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TRANSCRIPT
NHS Tameside and Glossop Clinical Commissioning Group Part A Governing Body meeting on Wednesday 24 February 2016
to be held at 13.00 at New Century House
1 Welcome and apologies
Verbal A Dow
2 Declarations of interest
Paper All 1
3 Consideration of items of any other business
Verbal All
4 Patient story
Verbal J Hurlston
5 Chair’s introduction
Verbal A Dow
6 Draft minutes of the Governing Body meeting held on 27 January 2015
Paper A Dow 7
7 Actions arising
Paper A Dow 22
8 Chief Operating Officer’s report
Paper S Allinson 24
9 Public and Patient Impact - Approved minutes of the Public and Patient
Impact Committee meeting of 20 January 2016
- Update from the Public and Patient Impact Committee of 17 February 2016
Paper Verbal
C Poole C Poole
27
10 Finance - Month 10 Finance Report - Approved minutes of the Finance and QIPP
Assurance Committee meeting of 20 January 2016
- Update from the Finance and QIPP Assurance Committee meeting of 17 February 2016
Paper Paper Verbal
K Roe D Swift D Swift
36 52
11 Quality - Approved minutes of the Quality Committee
meeting of 6 January 2016 - Update from the Quality Committee meeting
of 3 February 2016 - Performance Report
Paper Verbal Paper
C Poole C Poole C Watson / R Bircher
59
66
12 Planning, Implementation and Quality - Approved minutes of the Planning,
Paper
G Curtis
91
Implementation and Quality Committee meeting held on 13 January 2016
- Update from Planning, Implementation and Quality Committee meeting of 10 February 2016
Verbal
G Curtis
13 Integrated Governance, Audit, and Risk Committee
- Ratified minutes of the Integrated Governance, Audit, and Risk Committee of 28 October 2015
Paper
G Curtis
99
14 Primary Care Joint Committee - Approved minutes of the Primary Care Joint
Committee meeting of 6 January 2016 - Update from the Primary Care Joint
Committee meeting of 3 February 2016
Paper Verbal
D Swift D Swift
110
15 Transformation Report
Paper C Watson 114
16 Locality Leads - Draft minutes from the Locality Leads’
meeting of 26 January 2016
Paper
A Dow
120
17 Partnership and Greater Manchester meetings and updates
- Ratified minutes of the Association Governing Group meeting held on 19 January 2016
Paper
S Allinson
126
18 Any other business
Verbal A Dow
NHS Tameside and Glossop Clinical Commissioning Group Register of Interests 2015/16 – Governing Body
Name Position Held Declared Interest Date of Declaration / Confirmation
Membership of Professional Body Interest
Steve Allinson Chief Operating Officer Nil
Spouse is a PA at Pennine Acute Trust. Dinner invitations x2 Incl. Meetings with PWC (CPT) – both on register.
28/07/2015
Dr JS Bamrah Governing Body Secondary Care Clinician
British Medical Association member Royal College of Psychiatrists member Medical and Dental Defence Union of Scotland member British Indian Psychiatric Association member British Association of Physicians of Indian Origin member
Medical Director, Manchester Mental Health and Social Care NHS Trust Board Member, African and Caribbean Mental Health Services Manchester Board Member, LCMP Carelink Council Member British Medical Association National Chairman British Association of Physicians Of Indian Origin
26/08/2015
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NHS Tameside and Glossop Clinical Commissioning Group Register of Interests 2015/16 – Governing Body
Dr Richard Bircher
GP at Lockside Medical Centre - CCG Governing Board Member
Medical and Dental Defence Union of Scotland British Medical Association
GP at Lockside Medical Centre. Board of Trustees for Stockport World Citizens (Local Charity to help volunteers). Married to Dr Joanna Bircher. CCG Clinical Lead for Quality Improvement. GP Partner with Dr Thomas Jones. CCG lead for Cardiology.
04/08/2015
Graham Curtis Lay Deputy Chair Nil Expert by experience for Age UK – to do CQC Inspections in care homes. 22/07/2015
Dr Jamie Douglas
GP at Albion Medical
Royal College of General Practitioners member General Medical Council member
Salaried GP at Albion Medical Practice Locum GP in Tameside and Glossop Area. GP at Go-to-Doc for OOH work. GP at EUR TRIAGE with GMSS. Educational role with University of Manchester. GP Appraiser for NHS England Jamie and his family are now living in Tameside and will shortly be registering with a GP practice there
23/12/2015
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NHS Tameside and Glossop Clinical Commissioning Group Register of Interests 2015/16 – Governing Body
Dr Alan Dow
GP at Cottage Lane Surgery CCG Chair
West Pennine Local Medical Committee member NW Manchester General Practitioners Committee Representative NW Denery – Training Practice British Medical Association Royal College of General Practitioners’ Family Doctors Association Medical Protection Society
GP Cottage Lane surgery, Gamesley Glossop providing GMS services and enhanced type services for smoking cessation, family planning, minor surgery, substance misuse and alcohol, health checks. Orbit Shareholder. Wife is an Anaesthetist at Tameside General Hospital. Attended various training events sponsored or subsidised by pharmaceutical industry. No substantial gifts. Various offers to chair or advise declined. Marks and Spencer vouchers offered (but never received) for attending meetings with Primed Meal with Price Waterhouse Cooper on 2 December 2015 to the value of £30
02/12/2015
Gill Gibson Director of Nursing & Quality The Nursing & Midwifery Council Nil 27/07/2015
Dr Tina Greenhough GP Board Member Local Medical Council member for
West Pennine
GP Principal Mossley Medical Practice Director GoToDoc (OOH provider and provider of APM procedures) Employed as a Clinician for St Martins Healthcare who are sub contracted to Lifeline to provide drug and alcohol services for Tameside.
12/10/2015
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NHS Tameside and Glossop Clinical Commissioning Group Register of Interests 2015/16 – Governing Body
Dr Amir Hannan
GP at Haughton Thornley Medical Centre – CCG Board Member
Medical Protection Society member Royal College of General Practitioners member
Co-Chair Greater Manchester NHS Values Group Member of the Equality Diversity Council, NHS England Dr Nadeem Rasul, one of the doctors in the practice is also the Prescribing Lead for the CCG Dr Faisal Bhutta is a member of the West Pennine Local Medical Committee Vice Chair West Pennine Local Medical Committee Orbit Shareholder Partner at Haughton Thornley Medical Centres which offers GMS and enhanced services including IUD, implants, minor surgery, DMARD monitoring, anti-coagulation, Alcohol DES, Drugs DES, £5 per head for over 75’s, Pessary fitting, Zoladex, Insulin initiation, NHS healthchecks, vaccines and immunisations, avoiding unplanned admissions, extended admissions, extended hours, dementia diagnosis, learning disability health checks. We are also a training practice teaching medical students as well as FY2 and GP registrars. Chairman of the World Health Innovation Summit
25/11/2015
Angela Hardman
Director of Public Health
Member of the Faculty of Public Health Nil 03/11/2015
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NHS Tameside and Glossop Clinical Commissioning Group Register of Interests 2015/16 – Governing Body
Jean Hurlston Lay Advisor NHS England Public & Patient Groups (various) notified as and when required.
Virtual PPG panel member – Albion Practice. CVAT Member Voluntary Action Oldham Steering Group member. Rotary club of Ashton Under Lyne: PR Officer. Coordinator Oldham Street Angels. Oldham Street Angels has received ‘Dragons Den’ funding to cover costs of sessional healthcare workers (Non recurrent) Locum Chaplain with THFT Member of Chaplaincy team at Manchester Airport. Chaplain at Ashton Sixth Form College. Member of the Greater Manchester Values Group
20/01/2016
Dr Alison Lea GP Governing Board Member
Membership of the Royal College of General Practitioners Member of the Academy of Medical Examiners British Medical Association (member) Medical Defence Union (member)
Churchgate Surgery: GP Partner with Dr Asad Ali (Locality Lead and Orbit Director). T&G Appraiser. Director, RWL consultants. Training Programme Director, Tameside and Glossop. Orbit member (GP Federation) NHS England GP Appraiser Provider of enhanced services: IUD, implants, minor surgery, DMARD monitoring, anti-coagulation, Alcohol DES, Drugs
25/11/2015
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NHS Tameside and Glossop Clinical Commissioning Group Register of Interests 2015/16 – Governing Body
DES, £5 per head for over 75’s, Pessary fitting, Zoladex, Insulin initiation, NHS healthchecks, vaccines and immunisations, avoiding unplanned admissions, extended admissions, extended hours, dementia diagnosis, and learning disability health checks.
Paul Pallister Assistant Chief Operating Officer Nil A close personal friend is an equity partner at Hempsons 28/07/2015
Celia Poole Lay Member
Member Chartered Institute of Public Relations Associate Chartered Management Institute
Director of CP Media Services Ltd. 50% shareholdings in CP Media Services Ltd. Commissioned through CP Media Services Ltd to deliver service for and on behalf of Active Tameside. CP Media Services Ltd has been contracted by NHS England for the period 21 December 2015 until 31 March 2016 to deliver communications services
23/12/2015
Kathy Roe Chief Finance Officer
Association of Accounting Technicians Chartered Institute of Management Accountants
Nil 22/07/2015
Lesley Surman Lay Advisor to CCG T&G
Nil
Member of PPG at GP Practice. Chairperson of Patient Locality Group Glossop. Advisor to Self-Advocacy work stream at Tameside Healthwatch. Healthwatch Derbyshire & Healthwatch Tameside enter and
03/08/2015
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NHS Tameside and Glossop Clinical Commissioning Group Register of Interests 2015/16 – Governing Body
view representative Tutor for self-management UK. RSPCA – home assessor. Glossop voluntary centre.
David Swift Lay Advisor Member of the Chartered Institute of Internal Auditors
Sessional Audit Committee member at NHS Stockport CCG. Wife is an Associate Manager for Mental Health Act reviews (sessional) at Calderstones Partnership Foundation Trust. From 01/11/2015 – Lay member for Governance and Audit at East Lancashire CCG
01/11/2015
Clare Todd Governing Body Nurse
Nursing and Midwifery Council - registered Governing Body Nurse at NHS Salford CCG 02/12/2015
Clare Watson Director of Transformation Nil CHP – BTG Lift Co Ltd (Public Sector Director) 07/08/2015
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Draft minutes of the Governing Body meeting held on 27 January 2016
Part A
Present
Mr Steve Allinson Chief Operating Officer Dr JS Bamrah Secondary Care Consultant Member Dr Richard Bircher GP Member and Clinical Lead for Urgent Care Mr Graham Curtis Deputy Chair and Lay Member Dr Jamie Douglas GP Member and Clinical Lead for Primary Care Dr Alan Dow GP and Chair of NHS Tameside and Glossop
CCG Dr Christina Greenhough GP Member, Clinical Vice-chair, and Clinical
Lead for Mental Health, Children and Families, and Integration
Dr Amir Hannan GP Member and Clinical Lead for Long Term Conditions and IM&T
Dr Alison Lea GP Member and Clinical Lead for Planned Care, Cancer, and End of Life Care
Ms Celia Poole Lay Member Mrs Kathy Roe Chief Finance Officer Ms Clare Todd Governing Body Nurse
In attendance
Mrs Gill Gibson Director of Nursing and Quality and Caldicott Guardian
Ms Jean Hurlston Lay Adviser Ms Alison Lewin Deputy Director of Transformation Mr Paul Pallister Assistant Chief Operating Officer and Company
Secretary Ms Michelle Rothwell Deputy Director of Nursing and Quality Dr Gideon Smith Consultant in Public Health, Tameside
Metropolitan Borough Council Dr Lesley Surman Lay Adviser Mr David Swift Lay Adviser
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1 Welcome and Apologies
A Dow welcomed the Governing Body members and members of the public to the January 2016 meeting.
2 Declarations of Interest
A Dow invited the Governing Body to make any new declarations of interest. He explained that there are some forms available for the members to make any necessary updates to their existing declarations.
The Governing Body received the current Register of Interests as at January 2016 and noted the updates.
3 Consideration of Any Other Business
A Dow asked the members if they had any further items of business for today’s meeting.
There were no additional items requested.
4 Patient Story
The Governing Body heard a patient story narrated by J Hurlston regarding the multi-agency support received by Jade. The members heard how, following the birth of her first child, Jade and her partner had received regular support from both the health visiting service and the Well Baby clinic. However, after the birth of her second child thirteen months later the family circumstances changed dramatically and the children became at risk. The health visiting service responded rapidly by identifying multiple and complex needs, and the long-term health and development needs of the children were identified and dealt with quickly. The children were taken into the care of the Local Authority temporarily during which time the parents were fully engaged with the process and sought the help that was required. Six months later the children returned home under a child protection plan and work began with the whole family.
The members were pleased to hear how the family have made significant progress, with the children coming off the child protection plan and continuing to receive support. It is hoped that the family will continue to sustain the changes made. It was recognised that the intervention from the multi-agency services have allowed the children a chance to have positive childhood experiences, which will hopefully impact on their own children and break the negative cycle that they were in.
The key factors in this success story were identified as being effective multi agency working, assessing their needs as a whole family and not just as individuals, the tenacity of the workers who supported the family, and that the story reflects the benefits of true partnership working and of taking a collaborative approach when working with children and families.
The Governing Body noted that this story emphasises the need for joint commissioning and a model to ensure we wrap services around the individuals. G Gibson advised how lessons learnt over the years have helped the CCG shape how we now work with children and their families.
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S Allinson made reference to the CCG in April 2013 being granted authorisation with six conditions; three of which were in relation to Safeguarding. He felt that this story demonstrates the progress the CCG has made and thus allows the Governing Body to gain assurance that our children and their families are appropriately safeguarded.
The Governing Body noted the contents of the patient story.
5 Chair’s Introduction
A Dow reported that, further to the agreement to create a Single Commissioning function, the following inaugural meetings have taken place during January:
Shadow Joint Management Team meeting Shadow Joint Commissioning Board Joint visit to see the discharge process at Tameside Hospital NHS Foundation Trust A whole team to team meeting held on 19 January 2016.
A Dow reported TMBC’s intention for the Joint Commissioning Board to be the decision-making board for both health and social care. In view of this the Governing Body was asked to decide how they wished to proceed with regards to decision making. A Dow asked the Governing Body to decide whether the Joint Commissioning Board is to be given delegated powers by both the Council and the CCG to make decisions, as opposed to being a body which makes recommendations back to the CCG’s Governing Body. A Dow noted that this was not part of the construct that was originally agreed when discussing the governance around bringing the two organisations together.
He asked the Governing Body; should it take the decision to appoint the Joint Commissioning Board as a decision-making body, if there would then be the need to approach the individual member practices to determine agreement, noting however that it is not a requirement in the Constitution.
A Dow invited comments on the two items for consideration.
C Poole replied that member practices have vested their interest in the elected Governing Body GP members to represent their views and to make decisions on their behalf.
D Swift reminded the Governing Body that the Constitution to which the CCG is currently working reflects the existing legislation; therefore he would be more comfortable with agreeing to a recommendation-making body. A Dow confirmed however that in discussion with Graham Urwin, NHS England are in agreement with our direction of travel and would support this proposal.
C Todd and C Greenhough were both of the opinion that the Governing Body should consult with the member practices; however J Douglas expressed concern that a response may only be received from a small number of GPs and queried whether this would provide a representative response.
A Dow pointed out the efficiencies in supporting the proposal: it would allow decisions to be made in a timelier manner, as opposed to waiting for recommendations to be returned to the Governing Body for approval.
A Lea and A Hannan expressed the opinion that they would prefer sight of a governance structure prior to making any decision. A Dow referenced a useful governance map which P Pallister had previously shared at a Governing Body development session.
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C Todd asked if it could be implicit that the decision was taken dependent upon the most appropriate governance and management structure that is put in place. However, the members recognised that governance structures can be amended over time.
G Curtis expressed to the Chair his preference that a vote be taken to decide whether the Governing Body supported moving towards having a joint commissioning board where the decisions are formally delegated from the CCG.
The Chair therefore asked for members to cast their vote and it was agreed unanimously as the way forward.
The Governing Body:
- recommended that the Joint Commissioning Board be the decision-making body for both TMBC and CCG
The Governing Body:
- agreed for A Dow to write to the member practices advising them of this recommendation to appoint the Joint Commission Board as the decision-making body and asking for their support.
6 Draft minutes of the Governing Body meeting on 23 December 2015
A Dow invited the Governing Body to comment upon the accuracy of the draft minutes of the meeting held on 23 December 2015.
The minutes of the meeting held on 23 December 2015 were agreed as being an accurate record.
7 Actions Arising
The Governing Body reviewed the action log: 050515: Integrated Governance, Audit, and Risk: To update on the responsibilities being delegated to the Programme Board: S Allinson confirmed that there is no progress with delegation to Programme Board and that at present we do not have a scheme of delegation. G Curtis asked that the Governing Body remains sighted on the governance of the Care Together Programme Board; however this item can be removed from the list
011115: For the GP Governing Body members to include in their declarations of interest any enhanced services delivered by their practice: P Pallister reported having received declarations from J Douglas and C Greenhough; he is due a conversation with R Bircher
G Curtis reiterated that the locality leads have been given a list of Registers of Interest for the members in their localities
031115: To produce an information park for the practices of the Over 75s bids: A Lewin agreed to check if the information pack has been disseminated
051115: To reflect in the next iteration of the locality plan the principle that those people whose services are being transformed are to be involved in shaping them: S Allinson confirmed that the locality plan will not be updated until March 2016 however he agreed to share the proposed content with the members in advance
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071115: To discuss the experience of applying for continuing healthcare support with the main carer of the patient from November’s patient story: S Allinson confirmed that both he and G Gibson had met with the main carer, and he would be providing an update within his Chief Operating Officer report later in the meeting
011215: To raise the lack of a specialised breastfeeding service for Glossop residents at the Derbyshire Health and Wellbeing Board: A Lewin confirmed that this has been raised with Public Health colleagues in Derbyshire however clarification is still required as to whether it has been formally raised at the Health and Wellbeing Board
A Dow made reference to several charities which have now withdrawn from providing services to Glossop residents. He asked if it would be possible to obtain an up-to-date list of charitable organisations that support Tameside residents but no longer offer support to residents within Glossop. A Lewin suggested approaching the Glossop Volunteer Centre to ask if they could co-ordinate this on our behalf
021215: To issue to staff and member practices a positive message regarding the CCG’s
financial position: K Roe confirmed that this communication has been cascaded. This item can be removed from the list
031215: To look into the delays for diagnostics: A Lewin confirmed that there is a plan with NHS England which aims for recovery in 2016/17. A Dow pointed out that this was more in relation to diagnostics at Central Manchester NHS Foundation Trust and that the issue was whether or not we should be advising our patients of any known delays
041215: To look into the performance regarding referrals to the memory clinic: formal processes are now in place to address this on-going pressure with Pennine Care. This item can be removed from the list
051215: To look into the self-referral process for the Healthy Mind service: C Greenhough recognised that the online referral service is now well-established. She highlighted that there remains a gap in relation to telephone access for self-referrals
061215: To issue a communication to the member practices following the Joint Locality meeting: A Lewin confirmed that this has been distributed. This item can be removed from the list.
The Governing Body noted the updates provided.
8 Chief Operating Officer’s Report
S Allinson provided an overview of his meeting with the main carer and family of the patient from the November patient story. G Gibson had also attended the meeting which captured the experiences of applying for continuing healthcare support from a carer’s perspective. Following the visit the carer has accepted an invitation to work with the CCG to help reframe and put forward clear guidance to staff and families. She has also agreed to assist in training programmes that will include how to undertake an assessment which is sensitive to the family’s needs and is representative of the legislative frameworks.
J Hurlston commented that what was originally a poor experience has now resulted in a better experience for others with good learning outcomes. J Hurston stated that this outcome illustrates how we are keeping the patient focus in our plans. G Curtis added that, on reflection, we need to be proactive in identifying such stories from patients who are not so
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eloquent. M Rothwell replied that the CCG will be engaging with those hard to reach patients in designing the feedback tool for continuing care assessments and provision.
S Allinson also updated the Governing Body regarding the recent Healthier Together announcement. Following the ‘Keep Wythenshawe Special’ challenge the outcome of the
judicial review is that there is not a case to be taken forward. He informed the Governing Body that the CCGs are now at the point of mobilising Healthier Together across the specialised units.
S Allinson reported having recently attended a South East Sector meeting with representation from Stockport NHS Foundation Trust, Tameside Hospital NHS Foundation Trust, East Cheshire Hospital and NHS North Derbyshire CCG to agree next steps regarding the care models and how the governance is managed. S Allinson agreed to bring information regarding the four care models through the Planning, Implementation, and Quality Committee and intends to obtain the mandate from the Integrated Governance, Audit, and Risk Committee to act on behalf of the CCG in conversations with South Sector colleagues. A conversation will also be required with the Public and Patient Impact Committee to ensure we have a clear line of sight in this respect.
JS Bamrah made reference to a paper regarding the Greater Manchester Strategic Plan. S Allinson confirmed that this paper had been discussed at last month’s Governing Body
meeting and that the CCG has until the end of March 2016 to respond. He added that he and P Pallister are collating a response on behalf of the CCG and that further discussion will be scheduled for the next Governing Body meeting.
S Allison provided an update regarding the positioning of Greater Manchester Devolution, the CCGs, and the Transformation funding. He made reference to Tameside and Glossop’s
locality plan and stated that there is now the need to transition this from a statement of intent into a plan of action that mobilises our integrated care system and single commission.
S Allinson informed the Governing Body that, with regard to the national transformation fund, under the Devolution arrangements Greater Manchester now has knowledge that it will receive £450m of this fund. The locality is now building its financial case which demonstrates our requirements of the fund. S Allinson commented that it has now become clearer that this is a transformation fund and not a financial sustainability award, which is a separate issue for the Foundation Trust and is being taken forward by Monitor and the Department of Health.
S Allison advised the Governing Body that, over the next few months, the locality will be producing its Annual Operating Plan. In addition, it is required to produce a one-year snap shot of its five year strategy. He noted that this will need to detail our commitment to delivering on standards for local people and will require all of the partners’ plans being brought together as one unified strategy.
The Governing Body noted the content of S Allison’s verbal update.
9 Public and Patient Impact
C Poole presented the ratified minutes of the Public and Patient Impact Committee meeting of 2 December 2015 reminding the members that she had previously provided a verbal update from this meeting.
C Poole presented the key messages from the committee’s meeting of 20 January 2016:
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- Commissioning of the MSK and ENT pathways: PPIC have requested evidence that patients are at the centre of these bridging pathways
- The CCG website is scheduled to ‘go live’ imminently - Greater Manchester Devolution is bringing the Key 103 bus to Tameside for one day
in February. The communications around this are to be dealt with by CCGs and our Communications Team have noted this
- Quality Assurance mechanism: in order to be timely it was agreed for the IGAR Committee to provide a virtual review of the proposals
- A verbal update from the second patient network meeting was received - Patient Access to Records paper: to be presented to PIQ.
A Dow invited questions from the Governing Body.
S Allinson asked the members to give some thought on how the CCG is to position itself in terms of Greater Manchester Devolution and the Locality Plan and advised that there is now the opportunity to be proactive in this respect.
G Gibson was pleased to report that members of the CCG’s Communications and Engagement Team now attend Greater Manchester Devolution communications and engagements meetings.
A Dow asked how the CCG aims to communicate with Glossop residents regarding the Key 103 bus visit given that Glossop is within High Peak. G Gibson agreed to liaise with the Communications Manager with this regard.
JS Bamrah commended PPIC for its work around the Extension of Care Project Funding for 2016/17. L Surman was pleased to note that this is to be included in the Locality Community Care Team work plan.
JS Bamrah made reference to the blog of the Independent Chair, Care Together Programme and suggested that this become a joint blog with the CCG senior colleagues.
The Governing Body:
- received the ratified minutes of the Public and Patient Impact Committee meeting of 2 December 2015
- noted the update from the Public and Patient Impact Committee meeting of 20 January 2016
- noted that the IGAR Committee is to provide a virtual review of the Quality Assurance mechanism proposals.
10 Finance
K Roe presented the Month 9 Finance Report. She drew to the members’ attention the
following key messages:
- the CCG is on track to meet all of its key financial duties, including its surplus target of £6,746k, but still needs to mitigate some risks further to ensure this will be achieved
- An agreement has been made with Tameside Hospital NHS Foundation Trust of £128.4m for 2015/16 which removes a significant amount of financial risk to the CCG and allows for Quarter 4 to be a period of stability for both organisations to focus on the priorities of the integration programme
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- Contingencies have been released to support the shortfall on the QIPP target of £5,200k
- The running cost allocation for 2015/16 has reduced by £585k to £5,202k as per National guidelines. However corporate budgets are still forecast to under spend by £285k at year end.
K Roe expressed serious concern regarding the impact this will have on 2016/17’s
allocation. She estimated that next year’s QIPP target will be in the region of
approximately £10m. This will place the CCG in a very difficult position as it will not realise the financial benefits of transformation for at least two years.
K Roe stated that, although there are positive messages being given regarding allocations to the NHS, very little of these allocations will be received by CCGs.
K Roe alerted the members to the fact that significant decisions will be required on how the CCG manages its budgets and difficult conversations will need to take place to agree in what it chooses to invest.
C Todd raised a query regarding non-medical prescribing and expressed concern that this issue may get lost during transition. Although she recognised this is a small area in comparison to the financial concerns she felt that some smaller problems when resolved could have a greater financial benefit. G Gibson confirmed that it is intended to undertake a piece of work with the Foundation Trust around this.
A Hannan reminded the Governing Body that the financial problem is a Care Together problem and that we need to prioritise and address the problem as a whole system.
JS Bamrah asked if the CCG has looked at what duties it could cease doing in order to save monies. K Roe replied that this task has been undertaken several times but to no avail: anything identified would only result in creating a pressure elsewhere. K Roe informed the Governing Body that the CCG does, however, continue to review its low clinical value procedures and will continue to seek ideas from its member practices.
A Dow made reference to previous working methods which involved incentivised budgets at both practice and locality level, and was of the opinion that the financial situation has deteriorated since the CCG moved away from this way of working. A Dow suggested that we should revisit this way of working which did have a positive outcome. S Allinson supported A Dow’s suggestion and considered that the CCG should be supporting this innovation and design. S Allinson informed members that both the Foundation Trust and Tameside Metropolitan Borough Council are in as difficult financial positions as the CCG; therefore it is imperative that the three work together to address this.
D Swift presented the approved minutes of the Finance and QIPP Assurance Committee meeting of 16 December 2015. No questions pertaining to the minutes were raised.
D Swift verbally updated the Governing Body following the Finance and QIPP Assurance Committee meeting held on 20 January 2016. The items to note had already been covered within K Roe’s earlier Month 9 Finance Report update.
D Swift informed the Governing Body that, with regard to the Better Care Fund for Tameside, there is an on-going monitoring process which has provided the assurance that the fund will meet the strict financial target which has been set. With regard to the Better Care Fund for Glossop the Governing Body was assured that all of the CCG’s contribution is being spent within Glossop.
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The Governing Body:
- discussed the 2015/16 financial position and outturn forecast as at Month 9 (December 2015) - acknowledged the change in risk profile identified within the report for 2015/16 and supported the mitigating actions proposed - noted the 2015/16 financial position and outturn forecast as at Month 9 (December 2015) - received the approved minutes of the Finance and QIPP Assurance Committee meeting of 16 December 2015 and noted the verbal update of the meeting of 20 January 2016.
11 Quality
C Poole presented the ratified minutes of the Quality Committee meeting of 16 December 2015. No questions pertaining to the minutes were raised.
C Poole presented the following highlights from the Quality Committee meeting of 6 January 2016, noting the shorter timescale between meetings, given the change in committee cycle. The Committee had received:
- Update on Darnton House - Primary Care Quality Report proposals - Primary Care Locally Commissioned (Enhanced) Services Post Payment Verification
Process and Outcome report - Draft report on a proposed quality assurance mechanism to inform the Shadow
Single Commissioning function: Quality Committee had discussed and amended the model and agreed for the report to be presented to the January meeting of the Public and Patient Impact Committee and return to Quality Committee in February for ratification.
JS Bamrah alerted the Governing Body to a new directive from Sir Bruce Keogh regarding mortality reviews and asked if our template has been adapted to reflect this. C Poole replied that J Bircher is the Quality Lead for the CCG and provides regular updates regarding Standard Health Mortality Index. C Poole agreed to highlight this new directive with J Bircher.
R Bircher presented the performance report and asked the Governing Body to note the 2015/16 CCG Assurance position and identify any areas in which they would like further scrutiny.
R Bircher reported that performance concerns continue around waiting times in diagnostics with Endoscopy remaining the key challenge, particularly at Central Manchester NHS Foundation Trust. He reported the number of patients still waiting for planned treatment 18 weeks and over continues to decrease and the risk to delivery of the incomplete standard and zero 52 week waits is being reduced.
R Bircher was pleased to report that the Cancer standards have been achieved in November. However, he was disappointed to report that discharge summaries at Tameside Hospital NHS Foundation Trust are beginning to drop again.
The Governing Body was informed that Emergency Department standards were not met at Tameside Hospital NHS Foundation Trust and are amongst the lowest in Greater
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Manchester. In addition, the number of Delayed Transfers of Care recorded remain higher than planned.
The ambulance response times were not met at a local or at the North West level
R Bircher expressed his opinion of the Meridian dashboard contained in the report. He did not feel that this dashboard provided the information that the Governing Body requires.
C Greenhough asked if the Governing Body intended to take any action with regards to the delays in Endoscopy at Central Manchester NHS Foundation Trust. She suggested notifying patients of the delays and advising them to be referred elsewhere. A Lewin expressed concern that this could have an impact on capacity elsewhere.
A Lea informed the Governing Body that the ISCAT Services contract is due to expire shortly and this is likely to impact on other services as a result.
The Governing Body discussed the various reasons for patients not being discharged from hospital in a timely manner and recognised the need to identify ways of assisting this with the lack of available beds being the main problem.
G Curtis was pleased to note that the Governing Body is no longer required to hold conversations regarding Clostridium Difficile; no risks are reported by the hospital in this area.
S Allinson asked the Governing Body to consider whether or not they wish to receive the performance report in a slightly different format and suggested a report that details what is different from last month; what is the action plan regarding specific areas; and to include a status report on specific areas. The Governing Body welcomed this approach and agreed three specific areas for next month’s performance report. These will be the flow through the hospital; Endoscopy at Central Manchester NHS Foundation Trust; and Meridian reporting.
The Governing Body agreed to review the provision of Endoscopy services at Central Manchester NHS Foundation Trust and to assess capacity in relation to this. A Dow confirmed that, if required, after A. Lea and A. Lewin looked into it, a letter will be issued to practices asking that they advise their patients to be referred elsewhere because of the lengthy waiting times at Central Manchester NHS Foundation Trust.
The Governing Body agreed that Locality Community Care Teams need to be designed to take the known pressures out of the system. R Bircher noted this as an action.
A Dow made reference to recent GP e-mail conversations regarding the two week upper Gastro-intestinal cancer pathway and informed the Governing Body that this is now being discussed with the Medical Director at Tameside Hospital NHS Foundation Trust.
A Lea confirmed that she intends to highlight the GI Cancer pathway problem with the Cancer Board later today and asked the Governing Body if there are any other issues which they would like raising.
G Gibson reminded the Governing Body that there was a new email address to which GPs can forward issues of concern. However, to date, only one communication has been received via this route. G Gibson suggested this route could be used for issues such as this concern regarding the GI Cancer pathway. In addition J Douglas reported that the Primary Care Team is now routinely reviewing the incident reporting systems in order to compile a list of concerns. These will then be addressed. G Gibson welcomed this positive approach.
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11
A Lea reminded the members that as of 1 February 2016 the ISCAT services will cease and, as a result, there will be no pathways being delivered by Care UK in relation to Gynaecology, Urology, or Gastroenterology. There will be new pathways in relation to MSK and ENT and, from April, Ophthalmology.
The Governing Body:
- received the ratified minutes of the Quality Committee meeting of 16 December 2015
- noted the verbal update of the meeting of 6 January 2016 - received the performance update dated 19 January 2016 - noted the 2015/16 CCG Assurance position - agreed a new style Performance Report - agreed to review the provision of Endoscopy Services at Central Manchester NHS
Foundation Trust and, if required, for a letter to be issued to practices in this respect.
12 Planning, Implementation, and Quality
G Curtis presented the approved minutes of the Planning, Implementation, and Quality Committee meeting of 9 December 2015.
G Curtis provided a verbal update from the committee’s meeting on13 January 2016.
The Governing Body were reminded that the Over 75’s monies are still available. There are strict Better Care Fund criteria to be met in relation to admission avoidance; innovative and good value for money bids towards this fund are welcomed.
G Curtis reported that the PIQ Committee discussed the report ‘Delivering the Forward View for Planning Guidance for 2016/17’. The Governing Body were asked to support the recommendations that the CCG adopts a style and format developed by NHSE, that it assigns lead directors for each element of the submission, that it clarifies the required governance process, and that Directors, Lead Commissioners, and Clinical Leads conduct a gap analysis and ensure plans are developed to address any gaps identified.
J Douglas asked if practices which have previously received Over 75s monies and have innovatively invested are eligible to submit further bids or is the process to exclude practices from the bid if they have had funds rolled over from the previous year. A Lewin advised that all bids will be considered however a strong business case will be required to support them.
K Roe asked if discussion could take place within the locality meetings regarding which schemes had worked well for some practices, and whether or not these could be rolled out to other practices. C Greenhough confirmed that such discussions have taken place in Stalybridge however there was uncertainty if such conversations had been held in other localities. It was recognised that not all schemes would work well in all areas; however, the suggestion was that these could be slightly adapted in order to make them productive.
The Governing Body:
- received the ratified minutes of the PIQ Committee of 9 December 2015 and ratified the recommendations contained there in
- ratified the four recommendations in relation to Delivering the Forward View for Planning Guidance 2016/17.
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12
13 Integrated Governance, Audit, and Risk Committee
G Curtis presented the approved minutes of the Integrated Governance, Audit, and Risk Committee meeting of 26 August 2015. No questions pertaining to the minutes were raised.
G Curtis presented the revised Terms of Reference pertaining to the IGAR Committee.
G Curtis provided a verbal update of the IGAR Committee meeting held on 27 January 2016. He reported a discussion that had taken place regarding the Register of Gifts and Hospitality and it was noted that a consistent approach is required within the Single Commissioning function.
The Governing Body was informed that both G Curtis and D Swift are to attend a Conflict of Interest update session in March.
The members were advised that P Pallister has produced a Register of Procurement which identifies which procurements the CCG has been through and which are on-going. This is available on the CCG website.
The IGAR Committee expressed concerns regarding Human Resources and whether or not policies were up to date. The lack of an induction programme was also highlighted.
G Curtis reminded the Governing Body of the mandatory training for Information Governance which is required to be undertaken. The CCG is currently at 92% compliance. The Governing Body was therefore asked to ensure they undertake this training ahead of the CCG’s assessment on 18 February 2016.
G Curtis reported that the IGAR Committee has volunteered the CCG to be a pilot for the Quality Assurance Assessment Process being introduced by NHS Protect. It was noted that there will be no cost to the organisation in relation to this and the time element will be kept to a minimum.
The Governing Body was advised that the CCG has now been assigned two new external auditors. The CCG is now in the position to appoint its own external auditors during this year. The Governing Body was therefore asked to agree a Health Auditor Panel consisting of G Curtis, D Swift, and R Bircher.
The Governing Body:
- received the ratified minutes of the IGAR Committee of 26 August 2015 - approved the revised Terms of Reference of the IGAR Committee - approved G Curtis, R Bircher, and D Swift as the Health Auditor Panel for the
external auditor roles.
14 Primary Care Joint Committee
D Swift presented the ratified minutes from the Primary Care Joint Committee meeting of 2 December 2015. No questions pertaining to the minutes were raised.
D Swift provided a verbal update from the committee’s meeting on 6 January 2016.
Following his attendance at the Co-commissioning Management Board D Swift reported that, with regard to the Memorandum of Understanding between ourselves and NHS England, the CCG has been assured that the level of support its receives will not be diluted when moving
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from Level 2 commissioning to Level 3. The Transformation Team were recognised for their contribution in achieving this level of delegation.
The Governing Body:
- received the ratified minutes of the Primary Care Joint Committee meeting of 2 December 2015
- noted the verbal update from the meeting of 6 January 2016.
15 Quality Report
G Gibson presented the Quality Report for January 2016 to inform the members of the activity being undertaken by the directorate. No questions pertaining to the report were raised.
At this juncture, S Allinson highlighted to the Governing Body that the CCG has not met with its local MPs for some time and that it is his intention to arrange a conversation with them to update them on the transition plans.
The Governing Body noted the contents of the Quality Report.
16 Locality Leads
A Dow presented the minutes of the Locality Leads’ meeting of 29 December 2015. He
reported that a conversation had taken place regarding the remits of the Locality Leads; however a conclusion had not been reached. A Dow informed the Governing Body of a suggestion that has been made that for representative from each of the localities to sit on the Governing Body. The Governing Body members were asked for their views on this suggestion.
J Douglas commented that each locality is currently represented by a GP on the Governing Body; however this was seen to be a co-incidence as opposed to a deliberate situation.
G Curtis reminded the members of the direct link the Locality Leads have with the Governing Body decision-making processes. He considered this arrangement to work well for the CCG and feels it important that this link between the CCG and its member practices be maintained.
A Hannan commented on the lack of representation from Practice Nurses and Practice Managers and he suggested it could be beneficial to the CCG business in the future if their voice be heard.
The Governing Body received the minutes of the Locality Leads’ meeting of 29 December 2015.
17 Partnership and Greater Manchester Meetings
D Swift raised a question in relation to the AGG minutes that detailed major issues with Greater Manchester Shared Service’s staffing vacancies and asked if this has been noted on the CCG risk register. S Allinson confirmed that issues are being addressed particularly with the Contracting function which is being in-housed. S Allinson reported that most services are being brought in-house; however he agreed to undertake a review of the situation.
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14
The Governing Body received the Healthier Together Update (22 January 2016) which included the Terms of Reference for the Healthier Together Joint Committee.
P Pallister notified the Governing Body of the Healthier Together Committees-in-Common proposal to move towards a Joint Committee governance structure. The QIPP principle addressed by this proposal is to produce more effective health services for the population of Greater Manchester.
The Governing Body received the ratified minutes of:
- the Association Governing Group meeting of 15 December 2015 - the Derbyshire Health and Wellbeing Board meeting of 19 November 2015 - The Tameside Health and Wellbeing Board meeting of 12 November 2015
The Governing Body agreed:
- to establish a joint committee with the other Greater Manchester CCGs to take decisions in relation to Healthier Together, to be known as the Healthier Together Joint Committee;
- to approve the terms of reference for the Healthier Together Joint Committee in their current form; and
- to delegate authority to a member of the Governing Body to approve any changes to the terms of reference that involve updating the members or deputy members of the committee or any other minor changes.
18 Any Other Business
The Governing Body was informed that the development session originally scheduled for 16 March 2016 is no longer suitable for both A Dow and S Allinson.
It was therefore agreed that P Pallister identify an alternative date for this purpose.
A Dow closed the meeting at 17:00
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NHS Tameside and Glossop CCG Governing Body
Actions Log following the meeting of Wednesday 27 January 2016
Action Number
Action Description Owner Deadline Update
011115 For the GP Governing Body members to include in the declarations of interest any enhanced services delivered by their practice
All GP Governing Body members
December 2015 January 2016
031115 To produce an information pack for practices of the Over 75s bids
C Watson January 2016
051115 To reflect in the next iteration of the locality plan the principle that those people who use services are to be involved in shaping them
S Allinson January 2016 S Allinson to share the proposed content for the Locality Plan with members in advance
011215 To raise the lack of a specialised breastfeeding service for
Glossop residents at the Derbyshire Health and Wellbeing Board
C Watson January 2016 February 2016
031215 To look into the delays for diagnostics C Watson January 2016 February 2016
041215 To look into the performance regarding referrals to the memory clinic
C Watson January 2016 February 2016
051215 To look into the self-referral process for the Healthy Mind service – telephone access required
C Watson January 2016 February 2016
010116 Glossop Volunteer Service to be asked to co-ordinate a list of charitable organisations that are supporting Tameside but not Glossop
C Watson February 2016
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Action Number
Action Description Owner Deadline Update
020116 To bring information regarding the four care models through the Planning Implementation and Quality Committee and intended to obtain the mandate from the Information, Governance and Risk Committee to act on behalf of the CCG in conversations with south sector colleagues. Conversation will also be required with the Public and Patient Impact Committee to ensure we have a clear line of sight in this respect.
S Allinson February 2016
030116 To highlight Sir Bruce Keogh’s new directive regarding mortality reviews with CCG Quality Lead
C Poole February 2016
040116 To review the provision of Endoscopy Services at Central Manchester NHS Foundation Trust and if required, write out to practices asking that they advise patients to be referred elsewhere
C Watson / A Lea
February 2016
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GOVERNING BODY MEETING
Title of Subject:
Chief Operating Officer Report
Date of paper:
24th February 2016
Prepared By:
Steve Allinson
History of paper:
Each month I summarise the key meetings / actions I
have taken and share them with our public and
Governing Body.
Executive Summary:
This report sets out key steps taken to ensure full staff
engagement in the development of our single
commission.
I set out detail on Planning arrangements for 2016/17
and how these link with GM Devolution.
I raise the development of a Sector Board to oversee
our mobilising the care standards agreed through
consultation on Healthier Together; this and the
emergent GM-wide Joint Commissioning Board will
have to be established in our reforming governance
locally. I raise with Governing Body the need for a
piece of work to bring that about.
Recommendations required
of the Governing Body
(for Discussion and
Decision)
Governing Body is asked to note the content of
this report
QIPP principles addressed
by proposal:
All
Direct questions to:
Steve Allinson
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CHIEF OFFICER REPORT FEBRUARY 2016
Single Commission It is becoming apparent that our proposal to establish a single commission is being mirrored in localities across GM as highlighted by analysis in the HSJ and of course in conversation with colleagues from AGG and AGMA. Like us, a number are looking to form single teams and co-locate staff; others are strengthening existing joint working infrastructure. Almost all are extending their ambition for joint commissioning beyond BCF and intend to pool a greater range of budgets covering public health and health and social care across their area. However, my focus has been to ensure locally, our work is undertaken with due diligence and engagement of our staff. We have strengthened our engagement activities and in early February, held a second joint team workshop with colleagues from health and social care. I followed that up personally asking for feedback from staff individually and collectively and have been pleased to learn our approach has been seen positively to engage and involve everyone as should be the case. Further, I have been meeting with our Union representatives to ensure we have a constructive engagement and that they are active also in offering advice and support to any member of staff who feels that would be of benefit. At the time of writing this report, we were signing off a next iteration of our staff ‘FAQ’ brief. This will have been published by the time Governing Body meet. We have already begun the process of bringing our teams together. I am pleased to report that the Public Health Team now has a base here at New Century House. Also, we issued a proposal for full co-location to our teams in the week of 15th February 2016. Planning for 2016/17 I attended a joint meeting between NHSE and our GM devolution leadership team with CCGs, Provider Trusts and Local Government. The meeting was called to ensure there is a clear, coherent approach to planning for 2016/17. It was organised, in part, in response to national guidance and expectation that annual operating plans and NHS contracts for service are signed off by the end of March 2016, and that local systems produce Strategic Transformation Plans (STP) by June 2016 in order to access transformation funding. However, those are national arrangements. There will be a subtly different arrangement in GM due to our devolution agreement. We must (and are on target to) complete our annual operating plan and sign our contracts by the end of March 2016. However, we will not be required to prepare a Strategic Transformation Plan. That is because there is already an agreed GM-wide strategy for reform underpinned by ‘locality plans’. Also, GM has already received notification of the level of transformation funding for 2016/17. Our focus is now on producing the business case to access those transformation funds. This is being overseen by our Care Together Programme Board. A draft was received and approved at the February meeting of the Programme Board. It will be refined in light of comment there and in a follow-up discussion with the GMD planning lead; also in response to criteria to be set by the GM Devolution Programme Board. We will include key deliverables and milestones in that next iteration which will help bring together our ‘plan’, resources and an implementation programme. These are requirements of the GMD arrangement.
25
Members of Governing Body may have heard that each economy must agree their ‘STP’ footprint, and then agree a lead executive from across the health/local government community. I have alluded to the STP footprint being set here, at the GM-level. On this basis, the proposal to appoint a Chief Officer for health and social care devolution would satisfy that second requirement. Arrangements are already in place to recruit to and make that appointment. Sector and GM commissioning arrangements Further to the outcome of the call for judicial review of the decision of the CIC in respect of ‘Healthier Together’: work is now underway to mobilise the single service model standards initially for emergency general surgery and then emergency care services. We are a part of the Southeast Sector. I represent the CCG at a partnership board which has been established to oversee the mobilisation of these new care standards. It is expected that a detailed mobilisation plan will be developed for June 2016. I will be working with partners locally in the coming weeks, to ensure that that plan is developed and firmly rooted in our own Care Together reform programme. There are elements relating to service design and financial modelling for example which must dovetail with arrangements for our ICO. Without wishing to pre judge, it will be important to make clear decision making arrangements between the SE Sector, our professional reference body underpinning the single commission, and the governance arrangements of Care Together. I attended the February meeting of the GM Joint Commissioning Board as deputy for the CCG Chair. I referred a number of the items through to our PIQ for information/discussion. These include the development of a GM-wide commissioning strategy and arrangements for the re-provision of services currently delivered from the Calderstones hospital in Whalley. In the coming weeks, I will be working with our governance leads locally to ensure local professional advice and decision making are aligned with GM-wide commissioning arrangements. Action required of Governing Body Governing body is invited to raise questions on these or any other matters relating to the role of Accountable Officer. S ALLINSON ACCOUNTABLE OFFICER 19th FEBRUARY 2016
26
GOVERNING BODY MEETING
Title of Subject: January Final Public and Patient Impact Committee minutes
Date of paper: 20th January 2016 Prepared By: Celia Poole
History of paper: Public and Patient Impact Committee held a meeting on 20th January 2016 and will meet regularly, promoting and providing assurances to the Governing Board that the CCG is providing strategic leadership for the development of Public and Patient Engagement.
Executive Summary: Key Issues discussed: Care Together The communications and engagement teams from TMBC, the single commissioning organisation and the Trust are looking at how they can work together and best utilise all available resource from each team to support communications and engagement. Tameside Hospital NHS Foundation Trust in the media MEN article – 14th January 2016 Recent headlines on Tameside hospital reported to be the worst in the country for A&E waiting times. Financial statement A financial statement was issued on 15th January 2016 and all Trusts in GM were asked by the MEN to provide details of their financial deficits. This information was used in an article in the MEN on 19th January 2016. Recent campaigns Self-care week – week commencing 16th November Winter Campaign – Stay Well This Winter Cervical Cancer Prevention Week (24 – 30 January 2016)
Posters will be displayed in New Century House
A week to go notice to campaign on Twitter and Facebook Daily tweets and Facebook messages scheduled on Buffer Re-tweeting of messages from NHS organisations
Article in Update newsletter Devolution Manchester Between February and March, there will be a big push on public engagement in relation to GM Devo. The Key 103 bus will be coming to Tameside (Asda car park) one day in February. Report on proposed Quality Assurance Mechanism PPIC received a report on a proposed quality assurance mechanism to inform the Shadow Single Commissioning Function. The report was written following a Quality workshop held on 18th November 2015 to review the effectiveness of the committee in providing assurances to
27
the Governing Body on the quality of services commissioned by T&G CCG on behalf of its local population. Patient Engagement Update
Ali Lewin gave a presentation on the Locality Community Care Teams and discussed some of the work streams. Louise Roberts also attended to present members with a draft patient leaflet ‘A guide for patients’ as a draft as a tool for GPs to aid discussion with patients about Examples of Procedures of low clinical value. Louise received some comments and feedback for consideration for developing the leaflet. Patient Network members agreed to sign off the Terms of Reference. Patient Access to Records and Understanding PPIC received a Business Case from Amir Hannan for Records Access. The business case sets out the challenges faced with trying to get a national policy for everybody to access their records. PPIC agreed to the principals set out within the business case and for onward presentation at PIQ. Local Community Care Teams AL presented a paper which sets out the vision for Local Community Care Team to provide quality, integrated health, social care and third sector services to adults (18+) in need of planned care in Tameside and Glossop. It will enable people to remain in their own homes and to lead independent lives for longer. PPIC will receive on-going updates as part of the Care Together Locality Development work stream. 7 day access AA gave a brief update on 7 day access as follows:
Hub 1 is now live Hub 2 in Glossop will open soon Hub 3 in Hyde will go live early February
The Hubs run from 6.30am-8pm weekdays and 9am-12 noon at weekends and is aimed at providing service to patients who cannot access appointments during normal business/working hours and is therefore not intended for urgent care. A meeting is taking place with NHS England and Manchester University to review whether it is value for money and members asked whether Friends and Family test would link in and patient feedback collated by University of Manchester when evaluation takes place.
Recommendations required of the Governing Body (for Discussion and Decision)
To discuss and note the key issues discussed and agreed at the meeting on 20th January 2016.
QIPP principles addressed by proposal:
To receive the report
Direct questions to: Celia Poole
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Final
1
MINUTES PATIENT AND PUBLIC IMPACT COMMITTEE (PPIC)
Wednesday 20th January 2015 9.30-11.30am Nursing and Quality meeting room, New Century House, Denton
Present:- Celia Poole (CP) Governing Body Lay Member, CCG (Chair) Lesley Surman (LS) Governing Body Lay Advisor, CCG Jean Hurlston Governing Body Lay Advisor, CCG Jane Birch (JBir) Healthwatch Officer, Healthwatch Derbyshire Clare Todd (CT) Governing Body Nurse, CCG Dr Asad Ali (AA) Locality GP, CCG Alison Lewin (AL) Deputy Director of Transformation, CCG Lynn Jackson (LJ) Quality and Patient Engagement Lead, CCG Hazel Chamberlain (HC) Designated Nurse for Safeguarding, CCG In attendance:- Karen Goodhind (KG) Head of Communications and Engagement, CCG Tracy Turley (TT) Engagement Lead, CCG Clare Bromley (CB) PA, Corporate Office, CCG (note taker) 1. Chairs welcome and apologies CP welcomed everyone to the meeting. Apologies were received from:- Peter Denton Healthwatch Manager, Healthwatch Tameside Gill Gibson Director of Nursing and Quality, CCG Naseem Yasin Equality and Diversity Manager, CCG Anna Hynes Coordinator for the Health and Social Care Network, CVATs Nigel Caldwell High Peak CVS Dr Amir Hannan Governing Body GP Member, CCG CB noted that Julie Farley has now taken up post as Chief Officer at the Volunteer Centre Glossop and during Nigel Caldwell’s absence Esther Jones, Sustainable Adviser will attend. They will keep with the arrangement Jo Baines and Nigel had in sharing the dates and taking it in turns to attend. CB agreed to share the contact details for Esther and Julie with PPIC members.
Action: CB 2. Declarations of interest AA declared an interest as a member of Orbit Healthcare, GP Federation. Register of Interests It was noted that although the Register seemed to be updated, CT’s NMC registration is not included. CB to check this with Paul Pallister and provide an updated version at the February meeting.
Action: CB 3. Minutes of the previous meeting: 2nd December 2015. The minutes of the previous meeting were agreed as an accurate record. The following actions were discussed: Item 12 (02.09.15) Evaluation of an integrated service to support people with respiratory conditions
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Final
2
Naseem Yasin had noted her interest to speak further with Philippa Robinson to address some of the issues identified with people that did not take up the project in terms of hard to reach/protected groups. CB to remind Naseem of this action.
Action: CB GG confirmed that membership of the Communications and Engagement Reference Group has been reviewed and the group is expected to be established soon. KG has received representative volunteers to join the group. Item 5. (02.12.15) – Winter Campaign LS confirmed receipt of an email from Adam Shepphard regarding access to some materials for sharing with locality groups on winter messages This led to some discussion on Self-Care week and World COPD Day. AA raised the need to promote self-care locally and queried whether there is a program of works available on forthcoming events on tackling approach to patients and raising awareness around self-care and encouraging patients to use the NHS correctly. It is important to help the public understand where they can go for help and a query was raised about pharmacist advice and the training programme for pharmacists set up by NHS England as an enhanced service and it was thought that there may have been a low uptake. AL agreed to ask Peter Howarth more about this and whether it is part of the minor ailments scheme.
Action: AL
AL noted that the commissioning team have been involved with communications and engagement team around the Local Community Care Team (LCCT) work which includes pharmacies, public health work and care together work. The Emergency Care Network (ECN) has requested that all parties bring a list of frequent flyers as a deep dive exercise. AA suggested more to be done to utilise practice screens as it is free and for those practices that do not have one currently installed, it is relatively low cost. Item 9. (02.12.15) Equality and Diversity Group Naseem agreed to send members an electronic version of the draft Terms of Reference for the Equality and Diversity Group via CB to request comments. CB has since spoken to Naseem who confirmed that the Terms of Reference will first be presented to the next E&D Group meeting before presenting to PPIC.
Action: Naseem Yasin Item 11 (02.12.15) – Terms of Reference for PPIC PPIC signed off the Terms of Reference for PPIC in December 2015. CB confirmed that these will be submitted to Information Governance and Risk (‘IGAR’) Committee in March.
Action: CB 4. Matters arising not otherwise on the agenda
Update on Integrated Care – MSK and ENT CB noted that Louise Roberts had requested to circulate a brief update to members after the meeting. CP reminded members of the presentation received at the November meeting where members had expressed several concerns with the integrated care pilot for both MSK and ENT and did not feel that patients was at the centre of the pathways described. An update was presented to PPIC in December and PPIC requested further discussion take place.
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Final
3
AL updated PPIC on the bridging arrangements put in place for the services to continue. PPIC queried the provisions made to public and patients and what engagement has taken place with patients. AL agreed to speak to Elaine Richardson.
Action: AL CP agreed to follow up the circulated update from Louise Roberts and request evidence that patients have been involved. PPIC agreed to chairs action on this and it was agreed that this would be included on the agenda for the February meeting.
Action: CP 5. Communications and Engagement Care Together The first single commissioning team meeting was held at on 19th January at Hyde Town Hall. The event was led by Steven Pleasant, Chief Executive at Tameside Metropolitan Borough Council with input from members of the single commission leadership team. The event was the first of what will become regular monthly meetings where the whole team will come together to work together on commissioning health and social care services in Tameside and Glossop. The new Integrated Care Organisation will be in shadow form from April 1 2016. The communications and engagement teams from TMBC, the single commissioning organisation and the Trust are looking at how they can work together and best utilise all available resource from each team to support communications and engagement. Tameside Hospital NHS Foundation Trust in the media MEN article – 14th January 2016 PPIC discussed the recent headlines on Tameside hospital reported to be the worst in the country for A&E waiting times. Financial statement A financial statement was issued on 15th January 2016 and all Trusts in GM were asked by the MEN to provide details of their financial deficits. This information was used in an article in the MEN on 19th January 2016. Winter campaign Self-care week This took place week commencing 16th November. Coverage included: Social media campaign: two daily tweets on Twitter and message on Facebook CCG news item on website and intranet Article in Update newsletter Winter Campaign – Stay Well This Winter
In the run up to Christmas and throughout the Christmas and NY period: two daily tweets and a Facebook message including short stay well this winter/flu campaign images and videos plus pharmacy opening times over the bank holiday period
Pharmacy times went into the Manchester weekly news and the reporter/chronicle
A film was made of Alan Dow to promote flu vaccination and posted on Twitter Adam informed other Communications leads of our campaign efforts and encouraged
them to re-tweet any of our messages on social media
Three daily tweets Daily Facebook message Posters displayed in NCH
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Final
4
Re-tweeting messages from other NHS organisations Cervical Cancer Prevention Week (24 – 30 January 2016)
Posters will be displayed in New Century House
A week to go notice to campaign on Twitter and Facebook Daily tweets and Facebook messages scheduled on Buffer Re-tweeting of messages from NHS organisations
Article in Update newsletter Devolution Manchester Between February and March, there will be a big push on public engagement in relation to GM Devo. The Key 103 bus will be coming to Tameside (Asda car park) one day in February. KG received an email during the PPIC meeting taking place and agreed to share details contained within the email confirming top lines and key messages and agreed to confirm which Asda within Tameside and the exact date and times.
Action: KG The issue of whether Glossop was to be included within GM Devo engagement plans was also raised by PPIC. KG undertook to check with GM Devo. It is noted that it is up to CCGs to decide what messages to give the public; this led to concerns with the delayed go live date for the new CCG website. KG agreed to update further on this at the next meeting in February.
Action: KG 6. Report on proposed Quality Assurance Mechanism PPIC received a report on a proposed quality assurance mechanism to inform the Shadow Single Commissioning Function. The report was written following a Quality workshop held on 18th November 2015 to review the effectiveness of the committee in providing assurances to the Governing Body on the quality of services commissioned by T&G CCG on behalf of its local population. The proposal leads to amalgamating the Quality Committee with the Public and Patient Impact Committee as within the governance arrangements both committees provide assurance to the Governing Body in relation to quality and patient experience. Quality Committee agreed to the report in principle on 6th January 2016. Some debate took place around the agreement to endorse the triangle based on the domains of the commissioning for quality Framework. LJ had met with Joanna Bircher to further debate the wording surrounding the triangle and to discuss the report in different situations and scenarios. Amendments have since been made to the report and GG has since presented this to Joint Committee for discussions on the single commissioning arrangements. CP noted the importance to measure impact to patients and to not lose the patient engagement and impact element of the mechanism. PPIC accept the principals of the report noting that the wording may change and requested that further review of the report be presented to PPIC prior to presentation to Governing Body in February. It was agreed that a covering paper be included capturing work in progress. LJ to reflect this in the timeline set out within the report.
Action: LJ
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Final
5
7. Patient Engagement Update
Patient Network draft minutes – 18th January 2016 TT gave a brief update on the Patient Network meeting that took place on Monday evening on 18th January 2016 and noted the key highlights: Ali Lewin gave a presentation on the Locality Community Care Teams and discussed some of the work streams. The presentation included a link to Sam’s story. Ali has since circulated the presentation to members. Louise Roberts also attended to present members with a draft patient leaflet ‘A guide for patients’ as a draft as a tool for GPs to aid discussion with patients about Examples of Procedures of low clinical value. Louise received some comments and feedback for consideration for developing the leaflet. Patient Network members agreed to sign off the Terms of Reference. Each of the Localities fed back key highlights from their respective locality group meetings. PPIC dates were shared with members of the Patient Network and it was agreed that a nominated representative attend future meetings on a rotational basis. Discussion took place about patient representatives attending the GP Locality meetings. It was agreed that AL, AA, LS and CP would meet separately to discuss some of the issues and concerns raised. 8. Patient Access to Records and Understanding PPIC received a Business Case from Amir Hannan for Records Access. CP felt it was a comprehensive report. The business case sets out the challenges faced with trying to get a national policy for everybody to access their records. CP agreed to feedback to Amir with any comments received from PPIC before he presents to PIQ.
Action: CP AA noted that the benefits do seem to outweigh some of the challenges faced and gave LCCT as an example of when access to records would be required, although AA highlighted that not all GPs share this view. PPIC noted that any further debate would need to address and understand some of the concerns shared amongst GPs. There was a question raised around whether patients would want to access their records and were they aware that they could. It was agreed that these conversations would be included in the Care Together communications and engagement although it was expressed that the public would need to understand that with such rights comes responsibility and any communication would need to be carefully managed. This raised further concerns that access to patient records could open up GPs to litigation. It was also noted that social care records are not currently accessible. Finally, it was raised that assurance would be required around safeguarding for adults and children. PPIC agreed to the principals set out within the business case and for onward presentation at PIQ.
33
Final
6
9. Local Community Care Teams AL presented a paper which sets out the vision for Local Community Care Team to provide quality, integrated health, social care and third sector services to adults (18+) in need of planned care in Tameside and Glossop. It will enable people to remain in their own homes and to lead independent lives for longer. PPIC will receive on-going updates as part of the Care Together Locality Development work stream. AL noted the matrix for work set out in the business case and confirmed that the work does not stop after the 11 weeks consultation Support will remain on-going as the teams develop. AL and TT worked through the patient toolkit together to support this business case. Ali has since presented this to the Glossop Patient Locality Group and to the Patient Network and requested advice from PPIC as to where else this could be usefully presented and for dates to be shared with AL and the commissioning team in order to forward plan and allocate resource to deliver presentations. LJ suggested use of the CHC patient experience project and to use patient opinion to include a blog for people to contribute to. AL and TT agreed to explore this further and to discuss possible questions posed.
Action: AL/TT JBir suggested Derbyshire’s Intelligence and Insight Group taking place on 24th February and JH suggested the forthcoming lay team meeting for input/advice. LS suggested sending AL the locality dates for the year. All agreed to send AL any useful dates for her diary. PPIC supported the proposed way forward with the development and implementation of LCCTs. 10. Items for Information:-
NHS England new Patient and Public Participation Policy and Statement of Arrangements Members received an easy read version of NHS England’s new Patient and Public Participation Policy and Statement of Arrangements. The report includes a link for opportunity to comment and feedback on line to NHS England. TT noted that she was invited to attend a workshop to input into this Policy and noted that as a CCG we have already sent in feedback to NHS England. 11. Any other business
Heathwatch Derbyshire update JBir gave members a hand out of the latest Heathwatch Derbyshire newsletter. 7 day access AA gave a brief update on 7 day access as follows: Hub 1 is now live Hub 2 in Glossop will open soon Hub 3 in Hyde will go live early February The Hubs run from 6.30am-8pm weekdays and 9am-12 noon at weekends and is aimed at providing service to patients who cannot access appointments during normal business/working hours and is therefore not intended for urgent care.
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Final
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There is a meeting taking place with Sara Roscoe at NHS England and Manchester University to review whether it is value for money and members asked whether Friends and Family test would link in and patient feedback collated by University of Manchester when evaluation takes place. PPIC also request to know whether local informal feedback will be collated and link in to assess whether it matches what is required locally and if not an opportunity to ask questions be provided. It was agreed that we could independently review this locally in terms of the flexibility of hours and whether it works or not. AA agreed to raise the queries at the meeting and feedback to PPIC.
Action: AA 12. Date and time of next meeting – Wednesday 17th February 2016. Meeting closed: 11.45am
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1
GOVERNING BODY MEETING
Title of Subject: Finance Report Month 10
Date of paper: Governing Body 24th February 2016
Prepared By: Kathy Roe – Chief Finance Officer
History of paper: Finance Committee 17th February 2016
Executive Summary: The CCG is on track to meet all of its key financial duties, including its surplus target of £6,746k, but still needs to mitigate some risks further to ensure this will be achieved.
An agreement has been made with TFT of £128.4m which removes a significant amount of financial risk to the CCG and allows Q4 to be a period of stability for both organisations to focus on the priorities of the integration programme.
Contingencies have been released to support the shortfall on the QIPP
target of £5,200k.
The running cost allocation for 2015-16 has reduced by £585k to £5,202k as per National guidelines. However corporate budgets are still forecast to under spend by £239k at year end.
Recommendations required of the Finance Committee (for Information, Discussion or Decision)
To discuss the 2015-16 financial position and outturn forecast as at Month 10 (January 2016).
QIPP principles addressed by proposal:
Yes
Direct questions to: Kathy Roe / Tracey Simpson
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1. Headlines
The below table details the CCG’s total funding allocation, 2015-16 budgets and expenditure and the forecast surplus for 2015-16. The CCG is forecasting to achieve its required surplus of £6,746k and remain with its running cost allocation of £5,202k and although this is challenging, the risk is incrementally reducing as we approach year end.
To achieve a balanced position by the year end there are a number of risks that have to be managed:-
Achievement of the £5,200k QIPP target. The schemes are not delivering to the timelines initially outlined in plans and contingencies have been released to mitigate this.
An agreement has been made with our main provider (TFT) which substantially reduces the financial risk, however the risk associated with other providers still needs to be managed and risks mitigated.
The increasing financial pressures and volatility in relation to Continuing Healthcare.
Summary of Financial Position
Year to Date (M10) Year End Change in Position
£000's £000's £000's £000's £000's £000's £000's £000's
Budget Actual Variance Budget Forecast Variance Previous
Month Movement
in Month
Funding Allocation 286,825 286,825 0 347,030 347,030 0 0 0
Acute 156,684 159,876 (3,192) 188,158 192,427 (4,269) (4,510) 241
Mental Health 23,133 22,692 441 28,593 28,140 453 471 (18)
Primary Care 41,639 42,323 (684) 49,734 50,248 (514) (357) (157)
Continuing Care 10,441 11,208 (767) 12,620 13,469 (849) (766) (83)
Community 22,368 22,385 (17) 26,840 26,952 (112) (111) (1)
Other 18,440 18,698 (258) 22,893 23,399 (506) (34) (472)
Reserves 4,032 0 4,032 6,244 686 5,558 5,022 536
Total Programme 276,737 277,182 (445) 335,082 335,321 (239) (285) 46
Running Costs 4,467 4,022 445 5,202 4,963 239 285 (46)
Total Costs 281,204 281,204 0 340,284 340,284 0 0 0
Surplus / (Deficit) 5,621 5,621 0 6,746 6,746 0 0 0
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2. Acute
Forecast outturn at month 10 on acute budgets is £192,427k which shows a marginal improvement of £9k from the month 9 forecast outturn of £192,436k. A significant amount of financial risk has been reduced on acute areas given the CCG’s year end agreement with its main provider, Tameside FT of £128.4m which is a fixed and final settlement. This has brought stability for both organisations and allows us to focus on priorities of the integration programme and 2016-17 contracting setting.
Activity at Tameside FT will continued to be monitored until the end of the financial year, as this will be important when we align baseline contract values with the Trust as part of 2016-17 contract negotiations.
Acute budgets are forecasts to overspend by (£4,269k), which shows an improvement of £241k from the month 9 position. However it must be noted that the majority of this movement is due to a budget realignment exercise following an in depth review of stroke activity (more detail is discussed under Stockport FT of this report). Although the CCG has an agreement with TFT, the CCG’s financial position
remains challenging in 2015-16 and there are other pressures within acute budgets which are a real cause for concern.
Independent Sector
We are experiencing unprecedented levels of growth in 2015-16 across a number of our independent sector providers. Activity in this area continues to grow at pace and the most recent activity data (month 9) was much higher than anticipated, which has resulted in an adverse movement of (£146k) from the previous month’s forecast. We have seen an increase across a number of providers; however the table below shows the most significant areas of overperformance which is set to reach an overperformance of (£835k) by the end of the financial year.
Year End Change in F’cast Position
£000's £000's £000's % £000's £000's
Provider Budget Forecast Variance Variance Previous
Month Movement
in Forecast
BMI 1,100 1,208 (108) 10% (91) (17) Spa Medica 922 1,308 (386) 42% (330) (56) Mediscan 269 444 (175) 65% (148) (27) Oaklands 266 432 (166) 62% (120) (46) TOTAL 2,557 3,392 (835) 33% (689) (146)
As illustrated in the table above Spa Medica is by far the largest overperformance (£386k), which makes up 46% of the total overperfomance. Following a detailed review of Spamedica’s activity data, a
significant proportion of this activity relates to cataract surgery (BZ02Z- Phacoemulsification Cataract Extraction and Lens Implant). In order to ascertain whether this activity has shifted from our main acute providers, the table below shows a consolidated position:
Year to Date Year End
£000's £000's £000's £000's £000's £000's
Provider Budget Actual Variance Budget Forecast Variance
CMFT 238 194 44 285 233 52 PAHT 305 374 (69) 368 449 (81) SFT 108 78 30 129 93 36 Sub Total 651 646 5 782 775 7
Spa Medica 772 1,110 (338) 922 1,308 (386) TOTAL 1,423 1,756 (333) 1,704 2,083 (379)
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The consolidated position shows a year to date over performance of (£333k), with a year end forecast of (£379k). The increase in cataract surgery is intrinsically linked to NICE guidance, which highlights cataract surgery as very cost effective with 85–90% of people who undergo surgery will have corrected vision that meets the minimum driving requirements.
We have also seen significant increases at Oaklands, BMI and Mediscan with the majority of this activity being MSK related. It is felt that the activity shift is through patient choice, however were not seeing any corresponding reductions at our main acute providers to offset this.
The trends being observed within the independent sector is placing significant pressure on the CGG’s
financial position. Achievement of our control total for 2015-16 remains challenging and any adverse movements in secondary care activity are make this increasingly difficult.
Associate Provider Contracts
This section of the Finance Report will focus on the financial forecasts for other providers. The table below shows the forecast positions for our associate provider contracts:
Year to Date Year End Change in F’cast
Position
£000's £000's £000's £000's £000's £000's £000's £000's
Provider Budget Actual Variance Budget Forecast Variance Previous
Month Movement
in Month
CMFT 16,427 16,085 342 21,899 21,600 299 234 65 SFT 8,373 8,844 (471) 11,104 11,517 (413) (550) 137 UHSM 4,090 4,697 (607) 5,430 6,180 (750) (755) 5 PAHT 2,924 2,850 74 3,920 3,811 109 32 77 SRFT 2,364 2,235 129 3,129 3,000 129 128 1 WWL 862 1,024 (162) 1,163 1,347 (184) (218) 34 BOLT 70 60 10 93 76 17 14 3 TOTAL 35,110 35,795 (685) 46,738 47,531 (793) (1,115) 322
Further detail is provided below in support of those providers with a forecast of £100k+. Central Manchester Foundation Trust (CMFT)
CMFT contract is forecast to underspend by £299k based on 9 months activity data, which represents a favourable movement of £65k from the previous forecast. As reported previously the biggest area of underspend is against Elective and Day cases which are forecast to underspend by £340k by the end of the year. This comprises of underspends in General Surgery £171k and Cardiology £118k. As part of the 2015-16 contracting round additional investment (above 2014-15 outturn) was made in relation to elective activity as the Trust set a capacity plan based on the delivery of RTT targets. However activity to date appears lower than anticipated which has resulted in a significant underperformance. NEL Admissions continue to underperform are forecast to underspend by £301k by the end of the financial year. However this is offset by pressures within PbR excluded drugs (£268k) and critical care (£72k). Pressures within PbR excluded drugs are a continuation of those issues reported in last months reports. We have seen a significant spike in two particular drugs (Adalimumab and Etanercept) which is felt to be linked to the treatment of rheumatoid arthritis, with both drugs being NICE recommended for patients with active rheumatoid arthritis.
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Stockport FT (SFT)
The SFT contract is forecast to overspend by (£413k) as at month 9 which is due to overspends on emergency admissions (£142k), High Cost Drugs (£150k) and critical care (£86k) Emergency admissions are overspent by (£125k) on a YTD basis based on 9 months activity data, which is due to pressures within general medicine. High cost drugs are currently overspending by (£112k), and forecast to overspend by (£150k) by the end of the financial year. Whilst some of the increase is believed to be related to NICE guidance as at CMFT, we have asked for further clarity from the trust in order to understand the reasons for significant growth in 2015-16. Following an in depth review and full reconciliation of all stroke activity (across all providers), budget adjustments have been made in month 10 reporting to ensure these are aligned to where activity the activity is taking place. This helps to explain why we have seen an improvement in the year end forecast at SFT moving from (£550k) over performance to (£413k) at month 10. University Hospital South Manchester FT (UHSM)
UHSM contract is overspent by (£607k) as at month 9 which comprises overspends in:
NEL admissions - (£345k), Daycases - (£220k)
The NEL admissions overspend comprises over performances in vascular surgery (£265k) and Geriatric medicine (£51k). The overspend on vascular is linked to the on-call rota system whereby activity for emergency vascular surgery is now principally provided by UHSM. We have seen underspends totalling £55k in vascular at CMFT and PAHT, which is offsetting some of the over performance seen at UHSM within vascular surgery. Daycases are overspent by (£220k). One significant area of over performance is plastics activity (£100k). As part of 2015-16 contracts it was anticipated that a proportion of plastics activity would transfer from UHSM to TFT and financial plans were adjusted accordingly with an increase to the TFT contract. However based on the month 9 activity data it appears that the majority of plastics activity is still being carried out at UHSM. Salford Royal FT (SRFT)
SRFT is underspent by £129k which is due to underspends in elective activity £42k, outpatient follow ups £30k and diagnostic imaging of £15k. Underspend within elective activity is due to underperformances within ENT and Urology. Wrightington, Wigan & Leigh FT (WWL)
WWL is overspent by (£162k) based on nine months’ activity data. The overspends relate to Day Cases (£58k), NEL admissions (£40k) and Rehab (£38k). Daycase / elective activity in month 9 (December) reduced significantly resulting in a favourable movement of £34k to our year end forecast position. It is felt that this is a seasonal impact than any real change in activity patterns. We anticipate levels in quarter 4 to return to planned levels and an adjustment to the forecast has been made for this. Rehab costs of (£38k) were the result of one high cost patient with spinal cord injuries and required a significant number of days in rehabilitation.
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3. Mental Health
The consolidated Mental Health (MH) position comprises a year to date underspend of £441k with a forecast under spend of £453k by year end. Overall there has only been an (£18k) movement from last months reported position though the points below are to be noted: The continued review of adult placements and their reassignment into a more appropriate
healthcare setting, which is often Continuing Healthcare (CHC) is almost complete and is a significant contributor to the reported underspend in mental health.
The Calderstones’ contract has now been signed. There is an agreed extension of the current
contract to 30/09/16 with Mersey Care NHS Trust as the lead. It has been agreed that the CCGs will contribute to any shortfall on the basis of the number of occupied beds as at 30/09/2015. For Tameside and Glossop this represents 2 clients.
In light of the Mental Health Parity of Esteem we continue to review our increased investment with
additional funding due in the latter half of the year (CAMHS, IAPT etc.). Notification of the planned spend is to NHSE on a monthly basis and we continue to be on track to deliver and potentially exceed the target spend of £32.4m.
4. Primary Care
Primary Care budgets at month 10 are forecast to overspend at year end by (£514k); this is an adverse movement in month of (£157k) which primarily relates to a change in the position on prescribing.
Prescribing budgets are forecast to overspend by (£302k), this is a compared to the forecast of (£125k) previously reported. The position reported here is based on the 8 months of data available to us. Analysis of this data shows that October and November actuals were higher than had been anticipated and as a result the full year outturn position has been increased.
The work the Medicines Management Team is undertaking with practices continues and there is good engagement. In addition, a number of practices have a practice pharmacist supporting them, undertaking medication reviews, reviewing patients in care homes, looking at patients on multiple disease registers and polypharmacy. Both these work streams have positive feedback when discussed through MMC and Locality meetings and, although both will impact on the prescribing position and therefore have been acknowledged in the forecast outturn position, it is difficult to quantify timescale and the extent to which this will impact in the year. This is an area which will continue to be detailed in reporting to Finance Committee and Governing Body.
The other elements of spend under the Primary Care hierarchy are stable compared to the month
9 report.
5. Continuing Care
The overall position on Continuing Care budgets has seen a slight change in the forecast overspend with a forecast of (£849k) now reported; an (£83k) adverse change compared to the position reported at month 9. The nature of this area makes a degree of month on month volatility inevitable, however the Nursing & Quality and Finance directorates continue to work closely together to ensure the reported position is as accurate as possible.
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6. Community
Community Services are currently forecast to over spend by (£112k) by the year end. This is largely due to a pressure on Community IT software and on Non Medical Prescribing (NMP). An investigation as to the increased costs of NMP is currently taking place at SFT. Work has commenced between Stockport FT / Tameside FT and NHS Tameside & Glossop CCG in relation to the further development of Community Services as part of our vision for integrating health and social care.
7. Other
Areas of spend included within the “other” category comprise: Better Care Fund; Transition Cost; NHS 111; Recharges from NHS Property Services; Safeguarding team; Patient transport.
In total there is a forecast over spend of (£506k) by year end however this is largely offset by funding in reserves.
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8. Running Costs
The annual budget in 2015-16 for running costs is £5,202k which is a 10.10% reduction from 2014-15.
Running costs are currently forecast to underspend by £239k at year end. The below table and
commentary provide more detail.
Analysis of NHS Tameside & Glossop CCG - Running Costs 2015/2016
Administration
Directorate 2015/2016
Establishment 2015/2016
Budget £
2015/2016 Forecast
Outturn £ 2015/2016 Variance £
Commissioning 14.72 702,822 674,017 28,805
Finance 13.93 902,818 824,395 78,423
CEO / Board Office 4.00 669,171 661,921 7,250
Chair / Non Execs 1.00 238,745 244,425 (5,680)
Communication & PR 4.00 162,720 171,566 (8,846)
Corporate Governance 10.80 355,871 323,061 32,810
Human Resources 2.60 175,496 116,616 58,880
IM&T 1.00 314,724 316,978 (2,254)
IM&T Projects 0.00 175,899 196,350 (20,451)
Nursing Directorate 1.00 118,283 118,722 (439)
Contract Management 4.00 521,877 436,737 85,140
Corporate Costs 0.00 535,045 438,362 96,683
Equality & Diversity 0.00 26,761 16,510 10,251
Estates 0.00 430,466 430,466 0
Business Admin 0.00 (7,200) (7,200) 0
Admin Reserve 0.00 (121,498) 0 (121,498)
TOTAL 57.05 5,202,000 4,962,926 239,074
Human Resources is forecast to under spend by £59k, based on the current structure of staff. Finance is forecast to under spend by £78k at year end largely due to vacancies within the structure. The CCG has to remain within its running cost allocation of £5,202k in 2015-16. The CCG is currently
on track to meet this target as reported by the forecast underspend of 239k. This will continue to be monitored closely throughout the remainder of the financial year.
The above running costs are not the total costs of running the organisation as there are a number of teams who are charged to programme costs. (Medicines Management / Safeguarding / CHC Team / Transformation Staff and Project Staff).
The percentage of staff time to be charged directly to programme costs will be reviewed as part of the on-going management of running costs and working towards budget setting for 2016-17.
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9. QIPP
The table below shows progress against our QIPP schemes in 2015/16. All data is based on year to date data up to December 2015.
The CCG QIPP target for 2015/16 is £5.2m (which includes £522k of unfunded targets). The forecast outturn for activity based operational schemes shows a projected shortfall of £2,923k against the target of £5.2m. However as we reported last month, while we have been unable to fully address the 15/16 QIPP challenge using activity backed recurrent schemes, we have been able to meet the shortfall on a non-recurrent basis through release of contingency. As a result we are able to report achievement of QIPP to NHS England on a non-recurrent basis this for 2015/16, despite the fact savings have not come from the originally proposed schemes. This is largely the result of the contract settlement with Tameside FT which means we no longer have any risk of overspend with our largest provider. While this means we may not feel the full benefit of activity based schemes either going live or increasing in capacity during Q4 (e.g. DVT or cardiology outpatients), we have factored in an estimated position in our settlement which is guaranteed and will ensure the CCG as a whole is well placed to meet its financial control totals for 2015/16. We will continue to monitor activity in shadow form for the remainder to the year to ensure that the schemes are continuing to work from an operational perspective and so we can assess recurrent impact for 16/17.
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10. Risks
A number of risks have been identified which could prevent the CCG achieving its financial duties. These are summarised in the table below and an estimation of the probability and risk has been provided together with mitigation strategies in place to manage the risk.
Risk Probability Impact Risk RAG Additional Detail of Risk Mitigation The achievement of meeting the Care Together Sustainability Target (QIPP) recurrently.
2 3
6
A
The CCG QIPP target for 2015/16 is £5.2m (which includes £522k of unfunded targets). The forecast outturn for activity based operational schemes shows a projected shortfall of £2,923k against the target of £5.2m.
Contingencies have been released to cover the delays in implementation/realisation of efficiencies in some of the QIPP schemes. These contingencies have been able to be released because of the year-end settlement with Tameside FT. However, there is a risk on achieving efficiencies recurrently and this will be referenced on the CCG corporate risk register.
Over Performance of Acute Contract
2 3 6 A
Secondary care activity increases exacerbated by increased referrals and seasonal pressures.
An agreement has been reached with TFT for a fixed settlement value of £128.4m. This agreement removes a significant amount of financial risk from over-spends in secondary care acute contracts and brings substantial stability to the overall CCG forecast position.
Over spend against GP prescribing budgets
3 2 6 A
The total prescribing budget is £40,775k for 2015-16. The 2015-16 prescribing position is forecast to overspend by £302k at year end.
The revised profile and Cat m adjustments are now reflected in the prescribing position therefore giving the CCG more confidence in its year end forecast prescribing position.
Over spend against Continuing Health Care budgets
3 2 6 A
The CHC forecast position for the past quarter has been volatile due to a number of new CHC cases and reviewing of the CHC database.
The CHC database is being closely monitored between the finance team and the CHC team to ensure the most accurate and up to date data is being used for forecast projections.
Overspend against the pooled budget
1 2 2 G
The wider pooled budget will commence on 1st April 2016, however the CCG still has pooled budget arrangements in relation to BCF with TMBC and DCC.
The BCF is monitored on a monthly basis with the local authorities and national quarterly returns are submitted to NHSE. Plans are in place to mitigate any risks, and both BCF’s the CCG is part of, are forecast to achieve a balanced budget as set out in the guidance.
Fail to maintain expenditure within the revenue resource limit and achieve a 1% surplus.
1 4 4 G
The CCG has to deliver a surplus of £6,746k in 2015-16 which includes its mandatory 1% surplus in line with national guidance.
If all of the above risks are mitigated as explained then the CCG will achieve it required surplus of £6,746k. The year end settlement with Tameside FT adds further assurance.
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11. Better Care Fund (BCF)
The total Tameside BCF is £16,941k funded by £15,140k (89%) from Tameside & Glossop CCG and £1,801k (11%) from Tameside MBC. In total T&G CCG recharges the pooled BCF £3,336k (20%) and TMBC recharges the pooled BCF £13,605k (80%).
At bottom level the BCF is not allowed to either under spend or over spend – any pressures or benefits will be dealt with through the wider pooled budget risk share agreement (against which we have a 2% contingency in reserves). The key targets and metrics the BCF is monitored on for Tameside BCF are shown below.
Reduction in NEL Admissions. Percentage change in rate of permanent admissions to residential care per 100,000. Change in annual percentage of people still at home after 91 days following discharge. Newly diagnosed patients on primary care dementia registers. Overall satisfaction of people who use services with their care and support.
The Tameside BCF is on track to breakeven and spend all of the required £16,941k in 2015/2016. However the split of costs per scheme has moved since the original plan but bottom line the BCF will breakeven.
In addition to the Tameside BCF, Tameside & Glossop CCG also contributes £2,178k (3.5%) to the Derbyshire BCF which amounts to £61,489k. In total T&G CCG recharges the pooled Derbyshire BCF £443k (0.7%). The Derbyshire BCF is monitored against the same targets and metrics as the Tameside BCF.
Administration of this fund will be comparable to that of Tameside. The Glossop element of BCF will form part of the normal monthly reporting. In total the Derbyshire BCF will have annual income of £61.5m of which Tameside CCG contributes £2.1m. The major schemes under the Derbyshire BCF are Rapid Response / Reablement (£9,315k), Community / Specialist Equipment (£7,617k), Community Support Team (£3,392k), DFG (£3,200k) and the Care Act (£2,802k). The over 75 value is £158k. We are in regular contact with Derbyshire CC regarding updates on schemes and completion of returns and have a good working relationship.
The below tables show the emergency admission data for both the Tameside BCF & Derbyshire BCF that will be submitted on 26th February 2016. Q3 data for Derbyshire is still to be confirmed and validated.
Tameside BCF NEL Data
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Derbyshire BCF NEL Data
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List of Annexes
Annex A shows the monthly financial position broken down by locality. Annex B shows the monthly financial position broken down by practice. Annex C is the Glossary.
12. Recommendation
Members are asked to:-
Discuss the 2015-16 financial position and outturn forecast as at Month 10.
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Annex A
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Annex B
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Annex C
Glossary
Abbreviation Description
AQP Any Qualifying Provider
BCF Better Care Fund
CCG Clinical Commissioning Group
CHC Continuing Healthcare
CIS Commissioning Improvement Scheme
CSU Commissioning Support Unit
DC Daycase
EL Elective
GP General Practitioner
IAT Inter Authority Transfer
MH Mental Health
MMC Medicines Management Committee
NEL Non Elective
OP Outpatient
PIQ Planning, Implementation & Quality
PMD Prescribing Monitoring Document
PPA Prescription Pricing Authority
QIPP Quality, Innovation, Productivity, Prevention
SFT Stockport Foundation Trust
SHMI Summary Hospital Level Mortality Index
SLA Service Level Agreement
SLAM Service Level Agreement Monitoring
TFT Tameside & Glossop Foundation Trust
UHSM University Hospital South Manchester Foundation Trust
WTE Whole Time Equivalent
WWL Wrightington, Wigan and Leigh Foundation Trust
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GOVERNING BODY MEETING
Title of Subject: Ratified Finance & QIPP Assurance Committee Minutes – 20 January 2016
Date of paper: 17 February 2016 Prepared By: David Swift History of paper: Ratified at Finance & QIPP Assurance Committee on 17
February 2016. Executive Summary: Scheme of Delegation (SoD)
Going forward the SoD will go to IGAR only with virtual approvals when necessary. Month 9 Finance Report • The CCG is on track to meet all of its key financial
duties, including its surplus target of £6,746k, but still needs to mitigate some risks further to ensure this will be achieved.
• An agreement has been made with TFT of £128.4m and is now formally ratified.
• Contingencies have been released to support the shortfall on the QIPP target of £5,200k.
• Key movements in month were: o Acute – an adverse movement of (£554k) o Mental Health – a favourable movement of £192k
BCF The final quarterly return for the 2015/16 BCF is due on 26th February 2016 Future CCG/TMBC Alignment A paper will be going through both CCG and TMBC governance for a full aligned budget under the Shadow Single Commission from 1st April 2016. Financial Planning 2016/17 This is an area that is constantly changing with ambiguous areas and significant financial risk. • Under the terms of GM Devolution the Devolution
Strategic Plan – with a few amendments – will act as a GM level STP.
• here is a new Financial duties requirement to keep 1% of non-recurrent funds uncommitted. There is an obvious uncertainty and significant concern surrounding this and more clarity is being requested at CFO level.
• Allocations: although £4.3m higher than expected there are a number of new spending commitments which more than off-set this increase e.g. the increased PbR tariff inflation.
Recommendations required of the Governing Body (for Discussion and Decision)
To receive the approved minutes. No recommendations to be put forward to the Governing Body.
Direct questions to: David Swift
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NHS TAMESIDE & GLOSSOP
FINANCE & QIPP ASSURANCE COMMITTEE
Wednesday 20 January 2016
PRESENT: David Swift – Chair Graham Curtis - Lay Member
Tracey Simpson – Deputy Chief Finance Officer (representing KR, CFO) Clare Watson – Director of Transformation (from agenda item no 4) Dr Saif Ahmed – GP Locality Lead
In Attendance: David Milner – Assistant Chief Finance Officer
Vikki Forshaw – Senior Secretary 1. Apologies Apologies were received from Kathy Roe, Chris McGarry, Dr Jamie Douglas, Steve Allinson, Dr Alan Dow and Stephen Wilde. 2. Declaration of Interests/Quoracy The meeting was quorate in line with the Terms of Reference.
No new interests were declared. 3. Minutes of previous meeting held on 16 December 2015 The minutes were agreed as an accurate reflection of the previous meeting. 4. Matters Arising/Actions Actions were completed with the exception of the following, which will carry forward to the next meeting:
• CW is going to look into if the decision for UHSM to be the sole ‘on call’ provider for vascular services has been discussed with CCGs. AL explained that this has now been confirmed and all CCGs are aware that UHSM are the sole ‘on call’ provider. DM will adjust the 2016/17 finance plans to reflect this and will inform practices. – DM to confirm this has been done (Action: DM)
• DG to liaise with Jamie Douglas re the Programme Budgeting tool kits and prepare a paper to explain the merits of the most effective ones – Having spoken to JD, DG was advised to liaise with Dr Amir Hannan. DG will report back at February’s meeting. (Action: DG)
**CW joined the meeting**
• Submit the Commissioning Improvement Scheme to December’s meeting – CW felt that the 15/16 Commissioning Improvement Scheme was not a success and will therefore bring a paper to February’s meeting for discussion. (Action: CW)
• The need for additional support for practices should be assessed through Locality Support meetings (GPs need to communicate this to their Locality Lead). - SAh reported that this has not been taken forward. However there has been some improvement seen with one of the outlier practices showing a reduction in referrals from 170 to 70 in one month following SAh and Alan Dow’s practice visit. This practice is going to be monitored to check this was
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not a one off. If the data is validated the Locality Leads will look into how to transfer this process to other outlier practices. The committee agreed that reducing outlier GP practice referrals needs to be a priority as it has massive potential for savings. SAh is to discuss this at the next Locality Lead meeting, along with the main agenda item: LCCT. Following this discussion a proposal is to be sent to February PIQ. (Action: SAh/CW)
• Once the TFT year end settlement has been approved by GB a notice will be communicated out to all practices – Action completed.
• DM will provide a verbal update to SRG that there is no spare funding to bridge any financial shortfalls/pressures – Action completed.
• TS to amend the Finance Report to reflect the changes to the QIPP risk before it is submitted to GB on 23rd December – Action completed.
• VF will ask Sarah Hadfield to add Practice Visits to the PIQ workplan for quarterly updates. – Action completed.
Matters arising from the previous meeting were as follows:
• Discuss arranging a refresh Risk Management Training session for GB –PP will be taking the Risk Management Framework to January’s IGAR meeting where the relevance of future training will be discussed and taken forward if deemed necessary.
• TO’H to ask Peter Howarth if it is possible to gather data regarding the difference in what GPs prescribe and what pharmacies actually dispense – Following discussions between TO’H and PH it was established that this data could not be routinely collected. The committee were happy to close this item.
• Glossop – liaise with Elaine Richardson regarding assurance that funds are being spent on Glossop. – TS can confirm that she has spoken to ER and she is getting verbal confirmation that the BCF money is being spent on Glossop. There will also be an end of year report that will come to the meeting for assurance on this matter.
• DM to clarify the Year to Date (£25k) and Year End (£335) Variance for SFT & rectify a formatting error for WWL under the ‘Movement in Month’ column – DM reported back on this via email on 18th December 2015. He further explained his email highlighting that due to the national PbR system the pathway is not known until discharge, which explains the large gaps between actual figures and Year End projections.
5. Work-plan The work-plan was received for information
6. Scheme of Delegation The Scheme of Delegation (SoD) was presented to the Committee for approval with several amendments documented in the Executive Summary. The committee agreed that this was no longer in the remit of this committee and that it should go to IGAR for approval instead. If an amendment is needed during a month where IGAR does not take place then a virtual IGAR approval can be undertaken. VF will remove the SoD from the Finance Committee workplan (Action: VF) The committee therefore noted the amendments with the recommendation that they go to January’s IGAR Committee for approval. CW requested that due to operational needs her authorisation limit be increased from £50k to £100k. This authorisation limit is in line with other Directors and will be put forward for approval at January’s IGAR. (Action: VF)
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7. Month 9 Finance Report TS presented the Month 9 Finance Report to the committee with the following highlights: • The CCG is on track to meet all of its key financial duties, including its surplus
target of £6,746k, but still needs to mitigate some risks further to ensure this will be achieved. However, she emphasised how increasingly challenged the financial situation is becoming and particularly going forwards but further detail will be provided in the financial planning agenda item.
• An agreement has been made with TFT of £128.4m and is now formally ratified. This removes a significant amount of financial risk to the CCG and allows Q4 to be a period of stability for both organisations to focus on the priorities of the integration programme.
• Contingencies have been released to support the shortfall on the QIPP target of £5,200k.
• The running cost allocation for 2015-16 has reduced by £585k to £5,202k as per National guidelines. However corporate budgets are still forecast to under spend by £285k at year end.
• Key movements in month were: o Acute – an adverse movement of (£554k) o Mental Health – a favourable movement of £192k
SAh highlighted an issue that arose where Salford dermatology sent a generic letter out refusing to take out of area referrals in dermatology. CW will look into this and report back. (Action: CW) The focus for the acute section of the report was on those providers with a forecast of £100k or more as follows: • Central Manchester Foundation Trust (CMFT) - the contract is forecast to
underspend by £234k as at month 8 which represents an adverse movement of (222k) from the month 7 forecast mainly relating to an overspend in PbR excluded drugs. Following discussions with Medicines Management colleagues it is felt the increase could be linked to the treatment of rheumatoid arthritis.
There is a continued underperformance on Elective/Day cases which are forecast to underspend by £264k. This comprises of underspends in General Surgery £180k and Cardiology £111k. As part of the 2015-16 contracting round additional investment (above 2014-15 outturn) was made in relation to elective activity as the Trust set a capacity plan based on the delivery of RTT targets.
• Stockport FT (SFT) - The SFT contract is (£386k) overspent as at month 8 which is due to overspends on stroke pathway and High Cost Drugs. Issues surrounding difficulties in recording stroke activity have now been resolved however there are additional over spends in relation to rehab as this was not accounted for in the original budget. It is assumed that the overspends relating to high cost drugs will continue for the remainder of the financial year.
• University Hospital South Manchester FT (UHSM) - UHSM contract is overspent by (£535k) as at month 8 which comprises overspends in: NEL admissions (£288k) and Daycases (£178k) . The NEL admissions overspend comprises overperformances in vascular surgery and Geriatric medicine. The overspend on vascular is linked to the vascular on-call rota system as discussed in previous meetings. We have seen underspends totalling £42k in vascular at CMFT and PAHT, which is offsetting some of the over performance seen at UHSM.
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CW highlighted that the expected level of underspend in these areas is not materialising due to referrals increasing.
• Salford Royal FT(SFRT) - underspent by £44k which is due to underspends in relation to new GM stroke pathway, which is helping to offset some the over performance seen at SFT. Critical care is (£60k) overspent at month 8, due to two high cost patients.
• Wrightington, Wigan & Leigh FT (WWL) - WWL is overspent by (£174k) and is related to Day Cases (£60k), NEL admissions (£36k) and Rehab (£38k). This was the result of one high cost patient with spinal cord injuries and required a significant number of days in rehabilitation.
• Mental Health o The full year forecast has improved by £192k due to the continued
review of clients on the secure out of area placement database. o £48k forecast underspend is due to the continued review of adult
placements and their reassignment into a more appropriate healthcare setting, which is often Continuing Healthcare (CHC).
o The Calderstones’ contract has now been signed. There is an agreed extension of the current contract to 30/09/16 with Mersey Care NHS Trust as the lead. It has been agreed that the CCGs will contribute to any shortfall on the basis of the number of occupied beds as at 30/09/2015. For Tameside and Glossop this represents 2 clients.
o Parity of Esteem - Notification of the planned spend is sent to NHSE on a monthly basis and we continue to be on track to deliver the forecast plan of £32.4m.
• Primary Care budgets at month 9 and are forecast to overspend at year end by (£357k). Prescribing budgets are forecast to overspend by (£125k) by the end of the year however it must be recognised that this area has already been subjected to QIPP.
• Community Services - currently forecast to over spend by (£111k) by the year end. This is largely due to a pressure on Community IT software and on Non Medical Prescribing (NMP). An investigation as to the increased costs of NMP is currently taking place at SFT. Work has commenced between Stockport FT / Tameside FT and NHS Tameside & Glossop CCG in relation to the further development of Community Services as part of our vision for integrating health and social care. TS highlighted that there were terms in the original contract transfer from Tameside to Stockport that represented an unequal share of financial risk to the CCG and that she is concerned that the contract might transfer back to Tameside with these same areas of concern. It is important that the service lines are fully reviewed and amended accordingly to represent a more equitable sharing of risk. CW and TS will discuss this outside of the meeting.
8. BCF Reports 8a. Tameside DM presented the Tameside BCF report explaining that the year to date emergency admissions has reduced by 2.63% compared to the target of 2.70%. NHSE have confirmed they will not claw any funding back in 15/16 if an underperformance is reported against metrics. This is due to various competing pressures across healthcare systems. DS highlighted that the section Impact of New Care Act Duties needed reviewing and completing. DM will inform Stephen Wilde (Action: DM)
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The committee noted that the final quarterly return for the 2015/16 BCF is due on 26th February 2016. 8b. Glossop Elaine Richardson has reported that Derbyshire are giving assurances that the money is being spent on Glossop. As mentioned above the final data is due on 26th February so a Glossop BCF report will come to March’s meeting. 9. Future CCG/TMBC Alignment TS explained that a paper will be going through both CCG and TMBC governance for a full aligned budget under the Shadow Single Commission from 1st April 2016. Both the CCG and TMBC’s legal teams are involved in the process and are advising the best legal terminology to use. A Section 75 cannot be used in this instance and therefore a Partnership Agreement or Memorandum of Understanding will be used. Each organisation will retain their legal responsibilities however they will make joint commissioning decisions from one aligned health and social care budget. Whilst services are being discussed individual budgets will not be assigned to the ICO Care Design Groups within the paper. The paper will be going to the Programme Board on 16th March then will need to be approved virtually by IGAR before 23rd March where it will go to the CCG Governing Body for approval (Action: VF) TS assured the committee that the auditors were also being closely involved in the process. 10. Financial Planning 2016-17 DM presented a paper on the Financial Planning: 2016/17-2020/21 explaining that it is an area that is constantly changing with ambiguous areas and significant financial risk. He raised the following key highlights: • National guidance dictates that CCGs are required to submit a Five Year
Sustainability and Transformation Plan (STP) as well as a single year Operational Plan for 2016-17. However under the terms of GM Devolution the Devolution Strategic Plan – with a few amendments – will act as a GM level STP.
• Within the CCG’s key financial duties for 2016/17 there is a new requirement to keep 1% of non-recurrent funds uncommitted with progressive release in agreement with NHS England. There is an obvious uncertainty and significant concern surrounding this and more clarity is being requested at CFO level.
• Allocations: although £4.3m higher than expected there are a number of new spending commitments which more than off-set this increase e.g. the increased PbR tariff inflation.
Following the approval of delegated co-commissioning of primary medical services the allocations also include primary care; this figure for 16/17 is £30,922k. SAh highlighted that Tameside and Glossop (T&G) will struggle to recruit or retain GPs once pump prime investment ceases as without this T&G cannot match other local economies. CW reiterated a point made several times over the past year that it is essential for the GPs to take ownership within the whole system to secure economy/system wide efficiencies. CW agreed that conversations need to take place to look at primary care and savings.
• The CCG is currently planning to drawdown and spend the entire £6.746m retained surplus in 2016/17 to aid transformation/Care Together Programme. However the process for accessing this retained surplus is unclear and there is a high risk that we will be limited to accessing only the £2.5m that T&G volunteered to add to their
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surplus in 2015/16 with the remainder being held centrally to fund national pressures.
11. Asset Based Community Development This paper was submitted for information to explain what Asset Based Community Development is. TS explained that Public Health have submitted a bid for a pilot to NHS England and it has been accepted. 12. Review of Committee’s Effectiveness DS and GC will discuss this outside of the meeting. 13. Any Other Business No items were raised.
14. Date and Time of Next Meeting The next meeting is scheduled for 17th February 2016 at 9.30am, NCH. 15. Actions
Person Action Time Frame DM CW is going to look into if the decision for UHSM to be
the sole ‘on call’ provider for vascular services has been discussed with CCGs – AL confirmed that all CCGs are aware that UHSM are the sole ‘on call’ provider. DM will adjust the 2016/17 plans to reflect this and will inform practices. – DM confirm
17th February
DG DG to liaise with Jamie Douglas re the Programme Budgeting tool kits and prepare a paper to explain the merits of the most effective ones - Having spoken to JD, DG was advised to liaise with Dr Amir Hannan. DG will report back at February’s meeting.
17th February
CW Submit the Commissioning Improvement Scheme to December’s meeting – Deferred to February’s meeting.
17th February
SAh/CW Practice Visits – outlier practices re referrals: SAh is to discuss this at the next Locality Lead meeting and submit a proposal to February PIQ.
Next Locality meeting/February PIQ
VF SoD: • Remove from the Workplan • Request to IGAR for CW increase to £100k
authorisation
17th February 27th January
CW SAh highlighted an issue that arose where Salford dermatology sent a generic letter out refusing to take out of area referrals in dermatology. CW will look into this and report back.
17th February
DM Tameside BCF DM advise Stephen Wilde that the section Impact of New Care Act Duties needs reviewing/completing
17th February
DM Aligned CCG/TMBC Budget Arrange a one off or virtual IGAR meeting before 23rd March to review the paper before GB
17th February
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GOVERNING BODY MEETING
Title of Subject: January Final Quality Committee minutes
Date of paper: 6th January 2016
Prepared By: Celia Poole
History of paper: Quality Committee meets regularly, promoting and providing assurances to the Governing Board, on all matters relating to the vision and strategy for continuous quality improvement.
Executive Summary:
Key issues discussed:
Care Homes update Darnton House - There continues to be a suspension of any new placements to Darnton House. The Continuing Health Care Team, along with the TMBC, TFT & CQC, are meeting weekly with the provider to ensure that patient safety is maintained whilst the home make improvements to care delivery. Quality Committee Primary Care Quality Report Proposals Members received a report which makes proposals for reporting primary care quality to the Quality Committee. One part of the proposal includes the monthly standing agenda items on the Local Improvement Group (LIG) which is featured in the ratified minutes presented and signed off on a monthly basis to the Quality Committee. The second part of the proposal is a separate monthly report to Quality Committee consisting of:
Patient Experience Primary Care Web Tool Outliers CQC Reports
The aim of this approach is to provide both quality assurance and quality improvement. The proposed report trial period will be for six months when it will be then be reviewed. Primary Care Locally Commissioned (Enhanced) Services Post Payment Verification process and outcome Members received a report written by Alison Lewin and Chris Martin which sets out that the CCG commission a range of services from our practices in the form of Locally Commissioned Services (formerly enhanced services). Greater Manchester Shared Services (GMSS) currently provide contract support for these services, including the management and implementation of a Post Payment Verification (PPV) process and outcome. Draft Report on a proposed quality assurance mechanism to inform the Shadow Single Commissioning Function Quality Committee received an updated report on a proposed quality assurance mechanism to inform the Shadow Single Commissioning Function. The report was written following a Quality workshop held on 18th November 2015 to review the effectiveness of the committee in providing assurances to the Governing Body on the quality of services commissioned by T&G CCG on behalf of its local population. The proposal leads to amalgamating the Quality Committee with the Public and Patient Impact Committee as within the governance arrangements both committees provide assurance to the Governing Body in relation to quality and patient experience.
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Recommendations required of the Governing Body (for Discussion and Decision)
To discuss and note the key issues discussed and agreed at the meeting on 6th January 2016.
QIPP principles addressed by proposal:
Quality
Direct questions to: Celia Poole
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Minutes Quality Committee
Wednesday 6th January 2016 9.30am-12.30pm Boardroom, New Century House
Present:- Celia Poole (CP) Clare Watson (CW) Clare Todd (CT) Joanna Bircher (JB) Dr Jamie Douglas (JD) Lesley Surman (LS) Lynn Jackson (LJ) Hazel Chamberlain (HC) Julie Beech (JBee) Steve Allinson (SA) In attendance:-
Governing Body Lay Member (Chair) Director of Transformation, CCG Governing Body Nurse, CCG GP Clinical and Quality Improvement Lead Governing Body GP, CCG Governing Body Lay Advisor, CCG Quality Lead, CCG Lead designated for Safeguarding, CCG Healthwatch Officer, Healthwatch Tameside Chief Operating Officer, CCG (Item 9 only)
Chris Martin (CM) Gideon Smith (GS) Clare Bromley (CB)
Primary Care Lead, CCG Public Health Consultant, TMBC PA, Corporate Office, CCG (note taker)
1. Chairs Welcome, Introductions and Apologies CP welcomed everyone to the meeting. Apologies were received from:- Gill Gibson Director of Nursing and Quality, CCG Peter Denton Healthwatch Manager, Healthwatch Tameside Michelle Rothwell Head of Individualised Commissioning, Quality and Patient Safety, CCG 2. Declarations of interest There were no declarations of interest noted.
Register of interests Members received the updated Register of Interests and were reminded to complete the table of amendments if there are any changes to be made to the Register and send directly to Paul Pallister. 9. Any other business CP invited SA to open up the meeting with an item of any other business. SA briefed members on the current pressures on the urgent care system across Greater Manchester. Locally, Tameside General Hospital has declared an internal incident and the situation has since been escalated by Greater Manchester Gold Control. As the present Director on call SA participated in an urgent conference call to address the situation with GM Acute Trusts and NWAS for mutual aid to manage the system pressures. SA assured members that whilst Acute trusts are dealing with discharges for medically fit patients to be discharged to go onto the next appropriate setting of care for the individual patients and consideration given to any necessary adaptations to be made within that said setting of care, patient choice along with
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some anxieties of families/carers has proved to be slowing the discharge process or somewhat halting the discharge altogether. SA invited members for their views and input on the situation in terms of managing discussions with the public in general and in advance of the ICO as a single service not just in the extremities of the recent issues and challenges but also in the long term. Members felt that there needs to be some sort of holding system available and that it was important now to get the message out to the public that hospital is not the only safe setting for care to be delivered. The whole system would need to consider every aspect of this in becoming an ICO including for example, transitional issues such as transferring patients with dementia etc., where it is not just the adaptations with a care setting that becomes an issue. The aim for integration is for that continuum and for things to move quickly in terms of working together to reassure the public and involve them in the discussions and forward view of the urgent care system. Members discussed that dialogue with urgent care colleagues should include open discussions about admissions to hospital and the important need to unpick the main blocks of discharges. Members felt that it is also important to work in partnership to convince the public that it is not acceptable to always use the hospital setting as their first and only place of care. Further review is needed of discharge planning and to review how long it is taking for adaptations in other care settings to take place and to challenge the trust, as although managers seem focused on discharges, it is felt that some of the on the ground staff would require more learning and this could perhaps be a communication issue amongst teams and the need to address the different cultures. JBee highlighted the next Healthwatch Health and Care Debate event taking place on 11th February on the topic of urgent care and agreed to send invitations to members by email via CB for circulation.
Action: JBee Members discussed the requirement also for community nurses/district nurses to do ward rounds and pull patients out of a hospital setting where appropriate for them to be cared for at home or other care setting, rather than a push out from the wards. JB raised an example of a recent positive story of the new internal urgent care team who managed a lady in her own home and avoided admission to hospital and the need to make more use of that service. SA thanked members for the opportunity to raise this and for their input and contribution to the discussions and felt it was important to take advantage of the recent crisis as an opportunity to push for discussions and review of discharge planning to support the urgent care system and for those discussions to take place in the early stages of the ICO and to identify who is responsible and to ensure an end to end robust process. 3. Minutes of Previous meeting: 16th December 2015 The minutes of the previous meeting were agreed as an accurate record subject to a few minor amendments under Action 5. Improving the Referral Process to TGH - to separate out the paragraphs under ‘Mortality Steering Group’ and ‘Discharge Summaries’. This will also require amendment to the November minutes (18.11.15) from which the action derived. The following actions were reviewed: Action 5(i) (18.11.15) – Improving the Referral process to TGH
Discharge Summaries An issue arose that the new discharge templates are unable to be enacted due to software problems and that there did not seem to be an apparent date for the issues to be resolved. It was thought that the Trust’s IT department were in talks to resolve this with the provider and Gill Gibson had agreed to raise this and other issues with Peter Weller at their one to one meeting. In Gill’s absence, HC updated that Gill did raise this and the response from Peter Weller. CSC and HSCIC are in talks regarding the fix and
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when CSC can update the production system. Unfortunately CSC and HSCIC have still not been given a date for when the fix will be installed into our live system. Peter Weller together with Peter Nuttall have complained about tactical fixes in Lorenzo causing significant delays and is calling a meeting with the CSC Lorenzo Director and Vice President to resolve the overall delays and to complain formally about the slow process and have agreed to keep Gill updated accordingly.
E referrals During the discussion on E referrals and moving towards looking at the system as a whole, members raised this as one example of recording such issues for early input into the GM Devolution system and the suggestion was made for the development of a log to list practical issues arising locally to inform GM Devolution particularly to ensure the system has a patient centred focus. Members had made several suggestions on the mechanism for input into GM Devolution to include passing on to Alan Dow and Steve Allinson and ER suggested this go via Heads of Commissioning (HOCs) via Clare Watson and through planned care leads as well as urgent care and operational leads within the Trust. Another suggestion was via the Quality Surveillance Group via Gill Gibson. Gill Gibson had agreed to raise this at CMT for further discussion/action. HC noted that there had not been a CMT meeting since and would feedback to Gill that this action is still outstanding.
Action: HC Action 4. (16.12.15) - Bridgewater Action Plan Final sign off of the flow chart, developed to set out the simple clear process, a draft of which was presented in December, would now have final sign off at the meeting in February.
Action: LJ Action 5. (16.12.15) – Primary Care Quality Improvement work Elaine Richardson agreed to raise the issues around flu immunisations highlighted by JB arising from the Local Improvement Group (LIG) meeting on 9th November. QC supported a discussion around the single commissioning function and finding a way of good coverage for flu locally for all agencies as a field force approach. CB to check if Elaine raised this at the System Resilience Group (SRG) at the meeting on 18th December 2015.
Action: CB Action 7. (16.12.15) - Quality Walkabouts LJ updated that a meeting took place with LJ, HC, CT and Gill Gibson to review the 15 steps included in the protocol for the walkabout visits and that a further update would be presented at the next QC meeting in February.
Action: LJ Action 8. (16.12.15) – T&G CCG Health Inequalities Plan It was noted that due to various timelines of meetings taking place since the December meeting and the shift in weeks for QC to meet, GS would next present an update report in February.
Action: GS 4. Matters arising not otherwise on the agenda All matters arising are covered on the agenda. 5. Standing items - Monthly
Care Homes update Darnton House - There continues to be a suspension of any new placements to Darnton House. The Continuing Health Care Team, along with the TMBC, TFT & CQC, are meeting weekly with the provider to ensure that patient safety is maintained whilst the home make improvements to care delivery.
CT noted that it is important nothing is missed in managing this situation particularly in light of the current crisis situation.
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6. Quality Committee Primary Care Quality Report Proposals Members received a report which makes proposals for reporting primary care quality to the Quality Committee. One part of the proposal includes the monthly standing agenda items on the Local Improvement Group (LIG) which is featured in the ratified minutes presented and signed off on a monthly basis to the Quality Committee. The second part of the proposal is a separate monthly report to Quality Committee consisting of:
Patient Experience Primary Care Web Tool Outliers CQC Reports
The aim of this approach is to provide both quality assurance and quality improvement. The proposed report trial period will be for six months when it will be then be reviewed. The CCG has no leavers to encourage member practices to provide information or regular performance and quality reports as it is not a party to the contracts between NHS England and the 41 practices and there is no contractual requirement on practices to provide any form of reporting. Current primary care meetings hosted by the CCG and detailed within the current Governance arrangements include Joint Committee, the Primary Care Delivery Group and the Local Improvement Group (LIG). CM noted that different CCGs incentivise their practices to provide reports but that for T&G CCG EMIS system does not currently include this. The Primary Care dashboard is being set up although this is currently work in progress. As the work on this evolves this report may become more appropriately produced on a quarterly or even bi annually. LS highlighted that this arose as part of an induction programme and that the National GP survey formed part of interactive conversations with PPGs and review of the Primary Care Quality Scheme and how it fits into this as a suggested measurable way PPGs are collaborated with. JB felt that primary care quality assurance and some of the soft intelligence go to the LIG and is not therefore necessary for inclusion in this report. For instance the LIG review the Friends and Family data and this is reflected in the minutes received by Quality Committee. CW noted that the overall aim for this report is to triangulate some of the information received about practices to evidence how safe and good our Member practices are and to offer support to practices where needed. Members agreed that it is the early warning signals that are important and for support visits to take place in practices and for all information to inform the integration agenda. JBee noted that Healthwatch also receive soft intelligence which is then collated to produce the Healthwatch Intelligence Report and has also been received by Quality Committee. It was therefore suggested that this data link into the report CM will produce. JD suggested that the new contract options currently being reviewed in the forthcoming contract round could include some flex in terms of reporting and gaining some softer intelligence and information with data received. QC requested that CM consider the points made for input into the report and agreed to a monthly report to be presented for a trial period with the first report presented at the next meeting in February.
Action: CM
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7. Primary Care Locally Commissioned (Enhanced) Services Post Payment Verification
process and outcome Members received a report written by Alison Lewin and Chris Martin which sets out that the CCG commission a range of services from our practices in the form of Locally Commissioned Services (formerly enhanced services). Greater Manchester Shared Services (GMSS) currently provide contract support for these services, including the management and implementation of a Post Payment Verification (PPV) process and outcome. The report includes 4 reports produced by GMSS randomly selected for this process in 2015/16. 2 of the 4 practices provided all required information and all standards were met. However the other 2 selected practices had areas where the expected standards were not met and they were required to consider recommendations and subsequently provide assurance that actions had been taken to address the issues raised. Quality Committee considered the 4 reports and discussed what next steps could be taken in terms of further review of the practices that did not meet expected standards. It was agreed that we should discuss this with GMSS that support this contract service before we decide the issues should be address with Quality Committee or Joint Committee. From April 2016 level 3 commissioners and will host contract management in house and would therefore need to understand the spec criteria and weighting for the red, amber, green reporting. We need to take lead and liaise with commissioning managers on assessment and the need to manage this as a single commissioning function. HC agreed to feedback the comments made and request that an update/conclusion report be presented to Quality Committee in March.
Action: HC
8. Draft Report on a proposed quality assurance mechanism to inform the Shadow Single Commissioning Function
Quality Committee received an updated report on a proposed quality assurance mechanism to inform the Shadow Single Commissioning Function. The report was written following a Quality workshop held on 18th November 2015 to review the effectiveness of the committee in providing assurances to the Governing Body on the quality of services commissioned by T&G CCG on behalf of its local population. The proposal leads to amalgamating the Quality Committee with the Public and Patient Impact Committee as within the governance arrangements both committees provide assurance to the Governing Body in relation to quality and patient experience. Some debate took place around the agreement to endorse the triangle based on the domains of the commissioning for quality Framework. It was agreed that prior to presentation at the single commissioning board, LJ would schedule a half hour session to further debate around the wording surrounding the triangle and that the report could then be presented to the January PPIC meeting and then January Governing Body followed by final sign agreement by Quality Committee in February. LJ to therefore add these steps to the timeline set out in the report.
Action: LJ QC therefore agreed to the proposal in principle. 10. Date and Time of next meeting Wednesday 3rd February 2016, Boardroom, New Century House Meeting closed: 11.17am
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GOVERNING BODY MEETING
Title of Subject:
Delivering Excellence, Compassionate, Cost Effective Care
– Governing Body Performance Update.
Date of paper: 19/02/16
Prepared By: Ali Rehman
History of paper:
Regular Updates are presented on a monthly basis to CCG.
Executive Summary:
This paper provides an update on CCG assurance and
performance, based on the latest published data (at the
time of preparing the report). The December position is
shown for elective care and a February ‘snap shot’ in time
for urgent care. It includes a focus on current waiting time
issues for the CCG. The provider summaries are included.
The Governing body had asked for a themed report for the
next iteration covering, Urgent Care, Endoscopy and
Meridian contract. The performance teams capacity has
been taken by the 16/17 planning round therefore these
will be provided in the next report.(March 2016)
The CCG has been Assured as Good in four of the five
components in the assurance framework with Performance
being the only one with Limited assurance.
Performance issues remain around waiting times in
diagnostics and the A&E performance.
RTT
Incomplete
52WW Diagnostic A&E
Standard 92% 0 1% 95%
Actual 91.8% 1 2.50% 84.53%
The number of our patients still waiting for planned
treatment 18 weeks and over continues to decrease and
the risk to delivery of the incomplete standard and zero 52
week waits is being reduced.
Cancer standards were achieved in December.
Endoscopy is still the key challenge in diagnostics
particularly at Central Manchester.
A&E Standards were failed at THFT and are amongst the
lowest in GM.
Financial
Year to
07th
Feb16
Quarter
1
2015/16
Quarter
2
2015/16
Quarter
3
2015/16
Feb to
07th
84.53% 91.36% 89.59% 77.67% 70.50%
166
Attendances and NEL admissions at THFT (including
admissions via A&E) have increased on 2014 since August.
The number of Delayed Transfers of Care (DTOC) recorded
remains higher than plan.
Ambulance response times were not met at a local or at
North West level.
Recommendations required
of the Governing Body
(for Discussion and
Decision)
Governing Body are asked to:
Note the 2015/16 CCG Assurance position.
Note performance and identify any areas they
would like to scrutinise further.
QIPP principles addressed
by proposal:
Delivery of NHS Tameside and Glossop’s Operating
Framework commitments for 2015/16.
Direct questions to:
Ali Rehman/Clare Watson
267
Delivering Excellence, Compassionate, Cost Effective Care
Governing Body Performance Development Update
February 2015
1. Introduction
1.1 This paper provides an update on CCG assurance and performance, based on
the latest published data (at the time of preparing the report). The December
position is shown for elective care and a February ‘snap shot’ in time for urgent
care. It includes a focus on current waiting time issues for the CCG. The
provider summaries for THFT, SFT Community services, Pennine Care, Meridian,
GTD, 111 and Arriva are included.
1.2 It should be noted that providers can refresh their data in accordance with
national guidelines and this may result in changes to the historic data in this
report.
2 CCG Assurance
2.1 We have not been advised of any change to the CCG assurance level so it
remains as below.
Component Assurance Level
Well Led Organisation Assured as good
Delegated Functions Assured as good
Finance Assured as good
Performance Limited assurance requires improvement
Planning Assured as good
2.2 It is not expected that we will improve our assurance level in the short term, as
whilst the RTT performance continues to fluctuate, Central Manchester is
significantly affecting our diagnostics and we are not expecting sustained
delivery of the A&E 95% until Q1 2016/17.
3 Current CCG Performance
3.1 Elective Care – please note the December position is the latest available data.
3.2 The RTT standards are now monitored differently and for this report only the
incompletes is recorded.
3.3 In December the CCG failed the incompletes standard at 91.8% however THFT
continued to achieve at 92.2%. The National RTT stress test demonstrates the
trust are continueing to reduce the risk of RTT, this will have a positive impact on
CCG performance. On going discussions with NHS England.
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Incomplete (Standard 92%)
CCG Actual THFT Actual
Apr 89.34% 87.50%
May 90.65% 89.30%
Jun 91.44% 90.70%
Jul 91.79% 91.30%
Aug 92.03% 92.10%
Sep 92.16% 92.22%
Oct 91.81% 92.2%
Nov 92.18% 92.8%
Dec 91.8% 92.2%
3.4 The total number of incompletes for the CCG has stabilised and slightly
decreased this is primarily due to the reduction in under 18 weeks.The 18 weeks
and over has dereased slightly. There has been an increase in over 40 week
waiters and the 28 to 40 waits has also increased.
3.5 The one patient waiting more than 52 weeks for treatment at Tameside has
now been treated.
3.6 Tameside expects to report zero 52-week waits for January. However the risk of
52 week waiters remains with 18 patients at 43 to 47 weeks. Also there are 47
patients waiting over 36 weeks without a decision to admit. Earlier this year the
University Hospitals of South Manchester FT identified a data quality issue of
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patients who had been waiting >52 weeks not being identified. UHSM, NHSE,
Monitor, and SMCCG have been addressing this matter. Following identification
of this issue earlier this year, intensive validation work was carried out at the Trust
and are still finding new >52 week pathways. As of 10th February 2016, 3 have
been identified as T&G CCG patients all on completed pathways. We are
being updated regularly on the position and are keeping a close eye on the
issue.
3.7 The specialities of concern
with regard to current
performance or Clearance
Rate (how long to treat the
total waiting list assuming no
more were added and the
number completed each
week stays the same) are
shown below. Clearance
Rate is used as an indicator
of future performance with
10 to 12 weeks usually being
seen as the maximum to
deliver performance
however with specialities
with low numbers this is less
accurate.
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3.8 Four of these are the specialities where THFT also failed the standard and still
have a backlog. Whilst clearing the backlog for plastics, CT Surgery and
reducing Gastroentorology all others have increased. Overall the backlog at
THFT has only reduced by 1.
Specialty Incomplete
Performance > 18
Weeks < 18
Weeks Total Dec
Backlog Nov
Backlog Oct
Backlog Sept
Backlog August Backlog
July Backlog
June Backlog
General Surgery 92.2% 1837 155 1992 10 40 70 90 130
Urology 89.9% 744 84 828 20 5 25 10
Orthopaedics 84.8% 1956 350 2306 160 150 180 210 210 190 240
ENT 93.1% 1155 86 1241
Ophthalmology 98.5% 745 11 756
Oral Surgery 96.3% 493 19 512
Plastic Surgery 94.2% 131 8 139 7 30 15
CT Surgery 92.9% 13 1 14 1
Adult Medicine 94.0% 890 57 947
Gastroenterology 91.2% 750 72 822 6 30 10 35
Cardiology 91.5% 1233 114 1347 6 10 40 40 100 110
Dermatology 92.9% 999 76 1075
Rheumatology 94.2% 295 18 313
Gynaecology 93.4% 1124 80 1204
Other 97.2% 1538 45 1583
THFT position 92.2% 13903 1176 15079 192 193 255 315 320 390 515
3.9 Diagnostics- please note the December position is reported in this update.
3.10 In December we failed the diagnostic standard at 2.50% against 1.0% Standard
for waiting 6 or more weeks. This was primarily due to Central Manchester Trust.
3.11 This means we
have failed for
every month
this year and
the downward
trend in
performance
continues.
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3.12 At the end of December 103 patients were waiting 6 weeks and over for a
diagnostic test, 35 of which were over 13 weeks. 91 were at Central Manchester
Trust. Requests are continued to be made to obtain a copy of the action plan
from Central Manchester Trust including discussions with NHS England as their
role as assurers of Lead CCGs.
3.13 The challenge continues to be in endoscopy, accounting for 68% of breaches.
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3.14 THFT has shown a slight improvement in performance in endoscopy from last
month and Central Manchester showing a slight deterioration in performance.
873
3.15 Cancer- please note the December position is reported in this update
3.16 We achieved the standards In December.
3.17 Our full performance is shown below with all standards achieved.
Performance No. of patients not
receiving care within standard in Q3
Indicator Name Standard
Quarter 1
15/16
Quarter 2
15/16
Quarter 3
15/16
Cancer 2 week waits 93.00% 94.88% 96.02% 97.25% 65
Cancer 2 week waits - Breast symptoms 93.00% 84.98% 95.71% 96.47% 7
Cancer 62 day waits – GP Referral 85.00% 89.68% 86.30% 88.82% 18
Cancer 62 day waits - Consultant upgrade 85.00% 93.33% 81.82% 87.50% 3
Cancer 62 day waits - Screening 90.00% 100.00% 90.00% 100% 0
Cancer day 31 waits 96.00% 98.18% 98.29% 100% 0
Cancer day 31 waits - Surgery 94.00% 100.00% 100.00% 100% 0
Cancer day 31 waits - Anti cancer drugs 98.00% 100.00% 98.00% 100% 0
Cancer day 31 waits - Radiotherapy 94.00% 100.00% 100.00% 100% 0
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3.18 Tameside also achieved all the standards.
Performance No. of patients not
receiving care within standard in Q3
Indicator Name Standard
Quarter 1
2015/16
Quarter 2
15/16
Quarter 3
15/16
Cancer 2 week waits 93.00% 94.5% 95.6% 97.4% 74
Cancer 2 week waits - Breast symptoms 93.00% 84.4% 97.7% 96.9% 6
Cancer 62 day waits – GP Referral 85.00% 92.9% 88.4% 89.3% 19
Cancer 62 day waits - Consultant upgrade 85.00% 81.6% 77.4% 90.2% 2
Cancer 62 day waits - Screening 90.00% NA NA 100% 0
Cancer day 31 waits 96.00% 98.5% 99.5% 99.4% 0
Cancer day 31 waits - Surgery 94.00% 100% 100% 100% 0
Cancer day 31 waits - Anti cancer drugs 98.00% 100% 100% 100% 0
Cancer day 31 waits - Radiotherapy 94.00% 100% 100% 100% 0
3.19 The increase in two week wait referrals continues. Breast however, still remain
below 2014/15 levels.
3.20 The year to date increases in referrals continues compared to the same period
last year with Haematology, Urology, Lower GI, Head and Neck, breast and skin
showing the larger increases.
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3.21 Urgent Care – please note position reported is at 07th February.
3.22 THFT A&E performance continues to deteriorate due to issues across the health
and social care economy.
Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16
86.73% 93.75% 93.47% 92.09% 89.31% 87.74% 89.35% 77.19% 72.94% 73.41%
3.23 We remain amongst the lowest across the GM trusts, reported through Utilisation
Management.
Financial
Year to 07
Feb16
Quarter 1
2015/16
Quarter 2
2015/16
Quarter 3
2015/16
January
2015/16
February
to 07th
Wigan 95.34% 97.73% 96.31% 93.99% 89.77% 94.19%
Salford 93.92% 96.21% 95.22% 90.86% 92.56% 93.88%
Bolton 92.43% 95.68% 95.02% 90.93% 82.58% 80.21%
Stockport 87.04% 93.51% 92.97% 80.65% 73.49% 69.59%
Oldham 85.20% 92.63% 88.61% 77.59% 78.42% 76.39%
Tameside 84.53% 91.36% 89.59% 77.67% 73.41% 70.50%
Bury 84.80% 90.65% 89.43% 77.93% 75.02% 82.62%
North Manchester 83.43% 91.61% 86.13% 76.71% 73.23% 72.43%
3.24 There is still considerable variation on a daily basis with no clear reason. We
have failed every month this year and last achieved the standard on 25th
December.
3.25 The improvement seen at the
start of September has not
been maintained and
performance is on
downward trend despite the
commitment to a closer
focus on the daily
performance.
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3.26 Availability of beds is the main cause of A&E breaches with patients awaiting
beds the highest reason for breaches. The patients waiting also impact on
cubicle availability which results in breaches due to late first assessments. So far
in February we have seen a change to late first assessment rather than beds
being a main cause.
3.27 We frequently have fewer
emergency discharges than
emergency admissions and
so routinely have to escalate
discharge to manage the
daily demand. The loss of the
beds at Darnton House has
further impacted on our
ability to discharge from
acute beds recently.
3.28 Slight increase in A&E attendances during January as expected compared to
2014/15 and admissions have also increased.
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3.29 Since September there has been considerable variation in the numbers of
attendances and admissions and breaches have risen significantly.
Week Ending
Actual Number of A&E Type 1
Attendances
Actual Number of
4 hour Type 1
breaches
Actual Performance
Number of Emergency Admissions
via A&E
Number of Direct
Emergency Admissions
Total Emergency Admissions
1,596
06 Sep 1468 70 95.2%
378 63 441
13 Sep 1684 207 87.7%
413 96 509
20 Sep 1693 244 85.6%
427 80 507
27 Sep 1620 186 88.5%
406 95 501
04 Oct 1707 281 83.5%
377 85 462
11 Oct 1679 341 79.7%
377 92 469
18 Oct 1625 344 78.8%
381 82 463
25 Oct 1615 194 88.0%
425 88 513
01 Nov 1491 296 80.1%
420 89 509
08 Nov 1682 400 76.2%
403 120 523
15 Nov 1602 344 78.5%
377 101 478
22 Nov 1702 390 77.1%
423 99 522
29 Nov 1601 349 78.2%
418 100 518
06 Dec 1594 427 73.2%
358 139 497
13 Dec 1543 438 71.6% 388 95 483
20 Dec 1608 559 65.2% 405 101 506
27 Dec 1375 244 82.3% 368 72 440
03 Jan 1591 544 65.8% 384 70 454
10 Jan 1539 398 74.1% 403 72 475
17 Jan 1565 397 74.6% 396 89 485
24 Jan 1600 369 76.9% 411 98 509
31 Jan 1657 401 75.8% 396 91 487
07 Feb 1590 469 70.5% 387 86 473
3.30 Usage of the Alternative to Transfer service continues to be good and the level
of deflections remains above 80%.
September October November December January February to 7th
Referrals 138 154 183 215 210 51
Accepted 137 154 183 215 209 51
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Red Refusals to
Hospital also seen
10 12 21 20 21 10
Deflected 107 117 135 166 157 38
Accepted % 99 100 100 100 100 100
% Deflected (of
Referrals)
84 82 83 85 84 93
% Deflected (of
Accepted)
84 82 83 85 84 93
3.31 The number of Delayed Transfers of Care (DTOC) recorded has increased due
to community health and social care service capacity issues.
3.32 Reducing DTOC and the level of variation day by day is a key aspect of the
improvement plan with Integrated Urgent Care Team designed to significantly
impact on bed availability by improving patient flow out of the hospital and
avoiding admissions. This should deliver a culture of’ Discharge to Assess’ which
is key to delivering the national expectation that trusts will have no more than
2.5% of bed base occupied by DTOC.
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3.33 Ambulance – please note position reported is December
3.34 In December 2015 the CCG achieved the response rates locally with 76.6% for
CAT A 8mins Red 1 , however we failed with 65.3% for CAT A 8mins Red 2 and
91.2% for CAT A 19mins Red 2.
3.35 However, we are measured against the North West position which was 74.94%
for CAT A 8mins Red 1; 69.48% for CAT A 8mins Red 2 and 92.68% for CAT A
19mins Red 2 which means none achieved this month.
3.36 The number of ambulances with handover delays increased in December.
3.37 The trend is however still improving for ambulance turnarounds below 30
minutes.
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3.38 111– please note position reported is December
3.39 111 went live in GM 10th November so this is the first full month reported
under the new arrangements.
3.40 Operational performance in December was particularly challenged due to:
Staff attrition - NWAS and both sub-contractors have experienced high
numbers of staff leaving the organisation, well in excess of the modelled
staff turnover rate, creating a staff shortage
High staff sickness and reluctance to work overtime –In the second half of
December staff sickness rose to previously unseen levels. Set against an
existing lower than required staff base this additional loss, despite new
staff going live during the month, led to an inability to meet inbound
demand.
The modelling of inbound demand during peaks has uncovered some
significant differences between the previously modelled staff base, and
the actual requirements. Additional staff are now being recruited to meet
our revised modelling assumptions.
Additional demand created by the Christmas / New Year holiday period
In summary therefore, staff shortfalls, both through direct loss, and short term
absenteeism created a position where KPI delivery was severely challenged.
3.41 The North West NHS 111 service is performance managed against a range of
KPIs, however there are 4 primary KPIs which are accepted as common
‘currency’, reported by each NHS 111 service across England. These are:
Target Reported
Calls answered (95% in 60 seconds) 55.22%
Calls abandoned (<5%) 15.49%
Warm transfer (75%) 38.41%
Call back in 10 minutes (75%) 35.61%
3.42 The level 4 incidents where ambulances were urgently dispatched to patients
who did not want to be resuscitated are being followed up. It is essential that
GPs share DNACPR with Go to Doc through Special Patient Notes to enable 111
staff to see them and avoid distress to patients and families.
3.43 In December seven callers made 105 calls to the service. Discussion has taken
place re the best way to inform GPs on a regular basis of their patients who
appear on the report. It is likely this will be done by letter in the future from 111.
3.44 Our use is in line with NW levels.
15 and Under
16 to 65 65 and Over
Total
Callers Triaged by Age 1,046 1,789 797 3,632 % Breakdown 29% 49% 22% 100%
Total for NW Region 37,083 66,516 27,279 130,878 % Breakdown NW Region 28% 51% 21% 100%
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3.45 Our treatment is generally in line with NW levels.
Calls Triaged
Caller terminated call during
triage
Callers who were
identified as repeat
callers
Triaged Patients
Speaking to a
clinician
Patients Warm
Transferred to a Clinician
Where Required
Patients Offered a Call Back
Where Required
Call Backs in
10 Minutes
Caller Treatment 3,632 293 176 716 258 458 138 % Breakdown 100.00% 8.07% 4.85% 19.71% 36.03% 63.97% 30.13%
Total for NW Region 130,878 10,863 5,584 26,621 10,226 16,395 5,838 % Breakdown NW
Region 100.00% 8.30% 4.27% 20.34% 38.41% 61.59% 35.61%
3.46 Our onward referral is generally in line with NW levels.
Calls Triaged
Ambulance Despatches
Attend A&E
Primary and community
care
Recommended to Attend Other
Service
Not Recommended
to Attend Other Service
Referrals Given 3,632 482 250 2,243 116 541 % Breakdown 100% 13% 7% 62% 3% 15%
Total for NW Region 130,878 16,733 9,927 80,790 3,721 19,707 % Breakdown NW Region 100% 13% 8% 62% 3% 15%
3.47 Our dispostions are in line with this.
4 Provider Performance
4.1 The performance dashboards for THFT, SFT Community services, Pennine Care
are included, along with summaries for Meridian, GTD, 111 and Arriva are
included.
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5 Recommendation
5.1 Governing Body are asked to:
Note the 2015/16 CCG Assurance position.
Note performance and identify any areas they would like to scrutinise
further.
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Tameside and Glossop CCG Performance Dashboard for Board
Tameside NHS Foundation Trust – Acute Performance Dashboard
Reporting Period: December 2015
National operational standard Threshold YTD ActualYTD
RAG
4 month
trend
In month
actual
In month
RAGGM/ Local Operational standards Threshold YTD Actual YTD RAG
4 month
trend
In month
actual
In month
RAG
Incompletes 92% 91.10% R 92.20% G GM_1TIA cases investigated in 24 hours* 60% 55.4% R 69.2% G
GM_280% patients spend 90% time on stroke unit* 80% 61.40% R 41.1% R
Test waiting times 99% 99.30% G 99.60% G GM_13aStroke - Discharged with a joint H&SC plan**** 90% 93.0% G 93.00% G
GM_13b
Stroke - Discharged with a named point of
contact**** 90% 90.7% G
91.0% G
A&E waits - >4 hours 95% 86.20% R 72.94% R GM_14Maternity - % seen by 12 weeks and 6 days 90% 89.7% R 87.3% R
A&E trolley waits - >12 hours 0 0 G 0 G
GM_16Discharge summaries - A&E patients 95% 88.3% R 87.8% R
2ww - 1st outpatient appoinment 93% 95.9% G 97.80% G GM_17Discharge summaries - inpatients 85% 77.1% R 82.1% R
2ww - 1st outpatient appoinment (breast) 93% 91.5% R 96.70% G GM_18.1Discharge summaries - Outpatients 80% 62.2% R 60.3% R
31 days - first treatment* 96% 99.2% G 100% G GM_19Outpatient appmts - provider cancellation 3% 1.15% G 1.15% G
31 days - subsequent treatment (surgery)* 94% 100% G 100% G GM_20Nutrition - >60 yrs who under go an assessment 90% 95.5% G 100% G
31 days - subsequent treatment (drugs)* 98% 100% G 100% G GM_21Nutrition - >60 years trtmnt plan with dietetics 90% 100% G 100% G
62 days - first treatment* 85% 90.2% G 93.80% G GM_22Complaints - Reduction from baseline < 1.15 0.83 G 0.54 G
62 days - screening to treatment** 90% - - N/A - - GM_23Complaints - % acknowledged in 3 days 90% 97.6% G 95% G
62 days - first treatment after priority upgrade* 85% 82.3% R 81.80% R
GM_24VTE - RCA of all hospital acquired cases***** 100% 100% G N/A - G
MSA breaches 0 0 G 0 G GM_25VTE - reduction from baseline (Per 1000) 0.61 0.11 G 0.00 GCancelled ops (binding date within 28 days)*** 0 10 R 0 G GM_27Pressure ulcers - reduction from baseline (Per 1000) 0.70 0.52 G 0.74 R
Cancelled ops (no. cancelled a 2nd time) 0 0 G 0 G GM_28Falls - reduction from baseline (Per 1000) 0.61 0.12 G 0.25 G
MRSA (zero tolerance) 0 2 R 1 R GM_29UTI - % adults free from catheter induced UTI 96.5% 99.70% G 100.00% G
Avoidable C difficile 46 2 G 0 G
RTT (52 weeks) 0 20 R 1 R *Please note this is reported a month in arrears
VTE Risk Assessment 95% 96.70% G 96.40% G **Please note there have been no applicable patient to date
Publication of Formulary Yes Yes G Yes G ***Please note this is reported quarterly and In month actual relates to quarter 3 data
Duty of Candour Achieved Achieved G Achieved G ****Please note this is reported quarterly and In month actual relates to quarter 2 data
NHS Number field - Mental Health and Acute 99% 99.9% G 99.88% G *****Please note there have been no applicable patient in December
NHS Number - A&E 95% 99.3% G 99.08% G
Never Events 0 1 R 0 G
No. of handovers >30 minutes 0 315 R 60 R
No. of handovers >60 minutes 0 134 R 37 R
A&E handovers
Domain 1: preventing people dying prematurely
Domain 4: ensuring that people have a positive experience of care
Domain 5: treating and caring for people in a safe environment and protecting them from avoidable harm
Referral to Treatment (RTT) times
Diagnostics
A&E waits
Cancer
Operational efficiency & HCAI
4 month trend key:
Performance is improving
No change to performance
Decline in performance
1984
Tameside and Glossop CCG Performance Dashboard for Board
Stockport NHS Foundation Trust – Community Performance Dashboard
Reporting Period: December 2015
Patient Safety ThresholdYTD
Actual
YTD
RAG
4
month
trend
In month
actual
In
month
RAG
Patient Experience ThresholdYTD
Actual
YTD
RAG
4
month
trend
In
month
actual
In
month
RAG
HCAI
No. of Cdiff cases with provider contact <96 11 G 0 G E_B14Complaints received by T&G patients** 0 28 R 3 R
No. of MRSA cases with provider contact0 2 R 1 R
E_B15Complaints - % responded to within timescale**80% 93% G 80% G
Incidents and never events E_B16Complaints - % satisfied with outcomes** 75% 97% G 100% G
No. of reported incidents (Min 1100 per year) 1100 1607 R 146 - E_B17Compliments N/A 300 G 54 G
No. of incidents (Medication error) 0 77 R 10 R Staffing & training
Duty of candour (included in StEIS / RCAs) Achieved Achieved G Achieved G E_B18Staff turnover*** 13% 16.75% R 16.75% R
Number of never events 0 0 G 0 G E_B19Sickness level*** 4% 5.06% R 5.06% R
Harm-free care E_B20
% of eligible staff trained (Adult Protection Level
1)***95% 96.80% G 96.80% G
No. of inpatients with grade 2+ pressure ulcer
(avoidable)≤50 per 1000 NA R 13.14 G
E_B21
% of staff with an up-to-date appraisal and
PDP***95% 78.44% R 78.44% R
No. of inpatients falls (Moderate or Greater harm) <38 36 G 4 GE_B22% of eligible staff trained (Domestic Abuse)***
95% 64.95% R 64.95% R
% of venous ulcer wounds healed < 16 weeks of
treatment (grade 2-4)70% 88.2% G 75% G
E_B23% of eligible staff trained (Infection control)***95% 96.80% G 96.86% G
Referral to treatment times (RTT) - overall
Service specific KPIs - exceptions ThresholdYTD
Actual
YTD
RAG
4
month
trend
In month
actual
In
month
RAG E_B24
18 week maximum waits 95% 99.86% G 99.86% G
E_B256 weeks maximum waits - diagnotics 99% 100% G 100% G
Patients take up a pulmonary rehab programme 480 147 R 15 -
75% of patients taking up complete the course* 44% 25% R 11.00% R
**Please note this is reported a month in arrears and relates to November 2015 data
New/Follow up ratio is in line with the care
pathway 95% 92.85% R 95.18% G
*** 12 month rolling figure
Complaints & compliments
Pulmonary rehabilitation
HIV
*Please note as the Programme length is at least six weeks the data is not yet available
4 month trend key:
Performance is improving
No change to performance
Decline in performance
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Tameside and Glossop CCG Performance Dashboard for Board
Pennine Care NHS Trust – Mental Health Performance Dashboard Reporting Period: December 2015
T&G CCG Level Indicators ThresholdIn month
actual
In month
RAGPerformance Indicators (Pennine Care Contract ) Threshold
YTD
Actual
YTD
RAG
In month
actual
In month
RAG
Safety Incidents - 43 G E_B1IAPT Prevalence - Number 5380 5708 R 1552 G
Deaths - 1 G E_B2IAPT Prevalence - % (Quarterly)** 3.75% 4.29% G 4.33% G
Safeguarding - 1 G E_B3IAPT Recovery** 50% 38.83% R 48.80% RSTEIS Cases - 3 G E_B4IAPT 6 weeks (Threshold to be achieved by Qtr. 4)** 75% 58.30% R 56.20% RSickness & Absence 5.0% 8.47% R E_B5IAPT 18 weeks (Threshold to be achieved by Qtr. 4)** 95% 91.03% R 90.30% R
Bank & Agency Use TBD TBD - E_B6CPA 7 Day Follow Up** 95.0% 98% G 95.2% G
Effective and Responsive Local Key Performance Indicators
CPA reviews in last 12 months 95% 96.0% R E_B10CAMHS Admissions to Adult Wards 0 1 R 0 G
Delayed discharges 7.5% 2.20% G E_B11Physical health checks*** 95% 89% R 89.00% R
Gatekeeping (Tameside) 95% 100% G E_B12
Memory assessment service initial assessment 6
weeks* 80% 7% R 6.2% R
A&E 4 hour waits (Trust) 95% 100%G
T&G CCG Level IndicatorsPrevious
Month
Actual
YTD
Actual
YTD
RAG
In month
actual
RAG to
Prior
MonthLD green light toolkit compliance (Trust) Achieved Achieved G Caring and OutcomeGM Key Performance Indicators E_B7Compliments 5 61 N/A 3 RDischarge Summaries to GPs in 24 hrs*** 90% 31% R E_B8Complaints 3 59 N/A 4 G
Discharge Letters to GP in 10 days*** 90% 79% R E_B9FFT - satisfaction rate (Tameside) 88.0% 90.67% N/A 90% G
Nutritional & Weight Assessments* 95% 95% G NB - IAPT data relates to Pennine care performance and not against the CCG national target
SUI Investigations 80% 100% G NB - YTD Actual is based on the average monthly or quarterly data
SUI Commissioners Notified 100% 100% G NB - IAPT 6 weeks and 18 weeks - waiting times was changed from wait to firest treatment on entry to wait
Alcohol screening* 85% 85% G to first treatment on discharges
Alcohol brief intervention* 85% 100% G
Adult Safeguarding Training (Tameside) 90% 89% RChildren Safeguarding Training (Tameside) 90% 92% G
***Data published every 6 months and relates to September
Contract / Standards Framework Safe and Well Led
** Please note the 'in month actual' is the quarterly figure and relates to quarter 3 data. The 'YTD'
figure has been calculated from the quarter data
*Please note the 'in month actual' is the quarterly figure and relates to quarter 3 data.
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Tameside and Glossop CCG Performance Dashboard for Board
Meridian – Intermediate Care Performance Dashboard Reporting Period: December 2015
Total number of new reviews 0Total number of reviews ongoing 0
Total number of alerts 0Total number of DoLS 0
Total number of new reports 0 New reports C-Diff 0New reports MRSA 0
Issues arising 0 Total 0Dec YTD
Total number of complaints 0 2Total number of compliments 16 34Number of complaints via Ombudsman 0 1Total number of pre complaints
Dec YTDTotal number of contacts 0 2
DecNew 0Outside 45 days 0Closed 0
Total number of new inquests 0Total number of ongoing inquests 0
Total number of cases 0* Falls action plans in place Total number of new cases 0
Total number of cases concluded 0Total Number on Risk RegisterNewRemoved
Number rated 1 - 3 (Negligible)Number rated 4 - 6 (Moderate)Number rated 8 - 12 (High)Number rated 15 - 25 (Extreme)
Unsafe Discharge
Risk Register
1
0
Other Incidents
01
Incident Reporting by Type
Serious Case Reviews (Safeguarding Adults) Patient Experience Tracker
0
STEIS
Safety
3
0
20
Community ME
Pressure Ulcers by Grade
Safety
Safety Alerts
Infection Control
RIDDOR
Safeguarding Alerts and patients subject to DoLS
Total
Litigation
Investigation Reports
Coroners Inquests
0
PALS
Transport1
14
19000001
8000000000
2
0 5 10 15 20 25 30 35 40 45 50
Pressure ulcersMedication Error*Slips/Trips/Falls
Violence & AgressionSuspected suicide
Staffing levelsSelf Harm
SecurityPhysical Health incident
OtherManual Handling
Information SecurityInfection Control/N.Stick/COSHH
Fire & SmokingEquipment
Death-Expected/unexpectedAWOL/Absconded
Assaults to StaffAssaults to Patient
Accident
Number of incidents
Dec-15
0
1
2
3
4
5
6
7
8
9
10
Oct-15 Nov-15 Dec-15
Ungradeable
Grade 4
Grade 3
Grade 2
Grade 1
0
5
10
15
20
25
30
35
40
45
50
Oct-15 Nov-15 Dec-15
Nu
mb
er
of
Inci
de
nts
Incidents by Grade
Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
0
1
2
3
4
5
Dec-15
Complaints
0 04
05
101520
Oct-15 Nov-15 Dec-15
Medication Errors
2 0 1
05
101520
Oct-15 Nov-15 Dec-15
Pressure Ulcers
18
9
19
05
1015202530
Oct-15 Nov-15 Dec-15
Slips, Trips & Falls
6 6 7
0
5
10
15
20
Oct-15 Nov-15 Dec-15
Unsafe Discharge
2287
Tameside and Glossop CCG Performance Dashboard for Board
Go To Doc Limited – Out of Hours GP Performance Dashboard Reporting Period: December 2015
National Quality Requirements Threshold YTD ActualYTD
RAG
4
month
trend
In month
actual
In month
RAG
Number of patients referred to A&E* 7.80% 9.34% R 9.69% R
Assessments
Assessments within 20 mins of an urgent condition being answered 95% 95.41% G 100.00% GAssessments within 20 mins of an urgent condition arriving at the
centre 95% 100% G 100% G
Face-to-face consultations within 2 hours of the clinical assessment 95% 97.42% G 98.00% G
OOH Consultation details sent to GP Practice by 8am the next working
day 95% 99.49% G 99.65% G
Calls
Initial telepone calls that are abandoned 4.99% 3.22% G 2.47% G
Calls answered within 60 secs at the end of the intro message 95.00% 58.68% R 68.07% R
* data relates to October due to November and December data not received ** data relates to November due to December data not received
23 21 12 18 19
17 12 10 00 0 0 0 0 0 0 1 1
291 315 262 281 241 226 283 170 131
118 118 81 93 116 95 7850 38
594 612 436 469 510 405 505
234130
0 0 0 0 0 0 0
116175
132 135 107 112 112 124 108103
62
91 99 67 101105 96 120
172185
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Call Type Breakdown by Month
Visit
Treatment Centre
Speak To Clinician
See Clinician
Nurse Advice OLC
Nurse Advice
Medication Enquiry
Dr Advice
Bookings
999
0.00%
1.00%
2.00%
3.00%
4.00%
5.00%
6.00%
0
500
1000
1500
2000
2500
3000
Abandoned Calls by Month
Total Calls
AbandonedCalls (%)
0
20
40
60
80
100
120
140
160
180
Average Waiting Time for Visits (Mins)
4 month trend key:
Performance is improving
No change to performance
Decline in performance
2388
Tameside and Glossop CCG Performance Dashboard for Board
NHS 111 Performance Dashboard Reporting Period: December 2015
Performance Indicators (NWAS Contract as a Whole) Threshold111 in Month
Performance
In month
RAGPerformance Indicators
111 in Month
Performance
T&G CCG in
Month
Performance
% of calls abandoned after 30 secs 5.00% 15.49% R ## Calls Triaged 130878 3632
% of calls answered within 60 secs 95% 55.22% R ## % of Caller terminated calls during triage 8.30% 8.07%
% of life threatening calls referred to 999 within 3 mins 99% 96.50% R ## % of Callers who were identified as repeat callers 4.27% 4.85%
% of appropriate provision within 15 mins of initial contact 95% 100.00% G ## % of Triaged Patients speaking to a clinician 20.34% 19.71%## % of Warm Transferred to NHS 111 service Clinician 38.41% 36.03%
% of training in recognition of safeguarding issues 100% 100.0% G ## % of patients Offered a Call Back 61.59% 63.97%
% of answered calls triaged 60% 89.0% G ## % calls where the Time taken for call back <10
minutes35.61% 30.13%
Maximum Warm Transfer time (30 seconds) 95% 35.9% R
% of consultation details sent to patients practice by 8am
the next working day 95% 88.5% R ##
% of triaged calls transferred to 999
13.00% 13.00%
% of repeat callers (3 times in 96 hours ) whose use is
immediately highlighted to their registered GP 95% 38.5% R ##
% of triaged patients advised to attend A&E
8.00% 7.00%
% of calls made by frequent users (patients who call 111
more than 4 times in 31 Days) - 1.8% - ##
% Referred to Primary and Community care
62.00% 62.00%
## % Recommended to Attend Other Service 3.00% 3.00%
National Quality Requirements Caller Treatment
Local Quality Requirements
Referrals Given
84%
5%
1%0% 2%1%
7% T&G CCG Callers Triaged by Ethnicity
WhiteAsian or Asian BritishBlack or Black BritishChineseMixedOtherNot Collected
0
500
1000
1500
2000
15 and Under 16 to 65 65 and Over
T&G CCG Callers Triaged by Age
2489
Tameside and Glossop CCG Performance Dashboard for Board
Arriva Performance Dashboard Reporting Period: December 2015
Performance Indicators ThresholdGM In Month
PerformanceGM RAG
T&G CCG In
Month
Performance
T&G
CCG
RAG
Performance Indicators (Greater Manchester Core
Contract)Threshold
GM In Month
PerformanceRAG
Travel Time Booking System / Calls
Passenger Time on vehicle < 60 mins 80.0% 93.0% G 90.3% G % availability of online booking system 99.0% 99.0% G
Arrival % availability of telephone booking system 99.0% 100.0% G
% of arrivals 45 minutes prior to appointment 15.0% 8.0% G 7.2% G % of Calls answered within 20 seconds 75.0% 86.0% G
% of patients arriving within -45 / +15 mins of
scheduled appointment time 90.0% 74.0% R 71.5% R Average Time (in Secs) to answer inbound calls 60 15 G
% of arrivals 15 minutes after appointment 15.0% 18.0% R 21.3% R Cancellations
Departure % of journeys cancelled by provider 0.05% 0.00% GPatients collected within 60 mins of scheduled
collection time 80.0% 73.0% R 73.5% R
Patients collected within 90 mins of scheduled
collection time90.0% 86.0% R 84.2% R
Performance Indicators (Greater Manchester EPS
Contract)Threshold
GM In Month
PerformanceRAG
Travel Time
Passenger time on vehicle is <40 mins 85.0% 0.0% R
Arrival
% of arrivals 30 minutes prior to appointment 10.0% 10.0% G
% of patients arriving within -30 / +15 mins of
scheduled appointment time 90.0% 84.0% R
% of arrivals 15 minutes after appointment 15.0% 6.0% G
Departure
Patients collected within 30 mins of scheduled
collection time 80.0% 79.0% R
Patients collected 30 mins after scheduled collection
time 10.0% 21.0% R
NB GM data provided in December 2015. Dashboard updated
0
0.5
1
1.5
2
2.5
3
3.5
T&G CCG Complaints per 1,000 Patient Journeys
2014/15
2015/16
0
0.5
1
1.5
2
2.5
3
3.5
T&G CCG Complaints per 1,000 Patient Journeys
2014/15
2015/16
2590
GOVERNING BODY MEETING
Title of Subject: Minutes of the PIQ Committee Date of paper: 13th January 2016 Prepared By: Graham Curtis
History of paper: PIQ 10th February 2016
Executive Summary: Minutes and recommendations from the PIQ meeting to seek Governing Body ratification and approval.
Recommendations required of the Governing Body (for Discussion and Decision)
Delivering the Forward View: NHS Planning Guidance 2016-17 –
2020-21
PIQ recommended the following for GB approval:-
1. Adopt a style and format easy to assure by NHS England.
2. Assign Lead Directors for each element of the submission.
3. Clarify the required Governance process.
Directors, Lead Commissioners and Clinical Leads to conduct a gap analysis and ensure plans are developed to address any gaps identified.
QIPP principles addressed by proposal:
All
Direct questions to: Graham Curtis/Clare Watson
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Minutes of the PIQ Committee
Wednesday 13th January 2016, 12.30pm, Boardroom Attending: Graham Curtis - PIQ Chair Clare Watson – Director of Transformation Dr Alan Dow – CCG Chair Dr Naveed Riyaz – Locality Lead
Dr Saif Ahmed – Locality Lead Dr Andy Hershon – Locality Lead Dr Alison Lea – Governing Body GP Lead Celia Poole – Lay Member Dr Richard Bircher - Governing Body GP Lead Dr Amir Hannan - Governing Body GP Lead Paul Nuttall – Head of Finance Gideon Smith - TMBC
In Attendance: Ali Lewin – Deputy Director of Transformation
Chris Leese – Head of Primary Care Pat McKelvey – Head of Mental Health and LD Commissioning Mgr Al Ford - Commissioning Business Manager Louise Roberts – Commissioning Business Manager Peter Howarth – Head of Medicines Management Elaine Richardson – Head of Assurance & Delivery Sarah Hadfield – PA to the Director of Transformation
1. Apologies for Absence –Kathy Roe/Gill Gibson/Tina Greenhough/Stuart Allen
2. Minutes from the Previous Minutes
The minutes were agreed as a true record. There was discussion around the content of the minutes. Action: Accountable officer to confirm ratification of the minutes.
3. Matters Arising
Matters Arising All actions were completed. - AF explained that this work focuses around ADHD and Autism difficulties and that
it has seen increasing demand. Contract negotiations have discussed its capacity and demand and this feels the perfect avenue to do it. PN advised that from the £1.2m in the community contract we currently pay £250-300k as a block
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contract. PN felt that the contract meeting needed to happen before any agreement/decision is made. Action: AF to determine if there is a still a need for the service and then come back to PIQ for decision with the caveat that workforce establishment is looked into.
4. Declarations of Interest
GC gave a reminder to members to ensure entries on the register of interests meet requirement. DOIs- GP/Orbit – items 7,8 & 9 It was noted that processes for TMBC may differ to our own so this may need to be tailored.
5. Locality Leads
Hyde
A Hershon updated around the issues around Mental Health referrals to Healthy Minds. This was to be picked up with Dr Vinny Khunger at a further update. A Hershon also noted the negative response to the LCCT proposals. This matter would be discussed further within the over 75s item.
Ashton
NR reported that conversations were also held around the new Drugs and Alcohol service with Dr Vinny Khunger to update at the next meeting. Discussions were also held around the LCCT work in which feedback was positive and there was also positive feedback around the Over 75s scheme at Tame Valley emphasising the importance of social isolation.
Glossop
AD would feedback around a potential job share for the Glossop Locality Lead post in due course.
Denton
SAA reported that Orbit Healthcare are looking at IT work in relation to shared patient records using EMIS and viewing social care records. This work will align with the LCCT work.
SAA also asked around Lay PPG Presence at the locality meeting as this had been raised. It was felt that it would be the decision of the Locality to decide if there was a requirement for any part B arrangements.
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CP asked what will be rolled out in relation to the new Drugs and Alcohol service and whether a pack should be communicated to GPs as part of contract management. ER advised that we haven’t commissioned that service but agreed there should be a standardised way of roll out in line with ICO communications.
6. Finance Update
PN reported we have formally agreed the year end settlement with TFT and a report has gone to NHS England stating we are expected to achieve our QIPP target and other financial duties. This is still expected to impact 2016-17 and it is thought we will receive an allocation of around £370m next financial year. Though we appear to have a higher allocation we are aware that an increase of tariffs has been put into place. The QIPP target for 2016-17 is expected to stand at between £7-10m. Non recurrent funding is expected to be around £10.8m on the basis that we receive the surplus funds. ER felt that further savings may be received from the Trust from work which will look at EUR and Consultant to Consultant referrals. The Cardiology advice line should also see a cost saving. In terms of the Non recurrent business cases presented at the last few PIQ meetings PN advised that we will still have to demonstrate to NHS England this spend. PM informed that all carer schemes are non-recurrent, and year on year create uncertainty. PM added that we should integrate the work as part as core business. GC felt that we must identify what we are funding to avoid a first come first served approach.
Action: Further financial updates around the 2016-17 allocation/funding to be brought back to the February PIQ meeting.
7. Care Together Update
AD reported that we had held the first shadow meeting of the single/joint commission. The pace of change is fast with mapping expected to be complex. Structures are on the radar with it being questioned how much of the decision making will go through PIQ. Any ratification process through GB will now go to the Single Commission. The Joint Committee is legally required. A meeting is planned between Steven Pleasant and Graham Irwin to question whether changing the scheme of delegation is the right thing to do. PIQ would likely become a Professional Reference Group from April onwards, with an inclusion of Health & Social Care to underpin the Joint Committee. Decisions would be made here with delegated responsibility. GC felt that any newly constituted body would need to be agreed by the Governing Body. ER asked how Glossop would fit into the new governance. AD confirmed that Steven Pleasant is clear that inclusion of Glossop will remain. A Hannan felt that any filtering down of communication would
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be critical from the newly formed boards. CP asked where quality would fit in the new governance. It was confirmed that this is being looked at and that a quality paper would be presented to the Joint Committee.
8. Primary Care Update
- Extended Access Pilot - COI – SAA/JD CL updated that Glossop will go live in the last week of January. A third hub in Hyde is also expected to go live soon. Non Emis Practices were going live once they had been visited by the CSU and received the training (the visits were required per practice to enable the switchover unlike EMIS practices where the switch could be done remotely). SAA reported that a NHS England had asked for Manchester University who are evaluating all the pilots, to attend our Project Group due to the advanced nature of our project. ER asked if the service was working well why was Urgent Care still struggling and asked if GTD were able to book into it. CL advised that a phased entry is in place as per the business case that NHS England approved – the first phase is pre bookable appointments through a practice. As demand is assessed other entry points may come on line, but reminded PIQ that appointment capacity is limited and it is a pilot. JD asked around the pre booking and why we would pay Out of Hours anyway. RB felt that we were spending more money on Urgent Care in the wrong way and had concern that some practices use more than others which may cause bad feeling. The Joint Committee would be receiving a utilisation report in January to assess usage and PIQ were reminded that the EA pilot reported to the monthly Joint Committee as per the agreement with NHS England.
- New Proposals for a GM GP Contract Update
CW updated there will be a meeting around this tomorrow. No clinicians are expected to attend apart from Dr Dow. There is a complementary Expression of Interest from four practices in Hyde and a meeting is scheduled with Raj Patel to discuss further.
Level 3 delegated commissioning has now been approved and will see the change effective 1st April 2016.
There are issues around the Greater Manchester Quality standards and whether we adopt these once at level 3 delegated commissioning. CW confirmed that it would be expected as per the AGG commitment that we adopted the Standards but there wasn’t a suggestion that we abandoned our agreed approach and local framework which had committed spend and 100 percent Practice sign up. All issues around the GM / local standards were agreed to be picked up offline with CL.
9. Over 75s
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GC reiterated that any unfavourable decisions that came from the Over 75s scheme process were a group decision and that funding is still available should any individual member practices or groups of practice bids. A robust process to allocate funding and monitor evaluation of these bids was put into place and any schemes would have to deliver the objectives as set out in the Better Care Fund metrics. These metrics were set out when the process was originally presented in summer 2014.
A Lewin referred to the Hyde Locality meeting where the LCCT work was discussed. A Lewin made a plea that this work is separate to ay schemes from the Over 75s process and to reinforce its separation to it. A Hannan has also spoke on behalf of the CCG at Hyde and agreed there were difficult conversations. Even though they were aware the return would take a few years, there was resentment from initial positive messages. GCs view on the conversations were that they were heated and noted that the Hyde Locality Lead was not present to defend this position at today’s PIQ. S Ahmed felt that in comparison to their Stalybridge scheme, his locality were aware that any schemes would need to save money. S Ahmed added that the Lockside and pharmacy models have clear evidence base that they work and suggested that when level 3 commissioning is in place, we utilise this schemes funding to pool alongside GMS monies to form new practice for over 75s. CW explained that any future proposals would need to meet guidelines for the Better Care Fund. It was agreed that Locality Leads should go back to practices to give them opportunity to rebid, not only for over 75s schemes and finding, but any other activities deemed innovative and Value for Money. Action: PN to recirculate guidance relating to Better Care Fund for 2016-17 and to circulate revised figures for list sizes.
10. Delivering the Forward View: NHS Planning Guidance 2016-17 – 2020-21
LR presented the additional guidance issued which will aid how we deliver our forward view. The guidance sets out its new mandate with 9 clear must dos including NHS constitutional requirements, quality improvement plan, Dementia targets, new models of care and sustainability around General Practice. Contracts will need to be signed by the end of March and a checklist has been pulled together a checklist which identifies any gaps. It will include our local plan and our Single Commissioning plan to form the basis of the five year delivery. The plan will receive Director Sign off of the three key areas with assurance that it will be sent through the relevant governance process. CW added that the plan has been discussed at the Single Commissioning Board as part of the Single Commissioning operational plan. A contract meeting is also in place with TFT to ensure alignment with their plans.
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ER asked that we remain mindful that some things won’t be set in stone with an
example of the CATS transition activity, as this could take out 20% of outpatient appointments. It was noted that we can’t transform and not expect it to change but
we must be looking at what we currently have in the system. The key factor will be that the Trust will align and change at the same time. PIQ recommended the following for GB approval:-
1. Adopt a style and format easy to assure by NHS England.
2. Assign Lead Directors for each element of the submission.
3. Clarify the required Governance process.
4. Directors, Lead Commissioners and Clinical Leads to conduct a gap analysis and ensure plans are developed to address any gaps identified.
11. Elective Redesign Pathways
ER updated that Care UK are now in place to provide the bridging arrangements as agreed at the last meeting. The trust are operating a 7 day week service within the redesign work of ENT and MSK and advice and guidance will be provided to allow effective movement between providers. Work is being carried out with patients to ensure support and the service will be run until ICFT are in a position to provide the new service. All providers are on board but asked that any issues be fed back. There may be some challenges when Community Healthcare transfers to TFT but these issues are being looked at to ensure we minimise risk to patients. GPs will still be able to refer and offer choice around EUR/follow ups. Ophthalmology will go live 1st April and is expected to be more complicated in terms of macular support into Tameside and Glossop. Any concerns will need to be directed to ER/A Lea/Saif Ahmed. CW gave thanks to ER, A Lea and S Ahmed for their work undertaken so far.
12. LCCTs Update
AL updated that project team meetings and steering groups are in place and the feeling is that it is progressing well. There is a lot of ongoing work with providers and any issues within locality discussions will need to feed in to come back to PIQ. Brendan Ryan has been invited to the locality leads sessions later in the month with commissioning managers to be identified to provide support to these locality level discussions and ensure utilisation of third sector. RB noted that he had heard some reassuring stories come out of this work and that feedback so far had been great.
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13. Any other Business
There was no further business to discuss.
14. Date & Time of the Next Meeting – Wednesday February 10th 2016, 12.30pm For information
15. Medicines Management Minutes
PIQ noted all minutes for information.
16. Heads of Commissioning Minutes
PIQ noted all minutes for information.
17. System Resilience Group Minutes
PIQ noted all minutes for information.
18. Emergency Care Network Minutes
PIQ noted all minutes for information.
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GOVERNING BODY MEETING
Title of Subject: Ratified IGAR Minutes – 28th October 2015 Date of paper: 27th January 2016 Prepared By: Graham Curtis History of paper: Ratified at IGAR Committee on 27th January 2016 Executive Summary: Corporate Risk Register
Concern was raised over the amber rating of the financial risk. Finance & QIPP Assurance Committee will monitor very closely. Governance Group This meeting will become more formalised and will report into IGAR going forward. Register of Interests The registers have been redesigned and subdivided into Committees, Localities and All Staff. Conflict of Interests (CoI) A procedure note regarding minuting CoIs was received and approved. IG Toolkit Work is taking place to ensure all staff complete their mandatory IG training. IG Strategy Group This meeting will be reinstated. External Auditors The appointment of external auditors for 2017/18 must be made by the end of 2016, the CCG’s auditor panel needs to be in place early in 2016 so that it can fulfil its responsibilities in relation to the procurement and appointment of auditors. Terms of Reference (ToR) The revised IGAR ToR was approved on the agreement with minor changes. The December 2015 meeting was cancelled.
Recommendations required of the Governing Body (for Discussion and Decision)
Given the time lag Governing Body are reminded that: • A CCG auditor panel needs to be in place in early
2016 • Revised IGAR ToR were recommended to GB for
approval QIPP principles addressed by proposal:
Direct questions to: Graham Curtis
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MINUTES
INTEGRATED GOVERNANCE AUDIT AND RISK (IGAR) COMMITTEE Wednesday 28th October 2015 9.30am
Boardroom, NCH Denton PRESENT: Graham Curtis – Chair
David Swift – Lay Adviser Dr Richard Bircher – Governing Body GP (from agenda item No 9)
IN ATTENDANCE: Tracey Simpson – Deputy Chief Finance Officer Clare Watson – Director of Transformation (from agenda item No 4 to No 20.2) Chris McGarry – Senior Finance Officer Paul Pallister – Assistant Chief Operating Officer Mark Heap – External Audit (from agenda item No 7) Lisa Warner – Internal Audit, MIAA Heather Lang – Internal Audit, MIAA Beric Dawson – Counter Fraud, TIAA Caroline Cross - GMSS (presenting agenda item No 15) Vikki Forshaw – Senior Secretary (minutes)
RISK 1. Welcome and Apologies
Apologies were received from Dr Alan Dow, Steve Allinson, Kathy Roe and Lynn Jackson. GC welcomed the following people: Heather Lang (MiAA), who is observing the meeting in order to complete a review of the effectiveness of the Committee; Beric Dawson in his new role as Counter Fraud Manager for TIAA and Chris McGarry a new member of the CCG’s Finance team.
2. Declarations of Interests
DS declared the following declarations to the members and asked for them to be added to the Register of Interests:
• Qualifications: Member of the Chartered Institute of Internal Auditors • Job role at East Lancashire CCG from 1/11/2015 will be as Lay Member for
Governance and Audit. VF will ensure that the declarations are added to DS’s Declaration of Interests form and then signed by DS before being added to the register.
Action: VF/DS 3. Actions and matters arising from risk element of Minutes of 26 August 2015 Actions have been undertaken in relation to the risk element with one exception as follows:
Agenda Item No 3 - Actions and matters arising from risk element of Minutes of 25 February 2015: SUI When discussing STEIS, it was noted that although specific processes are in place and run parallel, there is scope for combining [CCG and Council] systems. CW emailed Steph regarding this and will follow up.
Action: CW
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4. Corporate Risk Register
PP presented an Operational Risk Report alongside the current Corporate Risk Register as of October 2015. PP made the following key points:
• Risk 5 (review of policies) has been removed from the Risk Register and instead has become a standing agenda item for the IGAR Committee to review.
• All risks with an interim manager listed as being the owner now have a supporting substantive named manager at deputy or director level.
GC raised his concern that the risk rating regarding the CCG’s financial position is not reflective of the severity of the risk. DS, via the Finance & QIPP Assurance Committee, will monitor this risk very closely. The risk rating will directly correlate with the outcome of the CCG’s agreed year end position with Tameside Foundation Trust (TFT). DS raised concern over the new risk regarding the replacement of the Community Services Core clinical system, in particular to the mention of ‘…to waiver any form of OJEU tender process…’ This, along with the fact that the risk has only just been identified and is already at a level 5 red rating, needs to be discussed and clarified with John Winter and the Committee updated at the next meeting.
Action: PP
**CW joined the meeting** The committee discussed the financial risk of the transfer of Community Services and the due diligence work being undertaken by Nikki Leach and CMcG surrounding this. GC also highlighted the risk of staff wellbeing through the process of being transferred from Stockport NHS Foundation Trust to TFT with another imminent transfer to the Integrated Care Organisation (ICO) in the near future. PP is attending the TCS governance group of the programme Meeting? as the CCG’s representative to ensure IGAR are sighted on the transition. CW/NL are to provide an update on the risk surrounding the transfer of Community Services at the next meeting.
Action: CW/NL The committee highlighted an inaccurate date in reference to risk 6 under the Milestones/Timescale column regarding HR services being brought in house. This section should read ‘July 2015’ instead of ‘July 2016’ and PP will amend accordingly.
Action: PP
5. Governing Body Assurance Framework
PP explained that this item will be deferred to the next meeting. The reviewed document will incorporate best practice from the MiAA Benchmarking Review which LW has provided.
Action: VF/PP
6. Review of Audit Committee Handbook
LW advised the most recent version of the Audit Handbook was from 2014/15 and PP will ensure that the CCG is up to date and in line with this version.
Action: PP 7. SUI Update The SUI report was submitted for information with the request for VF to collate any
questions from the committee on behalf of LJ in her absence. The committee were happy to receive the report with no queries raised.
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PP reported an additional matter arising stemming from an action raised at Governing Body (GB) concerning a discrepancy in SUI figures between the reports submitted to IGAR and GB. Gill Gibson has reported that the data for each report came from different time periods, with IGAR’s being more up to date, and that work was underway to ensure that GB receive the most up to date position going forward.
RISK ACTIONS Person Action Time Frame VF VF to ensure that DS’s declarations are added to his
Declaration of Interests form and then signed by DS before being added to the register.
Within 28 days (25th November 2015)
CW When discussing STEIS, it was noted that although specific processes are in place and run parallel, there is scope for combining [CCG and Council] systems. CW emailed Steph Butterworth regarding this and will follow up. CW to update.
January IGAR
PP CW/NL
Corporate Risk Register: • PP to discuss with JW:
o the replacement of the Community Services Core clinical system risk (in particular to the mention of ‘…to waiver any form of OJEU tender process…’)
o the fact that the risk has been introduced at a level 5 red rating
• Risk 6 (Milestones/Timescale column): amend HR services being brought in house date to ‘July 2015’ instead of ‘July 2016’
Provide an update on due diligence/transfer of Community Services.
January IGAR
PP The Governing Body Assurance Framework will be deferred to the next meeting.
January IGAR
PP PP to review 2014/15 Audit Committee Handbook to ensure the CCG is up to date and in line with this version.
January IGAR
AUDIT 8. Welcome and Apologies Apologies were received from Gareth Mills. 9. Declarations of Interests None declared. ** RB joined the meeting ** 10. Minutes of Previous Meetings held on 26 August 2015
Approved as a correct record of the previous meeting. 11. Actions / Matters Arising:
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Actions have been undertaken in relation to the audit element with a small number of exceptions. Updates and exceptions were noted as follows:
PP and GG are reviewing the Business Continuity Plans – CMT action to be completed by 31st December for PP to report back at January IGAR
Action: PP Financial Control Environment Assessment - LW to gain a view on other CCGs to ensure a consistent approach to the assessments and will report back. – LW to send out report to CCGs
Action: LW BD reported that Pauline Smith, Regional Manager of NHS Protect, enquired if Audit Committee Chairs would like a similar Standards Forum to the CFOs. GC agreed that this would be useful and BD will feed this back.
Action: BD GC agreed to review when the IGAR Annual Report should fall on the work plan and VF to update the workplan accordingly. – The IGAR Annual Report will be on January’s agenda.
12. Training Reports and Meetings Attended by IGAR Committee Members
DS attended the MiAA course Where Next for the NHS? and felt that the training was very good. GC attended an NHS England North conference, alongside SA, as well as attending Dementia training.
13. CCG Reports 13.1 Governance Group Briefing Note PP explained that the Governance Group will become more formalised with any actions being reported to IGAR to take forward via a briefing note. 13.2 Losses and Special Payments Register There was no update for this agenda item. 13.3 Register of Waivers There was no update for this agenda item. 13.4 Register of Interests PP presented the redesigned Registers of Interest which are subdivided into committees. All committees, including IGAR, will have their Register of Interest as a standing agenda item and the Chair will review this against the agenda at pre-meets to assess any potential conflicts of interest. All of the registers will come to IGAR annually for review and sign off. 13.4.1 Managing Conflicts of Interest Procedure PP presented a procedure for managing conflicts of interest. If a conflict of interest is raised it is the Chair’s responsibility to decide the level of input the member has on that agenda item’s discussion/voting and this will be clearly communicated and minuted in the meeting as per the procedure note. BD commented that this system is an excellent example of the CCG meeting an NHS England standard.
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13.5 Gifts & Hospitality There were no updates for this item. 13.6 Policy Review PP presented the list of current CCG polices with corresponding review dates. PP highlighted that policies is an area that requires attention and further review however it was presented to the committee to discuss prioritisation. The committee, including external audit, agreed with the policies PP had proposed to prioritise within section 1.3 of the Executive Summary. The committee commented on the large amount of policies and the amount of work this involved. Discussions took place on how policies could be managed effectively to balance keeping the organisation safe against superfluous use of resources. Suggestions were made to merge some policies and LW mentioned that it might be useful to group policies under sections e.g. HR. BD and LW offered to provide PP with examples of other organisations that have merged policies.
Action: BD/LW PP will review the current policies to assess merging relevant policies.
Action: PP The committee also agreed that HR policies should come to IGAR and that HR should report to January’s meeting an update on Investors in People (IiP).
Action: GC/Kate Quinn 13.7 Business Continuity This item will be discussed further in January’s meeting. 13.8 Scheme of Delegation (Financial Limits) The committee were advised that Carole Piddington will be leaving the CCG shortly and therefore will be removed from the Scheme of Delegation. VF will replace Carole in her Petty Cash role. 13.9 IGAR Work Plan GC highlighted that the 2016 IGAR meetings will commence in January as opposed to February to align with the Annual Accounts submission and this is reflected in the workplan. BD also advised that the counter fraud dates need to be amended to March, July and November.
Action: VF 14. CCG Performance
14.1. Transformation This item was deferred to allow clarification of what IGAR expects from the CCG directorate performance updates. The update must directly link to the risks associated with the directorate in question as per the Corporate Risk Register.
Action: GC
16. Counter Fraud 16.1 MiAA: Counter Fraud Contract Closure Report
LW presented the closure report for information. She explained that the report mainly consisted of reviews that had already come to IGAR in the past 6 months. The report will allow for continuity when the new provider, TIAA, provides the annual report at the close of the year.
BD confirmed that Darrell Davies had passed on the query regarding the standards. He explained that in response to this query he had sent the NHS Protect Q&A to GC and PP which had answered some questions
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** CC joined the meeting** 16.2 TIAA Counter Fraud Workplan
BD presented the TIAA Counter Fraud Workplan that follows on from MiAA’s workplan for a continuous service. There is a particular focus on the close working relationship with the Local Authority and the risks that this will create. TIAA will assess any areas where they feel further work is required and this will be incorporated into next year’s workplan. The workplan is yet to have days allocated however the contract includes 140 days shared between seven CCGs (20 days a year per CCG). TS questioned how the role of the different consultancies carrying out work for GM Devolution would be reported and managed. There will be similar questions regarding GM Shared Services. BD will further investigate this issue by contacting Deloittes and will report back.
Action: BD 15. NWCSU Assurance
15.1 Information Governance Assurance: IG Toolkit Progress Update 15.1.1 IG Toolkit Progress Update
GC welcomed Caroline Cross to the committee. CC will be presenting the IG Assurance updates going forward as Paul Hague has now left GMSS. CC explained the following key highlights:
• The Improvement Plan is currently being amended and will be circulated upon completion.
• There have been no IG incidents reported so far. • Work is being completed on mandatory training ensuring those members of staff
due to complete the training do so. GC explained that although his mandatory IG training is due he has not received a reminder email. CC will look into this and report back.
Action: CC • CW queried Primary Care Devolution/NHS England. CC/CW to discuss this
outside of the meeting. • RB raised a query regarding IG work and whether the CCG or Council should
lead on this. CC explained that a Privacy Impact Assessment needs to be completed to establish who owns the data which in turn should help assign the relevant IG lead. RB raised the question of streamlining IG by merging the functions of the three organisations. The group agreed that this was a conversation for CC and RB to pick up outside of the meeting.
• Appendix A of the report should be forwarded on to the group Action: CC
• CC will discuss reinstating the IG Strategy Group with JW Action: CC
15.1.2 National/Local Issues There was no update on this agenda item. 15.1.3 IG Policy and Strategy
CC presented the IG Policy and Strategy to the group for approval. The Committee approved the policy providing that the framework schematics were reviewed and updated regarding areas of accountability.
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**CC left the meeting**
17. Internal Audit 17.1 Progress Report
LW presented the progress report providing an update in respect of the assurances, key issues and progress against the Internal Audit Plan for 2015/16. Since MiAA’s re-appointment as the CCG’s internal audit provider from 1 October 2015 LW has met with KR to confirm that the 2015/16 audit plan approved by the IGAR Committee in April 2015 still reflects the organisation’s key risks and assurance requirements and this was confirmed. LW explained that there were a number of pieces of work in progress such as Contracting Arrangements, IGAR Committee Effectiveness, and QIPP. All the timings for the audits have been agreed and LW is confident that the plan will be delivered in the time specified. DS questioned why the two reports that were due in September were not in this report. LW explained that the ‘Use of Contractors’ start date was delayed slightly and that the IGAR Committee observation needed completing before the report on Committee Effectiveness could be completed. Both reports should be completed within the next 2 -3 weeks. DS also highlighted that with the new tender a different style of reporting was required where days and progress of each task were included e.g. how many days have been agreed and how many have been used to date. LW will look into the tender requirements and adapt the report accordingly.
Action: LW Discussions took place regarding bringing forward the review of Primary Care to aid the CCG’s evidence pack for the Level 3 application however with the deadline of 6th November the report is unlikely to be ready in time for CW to review and include in the application. LW and PP will discuss this further outside of the meeting.
Action: PP/LW
17.2 MiAA Insight Audit Committee update paper LW presented the Insight Audit Committee Update paper for information. The report details upcoming events and summaries from recent events. There are also details of the briefing notes with LW highlighting the note concerning Cyber Security as particularly pertinent. LW will circulate the Briefing Notes and GC and PP will review them.
Action: LW/PP&GC 17.3 CCG Assurance Framework Benchmarking Report LW presented the CCG Assurance Framework Benchmarking Report for information. The report builds on the report completed last year highlighting comparisons between 2014 and 2015. The report is tailored to signpost T&G CCG and highlights the top ten risk themes – T&G CCG’s Assurance Framework has at least one risk in three of the ‘top ten’ themes. LW advised that the CCG should consider the other seven risks to ensure that the CCG is happy they are covered for these. CW felt that it would be useful to highlight any useful GM Devolution risks that run across the 12 GM Assurance Frameworks. PP will take this forward at the GM Governance Group.
Action: PP 17.4 Internal Audit Contract Closure Report The Internal Audit Contract Closure Report was presented for information and included all the reports that have come to IGAR over the last six months. 17.5 Review Committee’s Effectiveness – MiAA
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The review of IGAR Committee’s Effectiveness is in progress and Heather Lang is observing this meeting. The report will come to the January meeting.
20. Due Diligence 20.1 Transfer of Community Services
CMcG updated the Committee on the Due Diligence process for transferring Tameside and Glossop’s Community Services from Stockport FT to Tameside FT highlighting the progress in discussions and identifying areas of risk. He explained that CCG officers are working with THFT and SFT under the auspices of the TCS Project Board to highlight key areas of work that require completion to specific timescales. There are several workstreams and each has members from THFT, SFT and CCG with a terms of reference which detail the required outcomes for each group and timescales or their achievement. Each workstream will report back to the Project Board and will maintain a Risk Register. The main focus is that the services and relevant funding transfer over successfully. GC raised a concern about staff welfare as they will be transferring twice in a short space of time due to the Care Together Programme/Integrated Care Organisation (ICO). CW agreed that staff welfare is important and that they need to be fully informed and supported.
20.2 NHS England Primary Care Commissioning TS explained that we have had confirmation that our extended access funding bid has been accepted however the demands for funds exceed supply. The funding for year one (December 2015 – November 2016) is confirmed; however, only those who have been successful and can evidence value for money will become funded recurrently. The scale of recurrent funding is unknown but there is the option of three sites – Ashton, Glossop and Hyde – to allow for flexibility; Ashton and Glossop will be used as a pilot to start with.
**CW left the meeting** 18. External Audit
18.1 Progress Report The External Audit Progress Report was presented for information and as expected there is not much to report due to the time of year which is dedicated to planning.
18.2 Final Key Issues The Key Issues for Clinical Commissioning Groups paper was presented to the group for information. MH explained that the key issues have been split into three areas: Emerging Issues, Stubborn Issues and Issues on the Horizon. Devolution figures prominently in Issues on the Horizon. MH made particular note to the fact that as the appointment of external auditors for 2017/18 must be made by the end of 2016, the CCG’s auditor panel needs to be in place early in 2016 so that it can fulfil its responsibilities in relation to the procurement and appointment of auditors. GC advised that he and PP were already discussing this process. GC raised the point that in the near future it would be necessary to discuss how External Audit of the CCG and the Council can be brought together in light of the move to integration. MH highlighted to the committee the Final Accounts Key Issues Section reiterating what a good job T&G CCG/CSU Finance team has done. GC asked that TS relay his thanks back to the Finance Team.
19. Terms of Reference
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The committee were happy to approve the Terms of Reference on the proviso that the deputy Chair be amended to RB as DS cannot act as deputy chair due to his role as Primary Care Joint Committee Chair. PP will amend accordingly and then submit them to Governing Body for approval.
Action: PP
21. Any Other Business 21.1 December Meeting The December meeting will be cancelled to allow for IGAR to start its schedule of meetings in January 2016 to align with the submission of end of year accounts in May 2016. VF to confirm the cancellation via email.
Action: VF
TS advised the committee that Judith Stevens has been appointed as Head of Finance: Technical & Projects and will be a valuable addition to the team.
22. Date and Time of Next Meeting: 27 January 2016
23 March 2016 25 May 2016 27 July 2016 28 September 2016 23 November 2016
23. Exclusion Officers
An Exclusion of Officers meeting was held. AUDIT ACTIONS Person Action Time Frame PP PP and GG are reviewing the Business Continuity Plans –
CMT action to be completed by 31st December for PP to report back at January IGAR
January IGAR
LW Financial Control Environment Assessment - LW to gain a view on other CCGs to ensure a consistent approach to the assessments and will report back. – LW to send out report to CCGs
ASAP
BD BD to pass on GC’s interest of a similar Standards Forum to the CFOs for Audit Committee Chairs.
ASAP
BD/LW Provide PP with examples of other organisations that have merged policies.
ASAP
PP PP will review the current CCG policies to assess merging relevant policies.
ASAP
GC GC to talk to Kate Quinn regarding HR policies coming to IGAR
January IGAR
VF VF to update the workplan with correct Counter Fraud dates (Mar/Jul/Nov)
January IGAR
GC GC to communicate requirements of CCG directorate performance updates – to link directly to the Corporate Risk Register.
Before January IGAR
BD BD will contact Deloittes to look into the role of the different consultancies carrying out work for GM Devolution and how this would be reported and managed. There will be similar
January IGAR
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questions regarding GM SS. CC Information Governance:
• Look into why GC has not received an IG mandatory training reminder email
• Circulate Appendix A of the IG Toolkit Strategy Update from October’s report
• Discuss reinstating the IG Strategy Group with JW
ASAP
LW LW will look into the tender requirements and adapt the report accordingly regarding allocated days and progress to date.
January IGAR
LW/PP To discuss bringing forward the Primary Care Review to aid the CCG’s Level 3 application
Before 6th November submission
LW/PP&GC LW will circulate the Briefing Notes and GC and PP will review them.
ASAP
PP CW felt that it would be useful to highlight any useful GM Devolution risks that run across the 12 GM Assurance Frameworks. PP will take this forward at the GM Governance Group.
The next GM Governance Group meeting
PP PP will amend the ToR in line with IGAR’s comments and then submit to Governing Body
Before January IGAR
VF Confirm to all members/attendees that the December meeting has been cancelled
ASAP
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GOVERNING BODY MEETING
Title of Subject: Ratified Minutes of the Primary Care Joint Committee Minutes Part A Date of paper: 6th January 2016 Prepared By: David Swift History of paper: Primary Care Joint Committee – 10th February 2016
Executive Summary:
To inform Governing Body members of the discussions held at the Primary Care Joint Committee meeting and to ratify minutes
Recommendations required of the Governing Body (for Discussion and Decision)
Ratification of the minutes
QIPP principles addressed by proposal:
All
Direct questions to: David Swift/Clare Watson
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Primary Care Joint Committee Agenda
Part A Minutes
Wednesday 6th January 2016, 15.30pm
Boardroom, NCH
Attendees: Dave Swift – Lay Member (Chair) Clare Watson – CCG Director of Transformation
Ann Gough - NHS England Ben Squires – NHS England Dr Alan Dow – CCG Governing Body Chair Dr Jamie Douglas – CCG GP Governing Body Member Chris Leese – CCG Head of Primary Care Chris Martin – Primary Care Quality & Development Manager Graham Curtis – CCG Deputy Lay Chair Gill Gibson – Director of Nursing & Quality Tori O’Hare – CCG Head of Finance Sarah Hadfield – Personal Assistant to the Director of Transformation Gideon Smith – TMBC Consultant in Public Health
Public Members: One in attendance
1. Introductions & Apologies for Absence - Tracey Simpson/Peter Denton
2. Declarations of Interest for Primary Care Joint Committee
All declarations will be stated against each relevant item.
3. Minutes of the previous meeting/ Matters Arising/Action Log
The minutes were agreed as a true record. Action: SH to amend attendance list for December Primary Care Joint Committee to reflect attendance of AD.
4. Update from Co-Commissioning Management Board AG added that there had been agreement for the MOU to be refreshed and that other contractor groups would form part of MOU/Offer. CW added that she would be involved within the HR element of the GM Primary Care working group. Other items discussed included the proposed MCP contract.
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5. Delegated Commissioning Update
Internal Audit Review of Co-Commissioning The Primary Care Joint Committee confirmed they were happy with this though GC added that the Conflicts of Interest policy was not yet finalised. Approval for delegated arrangements A letter has been drafted ready for submission for approval of level 3 delegated arrangements alongside an internal audit review of arrangements so far. DS and GC confirmed they had booked to attend the Lay Member training for this work in March 2016. CW asked what difference would be seen post 1st April 2016 and whether any existing level 3 delegated CCGs could share any lessons learned. AG advised that practices should make any first point of contact to NHS England around issues such as list closures and that these types of queries would then be made known to CL and the Primary Care team. AG added that support would be as much or as little as we feel and that back office function would still be provided. CW noted concern around capacity which has been raised by CL and others and what we may absorb as we Tameside do have the skillset but not the capacity. There was also further discussion required in respect of Primary Care Quality and where this sat moving forward. CW advised that the Terms of Reference would need to change and would be renamed as a Primary Care Committee. BS added that it would be key to ensure the committee is quorate with NHS England still requiring a presence and that currently NHS England has casting vote. CW confirmed that DS was still eligible to remain as chair. It was noted that the delegating of Primary Care contracts is to the CCG as the accountable organisation, by NHS England, not to any other statutory body. Action: CW to speak to PP and ensure the Governance arrangements are in place to be actioned. Action: Further discussion regarding capacity of the Organisation to balance the Transformation and Core Contracting/Quality issues was required between GG, CW and CL with further discussion in Part B
6. Finance Update TOH explained there was minimal difference to the Month 7 report with slight changes around the forecast underspend in relation to maternity and locum cover. The figure in the level three delegated commissioning submission was slightly higher than the forecast here though this does not mean the figure will translate. CW asked around the enhanced services annual budget against its forecast as there was a £337k place based underspend. BS advised that this was established at a 100% take up at delivery and wasn’t sure how it would translate into next year’s budget. It is hoped though that it may be included into allocations next year. AD noted the negative figure around notional rents. BS explained that the notional rent budgets with uplifts on yearly reviews haven’t come through as yet so it shows as an underspend. These reviews do happen though on a three yearly basis.
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7. NHS E Update There were no updates to report.
8. Primary Care Strategy Update
CL updated that the Primary Care Delivery Group had reviewed items which were red rated (strand 1) within the Quality Framework and there would be a panel set up to review all plans by practices. The Practices who have outstanding plans are being chased.
9. Patient/Public Involvement
This item was deferred to the February meeting in the absence of PD.
10. AOB A response had been received from Stuart Allen, Chair of the West Pennine Local Dental Committee in relation to the query from JD around responsibilities of GPs around tooth extraction for patients under certain medicines. JD felt that it had missed the point and still felt it was putting responsibility on the GP when this should lie with the dentist. AD agreed with JD and felt that though an element of medical advice is fine he would not be sure what the NICE guidance is for teeth removal. BS added that there are no contractual or clinical guidelines in place in relation to this issue and suggested we refer to the LMC/LDC to resolve. Action: AD to refer the issue to the LDC/LMC.
11. Date & Time of Next Meeting Wednesday 3rd February 2016, 15.30pm
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GOVERNING BODY MEETING
Title of Subject:
Transformation Report
Date of paper:
February 2016
Prepared By:
Alison Lewin
History of paper:
n/a
Executive Summary:
The Report provides the Governing Body with an
overview of the transformation work which is on-
going supporting the GB clinical leads.
Recommendations required
of the Governing Body
(for Discussion and
Decision)
The Governing Body is asked to note the content
of the Report and provide feedback on the
content and the projects described.
QIPP principles addressed
by proposal:
All
Direct questions to:
Clare Watson
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Transformation Directorate Report – February 2016
The aim of this report is to provide Governing Body with an overview of the transformation work which is ongoing, supporting the GB Clinical Leads. The report does not include information on ALL projects, but aims to ensure the report is concise and informative, identifying areas which are our priorities and which demonstrate both success and the challenges we face, and not duplicating information presented to GB on other projects. The Transformation Directorate covers a wide range of commissioning areas, and works through 4 “teams”. We work closely with colleagues in other directorates and are represented on all CCG Committees, ensuring the work we produce receives appropriate discussion, input and ultimately “sign off” prior to implementation.
Strategic Programmes / Planned Care /Urgent Care
CCG Assurance: Returns are required on a monthly basis when performance by THFT is below operating standards or the CCG is not delivering mental health waiting times and recovery levels. Currently we are submitting returns for A&E and Mental Health. Operational Planning: Supporting 2016/17 planning including DCC Better Care Fund submission. SRG Assurance: A series of requests for information and self-assessment from NHSE are being managed with daily and weekly reports required due to the failure to deliver A&E. Weekly NHSE conference calls are also required. Updates are being submitted to provide NHSE with sufficient confidence that the SRG is prepared for winter. However, being assured is dependent on delivering A&E. System Resilience: Reviewing use of 2015/16 funding and planning for 2016/17.
Service Development: Bridging arrangements with Care UK for Ophthalmology being developed. Planning longer term arrangements with THFT and Care UK for ENT, MSK and Ophthalmology. Discussions held with THFT on Incontinence as opportunities for service improvement have been identified. Supported the implementation of 111 on 10th November. Working with GM team to identify issues and review impact. Implemented arrangements for Special Patient Notes. Supporting redesign of Urgent and Intermediate Care services to improve patient flow. Developing opportunities to work with other emergency services.
Contracting: Bridging arrangements in place for ENT and MSK with Care UK. These also support the Advice and Guidance for clinicians. Additional Endoscopy capacity arranged at THFT. Work is on-going across GM regarding extensions to the AQP services that are due to terminate March 2016. Patient Transport Services preparing for mobilisation. Discussions ongoing with Trafford and other GM CCGs regarding reprocurement of IVF under AQP. Supporting GM CATS close down. Developing ‘At a Glance’ guide for GPs to support EUR and Low Clinically Value Indicated procedure
Mental Health & Learning Disability / Children & Families
Mental Health: Healthy Minds (IAPT Improving Access to Psychological Therapies) – We continue to see a steady improvement in our waiting times and recovery targets however the ongoing demand for the service presents challenges. Accommodation issues continue to affect the team as pressures elsewhere are reducing the availability of clinic space – this is a major problem in Hyde. The needs of the service have been fed into the Estates Strategy.
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Liaison Mental Health – A range of projects are being taken forward by Pennine Care and the FT to improve how mental health needs are addressed with the district general in line with Royal College recommendations.
Learning Disabilities: Transforming Care – We continue to work with Greater Manchester partners to deliver the challenging GM Fast Track Plan. We are involved in a number of workstreams, taking the lead on Early Intervention and Prevention – aiming to look at how we can best invest all public service resources in the evidence based support to families.
Dementia – Care Together: As part of the development of the PCFT Vascular Dementia CQUIN a vascular information Group will be run from 5th April 2016 on a monthly basis co-delivered with the Alzheimer’s Society and or the Carers Centre; the aim of the group is to assist with coping, adjustment and planning, and provide information and support to clients and carers. This has been an area where support has been lacking. Fifty-one patients have been identified in General Practice that are on dementia medication but have no diagnosis recorded. We have emailed each practice with 3 or more and asked them to review this. Dr Tim Dowling, Clinical Lead for Dementia and Carers aims to follow this up if we do not see an improvement. The Memory Assessment Service - Capacity and Demand modelling exercise to speed up the diagnostic pathway is being undertaken by the Service Manager and The Performance Team at PCFT. Dementia Diagnosis rates continue to rise, the dementia diagnosis rate is 68.9%. Currently there are an estimated 927 patients requiring diagnosis.
Personal Health Budgets: Two recent engagement events have gone well, offering challenge and guidance into our developing local offer. On the 1st of Feb we had a vibrant workshop attended by 43 frontline staff and service users and carers, led by People Hub who are experts by experience. The Project Team are meeting regularly to take forward a range of work strands, supported by NHS England programme leads.
Carers: Following the decision from PPIC and PIQ to maintain investment, a number of meetings to progress this have been scheduled. We will be prioritising Young Carers needs, although all areas will be progressed. Derbyshire have shared plans to refresh their carer’s strategy. A meeting with the DCC Service Manager (Commissioning) has been set to agree the way forward for Glossop carers.
Children & Families Commissioning: Maternity: The National Maternity Review published findings have been delayed again and our now expected mid to late February 2016. The GM Maternity specification is still in draft form. Concerns, that are being addressed, is there has been little commissioning involvement in its redesign. However we are persisting in feeding in to the GM process our thoughts to ensure a collaborative approach to its production. The CCG recent Quality Monitoring Visit of the Maternity Unit concluded there were numerous areas of good practice as summarised within the report taken Quality Committee. There were also some challenges and issues which were acknowledged. There are areas which are in need of modernisation and development, and at the time of the Visit we understand plans are in place to refurbish the antenatal environment. The Visiting Team felt the building did not reflect or support the high quality of service being delivered and could impact negatively on patient’s initial perceptions of the Service. CAMHS: Delivering the vision and ambition set out in our Emotional Wellbeing and CAMHS Transformation plan 2015-2020 is well under way. Contract variations and funding programmes have or being established to ensure that the new monies associated to local transformation plans is being used to greatest effect. The system is truly in transformation with systems, model of care and service offer changing and evolving. The scale of change is being hampered by capacity with the system to drive the reforms and redesign we seek. This despite that our plan seeks a phased approach to deliver the vision and ambition - that by 2020 Tameside and Glossop has a sustainable system that delivers a truly personalised, joined up approach; supporting all children and young people to stay well and provides
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the very best support and care when and where they need it. SEND: Cost and demand pressures have been established with the Integrated Service for Children with Additional Needs (ISCAN) as result of increasing demand and costs on the service. These are being taken forward to a degree in the negotiations with the new ICO. However, a business case will need to come back to PIQ to resolve the outstanding issues and seek uplift in the service funding to enable ISCAN to increase its staffing establishment.
Long Term Conditions / Proactive and Preventative Care / End of Life Care
24 hour ECGs: Following a formal procurement process, Broomwell Healthwatch Ltd. won the contract to provide the community based 24 hour ECG service. Practices across Tameside & Glossop were offered the opportunity to be a hub site. This will require the practice to fit the equipment and download the results for Broomwell to interpret and feedback to the referring GP practice. Six practices have decided to participate: Ashton locality - Tame Valley Medical Centre Denton locality - Droylsden Medical Practice Denton locality - Market Street Medical Practice Glossop locality - Manor House Surgery Hyde locality - The Smithy Surgery Stalybridge locality - King Street Medical Centre Broomwell have provided training and are in the process of setting up IT software in each of the participating practices. Referrals from GP practices will be received from March 2016.
Local Community Care Teams: The Transformation Directorate are working with colleagues across the CCG, General Practice, Tameside MBC, Derbyshire County Council, Stockport FT, Tameside FT, patient representatives and a range of 3rd sector organisations on the development and implementation of the Local Community Care Team model. We aim to have a level of integrated locality based working in place in all localities by the end of March, with a view to having fully operational LCCTs by September of this year. The design and development of this model is being led at a locality level to ensure the teams are tailored to meet the needs of the locality. We are currently putting together the “operating model” and an outline structure for these teams, and collating the information on the locality assets available to each team.
EPaCCS: We continue to work with our 10 pilot practices on the further development and implementation of the Electronic Palliative Care Co-ordination Systems. We are currently undertaking a data analysis exercise, to review the impact of the system (working with the Greater Manchester team and with the support of the practices and the CCG data quality team) and will be reviewing progress to date via the project team during March 2016.
Integrated Community Equipment Service (ICES): There are still great demands on the ICES service as there has been an increase in the number of orders and there are also around 200 new people receiving equipment every month. There is work underway around the authorisation of emergency and out of hours deliveries although the new integrated Urgent care team should help to alleviate this pressure. There has also been an increase in the complexity of the equipment being requested and almost 50% of the overall spend is on pressure care equipment. There has also been a lot of work done to identify and retrieve equipment from care homes. Taking all of that into account, the ICES team have worked very hard and it is anticipated that this year’s total spend will come in at just under £1.6 million.
Specialist Parkinson’s nurse: A new Specialist Parkinson’s Nurse joined the Community Neuro Rehab Team in December 2015. The aim of the nurse is to meet people who have a diagnosis of Parkinson’s disease and provide holistic management plans, medication reviews, and care closer to home. This will then reduce the number of “crisis” admissions, lead to shorter length of stay, reduce carer burden, improve social integration and provide more person centred care.
Medicines Management
Pharmacy Repeat Prescription Ordering: For the past year MMT have been working with pharmacies to have them follow best practice when ordering repeat prescriptions on behalf of patients. Despite this there have been many continuing problems involving excess/early/discontinued medicines ordering incurring both excess costs and generating patient safety incidents. To try and bring a better level of control to this area of activity MMT is now working with GP Practices to
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restrict pharmacy ordering to only those patients who do not have effective support in the community and could not order for themselves and to encourage all other patients to order their own medication. The aims of this activity is to encourage patient independence and responsibility for their medicines, increase accuracy of ordering, reduce waste and thus reduce prescribing costs and also to reduce work load for pharmacies and thus promote patient safety. A standard set of protocols and template letters have been developed to help practices achieve this change and the first of the practices are now implementing this new system.
Prescribing Support: MMT continue to work in GP practices to support the 15/16 GP Commissioning Improvement Scheme by working with their top 10 spend areas. To the end of November savings of £702,000 had been identified. As a part of the review of the CIS benefit a summary of interventions and areas of work is being complied for review by PIQ.
Minor Ailment Scheme: MMT has now fully launched the NEW scheme, and from 1st July 2015 all pharmacies in Tameside and Glossop (except 1) can provide the NEW service. The one unsigned pharmacy is being chased up to participate. The scheme is based on a number of conditions that each have a robust protocol, including definition of condition and description of symptoms, inclusion and exclusion criteria, investigative questions to be asked, advice to be given, suitable medications (if appropriate), non-pharmacological treatments and referral criteria. The conditions that can be treated as part of the scheme are: Athletes foot, hay fever, high temperature (fever), cough, nasal congestion (blocked nose), head lice, thread worm, sore throat, headache, conjunctivitis, vaginal thrush This is an advice driven service but if a medication is required patients who do not pay for their prescriptions will receive any medication required as part of this scheme for free. The pharmacy is paid £3 per consultation plus the cost price of any medication supplied. The aim of this scheme is to prevent patients from taking GP appointments or turning up at A&E or out-of-hours services for conditions that can be effectively and safely treated in the community pharmacy. The administration and control of the MAS is carried out by use of the Neo i.t. system which allows prompt payment of invoices and review of activity levels by site and condition.
LTC Inhaled Therapies: The CCG, in conjunction with the LPC & CPPE, ran an event to help train/ update pharmacists in respiratory therapeutics and patient counselling for use of inhalers. The event was well attended and had good feedback. Attendance at the event allowed pharmacists to fulfil the criteria to participate in the NHSE enhanced service for inhaled therapies which the CCG hope to utilise in conjunction with enhanced pharmacy GP interface working to help the CCG deliver better outcomes for LTC respiratory patients.
Practice Based Pharmacists: As a part of the primary care funding arrangements a number of practices from Ashton, Denton, Stalybridge, Hyde and Glossop have sessional practice based pharmacists support. The Denton locality has arranged for its support to come from TFT, others have made their own arrangements or hired sessional support from an agency. The range of activities that are being undertaken by practice pharmacists varies from practice to practice but includes level 2 & 3 medication reviews including polypharmacy and over 75’s reviews, care home patient reviews, DNP, specials and Red list reviews, discharge planning and seamless care, dealing with minor ailments requests and pharmacy repeat ordering. With the end of financial year approaching the outcomes are being collated so that the CCG can determine the additionality that the various pharmacist schemes have provided and assess benefit s of ongoing practice pharmacist funding.
Primary Care
Co-Commissioning: Movement to Level 3 Delegated Commissioning Of Primary Care The application to move to Level 3 Delegated Commissioning was submitted to NHS England following sign of by the local Greater Manchester and Lancashire Offices and was subsequently approved nationally. We will move to Level 3 Delegated authority for Primary Care (General Practice) from 1st
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April underpinned by a Memorandum of Understanding with NHS England GM Level and revised internal governance structures. The current Joint Committee for Primary Care will continue to oversee this. • APMS Reviews This exercise is ongoing with a project plan being developed with NHS England for Engagement and re procurement • PMS Contracts The revised contract documentation have been forwarded to the PMS Practices for signing.
Development of a Primary Care Strategy: The CCG has developed through Consultation with Practices, an overarching Primary Care Strategy with 5 Strands (1) Strengthening Primary Care Infrastructure (2) Developing Models of Primary Care that are meaningful to Practices and Patients (3) Developing relevant and meaningful outcomes for Primary Care Investment – including local quality indicators/framework (4) Developing Our Membership – Engagement and Communication with General Practice (5) Putting Patients at the Centre – Engagement and Involvement of Patients Our Vision is to support General Practice to be a great place to work and for patients, a great place to access Care. A Primary Care Delivery Group meets monthly to oversee development and progress of the Strategy and accompanying actions.
Primary Care Strategy Strand 1: Phase 1 Non-Recurrent Investment in General Practice Practices have submitted their first update report on this spend to the CCG and where additional information was requested , this has been submitted, with all Practices on track to deliver their individual planned spend plan.
Primary Care Strategy Strand 2: Developing Models of Care : Extended Access Extended Access (out of hours) This pre bookable service via local Practices is now live at Ashton and Glossop. A third hub at Hyde will go live during late February. The Primary Care Joint Committee received its first full months data at the February meeting and follow on actions were discussed with the Providers. New Model Contracts The CCG are working with NHS England and local practices/localities that expressed an interest in developing the Greater Manchester model locality based contract.
Primary Care Strategy Strand 3: Developing Models of Care : Extended Access All Practices are working on their individual plans which will be finally assessed in April, having already been through CCG Panels, with more information being requested where it was felt necessary. PIQ received an update on this in February.
Recommendations
Governing Body are asked to note the content of the report and provide feedback on the content and the projects described.
Ali Lewin Deputy Director of Transformation
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1
Title of Subject: Locality Leads Minutes of Meeting –
26th January 2016
Date of paper:
27/01/ 2016
Prepared By: Louise Roberts
History of paper: N/A
Executive Summary: The purpose of the clinical leads
meeting will be to act a clinical
network across the five CCG
Localities, collecting and sharing
experiences from the respective
constituent practices, acting as a
conduit between CCG Board and
PIQ.
Recommendations required of the
Governing Body
(for Discussion and Decision)
To note the content of the minutes
and actions being taken forward.
Direct questions to:
N/A
GOVERNING BODY MEETING
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Tameside & Glossop Locality Leads meeting
Tuesday 26th January 2016, 12.30-2.00pm
Churchgate Surgery, Denton
Present:
Christopher Martin, Commissioning Business Manager
Tori O’Hare, Finance Manager
Graham Curtis, PIQ Chair and Lay Member of Governing Body
Dr N Riyaz, Clinical Locality Lead for Ashton
Dr S Ahmed, Clinical Locality Lead for Stalybridge
Dr Joanne Bircher, Quality Improvement Lead
Louise Roberts, Commissioning Business Manager
Dr Andy Hershon, Clinical Locality Lead for Hyde
Wassiem Rafique, Commissioning Business Manager
Dr A Ali, Clinical Locality Lead for Denton
Apologies:
Heather Palmer, Commissioning Business Manager
Alan Ford, Commissioning Business Manager
In Attendance:
Alison Lewin, CCG
Sam Hogg, CCG
Dr Alan Dow, CCG Governing Body Chair /Representing Glossop
Dr Jane Harvey,
1. Notes of the last meeting and matters arising.
The minutes from the previous meeting were noted and accepted as a true
reflection of the discussions that took place.
WR agreed to provide an update on the Locality Lead for the Glossop,
following the next Locality meeting at Glossop.
Action: WR to provide an update on the Locality Lead for Glossop.
2. LCCT
There was a discussion on the development of LCCT in each of the Localities
and feedback from the January Locality meetings. This will remain a standing
agenda item at the Locality meetings from in February and March. A
discussion took place on the best approach to develop LCCT within each
Locality. It was agreed that a champion was required within each Locality. It
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was agreed that we can learn from the concerns and issues that were raised
regarding the Northumbria visit, Stalybridge pilot and Over 75s projects.
A creative/supportive network working more efficiently, will enable access to
locally based resources; access to a wide range of support, information and
knowledge. It will support patients, practices and the workforce.
AL agreed to prepare a template to assist localities to visualise LCCT. It was
agreed that a practice based pharmacy could be included in this model.
Action: AL to prepare a template to support LCCT development.
3. EUR/LCV
LR circulated a report designed to support localities and practices with
adherence to Effective Use of Resources (EUR) and Low Clinical Value (LCV)
policies. We are forecasting spending £1.9 million on Procedure of LCV and
£1.6 million on other EUR procedures. The Locality report focused on the top
five procedures by activity. Practices can request a practice level detailed
report should they wish to carry out an audit.
Those present discussed the report and recommended removing procedures
that are out of the GPs influence e.g. Caesarean Section and Cataracts.
Action: The revised report will be discussed at the next Locality meetings.
4. Locality Risk Register
All CCG Members within each locality are required to complete a
Declaration of Interest.
Action: GC to re circulate the declaration of interests.
5. Finance update
TOH presented the CCG Month 8 (November) Summary Report.
A discussion took place on how the CCG can productively reduce costs and
what information was required by practices to support this.
It was agreed that to support discussions at locality and practice meetings;
benchmarking reports; to show:
Levels of activity
Variation
What can be done locally e.g. reduce OP costs
Focusing on:
High costs
Currency
Prescribing
Changes to guidance (for example UTI in Paediatrics)
This would support practices with audits and enable Shared learning.
6. Over 75s – Practice Based Pharmacy
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AH wanted clarification on the Over 75s monies. GC confirmed that money is
still available if practices want apply, money may be awarded as long as it
meets the BCF requirements: Innovative/cost savings; Evidence based and
proven to be done well.
7. Asset Based Primary Care (ABPC)
NHSE are piloting ABPC training course, this will support Localities to makes the
most of assets available within the community. AH agreed to discuss this
further at the next Locality meeting.
Action: CM to recirculate information.
Action: Add to the Hyde Locality Agenda
8. NHS111 update – Special patient notes
There are revised forms for the Special Patient notes and Feedback forms.
WR escalated the issues / concerns regarding inappropriate referrals; NHS11
can’t action these unless they HPF forms are completed (on EMIS). The HPF
forms are now easier to use.
WR provided an update on the performance reports.
The North West NHS 111 service is performance managed against a range of
KPI’s, however there are 4 primary KPI’s which are accepted as common
‘currency’, reported by each NHS 111 service across England. These are:
Target Achieved (December 2015)
Calls answered 95% in 60seconds 81.7%
Calls abandoned <5% 3.82%
Warm transfer 75% 48.1%
Call back in 10 minutes 75% 38.2%
The North West NHS 111 service was offered 149,812 calls in the December
2015, answering 134,391 of which 122,214 calls were classified as being
triaged (90.94%)
Across Tameside and Glossop there were 3632 calls placed in December.
The dispositions identified for patients show that T&G activity was in line with
Regional expectations with referrals breaking down as:
Primary Care & Community Care 62% (2243)
Not recommd. to attend a service 15% (541)
Ambulance Dispatches 13% (482)
Attend A&E 7% (250)
Attend other services 3% (116)
Of the 2243 Primary Care & Community Care dispositions, 1625 patients were
recommended to attend PC&CC services, 415 were asked to speak whilst 203
were asked to attend a Dental service or visit their Pharmacy.
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Out of the 482 Ambulance Despatches, the vast majority were Red2 (196)
and Green 3/4 (228) dispatches with only 15 being given an urgent Red1
disposition
The age breakdown of callers has shown the callers were 16-65yrs (49%) with
callers Under 15 making up 29% of all calls. 22% were over 65 which is in line
with Regional performance levels
The primary ethnicity of callers was White (84%) followed by Asian/Asian British
(5%). The ethnicity of 7% of callers was not collected during the call.
WR advised he wasn’t able to ask NHS 111 to investigate any issues that are
raised by locality leads or GPs without an appropriate HPF being submitted.
There had to be a formal trail into NHS 111 Quality teams in order for an
investigation to be triggered. The group were disappointed by this and
added that GPs don’t have capacity to undertake filling out of forms to the
extent that may be required. WR advised that the HPF form has been revised
and can now be accessed via EMIS where it would self-populate in the
majority of areas. He also highlighted that unless HPF forms are sent through
to the regional 111 teams, the service will not be able to pick up issues and
address processes/pathways on a strategic level unless they get appropriate
feedback from a locality level.
WR also informed the members of the generic email address that all Practices
are required to use to share SoI, End of Life patient information with GTD and
that we needed to continue and encourage its use. He advised that when
EPAACS is fully operational it would supersede this process however, in the
meantime, we need all localities to push the email address so the SPNs can
be shared with the appropriate organisations. WR informed the group that
there were 7 deaths in Care Homes that resulted in a multi agency response
from NWAS, Police, Fire Service etc., due to the appropriate SPN information
not being properly shared by Practices or appropriately updated on to
ADASTRA by GTD. All cases are being investigated.
9. AOB
The development of the LCCT will need to reflect key learning’s from the
Health Living Project in Hyde. JH had provisional discussions with GS to discuss
the benefits of social prescribing.
AD updated those present on:
the re naming of the ICO to replace the name THFT
development of the Joint Commissioning Strategy, to include setting
prioritises (for example reduction in Healthy Years lost and/or prioritise
3% of conditions).
AA asked if locality leads can be represented on the ICO Board / Single
Commissioning Board; noting LL’s have a conflict of interests.
AA noted that there is a conflict of interest with the new lay member for
Denton. Interim plans in place.
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There was a discussion the National ISACTS service coming to an end on the
01st February 2016; practices can continue to refer into the service prior to the
that.
Action: AD to enquire about LL representation on developing Boards.
10. Date of the next meeting will be Tuesday 23rd February 2016
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GM ASSOCIATION OF CCGs: Association Governing Group (AGG) TUESDAY, 19 JANUARY 2016
13:00-16:45 Conference Suite, Level 2, Manchester Town Hall
Attendance: Steve Allinson (SA) NHS Tameside & Glossop CCG Wirin Bhatiani (WB) NHS Bolton CCG Alan Dow (Arrived 13:55) (AD) NHS Tameside & Glossop CCG Chris Duffy (CD) NHS HMR CCG Ranjit Gill (Arrived 14:00) (RG) NHS Stockport CCG Denis Gizzi (Arrived 13:15) (DG) NHS Oldham CCG Nigel Guest (Arrived 13:40) (NG) NHS Trafford CCG Caroline Kurzeja (CK) NHS South Manchester CCG
Stuart North (SN) NHS Bury CCG Hamish Stedman (HS) NHS Salford CCG (Chair) Bill Tamkin (BT) NHS South Manchester CCG Martin Whiting (Left 16:15) (MW) NHS North Manchester CCG Gaynor Mullins (GMu) NHS Stockport CCG Apologies:
Trish Anderson
(TA)
NHS Wigan Borough CCG
Tim Dalton (TD) NHS Wigan Borough CCG Ed Dyson (ED) NHS Central Manchester CCG Michael Eeckelaers (ME) NHS Central Manchester CCG Anthony Hassall (AH) NHS Salford CG Gina Lawrence (GL) NHS Trafford CCG Su Long (SL) NHS Bolton CCG Kiran Patel (KP) NHS Bury CCG Ian Wilkinson (IW) NHS Oldham CCG Simon Wootton (SW) NHS HMR CCG In Attendance: Kate Ardern (Agenda item 10 only) (KA) Director Public Health – Wigan Council Rob Bellingham (Arrived 14:25) (RB) NHSE - GM & Lancs Sub Region Team Sandy Bering (Agenda item 10 only) (SB) NHS Trafford CCG Andrea Dayson (ADa) GM Association of CCGs Warren Heppolette (WH) Health & Social Care Reform Sophie Hargreaves (Agenda item 5 only) (SH) Healthier Together Jonathan Kerry (Agenda item 6 only) (JR) NHS Wigan Borough CCG Stephanie Pearson (SP) GM Association of CCGs (Minutes) Annette Walker (Arrived 13:55/ Left 16:30 (AW) NHS Bolton CCG (CFO Chair) Ian Williamson (Agenda item 4 & 5 only) (IWi) GM Devolution Kath Wynne Jones (KWJ) NHS Oldham CCG (HoC Chair)
1.WELCOME & APOLOGIES FOR ABSENCE
The chair welcomed all members and noted apologies.
MW & CK are representing all three Manchester CCGs.
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2. DECLARATION OF INTEREST
None noted.
3. MINUTES OF THE LAST MEETING 15.12.15
Noted and agreed
All actions completed.
4. DEVOLUTION UPDATE
IW and WH attended to give a brief description of the current position of devolution:-
Main pieces of work going forward – o Design the implementation framework of the Strategic Plan. o Transformation fund – the rules and criteria have been drafted. o #Taking charge agenda. o Detailed paper around the accountability arrangements described at the SPB Executive. o Need to agree management arrangements and a firm foundation for responsibilities.
Implementation Working Group was established to oversee all elements of the Strategic Plan.
Implementation Working Group (IWG) met last week with RG in attendance for the CCGs.
Operational Management Team to focus on BAU - transfer of functions from NHS England.
Need to develop a programme risk register.
Transformation fund criteria; AGG to schedule time in February to co-ordinate discussion.
IW confirmed the AGG Executive has provided consistent representation which is working well.
As we move towards implementation we need to continue discussions with the CCGs.
ACTION:
Transformation Fund paper scheduled for February AGG for discussion – ADa
5. HEALTHIER TOGETHER IMPLEMENTATION
IW and SH attended to provide on update on HT:-
12 CCGs will remain accountable with a reporting route into the JCB to ensure oversight into HT.
Programme plan – programme board 5th Feb to look at the first plan.
Sequencing – some sectors might take longer to go through all the stages due to capital build.
Programme plan – take a baseline in March and then take an assessment every 6 months.
Capital funding is an issue and the main priority with no timescales as yet.
NWAS – flagged as a risk as timeline still not received; Pathfinder is crucial element.
Best possible result from the judicial review – noted thanks to everyone for their support.
Thanks also formally minuted to the HT team from the CCGs.
There is a right appeal within 21 days of the decision which would be the 28th January.
Work with the CFOS and report into the financial framework will report into the programme board – Governance discussed and agreed that this could be routed through CFOs.
CK/ED wanted to alert members to a communications paper to request funding support.
GM recruitment process had started to ensure that spread is even across GM.
Jane Eddleston appointed as chief medical advisor. Interviews on going for clinical champions.
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Recover of legal costs to go to COOs and CFOs to discuss further
ACTION:
COOs to discuss the recovery of legal costs form the Judicial Review.
6. DIGITAL ROADMAP
Jonathan Kerry presented a paper on the update on progress:-
Assurance that this is being dealt with in terms of how it fits into the locality plans.
Lot of direction from NHSE – how they will review road maps and the 7 key areas.
Need to link with locality plans and devolution.
Pull together a working group – deadline to complete is April 16.
Progress to date – locality plans to pick up key themes to understand and progress forward.
Engagement event last week with IMT leads.
Data service for commissioner – ask for analysis to show the pathways. Could be quick wins to link organisations together.
AD noted that point 4.2.5 needs to include Glossop.
The digital roadmap is a CCG agenda and NHSE have delegated responsibly to CCGs to devise.
Will link into the strategy/assurance group that Joe McGuigan chairs.
ACTION:
AGG noted progress and await further review in a few months
7.3 GOVERNANCE
Primary Care standards – SL previously highlighted a need for GM social care standards.
Governance group meets on a weekly basis current focus on JCB.
JCB paper re; accountability and delegation of budgets input from Claire Wilson.
Paper about delegation and NHSE governance going to Operational Management Team.
JCB Working Group chaired by RB had its first meeting – CCG representation from Andrea Dayson, Steve Dixon, Kath WJ, Melissa L and Melissa S.
Work needs to be done to look at AGG and how this supports the JCB agenda.
7.4 DMT
DMT now transitioned to the Operational Management Team (OMT)
Establishment of an Implementation Working Group (IWG) – RG attended the first meeting
Need to work though the approach on poor A&E targets – different approach moving forward.
From April will be judge as GM – will be judge on all failures not just local failures.
IW in discussions with regulators to be a part of the OMT.
OMT and IWG – relying on the AGG Executives to support due time commitments required.
RB interim chair of the OMT until the GM CO is appointed.
WH will be pulling together a paper as accountability needs to be properly agreed.
Need to steer clear of micromanagement but needs to move towards brokerage.
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ACTION:
AGG agreed AGG Executive to support OMT and IWG
7.5 DEVOLUTION PROGRAMME BOARD
Transformation fund from PWC and Carnall Farrer – needs to be reviewed at a future AGG.
Need to be aware what is included in the Transformation Fund.
Need to make sure that papers are presented in a timely manner but understand this is difficult.
Accountability framework document – reference the sustainability budget.
Regulators wrote to all providers to confirm what funds they will receive we need to ensure all conditions come through the transformational team.
Comms need to be highlighted to ensure that they include CCGs in communications.
ACTION:
GM Transformation Fund document circulated to AGG - complete
ADDITIONAL ITEM: PRIMARY CARE
A draft refresh of the primary care strategy requires AGG approval.
GMu proposed to establish a small task and finish group to review the strategy further.
Work shop took place on Thursday – strong attendance and regarded as a positive event.
There is funding potentially available for this – slippage money available.
Non recurrent funding for implementation and legal costs available.
Looking to put forward further details in the next 4 days – full details to COOS on Friday.
ACTION:
AGG agree to the proposal to establish a task and finish group to review the refresh of the Primary Care Strategy.
8. SPECIALISED COMMISSIONING
RB was thanked for his contribution to the paper:-
Describes the governance and what needs to be done from April 17.
4 main recommendations – has been viewed previously.
3rd option NG and GL as Trafford CCG Lead with RB, transformation team and specialised commissioning team.
Developing an MOU with the specialised commissioning to access resources/expertise.
Suggesting for the first year to work alongside NHSE in a delegated role.
Proposing work under the delegated authority for 12 months then move to full devolution – financial risk sits with NHSE along with accountability.
AGG to work with NHSE to understand further how the services are to be commissioned.
Not a great deal of transformation of services has progressed more BAU.
Paper will be discussed at the JCB – has already been to the SPB exec.
Further details will be received regarding the Mental Health Vanguard.
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ACTION:
AGG approved the paper and the option for Trafford CCG to lead specialised services on behalf of the AGG.
9. LD FAST TRACK
CK presented a paper that details significant changes:
Focus on ensuring ‘early wins’ set the foundation for the long-term transforming care agenda.
Talked previously about why GM was selected as a fast track with approximately 150 of GM patients in Calderstones or similar settings.
Key risk – cultivating the market place.
Time frame for closure is over 3 years – expectation is to move the patients faster to manage risks with staffing.
4 key areas with high numbers are Bolton, Manchester, Wigan and Trafford.
Standardise the best practice around LD – Tameside have a good LD commissioner and Salford have long standing commissioning arrangements that we can use in the learning.
Areas of concern have been unclear re: dowry arrangements; work on going with Mike Tate.
Consultation process; GM is our locality with a plan to bring people back into GM as a whole.
Need to be certain that the new arrangements will deliver improved key community care.
Originating CCG will fund the patient to go through CFOs to make sure this makes sense.
ACTION:
AGG endorsed the paper and agreed GM as the locality footprint
10. MENTAL HEALTH 10.1 MH PROGRAMME UPDATE
MW presented the MH strategy which was a piece of work identified as an early priority:
MH Partnership Board meeting established and chaired by Jim Battle from the GM police.
Work area updates have been through HoCs by SB – status is still in draft form.
Substantive document is proposed for the SPB in February.
All agreed MH strategy is a priority.
Strengthening the GP role – empowerment of the practitioners who can be part of the front line.
Connect to system management, areas that will reduce A&E targets.
Clear evidence of potential benefits that we need to integrate and align to the Strategic Plan.
Need to be clear on how we reshape the market.
Excellent document needs further scrutiny around the costs.
The MH Partnership Board and AGG need to review which areas of work need to be prioritised.
Great appetite for this piece of work – aspiration for GM to be transformational.
MH wellbeing needs to be included in the locality plans from 16/17.
Will come back to AGG in March with the implementation plan and priorities – testing of the system on how we implement into locality plans for GM.
ACTION:
AGG noted the progress of the MH Strategy
To further review in March to assess the implementation plan and priorities.
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Confirmation of RADAR support for 3 years CFOs to agree funding options.
10.2 GM ALCOHOL / SUBSTANCE MISUSE / RADAR
Professor Kate Ardern attended to provide an update on the GM alcohol Strategy:
GM alcohol strategy 14/17 – strategy started off as a part of the home office initiatives.
Partnership arrangement set up to look at a multi-agency approach.
H&SC devolution strategy – exploration of regulatory compliance.
4 key areas o Common licence across GM o Enforcement hubs across GM o Possibly having a single licencing authority o Devolution mandatory licensing conditions.
Identified as a key priority for the Prevention Board for devolution.
Potential of introducing a levy on late night licencing.
Responsible student drinking – Salford, Manchester student union and MMU adopted as pilots.
Also embracing further education areas.
Asset based approach working with local communities – culture of responsible drinking.
Building on good work with the development of Community Health Champions.
Reviewing the potential of joint commissioning with alcohol/drugs/legal highs. Working on a set of principles to set out the framework and then review options on how to streamline funding.
Work is being aligned with SB and the work on RADAR.
Contribution from NHSE will link in with A&E and front end care linked to RAID and RADAR.
Delegated the authority through to the CFOs – more details in the reports.
Paper will go to the WLT, police and crime team.
Other work on going with the drink drive limits – GM lead across the North on England.
Agreed that a future discussion with clinicians to endorse the alcohol unit price can be arranged.
Evidence is clear that minimum unit pricing makes a different.
Everything in the license is based on evidence based strategy.
Also working closely with the leisure services providers.
11. ANY OTHER BUSINESS
12.1 PROPOSAL TO MOVE ALL AGG MEETINGS TO THE AFTERNOON
Move to afternoon – all agreed.
Discussions still needed re venue and JCB dates going forward 12.2 HS RETIREMENT
HS retiring from GP in June 2016 and Chair of Salford CCG from July 16
Chair for the AGG needs to considered – incorporate into away day.
NEXT MEETING
DATE: AGG/HOC/CFO JOINT AWAY DAY 2 FEBRUARY 2016
TIME: 09:30 – 14:30
VENUE: AJ Bell Stadium, 1 Stadium Way, Barton-upon-Irwell, Salford, M307EY
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