MINUTES/ACTION NOTES Meeting Governing Body Meeting in Public Date and time Tuesday 25 th March 2014, 14.00 17.00 Venue Chairman Cranleigh Arts Centre, High Street, Cranleigh Dr David Eyre-Brook (DEB) Chair Members Dr Darren Watts (DW) Vice Chair (Clinical)/GP Member Dr Jonathan Inglesfield (JI) Dr Clare Stevens (CS) Dr Jonathan Barnardo JB) Dr Ann Hennell (AH) Dr Susan Tresman (ST) Dr Anne Wilkinson Phelim Brady (PB) Stephen Park (SP) Dr Geoff Watson (GW) Robin Forward (RF) Dominic Wright (DWr) Karen McDowell (KMc) Vicky Stobbart (VS) Joe McEvoy (JMc) Elaine Newton (EN) Jonna Mundy (JM) Medical Director (Commissioning)/GP Member GP Member GP Member GP Member Vice Chair (Lay Member Quality and Governance ) GP Member Lay Member Patient & Public Engagement Lay Member Finance and Audit Medical Director (Acute) Practice Manager Representative Chief Executive Chief Finance Officer and Deputy Chief Executive Executive Nurse/Director of Quality & Safeguarding Director of Clinical Commissioning Director of Governance and Compliance Interim Director of Human Resources In attendance Julie George (JG) Consultant in Public Health (Surrey County Council) 1
David Sargeant (DS) Kathleen Andrews (KA) Assistant Director personal Care and Support Adult Social Care Services Primary Care Liaison Manager (Note Taker) Apologies None NB: Those present at this meeting should be aware that their names will be listed in the notes of the meeting which may be released to members of the public on request under Freedom of Information requirements. 1 Introduction 1.1 Apologies for Absence No apologies were received. 1.2 1.3 Register of Interests No new declarations of interests were received. Chair s introduction and opening remarks Dr David Eyre-Brook (DEB) welcomed the public and commented that it would be appropriate at the final GB meeting of 2013/14 to look back on the CCG s achievements in its first year of operation. NHS G&W CCG had proved itself as an effective organisation, which is clinically led and supported by a strong executive team. DEB advised the outcome of the recent nomination and selection process for the four GP Clinical Representative vacancies on the Governing Body, which had been successfully filled. Three GPs had applied to extend their terms of office and there had been one new application. It was noted that Robin Forward had stepped down as Practice Manager representative on the Governing Body; she was thanked for her contribution. In terms of the CCG s challenges, DEB cited the following areas: financial balance a quality, versatile elective service responsive to needs is required. The dermatology service is successful and other services are to be set up using a similar delivery model an integrated emergency service, which minimises duplication between organisations and prevents patients remaining in secondary care longer than is necessary. 2
1.4 Questions Received from the Public The Chair then took the following questions which had been submitted by the public. Appendix 1a details questions and responses. 1.5 1.6 1.7 Minutes of Previous Meeting - 11 February 2014 The minutes were agreed. ACTION: To arrange for signature of minutes by Chair Matters Arising Updates on actions from the 11 February 2014 meeting were included with the papers (Appendix 1a) and were noted. In response to a question from PB, concerning the consultation on the short breaks review in which The Beeches facility was included, DEB confirmed that each CCG retained statutory responsibility for decision making about its future outcome. Chief Executive s Report DWr presented the report highlighting: CH 01/04/14 the strategic direction around transforming scale and function to deliver outcomes and commission for value with an emphasis on the development of strong and trusting relationships with providers and stakeholders Elaine Newton (EN) was welcomed to the Governing Body as the Director of Governance and Compliance along with other staff to substantive posts two compliance areas of information governance and equality, the latter of which was a separate item on the agenda. In this context, DS commented on the recent publication of ONS statistics and the difference in life expectancy between Bradford and Guildford is 20 years which whilst positive, masked health inequalities which would need to be addressed Running costs for the CCG have been met this year but it is expected that there will be a reduction in 2015/16 with management support reducing by 10% 85,000 has been secured for the Friends and Family Test (FFT) pilot through Referral Support Service (RSS). This will provide valuable data on 3
patient experience on the referral pathway between primary and secondary care services and will be used to improve services in the future A workshop designed to evaluate preparedness in emergency situations was well attended. Valuable feedback was received from participating organisations DEB is to lead the Surrey Transformation Board to expedite real transformational change across the Surrey health and social care economy, with focus on clinical quality. An update on the Francis Report, one year on, was also given, with focus on patients attending RSCH experiencing longer than 4 hour waits. The whole health community need to work together to understand issues and learning, to ensure that a quality service is delivered. The CCG are focused to ensure services are of high quality. Royal Surrey County Hospital (RSCH) has been rated as good in a recent CQC inspection. The commissioning of mental health crisis care should recognise the importance of physical as well as mental health, that is patient centred and holistic. Recommendation: The Governing Body were asked to note the Chief Executive s Report. The Governing Body noted the Chief Executive s report 2 Governance and Assurance 2.1 Annual Equality Report 2013/14 EN introduced the CCG s first Annual Equality Report, giving particular thanks to the Director of HR who had been instrumental in pulling this cross cutting work together with its focus on commissioning, patient experience, leadership and workforce. GB members were informed that a workshop had been held, involving staff, patient representatives and public health, to grade the CCG s performance against 18 outcomes which made up the Equality Delivery System. The grading scale was described and the before and after picture given to convey the significant progress achieved. This would be published on the website in 4
accordance with stipulated deadlines. Significant improvement had been shown in the CCG as an employer. There was also extensive evidence of equality initiatives in commissioning, but a more systematic approach across the 9 protected characteristics will be required to achieve the highest grading - excelling. ACTION: The report to be put on the website and promoted. Equality Delivery System leads had been nominated to promote and take the EDS2 system forward with a focus on ensuring equality considerations underpinned all future commissioning decisions. GB members attention was drawn to the four objectives for 2014/15, for which approval was sought. In response to a question from Dr Susan Tresman (ST), Elaine Newton (EN) confirmed that equality and diversity would be included as a session on the Governing Body s Organisational Development programme. Recommendations: 1. For the Governing Body members to approve and support the Annual Equality Report 2013/14 2. To acknowledge the robust process that was applied in the 20 March EDS Lead workshop to award the final grading of EDS outomces 3. To endorse the EDS2 objectives 2014/15, noting any amendments from EDS Leads on the 20 March 2014. The Governing Body approved the report and acknowledged the process. Objectives were endorsed. 2.2 Phase 4 HR Policies JM introduced the phase 4 HR policies and identified those which were new and those which were existing policies that had been amended in the light of experience and best practice. Recommendation: To approve the revision to the 2 policies and the implementation of the 5 new policies. EN 5
The Governing body approved revision to 2 policies: Disciplinary and Capability Policy Internet Use and Email Policy The Governing body approved the following policies: Adverse Weather Policy Drug and Alcohol Misuse Policy No Smoking Policy Long Service Awards and Achievement Policy Relocation Expenses Policy GB03/14 2.3 Quality and Safety Report VS introduced this report. All quality and safety issues had been presented to the Quality and Governance committee, with agreed action plans where there are quality issues identified. Royal Surrey County Hospital (RSCH) Ophthalmology services CQC action plan continues to be monitored at the monthly Clinical Quality Review meetings. RSCH has accepted the Ophthalmology clinical review report, which is for final sign off at Quality and Clinical Governance Committee on Tuesday Serious Incident Closures 24 open serious incidents (at the end of February 2014). Joint agreement with the RSCH to focus on closures and learning from serious incidents when the serious incident panel is managed in-house from April 2014 Learning Disability Services had received an excellent peer review report on their learning disability awareness and strategy South East Coast Ambulance (SECAmb) End of Quarter 3, Red 1 and Red 2 performance is 67.7%, national target is 75%. Work underway with North West Surrey CCG, as the new Surrey host CCG for SECAMb re quality improvements. VS VS VS Ongoing 6
Surrey and Borders Partnership (SABP) Care Quality Commission visits to 21 sites highlighted four key themes: promoting dignity and privacy, care planning, environment and staffing. Out of 150 actions, 109 (73%) have now been completed. NHS G&W CCG will visit a number of SABP facilities as part of a quality monitoring exercise. BMI Mount Alvernia A meeting was held with BMI Mount Alvernia to discuss the re-instatement of the contract following full assurance of the areas identified in the quality assurance exercise. The contract will recommence on April 1 st 2014 with regular clinical quality review meetings to focus on areas identified in previous Care Quality Commission reports. PB highlighted that patient feedback in the CQC report had been positive and questioned the best approach for ensuring comprehensive gathering of feedback in the future. Vicky Stobbart (VS) commented that patient experience will continue to be monitored at the regular quality meetings. Quality Premium Due to non-achievement of the quarter 3 4 hour wait in A&E this will impact on the CCG receiving the full quality premium payment and it is anticipated that it will be a lesser amount of 25% VS Recommendation: The Governing Body To review quality performance in the relevant providers. The Governing Body noted the contents of the report and actions to be taken. 2.4 Board Assurance Framework (BAF) EN introduced the end of year BAF report with a stocktake on the risk profile which the CCG had monitored and managed throughout the year. Changes to the BAF since its last presentation were highlighted. 7
Governing Body members were advised that an intensive review of the latest risks by directorate will be undertaken, followed by a sense check by the executive management team (EMT), in advance of presentation to the audit committee in April and GB in 2014/15. This was important to ensure risks remained current and GB members assured that the right risks had been identified and the right mitigations were being applied Stephen Park (SP) commented, as Chair of the Audit Committee, that encouraging progress had been made in the first year of the CCG s operation and was encouraged at the signs that this effort will continue in the coming months. He emphasised that the role of the EMT in reviewing and calibrating the BAF was critical in enabling the Audit Committee to take more of an assurance role ST commented that she had welcomed the approach adopted by the Quality and Clinical Governance Committee, whereby risk handlers were being invited to comment on new risks - learn and raise awareness and promote equality EN commented that corporate risk ownership of the top half a dozen risks was essential to good governance - everyone should have a sense of ownership and know the top five risks EN 22/04/14 Recommendation: to review the latest version of the BAF and the proposed approach for refreshing the BAF and risk registers for 2014/15 The Governing Body reviewed the latest version of the BAF and the approach for refreshing the BAF and the risk registers in the future. Regular reports will be presented to the GB for review. 3 Clinical Commissioning Operational Plan and Draft Strategic Plan 3.1 JMc presented the plan and requested the Governing Body s agreement to approve the submissions for the 4 th April deadline and to approve the delegated authority to the Chief Executive and the Chair to sign off any further amendments to the reports. GB members were reminded that the CCG had submitted a 2 year operational plan and a 5 year 8
strategic plan to the Area Team and was now addressing their feedback of not assured, which in part derived from the strategic but not the operational plan being reviewed. Work will be undertaken to ensure the plans are approved. In order to address any changes made to the version presented at the meeting and the next submission to the Area Team on the 4 April 2014, Governing Body members were asked to agree to a Chair s Action process, and nominate a clinical and non-clinical member of the GB who would be consulted on changes. SP asked that the Chair and Chief Executive take a judgment on the parameters of the changes being approved through the Chair s action and if these were significant an emergency meeting might be considered more appropriate. Comments on the Strategic Plan: Page 22 - we are focusing on specific conditions that cause parents to take their children to A&E, specifically bronchiolitis, asthma and fever Amendment: we are focusing on specific conditions that cause parents to take their children to A&E, specifically bronchiolitis, fever and diarrhea and vomiting Page 23 - other programmes that incorporate our integration agenda include rolling out Telehealth to people with COPD and heart failure; improving the responsiveness of our Continuing Health Care Service and ensuring our population is fully utilizing their Personal health budgets Amendment: Other programmes that incorporate our integration agenda include: Rolling out Telehealth to people with COPD and heart failure Improving the responsiveness of our Continuing Health Care service Ensuring our population is fully utilising their Personal Health Budgets. Comments on the Operational Plan:. Page 3 Additional bullet point - Health and Wellbeing Board Addition of section entitled Organisational Development detailing development 9
Page 16 Workforce Planning to amend wording Page 28 amendment to table regarding workforce to mobilise and skill mix. ACTION: To reflect above amendments to the plans JMcE 04/04/14 Recommendations: To approve the submission for the 4 April deadline and note the next steps To approve delegated authority to the Chief Executive and the Chair, having consulted with at least one clinical and non-clinical member of the Governing Body, to sign off any further amendments to today s versions between now and the next submission date of the 4 April 2014 The Governing Body Approved the plans with minor amendments and nominated ST and DW, as the non clinical and clinical members respectively, to support Chair s Action 3.2 QIPP Report Dr Jonathan Inglesfield (JI) introduced the report, highlighting the following aspects: Year to date performance this financial year is showing a shortfall which is a significant financial risk to the CCG The QIPP programme focuses on the re-design of services to maximise quality, to be innovative, release savings, and prevent disease through education Although the shortfall is disappointing, achievements have been made. Many of the clinically led service changes have been implemented but the full impact has not yet been realised The dermatology service is a high quality service expected to make savings Referral Support Service (RSS) is a new innovative high quality service which offers alternative treatment options to patients Friends and Family Test (FFT) the pilot scheme will look at patient experience through referral, appointment and service. This has not been done before and is an exciting opportunity Pharmacy Care home reviews and care planning for dementia will expand to all vulnerable people. 10
A Pressure Ulceration Workshop will be held this week to promote a quality prevention service. Recommendation: To note the contents of the report and the recommended actions. The GB reviewed and noted the QIPP Report. 4 4.1 Performance and Finance Draft Medium Term financial Strategy Karen McDowell (KMc) presented the draft financial strategy for the next 5 years, focusing on the financial position and financing the strategy to deliver health objectives. KMc highlighted the following: The GB was asked to agree the strategy and note the risks and the plans to address the risks The financial position will be monitored on a monthly basis with regular updates to the Finance and Performance committee It was noted that all the plans needed to be actioned to deliver all the changes required. To note that the report is in draft stage until final submission of Financial Plans. KMc Ongoing Recommendations: 1. To agree the Medium Term Financial Strategy 2014/15 to 2018/19 2. To note the risks identified within the strategy and the mitigations to address the risks. The Governing Body Approved the draft medium term financial strategy. 4.2 Draft 14/15 Budget Book Karen McDowell (KMc) presented the report and highlighted the key factors underpinning the organisation s finances: KMc highlighted the following areas in the report: CCG Statutory duties page 1 High Level Resource allocation for 2 years page 2 QIPP target of 11.5m on page 3 11
Running costs on page 4, noting that there will be a 10% reduction in 15/16 Highlighting the key risks on page 6, also for the GB to note that not all Acute SLAs had been agreed at the date of writing the attached report. Questions raised from GB Member Page 7 to include within budget holder responsibility the need to pay invoices within 30 days Following a question regarding the availability of money for investment, it was noted that this was not an option with NHS finances SP asked whether cash balances are offset or with the CCG s control. KMc confirmed that bank accounts are set up through a National system, which are managed outside the CCG s control. Recommendations: 1. Approve the detailed Draft capital and revenue budgets for 2014/15, to note that further changes will be required. 2. Note the risks identified within the report and the mitigations to address the risks. The Governing Body Approved the draft Budget Book. 4.3 Month 10 Finance Report Karen McDowell highlighted the following from the report: The CCG was on track to deliver a year to date (YTD) surplus of 1.2 million in line with the financial plan. The key financial risks were highlighted as follows: Overspend in the acute portfolio to be offset by contingency and reserves NHS England has yet to confirm whether outstanding PCT liability in relation to continuing health care will need to be accounted for by CCGs. This has not been reported within budgets so far but it is anticipated that the CCG will receive an indication on what transactions may need to take place. It was stated that there are a range of potential liabilities which are difficult to estimate at this stage. 12
Recommendation: To review the following: The forecast financial position for 2013/14 The key risks as described in the paper The Governing Body noted the forecast financial position and the key risks. 4.4 Performance Report Karen McDowell (KMc) highlighted the key areas of underperformance as follows: Incidence of C diff had increased to a year to date (YTD) total of 22 cases 22 mixed sex accommodation breaches were reported in January Mental Health performance is below target. It was noted that the issue is to be raised with Surrey and Borders Partnership (SABP). The problem affects small numbers of patients, and is often due to the logistics in accessing the patients rather than the service itself Cancer maximum two week wait and waiting times in A&E were below target Trauma and orthopaedics and Urology are underperforming. These risks are being closely monitored by the CCG and plans are in place to rectify. Recommendation: To review the areas of adverse performance and the actions identified to rectify. The Governing Body reviewed the areas of adverse performance and agreed the necessary actions to rectify. 5 Minutes of Committees 5.1 5.2 DEB invited the Chairs of the Committees to highlight any particular issues from the minutes included with the papers. Audit Committee minutes January 2014 Chair Stephen Park Lay Member Finance and Audit The minutes were noted Clinical Commissioning Committee minutes January 2014 Chair Dr Jonathan Inglesfield Medical Director (Commissioning)/ GP Member 13
5.3 5.4 The minutes were noted Finance and Performance Committee minutes- January 2014 Chair Dr Jonathan Barnardo - GP Member The minutes were noted Quality and Governance Committee minutes November 2013 and January 2014 Chair Dr Susan Tresman Lay Vice Chair (Lay member Quality and Governance) The minutes were noted 6 Any Other Business There was none. 6.1 The date of the next Governing Body meeting: Tuesday 27th May 2014, 14.00 17.00 Venue: Godalming College, Tuesley Lane, Godalming, Surrey GU7 1RS Signed: Dated: 2/6/14 Dr David Eyre-Brook, Chair 14