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CKWCB/12/106 NHS Calderdale, Kirklees and Wakefield District Cluster

Minutes of the CKW Cluster Board held on Tuesday 27 March 2012 at 9.00am in the Kingswood Suite, Wakefield Town Hall Present: Angela Monaghan Sandra Cheseldine Ann Liston Keith Wright Roy Coldwell Mehboob Khan Tony Gerrard Mike Potts Jonathan Molyneux Ann Ballarini Dr Matt Walsh Dr Judith Hooper Dr Graham Wardman In attendance: Peter Flynn June Goodson-Moore Carol McKenna Gill Galdins Julie Lawreniuk Sheila Dilks Vicky Pickles Chris Dowse Ian Currell Alison Hughes Jayne Beecham Pauline Kershaw Alison Fearnley

Chair Non-Executive Director Non-Executive Director Non-Executive Director and Audit Committee Chair Non-Executive Director Non-Executive Director Non-Executive Director Chief Executive Interim Executive Director of Finance and Efficiency Executive Director of Commissioning and Service Development Executive Medical Director Executive Director of Public Health (NHS Kirklees) Executive Director of Public Health (NHS Calderdale)

Director of Performance and Commissioning Intelligence Executive Director of Workforce and Corporate Development (left the meeting between 9.15am and 10.30am) Chief Operating Officer (NHS Kirklees) Chief Operating Officer (NHS Wakefield District) Chief Operating Officer (NHS Calderdale) Director of Transformation Head of Corporate Affairs (NHS Calderdale) Director for Transition, NHS Calderdale and Programme Director for Mid Yorkshire health & Social Care Partnership Director of Finance (as from 23 April 2012) Managing Director, Commissioning Support Services Communications Manager (NHS Wakefield) Executive Assistant (NHS Kirklees) Corporate Governance Administrator (NHS Kirklees)

In addition there was one member of the public also in attendance. The Chair opened the meeting by welcoming all those in attendance. CKWCB/12/76

Apologies for Absence Apologies for absence were received from Roger Grasby, Non-Executive Director and Vice-Chair, Sue Cannon, Executive Director of Quality and Page 1 of 10


Governance (Executive Nurse) and Andrew Furber, Executive Director of Public Health (NHS Wakefield). CKWCB/12/77

Declarations of Interest No Cluster Board members declared interests in any of the agenda items.

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Minutes of the last meeting held 6 March 2012 The minutes of the Cluster Board meeting held on the 6 March 2012 were AGREED as a true and accurate record.

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Matters arising from the Minutes of the last meeting and action log sheet CKWCB/12/57

Quality and Patient Safety Report

MRSA The Board was assured that the point raised at the last meeting regarding the 10 point plan adopted by Mid Yorkshire in 2009 would be followed up at the next Quality Board. CKWCB/12/58

Finance and Efficiency Report

QIPP (Quality, Innovation, Productivity and Prevention)Schemes The Board was assured that delivery of the QIPP schemes was continuing to be robustly monitored via the Finance and Performance Committees The Board also reviewed the action log sheet which would be updated as necessary. CKWCB/12/80

Public Question Time The Chair gave an opportunity for any members of the public to raise any questions. No questions were raised.

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Chair’s Comments The Chair reported that Sheila Dilks was due to retire at the end of the month. The Board acknowledged Sheila’s valued contribution to both NHS Kirklees and the wider CKW Cluster and wished her all the best for her future retirement.

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Chief Executive’s Report Mike Potts presented his report to the Board highlighting the following:

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Mike reflected on the three strategic priorities the Board is focussed on in managing the transition to the reformed NHS. These being: Control Create Close It was recognised that the development session arranged for 3 April would provide the Board with an opportunity to explore this in more detail and how the Board’s work programme for the next 12 months will shape as we move through the final stages of transition. The Board RECEIVED and NOTED the contents of the Chief Executive’s Report. CKWCB/12/83

Finance Report The Board was presented with the month 11 financial position for NHS Calderdale, NHS Kirklees and NHS Wakefield District. Jonathan Molyneux explained that the report summarised the financial position for the year to date, up to 29 February and confirmed that the three PCTs were forecasting that they would all meet their key financial targets, including the income and expenditure surplus, by the year end (£15m). Keith Wright requested further clarity regarding the £2.5m overspend showing on the non recurrent reserve line for NHS Wakefield District as raised at the last meeting. It was AGREED that Julie Lawreniuk would clarify this position outside of the meeting. In addition Keith requested clarification regarding the provision for redundancies. It was recognised that this had not been fully reflected as at the end of February and Jonathan AGREED to provide these figures to the Board Jonathan advised that each PCT had to produce a set of Statutory Accounts for the year. It was noted that these were due by 23 April and the final audited accounts had to be submitted to the Department of Health by 8 June 2012. In view of the tight timetable it was proposed that the review and sign off of the annual accounts is delegated to the Cluster Audit Committee. This was subsequently AGREED. The accounts would then be presented to the following Cluster Board meeting on 12 June. An invitation was therefore extended to other Board members to attend the Audit Committee on 6 June to discuss this item. The Board AGREED to: NOTE the summary of the Cluster’s and three PCTs’ financial performance against key financial targets for the year to date and the annual forecast for 2011/12. DELEGATE the review and sign off of the 2011/12 annual accounts to the Cluster Audit Committee. Page 3 of 10


Invite all Board members to attend the Audit Committee on 6 June for the sign off of the accounts.

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Critical Risks Jonathan provided a verbal update regarding one finance critical risk concerning Mid Yorkshire Hospitals NHS Trust’s financial position. It was noted the end of year deficit was £19.7m for 2011/12. Furthermore it was recognised that the Cluster had been asked to provide an additional £10m of transitional support for 2012/13. The Board acknowledged this posed a significant risk to the North Kirklees and Wakefield Clinical Commissioning Groups until the financial implications at MYHT had been fully resolved. Jonathan provided assurance that the CKW Cluster was working closely with the Strategic Health Authority (SHA) and the wider health economy to address the ongoing problems. The Board NOTED that new Critical Risk reporting template would be circulated as soon as possible.

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Review of Standing Orders and Standing Financial Instructions The Board was presented with revised Standing Orders and Standing Financial Instructions for formal approval. Vicky Pickles explained that it had been agreed to undertake a review of these documents after three months to ensure they were appropriate and delivering clear governance for the Cluster. It was recognised that minor amendments had been made which had been overseen and approved by the Audit Committee on 21 February 2012. The Board AGREED to APPROVE the proposed amendments to the Standing Orders and Standing Financial Instructions.

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Pharmacy Panel Terms of Reference The Board was presented with revised Terms of Reference that set out proposed new arrangements for Pharmacy Panels. Vicky Pickles provided a brief overview and explained that due to reduced workforce resources, following clustering, the best approach would be to develop one pharmacy panel across the Cluster. A discussion ensued regarding the future revision of the Pharmaceutical Needs Assessment (PNA). It was recognised that the PNA would become a sub-set of the Joint Strategic Needs Assessment and that Clinical Commissioning Groups (CCGs) would have a duty to support the production of the PNA. The Board AGREED to:

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APPROVE the proposal for the establishment of a single Pharmacy Panel on behalf of Calderdale, Kirklees and Wakefield District Primary Care Trusts; APPROVE the Terms of Reference for the Pharmacy Panel; and APPOINT Angela Monaghan as the Non Executive member of the pharmacy panel. DELEGATE responsibility to the Chair to appoint a deputy NonExecutive Director and the Chief Executive to appoint a Director and Medicines Management lead, plus deputies, to the Pharmacy Panel. CKWCB/12/87

Final Cluster Operating Plan 2012-2015 The Board was presented with the final version of the 2012-2015 Cluster Operating Plan for sign off. Peter explained that further work had been undertaken to finalise the plan since the last meeting and he highlighted the key changes. It was recognised that these were mainly presentational amendments. Peter provided clarity regarding the level of transformational savings required over the 3 year plan. The Board acknowledged this was now 50%. It was recognised that the QIPP plans had therefore been substantially revised and Peter circulated a revised copy of Section 1 which was now headed Transformation instead of Overarching. Peter provided assurance that all relevant stakeholder organisations had been involved in co-design and ownership of the whole-system plans. It was acknowledged this was a challenging agenda with significant risks. Work was being undertaken, with partners, to manage these challenges and resolve them as early as possible in the new financial year. Concerns were raised about whether the pace and level of change would impact on quality and safety. The Board were assured that there continues to be a clear focus on the quality and safety indicators particularly through the quality boards to ensure that the quality and safety of indicators is not compromised. Discussion was had on whether the Joint Strategic Needs Assessments were sufficiently reflected in the plans along with the role of Health and Wellbeing Boards. It was clarified that the individual Clinical Commissioning Group Plans, included more detailed in terms of the health needs of the local populations. It was AGREED that this should be reflected in the introductory letter. The Board ASKED that the Plan be reviewed in light of the changing financial position to ensure that the numbers are aligned. The Board APPROVED the Plan subject to these two amendments.

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Budgets and Key Financial Targets 2012-13

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Jonathan Molyneux presented the report setting out a summary of the budgets for 2012/13, an overall total of £1,723.7 million, with a planned surplus of £13.3 million. It was noted that the contracts with all the main providers had been agreed with non-recurrent transitional funding for Mid Yorkshire Hospitals Trust, Calderdale and Huddersfield NHS Foundation Trust and Leeds Teaching Hospitals. In addition, non-recurrent funding had been identified for business planning investment during the year. It was noted that the budgets identified for Clinical Commissioning Groups still included those for public health which will transfer to local authorities. All the information required to be able to split the budgets more accurately had not been received, therefore budgets had been set based on historical financial information. Jonathan Molyneux also confirmed that the position in relation to corporate budgets and what should and shouldn’t be included remained unclear. The need to have a balanced financial position to hand over to CCGs was recognised. Julie Lawreniuk confirmed that all CCGs had been involved in the financial planning and had received the draft budgets at their Finance and Performance Sub-Groups. Julie Lawreniuk reported that the prescribing budgets had been uplifted by 5% net of the QIPP target. The Board NOTED the opening income for each primary care trust for 2012/13. The Board APPROVED the opening expenditure budgets and the income and expenditure surplus target for each PCT for 2012/13. The Board NOTED the total proposed capital expenditure for each PCT for 2012/13, subject to confirmation of the limit by the Department of Health. The Board NOTED the requirement to work within the cash limit set out in the report and to work to the public sector payment policy. The Board APPROVED the QIPP savings for 2012/13 and NOTED the requirement to achieve them.

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Commissioning Development Ann Ballarini presented the report, noting that the Health and Social Care Bill had been passed by Parliament and that there would be more guidance being published on the different elements of transition. Ann set out the steps required to achieve authorisation of the CCGs. It was noted that the timescales were challenging and a further update would be brought to the Board in May.

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Discussion took place on the development of the South Wakefield Commissioning Partnership. Ann reported that positive meetings had taken place between the South Wakefield and the Wakefield Alliance CCGs and a further meeting was due to be held to try to resolve the issues. Further information on this would be reported at the next full Board meeting. The Board AGREED not to set up a further Clinical Commissioning Executive at this time. Alison Hughes set out the timescale for the implementation of Commissioning Support Services. The next checkpoint to be met was the submission of the outline business plan on 30 March 2012. Alison confirmed that this would be met. It was noted that further work needs to be done to tell staff about the CSS and engage them in its development. Alison responded that her appointment as Managing Director would mean that this work could now be accelerated. The Board noted that all six portfolio areas appear to be on track. The main risk areas being CCG authorisation and ensuring the timescales are met and the right support is provided; and CSS development and the tight timescales. The Board RECEIVED the Strategic Health Authority’s document on new system working and NOTED its content. The Board AGREED to invite CCGs to the May Board meeting. CKWCB/12/90

Update on Public Health Transition The Board RECEIVED the full public health transition plans for each of the three PCT areas. It was noted that the plans are quite different and a standard reporting process was required. Judith Hooper informed the Board that a letter had been sent to the Department of Health in relation to the disparity in the Kirklees allocation for public health. Graham Wardman highlighted the areas of concern as being: - The allocation of resources to the local authority for the implementation of responsibilities that the Councils will inherit and how this will reflect any additional investment made by PCTs since the baseline was set. - The lack of national guidance to govern staff transfers to the local authority and particularly the NHS Commissioning Board or Public Health England where very little information is available. - The need for consistent due diligence across the PCTs. The Board NOTED that plans had been considered and approved by the three local Authorities. The Board APPROVED the plans and ASKED that future reports be done on an exception basis.

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Transformation Programmes Report Page 7 of 10


Progress report on the Calderdale and Greater Huddersfield transformation programme Sheila Dilks present the report setting out the programme of work for the review of health and social care services across Calderdale and Huddersfield. It was noted that full engagement and ownership of the plans by CCGs was crucial. Sheila commented that partners were all experiencing financial challenges and it was recognised that integration was a way of managing these challenges. The Board ASKED that future reports include the key risks. It was also recognised that the governance arrangements should include membership of Non Executive Directors. Sheila agreed to review the governance arrangements and bring them back to the Board for approval. Mid Yorkshire Hospitals Trust Programme Board Chris Dowse presented the report, explaining that at future meetings the Board would receive a highlight report with the risk register. It was noted that the Chief Executive of the Trust had requested a pause of the Clinical Services Strategy. The pause would enable a review of progress and clarify the way forward following the changes in management. Chris commented that this was a complex programme of activity that would lead to high level changes in the way services are delivered. Chris assured the Board that there was a detailed risk register in place for the programme and that these were regularly reviewed and managed. Discussion took place on the resources to support the programme. Chris explained that each work stream has a lead and reported that the Martin Land, the Programme Manager, had left, so replacement support was being secured. The Board thanked Martin for his work to move the programme forward. The Board considered the governance arrangements and recommended that the Programme Board should not be chaired by the Chief Executive of the Trust. Mike Potts agreed to look at whether this should be a Cluster or CCG lead. Sheila Dilks confirmed that the Chair of the Calderdale and Huddersfield Programme Board would be a GP. The Board RECEIVED the report and NOTED the next steps. Judith Hooper and Carol McKenna left the meeting at this point. CKWCB/12/92

Emergency Preparedness Annual Report Mike Potts explained that the report set out the emergency planning activity undertaken across Calderdale, Kirklees and Wakefield District over the previous year. The report also set out the assurance received from the main providers as to their emergency preparedness. Page 8 of 10


Mike highlighted the priorities for 2012/13, recognising that there continues to be a lot of work to be undertaken in the future. It was clarified that GP consortia will be category 2 responders and further work was needed to understand what their role will be in the future. It was noted that Ian Dalton was leading this work nationally and that there was a particular focus on emergency preparedness in the run up to the Olympics. The Board RECEIVED the report, noting the change in lead director from Sue Cannon to Judith Hooper. The Board ASKED that the accountability arrangements, exceptions and risks should continue to be reported through the Portfolio 6 section of the Commissioning Development report to the Board. CKWCB/12/93

Minutes of the Yorkshire and the Humber Specialised Commissioning Group It was confirmed that the financial positions set out in the minutes had been included in the financial planning and budget setting for the Cluster. The minutes of the Yorkshire and the Humber Specialised Commissioning Group held on 24 February 2012 were ADOPTED by the Cluster Board.

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Minutes of the Governance Committee Matt Walsh highlighted that the Governance Committee should have received a paper on Controlled Drugs and that this would be presented to the next Board meeting. The minutes of the Governance Committee held on 15 February 2012 were RECEIVED and NOTED by the Cluster Board.

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Minutes of the Audit Committee The minutes of the Audit Committee held on 21 February 2012 were RECEIVED and NOTED by the Cluster Board.

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Minutes of the Calderdale Clinical Commissioning Executive The minutes of the Calderdale Clinical Commissioning Executive held on 16 February 2012 were RECEIVED and NOTED by the Cluster Board.

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Any Other Business There were no items of any other urgent business or input as for matters arising

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Date and time of the next meeting

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It was AGREED that the next meeting of the Cluster Board would take place between 1pm and 1.30pm on the 3 April 2012 in the Cypress Room, Cedar Court Hotel, Denby Dale Road, Calder Grove, Wakefield, WF4 3QZ

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