Reporting Committee Management Group AGENDA ITEM 7 Annex (i) 16 SEPTEMBER 2014 Lead Executive Specialised and Tertiary Services Director Date of last meeting 4 September 2014 Summary of key matters considered by the Committee and any related decisions made. Members noted the actions that had been taken in relation to the serious concerns and agreed a number of areas for improvement. These will be implemented in future reports. Members noted and supported the report outlining the keys issues in terms of Thoracic Surgery. The Joint Committee will consider the report at the meeting in September. Members noted and supported the recommendations outlined in terms of CAMHS. The Joint Committee will consider the report at the meeting in September. Members received the draft action plan for Neurological Conditions and agreed that a period of consultation would now take place before agreement in October 2014. Members received the monitoring report on the Integrated Commissioning Plan and discussed the iterative development of the financial tracker. Members approved new commissioning intentions to redirect resources within laboratory genetic services to increase the range of UKGTN tests available for patients in Wales, and to reduce the inequity of access and increase the value of the Array Testing, to reduce waiting times. Members received a report on the Paediatric Intensive Care Unit Retrieval Service and agreed that an options appraisal should continue with the development of a business case for the viable options. Key risks and issues/matters of concern and any mitigating actions Members noted the key risks in terms of the delivery of the Plastic Surgery RTT. The actions were agreed and an update on the position would be reported at the next meeting. Chair Management Group Page 1 of 38 Joint Committee
Matters requiring Committee level consideration and/or approval Commissioning Through Evaluation Integrated Commissioning Plan Thoracic Surgery Cardiac Surgery CAMHS Financial Position Corporate Risk and Assurance Framework Matters referred to other Committees None. Committee minutes submitted (insert ) Yes X No Date of next meeting 9 October 2014 Chair Management Group Page 2 of 38 Joint Committee
MINUTES OF THE MANAGEMENT GROUP MEETING HELD 14 AUGUST 2014 BOWEL SCREENING WALES, LLANTRISANT PRESENT Members Mr John Palmer Dr Geoffrey Carroll Mr Stuart Davies Mr Daniel Phillips Miss Pam Wenger Dr. Sharon Hopkins Mrs. Angela Jones Mr. Robert Mahoney Deputy Members Ms Julie Keegan Mr. David Eve Mr. Huw Llewellyn Mr. Philip Meredith Ms. Lynne Edwardson Ms. Gillian Milne Specialised and Tertiary Service (Chair). Medical Director, WHSSC. Finance, WHSSC. Planning, WHSSC. Committee Secretary, WHSSC. Public Health, Cardiff & Vale UHB. Aneurin Bevan UHB. Finance Manager, Cardiff & Vale UHB. General Commissioning Manager, Cwm Taf HB. Assistant Finance, Hywel Dda HB (via VC). Assistant Finance, Abertawe Bro Morgannwg UHB. Finance Business Manager, Aneurin Bevan UHB. Planning & Co-ordination Manager, Betsi Cadwaladr UHB (via VC). Finance Officer, Betsi Cadwaladr UHB (via VC). In Attendance Mr. Carl Shortland Mr. Chris Moss Specialist Lead for Forensic Services, WHSSC. Secondary Care & Specialised Services Manager, Aneurin Bevan UHB. Chair Management Group Page 3 of 38 Joint Committee
Ms. Debra Davies Mrs. Dominique Gray- Williams Executive Assistant to the DSTS, WHSSC. Assistant Specialised Planner, WHSSC. MG14/91 WELCOME AND INTRODUCTIONS The Chair welcomed and thanked everyone for attending the Management Group meeting. MG14/92 APOLOGIES FOR ABSENCE Apologies for absence were RECEIVED from Mr Nigel McCann, Mr. Robert Holcombe, Ms. Ruth Treharne, Mr. Steve Webster and Mr. John Darlington. MG14/93 DECLARATIONS OF INTEREST Cardiff and Vale, Abertawe Bro Morgannwg and Cwm Taf UHBs have a standing declaration of interest in relation to the agenda items which relate to services for which they are providers. MG14/94 MINUTES OF THE MEETING HELD ON 10 JULY 2014 The minutes of the last meeting were AGREED as a true and accurate record of the meeting subject to the following amendments: MG14/74 Mr R Mahoney requested the tenth paragraph be revised to read Mr R Mahoney advised that SIRT is a highly sensitive area with nearly all C & V UHB top up payment activity being in this area. Mr Mahoney advised that there were two sensitivities in Cardiff which need to be considered: Professional concerns around by-passing a Welsh Provider when the expertise is in Cardiff; and Equity of access. Dr G Carroll confirmed that C & V UHB have recently completed a designation process which is currently being assessed to ascertain whether C & V UHB are compliant with the standards for designation. A response should be received very shortly. Dr Carroll acknowledged that patient selection was going to be challenge. Mr Palmer (Chair) advised that Chair Management Group Page 4 of 38 Joint Committee
he mirrored Mr Mahoney s concern and has requested a further report on Commissioning through Evaluation be presented to the WHSSC Executive Board in September 2014. MG14/82 Mr R Mahoney requested that the second/third paragraphs be amended as follows 250k has been included to be shared across commissioners and should have been included in respective LHB Plans, subject to the final model being agreed through the WHSSC commissioning process. Mr. Mahoney confirmed that the Children s Hospital for Wales is scheduled to open in March, 2015 and there will be a cost implication for commissioners in 2014/2015. MG14/82 Mrs J Keegan requested that the fourth paragraph should be amended to read Mrs Keegan felt that it was important to get the model right. A critical point to sort out would be whether this should be a Consultant led or Consultant provided service as this would have cost implications. MG14/83 paragraph 2 should read Mrs Keegan raised the fact that in 2010 Neurology was on the list of services that should transfer to Health Boards. MG14/89 Mr. Nigel McCann re-iterated that BCUHB still have two issues outstanding: 1) working with the WHSSC Finance Team, BCUHB have not been able to fully reconcile the 3.95 million of additional BCU investment per the Annual Plan, in the month 2 or month 3 WHSSC budgets. 2) The BCU shortfall (circa 170k) against the Welsh Government approved and funded Neonatal Business Case, in the month 3 budgets was still not resolved. MG14/95 Matters Action and Decision Logs Members noted the progress on the actions from the last meeting and noted the contents of the decision log. Chair Management Group Page 5 of 38 Joint Committee
MG14/74 SIRT Dr Carroll provided an update in relation to the Commissioning through Evaluation (CtE) Programme and in particular the designation process for SIRT. Members noted the update in relation to the Firefox trial which will report in 2017. All Members MG14/76 Andrew s Report Mr Palmer encouraged Members engage in the process and feed in views before the next meeting of the Management Group on 4 th September, 2014. Dr G Carroll will re-circulate the paper to Members. MG14/82 Childrens Hospital for Wales Mr R Mahoney confirmed that a letter analysing individual liability has been drafted to be sent to WHSSC. Medical Director, WHSSC. MG14/83 Neurological Conditions Miss P Wenger advised that a letter on the services that had been transferred was being issued. MG14/96 REPORT FROM THE DIRECTOR OF SPECIALISED & TERTIARY SERVICES Members received a report from Mr J Palmer updating on the key issues since the last meeting of the Management Group. Mr Palmer reported on the Chairman s action taken and members ratified the action. Members also noted the commissioning policies that had been approved by the Executive Board. Members noted the progress against the work programme since the last meeting including : Participating in the Week in, Week out BBC Wales programme on Bariatric Surgery; Appointment of Miss Eiri Jones, interim Nursing & Quality; Engaged with Cwm Taf in early discussions on the potential for integrating back office functions; Engaged with Powys in early discussions on the potential for consolidating commissioning Chair Management Group Page 6 of 38 Joint Committee
functions; Engaged with EASC on the potential for joint working and on resourcing; Started to engage with the CAMHS; Renal; Neonatal; and Low/Medium Secure Mental Health networks to begin developing a more standardised and consolidated approach to these important elements of WHSSC business; Engaged with 1000 lives to confirm WHSSC involvement in Team Wales and potential involvement in the development of the Specialised Services Strategy; and Engaged with NWIS to draw together a workshop on data. Mr Palmer drew members attention to the update on the transfer of tertiary paediatric endocrine. Mr Phillips agreed to provide an update to Dr S Hopkins regarding the Business Case and that this would be brought back for review at a future Management Group. Mr Palmer updated members on the discussions regarding WHSSC role in performance management and agreed to circulate a copy of the letter from Mr S Dean. Members supported the direction of travel in terms of strengthening the performance management function and role of WHSSC. Planning, WHSSC. Specialised & Tertiary Services Members noted the proposed Governance Review which would be undertaken by the Good Governance Institute. Mr Palmer confirmed that this would be funded within the existing budget. Members noted the progress made in relation to the areas outlined in the report. Members RESOLVED to: NOTE the contents of the report; and make any responses that could strengthen the approaches outlined; and RATIFY Chairman s action. MG14/97 SERIOUS CONCERNS Members received a verbal update on three concerns: Chair Management Group Page 7 of 38 Joint Committee
Review of Children s Cardiac Surgery at Bristol; Alder hey Children s Foundation Trust; and Renal Transplantation. Members noted that there was an Alder Hey stakeholder event planned for 15 August 2014 where the CQC would be providing feedback. Dr Carroll confirmed that WHSSC would be represented at the event. In terms of the review of Children s Cardiac Surgery at Bristol, Mr S Davies clarified that the funding dispute was between University Hospital Bristol and NHS Commissioners (not WHSSC). Members RESOLVED to: NOTE the verbal update report in relation to Serious Concerns. MG14/98 PROGRESS AGAINST THE INTEGRATED COMMISSIONING PLAN FOR 2014/15 Members received the report on progress against the Integrated Commissioning Plan for 2014/15. Mr D Phillips confirmed that the Joint Committee have agreed to adopt a one year plan, with caveats, but were unable to approve the plan because the financial position for NHS Wales was not yet balanced. Members were pleased with the improvements in the development of the financial tracker. Dr S Hopkins suggested that quality outcomes should be reflected in the tracker as currently the quality elements were not visible. Mr S Davies clarified that there is to be a separate dashboard which will include the quality outcomes. Mr Davies confirmed that the complete scorecard is to be presented to the Management Group in September, 2014. Mrs A Jones felt that this was a big step in the right direction but, suggested that there was a lot more that could be linked into the Triple Aim. Mrs J Keegan suggested that there should be some mechanism in place to enable scrutiny of significant overspending. Mrs Keegan felt that a schedule of Chair Management Group Page 8 of 38 Joint Committee
business cases/business justification cases should be included. Miss P Wenger confirmed that the decision of the Joint Committee was to hold on developments. Members noted that with the exception of the Hepatologist, any new developments would require scrutiny by the Management Group. Dr G Carroll drew members attention to the list of services listed at Annex 1 on page 4 of 7, would need to be updated. Finance, WHSSC. Members supported the direction of travel and agreed that further development was required to ensure linkages with the Triple Aim. Members RESOLVED to: NOTE the progress undertaken to date in the implementation of the Integrated Commissioning Plan for Specialised Services 2014/15; and NOTE the work that is being taken forward to develop the balanced scorecard. MG14/99 FINANCIAL POSITION AS AT MONTH 4 Members noted the financial performance position as at month 4. Mr S Davies drew Members attention to the summary of key movements and issues. A discussion was held in relation to the reported position on IPFR. Mrs J Keegan stated that there needs to be clarity around what are true IPFR cases and those which are prior approvals. Mrs Keegan suggested that there is a need to identify and separate non-commissioned activity. Miss P Wenger confirmed that Mrs C Dew, IPFR Manager, WHSSC is progressing work around the definitions. Mrs A Jones advised that Aneurin Bevan UHB have developed an out of area policy and that they would be happy to offer support to WHSSC. Mr J Palmer suggested that WHSSC should support Health Boards in looking at clinical criteria and a further discussion in relation to this be convened. Chair Management Group Page 9 of 38 Joint Committee
Ms L Edwardson advised that she was extremely concerned about the English contracts performance and will need to work through with Mr Davies Team to understand the position. Mr S Davies advised that he will be formally approaching BCUHB and Powys thb to discuss performance management. Finance, WHSSC. Mr S Davies highlighted an underlying risk from a delay in repatriating renal immunosuppressant patients in the Cardiff Centre and advised that it is essential that the pace of progress improves in this area to avoid moving into an overspend position. Mr Palmer advised Members the Chief Executives have acknowledged that this is a challenging period in relation to cardiac outsourcing and supported the ceasing of outsourcing for South East Wales. Members noted the issues around the additional cases for Aneurin Bevan University Health Board and further discussions would need to take place with ABUHB as soon as possible. Members RESOLVED to: NOTE the current financial position against the updated budget; NOTE the risk from increased activity in English providers and review the additional local actions that need to be taken to increase awareness of cost and the need to follow only appropriate pathways optimising the use of Welsh services; and NOTE the additional scale of commitment in relation to cardiac surgery outsourcing, the likely level of financial liability for 2014/15 and the outstanding agreement around risk sharing. MG14/100 SPECIALISED STRATEGY FOR WALES Members received a presentation on the development of a specialised services strategy for NHS Wales. Mr Palmer highlighted specific areas where LHB engagement would be required and asked Members to consider how they would like to engage in the Specialised Services Strategy and feedback to him. All Members Chair Management Group Page 10 of 38 Joint Committee
Members welcomed the presentation and the direction of travel and felt that there had been an improvement over the last few months. Mrs A Jones agreed the need for working collaboratively and ensuring that specialised services was integral to health board business. Mrs Jones also suggested that public engagement and consultation should be included as this was a key area that would need further consideration. Mrs J Keegan suggested that care should be taken when using the word Prudent as that is essentially the role and purpose of commissioning. MG14/101 CARDIAC SURGERY IMPROVING OUTCOMES AND WAITING TIMES PROJECT Members received a report on the Cardiac Surgery Improving Outcomes and Waiting Times Project and noted the current position with outsourcing activity in South East and South West Wales. Mr S Davies outlined the finance and contracting engagement processes that had taken place between WHSSC, ABMUHB and C&V UHB. Members noted that confirmation is awaited to ensure the contract for outsourcing will be met by Abertawe Bro Morgannwg UHB. Mr H Llewellyn requested clarity on the process for approval of the business case for ABM and whether the scrutiny of the business case by WHSSC and Welsh Government could take place in parallel. Mr Llewellyn explained that this would be helpful if this approach could be supported so not to delay the process. Assistant Finance, ABMUHB. Mr Palmer stated that he could not support that process and that following the meeting with Welsh Government, Mr Llewellyn agreed to update Mr Palmer. Mr Palmer advised that he would need to speak to Welsh Government officials and the Chief Executive following the feedback. Dr G Carroll updated Members in relation to the current position with policies and the implementation of clinical access criteria and frailty assessment measures. Members discussed in some detail the Medical Director, Chair Management Group Page 11 of 38 Joint Committee
status of the policies and in particular the issues raised by the cardiac network in terms of the frailty score. WHSSC. Miss P Wenger confirmed that the policies were approved at the last meeting of the Management Group and it was agreed that there will be delay in the implementation of the frailty score whilst the issues are worked through with the Cardiac Network. After discussion it was agreed that Dr G Carroll would send a letter confirming the policies that were approved and the implementation timetable. Members accepted that the policies were still urgent but the pace of implementation should be reviewed. Dr S Hopkins requested clarity in relation to the funding for outsourcing in South West Wales. Mr Philips confirmed that Mr P Roberts, CEO, ABMUHB and Mrs K Howell, CEO, Hywel Dda Health Board had agreed at the Joint Committee that their Health Boards would provide the additional resources required to fund the volume of outsourcing to meet the RTT target. Dr Hopkins suggested that this is not shown in either of the Health Board s Plans for this year or next. Mr S Davies confirmed that it had been included in their Plans and there was an absolute commitment although it may not be transparent. Dr Hopkins suggested that this needed to be followed through and reassurance sought. Mr Eve requested reassurance that all negotiations and discussions in relation to performance with AMBUHB would be completed by the time of the Cardiac Surgery Summit which is scheduled for 28 th August, 2014. Mr S Davies confirmed that that was the intention and that he would do all he could to facilitate that. Mr Palmer reported that WHSSC has been reviewing the Cardiology pathway. Mr Palmer has been liaising with WG and there is an opportunity to pull a wider group together to have a discussion around this. Finance, WHSSC. Specialised & Tertiary Services Mr Palmer reported that WHSSC has been explicitely asked to step into the performance management Chair Management Group Page 12 of 38 Joint Committee
space around outsourcing. Letters will be sent to Health Boards. Mr Palmer reported that during recent discussions with providers in relation to mortality on waiting list data, there has been much hesitancy and the process had not been smooth. Mr Palmer suggested that this process needs to be seamless and will need to be resolved within two weeks. After discussion Members RESOLVED to: RECEIVE the project update report including: o Actions agreed at the Chief Executives Peer Group Meeting; o Waiting times: patients waiting over 36 and 26weeks; o Outsource activity in South East and South West Wales; o On-going work to manage the outsourcing initiative; and o Implementation of clinical access criteria and frailty assessment measure. MG14/102 ALL WALES MEDICINE GENETIC CENTRE: LABORATORY SERVICES Members received a report on the All Wales Medicine Genetic Centre: Laboratory Services and outlined the key issues and recommendations for consideration. Members discussed the issue of the benefits to be derived from the additional investment. Mrs Gray- Williams confirmed that the benefits would include quicker diagnosis, less testing and equity of access. Mrs A Jones suggested that savings should be tracked through the annual plan process to enable value for investment could be demonstrated. Mrs J Keegan felt that there was a great deal of pressure within the Plan and in terms of prioritisation would need to be considered when investing in new services. Mr D Phillips confirmed that this service was included with the frame of the Annual Plan and that a report in relation to these Services had been presented to the Chair Management Group Page 13 of 38 Joint Committee
Management Group in March and April, 2014. Mr R Mahoney voiced his concerns around linking a saving with an investment. Mr Mahoney advised that the Clinical Board at Cardiff & Vale UHB are unaware of this. Mr. Mahoney also questioned whether this was a financial flow which is currently being transacted to C & V UHB and if so, on what basis it can be removed. Mr H Llewellyn felt that the governance process could be strengthened and suggested that this be discussed further at the Business Processes Workshop scheduled for 11 th September, 2014. Members agreed that Mr D Phillips would draft a further to report to clarify points raised as follows: Benefit to be accrued from additional investment; Savings to be tracked through the annual plan process to demonstrate value of the investment; Ensure rigour around decisions on further investments; Concerns around linking a saving with an investment; Is this a financial flow which is currently transacted to C & V UHB and on what basis can it be taken away; Strengthening of governance process; Benchmarking. Members agreed to note the report and support the recommendations in principle. It was further agreed that an updated Report be presented to the Management Group in September, 2014. Planning, WHSSC. Chair Management Group Page 14 of 38 Joint Committee
Planning, WHSSC. MG14/103 CHILDREN AND ADOLESCENT MENTAL HEALTH SERVICES Members received a Report on Children and Adolescent Mental Health Services. Mr C Shortland Mr D Phillips and Mr S Davies briefed Members on the background, highlighted a number of areas of progress and timescales for completion. Mr R Mahoney reported that there had already been discussions around rebasing and that there are still some children going out of area. Dr S Hopkins felt that this could be agreed in principle but it would have to be done in a managed way and suggested that there needs to be more thinking around this. Members discussed the issue of risk sharing and whether this would affect the timescale for the completion of the risk sharing review commitment. Mr Davies clarified that it was anticipated that this would be completed by the set timescale of October 2014. Mr Phillips reminded members that there would be a further report at the next Management Group. The decision required today was to note progress and approve the protocol that was received in the July meeting. After discussion it was agreed that an explicit report be prepared which sets out individual responsibilities and presents the options to enable an informed decision for presentation at the September Management Group. Members RESOLVED to: NOTE the progress to date and support development of final proposals for revising the commissioning, contracting and risk sharing framework for CAMHS; and APPROVE the new CAMHS Transition Protocol and confirm implementation with immediate effect. Planning, WHSSC. Chair Management Group Page 15 of 38 Joint Committee
MG/104 BUSINESS CYCLE FOR THE PERIOD 2014-16 Miss P Wenger presented the outline business cycle and explained that this would be refined over time and as new issues arise. Members RESOLVED to: NOTE the report and the attached business cycle; and SUPPORT the business cycle for the Joint Committee. MG14/105 BUSINESS CASES The Chair reported that no new business cases have been received. Members RESOLVED to: NOTE the verbal report received. MG14/106 DISPUTES The Chair confirmed that no new disputes had been reported. Members RESOLVED to: NOTE the verbal report received. MG14/107 ANY OTHER BUSINESS There was none. MG14/108 DATE OF NEXT MEETING The date of the next meeting was confirmed as: 4 th September, 2014, Meeting Room 1, NLIAH, Llanharan. Signed. John Palmer (Chair) Date.. Chair Management Group Page 16 of 38 Joint Committee
MINUTES OF THE MANAGEMENT GROUP MEETING HELD 10 JULY 2014 BOWEL SCREENING WALES, LLANTRISANT PRESENT Members Mr John Palmer Mr John Darlington Dr Geoffrey Carroll Mr Stuart Davies Mr Rob Holcombe Mr Nigel McCann Mr Robert Mahoney Mrs Cathie Steele WHSSC Miss Pam Wenger Specialised and Tertiary Service (Chair) Assistant Planning, Betsi Cadwaladr UHB (via VC) Medical Director, WHSSC Finance, WHSSC Assistant Finance Director, Aneurin Bevan UHB Assistant Finance, Betsi Cadwaladr UHB (via VC) Finance Manager, Cardiff and Vale UHB Corporate Governance Manager, Committee Secretary, WHSSC Deputy Members Ms Julie Keegan Mr. David Eve General Commissioning Manager, Cwm Taf HB Assistant Finance, Hywel Dda HB (via VC) In Attendance Mr Charlie MacKenzie Mr James Dalton Mr. Ian Langfield Mr. Luke Archard Head of SLR and External Commissioning, Abertawe Bro Morgannwg UHB Contact Support Accountant, Cwm Taf UHB Assistant Planning, WHSSC Specialised Planner, WHSSC Chair Management Group Page 17 of 38 Joint Committee
Ms. Debra Davies Mrs. Nicola Johnson Mr. Carl Shortland Executive Assistant to the DSTS, WHSSC. Specialised Planner, WHSSC Specialist Lead for Forensic Services, WHSSC. MG14/69 WELCOME AND INTRODUCTIONS The Chair welcomed and thanked everyone for attending the Management Group meeting. MG14/70 APOLOGIES FOR ABSENCE Apologies for absence were RECEIVED from Mr D Griffiths, Dr S Hopkins, Mr D Phillips, Mr. S Webster, Ms. R Treharne, Mr. B Hopkins and Mr. H Llewellyn. MG14/71 DECLARATIONS OF INTEREST Cwm Taf University Health Board confirmed a declaration of interest in relation to agenda item 16 - CAMHS. Cardiff and Vale, Abertawe Bro Morgannwg and Betsi Cadwaladr UHBs have a standing declaration of interest in relation to the agenda items which relate to services for which they are providers. MG14/72 MINUTES OF THE MEETING HELD ON 12 JUNE 2014 The minutes of the last meeting were AGREED as a true and accurate record of the meeting subject to clarification on the following: MG14/59: Mrs. J Keegan advised that she was not aware of the agreement on the report on treatment times for Plastic Surgery being to September, 2014. She was expecting to see something before that date. Mr. S Davies confirmed that a Delivery Plan was awaited from ABMUHB. Mr. C Macknezie agreed to chase the response so this could be submitted to WHSSC within the next week. Members AGREED that the actions in relation to RTT would need to be dealt with quickly and that an Head of SLR & External Commissioning, ABMUHB Finance, WHSSC Chair Management Group Page 18 of 38 Joint Committee
report on action taken would be considered the Management Group in September, 2014 with an expectation that the RTT target should be back on track before 31 st March, 2015. MG14/73 Matters Action and Decision Logs Members NOTED the progress on the actions from the last meeting and NOTED the contents of the decision log. MG14/45 Management Group Business Processes Miss. P Wenger confirmed that the Business Review had commenced. Mr. R Holcombe stated that the timeframe between receipt of papers and the date of meetings is too short and does not give enough time for considered responses. Mr. Holcombe suggested papers be received 7 clear days before the meetings. Miss Wenger AGREED to look at alternative ways for the issuing of papers. The Chair confirmed that this is in hand and that the September cycle should be better. The Chair also advised that he will be arranging a Workshop in relation to Business Processes and would welcome engagement. Members discussed the length of the minutes and whilst recognising that this was necessary at the present time as there were specific and complex issues being discussed. Miss Wenger agreed to review to ensure they were more succinct. MG14/46 Cardiac Surgery Mrs. Keegan recalled that the agreement at the last meeting was to undertake an impact assessment of policies within three months. She asked for clarification of the timescale. Dr. Carroll suggested that a six months timescale would be more practical. Mrs. C Steele will revisit the minutes and amend if necessary. Chair Management Group Page 19 of 38 Joint Committee
MG14/64 Paediatric Endocrinology Service for North Wales Mr. McCann confirmed that he has sent a formal response to Mrs K Williams last week and updated Members orally. It was AGREED that an update/closing Report be included on the Agenda of the next Management Group meeting for completeness. MG14/63 Intra-contracting with Health Boards Mr. Davies confirmed that this issue has been escalated to Mrs R Richards and Ms C Moar, the lead Directors of Finance. Mrs R Richards will lead the process of concluding this through the Directors of Finance. MG14/74 TO RECEIVE A REPORT FROM THE DIRECTOR OF SPECIALISED AND TERTIARY SERVICES Members received a report from Mr J Palmer, (the Chair). The Chair briefed Members on the content orally and highlighted important issues: The Andrews Report, Trusted to Care: (This is included as a substantive item on the Agenda); The WHSSC Integrated Commissioning Plan: The Joint Committee have agreed a one year plan on current activity and to hold new developments pending further review; Cardiac Surgery: The Joint Committee have requested further work be carried out on a collaborative opportunity between providers. This issue will be discussed further at the Chief Executives Peer Group on 21 st July, 2014; The Specialised Services Strategy for Wales: Chief Executives have confirmed their support in the direction of travel, underlining the need to strengthen patient focus and to handle innovation with care (This is included as a substantive item on the Agenda) The Chair updated Members on his regular meetings Chair Management Group Page 20 of 38 Joint Committee
with Mr. J Hill-Tout, Interim Chair of WHSSC and reported that Mr. Hill-Tout has confirmed that he is content to continue in his interim role until a New Chair is appointed. The Chair confirmed that the Chief Executive NHS Wales/Director General has indicated that there is support for: Scrutiny arrangements so that the WHSSC QPS Committee can call in providers to scrutinise services; Development of set of quality metrics that will be developed between WHSSC and WG; Development of an approach to escalation against these metrics that will connect to WG/HB performance routine arrangements. The Chair reported that the Bristol Review in relation to Paediatric Cardiac Surgery was formally launched on 23 rd June, 2014. Members NOTED that Dr. Geoffrey Carroll is leading on the review on behalf of WHSSC and he will be writing to Health Boards to communicate the approach to the review shortly. Members NOTED the position in relation to the Renal Dyalisis Facility at Withybush Hospital. The Chair confirmed that WHSSC have worked extremely closely with ABMUHB, Hywel Dda HB and WG over the last few weeks and this had been a good joint effort. The Chair reported that a huge amount of work has been done in relation to access to Sofosbuvir drug treatment over the last few weeks. Medical Director Members were very supportive of the approach taken and Dr. Carroll confirmed the process to be followed going forward. Dr. Carroll AGREED to circulate the recent correspondence with Chief Executives/Medical Directors to Members for information. The Chair reported that Dr. Carroll had recently taken part in a Week In Week Out Programme interview in relation to Bariatric Surgery. The Chair Chair Management Group Page 21 of 38 Joint Committee
also advised that WHSSC will be engaging more with the media and that Health Board Clinicians may be needed to support from time to time. The Chair reported that WHSSC has had a series of discussions with the DCMO around Commissioning for Evaluation and how WHSSC can work more collaboratively with England initially on SIRT. Mr. R Mahoney advised that SIRT is a highly sensitive areas with nearly all C&V UHB top up payment activity being in this area. Mr. Mahoney asked for reassurance that when the service is commissioned that consideration could be given at local options. The Chair confirmed that it had been. The Chair briefed Members on the organisational developments at WHSSC and advised that he is keen that the Management Group participate with WHSSC in the development of a workshop in early September to embrace necessary improvement activity. Mr. J Darlington asked that consideration be given to location when arranging the workshop to enable all Members to attend rather than VC. Medical Director All Health Boards All Health Boards Chair Members RESOLVED to: NOTE the contents of the report. Chair Management Group Page 22 of 38 Joint Committee
MG14/75 SERIOUS CONCERNS Members received a summary report on three clinical governance concerns which have already been presented to the Joint Committee. Mr. S Davies advised that these issues are being fully embedded in the contracting discussions with the providers. Members RESOLVED to: NOTE the updated report on current governance concerns and action related to: o Alder Hey Children s Foundation Trust; o Bristol Children s Cardiac Surgery; and o Liver Cancer Surgery at University Hospital of Wales. MG14/76 PROFRESSOR ANDREWS REPORT ON CARE IN PRINCESS OF WALES AND NEATH AND PORT TALBOT HOSPITALS Members NOTED the report on the WHSSC initial assessment and actions required in relation to the Andrews & Butler report. Dr. Carroll briefed Members on the content of the report and drew Members attention to the highest priority clinical services. Dr. Carroll confirmed that effective collaboration would be required between WHSSC and Health Boards to ensure progression of the agreed/preferred Option 3. Members RESOLVED to: NOTE the report and SUPPORT the work to develop an urgent stock take and planned implementation of option 3. All Health Boards/ WHSSC MG14/77 INTEGRATED COMMISSIONING PLAN FOR SPECIALISED SERVICES 2014/15 2016/17 Members received a report on the Implementation of the Integrated Commissioning Plan for Specialised Services 2014/15 2016/17. Mr. Langfield briefed Members in depth on the Chair Management Group Page 23 of 38 Joint Committee
background and progress to date, the development of schemes and further work being taken forward. Mr. Langfield confirmed that monthly updates will be provided to the Management Group and to each of the Health Boards at the regular one to one commissioning meetings. Members discussed the financial component of the plan and it was confirmed that the 5.6m held in reserve at present is included in the Annual Plan, is being managed as a central resource. Mr. Davies also confirmed that Bariatric Surgery was not included in the Plan. Mr. McCann acknowledged that a considerable amount of work had been undertaken in relation to demand management but questioned the appropriateness of referral management. Mr. McCann suggested a reflection on the appropriateness of processes and how they may be reviewed. Mr. Davies acknowledged the need for ongoing review following which criteria may need to be sharpened and filtered in a different way. Mr. Palmer re-iterated that the scorecard would be an active model of pursuing balance and giving options. WHSSC will now be populating the scorecard in readiness for presentation at the Management Group meeting in September, 2014. Mrs. Keegan suggested the introduction of a Savings Plan. This would enhance sharing of good practice and enable review and monitoring of savings. The Chair confirmed that at present this was a tool to drive forward towards a product which would be a Savings Plan. Mr. Davies will draft a report on Demand Management and Referral Management to agree an approach to include best practice etc. to move forward collaboratively. Finance, WHSSC In response to Mr. Dalton s suggestion in relation to the table at paragraph 5 summarising the schemes, Mr. Davies confirmed the Annual Plan process had been followed. Mr. Dalton also suggested that Chair Management Group Page 24 of 38 Joint Committee
some parts of the Plan were not included in the holding position and asked for clarity around this. Mr. Davies acknowledged this and advised that if Mr. Dalton let him have a series of questions he will respond directly. Members had a detailed discussions regarding the approach to provider efficiencies. Mr. Davies advised that the approach in England is to use a deflator. It has been recognised that this is not be appropriate for use in Wales and therefore the flat cash position has been used as a recognition of efficiency. Finance, WHSSC Mr. Mahoney disagreed that a like for like comparison had been made and felt that a debate around how savings efficiency should be reinvested, shared, incentivised should take place to establish a clear protocol. The Chair acknowledged this and advised that WHSSC is currently working on population of the scorecard which will lay out work and consider what a savings plan will look like. Members had differing views about the development of a protocol however, it was agreed this would be considered as part of the overarching savings plan. Mr. McCann requested clarity in relation to the reconciliation exercise. Mr. Davies confirmed that a review against Health Boards Plans had been undertaken to ensure that the correct share for WHSSC was included in the plans. Members NOTED that provided a further updated iteration of the reconciliation exercise will be provided to Joint Committee in September, 2014. Mrs. Keegan suggested that there is a need to agree collectively the currency to be used and that there should be a contract around this to be able to benchmark effectively and efficiently. Mr. Davies AGREED that the currencies should be refreshed and that is part of the work going on with C & V at the moment. Chair Management Group Page 25 of 38 Joint Committee
Mr. Mahoney confirmed that he was generally supportive of the direction but that there is need for caution around the two different approaches that are being taken. Members discussed the current position with the Hepatology Business Case. Mr. Davies confirmed that the only developments agreed at present were the appointment of the Hepatologist and the strengthening of the MDT. Mr. Davies suggested that a further report be prepared for presentation to the Management Group in relation to whether this service should be fully transferred to WHSSC. Members RESOLVED to: NOTE the progress undertaken to date in the implementation of the Three Year Commissioning Plan for Specialised Services 2014/15 2016/17; NOTE & SUPPORT the work that is being taken forward to develop the balanced scorecard; AGREE the list of development schemes for further scrutiny prior to submission to the September meeting of the Joint Committee; REVIEW the Annual Plan and highlight any further specifics for clarification; RECEIVE and updated Report at the September meeting of the Management Group; RECEIVE a populated scorecard at the September meeting of the Management Group; RECEIVE and update on progress at the September Management Group in relation to clarifying protocol on savings share; RECEIVE an update on progress at the September Management Group in relation to standardising mixed currency. MG14/78 TO RECEIVE THE FINANCIAL PERFORMANCE REPORT Members NOTED the financial performance report for month 3. Mr. Davies drew Members attention to the summary of key movements and issues. Finance Planning, WHSSC Finance, WHSSC Chair Management Group Page 26 of 38 Joint Committee
Mr. Davies highlighted that the Joint Committee have agreed that risk sharing needs to be re-visited and therefore WHSSC will be instigating a formal risk sharing rebasing review. Members NOTED that Mr. Davies will be writing to Health Boards within the next couple of weeks requesting senior representation for this review. A draft ToR will be circulated quickly and Mr. Davies asked for a swift response so that this Group can be set up as soon as possible. All Health Boards Mr. McCann asked for clarity in relation to the proposal to update the planned risk shares for month 4. In response Mr. Davies confirmed that this was part of the normal process and invited views from Health Boards. Mr. Davies confirmed that the risk share is only used in connection with in year variances, for new contributions or changes in the annual plan. It is only an incremental risk sharing. (Mrs. Nicola Johnson joined the meeting) Members were asked for their views on updating the risk share and the majority view was to update the risk share. The positions of Hywel Dda UHB and Betsi Cadwaladr UHB were NOTED that they did not support the updating of the risk share. Mr. McCann confirmed that based on the decision to update the risk shares for month 4 he wished to update Members on the item included in the Action Log (MG14/48) which he did not feel had been covered at this meeting. Mr. McCann confirmed that BCUHB have 3.5m in the plan and at the moment are only getting benefit of 3.6m[sic]. It was the view of Mr McCann that changing the risk sharing from this point will only worsen the position and that a further decision was required in relation to the financial contribution by BCUHB in relation to the Plan. Mr McCann stated that BCUHB would need to reduce their contribution by 250k. Chair Management Group Page 27 of 38 Joint Committee
It was AGREED that Mr. Davies and Mr. McCann follow up with an urgent discussion within the next 48 hours after which Mr. T Purt, CEO BCUHB and the Chair be briefed to ensure resolution of the issue. Members NOTED the update on the agreement for funding of outsourcing in relation to Cardiac Surgery. The Chair advised that following his meeting with Mr. S Dean that WHSSC has been asked to put together a submission to include options which will clarify the journey required to move from 36 to 26 wks. Mr. S Davies AGREED to provide regular updates at DoF s around this particular issue. Members RESOLVED to: NOTE the current financial position against the updated budget; NOTE the real underlying performance to date is better by up to 0.7m than reported owing to the phasing of the impact of the cardiac surgery outsourcing initiative; NOTE the risk from increased activity in English providers and AGREE to take local actions to review control processes to ensure referrals out of area to English providers remain within funded levels; NOTE the additional scale of commitment in relation to cardiac surgery outsourcing, the likely level of financial liability for 2014/15 and the outstanding agreement around risk sharing; AGREE an update report to be prepared for presentation at the next Directors of Finance meeting. Assistant Finance, BCUHB/Director of Finance, WHSSC. Finance, WHSSC MG14/79 SPECIALISED SERVICES STRATEGY FOR WALES The Chair will circulate to Members and present at the Management Group meeting on 10 August, 2014. Committee Secretary MG14/80 TO RECEIVE THE FINAL REPORT AND RECOMMENDATIONS OF THE THORACIC Chair Management Group Page 28 of 38 Joint Committee
SURGERY TASK & FINISH GROUP Members received a Report on the recommendations of the Thoracic Surgery Task & Finish Group. Mr. Archard briefed Members in depth and highlighted significant points and recommendations included in the final report. Mrs. Keegan felt that this was a very good piece or work and she was supportive of the direction of travel. Mrs. Keegan thought that the three recommendations were in principle the right way forward but questioned the cost implications or whether this would be cost neutral. Mrs. Keegan advised that she would not be able to support if there were cost implications. Mr. Holcombe asked for clarity on the current demand, compared with waiting lists and waiting times and to gain an understanding why the resections currently are not being done. Dr. Carroll noted that there were no cost/low cost quality components and the report did not mention surgical training. Dr. Carroll suggested a Service Specification be drafted as a way forward. The Chair summarised discussions that the key issues in the report could have been presented in a better way. Members AGREED that further work was required to understand the demand modelling against the baseline and the financial impact. Members RESOLVED to: NOTE the work undertaken and the findings of the Thoracic Surgery Task & Finish Group; NOTE the recommendations 1 to 3 for early implementation to put in place improved cover for MDT meetings, a second opinion process and provider action plans; RECEIVE a further report to include a financial analysis and impact of the recommendations including an analysis of the impact of moving to median and upper quartile for each Health Board patient numbers and financial impact. AGREE the Task & Finish Group will be Specialised Chair Management Group Page 29 of 38 Joint Committee
reconvened with revised terms of reference to advise the Management Group and Joint Committee on the implications of the NHS England standards and service specification once published. Planner, WHSSC MG14/81 CARDIAC SURGERY IMPROVING OUTCOMES AND WAITING TIMES PROJECT Members received and update report on the developments over the last month of the improving waiting times and outcome project. Mr. Langfield briefed Members on the content of the report. The Chair updated Members orally in relation to the risks of reporting mortality data. The Chair reported that he has recently met with NWIS who agreed to support WHSSC in relation to automating the reporting of the data. Members NOTED that Dr. Carroll had met with Dr J Shannon and his Team at Cwm Taf UHB and agreed to work with Dr Shannon and his team in relation to this. Members NOTED the current position and that a report would be considered at the next Chief Executives Peer Group meeting in July 2014. The Chair reassured Members that it was clear that Members were nervous about 36 weeks and that any movement beyond that is completely understood. The Chair requested absolute validation of 36 weeks to ensure clarity for the Chief Executives. A discussion was held in relation to cardiology and it was confirmed that this was an explicit part of the conversation. The Chair has also confirmed that he had received a letter from Dr A Goodall in relation to joint working on cardiology pathways. All Health Boards Members NOTED the update on mortality data and that there was no turn as yet but, that it was an explicit part of the discussion. Patient selection/access criteria/frailty assessment should all start to come into the system and this will be tracked over the next two quarters. Chair Management Group Page 30 of 38 Joint Committee
(Mr. John Darlington left the meeting) The Chair provided an update in relation to outsourcing and advised that he is waiting for reassurance that the level of outsourcing we have now achieved gives us a guaranteed 36 week position at year end. The position will be reported to the Chief Executives in July, 2014. In answer to Mr. Holcombe s request for clarity around cardiac surgery planning and volumes the Chair confirmed that the demand modelling is 1650. Mr. Holcombe requested an update on the position with Bristol Spire. Mr. Davies confirmed that they are now willing to discuss capacity but volumes and timeframes need to be confirmed. Members RESOLVED to: RECEIVE the project update report including: Progress towards a sustainable services (outcome and action following June Joint Committee); Waiting times: patients waiting over 36 and 26 weeks; Outsource activity in South East and South West Wales; On-going work to manage the outsourcing initiative; and The measurement and analysis of waiting list mortality. MG14/82 PAEDIATRIC INTENSIVE CARE AND RETRIEVAL SERVICE IN SOUTH WALES Members received a report in relation to the Paediatric Intensive Care and Retrieval Service in South Wales. Mr. Langfield briefed Members on the background, the current options available and the proposals to move forward. Mr. Mahoney confirmed that the revenue plan for the Children s Hospital of Wales did incorporate a small element of incremental costs to deal with PICU retrieval. 250k has been included to be shared Chair Management Group Page 31 of 38 Joint Committee
across commissioners and should have been included in respective LHB plans, subject to the final model being agreed through the WHSSC commissioning process. Mr. Mahoney confirmed that the Children s Hospital for Wales is scheduled to open in March, 2015 and there will be a cost implication for commissioners in 2014/15. Mrs. Keegan felt that it was important to get the model right. A critical point to sort out would be whether this should be consultant led or consultant provided service as this would have cost implications. Mr. Davies confirmed that the costs were not included in the WHSSC plan at present. The original message from the Minister at the time was that there was a recognised net cost but that the provider would need to work to eliminate this before opening. Mr. Davies acknowledged that this would now need to be included. Members RESOLVED to:- NOTE the report; SUPPORT the direction of travel. WHSSC to be fully sited on a set of provider elements which have come from previous agreements; AGREED that the Options Appraisal should be clear in relation to the Consultant led element of the service; AGREED that an update on the Ministerial line be sought; AGREED that an update Report be prepared for presentation at the September meeting of the Management Group. Assistant Planning, WHSSC MG14/83 NEUROLOGICAL CONDITIONS DELIVERY PLAN Members received a briefing paper on the Neurological Conditions Delivery Plan. Mr. Langfield briefed Members on the background and highlighted key themes and actions. Mrs. Keegan raised the fact that in 2010 Neurology was on the list of services that would transfer from Chair Management Group Page 32 of 38 Joint Committee