MC thanked AL for the presentation and stated it had raised a number of important points. Reference was made to examples that had been provided of the care received by a transgender patient at Washway Road Medical Centre and therefore MC suggested some Governing Body members could have a potential conflict. MC referred to the patient experiences that had been raised and asked how representative this view was across LGBT patients. AL suggested feedback in terms of the lack of knowledge within primary care in terms of LGBT care was consistent and transgender patients felt they educated GPs themselves. CT queried who held the contract for GIC and JC stated this service was commissioned by NHS England in terms of specialised commissioning. AL suggested the CCG could provide support to GP practices in terms of them supporting LGBT patients for example, advice and assurance with regards to bridging prescriptions. In addition members were advised the LGBT foundation offered 12 free counselling sessions to patients. NG stated it would be useful to understand who the 6 GP practices were who had been trained by the pride in practice. In addition it was suggested the TCC had a role to play in terms of supporting LGBT patients and commented the foundation should be listed on the directory of services. NG suggested via NMoC it would make sense for a consistent service for LGBT patients to be provided. NG added as the GIC service was commissioned by NHS England, lobbying amongst all GM CCGs could take place to improve the service. JM referred to the GM effective use of resources treatment policies and suggested LBGT patients be made aware of these policies to promote understanding of the processes currently in place. AL stated she was working with patients to raise awareness of these policies. ED commented the LMC had received details of the pride in practice service and asked AL to send further details and suggested meeting to discuss how the LMC could support this service. ED suggested the LMC liaises with the CCGs education lead to discuss how the scheme could be integrated in practice training in the future. JC welcomed the pride in practice service and stated it would be useful to roll this out to social care services. AL explained the current funding from NHS England and the GM H&SCP applied to primary care only. Training and support could be provided to social care services but at a cost. Page 5 of 17

6 JC referred to the Health and Wellbeing Board Strategy and suggested feedback from LGBT patients in 2014 suggested there was a lack of understanding in terms of specialised services and visibility was difficult. It was therefore suggested further patient engagement was carried out and LGBT patients be asked more explicitly about their views in terms of pathways and screening. JC added the feedback received today had been positive in terms of how GPs tried to support LGBT patients and it was bureaucracy that added barriers for patients. AL explained the experiences of a lot of transgender patients were that professionals were not expecting them and therefore were unsure of how to treat them. However an example was provided of a transgender patient who had attended UHSM for an appointment and felt he had been expected and the hospital were prepared which had been a positive experience. PN questioned whether any patient surveys had been carried out with LGBT patients and AL confirmed surveys had been carried out but the information obtained was limited. AL added Public Health England were carrying out a survey at the moment. AL stated patients from black, asian and minority ethnicity backgrounds were under represented in the feedback as were older patients. Therefore work was being carried out to try to improve this. MC thanked AL for the presentation and stressed the importance of progressing this work stream. It was agreed MM would lead on this piece work. MC suggested there were potentially a number of failings in terms of the services provided to LGBT patients and there was a need to fully understand the current position based on evidence. 1) The NHS Trafford Clinical Commissioning Group Governing Body noted the patient story and MM to lead on this area of work moving forward. 2) A representative from the LMC to liaise with the CCGs education lead to discuss how the scheme could be integrated in practice training in the future. AL and TC exited the meeting at this point 1718/90 CARE COMPLEX STRATEGIC OUTLINE CASE MM presented a report which included the strategic outline case (SOC) for the development of a Care Complex and required Governing Body approval to progress to the next stage which would be to prepare an outline business case Page 6 of 17

7 (OBC) prior to a full business case (FBC). Members were advised these two cases would be presented at future Governing Body meetings for approval before moving to the next stage. MM explained care complex was a facility being designed for elderly and frail patients. It was suggested an acute setting for elderly and frail patients posed a number of risks and therefore a solution to how care was provided to this cohort of patients was required. In terms of the care complex provision, members were advised this included the following: Continuing health care 50 beds. Intermediate care 50 beds. Palliative care 15 beds. It was noted that currently, this service was provided in Stockport. Respite care 10 beds. Specialist neuro rehab 5 beds. Guest house 8 beds. It was suggested this facility would be for families and carers to visit patients. NG made reference to the milestone dates included within the SOC on page 13 and stated these needed to be updated. It was also suggested if members approved to progress the SOC to an OBC, work was required at pace to progress the project. AH referred to the Trafford Care Complex and suggested this would be another TCC abbreviation in addition to the Trafford Coordination Centre and suggested consideration be given to this. MC welcomed this point. AF commented on the details in relation to the economies within the SOC and stated further clarity was required. JM stated further work with regards to the economies would be carried out throughout the development of the OBC including an options appraisal and breakdown of high level costs. MC stated the importance of collating and capturing details of all of the engagement and consultation carried out with regards to the care complex. SS queried the feedback from the CCG s senior management team in terms of the SOC and JM explained Trafford was experiencing a rise in patients and in addition, patients with complex needs. Therefore some patients were treated out of the Trafford area and in some cases outside of Greater Manchester. Therefore there was a challenge in terms of meeting the needs of the Trafford population. NG supported this view and stated the right level of resources were required to drive forward the project and ensure its success. It was suggested Page 7 of 17

8 the next phase was transformation to gain additional resources. SS referred to the JSNA and the demographics that were known and questioned how the care complex would make a difference to these patients. ER commented the older population within Trafford was increasing and some of this cohort of patients had intensive healthcare needs. ER added there was a poor record of end of life care and suggested investment should be made into a MDT to help people stay at home. HF commented on the suggested provision and expressed uncertainty in terms of the rationale regarding these numbers. In addition it was suggested the provision did not take into account patients with dementia. HF expressed overall support for the SOC and suggested wider consultation was required to inform the FBC. MC stated the next stage was to develop the OBC and FBC and suggested a forum be developed to address any issues and gain the knowledge and expertise from a number of stakeholders to ensure meaningful engagement was carried out. JL welcomed the SOC and suggested the concept of care complex was revisited to ensure the model was correct for the Trafford population. JM commented part of the model was currently being tested at Ascot House and with a multitude of providers. NG commented care complex would not be developed in isolation and would be done so in conjunction with the wider transformation agenda. It was noted the CCG had a contract with St Ann s Hospice which was located in Stockport. NG advised this service was significantly under used and was a significant cost to the CCG. NG added there was a rise in the elderly population within Trafford and therefore there was a need for the care complex service. In addition, NG advised the service would support patients with dementia. JC stated this was the first time she had seen the proposal which included a lot of detail. Reference was made to the asset based approach of social care taking place in Sale and suggested this highlighted different ways of engagement. JC stated a lateral view of the entire care complex model was required and MC commented the project would link into the wider transformation agenda. CT expressed clinical support for the care complex and recommended each of the procurement routes required a full cost benefit analysis to be carried out. PN questioned the role of the Trafford co-ordination centre and how this would link to the care complex. MJ suggested there was a need to optimise care coordination and to maintain and increase services to meet the needs of patients. Page 8 of 17

9 LC referred to a mental health step down service and questioned whether there was scope to link these services. JM stated the TCC was not currently being utilised to its potential in terms of identifying patients. It was noted whilst mental health formed part of the GM strategy, it did not cover all of Trafford s need and therefore further work was required. LC requested a provision of homeless beds be considered as part of the care complex proposals. ER expressed support for the SOC and progression to the OBC and FBC and noted prevention should be a key component. MC summarised the presentation and stated transformation involved a number of components which would be based on population need with a key work stream required in relation to prevention. MC added the care complex was required now and in the future 1) The NHS Trafford Clinical Commissioning Group Governing Body supported the strategic outline case and supported progression to prepare an outline business case (OBC) prior to a full business case (FBC). 2) Consideration be given to developing a working group to progress the care complex. 1718/91 TRAFFORD CO-ORDINATION CENTRE OPTIONS APPRAISAL JM presented a report to inform members of the cost benefit analysis (CBA) and options appraisal for a decision to be taken on the preferred option for the CCG with regard to the future of the TCC. Members were advised following the audit carried out by the Greater Manchester Health and Social Care Partnership (GM H&SCP), Mazars was commissioned to undertake the development of a CBA and options appraisal. JM reminded members the TCC was commissioned on a phase 1 and phase 2 basis and there was a need to ensure that phase 1 was delivering. MJ suggested the original concept was that an automated service would be in place to gain real time data. However MJ expressed a view this process was not in place which was required to get GP assurance within the system. JM explained a partnership group had been established and referral management would be a key focus. It was stated there was a huge opportunity in terms of care co-ordination and it was envisaged the automated systems would be in place by the end of the year. Page 9 of 17

10 JM referred to the CBA and suggested this did not capture the full level of opportunities which could be gained if all partners operated within the system. MJ expressed the need to get the system working and suggested the progress over the last 2 years has not resulted in the predicted level of return. LC made reference to GP referrals and sought clarity this would mean 100% electronic referrals. JM stated this was work in progress with GPs. Reference was made to cancer referrals and members were advised this pathway would be picked up via New Models of Care (NMoC). JM added there was capacity within the system to enrol 3000 patients for care co-ordination which was not being fulfilled. LC queried the identification of elderly and frail patients via EMIS and JM confirmed this cohort of patients were being linked in to the process. PN suggested for the TCC to work, a cultural shift was required. JM advised members 2 partnership meetings had been held and it had been agreed to pilot parts of the TCC within hospitals. It was suggested once patients utilised the system and experienced the benefits, it would help promote the system. PN stated public facing information was not evident and MC stated there was a need to ensure key organisations were integral to this. SS expressed support for the recommendations made and sought clarity that all options had been considered. SS commented on the importance of GP and partner engagement to gain confidence in the system and the opportunity to create a shared culture amongst partners in terms of the TCC. JM advised a full engagement plan would be built into the process which would be driven by a clinical lead. It was stated 2 years ago a memorandum of understanding had been agreed however, an ambassador within each organisation would be identified to drive the system forward. JC made reference to patients and the need to capture patient involvement and experiences. JC added Trafford MBC was committed to the optimisation of the TCC but there was a need to reduce the amount of bureaucracy currently in place. In addition, patient engagement was required to publicise the system and consideration should be given to utilising local ambassadors for example local councillors to promote the TCC. ED referred to option 3 expansion of the service and queried the likelihood of a reduction in acute admissions as this hadn t been evidenced and questioned what measures would be put in place through expanding the service that reductions would be realised. JM stated currently approximately 1400 patients were registered for care co-ordination and acute admissions had reduced. There was a need to register more patients for care co-ordination for further Page 10 of 17

11 benefits to be realised. JM added option 3 would be implemented once option 2 had been carried out and the contract was delivering what it was intended to. JM advised members no further investment was required for option 3, which would be achieved by partnership engagement and buy in. In addition there was a need for patients to understand how the TCC would benefit them. JM suggested meeting with ED outside of the meeting to discuss this further. ER expressed support for the prospects of the TCC and asked how NMoC would support the TCC in terms of identifying patients before their needs became complex. NG stated the system was now in a position to be utilised and there was a need to ensure the correct risk stratification was in place to identify high risk patients that did not have complex needs but required prevention. It was noted appropriate referral mechanisms were required and were now in place. 1) The NHS Trafford Clinical Commissioning Group Governing Body agreed the preferred option in the CBA which was for option 3 to expand the TCC once option 2 target operating model was delivered over the next 6 months. The implementation of option 3 would commence from April ) JM and ED to meet outside of this meeting to discuss the TCC. MJ exited the meeting at this point. 1718/92 BOARD ASSURANCE FRAMEWORK RR presented an update on the current strategic risk position including the 2017/18 Board Assurance Framework (BAF) dashboard and sought members approval with regards to the changes and movement of risks recorded in section 2 of the report. RR advised members that the CCG s committees were given oversight of the risks listed on the BAF and full details of each risk were presented to the relevant committee. AF referred to risk 6 current secondary care provision unable to effectively deliver role as part of the integrated health and social agenda and questioned what area this related to. RR commented this included the current insufficient use of the intermediate care provision. HF referred to the previous report relating to the TCC presented to members which highlighted areas of over and under performance and questioned how this was addressed. MC stated issues were not considered in isolation and Page 11 of 17

12 themes were picked up which would help form the transformation models. MJ entered the meeting at this point. NG commented a multitude of data including the corporate, operational and project risks registers were in place which linked to governing body agenda items. SS referred to risk 7 inability to deliver themes of the Health and Social Care Partnership standards start well, live well, age well which the net score had decreased. However, the Accountable Officer report indicated the CCG had received a rating of requires improvement within the annual CCG assessment and therefore clarity was sought. RR explained whilst the CCG received a requires improvement rating in relation to leadership and finance, a number of areas including cancer, mental health and dementia had been highlighted as outstanding resulting in the risk score reducing. 1) The NHS Trafford Clinical Commissioning Group Governing Body approved the changes and movement of risks recorded in section 2 of the report with regards to the 2017/18 Board Assurance Framework. SM entered the meeting at this point. 1718/93 OPERATIONAL FINANCIAL PLAN UPDATE JM presented a report to advise members with an update on the in-year financial position for 2017/18, the indicative forecast out-turn position and to update on the operational financial plan for 2017/18 including progress on QIPP plans. JM advised members the indicative forecasts at this stage for the 2017/18 outturn were showing a 2.75m deficit largely driven by 7m of unidentified savings. In terms of overspend, members were informed this related mainly to (i) NHS acute trusts, (ii) prescribing, and (iii) independent providers. In addition, members were advised of a supply issue with anti-psychotic drugs being experienced on a national scale and generic savings potentially being topsliced by NHS England. It was suggested this could be up to 2m for the CCG. JM stated this issue was being raised however, not all GM CCGs were in the same financial position. Frustration was expressed in terms of the CCG working hard to make savings which would potentially be taken away. ED made reference to the marginal underspend of the LCS budget and asked Page 12 of 17

13 what this related to. JM stated he would share this information and added via NMoC, there would be a review of all LCS to ensure the schemes were delivering what they should do. 1) The NHS Trafford Clinical Commissioning Group Governing Body noted the update. 2) JM to share details of the LCS underspend with ED. 1718/94 QUALITY AND PERFORMANCE UPDATE SM presented a report to update members on the performance against the 2017/18 statutory frameworks and the performance of the CCG s main providers; University Hospital of South Manchester (UHSM), Central Manchester Foundation Trust (CMFT) and Pennine Care Foundation Trust (PCFT). SM made reference to the ambulance response programme (ART) and stated further information was being attained in terms of performance. Members were informed due to a change in the targets in August 2017, like for like data was not available and therefore performance could not be compared. Details regarding the categories could be sent to members if required. SM stated due to the change in targets and lack of comparable information that was available, this issue would be listed on the risk register. RR stated this would be correlated with the quality, finance and performance committee operational risk register. Members were advised the format of the report had changed and areas of concern had been listed at the front of the report to clearly highlight to members areas for concern. Members welcomed the new format. 1) The NHS Trafford Clinical Commissioning Group Governing Body noted the update. 2) Details of the ambulance response programme be included on the quality, finance and performance committee operational risk register. SM exited the meeting at this point. Page 13 of 17

14 1718/95 ACCOUNTABLE OFFICER UPDATE JM presented the Accountable Officer s update to provide a short round up of several topics for information. Members were advised following the annual CCG assessment, a programme of work had been put in place to deliver improvements. AF questioned when the decision in terms of the transformation fund would be made and JM advised a meeting had been arranged on the 28 September 2017 when the final decision would be made. JC added a clarification meeting with the partnership was due to be held following this governing body meeting. SS questioned when the money would be received and it noted approved funding would be received once a decision had been made. 1) The NHS Trafford Clinical Commissioning Group Governing Body noted the update. 1718/96 PUBLIC HEALTH ANNUAL REPORT 2016/17 ER presented the Trafford Public Health Annual Report 2016/17 to provide members with an opportunity to comment on the report and consider its response to the recommendations. ER advised the report had a key focus on children and young people health outcomes. Members were provided with an overview of health outcomes compared to areas across England. Outcomes marked as red were being reviewed which related to (i) A&E attendances 5-9 year olds, (ii) school readiness in free school meal children, (iii) admission of babies <14 days, (iv) admissions for respiratory infections, (v) accident/deliberate injury admissions age 0-4, and (vi) physically active age 15. In terms of hospital admissions of children, length of stay was zero and no follow up appointments were required. Therefore there was a need to ensure families had enough confidence in the services available to them to prevent hospital admissions. ER commented on the work being carried out to understand the impact of adverse childhood experiences and work with parents to highlight how their own childhood experiences could differ to their children. MC commented the annual report had been discussed at the Health and Wellbeing Board (H&WB) and JL stated progress was being made with regards Page 14 of 17

15 to some of the areas listed as red. NG welcomed the annual report and the emphasis on children and young people. However it was suggested some information had not been included within the report as a result of this emphasis. It was questioned whether a specific action plan would be put in place in relation to the recommendations and it was noted a children and young people strategic group would be developed focusing on various strands of work. JL added the H&WB was considering the structure and the group would utilise the annual report to determine the focus, what would be delivered and when. PN referred to the summary of children s weight in Trafford and the difference between children ages 4-5 to ages ER suggested at the age of 7 a girl s physical activity would potentially reduce and children started to have access to pocket money which could be spent on unhealthy foods contributing to weight gain. It was suggested the food industry played a big part. ED exited the meeting at this point. PN questioned how partners would be engaged with to drive the action plans forward. ER stated this would be carried out via the Trafford Partnership. In addition, work was being carried out with licensing in terms of fast food outlets. ER suggested focus was on wider determinants and not the services that were provided. PN suggested the voluntary sector were a key asset that could be utilised and members agreed with this comment. SS welcomed the report and stated it would be useful to receive details of the public health structure including team and budget. ER stated this information could be provided within a future report. SS suggested business partners could be asked to support this work for example the Trafford Centre and Kellogg s. JC stated some partnership work had been carried out with local business and intu Trafford Centre had supported the breastfeeding initiative. 1) The NHS Trafford Clinical Commissioning Group Governing Body noted the update. 2) A future report include information in relation to the public health structure, team and budget. 1718/97 HEALTHWATCH UPDATE HF presented a report to provide members with an update on the work of Page 15 of 17

16 Healthwatch Trafford in June and July HF made reference to the involvement of Healthwatch in the Trafford Talks events in terms of planning and support and expressed support for future events. Members were advised Healthwatch were carrying out a piece of work in relation to intermediate care which involved surveying a range of organisations regarding intermediate care. It was envisaged the results would feed into the CQC review being carried out in October MC welcomed the update and stated the Trafford Talks events were the beginning of an engagement process which would progress. 1) The NHS Trafford Clinical Commissioning Group Governing Body noted the update. 1617/ /99 DATE AND TIME OF NEXT MEETING TUESDAY 26 SEPTEMBER 2017, 1PM ANNUAL GENERAL MEETING AT THE WATERSIDE ARTS CENTRE, WATERSIDE PLAZA, SALE, M33 7ZF. ANY QUESTIONS FROM MEMBERS OF THE PUBLIC RELATING TO ITEMS COVERED BY THE GOVERNING BODY JCo raised a number of points in relation to the agenda items which included: Children hospital at Wythenshawe and GP and patient referral worked well. Concern regarding re-inventing the wheel of care complex services and MC provided assurance learning from past projects would be taken into consideration. Single Hospital Review and a suggestion to use Withington and Altrincham hospitals as an opportunity to engage with patients. MA questioned what plans the CCG had in place in terms of winter planning, in relation to recent concerns raised by NHS providers and requests for funding. JM commented the CCG planned for winter throughout the year and some providers potentially raised concern in the hope to secure national funding. In terms of the short term impacts, JM advised performance targets could be impacted and added the CCG funded all of the care that was required for patients. NG stated the CCG planned for winter throughout the year and whilst it was complex, it was built into plans. Page 16 of 17

17 MA made reference to the proof of concept work stream and asked why details had not been presented to the Governing Body. JC suggested a future presentation be delivered to the Governing Body and MC supported this suggestion. 1) An update with regards to the proof of concept work stream be presented to a future meeting of the Governing Body. Page 17 of 17