Minutes of the NHS Tower Hamlets Clinical Commissioning Group
Governing Body Meeting (Part 1)
Tuesday, 26 January 2016, 14.30 – 17.00
The Theatre Room, Oxford House, Derbyshire Street, E2 6HG
1.1.1 Present
Name / Role / OrganisationSam Everington / Chair – LAP 6 representative – Bromley By Bow Practice / NHS THCCG
Archna Mathur / Director of Quality and Performance / NHS THCCG
Cate Boyle / Vice Chair Lay Member (Patient Public Engagement) / NHS THCCG
Haroon Rashid / LAP 2 representative – Albion Practice / NHS THCCG
Henry Black / Chief Finance Officer / NHS THCCG
Isabel Hodkinson / LAP 5 representative - Principal Clinical Lead - The Tredegar Practice / NHS THCCG
Jane Milligan / Chief Officer / NHS THCCG
Judith Littlejohns / LAP 1 representative – The Mission Practice / NHS THCCG
Luke Addams / Corporate Director / LBTH
Mariette Davis / Lay Member (Governance) / NHS THCCG
Martha Leigh / LAP 4 representative – Wapping Practice / NHS THCCG
Noah Curthoys / Lay Member / NHS THCCG
Richard Quinton / Interim Director of Commissioning / NHS THCCG
Shah Ali / LAP 8 representative – Barkantine Practice / NHS THCCG
Somen Banerjee / Director of Public Health / LBTH
Tan Vandal / Secondary Care Specialist Doctor / NHS THCCG
Victoria Tzortziou-Brown / LAP 3 representative - Principal Clinical Lead – All Saints Practice / NHS THCCG
Virginia Patania / Practice Manager representative / NHS THCCG
1.1.2 In attendance
Name / Role / Organisation /Charlotte Fry / Commissioning Support Director / NEL CSU
Emily Fieran-Reed / Corporate Strategy and Equality / LBTH
Jacqueline Tottterdale / Chief Operating Officer (item 2.4 only) / Barts Health
Josh Potter / Deputy Director of Commissioning / NHS THCCG
Keith Dickinson / Interim Governance Manager / NHS THCCG
James Friend / Programme Director (item 2.4 only) / Barts Health
Lee Eborall / Director of Acute Contract Management / NEL CSU
Xena Cooke / Director of Corporate Resources / LBTH
1.1.3 Apologies
Name / Role / OrganisationMaggie Buckell / Registered Nurse / NHS THCCG
Osman Bhatti / LAP 7 representative – Chrisp Street Practice / NHS THCCG
1.1.4 Welcome
Dr Sam Everington welcomed members and attendees to the meeting and introduced Noah Curthoys as the new lay member. Noah will be taking on a co-opted role as interim vice chair until a new PPI lay member is appointed following Cate Boyle’s departure. He went on to point out that as Kate Boyle was stepping down this was her final meeting and thanked her for her extensive contribution as the PPI lay member.
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:
1.3 Chair’s report
Sam Everington presented the Chair’s report highlighting changes to membership of the Governing Body and additions to Barts Health NHS Trust executive team. Reference was made to the importance of the approaching implementation phase of Transforming Services Together as one the two key priorities for the CCG. The meeting was also advised that, at this stage and contrary to misleading press reports, the junior doctors’ strike was still going ahead; the CCG intended to make the same preparatory arrangements as it did for the last strike. The Chair went on to commend
- A clear and practicable definition of seven day services that had been agreed across the NHS in Scotland
- a local initiative to create a staff college that would provide fourteen days leadership training for all staff; this would help engender a single vision across the area and develop young leaders as part of succession planning. Similar initiatives at UCLH and by a consortium of Birmingham CCGs had proved successful and provided opportunities for seeking out best practice.
There followed an update on the HSJ article ‘Choose and Consult’ and its means of operation whereby there was a revised process for a GP seeking specialist advice; responsibility for managing each step is clear and the interchange continues until all agree that full responsibility passes back to the GP. The patient, GP and specialist then all receive a summary of the action plan by email. Responsibility for managing each step is clear.
Action Jan16 #1: JM to circulate the seven day service definition and the HSJ article to GB members.
Sam Everington informed the members of the Clinical Commissioning and GP Forum held on Tuesday 1st December and in particular Workstream 1 where there was four volunteer pilot practices involved in the first wave. Virgina Patania emphasised its success and the results it was producing around patient engagement and experience. Isabel Hodkinson added her support to these views.
The members NOTED the report.
1.4 Chief Officer’s report
Jane Millgan presented the item. The following highlights were reported
- Independent review of deaths of people with a Learning Disability or Mental Health problem
- Introduction of Nurse and Midwifery Revalidation
- NHS preparedness for a major incident
Particular note was made that the CCG has secured £2.6m funding from the Section 106 programme. Along with the local authority it was an opportunity to this creatively and invest in new models of primary and secondary care.
The members NOTED the report.
1.5 Member Story – PCMF Engagement
Virginia Patania introduced a video of PCMF Engagement and in the ensuing discussion it was reported that good progress had been made with all hubs now open and the central fitting in with the seven day working and single point of access strategies. Shah Ali endorsed the success but it was noted that success would bring financial challenges. Cate Boyle advised of the need for an evaluation before further funding was released.
Action Jan16 #2: Ellie Hobart to include update in Newsletter
The members NOTED the report.
1.5 Minutes and Matters Arising of the Meeting held September 1st 2015
1.5.2 Minutes
The minutes for the Governing Body 3 November 2015 part I were APPROVED as an accurate record of the meeting, subject to the following change at para 3.3
Dr Isabel Hodkinson expressed that it was difficult for General Practice to get on board with the MECC system as the Tower Hamlets Community Education Provider Network (CEPN) had decided not to pay backfill for GP staff so that GPs are being asked to bear the cost of a programme that does not directly provide benefit to them as an organisation, we need to move to a more system oriented way of thinking about supporting such work. Abigail Knight stated that she had taken this feedback on board.
1.5.3 Matters arising
The matters arising were reviewed with outstanding actions carried forward.
2 Performance and Operations
2.1 Board Assurance Framework 2015/16
Jane Milligan summarised the risks set out in the Board Assurance Framework drawing particular attention to Risk 1.1 (Failure to ensure effective systems and processes are in place to monitor, challenge and support Barts Health NHS Trust delivery of NHS Constitution targets). It was explained that further detail around AE performance would be provided later in the meeting by Jacqueline Totterdale the Chief Operating Officer of Barts Health NHS Trust. Turning to risk 2.2 (tight timeframes to deliver the system model and the long term financial model could impact on the ability to deliver the 5- year strategic plan within the timeline of the programme) it was explained that the reporting of the risk merited greater narrative to explain fully the range and impact of the extensive controls that were in place. In a similar vein, Cate Boyle added that Risk 3.6 (failure to deliver on the Operating Plan) failed to convey a true sense of what was happening and the actions that were being taken to demonstrate it was being properly managed.
Mariette Davis informed the members that the Audit Committee has reviewed the BAF the previous week. Audit Committee held the view that the BAF could usefully be used as a tool to help identify commissioning priorities. She highlighted the fact that in some cases the risk rating was considerably greater than the stated risk appetite and that actions planned should bring the level down towards the risk appetite. Mariette also noted that when the Bart’s Board had settled in, a Board to Board meeting should be held.
The members NOTED the report.
2.2 Finance and Activity
2.2.2 Finance report Month 8
Henry Black introduced the report explaining that, due to the deferred date of the meeting, the information contained in the report was now slightly out of date. On a positive noted he reported that the CCG was close to concluding and agreeing, with Barts Heath NHS Trust, the final value of the contract. Turning to the main areas of risk, it was reported that in respect of
- Primary Care Co-Commissioning was reporting a year to date underspend of £93k with a full year break even position. The year to date and forecast position has improved from last month due to a release from the CCG’s reserves to cover the underachievement of projected QIPP schemes.
- Prescribing were reporting a year to date over spend of £582k with a full year forecast overspend position of £873k. This was based on using the NHS Business Services new profiles on projecting expected expenditure levels. Prescribing costs in April and May this year were 5.8% higher than the same time last year
- Acute Contracts: the total budget is £170.6m. At Month 8 the Acute position is currently showing a year to date overspend position of £2.3m with a full year projected overspend of £3.5m against plan though this position is being mitigated with additional QIPP Schemes that are bringing it back on track.
The main areas of over performance are
- BMI with the main pressures are within elective/day cases, outpatients procedures and outpatients first/follow ups – these relate specifically to the areas of T&O, Urology, Anaesthetics, Gynaecology and General surgery.
- Guy’s & St. Thomas’s with the main pressures are within maternity and obstetrics.
- Homerton with the main pressures are within outpatient first and follow ups, non electives and maternity.
Barts Health NHS Trust is experiencing an increase in day cases, indicating they are clearing the backlog previously reported.
Non Acute Healthcare Provision has a year to date overspend position of £750km with a projected full year overspend position of £1.3m. The main drivers relate to overspends in Prescribing and Continuing Healthcare; a more detailed update will be provided at the next meeting
In the discussion that followed Isabel Hodkinson expressed concern over the impact on Barts Health NHS Trust and Victoria Tzortziou-Brown thought a comparison between BMI and Barts Health NHS Trust would be useful. Tan Vandal wondered if both providers were seeing increased activity and queried whether value for money was being achieved, especially if BMI were ‘cherry picking’ the lucrative cases. Jane Milligan responded by explaining that the CCG had been helping Barts Health NHS Trust identify the right patients, especially the Royal London Hospital who have complicated cases, whilst BMI could only deal with cases of limited complexity. It was also recognised that the CCG had been challenged by NHSE over the uptake of provision by private providers, to ensure that there was full utilisation of alternative routes.
Action Jan16 #3: Archna Mathur to liaise with Lee Eborall regarding the evaluation of BMI cases
Action Jan16 #4: Archna Mathur to arrange QA visit to BMI
Action Jan16 #5: Archna Mathur to explore feasibility of Healthwatch enter and view visit to BMI
Action Jan16 #6: Richard Quinton to ensure suitable contractual arrangements.
The members NOTED the report.
2.3 Performance and Quality Report
In respect of the special measure in place regarding RLH, Archna Mathur began by explaining that assurance meetings occurred each month. The focus of the meetings was to gain assurance on progress against key milestones within the RLH improvement plan. Further detailed key lines of enquiry at the January meeting will be based in assurance around clinical engagement in the Clinical Harm Review Process, safety standards for invasive procedures and mandatory training. The deep dive will be on outpatients and medical records. The Trust Oversight and Assurance Group was being reviewed so as to understand how it fitted into the wider operating framework for managing Barts Health whilst in special measures. There was now a heightened need to achieve systemwide impact on the issues the Trust was facing. An update was then given on the report in general with particular attention drawn to the following points.
There were positive outcomes and assurance on delivery of Cancer Waiting Times with Barts Health achieving all 8 standards in October; this included the standards for 2 week urgent referrals, 31 day 1st treatment standard and the 62 Day GP urgent referral. As a CCG Tower Hamlets achieved 7 out of 8 standards, in October, including the the 2 Week urgent referral, the 31 day 1st treatment standard and the 62 Day GP urgent referral. The Breast 2 week symptomatic standard was not achieved. Virginia Patania queried some of the data relating to cancers and in response Archna Mathur explained that the counting systems were not identical and rare cancers required a manual counting system. In discussion it was agreed that further information was needed in relation to non cancer performance. Virginia Patania concluded by stressing the importance of the 31 day target as well as the 62 day target.
The November 62 day position dipped just under standard at 84.3% and this is due to a reporting technicality where the 31 day position of rare cancers must also be included in the 62 day final position. If rare cancers were not included, performance would have been at 85.1%.
Deep Dives have been conducted for skin cancer, where performance on the RLH site had been a challenge but was achieved for the first time since March, in December. Head and Neck Cancer did not reach the 2ww standard on the RLH site for 2015/16 but have now been achieved for October and November. 62 Day performance for Head and Neck was also been achieved for October and November. Overall the Deep Dive for Head and Neck produced good results. As many of the issues relate to diagnostics, future cancer speciality deep dives will be extended to include diagnostics impacting on cancer.