MINUTES OF THE MANAGEMENT GROUP MEETING held 25 February Boardroom, Welsh NHS Confederation, Ty Phoenix, 8 Cathedral Rd, Cardiff CF11 9LJ

Transcription

1 Present Members MINUTES OF THE MANAGEMENT GROUP MEETING held Boardroom, Welsh NHS Confederation, Ty Phoenix, 8 Cathedral Rd, Cardiff CF11 9LJ Daniel Phillips (Chair) (DP) Acting Managing Director, Valarie Attwood (VA) Associate Director Of Contracting, BCUHB (VC) Stuart Davies (SD) Director of Finance, Robert Holcombe (RH) Assistant Director of Finance, ABUHB Julie Keegan (JK) General Manager Commissioning, CTUHB Ian Langfield (IL) Acting Director of Planning, Sian Lewis (SL) Acting Medical Director, Huw Llewellyn (HL) Assistant Director of Finance, ABMUHB Robert Mahoney (RM) Assistant Director of Finance, CVUHB Phillip Meredith (PM) Finance Business Partner, ABUHB Rob Nolan (RN) Finance Director - Commissioning & Strategy, BCUHB (VC) Pamela Wenger (PW) Committee Secretary, Melanie Wilkey (MW) Head Of Outcomes Based Commissioning, CVUHB Deputy Maxine Evans (ME) Corporate Planning Manager, ABMUHB (Deputy to Darren Griffiths) David Eve (DE) Assistant Director of Finance, HDUHB (VC) Andrew Jones (AJ) Head of Finance, CTUHB (Deputy for Steve Webster) Peter Richards (PR) Finance Business Partner, PTHB Denise Vaughan In Attendance (DV) Senior Commissioning Manager, PTHB (Deputising for Hayley Thomas) Juliana Field (JF) Corporate Governance Officer, (Minutes) James Leaves (JL) Finance Manager, Page 1 of 16

2 The meeting opened at PRELIMINARY MATTERS MG15/194 Welcome and Introductions Action The Chair WELCOMED all to the Management Group meeting. Members of the Group introduced themselves. MG15/195 Apologies for Absence Apologies were received from John Darlington and Carole Bell. MG15/196 Declarations of Interest There were no declarations of interest to note. MG15/197 Minutes of the meeting held on 21 January 2016 Minutes of the meeting held 21 January 2016 were approved as a true and accurate record. Action Log The action log was reviewed and updated. A query was raised in relation to the outsourcing framework and the issues raised by Cardiff and Vale UHB regarding commissioning responsibilities and acceptability of provider issues. It was agreed that would provide a response to the letter and provide an update at the next in March It was noted that as part of the final sign off for outsourcing this would be undertaken by the Medical Director. A detailed discussion took place around the governance arrangements for the Corporate Directors Group and the Management Group as the framework was brought for information only. It was agreed that the approval responsibility lies with the Corporate Directors Group however, in respect of the framework it would have been beneficial to seeks views of the Health Boards in advance. All Members were invited to provide any further comments outside of the meeting. Page 2 of 16

3 Matters Arising Quality Assurance Improvement Team (QAIT) Members debated the role and functions of the QAIT and in particular the issue in relation to the funding for the team. It was discussed in some detail the fact that additional resources were being considered as part of the ICP as the case management function was not being undertaken. Members noted that a paper had been considered by the CEO Group in terms of the functions and accountability for the team. A meeting had been arranged with Stephen Harrhy to discuss. DP provided an overview of the understanding of the current position and the responsibility in regard to the Invest to Save initiative lying with the Health Boards. There was a detailed discussion relation to the Joint Committee Chair s action in relation to Mental Health and Learning Disability Collaborative Commissioning Group. Members suggested that the reporting lines of the Group should be via the Management Group. It was noted that the terms of reference had been agreed and therefore any change would need to be agreed with the Joint Committee. It was noted that there were ongoing discussions regarding the reporting and accountability arrangements for the MH/LD collaborative. It was agreed that correspondence in relation to this work be circulated to members of the Management Group. ACTION: Members to receive an update regarding the QAIT position at the next meeting PW to Circulate Annual Report from Mental Health and Learning Disability Collaborative Commissioning group to members ACTION: PW to Circulate correspondence in relation to MH/LD collaborative to members A query was raised regarding the transfer of the Emergency Medical Retrieval and Transfer service from to EASC. Members were advised that a report was timetabled for considered at the next Joint Committee. Acting Managing Director, Committee Secretary, Committee Secretary, Page 3 of 16

4 NWIS data validation process A discussion was held regarding the decline in levels of commitment from NWIS in supporting work and the requirement to fully understand the impact of this and agree actions to ensure delivery. PW left the meeting Members noted the progress to date and were informed that a meeting was planned for week commencing 29 February 2016 during which timescales were to be discussed. PW returned to the meeting RH left the meeting ACTIONS: SD to provide members with an update on the work being undertaken with NWIS Item to be added to the agenda for the next Director of Finance, Committee Secretary, MG15/198 Acting Managing Director s Report Members noted the updates including: Level 3 Neonatal Services in South Wales - The work would be led by and supported by the Network and the Collaborative Team (including the CRG). Members noted that the report would be considered at the Joint Committee meeting in March. Renal Delivery Plan Consultation will begin in the next few weeks and the Management Group will be invited to provide comments as part of this process. Note the report. MG15/199 Collective Commissioning Framework Members received an overview of the report which set out the four categories of the framework which had previously been presented at the Management Group workshop sessions. Members noted the recommendations made regarding the approval process for collective commissioning, though which the Joint Committee would support for approval by each individual Heath Board via their own arrangements. Page 4 of 16

5 A discussion followed regarding the route of sign off and it was agreed that the form should include executive level sign off to provide a more robust process. Proposal for collective commissioning form to include Executive Sign off Members requested greater clarity regarding the services identified for collective commissioning and under which of the four categories they fell. A discussion followed around where the financial impact should sit and it was agreed that this would need to be reported as a separate section in the ICP. IL to circulate ICP appendix identifying proposed services for collective commissioning for next year and their category. Acting Director of Planning, Acting Director of Planning, Approve the Collective Commissioning Framework subject to the amendments noted above. MG15/200 Integrated Commissioning Plan (ICP) Update Members received a presentation on the development and progress of the 2016/19 ICP. Members noted that the finance tables and the reduction in the financial quantum since the draft plan was submitted. A discussion took place around the process for building in finance impact in year and to refresh the growth in line with the planning assumptions. Members supported the positive discussions held during the workshops in relation to the amber rated schemes. A discussion followed the reconciliation to Health Board Intermediate Medium Term Plans (IMPTs) and the difference between the ICP for Specialised Services. SD provided members with an overview of the next steps, noting the principles of the funding release process. IL left the meeting Members discussed the content of the presentation and Page 5 of 16

6 agreed that the process had achieved a natural end point. Members agreed that at the next workshop the process would need to be concluded and a recommendation on the options agreed in the context of the financial framework for sign off by the Joint Committee. Acting Director of Planning, IL returned to the meeting The discussion continued around the content for the next workshop and it was suggested that there was a requirement to ensure a discussion was held in relation to referral management. Note the update; Support the approach in relation to the process of the ICP; and Agree recommendations to be signed off at the next Management Group Workshop. The Chair proposed a short adjournment of the meeting at 11.40am. The meeting reconvened at 11.54am MG15/201 Delivery of the Integrated Commissioning Plan 2015/16 Members noted the update report. Members received an update on the Joint Committee Chair s action taken in regard to UKGTN. Members noted the agreement at the Joint Committee in relation to Cochlear Implants and BAHAs and that work was in progress to identify the level of activity which could be achieved before 1 April RH sought clarification around the Mental Health and Learning Disability Collaborative Commissioning Group. A discussion took place regarding the terms of reference for the Mental Health and Learning Disability Collaborative Commissioning group. It was recommended that the Mental Health and Learning Disability Collaborative Commissioning Group review the terms of reference at its first meeting. Mental Health and Learning Disability Collaborative Commissioning group to review its Committee Secretary, Page 6 of 16

7 terms of reference at their first meeting. Members were informed that the Directors of Finance (DoF) Group were scheduled to receive a presentation from the NHS Wales Collaborative Commissioning Team. It was agreed that a briefing would be circulated to Management Group Members following the meeting. Briefing to be circulated to members following the DoF meeting. Director of Finance, Note the funding release proforma schedule; Note the progress against the work plan for 2015/16; and Note the risk management summary. MG15/202 Alternative and Augmentative Communication Policy and Service Specification. IL introduced the report and referred members to the policy and service specification for support. Members noted that the Equality Impact Assessment was not yet complete however would be presented to the Joint Committee in March Members noted the appointment of a Project Manager to lead this work. Members discussed the funding arrangements for the service and noted the discussion that was held at the Joint Committee. It was noted that it was a matter for individual Health Boards regarding the use of the Intermediate Care Fund (ICF) to support delivery. Members noted the action from the Joint Committee to write to Welsh Government in relation to the funding position. Note the content of the report; Support the AAC Hub service policy and service specification; and Approve submission of the policy and service specification to the Joint Committee in March for final approval. MG15/203 Genetics Service Specification Members received an overview of the report and were informed that the specification included amendments Page 7 of 16

8 following consultation. Clarification was sought as to the period for which the specification covered and it was noted that that the specification only related to 2015/16. It was agreed that any future developments would need to be included within the ICP and approved by the Management Group. A query was raised around section 4.1 of the specification which referred to performance monitoring. A discussion followed in relation to the funding and activity reporting requirements. It was suggested that to include unit cost comparison in the performance report to understand a baseline position for future commissioning. It was agreed on receipt on the first quarter performance report; the Management Group would confirm whether the reporting arrangements meet their requirements. Members to confirm reporting arrangements meet requirements on review of the first quarterly performance report. Director of Finance, Note the contents of the report; Note the results of the formal consultation on the genetic service specification and resultant amendments made to both documents; and Approve the genetic service specification. MG15/204 Neonatal Services Revised Funding Model Members noted the report on the proposed funding model for Neonatal services covering neonatal intensive, high dependency and special care. Members were advised that the finance working group had been unable to reach a unanimous agreement although there was a majority view which formed the basis of the recommendation outlined within the report. A detailed discussion was held in relation to the funding baseline including standard prices. A query was raised regarding the use of terminology and it was advised that the term standard cost referred to standard price. The discussion continued around the need for assurance regarding resources and it was noted that the outlined approach would be Page 8 of 16

9 resource neutral. SD presented a detailed overview of each of the options and recommendations made as noted in the report. Clarity was sought in relation to the requirement to rebase the baseline each year as well as in year variation. A discussion followed regarding the incentivisation and network movement in future plans due to being dynamic rebasing should be done annual as a refresh in plan. RH stated that ABUHB were still considering their position regarding neutralisation and could not agree that element at the time of the meeting. It was advised that a resolution was expected from ABUHB in the next few weeks. Members agreed to support Option 1 to re-state the commissioner investment and provider contracts at the standard rates detailed, utilising an average of 2012/13 to date to establish a new contract volume baseline that would include SCBU and transitional care. Members agreed that future variation against the baseline will be funded or recovered at full cost. Members agreed that financial flows related to SCBU will need to be implemented via Collective Commissioning arrangements. MG15/205 Note the current position in respect of the proposed revised funding model; Agree the recommendation to conclude the work and implement the revised model based on the majority view; and Agree that financial flows related to SCBU will need to be implemented via Collective Commissioning arrangements. Savings Report Update SL provided an overview of the report highlighting the following areas to note. Bariatric Surgery Members noted that there had been difficulties progressing work in this area due to low activity levels and that there was ongoing performance management of the service. It was noted that an Audit Day was planned for May 2016 during which a review of the types of practice would be undertaken. Page 9 of 16

10 A discussion was held regarding modality of treatment as an area for future savings and it was agreed that this would be raised for discussion during the planed Audit Day. A query was raised regarding the contract with the current provider and it was noted that there was only availability to commission one service. Renal Dialysis Members noted that Wales benchmarked higher within a more difficult population for home dialysis, though areas of variation within the benchmarking were highlighted. Clarity was sought regarding how work was progressing and future opportunities for saving. It was noted that there were no new initiatives and that improvements had been made through best practice. Cardiac Resynchronisation Therapy (CRT) SL provided an overview of the clinical position for Wales. Members noted the 2015 NICE guidance favouring the defibrillator device and that work was ongoing to challenge this in regarding the requirements of the Welsh population. A discussion was held regarding the approach taken to identify cost savings and members agreed the requirement to have a more systematic approach going forward. Challenge was raised regarding the areas of saving and need to provide a more formal comprehensive report of the three areas to provide assurance in terms of these specific schemes identified as part of the ICP process. There was a detailed discussion in relation to the savings schemes and that the current report did not provide sufficient assurance. Members acknowledged that these areas were identified via the prioritisation process at that time, and that if there was no further work that could be progressed, an assurance report covering the explanations provided should be considered by the Management Group. Actions Assurance report to be presented to the Group which will also outline an approach to a more systematic way to identify saving areas for the future. Acting Medical Director, RM left the meeting Page 10 of 16

11 A concern was raised regarding the timescales for undertaking a systematic approach to identification of savings and whether a there was a requirement for a saving plan in a similar way to that for investments. A discussion followed regarding the involvement of in development of saving plans and management of total cost; recognising collective work. Members were asked if they would share their best practice in regard to the value based approach with. Members to share examples of best practice from individual health boards around development of saving plans; including values based approach and expansion through prudent healthcare. All Members RM returned to the meeting Note the contents of the report; and Support progress to date The Chair proposed a short adjournment of the meeting at 1.27pm. The Meeting reconvened at 1.45pm MG15/206 Thoracic Surgery Update IL provided an update on progress and noted that the business cases had not yet been received from providers. It was noted that it was expected that a report would be presented at the next Joint Committee for approval following the approval of the Integrated Commissioning Plan in March A discussion took place regarding the proposed timescales and that it was anticipated that the initial review of work would be accelerated to complete in six months, as agreed by the Joint Committee. Members discussed the financial impact of the service and agreed to receive an updated report in March/April 2016 depending on the availability of information from providers. Action Report update to be provided in April 2016 following receipt of information from provider. Acting Director of Planning, Page 11 of 16

12 Note the implementation of the funding release for approved for 2015/16; and Note the actions taken to mitigate the risks to the commissioning plan for thoracic surgery for 2016/17. MG15/207 Finance Report SD introduced the report advising the position at month 10 was aerspend of 2.5 million and a forecast outturn position of 4.2 million overspend. Members noted the key risks as highlighted within the report and actions taken around areas of over performance. Members were informed that the format of the report continued to evolve and an additional summary had been provided regarding analysis of risk to health board movements as Commissioner to provide additional information to Members. Members noted the sustained alas position acknowledging the work undertaken with Welsh Government to secure additional funding to support resources and performance to ensure performance levels are maintained. A query was raised regarding the recommendation to note the liability regarding WAST approved by the EASC Joint Committee. Members were advised that this information had not been provided within the report as this was reported to EASC. Note that the underlying financial risks detailed in the IMTP process remain, in particular the risks regarding the activity and financial trends in English contracts; Discuss and agree any specific corrective action that can be agreed to reduce forecast overspending; Note the residual commitment in relation to cardiac surgery outsourcing and the likely level of financial liability for 2015/16; and Note the updated financial position against the approved ICP for 2015/16 MG15/208 Performance Dashboard SD presented the report which provided members with a Page 12 of 16

13 summary of the key issues arising detailed actions taken to address areas of non-compliance. Members noted the following key areas as highlighted: Cardiac Surgery Members noted the waiting times position and that the 36 week RTT target remained on track. Paediatric Surgery Members noted the position in Paediatric Surgery and that this was being escalated with the Provider. Members noted in particular the breaches as they relate to each individual Health Boards. It was agreed that the profile of the breaches, broken down by Health Boards would be included into future reports. Members discussed the significant clinical risks in relation to the current waiting lists and it was agreed to provide this level of detail to each of the Health Boards. Members agreed to receive a more detail report in relation to Paediatric Surgery. Members agreed to support a high level exception report to the Joint Committee in terms of the performance dashboard. Information regarding breaches in performance to be provided by health board in future reports. Detailed report regarding concerns around paediatric surgery to be provided at the next meeting in March 2016 Director of Finance, Acting Director of Planning, / Acting Medical Director, Note the use of the new interim 2015/16 performance dashboard; Support the progress in developing the commissioning teams and quality framework to further input into the dashboard; and Note current performance and the action being taken to address areas of non-compliance. MG15/209 Corporate Risk and Assurance Framework (CRAF) PW presented the report reminding members of the agreement to present the CRAF to the Group twice a year for Page 13 of 16

14 assurance. Members noted that work had been undertaken to identify alignment of the Corporate Risk Register with that of Health Boards which highlighted a number of discrepancies. It was acknowledged that further work regarding this was required to refine the process. Members were asked to consider the risks detailed within the report and consider if there are any additional risks for inclusion as members would be required to provide some assurance to the Joint Committee. PW to liaise with HB Corporate Secretaries to address areas of discrepancy between risk registers. Members to review HB risk registers and identify any items for inclusion on the risk register Committee Secretary, All Members A discussion followed regarding the process for identifying top level risks, acknowledging that further work was underway to strengthen the system and process following the Good Governance Institute Governance Review. It was noted that the risk relating to Paediatric Surgery was identified following the production of the report and therefore was not included in the version circulated. Note the update provided within the report; Consider the risk for which the assurance committee is the Corporate Risk Committee; and Discuss whether there are any other risks for inclusion on the Framework. MG15/210 Renal Service Specifications Members received the report for information. It was noted that the service specifications will be issued to the Renal Services in Wales confirming that these will continue to be reviewed through 2016/17 as part of the gap analysis and impact assessment agreed with Management Group. Note the progress against the four priorities set out in Page 14 of 16

15 the specifications and contained within the Renal Delivery Plan; and Note that the service specifications will be issued to the Renal Services in Wales confirming that these will continue to be reviewed through 2016/17 as part of the gap analysis and impact assessment agreed with Management Group. MG15/211 Joint Committee Annual Business Cycle 2016/17 Members received the report for information and were informed that it was anticipated that a work plan would be developed for the Management Group. Note the contents of the report; Note the schedule of meetings as listed; and Note the Annual Business Cycle for the Joint Committee. MG15/212 Management Group Membership Members received the report for information and were informed that some updates to the membership had been received since circulation. A detailed discussion followed around the role and functions of the Management Group as this was discussed at the last Joint Committee. Members noted that the Governance Review had found that the role and seniority of the members required a review. It was acknowledged that the fieldwork for the review was some time ago and since that time, the Management Group felt that they had developed and matured as a group. SL left the meeting HL left the meeting Members reflected on the comments made by the Chair. A detailed discussion followed around lessons that could be learnt and it was agreed that it was important to ensure that there was clarity in terms of the functions of the Management Group to enable effective and timely decision making. SL returned to the meeting Page 15 of 16

16 Note the content of the report MG15/213 s and Venues Members received the report for information. Note the content of the report. MG15/214 Other Items of Business Royal National Orthopaedic Hospital NHS Trust - Referrals from Wales - Improving Prior Authorisation Process for the Benefit of the Patients and Minimising Financial Risk. Members discussed the letter received by Health boards regarding a request for to act as a central point. Members agreed that Health Boards would manage their own contracts and that would not take a central coordination role on behalf of the Health Boards. Paroxysmal Nocturnal Haemoglobinuria (PNH) Members were informed that an had been circulated to all Health Boards regarding the revised process for PNS claims. It was noted that Leeds were no longer completing paper work and that this should now be carried out locally in line with the protocol for the rest of the UK. It was confirmed that this would not impact the current contractual arrangements. SL to share numbers for each health board Acting Medical Director, MG15/215 Date of Next Meeting It was agreed that the date and time of the next meeting would be Thursday 24 March 2016 The Chair CONCLUDED the at 2.54pm Page 16 of 16