Report to the Sutton Clinical Commissioning Group Governing Body Date of Meeting: 14 th November 2015 Agenda No: 21 ENCLOSURE: 18 Title of Document: Approved minutes of Committees of the Sutton CCG Governing Body Report Authors: As per details on each attachment Purpose of Report: For Note Lead Director: As per details on each attachment Executive Summary: The following minutes are attached for the Governing Body to note: Executive Committee: 30.09.15, 14.10.15 Finance Committee: 19.08.15, 17.09.15 Quality Committee: 20.08.15, 17.09.15 SWL Joint Committee for Primary Care: 09.07.15 Recommendation(s): The Governing Body are asked to: NOTE the minutes.
NOTES OF THE SUTTON CLINICAL COMMISSIONING GROUP EXECUTIVE COMMITTEE MEETING Wednesday 30 th September 2015, 2.00pm - 3.30pm Meeting Room 1, Priory Crescent, Cheam SM3 8LR Present Dr Chris Elliott CE Chief Clinical Officer / GP - Benhill & Belmont Surgery (Chair) Jonathan Bates JB Chief Operating Officer Dr Jeffrey Croucher JC Locality Lead, Sutton & Cheam / GP - Benhill & Belmont Surgery Dr Simon Elliott SE QIPP Lead-Medicines Management Dr Dino Pardhanani DP QIPP Lead-LCCs & Service Redesign / GP - Mulgrave Road Surgery Dr Roshni Scott RS QIPP Lead-Medicines Management Dr Chris Keers CK QIPP Lead-Mental Health / GP - Wrythe Green Surgery Sue Roostan SR Director of Commissioning and Planning, SCCG Sian Hopkinson SH Director of Performance & Primary Care, SCCG Dr Farhan Rabbani FR Wallington Locality Lead Dr Mark Wells MW QIPP Lead-Acute Contracts / GP - Wrythe Green Surgery In Attendance Ian Gordon IG Associate Partner - Contracts, South East CSU Mary Hopper MH Director of Quality, SCCG Dr Brendan Hudson BH SCCG Chair, Observer Sarah Taylor ST Head of Medicines Optimisation (Chief Pharmacist), SCCG Dr Vinesh Patel VP Cancer Clinical Lead, SCCG Dr Zaitun Ahmed- ZA-J Macmillan GP, SCCG Jushuf Sarah Raheem SRa Commissioning Manager, SCCG Jackie Sullivan JS Chief Operating Officer, ESH Dr Jonathan Ratoff JR Cancer Clinical Lead, ESHT Dr Pieter LeRoux PLR Consultant Urologist, ESHT Badriya Maghrabi BM New General Manager for Cancer, ESTH Paul Chiles PC General Manager for Cancer, ESTH Deborah Frodsham DF Deputy Chief Operating Officer, ESTH Dr Shelley Dolan SD Chief Nurse, RMH Dr Nicola Lang NL Director of Public Health, LBS/SCCG Apologies Jane Walker JW Head of Corporate Governance, SCCG Karol Selvey KS QIPP Lead / Nurse Practitioner & Partner - Dr Grice & Partners Geoffrey Price GPr Chief Finance Officer, SCCG Dr Ash Mirza AM Carshalton Locality Lead / GP - Faccini House Surgery
Welcome & Introduction 1. Welcome and Apologies CE welcomed everyone to the meeting and introductions were made. ACTION Apologies of absence are noted above. Understanding and Improving Cancer Performance 2. Understanding & Improving Cancer Performance Primary Care VP gave a comprehensive and detailed presentation on key areas which included the two week rule referrals and the implications, the implementation of straight to scope, the new NICE guidance and follow up in primary care for prostate cancer patients. Epsom and St Helier University Hospitals NHS Trust JS and JR presented a thorough insight on their challenges to achieve the 62 day target, highlighting specialities such as urology and colorectal. Royal Marsden NHS Foundation Trust SD gave a presentation from RMH standpoint on the 62 day pathway, a reflection of targets and the effects. The action plan incorporated the challenges internally as well as on the systems, the actions to date and the perceived next steps in order to move this forward. CE thanked VP, JS, JR and SD for their extensive presentations. 3. Understanding & Improving Cancer Performance Questions and discussion session CE: What is the quality of referrals and is it possible to identify themes around potentially unnecessary referrals. There is a concern we will see a rise in referrals, from the new NICE guidelines some of which will be inappropriate. JR: Referrals are received into the Trust electronically; these should contain all the mandatory fields and remove any issues we had previously. There are fields that need to be completed correctly before the referral goes to the MDT. PLR: This is not a major issue for Urology, as patients go straight to imaging (haematuria). A One Stop service, involves triage with patients going onto receiving a CT scan prior to hysteroscopy and booked for resection. However for cases of Prostate cancer - it may be correct to refer a patient on a TWR pathway. In cases where patients are elderly e.g. Page 2 of 4
an 89 year old man and borderline PSA there is potential not to put them onto a two week pathway, they could be followed up as a watchful wait. It is difficult to find the time to downgrade - easier to let a referral run on course and take up an appointment slot. CE: The new NICE guidelines stipulate tests being done, which will help appropriate referrals being received into the Trust. Clearly in cases of invasive bladder cancer, it is clear that a patient will need to be treated urgently with resection. JB: Noted there had been a lot of progress highlighted in the presentations from primary care and provider perspective, and asked what should be the specific goals set for the next 12 months? VP: From a primary care perspective we need to continue to improve communication to practices, and the drive to ensure GPs gather the necessary information to improve the quality of referrals. GPs need to have the discussions with patients and make them aware of availability once on an urgent pathway. If patients are unable to commit to being available this will reduce the number being added to an urgent pathway. The CCG hopes to support the Trust in working through the implementation of the new guidelines and patients being seen in 7 days. JR: ESTH - working with radiology and endoscopy, changing the pathways. Trust does 31,000 CT scans and only has two scanners which is challenging when managing the current throughput of referrals. SD: GSTT model makes sense for Prostate - need a nurse practitioner. RMH Vanguard - key KPI s around the 62 Day standard can be met if North and SW London join together to improve patient experience. More about service delivery and not about revising pathways. Commissioners need to spend money wisely for common cancers. NL: VP s presentation had highlighted that screening uptake for Sutton was below average in terms of coverage. NL will link Public Health NHSE with Sutton CCG s cancer team to address this. SE: Primary care can help with conversion rates, lots of variation exists. Practices should do an audit of two week rule referrals to see how many convert to cancers. SD: More about good communication across the system and having capacity to treat our patients. Page 3 of 4
At practice level this audit could be funded from Prostate Cancer research monies with Prof Wiseman s assistance. JC: Potential to put cancer care into the GP Engagement scheme. Should ensure it doesn t take too much time to downgrade referrals in secondary care. There will be opportunities for GPs to do tests before referrals to ensure that correct referrals are made. DP: Need to look at the evidence in primary care- is it a lack of direct access to diagnostics? For Urology, is there opportunity to develop an urgent outpatient referral form at 2-4 weeks for patients to be seen? CE: An audit was done two years ago. Practice Profile date is available from TCST which summarises the data. SH: The Practice Profile data has TWR data - but this is challenging to see. Do we have a toolkit for TWR s? SD: One point of contact is Teresa Moss, Lead of TCST (Transforming Cancer Services Team). CE: We need this information available to us by locality. RMH Slide - Patient story using examples of practice nurses for low risk or follow up cases. CE once again expressed his thanks to the presenters for attending the Executive Committee and reiterated the significance of continually working together to ensure the provision of services to patients. Any Other Business 4. Any Other Business No further business for discussion. 5. Date of Next Executive Committee Meeting Wednesday 14 th October 2015, 1.00-3.00pm, Meeting Room 1, Priory Crescent. Page 4 of 4
MINUTES OF THE SUTTON CLINICAL COMMISSIONING GROUP EXECUTIVE COMMITTEE MEETING Wednesday 14 th October 2015, 1.00pm - 3.00pm Meeting Room 1, Priory Crescent Present Jonathan Bates JB Chief Operating Officer Dr Jeffrey Croucher JC Locality Lead, Sutton & Cheam / GP - Benhill & Belmont Surgery Dr Chris Elliott CE Chief Clinical Officer / GP - Benhill & Belmont Surgery (Chair) Dr Simon Elliott SE QIPP Lead-Medicines Management Sian Hopkinson SH Director of Performance & Primary Care Dr Ash Mirza AM Carshalton Locality Lead / GP - Faccini House Surgery Dr Dino Pardhanani DP QIPP Lead-LCCs & Service Redesign / GP - Mulgrave Road Surgery Geoffrey Price GPr Chief Finance Officer, Sutton CCG Dr Farhan Rabbani FR Wallington Locality Lead Sue Roostan SR Director of Commissioning and Planning Dr Roshni Scott RS QIPP Lead-Medicines Management Karol Selvey KS QIPP Lead / Nurse Practitioner & Partner - Dr Grice & Partners In Attendance Ian Gordon IG South East CSU Dr Brendan Hudson (part) BH Chair Alastair Hughes (part) AH Interim Director of Service Transformation Carol Lambe (part) CL Assistant Director Commissioning, Children s & Community Services Megan Milmine (part) MM QIPP Programme Director Jane Pettifer (part) JP Head of Continuing Care Jane Walker JW Head of Corporate Governance Apologies Dr Chris Keers CK QIPP Lead-Mental Health / GP - Wrythe Green Surgery Dr Mark Wells MW QIPP Lead-Acute Contracts / GP - Wrythe Green Surgery Welcome & Introduction 1. Welcome and Apologies CE welcomed everyone to the meeting and apologised for the length of the agenda and the volume of papers. He asked JB to discuss with Management Team the possibility of improving the content of the cover sheets to reduce the volume of reading. ACTION JB Apologies of absence were noted and recorded as per the above. Page 1
2. Declarations of Interest The Register of Interests was agreed as a correct and accurate recorded. 3. To approve the minutes of the Executive Committee meeting held on 2 nd September 2015 The minutes of the meeting held on the 2 nd September 2015, were approved as a correct record of the meeting. The minutes of the meeting held on the 30 th September 2015, would be submitted for approval to the 21 st October 2015 meeting. 4. Matters Arising & Action Long The action log was updated and would be submitted to the next meeting of the Executive Committee. JW JW Items for Decision 5. Governing Body Draft Agenda 4 th November 2015 JB presented the draft agenda for both Part 1 and Part 2 of the Governing Body meeting scheduled for the 4 th November 2015. Members were asked to note the key items on the agenda subject to final sign off by BH and CE. It was agreed to move the Locality Lead Appointment from for approval to for information, as it was only the responsibility of the Governing Body to announce the new appointment rather than agree. JW 6. Primary Care Support Model A Plan for Implementation MM attended the meeting on behalf of Terri Brunne, Projects Manager, to present a paper which set out a plan to implement the Primary Care Support Model business case by putting in place a package of on-going support to GP practices to enable and strengthen proactive care planning and multi-disciplinary working. MM stated the paper detailed amendments to the proposal previously agreed at both Management Team and the Executive Committee. It was now proposed that a team of six clinical facilitators were required together with one administrator, rather than the previously agreed five facilitators and a senior post. Page 2 of 9
This was to take into account that the team would be hosted by the Royal Marsden and to ensure that the facilitators could be allocated adequately across the three localities. The Royal Marsden had agreed to manage the recruitment process with the aim of having the team in post by January 2016. MM confirmed that even though the post would be hosted and accountable to the Royal Marsden, MM would be overseeing the work of the team including the relationship between the facilitators, patients and their care plans. The Executive Committee APPROVED the composition of a support package to GP practices and a plan to implement it. The Executive Committee AGREED the objectives against which to measure the proposed support package as detailed within the paper. 7. Digital Road Map Geography SH introduced a paper which confirmed that all CCGs were required to develop a Digital Road Map to describe how they and partner organisations plan to advance the digital agenda. SH stated that the first step was to agree which organisations were in each CCG s footprint and whether the CCG intended to work collaboratively with other CCGs. Given SWL CCGs were already working together on a number of IM&T workstreams, it was proposed that the six CCGs would work collaboratively on a digital road map. SH confirmed that the paper outlined the proposal in detail and described the current IM&T governance. It was included draft templates for submission, showing the partner organisations within the SWL footprint and nominating Merton CCG as the lead CCG. SH agreed to check whether or not SELDOC sat within the SEL geography, otherwise it would need to be included within the SWL footprint. It was also suggested that Central LCH should now be included. SH also agreed to be the lead contact for the digital roadmap on behalf of Sutton CCG, rather than as currently identified, Jonathan Bates. SH SH Page 3 of 9
The Executive Committee AGREED the local digital roadmap footprint following clarity with regards to SELDOC and Central LCH. 8. 2015/16 Investments Refresh AH presented a revised portfolio of investments which was in line with the Sutton CCG investment strategy and had been reviewed at both the Management Team meeting and the Clinical Strategy Group. The presentation also summarised the overall impact on the non-recurrent and recurrent spend commitments. AH confirmed that there was further room for the submission of new business cases throughout the year, with another refresh planned for December 2015. CE stated that he felt reassured to note that the proposer of each investment included both a manager and clinician. It was also noted that a number of the investment proposals would hopefully reduce the number of emergency admissions which could then release more funding for investment next year. The Executive Committee APPROVED the portfolio of new proposals. 9. SWLCC Crisis Response Business Case Transformational Funding Application 2015/16 SR introduced a paper which had previously been circulated and considered virtually by the Executive Committee to support the Doc in a Car initiative ran by Sutton CCG last winter and which was now planned to be replicated across SWL. SR reported that there had been agreement by a clear majority of the Executive Committee to support the crisis response business case. The paper also set out how a good initiative instigated in Sutton was being replicated across other SWL CCGs. The Executive Committee formally endorsed the decision made virtually to support thee crisis response business case. Page 4 of 9
10. Clinical Strategy Group Terms of Reference AH introduced the draft terms of reference for the newly established Clinical Strategy Group which would take the place of the previous QIPP Steering Group and Clinical Effectiveness Group. AH confirmed that the Clinical Strategy Group had been established in accordance with Sutton CCG s Constitution. AH confirmed that the Chair s intention was to step down after an initial period of three months to enable a new Chair to develop and step in to his place. AH noted that Jonathan Cockbain should be removed from the membership and even though all three Locality Leads should be invited it would be appropriate for only one to attend. AH The Executive Committee APPROVED the Terms of Reference subject to the above amendment. 11. CAMHS Transformation CL attended the meeting and presented a paper on the CAMHS Transformation Plan 2015/16 which outlined Sutton s response to Future in Mind; Promoting, Protecting and Informing our Children s Mental Health and Wellbeing (March 2015). CL confirmed the funding allocation awarded to Sutton CCG following guidance published by NHSE in August 2015. This was detailed within the report. Local Transformation Plans must be signed off by HWBB and submitted to NHSE by October 16 th 2015 in order to access the 2015/16 allocation. CL explained that the Transformation Plan needed to demonstrate the 2015/16 allocation ( 262,496) would be spent in year on additional services to meet the future in mind recommendations. CL stated that the main areas of investment included: - Self-referral - On-line resource (working with jump-start) - A drop-in centre run by the voluntary sector - MH leads within local schools. CL agreed to ask CAMHS to inform both schools and GPs when children present to ensure a whole systems approach. CL Page 5 of 9
Following discussion the Executive Committee welcomed and agreed the Transformation Plan. Items for Discussion 12. Commissioning Support Services Re-procurement GP presented an update following the previous report presented to the Executive Committee at its meeting on 2 September 2015, whereby SWL CCGs preference was to extend the current contract for a year (with the exception of some services) so that a new contract would start on 1 April 2016. GP confirmed that Paula Swann (CO of Croydon CCG and CO lead for the procurement for SWLCCGs) sent a SWL CCG position paper to NHSE which set out the context of local needs, national timeline extension and general nervousness. It set out that SWL CCGs would enter the LPF framework in early April 2016 but not commence a new contract until April 2017. This would mean extending the existing SLAs for 12 months on existing terms subject to some service line amendments for specific CCGs. It was also noted that this provides additional security to the SECSU at a critical time where they are financially challenged. It was also reported that NHSE's response was that they support this approach. GP raised the potential issue of SEL CCGs working to a new contract date of 1 July 2016. If this was to go ahead and they select an alternative provider, there was a risk this could effect the viability of the SECSU with a consequent impact on Sutton (and other SWL CCGs). GP agreed to circulate a list of services the CCG were planning to continue to purchase and keep the Executive Committee informed of any developments. GP The Executive Committee NOTED the report. 13. 2015/16 Commissioning Intentions update SR presented an update paper of the 2015/16 Commissioning Intentions. Attached to the report were the notice letters for acute contracts and the mental health contracts for information. Page 6 of 9
SR reported that due to the new contract for community services that would commence in April 2016, there was not a need to send a full commissioning intentions letter as the new service specification included this for the coming year. SR confirmed that feedback following the Sutton CCG away day would be fed into the contracting round discussions over the coming weeks/months. The CCG was expecting guidance late December 2015/early January 2016 that would also support commissioning in 2016/17. SR confirmed that a further paper, including the output from the away day would be submitted to the Executive Committee on 21 st October 2015. SR The Executive Committee NOTED the report. 14. Appointment of an Independent Clinical review Clinician and additional session for Cancer Lead SR presented a job description for approval by the Executive Committee and to agree to recruit to the role. The purpose was to support independent clinical review which reduces conflict of interest in clinical areas. SR also requested Executive Committee approval to increase the sessions of the Cancer Services clinical lead from 1 to 2 per week, due to the high priority to improve 62 day cancer waits. The Executive Committee APPROVED the JD and supported recruitment into this role, noting a review date of March 2016. The Executive Committee APPROVED the request for an additional session (1 per week) for the cancer services lead clinical. 15. Report on CHC Spend and Budget JP tabled a paper which provided the Executive Committee with an update on Continuing Care management and spend. JP agreed to continue to provide the Executive Committee with regular updates as requested at their meeting on 2 September 2015 due to the reported overspend. JP Page 7 of 9
The Executive Committee NOTED the update. Standard Items 16. Feedback from Localities Key areas of feedback included: - Locality workshop and discussions around the engagement scheme and future ways of working. - Presentations from GPs with regards to regular attendees at A&E. - CQC workshop and useful feedbacks from practices. It was noted that the Locality Lead vacancy for Sutton & Cheam had now closed. A Nominations Committee had been arranged to review the shortlist prior to the Locality meeting scheduled for the 28 th October 2015. 17. QIPP Report - Month 5 AH presented the QIPP report and confirmed that the current (M4) forecast outturn is 107% of the net target at year end. It was noted that the majority of schemes were performing at or above plan. There were also a small number of schemes with delayed starts or were a risk. The Executive Committee NOTED the report. 18. Finance Report - Month 6 GP reported that the CCG was on plan year to date and full year forecast. Acute services full year forecast was 700k underspent. A written report would be submitted to the 21 st October Executive Committee. The Executive Committee NOTED the update. For Information 19. Approved Minutes The Executive Committee noted the following approved minutes: - Primary Care Steering Group 2 July 2015, 6 August 2015 - Planned Care Working Group 27 August 2015 - Management Team Action Notes August/September 2015. Page 8 of 9
20. Governing Body Appointments JB confirmed that Sally Brearley had been re-appointed as the Governing Body lay member for PPI. No appointment was made to the Independent Nurse post. Any Other Business 21. Nurse Revalidation KS informed the Executive Committee that Nurse Revalidation was due to commence April 2016. KS confirmed that practices were required to support the process and ensure nurses were given protected time to complete the nurse revalidation on-line tool. KS agreed to circulate the slides through the Practice Managers Forum. Estates Strategy GP confirmed that the CCG were required to produce an Estates Strategy by the end of December 2015 for submission to NHSE. This would come back to a future meeting of the Executive Committee. KS GP 22. Date of Next Meeting Wednesday 21 st October 2015, 2.00pm-3.30pm, Meeting Room 1, Priory Crescent. Page 9 of 9
Attachment 2 SUTTON CLINICAL COMMISSIONING GROUP DRAFT MINUTES OF A MEETING OF THE FINANCE COMMITTEE Wednesday 19 August 2015 Present : Dr Brendan Hudson ( Chair ) Paul Sarfaty, ( lay member, governance and audit ) Les Ross, ( lay member, secondary care consultant ) In attendance: Geoff Price, CFO 1. Apologies and minutes of the meeting of 17 June ( note no meeting held in July ). Apologies Jonathan Bates The minutes of the meeting of 17 June were approved. Matters Arising The committee noted the NHSE letter of 15 July 2015 which gave approval of the CCG s 1516 operating plan which was assured for finance, activity and performance. 2. Financial Report M04 GP presented the report. The CCG reported to NHSE on 12 August on the M04 financial position. That report shows that the CCG is on plan year to date ( the 4 months ended 31 July 15 ) and full year forecast. As usual this is based on M03 acute numbers. In terms of the full year forecast Overall the CCG is reporting meeting plan for both program and running costs There is an overspend on continuing health care costs of 1.25m but this is covered by the acute underspend and reserves The CCG is reporting a full year forecast underspend of around 800k on acute services contracts ( based on M03 acute SLAM returns ). This is a prudent view of the acute position and based on o Where a provider is overspent, that overspend will continue
o Where a provider is underspent, that the provider will work to plan for the remainder of the financial year The CCG continually reviews the forecast full year outturn and prepares various scenarios based on assumptions on commissioned services. The year end outturn will depend on the acute outturn, any new investment slippage; recovery of excess 1415 overseas visitor costs and other factors. The Committee discussed the CCG s financial position and the implications of an acute underspend. The Committee decided to wait until more concrete acute data was available when a more robust full year forecast could be made. The balance sheet position is satisfactory. The level of debtors and creditors are reasonable and KPIs have been met with regard to month end cash balances and the BPPC code of conduct ( at least 95% of invoices paid within 30 days of receipt ). Overall the CCG is reporting a satisfactory financial position.. 3. Financial Control Environment Assessment Mr Price presented the report. NHSE has asked all CCGs to carry out a self-assessment of their financial stewardship arrangements. This is in the context of the significant financial challenges facing the NHS and prior to the roll out of a financial resilience toolkit. The letters from NHSE ( dated 17 July from Paul Baumann, Finance Director, NHSE, and a follow up letter from the NHSE London Region office ). An initial draft needs to be submitted by 24 August and a final, subject to Audit Committee and Governing Body sign of, at the end of August. These two committees meet on 03 September and 09 September respectively. The Committee reviewed the template return together with comments from internal audit who had been sent the draft return. The Committee agreed some amendments suggested by internal audit and agreed a draft to be submitted on 24/08. Comments should then be received from NHSE before the final submission before 31/08. This is subject to Audit Committee and Governing Body approval. 4. Charitable Funds Mr Sarfaty reported that there were no significant items to report. However subsequent to the meeting it was discovered that the 1415 report and accounts should have been included on the agenda so that these could be reviewed and recommended for approval. Thus following the meeting the draft report and accounts were circulated to members. The report and accounts were considered by the Charity Committee and
recommended for approval at its meeting on 22 June. The Charity Committee reports to the CCG Finance committee who then make recommendation to the Governing Body which is the corporate trustee of the Charitable funds.the auditors have completed their independent examination and have no issues to raise on the accounts. Members of the Finance Committee were sent A high level summary of income and costs for the last 5 years The 1415 annual report The 1415 accounts The balance on the various funds making up the total fund as at 31 March 2015 After perusal, the members of the finance committee agreed to recommend the draft 1415 report and Accounts of the Sutton and Merton CCGs Charitable Fund for approval by the Governing Body at its meeting on 09 September.. 5. Any Other Business Managing Risk across SWL 2015/16 Mr Price presented a paper on titled Managing Risk across SWL 2015/16, written by the CFO of Wandsworth CCG who also acts as the nominated CCG finance lead for the SWLCC. This paper has had input from all the other CCG CFOs and is supported by them. The paper and its recommendations are being taken through internal governance in the SWL CCGs and to the SWL Joint Commissioning Group for approval. The paper includes support to Croydon CCG ( CCCG ). At the last Governing Body meeting on 01 July, the GB agreed to delegate the decision on any support to Croydon CCG to the Finance Committee. Such decision to be reported to the GB. In summary the paper proposes balancing the funding and costs of the SWL risk pool, the SWL transformation pool ( also known as clinical development group ( CDG ) investment pool ), the London Transformation program ( LTF ) and the costs of the SWL Commissioning Collaborative ( SWLCC ) taking account of the following : Currently no NHSE contribution to the costs of the SWLCC The need to demonstrate more effective collaborative commissioning by producing a financial plan that shows CCG sustainability and in particular how will CCGs support Croydon CCG given their financial position Create a transformation pot for providers to access in order to develop a sustainable provider landscape Demonstrating the above in order to access funds from NHSE to support transformation in SWL.
In reaching a revised proposal to close the gap the CFOs wanted to ensure some key points were emphasised before reaching agreement, namely: This is a one year agreement as some of the sources are non-recurrent This proposal does not set a precedent for any future year agreement No additional contributions should be sought from SWL CCGs whilst maintaining a risk pool Continue to pursue NHSE-L for a contribution in 15/16 Emphasise that this agreement should be seen as a step towards unlocking significant funds as demonstrated in other SPGs Keep budget of SWLCC at 5m and ensure costs remain within plan Expect and plan for return of slippage on LTF (currently 10% of 2.5m SWL contribution) The impact on Croydon CCG is: Contribute towards the SWL Risk Pool but get first call on return of contribution if unused Contribute to SWLCC programme costs at a reduced level which recognises the financial pressure No contribution to LTF made up through other CCGs contribution to the CDG pot No contribution to the CDG investment pool unlike other CCGs the historic deficit position prevented CCCG from accessing its legacy Continuing Health Care payment which has been used by SWL CCGs to create an investment pot Overall, and in total, the non-contributions benefit CCCG by around 2.3 million. All of this benefit has been used to minimise the CCCG deficit to 11.9m Mr Price had calculated the Sutton CCG contribution to CCCG. This is around 195k and is SCCG s proposed share to make up the reduced contribution of CCCG to the costs of the SWLCC and nil contribution to the LTF. The recommendations of the paper are 1. SWLCC continue to pursue NHSE-L for contribution to the programme 2. SWL CFOs work with SWLCC to ensure expenditure remains within the original budget of 5m 3. The overall funding shortfall of 3m identified is funded from the 4m CDG investment pot 4. Any slippage from the LTF that is returned to CCGs goes back into the CDG investment pot
5. SWLCC works with NHSE to outline next steps to access significant support funds as demonstrated in other SPGs 6. The revised proposal is for 2015/16 only The Committee discussed all the above at length and concluded, in all the circumstances, to support the recommendations including the support to Croydon CCG. SWL acute providers seeking financial support from commissioners Mr Price stated that Sutton CCG had directly received a request for financial support from Epsom St Helier NHs Trust and SWL CCGs as a whole had received a request for support from all the acute providers in SWL. A response was being considered by the JCB. It is likely that any support, either individually from a CCG or collectively, assuming CCGs have the resources to do so, will be for transformation support only, ie to support putting the providers on a sustainable financial basis and not to support deficit positions. The Committee agreed with this position. Next meeting The meeting scheduled for 16 September 2015 now clashes with the CCG AGM. It was agreed to have the next meeting on Thursday 17 September at 1pm.. Matters carried forward Update on support for proposals for managing risk in 1516 Update on acute provider support
Attachment 1 SUTTON CLINICAL COMMISSIONING GROUP DRAFT MINUTES OF A MEETING OF THE FINANCE COMMITTEE Thursday 17 September 2015 Present : Dr Brendan Hudson ( Chair ) Paul Sarfaty, ( lay member, governance and audit ) Les Ross, ( lay member, secondary care consultant ) In attendance: Geoff Price, CFO 1. Apologies and minutes of the meeting of 19 August. Apologies Jonathan Bates Not all members had access to the minutes and it was agreed these would be reviewed and agreed at the next meeting. Matters arising : Update on support for proposals for managing risk in 1516 at its meeting on 09 September the CCG Governing Body endorsed the decision of the Finance Committee ( to whom such decision had been delegated ) Update on acute provider support SWL COs had written to the CEO of ESH ( who had written to SWL CCGs on behalf of SWL acute hospital providers ) asking for clarification of support requested and specific proposals. These have not been received to date. 2. Financial Report M05 GP presented the report. Financial Control Environment Assessment The final Financial Control Environment Assessment template had been submitted to NHSE on 01 September. This had been approved by the Audit Committee and Governing Body and signed off by the CCG Accountable Officer. Action : the Committee requested copy of the final submission.
Financial Report M05 The CCG reported the M05 position to NHSE on 09 September. Key Financials Surplus/(Deficit) 000 Running costs 000 Plan YTD 608 1699 Actual YTD 608 1699 Full year plan 2340 4078 Full year 4078 2340 forecast The CCG is reporting on plan year to date ( the 5 months ended 31 August 15 ) and full year forecast. This report uses month 03 prescribing and month 04 acute data. In terms of the full year forecast, overall the CCG is reporting meeting plan for both program and running costs. Highlights are : A full year forecast overspend on continuing health care costs of 1.75m A full year forecast underspend on acute contracts of 500k A full year forecast overspend on MH of 500k due to high cost placements A full year forecast underspend on prescribing of 500k. Action : the Committee requested a report on the CHC and action being taken. All other commissioned services on plan. The net overspend is covered by reserves. The CCG is reporting an underspend of around 500k on acute services. However this is a prudent view of the acute position and based on Where a provider is overspent, that overspend will continue Where a provider is underspent, that the provider will work to plan for the remainder of the financial year The summary income and expenditure account is shown in appendix A. The summary acute provider position is shown in appendix B. For information the overall acute provider contract position for SWL was given in appendix C. This showed that ESH was the only significant acute provider that was operating at or around contract level. Most others were overperforming on contract, particularly Kingston and St Georges, though not with Sutton CCG.
NHSE has asked CCGs to reflect on their financial position when reporting M06 given the national NHS financial position and if possible increase planned surpluses. Sutton CCG reviews and monitors it s financial position on an ongoing basis. Schedule D includes such review based on different scenarios for discussion at the meeting. After discussion, the Committee felt that the CCG should report on plan subject to the underlying results and discuss options at the next meeting in terms of potential forecast outturns. Action : financial options to be discussed at the next meeting in terms of potential forecast outturns. 3. Charitable Funds Mr Sarfaty reported that the 201415 Report and Accounts were approved by the CCG Governing Body as corporate trustee at its meeting on 09 September. There were no other significant items to report. The next meeting was on 19 October. 4. Any Other Business Next meeting The next meeting is scheduled for 21 October at 9am. Matters carried forward Action : the Committee requested copy of the final Financial Control Environment Assessment submission. Action : the Committee requested a report on the CHC and action being taken Action : financial options to be discussed at the next meeting in terms of potential forecast outturns
MINUTES OF THE SUTTON CLINICAL COMMISSIONING GROUP QUALITY COMMITTEE MEETING Thursday 20 th August 2015, 2.00pm - 4.00pm at Priory Crescent Present Sally Brearley SB Chair, Quality Committee Annette Brown AB Healthwatch Dr Jonathan Cockbain JC GP Clinical Lead - Urgent Care Dr Simon Elliott SE GP Clinical Lead - Medicines Management Mary McKenna MM Independent Nurse Governing Body Member Les Ross LR Secondary Care Consultant Governing Body Member Dr Roshni Scott RS GP Clinical Lead - Medicines Management Karol Selvey KS Nurse Practitioner Governing Body Member Clare Ridsdill-Smith CRS Public Health Principal In Attendance Anna Cassin AC Designated Nurse Safeguarding Adrian Davey AD Joint Commissioning Manager Mental Health Mary Hopper MH Director of Quality Carolyn Moore CM IPC Specialist Claire Symons CS Designated Adult Safeguarding Manager Sarah Taylor ST Head of Medicines Optimisation Jane Walker JW Head of Corporate Governance Apologies Jonathan Bates JB Chief Operating Officer Dr Chris Elliott CE Chief Clinical Officer Geoffrey Price GPr Chief Finance Officer, Sutton CCG Hilary Smith HS Vice Chair Sutton CCG Patient Reference Group Dr Mark Wells MW GP Clinical Lead - Acute Contracts Welcome & Introduction 1.1 Welcome and Apologies SB welcomed everyone to the meeting. ACTION 1.2 Declarations of Interest The Quality Committee approved the Register of Declared Interests as a full, accurate and current statement of all interests held noting the following amendments: Les Ross confirmed that his son was no longer employed by Sutton Council and asked for it to be removed from the Register of Declared Interests. It was noted that Dr Roshni Scott was not currently listed on the Register of Declared Interests for the Quality Committee. It was agreed to add Dr Scott for future meetings. JW
For Review/Discussion 2.1 Quality & Performance Report MH introduced the Quality section of the report and informed the meeting that the full report, both Quality and Performance, would be discussed at the Executive Committee on 2 nd September 2015. MH confirmed that a number of questions raised with regards to the Quality report at the July Governing Body meeting had been included within the revised report. MH suggested that in future members raise questions at the Quality Committee rather than the Governing Body meeting as more time could be dedicated to responding. MH summarised a number of key areas within the report: Epsom and St Helier University Hospitals NHS Trust Focus continued on Health Care Acquired Infections, Cancer and meeting 18 weeks waiting times across all specialities. CQUINs for 2015/16 had been agreed. Increased efforts were being made to address the delay in responding to complaints, the Trust hope to see a vast improvement in this by October 2015. St Georges Work was underway to support improved process around inter hospital transfers. The initial analysis had been completed and actions were now being put in place. Increased scrutiny was being undertaken by the lead CCG to ensure the current financial position of St Georges did not impact on quality. South West London and St George s Mental Health NHS Trust Good progress had been made across the Trusts transformation programme and improvements were now being seen. Safeguarding The CCG team had been delivering a wide range of training and developing more robust governance and assurance mechanism s across children and adults responding to local and national directives. MH confirmed that a more in depth discussion with regards to Cancer Waits was due to take place at the Executive Committee at the end of September 2015, with representatives from Epsom & St Helier attending. MH stated that work continued at Epsom & St Helier to improve the complaints response time, with a recent appointment to an additional Page 2 of 6
band 6 staff member to oversee the complaints process more closely. MH agreed to invite the Trust to the October meeting of the Quality Committee to talk through the complaints process. MH also confirmed that the CQC visit to Epsom & St Helier had been arranged for 5 th November 2015. The CQC had written to SCCG asking for input prior to the visit. The Management Team were currently drafting a response. MH invited members of the Quality Committee to contribute any comments they wished to make via herself. MH reported that following an investigation into a never event at Epsom & St Helier the Trust was keen to share the finding of the investigation. A learning event had been arranged for 10 September 2015, which the CCG had been invited to. Members of the Quality Committee were also invited to attend. AD informed the meeting that both himself and SB had recently made a visit to both Crocus Ward and Ward 3, where they were impressed with the quality and general feel of the Wards. AD suggested that representatives of Ward 3 should be invited to a future meeting of the Quality Committee to provide an update. MH agreed to add this to the workplan. With regards to SWL&STG Paediatric Diabetes, KS requested comparable data from Epsom & St Helier. It was agreed to ask for this data via the CQRG meeting. CS and AC agreed to ask the school health team for comments with regards to managing diabetes in schools and the problems highlighted in the report at 5.6. MH also agreed to bring back to a future Quality Committee a list of other SCCG Providers. MH ALL ALL MH MH CS/AC MH The Quality Committee NOTED the Quality Report. 2.2. Safeguarding Adults & Children Revised Safeguarding Children s Policy AC presented the revised Safeguarding Children s Policy which had been updated with reference to new guidance and legislation. AC requested for Quality Committee members to provide any feedback by Friday 21 August 2015, prior to final approval at the Governing Body meeting on 9 September 2015. ALL The Quality Committee AGREED the revised policy. Page 3 of 6
Revised NHS Safeguarding Accountability and Assurance Framework 2015 AC asked the Quality Committee to note the revised NHS Safeguarding Accountability and Assurance Framework 2015 and the assurance role of NHSE who will be completing a deep dive audit in Oct/Nov 2015. The Quality Committee NOTED the revised framework. Care Leavers Project AC updated the Quality Committee on the plans to work with the Care Leavers Association and other local partners to support their project looking at the health needs of care leavers and adults who were in care. The project would involve engagement with young people and adults who have care experience in Sutton. The findings would inform both local and national agenda for both service design and provision. AC agreed to circulate an invite to the first meeting for Sutton scheduled for 1 st October 2015. AC The Quality Committee NOTED the documentation and AGREED to offer advice or support to the project. For Approval 3.1 Draft minutes of meeting held on 16 th July 2015 The minutes were agreed as an accurate record noting a couple of typos that would be amended. 3.2 Action log The action log would be updated and taken to the next meeting of the Quality Committee. JW JW 3.3 Quality Risk Register MH introduced the Risk Register and confirmed that no risks had been added to or removed from the Quality Risk Register and there had been no significant changes to report since the last meeting of the Quality Committee. The Quality Committee NOTED the Quality Risk Register. 3.4 Amendment to the Pharmaceutical Industry Policy ST introduced the amendment to the Pharmaceutical Industry Policy stating that the previous policy for working with the Pharmaceutical Committee was approved by Sutton & Merton CCGs Medicines Management Committee in August 2014, and noted by the Quality Committee in November 2014. Recent media interest in relation to senior NHS staff involvement in Advisory boards has necessitated a review of the policy. As a result Page 4 of 6
of the review, it was considered appropriate that the CCG policy on participation in Advisory boards be amended. Participation in Advisory boards, whether paid or unpaid, would not be permitted by Sutton CCG staff, as defined in the policy. ST stated that the policy had been approved by Sutton & Merton CCGs Medicines Management Committee (by chairs action) and asked the Quality Committee to ratify prior to submission to the Executive Committee on 2 September 2015. The Quality Committee RATIFIED the Policy. Standing Items 4.1 Never Events/Serious Incidents/Serious Case Reviews Adults and Children MH confirmed that there had been one Never Event at Epsom & St Helier. The investigation had been concluded as per item 2.1 above. 4.2 Intermediate Care/Continuing Health Care JP updated the Quality Committee with regards to the procurement process for intermediate care beds in Sutton. JP confirmed that the CCG were seeking nursing home providers within Sutton to provide a total of 22 Intermediate Care Beds. It was noted that the contracts with current provides was due to end on December 2015. JP agreed to include a representative from Healthwatch as part of the site visit team. JP 4.3 Infection Control CM gave a verbal update on the current situation with regards to infection control. CM stated that the number of cases within the Trusts were dropping but becoming more complex. 4.4 CQRG Approved Minutes and Feedback The approved minutes and action points from the most recent meeting of the CQRG were noted by the Quality Committee. 4.5 Forward Plan The forward plan was noted and would be updated prior to the next meeting. MH Any Other Business 5.1 Any Other Business There was no further business to discuss. 5.2 Date of Next Meeting The next meeting would take place on Thursday 17 September 2015, 2.00-4.00pm at Priory Crescent. Page 5 of 6
Page 6 of 6
MINUTES OF THE SUTTON CLINICAL COMMISSIONING GROUP QUALITY COMMITTEE MEETING Thursday 17 th September 2015, 2.00pm - 4.00pm at Priory Crescent Present Sally Brearley SB Chair, Quality Committee Jonathan Bates JB Chief Operating Officer Dr Jonathan Cockbain JC GP Clinical Lead - Urgent Care Dr Chris Elliott CE Chief Clinical Officer Mary McKenna MM Independent Nurse Governing Body Member Geoffrey Price GPr Chief Finance Officer, Sutton CCG Dr Roshni Scott RS GP Clinical Lead - Medicines Management Karol Selvey KS Nurse Practitioner Governing Body Member Clare Ridsdill-Smith CRS Public Health Principal In Attendance Anna Cassin AC Designated Nurse Safeguarding Christine Harger CH Quality Assurance Lead Mary Hopper MH Director of Quality Dr Brendan Hudson BH Chair Athar Khan AK London Ambulance Service Jaqui Linoridge JL London Ambulance Service Carolyn Moore CM IPC Specialist Carole Matlock CMa Commissioning Manager for LAS, Hillingdon, Harrow and Brent CCG (via conference call) Jason Morris JM London Ambulance Service Viccie Nelson VN Vanguard Programme Lead Sue Roostan SR Director of Commissioning & Planning Paul Sarfaty PS Governing Body - Lay Member Jane Walker JW Head of Corporate Governance Apologies Annette Brown AB Healthwatch Adrian Davey AD Joint Commissioning Manager Mental Health Dr Simon Elliott SE GP Clinical Lead - Medicines Management Les Ross LR Secondary Care Consultant Governing Body Member Hilary Smith HS Vice Chair Sutton CCG Patient Reference Group Claire Symons CS Designated Adult Safeguarding Manager Sarah Taylor ST Head of Medicines Optimisation Welcome & Introduction 1.1 Welcome and Apologies SB welcomed everyone to the meeting, especially representatives from the London Ambulance Service. ACTION 1.2 Declarations of Interest The Quality Committee approved the Register of Declared Interests as a full, accurate and current statement of all interests held.
For Review/Discussion 2.1 London Ambulance Service SB welcomed Carole Matlock, Commissioning Manager for LAS, Hillingdon, Harrow and Brent CCG, who joined the meeting via conference call and representatives of the London Ambulance Service for attending the meeting and agreeing to give a presentation on current quality and performance issues both in relation to Sutton CCG and across the whole of London. A number of key areas where discussed throughout the presentation including: LAS pay rates Recruitment and retention of staff including international staff Sickness rates of staff Paramedic training Planning ahead for London events Trajectory of LAS targets Joint working with the LA regarding alcohol related incidents Much of the above was covered by the presentation and would be attached to the minutes for information. The LAS agreed to share further information with the CCG with regards to local data including recruitment within Sutton and local call information. SR also suggested that the LAS link with Adrian Davey with regards to the work around Mental Health Street Triage. SB thanked members of the LAS for attending the meeting and giving such an informative presentation. 2.2 Draft Section 11 Safeguarding Children LSCB Self-Assessment AC asked the Quality Committee members to review and agree the content of the Sutton CCG Draft Section 11 Safeguarding Children LSCB Self-Assessment, for submission to Sutton Local Safeguarding Children Board by 18 th September 2015. AC confirmed that both Mary Hopper and Dr Brendan Hudson had reviewed the self-assessment. AC stated that there were still a couple of areas that needed to be added, including the recently ratified Children s Safeguarding Policy. The Quality Committee APPROVED the content of the Self- Assessment, noting the additions to be included. Page 2 of 4