nhs tameside and glossop clinical commissioning group ... · 1 welcome and apologies verbal a dow 2...
TRANSCRIPT
NHS Tameside and Glossop Clinical Commissioning Group Governing Body meeting
on Wednesday 27 January 2016
to be held at 13.00 at New Century House
1 Welcome and apologies
Verbal A Dow
2 Declarations of interest
Paper All 1
3 Consideration of items of any other business
Verbal All
4 Patient story
Verbal J Hurlston
5 Chair’s introduction
Verbal A Dow
6 Draft minutes of the Governing Body meeting held on 23 December 2015
Paper A Dow 8
7 Actions arising
Paper A Dow
8 Chief Operating Officer’s report
Verbal S Allinson
9 Public and Patient Impact - Approved minutes of the Public and Patient
Impact Committee meeting of 2 December 2015
- Update from the Public and Patient Impact Committee of 20 January 2016
Paper Verbal
C Poole C Poole
22
10 Finance - Month 9 Finance Report - Approved minutes of the Finance and QIPP
Assurance Committee meeting of 16 December 2015
- Update from the Finance and QIPP Assurance Committee meeting of 20 January 2016
Paper Paper Verbal
K Roe D Swift D Swift
30 45
11 Quality - Approved minutes of the Quality Committee
meeting of 16 December 2015 - Update from the Quality Committee meeting
of 6 January 2016 - Performance Report
Paper Verbal Paper
C Poole C Poole C Watson / R Bircher
54
61
12 Planning, Implementation and Quality - Approved minutes of the Planning,
Paper
G Curtis
84
Implementation and Quality Committee meeting held on 9 December 2015
- Update from Planning, Implementation and Quality Committee meeting of 13 January 2016
Verbal
G Curtis
13 Integrated Governance, Audit, and Risk Committee
- Ratified minutes of the Integrated Governance, Audit, and Risk Committee of 26 August 2015
- Revised Terms of Reference
Paper Paper
G Curtis G Curtis
95
104
14 Primary Care Joint Committee - Approved minutes of the Primary Care Joint
Committee meeting of 2 December 2015 - Update from the Primary Care Joint
Committee meeting of 6 January 2016
Paper Verbal
D Swift D Swift
113
15 Quality Report
Paper G Gibson 116
16 Locality Leads - Draft minutes from the Locality Leads’
meeting of 29 December 2015
Paper
A Dow
121
17 Partnership and Greater Manchester meetings and updates
- Ratified minutes of the Association Governing Group meetings held on 15 December 2015
- Ratified minutes of the Derbyshire Health and Wellbeing Board meeting of 19 November 2015
- Ratified minutes of the Tameside Health and Wellbeing Board meeting of 12 November 2015
- Draft Terms of Reference for the Healthier Together Joint Committee
Paper Paper Paper Paper
A Dow S Allinson A Dow A Dow
125
129
139
145
18 Any other business
Verbal A Dow
NHS Tameside and Glossop Clinical Commissioning Group Register of Interests 2015/16 – Governing Body
Name Position Held Declared Interest Date of Declaration / Confirmation
Membership of Professional Body Interest
Steve Allinson Chief Operating Officer Nil
Spouse is a PA at Pennine Acute Trust. Dinner invitations x2 Incl. Meetings with PWC (CPT) – both on register.
28/07/2015
Dr JS Bamrah Governing Body Secondary Care Clinician
British Medical Association member Royal College of Psychiatrists member Medical and Dental Defence Union of Scotland member British Indian Psychiatric Association member British Association of Physicians of Indian Origin member
Medical Director, Manchester Mental Health and Social Care NHS Trust Board Member, African and Caribbean Mental Health Services Manchester Board Member, LCMP Carelink Council Member British Medical Association National Chairman British Association of Physicians Of Indian Origin
26/08/2015
1
NHS Tameside and Glossop Clinical Commissioning Group Register of Interests 2015/16 – Governing Body
Dr Richard Bircher
GP at Lockside Medical Centre - CCG Governing Board Member
Medical and Dental Defence Union of Scotland British Medical Association
GP at Lockside Medical Centre. Board of Trustees for Stockport World Citizens (Local Charity to help volunteers). Married to Dr Joanna Bircher. CCG Clinical Lead for Quality Improvement. GP Partner with Dr Thomas Jones. CCG lead for Cardiology.
04/08/2015
Graham Curtis Lay Deputy Chair Nil Expert by experience for Age UK – to do CQC Inspections in care homes. 22/07/2015
Dr Jamie Douglas
GP at Albion Medical
Royal College of General Practitioners member General Medical Council member
Salaried GP at Albion Medical Practice Locum GP in Tameside and Glossop Area. GP at Go-to-Doc for OOH work. GP at EUR TRIAGE with GMSS. Educational role with University of Manchester. GP Appraiser for NHS England Jamie and his family are now living in Tameside and will shortly be registering with a GP practice there
23/12/2015
2
NHS Tameside and Glossop Clinical Commissioning Group Register of Interests 2015/16 – Governing Body
Dr Alan Dow
GP at Cottage Lane Surgery CCG Chair
West Pennine Local Medical Committee member NW Manchester General Practitioners Committee Representative NW Denery – Training Practice British Medical Association Royal College of General Practitioners’ Family Doctors Association Medical Protection Society
GP Cottage Lane surgery, Gamesley Glossop providing GMS services and enhanced type services for smoking cessation, family planning, minor surgery, substance misuse and alcohol, health checks. Orbit Shareholder. Wife is an Anaesthetist at Tameside General Hospital. Attended various training events sponsored or subsidised by pharmaceutical industry. No substantial gifts. Various offers to chair or advise declined. Marks and Spencer vouchers offered (but never received) for attending meetings with Primed Meal with Price Waterhouse Cooper on 2 December 2015 to the value of £30
02/12/2015
Gill Gibson Director of Nursing & Quality The Nursing & Midwifery Council Nil 27/07/2015
Dr Tina Greenhough GP Board Member Local Medical Council member for
West Pennine
GP Principal Mossley Medical Practice Director GoToDoc (OOH provider and provider of APM procedures) Employed as a Clinician for St Martins Healthcare who are sub contracted to Lifeline to provide drug and alcohol services for Tameside.
12/10/2015
3
NHS Tameside and Glossop Clinical Commissioning Group Register of Interests 2015/16 – Governing Body
Dr Amir Hannan
GP at Haughton Thornley Medical Centre – CCG Board Member
Medical Protection Society member Royal College of General Practitioners member
Co-Chair Greater Manchester NHS Values Group Member of the Equality Diversity Council, NHS England Dr Nadeem Rasul, one of the doctors in the practice is also the Prescribing Lead for the CCG Dr Faisal Bhutta is a member of the West Pennine Local Medical Committee Vice Chair West Pennine Local Medical Committee Orbit Shareholder Partner at Haughton Thornley Medical Centres which offers GMS and enhanced services including IUD, implants, minor surgery, DMARD monitoring, anti-coagulation, Alcohol DES, Drugs DES, £5 per head for over 75’s, Pessary fitting, Zoladex, Insulin initiation, NHS healthchecks, vaccines and immunisations, avoiding unplanned admissions, extended admissions, extended hours, dementia diagnosis, learning disability health checks. We are also a training practice teaching medical students as well as FY2 and GP registrars. Chairman of the World Health Innovation Summit
25/11/2015
Angela Hardman
Director of Public Health
Member of the Faculty of Public Health Nil 03/11/2015
4
NHS Tameside and Glossop Clinical Commissioning Group Register of Interests 2015/16 – Governing Body
Jean Hurlston Lay Advisor NHS England Public & Patient Groups (various) notified as and when required.
Virtual PPG panel member – Albion Practice. CVAT Member Voluntary Action Oldham Steering Group member. Rotary club of Ashton Under Lyne: PR Officer. Coordinator Oldham Street Angels. Oldham Street Angels has received ‘Dragons Den’ funding to cover costs of sessional healthcare workers (Non recurrent) Locum Chaplain with THFT Member of Chaplaincy team at Manchester Airport. Chaplain at Ashton Sixth Form College. Member of the Greater Manchester Values Group
20/01/2016
Dr Alison Lea GP Governing Board Member
Membership of the Royal College of General Practitioners Member of the Academy of Medical Examiners British Medical Association (member) Medical Defence Union (member)
Churchgate Surgery: GP Partner with Dr Asad Ali (Locality Lead and Orbit Director). T&G Appraiser. Director, RWL consultants. Training Programme Director, Tameside and Glossop. Orbit member (GP Federation) NHS England GP Appraiser Provider of enhanced services: IUD, implants, minor surgery, DMARD monitoring, anti-coagulation, Alcohol DES, Drugs
25/11/2015
5
NHS Tameside and Glossop Clinical Commissioning Group Register of Interests 2015/16 – Governing Body
DES, £5 per head for over 75’s, Pessary fitting, Zoladex, Insulin initiation, NHS healthchecks, vaccines and immunisations, avoiding unplanned admissions, extended admissions, extended hours, dementia diagnosis, and learning disability health checks.
Paul Pallister Assistant Chief Operating Officer Nil A close personal friend is an equity partner at Hempsons 28/07/2015
Celia Poole Lay Member
Member Chartered Institute of Public Relations Associate Chartered Management Institute
Director of CP Media Services Ltd. 50% shareholdings in CP Media Services Ltd. Commissioned through CP Media Services Ltd to deliver service for and on behalf of Active Tameside. CP Media Services Ltd has been contracted by NHS England for the period 21 December 2015 until 31 March 2016 to deliver communications services
23/12/2015
Kathy Roe Chief Finance Officer
Association of Accounting Technicians Chartered Institute of Management Accountants
Nil 22/07/2015
Lesley Surman Lay Advisor to CCG T&G
Nil
Member of PPG at GP Practice. Chairperson of Patient Locality Group Glossop. Advisor to Self-Advocacy work stream at Tameside Healthwatch. Healthwatch Derbyshire & Healthwatch Tameside enter and
03/08/2015
6
NHS Tameside and Glossop Clinical Commissioning Group Register of Interests 2015/16 – Governing Body
view representative Tutor for self-management UK. RSPCA – home assessor. Glossop voluntary centre.
David Swift Lay Advisor Member of the Chartered Institute of Internal Auditors
Sessional Audit Committee member at NHS Stockport CCG. Wife is an Associate Manager for Mental Health Act reviews (sessional) at Calderstones Partnership Foundation Trust. From 01/11/2015 – Lay member for Governance and Audit at East Lancashire CCG
01/11/2015
Clare Todd Governing Body Nurse
Nursing and Midwifery Council - registered Governing Body Nurse at NHS Salford CCG 02/12/2015
Clare Watson Director of Transformation Nil CHP – BTG Lift Co Ltd (Public Sector Director) 07/08/2015
7
1
Draft minutes of the Governing Body meeting held on 23 December 2015
Part A
Present
Mr Steve Allinson Chief Operating Officer Dr JS Bamrah Secondary Care Consultant Member Dr Richard Bircher GP Member and Clinical Lead for Urgent Care Mr Graham Curtis Deputy Chair and Lay Member Dr Jamie Douglas GP Member and Clinical Lead for Primary Care Dr Alan Dow GP and Chair of NHS Tameside and Glossop
CCG Dr Tina Greenhough GP Member, Clinical Vice-chair, and Clinical
Lead for Mental Health, Children and Families, and Integration
Dr Amir Hannan GP Member and Clinical Lead for Long Term Conditions and IM&T
Ms Celia Poole Lay Member Mrs Kathy Roe Chief Finance Officer Ms Clare Todd Governing Body Nurse
In attendance
Mrs Gill Gibson Director of Nursing and Quality and Caldicott Guardian
Ms Jean Hurlston Lay Adviser Mr Paul Pallister Assistant Chief Operating Officer and Company
Secretary Mr Steven Pleasant Chief Executive, Tameside Metropolitan Borough
Council Dr Gideon Smith Consultant in Public Health, Tameside
Metropolitan Borough Council Dr Lesley Surman Lay Adviser Mr David Swift Lay Adviser Mrs Clare Watson Director of Transformation
Apologies
Dr Alison Lea GP Member and Clinical Lead for Planned Care, Cancer, and End of Life Care
8
2
1 Welcome and Apologies
A Dow welcomed the Governing Body members and members of the public to the December 2015 meeting.
Apologies were received from A Lea.
2 Declarations of Interest
A Dow invited the members to make any new declarations of interest. He explained that there are some forms available for the members to make any necessary updates to their existing declarations.
J Douglas declared that he and his family are now Tameside residents and will be registering with a Tameside GP practice.
J Hurlston declared that she is now a member of the Greater Manchester Values Group.
The Governing Body received the current Register of Interests as at December 2015 and noted the updates.
3 Consideration of Any Other Business
A Dow asked the members if they had any further items of business for today’s meeting.
There were no additional items requested.
4 Patient Story
The Governing Body viewed a video patient story of Ernie who talked about his experiences of having been diagnosed with diabetes and of receiving local diabetes services.
J Hurlston observed how this is a positive story; Ernie feels that it is helpful for his GP to know what services are available in the community. He feels that he receives great support from his GP and from the voluntary sector working in a coordinated manner.
A Dow noted that it is good to hear a positive account of a service which the CCG has been a part of developing. L Surman noted the emphasis of a holistic approach to patient care involving the third sector. C Poole supported the suggestion of uploading this patient story video to the CCG website as it may then encourage other people to view such holistic therapies in a positive manner.
S Allinson noted that this patient story presents a scenario which emphasises the essence of the integrated care organisation with these preventative services wrapped around the patient. J Douglas noted the value of including the voluntary sector in patient core treatment plans. C Watson welcomed the suggestion of engaging the third sector in the pathways for longer term conditions; L Surman suggested including Patient Participation Groups in such conversations.
J Hurlston concluded by reminding the members that, following the patient story at the November meeting, S Allinson is meeting with the patient’s family to understand in more
detail the issues they faced when applying for individual funding.
9
3
The Governing Body noted the contents of the patient story.
5 Chair’s Introduction
A Dow reminded the members that at last month’s meeting there had been a deliberate emphasis on focusing more on the present and on the future rather than on the past and he reflected that it had resulted in more focused discussions. The meeting had also considered the themes of thinking, feeling, and behaving. He proposed that this continues for today’s
meeting.
A Dow informed the members that the CCG has been authorised by NHS England to take on responsibility for the commissioning of general medical care functions from 1 April 2016 (level 3 delegated responsibility).
The Governing Body noted the updates.
6 Draft minutes of the Governing Body meeting on 25 November 2015
A Dow invited the members to comment upon the accuracy of the draft minutes of the meeting held on 25 November 2015.
The minutes of the meeting held on 25 November 2015 were agreed as being an accurate record.
L Surman noted from the minutes that the breastfeeding service continues for Tameside residents but not for the residents of Glossop; she asked the members if they are happy with this situation. A Dow said that a few examples had been given at the previous meeting and suggested that this is a conversation to take to the Derbyshire Health and Wellbeing Board as this is an outcome of a commissioning decision by the Derbyshire Public Health team. G Gibson made the point that these are additional, specialist breastfeeding support services above the regular services which continue to be provided for our residents in both Tameside and Glossop.
C Watson agreed to raise this at the next Derbyshire Health and Wellbeing Board but reminded the members that the preference had been for representation to be made at these meetings by a GP. A Dow reported that although followed up no one had replied that they were able to do this.
7 Actions Arising
The members reviewed the action log: 050515: Integrated Governance, Audit, and Risk: To update on the responsibilities being delegated to the Programme Board: S Allinson explained that this is still a work in progress and asked that this remains as an open action
090715: To arrange for the minutes of the Programme Board to be received by the Governing Body: K Roe reminded the members that a report from the Care Together Programme Board was received during today’s Part 2 meeting and in future the Governing
Body will also receive the updates by the Independent Chair and the Programme Director. This item can be removed from the list
10
4
021015: To share the Governing Body’s feedback on the proposed Greater Manchester
Devolution governance arrangements with the Devolution Management Team: S Allinson stated that the views of the Governing Body have been shared with the Devolution Management Team, and that email has now been shared with the Governing Body for their information. S Allinson added that recent revisions to the devolution governance do now include greater emphasis on public engagement and a more defined voice for general practice. This item can be removed from the list
031015: To ensure update forms for the Declarations of Interest are routinely available at Governing Body and committee meetings: P Pallister explained that these forms are now available. This item can be removed from the list
051015: To share with the Governing Body the formal communication regarding the Governing Body’s feedback on the proposed Greater Manchester Devolution governance arrangements: as per the update for item 021015 above this item can be removed from the list
021115: To include in a future newsletter details of the locality plan and of the feedback provided by the Governing Body regarding Greater Manchester Devolution governance: P Pallister updated the members that this had been included in the latest edition of the newsletter. This item can be removed from the list
041115: To update the Governing Body following discussion of the rating of the CCG’s QIPP
risk: G Curtis informed the members that he and K Roe have reached an agreement on this issue. They agreed how to explain the progress being made towards the QIPP target (from contingency rather than by the anticipated schemes), and that for now this remains an amber risk. This risk will be reviewed more regularly with more frequent updates provided to maintain the awareness by the Governing Body of the CCG’s current position regarding its
QIPP target. This item can be removed from the list
061115: To raise with colleagues at Tameside Hospital NHS Foundation Trust why the busy Emergency Department is used as the route into the hospital’s other departments: C Watson
updated the members that she has raised this issue with colleagues at the Foundation Trust and that this will be addressed by the Integrated Urgent Care work stream of the Care Together programme. This item can now be removed from the list
071115: To discuss the experience of applying for continuing healthcare support with the main carer of the patient from November’s patient story: S Allinson asked for the due date
for this action to be altered to January 2016 as this meeting is scheduled for early January. This request was supported by the Governing Body
J Hurlston updated the members concerning the provision of chaplaincy services at Tameside Hospital NHS Foundation Trust. She explained that Tameside Hospital will be negotiating the terms of the future agreement with Pennine Care NHS Foundation Trust. A Dow noted this successful outcome, and asked for the minutes of the meeting to record J Hurlston’s conflict on this matter.
The Governing Body noted the updates provided.
8 Chief Operating Officer’s Report
S Allinson presented his update for this month which is comprised of two reports.
11
5
There has been a series of frank conversations within the local health and care system regarding the current performance of the urgent care system and what is required to make the best provision for our population over the coming winter period. We have now released all of the System Resilience Group monies so all of the resources available to the CCG have been made available to the locality. The three main partners have agreed to make the best use of this funding across the whole system; as an example this could result in health funding being directed into social care provision (such as into home adaptations to enable patients to return home) if it is considered that this will have the greatest positive impact. S Allinson asked the Governing Body to be supportive of this approach.
C Watson added that we have a very reactive urgent care system. There is confusion over the various patient lists and this does not support the smooth flow of patients through the system. She noted the need for some frank conversations about what is fundamentally wrong with the current system and what can be made to work better.
G Gibson added that there are daily telephone conferences regarding delayed transfers of care, and it is intended that the System Resilience Group meeting at the end of January will focus upon reviewing the learning from these. The three Chief Executives are to be invited to this session.
J Douglas observed that a lot of effort is expended on trying to reduce attendances at the Emergency Department and these do not always appear to have the required impact. He suggested instead that such effort and resources could be directed towards improving the discharge processes. R Bircher supported this suggestion; he mentioned that a document published recently by NHS England reviewed evidence from worldwide attempts to reduce Emergency Department attendances which failed to identify that these were effective and instead he supported focusing upon reducing length of stay through improving discharge processes.
A Dow challenged this proposition saying there is both National and International evidence that a better investment in Primary Care did demonstrate fewer referrals and admissions to hospital and fewer deaths in hospital.
C Watson added that there is work underway to review the patient lists to try to facilitate discharging patients as soon as is appropriate. G Gibson added that these lists also need to be reviewed for their accuracy.
C Todd observed that this has been the situation for many years and suggested that the CCG needs to take effective actions to address it.
S Allinson concluded this part of his update by stating that the state of the urgent care system is taking a considerable amount of time and focus by the management team.
S Allinson presented the second part of his update which concerns developments regarding Greater Manchester Devolution. Included in today’s reports is the draft Greater Manchester
Strategic Plan; there will be a three month discussion with stakeholders including our GP membership and the public. In addition the locality will be engaging with stakeholders on the locality plan and he explained to the Governing Body that the CCG’s Communications Team
will be taking great care to position clearly both of these engagement exercises for the populations of Tameside and Glossop.
He continued that the CCG has the challenge of producing a credible ‘ask’ to the Devolution
Management Team for a proportion of the Transition Fund. This will need to explain how our local solution accords with the direction of travel for Greater Manchester, and that it
12
6
articulates our pressing requirement for timely access to such funding. This financial case is to be developed by the end of January 2016. The aim is to convey to the Devolution Management Team that we have a pressing problem but also that we have a solution which has been subject to a great deal of external scrutiny and has been shown as being credible.
A Hannan stated that he read the draft Greater Manchester Strategic Plan as a useful way of summarising the current challenges and opportunities into one document. He suggested that it might be useful to see an independent critique of the document.
S Allinson replied that the CCG has very recently received the latest planning guidance. Our Finance Team are reviewing this to understand the detail and he suggested that following this review we will be in a better place to be able to critique the draft Greater Manchester Strategic Plan from the perspective of its expectations of this locality and its impacts upon our ambitions.
JS Bamrah asked if we know yet how the funding available to Greater Manchester is to be allocated between the localities. He also asked when the staff and public engagement is due to start. K Roe reminded the members that the CCG will need to meet both Greater Manchester requirements as well as national requirements. She continued that regardless of the source of funding the localities will need to consider how best to deliver affordable improvements for the population. S Allinson added that he has asked G Gibson to work with communication colleagues across the locality and Greater Manchester to build a single, clear communications approach to run from January to March 2016. He supported JS Bamrah’s observation that we need to support our staff through this.
JS Bamrah asked if that communications plan would be brought to the Governing Body and S Allinson replied that he has asked the PPI Committee to monitor and review this.
A Dow reflected that Greater Manchester is in a strong position through devolution to be able to better address the health inequalities of its population.
The Governing Body:
- supported and endorsed the contents of the current draft Greater Manchester Strategic Plan in advance of any iterations following wider stakeholder engagement from January 2016
- noted the update on the urgent care system - supported the potential use of health monies to fund social care provision if that is
considered likely to deliver the greatest benefit.
9 Public and Patient Impact
C Poole presented the ratified minutes of the Public and Patient Impact Committee meeting of 4 November 2015 reminding the members that she has previously provided a verbal update from this meeting.
C Poole presented the key messages from the committee’s meeting of 2 December 2015:
- the CCG’s website is undergoing a soft launch; a full launch is taking place mid-January 2016. This website is needed to support the CCG’s engagement activity for
the Care Together programme - there was an update on the promotional activities of the Communications Team - there was an update from the inaugural Patient Network Group
13
7
- the committee received a report on the patient and public engagement toolkit; this will support commissioners in assessing the engagement required for business cases
- there was an update by Healthwatch Derbyshire - the committee received the draft Terms of Reference of the refreshed Equality and
Diversity Group.
There were no questions forthcoming from the Governing Body.
The Governing Body:
- received the ratified minutes of the Public and Patient Impact Committee of 4 November and noted the update from the Public and Patient Impact Committee meeting of 2 December 2015.
10 Finance
K Roe presented the Month 8 Finance Report. She drew to the members’ attention the following key messages:
- the CCG is still on track to deliver its statutory financial duties - the Governing Body is aware of the challenges facing the CCG concerning the acute
contract position. K Roe explained that, following the discussion at November’s
Governing Body meeting, there has been a positive outcome to negotiations with the finance and business intelligence colleagues at the Foundation Trust and an agreement in principle has been reached. This removes a significant degree of risk on the CCG’s year-end position although it does exceed the budgeted position by over £3m
- there are some QIPP schemes which will not deliver in-year; therefore it has been agreed that any shortfall will be met from non-recurrent contingencies
- we are still seeing some pressures on other contracts across Greater Manchester - there are some positive indications regarding the prescribing budget.
A Dow noted the positive messages. He agreed with K Roe’s suggestion of putting out a
positive message to staff and the member practices.
S Allinson suggested identifying the proportion of the £3m contract overspend which is as a result of providing additional support to the urgent care system when we know that our future plans address this by better supporting people to remain in a non-acute setting.
R Bircher asked if the contract position was negotiated on the basis of the Foundation Trust’s need or of the CCG’s affordability. K Roe explained that the negotiated position took
account of the recent coding issues as well as the CCG’s affordability.
J Douglas asked if the Foundation Trust is being challenged on the lists which are being sent to general practice which state people are in hospital when this is not the case. R Bircher responded that he has received assurances that the accuracy of the data in these lists is being improved. A Dow asked how the member practices can be confident of the data contained in these lists and K Roe explained that the Foundation Trust’s Director of IM&T is
being invited to a future meeting of the Finance and QIPP Assurance Committee to explain this matter. A Dow commented that it would be better if the member practices received lists which had already been subject to accuracy checks.
G Smith asked if any progress has been made on developing Greater Manchester tariffs and K Roe explained that these are likely to be available for the contracting round for 2017/18.
14
8
D Swift presented the ratified minutes of the Finance and QIPP Assurance meeting of 18 November 2015.
D Swift informed the Governing Body of the following key messages from the committee’s
meeting of 16 December:
- regarding the Better Care Fund the committee at its November meeting questioned if the fund was delivering the intended reductions to the numbers of emergency admissions; it is achieving an outcome of 2.6% against the target of 2.7% for Tameside; the figures for Derbyshire are showing an achievement in excess of the target
- there is a £61,000 projected underspend for this year for running costs.
S Allinson asked if the CCG has received any indication if running costs are to be reduced further for 2016/17. K Roe replied that this is not yet clear; whilst it was the intention to reduce further the CCGs’ running costs targets it is likely that this will not proceed as the
CCGs are taking on additional responsibilities from NHS England. S Allinson asked that the IGAR Committee reviews some metrics regarding the workforce to provide some assurance that we are not putting our staff under too much strain with the current high levels of work.
The Governing Body:
- noted the 2015/16 financial position and outturn forecast as at Month 8 (November 2015)
- acknowledged the change in risk profile identified within this report for 2015/16 and supported the mitigating actions proposed
- received the approved minutes of the Finance and QIPP Assurance Committee meeting of 18 November and noted the verbal update of the meeting of 16 December 2015.
11 Quality
C Poole presented the ratified minutes of the Quality Committee meeting of 18 November 2015.
C Poole presented the following highlights from the Quality Committee meeting of 16 December 2015:
- the committee received a lessons learnt review of the Bridgewater Hospital liquidation. One of the key outcomes was a flowchart to provide a pathway by which any future similar events could be managed
- there was an update by the CCG’s Quality Improvement Lead that the flu immunisation data is not accurate as a result of the data collection process being inefficient
- there was an update on the suspension of places at Darnton House - the committee is revisiting the walkaround programme - the committee received a report following the workshop to consider the future role of
the committee. There was a proposal setting out what could be a list of quality indicators. There will be a further report to the committee’s next meeting.
G Gibson reminded the Governing Body that for future ‘flu immunisation programmes the CCG will be responsible and therefore, working jointly with Public Health colleagues, we will have the opportunity to improve upon what has gone before.
15
9
G Gibson explained to the Governing Body that there are still thirteen residents at Darnton House and her team are conducting daily spot checks. It has been decided that it is not appropriate to move these residents out just before Christmas.
G Curtis asked for the proposal document of the committee’s refreshed purpose to be brought to the Governing Body in full; this was accepted.
C Todd raised the issue that the committee had discussed how it could support some of the on-going strategic work such as that taking place for Greater Manchester Devolution to ensure that quality remains an explicit part of its agenda.
The Governing Body:
- received the ratified minutes of the Quality Committee meeting of 18 November and noted the verbal update of the meeting on 16 December 2015.
12 Performance
R Bircher presented the performance report.
The CCG is still not delivering the Emergency Department four hour performance target for our patients. There are on-going issues with delayed transfers of care.
There is an improvement in the delivery of the 18 week referral to treatment target. The specialties with the longest waits are orthopaedics and cardiology. C Watson added that the number of people waiting up to 13 weeks is increasing and this will produce a future pressure upon this target. This is in the context of the additional capacity which the Foundation Trust has introduced to help to reduce the waiting lists.
The delays in respect of diagnostics are almost solely within the specialty of endoscopy. C Watson agreed to look into this issue.
R Bircher noted that there is the target of 80% of patients referred to the memory clinic being seen within six weeks and the CCG is achieving only 6.1% for this. C Watson offered to look into this in the context of the redesign of dementia services. T Greenhough added that there have been changes to the pathway so that patients are being identified who can be appropriately managed in primary care. There are conversations taking place with the consultants to discharge such patients to free up capacity for them to be able to see people who are on the waiting list.
C Watson reminded the members that, following the CCG’s recent assessment by NHS
England, the CCG has been assessed as ‘assured as good’ for four of the five components.
The fifth component is ‘Performance’ for which we have been assessed as ‘limited
assurance requires improvement’ which is as we would expect.
The Governing Body:
- noted the 2015/16 CCG Assurance position - noted the performance position.
13 Planning, Implementation, and Quality
G Curtis presented the approved minutes of the Planning, Implementation, and Quality Committee meeting of 11 November 2015.
16
10
G Curtis provided a verbal update from the committee’s meeting on 9 December 2015. The committee recommended that RAID, Early Intervention in Psychosis, and Street Triage be supported non-recurrently for one year. C Watson added that there is a recurrent element to this funding and therefore there will need to be a further conversation at the committee’s
January meeting. K Roe reminded the members that even if there is recurrent funding available it is necessary that services are regularly evaluated to ensure that they are still meeting our needs.
G Curtis continued that there had been a lengthy discussion regarding the re-commissioning of Ophthalmology, MSK, and ENT services. T Greenhough noted that whilst it continues to be the CCG’s ultimate aim that the services are delivered by Tameside Hospital it has been
necessary to ask Care UK to provide interim arrangements in order to maintain services for patients.
C Todd asked how we can ensure that the quality of services will not deteriorate. C Watson assured the Governing Body that this situation is captured on the CCG’s operational risk register.
S Allinson stated that it is important for the members to understand that the contract is to be held by the reformed Tameside Hospital as the integrated care organisation and not by Tameside Hospital in its current form. C Watson supported this and explained this is why the PIQ recommendations are for bridging arrangements until the formation of the new provider.
A Dow agreed that the committee had been very clear on this point regarding the future contract being held by the integrated care foundation trust.
C Poole added that when a paper considering the MSK and ENT services had been brought to the Public and Patient Impact Committee the committee had raised concerns that patients had not been well-considered during the service development and asked for this to be addressed in future. C Watson agreed to address this as part of the future assurance.
G Curtis explained that the committee had considered a paper regarding personal health budgets. K Roe asked that a piece of work be undertaken to see if the suggested £150,000 could be funded from any other routes such as from the Better Care Fund. C Watson proposed that the Transformation and Finance directorates work together to identify other possible sources for this funding. G Gibson made the point that this funding of £150,000 is intended for the implementation of the mechanisms for the fund and is not in itself the funding for personal health budgets as such funding is already included within existing contracts. T Greenhough observed that this is something which the CCG is mandated to do as people are entitled to have a personal health budget. G Curtis suggested that this recommendation be revisited on the basis of affordability and funding options; S Allinson supported that this work be included within a prioritisation conversation.
The Governing Body received the ratified minutes of the PIQ Committee of 11 November 2015 and ratified the following recommendations:
- that RAID, Early Intervention in Psychosis, and Street Triage services are supported non-recurrently for one year
- that the overall strategic leadership for the redesign and commissioning of Ophthalmology, ENT and MSK to sit with the CCG, under Dr Alison Lea and the Directorate of Transformation with the caveat that the rebranding of the MSK work be looked at
- that the ICFT remains as lead provider for all three pathways, thereby the CCG continues with the ‘Most Capable Provider’ model and does not take this redesign
17
11
work through a formal procurement exercise. The Checkpoint assurance methodology will be strengthened and formalised
- that Care UK leads the establishment of bridging arrangements in the spirit of the CCG’s integrated pathways principles and objectives for all three pathways, for ENT and MSK from 1 February 2016, and for Ophthalmology from 1 April 2016
- that the bridging arrangements for all three pathways will run and transition into the new delivery models and contractual arrangements by 1 April 2017 at the latest
- that as a consequence of the bridging arrangements the CCG invites Care UK to take the lead integrator role for the new delivery models for all three pathways. The lead integrator role will co-ordinate ALL partner providers and lead the development of the new service models in partnership with the CCG
- that a finance and activity work stream is established to ensure system value for money during the bridging period into a new contractual arrangement with the ICFT
- that resources from the Care Together transformation fund are supported to cover the costs of Care UK’s project management capacity to help manage the bridging and transition arrangements
- that on-going investment of £687,500 in Carer Support is made on the basis that significant redesign will take place within our Care Together plans. This funding will be reworked into the LCCT budget.
14 Primary Care Joint Committee
D Swift presented the ratified minutes from the Primary Care Joint Committee meeting of 22 October 2015. He reminded the Governing Body that the CCG has been successful in its application for level 3 (delegated) commissioning with no conditions which is a positive reflection of the work of the Primary Care Team.
The Governing Body received the ratified minutes of the Primary Care Joint Committee meeting of 22 October and noted the verbal update from the meeting of 2 December 2015.
15 Transformation Report
C Watson presented the Transformation Report to inform the members of the activity being undertaken by the directorate.
J Douglas noted from the report that it appears that there is pressure upon the Healthy Mind service; he informed the members that one of his patients had self-referred into this service which had resulted in the practice receiving a letter stating that the patient was not appropriate for this service. J Douglas asked if the patient ought to have received that letter rather than the practice which had had no involvement in the self-referral. It was decided that a member of the Transformation Directorate would look into these processes.
The Governing Body noted the contents of the Transformation Report.
16 Locality Leads
T Greenhough informed the members that the Locality Leads had received a presentation by St Martin’s Health Care which works with Lifeline to deliver drugs and alcohol services for the CCG. She added that she had found this meeting very positive and practical.
18
12
G Curtis added that there had been a Joint Locality meeting on 16 December 2015. A Hannan suggested issuing a questionnaire to the members asking how they viewed the session; T Greenhough suggested instead that a set of minutes and key messages could be helpful. C Watson agreed to follow this up once she has reviewed what has already been issued.
The Governing Body received the minutes of the Locality Leads’ meeting of 24 November
2015.
17 Partnership and Greater Manchester Meetings
A Dow drew to the members’ attention the minutes of the Healthier Together Committees-in-Common of 15 July 2015 which contains the detail of the discussion regarding the fourth site for specialist services.
The Governing Body received the ratified minutes of the Association Governing Group meeting of 17 November and 1 December 2015, and of the Healthier Together Committees-in-Common meeting of 15 July 2015.
18 Any Other Business
A Dow reminded the members that there is a further Governing Body Development session on 20 January 2016. He suggested that this could include updates by the Governing Body GP Members regarding their work streams. This suggestion was supported.
A Dow closed the meeting at 16.09.
19
NHS Tameside and Glossop CCG Governing Body
Actions Log following the meeting of Wednesday 23 December 2015
Action Number
Action Description Owner Deadline Update
050515 Integrated Governance, Audit and Risk: To update on the responsibilities being delegated to the Programme Board
S Allinson June 2015 September 2015 November 2015 January 2016
011115 For the GP Governing Body members to include in the declarations of interest any enhanced services delivered by their practice
All GP Governing Body members
December 2015
031115 To produce an information pack for practices of the Over 75s bids
C Watson January 2016
051115 To reflect in the next iteration of the locality plan the principle that those people who use services are to be involved in shaping them
S Allinson January 2016
071115 To discuss the experience of applying for continuing healthcare support with the main carer of today’s Patient Story
S Allinson December 2015 January 2016
011215 To raise the lack of a specialised breastfeeding service for Glossop residents at the Derbyshire Health and Wellbeing Board
C Watson January 2016
021215 To issue to staff and member practices a positive message regarding the CCG’s financial position
K Roe January 2016
031215 To look into the delays for diagnostics C Watson January 2016
20
041215 To look into the performance regarding referrals to the memory clinic
C Watson January 2016
051215 To look into the self-referral process for the Healthy Mind service
C Watson January 2016
061215 To issue a communication to the member practices following the Joint Locality meeting
C Watson January 2016
21
GOVERNING BODY MEETING
Title of Subject: December Final Public and Patient Impact Committee minutes
Date of paper: 2nd December 2015 Prepared By: Celia Poole
History of paper: Public and Patient Impact Committee held a meeting on 2nd December 2015 and will meet regularly, promoting and providing assurances to the Governing Board that the CCG is providing strategic leadership for the development of Public and Patient Engagement.
Executive Summary: Key Issues discussed: Continuing Healthcare Patient Experience Project The bid for pilot funding was submitted to NHS England and was successful. Communications and Engagement
Care Together NHS Tameside and Glossop Clinical Commissioning Group (CCG) and Tameside Metropolitan Borough Council (TMBC) have announced the next step of reform for Tameside and Glossop. This will involve the two organisations bringing together their commissioning functions. A communications and engagement workshop will be held today (Wednesday 2nd December 2015) with the Heads of communications and engagement and partnership and relationships across the three organisations to agree an implementation plan and actions over the coming months. CCG Website This will be passed to the CCG and will be built with the aim of a soft launch before Christmas. A full launch will be conducted in the early New Year once all testing has taking place. (The Go Live date has since been delayed until mid-January 2016 due to the lack of technical support over the Christmas period) Winter campaign The CCG continues to support the national campaign and is the local lead across partners in T&G. There are links locally with some national and international events including Self-Care Week and World COPD Day. A flu-awareness video featuring Dr Alan Dow has been produced. Local pharmacy opening times for the Xmas and New Year period will be put in local papers as in previous years (this will take up the bulk of the advertising budget slotted to this year’s campaign). This will include a series of the key messages from the campaign and will run the week before Xmas.
22
Patient Engagement update PPIC were presented with the minutes of the inaugural Patient Network meeting that took place on 13th October 2015. Hadrian Collier from GM Clinical Assessment and Treatment Service (GMCATS) attended to talk to the Patient Network group to explain about the service that GMCATS provide and to engage with patients in T&G to find out their views about the service. Induction Programme The first induction programme took place on 30th October with 17 members of the public attending from PPGs and local groups. A mop up session took place on 27th November with a further 6 reps. The sessions were reported as very interactive and all reps signed up to the code of conduct the feedback received was very positive with reps commenting how useful the sessions were and very informative and feeling that they were now more understanding of the work of the CCG. Public and Patient Engagement Toolkit report Commissioners have now been presented with the toolkit and have started to use the toolkit. Ali Lewin will present a business case in January and will co-present with Chris Leese to PPIC in January which will demonstrate/evidence use of the toolkit. NHSE have asked for a copy of the toolkit and have fed back that they find it very useful. It was noted that Anna Livingstone, Quality Assurance Officer, is also reviewing the toolkit as part of the Continuing Healthcare patient experience project. Extension of Carers Projects Funding for 16/17 – Review and Forward Planning Geoff Holliday presented a paper to PPIC regarding CCG Investment in Carers. It is anticipated that the final model will be a mixture of existing provision where that is judged and proven to be the most effective way to support carers and adjustments and total redesign where services can be improved. Time is required to do this well and, in the context of the whole scale change currently underway, a pragmatic incremental approach to redesigning carer support over the coming 15 months is proposed. The paper provides the assurance that the commissioning intentions will be developed and fully assessed as part of the process and that carers would be involved and engaged on the revised model.
Recommendations required of the Governing Body (for Discussion and Decision)
To discuss and note the key issues discussed and agreed at the meeting on 2nd December 2015.
QIPP principles addressed by proposal:
To receive the report
Direct questions to: Celia Poole
23
Final
1
MINUTES
PATIENT AND PUBLIC IMPACT COMMITTEE (PPIC) Wednesday 2nd December 2015 9.30-11.30am
Boardroom, NCH Denton Present:- Celia Poole (CP) Governing Body Lay Member, CCG (Chair) Clare Todd (CT) Governing Body Nurse, CCG Hazel Chamberlain (HC) Designated Nurse, Safeguarding, CCG (Nursing and Quality
rep) Lesley Surman (LS) Governing Body Lay Advisor, CCG Jean Hurlston (JH) Governing Body Lay Advisor, CCG Karen Goodhind (KG) Head of Communications and Engagement, CCG Dr Asad Ali (AA) Locality GP, CCG Dr Amir Hannan (AH) Governing Body GP Member, CCG Jane Birch (JBir) Healthwatch Officer, Healthwatch Derbyshire Geoff Holliday (GH) Commissioning Manager, CCG (Transformation rep) Naseem Yasin (NY) Equality and Diversity Lead, CCG In attendance:- Tracy Turley (TT) Engagement Lead, CCG Clare Bromley (CB) PA, Corporate Office, CCG (note taker) Apologies:- Nigel Caldwell Chief Officer, Volunteer Centre, Glossop Peter Denton Healthwatch Manager, Healthwatch Tameside Lynn Jackson Quality Lead, CCG Gill Gibson Director of Nursing and Quality, CCG Alison Lewin Deputy Director of Transformation, CCG Anna Hynes Coordinator for the Health and Social Care Network, CVATs Tanya Nolan Community Involvement Officer, Healthwatch Derbyshire 1. Chairs Welcome and Apologies CP welcomed everyone to the meeting and conducted round the table introductions. 2. Declarations of interest AA declared an interest as a GP and a member of Orbit. Register of interests Members were presented with the register of interest and a blank register of interest form and were asked to provide any updates to the register via the table of amendments. Members noted the register was not the most up to date. CB to request the most updated register from Paul Pallister for presentation at the January meeting.
Action: CB 3. Minutes of the previous meeting: 4th November 2015 The minutes of the previous meeting were agreed as an accurate record. The following actions were discussed:
24
Final
2
Item 6 (02.09.15) – Personal Health Budgets and Item 12 (02.09.15) – Interim Evaluation of non-recurrent funding to support the delivery of an integrated service to support people with respiratory conditions CB received the following updates from Philippa Robinson: Item 6 (02.09.15) – Personal Health Budgets: The finer details are being discussed and developed and will be presented along with our local offer, which communications and engagement are included in developing. Patient outcomes will be a key part of the service and will provide the evidence that patients and families are receiving the most effective and appropriate care to meet their needs, including people with health inequalities. A number of events are being planned such as an Executive Challenge Meeting and a staff and patient exploratory engagement event. Following research we have decided that rather than having a phased approach we are going to open up the offer to all high users of healthcare aiming to support 30 people in 2016/17 with a PHB to better meet their needs and use 16/17 as a co-production year taking all these people, staff and providers on our journey to understand the health outcomes. An update and forecast will be presented to PIQ in December and then our local offer can be developed and published. Item 12 (02.09.15) – Interim Evaluation – Non recurrent funding to support the delivery of an integrated service to support people with respiratory conditions: Philippa spoke to Heather Palmer and fed back to Jo Baines around the links with people and services in Glossop. Heather confirmed that they did contact people who did not take up the project. NY noted her interest to discuss this further with Philippa to address some of the issues identified for people that did not take up the project in terms of hard to reach/protected groups.
Action: NY Item 8 (04.11.15) Integrated Care – MSK and ENT Following a presentation received at the last meeting in November, members had expressed several concerns with the integrated pilot for both MSK and ENT and did not feel that the patient was at the centre of the pathways described. CP received the following brief update for members from Louise Roberts: Building on the Public and Patient engagement and consultation around Care Together; a patient reference group was set up to help us develop the integrated selective services for Ophthalmology, ENT and MSK. Together with the patients we developed the aims, objective and principals of the pathway; learning from their own personal experiences. Each service will provide prompt assessment and diagnosis and jointly develop with a patient a personalised management plan that supports the patient to remain health and independent. It will deliver treatment and advice that addresses immediate, medium and long term needs and enables the patient to self-manage their condition. The key objectives are to: Improve patient experience and outcomes for service users including seven day
access with appointments outside 09:00 to 17:00 and provision of the most effective clinical care
25
Final
3
Ensure timely access to multidisciplinary team assessment with the right person seen by the right professional to support their care
Ensure that care takes place in the most appropriate setting, where possible in the community
Ensure effective communication with primary care and other services involved to avoid duplication and people having to tell their story more than once
Promote self-care and use of the voluntary sector, developing management plans with patients and ensuring patients and carers have help and support t be able to self- manage their conditions and remain independent in their own homes as long as possible, with informed choice
As discussed at the previous PPIC the patient reference group will reconvene and continue to be at the centre of the approach we are taking in continuing to develop and implement the pathway. CT requested that PPIC receive a breakdown on how this would be achieved and delivered and that holding a patient reference group in itself did not satisfactorily meet the needs of a developing service in which patients would need to be integral to on-going development of the service. PPIC suggest that work takes place within existing mechanisms such as PPGs, Equality and Diversity Group and approach to the Patient Network. TT raised a query as to which patients are being approached and engaged with and noted that it would be useful to see the outcome aims of the focus group. PPIC would welcome a further discussion on this in terms of ensuring we get the patient engagement and investment right as the start for integration in order to support the whole integration agenda. Finally, PPIC discussed that training could be delivered as part of organisational development work around the way that presentations are delivered. It was noted that clear, informative presentations are key to telling the story of patient engagement and instrument in service design and delivery. Action 9 (04.11.15) Mental Health Crisis Services KG confirmed there is now a link to the Healthy Minds self-help page on the website and that this was added to update and Twitter. 4. Matters arising not otherwise on the agenda
Continuing Healthcare Patient Experience Project HC confirmed that the bid for pilot funding was submitted to NHS England and was successful. All other matters arising are covered on the agenda. 5. Communications and Engagement
Care Together NHS Tameside and Glossop Clinical Commissioning Group (CCG) and Tameside Metropolitan Borough Council (TMBC) have announced the next step of reform for Tameside and Glossop. This will involve the two organisations bringing together their commissioning functions. A communications and engagement workshop will be held today (Wednesday 2nd December 2015) with the Heads of communications and engagement and partnership and relationships across the three organisations to agree an implementation plan and actions over the coming months.
26
Final
4
CCG Website This will be passed to the CCG and will be built with the aim of a soft launch before Christmas. A full launch will be conducted in the early New Year once all testing has taking place. (The Go Live date has since been delayed until mid-January 2016 due to the lack of technical support over the Christmas period) Winter campaign The CCG continues to support the national campaign and is the local lead across partners in T&G. There are links locally with some national and international events including Self-Care Week and World COPD Day. LS noted that she is awaiting response from Adam Shepphard regarding access to some materials for sharing with locality groups. KG to request Adam to respond to LS about this.
Action: KG
A flu-awareness video featuring Dr Alan Dow has been produced. Local pharmacy opening times for the Xmas and New Year period will be put in local papers as in previous years (this will take up the bulk of the advertising budget slotted to this year’s campaign). This will include a series of the key messages from the campaign and will run the week before Xmas. Proactive Media Celebrating Tameside and Glossop CCG’s recent successes:
First CCG in the country to be an accredited hub for student nurse training Successful bid for Continuing Healthcare Patient experience Project Self-Care week – there has been a press release to include a quote from Amir
COPD testing at Ashton Curzon FC 6. Patient Engagement update
Patient Network minutes – 13th October 2015 PPIC were presented with the minutes of the inaugural Patient Network meeting that took place on 13th October 2015. Hadrian Collier from GM Clinical Assessment and Treatment Service (GMCATS) attended to talk to the Patient Network group to explain about the service that GMCATS provide and to engage with patients in T&G to find out their views about the service. The drafts ToR for the Network were presented for review and comment prior to final sign off at the next meeting on 18th January 2016. The schedule of dates for PPIC meetings for 2016 was shared with members for representation at future meetings to commence in January. Ashton Locality Group reported on their delivery of over 75s project and had liaised with practice nurses for comment and suggestions. They are currently looking at websites to see how they fair in terms of benchmarking and aim to discuss at a future locality meeting.
27
Final
5
Stalybridge and Denton Locality Group – Windmill Surgery is starting up a PPG and will be encouraged to undertake the induction programme. The chair will be the rep from Lockside in Stalybridge who attended their induction on 16th December. Glossop and Hyde Locality Group – First patient rep, Bill Burgoine, is attending the Emergency Care Network meeting. Induction Programme The first induction programme took place on 30th October with 17 members of the public attending from PPGs and local groups. A mop up session took place on 27th November with a further 6 reps. The sessions were reported as very interactive and all reps signed up to the code of conduct the feedback received was very positive with reps commenting how useful the sessions were and very informative and feeling that they were now more understanding of the work of the CCG. 7. Public and Patient Engagement Toolkit report Commissioners have now been presented with the toolkit and have started to use the toolkit. Ali Lewin will present a business case in January and will co-present with Chris Leese to PPIC in January which will demonstrate/evidence use of the toolkit. NHSE have asked for a copy of the toolkit and have fed back that they find it very useful. It was noted that Anna Livingstone, Quality Assurance Officer, is also reviewing the toolkit as part of the Continuing Healthcare patient experience project.
PPIC have asked that the numbers of use and evaluation/audit is carried out of to evaluate impact of the toolkit be brought to a future meeting. PPIC also felt it would be useful to evaluate the ‘you said – we did’ and feedback to patients along with recommendations made by public and patients, even those we cannot engage on, then link feedback to specific pieces of work. One suggestion of how to do this is to display examples on the website. . 8. Healthwatch Derbyshire update Jane Birch from Healthwatch Derbyshire provided members with the Intelligence Report for December 2015 of current areas of work on-going in Derbyshire. Jane highlighted a number of flyers and surveys on line that will run until March 2016 to include: Children and Young People – Your Shout Your Health and Social Care Services are changing significantly over the next 5
years CB to circulate the intelligence report together with PPIC via email.
Action: CB
9. Equality and Diversity Group minutes – 9th November 2015 PPIC were presented with the Equality and Diversity Group draft minutes from the meeting on 9th November 2015. The draft ToR was presented to PPIC for comments. NY agreed to send this to CB via email to circulate to members requesting feedback to NY prior to the next meeting in January.
Action: NY
28
Final
6
10. Extension of Carers Projects Funding for 16/17 – Review and Forward Planning Geoff Holliday presented a paper to PPIC regarding CCG Investment in Carers. The paper seeks to establish the process for a revised model of operation that will: Ensure carers have appropriate and timely advice and support Ensure carers have access to take an Individual budget Ensure carers have appropriate support to access the services they need Ensure that flexible breaks provision is in place to meet the needs of carers and their
families Ensure that support is available to carers to help maintain their health and well being Ensure the carers are supported in their caring role. Ensure that carers have opportunities to maintain a good quality of life It is anticipated that the final model will be a mixture of existing provision where that is judged and proven to be the most effective way to support carers and adjustments and total redesign where services can be improved. Time is required to do this well and, in the context of the whole scale change currently underway, a pragmatic incremental approach to redesigning carer support over the coming 15 months is proposed. The paper provides the assurance that the commissioning intentions will be developed and fully assessed as part of the process and that carers would be involved and engaged on the revised model. PPIC approved the paper for onward presentation to PIQ. 11. Terms of Reference for sign off Members endorsed the amendments made to the ToR and agreed for final sign off and for the ratified ToR to be presented to IGAR. CB to submit the final version to Paul Pallister and Graham Curtis for IGAR.
Action: CB 12. Any other business AH noted that there is some work being carried out by the Police with social services looking at some place based communications with a group set up to look at patient journeys and having some information displayed in stations. AH is involved with the group and has received feedback/suggestions from other GPs. AH believes this goes some way to support data sharing and although this is a piece of work that is in its early stages it could inform Care Together and GM Devolution links via Alan Dow and Steve Allinson. AA suggested raising this at the joint locality meeting taking place on 16th December. 13. Date and time of next meeting - Wednesday 20th January 2016. Meeting closed: 11.30am
29
1
GOVERNING BODY MEETING
Title of Subject: Finance Report Month 9
Date of paper: Governing Body 27th January 2016
Prepared By: Kathy Roe – Chief Finance Officer
History of paper: Finance Committee 20th January 2016
Executive Summary: The CCG is on track to meet all of its key financial duties, including its surplus target of £6,746k, but still needs to mitigate some risks further to ensure this will be achieved.
An agreement has been made with TFT of £128.4m which removes a significant amount of financial risk to the CCG and allows Q4 to be a period of stability for both organisations to focus on the priorities of the integration programme.
Contingencies have been released to support the shortfall on the QIPP
target of £5,200k.
The running cost allocation for 2015-16 has reduced by £585k to £5,202k as per National guidelines. However corporate budgets are still forecast to under spend by £285k at year end.
Recommendations required of the Finance Committee (for Information, Discussion or Decision)
To discuss the 2015-16 financial position and outturn forecast as at Month 9 (December 2015).
To acknowledge the change in risk profile identified within this report for 2015-16 and support the mitigating actions proposed.
QIPP principles addressed by proposal:
Yes
Direct questions to: Kathy Roe / Tracey Simpson
30
2
1. Headlines
The below table details the CCG’s total funding allocation, 2015-16 budgets and expenditure and the forecast surplus for 2015-16. The CCG is forecasting to achieve its required surplus of £6,746k and remain with its running cost allocation of £5,202k and although this is challenging, the risk is incrementally reducing as we approach year end.
To achieve a balanced position by the year end there are a number of risks that have to be managed:-
Achievement of the £5,200k QIPP target. The schemes are not delivering to the timelines initially outlined in plans and contingencies have been released to mitigate this.
An agreement has been made with our main provider (TFT) which substantially reduces the financial risk, however the risk associated with other providers still needs to be managed and risks mitigated.
The increasing financial pressures and volatility in relation to Continuing Healthcare.
Summary of Financial Position
Year to Date (M9) Year End Change in Position
£000's £000's £000's £000's £000's £000's £000's £000's
Budget Actual Variance Budget Forecast Variance Previous
Month Movement
in Month
Funding Allocation 256,856 256,856 0 347,341 347,341 0 0 0
Acute 140,612 143,801 (3,189) 187,926 192,436 (4,510) (3,956) (554)
Mental Health 20,742 20,300 442 28,593 28,122 471 279 192
Primary Care 37,748 37,990 (242) 49,734 50,091 (357) (319) (38)
Continuing Care 9,424 9,938 (514) 12,620 13,386 (766) (856) 90
Community 20,132 20,140 (8) 26,840 26,951 (111) 0 (111)
Other 16,016 15,999 17 22,567 22,601 (34) 250 (284)
Reserves 3,083 0 3,083 7,113 2,091 5,022 4,540 482
Total Programme 247,757 248,168 (411) 335,393 335,678 (285) (62) (223)
Running Costs 4,039 3,628 411 5,202 4,917 285 62 223
Total Costs 251,796 251,796 0 340,595 340,595 0 0 0
Surplus / (Deficit) 5,060 5,060 0 6,746 6,746 0 0 0
Key Movements in month
Acute – an adverse movement of (£554k) – See Pages 3, 4 and 5. Mental Health – a favourable movement of £192k – See Page 5.
31
3
2. Acute
The CCG has reached an agreement with our main provider, Tameside FT of £128.4m which will substantially reduce the overall financial risk on the Acute areas of spend and allows Q4 to be a period of stability for both organisations to focus on the priorities of the integration programme.
Activity will continued to be monitored until the end of the financial year, as this will be important when we come to align baseline contract values with the Trust in 2016-17.
This section of the Finance Report will focus on the financial forecasts for the other providers. The table below shows the forecast positions for our associate provider contracts:
Year to Date Year End Change in F’cast
Position
£000's £000's £000's £000's £000's £000's £000's £000's
Provider Budget Actual Variance Budget Forecast Variance Previous
Month Movement
in Month
CMFT 14,622 14,358 264 21,899 21,665 234 456 (222) SFT 7,458 7,844 (386) 10,872 11,422 (550) (335) (215) UHSM 3,631 4,166 (535) 5,430 6,185 (755) (711) (44) PAHT 2,601 2,589 12 3,920 3,888 32 (31) 63 SRFT 2,108 2,064 44 3,129 3,001 128 145 (17) WWL 766 940 (174) 1,163 1,381 (218) (194) (24) BOLT 62 53 6 93 79 14 7 7 TOTAL 31,248 32,017 (769) 46,506 47,621 (1,115) (663) (452)
Further detail is provided below in support of those providers with a forecast of £100k+. Central Manchester Foundation Trust (CMFT)
CMFT contract is forecast to underspend by £234k as at month 8 which represents an adverse movement of (222k) from the month 7 forecast. The majority of this movement is due to an overspend in relation to PbR excluded drugs which are now forecast to overspend by (240k). Following an analysis of drug spend there are two drugs which have increased significantly in 2015-16, this is further illustrated in the table below:
Year to Date (M1-8)
£000's £000's £000's
Drug Budget Actual Variance
Adalimumab 220 349 (129) Etanercept 136 183 (46) TOTAL 356 532 (176) Following discussions with Medicines Management colleagues it is felt the increase could be inked to the treatment of rheumatoid arthritis. This is typically where patients have already tried alternative drugs e.g. methotrexate and another disease-modifying anti-rheumatic drug (DMARD). There is also NICE guidance which recommends the use of adalimumab, etanercept and infliximab as possible treatments for people with rheumatoid arthritis and who have 'active' rheumatoid arthritis, as assessed by a rheumatologist on two separate occasions. It has been difficult to ascertain a true underlying trend in this area, however following analysis and discussions with Medicines Management we are forecasting this trend will continue until the end of the financial year. We continue to see underperformances on Elective/Day cases which are forecast to underspend by £264k. This comprises of underspends in General Surgery £180k and Cardiology £111k. As part of the 2015-16 contracting round additional investment (above 2014-15 outturn) was made in relation to elective activity as the Trust set a capacity plan based on the delivery of RTT targets. However activity
32
4
to date appears to be below that originally anticipated and this is helping to partially offset some of the elective / daycase pressures we are seeing at TFT.
Stockport FT (SFT)
The SFT contract is (£386k) overspent as at month 8 which is due to overspends on stroke pathway (£235k) and High Cost Drugs (£91k). As reported previously since the implementation of the new GM pathway the Trust has been experiencing difficulties in recording stroke activity. This has led to previous issues around charging, resulting in the CCG being charged for all stroke assessments done in A&E. Following the assessments some patients are not admitted, which would not attract the GM Tariff of £2,700. This issue has now been resolved and a total of 64 stroke charges (£176k) have been removed from the activity data in months 1-7. The revised stroke position now shows an overspend of (£235k), which comprises of overspends in relation to Hyper Acute Stroke Assessments (HASU) (£169k) and rehabilitation (£66k). Although it has previously been anticipated that performance would be in line with planned levels, it must be noted that SRFT is underspent by £107k in relation to GM stroke pathway. The combined stroke position is summarised in the table below:
Year to Date
£000's £000's £000's
Budget Actual Variance
Hyper Acute Stroke Assessment (HASU) SFT 626 794 (168) SRFT 126 19 107 Sub Total HASU 752 813 (61)
SFT - Rehab 0 66 (66) TOTAL 752 879 (127)
Therefore we have seen a net over performance of (£61k) in relation to HASU and (£66k) in relation to Rehab. Activity plans were set based on the assumption that all Tameside patients would be repatriated (at Day 4) to Tameside FT and therefore no plan was set at SFT in relation to Rehab days. This explains why there is an over performance of (£66k) in relation to Rehab. Following on from this the CCG are reconciling the stroke position across all providers, this may result in a transfer of budgets once this work is complete. High cost drugs are currently overspending by (£91k), we have asked Medicines Management colleagues for comment around some of the specific drugs and have also asked for supplementary information direct from the provider. For forecasting purposes it is assumed that this trend will continue for the remainder of the financial year. University Hospital South Manchester FT (UHSM)
UHSM contract is overspent by (£535k) as at month 8 which comprises overspends in: NEL admissions - (£288k), Daycases -(£178k)
The NEL admissions overspend comprises overperformances in vascular surgery (£201k) and Geriatric medicine (£51k). The overspend on vascular is linked to the vascular on-call rota system whereby activity for emergency vascular surgery is principally provided by UHSM. We have seen underspends
33
5
totalling £42k in vascular at CMFT and PAHT, which is offsetting some of the over performance seen at UHSM. Daycases are overspent by (£178k). One significant area of over performance is plastics activity (£68k). As part of 2015-16 contracts it was anticipated that a proportion of plastics activity would transfer from UHSM to TFT and financial plans were adjusted accordingly with an increase to the TFT contract. However based on the month 8 activity data it appears that the majority of plastics activity is still being carried out at UHSM. The (£68k) over performance at UHSM is offset by an underperformance of £27k at TFT. Salford Royal FT (SRFT)
SRFT is underspent by £44k which is due to underspends in relation to new GM stroke pathway £120k, which is helping to offset some the over performance seen at SFT. Critical care is (£60k) overspent at month 8, due to two high cost patients. Wrightington, Wigan & Leigh FT (WWL)
WWL is overspent by (£174k) based on eight months’ activity data. The overspends relate to Day Cases (£60k), NEL admissions (£36k) and Rehab (£38k). This was the result of one high cost patient with spinal cord injuries and required a significant number of days in rehabilitation.
3. Mental Health
The consolidated Mental Health (MH) position comprises a year to date underspend of £442k with a forecast under spend of £471k by year end. The full year forecast has improved by £192k due to the continued review of clients on the secure out of area placement database. £48k forecast underspend is due to the continued review of adult placements and their
reassignment into a more appropriate healthcare setting, which is often Continuing Healthcare (CHC). The majority of the reviews have now been completed therefore we do not envisage this under spend to continue.
The Calderstones’ contract has now been signed. There is an agreed extension of the current contract to 30/09/16 with Mersey Care NHS Trust as the lead. It has been agreed that the CCGs will contribute to any shortfall on the basis of the number of occupied beds as at 30/09/2015. For Tameside and Glossop this represents 2 clients.
In light of the Mental Health Parity of Esteem we continue to review our increased investment with
additional funding due in the latter half of the year (CAMHS, IAPT etc.). Notification of the planned spend is to NHSE on a monthly basis and we continue to be on track to deliver the forecast plan of £32.4m.
34
6
4. Primary Care
Primary Care budgets at month 9 and are forecast to overspend at year end by (£357k). For reference the forecast overspend reported last month was (£319k) therefore this shows a continuation of a relatively stable position.
Prescribing budgets are forecast to overspend by (£125k) by the end of the financial year. The revised profile has been received in month and therefore has been used to update our year
end forecast. This revised profile takes into account actual data up to October 2015 and a Cat M adjustment from January 2016.
The updated forecast, along with increased rebate income shows an improvement in the prescribing position for the remaining months of the year which gives a forecast outturn in this area of (£125k).
There is a slight increase in the forecast outturn overspend on central drug costs with the forecast rising to (£156k) compared to (£112k) reported last month.
5. Continuing Care
The overall position on Continuing Care budgets has seen a further small reduction in the forecast overspend reported last month. The forecast last month of (£856k) has fallen to (£766k). This change is the impact of actuals in month previously estimated now adjusted in month; this is the natural impact of a further months data and lower risk as there are less months to forecast.
As previously noted, the volatility and risk in this area is recognised in all CCG reporting, both internally and via returns to NHSE and therefore will continue to be closely monitored and reviewed between the Finance and Nursing & Quality directorates.
6. Community
Community Services are currently forecast to over spend by (£111k) by the year end. This is largely due to a pressure on Community IT software and on Non Medical Prescribing (NMP). An investigation as to the increased costs of NMP is currently taking place at SFT. Work has commenced between Stockport FT / Tameside FT and NHS Tameside & Glossop CCG in relation to the further development of Community Services as part of our vision for integrating health and social care.
7. Other
Areas of spend included within the “other” category comprise: Better Care Fund (reported separately); NHS 111; Recharges from NHS Property Services; Safeguarding team; Patient transport.
In total there is a forecast over spend of (£34k) by year end.
35
7
8. Running Costs
The annual budget in 2015-16 for running costs is £5,202k which is a 10.10% reduction from 2014-15.
Running costs are currently forecast to underspend by £285k at year end. The below table and
commentary provide more detail.
Analysis of NHS Tameside & Glossop CCG - Running Costs 2015/2016
Administration
Directorate 2015/2016
Establishment 2015/2016
Budget £
2015/2016 Forecast
Outturn £ 2015/2016 Variance £
Commissioning 14.72 702,822 675,096 27,726
Finance 13.93 902,818 832,186 70,632
CEO / Board Office 4.00 669,171 661,921 7,250
Chair / Non Execs 1.00 238,745 244,425 (5,680)
Communication & PR 4.00 162,720 165,244 (2,524)
Corporate Governance 10.80 355,871 323,517 32,354
Human Resources 2.60 175,496 113,983 61,513
IM&T 1.00 314,724 301,150 13,574
IM&T Projects 0.00 175,899 154,833 21,066
Nursing Directorate 1.00 118,283 118,950 (667)
Contract Management 3.00 521,877 449,131 72,746
Corporate Costs 0.00 535,045 436,871 98,174
Equality & Diversity 0.00 26,761 16,510 10,251
Estates 0.00 430,466 430,466 0
Business Admin 0.00 (7,200) (7,200) 0
Admin Reserve 0.00 (121,498) 0 (121,498)
TOTAL 56.05 5,202,000 4,917,083 284,917
Human Resources is forecast to under spend by £62k, based on the current structure of staff. Finance is forecast to under spend by £71k at year end largely due to vacancies within the structure. The CCG has to remain within its running cost allocation of £5,202k in 2015-16. The CCG is currently
on track to meet this target as reported by the forecast underspend of 285k. This will continue to be monitored closely throughout the remainder of the financial year.
The above running costs are not the total costs of running the organisation as there are a number of teams who are charged to programme costs. (Medicines Management / Safeguarding / CHC Team / Transformation Staff and Project Staff).
The percentage of staff time to be charged directly to programme costs will be reviewed as part of the on-going management of running costs and working towards budget setting for 2016-17.
36
8
9. QIPP
The table below shows progress against our QIPP schemes in 2015/16. All data is based on year to date data up to November 2015.
The CCG QIPP target for 2015/16 is £5.2m (which includes £522k of unfunded targets). The forecast outturn for activity based operational schemes shows a projected shortfall of £2,923k against the target of £5.2m. However as we reported last month, while we have been unable to fully address the 15/16 QIPP challenge using activity backed recurrent schemes, we have been able to meet the shortfall on a non-recurrent basis through release of contingency. As a result we are able to report achievement of QIPP to NHS England on a non-recurrent basis this for 2015/16, despite the fact savings have not come from the originally proposed schemes. This is largely the result of the contract settlement with Tameside FT which means we no longer have any risk of overspend with our largest provider. While this means we may not feel the full benefit of activity based schemes either going live or increasing in capacity during Q4 (e.g. DVT or cardiology outpatients), we have factored in an estimated position in our settlement which is guaranteed and will ensure the CCG as a whole is well placed to meet its financial control totals for 2015/16. We will continue to monitor activity in shadow form for the remainder to the year to ensure that the schemes are continuing to work from an operational perspective and so we can assess recurrent impact for 16/17.
37
9
10. Risks
A number of risks have been identified which could prevent the CCG achieving its financial duties. These are summarised in the table below and an estimation of the probability and risk has been provided together with mitigation strategies in place to manage the risk.
Risk Probability Impact Risk RAG Additional Detail of Risk Mitigation The achievement of meeting the Care Together Sustainability Target (QIPP) recurrently.
2 3
6
A
QIPP has £2.7m of red rated schemes and £0.9m of amber rated schemes identified. £1.5m of QIPP schemes are rated green and have already been achieved.
Contingencies have been released to cover the delays in implementation/realisation of efficiencies in some of the QIPP schemes. These contingencies have been able to be released because of the year-end settlement with Tameside FT. However, there is a risk on achieving efficiencies recurrently and this will be referenced on the CCG corporate risk register.
Over Performance of Acute Contract
2 3 6 A
Secondary care activity increases exacerbated by increased referrals and seasonal pressures.
An agreement has been reached with TFT for a fixed settlement value of £128.4m. This agreement removes a significant amount of financial risk from over-spends in secondary care acute contracts and brings substantial stability to the overall CCG forecast position.
Over spend against GP prescribing budgets
3 2 6 A
The total prescribing budget is £40,775k for 2015-16. The 2015-16 prescribing position has become more stable over the past few months.
The revised profile and Cat m adjustments are now reflected in the prescribing position therefore giving the CCG more confidence in its year end forecast prescribing position.
Over spend against Continuing Health Care budgets
3 2 6 A
The CHC forecast position for the past quarter has been volatile due to a number of new CHC cases and reviewing of the CHC database.
The CHC database is being closely monitored between the finance team and the CHC team to ensure the most accurate and up to date data is being used for forecast projections.
Overspend against the pooled budget
1 2 2 G
The wider pooled budget will commence on 1st April 2016, however the CCG still has pooled budget arrangements in relation to BCF with TMBC and DCC.
The BCF is monitored on a monthly basis with the local authorities and national quarterly returns are submitted to NHSE. Plans are in place to mitigate any risks, and both BCF’s the CCG is part of, are forecast to achieve a balanced budget as set out in the guidance.
Fail to maintain expenditure within the revenue resource limit and achieve a 1% surplus.
1 4 4 G
The CCG has to deliver a surplus of £6,746k in 2015-16 which includes its mandatory 1% surplus in line with national guidance.
If all of the above risks are mitigated as explained then the CCG will achieve it required surplus of £6,746k. The year end settlement with Tameside FT adds further assurance.
38
10
11. Better Care Fund (BCF)
The total Tameside BCF is £16,941k funded by £15,140k (89%) from Tameside & Glossop CCG and £1,801k (11%) from Tameside MBC. In total T&G CCG recharges the pooled BCF £3,336k (20%) and TMBC recharges the pooled BCF £13,605k (80%).
At bottom level the BCF is not allowed to either under spend or over spend – any pressures or benefits will be dealt with through the wider pooled budget risk share agreement (against which we have a 2% contingency in reserves). The key targets and metrics the BCF is monitored on for Tameside BCF are shown below.
Reduction in NEL Admissions. Percentage change in rate of permanent admissions to residential care per 100,000. Change in annual percentage of people still at home after 91 days following discharge. Newly diagnosed patients on primary care dementia registers. Overall satisfaction of people who use services with their care and support.
In addition to the Tameside BCF, Tameside & Glossop CCG also contributes £2,178k (3.5%) to the Derbyshire BCF which amounts to £61,489k. In total T&G CCG recharges the pooled Derbyshire BCF £443k (0.7%). The Derbyshire BCF is monitored against the same targets and metrics as the Tameside BCF.
Administration of this fund will be comparable to that of Tameside. The Glossop element of BCF will form part of the normal monthly reporting. In total the Derbyshire BCF will have annual income of £61.5m of which Tameside CCG contributes £2.1m. The major schemes under the Derbyshire BCF are Rapid Response / Reablement (£9,315k), Community / Specialist Equipment (£7,617k), Community Support Team (£3,392k), DFG (£3,200k) and the Care Act (£2,802k). The over 75 value is £158k. We are in regular contact with Derbyshire CC regarding updates on schemes and completion of returns and have a good working relationship.
The below tables show the emergency admission data for both the Tameside BCF & Derbyshire BCF that were submitted to NHSE on 27th November 2015.
Tameside BCF NEL Data
39
11
Derbyshire BCF NEL Data
The final quarterly return for the 2015/2016 BCF is due on 26th February 2016.
40
12
List of Annexes
Annex A shows the monthly financial position broken down by locality. Annex B shows the monthly financial position broken down by practice. Annex C is the Glossary.
12. Recommendation
Members are asked to:-
Discuss the 2015-16 financial position and outturn forecast as at Month 9.
To acknowledge the change in risk profile identified within this report for 2015-16 and support the mitigating actions proposed.
41
13
Annex A
42
14
Annex B
43
15
Annex C
Glossary
Abbreviation Description
AQP Any Qualifying Provider
BCF Better Care Fund
CCG Clinical Commissioning Group
CHC Continuing Healthcare
CIS Commissioning Improvement Scheme
CSU Commissioning Support Unit
DC Daycase
EL Elective
GP General Practitioner
IAT Inter Authority Transfer
MH Mental Health
MMC Medicines Management Committee
NEL Non Elective
OP Outpatient
PIQ Planning, Implementation & Quality
PMD Prescribing Monitoring Document
PPA Prescription Pricing Authority
QIPP Quality, Innovation, Productivity, Prevention
SFT Stockport Foundation Trust
SHMI Summary Hospital Level Mortality Index
SLA Service Level Agreement
SLAM Service Level Agreement Monitoring
TFT Tameside & Glossop Foundation Trust
UHSM University Hospital South Manchester Foundation Trust
WTE Whole Time Equivalent
WWL Wrightington, Wigan and Leigh Foundation Trust
44
GOVERNING BODY MEETING
Title of Subject: Finance & QIPP Assurance Committee Minutes – 16th December 2015
Date of paper: 20th January 2016 Prepared By: David Swift History of paper: These minutes have been ratified at the January Finance &
QIPP Assurance Committee meeting Executive Summary:
Key highlights:- Tameside FT 2015/16 Settlement Finance committee had received an update on the negotiations that took place to agree the Tameside FT (TFT) 2015/16 year-end settlement. Following the recommendation from the previous meeting of aiming for a settlement figure of between £3m and £4.2m, the Governing Body (GB) had suggested a cap of £3.6m Both parties agreed that TFT’s forecast should be reduced by approximately £409k to reflect the coding changes and this is reflected in the year end settlement figure. Both parties reached an agreement in principle with a 2015-16 year end settlement of £123,504k in relation to core contract performance. This equates to an overperformance of (£3,618k), which is in line with the recommendation from both the Finance & QIPP Assurance Committee and GB. The committee agreed that once this has been officially agreed and approved by GB a notice will be communicated out to all practices. Better Care Fund (BCF) Submission Next year the BCF will be monitored against the standard plan making it more transparent and easier to complete than it has been his year. It has also been suggested that from 2017-18 those organisations that have a credible alternative in place will be able to opt out of BCF. Aligned Pooled Budget Following concerns raised at the previous meeting as well as from the council, the decision has been made to withdraw the £100m Wider Pooled Budget. The focus and efforts will instead shift to getting the full aligned budget in place for 1st April 2016 alongside the Single Commissioning function. This aligned budget will be under a Partnership Agreement rather than a legally binding Section 75 and will be managed through a recharge system; the CCG and Local Authority will retain their statutory obligations.
45
MH PbR Update DM explained that Tameside & Glossop (T&G) CCG are involved in a Greater Manchester (GM) wide Risk Share Agreement for MH PbR. 2015-16 is the second year of a Risk Share Agreement and the GM MH Contract Steering Group is currently discussing potential options for 2016-17. As it stands T&G CCG are overpaying by £3.5m and this has been re-paid to date through a ‘£250k cap per CCG per year arrangement to ensure the GM economy remains stable. The aim is to realign the contracts in 2016/17 to reflect more accurate contract values. However, the options for doing this needs further discussion across GM as there is not yet complete confidence in the data and we also need to mitigate the risk of destabilising some GM CCGs which in turn could adversely affect the GM economy.
Recommendations required of the Governing Body (for Discussion and Decision)
To receive the ratified minutes The Committee recommend that GB approve the overperformance of £3,618k, which is in line with the recommendation from both the Finance & QIPP Assurance Committee and GB, and then a notice can be communicated to all practices.
QIPP principles addressed by proposal:
Direct questions to:
David Swift
46
1
NHS TAMESIDE & GLOSSOP
FINANCE & QIPP ASSURANCE COMMITTEE
Wednesday 16 December 2015
PRESENT: David Swift – Chair Graham Curtis - Lay Member
Kathy Roe – Chief Finance Officer (present for items 1-8) Tracey Simpson – Deputy Chief Finance Officer (representing KR from Item 9) Dr Amir Hannan – GB Member (from partway through item No 7) Dr Saif Ahmed – GP Locality Lead (from item 2)
In Attendance: Tracey Simpson – Chief Finance Officer (in attendance for items
1-8) Alison Lewin – Deputy Director of Transformation (deputising in
CW’s absence) David Milner – Assistant Chief Finance Officer Stephen Wilde – TMBC Finance Representative (co presenting
items 10&12) Vikki Forshaw – Senior Secretary
1. Apologies
Apologies were received from Clare Watson, Chris McGarry, Dr Jamie Douglas, Steve Allinson and Dr Alan Dow. 2. Declaration of Interests/Quoracy **SAh joined the meeting** The meeting was quorate in line with the Terms of Reference.
No new interests were declared. 3. Minutes of previous meeting held on 18 November 2015
The minutes were agreed as an accurate reflection of the previous meeting. 4. Matters Arising/Actions Actions were completed with the exception of the following, which will carry forward to the next meeting:
• Discuss arranging a refresh Risk Management Training session for GB – KR reported that Paul Pallister is in the process of taking this forward. (Action: PP (KR))
• CW is going to look into if the decision for UHSM to be the sole ‘on call’ provider for vascular services has been discussed with CCGs – AL explained that this has now been confirmed and all CCGs are aware that UHSM are the sole ‘on call’ provider. DM will adjust the 2016/17 finance plans to reflect this and will inform practices. (Action: DM)
47
2
• TO’H to ask Peter Howarth if it is possible to gather data regarding the difference in what GPs prescribe and what pharmacies actually dispense – AL to check with Peter Howarth that this is being reported. (Action: AL (CW))
• DG to liaise with Jamie Douglas re the Programme Budgeting tool kits and prepare a paper to explain the merits of the most effective ones – DG to provide an update on this action for January’s meeting. (Action: DG)
• Submit the Commissioning Improvement Scheme to December’s meeting – Deferred to January’s meeting. (Action: CW)
• Glossop – liaise with Elaine Richardson regarding assurance that funds are being spent on Glossop. – TS to follow up with ER. (Action: TS)
There were no additional matters arising from the previous meeting.
5. Work-plan
The work-plan was received for information. It was noted that the Care Together Update has been removed as a standing item as this is now part of day to day business.
6. Scheme of Delegation The Scheme of Delegation (SoD) was presented to the Committee for approval with several amendments documented in the Executive Summary. TS highlighted that since the writing of the report Stephen Beswick has now secured a substantive post at Bury CCG and therefore needs removing from the SoD (Action: VF) The committee were happy to approve the amendments put forward.
7. Tameside FT 2015/16 Settlement DM updated the committee on the negotiations that took place to agree the Tameside FT (TFT) 2015/16 year-end settlement. Following the recommendation from the previous meeting of aiming for a settlement figure of between £3m and £4.2m the Governing Body (GB) suggested a cap of £3.6m. Negotiations centred on numerous areas with the following key highlights:
• The CCG’s offer matched all, with the exception of two – SHMI Coding/Excess Bed Days - of TFT’s forecasts.
• RTT/Elective activity was a main point of disagreement between the CCG and the Trust. The CCG were anticipating a decrease of activity in this area due to the fact that TFT had delivered compliance with the targets of performance against the ‘incomplete pathway’ standard of 92% three months ahead of the improvement trajectories agreed in the RTT Recovery Plan. However, TFT successfully demonstrated that there had been a significant increase in the number of patients on the Trust’s RTT waiting list and therefore, to maintain the national 92% target, the Trust would need to maintain similar rates of elective activity between now and the end of the financial year.
• SHMI/Coding Review: DM explained that although it is difficult to quantify the ‘true’ value of coding improvements as part of the year end forecast the CCG were able to use one robust example in relation to Urinary Tract Infections (UTI). This example allowed the CCG to establish a clear correlation between an increase in complex cases (and the subsequent charging at a higher tariff) being coded and the commencement of the coding review. The data clearly
48
3
showed that as the number of major complications increased the intermediate complications and ‘UTIs with a length of stay less than 1 day’ decreased. Both parties agreed that TFT’s forecast should be reduced by approximately £409k to reflect the coding changes and this is reflected in the year end settlement figure. SAh still had reservations regarding the quality of coding and the impact this could have on patient safety following on from the incident raised at the previous meeting where a patient’s discharge letter listed inaccurate comorbidities. KR explained that Peter Nuttall (TFT) is looking into the quality of coding using information received from GPs and Practice Managers to make the process more robust. He also explained that different systems are used for discharge letters and charging. The committee decided to pass this on to the Quality Committee to investigate further and KR suggested that Quality Committee invite Peter Nuttall to the meeting for an update. VF will communicate this to Quality Committee to take forward as well as adding it to IGAR Committee’s January agenda to be discussed. (Action: VF)
• QIPP – Cardiology Outpatients - AL explained how this scheme will produce savings once the Trust fully engages. To date the Trust has only provided 453 patient records for review out of the approximate 4,000 agreed. This has been raised with TFT and deadlines for the practices will be amended to ensure that they are realistic. The financial pressure will be with TFT and not the CCG should the savings for this scheme not be realised.
• Excess Bed Days – this is an area that has been significantly underperforming due to several QIPP schemes in progress in 2015/16, notably new leadership for the Integrated Transfer Team (ITT). Both parties agreed that TFT’s forecast should be reduced by £191k to reflect this underperformance.
• Contract Penalties – The CCG agreed to reinvest penalties with the Trust to enable support plans to improve the areas that contribute to the breaches. There is a possibility that NHSE will mandate that all contract penalties are redistributed nationally however the CCG’s NHSE Link Accountant has advised that the further into Q4 we get, the less likely this will come to fruition.
Both parties reached an agreement in principle with a 2015-16 year end settlement of £123,504k in relation to core contract performance. This equates to an overperformance of (£3,618k), which is in line with the recommendation from both the Finance & QIPP Assurance Committee and GB. The committee agreed that once this has been officially agreed and approved by GB a notice will be communicated out to all practices. (Action: KR) DS formally thanked the Finance team for their efforts in securing the £3.6m year end settlement, recognising that this was a challenging task. The agreement will bring considerable stability to the health economy however it is important to recognise that the £128,402k is at the maximum affordability limit for the CCG. There is no spare funding to bridge any financial shortfalls/pressures that may emerge over the coming months. KR raised a concern over possible winter pressures and recognises that emergency talks would be required in the event of a bad winter. DM will communicate this to the Systems Resilience Group (SRG) at the next meeting. (Action: DM) 8. Month 8 Finance Report TS presented the Month 8 Finance Report to the committee. Due to the separate paper prepared outlining the agreement reached with the CCG’s main provider (TFT) the report focused instead on the associate provider contracts. The focus for the acute
49
4
section of the report was on those providers with a forecast of £100k or more. The key highlights were as follows:
• Central Manchester Foundation Trust (CMFT) – CMFT contract is underspent by £347k due to elective activity being below what was anticipated. This is helping to partially offset some of the elective/daycase pressures we are seeing at TFT.
• Stockport FT(SFT) – SFT are showing an overspend of (£25k) however they are currently experiencing difficulty in recording stroke activity which could be affecting the data. This issue has been escalated at the SFT Contract meeting and there is an aspiration to have this resolved by quarter 3. GC questioned the large gap in Year to Date (£25k) and Year End (£335) Variance; DM will look into this and clarify via email as well as rectify a formatting error for WWL under the ‘Movement in Month’ column. (Action: DM)
• University Hospital South Manchester FT (UHSM) – UHSM is showing an overspend of (£428k) however a significant part of this is due to the vascular on-call rota that was discussed early under agenda item 4, ‘Actions’. Underspends in vascular at CMFT and PAHT offset some of the overperformance seen at UHSM.
• Salford Royal FT (SRFT) – SRFT is underspent by £97k linked to the new GM stroke pathway. They are having similar problems with recording stoke activity as SFT.
• Wrightington, Wigan & Leigh FT (WWL) – WWL is overspent by (£151k) due to one high cost patient with spinal cord injuries.
• Mental Health - The full year forecast has improved by £114k due to two clients having a revised service entry date. The CCG are also on track to deliver the Parity of Esteem forecast plan.
The Calderstones’ contract has been signed and there is an agreed extension of the current contract to 30/09/16 with Mersey Care NHS as the lead. The CCGs will contribute any shortfall on the basis of the number of occupied beds as at 30/09/2015 which represents two clients for Tameside and Glossop.
• Primary Care – showing an overspend year to date of (£208k) and at year end by (£319k). This is thought to be a relatively stable position.
• Continuing Care – The overall position on Continuing Care budgets has seen a reduction to the forecast overspend reported last month. The volatility and risk in this area is recognised in all CCG reporting and is closely monitored and reviewed between the Finance and Nursing & Quality directorates.
• Community – Community Services are forecast to break even by year end. Work has commenced in transferring services from SFT to TFT.
• Running Costs – currently forecast to underspend by £62k and is being monitored closely.
• QIPP – Due to the favourable TFT year end settlement contingencies have been able to be released to cover the delays in implementation/realisation of efficiencies in some of the QIPP schemes.
• Risks – All risks are RAG rated either amber or green. TS asked the committee for their thoughts on the QIPP risk rating currently rated as green. The committee agreed that the wording of the risk should be amended to highlight the risk shifting to whether the QIPP target could be met recurrently. With this revised wording the committee agreed the risk RAG rating should move from green to amber. TS will amend the Finance Report to reflect this change before it is submitted to GB on 23rd December. (Action: TS)
** KR left the meeting. TS represented the CFO from this point forward. **
50
5
9. CT Sustainability Target (QIPP) This item was discussed during the item No 8. 10. Better Care Fund (BCF) Submission DM explained that there was no new data to report so instead he talked through the BCF submission. From the data there are no concerns that we won’t meet year end targets Next year the BCF will be monitored against the standard plan making it more transparent and easier to complete than it has been his year. It has also been suggested that from 2017-18 those organisations that have a credible alternative in place will be able to opt out of BCF. SW confirmed that TMBC invoice the CCG on a monthly basis in line with the BCF guidelines.
11. Practice Visit Update This paper was written following discussions around practice visits at November’s meeting. The group discussed the benefits of the practice visits and what sort of approach should be taken going forward. SAh agreed that the visits were useful and allowed the practices to develop a good relationship with the CCG. It was clear however that some improvements could be made. The committee concluded that the following steps should be taken:
• Visits should be continued for all practices • The aim of the visits should be to offer practices support • Outliers should have additional visits and support put in place • Prescribing Analysis and LIG Dashboard data should be updated quarterly • The need for additional support should be assessed through Locality Support
meetings (GPs need to communicate this to their Locality Lead). If it is found that additional support/resources are needed and that this in turn will save the economy money then a business case will be submitted to PIQ. (Action: AL/SAh)
The committee agreed that updates on the practice visits should be reported to PIQ. VF will contact Sarah Hadfield to ask her to add this to the PIQ workplan for quarterly updates. (Action: VF) 12. Aligned Pooled Budget Following concerns raised at the previous meeting as well as from the council the decision has been made to withdraw the £100m Wider Pooled Budget. The focus and efforts will instead shift to getting the full aligned budget in place for 1st April 2016 alongside the Single Commissioning function. This aligned budget will be under a Partnership Agreement rather than a legally binding Section 75 and will be managed through a recharge system; the CCG and Local Authority will retain their statutory obligations. KR and Jess Williams have the CCG’s legal team, Hempsons, working on the Partnership Agreement to ensure it is in effect from 1st April 2016. Once developed the Partnership Agreement will be submitted to the CCG’s IGAR Committee for recommendation of approval to GB. 13. MH PbR Update DM explained that Tameside & Glossop (T&G) CCG are involved in a Greater Manchester (GM) wide Risk Share Agreement for MH PbR. 2015-16 is the second
51
6
year of a Risk Share Agreement and the GM MH Contract Steering Group is currently discussing potential options for 2016-17. As it stands T&G CCG are overpaying by £3.5m and this has been re-paid to date through a ‘£250k cap per CCG per year arrangement to ensure the GM economy remains stable. The aim is to realign the contracts in 2016/17 to reflect more accurate contract values. However, the options for doing this needs further discussion across GM as there is not yet complete confidence in the data and we also need to mitigate the risk of destabilising some GM CCGs which in turn could adversely affect the GM economy. 16. Financial Planning 2016-17 This item was deferred to January’s meeting. 15. Any Other Business AH informed the committee that there are now five thousand patients accessing their own records which represents a real milestone. He explained that for this to move forward funding would be needed to support the practices. A paper will be submitted to PIQ to request this funding.
17. Date and Time of Next Meeting
The next meeting is scheduled for 20th January 2016 at 9.30am, NCH. 17. Actions
Person Action Time Frame PP (KR) Discuss arranging a refresh Risk Management
Training session for GB – KR reported that Paul Pallister is in the process of taking this forward.
Early 2016
DM CW is going to look into if the decision for UHSM to be the sole ‘on call’ provider for vascular services has been discussed with CCGs – AL confirmed that all CCGs are aware that UHSM are the sole ‘on call’ provider. DM will adjust the 2016/17 plans to reflect this and will inform practices.
ASAP
AL (CW) TO’H to ask Peter Howarth if it is possible to gather data regarding the difference in what GPs prescribe and what pharmacies actually dispense – AL to check with Peter Howarth that this is being reported.
For the next meeting
DG DG to liaise with Jamie Douglas re the Programme Budgeting tool kits and prepare a paper to explain the merits of the most effective ones – DG to provide an update on this action for January’s meeting.
For the next meeting
CW Submit the Commissioning Improvement Scheme to December’s meeting – Deferred to January’s meeting.
For the next meeting
TS Glossop – liaise with Elaine Richardson regarding assurance that funds are being spent on Glossop. – TS to follow up with ER.
ASAP
VF Update the SoD to remove Stephen Beswick For the next meeting
VF VF will communicate to Quality Committee to take forward the investigation re inaccurate TFT coding/ impact on Patient Safety as well as adding it to IGAR Committee’s January agenda to be discussed.
ASAP
KR One the TFT year end settlement has been approved by GB a notice will be communicated out to all
ASAP
52
7
practices.
DM DM will provide a verbal update to SRG that there is no spare funding to bridge any financial shortfalls/pressures.
December 2015 SRG
DM DM to clarify the Year to Date (£25k) and Year End (£335) Variance for SFT & rectify a formatting error for WWL under the ‘Movement in Month’ column
ASAP
TS TS to amend the Finance Report to reflect the changes to the QIPP risk before it is submitted to GB on 23rd December
Before 23rd December 2015
SAh/AL The need for additional support for practices should be assessed through Locality Support meetings (GPs need to communicate this to their Locality Lead).
ASAP
VF VF will ask Sarah Hadfield to add Practice Visits to the PIQ workplan for quarterly updates.
ASAP
53
GOVERNING BODY MEETING
Title of Subject: December Final Quality Committee minutes
Date of paper: 16th December 2015
Prepared By: Celia Poole
History of paper: Quality Committee meets regularly, promoting and providing assurances to the Governing Board, on all matters relating to the vision and strategy for continuous quality improvement.
Executive Summary:
Key issues discussed: Bridgewater Action Plan QC reviewed the embedded evidence within the revised action plan. The Quality Assurance team at the CCG have discussed some of the learning and agreed a draft flow chart setting out the following steps when dealing with any issues that may arise such as the incident with Bridgewater:
Identify the lead for the process to any issues that may occur Understand the severity of the issue and the impact on patients
under particular cohorts of patients Agree action plan to deliver level of care required safely manage
the movement of patients Consistency of communication
GP Clinical Quality Improvement Lead (update) Trust Mortality Steering group
The Group met this month and there was positive news from the most recent AQuA mortality review. Every death continues to be subject to peer review.
Discharge summaries A fault has been identified in the Lorenzo software which means the Trust cannot upload the new discharge/handover templates until it is fixed. The problem has been passed to the software teams in the US and India with no date set for resolution.
Improving the Referral process to TGH This work is progressing and Joanna Bircher is ensuring both GP input into the Trust Access Policy to ensure the processes do not include addition steps for GP practices when patient’s miss their appointments. Peter Nuttall has passed it through the Trust’s senior team and has confirmed that he will pass on to Joanna for comment once agreed.
Improving the Results interface with the path lab This work is on-going. Nikki Bullough at the Trust will soon send out the annual user survey to GPs and their teams and there has been GP input into the format of this survey.
Primary care Quality Improvement work The Local Improvement Group (LIG) discussed an important topic was the risk that the flu immunisation uptake data was incomplete due to issues with the implementation of the pharmacy flu scheme. Some pharmacies had been only informing GPs practices if patients tick a box on the consent form. JB has shared this information with Anna Moloney from Public Health/TMBC.
Support to practices and individuals wanting to improve their Quality Improvement (QI) skills
Joanna has led a further two sessions for Practice Managers on Quality Improvement and how to gather and interpret practice data. The Primary Care Quality Scheme appears to be making practices more interested in their performance data and Quality Improvement.
Data Quality Initiative
54
The data quality report has been re-run and Joanna will be analysing the findings.
Professional Portal for concerns A work around for practices being able to easily report concerns is in development by the Primary Care team. Care Homes update Suspensions remain in Darnton House and still awaiting CQC decision on enforcement of action. 15 patients remain in Darnton House and are still being supported. This decision has been discussed with families/carers and patients wellbeing is still being supported with a member of Michelle Rothwell’s team present daily including Michelle herself doing walkabout. 2015/16 Quarter 2 CQUIN Position Update QC was briefed on the Quarter 2 CQUIN position for 2015/16 for the following contracts: Tameside Foundation rust – Acute Contract Stockport Foundation Trust – Community Contract Pennine Care Foundation Trust – Mental Health Contract Meridian/Grange View – Intermediate Care Contract Most CQUINs have been achieved for this quarter although awaiting some further information this week before final sign off. Quality walkabout to the Integrated Response and Intervention Service (IRIS) QC reviewed the report on the recent quality walkabout visit and the recommendations contained within the report. QC expressed their concern that the report does not reflect the intentions of the quality walkabout visits as previously agreed. The visits were to be based on ALL 15 steps of the quality walkabout policy agreed by QC and not just a few of the steps. It was agreed that if the process is not working then there should be a planned protocol in place and that all future visits set out on the schedule of visits should be postponed and held off until the follow up contract workshop where there can be a review of visits taking place. Tameside and Glossop CCG Health Inequalities Plan Progress Report QC received a draft reporting framework for the Health Inequalities Plan. This sets out the first steps of progress to date. Gideon noted there is not yet much change to the plan aside from an additional column to gather information/evidence and capture progress to date which can be reported quarterly. The outcomes will be reported on a set of baselines and will be reported annually and a further update report will be presented to QC in January. Follow up discussion from Quality workshop QC reviewed a set of slides illustrating the collated feedback from the Quality Workshop that took place on 21st October. It was agreed that the Nursing and Quality team would pull together a draft report to set out the functionality and purpose of a Quality Committee to inform the single joint commissioning function and a set of agreed principles to feed into that function.
Recommendations required of the Governing Body (for Discussion and Decision)
To discuss and note the key issues discussed and agreed at the meeting on 16th December 2015.
QIPP principles addressed by proposal:
Quality
Direct questions to: Celia Poole
55
Final
1
Minutes Quality Committee
Wednesday 16th December 2015 9.30am-12.30pm Boardroom, New Century House
Present:- Celia Poole (CP) Gill Gibson (GG) Clare Todd (CT) Joanna Bircher (JB) Dr Jamie Douglas (JD) Lesley Surman (LS) Lynn Jackson (LJ) Michelle Rothwell (MR) Elaine Richardson (ER) Hazel Chamberlain (HC) In attendance:-
Governing Body Lay Member (Chair) Director of Nursing and Quality Governing Body Nurse, CCG GP Clinical and Quality Improvement Lead Governing Body GP, CCG Governing Body Lay Advisor, CCG Quality Lead, CCG Head of Individualised Commissioning, Quality and Patient Safety, CCG Head of Delivery and Assurance, CCG (Transformation Rep) Lead designated for Safeguarding, CCG
Julie Beech (JBee) Kate Cooper (KC) Gideon Smith (GS) Clare Bromley (CB)
Healthwatch Officer, Healthwatch Tameside Contract Manager, CCG (Item 6 only) Public Health Consultant, TMBC PA, Corporate Office, CCG (note taker)
1. Chairs Welcome, Introductions and Apologies CP welcomed everyone to the meeting particularly to Julie Beech representing Healthwatch in Peter Denton’s absence. Apologies were received from:- Clare Watson Director of Transformation, CCG Peter Denton Healthwatch Manager, Healthwatch Tameside 2. Declarations of interest There were no declarations of interest noted. CP noted that the Register of interests will be presented at each meeting and if members have any amendments/updates to make to the Register they must complete the table of amendments and pass directly to CB for filing with Paul Pallister.
Register of interests It was noted that the Register of Interest was not up to date. CB to obtain an up to date copy from Paul Pallister to be circulated with papers in time for the next meeting in January.
Action: CB 3. Minutes of Previous meeting: 21st October 2015 The minutes of the previous meeting were agreed as an accurate record. The following actions were reviewed: Action 6 (16.09.15) – CQUIN report Q1 – all providers Kate Cooper had provided an update on the information requested by members to know the margin of failure to assess impact of quality of care. CB had circulated the updated information to members prior
56
Final
2
to today’s meeting which confirmed that: All staff within the business group to receive training relating to dementia and delirium, the compliance was 95.77% (28 staff did not received training) Action 5 (i) – Improving the Referral process to TGH Issues were raised with the mortality steering group not meeting and the reasons behind meetings not take place. QC had noted that on approach to the ICO this would need careful monitoring and that perhaps a letter of concern sent to the trust on behalf of QC be an option. In the first instance CP agreed to raise this at the next Governing Body meeting. CP updated that she did raise this at Governing Body however it has since been confirmed that another meeting has taken place and that GG has received assurance that work is continuing at the Trust on this and that dates have been set for 2016. Discharge summaries One issue that arose was that the Lorenzo software providers were unable to update the template used in the referral process. The Trust’s IT department were in talks to resolve this with the provider and GG agreed to raise this and other issues with Peter Nuttall at their one to one meeting later today.
Action: GG In terms of the access policy, ER confirmed that this has already been agreed with input from Dr Saif Ahmed and Dr Asad Ali. It was noted that the RTT target changed hence the need for the policy to change. JB agreed to liaise further with ER about that to discuss feedback received from GPs.
Action: JB During the discussion on E referrals and moving towards looking at the system as a whole, members raised this as one example of recording such issues for early input into the Devo GM system and the suggestion was made for the development of a log to list practical issues arising locally to inform Devo GM particularly to ensure the system has a patient centred focus. Members made several suggestions on the mechanism for this to happen to include passing on to Alan Dow and Steve Allinson and ER suggested this go via Heads of Commissioning I(HOCs) via Clare Watson and through planned care leads as well as urgent care and operational leads within the Trust. Another suggestions was via the Quality Surveillance Group via GG. GG agreed to raise this at CMT for further discussion/action.
Action: GG All other previous actions were either completed or included on the agenda for update/discussion 4. Matters arising not otherwise on the agenda Key highlights:
Bridgewater Action Plan QC reviewed the embedded evidence within the revised action plan. LJ and ER met with Anna Livingstone, Quality Assurance Office at the CCG, to discuss some of the learning and agreed a draft flow chart setting out the following steps when dealing with any issues that may arise such as the incident with Bridgewater:
Identify the lead for the process to any issues that may occur Understand the severity of the issue and the impact on patients under particular cohorts of
patients Agree action plan to deliver level of care required safely manage the movement of patients Consistency of communication (LJ has liaised with the communications lead on this)
57
Final
3
Members agreed that the flow chart sets out a simple clear process for all and it was agreed that final sign off for this would be undertaken at the next meeting in January.
Action: LJ 5. Standing items - Monthly
5 (i) GP Clinical Quality Improvement Lead (update) Members were presented with a report from Joanna Bircher detailing the recent clinical quality improvement work streams. Members discussed the following highlights:
Trust Mortality Steering group The Group met this month and there was positive news from the most recent AQuA mortality review. Every death continues to be subject to peer review.
Discharge summaries JB noted that a fault has been identified in the Lorenzo software which means the Trust cannot upload the new discharge/handover templates until it is fixed. The problem has been passed to the software teams in the US and India with no date set for resolution.
Improving the Referral process to TGH This work is progressing and Joanna is ensuring both GP input into the Trust Access Policy to ensure the processes do not include addition steps for GP practices when patient’s miss their appointments. Peter Nuttall has passed it through the Trust’s senior team and has confirmed that he will pass on to JB for comment once agreed.
Improving the Results interface with the path lab This work is on-going. Nikki Bullough at the Trust will soon send out the annual user survey to GPs and their teams and there has been GP input into the format of this survey.
Primary care Quality Improvement work Members received the LIG ratified minutes from the meeting that took place on 7th November. JB noted that the LIG discussed an important topic was the risk that the flu immunisation uptake data was incomplete due to issues with the implementation of the pharmacy flu scheme. Some pharmacies had been only informing GPs practices if patients tick a box on the consent form. JB has shared this information with Anna Moloney from Public Health/TMBC. It was noted that NHS England are aware of these issues as it is not just common to Tameside. QC supported a discussion around the Single Commissioning Function and finding a way of good coverage for flu locally for all agencies as a field force approach. Elaine Richardson agreed to raise this discussion at (System Resilience Group) this Friday (18th December).
Action: ER
Support to practices and individuals wanting to improve their Quality Improvement (QI) skills
JB has led a further 2 sessions for Practice Managers on Quality Improvement and how to gather and interpret practice data. The Primary Care Quality Scheme appears to be making practices more interested in their performance data and Quality Improvement.
Data Quality Initiative The data quality report has been re-run and JB will be analysing the finding.
Professional Portal for concerns
58
Final
4
A work around for practices being able to easily report concerns is in development by the Primary Care team.
5 (ii) Care Homes update Suspensions remain in Darnton House and still awaiting CQC decision on enforcement of action. 15 patients remain in Darnton House and are still being supported. This decision has been discussed with families/carers and patients wellbeing is still being supported with a member of Michelle Rothwell’s team present daily including Michelle herself doing walkabout. There is a meeting scheduled to review the action plan. 6. 2015/16 Quarter 2 CQUIN Position Update QC was briefed on the Quarter 2 CQUIN position for 2015/16 for the following contracts: Tameside Foundation rust – Acute Contract Stockport Foundation Trust – Community Contract Pennine Care Foundation Trust – Mental Health Contract Meridian/Grange View – Intermediate Care Contract Most CQUINs have been achieved for this quarter although awaiting some further information this week before final sign off. 7. Quality walkabout to the Integrated Response and Intervention Service (IRIS) QC reviewed the report on the recent quality walkabout visit and the recommendations contained within the report. QC expressed their concern that the report does not reflect the intentions of the quality walkabout visits as previously agreed. The visits were to be based on ALL 15 steps of the quality walkabout policy agreed by QC and not just a few of the steps. It was agreed that if the process is not working then there should be a planned protocol in place and that all future visits set out on the schedule of visits should be postponed and held off until the follow up contract workshop where there can be a review of visits taking place. GG agreed to discuss this further outside of the meeting with LJ and HC to progress.
Action: GG 8. Tameside and Glossop CCG Health Inequalities Plan Progress Report GS presented a draft reporting framework for the Health Inequalities Plan. This sets out the first steps of progress to date. Gideon noted there is not yet much change to the plan aside from an additional column to gather information/evidence and capture progress to date which can be reported quarterly. The outcomes will be reported on a set of baselines and will be reported annually. A further update report will be presented to QC in January.
Action: GS
9. Schedule of dates for announced and unannounced walkabout visits 2015/16 Members were provided with the schedules of dates for announced and unannounced walkabout visits 2015/16 which now include times as per members’ request. However as discussed under item 7, QC agreed to postpone any future visits until the next contract workshop to decide where there can be a review of visits taking place. 10. Follow up discussion from Quality workshop QC reviewed a set of slides illustrating the collated feedback from the Quality Workshop that took place on 21st October.
59
Final
5
It was agreed that GG and her team would pull together a draft report to set out the functionality and purpose of a Quality Committee to inform the single joint commissioning function and a set of agreed principles to feed into that function.
Action: GG
QC will discuss the report in January with the aim to discuss with partners. 11. Date and Time of next meeting Wednesday 6th January 2016, Boardroom, New Century House Meeting closed: 11.40am
60
GOVERNING BODY MEETING
Title of Subject:
Delivering Excellence, Compassionate, Cost Effective Care –
Governing Body Performance Update.
Date of paper: 19/01/16
Prepared By: Ali Rehman
History of paper:
Regular Updates are presented on a monthly basis to CCG.
Executive
Summary:
This paper provides an update on CCG assurance and performance,
based on the latest published data (at the time of preparing the
report). The October position is shown for elective care and a
December ‘snap shot’ in time for urgent care. It includes a focus on
current waiting time issues for the CCG. The provider summaries are
included.
The CCG has been Assured as Good in four of the five components in
the assurance framework with Performance being the only one with
Limited assurance.
Performance issues remain around waiting times in diagnostics and
the A&E performance.
RTT
Incomplete
52WW Diagnostic A&E
Standard 92% 0 1% 95%
Actual 92.18% 0 2.43% 85.52%
The number of our patients still waiting for planned treatment 18
weeks and over continues to decrease and the risk to delivery of the
incomplete standard and zero 52 week waits is being reduced.
Cancer standards were achieved in November.
Endoscopy is still the key challenge in diagnostics particularly at
Central Manchester.
A&E Standards were failed at THFT and are amongst the lowest in GM.
Financial
Year to
10th
Jan16
Quarter
1
2015/16
Quarter
2
2015/16
Oct
2015/16
Nov
2015/16
Dec
2015/16
Jan to
10th
85.52% 91.36% 89.59% 89.35% 77.19% 72.94% 68.23%
Attendances and NEL admissions at THFT (including admissions via
A&E) have increased on 2014 since August.
The number of Delayed Transfers of Care (DTOC) recorded remains
higher than plan.
Ambulance response times were not met at a local or at North West
level.
61
Recommendation
s required of the
Governing Body
(for Discussion
and Decision)
Governing Body are asked to:
Note the 2015/16 CCG Assurance position.
Note performance and identify any areas they would like to
scrutinise further.
QIPP principles
addressed by
proposal:
Delivery of NHS Tameside and Glossop’s Operating Framework
commitments for 2015/16.
Direct questions
to:
Ali Rehman/Clare Watson
62
Delivering Excellence, Compassionate, Cost Effective Care
Governing Body Performance Development Update
January 2015
1. Introduction
1.1 This paper provides an update on CCG assurance and performance, based on
the latest published data (at the time of preparing the report). The November
position is shown for elective care and a January ‘snap shot’ in time for urgent
care. It includes a focus on current waiting time issues for the CCG. The
provider summaries for THFT, SFT Community services, Pennine Care, Meridian,
GTD, 111 and Arriva are included.
1.2 It should be noted that providers can refresh their data in accordance with
national guidelines and this may result in changes to the historic data in this
report.
2 CCG Assurance
2.1 We have not been advised of any change to the CCG assurance level so it
remains as below.
Component Assurance Level
Well Led Organisation Assured as good
Delegated Functions Assured as good
Finance Assured as good
Performance Limited assurance requires improvement
Planning Assured as good
2.2 It is not expected that we will improve our assurance level in the short term, as
whilst the RTT performance continues to improve, Central Manchester is
significantly affecting our diagnostics and we are not expecting sustained
delivery of the A&E 95% until Q1 2016/17.
3 Current CCG Performance
3.1 Elective Care – please note the December position is the latest available data.
3.2 The RTT standards are now monitored differently and for this report only the
incompletes is recorded.
3.3 In November the CCG acheived the incompletes standard at 92.18% THFT
continued to achieve at 92.8%.
63
Incomplete (Standard 92%)
CCG Actual THFT Actual
Apr 89.34% 87.50%
May 90.65% 89.30%
Jun 91.44% 90.70%
Jul 91.79% 91.30%
Aug 92.03% 92.10%
Sep 92.16% 92.22%
Oct 91.81% 92.2%
Nov 92.18% 92.8%
3.4 The total number of incompletes for the CCG has stabilised and slightly
decreased but the 18 weeks and over has risen slightly. The decrease in over
40 week waiters continues and the 28 to 40 waits has slightly increased.
3.5 No patients waiting more than 52 weeks for treatment.
3.6 Tameside expects to report zero 52-week waits for December. However the risk
of 52 week waiters remains with 12 patients at 43 to 47 weeks. Also there are 19
patients waiting over 36 weeks without a decision to admit.
64
3.7 The specialities of concern with regard to current performance or Clearance
Rate (how long to
treat the total waiting
list assuming no more
were added and the
number completed
each week stays the
same) are shown
below. Clearance
Rate is used as an
indicator of future
performance with 10
to 12 weeks usually
being seen as the
maximum to deliver
performance
however with
specialities with low
numbers this is less
accurate.
0-18
Weeks
18-22
Weeks
23-27
Weeks
28-32
Weeks
33-37
Weeks
38-42
Weeks
43-47
Weeks
48-51
Weeks
52+
Weeks
Cardiology 1,358 56 34 14 2 2 1 - - 1.3%
Cardiothoracic Surgery 45 6 - 1 - - - - - 1.9%
Dermatology 915 30 16 6 4 - - - - 1.0%
Ear, Nose & Throat (ENT) 1,490 67 22 17 11 1 2 - - 1.9%
Gastroenterology 787 55 12 5 2 1 - - - 0.9%
General Medicine 1,032 36 28 11 3 - - - - 1.3%
General Surgery 2,070 82 48 29 17 6 4 1 - 2.5%
Geriatric Medicine 7 - - - - - - - - 0.0%
Gynaecology 1,241 41 19 5 2 - 1 1 - 0.7%
Neurology 15 - 1 - - - - - - 0.0%
Neurosurgery 4 - - - - - - - - 0.0%
Ophthalmology 1,519 23 9 1 - 1 - - - 0.1%
Oral Surgery - - - - - - - - -
Other 2,556 101 55 35 21 13 2 1 - 2.6%
Plastic Surgery 181 19 13 6 2 2 - - - 4.5%
Rheumatology 339 9 4 4 - - - - - 1.1%
Thoracic Medicine 108 6 - 1 - 1 - - - 1.7%
Trauma & Orthopaedics 2,863 192 100 52 12 4 2 1 - 2.2%
Urology 1,172 70 24 12 - 1 - - - 1.0%
Total 17,702 793 385 199 76 32 12 4 - 1.7%
# of Patients Waiting by Specialty % of
Incomplete
at 28 Weeks
and over
65
3.8 Five of these are the specialities where THFT also failed the standard and still
have a backlog. Overall the backlog at THFT has reduced. Further discussions
with THFT regarding the backlog in Gastroentorology.
Specialty Incomplete
Performance > 18
Weeks < 18
Weeks Total November
Backlog October Backlog
September Backlog
August Backlog
July Backlog
June Backlog
General Surgery 92.0% 162 1865 2027 10 40 70 90 130
Urology 91.6% 73 796 869 5 25 10
Orthopaedics 85.9% 343 2095 2438 150 180 210 210 190 240
ENT 92.8% 91 1174 1265
Ophthalmology 99.3% 6 884 890
Oral Surgery 97.9% 11 511 522
Plastic Surgery 87.8% 17 122 139 7 30 15
CT Surgery 83.3% 2 10 12 1
Adult Medicine 92.6% 76 954 1030
Gastroenterology 90.7% 84 816 900 30 10 35
Cardiology 92.4% 103 1257 1360 10 40 40 100 110
Dermatology 94.8% 61 1109 1170
Rheumatology 95.9% 13 303 316
Gynaecology 95.2% 58 1154 1212
Other 97.4% 43 1580 1623
THFT position 92.8% 1143 14630 15773 193 255 315 320 390 515
3.9 Diagnostics- please note the November position is reported in this update.
3.10 In November we failed the diagnostic standard at 2.43% against 1.0% Standard
for waiting 6 or more weeks.
3.11 This means we have
failed for every
month this year. The
slight increase in
performance needs
to be monitored to
see if it will be
sustained.
66
CMFT do not anticipate achieving the standard until April 2016.
3.12 At the end of November 105 patients were waiting 6 weeks and over for a
diagnostic test, 43 of which were over 13 weeks.
3.13 The challenge continues to be in endoscopy, accounting for 81% of breaches.
67
3.14 THFT has shown a slight deterioration in performance in endoscopy from last
month and Central Manchester showing a slight improvement in performance.
3.15 Cancer- please note the November position is reported in this update
3.16 We achieved the standards In November.
3.17 Our full performance is shown below with all standards achieved apart from the
62 day consultant upgrade.
Performance No. of patients not
receiving care within standard in Oct
Indicator Name Standard
Quarter 1
15/16
Quarter 2
15/16 Oct 15
Nov 15
Cancer 2 week waits 93.00% 94.88% 96.02% 96.75% 97.66% 18
Cancer 2 week waits - Breast symptoms 93.00% 84.98% 95.71% 94.60% 96.72% 2
Cancer 62 day waits – GP Referral 85.00% 89.68% 86.30% 86.77% 93.02% 3
Cancer 62 day waits - Consultant upgrade 85.00% 93.33% 81.82% 91.67% 80.00% 1
Cancer 62 day waits - Screening 90.00% 100.00% 90.00% 100% 100% 0
Cancer day 31 waits 96.00% 98.18% 96.00% 100% 100% 0
Cancer day 31 waits - Surgery 94.00% 100.00% 94.00% 100% 100% 0
Cancer day 31 waits - Anti cancer drugs 98.00% 100.00% 98.00% 100% 100% 0
Cancer day 31 waits - Radiotherapy 94.00% 100.00% 94.00% 100% 100% 0
3.18 The 2 breast breaches involved 2 patient choice. All 3 GP referral breaches
were delays in diagnostics.
68
3.19 Tameside also achieved all the standards apart from the 62 day Consultant
upgrade.
Performance No. of patients not
receiving care within standard in Oct
Indicator Name Standard
Quarter 1
2015/16
Quarter 2
15/16 Oct 15
Nov 15
Cancer 2 week waits 93.00% 94.5% 95.6% 96.7% 97.8% 20
Cancer 2 week waits - Breast symptoms 93.00% 84.4% 97.7% 98.4% 98.4% 1
Cancer 62 day waits – GP Referral 85.00% 92.9% 88.4% 85.9% 93.8% 3
Cancer 62 day waits - Consultant upgrade 85.00% 81.6% 77.4% 100% 81.8% 1
Cancer 62 day waits - Screening 90.00% NA NA NA NA
Cancer day 31 waits 96.00% 98.5% 99.5% 100% 100% 0
Cancer day 31 waits - Surgery 94.00% 100% 100% 100% 100% 0
Cancer day 31 waits - Anti cancer drugs 98.00% 100% 100% 100% 100% 0
Cancer day 31 waits - Radiotherapy 94.00% 100% 100% NA NA
17 of the 20 two week wait breaches were due to patient choice, two due to clinic
capacity/cancellation.
3.20 The increase in two week wait referrals continues. Breast however, still remain
below 2014/15 levels.
3.21 The year to date increases in referrals continues compared to the same period
last year with Haematology, Urology, Lower GI, Head and Neck, breast and skin
showing the larger increases.
69
3.22 Urgent Care – please note position reported is at 10th January.
3.23 THFT A&E performance continues to deteriorate due to issues across the health
and social care economy.
Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15
86.73% 93.75% 93.47% 92.09% 89.31% 87.74% 89.35% 77.19% 72.94%
3.24 We remain amongst the lowest across the GM trusts, reported through Utilisation
Management.
Financial
Year to
10th Jan16
Quarter 1
2015/16
Quarter 2
2015/16
October
2015/16
November
2015/16
December
2015/16
January
to 10th
Wigan 95.67% 97.73% 96.31% 96.72% 93.27% 93.64% 87.06%
Salford 93.82% 96.21% 95.22% 94.89% 92.10% 90.42% 86.96%
Bolton 93.47% 95.68% 95.02% 95.00% 88.73% 91.10% 82.88%
Oldham 88.85% 93.51% 92.97% 92.78% 77.97% 73.73% 74.74%
Stockport 88.50% 92.63% 88.61% 89.14% 79.44% 72.93% 76.16%
Tameside 85.52% 91.36% 89.59% 89.35% 77.19% 72.94% 68.23%
Bury 85.43% 90.65% 89.43% 88.29% 74.37% 81.16% 71.23%
North Manchester 84.47% 91.61% 86.13% 87.62% 75.61% 74.80% 74.41%
3.25 There is still considerable variation on a daily basis with no clear reason. We
have failed every month this year and last achieved the standard on 24th
December.
3.26 The improvement seen
at the start of September
has not been
maintained and
performance is on
downward trend despite
the commitment to a
closer focus on the daily
performance.
70
3.27 Availability of beds is the main cause of A&E breaches with patients awaiting
beds the highest reason for breaches. The patients waiting also impact on
cubicle availability which results in breaches due to late first assessments.
3.28 We frequently have fewer
emergency discharges
than emergency
admissions and so routinely
have to escalate discharge
to manage the daily
demand. The loss of the
beds at Darnton House has
further impacted on our
ability to discharge from
acute beds recently.
71
3.29 Slight decrease in A&E attendances during December as expected compared
to 2014/15 and admissions have also decreased.
3.30 Since September there has been considerable variation in the numbers of
attendances and admissions and breaches have risen significantly.
Week Ending
Actual Number of A&E Type 1
Attendances
Actual Number of
4 hour Type 1
breaches
Actual Performance
Number of Emergency Admissions
via A&E
Number of Direct
Emergency Admissions
Total Emergency Admissions
1,596
06 Sep 1468 70 95.2%
378 63 441
13 Sep 1684 207 87.7%
413 96 509
20 Sep 1693 244 85.6%
427 80 507
27 Sep 1620 186 88.5%
406 95 501
04 Oct 1707 281 83.5%
377 85 462
11 Oct 1679 341 79.7%
377 92 469
18 Oct 1625 344 78.8%
381 82 463
25 Oct 1615 194 88.0%
425 88 513
01 Nov 1491 296 80.1%
420 89 509
08 Nov 1682 400 76.2%
403 120 523
15 Nov 1602 344 78.5%
377 101 478
22 Nov 1702 390 77.1%
423 99 522
29 Nov 1601 349 78.2%
418 100 518
06 Dec 1594 427 73.2%
358 139 497
13 Dec 1543 438 71.6% 388 95 483
20 Dec 1608 559 65.2% 405 101 506
27 Dec 1375 244 82.3% 368 72 440
03 Jan 1591 544 65.8% 384 70 454
10 Jan 1539 398 74.1% 403 72 475
3.31 Usage of the Alternative to Transfer service continues to be good and the level
of deflections remains above 80%.
72
September October November December January to
11th
Referrals 138 154 183 215 85
Accepted 137 154 183 215 85
Red Refusals to Hospital
also seen
10 12 21 20 3
Deflected 107 117 135 166 69
Accepted % 99 100 100 100 100
% Deflected (of Referrals) 84 82 83 85 84
% Deflected (of Accepted) 84 82 83 85 84
3.32 The number of Delayed Transfers of Care (DTOC) recorded has increased due
to community health and social care service capacity issues.
3.33 Reducing DTOC and the level of variation day by day is a key aspect of the
improvement plan with Integrated Urgent Care Team designed to significantly
impact on bed availability by improving patient flow out of the hospital and
avoiding admissions. This should deliver a culture of’ Discharge to Assess’ which
is key to delivering the national expectation that trusts will have no more than
2.5% of bed base occupied by DTOC.
73
3.34 Ambulance – please note position reported is November
3.35 In November 2015 the CCG failed the response rates locally with 70.4% for CAT
A 8mins Red 1; 61.6% for CAT A 8mins Red 2 and 90.2% for CAT A 19mins Red 2.
3.36 However, we are measured against the North West position which was 73.42%
for CAT A 8mins Red 1; 68.45% for CAT A 8mins Red 2 and 91.99% for CAT A
19mins Red 2 which means none achieved this month.
3.37 The number of ambulances with handover delays increased in November.
3.38 The trend is however still improving for ambulance turnarounds below 30
minutes.
74
3.39 111– please note position reported is December
3.40 111 went live in GM 10th November so this month is the first full month report and
it contains NW level data.
3.41 The North West NHS 111 service received 149,812 calls in December 2015,
answering 134,391 of which 1222,214 calls were classified as being triaged
(90.94%)
3.42 There are 4 primary KPIs which are accepted as common ‘currency’.
Target Actual (Dec 2015)
• Calls answered 95% in 60seconds 81.7%
• Calls abandoned <5% 3.82%
• Warm transfer 75% 48.1%
• Call back in 10 minutes 75% 38.2%
3.43 Staffing capacity is believed to be a factor in the actual performance and is
being addressed. Additional the contingency arrangements across the north
and nationally increased the demand above expected levels.
3.44 Our use at 3632 calls is in line with NW levels.
15 and Under
16 to 65 65 and Over Total
Callers Triaged by Age 1,046 1,789 797 3,632
% Breakdown 29% 49% 22% 100%
% Breakdown NW Region 28% 51% 21% 100%
3.45 Our treatment is generally in line with NW levels, as is our disposition.
Calls Triaged
Caller terminate call during
triage
Callers who were identified as repeat
callers
Triaged Patients Speaking
to a clinician
Patients Warm
Transfer to a Clinician
Where Required
Patients Offered a Call Back Where
Required
Call Backs in
10 Minutes
Caller Treatment 3,632 293 176 716 258 458 138
% Breakdown 100% 8% 5% 20% 36% 64% 30%
% Breakdown NW Region 100% 8% 4% 20% 38% 62% 36%
75
4 Provider Performance
4.1 The performance dashboards for THFT, SFT Community services, Pennine Care
are included, along with summaries for Meridian, GTD, 111 and Arriva are
included.
5 Recommendation
5.1 Governing Body are asked to:
Note the 2015/16 CCG Assurance position.
Note performance and identify any areas they would like to scrutinise
further.
76
Tameside and Glossop CCG Performance Dashboard for Board
Tameside NHS Foundation Trust – Acute Performance Dashboard
Reporting Period: November 2015
National operational standard Threshold YTD ActualYTD
RAG
4 month
trend
In month
actual
In month
RAGGM/ Local Operational standards Threshold YTD Actual YTD RAG
4 month
trend
In month
actual
In month
RAG
Incompletes 92% 91.07% R 92.70% G GM_1TIA cases investigated in 24 hours 60% 55.4% R 69.2% G
GM_280% patients spend 90% time on stroke unit* 80% 61.40% R 78.9% R
Test waiting times 99% 99.22% G 99.30% G GM_13aStroke - Discharged with a joint H&SC plan*** 90% 92.8% G 93.00% G
GM_13b
Stroke - Discharged with a named point of
contact*** 90% 90.6% G
91.0% G
A&E waits - >4 hours 95% 87.81% R 77.19% R GM_14Maternity - % seen by 12 weeks and 6 days 90% 89.9% R 90.4% G
A&E trolley waits - >12 hours 0 0 G 0 G
GM_16Discharge summaries - A&E patients 95% 88.4% R 91.6% R
2ww - 1st outpatient appoinment 93% 95.6% G 97.80% G GM_17Discharge summaries - inpatients 85% 76.5% R 80.8% R
2ww - 1st outpatient appoinment (breast) 93% 91.0% R 98.40% G GM_18.1Discharge summaries - Outpatients 80% 62.4% R 63.2% R
31 days - first treatment 96% 99.2% G 100% G GM_19Outpatient appmts - provider cancellation 3% 1.10% G 1.39% G
31 days - subsequent treatment (surgery) 94% 100% G 100% G GM_20Nutrition - >60 yrs who under go an assessment 90% 96.0% G 93% G
31 days - subsequent treatment (drugs) 98% 100% G 100% G GM_21Nutrition - >60 years trtmnt plan with dietetics 90% 100% G 100% G
62 days - first treatment 85% 90.2% G 93.80% G GM_22Complaints - Reduction from baseline < 1.15 0.85 G 0.68 G
62 days - screening to treatment** 90% N/A - N/A N/A - GM_23Complaints - % acknowledged in 3 days 90% 97.8% G 97% G
62 days - first treatment after priority upgrade 85% 82.3% R 81.80% R
GM_24VTE - RCA of all hospital acquired cases 100% 100% G 100% G
MSA breaches 0 0 G 0 G GM_25VTE - reduction from baseline (Per 1000) 0.61 0.13 G 0.33 G
Cancelled ops (binding date within 28 days)*** 0 6 R 0 G GM_27
Pressure ulcers - reduction from baseline (Per
1000) 0.70 0.52 G 0.34 G
Cancelled ops (no. cancelled a 2nd time) 0 0 G 0 G GM_28Falls - reduction from baseline (Per 1000) 0.61 0.11 G 0.00 G
MRSA (zero tolerance) 0 1 R 0 G GM_29UTI - % adults free from catheter induced UTI 96.5% 99.74% G 99.50% G
Avoidable C difficile 46 2 G 0 G
RTT (52 weeks) 0 19 R 0 G
VTE Risk Assessment 95% 96.70% G 96.10% G
Publication of Formulary Yes Yes G Yes G
Duty of Candour Achieved Achieved G Achieved G
NHS Number field - Mental Health and Acute 99% 99.9% G 99.90% G
NHS Number - A&E 95% 99.3% G 99.32% G
Never Events 0 1 R 0 G
No. of handovers >30 minutes 0 255 R 67 R
No. of handovers >60 minutes 0 97 R 26 R
*Please note this is reported a month in arrears
**Please note there have been no applicable patient to date
***Please note this is reported quarterly and In month actual relates to quarter 2 data
A&E handovers
Domain 1: preventing people dying prematurely
Domain 4: ensuring that people have a positive experience of care
Domain 5: treating and caring for people in a safe environment and protecting them from avoidable harm
Referral to Treatment (RTT) times
Diagnostics
A&E waits
Cancer
Operational efficiency & HCAI
4 month trend key:
Performance is improving
No change to performance
Decline in performance
77
Tameside and Glossop CCG Performance Dashboard for Board
Stockport NHS Foundation Trust – Community Performance Dashboard
Reporting Period: November 2015
Patient Safety ThresholdYTD
Actual
YTD
RAG
4
month
trend
In month
actual
In
month
RAG
Patient Experience ThresholdYTD
Actual
YTD
RAG
4
month
trend
In
month
actual
In
month
RAG
HCAI
No. of Cdiff cases with provider contact <96 11 G 3 G E_B14Complaints received by T&G patients** 0 25 R 4 R
No. of MRSA cases with provider contact0 1 R 0 G
E_B15
Complaints - % responded to within
timescale**80% 92% G 80% G
Incidents and never events E_B16Complaints - % satisfied with outcomes** 75% 96% G 100% G
No. of reported incidents (Min 1100 per year) 1100 1461 R 145 - E_B17Compliments N/A 246 G 65 G
No. of incidents (Medication error) 0 67 R 4 R Staffing & training
Duty of candour (included in StEIS / RCAs) Achieved Achieved G Achieved G E_B18Staff turnover 13% 15.85% R 15.85% R
Number of never events 0 0 G 0 G E_B19Sickness level 4% 5.06% R 5.06% R
Harm-free care E_B20
% of eligible staff trained (Adult Protection
Level 1)95% 95.40% G 95.40% G
No. of inpatients with grade 2+ pressure ulcer
(avoidable)≤50 per 1000 12.90 G 12.90 G
E_B21
% of staff with an up-to-date appraisal and
PDP95% 77.63% R 77.63% R
No. of inpatients falls (Moderate or Greater harm) <38 32 G 2 -E_B22
% of eligible staff trained (Domestic
Abuse)95% 65.49% R 65.49% R
% of venous ulcer wounds healed < 16 weeks of
treatment (grade 2-4)70% 90.7% G 80% G
E_B23
% of eligible staff trained (Infection
control)95% 95.40% G 95.40% G
Referral to treatment times (RTT) - overall
Service specific KPIs - exceptions ThresholdYTD
Actual
YTD
RAG
4
month
trend
In month
actual
In
month
RAG E_B24
18 week maximum waits 95% 99.86% G 99.88% G
E_B256 weeks maximum waits - diagnotics 99% 100% G 100% G
Patients take up a pulmonary rehab programme 480 132 R 19 - **Please note this is reported a month in arrears and relates to October 2015 data
75% of patients taking up complete the course* 44% 30% R 15.00% R
New/Follow up ratio is in line with the care
pathway 95% 92.55% R 96.30% G
Complaints & compliments
Pulmonary rehabilitation
HIV
*Please note as the Programme length is at least six weeks the data is not yet available and in
month relates to September
78
Tameside and Glossop CCG Performance Dashboard for Board
Pennine Care NHS Trust – Mental Health Performance Dashboard
Reporting Period: November 2015
T&G CCG Level Indicators ThresholdIn month
actual
In month
RAGPerformance Indicators (Pennine Care Contract ) Threshold
YTD
Actual
YTD
RAG
In month
actual
In month
RAG
Safety Incidents - 200 G E_B1 IAPT Prevalence - Number 5380 4156 G 533 G
Deaths - 1 G E_B2 IAPT Prevalence - % (Quarterly)** 3.75% 4.29% G 4.47% G
Safeguarding - 0 G E_B3 IAPT Recovery** 50% 39.35% R 39.10% RSTEIS Cases - 5 G E_B4 IAPT 6 weeks (Threshold to be achieved by Qtr. 4)** 75% 59.35% R 56.90% RSickness & Absence 5.0% 8.58% R E_B5 IAPT 18 weeks (Threshold to be achieved by Qtr. 4)** 95% 91.40% R 90.20% R
Bank & Agency Use TBD TBD - E_B6 CPA 7 Day Follow Up** 95.0% 100% G 100.0% G
Effective and Responsive Local Key Performance Indicators
CPA reviews in last 12 months 95% 94.8% G E_B10 CAMHS Admissions to Adult Wards 0 1 R 0 G
Delayed discharges 7.5% 2.20% G E_B11 Physical health checks*** 95% 89% R 89.00% R
Gatekeeping (Tameside) 95% 100% G E_B12
Memory assessment service initial assessment 6
weeks* 80% 12% R 6.1% R
A&E 4 hour waits (Trust) 95% 99%G
T&G CCG Level IndicatorsPrevious
Month
Actual
YTD
Actual
YTD
RAG
In month
actual
RAG to
Prior
MonthLD green light toolkit compliance (Trust) Achieved Achieved G Caring and OutcomeGM Key Performance Indicators E_B7 Compliments 10 58 N/A 5 RDischarge Summaries to GPs in 24 hrs** 90% 31% R E_B8 Complaints 11 55 N/A 3 G
Discharge Letters to GP in 10 days** 90% 79% R E_B9 FFT - satisfaction rate (Tameside) 87.0% 90.75% N/A 88% G
Nutritional & Weight Assessments* 95% 96% G NB - IAPT data relates to Pennine care performance and not against the CCG national target
SUI Investigations 80% 100% G NB - YTD Actual is based on the average monthly or quarterly data
SUI Commissioners Notified 100% 100% G NB - IAPT 6 weeks and 18 weeks - waiting times was changed from wait to firest treatment on entry to wait
Alcohol screening* 85% 86% G to first treatment on discharges
Alcohol brief intervention* 85% 100% G
Adult Safeguarding Training (Tameside) 90% 88% RChildren Safeguarding Training 90% 92% G
***Data published every 6 months and relates to September
Contract / Standards Framework Safe and Well Led
** Please note the 'in month actual' is the quarterly figure and relates to quarter 2 data. The
'YTD' figure has been calculated from the quarter data
*Please note the 'in month actual' is the quarterly figure and relates to quarter 2 data.
79
Tameside and Glossop CCG Performance Dashboard for Board
Meridian – Intermediate Care Performance Dashboard Reporting Period: November 2015
Total number of new reviews 0Total number of reviews ongoing 0
Total number of alerts 0Total number of DoLS 0
Total number of new reports 0 New reports C-Diff 0New reports MRSA 0
Issues arising 0 Total 0Nov YTD
Total number of complaints 0 2Total number of compliments 0 18Number of complaints via Ombudsman 0 1Total number of pre complaints 0 0
Nov YTDTotal number of contacts 0 2
NovNew 0Outside 45 days 0Closed 1
Total number of new inquests 0Total number of ongoing inquests 0
Total number of cases 1* Falls action plans in place Total number of new cases 1
Total number of cases concluded 0Total Number on Risk RegisterNewRemoved
Number rated 1 - 3 (Negligible)Number rated 4 - 6 (Moderate)Number rated 8 - 12 (High)Number rated 15 - 25 (Extreme)
Safeguarding Alerts and patients subject to DoLS
Total
Litigation
Investigation Reports
Coroners Inquests
0
PALS
Transport3
Pressure Ulcers by Grade
Safety
Safety Alerts
Infection Control
RIDDOR
5
0
20
Community ME
Incident Reporting by Type
Serious Case Reviews (Safeguarding Adults) Patient Experience Tracker
0
STEIS
Safety
Unsafe Discharge
Risk Register
1
0
Other Incidents
01
Community Services Integrated Governance Dashboard - Grange View
Reporting Period: November 2015
00
9000000
5001
000000
2
0 5 10 15 20 25 30 35 40 45 50
Pressure ulcersMedication Error*Slips/Trips/Falls
Violence & AgressionSuspected suicide
Staffing levelsSelf Harm
SecurityPhysical Health incident
OtherManual Handling
Information SecurityInfection Control/N.Stick/COSHH
Fire & SmokingEquipment
Death-Expected/unexpectedAWOL/Absconded
Assaults to StaffAssaults to Patient
Accident
Number of incidents
Nov
0
1
2
3
4
5
6
7
8
9
10
Sep-15 Oct-15 Nov-15
Ungradeable
Grade 4
Grade 3
Grade 2
Grade 1
0
5
10
15
20
25
30
35
40
45
50
Sep-15 Oct-15 Nov-15
Num
ber
of In
cide
nts
Incidents by Grade
Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
0
1
2
3
4
5
Nov-15
Complaints
40 0
05
101520
Sep-15 Oct-15 Nov-15
Medication Errors
1 20
05
101520
Sep-15 Oct-15 Nov-15
Pressure Ulcers
16 18
9
05
1015202530
Sep-15 Oct-15 Nov-15
Slips, Trips & Falls
18
6 6
0
5
10
15
20
Sep-15 Oct-15 Nov-15
Unsafe Discharge
80
Tameside and Glossop CCG Performance Dashboard for Board
Go To Doc Limited – Out of Hours GP Performance Dashboard
Reporting Period: November 2015
National Quality Requirements Threshold YTD ActualYTD
RAG
4
month
trend
In
month
actual
In
month
RAG
Number of patients referred to A&E* 7.80% 9.34% R 9.69% R
AssessmentsAssessments within 20 mins of an urgent condition being answered 95% 94.83% R 94.29% RAssessments within 20 mins of an urgent condition arriving at the 95% 100% G 100% G
Face-to-face consultations within 2 hours of the clinical assessment 95% 97.35% G 93.00% R
OOH Consultation details sent to GP Practice by 8am the next working
day 95% 99.48% G 99.79% G
Calls
Initial telepone calls that are abandoned 4.99% 3.62% G 2.47% G
Calls answered within 60 secs at the end of the intro message 95.00% 66.02% R 68.07% R
* data relates to October due to November data not received
23 21 12 18 19
17 12 100 0 0 0 0 0 0 1
291 315 262 281 241 226 283 170
118 118 81 93 116 95 7850
594 612 436 469 510 405 505
234
0 0 0 0 0 0 0
116
132 135 107 112 112 124 108103
91 99 67 101105 96 120
172
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Call Type Breakdown by Month
Visit
Treatment Centre
Speak To Clinician
See Clinician
Nurse Advice OLC
Nurse Advice
Medication Enquiry
Dr Advice
Bookings
999
0.00%
1.00%
2.00%
3.00%
4.00%
5.00%
6.00%
0
500
1000
1500
2000
2500
3000
Abandoned Calls by Month
Total Calls
AbandonedCalls (%)
0
20
40
60
80
100
120
140
160
180
Average Waiting Time for Visits (Mins)
4 month trend key:
Performance is improving
No change to performance
Decline in performance
81
Tameside and Glossop CCG Performance Dashboard for Board
NHS 111 Performance Dashboard Reporting Period: November 2015
Performance Indicators (NWAS Contract as a Whole) Threshold111 in Month
Performance
In month
RAGPerformance Indicators
111 in Month
Performance
T&G CCG in
Month
Performance
% of calls abandoned after 30 secs 5.00% 3.82% G ## Calls Triaged 122214 3110
% of calls answered within 60 secs 95% 81.70% R ## % of Caller terminated calls during triage 9.00% 9.00%
% of life threatening calls referred to 999 within 3 mins 99% 96.20% R ## % of Callers who were identified as repeat callers 3.00% 4.00%
% of appropriate provision within 15 mins of initial contact 95% 100.00% G ## % of Triaged Patients speaking to a clinician 24.00% 25.00%## % of Warm Transferred to NHS 111 service Clinician 48.00% 47.00%
% of training in recognition of safeguarding issues 100% 100.0% G ## % of patients Offered a Call Back 52.00% 53.00%
% of answered calls triaged 60% 90.9% G ## % calls where the Time taken for call back <10
minutes38.00% 36.00%
Maximum Warm Transfer time (30 seconds) 95% 15.4% R
% of consultation details sent to patients practice by 8am
the next working day 95% 74.1% R ##
% of triaged calls transferred to 999
13.00% 14.00%
% of repeat callers (3 times in 96 hours ) whose use is
immediately highlighted to their registered GP 95% 39.5% R ##
% of triaged patients advised to attend A&E
9.00% 8.00%
% of calls made by frequent users (patients who call 111
more than 4 times in 31 Days) - 1.9% - ##
% Referred to Primary and Community care
60.00% 59.00%
## % Recommended to Attend Other Service 2.00% 2.00%
National Quality Requirements Caller Treatment
Local Quality Requirements
Referrals Given
86%
4%
0%0% 2%1%
7% T&G CCG Callers Triaged by Ethnicity
WhiteAsian or Asian BritishBlack or Black BritishChineseMixedOtherNot Collected
0
500
1000
1500
2000
15 and Under 16 to 65 65 and Over
T&G CCG Callers Triaged by Age
82
Tameside and Glossop CCG Performance Dashboard for Board
Arriva Performance Dashboard Reporting Period: October 2015
Please note the Provider Level data has not been provided since July 2015
Performance Indicators ThresholdGM In Month
PerformanceGM RAG
T&G CCG In
Month
Performance
T&G
CCG
RAG
Performance Indicators (Greater Manchester Core
Contract)Threshold
GM In Month
PerformanceRAG
Passenger Time on vehicle < 60 mins* 80.00% - - 89.69% G % availability of online booking system* 99.00% - -
% availability of telephone booking system* 99.00% - -
% of arrivals 45 minutes prior to appointment* 15.00% - - 4.17% G % of Calls answered within 20 seconds* 75.00% - -
% of patients arriving within -45 / +15 mins of
scheduled appointment time* 90.00% - - 62.11% R Average Time (in Secs) to answer inbound calls* 60 - -
% of arrivals 15 minutes after appointment* 15.00% - - 33.72% R
% of journeys cancelled by provider* 0.05% - -Patients collected within 60 mins of scheduled 80.00% - - 71.98% R
Patients collected within 90 mins of scheduled
collection time*90.00% - - 82.83% R
Performance Indicators (Greater Manchester EPS
Contract)Threshold
GM In Month
PerformanceRAG
Passenger time on vehicle is <40 mins* 85.00% - -
% of arrivals 30 minutes prior to appointment* 10.00% - -
% of patients arriving within -30 / +15 mins of
scheduled appointment time* 90.00% - -
% of arrivals 15 minutes after appointment* 15.00% - -
Patients collected within 30 mins of scheduled
collection time* 80.00% - -
Patients collected 30 mins after scheduled collection
time* 10.00% - -
* GM provider data not available NB Reports relates to October's data due to November report not submitted
Departure
Booking System / Calls
Cancellations
Travel Time
Arrival
Departure
Travel Time
Arrival
00.5
11.5
22.5
33.5
T&G CCG Complaints per 1,000 Patient Journeys
2014/15
2015/16
83
GOVERNING BODY MEETING
Title of Subject: Ratified Minutes of the PIQ Committee Date of paper: 9th December 2015 Prepared By: Graham Curtis
History of paper: PIQ 13th January 2016
Executive Summary:
Finance Update
- Non Recurrent Funding
- SFT Non Recurrent Funding
PIQ recommended approval of the allocation for non-recurrent funding in
2016-17 as outlined in the business case. This also included the business
cases which were presented at November PIQ for RAID, Street Triage and
Early intervention into Psychosis non-recurrently.
It was noted that the HALS business case which came to the November PIQ had previous been agreed recurrently and was already in the contract.
Elective Redesign Pathways
PIQ recommended the following for approval at the CCG Governing Body:-
1. The overall strategic leadership for the redesign and commissioning of Ophthalmology, ENT and MSK to sit with the CCG, under Dr Alison Lea and the Directorate of Transformation with the caveat that the rebranding of the MSK work be looked at.
2. That the ICFT remains as lead provider for all three pathways, thereby the CCG continues with the ‘Most Capable Provider’ model and does not take this redesign work through a formal procurement exercise. NB the Checkpoint assurance methodology will be strengthened and formalised.
3. That Care UK leads the establishment of bridging arrangements in the spirit of the CCG’s integrated pathways principles and objectives for all three pathways, for:-
ENT and MSK from 1st February 2016
Ophthalmology from 1st April 2016
4. That The bridging arrangements for all three pathways will run and transition into the new delivery models and contractual arrangements by 1st April 2017 at the latest.
5. As a consequence of the bridging arrangements, the CCG decided to:-
84
Invite Care UK to take the lead integrator role for the new delivery models for all three pathways.
The lead integrator role will co-ordinate ALL partner providers and lead the development of the new service models in partnership with the CCG.
This recommendation was subject to a vote including the following
members:-
Five PIQ members voted in favour to invite Care UK to take the lead integrator role for the new delivery models for all three pathways. Three PIQ members voted in favour to retain the original lead integrator roles, i.e. TFT for Ophthalmology and ENT, and Care UK for MSK.
6. That a finance and activity work stream is established to ensure system value for money during the bridging period into a new contractual arrangement with the ICFT.
7. That resources from the Care Together transformation fund are supported to cover the costs of Care UK’s project management capacity to help manage the bridging and transition arrangements.
CCG Investment in Carers
PIQ recommended agreement to on-going investment of £687,500 in
Carer Support on the basis that significant redesign will take place within
our Care Together plans. Carers investment will be taken forward as an
integral part of the LCCT developments.
Personal Health Budgets
PIQ recommended the following:-
Proposal to move away from a phased approach based on clinical
groups to a more open, co-production approach as described in the
paper.
Establish a budget to support roll out of PHBs with an amount of
£150k to be allocated non-recurrently, with an update to be
provided at the September 2016 PIQ meeting.
Recommendations required of the Governing Body (for Discussion and Decision)
Approval
QIPP principles addressed by proposal:
All
Direct questions to: Graham Curtis/Clare Watson
85
Minutes of the PIQ Committee
Wednesday 9th December 2015, 12.30pm, Boardroom Attending: Graham Curtis - PIQ Chair Clare Watson – Director of Transformation Dr Alan Dow – CCG Chair Dr Naveed Riyaz – Locality Lead
Dr Saif Ahmed – Locality Lead Dr Andy Hershon – Locality Lead Dr Alison Lea – Governing Body GP Lead Celia Poole – Lay Member Dr Richard Bircher - Governing Body GP Lead Dr Tina Greenough - Governing Body GP Lead Dr Amir Hannan - Governing Body GP Lead Paul Nuttall – Head of Finance
In Attendance: Ali Lewin – Deputy Director of Transformation
Steven Pleasant – Chief Executive, TMBC Chris Leese – Head of Primary Care Pat McKelvey – Head of Mental Health and LD Commissioning Mgr Sue Gibson – Commissioning Development Officer Louise Roberts – Commissioning Business Manager Chris McGarry - Senior Finance Officer Geoff Holliday – Commissioning Development Manager Philippa Robinson – Commissioning Development Manager Jackie McShane – TFT David Warhurst - TFT Peter Howarth – Head of Medicines Management Elaine Richardson – Head of Assurance & Delivery Sarah Hadfield – PA to the Director of Transformation
1. Apologies for Absence – Jamie Douglas/Stuart Allen/Gideon Smith/Peter Howarth/Kathy Roe/Gill Gibson Action: GC to write to LMC to formally invite and ask for a response to PIQ.
2. Minutes from the Previous Minutes
The minutes were agreed as a true record.
3. Matters Arising
Matters Arising Action: SH to ensure COI recorded for all GPs for item 11. Action: SH to amend wording within Mental Health items and revise title of item. All other actions were completed.
86
4. Declarations of Interest
GC asked that members inform SH to any changes the register. All items would be stated against each relevant item. Action: SH to chase PP around ensuring lists are consistent between committees.
5. Locality Leads
Denton SAA reported that he had invited locality members to input any ideas they may have for the Joint Locality meeting to be held on the 16th December agenda. Glossop AD reported a potential Expression of Interest in the Glossop Locality Lead job share role. AD added that Glossop’s local Federation would not be helping with the Derbyshire Public Health LES’s and that a decision had been made go with two different Derbyshire Federations for these services. Hyde Items covered included the Commissioning Improvement Scheme. Ashton Items covered included the Commissioning Improvement Scheme. Stalybridge SA advised that with regards to the Stalybridge LCCT this will remain where it is currently. Action: Locality leads to meet with GC around agenda and content of Joint Locality meeting.
6. Finance Update
PN updated members that in terms of QIPP we were still reporting it as being offset with an amber rating given. The 2016-17 financial position indicates a shortfall of £7.2m but we are still awaiting tariff uplifts so this figure may change. As part of the spending review an approximate figure of around £16m is expected for 2016-17. However this allocation will come with massive commitments which will offset it and there will be a 3% pressure on tariff.
- Non Recurrent Funding We are reporting on the basis can will have a £10.1m surplus to invest non recurrently within 2016-17. There is currently still £5.4m to invest where this committee thinks is best placed. CW added that some of this funding will be against the Transformation and Care Together funding and would be contingent on NHS England funds.
87
ER felt that we would need to be clearer around what this funding means and we must be conscious of any double running. CW added that had not yet agreed what is in scope as part of single commission so this would also factor in any decision.
- SFT Non Recurrent Funding
PIQ have previously approved non-recurrent 2014-15 and 2015-16 funding for:
IRIS Pulmonary Rehabilitation Continence service products Community Neuro Rehabilitation Team Pulmonary Rehabilitation
This funding was approved on a non-recurrent basis to 31.03.16 on the grounds that the models of integrated care through Care Together would have been designed and implemented and any costs would be included with the integrated care models. The services listed above fall within the Integrated Urgent Care Team, Local Community Care Team (linked to Specialist Respiratory) and Neuro Rehabilitation business cases previously presented to PIQ.
AL explained that we want to continue the level of service into 2016-17 pending any redesign. This will not be like for like and there will be discussions around efficiencies to be made. CW asked whether TMBCs contribution for IRIS will be rolled forward into 2016-17. AL felt that it would be and that due to the amount of vacancies within SFT and that we would not want to hand over the full budget whilst these were there. GC referred to the patients and staff and that if SFT were to give us back an amount of money whilst holding vacancies, this may be cause for concern. AL reported that these issues were being looked into. A Hannan added that IT issues were also high. PM asked how we may bring children’s issues into this around the underfunding. CW advised that the papers were being drawn up around the risks within various workstreams and the TCS Project Board. We must ensure that we collectively own this work and seek assurance around leadership and transition. PIQ recommended approval of the allocation for non-recurrent funding in 2016-17 as
outlined above. This also included the business cases which were presented at
November PIQ for RAID, Street Triage and Early intervention into Psychosis non-
recurrently.
It was noted that the HALS business case which came to the November PIQ had previous been agreed recurrently and was already in the contract. Action: PN to clarify contract for HALS. Action: Further updates to be given in January.
- QIPP CM gave an overview of the QIPP position explaining that figures shown were the QIPP Difference between what we spend and what we budget for. This years target stands at £5.2m with next years projected to be £7.2m. Commissioners and Finance worked together last year to bridge the gap with a number of schemes out
88
into place to save money. Some of these schemes have been successful or haven’t happened. We are currently over £2m short of our £5.2m target with a large amount of this as part of the Commissioning Improvement Scheme which has yet to see any savings. There has been success seen within Medicines Management efficiencies with reductions in costs for DVTs and Cardiology outpatients. This year we have identified Non Recurrent savings/slippage to cover the gap. From next year, dependant on next year’s contracts, it may prove difficult to achieve the £7.2m QIPP and we will be looking at PBR alongside gain shares with the Trust. PIQ are asked to input any ideas they may have. AD added that this should not be looked at in just a financial sense and that we must put ourselves into the mind set of our practices into a closed space. We must incentivise any innovation such as the Minor injury scheme. £12,500k within one scheme could be implemented through LCCTs. S Ahmed suggested QIPP savings in relation to TFT around the potential of having a Community Doppler/Ultrasound. CW agreed with ADs comments around the Commissioning Improvement Scheme and asked what the level of risk was we would be prepared to take. As part of the model of care steering group, each workstream will have a commissioning budget. Action: QIPP to be discussed at the January meeting.
7. Care Together Update
AD felt it was important to start to normalise the term ‘ICFT’. AD added that the Joint Development Management Team held that morning had been a good example of how difficult and complex the conversations will be. Internal development discussions protected space last week with the conclusion that we could see our subcommittees becoming joint committees rather than preserving two infrastructures to support Joint Commissioning, CCG and Council.
8. Primary Care Update
COI– A Hannan – LMC Delegated Co-Commissioning CL reported that the submission for level three delegated co-commissioning had now been submitted for sign off. Approval of this submission is expected but this is undertaken at a National rather than Local Level. The Local GM office signed off our application. CL gave thanks to SAA who had been involved with the Ashton hub pilot last week. Two sessions have been tested with feedback from GPs and patients being very positive. We are expected to go live Tuesday 15th December with the EMIS solution for EMIS Practices – non EMIS Practices will be later this month/early next but this deadline was changing daily. CW passed on her thanks on behalf of the CCG for all the hard work that had gone into this project.
S Ahmed asked whether communications had been circulated. CL advised that this information would be led by the Provider and a Communications Plan was in place.
Action: A Hannan to bring paper around IG/Patient consent to next PIQ in relation to LCCT (related issue)
89
New Proposals for a GM GP Contract Update
COI – All GPs
CW referred to a letter issued by NHS England which includes detail of how we will sell our vision within localities to Greater Manchester and NHS England when it will trialled as part of the Primary Care summit as part of the new Greater Manchester new contract. We will need to look at how we pull together our vision for locality care teams and where Primary Care and community services fit together, as part of this. To allow us to receive the resource this will need to be signed off as part of our Locality Plan and Care Together. Within the existing review of Enhanced Services we will need to look at budgets differently with practices working as part of the localities. We are proposing that the CCG holds the contract for any discretionary spend to work with the ICO and develop the Workstream further.
AD added that this subject was hot off the press and for PIQ timing of this is quite good. PIQ, All Localities, LMCs and Clare Watson and I are aligned - but we have a different interpretation of how it will go. Looks just like Adele tickets appearing instantly on GetMeIn, with some areas already primed to go it aligns like a euro coin with the U.K. stamp on it. Our federation are also already enthusiastic
CW agreed but felt we should do something proactively and make it work within our model. A Hannan agreed and felt that there is still opportunity for some engagement to happen. More chance of shaping if at the front at the start.
AD explained how we is now on the Primary Care Devolution team as AGG's representative. AD likes the innovation and drive and liked MCP as a health care model. Evidence based AD likes some of the underpinnings: a common estates policy, a single data sharing agreement but worries about the pan GM approach (8-8, GMPCS) there is also worry about it as a potential competitor to the contractual models possible through an ICO.
CP asked around funding. CW advised that there will be resources for the backfilling of clinical and legal time.
A Lea agreed in principle but asked what the locality offer was and whether or not member practices had been engaged and this has already part of the ongoing work but more will need to be done.
9. Elective Redesign Pathways
CW explained that the MSK, ENT and Ophthalmology pathways through Care UK is due to end and that Tameside & Glossop have been leading the exit across GM. The Care UK contract receives 85% of total contract value no matter what the activity is and there is no tapering down of the service. We have managed a continuing service provision and at the end of the contract we needed an alternative provision. MSK, ENT and Ophthalmology were our priorities and rather than just focusing on Care UK we wanted to look at something transformational. A proposal previously went to PIQ to look to provide an outcome based commissioning approach to provide an integrated model. Market days were held and in July lead integrators for these services were in place and were TFT and Care UK. Referrals would need to be in place by the 1st February 2016 to ensure there was provision in place and regular checkpoint meetings involving Alison Lea, Saif Ahmed and Finance have taken place. In early November the CCG met with TFT around what potential risks there may be as TFT would be the lead provider for all 3
90
pathways in line with Care Together and the ICO. On the 23rd November TFT advised that they would not be in a position to go live with the services and PIQ are asked to review the seven recommendations set out in the paper to assess how we take this forward, in particular the bridging arrangements for MSK and ENT. AD conveyed the massive work TFT had taken on alongside all other pressures being faced by the Trust. As an interested organisation entering a new world of fairly sharing services can we not ask the Primary Care ophthalmologists to do it for ophthalmology? AD added why would it be a priority for TFT as it is enlarging the role of Primary Care. There are examples of voluntary services and charities being lead integrators and why was this not within Primary Care eyes? A Hannan didn’t feel that the work was as open as it could be and that the PPIC presentation had been poor with a risk of not tapping into our own expertise. ER added that Orbit Healthcare and all GPs had been invited to every single meeting so were party to the decision of the lead integrator. C Poole questioned the most capable provider option being TFT. S Ahmed felt it was a tragedy for our patients as it was designed for them to be at the centre and that this experience did not provide much hope for the future. A Lea felt that the challenges faced were key assist how we will deal with future change and will form the principles in building an ICO. It will also be important to ensure clinicians from secondary and primary care are more joined up. Jackie McShane explained that the Trust want to be supportive of the situation and recognises the issues and involvement. JM added that it had been a difficult timescale and that lessons had been learnt. Though resource wasn’t efficient in terms of capacity, TFT would like to provide reassurance that they see this work as part of our future. TFT want to passionately deliver this for our patients and the pathways have been signed off but are not operationalised. There is concern with the financial aspect. DW added that as a stepping stone to the ICO, if we don’t move forward with this it would be a risk and the work requires internal governance. PIQ recommended the following for approval at the CCG Governing Body:-
8. The overall strategic leadership for the redesign and commissioning of Ophthalmology,
ENT and MSK to sit with the CCG, under Dr Alison Lea and the Directorate of Transformation with the caveat that the rebranding of the MSK work be looked at.
9. That the ICFT remains as lead provider for all three pathways, thereby the CCG continues with the ‘Most Capable Provider’ model and does not take this redesign work through a formal procurement exercise. NB the Checkpoint assurance methodology will be strengthened and formalised.
10. That Care UK leads the establishment of bridging arrangements in the spirit of the CCG’s integrated pathways principles and objectives for all three pathways, for:-
ENT and MSK from 1st February 2016
Ophthalmology from 1st April 2016
11. That The bridging arrangements for all three pathways will run and transition into the new delivery models and contractual arrangements by 1st April 2017 at the latest.
12. As a consequence of the bridging arrangements, the CCG decided to:-
Invite Care UK to take the lead integrator role for the new delivery models for all three pathways.
91
The lead integrator role will co-ordinate ALL partner providers and lead the development of the new service models in partnership with the CCG. This recommendation was subject to a vote including the following members:-
Five PIQ members voted in favour to invite Care UK to take the lead integrator role for the new delivery models for all three pathways.
Three PIQ members voted in favour to retain the original lead integrator roles, i.e. TFT for Ophthalmology and ENT, and Care UK for MSK.
13. That a finance and activity work stream is established to ensure system value for money
during the bridging period into a new contractual arrangement with the ICFT.
14. That resources from the Care Together transformation fund are supported to cover the costs of Care UK’s project management capacity to help manage the bridging and transition arrangements.
Action: RB to share the recommendation that we use ICFT where required within terminology.
10. LCCTs
AL updated that within the five localities the Local Authority support proposals to work around those patients who are still on a resident basis. Practices will have one locality team to work with and in terms of assurance of risk stratification this will go through the programme board and other Care Together governance in the New Year. Psedonimsied data will look at what needs there are with any patient consent issues to be addressed. There is one practice that hasn’t agreed to this so far which will be picked up with the lead. AD felt that this was the best iteration that he had seen. AL added that it would shape over time and that discussions will broaden with THFT to be included in future discussions. Examples such as Physio activity doubling within MSK is a resource that LCCTs can call upon. S Ahmed also felt that we may be able to build in a geriatrician or paediatrician. AL added that these discussions were being looked into with TFT and conversations will also be held with PPG, PPIC and PIG. CP asked where Drugs and Alcohol would fit into this work. Though this was not in the original scope it is something that could be relooked at and PM added that a practitioner could work well and link in with the Public Sector Reform work. CW added that this will sit within the Healthy Lives locality which will look at how they fit together including utilisation of the third sector. A Lea asked around workforce and hospital based components to enable an ICFT. TG added that this was a major workstream for Greater Manchester which feels unease around integrated care when linked with troubled families and children so felt that the links from the Public Sector Reform hub were extremely important. AD noted his discomfort that the social agenda isn’t portrayed more.
11. CCG Investment in Carers
The CCG approved a business case in July 2012 for a range of carer’s projects and
schemes in line with our Joint Carers Strategy, 2011-14. Funded originally for three years from 2012/2013 the funding was extended by PIQ for a further 12 months until March 2016. This paper proposes the next steps.
92
The paper outlines CCG investment and we have struggled to get an accurate indication of the LA investment, but it is expected that this has reduced considerably since the project was set up three to four years ago through the Better Care Fund. PN advised that funding of £687k is available recurrently. CW added that we were asking to roll the budget forward to March 2017, in the first instance, but used differently. The proposal is that £412k will be considered with LA carer investment within the LCCT development work; the investment in Young Carers is considered in partnership with TMBC as we are anticipating a reduction in investment; DCC information on changes to commissioning carer support will be used to shape carer investment in Glossop; Parent carer support to be considered within the All Age Learning Disability business case. A Hannan felt that we must support this and ensure assurance is right so that funding is being spent correctly. A Hannan offered his support to work to get the framework in place as part as an asset based community development. PIQ recommended agreement to on-going investment of £687,500 in Carer Support on
the basis that significant redesign will take place within our Care Together plans. Carers
investment will be taken forward as an integral part of the LCCT developments.
12. Personal Health Budgets
PM advised that though this was a challenging area it was felt that we could aim to reduce bureaucracy and take a more open approach by recruiting 30 patients to help us develop our local offer in 2016/7. Interested patients with high use of health services will be offered the opportunity to see how they could use existing health investment differently to achieve better health outcomes by having more control and choice.
A start-up budget is requested to include engagement support, coordination capacity and provide PHBs. It was suggested that there may be capacity within the new admin posts to meet the need for a part time administrative post. PIQ recommended the following:-
Proposal to move away from a phased approach based on clinical groups to a more
open, co-production approach as described in the paper.
Establish a budget to support roll out of PHBs with an amount of £150k to be allocated
non-recurrently, with an update to be provided at the September 2016 PIQ meeting.
13. Any other Business
PTS Contract ER updated that we were in the process of recognising a tender for the PTS contract. This process will be carried out on a bigger level, greater than GM. Previously it was reported that the current provider Arriva had been misrepresenting their performance targets. They were one of the bidders but have now withdrawn and there are now two remaining following interview stage. A financial impact is expected with a further increase of £12k value, dependant on case mix.
14. Dates of the 2016 PIQ meeting
Members noted the dates.
15. Date & Time of the Next Meeting – Wednesday 13th January 2016, 12.30pm For information
93
16. Medicines Management Minutes
Not available.
17. Heads of Commissioning Minutes
PIQ noted all minutes for information.
18. System Resilience Group Minutes
PIQ noted all minutes for information.
19. Emergency Care Network Minutes
PIQ noted all minutes for information.
94
GOVERNING BODY MEETING
Title of Subject:
Integrated Governance Audit and Risk Committee
Date of paper: 26th August 2015 Prepared By: Graham Curtis History of paper: To provide regular assurances to the Governing Body Executive Summary:
To note the key discussions and decisions made at the meeting, noting that a comprehensive verbal update was given to Governing Body at the August meeting. SUI Update The high numbers of pressure ulcers remain a cause for concern. The high numbers are explained in the narrative contained within the report as requested by Quality Committee. Pooled Budget / BCF Report It has been agreed that TMBC will be the host organisation for this and section 75 pooled fund. Register of Waivers This has been signed off by the CFO for the current financial year. It was noted that due to restricted timelines, 4 members of IGAR had been emailed prior to the meeting as a virtual process for agreement on a waiver for a business case which details 2 additional posts to support the transfer of SFT. IGAR agreed to accept the waiver. Policy Review A programme of review is now in place. IG Assurance: IG Toolkit Progress Update Noted that all employees should complete their training by November 2015. Scheme of Delegation (Financial Limits) Change had taken place to increase GG’s value for the CHC team within Nursing and Quality reflected in a column on the Scheme of Delegation that a change cannot take place to an individual value but rather a directorate as a whole. CCG Performance - Quality There is a newly established quality team within the Nursing and Quality directorate with the Head of Quality and extra capacity to oversee quality and patient safety. CCG Performance – Communications and Engagement Strategy developed to support service reconfiguration and redesign to align with the Care Together work and programme. This involved internal communications along with member practices for input on the strategy and policy. Work is on-going to strengthen communications and engagement and GG confirmed that the new interactive website is on track for a Go Live date in early October.
95
GM Shared Service Assurance – SAR Checklist It was confirmed that the audit team will be in discussions with Oldham and CSU in future before year end and discussions will be reflected in the audit plan for year end. A Memorandum of Understanding is in place for the next 20 months to March 2017 in which NHS England say CSU can be hosted in Oldham. Oldham will account for their share to CCGs. Financial Control Environment Assessment All CCGs must complete a ratified assessment to Audit Committee in each CCG and submit these to NHS England. Internal Audit’s comments have been incorporated into the relevant areas. Counter Fraud – Initial Gap Analysis and Action Plan IGAR had agreed for Counter Fraud to submit the report with a statement that is not supported by IGAR members. Internal Audit - Progress Report There is a larger risk identified to the Tameside element which has in turn identified follow up plans to assess later in the year to include a look at Glossopdale. Review of IGAR Terms of Reference In line with the CCG’S QIPP plans it has been agreed that CP would no longer attend future IGAR meetings. In light of this decision it was agreed to reduce quoracy from 4 members to 3 with at least 2 of those members present to provide quoracy. RB to be named as Vice Chair. The Committee reviewed its Terms of Reference at its October meeting.
Recommendations required of the Governing Body (for Discussion and Decision)
To receive the Minutes To ratify the draft Terms of Reference revised version
Direct questions to: Graham Curtis
96
V2
1
MINUTES
INTEGRATED GOVERNANCE AUDIT AND RISK (IGAR) COMMITTEE Wednesday 26th August 2015 9.30am-12.30pm
Boardroom, NCH Denton
Present:- Graham Curtis – Chair
David Swift – Lay Advisor Celia Poole – Governing Body Lay Member Richard Bircher – Governing Body GP (from item No 18) In attendance:-
Gareth Mills – External Audit (from agenda item No 6) Lisa Warner – Internal Audit Paul Pallister – Assistant Chief Operating Officer Gill Gibson – Director of Nursing and Quality (presenting item No 12 only) Lynn Jackson – Quality Assurance Officer (presenting item No 5) Judith Stevens – (presenting item No 13) Tracey Simpson – Deputy Chief Finance Officer John Winter – (presenting agenda item No 13.2 only) Darrell Davies – Counter Fraud (representing Beric Dawson) Steven Wild – TMBC (co-presenting item No 18 only with TS) Clare Bromley - Notes
RISK 1. Welcome and Apologies Apologies were received from Dr Alan Dow, Steve Allinson, Kathy Roe, Ali Lewin, Clare Watson, Steve Connor, Beric Dawson, Dr Amir Hannan and Paul Hague. 2. Declarations of interest None declared. PP noted the good progress made with the revised new Register of Interests. 3. Actions and matters arising from risk element of Minutes of 24 June 2015 Actions have been undertaken in relation to the risk element of the minutes and they were approved as an accurate record. Updates and exceptions were noted as follows: Agenda item No. 3 – Actions and matters arising from risk element of Minutes: SUI CW emailed Steph Butterworth regarding scope for combining CCG and Council systems. In Clare’s absence it as agreed that this would be deferred to the next meeting. Agenda item No. 6 – LJ clarified that the April CAMHS incident be considered a ‘never event’ and confirmed that it should. 4. Corporate Risk Register PP presented the Corporate Risk Register for July 2015 and highlighted recent amendments made in red. PP made particular note to the following:
• Risk ref 1 – Elective Incentive Support Team have confirmed that appropriate measures are in place at THFT to treat elective patients in line with standards. PP noted that Elaine Richardson is providing monthly updates. GC challenged the risk rating from amber to red and it was agreed that this is one to monitor.
97
V2
2
• Risk ref 2 – There is an increased financial risk regarding the volume of RTT activity and acuity/complexity of patients presenting at TFT with the consequential increase in costs/financial overspend against plan. It was noted that position status has been requested from TFT on forecast. TS confirmed that it is hoped the two provider organisations Trust and CCG to reach an agreement to stabilise the position.
At this juncture, CP raised a query as to whether IGAR consider that the recent Bridgewater review be placed on the risk register linking in with Risk ref 10 and 16 highlighted as art of the mitigation and if not hit by a due date then suggestion was made to add this as a stand alone risk. TS suggested that this was to be reviewed in the contract in house and ensure within the specification. LJ agreed with this suggestion and proposed consideration be given under section 6 of the contract. PP to consider these proposals for reflection on the Risk Register.
Action: PP • Risk ref 4 PP confirmed that Greater Manchester Shared Service was established
from 1 July 2015 and being hosted by Oldham CCG. Monitoring reports are being received and outcomes/actions being followed up.
• Risk ref 5/005 On-going review, process and timetable for review of policies is being monitored by the Business Implementation Group (BIG). IGAR therefore agreed to the recommendation to remove this item from the Risk Register.
Action: PP PP further highlighted some of the ownership changes on the Risk Register and reminded IGAR that PP and GC hold routine meetings to monitor the Risk Register during pre meets and to assure BIG. It was agreed the Risk Register would include double badge ownership where a lead role was interim and should therefore be accompanied by the lead Director. For instance Risk ref 16 and 12 JW/KR (John Winter/Kathy Roe) and 17 KQ/SA (Kate Quinn/Steve Allinson).
• Risk ref 13 – CP confirmed receipt of comments from John Winter regarding the CCG website Go Live of which is on track for early October.
PP agreed to update the Risk Register accordingly.
Action: PP 5. SUI update LJ provided a brief summary of STEIS activity for July 2015 bringing the report up to date and only one month in arrears. The high numbers of pressure ulcers remain a cause for concern. The high numbers are explained in the narrative contained within the report as requested by Quality Committee. LJ confirmed this was more around the process of reporting when the cases do not belong to a provider. It was noted that it can be identified where cases have originated from which raises questions and in turn provides assurance. RISK ACTIONS Person Action Time Frame CW When discussing STEIS, it was noted that although specific
processes are in place and run parallel, there is scope for combining [CCG and Council] systems. CW emailed Steph Butterworth regarding this and will follow up. CW to update.
October IGAR
PP Corporate Risk Register: • PP to consider proposals around the Bridgewater
review/contracts and decide how this should be reflected on the Risk Register.
• Remove review of policies this item from the Risk Register. • Include double badge ownership where a lead role was
interim and should therefore be accompanied by the lead
October IGAR
98
V2
3
Director e.g. risk ref 16 and 12 JW/KR and 17 KQ/SA. AUDIT 6. Welcome and Apologies Apologies were received from Mark Heap. 7. Declarations of Interest None declared. 8. Minutes of the Previous Meetings held on 24 June 2015 Approved as a correct record of the previous meeting. 9. Actions / Matters Arising Actions have been undertaken in relation to the audit element. Updates and exceptions were noted as follows: Agenda item 16.8 – IGAR Workplan GC confirmed that all committees have provided a first draft workplan included within the papers for today’s meeting. IGAR were asked to review the workplans and feedback any comments accordingly, particularly auditors input. CP confirmed that for the Public and Patient Impact Committee (PPIC) workplan, Healthwatch representatives, CVAT and the CEO at Glossop volunteer centre have been invited to add to the future workplan for 2015-16. Agenda item 12.2 – Register of Waivers TS has sought clarity on the difference between Best Practice and Register of Waivers. It was thought that where some contractors appear on both this was as a result of the internal review on consultancy and where it seemed dates and rates of charge did not add up this was due to extensions agreed and the transfer on spend. Register of waivers was completed as part of the strategic reporting. Agenda item 12.5 – Policy review BIG have previously overseen the policy Review and PP confirmed he is assigned to lead on this review. A programme of review is now in place. Vikki Forshaw has sent Paul a report, which PP will work on.
Action: PP Agenda item 14.1 – IG Assurance: IG Toolkit Progress Update PH was not in attendance therefore all actions carry forward to the next meeting:
• Going forward PH is to provide regular updates of this with clear statements of progress e.g. Where are we up to and where do we need to get to?
• GC advised that all employees should complete their training by November 2015 • Liaise with Locality Leads regarding chasing GP annual IG toolkit submissions
Agenda item 16.2 – Insight Losses and Compensation MiAA ensure this is highlighted in future reports.
Action: MiAA **RB arrived at the meeting** 18. Pooled Budget/BCF Report The BCF Report was tabled and TS briefed members on highlights of the report.
99
V2
4
It has been agreed that TMBC will be the host organisation for this and section 75 pooled fund. TS noted that the report is still being worked on and members agreed that the report should be presented and monitored by Finance Committee with any further issues to be raised with IGAR. 10. Training Reports and Meeting attended by IGAR Committee Members There were no reports submitted for this item. 11. CCG Reports 11.1 Losses and Special Payments Register There were no updates for this agenda item. 11.2 Register of Waivers This has been signed off by the CFO for the current financial year. PP noted that due to restricted timelines, he had emailed 4 members of IGAR prior to today’s meeting as a virtual process for agreement on a waiver for a business case which details 2 additional posts to support the transfer of SFT. IGAR agreed to accept the waiver. 11.3 Register of Interests
PP reconfirmed good progress with the new Register of Interests. 11.4 Gifts and Hospitality There were no updates for this agenda item. 11.5 Policy Review Noted under agenda item 9. Actions/Matters Arising. 11.6 Business Continuity PP and GG are reviewing the Business Continuity Plans.
Action: PP/GG 11.7 Scheme of Delegation TS confirmed that one recent change had taken place to increase GG’s value for the CHC team within Nursing and Quality reflected in a column on the Scheme of Delegation tat a change cannot take place to an individual value but rather a directorate as a whole. 11.8 IGAR Work Plan As previously discussed IGAR’s workplan is attached to agenda for review. GC highlighted the Review of Committees’ Effectiveness at the October meeting to include plans for LW to watch a meeting in progress and hold discussions with individual members. 12. CCG Performance GG briefed members on current CCG Performance for the following key areas: 12.1 Quality GG explained that there is a newly established quality team within the Nursing and Quality directorate with the Head of Quality and extra capacity to oversee quality and patient safety. Quality meetings are held with all providers and the report details quality audits for those contracts with lower contract value. The purpose of the quality meetings with providers Is to the monitor quality indicators within the main KPI areas for focus with quality and patient safety and safeguarding to include patient engagement as an integral part of Care Together.
100
V2
5
GG confirmed that the Clinical Quality report for Q1 is now available. 12.2 Communications and Engagement The CCG’s Communications and Engagement team have now developed a Communications and Engagement Strategy to support service reconfiguration an redesign to align with the Care Together work and programme. This involved internal communications along with member practices for input on the strategy and policy. Work is on-going to strengthen communications and engagement and GG confirmed that the new interactive website is on track for a Go Live date in early October. PP offered thanks to the Communications and Engagement team for their input and support with the Annual Report and for the recent patient stories gathered for presentation to the CCG’s Governing Body. 13. GM Shared Services Assurance 13.1 SAR Checklist JS briefed members on the update for the GM Shared Service Auditor Reporting to CCGs across GM. GM confirmed that the audit team will be in discussions with Oldham and CSU in future before year end and discussions will be reflected in the audit plan for year end. JS confirmed that the Memorandum of Understanding is in place for the next 20 months to March 2017 in which NHS England say CSU can be hosted in Oldham. Oldham will account for their share to CCGs. 13.2.1 IG Toolkit Progress Update
This item was deferred in the absence of an IG representative. 13.2.2 National / Local Issues
No issues were reported under this agenda item.
13.2.3 Draft IG Strategy Group Minutes August 2015 IGAR received and noted the draft IG Strategy Group Minutes August 2015, provided for information.
14. Financial Control Environment Assessment All CCGs must complete a ratified assessment to Audit Committee in each CCG and submit these to NHS England. LW’s comments have been incorporated into the relevant areas. Areas to include are based on the following:
1) Good rationale 2) Contracts signed on time 3) Good financial position – plan to meet statutory financial duties
Areas not applicable for self-assessment derive when the service is outsourced and is based on that theory. CP queried whether there is scope to hold those to account and responsible requesting evidence to support that and make those areas applicable. However, it was noted that advice was taken from external auditors. LW agreed to gain a view on other CCGs to ensure a consistent approach to the assessments and will report back.
Action: LW 15. Counter Fraud 15.1 Initial Gap Analysis and Action Plan
101
V2
6
IGAR agreed for DD to submit the report with a statement that it is not supported by IGAR members.
Action: DD Can’t evidence some standards where no cases so have to score amber. IGAR noted that this is not consistent with our own framework and therefore rejected the report and requested that DD feedback to NHS Protect.
Action: DD 16. Internal Audit 16.1 Progress Report LW presented the Internal Audit Progress Report to the Committee highlighting the following key areas: There is a larger risk identified to the Tameside element which has in turn identified follow up plans to assess later in the year to include a look at Glossopdale. It was noted that the Governing Body receive minutes that discuss the Better Care Fund and it was therefore agreed that a quarterly return will be presented to committees. 17. External Audit 17.1 2015/16 Annual Audit Letter Members reviewed the annual audit letter. GC reiterated that the timing of next year’s deadline should not be affected by the bank holiday and half-term for 2015/16. 19. Review of IGAR Terms of Reference (ToR) In line with the CCG’S QIPP plans it has been agreed that CP would no longer attend future IGAR meetings and GC thanked CP for her contributions to IGAR. In light of this decision it was agreed to reduce quoracy from 4 members to 3 with at least 2 of those members present to provide quoracy. Further observations/comments were made for consideration when reviewing the Terms of Reference (ToR) as follows: RB to be named as Vice Chair. LW made the following suggestions for amendments to the ToR: 1.1 2014 1.2 sec 2-8 then 8-17 6.3 Annual Governance Statement. reps from other individuals be invited 7. Chief External Audit 9.5 Safeguarding arrangements 9.6 Sign off SUIs reviewed by QC 13. Heading around counter fraud NHS Protect Standards? Check outside? 15.4 Quarterly – bi-annually reports not currently come here and in work plan. 9.7. amending review PP and GC to consider comments made and review prior to sign off at the next meeting in October.
Action: GC/PP
20. Committee Work plans GC requested that members and Auditors review the individual work plans for CCG committees and comment accordingly. It was agreed that the Assurance Framework would be reviewed in light of work plans.
102
V2
7
21. Any Other Business PP noted that the Annual Report was due for presentation at today’s meeting. GC agreed to review when this should fall due on the work plan.
Action: GC 22. Date and time of next meeting – 28 October 2015 Meeting closed: 11.55am AUDIT ACTIONS Person Action Time Frame PP PP to review and update the Policy Review October IGAR LW MiAA ensure Insight Losses and Compensation is highlighted in
future reports Going forward
PH CSU Assurance - Information Governance Assurance: IG Toolkit Progress Update
• Going forward PH is to provide regular updates of this with clear statements of progress e.g. Where are we up to and where do we need to get to? • GC advised that all employees should complete their training by November 2015 • Liaise with Locality Leads regarding chasing GP annual IG toolkit submissions
From August IGAR
PP/GG PP and GG are reviewing the Business Continuity Plans January IGAR LW Financial Control Environment Assessment - LW to gain a view
on other CCGs to ensure a consistent approach to the assessments and will report back.
October IGAR
MiAA – Counte Fraud
Initial Gap Analysis and Action Plan • IGAR agreed for DD to submit the report with a statement
that it is not supported by IGAR members. • Can’t evidence some standards where no cases so have to
score amber. IGAR noted that this is not consistent with our own framework and therefore reject the report and requested that DD feedback to NHS Protect.
ASAP
GC/PP Review of IGAR Terms of Reference PP and GC to consider comments made and review prior to sign off at the next meeting in October.
October IGAR
GC/VF GC agreed to review when the IGAR Annual Report should fall on the work plan and VF to update the workplan accordingly.
October IGAR
103
NHS Tameside & Glossop Clinical Commissioning Group
Integrated Governance, Audit, and Risk Committee
Terms of Reference Version 2.1 Draft
104
1 Introduction 1.1 These Terms of Reference have been prepared with reference to the NHS
Audit Committee Handbook Specimen Terms of Reference [2014]. 1.2 Sections 2 to 8 below cover the establishment of the Integrated
Governance, Audit, and Risk Committee with Sections 9 to 17 covering its duties.
1.3 In addition to those duties recommended in the Specimen Terms of
Reference these Terms of Reference also include aspects relating to the Committee’s responsibilities for governance and risk management.
2 Constitution 2.1 NHS Tameside and Glossop Clinical Commissioning Group (CCG)
Governing Body hereby resolves to establish a committee of the CCG Governing Body and to be known as the Integrated Governance, Audit, and Risk Committee (hereafter “the Committee”). The Committee is a non-executive committee of the CCG Governing Body and has no executive powers other than those specifically delegated in these Terms of Reference.
3 Membership 3.1 The members of the Committee are:
- The Lay Member with responsibility for Governance (Chair of the Committee)
- The Lay Adviser and Chair of the Finance and QIPP Assurance Committee
- A GP Member of the Governing Body (Deputy Chair of the Committee).
3.2 The Committee shall be appointed by the CCG Governing Body from
amongst the Lay Members, the Lay Advisers, and the GP Members of the CCG’s Governing Body. It shall consist of no fewer than three members. One of the Lay Members will be recruited and appointed specifically with the remit for governance and shall chair the Committee. A quorum shall be three members.
4. Quorum 4.1 The minimum attendance for quoracy is two members.
105
4.2 In the event of a member being unable to attend, every effort should be made to ensure the attendance of a deputy.
5. Chair’s Action
5.1 When an urgent decision is required outside of the meeting, the Chair
may make a decision after conferring with at least one other member.
5.2 When Chair’s Action has been taken then it must be ratified by the next quorate meeting of the Committee.
6 Attendance 6.1 A Governing Body member will attend each meeting. The Chief Finance
Officer and appropriate Internal Audit, Counter Fraud, and External Audit representatives shall normally attend meetings at the invitation of the Chair of the Committee. However, at least once a year the Committee should meet privately with the External and Internal Auditors. External Auditors shall not normally attend for the risk management section of the agenda.
6.2 The Chief Operating Officer or other appropriate senior managers may be
invited to attend, and particularly when the Committee is discussing areas of risk or operation that are the responsibility of that senior manager.
6.3 The Chief Operating Officer should be invited to attend, at least annually,
to discuss with the Committee the process for assurance that supports the Annual Governance Statement.
6.4 The Corporate Office will be responsible for facilitating meetings of the Committee who shall issue the agenda, attend to take minutes of the meeting, and provide appropriate support to the Chair and members.
7 Frequency 7.1 The Committee shall meet at least six times per annum (subject to on-
going review). The Chief External Auditor or Head of Internal Audit may request a meeting if they consider that one is necessary. At least one week’s notice of a meeting will be given.
8 Authority 8.1 The Committee is authorised by the CCG Governing Body to investigate
any activity within its Terms of Reference. It is authorised to seek any
106
information it requires from any employee or CCG member, and all employees are directed to co-operate with any request made by the Committee. The Committee is authorised by the CCG to obtain outside legal or other independent professional advice and to secure external input with relevant experience and expertise if it considers this necessary.
9 Governance, Risk Management, and Internal Control 9.1 The Committee shall review the establishment and maintenance of an
effective system of integrated governance, risk management, and internal control across the whole of the organisation’s activities (both clinical and non-clinical) that supports the achievement of the organisation’s objectives.
9.2 In particular the Committee will review the adequacy of:
• all risk and control-related disclosure statements (in particular the Annual Governance Statement together with any accompanying Head of Internal Audit statement, external audit opinion or other appropriate independent assurances) prior to endorsement by the CCG Governing Body
• the underlying assurance processes that indicate the degree of the
achievement of corporate objectives, the effectiveness of the management of principal risks, and the appropriateness of the above disclosure statements
• the policies for ensuring compliance with relevant regulatory, legal, and
code of conduct requirements
• the policies and procedures for all work related to fraud, bribery, and corruption as set out in Secretary of State Directions and as required by NHS Protect.
The Committee will also:
• review and recommend for approval by the Governing Body proposals for
changes to the governance documents of the CCG (comprising the Standing Orders, Prime Financial Policies, Scheme of Delegation, and Schedule of Powers Reserved to the Governing Body)
• review the mechanisms and levels of authority and make
recommendations to the CCG Governing Body • review incidents of fraud, bribery or corruption, or possible breaches of
ethical standards or legal or statutory requirements that could have a significant impact on the CCG’s published financial accounts or on its reputation.
107
9.3 In carrying out this work the Committee will primarily utilise the work of Internal Audit, External Audit, and other assurance functions but will not be limited to these audit functions. It will also seek reports and assurances from directors and managers as appropriate concentrating on the over-arching systems of integrated governance, of risk management, and of internal control together with indicators of their effectiveness.
9.4 In particular, the Committee shall ensure the adequacy of systems for risk and governance by reviewing:
• Risk Registers
• the Governing Body Assurance Framework • Major incident and emergency planning procedures and plans. The
Committee will seek assurance that contractual arrangements and associated monitoring are appropriate in this regard, and may also request reports from the relevant lead commissioner
• Organisational Health and Safety and security arrangements • Risk-related policies • Information Governance arrangements (included within this responsibility
is the need for the Committee to have assessed its information requirements and to have planned the capacity and capability to deliver those requirements; and that the CCG has used the Information Governance Toolkit to assess its capability to meet Information Governance requirements)
• Information Technology Systems implementation and plans • Patient safety issues including the arrangements for regular reporting to
the NRLS • Safeguarding arrangements.
9.5 The Committee will monitor and sign off of all Serious Untoward Incident
reports and StEIS reports relating to Tameside and Glossop patients following their review by the Quality Committee.
9.6 Effective governance, risk management and internal control will be
evidenced through the Committee’s use of an effective Governing Body Assurance Framework to guide its work and that of the audit and assurance functions that report to it.
108
10. Conflicts of Interest The Committee will provide advice on relevant conflict of interest matters
and make recommendations to the Governing Body. Advice as required will be sought from audit colleagues.
11 Internal Audit 11.1 The Committee shall ensure that there is an effective internal audit
function established by management that meets mandatory NHS Internal Audit Standards and provides appropriate independent assurance to the committee, to the Group, to the Accountable Officer, and to the CCG’s Governing Body.
This will be achieved by:
• the consideration of the provision of the Internal Audit service, the cost of the audit, and any questions of resignation and dismissal
• the review and approval of the Internal Audit strategy, operational plan, and more detailed programme of work ensuring that this is consistent with the audit needs of the organisation as identified in the Governing Body Assurance Framework
• the consideration of the major findings of internal audit work (and
management’s response) and ensuring the co-ordination between the Internal and External Auditors to optimise audit resources
• ensuring that the Internal Audit function is adequately resourced and has appropriate standing within the organisation
• an annual review of the effectiveness of Internal Audit.
12 External Audit 12.1 The Committee shall review the work and findings of the appointed
External Auditor and consider the implications and management’s responses to their work. This will be achieved by:
• consideration of the appointment and performance of the External Auditor
as far as the rules governing the appointment of the external auditor permit
• discussion and agreement with the External Auditor, before the audit commences, of the nature and scope of the audit as set out in the Annual
109
Plan and ensure coordination, as appropriate, with other External Auditors in the local health economy
• discussion with the External Auditor of their local evaluation of audit risks
and their assessment of the CCG and the associated impact on the audit fee
• the review of all External Audit reports including agreement of the annual
audit letter before its submission to the CCG Governing Body and before any work is carried out outside the annual audit plan, together with the appropriateness of management responses.
13 Other Assurance Functions 13.1 The Integrated Governance, Audit, and Risk Committee shall review the
findings of other significant assurance functions, both internal and external to the organisation, and consider their implications for the governance of the organisation.
13.2 These will include, but will not be limited to, any reviews by Department of
Health Arm’s Length Bodies or Regulators and Inspectors (for example by the Care Quality Commission or the NHS Litigation Authority) and by professional bodies with responsibility for the performance of staff or functions (for example the Royal Colleges and accreditation bodies).
13.3 In addition the Committee will review the work of other committees within
the organisation whose work can provide relevant assurance to the Integrated Governance, Audit, and Risk Committee’s own scope of work.
14 Management 14.1 The Committee shall request and review reports and positive assurances
from directors and managers on the overall arrangements for governance, risk management, and internal control.
14.2 It may also request specific reports from individual functions within the
organisation (or support services such as the Greater Manchester Shared Service) as they may be appropriate to the overall arrangements.
15 Financial Reporting 15.1 The Integrated Governance, Audit, and Risk Committee shall review the
Annual Report and Financial Statements before submission to the CCG’s Governing Body focusing particularly on:
110
• the wording in the Annual Governance Statement and other disclosures relevant to the Terms of Reference of the Committee
• changes to, and compliance with, accounting policies and practices
• unadjusted mis-statements in the financial statement
• major judgemental areas, and
• significant adjustments resulting from the audit.
15.2 The Committee shall recommend the approval of the Annual Financial
Statements to the CCG’s Governing Body. 15.3 The Committee should also ensure that the systems for financial reporting
to the CCG’s Governing Body, including those of budgetary control, are subject to review as to their completeness and the accuracy of the information provided to the Governing Body.
15.4 The Committee shall receive and approve reports including:
- the Schedule of Losses and Compensations - the Schedule of Waivers - the Register of Interests - the Register of Gifts and Hospitality (including corporate sponsorship),
and - the Quarterly Schedule of Debtors and Creditors.
The Committee shall also receive further reports which are detailed in the Committee work plan.
15.5 The Committee shall conduct an annual review of the CCG’s major
accounting policies. 16 Reporting 16.1 The minutes of the Integrated Governance, Audit, and Risk Committee’s
meetings shall be recorded formally by the Corporate Office and submitted to the Governing Body. The Chair of the Committee shall draw to the attention of the Governing Body any issues that require executive action.
16.2 The Committee will report to the Governing Body annually on its work in
support of the Annual Governance Statement specifically commenting upon the fitness for purpose of the Governing Body Assurance Framework, on the completeness and embeddedness of risk management in the organisation, and on the integration of governance arrangements.
111
17 Other Matters 17.1 The Committee shall be supported administratively by the Corporate
Office by duties including:
• the agreement of the agenda with the Chair and the collation of papers
• by taking the minutes and keeping a record of matters arising and issues to be carried forward
• by advising the Committee on pertinent areas.
17.2 These Terms of Reference shall be reviewed at least annually. Version 2.1 Draft January 2016 P Pallister
112
GOVERNING BODY MEETING
Title of Subject: Ratified Minutes of the Primary Care Joint Committee Minutes Part A Date of paper: 2nd December 2015 Prepared By: David Swift History of paper: Primary Care Joint Committee – 2nd December 2015
Executive Summary:
To inform Governing Body members of the discussions held at the Primary Care Joint Committee meeting.
Recommendations required of the Governing Body (for Discussion and Decision)
Approval
QIPP principles addressed by proposal:
All
Direct questions to: David Swift/Clare Watson
113
Primary Care Joint Committee Agenda
Part A Minutes
Wednesday 2nd December 2015, 16.30pm
Boardroom, NCH
Attendees: Dave Swift – Lay Member (Chair) Clare Watson – CCG Director of Transformation
Ann Gough - NHS England Dr Jamie Douglas – CCG GP Governing Body Member Dr Alan Dow – CCG Governing Body Chair Chris Leese – CCG Head of Primary Care Graham Curtis – CCG Deputy Lay Chair Peter Denton – Healthwatch Gill Gibson – Director of Nursing & Quality Tracey Simpson – CCG Head of Finance Sarah Hadfield – Personal Assistant to the Director of Transformation Gideon Smith – TMBC Consultant in Public Health
Public Members: Jennifer Voorhees
1. Introductions & Apologies for Absence - Laura Browse/Ben Squires
2. Declarations of Interest for Primary Care Joint Committee
There were no new declarations to note.
Action: SH/DS to review membership and state remit of attendance at meeting.
3. Minutes of the previous Meeting/ Matter Arising/Action Log
The minutes were accepted as a true record.
4. Delegated Commissioning CL informed that this had been discussed at the Primary Care leads meeting and an answer is expected from the central team in early December from Greater Manchester, not NHS England. Due to GM Devolution the expectation is that it will be a move to level three for all GM CCGs.
5. CCG delegated Function Self Certification signed 01.12.15
Members noted the second quarterly return which was submitted 1.12.15.
6. Finance Update
114
TS presented the update and asked members to note that signage reads the opposite way round to standard CCG reporting. A slight change in forecast outturn was reported with a 70p increase in global sum. CW added that we must look at the DES differently and hope to seek out opportunity with NHSE around this. Action: AG to take back potential opportunities around reworking of the DES.
7. NHS E Update A letter had been sent to GP practices following the announcement from the last Primary Care summit around the new models of care. Expressions of Interests are being asked for before the 23rd December deadline. This information will be discussed at PIQ and the Locality meeting and expressions of Interest will be accepted from 30-50k (list size?) practices. AD added that AGG had been sighted around this and they had discussed what would be expected of commissioners. AG understood the offer to be voluntary but NHS England do feel there is an appetite for it. CW explained that she had a meeting in place with Gaynor Mullins to discuss further and though timescales were tight she hoped it would be a joint locality/CCG bid. AD added that AGG wants two CCG leads and two leads from GM Devolution and that one of the CCG representatives would be him. Action: CW/AD to ensure item is discussed and the relevant lead attends the 16th December locality meeting.
8. Primary Care Strategy Update CL updated that all practices have submitted where they are up to with the strategy and that it had been RAG rated. Next week’s Primary Care Delivery Group will go through the red rated items to discuss what action to take where there is no movement on spend. Jamie Douglas and Joanna Bircher are involved in the quality framework which is due on the 15th December. All practices are signed up to this but a separate conversation will be held for APMS contract holders.
9. Patient/Public Involvement
PD updated that the first draft for the work around the GPs headlines would go to LIG on the 7th December. A formal report will be available in the New Year but there had been around 180 responses that relate to GP care. Action: PD to circulate GP Headlines work once available to Joint Committee members.
10. AOB JD referred to conversations held at Quality Committee in relation to an increase in optician referrals for cataracts. GPs then have to refer cases to the Trust when they should have been done directly from the opticians. CW explained that the pathways through Ophthalmology are being looked at and the redesigning of this should address the issue.
11. Date & Time of Next Meeting – Wednesday 6th January 2016, 15.30pm, BR NCH
115
GOVERNING BODY MEETING
Title of Subject: Nursing and Quality directorate update report
Date of paper: January 2016
Prepared By: Gill Gibson
History of paper: This report is submitted to the Governing Body on a bi-monthly basis.
Executive Summary:
The Report provides the Governing Body with an overview of the Nursing and Quality work which is on-going within the directorate.
Recommendations required of the Governing Body (for Discussion and Decision)
The Governing Body is asked to note the content of the Report and provide feedback on the content and the projects described.
QIPP principles addressed by proposal:
All
Direct questions to: Gill Gibson
116
Nursing and Quality Directorate Report – January 2016 The aim of this report is to provide Governing Body with an overview of the Nursing and Quality work which is on-going within the Directorate. The report does not include information on ALL projects, but aims to ensure the report is concise and informative, identifying all areas which are our priorities and which demonstrate both success and the challenges we face, and not duplicating information presented to GB on other projects. The Nursing and Quality Directorate covers a wide range of areas, and works through 4 “teams”. We work closely with colleagues in other directorates and are represented on all CCG Committees, ensuring the work we produce receives appropriate discussion, input and ultimately “sign off” prior to implementation.
Nursing, Quality and Patient Safety/Customer Service/Business Intelligence/Safeguarding
Nursing, Quality and Patient Safety The directorate continues to hold quality meetings with Tameside Foundation Trust, Stockport Foundation Trust and attend Pennine Care quality meeting. These meetings allow the Directorate to check the quality of services we commission. Regular agenda items are on are safe staffing, serious untoward incidents, patient experience, coroner’s regulation 28 notices and clinical effectiveness. The future focus for the Directorate will be ensuring effective processes and systems are in place to assure the continued quality of services as we progress towards an ICO. We now have a schedule to monitor the quality of all lower value contracts. The Directorate receives all Serious Untoward Incidents/Steis reportable incidents and reviews the quality and learning from the reports to feed back into the commissioning and provider system. The Directorate also attend all Serious and Untoward Incident panels held by Pennine Care Foundation Trust. The Directorate also continues to monitor HCAI via the monthly reviews meeting. The lessons learnt are shared with WHE HCAI group. The Strategic HCAI action plan has been developed for 2016/17. The Head of Business Intelligence and Performance has recently started in post, this role will further enhance the links between performance and patient safety or experience. This new role will review the processes in place around the provision of data and how proactive reporting can be achieved along with bringing together organisational
Customer Service/Patient Transport Patient Transport booking services continues to provide high quality services to our patients attending their first outpatient appointment. The Directorate attends established tri-part meetings (CCG, Tameside Hospital Foundation Trust and Arriva) to monitor the Arriva contract and address any areas of quality. The Directorate is actively using patient experience of patient transport to inform the re specification of patient transport. The new patient transport contract has been awarded to the North West Ambulance Services commencing from April 2016.
FOIs: The Freedom of information function sits in the Directorate we receive process and sign off any requests overseeing quality of response. We are working in the next few months to ensure our required publication scheme is fit for purpose. Figures for November/December in relation to this function are: Freedom of Information requests: Month Received Breached
November 2015
25 1
December 2015
13 0 to date
Complaints: Month Received Status
November 1 – CCG responded December 1 –
Independent provider
On-going – CCG supporting investigation.
117
performance data and quality performance. The directorate is working on the contract for THFT to develop new mechanisms for quality payments. The CCG Quality Framework has been reviewed and work is taking place to develop assurance mechanisms for the Single Commissioning Function. The Directorate continues to coordinate and undertake quality walkabout visits for all provider contracts; a recent announced visit took place with IRIS (Initial Response and Intervention Service)
2 – NHS providers
Referred on.
PALS: Month Received
November 13 December 12
MP enquiries: Month Received Status November 3 completed December 0 N/a
Patient Transport booking services continues to provide high quality services to our patients attending their first outpatient appointment. The Directorate attends established tri-part meetings (CCG, Tameside Hospital Foundation Trust and Arriva) to monitor the Arriva contract and address any areas of quality. The Directorate is actively using patient experience of patient transport to inform the re specification of patient transport.
Patient Experience As a Directorate we want to enhance our capability in harnessing patient experience; as such we have worked with Patient Opinion to ensure commissioners and quality leads receive timely alerts for patient stories posted onto patient opinion. The alerts have been set up in such a way that commissioners receive alerts pertinent to their areas of responsibility which enables them to inform any commissioning decisions / intentions. The Directorate has developed a patient experience data base which will enable interrogation of the range of soft intelligence made available to T&G CCG. The data base will be being populated during Q4 with a draft soft intelligence report available in Q1 16/17 Customer services is managed within the directorate, this function receives all CCG complaints and monitors complex complaints across NHS and Local Authority services. We also survey NHS Choices and Patient Opinion for any areas of poor or good practice within our health economy. The Freedom of information function sits in the Directorate we receive process and sign off any requests overseeing quality of response. We are working in the next few months to ensure our required publication scheme is fit for purpose.
Business Intelligence and Performance Ali Rehman has now joined the CCG as Head of Business Intelligence and Performance who will take forward the Business Intelligence requirements for the CCG and ICO. Working closely with senior leads in the organisation, his role will be to initially scope out design and review the requirements and recommend next steps to deliver including a performance strategy. The first phase of the role will require management support and leadership to the BI team
118
and continued BI support to the organisation. Then move on to reviewing existing functions which exist across the CCG and Health and Social care economy to determine the current resource available. This will lead on to the implementation of a new structure and implementation of new systems and processes. Sitting under the Nursing and quality directorate will also allow the BI team to integrate and enhance the links between performance and patient safety or experience. Ali has been meeting with senior officers in the organisation since he started as part of the first phase of the project.
Safeguarding Children, Adults at Risk and Looked After Children There are two Serious Case Reviews on-going to investigate two incidents of child deaths and although no adult serious case reviews one of the incidents of child deaths involves as much emphasis on the child’s mother with a learning disability. There is one further Learning Review on a child with physical injuries. Supervision arrangements are in place for the team and the Child Protection Forum and the Adult Safeguarding Forums are all in place and booked for 2016. NHS England has requested that CCGs audit their own safeguarding practices and submit a return to NHS England by 31st March 2017. The Safeguarding team are working together to pull together the information needed. Looked After Children Health Assessments – Glossopdale: Derbyshire County Council (DCC) has de-commissioned school nursing services therefore there is presently no permanent provision to review health assessments in school aged children. The Safeguarding team are continuing to work with Derbyshire County Council to rectify this and Stockport Foundation Trust have agreed to continue providing the service until a permanent solution is achieved.
Continuing Healthcare/Individualised Commissioning
NHS Funded Care and Treatments
One care home provider in the Borough has had significant challenges in relation to poor quality care. The team continue to work with the provider, patients and relatives to improve and sustain quality.
The team continues to case manage all clients in care homes with nursing in Tameside and Glossop.
Members of the team have been working together with colleagues from the urgent care system to support Tameside Hospital Foundation Trust to improve patient flow and discharge processes.
Nursing Home Manager Forums are lead and facilitated by the team, these have now been widened to include residential home managers, representatives from Tameside Foundation Trust now attend this meeting to start to build relationships between providers.
The CCG jointly chairs a Care Home Quality Forum where all residential and nursing home providers are risk assessed using formal quality monitoring data and soft intelligence provided by all health and social care professionals. The CHC team, TMBC and Quality team have now developed a joint quality performance dashboard to be implemented in the coming months.
Advanced Accreditation – The team has been accredited by Salford University to take on 3rd year students.
The PINK Programme (Programme to Invest in Nurses Knowledge) continues to be developed and co-ordinated by the team. This training programme delivers up to date clinical training to all care home nurses in Tameside and Glossop. This programme is currently being expanded and further developed to include and enhance the programme.
119
The team has provided awareness training for all care home managers and nurses regarding nurse revalidation and the evaluation was very positive.
The team continues to work with providers to implement the learning from safeguarding adults’ investigations.
The team has successfully implemented the NHSE Continuing Healthcare Assurance Framework. T&G CCG was peer reviewed by Bury CCG as part of this process.
Restitution cases continue to be investigated by the team. The team is currently on target to meet its trajectories. The CCG has 36 investigations left to complete. The numbers of cases at appeal stage continues to increase.
Communications and Engagement
The communications and engagement team work has focussed on the following:
The communications team is still working on the new website adding pages and carrying out user testing the system ahead of its launch. The process was delayed in December due to lack of support being available from the website suppliers.
The team continues to work on Care Together communications and engagement. Further work is now being developed to support the communications and engagement element of the Care Together programme.
Communication and engagement work to support key programmes is taking place. This includes (but is not restricted to): Winter pressures where the CCG is working with other partners including TMBC to support this winter’s key communications (Adam Shepphard is leading on a communications work stream across Tameside and Glossop in relation to this). Other programmes being supported by communications and engagement include: Personal Health Budgets (PHB) – working alongside Continuing Healthcare (CHC).
The communications team continues to work the Healthier Together and Devolution Manchester communication and engagement teams - sharing their/our related information on their programmes and on Care Together.
Tracy Turley continues to work on patient stories that are then being used at Governing Body and to inform programmes of work at the CCG.
Patient Network – draft Terms of Reference presented to Network for approval and comment. Terms of Reference were ratified on Monday 18 January 2016 (subject to a few very minor suggested changes).
Public and Patient Engagement Toolkit – Tracy Turley is working with teams at the CCG to utilise the toolkit in support of programmes of work.
Red Cross and Macmillan project – Tracy Turley is working with Macmillan to bring together a cohort of patients who have been affected by cancer.
The latest edition of Update publication is due out at the end of January. This will now be produced on a monthly basis as opposed to its previous two-week production.
Recommendations: Governing Body is asked to note the content of the report and provide feedback on the content of the work streams described. Gill Gibson Director of Nursing and Quality
120
1
Title of Subject: Locality Leads Minutes of Meeting –
29th December 2015
Date of paper:
29/12/ 2016
Prepared By: Louise Roberts
History of paper: N/A
Executive Summary: The purpose of the clinical leads
meeting will be to act a clinical
network across the five CCG
Localities, collecting and sharing
experiences from the respective
constituent practices, acting as a
conduit between CCG Board and
PIQ.
Recommendations required of the
Governing Body
(for Discussion and Decision)
To note the content of the minutes and actions being taken forward.
Direct questions to:
N/A
GOVERNING BODY MEETING
121
2
Tameside & Glossop Locality Leads meeting
Tuesday 29th December 2015, 12.30-2.00pm
Churchgate Surgery, Denton
Present:
Dr S Ahmed, Clinical Locality Lead for Stalybridge
Louise Roberts, Commissioning Business Manager
Tori O’Hare, Finance Manager
Dr Joanne Bircher, Quality Improvement Lead
Christopher Martin, Commissioning Business Manager
Wassiem Rafique, Commissioning Business Manager
Dr Andy Hershon, Clinical Locality Lead for Hyde
Apologies:
Dr N Riyaz, Clinical Locality Lead for Ashton
Dr A Ali, Clinical Locality Lead for Denton
Graham Curtis, PIQ Chair and Lay Member of Governing Body
Heather Palmer, Commissioning Business Manager
In Attendance:
Louise Kay, Practice Nursing Development Lead
Alison Lewin, CCG
Dr Alan Dow, CCG Governing Body Chair /Representing Glossop
1. Notes of the last meeting and matters arising.
The minutes from the previous meeting were noted and accepted as a true
reflection of the discussions that took place.
CIS/EUR
A discussion took place on the CIS, following the accuracy of data presented
to SA. Practices should ensure they have internal processes to support
adherence to the CCG/GM EUR Policies. Quick reference guide and patient
leaflet to follow. Practices may wish to support adherence to the policies via
internal training for staff.
There was a discussion on the quality of the data presented to SA.
Action: AF to review EUR report and provide feedback.
NHS111
122
3
SA provided feedback on the disposition forms; the appropriateness of the
referrals and duplications within EMIS. Please can Practices send a copy of
any issues / concerns regarding to NHS111; relating to inappropriate
dispositions to WR.
Action: Practices to send any issues/ concerns regarding NHS111 to WR.
Joint Locality Meeting
It was agreed that the Joint Locality meeting went well.
AD confirmed that the CCG has registered an interest to work within the GM
Contract Model to develop a local option.
2. LCCT
There was a discussion on the development of LCCT in each of the Localities.
This will be a standing agenda item at the Locality meetings from January to
March with Januarys meeting dedicated to LCCT. Input is required from all
GPs. AL agreed to attend the meetings and AH asked if AL can prepare a list
of questions to aid discussions; to explore what the potential barriers may be.
SA provided feedback on the MDT meetings in Stalybridge; this brings
together Health and Social Care but needs to include a wider range of staff.
Action: Include LCCT as an agenda item to the Locality, Locality Leads and
Target meetings, January through to March.
3. Locality Urgent Care Usage
The draft report indicates a high level of walk in centre usage and was
designed to aid discussions on the impact on A&E. The data quality needs to
be reviewed.
4. Bowel Cancer Screening programme
It was agreed that the lead for bowel cancer screening will attend practice
managers forum and LIG to encourage uptake of the screening programme.
5. Finance update
Each practice now receives a data feed on admission data from the Trust;
reports are available via Docman. The Practice can e mail the Trust directly
with any queries. Practices are looking for assurance that the CCG are
charged appropriately and how they have influence the L.O.S.
Action: Finance to remind practices of the process, context and how to flag
issues, with a reminder that the data is just for information and requires no
formal action.
6. Asset Based Primary Care (ABPC)
NHSE are piloting ABPC training course, this will support Localities to makes the
most of assets available within the community. AL agreed to incorporate this
into discussions regarding LCCT.
7. AOB
123
4
Personal Health Budgets, request for Pat McKelvey to attend all locality
meetings with a 15 min update.
Mental Health Update - There are a number of updates to share with
colleagues pertinent to Primary Care and Tina/Vinny are keen to attend each
locality in January to present.
It was agreed that due to the LCCT work priority over the coming months that
it might be better to attend the Practice Managers meeting and Target.
8. Date of the next meeting will be Tuesday 26th January 2016
AD will revisit with Manor House the possibility of a job share for the role of
Locality Lead.
AD encouraged responses to AH’s e mail to increase access to records. JB
expressed concern that this duplicated the Primary Care Strategy.
AD agreed to share a breakdown of NHS111 data; this showed where calls
go, 60% to Primary Care and 30% to A&E.
Action: AD to circulate NHS111 data.
Action: AD to update on the Locality Lead vacancy
124
Page 1 of 4
GM ASSOCIATION OF CCGs: Association Governing Group (AGG) DATE 15th December 2015
TIME 13.30-17.30 The Willows, AJ Bell Stadium
Attendance: Steve Allinson (SA) NHS Tameside & Glossop CCG Trish Anderson (Chair) (TA) NHS Wigan Borough CCG Steve Dixon (Behalf AH) (SD) NHS Salford CCG Alan Dow (Arrived 14:20) (AD) NHS Tameside & Glossop CCG Ed Dyson (Arrived 13:55) (ED) NHS Central Manchester CCG Ranjit Gill (Arrived 14:15) (RG) NHS Stockport CCG Denis Gizzi (DG) NHS Oldham CCG Su Long (SL) NHS Bolton CCG Lesley Mort (LM) NHS Heywood, Middleton & Rochdale CCG Gaynor Mullins (GMu) NHS Stockport CCG Stuart North (SN) NHS Bury CCG Apologies: Wirin Bhatiani (WB) NHS Bolton CCG Tim Dalton (TD) NHS Wigan Borough CCG Chris Duffy (CD) NHS Heywood, Middleton & Rochdale CCG Michael Eeckelaers (ME) NHS Central Manchester CCG Nigel Guest (NG) NHS Trafford CCG Anthony Hassall (AH) NHS Salford CCG Caroline Kurzeja (CK) NHS South Manchester CCG Gina Lawrence (GL) NHS Trafford CCG Kiran Patel (KP) NHS Bury CCG Hamish Stedman (Chair) (HS) NHS Salford CCG Bill Tamkin (BT) NHS South Manchester CCG Annette Walker (CFO Chair) (AW) NHS Bolton CCG Martin Whiting (MW) NHS North Manchester CCG Ian Wilkinson (IW) NHS Oldham CCG Simon Wootton (SW) NHS North Manchester CCG In Attendance: Rob Bellingham (RB) NHSE - GM & Lancs Sub Region Team Andrea Dayson (ADa) GM Association of CCGs Julie Daines (Agenda item 6 only) (JD) NHS Oldham CCG Warren Heppolette (WH) Health & Social Care Reform Stephanie Pearson (Note Taker) (SP) GM Association of CCGs Kath Wynne Jones (HoC Chair) (KWJ) NHS Oldham CCG
1.WELCOME & APOLOGIES FOR ABSENCE
8 out of the 12 CCGs present.
Apologies noted.
2. DECLARATION OF INTEREST
Noted
125
Page 2 of 4
3. MINUTES OF THE LAST MEETING 1.12.15 / REVIEW OF ACTIONS
Minutes approved
All actions completed
4. LD UPDATE
ACTION:
Has been scheduled for January AGG in agreement with CK.
5. DEVOLUTION LEAD UPDATES
5.1 SRO LOCALITY PLANS
Meetings have been focused on financial planning.
Wendy Meredith in the new devolution role is now leading on outcomes focused work.
Three key issues: o Balance of the finances. o Implementation plans. o Outcomes and the metrics locally.
Linking all work to the CCG conversations around assurance.
Plans will be revised after receiving the national planning guidance and settlements with final versions expected by March 2016.
5.2 GOVERNANCE
Discussion paper and draft ToR for the Joint Commissioning Board (JCB) being presented to Joint AGG/AGMA meeting to follow.
Discussions with Health Education England (HEE) re: proposed Memorandum of Understanding.
Possibly need to consider a session to determine what needs to be agreed through the JCB; task for AGG Executive to start preparatory work.
Need to strengthen and determine our own infrastructure and links.
Helen Stapleton is planning to propose a working group for the JCB to also look at pulling together proposals for the JCBE to consider.
KWJ (HOC Chair) and TA are meeting in New Year about the future of HoCs in terms of agreeing a work plan that supports AGG.
Need to understand how the health and social care elements align with other devolved powers.
Paper for the JCB has examples of services which might be best pooled.
AGG needs to determine the route for clinical commissioning – require a structured facilitated session in the New Year.
Concerns rose re: meeting duplication and some areas working in silo not involving the right people with the appropriate expertise.
5.3 DMT
Covered in the previous items.
126
Page 3 of 4
ACTION:
AD To arrange a joint session with AGG / CFOs / HOCs
6. GM SHARED SERIVCES
Challenges arisen from NHSE on behalf of Bob Rickets and Simon Stevens asking for clarity around the GM IM&T plan.
Report circulated - main points: o Current governance arrangements will stay in place until 31st March 2016. o Agreed at previous AGG to utilise the AGG infrastructure for decisions. o Starting to establish a user group to connect coordinating commissioners with the
shared service to ensure continuity and address any issues. o NWCSU will cease to exist when Cheshire and Mersey CSU stops on 1st March 2016 -
shared services will become fully hosted by Oldham CCG from 31st March 2016.
Mark Aspinall, commissioned to provide expert support and leadership to Technical transition.
Advice has been sourced from KPMG in respect of Accounting, Reporting and Legal aspects of the hosting arrangements. Recommendations are currently informing our dialogue with NHS England, auditors and potentially HMRC.
CCG CFOs have confirmed that they concur with KPMG advice that financial reporting for GMSS should be on a Gross Accounting basis through Oldham CCG books.
Oldham CCG is drawing up the rationale for Gross Accounting treatment to enter dialogue with Oldham CCG external auditors.
Staff uncertainty is a major issue with staff leaving covering vacancies with agency staff.
Options for staffing arrangements from 1st April: o Tupe to Midlands and Lancs CSU (Strategic partner for the interim arrangement for HR
purposes). o Tupe the staff into Oldham CCG
Trade unions support Oldham CCG but needs approving through Oldham CCG governing body.
MOU3 will be redeveloped for sign off by the 1st April 2016.
22 redundancies have been approved –the last person to leave will be on the 9th March.
AGG supports linking the shared service work under devolution with greater alignment to LAs.
Need to start the consultation by the 11th January in order to complete by March 31st.
NOTED THAT STAFF HAVE NOT BEEN CONSULTED ON THIS AND COMMERCIALLY SENSITIVE.
ACTION:
AGG supported option for staff tupe to Oldham CCG.
AGG supported linking the Shared Service work with GM Devolution and alignment to LAs
JD to revise paper with an addendum to accurately reflect decision.
7. DEVOLUTION UPDATE / GM CLINICAL & FINANCIAL SUSTAINABILITY (STRATEGIC) PLAN
STRATEGIC PLAN:
Draft narrative and content shared with SPB Exec on 7th December - TA and SN present.
RG has fed into the process with a number of comments.
Draft will be going to the Strategic Programme Board tomorrow.
Unlikely detail of the CSR will be worked out by tomorrow - NHSE board meeting on Thursday.
127
Page 4 of 4
Same draft will go to SPB on Friday - this will be a public meeting live streamed. Need to identify a CCG clinical voice noted that RG has sent his apologies.
Communications pack for release after the SPB to translate this into the public domain.
CSR:
Current offer is £450m of the requested £500m with no clarity as to what is included – Gm view is that vanguard monies should not be included in the overall settlement as this has not been assured through local governance processes.
Next meeting will seek to agree assumptions upon which the strategic plan will be submitted.
Local authorities have agreed to increase contributions to 2% for social care transformation.
CCGs have been putting in 1% for transformation informally - suggested we need to agree this formally in future through appropriate governance.
Strategic plan and locality plans will be refreshed following CCG planning guidance and social care settlements.
Need to have a conversation about how this is delivered with regards to skill and resource.
Need to agree if the funding is recurrent or none recurrent and potential impact on social care.
Given the uncertainty around the CSR outcome - finance section not completed.
Tariff efficiency saving is 2% not 4% - alters what elements the providers need to deliver and what the commissioners need to deliver.
Influence is growing as we offer a stronger relationship with provider reform.
Need to be realistic around how much we can spend next year clear planning required. Critical year will be 17/18 when the expected changes will be delivered.
Strategic plan will be in public domain from Friday -next steps will be to finalise it and engage with the public and individual organisations for final sign off.
8. DEVOLUTION LEADS UPDATES
8.1 SPB
Noted that RG won't be in attendance to speak on behalf of AGG.
Strategic plan will be circulated today – email conversations may be needed if anyone feels they need to make any fundamental changes.
CSR – support in relation to the finance settlement.
Need a clinician to be available on Friday – Need to see who is attending.
ACTION:
MS to circulate message to confirm clinical representation at Fridays SPB.
9. AOB
None noted.
NEXT MEETING
DATE: 5th January 2016
TIME: 8.30am-12.30pm
VENUE: The Willows, AJ Bell Stadium
128
1
MINUTES of a meeting of the DERBYSHIRE HEALTH AND WELLBEING BOARD held on 19 November 2015 at Gothic Warehouse, Cromford Wharf, Cromford
PRESENT
Councillor D Allen (in the Chair)
T Allen DCHS S Allinson Tameside and Glossop CCG H Bowen Chesterfield Borough Council T Campbell Chesterfield Royal Hospital Dr D Collins North Derbyshire CCG A Gregory Hardwick CCG Councillor C A Hart Derbyshire County Council J Hollister Derbyshire County Council I Johnson Derbyshire County Council D Lowe Derbyshire County Council I Majid Derbyshire Healthcare Foundation Trust R Marwaha Erewash CCG E Michel Derbyshire County Council Dr A Mott Southern Derbyshire CCG K Ritchie HealthWatch Derbyshire J Simmons HealthWatch Derbyshire B Smith North Derbyshire CCG Councillor P J Smith Derbyshire County Council T Smith Derbyshire Healthcare Foundation Trust I Stephenson Derbyshire County Council G Thompson Southern Derbyshire CCG G Tomlinson Derbyshire Fire and Rescue Service Councillor A Western Derbyshire County Council Councillor R J Wheeler South Derbyshire District Council P Wood Voluntary Sector Also in Attendance – L Allison (3D), T Illsley, A Johnson (Derbyshire Fire and Rescue Service), E Langton (Derbyshire County Council), C O’Leary, G Spencer (Derbyshire County Council) R Sunley, K Venables, S Wilson (Derbyshire Police) Apologies for absence were submitted on behalf of G Boyle, A Charles, Councillor J A Coyle, Dr A Dow, S James, G Knighton, H Phillips, B Murray-Carr, P Singh and J Willis 59/15 MINUTES RESOLVED that the minutes of the meeting of the Board held on 10 September 2015 be confirmed as a correct record.
129
2
60/15 MATTERS ARISING – (a) Consultation on Proposed Public Health Grant Reduction (Minute No 54/15 refers) It was reported that the preferred option of reducing all local authority allocations by 6.2% had been agreed and would take effect. This meant that Derbyshire County Council had to cut £2.5m in the current financial year. It was anticipated that further cuts would be set out in the Comprehensive Spending Review. 61/15 MINUTES OF ASSOCIATED BOARDS RESOLVED to note the minutes of 21st Century Plan Delivery Group, Tameside and Glossop Care Together, Joined Up Care Board and Children’s Trust Board. 62/15 HEALTH AND WELLBEING STRATEGY 2015-17 A draft copy of the refreshed strategy had been presented to the last meeting of the Board, and comments had been incorporated into the final version, which had been reviewed by the Health and Wellbeing Core Group. The Board was asked to formally adopt the strategy for implementation. A more detailed implementation plan was currently in development and would outline how the actions under each priority would be delivered, utilising wherever possible existing projects or groups to co-ordinate the delivery. For a small number of the actions, additional work would need to be undertaken and discussions would take place with Board members to identify the most appropriate organisation or group to develop these. The implementation plan would outline how the Board would evidence the delivery of priorities and outline early success against actions. If poor performance or potential issues were identified this would be reported by exception to the Core Group. In addition, the high level indicators detailed for each priority would be tracked over the life course of the strategy to demonstrate the progress that had been made and the addressing of key health and wellbeing challenges. The implementation plan would be presented at the next meeting of the Board. RESOLVED to (1) adopt the Health and Wellbeing Strategy for implementation; and (2)note that an implementation plan will be presented to the Health and Wellbeing Board in January, identifying early achievements and outlining how each priority will be delivered. 63/15 SOCIAL CAPITAL IN DERBYSHIRE A Task and Finish Group had previously been set up to explore how partners could better deliver the ambition of building social capital, and a report was presented on the work of the Group. The report provided a definition of social capital, how it could improve health outcomes, and made thirteen recommendations. It also set the agenda for practical ways in which partners could support the development of social capital in Derbyshire. The recommendations covered
130
3
the themes of connectivity, sharing, trust, social value, community action, and metrics. The report looked to build on, and focussed existing activity across Derbyshire, as well as highlighting opportunities for cross-partnership working. Much of the evidence, engagement and policy development work undertaken for the report aligned with both local and national policy documents and reflected current issues in health and social care. It was therefore proposed that the draft report be approved and an action plan be developed. The existing Task and Finish Group would continue to oversee the implementation and would establish working groups to take the plan forward. Further reports would be made on progress. RESOLVED (1) to approve the Social Capital in Derbyshire report; and (2) that progress reports be made to future meetings. 64/15 REVIEW OF VCS INVESTMENT An update was provided on the work to review Voluntary and Community Sector (VCS) investment in Derbyshire in relation to health and social care. In terms of activity to date, the project had progressed in two phases. The first phase of the project had involved mapping current investment in the VCS for health and social care across HWB partners. Members had previously developed a joint set of outcomes and principles for VCS investment and these had been agreed by the Board. The project had been paused as a result of the County Council’s decision to create a fund from the Public Health grant and use reserves to support VCS services providing health and wellbeing support for 2015/16. The second phase of the project had resumed in January 2015, and it was agreed that an aligned budget between the current County Council Adult Care VCS budget and CCG VCS budget for adults should be sought. The joint outcomes and principles had been supplemented by additional criteria and evaluation questions and it was intended that these would help inform any future commissioning. A Joint Commissioners Group had been established and was considering how future commissioning was used to secure efficient, effective and sustainable provision that addressed the needs in communities and contributed to the further development of integrated care. Work had also been undertaken to explore the issue of infrastructure support – this was ongoing and it was intended it would form part of the consultation submissions. Early engagement had also taken place with the VCS Health and Social Care Forum, and further events had taken place to inform representatives from the VCS about the proposed decision-making and engagement process. It was the intention that regular engagement activity took place with the sector on an ongoing basis throughout the process.
131
4
Following consideration of the evidence gathered to date, it had been agreed that HWB member organisations that currently provided funding to the VCS would seek approval from their respective Governing Body to commence a period of formal consultation to disinvest/invest in a range of services which were aligned to both HWB and organisational outcomes. It was also proposed that a single joint commissioning process be developed. Consultation would take place with the VCS and wider stakeholders aligned to the Derbyshire Compact, and a full analysis of equality issues would be undertaken to inform and support the decision making process. At the end of the consultation period, Cabinet and CCG Governing Bodies would receive a report detailing the outcomes and analysis of the consultation, the completed equality analysis, recommendations and details of the next steps and timescales in process. This would take place in spring/summer 2016, and assuming approval, there would be a notice to organisations/the re-commissioning of services, and new services would commence in autumn/winter 2016/17. It was proposed that the Joint Commissioners Group continued to meet to provide ongoing project management support and co-ordination to the process, and the Group would provide regular reports to the Joint Investment Task and Finish Group, the HWB Core Group and the main Board. RESOLVED to (1) note the progress of the VCS investment project to date; (2) note the proposed process and timescales going forward; (3) note that detailed reports will be presented to CCG Governing Bodies and DCC Cabinet for approval to proceed; and (4) agree that the Joint Investment Group and Joint Commissioners Group continue to meet to provide project management support and co-ordination. 65/15 DERBYSHIRE DEVOLUTION It was reported that good progress was being made in terms of the content of the devolution deal. The Authority was currently in detailed discussions with central Government and a more firm document was being produced. It was not yet certain when there would be a definitive announcement as to the outcome of the deal. In relation to the Health aspect of the deal, it was suggested to establish a Public Service Reform Board, and this would look at the impact on services and places. It would be helpful to continue with discussions, and it was noted that if a deal could be agreed, this would provide an ongoing dialogue with Government for further devolution and the potential for one off injections of funding. The issue of social capital was raised, and it was felt that it would be
132
5
useful to feed the Board’s comments into a meeting that had been convened by Nottinghamshire County Council. Voluntary Sector representatives offered to assist wherever possible once information was more definitive, and this was welcomed. 66/15 CARE TOGETHER PROGRAMME An update was provided on the progress of the Care Together Programme in Tameside and Glossop. It had been recognised by all partners in Tameside that making no changes to the health and social care system was not an option, and it was necessary to bring together social, primary, community and hospital services to provide an integrated care system. There had also been wide recognition of a need to focus on the wider public health system in order to close the gap in health inequalities.. A Tameside Contingency Planning Team report had been published which outlined the proposed new model of integrated care. This would involve local community care teams co-ordinating all care being provided to residents; a new Urgent Care Service would bring together intensive support services; Tameside Hospital would continue to provide A&E, maternity and elective services, although there would be a reduction in medical beds due to improved prevention of illness and the shift of care into localities; and a position had been agreed with Derbyshire County Council to align but not integrate services and commissioning budgets. The recommendations within the Contingency Planning Team report had been welcomed and accepted by health partners in Tameside, where it had been agreed that an integrated system of health and social care was the best way to ensure improved health and social care outcomes for local residents; that Tameside Hospital Foundation Trust would transform into a new organisation to deliver this, and the Boards also agreed to work together to ensure that this was delivered collectively. A series of key milestones were highlighted – the joint commissioning function would start on 1 January 2016, the shadow Integrated Care Organisation would commence on 1 April 2016, and there would be a legal Integrated Care Organisation from 1 April 2017. 67/15 FUTURE IN MIND The Board received, for information, the Future in Mind Plan. The joint Plan had recently been approved and funding of £1.9m had been made available to improve the emotional health and wellbeing of children and young people. The Plan would deal with a range of issues, but there would be a focus on eating disorders. Progress reports would be presented to the Board, and a detailed action plan had been produced to ensure that the key milestones were being met.
133
6
68/15 HEALTHWATCH DERBYSHIRE INTELLIGENCE REPORT HealthWatch presented the findings, recommendations and responses so far to the Cancer Services Report; the response from the Autism Co-ordination Group to the Autism Report; and an update on the outcomes of the CAMHS reports. The Cancer Services Report gave a summary of the experiences of 102 cancer patients who had been interviewed. A number of responses from service providers and commissioners were detailed within the report, but a few responses were still being awaited. Based on the information provided, HealthWatch Derbyshire had put forward a number of considerations for providers and commissioners of relevant services in Derbyshire. In relation to the CAMHS reports, HealthWatch would revisit these in two years to see whether there had been improvements. It was also noted that the Group who had taken on responsibility for implementing the recommendations in the Autism Report would revisit these in six months. The latest HealthWatch Intelligence Report was presented, and this detailed current areas of work, recent Enter and View Reports, upcoming reports and current priorities. RESOLVED to note (1) the recommendations from the Cancer Services report and Autism Report; and (2) the key points from the latest HealthWatch Intelligence Report. 69/15 BETTER CARE FUND UPDATE Work to develop a local performance monitoring system had been outlined at the last meeting of the Board, and following feedback from the meeting concerning the level of detail required, development of the dashboard had focussed on the five high-level schemes which contained the 46 projects funded through the BCF. Budget and risk performance were also being included in the dashboard to provide a holistic overview of each scheme. The dashboard was currently being tested by the BCF Finance and Performance Sub-Group, and implementation was expected for the second half of the BCF reporting year. A joint audit of the BCF was due to take place shortly, but the scope of the audit did not encompass Tameside and Glossop CCG. The objective of the audit was to provide assurance that the appropriate governance and management arrangements were in place for the BCF, and this included ensuring a number of controls were in place. It was proposed that a joint report covering all partners was produced, and where any significant issues were identified during the review that were specific to any partner
134
7
organisation, the reporting arrangements could be reviewed. Following completion of the audit, a summary of findings and any action plans required would be reported to the Board. Formal confirmation of an extension of the BCF into 2016/17 had been provided by the Department for Health on 16 October, but full details on what would be required would not be provided until after the Government’s Comprehensive Spending Review on 25 November. However, Health and Wellbeing Board areas had been encouraged to begin the planning process for next year. The BCF Programme Board had begun identifying possible options for next year and had held a workshop in September to begin the process. The Health and Wellbeing Board would be required to provide further quarterly reports to NHS England on the performance of the BCF for 2015/16. The Board would continue to be kept informed of progress against the BCF in line with the reporting dates as well as the outcomes of the work outlined. RESOLVED to approve (1) the report; and (2) the next steps as set out in the report. 70/15 PUBLIC HEALTH ROUND-UP The Derbyshire Substance Misuse Strategic Plan had been approved for submission by the multi-agency Derbyshire Substance Misuse Strategic Commissioning Group on 3 September 2015. The Strategic Plan documented the aims of a working partnership of agencies and individuals across Derbyshire to deliver a reduction in the various harms caused by alcohol and substance misuse. In Derbyshire, as nationally, alcohol harm was increasing. Adult obesity was significantly higher in the county than the national and regional average, and there was also room for improvement in vaccination, testing and treatment for the vulnerable populations most at risk of viral hepatitis. In response to a national and regional call to action on liver disease, a number of evidence based actions had been identified that would add value to work already underway in Derbyshire, and these formed the core of the Improving Liver Health Plan. The State of Mental Health report summarised information on the current state of mental health and wellbeing in Derbyshire. The indicators included in the report explored the wider determinants of good and poor mental health, the prevalence of mental illness, access and outcomes from mental health services and spend. The report recognised that there were a wide range of factors that could influence mental health that needed to be addressed to improve the mental health of the population. The information was presented as a profile report to inform priority setting and the planning of
135
8
mental health services, and it highlighted indicators where Derbyshire was significantly different and where there was variation at a sub-county level. The report had been launched, alongside the Joint Vision and Strategic Direction for Adult Mental Health 2014-19 on 30 September 2015, and the key points from the launch event were presented. It had been agreed earlier in the year that adopting and implementing the principles of the Healthy Cities/Communities programme would be one of four strands for the refreshed Health and Wellbeing Strategy. The Council had become a member of the UK Healthy Cities/Communities Network in May 2015 with all the district/borough councils as associate members. The Healthy Cities/Communities Core themes had been presented to the last meeting of the Health and Wellbeing Board where the collective approach had been endorsed, and a briefing had been sent to partners outlining the next steps. Since this, a range of actions had been taken, and alongside these, there had been ongoing work on the Locality Programme including implementation of the Locality Public Health plans and development of a revised performance monitoring system which would be piloted from December. An update was provided from the Health Protection Board. Quarter 1 performance data for childhood vaccinations in Derbyshire had been presented by NHS England and had showed sustained very good performance across all antigens. The Health Protection Board had been advised regarding a range of changes to commissioned immunisation services; a detailed report of screening performance had been provided by the Screening and Immunisation Lead along with key messages; and other agenda items at the Board were detailed. An update was given from the Local Health Resilience Partnership. All NHS partner organisations had completed their emergency planning and response assurance assessment and were ‘substantially compliant’ in all areas of the EPRR competencies on an individual organisational level. Over the last year, there had been two major simulations, and the key emerging areas for improvement were detailed. The next steps in relation to the Derbyshire Substance Misuse Strategic Plan, Liver Health Plan, State of Mental Health in Derbyshire, and Healthy Communities were presented. RESOLVED to note the updates, endorse the strategies, approve the next steps and agree to receive regular updates on progress against the strategic objectives. 71/15 HEALTH AND WELLBEING BOARD ROUND UP A round up of key progress in relation to health and wellbeing issues and projects was given.
136
9
At the NHS Expo 2015, a number of announcements had been made regarding the increased use of technology in the health and social care sector. CCGs, working with local authority partners and providers of care, had to submit delivery plans by April 2016 on how they intended to eradicate the use of paper across all health and care services by 2020. CCGs and providers would be asked to complete a self-assessment to benchmark their digital services, and the results would form a ‘digital maturity index’ giving a picture of how far the NHS had come in making effective and meaningful use of technology and highlighting areas for improvement. A report by the National Cardiovascular Intelligence Network had analysed five years of data from the Health Survey for England and had estimated that five million people over the age of 16 in England were at high risk of developing Type 2 diabetes. The preventative approach was the rationale for the NHS Diabetes Prevention Programme which would be rolled out in stages from 2016. The NHS had announced a £5m plan to improve and support the health and wellbeing of 1.3 million health service staff, and this formed a major part of the implementation of the NHS Five Year Forward View. NHS organisations would be supported to help their staff stay well, and this would include serving healthier food, promoting physical activity, reducing stress, and providing health checks covering mental health and musculoskeletal problems. The Mental Health Taskforce: Engagement Report had been launched, and this had considered the views of people on the top priorities for reshaping mental health services as part of a drive to develop a five year national NHS strategy for people of all ages. The report would be used to inform the work of the taskforce to explore the variation in the availability of mental health services, look at the outcomes for people who were using services, and identify key priorities for improvement. The LGA had published a document which provided shared principles to ensure that service redesign met a number of fundamental requirements. The principles ensured that proposals were focused on improving services and health and wellbeing outcomes and emphasised the need to co-create and co-design new services in partnership with local service users and the community. The shared principles were intended to provide a consistent framework within which to test that proposals were person-centred, locally appropriate, evidence based and focused on whole-system effectiveness. The Care Quality Commission had published a State of Care report, and this provided an annual overview of health and adult social care in England. The analysis had showed that many services had managed to either
137
10
improve or maintain quality. However, there remained significant variation in quality and an unacceptable level of poor care, and safety remained the largest concern across all of the services inspected. Under the requirements of the National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013, the NHS Commissioning Board had to notify the Health and Wellbeing Board of all relevant applications to provide pharmaceutical services, including the relocation of existing pharmacies. Notification of a number of applications had been received. RESOLVED to note the information contained in the round-up report. 72/15 LAST MEETING It was reported that this was to be the last meeting for Elaine Michel and Sue James. Both were thanked for their work and the contribution they had made to the Health and Wellbeing Board.
138
TAMESIDE HEALTH AND WELLBEING BOARD
12 November 2015
Commenced: 10.00 am Terminated: 11.50 am
PRESENT: Alan Dow (Deputy Chair – in the Chair) – Clinical Commissioning Group Councillor Brenda Warrington – Tameside MBC Steve Allinson – Clinical Commissioning Group Jane Ankrett – Stockport NHS Foundation Trust Stephanie Butterworth – Tameside MBC Judith Crosby – Pennine Care NHS Foundation Trust
Graham Curtis – Clinical Commissioning Group Ben Gilchrist – CVAT Angela Hardman – Tameside MBC Karen James – Tameside Hospital NHS Foundation Trust David Niven – Tameside Safeguarding Children Board Steven Pleasant – Tameside MBC Tony Powell – New Charter Housing Trust
Dominic Tumelty – Tameside MBC IN ATTENDANCE: Sandra Stewart – Tameside MBC Jessica Williams – Programme Director for Integration Debbie Watson – Tameside MBC Ben Jay – Tameside MBC APOLOGIES: Councillor Kieran Quinn – Tameside MBC
Councillor Allison Gwynne – Tameside MBC Councillor Lynn Travis – Tameside MBC
Christina Greenhalgh – Clinical Commissioning Group Andy Searle –Tameside Safeguarding Adults Board 24. DECLARATIONS OF INTEREST There were no declarations of interest submitted by members of the Board. 25. MINUTES OF PREVIOUS MEETING The Minutes of the Health and Wellbeing Board held on 1 October 2015 were approved as a correct record. 26. CARE TOGETHER PROGRAMME: UPDATE Consideration was given to a report of the first report of the Independent Chair and Programme Director summarising progress and key milestones for the Tameside and Glossop Care Together Programme. As the programme moved into a different phase, the structure of the programme had been realigned to ensure appropriate engagement in the detailed design work as well as delivery. The new structure identified the three main working parties focusing on Single Commissioning, the Model of Care and the plans to deliver an Integrated Care Organisation Foundation Trust. The architecture to support these groups was currently being determined and would be reported at the next meeting of the Board. A governance structure, risk log and an interim budget had been developed to enable the work to be progressed at scale and pace. A high level plan to demonstrate the milestones for the Programme was being finalised and would also be reported to the next Board meeting.
139
An important initial step in the development of an integrated care organisation was the transfer of the Tameside and Glossop community staff currently hosted by Stockport Foundation Trust into Tameside Hospital Foundation Trust. This process was now underway and would be completed on 1 April 2016. The governance arrangements for this transaction focused on a fortnightly Project Board and a number of work streams had been established to manage the detail and be accountable for progress. RESOLVED That the content of the update report be noted. 27. TAMESIDE AND GLOSSOP LOCALITY PLAN Consideration was given to a report of the Chief Executive, Tameside MBC, and the Chief Operating Officer, Clinical Commissioning Group, explaining that in 2015/16 Greater Manchester Devolution was submitting a five year comprehensive Strategic Sustainability Plan for health and social care in partnership with NHS England and other national partners. Each of the GM areas had been asked to submit a Locality Plan to provide a “bottom up” approach to the development of the GM Plan. The GM Strategic Sustainability Plan would be based on the following objectives to: Improve health and wellbeing of all residents of Greater Manchester, with a focus on
prevention and public health, and providing care closer to home; Make fast progress on addressing health inequalities; Promote integration of health and social care as a key component of public sector reform; Contribute to growth, in particular through supporting employment and early years services; Build partnerships between health, social care, universities, science and knowledge sectors for
the benefit of the population. As such, the Tameside and Glossop Locality Plan addressed how these objectives would be met locally and how health and care services would be reorganised to contribute more effectively towards better prosperity, health and wellbeing. Tameside and Glossop had a significant financial challenge as evidenced by the estimated £69m gap in funding across the health and social care economy by 2020. Continuing with the current system was not an option and the proposals for a single health and care provider had been analysed and subjected to external financial scrutiny and once fully implemented, would reduce expenditure by £28m. Additionally, other key plans described within the Locality Plan showed how by leading together and pooling resources, financial sustainability could be reached within five years. A clear vision and strong partnership in conjunction with the opportunities provided within the Greater Manchester Devolution, provided the platform to drive forward shared objectives. Working with local people across the statutory, private, voluntary, and community sectors would enable ambitions to be achieved. RESOLVED That the content of the report be noted and the Tameside and Glossop Locality Plan be endorsed. 28. WORKING WELL UPDATE Consideration was given to a report of the Assistant Executive Director (Development, Growth and Investment) advising on progress with the current Working Well pilot and Phase 1 of the expansion from the existing 5,000 cohort to 15,000 across Greater Manchester. The report also set out the opportunities in the expanded Working Well Programme scheduled to go live in February 2016.
140
It was explained that the current Working Well pilot started in March 2014 to support the Employment Support Allowance Work Related Activity Group claimants who had spent two years unsuccessfully on the Work Programme into sustained employment. The scheme had been built around a key worker model giving providers the freedom to innovate and design services in the most effective and efficient way possible. Demonstrating that this model worked was a key priority for GM as it had a direct impact on future decisions around commissioning the Work Programme or its successor. Integrating Working Well with health services had been challenging although many successes had been achieved to date. The Working Well expansion provided a significant opportunity to develop integration at a faster pace on a larger scale. So far, in Tameside, Working Well had been implemented successfully and was being managed by a local partnership Steering Group whose role was to understand, progress and problem solve any blockages or barriers to the programme. The Steering Group was continuing to explore opportunities to specifically integrate Working Well into health services and the key activities supporting this twin approach were highlighted. The successes for the programme were detailed in the report together a number of cases studies. It also set out information about employment barriers clients faced when entering into the programme and it was noted that bereavement continued to be above the GM average. Reference was made to the expansion of Working Well Phase 1 which represented an important change in the welfare to work system in GM and increased and widening of cohorts and enhanced integration should be viewed as key successes. The further expansion would enable providers to become more operationally involved in holistically tackling work, skills and health by providing a referral route and increasing opportunities for co-case management. The Health and Wellbeing Board considered the opportunities of the expanded programme and how these could be realised through an updated Tameside Working Well Integration Plan which was being continually being developed by the Tameside Working Well Steering with local agencies and providers. Engagement and integration between work, skills and health was progressing and would be strengthened further by the expansion of Working Well. RESOLVED (i) That the progress of Working Well be noted. (ii) That the opportunities for the expansion of Working Well in 2016 including the
development of a health referral route be supported. 29. ADVISORY COMMITTEE ON RESOURCE ALLOCATION CONSULTATION 2016/17 ON
PUBLIC HEALTH GRANT Consideration was given to a report of the Executive Member (Health and Neighbourhoods) and the Director of Public Health explaining the Advisory Committee on Resource Allocation public health grant proposed target allocation formula for 2016/17 and how it had been developed and the implications for Tameside. The Advisory Committee on Resources Allocation (ACRA) developed a formal for public health grants for the first time in 2012 which was used to set target allocations for 2013/14 and 2014/15 for public health grants to Local Authorities. Between 8 October 2015 and 6 November 2015 the Department of Health was consulting, on behalf of ACRA, on interim recommendations for a number of changes to the target formula for the public health grant for 2016/17 onwards. The key steps in setting the Public Health allocations were: Setting the preferred relative distribution of resources; Setting the total resources available;
141
Deciding how quickly to move organisations from their baseline position towards the level of resources implied by the preferred distribution.
A copy of the consultation response from Tameside Council was appended to the report. Board Members referred to the existing public health grant formula and the proposed changes to the formula and their impact on Tameside MBC target allocation was summarised. The overall impact on Tameside of the proposed target allocation formula for 2016/17 was highlighted which represented a 0.1% reduction of relative share. The 1% decrease in the Tameside MBC allocated share would decrease from 0.25% to 0.24% which in financial terms was equivalent to a reduction of £340,000 in grant allocation for Tameside. RESOLVED (i) That the funding formula consultation for 2016/17, proposed changes and
implications for Tameside be noted. (ii) That the consultation response be endorsed. (iii) That a further update following the autumn statement be submitted to the January
2016 meeting of the Health and Wellbeing Board. 30. 0-5 TRANSITION OF HEALTH CHILD PROGRAMME: UPDATE Consideration was given to a report of the Executive Member (Children and Families) and the Director of Public Health updating the Board on the transfer of commissioning responsibilities for 0-5 public health services from National Health Service (England) to the Council and the transformation undertaken by the provider of Health Visiting and Family Nurse Partnership services. Particular reference was made to health visitor performance, health visitor workforce, finance and the challenges ahead. RESOLVED That the key issues and update on the transfer of commissioning responsibilities for 0-5 public health services from the NHSE to Tameside MBC be noted. 31. CHILDREN AND ADOLESCENT MENTAL HEALTH SERVICES – TRANSFORMATION
PLAN Consideration was given to a report of the Commissioning Business Manager for Children, Young People and Families, Clinical Commissioning Group, and the Children and Young Peoples Emotional Wellbeing and Mental Health Plan for 2015-2012. This had been produced by the Children and Young Peoples Emotional Wellbeing and CAMHS Transformation Programme Board, led by the Clinical Commissioning Group. RESOLVED (i) That the Plan be accepted. (ii) That the progression of the priorities and deliverables under the Plan be supported. (iii) That the Board receive further updates on progress. 32. TAMESIDE SAFEGUARDING CHILDREN’S BOARD ANNUAL REPORT The Chair welcomed David Niven, Independent Chair, who presented the Tameside Safeguarding Children Board Annual Report 2014/15, providing an overview of the Board‟s safeguarding activity against its 2014/15 priorities. It identified particular vulnerable groups and outlined emerging themes and details of the Board‟s strategic priorities for 2015/16.
142
RESOLVED That the Tameside Safeguarding Children Board Annual Report 2014/15 be received. 33. HEALTHWATCH TAMESIDE ANNUAL REPORT 2014/15 The Chief Executive, Healthwatch Tameside, was pleased to present the Healthwatch Tameside Annual Report 2014-15. It highlighted the statutory functions, activities during the year and outcomes that have been achieved. In particular, the Board noted: Healthwatch Tameside engaged with significant numbers of local citizens, including people
from seldom heard communities. Tameside Hospital welcomed and acted on a set of Enter and View visits undertaken by
Healthwatch Tameside. Healthwatch Tameside has established a large online following as well as providing face to
face contact in a number of community settings. Healthwatch Tameside took on the NHS complaints advocacy function this year with no
additional funding. They have seen a 55% increase in active cases during the year (due to being more accessible to the local population).
Healthwatch Tameside played a significant role in ensuring that local residents responded to the Healthier Together consultation. Our Borough had the highest number of responses for any area where the future role of the local hospital was not being consulted on.
The report included three examples of „impact stories‟ where Healthwatch has made a difference to local people or services.
Future Healthwatch priorities including helping the local population to engage with Care Together and the GM Devolution agenda.
RESOLVED That the content of the report be noted. 34. HEALTH WATCH TAMESIDE ANNUAL INTELLIGENCE REPORT 2014/15 Consideration was given to a report of the Chief Executive, Healthwatch Tameside providing a summary of the aggregated data from 770 patient stories and survey responses received by Healthwatch Tameside during 2014. The purpose of this is to enable themes and patterns to be identified that were not always immediately obvious when reading a single story in isolation. The report pulled together data from: Patient opinion; Healthwatch surveys; Patient stories we have been told but asked not to share on an individual basis; Informal comments collected by the Healthwatch Champions; Themes from NHS complaints where help had been provided for people to use the formal
complaints system. RESOLVED (i) That the report be recognised as part of the evidence base for the Joint Strategic
Needs Assessment with a new version being sent to the Board annually; (ii) That the three main themes emerging from patients’ comments especially where it
may provide useful context and insight for future planning and commissioning decisions be noted and shared:
Appointments (GP and hospital);
Communication (explanations, information, listening, advice and correspondence);
Staff.
143
(iii) That Healthwatch Tameside’s intervention to work with commissioners and providers to identify and implement improvements in patient experience when the more detailed output from the follow-up data collection exercise around appointments, communication and staff is complete be supported.
35. PUBLIC HEALTH OUTCOMES FRAMEWORK SCORECARD Consideration was given to a report of the Executive Member (Health and Neighbourhoods) / Director of Public Health providing an update regarding the current position of the Tameside Public Health Outcome Framework indicators and the comments against each indicator advising Members of the Health and Wellbeing Board of emerging issues or concerns within indicator movements. RESOLVED That the contents of the report be noted. 36. URGENT ITEMS The Chair advised that there were no urgent items for consideration at this meeting. 37. DATE OF NEXT MEETING To note that the next meeting of the Health and Wellbeing Board will take place on Thursday 21 January 2016 commencing at 10.00 am. CHAIR
144
GOVERNING BODY MEETING
Title of Subject:
Healthier Together update
Date of paper:
22 January 2016
Prepared By:
Paul Pallister
History of paper:
Healthier Together Committees-in-Common: October 2015
Executive Summary:
The Healthier Together Committees-in-Common have proposed moving to a Joint Committee governance structure. The purpose of this paper is to secure the support of the Governing Body for this action. Attached are: - an explanatory covering letter from Hempsons solicitors The draft Terms of Reference for the Healthier Together Joint Committee
Recommendations required of the Governing Body (for Discussion and Decision)
The Governing Body is asked to: i) establish a joint committee with the other GM CCGs to take decisions in relation to Healthier Together, to be known as the Healthier Together Joint Committee; ii) approve the terms of reference for the HTJC in their current form; and iii) delegate authority to a member of the Governing Body to approve any changes to the terms of reference that involve updating the members or deputy members of the committee or any other minor changes.
QIPP principles addressed by proposal:
Productivity: one of the key aims of the Healthier Together programme is to produce more effective health services for the population of Greater Manchester.
Direct questions to:
A Dow
145
Cont'd/…..
A full list of Partners is available for inspection at the above address | Service of pleadings by email will not be accepted Hempsons is authorised and regulated by the Solicitors Regulation Authority, No 51059
Our Ref: 50714/29/31672 22 December 2015 Your Ref: Strictly Private and Confidential Mr Paul Pallister Assistant Chief Operating Officer and Company Secretary NHS Tameside & Glossop CCG By e-mail only: [email protected] Dear Paul, Healthier Together – Establishing the Healthier Together Joint Committee NHS Tameside and Glossop CCG’s Constitution When the Greater Manchester CCGs (GM CCGs) began the Healthier Together programme, CCGs did not have the power to establish joint committees and so the GM CCGs established the Healthier Together committees-in-common (HTCiCs) to take decisions in relation to the programme. In preparation for the implementation phase of Healthier Together, it is now proposed that the GM CCGs establish a joint committee which will take over decision-making responsibility from the HTCiCs. CCG Constitution At the October 2015 meeting of the Healthier Together Committees-in-Common, it was agreed that Hempsons would write to each of the GM CCGs to confirm whether the CCG’s Constitution is drafted in a way as to permit the CCG to establish the Healthier Together Joint Committee (HTJC) or whether further amendments are required. As we have previously confirmed, the CCG’s Constitution will, as drafted, enable the CCG to establish the HTJC. Approving the terms of reference for the HTJC A new set of terms of reference has been drawn up for the HTJC. The CCG’s Governing Body will need to resolve to establish the HTJC and approve the terms of reference. We enclose with this letter the terms of reference. We are aware that Cathy Georgeson from the Healthier Together Programme Team has been in touch with the CCG today to confirm the details of its member and deputy for the HTJC. The terms of reference have been updated to include any responses received from the GM CCGs before 2pm today. As the terms of reference will need to be updated in due course to include any new details provided by the other CCGs, we recommend that the CCG’s Governing Body resolves to:
Hempsons | Harrogate
The Exchange
Station Parade
Harrogate HG1 1DY
t: +44 (0)1423 522331
f: +44 (0)1423 724047
DX11965 Harrogate 1
www.hempsons.co.uk
Also at:
London, Manchester & Newcastle
146
2
i) establish a joint committee with the other GM CCGs to take decisions in relation to Healthier Together, to be known as the Healthier Together Joint Committee;
ii) approve the terms of reference for the HTJC in their current form; and iii) delegate authority to a member of the Governing Body to approve any changes to the
terms of reference that involve updating the members or deputy members of the committee or any other minor changes.
Once the CCG’s Governing Body has passed the relevant resolutions, we would be grateful if you could send us a copy of the minutes of the Governing Body meeting recording the resolutions using the contact details below. This will enable us to confirm to the Healthier Together Programme Team that the CCG can establish the HTJC. We would be grateful if you could send this information to us no later than 18 February 2016. If you have any queries about this letter then please get in touch. Yours sincerely, Carol Mosedale Solicitor HEMPSONS d: 01423 724007 e: [email protected]
147
1
Version Control Title Terms of Reference for Greater Manchester Healthier Together Joint
Committee
Author Alex Heritage ( Programme Director)
Version V 1.4
Target Audience Greater Manchester Clinical Commissioning Group Governing Bodies
HTP Reference
Created - date 28th November 2014
Date of Issue
Document Status Draft v0.8
Description Terms of Reference for Greater Manchester Healthier Together Joint Committee
File name and path
Document History:
Date Version Author Notes
28/11/2014 0.1 Alex Heritage Draft for legal advice
04/12/2014 0.2 Hempsons Solicitors
Amendments to draft
19/12/2014 0.3 Gemma Batchelor
Slight changes made to grammar following comments at CIC meeting
29/09/2015 0.4 Mandy Noble Amendments to ‘functions’ and ‘decisions’ to take account of programme implementation
06/10/2015 0.5 Alex Heritage Final draft review
13/10/2015 0.6 Hempsons Solicitors
Amendments to draft
28/10/2015 0.7 Mandy Noble Amendments following comments at CIC meeting
22/12/2015 0.8 Rachel Volland Amendments to membership lists
Approved by:
These TOR were considered and approved by the HT Joint Committee on:
148
2
NHS Greater Manchester Clinical Commissioning Groups
Healthier Together Joint Committee
Terms of Reference
These Terms of Reference are drawn up using the template in Appendix 2 of the CCG
Establishment Agreement (clause 12.3.2). In the event of contradiction or dispute, this
document should be seen as the authoritative document in respect of the Healthier Together
Joint Committee functions.
1. Introduction
The Greater Manchester Clinical Commissioning Groups have established an association of them known as the Association of Greater Manchester Clinical Commissioning Groups (Association). The Association was established by an agreement dated 2nd April 2013 (Establishment Agreement). The CCG members of the Association who are listed in the table below as Voting Members (CCGs) have decided to work together on the Healthier Together programme. To this end, the CCGs established the Healthier Together committees-in-common (HTCiC) and have now agreed to establish a Joint Committee, as the successor to the HTCiC, which shall be responsible for Level B decision making in relation to the Healthier Together programme. The CCGs’ Joint Committee shall be called the Healthier Together Joint Committee (HTJC).
The HTJC is comprised of one representative from each of the CCGs and its constitution; meeting arrangements etc are set out in these terms of reference. Healthier Together is one part of an overall public sector service transformation programme led by Greater Manchester Local Authorities and the NHS, alongside other partners. The scope and focus of the Healthier Together hospital programme is: Urgent, Emergency & Acute Medicine; General Surgery. In addition, it is recognised that there are key services that are interdependent with the above services which will be included to the extent of their dependency, within the final Model of Care (Hospital Services): Anaesthetic Services; Critical Care; Clinical Support Services (e.g. Diagnostics). Furthermore, programme documentation will also describe the enabling changes in local ‘Out of Hospital’ services that will need to take place before changes to hospital services are made. The HTJC will perform the functions delegated to it by the CCGs in relation to any healthcare service changes (either in hospital or out of hospital) proposed as part of the Healthier Together programme, which involve the oversight and assurance of programme implementation.
149
3
2. Establishment
The CCGs have agreed to establish and constitute a Joint Committee with these terms of reference to be known as the HTJC. The HTJC will supersede the Healthier Together Committees in Common (HT CiC) following the endorsement of the Decision Making Business Case (DMBC) and the conclusion of the Healthier Together decision making phase.
3. Functions of the Committee:
Agree and oversee programme plans of the Healthier Together implementation process. Act as the decision making body; authorising subgroups (e.g. Programme Board) to
oversee and lead Healthier Together changes.
Determine and issue guidance for the formation of single services. Make decisions as to a sequencing approach for the implementation of single service
changes. Make decisions as to each single service’s state of readiness for implementation at the
relevant stages of change. Agree and oversee a pan Greater Manchester HR and Workforce framework to deliver
workforce standards as described in the Healthier Together Model of Care. Assure that a suitable pan Greater Manchester financial framework to detail activity and
finance assumptions to support single service business cases is developed by Chief Finance Officers.
Endorse GM clinical specifications and standards as recommended by the Greater
Manchester Clinical Alliance. Assure appropriate patient engagement in each single service.
Ensure compliance with public sector equality duties for the purposes of implementation. Assure appropriate communications and engagement in each single service. Assure the North West Ambulance Service implementation plan. Agree the benefits framework to underpin benefits realisation and monitor the
consistency of service provision during transition.
Assuring the attainment of the Healthier Together Implementation Conditions and the Equality Conditions.
150
4
In discharging its responsibilities the HTJC will also: Oversee pan Greater Manchester assurance and oversight to deliver implementation.
Ensure appropriate mechanisms are in place to enable single services to develop and operate in concert for the benefit of Greater Manchester patients.
4. Category 1 and Category 2 decisions
The following decisions of the Joint Committee shall be Category 1 decisions:
i. To agree a sequencing order for the implementation of the 4 single services; ii. To agree each single service’s state of readiness for Go-Live patient level changes in
relation to high risk general surgery patients.
All other decisions of the Joint Committee shall be Category 2 decisions, unless the Joint Committee specifically and unanimously agrees that another issue should be considered as a Category 1 decision.
5. Membership
The Joint Committee will be chaired by a Non-voting Independent Chair. The voting members of the Joint Committee shall comprise one Governing Body member from each of the CCGs. Each CCG’s nominated Governing Body member is listed in the table overleaf (“Joint
Committee Member”). Membership of the Joint Committee will combine both Voting and Non-voting members. Non-voting members of the Joint Committee represent other functions/parties/organisations or stakeholders who are involved in the programme and will provide support and advise the voting members on any proposals.
151
5
Independent Chair – Philip Watson CBE
Voting Members
Organisation Member
Nomination
Title Remarks
1 NHS Bolton CCG Dr. Wirin Bhatiani CCG Chair
2 NHS Bury CCG Dr. Kiran Patel CCG Chair
3 NHS Central Manchester CCG Dr. Mike Eeckelaers CCG Chair
4 NHS Heywood, Middleton and Rochdale CCG Dr. Chris Duffy CCG Chair
5 NHS North Manchester CCG Dr. Martin Whiting CCG Clinical Accountable Officer
6 NHS Oldham CCG Dr. Ian Wilkinson CCG Clinical Accountable Officer
7 NHS Salford CCG Dr. Paul Bishop CCG board member
8 NHS South Manchester CCG Dr. Bill Tamkin CCG Chair
9 NHS Stockport CCG Dr. Ranjit Gill CCG Clinical Accountable Officer
10 NHS Tameside and Glossop CCG Dr. Alan Dow CCG Chair
11 NHS Trafford CCG Dr. Nigel Guest CCG Clinical Accountable Officer
12 NHS Wigan Borough CCG Dr Tim Dalton Clinical Chair
Non - Voting Members
1 Programme Sponsor Ian Williamson
2 Greater Manchester Association of Clinical Commissioning Groups
Hamish Steadman Chair
3 Greater Manchester Service Transformation Leila Williams Director of Service
Transformation
4 AGMA Representative Steven Pleasant Lead Local Authority Chief Executive for Health
5 Health Watch representative Jack Firth
6 Greater Manchester Service Transformation Sophie Hargreaves Programme Director
7 NHS Eastern Cheshire CCG Dr Fleur Blakeman Strategy & Transformation Director
8 NHS East Lancashire CCG Dr Peter Williams GP
9 NHS North Derbyshire CCG Dr Debbie Austin Governing Body GP
Neighbouring CCGs have been engaged to participate as non-voting members, see above.
152
6
6. Deputies
The individual named in the table below (who is a Governing Body member) may deputise for the Joint Committee Member appointed by its CCG: The table of individuals authorised by the CCGs to deputise for their representatives is shown below:
Organisation Deputy
Nomination Title
1 NHS Bolton CCG Susan Long CCG Chief Officer
2 NHS Bury CCG Stuart North CCG Chief Officer
3 NHS Central Manchester CCG Edward Dyson Interim CCG Chief Operating Officer
4 NHS Heywood, Middleton and Rochdale CCG
5 NHS North Manchester CCG Helen Speed
Programme Director Urgent Care and Collaborative Commissioning
6 NHS North Manchester CCG Joanne Downs Head of Finance
7 NHS North Manchester CCG Moneeza Iqbal Programme Director - Planned Care, Long Term Conditions and Public Health
8 NHS North Manchester CCG Joanne Newton Director of Finance
9 NHS Oldham CCG Denis Gizzi CCG Managing Director
10 NHS Oldham CCG Julie Daines Chief Finance Officer
11 NHS Salford CCG Steve Dixon Chief Finance Officer
12 NHS South Manchester CCG Caroline Kurzeja CCG Chief Officer
13 NHS Stockport CCG Gaynor Mullins CCG Chief Operating Officer
14 NHS Tameside and Glossop CCG Steve Allinson CCG Chief Officer
15 NHS Trafford CCG Gina Lawrence Director of Commissioning and Operations / Chief Operating Officer
16 NHS Wigan Borough CCG Trish Anderson CCG Chief Officer
17 NHS Wigan Borough CCG Frank Costello Vice Chair
Any other individual may deputise for any Joint Committee Member provided that the relevant CCG has sent a completed authorisation form (Appendix 4 to the Establishment Agreement for the Association of GM CCG) in respect of such individual’s attendance at the
meeting to the Chair of the Joint Committee to arrive no later than the day before the relevant meeting (or within such shorter period before the meeting as the Chair may in his or her sole discretion decide). Any individual so authorised must be a member of the CCG’s
Governing Body.
153
7
7. Meetings
The Joint Committee shall meet at such times and places as the Chair may direct on giving reasonable written notice to the members of the Joint Committee. Meetings will be scheduled to ensure they do not conflict with respective CCG Boards. Meetings of the Joint Committee shall be open to the public unless the Joint Committee considers that it would not be in the public interest to permit members of the public to attend a meeting or part of a meeting. A protocol for public meetings is included at Appendix A.
8. Quorum
The quorum for a meeting of the Joint Committee shall be:
For a meeting at which a Category 1 decision will be made, all of the voting members of the Joint Committee must be in attendance or able to participate virtually by using video or telephone or web link or other live and uninterrupted conferencing facilities.
For a meeting at which no Category 1 decisions will be made, as close to 75% (in terms of whole numbers) of the voting members of the Joint Committee (therefore 9 out of 12) are required to be in attendance or able to participate virtually by using video or telephone or web link or other live and uninterrupted conferencing facilities.
9. Attendees
The Chair of the Joint Committee may at his or her discretion permit other persons to attend its meetings but, for the avoidance of doubt, any persons in attendance at any meeting of the Joint Committee shall not count towards the quorum or have the right to vote at such meetings.
10. Attendance at meetings
Members of the committee may participate in meetings in person or virtually by using video or telephone or web link or other live and uninterrupted conferencing facilities.
11. Voting
The voting members (which, for the avoidance of doubt, include any deputies attending a meeting on behalf of the Joint Committee Members in accordance with paragraph 6 above) shall each have one vote. For Category 1 decisions, a majority vote would require the support of as close to 75% (in terms of whole numbers; therefore 9) of the total number of voting members at any given time. Assuming that any meeting is quorate for Category 2 decisions, the support of as close to 75% (in terms of whole numbers, see Appendix B) of CCG voting members participating in the respective decision would be required for it to be agreed.
154
8
12. Administrative
Support for the Joint Committee will be provided by the Service Transformation Directorate. Papers for each meeting will be sent to Joint Committee members no later than one week prior to each meeting. By exception, and only with the agreement of the Chair, amendments to papers may be tabled before the meeting. Every effort will be made to circulate papers to members earlier if possible.
155
9
Appendix A
Protocol for Public Meetings
1. Introduction Meetings of the Joint Committee shall be open to the public unless the Joint Committee considers that it would not be in the public interest to permit members of the public to attend a meeting or part of a meeting. Category 1 decisions must be taken in a public meeting. The purpose of this protocol is to provide guidance on the preparation and running of any public meeting arranged by the Service Transformation Directorate. 2. Preparation for a Meeting The following issues should be considered at the initial preparation stage:
Objectives/purpose. All Category 1 decisions should be taken at public meetings of the Joint Committee.
Time, date and venue. Consideration should be given to the likely number of attendees, thinking particularly about places that have convenient access for people with disabilities. A suitable venue should be chosen which can accommodate the numbers expected to attend.
Publicity. The event should be publicised, as agreed by the Joint Committee, at least four weeks in advance of the meeting so that people can plan to attend, know where to go and what to expect. The Joint Committee will be required to publicise the event as follows:
o The Healthier Together website o All CCG member websites and in the normal places where local CCG Governing
Board meetings are publicised (by CCG’s). o Through key stakeholder groups to be identified when the agenda for the meeting
is set (by CCGs where applicable). .
Chairing arrangements. Meetings will be formally chaired by the appointed Independent Chair who will be required to work with the team to agree the use of presentational aids (where required) and general housekeeping matters.
Provide accessible and timely information. The Joint Committee will publish the agendas (only) for all meetings one week in advance of the meeting taking place on the Healthier Together website. Unless otherwise directed by the Joint Committee, Members will receive papers for public meetings one week in advance of the meeting taking place at which point papers will be available to the public on request. To ensure papers are understandable each paper will have an overview summary or introduction to the topic that external audiences can easily understand.
156
10
3. Guidelines for the Meeting The role of the Chairman should be to:
open the meeting keep the meeting focused on the agenda – if necessary, to refer people back to the
agenda make sure that everyone who wants to speak gets a chance – not allowing one or two
people to dominate proceedings draws the meeting to a close at the appropriate time. Creating the right atmosphere The organiser(s) should aim to arrive at the venue in good time to check that any equipment and facilities requested are in place. This will include any catering arranged, as well as the equipment needed at the meeting. The location of firedoors and alarms should also be checked. Those attending should be greeted as they arrive, avoiding any serious debates or discussions before the meeting starts. Making a good start The meeting should be started at the time arranged, with the appropriate introductions and a summary of the purpose of the meeting. If it is likely to be a while before the attendees can express their views (e.g. because there is a short, initial presentation), this should be made clear, so that people have an expectation about the way the event is likely to proceed. Getting the most from the meeting
Make good use of questions raised at the meeting to probe, challenge and fully understand the views that people may have
Arrange for someone to keep notes on the main points raised Keep an attendance sheet, with contact details, so that those attending can be provided
with follow up information At the end of the meeting thank people for attending and explain clearly what the next
steps will be. After the Meeting All agreed actions should be followed up after the event. Consideration should also be given to lessons learnt from the process, such as: did the meeting achieve what was expected? what aspects of the meeting were successful and what did not work? did things go as planned or were there any surprises? were there any problems that could have been avoided?
157
11
Appendix B
Quoracy & Voting for Category 2 Decisions
Quorate
For a meeting at which no Category 1 decisions will be made, as close to 75% (in terms of whole numbers) of the voting members of the Joint Committee (therefore 9 out of 12) are required to be in attendance or able to participate virtually by using video or telephone or web link or other live and uninterrupted conferencing facilities.
Voting
Assuming that any meeting is quorate for Category 2 decisions, the support of as close to 75% (in terms of whole numbers) of CCG voting members participating in the respective decision would be required for it to be agreed.
As a minimum of 9 CCG voting members are required to participate in a Category 2 decision the following rules apply.
Number of Voting Members Participating Number of Votes Required to In the Category 2 Decision Support Decision 12 9 11 8 10 8 9 7
158