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NHS ROTHERHAM
Approved by Chair/ approved by 6th November meeting
Minutes of the NHS Rotherham Clinical Commissioning Group Governing Body held on
Wednesday 2 October 2013 in the Elm Room, Oak House
Present: / Dr J Kitlowski (Chair) / Mr J Gomersall (Vice-Chair)……
Dr H Ashurst / Dr R Carlisle
Mrs S Cassin / Dr R Cullen
Mr C Edwards / Mrs K Firth
Dr L Jacob / Dr S MacKeown
Participating observers: / Dr J Radford, Director of Public Health, RMBC
Observing: / Neil Chapman, Director of Finance, Trust Development Agency
In Attendance: / Mrs S Whittle, Assistant Chief Officer (Governing Body Secretary)
Mr G Laidlaw, Communications Manager
Mrs W Commons, Secretariat
5 Pharmaceutical Industry Representatives
1 Representative from SY Housing
159/13 / Apologies for Absence
Apologies for absence were received from Ms S Lockwood & Cllr K Wyatt.
160/13 / Declarations of Pecuniary or Non-Pecuniary Interests
Itwas acknowledged that DrsKitlowski, Cullen, Jacoband Mackeownhad an(indirect) interest in most items. In addition, Dr Jacob declared a particular interest in items relating to The Rotherham Foundation Trust as he is employed by them on a sessional basis.
161/13 / Minutes of the Previous Meeting
The minutes of the Clinical Commissioning Group Governing Bodyheld on4 September 2013were confirmed as a correct record.
162/13 / Matters Arising
147/13c Chairman’s Last Meeting
Mr Edwards and Mr Gomersall confirmed that they had sent a letter of thanks to Dr Tooth on behalf of the Governing Body.
147/13h Berwick Report
Mrs Cassin advised that mapping of the actions from the Francis, Berwick, Keogh and Winterbourne reports was being undertaken and would be included as part of her report to the November Governing Body.
Action: Mrs Cassin
147/13i Improving General Practice – Call for action Letter
Dr Carlisle clarified that the CCG had not in fact responded to NHS England seeking views on shaping the future of primary care services in England but individual GPs were at liberty to do so. Instead Dr Carlisleshared the response to the consultation on the NHS mandate with Cllr Wyatt.
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At this point Dr Kitlowski advised members that she had been a member of the interview panel at TRFT for the recently advertised clinical director posts. She confirmed that quality appointments had been made to the four vacancies. It was anticipated that the new clinical directors will be introduced to Governing Body members in due course.
163/13 / Chief Officer’s Report
Mr Edwards presented his report. Points of note included:-
a)52 Week Waits at Doncaster
Mr Edwards confirmed that he had received information from Doncaster & Bassetlaw NHS Foundation Trust assuring Governing Body that there were no imminent risks to RCCG relating to long waiting patients. Dr Carlisle advised that the CCG has had assurance from all lead providers in relation to 52 week waits but concerns still remainabout Sheffield Teaching Hospitals where 51 week waits are being reported. This situation is being monitored and reviewed with the Trust.
b)Commissioning Support Arrangements
Confirmation has been givento W & SY & B Commissioning Support Unit that we wish to extend our contract with them to March 2015 for ten of the eleven services they currently provide subject to prices and efficiencies being agreed. Communications would be delivered in house in future to allow closer working of CCG communications services with the Hospital and the Council. Mr Edwards confirmed that Rotherham is well aligned with other CCGs withregard to our intentions.
c)Review of Urgent & Emergency Care – Sir Bruce Keogh
As requested at last month’s Governing Body, Mr Edwards confirmed that the above consultation and report is expected to be completed in January 2014 and will subsequently be reviewed at Governing Body for implications.
d)Rotherham Local Safeguarding Children Board
Members noted the report and the key priorities for the Board through 2013-16.
e)Healthwatch
Mrs Whittle attended the official launch of the new service earlier that day. Members agreed to invite Healthwatch to attend a future Governing Body to update members on their journey so far.
Action: Mr Edwards
164/13 / Personal Health Budgets
Mrs Firth presented a third update on the pilot being undertaken by the CCG to offer personal health budgets to eligible patients in receipt of domiciliary continuing healthcare packages. Members discussed the importance of having robust governance arrangements in place going forward and specifically noted the potential risks the CCG may be exposed to in relation to employment issues.
Governing Body noted the progress made so far in establishing the systems and processes to implement Personal Health Budgets and the financial implications and the controls put in place to mitigate against the risk of probity issues. Mrs Firth advised members that further work will continue to establish the views from client surveys and assess the impact to the CHC budget, CCG running costs and governance implications. A further update and consideration of next steps will be presented in February 2014.
Action: Mrs Firth

At this point Drs Kitlowski, Cullen, Jacob & MacKeown declared an interest in the next item and left the room. Mr Gomersall took over chairmanship for this item only.

165/13 / Future Commissioning of Locally Enhanced Services
Mrs Firth presented the paper explaining the extent to which the arrangements for LESs can continue whilst ensuring that the CCG remains compliant with the NHS (Procurement, Patient Choice and Competition) Regulations 2013.
The Governing Body agreed to continue with the current contracts as outlined in Table 1 & 2 of the paper presented, approved the publication of the voluntary transparency notice on the CCG’s website and Supply2Health and agreed to review its outcome within 6 months. All LES procurements will be reviewed in 12 months’ time.
Drs Kitlowski, Cullen, Jacob & MacKeown all re-joined the meeting and were informed of the decision taken above.
166/13 / GP Members Committee
Dr Jacob gave a verbal update from GP Members Committee held on 25thSeptember 2013. Consultants from TRFT had attended and discussed a range of issues that theGPMC had been concerned about. The discussions had proved positive for both the CCG &TRFT. Two of the main concerns were around the management of the community nursing service and discharge letters. Although the former is still being addressed, work had been undertaken on discharge letters which has resulted in much improvement.
Dr Ashurst was pleased to hear about the positive meeting with secondary care doctors. Dr Jacob extended an invitation to Dr Ashurst to attend a future meeting and would supply the dates.
Action: Dr Jacob
Changes made to the delivery of the Children and Mental Health Service (CAMHS)by RDaSHhad resulted in disquiet from GPs raised via GPMC. In order to establish the issues, Dr McKeown had undertaken a quality review ofthe service and had been assured that some clinical changes have been made. Dr MacKeown will produce a full report for GPMC. Following discussion it was agreed that the report findings will be shared with Governing Body members prior to the planned Board to Board meeting with RDaSH in November.
Action: Dr MacKeown
Members also requested an update on the RDaSH current contract position.
Action: Dr Carlisle
Members acknowledged the importance of communication with providers and Dr Carlisle highlighted that the bi- annual commissioning event was scheduled for December and will provide further opportunity.
Members noted the GPMC Annual Report and welcomed the scope of the report and the Committee’s work.
167/13 / Quarter 1 Assurance
Dr Carlisleconveyed the outcome of the Quarter 1 Assurance meeting that had taken place with NHS England on 2 September 2013 where assurance for this CCG was relatively positive. Members noted the timescales for the assurance framework and the planned publication of the outcomes from Quarter 1 on the website on 18 October.
The Governing Body delegated authority to the Operational Executive to make self declarations on Quarter 2 in October.
Further discussion around recent assurance issues would take place in the performance report section later in the meeting.
168/13 / Patient Safety & Quality Report
Mrs Cassin highlighted that there had been 4 cases of C-Diff reported by TRFT in September resulting in the CCG being above trajectory on its plan to date.
In relation to incident reporting, NHSE are undertaking a piece of work to map levels of reporting across the SY & Bassetlaw patch which Mrs Cassin will share with Governing Body once completed. In the meantime, in response to member’s requests, she had provided some comparative data from the national reporting and learning system, breaking down the types and numbers of incidents reported and explained the data which showed TRFT in a strong position as a reporter of incidents.
Mrs Cassin advised that the report had been revised to contain more detail around complaints. Improvements were continuing at TRFT in the overall response rate for the friends and family test following the introduction of token system in A&E.
Members also noted that unannounced night visits willcontinue and TRFT are
increasing nursing staffing levels at nighttime.
Members noted the contents of the report and the GPMC Chair congratulated the Quality Team on unannounced visits undertaken at TRFT and improvements as a result of these.
169/13 / Integrated Performance Report
Dr Carlisle presented the report and updated members on 3 key issues since the report had been published:
  • Despite requesting and being given assurances from its providers, the CCG were not assured in relation to 52 week waiters
  • Performance against the Red 1 target for Yorkshire Ambulance Service had fallen below target andoverall performance issues had resulted in a contract query notice being issued by Contract Managers. Sheffield CCG (as Lead Commissioners) hold YASto account on behalf of Rotherham CCG and their recent consistent approach has resulted in the providers offering to explain the issues to Governing Body.
  • At TRFT, despite assurances, A&E performance has not improved.As a result a contract query notice has been issued. TRFT shared a paper prepared for their Board detailing the actions taken. A 52 week wait breach has also occurred which TRFT related to EPR implementation issues. The CCG were given strong assurances at the time of implementation that detailed work had been done to track patients. In the past week a C-Diff outbreak had been reported and the divert policy had been applied for patients on the Maternity Ward.
The CCG had asked the provider for assurance and the above issues at TRFT have been discussed with NHSEngland. On their advice, The Chief Officer and Chief nurse have convened a quality review meeting has been arranged for 22 October with NHSEngland, CQC, Monitor Local Authority and TRFT.
Governing Body members will be informed of the outcome from the meeting and next steps.
Members agreed to invite YAS to discuss their performance position.
Action: Mr Edwards
Members discussed the breastfeeding initiation rates at TRFT and were advised that a series of actions were being taken through the contract performance route. Dr Radford confirmed that Public Health is reviewing the indicators to identify outliers and standardise delivery across service providers. Dr Radford will provide a report for Governing Body.
Action: Dr Radford
Mrs Firth reported that the CCG is still expected to achieve the planned surplus of £3.3m and advised of an opportunity to carry forward monies which had arisen due to the rebasing and settling of the changes post April 2013.
Governing Body delegated authority to Mrs Firth to make the necessary arrangements to carry forward monies which would be guaranteed to be returned in for 2014/15.
Action: Mrs Firth
170/13 / Health & Well Being Board
The minutes from the meeting held on 11 September 2013 were received and noted for information.
171/13 / South Yorkshire Commissioners (SYCOM)
The minutes fromSYCOM Commissioner only meeting held on2 August2013 were received and noted.
172/13 / CCGCOM
The minutes from theCCGCOM meeting held on 2 August 2013 were received and noted.
173/13 / Future Agenda Items
Personal Health Budgets – February 2014
Invitation to Healthwatchto update on progress
Action Plan from the 4 big reports, Francis, Keogh, Winterbourne & Berwick
Outcome of the Urgent & Emergency Care Consultation – Keogh Report – Jan 2014
174/13 / Issues For Escalation – to Governing Body or other Committees
Governing Body requested that the CCG’s Operational Executive Team review risks in relation to TRFT on a regular basis.
Action: Mr Edwards
175/13 / Date, Time and Venue of Next Meeting
Rotherham Clinical Commissioning Group Governing Body’s next public meeting is scheduled to commence at 12.30pmon Wednesday 6 November2013at Oak House, Moorhead Way, Bramley, Rotherham S66 1YY, followed by RDASH Board to Board commencing at 3.30pm for members only.
176/13 / Exclusion of the Public
In line with Standing Orders, the Governing Body approved the following resolution:
“That representatives of the press and other members of the public be excluded from the meeting, having regard to the confidential nature of the business to be transacted - publicity on which would be prejudicial to the public interest.”
[Section 1(2) Public Bodies (Admission to Meetings) Act 1960 refers].