MINUTES OF THE JOINT COMMITTEE MEETING HELD 7 JULY 2015 AT MEETING ROOM, BOWEL SCREENING WALES, LLANTRISANT

/~, GIG ~~/~~ CYMRU ~~#,..." NHS,~/ WALES Pwyllgor Gwasanaethau lechyd Arbenigol Cymru (PGIAC) Welsh Health Specialised Services Committee (WHSSC) MINUTES OF THE JOINT COMMITTEE MEETING HELD 7 JULY 2015 AT MEETING ROOM, BOWEL SCREENING WALES, LLANTRISANT PRESENT Members: Ann Lloyd, Sian-Marie Chris Tillson Maria Thomas Karen Howell Judith Paget James Carol Shillibeer Geoffrey Carroll Chair Independent Member (Vice Chair) (SMJ) Independent Member (CT) Independent Member (MT) Managing Director, Specialised and Tertiary Commissioning (KH) Chief Executive, Aneurin Bevan UHB (JP) Chief Executive, Powys THB (CS) Medical Director, WHSSC (GC) Associate Members: Simon Smail Chair of the Quality and Patient Safety Committee and Chair of the Gender Dysphoria Partnership Board (SS) John Williams Chair of Welsh Renal Clinical Network (JW) In Attendance: Rhiannon Beckett David Eve Russell Favager Finance Manager, WHSSC (RB) on behalf of Stuart Davies Assistant Director of Finance, Hywel Dda UHB (DE) on behalf of Steve Moore Director of Finance, Betsi Cadwaladr UHB (RF) on behalf of Simon Dean Page 1 of 16

Ian langfield James leaves Daniel Phillips Cathie Steele Ruth Treharne Pamela Wenger Eifion Williams Assistant Director of Planning, WHSSC (Il) Finance Manager, WHSSC (Jl) on behalf of Stuart Davies Director of Planning, WHSSC and Chair of Posture and Mobility Partnership Board (DP) Corporate Governance Manager WHSSC (CES) Director of Planning and Performance, Cwm Taf UHB on behalf of Allison Williams Committee Secretary, WHSSC (PW) Director of Finance, Abertawe Bro Morgannwg UHB (EW) on behalf of Paul Roberts In attendance as observers: Carole Bell Director of Nursing and Quality (designate), WHSSC David Heyburn Renal Network Manager, WHSSC Julie Keegan Interim General Manager - Commissioning, Cwm Taf UHB Sian lewis Deputy Medical Director, WHSSC Roxanna Williams Assistant Specialised Planner, WHSSC PRELIMINARY MATTERS Action WHSSC15/01 WELCOME AND INTRODUCTIONS The Chair welcomed all to the meeting. The Chair reported that the meeting was not quorate and therefore requested that Members support her request to take Chair's action. This was agreed. WHSSC15/02 APOLOGIES FOR ABSENCE Apologies for absence were received from Adam Cairns, Cardiff and Vale UHB; Simon Dean, Betsi Page 2 of 16

Cadwaladr UHB; Allison Williams, Cwm Taf UHB; Steve Moore, Hywel Dda UHB; Stuart Davies, WHSSC; Tracey Cooper, Public Health Wales NHS Trust and Steve Ham, Velindre NHS Trust. WHSSC15j03 DECLARATIONS OF INTEREST The Chair reminded Members of the ways in which conflicts of interest would be dealt with in accordance with the Standing Orders. It was reported that the following declarations have previously been received: Abertawe Bra Morgannwg UHB in relation to services where it is a provider including cardiac surgery, plastic surgery and lymphoedema; Cardiff and Vale UHB in relation to services where it is a provider including cardiac surgery; Cwm Taf UHB in relation to services where it is a provider including CAMHS Tier 4. WHSSC15j04 MINUTES OF THE MEETING HELD ON 17 MARCH 2015 The minutes of the meeting held on 17 March 2015 were agreed as a true record. WHSSC15j05 MATTERS ARISING Members noted the progress against the action log and received the decision log. WHSSC14/79 Collective Commissioning Model KH provided Members with an update. It was noted that she is working with Mr Bob Hudson to define the differences in responsibility between the WHSSC and the Collaborative. WHSSC14/ HIW Review KH provided Members with an update. She reported that the review is taking longer than the HIW team expected. All evidence has been provided and the review team are currently working through this. It was agreed that further updates will be provided to future meetinqs. Page 3 of 16

Gender Dysphoria Partnership Board SS reported that a meeting had been held with Bobbi Bolt, Deputy Chief Operating Officer at Aneurin Bevan UHB who has agreed to help progress the work to develop and all Wales clinical pathway (primary care through to tertiary care). SS highlighted that whilst WHSSC is leading on work the main issues relate to primary and secondary care which is outside its remit. It was noted that the Welsh Government has commenced consultation on its Transgender Action Plan which includes actions for the NHS Wales. These actions will have an implication for the clinical pathway working group. WHSSC15j06 REPORT FROM THE CHAIR Members received an oral report from the Chair. KH introduced Mrs Carole Bell, Director of Nursing and Quality who will take up post in September and Dr Sian Lewis, who has recently taken up post as Deputy Medical Director. KH provided an oral report on how the work of the could be improved in the future and in particular the way in which the Management Group operated. KH explained that a review of the membership was now required and that it was appropriate that this was at Director level. Members supported the view that the papers to the Joint Committee would need to be streamlined and that the Management Group must operate in way that provides assurance to the. Governance Review The Chair reported that the report has not been received. She noted that the report is seven months overdue and that officers had been vociferous in their requests for the report. She reported that she will be meeting with the Chief Executive of the Good Governance Institute. She agreed to formally represent the disappointment of members regarding the absence of the report. Page 4 of 16

Meeting with Minister The Chair reported that she had met with the Minister and had discussed requests for services currently not funded and pressure to develop services that have not been through due process in NHS. She reported that she will be writing to Members asking that they encourage their consultants to use due process and not encourage patient groups to lobby for services which are not supported by NHS Wales. She noted that the current practice of some consultants is unhelpful for NHS Wales who are trying to ensure appropriate prioritisation of services and proper use of resources. Commissioning Performance Indicators The Chair has reported that she has asked a colleague, who previously developed the CCG commissioning indicators, to work with Wales to develop and adapt commissioning indicators for specialised services in Wales. She reported that she expected to receive the first draft in the next six weeks and would then be seeking views from Members. Managing Director of Specialised and Tertiary Services The Chair reported that KH is leaving WHSSC and will be taking up the post Of Chief Executive in the Wirral Community NHS Trust. The Chair congratulated KH on the appointment. The Chair reported that she had discussed recruitment to the post of Managing Director of Specialised and Tertiary Services Commissioning with AW and is hopeful that interviews for a replacement will be held in September. The Chair reported that a Deputy Managing Director of Specialised and Tertiary Services Commissioning will be appointed and they will provide cover in the interim period between KH leaving the organisation and a new Managing Director commencing. This action was endorsed by the committee. Page 5 of 16

Green Paper SS highlighted that Welsh Government is currently consulting on a green paper Our Health, Our Health Service. He suggested that this is an opportunity for specialised services. It was agreed that the green paper would be discussed and a collective response be considered. Membership of the Quality and Patient Safety Committee The Chair reported that a letter has been sent to the LHBs seeking nominations for new members for the Quality and Patient Safety Committee. She thanked Aneurin Bevan UHB for their nomination and noted that she looked forward to receiving other nominations from the other LHBs. All Members NOTE the contents of this report WHSSC15/07 REPORT FROM THE MANAGING DIRECTOR OF SPECIALISED AND TERTIARY COMMISSIONING Members received a report from the Managing Director of Specialised and Tertiary Commissioning. Members discussed the contracting framework including quality indicators and the definitions commissioners and providers. It was agreed that a clear definition would be included in the work. KH Director of also noted that further work was required to ensure Finance that WHSSC commissions against strong standards and contracts. She noted that WHSSC will need to be reshaped and fully resourced if this work is to be progressed. NOTE the contents of the report. WHSSC15/08 REPORT ON DEVELOPMENT OF THE INTEGRATED COMMISSIONING PLAN FOR SPECIALISED SERVICES FOR 2015/16-2017/18 Members received a report on the Integrated Commissioning Plan. DP reported that the draft Integrated Page 6 of 16 Commissioning

Plan had been considered and discussed at the last Management Group Meeting and members were supportive of the plan being brought to the Joint Committee for approval. He reported that a number of risks that were outside the previous version of the draft plan had now been scrutinised further and were included in the version presented to Joint Committee. DP reported that the Management Group had a crucial role in the future scrutiny of business cases. He noted issues of performance management of providers; a new issue was arising in paediatric surgery and that the same performance management model would be applied to this specialty as to others. DP reported that with regards to the transfer of services a project will be established to take this work forward. Members discussed risk sharing arrangements. KH reported that WHSSC could not be the arbitrator of the risk sharing pool as it was a commissioner of services. The should not be used as the vehicle to approve any risk share. It was agreed to request that Karen Miles convene a meeting of the all-wales Directors of Finance Group so that a proposal could be developed and recommendations could then be presented to the LHB Chief Executives. Members discussed the process of considering business cases for each of the assessed schemes and agreed that the scrutiny would take place by Management Group where business cases were required. Members discussed the issue of prudent healthcare and agreed that any net improvement in the underlying financial position would not be used to support new schemes. Members agreed that the cost savings arising from scrutiny of business cases would be allocated back to the funding health boards as part of the WHSSC financial reporting process. Members supported the principle of maximisinq Page 7 of 16

savings wherever possible by following through the outcomes of the prioritisation processes that have started and by any new decommissioning or procurement opportunity. Members also discussed the savings contained within the plan and noted that the savings that WHSSC is making are understated. It was agreed that consideration would be given to how all savings could be more effectively reflected. Members were supportive of the process undertaken to develop the plan and recognised the work of the task and finished group. The Chair thanked DP, Aneurin Bevan UHB for releasing Mr R Holcombe to lead the task and finish group and also the other Health Board members in ensuring the task and finish group achieved its work. Members approved the Integrated Commissioning Plan and, in view of the meeting not being quorate, the Chair agreed to write to all Members requesting formal endorsement. Endorse the process undertaken to finalise of the Integrated Commissioning Plan for Specialised Services 2015/16; and Approve the Integrated Commissioning Plan for Specialised Services 2015/16. WHSSC15/09 REPORT ON THE PRIORITISING INVESTMENT IN SPECIALISED SERVICES: METHOD AND RESULTS Members received a report on the methods of evidence appraisal and prioritisation that have been applied to support the construction of the Integrated Commissioning Plan. Members discussed the need to have robust governance arrangements for the prioritisation panels and clinical evidence and evaluation groups which are crucial to the WHSSC work. SS stated that assurance was required in terms of the contestabilitv of the process and aovernance. Page8 of 16

Members agreed that it was important to ensure that the membership was appropriate and agreed to review the current governance arrangements in terms of the process. Members noted that a lesson learnt review on the process is underway so that ways of improving the process in the future can be taken into account. Note the results of the application of the evidence appraisal and relative prioritisation which have been provided to the Management Group to inform the development of the Integrated Commissioning Plan. WHSSC15/10 REPORT ON TRANSPORT UNIT HAEMODIAL YSIS Members received a report Transport. on Unit Haemodialysis JW reported that the working group had focused on three areas: Standards and Performance Indicators. Commissioning arrangements; and Reimbursement. He provided Members with further detail regarding these three areas. He also reported that there had been good patient representation at the workshop. JW reported that the paper had been considered by the Management Group. He reported that the Management Group had requested further work on the reimbursement scheme including legal advice on equality and equity of access. It was also reported that further work is to be undertaken on the deliverability of the standards. Members discussed the paper in further detail. Members did not support implementation of the Dialysis Reimbursement Scheme. It was agreed that further work was needed including legal advice and value for money work done. It was agreed that further detail would be presented to the Joint Committee scheduled for September. Page 9 of 16

Note the report and the views of the Management Group; however, this report is supported by the WRCN as a sub-committee of the ; Support the recommended standards for unit haemodialysis transport (these will be then be included in the NEPT enhanced service specification) ; Approve the recommendation that there should be a single commissioner for unit haemodialysis transport (this will inform the NEPT discussions for commissioning); and Note the NEPT transformation work is seeking a single commissioner and honest broker role and that the two work streams are aligned with the WRCN agenda. WHSSC15/11 REPORT ON PICU RETRIEVAL Members received a report recommending approval of the PICU Retrieval Service business case which was supported by Management Group in May 2015. The new service will provide a combined 24 hour paediatric target service for critically ill children across South Wales, Mid and West Wales and South West England in line with UK developments. Approve the establishment of the proposed service WHSSC15/12 REPORT ON l YMPHOVENOUS ANASTAMOSIS (lva) FOR THE TREATMENT OF PRIMARY AND SECONDARY lymphoedema COMMISSIONING POLICY AND SERVICE SPECIFICATION Members received a report on the development of a commissioning policy and service specification for lymphovenous Anastamosis (lva) for the treatment of primary and secondary lymphoedema. Members asked whether or not the service had been considered as part of the prioritisation work. KH reported that work had been undertaken with Abertawe Bro Morgannwg UHB and it has been made clear that this is 12 month position and that there is no additional fundinq (plastics underperforrnance). Page 10 of 16

It was agreed that within future reports it would be made clear where there are areas of non compliance in equality impact. Note the contents of the report; Note the results of the formal consultation on the LVA Clinical Commissioning Policy and Service Specification and the resultant amendments made to both documents; Approve the LVA Clinical Commissioning Policy and Service Specification with immediate effect, enabling the surgical service to commence on the 1st September 2015; Support further work with ABMUHB to agree implementation, delivery and performance management arrangements for the LVA service. WHSSC15/13 REPORT ON THE RECOMMENDATIONS OF THE NEUROENDOCRINE TUMOURS TASK AND FINISH GROUP REGARDING SERVICES IN SOUTH WALES Members received a report on the recommendations of the Neuroendocrine Tumours Task and Finish Group regarding services in South Wales. DP provided Members with further information on the historical background to the service, the establishment of the task and finish group and the inequity of the current service model. He reported that there is no evidence that there are concerns about the competencies of those providing service in South Wales. DP reported that he was seeking support from Members to ask Cardiff and Vale UHB to provide a business case, in collaboration with Abertawe Bro Morgannwg UHB and Velindre Cancer Centre, for the service model as described in this paper; and to ask Cardiff and Vale UHB to provide a business case for the short term solution described in Recommendation 4. The Chair emphasised the issue of equity, noting that the service for North Wales is provided in an Page 11 of 16

accredited centre and that the service in South Wales was not in an accredited centre and did not promote the range of services available to Mid and North Wales residents. She noted that the business case from Cardiff and Vale UHB is important and that it is not at this stage definitive that they will provide the future service. In response to the further discussion and queries from Members, OP confirmed that the recommendations would be adapted to form a commissioning framework and that it is expected that the two business cases be received in the next few months. Approve the 13 recommendations of the Task and Finish Group as listed in section 8.0; Support the request for business cases for the recommended service model as outlined in section 9.0; and Agree that equity should be established in Wales whilst discussions continue on the business case from Cardiff and Vale UHB and patients should have the option to be referred to the North Wales Service. WHSSC15/14 REPORT ON CONCERNS Members received a report on concerns. GC drew Members attention to key issues within the report included the large number of concerns which relate to funding and the lessons learnt. It was agreed that 2 day and 30 day compliance measures would be included within future reports. Note the report. Corporate Governance Manager WHSSC15/15 REPORT ON PERFORMANCE DASHBOARD Members received the report on performance. It was agreed that future reports would provide details on the actions for those areas that are "red". Executive Directors Page 12 of 16

Note the report. WHSSC15/16 REPORT ON CARDIAC SURGERY OUTSOURCING PERFORMANCE DASHBOARD Members received the report on cardiac surgery outsourcing performance. It was agreed that a report on the patient outcomes would be brought to the scheduled for September. Note the report. WHSSC15/17 REPORT ON THE CORPORATE RISK ASSURANCE FRAMEWORK Members received a report on the corporate risk assurance framework. PW presented the risk appetite statement for Specialised Services which was supported by the Management Group. She reported that the Integrated Governance Committee had agreed to review the corporate risks as part of the assurance process. Members agreed that the will in future receive a report on a six monthly basis and that any risks that require escalation will be brought to by exception. Note the contents of this report; Approve the risk appetite statement and the direction of travel in terms of the corporate risk and assurance framework; Note the changes to the risk scores; and Agreed to receive a report every six months. WHSSC15/18 TO RECEIVE A REPORT ON THE FINANCIAL POSITION Members received a report the financial position. The Chair requested that assurance is provided in Page 13 of 16

future reports on any projected overspend. Members noted that the report presented did not align to the Integrated Commissioning Plan agreed earlier in the meeting. It was agreed that further work will be undertaken through the Management Group to ensure that the report aligns with the approved Integrated Commissioning Plan. Members requested further information regarding the budget allocation for WAST. It was noted that the WHSS did not have responsibility for WAST funding and that the discussion on WAST budget should be at the Emergency Ambulance Services (EASC). It was agreed that a further discussion would be undertaken at the next all-wales Directors of Finance meeting. KH noted that the relationship between EASC and WHSSC required further consideration. Director of Finance, BCUHB Note the estimated financial position against the baseline budget. Note that the underlying financial risks detailed in the IMTP process remain, in particular the risks regarding the activity and financial trends in English contracts. Note the residual commitment in relation to cardiac surgery outsourcing and the likely level of financial liability for 2015/16. Note the liability regarding WAST approved by the EASC. WHSSC15/18 TO RECEIVE A REPORT FROM THE CHAIRS OF THE SUB COMMITTEES AND SUB GROUPS a) Management Group Members noted a report from KH, Chair of the Management Group. Note the contents of the report; and Receive the confirmed minutes of the meeting held 26 March 2015, 30 April and 28 May 2015. bl Audit Committee Page 14 of 16

Members noted a report from MT, Audit Lead. Note the contents of the report; Receive the Annual Governance Statement; and Receive the confirmed minutes of the meeting held 13 April 2015. c) Welsh Renal Clinical Network Board Members "noted 'a' report from JW, Chair of the Welsh Renal Clinical Network. Note the contents of the report; and Receive the unconfirmed minutes of the meeting held 5 May 2015. d) All Wales Neonatal Network Steering Group Members noted a report from RT, Chair of the all Wales Neonatal Network Steering Group. Note the contents of the report; and Receive the Annual report. e) Integrated Governance Committee Members noted a report from the Chair. f) Quality and Patient Safety Committee Members noted a report from 55, Chair of the Quality and Patient Safety Committee. SS reported that two committee Members had recently resigned, Michael Williams and Andrew Phillips, and that replacements were being sort. Note the contents of the report; Receive the confirmed minutes of the meeting held 9th October 2014 and 11th December 2014. WHSSC15/19 ANY OTHER BUSINESS There were no other matters for discussion. Page 15 of 16

WHSSC15/20 DATE OF NEXT MEETING The date of the next meeting was confirmed as 15 September 2015 Signed ~1oJM,II~ (Ch air) Date... J~~...~...~. Page 16 of 16