Minutes of the Joint Commissioning Board held on Wednesday 18 September 2013, 9.00 11.15am, in 25a Boardroom, Friars Walk, Lewes ` Present: Amanda Philpott Catherine Ashton Dr Elizabeth Gill Keith Hinkley Cynthia Lyons John O Sullivan Michael Schofield Alison Smith (Chair) Accountable Officer, EHS CCG, and Joint Chief Operating Officer, EHS CCG and H&R CCG (ALP) Associate Director Strategy and Whole Systems Working EHS CCG and H&R CCG Chair, HWLH CCG (EG) Director of Adult Social Care, ESCC (KH) East Sussex Director of Public Health, ESCC (CL) Joint Chief Finance Officer, EHS CCG and H&R CCG (JOS) Finance Director, HWLH CCG Strategic Lead for Health for Children and Maternity-East Sussex (until item 63/13) In Attendance: Natasha Cooper Integrated Care Programme Manager, ESCC (item 63/13) (NC) Louise Goatcher Quality, Risk and Corporate Services Officer, East Sussex CCGs (minutes) (LG) Katie Merrien Corporate Services Manager, East Sussex CCGs (minutes) (KM) Martin Packwood Head of Strategic Commissioning Mental Health, ESCC (items 60/13 (iii) - 62/13) (MP) Ashley Scarff Head of Commissioning and Strategy, HWLH CCG (AS) 56/13 Welcome and Apologies Action The Chair welcomed everyone to the meeting. Apologies were received from: Ian Gutsell, Head of Strategic Finance, ESCC Beverley Hone, Assistant Director of Adult Social Care/ Strategy and Commissioning, ESCC Dr Matt Jackson, Clinical Chief Officer Designate, EHS CCG Alison Jeffrey, Assistant Director, Early Help and Commissioning, ESCC (represented by Alison Smith) Frank Sims, Chief Officer, HWLH CCG Dr Greg Wilcox, Clinical Chief Officer, H&R CCG, and Michael Saunders, Consultant Surgeon, East Sussex Healthcare NHS Trust (ESHT), on behalf of the Planned Care Network. 57/13 Declarations of Interest There were no declarations of interest considered prejudicial to any of the items on the agenda. 58/13 Minutes: 26 June 2013 The minutes were agreed as an accurate record of the meeting, subject to the title of item 46/13 being amended to Budgets 2013/14. 59/13 Matters Arising/Action Log The Action Log was updated by members. Item 12 Any Other Business - Local Safeguarding Children s Board (LSCB): Alison Smith agreed to ask Alison Jeffery to submit the business case justifying the increase of funding to the CCGs Governing Bodies. KM AS 1
Items 26/13.4 Carers Expenditure Plan: Keith Hinkley noted there were a number of outstanding actions from the Care Group, because the work was being done jointly by a number of partners. The Chair noted it would be useful to see the whole picture before her discussion about Primary Care Safeguarding with NHS England. The Board agreed to include a full discussion of the Carers Expenditure Plan in the forward plan for March 2014. Item 30/13 Children s Services; Alison Smith agreed to ask Alison Jeffery to chase for feedback from the lawyers. Item 45/13 Finance and Performance Review 2012/13: Keith Hinkley noted the work was on-going and had been discussed by the Joint Commissioning Operational Group (JCOG). Item 46/13 Budgets 2013/14: John O Sullivan confirmed that an in-year performance report would be submitted to the Board on 4 December 2013. Item 51/13 Network Reports (ii) Urgent Care Network: The action was marked as complete. Item 52/13 Update on children s strategy: Keith Hinkley noted the CCGs Governing Body meetings were receiving the strategy during September 2013 as a decision in principle, because further information and discussion was required on priorities. Alison Smith agreed to remind Alison Jeffery that details of how the priorities had been selected were still to be submitted to the Board. Item 53/13 Minutes from sub-committees: Keith Hinkley proposed that a review of GP membership for the Improving Life Chances Partnership Board (ILCPB) was included in a wider discussion about GP membership of all Boards that fed into the JCB, under a transformation conversation about governance. KH/KM 19/3/14 AS JOS AS Catherine Ashton noted there had been concerns in the Older People s Partnership Board (OPPB) about the lack of health sector representation, but gave assurance that appropriate representatives had now been identified to attend future meetings. The Board agreed the importance of health sector representation at each Board s meetings, but noted representatives did not necessarily need to be clinical. Keith Hinkley highlighted that the priorities from the range of needs assessment had identified the need for earlier clinical engagement about delivery with a broader set of stakeholders. Elizabeth Gill stated HWLH CCG had recruited 8 new clinical leads, and would be looking to use their skills to maximum effect. The Board noted Hugo Luck, Corporate Development Manager, HWLH CCG, and Angie Simons Business Manager, EHS CCG, had discussed now to assign leadership roles within HWLH CCG and agreed that several of the new clinical leads would not hold specific portfolios; allowing them to be deployed to individual projects as required. Action: The Chair noted she would ask Hugo Luck and Angie Simons to confirm the timeline for aligning clinical lead responsibilities to the CCGs clinical leads. ALP The Board agreed all three CCGs would become more proactively engaged with the Boards, including helping to shape their agendas and arranging for 2
appropriate clinical representation at Board meetings. i) Finance and Performance Review 2012/13 John O Sullivan explained the quarterly reporting schedule for Social Care had prevented the submission of an update in September 2013, but confirmed it would be ready for December 2013. Keith Hinkley reported the JCOG had agreed the templates for strategic reporting and specific service area reporting, which could be applied to additional areas if found to be useful. 60/13 Finance i) Quality, Innovation, Prevention and Productivity (QIPP) update John O Sullivan gave assurance that all three CCGs were reviewing performance against existing QIPP schemes and looking to identify additional areas in which to make savings, to ensure they delivered their control totals. Action: John O Sullivan agreed to circulate the data for Urgent Care and Mental Health with the draft minutes of the meeting. The Chair raised a concern that some reports had been unavailable for the Board meeting due to individual absences, and highlighted this had prevented the Board from fully discussing and understanding current data. It was agreed that a focus on appropriate information systems was crucial, to ensure the problem was resolved. JOS JOS 23/9/13 All John O Sullivan reported Sussex Partnership Foundation Trust (SPFT) had agreed to add 2m of QIPP savings to its 2013/14 contract, which had been included in the report, but that another 250k of savings remained to be agreed with the Trust. John O Sullivan noted 700k of the 2m Mental Health (MH) QIPP savings for 2013/14 sat with SPFT, and discussions with the Trust were on-going regarding closures and changes to Dementia pathways and substance misuse treatments. The Chair asked for future reports to contain headlines and details of the jointly commissioned services in an accessible format, to allow the Board to view the combined spending of ESCC and the three CCGs. Alison Smith highlighted the importance of the Joint Commissioners understanding the data reporting expected of them to ensure the appropriate information was submitted to the Board. Keith Hinkley stated that the Board must consider each organisation s influence beyond the JCB. Action: Keith Hinkley agreed to provide comparable information for ESCC as had been provided by CCGs regarding the overall council savings plan and actual delivery. ii) Department of Health guidance on the NHS Transfer to Social Care Michael Schofield requested a breakdown of the use of the 9.2m social care grant which was not included in Ian Gutsell s paper, highlighting in particular the transformational schemes mention in the text. Action: Keith Hinkley agreed and stated Ian Gutsell would provide that information. JOS/ MS/IG KH/IG KH/IG The Board noted the Health and Wellbeing Board (HWBB) report and drafted joint report had yet to be received. Keith Hinkley gave assurance that the report was not required by October 2013 as previously assumed, and noted the importance 3
for the Board to agree the content prior to submission. It was noted that a later submission of the report would allow specific issues to be addressed in advance. John O Sullivan confirmed that all of the funding had been put into community care, and gave assurance that the CCGs and the NHS England Area Team (AT) did not intend to disturb the flow of funding, but did need to feel assured as they may be required to sign off the grant transfer. Action: Keith Hinkley agreed to submit the HWBB report and the Section 256 report, including details of the 2014/15 spend, to the 4 December 2013 Board meeting prior to their submission, to align with the discussions about the outlined proposals for 2014/15. iii) Integration Transformation Fund Michael Schofield raised a concern that Carers Breaks funding and other existing funding streams potentially were not currently being spent as intended; which needed to be resolved by the CCGs and County Council to align the spend with the deployment of the Integration Transfer Funding (ITF). KH MS/JOS/ IG Michael Schofield noted he had extrapolated the national ITF figures to calculate the indicative additional savings; which would be sourced from the acute providers and managed in a similar way to QIPP. Michael Schofield reported the finalised two-year plan, including risk sharing and a contingency plan for East Sussex, was required by 31 March 2014. The Board noted HWLH CCG had currently delivered half of its 8m (c4%) QIPP savings target, which was likely to increase to 5.6% for 2014/15. Michael Schofield explained the ITF would assign an additional 3% savings target to each CCG; breaching the 2.5% limit set by NHS England for CCGs funding plans being agreed without scrutiny. Concern was raised about the significant gap between resources and future spend in East Sussex; with a 70m gap split between EHS CCG and H&R CCG, a 100m gap at ESHT, and a 75m gap at ESCC. It was noted that achieving a sustainable health and social care economy was the major driver behind the East Sussex 2020 Vision programme. John O Sullivan highlighted that the CCGs held half of the 3.1m of reablement funding for 2013/14, which would increase to a 4m target for 2014/15; of which only 1.3m had been saved to date. Action: John O Sullivan agreed to include further details about the reablement funding in the December 2013 finance paper, to ensure the Local Authority was aware of any reductions in the amount which could be transferred from the CCGs. JOS Michael Schofield confirmed the Trusts Finance Director was aware that Community Services were a key strategy for HWLH CCG, and that this would be mapped out across the whole of Sussex. The Board noted each acute provider within Sussex would have to save c 20m to release the funds needed to increase the ITF. The Board considered the creation of a single ITF plan for East Sussex, and the benefits of applying the funding to the agreed joint schemes instead of creating new schemes; subject to the associated conditions of how ITF could be spent. BH/CA/ AS 4
The Board agreed the importance of using the ITF for its intended transformational purpose and of ensuring there was a risk sharing agreement with Trusts and contingency plans in place. 61/13 Pioneer Site Bid Keith Hinkley noted the details of the Pioneer Site Bid had been widely circulated for information, and stated the East Sussex presentation to the interview panel on 9 September 2013 had gone well. The Board noted the number of applicants was unknown, but that the number of pilot sites may be increased from 10 to 15; with successful bidders to be notified in by early November 2013. Catherine Ashton noted the key issues raised by the panel had included financial levers and leadership engagement; which had been fully demonstrated by the attendance of all organisations except SPFT. Additional questions had addressed risk sharing and planning for the integrated workforce as part of the larger transformational agenda. The Chair highlighted the importance of progressing the principals agreed within East Sussex, regardless of the bid s success, and formally thanked the staff who had worked on the bid. 62/13 Mental Health Update i) Memory Assessment Services (MAS) Martin Packwood reported that the provider circumstances for MAS had recently radically changed, and the JCOG would receive a report explaining the changes on 1 October 2013. ii) Health in Mind Catherine Ashton reported the JCOG s recent discussion of the Health in Mind (HiM) service had revealed a difference of opinion amongst the CCGs, which had been reflected by including four possible options in the Board paper. Ashley Scarff reported HiM had attended a recent meeting of HWLH CCG s Clinical Executive Committee, where the CCG had raised the current significant underutilisation of the service within HWLH. This included understaffed Primary Care Mental Health Workers (PCMHW), which could explain the data showing the service as under-subscribed, and GP disappointment with the Improving Access to Psychological Therapies (IAPT) service. The Board noted HWLH CCG wished to review its level of financial investment in HiM, and fell between Options 2 and 3. John O Sullivan asked whether the contract could move to a cost-per-case basis for year five. Martin Packwood explained the HiM contract was essentially a block contract which had been part of the national pilot for Payment by Results (PbR) contracts, and that the specification was due to be revised in 2014. Michael Schofield proposed that each CCG created a list recording when each of its contracts was due to expire. The Chair expressed concern about the proposed extension to the contract, as it reflected poorly on the original procurement, and asked for lessons to be learnt to avoid this in the future. 5
The Board agreed to progress Option 4 and extend the existing contract for 12 months, alongside the creation of clear recommendations for re-procurement which took service feedback into account. The Board agreed the JCOG would discuss managing risk and the existing market, before the recommendations for re-procurement were submitted at a future Board meeting. 63/13 Special Education Needs and Disability (SEND) Joint Commissioning Alison Smith explained the Local Authority and the Health Service had a statutory requirement for SEND Joint Commissioning, which was set within a national timeframe, and would involve two complex systems being brought together. Alison Smith noted that a scoping document had been created with Public Health colleagues, undertaking a needs assessment to establish a more accurate position on needs of the Children and Young People with SEND and highlighted the importance of establishing an accurate financial position. MP Alison Smith reported ESCC had recently identified a finance officer lead for this work and confirmation of the finance manager leads for the CCGs was awaited. Action: John O Sullivan and Michael Schofield agreed to nominate a CCG finance representative to work with the lead identified by ESCC. Alison Smith explained that the Local Authority would need to run a dual system of Education, Health and Care (EHC) and statementing from 2014 to 2016; giving parents access the old statemented process alongside to the new EHC planning process. JOS & MS Catherine Ashton gave assurance that the risks regarding children s wheelchair provision had been picked up by the Children and Young People s Joint Commissioning Group (CYPJCG). Alison Smith confirmed the risks associated with wheelchair services were still being assessed, and a more detailed report would be submitted to the JCOG for consideration as required. Assurance was given that a risk assessment of the disaggregation of services would be completed, including the potential for any additional costs. Alison Smith reported that the potential future risks for some children s community services were being investigated, and the commissioners would determine whether the services could be provided elsewhere with better value for money. The Board noted there was still time to consider any additional areas to be included in joint commissioning plans as future statutory requirements for service delivery. The Board: Considered the challenges identified. Identified the need for ESCC and CCG financial officer engagement in the commissioning cycle. Supported the need to run a dual process for statementing of children and delivering on Education, Health and Care (EHC) plans, with capacity to be assessed every six months; including consideration of current staff capacity and any potential requirements to increase staffing levels Discussed the challenge of bringing into the area of SEND the other elements of health provision such as children s therapy and specialist health care and advised on a timeframe for exploring these (suggested 2014/15 financial year). 6
Agreed the timeframe as set out in the attached draft Project Initiation Document (PID) at Appendix 1 and GANTT chart at Appendix 2 for the detailed work. 64/13 Health Improvement Service Commissioning Cynthia Lyons reported that Tranche 1 commissioning of health improvement services (i.e. specialist smoking cessation support/service, weight management adults, weight management children, Health Trainers, Alcohol IBA Training) was proceeding to plan, and an opportunity to tender for the services had been advertised; with a closing date of 22 October 2013. Cynthia Lyons also reported on progress in relation to Public Health Locally Enhanced Services (LES) agreements, which could not continue as such beyond March 2014. Cynthia Lyons gave assurance that ESCC hoped to make the process as simple as possible, with minimal variation to the existing contracts prior to the transfer onto ESCC paperwork. The Chair highlighted the importance of robust communication, as any changes could unintentionally impact elsewhere, and suggested that Murray King, EHS CCG s Deputy Chief Operating Officer and Wendy Carberry, HWLH CCG s Head of Delivery, would be key contacts between Public Health and the CCGs for these services. Cynthia Lyons explained ESCC had a cross-council group that informed Public Health commissioning, but that it was to be revised, and confirmed that CCGs would be invited to send representatives to that group. Action: Cynthia Lyons agreed to submit an update paper on Tranche 1 commissioning and Public Health Enhanced Services to the next meeting of the Board. CL The Board noted the report. 65/13 Network reports i) Planned Care Network Catherine Ashton noted that, in Mike Saunders absence, she was unable to provide an update beyond the detail contained within the report. Ashley Scarff explained HWLH CCG had yet to attend a meeting of the Planned Care Board, due to being more focused towards Brighton and Sussex University Hospitals Trust (BSUH) for patient pathways; which was why the report did not mention HWLH CCG. Action: The Chair agreed to feed back the Board s concerns that the report did not provide sufficient assurance to Murray King, including the lack of supporting figures or agreed timeframes for actions. Action: The Chair agreed to investigate whether the Board could receive Planned Care Network reports from providers besides ESHT. ALP ALP ii) Urgent Care Network Catherine Ashton noted that, in Susan Rae s absence, she was unable to provide an update beyond the detail contained within the report, but confirmed work was 7
underway on health surge plans. The Chair highlighted the links between QIPP impact and the wider implications for Urgent Care. It was agreed that the report contained robust actions, but that further information was required about whether A&E reductions meant patients were therefore being treated in a more appropriate location. iii) Integrated Care Network Report Keith Hinkley gave assurance that the Network now had access to a wider range of information about enhanced services, such as District Nursing. The Chair noted the usefulness of being able to see the perceived impact on services. Natasha Cooper, Integrated Care Programme Manager, reported Key Performance Indicators (KPIs) were being embedded for Respiratory Services (RESPS) to prevent a decline in performance and address some specific issues. The Board noted the enhanced nursing service launch date was 1 October 2013 but that, despite a robust drive for recruitment, the current staff level was less than the target required for the service to go live. Natasha Cooper reported the Network was now looking to alter the core nursing specification and re-focus the enhanced nursing service; which would involve a significant risk around communicating with GPs. Catherine Ashton raised concerns about the ambitiousness of ESHT s recruitment target and highlighted that anything dropped from the service (such as flu vaccines or Phlebotomy) would impact Primary Care; which would simply shift the problem. Catherine Ashton noted ESHT needed to create a plan outlining the potential impact before the CCGs could create a mechanism to prevent a shift. Natasha Cooper highlighted that the mechanisms for payment were yet to be signed off with the Trust. Ashley Scarff noted concern that some bands of nursing within HWLH had vacancy levels of 60%; with 5 of the 21 District Nurses currently in place based at the opposite end of East Sussex to HWLH. John O Sullivan gave assurance that ESHT s block contract meant the Trust would only be paid for the 17 Healthcare Assistants (HCAs) in place from the 32 posts; even if ESHT moved staff from its core contract to supplement the 17 HCAs. Natasha Cooper reported ESHT had been asked to attend an urgent meeting with Network representatives and Colin Peel, Senior Account and Contract Manager at Surrey and Sussex Commissioning Support Unit (CSU), to discuss its proposal to resolve the existing problems. It was noted that even if ESHT moved nursing staff out of core services, the emergency nursing services may still not be safe. Action: Catherine Ashton, Ashley Scarff and Natasha Cooper agreed to ensure ESHT s proposals were appropriately reviewed by the right staff, and to circulate a progress update to the Board by 20 September 2013. Action: The Board agreed that more consistency was urgently required in the Networks reporting, and that data needed to be drilled down to CCG-level; with all reports and actions to fit into East Sussex 2020. CA, AS & NC 20/9/13 CA 8
The Board asked for a dashboard to be created for each Network, to measure their progress against the previous year and show whether they were making the required savings. The Chair gave assurance that the dashboards could be put in place by the CSU and Social Services for 2014/15. CA/MK/ BH The Board noted the report. 66/13 Minutes and Summary from sub-committees for information. The Board noted the following minutes and meeting summaries, which had been circulated for information: i) Improving Life Chances Partnership Board (ILCPB) 15/07/13 ii) East Sussex Older People s Partnership Board (OPPB) 25/04/13 and 22/07/13 iii) Carers Partnership Board (CPB) meeting 19/03/13 and 05/06/13 iv) Children and Young People s Joint Commissioning Groups (JCGs) 19/06/13 67/13 Any Other Business Boards reporting to the Joint Commissioning Board (JCB) The Chair confirmed the JCOG was an operational group of the JCB and therefore required to regularly report to the Board. Action: It was agreed that updates from the JCOG would be submitted to future meetings in the form of action points, instead of the full sets of minutes. Action: The Board agreed to ask the ILCPB, the OPPB, the CPB, the Children and Young People s JCGs, the Learning Disability Partnership Board (LDPB) and the Mental Health Action Groups to present their key actions and achievements to the Joint Commissioning Board and the Health and Wellbeing Board once a year. KH KH Clinical Network representation at Board meetings Catherine Ashton reminded the Board that Network representatives were supposed to attend Board meetings to gain a strategic steer on their work. Keith Hinkley proposed included a discussion on the Clinical Networks was included in the Board s conversation about transformation. 68/13 Forward Plan The Board agreed to include the following items on the next meeting s agenda: An update on the Clinical Networks, supported by more consistent reports, led by Catherine Ashton. A Public Health update, led by Cynthia Lyons A robust Finance and Performance update, including fully populated appendices, led by John O Sullivan, Ian Gutsell and Michael Schofield. The Board agreed to include the following items on the 19 March 2014 agenda: An update on Safeguarding. A full discussion of the Carers Expenditure Plan, presented by Keith Hinkley. Future Meetings Quarterly, starting at 9.00am: 4 December 2013, 19 March 2014, 25 June 2014, 24 September 2013, 17 December 2014 Freedom of Information Act: Those present at the meeting should be aware that their names and designation will be listed in the minutes of this Meeting which may be released to members of the public on request. The meeting closed at 11.15am. 9