Minutes of the Clinical Commissioning Executive Meeting held on 16 February 2012 in the Shibden Meeting Room, F Mill, Dean Clough Mills, Halifax Present:
Dr Alan Brook Dr Hazel Carsley Dr Dinesh Kumar Dr Krishna Kumar Trevor Lake Julie Lawreniuk John Mallalieu Bev Maybury Dr Nigel Taylor Dr Graham Wardman Penny Woodhead Keith Wright
Clinical Commissioning Group (CCG) Board Chair (Chair) CCG Board member CCG Board member CCG Board member Non Executive Associate Chief Operating Officer Non Executive Associate Director of Adults, Health and Social Care, Calderdale Metropolitan Borough Council CCG Board member Director of Public Health Deputy Director of Quality and Professional Development Non Executive Director
Apologies for absence:
Dr Majid Azeb Dr Steve Chambers Dr Steven Cleasby Dr Peter Davies Dr John Taylor Dr Matt Walsh
CCG Board member CCG Board member CCG Board member CCG Board member CCG Board member Shadow Accountable Officer/Executive Medical Director
Executive Director of Quality and Governance (Nursing) (for items 30/12 & 31/12) Programme Director, Transition (for items 35&36/12) Associate Director of Business Intelligence (for item 26/12) Designated Doctor, Looked After Children (for item 30/12) Assistant Programme Manager (Mental Health) (for item 23a/12) Deputy Director, Joint Commissioning for Children, Young People and Maternity Services (for items 30/12 & 31/12 Head of Commissioning for Adults, Calderdale Metropolitan Borough Council (MBC) (for items 23a, 23b & 27*/12) Designated Nurse, Looked After Children(for item 30/12) Assistant Director of Workforce (for item 29/12)
Interim Director of Children and Young Peopleâ€™s
Chris Dowse Deborah Graham Dr Liz Higgs Mike Hughes Chris Jewesbury
Rachel Spilsbury, Deborah Turner Judith Whitehead Jane Brownlie
Services, Calderdale MBC (for items 30/12 & 31/12) Commissioning Support Offer Project Manager (for item 35/12) Assistant Director of Quality Improvement (Safeguarding Children) (for items 30/12 & 31/12) Head of Clinical Commissioning Board Secretary/Corporate Governance Manager
DECLARATIONS OF INTEREST There were no declarations of interest.
MINUTES OF THE MEETING HELD ON 12 JANUARY 2011 The minutes of the meeting held on 12 January 2012 were accepted as a correct record.
MATTERS ARISING FROM THE MINUTES AND ACTION SHEET (a) MENTAL HEALTH PROGRAMME FOR CALDERDALE (previously referred to as Mental Health Strategy) The Head of Commissioning for Adults, Calderdale Metropolitan Borough Council presented this report which introduced and included at its appendix the Mental Health Programme for Calderdale. It was reported that the Programme had been developed in line with the national Mental Health Strategy “No Health Without Mental Health” and provided a framework for the development of mental health commissioning activity. It was noted that there had been an extensive consultation exercise with all stakeholders. The Programme had been presented to the Council’s Adults, Health and Social Care Directorate Management Team and a presentation on the programme had been given to the Calderdale Clinical Commissioning Group (copies of the slides were appended to the report). A Draft Implementation Plan had also been appended to the report and the Director of Adults, Health and Social Care advised that her Management Team had suggested that reference to personalisation needed to be included in the implementation plan. In discussion, comment was made upon the absence of reference to the reconfiguration presently on-going with mental health services. It was also suggested that it would also be useful to draw out the story of the transformation of mental health services locally. Reference was also made to the fact that the figures quoted in the presentation appended to the report were an extrapolation of the national figures, but the CCE was advised that these figures were felt to be reasonably representative. A question was also asked about affordability and it was acknowledged that although the Programme was aspirational it also needed to be underpinned by a sound financial strategy. DECISION That the Mental Health Programme be approved subject to the points 2
outlined above regarding personalisation, reference to the reconfiguration of mental health services and drawing out of the story of the transformation of mental health services locally. (b) TERMS OF REFERENCE OF (i) MENTAL HEALTH PARTNERSHIP GROUP (ii) LEARNING DISABILITIES PARTNERSHIP BOARD The Head of Adult Commissioning, Calderdale Metropolitan Borough Council advised that amendments had been made to both sets of terms of reference following discussions at the previous meeting. However it was intended to present those changes to the next meetings of the respective Group/Board before a finalised version was referred back to the CCE. DECISION That further reports on the Terms of Reference of the Mental Health Partnership Group and the Learning Disabilities Partnership Board be presented to the next meeting on 8.3.12. 24/12
CHIEF OPERATING OFFICER’S REPORT The Chief Operating Officer presented this report which provided information on senior staff changes at Cluster level, the NHS national bowel cancer public awareness campaign, communication with staff affected by transition, the process for appointing the heads of service roles in the CCG structure, baseline allocations for CCGs and public health for 2012/13, advice on PIP breast implants, arrangements for the future ownership and management of PCT estate and the design of the NHS Commissioning Board. The Chief Operating Officer also reported that Owen Williams, the present Chief Executive of Calderdale MBC had been appointed to the post of Chief Executive of Calderdale and Huddersfield Foundation Trust. DECISION That the report be noted.
QUALITY AND SAFETY REPORT The Deputy Director of Quality and Professional Development presented this report which provided an update on recent quality and patient safety activities and included, at its appendix, a copy of the current Calderdale Quality Dashboard. Discussion took place regarding the incidents of MRSA at CHFT. The Director Of Public Health advised that he understood there had recently been a further case of MRSA at CHFT so the Trust had now passed its MRSA target of 5 cases for the 2011/12 year. It was noted that two “cases” had actually been contaminated samples, but that the system did not allow such cases to be deducted from the figures. The report included information on action that had been taken by the Trust to reinforce infection prevention measures, including a paper having been submitted to the recent CHFT Board meeting proposing 3
significant changes to current practices. It was understood that those proposals had been accepted by the Board. With regard to the elimination of mixed sex accommodation, it was noted that no further breaches at CHFT had been notified since the report considered at the previous CCE meeting. The Deputy Director of Quality and Professional Development advised that the relevant financial penalties were being imposed on CHFT in respect of those earlier breaches. However it was acknowledged that the Trust had accepted that mistakes had been made and had taken action promptly to minimise the risks of a repetition. DECISION That the report be noted. 26/12
CORPORATE PERFORMANCE REPORT The Associate Director of Business Intelligence presented this report which provided an update on the headline indicators identified in the Annual Operating Framework 2011/12. Reference was made to discussion at the previous meeting when concern had been expressed at the length of time spent in A&E by patients subsequently admitted to hospital. In January 2012 it had been noted that the target time had been exceeded and that it had increased since the previous monthâ€™s report. The issue had therefore been raised with CHFT and the report outlined the explanation received on the reasons for these times, which included reference to the time needed to stabilise certain patientsâ€™ conditions prior to them being able to be moved to a hospital ward, the Intensive Care Unit or to be transferred to another hospital for specialist treatment. In discussion it was acknowledged that these patients were being treated appropriately from a clinical perspective, but the way they were being classified was detrimental to the performance figures. It was noted that CHFT had established a review process in respect of cases expected to exceed the target times and CCE members speculated as to whether there might be a more appropriate method of classifying these patients in recognition of the fact that they were undergoing more active hospital management than the figures might suggest. It was agreed that an update be provided in the Corporate Performance Report submitted to the next meeting.
The Non Executive Director referred to the strategic outcomes chart appended to the report and commented upon the fact that performance on 40% of the strategic objectives were RAG rated as red. A Non Executive Associate also referred to this chart and asked why there was a difference between the targets quoted for Breastfeeding and Smoking Quitters for Quarter 2 of 2011/12 on this chart and the chart submitted to the December 2011 meeting. The Associate Director of Business Intelligence agreed to check into this issue and advise CCE members of the reason prior to the next meeting.
DECISIONS 1. That the current levels of achievement made in Calderdale be noted. 4
2. That the update on the Accident & Emergency and Cancer Waiting times be noted. 3. That the Associate Director of Business Intelligence respond to the question regarding the discrepancy between the December 2011 and February 2011 reports in respect of the targets for breastfeeding and smoking quitters for Quarter 2 of 2011/12. 27/12
UPDATE REPORT ON ADULTS HEALTH AND SOCIAL CARE LED ELEMENTS OF THE SINGLE COMMISSIONING PLAN The Head of Commissioning, Calderdale Metropolitan Borough Council presented this report which provided information on progress with the Adults, Health and Social Care led elements of the Single Commissioning Plan for 2011/12. A table was appended to the report and this outlined the three main strategic areas of work, broken down into detailed activity areas and progress made on each of them. The Head of Commissioning, Calderdale MBC pointed out that the only area where progress was RAG rated as red was related to Older Peopleâ€™s supported living and he advised that this had been due to the consultation exercise having taken longer than anticipated, as it had involved a large number of people and providers. The Non Executive Director (being also the Chair of the Audit and Governance Group) reported that the Audit and Governance Group had been advised of issues of capacity in respect of contract management. The Director of Adults, Health and Social Care responded that this issue had recently been raised with her and the Council was now looking at increasing staffing capacity in this area. DECISION That the report be noted.
FINANCIAL AND EFFICIENCY REPORT The Chief Operating Officer presented this report which outlined the current and forecast financial position for 2011/12 together with associated risks. She referred to appendix 2.8 of the report which detailed schemes approved for funding from the 2011/12 contingency fund and advised that since the writing of the report further schemes had been approved so that the entire contingency fund of ÂŁ3m had now been allocated. In respect of the QIPP (Quality Innovation Productivity and Prevention) the Chief Operating Officer confirmed that the 2011/12 Plan was on track overall to deliver the savings required and attention was now being focussed on the plan for 2012/13. With regard to the running costs, it ws anticipated that the target would be challenging for 2012/13 bearing in mind the on-going transition. The Chief Operating Officer commented that a tipping-point had been reached in respect of reducing staff numbers whilst continuing to deliver functions and key statutory duties. In respect of contract performance it was noted that there were apparently 5
significant under-trades with several out of area hospital trusts but it was pointed out that these analyses were subjective as it was not contracted activity and due to the numbers/costs involved they were of much less significance than the position with CHFT, the main provider. It was reported that CHFT was still under-trading and had recently been facing significant pressure in Accident and Emergency attendance, but the 18 week treatment target was being maintained and the recent allocation of £1.4m access money (reported at the previous meeting) would presumably assist the position. DECISIONS 1. That the forecast financial position for 2011/12 be received. 2. That the risk RAG rating of green for achieving the control total be noted. 29/12
WORKFORCE REPORT The Assistant Director of Workforce presented this report which set out key workforce headlines and workforce information figures, trends and trajectories for directly-employed NHS Calderdale staff. In respect of staff turnover, it was still anticipated that the trajectory figure would be met and it was expected there would be an increase shortly due to voluntary redundancy scheme departures. It was noted that sickness absence levels had recently increased above target, but it had been expected that there would be such an increase in the winter and it was anticipated that the target would still be achieved by the year end. DECISION That the report be noted.
LOOKED AFTER CHILDREN ANNUAL REPORT - APRIL 2010 – DECEMBER 2011 The Designated Nurse (Looked After Children) and the Designated Doctor (Looked After Children) presented this report which reviewed the work of the Looked After Children (LAC) health team and described the health outcomes for these children. It was explained that the extended timescale of this “annual” report was due to the delay in availability of benchmarking data. It was agreed that in future the preparation of the Annual Report should not be held back by awaiting such data but could be prepared using the latest available data. Reference was made to there having been a significant increase recently in the number of Looked After Children both nationally and locally. It was noted that there had been an increase of 22% in Looked After Children in Calderdale over the previous 12 months and this had put the services supporting these children under considerable strain. Discussion took place upon the statutory requirement for an initial medically-led health check to be carried out on all children within 28 days of their becoming 6
Looked After by the Local Authority. It was noted that at the end of 2011 only 45% of children were being assessed within the target time and, bearing in mind the increase in the numbers of these children, the PCT had committed additional non recurring monies to increase the Designated Doctor capacity up to the end of the 2011/12 financial year. (A business case for recurring additional funding was also being considered). Work was also on-going to analyse the reasons for the delays (in addition to the increased volume), which included delays in receipt of electronic notification of the case from the local authority, delays in returning of signed consent forms, failure of the carer to bring the child to the assessment appointment (particularly where the carer was an associated person/relative). Timeliness of health assessments had also been included as an action point on the Single Improvement Implementation Plan developed by the Director of Children’s Care Services (see also Minute 31/12 below). The meeting was informed that the review health assessments could be nurseled and where possible the aim was to use mainstream services (school nurses and health visitors employed by CHFT) as this carried less stigma and kept the number of health professionals involved with each child to a minimum. It was reported that the school nurses and health visitors had been very co-operative and supportive, but the increased volume of cases was having a significant impact on CHFT community services. A Non Executive Associate asked about the extent of improvement in timing of health assessments being anticipated by the increase in capacity being funded. In response it was commented that the aim would be to always meet the specified time limit for health assessments, although this was not something totally within NHS Calderdale’s control and it was therefore important to ensure all the processes for referral etc. were in order and operating properly. The Interim Director of Child and Young People’s Services commented that the number of school nurse posts on the establishment was appropriate, but there were sometimes problems with delays in filling vacancies. Reference was also made to the Looked After Children health team’s role in relation to fostering and adoption. The Interim Director of Child and Young People’s Services advised the meeting of the present campaign to increase the number of foster carers in Calderdale which was particularly important due to the increase in numbers of Looked After Children and the high costs involved in placing children out of area when local foster placements were not available. It was agreed to encourage GP practices to return their reports for prospective carers as quickly as possible. DECISIONS 1. That the Looked After Children Annual report be received. 2. That the achievements and progress made in 2010-2011 be noted. 3. That the priorities and next steps for 2011-12 be supported. 4. That the Quality Group monitor progress with the Implementation Plan in 6 months time, with the option for the issue to be escalated to the CCE if considered necessary. 7
SAFEGUARDING CHILDREN UPDATE – IMPROVEMENT JOURNEY FOCUSING ON THE SINGLE INTEGRATED IMPROVEMENT PLAN The Assistant Director of Quality Improvement (Safeguarding Children) presented this report which provided a summary of the support NHS Calderdale and its associated health partners had provided since Calderdale MBC had received its “Notice to Improve” in April 2010 following an OFSTED/CQC Inspection of Looked After Children Services and Safeguarding Children services. The report included at its appendices a copy of a progress report due to be considered by the Calderdale Safeguarding Children Improvement Board on 6 March 2012. The Interim Director of Child and Young People’s Services referred to the Single Integrated Improvement Plan (SIIP) which was also appended to the report and which provided a comprehensive outline of the various action points and progress made to date in implementing them. He reported upon the importance of co-ordinated working and co-operation in the future, particularly with schools and early intervention. He commented upon the previous lack of availability of early intervention support, which had resulted in many inappropriate referrals to social services in the past. The Interim Director of Child and Young People’s Services also referred to a public health survey of schoolchildren undertaken in 2010 which had placed Calderdale as an outlier on issues of children reporting not feeling safe, low self esteem and incidents of self harm. The Executive Director of Quality and Governance (Nursing) referred to the national picture regarding child safeguarding being in transition and she commented that work on-going in respect of the NHS Accountability Framework for Safeguarding might prove helpful in dealing with some of the local issues. The Interim Director of Child and Young People’s Services was asked about specific assistance that might be required in the next year or so and he advised that there might need to be further discussions on particular areas of concern, such as school nurse vacancies. The Assistant Director of Quality Improvement (Safeguarding Children) asked how the CCE would like to be updated on this issue. It was agreed that this should be discussed with the CCE lead on safeguarding (who was not present at this meeting). DECISION That the report be noted.
RISK REPORT AND HIGH LEVEL RISK LOG The Deputy Director of Quality and Professional Development presented this report which provided information on the current risk position for NHS Calderdale and included at its appendix the High Level Risk Log (incorporating risks scored at 15 and above). It was noted that the Audit and Governance Group had already considered the report in detail and recommended the HLRL to the CCE as a true reflection of 8
the risk position as at January 2012. Two CCG Board members (being also Audit and Governance Group members) referred to issues having been raised at the Audit and Governance Group meeting on 2.2.12 on the risks relating to failures in performance of partner organisations and the suggestion that CCG leads in specific areas have discussions with relevant managers so as to ensure that they fully understood the risks in that area and the systems for identifying, assessing and escalating risks. The Chair commented upon the start date for all risks on the HLRL being recorded as January 2012. It was felt that this might be an error and the Deputy Director of Quality and Professional Development agreed to check into this further. DECISIONS 1. That the HLRL be accepted as a true reflection of the risk position as at January 2012 (subject to the start date of the risks being checked).
2. That the HLRL be referred to the Calderdale, Kirklees and Wakefield District Cluster Board with the recommendation that it be accepted as a true reflection of the risk position as at January 2012.
3. That the Deputy Director of Quality and Professional Development check into the accuracy of the start dates of risks entered on the High Level Risk Log.
UPDATE REPORT ON THE PROCUREMENT OF NHS 111 AND THE REPROCUREMENT OF THE OUT OF HOURS CONSULT AND TREAT SERVICE IN CALDERDALE The Chief Operating Officer presented this report which referred to the requirement for all PCTs/CCGs to commission a NHS 111 service by April 2013, and the decisions to procure a Yorkshire-wide 111 service and to include the out of hours contract within this procurement. It was noted that Dr Haider had been appointed as a clinical associate to provide clinical input into the project. DECISION That the report be noted.
CLINICAL COMMISSIONING GROUP STRUCTURES The Chief Operating Officer reported orally upon the arrangements for filling the six Heads of Service posts in the CCG structure, with existing staff having been slotted into five of the posts and with an interview process being required to fill the sixth post. DECISION That the Chief Operating Officerâ€™s report be noted. 9
COMMISSIONING SUPPORT OFFER The Commissioning Support Offer Project Manager presented this report which introduced and included at its appendix a draft commissioning support prospectus. The report offered the opportunity for further feedback, outlined key milestones for developing the commissioning support offer and raised the issue of developing a process for signing off a Memorandum of Understanding for commissioning support. The Chair referred to the draft Memorandum of Understanding which proposed a block arrangement and notional funding and he expressed reservations as to how Calderdale CCG would ensure it received its fair share of the services provided. In discussion, reference was made to the lack of clarity in the report as to precisely what the CCG would receive for its money and to the outstanding requirement for a piece of work to be undertaken in Calderdale to specify which functions were to be carried out locally and which were to be purchased from the CSU. The view was expressed that the emphasis should be on the CCG determining and specifying precisely what it wanted to purchase from a CSU and then being advised of what the cost would be. Reference was made to the need to balance the desirability of preparing detailed specifications of precisely what services were required from the CSU with the time pressure of agreeing a Memorandum of Understanding by the end of February 2012 so as to avoid jeopardising the timetable for full authorisation of the CCG. The Director of Adults, Health and Social Care (Calderdale MBC) also referred to the need to take into account what functions were presently being provided jointly. The Chair commented that the report/its appendices did not include any reference to affordability for the CCG and he expressed the view that he would like to see a team of staff based locally even if they were not employed locally. It was suggested that a CCG Workshop be arranged as a matter of urgency to enable further consideration of the Heads of Agreement.
DECISIONS 1. That the draft prospectus and Draft Memorandum of Understanding be noted. 2. That a CCG workshop be arranged to enable further consideration of the Heads of Agreement. 36/12
UPDATE ON THE DEVELOPMENT OF CALDERDALE COMMISSIONING GROUP The Programme Director, Transition presented this report which provided an update on progress made towards the establishment of the CCG as a statutory body, the risks to making continued and satisfactory progress, actions to mitigate those risks and the key priorities for the next few months. 10
It was noted that progress on all the activities in the CCG transition plan were rated as “green” apart from the Memorandum of Understanding and the Service Level Agreement with the Commissioning Support Services. Reference was made to the need for the CCG to undertake a further 360o review quite soon, with this involving a wider group of people than the previous review. The Programme Director for Transition also referred to a decision to undertake the process of re-election/selection of CCG Board members to the end of the year. DECISION That the report be noted. 37/12
MINUTES TO BE RECEIVED Minutes of the following meetings were received: (a) Calderdale, Kirklees and Wakefield District Cluster Board – Draft minutes of the meeting held on 17 January 2012 The Chair referred to the minute regarding NHS Health Checks on page 8 of the report which stated “…more proactive work needed to be undertaken to improve the effectiveness of this programme ……it was AGREED to ask the CCEs to review this issue.” ACTION The Chief Operating Officer advised that this issue might be being addressed as part of the Business Planning Process, but she would check into this. (b) Quality Group – Draft minutes of the meeting held on 19 January 2012 (c) Calderdale Children’s Social Care Improvement Board – Draft minutes of the meeting held on 10 January 2012 (d) Calderdale Safeguarding Children Board – Draft minutes of the meeting held on 18 January 2012 (e) Calderdale Safeguarding Adults Board – Minutes of the meeting held on 6 December 2011
ANY CCE DECISIONS FOR INCLUSION IN THE LEGACY DOCUMENT (a) Mental Health Programme
ITEMS FOR REFERRAL TO THE CLUSTER BOARD OR ANY OF THE SUBGROUPS (a) Risk Report and High Level Risk Log referred to the Cluster Board (b) Safeguarding Children – monitoring of implementation of Single Integrated Improvement Plan CHAIR
Clinical Commissioning Executive action sheet 16 February 2012 Report name
23a/12 Mental Health Programme for Calderdale Terms of Reference of Mental Health Partnership Group and Learning Disabilities Partnership Board
Corporate Performance Report
Looked After Children Annual Report
Amendments to be made to Mental Health Programme in respect of personalisation, present reconfiguration of mental health services and possibly drawing out of story on transformation on mental health services locally Further reports to be presented to the meeting on 8.3.12
Update on classification of patients being stabilised in Accident & Emergency before admission to be included in Corporate Performance Report.
Associate Director of Business Intelligence to check into difference in targets quoted for Breastfeeding and Smoking Quitters for Quarter 2 in CCE reports of December 2011 and February 2012 and to update CCE members accordingly Quality Group to monitor delivery of the Single Integrated Implementation Plan in 6 monthsâ€™ time and escalate the issue to the CCE if considered necessary
On Agenda for meeting on 8.3.12
Comments (include, expected completion date, areas of concern etc) Completion date: 8 March 2012
Completion date: 8 March 2012
Completion date: 8 March 2012
Complete 8 March 2012
Not yet due
Completion date: August 2012
Safeguarding Children â€“ Single Integrated Improvement Plan
Procedure for updating CCE on progress with Single Integrated Improvement Plan to be discussed with CCG Lead on Safeguarding
Completion date: 8 March 2012
High Level Risk log to be referred to Cluster Board
Completion date: 8 March 2012
Deputy Director of Quality and Professional Development to check on start date of risks entered on High Level Risk Log
CCG Workshop to be arranged to discuss the Heads of Agreement of the Commissioning Support Offer Chief Operating Officer to check whether issue of Health Checks was being addressed as part of the Business Planning Process
Rachel Spilsbury/ Judith Salter Julie Lawreniuk
Risk Report and High Level Risk Log
Commissioning Support Offer Cluster Board minutes of 17.1.12 â€“ Health Checks
Completion date: 8 March 2012 Completion date: 8 March 2012