Governing Body 23 January 2018

Transcription

1 Paper 01 Governing Body 23 January 2018 Minutes (confirmed) Subject Governing Body of Coastal West Sussex Clinical Commissioning Group Date 23 January 2018 Time 09:30 12:30 Venue 1 The Causeway, Goring by Sea Chair Kieran Stigant Member Position Present Kieran Stigant (KSt) Lay Chair Dr Katie Armstrong (KA) Clinical Chief Officer Margaret Ashworth (MA) Interim Chief Financial Officer Anna Raleigh (ARa) Director of Public Health Dr Louise Baverstock (LB) Locality Director Regis Mr Ralph Beard (RB) Independent Clinical Member: Secondary Care Clinician Dr Richard Brown (RBr) Local Medical Committee Representative Jayam Dalal (JD) Lay Member Dr Yvonne Grant (YG) Locality Director - Arun Alison Lewis-Smith (ALS) Lay Member Chris Moore (CM) Lay Member Dr Alex Rainbow (AR) Locality Director Chanctonbury In Attendance Alison Cannon Chief Nurse Item 17/28 Sarah Henley (AF) Head of Urgent Care Item 17/29 Amanda Fadero (AF) Wendy Lewis (WL) Ralph McCormack (RM) Zoe Smith (ZS) Sally Walker (SW) Programme Director Deputy Locality Director - Adur Executive Lead for Stabilisation and Transition Acting Company Secretary (Minutes) Deputy Locality Director - Arun

2 Questions from the Public Kieran Stigant (KS) referred members to responses to questions received from the public in advance. These had been circulated and were also available to members of the audience. Peter Adamson asked when diabetes work would start. Ralph McCormack stated that this was likely to be in May/June There were no further questions from the audience. 17/25 Introduction Welcome, apologies and declarations Kieran Stigant (KS) welcomed all in attendance to the Governing Body. Apologies were received from Dr Katie Armstong. Pending a formal appointment to the CCG s Accountable Officer role, Ralph McCormack was stepping in as Lead Executive. Apologies were also received from Dr Yvonne Grant and Ralph Beard. Sally Walker, Deputy Locality Director, was attending in Yvonne Grant s place KS announced appointments to Locality Director roles for Adur (Dr Jo Monjardino) and Chichester (Dr Ned Ford) to start from February and welcomed Anna Raleigh, new WSCC Director of Public Health. Kate Bailey was thanked for her contribution as Public Health Consultant pending the Anna Raleigh s appointment The meeting was confirmed as quorate. There were no declarations of interest in relation to agenda items. Minutes and actions of the meeting 28 November The minutes from 28 November 2017 were accepted as an accurate record of the meeting. Jayam Dalal (JD) commented that, in relation to item 20.16, the assessment rating was not supposed to be in the public domain although the CCG had not been advised of this until after the meeting Alison Lewis-Smith (ALS) asked if there was any update on the development programme or appointments. Ralph McCormack (RM) referred to the delay in receiving confirmation of Chief Officer arrangements, noting that the appointee will need to make sure the CCG has the right executive capacity. The CCG s business planning process will align wider resources to key priorities Action 25 had not been carried across to the Action Log. Post meeting note: Action 25 has been added to the Action Log It was noted that Performance should come ahead of Finance on the agenda. This would be reflected in future agendas. Action Log The action log was reviewed and members agreed the actions for closure. In relation to Actions 24 and 30 Margaret Ashworth (MA) confirmed that the stakeholder workshop on 1 st February would progress the CCG s understanding of the need for estate for its population. There would be a report to the Governing Body in March. Executive Update 1.09 RM presented the Executive Update. The local health system was still under significant and persistent pressure and this was likely to continue for several weeks. Escalation calls were taking place daily, with a weekly chief officer call to unblock patient flow. The CCG 2

3 acknowledged the demands being placing on clinical practitioners and thanked colleagues for their continued efforts Chris Moore asked about social care in relation to Delayed Transfers of Care (DTOCs). It was confirmed that 3% level of DTOCs had been maintained which was good given the conditions. The main issue was flow resulting from the acute provider s inability to discharge due to high levels of acuity and lack of suitable facilities in non-acute environments. An additional 616k of winter resilience funding prior to Christmas had been used to bolster community beds to assist with flow The CCG s 2016/17 Improvement and Assessment Framework rating of Good for diabetes reflected the hard work and effort of colleagues. There was more work to do and the CCG would not rest on its laurels The CCG s Financial Recovery Plan (RFP) had been acknowledged in writing as a strong plan and was being used as an exemplar for other CCGs, although there was still a distance to travel to full recovery. CWS had been invited to join a new NHSE programme to improve commissioning capacity and capability. Five CCG leaders along with colleagues in partner organisations would engage in a 12 week programme to help strategic and operational planning and implementation to support continued sustainability and recovery Accountable Officer interviews had been held and an outcome was awaited from Simon Stevens, Chief Executive of NHSE. The CCG had been successful in appointing Dr Su Stone as Clinical Chair. Dr Stone was currently Deputy Medical Director at Sussex Community Foundation Trust and a locum GP, having previously been a Clinical Lead for the CCG. ALS asked about recruitment of a substantive CFO. RM reported that although recruitment in June 2017 had identified a preferred candidate, the CCG had been unable to unlock the financial package sought therefore unable to confirm the appointment. Options were being discussed with NHSE. The CCG had not given up on having a substantive Chief Finance Officer but would need to find a pragmatic solution Integrated urgent care was a key programme in relation to system transformation to support better care in the right place. The CCG was cognisant of the challenges ahead and remained committed to making changes for the benefit of the population. Development of Local Community Networks (LCNs) and aligned incentive contracts were the first steps and evidenced the CCG s progress and recovery. Other commissioners were looking to learn from the CWS experience and the expectation for 2018/19 was that lead commissioners would pursue aligned incentive contracts with the main providers ALS voiced concern about the impact on the patient of Clinically Effective Commissioning and asked about Sustainability and Transformation Partnership (STP) arrangements to get feedback from patients. Action 31: The Public Engagement Committee to receive assurance of STP engagement arrangements for Clinically Effective Commissioning (JD) BAF and Escalated Risks As agreed in November the Board Assurance Framework (BAF) was now being used to structure Governing Body agendas. Sections 2 to 6 on the January agenda corresponded to the BAF s principal business objectives. The complete BAF was presented as part of papers, as well as a summary of the principal business objective under the relevant section of the agenda. The January 2018 BAF was not materially different to the version presented in November 2017 and would continue to be a work in progress. 3

4 25.17 The risk heat map highlighted risks scored 15 or above pre-mitigation, shown at the postmitigation score. The intention of this was to give Governing Body clarity about of the most significant risks to the CCG CM commented on the absence of risks from the top right corner of the heat map given the challenges facing the CCG. 17/26 Principal Business Objective 1: Recover and stabilise the CCG's Position BAF Summary RM summarised the Principal Business Objective 1 around recovery and stabilisation and delivery of the CCG s financial requirements. Finance Report MA presented a summary of the detailed report that had been to the Finance and Performance Committee. The CCG had an operating plan deficit of 15.4m and an agreed forecast outturn deficit of 22.3m which it was on track to deliver. Delivery now rested upon delivery of Quality Improvement Productivity and Prevention (QIPP). The QIPP gap was revised and reviewed each week by the CCG s Recovery and Stabilisation Board. In addition to actions which could be taken in terms of QIPP delivery there were also some one-off actions that could be taken. These were auditable and legitimate but non-recurring and would therefore make it harder for next year. The report outlined adverse and favourable variances, the reasons for which had not changed and would not change before the year end. The CCG s cash position was no longer of concern as the CCG now had maximum cash drawdown based upon its forecast outturn deficit of 22.3m rather than its operating plan deficit of 15.4m. The CCG was on track not to be holding more than 1.25% of this cash drawdown at the end of the year CM thanked MA and the team noting that the CCG was in a much more stable position now than in the last 18 months. Executives were to be commending for stabilising and clarifying the CCG s position. CM expressed serious doubts that break-even over 2018/19 was achievable and noted that there was not a recovery plan critical success factor on the BAF, making the BAF weak in this area. Action 32: Financial Recovery Plan critical success factor to be added to the Board Assurance Framework (RM/MA) MA acknowledged that it would be demanding and challenging to get back to break-even. RM noted that meeting the QIPP requirement for break-even would be a substantial achievement in a single year. The CCG needed to identify what could be achieved and what risks there were to its achievement. This would form the basis for a conversation with NHSE and the CCG was in the process, through the business plan, of developing a level of clarity about that. The CCG should be realistic about what could be achieved and how risk could be managed to ensure deliverable. Stabilisation and Transition Action Plan RM presented an update on the Stabilisation and Transition Action Plan, noting that the process for the Accountable Officer appointment had been run and the outcome was awaited. Following Gill Galliano s appointment as Lay Member for Finance and Performance/Finance and Performance Committee Chair, the committee s processes would be reviewed and there may be changes as a result leading to a review of action 8 s amber status. Work by Clarity on clinically effective commissioning had been extended to the end of February by mutual agreement of 4

5 Sussex commissioners. This was to support policy development for Tranches two and three which would be brought forward to the Governing Body through proper process. Further to ALS earlier comment, Alex Rainbow (AR) sought assurance that Clarity were on board with the need for patient engagement. Action 33: Stabilisation and Transition Action plan to be reviewed to better reflect actual RAG status and current action owners (RM) Coastal West Sussex Business Plan Amanda Fadero (AF) joined the meeting to update the Governing Body on progress with the CCG s draft 2018/19 business plan. Reflecting on earlier discussions, AF highlighted the need to answer questions posed regarding the CCG s level of confidence, how to ensure patient engagement is central and how to drive up quality as well as delivering the finances AF noted that although CCG was due to deliver its revised forecast outturn for 2016/17 there had been significant changes in the system which had influenced the CCG s approach this year. These changes needed to be integrated into planning for 2018/19 as would NHSE Planning Guidance when released. Threaded throughout the plan was the CCG s commitment to deliver accountable care and focus on population health, using every pound wisely. The plan therefore covered the totality of the CCG s spend in an integrated way, and was aligned to the CCG s ambition, mission and vision on behalf of the population The duty to break even would require savings of 44.1m in 2018/19 and within the draft plan there were good plans to secure 15m of this, as well further opportunities identified with substantial clinical engagement. Over 100 potential opportunities identified through Clarity/capped expenditure/rightcare had been reduced to opportunities still to be explored. The Business Plan 2018/19 integrated the Coastal Care Delivery Plan presented in November 2017; it encompassed how the CCG would manage the ongoing development of the Accountable Care Partnership and the future of commissioning AF talked members through the 2018/19 Business Plan Update. The Governing Body was asked to note the financial challenge, the progress to date in identifying and defining schemes to bridge the gap and the timeline ALS gave thanks for a comprehensive piece of work and asked about the impact on quality and on the patient. These were implied in the draft Business Plan presented but were not explicit. AF confirmed that Quality Impact Assessments were scheduled as part of the Project Initiation Document (PID) process and plans-on-a-page were being reviewed before progression to PID to ensure that the CCG was not working up projects where there might be an unacceptable impact Gill Galliano (GG) asked whether PIDS been developed for the 15m already identified. AF confirmed that there were seven PIDS, five for mental health, one for aging population and one emerging for urgent care. MA clarified that, of the 15m, 3.3m was the full year effect of schemes already in place GG asked about investment to get schemes of the ground. AF responded that there was no assumption of investment in 2018/19 in line with the Financial Recovery Plan but that investment was planned for 2019/20 when enablers and infrastructure would be in place JD asked about patient and public engagement. AF gave assurance of robust engagement on schemes in the 15m, noting that many of the plans were works in progress. Opportunities, however, had not yet been subject to engagement. Action 34: Ensure that quality and patient and public engagement are more explicitly referenced in the 2018/19 Business Plan and that there is a link between business planning and E&D strategy (AF) 5

6 26.14 CM gave congratulations on a more developed approach than in previous years asking when the Governing Body would see what the CCG thinks possible as opposed to what is required. AF referred to the Governing Body s development session on 27 February as giving members the opportunity to review prior to the March formal Governing Body meeting There was discussion of whether the CCG would align to the STP or whether the STP would align the Coastal place-based plan. AF confirmed that she was meeting with the STP to understand how it could help with the enablers (IT, workforce, digital) required by the Coastal plan. This was in addition to regular CCG attendance at STP Executive and Programme Board meetings. CM asked whether arrangements for CWS representation were sufficient to ensure that STP plans reflected the requirements of the CWS population. Richard Brown (RBr) noted that there were 24 organisations within the STP each of which would have similar concerns. Expectations therefore needed to be realistic. AF commented that the new STP Chair, Bob Alexander, had not yet shaped the STP s direction and the CCG would seek to work with the STP in a way which delivered its plan JD raised the governance structure of the STP. CM noted that the Governing Body had seen a proposal for the governance model for the STP under its old leadership. AF confirmed that the new leadership was reviewing the governance model and part of her meeting with Bob Alexander would be to look at how STP governance would support the four place-based plans across the footprint. With the exception of acute services reconfiguration, the STP had no other plan of its own apart. Action 35: Governing Body (through the Executive) to have sight of the emerging revised governance model for the STP (RM) MA presented the financial analysis. The bridge diagram showed the journey from the 30.9m 2017/18 original deficit plan to 2018/19 year end break-even. Within that there was still a need to plan for contingency and reserve and if these were not required under NHSE planning guidance then this benefit would be ring-fenced to offset cost pressures. There was a savings requirement to achieve break-even of 44.1m and the CCG would show how it could achieve that figure with all risks mitigated as well as the value of any unmitigated risk. Provider negotiations were still to be concluded and there would be an element of QIPP delivery within contracts although the CCG could not assume 24m in the Western Sussex Hospitals Foundation Trust (WSFHT) Aligned Incentive Contract (AIC) next year. Work was ongoing to deliver further detail and this would be worked up for 27 February, including work on enablers CM sought confirmation that 2018/19 activity growth shown was based on national planning guidance and noted that the financial analysis presented was contingent on the CCG s 2017/18 year-end position. MA confirmed that the forecast outturn was set, although how it was delivered would impact on next year The potential impact of 2016/17 challenges with WSFHT was raised. This was noted as a cost pressure within the analysis. Gill Galliano (GG) commented on the challenging 5.6%/ 44.1m QIPP requirement and asked about scope to discuss with NHSE. MA reported an expectation from NHSE that the CCG should plan for break-even as this was what was in its agreed Financial Recovery Plan. However the plan, which would need to formally submitted following the March Governing Body meeting, should also show all the risks and mitigations. CM reminded members that CCG QIPP achievement had rarely exceeded 3% in recent years Dr Alex Rainbow (AR) suggested that specialist commissioning should have its own section of the forecast outturn split by area of spend pie chart and asked about the impact of the CWS demographic. To what extent did this inform CCG AIC negotiations and other plans. Work was 6

7 in progress to and it was acknowledged that more should be done to highlight and reflect this in the CCG s commissioning plans RBr asked about the Better Care Fund minimum contribution of 33.5m. The Indicative Financial Plan showed it as just over 14.5m. MA committed to clarify. Post meeting note: An was sent to Governing Body members on 23/01/18 clarifying that the forecast of 14.5m in 2017/18 and plan for 2018/19 of 14.9, related only to the cost of services within the Better Care Fund that were provided by, or paid for directly by, WSCC and confirming the CCG s total contribution in line with Planning Guidance AF highlighted the summary of RightCare data and alignment with CCG projects along with the table showing the indicative impact of programmes on both disease and point of delivery. This was important in informing how incentives were aligned in contracts and shaping transformation of delivery. The joint commissioning review currently underway was also highlighted. This would look to maximise the impact of joint commissioning spend and would report at the end of February Enabler transformation programmes such as workforce were highlighted using the example of diabetes. Diabetes nurses working together in a connected, LCN rooted way would drive community-based benefits for patients. LCNs and the Future of Commissioning were key enablers to how the CCG would work over 2018/19. They were not loud in the current iteration but would be developed for the March version An indicative heat map of risk was included. The intention was to work with the Governing Body to develop the heat map once a more robust plan was in place AF summarised next steps, including incorporating comments made at this meeting Anna Raleigh (ARa) commended the work, particularly the clear narrative and the section on prevention. Clarity was needed regarding circulatory disease and the plan could be more explicit about prevention interventions AF and colleagues were thanked for their work on the Business Plan 17/27 Principal Business Objective 2: Be the best in the country at caring for older people with chronic diseases, multiple conditions and frailty BAF Summary RM introduced the item, noting the intention to review the performance report which gave broader insight into CCG delivery. Performance Report The detail of the Performance Report was presented as an appendix. All cancer targets had been met in November and all seven targets were achieving the national threshold on a cumulative basis. The Improving Access to Psychological Therapies (IAPT) recovery rate was in the top quartile for the CCG s peer group. However, the CCG was not compliant on RTT for the fifth consecutive month and would continue to be non-compliant for at least two more months. The CCG was also non-compliant with the A&E target for December MA suggested bringing back the briefing notes discussed at the Finance and Performance Committee to the main body of the Governing Body to give more substance to the item CM cautioned against bringing too much detail back to the Governing Body. Financial and other performance should to be looked at in the context of principal business objectives. RM agreed that content discussed by the Governing Body needed to more accurately and appropriately reflect the intention of the stated objective. 17/28 Looked After Children (reordered agenda) 7

8 28.01 Alison Cannon (AC), STP Chief Nurse, joined the meeting to present an update on Looked After Children (LAC). AC assured the Governing body that a new designated nurse would start from 1st April. The previous post-holder had reviewed service specifications and these were now out for comment on an STP-wide basis. A project manager would be appointed for six months to review commissioning for out of county LAC and asylum seekers, ensuring that statutory requirements had been met and quality standards achieved. An annual report would be produced covering the progress of commissioning responsibilities for LAC once the new designated nurse had taken up her post ALS thanked AC for the update, reporting that the Quality Committee (QC) had been raising these issues for some time. Joint commissioning and wider stakeholder issues had been difficult to penetrate. The Audit and Assurance Committee (AAC) and the Quality Committee had both now reviewed the work in progress which would hopefully move at a reasonable pace. AF noted that PwC work on joint commissioning would focus on three key areas, one of these being children and young people CM commented that it was excellent to know that progress was been made and highlighted the concern raised by AAC in relation to how the CCG receives assurance where it has delegated to a lead commissioner, and how it gives assurance where it is the lead commissioner. Action 36: The CCG to give consideration to how it receives assurance on joint commissioning arrangements led by others, and how it reports to others where it is the lead commissioner (RM) AR requested an update on initial health assessments for out of area children. AC confirmed that the Project Manager would look at how this was commissioned and delivered. This was the highest risk for LAC and was on the risk register The Chair thanked AC, noting that while it was good to hear about process improvements, what the CCG really wanted to see was improvements in outcomes for Looked After Children and this should be reflected in reports. 17/29 Principal Business Objective 3: Integrate Care BAF Summary RM introduced the item focusing on the implementation of integrated urgent care and an update on proposals for the integrated urgent care model. Urgent Care Model Sarah Henley (SH), Strategic Lead for Urgent Care, joined the meeting. There had been a huge amount of engagement looking at the CWS population and the urgent care needs of the population. A comprehensive piece of work had been undertaken with clinicians and partners by Vickie Beattie, the Clinical Lead for Urgent Care, and c. 6,000 responses had been received to the CCG s survey about what frustrates people with regard to urgent and primary care The CCG had an ambitious vision to bring together the four services which will exist in future into one contract to remove barriers to patients in trying to get an appointment. Two of these were mandated - GP extended access between 6.30 and 8pm and at certain times over weekend, and the development of urgent treatment centres (UTCs). The other two services were the out of hours visiting service and out of hours clinics. The CCG had completed extensive demand and activity profiling and understood the urgent care need of the population and where they go. 8

9 29.05 Next steps, in addition to undertaking Quality and Equalities Impact Assessments, included understanding where the new Urgent Treatment Centre and GP Extended Access Hubs should be located and completing financial modelling. There were some must do s for example, patients needed to be able to access primary/urgent care in local facilities up until 10pm, the needs of the rural population needed to be addressed particularly near CWS boundaries and in the North West of Coastal West Sussex. A business case would be developed including phases of implementation to different deadlines The CCG was working with other CCGs as part of the 111 projects and the Coastal model would align with NHS 111 as part of a comprehensive service. There was however a point of difference with other CCGs in that the CWS model included the visiting service in the local model. The clinical view in CWS was that this model was right for the population although delivery would need to be determined in sync with the 111 Programme Board JD commented that the Integrated Urgent Care Communications Plan that had come to the Public Engagement Committee had not included the same level of detail as the report now presented to the Governing Body and that this was complex model for patients to understand. It was acknowledged that this was a complex area of work. However the proposed model was simpler than the current model and would minimise any risk of confusion with one handoff from 111 into a single local model rather than many handoffs into individual services Concern was expressed in relation to procurement and it was confirmed that that Integrated Urgent Care would come to the Governing Body again prior to procurement to assure the robustness of the process proposed. Risks would be worked through in the business case including staging delivery and communications and it was important that the Governing Body understood the linkage with the 111 procurement There was discussion of the difference between convenience and need for patients and the additional cost of convenience. Demand and activity modelling would be crucial and the CCG would need to communicate the need to balance convenience and cost. Patient engagement through practice PPGs was needed although, as the CCG s survey had shown, the majority were prepared to travel for urgent care need AR highlighted that, as a GP partner, he could have a conflict of interest in any discussions about procurement of the proposed model Given the difference between the CWS model, which works locally and has clinical support across the CWS health economy, and the model being procured by other Sussex CCGs, members considered how CWS would ensure that its programme was not blown off course. SH noted a small chance of this in relation to the visiting service. If the CCG was not able to implement its plan for the visiting service initially, it would be phased into the local model GG noted the tight timetable for procurement and sought assurance that the CCG was taking procurement advice. SH confirmed that procurement advice was being taken from the same team as for 111 so that the procurement team understood both models. The CCG was doing all it could to understand the market and would be open and transparent to avoid the potential for challenge, applying lessons learned from elsewhere in the country. 17/30 Principal Business Objective 4: Outstanding capability to manage demand BAF Summary RM introduced Principal Business Objective 4, noting two areas of activity. The first being activity outside of the AIC, and the second to deliver Clinically Effective Commissioning objectives. Members discussed whether the BAF summary captured what the CCG needed to do to demonstrate outstanding capability to manage demand. It was noted that further work was needed on the Critical Success Factors to describe how the CCG would meet the objective. 9

10 Action 37: BAF critical success factors to be reviewed at a Governing Body development session (RM) Clinically Effective Commissioning: Rhino/septoplasty The Tranche One policies approved by the Governing Body in November excluded Rhino/septoplasty due to further work needed. This had now been through due process and Governing Body approval was sought to add in to the Tranche One suite of policies The policy specified those procedures that would not routinely be funded and excluded facial trauma and relevant parts of the cancer pathway. The CCG would continue to commission rhino/septoplasty for those JD expressed concern that this had not been to the Public Engagement Committee. ALS noted there was lay membership at the Clinical Effectiveness Committee AR asked how this would apply in practice and sought clarification of what this meant for primary care. RBr noted that GPs should not refer for particular procedures but for an opinion KSt asked about cost implications. RM confirmed that the policy would ensure that procedures satisfied requirements therefore eliminating inappropriate activity. Some reduction in cost could be expected as a result. Decision: The rhino/septoplasty policy was approved, subject to clarification that primary care referrals should be for an opinion and not for a particular procedure. 17/31 Principal Business Objective 5: Develop the Coastal West Sussex Health System BAF Summary RM noted that there was no specific agenda item relating to this objective at this meeting. There may be something in March further to the conclusion of PWC s work on joint commissioning. This should establish county-wide priorities for joint commissioning between health and care and contribute to a more integrated system for residents and patients CM stated that he would expect to see plans and strategies for the future of commissioning as well as updates on Accountable Care within this section. RM committed to bringing more on this to the March Governing Body meeting. 17/32 Assurance Clinical Innovation and Strategy Committee The report of the Clinical Innovation and Strategy Committee was taken as read. Finance and Performance Committee GG gave specific assurance in relation to the CCG s cash position. Primary Care Commissioning Committee CM updated the Governing Body in Ralph Beard s absence. The Chair was revisiting the purpose of the Committee to ensure that the primary responsibility of the Committee was to manage conflicts of interests of decisions in relation to primary care commissioning. The Chair was also focussed on matters coming to the Committee earlier and avoiding the risk of the committee being asked to give post-hoc assurance. Public Engagement Committee 10

11 32.04 JD made some verbal corrections to dates featured in the report of the Committee and reported that the CCG was waiting for permission from NHSE to publicise its recent good rating for patient and public involvement on the Improvement and Assessment Framework Feedback from NHSE had been that there needed to be a clear link evidenced between its Equality and Diversity strategy and commissioning plans, that there needed to be more interactive forms of information on the website and more evidence of demographic modelling. The CCG would look to implement these as part of its public engagement approach. The Committee s terms of reference had been updated to include ensuring that the requirements of the Equality Act 2010 are embedded within the commissioning process and to include LCN representation in the membership. Quality Committee ALS reported assurance of the current process. The Committee meets bi-monthly with meetings of the Chair and Head of Quality in the intervening month. It was noted that that the STP Chief Nurse had referred to it as the Quality and Performance Committee and this might be an opportunity to further develop the quality agenda alongside the wider strategy and structure. The Looked After Children issues referred to in the Committee report had already been dealt with Remuneration Committee KSt confirmed that the January 2018 Remuneration Committee had looked at the practical implications of the leadership changes previously referred to CM questioned why there was no Committee report for the Audit and Assurance Committee. Post meeting note: The November meeting of the Audit and Assurance Committee was reported to the November Governing Body and there had been no meeting of the Audit and Assurance Committee since November. On future agendas it will be made clear where this is the case. Meeting closed. Signed Kieran Stigant - Coastal West Sussex Clinical Commissioning Group Dated: 11