CCG GOVERNING BODY 10 th July 2014 160 Tooley Street London SE1 2QH Minutes GOVERNING BODY MEMBERS PRESENT: Dr Jonty Heaversedge (JH) CCG Chair & Dr Noel Baxter (NB) Dr Adam Bradford (ABr) Professor Ami David (AD) Registered Nurse Member Linda Drake (LD) Practice Nurse Member Dr Obi Ezeji (OE) Clinical lead Dr Richard Gibbs (RG) Lay Member Dr Jonty Heaversedge (JH) Dr Patrick Holden (PH) Dr Sian Howell(SH) Dr Nancy Kuchemann (NK) Dr Jaques Mizan (JM) Robert Park (RP) Lay Member Dr Jane Cliffe(JC) LMC Representative Dr Yvonneke Roe (YR) Andrew Bland (AB) Chief Officer Malcolm Hines (MH) Chief Financial Officer Tamsin Hooton (TH) Director of Service Redesign Dr Tan Vandal (TV) Secondary Care Doctor Member Alex Laidler (AL) Interim Director, Adult Social Care Southwark Council David Cooper (DC) Chair of Healthwatch Southwark IN ATTENDANCE: * Vicky Bradding Dr Alison Furey (AF) Rosemary Watts (RW) Amanda Williams Cepta Hamon Cathy Ingram Karen Titchener Corporate Secretary (minutes) Consultant in Public Health CCG Head of Membership & Engagement GSTT General Manager GSTT Head of Nursing GSTT Head of Therapies Deputy Head of Nursing *A list of attendees from the public seats are recorded at the end of the minutes APOLOGIES: Dr Tushar Sharma (TS) Malcolm Hines (MH) Gwen Kennedy (GK) Professor John Moxham (JM) Chief Financial Officer Director of Client Group Commissioning King s Health Partners 1
The meeting commenced with a short Patient Story film - perspective from a carer. 268/14 Chairs Welcome JH welcomed everyone to the meeting and members introduced themselves. JH welcomed the newly appointed members to the Governing Body- Dr Obi Ezeji, Dr Jaques Mizan, Dr Noel Baxter and Dr Yvonneke Roe and the newly appointed members outlined their backgrounds. JH thanked the outgoing members - Dr Amr Zeineldine, Dr Simon Fradd, Dr Roger Durston and Dr Pat Holden for their hard work and contribution over the past two years. 269/14 Declaration of Interests DF reported that she has been appointed as a Non Executive Director Board Member on Northampton Council on Addiction. No other changes were reported to the register of interests circulated. 270/14 Public Open Space Mrs Rylance-Watson stated that she had recently attended a meeting following an invitation from the Social Enterprise Board to provide ideas for the GP enhanced services. She stated that this provides an important opportunity to involve patients in co-production and design. However, to make a useful contribution, those involved need to know details of the NHS England (NHSE) core service arrangements and how the CCGs work with GP practices. AB replied that details of the core General Medical Services (GMS) contract provision can be provided but it is important that this is presented in a user friendly format. Patient Participation Groups (PPGs) have already been involved in discussions about the provider landscape and commissioner response. SH welcomed this initiative and ERW s comments. PPGs are key in contributing to the CCGs strategic plans, addressing inequalities and driving up quality. TH agreed and stated that details of what is commissioned by NHSE will be made available. PPGs are a vital component in ensuring that there is full engagement with patients as the work of the Primary and Community Care Strategy continues to be embedded. JH suggested that the information requested should also be posted on the website. ACTION AB/TH/RW to make available details of the GMS contract in 2
Plain English. 271/14 Minutes of the last meeting The minutes of the previous meeting held on 12 June 2014 were agreed to be a true record with the following amendments: Attendance Add In attendance: Alison Furey Consultant in Public Health Dr Obi Ezeji Dr Noel Baxter 258/14 second Para- delete 3 rd sentence. Insert: DC was certain that the CCG would note lessons that can be learnt from the serious case review 263/14 South East London (SEL) Five Year Strategic Plan- Page 2 para 2, delete "He responded that the CCG would note the lessons that can be learned from the Serious Case Review" and insert He responded that he expected CCG and Local Authority commissioners would want to learn from the recently published Serious Case Review into the events. Page 7 para 3 -delete whole para.insert DC commented that the plan, including the executive summary, was not written in a sufficiently accessible style, to engage patients or their representatives. Patients would also wish to see a better balance in the report, between whole systems, and local changes. That engagement should not be a separate section or theme but run throughout the report. 272/14 Matters Arising & Action Sheet Dedicated portal on the website for quality issues- TH reported that she the quality alert system provides the best method for practices to submit quality comments about acute providers. There is a need to ensure that practices fully utilise the Quality Alert (QA) System and the link is publicised on the GP extranet. TH will ensure the QA system is publicised and that Quality Alerts remain on locality meeting agendas. In answer to a question from YR, TH stated that Quality Alerts are managed within her team. TH will continue investigating the feasibility of 3
extending the system to manage reverse quality alerts allowing acute providers to comment on quality issues with GPs. A number of hurdles to be reviewed. ACTION TH Monitoring of Pharmacies- AB will raise at next meeting of Health & Well Being Board (HWB ) on 24 th July ACTION AB Governing Body Seminar on the CCG Budgetary framework specifically mental health to be held ACTION MH Governing Body seminar to be run on the Quality Framework. Quality Framework Action plan to be developed to implement recommendations of the Quality Framework and to expand the system to allow acute providers to report quality issues. Action Plan to be shared with GB members ACTION TH Better Care Fund report being prepared for the HWB next meeting. To be circulated to GB ACTION TH 273/14 Chief Officer s Report AB highlighted the main points of the report: Fit for Purpose AB stated that this is the final week of the consultation period with staff. DC welcomed the CCG emphasis on membership engagement and enquired whether a smaller support team is envisaged. AB stated that Fit for Purpose has partly emerged from the need for all CCGs to reduce their running costs by 2015 but is more about ensuring that the CCG is robustly fit for purpose. He agreed the need for the emphasis on engagement and he has tried to embed specialist input by restructuring and neither adding or taking away resources. Operational Resilience In answer to a query from NK, AB stated that primary care targets have not changed. Previously winter monies were received in winter but this year they have been received in June. Operational Resilience goes beyond Winter Resilience. There is focus on the whole system over a wider period with a call on the whole system to play a part. Choices will inevitably have to be made where direct monies are being used to make a contribution. DF welcomed the non-recurrent Referral to Treatment waiting times (RTT) funding. She highlighted that there is likely to be increased scrutiny of performance in the lead up to the General Election and therefore this money must be targeted well. AB replied that there is already a significant amount of scrutiny and an additional 9.1m 4
recurrent funding has been received The Governing Body noted the Chief Officer s report. 274/14 Integrated Governance & Performance (IGP)Committee report (June 2014) AB presented an overview of the committee structure in the CCG Constitution to demonstrate the roles, responsibilities and interrelationships of the different Governing Body sub committees. A copy of this presentation is attached to the minutes. RP outlined the discussion at the June meeting of the IGP Committee and highlighted the current areas of business detailed in the report. The committee has assessed and approved the appropriate Governance processes in place to address difficulties for RTT and consequential impact on 52 week waiting lists. Deep dives have been carried out into hospital acquired infections (HAI) and also Kings College Hospital NHS Foundation Trust (KCH) RTT performance. As a result of these, the CCG has requested assurance from KCH that patients are kept informed. GPs have also been alerted to this situation. RP also reported that the committee had reviewed the Performance Report, the Finance Report, the Board Assurance Framework and the QIPP Programme 2014/15. The Committee approved the increase in IAPT resources to recruit 10 high intensity worker to reduce waiting times and achieve targets. The committee also noted the financial position as at Month 2 and that the CCG is on track to achieve the annual surplus of 3972k. RP invited any questions YR requested that the accuracy of waiting times on Choose and Book is improved to inform patient choice at time of referral. AB suggested a separate discussion regarding Choose and Book and stated that whilst the CCG cannot change information on Choose and Book system there are other ways the CCG can make information available. Good information must be available re patient waiting times but he highlighted that national systems are not amenable to change. TH informed the GB that she had written to practices informing them of KCH waiting list but this message is not getting across adequately. 5
JC welcomed the use of additional resources on IAPT but stated that clarification is required re high and low intensity workers and highlighted the differences in North and South Southwark. AB highlighted it was non-recurrent funding and budgets had not been enhanced. Improved investment into IAPT had been provided for in the start budgets when money was identified for service improvements. JC also highlighted the difference in performance on the Friends & Family target at Guy s and St Thomas NHS Foundation Trust (GSTT) and KCH and said it contrasted her anecdotal evidence from patients. TH explained that there is more data beneath the report on this target which would explain more. DC stated that he was encouraged by the openness of KCH report. This is very positive especially in these challenging times. The GP is crucial in offering alternatives to patients and he wondered whether there are other ways that this can be tested. TV requested that real wait time is available to GPs in the surgery. He also stated that Choice is easier when a decision to operate has been made. He also enquired whether there is confidence that the 18 week data has been fully evaluated. AB replied that there has been an increased assessment of inpatients but this has not been carried out for the non admitted. Many measures, discussions and an action plan is in place to improve the situation. Regarding choice, he reported that the Council s Overview & Scrutiny Committee (OSC) has agreed that the use of the Orpington site as an additional elective centre is not a substantial change in service and provides additional choice for Southwark patients. KCH can provide information on numbers of cancellations and has also held events for patients. The OSC requested that ways of identifying patient feedback are put in place. OE pointed out that Friends and Family test is not a useful measure to compare services. He also suggested that the CCG demonstrate more proactivity rather than just seeking to remedy the situation AB stated that he is assured that the overall KCH RTT recovery plans are comprehensive and will make a difference. However, he is not assured that each individual part of the plan is guaranteed success. It is therefore crucial that there are quarterly reports to the IGP committee to ensure that patient choice is embedded in the process. 6
The Governing Body received and accepted the report from the IG&P Committee including the Performance Summary, Finance and Board Assurance Framework reports. 275/14 Commissioning Strategy Committee Report (May & June 2014) AB outlined the committee s current areas of business detailed in the report. He drew members attention to the expression of interest made in the Co-commissioning of Primary care across SE London. He emphasised that this is only an expression of interest at present. The proposal is not to hold contracts with associated performance management but is to enable a more integrated approach to the commissioning of primary care. JH stated that member support is vital and requested that information is posted on the member and staff zone of the CCG website. DC also requested more information on co commissioning. ACTION AB/RW The Governing Body received and accepted the report from the Commissioning Strategy Committee for May and June 276/14 Engagement & Patient Experience Committee(EPEC) Report (May 2014) DF stated that good interaction between the GB and EPEC is essential and the Southwark EPEC committee has been well served by JH as chair. She outlined the discussion at the last meeting. The GB discussed the challenges of hearing a representative patient voice within SEL. Healthwatch presented details of their work regarding patient Involvement and there was also a presentation on mental health. RP highlighted the need to reach groups who are not normally involved e.g. young people. DF stated that these groups will be involved through specific pieces of work. In answer to a question from NK, JH stated that anyone can attend their patient participation group meeting but EPEC members must be elected by their locality patient participation group. DC drew the GB attention to the recent publication of the Healthwatch annual. The Governing Body received and accepted the report from the Engagement & Patient Experience Committee for May 277/14 Report of the Director of Public Health 7
AF stated that Public Health now works and is represented across four organisations London Boroughs of Lambeth and Southwark and NHS Southwark CCG and NHS Lambeth CCG. She outlined the report and highlighted that the bid to the lottery for life expectancy funding had been successful. Discussion ensued. RG highlighted a number of areas which would be useful for inclusion in the report: It would be useful for the GB to receive Southwark-specific information for progress and recommendations for action, e.g. is statin prescribing in Southwark following the national recommendations. It could be that a Southwark specific report is required. AF stated that some items e.g. statins and smoking actions are being considered by the CCG in other meetings (CSC). Significant work is being carried out and further detail is provided in the Business Plan and the Public Health report. She stated that the report is intended to provide a flavour of current work across the four organisations. ACTION AF DF stated that the link between needs assessment and activity and outcome is not clearly indicated. She requested that there is a section within the public health report on life expectancy for mental health patients. AF stated that this is provided in the JSNA mental Health report ACTION AF ABr enquired whether work on the Chemsex Study is being coordinated within the local authority and queried whether the establishments used are licensed and whether the licences can be revoked. AF replied that there are only certain conditions whereby a licence can be revoked and she will check the LA control on behaviour in their licensed premises. SH stated that she would prefer a supportive approach be adopted. ACTION AF RP requested clarity on public health work programme for the year, including defined priorities and how the work programme will be progressed. The GB must be assured that the CCG priorities are covered. AF stated that there is an oversight group for public health which reports to the chief executives of the local authorities. This year s Annual Public Health Report will be available in September. JH highlighted the need to increase sensitivity around cancer symptoms and implement these locally. AF replied that this report relates to the 8
national campaign and national guidelines. The Governing Body received and accepted the report from the Director of Public Health 278/14 Presentation Guys & St. Thomas Community Services- Out of Hospital Update JH welcomed Amanda Williams, GSTT General Manager, Cepta Hamon, GSTT Head of Nursing, Cathy Ingram, GSTT Head of Therapies and Karen Titchener, GSTT Deputy Head to the meeting. They outlined the progress on Out of Hospital care (OOH), Admission Avoidance and Enhanced Rapid Response. KT stated that the OOH care programme is provided from 8am 11pm seven days per week and is well on the way to the maximum potential number of patients. The team are promoting the service during visits to all the GPs in Lambeth and Southwark. SH confirmed that the service provides a very positive experience. YR agreed and requested more publicity to make everyone aware of the service. RP enquired how progress is being monitored. KT highlighted key performance indicators in a monthly report, integrated score card and patient feedback. She stated that the readmission rate has dropped to less than 15 percent. KT stated that nationally each admission is an average of five bed days but locally this has been reduced to three, Work is also carried out within the Southwark and Lambeth Integrated Care programme (SLIC). JH stated that evaluation will be key and he would welcome impact and feedback in six months time. ACTION TH with GSTT CH highlighted difficulties recruiting nursing staff and outlined the community nursing plans and priorities. Regular meetings are held with District Nurses and all effort is being made to raise the profile of the service and to improve relationships with primary care. LD stated that there has been huge improvement and she welcomed the feedback on the processes. She stated that the transitions programme will attract more nurses into community care and she will work very closely to promote this. AL thanked the GSTT team for their transparent feedback. She suggested that the service could be developed for nursing home care as well. In answer to a question from JM, CH reported 40 new nurses have 9
recently been recruited. Effort is also being made to reduce the use of temporary and agency staff but this is quite tricky at the moment. NK suggested that current GSTT nurses could be rotated into community services. CH stated that relationships are being strengthened with the university to make the community a more attractive place to work. CI outlined progress on the Enhanced Rapid Response service. In answer to a question from JM, CI stated that there has been liaison with third sector providers not involved in the delivery of services. There has also been liaison with SLIC about how patients discharged from hospital can be supported. In answer to a question from JC, CI confirmed that the GP is informed when a patient is referred for enhanced rapid response services and this is followed up by letter. There is a unified telephone contact point. In answer to a question from DC, CI replied that telephone follow up is made to every patient and patient feedback is very positive. The Interpreting service is also used as necessary and male or female staff can be provided if requested. JH thanked the GST team for presenting. The Governing Body received and accepted the update on Out of Hospital Care. 279/14 CCG Business Plan AB presented the Business Plan and illustrated the links between NHS London requirements, high level corporate objectives, key actions and the work of the CCG. New clinical leads have recently been appointed and discussions are taking place in setting their portfolios. AF queried whether the Business Plan should be subject to Public Health challenge, but AB stated that challenge would be more appropriate on the strategic plans rather than on the business plan. In answer to a question from DF, AB stated that the purpose of the Business Plan is to bring all high level CCG plans in one document and to set Business objectives. In relation to her query about the Carers Strategy, AB stated that it is not possible to address all aspects of every strategy within the document. The Primary & Community Care Strategy 10
is an overarching strategy for the CCG and is therefore reflected within the plan. All strategies are underpinned by action plans and it is a challenge for the IGP committee to ensure that these are fulfilled. ABr welcomed that inequalities had been included and stated that it would be useful to have feedback on the triggers for this. He stated there is a real variation in Southwark and this must be fully recognised. AB emphasised that the Business Plan is for the implementation of the CCG strategies. The key areas of delivery are where the CCG has capacity and where all effort must be made. In answer to a question from DC, AB stated that the Business Plan is not written for the public. RP stated that the IGP have prime oversight and he requested that an item on review of the Business plan is included each quarter at IGP meetings. ACTION KS RG stated that he could not see reference to the SE London 5year Commissioning Strategy within the plan. AB agreed that linkage could be clearer but pointed out that the Business plan is the Southwark intonation of the SEL 5year Commissioning strategy. 280/14 The GB approved the CCG Business Plan 2014/5 and agreed to delegate the GB Authority to formally sign off at the IG&P meeting on 31 July 2014. Items for Information The Governing Body noted the following items for information: CCG Integrated Performance Report (M1) Minutes of the following CCG Committees Dulwich Programme Board (April 2014) Integrated Governance & Performance Committee (April 2014) Commissioning Strategy Committee (April & May 2014) Engagement & Patient Experience Committee (May 2014) Audit Committee (April 2014) Conflict of Interest Panel (April 2014) 281/14 ANY OTHER BUSINESS DC reported that Alvin Kinch is leaving Healthwatch to take up a position 11
with Healthwatch England. JH thanked Alvin for her hard work and contribution to the CCG particularly on the work in developing the Primary & Community Care Strategy 282/14 Public Open Space Lesley Chandler requested that the timing of CCG meetings follow a sensible sequence so that information can be fed through without delay. Difficulties in achieving this were acknowledged and this will be considered in 2015/6 schedule of meetings. ACTION JH/RW ERW requested that there is more consistency in terminology and that names adopted are adhered to. 283/14 DATE OF NEXT MEETING 11 September 2014 12
Attendance Sheet Southwark Clinical Commissioning Governing Body meeting Thursday 10 th July 2014 Catherine Worsfold Stuart Edwards Richard Cowhie Mok Okrekson Lesley Chandler Mark Batchelor Ian Brown Kirsty McGuire Elizabeth Rylance Watson CCG Corporate Governance Manager Convatec LTD Cherry Ltd Member of the public Member of the public Markman OTW NHS England NHS England Southwark Resident 13