Minutes of the North Kirklees Clinical Commissioning Executive held on

Wednesday 22nd

August, 9.00am – 12.30pm, Board Room, Broad Lea House

Present: David Kelly (DK) CCG Chair – Chair Chris Dowse (CD) Shadow Accountable Officer David Boothroyd (DB) Senior Lead, Contracting and Commercial Intelligence Helen Shallow (HSh) Senior Finance Manager Kathryn Greaves (KG) CCG member Helen Severns (HS) Head of Service Improvement Isle Newsome (IN) Interim Governance Manager

Deborah Turner Head of Quality and Safety Jan Randall (JR) Head of Strategic Development & Business Tony Gerrard (TG) Non-executive Director Ajit Mehrotra (AM) - Part CCG member Khalid Naeem (KN) - Part CCG member Farhad Kohi (FK) CCG member Minutes: Emma Trisconi (ET) PA to Chris Dowse EC/12/151 Welcome & Apologies

Valerie Aguirregoicoa (VA) Natasha Brown (NB) Jackie Holdich (JH) Yasar Mahmood (YM) Imran Patel (IP) Sarah Muckle (SM) Steve Brennan (SB)

The Chair opened the meeting by welcoming all those in attendance. EC/12/152 Accuracy of minutes from last meeting 25th

July 2012

The minutes of the Clinical Commissioning Executive meeting held 25th

July 2012 were accepted as a true and accurate record with noted amendments.

Tony Gerrad declared an interest in agenda item EC/12/8.4 Declarations of Interest

EC/12/4

The group reviewed the action log from the previous meeting. Live Action Sheet

EC/12/155 – JH to liaise with MYHT regarding a site visit. HS is now leading whilst JH is on leave. EC/12/156 – DT to circulate the Assurance Framework to all board members. DT confirmed this is going to the Safeguarding board for discussion on 12th

September.

EC/12/156 – DT to assist when replying to CAHMS - HS confirmed that no letter has been received. EC/12/158 – DT to request either AM or KN to attend the MYHT meeting on 2nd and 14th August

– AM is attending and will feedback to the Quality group.

EC/12/5.1 Quality & Safety Report

DT presented the report; this has now been scrutinized by the Quality & Safety sub group. DT acknowledged that due to the tight timescales the infection control data has not been validated, DT is to update the information for the next meeting. Key areas highlighted were: Action: Deborah Turner to update infection control data for the next meeting. • Mixed Sex accommodation

There have been no EMSA breaches in CHFT during June 2012. There have still been no breaches in SWYPFT during 2012. DT highlighted that she is pleased with the progress being made at Mid Yorkshire hospitals and that several changes are being made to wards to avoid breaches.

• MRSA

NHSK currently have 7 MRSA cases pre and post-operative wounds. This includes 2 cases from Kirklees, 1 post-operative case from Mid Yorks and 1 pre-operative case from Kirklees. DT confirmed that this data has been added to the risk register with a trajectory of 10 cases predicted which JOD confirmed is likely to be breached. An external review at Mid Yorkshire has increased pressure and JOD is currently working alongside Stephen Eames to look at improvements. DT confirmed that the MSSA’s totals are currently are 22 with Mid Yorks recording at 11 and that Ecoli cases are reporting at 104 with Mid Yorks at 43.

• C.DIF

Invalidated data currently suggests that 17 C.diff infections were reported in July across Kirklees residents. As this is still invalidated data this cannot be confirmed until the 16th

.

• HSMR

DT confirmed that the action plan has now been received from Mid Yorkshire. Currently the high level data suggests:

• Palliative care coding has fallen from 94% to 58% • HSMR for non-elective admissions are likely to rebase as outliers

AM added that he is involved in meetings to discuss the coding issues and agreed that there are issues with mortality coding and patient transfers. AM is attending a task and finish group led by Dr Adam Sheppard and will continue to feedback to this meeting. It was also noted that AM is reporting all issues to the Executive Contract Board for further discussion.

• Serious incidents

No Never Events were reported by MYHT, SWYPFT or YAS in 2011/12 MYHT have two open NPSA alerts, non-compliance with the alerts has been added to the trust’s risk register and reported at the Executive Contract Board.

• Mid Yorkshire Hospitals Trust

The CQC performed a unannounced inspection in July to ward 2 at Dewsbury District hospital and its maternity services ward. A formal warning has been issued to Mid Yorkshire regarding serious concerns on ward 2 in relation to patients’ dignity and respect and staffing issues. A remedial action plan has now been put into place and will be discussed in further detail at the August Executive Contract Board. The board received the report.

EC/12/5.2

High Level risk log

DT confirmed that Steve Brennan has now signed off all the risks. It has been agreed that Steve will continue to be the lead for risks for the immediate future with CD taking over from April 2013. • Transformation programme – there are concerns over timescales and capacity. It

has been stated that further capacity is needed to support the programme and an outline business case is being submitted.

DT highlighted that more in depth conversations need to be had at SMT and it was agreed that CD will lead a conversation at the next meeting and feedback.

Action: CD to discuss high level risks in further detail at SMT and feedback to the next meeting.

EC/12/6.1 Contracting and Finance report

Helen Shallow presented the report highlighting the following areas: • North Kirklees CCG are still forecast to meet our financial targets. However there

is an overspend of 110k due to costs occurred in the last financial year. DB confirmed that some of the overspend has occurred due to the number of fixed term contracts in place.

CD raised concerns about an increasing overspend and highlighted that we will likely be seeking to invest over the next financial year in the Mid Yorkshire transformation programme as well as our own Primary Care Strategy. CD confirmed that an Urgent Care Transformational Board and Urgent Care Operational Board have been set up and that redesign and investment conversations will be managed initially in these forums.

JR explained that QIPP is currently reporting for 2012/13 and will continue to report for the next 3 years. Currently the reports state that the QIPP programmes are on track. NA has sent out all the summary programmes to all leads asking for a month by month breakdown of activity, savings and quality indicators. Discussion was had about the level of detail that needs to be reviewed by the board as detailed scrutiny takes place at the Finance and Performance sub committee, it was agreed that the majority of detailed discussion should take place at Finance and Performance with the reports and feedback/overview brought to this meeting. It was agreed that a detailed analysis of planned return of trajectory should be brought to the next meeting – SB to compile. • The MYHT In – year trading position data is to be viewed as flex information which

means there is a high chance that this data will change. • Primary Care – the report now includes LES and out of hours funding data, this is

forecast to break even. Action: Steve to compile planned return trajectory analysis and present at e the next meeting. The board received the report.

EC/12/6.2 Performance Report

Natalie Ackroyd entered the meeting. NA gave an overview of the report. Highlights of the report were:

• There is currently a backlog of approximately 200 patients split between Oral surgery, Orthopaedics and Gynaecology services. There are 24 patients in Kirklees with a wait time which has exceeded the 40 weeks target, NA confirmed that 19 of these patients are for plastics.

• 18 week waits appear to be back on target apart from plastics – further discussions to highlight the issue is to take place at the Executive Contract board.

NA confirmed that Mental Health access measures are being reported at 94% amber against a target of 100% when in fact the national target is 95%. This is because NHS Kirklees has implemented a stretch target of 100%.

• Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s is being reported as Red, NA confirmed that these are only small numbers and HES confirmed that work is taking place to consider in more detail.

• Both MRSA and C.diff are reporting red • Smoking quitters is reporting red however NA confirmed that this is normal for the

trajectory at this time of year. It was agreed that work needs to look at seasonal profiles and a relook at the LES. FK has agreed to raise this at the next Health & Wellbeing board.

• NG confirmed that 29 practices out of 31 have signed up to offer healthchecks. FK has agreed to talk to the remaining practices about signing up.

• There were 3 breeches of Mixed Sex Accommodation at a Mid Yorkshire respiratory ward.

• Patient choice figures suggest that this is below the 90% target however JR confirmed that this is being discussed at the next CSG event.

• Healthchecks – CD asked for clarification around the number of healthchecks being offered and taken within Kirklees and what the targets are. NA confirmed that up to date 323 healthchecks were offered and delivered throughout the whole of Kirklees with 54 practices in Kirklees being signed up to the LES. This is against a target of 20,000 to be offered across the whole of Kirklees.

The board received the report.

EC/12/6.3 Audit Committee/ Sub group Annual Report

Tony gave an overview of the report. TG has suggested including annual reporting to the board in each sub groups Terms of Reference so that the board can keep up to date with each group’s progress. The board agreed that the annual report is beneficial and provides a good insight into the group’s work. DK questioned what the timescales are for the report and TG confirmed that the Governance cycle runs on a accountancy year of April – March. DT asked if the Audit and Governance group would benefit from having sight of the Quality Governance arrangements and has agreed to attend the next meeting to present the Quality Handover document. Action: Deborah to present Quality Handover document to the next Audit & Governance meeting. Discussion was had around senior managers’ attendance at the sub groups and it was agreed that it would be beneficial for all senior managers to attend one sub group meeting to learn about the group and have input. CD has agreed to attend the next Audit and Governance meeting on the 27th

September. [DN: CD is actually on leave that week and will attend the following sub committee meeting.]

Action: Senior Managers to attend a sub group and feedback at a future meeting.

EC/12/8.1 Accountable Officer’s and Chairman’s report. CD discussed the report. Highlights were:

• The CCG structure is now out for consultation. • The CSS structure has now been circulated with figures resulting in £13 per head

in comparison with the CCG’s assumption of £9 per head. CD confirmed that she would be reviewing and revising the staffing structure to reduce costs..

• The draft Order Book with WYCSU has been agreed but no costings have been finalised.

• Steve Brennan has successfully been interviewed and appointed as North Kirklees Chief Finance Officer.

• Public Health will transfer across to the Local Authority on 24th

• The CCG submitted their list of stakeholders to the Commissioning Board on 16

October and will be based in Central Huddersfield. Sarah Muckle who is the Public Health lead for North Kirklees will be on site to work with the CCG every Wednesday once the transition has been implemented. .

th

• DK attended a local area meeting which was attended by 70 members of the public to meet public representatives, the local authority and answer any questions. FK has agreed to attend the next meeting and both agreed that public meetings are highly beneficial and good development for the board. Board members are encouraged to attend public meetings on a regular basis.

August.

EC/12/8.2 Matters for Escalation There were no items for escalation. EC/12/8.3 MYHT Clinical Services Strategy – preparing for outline business case

IN presented her report. IN has suggested defining the CCG’s commissioning intentions so that all members are clear about goals and then build on business cases and the Mid Yorkshire programme around the intentions initially established. The SMT has proposed its Strategic Objectives which they believe accurately reflect the CCG’s vision. These are as follows; 1. Enabling the population to exercise choice about and control over the care they

receive. 2. Reducing inequalities and minimising vulnerability in health and wellbeing. 3. Improving the health and wellbeing outcomes for the population we serve through

transformation. 4. Commissioning high quality, safe, efficient and effective services from sustainable

providers with appropriately trained staff. 5. Commissioning the right service in the right setting at the right time, according to

need.

IN has recommended formally writing to Stephen Eames to communicate the CCG’s commissioning intentions to make it clear that the Mid Yorkshire Outline Business Case needs to reflect and achieve

these intentions. It was agreed that IN will draft the letter to Stephen Eames for DK to sign. iscussion was had regarding the level of detail that the CCG wished to see in relation to the developing options of MYHT’s Clinical Services Strategy and in particular to the Outline Buisness Case. This so the CCG could carry out its responsibility in testing those proposals against its commissioning intentions and taking account of local views. . It was agreed that the letter will briefly describe our Commissioning Intentions..

Action: IN to draft letter for DK to sign Action: all board members/ senior managers to email IN a list of concerns/requirements they wish to be included in the appendix for sign off at tomorrow’s SMT meeting.

EC/12/8.4 Governing Body Membership

TG declared his conflict of interest in the agenda item. It was agreed the board will hear TG’s input and then excuse TG for the formal decision making process. IN presented the report to the group which presents two options to the board for decision. Currently the CCG has two lay members recruited to attend its committees; however a new committee structure has been developed which will incorporate a third large committee. The three sub committees to the board will be: 1. Audit and Terms and Remuneration Committee 2. Quality, Performance and Finance Committee 3. Governance and Corporate Affairs Committee Due to the increase in Sub Committees, the Board was asked to consider recruiting a third lay member to the new governing body.. The options presented to the board were: 1. Retain 2 lay members – this could lead in a ‘hung’ vote in the business operation of

the governing body and has the risk of overburdening the lay members 2. Recruit an additional lay member – this will increase running costs by £7,882 p.a.

and will allow each lay member to chair/ attend a more manageable amount of meetings.

In response to question regarding the time commitment of Non-Executive Directors, TG outlined the time he spent on NHS duties. Like many NEDs, he spent considerably longer than the suggested days per month. He pointed out that PCT Audit Chairs were currently paid an additional £5000 per annum. This had been the practice since 2006. TG also expressed concerns regarding the merger of Finance and Performance and Quality sub committees and questioned whether both agendas would be covered in the limited meeting time. TG was excused from the meeting.

The board agreed that due to the number of committees and level of content associated it would be beneficial to have more lay member input. IN confirmed that the draft constitution with 3 lay members will bring the total to 15 which will allow for a decision making voting system. The board agreed on option 2 and decided to recruit an additional lay member giving a total of three for the governing body.

EC/12/9

Receipt of Minutes

Minutes from the Finance and Performance Subgroup The minutes from the Finance and Performance Subgroup held on 18th

July 2012 were RECEIVED and NOTED by the Clinical Commissioning Executive Board.

Minutes from the Quality Review Group The minutes from the Quality Review Group held on 12th

July 2012 were RECEIVED and NOTED by the Clinical Commissioning Executive Board.

Draft minutes from the Clinical Strategy Group The draft minutes from the Clinical Strategy Group held on 8th

August 2012 were RECEIVED and NOTED by the Clinical Commissioning Executive Board.

EC/12/11 • Mid Yorkshire Clinical Services Strategy Summary of Engagement Any Other Business

CD tabled the engagement paper presented at the last Mid Yorkshire Transformation Programme meeting. Both CD and DK have expressed that the level of engagement with the public has not been as high as the CCG wanted and JR has agreed to take this for further discussion at the next PPE meeting.

Action: JR to email paper to PPE group to discuss at the next meeting.

• Tenure for Governing Body JR confirmed that the Authorisation & Development group will be deciding on the tenure for Governing Body members at this afternoon’s meeting. • Draft amended agenda IN asked for feedback from the board regarding the new agenda layout, the board agreed the new layout. It was agreed that timings will be added to the future agendas and that a coffee break will also be added.

EC/12/12 Date and Time of Next Meeting

Wednesday 26th

9.00am – 12.30pm September 2012

The Annexe Room, Northorpe Hall, Mirfield

This concluded the content of the CCE meeting and the Chair declared the meeting CLOSED at approximately 12.30pm.

Chairman’s Signature: ……………………………………………. Date: ………………….