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Minutes of the NKHA Shadow Board Executive Commitee Meeting held on Wednesday 3rd August 2011 at 9.00am in the Stewart Room, Broad Lea House, Bradley Business Park, Huddersfield Present: Valerie Aguirregoicoa David Kelly Farhad Kohi Ajit Mehrotra Rachael Kilburn Kathryn Greaves Yasar Mahmood Khalid Naeem Carol McKenna Jan Randall Alex Wilson David Boothroyd Natalie Ackroyd

Non-executive Director and Chair Shadow Board Chair Shadow Board Vice Chair Shadow Board member Shadow Board member Shadow Board member Shadow Board member Shadow Board member Chief Operating Officer GP Commissioning Manager Assistant Director of Finance Contracting Manager Business Reporting/Planning Manager

In Presence: Claire Sibbald

GP Commissioning Facilitator


Welcome & Apologies The Chair opened this first meeting by welcoming all those in attendance and the attendees introduced themselves. Apologies for absence were received from: Imran Patel – Non-executive Director Dr Nadeem Ghafoor Shadow Board member Steve Brennan, Assistant Director of Finance


Terms of Reference The attendees reviewed the draft Terms of Reference for the Shadow Board meeting and the following queries were raised:


Val queried the responsibilities of the Shadow Board. Carol said that at present everything that needed a decision would need to go through the formal Executive Committee. However, this is likely to change in future.

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The attendees then reviewed the draft Terms of Reference for the Executive Committee meeting and the following was discussed:



David felt that there was a lot of duplication in both Terms of Reference and that the responsibilities for each should be clearer. The business responsibility was discussed and agreed that it should be within the Executive Committee meeting only. Val suggested that once small amendments had been made then the Terms of Reference were accepted at present and revised in October, when further advice about roles and responsibilities had been given.

Action: Carol and David to review and make amendments now where necessary. Version control also to be added.


Context Setting and Terms of Reference The declarations of Interest document outlining areas of interest for the Shadow Board members was received and reviewed. There were a number missing from the list which were completed by the members during the meeting. Action: Once updated the list of the whole shadow board and including declarations from NEDs and Carol McKenna needs to be circulated to attendees. Action: List to be amended as Kathryn Greaves currently listed as Dr.


Update on NHS Transition Carol McKenna updated the attendees. The key areas discussed were as follows: -

Latest developments predominantly relate to cluster arrangements, which will be set nationally for consistency. The information will be discussed at meeting of Kirklees board next week. However, proposal is that the cluster board should become official board with more allocated responsibilities, reducing duplication. Angela Monaghan will take on role as chair of cluster. - There are a number of queries about how responsibilities will be delegated to NKHA board? Will they need to form their own Finance and Business subcommittee etc? Carol assured that by November they should know how this will work. Action: Carol and David to discuss latest document in more details before next Shadow Board meeting. Page 2 of 7




David suggested that the SHAs were now clustering and that there will be a Northern sector. Farhad said that an event is being held in London on the 14th September where there will be some consultation with the shadow board members on the future. Carol told that the Authorisation framework is imminent and that is was likely that goals/objectives will be set from this. Val confirmed that once the plan is out it will form a standing item on the agenda. A toolkit has also been proposed for helping with accreditation and the letter about this is currently with Karen Gallagher. There will be a meeting about this which is would be useful to attend.

Action: Discussion will be revisited once Authorisation framework has come out. Action: JR - Check event on 14 September -


Requirement for new members such as consultants and nurses to join Consortia Boards. Following a detailed discussion it was agreed that it was too early for the Shadow Board to take this further and to await further guidance from the Department of Health.

Primary Care Engagement Activity This discussion was led by David and split into engagement with practices and engagement elsewhere. Engagement with practices: -




Every practice has now signed up and agreed the constitution and Inter Practice SLA. The first cluster meetings have also taken place and feedback from these was very positive. The Practice Managers working group is up and running and providing support where necessary. The 2 monthly forum took place in May and July as did the nurse forum, which was also met positively. Clinical leads are also in the process of contacting practices once a month outside of the quarterly cluster meetings, to provide support on the actions that have been set. Newsletter is being written and there is also a single point of access for communication. Jackie is also setting up a quality board, which will look at quality and performance in primary and secondary care and Jan is creating an operational risk management process and tool. They are also keeping a register of GPs interests, which will be used if projects in certain areas need to be developed. Page 3 of 7

In answer to a question from Val about how engaged board members felt practices were Farhad said the group he was working with were very open and had volunteered to do additional work. The consensus was that although it was early days it was a very positive start. Engagement elsewhere: -



Jan had visited Link and introduced them to what NKHA was. The meeting went well and they have agreed that NKHA can help shape health watch. Link will also have some input into the commissioning plan prioirities. In terms of PPI Jan is meeting with team monthly to find out what work is currently being done and what NKHA can feed into and is putting together a PPI strategy that will be delivered by all the team. PCT Staff: NKHA meeting with staff on the 10th and 24th August at Broad Lea. They will do a presentation about visions and aims and take the opportunity to listen.

In regard to this Ajit asked if NKHA had decided on the support they need moving forward. Val said that NKHA need to be very clear about alignment as early as possible to give reassurance to staff. EC/11/05

Finance Report Alex Wilson attended the meeting as Steve Brennan had sent apologies. She presented his report updating the Shadow Board on its forecast financial performance for 2010/11, including associated risks and action being taken to manage those risks. Alex said that NKHA are currently looking at a £1.6million problem, this is mostly due to QIPP. Reserves and contingency are very limited and there are areas of Mid Yorkshire that are overspent. Latest on Mid Yorkshire without challenges is £1million over. The main risks are Mid Yorkshire contract, their performance prescribing as this is 2 months in arrears and continuing care expenditure. This year due to the cuts in funding there is also very little contingency money. At the moment clinical engagement is forecast to come in on budget, however there may be slippage. QIPP secondary care £1.3million is mainly planned care and clinical stop list. SLA £363K relates to SWYMHT as it was expected to have savings this year. However, this is non-recurrent and would need to be addressed next year. This was affected by the contract being delayed.

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Alex confirmed that main risk is Mid Yorkshire and that the contingency pot is for Kirklees as a whole, it is not split by consortia as it may just need to be used in one place. To try and combat Mid Yorkshire costs the contract needs to be controlled and activity needs to be reviewed. This should be done through looking at QIPP and patient requirements. If demand is being managed by Primary Care then savings will need to be made by Mid Yorkshire. Rachael requested more information on QIPP schemes to take to the next Mid Yorkshire run meeting. Action: Finance to provide more recent clinical engagement budget data at the next meeting as it’s currently 2 months behind. Action: Alex also to provide information on what Mid Yorkshire not expecting to pay on and re-admission following elective admission within 30 days. The Shadow Board RECEIVED and NOTED the contents of the Finance Report.


Contracting Report David Boothroyd presented the Contracting report but explained that it just focused on Mid Yorkshire and should be further reaching for the next NKHA meeting. David highlighted 2 particular issues: - Mid Yorkshire have the capacity to increase beds by 76 at Dewsbury, however, they are not keen to increase levels of activity as they don’t have capacity to deal with it at present. - Rachael raised concerns regarding palliative care as currently GPs are unable to refer to the these service. Mid Yorkshire are now recruiting additional nurses with the hope of providing this service again by October. Action: Rachael to liaise with Paul Howarthson about this and feedback. Farhad raised a query about patients under the 18 week wait for Orthopaedics. To achieve the target patients are sent by Mid Yorkshire to a private provider, however they do not screen them before they do this. As a result any patients that has a problem which may mean they need additional care is discharged by the private provider. The patient then has to return to their GP for a second referral and has to start their 18 week wait all over again. Page 5 of 7

Action: Farhad to send examples of this to David Boothroyd so that it can be logged and followed up. There is also an issue for Rheumatology patients who need injections every 3 months. After each injection they are discharged and have to be referred by their GP again. Each new referral attracts a first referral charge, when they should just been seen as follow ups. Action: Members to bring examples of this to share with David Boothroyd. Action: David Boothroyd to discuss with contracting team and identify a process for logging and raising these issues. The Shadow Board RECEIVED and NOTED the contents of the Contracting Report. EC/11/07

Performance Report Natalie delivered the report and informed the board that the 2011/12 operating framework sets out areas that will be reported on and the frequency. She brought an example of all the data that will be received in future for information only. On a monthly basis the board will receive the headline measures. Quarterly they will receive the full operating framework and at Mid Year and Year end they will receive a full report including the Strategic plan, QIPP progress, health and wellbeing and public health. The reports will also go to the cluster and PCT boards, however the cluster will increasingly fall to NKHA to show how they are dealing with information from these reports. Action: Board to review documents and inform Natalie of any data they feel is missing. The period target/2011-12 plan shows plan for year compared to what’s happened to date. Board agreed that Natalie would focus on Red/Amber areas for NKHA. Natalie informed the board that where there is a gap in data that is because it is a new report and there will be more data in September. An area of red was mixed sex accommodation, where there is a high level of breach. This is a problem with the MAU at Dewsbury hospital, which the board were already aware of. Action: A&E data which is site specific to be included in the next report, as is data on Health Visitors per CCG cluster. Natalie also to add Ambulatory Conditions data once received via SUS.

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The Shadow Board RECEIVED the documents and NOTED the performance against the key performance indicators. EC/11/08

Any Other Business

Action: Hard copies of all papers to be sent to practices for shadow board members 1 week before meeting, which they will then bring to the meeting. Action: Public Health to be invited to attend meetings. Attendance at the meeting was discussed and the board felt that it was appropriate for the two Commisisoning Managers and the Public Health Consultant to be present at the meetings going forward Action: JR to advise Jackie Holdich and Sarah Muckle Action: Future meetings – Contracting, Performance and Finance to be put on the agenda together so an hour of the meeting can be dedicated to this. The Medway directory was tabled for information. David felt that this was a piece of work that should be looked at wider, including other CCG or even West Yorkshire wide. Action: Board to read document for information about how processes have been reviewed in other areas. Medway Directory to be added for discussion at a future meeting.

This concluded the content of the Board meeting and the Chairman declared the meeting CLOSED at approximately 12.00 noon. Date of next meeting: 31 August 2011 – 9.00 to 12.00 – Board Room, BLH

Chairman’s Signature: ……………………………………………. Date: ………………….

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