GOVERNING BODY LEAD: Chair ATTACHMENT: Agenda item: A ACTION: For Approval MEETING DATE: 5 th September 2017 MINUTES OF THE THIRTY-SECOND MEETING OF THE GOVERNING BODY OF KINGSTON CLINICAL COMMISSIONING GROUP HELD ON TUESDAY 4 th JULY 2017 KING S CENTRE, CHESSINGTON PRESENT: Dr Naz Jivani CCG Chair Dr Phil Moore Deputy Chair - Clinical Sarah Blow Accountable Officer, SWL Alliance James Murray Interim Chief Finance Officer, SWL Alliance David Knowles Vice Chair & Lay Member Jim Smyllie Lay Member PPE Tonia Michaelides Managing Director, Kingston & Richmond CCGs Dr Gareth Hull GP Member Dr Naeem Iqbal GP Member Dr Pete Smith GP Member Dr Annette Pautz GP Member Nadeem Nayeem Secondary Care Specialist Kathryn Yates Nurse Member MEMBERS IN Dr Atin Goel Council of Members Chair ATTENDANCE: Yarlini Roberts Local Director of Finance, Kingston & Richmond CCGs Kathryn MacDermott Local Director of Primary Care & Planning, Kingston & Richmond CCGs Fergus Keegan Local Director of Quality, Kingston & Richmond CCGs Hannah Keates PPEI & Equalities Lead Jo Dandridge Business Manager APOLOGIES: Paul Gallagher Lay Member & Audit Chair Julia Gosden Local Director of Commissioning Vicki Harvey-Piper Local Director Corporate Affairs & GovernanceIo Iona Liddington Public Health Representative Grahame Snelling Healthwatch Kingston Chair Version: Draft A - 1
Welcome and Introductions: Members of the public were welcomed to the thirty-second meeting of the Governing Body. Declarations of Interest relating to items on the agenda: Members were asked to declare any possible conflicts of interest that had not already been declared on the CCG Register. (All declarations of interest for Governing Body members are listed in the register available at each meeting and also published on our website) Dr Phil Moore declared he was a partner at Central Surgery which provides the medical cover for the community beds currently located at Cedars Unit on the Tolworth Hospital site. Re-provision of these community beds was being discussed at item 17/43. 17/38 MINUTES OF THE THIRTY-FIRST MEETING HELD 23 rd MAY 2017 The minutes of the thirty-first meeting held on 23 rd May 2017 were agreed as an accurate record. 17/39 MATTERS ARISING 33.1 Mental Health Access Standards Following previous discussion within the Integrated Governance Committee Performance report on the nationally reported mental health service targets, it was agreed that the totality of mental health services locally would be the focus of a future Governing Body meeting. Action: Phil Moore 33.1 Dementia care software Further exploration of the dementia care software being used in care homes would be explored outside of the meeting in relation to the community sides of both Kingston & Richmond. Action: Fergus Keegan 17/40 QUESTION TIME The following question had been submitted in advance of the meeting: When a patient is in Kingston Hospital, if they have a problem such as a problem with their hearing and they can be ferried around on a wheel chair; why can they not have the problem dealt with whilst resident in hospital, in this case a hearing test or their ears syringed. This person had to wait until she was discharged from Kingston and in this case she was sent to Tolworth and Tolworth did actually look at her hearing problem. Why can we not have joined up services which would be more efficient and caring for the patient, more efficient for the services when they are all on the same site, save on further appointments etc. with GP s and clinics plus the time and travelling involved for the patient and sometimes the supporting members of the family. A response was provided that care should be given in the most clinically appropriate setting. Routine procedures such as ear syringing and hearing tests are best performed in a community setting. If a patient remains in a hospital bed waiting for a routine diagnostic test or procedure, this can lead to pressures on availability of beds for acutely ill people. Version: Draft A - 2
17/41 CHAIRMAN S REPORT Dr Jivani provided a verbal report to the Governing Body on the following items: 41.1 NHS Confederation The NHS Confederation Annual Conference held in June 2017 brought the health and social care sector together for talks on what the outcome of the recent general election means for the NHS, its workforce, the transformation agenda and the next steps. Members were also briefed on highlights from key-note speeches as follows: Jim Mackey, Chief Executive warned of the tough times ahead to bring the NHS books into balance NHS improvement debate held on why people were trying to save the NHS from transformation Retention of NHS staff and the challenge on cuts to Continual Professional Development funding Opportunities and challenges digital technology presents to improve workforce productivity Jeremy Hunt, Secretary of State for Health suggested cross-party work needed to ensure success of STPs, post-brexit Simon Stevens discussed the NHS overriding priorities over the next year including meeting the A&E target and turning a corner on investment in primary care 41.2 Healthwatch Representation Members were advised that Grahame Snelling would no longer be the Kingston Healthwatch representative on the Governing Body and that details of the new representative would be provided in due course. Grahame Snelling was thanked for his contribution to the Governing Body over the past few years. 41.3 Governing Body Changes The Chair welcomed Dr Annette Pautz as the sixth Governing Body GP Member to replace Dr Junaid Syed who has retired due to ill health. The Governing Body expressed their appreciation to Dr Syed for his valued contribution to the CCG since his appointment in 2012. Dr Atin Goel was also welcomed as the new Council of Members Chair and non-voting member of the Governing Body. 17/42 MANAGING DIRECTOR S REPORT This report highlighted items of interest to Governing Body members and the public including issues not contained within the substantive agenda. 42.1 Local Delivery Unit Members noted that since April 2017, Kingston and Richmond CCGs have been working with a shared management team and within the South West London Alliance. An organisational development plan is in place to support the bringing together of the two staff groups through this period of change. The two Governing Bodies have also been meeting regularly to find areas to work more closely together and governance arrangements were being reviewed to reflect these new working arrangements. Version: Draft A - 3
42.2 Primary Care Leaflet Drop Members were advised that a door drop of Kingston s primary care booklet Stay Well in Kingston: Improving Access to Primary Care was underway and being delivered to 66,000 homes across the borough. Feedback on future iterations was being sought. 42.3 CQC Rating for Your Healthcare CIC Members were informed that Your Healthcare CIC, the provider of health and social care community services had been awarded an overall good rating by the Care Quality Commission following their recent planned inspection. This was Your Healthcare s first inspection since registering as a Community Interest Company and they were awarded good in the four domains of safe, caring, responsive and well-led, and rated as requires improvement for effective services. 42.4 Changes at Kingsdowne Surgery Members noted that Kingsdowne Surgery would merge with the nearby Central Surgery based within Surbiton Health Centre on 1 st July 2017 following the retirement of Dr Syed. Patients will be able to access GP services from both the Kingsdowne Surgery and Central Surgery sites up to the 30 th September 2017 after which date, Kingsdowne Surgery would close permanently. Patients have been assured that their medical records will be securely shared with Central Surgery and there is no need for them to re-register. 42.1 Kingston CCG s Annual General Meeting Members were informed of the CCG s Annual General Meeting which is being held on Tuesday, 12 th September 2017 from 12.45pm to 2.45pm at the King s Centre, Coppard Gardens, Chessington. 17/43 REPROVISION OF KINGSTON COMMUNITY HOSPITAL BEDS Members received a report detailing the options for a short term solution to move the 35 beds currently located at the Cedars Unit on the Tolworth Hospital site to a 25 bedded unit at Teddington Memorial Hospital and a home care based solution for provision of the remaining 10 beds. Members considered the report to be very comprehensive and believed the preferred option seemed sensible as an interim solution. There was some concern expressed about the reduction of 10 community inpatient beds but recognised that a large proportion of these patients could receive enhanced home based care. Members were advised that Richmond currently run the same community hospital service with 25 beds and had managed to reduce the length of stay to ensure beds were regularly available. Members agreed that a caveat should be introduced to ensure Kingston used the same criteria for accepting patients as Richmond. Members emphasised the need to maintain a cost neutral position and were advised that Hounslow & Richmond Community Healthcare Trust were able to consume minimal costs within their capital programme. Members also expressed their concern around workforce retention and issues experienced with recruitment. Version: Draft A - 4
The Governing Body AGREED to support the preferred option for the short term solution subject to the above caveats and the working up of an options appraisal for a more permanent solution for the long term provision of community beds or their alternative. 17/44 IPSOS MORI 360 0 CCG STAKEHOLDER SURVEY Members received a verbal report on the outcome of the 2017 360 o Stakeholder Survey carried out by Ipsos Mori and were advised that Kingston CCG s scores had improved in most areas from previous years. Members noted that 91% of stakeholders described their relationship with the CCG as good and this had improved steadily over the past two years. It was also reported that 61% of stakeholders feel they have been given an opportunity to influence the CCG s plans which was an improvement on last year s 50%. Members were reminded that the 2016 survey highlighted the need to strengthen communication with the Council of Members and that significant time and effort had been put into this and it was encouraging to see an improved score in this area. The Governing Body NOTED the 360 o Stakeholder Survey for 2017. 17/45 PICKER INSTITUTE CCG STAFF SURVEY 2016 Members received a verbal report on the findings from the 2016 Staff Survey carried out by Picker Institute Europe on behalf of Kingston CCG. Members noted that over the last year, staff in Kingston report that the organisation provides equal opportunities for career progression and promotion. There had also been a reduction in the number of staff experiencing harassment, bullying or abuse from patients, relatives or the public. In terms of harmful errors, near misses or incidents, the number of staff witnessing them had reduced whilst there had been an improvement in the fairness and effectiveness of reporting them. Members were advised that the Ways of Working Group comprising representatives from each directorate had been adopted from Richmond CCG and an action plan to address areas for improvement had been developed. Members recognised the opportunity to take lots of learning from Richmond CCG around the appraisal process. Members noted that the Kingston CCG annual staff survey would continue to be done separately from Richmond CCG as the two organisations remained separately in statute. However, a mid year review would be considered for comparison purposes. The Governing Body NOTED the results of the Staff Survey for 2016. Version: Draft A - 5
17/46 CHOOSING WISELY Members received an interim report on the engagement programme about proposed changes to prescribing, IVF and specialised fertility services and supporting patients to be surgery ready. Members were reminded that following agreement given by the Governing Body for a six week programme of engagement beginning in March 2017, a general election had been called which halted all communication and engagement activity associated with the Choosing Wisely programme. Activity was resumed in June, following the election and an additional period of engagement was provided so the survey would remain open until 14 th July 2017. Members noted that results to date, indicate that whilst the response to some of the proposals have been positive, there is less support for the proposals to stop prescribing gluten free foods and baby milks, and the changes to IVF criteria. For all proposals including those generally supported, respondents raised specific concerns which will require further consideration by the CCG. A full engagement report will be brought back to the Governing Body in September 2017. Members stressed the importance of ensuring hard to reach groups and particularly BME communities in Kingston are given further opportunity to engage with the programme. The Governing Body NOTED the feedback from the Choosing Wisely engagement programme to date. 17/47 COMMISSIONING 47.1 Integrated Governance Committee Report A report detailing issues discussed at the most recent Integrated Governance Committee meeting held in June 2017 had been circulated for information. Members noted that the two main areas of concern are the Dementia Diagnosis rate and A&E waiting times. Members were advised of the one Very High (red) rated risk on the Risk Register as follows: Failure to deliver the 2016/17 South West London STP Objectives; Failure to plan effectively to implement STP objectives from 2017/18 onwards. Members also pointed out that the Risk Register had been reviewed by the Integrated Governance Committee in May 2017 and not December 2017 as stated in the report. Members discussed the performance against the constitutional standards and noted the following in particular: Version: Draft A - 6
Incidence of healthcare associated infection MRSA investigations were ongoing and it was believed to have been acquired in the community A&E waiting times position had improved slightly. A&E Delivery Board membership had been strengthened and an overall plan to meet the standards had been agreed for the remainder of the year. The plan had been shared with the South West London Alliance and NHS England and included: Internal systems & process Urgent care centre development Support for MH problems presenting in A&E System & partnership working on DTOC & partnership working Ambulance clinical quality (Category A response times) a partner/stakeholder event was being held on 5 th July to discuss leadership and processes. Work would be completed over the Summer to ensure maximum benefits for the winter period. Discussion was held on the level of breaches of audiology assessments at St George s across all CCGs. Wandsworth CCG as host commissioner for St Georges have received a recovery plan to rectify performance by test which includes additional available community capacity for ultrasound and MRI as well as recruitment of additional diagnostic staff at St Georges. The audiology breaches have subsequently been flagged as data quality issues, rather than actual breaches. The Governing Body NOTED the Performance Report. 47.2 Finance Report Month 2 Members received the finance report for Month 2 and although limited data was available, where no other data had been available, expenditure had been forecast at budget. Members noted the following: the CCG is on target to achieve its business rules for 2017/18 the CCG is forecast to meet its planned 0.5% in-year surplus of 1,151k Reserves have been used to enable delivery of the surplus BPPC and cash targets were achieved in Month 2 the CCG expects QIPP plans to deliver target savings, however limited data is available at this early stage Members also noted that a combination of reduced allocation growth, tariff price rise and increased national requirements had led to a challenging QIPP target in 2017/18, however good progress had been made and there were no unidentified schemes, however there is risk associated with delivery of the required savings. Acute Commissioning Members noted that 19 out of 20 acute contracts had been agreed but only 6 of these had been signed. The Royal Marsden acute contract was the last Version: Draft A - 7
remaining contract yet to be agreed, the outstanding issue with this contract is the critical care tariff that had not been agreed. Non Acute Commissioning Primary Care Members noted that early analysis of the MAR referral system indicated there had been a reduction in referral rates. QIPP Members were advised of the system wide QIPP PID Peer Risk Review which had revealed areas of strength and identified areas for adapting a system working approach. Members also noted that in order to meet the system wide control total, additional in-year QIPP savings were being asked for from each CCG. Members recognised the importance of ensuring clinical principals were in place to support QIPP schemes and were informed that in order to mitigate risks within the QIPP plan, more clinical leadership was needed on the CCG s Delivery Group and a plea was made for representation from Governing Body GPs. Members were also advised of the respiratory work being undertaken jointly with Richmond CCG and of potential further joint opportunities on MSK within the SWL Alliance. The Governing Body NOTED the Finance Report for Month 2. 47.3 Council of Members Report Members received a report detailing items discussed at the most recent Council of Members meeting held on 6 th June 2017. At the meeting, Yarlini Roberts the Local Director of Finance attended to provide members with a financial review of 2016/17 and Vicki Harvey-Piper the Local Director of Corporate Affairs and Governance updated members on the new joint operating model for the two CCGs. Members also took part in a workshop session looking at referral management. Kathryn MacDermott, the Local Director of Primary Care and Planning also gave her regular update on primary care issues. The Governing Body NOTED the Council of Members Report. 17/48 MINUTES FOR INFORMATION AND UPDATES FROM SUB COMMITTEES 48.1 Audit Committee Minutes of the Audit Committee meeting held on 27 th March 2017 were received for information. 48.2 Finance Committee Minutes of the Finance Committee meetings held on 24 th April 2017 and 22 nd May 2017 were received for information. Version: Draft A - 8
48.3 Health & Well Being Board Minutes of the Health & Well Being Board meeting held on 28 th March 2017 were received for information. 48.5 Primary Care Commissioning Committee Minutes of the Primary Care Commissioning Committee meeting held on 7 th March 2017 were received for information. 17/49 RECENT POLICY APPROVED BY INTEGRATED GOVERNANCE COMMITTEE The Governing Body received the Health and Safety Policy that had recently been approved by the Integrated Governance Committee. 17/50 QUESTION TIME None. 17/51 DATE OF NEXT MEETING TO BE HELD IN PUBLIC Tuesday 5 th September 2017 Venue: King s Centre, Chessington Version: Draft A - 9