Bromley CCG Integrated Governance Committee Minutes of a meeting held on Thursday 7 May 2015 in the Harry Lyne Room, Beckenham Beacon Present: Harvey Guntrip Lay Member Chair Dr Mark Essop Martin Lee Lay Member Sarah Cottingham CSU Keith Fowler Head of Corporate Affairs Sonia Colwill Director of Quality, Governance & Patient Safety Mark Needham Director of Commissioning Dr Atul Arora Mark Cheung Chief Finance Officer Dr Andrew Parson Clinical Chair Dr Angela Bhan Chief Officer Dr Ruchira Paranjape Principal Dr Ade Fowler Assistant Director of Public Health Dr Mandy Selby In attendance: Jackie Peake Corporate Governance Manager Ian Wall Head of Financial Planning Tracy Brookman Governance Officer Minutes Apologies: Ali Kalmis CSU Harriet Agyepong CSU Dr Jon Doyle Sarah Osborn Head of Planning & Performance 1. Welcome & introductions: The IGC and those in attendance introduced themselves. 2. Declarations of Interest: There were no Declarations of Interest. 3. Minutes of the meeting held on 9 April 2015: The minutes of the meeting held on 9 April 2015 were approved as a correct record after the records were amended to show that Sarah Cottingham (CSU) was in attendance. 4. Matters Arising & Review of Action Log: There were no matters arising. The action log was reviewed and updated. It was agreed to close the following actions: 17/15 Session on Transformation strategy had been held for Governing Body members on 23 April 2015. 1
47/14 Dementia services: It was confirmed that mental health services would be covered at the June Governing Body seminar as requested. 49/14 Oxleas Rate of self-harm. Professionals had advised that an increase in reporting was likely to be due to raised awareness. 01/15 RTT would be covered in the Performance Report. 03/15 NHS111 Mark Essop reported that that in his opinion NHS 111 did not have much of an impact on the admission rate. In fact, South East London had one of the lowest referral rates from NHS 111 at 7/8%. Information on numbers of people going to A&E independently rather than being sent by NHS111 was not easily available. However, an individual patient audit was being done by Dr Patrick Harborrow, the. 11/15 SHMI figures Difference in figures explained. KCH report any deaths occurring within 30 days whereas national reporting is within 70/80 days. 5. King s acquisition of the PRUH: The committee was updated on a number of areas regarding Kings. 5.1 Contracts Sarah Cottingham explained that, after lengthy negotiations between NHS England and Hospital Trusts following the national tariff changes, agreement had now been reached with King s that they would sign the 2015/16 NHS standard contract with a 2014/15 rollover tariff and 1.5% for local quality measures (no longer called CQUINs). This was a satisfactory outcome for Bromley CCG. In addition to this a block contract had been agreed with Guys and St Thomas Trust. Mark Needham added that local providers (eg Bromley Healthcare, Oxleas and Kings) had signed up to working in partnership to improve the flow of patients. Investment was being provided for this and a co-ordinated set of indicators was being prepared against which behaviours would be assessed. He agreed to bring these to a future IGC meeting. 5.2 Monitor Angela Bhan gave an update on the work taking place following the Monitor inspection. The 1 and 2 Year plans were now being combined and a draft was due the following week. A 5 Year plan would then follow which Monitor would take to the Department of Health to advise what additional funding the hospital may need. Monitor had also set up oversight groups - a POG (Performance Oversight Group) and a SOG (Strategic Oversight Group). Lambeth, Southwark, Bromley, King s and NHS England were all involved to ensure there was a system in place to move forward. In the meantime, work on recovery plans continued. The new Medical Director, Jeremy Towser, was closely involved and Sue Bowher, new Director of Integrated Care, was much in evidence at the PRUH site. This meant that the CCG no longer had to Chair the Platinum Command. The 4 hour A&E and RTT recovery plans were back on track with the trajectory to achieve the A&E target of 95% within 4 hour waiting time by the end of Q2. Bed capacity had also improved with beds being available each day, despite the effect of Norovirus. The challenge would be to maintain this performance over winter as there would be pressure on the bed base. There was discussion regarding the availability of Care Home beds, bearing in mind that the majority are within the private sector and that there is significant demand from residents of other boroughs for beds within Bromley. The committee recognised the importance of looking at this as a whole system and working with the Local Authority to work out how to address this. This issue would be discussed further at Clinical Executive and as part of the Transformation programme. It was agreed to revisit this area in July and also think 2
about whether to revisit the risk register. 6. Corporate Risk Register: Keith Fowler presented an updated risk register and explained that this was the final quarterly assessment of the organisation s risks associated with its corporate strategic objectives for 2014/15. This had been actively reviewed by Directors following discussion at the Clinical Executive Group on 30 April. The 2015/16 Operating Plan would be going to the Governing Body on 21 May, setting the objectives for the year, and the Corporate Risk Register would be refreshed to reflect the new strategic objectives. It was noted that the King s risk (BRO1413) had been updated to reflect the current situation including the Monitor and CQC reviews taking place. The residual risk had increased from amber to Red. The heat map showed that the majority of risks were in the moderate to major impact categories (yellow to amber). Harvey Guntrip asked how the Bromley risks related to the South East London work. Keith stated that the South East London programme had an overarching risk register and the intention was to incorporate this into Bromley s 2015/16 Corporate Risk Register in order to focus on risks for Bromley. There was a discussion on how Bromley s risk register benchmarked against other CCGs. It was explained that most of the risks were in line and it was agreed the emphasis should be on relevance and validity for Bromley and not just matching others. This would continue to be reviewed at the Audit Committee reported to the IGC. KF left the meeting at 10:30 hours. 7. Procurement Schedule: Mark Cheung presented an updated schedule of planned procurements and advised the Committee that this would be kept under review to ensure the individual tender processes fit with internal business and governance processes. In order to give more of a forward plan, more entries would be added as the Contracts Register was reviewed. Martin Lee felt the scheme was a little ambitious as there were a number of key points at which business cases would go to the Governing Body and he wondered if there would be sufficient capacity to do this. The Committee was assured that this was being monitored on a regular basis. Proper process would be followed and timings would be extended if necessary in order to ensure procurements were compliant with legal guidance. There was discussion of whether all procurements on the schedule warranted full Governing Body ratification. Mark Cheung said that he would review the Operational Scheme of Delegation and the value of what would need to be taken to Governing Body. Refer to Action Log It was advised that a report would be done for the GP Membership, outlining what was coming up for procurement. The Chair thanked Mark Cheung for his hard work on this. 8. 2015/16 Operating Plan Narrative: Mark Cheung presented the narrative to accompany the annual Operating Plan. He explained it was supplementary information requested by NHS England in addition to finance, activity and performance plans and followed a template provided by NHSE. The IGC was asked to review prior to submission on 20 May and it was confirmed there were no significant changes to the figures already agreed by the Governing Body at its meeting in March. Highlighting the aspiration to implement at least 5 of the 10 clinical standards for Seven Day working Martin Lee queried how the most important standards would be chosen and whether they would be deliverable within a sensible timescale. Angela Bhan confirmed this was a realistic aspiration as there was additional investment for Seven Day working. She added that much of the activity in the plan was already being progressed, including joint work with the 3
Local Authority utilising the Better Care Fund. It was agreed that the narrative should be presented in a clearer format for public use. 9. Information Governance Update: Mark Cheung provided a verbal update to the IGC and advised that fuller information would be available after the Information Governance Working Group next met. He reported that an internal audit had recently been carried out on the IG Toolkit and that he would provide an update on the actions resulting from this. 10. Integrated Governance Report: Mark Cheung presented a report for Month 11 and highlighted the key headlines. 10.1 Performance: Mental Health: The IGC welcomed the fact that the IAPT target was met in Q4 and there had been a big improvement in Dementia diagnosis rates, reaching 56.7% in March. RTT: At the end of March, there was a breach of end of year position for RTT performance with a backlog of 1,186 which had come down from February but not far enough. The private sector had significantly under-delivered, with BMI delivering 197 cases from a contract for 1,100. Sarah Cottingham stated the trajectory to clear the backlog for both sites (Denmark Hill and PRUH) was to deliver the national target by October. This was a challenge and additional assurance had been requested from Kings. Waiting List Reporting: Sarah Cottingham reported that the PIMs migration which took place in late Autumn had created a number of reporting issues and Kings had taken the unusual step of requesting a suspension of national reporting for the 6 month period, April to September, in order to clear these. This had been agreed by NHS England and would happen from April reporting onwards. Talks were continuing with Kings about what reports would be delivered to provide assurance locally and ensure the commissioners could continue to monitor performance. Members were very concerned at the situation but accepted that there was little choice if this was the only way to restore data quality and have confidence in reporting going forward. In the meantime having local data available on KPIs to allow monitoring of the Kings recovery plan was essential. The IGC would also require assurance that patients were being monitored along the pathway. Sarah Cottingham confirmed that information would still be provided on any backlogs and on the RTT reduction plan by specialty. It was suggested that more use could be made of the Quality Alert system to indicate any possible issues and that individual cases of cancelled operations could be registered through this route.. 10.2 Quality Sonia Colwill discussed the King s paper that had been through the Quality Assurance Sub Committee, mentioned on page 29 of the Integrated report. There were good results from work on pressure ulcers that King s was doing with Bromley Healthcare and with Care Homes. The Urology pathway was also discussed as there were continuing concerns with this service. There had now been three Serious Incidents reported since the PIMs migration. Although the hospital had said the migration had had no effect on this, a review process was being led by Southwark and Lewisham chief officers to check no harm had resulted. Martin Lee highlighted a recent coroner s report into the death of a patient who died post-op at King s due to a brain tumour. The report had said that a failure to provide improvements in levels of specialist paediatric nursing could risk further, avoidable death. Sonia Colwill advised she was looking into this matter and would agree a dashboard for improvement. It was noted that Kings were required to respond to the Coroner with 56 days setting out Refer to Action Log 4
actions they proposed to take to avoid/mitigate further deaths. Martin suggested the CCG could register as an interested party to gain access to the report. It was advised this should be taken up through the CQRG. 10.3 Finance Mark Cheung provided the Month 12 figures and reported that the CCG had met all its statutory financial duties based upon the draft 2014/15 accounts which had been seen by the Audit Committee. The accounts were currently being audited and the final version would be taken to the Audit Committee on 22 May prior to formal submission. The year end surplus stood at 5.9m with the original plan being 4.8m. This increased surplus would be carried forward into next year and the plans submitted for 2015/16 assumed that it would remain at the same level. There was a small shortfall against the QIPP target with 11.86m being achieved against a target of 12.01m. The team were thanked for their hard work in achieving this result in what had been a difficult year. 11. Quality Assurance Sub Committee: The IGC received the minutes of the meeting of the Quality Assurance Sub Committee held on 31 March 2015. 12. Any other business: None. Date of next meeting: 09:30 hours on Thursday 4 June 2015 in the Harry Lyne Room, Beckenham Beacon. 5