Governing Bodies meeting as Committees in Common- 8 May 2018

Airedale, Wharfedale & Craven CCG

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Bradford City CCG

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Bradford Districts CCG

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DRAFT Minutes of the Governing Bodies meeting as Committees in Common Meeting

Tuesday 8 March 2018, 13:15 – 16:15 Present: James Thomas Clinical Chair (Meeting Chair) BC Akram Khan Clinical Chair AWC Colin Renwick Clinical Executive Member AWC Nick Hayward Clinical Board Member BD Sohail Abbas Clinical Board Member BC Bryan Millar Lay Member for Finance AWC, BC, BD Neil Fell Lay Member for Governance AWC Ruby Bhatti Lay Member for Governance BC Richard Wilkinson Lay Member for Governance BD Pam Essler Lay Member for PPI AWC Maxwell McLean Lay Member for PPI BC David Richardson Lay Member for PPI BD Angie Clegg Registered Nurse AWC, BC, BD Peter Brunskill Secondary Care Consultant AWC John Young Secondary Care Consultant BC, BD Helen Hirst Chief Officer AWC, BC, BD Julie Lawreniuk Chief Finance Officer & Deputy Chief Officer AWC, BC, BD Michelle Turner Director of Quality and Nursing AWC, BC, BD Ali Jan Haider Executive Director Bradford Districts /

Director of Strategic Partnerships BD AWC, BC, BD

Liz Allen Executive Director Bradford City BC Sue Pitkethly Executive Director AWC AWC Bruce Woodhouse Chair, Council of Members AWC Apologies: Andy Withers Clinical Chair BD In Attendance: Sarah Dick Head of Governance AWC, BD, BC Sue Jones Head of Communications AWC, BD, BC Stacey Waterworth Governance and Corporate Manager (Minutes) AWC, BD, BC Members of the public: 85 1 Welcome, Apologies, Quorum and Declarations of Interest

James Thomas, acting as the Meeting Chair, welcomed everyone to the meeting of the three CCGs’ Governing Bodies as Committees in Common. James advised those present that this was a meeting in public and not a public meeting, however members of the public would be able to ask questions at a specific point during agenda item 2 (Craven Community Services and Castleberg Community

Governing Bodies meeting as Committees in Common- 8 May 2018

Hospital). The meeting was being held in one room and broadcast into a second room within the same building in order to accommodate members of the public. James advised that only members of the AWC CCG Governing Body would contribute to discussion and decision making regarding agenda item 2. It was noted that Liz Allen, Ali Jan Haider, Akram Khan, Max McLean, Sohail Abbas and John Young would join the meeting following agenda item 2 as they are members of Bradford Districts and Bradford City Governing Bodies (and therefore not part of the decision making Governing Body for the item).

Apologies were noted from Andy Withers.

It was noted that AWC CCG Governing Body was quorate for agenda item 2. It was also noted that when the members of the other Governing Bodies (as noted above) joined the meeting, Bradford Districts and Bradford City Governing Bodies would also be quorate. The Chair asked if there were any interests to declare regarding any items on the agenda. Colin Renwick declared that his spouse is a partner of Townhead Surgery, which is located in the Craven area and would support and access services at Castleberg hospital should it be re-opened. James advised that a conversation had been held with Colin about how to manage the indirect and financial conflict of interest and it had been agreed that Colin would not participate in the decision making process. However, due to Colin’s extensive knowledge from working as a GP in the area, it was decided that Colin could remain in the meeting room during discussion in order to provide points of clarification should they be required. All present agreed they were happy with this arrangement.

The registers of interests records can be found at:

AWC: http://www.airedalewharfedalecravenccg.nhs.uk/about-us-/publication-

scheme/lists-and-registers/

BD: http://www.bradforddistrictsccg.nhs.uk/about-us/publication-scheme/lists-and-registers/

BC: https://www.bradfordcityccg.nhs.uk/about-us/publication-scheme/lists-and-

registers/

2 Craven Community Services and Castleberg Community Hospital

James Thomas introduced the item regarding Craven Community Services and Castleberg Community Hospital. It was noted that questions from the public had been requested by 8am on Monday 7 May 2018 in order for full responses to be provided for the meeting. James advised that responses to these questions would be read out by Helen Hirst, Chief Officer, followed by a presentation by Sue Pitkethly, Executive Director AWC CCG. Once the presentation had been given, there would be the opportunity for further questions from the public and then the AWC CCG Governing Body would discuss the item further before being asked to make a decision.

Governing Bodies meeting as Committees in Common- 8 May 2018

Helen Hirst read out the responses to the written questions received. Question 1: Has the CCG taken into account the problem of providing individual help all the time it is needed to persons living in remote rural areas, especially in adverse weather conditions, when travelling would cause problems for carers, petrol expenses to pay and possible damage to cars.

Yes, we have taken account of the challenges of living in rural areas and our consultation outcome report reflects this. During the process we also took into account Healthwatch North Yorkshire’s “Rural Access to Services” report, published in June 2017 www.healthwatchnorthyorkshire.co.uk/resources/rural-access-services-report The clinical executive group considered both of these when making its decision to recommend to the governing body the re-opening of Castleberg Hospital, following the completion of essential repairs.

Question 2: Would the CCG agree that, in certain circumstances, it is better for clients to be cared for at a small community hospital such as Castleberg where several staff are working together and are able to provide the necessary care and support each other when required.

Yes, in some circumstances people do need additional care and support that they would not normally be able to receive in their own homes. This was also an essential part of the factors considered by the clinical executive group when making its recommendation to the governing body to re-open Castleberg Hospital, following the completion of essential repairs. Question 3: Why were none of the consultation meetings held in Ingleton, which is a highly deprived community with substantial need of care services? Was this because our views are not compatible with your intention to close the hospital? There is a very real need in our community for accessible care services that Castleberg has provided successfully for many years and I want it to continue.

During the consultation we heard and considered the very strong views of people living in Ingleton and Bentham, particularly about the lack of nursing/care home facilities in the immediately surrounding areas.

We have valued everyone’s views about the services concerned, and these are considered in detail in the consultation outcome report that has particular sections on the difficulties faced by people living in Ingleton and Bentham. This report was a key part of the discussions by our clinical executive group, following which they recommended to the governing body the re-opening of Castleberg Hospital.

We held seven consultation meetings in five locations – three in Settle and one each at Grassington, Skipton, Gargrave and Bentham. As it would have been impractical to hold meetings in every village and settlement in Craven, we located meetings at venues on the A65 “spine”, giving everyone an opportunity to access one or more of them. We also took into account that the distance between Ingleton and Bentham is 3.5 miles and to Settle is 10.9 miles. Both have a regular bus service and are easily accessible by road.

Governing Bodies meeting as Committees in Common- 8 May 2018

As well as the consultation meetings, there have also been other types of opportunities for people to get involved – for example, by contacting us by telephone, email or letter. Our ‘Engaging People’ team has also provided outreach sessions in some of the more outlying rural areas, as well as on market days in Settle and Skipton, and in places – such as nursing homes – where opportunities to be involved could have been limited by a person’s medical condition. Question 4: Can you please explain the process of how the CCG governing body is going to make the decision of either to approve or disapprove of the clinical executive group's recommendations?

The CCG governing body will meet today (8 May 2018) and make the decision at one of its two-monthly meetings, held in public. Board members have received and read the supporting papers, and are aware of the clinical executive group’s recommendations. The decision will be made, following presentations and debate, at the meeting. Question 5: If the CCG governing body disapproves of the clinical executive group's recommendations, please can you justify it and would there be opportunity for the public to appeal against its decision? If so, what would be the timescale that the appeal needs to be launched?

If the governing body disapproves of the clinical executive group’s recommendations, this will be justified at the meeting.A film of the meeting will be available on our website shortly for those who are unable to attend.

Whilst there is no appeal process to the CCG itself, the issue could be discussed with North Yorkshire Council Council’s health scrutiny committee, who scrutinise processes of, and decisions made by, health bodies in relation to service change. Question 6: If the CCG governing body approves of the clinical executive group's recommendations, please can you inform us if ANHSFT and Townhead Surgery, Settle will continue to provide the care in Castleberg as per pre-closure levels? If not, would the CCG tender the services out to providers to bid for them?

At this stage there is no plan to tender any services but whether services will continue at the same levels is not something we would commit to. Question 7: Can the CCG gives us an estimate of the timescale of the repair work needed to carry out in Castleberg before it will be re-opened again?

We anticipate that it would take about six months for repairs and recruitment of staff to be completed, subject to availability of workforce. Question 8: Would the number of beds be the same?

There may be the same number of beds initially but this may not always be the case as the care model is reviewed. Question 9:The second recommendation by the clinical executive group sounds more like an aspiration, rather than a concrete plan to use Castleberg as a community hub and expansion of other community services in addition to the in-patient beds facilities for intermediate care and palliative care. Please can the CCG elaborate on this and is there extra funding available to deliver it?

Governing Bodies meeting as Committees in Common- 8 May 2018

Funding for services based at Castleberg Hospital and those offered in the community will remain unchanged within the same funding envelope. Additional provided by the CCG will be used to repair and restore the hospital building.

Working with the Craven Community Group – a range of health and care partners and professionals – and Craven District Council, we plan to use an asset-based approach to develop services at the hospital. We will be asking VCS groups and members of the public to help us drive forward how health and care is delivered in Craven. Interested members of the public can get in touch with the CCG via engage@awcccg.nhs.uk .

Services that are interested in leasing space in the building can contact NHS Property Services via its customer services team on 0800 085 3015 or by email at customer.services@property.nhs.uk.

Question 10: I most warmly welcome the Executive's recommendation of Option 1; and of the re-development of Castleberg as a community-based asset providing a richer service model. In view of this, will the CCG require there to be a locally-based management charged with the effective use of the site and its integration into the community?

The site will continue to be managed by NHS Property Services, in liaison with Airedale NHS Foundation Trust.

NHS Property Services will implement an ongoing lifecycle programme to ensure the maintenance of the building.

Question 11: Maintenance issues caused the closure over a year ago: what arrangements will be put in place to ensure that maintenance can be done straightforwardly and economically?

The issues which caused closure will be repaired and restored while the building is empty. NHS Property Services will then implement an ongoing lifecycle programme to ensure the maintenance of the building.

Question 12: How can I be assured that at least some of the views expressed in response to the consultation were positive suggestions and ideas for saving Castleberg and looking to the future, if the NHS could prevent permanent closure of the facility? I know of a few examples, both financial and practical, which could perhaps contribute to a successful rescue and transformation of the service.

Members of the public interested in the transformation of services throughout Craven could join the Craven Community Group.

Working with the Craven Community Group – a range of health and care partners and professionals – and Craven District Council, we plan to use an asset-based approach to develop services at the hospital. We will be asking VCS groups and members of the public to help us drive forward how health and care is delivered in Craven. Interested members of the public can get in touch with the CCG via engage@awcccg.nhs.uk

Governing Bodies meeting as Committees in Common- 8 May 2018

Services that are interested in leasing space in the building can contact NHS Property Services via its customer services team on 0800 085 3015 or by email at customer.services@property.nhs.uk

Question 13: If the Board accepts the recommendations, will they set up a Project Team to implement the CCG estates strategy outlined in the report, which will incorporate all interested parties, both within and outwith the NHS, and including service users/patients and carers and their representatives? How can I be assured this will be done in a timely, inclusive and transparent fashion?

Members of the public interested in the transformation of services throughout Craven could join the Craven Community Group. This is an existing group which aims to promote inclusivity by working closely with VCS and members of the public who are interested in local NHS services.

Working with the Craven Community Group – a range of health and care partners and professionals – and Craven District Council, we plan to use an asset-based approach to develop services at the hospital. We will be asking VCS groups and members of the public to help us drive forward how health and care is delivered in Craven. Interested members of the public can get in touch with the CCG via engage@awcccg.nhs.uk

Services that are interested in leasing space in the building can contact NHS Property Services via its customer services team on 0800 085 3015 or by email at customer.services@property.nhs.uk

Question 14: In the interests of the desired collaborative working, can I be assured that the protocols, standards and costings of the Social Care service provided by North Yorkshire County Council for Craven residents will be commensurate with that provided for residents of the other AWC CCG areas?

As an NHS organisation, the CCG is unable to respond to questions about the protocols, standards and costing of social care in North Yorkshire County Council for Craven residents. This issue would be better taken up with your county councillor.

Sue Pitkethly then gave a presentation which appeared on screens for those present to see. Sue advised that AWC CCG had been through a lengthy, transparent and rigorous process when considering the future of community services in Craven. Sue provided those present with background to the process, noting that a plethora of information had been received by the Clinical Executive Group (CEG) prior to a recommendation being made to the Governing Body. It was noted that a pre-consultation period of six weeks had been undertaken with the public. Following this further consultation and engagement activity was undertaken and a decision making business case had been developed. The presentation provided further information regarding the significant estate issues at Castleberg hospital which had led to its temporary closure.

Governing Bodies meeting as Committees in Common- 8 May 2018

In order to assess the impact of the temporary closure on community services, AWC CCG reviewed and analysed activity data reported by Airedale NHS Foundation Trust (ANHSFT) and compared this to a period prior to the closure. Sue advised that NHS England (NHSE) had been informed of the issues at Castleberg and the CCG instigated the NHS England Planning and Assuring Service Change for Patients. It was noted that there were two options for consultation: Option 1: Continue to provide inpatient care in the community and keep Castleberg Hospital open. Option 2: Provide care in people’s homes or in an alternative community setting (determined by need) and permanently close Castleberg Hospital. Sue then advised those present of the extensive consultation work that had been undertaken with the public. Engagement colleagues had visited villages across Craven to encourage communities to get involved with the consultation and there had been a number of media releases. There had been seven consultation events held in Craven (three in Settle, on in Bentham, one in Grassington and one in Gargrave) and consultation information had been promoted on the AWC CCG website and through social media. Following the consultation, a decision making business case (DMBC) was produced which described in detail the rationale for the temporary closure and included over 20 appendices to further support decision making and external scrutiny of the process. The DMBC also focussed on key areas such as the rurality and geography of Craven and addressing the patient safety concerns for the local community.

Sue advised those present that there had been an overwhelming response online and through hard copy questionnaires and attendance had been high at engagement events. It was noted that the CEG fully considered the NHSE five tests of service reconfiguration and were assured that for both options, four of the tests were satisfactorily met, however when the fifth test was applied to option 2, the CEG were not sufficiently assured. The Clinical Senate had been appointed to review the two options and felt that option 2 was the stronger option. The DMBC, appendices and CEG rationale for making the recommendation were also considered by the NHSE Yorkshire and Humber Service Reconfiguration Oversight Group in order to gain assurance regarding the sustainability and viability of the options proposed and to gain assurance that the recommendation adhered to the AWC CCG strategy.

It was noted that NHS Property Services had advised the CCG that approximately £1.2million (£60k per year over twenty years) would be required to maintain Castleberg, in addition to the current annual premises cost of £250k. It was felt by the CEG that even though the additional cost would be incurred in keeping the site open, this was not unaffordable and would be built into future financial planning. Sue advised that the CEG recommend that the service model takes full account of the AWC CCG strategy for integrating care in the community. It was noted that there was a multidisciplinary group working together to design a new care model to encourage

Governing Bodies meeting as Committees in Common- 8 May 2018

communities to own the services and use community assets in the area. It was felt that whatever decision the Governing Body reached, it was important to consider the opportunity to develop a different approach to community care in the Craven area and not continue with a ‘like for like’ service at Castleberg, but look for ways to build a community asset based approach. Following the presentation, James Thomas advised that there would now be the opportunity for members of the Governing Body to gain any further points of clarification. Bryan Millar, Lay Member of Finance, and Neil Fell, Lay Member for Governance, queried what assurance had been provided by NHS Property Services that they would maintain Castleberg so that the issues that had caused the temporary closure would not happen again. Sue Pitkethly advised that conversations had been held with NHS Property Services and assurance had been sought. Conversations had also been held with ANHSFT to discuss how the maintenance programme with NHS Property Services could be monitored effectively. Bryan queried why Option 1 was being recommended by the CEG when Option 2 had been recommended as the stronger option by the Clinical Senate. Sue Pitkethly advised that the senate had not said Option 1 was not a viable option, but they had felt that option 2 was stronger based on the evidence they had received. James Thomas advised that it was hoped the CCG could work towards a model similar to that noted in Option 2, but the CCG was not yet ready to deliver it. It was suggested that the second option could have been tested more thoroughly as an alternative during the temporary closure. A query was made as to whether the CCG had tried to commission different services in the twelve months that Castleberg had been closed. It was suggested that the money spent on estates could be used to commission different services in order to work towards Option 2. Julie Lawreniuk, Chief Finance Officer and Deputy Chief Officer, advised that during the temporary closure of Castleberg, there had still been estate costs in order to ensure the building was secure. Money had also been spent on maintenance for other buildings. It was felt that the reinvestment of the premises costs in intermediate beds outweighed the potential investment of the money into an alternative service model. Pam Essler, Lay Member for PPI, wished to thank the public for their engagement and input into the process. The input of the public had been invaluable in helping the CCG better understand the issues faced by the community in accessing care in a rural setting. Angie Clegg, Registered Nurse, advised that she was in support of Option 1, with the aspiration that the CCG should aim for the model described in Option 2. Pam agreed and felt it was important to invest in community services that considered the ‘whole person’. Sue Pitkethly advised that the Craven Community Group had representation from a wide range of disciplines (such as fire services, police, health and housing) to consider how community assets could be used to the best advantage. Peter Brunskill, Secondary Care Consultant, felt it was important to choose Option 1 as the bed base available at Castleberg was an important enabler for patients, but also Option 2 should be developed to provide better care for people in their homes. James Thomas then asked the public if there were any points they wished to be clarified. A member of the public asked for clarification regarding the number of beds

Governing Bodies meeting as Committees in Common- 8 May 2018

that would be available at Castleberg should it be re-opened. James advised that it was hoped ten beds would be available, but this was conditional on replacing the full complement of staff at Castleberg. Another member of the public requested assurance that the multidisciplinary community group would not delay improvements to services. Sue Pitkethly advised that the group had been meeting for several months already and it was hoped that by having multiple services involved, this would speed up the development of the model. Another query was made about ownership of the Castleberg Hospital building. Julie Lawreniuk advised that CCGs were not allowed to own property. Under the health reforms, Primary Care Trusts (PCTs) became CCGs and all property that was owned by PCTs passed to NHS Property Services. The property was then rented to CCGs or Trusts. It was clarified that NHS Property Services is a public owned company. A member of the public queried when the recording of the meeting would be made available to the public. Sue Jones, Head of Communications, advised that the recording would be available in the next few days following the meeting on the AWC CCG website. James Thomas drew the questions to a close and advised that the AWC CCG Governing Body needed to make a decision. James advised that Option 1 (continue to provide inpatient care in the community and keep Castleberg Hospital open) had been recommended by the CEG. James asked if all those present were in favour of this option. All present were in favour of approving Option 1. There were no dissenting views. James then thanked everyone who had been involved in the consultation work, namely Sue Pitkethly, Sue Jones and Lynne Scrutton and their teams, for all their tireless work and due diligence throughout the process. James also thanked ANSFT, North Yorkshire County Council, Healthwatch, Townhead Surgery and NHS Property Services for their valuable input. James then thanked the population of Airedale, Wharfedale and Craven for their engagement and involvement. It was felt that the decision taken today showed that the CCG had listened to the community and the Governing Body were assured by the process. RESOLVED:The AWC CCG Governing Body:

1. Supported the Clinical Executive Group’s recommendation to support Option 1 (Continue to provide inpatient care in the community and keep Castleberg Hospital open)

2. Supported the Clinical Executive Group’s recommendation that in pursuing Option 1, this should not be a like for like service model to that which was in place prior to the temporary closure of Castleberg Hospital. The future model should take full account of the AWC strategy for integrating services closer to patients’ homes and build on a community asset based approach that sees Castleberg as a community based facility with options for a broader range of support services.

A comfort break followed and all members of the public left the meeting. Liz Allen, Ali Jan Haider, Max McLean, Sohail Abbas, Nick Hayward and Akram Khan joined the meeting.

Governing Bodies meeting as Committees in Common- 8 May 2018

James Thomas asked those joining the meeting if they wished to declare any interests in the remainder of the agenda items. No one declared any interests in the remaining agenda items. James also introduced John Young, Secondary Care Consultant and Sohail Abbas, GP Member, as new members of the Governing Bodies.

3 Minutes of the meetings held on 9 January 2018 & 10 April 2018, Action Log and Matters Arising

The Governing Bodies ratified the minutes of the meeting held on 13 March 2018 with the following amendment to make: Nick Hayward requested that a conflict of interest be added regarding Item 14 (GP Extended Access) for himself. The declaration had been made at the meeting, however had not been included in the minutes of the meeting.

The Governing Bodies reviewed the notes of the development session held on 10 April 2018. Helen Hirst advised that these had been incorrectly recorded as minutes and requested that they be amended to reflect that these were notes taken at the development session and not formal minutes of a constituted meeting. At the development session, a sub-group of the Governing Bodies had supported the financial plans for 2018/19, subject to these being formally ratified. The notes of the development session therefore needed to be amended to reflect that the recommendation had been made that the financial plans would be formally ratified later in the public meeting held today. The action log was reviewed and updates were provided: 10 April 2018

Action 1, Sign off 2018/19 Financial Plans Julie Lawreniuk advised that Andy Withers and herself had met and clarification had been provided regarding the Districts Practice Transfer value. The action was marked as complete.

13 March 2018

Action 1, Patient Story Ali Jan Haider provided an update on the refresh and development of the carer strategy. Ali Jan advised that he had been to a meeting of the Executive Commissioning Board (ECB) and progress was being made.

Action 2, AWC Primary Care – GP Forward View £1.50 non-recurrent investment Sue Pitkethly advised that a decision could not be reached at the Governing Body meeting held on 13 March due to conflicts of interest and it had been agreed that further clinical input would be sort regarding the proposal for the investment, and then a decision would be reached virtually by AWC CCG Governing Body. Sue advised that clinical input had been provided by Akram Khan and there had been an email debate by the AWC CCG Governing Body. Following the online debate, there had been approval of the Modality proposal. This action was marked as complete.

Governing Bodies meeting as Committees in Common- 8 May 2018

Action 3, GP Extended Access Julie Lawreniuk provided the figures relating to investment in extended access for each CCG as follows: Bradford City CCG: £613,557 Bradford Districts CCG: £1,625,643 AWC CCG: £539,158 This action was marked as complete.

Action 4, Preparation for GDPR implementation Julie Lawreniuk advised that Fiona Jeffrey had provided a briefing to be shared with the Governing Bodies and this was shared following the meeting. It was noted that a communication had already been shared with practices. This action was marked as complete. 9 January 2018

Action 4, Finance, Contracting and Performance Report Julie Lawreniuk advised that risks associated with the Financial Position and QIPP 2018/19 for each CCG would be added to the risk register during the first cycle of the new risk reporting year.

4 Questions received from the public ahead of the meeting regarding the rest of

the agenda items

No questions relating to the rest of the agenda items had been received from the public ahead of the meeting.

5 Chief Officer’s Report Helen Hirst, Chief Officer, presented the Chief Officer’s Report which provided an update to the Governing Bodies about national, regional and local issues pertinent to the three CCGs. Key messages included:

At the West Yorkshire and Harrogate (WY&H) Health and Care Partnership there had been discussion regarding the establishment of the Integrated Care System (ICS). Positive feedback had been received regarding the ICS from NHSE and NHS Improvement (NHSI).

It was noted that discussions at the April 2018 meeting of the Bradford Health and Wellbeing Board (BHWB) had focussed on economic development. Helen advised that the membership of the BHWB had expanded to include representative from the fire service, police, re-generation and housing providers. It was hoped that by expanding the membership, there would be a broader consideration of determinants of health and wellbeing. Dave Baldwin, Chair of the Bradford economic partnership, had provided an update on the achievements of the partnership and noted progress on the northern powerhouse rail link and Made in Bradford (a website developed to promote Bradford in terms of economic potential).

Governing Bodies meeting as Committees in Common- 8 May 2018

Helen advised that the April 2018 meeting of the Integration and Change Board (ICB) had been positive, with a focus on the progress on self-care and prevention. There had also been an update on the workforce programme and the plans for Digital 2020 with a clear articulation of the challenge faced by the programme. Those present had been able to visualise how the programme would work and what it was trying to achieve and in turn supported additional resources, shared by all members of ICB, to resource the programme further.

An update was provided regarding new appointments made in the local area. It was noted that Brendan Brown has been appointed as the Chief Executive and partnership lead for the AWC Health and Care Partnership.

Brent Kilmurray had also been appointed as the new Chief Executive for Bradford District Care Foundation Trust (BDCFT).

Helen provided an update regarding the IAF year-end review with NHSE. NHSE are not currently able to share ratings, but nothing had arisen from the meeting to suggest any concerns regarding performance and it was felt that the rating would be similar to last year. The review had provided to the opportunity to discuss with NHSE concerns regarding operational planning requirements and the inconsistency of the patient experience rating given to AWC CCG when compared to the two Bradford CCGs against the same criteria.

It was noted that the CCGs had now received their 360 stakeholder survey reports. The small sample size was noted but generally it was felt that the CCGs scored well in most of the categories covered. Those present were asked if they had any questions about the Chief Officer’s report. David Richardson noted that the WY&H partnership had made great efforts to engage with the public and it was hoped that in future patient participation groups (PPGs) could be included. Pam Essler raised a query regarding the approach to the national directive about advanced care planning for people with dementia. Ali Jan Haider noted that there was a dementia planning group where this was discussed. Ali Jan advised that he would meet with Pam outside of the meeting to provide an update. ACTION: Ali Jan Haider to meet with Pam Essler to discuss the CCGs’ approach to advanced care planning for people with dementia.

RESOLVED: The Governing Bodies noted the content of the Chief Officer’s Report.

6 Chairs’ Report

It was noted that the Chairs’ Report provided an update on key meetings attended by the Clinical Chairs during March and April 2018.

Governing Bodies meeting as Committees in Common- 8 May 2018

Akram Khan noted that there had been a discussion at the last Council of Members (CoM) meeting and it had been decided that practices would not undertake additional work associated with the Quality Premium (QP) over and above that which was already covered by other schemes given the lack of resources to support this Akram also provided an update regarding the Bradford Improving Cancer Survival (BICS) initiative and it was also noted that Bradford and Wakefield CCGs were progressing work on a West Yorkshire and Harrogate programme around lung cancer. James Thomas advised that there had been discussion at CEG regarding Quality, Innovation, Productivity and Prevention (QIPP) plans. It was noted that robust plans were being developed regarding planned care and medicines management. James noted that CEG had been assured by the min-year recurrent value of investment regarding the Incentive Scheme 2017/18. James noted that national guidance had been produced regarding gluten free prescribing and this had been discussed at CEG. The CEG had agreed to maintain the current restrictions. (City and Districts confirmed that a similar agreement had been made by their Boards also) The future of Castleberg Hospital had also been an item discussed by the CEG in order to reach a recommendation to the Governing Body. Ali Jan Haider advised that Bradford Districts CCG Clinical Board had discussed strategic priorities for 2018/19. Work with John Hartley had been completed to review data regarding key areas of focus, such as COPD. An update was provided regarding the Joint Clinical Committee (JCC), noting that the impact of Local Authority budget cuts on the school nursing service had been discussed. An update had been provided to the JCC regarding minor surgery to ensure members were sighted on pathway redesign. It was hoped that a collaborative approach across Bradford and AWC could be developed to provide an equitable service across the patch. It was also noted that there had been a discussion regarding sepsis, and each practice had been asked to identify an infection control lead in an effort to address sepsis in the community. RESOLVED: The Governing Bodies noted the content of the Chairs’ Report.

7 Performance Reports

7.1 Finance, Contracting and Performance Report

Julie Lawreniuk, Chief Finance Officer & Deputy Chief Officer, presented the Finance, Contracting and Performance Report. Finance

Governing Bodies meeting as Committees in Common- 8 May 2018

Julie noted that all three CCGs had met their financial duties. It was noted that the accounts were subject to the audit process and there was a requirement to provide a full set of accounts by 25 May 2018. Airedale, Wharfedale & Craven CCG (AWC CCG) A £3.1million in year surplus (subject to audit) had been noted for AWC CCG. It was noted that a significant part of the reserves used to support the financial position for 2017/18 were non-recurrent and as a result, it was forecast that that AWC CCG would take an underlying deficit into 2018/19 of £3.8million. Bradford Districts CCG (BD CCG) A £2.7million in year surplus (subject to audit) had been noted for BD CCG. It was felt that BD CCG would be in a strong position going in to 2018/19.

Bradford City CCG (BC CCG) An £822,000 in year surplus (subject to audit) had been noted for BC CCG. It was felt that BD CCG would be in a strong position going in to 2018/19. Contracting Julie advised that all contracts with providers had been agreed for 2018/19. This had been done within timescales issued by NHSE and NHSI. There had been discussions at Finance and Performance Committee (FPC) about the impact on data following the implementation of EPR (Electronic Patient Record) at BTHFT. It was noted that assurance had been given by BTHFT that data would be provided by May 2018 and from that point onwards, data would be available month-by-month.

Performance It was noted that both BTHFT and AHFT continued to struggle to deliver the four hour A&E waiting time target, with performance at 92.6% and 86% at AHFT respectively. Referral to Treatment times were also noted, noting that AHFT continue to meet this target, but ongoing capacity issues remained. It was noted that at BTHFT, following the implementation of EPR, there had been a rise in patients waiting over 18 weeks. Discussion followed about what action might be taken should it continue that data was not fully available to the CCGs. It was noted that as a payment by results contract was in place, payment would be made on what data had been received. It was also noted that there were a number of performance managing processes in place to gain assurance, such as monthly contract board meetings, and meetings with NHSE and NHSI. Richard Wilkinson left the meeting. A query was raised regarding the impact of the new Acute Assessment Unit (AAU) at AHFT in reducing the number of patients waiting over four hours. It was felt that the new unit was helping to reduce the number of patients waiting in A&E. It was noted that there was ongoing monitoring in place to ensure double charging did not occur.

Governing Bodies meeting as Committees in Common- 8 May 2018

7.2 Quality Report

Michelle Turner, Director of Quality and Nursing, presented the Quality Report. The Sentinel Stroke National Audit Programme (SSNAP) data was discussed. It was noted that the Bradford position had slipped from a Level D to a Level E. The Airedale position was also deteriorating but remained at a Level D. It was noted that transformational work was being undertaken and it was hoped that the position would improve by the end of 2018/19. It was noted that a key action being taken was to move to a single service rather than a joint service across the two Trusts. Due to reporting mechanisms, it was noted that a change in data would not be seen until later in the year. A query was raised regarding how the work carried out in the three CCGs fit with the wider West Yorkshire and Humber (WY&H) stroke development work. Michelle advised that Andy Withers was connected to wider stroke work on different models of working. Michelle advised that both Airedale and Bradford Trusts were not currently meeting the two week wait for cancer and 62 week waiting times. It was noted that there had been a lengthy discussion at the Joint Quality Committee (JQC) about several high level concerns regarding the timeliness of assurance that BTHFT were able to provide regarding the provision of effective services. To gather further assurance, a meeting had been arranged for members of the JQC to meet with the Trust’s Quality Committee to discuss concerns. Discussion followed about the need to gain assurance that no harm had come to patients when constitutional targets had not been met. It was felt that further information should be made available to understand what mechanisms were in place in the Trust to provide assurance that progress was being made to achieve targets. RESOLVED: The Governing Bodies:

Noted and approved the recommendations set out in the Finance, Contracting, QIPP& Performance Report.

Noted and approved the recommendations set out in the Quality Report.

8 Strategic Partnership Report

Ali Jan Haider, Director of Strategic Partnerships, presented the item regarding the Strategic Partnerships Report. Ali Jan advised that a multi-agency event had taken place on domestic and sexual violence. A key outcome of the event was that an approach would be developed with service users, with a key focus on families where abuse had taken place, and this would be fed into plans to recommission a joint service. It was noted that the community eating disorder service was now staffed and fully operational.

Governing Bodies meeting as Committees in Common- 8 May 2018

Ali Jan advised that positive feedback had been received from the national team on the Future in Mind Programme and work was being progressed to address wider determinants of mental wellbeing. Ali Jan advised those present that lessons had been learned from the Special Educational Needs and Disability (SEND) peer review and there had been a change in how the system worked. It was noted that a SEND Clinical Advisor had been recruited for six months from April 2018 – September 2018. It was noted that the CCG colleagues continued to work closely with CBMDC regarding Prevention and the Early Help Consultation and practical concerns regarding the impact of budget cuts had been noted. Significant risks had been identified regarding the impact and Public Health commissioners were engaged with Clinical Boards/Executive to address how these could be mitigated. It was felt that these risks could be better expressed on the Risk Register. ACTION: Ali Jan Haider to review and update the risks and mitigating action on the register regarding the potential impact of CBMDC budget cuts Ali Jan advised that the Transforming Care Programme were due to meet to discuss the programme beyond March 2019 and to look at ways of mainstreaming the work as well as broadening the scope of the programme to consider all of learning disabilities and autism.

RESOLVED: The Governing Bodies received and noted the Bradford District and Craven Strategic Partnerships report.

9 Health and Care Partnership Update Reports

9.1 AWC Health and Care Partnership Update

Sue Pitkethly, Director Accountable Care Airedale, presented the AWC Health and Care Partnership Update. It was noted that at the April meeting, the AWC Accountable Care Board had agreed to change their name to AWC Health and Care Partnership Board. Sue advised that a system ‘case for change’ proposal was being developed for the June 2018 checkpoint. This would provide the opportunity to review the workstreams in the programme and to ensure activity demonstrated at the February 2018 checkpoint had continued. Sue advised that initial expenditure analyses continued to be produced for each community so they were aware of activity and to provide them with areas to focus expenditure. It was noted that a shared RAID (Risk, Assumptions, Impact and Dependencies) log was in development to provide a means of active risk management. RESOLVED: The Governing Bodies received the AWC Health and Care Partnership Programme Report and noted the progress of the work programmes in AWC. 9.2 Bradford Health and Care Partnership (BHCP)Board Update

Governing Bodies meeting as Committees in Common- 8 May 2018

Liz Allen, Executive Director Bradford City, presented the Bradford Health and Care Partnership update. Liz advised that a workshop had been held in April 2018 where the ambitions for the Board had been discussed with a focus on what could be developed by 2021. System leadership within organisations, collective responsibility and accountability had been discussed at the workshop. Liz provided those present with an update on Primary Care Home communities. It was noted that there was mounting excitement about the development of the communities and professionals were working well together to progress the delivery of innovative services. Ways of working was discussed and it was decided that sharing the experience of patients through the use of case studies and patient stories would help the improvements in transformation. A Bradford community bed summit had been held in April 2018 where there had been a discussion regarding proposals for a transformed operating model. It had been agreed that a task and finish group would consider options further and a model would be discussed further at the Out of Hospital (OOH) programme board by June 2018. RESOLVED: The Governing Bodies:

Received and noted the progress made in the last two months towards developing and achieving our BHCP.

Noted the key points summarised in the associated risk dashboard. 10 2018/19 Planning – 2018/19 Operational Plan and Financial Plans 10.1 2018/19 Operational Plan

Julie Lawreniuk introduced the item regarding the 2018/19 Operational Plan, noting that the NHS already has two-year contracts and improvement priorities set as part of the two year planning guidance. CCGs and providers have been asked to update the second part of the plans in light of revised national guidance. The operational plan sets out that the CCGs have committed to deliver the national requirements. The plan also sets out the agreed trajectories to meet national targets by March 2019 where these are not currently met. Work has also been undertaken across all three CCGs to align their approach to elective and non-elective activity. It was felt that the right activity had been commissioned to meet the trajectories, however there are some risks regarding the delivery of these by March 2019. Julie advised that the paper sets out programmes of work undertaken in 2017/18 and it was hoped that the operational planning process would help people better understand what activity had been bought to meet the key deliverables for 2018/19.

10.2 2018/19 Financial Plan

Julie Lawreniuk advised that the 2018/19 Financial Plans had been discussed at the Governing Body and Clinical Board/Executive development session held on 10 April 2018.

Governing Bodies meeting as Committees in Common- 8 May 2018

The Financial Plans capture the requirements set out in the operational plans and meet the control total requirement set by NHSE. Julie advised that there had been significant discussion regarding the Financial Plans and the sub-group of Governing Body members present at the development session had recommended their approval at the meeting today. The Chair asked if all were in agreement to approve the 2018/19 Financial Plans. All were in agreement. There were no dissenting views. RESOLVED: The Governing Bodies:

Noted the update on the work to deliver the three CCGs two year Operational Plan.

Noted the refreshed Operational Plans for 2018/19.

Approved the 2018/19 Financial Plans. 11 High Level Risk Register Report

Sarah Dick, Head of Governance, presented the item regarding the High Level Risk Register Report at the end of Cycle 6 2017/18.

It was noted that a new review cycle had begun and several new risks regarding 2018/19 financial position and QIPP identification would be added to the register as part of Cycle 1 reporting. The report received by the Governing Bodies noted the high level and serious risks. A number of risks had been closed during Cycle 6 and it was noted that this was usual activity for the end of the review year. The 2017/18 financial position and QIPP risks for the CCGs had been closed as these had been successfully managed in-year. Sarah noted that three risks specific to AWC CCG had been closed. These risks had arisen from a Care Quality Commission (CQC) inspection but they had now been resolved following action being taken to address the concerns. Helen Hirst made a request for wording on the risk register to be more specific and detailed. Discussion followed about the need to review static risks and to provide updates where possible to show that action was being taken to mitigate the risks. RESOLVED: The Governing Bodies received and noted the Risk Register Report

and High Level Risk Log as at the end of Cycle 6 2017/18.

12 Minutes of the Primary Care Commissioning Committees

The minutes of the Primary Care Commissioning Committees held on 8 January 2018 (BC CCG) and 9 January 2018 (BD CCG) were presented for information and assurance. It was noted that the AWC CCG Primary Care Commissioning Committee due to be held in January 2018 had been cancelled.

Governing Bodies meeting as Committees in Common- 8 May 2018

RESOLVED: The Governing Bodies received and noted the minutes of the Primary Care Commissioning Committees held on 8 January 2018 and 9 January 2018.

13. Minutes of the Joint Quality Committee

The minutes of the Joint Quality Committees held on 1 February 2018 and 8 March 2018were presented to the Governing Bodies for information and assurance.

RESOLVED: The Governing Bodies received and noted the minutes of the Joint Quality Committees held on 1 February 2018 and 8 March 2018.

14. Minutes of the Joint Finance, Performance and Governance Committee

The minutes of the Joint Finance, Performance and Governance Committees held on 1 February 2018 were presented to the Governing Bodies for information and assurance. It was noted that the meeting due to be held in March 2018 had been cancelled due to adverse weather. RESOLVED: The Governing Bodies received and noted the minutes of the Joint Finance, Performance and Governance Committees held on 1 February 2018.

15. Engagement Tracker

The Engagement Tracker was presented to the Governing Bodies for information and assurance. RESOLVED: The Governing Bodies received and noted the Engagement Tracker.

16. Date and time of next meeting

Before bringing the meeting to a close, James Thomas wished once more to thank everyone involved in the Castleberg item for their hard work. Colin also thanked everyone for travelling to Settle to attend the meeting. The next meeting of the Governing Bodies meeting as Committees in Common will be held on Tuesday 10 July 2018, 13:15 – 16:15.

17. Exclusion of the public – It is recommended that the following resolution be passed: “That representatives of the press and other members of the public be excluded from the remainder of the meeting, having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest”.

RESOLVED: The Governing Bodies passed the resolution to exclude

representatives of the press and other members of the public for the remainder of the meeting.