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