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Enclosure A YORKSHIRE AND THE HUMBER SPECIALISED COMMISSIONING GROUP Minutes of the meeting held on Friday, 26th November 2010 In the Boardroom, NHS Kirklees Present: Ailsa Claire Steve Broughton Steve Hackett Simon Morritt Graham Wardman Joanne Forrestall Ivan Ellul Julia Mizon

Andy Buck

Chief Executive (Chair) Assistant Director Director of Finance Chief Executive Public Health Consultant Commissioning Manager Chief Executive Assistant Director – Contracting and Performance Chief Executive Acting Executive Director of Commissioning Director of Strategic Commissioning and Development Chief Executive Head of Secondary Care and Local Authority Contracting Chief Executive

Simon Kirk Ann Ballarini

Director of Strategy and Transition Director of Strategy

Mike Potts Philomena Corrigan Caroline Briggs Jayne Brown Mike Ireland

NHS Barnsley NHS Barnsley NHS Barnsley NHS Bradford & Airedale NHS Calderdale NHS Doncaster NHS East Riding NHS Hull NHS Kirklees NHS Leeds NHS North Lincolnshire NHS North Yorkshire & York NHS Rotherham (from item 5c) NHS Rotherham (up to item 5c) NHS Sheffield NHS Wakefield

In Attendance: Cathy Edwards Kevin Smith Frances Carey Laura Sherburn

Paul Crompton Stephanie Ryan

Director Medical Advisor Deputy Director of Finance Deputy Director of Commissioning – Specialised Services Asst Director of Commissioning – Specialised Services Business Manager Head of Marketing

Wendi Murphy

Strategic Development Lead

Pia Clinton-Tarestad

SCG 124/10

Yorkshire & the Humber SCG Yorkshire & the Humber SCG Yorkshire & the Humber SCG Yorkshire & the Humber SCG Yorkshire & the Humber SCG Yorkshire & the Humber SCG Yorkshire & the Humber PCT Collaborative Child Health Development Programme - ChiMat item

Apologies Chris Welsh Sue Rogerson John Lawlor Annette Laban Jan Sobieraj Rob Webster Maddy Ruff Steve Wainwright

Medical Director Director of Collaborative Commissioning Chief Executive Chief Executive Chief Executive Chief Executive Director of Commissioning Deputy Chief Executive

NHS Yorkshire & the Humber North East Lincolnshire Care Trust Plus NHS Leeds NHS Doncaster NHS Sheffield NHS Calderdale NHS Hull NHS Barnsley

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Action SCG Declarations of Interest 125/10 There were no declarations of interest. SCG Minutes of the meeting held on Friday 22nd October 2010 126/10 The minutes of the meeting held on the 22nd October 2010 were presented to the meeting. It was agreed that the minutes of the meeting held on the 22nd October 2010 were a true and accurate record.

Paul Crompton

SCG Matters Arising 127/10 Items not on the agenda A question was raised in respect of Evidence Based Commissioning Policies and it was reported that a further list would be considered by the Regional Policy Sub Group and that these would be brought to the SCG Board meeting in January 2011.

Paul McManus

Items on the agenda (a)

Paediatric Cardiac Surgery A verbal update was given to the meeting on the matter. The additional mortality and morbidity review of the three centres (Leeds, Leicester, Evelina) would be taking place on 29th November. This would be followed by a discussion with each of the 3 SCGs to advise on any immediate concerns. In terms of the situation in the Yorkshire and Humber area discussions had taken place with the OSC network and there was work in progress to secure formal agreement to a joint OSC response to the consultation. Cathy Edwards reported that she would making a pre consultation briefing to the OSC network in January. The formal consultation period was expected to commence in February or March. There would be one nationally organised consultation event in Yorkshire and the Humber. Consideration would need to be given as to how this national event can be complemented with more regional and locality events. The issue of how local MPs should be engaged and briefed was raised, particularly in view of the interest of Yorkshire and Humber MPs in the health portfolio. It was agreed that :the update report be noted; the presentation to the OSC network be made to the SCG Board at the December meting; a communication brief be prepared for PCTS; actions be put in place to engage with the local MPs

(b)

Cathy Edwards

Cancer Services IOG update

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Action (i)

Brain/CNS It was reported that Jayne Brown would be taking forward the relevant issues with Hull Hospital Trust. The network MDT had now been established.

(ii)

Sarcoma It was reported that a local implementation group was being set up with senior manager input. A full update would be made to the SCG Board at the January 2011 meeting.

(c)

Jayne Brown

Pia ClintonTarestad

CAMHS Commissioning Framework A report was presented to the meeting setting out the revised CAMHS commissioning proposals. In October 2010 SCG Board received the final draft of the CAMHS Tier 4 Commissioning Strategy, and an options paper regarding the Commissioning Framework. It was felt that as the demand and capacity requirements had not been absolutely defined in the strategy, this affected the ability to choose an appropriate commissioning option; in addition, the work ongoing to establish a common commissioning approach to specialised mental health services needed to be understand in terms of its application to CAMHS before a decision could be taken. Following further conversations internally within the Specialised Commissioning Team (SCT), and also with the PCT CAMHS Commissioner and Clinical Reference Groups, the paper set out a number of steps to firm up the commissioning position, which were consistent with the approach taken to other aspects of specialised mental health. It was recognised that the next stage in taking forward the draft CAMHS Tier 4 strategy was to do further work to understand the true demand and need for Tier 4 services in Yorkshire and Humber, taking into account the interface with Tier 3 services of varying nature across the patch. An intense period of work over a 6 month period was proposed, to include the follows:An individual review of each patient admitted to Tier 4 services within a 12 month period, to include retrospective and prospective patients, including those in spot purchased placements, to fully understand their need for Tier 4 services and the Tier 3 pathways that has culminated in an admission. This review would be undertaken by a SCT case manager. The design of the review would be aided by members of the Tier 4 Clinical Reference, Provider Management, and Commissioner Groups, to ensure whole system ownership. Development of a regional access and egress protocol to Tier 4 services by the Tier 4 Clinical Reference

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Action Group. A dedicated programme of work around service user involvement and PPI, on the context of the strategy Further work on the financial envelopes available for Tier 4 commissioning within PCTs to be undertaken. Continue to transfer all current contracts for Tier 4 services from PCTs to SCGs by April 2011. In conclusion it was agreed that :the commissioning strategy be approved; the proposal actions to firm up the commissioning position be approved and; a report on progress be submitted to the SCG Board meeting - July 2011

Laura Sherburn

Strategy and Direction SCG (a) 128/10

Paediatric Services At the SCG Board meeting on 28 May it was agreed that there was a need to undertake further work on a range of issues relating to paediatric services. Specifically it was agreed that there would be:An analysis of current activity for electives and nonelectives, by Trust. A stocktake of current services against the draft standards for the “critically ill child” and paediatric surgery. Further work undertaken on the medium/long term workforce issues. The report presented to the meeting provided an update on progress in each of these areas. (i)

Activity Review Activity graphs for elective and non-elective activity were presented. However it was advised that the information was yet to be quality assured, so the information should not be used until this work had been completed and robust data around age groupings was available.

(ii)

Laura Sherburn

Standards Stocktake Wendi Murphy gave a presentation of the work that had been undertaken in relation to the standards stocktake. Two spreadsheets – acutely unwell children and paediatric surgery – of results were explained in terms of the extended red, amber, green ratings and the eleven standards.

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Action It was evident that there were potentially a number of issues identified in the data in respect of the current service provision. The stocktake had been undertaken by remote self assessment of clinicians and service managers nominated by the Trust Chief Executives. A discussion followed and it was felt that appropriate actions needed to be taken by the SCG to address the potential issues that had been highlighted. It was agreed that :provider Trusts be provided with a copy of their individual results in the standards stocktake and that they be asked to validate the data and make comments as a matter of urgency; provider Trusts be asked to undertake a stocktake for each site, where there was more than one; the information analysis be competed; and a small task group of the SCG Board members be established to consider the data and provide guidance to the SCG Board on the next steps to be taken and that a report be made to the January 2011 meeting. Andy Buck, Simon Morritt and Caroline Briggs indicated that they would be part of the task group and consideration would be given to how clinicians could be represented. (iii)

Cathy Edwards/ Wendi Murphy

Andy Buck/ Cathy Edwards

Workforce This paper provided an update on the work undertaken on staffing issues in paediatricsâ€&#x; following the problems experienced over the winter 2009/10 and to outline options for further action. With regard to the short term position trainee recruitment in August was better than for the previous February rotation with most places filled. However, risks in the system persist because of the number of doctors taking maternity leave. 15-20 doctors are close to their qualifying date and therefore soon potentially available for consultant recruitment. Both Leeds and Sheffield PICUs have gaps in Consultant staffing – both with 5 consultants against an establishment of 7 with little or no response to adverts. Embrace was now up and running.

In terms of the medium term a number of options were being pushed including: lead employer arrangements for all junior doctors in Yorkshire and the Humber; enhances PICU training; and increasing the number of Z:\Corporate Services\Meetings\Board\2011\Jan 11\KPCT-11-18 3 Y&H SCG Minutes 26 November 10.doc

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Action nurse practitioners. There were no indications that there would be a reduction of paediatric trainees over the next three years. It was agreed that :the contents of the report be noted; and the workforce report be considered at the January 2011 SCG Board meeting when paediatric issues were to be discussed further. SCG (b) 129/10

Cathy Edwards

Neonatal Taskforce Implementation Update In July 2010 the SCG Board approved in principle the eight Taskforce principles subject to a full risk and impact assessment. A report was presented to the meeting which set out the progress in relation to the impact assessment, and in particular the three main principles which have the greatest impact on delivery. Organisation of capacity (including gestational cut off) Workforce ratios Surgery integration The Clinical Standards Sub Group had considered the current service at the meeting on the 11th November and agreed that the level of service with its wide variances across the Yorkshire and Humber area was not acceptable. A discussion followed, which included a reprise of the position in the North Trent Network. The North Trent Network was seeking evidence of how the service was provided in the areas. The Network agreed that the Taskforce standard should be adopted and the matter was being taken forward with the provider Trusts. It was considered that neonatal surgery integration in the North Trent area would not be practical so the standards of care would need to be ensured in this scenario; these standards would need to be consistent and set in common with the national standards required. There were no standard understanding of „current capacityâ€&#x; across the Yorkshire and Humber area and indeed nationally. Discussions were required with the provider Trusts to make progress on finding an agreed understanding. It was noted that the North West SCG treated the Taskforce standards as mandatory, whilst the East Midlands SCG made agreements with each provider unit and were not necessarily working to the 27 weeks. The problematic nature of the data collection in the Yorkshire and Humber area was also noted and it was felt appropriate that the SCG Deputy Director of Commissioning liaise with PCT Chief Executives if problems persisted. In conclusion it was agreed that:-

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Action the contents of the report on the Neonatal Taskforce Principles Implementation be noted; working towards the Taskforce gestational cut-offs, along with the principle that some limited reconfiguration may be required in North Trent Neonatal Network, be endorsed; additional capacity in the Yorkshire Neonatal Network be approved subject to zero net financial impact in 2011-12 (joint work to be undertaken across providers & PCTs to calculate this); delivery of appropriate staffing to Taskforce standards over a 5 year programme of growth; specifically in 2011, continue with current prices, and current staffing levels (70%), with a view to understanding the impact of further implementation in 2012 once reference costs were available and further options around skillmix redesign have been explored, be endorsed. PCTs ensure that their staff are aware of the data collection requirements of the SCT; agreement is reached with stakeholders on the definition of current capacity; and an update report is made to the SCG Board meeting in February 2011. SCG (c) 130/10

PCTs

Laura Sherburn

Financial Plan (i)

Financial Plan 2011-12 Update An update report was presented to the meeting in respect of the Financial Plan 2010/11 to 2013/14. Revised horizon scanning figures had been sent to PCTs. A review of the 2010/11 LOP investments under the growth category had been undertaken and where the costs were still expected to materialise in 2010/11 then these had been added in. PCTs were advised to keep these amounts in reserves for 2010/11. The forecast out-turn figures had been updated using month 6 data. The contrast floor figure for LTHT had been included in the summary. There was further work being undertaken with the Trust to clarify the floor and ceiling values. Forecast QIPP savings as identified at November 2010 had been incorporated at SCG level in the summary financial plan, subject to the risks identified in the separate QUIPP report. Following the first confirm and challenge event the costs for HIV and cochlear implants were being reviewed and information would be sent out to PCTs shortly. This would take into account local circumstances. It was understood that the Operating Framework would not now be issued until January 2011 therefore the

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Action financial planning assumptions remain the same as those issued by the Yorkshire and the Humber SHA during 2009/10. (ii)

Confirm and Challenge It was verbally reported that a further confirm and challenge event was to take place in February.

(iii)

PbR Top Ups Update A report was presented to the meeting updating the developments relating to Payment by Results in respect of specialised services top ups. The proposals for the 2011/12 PbR arrangements included a range of changes to the specialised services top ups. These included a significant drop in the percentages attached to the specialist childrenâ€&#x;s top up from 78% and 25% and the introduction of a 21% cancer top up. The 10 SCG Directors supported by the national SCG Finance Network had reviewed both the eligibility criteria and the eligibility lists to ensure that only those Trusts that are undertaking significant specialised work as defined by the specialised services definition sets would receive the top ups. The recommendations from the SCGs would be considered by a panel, chaired by Bill Shields (Director of Finance and Performance at South West SHA) to ensure consistency of approach across all SCGs. A summary of the SCG recommendations was set out in the report. It was agreed that :the update of the Financial Plan be noted; a report be made to the SCG Board meeting in December 2010 in respect of the PCT responses to the confirm and challenge exercise; and the impact of QUIPP delivery for 2001/12; the report in respect of Payment by Results be noted.

SCG (d) 131/10

Frances Carey

Clinical Networks – NEYHCOM update A verbal update was given to the meeting on clinical networks in NEYHCOM. It was noted that the Cancer Network, Cardiac Network and Critical Care Network staff were being brought together in an integrated team. It was agreed that the background paper work in relation to the NEYHCOM Network restructure be circulated to SCG Board members.

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Jayne Brown

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Action SCG (e) 132/10

Radiotherapy Update A report was presented to the meeting which summarised the background and inter-related factors that needed to be considered in developing strategic commissioning plans for radiotherapy. The National Radiotherapy Advisory Group (NRAG) reported to Ministers in 2007. The national recommendations proposed that the expansion of radiotherapy was necessary because:(i)

There is an increasing ageing population

(ii)

National requirement to reduce waits for all cancer treatments to 31 days

(iii)

There is an evidenced historical under-utilisation of radiotherapy treatments.

In January 2010, a paper was presented to the Yorkshire and the Humber Specialised Commissioning Group outlining the findings from the modeling analysis undertaken by the three Cancer Networks in the region. The joint exercise demonstrated that: (i)

In the short term, there was sufficient linear accelerator capacity to manager the estimated increase in demand but that the activity would need to be reviewed locally on a regular basis.

(iii)

Over the next 12-18 months a number of planning activities, should continue in all three networks to take account of the significant uncertainty, including:A rigorous monitoring of growth in radiotherapy activity to demonstrate the need for additional linear accelerators to 2016. It was agreed that this should take account of any changes to existing referral or clinical practice Defining the commissioning capacity

procurement process for the additional radiotherapy

Refining the efficiency and productivity modeling principles in line with further national guidance, innovation and emerging technology.

There were two national standards and three secondary milestones driving the radiotherapy expansion plans:The first standard was the 31 day (First Treatment) standard (Decision to Treat to First Definitive Treatment) which was generally being met by all three providers. The second, 31 day subsequent treatment target, was due to be fully implemented by December 2010 with the expectation that the Z:\Corporate Services\Meetings\Board\2011\Jan 11\KPCT-11-18 3 Y&H SCG Minutes 26 November 10.doc

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Action performance would be sustained or above the operational standard from 1st January 2011. The operational standard for patients receiving second or subsequent radiotherapy had been set at 94%. An appendix summarised the individual PCT position against the second standard, it was noted that two PCTs in the Yorkshire and Humber area were below the standard. The national expectation was that 52% of cancer patients should receive radiotherapy as part of their treatment by December 2010. None of the Yorkshire and Humber networks would meet this target and it was estimated that the current performance was 35%. There are significant uncertainties to predicting the continued level of growth over the next five years. The project procurement requirements in the three radiotherapy centres were set out. The timescales assumed a lead in time of two years from procurement to fully operational status. The report noted that the national drive was also about enhancing access to complex radiotherapy treatments including Intensity Modulated Radiotherapy (IMRT), Image Guided Radiotherapy (IGRT), Stereotactic Radiotherapy and Rapid ARC. The three Radiotherapy centres in Yorkshire and Humber were all able to provide IMRT to a small cohort of patients but nationally there was an expectation that 33% should receive this mode of treatment delivery. The “fraction� currently for radiotherapy does not reflect the variable complex nature of individual treatments, current and future, and the potential consequent reduction in fractions involved in the introduction of new treatment techniques. The national recommendations require that patients have a travel time of no longer than 45 minutes. Each of the Cancer Networks was currently assessing the potential for satellite radiotherapy to identify a preferred Yorkshire and the Humber wide solution. The report identified a number of issues and challenges including: population assumptions around the three centres; inconsistencies in contractual arrangements; ensuring consistent practice and technology; changes to clinical practice and changes in commissioning. Against this backdrop and in order to develop robust plans the report recommend that:The tri-network group develops a modeling tool to redefine the capacity requirements in 2016 in line with technological developments and changes in clinical practice. Good quality and comparable data would be Z:\Corporate Services\Meetings\Board\2011\Jan 11\KPCT-11-18 3 Y&H SCG Minutes 26 November 10.doc

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Action essential in supporting this approach as well as the contracting process. The tri-network group develops recommendations to ensure consistent clinical practice, working practices and efficiencies are delivered. A set of common commissioning principles across the SCG are developed to ensure consistency in the contract process. The Yorkshire and Humber mapping exercise is completed to define the optimum location of additional radiotherapy sites and programme of procurement across the region matched to the capacity requirements. A third report on progress should be presented to SCG in six months time. It was agreed that :The contents and recommendations in the update report on the implementation of the National Radiotherapy Advisory Group be noted; A further update report to be made to the SCG Board which would include an understanding of the Yorkshire and Humber performance compared to other areas.

Cathy Edwards/ Kim Fell

Policy SCG (a) 133/10

Draft Risk Share Policy A report was presented to the meeting which outlined progress in producing a revised risk share policy and included a copy of the proposed policy. The initial drafting was based on input from several PCTs and the Finance Network Group and the Mental Health General Group had also considered the matter. It was recognised that risk shares would need to be reviewed in the medium to long term there was a need to consider this in the context of the proposed new commissioning arrangements. It was verbally reported to the meeting that in respect of the low secure risk share, three out of four of the prospective new PCT joiners to the scheme, were now in doubt. A letter had been sent to PCTs seeking clarification of their future intentions. A discussion followed and it was felt that a position statement and data needed to be prepared to assist in discussions with GP consortia and supra commissioning arrangements from 2012/13. It was agreed that the draft risk shares policy be finalised and brought back to the SCG Board meeting in December 2010

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Frances Carey 11


Action for approval. SCG (b) 134/10

Excess Treatment Costs – Renal A report was presented to the meeting which outlined the background to the Renal Transplant Study. This study was the first national multi-centre investigator-led renal transplant study. Currently there was national variation in the immunosuppressant drugs used post renal transplant. This was a pragmatic (but complex) study which aimed to address this by comparing four drug regimens, to determine the most effective, and most cost-effective of these, to define a national standard. A maximum of 50 patients would be recruited into the study over a five year period; in that interval approximately 750 renal transplants would be performed. This study was within the NIHR portfolio so that the other costs within the trial were born by the study sponsor and the Comprehensive Local Research Networks. It would be only the drug acquisitions costs that needed to be considered by commissioners. Some of the drugs would be available as generics in the very near future, which would mean that the current Leeds standard treatment would become cheaper, assuming transfer to generic products. The trial mandated the branded drugs (to avoid variation within a controlled trial), and therefore for patients on the trial, the major cost impact would be a treatment cost on current drug costs. The excess costs would be spread across the 10 PCTs using the Leeds renal service resulting in an excess cost per PCT of £36.6k over five years, £7.3k per year per PCT. It was confirmed that the issues previously raised by the Finance Network had been addressed. It was agreed that approval be given to the Renal Transplant Study and associated excess treatment costs, subject to ratification by the Renal Strategy Group.

SCG (c) 135/10

Pia ClintonTarestad/Chas Newstead

Interim Cancer Drugs Fund Update A report was presented to the meeting providing an update in respect of implementing the Interim Cancer Drugs Fund (ICDF). The SHA ICDF policy set out the approach taken to fund drugs from the ICDF. This included agreeing a list of drugs that would be funded through the ICDF, the “ICDF Priority Medicines List” (SHA ICDF policy 6.2.1). The development of this list had been clinically led, initially through regional site specific groups, followed by a clinical group chaired by the SHA Medical Director and comprising the twelve regional site specific group leads, supported by the three Cancer Networks. This group had made recommendations to the ICDF panel on the 19th November

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Action 2010, where the list had been unanimously agreed. The ICDF panel took into consideration:Clinical effectiveness Cost-effectiveness The existence, or otherwise, of alternative treatments for conditions The associated costs in relation to the provision of the medicines (the „on-costs‟ which will be funded by the relevant PCT) The rarity of the condition (including whether the drug is an orphan drug) The drugs within the Yorkshire and Humber priority medicines list were broadly in line with other regions. In addition to the Priority Medicines List, the SHA ICDF policy stated that there would be a non-approved list. The policy stated that non-inclusion in the approved list would lead to inclusion on the non-approved list. The ICDF panel agreed that an exception to this rule should be made for paediatrics and for very rare conditions (less than 5 cases per year). Funding for these could continue to be requested from the ICDF through Individual Patient Applications (IPAs). The finalization of the non-approved list was now underway and this list would be published in due course. The total estimated drug costs to 31 March 2011 to be funded from the ICDF are £3.7 million (worst case) Total estimated associated treatment costs to 31 March 2011 to be funded by PCTS were £1.0 million (worst case). A briefing note had been circulated to providers and PCTs setting out the actions required to support the contracting arrangements for the Interim Cancer Drugs Fund including the key requirements of PCTs, providers and the Specialised Commissioning Teams. It was noted that there was a national consultation exercise in progress on the Cancer Drug Fund for 2011/12 – 2012/13 and it was felt important that a response was made to this by all interested parties.

It was also confirmed that clinicians were signed up to the process and panels had been meeting each week. The SCG website contained all the up to date information on the issue. It was important to note that individual Funding Requests (IFR) panels in PCTs should not take into account the ICDF when making decisions. It was very important that the paperwork did not confuse the two systems of IFR and ICDF. It was agreed that PCT Chief Executives be circulated with the relevant information relating to the current issues which Z:\Corporate Services\Meetings\Board\2011\Jan 11\KPCT-11-18 3 Y&H SCG Minutes 26 November 10.doc

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Action had arisen. The Chair and the meeting expressed their appreciation and thanks to Paul McManus and Pia Clinton-Tarestad for the work they had done on the implementation of the ICDF in the Yorkshire and Humber area. It was agreed that :The update report on the ICDF be noted; The agreed „ICDF Priority Medicines List‟ be noted The potential associated treatments costs and expectations on PCTs to fund be noted; The contractual arrangements for the ICDF be noted; Performance SCG (a) 136/10

Exception Performance Report up to 31 August 2010 The Exception Performance Report for the five months ending 31st August 2010 was presented to the meeting. The year end forecast was showing a projected underspend of (£1061k). It was agreed that the Exception Report for the period up to the 31st August 2010 be noted.

Laura Sherburn /Frances Carey

A discussion followed on PCT activities in relation to SCG commissioned Services where PCTs would need to be mindful of the impact on other PCTs, the SCG and patients. Any changes that affect the SCG would have to be discussed by the SCG Board. It was very important that PCTs advised the SCT of any proposed discussions and changes to services. SCG (b) 137/10

PCTs

Commissioning Intentions 2011-12 A report was presented to the meeting setting out the overarching principles in relation to finance and planning that would underpin the commissioning intentions for 2011/12. It was agreed that the commissioning intentions for 2011/12, as outlined, be approved.

SCG (c) 138/10

Frances Carey

QIPP (i)

General Update A report was presented to the meeting setting out the QIPP programme summary, financial summary and the 19 project highlight reports. A summary of the most significant changes and risks were as follows:Blood product figures may charge Timelines for mental health secure services project need to be met if pilots with providers to proceed

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Action on time. A change in the Leeds contract would be required for the PIC project in order to realise the benefits. Recruitment of financial support was still underway, but not yet in post Some positive project highlights are as follows:Tender documents are out into the market place for the mental health rehabilitation project In the mental health case management project, following interventions with high secure responsible clinicians and Ministry of Justice 2 high secure patients had been transferred. Work was ongoing in relation to case management involvement with individual PCTs and the transfer of patients to local services Renal services, access to conservative & palliative care project had received funding of £25K from NHS End of Life Care, to recruit a part-time palliative care consultant, to develop a Yorkshire and Humber wide strategy and patient pathway for renal conservative care. The individual monthly profiles of savings per PCT per project continued to be circulated for comment and agreement to the SCG Finance Network Group and Performance Monitoring Sub Group for submission via the individual PCT trackers to the SHA. It was agreed that :The contents of the QIPP programme summary, financial summary and 19 project highlight reports be noted; Approval be given for the report to be submitted to the Yorkshire and Humber SHA. (ii)

Laura Sherburn

Cardiac PID A report was presented to the meeting setting out the Cardiac QUIPP Project Initiation Document (PID) The Cardiac PID had been produced by the Cardiac QIPP Steering Group, chaired by Jan Sobieraj and was the basis for managing and delivering the cardiac QIPP. The Cardiac QIPP aimed to Deliver care that is evidence based and consistent with recommended practice Deliver care that is at the level of intervention appropriate to the patients clinical need Improve „gate keeping‟ and pathway management This would to be achieved through the development and implementation of agreed clinical thresholds; and as a result :-

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Action deliver the SCG QUIPP financial target of £1millow recurrent reflecting the anticipated reduction in CABG surgery. generate savings for PCT commissioners (estimated at £1million) resulting from the anticipated reduction in diagnostic and revascularisation procedures. It was agreed that :The Cardiac QUIPP Project Initiation Document be approved

Lisa Marriott

The Project Board be mandated and supported (iii)

Fertility Business Case/LTHT A report was presented to the meeting setting out the case for a competitive procurement of fertility services in the Yorkshire and Humber area The primary objective of a competitive procurement process would be the realization of cash releasing saving through improved prices. If best pricing could be realised across Yorkshire and the Humber, the estimated savings to commissioners would be in the region of £500,000 (over and above the savings realised in 2010/11) shared across all PCTs excluding South Yorkshire. The report highlighted a number of clinical, financial and organisational risks associated with the competitive procurement process. In view of the risks associated with procurement and the fact that the Yorkshire and Humber market did not lend itself to this process, that contract negotiations would be a more productive way forward. It was agreed that :a better price for fertility services for 2011/12 be sought through contract negotiations for both SCG and PCT contracted services; A review of the case for competitive procurement of this service be undertaken in April 2011.

SCG Minutes of the Performance Monitoring Sub Group 139/10 The minutes of the Performance Monitoring Sub Group meeting held on 14th October 2010 were presented to the meeting. It was agreed: that the minutes of the Performance Monitoring Sub Group meeting held on 14th October be received. SCG

Laura Sherburn

Minutes of the Clinical Standards Sub Group

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Action 140/10 The minutes of the Clinical Standards Sub Group meeting held on the 14th October 2010 were presented to the meeting. It was agreed: that the minutes of the Clinical Standards Sub Group meeting held on the 14th October 2010 be received.

Kevin Smith

SCG Draft Minutes of the Regional Policy Sub Group 141/10 The draft minutes of the Regional Policy Sub Group meeting held on the 2nd November 2010 were presented to the meeting. It was agreed: that the draft minutes of the Regional Policy Sub Group meeting held on 2nd November be received.

Paul McManus

SCG Draft Minutes of the North Trent Neonatal Network Steering 142/10 Group The draft minutes of the North Trent Neonatal Network Steering Group meeting on 5th November 2010 were presented to the meeting It was agreed: that the draft minutes of the North Trent Neonatal Network Steering Group meeting held on the 5th November 2010 be received.

Laura Sherburn

SCG Draft Minutes of the Yorkshire Neonatal Network Board 143/10 The draft minutes of the Yorkshire Neonatal Network Board meeting held on the 15th October 2010 were presented to the meeting. It was agreed: that the draft minutes of the Yorkshire Neonatal Network Board meeting held on 15th October 2010 be received.

Alison Gibbs

SCG Any Other Business 144/10 The Chair advised the meeting that Kate Caston had been appointed as the national project lead for the implementation of the new commissioning arrangements for specialised services. SCG Meeting in Private 145/10 SCG Date of Next Meeting 146/10 9.00 am Friday 17th December in the Chevet Suite, Sandal Rugby Club.

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Yorkshire and the Humber Specialised Commissioning Group Board Meeting – 26 November 2010 Decision Summary for PCT Boards

1

Strategy and Direction Nothing to report

2

Policy Excess Treatment Costs – The SCG agreed the excess treatment costs associated with participating in the Renal Transplant Study (NB only PCTs using Leeds renal service are affected). Interim Cancer Drug Fund – SCG endorsed the Interim Cancer Drugs fund priority medicines list and the predicted associated treatment costs.

3

Governance Nothing to report

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