Present: Telford and Wrekin Clinical Commissioning Group Governance Board Minutes of the Meeting held on Tuesday 13 th January 2015 Telford Whitehouse Hotel, Watling Street, Wellington, Telford, TF1 2NJ Dr Mike Innes (Chair) MI CCG Chair Dr Jim Hudson JH GP CCG Board Member Dr Louise Warburton LW GP CCG Board Member Dr Andy Inglis AI GP CCG Board Member Mr David Evans DE Chief Officer Mr Andrew Nash AN Chief Finance Officer Mrs Christine Morris CM Executive Lead for Nursing, Quality and Safety Mrs Fran Beck FB Executive Lead for Commissioning Mr Geoff Braden GB Lay Member for Governance Mr Dylan Harrison DH Lay Member for PPI Mrs Carol Wall CW Practice Manager Board Member Dr Martin Allen MA Secondary Care Clinician Mrs Liz Noakes LN Director of Public Health, Telford & Wrekin Council Mr Paul Taylor PT Assistant Director Social Care, Specialist (Mr Taylor joined the meeting at 2.55pm FutureFit agenda item) Mrs Christine Choudhary CC Chair Health Roundtable Also in Attendance: Mrs Karen Ball KB PA to the Chief Finance Officer Dr Chris Parker CBE CP Managing Director, West Midlands Academic Health Science Network Mrs Nicky Wilde NW Interim Deputy Executive Lead for Commissioning and Quality In-hospital Services Mr Darren Francis DF TRAQS Support Mrs Jacqui Seaton JS Head of Medicines Management 01.15 Welcome Dr Innes opened the meeting and wished Board members and members of the Public a Happy New Year. Dr Innes also welcomed Mrs Choudhary on her return to the Board meeting. Dr Innes continued by expressing his gratitude to CCG staff for their hard work in the past few weeks, which has proved to be a challenging period. 02.15 Apologies: Dr J Leahy, Miss A Smith, Mrs Z Young 03.15 Members Declaration of Interest None noted. 1
04.15 Minutes of the Governance Board Meeting Held on 9 th December 2014 The minutes of the previous Board meeting were approved as a correct record subject to the following amendments: Page 2-143.14 Matters Arising 97.14.3.3 Cancer Report Action 09.12.14 regarding MSK should be under 97.14.3.4 18 Week Referral to Treatment Update. Page 4-145.14 Chief Officers Report NHS England Restructure, first bullet point should read..mr Urwin s successor will be Ms Wendy Saviour, currently Director of Birmingham and Black Country Area Team. 05.15 Matters Arising 74.14.2 Ambulance Commissioning Intentions Dr Innes requested that an update report from WMAS should be presented to Board in November, 2014. 09.12.14 Mrs Beck to speak with Telford and Wrekin Lead Commissioner for Ambulance Services regarding producing reports in a timely manner for Board. Dr Innes to send a letter from the CCG Board to Senior Managers reinforcing the desire to engage. 13.01.15 Dr Innes had written to Ms Gail Fortes-Mayer and Ms Fortes-Mayer will present an update on WMAS performance at the January 2015 Planning, Performance and Quality (PPQ) Committee meeting. Members will receive an update via the PPQ Chairs report. 97.14.3.2 18 Week Referral to Treatment Update Mrs Beck to seek clarity as to whether SaTH Trauma and Orthopaedic Consultants are referring Telford and Wrekin pain management patients to Patient Management Solutions. 09.12.14 Mrs Beck to invite representatives from Pain Management Solutions to present an update on the effectiveness of the service at a CCG Board meeting early in the New Year. 09.12.14 Mrs Beck advised that an update on progress against MSK is unlikely to be presented to the Board in the near future as the tender process for the new service was ongoing. It was agreed that this would be taken off the agenda. However all patients were being referred by consultants to the new service. Dr Hudson asked that clarity of clinical input into the pathway was given. It was agreed that Mrs Beck would take this matter forward. 13.01.15 Mrs Beck informed Board members that the MSK tender outcome for the preferred provider will be brought to the February 2015 Confidential CCG Board meeting. An evaluation of the service provided by Pain Management Solutions would be presented at the March 2015 CCG Board meeting. 108.14 Chief Officers Report Mr Evans confirmed that Dr Parker, Managing Director of WMAHSN would be attending the January 2015 CCG Board meeting. 13.01.15 The Board noted that this item would be discussed under agenda item 6. 122.14.2 Planning Prioritisation for 2015/16 The Board to receive final proposals at the February 2015 Board meeting. 13.01.15 Mrs Beck noted that this item would be partly covered under 9.3. 133.14.1 The Shropshire and Telford and Wrekin Safeguarding Adults Annual Report Mr Taylor agreed to bring a report to Board, which would explain the new Adult Safeguarding arrangements and progress to date to the January or February 2015 CCG Board meeting. 2
13.01.15 Mrs Morris highlighted that work on the report is ongoing and will discuss with Mr Taylor the report coming to the February 2015 CCG Board meeting. 135.14.5 Update on Decision Making for Prioritisation An updated version of the decision making tool for use in making prioritisation decisions for 2015/16 onwards would be brought to the December CCG Board meeting for approval. 09.12.14 Mrs Beck stated that this action needed to be revisited as the CCG was not in a position where scoring for decisions could be made and that individual business cases were currently being looked at. Dr Innes said that the CCG needed to have a consistent and systematic approach on their views about decommissioning as much as commissioning. Mrs Beck replied that if there was a robust business case this could rationalise a consistent approach to the decision making process. Dr Innes said that as the CCG was not yet in a place where services were being decommissioned and suggested that this matter be an agenda item at the February 2014 meeting as a recommendation for a systematic process. The Board agreed that the Decision Making process should be published on the CCG website. 13.01.15 The Board noted that this item would be discussed under agenda item 9.5. 06.15 Introduction to the West Midlands Academic Health Science Network Dr Chris Parker CBE, Managing Director, West Midlands Academic Health Science Network (AHSN) attended the meeting and gave a presentation of the work of the Network. The following key points were highlighted: There are 15 AHSN s across the country. The role of the AHSN is to support the spread of innovation across the NHS in England. To align clinical research, informatics, training, education and healthcare delivery in their respective regions, with the twin objectives of improving healthcare and generating wealth. AHSNs have four core objectives: Focus on the needs of patients and local populations; build a culture of partnership and collaboration; speed up adoption of innovation into practice to improve clinical outcomes and patient experience and to create wealth. AHSN s have three areas they work on: long-term conditions; mental health and medicines and six enabling themes. Dr Parker highlighted the work of the Small Business Research Initiative (SBRI), which aims to bridge the gap between health and economic growth. It is a NHS England funded initiative, which is managed by the Eastern AHSN. Dr Parker discussed the 100,000 Genome Project, which all the West Midlands Acute Trusts have signed up to. Dr Innes questioned the juxtaposition of Improving health and creating wealth and questioned whether it could cause a conflict of interest. Dr Parker responded by saying that the NHS is such a large organisation, with a large buying power, that if British companies develop products and services for the NHS it can help these companies to sell their products further afield. A patient s health could be improved and therefore minimise the time they are away from work when ill. Dr Innes also suggested that this could be seen as pushing the privatisation agenda within the NHS. Dr Parker said that it was more of an alignment with public health and wealth creation and does not see it as being about privatisation. MA questioned that as the Network had been running for a year how does the Network endeavour to get the message of their work across to clinicians who are not aware of what they do and may therefore be missing an opportunity to engage with the Network. Dr Parker responded by saying that good communication processes with secondary care and CCGs was key. Dr Parker highlighted patient safety and said there was a need to involve local authorities and the private sector. Mrs Choudhary said that as a patient she struggled to understand the benefits for patients, the timescales involved and the process for communicating programmes to 3
patients. Dr Parker said that a number of WMAHSN programmes and mentioned STarT Back, which is a stratified approach, to managing back pain and matching treatment with need. Dr Parker, however, accepted that it can take time to set up patient programmes. Dr Innes asked about the level of patient involvement when developing programmes. Dr Parker responded by saying that there was patient involvement and the AHSN were in the process of developing a PPI group. Board members agreed that it would be useful to receive updates from the WMAHSN. Dr Parker said that there is a weekly communication, which can be accessed. AHSN s also produce an annual report. Dr Innes thanked Dr Parker for attending the meeting. 07.15 Items Raised by Members of the Public There were no items raised by members of the public. 08.15 Chief Officers Report Accident and Emergency Performance Mr Evans discussed the considerable pressures on the urgent care system both locally and nationally, over the past few weeks. Mr Evans said that a large number of patients are attending SaTH Accident and Emergency departments with a respiratory infection. The number of patients attending A&E, who are presenting as being extremely ill, had been higher than would have been anticipated. On Saturday 27 th December 2014 SaTH A&E departments had over 420 attendances. A significant number of patients have breached the national 4 hour target, a small number of patients had waits of over 12 hours. A deep dive into these breaches is being undertaken. Locally, a Major Incident has not been declared, however the two CCGs have jointly, in line with their Incident Response Plans, escalated the level of response to significant for the health care system in Telford and Wrekin and Shropshire. An incident room had been in operation, from 7am to 10pm, for just over a week, this however is due to be stood down on Friday, 16 th January 2015, as the situation continues to improve. The situation will continue to be managed through a formal Project Management process. Mr Evans wished to relay his thanks to Telford and Wrekin CCG staff who had been working within the incident room. Mr Evans also wished to recognise all partner organisations across health and social care who have worked extraordinarily hard over the past few weeks and thanked colleagues and staff across the sectors for their hard work and commitment to deliver good care in what had been a challenging period. Mr Evans would update Board members if the current situation deteriorates. Mr Evans recognised that SaTH are committed to delivering the 95% 4 hour target. Primary Care Co-Commissioning The GP CCG Forum, at their December 2014 meeting, voted in favour of the CCG putting an application to NHS England to take delegated responsibility for the co-commissioning of Primary Care. The submission was supported by the Area Team of NHS England. The submission formed part of the papers for the Board meeting. The submission will be looked at by the regional moderation panel later this week and it is expected that feedback will be received early next week. 2015/16 Planning Planning for 2015/16 has commenced following guidance received from NHS England. An update on progress will be presented at the March 2015 CCG Board meeting. 4
NHS England North Midlands Mr Evans reported that the following appointments had been made to Ms Wendy Saviour s, Director of Commissioning Operations, team: Director of Finance, Mrs Ros Francke. Director of Nursing, Mrs Brigid Stacey. Medical Director, Dr Ken Deacon. Following discussion the Board Noted the contents of the Chief Officer s Report. 09.15 Assurance 09.15.1 Finance Finance Report Month 8 The Board received an outline of the report and the following key points were highlighted: The CCG are in a position to report a small surplus for the year to date of 688K, which is line with planned trajectory. The CCG is on target to reach a breakeven position at the end of the financial year. Mr Nash commented that there was no room for complacency and risks still remain, the CCG had not yet received all of its assumed income. Whilst achieving a breakeven position would be a considerable achievement, given the CCG s position at the start of the year, NHS Business Rules require the delivery of a surplus of 1% ( 1.9m). The CCG forecast, therefore fall short of the NHS Business Rules by 1.9m. Members continued by discussing the SaTH A&E Deep Dive and highlighted a number of areas: Around 17% of attendees to A&E are under 4 years old. 23% of children in this age band are admitted to hospital. Mr Harrison highlighted the high number of 20-24 year olds who attend A&E, when compared to the numbers within this age group who are admitted to hospital. Members questioned whether this age group attend A&E as a provider of choice as they wish to have instant access to healthcare, and questioned whether the CCG should look at ways of providing health care services to this age group. Comparisons from NHS Benchmarking Network show that the number of Telford and Wrekin patients discharged from A&E within 2 hours of arrival is around 85% and when compared with other areas it is the fourth highest figure. Members highlighted the GP at the front of A&E initiative and wondered how these figures would compare if they were benchmarked against current A&E attendance figures, however this information is not currently available. Mr Evans discussed A&E target breaches and said that most breaches happen outside of normal working hours. Mr Nash said that this is something that would warrant a deep dive report to the PPQ Committee being carried out to look at this reasons why this is the case. The CCG (and SaTH) had recently met their Referral to Treatment Time (RTT) target, against the planned trajectory is on course to achieve the year-end target. There is however a risk that emergency bed pressures will impact on elective activity and this may impact on RTT performance. Members continued by discussing the numbers of patients diagnosed with gastrointestinal conditions and questioned whether this is an area that could be looked in a report to the PPQ Committee. Mr Nash suggested that a deep dive report is presented to PPQ providing a further analysis of A&E activity including weighted benchmarking for age cohorts and geography. The report will also include an analysis of A&E attendance over time. 5
10.15 Strategy Following discussion the CCG Board: Noted the current financial position reported at Month 8. The CCG remains in formal financial recovery. Noted the key risks and actions being taken to address them and the need to continue the focus on QIPP delivery. Consider the additional financial challenges faced by other organisations within the Health System. 09.15.2 Members Engagement The Clinical Commissioning Group Practice Forum Chair s Report for meeting held on 16 th December 2014 The Board received a summary of the report and the following key points were highlighted: Forum members had congratulated Julie Snead, Health Care Assistant, at Lawley Medical Practice, on becoming a West Midlands Clinical Champion for her work with Assistive Technology programme called Florence. Forum members approved the changes to the CCG Constitution. A large part of the Forum meeting was taken up discussing the allocation of winter money for Primary Care. Following discussion the Board Noted the content of the report. 09.15.3 The Patients Voice Health Roundtable Committee Chair s Report of the meeting held on 4 th December 2014 The Board received a summary of the report and the following key points were highlighted: Mrs Choudhary thanked CCG Board members for welcoming Mr Patrick Spreadbury to the Board meetings in her absence. Mrs Choudhary highlighted issues with the development of a Constitution leaflet. The Health Roundtable had had input into the leaflet and were concerned that nearly a year down the line it had still not been completed. Mrs Morris responded by saying that she had received a copy of the leaflet that morning from the CSU and would make it a priority to have a look at it. Mrs Choudhary said that the Health Roundtable would like a further opportunity to meet with Board Members. Members agreed that a meeting with the Roundtable prior to a Board meeting would be arranged. Mr Evans said that he would be attending the February 2015 Health Roundtable meeting. Dr Innes recognised the excellent support given to the CCG by the Health Roundtable. Following discussion the Board Noted the content of the report. 10.15.1 Future Fit Update Report The Board received a brief outline of the report and the following key points were highlighted: Following the Future Fit Board s decision to undertake further work prior to shortlisting, the timing of subsequent stages of the programme had been reviewed. Since the creation of the original programme plan, guidance had been published that one or more Strategic Outline Case will be required by the NHS Trust Development Authority (NHS TDA). In parallel with this commissioners must prepare a Pre Consultation 6
Business Case for approval by NHS England. The timeline has therefore been adjusted to accommodate the above and the public consultation is now scheduled to start in December 2015, unfortunately this is an unavoidable delay. Following discussion the Board: Noted the content of the December 2014 Programme update reports. 10.15.2 Conflicts of Interest Policy The Board received a brief outline of the report and the following key points were highlighted: As part of the document submission for delegated commissioning of primary care Telford and Wrekin CCG had to review the current Conflicts of Interest Policy, amend the policy where it feels appropriate, and submit to the NHS England Area Team by 6 th January 2015 and the NHS England national team by 9 th January 2015 to provide assurance on the CCG s governance controls. Due to the 9 th January deadline, NHS England had asked that a draft Conflict of Interest Policy was submitted by that date. The CCG must ensure that the final amended versions are ratified by the CCG Board by the end of January 2015. The amendments being proposed were highlighted within the second draft version of the Policy. Amendments being proposed include a new register of procurement decisions and an amended declaration of conflict of interest for bidders and contractors. In order for the CCG to maintain transparency of decision making and to demonstrate conflicts of interest are managed effectively, the CCG will maintain and publish a register of procurement decisions. The register will be published on the CCG s website. Members discussed 4.6 Declarations of Interests on Application for Appointment or Election / appointment to the CCG. Members felt that substantial business as highlighted within the last paragraph should be defined further. Changes to this section would be approved by the Chair and Chief Officer under delegated authority. Following discussion the CCG Board: Approved the changes to the Conflicts of Interest Policy highlighted within draft version 2. Agreed that the wording substantial business should be defined. Changes would be approved by the Chair and Chief Officer under delegated authority. Agreed that the amended Policy would be shared with GP Practice Forum members at their January 2015 meeting. Agreed that the Policy would be included within the papers for the February 2015 CCG Board meeting under for information agenda item. 10.15.3 National Planning Guidance and Telford and Wrekin CCG Commissioning Intentions 2015/16 Mrs Nicky Wilde attended the meeting for this agenda item. The Board received a brief outline of the report and the following key points were highlighted: The report detailed the Telford and Wrekin CCG Commissioning Intentions for 2015/16, the link with the Quality Innovation Prevention and Productivity (QiPP) Programme and the National Planning Guidance for 2015/16, which was published in December 2014. It was noted that the Commissioning Intentions were developed prior to the national guidance being released and they will need to be revisited to ensure that all required elements are included. Patient and public engagement had taken place via two workshops. Further patient 7
and public engagement will take place. A copy of this Board report will be presented at the February 2015 Health Roundtable meeting. The date for submission of the full draft plans is 27 th February 2015 with assurance from NHS England between 27 th February and 30 th March 2015. The indicated date for submission of the full and final plans is 10 th April 2015. Discussions are taking place with provider organisations with regards to commissioning intentions. The submission will be shared with the Telford and Wrekin Health and Wellbeing Board at their March 2015 meeting. A group will be set up with representation from Telford and Wrekin CCG, Shropshire CCG and SaTH to look at SaTH s commissioning intentions. Mrs Noakes commented that the Commissioning Intentions 2014/15 highlight the processes for supporting the commissioning intentions but it was not clear on outcomes to be achieved. Mrs Wilde will reformat the document to include an outcomes measure. Detailed reports including outcome matrix and objects will be discussed by the PPQ Committee and the QIPP sub-committee. Dr Innes said that this is an area that the CCG Board members could look at this at their development day at the end of January 2015. Mrs Beck recognised that further work was required to develop the annual timetable to ensure that there is time for the commissioning intentions to have the full impact. Mr Nash highlighted a greater emphasis on closer working with provider organisations. Dr Allen highlighted the importance of robust CQUINs in achieving outcomes and driving up standards. Dr Allen said that he would be happy to be involved in developing CQUINS. Following discussion the CCG Board: Agreed the commissioning intentions for 2015/16. Members agreed that following the Board development a summary report will be generated which provides a read across from strategy through objectives and commissioning intentions to outcomes, which will be presented at the March 2015 CCG Board meeting. 10.15.4 TRAQS Integrated Care Gateway (ICG) Update Mrs Nicky Wilde and Mr Darren Francis attended the meeting for this agenda item The Board received a brief outline of the report and the following key points were highlighted: The report outlined the implementation of the TRAQS Integrated Care Gateway (ICG) system, which was implemented in June 2014 and replaced the VEDAS system. The ICG system had been very well received and had surpassed expectations with regards to savings in terms of processing time, both at GP Practices and within TRAQS. All GP Practices now had access to an audit tool, which will enable them to see their own information and to undertake weighted comparisons of referrals by volume, speciality, GP, provider and priority. They would also be able to compare GPs to GPs by top 10 specialities. The current trend is showing an on-going increase in the volume of referrals by 30%. It was noted that all GP Practices are sending all non-urgent referrals through TRAQS. Mrs Wall commented that it would be interesting if GP Practices had access to information, which highlighted the patient s journey from when the initial referral was made. Mrs Wilde said that it is not possible to marry up all data regarding patient referrals, however this is an area that could be looked at for some patients, whilst 8
being mindful of information governance. GP Board members discussed the variation in the number of patients GPs refer with the highest being around 30 a month and the lowest being 10 and the possible reasons behind this. Dr Inglis said that he discusses high referral numbers with the GPs involved to understand further. GP Practice CCG quality visits also take place and any issues around the number of referrals a Practice makes so it would also be picked up then. Following discussion the CCG Board: Noted the progress to date implementing new IT system for TRAQs; the benefits realised and the efficiencies achieved so far. Noted that proposals for further enhancements e.g. streaming of the onward process, noting potential requirement for additional resources would need to be part of a prioritisation business case submission. Congratulated the TRAQS team for the work they are doing. 10.15.5 Decision Making Policy Mrs Jacqui Seaton attended the meeting for this agenda item. The Board received a brief outline of the report and the following key points were highlighted: The Decision Making Framework has been developed as a tool to aid decision making on healthcare services, including medicines and new technologies. The framework has been adapted from a version approved for use by NHS England. The intention is that both the ethical framework and decision making framework would be used by all CCG Committees / groups responsible for making decisions or making recommendations to the CCG Board / PPQ Committee. Members welcomed the Framework as it clearly sets out the criteria and process for decision making. Dr Inglis suggested that the Individual Funding Panel could trial the 10 points Underpinning Principles to Decision Making when considering Individual Funding Requests. Following discussion the CCG Board: The Board supported a mapping exercise to identify all CCG groups / committees that are responsible for either decision making or making recommendations to PPQ / Board. This will allow a transparent map of decision making processes to be developed and allow the CCG to ensure that the ethical framework and decision making framework is implemented by all of these groups / committees. 11.15 For Information Only 11.15.1 Minutes of the System Resilience Group held on 14 th November 2014 The CCG Board noted the content of the minutes. 11.15.2 Submission for delegated primary care commissioning arrangements to NHS England. 12.15 Any Other Business The CCG Board noted the content of the submission. There was no further business to report. 13.15 Items Raised by Members of the Public 9
Dr Innes thanked Mr Barry Parnaby, Telford Healthwatch, for attending the meeting. 14.15 Date and Time of Next Meeting Tuesday 1.30pm Tuesday, 10 th February 2015, The Walker Room, Meeting Point House, Southwater Square, Telford, TF3 4HS 10