GHCCG_Public_GB_papers_06.02.13 by NHS Kirklees

NHS Greater Huddersfield Shadow Governing Body Date: Wednesday 6th February 2013

Time: 1.30 – 3.45pm

Venue: Board Room, Broad Lea House

Apologies: None

Time

Item

Who

Purpose

1.30

Steve Ollerton

1.40

1.45

Opportunity for questions from the members of the public Welcome, introductions and apologies • Declarations of Interest Accuracy of Minutes from 9 January 2013 • Matters Arising • Action log ITEMS FOR DECISION AND CONSIDERATION

An opportunity to receive questions from members of the public and respond. To open the meeting with any new introductions, record any apologies and declare any interests outside the CCG. To agree and ratify the minutes To pick up on any matters arising To pick up on any actions

1.55

2.05

Clinical Leader /Designate Chief Officer update Quality & Safety Report

Steve Ollerton/ Carol McKenna Penny Woodhead

2.20

Performance Report

2.35

Finance, Contracting and QIPP Report

2.50

BREAK

2.55

Steve Ollerton

Attachment

Enclosure & Page No

GB/13/250

GB/13/251 √

GB/13/252

To receive an update on issues relevant to the CCG.

√

GB/13/253

To receive the report and consider any issues raised

√

Natalie Ackroyd

To receive the report and consider any issues raised

√

Julie Lawreniuk

To receive the report and consider any issues raised

√

Update on Planning Process 2013-14

Vicky Dutchburn

√

3.05

CAMHS Tier 3

Carol McKenna

To an update on the progress made with the planning process and confirm next steps. To discuss the outcome of the tender process

3.15

Pain Service tender update

Martin Pursey

3.25

Calderdale & Huddersfield Health and Social Care Strategic Review update ITEMS FOR INFORMATION

Paul Wilding/ Vicky Dutchburn

3.35

Receipt of minutes • Cluster Board Meeting

Steve Ollerton

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 1 of 124

To receive a verbal update on the position with the pain service tender and confirm next steps. To receive the report and consider any issues raised

To receive copies of minutes for information purposes. 27/09/12 meeting

√

Pages 3-15

Pages 16-30

GB/13/254

Pages 31-39

GB/13/255

Pages 40-44

GB/13/256

Pages 45-70

GB/13/257

Pages 71-76

GB/13/258

Pages 77-83

GB/13/259

√

GB/13/260

Pages 84-89

GB/13/261

Pages 90-124

NHS Greater Huddersfield Shadow Governing Body • Finance & Performance Subgroup • Quality & Safety Subgroup 13

3.40

3.45

Any other business • Matters to escalate to Cluster Board Date and Time of next meeting:

All Steve Ollerton

19/12/12 meeting 19/12/12 meeting To discuss any other business raised To raise any items for escalation to Cluster Board Wednesday 6th March 2013, 1.30 – 4.30pm, Board Room, Broad Lea House.

The Board is recommended to make the following resolution: “That representatives of the press and other members of the public be excluded from the remainder 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” (Section 1 (2) Public Bodies (Admission to Meetings) Act 1970)”.

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 2 of 124

GB/13/262 GB/13/263

NHS Greater Huddersfield Clinical Commissioning Group

Minutes of the NHS Greater Huddersfield Clinical Commissioning Executive (CCE) Meeting held on Wednesday 9th January 2013, 1.30 â&#x20AC;&#x201C; 4.30pm, Board Room, Broad Lea House. Present: Dr Steve Ollerton (SO) Dr Dil Ashraf (DA) Dr Judith Parker (JP) Dr Anuj Handa (AH) Dr Paul Wilding (PaW) Dr Jane Ford (JF) Carol McKenna (CM) Penny Woodhead (PeW) Irving Cobden (IC) Moira Wilson (MW) Tony Gerrard (TG) Alison Oâ&#x20AC;&#x2122;Sullivan (AOS) Julie Lawreniuk (JL) Nicky Hoyle (NH) Angela Monaghan (AM) In attendance: Vicky Dutchburn (VD) Martin Pursey (MP) Natalie Ackroyd (NA) Tracey Hollis (TH) Sapphire Wright (SW) Keith Smith (KS)

Minutes: Kelly Chadwick (KC) EC/12/234

CCG Clinical Leader and Chair GP Practice Representative GP Practice Representative GP Practice Representative GP Practice Representative GP Practice Representative Designate Chief Officer Head of Quality & Safety Consultant Advisor Lay Member Lay Member Director of Children & Young People, Kirklees Council Chief Financial Officer Public Health Consultant Nurse Advisor

Head of Strategic & Business Planning Head of Contracting Performance Manager Communications Manager Graduate Management Trainee Assistant Director, Commissioning & Health Partnerships, Kirklees Council

Personal Assistant to Greater Huddersfield CCG

Welcome, Introductions and Apologies for Absence SO welcomed the meeting and introductions were made around the table. Apologies for absence were received from; Mehboob Khan (MK) Dr Karen Dean (KD) Dr David Hughes (DH) Jan Giles (JG)

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Non-executive Director GP Practice Representative GP Practice Representative Head of Practice Support & Development

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Declarations of Interest A declaration of interest was recorded for all GPs present for agenda item no 5 – Non-Recurrent Money for Primary Care. SO informed the CCE that TG will chair that particular agenda item. A further declaration of interest was noted from TG as he is a lay member representing both GH and NK CCGs. EC/12/235

Accuracy of Minutes of 5 December 2012 The minutes were AGREED as accurate. Matters Arising None raised. Action Log EC/12/220 – Accuracy of Minutes from November meeting – Referral Pathway Software SO informed the CCE that Calderdale CCG were leading on this piece of work and added that KC had received an email from Rhona Radley before Christmas advising that a Case of Need had been submitted to Calderdale CCG, which had been approved. A full business case is now in development and will be taken to Calderdale CCG Governing Body meeting later this month for sign off. AH is liaising with Rhona on behalf of GHCCG and will provide feedback when available, as well as ensuring that this work feeds into our planning processes as required. It was AGREED that this action is now COMPLETE. EC/12/220 – Action Log from September meeting – Health Checks JL advised that the Locala service was decommissioned in November and funding was removed from the 2012/13 contract. However GHCCG agreed to support the clinical staff until the end of March 2013. It was AGREED that this action is now COMPLETE. EC/12/220 – Action Log from November meeting – Draft Equality & Diversity Strategy TG confirmed he has now spoken to Imran Patel about the draft strategies. Imran had confirmed he is happy that they are now complete. It was AGREED that this action is now COMPLETE.

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EC/12/223 â&#x20AC;&#x201C; Performance Report PeW advised she was meeting with Deborah Turner on the 11 January to discuss the Locala community care training. PeW requested this action to be left open until feedback is provided next month. It was AGREED that this action is left open as requested. All other actions were recorded as complete. EC/12/236

Clinical Leader/Designate Chief Officer Report CM provided an overview of the report and highlighted the key points to note; Pain Tier 2 Service CM informed the CCE that this will be picked up under the private section at the end of this meeting. EMIS web viewer SO informed the CCE he had attended a meeting on 3 January with CHFT. SO explained that CHFT already have the Systmone Clinical record viewer which gives them access to summary care record of EMIS practices (who have uploaded them). The EMIS record viewer has a significant cost attached and at the moment will not give much more information over and above the S1 viewer which is free. For this reason there is not an immediate plan for implementing the EMIS viewer. However there are to be developments to the functionality of the EMIS viewer later this year so this decision will be reconsidered. Authorisation CM explained that we had recently submitted some additional evidence in relation to our 2 outstanding red buttons. We have also submitted a letter written by Ann Ballarini, after meeting with her to discuss what could be done to provide further evidence to show that we can meet the criteria. CM added that we will know the outcome of the authorisation decision on 21 January. Planning Guidance JL advised that she had recently attended a development session with SO/CM based on the newly published Planning Guidance. Further supporting papers have now also been released. JL explained the guidance and advised that series of pieces of work are underway and the CCE will need to sign all of these off during the March meeting.

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JL added that there are various upcoming deadlines to be met and these will be key to the development of the CCG. The Case of Need template is being utilised regularly and a set of financial templates are currently being developed in readiness for April. 2013/14 QIPP schemes are being discussed along with the budget allocations. There is to be a development session on 30 January where further work will be undertaken on all these aspects. CM highlighted the importance of linking with the Shadow Health and Wellbeing Board during these key periods. PeW informed the CCE that a useful discussion had taken place at the Clinical Strategy Group on 2 January around the quality aspect of the planning guidance and CQUINS. The CCE RECEIVED and NOTED the contents of the report and thanked CM/SO. EC/12/237

Draft CCG Financial Strategy JL provided an overview of the strategy to the CCE. JL advised that this strategy has been discussed briefly at the Finance & Performance Group a few months ago and it will now be refreshed to include the recent release of the budget allocations. It will be brought back to the CCE in March for formal sign off. JL explained the background and content strategy and welcomed any comments from the CCE members. JL explained that GHCCG will receive a programme allocation of ÂŁ263 million, of which an allocation for specialist commissioning has already been taken off. JL added that this will be discussed again, in more detail at the next F&P meeting. AOS asked how closely linked to future spending plans the Strategic Review is. JL advised that the Strategic Review will be used as a driver, and as a key delivery mechanism for the CCG. JL informed the CCE that the Strategic Review has a working group of Finance Directors/Chief Financial Officers who will be developing a financial plan to sit under the Strategic Review as a whole. Discussion took place about what will be included in the specialist commissioning budget. JL explained how its broken down and MP added that there are 38 specialist commissioning services nationally prescribed but some of those are based on national figures and might not specifically relate to GHCCG, or even West Yorkshire. JL highlighted the importance of needing to share the risk as there will be an overall impact.

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MP added that in Yorkshire & the Humber over the last 2-3 years, there has been lots of activity in developing QIPP schemes which are applied to the SCG activity as well as day to day activity. JL informed the CCE that SCG for Yorkshire & the Humber will be managed by South Yorkshire Local Area Team in the future. The CCE RECEIVED and NOTED the contents of the strategy and thanked JL. EC/12/238

Non-Recurrent Money for Primary Care TG took over as Chair and asked the non-GP members if they were happy for the GPs to stay in the room during this agenda item. All AGREED with this. CM advised that the total financial envelope had already been agreed and the item was just here for formal sign off of the full equipment list. CM highlighted that only non-GP voting members could do this and for clarity, added that this would be herself along with, IC, AM, PeW, JL, TG and MW. All AGREED with this SW presented the paper and advised that there has been £600k allocated to Primary Care. £29k of this would be used towards training and education for GHCCG and a further £46k towards honouring Newsome Surgery’s freed up resources allocation. SW explained the process for collating the list of equipment to date. SW went on to explain what was not covered to be explicit and advised that practices would also be made aware of this. SW informed the CCE that they will be required to agree to support the proposal to take this forward and formally sign off the equipment list. TG asked for comments and questions. IC asked if any of the items are going to be income generating. SW advised that potentially some of these could be, but these would only be small items and there are some clear criteria with respect to what is or isn’t included. AM asked if any of the items will allow patients to move from secondary care to being seen in a primary care setting. JL advised that this wasn’t the intention for this pot of money, although it is to be used for services/equipment that will help improve patient care. TG asked the CCE if they were happy with the explanations given. All AGREED. TG then asked the non-GP voting members if they would be happy to support the proposal and sign off the list of equipment. All AGREED. The CCE RECEIVED and NOTED the contents of the proposal and thanked SW for her attendance.

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SO resumed the Chair for the remainder of the meeting. EC/12/239

Membership Report CM presented the report on behalf of JG. There has been lots of work taking place since the report was last presented to CCE. A development session with an external consultant was held in November and 2 of the sessions within the Commissioning Readiness Scheme have also focussed on membership. CM explained the feedback included in the report. There are a range of co-opted members in place and these will be reviewed in the coming months. SO provided an overview of the Practice Managers Reference Group and informed CCE that there has recently been 2 new Practice Managers starting with the group. CM explained the importance of the future relationships with the Local Area Team (LAT) and the LMC. CM added that there is a piece of work currently underway to review all Enhanced Services. This will be completed by September 2013. It was AGREED that a further update on enhanced services should be provided next month by JG. Action: JG to provide an update on Enhanced Services during matters arising for the February CCE. It was noted that Ashridge Consultancy are attending the Clinical Strategy Group on 23 January for an in-depth discussion on High Performing Membership Organisations. A Task & Finish group also met in December to discuss membership. A further meeting is scheduled for 16 January to discuss developing a membership strategy. The CCE RECEIVED and NOTED the contents of the report and thanked CM for presenting on behalf of JG.

EC/12/240

Integrated Commissioning Keith Smith, Assistant Director, Commissioning & Health Partnerships for Kirklees Council introduced himself and explained the report he was presenting on behalf of Iain Baines. CM provided some background information in relation to the paper and informed the CCE that there had been discussions about integrated commissioning during our authorisation process. There have also been various meetings held between GH and NK CCGs and Kirklees Council about how to take this forward.

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KS informed the CCE that discussions about integrated commissioning began about 6 months previous. A piece of work needs to be carried out to reflect what type of arrangements are currently in place and to review how these might need to change. We have begun to look at resources for shared services in the future. We need to review the ways in which we undertake commissioning approaches and look at how this will work. We need to adopt an approach in which we are consistent at commissioning. KS added that the briefing paper explains “clusters” of services and patients and these could be reviewed to ensure they reflect current thoughts and comments. The discussion was opened up for questions and comments. AM asked if it was anticipated that this new arrangement will allow for changes in services to happen. KS advised that it isn’t clear if commissioning will make these kind of changes but it is a way of understanding the needs of the population and having a shared understanding can only been seen as a good point. CM informed the CCE that some of the integrated work is already happening but some areas need to be revisited and reviewed. This will be frequently discussed at the Shadow Health and Wellbeing Board meetings. MW added that there are various scopes and themes to link back to HWBB priorities and Communications & Engagement are key areas to be reviewed KS agreed that communication is vital. KS asked for approval of the approach of integrated commissioning in its current direction of travel along with the associated timeline. CM highlighted that there needs to be some prioritisation work tied in with this and a working group will be agreed to take this forward on behalf of GH and NK CCGs and Kirklees Council. AOS agreed and added that priorities need to be agreed via a workplan for the whole programme. The CCE RECEIVED and NOTED the contents of the report and AGREED with the approach. The CCE thanked KS for his attendance. EC/12/241

Finance, Contracting and QIPP Report JL explained that the report was a combined finance, contracting and QIPP report, of which the detail had been discussed during the last meeting of the Finance & Performance Group. Some key points to note are; • NHS Kirklees are forecasting to meet their control total for the year. • GHCCG are forecast to underspend by £207k • GHCCG have a forecast of £4 million savings for QIPP.

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JL explained the spending plan for the non-recurrent money. SWYFT and Locala are almost committed. The Primary Care aspect has been finalised today. Everything else is now committed and the £3 million allocation will be spent. JL explained the 2013/14 allocations and what the breakdown of these means to GHCCG. We will be receiving a separate allocation for running costs for the first time. Our Heads of Service are working with SMT to look at the structure to ensure running costs are managed. A paper will be brought to CCE for formal sign off in due course. SO questioned the prescribing element and JL explained why this budget was so volatile. JP asked about the contracting dashboard and if there were any concerns about the trading positions for Leeds/Barnsley/Bradford. MP explained that financially we are marginally protected but there will be a risk going forward as Leeds is our main SCG provider so we need to manage this effectively. MP also explained how poor performance will be managed. MW asked how the £5.9 million for running costs compares with the previous year. JL advised that the intention was to reduce the running costs targets from the start. NHS Kirklees had a target to reduce by approximately £2 million and they achieved that target. The CCE RECEIVED and NOTED the contents of the report and thanked JL. EC/12/242

Performance Report NA provided an overview of the report. The key points to note are; Ambulance response times are currently 73.4% for October, 74.3% YTD. YAS are reviewing action plans and staff rotas to look at whether this can be improved. They are also working with Bradford, who is lead commissioner, to review plans. Cancer 62 days – first time we have breached the standard target. CHFT and MYHT are both meeting the targets overall. Some issues due to the complex needs of the patients. There are meetings in place with the Trusts and YCN to review targets. However there is no update regarding action plans and NA advised she will chase this and feedback next month. Action: NA to chase action plans for breach of cancer 62 days.

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Unplanned hospitalisations in relation to COPD and AF were explained.. It has been decided to look at length of stay to recognise if anything further can be done in primary care initially. NA explained that the case of need for prioritisation has shown the need for more appointments slots which does link to pulmonary rehab. Unplanned hospitalisation for under 19’s for asthma, epilepsy and diabetes. Working ongoing to look at each patient’s stay to check if appropriate. This will be picked up via the Children's Carestream as well. NA highlighted a potential coding issue and AGREED to raise this with CHFT. Action: NA to raise potential coding issue for unplanned hospitalisation for under 19’s with CHFT. Emergency admissions for acute conditions not usually requiring admission – NA informed the CCE that the overall issue is UTI’s and also areas such as cellulitis. VD added that concerns raised last month have been picked up with Locala and there is a capacity issue to note. Discussions took place about what can be put in place to manage this. VD advised that we are currently working towards contract negotiations at the moment so realistically it will be March before any changes can be made. At the moment this is being dealt with on a cost per case basis to ensure patients are being managed appropriately. It was agreed that a detailed discussion around cellulitis should be brought to a future CSG. AM highlighted a similar problem in her substantive role and felt that a sufficient amount of activity needs to take place to maintain the standards. VD advised that there are discussions with Locala regarding resources. PeW added that the workforce development element needs to be taken to the Strategic Review Board for discussion. Action: Cellulitis to be added to April’s CSG for a detailed discussion. MRSA – NA highlighted that this will be picked up during the Quality & Safety report. Non-elective – issues are due to increases in short stay and that some of the QIPP schemes haven’t taken place. There has also been an increase in paediatrics admissions due to the adverse weather during the summer months. Diagnostics – there has been an increase in both endoscopy and non-endoscopy tests. There are investigations underway to find out the reason for the increase but initial thoughts link to the bowel cancer campaign. A suggestion was made about an endoscopy audit and whether this would be useful. It was agreed to monitor activity and performance over the next few months to see if it stabilises before commencing any further work. Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 11 of 124

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The CCE RECEIVED and NOTED the contents of the report and thanked NA. EC/12/243

Quality & Safety Report PeW provided an overview of the report. The key points to note are: MRSA – there have been 5 cases for GHCCG reported. An action plan is in place but this is being reviewed for any further actions to be carried out. The actions have also been incorporated into the Trust’s action plan. C-Diff – there have been 77 cases reported in 6 months Apr-Oct, 35 of which relate to GHCCG. There will be an improvement plan review undertaken with Jane O’Donnell via the Quality & Safety Subgroup for 2013/14. PeW advised that a plan for the year has been agreed for HCAI. PeW highlighted that this is a significant challenge for next year as there is an approximate 24% reduction in target for GHCCG. SO suggested using a First Tuesday Post Graduate education meeting to focus on HCAI. PeW AGREED to follow this up with Judith Parker and/or Claire Sibbald. Action: PeW to speak to JP/CS to discuss HCAI as a topic for a First Tuesday meeting. PeW informed CCE that Calderdale Hospital had recently undergone a CQC inspection. Non-compliance has been noted on patient records. This has been discussed at CQB and an action plan has been submitted. BMI – PeW explained that a full response has now been provided and an action plan submitted. Assurance is expected at the next CQB to sign that off. The CCE RECEIVED and NOTED the contents of the report and thanked PeW.

EC/12/244

Strategic Review Report PaW explained the changes to the Strategic Review Board, which is now called the Executive Steering Group. The November minutes of this group were included in CCE papers for information and these explain the changes in more detail. PaW informed CCE that the public consultation is expected approximately 13 May 2013. There are 4 key deliverables for the programme in January. PaW explained these to the CCE. One includes the financial element of the Strategic Review, the second

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key workstream is to define workforce and activity, the third workstream is to define a benefits led programme and the fourth workstream is solution content/service models. The Carestreams continue to work well. SO asked if the capacity and capability issues have now been addressed? PaW confirmed that they appear to be and PA Consulting is working well with the Programme Office. PaW informed the CCE that he and CM are attending the Overview & Scrutiny Panel on the 15 January and will provide feedback on this at the next meeting. EC/12/245

Receipt of Minutes The CCE RECEIVED and NOTED the minutes of the following meetings; • Finance & Performance Subgroup – 21/11/12 • Quality & Safety Subgroup – 21/11/12 • Clinical Strategy Group – 10/10/12, 24/10/12, 14/11/12 and 29/11/12 • Strategic Review Board – 27/11/12 It was AGREED that all the minutes were accepted. Discussion took place about which minutes should remain within the public papers and which should be moved to the private section in readiness for the public meetings. Action: CM agreed to review the minutes to establish which sets should be formally reported once the CCE became the shadow Governing Body in February.

EC/12/246

Any Other Business Matters to escalate to Cluster Board CM informed the CCE that her report to Cluster Board was being completed this month. New Shared Head of Finance CM informed the CCE that we have now appointed a new shared Head of Finance. Lesley Stokey will be joining us from Bradford on a part time basis from February and full time from March. Transition updates NH advised that the Diabetic Retinopathy team will be moving to CHFT as of 1st April and the Infection Control team will be moving to the Local Authority but will still be closely connected to the CCGs.

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Public Meeting Discussion took place about the first public meeting taking place on 6th February and the following points were AGREED; • Name plates would be available for all CCE members • A decision summary would be provided after the meeting • The meeting will be advertised publicly and questions will be asked for in advance of the meeting. EC/12/247

Date and time of the next meeting The date of the next scheduled meeting is Wednesday 6th February 2013, 1.30-4.30pm. Board Room, Broad Lea House. This concluded the content of the CCE meeting and the Chair declared the meeting closed at approximately 4.30pm.

Chair’s Signature: ........................................................ Date: ..................................

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AGREED ACTIONS – Greater Huddersfield Clinical Commissioning Executive – 9 January 2013 Agenda Item

Lead Name

Action

EC/12/239 – Membership Report

Jan Giles

JG to provide an update on Enhanced Services during matters arising for the February CCE

EC/12/242 – Performance Report

Natalie Ackroyd

NA to chase action plans for breach of cancer 62 days.

Natalie Ackroyd

NA to raise potential coding issue for unplanned hospitalisation for under 19’s with CHFT

Kelly Chadwick

Cellulitis to be added to April’s CSG for a detailed discussion.

EC/12/243 – Quality & Safety Report

Penny Woodhead

PeW to speak to Judith Parker/Claire Sibbald to discuss HCAI as a topic for a First Tuesday meeting.

EC/12/245 – Any Other Business

Carol McKenna

CM agreed to review the minutes to establish which sets should be formally reported once the CCE became the shadow Governing Body in February.

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Comments

Date of completion

COMPLETE – added to agenda items forward planner

29.01.13

COMPLETE

29.01.13

Agenda Item: No 4 Enclosure: GB/13/253

Report To:

Greater Huddersfield CCG Shadow Governing Body

Date:

6 February 2013

Title of Report:

Clinical Leaders and Designate Chief Officers’ Report

FOI Exemption Category: Open

Management Lead:

Carol McKenna, Designate Chief Officer

Clinical Lead:

Dr Steve Ollerton, Clinical Leader

Report Author and Job Title:

Carol McKenna, Designate Chief Officer Dr Steve Ollerton, Clinical Leader

Executive Summary:

This report is provided to update the shadow Governing Body on relevant issues not covered elsewhere on the agenda.

(to highlight if applicable) • Risk assessment • Legal implications • Health benefits

The report covers: • • •

The CCG’s authorisation decision The publication of ‘Compassion in Practice’ Key appointments made locally and regionally

Resource Implications (including workforce):

None identified.

Outcome of Equality Impact Assessment:

Not applicable.

Sub Group/Committee:

Not applicable.

Recommendation (s):

The shadow Governing Body is asked to note the contents of this report.

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Designate Chief Officer and Clinical Leaders’ Report Greater Huddersfield Shadow Governing Body 6 February 2013

Authorisation Decision On 22 January 2013, NHS Greater Huddersfield CCG received notification from the NHS Commissioning Board that our CCG is authorised in full, without any conditions. A copy of the letter from Sir David Nicholson, which also attaches details of a CCG’s statutory functions is attached to this report. We would like to formally acknowledge the extensive support we have received from our practices, management team, service users and partner organisations throughout the authorisation process. This positive outcome gives us an excellent basis on which to move forward and deliver on our commitments to our population. A separate letter was also sent to the designate Chief Officer on 22 January formally appointing them to the Accountable Officer role for the CCG. Compassion in Practice – nursing strategy Compassion in Practice is the new three year vision and strategy for nursing, midwifery and care staff was published on 4th December 2012. This strategy sets out the shared purpose of nurses, midwives and care staff to deliver high quality, compassionate care, and to achieve excellent health and wellbeing outcomes. It builds on the enduring values they have set out and the pledges and rights of the NHS Constitution, which patients, the public and staff should and will expect. Every patient and person supported can and should expect high quality; we and the strategy sets out a commitment to deliver this. The strategy is centred round 6Cs which are fundamental to the delivery of excellence in practice: Care, Compassion, Competence, Communication, Courage, and Commitment. The Quality Group will have oversight of the implementation of the strategy locally, early actions will include mapping of strategy and key areas for actions against the CCG priorities, and work with our providers to consider how the strategy is taken forward, this will include the CCG practice nursing community. The full report can be found at the following link: http://www.commissioningboard.nhs.uk/nursingvision/ Appointments NHS North of England Professor Paul Johnstone has been confirmed as the Regional Director for Public Health England North (PHE). PHE will start to operate in shadow form from January 2013. NHS Commissioning Board - Cumbria, Northumberland, Tyne and Wear Area Team John Lawlor has been appointed as the NHS Commissioning Board’s Area Team Director for Cumbria, Northumberland, Tyne and Wear. John is currently Chief Executive of Airedale, Bradford and Leeds PCT Cluster, and previously been Chief Executive of NHS Leeds.

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NHS Commissioning Board â&#x20AC;&#x201C; West Yorkshire Area Team Alison Knowles has been appointed Director of Commissioning for the West Yorkshire Area Team. Alison is currently working at Sherwood Forest Hospitals NHS Foundation Trust and has previously worked at SHA, PCT and community levels. A starting date for Alison to take up her new role has yet to be agreed. West Yorkshire Commissioning Support Unit (WYCSU) Ming Tang has been appointed as Director for Data and Information Management Systems at the NHS Commissioning Board and will be leaving her role as Managing Director of South Yorkshire and Bassetlaw Commissioning Support Unit (CSU) later this month. Alison Hughes, Managing Director of West Yorkshire CSU, will now also take responsibility for South Yorkshire and Bassetlaw CSU. Mid Yorkshire Hospitals NHS Trust Dr Richard Jenkins has been appointed as Medical Director. Richard is a Consultant in Diabetes and Endocrinology and has been with the Trust since 2002 after completing his training in South Yorkshire. He has held a number of medical leadership roles in the Trust since 2004, most recently as the Divisional Clinical Director for Medicine. Richard works clinical at all three MYHT sites and in the community. South West Yorkshire Partnership NHS Foundation Trust Tim Breedon has been appointed as Director of Nursing, Clinical Governance and Safety. Tim has been acting in this role over the past few months and was previously District Director for the Trustâ&#x20AC;&#x2122;s Wakefield Business Delivery Unit.

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22 January 2013

Mr Steve Ollerton, NHS Greater Huddersfield CCG, Broad Lea House, Dyson Wood Way, Bradley, Huddersfield, HD2 1GZ

Dear Mr Ollerton, CLINICAL COMMISSIONING GROUP AUTHORISATION – FINAL DECISION I am writing to notify you of the NHS Commissioning Board‟s (NHS CB) decision in relation to the application made by NHS Greater Huddersfield CCG under section 14B of the National Health Service Act 2006 (as amended) to be established as the clinical commissioning group (CCG) for the area specified in its constitution. This includes the geographic areas that cover the Lower-Layer Super Output Areas (LSOAs) which are situated within the boundaries of Kirklees Council. This letter sets out the reasons for the NHS CB‟s decision and details of how this affects your CCG. As you are aware, under section 14C of the NHS Act 2006, the NHS CB must grant an application for establishment made under section 14B if it is satisfied as to the matters specified in section 14C(2) of the NHS Act 2006. Where the NHS CB is not fully satisfied as to the matters set out in section 14C(2) it may still grant an application but it can, amongst other things, impose conditions in relation to such a grant.

Decision Following the NHS CB CCG authorisation sub-committee meeting of 18 January 2013, I am pleased to inform you that the NHS CB is fully satisfied as to the matters listed in section 14C(2) of NHS Act 2006, as follows: Section 14C(2)(a) Section 14C(2)(b) Section 14C(2)(c) Section 14C(2)(d)

Constitution complies with the requirements of Part 1 of Schedule 1A and is otherwise appropriate Each member specified in the constitution will be a provider of primary medical services on the date the CCG is established Area specified in the constitution is appropriate Appropriate to appoint, as the Accountable Officer of the group, the person named in the application

NHS Commissioning Board Quarry House | Quarry Hill | Leeds | LS2 7UE commissioningboard@nhs.net Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 www.commissioningboard.nhs.uk Page 19 of 124

Section 14C(2)(e) Section 14C(2)(f)

Applicants have made appropriate arrangements to ensure that the CCG will be able to discharge its functions Applicants have made appropriate arrangements to ensure that the group will have a governing body which satisfies any requirements imposed by or under this Act and is otherwise appropriate

Accordingly, the NHS CB has decided to authorise your CCG in full and without any conditions. In coming to its decision, the NHS CB took into account all relevant information, including the factors set out in Schedule 1(2) of the National Health Service (Clinical Commissioning Groups) Regulations 2012. ANNEX A sets out in full the authorisation outcomes for your CCG and how this relates to the matters set out in section 14C of the Act. A separate letter has been sent to your proposed Accountable Officer formally appointing them to that role. Please note that the NHS CB will not review this decision and that neither the National Health Service Act 2006 or the Health and Social Care Act 2012 provides for any appeal against the NHS CBâ&#x20AC;&#x;s decision.

Your functions The NHS CBâ&#x20AC;&#x;s decision means that from 18 January 2013, your CCG will be authorised to carry out the functions that came into force from 1 October 2012. Once PCTs are formally abolished, your CCG will become fully operational as a statutory body. This is expected to take place on 1 April 2013. ANNEX B sets out the statutory powers, responsibilities and duties for which you are responsible from authorisation in the period prior to 1 April 2013. As you are aware, PCTs may make arrangements with you to exercise functions under delegated arrangements in the period prior to April 2013, and may provide assistance or support to you on such terms it considers appropriate. PCTs retain statutory responsibility for commissioning health services until they are abolished. We will write to you again before 1 April 2013, where we will document the full range of your duties, powers and responsibilities from that date.

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Next steps Of course, authorisation is the first step on your commissioning journey of continuous improvement. I know that you will now want to develop the full potential of the clinical leadership of commissioning for the benefit of your local community. Over the next few weeks a local representative from the NHS CB will be in touch to begin the process of agreeing a development plan with you.

Conclusion On behalf of the NHS CB, I would like to acknowledge the hard work, commitment and enthusiasm from your CCG which has been necessary to arrive at this stage. I would like to take this opportunity to congratulate you, your governing body and your team on this tremendous achievement. I look forward to having an excellent working relationship with you as we progress clinical commissioning and all become as good as we possibly can be. Should you require any assistance in understanding this decision and the powers, responsibilities and duties that accompany it, please contact ccg.mailbox@nhs.net. For your information, please also note that the details of the outcomes of Wave 2 of the CCG authorisation process will be published on the NHS CB website on 23 January 2013.

Yours sincerely,

Sir David Nicholson KCB CBE Chief Executive

Inc: ANNEX A - Authorisation outcomes ANNEX B - Statutory powers, responsibilities and duties for CCGs from authorisation

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 21 of 124

ANNEX A – NHS GREATER HUDDERSFIELD CCG AUTHORISATION OUTCOMES See attached PDF – „CCG Authorisation Report‟ - for full details

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 22 of 124

ANNEX B â&#x20AC;&#x201C; STATUTORY FUNCTIONS FOR CCGS FROM AUTHORISATION Once authorised, a CCG may do anything that is intended to aid the discharge of functions conferred on it. However, CCGs will not assume full statutory responsibility for their functions until 1 April 2013. The list below details the key statutory functions that CCGs will have in the period between establishment and 1 April 2013.

This list is subject to any conditions and/or directions imposed by the NHS CB. However, where a CCG has been directed by the NHS CB not to exercise a function, this does not prevent the CCG from taking action for the purpose of preparing itself to exercise that function.

A PCT may at any time before 1 April 2013 make arrangements with a CCG, under which the CCG exercises any functions of the PCT on its behalf. A PCT may provide assistance or support to a CCG, including financial assistance, or making available the services of the PCTâ&#x20AC;&#x;s employees, or other resources, on such terms and conditions as the PCT considers appropriate. CCGs must comply with any restrictions the PCT may impose on the use of financial or other assistance.

Further details on the duties and powers below are set out in The Functions of CCGs, which is available at http://www.dh.gov.uk/health/2012/06/ccg-functions.

Finally, this list is intended to assist CCGs during the interim period. It is not intended to be a substitute for the relevant legislation and guidance, or for seeking appropriate legal advice.

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 23 of 124

Function

Power / Duty

Statutory reference (all references are to the NHS

Date of commencement

Act 2006, as amended by the Health and Social Care Act 2012, unless otherwise stated) Powers as a body

Power

Section 1I

corporate

Section 1I(1) partially in force from 1 October 2012

Function of arranging

Duty

Schedule 1A

Section 1I(2) â&#x20AC;&#x201C;

for the provision of services for the purpose

partially in force from 1 February 2013 but

of the health service in England in accordance

only to the extent that the function

with the Act

relates to the provision of services on or after 1 April 2013.

General power to do

Power

Section 2

anything which is calculated to facilitate, or is conducive or incidental to, the discharge of any function conferred on the CCG by the Act

Partially in force from 1 October 2012 Until the abolition of PCTs, the power under s 2 does not include the power to: enter into a commissioning contract (except in relation to contracts under which services are to be provided as part of the health service on or after 1 April 2013); acquire and dispose of property; or accept gifts (including property to be held on trust for the purposes of the CCG).

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Duty to commission

Duty

Section 3

Partially in force from

certain specified health

1 February 2013, but

services

only to the extent that the function relates to the provision of services on or after 1 April 2013.

Power to commission

Power

Section 3A

certain health services

Partially in force from 1 February 2013 but only to the extent that the function relates to the provision of services on or after 1 April 2013.

Power to make

Power

arrangements for the provision of vehicles for

Section 5

Partially in force from

Schedule 1

1 February 2013 but only to the extent

disabled persons

that the function relates to the provision of services on or after 1 April 2013.

Power to arrange for the

Power

Section 6(1A)

1 February 2013

Duty

Section 6E

1February 2013 (but

provision of anything that a CCG has a duty or power to arrange for the provision of under section 3, 3A, 3B, 4 or Schedule 1 outside England Duty to comply with Standing Rules

note that restrictions apply in relation to any Standing Rules coming into force before 1 April 2013).

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Power to enter into

Power

Section 9

1 October 2012

Power

Section 12ZA

1 February 2013 but

agreements with another defined health service body that are NHS contracts Power to make commissioning arrangements in relation

only to the extent that the

to the exercise of certain functions with

arrangements relate to commissioning

any person or body,

arrangements to take

including public authorities and

effect on or after 1 April 2013

voluntary organisations Power to apply to the

Power

Section 14E

1 October 2012

Power

Section 14G

1 October 2012

Power

Section 14H

1 October 2012

Duty (proactive)

Section 14J

1 October 2012

NHS CB to vary constitution Power for two or more CCGs to apply to the NHS CB in the context of a proposed merger (and related powers, including the ability to modify an application) Power to apply to the NHS CB to be dissolved Duty to publish constitution that

Schedule 1A

complies with statutory requirements Duty to have a properly

CCG Regulations Duty (proactive)

constituted governing

Section 14L

1 October 2012

Schedule 1A

body

CCG Regulations Duty for the CCG governing body to have a properly constituted audit committee and a

Duty (proactive)

Section 14M

1 October 2012

Schedule 1A CCG Regulations

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 26 of 124

remuneration committee Duty to comply with the

Duty (proactive)

Section 14O

1 October 2012

Duty to promote the NHS Constitution

Duty (proactive)

Section 14P

Partially in force from 1 October 2012

Duty as to effectiveness and efficiency

Duty (proactive)

Section 14Q

1 October 2012

Duty as to the improvement in quality

Duty (proactive)

Section 14R

1 October 2012

Duty (proactive)

Section 14T

1 October 2012

Duty (proactive)

Section 14U

1 October 2012

Duty (proactive)

Section 14V

1 October 2012

Duty to obtain appropriate advice

Duty (proactive)

Section 14W

1 October 2012

Duty to promote innovation

Duty (proactive)

Section 14X

1 October 2012

Duty in respect of research

Duty (proactive)

Section 14Y

1 October 2012

Duty to promote integration

Duty (proactive)

Section 14Z1

1 October 2012

Duty as to public involvement and

Duty (proactive)

Section 14Z2

1 February 2013

register of interests and management of conflict of interest requirements, including the duty to have regard to guidance issued by the NHS CB in relation to this

of services Duty as to reducing inequalities Duty to promote involvement of each patient Duty as to patient choice

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 27 of 124

consultation Arrangements by CCGs

Power

Section 14Z3

in respect of the

Partially in force from 1 October 2012

exercise of functions Duty to comply with any

Duty (proactive)

Section 14Z10(5)

1 October 2012

Duty (proactive)

Section 14Z11

1 October 2012

(section 14Z12, revising plans,

Section 14Z11(6)

also applies to the extent that it relates to the plan for the year

and (9) and other related provisions do

ending 31 March 2014)

not come into force until the

restrictions imposed on the use of any financial or other assistance or support, provided by the NHS CB under section 14Z10

Duty to prepare and publish a commissioning plan (but only to the extent that the CCG must plan for the financial year ending 31 March 2014)

establishment of Health and Wellbeing Boards.

Duty to consult about

Duty (proactive)

Section 14Z13

Partially in force 1

commissioning plan and

October 2012

to publish a summary of the expressed views of

(section 14Z13(1), (2), (8)(a) and (b))

the individuals consulted and how the

Note that until

CCG has taken account of those views

section 13 of the Health and Social Care Act comes into force (1 February 2013), the definition of â&#x20AC;&#x153;individuals for whom it has responsibility for the purposes of section 3â&#x20AC;? has been revised.

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 28 of 124

Financial duties of

Duty (proactive)

Section 223I

CCGs (use of resources

Partially in force from 1 October 2012

â&#x20AC;&#x201C; any capital or revenue resource use by a CCG must not exceed the amounts set out by the NHS CB) Where the NHS CBâ&#x20AC;&#x;s

Duty (reactive)

Section 14Z18, 14Z19

powers under section 14Z18 and 14Z19 apply,

1 October 2012 [Note these sections apply where the NHS CB has reason to

CCGs have a duty to provide any information, documents, records or

believe that the area of a CCG is no

other items that the NHS CB considers

longer appropriate or that a CCG might have failed, might be

necessary or expedient in order to discharge

failing or might fail to discharge any of its

any of its functions relating to the CCG and/or to provide an

functions]

explanation to the NHS CB (either orally or in writing) Where the NHS CB

Duty (reactive)

Section 14Z21

exercises its power under section 14Z21 to,

1 October 2012 [Note that this section applies where the NHS CB is

for example give directions, the CCG must comply

satisfied that a CCG is failing or has failed to discharge any of its functions, or there is a significant risk that a CCG will fail to do so]

Duty to comply with

Duty (reactive)

Schedule 1A

1 October 2012

requests for information from the Secretary of State

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Other primary legislation Duties that apply to all public bodies, such as the Equality Act 2010, the Data Protection Act 1998, the Human Rights Act 1998 and health and safety legislation will also apply from the date of authorisation, to the extent relevant. Certain amendments to primary legislation come into force prior to 1 April 2013, including: Section 149 of the Equality Act 2010 (public sector equality duty); Freedom of Information Act 2000 (powers and duties apply accordingly in terms of responding to requests for information made under this legislation); Section 2 of the Health Act 2009 (duty to have regard to the NHS Constitution); and Section 117 Mental Health Act (provision of after-care services for the purposes of the health service in England on or after 1 April 2013). CCGs will also be subject to public law duties that apply to all public bodies.

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 30 of 124

Agenda Item: No 5 Enclosure: GB/13/254

Report To:

GHCCG Shadow Governing Body

Date:

6th February 2013

Title of Report:

Quality & Safety Report

FOI Exemption Category: Open

Management Lead:

Penny Woodhead, Head of Quality & Safety

Clinical Lead:

Dr Judith Parker

Report Author and Job Title:

Penny Woodhead, Head of Quality & Safety

Executive Summary:

This report provides the Quality & Safety Group with progress against recent quality and patient safety activities including:

(to highlight if applicable) • Risk assessment • Legal implications • Health benefits

•

Reports on quality performance information for Eliminating Mixed Sex Accommodation (EMSA), National Patient Safety Agency (NPSA) and Venous Thromboembolism (VTE)

•

An update on Care Quality Commission (CQC) activities

•

An update of issues escalated from the Quality and Safety Sub group, including Winterbourne View Review

Risk assessment The risk that patients’ experience of services and care is not at the standard expected is scored 8 on the Corporate Risk Register. The risk that the anticipated quality improvement requirements set out in the 2012/13 Commissioning for Quality and Innovation (CQuINs) scheme may not be achieved, therefore patients may not receive best possible care is scored 8 on the Corporate Risk Register. Patient safety and failure to achieve national Healthcare associated infection objectives are recorded on the corporate risk register. Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 31 of 124

Health benefits This Quality and Safety report focusses on areas of work positively affects the Outcomes Framework, in particular Domains 4 & 5 Resource Implications (including workforce):

CQuINs has a financial value attached to outturn contract value

Outcome of Equality Impact Assessment:

Not applicable

Sub Group/Committee:

Quality and Safety Sub Group

Recommendation (s):

The Shadow Governing Body is requested to: • • •

receive reports on quality performance information for Eliminating Mixed Sex Accommodation (EMSA), NPSA and VTE and note any actions being taken; receive and note CQC activity information receive and note issues escalated for Quality & Safety Sub Group

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 32 of 124

1.0

Purpose of the Report To provide an update on current quality and safety information and activities. The report is structured into: • • •

2.0

Performance against national quality indicators Quality accounts Other quality and safety activity

Elimination of Mixed Sex Accommodation (EMSA) The NHS Operating Framework for 2011/12 required that each year, on or by 1 April 2012, all organisations must publish a declaration on their website of whether they are compliant or not with the national definition of same sex accommodation - to eliminate mixed sex accommodation, except where it is in the overall best interest of the patient, or reflects their patient choice. Calderdale and Huddersfield Foundation Trust (CHFT) and South West Yorkshire Partnership Foundation Trust (SWYPFT) completed the declaration exercise by 31 March 2012. EMSA remains a standing item on Clinical Quality Board with CHFT. Providers of NHS-funded healthcare reported 177 breaches of the MSA guidance in relation to NHS patients in sleeping accommodation in England during November 2012, compared to 242 in October 2012. Of the 161 Acute Trusts that submitted data for November 2012, 138 (86%) reported zero sleeping breaches. All 177 of the breaches occurred in Acute Trusts. Table 1 demonstrates the breach rate (per 1000 finished consultant episodes) by provider and NHS Kirklees for April – November 2012

Provider

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

CHFT

0.1

0.2

SWYPFT

Locala

0.1

Spire Elland NHS Kirklees

Dec

Jan

Feb

Mar

Table 2 shows the number of breaches by provider and for NHS Kirklees for April - Nov 2012 Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

CHFT

SWYPFT

Locala

Provider

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Dec

Jan

Feb

Mar

Spire Elland NHS Kirklees 3.0

Healthcare Associated Infection (HCAI) The tables below shows the HCAI performance data year to date for 2012/13.

3.1

Meticillin- resistant Staphylococcus Aureus (MRSA)

Provider

Obj

April

May

Jun

NHSK

CHFT

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

YTD

CHFT CHFT had no post 48 hour bacteraemia cases reported in November; therefore remain on three cases against a trajectory of four. CHFT has developed an action plan following receipt of the report from the visit in October 2012 by NHS North of England HCAI lead to undertake a diagnostic review of the Trust. The review was at the request of the Trust Executive Team following a rise in the number of infections over the preceding months and an apparent reduction in the anticipated sustained improvement compared to the same period in the previous year. NHS Kirklees One pre 48 hour MRSA bacteraemia cases was reported in November in Kirklees residents (North Kirklees); The cumulative total to date is eleven cases therefore the trajectory for 2012/13 has been breached. All cases are subject to root cause analysis review, the reviews are considered at the Health Economy Health care associated Infection group and summary of learning and action are discussed at the Quality and Safety group. 3.2

Clostridium Difficile (CDI)

Provider Obj NHSK

April

May

Jun

Jul

Aug

104

CHFT

Sep 9 1 GHCCG 8 NKCCG

Oct

Nov

11 5 GHCCG 6 NKCCG

6 3 GHCCG 3 NKCCG

Dec

Jan

Feb

Mar

A Clostridium difficile management plan has been agreed across the wider health economy to address Clostridium difficile issues, supported by NHS North of England. Clostridium difficile is a major part of the Calderdale and Kirklees HCAI group work plan for 12/13 and the Clostridium difficile management plan will be monitored through this forum. CHFT have had an independent review of their CDI management, which has Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 34 of 124

YTD

recommended a programme of disinfection. A business case has been submitted by CHFT IPC team. The HCAI Improvement Plan is being driven forward by the CHFT HCAI Operational Group. Quality Board have received the CHFT Infection Prevention and Control Annual Plan which includes actions to address recommendations from Director of Infection Prevention and Control’s Trust Board Paper December 2011. Quality Board received an update the December 2012 meeting. 3.3

MSSA and E. Coli From January 2011, it became a mandatory requirement for all acute NHS Trusts to report Meticillin Sensitive Staphylococcus Aureus (MSSA) bacteraemia and from 1 June 2011, Escherichia coli (E.Coli) bacteraemia. There are no objectives for either of these. The following table shows the reported bacteraemias reported by PCT and Acute Trust for 2012/13 year to date. MSSA cases are apportioned to Primary care Organisations and Acute Trusts in the same way as MRSA and CDI. MSSA

Provider April NHSK CHFT

May

June

Jul

Aug

Sep

Oct

4 0

Nov

Dec

Jan

Feb

Mar

YTD

E-Coli – data collection began June 2011 – no objective Provider April NHSK CHFT

4.0

May

June

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

YTD

181

Venous Thromboembolism (VTE) VTE risk assessment measures were introduced as part of CQUIN schemes in 2010/11. The performance for CHFT against the measure of the % of all adult in patients who have had a VTE risk assessment on admission to hospital using the clinical criteria of the national tool is included in the table below. The national performance target is 90%. The next quarterly information is due to be submitted at the end of January 2013 for Quarter 3, this information will be reported at a future meeting VTE performance 2012 –13 The following table shows VTE risk assessments carried out for Acute provider’s year to date 2012/13

Provider

Apr

May

Jun

Qtr 1

Jul

Aug

Sep

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 35 of 124

Qtr 2

Oct Nov Dec

Qtr Jan Feb Mar 3

CHFT

90.1%

90.5%

90.4%

90.3%

90.2%

90.4%

90.3%

Spire Elland

98.4%

94.3%

92.5%

95.2%

93.8%

96%

99.1%

95.8%

BMI

99.4%

98.2%

97.6%

98.4%

99.5%

92.7%

97.1%

The draft 2013/14 CQUIN guidance published in December 2012 outlines the nationally mandated CQUIN indicators for 2013/14. The VTE risk assessment threshold for payment has been set at 95% achievement monthly. An additional measure around an improvement target for root cause analysis for hospital acquired thrombosis occurring whilst an inpatient or up to 90 days post discharge. 5.0

Care Quality Commission (CQC) Activity The following table details the outcomes of recent dental practice inspections:

Provider

Lindley Dental

Skelmanthorpe Dental Practice

Netherton Dental Practice

Date of Review

1 November 2012

November 2012

9 November 2012

Type of Review

Planned routine inspection

Link to Report

Lindley Dental Nov 12

Skelmanthorpe Dental Practice Nov 12

Netherton Dental Practice Dec 12

02 – Consent to care & treatment

Compliant

04 – Care and welfare of people who use services

Compliant

Non compliant Moderate impact – compliance action required

Compliant

Outcomes

Care & treatment planned & delivered in a way that was intended. However the arrangements for the checking of emergency drugs & equipment did not ensure people’s safety & welfare 08 – Cleanliness & infection control

Compliant

12 – Requirements relating to workers

Non compliant Moderate impact – compliance action required

Compliant

Effective recruitment procedures to ensure that people were cared for, or supported by, suitably qualified, skilled & experienced staff were not in place Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 36 of 124

16 – Assessing & monitoring the quality of service provision

Compliant

Copies of the action plans submitted to CQC to address the non compliance issues have been received and shared with the Primary Care Contracting Team. The practices concerned will receive a follow up inspection by CQC in due course. 5.1

BMI Huddersfield CQC carried out an unannounced inspection on 25th October 2012 and found BMI Huddersfield non-complaint with Outcome 4: Care and welfare of people who use services. The CQC inspectors reported that there were plans in place for the urgent provision of blood and blood products as required in all hospitals under the terms of the NHS National Patient Safety Agency Rapid Response Report (NPSA/2010/RRR017) "The transfusion of blood and blood products in an emergency" (October 2010). However, there was no evidence available at the time of inspection to demonstrate that these plans, including out of hours, had been tested and timed. The BMI Huddersfield Hospital has its blood transfusion services managed by TDL (The Doctor’s Laboratory) Manchester. Blood and blood products are supplied to the hospital by TDL. The hospital retains two units of ‘O’ Negative blood available for use in an emergency. There is also a service level agreement in place with Huddersfield Royal Infirmary, which allows for the provision of emergency blood and blood products in the event that TDL are unable to deliver replacement blood in a timely manner in the event of major haemorrhage. BMI Huddersfield has provided a report and actions taken to address the concerns raised. The actions include ensuring there is extra blood available for urgent use and have undertaken 2 scenarios to test both TDL and HRI provision of blood both in and out of hours. A copy of the inspection report can be found at: http://www.cqc.org.uk/sites/default/files/media/reports/1102643500_BMI_Healthcare_Limited_1128766884_BMI_The_Huddersfield_Hospital_20121116.pdf

6.0

Quality Standards for NHS Standard Contract 2013/14 We are in the process of reviewing the current quality standards within the 2012/13 NHS Standard Contract and working through the additional requirements for the 2013/14 NHS standard contract. The areas to be included are: • • • • • •

Safeguarding of Adults and Children Infection Prevention and Control Equity of Access, Equality and No Discrimination Complaints Incidents and Serious Incidents Never Events

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• • • • • •

Patient Safety, External Alerts Management and Dissemination CQC Registration and Inspections Mixed Sex Accommodation Nice Guidance Clinical Audit Patient Carer and Staff Surveys

The draft document will be presented to the Quality and Safety Sub Group in March 2013. 7.0

National Patient Safety Agency (NPSA) – Safety Alerts CHFT have one alert open - Safer spinal (intrathecal), epidural and regional devices (NPSA/2011/PSA001) – which remains open past the closure date of 2 April 2012. Details of this were reported at a previous meeting. There are no open alerts for SWYPFT or YAS up to December 2012.

8.0

Winterbourne Serious Case Review (SCR) action plan

On 10th December 2012 the government published its final report into the events at Winterbourne View hospital and set out a programme of action to transform services so vulnerable people no longer live appropriately in hospital and are cared for in line with best practice.. The programme of action includes: • By spring 2013, the Department of Health will set out proposals to strengthen accountability of boards of directors and senior managers for the safety and quality of care which their organisations provide. • By June 2013, all current placements will be reviewed, everyone in hospital inappropriately will move to community-based support as quickly as possible, and no later than June 2014. • By April 2014, each area will have a joint plan to ensure high quality care and support services for all people with learning disabilities or autism and mental health conditions or behavior described as challenging, in line with best practice. • The Care Quality Commission will strengthen inspections and regulation of hospitals and care homes for this group of people, including unannounced inspections involving people who use services and their families. • A new NHS and local government-led joint improvement team will be created to lead and support this transformation. This programme is backed by a concordat signed by more than 50 partners, setting out what changes they will deliver and by when.The Quality and Safety Sub Group received a position statement on actions taken to date in response to the initial Winterbourne view publications and an action plan in response to the recommendations of the report published December 2012, at its January meeting and will continue to have oversight of the work on behalf of the Governing body.

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 38 of 124

9.0

Recommendations It is recommended the Shadow Governing Body receives this update on the Quality and Safety information and activity and specifically: • • •

receives the report on quality performance information for Eliminating Mixed Sex Accommodation (EMSA), NPSA and VTE and notes any actions being taken; receives an update on recent regulatory activity published by the Care Quality Commission (CQC), the actions being undertaken to address areas of concern. receives and note issues escalated for Quality & Safety Sub Group

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 39 of 124

Agenda Item: No 6 Enclosure: GB/13/255 Report To:

Greater Huddersfield CCG – Shadow Governing Body Meeting

Date:

6 February 2013

Title of Report:

Performance Report: Executive Summary & Exception Report

FOI Exemption Category:

Open

Management Lead:

Vicky Dutchburn – Head of Strategic Planning

Clinical Lead:

Dr Steve Ollerton - Chair

Report Author and Job Title:

Natalie Ackroyd: Business Performance Reporting and Planning Manager

Executive Summary: (to highlight if applicable) • Risk assessment • Legal implications • Health benefits

Greater Huddersfield Clinical Commissioning Group (GHCCG) actual performance against the 2012/13 NHS Operating Framework & NHS Outcomes Framework key outcomes/measures. The report was considered by GHCCG Finance and Performance Committee on 16th January 2013. Meeting performance targets enables patients to access services appropriately.

Resource Implications (including workforce):

None identified to date.

Outcome of Equality Impact Assessment:

None identified to date.

Sub Group/Committee:

The Finance & Performance Committee

Recommendation (s):

The GHCCG Executive Committee is asked to:• NOTE GHCCG performance against the key outcomes and measures for 2012/13; • APPROVE the actions being taken to address areas of under/over performance; • HIGHLIGHT any areas that the Committee feel should be escalated to the CKW Cluster Board.

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 40 of 124

Greater Huddersfield Clinical Commissioning Group 2012/13 NHS Operating Framework & NHS Outcomes Framework Executive Summary - As at 25th January 2013 PAF Outcome and Measure Ambulance Response Times

*Status Category R1 & R2 (A 8 mins) Category R1 & R2 (A 19 mins) 2 week waiting time standards

Cancer Waiting Time Standards Unplanned hospitalisation (adults)

Quality

Unplanned hospitalisation (children) Emergency admissions

18 Week RTT Standards

31 day waiting time standards (surgery only) 62 day waiting time standards Emergency admissions for ambulatory care sensitive conditions (18+) Rate of emergency admissions for asthma, diabetes and epilepsy in under 19s Rate of emergency admissions for acute conditions (ear/nose/throat infections, kidney/urinary tract infections and heart failure) usually managed in primary care Admitted Non-Admitted Incomplete Diagnostics - 6 weeks

A & E 4 Hour Waiting Time Standard

% who spent 4 hours or less in A & E

Mixed Sex Accommodation

Number and rate of unadjusted breaches

Healthcare Associated Infections VTE Risk Assessment

Number of Clostridium Difficile cases % of adult inpatients who have had an assessment

Financial Balance

Performance against plan

Running Costs

Actual against target

QIPP

GP Written Referrals to Hospital Other Referrals for a First Outpatient Appointment First Outpatient Attendance following GP Referral

QIPP savings Total number of non elective FFCEs in G & A specialties in a month Number of written referrals in period Number of referrals other than from GP for a first outpatient appointment in G & A specialties in period Number of first outpatient appointments following GP referral (consultant led)

All First Outpatient Attendances

Number of all first outpatient attendances (consultant led)

Non Elective Activity

Resources

Number of MRSA cases

Elective FFCEs Diagnostic Activity Number waiting on an Incomplete 18 week RTT Pathway Health Visitor Numbers

Elective FFCEs (ordinary admissions) Elective FFCEs (daycases) Total number of diagnostic endoscopy tests Total number of diagnostic non-endoscopy tests Total number of Incomplete RTT pathways at the end of the period Number of health visitors (FTE)

Reform

Bookings to services where named consultant led team was available even if not selected Choice

Proportion of GP referrals for first outpatient appointment booked using Choose & Book Trend in value/column of patients being treated at nonNHS hospitals

* Traffic Light Key: Standard NHS Performance Assessment Framework rating rules Green - no concern Amber - minor concern Red - major concern Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 41 of 124

Greater Huddersfield Clinical Commissioning Group - 2012/13 Exception Report Performance as at 25th January 2013 Indicator Level

Standard

Nov-12

YTD

F'Cast

75%

73.1%

74.1%

PHQ01: Ambulance Response Times: Category R1 & R2 (A - 8 minutes)

Ambulance Response times

What actions are being taken to address?

90 80 70 60

12/13 Actual

Indicator Level

QUALITY: PATIENT ACCESS

Mar-13

Feb-13

Jan-13

Plan

Nov-12

YTD

F'Cast

138 / 976 /1,503

138

1,144

1,716

Unplanned Hospitalisation for Chronic Ambulatory Care Sensitive Conditions

What actions are being taken to address?

Data for chart (can b

YTD

F'Cast

Month 22 YTD 101

133

228

Unplanned hospitalisation for Asthma, Diabetes and Epilepsy in under 19s

What actions are being taken to address?

NHS Kirklees is closely performance monitoring this new outcome/measure for which the PCT set a challenging 2012/13 target. NHS Kirklees is aware there are a few children at 'end of life;/ and they have been re-admitted on numerous occasions, although significant continuing care provision is provided in the home.

We have further invested the data and this shows that the children 151 have not always been admitted for their Long Term Condition (LTC). 101 51

Expected date to meet the standard Lead Manager

Page 2 of 4

Mar-13

Feb-13

Jan-13

Dec-12

Nov-12

Oct-12

Sep-12

Aug-12

Jul-12

Jun-12

Apr-12

12/13 Actual

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 42 of 124

Mar-13

Oct-12

What is driving the over-performance?

One child had a fracture and one was due to social problems, however they were coded to a LTC. We recognise that many of these children have open access to the ward and may not be using Primary Care services accordingly. This is something that the Strategic Review panel are considering and will form part of their proposed work in the transformational change plan.

Julie Oldroyd

Plan

May-12

PHQ16: Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s (rate per 100,000 population)

Feb-13

month-on-month

Lead Manager(s)

Indicator Level

Jan-13

12/13 Plan

Expected date to meet the standard

QUALITY: PATIENT ACCESS

Dec-12

Nov-12

Oct-12

Sep-12

Aug-12

Jul-12

1600 Through the Business Planning and Prioritisation for 13/14 the Early 1400 Supported Discharge Service for COPD is being identified as a 1200 priority to ensure that these emergency admissions are kept to a 1000 minimum. 800 600 400 200 0

12/13 Actual

There were a further 27 emergency admissions for Children with asthma, diabetes and epilepsy in the month of October. This brings the Year to Date total to 133 against a target of no more than 101 admissions.

Dec-12

Pat Andrewartha

Apr-12

It has been highlighted that there is a significant increase in Emergency Short Stays for COPD.

Lead Manager

Jun-12

Overall activity is down by 16 spells (-1.3%,) however there are increases in COPD 56 spells, there are a number of repeat admissions during 12/13 combined with more individuals being admitted compared to the previous year.

31st march 2013

May-12

What is driving the over-performance?

12/13 Plan

Expected date to meet the standard

PHQ15: Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults)

Nov-12

Oct-12

Sep-12

Jul-12

Aug-12

50 Jun-12

November's activity for GHCCG shows an in-month It has been agreed by the GHCCG Clinical Executive to continue to performance of 73.1%, and a year-to-date position of 74.1%. actively monitor this measure, liaise closely with YAS and consider This is a slight deteriation from last month and still not further actions/solutions as these become available and known. reaching the 75% standard. No further specific action to be taken at this moment in time. The localities within GHCCG highlighted as showing a significant under-performance continue to be Denby Dale & Kirkburton at 29.1% and The Valleys at 64.9%. for November. However, this is a significant improvement on the October figures of 22.2% and 55.3% respectively.

Apr-12

What is driving the under-performance?

May-12

QUALITY: PATIENT ACCESS

12/13 Plan

month-on-month Karen Poole

Greater Huddersfield Clinical Commissioning Group - 2012/13 Exception Report Performance as at 25th January 2013 Indicator Level

PHQ17: Emergency admissions for acute conditions that should not usually require hospital admission

Plan

Nov-12

YTD

F'Cast

97/977/ 1,435

152

1177

1,766

Emergency Admissions that should not require hospital admission

12/13 Actual

PHS06: Non-Elective Activity - Total number of non elective FFCEs in G & A specialties in a month

Mar-13

Feb-13

month-on-month

Lead Manager(s)

Indicator Level

Jan-13

12/13 Plan

Expected date to meet the standard

RESOURCES: Activity

Dec-12

Nov-12

Oct-12

Further work needs to be undertaken to build on existing work in relation to IV Therapies.

Sep-12

1460 1310 1160 1010 860 710 560 410 260 110 Aug-12

Following an in-depth review of admissions the following issues were highlighted that Pathways for relating to the above conditions require review; Service redesigns require review of whole systems and all related providers; Access to a highlight specialised service in A & E could prevent some admissions, but would require the availability of appropriate community/primary care services, e.g. minor surgery (cutaneous abscess); IV antibiotics (cellulitis); Public Health initiatives should be incorporated into redesign plans, e.g. influenza campaign/handwashing etc.

Jul-12

Activity is increasing as at the November position, there have been specific increases in cellulitis which has increased by 25% (specifically cellulitis in other parts of limb) and influenza and pneumonia (+20%).

Jun-12

What actions are being taken to address?

May-12

What is driving the over-performance?

Apr-12

QUALITY: PATIENT ACCESS

Julie Oldroyd

Plan

Nov-12

YTD

F'Cast

2,039/16,078/ 24,402

2,255

17,287

25,931

Non - Elective Activity

What is driving the over-performance?

What actions are being taken to address?

There is a further increase against plan being shown for NonElective admissions in November compared to October data, November shows a variance of 13.8% an increase on the 12.5% variance identified in October, YTD the variance is also above plan by 7.9%. Investigations have highlighted this is mainly due to some of QIPP schemes being planned but not being realised at the same levels. This along with a natural increase that we had not planned for have seen the Trust perform above contractual plans in this area.

NHS Greater Huddersfield CCG are reviewing all QIPP schemes and commissioning intentions for 2013/14.

2400 2300 2200 2100

The Increase is mainly in emergency short stay activity, as mentioned partly related to non-delivery of QIPP. Also seen an increase in paediatric admissions due to adverse weather over summer. This has been corrected in the 13/14 demand plan.

2000

1900

Plan

Nov-12

YTD

F'Cast

1,649/12,771/ 18,844

1,776

14,278

21,417

3700

2000

3100 1900

1800 2900 1700

2700 1600

1500 1400 1300 2300 1200

12/13 Actual

Expected date to meet the standard Lead Manager

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 43 of 124

Page 3 of 4

Mar-13 Mar-13

Feb-13 Feb-13

Jan-13 Jan-13

Nov-12 Nov-12

2100

Oct-12 Oct-12

2500

Sep-12 Sep-12

This is compounded by the expectation of the Trusts to reduce Other Referrals in the plan. This is picked up through contracting meetings where the trust is expected to report back on how they will address this.

2100 3300

Aug-12 Aug-12

A comparison of the YTD position at CHFT in 12/13 and 11/12 identify an increase of 23.4%.

Jun-12 Jun-12

November actual activity is showing an increased variance above plan of 7.6%, however this is a reduction on last months variance of 21.5%. YTD the variance is also above plan at 11.8%. The reason for this is varied, including the use of different clinical staff for referrals, inter-departmental referrals and coding of midwife referrals (NT Scans previously not captured).

Other Referrals

3500 2200

May-12 May-12

What actions are being taken to address?

Apr-12 Apr-12

What is driving the over-performance?

Mar-13

Martin Pursey

Jul-12 Jul-12

PHS08: Other Referrals for a First Outpatient Appointment

Feb-13

month-on-month

Lead Manager

Indicator Level

Jan-13

12/13 Plan

Expected date to meet the standard

RESOURCES: Activity

Dec-12

Nov-12

Oct-12

Sep-12

Aug-12

Jul-12

Jun-12

12/13 Actual

Dec-12 Dec-12

A comparison of the Provider Level YTD position this year 12/13 and the previous year 11/12 indicates that CHFT has a +3% variance.

May-12

Apr-12

1800

12/13 Plan

month-on-month Martin Pursey

Greater Huddersfield Clinical Commissioning Group - 2012/13 Exception Report Performance as at 25th January 2013 Indicator Level

RESOURCES: Activity

PHS14: Diagnostic Activity â&#x20AC;&#x201C; Endoscopy Tests What is driving the over-performance?

What actions are being taken to address?

November activity is showing a 4% increase above plan for Kirklees. Comparing activity YTD in 12/13 against 11/12, colonoscopies are showing the greatest increase +304.

We are currently investigating if this increase is due to the national bowel cancer screening campaign.

Plan

Nov-12

YTD

F'Cast

640/ 4,810/ 7,101

744

5,048

7,572

3700 5800 3500 750 5300 3300 700 4800 3100 4300 650 2900 3800 2700

Endoscopy Tests

600

3300 2500

550

2800 2300

12/13 Actual

PHS15: Diagnostic Activity â&#x20AC;&#x201C; Non Endoscopy Tests What is driving the over-performance?

What actions are being taken to address?

November activity is showing a 7% increase above plan for Kirklees. Comparing activity YTD in 12/13 against 11/12 at CHFT the following Non Endoscopy Tests were showing an increase: Magnetic Resonance Imaging +1,265, Computer Tomography +1,872 and Non-obstetric ultrasound +1,021. Overall activity across all Non-Endoscopy tests is +5,114.

The number of Chest x-rays have increased as a result of the lung cancer campaign (3 week cough requires a chest x-ray) & therefore justified.

Mar-13 Mar-13

Feb-13 Feb-13

month-on-month

Lead Manager

Indicator Level

Jan-13 Jan-13

12/13 Plan

Expected date to meet the standard

RESOURCES: Activity

Dec-12 Dec-12

Nov-12 Nov-12

Oct-12 Oct-12

Sep-12 Sep-12

Aug-12 Aug-12

Jul-12 Jul-12

Jun-12 Jun-12

May-12 May-12

Apr-12 Apr-12

500

2300 2100

Martin Pursey

Plan

Nov-12

YTD

F'Cast

5,549 / 41,727 61,422

5,899

44,692

67,037

3700 5800 3500 6700 5300 3300 6200 4800 3100 5700 4300 5200 2900 3800 4700 2700

Non-Endoscopy Tests

4200 3300 2500 3700 2800 2300

12/13 Actual

Expected date to meet the standard Lead Manager

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 44 of 124

Page 4 of 4

Mar-13 Mar-13

Feb-13 Feb-13

Jan-13 Jan-13

Dec-12 Dec-12

Nov-12 Nov-12

Oct-12 Oct-12

Sep-12 Sep-12

Aug-12 Aug-12

Jul-12 Jul-12

Jun-12 Jun-12

May-12 May-12

Apr-12 Apr-12

3200

2300 2100

12/13 Plan

month-on-month Martin Pursey

Agenda Item: No 7 Enclosure: GB/13/256

Report To:

Greater Huddersfield CCG Shadow Governing Body

Date:

6 February 2013

Title of Report:

Finance and Contracting Report

FOI Exemption Category: Open

Management Lead:

Julie Lawreniuk

Clinical Lead:

Steve Ollerton

Report Author and Job Title:

Theresa Fawcett – Finance Manager

Executive Summary: (to highlight if applicable)

Kirklees PCT continues to forecast to meet their financial control total.

• Risk assessment • Legal implications • Health benefits

The overall financial position for Greater Huddersfield is currently an under spend of £415k.

Resource Implications (including workforce):

None

Outcome of Equality Impact Assessment:

Not applicable

Sub Group/Committee:

Finance and Performance Sub Group

Recommendation (s):

The Greater Huddersfield Clinical Commissioning Group is asked to note the forecast outturn financial position.

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 45 of 124

Finance Report for the 9 Months Ending December 2012

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 46 of 124

Purpose of this Report 1.1

The purpose of this report is to provide the Greater Huddersfield Clinical Commissioning Executive with an overview of its financial and contracting position for 2012/13, including associated risks, and to advise the Group on the actions being taken to address those risks.

Summary Financial Position 2.1

Kirklees PCT continues to forecast to meet their control total.

2.2

A summary of the Greater Huddersfield financial position is shown in Table 1 and more detail is shown in Appendices A & B.

2.3

The overall position for Greater Huddersfield is currently forecasting to under trade by (£415k).

Table 1 Summary Financial Position GHCCG Financial Performance At December (M9) Budget

Budget £

Year To Date Actual £

Variance £

Budget £

Forecast Outturn Variance £ £

Variance %

Prescribing Provider Services Other

101,308,485 8,037,702 17,716,681 3,036,660 16,810,928 2,776,723 7,422,419 10,826,481 24,303,010 12,452,646 5,824,500

101,313,072 8,132,844 17,157,454 3,030,274 16,814,263 2,838,053 7,422,419 10,781,579 24,475,127 12,446,011 5,514,970

4,587 95,141 (559,227) (6,385) 3,335 61,330 0 (44,902) 172,117 (6,636) (309,529)

135,077,996 10,716,938 23,622,277 4,048,913 22,414,571 3,702,360 9,896,559 14,435,390 32,404,038 16,847,836 7,880,088

135,050,147 10,905,568 23,277,594 4,098,766 22,419,043 3,780,739 9,896,559 14,303,063 32,540,102 16,838,857 7,521,769

(27,849) 188,630 (344,683) 49,853 4,472 78,379 0 (132,326) 136,064 (8,979) (358,318)

(0.0%) 1.8% (1.5%) 1.2% 0.0% 2.1% 0.0% (0.9%) 0.4% (0.1%) (4.5%)

Total GHCCG M9

210,516,235

209,926,067

(590,169)

281,046,965 280,632,207

(414,758)

(0.1%)

Calderdale and Huddersfield NHS FT Leeds Teaching Hosp NHS FT Other NHS Commissioning Non NHS Commissioning SWYPFT - MH Other - MH Continuing Care - Specialist Services Other - Specialist Services

Acute Contract Position Calderdale & Huddersfield NHS Foundation Trust 9 (CHFT) 3.1

The main contract for GHCCG is with CHFT, the total value of GHCCG’s element of the contract is £133.9m. The forecast outturn position on this contract shows a small under spend of (£28k) and this is mainly due to prior year benefits realised this month, however this is masking a provision being made for potential movement in incomplete spells of care at the end of the financial year.

3.2

Month 8 freeze data is available and shows an over spend of £511k. GHCCG‘s share of the contract relates to 95.5% of total activity and costs. The actual forecast has moved adversely by £525k from the previous month, the details of this movement will be covered in more depth within the contracting report. As we are working with a fixed contract sum with CHFT in 2012/13 the over trade does not impact on our overall financial position.

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 47 of 124

Other Acute Contracts 3.4

There are a number of small forecast over trades on other acute contracts. The main one being on Leeds Teaching Hospital Trust(£189k) which is due to the impact of the quarter 4 reconciliation for drugs & devices. These are classed as pass through costs and not included in the main fixed cost contract.

3.5

Included within Other NHS Commissioning there are, however, favourable positions on the Sheffield Teaching Hospital contract (£97k) as a result of the final 2011/2012 reconciliation and there is also a projected underspend of (£112k) this financial year. There has been a prior year benefit on non contracted Activity (£102k) and an projected in year underspend of (£268k). There is also a favourable position on Pennine Breast Screening (£154k) due to a reduction in the negotiated contract. These are masking a pressure on Yorkshire Ambulance Services Accident &Emergency contract of £273k and Bradford of £190k.

3.6

The full contracting report is included as a separate agenda item.

Prescribing 3.7

The prescribing budget is showing a year to date over spend of £172k and a forecast outturn overspend position of £136k. This is a movement on the breakeven position reported last month. There is a risk around this position in that the forecast is based on month 7 Prescribing information and prescribing spend in previous years has been volatile, however has the year progresses this risk reduces.

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 48 of 124

QIPP Position 4.1

A summary of the QIPP programmes is shown below.

QIPP Scheme

Year To Date Year To Date QIPP QIPP Annual Year To Date QIPP Plan Savings Plan Variance November November

Forecast Yearend QIPP Savings

Forecast Yearend Variance

QIPP WIP Wellbeing and Integration Programme: Greater Huddersfield

1,005,027

746,512

419,900

(326,612)

625,100

(379,927)

QIPP Planned Care: Greater Huddersfield

1,704,000

1,136,000

770,000

(366,000)

1,155,000

(549,000)

666,716

400,000

474,313

74,313

660,313

(6,403)

84,000

55,992

84,000

QIPP Reduction in PCTs own Cost Base: Greater Huddersfield

855,000

570,000

855,000

QIPP Women's & Children: Greater Huddersfield

222,000

148,000

(148,000)

(222,000)

QIPP Mental Health & Learning Disabilities: Greater Huddersfield

730,000

486,656

730,000

243,344

730,000

QIPP Medicine Management: Greater Huddersfield

QIPP Public Health: Greater Huddersfield

Mitigating Plans QIPP Programme: Overall Total Greater Huddersfield

Forecast Yearend Variance RAG

1,157,330

5,266,743

3,462,241

3,020,205

(442,036)

4,109,413

4.2

Greater Huddersfield requires £5.3m of savings to be realised from budgets this year in order to achieve our target. Our current forecast is that we will achieve £4.1m this year, an overall shortfall of £1.2m as detailed in the table above.

4.3

£929k of our shortfall relates to elective and non elective schemes. The shortfall does not pose any financial risk this year as we have a fixed price contract with our main acute provider.

4.4

For external reporting purposes we are forecasting a balanced QIPP plan and have included a line of mitigating actions to this effect.

4.5

Any recurrent under delivery of QIPP in 2012/13 will need to be delivered recurrently in 2013/14. The full QIPP dashboard is included within the financial reporting pack appendix.

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 49 of 124

Primary Care 5.1

Contingency and Investment Reserves 6.1

The contingency fund and investment reserves still held centrally at PCT level are under spending.

6.2

Greater Huddersfield CCG have agreed a spending plan totalling £3m to utilise their share of the under spend. The plan was approved by the Cluster Board at their meeting on the 6th November 2012.

6.3

All of the £3m has now been committed as per the plan.

Financial Risk Analysis 7.1

7.2

The report now includes the Locally Enhanced Services and out of hours funding which will remain the responsibility of the CCG to commission. These are currently forecast to break even.

There continues to be a number of risks for the Group to be aware of for 2012/13: •

QIPP plans don’t deliver the required level of recurrent savings, although this will not pose a financial risk in 2012/13 (fixed income contracts in place with CHFT and Leeds) it will impact on 2013/14 negotiations.

•

The ability to fully utilise contingent and investment reserves this has been mitigated by the agreement of the spending plan.

•

The deadline for restitution claims between April 2004 and March 2011 has now passed. Early estimates of claims that will be paid out are significant. NHS Kirklees has made a provision for these claims but any payment over and above this provision will need to be be managed within the overall financial position.

•

The ongoing re-organisation of the PCT has the potential to inadvertently reduce our focus on managing this year’s position and we must ensure that this does not happen.

Risks will continue to be monitored and reported on an on-going basis and we are confident that we will mitigate our financial risks and achieve all our duties this year.

Public Sector Payment Policy a.

Across NHS Kirklees we paid 90.6% of invoices by value within 30 days and 92.4% of invoices by volume within 30 days.

We will continue to work towards achieving this target; however the reduced numbers of staff is beginning to have a negative impact on the timeliness of invoice payment.

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 50 of 124

Summary Performance against Key Statutory Duties/Targets a.

A summary of the forecast achievement of Kirklees PCT’s financial duties are shown in the table below.

Table 3: Summary of financial duties Financial Duties /Targets

10.

Forecast Financial Duty Achieved

Meet our £6.6m revenue surplus control total

Green

Containing capital expenditure with the PCT’s capital resource limit.

Green

Recovery of full costs on provider activities.

Green

To manage cash payments within the PCT’s cash limit

Green

Public Sector Payment Policy

Amber

Recommendations •

The Greater Huddersfield Clinical Commissioning Executive is asked to note the forecast outturn financial position.

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 51 of 124

Appendix FINANCIAL REPORT PACK 9 Months Ending December 2012

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 52 of 124

Greater Huddersfield Clinical Commissioning Group Detailed Commissioning Position December 12 NHS Kirklees Acute NHS Commissioning Detailed Expenditure Position December 12 CHT NHS Foundation Trust Mid Yorks Hosp NHS Trust Leeds Teaching Hosp NHS Bradford Teach Hospital Foundation Trust Barnsley Hospitals NHS Foundation Trust Sheffield Teaching Hospitals NHS Foundation Trust Sub Total Main Acute Contracts Non-Contracted Activity (NCAs) Pennine Breast Screening Service Other Sub Total Other Acute Activity Yorkshire Ambulance Service - 999 Service Yorkshire Ambulance Service - PTS Service Sub Total Yorkshire Ambulance Service QIPP Total

NHS Kirklees Mental Health and Learning Disabilities Detailed Expenditure Position December 12 South West Yorkshire Mental Health Trust Other SLAs Sub Total NHS SLAs St Anne's Mental Health Kirklees - Care in the Community Other Mental Health and Learning Disabilities Sub Total Other Mental Health and Learning Disability Total

NHS Kirklees Specialist Services Detailed Expenditure Position December 12 Continuing Care Free Nursing Care Long Stay Mental Health and Learning Disabilities Non NHS Out of Area - MH and LD Health Funding for the Benefit of Social Care Other Specialist Services Total

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 53 of 124

Budget

135,078 2,097 10,717 3,177 3,514 1,229 155,812 2,912 149 1,738 4,800 7,738 1,430 9,168 -362 169,417

Budget

22,415 325 22,740 2,111 452 814 3,377 26,117

Budget

9,897 1,339 2,158 3,854 2,704 4,381 24,332

Full Year Forecast Outturn

Variance (under)/over

135,050 2,100 10,906 3,367 3,596 1,020 156,040 2,543 -143 1,757 4,157 8,011 1,388 9,399 -362 169,233

Full Year Forecast Outturn

-28 3 189 190 83 -209 228 -370 -293 19 -643 273 -41 231 0 -184

Variance (under)/over

22,419 377 22,796 2,115 453 835 3,404 26,200

Full Year Forecast Outturn

4 52 56 4 1 22 27 83

Variance (under)/over

9,897 1,339 2,158 3,854 2,702 4,251 24,200

Finance Monthly Reporting Pack Page 4

0 0 0 0 -1 -131 -132

Greater Huddersfield Clinical Commissioning Group Summary Expenditure Position December 12 Start Budget 2011/12 £'000

Budget Changes To Date £'000

Current Annual Budget £'000

(1 + 2)

Year To Date

Commissioning PCT NHS Commissioning Non NHS Commissioning Consortium Total Contracting Adults Childrens Mental Health NHS SLA MH / LD Specialist Services Medicines Management Provider Services Practice Based Commissioning Total Other Commissioning GMS PMS Dental Pharmacy Opthalmic Total Primary Care Contracting Public Health Commissioning DAT Programme Total Public Health Corporate Services IT Estates Specialised Services Cluster Partnership Executive Commissioning Support Services Total Headquarters Commissioning Deficit/Surplus Reserve Earmarked Reserves Uncommitted Reserves Contingency Reserve Total Reserves Adjustment required to achieve control total Total Commissioning PCT Costs

166,844 3,778 88 170,710 2,183 430 22,263 3,615 25,558 35,347 15,630 1,707 106,733 86 2,181 0 45 0 2,312 0 0 0 0 0 0 0 0 0 0 0 5,718 444 0 6,162

2,573 271 0 2,844 (32) 93 477 (238) (1,226) (2,943) 1,218 77 (2,574) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 (4,696) (444) 0 (5,140)

169,417 4,049 88 173,554 2,151 523 22,740 3,377 24,332 32,404 16,848 1,784 104,159 86 2,181 0 45 0 2,312 0 0 0 0 0 0 0 0 0 0 0 1,022 0 0 1,022

285,917

(4,870)

281,047

285,917

(4,870)

281,047 TOTAL PCT Costs

Full Year

Previous Month

Budget

Forecast

£'000

Variance (under)/over £'000

(1 + 2)

(5 - (1 + 2))

Movement in Variance Variance from Forecast Previous (under)/over £'000 £'000 £'000

Budget

Actual

£'000

Variance (under)/over £'000

(4 - 3)

127,063 3,037 66 130,166 1,613 392 17,055 2,533 18,249 24,303 12,453 1,338 77,936 64 1,636 0 34 0 1,734 0 0 0 0 0 0 0 0 0 0 0 767 0 0 767

126,603 3,030 66 129,699 1,594 389 17,098 2,554 18,204 24,475 12,446 1,007 77,767 368 1,376 0 34 0 1,778 0 0 0 0 0 0 0 0 0 0 0 767 0 0 767

(460) (7) 0 (467) (19) (3) 43 21 (45) 172 (7) (331) (169) 304 (260) 0 0 0 44 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

169,417 4,049 88 173,554 2,151 523 22,740 3,377 24,332 32,404 16,848 1,784 104,159 86 2,181 0 45 0 2,312 0 0 0 0 0 0 0 0 0 0 0 1,022 0 0 1,022

169,233 4,099 88 173,420 2,131 518 22,796 3,404 24,200 32,540 16,839 1,450 103,878 86 2,181 0 45 0 2,312 0 0 0 0 0 0 0 0 0 0 0 1,022 0 0 1,022

(184) 50 0 (134) (20) (5) 56 27 (132) 136 (9) (334) (281) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

169,416 4,049 88 173,553 2,151 523 22,740 3,377 24,332 32,404 16,594 1,784 103,905 86 2,181 0 45 0 2,312 0 0 0 0 0 0 0 0 0 0 0 1,022 0 0 1,022

169,534 4,099 88 173,721 2,134 518 22,796 3,383 24,200 32,404 16,586 1,509 103,530 86 2,181 0 45 0 2,312 0 0 0 0 0 0 0 0 0 0 0 1,022 0 0 1,022

118 50 0 168 (17) (5) 56 6 (132) 0 (8) (275) (375) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

(302) 0 0 (302) (3) 0 0 21 0 136 (1) (59) 94 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

210,603

210,011

(592)

281,047

280,632

(415)

280,792

280,585

(207)

(208)

210,603

210,011

(592)

281,047

280,632

(415)

280,792

280,585

(207)

(208)

Budget £'000

Note : Movements from opening budgets are detailed in Page 7, Revenue Allocations.

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 54 of 124

Finance Monthly Reporting Pack Page 3

Contract Update: Part 1 – Month 8 Activity Acute contract summary dashboard The following table provides a headline summary of performance against two dimensions: contract activity value and 18 weeks aggregate performance for referral to treatment for admitted patient care. Annual plan value

Latest Trading Position Against Plan

Contract activity value performance against plan

18 weeks Admitted RTT November 2012 Aggregate Performance

Calderdale & Huddersfield NHS FT

£139,832,380

N/A

91.5% -

Mid Yorkshire Hospitals NHS T

£106,698,190

N/A

89.1% ↓

Leeds Teaching Hospitals NHS T (inc SCG)

£48,849,000

-£87k ↓

0.3% ↓

86.6% ↑

Bradford Teaching Hospitals NHS FT

£5,398,764

£202k ↑

5.6% ↓

78.3% ↑

Barnsley Hospital NHS FT

£3,914,055

£63k ↓

2.4 % ↑

93.9% ↓

Spire Hospitals (Independent Sector)

£3,053,488

-£166k ↑

-1.8% ↓

100.0% -

BMI Hospitals (Independent Sector)

£2,703,565

-£126k ↓

-7.0% ↓

98.0% ↑

Sheffield Teaching Hospitals NHS FT

£1,793,655

95.7% ↑

Provider

Key: ↑ denotes improving position, ↓ denotes worsening position, - denotes no change

Contract activity value With exception of Calderdale and Huddersfield Foundation Trust (CHFT) and Mid Yorkshire Hospitals Trust (MYHT) where there are fixed value agreements in place, this measure compares actual contract activity value as at Month 8 with the planned or expected value. The RAG status applied is based on the following: < 98.5% of plan

>98.5% to 100.5% of plan

> 100.5% of plan

18 weeks admitted referral to treatment This measure is based on performance against the admitted aggregate target of 90%. The RAG status applied is based on the following: >90.5%

> 88% to 90.5%

< 88%

NHS Kirklees- CCG split The contract positions contained within this report relates to NHS Kirklees as a whole, however to give context to the relevance of the contract to Greater Huddersfield CCG the report indicates within each section, where available, the approximate budget proportion attributable to GHCCC for that provider.

1 Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 55 of 124

Acute contract activity – NHS Providers Calderdale and Huddersfield NHS Foundation Trust (CHFT) NHS Kirklees- GHCCG split The GHCCG proportion of NHSK budget and expenditure is 96.26%, approximate contract spend of £134.6m. Financial Performance The contract with CHFT is based on a fixed value principle, with the plan being based on an expected level of activity and value. The contract value is £139.83m. In Month 8 there is a notional over-trade of £514k, this represents a significant shift from an undertrade of £15 at Month 7. Contract challenges based on activity in Month 7 will be submitted in accordance with the agreed challenge and reconciliation timetable. Activity Performance The following represents a summary of significant variances (at Month 8 - £90k for inpatient and £30k for outpatient and other activity) between actual and planned activity within the contract. It should be noted that all variances are identified and monitored but for the purposes of reporting only those above the threshold are presented. Elective Elective activity is under-trading against the plan by £816k, with the main variances as follows: Daycase Over-trading:Specialty 130 – Ophthalmology Specialty 160 – Plastic Surgery Specialty 100 – General Surgery

326 spells 188 spells 143 spells

£264k £147k £124k

Under-trading:Specialty 191 – Pain Management Specialty 110 – Orthopaedic Surgery: Knees Specialty 110 – Orthopaedic Surgery: Carpal Tunnels Specialty 110 – Trauma & Orthopaedics

685 spells 47 spells 93 spells 11 spells

£406k £104k £92k £97k

The under-trade in pain management is predominantly due to the temporary closure of this service on Choose & Book due to capacity and demand issues. The service has now been re-opened on Choose & Book and is up and running in the usual way. However, further investigation into the significant under performance in this area is underway. Elective Over-trading:Specialty 811 – Interventional Radiology Specialty 110 – Orthopaedic Surgery: Knees Specialty 107 – Vascular Surgery

80 spells 40 spells 17 spells

£136k £181k £105k 2

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 56 of 124

Under-trading:Specialty 100 – General Surgery Specialty 110 – Trauma & Orthopaedics Specialty 110 – Orthopaedic Surgery: Hips

295 spells 62 spells 10 spells

£534k £204k £118k

As previously advised vascular intervention procedures previously coded to general surgery are now captured under interventional radiology which provides part of the explanation for the over trade in interventional radiology and the under trade in general surgery. Endoscopy Daycases Over-trading:Specialty 100 – General Surgery

457 spells

£237k

Under-trading:Specialty 101 – Urology Specialty 301 – Gastroenterology

774 spells 415 spells

£157k £189k

The under-trade in urology endoscopy daycases is offset against an over-trade in outpatient procedures due to the implementation of best practice tariffs for cystoscopy where the provider is incentivised to carry out this type of procedure as an outpatient procedure. Mandatory GP first outpatient attendances Under-trading:Specialty 110 – Trauma & Orthopaedics Specialty 501 – Obstetrics Specialty 100 – General Surgery

373 attendances 391 attendances 231 attendances

£53k £48k £46k

Over-trading:Specialty 501 – Obstetrics Specialty 420 – Paediatrics Specialty 501 – Gynaecology Specialty 320 – Cardiology

514 attendances 215 attendances 342 attendances 138 attendances

£64k £52k £49k £30k

Under-trading:Specialty 110 – Trauma & Orthopaedics

249 attendances

£35k

Over-trading:Specialty 560 – Midwife Episode

558 attendances

£35k

Under-trading:Specialty 130 – Ophthalmology Specialty 191 – Pain Management Specialty 340 – Respiratory Medicine

1,126 attendances £78k 379 attendances £36k 287 attendances £31k

Mandatory other first outpatient attendances

Mandatory outpatient follow up attendances

3 Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 57 of 124

Other first outpatient procedures Over-trading:Specialty 560 – Midwife Episodes Specialty 101 – Urology Specialty 502 – Gynaecology

1,848 attendances £228k 131 attendances £53k 171 attendances £33k

The over-trade in other first midwife episodes is offset against an under trade in follow ups due to an acknowledged technical error on the demand plan. Mandatory outpatient procedures follow ups Over-trading:Specialty 101 – Urology Specialty 130 – Ophthalmology Specialty 655 – Orthoptics

724 attendances 369 attendances 262 attendances

Under-trading:Specialty 560 – Midwife Episodes Specialty 120 – ENT Specialty 140 – Oral Surgery

1,656 attendances £248k 463 attendances £56k 241 attendances £33k

£303k £50k £40k

The over-trade in urology is offset against the under-trade in endoscopy daycases due to the implementation of the best practice tariff for cytology. The under-trade in midwife episodes is offset against the over-trade in other firsts due to a technical error on the demand plan. Ward attenders Under-trading:Specialty 324 – Anticoagulant Service

322 attendances

£35k

The under-trade in anticoagulant ward attenders is due to the incorrect assignment of activity to this specialty in the plan. Year to date activity is coming through as part of specialty 320 Cardiology. Non Elective Non elective activity is over-trading against the plan by £635k, with the main variances as follows: Emergency short stay Over-trading:Specialty 300 – General Medicine Specialty 180 – Accident and Emergency Specialty 420 – Paediatrics Specialty 328 – Stroke Medicine

362 spells -89 spells 200 spells 39 spells

£432k £276k £135k £103k

Under-trading:Specialty 430 – Geriatric Medicine Specialty 110 – Trauma & Orthopaedics

249 spells 48 spells

£191k £106k

170 spells 87 spells

£582k £294k

Emergency long stay Over-trading:Specialty 340 – Respiratory Medicine Specialty 301 – Gastroenterology

4 Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 58 of 124

Specialty 420 – Paediatrics Specialty 306 – Hepatology Specialty 100 – General Surgery Specialty 370 – Medical Oncology

102 spells 39 spells 62 spells 26 spells

£142k £120k £99k £91k

Under- trading:Specialty 300 – General Medicine Specialty 430 – Geriatric Medicine Specialty 110 – Trauma & Orthopaedics Specialty 320 – Cardiology

251 spells 258 spells 26 spells 88 spells

£829k £633k £300k £125k

As previously noted, due to a specialty reconfiguration at CHFT there has been a change in the assignment of some medical specialties. This accounts for part of the over-trade in medical specialties and is offset against the under-trade in general medicine and geriatric medicine. However, the position overall is over-trading which is due to an increase in activity. Other non-elective short stay Over-trading:Specialty 501 – Obstetrics: Non-Delivery Admissions Specialty 501 – Obstetrics

219 spells 31 spells

£103k £87k

46 spells

£170k

Other non-elective long stay Over-trading:Specialty 501 – Obstetrics Best Practice Tariffs (BPT) top ups Over-trading:Acute Stroke Care Top-Up

£230k

The financial impact of CHFT achieving delivery of best practice for Stroke Top-ups was not reflected in the plan and is monitored in “shadow form” for 12/13 in order to set an accurate baseline for this activity in 13/14. Cost per Day and High Cost Drugs Cost per day elements Over-trading:SCBU

245 spells

£100k

Under-trading:Rehab bed days ICU

223 spells 12 spells

£52k £65k

Rehab bed days has seen a significant movement from Month 7. Further investigation is underway to understand the position. High Cost Drugs High cost drugs is over-trading by £53k. Direct Access Over-trading:Biochemistry

27,505 tests £106k 5

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 59 of 124

General Radiology MRI

3,090 tests £76k 386 scans £80k

As previously reported the analysis by CHFT into the increase in biochemistry direct access continues to indicate an increase in demand for DMARD (disease-modifying anti-rheumatic drugs) monitoring, CD4 counts and Tobramycin. There also appears to have been an increase in activity for Vitamin D, Vancomycin, Total & HDL Cholesterol, TPMT and bile acids. Community services Over-trading:COPD Early Supported Discharge Under-trading:Community Midwife Ante-natal Attendances Community Midwife Post-natal Attendances

32 spells

£75k

1,555 attendances £62k 1,042 attendances £52k

Issues to note in relation to CHFT Emergency admissions There has been an increase in emergency admissions in 12/13 and performance is showing a combined over-trade for emergency short stay and emergency long stay of 280 admissions at a cost of £340k. Compared to the same period last year emergency activity has increased by 307 admissions or 2.3%. Non-recurrent funding has been approved to support pilot schemes to reduce emergency admissions. Timescales for the commencement of these schemes have seen a delay due to recruitment issues at the provider. Mid Yorkshire Hospitals NHS Trust (MYHT) NHS Kirklees-GHCCG split The GHCCG proportion of NHSK budget and expenditure is 1.96% for MYHT, approximate contract spend of £3.1m. Contract Performance The contract with MYHT is based on fixed value principle, with the plan being based on an expected level of activity and value. The overall contract value is £106.7m, split by £103.6m North Kirklees CCG and £3.1m Greater Huddersfield CCG. At Month 8 there is a notional over-trade of £3.6m which represents a worsening trading position from £3.3m at Month 7. Leeds Teaching Hospitals NHS Trust (LTHT) NHS Kirklees-GHCCG split The GHCCG proportion of NHSK budget and expenditure is 48.5% for LTHT, approximate contract spend of £23.7m.

6 Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 60 of 124

Contract Performance The contract with LTHT is based on a fixed cost element of £41.1m for core and SCG activity based on last year’s outturn value. High Cost Drugs & Devices are excluded from the fixed cost agreement and will be charged as a pass-through cost with a planned value of £7.7m. As with the agreement last year there is limited financial impact to Kirklees for this year, core and SCG activity at LTHT is monitored using actual contract activity data and any variance against plan will be reported accordingly. Month 8 reporting shows there is an overall under-trade of £776k, with the core element under-trading at £1.0m and SCG over-trading at £248k. The main variances are as follows: Core – Elective inpatients under-trading by £238k, non-elective inpatients under-trading by £511k and outpatient attendances under-trading by £56k. SCG – non-elective inpatients over-trading by £279k and elective inpatients undertrading by £93k. Pass through – the pass through element of the contract is undertrading by £87k. Bradford Teaching Hospitals NHS Foundation Trust (BTHFT) NHS Kirklees-GHCCG split The GHCCG proportion of NHSK budget and expenditure is 58.9% for BTHFT, approximate spend of £3.1m. Contract Performance As at the end of Month 8, BTHFT is over-trading by £202k on its core contract. This represents a worsening trading position from an overtrade of £189k at Month 7. This overtrade is made up of £90k for outpatients, £42k for former Bradford Managed services (mainly ICU, HDU and SCBU) and £67k cost per case/direct access. Barnsley Hospital NHS Foundation Trust (BHFT) NHS Kirklees-GHCCG split The GHCCG proportion of NHSK budget and expenditure is 89.77% for BHFT, approximate contract spend of £3.5m. Contract Performance As at the end of Month 8 BHFT, is over-trading by £63k. This represents only a slight change from Month 7. The main areas to over-trade are elective inpatients £17k and outpatient procedures £44k which is mainly due to ENT although this is offset by an under-trade in ENT daycases. Sheffield Teaching Hospitals NHS Foundation Trust (STHFT) NHS Kirklees-GHCCG split The GHCCG proportion of NHSK budget and expenditure is 68.5% for STHFT, approximate contract spend of £1.2m. Contract Performance Contract monitoring information for STHFT Month 8 has not been received yet.

7 Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 61 of 124

Acute activity – Independent Sector Providers – Spire Hospitals NHS Kirklees-GHCCG split The GHCCG proportion of NHSK budget and expenditure is 20% for Spire, approximate contract spend of £600k. Contract Performance As at the end of Month 8, Spire Elland is under-trading by £166k, this represents an improved position from an under-trade of £143k at Month 7. Activity against plan is up whilst the case-mix value is down significantly compared to last year. BMI Hospitals NHS Kirklees-GHCCG split The GHCCG proportion of NHSK budget and expenditure is 96% for BMI, approximate contract spend of £2.6M. Contract Performance As at the end of Month 8, BMI Huddersfield is under-trading by £126k, this represents a worsening trading position from an under-trade of £189k at Month 7. We are continuing to monitor activity closely.

Specialist Commissioned activity The Yorkshire and Humber Specialist Commissioning Group (SCG) contract on behalf of NHS Kirklees with providers of designated specialist high cost and complex activity. This activity has a planned annual value of £52.3m (this value includes £27.6m of activity at LTHT, which due to the agreement reached is reported as part of the overall LTHT contract). The following provides the summary of Kirklees initial planned contract values. Provider / Contract Area

Leeds Teaching Hospitals NHS T Bradford Teaching Hospitals NHS FT Calderdale & Huddersfield NHS FT Mid Yorkshire Hospitals NHS T Sheffield Children’s Hospital NHS FT Sheffield Teaching Hospitals NHS FT Hull & East Yorkshire Hospitals NHS T Rotherham Non Yorkshire and Humber Providers Independent Sector Non Contract Activity National Contracts (various providers) Other Mental Health Providers Secure Services (various providers)

2012/13 Planned Value

£27,632k £911k £ 1,390k £2,859k £ 612k £932k £143k £81k £247k £876k £77k £1,208k £3,576k £11,875k

8 Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 62 of 124

Management of these contracts is undertaken by SCG on our behalf. Contract financial and activity performance is reviewed each month at the Yorkshire & Humber SCG Performance and Monitoring Sub Group. The latest contract performance is based on Month 7 monitoring information which indicates Kirklees having year to date under-trade of £208k compared to an under-trade of £359k at Month 6. In relation to the anticipated year-end position, at Month 7, an over-trade of £534k or 1.0% is forecast. This forecasted position is made up of the following: contracts with Yorkshire and Humber providers over-trading by £738k (MYHT £486k); Secure and other mental health services under-trading by £162k; All other areas are forecast to be on or around plan value.

Non Acute Activity South West Yorkshire Partnership Foundation Trust (SWYPFT) NHS Kirklees-GHCCG split The GHCCG proportion of NHSK budget and expenditure is 56% for SWYPFT, approximate contract spend of £21.8m. Contract Performance The Contract with SWYPFT is a Block Contract with a planned value of £39m. Performance has been in line with targets throughout the year. Penalties are chargeable within the contract but based on current performance it is unlikely that penalties will be charged in 2012/13. The above value does not include the value of the CQUIN scheme at £0.9m. In Quarter 1 SWYPFT only achieved 85% of the available CQUIN. In Quarter 2 only 76% of the CQUIN was achieved. Locala The contract with Locala is based on a fixed value principle. The contract value is £36.8m. Locala is expected to present an action plan on activity against each service line. This work will inform re-apportionment of the budget in future if this is required. In November performance was Green on most targets with the exception of: • • •

unplanned re-attendance at A&E - 6% (Target <5%), inter provider transfers within 4 weeks - 60% (Target 100%) community equipment - 98.39% (Target 100%).

Yorkshire Ambulance Service – A&E (YAS A&E) NHS Kirklees-GHCCG split The GHCCG proportion of NHSK budget and expenditure is 56.3% for YAS, approximate contract spend of £13.7m. Contract Performance The contract with YAS is a cost and volume based agreement, with a planned value of £13.7m. The contract ensures that any under / over performance against plan will be paid at a marginal rate. For NHS Kirklees overall the activity over plan for November is 3.8% (161) contributing to a year to date (YTD) over-trade of 4.4% (2239). 9 Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 63 of 124

NHS Kirklees overall contract performance: in relation to calls under 19 minutes is 98% YTD against the target of 95%; for calls under 8 minutes 76.4% YTD against a target of 75%. The graph below indicates that although performance in the Greater Huddersfield area has improved since 2011/12 it is still not achieving the 75% target.

Yorkshire Ambulance Service – Patient Transport Services (YAS PTS) NHS Kirklees-GHCCG split The GHCCG proportion of NHSK budget and expenditure is 56.3% for YAS, approximate contract spend of £1.0m Contract Performance The Contract for PTS which includes Core, Unscheduled and Extra Contract Referrals (ECRs) with YAS is a Block Contract with a planned value of £1.86M. There has been a 10% increase in PTS usage in Kirklees during 2012/13 despite the fact that there have been significant reductions in the use of stretcher and T2 vehicles. The largest increase in demand has been for saloon cars where demand has increased by 21%. This is due to the increase in demand from renal patients. Further analysis is being undertaken in relation to this increase. Performance has improved since 2011 with most KPIs indicating achievement of the targets. However, in November performance on the following KPIs was below target: KPI

% of patients to depart within 60 minutes of booked ready time % of patients to depart no more than 120 mins after ready time (penalties apply)

Target

75%

Actual

73.4%

97.4%

95.7%

% of patients to depart within 60 minutes of ready time (renal)

97.5%

97.1%

% of patients arriving more than 60 minutes early

2.1%

2.7%

% of patients arriving 60 minutes late (penalties apply)

1.5%

2.7%

% of patients arriving more than 30 minutes early (renal)

13.5%

% of patients arriving more than 90 minutes early (renal)

0.1%

10 Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 64 of 124

The activity for the year shows an over-trade against plan of 10.2% (7,105 journeys), the month on month activity is as follows: Plan Actual Variance to plan %

April 8195 8556

May 8877 10230

June 9272 9007

July 8522 9933

Aug 8799 9981

4.4%

15.3%

-2.9%

16.6%

13.4%

Sept 9037 9170

Oct 8626 10079

1.5%

16.8%

Nov 8321 9798 17.8%

NHS Direct – Out of Hours Access and Assess Provider The Contract for Access and Assess with NHS Direct is a West Yorkshire wide contract managed by NHS Calderdale as lead commissioner. The planned value for the NHS Kirklees element is £0.99m, with activity charged on a cost and volume basis. Activity across West Yorkshire has been higher in 2012. However in Kirklees the demand has been less than expected. If demand remains as it is, it is anticipated that there will be an under-spend of £40K at year end. The contract will expire in March 2013 to be replaced by the 111 contract. Performance is currently at an acceptable level in most areas. As reported previously, performance against the KPI for A&E Referrals was 7% in September and has been maintained at that level since. The increase was as a result of transition work in relation to the 111 service. Exit planning arrangements have been put in place with the objective of maintaining current performance to the end of the contract. Local Care Direct (LCD) – Out of Hours Treatment Provider The Contract has a planned value of £2.6m per year. The forecast outturn value is £2.3m. Performance in November was Green on targets except: •

PCC within 2 hours which was classed as Amber

•

urgent home visits within 2 hours which was classed as Red

•

urgent home visits within 6 hours which was classed as Amber (48 breaches, of which 31 were urgent and 17 routine).

Out of hours providers have noticed an increase in the number of home visits being prioritised as emergency or urgent by NHS Direct. For LCD there has been a 4% increase compared to November 2011. The reason for this increase is subject to investigation.

11 Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 65 of 124

Contract Update: Part 2 - 18 Weeks Update The NHS Operating Framework for 2012/13 retains the RTT operational standards that 90 per cent of admitted and 95 per cent of non-admitted patients should start consultant-led treatment within 18 weeks of referral. This requirement applies to all specialties, however it is anticipated that as in previous years there will be a monitoring threshold for the number of patients within each specialty. In addition to these requirements and in order to sustain delivery of these standards, 92 per cent of patients who have not yet started treatment should have been waiting no more than 18 weeks. Aggregate Performance - Provider The following table provides information relating to the admitted, non-admitted and incomplete pathway performance of NHS Kirklees main acute providers for the year to date up to the end of November. 18 weeks Admitted RTT 2012/2013 Aggregate Performance

18 weeks Non Admitted RTT 2012/2013 Aggregate Performance

18 weeks Incomplete pathways 2012/2013 Aggregate Performance

Calderdale & Huddersfield NHS FT

91.5%

99.2%

93.9%

Mid Yorkshire NHS T

89.1%

95.7%

93.2%

Leeds Teaching Hospitals NHS T (inc SCG)

86.6%

94.6%

94.0%

Bradford Teaching Hospitals NHS FT

78.3%

68.6%

NHS Kirklees Overall Position

90.7%

97.6%

94.0%

Provider

Admitted performance in Month 8 The following table provides information relating to the admitted performance by specialty of NHS Kirklees main acute providers for the month of November. % Patients within 18 weeks Specialty

CHFT

MYHT

LTHT

BTHFT

Cardiology

100.0%

90.0%

100.0%

Cardio Thoracic Surgery

100.0%

Dermatology

100.0%

ENT

80.0%

73.5%

28.6%

100.0%

Gastroenterology

100.0%

General Medicine

100.0%

General Surgery

86.3%

89.9%

93.3%

50.0%

Geriatric Medicine

100.0%

Gynae/Obstetrics

100.0%

90.4%

100.0%

12 Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 66 of 124

Neurology

100.0%

Neurosurgery

60.0%

Ophthalmology

97.3%

89.5%

100.0%

Oral Surgery

95.3%

94.6%

100.0%

85.7%

Other

94.6%

90.0%

86.0%

50.0%

Plastic Surgery

94.8%

85.3%

100.0%

68.4%

Rheumatology

100.0%

Thoracic Medicine

100.0%

Trauma & Orthopaedics

85.3%

85.9%

60.0%

71.4%

Urology

97.0%

81.2%

100.0%

Total

91.5%

89.1%

86.6%

78.3%

Non-Admitted performance in Month 8 The following table provides information relating to the non-admitted performance of NHS Kirklees main acute providers for the month of November 2012. % Patients within 18 weeks Specialty

CHFT

MYHT

LTHT

BTHFT

Cardiology

100.0%

98.7%

91.7%

75.0%

100.0%

Dermatology

98.2%

100.0%

92.3%

ENT

98.1%

82.0%

100.0%

81.5%

Gastroenterology

100.0%

87.5%

100.0%

25.0%

General Medicine

98.4%

100.0%

General Surgery

99.4%

97.4%

96.7%

66.7%

Geriatric Medicine

100.0%

Gynae/Obstetrics

100.0%

99.2%

100.0%

Neurology

98.0%

91.1%

100.0%

91.2%

Ophthalmology

99.7%

97.6%

92.9%

100.0%

Oral Surgery

99.3%

100.0%

88.9%

57.1%

Other

99.5%

96.0%

94.8%

54.5%

Plastic Surgery

96.7%

97.9%

80.0%

62.5%

Rheumatology

98.0%

92.8%

100.0%

97.3%

100.0%

99.7%

95.0%

90.0%

100.0%

Cardio Thoracic Surgery

Neurosurgery

Thoracic Medicine Trauma & Orthopaedics

13 Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 67 of 124

Urology

97.8%

94.9%

80.0%

25.0%

Total

99.2%

95.7%

94.6%

68.6%

Incomplete pathways performance in Month 8 The following table provides information relating to the incomplete pathways performance of NHS Kirklees main acute providers for the month of November. % Patients within 18 weeks Specialty

CHFT

MYHT

LTHT

BTHFT

Cardiology

100.0%

97.9%

100.0%

No data

87.3%

Dermatology

97.7%

100.0%

96.9%

ENT

92.4%

87.2%

88.7%

Gastroenterology

99.4%

92.6%

100.0%

General Medicine

99.2%

100.0%

General Surgery

90.7%

91.7%

94.3%

Geriatric Medicine

100.0%

Gynae/Obstetrics

99.2%

94.3%

100.0%

Neurology

95.1%

96.2%

100.0%

88.7%

Ophthalmology

98.0%

96.8%

100.0%

Oral Surgery

94.9%

97.9%

100.0%

Other

93.9%

93.3%

97.3%

Plastic Surgery

80.3%

79.0%

70.5%

Rheumatology

98.3%

92.7%

100.0%

Trauma & Orthopaedics

90.0%

92.2%

73.1%

Urology

90.3%

89.1%

92.7%

Total

93.9%

93.2%

94.0%

Cardio Thoracic Surgery

Neurosurgery

Thoracic Medicine

18 weeks breaches – CHFT Following investigation the following narrative provides some context for breaches by specialty for GHCCG’s main provider, CHFT: ENT – admitted performance has breached the target at 80.0% this represents an improved position from 72.6% at Month 7 and is due to the clearance of the backlog. An additional 20 breached patients are being treated in November and December which should result in an improvement of performance to meet the target in January. Weekly monitoring reports are currently being received in relation to ENT. 14 Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 68 of 124

Trauma & Orthopaedics – admitted performance has breached the target at 85.3%, this is a worsening position from 89.4% at Month 7. Additional capacity has been put in place to improve the position. An additional 30 breached patients per month will be treated from January to March which should result in an improvement of performance to meet the target from April 2013. Weekly monitoring reports are currently being received in relation to T&O. General Surgery – admitted performance has breached the target at 86.3%, this represents a worsening position from 88.0% at Month 7 and is due to clearance of the backlog in order to improve the position from January onwards. Incomplete pathways performance – a number of specialties have breached the incomplete pathways target. An exercise has been done at CHFT to validate incomplete pathway patient records which has resulted in a number of pathways being closed down (the position has improved from 642 incomplete pathways at Month 7 to 544 at Month 8). Work is on-going in this area and capacity is being identified to complete this exercise on a quarterly basis. The total year to date number of breaches at our main provider, CHFT, is 772. The main reason for breaches is ‘insufficient capacity’. The total number of Kirklees patients on an incomplete pathway, waiting over 18 weeks, up to the end of November is shown below. Next year it is likely that there will be an expectation that there are no waits above 26 weeks for in any specialty. Specialty

Cardiology Dermatology ENT Gastroenterology General Medicine General Surgery Geriatric Medicine Gynaecology Neurology Ophthalmology Oral Surgery Other Plastic Surgery Rheumatology Thoracic Medicine Trauma & Orthopaedics Urology Grand Total

Patients waiting between 18-26 weeks 0 5 44 2 2 178 0 6 11 14 22 14 22 2 0 53 39 414

Patients waiting between 26-40 weeks 0 3 24 1 0 22 0 0 1 2 7 19 10 0 0 22 7 118

Patients waiting between 40-52 weeks 0 0 0 0 0 1 0 0 0 0 0 3 2 0 0 6 0 12

Patients waiting over 52 weeks 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

15 Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 69 of 124

Over 52 week waiters â&#x20AC;&#x201C; latest position As at the end of November there are no Kirklees patients waiting over 52 weeks. Other providers Bradford Teaching Hospitals NHS Foundation Trust The trust continues to fail the 18 week performance standards. Contractual penalties are being applied. BTHFT is currently validating all their waiting lists with the support of the Intensive Support Team. The current trajectory plan is to clear the backlog of long waiters by the end of March to ensure achievement of the 18 week RTT targets from April 2013.

16 Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 70 of 124

Agenda Item: Enclosure: Report To:

Greater Huddersfield Shadow Governing Body

Date:

6th February 2013

Title of Report:

Update on Planning Process 2013-14

FOI Exemption Category:

Open

Management Lead:

Vicky Dutchburn – Head of Strategy, Business Planning & Service improvement

Clinical Lead:

Report Author and Job Title:

Executive Summary: (to highlight if applicable) • Risk assessment • Legal implications • Health benefits

Dr P Wilding

Vicky Dutchburn – Head of Strategy, Business Planning & Service improvement The purpose of this paper is to describe the progress made with the integrated planning process for 2013 onwards, both to meet our own internal requirements, those of the NHS Commissioning Board, and to inform and engage with our strategic partners. This paper will also summarise the proposal around selection of the 3 local priorities for the Quality Premium 2013/14, and request formal sign off from our shadow governing body.

Resource Implications (including workforce):

N/A

Outcome of Equality Impact Assessment:

Greater Huddersfield Clinical Commissioning Group strives to design and implement services, policies and measures that meet the diverse needs of our population and workforce, ensuring that none are placed at a disadvantage over others. A full EIA is carried out for all our planning activities, including on any integrated and strategic plans produced, to consider the needs of and assess the positive, adverse or neutral impact of these plans on all groups within our local communities. A full EIA will be submitted to support the 5 year strategic Plan.

Sub Group/Committee:

Clinical Strategy Group Quality Group Finance & performance committee Joint Kirklees Health & Wellbeing Board

Recommendation (s):

The Shadow Governing body are asked to note and approve the proposals within this paper around the selection of the 3 Quality Premium indicators for 2013-14.

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 71 of 124

1. Purpose The purpose of this paper is to describe the progress made with the integrated planning process for 2013 onwards, both to meet our own internal requirements, those of the NHS Commissioning Board, and to inform and engage with our strategic partners. This paper will also summarise the proposal around selection of the 3 local priorities for the Quality Premium (QP) 2013/14, and request formal sign off from our shadow governing body. 2. National requirements To meet a deadline set by the NHS Commissioning Board (CB) of 25th January, we have recently submitted our “Plan on a Page” (See Appendix 1) which gives a one page summary of our commissioning and planning priorities for 2013 – 2018. We also gave provisional notification of our 3 local priorities for the Quality Premium (QP). We stated within our return that these 3 priority areas were subject to further discussion internally, to ensure the robustness of the data, and also that we would need to get sign up from our Shadow Governing Body and the Kirklees Health and Wellbeing Board. The 3 priority areas are proposed as follows: • • •

Emergency readmission Rates - within 30 days of discharge from Hospital Mental Health – IAPT – of the patients classified at ‘caseness’, 52% moving to recovery NHS Health Checks – 25% of eligible population offered screening

2.1 Rationale As an overriding principle throughout all of our planning activities and in selecting the 3 Quality Premium priorities, we have stressed that there must be strategic fit to our Whole System, Strategic Review Transformational Programmes and to the Joint Health and Wellbeing Strategy (JHWS) for Kirklees. This is an opportunity to be able to put in place an additional incentive to contribute towards a wider vision and strategy which will have a positive influence on achieving our commissioning outcomes as described in our Integrated Plan. The QP priorities also have clear links to contributing to achieving the outcomes described in the Joint Health and Wellbeing Strategy (JHWS).The JHWS describes 15 outcome measures (see Appendix 2) across four main priority areas described in the Joint Strategic Needs Assessment. To identify the local indicators we have: • Identified shared outcomes as proposed in the Joint Health and Wellbeing Strategy; • Identified shared Key Performance Indicators in the NHS Outcomes Framework, Public Health Outcomes Framework and Adult Social Care Outcomes Framework; • Identified Key Performance Indicators as highlighted in the Clinical Commissioning Group(CCGs) Benchmarking Support Pack, with poor outcomes; • Identified Key Performance Indicators in the Primary Care Quality Matrix highlighted in the Primary Care Strategy; By process of elimination we excluded all indicators where: • Outcomes were good or better than ONS Cluster CCGs; • Those already identified as part of Quality Premium; • Any Key Performance Indicator that is not benchmarked and/or from a robust data source. From the Key Performance Indicators that made our short list: we highlighted the Strategic Fit with: • Neighbouring CCGs as partners of the Whole System Strategic Review; • Neighbouring CCGs within the same Local Authority Boundary; • Local Authority as identified through the joint Health and wellbeing Board and JHWS; • Local Priorities as identified from Plan on a Page. Greater Huddersfield CCG is proposing a joint approach with Calderdale CCG, in selecting Emergency readmission rates, - which actively supports the Whole System Strategic Review and Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 72 of 124

North Kirklees CCG in selecting – IAPT and NHS Health Checks,- to promote partnership working and joint commissioning arrangements. 2.2 Emergency readmission Rates, This measure actively supports the whole system strategic review and transformational change and supports outcomes proposed in the Joint Health and Wellbeing Strategy, through supporting integrated working, improving health and reducing health inequalities through health promotion, prevention and early identification/intervention resulting in hospital avoidance and promoting care closer to home. It will also address the core themes for action by improving communication and cohesion between services, identifying issues as soon as possible, leading to coherent integrated commissioning, Taking account of the impact of action in one area on the rest of the system. 2.3 IAPT For the mandated trajectory – access standard – we must achieve 15% of the recognised population with depression and/or anxiety being able to access IAPT services by 2014-15. The proposed local stretch trajectory across the Kirklees health economy is for 52% of those patients accessing services to move to recovery. Recovery is measured from clinical “caseness” at entry to service. Patients will be measured through exiting from sickness benefit; and not showing clinical “caseness” on PHQ9 / GAD7. The measure has been selected as a priority across Kirklees as it supports the JHWS by getting people off sickness benefit and back into work; it supports and promotes service users being in control of their lives, and taking more responsibility for their own health and wellbeing – through facilitated cCBT and promoting skills to self manage. It supports people managing their own vulnerabilities and helps service users to choose appropriate interventions appropriate to their own needs, across the pathway. Adopting a common standard across Kirklees will promote greater joint working across the health and social care community, by involving key partners in achieving the outcomes through means of integrated provision, e.g. job centre plus, primary care based services, and partnership work with third sector organisations. It supports one of the JHWS core principles of making mental health everyone’s business. 2.4 NHS Health Checks The stretch target for the Kirklees health economy has been set at 25% for 2013-14. The rationale for selecting this indicator is that it supports the strategic direction of early identification and recognition of people which then supports local strategic plans for self-management, self-care and fundamentally supporting transformation of acute services through integrated care planning and “care closer to home”. This indicator supports the JHWS through enabling people taking control of their own health and wellbeing; taking responsibility for their lives; minimising impact of vulnerabilities and taking part in design and delivery of services. It will support reducing health inequalities and increasing skills and capacity in communities. It supports multi-organisational working. It supports the JHWS core principles by focussing on all three levels of prevention – stopping issues starting, detecting and dealing with issues and minimising the consequences where they do. 3. Strategic and Operational Commissioning Plan Greater Huddersfield CCG is also in the process of updating its Strategic and Operational Commissioning Plan for 2013-18, a final draft of which will be shared with strategic partners and the NHS CB in early April 2013. We are also required, as a national requirement by the NHS CB, to produce a “prospectus” (i.e. a public facing document summarising our plans) by May 2013. 4. Recommendations The recommendation is that the Shadow Governing Body members agree to and formally sign off the process described above, and specifically the selection of the 3 local priority areas for the Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 73 of 124

requirements of the Quality Premium, which are based on a strong rationale that has a clear focus upon delivering our strategic objectives along with the outcomes described in the JHWS.

5.0

Appendices Appendix 1: Greater Huddersfield CCG Plan on a Page 2013 â&#x20AC;&#x201C; 2018 Appendix 2: Kirklees Joint Health and Wellbeing Strategy Outcomes

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Appendix 1:

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 75 of 124

Appendix 2:

Kirklees Joint Health and Wellbeing Strategy Outcomes

Across the whole population of Kirklees we want: Inequalities in health and wellbeing to be reducing, both locally and against national outcomes;

Example headline indicator: Specify in targets relating to other indicators

Increased skills and capacity in communities generating energy for change;

Levels of volunteering

The level of support available to individuals, families and communities reflecting their level of need;

Assess by strategic thinking framework / by specific issues

Threats to public health to be minimised and dealt with speedily.

Immunisation coverage

We want more people to: 1. Have the best possible start in life from conception.

Example headline indicator: Children living in poverty

2. Feel healthy, active and included, particularly older people.

Self-reported wellbeing

3. Be able to take control of their lives, so they enjoy life and flourish - by feeling involved, supported, confident and more resilient.

Ensuring people feel supported to manage their condition

4. Take more responsibility for their lives and so have greater independence and contribute to their family and communities, whilst being aware of the impact of the choices they make for themselves, families and others and recognise that interdependence.

Emotional wellbeing of children

5. Make the most of their strengths, talents, skills and qualities to fulfil their potential.

18-24 year olds in education, employment or training

6. Maximise their income through having access to paid work or relevant benefits.

Jobs available compared with no of people on unemployment benefits

7. Have access to work or activities to increase their selfesteem.

Employment for those with a longterm health condition including those with a learning difficulty/disability or mental health

8. Have a decent home that is affordable, warm and meets their needs.

Fuel poverty (better local alternatives)

9. Be safe from harm and abuse, have a sense of safety and belonging and be at ease with each other.

Fear of crime

10. Be able to minimise the impact of their vulnerabilities.

Health-related quality of life for people with long-term conditions Assess by strategic thinking framework

11. Take part in the design and delivery of services that are suitable for their needs.

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 76 of 124

Agenda Item: No 8 Enclosure: GB/13/257

Report To: Date:

Title of Report:

Greater Huddersfield CCG Shadow Governing Body 6 February 2013

Tier 3 Child and Adolescent Mental Health Services

FOI Exemption Category: Open

Management Lead:

Clinical Lead:

Report Author and Job Title:

Executive Summary: (to highlight if applicable) • Risk assessment • Legal implications • Health benefits

Carol McKenna, Designate Chief Officer

Dr Peter Davies, GP, NHS Calderdale CCG (on behalf of the three CCGs) David Warsop, Senior Procurement Manager Debi Hemingway, Programme Manager, Child & Adolescent Mental Health Services

A formal tender process was undertaken for the provision of a Tier 3 CAMHS Service across the Kirklees and Calderdale area. The procurement followed PCT policy and the appropriate Tender regulations. As a result of the tender process, the evaluation panel has put forward a recommendation to award a contract for the service. The recommendation was to award a contract to Bidder 5 based on outcome of the Award system scores. The total estimated costs for the delivery of the Tier 3 CAMHS Service for 3 years by the recommended provider in this report is: £8,368,720 Due to the financial value of the contract, authority for formal approval still rests with the Cluster Board. The attached report was taken to the Cluster Board’s procurement sub-committee on 21 January and approval given to proceed to contract award.

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Bidders were notified of the outcome on 21 January, and the 10 day standstill period is in operation until 31 January 2013. Resource Implications (including workforce):

None identified.

Outcome of Equality Impact Assessment:

This was undertaken in advance of the procurement exercise being launched and formed part of the documentation considered by the Cluster.

Sub Group/Committee:

Not applicable.

Recommendation (s):

The shadow Governing Body is asked to note and endorse the procurement process undertaken and the agreement of the Cluster to award a contract to the preferred bidder.

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 78 of 124

Greater Huddersfield CCG Tier 2 Chronic Pain Tender Contract Award

1.0

Purpose of Report The following report provides the Board with a summary of the formal tender process undertaken for the provision of a Tier 3 CAMHS Service across the Kirklees and Calderdale area. As a result of the restricted tender process, the evaluation panel has put forward a recommendation to award a contract for the service. The Board are asked to approve these recommendations.

2.0

Background Tier 3 Specialist Child and Adolescent Mental Health Service Specialist CAMHS is one part of the provision of Universal CAMHS which encompasses all the services provided by the Local Authority, Education, Health and Voluntary sector. The Specialist CAMHS provides mental health service to children and adolescents up to 18 years of age with complex and severe mental health problems. As a result of long standing issues surrounding Tier 2 and Tier 3 CAMHS it was agreed by the 3 Clinical Commissioning Groups, North Kirklees, Greater Huddersfield and Calderdale, that there was scope to transform the way childrenâ&#x20AC;&#x2122;s mental health service were commissioned. Although there were some excellent areas of good practice, services were inconsistent, severity and complexity was increasing and data reporting was poor. In order to provide an integrated and consistent model for child and adolescent mental health services a procurement process was undertaken for Tier 2 and Tier 3 CAMH services. Kirklees Local Authority led on the procurement for Tier 2 and Northorpe Hall have recently been awarded the contract to provide early intervention and targeted mental health services across Kirklees. The procurement of Tier 3 led by NHS Kirklees incorporated a robust engagement process to enable all stakeholders including service users and carers to inform the development of the service specification, resulting a an integrated Single Point of Access with Tier 2 The benefits of the service redesign include the provision of sustainable integrated CAMHS in the context of growing demand, high quality cost effective services and wherever possible release financial savings through the Quality Innovation Productivity and Prevention (QIPP) programme. The redesigned service will achieve the following objectives: Improve Children, Young People and their familiesâ&#x20AC;&#x2122; access to Specialist CAMHS and address inequities across Kirklees and Calderdale;

Deliver high quality evidence based care which will deliver improved outcomes for children & young people Greater Huddersfield Shadow Governing Body Public Meeting Papers 1

Wednesday 6 February 2013 Page 79 of 124

Promote continuous development, improvement & innovation in service delivery across all Tiers of Comprehensive CAMHS Ensure a culture of continual service user and carer involvement to improve service delivery Promote accessible, consistent services across all areas Kirklees and Calderdale

2.2 Outcome of Equality Impact Assessment A full Equality Impact Assessment (EIA) has been conducted and is included in this report to ensure that the new service reduces health inequalities and meets the needs of a diverse population across Kirklees and Calderdale. The Specialist CAMH service will specifically meet the needs of the most vulnerable groups including Looked After Children, those in the Youth Offending Team and those with a co-morbid mental health and Learning Disability. 2.3 Proposed Procurement Due to the complexity and issues with the Specialist Tier 3 CAMH service, it was agreed that there was sufficient evidence to procure a new service across the Greater Huddersfield, Calderdale and North Kirklees Clinical Commissioning Group area. The service will deliver a Tier 3 Specialist Child and Adolescent Mental Health service that provides a multi-disciplinary, person centred assessment and appropriate intervention, according to the severity and complexity of the problem. 2.4

Procurement Process

It was anticipated that the CAMHS Tier 3 procurement would attract bidders locally, nationally, and from the independent sector, as well the NHS. A business case was presented to North Kirklees, Greater Huddersfield and Calderdale CCGs, with an outline of the procurement options for the Tier 3 CAMHS Service, with the recommendation and subsequent approval of a full tender, with a contract period of three years. In order to ensure a robust procurement process and to mitigate the risks of possible challenges by potential bidders, it was decided to follow the EU restricted tender process. The restricted process was also appropriate due to the anticipated high volume of bids. The short listing process would limit the number of tender submissions that would require evaluation. This process is currently recommended as best practice by the UK Government. An e-evaluation system â&#x20AC;&#x2DC;AWARDâ&#x20AC;&#x2122; was utilised for the collection, collation and reporting of the evaluation and acted a vehicle to communicate between bidders and commissioners.

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 80 of 124

The procurement process adopted is summarised in Figure 1 and is taken from NHS Kirklees Policy for the Tender and Procurement of Commissioned Health Services. Figure 1: EU Restricted Tender Process

Advert

Expressions of Interest

PQQs Completed

Receive & Evaluate Completed PQQs

Selection of Shortlist

Invitation to Tenders ITT

Evaluate, Select and Award Contract

Initially, twenty one expressions of interest were received; seven subsequently submitted pre-qualification questionnaires (PQQs). Following closure of the prequalification period, the provider submissions were evaluated for organisational suitability and financial robustness. One provider failed to meet the required criteria at this stage and was therefore eliminated from the process; six potential providers were then invited to tender for the service and five submitted tenders 2.5

Invitation to Tender and Evaluation

The Invitation to Tender (ITT) required potential providers to respond to questions within five domains within which the submissions were evaluated. These were: 1. 2. 3. 4. 5.

Cost of Service Financial Information Service Delivery Service Quality & Patient Experience Performance and Monitoring

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 81 of 124

Each domain comprised a range of specific questions with associated evaluation criteria and scoring guidance. The evaluation of the potential provider responses was undertaken by a tender evaluation panel consisting of individuals with specific technical, clinical and commissioning expertise. Bidders were also invited to present to the evaluation panel, this process provided commissioners from health and the Local Authorities with an opportunity to clarify any points that may have arisen from the evaluation process. Please note that at the presentation stage of this process, bidders were not able to add new elements not previously disclosed in the formal bids. Members of the evaluation panel met on a number of occasions as part of the due diligence process. Carol McKenna, (Chief Officer Designate for Greater Huddersfield CCG) acted as Chair of the evaluation panel and moderator of the evaluation process and final decision. 3.0

Outcome

3.1

Results

Five organisations responded to the invitation to tender for the service. The evaluation process was performed on the Award system to provide a full audit trail. The final scores for each question and the overall scores for each of the provider bids per lot were agreed by the full evaluation team. A summary of the percentage weighted scores is set out below: Section

Bidder 1 Bidder 2

Bidder 3 Bidder 4

Bidder 5

1.0 Cost of Service

20.10

29.40

19.50

21.90

30.00

2.0 Financial Information

7.50

10.00

3.0 Service Delivery

12.20

15.00

18.00

15.00

16.00

4.0 Service Quality and Patient Experience

15.83

16.66

15.50

13.83

14.33

5.0 Performance and Monitoring

12.20

13.60

18.00

14.60

16.00

Overall

67.83

82.17

81.00

75.33

86.33

In line with the result of the evaluation, the successful bidder was Bidder 5.

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 82 of 124

3.2

Finance/Resource Implications

The total estimated costs based on of the delivery of the Tier 3 CAMHS Service by the recommended provider in this report for the 3 year period is: ÂŁ8,368,720 which is within the assigned budget.

3.3

Risk Management

Following the successful award of the contract, the risk register will be reviewed and updated to take into account the mobilisation phase of the new service. In relation to the mobilisation of the new service, Board members are also asked to note that as part of tender evaluation process all bidders were asked to provide assurance of their approach to managing the risk associated with their implementation plans, within the stated timescales. As with all procurements there is the risk that any of the bidders may challenge the final outcome. To mitigate these risks, all the results of the procurement process are contained within the AWARD system and are available to support the recommendations if such a challenge was put forward. 4.0

Next Steps Following Board approval, the successful bidder will be informed of the decision and the contract awarded. The contract award will be advertised at the same time and the unsuccessful bidders informed of the final outcome. The outcome of the procurement exercise will also be reported to CCG shadow Governing Bodies for their endorsement. A ten day stand still period follows the contract award, during this time unsuccessful bidders are able to challenge the decision and halt the process. After the stand still period commissioners will commence the implementation and mobilisation phase of the service with the new provider.

5.0

Recommendations It is recommended the Board: i)

Approve the recommendations made by the evaluation panel in section 3.1 and as stated below and approve that the contract be awarded to Bidder 5 for the provision of a Tier 3 CAMHS Service for a period of 3 years commencing April 2013.

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 83 of 124

Agenda Item: No 11 Enclosure: GB/13/260 Report To:

Greater Huddersfield Shadow Governing Body

Date:

6 February 2013

Title of Report:

HEALTH AND SOCIAL CARE STRATEGIC REVIEW‘UPDATE’ REPORT- January 2013

FOI Exemption Category:

Open

Management Lead:

Vicky Dutchburn – Head of Strategy, Business Planning & Service improvement

Clinical Lead:

Report Author and Job Title:

Executive Summary: (to highlight if applicable) • Risk assessment • Legal implications • Health benefits

Dr P Wilding

Dr Paul Wilding / Chris Green – PA Consultancy 24th January 2013 The attached report has three objectives: 1. To provide an update on the progress of the strategic review 2. Make recommendations to maintain and accelerate progress 3. To act as a basis for communicating progress to partner organisations. A/R The programme has a current rag rating status of Amber/Red: At risk, with one or more major issue that needs urgent attention. – Recommended actions required within the next month to improve the rating are: • Resourcing recommendations need to be actioned • Data requirements need to be fulfilled • Communications and Engagement workstream for consultation to be integrated within the Programme Care Stream update: additional areas that have been identified and need further consideration: • Dementia, Diabetes, End of Life, Geriatric outreach • Linkages to other programmes • Compassionate care • Self-management and culture change, health literacy • Involvement of the 3rd Sector. The focus of work of the Care Streams over the next few weeks will be to support the production and approval of the following key documents that will form the foundations of the pre-consultation

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 84 of 124

business case: • The Case for Change • The Vision for Future Models of Care and Support • A Programme Baseline • The proposed Benefits Framework for the programme Progress will be reported at the Executive Steering Group in February. Key Programme Risk Within the report the 5 key risks have been identified by the Programme Team – section 9. A full programme risk and issue identification and analysis exercise is underway to be completed by 1st February, reporting to the programme board and Executive Steering Group Resource Implications (including workforce):

A paper has been presented to the Executive Steering Group for consideration, in relation to the programme Office Management and related functions post march 2013, to deliver the programme timeline.

Outcome of Equality Impact Assessment:

Sub Group/Committee:

Clinical Strategy Group Finance & performance committee Joint Kirklees Health & Wellbeing Board

Recommendation (s):

The Shadow Governing body are asked to note and approve the proposals within this paper around the selection of the 3 Quality Premium indicators for 2013-14.

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 85 of 124

REPORT TO CALDERDALE AND HUDDERSFIELD HEALTH AND SOCIAL CARE STRATEGIC REVIEW EXECUTIVE STEERING GROUP ‘UPDATE’ REPORT- January 2013 1.0 PURPOSE This report has been produced for use by all partners and the report has three objectives: 1. To provide an update on the progress of the strategic review 2. Make recommendations to maintain and accelerate progress 3. To act as a basis for communicating progress to partner organisations. 2.0

PROGRESS UPDATE 2.1 Current Status – we have introduced a summary view of Programme Status to enable stakeholders to understand the big issues at a glance and focus on the key actions to improve. Current Status R A/R G/A G

Trend since Last report

Worse Same eu

Highlights • Care streams have made great progress to complete the first round of the design lock in • Data analysis is underway with all requests for data out Actions to improve • Resourcing recommendations need to be actioned • Data requirements need to be fulfilled • Communications and Engagement workstream for consultation to be integrated within the Programme

Better

Note on status ratings: • Red: Major issue impacting programme delivery • Amber/Red: At risk, with one or more major issue that needs urgent attention • Green/Amber: At risk but containable • Green: On track, no major issues Key achievements • Case for Change issued and comments received • Design Lock in taken place and clear actions in place • Introductory meeting with SCAP committee took place • Introductory meeting with Overview and Scrutiny Committee took place Planned achievements for next reporting period • Financial baseline confirmed • Case for Change published • Vision and Design Principles approved • Benefits framework finalised • Options identified and shortlisted • Stakeholder strategy finalised 3.0

RECOMMENDATIONS FOR DECISION Programme Progress Report, December 2012

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It is recommended that: 3.1 3.2 3.3 3.4 3.5 3.6 4.0

Additional Resources are confirmed The Case for change is approved pending additional work to confirm the financial baseline and challenge across the whole system Progress in developing the Care stream visions is noted and the programme of work with the Care Streams to prepare for the engagement event on 27th February is approved The draft Benefits Framework is approved for consultation with the Care Streams and within partner organisations The Financial base case be approved [outside the regular meeting schedule] Resources for data analysts are appointed.

PROGRAMME BOARD UPDATE The Care Streams completed the planned ‘lock in’ and an overview of progress across all the Care Streams was presented to the Programme Board on 18th February. There are three themes that are emerging across the Care Streams: • Use of technology to support innovative ways of working • Configuration of services to ensure financial sustainability and improve outcomes • Integration of services to improve patient care and experience by working more effectively across organisational boundaries The Programme Board were supportive of the progress to date and identified additional areas that need further consideration: • Dementia, Diabetes, End of Life, Geriatric outreach • Linkages to other programmes • Compassionate care • Self-management and culture change, health literacy • Involvement of the 3rd Sector. The focus of work of the Care Streams over the next few weeks will be to support the production and approval of the following key documents that will form the foundations of the preconsultation business case: • The Case for Change • The Vision for Future Models of Care and Support • A Programme Baseline • The proposed Benefits Framework for the programme The key milestones for the Care Streams over the next few weeks are as follows: • Programme Board (15th Feb) – Review of Vision for Future Models of Care and Support and proposed Benefits Framework • Executive Steering Group (20th Feb) – Review and Approval of Vision for Future Models of Care and proposed Benefits Framework • Engagement Event (27th Feb) – sharing the vision and opportunity for the Care Streams to showcase the work to date.

5.0

RESOURCE PLANNING UPDATE Additional resources are required to support the programme in the run-up to consultation. Some of these resources have been secured (Programme Assurance, Finance analysis, solution development). Additional resources are requested to lead the Quality and Safety review and evaluation of options. Two additional analysts were approved at the last ESG meeting and appointment is pending.

Programme Progress Report, December 2012

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 87 of 124

6.0

CASE FOR CHANGE UPDATE The Case for Change has been completed as a draft. Some further work is required to finalise the financial baseline. Work is then required to agree the plan for publication of the Case for Change.

7.0

BENEFITS FRAMEWORK UPDATE The Benefits framework template has been drafted. Once the outline framework is approved by the ESG the Care Streams will populate the framework.

8.0

DATA ANALYSIS UPDATE Baseline finance data is being actively sought from all partner organisations for insertion into the Case for Change. Activity Data has been requested from all partner organisations for analysis.

9.0

KEY PROGRAMME RISKS A full programme risk and issue identification and analysis exercise is underway to be completed by 1st February. The Programme Team has identified the following top 5 risks that the ESG should be aware of. Risk The Partners fail to reach agreement on what to include in the scope of the public consultation. This could be a result of • fundamental disagreement between Partners about options • weak management of decision-making process preconsultation

Impact Public consultation delayed or stopped

Mitigation 1. Build partnership approach to developing and evaluating options, led by ESG 2. Sufficient resources mobilised to undertake detailed work 3. Open and active dialogue with relevant assurance process, ie NCAT/SCAP/Gateway

The capacity and capability need to complete the required level of detailed analysis and to inform robust decision-making is not available within the current timeline

The Programme is not confident enough of success to go to public consultation in mid-May

•

Programme does not plan and deliver sufficiently for volume of public meetings, materials and media handling required for a public consultation

Communication and Engagement of stakeholders during public consultation is not robust enough to meet core consultation requirements

•

PMO working with C&E team to integrate planning within Programme

Dependency on MidYorkshire review delays H&SCR Programme because of: • Clinical dependency on MY configuration decision

Public consultation delayed

•

To ensure the right flow of information between the two strategic reviews to be achieved by a thorough analysis of the key operational

•

Programme Progress Report, December 2012

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 88 of 124

Build partnership approach to developing and evaluating options, led by ESG Sufficient resources mobilised to undertake detailed work in challenging timescales

•

Public controversy surrounding nearsimultaneous reviews to MY and Y&tH health systems

•

Cost of full transformation programme breaches affordability limits of the Partners

Partners cannot make informed decision re. options for consultation without completing further financial review and analysis

• •

touch points within the scope of the respective reviews, ensuring an on-going and active dialogue at the senior executive level to ensure early and rapid escalation of any risks that arise to ensure respective governance arrangements are able to share relevant information in a practical and quick manner Secure baseline finance data Conduct robust options appraisal process to assess affordability at an early stage

10.0 PROGRAMME MANAGEMENT UPDATE The PMO is working to complete a full review of all programme risks and will complete three key activities: • Reviewing and updating the Programme Plan to ensure the critical path is visible to all stakeholders, and that activity can be actively monitored and controlled via the PMO • Facilitating a session with PMO members to identify Risks and Issues and ensure mitigation strategies are in place • Developing a stakeholder strategy that highlights the current and desired positions of all key stakeholders, and key activities required to move stakeholders to desired positions. The PMO is ensuring readiness for all programme assurance (DoH Gateway review, SCAP, O&SC) activities. Key review points will be incorporated into the Programme Milestone plan. The PMO is also embedding the communications and engagement workstream for the consultation within the Programme, working with Eleanor Nossiter to integrate plans, governance structures and reporting cycles. _______________________ Paul Wilding / Chris Green 24th January 2013

Appendix – High Level Programme Management Plan

Programme Progress Report, December 2012

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 89 of 124

NHS Calderdale, Kirklees and Wakefield District Cluster

Minutes of the CKW Cluster Board held on Thursday 27 September 2012 at 9.00am in the Shibden Room at Dean Clough, Halifax Present: Angela Monaghan Roger Grasby Keith Wright Sandra Cheseldine Tony Gerrard Mehboob Khan Mike Potts Sue Cannon

Chair Non Executive Director and Vice Chair Non Executive Director and Audit Committee Chair Non Executive Director Non Executive Director Non Executive Director Chief Executive Executive Director of Quality and Governance (Executive Nurse) Executive Director of Finance Executive Director of Public Health (NHS Kirklees) (from 9.30am) Executive Director of Public Health (NHS Wakefield District) Executive Medical Director and Primary Care Lead

Ian Currell Dr Judith Hooper Dr Andrew Furber Dr Damian Riley In attendance: Peter Flynn June Goodson-Moore Gill Galdins Jo Webster Dr Matt Walsh Carol McKenna Andrea McCourt Eleanor Nossiter Steve Brennan Pauline Kershaw Alison Fearnley Michaela Iveson Judith Salter

Director of Performance and Commissioning Intelligence Director of Workforce Director of Corporate Development and Transition Designate Chief Officer (NHS Wakefield CCG) Designate Chief Officer (NHS Calderdale CCG) Designate Chief Officer (NHS Greater Huddersfield CCG) Head of Corporate Governance (NHS Wakefield District) Head of Communications (NHS Wakefield) Chief Finance Officer (NHS North Kirklees CCG) Executive Assistant (NHS Kirklees) Corporate Governance Administrator (NHS Kirklees) Senior Engagement Manager (NHS Wakefield District) (Agenda Item CKWCB/12/187) Assistant Director of Transition (Agenda Item CKWCB/12/193)

In addition there were two members of the public also in attendance. CKWCB/12/176

Apologies for Absence Apologies for absence were received from Ann Liston, Non Executive Director, Roy Coldwell, Non Executive Director, Ann Ballarini, Executive Director of Commissioning and Service Development, Chris Dowse, Shadow Accountable Officer, NHS North Kirklees Clinical Commissioning Group (CCG) and Dr Graham Wardman, Executive Director of Public Health (NHS Calderdale).

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CKWCB/12/177

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

CKWCB/12/178

Minutes of the last meeting held 3 July 2012 The minutes of the Cluster Board meeting held on the 3 July 2012 were AGREED as a true and accurate record. The action log was reviewed and updated as necessary.

CKWCB/12/179

Matters arising from the Minutes of the last meeting There were no other specific matters arising from the minutes of the last meeting other than those reviewed on the action log sheet.

CKWCB/12/180

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

CKWCB/12/181

Chair’s Comments The Chair expressed her appreciation to staff for their continued hard work to deliver excellent services, despite difficult times, through the transition and closedown period. This was supported by the Cluster Board and it was AGREED that a message would be included in the next Staff Briefing.

CKWCB/12/182

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

NHS Calderdale, Kirklees and Wakefield District Annual Review The Board noted a letter that had been received from Ian Dalton, Chief Executive, NHS North of England, following the annual review on 21 May 2012. It was noted that feedback was awaited from a quarterly review meeting held on 14 August 2012. A Non Executive Director asked whether the Cluster was on target to achieve the 5.6% Quality, Innovation, Productivity and Prevention (QIPP) reduction in non-elective activity over the coming year. It was acknowledged that achievement of this target was challenging nationally and the Cluster was focusing on how this could be accomplished.

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â&#x20AC;˘

Mid Yorkshire Hospitals NHS Trust The Board noted that three non-executive directors (NEDs) had been appointed to the Board of Mid Yorkshire Hospitals NHS Trust (MYHT). These were: -

Pat Garbutt Trevor Lake Rosie Valerio

In addition, it was noted that the Appointments Commission had appointed a new Chairman to MYHT, Mr Jules Preston, MBE. Jules is to take up his new role from 1October 2012. The Board RECEIVED and NOTED the contents of the Chief Executiveâ&#x20AC;&#x2122;s Report. CKWCB/12/183

Quality and Performance Report The Board was circulated a copy of two press releases concerning a review of compliance undertaken by the Care Quality Commission (CQC) at MYHT. These related to an unannounced CQC inspection of the Day Surgical Unit at Pinderfields Hospital in Wakefield on 5 September 2012. It was noted that the CQC had imposed an urgent legal restriction on the registration of MYHT, preventing the use of the day surgical unit at Pinderfields Hospital for patient stays in excess of 23 hours. The concerns raised by the CQC related to the facilities and physical environment of the Unit for patients spending more than 23 hours there. The Executive Director of Quality and Governance provided background to the inspection undertaken and confirmed the immediate action that had been taken by the Trust to address the issues of concern. The Cluster Board was concerned that internal governance arrangements (e.g. whistleblowing procedures) had not been used to raise concerns. Mike Potts reassured the Board that Stephen Eames, Interim Chief Executive of the MYHT, was firmly sighted on these issues and was working collectively with the CKW Cluster to address the areas of concern. Attention was then drawn to the regular Quality and Performance Report previously circulated to the Cluster Board. Peter Flynn highlighted some minor errors within the report and provided assurance regarding the actions being taken to improve areas of underperformance. In particular the following points were highlighted:

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 92 of 124

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•

18 Weeks Referral to Treatment (RTT) It was recognised that 13 patients had breached the national waiting time standards - 4 at Calderdale and Huddersfield NHS Foundation Trust (CHFT) and 9 at MYHT. The Board acknowledged that robust action was being taken to address this issue.

•

NHS Health Checks It was noted that the RAG status for Calderdale and Wakefield showed RED rather than GREEN.

•

A & E 4 Hour Wait (CHFT) It was recognised that performance at CHFT was showing below target. The indicator was showing AMBER due to a problem with the clinical software system which has since been resolved.

The Cluster Board AGREED to: •

•

CKWCB/12/184

NOTE the performance of NHS Calderdale, NHS Kirklees and NHS Wakefield District PCTs against key principal outcomes/measures for 2012/13 and key quality and safety metrics; and APPROVE the action being taken to address areas of under/over performance.

Finance Report The Board received a summary of the financial position for the year to date, up to 31 August 2012 (Month 5). It was noted that the income and expenditure surplus at Month 5 was £7.6m for the cluster against a budget of £5.5m and the forecast annual surplus is £13.3m in line with the original budget. The Director of Finance emphasised that it was important that each control total was met in full and was not either under or over achieved. He also confirmed that he had written to each of the Designate Chief Officers and Chief Finance Officers asking for detailed plans showing how any in year flexibility would be used. The Board acknowledged that the forecast was subject to a number of risks. The significant ones which may be critical to the achievement of these targets include: • • •

Delivery of QIPP savings Delivery of running cost targets Financial challenges at MYHT

The Board acknowledged the improved financial position in relation to NHS Wakefield District. Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 93 of 124

Page 4 of 18

A discussion ensued regarding the non recurrent reserves for NHS Calderdale. It was recognised that there were uncommitted reserves/resources at present however the Finance and Performance Group was exploring how this would be used. A further discussion ensued regarding prescribing savings and whether there were any benefits from cross cluster learning. Steve Brennan explained the current reporting position and confirmed that QIPP plans were all on target. It was recognised that the way forward to cross cluster learning was via the West Yorkshire Commissioning Support Unit (WYCSU). The Board received and noted the 2011/12 Annual Audit Letters for each PCT. A discussion ensued regarding the Healthcare Resource Groups (HRG) error rate at MYHT noting this was 16.5%. This was worse than the national average from 2009/10 of 9.1%, and was also worse than the Trustâ&#x20AC;&#x2122;s results in 2010/11 when 7.7% of HRGs were incorrectly coded. It was noted that the Cluster Audit Committee was sighted on this issue and had requested that a plan is agreed with MYHT to improve coding, as previous assurances on this issue had been sought but not led to improvements. The Designate Chief Officer for Wakefield CCG also provided assurance that this had been raised with the Executive Contracting Board for MYHT and advised that a report was being issued on how the Trust will improve clinical coding in the future. In addition, it was recognised that extra staff had been recruited to improve clinical coding. The Cluster Board AGREED to NOTE the report and the financial risk identified. CKWCB/12/185

Governance and Risk Report The Director of Corporate Development and Transition introduced the report to the Board. She explained that the report provided information on governance and risk arrangements across the cluster and asks for the Board to approve a number of recommendations. Additionally, the report also provided an update on risk management. In particular, the following key areas were discussed: â&#x20AC;˘

Clinical Commissioning Groups It was recognised that it would be appropriate for the Clinical Commissioning Executive Committees of the CCGs to become the shadow Board for CCGs from the point of authorisation, holding meetings in public as CCGs prepare to become statutory organisations and adjust to meeting in an open environment. The Board was reassured that each CCG had a development plan in place to achieve meeting in public following authorisation, however it was acknowledged that the CCGs were at different stages of the authorisation process.

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A Board member challenged how recommendation iii on page four of the report fitted in with the transition planning arrangements outlined in David Nicholson letter appended at Appendix 1 of the report. Mike Potts explained the arrangements for developing the Local Area Team (LAT) in West Yorkshire. It was acknowledged that these would currently run differently until the West Yorkshire LAT was fully established and that this would be reviewed in December. It was therefore AGREED to ensure that as the LAT develops their role around planning for 2013/14 is clear. It was AGREED to add some additional narrative to recommendation iv on page four “...taking into account any national guidance relating to directly commissioned primary care services”. It was AGREED to: • • •

APPROVE the proposal for CCG Clinical Commissioning Executive Committees to act as shadow Boards and meet in public from the point of authorisation; ADOPT a revised CCE membership following confirmation of authorisation by the NHS Commissioning Board; and APPROVE that CCGs can have autonomy in financial decision-making relating to expenditure for 2013 onwards, with ratification by the Board taking into account any national guidance relating to directly commissioned primary care services.

•

NHS Commissioning Board Local Area Team The Board NOTED the arrangements in place for the recruitment to the West Yorkshire LAT.

•

Governance Committee The Board was presented with revised Terms of Reference for the Governance Committee following a review of its role within the context of changes to the commissioning architecture of the NHS. It was recognised that the focus of the Governance Committee, in its last six months, should be on seeking assurance during the transition period, focussing on areas of change such as Public Health transfer of functions, the closedown of the three Primary Care Trusts within the Cluster and the quality legacy. Following discussion it was AGREED that the Governance Committee would be given delegated authority to approve Section 75 agreements with local authorities if required. It was AGREED to:

Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 95 of 124

Page 6 of 18

•

APPROVE the Governance Committee Terms of Reference and delegate authority to the Governance Committee to approve Section 75 agreements with local authorities if required.

Procurement Committee The Board was presented with Terms of Reference for establishing a Procurement Committee as a sub-committee of the Board. It was noted that these had been proposed to ensure that decisions relating to procurement were not held up due to the reduced frequency of Board meetings. It was AGREED to: •

•

APPROVE the establishment of a Procurement Committee and the Terms of Reference.

Changes to Scheme of Delegation and Reservation – Section C The Board noted that minor changes had been proposed to the Scheme of Delegation and Reservation – Section C, namely the deletion of item 13 relating to decisions reserved to the Board ‘Strategy, Operational Plan and Budgets’. These changes had been discussed and agreed by the Audit Committee on 18 September 2012 where it was recommended that the Board approve these. No significant issues were raised regarding the removal of this section. It was therefore AGREED to: •

APPROVE the deletion of item 13 of the Scheme of Delegation and Reservation as detailed above.

• Risk Management update The Board received an update on critical risks on the risk register. An assurance that CCGs are engaged in risk management was also given. The Chair of the Audit Committee raised an issue with regard to a delayed infection control report and the interface between NHS Leeds and NHS Calderdale. This related to the critical risk of breaching the MRSA target. It was AGREED this issue would be addressed outside of this meeting. •

Board Assurance Framework (BAF) It was noted that the BAF was currently being reviewed to ensure that it was a dynamic document, and also in light of the PCT closedown, prior to an update being presented to the Board.

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It was noted that the updated BAF would be presented to the Governance Committee in November 2012, Audit Committee on 27 November 2012 and the Board at its meeting on 22 January 2013. The Board NOTED the critical risks identified from the Risk Register. CKWCB/12/186

Designate Chief Officer Reports The Board received an update report from each of the Designate Chief Officers of the local Clinical Commissioning Groups (CCGs). The reports covered the following: • • •

Quality, safety, finance and performance and progress towards Authorisation and establishment for the CCG; The approach to governance and risk; and System transformation

It was agreed that future reports from Designate Chief Officers should include reports on: • •

Health and Well Being Strategies and Transformation Programmes Highlight any CCG decisions requiring ratification by the Board

Each of the Chief Officers provided a summary of their report. In particular the following points were highlighted: Calderdale CCG •

NHS Health Checks It was noted that overall there was a marked improvement on the previous year’s achievement and assurance was provided on achieving the required target this financial year.

•

Financial position Work was ongoing to apply for non recurrent funding to support the strategic review.

•

Quality, Innovation, Prevention and Productivity Schemes (QIPP) Rigours arrangements were in place for monitoring 2012/13 QIPP plans. It was acknowledged that further work was needed to reduce non-elective demand and work was underway to address this.

•

Quality and Safety Assurance was provided that the CCG was sighted on ensuring quality and safety in the future.

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•

CCG Authorisation and development The authorisation site visit was undertaken by the NHS Commissioning Board assessor team on 25 September 2012. Positive feedback had been received regarding the strength of the governance arrangements. A formal response from the site visit was expected mid November.

Greater Huddersfield CCG •

CCG authorisation and development It was noted that the CCG infrastructure was well developed, with appointments now confirmed for lay members, an external nurse and a consultant. The wave two authorisation application was submitted on 3 September and the authorisation site visit was due to take place on 19 October 2012. It was recognised that the CCG was also working well with external partners on other elements of transition, such as the development of the Health and Well Being Board. Following discussion it was AGREED that Mike Potts and Mehboob Khan would look at working through connectivity between the Health and Well Being Board and the Calderdale and Huddersfield Health and Social Care Strategic Review. It was also AGREED that future Designate Chief Officer reports should include an update on Health and Well Being strategies and transformation programmes.

•

Infection Control It was emphasised that this was a high priority area for the CCG and that enhanced surveillance continued to be undertaken by NHS Kirklees infection prevention and control team.

•

NHS Health Checks It was noted that a new Locally Enhanced Scheme had been launched during July 2012 to focus on driving this work forward. 33 GHCCG practices had signed up to the scheme.

North Kirklees CCG •

CCG Authorisation and development The CCG will submit its application in line with the planned timescale of 1 November 2012. Engagement with stakeholders had been extremely positive.

An update on Governing Body appointments was given, noting lay member appointments were currently underway. An external nurse had been appointed but no appointment had Greater Huddersfield Shadow Governing Body Public Meeting Papers yet been made to the consultant role. Wednesday 6 February 2013 Page 98 of 124

Page 9 of 18

Steve Brennan provided assurance that there were no critical risks aligned to the authorisation process following a query raised by the Chair. •

Transformational Programmes It was noted that non-recurrent funding was being used to fund this work.

Wakefield CCG •

Quality and Safety Jo Webster confirmed that robust action was being taken to address the quality issues identified within the report and provided assurance that the CCG was working collaboratively with colleagues within the health economy.

•

CCG Authorisation and development A site visit from the external assessor panel took place on 26 September. Initial feedback had been positive, particularly regarding the membership model and the Equality Strategy.

•

Performance It was acknowledged that there had been improved performance in the following areas: -

Accident and Emergency; and Stroke.

It was noted that a utilisation review was being undertaken regarding the Accident and Emergency Department. A deep dive of analysis was also being undertaken around non-elective admissions, looking at the effectiveness of practice action plans. The Cluster Board RECEIVED and NOTED the individual Designate Chief Officer Reports. CKWCB/12/187

NHS Calderdale, Kirklees and Wakefield District Consultation Report 2011/12 June Goodson-Moore introduced this report and Michaela Iveson, Senior Engagement Manager, joined the meeting to present the Consultation Report to the Cluster Board. It was recognised that Primary Care Trusts (PCTs) have a statutory duty to report annually on engagement activities relating to commissioning decisions. The Board acknowledged that the report covered all consultation carried out across the Cluster between 1 April 2011 and 31 March 2012, and provided details of activity planned for 2012-13. Michaela confirmed that CCGs would continue to be responsible for the future as it would remain a statutory duty.

Greater Huddersfield Shadow Governing Body Public Meeting Papers publishing this report in Wednesday 6 February 2013 Page 99 of 124

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It was emphasised that CCGs were sighted on the importance of engaging with the public. The Board acknowledged the report covered a number of interesting themes that would influence future consultation and demonstrates where engagement had been beneficial. A discussion ensued regarding the resource requirements to produce the report to meet this statutory duty. It was acknowledged that the report had been compiled as part of ongoing work throughout the year and therefore the production of the report had not impacted significantly on resources. The Cluster Board RECEIVED and NOTED the contents of the report and APPROVED it for publication and submission to NHS Yorkshire and the Humber for the deadline of 30 September 2012. CKWCB/12/188

Primary Care Trust Baseline Spend Exercise The Cluster Board was presented with a summary of the PCT baseline spend exercise that would help inform allocations to new organisations post April 2013. The Director of Finance explained the background to the exercise and the assurance process. It was recognised that analysis would help inform how funding allocations are made between CCGs, National Commissioning Board, Local Authorities and Public Health England. It was noted that the baseline spend of Kirklees PCT had to be split between North Kirklees CCG and Greater Huddersfield CCG. Where actual activity information was available that was used, where not the split was based on weighted capitation. It was acknowledged that achieving financial stability was fundamental as well as establishing some risk sharing arrangements. The Cluster Board NOTED the content of the report and the risks associated with this.

CKWCB/12/189

NHS West Yorkshire Commissioning Support Unit Update The Board received an update on progress with the development of the West Yorkshire Commissioning Support Unit (WYCSU). June Goodson-Moore introduced the report and highlighted the progress made to date, key risks and next steps. The Board noted that significant progress had been made in recent weeks in the following areas: â&#x20AC;˘

The appointment of interim divisional lead roles;

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• •

• • • • •

Establishing the WYCSU’s vision and values and sharing these with staff for consultation; The draft structure had been developed and published to all staff for consultation and there had been regular; communication with staff through newsletters and staff briefings; The draft order book was completed in July 2012 and negotiations with CCGs was taking place to finalise their service requirements and the pricing for these services; A draft operating model had been developed; A draft service specification had been developed; A draft organisational development strategy had been developed; and There had been two meetings of the joint committee of the two PCT Cluster Boards. It was noted that minutes from these meetings would be received by the Cluster Board under a separate agenda item.

The Board noted that a key risk to the further development of the WYCSU was the lack of capacity to manage and deliver the scale of change and the work programme required to ensure the WYCSU is ready to operate effectively from 1 April 2013. It was acknowledged that this would be addressed by putting in place additional project and implementation support through approved HR recruitment processes. It was noted that the “pooling and matching” process was due to be underway next week. It was anticipated that this would be complete together with any external recruitment required to fill posts not filled through “pooling and matching”, by the end of December 2012. The Board AGREED to: • • •

CKWCB/12/190

NOTE the progress and key next steps identified in the report; NOTE the risks identified re lack of capacity and the intention to address this through additional project, implementation support; and NOTE that the CSU will undertake a risk assessment re the contracting round to ensure that the programme plan takes into account any new risks identified.

Commissioning Development Report and Public Health Transition Update

Mike Potts introduced the report to the Board explaining that the report provided an update on the latest developments in establishing the new national commissioning system and progress of the commissioning development milestones that the Cluster Board is responsible for ensuring delivery against. In addition it was noted that the report also outlined the proposal to develop a section 75 Partnership Agreement between the Local Authority and Wakefield District Public Health function. Greater Huddersfield Shadow Governing Body Public Meeting Papers

Wednesday 6 February 2013 Page 101 of 124

Page 12 of 18

The Board noted the Local Area Team (LAT) Director appointments that had been made by the NHS Commissioning Board to the North of England. In addition to those listed in the report he confirmed that Ian Currell had been appointed as Director of Finance and Damian Riley had been appointed to the post of Medical Director for the LAT. It was noted that work was underway to develop a Section 75 Partnership Agreement between the Local Authority and Wakefield District Public Health function to agree what Public Health support will continue to be provided to NHS Wakefield District. It was therefore AGREED, as discussed earlier, that the Board would delegate authority to the Cluster Governance Committee to consider the proposal to enter into a Section 75 agreement to transfer lead commissioning and establish a pooled budget agreement for defined public health services for the shadow period 1 November 2012 to 31 March 2013 to the local authority. The Board AGREED to: • • •

• •

CKWCB/12/191

NOTE the progress made against the transition milestones and update on progress towards transition; RECEIVE the Public Health exception report; DELEGATE authority to the Cluster Governance Committee to enter into a Section 75 agreement to transfer lead; commissioning and establish a pooled budget agreement for defined public health services for the shadow period 1 November 2012 to 31 March 2013; DELEGATE the development of the agreement to the Wakefield Public Health Transformation Steering Group; and NOTE the work being undertaken to agree the most appropriate way forward in respect of public health contracts included in NHS and GP contracts.

Workforce Report The Board received an update on progress headlines associated with workforce metrics and with people transition to the new NHS Commissioning system. In particular, the following points were highlighted: • • • •

Workforce numbers across the Cluster continue to fall, although at a much slower pace than in 2011/12; Sickness levels remain higher than in 2011/12; CCGs and the CSU have consulted on their draft organisation structure; and The filling of posts process is due to commence 1 October, with employees being “pooled and matched” to new organisational structures.

It was emphasised that the Cluster had a number of measures in place to help ensure that staff are supported and engaged throughout Greater Huddersfield Shadow Governing Body Public Meeting Papers the process of organisational change. Wednesday 6 February 2013 Page 102 of 124

Page 13 of 18

It was confirmed that Chris Dowse had been appointed to the post of Designate Chief Officer for North Kirklees. It was noted that formal consultation with employees working in functions due to transfer to other receiver organisations, including Local Authorities, NHS Property Services and the NHS Commissioning Board would take place separately. The Director of Workforce and Corporate Development agreed to check if Public Health England job descriptions had been issued. The Board noted that a new West Yorkshire Workforce Transition microsite was due to be launched later that week which all staff would be able to access including staff on maternity or long term sick leave. It was acknowledged that there was some disparity in the system regarding TUPE arrangements and that legal clarification was awaited from the Department of Health. The Cluster Board AGREED to NOTE the content of the report. CKWCB/12/192

Transformation Programmes’ Reports The Board received an update on two areas of transformation:Calderdale and Huddersfield Health and Social Care Strategic Review Programme Matt Walsh provided background on the programme of transformation for the health and social care economy in Calderdale and Huddersfield. It was noted that the programme had entered the crucial phase of establishing the four ‘Care Streams; and the ‘CrossCutting Themes’ that will expedite the design work that will comprise the intentions of the Strategic Review. The Board noted that the timeline as shown in Appendix B of the report had been extended by 2 to 4 weeks to enable more support for producing business cases. It was recognised that overall the timeline was particularly challenging. The Board requested that future reports include an indicative decision-making timetable and confirm where decisions need to be made. Secondly, that future reports also highlight relationships between Health and Well Being Boards and furthermore it was AGREED to invite the Programme Director, to attend a future Board meeting. The Board AGREED to: • •

RECEIVE and NOTE the contents of the progress report; and NOTE the potential for significant changes to be proposed as a result of the strategic review.

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Mid Yorkshire Health and Social Care Partnership Programme It was noted that the report provided an overview of the work that had taken place during this reporting period in relation to the following transformation schemes: • • • •

Clinical Services Strategy The Out of Hospital Care Programme The Urgent Care Programme The Maternity, Children and Young People’s Programme

It was emphasised that the next major milestone would be the submission of the Outline Business Case (OBC) for the Clinical Services Strategy. The Board noted that this was currently planned to be presented to the Board in a joint meeting with MYHT and the CCGs Boards for Wakefield and North Kirklees on 31 October 2012. It was noted that it had become evident that more time was needed on engaging with local elective members and members of the public. The Board acknowledged that a review would be undertaken. The Head of Communications expanded on how public engagement was being addressed and provided assurance that they were exploring new ways of improving this. It was recognised that the Board would have an opportunity to discuss the development of transformation schemes and the OBC in more detail on 15 October, prior to meeting on 31 October. The Board RECEIVED and NOTED the content of the highlight report. CKWCB/12/193

CKW Transition and Closedown: governance arrangements Judith Salter, Assistant Director of Transition, joined the meeting to present the report to the Board. She explained that a programme had been established to: • • •

Support the transition of Calderdale, Kirklees and Wakefield District staff, functions, assets and documents to their successor organisations; Support the closedown of the Primary Care Trusts; and Ensure a strong legacy is transferred to the successor organisations .

It was noted that the report provided the Board with assurance on the governance arrangements to support this process. Judith explained that a Steering Group had been established to oversee the delivery of the programme. The group currently met monthly and it was proposed that this group would report to the Cluster Governance Committee who would provide the oversight and Greater Huddersfield Shadow Governing Body Public Meeting Papers scrutiny of the programme on behalf of the Board. Wednesday 6 February 2013 Page 104 of 124

Page 15 of 18

Draft Terms of Reference for the Steering Group were reviewed by the Board. It was acknowledged that Gill Galdins would act as a link to Public Health by attending Public Health Transition Groups, rather than bringing a specific steering Public Health lead onto the Steering Group. Furthermore, it was acknowledged that the steering group was mindful of the opportunities to make best use of resources eg by taking joint legal advice, with the Airedale, Bradford and Leeds Cluster. It was AGREED that Gill Galdins would liaise with Damian Riley to consider the impact of the development of the LAT. The Cluster Board AGREED to: • • • •

CKWCB/12/194

RECEIVE the update report; SUPPORT the proposals that the Governance Committee provide the oversight and scrutiny to the programme on behalf of the CKW Cluster Board; APPROVE the Steering Group Terms of Reference; and NOTE the first draft of the programme plan, which will be scrutinised by the Governance Committee in future.

Minutes of the Yorkshire and the Humber Specialised Commissioning Operational Group The minutes of the Yorkshire and the Humber Specialised Commissioning Operational Group held on 27 July 2012 were ADOPTED by the Cluster Board.

CKWCB/12/195

Minutes of NHS Calderdale Clinical Commissioning Executive Committee The minutes of NHS Calderdale Clinical Commissioning Executive Committee held on 14 June 2012 were RECEIVED and NOTED by the Cluster Board.

CKWCB/12/196

Minutes of NHS North Kirklees Commissioning Executive Committee The minutes of NHS North Kirklees Commissioning Executive Committee held on 23 May, 27 June and 25 July 2012 were RECEIVED and NOTED by the Cluster Board.

CKWCB/12/197

Minutes of NHS Greater Huddersfield Commissioning Executive Committee The minutes of NHS Greater Huddersfield Commissioning Executive Committee held on 23 May, 27 June and 8 August 2012 were RECEIVED and NOTED by the Cluster Board.

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CKWCB/12/198

Minutes of NHS Wakefield Clinical Commissioning Executive The minutes of NHS Wakefield Clinical Commissioning Executive held on 22 May, 28 June and 24 July 2012 were RECEIVED and NOTED by the Cluster Board. Attention was drawn to the separate decision sheet appended to the minutes where two decisions were requested to be taken by the Board. The Chair advised that any CCE decisions requiring ratification by the Cluster Board should be highlighted separately via the Designate Chief Officer report. With reference to the first issue regarding the Stanley Health Centre Capital Bid; it was noted that a decision had already been taken via Chairâ&#x20AC;&#x2122;s action which was to be reported to the Board separately under item CKWCB/12/204. With regard to the second issue on the decision sheet, it was AGREED that Angela Monaghan and Keith Wright would review the decision taken by the Executive team regarding Tackling Inequalities, checking that this was within Standing Financial Instructions and confirming whether the decision had been appropriately made.

CKWCB/12/199

Draft Minutes of the Cluster Governance Committee The Draft Minutes of the Cluster Governance Committee held on 20 June were RECEIVED and NOTED by the Cluster Board.

CKWCB/12/200

Minutes of the North of England Specialised Commissioning Group The minutes of the North of England Specialised Commissioning Group held on 13 July 2012 were RECEIVED and NOTED by the Cluster Board.

CKWCB/12/201

Minutes of the Remuneration and Terms of Service Committee The minutes of the Remuneration and Terms of Service Committee held on 17 November 2011, 23 February, 23 March, 3 April and 19 July 2012 were RECEIVED and NOTED by the Cluster Board.

CKWCB/12/202

Minutes of the West Yorkshire Commissioning Service Joint Committee The minutes of the West Yorkshire Commissioning Service Joint Committee held on 11 July 2012 were RECEIVED and NOTED by the Board.

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CKWCB/12/203

Minutes of a Board Sub-Committee – Procurement The minutes of a Board Sub-Committee held on 31 July and 14 August 2012 were RECEIVED and NOTED by the Cluster Board. These minutes highlighted the Chair’s action taken on the following: • •

CKWCB/12/204

Greater Huddersfield Clinical Commissioning Group Chronic Pain Service Tender Contract Award; and NHS Wakefield Community Dermatology Tender Contract Award.

Receipt of Chair’s Action Report The Board received a report that confirmed information on Chair’s actions taken since the last meeting held on 3 July 2012. The Board noted that Chair’s action had been taken on three occasions relating to: • • •

Award of a Substance Misuse Psychosocial Interventions Service (PSI) at HMP and YOI New Hall; Submission of the Outline Business Case for the Capital Bid for the refurbishment and development of Stanley Health Centre, Wakefield; and The Calderdale, Kirklees and Wakefield District/Airedale, Bradford and Leeds policy for filling of posts on behalf of the CKW Cluster.

The Cluster Board AGREED to ratify the Chair’s action taken on the above. CKWCB/12/205

Date and time of the next meeting It was AGREED that the next meeting of the Cluster Board would take place on 22 January 2013 between 9am and 1pm in the Boardroom at White Rose House, Wakefield.

CKWCB/12/206

Resolution to Exclude Public from Part two of the meeting It was RESOLVED that: “representatives of the press and other members of the public be excluded from the remainder 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” (section 1 (2) Public Bodies (Admission to Meetings) Act 1970).

Chair’s Signature: ..........................................................

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Date: .............................. Page 18 of 18

NHS Greater Huddersfield Clinical Commissioning Group

Minutes of the Finance & Performance Subgroup Wednesday 19 December 2012, 2.30 â&#x20AC;&#x201C; 5.00pm Board Room, Broad Lea House, Huddersfield Present: Carol McKenna (CM) Julie Lawreniuk (JL) Dil Ashraf (DA) Natalie Ackroyd (NA) Tony Gerrard (TG) Nicky Hoyle (NH)

Designate Chief Officer (Chair) Chief Financial Officer CCG Member Performance Manager Lay Member Consultant in Public Health

In attendance: Vicky Dutchburn (VD) Yvonne Hoorman (YH) Rob Willis (RW) Theresa Fawcett (TF) Jan Giles (JG) Sapphire Wright (SW)

Head of Strategic & Business Planning Senior Contracts Manager Finance Manager Finance Manager Head of Practice Support & Development Graduate Management Trainee

Apologies: Steve Ollerton (SO) Martin Pursey (MP) Penny Woodhead (PeW)

CCG Clinical Leader Head of Contracts Head of Quality & Safety

FP/12/33

Welcome, Apologies and Declarations of Interest VD opened the meeting on behalf of CM and welcomed everyone to the GHCCG Finance & Performance Subgroup. Apologies were noted. Declarations of Interest TG declared an interest in the entire meeting as a lay member for both GH and NK CCGs.

FP/12/34

Accuracy of the minutes of meeting held 21st November 2012 The minutes were agreed as an accurate record.

FP/12/35

Matters Arising and Action Log Matters Arising: None raised.

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Actions: FP/12/23 – Matters Arising from November Minutes – Inter-Practice Referrals KC advised that there has been added to the Clinical Strategy Group agenda for 2 January for further discussion. Action recorded as COMPLETE. FP/12/23 – Matters Arising from November Minutes – Spending Plan VD confirmed she had now received the breakdown of the information regarding the 3 year waiting list for children’s autism assessments and an action plan now needs to be agreed. Action recorded as COMPLETE. FP/12/24 – Finance Report from November meeting YH confirmed that the CHFT financial picture does not include penalties and there is no significant difference financially. FP/12/25 – Contracts Report from November meeting YH advised that the trajectory for T&O to meet the 18 weeks performance target has been received and CHFT are on track to deliver this by the end of Q4. FP/12/29 – Health Checks CM confirmed that she had received the outstanding information in relation to the 6 remaining practices not signed up to Health Checks. This information has been passed on to Claire Sibbald and it will be raised again during practice visits and at the Practice Managers Reference Group to agree how to manage the patients of these 6 practices. All other actions were recorded as complete. FP/12/36

Primary Care Non-Recurrent Money SW and JG were in attendance to present the paper. SW explained about the allocated £600k for primary care. Some of the money has been top sliced for training and education for practices and also some for Newsome Surgery’s freed up resources business case. This leaves approximately £500k to share proportionally with practices based on list size. SW explained that a proposed list of equipment has been shared with practices for consideration. The same list has also been reviewed by Steve Ollerton, Karen Dean and Jan Giles. The list of equipment will be presented to the CCE on 9 January and will need formal sign off by the non-GP voting members of the Governing Body.

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Page 2 of 8

DA informed the group he had recently had a conversation with SO about whether to allow practices to buy iPad/tablets etc to take out on visits. Discussion took place about this and there were various concerns raised about the practicality of this as well as clear governance issues. It was AGREED that this wasn’t a suitable option at this moment in time. DA also highlighted that some certain items of the list will bring about a debate from the practices. A further discussion took place about the suggestion of digital dictation which would be useful/valuable but it would be at a cost of £2k each. It was agreed that the non-recurrent money should be spent useful and not wasted. In summary CM advised that the group were comfortable with the Newsome business case proposal. It was also agreed that the approved list is to be shared and agreed at CCE before final release to practices. RW asked a question about the Newsome business case. He asked if the activity would be monitored over the course of the 2 years. JG advised that yes this is planned as its important that we monitor and evaluate this activity. RW asked how this is to be measured. Discussion took place about being able to measure the outcomes and it was agreed that this needs to be built into the business case. It was agreed that NA and SW will meet to discuss some outcome measure that could be included. Action: NA to meet with SW to discuss and agree outcome measures for the business case for Newsome Surgery. The group RECEIVED and NOTED the contents of the paper and thanked SW/JG. FP/12/37

Finance Report JL presented the paper and provided the key highlights; • NHS Kirklees continue to forecast to meet their control total. • GHCCG are currently undertrading by £207k. Last month there was a bigger underspend because of the prescribing but this has now been amended and the underspend transferred to reserves to cover the spending plan. • CHFT position was discussed. There is a small underspend of £28k overall. There are also a number of other small over and underspends. JL explained progress against he spending plan to date. There is only Locala and SWYFT to finalise plans then all of the £3 million will have been committed. Winter pressures has been addressed via the £50k allocated to Comms after discussion informed us that a plan was already in place for winter communications and this money would need to be used for this aspect. JL went on to explain the update on the risk and liability relating to the outstanding continuing care restitution claims. This could potentially move forward with us post April and we need to be mindful of that.

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VD explained the number of claims so far and what may still arise. VD confirmed that the continuing care allocation will now sit within GHCCG’s remit. VD added that our CCG is in a much better position relating to projection and provision than some other areas. VD informed the group that she would be presenting a paper to both SMT and CCE early in the New Year regarding next steps. JL informed the group that the CCG allocations for 2013/14 have now been received and these will be discussed in more detail at the next meeting. JL added that the programme and the running costs have been split into 2 separate allocations. We are a £274 million organisation in total. JL highlighted that there are some areas that are a huge risk including SCG allocation. The group RECEIVED and NOTED the content of the finance report and thanked JL. FP/12/38

QIPP Update VD gave a brief update on QIPP. VD explained that a high level summary has been provided within the finance report this month. There is no real change as we are moving towards year end. There has been progress on the work for next year. A case of need template has been developed and shared. VD and NA are tracking these back to a spreadsheet to enable us to keep a record of them. Some are already being worked up into full business cases but others will need for work first. A meeting has been scheduled for early January to review progress. VD explained that discussions have taken place with SWYFT about their involvement in some areas. VD informed the group that this is a cultural shift and some people are learning to identify QIPP savings. A programme, will which be on a rolling basis, is being developed for post April to allow for tracking. TG questioned if we had any indication on how close we are to achieving the £4.5 million savings this year. VD responded to say that this should be clearer in early January and she would provide an update after that. The group RECEIVED and NOTED the verbal update provided and thanked VD.

FP/12/39

Contracting Report YH provided an overview of the CHFT contract and the other main contracts. The contracts positions are as follows; • CHFT – undertrading by £15k at month 7 of which;

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Page 4 of 8

o Elective undertrade of £895k o Non-elective overtrade of £502k MYHT are currently overtrading by £3.3 million which is a worsening trade position from last month. The main reason for this is due to daycase and non-elective activity. YH highlighted the key points relating to the other contracts; • • • • • •

Leeds are undertrading by £722k overall Bradford are overtrading by £189k Barnsley are overtrading by £60k Sheffield are undertrading by £49k Spire are undertrading by £143k BMI are undertrading by £189k

JL highlighted that all contracts relating to GHCCG are mainly in balance. YH explained that the activity relating to contracts such as Spire/BMI etc could possibly be down to North Kirklees using Choose & Book more than GHCCG. YH highlighted key points from the non-acute providers. • YAS – Q2 information only on activity. Performance up to October on R1 and R2 is showing they have achieved the target this month. • 18 weeks – CHFT have achieved targets on admitted, nonadmitted and incomplete pathways. There has recently been a validation exercise carried out on incomplete pathways and further details will be included in next month’s report. • 2 patients still logged as over 52 week waits – this is due to patient choice. DA asked if exception reporting can be noted for this. JL advised that the only way for this to happen is to minute that the issue has been discussed at the Finance & Performance Group and we are aware it is by patient choice. The group RECEIVED and NOTED the contents of the contracting report and thanked YH. FP/12/40

Performance Report NA attended and provided an overview of the report.

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Key points to note are; • Ambulance response times for October are slightly under. There is no change as to why the thresholds are low. This has also pulled down the Kirklees picture very slightly. • Cancer waiting times – NA highlighted the risks/concerns of the breaches. These are small numbers so if one breaches then we are likely to fail the target overall. NA advised hat there is new cancer lead for the Cluster now in place and we are awaiting a response from them on the breaches. TG asked for some background information relating to a patient refereed on day 93 of a 62 day pathway. NA explained that this was due to the transfers between 2 sites i.e. MYHT and Leeds. Discussions took place about if or how the data can be changed retrospectively should the information change. • PHQ15 and PHQ16 – no change to report as October information not received yet. • 18 weeks is currently achieving. • A&E – Q3 achieving 95.01%. NA highlighted that a discussion took place at CMB on 18 December about the current picture of A&E performance at CHFT. • MRSA – 1 case reported but this has been allocated to North Kirklees. GH YTD has 5 cases but none reported in November. • CDiff – 6 cases, 3 to each CCG but none reported in November for CHFT. Action: NA to provide detailed paper on next year’s plans for performance reporting for next month. TG asked which QIPP plans have failed causing the performance to drop. NA explained that there are number of reasons why these have failed. NA/VD have been reviewing how we can change these for next year to make sure they are more robust. NA advised we are also working on improving outcomes for 2 particular areas with the YHPHO. DA highlighted that CHFT have suggested they may change the waiting times on some specialities in the future. JL advised that this won’t happen without further discussion. The group RECEIVED and NOTED the contents of the performance report and thanked NA.

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FP/12/41

Business Planning Update VD provided a brief update on the business planning cycle that is currently being developed. There have been a series of dates agreed throughout January where we will bring back Cases of Need/Business Cases for review and approval. The first set of these will be available for discussion at the OD session on Wednesday 30 January. NH asked if we know what we want to achieve strategically, are there any gaps and how do we fill them. VD confirmed that all areas have been pulled together onto a master spreadsheet to be able to manage appropriately. There is also a full prioritisation matrix being developed to allow us to map out any gaps. CM informed the group that she had attended a workshop recently with SO/JL about Planning Guidance which had highlighted some new proposed ways of working. There was a document readily available entitled Everyone Counts – Planning for Patients 2013/14 which is useful information. It was AGREED that KC would circulate the link to the document. This would be relevant to the OD Session on 30 January too. There was further debate regarding the potential challenges and changes to ways of working. Action: KC to circulate link to Everyone Counts – Planning for Patients 2013/14. The group RECEIVED and NOTED the verbal update provided and thanked VD.

FP/12/42

Running Costs/Structures JL explained the paper that was shared with the group. GHCCG has £5.9 million for running costs. There is a risk that if there is a pay award next year, GHCCG will have to absorb the cost of approximately 1% from our contingency. JL explained that Kirstie Gallant in Finance will start working with our Heads of Service to look at staffing, non-pay etc to ensure we have everything mapped out. We will also need some contingency to be put in place. JL highlighted that the CSU are our highest costs. Discussions took place about Governing Body member payments and JL confirmed that a paper is being written and will be presented at a future meeting. The group RECEIVED and NOTED the information and thanked JL.

FP/12/43

NHS Outcomes Framework and Mandate CM informed the group that these documents have been received previously and were included on the agenda again to ensure everyone was aware of them. CM added that both the documents were discussed at the recent Planning Guidance workshop and will be discussed at various meetings in detail over the coming months, in particular at the OD Session at the end of January. The group RECEIVED and NOTED the information and thanked CM.

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FP/12/44

Finance & Performance Draft Workplan It was AGREED to add in performance reporting for next month. Action: KC to add Performance Reporting to next month.

FP/12/45

Any other business No other business was raised.

FP/12/46

Date and Time of next meeting The next meeting is scheduled for Wednesday 16th January 2013, 2.00 â&#x20AC;&#x201C; 5.00, Board Room, Broad Lea House. This concluded the content of the Finance & Performance Subgroup meeting and the Chair declared the meeting closed at approximately 5.00pm.

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Minutes of the Quality & Safety Sub Group Meeting Wednesday 19 December 2012, 1.30pm-3.00pm Lonsbrough Room, Broad Lea House, Huddersfield Present: Judith Parker (Chair) Penny Woodhead Christina Fairhead Jan Giles Eric Power Sue Ross Moira Wilson

GP, GHCCG Head of Quality and Safety, GHCCG Designated Nurse for Safeguarding Children Head of Practice Support and Development GHCCG Senior Medicines Management Advisor Lead Nurse Infection Control Lay Member for CCG Board

In attendance: Sam Royal Quality Improvement Co-ordinator (minute taker) Victor Thompson Head of Patient Safety and Risk – items QS/12/122 & QS/12/123 Sarah Mackenzie-Cooper Equality and Diversity Manager – item QS/12/127 QS/12/116

Apologies for absence Apologies were received from Jane Ford, Jane O’Donnell and Karen Dean.

QS/12/117

Minutes of the last meeting The minutes were accepted as a true record.

QS/12/118

Matters Arising

QS/12/38 ACTION:

National Audit of Psychological Therapies for SWYPFT Penny Woodhead to update the Q&S Sub Group on assurances regarding actions taken to implement improvements once discussed at the next SWYPFT Clinical Quality Board meeting.

QS/12/40 ACTION:

Learning from Patient Experience Penny Woodhead to present the Patient Experience Audit Action Plan once this has been refreshed. To be brought to the meeting in February 2013.

QS/12/76 ACTION:

30 day readmission audit 1. Jan Giles to take the lessons learnt from the audit to the Practice Support and Development Group for discussion. This has been done and actions will be taken through the strategy.

ACTION:

2. Penny Woodhead has requested an update following receipt of a response from CHFT regarding the significant event of a missed fractured neck of femur. Not yet received.

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QS/12/94

Patient and Public Engagement/Patient Experience Meetings have been arranged between Penny, Dasa Farmer, Moira Wilson and Gill Bell. An update will be provided at the January meeting.

QS/12/112

CQC QRPs Sam has requested a copy of the CHFT 2010 Audit report for Falls and Bone Health in Older People, yet to be received.

QS/12/114

CQUINS 2013-14 Development Penny advised that the first meeting with CHFT had taken place and comments received. Coming to see your Doctor – PLEASE poster Posters are currently being produced and will be presented at the next PPT event if available in time.

QS/12/119

Quality and Safety Report Penny Woodhead presented the report and highlighted the following information: EMSA – no breaches for October 2012. VTE – no update of information, as this is received quarterly. Penny advised that planning guidance had been received and the national CQuIN target would be 95%. CQC activity – two recent inspections were noted: BMI The Huddersfield Hospital - one “moderate impact” action relating to Outcome 4 – Care and welfare of people who use services – and Penny advised that a letter had been sent to gain assurances of actions being taken to address this. Calderdale Royal Hospital – one “moderate impact” action relating to Outcome 21 – Records – which centred around two separate incidents. The first incident was around one patient’s records being found in a different patient’s care records. The second incident related to an incomplete DNAR form which had not been reviewed by a doctor upon admission. Penny advised that this had been discussed at the Clinical Quality Board meeting and work was already being undertaken to make improvements. An action plan has also been submitted to CQC. It was noted at the Board meeting that the report also contained lots of positive outcomes. NPSA – CHFT have one alert open past the closure date. There is no product on the market that they can use and they have added this alert as a risk on their corporate risk register. There are no open alerts for SWYPFT or YAS. The Group received and noted the information. Page 2 of 9

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QS/12/120

CQC/Ofsted Safeguarding Children Action Plan update and Safeguarding Children Quarterly update report Christina provided a quarterly update on the Safeguarding Children agenda, highlighting the following: • •

• • •

A safeguarding newsletter and safeguarding children contact information leaflet have been produced for both Calderdale and Kirklees. The safeguarding children pack for GPs has been updated and will be sent out electronically to all GP practices, as well as being uploaded onto the CCG website. Judith asked if the GP pack could be presented at a future PPT event. Safeguarding training sessions for Independent Contractors are fully booked. Any new enquiries regarding training are being directed to elearning in the meantime. The Sudden Unexpected Death in Childhood (SUDIC) process was being reviewed and a report would be produced. The final Ofsted report regarding the Local Authority visit in Kirklees in August 2012 would be published in January 2013. Informal feedback has been received and there is a possibility of the services in Kirklees being highlighted as good practice.

ACTION:

Future PPT dates and timeslots to be given to Christina in order to present the GP safeguarding pack.

ACTION:

The SUDIC review report to be brought to the January meeting for discussion and decision. The CQC/Ofsted Action Plan was received and Christina advised that all previously open actions had now been completed. As the action plan was for across Kirklees, Christina was asked to check with North Kirklees CCG that it was in agreement with the action plan status. Following discussion, the action plan was formally received and closed. CQC would be notified in due course, once feedback had been received from North Kirklees CCG.

QS/12/121

Infection Control Report Sue Ross presented an update on the HCAI agenda and highlighted the following information: MRSA – as agreed the last meeting, the figures for Kirklees were now split into Greater Huddersfield and North Kirklees. For Kirklees, 11 cases had been

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reported, 5 of which were Huddersfield residents. Of these 5, 3 were post 48 hour cases and 2 were pre 48 hour cases. Patient held alert cards had now been launched and positive feedback received. Work continued around the alert “flagging” on clinical systems for patients with MRSA infection/colonisation and C.Diff. CHFT – no new reported MRSA cases for October or November 2012, therefore under target. Still issues around contaminants and further work required. C.Diff – NHS Kirklees is over the planned trajectory to date, with 77 cases reported for April – October 2012, against a trajectory of 104 cases. 35 of the cases reported related to Huddersfield residents. Weekly data continues to be reviewed and submitted to the NHS North of England HCAI lead with monthly mapping of all cases to identify trends. CHFT – 3 C.Diff post cases 72 hour, bringing the cumulative total to 22, against a target of 33. MSSA – 6 new cases for Kirklees, bringing the total to 37. 1 new case for CHFT, bringing the total to 6. E Coli – 8 new cases for Kirklees, bringing the total to 164. 1 new case for CHFT, bringing the total to 17. Sue advised that intelligence was shared with both the Local Authority and the CQC when required, and all organisations worked together on the HCAI agenda. Penny advised that the name of the new local Compliance Manager for CQC had now been obtained and a meeting would be arranged to meet with the Heads of Quality to discuss future working. Information was shared regarding the update of flu vaccines and the Group was informed that the update for GPs was 44.1%. Sue advised that emails had been sent to all GP practices, giving information around targets and what actions were required. Jan raised a concern regarding an incident involving a patient in intermediate care who had been given the flu vaccine whilst in the home and subsequently the GP practice. The Group discussed how this could be avoided in the future and Judith advised that GP practices need to be informed immediately if a flu vaccine has already been administered. Penny agreed to discuss with Jane O’Donnell. ACTION:

Penny to discuss flu vaccine incident with Jane O’Donnell. Penny advised that the recently published planning guidance was vague around the HCAI agenda. HCAI would be a quality premium for CCGs therefore an understanding was needed as soon as possible. Page 4 of 9

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The Group received and noted the report. QS/12/122

Serious Incidents (SIs) Report Victor Thompson presented a summary of all open SIs as of 30th November 2012. There had been a slight increase from a total of 33 in September to 35 in November. Following the Risk Management Overview Group (RMOG) meeting, 18 had been closed. SWYPFT – RMOG had raised concerns that the same common themes were reappearing, therefore a meeting had taken place with senior managers at SWYPFT to discuss. SWYPFT advised that there had been a delay in appointing to new posts and gave assurances that issues would be resolved. Penny informed the Group that a high level summary had been discussed at the Quality Board meeting, and discussions around capacity had taken place. SWYPFT have now appointed to the Director of Nursing and Governance, which will hopefully provide stability and support. CHFT – following an incident regarding the wrong organ being removed and subsequent incident report, concerns had been raised around the lack of information in the report. This has been discussed with senior managers at the Trust and after receiving further assurances and information, RMOG have therefore agreed to now close. Penny advised that SIs have been discussed at the Quality Board meeting and should the necessary information not be submitted, to let Penny know and this would be raised at the Quality Board meeting. Locala has now begun reporting incidents, with 2 being reported in total, both in relation to Greater Huddersfield residents. The Group received and noted the report.

QS/12/123

Listening and Learning: The Ombudsman review of complaint handling by the NHS in England 2011-12 Victor presented information around the complaints received by the Health Service Ombudsman about the NHS in 2011-12. Key points were highlighted, including: Complaints about GPs – concerns were identified regarding the rise in the number of complaints being referred to them about unfair or hasty removal of patients from GP patient lists. Dr Lee has subsequently written to all GP practices to advise on the process. CCGs will be responsible for dealing with complaints about commissioning decisions and using complaints data from providers to inform future commissioning decisions. Page 5 of 9

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Penny informed the Group that it was unclear which function in the National Commissioning Board would be dealing with complaints in the future. Dealing with local complaints for CCGs was within the SLA for the CSU. As appointments have not yet been made for this function, contact would be made once the post(s) had been filled. The Group received and noted the report. QS/12/124

NHS Outcomes Framework 2013-14 and NHS Mandate The Group received an update regarding the changes to Domain 4 in the NHS Outcomes Framework â&#x20AC;&#x201C; Ensuring that people have a positive experience of care. One of the main changes to this domain was the introduction of the Friends and Family Test. Penny advised that this would be performance managed and an update around this would be presented at the January meeting. The Friends and Family Test would also become a national CQuIN indicator for 2013-14. It was also noted that the first Mandate between the Government and the NHS Commissioning Board setting out the ambitions for the health service for the next 2 years has now been published. The Group received and noted the report.

QS/12 /125

Care Quality Commission (CQC) Quality Risk Profiles (QRPs) The QRPs for December 2012 were received and noted for CHFT, SWYPFT and YAS. It was noted that information from the recent CQC A&E Survey was now appearing on the profiles and the Group was advised that a report regarding the survey would be presented at the January meeting. A discussion regarding future reports took place and it was agreed that following scrutiny of the QRPs by the Quality Improvement Team, only items of concern would need to be presented to the Group in future.

QS/12/126

Quality Handover Document The latest draft version of the NHS Kirklees Quality Handover Document was received and noted. The Cluster Board will be expecting to receive the final version at the end of January 2013, with final submission to the area team in March 2013. The Group was reminded that the document contained confidential information and that a formal handover of all information to the new organisations, including quality, would need to take place in March/April 2013. Judith asked if the graphs around infection control could be replicated for local trusts, Sue Ross agreed to look into.

ACTION:

Sue Ross to look into producing graphs of infection control for local trusts. Page 6 of 9

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Following discussion, it was agreed that the handling of Coroners Reports should be discussed at Clinical Quality Board meetings to seek formal assurance of how these would be handled. Eric raised a query around receiving letters from councillors regarding medicines and care homes and how this would be handled in the future. Moira also asked for confirmation that a regular report on safeguarding adults would be received at this meeting. Penny advised that recruitment to the Safeguarding Adults post was required as soon as possible. Once this had taken place, discussions could be held regarding this issue. QS/12/127

Equality and Diversity Action Plan Update Sarah Mackenzie-Cooper presented a report outlining the progress against the equality and diversity action plan as detailed in the CCG’s Equality and Diversity Strategy 2012-15. The report also outlined the current position in relation to the statutory duties. Sarah advised that the team was currently working to support the transition work and that learning was needed about the priorities for Greater Huddersfield in order to begin to support this. Penny felt this area was a potential risk, as there was lack of clarity from the National Commissioning Board regarding when the CCGs would become statutory responsible for a number of functions, including Equality and Diversity. The Group agreed that work was needed to ensure that it was set up accordingly. Penny agreed to work with Sarah to ensure the necessary processes were in place and would report back at a future meeting.

ACTION:

Penny to work with Sarah around the Equality and Diversity set up for Greater Huddersfield CCG.

QS/12/128

Minutes to receive The following minutes were received for information: • Kirklees Infection Control Committee 5.9.12 • Kirklees Safeguarding Children’s Board 25.9.12 • Locala Quality Board 9.11.12 • GHCCG Practice Support and Development 6.11.12 Penny advised that this would be the last time the Group received minutes from the Safeguarding Children’s Board, as these would now be received as part of the private section of the CCE meetings.

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Penny informed the Group that as from 2013, she would be the governing body manager lead on the Safeguarding Childrenâ&#x20AC;&#x2122;s Board and Jane Ford would be the clinical lead.

Penny also informed the Group that a request had been made for the process for developing Locala CQuINS for 2013/14 to be circulated in order to be able to comment. QS/12/129

Work Plan The current work plan was received for information.

QS/12/130

Any Other Business Christina circulated a copy of the Yorkshire Childrenâ&#x20AC;&#x2122;s Centre Domestic Violence Perpetrator Programme information leaflet. Christina had met with the Domestic Violence Project who were looking to obtain funding for their project. Penny agreed to send Christina a template to complete to apply for funding, as budgets for next year were currently being looked at.

ACTION:

Penny to email Christina a template for funding application.

QS/12/131

Date and time of next meeting Wednesday 16 January 2013 at 12.30pm, Lonsbrough Room, BLH. Judith gave her apologies and advised that either Jane Ford or Karen Dean would be asked to Chair.

Page 8 of 9 Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 123 of 124

QUALITY & SAFETY SUB GROUP ACTION SHEET FROM MEETING HELD ON 19 DECEMBER 2012 Agenda item Action

By When

QS/12/38

20 February 2013

Responsible for action Penny Woodhead

20 February 2013

Penny Woodhead

16 January 2013

Penny Woodhead

Completed – update at January 2013 meeting 20 February 2013

Moira Wilson/ Penny Woodhead/ Dasa Farmer Rob Lees

Requested – awaiting response

Sam Royal

16 January 2013

Jan Giles

16 January 2013 – Now 20 Feb 2013

Christina Fairhead

Completed Response emailed

Penny Woodhead

16 January 2013

Sue Ross

16 January 2013

Penny Woodhead

Completed

Penny Woodhead

QS/12/40 QS/12/76

QS/12/94

QS/12/107

QS/12/112

QS/12/120

QS/12/121 QS/12/126 QS/12/127 QS12/130

National Audit of Psychological Therapies for SWYPFT Penny Woodhead to update the Q&S Sub Group Group on assurances regarding actions taken to implement improvements once discussed at the next SWYPFT Quality Board meeting Learning from patient experience Penny Woodhead to present the Patient Experience Audit Action Plan once this has been refreshed. 30 day readmission audit Penny Woodhead to provide an update following receipt of a response from CHFT regarding the significant event of a missed fractured neck of femur. Patient & Public Engagement/Patient Experience Penny Woodhead/Moira Wilson/Dasa Farmer to meet to discuss PPE Operational Group Terms of Reference and membership Stroke Peer Review & Stroke Performance Rob Lees to provide a further update regarding the Stroke Peer Review at the January meeting and provide updated stroke performance report with comparisons across the region. CQC QRPs Sam Royal to request a copy of CHFT 2010 Audit report for Falls & Bone Health in older people and add on the agenda for the next meeting. Safeguarding Children’s Pack for GPs 1. Christina to be given dates/times for PPT sessions in order to present the GP Safeguarding Pack 2. SUDIC review report to be presented at the next meeting HCAI report – Flu Vaccine Penny to discuss intermediate care incident regarding patient being immunised twice in error with Jane O’Donnell Quality Handover Document Sue Ross to look into producing graphs of infection control for local trusts Equality and Diversity Action Plan Update Penny to work with Sarah Mackenzie-Cooper around the Equality and Diversity set up for Greater Huddersfield CCG Funding request template Penny to send funding request template to Christina Fairhead

Page 9 of 9 Greater Huddersfield Shadow Governing Body Public Meeting Papers Wednesday 6 February 2013 Page 124 of 124