Present Minutes of the Welsh Health Specialised Services Committee Management Group Meeting held on 21 September 2017 at Health and Care Research, Castlebridge 4, 15-19 Cowbridge Road East, Cardiff CF11 9AB Members Stuart Davies (SD) Director of Finance, WHSSC (Acting Chair) Clare Lines (CL) Assistant Director Commissioning Development, PTHB Huw Llewellyn (HL) Assistant Director of Finance, ABMUHB Phillip Meredith Rob Nolan Kevin Smith (PM) (RN) (KS) Finance Business Partner, ABUHB Finance Director - Commissioning & Strategy, BCUHB Committee Secretary and Head of Corporate Services, WHSSC Melanie Wilkey (MW) Head of Outcomes Based Commissioning, CVUHB Deputies Maxine Evans (ME) Corporate Planning Manager, ABMUHB David Eve Charlie McKenzie (DE) (CM) Assistant Director of Finance - Financial Planning & Governance, HDUHB (VC) Finance Business Partner, ABMUHB Claire Nelson Peter Richards (CN) (PR) Acting Assistant Director of Planning Finance Business Partner, PTHB In attendance Christopher Coslett (CC) Specialised Planning Manager, WHSSC Chris Stevens (CS) PFM Commissioned Services, ABMUHB Shakeel Ahmad (SA) Associate Medical Director, WHSSC Apologies: Carole Bell (CB) Director of Nursing and Quality Assurance, WHSSC John Darlington (JD) Assistant Director, Corporate Planning, BCUHB Robert Holcombe Julie Keegan Ian Langfield Sian Lewis (RH) (JK) (IL) (SL) Assistant Director of Finance, ABUHB Assistant Director of Commissioning, CTUHB Acting Director of Planning, WHSSC Managing Director, WHSSC (Chair) Robert Mahoney (RM) Assistant Director of Finance, CVUHB Minutes Juliana Field (JF) Corporate Governance Officer, WHSSC The meeting opened at 10.00am Version: Confirmed v1.0 Page 1 of 8 Minutes of the WHSSC Management Group
MG17/055 Welcome, Introductions and Apologies The Chair opened the meeting welcoming members. Apologies were noted as above. MG17/056 Declarations of Interest There were no declarations of interest. MG17/057 Accuracy of Minutes from 31 August 2017 The minutes of the meeting held on 31 August were agreed as a true and accurate record. MG17/058 Action Log 2016-17 and Matters Arising Members reviewed the action log and the following updates were provided: MG001 NWIS Project on English Data Flows The most recent meeting had determined that it was now appropriate to close the HCS contract. The In Patient and ITU elements of the WHSSC work had been built and were now available for health boards to use; the Out Patient element would follow. An individual patient tracker had also been developed. MG024 Cardiac Surgery Review An update was provided within the Managing Directors report and members noted that the Delivery Unit would be invited to the next Management Group meeting to present their report. MG033 Royal Orthopaedic Hospital, Birmingham It was noted that information had been distributed within the Health Boards and that WHSSC would provide additional information for circulation. MG039 Plastic Surgery Performance It was noted that there was no further requirement for a teleconference between WHSSC, Powys teaching Health Board (PtHB) and Wye Valley NHS Trust as it was highlighted that PtHB hand and breast plastic surgery was managed via Abertawe Bro Morgannwg University Health Board (ABMUHB) Action Closed Matters arising None to note. MG17/059 Report from the Managing Director Members received the report and noted the following key areas: Interventional Neuroradiology (INR) and Thrombectomy Version: Confirmed v1.0 Page 2 of 8 Minutes of the WHSSC Management Group
Cardiff and Vale University Health Board is still unable to provide an INR service for the patients of south Wales. It was noted that all nonelective patients were being managed through North Bristol NHS Trust and elective patients through The Walton Centre. WHSSC was in negotiation to formalise arrangements with Bristol to support service provision. Members were informed that Bristol had raised concerns around its own capacity and discussions were being held between North Bristol NHS Trust and NHS England in relation to a longer term strategy for provision of a sustainable INR service. Members noted the importance in ensuring that patients were transferred back to Cardiff from Bristol as soon as possible. Members were informed that an announcement from the Welsh Government was anticipated relating to a push on provision of a thrombectomy service, which was usually delivered by INR consultants, and asking Health Boards to direct the discussions. Members noted that WHSSC had approached Welsh Government to raise concerns relating to inequity of access and potential confusion within the system. A discussion was held around the current provision and retrospective payment process and concerns around formalising arrangements creating greater cost pressures and the need for greater control of access criteria. It was acknowledged that thrombectomy was usually carried out in urgent/emergency situations and therefore was more difficult to manage. Members noted that pressures in both England and Wales for mechanical thrombectomy, which was not a WHSSC Commissioned service, could further destabilise the INR service. Members were advised that a new INR consultant was due to join Cardiff and Vale University Health Board (CVUHB) in October 2017. Cardiac Surgery It was anticipated that the Delivery Unit team would present their report at the next Management Group meeting. Substantial issues had been raised around inadequacy of process for transferring patient information impacting on reported waiting times for patients. Welsh Referral to Treatment (RTT) Targets: WHSSC Bid WHSSC had put a proposal to Welsh Government for extra funding to improve RTT performance for Cleft lip and palate, Cochlear and BAHA, Interventional cardiology, IVF and Neurosurgery. There had been no discussion yet on timescale for any response or mechanism for the flow of funding. Welsh Government were aware of the need to ensure equity of access for all Welsh patients, irrespective of location of service provider. Restructuring of staffing models within the Welsh Health Specialised Services Team Version: Confirmed v1.0 Page 3 of 8 Minutes of the WHSSC Management Group
Members were reminded of the Good Governance Institute and Health Inspectorate Wales Reviews reported in 2015 which recommended the strengthening of the quality team within WHSSC. This had been identified in the WHSSC ICP however no funding had been identified. Members noted that a paper summarising opportunities identified for cost neutral restructuring, to support the development of the quality team, was to be taken to the WHSSC Joint Committee meeting in September 2017. Note the content of the report. MG17/060 All Wales Lymphoma Panel Key Performance Indicator Report Members received a paper which provided an update on implementation of the additional investment in the All Wales Lymphoma Panel in 2015/16, performance against key performance indicators for 2016/17 and the actions being taken under the WHSSC escalation process. Members were reminded that additional funding of 345,000 for the service was released in November 2015, on the understanding that key performance indicators for the service would be developed. These were developed in line with Royal College of Pathologists Key Performance Indicators in Pathology 2013, the Royal College of Pathologists Standards for Specialist Laboratory Integration and Datasets for the Histopathological Reporting of Lymphomas 2015 and the WHSSC Quality Framework, 2015. Members noted that the business case had been fully implemented by CVUHB and that there had been some improvement in multidisciplinary team (MDT) attendance. Members received an overview of the data presented within the report, noting that turnaround times were substantially below the standards set in 2015 and that there appeared to be no significant improvement in turnaround times reported in 2014. It was noted that the number of cases had increased from 510 in 2002 to 1373 in 2012 and 1374 in 2015-16. It was noted that feedback from user satisfaction surveys was generally positive and that no significant incidents had been recorded on the DATIX system within the last six months. Members were informed that, given the lack of improvement within the service since investment in 2017, the service had been escalated to stage 1 of the WHSSC escalation process and that an action plan was being developed to address the issues within the service. Note the performance of the AWLP against the KPIs that were agreed for delivery through the additional investment in Version: Confirmed v1.0 Page 4 of 8 Minutes of the WHSSC Management Group
2015/16. Note that, given the level of performance, stage 1 of the escalation process was initiated, including: o CVUHB to provide WHSSC with a detailed action plan, with clear timelines, for achieving the KPIs for MDT attendance and turnaround times. o CVUHB to report KPI performance monthly (including attendance by MDT and turnaround times by testing centre). o CVUHB to provide monthly updates to the action plan; Monthly performance meetings between the Cancer & Blood commissioning team and CVUHB Clinical Diagnostics Clinical Board to review KPI performance and delivery of the action plan. Note the inclusion of AWLP performance within the WHSSC performance report. MG17/061 Risk Sharing Update Members received an oral update around the current position and actions being taken by the finance working group. Members were informed that the finance sub-group met on 20 September 2017, following which a paper was to be developed for presentation to the WHSSC Joint Committee on 26 September 2017. It was noted that the baseline had been neutralised to the end of 2013-14 in line with the agreement made in May 2017 by the Joint Committee, with the expectation that any volatility would be compressed to a middle point. Members were advised that, following a significant amount of work by the finance sub-group, this had not been achieved and had identified a risk that regardless of whichever point in time was used for neutralisation the sensitivities in relation to actual activity data resulted in a fluctuation in impact (positive to negative and negative to positive) for individual Health Boards. It was further noted that CAMHS was a significant factor but there remained some need for verification of the overall data and explanations as to the overall impacts. The finance sub-group had held discussions around the agreed principles and opportunities for reconsideration as it was noted that most members still favoured the utilisation/activity based approach, rather than neutralisation. However, it was recognised that this also might not result in an outcome that was satisfactory to all Health Boards. The impact on investments since 2013-14 was being investigated but this wasn t expected to be material. It was noted that the WHSSC Joint Committee would be asked to take a view on how the volatility should be addressed and a decision in principle, subject to further verification work and explanation of the Version: Confirmed v1.0 Page 5 of 8 Minutes of the WHSSC Management Group
significant swings. Members held a discussion around the positions of individual Health Boards, the requirement to ensure that the CAMHS issues are addressed and the potential impact on the IMPT processes. The discussion continued around the level of volatility, utilisation based approach and how population shares had been determined. It was noted that WHSSC would provide members with a copy of the report as soon as it was available. Action: Copy of Risk Sharing report to Joint Committee to be circulated to members once available. Note the update. MG17/062 Financial Performance Report Members received the report which set out the estimated financial position for WHSSC for the fifth month of 2017-18. It was noted that no corrective action was required. The overall financial position at Month 5 was an over spend of 1,109k ( 1,153k including EASC and QAIT) year to date with a forecast year end under spend of 2,082k ( 1,997k including EASC and QAIT). 2m of reserves were written back in the month from previous year accruals relating to IPFR, Development, IVF and Mental Health. Some reserves remained against English contracts where matters were unresolved. Progress on the HRG4+ dispute remained slow, however the Welsh Government were now positively engaged with the process; which whilst recognised by NHS Improvement was not yet accepted by NHS England, although individual English providers were sympathetic. It was noted that the HRG4+ position was estimated to be an additional cost of around 5-6m overall and that PtHB had put this subject on the agenda for a Welsh Government/ Department of Health cross-border meeting on 22 September 2017. Members noted that the WHSSC team had completed an analysis around total cost consequence, activity variance, pricing movement and volume, and impact on Health Boards, which was to be shared with Health Boards. Action: Analysis undertaken in relation to HRG4+ and English Contracts to be sent to Health Boards. Version: Confirmed v1.0 Page 6 of 8 Minutes of the WHSSC Management Group
A discussion was held around the agreement of HRG4+ payments by Health Boards, the pressures on individual providers, the level of confidence around the NHS England position, and lack of clarity around timescales for a resolution. It was noted that a discussion would be held at the WHSSC Joint Committee on 26 September 2017. Members noted that the Individual Patient Funding Request year-todate position remained broadly stable and that, despite some concerns, the overall month 5 position was positive. Note the current financial position and forecast year-end position. MG17/063 Integrated Performance Report Members received a report which provided a summary of the performance of services commissioned by WHSSC for June 2017 and detailed the action being undertaken to address areas of noncompliance. Escalation Child and Adolescent Mental Health Services had been escalated to level three of the WHSSC Escalation process. This was in addition Neurosurgery and Paediatric Surgery services which were also noted at stage three of the Escalation process. Key areas to note: 56 week breaches continued in Cardiac Surgery, with breaches also seen in thoracic surgery. The service specification for Bariatric Surgery had been published for consultation. Waiting lists for Neurosurgery were now exceeding 100 weeks; this was being closely monitored as an ongoing issue. Improvement in Paediatric Surgery with no 52 week breaches anticipated for September 2017, this would be updated in the next month s Integrated Performance Report. Thoracic Surgery A presentation was to be given to the WHSSC Joint Committee on 26 September 2017; however data were still awaited from the Cancer Network as only data for CVUHB had been received to date. Members noted the importance of this data being provided in a timely manner and it was commented that this data was regularly submitted to the Welsh Government, so should be available. Version: Confirmed v1.0 Page 7 of 8 Minutes of the WHSSC Management Group
Note current performance and the action being undertaken to address areas of non-compliance. MG17/064 Items of Any Other Business Members agreed to defer the Management Group Workshop meeting scheduled for 12 October 2017 due to a clash with a demand/capacity workshop which had also been scheduled for this date. Action: CN to circulate alternative date for the Management Group Workshop previously scheduled for 12 October 2017. MG17/065 Date and Time of Next Meeting It was confirmed that the next meeting would be held on 26 October 2017 at Health and Care Research Wales, Cardiff. The Management Group Meeting concluded at approximately 13.00pm. Version: Confirmed v1.0 Page 8 of 8 Minutes of the WHSSC Management Group