Harrogate and Rural District Clinical Commissioning Group (HaRD CCG) Governing Body 5 April :00 12:30

Transcription

1 Harrogate and Rural District Clinical Commissioning Group (HaRD CCG) Governing Body 5 April :00 12:30 The Nidderdale Suite, Best Western Dower House Hotel, Bond End, Knaresborough, HG5 9AL Present Dr Alistair Ingram Sheenagh Powell Amanda Bloor Wendy Balmain Joanne Crewe Kate Kennady Lance Gilroy Dr Ian Woods Dr Rick Sweeney Dr Sarah Hay Dr Bruce Willoughby Kathy Clark Apologies Dilani Gamble Dr Angela O Donoghue In Attendance Sasha Sencier Alec Cowell Clinical Chair, HaRD CCG Vice-Chair / Lay Member, HaRD CCG Chief Officer, HaRD CCG Director of Transformation & Delivery, HaRD CCG Director of Quality & Governance/Executive Nurse, HaRD CCG Lay Member for Patient and Public Involvement, HaRD CCG Lay Member for Patient and Public Involvement, HaRD CCG Secondary Care Consultant, HaRD CCG GP Member, HaRD CCG GP Member, HaRD CCG GP Member, HaRD CCG North Yorkshire County Council Chief Finance Officer, HaRD CCG GP Member, HaRD CCG Board Secretary / Corporate Governance Manager Head of Finance Questions to the Governing Body Question 1 from Anne Veart: As you know I attended your meeting of the CCG on 7 December 2017 to highlight the tremendous benefit to diabetic patients in using this Flash Glucose monitoring system. I stressed to this CCG at that meeting about the savings to the NHS by using this device and asked for the approval of the Freestyle Libre to become available on prescription to patients in the Harrogate area as HbA1c results by those using this system have shown vast improvement in blood glucose control. My understanding now is that York and Leeds have approved its use and here in Harrogate we should provide approval too. We are now at the start of a new financial year and investment now for diabetic patients will save money in the longer term. I therefore ask that this system is approved in Harrogate today. CCG Response from Dr Bruce Willoughby: Dr Bruce Willoughby thanked Anne Veart for her question and noted that the demonstration of Freestyle Libre back in December 2017 was appreciated by the Governing Body. 1

2 Similar to all other drugs and devices the CCG need to ensure it understands the impact before they are commissioned. Since December 2017, the CCG has discussed the Freestyle Libre device at its Finance, Performance and Commissioning and Committee (FPCC). The Committee looked at available evidence and agreed that there is currently not the quality of evidence of who will derive the greatest benefit will benefit the greatest. The CCG agreed to review this again and did so in March The CCG is aware of neighbouring CCGs considering the approval of Freestyle Libre and, as part of a partnership across West Yorkshire CCGs, HaRD CCG is now waiting for the outcome of this. FPCC will consider this again in April Dr Bruce Willoughby will contact Anne Veart directly once a decision has been made. The CCG acknowledges that patients are happy with the convenience of using Freestyle Libre and the CCG needs to look at the cost / benefit as a whole as the use of Freestyle Libre may free up savings in other areas. A late question was received by a member of the public, Hazel Griffiths: Hazel Griffiths expressed her concern with the lack of autism training for GPs. There is statutory guidance in respect of autism training for GPs. CCG Response from Joanne Crewe: As the question was received late by the Governing Body there was no opportunity to provide a detailed response. As such, Joanne Crewe agreed to discuss Hazel s concerns outside of the meeting, if that is what she wished to do, and asked that Hazel contacted the CCG so a convenient time for her to meet could be arranged. Patient Story Due to a technical difficulty with internet connectivity the patient story was postponed. 1.0 Apologies for Absence Apologies were received from Dilani Gamble and Dr Angela O Donoghue. It was noted that Alec Cowell, Head of Finance is attending the meeting on behalf of Dilani Gamble to provide the financial updates. Noted attendance and absence and that the Governing Body is quorate. 2.0 Declarations of Interests in relation to the business of the meeting No declarations of interest were received in relation to the business of the meeting. Noted the above. 3.0 Minutes of the Meeting held on 2 February 2018 The Governing Body reviewed the minutes of the 2 February 2018 and a number of amendments were noted. 2

3 Amanda Bloor noted that there were a few minor amendments that would be picked up outside of the meeting. Under Item 6.1 the sentence in the third paragraph should read: There are pressures within the Community Care Teams and the CCG and Harrogate and District NHS Foundation Trust (HDFT) are working together to understand capacity and demand issues and how to improve the provision of community services and support for staff. Under Item 6.2 some additional words should be inserted to describe what the desktop exercise was. Joanne Crewe will provide wording outside of the meeting. Under Item 6.3 the last sentence should be changed to the following: The main issue will be the deliverability as the 3million of savings must be realised in year. Whilst this is achievable it is also challenging and a significant risk to the CCG. Approved the minutes of the meeting on 2 February 2018 as a true and accurate record, subject to the above amendments being made. 4.0 Matters Arising from the Minutes No matters arising were noted from the meeting on 2 February Accepted the matters arising. 5.0 Reports from Harrogate and Rural District Clinical Commissioning Group 5.1 Clinical Chair Dr Alistair Ingram noted his attendance at the West Yorkshire and Harrogate Sustainable Transformation Partnership (STP) meeting. Detail of this meeting is noted in the Chief Officer report. 5.2 Chief Officer Amanda Bloor presented the Chief Officer Report and also provided a verbal update. There was an in-depth look at the STP Memorandum of Understanding (MOU) at the most recent STP workshop. The Governing Body will also be looking at the MOU at the workshop this afternoon and will provide feedback. The MOU will then be signed off by each individual CCG. The STP is looking at the consistency of the approach to referrals to bariatric surgery. As part of a wider system leadership and with colleagues from North Yorkshire County Council (NYCC) the STP looked at the approach to capital funding through the STP. Amanda Bloor noted that the Section 75 Agreement needs to be signed by CCG Chief Officers. This agreement was already in existence and supports the Better Care Fund. It was noted that the CCG is aware that purdah is currently in place and there is nothing on the agenda to contravene this. 3

4 The Communications and Engagement Report provides an update on the 360 Report. This survey is carried out on an annual basis and it forms part of the CCG s annual assessment. The headlines are positive and broadly the same or better than the previous year. The CCG has consistently performed at the top of its cluster and regional group which is impressive. There were a total of 15 out of 17 respondents from GP Practices which demonstrated good engagement. The CCG received the formal letter from NHS England regarding the Quarter 3 Impact Assessment Framework (IAF) meeting. Notwithstanding financial challenges the CCG had a very positive review and demonstrated grip on the transforming care agenda. The Quarter 4 end of year IAF meeting is scheduled for 26 April The capacity and capability review has taken place and the CCG is expecting a final report next week. Details of this report will be shared with the Governing Body. 5.3 Communications and Engagement Report Joanne Crewe presented the Communications and Engagement Report that provides an update of the recent communications, involvement and engagement work taking place across the Harrogate and Rural District CCG. The paper has changed format to enable Governing Body to be assured that the CCG is compliant with the Patient and Public Involvement statutory guidance.. Joanne Crewe noted that a new Communications Officer, Rachael Durrett, had joined the organisation. The CCG has met with NHS England to provide assurance that the processes the CCG has in place to engage with our public around mental health services are meeting statutory requirements. The CCG now has in excess of 30 patient partners who want to work on engagement pieces moving forward. This group have a workplan that is aligned to some of the CCG s strategic priorities. Amanda Bloor commented that having 30 patient partners is reassuring and the CCG will need to harness this and link their dialogue directly into the Practices. 5.4 Audit Committee Sheenagh Powell, the new Chair of the Audit Committee, noted that one meeting had taken place since the Governing Body last met in February Given the financial position, Dilani Gamble, Chief Finance Officer had taken the initiative to assure the Committee around financial systems and processes. A financial control environment assessment template from NHS England had been completed and has now been updated twice and presented to the Audit Committee. The draft Internal Audit Plan 2018/19 was received by the Committee. The Senior Management Team was asked to make some additional amendments and a final draft will be submitted to the Committee on 24 April 2018 for approval. 4

5 The Committee received the Governing Body Assurance Framework and Risk Registers and were assured that adequate processes were in place to manage risk effectively within the organisation. The Committee discussed the results of the effectiveness review and it was agreed that the Governing Body should review these results alongside those of the other Committees at a Governing Body workshop. The CCG is reaching year-end and as such two Audit Committee meetings are scheduled over the next two months. 5.5 Primary Care Commissioning Committee Kate Kennady noted that one meeting had taken place since the Governing Body last met in February The Committee on 1 March 2018 was cancelled due to the inclement weather. The meeting was rescheduled to 13 March 2018 in order to approve a number of time critical items. All other nonurgent items are being deferred to the meeting to be held on 3 May The Committee approved, in principle, the investment for Data Quality Services and agreed to discuss this item again if Vale of York CCG decide not to pursue the service from embed as it would potentially have financial implications. It was noted that following this meeting Vale of York CCG approved the investment. The Committee approved awarding a contract direct to NYNET for the provision of Health and Social Care Network connections for GP practices only, for a maximum of 3 years duration. The Committee approved entering into a competitive procurement and evaluation process alongside the Leeds CCGs and the Bradford CCGs for GP online consultations. 5.6 Harrogate Health Transformation Board Dr Bruce Willoughby provided a verbal update of the key messages from the Harrogate Health Transformation Board (HHTB). There was a presentation from North East Hampshire and Farnham CCG Vanguard which was very interesting and helpful from a learning perspective as they are a few years ahead of the Harrogate Vanguard. It is hoped that discussions will continue and further learning will be shared. There was a discussion on the progression on the integrated care green paper, Your Community, Your Care and its principles. The collaborative had a number of questions and the CCG provided responses to those. The discussion was positive and very productive. The Board received a paper on lessons learned from the Vanguard programme and talked about how to utilise the lessons learned in the development of any new model going forward. Noted the reports from Harrogate and Rural District Clinical Commissioning Group. 5

6 6.0 Quality and Operational Performance 6.1 Quality and Safety Report Joanne Crewe presented the Quality and Safety Report and noted that a detailed discussion in relation to all the information contained in this paper had already taken place at the Quality and Clinical Governance Committee prior to the paper being presented to the Governing Body for assurance. There is a national requirement that organisations should be on track for 85% compliance with Prevent training by the end of March Both York Teaching Hospital NHS Foundation Trust (YTFT) and Tees Esk and Wear Valley (TEWV) have achieved the target. However, Harrogate and District NHS FT (HDFT) are currently reporting 62% compliance. The CCG is closely monitoring this and although there has been some increase in February 2018 it is looking doubtful that the end of year target will be reached. Amanda Bloor queried Prevent training in Primary Care and whether the training could be provided through a Protected Learning Time (PLT) event. Joanne Crewe agreed the training could be done this way, however most GPs will already have Prevent training completed through their Safeguarding training. An Independent investigation, commissioned by NHSE has now been made public. The report has taken some time to be published and the family has had significant involvement in the producing of the report. There are some lessons learned within the report. Our current provider in full (TEWV) was not the provider of local mental health services at the time of the incident but they have provided an assurance statement. Some significant failures were identified in the report and have already been addressed and TEWV has mechanisms in place to stop this type of failing again. Dr Rick Sweeney queried why there was a delay in the production of the report and Joanne Crewe informed that there was a combination of reasons for the delay, including accessing information so far after the event and the patient s family choice based on some of the investigation. Dr Rick Sweeney noted that there had been difficulties in the past including bereaved families in investigation and queried how this will be handled by agencies contracted to carry out any investigations. Joanne Crewe informed that the CCG has assurance that the agency that deals with investigations will deal with any issues professionally as they are experienced in these types of reviews. Received the Quality and Safety Report as assurance. 6.2 Performance Report Joanne Crewe presented the Performance Report which informs the Governing Body of performance against the CCG s performance dashboard and reflects the national CCG Improvement and Assessment Framework (IAF). In relation to Learning Disabilities and the target number of inpatient beds the CCG is monitored against is slightly higher than expected. The CCG continues to work with partners TEWV and NYCC on this.pen pictures (individual patient profiles) are being developed and analysed to 6

7 conduct a full needs assessment for the Transferring Care Partnerships (TCP s) inpatients to help identify and commission the right community and follow on support. There is a disappointing deterioration in the Continuing Healthcare (CHC) metrics in the reported period. A significant amount is being done to improve the position, including focussed work streams, particularly streamlining the discharge to assess process with daily early morning calls taking place between the Lead Nurse at the CCG and the discharge team at HDFT. Amanda Bloor queried the Improving Access to Psychological Therapies (IAPT) position which is currently at 49.8%, just below the 50% target and whether there is an indication of what the position will be at year-end. Joanne Crewe is confident the target will be achieved by year-end. Amanda Bloor queried the Improving Access to Psychological Therapies (IAPT) position which is currently showing a recovery rate of 49.8%, just below the 50% target, and whether there is an indication of what the position will be at year-end. Joanne Crewe is confident the target will be achieved by year-end. Received the Performance Report as assurance. 7.0 Finance and Activity 7.1 Transformation and Delivery Report Wendy Balmain presented the Transformation and Delivery Report which provides an update on the progress being made on the CCG s Transformation and Delivery (T&D) Programme, including the CCG s Quality, Innovation, Productivity and Prevention (QIPP) Plan 2017/18. The QIPP plan forecast savings out-turn for 2017/18 is 3.80m against the original plan of 8.5m. The CCG has regrouped its priorities under 4 key areas for 2018/19 and there is a continued focus around demand management. Referrals from Primary Care to Secondary Care have been maintained and in the context of having an aging population the CCG is doing well. Medicines Management are delivering against their programme of work and have now appointed two practice based pharmacists. Their roles will focus on care homes and medication reviews. A response to Your Community, Your Care principles, outcomes and scope has been received from the provider collaborative and a reply developed providing CCG clarification on several areas. The CCG is pleased with progress however there is still a real challenge to delivery. The recent adverse weather conditions have presented particular challenges for local health and social care services. A&E 4 hour targets are slightly under trajectory however over the Easter period the CCG achieved 95% on each of those days which is a very good position to be in. The local Trust is in the top 15 around the country on performance in this area. Winter conditions are expected to extend longer than anticipated however social care partnerships have been helpful in alleviating pressure on the system. 7

8 Amanda Bloor queried the A&E 4 hour position which is currently at 94.1%, just below the 95% target and whether there is an indication of what the position will be at year-end. Wendy Balmain is confident the target will be achieved by year-end as the unvalidated data is currently at 95%. Wendy further noted that the Trust has been taking diverts from York and this is now coming to an end so there should be a further reduction in waiting times moving forward. Amanda Bloor queried the extended access pilot and whether the capacity in the right place and if there are any duplications. Wendy Balmain informed that the pilot only went live in December 2017 and take-up is still growing. The CCG is undertaking a survey in April 2018 to understand the impact on practices and patients. The CCG will also engage with practice patient participation groups where appropriate. The feedback from this will inform the ongoing model beyond the pilot phase of the service. 7.2 Finance and Contracting Report In the absence of Dilani Gamble, Chief Finance Officer, Alec Cowell, Head of Finance presented the Finance and Contracting Report and noted that the CCG is reporting a position as expected. The year-end guidance from NHS England states that the 0.5% non-recurrent risk reserve held in CCGs and the Category M rebate held nationally will be released to the CCG at month 12. Following this, the CCG forecast position at month 12 will be reduced to a deficit of m. Sheenagh Powell commented that 0.5% in NHS England guidance does not need to be budgeted for the next financial year Sheenagh further noted that the CCG is in a good position to have consistently reported the position and achieve it. Received the Finance and Contracting Report as assurance. 7.3 Finance plans In the absence of Dilani Gamble, Chief Finance Officer, Alec Cowell, Head of Finance presented the Finance Plan which is a refresh of the two year financial plan signed off at 6 April 2017 Governing Body meeting. It incorporates the impact of the updated planning guidance, revisions to reflect expenditure in 2017/18 and refreshed NHS England business rules and requirements. The CCG needs to ensure there is no increase in the accumulative deficit and further work needs to be done following feedback from NHS England on the draft plans submitted by the CCG. Alec Cowell noted that the first and last bar chart in the report should be read as overspend. In relation to Mental Health Investment Standards, Sheenagh Powell recognised that the CCG is already meeting this standard and expectation for next year. Amanda Bloor informed that the CCG is committed to mental health investment in Harrogate and the work commissioned has allowed the CCG to be in its current position. Amanda Bloor noted that work on the Aligned Incentive Contract (AIC) focusses the CCG and HDFT to work better together. The risk is now significantly less than last year and whilst there are 8

9 still some gaps the CCG is in a better position. Sheenagh Powell agreed that the CCG has some breathing space and although we still need to deliver, this is a good position to be in. Dr Rick Sweeney queried the new Commissioner Sustainability Fund (CSF) to enable CCGs to return to in-year financial balance and the implications of the 10m funding if this control total is not delivered. Amanda Bloor informed that if the CCG does not achieve a year-end control total of 10m deficit then the CCG will not be able to access any additional funding. The CCG will not be penalised if it achieves a total year-end control total under the 10m. Amanda Bloor noted that the Governing Body will go through of this report in a significant level of detail at the workshop in the afternoon which will be helpful. Received the Finance and Contracting Report as assurance. 7.4 QIPP Quality, Innovation, Productivity and Prevention (QIPP) Plan 2018/2019 Wendy Balmain presented an update on the CCG s QIPP Plan for 2018/19 and describes what the CCG must deliver and the scale of the challenge. The paper describes that 2.6m must be identified and delivered against in the QIPP Plan for 2018/19. The paper does not include Continuing Healthcare (CHC) as further information is required to understand the detail of the potential for savings in this area. The CCG is conscious that when it looks at areas of spend some areas are not eligible for QIPP, for example those areas that are in a block contract and mental health where the CCG is committed to supporting the delivery of improved outcomes. Demand management will continue to be an important part of delivering an affordable healthcare system and how the CCG supports people to receive high quality healthcare but in the right time and at the right time. Amanda Bloor supported this position and noted that detail of the QIPP schemes are being led through the Transformation and Delivery Board. In order to succeed the CCG must have a joint approach with the Trust and people thinking in a new way. Dr Bruce Willoughby agreed and emphasised that as leaders we must recalibrate the way we think and this will be a real challenge. Amanda Bloor feels it would be helpful to organise a further GP and consultant event to explain this new culture and way of thinking. Wendy Balmain agreed that clinical engagement from GP Practices and HDFT is critical. The CCG and HDFT also need to consider how front line staff can be supported. It was noted that HDFT are putting in resources in order to support an Organisational Development Plan. Approved in principle the QIPP Plan and delegated authority to FPCC to approve the remaining QIPP schemes once savings estimates are finalised. 9

10 8.0 Strategy and Planning 8.1 EPRR Associated Plans and Strategy Joanne Crewe presented the Emergency Planning, Resilience and Response Core Standards Assurance Strategy and Policies paper. The CCG has completed a self-assessment which was brought to the Governing Body in October The Governing Body were sited on a number of actions that needed to be completed in order to move the CCG from partial to full compliance. A significant amount of work has now been completed to ensure that the approach is robust. Agreed that the plans and strategy represent a comprehensive approach to emergency planning, resilience and response for the CCG and, as such, approved the associated documentation. Governance 8.2 HaRD Governing Body Committees Annual Report Dr Alistair Ingram presented the Governing Body Committee s Annual Report The report covers the work of the Governing Body Committees of NHS Harrogate and Rural District Clinical Commissioning Group (HaRD) for matters relating to the year The report will form part of the CCG s Annual Report, Annual Governance Statement and Annual Accounts Received the Governing Body Committee s Annual Report as assurance. 8.3 Quality and Clinical Governance Committee Report Dr Sarah Hay presented the Quality and Clinical Governance Committee (QCGC) report. The QCGC, which is accountable to the CCG s Governing Body, provides assurance on the quality of services commissioned and promotes a culture of continuous improvement and innovation with respect to safety of services, clinical effectiveness and patient experience. Two Committee meetings have taken place since the Governing Body met last in February In addition to the detail included in the report, Sarah provided a verbal update. There have been some significant improvements made around Continuing Healthcare (CHC) framework adherence. E. Coli infection remains an issue however it is not out of step with other systems and there is a plan in place to monitor this and improve the situation. The Committee reviewed the Serious Incidents, Concerns and Complaints policy which will be brought to Governing Body for approval.. Noted the key messages as assurance from the Quality and Clinical Governance Committee. 10

11 8.4 Finance, Performance and Commissioning Committee Report The Finance, Performance and Commissioning Committee is accountable to the CCG s Governing Body and provides assurance on financial issues relating to the CCG. The Committee also provides assurance on the delivery of the QIPP programme, reviews the performance of the main services commissioned, receives commissioning proposals and business cases, and undertakes analysis and makes recommendations to the Governing Body. Two Committee meetings have taken place since the Governing Body last met in February In addition to the detail included in the report, Dr Bruce Willoughby provided a verbal update. The Committee reviewed its annual effectiveness and actions to be taken forward. The Committee continued to review the CCGs financial position. Noted the key messages as assurance from the Finance, Performance and Commissioning Committee. 9.0 Minutes of the Governing Body Committees to be Discussed by Exception 10.1 Audit Committee 28 November 2017 No issues were raised Primary Care Commissioning Committee 2 November 2017 No issues were raised. Noted the above Any Other Business No items were raised Next Meeting Thursday, 7 June 2018 Ripon Community House, Sharow View, 75 Allhallowgate, Ripon HG4 1LE 10:00 12:30 Noted the above. 11

12 Appendix A NHS Harrogate and Rural District Clinical Commissioning Group Actions from the Governing Body meeting on 5 April 2018 Meeting Date Item Action Responsibility 5 April Minutes of the Meeting held on 2 February 2018 Minutes to be amended from 2 February 2018 Sasha Sencier Action Completed / Due to be Completed (as applicable) COMPLETE 12