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NHS Calderdale, Kirklees and Wakefield District Cluster

Minutes of the Inaugural Cluster Board held on Tuesday 4 October 2011 at 9.00am at St Catherine’s Church Centre, Doncaster Road, Wakefield Present: Angela Monaghan Roger Grasby Ann Liston Keith Wright Sandra Cheseldine Tony Gerrard Roy Coldwell Mehboob Khan Mike Potts Matt Walsh Ann Ballarini Sue Cannon Dr Judith Hooper Dr Graham Wardman Dr Andrew Furber In attendance: Gill Galdins Julie Lawreniuk Carol McKenna Sue Ellis Peter Flynn Vicky Pickles Alison Fearnley Pauline Kershaw Cathy Edwards Matthew Day Andy Buck

Chair Non Executive Director and Vice Chair Non Executive Director Non Executive Director and Audit Committee Chair Non Executive Director Non Executive Director Non Executive Director Non Executive Director Chief Executive Executive Medical Director Executive Director of Commissioning and Service Development Executive Director of Quality and Governance (Nursing) Executive Director of Public Health (NHS Kirklees) Executive Director of Public Health (NHS Calderdale) Executive Director of Public Health (NHS Wakefield District) Chief Operating Officer (NHS Wakefield District) Chief Operating Officer (NHS Calderdale) Chief Operating Officer (NHS Kirklees) Director of Human Resources and Organisational Development Director of Performance and Commissioning Intelligence Head of Corporate Affairs (NHS Calderdale) Corporate Governance Administrator (NHS Kirklees) Executive Assistant (NHS Kirklees) Yorkshire & Humber Specialised Commissioning Group (Agenda item CKWCB/11/07) Yorkshire & Humber Specialised Commissioning Group (Agenda Item CKWCB/11/07) NHS South Yorkshire and Bassetlaw (Agenda item CKWCB/11/07)

In addition there were two members of the public also in attendance. The Chair opened the meeting by welcoming all those in attendance to the Inaugural meeting of NHS Calderdale, Kirklees and Wakefield District Cluster Board and formal introductions were raised. The Chair gave an opportunity for members of the public to raise any questions. No questions were made. Page 1 of 11


Apologies for Absence Apologies for absence were received from Sheila Dilks, Director of Transformation and Chris Dowse, Director of Transition, Calderdale & Mid Yorkshire Health Economy Foundation Trust Programme.


Declarations of Interest Roger Grasby and Ann Liston declared an interest in the agenda item CKWCB/11/07.1 regarding the 2010/11West Yorkshire Resilience Forum Annual Report given they are both members of the West Yorkshire Police Authority.


Minutes of the Cluster Partnership Meeting held on 6 September 2011 The minutes of the Cluster Partnership meeting held on the 6 September 2011 were AGREED as a true and accurate record.


Matters arising and review of progress against actions There were no matters arising from the minutes of the Cluster Partnership meeting held on 6 September 2011. The Cluster Board reviewed and updated the outstanding actions from the action log sheet. This would be updated and circulated with the Minutes from today’s meeting. Roger Grasby advised that there was a new emergency telephone number being established ‘101’ from 16 November 2011. Mike Potts confirmed he was sighted on this issue and had raised concerns both locally and nationally.


Chair’s Comments The Chair had no additional comments to make on this occasion.


Proposed Governance arrangements for the NHS Calderdale, NHS Kirklees and NHS Wakefield District Cluster Board Angela Monaghan introduced the report outlining the Governance arrangements for the Cluster Board and explained that there were a number of complex documents to be agreed by the Board. Vicky Pickles provided a summary of each of the documents and the Board reviewed the overarching issues. In particular the following points were made:

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Keith Wright expressed concern regarding paragraph 3.9 of the covering report concerning delegation of responsibilities from the Chief Executive and asked when this would be resolved. Vicky explained that this work linked to the revision of the Standing Financial Instructions (SFIs) which was still ongoing. In the meantime she confirmed that the Board was currently working to the existing SFIs adopted in March 2011 by the three individual PCTs which were based on Wakefield District PCT SFIs. Vicky also clarified that the SFIs delegate authority to officers of the PCT not GPs following a query raised by Roy Coldwell. The Board reviewed the diagram on page five of the covering report. It was acknowledged that a firm line needed to be put in between the box from the Cluster Board to the box of the Clinical Commissioning Executive(s) / Commissioning Executive Committee. The Board went on to review Appendix 1 – schematic diagram of the Proposed Cluster Governance Structure. Roger Grasby asked for clarity regarding the dotted lines between the Health and Wellbeing Boards and the Safeguarding Boards. Vicky explained that the dotted line represented the relationship between these boards and the Cluster Board confirming that there was no formal line of accountability between them. Roger suggested that there needed to be a different means of communicating this message. The Board went on to review the proposed Cluster Audit Committee ToR. Vicky explained that the ToR had been modelled from the NHS Audit Committee Handbook and in consultation with the three former Audit Committee Chairs. It was acknowledged that colleagues were broadly content with these but they could be subject to change in the future. It was therefore AGREED to review the Audit Committee ToR in 6 months rather than 12 months to reflect on whether the arrangements are working effectively. In addition it was also recognised that Internal Audit would be reviewing all ToR in the New Year. It was subsequently AGREED that the findings from the Internal Audit review would be presented to the Cluster Board in March 2012. It was noted that the Chair of the Audit Committee had been appointed by the Appointments Commission not the Cluster Board. Angela Monaghan made reference to paragraph 3.6 concerning urgent matters arising between meetings. She emphasised that any business carried out between meetings must be formally reported to the Committee at the next meeting. This issue applies to all the TOR being approved by the Board. Angela also made reference to paragraph six concerning relationships and reporting. The Board asked that the requirement for the local Audit and Governance Group to provide minutes to the Audit Committee be included. Page 3 of 11

The Cluster Board AGREED the Terms of Reference subject to the above comments. The Board reviewed the Cluster Governance Terms of Reference. Vicky explained that these had been drafted by the risk management leads across the three PCTs. The Board discussed and agreed the core membership of the committee which was seen to be fundamental. 3 Cluster Non Executive Directors (NEDs) Chief Operating Officers for NHS Calderdale, NHS Kirklees, NHS Wakefield District Executive Director of Quality & Governance (Executive Nurse) Executive Medical Director Head of Corporate Governance The Chief Executive, other Executive Directors and officers shall be invited to attend for discussions when the Committee is discussing areas that are the responsibility of that Director. Roy Coldwell suggested that a critical alert system needed to be put in place. Sue Cannon described the work that was being undertaken to develop a collective Board Assurance Framework (BAF) for the Cluster. She confirmed that a fit for purpose BAF would be in place by 1 November 201, which would be brought to the next meeting for approval. It was AGREED to include an additional bullet point under paragraph 5.2 concerning the list of duties of the Committee. To ensure that arrangements are in place that all relevant officers of the Board are informed of Critical Risks. It noted that the final bullet point under the governance section on page eight was incomplete and needed to be removed. It was suggested that the bullet point relating to non-compliance with the NHS Constitution needed to be more positive and include reference to staff pledges. Furthermore it was suggested that an additional statement regarding Workforce and Resilience issues needed to be added to the Governance section. Keith Wright enquired if the existing Risk and Governance Committees had now been disbanded. Vicky confirmed they had and explained that this was covered in the Legacy documents. She confirmed that outstanding actions and Minutes would be presented to the first meeting of the Cluster Governance Committee to ensure continuity of business. It was noted that new meeting dates would be set up when the membership had been agreed.

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The Board AGREED the Governance Committee Terms of Reference subject to the above comments/amendments. The Board then reviewed the Remuneration and Terms of Service Committee Terms of Reference. Sue Ellis pointed out that these ToR did not have the same Version Control as the other papers. Vicky AGREED to rectify this issue. It was pointed out that the membership of the committee needed to be more explicit; that the Committee shall consist of not less than three Non-Executive Directors rather than three members. The Board AGREED the Remuneration and Terms of Service Committee Terms of Reference subject to the above amendments. The Board APPROVED the proposed appointments to the Cluster Board Sub-Committees as outlined in Appendix 3 of the report and APPROVED the appointment of Roger Grasby as Vice-Chair of the Cluster Board. The Board NOTED the transition of sub-committee arrangement as outlined in Appendix 4. The Board then reviewed the revised Standing Orders. Vicky explained these had been reviewed in light of the requirement to move to a single board arrangement. Dr Hooper advised that the fourth bullet point outlined under paragraph 2 (3) concerning the Director of Public Health contradicted paragraph 3.10 of the overall report. It was subsequently AGREED to change the wording to the same as outlined in the cover paper. Angela Monaghan pointed out that paragraph 3.3 contradicted paragraph 3.2 (1) concerning the number of days written notice would be given to Board members regarding the proposed business to be transacted. It was subsequently AGREED that this should be 6 days not 3 days. A discussion ensued regarding paragraph 3.17 concerning the Admission of Public and the Press. Angela Monaghan emphasised that as much business as possible should be conduced in the public arena. It was subsequently AGREED that a specific criteria be drawn up for business that should be transacted when the press and public have been excluded from a meeting. Additionally it was AGREED to remove the sentence outlined under section 7.1.2 (h) concerning Practice Based Commissioning. The Board AGREED to ADOPT the Standing Orders subject to the above amendments. Page 5 of 11

It was NOTED that Standing Financial Instructions and the Scheme of Delegation would be presented to the Cluster Board on 1 November 2011. The Board RECEIVED and NOTED the Legacy reports from each of the individual Boards as presented at Appendix 6. Vicky explained that each of the reports had been considered by the three individual PCT Boards the prior week and she summarised the key comments and action taken. The Board then considered the draft Terms of Reference for each of the three Clinical Commissioning Executives. In particular the following points were raised: Kirklees - CCE It was noted that the Terms of Reference will become two documents; one for Greater Huddersfield Commissioning Consortium and one for North Kirklees Health Alliance. A discussion ensued regarding what influence the nominated Local Authority Director has and what their voting rights are. It was acknowledged that there was a difference in opinion across the health economy concerning this due to different options on shared resources/ business plans between PCTs and Local Authorities. It was AGREED that the Local Authority member on the CCE could be either a director or assistant / associate director. It was subsequently AGREED that the Local Authority member should be entitled to participate and vote like any other member. It was emphasised that the Cluster Board should not endeavour to operationally manage all the local arrangements and that the Cluster should empower the CCGs. Furthermore it was recognised that clear strategic objectives needed to be determined. A discussion ensued regarding the relationship/line of accountability between the CCE and the CCGs. It was recognised that in order to gain authorisation, the current CCE model needed to be established. It was recognised however that this was an evolving process. It was AGREED that the wording in paragraph 3.20 concerning Public Health Services should be adopted in the Calderdale and Wakefield ToR ie to review and consider public health services instead of to make decisions. Peter Flynn pointed out that the page appended to the back of the Calderdale CCE ToR relating to the list of ‘Key Targets to Deliver’ was missing from the Kirklees and Wakefield ToR. It was subsequently AGREED that this needed to be included. Membership should include: up to eight CCG Board members Page 6 of 11

Two non-GP clinical members (to be confirmed) Shadow Accountable Officer / Chief Operating Officer – NHS Kirklees – (instead of Executive Director) Director or Assistant Director nominated by Kirklees Council Executive Director of Public Health –NHS Kirklees Quality Lead – NHS Kirklees Chief Finance Officer – NHS Kirklees One Non Executive Director from the Cluster Board Two Non Executive Associates The Board APPROVED the Kirklees CCE Terms of Reference subject to the above amendments. Calderdale – CCE The Calderdale CCE Terms of Reference were APPROVED subject to the following amendments: paragraph 3.20 being amended as described above that the Local Authority member should be entitled to participate and vote like any other member Replace Executive Medical Director with Shadow Accountable Officer. In addition it was noted that some local flexibilities needed to be taken into consideration. Wakefield – CCE It was recognised that the federated model posed some difficulties for Wakefield. The Wakefield District CCE Terms of Reference were APPROVED subject to the following amendments: To remove the first sentence under paragraph 2 Membership is to include up to eight CCG Board members Replace Executive Medical Director with Shadow Accountable Officer paragraph 7.7.1 concerning Public Health Services being amended as described above (see Kirklees section re 3.20) that the Local Authority member should be entitled to participate and vote like any other member to include section regarding ‘Ways of Working’ as outlined in paragraph 9 in Kirklees and Calderdale CCE ToR Vice Chair to be a Non Executive Associate not a Non Executive Director Remove the first bullet point at top of page 4 concerning Executive Director of Commissioning Action needs to be taken to determine the appointments of two non GP clinical members Page 7 of 11

Finally the Board was given the opportunity to review and comment on the ToR for the CCE sub-groups outlined in Appendix 8. In particular the Board made the following comments/suggestions: Audit and Governance Group The membership should be reviewed as it was felt to be too long and needs to be consistent with other ToR ie Shadow Accountable Officer. It was recommended that paragraph 3.1 concerning the Chairing of Meetings is amended to reflect that; in the event of the Chair’s absence meetings will be chaired by the Vice Chair. It was recommended that core members should attend regularly and that named deputies should attend as a last resort. Finance and Performance Group It was suggested that it was the role of the CCE to drive the PCTs programme of work to improve QIPP (see item three outlined under paragraph 3.0 – Purpose of the Group. It was recommended that first bullet point under Membership is amended to include Shadow Accountable Officer alongside Chief Operating Officer. Quality Group It was suggested that there may be a danger of overlap between the Audit and Governance Group. Vicky provided some clarity regarding this point. It was recognised that consideration may need to be given to the workload of the NEAs sitting on all these sub-groups – frequency of meetings needs to be considered in terms of time commitment (ie need to balance capacity of NEAs). Finally, it was noted that a Register of the Boards Interests would be established between now and the next meeting. This concluded the discussion regarding the new governance arrangements. CKWCB/11/07

Safe and Sustainable – Review of Children’s Cardiac Services Cathy Edwards, Andy Buck and Matthew Day joined the meeting to update the Board on the following: Key timescales of review process for the coming months Page 8 of 11

Update on progress of the Joint Overview Scrutiny Committee (JOSC) Information that will be considered by the Joint Committee of Primary Care Trusts (JCPCT). It was noted that the briefing paper included the following Appendices, the content of which was NOTED by the Board: Appendix 1 – Briefing on Yorkshire and Humber CCAD figures for 2010/111 Appendix 2 – Briefing on the findings from the Interim Health Impact Assessment Appendix 3 – Briefing on the findings of the Report of the Public Consultation Cathy confirmed that the decision on the future configuration would be made by the JCPCT at a meeting in public on 14 December 2011 not 15 December as described in the report, subject to the outcome of the judicial review. It was therefore recognised that the timeline might have to be reviewed. It was noted that further consideration would be given to the following items at the next JCPCT meeting on 25 October 2011: Price Waterhouse Coopers (PWC) network configuration/patient flows report; The consultation findings; Any alternative options put forward Advice from the Steering Group Andy Buck, Chief Executive, NHS South Yorkshire and Bassetlaw, described his role in relation to the review. It was noted that he had assumed the role of Chair of the Specialised Commissioning Group (SCG) from 23 September 2011 as well as representative on the JCPCT. Andy clarified the delegated decision making process, explained his corporate responsibility on the JCPCT and provided assurance that all the issues had been duly considered. He confirmed that the outcome of the Joint Health Overview and Scrutiny Committees (JOSCs) would be made public after 5 October 2011. Matthew went on to describe the work which had been undertaken around the Health Impact Assessment process and provided feedback on the engagement forums with vulnerable sociodemographic groups. He confirmed that the sessions were productive and that he was satisfied that the issues that the population had reflected on were captured in Appendix 2. A discussion ensued regarding the patient flows. It was recognised that the outcome of the work being undertaken by PWC should establish if the options are viable or not. It was acknowledged that if further options emerge these would be considered by the JCPCT. Page 9 of 11

Discussion also took place regarding the impact on staffing. It was recognised that a sustainable workforce would need to be secured for the option that is considered. Assurance was provided that the review had covered workforce issues and that the JCPCT was working closely with Leeds Teaching Hospitals Trust to ensure that services were safe. It was noted that additional work would be carried out when a potential option had been identified. A debate followed regarding potential travel issues for families. Keith Wright asked if the JCPCT would be able to make specific recommendations around transport and resources for vulnerable families. It was acknowledged that the JCPTC might be minded to make these recommendations but this fell outside the remit of health. It was noted that there is a national set of arrangements for providing financial support to patients particularly those on benefits or low income, and that there is also charitable transport and accommodation available. In addition it was recognised that the responsibilities of EMBRACE may grow however they did not provide travel for relatives. The Board enquired what consideration had been given to the transition from childrens’ to adult’s services. It was recognised that the JCPCT was mindful of this. Mike also asked if Scottish provision had been considered. It was noted that Scotland was outside the national review, however Scotland had been involved in terms of consultation, as had Northern Ireland and Scotland are now undertaking their own review. A discussion ensued regarding table 1 concerning travel time impact. In particular what the impact on families was travelling to Newcastle. It was recognised that this information had previously been requested by the JCPCT but this had not been shared. It was therefore AGREED that the JCPCT would pursue this information from the JOSC. Finally, Andy provided the Board with assurance that all the concerns raised were being considered and that a corporate decision would need to be made for the country. It was NOTED that Mike Potts and Angela Monaghan would have an opportunity to comment on all the relevant information that has been gathered to inform the JCPCT’s final decision, at the regional Chairs and Chief Executives meeting being held on 15 November 2011. It was AGREED that a further update would be provided at the next meeting.

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Report on NHS Resilience and 2010/11 West Yorkshire Resilience Forum (WYRF) Annual Report Mike Potts presented the report to the Cluster Board and made some key observations concerning strengthening the West Yorkshire role within the WYRF. The Cluster Board RECEIVED and NOTED the report on NHS Resilience and the 2010/11 West Yorkshire Resilience Forum Annual report.


Yorkshire and the Humber Specialised Commissioning Group Annual Report 2010/11 The Cluster Board was presented with the Yorkshire and the Humber Specialised Commissioning Group (SCG) Annual Report. It was emphasised that the report underlined the benefits of collaborative commissioning to be taken forward in the future. Angela Monaghan said she would welcome comparative data with the previous year in the SCG financial report. It was AGREED that additional information would be brought back to the next meeting. The Cluster Board RECEIVED and NOTED the 2010/11 Specialised Commissioning Group Annual Report.


Any Other Business There were no items of any other urgent business.


Date and time of the next meeting It was AGREED that the next meeting of the Cluster Board would take place between 9.00am and 1.00pm on Tuesday 1 November 2011in the Boardroom at NHS Kirklees, Broad Lea House, Huddersfield.

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