Notes from the Welsh Cross Border Network meeting 9 May 2016, at St. Chads, 213 Hagley Road, Edgbaston, Birmingham, B16 9RG With teleconference links to Betsi Cadwaladr, Powys Teaching Health Board and Aneurin Bevan. Attendees: Name Job title Organisation Stephen James (SJa) (Chair) Lead Medical Director NHS Shropshire Clinical Robert Holcombe (RH) (Chair) Assistant Director of Finance NHS Aneurin Bevan Jon Holmes (JH) Referral Assessment Service and e-rs Development NHS Shropshire Clinical Manager (CdJ) Senior Commissioning Policy NHS England Manager Martha Dalton (MD) Commissioning Policy Manager NHS England Sahera Ramzan (SR) Commissioning Policy Officer NHS England Andrew Crawshaw (AC) Director of Operations and Delivery Jan Firby (JF) DHSS Strategy & Policy Welsh Government Lyn Summers (LS) DHSS Strategy & Policy Welsh Government Sian Sansum (SS) Senior Communications and Engagement Lead NHS England Cheshire and Merseyside NHS Midlands and Lancashire Commissioning Support Unit Via teleconference: David Adams (DA) Chief Officer Community Health Council Powys Nia Sparks (NS) Contracting Advanced Finance Analyst NHS Betsi Cadwaladr Sian Jenkins (SJe) Finance Business Partner Contracting NHS Aneurin Bevan Marion Andrew- Evans (MAE) Director NHS Gloucestershire Clinical Adrian Griffiths (AG) Head of Commercial Development NHS Herefordshire Clinical Stacey Taylor (ST) Finance Manager NHS Aneurin Bevan Mala Raghuram (MR) Management Accountant NHS Aneurin Bevan Vikki Taylor (VT) Director of Commissioning NHS England Midlands and East 1
Apologies: Julia Simon (NHS England), Ivan Ellul (NHS England), Rachel Pearce (NHS England), Nikki Holmes (NHS England), Keira Liburd (NHS England), Jenny Harper (Department of Health), Steven Wainwright (Gloucestershire Care Services Trust), Richard Barker (NHS England), Andrew Ridley (NHS England), Paul Watson (NHS England), Hayden Thomas (NHS England), Amanda Lonsdale (West Cheshire CCG), Carol McInnes (Shropshire CCG), Julie Davies (Shropshire CCG), Nikki Hilditch (Shropshire CCG), Hazel Braund (Herefordshire CCG), Barbara Ryan (Welsh Government), Chris Stevens (Abertawe Bro Morgannwg UHB), Anne Simpson (Abertawe Bro Morgannwg UHB), Dr Sue Fish (Mid-Wales Collaborative), Angela Jones (Aneurin Bevan UHB), Peter Horvath-Howard (GPC Wales), Jane Randall-Smith (Healthwatch). 1. Welcome and introductions RH opened the Cross Border Network (CBN) meeting and welcomed everyone. 2. Minutes and actions from the previous meeting RH went through the minutes of the previous meeting held on 8 February 2016. On page six it was noted that the last paragraph was to be re-worded to: RH queries whether NHS Wales Informatics Service (NWIS) priorities and the English NHS information strategy are aligned. On page eight a note was made to remove social services and replace with the NHS in Wales. A summary of the actions follows: A B C D E F G Action Action owner Progress PH-H to be invited to future meetings of /Jan the IT&F. Firby LHBs to forward Welsh clinical Local Health JH still requires more pathways information to the RAS. Boards detailed information and will contact LHBs directly. GR/CdJ to forward the updated Gill Rooke/Cat de commissioning queries list to the IT&F. SS to present the engagement and experience report as part of the evaluation feedback at the CBN in May. CdJ to ascertain the DH policy position on the issue of waiting list transfers. Waiting list transfers to be discussed at NHS England project board/it&f. Secretariat to add cross border IT&C as a standing agenda item for future CBN meetings and to ensure that Welsh and English informatics colleagues are 2 Jonge Sian Sansum Secretariat This action is delayed due to the revised phased implementation plan.
H I J K L M N O represented to update on this item. GR to send an update on the MOU to network members. RH to follow-up with Shirley Hughes in NWIS, as the cross border representative, to provide an update on informatics work in Wales. CdJ to invite NHS England colleagues involved with the digital road map work to provide an update on informatics work in England at a future meeting. CdJ to set out some broad definitions a list of principles, based on those previously agreed by ministers, prior to the CdJ and SJe to liaise regarding the Who Pays? guidance refresh. CdJ and JF to update the policy differences log, which will be reviewed at the May CBN. Secretariat to include the policy differences log as a standing agenda item and promote it to earlier in the agenda for the May meeting. CdJ to speak with LGA and determine the correct representative to invite to a future CBN. Gill Rooke Rob Holcombe Secretariat Outstanding CdJ has been in contact with information colleagues who have confirmed their attendance at the Deferred to the next meeting. Deferred to the next meeting. On the agenda for discussion. Guidance still in development and will be brought to a future CBN. On the agenda for discussion. Outstanding The minutes were agreed as an accurate account of the meeting. 3. Policy differences log CdJ presented the updated policy differences log. The log is intended to track changes in the two NHS systems and will be owned by the CBN. It will be developed into a public facing document and published in due course. RH asked that all network members review the information in the policy differences log (especially section D) and send comments to CdJ and JF within the next two weeks. The log will be updated regularly and reviewed at the CBN on a quarterly basis. 3
Action A: Members to send contributions for the policy differences log to CdJ and JF. 4. Cross-border project update and position statement and general updates from the membership CdJ presented a position statement about the status of the Referral Assessment Service (RAS) project and the progress that has been made to date. The statement will be publicly available in order to clarify the current position of the RAS project and the next steps. CdJ talked through the position statement highlighting the key areas: The statement reinforces the strong partnership working between the NHS in England and the NHS in Wales. GP practices are not under any contractual arrangements to join the RAS project and can join if and when they feel ready. The statement focuses on the provision for English residents registered with Welsh GP practices and their entitlements to consultant-led care under the NHS Constitution. RH confirmed that the statement would be published on behalf of the CBN alongside the meeting summary report. The network agreed that finance was out with the purpose of the paper and the relevant section could be removed. JF reported that Welsh Government (WG) would prefer a six month test phase, rather than a phased implementation approach. The test phase would then be followed by an evaluation. WG are still happy for as many practices to join the initial test phase. JH will confirm the process of starting the test, specifically whether each practice would be brought into the test bed individually, or if a group of practices could join simultaneously. DA said he would discuss Powys GP practices joining the RAS test further directly with RH. JF confirmed that, at present, no Powys practices have come forward to be part of the test. SJe mentioned that she is working with AG and MAE on the detail for direct referrals of urgent suspected cancers for Gloucestershire patients. RH asked WG colleagues for any other cross border activity updates; it was confirmed that there were no updates at present. 5. Information technology systems between England and Wales This agenda item was deferred to the September meeting where it is anticipated a representative from the English and Welsh informatics services will be in attendance. RH reminded local health boards to check for local informatics projects that might be happening. MAE informed the network of the joining up your information initiative which includes GP practices. RH asked if the lead of this project could come to talk to the CBN or present a position statement on the project. 4
MAE also updated on the online care pathway programme that all border GP practices are due to have access to via a web link. Action B: MAE to arrange lead from joining up your information project to attend the CBN or send a position statement. Action C: MAE to send web link to JH. RH suggested adding the informatics/technology differences to the policy differences log. 6. Principles paper CdJ presented the draft values and principles paper. This is intended to replace the current cross border protocol when the new arrangements are confirmed. The principles remain central to maintaining good relationships between partners on both sides of the border, to assure the quality and safety of patient care. Colleagues asked for clarification the legal rights and responsibilities of each NHS in England and Wales as set out in bullet point h which states that Cross-border commissioning should reflect the legal rights of patients in their country of residence. The group also had questions about the legal standing of points o (in reference to Crown indemnity), and q, and the application of point s about complaints procedures and the responsibility for complaints advocacy which was believed to be based on residency. Action D: CdJ to check the legal standing of the specific principles as outlined above. RH suggested there may be contributions from LHBs to add to the paper on the working arrangements across services along the border. RH suggested that all contributions for the paper are communicated to CdJ. CdJ will bring an updated paper for review at the next CBN. It was agreed once the next draft of the paper is complete the respective NHS representatives in England and Wales will work with their own legal teams to clarify any outstanding issues. 7. Handover of secretariat arrangements CdJ, as current head of secretariat, outlined that the meeting support currently provided by NHS England would come to an end after the meeting in September. In preparation, CdJ asked the network to consider who would take over future secretariat arrangements. As per the terms of reference for the CBN, the chair s position is also reviewed annually. RH asked for any nominations for the Chair from either England or Wales to be sent to CdJ. Action E: Volunteers to take on the secretariat arrangements for the CBN to contact CdJ. Action F: Colleagues interested in being nominated for the position of chair to contact CdJ/RH. 5
8. Any other business CdJ explained the work currently underway to ascertain responsibility for public health screening and immunisation programmes which are commissioned on different bases, in particular for children. Action G: A mapping exercise of public health screening and immunisation services in currently underway by NHS England and the output will be shared with LHB colleagues for their view. It is anticipated that this work will feed into the policy differences log. JH informed the network of the change of IT supplier at NHS Shropshire CCG. JH also informed the network that some LHBs are sending referrals directly to providers and requested LHBs to let providers know that the RAS project has not yet commenced. CdJ had received feedback that some patient groups are not able to access the meeting summary report. Action H: CCGs are requested to publish the patient facing summary report on their websites. Actions log: Action Action owner Deadline A Members to send contributions for the policy All 30.6.16 differences log to CdJ. B MAE to arrange lead from joining up your information project to attend the CBN or send a MAE position statement. C MAE to send online care pathway web link to JH MAE D CdJ to check the legal standing of the specific principles as outlined above. E Volunteers to take on the secretariat arrangements for the CBN to contact CdJ. All F Colleagues interested in being nominated for the All G H position of chair to contact CdJ/RH. A mapping exercise of public health screening and immunisation services in currently underway by NHS England and the output will be shared with LHB colleagues for their view. It is anticipated that this work will feed into the policy differences log. CCGs are requested to publish the patient facing summary report on their websites. All All 6
Future meetings: Date Time Location VC link Monday 12 September 2016 12-2.30pm St. Chads Court, 213 Hagley Road, Edgbaston, Birmingham B16 9RG Meeting room 11 Betsi Cadwaladr Powys CHC Link number - 512115 7