Sheffield Clinical Commissioning Group NHS Sheffield Clinical Commissioning Group Committee 6 September 2012 Minutes of the meeting held in public in the Boardroom at 722 Prince of Wales Road, Darnall, Sheffield, S9 4EU Present: Dr Tim Moorhead, GP Locality Representative, West (Chair) Dr Amir Afzal, GP Locality Representative, Central Ian Atkinson, Chief Officer (Designate) Dr Margaret Ainger, GP Elected City-wide Representative Kevin Clifford, Associate Director of Clinical Quality and Improvement Dr Anil Gill, GP Elected City-wide Representative Mohammed Ismail, Lay Advisor Dr Andrew McGinty, GP Locality Representative, Hallam and South Dr Zak McMurray, Joint Clinical Director Julia Newton, Chief Finance Officer Dr Marion Sloan, GP Elected City-wide Representative Dr Ilyes Tabani, GP Locality Representative, North Dr Ted Turner, GP Elected City-wide Representative Professor Malcolm Whitfield, Lay Advisor In Attendance: Katrina Cleary, Locality Manager, Hallam and South Dr Mark Durling, Chairman, Sheffield Local Medical Committee Sue Fiennes, Independent Chair, Sheffield Safeguarding Children Board (SSCB) and Sheffield Adult Safeguarding Partnership (SASP) (for item 208/12) Tim Furness, Associate Director of Business Planning and Partnerships Idris Griffiths, Associate Director of Commissioning Services and Compliance Steven Haigh, Right First Time Programme Manager (for item 218/12) Jane Harriman, Deputy Chief Nurse (for items 222/12(a) and (b)) Carol Henderson, Personal Assistant Sophie Jones, Communications Simon Kirby, Locality Manager, North Daniel Mason, Strategy Manager - Unscheduled Care (for item 219/12) Mike Smith, Chair, Sheffield Local Involvement Network (LINk) Linda Tully, Company Secretary / CCG Authorisation Project Director Richard Webb, Executive Director Communities, Sheffield City Council Dr Jeremy Wight, Director of Public Health Paul Wike, Locality Manager, Central Rachel Wilson, Head of Professional Standards (for item 208/12) Members of the public: Four members of the public were in attendance. A list of members of the public who have attended CCG Committee meetings is held by the Company Secretary 205/12 Welcome ACTION The Chair welcomed members of the NHS Sheffield Clinical Commissioning Group (CCG) Committee, those in attendance and 1
observing, and members of the public to the meeting. 206/12 Apologies for Absence Apologies for absence had been received from Malcolm Lindley, Lay Advisor, and Dr Richard Oliver, Joint Clinical Director Apologies for absence from those who were normally in attendance had been received from Rachel Dillon, Locality Manager, West 207/12 Declarations of Interest There were no declarations of interest. 208/12 Safeguarding Priorities Sue Fiennes, Independent Chair, Sheffield Safeguarding Children Board (SSCB) and Sheffield Adult Safeguarding Partnership (SASP), and Rachel Wilson, Head of Professional Standards, attended for this item. Ms Fiennes advised the Committee that she had been appointed by Sheffield City Council (SCC) to both Boards. She advised the Committee that "Working Together to Safeguarding Children 2010" - a guide to inter-agency working to safeguarding and promoting the welfare of children, was currently out to consultation and, until enacted, the current one was fit for purpose. Ms Fiennes gave a presentation that outlined the key leadership issues for the CCG and their responsibilities in relation to safeguarding. She reported that there was increasingly more engagement in safeguarding from GPs, with the recent PLI events in particular being well received, especially in the practical way the issues had been put over. Ms Fiennes emphasised the importance of appropriate training for CCG members and staff, including multi-agency training. It is imperative that the CCG has effective assurance and governance arrangements in place including reporting arrangements for providers. The Director of Public Health asked about the role of the Health and Wellbeing Board in relation to Safeguarding. Ms Fiennes responded that there would be a formal reporting role into the Board when it was firmly established. Annual reports from each Safeguarding Board would form part of this reporting mechanism. The Committee received and noted the presentation and report. 209/12 Minutes of the CCG Committee meeting held in public on 5 July 2012 The minutes of the Committee held in public on 5 July 2012 were agreed as a true and correct record and were signed by the Chair. 2
210/12 Matters arising from the minutes of the meeting held in public on 5 July 2012 a) Update on Emergency Preparedness, Resilience and Response (minute 177/12 (c) refers) The Director of Public Health explained that Category 2 responder organisations were "co-operating bodies" that were placed under lesser obligations beneath the Civil Contingencies Act (CCA) than Category 1 responders. Primarily their role was co-operating and sharing relevant information with Category 1 responders. They should be engaged in discussions where they can add value and furthermore, they must respond to reasonable requests. He would circulate a fuller briefing to members. JW b) Healthcare Procurement Work Plan Update (minute 186/12 refers) The Chief Finance Officer confirmed that she had discussed establishing timetables for future meetings with the Locality Manager, North. c) Month 2 Delivery and Quality Report: Smoking Quitters (minute 187/12 (h) refers) The Associate Director of Commissioning Services and Compliance explained that data for individual consortia was now presented as percentages in this month's report. He was also looking at developing data relating to the proportion of quits of the estimated number of smokers by locality for future reports. IG 211/12 Chair s Report The Chair presented his report and offered to expand on any issues if members so wished. He highlighted the key appointments to the CCG's senior team and welcomed questions on the Chair s report, which would be submitted to the Cluster the following day. 212/12 Chief Operating Officer s Report The Chief Operating Officer, informed the Committee of the following matters: He thanked the Company Secretary / Authorisation Project Director and her colleagues for their hard work to ensure that the CCG's authorisation application and supporting evidence had been submitted by the deadline of 3 September. The joint Yorkshire and Humber Academic Health Science Network (AHSN) expression of interest (EOI) with Leeds and Hull that had been submitted in July had been approved by the Department of Health (DH). A five year business plan had to be submitted to the 3
DH by 30 September 2012 and Sheffield was leading the process on behalf of South Yorkshire. The four Local Improvement Finance Trust (LIFT) schemes were broadly on target, with the exception of Darnall which was not now due for occupancy until November. The Chief Officer (Designate) would be writing out to members asking if members could attend openings of the buildings. IA The Committee noted the report. 213/12 Progress in the Pre-application Phase for Authorisation The Company Secretary / Authorisation Project Director updated the Committee as follows: She thanked NHS Sheffield and locality staff for all their hard work and huge effort for ensuring the formal application had been submitted by 3 September. Evidence that had been submitted included: Declarations of compliance in 11 service areas. Detailed commissioning arrangements for eight areas. Evidence of our capability over the 119 areas across the six domains, which included five case studies. Three external reports: The Strategic Health Authority's (SHA) assessment of the CCG, which had been a positive report. The report from the 360 stakeholder survey; - there had been 83% response rate from over 200 stakeholders, with positive comments and good feedback. CCG profiles from the SHA. Next steps involved the desk top review by external assessors culminating in a site visit on 18 October. Any areas of concern identified during the desk top review would become Key Lines of Enquiry (KLOE) on the day. A report including any KLOEs was expected two weeks before the site visit and would hopefully be available for the preparation day (4 October). The Company Secretary / Authorisation Project Director and the Chief Officer (Designate) had arranged to meet with colleagues from Rotherham CCG for feedback from their site visit. Dr Gill had undertaken site visit assessor training and would give feedback from this in the private session. 214/12 Finance Report The Chief Finance Officer presented this paper which provided the Committee with information on the financial position to the end of July 2012 and an assessment of the possible outturn position against plan. She advised the Committee that she was reporting a position which was overall in line with plan, with a year to date underspend of 0.1m and a 0.5m surplus at year end, but that a range of risks and 4
challenges existed which would need to be closely monitored and managed. She confirmed that a number of actions were being progressed to address the challenges and the likely impact had been incorporated into her assessment of the forecast out-turn position reported to this meeting. The main area of concern remained the level of over performance at Sheffield Teaching Hospitals NHS Foundation Trust (STH) The Committee: Noted the position at Month 4 and the risks to delivery of the financial plan. Endorsed the ongoing actions to manage the risks and challenges to secure delivery of the financial plan. Approved the budget changes made at Month 4 detailed in Appendix D. 215/12 Delivery and Quality Report The Associate Director of Commissioning Services and Compliance presented the key performance issues as at Month 4. He drew the Committee's attention to the following key highlights. a) QIPP: There was a shortfall of 0.25m on elective and non elective activity on QIPP, although we still forecasting it would deliver the planned savings at year end. b) A&E: Since the report was produced, there had been an encouraging improvement in performance at Sheffield Teaching Hospitals NHS Foundation Trust (STHFT) against the 95% 4 hour target. c) Cancer Referrals: Work was ongoing with STHFT especially in relation to 2 week wait referrals. The outcomes of a recent audit indicated that many patients seemed not to be aware of the potential urgency to be seen within two weeks and so declined the appointment. A letter would be drafted to practices to ask GPs to ensure that patients were made aware of how urgent these appointments were. IG d) Economic Climate Analysis Clarification would be given at the next meeting on the underlying causes for the increase in mental health referrals in the past couple of years, and the increase in the last three years of antidepressant drugs and drugs used in hypertension. IG d) Under 18 Conception Rates The Committee noted the additional detail included in the report that had been requested last month. 5
e) Quality The Associate Director of Clinical Quality and Improvement drew the Committee's attention to the following: (i) MRSA Bacteraemia STHFT were showing as 'Red' because of two cases to date against a target of one. (ii) Eliminating Mixed Sex Accommodation Breaches There had been no reports of breaches in any of the Sheffield Trusts to date this year. The Committee: Noted the progress relating to delivery the 2012/13 QIPP. Noted the key performance issues for Month 4. Noted the contracting performance as at Month 4. Noted the key issues relating to Quality. 216/12 HealthWatch Mike Smith, Chair, Sheffield Local Involvement Network (LINk), gave a presentation that outlined the work of Sheffield LINk, its achievements, and the development of HealthWatch Sheffield. His presentation recognised the work that LINk had done, which he thought would be useful for the CCG's engagement strategy. LINk had undertaken 35 Enter and View visits. Where necessary, service providers had been asked for actions plans to address the points raised. Favourable feedback had been received on the four annual reports that had been produced. A copy of the 2011/12 report would be circulated to members. (LT (CRH)) The Executive Director Communities, Sheffield City Council, thanked Mr Smith for the contribution that LINk had made across the city. He advised the Committee that Sheffield City Council (SCC) had to go out to tender for the provider of the local HealthWatch, which would be formally established from 1 April 2013, without knowing what their final financial position would be, so may have to have post-tender contractual discussions and negotiations. Learning from LINk's workshops and building on LINk's good practice had been fed into the drafting of the tender specification. Mr. Smith advised that LINk had decided not to bid to be the provider themselves, so were 'neutral'. Mr Smith commented that he was looking forward to making HealthWatch work in Sheffield and to working in partnership with the 6
Health and Wellbeing Board, Sheffield City Council and the CCG next year. The Committee received and noted the presentation. 217/12 Developing Long Term Clinical Strategies The Associate Director of Business Planning and Partnerships presented this report which set out proposals for a significantly different way of developing our strategies. He apologised to the Executive Director Communities, Sheffield City Council for the inaccuracies in the briefing at Appendix 8 and would provide a correct version as soon as possible. TF A detailed discussion took place and the following issues were raised and discussed. Members liked the principle of engaging with practices in the development of strategies. We need to be clear on the workload this might bring for localities. The process is expected to take four to six months before strategies would be ready to put on the CCG's website. There would need to be lengthy discussion at CCG Committee for each strategy. The driving element was sustainability, patient experience, quality, and how to get better services and outcomes for patients. The Committee: Endorsed the proposed approach to developing long term strategies to and set aside time for this purpose. Considered the contextual information provided to support those future discussions. Noted the issues identified in the appendices. Agreed to the refresh and update of Sheffield's LTC Strategic Framework (2009). Asked locality leads to discuss this approach with member practices and establish a means of securing the involvement of all practices. 218/12 Right First Time Programme Update Steven Haigh, Right First Time Programme Manager, was in attendance for this item. The Joint Clinical Director presented this report. He advised the Committee that the three projects were progressing well and the impact on patient flow through the system was encouraging. A discussion took place regarding the Integrated Care Teams programme, self care / care planning and GP Associations. There needed to be a wider discussion about governance and accountability of integrated care teams. 7
The Committee: Noted the updates for the current phase of the programme. Noted the impact of the programme year to date. 219/12 Update on the Progress towards Implementation of the new NHS111 Service in South Yorkshire and Bassetlaw Daniel Mason, Strategy Manager - Unscheduled Care, attended for this item and presented this report. He advised the Committee that the Yorkshire Ambulance Service (YAS) had been selected as the preferred provider of the service and had committed to 'go live' on 5 March 2013. NHS Calderdale was acting as lead CCG for the contract until CCGs were authorised. The NHS Direct 0845 number would be 'switched off' mid March. A series of OD workshops run by the South Yorkshire and Bassetlaw had taken place, an inaugural clinical governance meeting for South Yorkshire and Bassetlaw would take place on 13 September chaired by the Associate Director of Clinical Quality and Improvement, and a project team had been established. A discussion took place regarding the Directory of Services (DoS) and whether the national database could be shared more widely. Mr Mason responded that, if it could, training would need to be given. He would look at where there were opportunities for this. IA(DM) The Committee noted that Doncaster and Rotherham CCGs wanted to continue to provide their own out of hours calls until a NHS111 contract was established. In Sheffield, those practices that had opted out of providing out of hours services, and had them commissioned by the CCG, would see their calls automatically directed to the new service. A further update would be given to the next meeting. The Committee: Noted the good progress to date. Noted the issues concerning the requirement to the project team 220/12 Organisational Development Strategy Christine Joy, Principal HR Manager, attended for this item and presented this report. Members asked if the strategy could have a stronger focus on ambition, and be outward facing. IG(CJ) Subject to the amendments made as discussed, the Committee approved the strategy, 221/12 Audit and Integrated Governance Group (AIGG) On behalf of the Chair of the AIGG, the Chief Finance Officer advised 8
the Committee that the next meeting of the group would take place on 27 September a) The Talbot Trusts - Appointment of Nominated Trustees The Company Secretary / Authorisation Project Director presented this report which asked for the Committee's approval to nominate Dr Zak McMurray as a replacement for the Director of Public Health, whose period of office as a Trustee would come to an end on 9 December 2012 when his post would transfer to the Locality Authority. She advised the Committee the only responsibility for the CCG was to nominate trustees and they had no liability as a result of this nomination process. The Director of Public Health advised the Committee that he would be working with the Chair of Sheffield Local Medical Committee (LMC) and the Clerk to the Talbot Trusts to raise awareness of the Trust amongst GPs. JW The Committee approved the nomination of Dr Zak McMurray, Joint Clinical Director, as a Trustee of the Talbot Trusts, for a period of four years from 10 December 2012. b) Audit Arrangements for 2012/13 The Chief Finance Officer presented this report. 222/12 Assurance Group The Chair of the Assurance Group advised the Committee that the next meeting of the group would take place on 15 November. a) Commissioning for Quality Annual Report 2011/12 Jane Harriman, Deputy Chief Nurse, was in attendance for this item. The Associate Director of Clinical Quality and Improvement presented this report. He advised the Committee that it was an important document that provided assurance to the CCG on the delivery and strengthening of NHS Sheffield's quality assurance processes during the period of transition. b) Final Commissioning for Quality and Innovation (CQUIN) Schemes for 2012/13 Jane Harriman, Deputy Chief Nurse, was in attendance for this item. The Associate Director of Clinical Quality and Improvement presented this report which gave an outline of the CQUIN schemes for providers 9
across Sheffield for 2012/13. He drew the Committee's attention to the one outstanding scheme around community services transfer to STHFT. The Chief Finance Officer clarified that trusts could earn a percentage of CQUINs on any over trading. The Committee received the report and endorsed the schemes for 2012/13. c) NHS Sheffield CCG Commissioning Safeguarding Adults and Children Policy The Associate Director of Clinical Quality and Improvement presented this policy. The Committee received and approved the policy. 223/12 Commissioning Executive Team The Chair of the Commissioning Executive Team advised the Committee of the following matters: Commissioning Executive Team (CET) and Planning and Delivery Group (P&DG) Update The Chief Officer (Designate) presented this report. There were no particular items to draw to the Committee's attention this month. 224/12 Locality and Practice Reports The Locality Manager, Central, reported from the first Quality and Outcomes Framework (QoF) meeting held the previous day. Further feedback on this would be given in the private session. There were no further reports this month. 225/12 Specialised and Collaborative Commissioning Summary Report The Chief Officer (Designate) presented this report. There were no particular issues to draw to the Committee s attention this month. 226/12 Minutes of the South Yorkshire and Bassetlaw Commissioning and Business Support Services Advisory Group meetings held on 22 May 2012 and 19 June 2012 The Associate Director of Commissioning Services and Compliance presented these minutes. There were no particular issues to draw to the Committee s attention this month The Committee received and noted the minutes. 10
227/12 Feedback from GPs and Lay Advisers There was no feedback from GPs or Lay Advisors this month. 228/12 Questions from the Public There were no questions from members of the public this month. 229/12 Confidential Session The Committee resolved that representatives of the press and other members of the public be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest, section (2) Public Bodies (Admission to Meetings) Act 1960. 230/12 Any Other Business There were no other items of business to discuss this month. 231/12 Date and Time of Next Meeting The next meeting would take place on Thursday 4 October 2012 at 3.00 pm in the Boardroom, 722 Prince of Wales Road. 11