Governing Body Vice Chair and Lay Member, Camden CCG. Governing Body Lay Member, Barnet CCG

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1 Present: NORTH CENTRAL LONDON (NCL) JOINT COMMISSIONING COMMITEE Minutes of the meeting held in public on Thursday 5 October 2017, 15:00-17:00 Conference Hall Cypriot Community Centre Earlham Grove London N22 5HJ Voting Members Ms Karen Trew (Chair) Dr Mo Abedi Ms Sorrel Brookes Dr Peter Christian Ms Bernadette Conroy Ms Kathy Elliott Mr Simon Goodwin Ms Catherine Herman Ms Helen Pettersen Dr Kevan Ritchie Dr Jo Sauvage Dr Barry Subel Ms Sharon Seber Non-Voting Members Ms Parin Bahl Cllr Alev Cazimoglu Ms Sharon Grant Dr Jeanelle De Gruchy Cllr Hugh Rayner In attendance Mr Paul Sinden Ed Nkrumah Kath McClinton Mark Ruddy David Stout Mark Eaton Peter Ridley Governing Body Vice Chair and Lay Member, Enfield CCG Governing Body Chair, Enfield CCG Governing Body Lay Member, Islington CCG Governing Body Chair, Haringey CCG Governing Body Lay Member, Barnet CCG Governing Body Vice Chair and Lay Member, Camden CCG NCL Chief Finance Officer, Barnet, Camden, Enfield, Haringey and Islington CCGs Governing Body Non-Clinical Vice Chair and Lay Member, Haringey CCG NCL Accountable Officer, Barnet, Camden, Enfield, Haringey and Islington CCGs Governing Body Clinical Vice Chair, Camden CCG Governing Body Chair, Islington CCG Governing Body Clinical Vice Chair, Barnet CCG Practice Nurse Member, Haringey CCG Chair, Healthwatch Enfield Councillor, Enfield London Borough Council Chair, Healthwatch Haringey Director of Public Health, Haringey London Borough Council Councillor, Barnet London Borough Council NCL Director of Performance and Acute Commissioning, Barnet, Camden, Enfield, Haringey and Islington CCGs Head of Performance & Informatics, Enfield CCG Assistant Director Special Projects, Islington CCG Transforming Care Finance Lead, Islington London Borough Council Senior Programme Director, North Central London STP Director of Recovery, Enfield CCG Director of Planning, Royal Free London 1

2 Apologies: Cllr Janet Burgess Dr Debbie Frost Dr Neel Gupta Mr Andrew Spicer Cllr Jason Arthur Cllr Richard Olszewski Minutes: Ms Louisa Dearman Councillor, Islington London Borough Council Governing Body Chair, Barnet CCG Governing Body Chair, Camden CCG NCL Head of Governance and Risk, Barnet, Camden, Enfield, Haringey and Islington CCGs Councillor, Haringey London Borough Council Councillor, Camden London Borough Council Quality and Governance Support Officer, Haringey & Islington CCGs 1 Introduction 1.1 The Chair welcomed everyone to the meeting and introductions were made. Sharon Seber and Parin Bahl were welcomed as new members of the Committee Attendees were asked to review the declarations of interest register ahead of Committee meetings and to declare if they believed they were conflicted for any items on the agenda. There were no declared conflicts of interest Add Sharon Seber, Angela Dempsey, Matthew Clark, and Parin Bahl to the declarations of interest register. 1.3 There were no declarations of gifts or hospitality offered or received. 1.4 Minutes of the Committee meeting on 3 August The minutes were approved as an accurate record. 1.5 Notes from the Seminar held on 7 September It was noted that item 1.11 on the notes should read that it was the first seminar not meeting of the Joint Commissioning Committee. The notes were then approved as an accurate record of the Seminar. 1.6 Action log It was agreed to close the completed actions. The following updates on open actions were given: Action 1: Develop Performance Report to include in Acute Commissioning Report it was agreed that Paul Sinden would circulate the updated report which would include activity and trends for each trust; completed and closed. Action 4: Papers for Transforming Care Partnership to be on CCG websites Paul Sinden to circulate to all NCL Chief Operating Officers; completed and closed. Action 6: Develop easy read version of System Intentions document provided for discussion at today s meeting; completed and closed. Action 10: Update Committee s Risk Register to be discussed in today s meeting; completed and closed. 1.7 Questions from the public 2

3 1.7.1 There were no questions from the public. 2 Governance 2.1 Update on Independent Chair and Independent Clinicians It was noted that an Independent Chair was not appointed following interviews. It had been agreed that Karen Trew would remain as the interim Chair for the next six months, during which time there would be further consideration of the need to recruit an independent Chair of the Committee Three independent clinicians had been appointed to the Committee: Sharon Seber, Angela Dempsey, and Matthew Clark Sharon Grant raised a concern about the way the role of the Independent Chair was advertised, and suggested that greater clarity around the nature of the role was needed. It was agreed that greater discussion should be had with stakeholders about the role for any potential future advertisement of the post. It was agreed that the Committee should discuss this at a future meeting within the next six months. Add an item to the Committee s Forward Planner to discuss the recruitment to, and role and responsibilities of, the Committee Chair by April Activity and Performance 3.1 Acute Contract Report Paul Sinden provided a summary of the report and highlighted the key areas for noting Cancer 62 day pathway North Central London (NCL) as a system would not now achieve the targeted recovery of this waiting time standard by September 2017 mainly due to a backlog of referrals at University College London Hospital (UCLH) and Royal Free London (RFL). Recovery was now expected by the end of November It was highlighted that although the two Trusts met the standard for internal pathways, there were delays when there was a transfer of care into the Trusts respective tertiary cancer services from secondary care providers. Interprovider transfers should be made within 38 days leaving 24 days for the specialist provider to complete the pathway. In terms of mitigating against this, it was noted that pathways were being reviewed; there were fortnightly performance meetings with the Trusts supported by weekly teleconferences; work to improve the effectiveness of specific and complex pathways; and oversight by Contract Quality Review Groups (CQRGs) of the Root cause analyses (RCAs) of breaches and Clinical Harm Review Groups for waits in excess of 100 days Mo Abedi asked where delays in inter-provider transfers were impacting on performance. Paul Sinden noted that the problem was greatest for transfers into UCLH from Royal Free London and Barking Havering and Redbridge University Hospitals Trust (BHRUT), although UCLH only then treated 50% of transferred patients within the targeted 24 days due to the working of internal pathways. Communication to Primary Care would also need to be monitored as management from the beginning of the pathway was important in reducing delays In terms of gaining assurance around inter-provider transfers, Kathy Elliot queried whether a metric could be used to judge the process. Paul Sinden agreed that a metric would be included in future acute contract reports. 3

4 Include metric for measuring the inter-provider transfers and any delays in future Activity and Performance Reports for this Committee Referral to treatment (RTT) NCL had met the waiting time standard so far in 2017/18, but there were early warning signs of difficulty in maintaining performance particularly evident at UCLH and Royal Free London (RFL). CCGs were working with both Trusts to mitigate risks Bernadette Conroy raised a concern around maintaining RTT performance in terms of receiving up to date information from Trusts in order to act quickly and avoid dips in performance experienced previously. Paul Sinden noted that clinical harm reviews were undertaken with providers for waits in excess of 52 weeks, and commissioners were able to look ahead and mitigate risks by monitoring waiting list profiles. It was noted that using the marginal rates going forward would mitigate the financial impact of recovery plans London Ambulance Service (LAS) The process of tethering ambulances to localities to improve emergency response times had been halted by LAS. It was noted that this information reached Paul Sinden after papers for this meeting were circulated. Paul Sinden agreed to provide further detail to Committee members about the change to LAS recovery plans. Paul Sinden to provide further detail about LAS halting plans for tethering ambulances to localities Contracts It was highlighted that the position at month five was an overperformance of 5m, with a forecast outturn over-performance of 14.8m at the year-end. Most of the over-performance accrued from the contract with Royal Free London (RFL), with over spends of circa 1% against the contracts with UCLH and North Middlesex University Hospital (NMUH). Quarter one reconciliations with providers were underway to resolve differential assumptions on transactional elements of contracts. Progress was being made with the contract reconciliations with UCLH, North Middlesex University Hospital (NMUH) and Whittington Health with resolution expected by 6 October The reconciliation with Royal Free London (RFL) was more complex due to some prior year issues, poor data quality compared to other providers, and in-year counting and coding changes and was targeted for resolution by 13 October Key actions to reduce the forecast over performance on acute contracts would be a continued focus on transactional elements as well as delivering Sustainability and Transformation (STP) and local QIPP interventions In regards to the run rate of contract expenditure for each provider, it was agreed that it would be beneficial for the report to include the projected run-rate for the rest of the year as well as actuals for the year-to-date. It was noted that the quarter one reconciliation would make forecasting easier and reduce reporting volatility, and that the projected run rate would also show reductions as the impact of STP interventions increased. Paul Sinden to include the projected run rate in future reports 3.2 Learning Disabilities Transforming Care Cohort 4

5 3.2.1 Kath McClinton and Mark Ruddy provided an update on the further modelling undertaken to assess the local financial impact for both CCGs and Social Care on the repatriation of care from inpatient settings into the community. The report followed on from the August Committee where an overview of the quality assurance process for the transfer of care for individuals into the community from inpatient placements was provided There were two cohort of patients in inpatient placements one funded by CCGs and another cohort funded by NHS England through specialist commissioning. The NCL transforming care programme team had developed a banding system to assess the level of care, and associated costs, required for each patient with care being transferred into the community. The model was an example of good practice and NHS England intended to use it across London It was noted that for CCG funded placements the financial impact of transfers of care into the community would be low based on the assumption that existing CCG funding would be recycled across the health and social care system to cover the costs of community packages. However, NCL could potentially face financial pressure for the community care packages for individuals discharged from NHS England-funded inpatient care, as NHS England had yet to confirm funding transfer arrangements. The NCL programme team were continuing to work with NHS England to confirm funding transfer arrangements Concern was raised by the Committee that NHS England had yet to agree funding arrangements, and it was agreed that a letter be sent on behalf of the Committee to NHS England setting out the requirement for funds to transfer to cover the costs of community packages of care The Committee noted the progress with financial modelling, and requested further updates on progress with receipt of funds from NHS England. The Committee approved the principle for CCG funded patients that funding would flow from CCGs to the Local Authorities on discharge into the community to cover the costs of community packages. A letter be sent on behalf of the Committee to NHS England setting out the requirement for funds to transfer to cover the costs of community packages of care. 4 Commissioning 4.1 System Intentions Paul Sinden noted that system intentions had been circulated to all NCL providers on 29 September Individual letters to Trusts included more detail about local intentions from CCGs that sat outside of the Sustainability and Transformation Plan (STP). It was agreed that it would be useful for Committee members to have sight of the local intentions documents as well as the NCL-wide systems intentions. An easy read version of the system intentions had been prepared and was appended to the report. It was agreed that the easy read version would be revised with the assistance of Healthwatch It was agreed that patients should be involved in any procurement process, as was already the case with many procurements, and that there was a process of engagement throughout the procurement process. It was agreed to include this in the intentions document for future procurements. 5

6 4.1.3 Actions: Paul Sinden to circulate the local intentions to Committee members. Sharon Grant and Paul Sinden to develop an easy read version of the System Intentions document. 4.2 Procedures of Limited Clinical Effectiveness (PoLCE) Jo Sauvage introduced the paper on the NCL procedures of limited clinical effectiveness (PoLCE) programme. The policy set out a list of treatments that were only offered on the NHS when a patient met certain clinical criteria. This helped ensure that patients were only put forward for procedures that had a high chance of being successful and of making a measurable improvement to their health and quality of life, and that allocated resources were spent with care. The Programme was clinically led and evidence-based programme and focused on four areas: 1. Ensuring that the current NCL PoLCE Policy was consistently applied across the patch; 2. Reviewing the existing NCL PoLCE Policy to ensure that it was clear and reflected the latest evidence given that the policy was agreed some time ago; 3. Consulting on the adoption of additional procedures as PoLCE across the whole of North Central London that had been agreed by Enfield CCG Governing Body in September 2017 following clinical review and public consultation. This would ensure a consistent approach was used across NCL; 4. Seeking to review the evidence concerning a larger number of procedures classified to determine whether they should be classified as PoLCE. This work would be co-ordinated across London. Jo Sauvage further noted that the aim of this work was to maintain, improve and evolve services. There had been a shift over time to more evidence-based medical work within a finite resource for providing care The Committee was asked to note that local work on the policy was presented to the NCL Joint Health Overview Scrutiny Committee (JHOSC) on 22 September For the third workstream, wider NCL CCG adoption of the Enfield CCG additional PoLCE procedures, JHOSC recommended that each CCG should ask respective Health Overview Scrutiny Committees (HOSCs) on guidance for consultation. A consultation timeline based on JHOSC advice was presented for comment and approval. In response the Committee agreed that it would also be helpful for CCGs to work with Healthwatch in terms of planning engagement and consultation with residents and service users A concern was raised about the potential for different outcomes from the individual consultations being undertaken in each Borough. Jo Sauvage clarified that each Borough would take a view individually, and if consultations resulted in different outcomes the Committee would consider accommodations to arrive at a consistent policy. David Stout further added that any decision to make changes to the current PoLCE policy would come back to this Committee to agree on behalf of NCL CCGs. The consultation process in each Borough would also be cognisant of work already undertaken locally Helen Pettersen noted that there had been a good discussion on engagement and consultation for the PoLCE policy at the NCL Sustainability and Transformation Plan (STP) Advisory Board. The Board had agreed that different methods of public consultations would be required in different Boroughs based on consultation carried out to date, and that discussions should be held with local Healthwatch organisations as to how to best to run the consultations. 6

7 4.2.5 The Committee noted and approved the proposed timeline and approval process for the consultation for the eight procedures that are being rolled out across Barnet, Camden, Haringey and Islington following the work done in Enfield. 4.3 Planning for winter The Committee received and noted the report on preparations for winter 2017/18, with the report setting out performance priorities for 2017/18 (winter resilience, cancer waiting times and financial balance), governance and reporting requirements for the winter period, and a checklist from each A&E Delivery Board on readiness to deliver the eight high impact changes for emergency pathways set out in national planning guidance (the Five Year Forward View). The Committee requested site of winter plans, and supporting investment, submitted by each A&E Delivery Board to NHS England and NHS Improvement Helen Pettersen advised the Committee that operational delivery was co-ordinated through the A&E Delivery Boards. It was therefore recommended that the report also be taken to each of the CCG Governing Bodies In response to a query about the financial implications of winter pressures, Helen Pettersen advised that investment plans had been agreed through respective A&E Delivery Boards based on resilience funds held in CCG baselines and the Better Care Fund. The report provided an overview of winter plans with investment along the emergency pathway for admission avoidance, hospital flow, and prompt discharges. A&E Delivery Boards with the most severe performance challenges had been asked to submit additional contingency plans by NHS England to further assure resilience, for which additional winter finds might be made available. At the time of the Committee no confirmation of additional funds had been received from NHS England Paul Sinden to provide the winter planning report for discussion at NCL CCG Governing Bodies; Paul Sinden to provide an overview of winter plans from each of the A&E Delivery Boards. 4.4 Royal Free Medium Term Financial Strategy Peter Ridley presented an overview of the Trust s medium-term financial strategy that had previously been presented to the NCL Joint Health Overview and Scrutiny Committee. The report was set in the context of a revised control total for 2017/18 being agreed with NHS Improvement that would support Trust access to sustainability funds in-year, but would result in a more challenging control total for 2018/19. The Trust plan was predicated on a four-year recovery plan to reach a stable financial position In response to the plan Bernadette Conroy recommended that the release of single capital receipts should consider the long-term impact and not only be used as a short term solution to meeting single year financial targets. Peter Ridley agreed and noted that the Trust was looking to maximise revenue benefits through reinvestment In terms of the group model for the Trust, it was noted that management teams had been placed into each hospital site to concentrate on service delivery. Although there was an overall strategy for the Trust Group, each site would have individual 7

8 plans too. In response to a query about cost efficiency, Peter Ridley noted that the Trust was doing a piece of work to standardise clinical pathways to ensure consistent quality across the Trust sites. In regards to Edgware Hospital the Trust was reviewing services that would be provided from the site in the future including theatre capacity. The Committee recommended that any proposed changes to the future use of Edgware Hospital should go through a public consultation in line with the scale of service change being recommended Simon Goodwin welcomed the transparency and early sight of the Trust s presentation and agreed with the broad shape of the strategy. In terms of Edgware Hospital, he recommended that commissioners would need to work with the Trust on any planned changes to use of the site. Simon Goodwin also noted that he had previously been in conversation with the Trust s Director of Finance about the financial strategy along-with Paul Sinden and Will Huxter (NCL CCG Director of Strategy) Communication of the medium-term financial strategy, in addition to the JHOSC presentation, had been undertaken with Barnet Health and Wellbeing Board and Clinical Practice Groups. Patients had been involved in the development of clinical pathways It was noted that there was a more detailed slide pack that it would be beneficial for the Committee to receive. 5 Risk Circulate the more detailed RFL slide pack to the Committee. 5.1 NCL Joint Commissioning Committee Risk Register The Committee noted the update of the risk register to incorporate strategic as well as operational risks. The risk register for the Joint Commissioning Committee (JCC) had now been linked to individual CCG registers, with those risks with a rating of twelve or above on the JCC register also being added to CCG registers. 6 Questions from public 6.1 There were no questions. 7 Any other business 7.1 Forward Planner The Committee noted the forward planner. Pending the addition of a future discussion item about the Committee Chair, there were no additional changes. 8 Date of next meetings 8.1 Thursday 7 December L1 Large Room, The St Pancras and Somers Town Living Centre, 2 Ossulston St, Kings Cross, London NW1 1DF. 8