Tuesday 10 th September 2013 1.30pm-3.00pm Part 2 St Pauls Church, Hammersmith Elected and co-opted Members present: Tim Spicer H & F Clinical Commissioning Group GP (Chair) TS Susan McGoldrick H & F Clinical Commissioning Group GP (Vice Chair) SM Paul Skinner H & F Clinical Commissioning Group - GP PS Rob Jenkins H & F Clinical Commissioning Group - GP RJ Peter Fermie H & F Clinical Commissioning Group - GP PF James Cavanagh H & F Clinical Commissioning Group - GP JC Tony Willis H & F Clinical Commissioning Group - GP TW Zohreen Ashraff H & F Clinical Commissioning Group - GP ZA Michele Davison H & F Clinical Commissioning Group - GP MD Vanessa Andreae H & F Clinical Commissioning Group Practice Nurse VA Billy Awan H & F Clinical Commissioning Group Practice Manager BA Trish Longdon Lay Member TL Philip Young Lay Member PY Philippa Jones H & F CCG Managing Director PJ Daniel Elkeles Chief Officer, CWHH DE Clare Parker CFO, CWHH CP Jonathan Webster Director of Quality and Safety, CWHH JW Officers and attendees present: Ben Westmancott Company Secretary, CWHH BW Gilbert George Board Secretary, HFCCG (minutes) GG Rob Sainsbury Deputy Managing Director, OOH programme Manager, HFCCG RS Rachel Stanfield Head of OD and Governance, HFCCG RSt Item Agenda Item /Discussion Action Owner 1. Welcome & Introductions 1.1 Welcomes and introductions were given. 2. Apologies for absence 2.1 Apologies were received from Jane Wilmot and Rohan Hewavisenti 3. Declarations of Interest 3.1 The general conflict of GPs as commissioners and providers was noted. 4. 4.1 The minutes of the meeting on 9th July were approved for accuracy. 5. Matters Arising Report 5.1 Updates have been highlighted on the report. 6. Chairman s Update 6.1 BW was requested by the Chair to inform members of the outcome of the election for the Chair and Vice-chair of HFCCG. BW announced that the current HFCCG Chair, Tim Spicer and Vice Chair, Susan McGoldrick were re-elected to their current positions unopposed. TS invited Oliver Excell (OE) to inform members of progress being made on Shaping Healthier Future (SaHF) and Out of Hours Transformation: Page 1
Shaping Healthier Future 8 CCGs lead on SaHF NHS England have agreed multi-year, multi- million financial strategy to support implementation Four regional zones have been established for implementation, and teams have been recruited to manage them Currently in development are detailed implementation plans for service transition A tracking tool to monitor quality, shape change, activity change Hospital Transformation is underway Acute Trusts are all being provided with financial support to develop their business cases Major and Local hospital business cases are on track for delivery 2013/14 financial year Agreement reached with the NHS Trust Development Authority (TDA) on the approvals process The TDA leading on work to develop options for the future of Central Middlesex Hospital External support commissioned to develop proposals for enhanced services at Ealing and Charring Cross Out of Hours Transformation Developed pipeline for GP hubs and premises and securing support to develop business cases Commissioned work to develop a set of common principles for investing in primary care Submitted an application to become an Integrated Care pioneer site and we have been shortlisted Cross Cutting Workstreams Working with HE NWL to develop joints plans and establish a baseline to support modelling Established Finance group and developed a granular activity model Clinical Board reconvened and working to identify key risks, established Maternity, Paediatric and Urgent and Emergency Care CIG Re-formed the Patient Group (PPRG) and Travel Advisory Group (TAG The Chair also provided members with update on the following areas: Whole systems TS informed members of a presentation he had recently made to the Department of Health on Whole Systems as part of the process of gaining selection for pioneer status. Informal feedback indicated that the presentation was well received. Local Hospitals TS informed members that a programme of meetings and engagements events were being designed by PwC and that further updates on developments would be made available to Governing Body Members. 7. Chief Officer Update 7.1 DE informed governing body members that preparation of commissioning intentions for 2014/15 had begun. These will describe the healthcare services the CCG want providers to focus on during the coming year. The intentions will be set out in the context of the CCG s 5-year commissioning and financial strategy, key influences are: The Joint Strategic Needs Assessment Feedback from patients and other stakeholders Delivery of continuous improvements to the quality of care provided Page 2
Hammersmith and Fulham CCG Expectation that providers work with us to reduce non-elective (unplanned) admissions to hospital Delivery of Shaping a Healthier Future to improve hospital based services The Health and Wellbeing Strategy The whole systems integration pilot which is bringing health and social care services together The NHS Mandate, setting out the government s ambitions for the health service NHS Outcomes Framework Members were updated on the progress of the NW London bid for pioneer status for the whole systems integrated care work; NW had been shortlisted along with 27 other applications. Members were made aware of the June 2013 Spending Round outcome in particular the Integration Transformation Fund - the Government s announcement of 3.8 billion worth of funding to ensure closer integration between health and social care. The funding has been described as a single pooled budget for health and social care services to work more closely together in local areas, based on a plan agreed between the NHS and local authorities. Members were informed on the position regarding authorisation for all four Clinical Commissioning Groups, DE announced that all four had all passed through the authorisation programme with success and that following a review of the evidence by NHSE, all CCGs in the collaborative have been fully authorised without conditions. Members were notified that following consultation amongst the four CGGs there was widespread agreement among member practices to move to a single IT system (SystmOne), a roll-out programme for practices across CWHH is underway Members were advised of the status of main contracts as at the middle of July: West Middlesex University Hospital NHS Trust: Contract agreed and discussions continue about transitional funding relating to their partnership with Chelsea and Westminster Foundation Trust Chelsea & Westminster NHS Foundation Trust: Final minor issues are being addressed and checks are taking place and contract signing is imminent Imperial College Healthcare NHS Trust: Aim to sign the contract in early August, finalising CQUINS and the information schedule. London Ambulance Service: Contract finalised and signed. Hounslow & Richmond Community Healthcare NHS Trust: Contract finalised and signed. Central London Community Health NHS Trust: Finalising issues relating to the rebasing exercise carried over from previous years and disaggregation following the transfer of some services to local authorities. West London Mental Health NHS Trust: At final stage of agreeing documentation with the Trust and signing is imminent. Central & North West London MH NHS Foundation Trust: Contract finalised and signed. Members were also updated on the following: Equality objectives will be published on the 13 th October for consultation with various stakeholders. Page 3
Following the proposal that Ealing CCG moves to join the CWHH collaborative, work is underway to describe the transition plan (should the proposal be accepted). The decision for Ealing joining CWHH will rest with NHS England. NHS England has announced a fundamental review of the financial allocations policy. A series of workshops will be held in September to inform future resource allocations. Members were alerted to the fact that it is unclear over what timescales the changes will be implemented. Governing Body members noted the Chief Officer s Update. 8 Board Assurance Framework (BAF) 8.1 BW presented the BAF (updated 13 August) following a consultation period. Input was sought on the content from CCG committees and the CWHH Quality and Safety Committee. Members approved submissions for further updates to the BAF recommended by HFCGG subcommittees to be considered and agreed by CWHH Collaborative Governance Team and PJ. BW / PJ Concerns were raised by VA that the process for updating the BAF was far too long a process. BW informed VA that a further discussion to address her concerns would be arranged. Governing Body Members noted the report. 9. Developing CCGs Equality Objectives 2013-2017 9.1 Rachel Stanfield and Samira Ben Omar (SBO) presented a paper on developing the CCGs Equality Objectives 2013-2017. Members were reminded that the Public Sector Equality Duty came in to force in April 2011 (s.149 of the Equality Act 2010) and it brought the 3 previous duties on disability, gender and race together into a single duty, which were extended to cover the remaining protected characteristics (age, sexual orientation, religion or belief, pregnancy and maternity, and gender reassignment). Public bodies like Clinical Commissioning Groups are now required, in carrying out their functions, to have due regard toward the need to achieve the objectives set out under s149 of the Equality Act 2010. The proposed four equality objectives for Hammersmith and Fulham CCG are: 1 To deliver the EDS goal Better health outcomes for all A. Improve mental health and wellbeing for BME communities and people with learning disabilities B. Reduce social isolation for older people and for people with mental health issues C. Better understand the need and support requirements of carers and in particular young carers 2 To deliver the EDS goal Improved patient experience and access Work with providers through the Clinical Quality Group meetings to agree actions for improving patient experience data collection and analysis on Ethnicity, Religion, Sexual Orientation and Disability 3 To deliver the EDS goal Empowered, engaged and well supported staff Improve workforce data monitoring: ensure that equality and diversity monitoring data is up to date for all CCG staff and Governing Body Members. 4 To deliver the EDS goal Inclusive leadership at all levels As part of the CCG s Organisational Development Programme, the Governing Body and Page 4
Senior Managers will be supported through a programme of Equality Training and Governing Body Seminars to embed equality considerations into the CCG Commissioning Plans and assurance processes. Members were informed that these objectives were based on work with staff, voluntary and community sector organisations, patients and patient representatives that has been undertaken throughout the year. The work included a series of multi-agency workshops, a review of existing public health data and resident feedback which helped to identify a range of priorities. These draft objectives have been shared with the HFCCG Patient Reference Group, which includes representation from HealthWatch, Equalities Lead LBHF, the Older People s and Disability and Consultative Forum, H&F MIND and a range of other voluntary and community sector organisations. Feedback has been included in the summary of objectives given below. TL raised the concerns that the objectives are overly ambitious and must be outcome driven. RSt responded that the objectives had been developed from feedback from stakeholders and were objectives the CCG should aim for. SBO also added prioritising may come at a later stage once further work has been undertaken. 1 Agreed objective 1 to include scope of A, B and C 2 Agreed equality objectives two, three and four 3. Agreed that the Quality, Patient Safety and Risk Committee to receive progress reports. 10. Public Health CCG MoU 10.1 Dr Ike Anya - Consultant in Public Health Medicine presented the Public Health CCG Memorandum of Understanding (MOU), members were informed that the MoU establishes a framework for governing the relationship between the Triborough Public Health Service (PH) and Central London (CCG) for 2013 / 2014. It has been developed jointly through a working group involving all CCGs, 3BPH and other leads as appropriate including the Local Authority Clinical Chief Information Officer. Formal sign off would enable the Public Health Intelligence Team to have access to relevant data to support the JSNA and the CCG commissioning intentions. To approve the signing of the Public Health CCG Memorandum of Understanding but a review of the memorandum to be carried out by March 2014.Action Public Health CCG Memorandum of Understanding to be reviewed by March 2014 PJ 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. PJ 11. Incident & Serious Incident Policy CWHH CCGs collaborative 11.1 JW presented a collaborative Incident & Serious Incident Policy. Members were informed that the policy is designed to respond to incidents and serious incidents that occur within Hammersmith and Fulham CCG and CWHH CCGs Commissioning Collaborative. These incidents are likely to be limited to Information Governance and Health & Safety incidents but there might be some clinically related commissioning incidents that should also be reported. The policy is not intended to include incidents that occur within provider organisations, this is managed by the CSU, and their associated policies & processes. Page 5
Hammersmith and Fulham CCG To approve the Incident & Serious Incident Policy. 12. Conflict of Interest Policy 12.1 BW presented the Conflict of Interest Policy. Members were informed that the policy is designed to respond to any conflicts of interest that occur within Hammersmith and Fulham CCG and CWHH CCGs Commissioning Collaborative. Governing Body Members were informed that failure to deal appropriately with conflicts of interest can have serious consequences legally. To approve the Incident and Conflict Interest Policy. 13. Constitution amendments 13.1 BW presented a paper on amendments to the CCG Constitution, the following amendments proposed were: Ealing amendments relating to Ealing CCG joining the CWHH Collaborative; Whistleblowing David Nicholson has written to all CCGs asking them to include some standard wording in their Constitutions relating to whistleblowing; Investment Committee the committee had been set up to deal with areas of potential conflict of interest for Governing Bodies. The amendment specified the role and Responsibilities of the committees which currently do not appear in the Constitution. Governing Body Members were also informed that the Terms of Reference of the Audit and Remuneration committees and the Financial Policies needed to be updated to reflect previously agreed changes. To approve the submission of the amendments to the CCG Constitution to the CCG Members meeting on 17th October for approval. 14. CWHH update and approved committee minutes 14.1 The governing body noted the CWHH minutes. 15. QIPP summary Month 04 15.1 PJ presented the Quality, Innovation, Productivity and Prevention (QIPP) summary Month 4 report; Governing Body Members were informed that M04 reflected changes to the plan profile for Non-elective schemes and material change to the forecast for Prescribing and Acute contracts schemes. The YTD position currently reports a shortfall of 384k (11.7%) against planned savings of 3.29m. This was as a result of under delivery on Planned Care schemes ( 205k), Prescribing ( 76k) and Acute Contracts ( 317k). Under performance is partially offset by over performance against the target on Excess bed days scheme ( 131k) and 78k from contract negotiations with CLCH. Current forecast for the year is to deliver total savings of 8.94m against the plan of 10.54m, resulting in a gap of 1.60m. Governing Body Members noted the report. Page 6
16. Finance Summary Report Month 4 16.1 CP presented the Finance report for Month 4, Governing Body members were informed of the risk and opportunities position, total likely risk identified in month four was 3,488k and total opportunity was 3,970k. CP also brought to the attention of Governing Body members that In month four there had been material movement in the running cost forecast for Acute services, Prescribing, Primary Care Services. Whilst overall the year to date (YTD) position on Prescribing showed an under spend, this included over performance of 78k on the prescribing drugs element. Over spend has been masked by under spend in other budgets reported within the cost centre. In addition the YTD and forecast over spend on Primary Care Services was driven from central drugs. The favourable movement on "Other", which includes reserves and non recurrent programme and project costs, showed forecast under spend against budget of 2.9m. Under spend is driven by release of 2.2m of QIPP slippage reserve and pooled equipment reserve. Governing Body Members noted the report. 17. CCG Performance and Quality report 17.1 PJ presented the integrated report providing provider performance, management updates for operational performance, quality and finance. PJ highlighted there are continuing concerns about the accuracy and interpretation of the some of the data. Members have been informed that meetings have been held with the CSU Performance Team and that an issues log has been created and will be followed up to resolve issues. PJ will be reporting on progress on outstanding issues at November s Governing Body meeting. Members noted the performance report. 18. Approved Committee and verbal update 18.1 The Governing Body noted the Committee minutes. 19. Any Other Business 19.1 There was no other business. Next Meeting Tuesday 12th November, St Pauls Church, Queen Caroline St, W6 9PJ, Hammersmith Page 7