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Minutes of the NKHA Clinical Commissioning Executive Meeting held on Wednesday 26th October 2011 at 9.00am in the Ibbotson Room, Broad Lea House, Bradley Business Park, Huddersfield Present: Valerie Aguirregoicoa David Kelly Ajit Mehrotra Nadeem Ghafoor Khalid Naeem Kathryn Greaves Farhad Kohi Yasar Mahmood Tony Gerrard Imran Patel Carol McKenna Sheila Dilks

Non-executive Associate and Chair CCG Chair CCG member CCG member CCG member CCG member CCG member CCG Member Non-executive Director Non-executive Associate Chief Operating Officer Director of Transformation

In attendance: Jan Randall Jackie Holdich Rachel Carter Natalie Ackroyd Alex Wilson

Commissioning Manager Commissioning Manager Deputy Director of Commissioning & Strategic Development Business Performance Reporting and Planning Manager Assistant Director of Finance

Minutes: Natasha Brown

Personal Assistant to North Kirklees Health Alliance


Welcome & Apologies Apologies for absence were received from: Rachael Kilburn Sarah Muckle Steve Brennan


CCG member Senior Public Health Manager Assistant Director of Finance

The minutes of the meeting held on 28th September 2011 The minutes of the CCE meeting held on 28th September were AGREED as a true and accurate record.


Matters Arising / Action Sheet Page 1 of 9

The attendees looked through the action sheet and gave updates on any action points that were allocated to each of them. EC/11/34

Declaration of Interest No declarations of interest were voiced.


Transition updates Governance Arrangements – A paper summarising the revised governance arrangements were discussed. The paper included a diagram to show the relationship between the Cluster Board and the CCE, and the CCE and its subgroups. Below are the Non Executive Associate representatives for each of the Subgroups: Audit and Governance – Imran Finance & Performance – Imran Quality Group - Valerie Clinical Commissioning Executive Terms of Reference The Cluster Board have approved the Terms of Reference (TOR) for the CCE and this was discussed in detail. It was made apparent that no Standing financial Instructions have been produced, however Carol McKenna will bring these to the next CCE meeting. Action: Carol to bring Standing Financial Instructions to the CCE meeting, 23/11/2011 Action: (Item 4.2 & 13) Carol to raise declarations of interest issues with the Cluster Board. Quorum - It was confirmed that Valerie Aguirregoicoa will remain as the Chair of the Committee and David will remain as Vice Chair. Action – Carol to confirm with the Cluster Board whether David would count as a Clinical Member as well as a Vice Chair at CCE meetings. Voting - Attendees queried who will be the voting members that sit within the CCE. Action: Carol to query this with the Cluster Board. Audit and Governance Group Terms of Reference Two clinical CCE members from NKHA are required to attend future Audit and Governance Group meetings. It was agreed that Ajit would undertake this role as the governance lead and David would liaise with others outside the meeting to confirm the second representative Page 2 of 9

Action: David to confirm the second representative from NKHA. Finance & Performance Group Terms of Reference Action – David and Carol to discuss who will be chairing the F&P Group and will feed back at next CCE meeting (23/11/2011) Quality Group Terms of Reference Patient experience Action – Carol to include in point 7 that a representative from LINKS/PPE need to included in Required Attendees Reporting Arrangements Action – Sheila to review reporting arrangements from other groups whose remit should inform the work of this subgroup. Proposed Sheila to Chair the quality sub group, management support from Jackie. Action -Sheila & Jackie to amend TOR accordingly The Committee received and noted the CCE and SubCommittee terms of reference and asked that Carol feed comments back to Cluster Board. Commissioning Support Update Carol shared the Developing Commissioning Support draft paper with the CCE members. Self Assessment and Authorisation Carol informed the group that a meeting will be arranged to prioritise the outcomes of the self assessment and this will then be shared at a CCG meeting. Action – Carol to arrange a meeting with David, Jan and Jackie. EC/11/36

Mid Yorkshire Clinical Service Strategy David informed the CCE members that the Mid Yorkshire session that took place on 18th October was a very successful evening. Martin Land presented presentations around the 5 options and table top exercises were done by attendees. It was suggested that all work/comments that were completed on the night, will be collected and collated by Jan Randall and this would then be shared at the GP Forum on 17th November if available. Action – Jan Randall to request for all flip chart papers from the 18th October. Page 3 of 9

Action – Natasha to email Nadeem the NCAT review document. David has sent a letter to Julia Squire (Chief Executive, MYHT), inviting her to come along to the GP Forum on 17th November. The purpose of this is for Julia to outline the proposed service reconfiguration options for MYHT to our Practices and also give GP Practices the opportunity to give feedback on these proposals at the event. Julia Squire has not yet confirmed her attendance. Action – Natasha to contact Julia’s P.A and find out if the letter has been received. Carol stated the importance that as many CCE members attend the session for Senior Leaders regarding Mid Yorkshire Health Economy on 2nd & 3rd November at Roger Thorpe Hotel, Pontefract. CCE members who cannot be present at this event, but would like to feed in to this session should inform one of the attendees. Action – Natasha to ensure agendas are sent out and also to inform Judith Salter that Khalid will be attending on 3rd November. Action – Jan to produce a simple time line for Mid Yorkshire Clinical Service Strategy. EC/11/37

Performance Report Mixed Sex Accommodation: There were 14 reported breaches in August, an increase from 4 reported in July, these were all at Mid Yorkshire Hospital Trust and are reported as “on the HDU/MAU at Dewsbury District Hospital”. An NHS Yorkshire and the Humber wide meeting has been arranged in September to discuss the decision matrices being used to inform the declarations of mixed sex accommodation. 18 Weeks Referral to Treatment: The 18 Week Programme Board continues to meet on a bi weekly basis in order to manage and address the 18 Week RTT Admitted 95th Percentile and Incomplete issues highlighted in specific specialities. The Board is assured that the 18 week backlog continues to reduce, and on a whole, is in line to clear by November; however, some specialities are performing better than others. At the week ending 2 October 2011 there were 784 patients waiting over 18 weeks for treatment at MYHT, down by 58 from the previous week and by 1,391 from a high of 2,175 in March 2011. In the 23 weeks since the 18 week reduction plan was put in place in May 2011, the over 18 week backlog has fallen in all but 2 specialities. Page 4 of 9

A&E: Dewsbury District Hospital and Pontefract General Infirmary continue to achieve a year-to-date performance above 95%, however, it remains a significant challenge at Pinderfields General Hospital. The reasons for the breaches are still largely due to bed capacity and plans are in place to address this issue with additional beds coming on stream by the end of September. Mid Yorkshire Hospital Trust year-to-date A & E activity breakdown by site shows: -

Dewsbury District Hospital = 96.09% Pinderfields General Hospital = 89.11% Pontefract General Infirmary = 97.12% Progress on Delivery of QIPP Savings The majority of the QIPP plans are expected to deliver the required level of savings. However, there is a risk that ÂŁ1.5m of plans may not be fully achieved at the end of the year which is mainly due to slippage in implementing the agreed plans. The bulk of this risk, ÂŁ1.4m, rests with secondary care related schemes, although there is a risk of ÂŁ0.1m on mental health schemes. This position is an improvement from that previously reported. In order to fully deliver the QIPP target, the PCT is actively working with GP Commissioners to strengthen the delivery of secondary care efficiencies in a number of ways. This includes linking QIPP priorities to the PBC Incentive Schemes and QoF targets, as well as working with them to identify new areas of efficiencies. We are also working with them to help deliver the mental health efficiencies. Elective Activity The PCT is closely performance monitoring these supporting measures and although actual activity is showing above planned trajectory, there is confidence at this stage that the year-end plan figures will be achieved.


Finance Report Alex Wilson outlined the main messages contained in the written finance paper. Finance position - The main movements in month are an improvement in the QIPP position but a worsening in the acute trading position. This means that the overall position is now predominantly due to forecast overspends on acute contracts. Page 5 of 9

Secondary Care QIPP Position - The position has improved by £740k in month and is now forecasting and under achievement of £590k. Clarity has now been made on the level of category M drugs price related savings for 2011/12 and the expected impact of these for NKHA is £740k. This reduction appears to be borne out by the PPA forecasts. It is unlikely that acute QIPP schemes will enable to fully achieve their targets by the end of the year. For prudence the budget freed up by the category M drugs savings has been used to partly offset this position on a recurrent basis. This report emphasises the importance of continuing this work and ensuring that QIPP remains a high priority for the consortia. Acute Contact Position - A forecast overspend with Mid Yorkshire Hospitals Trust of £1,550k, which is an increase of £800k from the previous month. Discussions are ongoing with the Trust to further understand the trading position and likely forecast out turn. A forecast over spend with Bradford Teaching Hospitals NHS Trust of £330k which is a slight decrease from the previous month’s position. This is a significant variance on a contract with an annual value of £2.25m. Work is underway to understand the reasons for this variance and movement in month. A forecast under spend with the Yorkshire Ambulance Service of £150k relating to the patient transport service. This reflects the recently signed contract which is lower than the previous year’s contract value. Financial Risk Analysis - Prescribing expenditure information for 2011/12 has not yet been received from the PPA, and actual expenditure may differ from forecast as this information begins to flow. Prescribing expenditure has been volatile in previous years. Clinical Engagement Budget This budget incorporates the existing clinical engagement budget and the additional £2 per head of population funding for the development of consortia. Budget for shadow board members is forecast to be fully spent by the end of the year Budgets for other areas are currently under spending as these initiatives will be put into practice later over the coming months. Future Developments - As we move forward over the coming months the content and format of the financial reporting for the consortia will be developed. There are a number of strands to this: Page 6 of 9

Improving the reporting of information so there is less reliance on apportionment based on weighted list size wherever possible; Beginning to understand what the likely revenue allocation to the consortia might be and what the implications of this are; Linking Board level information and reporting to that available at practice level and developing ways of using this to best identify and deliver commissioning and financial priorities for the consortia. EC/11/39

Contracting Report Rachel presented highlights from the Contracting Report and responded to questions which covered the following: Overall referrals to Mid Yorkshire Trust remain below planned levels (-6%) mainly in General Medicine & Trauma and Orthopaedics. Total referrals are also below the same period last year for the main PCTs except Kirklees PCT. Other referrals are continuing to increase over last years levels particularly in Thoracic Medicine in spite of the restrictions on C2C referrals still being in place. 18 Weeks – The number of over 18 week waiters has continues to reduce during the month on both the admitted and the nonadmitted PTL however this is still over the agreed trajectory for admitted patients. Community Midwife Contracts – the new limit for 2011/12 restricts Midwife contacts to 15 per birth. Overall PCTs is under the ratio but contacts are over the ratio for Wakefield PCT: Total Delivery Event 1,279 15 Contacts per birth 19,185 Contacts above expected level + 415 Potential Financial impact at average contacts price £63.65 Potential adjustment £26.414 Any Qualified Provider- by October 2011, PCT Clusters are expected to identify three or more community mental health services in which to implement patient choice of Any Qualified Provider in 2012/13. Selection is to be based on priorities of pathfinder CCGs. Suggested early priorities for NKHA are: Diagnostics West Yorkshire Sexual Assault referral Centre Adult Hearing Services There was a lengthy discussion around the final suggested priorities many of those present felt that West Yorkshire Sexual Assault referral Centre is not a priority in North Kirklees.

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Action – All issues that were voiced, Tony Gerrard agreed to feed back comments to the Cluster Board. EC/11/40

Strategy Planning Jan stated that she has only received comments back from Rachael Kilburn on the strategy planning document. Jan emphasised the importance of CCG members to complete bullet points with their key leads before 5th November, and bring them to the Strategy meeting on 9th November. Action – All to ensure bullet points are completed by 5th November.


Any Other Business Minor Surgery Business Case The planned F&P meeting was cancelled on 19th October as they wasn’t a NED present. Action – Carol to take the Minor Surgery Business Case to Mike Potts for sign off. Action – Natasha to circulate the Equality Impact assessment Business Care Pro Forma The Business Case Pro Forma has now been approved and Steve has requested for it to be circulated. The prioritisation framework should be utilized by all departments. Communication with the Media and members of the public David asked the members present if anyone would be prepared to talk to the media and members of the public about the Mid Yorkshire Clinical Services Strategy. David, Khalid and Farhad expressed an interest, however it was felt that training was needed and the Communications team was arranging this. Action – Natasha to inform Alison Hyde of the members that have expressed an interest and also enquire about training.

111 Specification Farhad stated that he will bring the 111 Specification to the next meeting, and circulate the Urgent Care document to all members. Action – members to feedback any comments to Farhad by Thursday 3rd November. This concluded the content of the CCE meeting and the Chairman declared the meeting CLOSED at approximately 12.30pm. Date of next meeting: Wednesday 23rd November 2011 – 9.00 to 12.00 Stewart Room, Broad Lea House. Page 8 of 9

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

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