Governing Body 24 th July 2018 Minutes (confirmed) Subject Governing Body of Coastal West Sussex Clinical Commissioning Group Date 24 July 2018 Time 09:30 12:15 Venue Chair Goodwood Room, Gill Galliano Member Position Present Gill Galliano (GG) Acting Lay Chair Dr Su Stone (SS) Chair x Dr Tej Bansil (TB) Locality Director (Regis) Mr Ralph Beard (RB) Independent Clinical Member: Secondary Care Clinician Dr Richard Brown (RBr) Local Medical Committee Representative Jayam Dalal (JD) Lay Member Adam Doyle (AD) Accountable Officer x Dr Ned Ford (NF) Locality Director Chichester Dr Rob Henderson (RH) Locality Director - Cissbury Alison Lewis-Smith (ALS) Independent Clinical Member Registered Nurse Dr Jo Monjardino (JM) Locality Director Adur x Dr Sarah Pledger (SP) Locality Director - Arun Dr Alex Rainbow (AR) Locality Director Chanctonbury Anna Raleigh (AR) Director of Public Health x Pippa Ross-Smith (PRS) Chief Financial Officer In Attendance Dominic Wright (DW) Amanda Fadero (AF) Janice Smith (JS) Chris Jarvis (CJ) Daniel Deacon (DD) Managing Director Director of Transition Corporate Governance Secretariat PWC - Observer N V Ogo Okoye (NVOO) Head of Clinical Effectiveness for agenda item 13.02
Questions from the Public There were no questions from the public. 18/11 Introduction 11.01 Welcome, apologies, and declarations Gill Galliano welcomed people to the meeting. She said that she had been appointed as Acting Lay Chair, as Dr Su Stone, Clinical Chair, is currently on sick leave. Other apologies for absence were received from Adam Doyle, Anna Raleigh and Dr Jo Monjardino. Mr Ralph Beard reported that he is a school governor at a primary school and it was noted that this would be entered onto the Register of Interests. 11.02 Minutes and actions of the meeting 22 nd May 2018 Amendments to the minutes of the meeting of the 22 nd May 2018 were noted as follows: Members present; Alison Lewis-Smith is Independent Clinical Member, not Lay Member as recorded; 02.03 (i) Voluntary Action attendance should read Voluntary Sector attendance and (ii) it was noted that several organisations would no longer be attending should read Voluntary Action Arun and Chichester would no longer be attending ; 03.02 The sentence commencing.. asked that in future, there be a greater role for Committee Chairs in reviewing the content (of the Annual Report) should have added to it; in advance of the first draft being produced. Subject to these amendments, the minutes were agreed. 11.03 Action Log The action log was reviewed and members agreed the updates and proposed actions, noting that these would be reflected in the next iteration of the action log at the September 2018 Meeting of the Governing Body. These were as follows: Action 30: Members noted that the Estates Strategy and Tactical Update were due to be presented to Part 2 of the Governing Body Meeting; Action 35: STP governance model is still being reviewed by the Executive. AO will bring back to Governing Body when it is ready; Action 36: Looked after Children. Now assigned to the Managing Director. This continues to be a work in progress and will be discussed at Audit and Assurance Committee on the 14 August 2018. Action 39: Staff Survey. Updates included in Accountable Officer reports to the Governing Body. Therefore, action closed 2
Action 44: Progress being made on Looked after Children and Clinical Lead cover resolved. Therefore, action closed. Action 46: Ensuring compliance with NHS Equality and Diversity guidelines. This is in the particular context of the Governance Review. Vacancy for Lay Member Lead is still there. Updates will be brought to Governing Body. Action 49: Annual Report 18/19; noted that the timetable will be reviewed by the Senior Management Team in late October 2018, ahead of being presented to the Audit and Assurance Committee on the13 November 2018. Therefore, action closed. Action 54: HR Policies. To be routed via the Quality Committee. Therefore, action closed. Action 55: Cancer Alliance section on the website has been reviewed and updated. Therefore, action closed. 11.04 Report of the Managing Director A report was presented by the Managing Director providing the key messages and activities of the Senior Management Team since the last update to the Governing Body in May 2018. He referred to specific areas as follows: I. Formal Results of the CCG s 2017/18 Annual Assurance. Members of the Governing Body were advised that the final headline rating for 2017/18 for Coastal West Sussex CCG is inadequate, which was seen very much in the context of the challenges that the CCG faced last year. It was noted that the CCG was having conversations with NHS England about the key areas for improvement that were identified last year and how they are now being addressed. II. III. Clinical Leadership. It was noted that recruitment was taking place as follows; (i) The recruitment of an Executive Medical Director (ii) Advertising for an Assistant Clinical Chair (iii) Advertising for an Interim Clinical Co-ordinator, providing support to the Senior Management Team and the Clinical leadership within the CCG. Other issues from the Managing Director s Report Midhurst Hospital A question was asked concerning the decision of Sussex Community NHS Foundation Trust to close the Bailey Unit at Midhurst Community Hospital temporarily to new admissions. It was noted that this was due to long standing staff shortages and emerging concerns about the quality of care being provided there. Concern was expressed regarding the lack of discussion and consultation about this decision and the effect that this would have on families who needed to travel longer distances. In response, it was noted that the issue had been discussed at the Trust Board after which the CCG had been informed. It also was noted that the issue had been raised at the CCG Quality Committee. The Managing Director emphasised the importance of taking forward the agenda of sustainability and of establishing different models of care. 3
It was agreed that this issue should be put onto the action log for review at the next meeting of the Governing Body. Action 56: Review the issue of Community Hospital sustainability at the next Governing Body. Fitzalan Medical Group. It was agreed that discussion of this item would take place under Part 2 of the Governing Body Meeting. Having regard to the points raised, it was agreed that the report of the Managing Director be received as presented for Assurance. 11.04 Board Assurance Framework and Escalated Risks The Managing Director reported on progress being made in revising the Board Assurance Framework (BAF). Specifically, it was noted that a draft would be presented to the meeting of the Audit and Assurance Committee on 14 August 2018 and then to the meeting of the Governing Body on 25 September 2018. 18/12 Corporate 12.01 Performance Report The Managing Director presented a report providing the Governing Body with an overview of organisational performance and activity for Month 1. It was noted that the report (i) focuses on the quality and activity reporting of the CCG and (ii) illustrates progress against the delivery of the NHS Constitution, NHS Outcomes Framework and gives an overview of the CCG s IAF position. Issues to arise through discussion of the report were as follows: A question was asked as to why information was being received from April 2018. In response, it was noted that work was being carried out to establish a cycle of meetings with a better flow, together with the development of the Integrated Performance Report. A question was asked regarding dementia targets. In response reference was made to the support being offered through the Local Community Networks and in establishing a change of culture. The importance of raising awareness through patient and public engagement was also emphasised. Following discussion, the report was received for assurance. 12.02 Integrated Business Plan 2018/19 Q1 Progress Update The Director of Transition presented a draft progress update on the delivery of the Coastal West Sussex CCG Integrated Business Plan for 2018/19. It was noted that the paper sets out specific deliverables for the Business Plan for Quarter 2, to provide assurance around the implementation and delivery of the Plan. It was reported that by the end of Quarter 1 the CCG has made marked progress against the identified priorities. It was noted that the RAG rated update on the future delivery and that specific business plan deliverables for Quarter two have now been 4
developed to ensure that the implementation and delivery of the plan remains on track. Issues to arise from discussion of the report were as follows: A question was asked as to why the Enabling Delivery element of the update recorded a red RAG rating. In response, it was noted that there were some workforce and IT issues to be addressed; In response to a question, it was confirmed that all those sections that had been rated green, had been quality impact assessed; A question was asked as to why the stroke project was rated green. In response, it was noted that this was attributable to a senior leader in post and a programme of work being developed for which the Governing Body will see the outcome; In relation to QIPP Schemes, it was noted that these would be brought back to the Governing Body having been through the Finance and Performance Committee. Following discussion, it was agreed (i) that Members of the Governing Body pass on their thanks to Robert Szymanski and the rest of the team, for their hard work in producing such a clear report and (ii) that the report be received and noted for Assurance. 12.03 Finance Report The Chief Finance Officer presented a report informing the Governing Body of the financial position for the year as reported in the draft Annual Accounts 2017/18. It was noted that the paper highlights risks and assumptions in that position to enable the Governing Body to form a view on its level of assurance on the CCG s financial position. It was reported that the most significant risk to the delivery of the plan was the unidentified QIPP of 6.8m, being the minimum additional savings required to deliver the plan. It was also reported that the CCG has signed Aligned Incentive Contracts with Western Sussex Hospitals Foundation Trust and Brighton and Sussex University Hospitals Trust, its two main acute providers and so capped the expenditure for the majority of its acute spend. Discussion took place in relation to the CCG s non-compliance with Referral to Treatment (RTT), noting that the Performance Team has estimated, through a high level calculation, that it would cost 1.4m to achieve compliance of 92% and in the region of 3.4m to clear the backlog of patients waiting more than 18 weeks. Following discussion and having noted that any further queries should be directed to the Chief Financial Officer, it was agreed that the report be noted for Assurance. 18/13 Strategy and Commissioning 13.01 Managing Transition The Director of Transition presented a report with the purpose of providing a summary progress update on the Transition Programme which was introduced to 5
embed changes necessary to deliver the Coastal West Sussex CCG Business Plan 2018/19. It was noted that the paper represents a high level summary of the three phases of the Transition Programme, setting out the key achievements against the five domains of the Transition Programme, specifically, (i) the people programme (ii) estates (iii) the Business Plan (iv) Integrated Care and (v) future of commissioning. A number of issues arose through discussion of the report as follows: The importance of values applying to everything and living them and the particular benefits of the RESPECT programme; Ensuring the availability of people, particularly clinicians, in the delivery of services; Consideration of holding Board to Board meetings, underpinning the principles and requirements of good governance; It was noted that significant progress had been made in the development of the Estates Strategy This would be considered in more detail in part two of the meeting; In relation to the Business Plan, a question was asked as to where equality and diversity fitted into this. In response, it was noted that work was being carried out although further work was required. It was agreed that equality and diversity development should be embedded into programme delivery as much as possible; The role of the Local Community Network (LCN) was discussed, in the particular context of integration and the LOGIC Model for the LCN Delivery Plan; Emphasis was placed on the importance of aligning incentives between partner agencies; It was noted that Sussex Partnership NHS Foundation Trust was not included in the diagram of Integrated Care and discussion took place as to how it might be included going forward. Following discussion, it was agreed that the paper be received and noted for Assurance. 13.02 Clinically Effective Commissioning Programme N V Ogo Okoye, Head of Clinical Effectiveness, joined the meeting for this discussion. The Managing Director presented a paper updating the Governing Body on the Clinically Effective Commissioning Programme. By way of context, it was reported that the Sussex Clinical Effective Commissioning Programme was restarted in May 2018 to establish a robust infrastructure for delivering CEC (Clinical Effective Commissioning) in future years. The Sussex CEC Delivery Plan 2018/19 takes stock of the current readiness of the CEC infrastructure to effectively implement the CEC Programme and sets out the required elements as part of a Mobilisation Plan. Through wide ranging discussion of the papers, a number of issues arose as follows: 6
The importance of tackling variations across the system and the benefits that would be derived through achieving consistency; A question was asked as to whether the Executive Team was ready for Tranches 1 and 2 to go live and the confidence level of the Governing Body that the public is sufficiently aware of the proposed implementation; In response, it was noted that there had been consultation throughout the process, but that further consultation was required; The importance of focusing on particular groups was also emphasised. In this respect and a question was asked about whether Equality Impact Assessments were in place and sufficiently robust. In response. It was noted that Equality Impact Assessments are completed through a proper process and are embedded into the relevant contracts. It was noted that more information had been requested from the Quality Committee; Dr Richard Brown said that the GPs gateway through the process was not clear, and particular difficulties arose for GPs both in terms of (i) implementing the criteria and (ii) determining whether, in any event, this was an appropriate course of action; Discussion took place in relation to the Implementation Plan and it was noted that it had been agreed across the Sustainability and Transformation Partnership (STP). It was noted that local circumstances would be an important element of any future arrangements. Having regard to the issues and concerns raised: Members of the Governing Body agreed to approve the papers and associated recommendations for Assurance subject to: 1. Development of the Implementation Plan as discussed; 2. Ensuring that the Implementation Plan addresses areas of uncertainty as identified; 3. Ensuring that there is detailed on-going input from the Quality Committee and Public Engagement Committee. 13.03 South East Coast Ambulance Foundation Trust Update The Managing Director presented a report (i) seeking to provide assurance to the Governing Bodies of Sussex and East Surrey CCGs that appropriate monitoring and support is being given to the South East Coast Ambulance Foundation Trust (SECAmb) to improve their services and help them meet the aims of the Action Plan and (ii) presenting the current performance, activity and finance position. By way of background, it was noted that the Commissioners have been working with their respective regulators to create safe and sustainable services for the future, aligned to SECamb s strategy, the STP Strategy and Ambulance Response Programme. In November 2017 the CCG commissioned Deloitte to carry out a joint Demand and Capacity Review with the final report due in July 2018. During discussion of the report, specific reference was made to the potential interaction between response times in rural areas and the work that is being carried out to improve stroke services. 7
Following discussion Members of the Governing Body noted: 1. That there is a potential funding gap in the contract exacerbated by the new Ambulance Response Programme (ARP) Standards; 2. The progress being made to address the quality and performance issues with SECAmb; 3. That a further formal update report would be presented in three months time. 18/14 Assurance 14.01 Sussex, Kent and Medway Armed Forces Network Annual Report The Managing Director presented a paper providing information and assurance to the Governing Body of the CCG on the progress being made in delivering against the NHS Constitution, NHS Contracts and the Armed Forces Covenant, through the NHS Armed Forces Community (AFC). It was noted that the AFC Director and Support Team have a good understanding of the needs of the Armed Forces population within Sussex and Kent and Medway. It was agreed that the report was heartening to read and that the work with the AFC is of significant importance. Specific reference was made to the role of the Locality Directors in supporting the process and reference was made also as to how the work might be more extensively publicised. Following discussion, it was agreed that the report was informative and be received for Assurance. 18/15 Committee Reports 15.01 Audit and Assurance Committee The report of the Audit and Assurance Committee Meeting held on 24 May 2018 was received as presented for Assurance. 15.02 Clinical Innovation and Strategy Committee The report of the Clinical Innovation and Strategy Committee Meeting held on 19 June 2018 was presented. There was consideration of the methods of obtaining clinical advice and the output arising from this. It was noted that the CISC in its current form was not best placed to do this. It was noted that this should be included in the Governance Review currently being carried out. 15.03 Finance and Performance Committee The report of the Finance and Performance Committee Meeting held on 17 July 2018 was received as presented for Assurance. 15.04 Primary Care Commissioning Committee The report of the Primary Care Commissioning Committee held on 3 July 2018 was presented. The meeting was not quorate. Reference was made to ensuring that the Committee s relationship with other Committees is being considered as part of the Governance Review. The report was noted. 15.05 Public Engagement Committee The report of the Public Engagement Committee Meeting held on 19 June 2018 was presented and received for Assurance. Reference was made to discussions that had taken place concerning strengthening links at local level, 8
particularly with local networks and with the voluntary sector. 15.06 Quality Committee The report of the Quality Committee activity from March to June 2018 was received as presented noting the comment of the Chair of the Committee that it provided limited assurance. 15.07 Remuneration Committee The report of the Remuneration Committee was presented and received for Assurance, with particular reference to the meeting held on the 25 June 2018. 18/16 Date of Next Meeting 25 th September 2018 Meeting closed The Acting Lay Chair closed the meeting by reading the resolution of items to be heard in private to the Governing Body which was agreed. Signed Dated 9