DONCASTER CLINICAL COMMISSIONING GROUP (DCCG) COMMITTEE HELD ON THURSDAY 16 th February 2012 COMMENCING AT 1.00PM Present: Dr Eric Kelly DCCG Chairman Mrs Pam Horner Lay Representative and Vice Chairman Dr Niki Seddon DCCG Committee Member, North West Constituency Dr Andy Oakford DCCG Committee Member, North East Constituency Dr Jeremy Bradley DCCG Committee Member, North East Constituency Dr Nick Tupper DCCG Committee Member, Central Constituency Dr Sam Feeney DCCG Committee Member, Central Constituency Dr Harding DCCG Committee Member, South West Constituency Dr Eroje DCCG Committee Member, South East Constituency Mr Chris Stainforth Chief Operating Officer Dr Rupert Suckling Deputy Director of Public Health Mr Alan Burbanks Chief Finance Officer Mrs Mary Shepherd Associate Director of Quality Mr Albert Schofield Lay Representative Member Mrs Jill Morris Lay Representative Member Mrs Ann Gilbert Lay Representative Member Mrs Joan Beck Doncaster Metropolitan Borough Council (DMBC) Dr Dean Eggitt Local Medical Committee (LMC) Representative In attendance: Mrs Alison Hague (Taking minutes) Mrs Atkins Whatley Assistant Director of Governance & Equality 1 Welcome and Introductions ACTION Dr Kelly welcomed everyone to the second meeting of the Doncaster Clinical Leadership Group Committee held in public. Dr Kelly explained the public meeting will conclude at 3.00pm. Dr Kelly gave a statement on the tragedy that occurred recently in Doncaster. "We were saddened by the tragic death of Casey-Lyanne Kearney, the young Rossington schoolgirl who was murdered in Doncaster earlier this week. Our thoughts are with her family and friends at this very sad time. Casey- Leanne's death is now being investigated by the police and we will be providing any information that they need." There were fourteen members of the public in attendance at the meeting. 1
Questions from Members of the Public There were no written questions from members of the public. Dr Kelly encouraged members of the public to put questions to the Committee prior to future meetings no considered responses can be made at the start of each meeting. 2 Apologies Apologies were received from Dr Pieri North West Constituency Committee Member, Dr Andrew Pearce South East Constituency Committee Member, Tony Baxter, Director of Public Health and Dr Lindsay Britten South West Constituency Committee Member. 3 Declarations of Interest There were no declarations of interest made at the meeting. 4 Minutes from the Previous Meeting held on 19 th January 2012 The minutes of the meeting held on 19 th January 2012 were agreed as a correct record with the following amendments. PCT Revenue Allocations 2012/2012 The PCT revenue allocations for 2012/13 were published mid December. In headline terms PCTs are receiving growth of 2.8% in the current allocations plus an additional recurrent proportion of the national allocation of 150 million for reablement. Taken together, this a 3.0% growth in recurrent allocations. Matters Arising There were no matters arising within the minutes. 5 Performance Report Mr Burbanks presented the report and gave a detailed outline. Ambulance Performance During December 2012 the Category A 8 minute target was not met for the month for all commissioners and performance in Doncaster again failed to meet the target. A performance notice was issued to Yorkshire Ambulance Service (YAS). Year to date YAS continue to meet the target. 2
Dr Kelly advised that there had been reports in the press concerning response times. Mr Burbanks explained that the reports had been considered and would be discussed with the YAS Interim Chief Executive at a future Commissioning Executive meeting. Referral to Treatment Time (RTT) Cumulatively NHS Doncaster continues to meet the 18 week RTT target for both admitted and non admitted patients. NHS Doncaster has also met the RTT target for the month of December 2011 for total specialities. However there are issues with neurosciences at Sheffield Teaching Hospitals Foundation Trust where there are a number of individual breaches. In addition, a small number of admitted Cardiothoracic surgery and non admitted gastroenterology patients were not seen and treated within 18 weeks. Dr Kelly asked if there was any evidence that Sheffield were treating Sheffield patients first. Mr Burbanks informed Dr Kelly that there is no evidence of this happening. Cancer Mr Burbanks reported that cumulatively all cancer targets continue to be met for NHS Doncaster. For one month of December 2011 all targets were met with the exception of the 62 day consultant upgrade target where the performance was 86.3% against a local target of 90%, 3 out of 22 patients did not meet the target. The breaches are investigated on an individual basis. Dr Suckling advised close scrutiny of this target to assess the impact of the National Bowel Cancer Campaign now that it has been launched. Dr Tupper asked if primary care practitioners had been advised of the National Campaign. Dr Kelly informed the meeting that information was passed to primary care contractors at Target sessions. Mr Burbanks will ask Mrs Leighton to tabulate all the specialities to identify where the breaches are occurring. A&E Mr Burbanks reported that Accident & Emergency (A&E) continues to maintain performance. Stroke & TIA Services 3
Mr Burbanks reported that during quarter 3 of 2011/12 the target for high risk TIA patients was not met. In response to this level of performance NHS Doncaster issued a performance notice to Doncaster & Bassetlaw Hospitals NHS Foundation Trust (DBHFT) on 6 th February 2012. Mr Burbanks asked colleagues if they had any further questions on the report. Dr Seddon asked why the smoking quitter rate was low. Dr Suckling explained that these figures are for smoking quitters who quit through the smoking cessation service but doesn t include people who quit themselves. Dr Seddon asked how we compare nationally on this target. Dr Suckling informed the meeting that we have a high number of quitters, however, we have a high smoking prevalence and focussed work is currently ongoing in Doncaster. Mr Schofield asked if there was any further progress on Choose and Book. Dr Tupper informed the meeting that there will be a paper coming to this Committee in the near future on how we prioritise choose and book. A survey has also been carried out of users and non users in primary care. Noted the Performance Report. 6 Quality and Patient Safety Report Mrs Shepherd presented the report and gave a detailed outline. MRSA There has been one MRSA bacteraemia in December taking the total to 8. A root cause analysis has been undertaken. This leaves the PCT breaching the year end trajectory of 7. Out of this total 3 are attributed to DBHFT. C Diff There have been 7 new cases in December making a total 53 against a year end target of 79. Care Homes Mrs Shepherd reported that a number of deep dive visits have been undertaken in Care Homes in Doncaster. The visits have been in support of the Care Quality Commission. Safeguarding Children 4
Mrs Shepherd reported that the number of children who enter the care system in Doncaster is slowly increasing. We now have a team to improve health outcomes for children in care and have secured two extra health visitors to increase the terms capacity. Mental Health Out of Area Placements NHS Doncaster has a small number of children and young people receiving mental health services in out of area placements. Continuing Care There are 15 children who currently meet the continuing care criteria and have a package of care in place. There has been 1 new case in the last quarter. This is progressing well. Serious Incidents Mrs Shepherd reported that the Incident Management Forum received serious incidents and root cause analysis reports are produced. Mrs Shepherd opened the meeting up to questions. Dr Feeney asked if we have details on out of area placements for Doncaster. Mrs Shepherd to provide Dr Feeney with the figures outside the meeting. Mr Schofield said that over the last 12 months the PCT Trust Board at the time had a number of concerns around care homes. Following debate it was noted that the Care Quality Commission is ultimately the responsible body for these. Mr Schofield went on to say that he was interested to see in the report that it now says that the Health Protection Agency is now responsible. Mrs Shepherd clarified that for infection control outbreaks the Health Protection Agency is responsible but only for this area. Mrs Shepherd Dr Oakford informed the meeting that there has been recent press coverage in the local and national media around Out of Hours cover. Dr Oakford reassured the meeting that there had been no issues in Doncaster. Dr Oakford proposes to write to the provider to obtain assurance on this issue. Noted the Quality and Patient Safety Report. Dr Oakford 5
7 Finance Report Mr Burbanks presented the report and gave a detailed outline. Mr Burbanks pointed out that there was an error on appendix 3 of the finance paper and explained why this was. Mr Burbanks went on to explained that the year to date position reflects an under spend of 2,002,000 against a profiled surplus of 2,025,000. In line with the control total agreed with the Strategic Health Authority, the PCT is forecasting a 2.7 million surplus. Mr Burbanks reported that issues within the report should not impact on the bottom line. Mr Burbanks also reported that work is commencing with DBHFT and Sheffield Teaching Hospital on how to improve waiting times with the additional allocation we will be receiving. Discussions had also taken place on how to take CQUIN (Commissioning for Quality & Innovation) indicators forward next year. Dr Feeney asked why there is a high variance on the estates budget. Mr Burbanks explained that there is a piece of work currently being undertaken by the estates team to identify costs per building. We have seen one-off costs this year. Mr Schofield asked Mr Burbanks to clarify that there was still flexibility in the reserves. Mr Burbanks confirmed there was. Mr Schofield also asked why the Cluster QIPP Plan varies to the Doncaster QIPP Plan. Mr Burbanks advised he would review the Cluster report to ascertain what was different and also would discuss with Mr Steve Hackett from the Cluster. Mr Burbanks informed the meeting that looking forward to 2012/13 we are currently in contract negotiations with providers and are continuing to work on the financial plans submission. Mr Burbanks Mr Burbanks also reported that in terms of 2011/12 we have had preliminary discussions with auditors. Noted the Finance Report. 8 Chairman s Report Dr Kelly gave a verbal update on developments within Doncaster in relation to the GP Clinical Commissioning 6
Group. Dr Kelly highlighted: It is 409 days until the CCG become a statutory body. A number of representatives around the table continue to be involved in the development of the Shadow Health and Wellbeing Board working with elected colleagues from the Council and looking at how we can hold all commissioners to account for the health of Doncaster. We are involved in discussions with the Cluster looking at the commissioning support unit and looking at functions being delivered by the CCG. Our first draft plan has been developed and we will be working on this over the next 4-6 weeks and it will show what the CCG priorities are moving forwards. Our involvement at national level representing CCGs in the Children s Outcome Strategy Framework Group. Looking forward next week we have got our first session linked into NHS 111. The new telephone number going live will be all access to urgent care. First Clinical Leadership Forum will be held on 29 th March and will be looking at our Alcohol Strategy. We are involving wider stakeholders including voluntary sector, RDASH and users. We also have our second confirm and challenge event with Cluster colleagues looking at where we are with our development and authorisation processes. Noted the Chairman s Report. 9 Chief Operating Officer Report Mr Stainforth presented the report and highlighted the Social Care Assessment Unit is now open and being utilised. There will be a full evaluation in 7 months. Dr Eggitt asked if there was money available long term for this project. Mrs Beck informed Dr Eggitt that funding was guaranteed for Four years. Mr Stainforth also reported that we are in the middle of the Voluntary Redundancy Scheme. There will be assessments going on over the next few weeks. Mrs Gilbert expressed her concerns around losing further staff and having the capacity to deliver a good service. Mr Stainforth explained that we will need to ensure we still have capacity to deliver services. Mr Stainforth informed the Committee that the process will be a local panel that will meet to access local applications and then the panel will make a recommendation to the 7
Cluster Panel. At Cluster level they will look at the needs across the patch and ensure there is sufficient cover to ensure services can continue. The applications will then go to the Cluster Remuneration Committee and the final decision will be made. Noted the Chief Operating Officer Report. 11 Publishing Equality Objectives Mrs Atkins Whatley presented the paper and explained that The Equality Delivery System is a new NHS self-assessment tool launched in late 2011. The Doncaster Clinical Commissioning Group/NHS Doncaster has used this tool to develop draft scores against the 18 outcomes within the tool and has liaised with local interest groups including local community groups and staff to validate these draft scores. Scoring is based on a red/amber/green rating scale with the addition of a purple score for excelling organisations. There is a national expectation that organisations will be at red or amber in the first baseline year of 2011/12. The self assessment has also been used to generate draft Equality Objectives which are legislatively required by the Specific Public Sector Duties to be developed and published by 2 nd April 2012. Mrs Atkins Whatley went on to give a detailed overview. Mrs Morris asked if there has been a comparison carried out with other PCTs. Mrs Atkins Whatley informed the meeting that comparisons have been carried out with other PCTs across the Cluster in peer Confirm & Challenge. A question was raised around the equality of level of pay across the Cluster. Mrs Atkins Whatley informed the meeting that we have equal pay across the Cluster through agenda for change, but further work is taking place on the Management of Change Policy. We need to continue to monitor this when Voluntary Redundancy takes effect. Mr Schofield asked who marked the PCT as amber. Mrs Atkins Whatley explained that there is a grading manual that has to be followed and a clear criteria and local people are also asked to rate us. The DCCG Committee accepted the gradings put forward in the report and the equality objectives and will feed back any further comments to Mrs Atkins Whatley. Final sign-off of the submission was delegated to the Patient & Public Involvement Group. 8
Noted the Equality Delivery System and Equality Objectives Report and recommended the report to the Cluster Board. 12 Breastfeeding Dr Rupert Suckling presented the report and informed the Committee that in Doncaster around 1 in 7 women initiate breastfeeding after the birth of their child, but this rate quickly drops after ten days to around 1 in 3. Research carried out in Doncaster identified a number of barriers to women initiating and maintaining breastfeeding. Using this research alongside NICE recommendations, initiatives have been implemented across Doncaster to promote breastfeeding and support women to breastfeed for as long as they wish. Dr Sucking went on to say that at the centre of Doncaster s efforts to improve breastfeeding rates in the adoption of the internationally accredited programme for best practice in infant feeding, the UNICEF Baby Friendly Initiative. Other key projects target the breastfeeding drop off rate during the first 10 days after birth. It is proposed that the DCCG influence and support the breastfeeding agenda by ensuring a consistent approach to outcomes specification and monitoring and interagency pathways as well as a global one influencing primary care culture. Dr Feeney asked is the national data from mother s feedback or deprivation. Dr Suckling informed the meeting that we need to look at whole maternity pathway. We need to set out expectations of what normal maternity should look like. A detailed discussion took place around what maternity should look like and the support that can be provided in primary care and also in partnership working. Dr Suckling also informed the meeting that Dr Pearce is currently undertaking work on infant feeding and mortality and how we as a Committee link into maternity structures. Dr Kelly said the consensus is that the Committee want to do whatever we can to support breastfeeding and support Dr Pearce and Dr Suckling in taking this forward. Received and Supported the Breastfeeding Report. 9
13 Constituency Progress Central (Dr Feeney and Dr Tupper) Discussion around conflict of interest to ensure they are logged correctly. Presentation from Doncaster Alcohol Liaison Worker. Discussion around Dashboard for Primary Care looked at frequent flyers to hospital and recognising low rate in central. North East (Dr Oakford and Dr Bradley) Looked at non elective admissions. Questionnaire been adopted for locality asking why patients attended hospital and if looked at alternatives. North West (Dr Seddon and Dr Pieri) Finalised pathways for reducing referrals. COPD audit carried out. Presentation on Dashboard. Agreed root cause analysis work to undertake Discussed commissioning pathways to lower unplanned care GOS live on 1 st March. South East (Dr Pearce and Dr Ade Musah-Eroje) Dashboard presentation. Unplanned care pathways South West (Dr Harding and Dr Britten) Dashboard presentation Karen Wardman from Doncaster CVS attended and DAS Carried out Palliative Care Audit. Agreed unplanned care pathways. Two referral pathways going live. 14 Receipt of Minutes from Sub Groups Audit & Risk Group There were no minutes. Quality & Patient Safety Group The minutes of the Quality and Patient Safety Group were received and noted. Patient & Public Involvement Group There were no minutes 10
Commissioning Executive The minutes of the Commissioning Executive were received and noted. 15 Any Other Business Dr Harding informed the meeting that she will be attending a meeting across North Trent looking at five main cancers and early diagnosis. Will keep the Committee updated. Date and Time of Next Meeting Thursday, 15 th March 2012 11