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Calderdale, Kirklees and Wakefield District Cluster Partnership

Minutes of the Cluster Partnership Meeting held on Tuesday 5 July 2011 at 9.30am in the Boardroom, NHS Wakefield District, White Rose House, Wakefield

Present: Rob Napier Mike Potts Mehboob Khan Roger Grasby Sandra Cheseldine Keith Wright Ann Liston Andy Leary Sue Cannon

Peter Flynn Julie Lawreniuk Gill Galdins

Chair, NHS Kirklees and Acting Chair Chief Executive Non-executive Director, NHS Kirklees Chair, NHS Wakefield District Non-executive Director, NHS Wakefield District Non-executive Director, NHS Calderdale 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 Director of Human Resources and Organisational Development Director of Performance and Commissioning Intelligence Chief Operating Officer, NHS Calderdale Chief Operating Officer, NHS Wakefield District

In attendance: Pauline Kershaw Alison Fearnley

Executive Assistant, NHS Kirklees Corporate Governance Administrator, NHS Kirklees

Ann Ballarini Matt Walsh Sue Ellis

It was AGREED that Rob Napier would Chair the meeting in the absence of Angela Monaghan. CKWCP/11/16

Apologies for Absence Apologies for absence were received from Angela Monaghan, Chair, NHS Calderdale, Carol McKenna, Chief Operating Officer, Sheila Dilks, Director of Transformation and Graham Wardman, Director of Public Health, NHS Calderdale.


Declarations of Interest Sandra Cheseldine declared she was a Non-Executive Director of Wakefield Alliance Board. Matt Walsh declared he was the Shadow Accountable Officer of Calderdale Consortia.

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Minutes of the last meeting held on 7 June 2011 The minutes of the Cluster Partnership meeting held on the Tuesday 7 June 2011 were AGREED as a true and accurate record. In addition the group reviewed the action log sheet. It was AGREED that progress against the outstanding actions should be updated prior to each meeting and the action log sheet should also include a minute reference number and target date.


Matters Arising CKWCP/11/04

Chief Executive’s Report

Progress on 2010/11 Accounting Statements Mike confirmed that NHS Calderdale, NHS Kirklees and NHS Wakefield District had been provided with an unqualified audit opinion on their 2010/11 financial statements. English Defence League protest march Ann Ballarini provided feedback on the demonstration that took place in Dewsbury on Saturday 11 June led by the English Defence League. It was noted that there was nothing significant to report and that the Gold Command went well. Mehboob Khan also reported that he had visited various police sites to engage with partnership staff and confirmed organisations were well integrated. In particular he commended the work undertaken by public services in general. CKWCP/11/08 Governance Report It was noted that the draft Scheme of Reservation and Delegation (SoRD) had been presented to NHS Wakefield District Trust Board in June. The Board had commented on this and remitted it to the Audit Committee who had made some amendments. A discussion ensued regarding how this would now be taken forward. It was AGREED that Andy Leary would co-ordinate comments from all three Boards and take this work forward. CKWCP/11/20

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

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The Month: NHS Modernisation Mike pointed out that a considerable amount of information had been released from the Department of Health since the outcome of the NHS Listening Exercise. He made particular reference to The Month: NHS Modernisation issued on 20 June, where he reported on some of the key highlights and encouraged members to read the document in full. NHS Future Forum The Cluster Partnership also received a copy of a summary report on proposed changes to the NHS entitled NHS Future Forum. It was recognised that we are still in a period of transition and that the role of the Cluster Partnership is to oversee this transition. PCT Clusters Mike reported that from September 2011, NHS Leeds and NHS Bradford and Airedale would form a single cluster. Keith Wright enquired if Mike could provide any assurance that the cluster footprints would not change following the merger of SHAs. Mike confirmed that there was no indication to alter the CKW cluster footprint. Mehboob Khan remarked that there were strengths to the five West Yorkshire local authorities working co-terminously. It was recognised that this had previously been explored but there was some reluctance. However, it was acknowledged that some functions would be better shared on a West Yorkshire wide basis ie safeguarding procurement. Public Health System Reform It was noted that subject to passage of the Bill, the date for local authorities to assume their new public health responsibilities remains unchanged, at April 2013 following abolition of PCTs. Public Health England and the other new national bodies will now also take up their full accountability and financial responsibilities from April 2013. WYCOM Resilience update It was acknowledged that WYCOM was continuing to monitor resilience issues across West Yorkshire and that the position was changing from amber to red. The Cluster Partnership was reassured it would continue to receive regular feedback regarding any significant issues. Furthermore it was noted that an event was being held on 13 July 2011 to explore proposals on developing commissioning support functions. Feedback would be given to the Cluster Partnership following the event. Page 3 of 11

English Defence League protest demonstration - Halifax It was noted that a further demonstration was due to take place in Halifax on Saturday 9 July 2011. It was recognised that the learning from the event held in Dewsbury would be used and that Gold and Silver Command arrangements had been put in place as before. Review of Children’s Congenital Cardiac Services in England Mike circulated a briefing paper from Yorkshire and the Humber Specialised Commissioning Group regarding the above review. The briefing paper set out the following: Key milestones for the decision-making; Consultation overview, including in Yorkshire and the Humber; The evidence to be considered by the Joint Committee of Primary Care Trusts (JCPCT) when make a decision; and Key issues raised during the consultation period. It was noted that the consultation came to an end on 1 July 2011, however Health Overview and Scrutiny Committees will also have a further opportunity to consider the analysis of the consultation and the interim health impact assessment and supplement their original consultation response by 5 October 2011. It is planned that the decision on the future configuration will be made by the JCPCT at a meeting in public in November. Mike reassured the Cluster Partnership that all the issues raised, as part of the consultation exercise, had been considered. Mehboob Khan enquired whether there was representation from a Non-executive Director on the JCPCT. Mike confirmed that Ailsa Claire, Director of Commissioning, Yorkshire and the Humber, was a member. He also enquired what opportunity each PCT would have to go through the consultation issues with the JCPCT. Mike reported that this issue had been raised at the SCG meeting in June. It was acknowledged that the results from all of this work were being collated for the next SCG meeting in July and that information would be shared with the Cluster Partnership. Comments could then be fed back into the SCG on what is thought to be the right option for Yorkshire and the Humber. It was pointed out however that it was difficult for PCTs to respond to this as the JCPCT has delegated authority to act on our collective behalf. Roger Grasby had similar concerns and stated it was a worry to him that as the consultation process was being run by the JCPCT on behalf of PCTs, PCT Boards were unable to put their point of view over. Roger then enquired what assessment was being undertaken on what the impact of the outcome of the consultation Page 4 of 11

might be for Yorkshire and the Humber if we are unable to submit comments as a Board. Ann Ballarini provided assurance that this was covered as part of the Health Impact Assessment (HIA). Following a discussion it was suggested that the HIA is shared with the Cluster Partnership, if treated confidentially. In addition it was suggested that Cathy Edwards is invited to a future meeting to discuss this is more detail. The Chair emphasised that this was an important topic for discussion at the next meeting. The Cluster Partnership RECEIVED and NOTED the contents of the Chief Executive’s Report. CKWCP/11/21

Quality and Patient Safety Report Sue Cannon presented the Quality and Patient Safety Report which was RECEIVED and NOTED by the Cluster Partnership for information.


Performance Report Peter Flynn introduced the report explaining that it provided an interim summary of the performance indicators from the Operating Framework which highlights an indication of where the hot spots are locally across the patch. The Cluster Partnership was asked to feedback any views on the issues highlighted and comment on the format and style of the report. The Cluster Partnership RECEIVED and NOTED the summary of performance against the Operating Framework headline indicators.


Finance Report The Cluster Partnership RECEIVED and NOTED the month two financial position for NHS Calderdale, NHS Kirklees and NHS Wakefield District. It was recognised that it was still too early in the financial year to provide a detailed forecast on the outturn positions. It was emphasised however that all PCTs still have contingency reserves. Andy Leary explained that on this occasion the report only showed the QIPP details for Wakefield. Concerning this it was noted that the latest forecast outturn position against the QIPP target is showing an under-achievement on the schemes of ÂŁ748k. Andy provided assurance that the position was being continually reviewed and would be discussed in further detail by the Finance Page 5 of 11

and QIPP sub-committee later that day. Mike Potts expanded further on the work being undertaken around the QIPP programme. A discussion then followed regarding the £14m gap identified at MYHT. It was noted there was no commitment from the PCTs at present to fund this, however it was acknowledged that the PCTs were receiving additional pressure from the SHA to start and identify how they could support this. It was recognised that there was no suggestion that Calderdale would have to contribute to the £14m. A discussion then ensued around the proposed management costs/running costs target. It was noted that there was still a degree of uncertainty around this as this had still not been confirmed by the DH, however Andy expanded on how this might be determined. It was recognised that the challenge in Calderdale was more difficult in terms of achieving the £1.9m proposed target. Furthermore, it was recognised that it was likely that additional voluntary redundancies were needed to enable achievement of the management/running costs target. The Cluster Partnership RECEIVED and NOTED the Finance Report. CKWCP/11/24

Risk and Governance Report Sue Cannon presented the Risk and Governance report which set out the critical and serious risks for the three organisations across the cluster. These included: Calderdale – O critical risks; 17 serious risks Kirklees – 3 extreme risks (different terminology used) Wakefield – 3 critical risks; 10 serious risks It was recognised that the critical risks relate to MYHT’s ability to meet its targets, deliver the hospital development plan and acute services strategy. In addition Wakefield has also reported the development of the GP consortia as a critical risk. The Cluster Partnership RECIEVED and NOTED the Risk and Governance Report for information.


Commissioning Development Report Ann Ballarini presented the Commissioning Development Report. She explained that the report outlined the approach being taken to the development of a Cluster Programme Office to underpin future reporting and risk assessment of the implementation of the Cluster Partnership Responsibilities Framework and the new requirement of the Cluster Accountability Framework (CAF) set out by the SHA. Page 6 of 11

Secondly, the report provides an update on the approach to the development of Cluster Partnership level monthly reporting and risk assessment on the implementation of the NHS reforms. It was recognised that much of this work was still work in progress. It was also acknowledged that an electronic system was still being devised for monitoring this work. It was AGREED that future reports would be by exception only. Roger Grasby enquired what the costs of running the Programme Office were. Following a debate Julie Lawreniuk suggested an approach to costing this out. It was therefore AGREED that Andy Leary would prepare a report on the principles and costs. Finally, Sue Ellis confirmed that there would be more certainty around the HR process of setting up the Programme Office when the HR guidance is released from the DH. The Cluster Partnership NOTED the approach being taken to setting up the Programme Office and NOTED the 27 programme areas outlined in Appendix B of the report. CKWCP/11/26

Provider Development Report Ann Ballarini presented the Provider Development Report for information. It was noted that the report included an update on the Yorkshire Ambulance Service as requested at the last meeting. The Cluster Partnership NOTED the report and SUPPORTED the outlined actions.


Discussion Topics The Cluster Partnership went on to discuss the following topics: Delegation of responsibilities to commissioning consortia Mid Yorkshire Hospitals NHS Trust In particular the following was highlighted: Delegation of responsibilities to commissioning consortia This topic was deferred to the next meeting due to time constraints. However a discussion did take place around the PCT Cluster governance arrangements. Concerning this a letter from Bill McCarthy was circulated to the group proposing that PCT clusters move towards a single Board in Yorkshire and the Humber which matches the SHA clustering move. It was noted that the proposed change would take effect from 1 October 2011.

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The Chair explained that he had taken part in a conference call early that morning between Mike Potts, Angela Monaghan and Roger Grasby to discuss the proposed approach. He reported that it was proposed that Angela Monaghan is put forward as the new Chair of the single Cluster Partnership Board and he confirmed that Angela had accepted this proposal. The Cluster Partnership then discussed the proposed formation of the Cluster Partnership Board. It was proposed that there are six Non-executive Directors plus additional independent advisors to sit on the Commissioning groups. It was therefore AGREED that Mike Potts, together with Angela Monaghan, produce a report setting out the blueprint for governance structure. In the meantime Angela would invite each Non-executive Director to discuss whether or not they would be interested in a Non-executive Director position on the Cluster Partnership Board or whether they would prefer to be a lay member on one of the Commissioning Groups. In addition Mike Potts AGREED to clarify the role of the Appointments Commission with regard to appointing members to the Board etc. Mid Yorkshire Hospitals NHS Trust Mike Potts gave a presentation to the Cluster Partnership on the key aims of the Mid Yorkshire FT Health Economy programme. In particular he highlighted the following: The key aims of the programme management The structure for overseeing this work The key issues to be addressed during July The timescales The immediate questions and concerns It was recognised that the following were fundamental: service redesign; monitoring progress against CIPs; and the milestones of delivering FT status. The Cluster Partnership emphasised that a credible plan was needed to deliver the required outcomes. It was noted that Mike Potts was pursing the Interim reports which had been released by Finnamores. A discussion ensued regarding how credible MYHT’s plans were to improve performance; manage its financial position; work towards achieving FT status and what HR strategy was in place. Concerning the latter it was recognised that further work was required to produce a detailed workforce plan. In particular it was Page 8 of 11

noted that agency spend on consultant medical staff was considerably high. It was recognised that this needed to be resolved urgently and a coherent workforce plan needed to be determined. Sue Ellis provided assurance she was working with MYHT to resolve this. Sue Cannon provided assurance that work had been programmed to establish a Quality and Safety framework, in particular, around reducing staffing levels on the wards. The group went on to discuss the other key performance issues at MYHT. It was noted these included: A&E 18 Weeks RTT MRSA Mixed Sex Accommodation Stroke Fractured neck of femur It was recognised that emergency admissions were increasing, particularly at Pinderfields but were below agreed activity levels. It was highlighted that increasing emergency admissions impacted on elective activity which in turn impacts on meeting the 18 week RTT target and the mixed sex accommodation situation. It was highlighted that there are a significant amount of inappropriate admissions and that 85% of A&E activity was from people walking through the door, not referred by a GP and that they could be treated elsewhere. It was noted that some work was being undertaken to site GPs in the A&E department to support alternatives to admission and to provide additional capacity to handle primary care type work. Mike reported that some initial feedback had been provided but further work needed to be facilitated before a conclusion could be provided. The group also discussed staffing and leadership issues. It was noted continuity and commitment from staff was crucial. The group recognised that overall urgent care needed to be restructured as well as a whole system approach to address the overarching problems. The group went on to discuss the financial issues at MYHT in particular the support needed to bridge the ÂŁ14m gap. In addition it was noted the Audit Commission had issued a qualified audit opinion on Value for Money. Mike Potts also provided a summary of the recent quality and safety issues that had been raised. A number of issues had led to Page 9 of 11

the SHA instigating a Safety Summit on 28 June 2011. Feedback on the outcome of the summit revealed: High volumes in A&E High levels of staff sickness Ability to respond to a Major Incident was a cause for concern as was forthcoming winter pressures. Mike went on to highlight the areas of immediate risk for action which would be taken forward within the next three weeks. In addition to these it was noted a further action plan had been agreed to address the less immediate risks. Sue Cannon provided feedback on the outcome of the Finnamores report around maternity services at Dewsbury. It was recognised that the action plan that MYHT had produced from the outcome of the review did not address the issues raised and needed to be amended. Sue AGREED to circulate a summary of the outcome of the review to the Cluster Partnership for information. Finally the group discussed MYHT’s approach to the transition to achieving FT status. Concerns were raised whether the plan to achieve this was credible as well as the pace of delivery of the plan. Again it was emphasised that a whole system change was needed to address of the longstanding issues. Matt Walsh provided some assurance that following the safety summit he had found that clinicians were willing to lead and are motivated to improve, despite this it was emphasised that a controlled plan and rigorous intervention was needed to take this programme of work forward. It was recognised that progress on the programme management would continue to be reported via the Cluster Partnership. CKWCP/11/28

Work Plan and discussion topics Delegation of Responsibilities to commissioning consortia Partnership working with LA CEO’s



Items for Communication/key messages to be raised with Boards Communication via staff briefing re move towards a single Board Individual PCT Board meetings to be set up to discuss PCT cluster governance structure (collapse of PCT Boards) Skills and expertise of NEDs to be determined via Equality Impact Assessment Date and time of next meeting Page 10 of 11

It was noted that the next meeting would take place on Tuesday 2 August between 9.30am and 12.30pm in the Boardroom at Broad Lea House, Huddersfield.

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