Minutes of the NHS Tower Hamlets Clinical Commissioning Group
Governing Body Meeting (Part 1)
Tuesday, 03 November 2015, 14.30 – 17.00
Room 205, Professional Development Centre, 229 Bethnal Green Road E2 6AB
1 General Business
1.1 Welcome, introductions and apologies
1.1.1 Present
Name / Role / OrganisationHenry Black / Chief Finance Officer / NHS THCCG
Archna Mathur / Director of Quality and Performance / NHS THCCG
Dr Tan Vandal / Secondary Care Specialist Doctor / NHS THCCG
Maggie Buckell / Registered Nurse / NHS THCCG
Mariette Davis / Lay Member (Governance) / NHS THCCG
Dr Sam Everington / Chair – LAP 6 representative – Bromley By Bow Practice / NHS THCCG
Dr Judith Littlejohns / LAP 1 representative – The Mission Practice / NHS THCCG
Dr Martha Leigh / LAP 4 representative – Wapping Practice / NHS THCCG
Dr Osman Bhatti / LAP 7 representative – Chrisp Street Practice / NHS THCCG
Dr Victoria Tzortziou-Brown / LAP 3 representative - Principal Clinical Lead – All Saints Practice / NHS THCCG
Dr Isabel Hodkinson / LAP 5 representative - Principal Clinical Lead - The Tredegar Practice / NHS THCCG
Dr Somen Banerjee / Director of Public Health / LBTH
Luke Addams / Corporate Director / LBTH
1.1.2 In attendance
Name / Role / Organisation /Justin Phillips / Governance and Risk Manager / NHS THCCG
Charlotte Fry / Commissioning Support Director / NEL CSU
Lee Eborall / Director of Acute Contract Management / NEL CSU
Rob Mills / Nurse Consultant Safeguarding Children & Designated Nurse / NHS THCCG
Dr Julia Hale / Designated Doctor - Safeguarding / NHS THCCG
Dr Ben Ko / Designated Doctor for LAC / NHS THCCG
Shola Yemi / Designated Nurse for LAC / NHS THCCG
Karen Breen / Managing Director / Barts Health RLH
Dr Angela Wong / Clinical Director / Barts Health RLH
Abigail Knight / Acting Associate Director of Public Health / LBTH
1.1.3 Apologies
Name / Role / OrganisationJane Milligan / Chief Officer / NHS THCCG
Richard Quinton / Interim Director of Commissioning / NHS THCCG
Virginia Patania / Practice Manager representative / NHS THCCG
Dr Shah Ali / LAP 8 representative – Barkantine Practice / NHS THCCG
Dr Haroon Rashid / LAP 2 representative – Albion Practice / NHS THCCG
Cate Boyle / Vice Chair - Lay Member (Patient and Public Engagement) / NHS THCCG
1.1.5 Welcome
Dr Sam Everington welcomed members and attendees to the Governing Body meeting part I. Apologies were received for: Jane Milligan, Dr Shah Ali, Dr Haroon Rashid, Cate Boyle, Richard Quinton and Virginia Patania. It was noted for the purposes of quoracy that Archna Mathur was a nominated voting member as part of the requirement for two CCG senior managers to be in present. Luke Addams was welcomed to the TH CCG Governing Body replacing Robert McCulloch-Graham.
1.2 Declaration of Interests
Dr Sam Everington asked Members for any declarations of interest. No additional declarations of interest were noted for Part I of the meeting.
The complete register of interests is published on the NHS Tower Hamlets Clinical Commissioning Group’s website: http://www.towerhamletsccg.nhs.uk/about/conflict-of-interest-register.htm or is available from the Governance and Risk Manager:
1.2 Chair’s report
Dr Sam Everington presented the Chair’s report. The following highlights were reported:
- Primary Care Transformation
- Alwen Williams Appointed as Chief Executive of Barts Health NHS Trust
- Prime Minister’s Challenge Fund (PMCF)
Members noted the Chair’s report.
1.3 Chief Officer’s report
Henry Black presented the item. The following highlights were reported:
- Tower Hamlets CCG Annual General Meeting (AGM)
- Integrated Personal Commissioning Event
Members noted the Chief Officers report.
1.4 Minutes and Matters Arising of the Meeting held September 1st 2015
1.4.5 Minutes
The minutes for the Governing Body September 1st 2015 part I were approved as an accurate record of the meeting.
1.4.6 Matters arising
The matters arising were reviewed with outstanding actions carried forward.
2 Performance and Operations
2.1 Safeguarding Annual Report 2014/15 / Looked After Children Annual Report 2014/15
Rob Mills presented the Safeguarding Children Annual Report 2014/15 highlighting: the position for 2014-15 and current issues to be addressed; the impact of recent policy and guidance; the existing safeguarding children risks across health and specifically for the CCG; and the CCG’s plans to improve safeguarding children arrangements for the coming year.
The following points were raised in discussion:
Dr Somen Banerjee queried if the safeguarding data was considered as complete or if further work was required. Dr Julia Hale stated that Barts Health was identified as not having submitted data under the new arrangements; data is being submitted but it was estimated at 90% complete. The data is currently being extracted from maternity services and work is underway to extract data from gynaecology and CASH services. There is an expectation that safeguarding cases will increase with the improving data extraction and analysis.
Dr Isabel Hodkinson queried how Barts Health are going to communicate to GPs FGM cases as it is difficult to identify cases with the current discharge documentation. Dr Julia Hale stated that this should be captured in the current discharge documents as part of the action for GPs but that she would also raise this at a future FGM meeting.
Maggie Buckell thanked the Safeguarding team for the report. She welcomed Shola Yemi to the team as the full time designated professional for Looked After Children and thanked Anne Morgan for her work in the role.
Dr Ben Ko presented the Looked After Children Annual Report 2014/15. He highlighted the progress made in 2014/15: a substantive Designated Nurse was recruited, and has commenced in October 2015; a Nurse Specialist for LAC has been in post since August 2014 with remit for young offenders; meetings with CAMHS commissioners and providers has now taken place (Sept 2015), and further information will be included in the next annual report; and a new process for processing funding for statutory assessment and quality assuring reports from out of borough health providers has been set up.
Dr Ben Ko also updated the Governing Body on the CCG priorities for the following year: to continue to work with Social Care Service to ensure referrals for Statutory Health Assessments are made in a timely fashion; to monitor Bart’s Health’s responsiveness in carrying out Statutory Health Assessments; Mental Health Commissioners to review current pathways for mental health service for Looked After Children placed both in and out of Tower Hamlets, to ensure their mental health needs are identified and met in a timely fashion; to ensure adequate IT links between Bart’s Health and LBTH so that crucial information on LAC can be shared effectively; to improve monitoring of immunisation status of LAC and uptake of immunisation; to undertake an audit on the timeliness and quality of health assessment undertaken by external health providers for LAC placed out of borough; and establish formal links between designated professionals and Corporate Parenting Board, LBTH
The following points were raised in discussion.
Dr Judith Littlejohns updated the Governing Body regarding additional money from central government for CAMHS and it is the plan to invest specifically in LAC; there is a lot more work to be done on the design but the work should strengthen relationships and improve pathways.
Dr Osman Bhatti queried what the current situation is relating to the IT link between Barts Health and the borough. Dr Ben Ko stated that there is still difficulty accessing data between the Local Authority and the nurses and that the nurses were also given access to Emis for those based in the borough but that there are ongoing issues for those nurses that are based outside of the borough.
Ø Action: It was suggested that a meeting with Dr Osman Bhatti, Luke Readman and the Safeguarding team would be useful to address current IT / data issues
The Members approved the Safeguarding Annual Report 2014/15 and the Looked After Children Annual Report 2014/15.
2.2 Performance and Quality Report
Archna Mathur presented the Performance and Quality Report and highlighted that the coversheet provided a comprehensive review. The key areas to note were:
The Trust achieved the cancer 2 week wait (2ww) standard for July with performance of 95.9% and also for August with performance of 95.7%. This is the third consecutive month of Trust level achievement of the 2ww standard. This standard for RLH site was also achieved in July at 93.7% for the first time in 3 months, and was also achieved on RLH site for 3 of the challenged specialities, colorectal, lung and urology. Performance has dipped slightly in August to 91.7%.
A&E: The RLH site continues to be challenged in delivering the 95% standard and a Contract Performance Notice has been issued for non-compliance with this standard with the majority of breaches on average relating to ED triage (32%), and secondly bed management (29%). The Trust and CCGs were invited to a tripartite meeting in early October to understand root causes and plans for recovery. The RLH plan is robust however performance is still below trajectory. The tri-partite panel have therefore requested revision of the Trust trajectories to demonstrate a more realistic quarterly position. This is being reviewed currently. Key work streams within the plan relate to; urgent care and the initial assessment; emergency assessment; introduction of the “full capacity model acute surgical model; ambulatory care; and AAU process for discharge. Work streams are being rolled out early November but it is expected that they will take a bit of time to bed in.
The number of never events since the time of issuing the quality report had increased from 9 to 11; this compares with 2014/15 closing with 5 in total. Archna Mathur explained that external reviews were underway to address this concern.
The following points were raised in discussion:
Dr Osman Bhatti expressed his concern at the level of never events querying if trends could be identified. Archna Mathur outlined that there were numerous misplaced nasogastric tubes and retained surgical foreign objects.
Mr Tan Vandal welcomed and commended the improvement with cancer waiting times. He expressed serious concern relating to the number and type of never events stating that the situation is totally unacceptable. He requested further detail of the root causes querying if there were issues with the surgical team, team managers, pressures etc.?
Ø Action: The Governing Body requested an update at next Governing Body meeting re: never event external review.
2.3 Cancer Performance Improvement- A Collaborative ‘Deep Dive’ Approach
Dr Sam Everington welcomed Karen Breen (Managing Director – RLH) and Dr Angela Wong (Clinical Director for Cancer Services – Barts Health). Dr Angela Wong presented the paper: Cancer Performance Improvement – A Collaborative Deep Dive Approach. The key areas to note were:
Barts Health was failing between 5 to 8 of the 9 cancer waiting time standards between April and June 2014. A collaborative Deep Dive Programme chaired by Archna Mathur started on 25th April 2014 resulting in Barts Health achieving compliance in 8 cancer waiting time standards in July 2015.
Dr Angela Wong highlighted that cancer referrals (2 week wait) had increased approximately 40% resulting in increased diagnoses; the increase in demand has had a significant impact on cancer waiting times. In response to sustained poor performance, the CCG had taken served a Contract Performance Notice (CPN) in June 2015. As a consequence of this poor performance and the impact on patients, a meeting of key clinicians and managers was held in mid-April 2014. From this the Director of Performance and Quality at the CCG and the Clinical Director for Cancer Performance & Improvement at Barts Health jointly agreed to adopt a Programme Management approach and established the Cancer Services Deep Dives. The aim of Deep Dives are: to understand the root causes at speciality level leading to underperformance; support and drive clinicians and managers to identify the issues, resolve the issues and use data to effectively track their own performance; and, to encourage clinical ownership.
Dr Angela Wong gave an overview of: the identified challenged specialities; a summary of all the deep dives meetings and their impact; speciality level data demonstrating improvements with the cancer waiting time standards; and the proposed next steps.
The following points were raised in discussion:
Mr Tan Vandal thanked Angela for her dedication stating that he was very impressed with the data presented. He queried if as an extension of this work, whether the MDT of the various tumour groups are mandated to discuss waiting times also questioning the level of engagement with other Trusts where the standards are inter-Trust dependent. Dr Angela Wong informed the meeting that a standard MDT template was in use and part of this process was to generate live data recording straight to the Somerset System. She also updated on a meeting that Archna Mathur had set up with UCLH and that this had improved dialogue but that going forward consideration needs to be given to setting up a meeting with Queen’s Hospital.
Dr Victoria Tzortziou-Brown agreed that this was an amazing piece of work. She queried if further analysis had been carried out to determine what proportion of the 31 and 62 day standard breaches are due to patient choice and whether we needed to consider patient responsibility and education which could possibly link with the integrated care programme. Dr Angela Wong explained that this data is already captured and that changes such as improving the spread of appointments had reduced patient choice breaches but they were still seen in certain tumour sites such as head and neck.
Dr Osman Bhatti asked if the referral forms could be unified and if these could all be e-mailed instead of faxed. Dr Angela Wong said this would be something to focus on going forward.
Mariette Davis expressed that she was very impressed with the process and outcomes and questioned whether any funding had been allocated to drive the deep dive process. Archna Mathur explained that there had been a small amount of funding for tracking etc. but mostly this had been achieved by the hard work of all those involved.
Archna Mathur stated that as a consequence of this process, both parties are confident that improvements will be made with the cancer waiting time standards; although it is a slow process, it is sowing the seed for clinical engagement going forward and that it is a useful model to approach other quality and performance concerns going forward.