NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1 Minutes

Transcription

1 NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1 Minutes Date: Wednesday 25 October 2017 Time: Venue: Chair: 12:00 noon to 2:00pm Boardrooms A, B and C, Kirkdale House, Leytonstone, E11 1HP Dr Anwar Khan, Chairman Attendees Members ` Name Initials Title Dr Anwar Khan AK Chair Alan Wells, OBE AW Lay Member, Deputy Chair Terry Huff TH Chief Officer Les Borrett LB Director of Financial Strategy Dr Ken Aswani KA Clinical Director, Leyton and Leytonstone Dr Dinesh Kapoor DK Clinical Director Leyton/Leytonstone Dr Syed Ali SA Clinical Director Leyton/Leytonstone Dr A Q Sheikh AS Clinical Director Walthamstow Dr Ravi Gupta RGu Clinical Director Walthamstow Dr Mayank Shah MS Clinical Director Walthamstow Dr Tonia Myers TM Clinical Director Chingford Vineeta Manchanda VM Lay Member, Chair Audit Committee Linzi Roberts-Egan LRE Deputy Chief Executive, London Borough of Waltham Forest Joe McDonnell JMc Acting Director Public Health, London Borough of Waltham Forest Page 1 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

2 Members ` Helen Davenport HD Director of Nursing, Quality & Governance Jane Mehta JM Director of Strategic Commissioning Caroline White CW Lay Member, Public and Patient Engagement In Attendance Name Initials Title David Pearce DP Head of Governance Apologies Name Initials Title Althea Bart AB Healthwatch Manager Dr Rizwan Hasan RH Secondary Care Consultant Members of the Public in Attendance Name Initials Title Julia Walsh JW Head of Communications and Community Participation (CSU) Paul Rosenbloom PR Save Our NHS Noel Hayes NH Save Our NHS Louise Robinson General Medical Council (GMC) LR General Medical Council (GMC) Khadija Gitay KG PPG locality rep, Walthamstow Page 2 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

3 1. General Business 157/17 Apologies and Announcements AK Apologies were noted as above. AK formally welcomed CW to the NHS Waltham Forest CCG Governing Body as Lay Member, Public and Patient Engagement. 158/17 Declarations of Interest ALL In line with statutory guidance a declarations of interest checklist was reviewed by the Chair ahead of the meeting in order to identify any conflicts / potential conflicts of interest relative to the meeting agenda. There were no conflicts of interest raised. The Governing Body Declaration of Interest Register is available on the NHS Waltham Forest Clinical Commissioning Group (WFCCG) website. A copy of the register was available to the Governing Body for this meeting. 159/17 Draft minutes from Governing Body Meeting, 27 September 2017 AK The minutes of the Governing Body meeting, 27 September 2017, were approved subject to amendment to minute reference 146/17 (Proposed New NEL Commissioning Arrangement) as advised by LRE. 160/17 Matters Arising AK There were no outstanding Matters Arising 161/17 Chair s Update AK The Chair provided an update against 3 areas: 1. Letter of congratulations from Jeremy Hunt, Secretary of State for Health The Chair has received a letter of congratulations from Jeremy Hunt, Secretary of State for Health. The letter acknowledges the improvements at Waltham Forest CCG, particularly in respect to diagnostic performance which has been led by the CCG s Clinical Directors including Dr Dinesh Kapoor and Dr Abdul Sheikh, along with CCG staff members. It is testimony to the team s on-going hard work and really demonstrates the fruits of everyone s labours working in a learning organisation. Page 3 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

4 To have this CCG s efforts to improve the health outcomes of residents in Waltham Forest recognised in this way is something of which we can be immensely proud. I will be writing back to Mr Hunt highlighting other areas of good work as we don t blow our trumpet enough. 2. Health Education England (HEE) The Chairs of the 7 CCG Governing Boards in North East London have written to HEE to advise them of the challenges all the CCGs are facing in regard to; the recruitment of junior doctors quality of safety to patients The Chairs have advised the HEE that the CCGs are seeking to work collaboratively in addressing these issues and are looking forward to a positive response from them in respect to the educational work being done around changes to some planned services. 3. End of Life talk Plovdiv, Bulgaria The Chair will shortly be travelling to Bulgaria where he will visit Plovdiv to deliver an annual talk on end of life care. This will be combined with a recruitment drive to inform UK residents who are medical students there of the benefits of working in North East London. The Chair expresses his thanks to Gareth Noble and Ian Tompkins for their work in putting together the presentation slides that show case the joys of North East London. Page 4 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

5 162/17 Questions from the Public AK Waltham Forest Save Our NHS question 25 October 2017 Q1 On 16 August the Waltham Forest Guardian reported that members of the National Ankylosing Spondylitis Society (NASS) Wanstead Branch were told that the hydrotherapy pool at Whipps Cross is being drained and concreted over. NASS members have donated money to use the pool for three hours weekly since the one in Wanstead closed in Can the CCG provide details on the decision to close the hydrotherapy pool, eg who is responsible for commissioning it and whether or not its closure is related to required annual savings. A1 The CCG does not specifically commission the hydrotherapy pool. We contacted Whipps Cross Hospital and understand that Barts Health are in the process of writing to the local health and social care scrutiny committees to expand on their decision to close the pool. We understand that there has been a significant decline in NHS use of the Whipps Cross hydrotherapy pool over the last few years resulting in WXH stopping use of the pool 6 months ago. Barts Health has stipulated that the small number of patients that were using the pool under the NHS have been able to use their other pool at Mile End Hospital. If a clinician at any of the Barts Health hospitals feels a patient needs hydrotherapy on the NHS, they can be referred to use the hydrotherapy pool at Mile End Hospital, which is also part of the Barts Health estate. We also understand that Barts Health has committed to supporting the NASS members, who had been using the pool privately, to find a suitable alternative. As part of this the Trust has offered use of its Mile End pool to the group. The Trust is exploring alternative options for the use of the space in the hospital, and will reinvest the money saved each year into other front-line NHS services. AW enquired as to whether there were travel distance issues for patients if the use of the hydrotherapy pool at Mille End was needed. AW further enquired as to whether transport arrangements had been considered and / or arranged. JM advised that further information in respect to this issue was available albeit not yet in the public domain. SA, as responsible Clinical Director, agreed to discuss the issue raised with Barts Health. Page 5 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

6 2 Governance 163/17 Health and Wellbeing Annual Report JMc JMc presented the Governing Body with the finalised Waltham Forest Health and Wellbeing Board Annual Report JMc advised that the report as presented was the first Annual Report that had been produced. JMc further advised that the 2017/18 Health and Wellbeing Annual Report would be produced for publication for, around. May 2018 and that feedback on the adequacy and usefulness of the 2016/17 report would be useful in order to incorporate any feed back into that report. AW requested that dates of future Health and Wellbeing Boards be made available to the relevant Governing Body members to ensure their regular attendance. TM observed inaccuracies in respect to Governing Body membership sign off of the report within the supporting cover sheet. TH noted the inaccuracy and advised that he had signed off the report on behalf of the Governing Body as its only member present at the time of sign-off TM acknowledged TH, and further noted that the report was very helpful, and in particular in its focus on children. CW enquired, given that the report was available to the public, if a glossary of terms was available. JMc confirmed that a glossary of terms would be made available. AW advised that the report had limited detail in respect to outcomes achieved. JMc noted AW s comments and advised that a dashboard relating to outcomes was being developed and that this would form part of future reports. Page 6 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

7 TH noted that those key achievements referenced within the report were largely financial related and further noted that future reports would benefit from reference to key activities achieved in respect to patient outcomes. KA observed that whilst the report provided a broad overview of the activities of the Health and Wellbeing Board that future reports would benefit from the inclusion of more details of their activities. KA further emphasised the involvement of external agencies and that the contribution to improved health and wellbeing was not simply down to the health service. The Governing Body noted the Health and Wellbeing Annual Report. 164/17 Integrated Safeguarding Children, Young People and Adults Strategy HD HD presented the Integrated Safeguarding Children, Young People and Adults Strategy to the Governing Body. HD advised that the purpose of the report was to provide the Governing Body with an update and continuing safeguarding assurance with regards to strategic and policy activity in Q3 of 2017/18 which support the achievement of the CCG s strategic goals and compliance with statutory obligations under section 11 of Children Act HD advised that the integrated safeguarding strategy was comprised of three key documents: Safeguarding Strategy A Think Family Approach for Adults, Children and Looked after Children Safeguarding Training Strategy Safeguarding Children and Young People Supervision Policy HD further advised that the suite of documents provided the strategic direction for the implementation of a Think Family ethos across the health system in accordance with the approach adopted by the Waltham Forest Strategic Partnership. HD noted that the Safeguarding Strategy; Enabled the CCG to discharge its statutory obligations as a Health Commissioner and provided guidance to services commissioned and contracted out within the Health economy Outlined the strategic priorities for safeguarding adults, children and looked after children for in alignment with those of NHS England and the local Corporate Parenting, Safeguarding Children and Safeguarding Adult Boards Page 7 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

8 The strategy had been developed to drive safeguarding quality improvement within the health community and enable the impact of successful implementation to be evidenced through measurable outcomes. HD further noted that; The Safeguarding Training Strategy provided guidance on training needs and competencies for the relevant staff groups within organisations across the health system in accordance with the Intercollegiate Framework The Safeguarding Supervision Policy (i) provides strategic direction and options for the supervision models appropriate to staff groups; (ii) enables the critical reflection, professional challenge and the oversight required to maintain the safety of vulnerable children and young people. TM congratulated HD on an excellent and detailed report and sought clarity on the level of statutory mandatory training required by GPs. HD acknowledged that the language in the report was not necessarily clear and advised that she would liaise with NHS England to ensure that the differing levels of compliance were clarified. The Governing Body approved the Integrated Safeguarding Children, Young People and Adults Strategy /17 Annual Safeguarding Declaration HD HD presented the NHS Waltham Forest Safeguarding Declaration, to the Governing Body. HD advised that the declaration provided the Governing Body with an update and continuing safeguarding assurance with regards to the strategy and policy that support the achievement of the CCG s strategic goals and compliance with statutory obligations under section 11 of Children Act HD further advised that the statement confirmed all relevant assurance were in place to enable the CCG to demonstrate that it has appropriate systems in place for discharging its statutory duties in terms of safeguarding children. These include: A clear line of accountability for safeguarding, properly reflected in the CCG governance arrangements Clear policies setting out the CCG s commitment, and approach, to safeguarding children including safe recruitment practices and arrangements for dealing with allegations against people who work with children and adults as appropriate Training CCG staff in recognising and reporting safeguarding issues, appropriate supervision and ensuring that they are competent to carry out their responsibilities for safeguarding expected for their competencies and roles Ensuring effective arrangements for information sharing Page 8 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

9 The Governing Body approved the NHS Waltham Forest Safeguarding Declaration, Performance and Quality Report LB/HD 166/17 Performance LB presented the Governing Body with an update of the CCG s performance against the CCG Scorecard and other national performance and quality standards at the end of August LB advised that there were no significant changes since the last report to the Governing Body with that 15 of the targets were currently assessed as low risk to delivery; 5 were assessed as medium risk and 6 were assessed as high risk. LB drew attention to: Cervical Cancer Screening: Currently assessed as high risk, performance in October was 68% against a target of 71%. In order to address the cervical screening uptake the CCG is concentrating on raising public engagement and community activities. A business case has been approved to support a calling service to remind eligible women to uptake screening, alongside community engagement and communications. Learning Disabilities: Currently assessed as medium risk, performance in August was above the planned trajectory. A revised action plan is being developed by the CCG and will be agreed via the newly formed Learning Disability Health Transformation Board. Continuing Healthcare Assessments Out of Hospital: This is a new NHSE target that has become very prominent as an indicator for improving hospital flow and patient care. The CCG is not currently meeting this target but has a plan to be compliant by February TM, referencing cervical cytology, noted the need to be update GP training in this area. AK, acknowledged TM s observation and suggested that they progress the issue together. HD, acknowledging the issues in regard to training, further advised that the Performance & Quality Committee received reports in relation to the good work being achieved in cervical screening. The Governing Body approved the Performance Report. Page 9 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

10 167/17 Quality HD presented the Governing Body with an update against the quality provided to the patients of Waltham Forest at its provider organisations. HD advised that August data for Whipps Cross Hospital was not available at the time of the report being written. HD drew attention to Whipps Cross Exception report, noting in particular; details in respect to; Infection control: non-compliance against 90% target MRSA: 1 declaration in July 2017 has been referred to arbitration following difficulties in establishing the route cause Friends and Family Test (FTT): Continuing non-achievement against 95% target Safeguarding Children s Level 3 training: non compliance against 90% target HD drew attention to the NELFT Exception report, noting in particular; details in respect to; Staff turnover: non achievement against 10% target Safeguarding Adults level 2 training: 84% achievement against 85% target HD drew attention to the outcomes of CQC reports against 2 residential homes that had been subject to inspection during August HD advised that both residential homes had received good ratings against each of the CQC s 5 standards of care. HD drew attention to the Quality review visit to Whipps Cross Hospital, 22 September HD advised that the Deputy Nurse Director, Quality and Clinical Governance assisted the Associate Directors of Nursing with a visit to ward areas in order to audit adherence to the uniform policy. HD advised that whilst overall compliance was good there remained some areas that required addressing. AW observed that there was a 3 to 4 month gap in the data contained within the report and enquired as to the reason why. HD advised that there were a number of contributory factors and that following escalation to the Whipps Cross senior management the CCG were anticipating future reports to reflect up to date data. TH stressed the importance of Whipps Cross making up to date data available when required and to resolve the existing situation where data was only released following sight of the data by the Whipps Cross Board. Page 10 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

11 KA noted the importance of the lessons learnt following serious incident investigations being fed back and incorporated into any future investigations. HD, in agreement with KA, advised that whilst this was not always the case there were positive signs of improvement. The Governing Body approved the Quality Report. 4. Finance and QIPP LB 168/17 LB presented the Governing Body with an update of the CCG s financial position as at the end of September LB advised the Governing Body that the CCG was reporting a breakeven plan against plan year to date and was forecasting an in year surplus of 0.27 million at year end albeit that its financial position remained brittle. LB advised that there remained 2 outstanding claims with Barts Health and that these had been escalated to Chief Officer level with the anticipation that a resolution would be quickly achieved. TH noted the importance to move away from the current payment by results (pbr) payment mechanisms. LB, noting the low level of residual reserves, advised that there remained significant challenges and risks within the system. DK sought clarity on the CCG s ability to withhold monies from suppliers if there was a break in the terms of the contract for any reason. LB advised that contract issues were dealt with through the contract performance notice (CPN) process. LB further expanded on the benefits that arose from the adoption of an accountable care system (ACS) when compared to the existing pbr system of payment. TH noted the importance of the interoperability agenda which would lead to better patient outcomes, some of which were already being witnessed by GPs. The Governing Body approved the Finance report. 5. Strategy and Planning JM 169/17 Development of an Integrated Strategic Commissioning Function TH advised the Governing Body that the report as presented outlined the CCG s and Local Authorities shared commitment to the creation of a local ACS including, as an important early step, the establishment of an Integrated Strategic Commissioning Function. Page 11 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

12 TH noted that a consequence of the establishment of an Integrated Strategic Commissioning Function was a need to move towards an integrated budget. TH further noted that in so doing the Governing Body were requested to approve funding of circa 100K for external specialist advice albeit that the CCG would, where possible, seek to lever off funds that had already been committed within the system. JM, supporting TH, and further supported by LRE, drew attention to the next steps as presented within the report that were required to be addressed by April 2018 including; Design principles for the Integrated Strategic Commissioning Function, linked to a clearly defined set of outcomes related to improving the health and wellbeing of residents An organisational development plan that will set out the parameters for shared values, strategy, systems, styles, staff, skills and organisational structure The proposed governance arrangements for the new function, including associated HR processes The proposed legal framework for the function, including a proposal around pooled budgets and the associated documentation AK noted the good work that had been done jointly by the CCG and the Local Authority. TH enquired as to the key challenges to achieving an April 2018 deadline. LRE advised that the key challenges faced included: The importance of achieving well rather than simply achieving Resolution of key issues associated with organisational development The pooling of budgets Associated legal issues and VAT AW, supporting LRE, noted that there were cultural differences between the organisations and these would need to be addressed. AW further expressed his full support for the establishment of an Integrated Strategic Commissioning Function whilst further expressing some concerns in relation to the Governing Body approving 100k and requested that reports detailing how the monies were being spent be made regularly available to the Governing Body. VM noted that it would be useful to have some context in relation to the progress of Integrated Strategic Commissioning Functions within other boroughs. LRE further noted that similar challenges and issues existed in the establishment of accountable care systems. KA, noting the good progress made, further noted the importance of recognising the added value to patients health and wellbeing that would result Page 12 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

13 as a consequence of the implementation of the Integrated Strategic Commissioning Function. AW advised of the importance of establishing good governance processes and further noted that changes to the CCG s Constitution could be required. The Governing Body approved the report in regard to the Development of an Integrated Strategic Commissioning Function. 170/17 Organisational Development Strategy JM JM presented the Governing Body with an update of the CCG s Organisational Development (OD) Strategy. JM advised that the report as presented provided a refresh of the OD Strategy, building on the discussions that had taken place with the Governing Body in June JM further advised that the 6 monthly update was necessary in order to provide strong OD management to staff as a result of the changes in ways of working that would result as a consequence of the integrated strategic commissioning functions and also of the accountable care system. JM noted that whilst the report was CCG focussed there was work underway in respect to the wider WEL based systems. AW, noting the detailed content of the report, enquired as to the CCG s position in regard to the areas of focus of improvement identified against the national survey and how they linked to the areas detailed in the OD strategy. JM agreed to clarify. Action: Clarify how the areas of focus of improvement identified against the national survey link to the areas detailed in the OD strategy. JM TM, noting the positive nature of the document questioned if, given the pending organisational changes, whether the same positive outcomes would be repeated. TH advised that some issues had been foreseen and that the CCG had already implemented some staff resilience training and that staff were also being actively involved within the change process. The Governing Body approved the Organisational Development Strategy. 6. For Information 171/17 Audit Committee September 2017 There were no comments. Page 13 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

14 172/17 Minutes of Performance and Quality Committee September 2017 There were no comments. 173/17 Minutes of Medicines Optimisation Committee September 2017 There were no comments. 174/17 Highlights of Patient Reference Group September 2017 There were no comments 175/17 Minutes of Finance and QIPP Committee September 2017 There were no comments 176/17 Minutes of IT Committee September 2017 There were no comments. 177/17 Minutes of Primary Care Commissioning Committee September 2017 There were no comments 178/17 Actions from Leyton/Leytonstone; Chingford and Walthamstow Locality Meetings July and September 2017 There were no comments 179/17 Forward Plan No Actions A.O.B. Signature TH advised the Governing Body that interviews for the appointment of a Single Accountable Officer were due to take place and consequently the meeting may be the last one he attends. TH thanked the Governing Body members for their support during his time as Accountable Officer for Waltham Forest CCG. Date Page 14 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1

15 Next meeting Date: 22 November 2017 Time: Venue: Boardrooms A, B and C, Ground Floor, Kirkdale House, Leytonstone, E11 1HP Page 15 Minutes NHS Waltham Forest Clinical Commissioning Group Governing Body Part 1