Minutes of the Governing Body Meeting Part 1 Held on Friday 1 st May 2015, 12.30 16.00 hrs At Boundary House, Cricket Field Road, Uxbridge, Middlesex. UB8 1QG Present: In Attendance Apologies Dr Ian Goodman (IG) Ceri Jacob (CJ) Steve Hajioff Rob Larkman (RL) Bernard Quinn (BQ) John Riordan (JR) Keith Dickinson Dr Reva Gudi (RG) Sharon Daye (SD) Trevor Begg (TB) Kam Rahelu Minutes Tom Challenor (TC) Dr Kuldhir Johal (KJ) Dr Mitch Garsin (MG) Dr Mehboob Saleh (MS) Dr Stephen Vaughn-Smith (SV-S) Dr Steven Shapiro (SS) Graham Hawkes (GH) John Riordan (JR) Ursula Gallagher (UG) Allison Seidlar (AS) Dr Mayur Nanavati (MN) Jonathan Wise (JW) No. Item Action 1. Apologies Apologies as noted above 2. Minutes of the Last Meeting 27 th March 2015 Action Log The Minutes from the meeting held on 27 th March 2015 were deemed as accurate and approved. No new declarations were declared. Accountable Officer Update Presented by Rob Larkman (RL) An update was provided on five items:- Primary Care Co-Commissioning. The Governing Body were advised that substantial discussions has already taken place about Primary Care Co-Commissioning and that the CCG is now in Go Live mode as from 1 st April 2015. The first meeting of the Hillingdon CCG (HCCG) with NHS England will be held on 21 st May 2015 where the Terms of Reference (ToRs) Hillingdon CCG, Governing Body Meeting Part 1, Friday 1 st May 2015 Pg. 1
will be agreed and finalised. The meeting will be held in common with the seven other North West London CCG Joint Committees. A question was asked that at the recent Lay Members Event a number of issues had been highlighted one of which was the understanding that the next meeting of Primary Care Co-Commissioning would be held in shadow form. This was incorrect. For HCCG the ToRs had not yet been agreed and these need to finalised with NHSE. However, Primary Care Co-Commissioning went live on 1 st April so meetings could not be held in shadow form. A further question was asked as to how the ToRs would be resolved ahead of the the first formal meeting on 21 st May 2015 and were further meetings going to be scheduled to finalise these ahead of this meeting. It was responded that HCCG s ToRs would be discussed as an Agenda item at the meeting on 21 st May 2015. CCG Elections The Governing Body were advised that Dr Ian Goodman had been elected by the Governing Body to continue as Chair of the CCG for a further three years. Staff Event The Governing Body were advised that an All Staff Event which had been open to staff across Brent, Harrow and Hillingdon had taken place on 23 rd April 2015. The event included group work on behaviours that staff felt they could commit to facilitate a positive culture within the three CCGs and behaviours that should be avoided. This builds on work at the Collaboration Board and will be developed further across the eight NWL CCGs. The event had been very successful with good representation from HCCG. Integrated Care A North West London Whole Systems Integrated Care leadership summit was held on 15th April. This event brought together leaders from commissioning and provider organisations to look forward to the next stage of the programme and the actions needed to deliver the programme in full. Commissioners and providers from Hillingdon were well represented at the event and continue to work together to finalise plans to run in shadow form in the second half of the year. 2015/16 Contracts Very good progress has been made on the contracting negotiations for Hillingdon CCGs three main contracts with:- The Hillingdon Hospitals Foundation Trust The Central North West London Foundation Trust (Community) The Royal Brompton and Harefield Foundation Trust At this stage, there are no major concerns. 3. Questions from the Public Presented by Ian Goodman (IG) Hillingdon CCG, Governing Body Meeting Part 1, Friday 1 st May 2015 Pg. 2
The Governing Body were advised that four questions had been raised by Members of the Public and that full responses were published on the website. Items for Decision 4. Integrated Appraisal Team Presented by Jane Walsh (JWa) The Governing Body were advised that the Business Case is a service redesign targeted at patients who may require Continuing Health Care. This is a joint application for Readmissions Credit Reserve funding, from The Hillingdon Hospital (THH), the Hillingdon Clinical Commissioning Group (HCCG) Continuing Healthcare (CHC) Team and the London Borough of Hillingdon (LBH). The fundamentals for the Integrated Appraisal Team are the same as the joint Health and Safety care agreement and looks at the next steps for patients after hospital discharge. The proposal is to establish an integrated team to be operational in THH with the function of appraising patients on admission to acute care who are identified as having ongoing care needs. This early identification of patients will enable timely allocation of the appropriate staff to the case and efficient joint working between social care and health partners. It includes people whose care would be funded by LBH, by HCCG continuing health care and those people who are self-funding their care. The team will ensure patient and family expectations are managed from the outset and that they have early sight of available options and processes post discharge. The new team will consist or existing and new multidisciplinary staff employed by THH, HCCG and LBH. The funding will come from the LBH s 2015/16 Resilience Funding and some of the funding will come from the Readmissions Credit Reserve. Taking in to consideration recommendation from the CCG s Quality, Safety and Clinical Risk Committee, a Memorandum of Understanding (MOU) will be in be put in place to clearly describe the organisational responsibilities and detail the exit plan for the CCG as funding is for one year whilst the Trust mainstreams the approach. A question was asked if the 371,838 is a recurring cost. The Governing Body were advised that the cost was a one-off cost with a view that clinicians will be upskilled to manage length of stay and this cost related to the support being given by the CCG to allow The Hillingdon Hospital (THH) to do this. The recently negotiated contract with THH reflects this requirement. A further comment was also made in relation to the MOU and a request was made that this should be reviewed and agreed by the CCG s Quality, Safety and Clinical Risk Committee so that the Governing Body are appropriately assured. Jane Walsh Hillingdon CCG, Governing Body Meeting Part 1, Friday 1 st May 2015 Pg. 3
The Governing Body were asked to agree the Option 2 - To recruit to and implement an integrated appraisal team to be based in the Acute Medical Unit (AMU) at THH.. The Governing Body approved Option 2 - To recruit to and implement an integrated appraisal team to be based in the AMU at THH. 5. CAMHs Joint Strategic Plan Presented by Maggie McCutcheon (MMc) The Governing Body were advised the Business Case had already been presented to the CCG s Management Committee and Quality, Safety and Clinical Risk Committee and had been approved at both. The Governing Body were advised as part of NHSE s Five Year Forward Plan. The national initiative of Parity of Esteem charges CCGs to be just as focused on improving mental health as well as physical health, and that patients with mental health problems should not suffer inequalities either because of the mental health problem itself or because they do not get the best care for their physical health problems. In Hillingdon, to achieve parity of investment line in physical health care would require 7% increase in investment in mental health services ( 2.8 million). The Governing Body were reminded that significant improvements had been made in 2014/15 and the changes highlighted within the Report will enable people to recover from episodes of mental ill health and support people more effectively who have long term mental health needs, providing care as close to home as possible where and when it is needed. Hillingdon CCG has been working collaboratively with BHH and NWL CCGs to ensure alignment of local and wider priorities as part of the NWL Mental Health Strategy currently which is under development. A comment was made that a Plan such as this has been needed for some time in Hillingdon and across North West London. The Governing Body were asked to agree key priorities for mental health to: Approve the CAMHS Transformation Plan The Governing Body approved the plan. 6. Carers Strategy Presented by Jane Walsh (JWa) The Governing Body were presented with the Carers Strategy for the period 2015 to 2018 which has been developed in partnership with local carers, the London Borough of Hillingdon, Hillingdon Clinical Commissioning Group, Hillingdon Carers, Central and North West London NHS Foundation Trust, Hillingdon Hospital NHS Trust and members of the Carers Strategy Group. Hillingdon CCG, Governing Body Meeting Part 1, Friday 1 st May 2015 Pg. 4
A number of significant changes have taken place recently as part of the Health and Social Care agenda. The Health and Social Care Act of 2012 is now business as usual. The passage of the Care Act 2014 and Children and Families Act 2014 has set out to improve services and support, especially for carers. Approval from Hillingdon Council had been sought on the 23 April 2015. The Governing Body were advised the Delivery Plan will be updated as more information is shared by the stakeholders and that this will be ongoing. A question was asked in relation to the update that was asked for late 2015 and if any other information was currently available. It was responded that at this stage no further information is available. The Governing Body are asked to:- Approve the Carers Strategy 2015-18 and the activities included in the Delivery Plan 2015-16. That a progress update on the Strategy Delivery Plan be presented to Hillingdon CCG Governing Body in late 2015 at a date to be confirmed. Jane Walsh The Governing Body:- Approved the Carers Strategy 2015-18 and the activities included in the Delivery Plan 2015-16. Agreed a progress update on the Strategy Delivery Plan will be presented to Hillingdon CCG Governing Body in late 2015 with a date to be confirmed. Items for Discussion 7. BAF Report Presented By Keith Dickinson (KD) The new BAF report was presented to the Governing Body. At its meeting on 27 March the Governing Body approved its formal risk appetite however, a request to further consider specific risks that might hinder the achievement of the CCGs strategic objectives was made. These risks were reviewed at an organisational development session with Governing Body members on 15 April 2015. The Strategic Objectives are the same as identified as the previous year with some risks carried forward into 2015/16. However, three new risks have been identified:- 1. Risk 1H - relates to Primary Care Co-Commissioning and the potential for conflicts of interest to occur. 2. Risk 1I Public Health and Prevention 3. Risk 3K - Workforce Capacity and around staffing in the CCG. KD Hillingdon CCG, Governing Body Meeting Part 1, Friday 1 st May 2015 Pg. 5
A question was asked regarding Risk 3J around SaHF Finance and what the risk to HCCG would be. It was responded that there needs to be more specific detail about this and this would be available at the next review of the BAF report at the Governing Body meeting in July 2015. A question was also raised in relation to the Public Health and Prevention risk. Again further detail will be provided in future reports. The Governing Body were advised the risks are currently being defined and/or updated, and a summary report detailing the major assurances and progress relating to each strategic risk within the BAF will be also be presented to the Governing Body in July 2015. The Governing Body is asked to agree the list of principal strategic risks facing the CCG in 2015/16. The Governing Body agreed to the list o principal strategic risks facing the CCG in 2015/16. 8. Month 12 Finance Report 2014/15 Provision Outturn Presented by Jonathan Wise (JW) The Governing Body were presented with Highlights from the Month 12 Finance Report 2014/15 as follows:- Overall at month 12, the CCG is reporting a 3,333k surplus position at year end which is 133k higher than the Month 11 forecast. This will be carried forward and be available for the CCG in 2015-16. The 6.5m Acute forecast over performance is the position after the benefit of the 2014/15 THH transitional support ( 5.5m) and with the application of the marginal rate to the THH contract. The month 12 position is an assessment of the likely outturn based on a combination of Trust actuals to Month 11, plus forecasts for Month 12. It includes 1m of Paediatric reconfiguration costs to be funded from the NWL financial strategy. Other Acute budgets deteriorated by 281k in Month 12 whereas the Mental Health position improved by 541k due to receipt of credits from CNWL. The Continuing Care position deteriorated by c 400k which included a provision of 111k for Continuing Care claims. The Prescribing FOT worsened by 220k based on the January Prescribing information. Within Primary Care budgets, the Local Incentive Schemes improved by 628k of which 350k related to the Commissioning LIS and the 5 per Head Older people Investment slipped by a further 253k. Finally the report reflects the final release of old year creditor balances of 555k. Hillingdon CCG, Governing Body Meeting Part 1, Friday 1 st May 2015 Pg. 6
Overall the overspend on Acute, Prescribing and Continuing Care are more than offset by underspends in other generating the overall 3.3m surplus. However the underlying position at Month 12 remained a deficit of 7.7m, as reported in Month 11. The difference between the in-year surplus of 3.3m and the underlying position of 7.7m is accounted for by a combination of additional in-year allocations, slippage on investment plans, balance sheet gains from 13/14 and other non-recurrent underspends. The CCG s QIPP performance at year end was a shortfall of 2m against the 10.37m QIPP plan. The position improved by 36k compared to M11 FOT. A comment was made to recognise the hard work of both the Finance and QIPP teams who had worked arduously throughout the year. The Governing Body is asked to note the CCG s provisional Month 12 outturn position of a surplus of 3.33m. A full Month 12 will be available once the audit has been completed at the end of May 2015. The Governing Body noted the Report. 9. Integrated Performance Report Month 11 Presented by Bernard Quinn (BQ) The Governing Body were referred to Page 4 of the Report which relates to data specifically for HCCG and provides an overview of performance. The highlights from the Report were summarised as follows:- A&E and LAS Handovers continue to cause concern with targets unmet for a further month Cancer 31-day subsequent surgery and 62-day screening. The standard was not achieved. The Governing Body were asked to note that ICHT had not achieved 62-day screening in four of the last five months. Infection control. There had been a report of 1 case of MRSA in Month 11 at ICHT. An investigation was taking place following two other reported cases of MRSA in the same ward. With regard to LAS Handover over 30 minutes, 161 had been delayed at THH. A question was asked as to what the percentage of overall handovers are for the Trust. It was responded that this data will be provided at the next meeting of the Governing Body. There had been an underperformance in the number of new psychosis cases remaining which remained at 66.7% across CNWL. A question was asked in relation to data presented for 28 Days Cancelled Operations and what this means. It was clarified that this refers to where an operation is cancelled for a second time and that is should be rebooked within 28 BQ BQ Hillingdon CCG, Governing Body Meeting Part 1, Friday 1 st May 2015 Pg. 7
days. A request was made to include data in the report where operations had been cancelled more than twice. A further request was made to include data from Choose and Book the Report for the Governing Body to review. It was also requested that a CQC update should be provided to the Governing Body as a Part B discussion. A question was asked regarding the data on TB where the report details 30% of patients with TB wait 2 weeks for an appointment with a further 80% of those treated not completing their treatment. More information was requested about these statistics. It was commented that more information on TB was required generally. The data referred to patients in NWL and it was difficult to form an opinion on what this may be nationally. BQ CM BQ The CCG is asked to note the performance exceptions presented in the Report and the actions being taken to mitigate, with any further recommendations. The Report was discussed and noted by the Governing Body. 10. Annual Governance Statement Presented by Keith Dickinson (KD) The Governing Body were advised that annually, the NHS Chief Executive, as Accounting Officer for NHS England, requires the accountable officers of CCGs and other NHS bodies to give assurance about the stewardship of their organisation. The Governance Statement of Hillingdon CCG for 2014/15 has been drafted to demonstrate adequate stewardship and shows that the CCG is coping with the challenges it faces, that robust governance and procedures are in place and that the Governing Body is effective in discharging responsibilities. The Annual Governance Statement (AGS) has being reviewed by the Head of Internal Audit who concludes that significant assurance can be given that there is a generally sound system of internal control, designed to meet the organisation s objectives, and that controls are generally being applied consistently. It was noted, however, that weaknesses remain in respect of Continuing Health Care and the Transfer of CSU Functions Back in House. Ultimately however, no material concerns have thus far been raised by the External Auditors. It was advised that The AGS is reviewed by the Audit Committee and the timescale for are as follows:- 26 May 2015 - Audit Committee receive Auditors AGS letter 29 May 2015 - auditors send signed original copies of AGS to the Department of Health. Hillingdon CCG, Governing Body Meeting Part 1, Friday 1 st May 2015 Pg. 8
The Governing Body is asked to Approve the Annual Governance Statement. The Governing Body Approved the Annual Governance Statement. Items for Information 11. Re-Admissions Credit Reserve Presented by Helen Delaitre (HD). The Governing Body were advised the Paper is for noting and it was a report on the allocation of monies. Re-Admissions Credit Reserve had been approved by the CCG s System Resilience Group and Finance & QIPP Committee and the cover sheet in relation to this was incorrect. 12. Update on Procurement Process: Primary Care Contracts and Local Improvement Schemes Presented by Helen Delaitre (HD) The Governing Body were advised the paper provides an update on process followed and decisions made to-date by the Procurement Panel on behalf of the Governing Body. The Governing Body received the paper for information and were asked to note the content. The Governing Body noted the content.. 13. Collaboration Board Update Presented by Ian Goodman (IG) The Governing Body were provided with a summary update of the details of business that has been dealt with in recent formal meetings of the Collaboration Board. IFR Policies to have a summary paper that can be tabled at the Board meeting for the public to be aware of. ET The Governing Body were asked to note the Collaboration Board Update. The Report was noted. 14. Sub Committee Minutes The Governing Body noted the Minutes from the Sub Committees. 15. AOB No other business was raised. 16. Questions of Clarification Hillingdon CCG, Governing Body Meeting Part 1, Friday 1 st May 2015 Pg. 9
Presented by Ian Goodman (IG) No further questions for clarification were raised. Date of next Governing Body Meeting: Friday 5 th June 2015, Venue: Boundary House, Cricket Field Road, Uxbridge, Middlesex, UB8 1QG Hillingdon CCG, Governing Body Meeting Part 1, Friday 1 st May 2015 Pg. 10