DRAFT MINUTES of the NHS West Kent CCG Governing Body Meeting Held in Public Meeting held on Tuesday 23 rd May 2017 at 13.30 hrs At the Hadlow Manor Hotel, Maidstone Road, Tonbridge, Kent, TN11 OJH Date of Approval: Present: Dr Bob Bowes Ian Ayres Dr Andrew Cameron Dr David Chesover James Hedges Reg Middleton Dr Andrew Roxburgh Dr Stefano Santini Alistair Smith Sue Southon Dr Meriel Wynter Dr Garry Singh Dr Sanjay Singh Dr Nick Cheales Dr Katie Collier Mr Nic Goodger Caroline Becher Chair Accountable Officer Lay Member for Governance Chief Finance Officer Lay Member, Chair of the Primary Care Commissioning Committee Lay Member for Patient and Public Engagement Secondary Care Clinician Independent Nurse In attendance: Adam Wickings Richard Segall Jones Kofo Abayomi Paula Wilkins Gail Arnold Dr Tony Jones Observing: Tony Broadrick Apologies: Dr Tim Palmer Chief Operating Officer, Delivery Company Secretary Deputy Company Secretary (Minutes) Chief Nurse Chief Operating Officer, Transformation Patient Participation Group Chair
84/17 Questions from the public There were no questions from the public. 85 17 Welcomes and Introductions The Chair welcomed all to the meeting. 86/17 Apologies for Absence Apologies for absence were noted. 87/17 Quorum The Chair confirmed that the meeting was quorate. 88/17 Declaration of Members Interests No declarations were received above those already recorded in the CCG Register of Interest. 89/17 Minutes of the previous meeting held on 25 th April 2017 The Minutes of the previous meeting held on Tuesday 25 th April 2017 were approved as an accurate record of the meeting. 90/17 Actions arising from the previous meeting held on 25 th April 2017 The Chair noted the action updates provided, as detailed in the action log. In regards to the Chief Officer s action, Mr Ayres confirmed that there was a Sevenoaks District Health Action Team, chaired by Hayley Brooks, Head of Housing and Health. There was also the Health Liaison Board (chaired by Cllr Pat Boseley), which is a member Board looking at health related topics as referred from Member s Housing and Health Advisory Committee (advisory committee of the Cabinet, chaired by the Portfolio Holder for Housing and Health Cllr Michelle Lowe). Mr Ayres would commence engagement after the purdah period. 91/17 Matters Arising from the meeting held on 25 th April 2017 not covered elsewhere on the agenda There were no matters arising from the meeting held on 25 th April 2017. 92/17 Chairman s Report The Chair informed the Governing Body that a proposal would be put to the CCG membership to vote/agree in principle the establishment of a Joint Committee with Kent and Medway CCGs on the consultation of stroke services. The task of the Group is to be the
configuration of stroke services in Kent and Medway. It was noted that no work would be done prior to the formation of the Group. The Governing Body noted the Chair s update that the West Kent Improvement Board had its inaugural meeting and explained that the Group was a forum of the CCG, providers and partners to discuss and oversee the direction and implementation of the Sustainability and Transformation Plan (STP) in West Kent. The Governing Body noted and congratulated Dr Collier on the news that she was expecting a baby later in the year. Further to this, the Governing Body agreed that on this occasion, there was no need to have a bye election for an interim replacement whilst Dr Collier was on maternity leave. The Governing Body NOTED the Chair s verbal report. 93/17 Chief Officer s Report Mr Ayres provided an oral update on the following: The Governing Body noted Mr Ayres s update that his position as Accountable Officer at East Surrey CCG had come to an end and would resume back at West Kent CCG from the 1 st of June. Mr Ayres thanked the Governing Body for their support and patience during the period. Mr Ayres informed the Governing Body of the outcomes of the recent NHS ransomware attack and it was noted that there was no significant impact on Kent and Medway CCGs. Mr Ayres formally thanked members of staff that worked hard during the period to ensure the smooth operations of the CCG. Care Plan Management System (CPMS) update The paper formed part of the Chief Officer s report and was presented by Mr Brownless, Chief Information Officer. The report was taken as read and content noted. Mr Brown highlighted that there were now 7,200 care plans on CPMS with 730 registered clinical users and 54 out of 60 West Kent practices had signed up to the system. It was noted that work was in progress to increase usage. The Governing Body was assured that practices yet to sign up would be engaged with and encouraged to sign up to CPMS. The Governing Body noted the key achievements since inception i.e. data feeding into the system and Organisations that were being engaged to include their data on the system. Mr Brownless reported on progress with the organisations his team were engaging with to sign up to CPMS. Following from the CPMS Improvement Board meeting earlier in the day, there was now an estimated start date with MTW which was placed around the end of July.
The following comments were raised by Governing Body members: - Concerns on successful engagement with the six practices that were yet to sign up to CPMS. - Whether benefit realisation can be demonstrated and the need for quality audit of the system. The coming benefits realisation meetings would be able to feed back to the GB in due course. - The Governing Body/CCG to decide that CPMS was the means by which MDT would function and how to handle lack of engagement from the remaining six practices not signed up to CPMS and agree a way forward. The Governing Body NOTED the Chief Officer s oral report and the Care Plan Management Systems update. 94.1/17 Annual Report & Accounts Update 2016/17 Mr Middleton informed the Governing Body that the draft annual report and accounts had been submitted to NHS England at the required time and was currently being reviewed by the CCG s external auditors (KPMG) for external audit opinion. It was noted that there were a number of transactions relating to primary care co-commissioning that required testing before concluding the audit. KPMG had communicated that they were experiencing challenges extracting source information from the provider (Capita). Mr Middleton reported that the CCG had provided most of the necessary documentation to external audit however some transactions still needed to be evidenced. Assurance was provided to the Governing Body that external audit unqualified approval opinion was anticipated to be provided on the CCG s accounts. Furthermore the CCG was in a position to demonstrate value for money. It was noted that the external audit process would be followed by the Audit Committee sign off meeting. 94.2/17 Delegation of Authority to the CCG and Accountable Officer to sign off Annual Reports and Accounts Mr Segall Jones informed the Governing Body that it was anticipated that the Audit Committee would be presented with the final annual report and accounts at its meeting on the 24 th of May for scrutiny and sign off. However as a precautionary measure and in the event that issues arose from the draft submissions to NHS England, Mr Segall Jones sought Governing approval to delegate authority to the CCG Chair and Accountable Officer to sign off the final report on behalf of the Governing Body. It was noted that the Audit Committee had already been delegated this function. The Governing Body NOTED the update and delegated authority to the CCG Chair and Accountable Officer to sign off the annual report and accounts.
95/17 Revised Corporate Governance Policies (Conflicts of Interest Policy, Gifts & Hospitality and Sponsorship Policy and Procurement Policy) Introducing the paper, Mr Segall Jones informed the Governing Body that the proposed updated policies were for Governing Body approval following recommendations from the management of conflicts of interest guidance issued by NHS England in September 2016 and February 2017 respectively. It has since been established that the recommendations were mandatory for all CCGs to implement. This was a way of NHS England enabling the CCGs to fulfil their corporate governance obligations under the Act. Furthermore the guidance was issued primarily because of the increasing numbers of CCGs taking on delegated cocommissioning of primary medical care. The Audit Committee had previously reviewed and debated the aspects of the guidance issued and where appropriate adopted for recommendation changes to the CCG policies and processes so that we are in line with national requirements. The Governing Body noted that there was now a requirement for an annual audit review of the CCG s arrangements regarding conflicts of interest management and CCGs are further required to be in line with national requirements to be able to get a good assurance rating from the internal auditors. Mr Segall Jones explained that changes to the policies were reflected in track mark ups, further commentaries were added for clarity. Comments and questions were invited from the Governing Body. Mr Smith commented on the procurement policy by referring to the values relating to section 12 procurements needed to go through certain routes and stated that this needed clarity i.e. whether it meant lifetime value rather than yearly value. Mr Segall Jones responded that he was not clear on this requirement and would be seeking expert opinion. (Action: Mr Segall Jones). The Governing Body approved the proposals and changes to the Conflicts of Interests, Gift, Hospitality and Sponsorship and Procurement Policies. 96/17 360 Degree Stakeholder Survey Results 2017 Mr Segall Jones presented the result of the 360 degree stakeholder survey 2017 to the Governing Body which highlighted improvements and slippages from the previous year. Mr Hedges commented that feedback from clinicians indicated that there was a gap in what the clinicians perception of what the CCG was doing and the reality. This point was discussed and it was agreed that the Chair would write an adjunct to the next newsletter to address clinician comments from the last survey. Mr Ayres added that there were challenging times ahead for the CCG due changes in the NHS and advised the importance of open and transparent communication with stakeholders.
Mr Goodger enquired whether the survey defined precisely what the CCG does. The Chair responded that the survey was designed before the era of co-commissioning and did not cover all areas of CCG work. It was agreed that the CCG would design and carry out its own version of the stakeholder survey in order to get maximum benefit. Dr Cameron stated that the general opinion from the patch meetings was the lack of collaborative working between the patches and the CCG and advised a more collaborative approach from the CCG in order to make the relationship successful. Dr Sanjay Singh pointed out that a two way approach was required to make the relationship work, however patients were the focus of collaborative working above other reasons. Dr Jones added that workforce views also needed to be taken on board. From the above discussion, it was agreed that better and open communication of plans was required from the CCG and it was requested that GP Governing Body members champion the above message at cluster meetings. 97/17 Targeted and Specialist Mental Health Service for Young Children and Young People Procurement Outcome Introducing the paper, Mr Ayres provided a background, the need for the exercise and highlighted stages of the procurement. Mr Ayres highlighted stages of the procurement process and informed the Governing Body of the preferred bidder and it was noted that the service was scheduled to commence in the autumn. The report still anonymised the bidders including the preferred bidder due to the purdah period. Further to discussions of the above, the Governing Body approved the award of the contract to provider A. 98/17 West Kent CCG Quality Report The Report was taken as read and content noted. Dr Meriel Wynter outlined the following key areas: The Quality report for the current reporting period was more detailed than the previous month with all Governing Body feedback from April meeting reflected in the report. Outcomes of the serious incidents/never events meeting with the quality team of MTW were noted. One of the issues was under consideration by MTW as to whether to be categorised as a serious incident or never event.
A new quality reporting format was being developed similar to the CQC format. The format would be tested at a Governing Body meeting shortly. The following comments were raised and discussed: Ms Southon raised the following questions 1) clarification on the term never events and how it was treated. Ms Wilkins confirmed that it was a categorisation and treated in the same way and process. 2) details concerning the G4S issue. It was noted that a fuller report on the matter would be available shortly, in the interim the CCG Quality team were providing the support on the reporting format. 3) outcomes of SecAmb CQC inspection. It was noted that Ms Wilkins was awaiting the inspection report. Mr Hedges referred to complaints emerging from KMPT patient experience relating to lack of service provided and failure to adhere to care plan agreed with patients and enquired what the reasons were for this situation. Ms Wilkins was not in a position to provide an answer and agreed to look into the matter for detailed feedback (Action: Paula Wilkins). Mr Smith sought confirmation whether the primary care dashboard was launched on the 1 st of May. Dr Wynter and Ms Wilkins were currently not sighted on the completed dashboard and agreed to follow up the matter. (Action: Dr Wynter/Paula Wilkins). In response to Mr Goodger s query on whether there was a register to track serious incidents Ms Wilkins stated that information was recorded on the STEIS system and also kept on the CCG database, there were plans to link the database with providers and planned collaborative working with other CCGs in this area. It was noted that providers were requested to review trends and themes. Furthermore the quality team was scheduled to do a yearly review which would be reinforced by the work of the national quality team. The Governing Body noted the report and looked forward to the new reporting format. 99/17 & 100/17 Corporate Risk Register & Board Assurance Framework (BAF) The corporate risk register and BAF items were presented together by Mr Segall Jones. It was noted that the CCG corporate risk register and BAF were moderated by the Chief Officer prior to Audit Committee scrutiny. The key highlights from Audit Committee discussion were around how the BAF risks linked with the Sustainability and Transformation Plan (STP) risks and more importantly whether the CCG strategic goals were still relevant in view of recent changes in the NHS. The Governing Body noted the updates on the corporate risk register and feedback following Audit Committee review and recommendations. The following points were raised for discussion:
Mr Smith highlighted that the BAF risks were identified against the achievement of Mapping the Future, however it appeared that the Governing Body did not have a mechanism for monitoring how the CCG was performing against Mapping the Future. Therefore this presented a gap in control. The Chair explained that the Local Care plan to a larger extent would address issues identified in Mapping the Future. The plan would therefore provide the necessary assurance to the Governing Body. In reference to Mr Segall Jones observations on whether the CCG strategic goals aligned with STP, the Chair stated that STP risks from a West Kent perspective needed to be clarified, clearly articulated and assessed. In addition, the CCG strategic goals would need to be refreshed and redrafted in light of the STP as a matter of priority. As a result of the above discussion, it was agreed that that the CCG strategic goals would be reviewed by July and the risks to be refreshed by autumn. (Action: Ian Ayres/Company Secretary/SET). Dr Jones mentioned that there were risks around workforce such as retention, recruitment, workload/capacity pressure and challenges currently not reflected on the corporate risk register or the BAF. Mr Ayres commented that there were on-going discussions regarding whether the real challenges of implementing the STP went beyond the issue of finance and included workforce. It appeared from these discussions that sufficient level attention had not been given to workforce challenges across the system. Mr Ayres also supported the need for a more comprehensive risk analysis of workforce pressures and impact on the system. The Local Care plan would need to identify workforce requirements; detailed plans around workforce and the risk register would reflect the risks around achievement of the plan in this area. The Chair highlighted that the second risk on the BAF mentioned workforce in relation to specific commissioning plans and not to the extent of primary care. The Chair recommended that an additional risk be added following from the workforce discussion. (Action: Richard Segall Jones/Kofo Abayomi). The Governing Body noted the Corporate Risk Register and Board Assurance Framework. 101/17 West Kent CCG Integrated Performance Report (IPR) The report was taken as read and content noted. Mr Middleton highlighted the following for the reported period: There was no finance reporting within the IPR for this period. The year- end had been closed and it was anticipated that a positive outcome would be achieved from the annual report and accounts sign off meeting. Furthermore there was insufficient data to report on month 1 performance, this would change from next month.
In terms of NHS constitutional standards, there was improvement in A&E performance in comparison to the period in West Kent when the standards were lower than national targets across England. The CCG had now improved to an average position over the last few weeks. Slight decline in cancer standards with 27 of 104 patients not commencing treatment within the national constitutional standard. Adverse movement in cancer 2 week standard performance but as indicated in the report, this was driven by provider performance (Medway Foundation Trust). Dementia diagnosis rate had not improved as anticipated. Improvements are required across the constitutional standards in the new financial year to reflect the ambitions of the planning process agreed with NHS England. In addition to the above impacting patient experience, it had also affected the CCG in earning quality premiums income. Therefore the CCG s efforts to improve against a range of quality standards were negated by the CCG s failure to achieve constitutional standards. The Finance and Performance Committee have however requested a report on the capability to achieve the quality standard for 2018/19 with the view of earning quality premiums for that year. The Chair of the Finance and Performance Committee would be overseeing this process. The following were highlighted during the discussion: Dr Garry Singh highlighted that although the CCG was not achieving the constitutional standards, the CCG was still in line with national targets. He stressed the need to work with providers for improvements on constitutional standards. Mr Ayres made a clarification on page 308 of the report (Ambulance Waiting Times) regarding reference to Deloitte working with SECAmb and explained that Deloitte was commissioned by Commissioners across Kent, Surrey and Sussex to carry out an economic analysis of money that went into the ambulance service in regards to performance and benchmarked against other ambulance providers, The report was now completed and would be presented to the Commissioners shortly. Ms Collier commented on the dementia diagnosis, the figure for April indicated the right direction; however the chart on page 311 did not show all the practices. Mr Middleton agreed to correct this error in future reports. The Chair also recommended that the charts reflect rates for clarity purposes. Since this information was no longer offered, the Chair requested that the information be benchmarked against demographics. Dr Garry Singh
responded that this had been carried out and discussed at the Finance and Performance Committee. 102/17 Clinical Strategy Group Report The report was taken as read and contented noted. 103/17 Finance and Performance Committee Minutes The report was taken as read and content noted. 104/17 Audit Committee Report and Minutes The report was taken as read and content noted. 105/17 Governing Body Forward Planner The Governing Body forward planner was noted. 106/17 Any other business There was no other business. The Chair thanked everyone for their attendance and closed the meeting at 15.30 hrs. Date of next meeting: Tuesday 27 th June 2017 at 13.30 hrs The Village Hotel, Maidstone.