minutes – part 1 - public-i – part 1 nhs vale royal ... jamaila tausif : ... that the meeting...

Minutes – Part 1

NHS South Cheshire Clinical Commissioning Group NHS Vale Royal Clinical Commissioning Group

Meeting Name: NHS South Cheshire CCG and NHS Vale Royal CCG Governing Body Meeting Date/Time: Thursday 3rd August 2017 14:00 – 17:00

Venue: Conference Suite, Bevan House The Barony, Nantwich, CW5 5RD

Chair: Dr Andrew Wilson (SC CCG) Dr Jonathan Griffiths (VR CCG)

Meeting No:05: Reporting Period: 2017/18

Governing Body Attendance

Name Organisation Job Title Present

Dr Andrew Wilson NHS SC CCG Chair of NHS South Cheshire CCG

Dr Jonathan Griffiths NHS VR CCG Chair of NHS Vale Royal CCG

Moira Angel NHS SC CCG + NHS VR CCG Interim Exec Director of Quality & Safeguarding

Apols

Ian Ashworth Cheshire West & Chester Council Director of Public Health

Dr Nichola Bishop NHS VR CCG GP Member Apols

Dr Sinead Clarke NHS SC CCG GP Member

John Clough NHS SC CCG Lay Member

Dr Philip Goodwin NHS SC CCG GP Member

Ann Gray NHS SC CCG + NHS VR CCG Lay Member

Suzanne Horrill NHS VR CCG Deputy Chair of NHS Vale Royal & Lay Member

Dr Annabel London NHS SC CCG GP Member Apols

Dr Fiona McGregor-Smith NHS VR CCG GP Member

Diane Noble NHS SC CCG Lay Member

Tracy Parker-Priest NHS SC CCG/ NHS VR CCG Interim Chief Operating Officer Apols

Dr Bob Pugh NHS SC CCG/ NHS VR CCG Secondary Care Doctor

Fiona Reynolds Cheshire East Council Director of Public Health Apols

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Minutes – Formal Governing Body: 03.08.17

Name Organisation Job Title Present

Lynda Risk NHS SC CCG + NHS VR CCG Interim Accountable Officer

Brian Roberts NHS SC CCG + NHS VR CCG Co-opted Lay Member Apols

Terry Savage NHS VR CCG Lay Member

Dr Andrew Spooner NHS SC CCG GP Member

Dr Teresa Strefford NHS VR CCG GP Member

Judi Thorley NHS SC CCG + NHS VR CCG Chief Nurse and Exec Director of Quality & Safeguarding

In Attendance

Mandi Cragg NHS SC CCG + NHS VR CCG Executive Assistant to Clinical Chairs (Minute Taker)

Matthew Cunningham NHS EC CCG Programme Director, Unified

Commissioning (Cheshire)

Dylan Murphy NHS SC CCG + NHS VR CCG Business Manager

Jamaila Tausif NHS SC CCG + NHS VR CCG Associate Director of Commissioning

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Ref. Discussion and Action Points Name/

5.1 Committee Management

5.1.1 Welcome and Apologies Dr Jonathan Griffiths Chair of NHS Vale Royal CCG welcomed everyone to the NHS South Cheshire CCG and NHS Vale Royal CCG Formal Joint Governing Body Meeting. Dr Griffiths reminded the meeting that an audio-visual recording was being made and it would be live streamed. A disclaimer was read by the Chair to the attendees as follows: We are filming this meeting. The images and sound recording may be used to training purposes within the CCGs. Generally the public seating areas are not filmed, however by entering the meeting room and using the public seating area, you are consenting to being filmed and for the use of those images and sound recordings for webcasting and/or training purposes. Apologies were noted from Moira Angel, Fiona Reynolds, Tracy Parker-Priest, Brian Roberts and Dr Nichola Bishop. It was further noted that both NHS South Cheshire CCG and NHS Vale Royal CCG were quorate. John Clough, Lay Member for NHS South Cheshire CCG stated that he had been listed within the meeting agenda as representing both CCGs and asked that this was corrected going forward.

Noted

5.1.2 Declarations of Interest Declarations were made as follows:

• Dr Jonathan Griffiths: Chair of NHS Vale Royal CCG, direct interests as GP Partner at Swanlow Medical Centre, member of the Vale Royal GP Alliance and member of Dene Drive Property Partnership.

• Lynda Risk: Interim Chief Officer for NHS South Cheshire and Vale Royal CCGs declared no conflicts of interest.

• Jamaila Tausif: Associate Director of Commissioning at NHS South Cheshire and Vale Royal CCGs, declared no conflicts of interest.

• Ian Ashworth: Director of Public Health at Cheshire West & Chester Council declared no conflicts of interest.

• Suzanne Horrill: Lay Member NHS Vale Royal CCG, direct interest as non-Executive Director of Progress Housing. Indirect interest of a friend working at One to One Midwifery.

• Ann Gray: Lay Member for NHS South Cheshire and NHS Vale Royal CCGs, declared no conflicts of interest.

• Dr Phil Goodwin: GP Governing Body member NHS South Cheshire CCG, direct interests as GP Partner at Cedars Medical Centre, Alsager which is also a member of the GP Alliance, the Practice provides logistics to CWP and rents rooms to Specsavers.

• Dr Fiona McGregor Smith: GP Governing Body member NHS Vale Royal CCG, direct interests as GP Partner at Danebridge Practice, which is a

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member of the GP Alliance. A member of the Danebridge Medical Centre Building Group which owns the property.

• Terry Savage: Lay Member NHS Vale Royal CCG, declared no conflicts of interest.

• Dr Teresa Strefford: GP Governing Body member NHS Vale Royal CCG, direct interests as GP Partner at a practice in Vale Royal which is also a member of the GP Alliance. Indirect interest as one of the Partners at the Practice is a Director of the Alliance.

• Dr Andrew Spooner: GP Governing Body member NHS South Cheshire CCG, direct interests as GP Partner at a practice in South Cheshire which is also a member of the GP Alliance.

• John Clough: Lay Member NHS South Cheshire CCG, declared no conflicts of interest.

• Judi Thorley: Chief Nurse and Part-time Director of Quality and Safeguarding at NHS South Cheshire and Vale Royal CCGs. Direct interest as owner of Judi Thorley Solutions Ltd.

• Lucy Andrews: Administration Assistant, NHS South Cheshire and NHS Vale Royal CCGs declared no conflicts of interest.

• Mandi Cragg: Executive Assistant to the Clinical Chairs of NHS South Cheshire and NHS Vale Royal CCGs declared no conflicts of interest.

• Dr Andrew Wilson: Chair of NHS South Cheshire CCG, direct interests as GP Partner at Ashfields Primary Care Centre and member of the South Cheshire GP Alliance. The practice provided hosting services for a number of clinical services (as outlined in the full declaration of interest return). Indirect interests as a partner at the practice was a director of the GP Alliance and wife worked at St Luke’s Hospice.

It was noted that there were no conflicts of interest which would require members to withdraw from discussion or debate. All members therefore took a full part in the business of the meeting. Note: Governing Body members’ full declarations are available for review on the CCGs’ websites.

5.1.3 Patient Story Dr Jon Griffiths introduced “Caroline’s Story”, a short video produced by the CCGs, featuring Caroline Harley, Primary Care Contracts Manager at NHS South Cheshire and NHS Vale Royal CCGs. It was stated that it had not been possible for Caroline to attend the meeting to share her story in person; however Dr Jonathan Griffiths conveyed the thanks and best wishes of the Governing Bodies; adding that it was important that the meeting retained its focus on the patient experience.

5.1.4 Minutes from the previous meeting held on: • 6th July 2017 Dr Fiona McGregor-Smith asked for clarity on the use of the word ‘supported’ (item 4.2.1, page 9) in reference to the CEP. Lynda Risk and Dr Jonathan Griffiths advised that the phrase had been used in a letter from NHSE and

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NHSI. Furthermore, NHSE and NHSI are supporting the system to get back in to financial stability. Dr Fiona McGregor-Smith asked that it be noted within the minutes that the CEP does not feel like a supportive process. The minutes were agreed as an accurate record of the meeting. There were no matters arising that were not covered in the Action Log.

Noted

5.1.5 Action Log Update The Governing Bodies noted the submitted action log updates:

• Action 25 – Specialist dietetic advice currently offered will remain a part of the bariatric pathway. Action closed.

• Action 26 – Patients under the ongoing care of a particular hospital will not have to change hospitals. Action closed.

• Action 33 – To be discussed at the Board to Board meeting of Thursday 10th August 2017. Action ongoing.

• Action 34 – To be discussed at the Board to Board meeting of Thursday 10th August 2017. Action ongoing.

5.2 Financial & Contract Management

5.2.1 Finance Report Lynda Risk introduced the submitted report of the financial position at month 3, 2017/18. Members considered the report, noting that the report reflected month 3 data. NHS South Cheshire CCG Governing Body and NHS Vale Royal CCG Governing Body noted the submitted report and the following points in particular:

• The CCGs have previously identified and continue to work towards deficit positions for 2017/18, with financial deficits of £1.5 million for NHS South Cheshire CCG and £2.85 million for NHS Vale Royal CCG. There is likely to be further deficit, however the Financial Recovery Group (FRG) is actively looking at where additional savings can be made.

• Although both CCGs are bringing forward a deficit, the CCGs will be measured on their in year financial performance and the delivery of QIPP during 2017/18.

• The CCGs are being supported by the Capped Expenditure Process. The process looks at the costs in the Central Cheshire System as a whole. It was clarified that the CEP is not bringing less money into the system, but that the system as a whole has to work together to live within the allocated resources.

• Under the Connecting Care in Central Cheshire Programme the system will need to work jointly to an agreed control total of £3.5 million deficit.

• The Better Care Fund (BCF) schemes in 2017/18 have yet to be agreed with either local authority. There is only one significant contract agreement outstanding currently and that is for Mid Cheshire Hospitals

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Foundation Trust (MCHFT), however this is due to be signed by 31st August 2017. The agreement of the contract will form a key plank in the finalisation of the new system wide plan for Central Cheshire. The contract value has been agreed in principle at £154 million across both CCGs, with the activity schedules in the process of being finalised. The delay in signing is due to the necessity to align contracted activities with Capped Expenditure Process projects.

• There are a number of significant financial risks in the system, the key risks are:-

• the application of the specialist IR rules, • the impact of HRG4+, • the ability to deliver the required cost savings in the non-acute and

acute settings. • The risks facing the CCG will continue to be reviewed in year and

mitigations identified. Following consideration of the report, the following additional points were noted:

o The written and verbal reports contain a high number of acronyms, some of which are not clear or defined. The Chair asked that report writers and presenters be aware of this going forward, particularly as meetings will continue to be webcast. Definitions were given as follows:

− CHC - Continuing Healthcare. − IR - It was explained that IR is specialist commissioning. [IR =

‘Identification Rules’] o The CCGs are in discussion with University Hospitals of North Midlands

(UHNM) over the baseline. UHNM originally defined the plan, however they are not part of the same information system and are showing an over performance. It was noted that the secondary care reserve will be needed to cover the deficit and may not be available should other shortfalls arise.

o Concerns were raised in changes of coding admissions at UHNM. Action 35: Lynda Risk to contact the Co-ordinating Commissioner at UHNM to discuss the coding process.

o Increased numbers of patients are opting for treatment at BMI South Cheshire Hospital causing an over-performance on their contract.

o Action 36: Lynda Risk to check/ advise whether items in ‘Delegated Primary Care’ (p.38) with no budget against them have been reallocated. If so the reallocated amounts should be quantified.

o It is the expectation of NHSE that the CCGs eliminate the financial deficit over the next two years.

o Suzanne Horrill advised that she and John Clough had provided feedback to the finance team over the content and structure of the Finance Report at previous committee meetings.

LR LR

5.2.2 Better Care Fund Update, NHS South Cheshire CCG Jamaila Tausif introduced the submitted report, advising that it applied to NHS South Cheshire CCG only.

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https://www.england.nhs.uk/wp-content/uploads/2012/11/pss-ir.pdf


NHS South Cheshire CCG Governing Body noted the Q4 Better Care Fund (BCF) report and the following points in particular:

• Despite numerous challenges to the health and social care system locally, the BCF reporting of an unchanged position represents a positive outcome for Cheshire East.

• Partners are working together through the Better Care Fund Governance Group and the Discharge Steering Group to ensure the position improves in 17/18.

• Current schemes have been evaluated ( Appendix 1) and new options are now being put in place such as rapid access reablement teams within A/E to reduce admissions especially targeting patients on the frailty pathway or on the frailty ward within Mid Cheshire Hospital.

• Delayed Transfers of Care (DTOC) still too high, but new trajectory set agreed with NHSE to being trajectory to 3.5% in April 2018.

• Admissions to residential care were reduced in Q4. Following consideration of the report, the additional points were noted: o An Integrated Falls Service commenced in April 2017, and an 80%

reduction of people conveyed to hospital following a fall has been recorded. Central Cheshire Integrated Care Partnership (CCICP), Peaks & Plains and the ambulance service are supporting. Data to be further defined and aligned to each service in future reports.

o The Governing Body asked for a definition of the inflation statement, point 2, p.45 of papers. Action 37: Jamaila Tausif to clarify.

o The Cheshire Care Record (CCR) will continue. The line on page 59 of papers: ‘Decision taken to discontinue [the CCR] in 2017/18’ applies only to the BCF.

o All BCF schemes of 2016/17 have been reviewed and a report will come to the Governing Body in October 2017. The main focus of the BCF is outlined on page 45 of papers. The BCF will be taken to the A&E Delivery Board, which is attended by NHSE and NHSI, to discuss how the 2017/19 schemes align with other parts of the system.

o Table 51 of papers indicates an adverse out-turn in 2016/17 compared to 2015/16; the Governing Body sought assurance that 2017/19 plans address this and can rapidly identify where results are not being delivered. Assurance was provided as follows:

− Schemes that have not delivered will not be in the 2017/19 BCF. − A new activity dashboard is in place. Both qualitative and

quantitative data will be used and regularly reviewed.

NHS South Cheshire CCG Governing Body noted the report and the supporting recommendations.

JTa

5.3 Business

5.3.1 Chairs’ Report

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Dr Jonathan Griffiths and Dr Andrew Wilson presented a verbal Chairs’ report which included:

• A thank you to Lay Members who had supported the Chairs with practice visits. Practices have reported problems with ongoing recruitment of GPs; however some practices have recruited outwith the central Cheshire area.

• Continuing to improve the relationships between GPs and consultants at MCHFT. A ‘Fall Ball’ is being held on 8th September 2017 at Crewe Hall for MCHFT consultants and central Cheshire GPs.

• Interviews for the Interim Accountable Officer are being held on Friday 4th August 2017.

NHS South Cheshire CCG Governing Body and NHS Vale Royal CCG Governing Body noted the Chairs’ comments.

5.3.2 Chief Officer’s Report Lynda Risk drew Members’ attention to the contents of the submitted report which included sections on:

• CCG Improvement and Assessment Framework Update • Sustainability and Transformation Partnership Assessments • 360° Survey • Senior Staffing Changes Following consideration of the report, Members noted the following:

• The ‘inadequate’ rating of the CCGs, largely based on the relationship with MCHFT, is not reflective of where the CCGs and MCHFT are now.

• MCHFT were rated ‘good’ by the CQC/NHSI. Members queried the ratings difference between the organisations and were informed that a different body (NHSE) rates the CCGs, hence the variance.

• Both CCGs will move into ‘special measures’ as a consequence of the IAF. The definition of this is unclear; however involvement with the Capped Expenditure Process is likely to constitute a major part of any measures.

• Lay Members expressed disappointment with the low score on patient/ public involvement following the 360° survey, asking how they might become involved in addressing this and who was responsible for devising the action list following the report. Lay Members also recognised that promoting the CCGs needs to go beyond social media, but recognised that other forms of media such as using the local press might be costly. Action 38: Dr Jonathan Griffiths and Dr Andrew Wilson to meet Katy Brownbill to discuss further Lay Member involvement/ roles.

NHS South Cheshire CCG Governing Body and NHS Vale Royal CCG Governing Body noted the submitted paper and subsequent discussion.

JG, AW + KB

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5.4 Quality & Performance

5.4.1 NHS Performance Targets Report Lynda Risk introduced the submitted report which members discussed, noting the following points in particular:

• National A&E targets were not met, but MCHFT met the STF trajectory and was amongst the best performers in the country.

• Ambulance ‘Red’ targets continue to be missed. New targets come into effect on 7th August, and performance against both sets of targets will be monitored to see what effect this has.

• Referral to treatment (RTT) targets are being met. The CCG is investigating the 52-week wait breach with a UHNM patient and has written to the hospital to ask for additional information.

• All cancer targets are being met and the CCGs are performing strongly. • Improving Access to Psychological Therapies (IAPT) targets have

increased from 1.2% to 1.4% each month. • Assumptions were made in the initial plan submitted to NHSE regarding

non-elective activity. There has not been a significant rise compared to last year, but there has been against the plan due to assumptions made regarding the outcome of the dispute resolution.

• There may still be issues within GP referral/other referral reporting within MCHFT, this will be closely monitored in year.

• There has been an upwards trend in A&E attendances over the last year and it was noted that this was common to all Cheshire CCGs. The Finance and Performance Committee has asked for additional analysis, and this will be brought back to Governing Body at a later date.

Members commented on the report as follows:

o Some of the data contained within the report is not current; authors were asked to indicate how old the data is going forward.

o Electronic referral data for practices is incorrect. Some referrals have to be made on paper therefore the electronic referrals targets will not be met.

Action 39: Dr Andrew Spooner to discuss how e-referrals data collation could be improved with Michael Dearden.

o The chart on the top right on page 105 of papers should be titled ‘Vale Royal’, not South Cheshire.

o Clinicians questioned whether the report’s data indicated insufficient primary care provision across central Cheshire, the concern being that if people have nowhere in the community to go they will turn up at A&E.

o Across both CCGs one year cancer survival rates and the early diagnosis of cancers is improving.

o Time was spent discussing how the CCGs are addressing the issue of dementia, including:

− Practices have discussed this at PLT meetings. There is also a lot of background work underway.

− Ian Ashworth outlined CWAC’s ‘Dementia Strategy’, indicating that there are a lot of projects and they are very keen to further involve primary care.

− Clinicians advised they should be the ones to make a diagnosis of

AS

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dementia; it was felt this would expedite patient treatment. − CWP recently sent a letter to all practices regarding changes to

follow-up appointments. The Chair stated that the CCGs are in discussions with CWP over the letter’s content.

NHS South Cheshire CCG Governing Body and NHS Vale Royal CCG Governing Body: • Noted the contents of the report and scorecards outlining provider

performance against national targets for the month of April 2017. • Noted the exceptions highlighted and received assurance on the actions

being taken to resolve any performance issues.

5.4.2 Chief Nurse’s Update & Quality Report Judi Thorley introduced the submitted report and members discussed the following points in particular:

• The Quality & Safety Committee is closely monitoring NWAS’ performance around achieving the ‘Red 1’ ambulance target.

• Thanks were given to Tracey Cole and the CHC team in achieving a service rating of ‘good’ from NHSE following a performance ‘deep dive’.

• Payment submissions data for Annual Health Checks in 2016/17 will be available in time for the October 2017 Governing Body meeting. A CQUIN is in place with CWP for health facilitator training to support in preparing and delivering the health action plan following annual health checks.

• A full, detailed update around learning disabilities will be brought to October Governing Body.

• The young man whose mother delivered an in-person patient story at February 2017 Governing Body was discharged to home at the end of June and is doing really well.

• There are patients within Central Cheshire whose discharge has been delayed for over 3 years. There is an active programme in place to review and expedite these cases, and the CCG is working closely with CWP and the Complex care team to eliminate barriers/ blocks. Action 39: Judi Thorley to bring an update regarding delayed discharges to the Governing Body meeting of October 2017.

• The deep dive into Initial Health Assessment for Care for Children has identified some issues which have been addressed and there is an improvement plan in place. An update will be brought to a future meeting.

• The CCGs have now recruited to the Designated Nurse, Looked After Children post and the successful candidate should be in post in November/ December.

NHS South Cheshire CCG and NHS Vale Royal CCG Governing Bodies:

• Noted the position update relating to clinical quality and patient safety from the CCGs’ main providers: Mid Cheshire Hospitals NHS Foundation Trust; Cheshire and Wirral Partnership NHS Foundation Trust; Central Cheshire Integrated Care Partnership; BMI South Cheshire Private Hospital and North West Ambulance Service.

JTh

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5.5 Governance

5.5.1

Joint Commissioning Committee Dr Jonathan Griffiths introduced the item, stating that the Governing Bodies of NHS Eastern Cheshire CCG and NHS West Cheshire CCG had approved the paper. Discussion points from the meeting were as follows:

• The intention of setting up a Joint Commissioning Committee (JCC) is to remove duplication in the system and free up capacity, thus allowing each CCG to focus on delivery at a local level.

• Pending Joint Governing Body approval, South Cheshire Membership Council and Vale Royal Membership Assembly will be presented with the paper at a joint meeting on 17th August 2017.

• Pending Membership approval, a formal application will be made to NHSE to change the constitutions of all four CCGs during the week commencing 21st August 2017.

• The Governing Bodies queried the third point under Item 9 on page 161 of papers, ‘reducing unwarranted variation’. It was unclear how the Committee could tell the difference between warranted and unwarranted variation and how this could be measured. However, it was agreed that the point should remain within the paper as this will improve outcomes for patients.

• The JCC is not a statutory body; each CCG will delegate authority to the JCC to make decisions according to a pre-defined, mutually agreed workplan. Individual CCGs would remain the accountable statutory bodies.

• It was recognised that there is a challenge around decision making across the CCGs, however the Committee will have equal representation from each CCG and decisions will be made by consensus.

• JCC items or papers requiring a vote will be published far enough in advance to enable members of the JCC to gain views from their Governing Bodies and wider CCG where appropriate in order to inform their voting decision.

• Following a lengthy discussion regarding the Chairship of the JCC, it was proposed/ clarified that:

o The Chair should be independent of the four CCGs o The Chair should not be a lay member, however the cohort from

which to draw potential Chairs was not identified o The Chair should be accountable to the four CCG Chairs (given

that the JCC is a sub-committee of the CCGs and the Chairs are accountable to their Membership)

o Action 41: Lynda Risk to seek assurance that the JCCs Terms of Reference should state that the Chair will be independent and accountable to the four CCG Chairs.

• Both Cheshire West and Chester Council and Cheshire East Council are supportive of the proposed JCC. The Councils will be represented either by a Chief Executive Officer or Director of Public Health at JCC meetings; however they will be non-voting members.

NHS South Cheshire Governing Body and NHS Vale Royal Governing

LR

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Body were asked to: • Note the detail within the paper • Approve the recommendation of the Accountable Officer to approve the

terms of reference for the Joint Commissioning Committee of the four Cheshire CCGs;

• Note that the Clinical Chairs will provide the Membership Council/ Membership Assembly with the necessary constitutional changes required, for approval, via a separate paper to them (copied to the governing body) and that a formal application will be made to NHS England to approve the variation to the constitution.

• Subject to approval to proceed, note that the Accountable Officer will bring a further paper to a subsequent governing body seeking approval of the annual workplan of the Cheshire Joint Commissioning Committee;

• Endorse the continued direction of travel towards initially a unified health commissioning approach in Cheshire, and the wider long term ambition to unify health and social care commissioning.

NHS Vale Royal Governing Body:

o Noted the contents of the report and voted for the Accountable Officer to approve the terms of reference.

− 8 x votes for − 0 x votes against − 1 x abstaining

NHS South Cheshire Governing Body:

o Noted the contents of the report and voted for the Accountable Officer to approve the terms of reference.

− 8 x votes for − 0 x votes against − 0 x abstaining

In addition it was agreed that the Accountable Officer would be tasked to ensure there was a mechanism for the independent chair to be accountable to the four CCG Chairs. NHS Vale Royal Governing Body:

o Noted the contents of the report and voted to approve its content. − 7 x votes for − 2 x votes against − 0 x abstaining

NHS South Cheshire Governing Body:

o Noted the contents of the report and voted to approve its content. − 6 x votes for − 0 x votes against − 2 x abstaining

Vote carried

Vote carried

Vote carried

Vote carried

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5.5.2 Improvement & Assessment Framework Update The Chair introduced the submitted report. In response to a query, Dylan Murphy stated that NHSE had issued correspondence regarding a baseline assessment of CCGs’ patient/ public participation arrangements. The baseline assessment would be a desk-top exercise, conducted via an NHSE review of existing publicly available material (on CCG websites, in CCG Annual Reports etc.). A fuller assessment would be undertaken at year end and details of this were awaited. The Governing Body stated that the report was well-designed and easy to follow whilst also expressing disappointment at many of the nationally pre-defined reporting standards. It was noted that the numbers of falls injuries are escalating and members questioned whether these falls were within an Acute environment or whether patients were being admitted to hospital following a fall at home. Dylan Murphy stated that he believed that this related to emergency admissions to hospital following a fall (rather than falls within a hospital setting). Action 42: Dylan Murphy to clarify if falls figures relate to an Acute environment or patients admissions to hospital following a fall at home. NHS South Cheshire Governing Body and NHS Vale Royal Governing Body noted:

• The Improvement and Assessment Framework annual ratings for 2016/17 • Performance against each of the indicators in the Improvement and

Assessment Framework and the direction of travel during the year • Performance against:

a.) The indicators associated with Clinical Priority Areas b.) The indicators where either CCG is flagged in the lowest quartile c.) The activity underway to ensure continued delivery or improved

performance against those indicators

DM

5.5.3 Board Assurance Framework (BAF) The main themes of the BAF are:

• Sustainability of the CCGs • Sustainability of general practice • Ensuring there are enough staff to run services Lynda Risk advised the Governing Bodies that Appendix 1 outlines how the BAF aligns with the IAF. NHS South Cheshire CCG and NHS Vale Royal CCG Governing Bodies:

• Noted the contents of the report.

6.6 Operational Management & Regulatory Updates

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6.6.1 Committee Minutes: The Governing Bodies noted the following sets of minutes, as submitted: A&E Delivery Board – 26.04.17 + 31.05.17 The Governing Body noted the submitted minutes Clinical Commissioning Executive – 08.06.17 The Governing Body noted the submitted minutes. Governance & Audit – 25.04.17 The Governing Body noted the submitted minutes. Quality & Safety Committee – 19.04.17, 25.05.17 + 29.06.17 The Governing Body noted the submitted minutes.

5.6.2 Governing Body Forward Planner The Governing Bodies noted the submitted forward planner. All were asked to review the forward planner and inform Dylan Murphy of any required amendments.

5.7 Any Other Business

Dr Jonathan Griffiths thanked all for their contributions, noting that there had been no advance questions from members of the public, and formally closed the Part 1 meeting.

Date, time and venue of next meeting:

NHS South Cheshire CCG & NHS Vale Royal CCG Governing Body (Informal)

Thursday 6th September 2017 from 14:00 to 17:00hrs Boardroom 1, Bevan House, Nantwich

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