East Lancashire CCG Governing Body Minutes of the meeting held on 26 January 2015, 1pm at Walshaw House PRESENT: Dr Phil Huxley Michelle Pilling Steve Allcock Dr Stuart Berry Dr Fiona Ford Jackie Hanson Dr Paul Hartley Dr Mike Ions Dr Tom MacKenzie Dr Richard Robinson David Swift Dr David White Dr Ian Whyte Tom Wolstencoft Mark Youlton In Attendance: Angela Brown Olive Carroll Steve Dean Anne Pietrzak Min Ref: 15.01 Chair Lay Advisor – Quality & Patient Engagement/Deputy Chair Secondary Care Consultant GP Clinical Lead - Pendle GP Lead - Primary Care Development Director of Quality / Chief Nurse GP Lead - Acute Commissioning & Contracting Chief Clinical Officer GP Clinical Lead - Rossendale GP Clinical Lead – Hyndburn Lay Advisor GP Clinical Lead - Burnley GP Clinical Lead - Ribblesdale Lay Advisor - Governance Chief Finance Officer Head of Corporate Affairs/Board Secretary Director of Personal Social Care/Community Director, Healthwatch Lancashire Board Services Manager ACTION Scheduled Care Patient Experience Dr Mark Dziobon, GP and Clinical Lead for Scheduled Care gave a presentation describing how the Scheduled Care Team had engaged with patients from the earliest point in the process for transformational change of key clinical areas, following the 2013/14 Quality & Outcomes Framework – Quality/Productivity review. A event was held with all member practices to share the findings of the review and it was agreed to undertake a whole system change to Ophthalmology, Dermatology, Musculoskeletal and Orthopaedics. The approach was supported by the CCG and the Team scoped all of the options in terms of procurement or service re-design, including lengthy discussions with all providers and BwD CCG. The new service would need to meet all stakeholders views of the ‘shared vision’ and it was acknowledged that patient engagement was a powerful vehicle for change and would shape the ‘shared vision’. Mark described how the Scheduled Care Team and Non-Executive lead for patient engagement had attended outpatient clinic settings to obtain the views of patients using the services. Discussions had taken place with 260 patients and a wordol within the presentation provided feedback of what patients want and don’t want. Three specialty specific focus group sessions were then convened, with patients being more involved in discussions as to what transformed service might look like. Page 1 of 11 Minutes Approved by the Chair : 17.2.15 The Team considered the process of patient engagement was challenging and rewarding, highlighting the need to reflect and learn from the process going forward. They were very proud of the work they had done and thanked Michelle Pilling and Mark Youlton for their support. The Chair advised Members that the Scheduled Care Team were awarded the Patient Engagement Award for this work, which is testament for the work carried out, highlighting the need to use patients as much as we can as a resource to tailor patient expectations. Following discussion members were advised that it had been agreed to go out and meet individual patients who have used the services, rather than using locality Patient & Participation Groups, noting that all patients involved in the engagement had received feedback from the Team during the process. A membership scheme was also being developed to facilitate patient engagement. It was recognised that these processes capture people using the service, however there is a need to identify how to capture those people who are not currently using the service. Michelle Pilling felt the Team should be rightly proud of their work. There was a great deal of openness in meeting patients from all spectrums of society, pointing out the success was sitting in the clinics and listening to patients which provided very powerful messages that would not have been picked up by using questionnaires and surveys. She had recently heard from patients who say that the changes are now making a difference. Mark Youlton also congratulated the Team on an outstanding job as change in service delivery was a difficult process and important to have continuous discussion with patients. It was also noted that clinicians at ELHT received feedback from the Team regarding patient experience, however going forward it was agreed that as a principle, clinicians should be involved from the outset. In conclusion the Chair thanked Dr Dziobon and the Scheduled Care Team for the very good work they were doing on behalf of the CCG. 15.02 Welcome, Introductions & Chair’s Update The Chair welcomed everyone to the Governing Body meeting, confirming that he had officially taken the Chair from January 2015. He welcomed members of the public as observers and was happy to provide clarification regarding any issues following the meeting. Phil thanked Governing Body members and the CCG for supporting him through his first few weeks as Chair. He felt these were exciting times with lots of challenges and opportunities ahead. Phil welcomed two new members to the Governing Body. Dr Stuart Berry had been appointed Clinical Lead for the Pendle locality and David Swift, Interim Lay Advisor to maintain the importance of the lay voice to the Governing Body. 15.03 Apologies Apologies were received from Mike Leaf. 15.04 Governance Declarations of Interest The Chair advised that concerns had been raised regarding the CCG having a Clinical Accountable Officer and Clinical Chair. It was important to be clear that the organisation takes Conflict of Interest very seriously, pointing out that all Page 2 of 11 Minutes Approved by the Chair : 17.2.15 Members are asked to declare interests annually which are held on Declarations of Interest Register. Any changes during the year should be highlighted and Members were asked to declare any changes since the last Governing Body meeting: Dr Phil Huxley: Practice is a Member of Pendle Care Direct, a social enterprise organisation based in Pendle, looking to provide medical services in the community. Dr Stuart Berry: Reedyford Practice is a PMS Practice and a member of the EU Federation of Practices. Dr Tom Mackenzie: Practice is a member of EU Federation of Practices. Dr David White: Practice is a member of EU Federation of Practices. Dr Richard Robinson: Practice is a member of EU Federation of Practices. Dr Mike Ions: Director of Pendle Education Trust Board & his Practice is a member of EU Federation of Practices. Mark Youlton: Public Sector Director of LIFT Collectively GPs present declared an interest in agenda items 4.1, 5.1, 6.1, 6.3 and 7.1. Quoracy : The meeting was quorate. 15.05 Declarations of Other Business Reference was made to an article in The Sunday Times on 25 January 2015 relating to Calderstones Partnership Foundation Trust and potential closure. An update to provide assurance would be included in Dr Ions report on the agenda. 15.06 Public Questions No questions had been received from members of the public. 15.07 Minutes of Previous Governing Body Meetings 15.07.1 24 November 2014 Min:14.165 – Constitution Update : Steve Dean had reservations regarding changes to the constitution in respect of LCC representatives no longer being voting members but were in attendance. He expressed concern that since the decision had been taken, LCC representatives had not attending meetings. Members were advised that the CCG were actively pursing LCC attendance and Dr Ions was meeting with LCC Chief Executive to discuss replacements at Governing Body and Sub Committee meetings to ensure continuity. RESOLVED: that the minutes of the 24 November 2014 meeting were approved as an accurate record. 15.07.2 15 December 2014 RESOLVED: that the minutes of the Informal Governing Body meeting held on 15 December were approved as an accurate record. Page 3 of 11 Minutes Approved by the Chair : 17.2.15 15.08 Action Matrix 14.71 Dementia – Little response had been received following market testing and a written update would be presented to the next meeting. AW 15.124 Assurance Report – Details of how to access the Intranet had been Complete circulated to Members. 14.127 IT Strategy - Discussions had taken place at Senior Clinicians and further discussions were to take place with Jonathan Wood at ELHT and Stephen Lord, Head of IT with the CSU to discuss options and preference. The CSU had been asked to prepare a detailed strategy which would be available mid February 2015. The Strategy would incorporate Lancashire wide links to the Data Advisory Group and other IT Groups. 15.09 MY Matters Arising 15.09.1 Conflict of Interest This item was brought forward on the agenda. Angela Brown, Director of Corporate Business presented the report outlining governance arrangements for a number of key submissions required during the first two weeks of January. In readiness for the CCG taking on delegated commissioning of primary care services, the Conflict of Interest (CoI) arrangements and policy had been reviewed and amended in line with guidance issued nationally from NHS E. The Remuneration Committee had reviewed and approved the documentation and the CoI Policy was presented to the Governing Body for ratification. David Swift pointed out there was also a possibility that a decision may be called by the Audit Committee, highlighting the need to think carefully regarding membership of the Primary Care Committee, to ensure that it takes account of national guidance, particularly relating to ensuring there are sufficient numbers of lay members to address issues. RESOLVED: that Members ratified the decision of the Remuneration Committee and approved the Conflict of Interest Policy. 15.09.2 Ratification of Chair’s Action The report outlined the governance arrangements for a number of key submissions required during the first two weeks of January 2015. Members were advised of the significant amount of work undertaken leading up to Christmas in respect of the Constitution, Planning Process, Better Care Fund and the Co-Commissioning submission. All areas were discussed at the meeting on 15 December 2014 when Members approved Chairs Action for the Chair and Chief Clinical Officer to sign off on behalf of the Governing Body. It was confirmed that the CCG was able to submit all plans by the due date. Page 4 of 11 Minutes Approved by the Chair : 17.2.15 Better Care Fund Mark Youlton, Chief Finance Officer advised that John Bewick, the national assessor who had provided support, considered the second submission should be approved without query. Discussions were also ongoing regarding organisations working together across Lancashire and further information was to be submitted later in the day. Mark Youlton outlined the arrangements required to enable the CCGs to work with LCC, confirming that a Section 75 Agreement would be put in place to pool budgets, between LCC and the 6 Lancashire CCGs, with signatures from all organisations. A Governance Workshop had taken place to consider how this will work and a Steering Group, chaired by Mark Youlton, met regularly to consider and agree a framework to deliver, with proposals to the Health & Wellbeing Board for approval. It was noted the BCF was listed on the Risk Register, to provide assurance if not approved. Planning Process It was confirmed the full Planning submission would be presented to Members for approval in March. Co-Commissioning Members expressed concerns regarding the delegated budget allocated to the CCG, requesting clarity as to whether this was the correct budget for what we believe the Practices require in EL. It was confirmed the costs included in the initial submission were not final amounts and the submission was an Expression of Interest. The concerns would remain on the Risk Register until the financial position was known, which should be before final sign off was required. If there remained a financial gap, there was a need to accept and manage within the financial process, or opt out and accept Model 2. ACTION: Remain on the Risk Register. Members considered the need to be mindful of public perception regarding co-commissioning and it was confirmed that a Primary Care Committee, chaired by a Lay Advisor would provide the structure for managing delegated arrangements, noting the business of the Committee would be held in public to provide assurance. The new arrangements would also provide a model of commissioning where patients are involved from the infancy as new services are developed. RESOLVED: that Members ratify the actions of the Chair and Chief Clinical Officer in signing off the submissions. 15.010 Improving Access to Primary Care Lisa Cunliffe was in attendance for this item. Dr Huxley declared an interest in this item which outlined the principle of shifting aspects of secondary care to primary care. The report provided a summary of the significant amount of work ongoing to engage with the local population and stakeholders in EL. The engagement exercise had asked for views on what is good/not so good about primary care, Page 5 of 11 Minutes Approved by the Chair : 17.2.15 what could make it better and what the priorities should be for change. Focus Groups were held in all five locality areas and an on-line and hard copy survey was created providing an opportunity for patients and carers to give their views. A wider stakeholder event was held in October when attendees were asked to identify key areas from the feedback and themes provided from the patient engagement and the following priorities emerged: Access to appointments and services in Primary Care Access to information - About services - To support self-care and self-management - About patients by healthcare professionals Primary Care Workforce The report provided detailed feedback in relation to the identified priorities. In terms of the forward plan, it was envisaged that more concrete options would be available, however patients were keen to ensure the principles were right before going out to formal consultation. It was proposed to undertake further engagement, focusing particularly on protected groups and localities to ensure that models developed will meet the needs of all patients and provide options to move forward. It was recognised that the timeline for the different stages would need to fit with contracts already in place, with the aim of service redesign taking place in March 2016, following formal consultation. Members discussed the content of the report and were asked to endorse the direction of travel. ACTION: Members were asked to provide any additional comments directly to Colette Booth or Lisa Cunliffe. Provide dates in milestones against the areas of work to provide a robust timeline – review through LDG. ALL LC RESOLVED: that the Governing Body receive the report and approve the forward plan for the Primary Care Access Project. 15.011 Safeguarding Annual Report Jane Carwardine, Head of Safeguarding, was in attendance for this item. The Annual Report had been received by the Quality & Safety Committee and Governing Body members received a presentation highlight key issues. Safeguarding work was complex and workload continued to escalate with a range of safeguarding activity, new statutory guidance, launch of the safeguarding assurance framework by NHS England, health service reviews as part of the Jimmy Saville investigation and a refreshed CQC inspection programme for safeguarding. A number of challenges are faced in East Lancashire including child sexual exploitation, an increasing concern regarding the identification and management of female genital mutilation, domestic abuse and neglect and standards of care for vulnerable adults in residential and community care settings. Jackie Hanson, Chief Nurse advised that Jane was to retire at the end of March and wished to acknowledge her contribution and her efforts within the team. As a consequence, there would be a restructure to maximize and strengthen the Page 6 of 11 Minutes Approved by the Chair : 17.2.15 Safeguarding Team going forward. The report was presented to ensure GB members are sited on this important agenda. There was also a need to ensure systems are robust to raise awareness and raise alerts, particularly in primary care, noting that work was ongoing with partners to challenge and improve systems in place. It was noted that police and domestic abuse referrals were escalating month on month, with significant challenges in terms of manpower to manage the increasing referral rates. The report was well received, however concerns were expressed regarding restrictions in budgets which could impact on the very vulnerable people, noting that the Lancashire Safeguarding Children’s Board were looking at this. Olive Carroll provided feedback, confirming that any organisation reviewing staffing, had to take into consideration the safety of vulnerable people in the community. LCC was undergoing restructure, affecting senior management and there had not been a reduction in social work capacity in safeguarding. Dr Ions expressed concern regarding the proposed changes to HV services in primary care which could have significant impact on safeguarding and was happening without any consultation. ACTION: Review HV position outside the meeting. JH/MI The Chair thanked Jane for a very helpful presentation. RESOLVED: that the Governing Body receive the Safeguarding Annual Report. 15.012 Equality & Inclusion Annual Report Julie Wall, Equality & Inclusion Lead was in attendance for this item. Angela Brown presented the Annual Report which set out how the CCG is meeting its commitment to taking Equality, Diversity and Human Rights into account when commissioning services, employing people, developing policies, communicating with or engaging local people in its work. Angela introduced Julie Wall, Specialist Advisor for Equality & Inclusion (E&I) with the CSU who outlined key highlights. Training statistics had improved since the previous year and the Equality Delivery System (EDS) grading, which had public involvement, had shown a significant improvement from previous years grading. The report also included benchmarking of the EDS2 grading outcomes in 2014 with other CCGs in Lancashire. It was recognised that staff preferred face to face training rather than on-line training and a GB training session would take place later in the year. The Chair thanked Jules for the report which was presented in an easy to read format and was reassuring regarding the EDS progress. RESOLVED: that the Governing Body receive the Equality & Inclusion Annual Report. 15.013 Chief Clinical Officers Report Dr Ions, Chief Clinical Officer presented his report and drew members attention to the following key areas: Keogh Review : ELHT have developed a Quality Improvement Plan and a Page 7 of 11 Minutes Approved by the Chair : 17.2.15 date was awaited from NHS E for a Single Item Quality Surveillance meeting when the Plan will be presented by the Trust. Calderstones : following the CQC visit to the Trust a Quality Summit was held and a Quality Improvement Board had been established to support the delivery of the quality improvement agenda. A very detailed action plan had been developed in response to the CQC reports and there was a need to focus on a quality improvement process at a more strategic level. Work had commenced on the Quality Improvement Plan which included a section on integrated commission and had been shared with partner organisations. A formal update would be presented to the March meeting. JH Dr Ions made reference to a report in the Sunday Times suggesting that Calderstones is to close, pointing out that as commissioners the CCG has no knowledge of this and do not believe there is any truth in the article. Steve Dean had concerns regarding the terminology used by the CQC and was assured by the comments made. It was confirmed that a media statement had also been prepared relating to the article Urgent Care : Significant pressures had been experienced across the entire Urgent Care system with a large increase in demand, with significant impact on 4 hour performance in A&E. However it was important to note there were no breaches of 12 hours waits and positive news that ELHT was not one of the hospital who declared a major incident. The CCG has been working closely with the Trust to ensure quality is maintained. Planning for 2015/16 : Planning guidance was issued in December 2014, requiring CCGs to update the second year element of the 2 year Operating Plan. A time limited planning project had been established to deliver the submission in line with the prescribed timescales and regular updates would be presented to the GB. Reference was also made to the launch of the #hellomynameis ….# campaign across primary and community care. This was a campaign developed by Dr Grainger, a Consultant from Yorkshire who became frustrated with the number of staff who failed to introduce themselves to her when she was an inpatient. Members were also asked to support the ToR for the Collaborative Commissioning Board (CCB) which sits beneath the Network of GP Chairs and GP Accountable Officers and has responsibility for any collaborative commissioning ongoing across Lancashire. It was noted the CCB has no delegated authority and any decisions would come back to the GB for discussion. The report also outlined significant changes to Regional and Area responsibilities and senior appointments within NHS England. The CCG held its first Staff Excellence Awards in December which was a well supported event and provided an opportunity for sharing achievements and for staff to receive the recognition they deserve. Dr Ions thanked everyone involved, confirming this would be annual event. RESOLVED: that the Governing Body receive the report and support the ToR for the Collaborative Commissioning Board. Page 8 of 11 Minutes Approved by the Chair : 17.2.15 15.014 Financial Position Update Members received the financial position statement for the nine month period to 31 December 2014 and forecast outturn to 31 March 2015 which confirmed the organisation was on target to achieve the statutory duties. Main provider activity continued to over-perform and a significant overspend was forecast at year end. Areas of concern included increased A&E activity and overperformance in elective care and non-elective admissions. Members were advised that the CCG will receive its share of the national underspend of the Continuing Health Care (CHC) risk pool, equating to £1,187k. It was recognised that some CCGs had accounted for this funding to achieve targets, however the additional funding will increase the CCGs planned underspend to £11,687k. RESOLVED: that the Governing Body receive the report. 15.015 Performance Report Members received the Performance Report which provided a detailed summary of the position in respect of contracts, quality and performance. Admission to the Stroke Unit was below target and Steve Dean asked if information could be presented differently. Rather than using percentages, he would like to see the numbers of patients affected and the position where possible. Discussion had also taken place at the Quality & Safety Committee regarding Stroke performance, with a request for a formal briefing to the next meeting, particularly regarding admission from the A&E to the Stroke Unit. There had been improvement which had since deteriorated and there was a need to understand the detail, to ensure that the numbers of stroke patients arriving and the ring fenced beds were enough to manage demand. Regarding Ambulance performance, two deep dive discussions had taken place with NWAS and a further meeting was scheduled in June to continue multi agency discussions to understand the issues regarding increased demand and variation across East Lancashire. Work done and the understanding of issues was positive and NWAS were to pilot a way of paramedics working differently within localities. Another area of concern was the cancer 62 day consultant upgrade. In October there were 6 breaches leading to underperformance of the 86% target. Four of the breaches were unavoidable due to complex pathways and patients being unfit for treatment, with the remaining two being patient-initiated delays. ELHT were addressing this and the CCG had provided additional senior management support into the system to support this. RESOLVED: that Members received the report. 15.016 Healthier Lancashire Purpose Document Members received the Healthier Lancashire Purpose Document setting out the journey to date and the proposed next phase of the development and is designed to confirm the scope, align plans and set out priorities for action. The Healthier Lancashire Team had compiled the document and summarised discussions and decisions taken since September 2014. The next stage was for the Leadership Forum to continue discussions and develop a Strategic Plan. Page 9 of 11 Minutes Approved by the Chair : 17.2.15 Members discussed the report, noting there had been little patient engagement and the vision was not particularly clear. It was recognised that some things were working well and some areas were not working as they should be and there was a need to ensure the right scope and balance to ensure that Healthier Lancashire will make a difference. RESOLVED: that Members receive the report and comments would be fed back to the Lancashire Leadership Forum. 15.017 Review of Third Sector Grants The Burnley, Pendle & Rossendale Council for Voluntary Services (CVS) and Hyndburn & Ribble Valley CVS were given the opportunity to manage the Social Prescribing Small Grant programme for 2014/15 on behalf of the CCG. Working in partnership, they were able to jointly utilise their membership, networks and organisation resources to ensure the grants programme had the reach and impact required. The report provided a summary of use of Social Prescribing Grants and members were asked to consider if further grants should be awarded to the CVS going forward. Michelle Pilling, Lay Advisor provided feedback confirming she had met with both CVS and outlined the work ongoing behind the scenes to provide support to smaller groups. Michelle reported that increasingly GP practices were becoming social workers, with cut backs in local authority spending and the voluntary sector provides a lot of support to people in the community. The CVS had helped to start up a number of groups and charities and provide an understanding of the funding streams and monies allocated had gone to grass routes. It was important to ensure projects are aligned to primary care and to look at sustainability. RESOLVED: that Members receive the report and supported a further Social Prescribing Grant to the CVS for 2015/16. 15.018 Commissioning Support Services – Lead Provider Framework The report outlined the position regarding the establishment of a Lead Provider Framework (LPF) for securing Commissioning Support Unit services from April 2016. An agreement was in place with Midlands and Lancashire CSU for 2015/16, moving to a new contract in 2016, based on rates per hour for services, which was very different from the arrangements currently in place. NHS England have requested that CCGs collaborate with neighbouring CCGs to consider if it makes sense for organisations to buy together or release their tenders at the same time in order to make best use of the volume based discounts on offer. Members were asked to consider the use of the CSU Lead Provider Framework to run a mini-procurement exercise to award a CSU contract from April 2016 and delegate authority to the Chief Finance Officer to explore the options of joint procurement with some or all of the Lancashire CCGs, providing an update and procurement timetable to a future meeting. RESOLVED: that recommendations. Members receive the report and support the Page 10 of 11 Minutes Approved by the Chair : 17.2.15 15.019 Sub Committee Summary & Stakeholder Minutes The report summarised the business for each sub-committee of the Governing Body and included stakeholder committee minutes from the Pennine Lancashire Clinical Transformation Board, EL Health & Wellbeing Partnership Board and the Lancashire CCGs Network. There were two key areas to highlight following discussion at the Local Delivery Group in relation to primary care co-commissioning, noting that the GB had subsequently approved this proposal and ratified actions earlier in the meeting. The Retreat and Recovery update related to a scheme set up in Burnley but used by all 5 localities and provided training for front door staff in nightclubs. There was strong agreement from stakeholders that the Centre was not a viable service due to low and reducing activity levels and the service was to be decommissioned. Dr White confirmed that separate discussion were ongoing with partners to provide a service in a different way, particularly a more mobile service to be in place for home football games, bank holidays etc. RESOLVED: that Members receive the report and ratify the decisions taken. 15.020 Any Other Business Items for inclusion on the Corporate Risk Register The following items were to be included on the Corporate Risk Register: Better Care Fund Primary Care Co-Commissioning 15.021 Date & Time of Next Meeting Members received the Governing Body Meeting Schedule for 2015 and the next meeting was confirmed as Monday, 23 March 2015 at 1pm. The Chair thanked everyone for attending and members of the public for observing. Page 11 of 11 Minutes Approved by the Chair : 17.2.15
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