Wednesday, 22 June 2016 - NHS Tameside and Glossop Clinical

Transcription

NHS Tameside and Glossop Clinical Commissioning Group
Part A Governing Body meeting
on Wednesday 22 June 2016
to be held at 1pm in the Board Room at New Century House
Agenda
1
Welcome and apologies:
Verbal
A Dow
2
Declarations of interest
Paper
All
3
Consideration of items of any urgent business
Verbal
All
4
Chair’s introduction
Verbal
A Dow
5
Draft minutes of the Governing Body meeting held on 25 May
2016
Paper
A Dow
9
6
Actions arising
Paper
A Dow
22
7
Bringing the Public and Patient voice into our Governing Body
7.1 Patient Story
Verbal
7.2 Report of the meeting of 15 June 2016 and approved minutes of
Paper
the Public and Patient Impact Committee meeting of 18 May 2016
7.3 Public and Patient Impact Committee report
Paper
M Rothwell
C Poole
24
C Poole
30
Paper
S Allinson
41
Paper
A Dow
43
Verbal
Verbal
Paper
Paper
Paper
A Dow
A Dow
C Watson
M Rothwell
N Riyaz
51
58
64
Paper
C Poole
68
Paper
A Hardman
75
Paper
Paper
K Roe
D Swift
98
114
8
Chief Operating Officer’s update
9
Commissioning for reform
9.1 Report of the Single Commissioning Board meeting held on 7
June 2016 and approved minutes of 20 April 2016
9.2 Update on any matters referred to GB by SCB for information
9.3 Update on any matters received by SCB requiring GB approval
9.4 Transformation Report
9.5 Quality Report
9.6 Draft minutes of the Neighbourhood Leads meeting held on 31
May 2016
10 Quality review and assurance
10.1 Report of the meeting of 1 June 2016 and approved minutes of
the Quality Committee meeting of 4 May 2016
11 NHS Constitution performance review and assurance
11.1 Performance Update
12 Finance performance review and assurance
12.1 Month 2 Finance Report
12.2 Report of the meeting held on 15 June 2016 and approved
minutes of the Finance and QIPP Assurance Committee meeting
held on 18 May 2016
1
13 Integrated Governance, Audit and Risk Committee
13.1 Ratified minutes of the Integrated Governance, Audit and Risk
Committee meeting held on 23 March 2016
13.2 Proposed Terms of Reference of the Audit Committee
Paper
G Curtis
121
Paper
G Curtis
132
14 Partnership and Greater Manchester meetings and updates
14.1 Ratified minutes of the Association Governing Group meetings
held on 17 May 2016
Paper
S Allinson
144
15 Any items of urgent business
Verbal
A Dow
Register of Interests 2015/16 – Governing Body
Name
Position Held
Declared Interest
Membership of Professional Body
Interest
GP Clinical Lead Millbrook.
Dr Saif Ahmed
Steve Allinson
Locality Lead
Chief Operating
Officer
Royal College of General
Practitioners member
Clinical lead Grange View.
Date of
Declaration /
Confirmation
19/08/2015
Wife is Dr Christine Ahmed GP Locum Guide Bridge/ Skin
Viva Cosmetic Millbrook
Spouse is a PA at Pennine Acute Trust.
Nil
Dinner invitations x2 Incl. Meetings with PWC (CPT) – both on
register.
28/07/2015
GP at Lockside Medical Centre.
Board of Trustees for Stockport World Citizens (Local Charity
to help volunteers).
Dr Richard
Bircher
GP at Lockside
Medical Centre CCG Governing
Board Member
Medical and Dental Defence Union
of Scotland
British Medical Association
Married to Dr Joanna Bircher. CCG lead for Quality
Improvement.
GP Partner with Dr Thomas Jones. CCG lead for Cardiology.
31/03/2016
List of enhanced services to add to my list of interests:
IUD and implants; fitting minor Surgery; DMARD monitoring;
anti-coagulation; Alcohol DES; £5 per head for over 75’s;
Pessary fitting;
Zoladex; Insulin initiation; NHS healthchecks; vaccines and
immunisations; avoiding unplanned admissions; extended
hours;
learning disability health checks.
1
Expert by experience for Age UK – to do CQC Inspections in
care homes. – No longer in this role from 31.01.16
Graham Curtis
Lay Deputy Chair
Nil
Football ticket (Newcastle v AFC Bournemouth) worth £50
offered by Michelle Watson, Inspector NHS Protect. The ticket
was declined.
Salaried GP at Albion Medical Practice
31/03/16
Locum GP in Tameside and Glossop Area.
GP at Go-to-Doc for OOH work.
Dr Jamie
Douglas
GP at Albion
Medical – Governing
Body member
General Medical Council member
GP at EUR TRIAGE with GMSS.
Educational role with University of Manchester.
13/05/2016
GP Appraiser for NHS England
Jamie and his family are now living in Tameside and will
shortly be registering with a GP practice there
Jamie and his family are now patients at The Smith Surgery
West Pennine Local Medical
Committee member
Dr Alan Dow
GP at Cottage Lane
Surgery
CCG Chair
NW Manchester General
Practitioners Committee
Representative
NW Deanery – Training Practice
GP Cottage Lane surgery, Gamesley Glossop providing GMS
services and enhanced type services for smoking cessation,
family planning, minor surgery, substance misuse and
alcohol, health checks.
Orbit Shareholder.
06/4/2016
Wife is an Anaesthetist at Tameside General Hospital.
Attended various training events sponsored or subsidised by
pharmaceutical industry.
2
Practitioners’
Family Doctors Association
Medical Protection Society
No substantial gifts.
Various offers to chair or advise declined.
Marks and Spencer vouchers offered for attending meetings
with Primed - £100 cash received instead
Meal with Price Waterhouse Cooper on 2 December 2015 to
the value of £30
GP Principal Mossley Medical Practice
Director of GoToDoc (OOH provider and provider of APM
procedures)
Dr Tina
Greenhough
GP Principal at
Mossley Medical
Practice
Employed as a Clinician for St Martins Healthcare who are
sub contracted to Lifeline to provide drug and alcohol services
for Tameside.
Local Medical Council member for
West Pennine
GP Board Member
NHS England Appraiser
CCG Clinical Lead for Gateway Refugees and Asylum
Services
31/03/2016
GP Principle – MMP providing GMS and enhanced services
including: Alcohol and Substance Misuse Services; Smoking
Cessation; NHS Health Checks; £5 per head Over 75s
Scheme; Dementia Diagnosis and Screening; Extended
Hours, D-MARDS Monitoring; Vaccinations and
Immunisations; Avoiding Unplanned Admissions; Learning
Disability Health Checks.
Angela
Hardman
Director of Public
Health
Member of the Faculty of Public
Health
Nil
03/11/2015
3
On the PwC Advisory Board – Clinical Panel not involved in
any work in the UK at the present time
Trustee: National Confidential Enquiry into Patient Outcome
and death (NCEPOD)
Professor Tim
Hendra
Secondary Care
Consultant,
Governing Body
Royal College of Physicians
British Association of Stroke
Physicians
Specific interests in:
Non-professional Sheffield Hallum University
Chair MPTS tribunals
Assessor NCAS
20/05/2016
Free Mason
Previously a consultant physician at Chesterfield Royal
Hospital NHS Foundation Trust.
Now retired with effect from 9/5/2016
Virtual PPG panel member – Albion Practice.
CVAT Member Voluntary Action Oldham Steering.
Group Member. Rotary club of Ashton Under Lyne: PR
Officer.
Jean Hurlston
Lay Advisor
NHS England Public Patient
Groups (various) notified as and
when required.
Coordinator Oldham Street Angels.
Oldham Street Angels has received ‘Dragons Den’ funding to
cover costs of sessional healthcare workers (Non recurrent)
06/06/2016
Locum Chaplain with THFT – a permanent post from 1 June
2016
Member of Chaplaincy team at Manchester Airport.
Chaplain at Ashton Six Form College.
4
Member of the Greater Manchester Values Group
Member of the Access to GP Steering Group Research Study
with University of Manchester PhD student. Expenses
received from University of Manchester.
Churchgate Surgery: GP Partner with Dr Asad Ali (Locality
Lead and Orbit Director).
Membership of the Royal College
of General Practitioners
Dr Alison Lea
Paul Pallister
GP Governing Board
Member
Assistant Chief
Operating Officer
Member of the Academy of Medical
Examiners
(member)
T&G Appraiser.
Director, RWL consultants.
Training Programme Director, Tameside and Glossop.
Orbit member (GP Federation)
25/11/2015
NHS England GP Appraiser
Medical Defence Union (member)
Provider of enhanced services: IUD, implants, minor surgery,
DMARD monitoring, anti-coagulation, Alcohol DES, Drugs
DES, £5 per head for over 75’s, Pessary fitting, Zoladex,
Insulin initiation, NHS healthchecks, vaccines and
immunisations, avoiding unplanned admissions, extended
admissions, extended hours, dementia diagnosis, and
learning disability health checks.
Nil
A close personal friend is an equity partner at Hempsons
28/07/2015
5
Director of CP Media Services Ltd. 50% shareholdings in CP
Media Services Ltd.
Celia Poole
Lay Member
Member Chartered Institute of
Public Relations
Commissioned through CP Media Services Ltd to deliver
service for and on behalf of Active Tameside.
Associate Chartered Management
Institute
CP Media Services Ltd has been contracted by NHS England
for the period 21 December 2015 until 31 March 2016 to
deliver communications services – this contract has been
extended to 30 September 2016
06/06/2016
GP Principal Tame Valley Medical Centre
Dr Naveed
Riyaz
Ashton Locality Lead
General Medical Council member
GP Trainer
Primary Care Medical Educator (Health Education North
West)
Medical and Dental Defence Union
of Scotland member
Locality Representative (West Pennine LMC)
West Pennine LMC
Provider of core GMS services and enhanced services for
minor surgery, joint injections, extended hours,
anticoagulation, smoking cessation, family planning, IUD and
implant fits, substance misuse and alcohol, DMARD
monitoring, ring pessary fits, zoladex hormone treatments and
insulin initiation.
Health Education North West
(training practice)
Faculty of Sexual and
Reproductive Healthcare (member)
Orbit Healthcare
18/10/2015
Clinical interests in epilepsy and men’s health
6
Kathy Roe
Chief Finance
Officer
Michelle
Rothwell
Interim Deputy
Director of Nursing
Association of Accounting
Technicians
Chartered Institute of Management
Accountants
Nursing and Midwifery Council –
member
Gift - accepted a donation of an unused football ticket from
Matt Newton (contractor.) It was a season ticket not being
used by the contactor and is worth approximately £40 (no cost 03/03/2016
to the contractor.)
Nil
16/11/2015
Member of PPG at GP Practice.
Chairperson at Patient Locality Group Glossop.
Dr Lesley
Surman
Lay Advisor to CCG
T&G
Advisor to Self-Advocacy work stream at Tameside
Healthwatch. Healthwatch Derbyshire & Healthwatch
Tameside self-management UK.
Nil
RSPCA – home assessor.
24/02/2016
Glossop voluntary centre.
Member of the Access to GP Steering Group Research Study
with University of Manchester PhD student. Expenses
received from University of Manchester.
7
Lay Advisor to NHS East Lancashire CCG until 31/10/2015
Sessional Audit Committee member at NHS Stockport CCG.
David Swift
Lay Advisor
Member of the Chartered Institute
of Internal Auditors
Wife is an Associate Manager for Mental Health Act reviews
(sessional) at Calderstones Partnership Foundation Trust.
01/11/2015
Lay member for Governance and Audit at East Lancashire
CCG (from 01/11/2015)
Governing Body Nurse at NHS Salford CCG until 30/03/2016
Clare Todd
Governing Body
Nurse
Registered with the Nursing and
Midwifery Council
Clare Watson
Director of
Transformation
Nil
Caldicott Guardian for NHS Tameside and Glossop CCG as
of 01/04/2016
06/06/2016
CHP – BTG Lift Co Ltd (Public Sector Director)
07/08/2015
8
Draft minutes of the Governing Body meeting held on 25 May 2016
Part A
Present
Mr Steve Allinson
Dr Richard Bircher
Mr Graham Curtis
Dr Jamie Douglas
Dr Alan Dow
Dr Christina Greenhough
Dr Naveed Riyaz
Mrs Kathy Roe
Ms Clare Todd
Chief Operating Officer
GP Member and Clinical Lead for Long Term Conditions and IM&T
Deputy Chair and Lay Member
GP Member and Clinical Lead for Primary Care
GP and Chair of NHS Tameside and Glossop CCG
GP Member, Clinical Vice-Chair, and Clinical Lead for Mental Health,
Children and Families, and Integration
GP Member and Joint Clinical Lead for Urgent Care
Chief Finance Officer
Governing Body Nurse
In attendance
Mr Paul Connellan
Mrs Angela Hardman
Ms Jean Hurlston
Mr Paul Pallister
Mr Steven Pleasant
Ms Michelle Rothwell
Mrs Jayne Somerville
Mr David Swift
Mr Giles Wilmore
Mrs Clare Watson
Chair, Tameside Hospital NHS Foundation Trust
Director of Public Health
Lay Adviser
Assistant Chief Operating Officer and Company Secretary
Chief Executive, Tameside Metropolitan Borough Council
Interim Director of Nursing and Quality
Personal Assistant – Note taker
Lay Adviser
Director of Strategy and Partnerships, Tameside Hospital NHS
Foundation Trust
Director of Transformation
Mike Thomas
Perminder Sethi
Lisa Warner
Sarah Dowbekin
Tracey Simpson
Judith Stevens
In attendance for Item 3 only
Grant Thornton
Grant Thornton
MIAA
MIAA
Deputy Chief Finance Officer
Head of Finance
Apologies
Dr Saif Ahmed
Dr Tim Hendra
Dr Lesley Surman
Dr Alison Lea
Ms Celia Poole
GP Member and Joint Clinical Lead for Urgent Care
Secondary Care Consultant Member
Lay Adviser
GP Member and Clinical Lead for Planned Care, Cancer, and End of
Life Care
Lay Member
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1 Welcome and Apologies
A Dow welcomed the Governing Body members and members of the public to the May
meeting. He explained that during today’s meeting the members would be presented with
the CCG’s Annual Accounts and Annual Report and be asked to approve these. He added
that subject to their approval, he will call a short break to allow formal sign-off of these
documents by both himself and the Chief Operating Officer.
2 Declarations of Interest
A Dow invited the Governing Body to make any new declarations of interest. He explained
that there are some forms available for the members to make any necessary updates to their
existing declarations.
No declarations of interest were raised.
The Governing Body received the current Register of Interests as at May 2016 and noted the
updates.
3 Annual Report 2015\16
The Governing Body members joined the meeting of the Integrated Governance, Audit and
Risk Committee (IGAR) to receive and approve the 2015/16 Annual Accounts and Annual
Report alongside the IGAR members.
3.1
Head of Internal Audit Opinion Statement
L Warner presented the Head of Internal Audit Opinion highlighting that NHS Tameside
and Glossop CCG had achieved significant assurance whilst recognising that going
forward into the new financial year they would face a number of environmental challenges.
The Governing Body and Integrated Governance, Audit and Risk Committee were
satisfied with the report’s content.
3.2
ISA260 External Audit Report
P Sehti presented the ISA260 External Audit Opinion statement stating that External Audit
intended to issue an unqualified opinion on the CCG’s financial statements with no
material errors of uncertainties identified.
P Sehti highlighted that the Annual Governance Statement and Annual Report met the
necessary requirements however a recommendation was received regarding introducing a
formal review process before next year’s initial submission.
The report gave an unqualified regularity opinion on the CCG’s income and expenditure
and value for money. All Accounting policies, Estimates & Judgements assessments were
rated green.
The External Auditors issued two recommendations which CCG management will monitor
closely in 2016/17.
In conclusion the External Audit Opinion stated that the financial statements give a true
and fair view of the financial position of NHS Tameside and Glossop CCG as at 31 March
2016. In all material respects the expenditure and income recorded in the financial
statements have been applied to the purposes intended by Parliament and the financial
transactions in the financial statements conform to the authorities which govern them.
2
10
Grant Thornton and G Curtis, Chair of the Integrated Governance, Audit and Risk
Committee, thanked the CCG’s Finance team for their hard work during the audit. K Roe
also thanked the External Audit team for all of their support and co-operation during this
time.
3.3 Letter of Representation
P Sehti presented the letter of representation stating that it was a standard letter with no
areas of concern.
The Governing Body and Integrated Governance, Audit and Risk Committee received the
letter and were happy for it to be signed by the Chair (A Dow) and the Chief Operating
Officer (S Allinson).
3.4 Annual Report including Annual Governance Statement
The Governing Body and Integrated Governance, Audit and Risk Committee received the
2015/16 Annual Report along with a tabled Statement of the Accountable Officer.
The Governing Body and Integrated Governance, Audit and Risk Committee were happy
to approve the Annual Report and Annual Governance Statement with the inclusion of the
tabled statement.
3.5 Annual Accounts
J Stevens presented the 2015/16 Annual Accounts stating that there were no differences
to the finance reports that the Governing Body have received throughout the financial
year.
The Governing Body and the Integrated Governance, Audit and Risk Committee members
approved the Annual Accounts.
G Curtis took this opportunity to express his thanks to the Finance team for all of their
hard work. Thanks were also extended to both the External and Internal Auditors with
special thanks to L Warner. Integrated Governance, Audit and Risk Committee members
were also thanked for their role in checking and challenging throughout the year.
There followed a short break whilst A Dow and S Allinson left the meeting along with
External Audit colleagues to formally sign the relevant documents.
4 Consideration of Any Urgent Business
A Dow asked the members if they had any items of urgent business for today’s meeting.
K Roe asked if she could present the Governing Body with a QIPP (Quality, Innovation
Productivity and Prevention) update and this was agreed.
5 Chair’s Introduction
A Dow reported to the Governing Body that S Allinson, Chief Operating Officer, has received
a conditional offer following his application for a Chief Operating Officer post with NHS North
Derbyshire CCG. The Governing Body extended its congratulations to S Allinson.
A Dow reflected on the earlier presentation of the CCG’s Annual Report and Annual
Accounts and commended its content.
3
11
A Dow reported to the Governing Body that a major local public engagement event had taken
place at Hyde Town Hall on 23 May 2016 to raise awareness of the Care Together
Programme. He informed the Governing Body that Lord Peter Smith, Chairman of the
Greater Manchester Health and Social Care Strategic Partnership Board, had also
chaired the event.
A Dow was pleased to report to the Governing Body that following the CCG’s Quarter 4
Assurance Year End review meeting with NHS England the CCG has achieved "Good" in all
five areas.
A Dow updated the Governing Body following a successful, economy-wide introductory
session “Optimising your psychological wellbeing, confidence and success - The Chimp
Paradox” featuring Professor Steve Peters. The session which took place on 20 April 2016
was well attended (120 attendees) with 70 individuals signed up for the first tranche of
sessions.
A Dow was pleased to report to the Governing Body that the Tameside economy has two
winners of the British Medical Journal Awards. The Hyde Healthy Living Project has won
Primary Care Team of the Year and the Hospital Alcohol Liaison Service (HALS) within
Tameside Hospital NHS Foundation Trust has won Prevention Team of the year. The
Governing Body extended their congratulations to both teams.
A Dow also commended a note of personal excellence to a Tameside and Glossop GP
trainee who has achieved an Obstetrics and Gynaecology Diploma with the Faculty Prize for
achieving the highest mark in the year’s intake of some 400 candidates.
A Dow informed the Governing Body that Dr Andrew Thornley, a GP in Hadfield, has recently
won the prestigious title of British Veteran Fencing Champion of the Year.
6 Draft minutes of the Governing Body meeting on 27 April 2016
A Dow invited the Governing Body to comment upon the accuracy of the draft minutes of the
meeting held on 27 April 2016.
A correction was noted within Item 13.2 (page 16) which should read “… Discharge to
Assess model ” (not access).
The Governing Body approved the minutes of the Governing Body meeting held on 27 April
2016, subject to the above correction.
7 Actions Arising
The Governing Body reviewed the action log:
031115: To produce an information pack for the practices of the Over 75s bids: It had
previously been agreed that a summary of best practice to be shared with the member
practices. A suggestion had also been made that practices may wish to be informed of those
schemes which have not been as successful, in addition to those which have worked well.
C Watson confirmed that a paper is to be presented to the Professional Reference Group in
July which outlines the work to date and makes recommendations for 2017/18. She agreed
to ensure that this paper will capture the information required. C Watson and G Curtis to
review the paper in the first instance.
4
12
030316: Performance report to detail national comparison figures in relation to the NHS 111
Service: S Allinson confirmed that A Rehman is today attending a meeting with NHS 111
Service colleagues when it is hoped he will obtain this information.
S Allinson reported to the Governing Body that NHS Bury Clinical Commissioning Group is to
take on responsibility for the communication perspective of the 111 service.
050316: To coordinate a list of work plans with third sector colleagues within Derbyshire
(breastfeeding service and Glossop Volunteer service). A Hardman advised that she has
had discussions with Derbyshire colleagues in this respect and that a piece of work to
address this has now commenced.
070316: The Final Audit report on Quality Innovation Productivity and Prevention (QIPP) to
be shared with Governing Body members. K Roe agreed that this report has been submitted
to the Audit Committee earlier today and will be shared with Governing Body members
imminently.
100316: CCG Directors to consider the recommendations from the Healthwatch Survey and
decide how these are to be addressed. Quality Group to then be asked to provide the
required assurance. S Allinson asked that this action remain on the log for further
discussion.
150316: The Governing Body to receive a copy of the summary paper prepared by C
Watson regarding the CCG’s current position around LCCTs. S Allinson confirmed that he
has shared this document. It was therefore agreed to remove this action from the list.
010416: Norman’s Story: The CCG to work with both Tameside Hospital NHS Foundation
Trust and Pennine Care NHS Foundation Trust to understand what the time delay was in
responding to the complaint, and to identify what lessons had been learnt and what actions
had been taken from the learning. M Rothwell confirmed to the Governing Body that she has
received suitable assurance from both Tameside Hospital NHS Foundation Trust and
Pennine Care NHS Foundation Trust with regard to the actions they have taken as a result of
the issues raised. It was therefore agreed to remove this action from the list.
020416: The Terms of Reference of the Single Commissioning Board to be reviewed by the
Governing Body in 3-months’ time. Action due July 2016.
030416: Greater Manchester Commissioning Strategy to be routinely displayed with the
Professional Reference Committee agenda to remind colleagues of the CCG’s aim. C
Watson confirmed that the Strategy has previously been received by the Planning
Implementation and Quality Group. It was agreed to remove this action from the list.
040416: Contracts Forward Plan to be developed for consideration at the next meeting of the
Governing Body K Roe confirmed that an updated is to given at both the Single
Commissioning Board and Governing Body meetings in July 2016.
050416: S Allinson to forward G Curtis the recovery/action plan in relation to the NHS 111
service. S Allinson confirmed that this had been actioned and agreed to also forward a copy
to A Dow.
060416: With regard to the NHS 111 Service, it was agreed that in the first instance, the
Directory of Services be checked for accuracy. N Riyaz confirmed to the Governing Body
that the Directory of Services has been checked for accuracy and found to be in good order.
He advised the members that a safety net is also in place should any pathways change, with
the Directory of Service being amended to reflect the change. C Watson informed the
Governing Body that Tameside and Glossop’s Directory of Service has been praised by
colleagues as being very comprehensive.
5
13
The Governing Body noted the updates provided.
** G WILMORE JOINED THE MEETING **
8 Development of an Integrated Care Organisation
G Wilmore, Director of Strategy and Partnerships, Tameside Hospital NHS Foundation Trust
presented the Governing Body with a summary update of the key milestones, both to date
and going forward in relation to the transformation of Tameside Hospital NHS Foundation
Trust into an Integrated Care Organisation as part of the Care Together Programme.
G Wilmore reported to the Governing Body the successful transfer of Community Services
Staff from Stockport NHS Foundation Trust to Tameside Hospital NHS Foundation Trust with
effect from1 April 2016.
G Wilmore advised the Governing Body that there is now a dedicated team of staff working
on the transformation project to ensure the new Models of Care and the new organisational
form will be in place form 1 April 2017.
The Governing Body was informed that a framework for Care Together Communication,
Engagement and Consultation has been developed and was agreed by the Care Together
Programme Board in May. He advised the members of the new Care Together interactive
website which aims to engage both members of the public and staff and act as a means of
gathering views going forward.
G Wilmore made reference to the Care Together Engagement Event held on 23 May 2016 at
Hyde Town Hall and advised the Governing Body that the feedback from the event was
positive.
G Wilmore reported to the Governing Body that as from 1 October 2016 the Trust will be
legally known as “Tameside and Glossop Integrated Care NHS Foundation Trust”. The
Governing Body recognised this as an important step in establishing a new brand identity
which confirms the diversification of the services that will be provided by the ICO. G Wilmore
advised the Governing Body that this name was chosen following a vote. It is therefore the
name chosen by the public and staff and represents the public it serves.
G Wilmore advised the Governing Body that it is recognised that some Organisational
Development work is required and that he expected the neighbourhood meetings to assist in
shaping this piece of work.
A Dow recognised the list of services being transferred to be quite substantial. He asked if
information was available that details actual numbers involved in each division. G Wilmore
thought that this would be available and that he could forward it on.
C Watson reported that both she and M Rothwell are looking at the primary care nursing
workforce development across the whole health economy. She advised that NHS England
colleagues are happy for NHS Tameside and Glossop CCG to take this forward on behalf of
the 12 CCGs.
After discussion, the Governing Body agreed to consider retaining the Care Together brand
as this is the name that people are beginning to adopt. The Governing Body recognised this
as an objective over the coming months.
The Chair thanked G Wilmore for his update.
6
14
8a Finance Update: Quality, Innovation Productivity and Prevention Update
The Chair advised the Governing Body that he had agreed for an item of any other business.
K Roe presented the Governing Body with an update regarding Quality, Innovation,
Productivity and Prevention (QIPP).
K Roe informed the Governing Body that the CCG must identify QIPP schemes to the value
of £13m in 2016/17. She advised that schemes have been identified however there is a
large amount of risk with these, given that there is insufficient detail or assurance as to
whether or not these schemes will meet the required value.
K Roe highlighted to the Governing Body that focus is required on demand management and
that the economy must address how it manages its demand differently. She made reference
to the Greater Manchester Transformation Fund and confirmed that the economy is required
to demonstrate that it meets the business rules prior to it being eligible to apply for a
proportion of this fund.
Dr J Douglas asked if there are funds available to practices for innovation. K Roe replied
that there is a local fund which can be utilised for this purpose and that the Care Together
Programme Board monitors this.
K Roe assured the Governing Body that both the Transformation and Finance Directorates
within the CCG are committed to ensuring that the QIPP is delivered. An internal QIPP
Steering Group has been established. This will be responsible for ensuring that the CCG
has a robust QIPP plan in place and that individual commissioning leads and budget holders
are challenged and held to account on a regular basis. In addition, the QIPP Steering Group
will ensure that all financial activities are in line with the wider Care Together Programme and
the CCG Commissioning Improvement Scheme.
K Roe reminded the Governing Body that all financial decisions are required to be made
jointly with both the CCG and Tameside Metropolitan Borough Council.
K Roe informed the Governing Body that regular Quality, Innovation, Productivity and
Prevention updates will be provided to the relevant governance committees within the CCG
and the wider Care Together programme.
The Governing Body noted the update.
9 Bringing the Public and Patient voice into our Governing Body
9.1
Patient Story
The Governing Body heard a patient story narrated by J Hurlston.
Mark is 36 years old born and raised in Dukinfield. Unfortunately in 2008 Mark was
involved in a road traffic accident whilst driving to work on his motorbike. He is now
paraplegic from the waist down and only has 10% movement to his right arm even after a
series of operations.
The Governing Body heard how in August 2009 Mark returned to live with his parents in
Dukinfield. He was provided with a bed and shower chair by the local Social Services
team. After being assessed by Social Services, Mark was referred to a homecare
provider where he then had to go through another assessment process. Mark described
7
15
how there was no continuity in the process with everyone asking him the same questions.
This resulted in him feeling that he had lost his pride and dignity
The Governing Body were informed that a local District Nurse put Mark in touch with the
CCG’s Continuing Healthcare Team as she had heard of something called Personal
Health Budgets and thought it could be something that Mark could possibly qualify for.
This did require Mark having to go through another assessment process, however this
time there was something significantly different about the questions which Mark was
asked.
The CCG’s Continuing Healthcare Team specifically asked Mark what he wanted to get
out of life. His response was that he wanted to get his independence back, to take some
stress away from himself and his family, to carry on with his hobby of shooting, to have a
social life and to access physiotherapy and get back into the pool again.
Mark described the Personal Health Budget scheme as him being in control and having a
choice on what he could spend the money. From his Personal Health Budget Mark also
employed an independent organisation which provides good information, advice, and
support.
The Governing Body heard how through the Personal Health Budget and his care plan,
Mark’s parents are his personal assistants (carers). In addition, he has another new carer
who lives in the local area and is currently being trained on all the courses that are
relevant for Mark and his disabilities.
Mark commends having a Personal Health Budget which has made all the difference to
both his and to his family’s life, he feels like a weight has been taken off their shoulders
and that they can now be the family they once used to be
A Dow thanked J Hurlston for providing Mark’s Story and he invited the Governing Body to
comment on the content.
M Rothwell asked the Governing Body to note that currently there are ten Personal Health
Budgets within Tameside and Glossop for people with continuing healthcare needs.
A Hardman advised the Governing Body that the self-care approach needs to be aligned
with Personal Health Budgets and that Health Co-ordinators will be required to work with
individuals to help develop their personal care approach.
A Dow considered Mark’s Story to provide a good example of how to equate health with
cost.
R Bircher also commented that people in receipt of Personal Health Budgets access
urgent care systems less and considered it would be a useful exercise to review this.
The Governing Body noted the content of Mark’s Story.
9.2
Report of the meeting of 19 May 2016 and approved minutes of the Public and
Patient Impact Committee meeting of 19 April 2016
The Governing Body received the minutes of the Public and Patient Impact meeting held
on 19 April 2016. No questions pertaining to the minutes were raised.
C Poole provided a verbal update following the Public and Patient Impact Committee
meeting held on 18 May 2016.
8
16
The Public and Patient Impact Committee has requested assurance from the executives
that the functions of the Patient and Engagement Lead will be covered. C Poole informed
the Governing Body that Tameside Hospital NHS Foundation Trust has offered to share
their support for this function; however, it is the opinion of the Public and Patient Impact
Committee that the CCG requires its own postholder,
S Allinson confirmed that work is currently underway to reform teams and that capacity
will be reviewed. J Hurlston therefore asked on behalf of the Public and Patient Impact
Committee that the executives provide assurance that the Patient an Engagement
function will be captured within this review.
C Poole informed the Governing Body that within the Equality and Diversity Group update
to the Public and Patient Impact Committee, there had been a suggestion to expand the
group to include clinical/GP and commissioner representation.
C Poole advised the Governing Body that the Public and Patient Impact Committee has
expressed anxiety with regard to the reduction of funding to third sector services within
Glossop which is likely to have an impact on service delivery. G Curtis also expressed his
concern with regard to the possible closure of the Glossop Voluntary Services and asked
the Governing Body to consider having an input in the consultation around this decision.
The Governing Body discussed the emerging Memorandum of Understanding with
Derbyshire County Council and it was agreed to pursue this.
Governing Body:
-
received the ratified minutes of the Public and Patient Impact Committee of 19 April
2016
noted the update from the Public and Patient Impact Committee meeting of 18 May
2016
agreed to pursue a Memorandum of Understanding with Derbyshire County Council.
10 Chief Operating Officer’s Report
S Allinson provided the Governing Body with a verbal summary of key events that have
taken place during the last month.
S Allinson informed the Governing Body that the CCG has had its Quarter 4 Assurance Year
End review meeting with NHS England in April with the CCG achieving "Good" in all areas.
He considered this to be a testament of the CCG’s Governing Body, its member practices,
and all the staff.
S Allinson reported the launch of Care Together on 23 May 2016 and recognised this to be a
significant point for the CCG.
S Allinson was pleased to learn earlier in today’s meeting that the CCG has been granted
approval from both the Internal and External Auditors with the Annual Accounts having been
signed off.
S Allinson reported to the Governing Body the bringing together of staff within the Single
Commissioning function. He informed the members that all Single Commissioning staff are
now aligned under a strategic directorship with a single budget and a single management
team. He considered this collective leadership is now well placed to take the new model
forward.
9
17
S Allinson recognised substantial transformation within Tameside and Glossop over a 3-year
period and expressed congratulations to colleagues at Tameside Hospital NHS Foundation
Trust for achieving this.
The Governing Body noted the content of the Chief Operating Officer’s verbal update.
11 Strategic direction
11.1 South East Sector Memorandum of Understanding
The Governing Body received the South East Sector Memorandum of Understanding.
S Allinson advised that this document is to provide the Governing Body with guidance with
regards to signing off the Memorandum of Understanding, Confidentiality Agreement and
Non-Disclosure Agreement.
The Governing Body agreed the content of the South East Sector Memorandum of
Understanding. S Allinson to respond accordingly.
12 Commissioning for reform
12.1 Primary Care Committee (verbal update of the meeting held on 4 May 2016 and
approved minutes of the meeting held on 6 April 2016)
D Swift presented the Governing Body with the ratified minutes of the Primary Care
Committee meeting of 6 April 2016. He reminded the Governing Body that this was the
first meeting of Level 3 commissioning. No questions pertaining to the minutes were
raised.
D Swift provided the Governing Body with a verbal update following the Primary Care
Committee meeting of 4 May 2016. He advised that the meeting reflected the move from
Level 2 to Level 3 delegated commissioning. In addition, a Memorandum of
Understanding is now in place with NHS England.
The Governing body received the minutes of the Primary Care Committee meeting held
on 6 April 2016 and noted the content.
12.2 Neighbourhood Leads (draft minutes from the meeting of 26 April 2016)
A Dow presented the Governing Body with the draft minutes of the Neighbourhood Leads
meeting held on 26 April 2016. No questions pertaining to the minutes were raised.
A Dow advised the Governing Body that all Glossop practices are willing to move forward
as a Multispecialty Community Provider contract and he had asked practices to come up
with three priorities.
The Governing Body received the draft minutes of 26 April 2016 and noted the content.
13 Quality review and assurance
13.1 Report of the meeting of 4 May 2016 and approved minutes of the Quality
Committee meeting of 6 April 2016.
10
18
C Todd presented the Governing Body with the ratified minutes of the Quality Committee
meeting held on 6 April 2016. No questions pertaining to the minutes were raised.
C Todd provided the Governing Body with a verbal update following the meeting of the
Quality Committee held on 4 May 2016.
The Governing Body was informed that with regard to Darnton House, as at 4 May 2016,
there were two residents who were yet to be relocated. However, C Todd confirmed that
since the Quality Committee meeting, the premises are now empty.
The Governing Body:
-
received the ratified minutes of the Quality Committee of 6 April 2016
noted the update from the Quality Committee meeting of 4 May 2016
14 NHS Constitution performance review and assurance (paper received by the Single
Commissioning Board on 20 April 2016)
14.1 Performance Update
R Bircher presented the Performance Update to the Governing Body and asked that they
note the 2015/16 CCG Assurance position, identifying any areas in which they would like
further scrutiny.
R Bircher was pleased to reiterate the earlier confirmation that the CCG has been
‘Assured as Good’ in all of the five components in the assurance framework.
He was also pleased to report that NHS Tameside and Glossop CCG are currently the
best performing CCG in Greater Manchester with regard to Accident and Emergency
waiting times. In addition, the Governing Body was informed that the CCG has no Referral
to Treatment patients waiting over 52 weeks.
Continuing with the good news, the Governing Body was informed that NHS Tameside
and Glossop CCG has achieved all of its Cancer standards. In addition, the number of
patients still waiting for planned treatment 18 weeks and over continues to decrease.
However, R Bircher did report that performance issues remain around waiting times in
diagnostics, particularly at Central Manchester NHS Foundation Trust with 60% of these
delays being Tameside patients.
A Dow noted that this had been on the agenda for many months and expressed his
frustrations regarding the problems with diagnostics at Central Manchester NHS
Foundation Trust. He advised the Governing Body that, under the Quality and Outcomes
Framework Quality Premium, previously Glossopdale had implemented a “Referral
Interceptor Pathway” whereby a practice, if notified of a diagnostic plan, could pull
someone out of the secondary care process and have it undertaken sooner in Primary
Care, with that result then relayed. A Dow wondered if such a system could help with
these diagnostics at Central Manchester Hospital NHS Foundation Trust as an
investigation plan could really be signifying significant delay.
R Bircher reported that Accident and Emergency standards were failed at Tameside
Hospital NHS Foundation Trust however more recently performance has improved.
R Bircher reported that the CCG has failed to achieve its ambulance targets with
ambulance response times not being met at a local or a National level. There has also
been an increase in the delays in handover.
G Curtis noted that the performance of the NHS 111 Service remains to be a concern. A
Dow stated that the recently published GP Forward view states that there is to be an
increase in clinical presence of the 111 service nationally.
11
19
S Allinson asked the Governing Body to recognise the hard work of both the Providers
and the CCG, particularly C Watson and Transformation team in bringing the CCG to this
position.
15 Finance performance review and assurance
15.1 Approved minutes of the Finance and QIPP Assurance Committee meeting 20
April 2016 and verbal update of the meeting held on 18 May 2016.
D Swift presented the Governing Body with the ratified minutes of the Finance and QIPP
Assurance Committee meeting held on 20 April 2016. No questions pertaining to the
minutes were raised.
D Swift provided the Governing Body with a verbal update following the Finance and QIPP
Assurance Committee meeting held on 18 May 2016.
D Swift reported that the Finance and QIPP Assurance Committee had received a report
on the Better Care Fund 2016/17. He stated that the Delayed Transfer of Care is one of
the measures by which a decision will be taken as to whether the Better Care Fund is
successful or not.
D Swift confirmed that J Douglas’s attendance at the Finance and QIPP Committee was
appreciated as his expertise and knowledge of Effective Use of Resources was
considered valuable.
A Dow made reference to the intended practice visits and considered it would be useful
for a conversation to take place in a peer review context if practices are high users of
Effective Use of Resources. This has not however been captured within the
Neighbourhood Leads meetings and would lend itself excellently to that.
The Governing Body:
-
received the approved minutes of the Finance and QIPP Assurance Committee
meeting of 20 April 2016
noted the verbal update of the Finance and QIPP Assurance Committee meeting
held on 18 May 2016.
16 Audit and Assurance Committee
16.1 Grant Thornton External Audit Letter 2014/15
The Governing Body received the Grant Thornton External Audit Annual Audit Letter from
2014/15. G Curtis advised that whilst this is from last year, it is being presented to the
Governing Body for due process and in line with the Terms of Reference for the Integrated
Governance, Audit and Risk Committee.
The Governing Body asked to receive the Grant Thornton External Audit Letter for
2015/16 once formal correspondence is received by the CCG.
G Curtis expressed his thanks to P Pallister and his team for their contribution in bringing
the information together that is required for this end of year piece of work.
12
20
G Curtis highlighted to the Governing Body that the agenda item states Audit and
Assurance Committee; however this name change is yet to be approved by the Governing
Body. He advised that the amended Terms of Reference of the Information Governance,
Audit and Risk Committee are to be presented to the Governing Body at the next meeting
in June.
The Governing Body received the Annual Audit letter of 2014/15 and noted the update.
17 Partnership and Greater Manchester meetings and updates
17.1 Ratified minutes of the Association Governing Group meeting held on 3 May
2016
S Allinson presented the Governing Body with the ratified minutes of the Association
Governing Group meeting held on 3 May 2016. No questions pertaining to the minutes
were raised.
The Governing Body received the minutes of the Association Governing Group meeting
held on 3 May 2016.
17.2 Ratified minutes of the Derbyshire Health and Wellbeing Board meeting held
on 10 March 2016
C Watson presented the Governing Body with the ratified minutes of the Derbyshire
Health and Wellbeing Board meeting held on 10 March 2016. No questions pertaining to
the minutes were raised.
The Governing Body received the minutes of the Derbyshire Health and Wellbeing Board
meeting held on 10 March 2016.
A Dow closed the meeting 15:00hrs
13
21
NHS Tameside and Glossop CCG Governing Body
Actions Log following the meeting of Wednesday 25 May 2016
Action
Number
Action Description
Owner
Deadline
Update
031115
To produce an information pack for practices of the Over 75s
bids
C Watson
January 2016
February 2016
March 2016
April 2016
May 2016
June 2016
July 2016
Paper to be presented to PRG
in July
030316
Performance report to detail national comparison figures in
relation to the NHS 111 Service
A Hardman /
S Allinson
March 2016
April 2016
May 2016
June 2016
Ali Rehman attending meeting
with NHS 111 Services today –
27 May
050316
To co-ordinate a list of charitable organisations that are
supporting Tameside but not Glossop.
C Watson / A
Hardman
April 2016
May 2016
June 2016
Discussion held at PRG with
piece of work now having
commenced
070316
The Final Audit report on Quality Innovation Productivity and
Prevention (QIPP) to be shared with Governing Body
members
K Roe
May 2016
Circulated 27 May 2016
100316
CCG Directors to consider the recommendations from the
Healthwatch Survey and decide how these are to be
addressed. Following this, Quality Committee to then be
asked to provide the required assurance.
CCG
Directors
April 2016
May 2016
June 2016
020416
The Terms of Reference of the Single Commissioning Board
to be reviewed by the Governing Body in 3-months’ time.
A Dow
July 2016
22
Action
Number
Action Description
Owner
Deadline
040416
Contracts Forward Plan to be developed for consideration at
the next meeting of the Governing Body
K Roe
May 2016
June 2016
July 2016
060416
With regard to the NHS 111 Service, it was agreed that in the
first instance, the Directory of Services be checked for
accuracy
S Ahmed / N
Riyaz
May 2016
June 2016
010516
The Governing Body to consider a nickname for the new
integrated Care Organisation
All
July 2016
020516
To pursue a Memorandum of Understanding with Derbyshire
County Council
SP / SA
July 2016
030516
South East Sector Memorandum of Understanding:
Response to be submitted accordingly
SA
June 2016
040516
The Governing Body to receive the Grant Thornton External
Audit letter for 2015/16
G Curtis
July 2016
Update
Directory of Services checked
and accurate
23
Title of Subject:
Date of paper:
Prepared By:
History of paper:
Executive Summary:
GOVERNING BODY MEETING
May Final Public and Patient Impact Committee minutes
18th May 2016
Celia Poole
Public and Patient Impact Committee held a meeting on
18th May 2016 and will meet regularly, promoting and
providing assurances to the Governing Board that the CCG
is providing strategic leadership for the development of
Public and Patient Engagement.
Key Issues discussed:
Communications and Engagement
PPIC discussed the communications and engagement
activity for Care Together and highlighted the fact that there
still appears to be a lack of joined up thinking and activity
for the programme. PPIC made a request to invite Paul
Thorpe, Care Together communications lead, to attend
PPIC in June to present the communications and
engagement strategy and plan.
It was noted that the Communications and Engagement
plan was signed off by the Single Commission Board and
this would be included on the agenda in June.
There were particular concerns raised around the statutory
requirement for T&G CCG to consult and engage with
patients and how this may be impacted by plans to
combine the communications and engagement functions
from T&G CCG and TMBC into one team for the single
commissioning function. There were also concerns raised
that the THFT engagement lead has, on a number of
occasions, been offered as a partial solution to the
impending absence of a T&G CCG patient engagement
manager. There is the potential for a clear conflict of
interest in this respect and PPIC does not agree with this
approach.
The discussion also focused on the forthcoming APMS
contract and the absolute requirement for T&G CCG to
consult patients affected by the re-tendering and, again, the
immediate impact the departure of the Patient Engagement
lead will have on this project.
Glossop Volunteer Centre highlighted the potential for
‘engagement overload’ with patients and public as there is
GM Devolution consultation activity, as well as forthcoming
Care Together activity. It was noted that it is important that
all agencies involved in engagement are joined up.
The following key highlights for update were discussed:
24
Care Together Communications and Engagement Strategy
are due to be shared with Patient Locality Group Chairs.
APMS – Project Group established and there is an
engagement plan in place.
Personal Health Budget Leaflet – this is due to be finalised.
Personal Health Budget Peer Network – the first network
meeting takes place on Wednesday 25 May. TT is leading
on engagement element.
Mental Health Liaison Project – CCG working alongside
Healthwatch Tameside to engage with service users to find
out their views of service delivery. A meeting is scheduled
to take place with Healthwatch Tameside, TT and Pat
McKelvey and Pennine Care, to discuss next steps –
engagement activity planned for delivery early July.
Recommendations required
of the Governing Body
(for Discussion and
Decision)
QIPP principles addressed
by proposal:
Direct questions to:
Health Education England Regional Awards 2016 –
nominations put forward by the CCG - Lesley runner up in
her category ‘Volunteer of the year in Health and Social
Care’. Amir won his category ‘Career Progression in
Health and Care’.
Equality and Diversity Group update
PPIC received an update from the Equality & Diversity
Group and its increasing importance to the Care Together
communications and engagement activity was recognised.
Expanding the group to include clinical/GP and
commissioner representation was also discussed. This will
be reviewed and progressed by the E&D group.
Other business
The impending withdrawal of all funding by Derbyshire
County Council to the third sector in Glossop was raised by
and discussed. It was recognised by PPIC that this
reduction in funding and, therefore, services offered by the
third sector in Glossop, could have a profound effect on
patients and public in Glossop, particularly in relation to the
Glossop Neighbourhood Community care model.
PPIC made a strong recommendation that T&G CCG’s
Patient engagement lead post is filled to accommodate the
departure of the current lead onto a 12-month secondment.
To discuss and note the key issues discussed and agreed
at the meeting on 18th May 2016.
To receive the report
Celia Poole
25
Final
MINUTES
PATIENT AND PUBLIC IMPACT COMMITTEE (PPIC)
Wednesday 18th May 2016 9.30-11.30am
Boardroom, New Century House, Denton
Present:Celia Poole (CP)
Michelle Rothwell (MR)
Jean Hurlston (JH)
Dr Asad Ali (AA)
Lynn Jackson (LJ)
Heather Palmer (HP)
Julie Farley (JF)
Clare Todd (CT)
Naseem Yasin (NY)
Peter Forrester (PF)
Governing Body Lay Member, CCG (Chair)
Deputy Director of Nursing and Quality, CCG
Governing Body Lay Advisor, CCG
Locality GP, CCG
Quality and Patient Engagement Lead, CCG
Commissioning Manager, CCG (Transformation Rep)
Chief Officer, Volunteer Centre Glossop
Governing Body Nurse, CCG
Equality and Diversity Manager, CCG
Patient Network Rep - Ashton Neighbourhood Group
In attendance:Adam Shepphard (AS)
Clare Bromley (CB)
Communications Lead, CCG (Item 5 only)
PA, Corporate Office, CCG (note taker)
1.
Chairs welcome and apologies
CP welcomed everyone to the meeting and conducted round the table introductions.
Apologies were received from:Karen Goodhind
Head of Communications and Engagement, CCG
Hazel Chamberlain Designated Nurse for Safeguarding, CCG
Alison Lewin
Deputy Director of Transformation, CCG
Anna Hynes
Coordinator for the Health and Social Care Network, Action Together
Peter Denton
Healthwatch Manager, Healthwatch Tameside
Ben Gilchrist
Chief Executive, Action Together
Tanya Nolan
Healthwatch Officer, Volunteer Centre Glossop
Jane Birch
Healthwatch Officer, Healthwatch Derbyshire
Lesley Surman
Richard Bircher
Governing Body GP, CCG
CP updated that Richard Bircher has joined membership of PPIC as a Governing Body GP
for the CCG.
2.
There were no new declarations of interest noted.

Register of Interests
Members received the updated Register of Interests and were reminded to complete the
table of amendments if there are any changes to be made to the Register and send directly
to Paul Pallister.
CP has made a recent amendment to the Governing Body Register of Interests which will
update the register for this committee in time for the next meeting.
3.
Minutes of the previous meeting: 20th April 2016
The minutes of the previous meeting were agreed as an accurate record.
1
26
Final
The follows actions were reviewed:Item 5 – GM Devolution
CP confirmed raising the oversight of Glossop in the communications centrally at GM
Devolution. CP spoke to Kathy Roe as the CFO at the CCG, and it was noted that there was
a pot of money to GM Devolution per head including weighting for Glossop and was assured
that it is equal use for population. CP had raised the issue of Glossop being overlooked in
GM Devolution communications planning at the Board and would continue to ensure
Glossop remained at the forefront of all future communications planning.
Item 4 – Update for MSK and ENT
LJ now attends the Integrated Care Governance meetings and attended the pathway launch.
This piece of work has informed the development of pathways based on patient engagement
events.
LJ agreed to give a time frame for the continued work on the integrated care pathways and
specifically how patient experience remains a focus in both the design and delivery of the
new pathways.
Action: LJ
CP noted that Hadrian Collier is leading a piece of work on engagement and agreed to invite
Hadrian to a future PPIC meeting.
Action: CP
Item 5 – Communications and Engagement
LJ had raised an issue to Karen Goodhind about the widget for Patient Opinion who agreed
to feed this back to AS. Karen also agreed to raise the question about uploading papers and
documents for sharing, particularly on the Single Commissioning Function. AS agreed to
look into this and provide an update.
Action: AS
4.
Matters arising not otherwise on the agenda
All matters arising are covered on the agenda.
5.
Communications and Engagement
PPIC discussed the communications and engagement activity for Care Together and
highlighted the fact that there still appears to be a lack of joined up thinking and activity for
the programme. CP agreed to invite Paul Thorpe, Care Together communications lead, to
attend PPIC in June to present the communications and engagement strategy and plan.
Action: CP
It was noted that the Communications and Engagement plan was signed off by the Single
Commission Board and this would be included on the agenda in June.
There were particular concerns raised around the statutory requirement for T&G CCG to
consult and engage with patients and how this may be impacted by plans to combine the
communications and engagement functions from T&G CCG and TMBC into one team for the
single commissioning function.
PPIC made a strong recommendation that T&G CCG’s Patient engagement lead post is
filled to accommodate the departure of the current lead onto a 12-month secondment. There
were also concerns raised that the THFT engagement lead has, on a number of occasions,
been offered as a partial solution to the impending absence of a T&G CCG patient
engagement manager. There is the potential for a clear conflict of interest in this respect and
PPIC does not agree with this approach.
2
27
Final
The discussion also focused on the forthcoming APMS contract and the absolute
requirement for T&G CCG to consult patients affected by the re-tendering and, again, the
immediate impact the departure of the Patient Engagement lead will have on this project.
Glossop Volunteer Centre highlighted the potential for ‘engagement overload’ with patients
and public as there is GM Devolution consultation activity, as well as forthcoming Care
Together activity. It was noted that it is important that all agencies involved in engagement
are joined up.
The following key highlights for update were discussed:
Care Together Communications and Engagement Strategy are due to be shared with Patient
Locality Group Chairs.
APMS – Project Group established and there is an engagement plan in place.
Personal Health Budget Leaflet – this is due to be finalised.
Personal Health Budget Peer Network – the first network meeting takes place on
Wednesday 25 May. TT is leading on engagement element.
Mental Health Liaison Project – CCG working alongside Healthwatch Tameside to engage
with service users to find out their views of service delivery. A meeting is scheduled to take
place with Healthwatch Tameside, TT and Pat McKelvey and Pennine Care, to discuss next
steps – engagement activity planned for delivery early July.
Health Education England Regional Awards 2016 – nominations put forward by the CCG Lesley runner up in her category ‘Volunteer of the year in Health and Social Care’. Amir won
his category ‘Career Progression in Health and Care’.
AS briefed members on the upcoming campaigns and events which are all detailed on the
CCG’s website. However AS noted that his main focus has been on the Annual Report
which is due to be published.
6.
Equality and Diversity Group update – Minutes of April 2016
PPIC received the minutes of the Equality and Diversity Group meeting which took place in
April 2016.
PPIC received an update from the Equality & Diversity Group and its increasing importance
to the Care Together communications and engagement activity was recognised. Expanding
the group to include clinical/GP and commissioner representation was also discussed. This
will be reviewed and progressed by the E&D group.
NY noted that the EDS2 Public Grading Event is due to take place on 15 July at St. Johns
Church, Dukinfield with Steve Allinson set to open the event and invitations to stakeholders
will be sent out soon.
A report will be formally presented to the CCG’s Governing Body by Michelle Rothwell and
NY noted that this is an event that will take place annually with another one planned for
January 2017.
Suggestion was made to involve LJ in the E&D Group and for commissioner involvement to
support embedding the E&D culture into the organisation and taking that forward into the
SCB/Function.
3
28
Final
Action: LJ
This led to discussion of a process for internal staff grading to evidence embedding E&D
culture within the CCG. NY has some examples of evidence and agreed to provide PPIC
with these for the next meeting in June.
Action: NY
7.
Adoption of the High Peak Local Plan
PPIC received the adoption statement for the High Peal Local Plan for information. It was
felt that this was paper should be for information for Public Health rather than PPIC.
8.
Any other business
The impending withdrawal of all funding by Derbyshire County Council to the third sector in
Glossop was raised by JF and discussed. It was recognised by PPIC that this reduction in
funding and, therefore, services offered by the third sector in Glossop, could have a
profound effect on patients and public in Glossop, particularly in relation to the Glossop
Neighbourhood Community care model. JF will bring a paper to June PPIC highlighting and
quantifying the impact on service delivery that the county council’s withdrawal of funding will
have on patients and public in Glossop.
Action: JF
9.
Date and time of next meeting
Wednesday 15th June 2016, 9.30am-11.30am, New Century House.
4
29
Title of Subject:
Proposed withdrawal of funding from Derbyshire
County Council to third sector in Glossop
June 15, 2016
Date of paper:
Prepared By:
Julie Farley, Glossop Volunteer Centre/Celia Poole,
Lay Member
History of paper:
The attached paper was discussed by the Public and
Patient Impact Committee on June 15, 2016.
It outlines the impact a proposed withdrawal of
£131,169 funding from the third sector would have on
more than 600 older residents and 500 vulnerable
families in Glossop. It would also result in the
withdrawal of infrastructure support to a further 80
local voluntary and community groups. As a
consequence, PPIC is making two recommendations
for decision by T&G CCG Governing Body.
Executive Summary:
Derbyshire County Council has announced its
intention to consult on its proposals to cut around
£131,169 worth of annual funding to third sector
organisations in Glossop.
Notwithstanding the direct impact on the provision of
valuable services to Glossop residents such a cut
would have, the impact of a withdrawal of £131,169
into Glossop’s communities would have a significant
impact on T&G CCG’s plans to develop a Glossop
Integrated Neighbourhood.
The Integrated Neighbourhood model has yet to be
specifically defined in Glossop – and in the remaining
four Integrated Neighbourhoods across Tameside and
Glossop – but the broad concept of a successful
Integrated Neighbourhood model relies substantially
on partnership with, and involvement of, third sector
and voluntary bodies.
Additionally, should funding to these bodies in Glossop
30
be withdrawn, or reduced, by Derbyshire County
Council, there is likely to be an impact on our other
Integrated Neighbourhood teams who may end up
‘taking up the slack’ as a result of gaps in the provision
of vital community services in Glossop.
The attached report provides a clear picture of the
issues and the impact summary document
demonstrates the positive impact of Glossop
Volunteer’s Centre which is put at risk by Derbyshire
County Council’s proposals.
(for Discussion and
Decision)
T&G CCG Governing Body registers the strongest
objection to Derbyshire County Council’s proposals to
any funding cuts in Glossop.
T&G CCG Governing Body recommends that the Care
Together Programme develops a dedicated strategy
to engage with Derbyshire County Council and gain
its commitment to supporting and working with the
Care Together programme to establish an Integrated
Neighbourhood model in Glossop.
by proposal:
The impact of the withdrawal of funds would have a
negative impact on health and social care budgets
for Glossopdale.
Glossop Volunteer Centre, for example, works with 600
Glossop residents who are on the periphery of
eligibility for social care funding. Their work prevents
these 600 people from falling into the ‘eligibility’ status.
The Furniture Project also support 500 vulnerable
families across Glossopdale and receive referrals
directly from social care, Womens Aid, homeless
charities and mental health services.
Celia Poole/Lesley Surman
31
Report to:
Public and Patient Impact Committee
Title of Paper/Subject:
Issues for Care Together in Glossop
Report by:
Julie Farley – Chief Officer: Volunteer Centre Glossop
Date:
15th June 2016
1. Introduction
1.1 A key challenge facing Tameside and Glossop Care Together proposals will be the
conflicting commissioning strategies for Glossop being pursued separately by
Derbyshire County Council and Tameside and Glossop CCG.
1.2 This report outlines the potential impact on the Care Together proposals of Derbyshire
County Council’s proposed cuts to local voluntary and community organisations in
Glossop.
2. Background
2.1 In terms of the Greater Manchester Healthier Together Initiative, Glossop is something
of an anomaly. Geographically it falls within Tameside and Glossop CCG boundaries and
is financially costed into Healthier Together and Devo Manc initiatives. However,
Glossop also falls within High Peak Borough and Derbyshire County Council governance
rather than Greater Manchester.
2.2 As a result it is often overlooked in the Greater Manchester strategies and media
communications, and also falls off the radar for Derbyshire County Council who are
exploring joint Commissioning with North Derbyshire CCG which does not cover
Glossop.
2.3 Over the last few years both Derbyshire County Council and Tameside and Glossop CCG
have separately commissioned voluntary sector services for Glossop. The result is the
duplication of some services – Age Concern Glossop and District and Tameside Age Uk
both separately commissioned to provide Glossop services – alongside a dual lack of
investment in other groups resulting in gaps in services for adults with a learning
disability.
2.4 Commissioning anomalies within the 3rd Sector are common. However in other areas
across Greater Manchester pooled budgets and joint commissioning strategies between
local Councils and the CCG are seeking to address these issues. For Glossop however
this joint approach is some way off.
3. Conflicting Commissioning Priorities
3.1 The Tameside and Glossop Care Together Commissioning Strategy identifies four key
priorities for investment designed to improve health over the next 5 years. Priorities
include investing in early intervention and prevention across all groups to encourage
healthy lifestyles; enabling greater self-management of a long-term condition;
supporting mental wellbeing and support for the wider determinants of health
including economic wellbeing.
32
3.2 The commissioning strategy also recognises the 3rd Sector as a key partner providing
early intervention, prevention and step down services within the Integrated
Neighbourhood model.
3.3 In contrast Derbyshire County Council is pursuing a different relationship with the 3rd
Sector. In March it published proposals to cut grant funding to a wide range of
grassroots organisations across Derbyshire. Commissioning priorities with the 3rd Sector
focus on the statutory Care Act areas of Independent Advocacy, mental health, carers,
sensory loss and dementia support. Currently there is no commitment to invest in a
broader early intervention and prevention solution from the 3rd Sector designed to
reduce demand on health and social care services across all client groups including
those living with long-term health conditions.
4. Implications for Glossopdale INT
4.1 Under the current proposals Derbyshire County Council will cut all it’s funding to:
 High Peak CVS – who help create and sustain self help groups and voluntary services
as part of the wider health and social care market place; support with funding and
fundraising solutions, training to improve service quality etc.
 Glossopdale Furniture Project – helping people who are homeless or families
surviving on low incomes to furnish a house and prepare healthy meals (cut by both
DCC and North Derbyshire CCG).
 Volunteer Centre Glossop – creating volunteer led solutions in response to local
gaps in services, community solutions through timebank and formal volunteering
opportunities, pre employment support, central volunteer recruitment and training,
development of peer support.
 Community Companions – a VCG service providing volunteer befriending, computer
companions to keep people connected, shopping support for people who are
housebound, Shire Hill Hospital discharge support and volunteer car scheme to
enable people to get to GP and hospital appointments
4.2
Derbyshire County Council is currently consulting on these proposed cuts and a final
decision will be made in September 2016.
4.3
The loss of these services will impact on the Care Together objectives for the
Glossopdale INT set out in the Standard Operating Model:
 Developing the Glossopdale INT model: High Peak CVS and Volunteer Centre
Glossop are key partners in the development of the Glossopdale INT offer. They are
helping to shape the local model by bringing together local voluntary sector
organisations and engaging with local services through their close relationship and
connections with over 150 local groups and organisations. Cutting VCG will also
impact on the current relationship with many of the local GPs and ASC who refer
clients for supported signposting to voluntary services and community based
solutions.
 Delivering the operational model: removing key preventative services that support
vulnerable families, vulnerable older people, and people living with long term
limiting health conditions will increase the number of people hitting a crisis,
resulting in the need for more costly health and social care services including
residential care. This will put a much greater strain on the Glossopdale health and
social care INT. The cuts will remove support designed to speed up hospital
33
discharge from Shire Hill and the emerging community navigation service being
developed by the local voluntary sector. As a result the financial burden will shift to
Care Together to fill the gaps created by the loss of some or all of these preventative
services if it wants to achieve its INT vision.
 Care Together Engagement: Local people may use the Care Together engagement
process to raise frustrations about cuts in services that support health and wellbeing
as well as the significant cuts to local bus services. Due to the semi rural geography
of Glossopdale, cuts to bus services are expected to have a big impact on access to
health services, job opportunities, leisure activities and essential food shopping.
There is a danger that these combined cuts will be foremost in peoples minds and
make it hard to focus on Care Together as a positive development.
4.4
Finally both Care Together and Derbyshire County Council are looking at investing in
community connectors/community navigation roles. It goes without saying that if all
the cuts focus on local self help solutions, community and peer support groups, and
local volunteer services then there is a real danger that there will be very few selfmanagement solutions left to connect to.
34
April 2015 – March 2016
Annual Review
and Impact Summary
“
I came to the volunteer centre looking
for help and support. I didn’t know
where to turn. I joined a support group
and then started to volunteer as my
confidence grew. Two years down the
line I feel I have my life back again and I
can’t thank VCG enough for the support,
encouragement and understanding
they have given me. ”
Community Companions Volunteer March 2016
This document has been designed and printed
at no charge to Volunteer Centre Glossop.
35
Introduction from the Chair :
Glossop Volunteer Centre is at the heart of the community
connecting people and offering a wide range of services that
support people across Glossopdale. We do this by employing
an amazing staff team and over 100 volunteers, all of whom
live in Glossop and who are committed to providing support to
help others in the local community.
Last year :
We helped over
600 local
residents to
maintain their wellbeing
and live independently.
Much of the funding we rely on to keep us going comes from
fundraising activities and income generation. However 24% of
our income is grant funding from Derbyshire Council and this
is key to sustaining our services as it enables us to show other
grant funders that we are reliable and worth investing in. Over
the last three years we have brought in an additional £246,383
of funding mainly from Lottery and European funding. In fact
for every £1 invested by Derbyshire Council we secure an
additional £3.03 of match funding to spend on local services.
We also save the statutory sector a great deal of money
by reducing demand on services and diverting people
into alternative community solutions. We actively support
independent living, mental wellbeing and physical health so
reducing the demand on residential care, repeat GP visits and
hospital care.
The Volunteer Centre provides a lifeline to many local
people. We are proud to deliver services in Glossop and this
summary is to showcase how we change the lives of local
people for the better and to thank our supporters and our
amazing volunteers who give up their time, skills and
expertise to help others in the local community.
Peter Logan, Chair
Our volunteers provided
4,050 car trips
to GPs, hospital, hospices and
other medical appointments
100
Over
Glossop volunteers
helped to deliver
our services.
Community Companions costs
£139 per person
per year. Supporting people to
stay in their own homes saves about
£27,000 per person per year on care
home costs.
Supporting just
two people in this
Our Shire Hill
project can speed
way
up hospital discharge
saving approximately
£650 a week,
per person.
saves
£54,000
per year.
Our volunteers
gave over
9,300 hours
of volunteering time.
If we apply the living
wage this is equivalent
to an additional
£66,960 in wages.
36
our services :
In an average week
Independent living
through Community
144 local
people use Glossop’s
Companions
Community Companions
to help maintain
independent living.
“
Community Companions is for people who need a little bit of
extra support. It helps people look after their health, stay active,
live independently, and develop friendships with others in the
community. Community Companions costs £139 per person per
year and reduces demand on health services and residential care
at a cost of £27,000 per person, per year. Even with a conservative
estimate if we only keep 4 people out of residential care we save
£108,000 per year.
My daughter suggested
a care home but this service
helps me stay in my
own home.
Companions user December 2015
”
Companions focuses on the positive things in people’s lives. It is not a ‘one
size fits all’ instead it provides personalised care delivered by a team of 97
Companion volunteers supported by a member of staff.
Driver Companions help those
who can’t use public transport to look
after their health. Including trips to
hospitals, their dentist, chiropodist,
GP, optician and regular appointments
such as cancer treatments. It promotes
wellbeing and prevents missed
appointments. Last year our volunteer
drivers completed 4,050 trips.
Shopping Companions help
“
“
Very good, very helpful.
They push the wheelchair for
me and its great company.
They know where to go in
the hospital so it takes
the worry out of going.
”
people with long term and short
term health conditions, and those in
wheelchairs to get out to do the weekly
food shop, access the bank, post
office and local services. As part of the
shopping sessions people also get the
chance to have cuppa and a chat and
attend the weekly seated exercise class.
Since my husband and son
died and I had a fall I’ve
felt depressed and stuck in
the house on my own
– this gets you out.
Social Companions offer one to
one friendship and support for people
feeling lonely or isolated. Befriending
can involve anything from a walk in the
park, a regular telephone call, or a catch
up and a cuppa to share life’s ups and
downs.
“
I would be stuck in here
with no one to talk to.
I would feel lost if they
didn’t come.
”
Last year Community Companions supported 605 people living in Glossop
through 1,400 shopping trips, social events and befriending visits from
50 befriending connections. Tailored support and continuity of
care means that Community Companions works to delay
and, in many cases, prevent a crisis and the need for
more costly health and social care services.
37
”
Last year we helped
32 young
unemployed
adults move towards
paid employment through
volunteer placements.
our services :
Building Social Capital
through
volunteering
Volunteers put the heart into Glossop. Despite being made up
of a number of small tight knit communities Glossopdale has a
phenomenal number of volunteers. This freely given time and
energy provides a lifeline to local people; sustains local groups
and services and helps build a strong community spirit.
People volunteer for different reasons. Last year we helped 32 young
unemployed adults into paid employment through volunteering,
work place taster sessions and employment plans. We work with 102
community groups and voluntary organisations to offer placements,
undertake DBS checks and provide training.
“
Volunteering keeps me busy both mentally and
physically and the rewards are invaluable.
Companions volunteer December 2015
Last year more than
100 Glossop people
helped to deliver our
services giving over
9,300 hours of
volunteering.
Our volunteers tell us they benefit
from working with us, they say that
volunteering helps them to:
build
skills for
work
feel part
of the
community
=
=
39%
40%
develop
new skills
=
58%
”
Our pre employment project provides volunteering opportunities to build
confidence and self esteem; gain practical experience; try different work
roles to inform career choices; and develop new skills. In fact volunteering
has become a prerequisite for many professions particularly jobs in health
and social care.
“
Following voluntary redundancy I needed to find a
new career direction. Volunteering enabled me to
rebuild my confidence and add different skills to
my CV. This helped me to apply successfully for
work in Learning Support.
”
Companions volunteer December 2015
We also provide volunteering opportunities for people who want to meet
new people; keep active; share their knowledge and skills to benefit
others; or offer mutual support to manage a health condition or situation.
Last year we placed over 520 people who wanted to volunteer in Glossop.
We are able to do this because of the local
knowledge and connections of our staff team who
38
live and work in Glossop.
our services :
At the heart of
Want to see what
successful
the Glossopdale
social value and
social capital
We have moved on from being ‘just a volunteer
centre’. We empower people and act as the
social glue connecting residents, volunteers and
local groups together.
looks like?
Manchester
Our mission is to work with the Glossopdale community to identify local
needs and develop volunteer led solutions. We do this both through
formal volunteering and flexible timebank solutions that connect people
with new and/or existing community solutions.
Glossop
Our local knowledge and role means we can work across the different
geographical boundaries that exist between Tameside and
Glossop CCG and Derbyshire County Council.
Key to map areas
We also enable other voluntary organisations to provide
local solutions by providing meeting space, DBS checks,
training and administrative support. Groups include the
Talking Newspaper, the Visually Impaired Peoples group
and the local offices of the Derbyshire Carers and Derbyshire
Alzheimer’s Society and Stockport Cerebral Palsy Society.
Greater Manchester
Healthier Together
Tameside and Glossop
CCG boundary
Derbyshire County
Council
Area of boundary
overlap
Derby
“
When the patient attends the Shire Hill
group it lifts their mood and as a result
of this they become more motivated to
participate in their therapy, to get better
and hopefully go home sooner. Knowing
that the volunteer services are out there
to support patients once they are
discharged, instils confidence in the
patient to continue their recovery
once they get home. Lead OT Shire Hill Hospital March 2016
”
We are adapting our services to respond to the changing needs
of Glossop. In 2015 we began working with the local Intermediate
Care inpatient unit at Shire Hill. Our new weekly session,
Friends of Shire Hill, brings people together to socialise,
improve mental wellbeing and speed up recovery. Many
people are also referred directly into our seated exercise class
to continue their recovery once they go home.
This year we are expanding this to
include home visits to Glossop residents
discharged from Shire Hill. This service
will work with local GP’s and voluntary
partners to connect people to a range of
local community and self help groups,
and voluntary activities.
By doing this we will enable more people with long
term health conditions to live independently.
39
Financial
Summary
We offer a great
return on a small
for
every £1
investment:
April 2015 – March 2016
Breakdown of
Incoming
Resources :
Fundraising
& donations
4%
Earned
Income
27%
Derbyshire
County
Council
24%
This document has
been designed and
printed at no charge to
Volunteer Centre Glossop.
from Derbyshire Council
we bring in
£3.03 of additional
match funding
Grant
Income
45%
86% of
our income was
used for front line
service delivery.
Focussing our services on the needs of Glossop
residents makes us vulnerable to statutory sector
cuts. Grants are being replaced by ‘one size fits
all’ contracts covering large geographical areas.
Contracts that can be less cost effective.
Thanks to our
supporters:
For every £1 invested in our service by Derbyshire
County Council we secure an additional £3.03 in
match funding. On top of this our added social
value brings another £66,000 worth of volunteer
time delivering services every year. Our services
support the health and independent living of 600
Glossop people each year. Without us most of
these people will hit a crisis; increasing demand
on Adult Social Care and the need for more costly
health and social care services.
The average statutory
day care costs is
£227 per person
per week.
Our costs is
£139 per person
per year.
Prevention has to be better than cure.
For more information or to support our work
please visit our website
www.communitycompanions.org.uk
Volunteer Centre Glossop is a registered company, number
3455027, and a registered charity, number 1067170
Volunteer Centre Glossop,
Howard Town House, High Street East,
Glossop, Derbyshire SK13 8DA
Tel: 01457 865722 40
Email: [email protected]
an Andrea design ref 70252 e: [email protected] E&OE
Title of Subject:
Chief Officer’s Report
Date of paper:
22nd June 2016
Prepared By:
Steve Allinson
History of paper:
In my monthly reports, I highlight the key areas of
business attended to by me in the preceding month.
Executive Summary:
In this report, I lay out steps taken to conclude the
transition from our commissioning arrangements of
2015/16 to the full mobilisation of the Single
Commission in 2016/17.
(for Discussion and
Decision)
Governing Body is asked to receive this report,
seek further information or assurance as
appropriate
by proposal:
All
Steve Allinson
41
CHIEF OFFICER REPORT, JUNE 2016
Overview
Following interview in May 2016, I received my letter of appointment as Chief Officer
to North Derbyshire CCG. The start date is confirmed at 1 August 2016. I will be
taking annual leave in the week commencing 25th July making 22nd July my last
working day with NHS Tameside and Glossop CCG.
Much of this month was been spent preparing for the move, ensuring
 all staff were transitioned to their new working arrangement in the Single
Commissioning Team,
 coordination of NHS111 communications for the ‘county’ of GM was
transitioned to NHS Bury CCG, and
 Directors of the Single Commissioning Team here are familiar with any roles /
meetings for which I remain the sole CCG representative and that
appropriate briefing has been passed on
To this end, the Single Commissioning Team is to confirm attendance to the GM
CCG Chef Officer Forum and a managerial presence at the AGG. Governing Body
was appraised previously that we would align work on the healthier together models
of care with our wider reform programme, Care Together.
I guided the Care Together Programme Board on how to conclude and position our
proposal for Transformation Funding such that it represents a sensible conclusion to
our work on a reform programme developed over the lifetime of the CCG from the
Ernst Young and McKinsey reviews of 2013 and CPT report of 2015 to-date.
Finally, I briefed the Single Commissioning Team of the outcome of the review and
recommendations for a single (hospital) service model for Manchester, setting a
process in train to ensure the SCT is represented into the next phase of work to
include an appraisal of the implications for the residents of Tameside and Glossop.
When combined with our report at the May meeting of Governing Body of a
successful Q4 ‘Checkpoint’ meeting with NHS England and unqualified
recommendation from our auditors for the Annual report and year end accounts for
2015/16, this marks a natural point of transition to the singularity of commissioning
with TMBC agreed by the Governing Body in September 2015.
Action required of Governing Body
Governing Body is asked to receive this report, seek further information or
assurance as appropriate.
CHIEF OFFICER
JUNE 2016
42
Single Commissioning Board Minutes
Title of Subject:
Date of paper:
20 April 2016
Prepared By:
Paul Pallister, Assistant Chief Operating Officer /
Company Secretary
History of paper:
The minutes of 20 April were approved at the Single
Commissioning Board meeting on 7 June 2016
Executive Summary:
The minutes detail the :
 Approval of the Terms of Reference for the Single
Commissioning Board (SCB)
 3 month review of the governance arrangements to
ensure fit for purpose
 Agreement to the Term of Reference of the
Professional Reference Group
 Each sovereign organisation receive the minutes of
the SCB
 Noted the Section 75 joint finance pooled arrangement
and aligned partnership agreement
 Each sovereign organisation would manage their own
deficit for 2016/17
 TMBC would host the Section 75 pooled fund
agreement
 Approval of the Commissioning Strategy subject to an
Equality Impact Assessment and appropriate
Communication and Engagement Plan being
developed
 Contracts forward plan is being developed
(for Discussion and
Decision)
Note the minutes
by proposal:
Agreed that each sovereign organisation would manage
their own deficit for 2016/17
Paul Pallister, Assistant Chief Operating Officer /
Company Secretary
43
TAMESIDE AND GLOSSOP
CARE TOGETHER SINGLE COMMISSIONING BOARD
20 April 2016
Commenced: 3.00 pm
PRESENT:
Alan Dow (Chair) – Tameside and Glossop CCG
Richard Bircher – Tameside and Glossop CCG
Christina Greenough – Tameside and Glossop CCG
Graham Curtis – Tameside and Glossop CCG
Councillor Brenda Warrington – Tameside MBC
Councillor Peter Robinson – Tameside MBC
Steven Pleasant – Tameside MBC
Steve Allinson – Tameside and Glossop CCG
IN ATTENDANCE:
Sandra Stewart – Tameside MBC
Angela Hardman – Tameside MBC
Stephanie Butterworth – Tameside MBC
Kathy Roe – Tameside and Glossop CCG
Michelle Rothwell – Tameside and Glossop CCG
APOLOGIES:
Councillor G Cooney – Tameside MBC
1.
Terminated: 4.30 pm
WELCOME AND CHAIR’S OPENING REMARKS
In opening the meeting, the Chair welcomed Board Members to the Tameside and Glossop Care
Together Single Commissioning Board and in doing so made reference to a number of landmark /
reference papers to be discussed. He stated that there was an inevitable period of ‘work in
progress’ as a product of old systems passing into the new, for example the report on the Public
Health Grant.
Just as the Joint Commissioning function was now live after a shadow year, so was the Devolution
arrangement for Greater Manchester and the Tameside Hospital Foundation Trust entered its
shadow year to become an Integrated Care Foundation Trust. There remained a huge financial
challenge to address a deficit £69m by 2020/21 and in addition a quality challenge involving
monitoring, assuring and improving a system wide quality going forward. The update report on the
assurance framework going forward demonstrated that progress was being made.
In addition, the Chair stated there was a strategic challenge in moving the balance of the locality’s
interventions and resources, upstream into preventive and proactive care and made reference to
the new five year Commissioning Strategy and its four key priorities; tacking the wider
determinants of health, healthy lifestyles, best care of long term conditions and supporting positive
mental health.
2.
DECLARATIONS OF INTEREST
There were no declarations of interest submitted by Members of the Board.
3.
TERMS OF REFERENCE / GOVERNANCE OF THE SINGLE COMMISSION
The Executive Director (Governance and Resources) presented a report explaining the
governance and accountability framework to support the development and implementation of an
integrated health and care system in Tameside. It also set out the Terms of Reference and
44
detailed the proposed arrangements to support the Single Commissioning Board including a
Professional Reference Group ensuring that at the heart of decisions there was a strong clinical
voice.
She stated that the proposals had been set within the framework of the Memorandum of
Understanding and the governance and accountability arrangements agreed at Greater
Manchester level where responsibility for the Greater Manchester Strategic Plan and Greater
Manchester wide commissioning arrangements resided. Additionally, they must take account of
and interface with the governance arrangements of individual partner organisations.
The interim arrangements for the Single Commission started in January 2016 and this included the
formation of the Interim Single Commissioning Board. On 1 April 2016, this became the Single
Commissioning Board operating on the basis of the Terms of Reference as set out in Appendix 1
to the report. The governance arrangements were intended to provide a safe foundation from
which decisions would be made to deliver improved services to the people of Tameside and
Glossop.
Following discussion and in acknowledging that the framework for the Single Commissioning
Board had been agreed at Greater Manchester level, it was felt that an early review of the Terms of
Reference would be undertaken in 3 months to ensure that they best supported the Board’s
decision-making processes.
Consideration was also given to the draft Terms of Reference for the Professional Reference
Group set out in Appendix 2 to the report and it was proposed that membership be amended to
reflect that there would be no distinction between Members and Attendees of the Group . Again,
the Terms of Reference would be reviewed in 3 months time to enable further shaping / refining.
RESOLVED
(i)
That the governance arrangements including the Terms of Reference set out as
Appendix 1 of the Single Commissioning Board approved by both statutory
organisations and the progress being made to support effective commissioning
decision-making by the Single Commissioning Board be noted.
(ii)
That the intention to keep the Governance arrangements of the Single
Commissioning Board under review to ensure fit for purpose be noted and that an
early review be undertaken in 3 months.
(iii)
That the arrangements for a Single Commissioning Board working group to be
known as the Professional Reference Group be noted and the Terms of Reference
agreed as set out at Appendix 2 subject to the membership being amended and a
review taking place in 3 months time to enable further shaping / refining.
(iv)
That each of the parties to the Single Commissioning Board formally receive the
minutes of the Single Commissioning Board.
4.
FINANCIAL FRAMEWORK AND CURRENT POSITION
The Chief Finance Officer to the Single Commissioning Board, Tameside and Glossop CCG,
presented a report setting out the key principles required to establish the joint (single) fund from 1
April 2016 between the Council and the CCG to be managed by the Tameside and Glossop Care
Together Single Commissioning Board. The report was approved by the Tameside and Glossop
CCG Governing Body on the 23 March 2016 and the Tameside MBC Executive Cabinet on 24
March 2016.
Considerable due diligence had been undertaken to ensure risks were mitigated and lessons
observed from other organisations operating pooled funding arrangements. Both organisations
had worked closely with the Greater Manchester Integrated Care Programme Office, Monitor and
the DH Better Care Fund Task Force to identify the most appropriate way of doing this
45
acknowledging the current limitations of powers under Section 75 of the National Health Services
Act 2006.
She stated that the report set out the financial framework that the Tameside and Glossop Single
Commissioning Board would be required to manage all resources within the Integrated
Commissioning Fund (ICT) and comply with both organisations statutory functions from the single
fund. It was proposed that the pooled fund was hosted within the accounts of the Council on
behalf of the Single Commissioning Board.
The Chief Finance Officer explained that Appendix 1 to the report provided details of the 2016/17
budget allocations for inclusion in the ICF categorised into 3 distinct sections:



Section 75 Services;
Aligned Services; and
In Collaboration Services.
Details of services that could be included in a Section 75 was set out in Appendix 2. It also
provided information on those services which could not be included as determined within the
existing legislation. It was noted that the ICF would be bound by the terms within the existing
Section 75 agreement and associated Financial Framework agreement set out in Appendix 3 of
the report.
In conclusion, she made reference to significant progress on joint commissioning arrangements
that had already been made and detailed in the report. During April 2016 the first step towards the
new commissioning system would be completed. The key milestone of implementing the ICF
should not be underestimated and in acknowledging that the work had been complex, it would
support the future decision-making of the Single Commissioning Board. It was intended that the
Single Commissioning Board would receive regular monitoring reports at future meetings.
RESOLVED
(i)
That the inclusion of the 2016/17 Tameside MBC and Tameside and Glossop CCG
budgets as stated in Appendix 1 within the existing Section 75 joint finance pooled
arrangement and within an aligned partnership agreement be noted.
(ii)
That the decisions taken by the Tameside and Glossop Care Together Single
Commissioning Board (joint committee) relating to the Integrated Commissioning
Fund binding on the Council and the CCG be acknowledged.
(iii)
To note the principal that during 2016/17 each organisation would be responsible for
the management of their own deficit arising within the level of resources they
contributed to the Integrated Commissioning Fund as stated in Appendix 1.
(iv)
That it be noted that Tameside Council would continue to be the host organisation
for the existing Section 75 pooled fund agreement.
(v)
To note that the terms of the financial framework provided within Appendix 3 to
support the Integrated Commissioning Fund had been approved by both the Council
and CCG.
(vi)
To note that the level of resources within Appendix 1 be reviewed during 2016/17 and
updated accordingly in recognition of national funding decisions of the Government
and associated agencies together with funding decisions taken by the Council and
CCG.
(vii) That the inclusion of Greater Manchester Transformation Funding within the
Integrated Commissioning Fund, subject to award confirmation, be noted.
(viii) To note the intention to commence joint financial reporting and stringent monitoring
in shadow form on the Integrated Commissioning Fund stated in Appendix 1 to the
Tameside and Glossop Care Together Single Commissioning Board from 1 April
2016 on a monthly basis or as appropriate within the 2016/17 reporting governance
schedule for this Board.
46
5.
IMPACT OF CUTS TO PUBLIC HEALTH GRANT
The Director of Public Health introduced a report which explained that on 4 November 2015, the
Department of Health confirmed that it would reduce its spending on public health grants to local
authorities by £200m this financial year, 2015-16. This 6.2% in year cut in public health grant for
Tameside amounted to £942,928.
In the November 2015 Spending Review, additional cuts in the Public Health grant were
announced, which would be an average real terms cut of 3.9% each year to 2020-21. This
translated into a further cash reduction of 9.6% in addition to the £200m of savings announced
early in the year. For Tameside Council this would mean a confirmed reduction of £363,180 for
2016-17 and another reduction of £387,000 in 2017-18 having a very significant impact on the
commissioned Public Health services.
The Director of public Health made reference to the approach being taken to respond to the 201516 in year Public Health grant cut, and the reduction in grant funding that would continue to 202021. It was noted that 85% of the Public Health grant was commissioned through contracts and
confirmation of these reductions would present enormous challenge to reduce, decommission or
renegotiate contracts for April 2016/17. A prioritisation framework had been implemented and a
review of the total budget available for 2015/16 had been undertaken. A set of proposals against
current Public Health expenditure had been developed and a summary was detailed in the report
relating to the following areas:






Starting and Developing Well Programme – total saving £197,000;
Living and Working Well Programme – total saving £441,000;
Ageing Well Programme – total saving of £25,000;
Reducing staff costs and IT consumables – total saving of £36,000;
Review of all contracts commenced – target saving of £164,928; and
Public Health staffing redesign – identified part year saving of £79,000.
A letter from the Director of Public Health was sent to all providers in November 2015 informing
them of the proposed cuts to the Public Health budget and one to one meetings had taken place
throughout November / December to start the process of consultation and possible renegotiation of
contracts. In addition, Public Health commissioning leads had met with all providers to look at
possible funding scenarios of reductions on current contracts.
Members of the Single Commissioning Board heard that a public consultation on the Council’s Big
Conversation Website had taken place over a four week period commencing 4 December 2015 to
4 January 2016 where the proposals for the 2015/16 reductions were described and the public
invited to comment. The structure of the consultation and responses were detailed in Appendix 2
of the report.
In considering the proposals in the report, the Board expressed their deep concern and
disappointment regarding the cuts to Public Health budgets and the detrimental impact these
would have on many prevention and early intervention services. The Council had a statutory duty
to provide mandatory functions such as tackling alcohol and drug misuse, smoking and obesity as
well as generally promoting a healthier lifestyle. Investing in prevention ultimately saved money in
other areas by reducing the demand for hospital, health and social care services. The Board also
noted that the grant from 1 April 2016 would be included within the single commissioning pooled
fund and would therefore be aligned and considered alongside the outcomes of the single
commissioning strategy.
The Director of Public Health further advised that she intended to meeting with the Director of
Public Health for Derbyshire CC to understand the impact of the cuts to the public health grant in
Derbyshire, discuss system priorities going forward and how prevention programmes would be
secured for residents.
47
RESOLVED
That the approach being adopted in the report and response to the funding situation
described be noted.
6.
CARE TOGETHER COMMISSIONING STRATEGY
Consideration was given to a report of the Programme Director of the Care Together Programme
Board which stated that Care Together Commissioning for Reform Strategy 2016-20, appended to
the report, which was based upon discussions with key members of staff from the Single
Commission and Tameside Hospital Foundation Trust, Councillors and GPs, two staff workshops
and a review of existing plans and strategies.
It suggested an initial focus on four key commissioning priorities. These had been identified as the
areas which could have the biggest impact on improving health and wellbeing whilst reducing long
term costs. Further work was required in order to develop and appropriate outcomes framework to
underpin the commissioning priorities and to inform the development of an outcome based provider
contract.
The report also considered the role of the Single Commission in supporting the development of the
Integrated Care Organisation and the new model of care and the organisational development of
the Single Commission.
Reference was also made to the key actions over the coming months set out in the Strategy and
the development of the communications and engagement plan providing an early opportunity to
communicate with regard to the high level ambitions and intentions. The next stage also involved
an Equality Impact Assessment being undertaken to inform which stakeholders and patient groups
might be affected, in order that the Strategy could be shared, initially for information and comment.
RESOLVED
That the Commissioning Strategy and the key next steps be approved and progressed
subject to an Equality Impact Assessment and an appropriate communication and
engagement plan being developed.
7.
UPDATE ON 2016/17 COMMISSIONING CONTRACTS
The Director of Transformation presented a short update report setting out the work undertaken to
produce a single database of contracts in the scope of the Single Commissioning Board. There
was some outstanding information regarding a small number of CCG 2016/17 contract values,
which would be updated in the next few days and Public Health 2016/17 contract values would not
be finalised until end April to account for the full impact of the increase in the national living wage.
There would be ongoing housekeeping and administrative work to keep the database live and
accurate. For each contract it had been established:





Name and type of provider, e.g. Acute, Any Qualified Provider, Locally Commissioned
Service, Patient Ambulance Service, Local Authority, CHC, Community, Mental Health, Out
of Area Treatments, Hospice;
Whether the Local Authority and / or CCG was lead, co-ordinating, co or associate
commissioner and contract holder;
Type of contract and payment type;
Value, length of contract, start, end dates and notice period; and
Responsible contract and commissioning leads and monitoring process.
Further analysis would shortly commence to look at reviewing the contracts to understand for
example:
48




Where both Tameside MBC and the CCG commission and contract from the same
provider;
Where contacts’ notice periods were due within the next 6-12 months;
Opportunities for more outcome based / focused contracting arrangements; and
Opportunities for efficiencies / recommissioning / decommissioning.
In addition, consideration would be given as to how the single database could be interrogated to
provide easy, comprehensive summaries of contractual information for the commissioning team to
use and which would give the Single Commissioning Board the assurances it required that
contracts were being managed and getting best value for the residents of Tameside and Glossop.
A forward plan would be produced providing details of contracts that were due to expire to assist in
the future planning of the commissioning strategy.
The Board welcomed the update on commissioning contracts as it was a very positive move for the
Single Commission to know how, where and on what its budget was being spent.
RESOLVED
(i)
That progress in developing one contracts database for the Single Commissioning
function and the opportunities this would bring the locality to better manage and coordinate services and where appropriate make contracting efficiencies be noted.
(ii)
That a contracts forward plan would be developed for consideration at the next
meeting of the Single Commissioning Board.
8.
UPDATE ON ASSURANCE FRAMEWORK GOING FORWARD AND UPDATE ON CCG
2015/16 ASSURANCE POSITION
Consideration was given to a report of the Director of Public Health advising on the proposed GM
system-wide improvement and recovery approach to the health and social care system delivery
challenges, which recognised that the future of assurance on delivery would be delivered at the
place level through the newly connected system and recommending that a similar local approach
be adopted. The aim would be to establish a system which owned the process of assurance and
performance improvement, place based and driven by the locality determined and owned priorities.
The Locality Plans, as the foundation of the GM 5 year Health and Social Care Strategic Plan –
Taking Charge, articulated a strategic direction of travel to align and integrate commissioning and
new provision through a range of new models of care. This new model would be connected in new
ways and the current organisational focus of national assurance and regulatory processes, and
local scrutiny functions might need to be reviewed in this context.
The report also provided an update on CCG assurance and performance, based on the latest
published data. The January position was detailed for elective care and a March ‘snap shot’ in
time for urgent care to provide continuing reassurance whilst a new fit for purpose approach was
co-designed and consulted upon.
Additionally, attached to the report was a CCG NHS Constitution scorecard, showing CCG
performance across indicators. The CCG had been Assured as Good in four of the five
components in the assurance framework with Performance being the only one with Limited
assurance.
In Particular, Board members were asked the note the following:


Performance issues remained around waiting times in diagnostics and the A&E
Performance;
The number of patients still waiting for planned treatment 18 weeks and over continued to
decrease and the risk to delivery of the incomplete standard and zero 52 week waits was
being reduced;
49






Cancer standards were achieved in January 2016;
Endoscopy was still the key challenge in diagnostics particularly at Central Manchester;
A&E standards were failed at Tameside Hospital Foundation Trust (THFT) and were
amongst the lowest in GM.
Attendances and non-elective admissions at THFT (including admissions via A&E) had
increased on 2014 since August;
The number of Delayed Transfers of Care recorded remained higher than planned.
Ambulance response times were not met at a local or at North West level.
A discussion took place regarding minimising avoidable attendance at A&E and the challenge of
developing intelligence and early intervention to prevent emergency or unplanned hospital
admissions.
RESOLVED
(i)
That the approach described for a GM wide assurance process be noted.
(ii)
That the development of a locally based assurance model which aligned with the GM
approach and also supporting the localities ambitions be agreed.
(iii)
That the 2015/16 CCG statutory assurance position be noted.
(iv)
That the Board identify areas to scrutinise further as a holistic system wide
assurance system was developed.
8.
URGENT ITEMS
The Chair advised that there were no urgent items for consideration at this meeting.
CHAIR
50
Title of Subject:
Transformation Report
Date of paper:
June 2016
Prepared By:
Alison Lewin
History of paper:
n/a
Executive Summary:
The Report provides the Governing Body with an
overview of the transformation work which is ongoing supporting the GB clinical leads.
(for Discussion and
Decision)
The Governing Body is asked to note the content
of the Report and provide feedback on the
content and the projects described.
by proposal:
All
Clare Watson
51
Transformation Directorate Report – June 2016
The aim of this report is to provide Governing Body with an overview of the transformation work which
is ongoing, supporting the GB Clinical Leads. The report does not include information on ALL projects,
but aims to ensure the report is concise and informative, identifying areas which are our priorities and
which demonstrate both success and the challenges we face, and not duplicating information presented
to GB on other projects. The Transformation Directorate covers a wide range of commissioning areas,
and works through 4 “teams”. We work closely with colleagues in other directorates and are
represented on all CCG Committees, ensuring the work we produce receives appropriate discussion,
input and ultimately “sign off” prior to implementation.
Integrated Neighbourhoods: A key project within the Care Together programme is the development
and implementation of the Integrated Neighbourhood model. To support the development of
implementation plans in the context of the wider programme and the GM Devolution business case, the
Transformation Directorate are leading 5 workshops during June, to which all member practices in the
neighbourhoods along with a range of neighbourhood stakeholders are being invited, to develop the
LOCAL approach to this model. The outcomes will be reported through Care Together governance in
early July.
Joint Neighbourhood meeting: In July we will be convening a joint meeting of all Neighbourhoods,
rather than having the 5 separate meetings, to discuss key current issues including QIPP, Care Together
and the 2016-17 Commissioning Improvement Scheme.
Strategic Programmes / Planned Care /Urgent Care
CCG Assurance: The annual review was positive and preparation is on-going for the 2016/17 Assurance
Framework although we are awaiting clarity on the expectation of GM Devolution.
A&E and RTT Returns are currently no longer required on a monthly basis but requests have been made
for mental health waiting times and recovery levels.
Operational Planning: 2016/17 planning requirements were submitted including Quality premium and
Better Care Fund (BCF). Clarity has been provided for Tameside BCF with the expectation that the plan is
fully assured. Scheme level returns are being made for Derbyshire BCF.
SRG Assurance: A series of requests for information and self-assessment from NHSE are being managed
including on High Impact Changes and 111.
System Resilience: Planning for 2016/17. Maintenance of the Directory of Services to ensure patients
contacting 111 are notified of all the appropriate services. Initial evaluation of dispositions from 111 is
underway. Annual review of system wide escalation processes. Proposals to minimise the risk of high
demand in adverse weather and flu season are being developed.
Service Development: Continuing the tripartite arrangements to monitor the development of the
integrated elective services for ENT, MSK and Ophthalmology. Patient representation in place.
Continued monitoring of local use for Special Patient Notes to ensure all relevant parties are aware of
patients with DNACPR requests.
Facilitating discussions between THFT and HC-One to ensure effective transfer of patients into
Intermediate Care beds.
Participating in Urgent Care and Planned Care Model of Care work streams including development of
GM Devolution Home First business case and implementation of the local Referral Management System.
52
Participating in the GM AQP service development including involvement in the market day and future
procurement.
Contracting: On-going monitoring of bridging arrangements in place for ENT and MSK with NWCATS.
These also support Advice and Guidance for clinicians. Activity through the services being monitored
and Practices are being encouraged to use in particular Advice and Guidance
Bridging arrangements in place with GM Primary Eye Care with increased care available at local
Optometrists. Monitoring and identification of further developments.
MRI capacity in place with NWCATs to enable GP Direct Access. On-going work to refine the referral
form to support GPs in using effectively as initial evidence suggests not all patients require scans.
Patient Transport Services preparing for mobilisation in July.
Work on-going to ensure effective consolidation of Easy Go activity into new NWAS contract.
‘At a Glance’ guide for GPs to support appropriate referrals
Mental Health & Learning Disability / Children & Families
Children & Families Commissioning:
Maternity: Following the publication of the National Maternity Review, ‘Better Births’, the CCG needs
to consider carefully how the recommendation will be taken forward. A number of the recommendation
makes specific reference as to either CCGs or a joint responsibility for their delivery by 2020.
Most notable among the recommendation the CCG is seen as responsible for:
•
Under Personalised care centred on the woman her baby and her family: 1.4) Women should be
able to make decisions about the support they need during birth and where they would prefer to give
birth, whether this is at home, in a midwifery unit or in an obstetric unit after full discussion of the
benefits and risks associated with each option; and
•
Working across boundaries to provide and commission maternity services to support
personalisation, safety and choice: 6.3) Commissioners should take greater responsibility for improving
outcomes, by commissioning against clear outcome measures, empowering providers to make service
improvements and monitoring progress regularly.
The provider THFT through the Planned Care work stream of the ICO is developing an action plan how it
will meet the recommendations. This will require the support of the CCG and ensure it is fully costed
and affordable.
Finally, aligned to the publication of the Better Births report and in accordance with the CCG published
notice from May 2015 the Governing Body needs to review its decision that the CCG would not fund any
future referrals to One to One Ltd.
SEND: A new framework for the inspection of local areas’ effectiveness in identifying and meeting the
needs of children and young people who have special educational needs and/or disabilities has been
announced (May 2016). It is important to note that these inspections will evaluate how effectively the
local area meets its responsibilities, and not just the local authority. The local area includes the local
authority, CCGs and public health. The new joint inspection framework (OFSTED and CQC) for SEND seek
to hold CCGs to account and ensure that their commissioning plans are appropriate to meet local
demand, and to ensure they have an effective relationship with the key providers to ensure effective
arrangements for delivering completed and implemented EHC plans. As result of the announcement and
new inspection framework an audit (self-assessment) of the CCG will be undertaken to evidence how it
is meeting its responsibilities under the reforms. A key Children’s Health service in delivering the SEND
reforms has been placed on the CCG risk register due to the demand and capacity issues evidence within
the service.
53
CAMHS: The CAMHS Transformation Plan was formally launch at Hyde Town Hall at the end of April
2016. The launch event was opened by Councillor Lynn Travis. As such work to redesign the whole
system is now moving at pace. However, despite the new levels investment the transformation is at risk
as result of a shortage in qualified and experienced practitioners to fill new posts created through the
transformation funds. Across Greater Manchester (and nationally) locality areas are competing with
each other to bring on board and fill the new posts created through the new central funding.
Personal Health Budget:
 PHB Co-ordinator now in post (12 month secondment), full enhanced DBS check now available.
 PHB Leaflet finalised – available on CCG intranet & website/LA website and TFT website. Article for
information also included in CCGs Update newsletter.
 Revised Communications & Engagement plan for staff and key stakeholders now available as a working
document (see attached)
 Development of a PHB process/framework is being developed.
 First meeting of PHB Peer Network held in May 2016 – PHB Co-ordinator working alongside People
Hub to encourage membership and development of the network
 PHB provider soft market test – expressions of interest close 17 July via Local Authority, “The Chest”
Long Term Conditions / Proactive and Preventative Care / End of Life Care
Cancer 2WW referral forms:
All Great Manchester GP practices received an email on 8th June 16 informing them that new GM wide
NICE 2WW cancer referral forms were ready for uploading. The forms are:
•
Breast
•
Gynaecology
•
Haematology
•
Head & Neck
•
HPB
•
Lower GI
•
Upper GI
•
Lung and Pleural
•
Skin
•
Urology
These forms have been developed over the last 6 months by Dr Sarah Taylor (GP Cancer Early Diagnosis
Lead for GMLSCSCN, CRUK & GM) in conjunction with FT & CCG GP Cancer leads. It should be noted
however, that Tameside and Glossop CCG were not informed of this work until late on, and therefore,
prior communication to practices was not possible. All forms are now available and ready for use.
MPET EOLC Funding:
The CCG receives MPET funding to support training of all staff – generic and specialist – in end of life
care. This is allocated on an annual basis.
We are currently in a strong position with our MPET funding with a total sum of £89,068.38.
MPET funding cannot be carried forward and so we are gathering suggestions for the remaining funds to
be used by the neighbourhoods. A considerable proportion of this has already been approved and
allocated on the following:
•
£30K - 2 yrs of a GP MacMillan post - Dr Mary Ann O’Mara from Lockside Medical Centre,
Stalybridge was appointed and commenced in post on 6th June 16. As part of this role Mary Ann will
work with practices to review and improve their referral/diagnosis data including the use of the new 2
week wait guidelines, significant event analysis of cancer diagnoses and use of electronic decision
making tools.
•
A total of £820 for x2 Advance Communication Course for EOLC - Aug and Sept for 8 places on
each. These places have been offered to hospital staff, hospice staff, DNs & GPs.
•
Sage and Thyme
o Train the trainer course and packs - £1,500
54
o Licence fee for 15/16 and 16/17 £2000 TBC
•
Cardiff Diploma
•
GSF for GP practices and Hospital
•
Verification of death training
The allocation of the funding is discussed via the End of Life Care Strategy group. Plans are under
discussion to broaden this discussion and involve the neighbourhoods, ensuring we have the
appropriate governance in place for any decisions made.
Frailty Update
Frailty develops as a consequence of age-related decline in multiple body systems, which results in
vulnerability to sudden health status changes triggered by minor stress or events such as an infection or
a fall at home. Between a quarter and half of people older than 85 are estimated to be frail, with overall
prevalence in people aged 75 and over approximately 9% (Collard et al, 2012).
1 of the priorities for the Care Together Neighbourhood Development Workstream is Frailty. Frailty will
need to work across all Care Together workstreams and in order to take this forward (and report back to
the Neighbourhood Development Workstream) a task and finish group has been established which met
at the beginning of June. This Group (whose membership included attendees from acute/social
care/primary care and the community) agreed that the scope of the frailty offer should include ‘core
principles of frailty’ rather than a ‘stand-alone’ frailty pathway.
It was further agreed that the EMIS Electronic Frailty Index (eFI), which is now available in general
practice, should be used initially to collect baseline data to identify patients’ frailty scores and that
following the collection of baseline data, it is proposed that any patient who scores moderate or severe
on the frailty categories will be the first target group for priority work of the Integrated
Neighbourhoods. Different models of care used in other areas are being scoped out including the use of
an Extensivist model and a further meeting has been arranged to take the above forward at the end of
June.
National Diabetes Audit Data Collection 2015-16
The National Diabetes Audit (NDA) is the one of the largest annual clinical audits in the world,
integrating data from both primary and secondary care sources, making it the most comprehensive
audit of its kind. Preparation is currently underway for the 2015-2016 audit collection. The audit will
collect data for the period 1 January 2015 to 31 March 2016. Practices will only be required to make one
audit year submission during this collection window. The provisional dates for GP practices to submit are
20th June to 29th July 2016.
From June 2016, NDA metrics will be used for the audit indicators for the new Improvement and
Assessment Framework for CCGs (CCG IAF). The CCG IAF aims to empower CCGs to deliver the
transformation necessary to achieve the Five Year Forward View. Diabetes is one of the six priority
clinical areas for the CCG IAF and all CCGs will be assessed on the following NDA metrics:
• People with diabetes that have achieved all three NICE recommended treatment targets (HbA1c,
cholesterol and blood pressure)
• People with diabetes, diagnosed less than a year, who attend a structured education course
CCGs with <25% GP practice participation will be categorised as ‘inadequate’ due to poor data quality/
inability to make a reliable assessment. Therefore we are really keen that as many of our practices
participate in this national audit this year, to this end, we intend to assist practices as much as possible
to extract this data so hopefully we will be able to get all practices participating.
Medicines Management
Pharmacy Repeat Prescription Ordering: For the past year MMT have been working with pharmacies to
have them follow best practice when ordering repeat prescriptions on behalf of patients. Despite this
there have been many continuing problems involving excess/early/discontinued medicines ordering
55
incurring both excess costs and generating patient safety incidents.
To try and bring a better level of control to this area of activity MMT is now working with GP Practices to
restrict pharmacy ordering to only those patients who do not have effective support in the community
and could not order for themselves and to encourage all other patients to order their own medication.
The aims of this activity is to encourage patient independence and responsibility for their medicines,
increase accuracy of ordering, reduce waste and thus reduce prescribing costs and also to reduce work
load for pharmacies and thus promote patient safety. A standard set of protocols and template letters
have been developed to help practices achieve this change and the first of the practices are now
implementing this new system. A paper is being prepared to take to PRG discussing sactions which may
be taken against pharmacies not following best Practice.
Prescribing Support: MMT continue to work in GP practices to support the 16/17 GP Commissioning
Improvement Scheme. Practices are working on agreed areas where there are significant savings
realisable. The MMT have signed practice agreements covering what work they are doing at each
practice. To the end of May savings of £88,000 had been realised. This included resolving some charges
levied against a T&G practice which were out of area.
Minor Ailment Scheme: MMT has now fully launched the NEW scheme, and from 1st July 2015 all
pharmacies in Tameside and Glossop (except 1) can provide the NEW service. The one unsigned
pharmacy is being chased up to participate. The scheme is based on a number of conditions that each
have a robust protocol, including definition of condition and description of symptoms, inclusion and
exclusion criteria, investigative questions to be asked, advice to be given, suitable medications (if
appropriate), non-pharmacological treatments and referral criteria. The conditions that can be treated
as part of the scheme are:
Athletes foot, hay fever, high temperature (fever), cough, nasal congestion (blocked nose), head lice,
thread worm, sore throat, headache, conjunctivitis, vaginal thrush
This is an advice driven service but if a medication is required patients who do not pay for their
prescriptions will receive any medication required as part of this scheme for free. The pharmacy is paid
£3 per consultation plus the cost price of any medication supplied. The aim of this scheme is to prevent
patients from taking GP appointments or turning up at A&E or out-of-hours services for conditions that
can be effectively and safely treated in the community pharmacy.
The administration and control of the MAS is carried out by use of the Neo i.t. system which allows
prompt payment of invoices and review of activity levels by site and condition. A review of activity by
site and condition is currently being undertaken.
LTC Inhaled Therapies: The CCG, in conjunction with the LPC & CPPE, ran an event to help train/ update
pharmacists in respiratory therapeutics and patient counselling for use of inhalers. The event was well
attended and had good feedback. Attendance at the event allowed pharmacists to fulfil the criteria to
participate in the NHSE enhanced service for inhaled therapies which the CCG hope to utilise in
conjunction with enhanced pharmacy GP interface working to help the CCG deliver better outcomes for
LTC respiratory patients. Two sites are now almost ready to commence this service, one in Denton
neighbourhood the other in Ashton.
Practice Based Pharmacists: As a part of the primary care funding arrangements a number of practices
from Ashton, Denton, Stalybridge, Hyde and Glossop have sessional practice based pharmacists support.
The Denton locality has arranged for its support to come from TFT, others have made their own
arrangements or hired sessional support from an agency.
The range of activities that are being undertaken by practice pharmacists varies from practice to practice
but includes level 2 & 3 medication reviews including polypharmacy and over 75’s reviews, care home
patient reviews, DNP, specials and Red list reviews, discharge planning and seamless care, dealing with
minor ailments requests and pharmacy repeat ordering.
The current pharmacist cover is being aligned with a bid to PRG to increase numbers and at the same
time co-ordinate activity with the emerging Integrated Neighbourhood Offer. It is hoped that going
56
forward the pharmacists can help to better support the most vulnerable patients as identified by the
new public health risk assessment tool.
Primary Care
Co-Commissioning: Movement to Level 3 Delegated Commissioning Of Primary Care
Our application to become Level 3 holders of delegated Primary Care Commissioning was approved and
we went live on 1st April. The current Joint Committee for Primary Care will continue to oversee this as
the Primary Care Committee.
•
APMS Reviews
This exercise is ongoing with a project plan developed with NHS England for Engagement and re
procurement. This is being managed by a project group.
•
PMS Contracts
The revised contract documentation has been forwarded to the PMS Practices for signing and we are
waiting for one final draft to be returned.
Development of a Primary Care Strategy:
The CCG has developed through Consultation with Practices, an overarching Primary Care Strategy with
5 Strands
(1) Strengthening Primary Care Infrastructure
(2) Developing Models of Primary Care that are meaningful to Practices and Patients
(3) Developing relevant and meaningful outcomes for Primary Care Investment – including local quality
indicators/framework
(4) Developing Our Membership – Engagement and Communication with General Practice
(5) Putting Patients at the Centre – Engagement and Involvement of Patients
Our Vision is to support General Practice to be a great place to work and for patients, a great place to
access Care. A Primary Care Delivery Group meets monthly to oversee development and progress of the
Strategy and accompanying actions.
Primary Care Strategy Strand 2: Developing Models of Care : Extended Access
Extended Access (out of hours)
This pre bookable service via local Practices is now live at Ashton, Glossop and Hyde. The Primary Care
Committee oversee the delivery of this pilot
New Model Contracts
The CCG are working with NHS England and local practices/localities that expressed an interest in
developing the Greater Manchester model locality based contract and with localities that are developing
their own plans. Additional support on a non-recurrent basis has been funded by NHS England.
Primary Care Strategy Strand 3: Developing relevant and meaningful outcomes for Primary Care –
Primary Care Quality Scheme
Practices have been returning their plans since the end of April. Six are outstanding and the primary care
team is working with those practices to have them submitted in time for the review panels.
Two review panels have already been held with practices achieving between 80 % and 90% against the
indicators. Two further panels will be held in July.
A further update after the panels will be given to PRG in September.
Recommendations
Governing Body are asked to note the content of the report and provide feedback on the content and
the projects described.
Ali Lewin
Deputy Director of Transformation
57
Title of Subject:
Nursing and Quality Directorate Update
Date of paper:
June 2016
Prepared By:
M Rothwell
History of paper:
This report is submitted to the Governing Body on a bimonthly basis
Executive Summary:
This report provides the Governing Body with an overview
of the Nursing and Quality work which is on-going within
the Directorate
(for Discussion and
Decision)
The Governing Body is asked to note the content of the
report and provide feedback on the content and the
projects described
by proposal:
All
M Rothwell Interim Director of Nursing and Quality
58
Nursing and Quality Directorate Report – June 2016
The aim of this report is to provide Governing Body with an overview of the Nursing and
Quality work which is on-going within the Directorate. The report does not include
information on ALL projects, but aims to ensure the report is concise and informative,
identifying all areas which are our priorities and which demonstrate both success and the
challenges we face, and not duplicating information presented to GB on other projects. The
Nursing and Quality Directorate covers a wide range of areas, and works through 3 “teams”.
We work closely with colleagues in other directorates and are represented on all CCG
Committees, ensuring the work we produce receives appropriate discussion, input and
ultimately “sign off” prior to implementation.
Nursing, Quality and Patient Safety/Customer Services /Safeguarding
The Directorate continues to hold quality meetings with Tameside Foundation Trust; the
TOR for this meeting has now been amended to include the quality of community services,
since the transfer of community services to the Trust on the 1st April 2016.Team members
continue to attend PCFT and Meridian contract meetings.
The future focus for the Directorate will be ensuring effective processes and systems are in
place to assure the continued quality of services of our other contracts (such as where T&G
CCG are not lead commissioner) and lower value contracts.
The Directorate receives all Serious Untoward Incidents/Steis reportable incidents and
reviews the quality and learning from the reports to feed back into the commissioning and
provider system. The Directorate attend all Serious and Untoward Incident panels held by
Pennine Care Foundation Trust.
The Directorate continues to monitor HCAIs via the monthly review meeting. The number of
HCAIs across the health economy has reduced significantly this year with a total of 71
cases against a plan of 97.
The Directorate continues to work closely with Contract and Business Intelligence to
improve quality along the commissioning cycle.
The Directorate is developing a new quality report to provide robust assurance on the
quality of commissioned service including the use of patient experience data. This piece of
work sits alongside the wider assurance framework in development for the Care Together
programme.
The Directorate is actively involved in developing quality measures for the new integrated
care pathways (MSK, ENT and Ophthalmology).
Two quality initiatives have been developed by the Directorate and Quality Committee
members which a focus on THFT reaching out to the care home sector to improve quality in
pressure ulcer and HCAI prevention.
Members of the Directorate have been involved in the NHSE development of a GM
pressure ulcer framework which was presented to DON on the 27th May 2016.
As a Directorate we want to enhance our capability in harnessing patient experience; as
such we have worked with Patient Opinion to ensure commissioners and quality leads
receive timely alerts for patient stories posted onto patient opinion. The alerts have been
set up in such a way that commissioners receive alerts pertinent to their areas of
responsibility which enables them to inform any commissioning decisions / intentions.
59
The Directorate has developed a patient experience data base which will enable
interrogation of the range of soft intelligence made available to T&G CCG and will be used
to inform quality focus and the Directorate quality report.
The Directorate continues to coordinate and undertake quality walkabout visits for all
provider contracts. Two visits have been recently conducted: unannounced quality visit to
Slow Stream Rehabilitation Step-Down Service for Men (Hurst Place) and quality focus
groups with Adult Home Treatment Team and Home Intervention Team / Intensive Home
Treatment Service (Older People’s Services) at Pennine Care NHS Foundation Trust. For
the Hurst Unit, recommendations were made in respect of the patient environment and
ensuring co-production in respect of discharge pathways for patients. For the Home
Treatment Team (HTT), the visiting team recommended development of a range of
outcomes measures that demonstrated the client-focused and holistic approach of the
team; these could then be further shared with the developing LCCTs as a model of good
practice. Both sets of recommendations have been fed back to the teams and are currently
being implemented. The visits highlight the complexity of meeting the wide range of mental
health needs, notably the challenges of supporting people with severe and enduring mental
needs in a hospital and home environment.
The Directorate’s work on the Patient Experience and Continuing Healthcare (PEACH)
Project continues. A stakeholder workshop has been held to gain views of local voluntary
organisations, patients/carers are being contacted to request support and advice and a
carer champion has been identified and will be attending the Steering Group. A staff
workshop is also planned for the end of June 16.
Work is on-going to develop the Care Home data-set with the aim of providing an early
warning system for the joint commission in respect of both Care Homes and Care Homes
with Nursing. It has been acknowledged that the data cannot be looked at in isolation and
local intelligence must be used to inform decisions made in respect of the data. Work will
be continued throughout the year to develop and refine the data-set with the aim of
developing an early warning system.
Freedom of Information
The Freedom of information function sits in the Directorate we receive process and sign off
any requests overseeing quality of response. We are working in the next few months to
ensure our required publication scheme is fit for purpose.
FOIs:
Figures for April/May in relation to this function are:
Month
Received
Breached
April
23
0
May
17
0
Complaints:
Customer services is managed within the directorate, this function receives all CCG
complaints and monitors complex complaints across NHS and Local Authority services. We
also survey NHS Choices and Patient Opinion for any areas of poor or good practice within
our health economy.
Month
Received
Status
April
5
All Closed
May
1
Closed
PALS:
60
Month
April
May
Received
1
0
MP enquiries:
Month
Received
Status
April
3
All Closed
May
1
Closed
Patient Transport Service:
Patient Transport booking services continues to provide high quality services to our patients
attending their first outpatient appointment. The Directorate attends established tri-part
meetings (CCG, Tameside Hospital Foundation Trust and Arriva) to monitor the Arriva
contract and address any areas of quality. The Directorate is actively using patient
experience of patient transport to inform the re specification of patient transport. The new
patient transport contract has been awarded to the North West Ambulance Services
commencing from 1st July 2016.
Safeguarding
Safeguarding Children and Adults at Risk
There is one Serious Case Review on-going to investigate the death of a child. The report
is due to be presented to the LSCB Strategic Board on 27 June 2016. Publication of the
review will not occur until after the date of the inquest which is due to occur in August 2016.
A Tameside GP practice has been asked to contribute to a domestic homicide review which
has been commissioned by Manchester. The alleged perpetrator of this incident was
registered with the practice for a short period of time.
Supervision arrangements are in place for the team and the Child Protection Forum and the
Adult Safeguarding Forums are all in place and booked for 2016.
NHS England has carried out two peer audits for the North region. This has audited CCG
performance with respect to children, and adult safeguarding and Looked after children.
The CCG have received good feedback from both audits. Action has been taken to address
the recommendation that the LAC Nurse post for the CCG to be become full time.
A further safeguarding audit has been undertaken by MIAA. This has made a number of
recommendations of low priority. Actions from these are currently being undertaken by the
Safeguarding Team.
Looked After Children Health Assessments
Glossopdale: Derbyshire County Council (DCC) has de-commissioned school nursing
services therefore there is presently no permanent provision to review health assessments
in school aged children. The Safeguarding team are continuing to work with Derbyshire
County Council to rectify this and Stockport Foundation Trust have agreed to continue
providing the service until a permanent solution is achieved.
Continuing Healthcare/Individualised Commissioning

Individualised Commissioning Team
In line with statutory responsibilities the team continues to commission and review all
clients who are eligible for individualised commissioning by the NHS. This involves the ongoing amendment of highly complex packages of care that are bespoke to the individual
and in receipt of packages of CHC in other locations. The team is actively managing:
269 individuals who are eligible for NHS Continuing Health Care
36 individuals who are in intensive NHS rehabilitation placements
256 individuals who are in receipt of NHS funded nursing care
61

The team continues to work in partnership with TMBC in relation to the procurement of
home care packages.

The team along with the Quality Team, BI, TMBC and DCC have been involved in
developing joint quality performance dashboard for care homes. This will be live tested for
Q1 in August and aims to identify early indicators of any quality concerns so that supportive
action can be offered before patient safety is affected.

There remains one care home with nursing that remains suspended from taking new
admissions. The team continue to work with partner organisations, the provider, patients
and relatives to continue to improve and sustain quality before and during all placements.

Care Home managers Forum continue to be led and facilitated by the team, There is some
work being completed to look at the how attendance form the care home managers be
improved to allow for better networking across the sector.

The team jointly chairs the Care Home and Home Care Quality Forum.

The team’s first student nurse placement commenced on 13th June 2016.

PINK (Programme to Invest in Nurses Knowledge) Enhanced has launched its 1st Cohort.
This builds on the previous PINK Essential that was very successful and continues to be
offered to nurses working in care homes. The team are starting to develop links with the
Education Department in the shadow ICO to look at a whole economy offer of healthcare
training.

To date there has been one nurse within the team that was required to complete NMC and
that was completed successfully. The learning from this process has been shared across
the whole team.
Previously Unassessed Periods of Care
Restitution cases continue to be investigated by the team. The CCG has 25 investigations
left to complete. The team is reviewing its strategies to meet the trajectories targets as
there have been delays beyond their control (from claimants). This has been raised at the
GM CHC collaborative as other CCG’s have reported similar delay. The lead for this agreed
to inform the national team of the GM wide difficulties. The numbers of cases at appeal
stage continues to increase. NHS England has indicated a further role of another close
down period.
Transforming Care
The team are progressing with the Transforming Care Agenda; we continue to reduce the
number of inpatients beds used.
There are currently two people in NHSE LD Secure Inpatient both of whom are not ready
for discharge
We also have three people whom are in CCG funded LD inpatients one of which is not
ready for discharge and the other two have discharge planning processes in place
The team are also involved in the implementation of the Blue Light protocol and At risk
register
Our Transforming Care Data submissions to NHS England and HSCIC are timely and up to
date.
Winterbourne Care & Treatment Reviews (CTRs), we have completed all of our CTRs as
expected by NHS England.
We have released the MH/LD commissioning nurse 1 day a week to lead NHSE Case
Management Project as part of the Fast Track Plan.
62
Recommendations:
Governing Body is asked to note the content of the report and provide feedback on the
content of the work streams described.
Michelle Rothwell
Interim Director of Nursing and Quality
63
Title of Subject:
Neighbourhood Leads Minutes of
Meeting – 24th May 2016
31st May 2016
Date of paper:
Prepared By:
History of paper:
Executive Summary:
Heather Palmer
N/A
The purpose of the clinical leads
meeting will be to act a clinical
network across the five CCG
Neighbourhoods, collecting and
sharing
experiences
from
the
respective constituent practices,
acting as a conduit between CCG
Board and PRG.
Recommendations required of the
Governing Body
(for Discussion and Decision)
To note the content of the minutes
and actions being taken forward.
N/A
1
64
Tameside & Glossop Neighbourhood Leads meeting
Tuesday 24th May 2016, 12.30-2.00pm
Churchgate Surgery, Denton
Present:
Dr A Hershon, Clinical Neighbourhood Lead for Hyde - Chair
Dr S A Ali, Clinical Neighbourhood Lead for Denton
Dr N Riyaz, Clinical Neighbourhood Lead for Ashton
Dr A Dow, CCG Governing Body Chair /Representing Glossop
Dr J Bircher, Clinical Lead for Quality
Dr R Bircher, LTC Clinical Lead
Tori O’Hare, Finance Manager
Paul Nuttall, Finance Manager
Christopher Martin, Commissioning Business Manager
Peter Howarth, Head of Medicines Management
Louise Roberts, Commissioning Business Manager
Alison Lewin, Associate Director of Transformation
Brendan Ryan, THFT
Apologies:
Alan Ford
Dr S Ahmed
Graham Curtis
In Attendance:
Jo Strothers, TMBC Community Response Service (item 1 only)
Louise Kay, CCG Practice Nurse Facilitator
1. Use of Telecare to Reduce Hospital Admissions
Jo Strothers from the TMBC Community Response Service attended to advise
on the different telecare devices which her service provided. It was noted
that there was a weekly fee of £6.01 per patient (irrespective of how many
devices) and that the service currently had 3823 service users. In relation to
the ‘falls device’ Jo advised that for a 6 month period November 2015-April
2016 the CRS service had received 1057 call outs as a result of falls, of which
only 86 were taken to hospital. Therefore those present discussed the
potential reduction in hospital admissions for falls.
It was agreed to promote the CRS service within primary care and that a slot
on a TARGET soapbox would be the most appropriate way to take this
forward in the first instance. Heather would liaise with Jo for a date for the
TARGET soapbox.
Action: Heather Palmer
2
65
2.
Enhanced Training Practices
Louise Kay updated those present on an opportunity from Health Education
England for 5 practices to become Enhanced Training hubs. This opportunity
would attract £30,000 to the practice. Those present discussed the work
pressures on general practice, including nursing and Louise explained the
time commitments of being a ‘hub’ or a ‘spoke’. It was noted that Alison Lea
had expressed an interest, although it was unclear whether this was for her
own practice, or on behalf of the CCG. It was felt that this proposal should
go in the first instance to the Training Practices Group which met regularly
whose membership included Alison Lea and Jane Harvey. Louise would liaise
with Alison/Jane to take this forward.
Action: Louise Kay
3.
Notes of the last meeting and matters arising
The minutes from the previous meeting were noted and accepted as a true
reflection of the discussions that took place. Noted that Dr Joanna Bircher
attended the last meeting, not Dr Richard Bircher. This would be amended.
4.
Matters Arising from previous minutes
MSK, ENT and MRI Referrals
Louise Roberts advised those present regarding NWCATS. Louise advised that
NWCATS also offer a pain clinic. Louise agreed to email out the details again
to GPs/neighbourhoods in order that they are aware of the referral process
for MSK, MRI and ENT.
Action: Louise Roberts
Louise advised that referrals are at anticipated levels but Louise would check
which referrals are available via choose and book.
Joanna Bircher advised regarding an individual incident which had recently
occurred relating to one of her patients who had an acute emergency for
eye care. Joanna advised regarding the follow up appointments for this
patient which were at Rochdale. It was noted that Sue Gibson was already
following up these concerns.
5.
Integrated Neighbourhood Teams (formerly LCCTs)
Ali Lewin advised that at the Locality Development Workstream meeting on
11th May the discussions were around INT’s Standard Operating Procedures
and the detail of the Job Descriptions. It was agreed that 5 “lock in” workshop
sessions (half days) – one in each neighbourhood – to take forward the
implementation of the INT model and ensure neighbourhood ownership and
identification of priorities. Ali advised that 3 dates had been agreed Ashton,
Denton and Stalybridge. Hyde neighbourhood were hoping to use an
3
66
existing project steering group date; and the Glossop date was yet to be
arranged. Attendance at the workshops would be core neighbourhood
teams and additional members including DNs/Fire Service/Police. It was
understood that funding for backfill for attendances at these sessions would
be available and Ali agreed to check this with NHS England.
Action: Ali Lewin
Ali would check with Learning Disabilities who was attending.
Action: Ali Lewin
6.
Commissioning Improvement Scheme (CIS)
Tori O’Hare advised that the final version of the CIS had been distributed via
neighbourhood meetings and Practice Managers’ Forum. Chris Martin/Paul
Nuttall and Tori O’Hare were working with the CCG’s Business Intelligence
team to produce practice data packs which would be used during practice
visits which were in the process of being arranged by the Neighbourhood
Commissioning Managers.
7.
Enhanced Services
Chris Martin advised on a paper which would be discussed at PRG in July
regarding neighbourhood contracts for enhanced services.
Following
discussion it was agreed that Chris should attend each of the INT half day
sessions to have an agenda item on this potential new working process.
8.
Any Other Business
Substance Misuse
Asad Ali reported back on a recent meeting which had been attended by a
GP within his practice. Concerns regarding the proposed changes to the
payment structure of this enhanced service and that GPs would be expected
to sign the prescriptions were raised. Concerns were also raised in relation to
practices withdrawing from providing the service. It was noted that Heather
Palmer and Louise Roberts were meeting with Gideon Smith/Francine Cooper
from TMBC who had commissioned the service via Lifeline the following day
and they would report back to the next meeting.
Action: Heather Palmer/Louise Roberts
Date of the next meeting will be Tuesday 28th June 2016
4
67
Title of Subject:
Date of paper:
Prepared By:
History of paper:
Executive
Summary:
May Final Quality Committee minutes
4th May 2016
Celia Poole
Quality Committee meets regularly, promoting and providing assurances to
the Governing Board, on all matters relating to the vision and strategy for
continuous quality improvement.
Key issues discussed:
GP Clinical Quality Improvement lead update
Trust Mortality Steering group
The meeting Joanna Bircher attended in April shows some early signs that
the work they are doing is impacting SHMI.
Discharge Summaries
The Lorenzo fix has taken place and the new handover/discharge
templates are ready to upload on 4th May.
Primary Care Quality Improvement work
Joanna Bircher is continuing to provide coaching sessions with two
practices from January 3016, focusing on practice culture and patient
experience.
QC discussed presentation of feedback reports from the quality standards
and whether these should be presented to Quality Committee from a
quality perspective or to PRG as this is where they were previously
presented and where the agreement for funding these took place.
Care Homes update
Darnton House
JW updated that the close date is now planned for 10th April. 2 residents
remain in the home with 1 set to move out the following day Thursday 5 th
May and the last resident waiting for a new abode.
Downshaw Lodge
The suspension remains and the issues are still on-going. There is a
planned review process based on certain individual’s workforce
procedures and some developed internal leadership issues.
Proposal for Primary Care Delivery Group
QC received a report on a proposal for the Primary Care Delivery
Group to continue to encourage Quality Improvement by recognising
and celebrating the good work of member practices.
Quality Unannounced visit reports (Pennine Care NHS Foundation
Trust)
QC received two reports of quality unannounced visits that have taken
place at Pennine Care NHS Foundation Trust as follows:

Hurst Place

Adult Home Treatment Team
Safeguarding and Quality Serious Incident Update Report Q4
The purpose of this report is to provide an overview of Serious Incident
Reporting for 2015/16 Quarter 4. The report includes summary data in
respect of both new incidents reported and closure of incidents within
Quarter 4. The report also provides further information in respect of ongoing incidents and delays in reporting.
HCAI Report
This report provides an overview of the end of year performance against
68
Recommendations
required of the
Governing Body (for
Discussion and
Decision)
QIPP principles
addressed by
proposal:
for HCAIs against the targets set by NHSE. It also provides detail about
the quality assurance mechanisms in place for the CCG in relation to
HCAIs and the planned actions to continue to secure quality improvements
in the prevention and reduction of HCAIs for 2016/17.
Quality Account – THFT
Members received a copy of the THFT Annual Quality Account. The CCG
are to provide a statement of response back to THFT by 21st May.
To discuss and note the key issues discussed and agreed at the meeting
on 4th May 2016.
Quality
Celia Poole
69
Final
Minutes
Quality Committee
Wednesday 4th May 2016 9.30am-12.30pm
Boardroom, New Century House
Present:Celia Poole (CP)
Clare Todd (CT)
Lynn Jackson (LJ)
Joanna Bircher (JB)
Dr Jamie Douglas (JD)
Clare Watson (CW)
Lesley Surman (LS)
Julie Beech (JBee)
Jayne Wilkinson (JW)
Governing Body Lay Member (Chair)
Governing Body Nurse, CCG
Quality Lead, CCG
GP Clinical and Quality Improvement Lead, CCG
Director of Transformation, CCG
Healthwatch Officer, Healthwatch Tameside
Interim Head of Individualised Commissioning, CCG
In attendance:Slawomir Pawlik (SP)
Tracey Hurst (TH)
Clare Bromley (CB)
Quality Monitoring and Patient Safety Lead, CCG (Item 7 only)
Safeguarding Adults Lead, CCG (Observing)
Personal Assistant, Corporate, CCG (note taker)
1.
Chairs Welcome, Introductions and Apologies
CP welcomed everyone to the meeting.
Apologies were received from:Peter Denton
Healthwatch Manager, Healthwatch Tameside
Hazel Chamberlain Lead designated for Safeguarding, CCG
Michelle Rothwell
Interim Deputy Director of Nursing and Quality, CCG
Alison Lea
CP announced that this was to be the last attendance for Jamie Douglas at Quality Committee who has
since joined membership on the Integrated Governance and Risk Committee. Alison Lea will replace
Jamie on the membership for Quality Committee and hopes to be in attendance at the next meeting in
June.
QC thanked Jamie for his input to Quality Committee.
2.
There were no declarations of interest noted.

Register of interests
JBee noted an amendment for herself and Peter Denton to reflect the change of name for Tameside
CVAT and Oldham CVAT who have joined to become Action Together with effect from 1st April 2016.
CP also noted an amendment to the recent Governing Body Register. CB will discuss these
amendments with Paul Palliser and reflect on the Register for Quality Committee.
Action: CB
3.
Minutes of Previous meeting: 6th April 2016
The minutes of the previous meeting were agreed as an accurate record.
1
70
Final
The following actions were reviewed:
Action 5i – Discharge Summaries
CP did raise the issues at Governing Body to ensure that IM&T is on board with resolving the issues
raised with the Lorenzo software and the Trust not being able to upload the new discharge/handover
templates.
Action 7 – Primary Care Quality Report
JB and CP confirmed that a letter had been finalised to send out to practices to acknowledge that the
CQC have recognized when practices have made improvements.
Action 11 – SHMI Coding update
CP updated that Peter Nuttall from TGH will be attending the next meeting in June to present an update
on SHMI Coding.
Action 5ii – Care Homes update
Michelle Rothwell had highlighted there is some work on care homes being carried out in general on an
early indicator dashboard and agreed to keep QC informed when an update will be available on progress
of that work.
Action: Michelle Rothwell
4.
Matters arising not otherwise on the agenda
All matters arising are covered on the agenda.
5.
Standing items – Monthly
GP Clinical Quality Improvement lead update

Trust Mortality Steering group
The meeting JB attended in April shows some early signs that the work they are doing is impacting
SHMI.

Discharge Summaries
The Lorenzo fix has taken place and the new handover/discharge templates are ready to upload on 4th
May.
JB confirmed that a communications had been drafted to go out to GPs and practices and JB will
endeavour to recruit ‘spotter’ GPs and practices to give specific feedback so she can take forward any
further adjustments if necessary. JB was awaiting sign off for this communications and CW confirmed
during the meeting that this has since been signed off.
LJ agreed to share some anecdotal information received about medical handover to JB.

Primary Care Quality Improvement work
QC received the minutes of the LIG meeting 21st March 2016.
Action: JB
JB is continuing to provide coaching sessions with two practices from January 3016, focusing on practice
culture and patient experience. On 30 March JB delivered training on QI methods and Change
Management to this current year of GP Specialist Trainees who are completing their GP training in
Tameside and Glossop at the end of July this year.
CP noted that it would it would be useful if case studies that are shared with GPs at could be shared with
patient groups, particularly useful for work on a higher level antibiotic stewardship. CP therefore agreed
to put forward this request to Tim Dowling.
Action: CP
2
71
Final
QC discussed presentation of feedback reports from the quality standards and whether these should be
presented to Quality Committee from a quality perspective or to PRG as this is where they were
previously presented and where the agreement for funding these took place.
Chris Martin is the lead for the quality standard panels and it was agreed that once those panels have
considered the feedback reports they should be presented to Quality Committee to debate on the quality
of the delivery of the quality standards then to PRG for further consideration and full evaluation.
QC agreed that there needs to be a plot of reporting ahead of time and agreed the following action
points:
CW to speak to Graham Curtis regarding the work plan for PRG and feedback to QC on
timelines.
 Primary Care Delivery Group to make a decision when we need to receive reports.
Action: CW
Care Homes update
 Darnton House
JW updated that the close date is now planned for 10th April. 2 residents remain in the home with 1 set
to move out the following day Thursday 5th May and the last resident waiting for a new abode. JW
assured QC that both residents remain safe with regular contact from CHC nurse contact with both
residents and family members.

 Downshaw Lodge
The suspension remains and the issues are still on-going. There is a planned review process based on
certain individual’s workforce procedures and some developed internal leadership issues. Until that
review has taken place JW confirmed that the suspension will not be lifted yet. Tracey Hurst is involved
from a safeguarding perspective.
JW noted that the care home dashboard will provide a general overview in future.
6.
Proposal for Primary Care Delivery Group
QC received a report on a proposal for the Primary Care Delivery Group to continue to encourage
Quality Improvement by recognising and celebrating the good work of member practices. JB noted that
the proposal is to have an annual ‘Quality Award for General Practice’.
Members discussed briefly and considered the main resource implications. One further concern was
that this would need involvement from the communications team in the work that sits behind the
proposal.
Members agreed that this would need a decision from Governing Body and JB noted that Alan Dow, as
chair has commented that it goes with the staff awards and suggests carrying this out for a year and
letting it develop and also to consider future involvement of other providers.
JB agreed to amend the last paragraph to reflect comments prior to a decision from Governing Body.
Action: JB
7.
Quality Unannounced visit reports (Pennine Care NHS Foundation Trust)
QC received two reports of quality unannounced visits that have taken place at Pennine Care NHS
Foundation Trust as follows:

Hurst Place
The purpose of the visit was to observe the quality and effectiveness of the Service. The service accepts
males aged 18 to 65 years who are detained under the Mental Health Act although the client may have
an informal status as they progress through the discharge pathway.
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72
Final
SP updated that since writing the report, Pennine Care has sent through email confirmation of the
recommendations being carried out.
Home Treatment Team is one mechanism for Pennine Care to treat patients and the report highlights
some commissioning pathway type issues around communications around patient crisis to GPs. CW
agreed to discuss this further with Pat McKelvey and Tina Greenhough.
Action: CW

Adult Home Treatment Team
The purpose of the quality focus groups was to explore and discuss the quality and effectiveness of the
Services.
Members requested that consideration be given on how Pennine Care envisages gathering the feedback
from the focus groups and making this more explicit in the recommendations.
Action: SP
8.
Safeguarding and Quality Serious Incident Update Report Q4
The purpose of this report is to provide an overview of Serious Incident Reporting for 2015/16 Quarter 4.
The report includes summary data in respect of both new incidents reported and closure of incidents
within Quarter 4. The report also provides further information in respect of on-going incidents and delays
in reporting.
Members commented that a breakdown would be useful to review improvements and the importance not
to lose where issues are in an ICO.
LJ highlighted that Tameside and Glossop ranked 8 in the country showing outstanding in some areas.
There are still some incident open on the report for SFT and LJ confirmed that these are now closed
although had not been updated yet on STEIs pre 31st March 2016.
JBee had received some comments from Peter Denton regarding the investigations of the closed cases
for February and March and agreed to discuss these outside of the meeting with LJ.
Action: JBee
9.
HCAI Report
This report provides an overview of the end of year performance against for HCAIs against the targets
set by NHSE. It also provides detail about the quality assurance mechanisms in place for the CCG in
relation to HCAIs and the planned actions to continue to secure quality improvements in the prevention
and reduction of HCAIs for 2016/17.
LJ noted that a whole health economy action plan in place that brings together all of the work being
carried out captured across a breadth of work over a two year period. Members requested that this
include the work happening in care homes and LJ confirmed that future reports will include this.
Action: LJ
10.
Quality Account – THFT
Members received a copy of the THFT Annual Quality Account. The CCG are to provide a statement of
response back to THFT by 21st May. QC made the following initial observations of the account as
follows:

The construct of the report made it difficult to see the outcomes achieved and it did not feel like it
captured an overarching quality improvement approach.
4
73
Final

The reports structure did not seem to reflect the vast amount of work going on, although it was
recognised that the structure may well have been dictated by Monitor.

So what next? Accepting the fact that this is a statutory obligation for the trust to complete and
publish this Quality Account what do the trust plan for the year ahead? Based on this discussion
members have requested that the quality team at THFT (led by Peter Weller) be invited to a
future meeting to share with us their quality improvement priorities for 16/17 based on their
reflection on the quality work that has already taken place, particularly the amount of quality
improvement work that went into taking the Trust out of special measures. CB to pass on this
action to Michelle Rothwell to send invitation to Peter Weller.
Action: CB
CP therefore asked to provide comments directly to [email protected] to pass on to Steve Allinson
and Michelle Rothwell who will work to finalise a response.
11.
Any other business

Aqua Safety Report – For information
Members received the Aqua Safety Report for information at this stage. However, members agreed that
this would be best placed on the agenda for the June meeting with a request to Peter Nuttall to include
this as part of his presentation on SHMI coding.
Action: CB
This led to further discussion on Aqua reports that are provided to the CCG and Aqua being
underutilised in terms of the data it produces. It was agreed that further consideration be given to make
the offer more bespoke to support a wider remit and to explore. CP agreed to discuss this further with
MR to explore the offers of this, Advancing Quality an HSN.
12.
Date and Time of next meeting
Wednesday 1st June 2016, Boardroom, New Century House
Meeting closed: 11.15am
5
74
Title of Subject:
Date of paper:
Prepared By:
Delivering Excellence, Compassionate, Cost Effective Care
– Governing Body Performance Update.
16/06/16
Ali Rehman
History of paper:
Executive Summary:
Regular Updates are presented on a monthly basis to CCG.
This paper provides an update on CCG assurance and
performance, based on the latest published data (at the
time of preparing the report). The April position is shown for
elective care and a June “snap shot” in time for urgent
care.
Also attached to this report is a CCG NHS Constitution
scorecard, showing CCG performance across indicators.
The assurance framework for 2016/17 has been published
nationally however, we are awaiting the framework from
GM Devolution.
Performance issues remain around waiting times in
diagnostics and the A&E performance.
RTT
Incomplete
52WW Diagnostic A&E
Standard
92%
0
1%
95%
Actual
92.4%
0
2.55%
91.17%
The number of our patients still waiting for planned
treatment 18 weeks and over continues to decrease and
the risk to delivery of the incomplete standard and zero 52
week waits is being reduced.
Cancer standards were achieved in April apart from
consulatant upgrade.
Endoscopy is still the key challenge in diagnostics
particularly at Central Manchester.
A&E Standards were failed at THFT however recent
performance has improved.
Financial Year to
12th June16
91.17%
April
2016/17
92.46%
May
2016/17
92.16%
June to 12th
2016/17
85.32%
Attendances and NEL admissions at THFT (including
admissions via A&E) have increased on 2014 since August.
The number of Delayed Transfers of Care (DTOC) recorded
remains higher than plan.
75
Ambulance response times were not met at a local or at
North West level.
Governing Body are asked to:
(for Discussion and
Decision)
by proposal:

Note the 2016/17 CCG Assurance position.

Note performance and identify any areas they
would like to scrutinise further.
Delivery of NHS Tameside and Glossop’s Operating
Framework commitments for 2016/17.
Ali Rehman
76
Delivering Excellence, Compassionate, Cost Effective Care
Governing Body Performance Development Update
June 2016
1.
Introduction
1.1
This paper provides an update on CCG assurance and performance, based on
the latest published data (at the time of preparing the report). The April position
is shown for elective care and a June “snap shot” in time for urgent care. It
includes a focus on current waiting time issues for the CCG.
1.2
It should be noted that providers can refresh their data in accordance with
national guidelines and this may result in changes to the historic data in this
report.
2
2.1
3
CCG Assurance
The assurance framework for 2016/17 has been published nationally however,
we are awaiting the framework from GM Devolution. A recent WebEx led by
NHS England provided further info on the new assessment framework for 16/17.
CCGs will be assessed in relation to four key areas of their functions and
responsibilities, health, care, sustainability and leadership. The overall rating for
2016/17 and metrics will be transparent and published on My NHS. Six clinical
priorities will have independent moderation to agree an annual summative
assessment. Below is the framework NHS England intend to use.
Current CCG Performance
3.1
Elective Care – please note the April position is the latest available data.
3.2
In April the CCG achieved the incompletes standard at 92.4% and THFT
continued to achieve at 92.9%. The National RTT stress test demonstrates the
trust are continuing to reduce the risk of failing RTT, this will have a positive
impact on CCG performance.
1 77
Incomplete (Standard 92%)
CCG Actual THFT Actual Apr 89.34% 87.50%
May 90.65% 89.30%
Jun 91.44% 90.70%
Jul 91.79% 91.30%
Aug 92.03% 92.10%
Sep 92.16% 92.22%
Oct 91.81% 92.2% Nov 92.18% 92.8% Dec 91.8% 92.2% Jan 91.8% 92.7% Feb 92.1% 92.4% Mar 91.9% 92.5% Apr 92.4% 92.9% 3.3
The total number of incompletes for the CCG has stabilised and slightly
increased this is primarily due to the increase in under 18 weeks. The over 18
weeks has decreased slightly. There has been a decrease in over 40 week
waiters and the 28 to 40 waits have increased.
3.4
There was one patient waiting more than 52 weeks for treatment at UHSM who
has now been treated.
2 78
3.5
Tameside expects to report zero 52-week waits for May. However the risk of 52
week waiters remains with 17 patients at 43 to 47 weeks. Also there are 47
patients waiting over 36 weeks without a decision to admit. Earlier this year the
University Hospitals of South Manchester FT identified a data quality issue of
patients who had been waiting >52 weeks not being identified. UHSM, NHSE,
Monitor, and SMCCG have been addressing this matter. Following identification
of this issue earlier this year, intensive validation work was carried out at the Trust
and are still finding new >52 week pathways. As of 06th June 2016, five patients
had been waiting longer than 52 weeks when treated. These were patients that
we were not aware of when the last report was provided. We are being
updated regularly on the position and are keeping a close eye on the issue.
3.6
The specialities of concern
with regard to current
performance or Clearance
Rate (how long to treat the
total waiting list assuming
no more were added and
the number completed
each week stays the
same) are shown on the
right. Clearance Rate is
used as an indicator of
future performance with 10
to 12 weeks usually being
seen as the maximum to
deliver performance
however with specialities
3 79
with low numbers this is less accurate. The clearance rates have recently
improved.
3.7
Four of these are the specialities where THFT also failed the standard and still
have a backlog. Whilst reducing the backlog for Orthopaedics and Urology
there appears to be a small backlog in dermatology and Neurosurgery and
Gynaecology has increased. Gynaecology referrals appear to be increasing
and there may be impact from other trusts across GM. This is being reviewed.
Overall the backlog at THFT has decreased by 34.
Apr Mar Feb Jan Dec Nov Oct Sept August
Incomplete > 18 < 18 Backl Backl Backlo Backlo Backlog Backlog Backlo Backlo Backlo
Specialty Performance Weeks Weeks Total og og g g g g g General Surgery 94.4% 112 1884 1996
10 40 70
Urology 91.1% 71 724
795 7 30 30 40 20 5 25 10 Orthopaedics 87.3% 240 1650 1890 89 120 130 140 160 150 180 210 210 ENT 93.9% 61 937
998
Ophthalmology 99.4% 3 527
530 Oral Surgery 96.4% 23 623
646
Neurosurgery 89.6% 5 43
48 1 Plastic Surgery 93.8% 5 76
81 7 30 15 CT Surgery 100% 0 9
9
5
1
Adult Medicine 96.3% 32 835
867 Gastroenterology 96.7% 24 713
737
6
30
Cardiology 93.4% 62 878
940 6 10 40 40 Dermatology 91.1% 88 903
991 9
Rheumatology 94.4% 13 221
234 Gynaecology 86.8% 177 1163 1340 70 60 25 Other 96.3% 63 1622 1685
Trust 92.9% 979 12808 13787 176 210 190 180 192 193 255 315 320 3.8
Diagnostics- please note the April position is reported in this update.
3.9
In April we failed the diagnostic standard at 2.55% against 1.0% Standard for
waiting 6 or more weeks. This was primarily due to Central Manchester Trust.
4 July
June Backlo
Backlog
g 90
130
190 240 10
100 35
110 390 515 80
3.10 This means we
failed every
month last year
and continue
to fail this year,
but there has
been an
increase in
performance in
April.
3.11 At the end of April 115 patients were waiting 6 weeks and over for a diagnostic
test, 43 of which were over 13 weeks. 69 were at Central Manchester Trust.
Requests are continued to be made to obtain a copy of the action plan and
trajectory from Central Manchester Trust including discussions with NHS England
as their role as assurers of Lead CCGs.
3.12 The backlog in endoscopy appears to have slightly decreased and now
accounts for 46% of breaches. Central Manchester Trust has agreed with a
private provider to undertake additional activity to help with the backlog
clearance. They expect to clear the backlog by the end of June 2016.
5 81
3.13 THFT performance in endoscopy has increased from last month and Central
Manchester showing a slight increase in performance.
6 82
3.14 The latest update received from CMFT as at 21st April 2016 is as follows. The trust
has undertaken a clinical validation of the entire endoscopy waiting list, the
outcome of this validation is that 714 patients (Trust total) were identified that
required transferring to the active list, and 170 of which are priority. To address
the back log the trust has taken the following steps:

The trust is transferring patients from the planned list to the active list
and will report them in the next submission.

An extension to the arrangement with the independent sector for extra
capacity.

The balancing of waiting lists across the MRI and Trafford Endoscopy
units continues.

The director of performance now heads up a weekly meeting to review
all aspects.

Administrative and reporting routines have been improved/adapted.
The trust expect that they will be able to ensure resolution by end of June 2016. They
are developing a weekly trajectory in the next few weeks.
7 83
3.15 Cancer- please note the April position is reported in this update
3.16 We achieved all the standards In April apart from consultant upgrade.
3.17 Our full performance is shown below with all standards achieved apart from
consultant upgrade however the de-minimis rule applies.
Indicator Name 8 Standard
Performance
March April 15/16 16/17 No. of patients not receiving care within standard in Apr Cancer 2 week waits 93.00% 96.3% 95.82% 33 Cancer 2 week waits ‐ Breast symptoms 93.00% 98.88% 93.88% 6 Cancer 62 day waits – GP Referral 85.00% 93.75% 89.66% 6 Cancer 62 day waits ‐ Consultant upgrade 85.00% 88.24% 83.33% 3 Cancer 62 day waits ‐ Screening 90.00% 100% 100% 0 Cancer day 31 waits 96.00% 100% 100% 94.00% 100% 100% Cancer day 31 waits ‐ Anti cancer drugs 98.00% 100% 100% Cancer day 31 waits ‐ Radiotherapy 94.00% 100% 100% 0 Cancer day 31 waits ‐ Surgery 0 0 0 84
3.18 Tameside achieved all the standards.
Indicator Name Standard
Performance
March April 15/16 16/17 No. of patients not receiving care within standard in Apr Cancer 2 week waits 93.00% 95.8% 95.8% 37 Cancer 2 week waits ‐ Breast symptoms 93.00% 98.8% 93.8% 6 Cancer 62 day waits – GP Referral 85.00% 95.9% 91.3% 5 Cancer 62 day waits ‐ Consultant upgrade 85.00% 87.1% 89.5% 2 Cancer 62 day waits ‐ Screening 90.00% 100% N/A 0 Cancer day 31 waits 96.00% 100% 98.6% 0 Cancer day 31 waits ‐ Surgery 94.00% 100% 100% 0 Cancer day 31 waits ‐ Anti cancer drugs 98.00% 100% 100% 0 Cancer day 31 waits ‐ Radiotherapy 94.00% 100% 100% 0 3.19 The increase in two week wait referrals continues. Breast however, have
recently been close to 2015/16 levels.
3.20 The year to date increases in referrals continues compared to the same period
last year with Haematology, Urology, Lower GI, Head and Neck, breast and
lung showing the larger increases.
9 85
3.21 Urgent Care – please note position reported is at 12th June.
3.22 THFT A&E performance is as below.
Apr-16
May-16
92.46%
92.16%
3.23 We are currently the second best performer across the GM trusts YTD, reported
through Utilisation Management. Our May performance and June performance
to the 12th has not achieved the standard.
Financial Year
to 12 June 16
April 2016/17
May 2016/17
June to 12th
2016/17
Salford
92.23%
92.52%
90.21%
96.71%
Tameside
91.17%
92.46%
92.16%
85.32%
Wigan
91.02%
92.93%
90.30%
87.30%
Oldham
87.98%
86.89%
90.39%
84.12%
Bury
84.52%
82.72%
84.74%
88.11%
Bolton
81.00%
80.25%
81.29%
82.08%
Stockport
81.02%
79.31%
81.59%
83.59%
North Manchester
79.23%
80.20%
77.90%
80.48%
3.24 Recent
performance is on
an upward trend.
Improvement is
being maintained
by close monitoring
in A&E
underpinned by an
electronic board.
As use of the board
becomes
embedded it is
hoped that senior
manager scrutiny can reduce.
3.25 Activity was well managed during the two day period of junior doctors industrial
action. Activity levels were not below normal levels and performance was
above the standard.
3.26 There has previously been considerable variation on a daily basis with no clear
reason, but more recently that has stabilised. During April the standard was
achieved but May has seen a drop in performance.
10 86
3.27 During April and May, late first assessment is the main cause of A&E breaches
with patients having late assessments as the highest reason for breaches. The
patients waiting also impact on cubicle availability which results in breaches
due to late first assessments. Previously the main breach reason was awaiting a
bed.
3.28 We frequently have fewer emergency discharges than emergency admissions
and so routinely have to escalate discharge to manage the daily demand. The
loss of the beds at Darnton House has further impacted on our ability to
11 87
discharge from acute beds recently.
12 88
3.29
Slight increase in A&E attendances during April with much larger increase during May compared to 2015/16 and admissions
have also increased. The number of 4 hour breaches has decreased significantly during April but increased in May.
Variance
% variance
13 89
3.30 Since September 2015 there has been considerable variation in the numbers of
attendances and admissions and breaches have risen significantly. More
recently, this has stabilised and breaches have reduced.
Week Ending 03 Apr 10 Apr 17 Apr 24 Apr 01 May 08 May 15 May 22 May 29 May 05 Jun 12 Jun Actual Actual Number of Number of Actual 4 hour A&E Type 1 Performance Type 1 Attendances breaches 1,596 1787 202 88.7% 1641 217 86.8% 1495 166 88.9% 1639 47 97.1% 1609 38 97.6% 1770 84 95.3% 1797 190 89.4% 1682 157 90.7% 1688 106 93.7% 1676 134 92.0% 1673 336 79.9% Number of Emergency Admissions via A&E Number of Total Direct Emergency Emergency Admissions Admissions 453 421 382 406 445 435 450 414 411 373 413 80 85 58 71 68 74 66 69 75 58 62 533 506 440 477 513 509 516 483 486 431 475 3.31 Usage of the Alternative to Transfer service continues to be good and the level
of deflections remains above 80%.
January February March
Referrals
Accepted
Red Refusals to Hospital also seen
Deflected
Accepted %
% Deflected (of Referrals)
% Deflected (of Accepted)
14 210
209
21
157
100
84
84
207 203 29 150 98.1
86 86
241 223 22 189 98.8
88 88
April May 198 196 18 139 99.0
78.1 78.1
183 183 15 142 100 85 85 June to 12th 81 81 5 67 100
88 88
90
3.32 The number of Delayed Transfers of Care (DTOC) recorded has increased
recently.
3.33 Reducing DTOC and the level of variation day by day is a key aspect of the
improvement plan with Integrated Urgent Care Team designed to significantly
impact on bed availability by improving patient flow out of the hospital and
avoiding admissions. This should deliver a culture of’ Discharge to Assess’ which
is key to delivering the national expectation that trusts will have no more than
2.5% of bed base occupied by DTOC.
15 91
3.34 Ambulance – please note position reported is April
3.35 In April 2016 the CCG achieved the response rates locally with 81.48% for CAT A
8mins Red 1 , however we failed with 64.89% for CAT A 8mins Red 2 and 90.66%
for CAT A 19mins Red 2.
3.36 However, we are measured against the North West position which was 76.47%
for CAT A 8mins Red 1; 67.46% for CAT A 8mins Red 2 and 92.01% for CAT A
19mins Red 2 which means only CAT A 8mins Red 1 achieved this month.
3.37 Increases in activity have placed a lot of pressure on NWAS which has not been
planned for. This is impacting on its ability to achieve the standards.
16 92
3.38 The number of ambulances with handover delays decreased in April.
3.39 The trend is however still improving for ambulance turnarounds below 30
minutes.
17 93
3.40 111– please note position reported is April
3.41 111 went live in GM 10th November so this is the fifth full month reported
under the new arrangements.
3.42 Primary KPI performance

The North West NHS 111 service was offered 165,416 calls in the month,
answering 138,186.

125,187 (90.59%) of these calls were classified as being triaged
3.43 April’s operational performance delivered clear improvement over recent
months. This was as a result primarily of improved staffing in the HA and NPO
staff groups, and a slight seasonal reduction in activity leading to a better
match of staffing to demand. The primary improvements have been in call pick
up and calls abandoned, which in turn reduces the number of redialled calls,
allowing better management of the ‘actual’ demand in future.
Additionally, during the month of April, NWAS NHS 111 was able to successfully
contribute to the contingency arrangements for the Junior Doctors’ industrial
action.
Further recruitment will augment the NWAS NHS 111 workforce in mid May 2016,
leading to a return to more sustained performance improvement.
3.44 The North West NHS 111 service is performance managed against a range of
KPI’s, however there are 4 primary KPI’s which are accepted as common
‘currency’, reported by each NHS 111 service across England. These are:
Target
18 Reported

Calls answered (95% in 60 seconds)
79.5%

Calls abandoned (<5%)
5.9%

Warm transfer (75%)
35.3%

Call back in 10 minutes (75%)
39.4%
94
3.45 The level 4 incidents where ambulances were urgently dispatched to patients
who did not want to be resuscitated are being followed up (There were 3 cases
reported in April). It is essential that GPs share DNACPR with Go to Doc through
Special Patient Notes to enable 111 staff to see them and avoid distress to
patients and families.
3.46 Our use is in line with NW levels.
Callers Triaged by Age
% Breakdown
Total for NW Region
% Breakdown NW Region
15 and
Under
1,018
28%
32,438
26%
65 and
Over
771
21%
25,087
20%
16 to 65
1,909
52%
67,662
54%
Total
3,698
100%
125,187
100%
3.47 Our treatment is generally in line with NW levels.
Caller Treatment
% Breakdown
Total for NW Region
% Breakdown NW
Region
Calls
Triaged
Caller
terminated
call during
triage
Callers
who were
identified
as repeat
callers
Triaged
Patients
Speaking to
a clinician
Patients Warm
Transferred to
a Clinician
Where
Required
Patients
Offered a
Call Back
Where
Required
Call
Backs in
10
Minutes
3,698
100%
125,187
295
8%
10,762
161
4%
3,941
816
22%
26,417
279
34%
9,331
537
66%
17,086
182
34%
6,730
100%
9%
3%
21%
35%
65%
39%
3.48 Our onward referral is generally in line with NW levels.
Referrals Given
% Breakdown
Total for NW Region
% Breakdown NW
Region
Calls
Triaged
Ambulance
Despatches
Attend
A&E
Primary and
community
care
Recommended
to Attend Other
Service
Not
Recommended
to Attend
Other Service
3,698
100%
125,187
499
13%
15,085
273
7%
10,600
2,099
57%
73,168
99
3%
2,814
728
20%
23,520
100%
12%
8%
58%
2%
19%
3.49 Our dispositions are in line with this.
19 95
4
4.1
20 Recommendation
Governing Body are asked to:

Note the 2016/17 CCG Assurance position.

Note performance and identify any areas they would like to scrutinise
further.
96
NHS Tameside & Glossop CCG: NHS Constitution Indicators (April 2016)
Description
18 Weeks RTT
Indicator
Level
Apr‐16
89.0%
84.4%
85.8%
84.2%
83.9%
85.8%
86.0%
87.3%
89.1%
88.3%
88.8%
88.9%
86.8%
89.1%
Non‐Admitted patients to start treatment within a maximum of 18 weeks from referral
95%
88.7%
88.5%
87.2%
87.5%
80.3%
86.0%
83.5%
85.8%
85.1%
85.4%
84.9%
86.0%
85.7%
86.0%
T&G CCG
Exceptions
CCG target not achieved. Failing specialties are; T&O (75.19%), Gynaecology (78.72%), Others (89.76%). CCG at THFT failing specialities are; T&O (73.33%), Gynaecology (73.13%).
CCG target not achieved. Failing specialties are; general surgery (87.06%), urology (71.23%), T&O (89.04%), ENT (90.72%), opthalmology (94.53%), neurosurgery (71.43%), plastic surgery (88%), general medicine (83.05%), gastroenterology (75.63%), cardiology (77.85%), dermatology (85.51%), thoracic medicine (91.38%), rheumatology (94.12%), gynaecology (83.56%), other (87.01%). CCG at THFT failing specialties are; general surgery (86.79%), urology (65.05%), T&O (86.25%), ENT (89.58%), opthalmology (93.81%), neurosurgery (33.33%), plastic surgery (76.92%), general medicine (84.58%), gastroenterology (67.24%), cardiology (76.76%), dermatology (85.77%), rheumatology (94.32%), gynaecology (81.13%), other (85.69%). CCG failing specialties are; urology (87.56%), T&O (90.19%), plastic surgery (88.24%), cardiology (91.10%), dermatology (91.04%), gynaecology (88.08%). CCG at THFT failing specialities are; urology (90.68%), T&O (87.55%), dermatology (91.56%), gynaecology (86.36%).
In April 2016 there was 1 patient waiting 52+ weeks an incomplete pathway, 1 patient at UHSM for T&O. It has been confirmed that this patient has now been seen.
92%
89.3%
90.7%
91.4%
91.8%
92.0%
92.2%
91.8%
92.2%
91.8%
91.8%
92.1%
91.9%
91.6%
92.4%
Zero Tolerance
6
5
1
1
0
1
2
0
1
0
2
0
12
1
1%
1.2%
1.6%
1.7%
1.7%
2.1%
2.8%
2.8%
2.4%
2.5%
2.7%
1.8%
2.9%
2.2%
2.5%
CCG target not achieved. Failing for CCG are Central Manchester with 69 breaches for echocardiography, colonoscopy, flexi sigmoidoscopy, gastroscopy, MRI and urodynamics. PAHT with 4 breaches for colonoscopy an MRI. THFT with 28 breaches for audiology assessments, CT scans and neurophysiology. Pioneer Healthcare Limited with 14 breaches for neurophysiology.
95%
86.4%
93.6%
93.4%
91.8%
89.2%
87.7%
82.6%
77.2%
73.0%
73.4%
76.0%
93.1%
84.9%
92.4%
2015‐16 performance shows that 12,737 patients waited more than 4 hours (denominator 84,303). Breached by 8,522 patients. April 2016 performance is 92.41% breached by 179 patients.
Maximum two‐week wait for first outpatient appointment for T&G CCG
patients referred urgently with suspected cancer by a GP
93%
95.5%
93.9%
95.3%
94.1%
95.5%
98.1%
96.8%
97.7%
97.5%
97.4%
97.7%
96.3%
96.4%
95.8%
Maximum two week wait for first outpatient appointment for patients referred urgently with breast symptoms (where T&G CCG
cancer was not initially suspected)
93%
94.2%
91.1%
70.7%
93.6%
98.4%
96.7%
94.6%
96.7%
98.4%
96.1%
98.2%
98.9%
93.0%
93.9%
Maximum one month (31 day) wait from diagnosis to first definative treatment for all cancers
T&G CCG
96%
98.9%
97.7%
98.0%
99.0%
97.8%
98.1%
100.0% 100.0% 100.0% 100.0% 100.0%
100%
99.1%
100.0%
Maximum 31 day wait for subsequent treatment where that treatment is surgery
T&G CCG
94%
100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
100%
100.0%
100.0%
Maximum 31 day wait for subsequent treatment where that treatment is an anti‐cancer drug regimen
T&G CCG
98%
100.0% 100.0% 100.0% 93.8%
100%
99.1%
100.0%
Maximum 31 day wait for subsequent treatment where the treatment is a course of radiotherapy
T&G CCG
94%
100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
100.0%
100.0%
Maximum two month (62 day) wait from urgent GP referral to T&G CCG
first definative treatment for cancer
85%
97.7%
Maximum 62 day wait from referral from an NHS screening service to first definative treatment for all cancers
Patients waiting 52+ weeks on an incomplete pathway
T&G CCG
Patients waiting for diagnostic tests should have been waiting Diagnostics < 6 Weeks
T&G CCG
less that 6 weeks from referral
Cancer 2 Week Wait
YTD
90%
Patients on incomplete non emergency pathways (yet to start T&G CCG
treatment)
A&E < 4 Hours
Threshold Apr‐15 May‐15 Jun‐15 Jul‐15 Aug‐15 Sep‐15 Oct‐15 Nov‐15 Dec‐15 Jan‐16 Feb‐16 Mar‐16
Admitted patients to start treatment within a maximum of 18 T&G CCG
weeks from referral (unadjusted)
Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E department ‐ THFT
THFT
Cancer 31 Day Wait
Cancer 62 Day Wait
Ambulance
Mixed Sex Accommodation
83.7%
91.7%
83.0%
86.0%
86.8%
93.0%
88.2%
96.1%
93.3%
93.8%
89.9%
89.7%
82.4%
100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
95.3%
100.0%
Breach due to deferred treatment in Jan‐16.
T&G CCG
90%
100.0% 100.0% 100.0% 83.3%
Maximum 62 day wait for first treatment following a consultants decision to upgrade the priority of the patients (all T&G CCG
cancer)
85%
100.0%
81.8%
94.7%
78.6%
80.0%
81.8%
91.7%
80.0%
85.7% 100.0% 92.3%
88.2%
88.9%
83.3%
Category A calls resulting in an emergency response arriving within 8 minutes (Red 1)
NWAS
75%
71.2%
81.6%
79.8%
79.3%
77.7%
78.4%
75.9%
73.4%
74.9%
69.3%
70.5%
67.3%
74.8%
76.5%
High levels of demand and lengthening turn around times.
Category A calls resulting in an emergency response arriving within 8 minutes (Red 2)
NWAS
75%
72.1%
79.4%
78.2%
76.0%
75.4%
74.9%
72.5%
68.5%
69.5%
63.5%
61.1%
58.9%
70.4%
67.5%
Category A calls resulting in an ambulance arriving at the scene NWAS
within 19 minutes
95%
93.3%
96.4%
95.9%
94.6%
95.1%
94.6%
94.1%
92.0%
92.7%
89.9%
88.1%
86.7%
92.6%
92.0%
T&G CCG
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
THFT
0
6
0
4
2
12
95%
94.2%
100%
96.3%
100%
96.7%
3.75%
4.00%
4.50%
4.30%
Recovery
50%
38.20%
36.92%
44.00%
Wating times less than 6 weeks
75%
57.83%
54.81%
52.60%
Wating times less than 18 weeks
95%
90.50%
91.11%
89.61%
MSA Breach Rate
The number of last minute cancelled elective operations in the Cancelled Operations quarter for non‐clinical reasons where patients have not been (Elective)
treated within 28 days of last minute elective cancellation
Care Programme Approach (CPA)
87.2%
100.0% 100.0% 100.0% 100.0% 100.0% 96.2% 100.0%
The proportion of people under adult mental illness specialties on CPA who were followed up within 7 days of discharge from T&G CCG
psychiatric in‐patient care during the period
Number of last minute cancellations at THFT; Q1 = 63, Q2 = 54, Q3 = 86, Q4 = 96
IAPT
Access
97
Title of Subject:
2016/17 Month 2 Integrated Single Finance Report
Date of paper:
Governing Body 22nd June 2016
Prepared By:
Kathy Roe – Chief Finance Officer
History of paper:
Finance Committee 15th June 2016
Executive Summary:
This is a jointly prepared finance report between Tameside and
Glossop Clinical Commissioning Group and Tameside Council,
which reports on the financial position of the Integrated
Commissioning Fund.
The report provides an update on the month 2 financial position.
The Tameside & Glossop Care Together Single Commissioning
Board will be required to manage all resources within the
Integrated Commissioning Fund and comply with both
organisations’ statutory functions from the single fund.
of the Finance Committee
(for Information, Discussion
or Decision)
To discuss the 2016/17 financial position and outturn forecast as
at Month 2 (May 2016).
Acknowledge the significant level of savings required in 2016/17
to close the Financial Gap.
Acknowledge the significant amount of financial risk in relation to
achieving a balanced budget for 2016/17.
by proposal:
The Tameside Economy in 2016/17 is facing a £21.5m financial
gap. Please refer to the Financial Gap section for further details
regarding schemes and current progress.
Kathy Roe / Tracey Simpson / Paul Nuttall
98
1. INTRODUCTION
1.1
This report aims to provide an update on the financial position of the Integrated Commissioning
Fund (ICF) and the progress made in closing the financial gap for the 2016/17 financial year. The
total ICF is approximately £441m in value (See Appendix C), however this value is subject to
change throughout the year as new Inter Authority Transfers (IATs) are actioned and allocations
are amended.
1.2
The Tameside & Glossop Care Together Single Commissioning Board will be required to
manage all resources within the Integrated Commissioning Fund and comply with both
organisations’ statutory functions from the single fund.
1.3
The 2016/17 financial year is a particularly challenging year due to the significant financial gap.
This report also considers the financial risks of the ICF in 2016/17. Please refer to section 7 for
further details.
2
FINANCIAL SUMMARY
2.1
Table 1 details the 2016/17 budgets, expenditure and forecast outturn of the ICF. However in
order to achieve a balanced position by the year end there are a number of risks that have to be
managed:-








Achievement of the £21.5m Financial Gap (£13.5m T&G CCG and £8.0m TMBC).
Management of any potential over spend within Acute services. Any over spend would be an
additional pressure over and above the financial gap stated above.
Ensure Parity of Esteem is achieved in relation to Mental Health Services.
Management of Care Home placements due to the volatility in this area.
Management of unexpected and complex dependency placements within Children’s Services
Emergency In-year reductions to Central Government resource allocations
Pro-active management of Continuing Healthcare and Prescribing which are subject to volatility.
Remaining within the running cost allocation for 2016/17.
99
Table 1 – Summary of ICF Financial Position
Year to Date (M2)
£000's
£000's
£000's
Description
Acute
Mental Health
Primary Care
Continuing Care
Community
Other
QIPP
CCG Running Costs
CCG Sub Total
Adult Social Care
Adults Early Intervention
Childrens Services
Public Health
Strategy & Early Intervention
TMBC Sub Total *
GRAND TOTAL **
Budget
32,731
4,849
13,230
2,311
4,572
4,389
0
831
62,913
6,445
68
3,639
(1,596)
451
9,007
71,920
Actual Variance
32,853
(122)
4,862
(13)
13,498
(268)
2,550
(239)
4,571
1
3,830
559
2,206 (2,206)
749
82
65,119 (2,206)
7,299
(854)
68
0
3,905
(266)
(1,402)
(194)
451
0
10,321 (1,314)
75,440 (3,520)
£000's
Year End
£000's
£000's
Budget Forecast Variance
198,392 198,237
155
29,096
29,231
(135)
80,379
80,868
(489)
13,990
14,197
(207)
27,252
27,252
0
21,934
21,492
442
0
13,238 (13,238)
5,162
4,928
234
376,205 389,443 (13,238)
36,861
41,984 (5,123)
1,210
1,210
0
22,485
24,079 (1,594)
1,571
2,735 (1,164)
2,198
2,198
0
64,325
72,206 (7,881)
440,530 461,649 (21,119)
Movement
£000's
£000's
Previous Movement
Month in Month
0
155
0
(135)
0
(489)
0
(207)
0
0
0
442
(13,500)
262
0
234
(13,500)
262
(4,905)
(218)
0
0
(1,714)
120
(1,381)
217
0
0
(8,000)
119
(21,500)
381
*
Please note that accruals are included within the year end projections for the Council and not within the year to date totals.
Projected expenditure and income within Council services is monitored on a monthly basis via data maintained within the
respective service management information systems.
**
The total ICF is approximately £441m. This value will change throughout the year as new allocations and IAT’s are actioned.
3
COMMISSIONER FINANCIAL GAP
3.1
The Financial Gap in 2016/17 for the ICF is £21.5m which is split £13.5m Tameside & Glossop
CCG, and £8.0m TMBC. This is a significant financial pressure in 2016/17.
3.2
The CCG QIPP savings achieved at month 2 are the £230k for the wheelchair contract and the
£32k RADAR funding which is referenced in section 4 of this report under Mental Health.
3.3
Table 2 below details the individual schemes, the progress which has been made on a year to
date basis and a forecast outturn position by the year end.
3.4
As at 31st May 2016 (M2) £381k of total savings have been achieved. This is split £262k CCG
and £119k TMBC. Further detail in relation to each scheme and its progress will be shown in a
separate report.
3.5
Further details on identified schemes by Care Together (CT) work streams and progress updates
will be presented in subsequent reports.
3.6
Schemes which currently have no financial value allocated towards them or do not commence
and start to produce savings until 2017/18 onwards are not RAG rated in table 2 below.
100
Table 2 – Financial Gap Schemes 2016/17
101
4
MONTH 2 UPDATE
Acute
4.1
Acute budgets are forecast to under spend by £155k at year end. It must be noted only 1 month
of activity data has been received at the time of writing therefore there is an element of risk
associated with these figures. Activity will be monitored closely on a month by month basis.
4.2
Table 3 below details the position of our main acute providers:Table 3 - Main Acute Providers
Provider
TFT
CMFT
SFT
UHSM
PAHT
SRFT
WWL
BOLT
TOTAL
Budget
£000's
21,202
3,615
1,966
1,073
659
535
230
13
29,293
Year to Date
Actual
£000's
21,446
3,614
1,841
1,087
619
539
230
13
29,389
Variance
£000's
(244)
1
125
(14)
40
(4)
0
0
(96)
Budget
£000's
127,075
22,369
11,969
6,531
4,029
3,226
1,409
80
176,688
Forecast
Actual
£000's
127,075
22,369
11,896
6,527
3,985
3,221
1,409
80
176,562
Variance
£000's
0
0
73
4
44
5
0
0
126
4.3
Tameside FT – TFT is currently overspending by (£244k) based on month 1 activity data
however we are forecasting a breakeven position by year end. It is worth noting that there are a
number of transformational schemes within 2016/17 which will help to address the £70m
economy wide financial gap and start to reduce activity in the second half of the year. The
reduced activity levels will lead to an underperformance against the TFT contract and therefore
we expect any overspend in the early months of the year to be brought back into line as our
transformational schemes are implemented. However it must be noted this is a significant
financial risk to the CCG as an over performance on the TFT contract will result in a 50%
premium being paid. See section 7 (Risks) for further detail. The year to date pressures are
within Emergency admissions and Elective and further detail is provided below.
4.4
Emergency is overspent by (£246k) which is due to pressures with Non Elective Admissions
(£154k) and Ambulatory Care (£77k).
Non Elective admissions are 5.1% above planned activity levels and costs are 5.9% above plan
resulting in an overspend of (£154k).
Ambulatory Care Pathways are overspending by (£77k), the increase in use of ambulatory care
pathways is positive given this is in line with our Care Together service redesign intentions. The
tariff for ambulatory care is based on same day emergency care tariff, although there isn’t a direct
saving to the commissioner this is more efficient for the local health economy. Ambulatory care
pathways are crucial for the prevention and reduction of inappropriate admissions to hospital and
providing care closer to home.
4.5
Elective activity is 2.9% above planned activity levels and costs are 7.1% above plan resulting in
an overspend of (£112k). The majority of this overspend is driven by Trauma & Orthopaedics
(£88k) and general surgery (£40k).
As part of the 2016/17 contract setting the CCG has added in additional growth to ensure RTT
targets continue to be met. It is unclear at this stage whether the overspend seen in month 1 is
linked to the clearance of any backlog of patients waiting more than 18 weeks quicker than
102
anticipated, or whether this is a general increase in the demand for acute services. The CCG are
working closely with the Trust in order to understand the position in more detail, in particular
within Trauma & Orthopaedics.
It is also noted that within the month 1 data that there is a much richer case mix price for elective
activity above planned levels. Elective activity is +2.9% above planned levels, yet costs have
increased by +7.1%. Some of this could be linked to the continued improvements in the quality of
clinical coding following the Trust SHMI review. In line with our agreed contract terms any further
changes to counting and coding in 2016/17 e.g. to better capture pre-existing complexity or to
allow for more representative SHMI calculations should be at zero cost the CCG. The potential
financial impact of improved clinical coding will be considered as part of the preparation for
2017/18 contract baseline if material.
In addition the CCG are also analysing month 1 data to check adherence to outpatient protocols
and EUR policies.
4.6
Stockport FT - Stockport is currently underspent by £125k based on month 1 activity data. This
is due to underspends within elective services of £78k. The CCG would not expect this level of
underspend to continue for the remainder of the year.
Due to the difficulty in establishing trends so early in the financial year it is unclear how much of
the month 1 underspend is likely to continue into future months. It is felt that two months’ activity
data is needed before we can do some meaningful analysis and understand any underlying
trends and estimate the likely impact on the year end position. The CCG has made an
assumption that elective activity will be at planned levels for the remaining 11 months of the year.
A detailed review will be carried out in time for month 3 reporting.
Other areas of underspend within the month 1 activity data include underspends against the
stroke pathway of £24k. However as we can’t say with a level of certainty whether this will
continue the CCG have assumed that spend on the pathway will be equal to planned levels by
the end of the year.
4.7
The CCG has now received the final month 12 freeze files for its acute trusts in relation to
2015/16. The CCG has a cross year benefit of £206k on its acute contracts with the majority of
this being with UHSM (£196k).
Mental Health
4.8
The Mental Health budgets are forecast to over spend by (£135k) at year end. This is largely due
to additional placements within the Non CHC service which were not included within the baseline
budget. As with the CHC placements this continues to remain and area of volatility. Work will be
taking place in June 2016 between the finance team and the CHC team to fully review and
potentially amend the current CHC and Non CHC database, therefore a more robust and detailed
forecast will be provided in the month 3 report.
4.9
Confirmation has been received from Greater Manchester West FT that the RADAR service was
agreed as option 2 for which the CCG has correctly budgeted for. As noted in last month’s report
the CCG held a reserve of £32k based on the worst case scenario. This is now no longer
required and has been released as a recurrent QIPP saving.
4.10
It is assumed Parity of Esteem will be met in 2016/17 as notified to NHSE. Going forward this is
one area that will be monitored on a monthly basis by NHSE.
Primary Care
4.11
As at month 2 Primary Care is forecast to overspend by (£488k). The main financial pressure in
this area is prescribing. The CCG made an estimate for February and March prescribing costs in
103
the 2015/16 accounts. The February and March PMD data has now been received and this
places a (£185k) cross year pressure on the CCG. No data has been received for 2016/17 but
based on previous months’ data and the general trend in the final quarter of 2015/16 an estimate
has been made that at year end there will be an over spend of (£500k).
4.12
The CCG in its final plan submission had allocated a £1m QIPP target to prescribing for 2016/17.
There is a separate paper detailing a number of potential prescribing QIPP schemes for 2016/17
that will be presented to Finance Committee. The Medicines Management team continue to work
with GP practices managing their prescribing costs and repeat orders etc. but until the CCG
begins to see a reduction in its prescribing costs through the PMD reports, a year end forecast
position of a (£500k) overspend is felt to be more realistic. Therefore in order for the CCG to
achieve the prescribing QIPP target in 2016/17 the CCG would need to implement schemes that
actually achieve savings of £1.5m.
Continuing Care
4.13
The month 2 forecast outturn position for CHC is an overspend of (£207k). Work will be taking
place in June 2016 between the finance team and the CHC team to fully review and potentially
amend the current CHC database, therefore a more robust and detailed forecast will be provided
in the month 3 report.
CCG Running Costs
4.14
The CCG running cost allocation has been reduced in 2016/17 by £40k in line with NHS England
guidance, which means the total budget for 2016/17 is £5,162k. The CCG is forecast to under
spend on running costs by £234k at year end. Table 4 below shows the analysis of running costs
by each directorate.
Table 4 – CCG Running Costs 2016/17
104
Adult Social Care (Including Early Intervention)
4.15
Residential and Nursing Care Homes - The 2015/16 gross expenditure on Residential &
Nursing Care home placements was £24.858m (net expenditure was £13.976m when allowing
for client contributions and income from partner organisations).
4.16
The Council are engaging closely with the provider market to establish a new model of fees
across bed types. It is expected that there will be ongoing pressures from providers in future
years to increase fees as their cost base increases due to the introduction of the National Living
Wage.
4.17
The Council are mid-range compared to other NW Local Authorities in terms of placement
numbers into Residential & Nursing care for over 65’s but will seek to improve the position to be
top quartile performers as new models of care are implemented.
4.18
Homecare - The 2015/16 gross expenditure on Homecare was £6.161m (net expenditure was
£3.658m when allowing for client contributions and income from partner organisations).
4.19
There have been instances of provider failure over the last 18 months which has led to capacity
concerns across the homecare market. A decision was taken in January 2015 to increase the
hourly rate payable to providers from £11.42 to £12.81 to restore financial stability to the market.
4.20
The Council are engaging with providers to review the level of any potential increase to this rate
as a result of the implementation of the National Living Wage from 1 April 2016. Any resulting
increase will be subject to a separate decision.
4.21
The service continues to review existing commitments in line with statutory responsibilities to
deliver a balanced budget by the end of the financial year. Associated progress will be included
within further monitoring reports during 2016/17.
Childrens’ Services
4.22
The Service Improvement Board identifies and reviews savings opportunities whilst adhering to
statutory responsibilities and managing unexpected and complex need placement demand
pressures on the service budget. Associated progress will again be included within further
monitoring reports during 2016/17.
Public Health
4.23
Current proposals to reduce the fee payable to Active Tameside for management and operation
of the leisure estate will materialise during 2016/17. This will result in a cost saving to the
Council of £0.350m per annum (as a minimum from 2017/18) as Active Tameside improves its
financial self-sufficiency via capital investment by the Council in the estate.
4.24
The Directorate are engaging in negotiations on existing Public Health contracts. Details of
potential cost efficiencies will be provided in future reports as the service manages the impact of
reductions to the Public Health grant during the current and future financial years.
5
ADDRESSING THE LOCAL HEALTH ECONOMY GAP
5.1
The economy is currently working on plans to address the financial gap over the next five years
and business cases are being developed across all workstreams with supporting cost benefit
analysis. This approach will demonstrate to GM Health & Social Care Partnership that Tameside
105
and Glossop are investment ready for essential transformation funding of which £7.9m has been
requested in 2016/17.
5.2
It should be noted that there is considerable work underway to ensure the Economy is investment
ready by the end of June when the GM Strategic Partnership Board will consider the Tameside
and Glossop proposals for Transformational Funds. It is envisaged a decision on the proposals
will be known by early July.
6
LOCAL ECONOMY INVESTMENT
6.1
In order to help address the significant pressures in our urgent care system and to alleviate
potential regulatory intervention, the Council has agreed to consider offering one off support to
Tameside Hospital. It has been made clear through the recent contract negotiations, that any
offer of support would be contingent on the hospital delivering a plan by the end of June 2016
that would outline how the urgent care system will transform from the current working
arrangements to the new urgent care village being developed through the model of care work
stream by April 17.
6.2
The delivery of this new system should not be underestimated and Tameside Hospital has
submitted an initial plan totalling £2.3 million for the full year effect of achieving this. The Council
is considering initial support of £0.750 million (within the total of £ 2.3 million) until the transition
plan is received and consideration will then be given to any further contribution. The Council
investment will be subject to approval by the Council’s Executive Cabinet on 29 June 2016.
6.3
These investments are already producing tangible results with Tameside and Glossop being
named as one of the most improved locations in the country for urgent care.
7
RISKS
7.1
The key financial risks confronting the Economy at month 2 are detailed in table 5 :
106
Table 5: Schedule of Key Financial Risks – Month 2 2016-17
Risk
Probability
Impact
Risk
RAG
The achievement of
meeting the Financial
Gap recurrently.
3
5
15
R
Over Performance of
Acute Contract
3
4
12
A
Not receiving
Transformation funding
2
4
8
A
Over spend against GP
prescribing budgets
3
5
15
R
2
3
6
A
Over spend against
Continuing Health Care
budgets
Operational risk
between joint working.
1
5
5
A
Detail of Risk
Mitigation
The Financial Gap for 2016/17 is £21.5m. This is split
£13.5 CCG and £8.0m TMBC. The schemes identified
to achieve this target have been RAG rated. £19.7m of
the schemes have been red rated and £1.4m amber
rated. To date only £381k of QIPP savings have been
achieved.
As part of the Commissioning Improvement Scheme
(CIS), GP’s along with Commissioners are developing
schemes to improve care for patients and achieve the
required financial gap in 2016/17.
Only 1 month SLAM data is available for 2016/17,
however based on historic data and trends this is one
area that is potentially volatile and could therefore
create an additional pressure on the ICF in 2016/17. If
there is an over performance on the TFT contract a 50%
premium will be paid.
Both finance and activity data when available for
2016/17 will be monitored and challenged where
necessary. The CCG has a 1% uncommitted reserve
and a 0.5% contingency that have been set aside as per
NHSE guidance. The initial plan would be to utilise this
funding to offset such pressures, but confirmation from
NHSE would be required. It is anticipated
transformational funding will be received which will
enable investment in areas to redesign services that will
provide savings and better services for patients.
It is anticipated transformational funding will be received
in 2016/17. A decision on the value to be received will
be confirmed by early July 2016. We do not expect to
receive the full £7.9m requested from GM Health and
Social Care Partnership in year 1.
There is the potential to use some LA funding to bridge
the gap temporarily with the remainder of the £49m to
follow later. The CCG, TFT and TMBC are working
closely with the GM Health and Social Care Partnership
team and confirmation of how much funding will be
received will be confirmed in early July 2016.
A number of practices have or are looking to use a
practice based pharmacist to review prescriptions, along
with the ongoing work with the Medicines Management
team. This will hopefully drive costs down and identify
additional areas for savings. A separate paper identifying
potential prescribing QIPP schemes is being presented
to Finance Committee in June 2016.
Budgets have been set at outturn plus and an element of
growth and there is a provision on the balance sheet for
potential restitution claims. A full detailed analysis of the
Non CHC and CHC database is taking place in June
2016 between finance and the CHC team. This should
ensure a robust forecast is produced and all known
information recorded accurately.
Despite a QIPP scheme of £1m being set for 2016/17
for prescribing, the costs in the final quarter of 2015/16
increased considerably more than planned. The CCG
has incurred a cross year pressure of £185k on
prescribing and is forecasting a year end over spend of
£500k. Therefore there is a significant financial risk on
prescribing in 2016/17.
CHC has been an increasing cost pressure in 2015/16
to the CCG. Budgets have been set based on outturn
plus a level of growth.
The Integrated Commissioning Fund and integrated
working is a new way of working and reporting, bringing
together different cultures and different methods of
accounting, which therefore bring with it an element of
risk.
Working relationships between the CCG and TMBC are
very good. There are numerous meetings, and
committees which both members regularly attend,
contribute and make decisions. Therefore this should
mitigate any risk with joint working.
107
CCG Fail to maintain
expenditure within the
revenue resource limit
and achieve a 1%
surplus.
3
4
12
A
In year cuts to Council
Grant Funding
2
Care Home placement
costs are dependent on
the current cohort of
people in the system
and can fluctuate
throughout the year
Looked After Children
placement costs are
volatile and can fluctuate
throughout the year
2
2
3
3
3
6
6
6
A
A
A
Unaccompanied Asylum
Seekers
4
3
12
A
Provider Market Failure
2
5
10
A
If the QIPP target and risks stated above are not
mitigated the CCG would fail to achieve its mandated
1% surplus.
If all of the above risks are mitigated as explained then
by default the CCG would achieve a 1% surplus and the
ICF would have a balanced budget.
In 2015/16 the Public Health grant was reduced by £1m
part way through the financial year. The Council had to
fund committed expenditure through use of existing
reserves.
The Council maintains earmarked reserves, although
these should not be viewed as a long term solution.
Discussions are ongoing about more flexible contractual
arrangements to enable easier withdrawal to mitigate the
effect of similar reductions in the future.
Expenditure on Residential and Nursing care home
placements accounts for a significant proportion of Adult
Social Care spend. The Council aims to manage
placement profiles by offering community based
services as an alternative wherever possible. In some
cases however this is not possible due to the complexity
of individual needs. The average gross annual cost per
placement is £27k.
The current number of LAC supported by the Council is
435. This includes Fostering and Adoption placements
as well residential care homes. Numbers have
increased by 22 since April 2015 (5%) with some
individual placement costs in excess of £200k per year.
The service is also exposed to the risk of unexpected
and complex needs placements.
There will be a financial impact on the Tameside
Economy as unaccompanied Asylum Seekers are
accommodated within the borough. There is a risk that
associated Central Government funding does not
equate to related expenditure incurred by the Council
and CCG.
Continued development of the community based offer
and use of technology where appropriate to support selfmanagement of care. It is accepted however that it is
not possible to fully mitigate the risk of additional
placements.
The economy commissions services from the private
provider sector e.g. Homecare, Residential and Nursing
Care, Children’s Residential placements. Internal
intelligence suggests that some providers are
anticipating financial strain due to the impact of
delivering services within commissioned payment rates
(e.g. impact of national living wage etc).
A review is underway to reconfigure service delivery
requirements from the private sector market to ensure it
aligns with the strategic commissioning objectives of the
Integrated Care Organisation. The associated fee
structure aligned to the revised market provision will also
be considered within this review to ensure stability within
the market.
Multi-agency approach around Troubled families as part
of GM approved model in order to intervene earlier in the
child’s life and prevent the need for costly interventions
(such as care home placements). Incentives of the
fostering service to increase placements via this route
rather than costlier residential placements,
Central Government funding will be received to support
related expenditure. The economy will need to ensure
services are delivered within resource allocations
received.
108
8
RECOMMENDATIONS
8.1
As stated on the report cover.
9
SCHEDULE OF APPENDICES
9.1
Appendix A - Summary financial position of NHS Tameside & Glossop CCG.
9.2
Appendix B - Summary financial position of Tameside Council (services included within the ICF)
9.3
Appendix C – Reconciliation of the Integrated Commissioning Fund.
9.4
Appendix D - Glossary.
109
APPENDIX A
Summary of CCG Financial Position
110
APPENDIX B
Summary of TMBC Financial Position (ICF Fund Only)
111
APPENDIX C
Reconciliation of the Integrated Commissioning Fund
112
APPENDIX D
Glossary
Abbreviation
AQP
BCF
CCG
CHC
CIP
CIS
CQUIN
CSU
CT
DC
DDRB
DES
EL
GM
GMSS
GP
IAT
ICF
ISFE
MfA
MH
MMC
NEL
NHSE
NMP
ODN
OP
PES
PMD
PPA
PRG
QIPP
QOF
RADAR
SCB
SFT
SHMI
SLA
SLAM
TFT
UHSM
WTE
WWL
Description
Any Qualifying Provider
Better Care Fund
Clinical Commissioning Group
Continuing Healthcare
Cost Improvement Programme
Commissioning Improvement Scheme
Commissioning for Quality and Innovation
Commissioning Support Unit
Care Together
Daycase
Doctors and Dentists Review Body
Direct Enhanced Service
Elective
Greater Manchester
Greater Manchester Shared Service
General Practitioner
Inter Authority Transfer
Integrated Commissioning Fund
Integrated Single Financial Environment
Manual For Accounts
Mental Health
Medicines Management Committee
Non Elective
National Health Service England
Non Medical Prescribing
Operational Delivery Network
Outpatient
Paramedic Emergency Services
Prescribing Monitoring Document
Prescription Pricing Authority
Professional Reference Group
Quality, Innovation, Productivity, Prevention
Quality and Outcomes Framework
Rapid Access Detoxification Acute Referral
Single Commissioning Board
Stockport Foundation Trust
Summary Hospital Level Mortality Index
Service Level Agreement
Service Level Agreement Monitoring
Tameside & Glossop Foundation Trust
University Hospital South Manchester Foundation Trust
Whole Time Equivalent
Wrightington, Wigan and Leigh Foundation Trust
113
Title of Subject:
Date of paper:
Prepared By:
History of paper:
Executive Summary:
Ratified Finance & QIPP Assurance Committee Minutes –
18 May 2016
22 June 2016
David Swift
Ratified at Finance & QIPP Assurance Committee on 15
June 2016.
Draft 16/17 Integrated Single Finance Report
The committee approved a new style integrated report.
Locality Gap
The revised financial gap has shifted from £69m to £70m.
QIPP
KR reported that following the 2015/16 Internal Audit QIPP
review the CCG received Limited Assurance. On
investigation this was due to the approach/nature of
reporting taken in 2015/16 and a different approach will be
taken for 2016/17 with everyone owning the QIPP target.
Final Accounts & Annual Report Sign Off
The CCG is on target to submit the Annual Accounts and
Report to IGAR Committee and Governing Body on 25 May
as planned.
Terms of Reference
As the group will be reviewing the locality gap as well as
the CCG specific QIPP the Committee will become a Group
going forward.
(for Discussion and
Decision)
EUR
The committee agreed that there were large savings to be
made in this area. The group will monitor this.
To receive the approved minutes.
David Swift
114
NHS TAMESIDE & GLOSSOP
FINAL FINANCE & QIPP ASSURANCE COMMITTEE
Wednesday 18 May 2016
PRESENT:
David Swift - Chair
Dr Saif Ahmed – Governing Body GP/Neighbourhood Lead
Graham Curtis - Lay Member
Dr Jamie Douglas – Governing Body GP (from item 12)
Dr Alan Dow – Governing Body GP (GB Chair)
Kathy Roe – Chief Finance Officer (until item 9)
Tracey Simpson – Deputy CFO (representing CFO from item
10)
Clare Watson – Director of Transformation
In Attendance:
Vikki Forshaw – Senior Secretary
David Milner – Assistant Chief Finance Officer
Paul Nuttall – Head of Finance (from item 6)
Ali Rehman - Head of Business Intelligence and Performance
(presenting item 12)
Judith Stevens – Head of Finance
Stephen Wilde - Head of Resource Management, TMBC (up to
item 6)
1. Apologies
Apologies were received from Steve Allinson.
2. Declaration of Interests/Quoracy
The meeting was quorate in line with the Terms of Reference.
No new interests were declared.
3. Minutes of previous meetings held on 20 April 2016
The minutes were agreed as an accurate reflection of the previous meeting and they
were formally ratified by the committee. DS thanked SAh for chairing the previous
meeting.
4. Matters Arising/Actions
Actions were completed with the exception of the following, which will carry forward to
the next meeting:
•
Duplication of Care UK Ultrasounds by TFT:
Discuss quality issue with Gill Gibson (DNQ) – TS to liaise with CW/Elaine
Richardson to update at May’s meeting.- TS to email to confirm. (Action: TS)
Matters arising from the previous meeting were as follows:
• Identifying Priority Economy Cost Cutting Ideas 16/17 – all cost cutting ideas
have been incorporated into the 2016/17 QIPP
• GC to confirm with LW at May’s IGAR that MiAA has liaised with TMBC internal
audit to avoid duplication. – GC confirmed this with LW outside of the IGAR
meeting.
• QIPP Resource: KR to discuss a £100k resource request with CW, Steve
Allinson and the Local Authority with a view of taking this forward at pace. –
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115
due to the time it would take to train a new starter in this role it has been
decided to use existing staff already familiar with the QIPP situation/economy
and to backfill their positions.
5. Work-plan
The work-plan was received for information
6. Draft 16/17 Integrated Single Finance Report
The committee received a draft of the new Integrated Single Finance Report. The
committee was asked to comment on the structure and presentation rather than the
specific content. The committee approved the report with the following amendments
(Action: TS):
•
•
•
•
separate out the Section 75 and Aligned Funds
Table 1 to include the CCG £13.5 QIPP target
Remove wording regarding funding in Mental Health Section (p.4) before the
paper is submitted to the Single Commissioning Board on 7 June 2016
Risks:
o Over Performance of Acute Contract: increase probability to 3 and
overall risk to 12
o Over spend against prescribing budgets: increase probability to 3,
impact to 4 and overall risk to 12
TS highlighted that the total Integrated Commissioning Fund (ICF) has shifted and the
committee requested that a paper be brought to June’s meeting showing line by line
how the ICF has changed from £435m to £441m (Action: TS)
**PN joined the meeting**
The key areas of risk were highlighted as follows:
• Achievement of the £21.5m Financial Gap (£13.5m T&G CCG and £8.0m
TMBC) - Urgent QIPP commissioner meetings have been established to move
forward in this area. SAh raised concern around Primary Care recruitment and
retention when trying to implement transformational QIPP schemes.
• Management of any potential over spend within Acute services. Any over
spend would be an additional pressure over and above the Financial Gap
stated above. - TS to write a few bullet points for SAh regarding the TFT
contract not being a block contract but instead a 'cost and volume' for the
Target meeting. (Action: TS)
• Ensure Parity of Esteem is achieved in relation to Mental Health Services.
• Management of Care Home placements due to the volatility in this area.
• Pro-active management of Continuing Healthcare and Prescribing which are
subject to volatility
• Remaining within the running cost allocation for 2016/17.
DS thanked the Finance team for their hard work on drafting this new integrated report.
**SW left the meeting**
7. Ratified CFO Minutes – 15 March 2016
KR summarised the minutes highlighting the following key areas:
•
Healthier Together (HT) – There are many questions surrounding HT and
transition funds. Discussions are ongoing in this area.
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116
•
•
GM MH PbR Steering Group – gratitude to TS for progressing work in this
area.
GM Devolution Team – CFOs confirmed support for a period of 6 months
amounting to £750k (from GM levy.) The council has also contributed.
8. Local Economy Financial Gap
Locality Gap
DM presented the updated Financial Gap Analysis which included the impact of
recent changes including the updated national tariff, updated CCG allocations,
national sustainability funding, the social care precept and expected increases to
the Better Care Fund. The revised financial gap has shifted from £69m to £70m.
The paper detailed the significant changes between 13 May 206 gap and the
previously reported gap of £69m.
CCG Specific QIPP
KR reported that following the 2015/16 Internal Audit QIPP review the CCG
received Limited Assurance. On investigation this was due to the approach/nature
of reporting taken in 2015/16 and a different approach will be taken for 2016/17
with everyone owning the QIPP target. Ali Lewin will be taking the QIPP paper to
the Neighbourhood Leads meeting on 24 May.
PN explained that ‘Practice Visits’ will be commencing in early June. The
committee agreed that to utilise these visits they need to be standardised with
united outcomes and a clear line of feedback. PN/SAh will discuss this further at
the Neighbourhood Leads meeting and also look into focusing earlier visits on the
outlier practices. (Action: PN/SAh)
9. Final Accounts & Annual Report Sign Off
JS provided an update on the progress of the 2015/16 Annual Accounts and Annual
Report sign off to the committee. The draft accounts were submitted on time and four
weeks of the audit have already taken place. The Finance team is meeting with the
external auditors on a weekly basis and JS is confident that the audit is going well with
no significant findings being raised thus far. The CCG is on target to submit the Annual
Accounts and Report to IGAR Committee and Governing Body on 25 May as planned.
The external auditors raised concerns around the Draft Annual Report and Annual
Governance Statement but these concerns have since been addressed.
**KR left the meeting**
10. BCF (Tameside & Glossop)
The committee received the 2016/17 Better Care Fund paper for information with a
request to note the contents and discuss the 2016/17 financial plan. The total
Tameside BCF for 2016/17 has increased to £17,301k from £16,941k in 2015/16. This
is funded by £15,323k (89%) from Tameside & Glossop CCG and £1,978k (11%) from
Tameside MBC.
The Metrics are the same as in 2015/16 and PN will provide DS with the detailed
metrics for reference. (Action: PN) The committee requested that in future reports the
Glossop specific information is included in the Derbyshire table of Planned
Expenditure. (Action: PN)
11. Terms of Reference Discussion
Following the move to the Single Commission this committee will become a ‘Group’
going forward as it will deal with CCG and Single Commission finances. A more
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117
detailed review of the Terms of Reference will be completed later in the year when
more clarity on the governance structures has been received. (Action: VF)
12. Focus Report: EUR
AR presented an update on Effective Use of Resources (EUR) policies that are in
place for Tameside and Glossop (T&G) CCG. The report highlighted that across the
twelve Greater Manchester CCGs T&G ranked 11th based on 2014/15 data and 12th
based on 15/16 data clearly showing that this is an area where efficiencies can be
made. The report focused on three specific areas of large numbers of EUR referrals as
follows:
• Cataract Surgery – The GPs at the meeting agreed that if a referral is received
from an ophthalmologist regarding a cataract a GP will refer to the hospital on
their recommendation therefore there is no way a GP would be able to assess
if the patient meets the EUR criteria.
**JD joined the meeting**
Changes would need to be made to the referral form from the ophthalmologist
to include the EUR criteria to allow GPs to make an assessment before
referring on to the hospital.
•
•
JD will review the last twenty patients from Albion Surgery and report back at
the next meeting (Action: JD)
Persistent Non Specific Lower Back Pain – AD pointed out that although a GP
may refer to the hospital for this issue it is the hospital that decides how to treat
the condition. Therefore if they choose to use a treatment that is not approved
by NICE, e.g. facet joint injections, they should be held responsible payment.
Common Benign Skin Lesions – GPs at the meeting agreed that no case
should be referred to hospital. AR and PN will look into where these referrals
are coming form and will address this at practice visits. PN to report back
regarding this issue at the next meeting. (Action: PN)
**CW left the meeting**
The group felt that if a provider carried out treatment that was not in line with NICE
guidelines without prior approval from the CCG that the CCG should not pay for the
treatment. TS agreed to liaise with the contracting team to check the contract with the
providers around EUR Policies and referrals before drafting a letter in CW’s name.
(Action: TS) It was suggested that in the future all contracts include wording to state
that providers will be expected to follow Greater Manchester/NICE guidelines. (Action:
CW/TS)
**GC left the meeting**
JD stressed the importance of a central referral management system to get results in
this area. Bolton CCG has used this system and is the only GM CCG to see a
reduction. The group agreed with this but as a central referral management system
was unlikely to be in place before October 2016 it was agreed that immediate actions
should be taken such as changing the optometrist forms and encouraging lower back
pain referrals to Care UK as they do not offer facet joint injections as a treatment.
(Action: JD/AR)
13. Any Other Business
No items were raised.
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14. Date and Time of Next Meeting
The next meeting is scheduled for 15 June 2016 at 9.30am, NCH.
15. Actions
Person
TS/CW
TS
TS
TS
PN/SAh
PN
VF
TS
JD
PN
CW/TS
Action
Duplication of Care UK Ultrasounds by TFT:
Discuss quality issue with Gill Gibson (DNQ) – TS to liaise
with CW/Elaine Richardson to update at May’s meeting. TS to email to confirm discussions
Paper to come to June’s meeting on how ICF has changed
Time Frame
18 May 2016
15 Jun 2016
Integrated Single Finance report:
Amend the following:
• separate out the Section 75 and Aligned Funds
• Table 1 to include the CCG £13.5 QIPP target
• Risks:
o Over Performance of Acute Contract:
increase probability to 3 and overall risk to
12
o Over spend against prescribing budgets:
increase probability to 3, impact to 4 and
overall risk to 12
15 Jun 2016
Remove wording regarding funding in Mental Health
Section (p.4) before the paper is submitted to the Single
Commissioning Board on 7 June 2016
7 Jun 2016
TS to write a few bullet points for SAh re the TFT contract
not being a block contract but instead a 'cost and volume'
at the Neighbourhood Leads meeting.
Practice Visits:
• Discuss standardisation/outcomes
• Prioritising outlier practices
• Discuss process of feedback
BCF:
• Send full metrics to DS
• Add a Glossop column to the Derbyshire table of
Planned Expenditure.
ToR:
VF to add ToR to the workplan for later in the year
EUR:
TS to liaise with the Contract department to check the trust
contracts re EUR before drafting a letter in CW's name.
24 May 2016
15 Jun 2016
15 Jun 2016
15 Jun 2016
15 Jun 2016
15 Jun 2016
EUR Cataracts:
JD will review the last twenty patients from Albion Surgery 15 Jun 2016
and report back at the next meeting
EUR Common Benign Skin Lesions:
AR and PN will look into where these referrals are coming
15 Jun 2016
from and will address this at practice visits. PN to report
back regarding this issue at the next meeting.
EUR:
15 Jun 2016
It was suggested that in the future all contracts include
wording to state that providers will be expected to follow
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119
Greater Manchester/NICE guidelines.
JD/AR
EUR:
Immediate actions should be taken such as changing the
optometrist forms and encouraging lower back pain
referrals to Care UK as they do not offer facet joint
injections as a treatment.
15 Jun 2016
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120
Title of Subject:
Date of paper:
Prepared By:
History of paper:
Executive Summary:
Ratified IGAR Minutes – 23rd March 2016
22nd June 2016
Graham Curtis
Ratified at IGAR Committee on 25th May 2016
Corporate Risk Register
Risk 15 and 18 were closed
Governing Body Assurance Framework
A new format was recommended for GB approval
Register of Waivers
Following a review by MiAA on the process there will be a
number of changes made to make the process more
robust.
Policy Review
The following policies were approved by the committee:
• Complaints Policy: this has been updated by the
Customer Care Team
• Business Continuity Policy: this has been reviewed
and updated by the Business Implementation Group
(BIG). It has also been reviewed by the Information
Governance Strategy Group and by the GMSS
Resilience Manager
• Data Protection Policy: this was ratified by IGAR
Committee in January 2016
• Fire Safety Policy – this has been reviewed by the Fire
Safety Officer
• Freedom of Information Policy – this has been
reviewed by the Customer Care Manager
• Prime Financial Policies – these have been reviewed
by the CCG’s Technical Accountant
• Standards of Business Conduct and Commercial
Sponsorship Policy
• Internal Accident and Incident Policy and Procedure
• Induction Policy
• Subject Access Procedure
Register of Interests
The committee signed off the register for 2015/16.
IG IAR Full SIRO Report
A fill SIRO Report was received by the committee.
Constitution
NHSE received the draft Constitution and found the
changes acceptable.
Local Security Management/Security Self Review Tool
The CCG need to arrange for an LSM to carry out a
Security Management Self Review Tool.
121
Internal Audit
The committee received and approved the Internal Audit
2016/17 Audit Plan.
(for Discussion and
Decision)
by proposal:
External Auditors
The External Audit 2015/16 Audit plan was received and
approved by the committee
Given the time lag Governing Body are reminded that:
• A new GBAF format was recommended for GB
approval
• 10 x policies were approved
• IGAR agreed to recommend to the Governing Body
that GC, RS and DS form the external auditor
panel.
Graham Curtis
122
FINAL MINUTES
INTEGRATED GOVERNANCE, AUDIT, AND RISK (IGAR) COMMITTEE
Wednesday 23rd March 2016 9.30am
Boardroom, NCH Denton
PRESENT:
Graham Curtis – Chair
Dr Richard Bircher – Governing Body GP (from agenda item No 4)
David Swift – Lay Adviser
IN ATTENDANCE:
John Butler – Counter Fraud, TIAA
Steve Connor – Internal Audit, MiAA
Caroline Cross - GMSS (presenting agenda item No 13)
Beric Dawson – Counter Fraud, TIAA
Dr Alan Dow – Governing Body GP (Chair)
Vikki Forshaw – Senior Secretary (minutes)
Chris McGarry – Senior Finance Officer
Paul Nuttall – Head of Finance (from agenda item No 7)
Paul Pallister – Assistant Chief Operating Officer
Kathy Roe – Chief Finance Officer (from agenda item No 5)
Perminder Sethi – External Audit (from agenda item No 7)
Judith Stevens – Head of Finance (from agenda item No 4)
Lisa Warner – Internal Audit, MiAA
Clare Watson – Director of Transformation (from agenda item No 13.2.4)
Stephen Wilde - Head of Resource Management, TMBC
RISK
1.
Welcome and Apologies
Apologies were received from Steve Allinson and Tracey Simpson.
2.
Declarations of Interests
No interests were declared further to those held on file in the register.
3.
Minutes (Risk) of Previous Meeting held on 27 January 2016
The minutes were approved as an accurate record of the previous meeting.
** RB and JS joined the meeting**
4.
Action Log: Risk
Action updates from the Risk element of the Action Log were received as follows:
• 01-0116 – action completed
• 02-0116 – agenda item no 6 on the agenda; action completed
• 03-0116 – action to be carried forward to May’s meeting (Action: PP)
• 05-0116 – Risk 13 will remain on the Corporate Risk Register until additional
members of staff have been trained; action closed
• 06-0116 – assurance has been received and removal of the risk requested in the
March 2016 Operational Risk Report; action completed
• 07-0116 – update provided in the March 2016 Operational Risk Report; action
closed
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123
•
•
•
09-0116 – requested changes were made and the policy will be submitted to
March’s Governing Body for final ratification; action closed
10-0116 - the SUI report will be presented at the May and September IGAR
meetings. The IGAR workplan has been updated to reflect this; action closed
11-0116 – action update due at May’s meeting
**KR joined the meeting**
5.
Corporate Risk Register
The committee received an Operational Risk Report update and was asked to approve the
following recommendations:
• that risk 15 be closed as it has the same scope as risk 10
• that risk 18 be closed as G Gibson has confirmed that a secure email system is in
place
• that risk 21 is retitled to reflect the financial risk to the CCG
The committee approved all three of the above recommendations. PP will update the
Corporate Risk Register to reflect this. (Action: PP)
Internal Audit noted that the new index master list with a status overview was very helpful.
6.
Governing Body Assurance Framework
The committee received a new style Governing Body Assurance Framework of a similar format
to that of the Corporate Risk Register. The content is reflective of the old register and was
presented to the committee for discussion. The committee was happy to propose the
framework to the Governing Body for approval at this afternoon’s meeting.
AUDIT
**PN joined the meeting**
7.
Welcome and Apologies
Apologies were received from Mike Thomas.
8.
Declarations of Interests
GC declared that he no longer works for Age UK. VF will amend the register to reflect the end
date of GC’s role with Age UK. (Action: VF)
9.
Minutes (Audit) of Previous Meeting held on 27 January 2016
The minutes were approved as a correct record of the previous meeting.
10.
Action Log:
Action updates from the Audit element of the Action Log were received as follows:
•
•
•
•
•
12-0116 – PP will assess this throughout the policy update process going forward;
action closed
13-0116 – action completed
14-0116 – the committee agreed that this action can be removed from the IGAR
Action Log as it is a GM Devolution action; action closed
16-0116 – KR has liaised with LW regarding the Waiver process and will follow up
on recommendations received from MiAA to ensure the process is as robust as
possible; action closed
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124
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
17-0116 – going forward the Gifts and Hospitality Register will have ‘Company
Secretary’ sign off in line with the revised policy on today’s agenda for approval;
action closed
19-0116 – action completed.
20-0116 – Chris Leese advised that the Primary Care APMS tender is be run by
NHSE and therefore does not need to be on the CCG Register of Procurement at
this time; action closed
23-0116 – CC reported on this action during item 13 informing the committee that
there were now processes and links in place with HR to ensure that new starters
complete their IG training; action closed
27-0116 – the 2015/16 IGAR Annual Report has been moved to May’s meeting on
the workplan with Chair’s approval; action closed.
28-0116 - agenda item no 14 on the agenda; action closed
29-0116 – JS and LW have discussed the implications of Primary Care Level 3 and
are both happy with the proposals in place; action closed
30-0116 – BD advised that the wording will need a slight adjustment and will provide
the new wording once available. (Action: BD)
31-0116 - action to be carried forward to May’s meeting (Action: GC/PP)
33-0116 - action to be carried forward to May’s meeting (Action: PP)
11.
Training Reports and Meetings Attended by IGAR Committee Members
The following training sessions attended were reported as follows:
• National Audit Chairs, 1 March 2016 – attended by GC and DS
• Primary Care Level 3: Conflicts of Interest, 8 March 2016 – attended by GC and DS
• Leadership Training – attended by AD
12.
CCG Reports
12.1 Governance Group Briefing Note
Received by the committee for information. PP highlighted that draft versions of the Annual
Report and Annual Governance Statement are required to be submitted to NHS England
(NHSE) by 20 April 2016.
12.2 Losses and Special Payments Register
The committee received a nil return for losses and special payments.
12.3 Register of Waivers
The Register of Waivers was received by the committee with approval requested for the
following:
• 11- A Project Manager’s contract has been extended due to national
deadlines associated with the post being extended. This extension has led to
the costs associated with this role tripping the £50k waiver limit. Due to the
niche nature of the work the committee agreed to approve the waiver until
30th September 2016. An NHSE business case is not required as there is no
consultancy involved.
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125
•
12 – An Interim Senior Contracts Manager’s contract has been virtually
approved by IGAR due to an urgent capacity issue. A permanent post is
currently out to advert.
Following a review by MiAA on the process there will be a number of changes made to
make the process more robust. These changes will include the Register stating Chief
Operating Officer approval as opposed to Chief Finance Officer and a column to highlight
IGAR sign off to include virtual approvals. (Action: JS)
12.4 Gifts & Hospitality
The committee received the Gifts & Hospitality Register. AD stated that he had now
received a gift from Primed and will provide PP with the details so he can update both the
Register of Interest and Gifts & Hospitality accordingly. (Action: AD/PP)
GC and DS pointed out that the new NHSE Conflicts of Interest guidance was likely to
emphasise the importance of declaring all offers of gifts and hospitality including those that
are declined. Several GPs raised concerns over the workload this could create as GPs are
often inundated with offers of free conferences. The committee agreed that a ‘common
sense’ approach would need to be taken and GC, DS, PP and SC will meet to discuss this
further. (Action: GC/DS/PP/SC)
The revised Standards of Business Conduct and Commercial Sponsorship Policy includes
a Gifts and Hospitality Flow Chart that will be communicated out to staff and GPs for easy
reference of the process in the event that a gift or hospitality is offered. (Action: PP)
12.5 Register of Procurement
The committee received the Register of Procurement for information.
12.6 Policy Review Status Update
Following October’s IGAR the committee agreed the approval of eight policies to be
prioritised for review for March’s meeting. Due to other policies becoming a more urgent
priority two policies from this list – Health and Safety and Whistleblowing - have not yet
been reviewed.
The remaining six policies and an additional four policies have been reviewed and were
presented to the IGAR committee members for approval as follows:
• Complaints Policy: this has been updated by the Customer Care Team
• Business Continuity Policy: this has been reviewed and updated by the Business
Implementation Group (BIG). It has also been reviewed by the Information
Governance Strategy Group and by the GMSS Resilience Manager
• Data Protection Policy: this was ratified by IGAR Committee in January 2016
• Fire Safety Policy – this has been reviewed by the Fire Safety Officer
• Freedom of Information Policy – this has been reviewed by the Customer Care
Manager
• Prime Financial Policies – these have been reviewed by the CCG’s Technical
Accountant
• Standards of Business Conduct and Commercial Sponsorship Policy
• Internal Accident and Incident Policy and Procedure
• Induction Policy
• Subject Access Procedure
It has been agreed with the Chair of the IGAR Committee that these policies would be
issued for ratification to the three committee members only.
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DS provided a list of suggested minor amendments to the policies and the IGAR members
were happy to approve the policies on the condition that these minor amendments would
be taken into consideration. DS did note that the Business Continuity Policy was missing
essential supporting plans. The committee agreed to approve the policy on the proviso that
the supporting documents would be made available as soon as possible.
Members were also requested to support the recommendation from Grant Thornton that all
PCT policies adopted by the CCG have the policy updated to replace ‘PCT’ with ‘CCG.’ DS
and AD highlighted that all policies were reviewed when changing from a PCT to a CCG
and it was their understanding that this had already been done. PP will amend all ‘PCT’
policies and replace with ‘CCG.’ (Action: PP)
.
12.7 Schedule of Debtors/Creditors
The Schedule of Debtors/Creditors will be submitted to IGAR on a quarterly basis following
an MiAA recommendation from the IGAR Committee’s Effectiveness Report. The report
was received for information.
12.8 Registers of Interest
The committee were provided with a link to the current Registers of Interest for the 2015/16
annual sign off. The committee were happy to sign off the registers.
The committee agreed that the 2016/17 Declarations of Interest forms will be rolled out
following the receipt of new NHSE Conflicts of Interest guidance (due to be released in
June 2016) rather than on the 1 April 2016. (Action: PP)
12.9 IGAR Workplan
This was received by the committee for information. The Chair advised the committee that
IGAR will continue into the Single Commission function as a committee that supports the
CCG’s governance.
13.
GM Shared Services Assurance
13.1 Service Auditor Reports (SAR)
MiAA confirmed that they are currently concluding a piece of work with GM Shared
Services. MiAA will provide the CCG with a report and will raise any significant issues. SC
also confirmed that the CCG would be made aware of any significant issues regarding
ELFS if they were to arise. (Action: SC)
13.2
Information Governance Assurance
13.2.1 NHS Number Compliance Report
This report is new report due to the fact that, as part of their Information
Governance Toolkit submission, the CCG are required to demonstrate that there is
consistent and comprehensive use of the NHS Number in line with National Patient
Safety Agency requirements within their systems.
T&G CCG have reviewed their Information Asset Register which included the NHS
Number to be identified if being used.
Recommendations by the IG Team were made as follows:
•
•
•
Datix system is having an upgrade, the service will speak to the supplier to get
this changed
The spreadsheet/databases that are used within CHC needs reviewing to
change the search facility
The electronic files/assessments being used within CHC needs reviewing to
change the search facility
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Once completed the IG Team will send the report to the SIRO and Caldicott
Guardian for approval to the recommendations and then on to the IG Strategy
Group and IGAR for approval. If recommendations are approved by all parties the
IG Team will produce an Action Plan with timeframes, detailing what is needed to
make these assets NHS Number compliant.
13.2.2 IAR T&G Full SIRO Report
The Information Asset Register (IAR) needs further work completed on
Transformation and Primary Care Quality Assurance as detailed in the report.
The following next steps have been identified and CC will communicate this out to
the relevant people (Action: CC):
• High risks that have been highlighted within the Primary Care Quality
Assurance Service and Transformation Service need to go on the CCG Risk
Register and these risks need to be monitored
• Transformation Service needs to complete the review of their IAR, DFM and
Risks review by end of March. Once this review has taken place the high
risks that have been identified may change
• CCG Service Leads to review their service assets on a 3 monthly basis
• IG Manager to send the ‘SIRO Update Report’ on a 3 month basis during
2016/2017, if any changes are made, to the SIRO and IGAR
• IG Manager will send a full IG Risk report annually to the SIRO and IGAR.
VF will update the IGAR workplan to reflect this (Action: VF)
13.2.3 Information Security Policy
This policy was approved at the IG Strategy Group. No additional comments were
raised by the committee therefore the policy was approved.
** CW joined the meeting**
13.2.4 IS Internal Audit Report Leavers
This report was received for information. The committee agreed that the name of
the report caused confusion due to the ‘Internal Audit’ aspect therefore this will be
changed to ‘IS Summary Report.’ IG Strategy Group will continue reporting on this
area.
13.2.5 CCG Internal Accident Incident Policy and Procedure
This policy was covered under agenda item No 12.6.
13.2.6 IGTK Status Report
The Subject Access Policy still needs to be signed off by the IG Strategy Group. KR
and CC assured the committee that this will be done within a week. GC requires this
in order to review and approve the IGTK Self Assessment. (Action: CC/KR/GC)
13.2.7 Current TNA
CC reported that three members of staff still need to complete IG training modules.
CC assured the committee that the individuals in question have been contacted and
it is anticipated that all training will be completed before the final report.
13.2.8 IG Strategy Group Action Log
Received by the committee for information.
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14.
Integrated Commissioning Fund
The Integrated Commissioning Fund report has been prepared jointly by officers of the
Council and Tameside and Glossop CCG as part of the Integrated Care Programme in
Tameside. It sets out the key principles required to establish a joint (single) fund between
the Council and the CCG managed by a Single Commissioning Board.
Throughout the process legal teams, including NHSE’s, have been involved and although
known by several different names legal restrictions require the fund to be named as the
‘Integrated Commissioning Fund’ following the best practice of Plymouth who already have
a similar arrangement in place.
The scale for the fund from 1 April 2016 will be £435m net budget (14% TMBC/86% CCG.)
The fund is split into three distinct parts:
1. Section 75 Agreement (Better Care Fund)
2. Aligned agreement that includes various budgets that are not allowed under the
Section 75 Agreement
3. In collaboration services e.g. Primary Care (CCG/NHS England)
Parts 1 and 2 will report into the Single Commission Board and part 3 will report to the
Primary Care Joint Committee outside of the Single Commissioning function. The funds will
then be allocated to the four Care Design Groups to implement change and transformation.
We still await confirmation of the Single Commission’s GM Devolution transformation bid
which if it is successful will need to be incorporated into the proposal. The local
transformation fund is operated by the Programme Board and if a GM Devolution
transformation pot becomes available the governance around this fund will also need to be
confirmed.
Although very nearly complete the document is still live with amendments due to be made
to the Financial Framework. Areas around CCG governance and delegated decision
making will also be amended to reflect the CCG’s governance structure. Following any
IGAR and Governing Body initial approval of the majority of the proposal today a final virtual
approval will be sought from the IGAR and Governing Body Chairs before 31 March 2016.
The committee recognised the amount of work that had gone into the proposal and agreed
to recommend the proposal to Governing Body with caveats surrounding the Financial
Framework and CCG governance.
15.
Constitution
PP reported that NHSE have received the draft Constitution and find the changes
acceptable.
16.
Anti Fraud
16.2 Anti Fraud Inspection Report
The report from the pilot inspections has been issued and a number of lessons have been
learnt by both NHS Protect and the CCG. An action plan is required within 2 weeks for all of
the red and amber areas and BD has the relevant meetings set up around this.
16.1 Draft 2016-17 Workplan
BD explained that the 2016-17 workplan is a working document that will show progress
throughout the year.
There was also a recommendation from NHS Protect for the CCG to increase their number
of days from 20 to 25. GC will discuss this virtually outside of the meeting. (Action: GC/BD)
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The committee highlighted that some areas of red for the 2015/16 seemed unfair but BD
explained under the current NHS Protect scoring system there was no other way of
presenting the report. However it was noted that following learning from pilot the NHS
Protect system may change.
16.3 Local Security Management/Security Self Review Tool
BD made the committee aware that by June 2016 the CCG will need to carry out a Security
Management Self Review Tool (SRT) completed by an accredited Local Security Manager
(LSM). The CCG do not currently have an LSM and will need to look into how this will be
handled. (Action: KR/PP)
JB noted that other CCGs are also struggling with this and that services can be bought in to
complete the SRT.
17.
Internal Audit
17.1 Progress Report
The committee received the MiAA Progress Report updating on the assurances, key
issues and progress against the Internal Audit Plan for 2015/16.
The Key Financial Systems report received ‘Significant’ assurance with six medium
recommendations and three low recommendations. The committee were informed
that the Finance team have put an action plan in place to address all of the
recommendations.
Other reports due at the next IGAR are as follows:
• QIPP Schemes – a draft report has been issued with minor changes
expected
• Use of Contractors – a draft report has been issued. Joanne Keast will be
providing additional evidence before the report is finalised
• Information Governance Toolkit – a draft report has been issued
• Risk Maturity – a draft report has been issued
• Assurance Framework – this review is in progress
• Safeguarding – this review is in progress with a draft expected by the end of
March 2016
• Provider Contract Management – this review is in progress and MiAA is
taking into consideration capacity issues due to the critical time of year for
the contracting team
17.2
Insight Audit Committee Update
The Insight Audit Committee Update was received by the committee for information.
17.3
Interim Director of Internal Audit Opinion
The Interim Director of Internal Audit Opinion was submitted to NHSE by the
deadline date of 22 February 2016. GC and LW will meet before the May 2016 to
discuss the final assurance. (Action: GC/LW)
17.4
2016/17 Audit Plan
The committee received and approved the Internal Audit 2016/17 Audit Plan. The
plan aims to ensure that the CCG is provided with a comprehensive service that can
support the Governing Body and IGAR in discharging their governance
responsibilities. The plan is a live document that will be reviewed throughout the
year and outlined the core audit plan outputs for the financial years: 2015/16,
2016/17 and 2017/18. It was noted that Conflicts of Interest (CoI) may need to be
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reviewed annually but this will be confirmed in June 2016 following the circulation of
new CoI guidance. Timescales are still to be agreed.
LW will ensure that the ‘Better Care Fund/Pooled Budgets/Aligned Budgets’ review
title will be altered to reflect the Integrated Commissioning Fund. (Action: LW)
MiAA will liaise with the TMBC Internal Audit team to ensure that they do not
duplicate work across the Single Commissioning function.
18.
External Audit
18.1 Benchmarking 2014/15 Annual Report
The Benchmarking 2014/15 Annual Report was received by the committee for information.
The committee was asked to take particular note of the summary page which identified
differences between Tameside and Glossop and other CCGs.
GC, PP, DS and PS will consider the feedback when drafting the 2015/16 Annual Report.
(Action: GC/PP/DS/PS)
18.2 2015/16 Audit Plan
The External Audit 2015/16 Audit plan was received and approved by the committee. The
report had two new sections included covering ‘Materiality’ and ‘Other Material Balances
and Transactions.’
The report included a Medium and Low recommendation and both recommendations will be
monitored. (Action: PP)
19.
Any Other Business
No additional items of business were raised.
20.
Date and Time of Next Meeting: 25 May 2016
27 July 2016
28 September 2016
23 November 2016
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Title of Subject:
Draft Audit Committee Terms of Reference
Date of paper:
22 June 2016
Prepared By:
Paul Pallister
History of paper:
Version 1 Draft Audit and Assurance Committee Terms of
Reference were reviewed at IGAR Committee on 25 May
2016 and was recommended to Governing Body for
approval with a revised name: Audit Committee.
Executive Summary:
A signposting sheet is included to highlight all of the
changes that have been made to the IGAR Committee
Terms of Reference.
(for Discussion and
Decision)
To approve the Audit Committee Terms of Reference
by proposal:
N/A
Graham Curtis/Paul Pallister
132
Signposting Sheet for revisions to the Integrated Governance, Audit, and Risk Committee Terms of Reference – May 2016
Page
number
1, 2, 7,
8, 9
Paragraph
Reference
1.2, 2.1,
13.1, 13.3,
15.1, 16.1
All
Summary of change made:
Previous
Name change throughout the document: Integrated
Governance Audit, and Risk Committee
Version 2.1
2
1.3
2
3.1
2
3.2
2
4.1
4.2
5.1
New
Audit Committee
Version 1.2 (Version 1 went to IGAR Committee on 25
May 2016)
In addition to those duties recommended in the Specimen
Terms of Reference these Terms of Reference also
include aspects relating to the Committee’s responsibilities
for governance, assurance, and risk management.
In addition to those duties recommended in the
Specimen Terms of Reference these Terms of
Reference also include aspects relating to the
Committee’s responsibilities for governance and risk
management.
The Lay Adviser and Chair of the Finance and QIPP - The Lay Adviser who is Chair of the Finance and QIPP
Assurance Committee
Assurance Committee
- A Governing Body Nurse
The Committee shall be appointed by the CCG The Committee shall be appointed by the CCG Governing
Governing Body from amongst the Lay Members, the Body from amongst the Lay Members, the Lay Advisers,
Lay Advisers, and the GP Members of the CCG’s the GP and other clinical Members of the CCG’s
Governing Body. It shall consist of no fewer than three Governing Body. It shall consist of no fewer than three
members. One of the Lay Members will be recruited members. One of the Lay Members will be recruited and
and appointed specifically with the remit for appointed specifically with the remit for governance and
governance and shall chair the Committee. A quorum shall chair the Committee.
shall be three members.
The minimum attendance for quoracy is two The minimum attendance for quoracy is three of the four
members.
members.
In the event of a member being unable to attend,
Removed
every effort should be made to ensure the attendance
of a deputy.
When an urgent decision is required outside of the When an urgent decision is required outside of the
133
meeting, the Chair may make a decision after meeting, the Chair may make a decision after conferring
conferring with at least one other member.
with at least one other member. This is a Chair’s Action.
6.1
6.1
6.4
9.2
9.4
9.5
15.4
A governing Body member will attend each meeting.
External Auditors shall not normally attend for the risk
management section of the agenda.
The Corporate Office will be responsible for facilitating
meetings of the Committee and shall issue the
agenda, attend to take minutes of the meeting, and
provide appropriate support to the Chair who
members.
the policies and procedures for all work related to
fraud, bribery, and corruption as set out in Secretary of
State Directions and as required by NHS Protect.
Information Technology Systems implementation and
plans
The Committee will monitor and sign off of all Serious
Untoward Incident reports and StEIS reports relating
to Tameside and Glossop patients following their
review by the Quality Committee.
The Schedule of Losses and Compensations
Version: 2.1
Draft: January 2016
Removed
Removed
The Corporate Office will be responsible for facilitating
meetings of the Committee and shall issue the agenda,
attend to take minutes of the meeting, and provide
appropriate support to the Chair and members.
the policies and procedures for all work related to
countering fraud, bribery, and corruption as set out in
Secretary of State Directions and as required by NHS
Protect.
Information Technology Systems plans and their
implementation
The Committee will monitor and sign off of all Serious
Untoward Incident reports and StEIS reports relating to
Tameside and Glossop patients following their review by
the Director of Nursing and Quality.
The Schedule of Losses and Special Payments
Version: 1.2 Draft
Date: May 2016
134
NHS Tameside & Glossop Clinical Commissioning Group
Audit Committee
Terms of Reference
Version 1.2 Draft
Version: 1.2 (Draft)
Date: May 2016
1
135
1
Introduction
1.1
These Terms of Reference have been prepared with reference to the NHS
Audit Committee Handbook Specimen Terms of Reference [2014].
1.2
Sections 2 to 8 below cover the establishment of the Audit Committee with
Sections 9 to 17 covering its duties.
1.3
In addition to those duties recommended in the Specimen Terms of
Reference these Terms of Reference also include aspects relating to the
Committee’s responsibilities for governance, assurance, and risk
management.
2
2.1
3
3.1
Constitution
NHS Tameside and Glossop Clinical Commissioning Group (CCG)
Governing Body hereby resolves to establish a committee of the CCG
Governing Body and to be known as the Audit Committee (hereafter “the
Committee”). The Committee is a non-executive committee of the CCG
Governing Body and has no executive powers other than those
specifically delegated in these Terms of Reference.
Membership
The members of the Committee are:
-
3.2
4.
4.1
The Lay Member with responsibility for Governance (Chair of the
Committee)
The Lay Adviser who is Chair of the Finance and QIPP Assurance
Committee
A GP Member of the Governing Body (Deputy Chair of the Committee)
A Governing Body Nurse
The Committee shall be appointed by the CCG Governing Body from
amongst the Lay Members, the Lay Advisers, the GP and other clinical
Members of the CCG’s Governing Body. It shall consist of no fewer than
three members. One of the Lay Members will be recruited and appointed
specifically with the remit for governance and shall chair the Committee.
Quorum
The minimum attendance for quoracy is three of the four members.
Date: May 2016
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5.
Chair’s Action
5.1
When an urgent decision is required outside of the meeting, the Chair
may make a decision after conferring with at least one other member. This
is a Chair’s Action.
5.2
When Chair’s Action has been taken then it must be ratified by the next
quorate meeting of the Committee.
6
Attendance
6.1
The Chief Finance Officer and appropriate Internal Audit, Counter Fraud,
and External Audit representatives shall normally attend meetings at the
invitation of the Chair of the Committee. However, at least once a year the
Committee should meet privately with the External and Internal Auditors.
6.2
The Chief Operating Officer or other appropriate senior managers may be
invited to attend, and particularly when the Committee is discussing areas
of risk or operation that are the responsibility of that senior manager.
6.3
The Chief Operating Officer should be invited to attend, at least annually,
to discuss with the Committee the process for assurance that supports the
Annual Governance Statement.
6.4
The Corporate Office will be responsible for facilitating meetings of the
Committee and shall issue the agenda, attend to take minutes of the
meeting, and provide appropriate support to the Chair and members.
7
7.1
8
8.1
Frequency
The Committee shall meet at least six times per annum (subject to ongoing review). The Chief External Auditor or Head of Internal Audit may
request a meeting if they consider that one is necessary. At least one
week’s notice of a meeting will be given.
Authority
The Committee is authorised by the CCG Governing Body to investigate
any activity within its Terms of Reference. It is authorised to seek any
information it requires from any employee or CCG member, and all
employees are directed to co-operate with any request made by the
Committee. The Committee is authorised by the CCG to obtain outside
legal or other independent professional advice and to secure external
input with relevant experience and expertise if it considers this necessary.
Date: May 2016
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137
9
Governance, Risk Management, and Internal Control
9.1
The Committee shall review the establishment and maintenance of an
effective system of integrated governance, risk management, and internal
control across the whole of the organisation’s activities (both clinical and
non-clinical) that supports the achievement of the organisation’s
objectives.
9.2
In particular the Committee will review the adequacy of:
•
all risk and control-related disclosure statements (in particular the Annual
Governance Statement together with any accompanying Head of Internal
Audit statement, external audit opinion or other appropriate independent
assurances) prior to endorsement by the CCG Governing Body
•
the underlying assurance processes that indicate the degree of the
achievement of corporate objectives, the effectiveness of the management
of principal risks, and the appropriateness of the above disclosure
statements
•
the policies for ensuring compliance with relevant regulatory, legal, and
code of conduct requirements
•
the policies and procedures for all work related to countering fraud,
bribery, and corruption as set out in Secretary of State Directions and as
required by NHS Protect.
The Committee will also:
9.3
•
review and recommend for approval by the Governing Body proposals for
changes to the governance documents of the CCG (comprising the
Standing Orders, Prime Financial Policies, Scheme of Delegation, and
Schedule of Powers Reserved to the Governing Body)
•
review the mechanisms and levels of
recommendations to the CCG Governing Body
•
review incidents of fraud, bribery or corruption, or possible breaches of
ethical standards or legal or statutory requirements that could have a
significant impact on the CCG’s published financial accounts or on its
reputation.
authority
and
make
In carrying out this work the Committee will primarily utilise the work of
Internal Audit, External Audit, and other assurance functions but will not
be limited to these audit functions. It will also seek reports and assurances
from directors and managers as appropriate concentrating on the overarching systems of integrated governance, of risk management, and of
Date: May 2016
4
138
internal control together with indicators of their effectiveness.
9.4
In particular, the Committee shall ensure the adequacy of systems for risk
and governance by reviewing:
•
Risk Registers
•
the Governing Body Assurance Framework
•
Major incident and emergency planning procedures and plans. The
Committee will seek assurance that contractual arrangements and
associated monitoring are appropriate in this regard, and may also request
reports from the relevant lead commissioner
•
Organisational Health and Safety and security arrangements
•
Risk-related policies
•
Information Governance arrangements (included within this responsibility
is the need for the Committee to have assessed its information
requirements and to have planned the capacity and capability to deliver
those requirements; and that the CCG has used the Information
Governance Toolkit to assess its capability to meet Information
Governance requirements)
•
Information Technology Systems plans and their implementation
•
Patient safety issues including the arrangements for regular reporting to
the NRLS
•
Safeguarding arrangements.
9.5
The Committee will monitor and sign off of all Serious Untoward Incident
reports and StEIS reports relating to Tameside and Glossop patients
following their review by the Director of Nursing and Quality.
9.6
Effective governance, risk management, and internal control will be
evidenced through the Committee’s use of an effective Governing Body
Assurance Framework to guide its work and that of the audit functions that
report to it.
Date: May 2016
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139
10.
Conflicts of Interest
The Committee will provide advice on relevant conflict of interest matters
and make recommendations to the Governing Body. Advice as required
will be sought from audit colleagues.
11
Internal Audit
11.1
The Committee shall ensure that there is an effective internal audit
function established by management that meets mandatory NHS Internal
Audit Standards and provides appropriate independent assurance to the
committee, to the Group, to the Accountable Officer, and to the CCG’s
Governing Body.
This will be achieved by:
12
•
the consideration of the provision of the Internal Audit service, the cost of
the audit, and any questions of resignation and dismissal
•
the review and approval of the Internal Audit strategy, operational plan,
and more detailed programme of work ensuring that this is consistent with
the audit needs of the organisation as identified in the Governing Body
Assurance Framework
•
the consideration of the major findings of internal audit work (and
management’s response) and ensuring the co-ordination between the
Internal and External Auditors to optimise audit resources
•
ensuring that the Internal Audit function is adequately resourced and has
appropriate standing within the organisation
•
an annual review of the effectiveness of Internal Audit.
External Audit
12.1
The Committee shall review the work and findings of the appointed
External Auditor and consider the implications and management’s
responses to their work. This will be achieved by:
•
consideration of the appointment and performance of the External Auditor
as far as the rules governing the appointment of the external auditor permit
•
discussion and agreement with the External Auditor, before the audit
commences, of the nature and scope of the audit as set out in the Annual
Plan and ensure coordination, as appropriate, with other External Auditors
in the local health economy
Date: May 2016
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140
13
•
discussion with the External Auditor of their local evaluation of audit risks
and their assessment of the CCG and the associated impact on the audit
fee
•
the review of all External Audit reports including agreement of the annual
audit letter before its submission to the CCG Governing Body and before
any work is carried out outside the annual audit plan, together with the
appropriateness of management responses.
Other Assurance Functions
13.1
The Audit Committee shall review the findings of other significant
assurance functions, both internal and external to the organisation, and
consider their implications for the governance of the organisation.
13.2
These will include, but will not be limited to, any reviews by Department of
Health Arm’s Length Bodies or Regulators and Inspectors (for example by
the Care Quality Commission or the NHS Litigation Authority) and by
professional bodies with responsibility for the performance of staff or
functions (for example the Royal Colleges and accreditation bodies).
13.3
In addition the Committee will review the work of other committees within
the organisation whose work can provide relevant assurance to the Audit
Committee’s own scope of work.
14
Management
14.1
The Committee shall request and review reports and positive assurances
from directors and managers on the overall arrangements for governance,
risk management, and internal control.
14.2
It may also request specific reports from individual functions within the
organisation (or support services such as the Greater Manchester Shared
Service) as they may be appropriate to the overall arrangements.
15
Financial Reporting
15.1
The Audit Committee shall review the Annual Report and Financial
Statements before submission to the CCG’s Governing Body focusing
particularly on:
•
the wording in the Annual Governance Statement and other disclosures
relevant to the Terms of Reference of the Committee
Date: May 2016
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141
•
changes to, and compliance with, accounting policies and practices
•
unadjusted mis-statements in the financial statement
•
major judgemental areas, and
•
significant adjustments resulting from the audit.
15.2
The Committee shall recommend the approval of the Annual Financial
Statements to the CCG’s Governing Body.
15.3
The Committee should also ensure that the systems for financial reporting
to the CCG’s Governing Body, including those of budgetary control, are
subject to review as to their completeness and the accuracy of the
information provided to the Governing Body.
15.4
The Committee shall receive and approve reports including:
-
the Schedule of Losses and Special Payments
the Schedule of Waivers
the Register of Interests
the Register of Gifts and Hospitality (including corporate sponsorship),
and
the Quarterly Schedule of Debtors and Creditors.
The Committee shall also receive further reports which are detailed in the
Committee work plan.
15.5
16
The Committee shall conduct an annual review of the CCG’s major
accounting policies.
Reporting
16.1
The minutes of the Audit Committee’s meetings shall be recorded formally
by the Corporate Office and submitted to the Governing Body. The Chair
of the Committee shall draw to the attention of the Governing Body any
issues that require executive action.
16.2
The Committee will report to the Governing Body annually on its work in
support of the Annual Governance Statement specifically commenting
upon the fitness for purpose of the Governing Body Assurance
Framework, on the completeness and embeddedness of risk
management in the organisation, and on the integration of governance
arrangements.
Date: May 2016
8
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17
Other Matters
17.1
17.2
The Committee shall be supported administratively by the Corporate
Office by duties including:
•
the agreement of the agenda with the Chair and the collation of papers
•
by taking the minutes and keeping a record of matters arising and issues
to be carried forward
•
by advising the Committee on pertinent areas.
These Terms of Reference shall be reviewed at least annually.
Version 1.2
Draft May 2016
P Pallister
Date: May 2016
9
143
AGG Final Minutes 17.5.16
GM ASSOCIATION OF CCGs: Association Governing Group (AGG)
17/05/2016
13.30 – 17.30
The Willows, AJ Bell Stadium
Attendance:
Steve Allinson
Wirin Bhatiani
Tim Dalton
Alan Dow
Michael Eeckelaers
Ranjit Gill
Denis Gizzi
Nigel Guest
Anthony Hassall
Caroline Kurzeja
Su Long
Stuart North
Kiran Patel
Hamish Stedman
Mike Tate (Behalf TA)
Martin Whiting
Ian Williamson
(SA)
(WB)
(TD)
(AD)
(ME)
(RG)
(DG)
(NG)
(AH)
(CK)
(SL)
(SN)
(KP)
(HS)
(MT)
(MW)
(IWi)
NHS Tameside & Glossop CCG
NHS Bolton CCG
NHS Wigan Borough CCG
NHS Tameside & Glossop CCG
NHS Central Manchester CCG
NHS Stockport CCG
NHS Oldham CCG
NHS Trafford CCG
NHS Salford CG
NHS South Manchester CCG
NHS Bolton CCG
NHS Bury CCG
NHS Bury CCG
NHS Salford CCG (Chair)
NHS Wigan CCG
NHS North Manchester CCG
NHS Central Manchester CCG
Apologies:
Trish Anderson
Philip Burn
Chris Duffy
Melissa Laskey
Gina Lawrence
Gaynor Mullins
Ian Wilkinson
Simon Wootton
(TA)
(PB)
(CD)
(ML)
(GL)
(GMu)
(IW)
(SW)
NHS Wigan Borough CCG
NHS South Manchester CCG
NHS Heywood, Middleton & Rochdale CCG
NHS Bolton CCG (HoC Chair)
NHS Trafford CCG
NHS Stockport CCG
NHS Oldham CCG
NHS Heywood, Middleton & Rochdale CCG
In Attendance:
Rob Bellingham
Andrea Dayson
Steve Dixon
Adrian Hackney
Warren Heppolette
Wendy Meredith
Leila Williams
(RB)
(ADa)
(SD)
(AHk)
(WH)
(WM)
(LW)
GM Health & Social Care Partnership
GM Association of CCGs
NHS Salford CCG (CFO Chair)
NHS Trafford CCG
Transformation Unit
1.WELCOME & APOLOGIES FOR ABSENCE
The chair welcomed all members and noted the apologies.
2. DECLARATION OF INTEREST
Page 1 of 7
144
Noted.
3. MINUTES OF THE LAST MEETING 03.05.2016
The previous meeting minutes were approved as an accurate reflection of the last meeting.
Review of Actions:
IVF Letter: Outstanding
Dementia United:
ACTION:
 IVF Letter to be drafted for signature by Hamish Stedman
 Dementia United to be updated at a future meeting.
4. Devolution Update
WH attended the meeting to provide a devolution update. WH circulated slides prior to the meeting.
The below was noted:
 Locality plans have been assessed and areas for improvement outlined.
 Stockport, Salford and Tameside closest to the criteria for accessing transformation fund so
will test the cost benefit analysis and process.
 Need to ensure that all localities have a plan in place to get up to certain standard by late
summer.
 Assurance workshop next Thursday to work up how GM works with NHSI and NHSE and
develop a different assurance framework.
 Primary care access funds identified from NHSE is separate to the transformation fund and
16/17 co-commissioning budget.
 Transformation fund has been divided across the 5 transformation themes.
 Bids for priorities 1&2 have to come from locality plans, 3-5 will need a GM sponsor
 Some proposals will have a GM and locality element.
 Finance Executive Group – anything with a financial implication needs to be routed through
this group before going to the SPBE/B.
 Concern re leaving the weaker locality plans behind - have an obligation to reserve funds for
those further behind to achieve the greater good.
 Thought that there would be a phasing of money across the 5 years - unsure of pre
commitments against this year.
 Transformation funding is still with NHSE at present.
 Vanguard bids will be assessed as part of locality plans to the same standards
 Need for a dashboard and performance metrics - need to ensure the SPB are looking at
operational issues as well as strategic.
5. AGG FUTURE FORM
AH presented a slide pack which looked at further options around the AGG future form following
discussions at both the COOs and AGGE meetings:
 Discussed future form paper at previous AGG’s CO’s and AGGE’s.
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Feels that we are at a point given devolution that we need to have an in-depth look at how
we are working and how we position ourselves.
 Recent debate around the notion of the clinical chair – agreed at CO’s that the Clinical Chair
role but that this should be supported by a Chief Officer role.
 Need to supplement the management structure to support AGG and delivery of business.
 We are challenged on a performance and assurance role and we need to ensure that it is
represented and delivered within the structure.
 The document will need to be recast and reviewed through the AGGE and CO and bring back
to a future AGG for delivery.
Comments
 Fully supportive the slides need to change to make sure that we are leading devolution as
opposed to being led.
 Future form paper does not go far enough need a dramatic change.
 The key part is the enhanced clinical and managerial input into the role.
 Still need to be also clearer on our form in terms of what we will do? What will we do
together and individually? What are we delegating to GM so we can feedback locally? What
are we empowering people to do? It would help to have this level of detail to make us all
clear to what we are signing up too.
 Political management of our conversation requires the expertise of managerial leadership.
 Currently we are trying to do the new world job with the old world architecture. We need to
catch up.
 The direction is right change will be us all understanding the priorities.
 We cannot do everything together and the things we do together need to be with a united
approach.
 All agreed that more of a clinical presence/leadership is paramount.
ACTION:
 Task and Finish Group to meet to develop the future form paper based in the comments and
slide narrative
 AGG Future form to be scheduled on the 3rd June AGG agenda
6. STANDARDISING ACUTE HOSPITAL CARE
The chair welcomed LW - Standardising Acute and Specialised Services slides were circulated prior to
the meeting:
 Current scope worked through with providers but they also need to respond to the locality
plans the degree to which will vary depending on specialty.
 This is not necessarily about reconfiguration but more about scoping out clinical and
financial opportunities which are huge within specialised services.
 Standardising does not necessarily mean reconfiguration.
 Political element to women's and children's services.
 Specialised services continue to be much duplication.
 Programme reports into JCB.
 Need CCG reps on steering group - initially suggestion SRO but maybe not right mix need
clinical / managerial leads.
 Standardising is a mix of provider and commissioner responsibility but
reconfiguring/centralising is a commissioner responsibility which needs to be balanced.
 Need to ensure that services involved take into account whole care pathways and local
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redesign.
AGG has a key role to play in influencing the service list - using clinical expertise
Should focus on specialised services as this is the biggest financial risk
Elective surgery - priority of CCGs to have these services provided locally where practical and
possible.
Some service reconfiguration will be politically sensitive - would benefit from LA partnership
earlier in process and align estates issues
Note that if we want to make changes to hospital then we need a narrative on what
community services will look like.
Needs to be a joint discussion - what we want vs what can be provided
Transformation Unit has been commissioned to do this piece of work funded through the
Transformation fund.
Need to prioritise - still have not implemented HT which remains our priority
Some of this work will already be underway in localities and some will need immediate
action.
Ensure that we consider the election cycles whilst implementing change.
Potential to do a co-design a workshop.
ACTION:
 Agreed that the future form task and finish group will incorporate this into the future form
paper
 Identify the best 2/3 people for the steering group report back to the next AGG in June.
7. POPULATION HEALTH
The chair welcomed Wendy Meredith to the meeting who provided an update on the
Transformation Theme 1: Upgrade in population Health was circulated prior to the meeting:
 Bridge across the systems of health and social care and broader local government and
systems.
 Operates across the broader service reform.
 Behaviour change – use place based approach.
 Stronger prioritisation around health and wellbeing and early intervention.
 Tried to build the programme looking at the time horizons – may not implement in a 5 year
time period but starting to put the building blocks into place.
 Outcomes are challenging for GM with a need to close the health inequality gap.
 In some areas this is challenging; it is achievable but needs joint effort across the system.
 Start well, live well and age well – aims to empower people in the community to take more
control over their own lives.
 Real recognition that GM jobs that are created are commuter jobs for external people to
take up.
 This needs to be driven forward through an integrated commissioning approach.
 Second – living well – big theme is around work and health – breaks down into different
interventions.
 Looking at how we can make sure that work is good work – charter for businesses to adopt
best practice around health.
 Health check programme – scale up the impact and outcomes.
 Look at the opportunities we have in practices to identify people who have complex multi
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risk factors that are out of work – put together a different set of interventions for practices.
Aging well is being developed with the DAS who are keen that nutrition and hydration
addressed.
Review of the GM independent cycle review.
LCOs will be crucial to identify key population segments; working with RB and WH
Public Health – looking at how we might work with the capacity in a joint approach.
Some public organisations have a sickness rate of 12% - a lot higher than the private sector.
Need to address the public’s relationship with alcohol this is an on-going issue with a live
conversation ongoing; support from clinicians would be welcome.
LCO characteristics must include population health work.
Influenza vaccination current uptake is low – we should be aiming for 90% for adults and
children this has been identified in the outcomes framework as an important measure.
LCOs give us an opportunity to improve rates.
Need to tap into the voluntary sector and utilise these services more widely on a GM
footprint all needs to be connected.
AGG need to agree what we need to do collectively and then tackle the priority areas.
Behaviour change is difficult but utilising social movement – working up some ideas around
walking.
NHS organisations should lead by example across a whole range of issues in adopting
healthy lifestyles.
Priority is developing an approach in reducing smoking in pregnancy.
Some key elements of NHS services will have no NHS funding in 4 years’ time; wider
conversations required to develop a prioritisation process and funding options.
8. CANCER COMMISSIONING
AHk provided a cancer commissioning update a briefing paper was circulated prior to the meeting:
 Need to clearly articulate where we are, where we need to get too and how we get there.
 LW team have been taking the lead on some areas of cancer under the acute standardisation
work remit providing feedback.
 The work stream has been split into two areas:
o BAU - (Prevention, pathway boards, performance, cancer waiting times,
implementation of planning guidance etc.)
o Transformation – pathway redesign work that is require but not appropriate at
present i.e. breast
 Work to be done for the 7 day access into specialist palliative care.
 Vanguard – three work streams starting to understand where our system is working and
where it isn’t.
 Encouraged to review the commissioning architecture, payment methods etc through the
vanguard process.
 Financial funding is still uncertain but there is an expectation that the sum received will be
half what was requested for 16/17.
 The second year funding will need to be accessed through the transformation fund.
 Need to implement the national strategy some issues with the new care model in terms of
compliance with standards.
 Update and new model discussed with COs/HoCs/cancer commissioning managers to try to
identify a GM picture.
 Proposal to disestablished Manchester Cancer and Cancer Commissioning Boards to form a
single Cancer System Board.
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Need to review the current services and address non-compliant services we may need to
consolidate some of our services.
CO’s requested a pathway by pathway break down which will be completed and circulated.
Need to support the leadership role to prioritise cancer and commission appropriately.
Acknowledged that one CCG leading this can be a burden and that there is potential of
sharing with other CCG leads.
Need to design the leadership role or make a collaborative role.
GM Cancer Accountable Network ToR will be circulated this afternoon and will be going to
the provider board on Friday and the June Cancer Commissioning Board.
Definition of what is a vanguard and what isn’t a vanguard – cancer provider plan needs to
triangulate with the standardisation work.
The draft ToR for the new cancer system board highlights that this would be responsible for
the whole system including the hospital Standardisation work stream.
Opportunity to work up an appropriate submission to the transformation fund to be clear
around what it will deliver.
AHk has met with SD to ensure all the finance reporting is dovetailed.
ACTION:
 AHk to circulate the ToR for the Cancer Strategy Group and ask for comments.
9. DEVOLUTION LEAD UPDATES
SRO Locality Plans – No update
Governance/ Assurance:
 Need to have some clear principles on joint ownership and ensure that the best practice is
rolled out.
 Need appropriate senior representation at the assurance workshop – comments to SL
 Quarter one is coming and no clear specified plan.
SRO Work Force:
 Written update to be circulated.
 Transformation fund access – discussed at the work force group and will be seeking money
for staff. Localities must own and drive the workforce plans locally. The GM team will add
value to the strategic planning.
Primary Care:
 The Primary Care Strategy is complete and will go through the SPB and JCB in June/July.
 MCP – COOs discussed there is some correspondence to go through the system soon. Linked
to a health service article which was inaccurate quoting Manchester and not GM.
 GP forward view fits in with the primary care strategy.
LD/ Mental Health – No update
IM&T
 Meeting on Friday with DoH to discuss money that can be accessed outside of GM.
 Week on Thursday will sign off a draft strategy for IT.
Capital and Estates: No update
Medicines Optimisation: No update.
GM Shared Services:
 Forming a programme board to oversee process.
 Bob Ricketts made enquires with a reminder that it is 12 months after the original
agreement signed and would GM consider using the LPF where appropriate.
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 Shared what is currently happening in GM under current arrangements.
Research & Innovation:
 Acceleration into innovation pipeline; there is a proposal to set up a sub group to look at this
and requested CCG representation.
Contracting & Pricing: No update
Urgent & Emergency Care:
 Considering a proposition that has been worked up.
 Document will be shared after the meeting.
 Shared with UCCLs leads
Manchester Single Hospital Service:
 Commissioning in Manchester – engagement going forward with CCG colleagues.
 Noted from the Health and Wellbeing board that we need to speak with one voice.
 Joint Executive formed with the council in the interim.
 Support arrangements agreed to help the 3 CCGs support this.
Devolution Meetings:
OMT: Performance – ties in with assurance session
Strategic Partnership Board: No update.
Joint Commissioning Board:
 Joint Criteria paper circulated which has been shared extensively including AGG members.
 Joint Criteria paper to be circulated to CFOs for review/comments.
Implementation Working Group:
 Last meeting focussed on access to the transformation fund and slides were discussed.
 Struggling for attendance at the IWG on the 02nd June secretariat to approach the AGGE
deputy’s to seek additional representation.
ACTION:
 Secretariat to approach the AGGE deputy’s to seek additional representation for the
02/06/16 IWG.
 AH to represent GM on the Innovation into Practice Group
10. AOB
10.1 AGMA GOVERNANCE CONSULTATION
 Stockport governance lead has developed a response - deadline for tomorrow.
 Approved by RG and circulate for comment.
 SL agreed to discuss with Liz Treacy to seek a legal perspective and feedback to AD.
ACTION:
 SL to discuss with Liz Treacy and feedback to AD
NEXT MEETING
DATE:
TIME:
VENUE:
07.06.2016
13.30 – 17.30
The Willows, AJ Bell Stadium
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Wednesday, 22 June 2016 - NHS Tameside and Glossop Clinical

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