Minutes of the Governing Body Meeting. Part 1. At Uxbridge Civic Centre, CR4

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1 Minutes of the Governing Body Meeting Part 1 Held on Friday 23 rd May 2014, 12:30pm - 14:00pm. At Uxbridge Civic Centre, CR4 Present: Dr Steven Shapiro (SS) Jonathan Wise (JW) Dr Ian Goodman (Chair)(IG) Dr Mehboob Salhe (MS) Ceri Jacob (CJ) Sharon Daye (SD) Dr Kuldhir Johal (KJ) Rob Larkman (RL) Dr John Riordan Bernard Quinn (BQ) Apologies: Dr Stephen Mort Allison Seidlar (AS) In Attendance: Dr Mitch Garsin (MG) Dr Mayur Nanavati (MN) David Gibbins (DG) Dr Reva Gudi (RG) Trevor Begg (TB) Helen Delaitre (HD) Dr Steven V-Smith (S V-S) Keith Dickenson (KD Ursula Gallagher (UG) Kamran Bhatti (KB) Chandresh Somani (CS) Kam Rahelu (KR) (Minutes) No. Item Action 1. Submitted Questions from the Public: No questions were submitted via the HCCG website. 2. Apologies and Declaration of interests Apologies as noted above. There were no Declarations of Interest. 3. Minutes of the Last Meeting ( ), Action Log & Feedback.. The notes were deemed to be an accurate account of the last meeting. Items for Discussion 4. Finance Report - Month 12, 2013/2014 Presented by Jonathan Wise (JW) JW shared the headlines from the Finance Report and gave an update on the Hillingdon CCG, Governing Body Meeting Part 1, Friday 23 rd May pg. 1

2 external audit process which is ongoing. He advised the Month 12 Report which was presented in its normal format that the all previous reports are provided in. JW advised that the previous Governing Body had received the overall summary of the Report and that essentially, there had not been great change in the numbers in terms of outturn. JW advised:- The CCG s outturn deficit was 5.1 million on Programme with a small under spend on running costs; the overall position of outturn roughly 5million over plan in terms of deficit, which was a better outcome than planned and has been reported over the course of the year. The CCG has improved on its 12.25m deficit end of year plan by 7.243million. JW drew the Governing Body members to Page 6 of the report detailing the areas of variance against Plan from Month 11 to Month 12. The areas of variance remain the same as has been reported throughout the year. The CCG has improved on its 12.25m deficit end of year plan by 7.243million with 0.1m expenditure on Admin/Running Costs This position is in the CCG s draft accounts submitted NHSE on 23 rd April The reported position is still subject to external audit. The draft accounts submitted to NHSE were reviewed by the Audit Committee on 1 st May 2014 JW advised that the deadline for submission for the final Report set by NHS England was 6 th June It was also noted that the Reports had been submitted to the external auditors ahead of schedule and JW was applauded for this by the GB members. IG thanked JW and the whole Finance team for their work on the final submission to the external auditors. JW advised the feedback from NHSE would be presented at the next scheduled Audit Committee meeting. It was also confirmed that an Extraordinary Governing Body meeting had been arranged on 4 th June 2014 to approve the final Report ahead of submission and that the Governing Body would have sight of the Audit Letter and final Report ahead of this. 5. CSU Performance Report - Month 11 Presented by Bernard Quinn (BG) Hillingdon CCG, Governing Body Meeting Part 1, Friday 23 rd May pg. 2

3 The Month 11 CSU Performance Report identifies current CSU performance trends and issues and the recommended measures and actions being taken to respond to the needs of BHH CCGs and improve delivery, in line with the agreed SLA. The report provides a summary of CSU performance at Month 11 against the agreed standard KPI s where the measurement mechanism is in place. BQ advised four specific service and delivery issues had been raised two of which had been resolved. The two areas that were not yet resolved relate to the Finance and Procurement Support that was received:- The Procurement Support level of service has been unacceptable and they have not identified an acceptable way of addressing their working with Solent to manage that contract out. BQ advised that the CCGs will wish to consider how it procures procurement moving forward. The other area that has not yet been resolved related the Finance. BQ advised there is a concern around a considerable backlog around non contract activity as well as practice level reporting. The CSU have been pressed again to put in a reporting mechanism that is satisfactory. BQ shared the positive news that the CSU have confirmed that they have signed the contract with the Commissioning Support Services. BQ gave a brief update on the CSS Business Case and advised the Governing Body that we have now moved to transition contract management process with the Commissioning Support Services which is now being jointly managed across the eight CCGs with the CSU. CS asked if there had been any contract changes to what had been expected. confirmed it was as expected. BQ 6. Integrated Performance Report, Month 12 Presented by David Gibbins (DG) CCG Constitution and Mandated standards: The CCG is currently meeting constitutional performance measures with the exception of: RTT performance standards - Hillingdon CCG met RTT performance standards overall but not the 52-week wait or specialty standards in Month 12. The two 52-week breaches for the incomplete pathway were reported by University College Hospitals (UCLH) within Neurosurgery. Speciality performance has been largely impacted by North West London (NWLH), The Hillingdon Hospitals (THH ) and UCLH. Hillingdon CCG, Governing Body Meeting Part 1, Friday 23 rd May pg. 3

4 Health Care Acquired Infection - Hillingdon CCG met their c.diff standard in Month 12 and for the period 2013/14 with 35 cases reported against a tolerance of 37. Of the two cases reported in Month 12, one was apportioned to Heatherwood & Wexham Park Hospital. Hillingdon CCG met the zero tolerance MRSA standard in Month 12 but not for the 2013/14 period, with a total of 10 cases reported. Cancer - Hillingdon CCG met all cancer standards in Month 12. However it did not meet the 62-days standard for 2013/14 (84.7%) with the threshold being 85% Quality Premium - The CCG has reported 10 MRSA cases year to date against an annual tolerance of zero cases. The CCG is also not meeting the local measures to reduce emergency admissions from care homes or to reduce the average length of stay for people aged 65 +, admitted as a result of falls. DG advised that due to current performance the funding allotted was 847k from a potential fund of 1.36m This is also based on the CSU understanding that the cancer 62-days to treatment standard, the gateway metric to receiving quality premium funding, will be met after the reallocation exercise to be undertaken at Royal Brompton and Harefield Hospital (RBH). Areas where provider performance (Trust-wide across all CCGs) is below standard:- 18 weeks RTT - RBH and THH met RTT standards overall in Month 12, but not speciality standards. RBH had 1 breach of the 52-weeks standard, which has not impacted the CCG. NWLH did not meet the admitted RTT standard for Month 12 or overall for the 2013/14 period. It was noted that NWLH reported an improved position against the 52 week RTT standard in Q4 with no patients waiting in Month 12. A&E - NWLH did not meet the national all activity types standard in Month 12 achieving 93.09%. This standard has not been met for the year to date. I RL advised the severe pressures A&E have been experiencing recently that are highlighted in this report could have impending contract penalties implemented. Cancer - NWLH did not meet the 62-days to treatment standard in Month 12 (84.1%) and this standard has not been met for period 2013/14 (84.0%). RBH did not meet the 62-days to treatment and 62-days consultant upgrade standards in Month 12 achieving 58.8% and 50% respectively. Neither met the 62-days to treatment standard for 2013/14 (69.4%). THH met all cancer standards in Month 12 and for 2013/14 period. HCAI -THH and NWLH met the C.diff Tolerance for Month 12 and for Hillingdon CCG, Governing Body Meeting Part 1, Friday 23 rd May pg. 4

5 2013/14. RBH exceeded 2013/14 tolerance reporting 16 cases against a tolerance of 7. THH, NWLH and RBH met the zero tolerance MRSA bacteraemia standard for Month 12 but not for 2013/14, reporting 1, 2 and 2 cases respectively. LAS arrival to handover waits and 80 patient breaches > 30 minutes reported at THH and NWLH respectively. NWLH also reported 4 handover waits over 1 hour. CNWL HCH achieved 62.5% against the 75% target for Patients 65-years and over assessed for dementia. For Referrals responded to during the day, twilight or night service periods within 24 hours CNWL HCH achieved 82.5% against 90% target at Month 12. CNWL HCH achieved 76.7% at Month 12 year-to-date for Palliative care patients with a recorded place of preferred death. It was highlighted that CNWL have received a CQC report which has 11 domain standards listed. However although only 1 standard was met and passed, the others are split in to 5 minor and 5 moderate standards. The Governing Body agreed that conversations will be taken offline in regard to this and reported at next meeting. Items for decision 6. Everyone counts over 75s funding Presented by Helen Delaitre NHS England has announced that Clinical Commissioning Groups are expected to support practices in transforming the care of patients aged 75 or older and help reduce avoidable admissions by providing funding for practice plans to do so. Funding should be in the region of 5 per head of population which broadly equates to 50 for patients aged 75 and over. Funding can be used to commission new services from general practice or can be invested in other community services to secure integration with primary care provision. Guidance suggests that plans should complement initiatives funded through the Better Care Fund (BCF). This paper summarises proposals for the use of this funding. It was explained that recruitment of Health & Social Care Co-ordinators has been agreed and signed off and process to allocation to the GP Networks for Hillingdon. The proposed costing for primary care navigators for this was valued at 300k but it is more likely to come in at a 200k annual cost. It was highlighted that this will still need to be presented and signed off at the next Finance & QIPP meeting. It was asked by (CS) whom will have the responsibility of employing these Care Co-ordinators to which was agreed that a paper be requested for noting at next Governing Body meeting in June. This was also reflected that CNWL are HD Hillingdon CCG, Governing Body Meeting Part 1, Friday 23 rd May pg. 5

6 working together with David Simes in ensuring that training, induction and interviewing are put in place by 13 th June. With regard to the funding, HD confirmed that this will be from the CCG, but there will be a requirement for complete and proper evaluations of proposals by finance, and KPIs will be measured. CJ requested for a paper to be drawn up for review by Governing Body committee members, this was agreed by all committee members. HD 7. CSS Business case - Public Presented by Rob Larkman (RL) RL gave a summary of coversheet which sets out review and appraisal of a three options. RL drew attention to Page 22 of the Paper recommending Commissioning Support Services move out of the control of the CSUs and move to CCGs. The NW London CCG Governing Bodies are asked to confirm the recommendations outlined below. 1. This paper contains recommendations for the future of Commissioning Support Services which were initially agreed by the eight North West London Chairs at a meeting that took place in public on the 8 th May The paper builds on the recommendations agreed at the meeting of the collaboration of NW London CCG Chairs on 27 th March 2014 and detailed in the paper North West London CCGs: The future of collaborative working. 2. The detailed analysis and recommendations on the future of Commissioning Support Services are set out in a publicly available business case. This has been shared in draft form with the NW London CCG Chairs, CCG Governing Bodies, NHS England and North West London Commissioning Support Unit (NWL CSU) during its development. The completed business case had been circulated via ed to all NWL Governing Bodies. 3. RL advised the recommendations complement the proposals in relation to the subject of Primary Care Co Commissioning with NHS England and the agreement of the NWL Financial Strategy to deliver Shaping a Healthier Future. The proposals were considered and agreed at a meeting of the Collaboration of NW London CCG Chairs in public on 27 th March It was advised that eight CCGs across North West London met and reviewed this paper and although written confirmation has not been received to date, there was a verbal update of expression of interest. CJ questioned from page 59, collaboration board/commissioning decisions, RL advised this is related to support for contracting Hillingdon CCG, Governing Body Meeting Part 1, Friday 23 rd May pg. 6

7 commissioning. It was also advised that ensuring the right people are in place and is a priority for this to work for the future. CS raised a point on how would success be monitored and what and where will the responsibilities be. Also stated that reporting back to GB needed to be agreed. AS raised issue with recruitment and retention. TB spoke about the Communication Plan on Page 2 of the Paper and how to best to service sending proactive messages. RL confirmed there would be joint Communication control across the CCGs. The Governing Body reached agreement and approved Option A, as presented. 8. NWL Financial Strategy Presented by Jonathan Wise (JW) JW gave an overview of the Report over the three papers which were presented. The papers provide an update on the 2013/14 outturn for NWL-wide financial strategy for Shaping a Healthier Future budget, including Strategy & Transformation programmes. It was noted that this was not a paper for decision, but discussion. JW Highlighted that 41m will be pooled, and Hillingdon CCG are a major recipient and this comes in line with HCCG budget. JW advised the main changes in the paper being the introduction of a preamble that sets out the legislative and policy basis of the strategy and the inclusion of an additional 5m for Harrow under Part B (as agreed at the March NWL Collaboration Board meeting). The Governing Body were also advised:- JW advised that the paper and the numbers had been presented previously as part of the Budget paper. Advised that the fund would be split across the Eight CCGs. However attention was drawn to the fact that the paper was subject to agreement and formal sign off from NHS England. Agreement had already been made with regard to a slight change of wording but not the numbers. It was noted that 5 out of 8 local CCGs contributed to this (not Hillingdon, Harrow or Hounslow )and the budget split is as follows:- Decision is needed on how funding should be distributed across the 8 local CCGs by December to ensure that Strategy Governance, Finance Committee and Collaboration Board are established across these CCG. JW advised that although Hillingdon CCG were not contributors to the Fund, they Hillingdon CCG, Governing Body Meeting Part 1, Friday 23 rd May pg. 7

8 will benefit from this. CS asked that the final paper is presented to the Collaboration Board. The Governing Body agreed to the proposal as presented. 9. NHS 111 Future Commissioning Options Presented by Dr Kuldhir Johal (KJ) CCGs now need to consider how they will commission the NHS 111 service following the end of the pilot contracts. The Hillingdon contract expires February NHS England is recommending a reduction in contracts across London from the 11 quoted to between 3 and 5 providers. KJ advised In North West London there are currently 3 contracts and 2 providers. Although the evaluation of London 111 pilots has suggested that there could be system benefits to be gained from greater integration between 111 and GP OOHs, the complexity of the local landscape means that it is not practical at this time to integrate the two services and therefore the recommendation to NHS England on this point would be to continue to commission GP OOHs services under current arrangements. It was advised that primarily there are 11 contracts across 4 providers. There were workshops for 111 services, 3 CCGs have listed Care UK, and 5 CCGs have LCW. It was recommended that all Urgent Care Groups and Governing Bodies reduce this to between 1-2 contracts in future. There is scheduled a workshop to take place in June with North West London CCGs as advised the contracts are due for renewal February It was agreed that at present this paper could not reach a decision and that further information is required, so chair advised that the paper be brought back to next month s meeting for further review/decision. 10. IT Services Support Contract Presented by Dr Kuldhir Johal (KJ) (tabled) It was discussed and agreed that once the existing contract with CNWL expires, IT Service Support will be moved back in-house again. IG confirmed and approved of this decision. 11. Sub-Committee Minutes The Governing Body approved the following Minutes as per the Board Pack for:- Quality, Safety & Clinical Risk Committee Finance & QIPP Hillingdon CCG, Governing Body Meeting Part 1, Friday 23 rd May pg. 8

9 Prescribing PPI&E Urgent Care Working Group 12 AOB No items were raised. 13 Date of the Next meeting Friday 27 th June 2014, 12:30pm-16:00pm Venue: CR4, Civic Centre Hillingdon CCG, Governing Body Meeting Part 1, Friday 23 rd May pg. 9

GOVERNING BODY MINUTES OF THE FINANCE COMMITTEE HELD ON MONDAY 22 FEBRUARY 2016 GUILDHALL 1, KINGSTON

GOVERNING BODY MINUTES OF THE FINANCE COMMITTEE HELD ON MONDAY 22 FEBRUARY 2016 GUILDHALL 1, KINGSTON GOVERNING BODY LEAD: Paul Gallagher, Finance Committee Chair ATTACHMENT: K ACTION: For Information MEETING DATE: 24 th May 2016 MINUTES OF THE FINANCE COMMITTEE HELD ON MONDAY 22 FEBRUARY 2016 GUILDHALL