Agenda Item No: C DRAFT Minutes of the Meeting of the Governing Body held on Wednesday at 1.30 p.m. in Jubilee Suite, Orford Jubilee Suite, Winwick Road, Warrington Present: In Attendance: Dr Andrew Davies (Chair) Chair John Wicks Interim Chief Officer (commencing 2.12.13) David Cooper Acting Chief Finance Officer Dr Anthony Parkins GP Governing Body Member Healthy Warrington Dr. Simon Redfearn GP Governing Body Member - Phoenix Group Dr Dan Bunstone GP Governing Body Member Teaching Federation Dr Anita Malkhandi GP Governing Body Member Warrington Alliance Nick Atkin Lay Governing Body Member/Vice Chair Gareth Hall Lay Governing Body Member Pat Taylor Patient Representative John Wharton Registered Nurse Dr Stephen Bentley Specialist Doctor Simon Kenton Assistant Director Integrated Commissioning Linda Bennett Associate Director Health Services Commissioning Nick Armstrong Chief Operating Officer Rebecca Knight (for item Head of Assurance and Risk 072/13) Pam Broadhead (for item Head of Contracts and Performance 060/13) Jason DaCosta (for items Director of IT 071/13 and 073/13) Paul Steele Engagement, Experience & Communications Lead Stephen Bailey (providing Engagement, Experience & Communications Officer live tweets) Sam Lowe Governing Body Administrator (Minutes) There were 6 members of the public in attendance. Agenda Item No A B C APOLOGIES FOR ABSENCE Apologies were received from Stephen Sutcliffe and Gareth Hall. DECLARATIONS OF INTEREST IN AGENDA ITEMS There were no further declarations of interest declared aside from the standing declarations within the Register of Interest. MINUTES OF THE WARRINGTON CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING HELD ON WEDNESDAY 11 TH SEPTEMBER 2013 Action 1
058/13 Finance Report amend the first bullet point to read The organisation is still on track to achieve its surplus of 1.2m by year end and will need to build a strong recurrent position. The Board APPROVED the minutes of the meeting as a true and accurate record of the meeting subject to the amendment above. D MATTERS ARISING FROM THE MEETING There were no matters arising from the meeting. E CHAIR S REMARKS AND QUESTIONS FROM THE FLOOR Dr Davies welcomed everyone to the last Governing Body meeting for 2013. Dr Davies thanked Stephen Sutcliffe, David Cooper and Bryan Webb for the excellent acting up arrangements they have provided during Sarah Baker s absence. Dr Davies welcomed John Wicks to the meeting. John will be commencing as Interim Chief Officer for Warrington CCG on 2 nd December 2013 for a period of 12 months. Mr. Wicks introduced himself to the meeting and stated that he is looking forward to starting with the CCG. His background is within the NHS since he joined as a management graduate trainee. Mr Wicks spent the first half of his career in the hospital setting before moving to commissioning organisations. He has worked as Director of Commissioning in PCTs, however since the new year he has been working on a freelance basis within NHS organisations. Mr. Wicks explained that he wants to feel part of the team and pledged to give 100% of his time and energy into Warrington over the next twelve months. Dr Davies asked everyone to support himself and Simon Kenton who are growing moustaches for Movember to raise funds for prostate cancer. There were no questions from the floor. F GP GOVERNING BODY MEMBER FEEDBACK FROM FEDERATIONS Warrington Alliance There have been two meetings since the last Governing Body where the following issues were discussed: Presentation around CRI alcohol treatment services, screening and pathways Update on health checks from the Public Health Department. Discussion around the IT programme Looking at engagement for the QP Indicators Antenatal Community cardiologists in Primary Care 2
Phoenix There have been two meetings since the last Governing Body where the following discussions took place: Presentation from Dr Mike Dennis around shared care prescribing in mental health Issues around Padgate House Paediatric acute response Update on 111 services How care data is used by the Department of Health Presentation from Amanda Turton, Community Matron Update on health checks from the Public Health Department Primary Care Strategy developing bids for practices Healthy Warrington There have been two meetings since the last Governing Body Meeting, when the following was discussed: Presentation from Dr Catherine Doyle around medicines management spending figures Primary Care Strategy QP work where the top areas were Outpatient admissions and A&E Presentation from Public Health around the lifestyle survey initial results. Presentation from Dr Sue Burke around the cancer project Primary Care Strategy bids Presentation from Meg Kerr around the Community ENT update Teaching Practices There have been two federation meetings since the last Governing Body Meeting, where the following discussions took place: QP work - looking at attendances in A & E between January and March. Penketh, Folly Lane and Lakeside summarised their results so far including frequent flyers and inappropriate attendances. Paediatrics phlebotomy discussion to see if this is something the federation could take on or apply to primary care funding as a resource Primary care investment - discussion around possible projects and ideas for taking forwards with other practices Risk stratification - update from current pilot practices regarding risk stratification and how the process is progressing. Telehealth - discussion of proposals to have hypertension as a telehealth target and how this would work Discussion around usage of sip feeds and stoma bag prescribing lead by Dr Catherine Doyle Julie Purdy (safeguarding lead) attended to update the federation on her role and ways she can assist the federations. 3
Primary care investment fund and progress with applications Current SPA model as provided by Bridgewater and what is going well, or could go better. Possible practice involvement in an AF project being offered by a third party - no interest currently. G ACTING CHIEF OFFICER S REPORT Mr. Armstrong highlighted the key areas from the Acting Chief Officer s Report: The appointment of John Wicks as Interim Chief Officer for Warrington CCG The appointment of Simon Stevens as new Chief Executive of NHS England The appointment of Bob Williams as Chief Executive of the North West Ambulance Service The Commissioning Intentions are being refreshed for 2014/15. Mrs Bennett explained that the CCG is midway through its three year whole system transformation project. The CCG will use a variety of tools including the Commissioning for Value data packs 2013 developed by Right Care, and the Warrington CCG Annual Status Review 2013 developed by the Cheshire & Mersey Commissioning Support Unit to assess that the CCG is on the right track and the Intentions are still relevant to the local population. Mr. Wharton explained that the Keogh Review 2013 is a timely reminder to the CCG around their commissioning responsibilities. It also served to remind the CCG that it is responsible for ensuring that the appropriate values and behaviours are collectively demonstrated by both itself and its providers to improve the care provided to patients and communities which they serve. Warrington CCG s respiratory work has featured as a case study in the latest Commissioning for Value packs which are localised sets of data for every CCG in the country produced by NHS England, Public Health England and Right Care. Pregnant women and new mothers have been having their say through the Friends and Family Test since the beginning of October, the results of which will be published at the end of January 2014. The Annual NHS Commissioning Assembly event which took place at the end of September was a success and brought commissioners together to create one team of commissioning leaders across the NHS. Key themes included patients and the public, commissioning for quality and patient safety, aspirations for quality and service transformation. The North West 111 Service transferred to the North West Ambulance Service on the 29 th October 2013 and this contract will run until 31 st March 2015. In August 2013 NHS Protect wrote to all CCGs setting out urgent steps to be taken by each CCG to comply with a High Court Order. The Governing Body was assured that NHS Warrington CCG has completed all the steps requested and is therefore compliant with the High Court Order. 4
Mr. Kenton updated the Governing Body that the Local Government Ombudsman is to publish a finding against Warrington Borough Council and local NHS partners regarding maladministration in two cases relating to the provision of speech and language service for children with special needs. The Local Authority have been instructed to write letter of apology to the patients and to pay 500 in compensation to pay for the provision of private speech and language therapy for the children concerned, plus 6000 to each family for failure to communicate to the families. The Governing Body NOTED the contents of Chief Clinical Officer s report 068/13 QUALITY REPORT Mr. Wharton presented this report and highlighted the following areas: A recent unannounced routine inspection of essential standards of patient quality and safety was carried out at Halton Hospital on 30 th September to 1 st October 2013 which gives great assurance around patient safety and how patients are cared for and feel empowered with enough information on which to make informed decisions about their health. The inspection also showed that staff felt supported, and there were opportunities for staff to access specialist training courses when appropriate. The Trust s first Patient Safety Conference took place earlier this month. This was based on a Coroner s Court Inquest. The Barrister congratulated the Trust for their honesty and transparency. The CCG were notified of a press release which named the Trust as one of seven with a higher than expected hospital level mortality indicator. The Governing Body were assured that a number of measures have been put in place by the Trust around how data is collected and the CCG has been assured that this is a priority piece of work. Concerns have been raised regarding Bridgewater s assurance regarding data collection and reporting to the CCG. The implementation of the new TPP system still appears to be problematic. Data is required for commissioners to receive assurance that the service is providing good standards of service and also that any future decisions regarding changes in service delivery is based on accurate and informed data. The CCG are working with the provider to try and improve data collection and reporting. The CCG is working with Bridgewater and the Local Authority to ensure that standards of intermediate health care delivery and the competencies of practitioners working in this area of health care delivery remain of a high standard and that patient care is not compromised. In October the Care Quality Commission released their list of acute trusts in the risk categories, placing each Trust into six bands with Band 1 considered the highest risk and Band 6 the lowest. Warrington s local acute provider has been given a Band 5 status. St Rocco s Hospice is making some structural changes to its 5
building to improve patient care delivery and to support family members, partners and friends who spend large amounts of time supporting a loved one in the final days of their illness. Work is ongoing to improve the synergy between the CCG and the Local Authority looking at care provision in local elderly care environments. The CCG recently undertook a walkabout of the accident and emergency department where there appeared to be sufficient staffing and patients were being processed and treated with privacy, respect and the appropriate levels of care. The Governing Body discussed and noted the report. The Governing Body support the current direction of the quality agenda. 069/13 FINANCE REPORT Mr. Cooper highlighted the following points from his report: Background to the current position was given, including that the CCG is the second lowest funded CCG in the North West. The budget was set in February/March when an efficiency gap of 6% - equating to 13m was identified. The financial position at the end of month 6 is a surplus of 0.25m which is in line with the CCG s revised financial plan. This contributes to a planned surplus position for the 2013/14 financial year of 0.50m which equates to 0.22% of the 2013/14 baseline resource allocation for programme expenditure. The resource limit available to the CCG is 237.4717m at month 6 representing a reduction of 2.394m to that reported previously. Members were asked to note that an element of this funding reduction is offset by a matching reduction in CCG expenditure. This includes a final settlement for NHS England commissioned activity. At month 5 the contract activity for the Trust is reflecting a favourable position of 751k. GP prescribing expenditure, based upon the latest PPA data, is reported to have an adverse variance of 0.74m against plan year to date which is a further deterioration from the position reported at month 5. Saving schemed identified to deliver the 2013/14 GP prescribing efficiency target are performing and the agreed additional medicines co-ordinators appointed through the Community Support Unit are now in post to support the delivery of this target. Governing Body members were asked to note that it is projected that, offset by underperformance within high cost drugs, the overall position will be circa 1m above plan at the year end which is a risk. NHS Warrington CCG is still forecast to achieve its revised target surplus of 0.50m however there is limited resilience in the plan to respond to emerging financial pressures. The CCG needs strong Commissioning Intentions in order to build a strong financial position. 6
In response to questions from the Governing Body, Mr. Cooper confirmed that: In order to manage the 2013/14 financial position, Warrington CCG has revised its planned surplus from 1% to 0.2% which has resulted in a red RAG status and brings additional scrutiny on the CCG s finances from the Cheshire, Wirral and Warrington Area Team and the Department of Health. He explained that CCGs rating amber/red or red need to provide additional robust returns and information about their ledger, there will be more rigour in the system than if the organisation had a green rating. This red rating will impact on the Assurance visit and will impact on the recurrent position as CCG s have a statutory duty to break even. It was confirmed that a letter had been received from the Secretary of State to announce that CCGs will inherit PCT legacy balances. This will impact on the CCG in-year but is expected to be less than 100k. The Governing Body NOTED the financial position at the end of September 2013 and AGREED to the decision to revise its planned surplus from 1% ( 2.3m) to 0.2% ( 0.5). The Governing Body ACKNOWLEDGED the financial risks identified within the report. The Governing Body ACKNOWLEDGED the need to agree robust plans to deliver recurrent savings. 070/13 PERFORMANCE REPORT Mrs. Broadhead presented this report and highlighted the following areas: Members were reminded that the structure of the report emulates the NHSE assurance process, and the CCG undertakes a monthly estimation. When the assurance takes place at the end of this month, the Finance & Performance Committee will have reviewed the position to the end of September. At end of August, the performance against both the stroke and TIA had improved to be above the planned figure for the first time in 2013/14. However during September the figures have declined and a query has been sent to the Trust to understand the reason behind this decline. Members were asked to note that due to the poor performance earlier in 2013/14 both the Stroke and TIA indicators remain below target year to date and these indicators will remain reported as a risk until the sustainability of performance at or above target is maintained. Members were asked to note that First Outpatient Attendance figures remain a risk however despite outpatient activity levels remaining above plan to date no adverse impact on elective day case and inpatient activity has occurred and the total elective activity remains below plan. Therefore this risk will remain as a monitored risk with no formal remedial action plan, however the position will continue to be monitored. The decision made by Governing Body members to change its planned surplus means that the Balanced Scorecard position will change to show that Are CCG s commissioning services within their financial allocations will now change to Red meaning that as 7
of September there are two Red areas within the Balanced Scorecard. In response to questions asked by the Governing Body, Mrs. Broadhead assured members that: Although the CCG now has two red areas within the Balanced Scorecard, the CCG needs to know why the areas are red and to understand the actions and controls put in place. For example, one area is MRSA where we have zero tolerance in place, however there have been two recent cases. The CCG needs to provide assurance to NHS England that it has no concerns because of the rigour of the action plans behind the figures. NHS England are assured by the CCG s assurance process. The A&E 4 hour waiting target is clearly nationally going to the be the barometer of NHS resilience, however this is being monitored on a daily basis however a lot of this is to meet the targets rather than the needs and requirements of the patients which is why the CCG looks at this from a quality point of view as well. The introduction of the Urgent Care Unit at the Trust, which works alongside the A&E department has improved the situation and it is intended to increase the scope of this service over the winter months. The Governing Body reviewed the report and ACKNOWLEDGED the performance areas identified as at risk and their associated controls. 071/13 DIGITAL PATIENT ENGAGEMENT STRATEGY Mr DaCosta presented this report and highlighted the following areas: This is a joint paper for the CCG and the Trust to provide Governing Body Members information and provide advice and guidance around the need to augment patient engagement portfolios whilst at the same time exploit the opportunities that digital technologies have to offer. The Governing Body Members considered the four options contained within the report to utilise mixed media process to disseminate information to patients, carers and staff and the governance and investment required to realise this strategy and deliver a number of clearly defined workstreams. The Governing Body noted that: Although this policy is for the CCG and the Trust, it needs GPs on board to work successfully. GPs are invited to get involved and to attend the Partnership Board if they wish to. Dr Davies confirmed that he attends this meeting which brings Directors of IT together and stated that it does need more GP input. Work will be done to look at how to enable more people to be connected, looking at the council making new houses ready to connect to the internet, provision of the elderly in care homes to access the internet, and how to upskill and support people with 8
technology. The CCG has invested in the strategy via CQUIN funding in the Warrington & Halton Hospitals NHS Foundation Trust contract and therefore clarity on how this funding is utilised to enable the system transformation is required. This is done through the contract mechanism The Governing Body NOTED the progress on the options being developed around the Digital Patient Engagement Strategy 073/13 WARRINGTON SHARED INFORMATION STRATEGY The Governing Body received a presentation around the Warrington Information Strategy being developed by Mr. DaCosta, Director of IT for Warrington CCG and Warrington & Halton Hospitals NHS Foundation Trust. Members noted that Warrington s Transformation Programme is designed to drive integrated care across care settings enabling clinicians to move from unconnected silos of care to a seamless health and social care economy that supports the patient journey. Mr DaCosta explained that implementing a single integrated patient record across our health and social care economy is key to improvements in care and efficiency. The strategy looks at enabling new ways of working to improve clinical safety, medicines management, patient outcomes, the quality of patient experience and operational efficiency. The Governing Body NOTED the presentation around the Warrington Shared Information Strategy. 072/13 ASSURANCE FRAMEWORK Mrs Knight presented the Assurance Framework and highlighted the following key areas: There are 22 strategic risks on the Assurance Framework According to the risk rating scores, there are 2 high rated risks, 19 medium rated risk and 1 low rated risk. 3 risks require a review of the external assurance required 4 high rated risks are on the operational risk register There has been no increase or reduction in risks this month The positive assurance column is showing positive assurance against 20 risks where reports have been provided to the Governing Body or one of the CCG committees, and this includes assurance for the two high risks. All changes to the Assurance Framework since it was last presented to the Governing Body are shown in red. There has been some slippage in the actions required to address risks D1 and D4. There is already an agreement that the resource required to support the quality agenda needs review and any additional resource agreed will support the delivery of the outstanding actions. Mrs. Knight and Mr. Wharton are looking at the Quality Strategy and Terms of Reference and looking at the 9
work needed to support the quality agenda. Mr. Davies asked the Governing Body Member sponsors if they feel connected to the risks that they support. Drs Bunstone, Redfearn and Malkhandi agreed that they felt happy. Dr Parkins asked for additional information. Mrs. Knight agreed to provide this support to Dr Parking. There were no concerns noted around the risks. The Governing Body NOTED the high rated risks (red) in the Assurance Framework. The Governing Body NOTED the positive assurance received in relation to the relevant risks. The Governing Body discussed and AGREED that the assurance received in appropriate and relevant. The Governing Body NOTED that work is ongoing to identify if additional resource is required to address the quality agenda. 074/13 CHILDREN & YOUNG PEOPLE S JOINT COMMISSIONING STRATEGY Mr. Kenton presented this report and highlighted the following areas: This strategy provides assurance against risks H1 (failure to achieve integration of care pathways) and H2 (failure to achieve integration of commissioned services) of the Assurance Framework. This is the first strategy of its kind to be created and is informed by the Children & Young Peoples Plan and Wellbeing Strategy and Joint Strategic Needs Assessment. The strategy sets out the joint commitment of Warrington Borough Council (including Public Health) and Warrington CCG to a joint commissioning approach for integrated delivery of services for children, young people and families. The strategy focuses on four priority areas for joint commissioning focus, including two key improvement areas and two enablers for 2013/14. The developing joint commissioning plan will set out the prioritisation process, key joint commissioning opportunities and an overview of the proposed joint work programme and will be brought back to the Governing Body for approval on completion. The Governing Body NOTED and SUPPORTED the Children & Young People s Joint Commissioning Strategy and the subsequent joint commissioning plan which will be brought back to the Governing Body on completion. 075/13 SUMMARIES AND APPROVED MINUTES OF GOVERNING BODY COMMITTEES Dr Malkhandi gave a verbal update of the Quality Committee which took place on the 30 th October 2013 which included: The presentation of the Children s Safeguarding Update Report and the Adult s Safeguarding Update Report. The Audit Tool for case notes was approved 10
Tier 4 CAMHS update The recommendations from the Pan Mersey Area Prescribing Committee were considered. An update on serious incidents and associated risks was considered A report on patient engagement, experience and communications was noted. Dr. Davies explained that a workshop of the Clinical Forum members took place in October to look at the shift in focus of the group and a proposal was made that the Clinical Forum becomes a critical friend to the CCG. Dr Davis will bring a progress report back to the Governing Body once discussions have taken place. The Governing Body NOTED the decisions made by the CCG Committees on their behalf and supported them. 076/13 ANY OTHER BUSINESS There was no other business to discuss. 077/13 QUESTIONS FROM THE FLOOR There were no questions received from the floor. 078/13 DATE AND TIME OF NEXT MEETING Wednesday 8 th January 2014 at 1.30 p.m. in the Jubilee Suite, Orford Jubilee Park, Winwick Road, Warrington. Signed... Dated... 11