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Agenda Item: 02 Enclosure: CEC/10/95


Minutes of the Clinical Executive Committee Meeting Wednesday 11 August 2010 4.00 pm – 5.00 pm Northorpe Hall, Mirfield Present: David Anderson Carl Chapman Sheila Dilks Anuj Handa Judith Hooper Bert Jindal Bryan Machin Sally McIvor Dr Ajit Mehrotra Mike Potts Karen Worrall

In attendance Adele Mackin


CEC Chair MSK Practitioner Executive Director of Patient Care & Professions Clinical Lead, Respiratory Executive Director of Public Health Chairman, HCC Executive Director of Finance Head of Adult Social Care Operations, CEC Member GP Chief Executive Head of localities, Children & Young People’s Services, Local Authority

Personal Assistant

Apologies Apologies were received from Dr Anil Aggarwal, Liz Clough and Carol McKenna.


Accuracy of Minutes held 14 July 2010 The minutes held 14 July 2010 were agreed to be a true and accurate record.


Matters Arising In an earlier meeting David Anderson mentioned he would put clinicians into consultation documents and asked members if there were anyone who would like to run with this. Provider: Sheila Dilks needs interested partner – Dr Handa Commissioner: Anil Aggarwal Democratric – Ajit Mehrotra Outcomes – Bert Jindal / Judith Hooper 1 of 6

Agenda Item: 02 Enclosure: CEC/10/95 Mike Potts will confirm who the Director and Non Executive buddy are. David required somebody else to follow up on hip pathway from the PBC side. Bert Jindal recommended Dr J Schembri or Dr J Parker. David AGREED to approach Dr Schembri. David highlighted the clinician meeting to be held on 23 September between Huddersfield clinicians and CHFT. Dr Handa confirmed that this was in his diary. David confirmed that cross members on Planned Care invitation included himself and Dr Handa. David raised the proposal of a clinical effectiveness group that Judy Moorhouse was organizing using the original pathway meeting membership. The group was to be reconvened to discuss limited clinical effectiveness. It is to agree between primary and secondary care, which conditions should be on it. The group will report back to Clinical Executive Committee. Bert Jindal raised the key point made at Commissioning College today was about guidelines. David Anderson confirmed that Sue Richardson was pulling this group together. ACTION: • David Anderson to speak to Dr Schembri regarding Hip Pathway.


Declarations of Interest No declarations of interest were received.


BCG PGD The meeting agreed to approve this proposal.


Urgent Care update (verbal) Mike Potts advised that Mark Napper was on long term sick leave, therefore an alternative chairman was being sought. There were no key issues to be raised here today. Dr Jindal expressed concern about appropriate staffing levels following his recent meeting with the chief executive officer of Local Care Direct (LCD). Mike advised that he was unaware of any major gaps in terms of staffing for primary care centre. Dr Mehrotra advised that LCD had given full details of staffing but had not been clear about how urgent calls were filtered when staffing was low. It was agreed that staffing levels should not be problematic and that this should be a stable service. There would be opportunity to give twelve months notice on contracts on 1 April 2011 if we required any changes to the service. 2 of 6

Agenda Item: 02 Enclosure: CEC/10/95


Transforming Community Services update KCHS Right to Request to set up a Social Enterprise to provide community healthcare services in Kirklees for Clinical Executive to advise the Board David Anderson asked if the Clinical Executive Committee supported KCHS’s right to request. The meeting felt good vision statements had been made but with no specific focus, which was the nature of a right to request statement. Sheila confirmed that details would be expected should the request progress to the next stage. There was some confusion around who would commission which service and it was felt that, at the business case stage, there would need to be serious discussions about services. Mike Potts suggested KCHS would want their business to thrive and move forward; therefore GP commissioners would have leverage to drive issues as they wished. It would be important to remember GPs held the money and KCHS would want to work well with them to ensure continued business at the end of their initial period. Sheila felt the biggest challenge would be having a community service provider that could take beds out of the acute trust. Dr Jindal felt that, in terms of this application, details were not necessary but that strategic issues and community staff stability in the system were most important for progress. He felt KCHS documents had shown good infrastructure and team approach and felt positive about working influentially with a familiar organisation. He recommended the agreement. The meeting discussed the importance of good communication with staff and considered how changes to pension schemes and delays in decision making could potentially create dissatisfaction amongst staff. Mike Potts advised that all effort would be made to emphasise to staff that they were not being automatically transferred. Sheila considered the risk that community services could be moved twice if the KCHS request was not granted. If the social enterprise did fail in December, the fallback position would have to be to ask one of our other providers to host the service from April 2011. Sheila advised that any member of the Clinical Executive Committee was welcome to email Jim Barwick or herself with queries about this. The meeting agreed to make a recommendation to the Board to support this request.

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Agenda Item: 02 Enclosure: CEC/10/95 CC/10/87

Update on White Paper The meeting had no further comments on this subject following the preceding Commissioning College meeting.


Vascular Services Review Sheila Dilks asked that the CEC note the work Alison Bragg and the clinical leads had done. She felt it was important to recognise their efforts and achievements. The meeting discussed the risk of transferring patients and the importance of back-up on-call support. The vascular service society was very much in favour of centralisation but the meeting observed that Kirklees’ experience of centralisation had not been positive. There was concern that there would not be enough intermediate staff to cope with a centralised service. Mike Potts confirmed what would form back-up on-call. There would be one of the eight vascular surgeons. The meeting agreed the need to monitor the service for a period of time to ensure it would be safe. It was understood that this marked the start of a number of other centralisation issues. Work was ongoing from the leader of the healthcare group, having staff work as a team across a number of hospitals that shared functions. This was because not all hospital would be able to do everything as they became more specialised. Sheila observed that this made it even more important to get community services right. Mike explained that centralising services did not equate to double charges. Bryan asked that Dr Handa forward any concerns of double charging to him as this should not be happening. The meeting agreed that double charging was not acceptable and should always be challenged. Sheila confirmed that her team, Bryan’s finance team, and the contracting team always sought to eradicate double charging. The meeting agreed it would support this application and make its recommendation to the Board. David Anderson advised of a clinicians meeting with KCHS in September and asked if there was anything he should take for clinical discussion. It was agreed that contracting issues should be raised with the contracting team before being taken elsewhere. It was agreed that looking at oscopies and charges at Calderdale that Huddersfield was receiving was also a contracting issue. Sheila agreed to forward to David Anderson and Bert Jindal data showing very early operating for varicose veins and hernias, as this may be something to consider in the future. Action: • AH: Forward examples of double charging to Bryan Machin. • SD: Forward early operating data for varicose veins and hernias to David Anderson and Bert Jindal.

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Agenda Item: 02 Enclosure: CEC/10/95 CC/10/89

Good practice in research and Consent to Research The meeting received and noted the letter from Sue Smith for information.


Primary Care Commissioning Group minutes held 11 June 2010 The meeting received and noted the minutes for information.


NHS Kirklees/ MYHT Kirklees GP Liaison minutes held 20 May 2010 In response to Dr Mehrotra’s concern that PCT input had been missing at a recent meeting, David Anderson advised that he had spoken with Carol McKenna and she had scheduled the next meeting in her diary. Mike Potts suggested the meeting should be essentially a clinical debate and that PCT representation should not be essential. It was agreed that, although not essential, it would be useful to continue with close working between GPs and the PCT and that a PCT management representative would be useful. It was agreed that David would ask Carol McKenna to nominate somebody to attend the GP liaison meetings on a regular basis. Action: • DA: Ask Carol McKenna to nominate a KPCT representative to regularly attend the GP liaison meetings.


Any Other Business Bryan advised that Carol had spoken about prioritisation at the previous CEC meeting. High level prioritisation framework had been developed in Bradford and was now being considered in Kirklees. He asked the meeting how they thought prioritisation of the eleven programme areas should be dealt with in terms of investment/ disinvestment. Bryan and Carol had felt CEC would be the appropriate place to begin addressing this work. He provided an outline explanation to the process of this framework. His proposal was to use 30 to 45 minutes of the next CEC meeting to pilot the methodology. The meeting agreed to use 30 to 45 minutes of the next CEC meeting as requested by Bryan.


Date and Time of Next Meeting Judith felt it was inappropriate to include Choosing Health in Kirklees on the next Commissioning College agenda. It was agreed that the next meeting of the NHS Kirklees Clinical Executive Committee would take place between 4pm and 5pm on Wednesday 15 September 2010 at Northorpe Hall, Mirfield.

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Agenda Item: 02 Enclosure: CEC/10/95

Mike has asked me to contact you as the executive leads for the consultation groups, to ask if you could please take the lead in setting up meetings to bring your group (director/NED/PBC) together to understand how you are going to do your consultation and feedback by the end of September. Commissioning for Patients – Carol/ Valerie/Anil Aggarwal Local Democratic Legitimacy in Health – Mike/Helena/Judith/Imran/Ajit Mehrotra Regulating Healthcare Providers – Sheila/Tony/Anuj Handa Transparency in Outcomes – A framework for the NHS – Judith/Peter/Rob Millington/Bert Jindal Report of the arm’s length bodies – Sue/Mehboob

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