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Minutes of the NKHA Clinical Commissioning Executive Meeting held on Wednesday 31st August 2011 at 9.00am in the Board Room, Broad Lea House, Bradley Business Park, Huddersfield Present: Valerie Aguirregoicoa David Kelly Ajit Mehrotra Rachael Kilburn Kathryn Greaves Carol McKenna Steve Brennan

Non-executive Director and Chair CCG Chair CCG member CCG member CCG member Chief Operating Officer Assistant Director of Finance

In attendance: Jan Randall Jackie Holdich Jayne Crorken Natalie Ackroyd Rachel Carter Sarah Muckle

Commissioning Manager Commissioning Manager Commissioning Facilitator Business Reporting/Planning Manager Deputy Director of Commissioning & Strategic Development Senior Public Health Manager


Welcome & Apologies Apologies for absence were received from: Imran Patel – Non-executive Director Dr Nadeem Ghafoor CCG member Dr Farad Kohi CCG member Dr Yasar Mahmood CCG member


The minutes of the meeting held on 3rd August 2011 Suggestion made in future to list Shadow Board members as ‘Present’ and other attendees as ‘In attendance’. Also request to bring previous NKHA Commissioning Group minutes dated 10th August to this meeting to be ratified. Other suggestion for future meetings was to put agenda on fold out sheet that could be read whilst looking at documents in the pack. The Board AGREED in future to refer to NKHA Shadow Board Clinical Commissioning Group (CCG) and the Executive Committee as Clinical Commissioning Executive (CCE) The minutes of the CCE meeting held on 3rd August were AGREED as a true and accurate record. Page 1 of 7


Matters Arising EC/11/01 As discussed in previous meeting this would be tabled on a future agenda when roles and responsibilities were clearer. EC/11/02 Declarations of Interest were now all completed and correct. EC/11/03 It was noted that no-one available to attend event 14th September. EC/11/05 Information to be covered on today’s agenda item 6. EC/11/06 Rachel has fed back to Paul Howatson who had subsequently spoken to Macmillan. Jackie is meeting with Paul and Jim Lee today to discuss further. Jim Lee has agreed to act as co-opted member NKHA for Palliative Care programme. Rachel advised that all but 1 post had been filled at MYHT in Palliative Care to start in September. Action: Jackie to clarify with MYHT how information about the new posts was to be cascaded to the GPs and advise the CCE at next meeting. Rachel advised that she was still awaiting examples to be sent through – agreed that GPs need to know what the process is for logging concerns to identify trends and also to receive feedback from MYHT if these issues were being resolved. EC/11/07 Natalie had not received any feedback that any data was missing from the report. A&E data to be covered in report tabled today. EC/11/08 Medway Directory tabled on agenda today (Item 8).


Transition Update Carol McKenna shared slides with attendees which had been taken previously to the PCT Board. The key areas discussed were as follows: -

Proposal to establish Cluster Board as official Board by 1/10/11 to replace the PCT Board. The PCT Boards were due to meet end of September where they would hand over to the Cluster Board. The Cluster Board was then to meet early October to agree the responsibilities which were to be delegated to the CCEs (see slide 3). Group agreed that as sub-committee of Cluster Board the CCE would have a lot Page 2 of 7



more responsibility and CCEs would be held to account. Clarity was needed on scheme of delegation and TOR’s. Carol would be involved in determining content of TOR One option suggested had been for 1 CCE for 2 CCGs in Kirklees, however Carol had disagreed with this as she felt it would not give the CCEs sufficient exposure to decision making in advance of authorisation. CCE agreed with this decision. Once delegation scheme agreed the next step will be to ensure that appropriate sub-groups are in place.

Scheme of Delegation being produced in October to cover the following stages:1. 2. 3. 4.

Accountability Framework Schedule of Responsibilities Financial Schedule Governance Document

Action: Carol due to meet the NEDs who are members of the NHS Kirklees Audit Committee,Tony Gerrard and Valerie to gain better understanding of options available regarding subgroup for the CCE and to gain a better understanding of the functions of the various existing groups in the PCT. Action: Carol to check proposed membership of Cluster Board to clarify whether it includes CCG Chairs. Authorisation Process – Carol shared slides which summarised the main points of detail in CCE agenda papers. Assessment would be against 6 key domains and it will be useful to start gathering evidence for final authorisation. Diagnostic Tool – Carol suggested that Board complete self assessment tool by mid October and to have a clear organisational development plan by mid November. Action: Carol to find date for small group to meet to look at assessment tool to then bring to half day for all Board. Strawperson document – David shared document which was a summary of previous document shared by Ann Ballerini at CCG Board meeting 10th August and a suggestion of areas which might be at CCG, cluster or national level. It was noted that research & development was not included in the list and should be included. Action: CCE to feedback any comment to David Action: Carol and Jayne to liaise over attendance at key meetings on 6th September and 12th September for as David unable to attend. Page 3 of 7


Performance Report Natalie delivered the report on the key performance indicators against the key 2011/12 NHS Operating Framework headline outcomes/measures. It was noted that many of the indicators that had been an issue last year were being achieved this year. Natalie outlined areas of underperformance. A&E – indicator not being achieved due to problems at Pinderfields around capacity. Action: A&E – Carol to clarify whether extra beds had been provided at MYHT following the PCT agreement to extra funding and to understand how this linked with their current financial position. Cancer – all targets being achieved but Board felt more clarity was needed about specific detail to check whether this was being recorded properly Action: Jan Randall to provide Natalie with examples of cancer wait. Stroke/TIA – This target was not being achieved. A business case has been approved for the recruitment of stroke assessment nurses to be available in A&E 24/7 in order to bring the service in line with the regional Stroke Assurance Framework and they would be in post by September 2011. As achievement so low for this indicator the Board agreed to table this issue at a future CCG meeting where the performance and issues could be challenged and queried. Action: All Board members to forward queries to David who will collate a set of questions around the Stroke/TIA service at MYHT(include a deadline for this action) Action: Jackie to identify where best to discuss this further and feedback results to the Board. Mental Health – IAPT was an area where the CCE agreed work was needed. Action: Carol to speak to Vicky Dutchburn to ask Vicky and Khalid to bring report to either a future CCE or CCG on this. Smoking Cessation – Natalie advised that the LES was currently under review and the CCE commented that the LES needed to be Page 4 of 7

financially viable to reflect the work carried out in practice in order for it to be a success. Health Checks – The CCE acknowledged that the service was not adequate and queried whether the funding for this service was money well spent. Action: Natalie to request report from Programme Manager Hayley Hancock on outcomes and evaluation of the service and to request that Finance & Performance Committee discuss this on a future agenda. Emergency Beds – Natalie highlighted this as a local priority. It was raised that other provider’s performance should also be reviewed in the performance reports going forward. Action: Natalie to speak to Alison Bragg to decide how best to report on performance of other providers e.g. Locala The CCE RECEIVED and NOTED the contents of the Performance Report.


Finance Report Steve discussed with the CCE the current financial position at MYHT. It was acknowledged that CCE needs to be part of the decisions made as responsibilities are to become increasingly delegated to them. Carol advised that there was a PCT meeting on 1st September to further understand the figures. Steve pointed out that he was not looking for CCE to make any decisions today, but to be aware of situation and ensure that going forward individuals from the group were part of the decision making process, but in the meantime the CCE could help by maintaining a strong clinical focus. The CCE queried whether Leeds was involved in discussions. Action: At Finance meeting tomorrow Steve agreed to check where Leeds fit in. Action: Carol and David to discuss further with Mike Potts to clarify who is attending meetings and what authority they have. The budget held by the PCT for clinical lead cover is to be discussed at the next senior management meeting. The issue around making more timely payments to CCE members was almost resolved. Jan had produced a proposal document for Steve suggesting making payments by standing order with a suggestion to commence on 1st November. Steve needs to read Page 5 of 7

the proposal so CCE members to continue with current paper method until advised. At the CCG Development Day on 24th August there had been a discussion around co-opting more members, recruiting new CCG member and succession planning. Action: CCG to discuss options around co-opting new members at next development session and bring proposals to CCE. The CCE noted the Finance forecast and acknowledged the risks and the efforts being taken to resolve. It was also acknowledged that they wanted to be involved in any future decision making and agreed to table on a future agenda when other meetings are to take place and who will be involved. The CCE members agreed to maintain quality patient care as their priority. The CCE RECEIVED and NOTED the contents of the Finance Report.


Contracting Report Rachel presented the Contracting report which highlighted the position on secondary care. Rachel advised that information was being shared with Wakefield and that David was attending regular meetings with Wakefield. Rachel advised the CCE to identify areas where referrals are up and in which specialties to use in practice cluster conversations. The CCE agreed that this information could be taken to a quality meeting. David queried what controls the CCGs had over referrals and Rachel confirmed that the controls were purely in terms of processes e.g. consultant to consultant but that these processes were not currently audited. Any Qualified Provider (previously Any Willing Provider). PCT clusters to identify 3 or more community or mental health services in which to implement patient choice of Any Qualified Provider in 2012/13. It was not clear if the 3 areas were across 3 clusters or by CCG, Rachel advised that clarification on this was still being sought. Action: CCE to feedback to Rachel which areas from DH list they feel match the priorities of the CCG. David suggested diagnostics, psychological therapies and hearing services as a starting point. The CCE queried whether podiatry was part of the diabetes redesign. Page 6 of 7

Patient Transport Services – Rachel advised that transport between sites should be covered in tariff but in some cases the PCT was being charged extra. A piece of work was required to look at patient numbers and costs to renegotiate the contract. Wakefield currently have resource in their team to investigate this and Rachel was seeking approval from the CCE for Wakefield to carry out this piece of work and report their findings back to the NKHA CCE. It was acknowledged that the contract needed to include transport between various sites e.g. health centres and that the criteria needs to be clear. Jan advised that one of the CCG priorities was to look for alternative providers for patient transport to YAS and asked that this be included in Wakefield’s report. Action: Rachel to feed these comments back to Wakefield team and be the link between them and the CCG The CCE RECEIVED and NOTED the contents of the Contracting Report. Approved NHSWD to undertake PTS review on behalf of NHSK EC/11/17

Medway Directory In Yasar’s absence it was agreed to postpone this item to a future meeting. Action: Jayne to table for future CCE meeting.


Any Other Business

No items

This concluded the content of the CCE meeting and the Chairman declared the meeting CLOSED at approximately 12.15pm. Date of next meeting: Wednesday 28 September 2011 – 9.00 to 12.00 – Hargreaves Room, BLH

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

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