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Calderdale, Kirklees and Wakefield District Cluster Partnership

Minutes of the Cluster Partnership Meeting held on Tuesday 7 June 2011 at 9.30am in the Bankfield Room, Dean Clough, Calderdale

Present: Angela Monaghan Mike Potts Roger Grasby Sandra Cheseldine Rob Napier Rob Millington Keith Wright Andy Leary Sue Cannon Ann Ballarini

Julie Lawreniuk Gill Galdins

Chair Chief Executive Chair, NHS Wakefield District Non-executive Director, NHS Wakefield Chair, NHS Kirklees Non-executive Director, NHS Kirklees Non-executive Director, NHS Calderdale Executive Director of Finance and Efficiency Executive Director of Quality and Governance (Nursing) Executive Director of Commissioning and Service Development Executive Medical Director Executive Director of Human Resources and Organisational Development Chief Operating Officer, NHS Calderdale Chief Operating Officer, NHS Wakefield District

In attendance: Steve Brennan Natalie Ackroyd Pauline Kershaw Alison Fearnley

Deputy Director of Finance, NHS Kirklees Business Reporting and Planning Manager, NHS Kirklees Executive Assistant, NHS Kirklees Corporate Governance Administrator, NHS Kirklees

Matt Walsh Sue Ellis


Apologies for Absence Apologies for absence were received from Mehboob Khan, Non Executive Director, NHS Kirklees, Peter Flynn, Executive Director of Performance and Commissioning Intelligence and Carol McKenna, Chief Operating Officer, NHS Kirklees.


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


Chair’s Comments The Chair welcomed all those in attendance to the inaugural meeting of the Calderdale, Kirklees and Wakefield District Cluster Partnership. She summarised the principles for effective working as a Cluster which were agreed at the initial development workshop held on 17 May 2011 and then gave a brief presentation which covered the following topics: Page 1 of 10

CKW Cluster Partnership Establishment Agreement Y&H Cluster Accountability Framework Cluster Partnership – Responsibilities Framework Discussion took place around possible future models of working across the Partnership. It was recognised that the Cluster Partnership was still operating against a backcloth of uncertainty and that it is expected that further clarity will be available following the meeting in London of the Chief Executives on 12 July 2011. It was recognised that the Cluster Partnership would be kept informed of any changes. Finally it was noted that the Chair would circulate a copy of Karen Gallagher‟s report from the development workshop held in May. CKWCP/11/04

Chief Executive’s Report The Chief Executive presented his report to the Cluster Partnership highlighting the following. Cluster Executive Team He confirmed the final appointments of the Cluster Executive Team confirming that Dr Matt Walsh had been appointed as the Executive Medical Director and would continue to provide senior management support to the Calderdale Commissioning Consortium. Julie Lawreniuk had been appointed to take up the role of Chief Operating Officer in Calderdale and would continue to provide senior finance support to the consortium. Progress on 2010/11 Accounting Statements He reported that positive progress had been made across the patch on the audit of the 2010/11 annual accounts. NHS Listening Exercise It was noted that the opportunity to comment on the Government‟s Listening Exercise, came to an end on 31 May 2011. A response had been co-ordinated across Calderdale, Kirklees and Wakefield which had been shared with the Cluster Partnership for information. It is expected that there will be announcements on the impact of this towards the end of the month.

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Department of Health Transition in Yorkshire and the Humber It was noted that the assurance process took place on 13 May 2011. Initial verbal feedback indicated that the DH team were very positive regarding the development of CKW Cluster Partnership. Safe and Sustainable – Review of Paediatric Congenital Cardiac Services It was noted that the review continued to remain high profile and that a final decision on the future configuration of these services would be taken in November 2011. Cancer Networks It was noted that the Department of Health has committed to funding Cancer Networks in 2012/13. Government Policy on Adult Safeguarding It was noted that the Government had set out its policy for safeguarding vulnerable adults. At its core are six key principles that were developed across Government with health, social care and criminal justice sectors. Yorkshire and the Humber Postgraduate Deanery It was noted that Chris Welsh had been appointed as Interim Postgraduate Dean. Prime Minister’s pledges It was noted that David Cameron had made five pledges on the future of the NHS: :

- keep waiting lists low - maintain spending - not to privatise the NHS - to keep care integrated - to remain committed to the “national” part of the health service. English Defence League protest march It was reported that a demonstration was due to take place in Dewsbury on Saturday 11June led by the English Defence League. It was noted that the SHA had instigated a Gold and Silver Command in terms of Emergency Planning. The Cluster Partnership RECEIVED and NOTED the Chief Executive‟s Report. This was followed by a brief presentation from each of the Chief Operating Officers (Steve Brennan presented on behalf of Carol McKenna) on the Single Integrated Plans for each organisation. Page 3 of 10

It was noted that the SIPs provided a broader overview of the issues and risks for each organisation and what mitigating actions are being put in place. The QIPP challenges included: NHS Calderdale £6m NHS Kirklees £13m NHS Wakefield £11m It was recognised that there was a lot of commonality between the plans and that collaborative working was essential. It was agreed that further clarity was needed around the QIPP schemes. It was recognised that a co-ordinated approach to QIPP would be included in future Finance reports. CKWCP/11/05

Quality and Safety Report Sue Cannon presented the CKW Cluster Partnership Quality and Safety report. She explained that the report described the key quality and safety issues across the three organisations and highlights the key actions and arrangements for performance managing the quality and safety agenda. The main areas of concern highlighted included: Elimination of Mixed Sex Accommodation breaches HealthCare Associated Infection Serious Incident (SIs), including Maternity SIs and Never event Fractured Neck of Femur: Surgery within 48 hours – NHS Wakefield District In addition to this report, Sue circulated a briefing note regarding a Serious Case review update at NHS Wakefield District. This was RECEIVED and NOTED by the Cluster Partnership. It was emphasised that quality and safety should not be compromised in terms of any QIPP initiatives. A discussion ensued regarding the accountability and governance arrangements in terms of the Cluster Partnership‟s responsibility for overseeing this work. The Chair referred to the Accountability Framework. It was recognised that the Cluster Partnership has overall responsibility for the delivery of this work and if it is not satisfied sufficient action has been taken by individual PCTs then an alternative approach would be taken by the Cluster to improve performance.

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Sue Cannon provided further clarity and assurance regarding the performance management arrangements already in place across the Cluster. It was acknowledged that the role and function of the Cluster Partnership was to test each other and learn from each other‟s ways of working in order to transfer areas of good practice between PCTs. It was therefore suggested that future reports should highlight the individual areas of concern for each PCT and what corrective action is in place to address these. The Cluster Partnership RECEIVED and NOTED the Quality and Patient Safety report and AGREED: A standard way of reporting a key set of quality and safety metrics in the form of a dashboard Develop a standard way to report variation A quality and safety work programme and undertake a „deep dive‟ on priority quality and safety issues throughout the year (as outlined above). CKWCP/11/06

Finance Report Andy Leary presented the Finance Report. He explained that the report summarised the month one financial position for NHS Calderdale, NHS Kirklees and NHS Wakefield District. It was recognised that all PCTs were showing a level of consistency with their financial plans at present. However there were significant risks to note in achieving a breakeven position after control total targets agreed with the SHA. It was recognised that a monthly report would be considered by the respective PCT Finance and Performance Committees and PCT Boards (when they meet) but a reporting mechanism needed to be established for the Cluster. It was noted that future reports intend to highlight the key financial performance of the three PCTs in summary form. Andy explained the proposed format highlighting the approach to consolidated reporting. Following discussion it was AGREED that expenditure for each PCT would be reported separately but a consolidated position would be reported via an attached appendix in order to recognise the three PCTs as separate bodies. In addition it was AGREED that future reports should include QIPP reporting. The Cluster Partnership RECEIVED and NOTED the financial position and the risks identified.

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Performance Report Natalie Ackroyd joined the meeting to present the Performance Report to the Cluster Partnership. She explained that the report outlined a single approach to Cluster level monthly performance reporting (outlined in Appendix 2) as well as informing the Cluster of the ongoing performance challenges. These included: Accident & Emergency (A&E) Referral to Treatment (RTT) standards Cancer (62 days) It was noted that all of the above are a concern nationally and regionally. The suggested reporting format was supported by the group as it enabled comparisons to be easily made. However it was AGREED this should be further populated to include local priorities that fall outside of the Single Accountability and Assurance Process (SAAP). Mike reported that the Strategic Health Authority (SHA) had asked Mid Yorkshire Hospitals NHS Trust (MYHT) to develop a recovery plan in terms of improving A&E performance. It was highlighted that areas of good practice should be shared across the Cluster in terms of improving performance. Following discussion it was AGREED that MYHT key performance issues should form the basis of a hot topic discussion in the future. The Cluster Partnership AGREED: the proposed approach regarding the development of the Cluster performance reporting subject to additional; reporting on the local priorities that fall outside of the SAAP; to note the concerns on performance on 18 weeks (RTT), A&E and Cancer 62 days waits; to hold a future hot topic discussion on the key performance issues at MYHT.


Governance Report Sue Cannon presented the Governance Report to the Cluster Partnership. She explained that the report describes the Board Assurance Framework and risk management positions of the three cluster PCTs and highlights the critical risks facing the three organisations. Sue provided a comprehensive overview on the suggested approach to how the Cluster Partnership could receive assurance on the long term strategic risks and how these risks are being mitigated and managed appropriately. Page 6 of 10

The group discussed the level of information the Cluster needs to receive and what discipline needed to be exerted. Sue also explained the difference between the Corporate Risk Registers and the Board Assurance Framework. The following was therefore AGREED: to investigate the different reporting methods between the three organisations and whether a cluster assurance framework can be pulled together from the three BAFs to produce a monthly reporting table of the critical risks from each organisation scoring 20 or above, so that the Cluster can instigate additional challenge if necessary. There was uncertainty regarding what the Cluster Partnership had signed up to in terms of the Cluster Accountability Framework. Mike Potts provided clarity around this and how this mapped to the cluster implementation guidance. Following discussion it was suggested that some additional work is undertaken to assign lead executive directors to each area of the Cluster Accountability Framework and to capture how responsibility has been discharged via the report cover sheets, identifying any gaps and how these will be picked up in the work plan. The Cluster Partnership then considered the proposed Scheme of Delegation. It was suggested the language was ambiguous and the document could be better presented. Following discussion it was AGREED that the three PCT Boards should be given the opportunity to comment on the Scheme of Delegation; that the governance leads then incorporate the PCT Boardsâ€&#x; comments to generate a common document which would then be referred to respective Audit Committees for final approval. CKWCP/11/09

Commissioning Development The Cluster Partnership received an update on progress in the following commissioning areas: Commissioning Support Unit GP-led commissioning Health and Well Being Boards It was noted that outputs from the Commissioning Support Business Review stocktake revealed slight variances but there was nothing fundamental to report to the Cluster Partnership. The Cluster Partnership NOTED the key areas for development, the actions that have been identified and the associated timescales. It was suggested that future reporting should line up transition for individual PCTs.

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Provider Development The Cluster Partnership AGREED to RECEIVE the report for information and DEFER discussion around the MYHT issues to the July meeting. However there was a wider debate about what the Cluster Partnership wanted to gain from these discussions. The following was therefore AGREED in terms of the aims of the July discussions: 10 minutes historical background Discussion on key issues namely: CIP; wider health economy issues; FT plan Followed by a brain storming session Mike went on to provide clarity regarding the expectations of the Cluster Partnership in terms of endorsing the FT application for MYHT, given that respective PCTs will only meet three times a year. The Cluster Partnership RECEIVED and NOTED the Minutes from the Mid Yorkshire Health Economy Foundation Trust Programme Board meeting held on 28 March 2011. It was highlighted that the Cluster Partnership would continue to receive these minutes on a regular basis. Finally it was pointed out that future reports around the Provider development agenda needed to capture the key priorities for the Yorkshire Ambulance Service.


Cluster Workforce Position Sue Ellis provided and overview of the Cluster Workforce position highlighting the following: The CKW Cluster PCTs have broadly similar workforces demographically The CKW Cluster PCTs are aligned in their approach to assignment and transition Workforce risks are being proactively managed The HR&OD Shared Service now functions across the Cluster to provide consistent, resilient HR&OD support An HR&OD Business Plan for the Cluster is under development Workforce development and learning will be managed cohesively across the cluster. The Cluster Partnership was then asked to consider whether there should be a consistent approach to workforce reduction to meet running cost targets. It was pointed out that the management costs/running costs target for NHS Calderdale needed amending from ÂŁ0.9m to ÂŁ1.9m. Page 8 of 10

Roger Grasby advised that NHS Wakefield District had taken a slightly different approach to the policy for approving voluntary redundancies and said he did not feel it was necessary for a consistent approach to be determined given the PCTs were still separate bodies. With this in mind, it was AGREED that the context of approach may vary for approving redundancies, but that early action was needed and that all three organisations should begin the process at the same time. Sue Ellis therefore AGREED to take appropriate recommendations on these proposals to the respective Remuneration and Terms of Service Committees. CKWCP/11/12

Resilience Issues Mike provided verbal feedback from the West Yorkshire Sub Regional Commissioning Forum (WYCOM) meeting. He confirmed that WYCOM had agreed a detailed piece of work to look at the commissioning Support Unit approach and resilience issues. It was recognised that the outcome of this work would be presented to the Cluster Partnership. Additionally, it was recognised that „red‟ rated WYCOM issues would be brought to the attention of the Cluster Partnership.


Work Plan – Future Partnership “Thinking Time” Topics A list of suggested “thinking time” topics was circulated to the group for information. The group was asked to consider any additional topics. Following discussion it was AGREED to include the following: MYHT issues – (for discussion at the July meeting) Cluster governance arrangements – (for discussion at the August meeting, following national clarity on this topic). It was AGREED that in the meantime Mike would meet with Keith Wright to provide further clarity. The group was asked to feedback any additional comments on the programme of topics direct to the Chair or Chief Executive following the meeting.


Items for Communication and Escalation Delegate authority to Audit Committees to approve Scheme of Delegation and Reservation Key messages the Cluster Partnership should focus on included: Quality and Safety Transformation agenda High risk areas Page 9 of 10

Think topics on where the Cluster needs to focus as a group Operating model Feedback from Assurance process NHS Listening Exercise CKWCP/11/15

Date and time of next meeting It was noted that the next meeting would take place on Tuesday 5 July 2011 between 9.30am and 12.30pm in the Boardroom, White Rose House, Wakefield.

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