NHS TRAFFORD CLINICAL COMMISSIONING GROUP GOVERNING BODY 24 th February 2015

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1 Agenda Item No: 18 Part 1 X Part 2 NHS TRAFFORD CLINICAL COMMISSIONING GROUP GOVERNING BODY 24 th February 2015 Title of Report Purpose of the Report Minutes of the Public Reference and Advisory Panel held on the 6 th January 2015 and the draft minutes of the meeting held on 5 th February 2015 For information Actions Requested Decision Discussion Information X Strategic Objectives Supported by the Report 1. Consistently achieving local and national quality standards. 2. Delivering an increasing proportion of services from primary care and community services from primary care and community services in an integrated way. 3. Reduce the gap in health outcomes between the most and least deprived communities in Trafford. 4. To be a financial sustainable economy. Recommendations Discussion history prior to the Governing Body Financial Implications Risk Implications Equality Impact Assessment Communications Issues Public Engagement Summary Prepared by Responsible Director The NHS Trafford Clinical Commissioning Group Governing Body is asked to note the minutes of the Public Reference and Advisory Panel held on the 6 th January 2015 and the draft minutes of the meeting held on 5 th February 2015 (subject to ratification at next committee meeting) N/A N/A N/A N/A N/A N/A Jenna Lancaster, Governance Support Officer Paul Hulme, Associate Director of Corporate Services and OD

2 Minutes of the NHS Trafford Clinical Commissioning Group Public Reference & Advisory Panel Held on Tuesday 6 th January, 2015 At Crossgate House, Sale Meeting commenced: am Meeting ended: 1.00 pm PRESENT: Pricilla Nkwenti In the Chair Shabir Abdul Ann Day George Devlin John Howe Chris Jacob Patricia Lees Nasrullah Khan Moghal Lesley Spencer Lesley Thornton Brian Wilkins Representing the Trafford Population (North) Neighbourhood Participation Group Representative (North) Representing the Trafford Population (West) Neighbourhood Participation Group Representative (West) Third Sector Representative 42 nd Street Representing the Trafford Population (South) Third Sector Representative - Voice of BME, Trafford Neighbourhood Participation Group Representative (South) Third Sector Representative - Counselling and Family Centre Healthwatch Representative IN ATTENDANCE: Tracy Clarke Communications and Engagement Specialist Jill Colbert Head of Service, Integrated Commissioning Unit (for item 14/64) Julie Crossley Associate Director of Commissioning (for item 14/65) Adrian Hackney Associate Director of Transformation (for item 14/64) Jenna Lancaster Governance Support Officer (minutes) Imran Khan Service Transformation Project Manager (for item 14/65) Kate Provan Quality Lead (for item 14/68) Dr Marik Sangha Clinical Director of Primary Care Interface & Member Relations (for item 14/62) Mike Taylor Head of Governance, Planning and Risk (for item 14/63) Tim Weedall Head of Scheduled Care (for item 14/66 and 14/67) PRAP 15/57 APOLOGIES FOR ABSENCE An apology for absence was submitted from Ann-Marie Jones.

3 PRAP 15/58 ELECTION OF VICE CHAIR The Governance Support Officer informed members of the panel of the selfnominations that were received for the role of vice chair and were; Shabir Abdul, Ann Day and Lesley Thornton. Seven members of the panel submitted their vote and the Governance Support Officer announced that Ann Day had received the majority of votes and was therefore elected as the Vice Chair of PRAP. 1) That Ann Day be elected as Vice Chair of PRAP. PRAP 15/59 DECLARATIONS OF MEMBERS INTEREST CONCERNING AGENDA ITEMS Ann Day expressed an interest with regards to agenda item 14/62, Primary Care Co-Commissioning in relation to her role as Chair of Healthwatch. Ann Day also expressed a personal interest in agenda item 14/66 Early Supported Discharge. With regards to the completion of declaration of interest forms, the Governance Support Officer confirmed that all members of the panel had now completed and returned their form. 1) The declarations of interest be noted. PRAP 15/60 MINUTES FROM THE PREVIOUS MEETING HELD ON 6 th November 2014 INCLUDING THE ACTION LOG The minutes of the previous meeting held on the 6 th November, 2014 were agreed as an accurate record. Brian Wilkins commented on the minutes and questioned whether there was a requirement for them to be so comprehensive. The Communications and Engagement Specialist stated that the minutes contained the correct level of detail, due to the nature and credibility of the panel. The Governance Support Officer added that the minutes should reflect the points and discussions that took place at the PRAP. Ann Day commented that PRAP agendas were large and therefore the minutes would reflect this. Patricia Lees welcomed the format and level of detail contained within the minutes. The Communications and Engagement Specialist referred to the your views count survey and informed members that ten members of PRAP had Page 2 of 10 January 2015 Public Reference & Advisory Panel Minutes Date of Destruction: 30 January 2045

4 completed and returned the survey. It was reported that a number of members felt that they did not have sufficient time to read agenda papers prior to each PRAP meeting. It was stated that agendas and accompanying papers would be sent to members at the earliest opportunity and that this feedback would be disseminated to report writers. With regards to bi-monthly meetings of PRAP, the consensus was that members would prefer monthly meetings and would review this again in 3 months. It was discussed and agreed that if there were no items listed on the workplan for a meeting, the session could be utilised for training and development. The Communications and Engagement Specialist stated that she would produce a draft training plan for members perusal. She also informed members that she would look into the option of a lunchtime meet and greet session between PRAP members and Clinical Directors. The Governance Support Officer referred to future meetings of PRAP during 2015/16 and proposed that the panel meets on the first Thursday of every month from 10am 1pm, based on the preferences indicated by panel members in the your views count survey. Members agreed this proposal. Ann Day informed the Communications and Engagement Specialist that she would complete and return a short profile at the earliest opportunity. The Governance Support Officer informed members that the CCG was currently advertising the two PRAP vacancies and asked for members support in terms of advertising the roles. The Communications and Engagement Specialist referred to an education event that she was attending with practice managers on Wednesday 28 th January, 2015 and stated that she would promote the vacancies at this event. Members were asked to submit any ideas for promoting the vacancies to the Governance Support Officer. 1) The Public Reference and Advisory Panel (PRAP) approved the minutes of the previous meeting held on 6 th November, ) Future meetings of the PRAP would take place on the first Thursday of every month from 10am 1pm. PRAP 15/61 REVIEW OF WORKPLAN 2014/15 The Communications and Engagement Specialist presented the workplan for member s perusal and members requested that the following items be included on the workplan: Recruitment Update Thursday 5 th February, 2015 Quality Update Thursday 5 th February, 2015 Development of PRAP members Thursday 5 th March, 2015 Primary Care Co-Commissioning Update Thursday 5 th March, 2015 Page 3 of 10 January 2015 Public Reference & Advisory Panel Minutes Date of Destruction: 30 January 2045

5 A discussion ensued with regards to member s attendance at various meetings and the best method for reporting back to the panel. Brian Wilkins referred to the CCG LCS group meeting he attended and the briefing note he circulated via to all members to provide an update from this meeting. The Governance Support Officer supported this method and suggested that if members attended a meeting on behalf of PRAP, to prepare a short briefing that could then be circulated to all members for information. 1) The Public Reference and Advisory Panel noted the work plan. 2) That the workplan be updated to include the additional items requested. 3) That members who attend meetings on behalf of PRAP complete a short briefing to be sent to the Governance Support Officer, to circulate to all members. PRAP 15/62 PRIMARY CARE CO-COMMISSIONING Dr Marik Sangha, Clinical Director of Primary Care Interface & Member Relations attended the meeting to provide members with an overview of primary care co-commissioning and the options available to the CCG. Members were informed of the three options that were available to the CCG and included (i) greater involvement in primary care decision making, (ii) joint commissioning arrangements, and (iii) delegated commissioning arrangements. It was suggested that the CCG would apply for option (ii) joint commissioning arrangements which would result in a primary care cocommissioning committee being set up. Members were presented with the draft terms of reference for this committee. With regards to the proposed membership of the committee, Dr Sangha suggested that a member of PRAP would be invited to sit on the committee, with non-voting status. Lesley Thornton queried the proposed membership and sought clarity regarding the difference between the Lay Member for Public and Patient Involvement and the PRAP representative. Dr Sangha explained that the Lay Member for Public and Patient Involvement would be a governing body member of the committee and therefore, an independent PRAP member would be beneficial to the membership. A further question was asked with regards to the intentions of other Greater Manchester CCG s and Dr Sangha stated that all CCG s were currently in the process of determining their preferred option, based on their needs. However, members were informed that it was envisaged that the majority of CCG s would opt for option ii. Brian Wilkins referred to the Local Medical Committee (LMC) and Trafford GP practices and queried how they had been consulted with, with regards to the options. Dr Sangha stated that a meeting of the Council of Members was scheduled to take place on Wednesday 14 th January, 2015 to discuss and approve the option in which the CCG would opt for. In addition, members Page 4 of 10 January 2015 Public Reference & Advisory Panel Minutes Date of Destruction: 30 January 2045

6 were informed that the LMC were aware of and supported the CCG s intentions. In relation to the standing invitation to Healthwatch, the Health and Wellbeing Board and PRAP to appoint representatives to attend the primary care cocommissioning committee, Ann Day questioned whether these representatives would participate in both part 1 and part 2 of the committee. Dr Sangha stated that he would seek clarity with regards to this query and report back to members. Brian Wilkins commented on the potential of increased workloads in terms of resolving and dealing with conflicts of interest, as a result of primary care cocommissioning. Shabir Abdul referred to the proposed membership and sought reassurance that there was a commitment to ensuring that equality and analysis would be undertaken to ensure equal representation. Dr Sangha stated that equality was embedded throughout the CCG and that the Group had an overall commitment to ensuring that access to primary quality care was via equality across Trafford. In response, Brian Wilkins expressed concern that primary care providers were not consistent in their approach and therefore, equality would be affected. Dr Sangha informed members that the CCG intended to look at quality amongst all Trafford GP practices taking into account the national scorecard, local scorecard for Trafford, peer reviews and prescribing and outpatient data and when required, extra support would be provided to GPs to improve performance and quality. With regards to the report template that was presented to members, Shabir Abdul made reference to the equality impact assessment section that had not been completed and requested that this be completed in future to demonstrate the CCG s commitment to equality. PRAP members were informed that they would be updated throughout the process of primary care co-commissioning. The Governance Support Officer asked members to submit their interest to her, with regards to membership of the primary care co-commissioning committee. 1) The Public Reference and Advisory Panel noted the contents of the report. Dr Marik Sangha exited the meeting. PRAP 15/63 GOVERNANCE STRUCTURE The Head of Governance, Policy and Risk attended the meeting and provided members with further details with regards to the primary care cocommissioning committee. Page 5 of 10 January 2015 Public Reference & Advisory Panel Minutes Date of Destruction: 30 January 2045

7 Members were informed that the committee would be a committee of the Council of Members and therefore, the Governing Body could not intervene with any decisions that were made. With regards to the key responsibilities of the committee, this was currently being defined with NHS England. Ann Day referred to the previous agenda item and the discussion that ensued in relation to the standing invitation to Healthwatch, the Health and Wellbeing Board and PRAP to appoint representatives to attend the primary care cocommissioning committee, and questioned whether these representatives would participate in both part 1 and part 2 of the committee. The Head of Governance, Policy and Risk suggested that this decision could be at the discretion of the Chair. However, he was meeting with the Director of Commissioning at NHS England and would clarify this point and report back to members. George Devlin stated that the PRAP representative should be eligible to participate in both parts 1 and 2 of the committee and requested that this view be reflected in the meeting between the Head of Governance, Policy and Risk and the Director of Commissioning. Nasrullah Khan Moghal supported this view. The Head of Governance, Policy and Risk referred to part 2 agenda items and informed members of the CCG s intention to introduce a part 2 checklist, which would ensure robustness, openness and transparency. Brian Wilkins referred to the CCG s Constitution and the Head of Governance, Policy and Risk confirmed that the Constitution would be updated to reflect primary care co-commissioning. 1) The Public Reference and Advisory Panel noted the contents of the update. 2) That clarity be sought with regards to the standing invitation to Healthwatch, the Health and Wellbeing Board and PRAP to appoint representatives to attend the primary care co-commissioning committee, and whether these representatives would participate in both part 1 and part 2 of the committee The Head of Governance, Policy and Risk exited the meeting. PRAP 15/64 TRANSFORMING COMMUNITY PAEDIATRICS The Head of Service, Integrated Commissioning Unit and Associate Director of Transformation attended the meeting to provide an update to members with regards to transforming community paediatrics, which was originally presented to PRAP on 2 nd September, Members were informed that the project initiation document (PID) that was originally presented to PRAP had been amended to reflect a number of Page 6 of 10 January 2015 Public Reference & Advisory Panel Minutes Date of Destruction: 30 January 2045

8 suggestions and improvements that had been submitted via various groups and committees and to refine the project in further details. The final PID was scheduled to be presented to the Clinical Commissioning and Finance Committee for formal approval on Tuesday 20 th January, Upon approval of the PID, the first phase of the project would be to implement a general paediatric community clinic within the north of the borough, serving three GP practices with the highest number of referrals within this area. The Head of Service made reference to the lead Paediatrician who had over ten years experience and therefore had a high level of expertise, skills and knowledge to deliver this service. Upon successful implementation and delivery of phase one, members were informed that the project would be rolled out to a 2 nd location in March, Members were informed that phase one of the project would incur no extra cost and would be met from existing clinical resources within the Pennine community services contract. However, a small charge would be incurred for administration and business support. Lesley Spencer referred to existing referral rates for children with mental health issues and the Head of Service assured members that this process would not change and that safeguarding was embedded throughout all appointments. In addition, the Head of Services made reference to the expertise and knowledge of employees delivering this service in terms of identifying a mental health case. The Chair thanked the Head of Service and welcomed the pilot. The Chair asked if an update could be provided to PRAP in July, 2015 with regards to the progress of the project. 1) The Public Reference and Advisory Panel noted the contents of the update. 2) That an update be presented to members at PRAP in July, PRAP 15/65 FRAIL AND OLDER PEOPLE UPDATE The Associate Director of Commissioning and the Service Transformation Project Manager attended the meeting to provide members with an update in relation to frail and older people programme. Brian Wilkins referred to the imposed conditions and discharging patients from hospital sooner. He expressed concern that the correct level of resources and finance would be required to do so, including trained staff. The Associate Director of Commissioning informed members that the correct level of resources would be in place and that there was a need to ensure that patients who did not need to go into hospital were not admitted. With regards to staffing, the Associate Director stated that work was currently on going with Page 7 of 10 January 2015 Public Reference & Advisory Panel Minutes Date of Destruction: 30 January 2045

9 Pennine to look at workforce planning. In addition, a recruitment drive was currently being considered to look at the skills and expertise that was required, to support the delivery of services across the board, ensuring that staff were in the right roles. The Associate Director of Commissioning invited members to be involved in the work with regards to frail and older people and to express any interest to do so, via the Governance Support Officer. 1) The Public Reference and Advisory Panel noted the contents of the presentation. PRAP 15/66 EARLY SUPPORTED DISCHARGE The Head of Scheduled Care attended the meeting to inform members of the CCG s intention to commission an Early Supported Discharge (ESD) service at Trafford General Hospital site to deliver the same service to north Trafford stroke patients as was currently being delivered from Wythenshawe hospital. Members were informed that The Clinical Commissioning and Finance Committee approved to commission the Central Manchester Foundation Trust to deliver a 5 day ESD service from the Trafford General Hospital site at its meeting on 18 th November, Ann Day referred to patients who were discharged from hospital on a Friday and expressed concern that these patients would not see a professional for potentially 48 hours and could therefore have a significant impact on their wellbeing. The Head of Scheduled Care stated that he would look into how this currently operates and the option to discharge patients on a Thursday, opposed to a Friday. John Howe expressed concern with regards to patients being discharged from hospital with no support, for example patients who would not have any food at home. The Head of Scheduled Care informed members that specific criteria would have to be met, before a patient would be discharged to ensure that they was supported. Shabir Abdul requested further assurances that patients would be supported and the Head of Scheduled Care stated that further information could be provided for example care pathway details. Lesley Thornton referred to the community rehab team and asked how the work of the ESD team would link into their work. The Head of Scheduled Care stated that the ESD team would focus on stroke patients who had short term issues and therefore, the work of each team would not overlap. 1) The Public Reference and Advisory Panel noted the contents of the report. Page 8 of 10 January 2015 Public Reference & Advisory Panel Minutes Date of Destruction: 30 January 2045

10 George Devlin exited the meeting. PRAP 15/67 CLINICAL ASSESSMENT AND TREATMENT SERVICES (CATS) COMMISSIONING INTENTIONS The Head of Scheduled Care presented a report to inform members of the CCGs proposed commissioning intentions for the Clinical Assessment and Treatment Services (CATS), from March With regards to the Greater Manchester (GM) CATS contract and the potential financial risk to all GM CCGs in that the current provider proposes to stop accepting referrals from December, 2015, the Chair requested an up to date position. The Head of Scheduled Care stated that this was currently being challenged by NHS England and would provide an update to members once this was available. Chris Jacob questioned what the original intent of CATS was and the Head of Scheduled Care confirmed that it was to reduce waiting times and improve access. Shabir Abdul referred to the capacity of providers to deliver CATS and the associated cost. The Head of Scheduled Care informed members that the CCG had not achieved the 85% level of activity and therefore, resulted in an underspend. Ann Day questioned GP referrals to CATS and the Head of Scheduled Care stated that GPs were encouraged to refer patients to CATS however, the service was not available in the south locality and therefore some patients were not willing to travel. In addition, the perception of CATS amongst some patients deferred them from utilising the service. Shabir Abdul requested a copy of the equality impact assessment that had been carried out for the CATS intentions. 1) The Public Reference and Advisory Panel noted the contents of the report. 2) That a copy of the equality impact assessment be sent to Shabir Abdul. PRAP 15/68 ANY OTHER BUSINESS Kate Provan, Quality Lead attended the meeting to inform members of a number of quality visits that were scheduled to take place over the forthcoming months. Members were asked to inform the Governance Support Officer if they were interested in participating in these visits, which would require them to have a DBS check carried out. Members requested that a copy of the presentation made with regards to frail and older people be circulated. Page 9 of 10 January 2015 Public Reference & Advisory Panel Minutes Date of Destruction: 30 January 2045

11 Lesley Thornton referred to the frail and older people update and reference that was made to the alternative to transport review pilot and requested that an update be reported back to a future meeting of PRAP. 1) Members to express their interest to participate in the quality visits to the Governance Support Officer. 2) A copy of the presentation that was delivered with regards to frail and older people be circulated. 3) That an update with regards to the alternative to transfer review pilot be provided to members at a future meeting of PRAP. PRAP 15/69 DATE AND TIME OF NEXT FORMAL MEETING It was noted that the next meeting would take place on Thursday 5 th February, 2015 at 10.00am in the Partington Suite at Crossgate House. PRAP 15/70 POST MEETING REFLECTION A discussion ensued with regards to the format of the meeting and members agreed that it was very informative and that it was beneficial that report writers attended the meeting to present their items. It was suggested that upon circulation of an agenda, should members request any further information with regards to an agenda item prior to the meeting, to liaise with the Governance Support Officer. Reference was made to the equality impact assessment section of each report and it was requested that report writers complete this section as it was a legal requirement. The Governance Support Officer indicated that she would feed this back to report writers. 1) The Governance Support Officer to liaise with report writers to ensure that the equality impact assessment section was completed for all future reports. Page 10 of 10 January 2015 Public Reference & Advisory Panel Minutes Date of Destruction: 30 January 2045

12 DRAFT Minutes of the NHS Trafford Clinical Commissioning Group Public Reference & Advisory Panel Held on Thursday 5 th February, 2015 At Crossgate House, Sale Meeting commenced: am Meeting ended: 1.00 pm PRESENT: Pricilla Nkwenti In the Chair Ann Day John Howe Ann-Marie Jones Patricia Lees Lesley Spencer Lesley Thornton Brian Wilkins Neighbourhood Participation Group Representative (North) Neighbourhood Participation Group Representative (West) Third Sector Representative Age UK Trafford Representing the Trafford Population (South) Neighbourhood Participation Group Representative (South) Third Sector Representative - Counselling and Family Centre Healthwatch Representative IN ATTENDANCE: Tracy Clarke Communications and Engagement Specialist Sarah Gunshon Project Manager, Scheduled Care (for item 15/78) Jenna Lancaster Governance Support Officer (minutes) Mr M Nulty Audit Manager, MIAA Kate Provan Quality Lead (for item 15/77) Tim Weedall Head of Scheduled Care (for item 15/79) Krista isiams Project Support Officer, Scheduled Care (for item 15/80) PRAP 15/71 APOLOGIES FOR ABSENCE Apologies for absence were submitted from Mr Shabir Abdul, Mr George Devlin and Mr Nasrullah Khan Moghal. At this stage of the meeting, the Chair introduced Mr Nulty, Audit Manager who was attending the meeting as an observer. Members were informed that Mr Nulty was carrying out a review of committee effectiveness PRAP 15/72 DECLARATIONS OF MEMBERS INTEREST CONCERNING AGENDA ITEMS Ann Day expressed an interest with regards to agenda item 15/79, Diabetes Strategy.

13 1) The declaration of interest be noted. PRAP 15/73 MINUTES FROM THE PREVIOUS MEETING HELD ON 6 TH JANUARY, 2015 INCLUDING THE ACTION LOG The minutes of the previous meeting held on the 6 th agreed as an accurate record. January, 2015 were Ann Day informed the Communications and Engagement Specialist that she would complete and return a short personal profile at the earliest opportunity. Shabir Abdul, Ann Day, Pat Lees and Lesley Spencer had all expressed an interest in attending the quality visits. A discussion ensued with regards to DBS checks that were required to be carried out before each member could participate in the visits. Lesley stated that she had a DBS check that was transferrable and therefore, could be transferred to enable her to participate in the visits. Ann and Pat informed the Panel that they were to arrange to have a DBS check carried out. The Governance Support Officer and Communications and Engagement Specialist stated that they would support members to arrange for the checks to be carried out. The Communications and Engagement Specialist informed members that work with regards to the online forum for PRAP had been put on hold due to the Communications Officer being out of the office. Members were advised that this would be progressed at the earliest opportunity. 1) The Public Reference and Advisory Panel (PRAP) approved the minutes of the previous meeting held on 6 th January, ) The Communications and Engagement Specialist to progress the online forum. PRAP 15/74 MATTERS ARISING The Governance Support Officer referred to the Primary Care Co Commissioning Committee and informed members that Brian Wilkins had expressed an interest to represent PRAP at the Committee. Members unanimously agreed this course of action. 1) That Brian Wilkins would represent PRAP, at the Primary Care Co- Commissioning Committee. Page 2 of 11 February 2015 Public Reference & Advisory Panel Minutes Date of Destruction: 30 February 2045

14 2) Details of meeting dates for the Primary Care Co-Commissioning Committee be communicated to Brian. PRAP 15/75 REVIEW OF WORKPLAN 2014/15 The Communications and Engagement Specialist presented the workplan for member s perusal. The Governance Support Officer informed members that the workplan for 2015/16 would be presented to members at the next meeting. 1) The Public Reference and Advisory Panel noted the work plan. PRAP 15/76 RECRUITMENT UPDATE The Governance Support Officer informed members that two applications had been received for the PRAP vacancies. The Communications and Engagement Specialist suggested that more aggressive advertising was required to attract more applicants to the posts. Members agreed that the recruitment campaign should be extended for a further four weeks. A number of suggestions were provided by members in terms of advertising that included posters being sent to local supermarkets, St Martins Church and the Rugby Club. The Chair suggested attending community groups to inform them of the work of PRAP, to try to attract interest. The Governance Support Officer suggested sending the application pack to PRAP members, to forward on to any key contacts. 1) That the recruitment campaign be extended for a further four weeks, until Friday 6 th March, ) That a copy of the application pack be circulated to all PRAP members. It was noted that agenda item 15/77 was deferred to later in the meeting, following items 15/78 and 15/79. PRAP 15/77 QUALITY UPDATE The Quality Lead entered the meeting. The Quality Lead attended the meeting to inform members of the quality processes and procedures within the CCG. Members were presented with the quality assurance framework which detailed how intelligence was gathered, reviewed and analysed and the action that was taken. An example was provided with regards to intelligence that was received with regards to delayed diagnosis at the University Hospital of South Page 3 of 11 February 2015 Public Reference & Advisory Panel Minutes Date of Destruction: 30 February 2045

15 Manchester. As a result, an action plan was developed and monitored by the Quality Lead. The Quality Lead made reference to Equality and Diversity (E&D) and the nine protected characteristics and the correlation with serious incidents. The Quality Lead provided an example whereby a number of patients had developed pressure ulcers whilst being treated for serious incidents. Analysis of E&D statistics indicated that two babies within intensive care had developed pressure ulcers as a result of wearing a CPAC oxygen mask that was required for life saving intervention. As a result, work was now being carried out with the manufacturers of the CPAC oxygen mask regarding its design. The Quality Lead acknowledged the value of E&D statistics as a result of this example and indicated that providers were now being asked to collate patient data in relation to the nine protective characteristics. The Chair questioned the pathway for manufacturer equipment and the Quality Lead stated that when a concern was raised with regards to equipment, the National Patient Safety Agency would be alerted. However, the NHS had minor control over manufacturers. The Quality Lead referred to an inequality data gap, which was being addressed. However, members were informed that national systems do not allow providers to record the nine protective characteristics. Liverpool NHS was referred to, who had received beacon status for gathering patient information in relation to E&D, as a result of investing in provisions to gather intelligence. The Chair made reference that treating inequalities was a key objectives of the CCG, that could only be delivered if the correct level of intelligence was gathered. The Quality Lead asked members how they would like to be involved in future work with regards to quality. Lesley Thornton suggested that PRAP would be interested to receive updates with regards to good practice and areas for concern. In addition, it was acknowledged that a number of PRAP members had registered their interest to participate in the quality walk arounds. Ann Day made reference to the Quality and Performance report that was reported to the formal meeting of the Governing Body and stated that it was an exceptional report and very informative. It was suggested that members read this report on a bi-monthly basis for information. With regards to Primary Care Co-Commissioning, Ann Day questioned how the quality of primary care would be monitored. The Quality Lead stated that this would be the responsibility of the primary care team. The Governance Support Officer informed members that she would liaise with the primary care team and ask that an update was provided to a future meeting of PRAP. The Chair thanked the Quality Lead for the update and commented that it had been very useful. Page 4 of 11 February 2015 Public Reference & Advisory Panel Minutes Date of Destruction: 30 February 2045

16 1) The Public Reference and Advisory Panel noted the contents of the update. 2) The Governance Support Officer to liaise with the Primary Care Team with regards to measuring quality within primary care. The Quality Lead exited the meeting. PRAP 15/78 COMMUNITY NURSING The Project Manager entered the meeting. The Project Manager attended the meeting to inform members of the development of the community nursing project which formed part of the frail and older peoples work programme. Members were advised that the current community service was limited due to the existing capacity and demand for the service. Therefore, phase 1 of the project would be to complete a capacity and demand review of district nursing to redesign a community nursing offer, to provide excellent care to Trafford patients. It was expected that the review would be completed by June, 2015 in conjunction with the better care fund timeframe. The Project Manager referred to palliative care and stated that it was envisaged that this service would be delivered within an individual service and not as part of community nursing. Members were informed that a consultation exercise would be carried out with key stakeholders with regards to the current district nursing provision within Trafford, to seek their thoughts on service improvements. Members were asked for their advice with regards to consultation methods and how the CCG could obtain views from patients. The Project Manager suggested that patients could be asked to complete a survey when they were visited by a district nurse. Patricia Lees referred to the review and suggested that the role of a district nurse should be defined so that patients were aware and understood the services that were within a district nurses remit. Two examples were provided whereby a patient was not treated by a district nurse and were informed this was because the treatment required was not the role of the district nurse. Ann Day supported this view and commented that the role of the district nurse did need defining. The Chair commented on the timeframe that had been set to carry out and complete the review and expressed concern that it would not allow for meaningful engagement and consultation to be carried out. The Page 5 of 11 February 2015 Public Reference & Advisory Panel Minutes Date of Destruction: 30 February 2045

17 Communications and Engagement Specialist suggested working with the Project Manager to carry out some targeted engagement work. Brian Wilkins referred to palliative and end of life care and questioned why this service was excluded in the scope of the revised community nursing project. The Project Manager referred to the Department of Health (DH) statistics that indicated the end of life pathway required improvement. Patricia Lees expressed concern that if the services were separate, it would cause unease for the patient who would potentially be treated by a district nurse and then by a different person within another service towards the end of their life. Ann Day supported this view and stated that a patient would build up a relationship with a district nurse and therefore, would not want to be treated by a stranger at the end of their life. Ann-Marie Jones questioned whether there was any evidence to support the view that the separation of the services would be beneficial to the patient. The Project Manager stated that the DH end of life statistics would feed into the review. The Chair referred to the capacity of district nurses and suggested that training and development of existing nurses was crucial. The Project Manager referred to the Community Nursing Steering Group that was represented by a public health officer who was currently looking at workforce planning. In particular, treatment room provisions would be looked at to establish whether this could be delivered in a different way to free up capacity to provide domiciliary care. However, it was stated that clinics were utilised on a regular basis and therefore, the way the service was commissioned would be considered. Lesley Spencer referred to community nursing and questioned whether the service was provided by different home care providers. The Project Manager stated that the service was commissioned and provided solely from Pennine Care. Lesley suggested that communication between all of the providers of domiciliary care was required to support patients more effectively. For example, if a vulnerable patient was treated by a home care agency, intelligence could be passed on to district nurses. Ann Day referred to the DH figures and expressed concern that the statistics would include patients who had dementia and were cared for in private residential homes. Due to the level of care that was provided in private care homes, it was questioned whether the evidence was credible to feed into the review. The Project Manager informed members that she had requested further information with regards to the patient pathways and therefore, the information could be attributed solely to the review. Brian Wilkins made reference to the proposed integrated community based nursing service and questioned as the service developed, how it would affect secondary care. The Project Manager stated that the full business case would include more details. Page 6 of 11 February 2015 Public Reference & Advisory Panel Minutes Date of Destruction: 30 February 2045

18 Lesley Thornton suggested that patient experiences were crucial to the review and therefore, patients of palliative care should be consulted with to provide an understanding of what service was required. Due to the restricted timeframe of carrying out consultation, it was suggested that a simplistic survey be presented to patients when visited by a district nurse to complete. Patients should be given the option to complete the survey and provide it to the district nurse or to send it directly to the CCG. It was agreed that this method would provide a broader range of results in an efficient way. Ann Day questioned how the revised scheme would link into the community paediatrics service. The Project Manager stated that the services were interfacing and the transition of a patient from the community paediatrics service to the community nursing service would be considered within the review. The Chair asked for an update with regards to the Equality Impact Assessment (EIA) that was being completed for the review. The Project Manager informed members that the EIA was a working document and currently being produced in conjunction with Pennine Care and that the initial evidence was that there were no exclusions with regards to access to the service. The Chair requested a copy of the EIA. The Chair thanked the Project Manager for the report and welcomed an update to a future meeting of PRAP. 1) The Public Reference and Advisory Panel noted the contents of the report. 2) The Project Manager and Communications and Engagement Specialist meet to discuss the targeted engagement work. 3) A copy of the Equality Impact Assessment be sent to the Chair. The Project Manager exited the meeting. PRAP 15/79 COMMUNITY DERMATOLOGY SERVICE The Head of Scheduled Care entered the meeting. The Head of Scheduled Care attended the meeting to inform members of the CCG s intention to commission a Community Dermatology Service for the Trafford population, alongside South Manchester and Central Manchester CCGs. Members were informed that a full service specification was available upon request. The Head of Scheduled Care referred to the waiting list for dermatology referrals during 2013, which was eighteen weeks and that the majority of Page 7 of 11 February 2015 Public Reference & Advisory Panel Minutes Date of Destruction: 30 February 2045

19 referrals were from GPs. It was envisaged that the new service would reduce the waiting list to 3-4 weeks and that patients would be offered an appointment within 4 working days. Members were informed that there had been a delay in the bidder process which related to pricing. Once the successful bidder had been identified, there would be a ten day standstill period before the work could be progressed. Members were advised that the new service would be available to all Trafford patients from a minimum of two locations in the community. The Head of Scheduled Care made reference to the service specification that highlighted that patients of certain ethnicities may be more vulnerable to certain conditions and therefore, clinical expertise in this area was required given the CCGs ethnicity profile. Lesley Thornton referred to the eighteen weeks waiting list and questioned how the new service would reduce this to 3-4 weeks. The Head of Scheduled Care stated that procurement of a new service would make better use of best placed skills and competencies, reduce waiting times and offer patient choice. The Chair referred to the financial modelling and stated that the investment should provide value for money. The Head of Scheduled Care referred to the business plan that detailed all of the financial aspects of the proposed service and detailed the projected savings. Members were assured that the project would provide value for money. Ann Day queried the pathway that would be in place for patients with suspected Cancer. The Head of Scheduled Care stated that patients would be referred to secondary care as soon as possible, within a maximum of two weeks. Ann Day referred to the two bidders and requested that once the successful bidder had been announced, that members were informed. The Head of Scheduled Care stated that this information would be communicated to Members and that neither Central Manchester Foundation Trust or the University Hospital of South Manchester had submitted bids. The Chair thanked the Head of Scheduled Care for attaching the equality analysis form and stated that the form was sufficient and suggested that some sections required further detail. The Head of Scheduled Care asked members when they would like a future update with regards to the service and stated that the service was expected to commence in May. Lesley Spencer suggested that an update would be useful once the first set of metrics were available. Pat Lees questioned how patients would access the new service and the Head of Scheduled Care indicated that this would be via GPs. Page 8 of 11 February 2015 Public Reference & Advisory Panel Minutes Date of Destruction: 30 February 2045

20 1) The Public Reference and Advisory Panel noted the contents of the report and requested that an update be provided once the first set of metrics were available. 2) That members be informed of the successful bidder at the earliest opportunity. The Head of Scheduled Care exited the meeting. PRAP 15/80 DIABETES STRATEGY The Project Support Officer entered the meeting. The Project Support Officer attended the meeting to inform members of the development of Trafford s first Diabetes Strategy that had been developed by the Trafford Diabetes Network. Lesley Thornton referred to the image on page thirteen of the strategy and stated that it was not clear. The Project Support Officer stated that she would circulate a clear copy of the image for members information and update the strategy. Members were informed that the Trafford Diabetes Network had been established in October to produce the strategy and consisted of professionals from public health, medicines management, the quality and performance team, commissioners, diabetes UK and patient representatives. The Project Support Officer informed members that currently, there were inequalities in the diabetes service provision that needed to be addressed. Lesley Thornton questioned whether there was a difference amongst providers or whether there was a difference in how data was recorded. The Project Support Officer advised members that data checks had been carried out that indicated there was a difference in the services that were provided. The Project Support Officer referred to the statistics within the draft strategy and informed members that the document had been revised and details of patients with type one and type two diabetes would be reported separately. Lesley Thornton supported this amendment and indicated that the current format did not differentiate between the two different types. Ann Day referred to the complexity of the strategy and indicated that members of the public may not understand the charts. It was suggested that a patient version of the strategy that does not include all of the data could be produced. However, it was noted that members of the public had the right to view all of the data. The Chair suggested that it would be the role of the Communications and Engagement Team to ensure that the strategy was clearly communicated to members of the public. Page 9 of 11 February 2015 Public Reference & Advisory Panel Minutes Date of Destruction: 30 February 2045

21 John Howe informed the group that he had type one diabetes and as a result, carried out work on behalf of Diabetes UK. It was suggested that the current service that was provided was not sufficient and that GPs did not have sufficient time to effectively deal with and treat patients who suffered from diabetes. He also expressed concern with regards to the lack of support that was provided to patients. Ann Day supported this view. Brian Wilkins expressed his apologies and exited the meeting. The Chair questioned whether an action plan would be produced, detailing how the strategy would be delivered. The Project Support Officer informed members that within each section of the strategy, a number of network strategic intentions were listed which included the current position, the aim in terms of improving the current position, how it would be achieved and how the progress would be monitored. The Chair referred to prevention and early identification of diabetes and questioned how this was aligned with public health. The Project Support Officer informed members that the public health team within Trafford Council commissioned the majority of work with regards to prevention. In addition, the Project Support Officer stated that she was to meet with a representative from the public health team to discuss lifestyles and educating patients. Lesley Spencer referred to young people that had been diagnosed with diabetes and suggested that treatment was sometimes used inappropriately. The Project Support Officer assured members that the paediatrician nurses had very tight controls in place with regards to prescribing medication. Lesley Thornton referred to the strategic priorities listed within the strategy and expressed concern that some of the priorities would be difficult to achieve. For example, the priority to reduce the number of overweight and obese people within the population. Lesley questioned how the CCG would deliver this priority. It was suggested that the terminology could be amended to state that the CCG would contribute to reduce the number of overweight and obese people within the population. The Project Support Officer informed members that the strategic priorities were set with a strong view that they were achievable. The Chair sought clarity with regards to the timeframes for implementation of the strategy. The Project Support Officer informed members that the draft strategy would be presented to the Transformation Steering Group on 2 nd March, 2015 and the Clinical Commissioning and Finance Committee on 17 th March, Phase 2 of the implementation of the strategy would be reported back to a future meeting of PRAP. The Project Support Officer exited the meeting. 1) The Public Reference and Advisory Panel noted the contents of the report. Page 10 of 11 February 2015 Public Reference & Advisory Panel Minutes Date of Destruction: 30 February 2045

22 PRAP 15/81 ANY OTHER BUSINESS There were no items of any other business. PRAP 15/82 DATE AND TIME OF NEXT FORMAL MEETING It was noted that the next meeting would take place on Thursday 5 th March, 2015 at 10.00am in the Partington Suite at Crossgate House. PRAP 15/83 POST MEETING REFLECTION A discussion ensued with regards to the format of the meeting and members agreed that it was very informative. The Communications and Engagement Specialist commented that since the group was established, it had developed significantly and was now becoming more effective and efficient. The Governance Support Officer supported all of the views raised and referred to the number of items that had been presented at this meeting and the previous meeting whereby members were informed that updates would be provided to future meetings of PRAP. It was suggested that the online forum for PRAP members should be revisited that could provide a mechanism for updates to be provided on key issues/themes. Lesley Thornton referred back to the draft diabetes strategy and suggested that the PRAP would need to scrutinise it in further detail. Pat Lees commented that a lot of hard work had gone into producing the strategy and that credit should also be given to acknowledge this. 1) That the information be noted. Page 11 of 11 February 2015 Public Reference & Advisory Panel Minutes Date of Destruction: 30 February 2045

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