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Minutes of the Clinical Commissioning Executive Meeting held on 8 December 2011 in the Wainhouse Meeting Room, F Mill, Dean Clough Mills, Halifax Present:

Dr Alan Brook

Keith Wright

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

Apologies for absence:

Dr John Taylor

CCG Board member

Also present:

Jeevan Bhadare

Senior Programme Manager (Mental Health) (for item 181/11) Associate Director of Business Intelligence (for items 173/11 -179/11) Deputy Director, Joint Commissioning for Children, Young People and Maternity Services Head of Business Intelligence (for item 179/11) Head of Clinical Commissioning Board Secretary/Corporate Governance Manager

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

Deborah Graham Chris Jewesbury Tim Shields Judith Whitehead Jane Brownlie

173/11 DECLARATIONS OF INTEREST Dr Peter Davies declared an interest in item 179/11 (Corporate Performance Report [in relation to Choose and Book at Keighley Road Surgery]. 174/11 MINUTES OF THE MEETING HELD ON 10 NOVEMBER 2011 The minutes of the meeting held on 10 November 2011 were accepted as a correct record subject to the inclusion of the words “In relation to the Equitable Access Contract” at the beginning of the third paragraph on page 3 of the minutes.

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158/11 MATTERS ARISING FROM THE MINUTES AND ACTION SHEET (a) Standing Orders and Standing Financial Instructions – CCG Board members’ access to NHS Calderdale’s IT shared drive It was noted that work was still on-going on this issue. (b) Chief Operating Officer’s report – 111 Process The Associate Director of Business Intelligence reported that, since the previous meeting, it had been decided that once the Business Case had been agreed publicity of the service would be taken forward through a CCG development session rather than a briefing note to all GPs. (c) Adult Safeguarding – Training The Deputy Director of Quality and Professional Development reported that a variety of methods of delivering safeguarding training were being considered to suit the needs of different types of staff. (d) Update on Children’s and Young People’s element of Single Commissioning Plan – contract for special seating wheelchairs It was reported that monitoring of this contract was on-going and consideration was being given to possible methods of reducing children’s waiting times, including the possibility of Any Qualified Provider contracts and/or allocation of some pump priming monies. 176/11 CHIEF OPERATING OFFICER’S REPORT The Chief Operating Officer presented this report which included information on recent senior appointments at NHS North of England (the SHA) and Calderdale Metropolitan Borough Council, the launch of public consultation on the Ombudsman’s “Information Promise”; progress made and the CCG’s involvement in defining and agreeing a framework for the business planning process for 2012/13; progress with the voluntary redundancy scheme and information and the key elements of the recently published Operating Framework for 2012/13. In response to a CCG Board member’s question, it was confirmed that a pre-requisite for voluntary redundancy had been that the post was not business critical, so none of the seven applications approved were key posts required for the future. Discussion took place on the financial allocation with the running costs for CCGs having been set at £25 per head and PCT allocations being expected to grow by at least 2.5% (although this may be affected by the GDP deflator which attempted to redress previous allocation anomalies across the country). In discussion reference was made to the financial difficulties recently faced by some provider trusts and the importance of maintaining stability in the local health economy. It was noted that the potential CQUiN payments had been increased in recognition of this, but they would have to be earned by achieving the appropriate quality targets. In respect of performance, a CCG Board member referred to an anticipated further report on the Mid Staffordshire Hospitals Trust Inquiry. It was reported that a similar approach would probably be used to that followed on the previous reports, with local self assessment and an action plan of learning points being considered in detail by the Quality Group and a summary report being submitted 2


to the CCE.

DECISION That the report be noted. 177/11 QUALITY AND PERFORMANCE REPORT The Deputy Director of Quality and Professional Development presented this report which provided an update on recent quality and patient safety activities. It was reported that the Quality Dashboard had been refreshed to include areas of performance being monitored by the North of England SHA. The report also included a summary of NHS Calderdale’s main providers’ CQuINS (Commissioning for Quality and Innovation Scheme) performance for Quarter 2 of 2011/12. In respect of the two breaches of the elimination of mixed sex accommodation rules, it was noted that appropriate explanations had been received for both these incidents, but it was not yet known whether this would affect NHS Calderdale’s indicator rating. A CCG Board member asked about the suicide incidents included in the Serious Incident table and it was confirmed that the SWYPFT (South West Yorkshire Partnership Foundation Trust) suicides quoted had been Calderdale patients. It was noted that root cause analyses were carried out on all those incidents. DECISIONS 1. That the update on the Quality Dashboard be received. 2. That the update on Quarter 2 CQuINS performance be received. 178/11 FINANCIAL AND EFFICIENCY REPORT The Chief Operating Officer presented this report which outlined the current and forecast financial position for 2011/12, including associated risks. It was noted that this report had been considered in detail by the Finance and Performance Group and that NHS Calderdale was on target to deliver all its statutory duties and to achieve its control total/financial balance. As reported at the previous meeting, the Chief Operating Officer confirmed that the contract with CHFT (Calderdale and Huddersfield Foundation Trust) was still on schedule, so the contingency fund previously set aside to cover a possible overtrade was not required for that purpose. She confirmed that discussions were on-going on possible schemes for funding on a non-recurring basis. Clinical input would be needed on many of the schemes and it was expected that further details would be brought to the next CCE meeting. Discussion took place on the present under-trade on the contract with CHFT. It was noted that the Trust was presently putting on additional operating lists but that there was a capacity issue. The Chief Operating Officer confirmed that 3

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discussions, negotiations and contract challenge continued with the CHFT throughout the year and the PCT was currently working with the Trust on addressing the under-trade. In response to a CCG Board Member’s question, it was confirmed that, if considered appropriate, part of the contingency fund could be used to buy in services from elsewhere on a non-recurring basis. A Non Executive Director asked about the anticipated year end position on the CHFT contract performance and the Chief Operating Officer advised that the Trust anticipated the overall performance would be RAG rated as green, but the rating on some of the constituent elements might not be green. It was noted that the QIPP (Quality, Innovation, Productivity and Prevention) Plan was over-performing at present. A CCG Board member referred to the information included on medicines management and commented upon the importance of not viewing the QIPP information in isolation, but also looking at the budgetary position. A CCG Board member asked about page 21 of the report regarding Yorkshire Ambulance Service’s failure to achieve 75% performance in responding to Red 1 and Red 2 incidents within 8 minutes in October 2011, resulting in 2% of that month’s contract value being withheld until the year end, pending assessment of the annual performance. The Chief Operating Officer agreed to circulate an update on this issue.

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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. 3. That an update be circulated on the withholding of 2% of Yorkshire Ambulance Service’s October 2011 contract value. 179/11 CORPORATE PERFORMANCE REPORT Dr Peter Davies declared an interest on this item in relation to the use of Choose and Book at Keighley Road Surgery. The Head of Business Intelligence presented this report which provided updates on Calderdale’s position on the headline indicators in the Annual Operating Framework; actions being taken to improve performance in the areas requiring continued focus and supporting information on the SHA’s assessment of performance at the local acute Trust. The report also provided an update on business planning. Further to the request made at the previous meeting for further information on workforce issues the Chief Operating Officer reported that she was meeting with the Assistant Director of Workforce to consider what additional workforce information should be submitted to the CCE/included within the corporate performance report. Discussion took place upon the information included in the appendix on Accident and Emergency attendance and in particular the area where the target time had 4

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been exceeded, namely the length of time spent in the department by patients who were subsequently admitted. It was acknowledged that this could not be handled in isolation and was part of a larger issue of managing demand and throughput (both admission and discharge from the wards, the assessment units and appropriate use of observation beds) and it was noted that some delays could also be caused by awaiting diagnostic test results. It was reported that the issue of delays being caused by the Medical Assessment Unit being full had been discussed at the Finance and Performance Group and had been raised with CHFT at the Contract Board meeting. A CCG Board member referred to information in the appendix on underperformance on the proportion of GP referrals using Choose and Book. It was pointed out that there had been problems with the IT router at the Keighley Road Surgery which had taken several months to resolve. It was also pointed out that Choose and Book was not available for certain types of cases. DECISIONS 1. That the current levels of achievement made in Calderdale with the headline and supporting indicators established in the Annual Operating Framework be noted. 2. That the areas of performance requiring continued focus and the mitigating actions being taken be noted. 3. That the Cluster SHA assessment of performance at the local acute Trust be noted. 4. That the progress being made with business planning be noted. 180/11 STANDING ORDERS AND STANDING FINANCIAL INSTRUCTIONS – SUMMARY AND STAFF BRIEFING NOTE The Chief Operating Officer presented this report which referred to the fact that the PCT’s Standing Orders and Standing Financial Instructions had recently been revised and a summary version, together with information on budgetary limits and authorised signatories was appended to the report. It was noted that a full set of Standing Orders and Standing Financial Instructions was available on the PCT’s IT shared drive. It was stressed that all staff were required to comply with Standing Orders and failure to do so could lead to disciplinary action. The Chair drew particular attention to the requirements regarding declaration of gifts and hospitality. He also referred to the fact that the provisions on financial limits applied to the total cost of an entire project and not for example only the annual cost if a project’s duration exceeded one year and with it not being permissible to split financial transactions into separate parts. DECISION That the report be noted. 5


181/11 IMPROVING SHORT AND MEDIUM TERM REHABILITATIVE MENTAL HEALTH CARE The Senior Programme Manager (Mental Health) presented this report which outlined proposals to change and improve the pathway for short and medium term health care at Lyndhurst, Wells House and in the community. It was reported that this was one of the commissioning priorities and was part of the Mental Health QIPP Plan. The report referred to a 2011 NHS Confederation publication which was critical of the use of Out of Area placements in terms of patient/health outcomes (e.g. clients’ dislocation from their families and communities due to the physical distances involved) and on financial grounds. It was noted that the PCT currently commissioned services from SWYPFT provided at Lyndhurst, a 14 bedded 24 hour nursing care unit which provided low secure residential accommodation easing patients towards more independent living. Although Lyndhurst presently provided care with some capacity to detain, that capacity was limited so a number of clients had to be accommodated in out of area placements. The report outlined a proposal to improve the staffing levels and skills mix and make building adaptations at Lyndhurst so as to increase its capacity to accommodate clients with more complex needs (thus enabling the repatriation of some clients presently accommodated out of area). There were also proposals to strengthening provision at Wells House and in the community so as to enable an earlier “stepping down” of some of the clients with less complex needs presently accommodated at Lyndhurst and to reduce the length of stay at Lyndhurst. Additional investment proposed at Wells House was also outlined in the report. Discussion took place upon the anticipated costs and savings outlined in the report. It was noted that SWYPFT had agreed to fund the one-off capital costs of £195,960 and that an additional £145,438 was required in 2011/12 to pump prime the proposals (comprising staff recruitment and training costs). There would also be additional recurrent costs of £581,753 to fund the additional staffing costs for Lyndhurst, Wells House and community care. However it was anticipated that from 2012/13 onwards significant savings would be made from a reduction in out of area placements. The report outlined the anticipated savings based on higher and lower estimates of the out of area costs. With regard to the costs breakdown provided on page 19 of the report, the Senior Programme Manager advised that SWYPFT had agreed to fund all the medical costs. Discussion took place on the risks associated with the proposal, which were outlined in the report. A Non Executive Associate referred to the issue of the use of Lyndhurst being commissioned on a block contract basis, so the potential savings would not be realised if out of area clients were not transferred to Lyndhurst and/or its occupancy level fell. The Senior Programme Manager advised that there were provisions for penalty deductions to be made if occupancy fell below 90% (and, to discourage bed blocking, if the average length of stay exceeded 18 months). A CCG Board member asked about the admission criteria and the possibility of beds being filled by new clients as opposed to repatriated out of area clients. It was reported that a residential 6


panel would assess applications for admission and it was pointed out that SWYPFT also encountered difficulties when clients were placed out of area. It was confirmed that the proposals had been worked up jointly with SWYPFT and initially the proposals would be cost-neutral for SWYPFT, but it was anticipated that in subsequent years their income from the contract would increase. The Senior Programme Manager confirmed that the Senior Management Team had considered a similar report and supported the proposals. The Non Executive Director asked about authority to commit the required resources. The Chief Operating Officer reported that the proposal was included in the commissioning priorities and the QIPP Programme and the anticipated recurring additional costs would comprise a virement from the Out of Area budget allocation and would be incorporated in the budget setting exercises for 2012/13 and onwards. A CCG Board member asked about the safeguarding provisions for Lyndhurst clients. It was confirmed that this would be managed by the Continuing Care Team. The Deputy Director of Quality and Professional Development confirmed that she would check whether any additional safeguarding provisions ought to be included in the contract and she agreed to discuss this further with the CCG Safeguarding lead (Dr Stephen Cleasby). DECISION That the proposals outlined in the report on a new model for short and medium term rehabilitative mental health care for those needing 24 hour nursing care and the securing of pump priming funding to initiate the development be approved . 182/11 NHS 111 (a) ROLLING OUT OF NHS 111 ACROSS YORKSHIRE AND THE HUMBER See Minute 181(b)/11 below (b) NHS 111 BUSINESS CASE The Chief Operating Officer presented these two reports. The first report (which was open to public inspection) outlined the background to the decision to introduce a single 24 hour telephone number (111) to provide access to every kind of urgent health and social care need (other than 999 emergencies). The telephone lines were to be staffed by highly trained advisers who would assess callers’ needs, provide information, reassurance and advice and/or direct people to or arrange appropriate sources of care. The programme implementation plan was outlined in the report. The second report (which was classified as a restricted document due to issues of commercial confidentiality) set out the business case for NHS 111 and outlined a proposal for further development of the service specification and business case to be delegated to the recently established Yorkshire and the Humber NHS 111 Programme Management Board. The Chair stressed the importance of the work needing to be carried out locally 7

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to establish an appropriate range of options for the directory of services to be offered from the 111 calls. It was acknowledged that this initiative provided an opportunity for the re-design of local urgent care processes. Reference was made to a CCG development session having recently been held on NHS 111, when the proposals had been outlined in detail. A CCG Board member expressed concern at the tight timescale set for the introduction of NHS 111 and it was acknowledged that a great deal of work in revising local urgent care services would need to be undertaken over the next 15 months. However, it was noted that if the procurement timetable were not achieved then the NHS 111 function would be assumed by NHS Direct, which it was understood would probably be a relatively costly option. It was noted that the Calderdale, Kirklees and Wakefield District Cluster Board had already considered both these reports, approved the business case to enable procurement to proceed and noted that the specification was still subject to modification prior to publication at the Invitation to Tender stage in late February 2012. DECISIONS 1. That it be noted that the Calderdale, Kirklees and Wakefield District Cluster Board had received and accepted the recommendations in these two NHS 111 reports. 2. That the finalised Business Case and the financial and economic case for NHS 111 be received. 3. That it be noted that further development of the service specification and business case for NHS 111 had been delegated to the Yorkshire and the Humber NHS 111 Programme Management Board. 183/11 CHILDREN’S SAFEGUARDING REPORT The Deputy Director of Quality and Professional Development presented this report which provided information on progress made following Calderdale Metropolitan Borough Council’s receipt of a Notice to Improve after an OFSTED/CQC Inspection of the Council and NHS Calderdale’s safeguarding and looked after children’s services. The CCE was reminded that NHS Calderdale had received ratings of “good” on both safeguarding and looked after children. In view of the closely related roles, NHS Calderdale was represented on the Improvement Board established to oversee delivery of the action points on the Improvement Notice and had been supporting Calderdale MBC in seeking improvement. The report referred to a subsequent Unannounced Inspection (in January 2011) and a peer review to assess readiness for a full re-inspection, but it was pointed out that the Notice to Improve could not be removed until there had been a further full CQC inspection. In November 2011 OFSTED had published its Annual Assessment of Children’s Services and, since there had not been a further full inspection, the judgement published for Calderdale MBC was “Inadequate” as it was based on information 8


from the original inspection in January 2010 and the Unannounced Inspection in January 2011. This had led the media to believe that no improvement had been made since January 2011. Reference was made to the fact that statutory responsibility for safeguarding was to transfer to the CCE prior to April 2013. The report also referred to and outlined the issues referred to in the peer review, which was suggested for particular focus so as to maintain NHS Calderdale’s judgement when next inspected by the CQC. A copy of the Single Integrated Improvement Plan prepared in November 2011 had been appended to the report. Reference was made to the significant number of actions still RAG rated as red in terms of progress. The CCG Safeguarding Lead commented that safeguarding inherently carried significant risks and although the PCT had been supportive of Calderdale MBC there was still a significant number of areas where improvement was still required. The Non Executive Director expressed concern that the pace of improvement had not been faster. A CCG Board member referred to discussions having taken place with the Assistant Director of Quality Improvement (Safeguarding Children) with regard to GP attendances at case conferences and he expressed disappointment that this area was still listed as an area requiring improvement. The possibility of further involvement of the Local Medical Committee (LMC) was raised and the Deputy Director of Quality and Professional Development agreed to raise this issue with the Assistant Director of Quality Improvement (Safeguarding Children).

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The Chair questioned whether there might be further areas/ways in which the CCE could support Calderdale MBC and it was agreed that the Council’s Interim Director of Children’s Services be invited to a future meeting to discuss this and to enable assurances to be sought from him that the outstanding issues were being addressed/appropriate processes had been put in place. DECISIONS 1. That the report be noted. 2. That the possibility of further involvement of the LMC on the issue of GP attendances at case conferences be raised with the Assistant Director of Quality Improvement (Safeguarding). 3. That Calderdale MBC’s Interim Director of Children’s Services be invited to a subsequent CCE meeting. 184/11 ADULT PATHWAY FOR VITAMIN D DEFICIENCY IN PRIMARY CARE The Director of Public Health presented this report which outlined a pathway for addressing vitamin D deficiency in adults in Primary Care. It was noted that there had been primary care clinical input in the development of the pathway from Dr Seema Nagpaul and that the Medicines Management Group was supportive of the proposals. 9

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DECISIONS 1. That the Adult Pathway for Vitamin D Deficiency in Primary Care be approved. 2. That any CCE members with detailed questions on the pathway contact Dr Seema Nagpaul direct. 185/11 ORGANISATIONAL DEVELOPMENT PLAN The Head of Clinical Commissioning presented this report which introduced and included at its appendix the Organisational Development (OD) Plan for Calderdale Clinical Commissioning Group (CCG). It was noted that the plan would be continuously updated and was aimed at building the skills, knowledge and experience of the CCG to ensure it would be in a strong position to take on the roles, functions and accountability expected to be delegated from NHS Calderdale by 1 April 2013. It was reported that the OD Plan had been updated to take into account the results of the diagnostic toolkit self assessment previously undertaken. A Non Executive Associate commented that the CCE had not received a report outlining feedback from the self assessment. It was agreed that information be presented to the next meeting either as a dedicated report or a section within an OD Plan or CCG Development report. A CCG Board member referred to the speed of progress. In discussion it was acknowledged that individuals’ knowledge and perceptions had probably already changed since the assessment and it was envisaged that a further assessment exercise would need to be undertaken around the end of the financial year. Reference was made to the relevance of the content of this report to the meeting with the Calderdale, Kirklees and Wakefield District Cluster Board scheduled for 9 December 2011. DECISIONS 1. That the report be noted and the OD Plan be adopted. 2. That feedback on the diagnostic toolkit self assessment exercise be presented to the next meeting. 186/11 UPDATE ON DEVELOPMENT OF CALDERDALE CLINICAL COMMISSIONING GROUP The Head of Clinical Commissioning presented this report which provided an update on progress towards the establishment of the Calderdale Clinical Commissioning Group as a statutory body by 1 April 2013 and outlined the key priorities for the next few months. In respect of the Business Planning process it was noted that the approach being taken was completely different from that of previous years, with the process being clinically led and driven by the CCG Board and practice commissioning leads. 10

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In discussion reference was made to the risks associated with the CCG and the Executive Medical Director commented upon the need to ensure the relevant risks were included on the PCT’s risk register, so that the latter was complete and comprehensive. DECISION That the report be noted. 187/11 MINUTES RECEIVED Minutes of the following meetings were received: (a) Calderdale, Kirklees and Wakefield District Cluster board – minutes of the meeting held on 1 November 2011 (b) Finance and Performance Group – minutes of the meeting held on 25 October 2011 (c) Quality Group – draft minutes of the meeting held on 17 November 2011 (d) Yorkshire and the Humber Specialised Commissioning Group – minutes of the meeting held on 28 November 2011. 188/11 REVIEW OF WORK PLAN The Board Secretary/Corporate Governance Manager reported that the CCE Sub-Groups were presently reviewing their individual work plans and that a report on the work plans of the CCE and each of its Sub-Groups would be presented to the next meeting.

CHAIR

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Clinical Commissioning Executive action sheet 8 December 2011 Report name

Minutes

Action no. @

174/11 178/11

Financial and Efficiency Report

Improving Short and Medium Term Rehabilitative Health Care

181/11

183/11

Children’s Safeguarding Report

Action required

Lead

Current status*

Amendment to the draft minutes of 10 November 2011 1. Details of possible schemes for funding on a non-recurring basis from the contingency fund in 2010/11 to be presented to next meeting.

Jane Brownlie

Complete

Julie Lawreniuk

Item on Agenda for 12.1.12

2. Update on withholding of 2% of Yorkshire Ambulance Services October 2011 contract value to be circulated to CCE Deputy Director of Quality and Professional Development to check whether any additional safeguarding provisions ought to be included in the contracts and to discuss this issue further with the CCG Safeguarding Lead 1. Deputy Director of Quality and Professional Development to raise the possibility of further involvement of the LMC in the issue of GP attendance at Case Conferences with the Assistant Director of Quality Improvement (Safeguarding Children)

Julie Lawreniuk

2. Calderdale MBC’s Interim Director of Children’s Services to be invited to a subsequent CCE meeting

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Action underway

Comments (include, expected completion date, areas of concern etc) Completion date: 12.1.12 Completion date: 12.1.12

Completion date: 12.1.12

Penny Woodhead Completion date: 12.1.12 Penny Woodhead

Action underway

Penny Woodhead

Complete – due to attend CCE meeting on 16.2.12

12.1.12


185/11

Feedback on the diagnostic toolkit self assessment be presented to January 2012 CCE meeting

Judith Salter

188/11

Report on work plans for CCE and each of the Sub-Groups to be presented to 12.1.12 CCE meeting

Jane Brownlie

Organisational Development Plan

Review of Work Plans

Incorporated in item on CCG Development on Agenda for 12.1.12 Item on Agenda for 12.1.12

Completion date: 12.1.12

Completion date: 12.1.12

Clinical Commissioning Executive action sheet – Actions outstanding from previous meetings Report name

Standing Orders and Standing Financial Instructions Update on formation of CCE SubGroups

Adult Safeguarding (Training)

Action no. @

158a

160/11

164/11

Action required

Lead

Current status*

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

Shadow Accountable Officer/Executive Medical Director to pursue CCG Board Members access to NHS Calderdale’s IT shared drive with The Health Informatics Service Composite update report on Sub-Groups Terms of Reference and Work Plans to be submitted to a subsequent meeting

Matt Walsh

Work underway

Completion date: 8 December 2011

Jane Brownlie

Completion date: 12 January 2012

1. Quality Group to consider further provision of training on adult safeguarding. 2. Further adult safeguarding training to be targeted particularly at relevant primary care practices/staff identified as not have already received such training

Penny Woodhead

On Agenda for 12.1.12 meeting On Agenda for 12.1.12 meeting

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Penny Woodhead

Completion date: 19 January 2012


Update Report on Single Commissioning Plan – Adult Health and Social Care Led elements Governance Arrangements for the MHPG and the LDPB

151/11

135/11 -1

Revised Mental Health Strategy to be presented to CCE meeting (outstanding action from 13 October 2011 meeting)

Mick Mellors

On Agenda for 12.1.12 meeting

Completion date: Initially 10.11.11 Deferred to 12 January 2012

Mick Mellors to update the Terms of Reference for both groups to outline their exact responsibilities. (outstanding action from 8 September 2011 meeting)

Mick Mellors

On Agenda for 12.1.12 meeting

Completion date: Initially 13 October 2011 Deferred to 12 January 2012

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