Wandsworth Clinical Commissioning Group Board Date 6 TH June 2018

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Jennifer Sparks
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1 Wandsworth Clinical Commissioning Group Board Date 6 TH June 2018 Report Title Lead Director Author Summary Minutes See individual minutes Tony Foote Purpose Approval X Discussion X Noting Executive Summary: This paper contains summarised minutes of the following meetings: - Finance Committee in Common Integrated Governance Committee , Audit Committee These summaries are not intended to replace the formal minutes of these meetings. Those minutes are available upon request.. Conflicts of Interest: N/A Recommendation: The Board is asked to note the contents of the summarised minutes.

2 Corporate Objectives This paper will impact on the following: NA Risk This paper links to the following CCG risks: NA Financial Implications As contained within the summarised minutes Has an Equality Impact Assessment been completed Are there any known implications for equalities NA NA. Patient and Public Engagement and communication NA Committees previously considered at The various Committees have approved the full minutes of these meetings. Supporting Documents None

3 SUMMARISED MINUTES Finance Committee in Common Meeting date: Members Present: Chris Savory (Chair), David Smith, Stephen Hickey, Neil McDowell, James Blythe, Dr Mike Lane, Dr Andrew Murray, Main Items Discussed Wilson Project Benchmarking CHP Development Budget For the Project to progress the CCG was required to underwrite the development costs that would be incurred by Community Health Partnerships. This matter was considered by the February Finance Committee in Common meeting which requested further information of the costs and for these to be benchmarked to demonstrate they are within normal market range. This was undertaken and showed that the estimated Development Project Support costs of 713,600 compared favourably with the actual Nelson Health Care Project costs. The Finance Committee in Common APPROVED the recommendation for Merton CCG to under-write CHP estimated budget for project development costs of 713,600. MCCG Waiver of Formal Tender The MCCG Finance Committee APPROVED the recommendation to extend the pilot in respect of Off The Record ( 121,979) for a period of one year; and NOTED the Managing Director s action to extend the pilot regarding The Wish Centre ( 39,178) for a period of one year. Merton and Wandsworth Finance Report Month 11 The headlines of the report were: - Both CCGs continued to report their full year positions off plan as agreed with NHS England to accommodate the pressure on the prescribing budget due to no cheaper stock obtainable drugs costs. - Both CCGs were on track to meet the running cost targets - WCCG over-performance at SGH has increased by 0.5m, due principally to a rise in emergency spells. Outpatient activity is also above trend across various areas of the Trust. The impact of these factors on the forecast spend has been mitigated by the seasonality provision. - There was a significant risk that the CCGs would ill not receive the expected allocation adjustment related to specialised commission activity based on the data received from NHSE. The matter has been escalated to NHSE to resolve the position for 2017/18 and this matter would be added to both CCGs the risk registers. - In response to concerns raised by the Finance Committee that a formal governance process to manage the STP budget and provide oversight to the LDU as the host commissioners, NM advised that a PMO Audit would be undertaken to address the governance concerns. Its results would be shared with the Committee. The Finance Committee in Common APPROVED the M11 report. Budget setting and financial planning 2018/19 Merton and Wandsworth CCGs Contracts with acute providers had not yet been signed and so it was not possible to finalise the budgets for 2018/19. However, by April all contracts will be agreed and budgets finalised and to the Committee for approval.

4 - MCCG is required to deliver a control total surplus of 1.86m for 2018/19 an increase of 0.75% from 2017/18; - WCCG is required to deliver a small surplus of 91k against its allocation; - NHS Business rules: 1% non-recurrent reserve is no longer required and has been split as follows:- 0.25% has been set as SWL CCG risk reserve 0.25% has been added back into the CCG position. 0.50% is committed as per 17/18 against system wide initiatives such as the STP PMO and London Transformation Fund (Healthy London Partnership) - Analysis of how the risk relating to unidentified QIPP will be mitigated for 18/19 will come back to the Finance Committee. - Reserves were held for Acute Performance (RTT maintenance), QIPP investment and to input any growth or contract settlement post budget sign off. In addition the Contingency and SWL Reserves required under NHS Business Rules are also held. The Finance Committee in Common NOTED the update. Healthy London Partnership planning for 2018/19 The Finance Committee AGREED the recommendation to Governing Bodies to formally approve the HLP funding of 9,244k for 2018/19.

5 SUMMARISED MINUTES Integrated Governance & Quality Committee Meeting date: Members Present: Dr Andrew Murray, Dr Nicola Jones, James Blythe, Julie Hesketh, Josh Potter, Stephen Hickey, Dr Mike Lane, Dr Jonathan Chappell, Andrew Leigh, Sam Page, Julie Hall, Carol Varlaam, Clare Gummett, Dr Natasha Curran, John Atherton, Dr Tim Hodgson, Dr Karen Worthington, Kimball Bailey. Main Items Discussed: Integrated Governance Report Risk Update - Going forward there would be one common risk system: 4Risk. - All risks were currently being reviewed in depth to avoid duplication. - The Board Assurance Framework to come to the Committee twice a year. Finance Update - Both CCGs still projected to meet control totals but this remained very tight. Quality, Safety Effectiveness and Experience - Current Amber Alerts and Sis were highlighted. St George s - Merton CLCH felt there were a higher level of neonatal still births. SGH have been completing a review and this is being discussed at CQRG next week. The Alliance lead is going to look across the other providers as this is not just relevant to SGH. - There remained nine RCA reports pending and four sent for FIRs. The Committee its concern over the level of quality assurance at St George s and that the report received needed to assure the Committee regarding any quality impact as a result of the performance issues at SGH. AM and NJ agreed to discuss outside of the meeting what the reporting requirements for quality at SGH should look like. SWL SG Mental Health Trust - Kingston CCG would be taking back hosting responsibilities for the Trust from 2018/19. JHe emphasised that CCGs would to continue to be assured over key aspects of quality. - The Committee felt there should be a new risk added to the risk register in respect of the changes proposed. Performance Report - A&Es have had a couple of very difficult weeks post the cold period - DTOC levels remained very low although stranded patients remain a challenge with 35% of patients having been in hospital for over seven days. - JA acknowliedged a lack of clarity regarding reasons for high rate of 62 cancer waits for Royal Marsden. This is being addressed with the Trust at their performance meetings. GDPR Preparedness - Both CCGs were on track for compliance with GDPR although a decision about the Data Priotection Officer role is still required. - The issues of potential financial penalties for non-compliant GP Practices was raised and the possible destabilising effect this could have. The Committee felt that the CCG had a responsibilty to ensure primary care was not destabilised -

SUMMARISED MINUTES Integrated Governance & Quality Committee Meeting date: 17.04.

6 SUMMARISED MINUTES Integrated Governance & Quality Committee Meeting date: Members Present: Dr Andrew Murray, Dr Nicola Jones, James Blythe, Julie Hesketh, Neil McDowell, Dr Jonathan Chappell, Andrew Leigh, Sam Page, Dr Waqaar Shah, Carol Varlaam, Dr Natasha Curran, John Atherton, Dr Karen Worthington, Rod Ewen. Main Items Discussed: Integrated Governance Report Risk - It had been agreed to escalate the migration of Merton CCG risks from the CSU system across to the Wandsworth 4Risk system.. - Two risks were proposed for closure during the month. There were three new risks added (1xHigh and 2xMedium priority) Finance - Breakeven position reported for Merton CCG and a surplus for Wandsworth CCG as planned; - Continuing healthcare for Merton closed at an agreed level although accruals have been put in place for the financial risk remaining in 18/19. Additional money has been put aside in the 18/19 plan to cover this risk ( 1m). - Acute commissioning year end challenge has come from St George s issuing a significantly higher volume of invoices than was expected. Quality, Safety Effectiveness and Experience Wandsworth SIs - Five reported in March, including two Never Events. - Other commissioned SIs included a Southleigh homicide investigation report, focussed on care coordination, communication and assessment of mental health status. - The Committee requested that future reports should detail SIs involving Merton and Wandsworth borough residents at providers commissioned by other CCGs. Make a Difference Alerts Key issues included: - Discharges: delays in sending out discharge summaries along with some errors in medication issued on discharge. This has been raised with the Trust and their response was awaited. - Outpatient delays and referrals linked to RTT. There was a focused review on this due in June. JB said that going forward there was a need to consult with SWL colleagues over these issues as they were likely to be of common interest.

7 SGH Key Quality Focus EB highlighted key quality issues for the main commissioner and confirmed that: - The National Maternity and Perinatal Audit findings showed that the Trust compared favourably with other similar units. - There were two 12 hour breaches in A&E as a result of not following the correct escalation pathway at night time. - The quality team review the Quality Improvement Plan dashboard each month - No new cases of cases or harm reported in month. AM drew attention to the continued red performance targets for workforce. EB clarified that the HR Director reports quarterly to the CQRG and that information on safeguarding training is provided along with monitoring reports. There were no specific safeguarding concerns at present. Merton SI s - The key issue for Merton was around tightening the process for monitoring actions from SI s. Additionally, there were a number of homicide reviews in place for which reports will be brought through this Committee at a future meeting. Merton Amber Alerts - For SWL St Georges MHT the key theme was suicide and it had taken some time to produce the investigation reports. Assurances have been provided that the reports were going to the April Internal Governance meeting at the Trust and these would be released and discussed at the May CQRG. Performance Report Merton IAPT service - The provisional position of between % falls below the 4.1% access target. - During Q4 significant data quality issues were identified. A data quality audit of weekly and monthly data has been requested. RTT Position - The Trust has now implemented a new Patient Tracking List System and the Trust was working to prevent errors starting to appear on the list again. - The Trust has set a trajectory for the PTL to halve during the year (50,000 to 25,000). - 19,000 patients had previously been contacted to clarify if they need any further involvement by the Trust. Of these, 3,500 responded but only a small number have confirmed they require further intervention. St Georges Hospital Deep Dive The findings of this were summarised. The committee noted the consenus around the very high standard of inpatient care but the ongoing and systemic challenges in relation to outpatient and elective access and the requirement to ensure improved follow-up of SIs in this area.

9 SUMMARISED MINUTES Audit Committee Meeting date: Members Present: Stephen Hickey, Chris Savory, Carol Varlaam Main Items Discussed: Governing Body Board Assurance Framework - There had been a substantial amount of review of risks over the previous few weeks - It was proposed to simplify the categorisation of risk by moving from four categories (low, moderate, high, very high) to just three categories (low, moderate, high). - The review of risks with the frequency of review based on the current risk score (low = quarterly, moderate = bi-monthly, high = monthly) - The Executive Team will review all risk target dates to be clear on where risks will fall across financial years to provide greater clarity. Conflicts of Interest Policy The policy had been updated as a result of the latest guidance from NHSE and that the whole document be refreshed across the Alliance with the aim of having a standardised policy. The recent Audit Review recent review had shown an overall positive outcome. SH raised the point that due to the difficulty in finding the Register of Gifts and Hospitality on the CCG s website. CV also added that the register of interest on the website does not appear to be updated in line with in year changes provided. Gifts and Hospitality Policy - JH highlighted the small number of changes to the values of acceptable gifts issued in the new guidance. - The committee discussed the merits of the 50 limits for gifts from non-suppliers. CS raised the point that values should stipulate and 50 and above to ensure no value was not covered by the categorisation. - JH agreed to work towards a combined policy along with a short user guide to be shared across the SWL Alliance. NELCSU Service Auditor Report From the four key points raised these presented no significant concerns from an Internal Audit perspective Internal Audit Update Financial Planning and QIPP Report - This was a positive report although highlighted the need for better governance around the workbooks for schemes. - A new permanent Head of PMO has been appointed and the PMO was now reporting through the Finance Recovery Oversight Group, replacing the Savings Delivery Group Continuing Healthcare Report - The positive green outcome reflected the significant amount of work that had gone in to this area and that many other CCGs were still struggling with CHC and looking towards Wandsworth CCG as a high performer. Draft Head of Internal Audit Opinion There was nothing to indicate that the opinion would not remain positive but referred to the significant amount of work yet to conclude.

10 External Audit - Three main risks for audit consideration were identifies: Revenue cycle includes fraudulent transactions Management override of controls Operating expenses purchase of secondary healthcare - CS felt the range of materiality was quite big although NA clarified to the meeting that the 1.95% attributed was in line with previous years materiality range. - CS asked about the audit fee and the difference in range between 40k and 67k. SI clarified that the audit fees are set by PSAA and that the other CCGs in SWL had previously been set around the 40k mark. - CS questioned the 12.45m running cost breakeven figure. NM confirmed this was incorrect and appeared to reflect the corporate cost. Any Other Business The issue of audit committees coming together across the two CCGs was raised. NM confirmed that the aim was to align the audit cycle for both Committees - probably adopting the Wandsworth cycle. However, it was recognised that, at present, a large amount of work remains CCG specific. An annual plan of business for the audit committee providing a baseline to work from would be drafted and shared with members.

REPORT TO THE MERTON CLINICAL COMMISSIONING GROUP GOVERNING BODY

REPORT TO THE MERTON CLINICAL COMMISSIONING GROUP GOVERNING BODY Date of Meeting: 25 th January 2018 Agenda No: 9.2 Attachment: 11 Title of Document: Summary Report of the Merton CCG Finance Committee