Kingston Clinical Commissioning Group Report Summary Meeting Title Governing Body in public Date 9 th January 2018 Report Title Minutes of the 34 th Meeting held on 7 th November 2017 Agenda Item 3 Attachment A Purpose (please indicate with X) Approval/ Ratification x Discussion / Comment Information Report Author: (name & job title) Jo Dandridge, Governance & Business Lead Presented by: (name & job title) Dr Naz Jivani Chair, Governing Body MINUTES OF THE THIRTY-FOURTH MEETING OF THE GOVERNING BODY OF KINGSTON CLINICAL COMMISSIONING GROUP HELD ON TUESDAY 7 th NOVEMBER 2017 KING S CENTRE, CHESSINGTON PRESENT: Dr Naz Jivani CCG Chair David Knowles Vice Chair & Lay Member Dr Phil Moore Deputy Chair - Clinical James Murray Interim Chief Finance Officer, SWL Alliance Jim Smyllie Lay Member PPE Paul Gallagher Lay Member & Audit Chair Tonia Michaelides Managing Director, Kingston & Richmond CCGs Dr Annette Pautz GP Member Dr Gareth Hull GP Member Dr Naeem Iqbal GP Member Dr Pete Smith GP Member Nadeem Nayeem Secondary Care Specialist Kathryn Yates Nurse Member MEMBERS IN Liz Meerabeau Kingston Healthwatch representative ATTENDANCE: Dr Atin Goel Council of Members Chair Yarlini Roberts Local Director of Finance, Kingston & Richmond CCGs Vicki Harvey-Piper Local Director Corporate Affairs & Governance Iona Liddington Public Health Representative Julia Gosden Local Director of Commissioning Sue Lear Acting Deputy Director of Commissioning Version: Draft A - 1
Jo Dandridge Governance & Business Lead APOLOGIES: Sarah Blow Accountable Officer, SWL Alliance Fergus Keegan Local Director of Quality, Kingston & Richmond CCGs Kathryn MacDermott Local Director of Primary Care & Planning, Kingston & Richmond CCGs Welcome and Introductions: Members of the public were welcomed to the thirty-fourth meeting of the Governing Body. Declarations of Interest relating to items on the agenda: Members were asked to declare any possible conflicts of interest that had not already been declared on the CCG Register. (All declarations of interest for Governing Body members are listed in the register available at each meeting and also published on our website) Dr Phil Moore declared his interest as a partner at Central Surgery which provides the medical cover for the community beds currently located at Cedars Unit on the Tolworth Hospital site. Re-provision of these community beds was being discussed at item 17/81. 17/73 MINUTES OF THE THIRTY-THIRD MEETING HELD 5 th SEPTEMBER 2017 The minutes of the thirty-third meeting held on 5 th September 2017 were agreed as an accurate record. 17/74 MATTERS ARISING None 17/73 QUESTION TIME None. 17/76 CHAIR S REPORT Dr Jivani provided a verbal report to the Governing Body on the following items: 76.1 Kingston CCG s Annual General Meeting had been well attended and the Chair expressed his thanks to all those who had worked hard behind the scenes to make the event a success. 76.2 Catherine Millington-Sanders had been appointed as the CCG s End of Life Care Clinical Lead for Kingston & Richmond CCGs. 76.3 Centene UK had been invited to Kingston Hospital s Board Development Day and attendees had been briefed on population health management, analytics and dealing with patients on a population basis. 76.4 The South West London Health and Care Partnership were leading on the MSK pathway and were holding local workshops in order to develop the pathway. 76.5 The Kings Fund had been commissioned by the Mayor of London and had produced an independent analysis based on the content and common themes from the October 2016 Sustainability and transformation plans (STPs) of the five STPs across London. Version: Draft A - 2
76.6 A national meeting was being called for clinical leaders to take forward the key principles of the Accountable Care System. 76.7 A Strategic Systems Leadership Programme is being run nationally across the NHS fully funded by Health Education England. Dr Andrew Murray, Merton CCG Chair would be undertaking the programme which aims to prepare leaders to deliver the transformational change that is required for future local integrated health and social care. 17/77 MANAGING DIRECTOR S REPORT This report highlighted items of interest to Governing Body members and the public including issues not contained within the substantive agenda. 77.1 SWL Effective Commissioning Initiative Following the establishment of a Committees in Common to make decisions as a group of CCGs in South West London, the first piece of work undertaken together had been to develop a common version of the SWL Effective Commissioning Initiative policy, ensuring alignment of existing clinical thresholds and common process to monitor compliance with the policy. The Governing Body had received versions of each iteration of the policy as the work had progressed and members noted that the final draft document was being discussed at the next Committees in Common meeting on 16 th November 2017. Once approved, the policy would go live across South West London from 2 nd January 2018 and a co-ordinated programme of engagement with providers would take place leading up to this date. 77.2 Engagement Programme Quality in Primary Care Members were advised that the joint programme of engagement had commenced looking at the quality of general practice and community pharmacy services across Kingston and Richmond CCGs. The aim of the work is to develop a set of quality pledges for primary care. Dr Pete Smith reminded members of the commitment given to look at the clinical point of view as well as the patient perspective which had been requested by the Primary Care Quality and Development Group. It was agreed that there needed to be an opportunity to address this further in seminar mode before taking it to a public forum. POST MEETING NOTE: A PCCC seminar was being held on 14 th November 2017 and Liz Meerabeau, from Kingston Healthwatch would be invited to attend the Seminar to ensure the views of the local public are included. Once developed, the new primary care pledges would be introduced in April 2018. 77.3 National Diabetes Audit Members noted that for the second year running Kingston CCG had achieved 100% participation rate in the National Diabetes Audit. A note of thanks was being recorded for Kingston GP practices for their participation in the audit. Version: Draft A - 3
77.4 Cancer Awareness Drop In Kingston CCG and Kingston Council were holding a cancer awareness drop in session for the public and to launch the new cancer strategy that had been produced by health, care and the voluntary sector partners. 77.5 Springfield University Hospital and Tolworth Hospital Members were informed that South West London and St George s Mental Health NHS Trust had completed the final stage of a procurement process to build two new state of the art mental health hospitals at Springfield University Hospital and Tolworth Hospital. The preferred development partner selected was STEP (Kajima Partnerships and Sir Robert McAlpine Capital Ventures Ltd) and they were working with the trust to progress the estate modernisation programme to contract close. The Governing Body NOTED the Managing Director s Report. 17/78 SOUTH WEST LONDON COMMISSIONING PRIORITIES Members received a paper outlining the proposed Commissioning Intentions across South West London for 2018/19. Sue Lear, Deputy Director of Commissioning briefed members on the expected service changes across South West London: Urgent and Emergency Care Primary Care Mental Health Cancer Planned Care Maternity Learning Disabilities Children and Young people Integrated Community Further local priorities were also presented for Croydon, Kingston & Richmond, Merton & Wandsworth and Sutton CCGs. Members recognised the collaborative approach taken across South West London to refresh the commissioning intentions for 2018/19 and the importance of working together to resolve common pressures within the system. Members also noted that the intentions had been passed to providers in September 2017 in accordance with the national timescale and was being published as part of the contractual cycle. Members commented that it was difficult to identify the local Kingston intentions and although it was recognised that priorities and pressures are similar across Kingston and Richmond, there are different delivery vehicles in both boroughs. It was therefore requested that Kingston and Richmond focussed priorities should be identified and presented in different colours within the document so the differences would be more obvious. The Governing Body NOTED the contents of the proposed Commissioning Intentions across South West London for 2018/19. Version: Draft A - 4
17/79 HEALTHY LONDON PARTNERSHIP (HLP) Members received a report which gave an overview of the role of the Healthy London Partnership; its achievements to date; HLP s relationship with CCGs and the support for delivery of the sustainability and transformation plans; and what once for London looks like. Susan Harrison, Head of London Homeless Health Programme advised members that the HLP works to deliver the changes best done once for London to make the vision of the NHS Five Year Forward View and Better Health for London a reality. Members noted that the Urgent and Emergency Care Improvement Collaborative was being set up and would work with staff and leaders across urgent and emergency care and out of hospital care to define what the future support for improvement across London needs to address. Members also asked for the following areas to be included as further priorities in the programme of work by HLP: digital health to improve mental health and wellbeing the needs of children and young people air quality affordable / accessible housing Action: Members asked for regular updates on HLP progress to be presented to the Governing Body on a quarterly basis. The Governing Body NOTED the Healthy London Partnership update. 17/80 KINGSTON & RICHMOND LOCAL TRANSFORMATION BOARD UPDATE Members received a report on progress on the establishment of the Kingston and Richmond Local Transformation Board (LTB) for information. Members noted that the Kingston and Richmond LTB had been established to provide oversight and direction to the development of place-based level implementation plans which will deliver significant change in health and care systems. The LTB will expedite the design and delivery of these plans by bringing together key local organisations for agreement including contracting, reporting and financial issues. Members also received a copy of the draft Terms of Reference and a high level governance structure for the LTB. Members were advised that East Elmbridge (part of Surrey Downs CCG) had subsequently been included in the membership of the LTB due to its proximity to the boarders of Kingston and Richmond and similarities with its population. Members commented that within the terms of reference it was stated that there was no formal requirement for meetings to be quorate. It was advised that the LTB has no delegated responsibility and all decisions would therefore need to be taken by individual organisations. Members found the governance structure very helpful in siting how each organisation fits with the Local Transformation Board. Version: Draft A - 5
Action: Members agreed it would be helpful to receive regular updates on the Kingston, Richmond and East Elmbridge LTB. The Governing Body NOTED the contents of the report. 17/81 RE-PROVISION OF CEDARS COMMUNITY AND INPATIENT SERVICE Members received an update from Sue Lear, Acting Deputy Director of Commissioning on the latest position with regard to re-provision of the community hospital beds currently located at the Cedars Unit on the Tolworth Hospital site. Since the last Governing Body meeting, Your Healthcare had received formal notice from South West London and St George s Mental Health NHS Trust that their lease will end on 13 th April 2018. Your Healthcare will have to have vacated the Tolworth Hospital site by this date. A project group had been established to manage the reprovision of the beds to the Teddington Memorial Hospital site on a temporary basis. Your Healthcare and Hounslow and Richmond Community Healthcare Trust have reached an agreement on the funding required to accommodate the beds at Teddington Memorial Hospital and their legal team were currently working to produce a lease for the required bed space. Members noted that Your Healthcare are using a variety of communication approaches to ensure all staff are kept informed of plans and progress. Kathryn Yates advised that feedback from the staff engagement had been very positive to date. The Governing Body NOTED the contents of the report and would continue to receive regular updates at future meetings. 17/82 IVF / REVISED FERTILITY PATHWAY Members received a progress report on the work with the Assisted Conception Unit on proposed revisions to the fertility pathway. Members noted the decision taken by the Governing Body in September 2017 was for no changes to be made to the current eligibility criteria for access to IVF and specialised fertility services. However, as an alternative measure an initial proposal from the consultants at the Assisted Conception Unit had suggested changes in access to the fertility pathway against clinical criteria where the evidence demonstrates a reduction in the success outcome of fertility treatment. Members were being asked to support the re-design of the fertility pathway and for a meeting to be arranged between the Assisted Conception Unit and the CCG s clinical lead from the Governing Body to explore and develop the pathway further. Dr Naeem Iqbal commented on the very useful work undertaken to date and agreed to be the clinical lead involved in the re-design of the fertility pathway. Liz Meerabeau advised that clinical discussions needed to take account of the counselling services available to those couples accessing the fertility pathway. Action: The Governing Body would receive further progress reports. The Governing Body endorsed the approach to jointly review the fertility pathway with the Associated Conception Unit and to consider changes to the pathway based on clinical expectations of successful conception. Version: Draft A - 6
17/83 KINGSTON CO-ORDINATE CARE Members received an update on the development of the new locality model of care known as Kingston Co-ordinated Care. Members were advised that Kingston Co-ordinated Care was a new model of community care provision designed by multi agencies and underpinned by the voice of the customer through public engagement to understand the changes required within the system to deliver desired outcomes. Members were informed that a formal provider alliance had been established through a memorandum of understanding that sits over the existing provider contracts in an umbrella arrangement for 2017-18 between the partner agencies. Members noted that the main priority for the model is the establishment of locality teams to provide care to a defined population of at least 50,000 people. These teams will be aligned to GP practices and bring together existing staff across primary care, social care, mental health, community services, and hospital specialists. There will be greater emphasis placed on prevention and early intervention so that people stay well and access the right care for them in the right place. The new model of care will focus on the 65+ age group who are identified as high risk individuals. Members noted that Kingston Council had agreed to trial the establishment of Well- Being teams to deliver home care and support people to connect to the communities they live in. The provider alliance has therefore arranged a pilot in the New Malden area to align with initial work around locality working, as Well-Being teams need to be an integral element of those teams. Members were advised that the provider alliance had developed a detailed implementation plan and progress against implementation and evaluation of the New Malden pilot will be monitored through regular established commissioner provider meetings. The lessons learnt from this pilot will then inform the development of the model. The Governing Body NOTED the update on development of the Kingston Coordinated Care. 17/84 SOUTH WEST LONDON SUSTAINABILITY AND TRANSFORMATION PARTNERSHIP REFRESH Members received a paper which set out the approach developed to support the refresh of the South West London Sustainability and Transformation Partnership (STP). Members noted the refresh of the SW London STP was in order to change the conversation and to be locally focussed on prevention and early intervention, integrating with social care services and to strengthen locality teams made up of community, primary and social care. Members noted the new narrative included: a local approach works best for planning health and care strengthen the focus on prevention and keeping people well the best bed is your own bed Version: Draft A - 7
care is better when it is centred around a person, not an organisation likely to mean changes to services locally involving people at local level we are not closing any hospitals Members were advised that a two stage approach was being taken towards the refresh, the first stage being the STP one year on with an updated narrative, context and delivery so far; and the second stage to develop Place Plans for each of the four local transformation boards. Members welcomed the refresh and local placed based plans approach for Kingston & Richmond. Discussion followed on the best bed is your own bed approach and it was stressed that plans needed to address the needs of carers and specifically those unpaid carers for patients being treated at home. The issue of those patients who frequently call for an ambulance was also raised and although Kingston does not have a high number of these frequent callers, a piece of work had been done to analyse the data and multi-disciplinary teams would also pick up this issue as part of the Kingston Co-ordinated Care model. The Governing Body NOTED the South West London Sustainability and Transformation Partnership refresh report. 17/85 COMMISSIONING 85.1 Integrated Governance Committee Report A report detailing issues discussed at the most recent Integrated Governance Committee meetings in September and October 2017 had been circulated for information. Members noted that the two main areas of concern continued to be the Dementia Diagnosis rate and A&E waiting times. Members were advised that the IAPT access and recovery standards are behind trajectory as at September 2017 but a recovery plan was in place to recover both standards and being monitored through the monthly performance meetings. Additional funds have been agreed to deliver the increasing access standards for 2017-18 and 2018-19. The waiting times standards continue to be met. The Governing Body NOTED the Performance Report. 85.2 Finance Report Month 6 Members received the finance report for Month 6 (September 2017) and noted the following: the CCG expects to meet its planned 0.5% in-year surplus of 1,151k Cash and Better Payment Practice Code targets were achieved in Month 6 Version: Draft A - 8
Non-recurrent allocation of 30k has been received in Month 6 for Quarter 2 payment to Kingston Hospital to deliver the Faster Diagnosis standard The cost impact of Identification Rules (IR) is excluded from the acute position. Analysis work is being carried out with NHS England specialised team as it is anticipated that funding will be received to cover the shortfall QIPP savings are forecast to under achieve against plan, due to delays in starting some of the QIPP schemes. Action plans are in development to improve performance The CCG is using non-recurrent support to manage the forecast position, enabling delivery of the planned in-year surplus of 0.5% Acute Commissioning Members noted that acute spend had decreased in September 2017 due to a change in reporting of IR impact. Changes in IR rules has resulted in some activity within the specialised commissioning service has been transferred to CCGs and the allocation transfer does not match with the activity transferred. This is a significant issue within South West London and CCGs are seeking to reach an agreement with NHS England. Members noted the variation year to date in non-elective admissions had increased and the two main reasons for variation were the main QIPP programme to reduce non-elective admissions had been delayed and there had also been an increase in admissions as a result of the newly opened Clinical Decisions Unit (CDU) at Kingston Hospital. Members were advised that the over performance at St George s Hospital was due to their reported forecast position not including the IR impact of the 2017/18 tariffs. Analysis work is being carried out with NHS England specialised team and it is anticipated that funding will be received to cover the shortfall. Members noted the 2016/17 Kingston Hospital contract which was rolled over in 2017/18 states that 20% of the Urgent Care Centre activity should be charged at the local tariff of 59. However Kingston Hospital are disputing this and continue to charge all UCC activity at the higher tariff of 100. Kingston Hospital have requested a clinical review to take place on 23 rd December 2017. The CCG will share the UCC tariff structure with the CSU for benchmarking purposes so that a local price can be negotiated with Kingston Hospital and the issue can be resolved. QIPP Performance Members were advised that the overall QIPP forecast shows an expected under achievement of 1.5m based on savings seen year to date. 11 QIPP schemes are RAG rated red and forecast to under achieve significantly against plan. Members noted that the QIPP plan for next year will be even more challenging and extremely difficult to achieve. Version: Draft A - 9
The Governing Body NOTED the Finance Report. 85.3 Council of Members Report Members received a report detailing items discussed at the most recent Council of Member meetings held on 12 th September and 10 th October 2017. At the September meeting, the appointment of Vice Chair for the Council of Members was confirmed as Dr Adel Kartas. Members also gave their approval on revisions to Kingston CCG s Constitution to reflect the creation of the South West London Alliance. A demonstration was given of a newly created Excel workbook containing practice level referral information and a regular update on primary care issues including the list of new KPIs was presented. At the October meeting, Mr Alan Jones, Associate Medical Director at Kingston Hospital was in attendance. A presentation was given by Nick Merrifield on Kingston Co-ordinated Care, risk stratification and KPIs. Presentations were also given on Clinical Practice Research Datalink; Managing Clinical correspondence; and Respiratory KPI. The regular update on primary care included progress with the Kingston Medical Services contract. The Governing Body NOTED the Council of Members Report. 17/86 MINUTES FOR INFORMATION AND UPDATES FROM SUB COMMITTEES 86.1 Audit Committee Minutes of the Audit Committee meeting held on 24 th July 2017 were received for information. 86.2 Finance Committee Minutes of the Finance Committee meetings held on 24 th July 2017 and 26 th September 2017 were received for information. 86.3 Integrated Governance Committee Minutes of the Integrated Governance Committee meeting held on 19 th September 2017 were received for information. 86.4 Health & Well Being Board Minutes of the Health & Well Being Board meeting held on 14 th September 2017 were received for information. 86.5 Primary Care Commissioning Committee Minutes of the Primary Care Commissioning Committee meeting held on 4 th July 2017 were received for information. 17/87 RECENT POLICIES APPROVED The Governing body received the Business Travel and Expenses Policy and Procedures for Kingston & Richmond CCG staff. Members noted this policy did not apply to Governing Body members. 17/88 QUESTION TIME None. Version: Draft A - 10
17/89 DATE OF NEXT MEETING TO BE HELD IN PUBLIC Tuesday 9 th January 2018 Venue: King s Centre, Chessington Version: Draft A - 11