AGENDA Part 1 Chair: Dr Hilary Byrne - NHS South Norfolk CCG DOI... · Gwyneth Wilson Registered Nurse Governing Body Family members are employees of Queen Elizabeth Hospital, Kings

Meeting of NHS South Norfolk Clinical Commissioning Group Governing Body

13.30 – 15.30

Tuesday, 22nd March 2016

Colin Chapman Room, Hethel Engineering Centre, Chapman Way, Hethel, Norwich, NR14 8FB

AGENDA

AGENDA – Part 1 Chair: Dr Hilary Byrne

ITEM TIME SUBJECT

1. 13.30 Chair’s opening comments and housekeeping notes

2. Apologies for Absence

3. Declarations of Interest

4. Minutes from Previous Meeting

5. Decision Log

6. Chief Officers Report

7. 13.45 Decision/Discussion

7.1 Finance & Performance Report David Gilburt Paper

7.2 Commissioning and Contracting Update Jocelyn Pike Paper

7.3 QIPP 15/16 & 16/17 David Gilburt/Iain Taylor-Allen

Paper

7.4 Quality & Safety Update Karen Ward Paper

7.5 Governing Body Assurance Framework Karen Barker Paper

7.6 Corporate Affairs Report Karen Barker Paper

7.7 LD Astley Court Clive Rennie Paper

7.8 MIND Helpline Antek Lejk/Jocelyn Pike

Verbal

7.9 Maternity Review Karen Ward Paper

7.10 Health & Safety Policy Karen Barker Paper

7.11 Over 75’s, Frail & Complex Patients Policy Dustyn Saint Paper

8. 15.20 Information

8.1 Communications and Engagement Report Oliver Cruickshank Paper

8.2 Audit Committee Report Anna Bennett Paper

8.3 Aveco Report Karen Ward Paper

8.4 CCG Resilience Performance Update Karen Barker Paper

8.5 Annual SIRO IG Report David Gilburt Paper

9. 15.30 Any Other Business

Date and time of next meeting

The next meeting of NHS South Norfolk Clinical Commissioning Group Board will be held on Tuesday 24th May 2016, Colin Chapman Room, Hethel Engineering Centre, Chapman Way, Hethel,

Norwich, NR14 8FB

In accordance with the Public Bodies (Admission to Meetings) Act 1960, the public and members of the Press

will be excluded from the remainder of the meeting where there is business of a confidential nature to be transacted, publicity concerning which could be prejudicial to the public interest

(A) CSU (Anglia) Commissioning Support Unit LAT Local Area Team (of the National Commissioning Board)

2ww Two Week Wait LMC Local Medical Committee

A&E Accident and Emergency LTC Long Term Conditions

AQP Any Qualified Provider MFE Medicine for the Elderly

ASCU NHS Anglia Commissioning Support Unit MIU Minor Injuries Unit

AT Area Team MONITOR NHS Foundation Trust Regulator

BDC Broadland District Council MRSA Methicillin Resistant Staphylococcus Aureus

BMA British Medical Association MSOA Middle Layer Super Output Area

BMI Body Mass Index N&W CSU Norfolk and Waveney Commissioning Support Unit

C2C Consultant to Consultant NCB National Commissioning Board (Now NHS England)

C&B Choose and Book NCC Norfolk County Council

CCG Clinical Commissioning Group NCHC Norfolk Community Health and Care services provider organisation

CFT Community Foundation Trust NHS National Health Service

CHC Continuing Healthcare NHS NCB NHS National Commissioning Board

CHD Coronary Heart Disease NHSM&E NHS Midlands and East

CIC Community Interest Company NICE National Institute for Health and Clinical Excellence

COF Commissioning Outcomes Framework NNUHFT Norfolk and Norwich University Hospitals Foundation Trust

COPD Chronic Obstructive Pulmonary Disease NQB NHS National Quality Board

CPA Care Programme Approach NSFT Norfolk and Suffolk NHS Foundation Trust

CQC Care Quality Commission OOH Out of Hours

CQRM Contractual Quality Review Meeting PALs Patient Advice and Liaison Service

CQUIN Contracting for Quality and Innovation PbR Payment by Results

DES Directly Enhanced Service PCT Primary Care Trust

DIST Dementia Intensive Support Team PMS Primary Medical Services

DoH Department of Health PPE Patient and Public Engagement

DSR Directly Standardised Rates PPG Patient Participation Group

ECG Electrocardiogram PPI Patient and Public Involvement

EEAST East Anglian Ambulance Services NHS Trust PROMS Patient Reported Outcome Measures

EIT Early Intervention teams QALY Quality Adjusted Life Year

EMIS Egton Medical Information Systems (GP Information System) QEHKLFT Queen Elizabeth Hospital Kings Lynn NHS Foundation Trust

EoE East of England QIPP Quality, Innovation, Productivity and Prevention

ERPHO East of England Public Health Observatory QIR Quality Issue Report

FOI Freedom of Information QOF Quality and Outcomes Framework

FRR Financial Risk Rating R&D Research & Development

FT Foundation Trust RCA Root Cause Analysis

GBAF Governing Body Assurance Framework RCGP Royal College of General Practitioners

GP General Practitioner RMC Referrals Management Centre

H&WB Health & Wellbeing Board RTT Referral to Treatment

HCAI Healthcare Acquired Infection SCN Strategic Clinical Network

HDU High Dependency Unit SI Serious Incidents

HES Hospital Episode Statistics SLA Service Level Agreement

HOSC Health Overview and Scrutiny SNCCG South Norfolk Clinical Commissioning Group

IAPT Improving Access to Psychological Therapies SNDC South Norfolk District Council

ICAS Independent Complaints Advocacy Service SPA Single Point of Access

ICO Integrated Care Organisation SPOT Spend and Outcome relative to other CCGs

IFR Individual Funding Request SUS Secondary Uses Service

IG Information Governance TAG Therapeutic Advisory Group

IM&T Information Management and Technology TIA Transient Ischaemic Attack

IMD Index of Multiple Deprivations TOP Termination of Pregnancy

JHWS Joint Health and Wellbeing Strategy VTE Venous thrombo-embolism

JPUHFT James Paget University Hospital Foundation Trust WSH West Suffolk Hospital

KPI Key Performance Indicator Y&HPHO Yorkshire & Humber Public Health Observatory

LA Local Authority

Card Key

Elected Governing Body Member LAY Governing Body Member

Officers of SNCCG on Governing Body Officer SNCCG, not Governing Body

NHS South Norfolk Clinical Commissioning Group

This Register of Interests (Register) includes all interests declared by governing body members and members of committees or sub-committees, (including committees and sub-committees of the governing body) of NHS South Norfolk Clinical Commissioning Group (the CCG).

In accordance with the CCG’s constitution and section 14O of The National Health Service Act 2006, the CCG’s accountable officer must be informed of any interest which may lead to a conflict with the interests of the CCG and the public for whom they commission servicesin relation to a decision to be made by the CCG, that needs to be included in the Register within 28 days of the individual becoming aware of the potential for a conflict. The Register will be updated regularly (at no more than 3-monthly intervals). Interests that must be declared (whether such interests are those of the individual themselves or of a family member, close friend or other acquaintance of the individual) include:

roles and responsibilities held within member practices;

directorships, including non-executive directorships, held in private companies or PLCs;

ownership or part-ownership of private companies, businesses or consultancies likely or possibly seeking to do business with the CCG;

shareholdings (more than 5%) of companies in the field of health and social care;

a position of authority in an organisation (e.g. charity or voluntary organisation) in the field of health and social care;

any connection with a voluntary or other organisation contracting for NHS services;

research funding/grants that may be received by the individual or any organisation in which they have an interest or role;

any other role or relationship which the public could perceive would impair or otherwise influence the individual’s judgement or actions in their role within the CCG.


Register of Interests

Declared interests as at January 2016 of the Governing Body are in the table below.

Name Position Interest Declared

Dr Hilary Byrne Chair GP Partner at Attleborough Surgeries which is part of Iceni Healthcare Limited, Director of Tonian Ltd, spouse employee of Suffolk CCG – declared 21 April 2015

Margaret Blackett Interim Chief Officer Director of Blackett Sharp Ltd, Director of Britannia Sailing Ltd, Shareholder in Blackett Sharp Ltd – declared 19 January 2016

Alison Leather Director of Quality Assurance None – declared 30 December 2015

David Gilburt Interim Chief Finance Officer Director and part owner of a private company – Bonduca Solutions Limited, Associate Lay Member and Chair of the Audit Committee of West Cheshire CCG, Non-Executive Director of The Robert Jones and Agnes Hunt Orthopedic Hospital NHS Foundation Trust (RJAH), actively involved in activities which support the Neuromuscular Centre in Winsford, Cheshire which provides a range of services and specialist advice for people with muscular dystrophy, occasional paid ad-hoc specialist advice to the Gerson Lehrman Group which provides access to research for a wide range of financial and investments institutions and life sciences companies – declared 4 January 2016

Gwyneth Wilson Registered Nurse Governing Body Family members are employees of Queen Elizabeth Hospital, Kings Lynn and Cambridge & Peterborough NHS Foundation Trust – declared 10 February 2015

Kevan Baker Governing Body Member Practice Manager at Wymondham Medical Partnership, Postmill Close Wymondham which is a shareholder in South Norfolk Healthcare C.I.C and Iceni Healthcare Limited, Wymondham Medical Partnership has an RSI contract with the PCRN team – declared 10 April 2015

Cathal Daly Governing Body Member Employee of Elmham Surgery and work at Mattishall Surgery on a self-employed basis, both practices are part of Iceni Healthcare Limited.

In 2013/14 Paid to speak for Pfizer, Ferring, Abbott, Napp and Sanofi. Attended advisory boards for Pierre Fabre, Abbott, Dallas Ashbourne, Novartis, Eisai, Almirall, Nutricia, Astra Zeneca, MSD, Napp, Proteus, Novo Nordisk, Actavis, Lifescan. Paid for written work by Amgen.

In 2014/15 Attended a meeting sponsoured by Astra Zeneca. Paid to speak for Napp and Teva. Attended advisory boards for Warner Chilcott, Astellas, Leo, Nutricia, Sterling Anglian, MSD, Astra Zeneca, Biogen, Actavis and Boehringer Ingelheim. Paid to provide training by Astellas.

In 2015/16 Paid to speak for Napp and Teva. Attended advisory boards run for scope, Mead Johnson, Coloplast, Roche, Rosemont, Astra Zeneca, Nutricia, Bayer, Teva, HFA Healthcare, Shield Therapeutics and Philips. Paid for written work by Teva – declared 9 December 2015

Dr Keeva Rogers Governing Body Member GP Partner at Roundwell Medical Practice which is a part of Iceni Healthcare Limited, Class A shareholder in South Norfolk Healthcare C.I.C, Spouse employee Consultant of Norfolk and Norwich University Hospitals NHS Foundation Trust – declared 8 April 2015

Dr Graham Clark Governing Body Member GP Partner at Chet Valley Medical Practice, Loddon, which is part of Iceni Healthcare Limited, Class A shareholder in South Norfolk Healthcare Limited C.I.C, employed by Norfolk and Norwich University Hospitals NHS Foundation Trust as an Associate Specialist in the Accident and Emergency department, Partner works for Harleston Medical Practice – declared 25 April 2015

Dr Dustyn Saint Governing Body Member GP Partner at Long Stratton Medical Partnership which is part of Iceni Healthcare Limited, Director of Primary Care IT, Practice is part of South Norfolk Healthcare C.I.C, Partner of Clinical Opinions LLP; an organisation which provides the NHS, independent companies and overseas organisations with the opinions of experienced Clinicians working within the NHS – declared 19 January 2016

Dr Tony Palframan Governing Body Member GP Partner at Heathgate Medical Practice which is part of Iceni Healthcare Limited, Practice is part of South Norfolk Healthcare C.I.C, GP Tutor Health Education East of England, GP Education Lead East Anglia Faculty RCGP, Spouse is Brigade Manager, Norfolk Fire and Rescue. Registered patient of South Norfolk GP Practice – declared 28 July 2015

Susan Ringwood Lay Member, Patient & Public Involvement

Chief Executive of Age UK Norwich, Spouse is Manager of NCH&C charitable trust – declared 12 May 2015

Anna Bennett Lay Member, Governance Managing Director and Shareholder of AMB Business Management Ltd, Management Consultancy with NHS organisations (will not seek business with Norfolk NHS), Spouse is Director of AMB Business Management Ltd. Currently Interim Head of Contracting City and Hackney CCG (April 2014 to May 2015) – declared 9 September 2015

Dr Nicky Trepte Secondary Care Specialist Seckford Foundation Governor, Woodbridge Suffolk (Volunteer) and employee of Ipswich

Hospital NHS Trust – declared 21 April 2015

Alan Kent Associate Lay Member (Finance & Performance)

Director and shareholder of Litmus Health Limited which undertakes management consultancy with NHS organisations (will not seek business within Norfolk NHS)

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DRAFT Minutes of NHS South Norfolk Clinical Commissioning Group Governing Body Part 1

1.30pm – 3.30pm Tuesday 26th January 2016

Colin Chapman Room, Hethel Engineering Centre, Chapman Way, Hethel, Norwich, Norfolk,

NR14 8FB _______________________________________________________________________________

Present: Dr Hilary Byrne (Chair) (HB) Governing Body Member Margaret Blackett (MB) Acting Chief Officer Anna Bennett (ABe) Lay Member (Audit and Governance) Cathal Daly (CD) Governing Body Member Kevan Baker (KB) Governing Body Member Dr Dustyn Saint (DS) Governing Body Member Susan Ringwood (SR) Lay Member (Patient and Public Engagement) Gwyneth Wilson (GW) Lay Member (Registered Nurse) David Gilburt (DG) Interim Chief Finance Officer Dr Keeva Rogers (KR) Governing Body Member Dr Graham Clark (GC) Governing Body Member Dr Tony Palframan (TP) Governing Body Member

In attendance: Alan Kent (AK) Chair, Finance and Performance Committee Jocelyn Pike (JP) Chief Operating Officer Samantha Cox (SC) Business Support (Minutes) Alison Leather (AL) Director of Quality Assurance

1. Chair’s Opening Comments and Housekeeping Notes Action

HB welcomed all attendees to part 1 of the Governing Body meeting of NHS South Norfolk Clinical Commissioning Group (SNCCG). Introductions were made. HB requested questions from the members of the public be made at the end of the meeting.

2. Apologies for Absence

Apologies were received from: Amanda Brown (AB) Acting Head of Corporate Affairs Nikki Trepte (NT) Lay Member (Secondary Care Clinician)

3. Declarations of Interest

No new Declarations of Interest were identified at this time. HB reminded all to ensure their Declarations of Interest are up to date and are within national guidelines. DG declared that he has a conflict under agenda item 6.3.

4. Minutes from Previous Meeting & Actions Arising

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SC to make the following amendments to the minutes of the 24th November 2015 – Part 1.

Agenda item 5.2 – change the date from 01.04.2015 to 01.07.2015

Agenda item 5.4 – change AB to ABr

Agenda item 7.2 – change wording to say ‘The final report has gone to a COI and has given the Governing Body assurance’

Actions Arising:

MB to bring to the February’s Governing Body the coding & counting dashboard.

MB

5. Decision Log

SC informed the board that going forward a Decision Log would be bought to the public part of the meeting to inform of any decisions made in part 2.

6. Decision

6.1 Finance & Performance Report

DG presented the paper to the board, taking it as read. DG advised that NHS South Norfolk CCG is reporting a £5,870k deficit to the end of month 9 against a planned deficit of £4,803k. Expenditure programme costs are £1,325k overspent and running costs are £258k underspent against plan, giving an overall overspend of £1,067k against plan. The forecast full year position for 2015/16 is that the CCG will achieve its deficit target of £6,645k; this is in line with the financial plan submitted to NHS England in May 2015. The CCG must continue to focus on delivering the QIPP programme in full to restrict the deficit to this level. In addition to the forecast deficit, the CCG has undertaken a risk assessment that shows there is a potential overspend against the forecast of £910k at the year end, with risks being mainly around non-delivery of QIPP and unplanned activity. This can be offset by equivalent mitigations giving some confidence that the deficit target of £6,645k should not be exceeded. The CCG needs to continue to control costs and to focus on delivery of QIPP schemes and the actions necessary to do this. In line with previous months an adjustment has been made within ‘other’ costs to bring the phasing of the CCG’s year to date budget back in line with the original plan, while maintaining the YTD variance in line with the revised budget. This adjustment is made as NHS England continue to monitor performance against the original plan. DG advised the board that even though there has been significant overspend in CHC, savings are being achieved in cost per patient, the overspend is due to a rise in patients coming through on CHC. Finance and Performance committee raised concerns to DG that plans which had been submitted to NHS England were not in line with information that the CCG has been giving them, DG has assured the Finance & Performance committee that this is now in line with the same message that NHS England are receiving. AK raised concerns that the CCG is now in the last quarter and even though QIPP is on track, most of the savings are due to happen in the last quarter. NHS England have transferred additional unplanned costs to the CCG in recent months notice which is putting further pressure on contingency which is putting at risk our ability to achieve the target deficit of £645k. DG has flagged this additional risk up to NHS England. In accordance with the NHS contract DG advised the board that fines have been levered on the NNUHFT as a result of failure to deliver constitutional targets, these fines have been re invested in helping the NNUHFT improve performance and to fund beds in the independent sector. DS queried how the fines which have been reinvested fit with NHS England requiring that fines are to

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be sent back to them. DG advised DS that he has been explicit with NHS England regarding the money collected on fines and how the CCG has been reinvesting. ABe commented that as we approach the year end we need to ensure the identified mitigations are delivered in full and as soon as possible. DG confirmed he was working closely with MB and other local commissioners to achieve the required mitigations and offset the highlighted risks. After discussion members of NHS South Norfolk Clinical Commissioning Group Governing Body formally noted the progress and contents of the Finance Report and approved the actions being taken.

DG

6.2 QIPP 15/16 & 16/17

MB presented the paper to the board, taking it as read. MB advised that NHS South Norfolk CCG is reporting QIPP delivery of £3,173k to the end of Month 9 (December) against a budgeted plan of £3,895k, which is £723k behind plan. In Month 9 the CCG delivered £469k of savings, an increase on £410k delivered in Month 8. The year to date delivery at the end of Month 9 remains ahead of the revised phased delivery plan of £3,142k, with a favourable variance of £31k. However, it should be recognised that this has only been achieved as a result of an additional £229k (YTD) in year actions. Despite the progress made over the last few months the CCG is reporting a £444k risk to the delivery of the original £5,571k QIPP savings plan, with a reported forecast outturn of £5,127k, an improvement of £580k compared to month 8. To mitigate the risk of under delivery of the 2015-16 QIPP programme, SNCCG has introduced a series of additional in year actions with a total reported value of £499k at month 9. With the additional in year actions the reported 2015-16 QIPP FOT at month 9 is £5,626k, £55k better than plan. Whilst South Norfolk CCG is still reporting delivery of the planned financial position, it should be noted that the risk to delivery remains. Furthermore, many of the additional and increasingly challenging options for in year savings are already being implemented, reducing opportunities for further in year mitigation should this be required. At month 9 the reported position for SNCCGs three high QIPP programmes is as follows: Continuing Health Care - £126k delivered in month, £582k Month 9 YTD, with a forecast outturn of £995k, £345k above plan. Prescribing - £23k delivered in month, £447k Month 9 YTD, with a forecast outturn of £812k, £293k below plan. Coding and Counting - £40k delivered in month, £360k Month 9 YTD, with a forecast outturn of £1,340k, £210k below plan. QIPP Planning 2016/17 Progress to date is as follows:

• £14,121k total value of Opportunity • 37 projects in the ‘Gateway Process’ • 25 (68%) already achieved ‘approval to implement’, valued at £11,639k • 6 (16%) at Project Initiation Document stage, valued at £1,708k

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MB advised that coding and counting is the CCG’s highest risk. The team internally has caught up in terms of raising challenges and are in constant communication with North North Norfolk CCG regarding what the CCG are not prepared to do. Weekly meetings for QIPP are continuing to happen and MB can assure NHS England that everything possible is being done to meet the QIPP target. After discussion members of NHS South Norfolk Clinical Commissioning Group Governing Body formally noted the progress and contents of the QIPP 15/16 & 16/17 report.

6.3 Audiology Eligibility Threshold Proposal

JP presented the paper to the room, taking it as read. JP advised that the CCG Governing Body agreed to a period of consultation in order to understand the spectrum of opinions before making a decision on whether to increase the eligibility threshold for the provision of hearing aids to adults who are assessed with slight or mild hearing loss. This paper originally came to Leadership Team on the 28th August 2015 and then again to Governing Body on the 28th August 2015 where it was agreed that a consultation would be carried out. Following feedback received the CCG amended the consultation for responses to the 15th January 2016. A stakeholder workshop was also held on 1st December 2015. All information is available on the CCG’s website. The current contract with providers is due to expire at the end of March. JP advised that there are several organisations are working with NHS England to deliver a commissioning framework for hearing aids. JP advised the board that the paper doesn’t give a recommendation but more of a view from the CCG. Giving that commissioning framework is due out in April and the positive feedback from the consultation, the CCG feel that not to implement would be the right way forward. DS advised the board that the CCG has been through a really thorough consultation process with the public and that early conversations and feedback are positive. JP advised that the Quality & Patient Safety team has completed a whole quality impact assessment which is missing from this document, JP to circulate. HB asked whether a flow chart & guidance could be produced advising how soon GP’s can refer, JP to action. After further discussions the members of NHS South Norfolk Clinical Commissioning Group Governing Body agreed the feedback from the public consultation was robust. In addition it was preferable to wait for the commissioning framework due which is due out in April. In the meantime the CCG will continue to work with providers to renegotiate the tariff.

JP JP

7. Discussion

7.1 Summary of Planning Guidance 16/17

JP presented the paper to the board, taking it as read. JP advised the key points for the 2016/17 Planning Guidance and the key timelines for completion. JP further advised that the CCG’s have to come together locally as a team with a shared vision and that the whole guidance is focused on how we are going to implement the forward view. All CCG’s have to provide 2 separate plans; A Sustainability and Transformation plan which covers the next five years and the operational plan covering year 1. JP informed the board that there is a new CCG assessment in place which all CCG’s will be subject to. JP has no further details at this present time.

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The final deadlines for the Operational Plan are (This will need to reflect the emerging Sustainability and Transformation Plan) First submission – 8th February 2016 Full submission – 11th April 2016 JP and HB raised concerns around the tight deadlines for this. After discussion members of NHS South Norfolk Clinical Commissioning Group Governing Body formally noted the content and timelines of the report.

7.2 Commissioning & Contracting Update

JP presented the paper to the board, taking it as read. JP advised the following: A&E – from the NNUHFT perspective A&E have failed to meet their trajectory for December. The coordinating commissioner considered that the provider was in breach of the remedial action plan. The report has been issued under CG9 and the coordinating commissioner is looking to withhold 2% of the contract plan. JP advised that they are now looking to permanently withhold funds for September and October. Ambulance – Healthwatch audit and review of arrival to handover issues has been completed and a report has been published. On the back of this colleagues from North Norfolk CCG have assured us that they are meeting with both parties. The Remedial action plan is continuing where EEAST are required to attend. NHS England are doing their own internal review. RTT – A meeting was held in December, there needs to be substantial and sustainable investment in the Trust’s elective capacity in order to reduce long term reliance on a range of ad hoc arrangements. The Trust is looking at recovery plan for a recruitment drive. JP advised the board that the NNUHFT have a patient of the 7th January who has breached 52 weeks for vascular surgery. GW asked if the CCG has got assurance that patient has come to no untoward as CQRM has not picked this up. AL to pick up with CQRM. Cancer – The provider has failed to achieve against the trajectory of 77% for November 2015. The Trust anticipate that December will also be low on figures. 2% of the contract value will be withheld and a revised remedial action plan is in place. Diagnostic & Cancellations – these are being monitored through SPRG. Mental Health – NSFT are performing below target level of DTOC’s, a report has been submitted to NHS England which is being presented to SRG tomorrow. Out of trust placements – there have been 5 out of trust placements; all older people, 15 beds have also been closed in Lowestoft. AAT – NSFT are having to manually report as Lorenzo is not functional. The remedial action plan will not meet the 28 day standard until July. We will accept a revised plan but will permanently withhold 2% of the contract value until July, when the service may be tendered.

AL

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Intermediate Care Beds – South Norfolk CCG are operating within target. The target is pan Norfolk so is subject to a contract query notice. Community – 1 service is breaching this has been issued as a CQN. OOH/111 –2 CDQ’s have been issued. There is a meeting on 12/01/16 with Norwich CCG, IC24 and NHS England as they are concerns on the ability that the provider may not be able to deliver over Easter. Vasectomy – the CCG currently commission on this through Breckland, NSDC and Oak Street. The local tariff is £250 per procedure. The CCG need to make a decision whether we now put this through clinical threshold policy or negotiate down depending on decision. DG believes that it would be ideal to peg the tariff at the historic rate of £250. BME service – this was a legacy service which the CCG inherited from the PCT, it was decided at SMT that this service will no longer be funded at the end of March. The CCG have completed a review and there is no evidence of any impact. HB raised concerns that patients are not getting service they should be getting. HB asked JP how engaged does she feel providers are? JP advised HB that the NNUHFT have always delivered a good service to patients, this is the first year they have failed standards and that hopefully through management change things should improve. MB advised the board that the Norfolk system is failing up to 100 patients per day and that this is not totally a provider issue, it is a system wide issue as there is not enough engagement. MD advised that she had a call from the NNUHFT asking for help on 80 CHC assessments. JP advised that she is going to start having daily conversations with Assistant Director’s to assure that they are doing everything they can to move patients out of DTOC’s. AB believes that a ‘board to board’ meeting with representatives from the CCG would be a positive thing to happen. JP and SR agreed. HB to take this to the Joint Commissioning Committee and to feedback to the Governing Body. GW raised concerns that the public may not be familiar with some of the abbreviations within the document, JP noted this comment. After discussion members of NHS South Norfolk Clinical Commissioning Group Governing Body formally noted the contents of the Commissioning and Contracting Update report.

HB

7.3 Mazars Report & Recommendation – Independent review of deaths LD & MH Patients

AL presented the paper to the board, taking it as read. AL gave a summary to the board of the MAZARS Independent review of deaths of people with a Learning Disability or Mental Health problem in contact with Southern NHS Foundation Trust April 2011 to March 2015. AL advised the board of the below:

There had not been effective focus or leadership from the Board relating to the investigation and analysis of data relating to the deaths of its service users.

Insufficient time and attention had been spent on understanding deaths, using the information available to the Trust. Poor analysis and limited reporting had been a consequence while an opportunity of learning from deaths as distinct from other incidents had been missed.

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Management information, investigation and quality assurance had been given insufficient attention and there was no evidence of the Board or its directors enforcing improvement, despite warning signs throughout the last four years.

Board reporting on deaths and mortality was minimal. The Board had not been provided with sufficient reliable information to enable it to secure an accurate picture of the performance of SI reporting relating to deaths.

There had been inconsistent use of indicators at Board level with regular changes of measures of deaths over the period resulting in a lack of long term trend analysis and limited challenge.

Suicide numbers are reported on a rolling basis but unexpected deaths are only reported when they are considered to be SI reportable.

Non-Executive Directors had requested more information and assurance relating to investigations over the period and had been assured as to the quality of investigations. Despite this, investigations were not always undertaken when they should be and many are not robust.

The quality of investigations was poor and did not improve to any significant extent over the period despite reassurance to the Board.

The Board had not improved the timeliness of SI reporting.

Information in annual reports and the quality account was misleading in the presentation of unexpected deaths amongst service users by only reporting unexpected deaths when they are SIRIs.

AL advised that the CCG will be making sure providers are effectively managing and reporting the required statutory days and that SI investigations are being completed within the correct timeframe. After discussion members of NHS South Norfolk Clinical Commissioning Group Governing Body formally noted the contents of the Mazars Report & agreed the recommendations listed. AL asked that agenda item 19.4 from part 2 was bought forward to part 1. AL presented the paper, taking it as read. AL advised the below: Serious Incidents (SI’s) During December there were 16 SI’s reported for SNCCG:

o NCH&C – 14 SNCCG, 13 grade 3 pressure ulcers and 1 fall. o NSFT – none reported for SNCCG, 1 fall and 4 apparent/actual/suspected self-

inflicted harm reported for the other two central CCG’s. o NNUH FT – 3 SNCCG, both pressure ulcers grade 3. SNCCG patient VTE

unexpected death. o IC24 – none reported for SNCCG.

Never Events

No Never Events reported during December 2015. AL advised that one practice within South Norfolk is not performing well compared to national standards with regards to prescribing. The CCG are working with John Reuben on how we are going to address this.

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OOH/111 and IC24 OOH/111 and IC24 are having performance issues with quality and patient safety. This has been escalated to CQC. With regards to the NNUHFT an independent service review is has been completed on Never Events, AL is waiting on the report. Maternity AL advised that there had been a rise in SI’s according to a report due to be published in next few weeks.

7.4 Governing Body Assurance Framework

JP presented the paper to the board on behalf of AB, taking it as read. JP advised that AB has added a new risk concerning IC24 which has been added to the GBAF with a rating of 4x4=16. . After discussion members of NHS South Norfolk Clinical Commissioning Group Governing Body formally noted the contents of the report.

8. Information

8.1 Communications & Engagement Report

OC presented the paper to the board, taking it as read. No further questions were raised. After discussion members of NHS South Norfolk Clinical Commissioning Group Governing Body formally noted the contents of the report.

8.2 Transforming Care

AL presented the paper to the board, taking it as read. AL advised that this has previously been taking to the Joint Commissioning Committee where the decision was made. JCC’s recommendation was for option A which enables us to redesign the service. AL is now seeking approval from the Governing Body to approve this process also. SR raised concerns that paper isn’t user friendly and that the timings are wrong, AL will feed this back. After discussion members of NHS South Norfolk Clinical Commissioning Group Governing Body formally noted the contents of the report and agreed to go with the Joint Commissioning Committee’s recommendation of option A.

AL

8.3 Audit Committee Report

AB gave a verbal update to the board advising that the Audit Committee met on the 11th December 2015. The CCG have received 2 internal audit reports, one was financial which gave limited assurance due to a deficit budget. AB advised that from 1st April 2017 the CCG have to appoint external auditors and the appointment has to be made prior to the 1st April. This must be decided by a panel. There is a proposal to do this collectively within Norfolk CCG’s, AB asked if any members of the Governing Body had any objections. No objections were made. After discussion members of NHS South Norfolk Clinical Commissioning Group Governing Body formally noted the contents of the report.

8.4 Corporate Affairs Report

JP presented the paper to the board on behalf of AB.

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JP advised that the annual stakeholder survey will be launched shortly. JP also advised that the IG Governance toolkit action plan has been prepared, with no concerns feedback from internal auditors. DG advised that the annual report has to be completed the same time as the annual accounts, which is by the 22nd April 2016. The review of the business continuity plan was approved. After discussion members of NHS South Norfolk Clinical Commissioning Group Governing Body formally noted the contents of the report and approved the business continuity plan.

9. Any Other Business

Tom Fenson (Chairman of the Watton Patient Group) raised concerns with the board that providers are continuing to fail with enormous costs. TF advised of a member of the public who had called the 111/OOH service and had a 12 hour wait 12 hour wait to speak to a GP and after 2 phone calls which had never materialised, the nearest doctor available was in Redhill. HB encouraged practices to highlight issues.

Name Signature Date Signed on behalf of NHS South Norfolk Clinical Commissioning Group

South Norfolk CCG Decision Log from Governing Body – 26th January 2016 Part 2

Agenda Item 15.1 & 15.2 – Over 75’s

After discussion members of NHS SNCCG Governing Body agreed to extend both Attleborough over 75’s and Long Stratton Over 75’s until the end of June 2016. It was also agreed that any practices who wish to present to the Governing Body will also get assurance that they too can have an extension until June 2016.

Agenda Item 17.1 - East of England. Home Oxygen Collaborative Re Procurement Evaluation Report

After discussion members of NHS SNCCG Governing Body noted the contents of the report and supported that the service continues being provided by BOC.

Agenda Item 17.2 - NHS CHC Policy, Staff Procedures and Guide for Patients.

After discussion members of NHS SNCCG Governing Body noted the contents of the report and approved the revised NHS CHC Policy.

Agenda Item 17.4 - Ambulance Handover to Clear Healthwatch Report

After discussion members of NHS SNCCG Governing Body noted the contents of the report and agreed for AL & JP to compose a letter to the NNUHFT raising South Norfolk CCG’s concerns.

Agenda Item 17.5 - Clinical Academic Reserve – Draft Response (Commercial in Confidence)

Members of NHS South Norfolk CCG Governing Body noted the contents of the report and continues to supports the CCG’s resist in payment.

Documents

AGENDA Part 1 Chair: Dr Hilary Byrne - NHS South Norfolk CCG DOI... · Gwyneth Wilson Registered Nurse Governing Body Family members are employees of Queen Elizabeth Hospital, Kings