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Draft Minutes of the Clinical Commissioning Executive Meeting held on 13 October 2011 in the Shibden Meeting Room, F Mill, Dean Clough Mills, Halifax Present:

Dr Alan Brook Dr Majid Azeb Dr Hazel Carsley Dr Steve Chambers Dr Steven Cleasby Dr Peter Davies Dr Dinesh Kumar Dr Krishna Kumar Trevor Lake Julie Lawreniuk John Mallalieu Dr John Taylor Dr Nigel Taylor Dr Matt Walsh Dr Graham Wardman Penny Woodhead

Shadow GP Consortium Board Chair (Chair) Shadow GP Consortium Board member Shadow GP Consortium Board member Shadow GP Consortium Board member Shadow GP Consortium Board member Shadow GP Consortium Board member Shadow GP Consortium Board member Shadow GP Consortium Board member Non Executive Associate Chief Operating Officer Non Executive Associate Shadow GP Consortium Board member Shadow GP Consortium Board member Shadow Accountable Officer/Executive Medical Director Executive Director of Public Health Deputy Director of Quality and Professional Development

Apologies for Keith Wright absence:

Non Executive Director

Also present:

Associate Director of Business Intelligence Joint Head of Mental Health and Learning Disabilities Head of Corporate Affairs Assistant Director, Service Improvement Head of Business Intelligence Board Secretary/Corporate Governance Manager

Deborah Graham Mick Mellors Victoria Pickles Judith Salter Tim Shields Jane Brownlie

143/11 DECLARATIONS OF INTEREST John Mallalieu declared an interest in Item 151/11 (Single Commissioning Plan) Drs. Alan Brook, Majid Azeb, Hazel Carsley, Steve Chambers, Steven Cleasby, Peter Davies, Dinesh Kumar, Krishna Kumar, John Taylor and Nigel Taylor declared an interest in Item 147/11 (Annual Complaints Report) and Item 150/11 (Corporate Performance Report – smoking quitters element of the item)


144/11 MINUTES OF THE MEETING HELD ON 8 SEPTEMBER 2011 The minutes of the meeting held on 8 September 2011 were accepted as a correct record subject to the following: Page 6 – under Section 15 – Voting, the bullet point should be amended to read “There will be 10 voting GP members.” Page 10 – 139/11 GP Appraisal Annual Report 2010/11 – the final sentence of the fifth paragraph should be amended to read “Dr Davies confirmed that practices are paid by global sum at a rate of 25 pence per registered patient, which is part of the contract value.” Page 11 – the first full paragraph should be amended to read “Dr Cleasby queried the rate paid to NHS Bradford GP appraisers, which appeared to be higher than the rate paid in Calderdale. Dr Davies believed that Bradford colleagues were paid a higher rate but did not receive payment for the training groups” Page 11 – under Patient Capacity and Access Group – 28 July 2011, the final sentence should be amended to read “The group will only meet if there is clinical representation at the meeting.” Matters arising from the Minutes (a) Infection Prevention Annual Report 2010/11 It was agreed that the updated version of the Annual Report would be circulated to CCE members (b) Annual Report for Involvement It was reported that, as requested the comment on page 51 of the Annual Report on smoking cessation had been checked for accuracy and it had been confirmed to be correct. (c) Quality and Safety – update on incidence of pressure ulcers The Deputy Director of Quality and Professional Development referred to discussion at the previous meeting when concern had been expressed at the increase in category 4 pressure ulcers reported by the Calderdale and Huddersfield Foundation Trust (CHFT). She advised that there had been further discussions with CHFT, the information supplied had been confirmed to be accurate and an item on trajectory-setting to obtain an improvement by the year end was due to be discussed at the Quality Board meeting on 18 October 2011. (d) Quality and Safety – update on SWYPFT The Deputy Director of Quality and Professional Development referred to discussion at the previous meeting when concerns had been raised that SWYPFT performance for Quarter 1 was well below the CQuINS targets in certain areas and she had been asked to compare this year’s figures with those for Quarter 1 of 2010/11. The Deputy Director of Quality and Professional Development advised that, for the first time, this year’s performance had been measured separately for acute and non-acute services, so direct comparisons could not be made to last year’s performance.

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She also advised that work on developing CQuINS targets for 2012/13 needed to be started soon. It was proposed that the Quality Sub-Group would co-ordinate this development and an initial explanatory session was to be held with Practice leads at their next Practice Leads meeting. (e) Update on the Business Planning Process At its previous meeting the CCE had requested an update on the business planning process. The Head of Business Intelligence reported that it was being suggested that part of the CCG development session scheduled for 3 November 2011 be used to provide information on the business planning process, the timeline involved and to begin some initial preparatory work on the process to be followed and the stakeholders to be involved (with it being proposed that this should include Local Authority representatives of Adults Services, Children and Young People and Social Care). It was suggested that all the CCE members be invited to that session.

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The Director of Public Health advised that the local authority would be undertaking a similar process itself and he suggested that the Associate Director of Business Intelligence have a preliminary discussion with the appropriate Director at Calderdale MBC to co-ordinate the timetable. The Head of Business Intelligence circulated copies of slides listing the steps/stages in the Business Planning Process. It was noted that a further report would be submitted to the CCE after the CCG development session. DECISIONS 1. That the oral report be noted. 2. That the CCG Development session on 3 November 2011 be used to provide information and for preliminary discussions on how to proceed with the Business Plan and that all CCE members be invited to attend that session, with an expectation that all GP Board and officer members would attend. 145/11 GOVERNANCE STRUCTURE The Head of Corporate Affairs presented this report which introduced and included at its appendices the Terms of Reference for the Clinical Commissioning Executive (as approved by the Calderdale, Kirklees and Wakefield District Cluster Board) and draft terms of reference suggested for approval by the CCE for its Quality, Audit and Governance and Finance and Performance Sub-Groups. Reference was made to the two changes that the Cluster Board had made to the CCE Terms of Reference since the CCE had considered the previous draft,

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namely that the CCE should be reviewing and considering public health services during the transition period and that the membership of the CCE should be described as including the Shadow Accountable Officer rather than the Executive Medical Director (the post holder presently being the same individual). A Committee member asked about the register of interests referred to at point 12.2 and it was confirmed that the register covered all GP members of the CCE (and indeed all members of the committee). A Non Executive Associate asked about the availability of copies of Standing Orders and Standing Financial Instructions. The Head of Corporate Affairs confirmed that the Cluster Board had approved a revised set of Standing orders at its meeting on 4 October 2011 but that the Standing Financial Instructions were still being revised and were expected to be considered at the Cluster Board meeting on 1 November 2011. Both documents would be made available on NHS Calderdale’s IT shared drive.

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The suggestion that the Terms of Reference be reviewed in six months’ time was noted. Audit and Governance Sub-Group Terms of Reference It was pointed out that, as with all of the Sub-Groups, the Audit and Governance Sub Group’s purpose was to advise and assist the CCE in fulfilling its responsibilities. It was reported that, in view of the requirement for financial expertise and a degree of independence, the Chair of the Audit and Governance Sub-Group had been appointed by the Appointments Commission and was the Non Executive Director, Keith Wright. It was suggested that the wording on point 3.1 (Chairing of meetings) be amended to reflect the fact that meetings would be run by the Chair or in his absence the Vice Chair. In respect of the quoracy provisions it was suggested that this be amended to read two Non Executives (Director or Associate/s) and one clinician. In the first line of the bullet point on Equality and Diversity on page 6 it was agreed that the NHSWD needed to be amended to read NHS Calderdale.

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Reference was made to the proposal for membership of the sub-group to comprise three Non Executives and three CCE member nominees. After discussion it was agreed that, at least initially, all three CCE nominees should be clinicians. It was also agreed that the quorum should comprise two Non Executives and one clinician.

ACTION

In respect of the Finance and Performance Sub-Group discussion took place upon whether the use of the phrase “provide assurance” to the CCE should be amended to “advise the CCE” bearing in mind the fact that the CCE was not devolving any of its responsibilities to the sub-group. It was agreed that the Head of Corporate Affairs and the Corporate Governance Manager would consider this issue further.

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Discussion took place upon the chairmanship of this sub-group and it was agreed that this should be the Chief Operating Officer (also being the chief financial officer) with the Shadow Accountable Officer being the Vice Chair. Since there were no provisions for sub-groups to vote, it was agreed that the words “and vote” be deleted from the fourth sentence of point 9 (Substitutions). It was agreed that there should be provision for the Non Executive Associate (NEA) member to have a substitute and that this would be the second of the two NEAs. It was also agreed that the attendance of one NEA be included in the quoracy provisions. Quality Sub-Group It was agreed that the three CCE members of the sub-group should be described as CCE clinicians and that one of these clinicians should be Chair of the SubGroup. It was also agreed that provision be included for a Non Executive Associate deputy/substitute (as outlined above for the Finance and Performance Sub-Group) and that the attendance of one NEA be included in the quoracy provisions. DECISIONS 1. That the Terms of Reference for the Clinical Commissioning Executive, as approved by the Calderdale, Kirklees and Wakefield District Cluster Board be noted. 2. That the requirement for the Terms of Reference for the CCE to be reviewed in six months’ time be noted. 3. That the Head of Corporate Affairs and the Corporate Governance Manager consider the use of the word “advise” as opposed to “provide assurance to” be included at point 4.5 of the Terms of Reference of the Finance and Performance Sub-Group.

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4. That the Terms of Reference of the Audit and Governance Sub-Group, the Finance and Performance Sub-Group and the Quality Sub-Group be approved, subject to the amendments outlined above.

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5. That the following Shadow GP Consortium Board members be nominated to serve on the Sub-Groups:

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Audit and Governance Sub-Group Dr Majid Azeb Dr Hazel Carsley Dr Peter Davies Finance and Performance Sub-Group Dr Alan Brook Dr John Taylor


Quality Sub-Group Dr Steve Chambers Dr Steven Cleasby Dr Nigel Taylor 6. That the Terms of Reference documents be updated with the above amendments and re-circulated to all CCE members. 146/11 BOARD ASSURANCE FRAMEWORK AND HIGH LEVEL RISK LOG The Head of Corporate Affairs presented this report which introduced and included at its appendices the Board Assurance Framework and the High Level Risk Log. It was noted that the Board Assurance Framework had been considered at the NHS Calderdale Board meeting on 29 September 2011 and had been signed off as outlining the PCT’s long term strategic risks and, linked to that the High Level Risk Log which outlined the serious and critical risks which could threaten achievement of the organisation’s objectives. The Head of Corporate Affairs advised that, over the next few weeks it was intended to consider the long term strategic risks for the CCE and the mechanisms and structure to manage those risks. The Audit and Governance Sub-Group was expect to be closely involved in that process. The Chair commented upon the fact that some of the existing strategic objectives would be very difficult for the PCT alone to achieve (such as reducing childhood obesity). Reference was made to the forthcoming start of the business planning process, when there would be the opportunity to review and amend the existing objectives and consideration could be given to how achievable or aspirational the objectives should be. In response to a Committee member’s question, it was reported that in future it was intended that the Assurance Framework and High Level Risk log would be considered in detail by the Audit and Governance Sub-Group and would also be presented to CCE meetings on a bi-monthly basis. DECISIONS That the Board Assurance Framework and the High Level Risk Log be received. 147/11 ANNUAL COMPLAINTS REPORT Drs. Alan Brook, Majid Azeb, Hazel Carsley, Steve Chambers, Steven Cleasby, Peter Davies, Dinesh Kumar, Krishna Kumar, John Taylor and Nigel Taylor declared an interest in this item The Head of Corporate Affairs presented this item which introduced and included at its appendix the Annual Complaints Report 2010/11. It was noted that equality monitoring had been included in this report for the first time, following a suggestion of the NHS Calderdale Board when it had received the 2009/10 Annual report.


In accordance with the Local Authority Social Care and NHS Complaints Regulations 2009, the local providers and independent contractors had been asked to provide information on complaints received and the annual report was a composite report of that information received together with data on complaints received direct by NHS Calderdale. In discussion, reference was made to the fact that four GP surgeries had not submitted their annual complaints information and that three of those practices had also not submitted information in 2009/10. It was agreed that the Shadow Accountable Officer/Executive Medical Director would ask that this issue be included on the next Local Medical Committee meeting Agenda.

ACTION

Reference was made to the fact that one third of Care Homes had not submitted information and the Yorkshire Ambulance Service had reported that it had only received one complaint. The Deputy Director of Quality and Professional Development advised that, where appropriate, further information would be sought from the main providers at Quality Board meetings. She also advised that complaints information had previously been regularly considered at the former Patient Safety Group and, under the new structure, would regularly be considered by the Quality Sub-Group. She also anticipated that review of the complaints system would be included on the Work Plan of the Quality SubGroup. A Non Executive Associate referred to the increase in the number of complaints and wondered whether this was due to improved recording. He also referred to findings from the Mid Staffordshire Inquiry regarding complaints not being acted upon. The Chair acknowledged that learning from complaints received was crucial. DECISIONS 1. That the Annual Complaints Report 2010/11 be received. 2. That the Executive Medical Director request that General Practice complaints returns be included on the Agenda for a subsequent Local Medical Committee meeting. 148/11 UPDATE ON CALDERDALE COMMISSIONING GROUP DEVELOPMENT The Assistant Director, Transition Programme presented this report which provided an update on progress towards the establishment of the Clinical Commissioning Group as a statutory body by 1 April 2013. She asked that Committee members contacted her if there was particular information they would like to receive in subsequent update reports. A Committee Member commented that the report referred to progress having been made in implementing the Organisational Development (OD) Plan, but he had not seen that plan. The report also referred to the need to review the results of the first diagnostic self-assessment.

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The Shadow Accountable Officer/Executive Medical Director referred to the fact that although the GP Commissioning Programme Steering Group was looking at operational delivery of the OD Plan, the CCE itself needed to monitor delivery of its OD Plan and risks to delivery of the Plan. It was therefore agreed that the present OD Plan should be presented to the next meeting, together with the risk log. The Assistant Director, Transition Programme advised that since the OD Plan was a sub-set of the overall Transition Plan, it would also be useful for the Transition Plan to be submitted to the next meeting.

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Reference had been made in the report to the need to take into account the results of the first diagnostic self-assessment exercise when revising the OD Plan. It was agreed that it would be appropriate to present some feedback on the self-assessment to the next CCE meeting. Discussion took place upon the type of information to be presented and ACTION it was agreed that an overview of the responses with information on the mean date and extent of deviations would be appropriate. DECISIONS 1. That the report be noted. 2. That a further update report be presented to the next meeting, together with a copy of the present OD Plan, the Transition Plan and an overview of the diagnostic self assessment responses with information on the mean date and the extent of deviations.

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149/11 PATIENT SAFETY AND QUALITY REPORT The Deputy Director of Quality and Professional Development presented this report which provided an update on recent quality and patient safety activities. The report include information on Venous Thromboembolism (VTE) at CHFT which had been requested at a previous meeting. It was noted that the number of episodes was currently above the plan for the year to date and the information would be discussed further at the Clinical Quality Board meeting on 18 October 2011. In discussion reference was made to the fact that the data was all provided by the provider, but that there was an internal validation process and data was also to be reported through the Quality Accounts. A Committee member commented that there was no information on what action CHFT was taking to reduce VTE episodes and it was acknowledged that this question should be pursued at the Quality Board. In discussion, reference was made to the amount of detail in the report. It was noted that in future patient safety and quality reports would be considered in detail at the Quality Sub-Group, although they would also still be presented to the CCE. It was suggested that it might be useful for a report outlining the sources of the information/the way in which the report was compiled to be presented to the Quality Sub-Group. It was

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also suggested that comparisons/national benchmarking data would be useful.

DECISIONS 1. That the September 2011 quality dashboard and current quality performance information be received. 2. That the summary report on the National Patient Safety Agency organisation incidents be received. 3. That the an update on the Commissioning for quality scheme development for 2012/13 be received 4. That the update on recent Care Quality Commission activity be received. 5. That the update on National Quality Board report – Maintaining and Improving Quality during Transition be received. 6. That the update on the Peer Review of Children’s Social Care be received. 150/11 CORPORATE PERFORMANCE REPORT Drs. Alan Brook, Majid Azeb, Hazel Carsley, Steve Chambers, Steven Cleasby, Peter Davies, Dinesh Kumar, Krishna Kumar, John Taylor and Nigel Taylor declared an interest in respect of the smoking quitters element of this report The Head of Business Intelligence presented this report which provided an update on the progress being made with the achievement of key deliverables and local priorities established for Calderdale. In discussion, reference was made to the differing rates of smoking quitters between the specialist service and the Locally Enhanced Service operated through general practices. It was noted that there had been an improvement in the numbers of smoking quitters in both services. It was reported that the specialist service dealt with particular target groups, such as pregnant women and that there were links between the two services, for example with the specialist service relying on prescribing by General Practitioners. CCE members asked about the rationale behind the selection of individual priorities, particularly the more aspirational priorities, where the extent of NHS Calderdale’s influence could only be limited, such as childhood obesity. It was noted that these issues would need to be considered further in the future and that the Health and Wellbeing Board would also be looking into such issues. DECISIONS 1. That the current levels of achievements made in Calderdale be


noted. 2. That the areas of performance that require continued focus, and the mitigating actions taken in respect of them be noted. 3. That the developments associated with the strategic outcomes and impact on future governance for these indicators be noted. 151/11 UPDATE REPORT ON SINGLE COMMISSIONING PLAN – PROGRESS ON ADULTS HEALTH AND SOCIAL CARE LED ELEMENTS The Senior Programme Manager (Mental Health)/Joint Head of Mental Health and Learning Disabilities presented this report which provided information on progress with the Adults Health and Social Care (AHSC) led elements of the Single Commissioning Plan (SCP). The report also proposed a more consistent approach to reporting progress on the three elements of the Single Commissioning Plan. A full list of all the AHSCled actions of the Plan was appended to the report, together with comments on progress and it was noted that all but two had been RAGrated (red, amber, green) as green. The Senior Programme Manager (Mental Health) reported on the two red rated actions, the first of which was the review of the Mental Health Strategy which it was hoped would be available for consideration at the November 2011 meetings of the Health and Wellbeing Board and the Clinical Commissioning Executive. With regard to the second red-rated action (development/implementation of a local delivery plan following the review of provision for mentally disordered offenders), the Senior Programme Manager (Mental Health) advised that this had been deferred due to financial pressures. A Committee member referred to the fact that on page 15 there was no information in the progress column on the two actions on safeguarding. Discussion took place on the suggestion that there be a more consistent reporting style for each of the 3 elements of the Single Commissioning Plan. A Committee member commented that this report was very detailed and a summary and/or an indication of the most important actions/issues would have been helpful. The Shadow Accountable Officer/Executive Medical Director expressed the view that although consistency in reporting style was appropriate, he felt that further consideration needed to be given to what type of information was required before reporting styles were aligned. DECISIONS That the progress outlined in the report be noted.

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152/11 FINANCIAL AND EFFICIENCY REPORT The Chief Operating Officer presented this report which provided information on the month 5 expenditure and the forecast financial position to the end of 2011/12. The key risks to achieving the target surplus were also outlined. It was noted that expenditure had been contained within the budgets set at the start of the year. Although there was still an on-going dispute on the contract with CHFT, that budget was not expected to be exceeded. It was also reported that the Quality Innovation Productivity and Prevention Plan was mainly on schedule. It was therefore hoped that the contingency fund would be available for reinstatement of some of the schemes that had had to be postponed last year and/or emerging new priorities. It was confirmed that the Finance and Performance Committee had considered this report in detail and that its replacement body, the Finance and Performance SubGroup would be giving consideration to recommending a phased approach to releasing contingency monies. Further information would be included in the Financial and Efficiency report which would be submitted to the next CCE meeting. DECISIONS 1. That the forecast financial position for 2011/12 be received. 2. That the risk rating of green for achieving the control total be noted. 153/11 COMMISSIONING HIGH COST AND CANCER DRUGS POLICIES The Shadow Accountable Officer/Executive Medical Director presented this report which outlined a number of medicines commissioning policies considered by the Medicines Decision and Policy Group at its September 2011 meeting, with a number of policies having been developed locally and by the South West Yorkshire Area Prescribing Committee (based on NICE guidance) and being recommended for approval. The report also outlined a number of policies approved on NHS Calderdale’s behalf by the Yorkshire and the Humber Specialised Commissioning Group. DECISIONS 1. That the local and Area Prescribing Committee-developed policies outlined in the report be approved for use in Calderdale. 2. That the Specialised Commissioning Group- developed policies outlined in the report be noted. 154/11 COMMITTEE MINUTES RECEIVED DECISION


That the following minutes/draft minutes be received: (a)

Clinical Quality Board: Draft Minutes of Part 1 of the meeting held on 20.9.11

(b) Clinical Quality Board: Draft Minutes of Part 2 of the meeting held on 20.9.11 (c)

Patient Safety Group: Draft Minutes of the meeting held on 13.9.11

(d) West Yorkshire Urgent Care Clinical Review Group: Notes of the meeting held on 13 July 2011 (e)

Yorkshire Ambulance Service Clinical Review Group and CQUIN development group: Minutes of the meeting held on 13 September 2011

155/11 WORK PLANS FOR THE CLINICAL COMMISSIONING EXECUTIVE AND ITS SUB-GROUPS The Corporate Governance Manager tabled a preliminary draft of suggested Work Plans for the CCE and its sub-groups for 2011/12. DECISION 1. That the draft Work Plans for the CCE and its sub-groups be circulated for further comment/suggested amendments and that they be considered at the first meetings of the relevant subACTION groups. 2. That updated versions be considered for approval at a future CCE meeting.

CHAIR

ACTION


NHS Calderdale Board action sheet 13 October 2011 Report name

Action no. @

Minutes of the CCE meeting of 8 September 2011 Matters arising from the Minutes – Infection Prevention Annual Report Matters arising from the Minutes – Update on Business Planning Process

144/11

Action required

Lead

Various amendments to be made to draft minutes

Jane Brownlie

144a/ 11

Updated version of Infection Prevention Annual Report 2010/11 to be circulated to CCE members

144e/ 11

Current status*

Complete

Completion date: 10.11.11

Graham Wardman

Complete

Completion date: 10.11.11

CCE members to be invited to CCG development session on 3.11.11 to discuss business planning process

Debbie Graham

Complete

Completion date: 31.10.11

1. Standing Orders and Standing Financial Instructions to be made available on NHS Calderdale IT shared drive

Vicky Pickles

Complete

Completion date: 10.11.11

2. Various amendments to be made to Terms of Reference of CCE Sub-Groups and updated versions to be re-circulated

Vicky Pickles/ Jane Brownlie

Complete

10.11.11

3. Head of Corporate Affairs and Corporate Governance Manager to consider the use of the word “advise” as opposed to “provide assurance to” in Terms of Reference of Finance and Performance Sub-Group

Vicky Pickles/ Jane Brownlie

On Agenda for 10.11.11 meeting

10.11.11

145/11

Governance Structure

Comments (include, expected completion date, areas of concern etc)

13


Annual Complaints Report Update on Calderdale Commissioning Group Development

147/11

148/11

149/11

Patient Safety and Quality Report

Update Report on Single Commissioning Plan – Adult Health and Social Care led elements

151/11

155/11 Work Plans for the CCE and its Sub-Groups

Shadow Accountable Officer/Executive Medical Director to request that the issue of non return of GP annual complaints returns be placed on Local Medical Committee meeting Agenda Organisational Development Plan, Transition Programme and feedback on diagnostic self-assessment to be presented to next meeting 1. Quality Board to pursue with CHFT what action was being taken to reduce VTE episodes 2. Report outlining sources of information/the way in which the Patient Safety and Quality report was compiled to be presented to a Quality Sub-Group meeting Revised Mental Health Strategy to be presented to CCE meeting

1. Draft work plans to be circulated for further comment/suggested amendments. 2. Draft Work plans to be considered at first meetings of Sub-Groups 3. Updated versions of work plans to be considered for approval at a future CCE meeting

14

Completion date: 10.11.11

Matt Walsh

Complete

Judith Salter/Judith Whitehead

On Agenda for 10.11.11 meeting Complete (but will continue to monitor)

Completion date: 10.11.11

Penny Woodhead

Not yet due

30.11.11

Mick Mellors

Deferred to December 2011 meeting

Completion date: Initially 10.11.11 but deferred to 8.12.11

Penny Woodhead

Completion date: 10.11.11

Completion date: 8.12.11 Jane Brownlie

Underway

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http://www.kirklees.nhs.uk/uploads/media/CKWCB-12-25a_Calderdale_CCE_Final_minutes_13_October_2011.pdf

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