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NHS Calderdale, Kirklees and Wakefield District Cluster

Minutes of the CKW Cluster Board held on Tuesday 17 January 2012 at 9.00am at St Catherine’s Church Centre, Doncaster Road, Wakefield Present: Angela Monaghan Roger Grasby Tony Gerrard Sandra Cheseldine Roy Coldwell Ann Liston Keith Wright Mehboob Khan Mike Potts Jonathan Molyneux Ann Ballarini Sue Cannon Dr Matt Walsh Dr Andrew Furber Dr Judith Hooper

In attendance: Peter Flynn Sue Ellis Carol McKenna Gill Galdins Sheila Dilks Vicky Pickles Eleanor Nossiter Pauline Kershaw Alison Fearnley Cathy Edwards Kevin Smith

Chair Non Executive Director and Vice Chair Non Executive Director Non Executive Director Non Executive Director Non Executive Director Non Executive Director and Audit Committee Chair Non Executive Director Chief Executive Interim Executive Director of Finance and Efficiency Executive Director of Commissioning and Service Development Executive Director of Quality and Governance (Executive Nurse) Executive Medical Director Executive Director of Public Health (NHS Wakefield District) Executive Director of Public Health (NHS Kirklees) (From 9.50am)

Director of Performance and Commissioning Intelligence Director of Human Resources and Organisational Development Chief Operating Officer (NHS Kirklees) Chief Operating Officer (NHS Wakefield District) Director of Transformation Head of Corporate Affairs (NHS Calderdale) Head of Communications and Engagement (NHS Wakefield) Executive Assistant Corporate Governance Administrator Director of Yorkshire & the Humber Specialised Commissioning Group (Agenda item CKWCB/12/14) Medical Advisor Yorkshire & the Humber Specialised Commissioning Group (Agenda item CKWCB/12/14)

In addition there were four members of the public also in attendance. The Chair opened the meeting by welcoming all those in attendance. In particular it was noted that this was Sue Ellis’ final Cluster Board meeting as she was due to take up a new post at Leeds Community Health Trust. Angela thanked Sue, on behalf of the Board, for her valued contribution to both the Cluster and NHS Kirklees and wished her all the best for the future.


CKWCB/12/01

Apologies for Absence Apologies for absence were received from Julie Lawreniuk, Chief Operating Officer (NHS Calderdale), Dr Graham Wardman, Executive Director of Public Health (NHS Calderdale) and Chris Dowse, Director of Transition (NHS Calderdale) and MYHEFT Programme.

CKWCB/12/02

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

CKWCB/12/03

Minutes of the last meeting held on 6 December 2011 The minutes of the Cluster Board meeting held on Tuesday 6 December 2011 were AGREED as a true and accurate record. In addition the Board reviewed and updated the action log sheet.

CKWCB/12/04

Matters arising from the Minutes of the last meeting There were no specific matters arising from the last meeting.

CKWCB/13/05

Public Question Time The Chair gave an opportunity for members of the public to raise any questions. Cath Gleeson from Kirklees Local Involvement Network (LINk) provided feedback from a public meeting held in Batley regarding the Mid Yorkshire Clinical Services Strategy and advised that there was ongoing concern from the public regarding the future provision of Accident and Emergency services in Dewsbury. Mike Potts provided assurance that comments from these public meetings were being collated as part of the consultation process and confirmed that the Communications team were drawing up a report from the outcome of these meetings which would be published at a later date. In addition Cath advised that there were ongoing concerns in relation to the improvement of pressure sores and requested that more proactive work is undertaken to resolve this. Sue Cannon provided an update on the work being undertaken to achieve this and confirmed that steady progress was being made. In addition she provided assurance that this work was a priority for the Clinical Commissioning Groups which would continue to be robustly monitored.

CKWCB/12/06

Chair’s Comments Angela provided verbal feedback from the Board Development event confirming positive feedback had been received in relation to how the Board was operating. Angela AGREED to circulate the key feedback points to the Board for information.


CKWCB/12/07

Chief Executive’s Report Mike Potts presented his report to the Board highlighting the following: Employment Tribunal (ET) – Mid Yorkshire Hospitals NHS Trust (MYHT) v Eva Michalak The Board noted the ET settlement announced on 15 December 2011, relating to the above case. It was recognised that the Cluster would continue to work with MYHT to understand the impact this settlement would have on their ongoing financial position. Public Health Transition Update The Board noted that further guidance had been received regarding the transition of Public Health into the local authority and the establishment of Public Health England. It was recognised that the Board would receive a further detailed update on public health transition at the Board development session in February. Mehboob Khan suggested that it would prove useful to invite colleagues from the local authority to the Board development session. It was AGREED that Mike would liaise with representatives from the local authority with a view to appropriate colleagues attending this session. Calderdale and Huddersfield Foundation Trust (CHFT) Clinical Services Strategy The Board noted CHFT’s intention to begin work on reviewing their clinical services strategy for the next 3 – 5 years. It was recognised that the programme would embrace a whole health and social care economy approach to this review and not just look at the acute hospital element of care in isolation. It was noted that the Board would be discussing this in more detail at the Board development session in February. Keith Wright enquired what the timescales for the strategy were. It was recognised that these still needed to be determined. Sheila Dilks confirmed she would be working on the outline programme for this following the next Programme Board meeting due to be held the following week. It was acknowledged that engagement with commissioners across the local health economy was fundamental to this work. Children’s Congenital Heart Services Update The Board acknowledged that the Court of Appeal had granted the Joint Committee of Primary Care Trusts (JCPCT) the right of appeal on the basis that there are “arguable issues raised by the applicant and the outcome of the appeal is of public importance”. Furthermore it was noted that The Royal Brompton and Harefield NHS Foundation Trust had also cross appealed and the Court of Appeal Judge had, therefore, ordered that the hearing must take place as soon as possible


together with the Brompton’s cross appeal and at the latest by 4 April 2012. New Appointments: Calderdale Council and NHS North of England Mike advised that the following appointments had been confirmed: -

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Stuart Smith as the Director of Children and Young People’s Services for a period of 3 years at Calderdale Council. Beverley (Bev) Maybury recently started as the new Director of Adults, Health & Social Care (also at Calderdale Council) Allison Cooke, former Chief Executive at North Lincs PCT had been appointed as Transition Director starting from 23 January at NHS North of England.

David Nicholson’s proposed visit to the CKW Cluster Mike reported that David Nicholson was proposing to visit the CKW Cluster on 16 March 2012. It was noted that further details would follow in due course. The Cluster Board RECEIVED and NOTED the contents of the Chief Executive’s Report. CKWCB/12/08

Quality and Patient Safety Report Sue Cannon presented the Quality and Patient Safety report to the Cluster Board. In particular the following key points were discussed: Safeguarding Sue explained the governance arrangements for receiving the Safeguarding reports for 2010-11. It was recognised that in order to allow the reports to receive sufficient scrutiny it was recommended that the Board request the Governance Committee at its next meeting to receive and review these reports, reporting back to the Board at the March 2012 meeting. This was subsequently AGREED by the Board. Stroke Services Accreditation Roger Grasby welcomed the progress on Stroke Services Accreditation at Mid Yorkshire. Hospital Standardised Mortality Ration (HSMR) Roger also enquired what was being undertaken to reduce mortality rates at MYHT following the increased rate published in the Dr Foster Hospital Guide, flagging the Trust as a negative outlier. Matt Walsh provided assurance that the Cluster was working closely with colleagues from MYHT to develop a robust action plan regarding pathway changes and the management of patients. In addition it was noted that further assistance had been requested from the Public Health Observatory to understand changes in methodology of the formula.


Patient Experience Sandra Cheseldine enquired what work was being done at MYHT to improve the personal needs of patients. Sue Cannon confirmed that Tracey McErlain-Burns, Chief Nurse and Director of Patient Experience at MYHT, was leading some proactive work on improving patient experience and advised that additional help was being sought from the Local Involvement Network to assist with some walk-arounds. A discussion then ensued regarding the design and content of the Quality report. In particular, Roy Coldwell said he would welcome the inclusion of information showing trends. Sue described the work being undertaken by the Quality and Performance teams to develop a common presentational style for future performance and quality summary reporting to the Board. It was acknowledged that this would be informed by the North of England Strategic Health Authority (SHA) quality dashboard approach. In addition, it was recognised that detailed scrutiny of performance and quality data would be undertaken by the Clinical Commissioning Executives and the sub- groups. An exception report would be presented to the Cluster Board on the red and amber areas. It was AGREED that this approach would be tested out via the sub-groups and that a prototype would be presented to the Board in March with a view to being live from May 2012. Sue also welcomed some additional input from Non Executive Directors (NEDs) with this work. Anyone interested was asked to liaise direct with Sue. Temporary closure of Pontefract Accident & Emergency (A&E) The Board noted that the Pontefract A&E department remained temporarily closed between 10.00pm and 8.00am in the interests of patient safety, due to a shortage of experienced emergency doctors. The Board acknowledged that an external review had been undertaken to ensure that all possible measures and solutions to the issues had been explored. Matt Walsh described the terms of reference for the review, and outlined the process used. The review appeared to confirm that all the relevant issues had been considered by MYHT in taking the decision to partially close the department. The review identified 2 potential interventions for MYHT to consider in support of re-opening the service on an interim basis. These options are currently being considered. The report also pointed out that in another hospital, faced with admittedly different challenges, an approach had been made by them to the Army Medical Service. The report indicated that whilst the circumstances at Pontefract were different, MYHT should consider this option. Matt provided assurance that there was a shared will among the local health economy to have the service fully open and confirmed that the Board would be kept up to date regarding the outcome of this work.


In addition to the above measures, further work had been undertaken to assess the number of people who had attended to access the services, and the numbers of these who had required transfer to A&E at Pinderfields General Hospital. It was noted that the numbers were minimal and there had been no significant changes in terms of increased impact on NHS Direct or demand for urgent appointments. It was recognised that further work would be undertaken to ensure that resources are being used efficiently and effectively. The Board acknowledged however that there was ongoing concern from members of the public concerning the temporary overnight closure of the A&E department and its future. Mike provided assurance that these comments were being considered as part of the engagement work on the Clinical Services Strategy and that he was liaising closely with local MPs. The Board AGREED: Governance arrangements for the 2010/11 safeguarding reports; and a proposal for future quality and performance reporting arrangements.

The Board RECEIVED and NOTED: an update on the Commissioning for Quality and Innovation Scheme (CQUIN); quality performance information and details of action taken; a summary of the Dr Foster Hospital guide information in relation to Calderdale and Huddersfield Foundation Trust and Mid Yorkshire Hospitals Trust; an update on recent regulatory activity; the outcome and recommendations from the CQC/OFSTED inspection for Kirklees; a summary on Stroke Services Accreditation at Mid Yorkshire; and an update on the temporary closure of Pontefract A&E. CKWCB/12/09

Cluster Performance Report Peter Flynn presented the Cluster Performance report to the Board. He explained that the report had been expanded slightly to include additional information on Choose and Book and Workforce metrics following requests from the Board previously. The key topics discussed included: A&E 4 Hour Wait – 95% Waiting Time Standard The Board noted that MYHT year-to-date A&E activity for the whole trust was currently 93.9%. However, quarterly data confirmed that each of the three hospital sites had reached 95% and achieved this for some weeks in December. It was recognised however that performance at Pinderfields Hospital continued to fluctuate.


Stroke and TIA Peter reported that data was variable throughout Yorkshire and Humber due to different interpretations in reporting. PIP Breast Implants: global health scare Peter provided assurance that Executive Medical Officers in local provider and Foundation Trust organisations had been assessing patients who could have potentially received the faulty PIP breast implants on the NHS. It was acknowledged that none of these implants had been used by the Cluster’s providers. Mixed Sex Accommodation (MSA) Peter reported that MSA activity published in December relating to the November period showed 30 breaches. This was due to one event. Peter provided background to the details of the event and confirmed the action being taken. Bowl Cancer Screening Campaign Peter advised that the above campaign was due to commence on 20 January 2012. The Board acknowledged this was likely to impact on GP time and bowl cancer services. Non-recurrent Funding for improving patient access Peter advised that additional funding had been made available to PCTs/CCGs for improving access, however the allocation must be committed by 24 February and spent by the end of the financial year. Peter provided the Board with assurance that proposals were being explored to determine how this could be achieved. 18 Weeks Referral to Treatment Sandra Cheseldine asked for an update on the latest position with regard to the recovery plan at MYHT to see those people waiting longer than 18 weeks. Whilst it was recognised that there had been a decrease in the backlog, it was acknowledged that the position remained challenging, namely due to the amount of activity over the winter period. The Board was reassured regarding the measures being undertaken to improve this position, however, it was emphasised that this needed to be sustainable in the longer term which would take time to achieve. Smoking Quitters Dr Hooper and Dr Furber explained the action being taken to increase the number of smoking quitters. It was noted that the number of quitters had posed a challenge. It was recognised that resources were limited and need to be diverted to where they are most likely to have the greatest impact. It was AGREED to ask the Clinical Commissioning Executive Committees (CCEs) to ensure there is sufficient focus on achieving this target.


NHS Health Checks Mehboob Khan advised that more proactive work needed to be undertaken to improve the effectiveness of this programme. It was AGREED that Mehboob would liaise with Matt Walsh outside of the meeting to clarify what he believed were the specific issues. In addition, it was AGREED to ask the CCEs to review this issue. The Board NOTED NHS Calderdale, NHS Kirklees and NHS Wakefield District PCTs’ performance against the key headline and supporting outcome/measures, together with performance against local identified priorities and APPROVED the action being taken to address areas of under/over performance, subject to the points noted. CKWCB/12/10

Finance and Efficiency Report Jonathan Molyneux presented the Finance and Efficiency report to the Cluster Board. He explained that the report summarised the month eight financial position for NHS Calderdale, NHS Kirklees and NHS Wakefield District and that detailed monthly finance reports were continuing to be produced for each of the three statutory PCTs. Jonathan confirmed that all three PCTs were reporting financial positions consistent with agreed financial plans and he highlighted the collective summarised risks identified. It was noted that these remained unchanged from previous months and included the following: delivery of QIPP savings delivery of running cost targets; and Financial challenges at MYHT The other main area of risk remained with activity performance against contract values. Jonathan provided assurance that actions were in place to address this. The Board RECEIVED and NOTED the content of the Finance report.

CKWCB/12/11

Governance and Risk Report Vicky Pickles presented the Governance and Risk report to the Cluster Board. In particular, the following key points were highlighted: The Board noted that since the last meeting, Towards Establishment – Responsive and Accountable Clinical Commissioning Groups had been published by the Department of Health and received a summary of the main points. The Board was reassured that the document described much of what the Cluster had already undertaken in relation to putting in place clear governance arrangements. It was noted that an update to the document was expected at the end of January along with a model constitution and that the Board would continue to be kept up to date regarding this. In addition, Vicky confirmed that a briefing note would be circulated from the outcome of a recent event facilitated by the Strategic Health Authority.


Vicky then explained that the Governance Committee had approved the Policy on Policies setting out where decisions would be made. As part of this the Board was asked to consider delegating some policy sign off directly to the sub-groups of the Clinical Commissioning Executive to reduce the administrative burden on the CCEs. It was recognised that Vicky was undertaking some further work to establish which policies require reviewing and would identify which sub-group would be responsible for approving individual policies. In addition the Board was presented with revised Terms of Reference of the Governance Committee for approval. The Board: RECEIVED the report; APPROVED the proposal to delegate some powers to subgroups of the Clinical Commissioning Executives; NOTED the changes to the risk reporting cycles across the Cluster; and APPROVED the revised Terms of Reference of the Governance Committee. CKWCB/12/12

Board Assurance Framework (BAF) Sue Cannon introduced the Board Assurance Framework report to the Board and explained that the paper described the current position in developing the BAF. Whilst good progress had been made towards developing the BAF it was suggested that the BAF is scrutinised by both the Governance Committee on 15 February and the Audit Committee on 21 February to further strengthen this process prior to being presented to the Board for final approval in March. The Board went on to review the proposed cluster principle objectives outlined in Appendix 1 of the report, which had been drawn from the Accountability Framework. These were subsequently AGREED. The Board acknowledged the significant amount of work that had gone into developing the BAF and AGREED to: ENDORSE the approach to building the Board Assurance Framework AGREED the principal objectives outlined in Appendix 1 AGREED the proposed reporting and scrutiny arrangements RECEIVE the Board Assurance Framework in March 2012

CKWCB/12/13

2012/13 Operating Plan Peter Flynn gave a presentation to the Board on the purpose and content of the 2012/13 Operating Plan. Key points included: The purpose of the planning round Cluster Plan – Structure & time period


Content of the CCG Plan Key features expected in plans Roles/Responsibilities and Products Timetable of planning activities Key requirements and criteria for assessment: - Quality - Resources - Reform Overall summary of the Cluster Plan CCGs responsibilities It was noted that the Cluster Board would see the plan on two occasions, at final draft and in final version for sign off. In addition, between now and the final plan submission, the CCEs would be scrutinising and adjusting the elements of each CCG plan that in turn feed into the Cluster Plan. Peter confirmed that the final Cluster plan is to be submitted to the SHA week commencing 26 March 2012. Therefore the April Cluster Board meeting had been brought forward to 27 March to accommodate Board sign off. CKWCB/12/14

Clinical Standards Stocktake – Calderdale, Kirklees and Wakefield perspective Cathy Edwards and Kevin Smith joined the meeting from the Specialised Commissioning Group to present the Clinical Standards Stocktake from a Calderdale, Kirklees and Wakefield perspective. It was noted that the transition to NHS Commissioning Board commissioning of specialised services was reinforcing the need for nationally agreed standards of care for these services. Where these already exist, Yorkshire and the Humber SCG had used them to develop designation standards, service specifications and commissioning policies. Cathy explained that the report provided an assessment of the position relating to the standards, by service, focussing primarily on the services currently commissioned by the Specialised Commissioning Group. The narrative in the report related to services commissioned for the population of the CKW PCT Cluster and highlighted any particular issues relevant to the secondary care providers based in the CKW area. The Board discussed the particular areas relevant to the Cluster and debated the implications and potential solutions. The main topics of discussion included: Neo-Natal Vascular Services Morbid Obesity


Major Trauma The Board NOTED the position with regard to services for CKW Cluster residents and acknowledged the implications for local service providers. The Chair asked Chief Operating Officers to ensure that CCEs are fully sighted on this work and are clear about the implications. A discussion then ensued regarding the level of public consultation/engagement that may be required following the outcome of this work. With this in mind, Cathy urged the Cluster to liaise with local Overview and Scrutiny Committees, both locally and regionally. Mike provided assurance that local Overview and Scrutiny Committees were sighted on this work and that consideration would be given to the relevant timelines. It was noted that the Board would receive a further update regarding the progress of this work at a future meeting. CKWCB/12/15

Commissioning Development Report Ann Ballarini presented the Commissioning Development report to the Cluster Board and summarised progress on the following: January 2012 exception report against the requirement for commissioning transition including the Cluster Accountability Framework (CAF) and the Shared Operating Model for PCT Cluster requirements; An update on the development of the Commissioning Support Organisation (CSO); and An update on the Board to Board meeting held in December 2011 with the emerging Clinical Commissioning Groups (eCCGs); A discussion ensued regarding the development of the CSO. Roger Grasby reflected on some issues raised at a recent Health and Wellbeing Board and queried whether the local authority is a consumer of the CSO. Ann confirmed that a business case was being developed for the CSO working primarily with CCGs as being the main commissioners. However, it was recognised that there may be benefits to establishing a wider customer base and this would be considered. It was recognised that further work and guidance was needed to develop the governance arrangements for the CSO which would be discussed in more detail at the next Governance Committee. The Board RECEIVED and NOTED the Commissioning Development report.


CKWCB/11/16

Provider Development Report Roger Grasby declared an interest in this report as Chair of Spectrum Community Health Community Interest Company, given there was reference to this organisation within the report. Ann Ballarini presented the Provider Development report to the Cluster Board. In particular the following key points were noted: Update on the Yorkshire Ambulance Service NHS Trust’s application for Foundation Trust Status; An update on the Mid Yorkshire Hospitals NHS Trust Health Economy Foundation Trust Programme; A summary of the early benefits realised from the Transforming Community Services business transfers of PCT-provided community services to new provider forms; A progress report to extend patient choice through the Any Qualified Provider procurement route by September 2012 and beyond. The Board RECEIVED and NOTED the Provider Development report.

CKWCB/12/17

Infection Prevention and Control Annual Reports The Board RECEIVED and NOTED the following Infection Prevention and Control Annual Reports: 2010/11 Infection Prevention and Control Annual Report for NHS Calderdale; 2010-11 Annual Infection Prevention and Control Report for NHS Kirklees. The Board was asked to note that there is a specific issue with relation to Tuberculosis in North Kirklees. 2010/11 Prevention and Control of Infection Annual Report for NHS Wakefield District.

CKWCB/12/18

Minutes of the Yorkshire and the Humber Specialised Commissioning Group The minutes of the Yorkshire and the Humber Specialised Commissioning Group held on 28 October, 25 November and 16 December 2011 were RECEIVED and ADOPTED by the Board.

CKWCB/12/19

Draft Minutes of the Primary Care Transformation Scheme Sub Committee The Draft minutes of the Primary Care Transformation Scheme Sub Committee held on 12 December were RECEIVED and APPROVED by the Board subject to one amended being recorded within the minutes:


That the minutes of the previous meeting held on 28 November 2011 were approved at the meeting held on 12 December 2011. CKWCB/12/20

Minutes of the CKW Audit Committee The minutes of the CKW Audit Committee held on 9 November 2011 were RECEIVED and NOTED by the Board.

CKWCB/12/21

Minutes of the Cluster Governance Committee The minutes of the Cluster Governance Committee held on 31 October 2011 were RECEIVED and NOTED by the Board.

CKWCB/12/22

Minutes of the CKW Remuneration and Terms of Service Committee The minutes of the CKW Remuneration and Terms of Service Committee held on 18 October 2011 were RECIEVED and NOTED by the Board.

CKWCB/12/23

Minutes of the North Kirklees Health Alliance Clinical Commissioning Executive The minutes of the North Kirklees Health Alliance Clinical Commissioning Executive held on 26 October 2011 were RECEIVED and NOTED by the Board.

CKWCB/12/24

Minutes of the Greater Huddersfield Clinical Commissioning Executive The minutes of the Greater Huddersfield Clinical Commissioning Executive held on 28 September and 26 October 2011 were RECEIVED and NOTED by the Board.

CKWCB/12/25

Minutes of the Calderdale Clinical Commissioning Executive The minutes of the Calderdale Clinical Commissioning Executive held on 13 October and 10 November 2011 were RECEIVED and NOTED by the Board.

CKWCB/12/26

Minutes of the Wakefield Alliance Clinical Commissioning Executive The minutes of the Wakefield Alliance Clinical Commissioning Executive held on 6 October and 8 November 2011 were RECEIVED and NOTED by the Board. It was recognised that this committee existed prior to the new governance arrangements coming into place and has now been superseded.


CKWCB/12/27

Draft Minutes of the Mid Yorkshire Health Economy Foundation Trust Programme Board Draft minutes of the Mid Yorkshire Health Economy Foundation Trust Programme Board held on 11 November 2011 were RECEIVED and NOTED by the Board.

CKWDB/12/28

Minutes of the Primary Care Transformation Scheme Sub Committee The minutes of the Primary Care Transformation Scheme Sub Committee held on 28 November 2011 were RECEIVED and NOTED by the Board.

CKWCB/12/29

Date and time of next meeting It was AGREED that the next meeting of the Cluster Board would take place between 2.00pm and 4.00pm on Tuesday 7 February 2012 in the Boardroom at Broad Lea House, Huddersfield. Prior to this a Board Development session will take place between 9.00am and 1.00pm.

CKWCB/12/30

Exclusion of the Press and Public It was RESOLVED that: “representatives of the press and other members of the public be excluded from part two of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest” (sections 1 (2) Public Bodies (Admission to Meetings) Act 1960.

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