Present: Telford and Wrekin Clinical Commissioning Group Governance Board Minutes of the Meeting held on Tuesday 13 th August 2013 Telford Suite, Whitehouse Hotel, Watling Street, Wellington, Telford, TF1 2NJ Dr Mike Innes (Chair) MI Clinical Chairman Dr Andy Inglis AI GP CCG Board Member Dr Louise Warburton LW GP CCG Board Member Dr Jim Hudson JH GP CCG Board Member Dr Jo Leahy JL GP CCG Board Member Mr David Evans DE Chief Officer Mr Andrew Nash AN Chief Finance Officer Mrs Julie Ellis JE Practice Manager Board Member Miss Alison Smith AS Executive Lead for Governance and Performance Mrs Christine Morris CM Executive Lead for Nursing, Quality & Safety Dr Martin Allen MA Mr Paul Taylor PT Interim Director: Telford and Wrekin Council Mrs Helen Onions HO Interim Assistant Director: Telford and Wrekin Council Mrs Christine Choudhary CC Interim Chair: Roundtable Also in Attendance: Miss Laura Boden LB Deputy Chief Finance Officer Mrs Karen Ball KB PA to the Chief Finance Officer (Minute taker) 100.13 Welcome Actions Dr Innes opened the meeting and welcomed attendees. 101.13 Apologies: Mrs Zena Young, Mrs Fran Beck, Mr Dylan Harrison 102.13 Members Declaration of Interest There were no declarations of interest. 103.13 Minutes of the Meeting Held on 9 th June 2013 The Minutes were approved as a correct record subject to the following amendments: Page 4-94.13.2 paragraph 2 Should read new urgent Care Network Board to be chaired by the Accountable Officer of Shropshire CCG with the Accountable Officer for Telford and Wrekin as Deputy Chair. 104.13 Matters Arising 1
Members referred to the action list from the last meeting and the following were noted: 81.13.1 Performance against Vital Signs Review of the presentation of the report with same style report coming to PPQ in June and CCG Board in July with a revised version coming to PPQ in July and CCG Board in August. Members received a new style report with the papers for the meeting. 94.13.2 Urgent Care Network Board Mr Evans to confirm the Board would report to the Chief Officer Group and respective Boards and that this would be stipulated in the final terms of reference. Mr Evans confirmed that this action had been completed. 94.13.2 Non-emergency Transport (NEPTS) Tender Mrs Clennell agreed to get confirmation and report back on what the process would be if there was contract failure. Mrs Beck to go back and review the rationale on the break clause in the contract. Mr Evans will pick this action up with Mrs Beck and will update members via email. DE 94.13.3 Frail and Complex Further work required around finances and how the CCG could deliver the strategy. Mrs Beck and Mr Bennett to bring back report to August Board. Mr Bennett to strengthen the linkages to dementia in the next iteration of the paper. This item was deferred to the September 2013 CCG Board meeting. FB/MB 96.13.3 Audi Committee Chair s Report and Terms of Reference Miss Smith to circulate electronically to Board Members a copy of the Audit Committee forward plan for information. This item had been completed. 99.13 Date and Time of Next Meeting Mrs Ball to look at a new venue for Board meetings during the summer months due to the noise levels at Meeting Point House. Dr Innes asked members to consider whether they felt it would be feasible to hold Board meetings at different venues within Telford, therefore allowing better access to meetings by members of the public. Members agreed that this was an option that should be explored. MI/KB 105.13 Items Raised by Members of the Public No items were raised by members of the public. 106.13 Chief Officer s Report The Board received a summary of the report, a copy of Developing a Strategy for Sustainable Clinical Services presentation and a copy of The NHS belongs to the People document. The following key points were highlighted: 2
The first quarterly assurance meeting with the NHS England Area team took place on 9 th August. The CCG had been rated on four outcome framework domains as follows: o Are local people getting good quality care = amber / green o Are patient rights under the NHS Constitution being promoted = red o Are health outcomes improving for local people = amber / green o Are CCGs commissioning services within their financial allocation = amber / green The executive team carried out a self assessment of current CCG performance. A copy of the self assessment was included with the papers for the meeting. The Area Team highlighted that there are still some development needs for the CCG, and the CCG will have formal support around the area in the outcomes framework where they were rated red. The Area Team believe that the CCG has made good progress in the 3 months since 1 April 2013. Mr Evans passed on his thanks to all CCG staff and Board members for their contribution to the work that has been carried out since the inception of the CCG. Mr Evans discussed Developing a Strategy for Sustainable Clinical Services which was presented to the Joint Health Overview and Scrutiny Committee (JHOSC) at their meeting on 8 th August 2013. Mr Evans said that it was disappointing to see headlines in the local media relating to provision of health services within the county, which were not a balanced description of discussions that took place at the meeting. Mr Evans emphasised that at this stage no decisions have been made about any service restructuring. The presentation outlined the issues arising out of Call to Action, which was published by NHS England in July 2013. Mr Evans highlighted that due to on-going financial difficulties and demographical challenges it would be inevitable that NHS services are provided in a different way in the future. Mr Evans will present a paper to Board in September 2013 on progress of Developing a Strategy for Sustainable Clinical Services. Mr Evans discussed the Child Adolescent Mental Health Services (CAMHS) and the future intention to tender the service. However, in recent weeks a number of consultants have left their positions within Shropshire Community Healthcare Trust and following discussions with colleagues in Shropshire CCG, it is clear that the quality of the service may be compromised by the lack of consultant input. Therefore both CCGs may have to make an urgent decision to go out to tender as soon as possible, to ensure that a sustainable safe quality service is delivered for this client group in the future. Mr Evans will advise the Board at the next Board meeting on progress. Mr Evans highlighted, that following transfer of public health services to Telford Council, a number of services were tendered including smoking cessation. Unfortunately, due to technical difficulties there has been a delay in implementing the new services, which has caused some anxiety amongst GP colleagues. Mrs Onions added that currently contract discussions are taking place with the new provider, and it is hoped that the service will be up and running shortly. CCG GP Forum members will receive an update on the smoking cessation service at their meeting which is taking place on 20 th August. DE DE 3
107.13 Quality Noted the content of the report. 107.13.1 Roundtable Terms of Reference The Board received a copy of the draft Terms of Reference Mrs Morris thanked Mr Harrison, Mr Mayo and the Roundtable for the considerable work they had undertaken in developing the final version of the Terms of Reference. The Terms of Reference will be reviewed in September 2014. Mrs Choudhary said that elections to the roles of Chair, Vice-Chair and CCG Board Representative, who will serve for a term of three years, will take place at the end of September 2013. Following Discussion the Board: Approved the Terms of Reference 107.13.2 Serious Incident Reporting and Management Policy The Board received a summary of the report, a copy of the policy, and the following key points were highlighted: The policy was prepared, in compliance with best practice guidance, on behalf of the CCG, by the Commissioning Support Unit (CSU) and reflects the service provided by the unit for monitoring and reporting on provider serious incidents. Greater emphasis will be given to learning from serious incidents, which will be imbedded into provider contracts. The role of the CCG is to monitor serious incidents to ensure that they are properly investigated, action is being taken to improve patient safety and that lessons are learned in order to minimise the risk of similar incidents occurring in the future. This will be managed by Clinical Quality Review and reported via PPQ to Board. The timescale for completion of investigations into serious incidents is 45 working days from the date the incident is notified to the CCG. Mrs Morris highlighted the links to appendices at the back of the policy, which include documents produced by the National Patient Safety Agency and Department of Health. Dr Innes recognised that the production of the policy represented a significant development in the way serious incidents are managed. Members felt that it was important that a definition of what a Never Event is had been defined within the policy, and that appendices relating to Never Events were also included. Mr Braden referred to 8.5 Dissemination of Shared Learning and questioned where a Never Event occurs more than once is there something more specific that the CCG should be doing around shared learning? Mrs Morris said that where more than one Never Event had taken place within the same service, as had been the case at SaTH last year within the ophthalmology service, this had been escalated and the service had been inspected by an external organisation, which had given assurance. However, assurance had not been received in this instance from the Trust that lessons learned an associated actions had been completed. Members agreed that Mr Evans would write to the Chief Executive of SaTH asking for assurance that all actions had been completed. Mrs Morris emphasised that if more than one Never Event took place a DE 4
risk summit would be instigated. As commissioners, if there were any serious concerns with the quality of a service, provided by a provider organisation the CCG would cease using that service. Dr Innes highlighted the reporting of incidents by GPs as highlighted in 5.4 Accountability to Care Quality Commission and Monitor. GPs are required to report serious incidents directly to the CQC and can also report to the National Reporting and Learning System (NRLS). Dr Innes questioned whether GP practices should be asked whether they used NRLS and this should be communication to the Area Team. Discussion continued on the reporting of serious incidents by GPs via DATIX and the Strategic Executive Information System (STEIS). It is acknowledged that primary care services should be using DATIX to record incident and this should be included within the policy. Dr Inglis suggested having a PLT event on incident reporting and also suggested that an aide-memoir should be added to the CCG website. Dr Innes will include incident report in his Chair s report to the GP Forum. Dr Innes highlighted that within section 6 Serious Incident Report Process, 6.2 states When an incident is of such a serious nature that an external enquiry is required.. However, it does not define what serious nature means. Mrs Morris responded by saying once the process begins to deal with a serious incident there is a triage of the incident and it will be escalated depending on the seriousness of the incident; prior to which a discussion would take place to determine the seriousness of the incident. Following discussion Mrs Morris said that it would be possible to develop a flow-chart to be included within the policy around serious incident reporting. CM MI CM Approved the policy for implementation, with the amendment as discussed. Agreed that the policy should be reviewed in February 2014. 108.13 Commissioning 108.13.1 Performance against Vital Signs The Board received a summary of the report and the following key points were highlighted: Mr Evans information members that two months ago SaTH had made the CCG aware that 5 patients had not been included within the figures for 52 week waiting times, the CCG were informed that this was due to technical issues. Ten days ago a further cohort of patients had been found, which brings the total up to 39. It is unknown how many of these patients are Telford and Wrekin patients. Both CCGs have written to SaTH with regards to this issue. An investigation is currently being undertaken by the CSU and reporting mechanisms are being reviewed to ensure that accurate up to date information is available. SaTH have produced an action plan relating to cancer waiting times, which the CCG have asked the Trust to re-visit. Dr Allen was concerned to note the variation in the 2 week wait for cancer referrals as highlighted in the report. Members were keen to learn more about the development of the Cancer Board, whose role will be to enable detailed monitoring and performance management. Dr Innes highlighted that the detail within the report would normally have been reported to the PPQ Committee, however as there was no PPQ 5
Committee meeting in July 2013 it was instead shared at the CCG Board meeting, therefore Dr Innes asked members what they felt would be the appropriate level of detail to receive. Members felt that they should have the opportunity to access the fuller report which is shared with the PPQ Committee. Mr Evans suggested that the full report could be published on the CCG website. Members felt, that as the data isn t current, it would be useful to include trend analysis and information from commissioners highlighting where targets are now, with particular emphasis on targets that are red. It was highlighted that performance against A&E targets were met for May, June and July 2013, and is an improvement on last year. Members agreed that the report was a marked improvement on the previous report and thanked Miss Nicky Jones for the development of the report. Following discussion Dr Innes said that he would include reference to the performance report in his Chair s report to next weeks CCG GP Forum meeting. GP members felt that consideration should be given to holding a GP PLT event around performance reporting. Board asked that absolute numbers for cancer be given as well as percentage figure. MI AS Agreed that the actions being taken to mitigate those performance indicators highlighted as not meeting target or at risk of not meeting target were adequate. Agreed that the mitigating actions for each performance indicator provided sufficient assurance that targets will be met by the end of the year. Continued to be concerned about the red targets and asked that PPQ consider these in more detail. 108.13.2 CCG Commissioning Intentions 2014/15 Members received a verbal update from Mr Evans and the following key points were highlighted: Proposals need to be worked up during Quarters 3 and 4 to be implemented from 1 st April 2014. Transformation priorities are to move resources to where they can be most effective and to build on self care, integrated primary and community care and to improve the quality of hospital care through multi-team working and improved internal processes. Areas that would be looked at, would be an expansion of the role of voluntary / independent sector in admissions avoidance / rehabilitation and to expand the use of e-apps and telehealth equipment. Will look at redesigning teams around GP practices and the development of primary/community care setting services. Draft commissioning intentions report will be brought to the September 2013, CCG Board meeting. A consultation will be launched on the CCG website inviting patients and the public to comment in September 2013. Consultation events will also take place with stakeholders and the public. Members discussed the need to increase the provision of services for the growing population of Telford and Wrekin. Mr Evans recognised that the process of implementation is time challenged but needed to ensure that the right services were in place and will need to factor in if services are to be decommissioned. FB 6
Noted the content of the verbal report. 109.13 Financial Management 109.13.1 Month 3 Financial Position The Board received a summary of the report and the following key points were highlighted: Miss Boden highlighted that as at 30 th June 2013 the CCG was showing a year to date under spend of 220k on its operating budgets, which is below plan. At the time of writing the report there was no SUS data or contract reconciliation statements were available This is due to over performance at reported by SaTH, a slight overspend on prescribing, dental allocation reduction due to error in baseline allocation. It has not been possible to verify the over performance reported by SaTH due to issues relating to SUS data previously outlined. The CCG has proceeded at risk with a number of 2% bids and this prevented delays to QIPP schemes allowing commissioning leads accelerate QIPP delivery subject to the strength of business cases. Miss Boden continued by saying that due to the timing of the Board meeting she was now in a position to update members on month 4. During month 4 the CCG has received an increase in allocations of 1m, which has led to the year to date surplus returning to plan. The position is still volatile and may be subject to future change. SUS data has recently become available but still not stable and there are still some gaps. Initial contract reconciliation statements are being processed by the CSU. 2% bids, which were submitted to the Area Team have been approved. The key risks remain Specialised Commissioning, over performance at SaTH and QIPP delivery. T&W CCG and Shropshire CCG have both written to local providers outlining the financial pressures and highlighting both CCGs had maximized their level of investment in the 2013/14 contracting round. It is therefore important that providers do not plan for any contractual over performance. As a result of the communication a Health System Finance execs meeting has been arranged. Noted that the CCG has proceeded at risk with a number of 2% innovation schemes. Noted the current financial position reported at Month 3. Noted the allocation adjustments at Month 3. Noted the key risks to financial delivery. Noted the actions required to mitigate these risks including the need to further develop additional QIPP schemes. 109.13.1 Medium Term Financial Strategy Update The Board received a summary of the report and the following key points were highlighted: In 2012/13 the CCG produced a Medium Term Financial Strategy (MTFS) based on the PCT budget devolved to the CCG. At the time of the production of the strategy it was envisaged that the MTFS 7
would be revisited at least annually to enable a refresh in line with the NHS planning cycle. The strategy was developed prior to the completion of the baseline allocations exercise and therefore does not reflect a number of changes including the growth in activity assigned to specialised services. From 2015/16 the CCG will need to contribute significant funds to the social care integration fund. and this would require an updated MTFS with a number of scenarios Mr Taylor said it would be good if the CCG and Local Authority could work jointly to gain a common understanding of the baseline rules of the social care integration fund. Miss Boden added that a governance group will be set up, with membership from the CCG and Local Authority, which will report to the Audit Committee and CCG Board. Dr Innes questioned whether there was a need for a 5 year financial strategy. Mr Nash responded by saying it was beneficial to have a financial strategy for the next 5 years, but emphasised the need to have a sharp focus on the next 20 months. Mr Nash said the Strategy when updated will be shared with local providers to allow consistency. Noted the content of the report and the need to update the MTFS for a number of scenarios including the impact of transfers of funding for reablement. 110.13 Governance 110.13.1 Shropshire and Staffordshire Local Education Training Committee Update Report The Board received a summary of the report and the following key points were highlighted: Dr Leahy highlighted the roles and priorities of the Local Education and Training Committee LETC, which covers the health economies of Staffordshire, Shropshire and Telford and Wrekin. Provider workforce plans have been shared with the LETC, however there has not been an opportunity to get a real sense of the detail of the plans. Members discussed the need to understand the numbers of GPs who will be retiring, within Telford and Wrekin, in the next 5 to 10 years and suggested that an audit could be carried out along with an audit of the skills gap that will be lefts. Members highlighted concerns around the issue of what will happen when GPs who provide practice based commissioned services retire and the need to ensure that GP practice, if they wish to continue the service, have succession plans in place or if they don t wish to continue the service the CCG are informed at an early stage. Dr Leahy said that she would be happy to share a paper that addresses the issues. The LETC will have representation from the Area Team. The main four provider organisation s workforce submissions have been signed off by the CCG. Mrs Morris will share with Dr Leahy. Dr Allen questioned which ancillary groups were represented on the LETC. Dr Leahy responded by saying that it had been recognised that not all workforce groups are represented on the LETC, however workforce specialists are represented on the group. Dr Leahy said she would circulate the agenda for the LETC meeting, which CM 8
is taking place on 12 th September 2013 to Board members. Minutes of LETC meetings would be included within the papers for Board meetings. Board agreed to ask the Health and Wellbeing Board to invite the Managing Director of the LETC to give a presentation at a future meeting on how the LETC are planning for the future workforce in the local health economy. Members continued by discussing the need to ensure that medium to longterm commissioning intentions are built into workforce planning cycles. Mr Evans said that this could form part of next months commissioning intentions paper. Dr Innes said that he is aware that the lack of mandatory training for primary care providers is an issue and has raised this with the Area Team who have recognised this is an issue and are looking at developing training. Dr Inglis highlighted that currently there is no cytology or immunisation training available. Mrs Morris highlighted that in the short term the CCG would be undertaking cytology and immunisation training for GP practices. Report back to the Board in November 2013 on what progress the Area Team are making in taking forward primary care mandatory training on cytology and immunisation. JL DE/MI Received the report as an update on the activity of the LETC 111.13 Reports for Information Only 111.13.1 Update on Whole Economy Unscheduled Care Programme The Board noted the content of the report. 111.13.2 The Clinical Commissioning Practice Forum Chairs Report The Board noted the content of the report. 111.13.3 Health and Wellbeing Board Minutes of the meeting held on 15 th May 2013 The Board noted the content of the report. 111.13.4 Urgent Care Network Board Minutes of the meeting held on 20 th June 2013 The Board noted the content of the report. 112.13 Any Other Business No further items were raised. 112.13.1 Items Raised by Members of the Public No questions were raised by the one remaining member of the public. 113.13 Date and Time of Next Meeting Tuesday 10 th September 2013, The Reynolds Suite, The Holiday Inn, St Quentin Gate, Telford, TF3 4EH 9
10