Telford and Wrekin Clinical Commissioning Group Governance Board Minutes of the Meeting held on Tuesday 9 th May 2017 The Walker Room, Meeting Point House, Southwater Square, Telford, TF3 4HS Present: Dr Jo Leahy Dr Andy Inglis Mr David Evans JL AI DE Chair - CCG GP/Primary Care Health Professional CCG Board Member Chief Officer Mrs Christine Morris CM Executive for Quality, Safety and Nursing Mrs Fran Beck FB Executive for Commissioning Mrs Carolyn Fenton-West CFW GP/Primary Care Health Professional CCG Board Member Mr Peter Eastaugh Dr Martin Allen Mrs Tracey Slater PE MA TS Lay Member for Primary Care Secondary Care Clinician Member Secondary Care Nurse Dr Jim Hudson Mr Jon Cooke Mrs Christine Choudhary Mrs Liz Noakes Mr Geoff Braden JH JC CC LN GB GP/Primary Care Health Professional CCG Board Member Chief Finance Officer Telford Health Roundtable - Observer Telford & Wrekin Council, Director of Public Health Lay Member for Governance Also in Attendance: Mrs Debbie Vogler DV Future Fit Programme Director Mrs Nicky Wilde NW Deputy Director, Primary Care Mrs Jacqui Seaton JS Head of Medicines Management Mrs Lisa Rowley LR PA to the Executive Lead for Nursing, Quality and Safety (Minute taker) 59.17 Welcome Dr Leahy welcomed CCG Board members and members of the public to the meeting. Apologies were noted from Mr Clive Jones, Mr Neil Maybury and Miss Alison Smith Dr Leahy welcomed Mr Jon Cooke who joined Telford & Wrekin CCG in April, 2017 as the new Chief Finance Officer. 60.17 Apologies Apologies were noted from Mr Clive Jones, Mr Neil Maybury and Miss Alison Smith 61.17 Members Declaration of Interest 1
The following additional declarations of interest were noted: Dr Martin Allen informed members that he is now a member of the Pricing and Costing Board for NHS England and he is no longer a member of the Medical Specialist Board and requested that these be added/removed from the Declaration of Interest Register. 62.17 Minutes of the Governance Board Meeting Held on 11 th April 2017 The minutes of the meeting held on 11 th April 2017 were reviewed and accepted as an accurate record of the meeting, subject to the following amendments: Page 2 41.17 Minutes of the Governance Board Meeting held on 14 th March 2017 -second bullet point Dr Inglis highlighted that the, last sentence did not make sense and should say representation from the acute sector could not provide clinical input remove Primary Care. Page 10 46.17 Future Fit, Joint Committee Terms of Reference Mrs Noakes stated that the full function of the committee is not adequately articulated in this section and requires amendment. She also felt that it needs to be clear how the final decision post consultation is to be made before going to out to consultation. Mrs Noakes to provide a form of words. Page 11 49.17 Items raised by Members of the Public - Dr Inglis highlighted that in the first paragraph, reference to gender should be removed as this was not relevant and should read a member of the public Minutes of the Extraordinary Governance Board Meeting Held on 25 th April 2017 Page 2 54.17 Strategy Paragraph 4 Mrs Noakes highlighted that this paragraph refers to a comment she made and it should be noted that she was not in attendance at this meeting. Page 2 54.17 Strategy Paragraph 7 Mrs Beck highlighted that the sentence regarding Terms of Reference was written as a double negative and should read.. if the Terms of Reference are too specific, it is unlikely Shropshire CCG will agree to them. 63.17 Matters Arising Agenda Item 32.17.2 Governance (Audit Committee Chair s Report for the meeting held on 21 st February 2017): Dr Leahy requested that Mrs Clare discuss the issues raised at the meeting regarding online training technical issues with Miss Smith. 11.04.17: Miss Smith has spoken to Board members and explained that if they are experiencing problems accessing the online training or finding time to complete the mandatory training, arrangements can be made for them to complete training at a different time. Miss Smith is aware that new Board members have 7 modules to complete at the same time and appreciated this can be time consuming. Dr Inglis commented that he had a problem as he did not have Chrome installed on his computer at the CCG. Dr Inglis spoke to other members of staff and discovered only 50% of the computers at Halesfield have Chrome installed. Mrs Laura Clare agreed to action this and ensure Chrome (as well as Internet Explorer) are installed on all staff computers at Halesfield. 09.05.17 Mr Cooke advised that all staff computers have not been installed with Chrome. The Board agreed that this action could be removed from the action list. 2
45.17.1 Planning, Performance and Quality Committee Chairs Report for the meeting held on 28 th March 2017 11.04.17 - Dr Andy Inglis referred to page 16 of the report, which shows all indicators not achieving target. All except one have a PPQ assurance rating as red and Dr Inglis said it would be helpful if the indicators could be listed in priority focus order. Mrs Fran Beck agreed this was a good idea and she would ensure this is actioned. 09.05.17 Mrs Beck informed the Board that this report has undergone a change and the comment made by Dr Inglis at the April Board meeting detailed above has been incorporated. Mrs Beck added that the new style report will be taken to PPQ in May for approval and this will be presented to the CCG Governance Board meeting in June, 2017. The Board agreed that this action had been completed and could be removed from the action list. 64.17 Chief Officer s Report Mr David Evans provided a verbal report and the following points were highlighted: Mr Evans highlighted to the Board that as the CCG is currently in purdah careful consideration should be given to decision making. Mr Evans advised that a decision regarding the Community Paediatric Phlebotomy recurrent funding could not be made by PPQ members in April, 2017 as the meeting was not quorate. However, an emergency decision was taken outside of the PPQ meeting and it has been agreed to recurrently fund this service. Mr Evans highlighted that Cancer Waits are under performing and have had two patients waiting over 100 days for treatment, one for upper GI and one for lung. Mr Evans added that he did not wish to go into detail regarding the reasons for this in a public meeting however, this is been taken up with the tertiary providers. Mr Evans informed the Board that the nomination period for the appointment of a GP Board member has now closed, two candidates have come forward and the voting mechanism is underway and will be going to membership in due course. Mr Evans highlighted that A&E performance is still struggling. Some improvement has been seen, however this has not been sustainable. Mr Evans informed that the system is currently running at 75% and further meetings have been held with NHSE and NHSI and it has been mandated to have a primary care streaming process in place by September, 2017; indications for systems and how this is done is yet to be established. Mr Evans stated that he will provide a progress report in due course. 65.17 Assurance 65.17.1 Quality and Performance Planning, Performance and Quality Committee Chairs Report for the meeting held on 24 th April 2017 Dr Leahy assumed the report had been read and asked members for questions/comments. Mrs Beck said that it was important to reiterated that this would be the last time members would see report in the current format and that the new report will be 3
presented at PPQ in May for approval. Mrs Noakes said that with regard to planned care, the Chief Executive of SaTH had given a radio interview providing a briefing on Ophthalmology and Neurology and asked whether it would be beneficial if an update is given to Board. Mrs Beck stated that Telford & Wrekin have outsourced a number of specialities and have asked for a meeting with SaTH and CCG s to look strategically what the solutions are. However, despite interventions, performance is not getting better. Mrs Beck added that Telford & Wrekin CCG are looking closely at the TEMS Provider however, there is still a huge backlog in SaTH and suggested that the report is updated to reflect this. Mr Evans stated that with regard to emergency care, the IAF indicators show that there were 127 ambulance waits and wished the Board to note that going forward, fines attributable to ambulance waits will be levied against commissioners and not the provider. Dr Inglis asked whether the plan is for ambulances to unload patients on arrival. Mr Evans replied that there are complications locally and the problem is ambulances are turning up at the same time which makes it difficult to offload. Mr Braden stated that a discussion took place at the Board meeting in April regarding deterioration in performance around RTT and said that he felt uncomfortable about the actions being taken to mitigate this and asked when this would get back on track as he felt that the issues had been articulated however, he was not assured that there is a plan in place to turn this around. Mrs Beck stated that from the recovery plans seen, assurance could not be given and this has been discussed with commissioning Boards and SaTH. Mrs Beck added that the strategic approach may need to be looked at to get to a sustainable solution. Mr Braden stated that although additional work has been commissioned a dramatic decline is still being seen and if this was a financial performance, we would be very clear how this would be turned round. Mr Evans said that there are a number of contributory factors affecting RTT; one is the ability of the system to consistently reach the target which impacts on the service, workforce issues and locums, who tend to be more risk averse in admitting patients which can lead to risks to RTT. The commissioners need to work with the acute trust to draw up realistic plans either using capacity in SaTH or elsewhere. However, the problem is that there is no capacity elsewhere. Mrs Slater referred to page 8 of the report and asked whether we can be assured that SaTH is meeting its target for use of the WHO check list. Mrs Morris replied that a discussion took place at the April Board meeting regarding stroke services on the back of never events and assurance has been given in reports provided by the Trusts that they are achieving 100%. Mrs Morris questions that as the never events relate to non- site surgery how can they say they are achieving 100%. Mrs Morris advised that WMQRS have been asked for a formal action plan and this is yet to be received. Unannounced visits to theatres have been carried out and all staff has been questioned and at that time, were able to provide answers in terms of compliance. Mrs Morris added that there may be issues waiting for a formal response and will report back to board when in receipt. Mrs Noakes referred to page 29 of the report and highlighted that Maternity indicators is rag rated amber and felt that this should be red and added that Public 4 CM
Health and commissioners are working together to take necessary actions to mitigate this risk. Mr Evans replied that he disagreed with Mrs Noake s comment that the rag rate should be changed to red as the rate does fluctuate and there are good months and bad months. Noted the content of the report. 65.17.2 Governance The Audit Committee Chair s Report for the meeting held on 18 th April 2017 Mr Braden apologised to Board for the late submission of the report. Mr Braden highlighted that a review of local counter fraud annual report has taken place. Mr Braden stated that significant work has been completed on the annual report and the Audit Committee recognised the quality of work undertaken to produce this. Positive feedback has been received from both internal and external auditors on the annual report, both of whom felt that the report captured the key issues and challenges for the CCG. Mr Braden wished to thank Miss Smith for her hard and excellent work in producing this report. Noted the content of the report. Noted the Audit Committee work plan. 65.17.3 Primary Care Primary Care Committee Chair s Report for the meeting held on 4 th April 2017 Dr Leahy assumed the report had been read and asked members for questions/comments. Dr Inglis highlighted that as an observation, on page 5 of the report, reference to gender specific GP s should be removed as this was not pertinent. Mrs Choudhary stated that TELDOC does have a PPG and work has been done over the last month in preparation, the first open meeting is on May 10 th, 2017. Mrs Noakes referred to page 2 of the report regarding flu immunisation and noted that vaccinations for the over 65 s has declined and is currently below average and stated that she would welcome joint work across commissioners to increase this. Mr Evans suggested that Mrs Noakes has a discussion with Mrs Seaton, Head of Medicines Management to address this. Mrs Seaton highlighted that a report which will be submitted to Primary Care Committee in July 2017 picks up the point raised by Mrs Noakes. Dr Inglis added that patients falling within this age criteria had reported that they did not want the vaccination due to bad experiences. Dr Hudson said that a contributory factor for the drop is that pharmacies are 5
carrying out flu vaccinations. Noted the content of the report 65.17.4 Finance Financial Position Month 12 The Board received an outline of the report that provided an update on the financial position at Month 12: Dr Leahy assumed members had read the report and asked that questions/comments be directed to Mr Jon Cooke. Mr Evans said that the Board should recognise the significant amount of work Mrs Laura Clare and member practices have carried out over the last year. Mrs Noakes endorsed Mr Evan s comment and said that some of the financial planning that was done before the beginning of last year has paid off which has set a prudent financial plan in terms of activity and performance. Mrs Noakes asked whether the CCG would be in the same position this year. Mr Cooked replied that it was and a discussion with the Trust has taken place regarding the nature of the contract which is sound and does not expect any untoward surprises. Mr Evans highlighted that Telford & Wrekin CCG is one of two CCG s in the area team that is on a recurrent surplus position and that every other CCG has a deficit in their recurrent position. Dr Inglis said that it would be interesting to note how Shropshire CCG are doing to which Mr Cooke replied that the finance team are looking to integrate this information into the report. Mr Cooke wished it to be formally recognised and acknowledged the hard work carried out by Mrs Clare in her role as acting Chief Finance Officer. Noted the current financial position reported at Month 12 Noted that the CCG has achieved and exceeded the business rules 1% surplus, subject to external audit accounts. Noted the financial challenges faced by partner organisations within the health system. 65.17.5 Member Engagement GP Practice Forum Chair s Report for the meeting held on 18 th April 2017 Dr Leahy assumed members had read the report and added that the meeting held on 18 th April, 2017 was not quorate due to the meeting being held on the first day following the Easter holidays and GP s were unable to leave their practices, therefore no decisions could be made. There were no comments from Board members regarding the report. 6
65.17.6 The Patients Voice Health Roundtable Chair s Report for meeting held on 4 th May 2017 The Board received a verbal update and the following key points were highlighted: Mrs Choudhary highlighted that the Roundtable did not meet last week as they are in a difficult position because of the transformation period and there was not a real need to have a meeting. Mrs Choudhary informed members of the work ongoing by the group as follows:- o Work alongside and together with Telford Patient First Group o Work carried out on the Stoma project which is being set out in public places, facilities have been allocated. Two stores in Telford have complied with this and Morrisons in Donnington have provided the accommodation needed. o Involvement with the hypertension project has taken place. o Working with PPGS. o Working with Macmillan. On many occasions complaints have been made about the pod facilities, these have been listened to. o Work is ongoing with the neighbourhood working Group o A NAP awareness week promoting PPGs is in progress. 66.17 Strategy 66.17.1 Prescription Ordering Department (POD) Mrs Jacqui Seaton attended the meeting for this agenda item. Mrs Seaton assumed members had read the report and asked members for their comments/questions. Mrs Slater said that after reading the report she was impressed with the content and it was good to see a robust system in place. Mrs Seaton asked the GP s present for feedback on the POD from practices. Dr Hudson said that feedback has been variable. Donnington was the second practice to come on board and it had already been established with the first practice what they were doing. Dr Hudson added that good relationships are developing and the PODs seemed to be working well. Mrs Seaton said that they hope to build good relationships with prescription clerks in practices. Mrs Choudhary stated that members of PPG have been positive about the pod scheme and that Vicky Clayton will be giving a presentation at Teldoc about the scheme. Dr Inglis said that it was a good paper however, in terms of observation, has there been learning from TRAQS and will staff be reduced when new practices are established? Mr Evans stated that for transparency purposes regarding accommodation costs, the CCG are not taking on any additional space. Dr Allen stated that there should be processes in place for quality improvement 7
schemes. Mrs Noakes added that the paper was very positive and referred to Mrs Seaton s recent interview on Radio Shropshire saying that she thought Mrs Seaton did well in explaining the POD scheme. Noted the findings of the pilot and supported the Medicines Management Team s intention to expand the POD and further develop the service provided by the POD team. 66.17.2 RightCare Update Mrs Jacqui Seaton attended the meeting for this agenda item. The Board received a verbal update and the following key points were highlighted: Mrs Seaton advised the board that a request had been made previously for regular RightCare updates to be provided to Board. Mrs Seaton advised that the CCG has been mandated to participate in this programme. Mrs Seaton advised that comparisons between other CCGs are being looked at. Prioritised programmes of care have been identified which were agreed at Board in February 2017. Mrs Seaton advised that in terms of going forward, option 1 workshop must be completed by June. Part of the workshop involves different stakeholders and the aim is to look at what can be done differently. The second optimisation workshop is to be completed by 7 th July. Project plans have been done and two project leads are now in place. Mr Cooke stated that he had been invited to attend a launch of menu opportunities which is linked to right care which would be an opportunity to share good practice. Dr Allen asked whether the menu included acute care providers or just CCGS? Mr Evans replied that the circulation list indicated that it had been sent to CCGs only. 66.17.3 Medium Term Financial Strategy Dr Leahy assumed the report had been read and asked members for questions/comments. Mr Evans stated that no financial priorities would be made until after the election. Approved the updated five year financial plan and the budget for 2017/18 and noted the risks inherent within it. Noted the assumptions that have been made throughout the planning process. 66.17.4 Future Fit Update Mrs Debbie Vogler attended the meeting for this agenda item. 8
The Board received a verbal update and the following key points were highlighted: Mrs Vogler advised that an independent review has gone out to tender and Future Fit is now in a position to appoint with a view to commencing work in June 2017. The IAA is a longer piece of work which is ongoing. Mrs Vogler advised that the Future Fit Programme Board has asked to have clinicians in the group, however the report will not be ready for 8 weeks. Clinical data is being looked at however, as the CCG are in purdah, this has meant that the detailed focus group work cannot continue until after the election. The draft report will be received by Programme Board in the first week of July. Mrs Noakes asked whether the independent review would be going through a panel process again. Mrs Vogler replied that it would not at the moment as discussions need to take place with the Accountable Officer. Mr Evans added that the review had gone through the panel process twice and the first time no responses had been received and the second time did have a response but were unable to proceed. 67.17 For Information There were no items for information to report. 68.17 Any Other Business Dr Leahy thanked Mr Sandbach for his recent letter and advised that as it had only been received the day before the Board meeting she had not had chance to distribute it before today but wished to assure him that all executives had received a copy at the meeting. 69.17 Items Raised by Members of the Public Mr Sandbach highlighted that this week was mental health awareness week and said that bearing this in mind, asked that the CCG Board and Telford & Wrekin Council support the training of their staff as mental health first aiders and to market mental health first. Mrs Noakes advised that the CCG and Telford Council are already marketing first health light and there is a big push in terms of training staff in mental health. Dr Leahy highlighted that there was an invitation to drop-in at Strickland House this week and it was very impressive. Councillor Arnold said that as a member of the Regional Trade Union Body it was being advocated that trade union employees undertake training in mental health and that mental health trust activities were taking place in Asda. A member of the public highlighted that the extension to the M55 and works to the bypass can cause undue pressure on services if there are accidents and asked whether adequate consideration is given to the use of ambulances. Mrs Morris replied that as the Emergency Planning Officer for Telford & 9
Wrekin CCG, she is a member of a group that looks at all issues on an ongoing basis i.e. what happens if a road is blocked and the group do look at what happens and what can be done in the future to try and prevent that. Mrs Morris added that this is a concern for the CCG however, wished to give reassurance that all agencies that cover Shropshire and Telford are sighted on work to rectify this. 70.17 Date and Time of Next Meeting: Tuesday 13 th June 2017, 1.30pm Hadley Park House Hotel, Hadley Park East, Telford, TF1 6QJ 10