Governing Body 22 May 2018

Transcription

1 Paper 01 Governing Body 22 May 2018 Minutes (confirmed) Subject Date 22 May 2018 Time 09:30 12:30 Venue Chair Governing Body of Coastal West Sussex Clinical Commissioning Group Shaftsbury Room, Worthing Leisure Centre Dr Su Stone Member Position Present Dr Su Stone (SS) Chair Margaret Ashworth (MA) Interim Chief Financial Officer Dr Tej Bansil (TB) 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 Adam Doyle (AD) Accountable Officer John Eagles (JE) Lay Member Audit and Governance (Designate) Dr Ned Ford (NF) Locality Director Chichester Gill Galliano (GG) Lay Member Dr Rob Henderson (RH) Locality Director Cissbury Alison Lewis-Smith (AL-S) Independent Clinical Member Dr Jo Monjardino (JM) Locality Director Adur Chris Moore (CM) Lay Member Dr Sarah Pledger (SP) Locality Director - Arun Dr Alex Rainbow (AR) Locality Director Chanctonbury Anna Raleigh (AR) Director of Public Health In Attendance Amanda Fadero (AF) Dominic Wright (DW) Zoe Smith (ZS) Director of Transition Managing Director Acting Company Secretary

2 Questions from the Public Dr Su Stone (SS) explained changes to the procedure for the public to raise questions at Governing Body meetings. Members of the public present were asked if they wanted to raise any questions in addition to those submitted in advance. Peter Adamson asked for an update on the diabetes patient education programme. Amanda Fadero (AF) noted that this was a priority programme in the 2018/19 Business Plan and committed to further communication with Mr Adamson during June Ian Strand referred to his previous comments regarding the font size in Governing Body papers and asked that the CCG review the format of its Governing Body papers to ensure they are accessible to all. It was also suggested that Governing Body meetings be given more prominence on the CCG s website. SS outlined two questions which had been submitted in advance. John Gooderham had asked about the Cancer Alliance. SS noted that the CCG was part of the Cancer Alliance commissioned by NHS England (NHSE), that it supported the recommendation of that group and noted that the timescale was for completion by More news would be issued by the CCG as the 2021 deadline approached. Jan Birtwell had asked about Coastal Care governance. SS noted that Coastal Care was a way of working between statutory organisations which all had their own governance. There was no separate governance structure for Coastal Care. As a supplementary question, Jan Birtwell asked whether the CCG was still working towards Coastal Care. AF referred to the CCG s 2018/19 Business Plan which outlined the CCG s Coastal Care transformation programmes. Organisation form was not part of the current conversation in relation to Coastal Care. 18/01 Introduction Welcome, apologies and declarations Dr Su Stone (SS) introduced herself as the CCG s new Clinical Chair. There were introductions around the table and new members were welcomed to the Governing Body, including Adam Doyle, the CCGs new Accountable Officer The Chair thanked Chris Moore and Margaret Ashworth, noting that this would be their last CWS CCG Governing Body meeting Apologies were received from Dr Jo Monjardino, Gill Galliano and Dr Richard Brown The Chair confirmed that the meeting was quorate and members were asked to raise any conflicts of interest in relation to items on the agenda. No conflicts of interest were raised. However, Ned Ford declared that Selsey Medical Practice was part of Innovations in Primary Care Ltd and Adam Doyle (AD) declared that he was also the Accountable Officer for the five CCGs that comprise the Central Sussex and East Surrey Commissioning Alliance SS stated that any for information papers presented to the meeting would be taken as read unless questions were raised by members. Action 45: Declarations made at the meeting to be added to the CCG s Register of Interests (ZS) 2

3 Minutes and actions of the meeting 27 March The minutes from 27 March 2018 were accepted as an accurate record of the meeting, subject to the amendments listed below: Reference to Jo Wadey to be corrected to Deputy Locality Director for Cissbury To read RM confirmed that the staff action plan would reflect the CCG s statutory duty to ensure compliance with NHS equality and diversity guidelines and an action to be recorded in this respect. Action 46: CWS CCG staff action plan to reflect the CCG s statutory duty to ensure compliance with NHS equality and diversity guidelines (DW) Action Log The action log was reviewed and members agreed the actions proposed for closure In relation to Action 30, members noted that the Estates Strategy would come back to GB formally in July Action 35 was discussed and members noted that the Sussex and East Surrey Sustainability and Transformation Partnership (SES STP) had no decision-making powers under statute. While in some areas, CCG Governing Bodies had devolved some powers to STPs, this had not yet happened in SES STP. Adam Doyle (AD) reported that he sat on the STP Executive as representative of the six separate statutory CCG s of which he is Accountable Officer. He had formally requested a roadmap of decisions the STP Executive might be asked to make in 2018/19 so that they could be discussed in advance with Governing Bodies. Any decisions which needed to be made in extremis would be discussed with the Clinical Chair. Jayam Dalal (JD) asked about independent members on the STP Executive and publication of its minutes. AD responded that while there was an additional oversight committee comprised of Chairs, the STP had not yet reached the stage of its evolution where there was independent scrutiny however the STP would need to keep this under review. AD agreed that minutes should be in the public domain and noted that similar requests had been made by other Governing Bodies. Alex Rainbow (AR) asked whether the Governing Body needed to mandate AD to make decisions on behalf of the Governing Body at the STP Executive. AD commented that time was needed to build trust between himself as a new Accountable Officer and the Governing Body. While he had the decision making authority of the Accountable Officer for any urgent issues this was rarely required, and he would want to ensure collective discussions as a Governing Body on most matters as the STP developed. Action 47: Governing Body development session in October 2018 to reflect on STP decision making and Governing Body involvement (SS/AD) In relation to Action 36, Dominic Wright (DW) reported that the review of joint commissioning arrangements and discussions with West Sussex County Council were ongoing. The governance of joint commissioning arrangements and would also be part of an upcoming review of CCG governance being commissioned from PricewaterhouseCoopers LLP (PwC) Action 43 relating to the remit and operation of the Primary Care Commissioning Committee (PCCC) was discussed. This would be addressed as part of the PwC governance review. Anna Raleigh (AnR) noted that the local authority was also a small commissioner of primary care services. JD asked about lay representation on PCCC. 3

4 01.14 Members agreed to close Action 44 in view of progress being made on Looked After Children arrangements and the resolution of clinical lead cover during the Clinical Lead for quality s maternity leave Dr Alex Rainbow asked about the Tranche 2 Clinically Effective Commissioning Policies agreed in January 2018 and how the Governing Body would receive assurance on implementation. Alison Lewis-Smith (AL-S) reported on discussions of clinically effective commissioning at the Public Engagement and Quality Committee and JD confirmed that PEC had reviewed engagement plans. SS described the governance process through the Clinical Effectiveness Committee which reported to the Quality Committee. AD reported that a stock take was being held of clinically effective commissioning across the STP and a paper would come to all governing bodies by September Action 48: Update on Clinically Effective Commissioning implementation to be presented to each Governing Body meeting and an STP-wide paper on Clinically Effective Commissioning to be presented to all Governing Bodies by September 2018 (AD/DW) Report of the Clinical Chair The Clinical Chair s report was taken as read. SS reiterated her commitment to the CCG and reported on plans to ensure clinical lead alignment to the CCG s Business Plan and referred to a new role for an Executive Medical Director to manage the work of the clinical leads. Report of the Accountable Officer AD presented the report of the Accountable Officer highlighting areas of focus including stabilising the organisation, developing the leadership model and ensuring a clear plan is in place to address the legal directions. The key focus would be on meeting the CCG s financial target for the year. This would be challenging, requiring the right decisions and the right level of delivery, but AD was confident in the CWS team. Board Assurance Framework (BAF) and Escalated Risks SS explained that a new Board Assurance Framework (BAF) would be developed following agreement of the 2018/19 Business Plan and budgets at this meeting. A BAF summary relating to 2017/18 was presented for information. 18/02 Committee Reports SS summarised the role of Governing Body committees. The following Committee reports were taken as read: Finance and Performance Committee Primary Care Commissioning Committee Quality Committee Public Engagement Committee JD reported that Adrian Barratt, Adur Voluntary Action s representative on the Committee, had sadly passed away. Condolences were sent to Mr Barratt s family on behalf of the CCG Voluntary Sector attendance at PEC was raised. Voluntary Action Arun and Chichester would no longer be attending as they were also at the Locality Community Network (LCN) meetings. 4

5 Action 49: Include in the governance review how the CCG ensures that the patient and public voice is heard within the CCG, including a review of PEC membership (SS) Clinical Innovation and Strategy Committee Ralph Beard (RB) gave an outline of the Committee s background and function suggesting that it might become an advisory group rather than an assurance committee. RB requested that this was addressed within the PwC governance review. Audit and Assurance Committee CM confirmed that there was no Audit and Assurance Committee paper as there had been no meeting since the last Governing Body. The Committee would next meet on Thursday 24 May Remuneration Committee SS reported on virtual approval of arrangements for the new Accountable Officer and executive team in March The next meeting of the Committee was scheduled for early July /03 Annual Report and Business Planning 2017/18 Annual Report The CCG s annual report for 2017/18 was presented for information. This would need to be signed off by Audit and Assurance Committee on Thursday in accordance with the CCG s scheme of delegation. The report recognised the hard work of Kieran Stigant and Dr Katie Armstrong and that 2017/18 had been a challenging year for the CCG. While there had been significant positive work on CCG finances, the CCG was not where they needed to be and was still spending more than its allocation. The report also recognised the work of providers, including the improved rating of Sussex Partnership NHS Foundation Trust, and the strength of the CCG s patient and public engagement JD commented that lay members had not much time to review the annual report and asked that in future there be a greater role for Committee chairs in reviewing the content in advance of the first draft being produced. NHSE requirements in respect of patient and public engagement in the annual report were referred to and JD raised a concern in relation to the CCG s compliance, referring to comments on previous annual reports as part of NHSE s assessment of patient and public engagement. AD recognised that the timetable had been tight and encouraged Committee chairs to contact him directly with any concerns about the operation of the CCG CM noted that there was always time pressure on annual report production and asked members to contact him with any comments or concerns prior to the Audit and Assurance Committee on 24 May 2018 which would be asked to approve the annual report. Action 49: 2018/19 annual report timetable to be reviewed by executives prior to being presented for Audit and Assurance Committee approval. (DW) 2018/19 Business Plan AF emphasised the CCG s integrated approach to business planning for 2018/19. The Business Plan brought together in a single framework all the CCG s programmes of work for the year and all programmes in the Plan had project initiation documents. The Plan gave clarity about how 5

6 the CCG was spending its allocation and what expectations it had for improvements in care Work on the alignment of CCG staff to programmes of work, business delivery processes and governance was now underway and would come back to the Governing Body in July Action 50: Work on boxes 8 and 9 of the CCG s Business Plan (people, processes and governance) to come back to the Governing Body in July 2018 along with a review of the first quarter. (AF) AF highlighted page 26 of the Business Plan which showed the CCG s programme of work, green and amber schemes. Page 56 was also highlighted as a high level roadmap for the CCG over the next 2 to 3 months. There was still a gap in the Business Plan in order for the CCG to meet its deficit target and work was ongoing to bridge this RB reflected on issues raised in the Jane case study featured in the Business Plan. AF confirmed that IT was one of the key priorities in the Business Plan; IT systems talking to each other would be crucial to integrated care. In relation to integrated urgent care, the specification was being finalised along with the review of the impact assessment CM commented on the level of detail within the Plan which answered the question of how the CCG would achieve its objectives. He took assurance from the Plan that the CCG had addressed problems in many areas of its operations including having in place a Programme Management Office. The remaining financial gap represented significant challenge. CM recalled previous discussions of eligibility for Commissioner Support Funding (CSF) noting the CCG had not been eligible. MA confirmed that CSF was only made available for those CCGs that had a deficit plan and, having had a break even control total in 2017/18, the CCG had not been eligible. For 2018/19 the CCG had a 12m deficit plan, which when achieved would be met with 12m CSF to give a break-even position at the end of the year AL-S commended on the Plan and asked about the engagement of Sussex Community NHS Foundation Trust (SCFT). AF commented that they were very engaged, at both LCN and leadership levels. In addition, SCFT had committed to review contractual process next year to reflect alignment around community services AD recognised the work that had gone into producing a strong CWS Business Plan. AD would chair a quarterly stock take of progress against the Business Plan and a quarterly summary report would be presented to the Governing Body. There was more work to be done with CCG staff in order for them to recognise and own the Plan. Action 51: Quarterly summary of performance against Business Plan to be presented to the Governing Body. Decision: The Governing Body approved the 2018/19 Business Plan with detail of people, processes and governance to be presented to the Governing Body in July /19 Budgets MA presented, acknowledging the contribution made by Tom Devonshire in authoring the paper and in helping to develop the CCG s 2018/19 financial plan. As previously discussed by the Governing Body, a 2018/19 control total of break-even would have required 44.1m savings. However, following positive negotiations with NHSE based on the CCG s 2017/18 6

7 delivery, the Governing Body was now asked to approve a deficit plan of 12m which would be matched by 12m CSF to achieve break-even at the end of the year. NHSE were thanked for the positive approach taken to negotiations RB reflected on the conclusion of the outstanding 2016/17 contract challenges with Western Sussex Hospitals Foundation Trust (WSHFT) through expert determination. MA confirmed that the expert determination process had found 3.7m in favour of WSHFT and 4.9m in favour of the CCG. As no provision had been made for this in 2016/17, the CCG had had to absorb the cost in 2017/18 however NHSE had recognised this as a non-recurring event which was now closed down. MA thanked Jeremy Horgan, Deputy Chief Finance Officer, for his work in this area Dr Alex Rainbow (AR) asked when the Governing Body would receive more clarity regarding unidentified Quality Innovation Productivity and Prevention (QIPP) and whether worsening Referral to Treatment (RTT) times represented a financial risk to the CCG. MA responded, noting that RTT national guidance was now different to the NHS Constitution and that, within the aligned incentive contract, meeting RTT was non-negotiable. In relation to QIPP, the CCG had an immediate focus on how the gap could be closed including closely examining running costs. The CCG met weekly to refresh and update its QIPP plans and further detail would be brought back to the Governing Body in July AD complemented executives on the delivery of the aligned incentive contract stating that his focus was on identifying risks to the organisation. To achieve its 12m deficit target, the CCG also needed to manage spend. This would require difficult decisions about how the organisation worked and how it commissioned. The plan to do this would need to be approved by the Governing Body, and may involve challenging conversations with membership and the public The STP deficit was discussed. AD was clear that no investment decisions could be taken at STP level without AO and CFO agreement. CCG financial plans could not accommodate any last minute costs. Dominic Wright (DW) commented that while the aligned incentive contract delivered significant QIPP, it did restrict the CCG s discretion to spend in other areas including primary care, medicines management and mental health Heather Duffield, a member of the public, referred to an article in The Times 18 May 2018 regarding alleged NHS cost restraint on treatment for blood cancer. SS encouraged people to contact the CCG about any similar items of concern in the media. Action 52: CWS CCG to give a formal response to Heather Duffield s enquiry regarding the article about blood cancer treatment published The Times, 18 May (SS) Decision: The Governing Body approved the 2018/19CCG s budget. 18/04 Principal Business Objective 1: Recover and stabilise the CCG's Position The was taken as read. Performance Report 7

8 04.20 AR commented on the reduction in consultant to consultant referrals, noting the impact of the aligned incentive contract and improvement in quality of GP referrals. Finance Report The Finance Report was taken as read. No questions were raised. 18/05 Principal Business Objective 2: Be the best in the country at caring for older people with chronic diseases, multiple conditions and frailty The BAF summary was included as part of papers. There were no agenda items and the Critical Success Factors underpinning the objective would be reviewed during April /06 Principal Business Objective 3: Integrate Care The BAF summary was included as part of papers. There were no agenda items and the Critical Success Factors underpinning the objective would be reviewed during April /07 Principal Business Objective 4: Outstanding capability to manage demand The BAF summary was included as part of papers. There were no agenda items and the Critical Success Factors underpinning the objective would be reviewed during April /08 Principal Business Objective 5: Develop the Coastal West Sussex Health System The BAF summary was included as part of papers. Estates Update AF commented that the Local Estates Strategy to ensure that estates were fit for purpose for the delivery of commissioned services was a five to ten year plan. The CCG also had immediate estate issues in relation to The Causeway having been in business continuity since March 2018 due to a significant issue which arose within the building. This had highlighted a challenging backlog of maintenance required to the building which would be costly to resolve. The CCG was working closely with NHS property services and considering options for the CCG. DW noted that the CCG needed to provide a fit and proper, and safe environment for staff to work in CCG staff were commended for their ongoing efforts despite the accommodation situation and special thanks were given to Bryn Thomas for his contribution to project managing CWS accommodation in difficult circumstances. Action 53: The Governing Body to receive a strategic outline case for future CWS accommodation in July 2018 along with the Local Estates Strategy (AF) 18/09 Governance HR Policies Three HR policies flexible working, maternity and absence and attendance - were presented to the Governing Body for approval having been through internal processes. A cover sheet identified amendments made to the policies. 8

9 09.02 There was discussion of the difference between ratification and approval. SS clarified that the Governing Body was asked to ratify the policies presented AR requested a statement on all HR policies presented for ratification that amendments had been through due equality and diversity processes. Assurance was also sought that changes in legislation following GDPR would be reflected in all policies. Action 54: Future HR policies presented for Governing Body ratification to include a clear history of the approval process, including confirmation of how equality and diversity considerations have been addressed. The CCG s policy register to distinguish between policies for Governing Body/Committee approval and those for ratification. Decision: The Governing Body ratified amended flexible working, maternity and absence and attendance HR policies subject to confirmation that equality and diversity and GDPR implications had been properly addressed JD asked that consideration be given to discretionary days off for staff to celebrate other religious festivals in addition to bank holidays. AD stated that he would be reviewing the CCG s approach to equality and diversity, as part of a review of areas for which he had statutory responsibilities, during June JD asked to be involved in this RB commended the inclusion of gender pay differentials within the report of the Accountable Officer. 18/10 Other Items SS asked members of the public in attendance if they wished to raise further questions. Ian Strand commented on the decision made by the Governing Body on the 2018/19 Business Plan given that there were still actions to be completed and asked if risk of non-completion was on the CCG s risk register. Ian Strand then asked about the remuneration of Dr Katie Armstrong and about plans for LINACs. AF confirmed that the actions outstanding on the Business Plan would be reported to the Governing Body in July 2018 and the BAF would be reviewed to ensure all material risks were captured. In relation to LINACs, it had been acknowledged that Worthing would not be the right access point for the west of the area LINACs. A revision to the plan had been accommodated by NHSE and was now being reviewed by the Cancer Alliance. SS stated that it was not appropriate to comment on Dr Armstrong as an individual member of CCG staff, noting that consideration on such matters was reserved to the Remuneration Committee. Action 55: Content of the CCG website in relation to the Cancer Alliance to be reviewed. Meeting closed. Signed Su Stone - Coastal West Sussex Clinical Commissioning Group Dated: 9