Tuesday 1 st April 2014 3pm-4.30pm Part 2 (Public) Novotel London West, 1 Shortlands, London, W6 8DR Elected and co-opted Members present: Name Role Organisation Initials Tim Spicer GP Member (Chair) H & F Clinical Commissioning Group TS Susan McGoldrick GP Member (Vice Chair) H & F Clinical Commissioning Group SM Paul Skinner GP Member H & F Clinical Commissioning Group PS Peter Fermie GP Member H & F Clinical Commissioning Group PF James Cavanagh GP Member H & F Clinical Commissioning Group JC Tony Willis GP Member H & F Clinical Commissioning Group TW Michele Davison GP Member H & F Clinical Commissioning Group MD Vanessa Andreae Practice Nurse Member H & F Clinical Commissioning Group VA Billy Awan Practice Manager Member H & F Clinical Commissioning Group BA Jane Wilmot Lay Member H & F Clinical Commissioning Group JW Alan Hakim Secondary Care Consultant H & F Clinical Commissioning Group AH Philippa Jones HFCCG Managing Director H & F Clinical Commissioning Group PJ Daniel Elkeles Chief Officer CWHHE Collaborative DE Clare Parker Chief Finance Officer CWHHE Collaborative CP Jonathan Webster Director of Quality and Safety & CWHHE Collaborative JWe Secondary Care Nurse Member Officers and attendees present: Name Role Organisation Initials Ben Westmancott Company Secretary, CWHH CWHHE Collaborative BW Mariama Mansaray Board Secretary, HFCCG (minutes) H & F Clinical Commissioning Group MM Tessa Sandall Deputy Managing Director H & F Clinical Commissioning Group TSa Stuart Lines Director of Public Health London Borough of Hammersmith & Fulham SL Martin Waddington Associate Director London Borough of Hammersmith & Fulham MW Apologies: Name Role Organisation Initials Rob Jenkins GP Member H & F Clinical Commissioning Group RJ Zohreen Ashraff GP Member H & F Clinical Commissioning Group ZA Philip Young Lay Member H & F Clinical Commissioning Group PY Rohan Hewavisenti Lay Member H & F Clinical Commissioning Group RH Trish Longdon Lay Member H & F Clinical Commissioning Group TL Page 1
Item Agenda Item /Discussion 1. Welcome & Introductions 1.1 The Chair led a round of introductions which covered members of the Governing Body and those in attendance. 2. Apologies for absence 2.1 Apologies were received from Rob Jenkins, Zohreen Ashraff, Philip Young, Rohan Hewavisenti and Trish Longdon 3. Declarations of Interest 3.1 The Chair asked members for declarations of interest. No interests were declared however, the Chair made mention of the general declaration of conflict for GP and practice staff members as commissioners and providers of primary care. 4. of the previous meeting 4.1 The minutes of the meeting on 14 th January were approved for accuracy. 5 Matters arising 5.1 There were two on-going actions from the previous meeting: Public Health CCG MoU to be reviewed by March 2014 Public Health CCG MoU: Discussions to be held between Public Health and the CCG to clarify the availability of what services and support the CCG can expect from Public Health. Philippa Jones advised that both actions were in progress with a meeting in the diary with Stuart Lines, Director of Public Health (LBHF) and Public Health England to start these discussions. 6 Chairman s Update 6.1 he Chair s report contained the following headlines: Health & Wellbeing Board (HWBB) Chair, Tim Spicer informed members of a recent workshop that had taken place. Though a year ago it was not a well-functioning Board the HWBB is now beginning to take shape and form. It is felt that with key initiatives such as the Better Care Fund and an increased emphasis on Out of Hospital strategies the HWBB will become a forum for key pieces of work. Network Development Members were advised of work underway to further develop networks which are an important part of ensuring that primary care is viable in the future. Virtual Ward The virtual ward has gone live with a structure now in place to enable the ward to operate. Whole Systems Expression of Interest The CCG is working on the second stage of its expression of interest. There are two major acute providers in Hammersmith and Fulham, with all GP provider networks using a proportion of services from both. As such, there is a need to ensure that patients are equitably treated in both facilities. Homelessness The CCG will begin to work with Enabling Assessment Service London (EASL) on homelessness due to an increased recognition that it is more difficult to engage with certain cohorts of residents with a variety of health needs, which in turn can impact on unscheduled and A&E admissions. It is hoped that by working with third sector organisations the CCG can better commission healthcare for the homeless population. The Chair further informed members that he had approved a business case for funding in the amount of 25k for the aforementioned EASL service to provide a dual diagnosis service for homeless people with mental health needs. Members noted the Chair s update 6 Chief Officer s Update 6.1 Daniel Elkeles commented that the majority of the items within his update were covered by the agenda and the only additional point of note was the achievement of the eight CCGs within the North West London (NWL) Collaborative coming to a common decision over the future of collaborative working. The Governing Body noted the Chief Officer s Report Page 2
7 Board Assurance Framework (BAF) 7.1 Ben Westmancott presented the latest version of the BAF which had been updated since the last meeting, based on the review and comment of various committees. The two highest rated risks are 12, related to the proposed partnership between West Middlesex and Chelsea & Westminster and 16 which relates to the Commissioning Support Unit (CSU). It was noted that the decision made by CCGs last week in respect of the CSU went some way to mitigating risk 16. Ben went on to inform members that the outputs of the BAF Seminar held in March will be written up, circulated and reviewed for input into the BAF for 2014/15. Philippa Jones drew attention to risk 15; she argued that Imperial appeared to be singled out for performance issues when other providers performance was similar or worse. For example, there were similar performance issues at Chelsea & Westminster (ChelWest). In response, Ben commented that the performance issues at Imperial were at their highest at the beginning of the year and the shift in performance for all providers will be reflected in the BAF for 2014/15. Clare Parker also commented that ChelWest s performance had worsened over the year. Jane Wilmot drew attention to risks 5 and 6 which had been reviewed by the Quality, Patient Safety and Risk Committee which felt that the risk rating should change and the wording of the risk descriptions revised. Ben agreed to speak to Trish Longdon regarding this. ACTION: Ben Westmancott to speak to Trish Longdon regarding risks 5 and 6 Ben further advised that a new iteration of the BAF would be available in May based on the outputs of workshops held across all CWHHE CCGs. A paper summarising the outputs of these workshops would come to committees in April. The BAF will be kept up to date by allocating risks to committees who will use a proforma to report back to the Governing Body. In the coming year the intention is for there to be tighter ownership of risks by Director leads, with the aspiration to give individual ownership to specific MDs. The governing body noted the update on the BAF. 8 Risk Management Strategy 8.1 Ben Westmancott presented the CCG Risk Management Strategy developed at Collaborative level and approved by the Audit Committee on 16th January 2014. The strategy documents the CCG s approach to managing and mitigating risk and was presented to the Governing Body, for approval. The Risk Management Strategy was approved by the Governing Body. 9 CWHHE Information Strategy and Information Governance Committee -Terms of Reference 9.1 Ben Westmancott presented Terms of Reference (ToRs) for the CWHHE Information Strategy and Information Governance (ISIG) Committee to the Governing Body, for approval. He informed members that the Committee had been set up across CWHHE to focus on IT strategy and information governance (previously the remit of the CWHHE Quality Committee). The ISIG Committee is chaired by West London CCG lay member Alistair Gilchrist. The Hammersmith and Fulham CCG (HFCCG) representative is Dr Tony Willis. Ben further advised members of the following amendments to the ToRs in regards to the membership of the Committee there will be two lay members and a patient representative has also been added to the group. Susan McGoldrick asked whether there was a forum in which the eight CCG IT leads regularly meet, in particular to ensure oversight on what is happening with IT systems within provider organisations. Tony Willis confirmed that there was an informal group in place which meets to discuss issues such as the diagnostic cloud and whole systems informatics stream. There are no ToRs for this group and it does not have any decision making power however, it is seen as a good forum for sharing information and strategy. Susan McGoldrick commented that while the ISIG Committee represented the five inner north west London (INWL) CCGs it would be beneficial to have a formal group across the eight north west London (NWL) CCGs. Tony Willis agreed that in light of IT CQUINS and Whole Systems it would make sense to formalise the process. Daniel Elkeles also agreed, arguing that it would be sensible to work as an eight particularly in working with providers and in light of the development of the Hitachi warehouse. Jane Wilmot commented that she would like to see increased representation of lay members on the committee, so that if Page 3
one cannot attend there is back up. Ben Westmancott advised that this would be discussed and considered further. Members approved the ToRs for the CWHHE ISIG Committee 10 Health and Safety Policies 10.1 Ben Westmancott introduced this item. He advised members of the CCGs duties under the 1974 Health and Safety at Work Act and that the set of policies presented would help to ensure that the CCG meets the requirements of the Act in ensuring staff awareness and training, where appropriate. The policies presented have been reviewed by CCG Governance Leads and the CWHHE Quality Committee and recommended for Governing Body approval. Members approved the health and safety policies presented. 11 2014-15 Contracting Update 11.1 Cerith Lewis, Customer Account Director, updated the Governing Body on progress with the 2014/15 contracting round by providing the latest position on the key acute, mental health and community contracts; and confirmation of the inclusion of the CCG s contracting priorities. The Governing Body noted the 2014-15 Contracting update 12 Better Care Fund Outline Progress Report 12.1 Cath Attlee, Triborough Whole Systems Lead (NWLCSU) presented the near-final version of the Better Care Fund (BCF) Plan for approval by the Governing Body, prior to sign off by the Health and Wellbeing Board. The Plan is a national initiative which sets out the vision for joint working between health and social care services. Clare Parker informed members that the CCG is working with the local authority to agree a programme of service areas to improve outcomes and save money. The draft Plan will be submitted to NHS England on 4 th April. Jane Wilmot commented that the Plan had been discussed at the Lay Members Forum that morning where it was agreed that there should be alignment between the BCF and Whole Systems work. It was also felt that increased lay member representation and co-production would be required at every level. The Governing Body were asked to approve the Plan following review by the Finance and Performance Committee and discussion at a previous Governing Body Seminar. It was suggested that due to the complexity and large scope of the work it would be helpful to have a Governing Body Seminar to ensure that the implications of the Plan are fully understood. ACTION: Better Care Fund to come to a Governing Body Seminar for further discussion (MM) Members approved the Tri-borough Better Care Fund Plan 13 Shaping a Healthier Future (SaHF) Update 13.1 Oliver Excell from the SaHF Programme Management Office (PMO) provided members with a general overview of the progress of the SaHF programme since the January Governing Body meeting. George Moses, Chair of the LMC commented on the high number of ambulance handover waits of more than 30mins at ChelWest and Imperial and questioned whether SaHF and the closing of A&E departments would lead to increased demand on A&E. In response Philippa Jones informed those present that the issue was mainly due to delays in recording the time that patients were handed over rather than a delay in clinical staff treating patients, which had inflated the figures. Much work has been undertaken to improve the data quality in respect of the handover target. Standards for staffing have been built into SaHF and there will be more staff relative to patients than there is at present and increased consultant cover. Susan McGoldrick mentioned that at a recent SaHF Patient Reference Group meeting concern was expressed by one of the lay members that comms were not pitched correctly to communicate with various groups. Susan queried whether there were plans to address these concerns. Oliver advised that these concerns had been fed back to the team leading on comms for the programme and the Patient Planning Team. Members noted the SaHF update. 14 CWHH update and approved committee minutes and committee reports 14.1 Ben Westmancott presented approved minutes and reports from the Collaborative Committees, for information. Members were advised that further to comments at January s meeting regarding the sometimes lengthy delay in approved committee minutes being presented to the Governing Body, committee reports providing summaries of recent meetings were also Page 4
included in the papers for this item. Hammersmith and Fulham CCG Members noted the Collaborative Committee minutes and reports. 15 Personal Health Budgets for Children 15.1 From April 2014 CCGs will have a statutory requirement, under the Children and Families Bill, to offer personal health budgets (PHB) to children and adults who are eligible for continuing healthcare (CHC). Marie Trueman, Triborough Commissioning Manager, provided members with an overview of the proposed approach for personal health budgets for children from April 2014. Clare Parker added that the proposal had been discussed at length and supported by the Finance and Performance Sub-Committee. Jane Wilmot queried the quality assurance process underpinning the proposal. Marie Trueman advised that the emphasis is to give families responsibility in regards to who they purchase care from and that assurances will be needed that these care agencies meet CQC requirements. She also mentioned the importance of having a clear care plan in place with families and community nursing. Though more thought needs to be given as to how this will work. Members approved the approach for personal health budgets for children. 16 Planned Procedures with a Threshold Policy (PPwT) and Individual Funding Request (IFR) Update 16.1 June Farquharson and Dr Lily Wong presented this item. Members were advised that the PPwT and IFR proposals presented have previously been discussed at length at the Quality, Patient Safety and Risk Sub-Committee and a Governing Body Seminar. The following proposals were put to the Governing Body: 1. To endorse the recommendation of the establishment a policy development group 2. To discuss and agree the recommendation from the CCG Collaborative Group to endorse the recommendations made within the Acupuncture rapid review paper with regards to restricting acupuncture to those areas where there is established evidence of clinical and cost effectiveness within pathways such as Musculoskeletal (MSK) Pathway 3. To identify CCG representation for Policy Development Group 4. To discuss and agree the recommendation made by NWL CCG Chairs to keep the current upper age limit of IVF to 39. 5. To note the further discussion and refresh of the Cryo-preservation policy Members endorsed the first proposal. The second proposal regarding acupuncture was supported and agreed by the governing body. In regards to this proposal Susan McGoldrick commented that the CCG need to ensure that this proposal is incorporated with the work that the CCG is currently doing around MSK. In regards to the IVF recommendations, Jane Wilmot expressed discomfort at going against NICE guidelines and that HFCCG was the last in the collaborative to approve the recommendation. The Governing Body: Agreed that the age limit for IVF should remain at 39 years Approved the recommendation to remove the lower age limit for IVF Agreed that the policy to fund one cycle of IVF be retained Approved changes to the eligibility criteria for same sex couples in line with NICE recommendations Agreed to remove the specification on the number of embryos to be transferred per cycle 17 Finance Summary Report Month 10 17.1 Clare Parker introduced the Month 10 Finance Summary Report, which had previously been presented at the Finance and Performance Sub-Committee for discussion. Members were informed of the financial position of H&F CCG as at Month 10 and forecast outturn for 2013/14. At the end of January, the CCG was recording a surplus of 9.2m and the forecast outturn was for a surplus of 12.3m. Members noted the Month 10 Summary Report 18 QIPP summary Month 11 18.1 Philippa Jones introduced the M11 QIPP Summary Report which has been discussed at length at the Finance and Performance Committee. Year to date to M11, savings of 8,376k were delivered against the plan of 9,628k resulting in under delivery of 1,252k (13% variance). Based on a revised full year forecast QIPP schemes are expected to deliver total savings of 9,166k against the plan of 10,549k resulting in a shortfall of 1,383k (13.10% variance). Members were advised that QIPP had delivered in February, though there had been a slight deterioration in non-elective. Page 5
Due to difficulty in recruiting medical cover for the virtual ward its planned opening in January was postponed leading to the CCG being unable to deliver on QIPP in this area as expected. Members noted the M11 QIPP Summary Report. 19 CCG Performance and Quality Report - Month 10 19.1 Philippa Jones introduced the month 10 Performance and Quality Report, which had been discussed by the Finance and Performance and Quality, Patient Safety and Risk Sub-Committees. Philippa advised that rather than going through the report, the approach agreed with Trish Longdon was that she would cover the issues escalated by the Quality Patient Safety & Risk (QPSR) Sub-Committee around quality and performance. This month there were three issues escalated by the QPSR Sub-Committee: 1. Waiting Times at Central London Community Healthcare (CLCH) There are on-going concerns regarding particular services, including podiatry and rehab. Central London CCG (CLCCG) as the lead commissioner for CLCH has completed a review of waiting times and the systems in place for review management and produced a report. The QPSR Sub-Committee endorsed the recommendations within the report. Vanessa Andreae commented that the issue was impacted by CLCH undertaking a large amount of manual reporting and that the move to digital data reporting would help to alleviate the issue in the future. A KPI and metric for waiting times have also been included in the 2014/15 CLCH contract. The CCG has also asked for acknowledgement within 24hrs of referrals with patient contact, to be included in the contract for all CLCH s services. Susan McGoldrick commented that it would be useful to communicate this information to GPs. 2. Timely reporting of serious incident Chelsea & Westminster (ChelWest) Issues around the timeliness of reporting serious incidents, access to information and root cause analysis (RCA) reports were escalated by the QPSR Committee. Jonathan Webster added that there was a recurring theme with ChelWest of late reporting and submissions of RCAs. These issues have been picked up by the Clinical Quality Group (CQG) and a number of conversations have taken place with the trust. It has been agreed that a letter will be sent to the CEO of the trust on behalf of Daniel Elkeles identifying the CCG s concerns. It is acknowledged that the trust has a comprehensive governance system in place however, the issue is with the timely reporting of incident on to Strategic Executive Information System (STEIS). It has also been agreed that Trish Longdon will meet with the trust s Non- Executive Directors (NEDs) to take discussions forward. The CCG is sighted on the issues and is monitoring the situation closely via the CQG. The Patient Safety Clinical Network has also provided opportunity for provider trusts to benchmark against each other and joint learning from serious incidents resulting in positive change. 3. RTT Performance at Imperial The main issue is around performance in four sub specialities; general surgery; urology; ENT and orthopaedics. A performance notice has been issued and a remedial plan requested, which has now been supplied. The CCG has requested a meeting with the trust as amendments to the plan are required. The CCG is working closely with Imperial and monitoring their performance against the target via the CQG. More information has been requested on patients and the procedures they are waiting for. The CCG is also considering using other providers. The Governing Body noted the Month 10 Performance and Quality Report 20 GP Network Investment Proposal 20.1 Tessa Sandall presented a draft specification for external consultancy support for Hammersmith & Fulham CCG s network development programme, which had been recommended for Governing Body approval by the Finance and Performance Sub-Committee and Investment Committee. The Governing Body were asked to approve the overall approach to the development programme and the required level of investment. Members approved the GP Network Investment Proposal 21 Approved Committee and committee reports 21.1 The Chair directed members to approved minutes and reports from the CCG s Sub-Committees. Members noted the committee minutes and reports presented. 22 AOB 22.1 No items of additional business were raised. The Chair invited questions from members of the public in attendance in regards to the items discussed. No questions were raised. Page 6