a g e n d a - tameside · 2018-05-30 · a g e n d a . 1. welcome and apologies . 2. declarations...

TAMESIDE AND GLOSSOP CCG GOVERNING BODY PUBLIC MEETING TO BE HELD

ON WEDNESDAY NOVEMBER 5TH 2014 AT 1PM

BOARD ROOM, NEW CENTURY HOUSE DENTON

A G E N D A

1. Welcome and Apologies

2. Declarations of Interest

3. Register of Interests p4 -7

4. Consideration of Any Other Business

5. Chair’s Introduction

6. Chief Operating Officers Report – attached p8 -11

7. Minutes of the Meeting Held on October 1st 2014

and Action Log p12-31

8. Public and Patient Impact

- Draft Minutes of the PPIC Held on October

8th 2014 - attached Celia Poole p32-42

- Improving Engagement Between Tameside and Martin Carter

Glossop and its Member Practices - presentation

9. Quality

- Quality Committee Minutes Celia Poole p43-50

Held on September 24th 2014

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- Draft Quality Committee Minutes Celia Poole

Held on October 22nd 2014 – verbal update

- EPRR Core Standards Assurance Nikki Leach p51-59

10. Planning Implementation and Quality

- Draft Minutes of the PIQ Meeting Held on Graham Curtis p60-74

October 15th 2014

- Health to Social Services Transfer – Section 256 Clare Watson

To follow

- Bi-Monthly update – Transformation Directorate Clare Watson p75-80

- Health and Social Care Integration

– Care Together Kathy Roe p81-87

11. Draft Integrated Governance Audit and Risk Minutes

Held on October 1st 2014 Graham Curtis p88-95

12. Performance Report Elaine Richardson p96-116

13. Finance Report Kathy Roe p117-133

14. Draft Finance Committee Minutes

October 1st 2014 Yvonne Pritchard p134-137

15. Locality Meeting draft Minutes

October 28th 2014 Richard Bircher p138-143

16. Greater Manchester Meetings:

- Healthier Together Committee in Common Meeting

Held on September 17th 2014 Steve Allinson p144-152

- Association of GM CCGs Governing Group

Summary Update 7th October 2014 Steve Allinson p153-179

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17. Derbyshire Health and Wellbeing Board Minutes p180 -184

September 4th 2014

Tameside Health and Wellbeing Board Minutes Steve Allinson p185-190

Held on August 7th 2014

18. Any Other Business

19. Date and Time of Next Meeting – December 3rd 2014 at 1.p.m.

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Name of Person /

Position within

CCG

Name of Company / Interest Nature of Interest /

Position Held

Potential, or actual areas, where interest / conflict

could occur Action taken to mitigate risk

Date

Declared

Date

Withdrawn

This applies across all risks and individuals identified within this

Register of Interests for Tameside & Glossop CCG:

Financial, system and planning / operational controls in place, being routinely reviewed and updated. Compliance with the approved Constitution, Standing Orders, Financial Policies and the Scheme of Reservation and Delegation. Audit reviews and assurance through agreed oversight, scrutiny, reporting and governance processes. Committee and approval forum declarations and reporting. Regular review and updating of the Conflict of Interest and other relevant policies and procedures. Ongoing training and development and communications across the organisation. Regular updates and reporting of the Interests Register. Ongoing assessment and updates on risk through Risk Register and Governing Body Assurance Framework.

Would not take part in decision making / procedurement or other activities relating to this interest

Alan Dow - Chair Cottage Lane Surgery, Gamesley Glossop Principal GP

Commissioning, service and remuneration influence in decisions impacting upon personal, business and Practice interests, including financial and personal gain and the risk of fraud opportunity. 11-Mar-09

West Pennine LMC Officer

Commissioning, service and remuneration decisions impacting upon personal and business interests and relationships. 11-Mar-09

Secretary

Commissioning, service and remuneration decisions impacting upon personal and business interests and relationships.

Family Doctors Association Founder Member

Commissioning, service and remuneration decisions impacting upon personal and business interests and relationships. 11-Mar-09

Small Shareholder Various Shares

Commissioning, service and remuneration decisions impacting upon personal interests, including financial, business and personal gain. 11-Mar-09

General Practitioners Committee of BMA Member

Commissioning, service and remuneration decisions impacting upon personal and business interests and relationships. 20-Jul-11

Tameside Foundation TrustPartner employed as Anaesthetist

Commissioning, service and remuneration influence in decisions impacting upon other organisational and personal interests, including financial, contractual, employment and personal gain and the risk of fraud opportunity. 20-Jul-11

Graham Curtis - Deputy Chair / Lay Member CQC / Age UK Expert by Experience

Implications and decisions taken through inspection of Hospitals, GP Practices or Residential Care Homes (note: no local activity) 29-Jan-14

Commissioning, service and remuneration influence in decisions impacting upon other organisational and personal interests, including financial, contractual, employment and personal gain and the risk of fraud opportunity.

Dr Christina Greenough - GP Clinical Vice Chair Go to Doc Ltd Director

Commissioning, service and remuneration influence in decisions impacting upon personal, business and Practice interests, including financial and personal gain and the risk of fraud opportunity. 20-Jun-02

Mossley Medical Practice GP Partner

Commissioning, service and remuneration influence in decisions impacting upon personal, business and Practice interests, including financial and personal gain and the risk of fraud opportunity. 1-Apr-04

Pennine Care NHS Foundation Trust Employee

Commissioning, service and remuneration influence in decisions impacting upon personal and employing organisational interests, including financial, contractual, employment and personal gain and the risk of fraud opportunity. 11-May-06

LMC General GP Member

Commissioning, service and remuneration decisions impacting upon personal and business interests and relationships. 1-May-11

TMBC Clinical Lead for CDRP

Commissioning, service and remuneration influence in decisions impacting upon other organisational and personal interests, including financial, contractual, employment and personal gain and the risk of fraud opportunity. 1-May-11

Dr J S Bamrah - Governing Body GP Member Manchester Mental Health and Social Care Trust Interim MD

Commissioning, service and remuneration influence in decisions impacting upon personal and employing organisational interests, including financial, contractual, employment and personal gain and the risk of fraud opportunity. 6-Nov-13

Dr Richard Bircher - Governing Body GP Member Lockside Medical Centre Principal GP

Commissioning, service and remuneration influence in decisions impacting upon personal, business and Practice interests, including financial and personal gain and the risk of fraud opportunity.

which provide (payment received beyond GMS)Minor surgeryContraceptive implants and coilsAnticoag servicesRing pessary managementEnhanced services for people with alcohol problemsSmoking cessation servicesDMARD drug monitoring

Royal Colleage of GPs Member


Married to CCG Quality Lead and Partner at Lockside Medical Centre Married

Commissioning, service and remuneration influence in decisions impacting upon personal, business and Practice interests, including financial, contractual, employment and personal gain and the risk of fraud opportunity.

NHS TAMESIDE & GLOSSOP CCG

REGISTER OF INTERESTS

2014-15

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The partnership also are involved as trainers for the GPVTS, interview for the deanery, and has the CCG QUALITY LEAD, and the CCG CARDIOLOGY LEAD. We are all members of the royal college of GPs. Trainer, interviewer


.January 2013

Dr Jamie Douglas - Governing Body GP Member The Albion Medical Practice in Ashton Under Lyne Salaried GP

Commissioning, service and remuneration influence in decisions impacting upon personal and Practice interests, including financial and personal gain and the risk of fraud opportunity.

. January 2014

GoToDoc Out of Hours GP


. January 2014

Effective use of resources triage team at GMCSU in Salford Part of Triage Team

Commissioning, service and remuneration influence in decisions impacting upon personal and employing organisational interests, including financial, contractual, employment and personal gain and the risk of fraud opportunity.

.January 2014

University of Manchester Undergraduate Tutor


.January 2014

NHS England GP Appraiser

Commissioning, service and remuneration decisions impacting upon personal and service interests and relationships.

.January 2014

My wife is employed by Penine Acute Trust.


.January 2014

Dr Amir Hannan - Governing Body GP Member GP Principal GP 19-Apr-06

Thornley House Medical Practice Principal GP


.January 2013

offering following LESInsulin initiation 1-Jan-14Minor operations 1-Jan-14Anticoagulant monitoring 1-Jan-14Implanon service 1-Jan-14Ring pessary insertion 1-Jan-14Intensive Mental Health 1-Jan-14DMARDS 1-Jan-14Primary Care Access / HCA 1-Jan-14

F4C CharityDirector (no payment received)


.January 2013

LMC Deputy Chair

Commissioning, service and remuneration decisions impacting upon personal and business interests and relationships. 1-Nov-13

GP representative on Equality & Diversity Council, NHS England Principal GP

Commissioning, service and remuneration decisions impacting upon personal and business interests and relationships. 1-Jan-14

NHS Values Greater Manchester groupCo Chair


Dr Ram Jha - Governing Body GP Member Stamford House Principal GP


.January 2013

Practices in Tameside Minor Surgery


,January 2013

Tameside & Glossop Practice Vasectory


.January 2013

Asthetic Surgery Private work

Commissioning, service and remuneration influence in decisions impacting upon personal and business interests, including financial and personal gain and the risk of fraud opportunity.

.January 2013

LMC, GPC of BMA


Celia Poole - Lay Member CP Media Services Ltd Director

Commissioning, service and remuneration influence in decisions impacting upon personal and business interests, including financial and personal gain and the risk of fraud opportunity.

. January 2013

Cheshire & Greater Manchester Community Rehabilitation Company Ltd

Head of Marketing, PR and Communications


.January 2013

Yvonne Pritchard - Lay Advisor Nil

Dr Guy Wilkinson - Governing Body GP Member Manor House Surgery GP - PMS / GMS Practice


06/07/2011 and updated in November 2013, updated with further detail in January 2014

Additional Services:Cervical Smear, Minor surgery, Immunisations and Vaccs, Child Health Surveillance, Maternity

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Directed Enhanced Services

Extended Hours, Learning Disability, Online Access, Remove Care Monitoring, Risk Profiling, Pneumococcal and Flu Vaccs

Local Enhanced Services

ECG, Obesity L2 Management, Smoking Cessation, Ring Pessary, HRT Implants, Insulin Initiation, Health Care Assistant

National Enhanced ServicesAnticoagulant, DMARD Monitoring, Contraceptive Implants and Coils

Locally Commissioned Services:Skin cancer surgery, Ultrasound, Echocardiogram, Cardio Memo

Operating under the banner North West Travel Clinic:


Private Travel Health Services

North West Diagnostic and Treatment ServicesProvider of Extended Services to CCG


updated in November 2013

Training Practice for FY2 and ST2&3 Doctors employed atTameside Hospital FT


Training Practice for Medical Students from Manchester University


Relationship with Louise Roberts - Corporate Performance Manager, T&G CCG personal


.January 2014

Daughter Hannah Wilkinson - Mental Health nurse in training - Salford University personal


.January 2014

Clare Parker (was Symons) - Mental Health and Learning Disability Commissioning Manager / Governing Body Nurse / Caldicott Guardian Tameside & Glossop CCG

Mental Health Commissioning Manager

Commissioning, service and remuneration influence in decisions impacting upon other organisational and personal interests, including service, financial, contractual, employment and personal gain and the risk of fraud opportunity. 1-Jan-13

NHS England

Husband employed from 4/8/14 with NHS England as Safety Project Lead –

Learning Disability

Commissioning, service and remuneration influence in decisions impacting upon other organisational and personal interests, including service, financial, contractual, employment and personal gain and the risk of fraud opportunity. 4-Aug-14

NHS England

Partner employed from 6 January 2014 as Social Care Associate (Enhanced Quality Assurance Pgoramme (a workstream of the Winterbourne Joint Improvement Programme))

Commissioning, service and remuneration influence in decisions impacting upon other organisational and personal interests, including service, financial, contractual, employment and personal gain and the risk of fraud opportunity. 17-Dec-13 Aug-14

Steve Allinson - Chief Operating Officer Pennine Acute NHS Trust Married to employee

Commissioning, service and remuneration influence in decisions impacting upon other organisational and personal interests, including financial, contractual, employment and personal gain and the risk of fraud opportunity. 1-Apr-13

Kathy Roe - Chief Finance Officer / Deputy Chief Operating Officer Nil 15-Sep-11

Dr Saif Ahmed - GP Locality Lead GP at Millbrook Medcial Centre

Clinical lead at Millbrook Medical Practice Gotodoc APMS practice

Commissioning, service and remuneration influence in decisions impacting upon personal, business and Practice interests, including financial and personal gain and the risk of fraud opportunity. 7-Jul-14

Clinical lead Grange view intermediate care unit Gotodoc


Locality lead CCG Tameside and Glossop


Married to Dr Christine Clinton Works at Skin viva / locum GP

Commissioning, service and remuneration influence in decisions impacting upon other organisational and personal interests, including service, financial, contractual, employment and personal gain and the risk of fraud opportunity.

Dr Syed Asad Ali - GP Locality Lead GP at Churchgate Surgery


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Dr Andrew Hershon - GP Locality Lead / Clinical Lead GP at Hattersley Group Practice


Nikki Leach - Director of Nursing and Quality Nil

Clare Watson - Director of Transformation Nil

Dr Joanne Rowell - Lambgates Surgery


North Western Deanery


Dr John Doldon - Medicines Management Lead Staveleigh Medical Centre GP Partner

Commissioning, service and remuneration influence in decisions impacting upon personal, business and Practice interests, including financial and personal gain and the risk of fraud opportunity. 20.7.11

Associate Dean Postgraduate Medicine & Deanery


Dr Phaninder Tatineni - Governing Body GP Member Simmondley Medical Practice GP


Stuart Allan - Chair of Local Dental Committee Eagle House Dental Surgery GP Partner


West Pennine LDC Managing Director

Commissioning, service and remuneration influence in decisions impacting upon personal and employing organisational interests, including financial, contractual, employment and personal gain and the risk of fraud opportunity. 26-Jul-13

GM Federation of LDCs Officer


NHS England Officer


Bredbury & Romiley Community Centre Professional Advisor


Dr Naveed Y Riyaz - GP Locality Lead Tame Valley Medical Centre Trustee and Director

Commissioning, service and remuneration influence in decisions impacting upon personal and employing organisational interests, including financial, contractual, employment and personal gain and the risk of fraud opportunity. 24-Jun-14

West Pennine LMC GP Partner


Health Education North West Member

Commissioning, service and remuneration decisions impacting upon personal and business interests and relationships. 24-Jun-14

Dr Joanna Bircher - Clinical Quality Improvement Lead

Health Foundation Primary Care Medical Educator - leading the GP Training for GP Registrars in T&G

Commissioning, service and remuneration influence in decisions impacting upon personal, business and Practice interests, including financial, contractual, employment and personal gain and the risk of fraud opportunity. 7-Jul-14

RCGP

Generation Q Fellow to support my Masters in Leadership for Quality improvement


Clinical Support fellow for QI


Married to a GP board member

Commissioning, service and remuneration influence in decisions impacting upon personal, business and Practice interests, including financial, contractual, employment and personal gain and the risk of fraud opportunity.

Father is the Chair of Central Manchester University Hospital Trust


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GOVERNING BODY MEETING

Title of Subject:

Chief Operating/Accountable Office Report

Date of paper:

November 2014

Prepared By:

Steve Allinson

History of paper: COO Diary Review

Executive Summary:

The report summarises the key activities of the COO in

the month of October. Emphasis has been placed on,

Progressing public facing discussion about Care

Together; Progressing the leadership roles and

influence of the CCG; Reviewing our operational

needs and working arrangements, and, learning.

Recommendations required

of the Governing Body

(for Discussion and

Decision)

Governing Body is invited to raise questions or

matters relating to the work of the COO and

asked to note the content of this report

Direct questions to:

Steve Allinson

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CHIEF OPERATING OFFICER REPORT – OCTOBER 2014 This last month has seen me more out of the office than in: there being good and bad in this together with much personal learning. I have been focussing on three core activities: 1. Progressing public facing discussion about Care Together.

1.1. I was pleased to engage both the High Peak CVS and CVAT to organise, host and lead three listening events, one in Glossop and two in Tameside. We showed a Kings Fund video, ‘Sam’s Story’, to help illustrate why ‘joined up care’ matters and what it might look like Click here to see Sam's Story Our Commissioning Managers then shared our outline business cases after which CVS/CVAT facilitated table discussions with leaders of third sector faith and community groups to bring out their views and thoughts on what a completely re designed care system might offer.

1.2. Feedback was positive - that we had engaged at such an early stage with the genuine intent

to: listen; place and support local people at the heart of and taking control of their wellbeing and health and care; break down barriers, organisational working practices and behaviours which lead to so many people being passed between services and without any clear plan for how their needs are to be met; and continue the dialogue over the coming months. There were concerns: about support for people to travel to services and service accessibility; costs; whether we could actually do it and there were some who preferred things to stay as they are.

1.3. It is vital we do not lose the momentum of working with and through our public,

recognising the events did not reach far enough into our communities and the outline business cases are not fully developed and agreed commissioning intentions. I am pleased to see the continued evolution of our Engagement Strategy and this month we integrated the engagement and communications teams enhancing operational capacity to support the increased investment in lay capacity reported to last month’s meeting. It is perhaps worth noting also that following the recent engagement survey of Member Practices on how well we engage with them and what might be done better, we have re-formed and re-launched our newsletter.

2. Progressing the leadership role and influence of the CCG

2.1. Unusually, our Care Together Transition Board met for the second successive time at the CCG offices. We took the opportunity to meet, team to team, with colleagues from TMBC beforehand. Both were successful and productive meetings, and in the coming month we plan further discussion to deepen governance and explore closer operational working around joint decision making. I am particularly pleased to report on a meeting the following day at which the TMBC and CCG deputy directors of finance co presented to the GM provider and commissioner finance community on service and financial modelling that underpins Care Together. Not directly of my own activities of course, but the significance of such was visible togetherness and understanding of the respective financial positions, and commitment to share knowledge and understanding. It is worth noting the CCG has been invited to engage as stakeholder and consultee around TMBC’s budget proposals Try the TMBC budget Simulator here

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http://www.kingsfund.org.uk/audio-video/joined-care-sams-story

http://www.kingsfund.org.uk/audio-video/joined-care-sams-story

http://www.tameside.gov.uk/budget/consultation/intro

http://www.tameside.gov.uk/budget/consultation/intro

2

2.2. Together with our Chair, I participated in the Peer Review of the Derbyshire Health and Wellbeing Board. Following and initial telephone interview, I attended two meetings at County Hall, Matlock, to give feedback and also offer thoughts on how a more place based approach could help us all help our public particularly around integrated care. We have yet to receive the feedback letter but I anticipate this will be shared widely and I committed this CCG to continue to be a strong local joint advocate and commissioner, as well as a strategic leader supporting County-wide action. In addition to joint working with our County Council Colleagues, I met colleagues from the High Peak in an exploratory discussion and gave my support to joint working for sustainable communities. I will bring that discussion forward to the Glossop locality in the first instance.

2.3. Finally, I am pleased to announce that following nomination and testimonials from our chair

and from me, both our Deputy and our Chief Financial Officers have been shortlisted for the HFMA Award (Healthcare Financial Management Association) for Deputy CFO and CFO of the year. I know they each recognise how much their success is due to and dependent on colleagues from across the CCG and beyond. It is of course also recognition of their individual abilities and efforts. I know as a Governing Body we recognise both points.

3. Reviewing our operational needs and working arrangements

3.1. We have been reviewing our Constitution. Although this has been done largely to meet the NHSE timeframe and process for in-year amendments, it has been helpful giving us the opportunity to strengthen the Conflict of Interest and register of Interest policies in light of recent experience; also to tidy up one or two Constitutional clauses that are no longer relevant. NHSE have asked that we incorporate new text to reflect changes in legislation concerning Joint Committees and also changes in policy such as co commissioning. A draft revised document will be shared with Member Practices and key stakeholders before the final document is checked with our legal advisors for submission to NHSE for approval. My thanks to the chairs of all of the Committees for their work to review Terms of Reference in anticipation: also to our interim Governance Manager who has led the process with an acute eye for detail. Members will be aware our Governance Manager retired in September and I am pleased to advise that following a revision to the job role and job description, we have advertised and recently shortlisted for the substantive appointment. The interviews are scheduled for mid-November.

3.2. I attended a meeting of GM CCG Chief Operating and Finance Officers to hear the latest

national thinking about Commissioning Support to CCGs. There is a new ‘lead provider framework’ which is almost like a list of already approved and accredited suppliers from which we can choose; there is some emerging guidance about the need for us to market test our support services; and we need to give clear direction to the newly merged North West Commissioning Support Unit (bringing the former GM and Cheshire and Mersey CSUs together). I have asked each of our responsible Directors to review and advise on our changing needs and reflect also on the performance of current services so that we can bring together a proposal for discussion with the Governing Body. We need to be mindful of the changing nature of our commissioning work; for example, the expectation of us taking on functions from NHSE and the need for joint prioritisation and investment decision making with our local authorities. These commissioning support requirements discussions will progress throughout November to involve our clinical leadership, after which we will bring a full report to the December meeting of Governing Body.

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3

4. Learning

4.1. I feel much of the work undertaken to support our constitution/governance review may pass most by. However, the manner of working throughout the operational team and attention to detail gives me the confidence we continue to develop and our delivery stems from the skills and expertise of our teams. We are looking to further empower and support them so that we streamline our working without losing the identity of a clinically led decision making body.

4.2. I feel this coming month will see us take on a role if not function of NHSE, reaching out to

help support and develop our practices as providers. Whatever language we use to describe this extension, it will be a key step for all colleagues in general practice, clinical and non-clinical alike, and fundamentally for our public. I anticipate further reports and advice coming to the Governing Body describing what this will mean and what it will look like.

STEVE ALLINSON CHIEF OPERATING OFFICER 31 OCTOBER 2014

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1

MINUTES OF TAMESIDE AND GLOSSOP CCG GOVERNING BODY

OCTOBER 1ST 2014

Steve Allinson Chief Operating Officer

Dr .J. S Bamrah Secondary Care Doctor

Dr. R. Bircher GP Member (Urgent Care)

Graham Curtis, Deputy Chair/Lay Member

Jamie Douglas GP Member (Primary Care/Healthier Together)

Dr. Alan Dow GP (Chair)

Dr. T. Greenhough GP (Clinical Vice Chair Mental Health

Families and Partners and Integration)

Dr. Ram Jha GP Member (Planned Care/Cancer)

Amir Hannan GP Member (Long Term Conditions, IM&T)

Angela Hardman Public Health Advisor

Jean Hurlston Lay Advisor

Nikki Leach Director of Nursing and Quality

Clare Parker Nurse Member (Caldicott Guardian)

Celia Poole Lay Member

Yvonne Pritchard Lay Advisor

Kathy Roe Chief Finance Officer

Lesley Surman Lay Advisor

Clare Watson Director of Transformation

Guy Wilkinson GP Member (Planned Care Lead)

In Attendance: Julie Bell, Elaine Richardson,

1. Apologies for Absence

None to record

Welcomes

The Governing Body welcomed two new Lay Advisors – Jean Hurlston

and Lesley Surman.

Judith Wright and John Coates Pharmaceutical Representatives.


All Governing Body GPs, notably around PIQ decisions Item 9.

3. Consideration of Any Other Business

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2

There were no items of any other business to discuss.

4. Chairs Introduction

Alan Dow stated that there had been a plethora of local HT meetings.

The CCG had its first, CCG AGM & Care Awards around the 6C’s Care

Competence, Compassion, Communication, Commitment, Courage

and also a CSU Chairs innovation and CCG Team of the Year Awards.

Alan said it was good to have the opportunity to collate our progress

over the first 12 months and 6 months since then, and to hear some

personal perspectives from some of our Clinical and Lay GB Members

in terms of - what a lot we have seen, begun, completed. Examples

were IRIS the Diabetes Service, Care Together and the work streams

underpinning them that are coming through our committees such as

the PRG PPIC PIQ, at tremendous pace.

Good News Stories

Staff in the Endoscopy Unit at Tameside Hospital Foundation Trust were

celebrating the news that they had received the prestigious National

Quality Accreditation for achieving and maintaining the meticulous

standards set by the Joint Advisory Group (JAG) on Gastro-intestinal

Endoscopy.

Further good news for the CCG was the Lay Members invaluable

contribution and involvement in CCG Committees and that this had

now been expanded by two new members; Lesley Surman and Jean

Hurlston.

Not so good news was the fact that the CCG was still a Glossop

Locality Lead down and as a consequence a Sub-Committee was not

covered through this and, through scheduling, a further Locality Lead

who cannot attend a Wednesday morning meeting, which means that

both PPIC and IGAR are currently relying on the Governing Body

Clinician and not the intended two.

Graham Curtis tabled a proposal for 2015 Calendar of Committee

meetings, to ensure we have appropriate attendance at all.

Governing Body agreed the new dates and offered their special

thanks to Joanne Keast for helping to speed the decision up by

producing the Calendar with support from the Administrative team.

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3

Term of Office

Amir Hannan asked about the Term of Office. Alan Dow stated that

because the ballot was conducted outlining that the term of office

was for two years from authorisation, it therefore expired on March 31st

2015, this would be adhered to. It was noted that a process had

already commenced, led by Kate Calder, to ensure the CCG is ahead

of time to fill the roles by this date. Any member wishing to terminate

their term of office would be required to give the CCG a three months

notice period.

5. Chief Operating Officers Report

The report summarised the key activities of the Chief

Operating/Accountable Officer, in the month of September 2014

which emphasised – Next steps of Care Together/Monitor Led process;

HT Consultations; Lay Advisor Interviews; First Quarter Review

(Checkpoint); FFP discussion with Chair and Lay Deputy to review and

consider options for handling the changing demands on all our time.

The Governing Body received the update.

6. Minutes of the Meeting Held on September 3rd 2014

The minutes were agreed as a correct record of the meeting, with one

amendment:-

Angela Hardman’s name had been omitted from the attendance list

at the September meeting.

Alan made one observation on page 9 – PIQ minutes, where it was

written that it was enlightening to see all GPs thinking about

developing various business cases across the patch. Upon reflection he

stated that not all had responded as yet, indeed one had openly

stated that they did not have the capacity.

Matters Arising

Care Makers

Steve Allinson stated that Sam, the Care Maker, had been very

complimentary about his experience with this CCG. Hilary Garratt,

Director of Nursing at NHS England, was proposing to place student

nurses and Care makers into CCGs. The CCG would also have

14

4

reference at the Chief Nurses Annual Conference. The Governing Body

felt this was a positive move forward.

Nikki Leach stated that within the Nursing and Quality Directorate, work

was being undertaken with the University and the CCG will be taking

students, on placements shortly.

Ram Jha asked if this could be extended to attract GP trainees as well.

Steve stated that he would be happy to take this conversation forward.

Governing Body Action Log

Healthier Together Consultation

Steve Allinson stated that at the Committee in Common Meeting,

documentation was received which set out how the decision process

would be managed. This was a first draft, and CCGs were making

contributions in terms of how it could be improved. Steve would keep

the Governing Body apprised of developments.

Professional Portal for Concerns

Gill Gibson was in discussion with Joanne Bircher in order to feed back

intelligence to the CSU.

£5 per head over 75s – Scrutiny of Previous Bids

Graham had reassessed Hyde and Stalybridge bids, and checked the

process with Internal Audit. He stated that there were still issues which

had also been raised at IGAR earlier in the day, however, it was noted

that this was the first time this organisation had entered into a process

of this nature, and there will obviously be some mistakes and lessons

learned along the way.

It was noted that in February 2015 there would be a re-view of all the

bids and going forwards there would need to be assurance that the

bids evidence quality and value for money for our public.

Alan cautioned that, given the Conflict of Interest issues, there may be

some delays. Graham also stated that there was some disquiet at PIQ

in terms of making decisions about colleagues who were also in the

room.

Graham would be writing out to practices about the process and

expectations.

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5

In terms of independent scrutiny it was noted that all the information is

also sent to NHS England, as an added layer.

Clare Watson stated that practices could now go ahead with their

business cases and agreed to formally communicate this to the

relevant practices.

Health and Social Care Integration

In answer to Amir Hannan’s, Clare Parker’s and Celia Poole’s question

around engagement in the enabling work streams, Kathy stated that,

particularly for IM & T, there were still discussions taking place as to

whether IG was separate to IM & T and John Winter had been asked to

put proposals forward.

In terms of general engagement in the enabling work streams, Kathy

stated that there might be a requirement to have ‘virtual’

communications for different stages of development. All these types of

issues would be addressed through the Delivery Unit, going forwards.

Amir Hannan stated that the CCG would need to get GPs more up to

speed with Caldicott Guardian issues, and conversations would need

to be taken forward very soon.

Performance

Nikki Leach had met with Jamie Douglas outside the meeting

regarding pressure ulcers. It was noted that there would shortly be a

whole health economy approach to this issue and the new process

could also be used to agree KPI’s.

7. Draft Minutes of the PPIC Held on September 10th 2014

Yvonne Pritchard stated that the minutes were self evident, however

she outlined the key issues and decisions made at the meeting:-

Personal Health Budgets

The paper outlined the new eligibility rights of all patients (adults and

children) and that the full implications for the CCG were still unknown,

however, all GPs would need to become familiar with the policies.

111

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6

PPIC discussed the issue of a new provider who would likely

commence in October 2015 and the fact that 111 were asking for

public engagement by 17th September 2014. PPIC felt that this was

extremely short notice. Peter Denton (Healthwatch) asked if the new

start date could be extended to ensure time for meaningful public

engagement to allow more time to ensure that an improved service is

in place.

Steve Allinson stated that a Reference Group had been set up to

oversee the procurement process and we would have an opportunity

to put issues forward as part of that process.

The Governing Body received the draft minutes.

8. Quality Committee Minutes Held on August 27th 2014

Celia Poole had highlighted the key issues at the last Governing Body

meeting.

Arriva/Patient Transport

Alan Dow stated that three of his patients had been reluctant to go to

hospital through worry about difficulty getting back. Other members

had similar anecdotal stories.

After a lengthy discussion the Governing Body agreed that it was

imperative to commission a reliable service for our patients and Alan

Dow suggested that, as it was critical to the new world on integrated

care, it should be a part of our Care Together Programme.

Clare Watson agreed and stated that this would be addressed through

the ICO via the estates and transport work.

In the interim, Steve Allinson asked the following:

Alan Dow to have conversations with his patients to try to gain

further clarity on the exact issues.

Work could also be kicked-off with PPGs.

Governing Body received the minutes.

Mental Capacity Act – Safeguarding Update

It was noted that the CCG was seeking legal advice in terms of an

application to the Court of Protection.

Graham Curtis agreed to put this particular issue on the Risk Register.

17

7

Quality Committee Meeting Held on September 24th 2014 – verbal

update

Celia updated on the following key issues:-

Data Quality Initiative

It was noted that Quality Markers had been agreed and initial data

collection shows that locally we perform highly on data quality.

Practices will be receiving individualised reports in the next 6-8 weeks

and Joanna Bircher would provide a summary for the Quality

Committee.

At this juncture in the Governing Body meeting, Amir Hannan stated

that the CQC was about to announce which practices had failed.

Alan Dow said that the CQC would identify practices that required

support and was developing a system of declaring Practices in ‘Special

Measures’ as it did for hospitals.

Clare Watson agreed to follow this up in terms of when this was being

published and what were the Area Team’s contingency plans should

there be a local issue.

Improving Communications with Care Homes

It was noted that discussions had taken place regarding aligning care

homes with GP practices for new registrations in order to build up

strong relationships between the teams.

Review of Breast Cancer Service – Next Steps

It was noted that informal updates had been received following the

review however a formal response had not been received. This would

be picked up through the Interface meetings with THFT and through

the Contract and Quality meetings.

Review of the Terms of Reference

The changes to the ToR would now be submitted to IGAR.

CQUIN Workshop

A workshop was being arranged for Wednesday 26th November.

Governing Body noted the update and would receive the minutes at

the November meeting.

18

8

Draft Minutes of the PIQ Meeting Held on September 17th 2014

Graham Curtis presented the draft minutes to note the discussions and

decisions made by PIQ.

Governing Body approved the following:-

Care Together Outline Business Cases

Palliative Support Service

All Age Learning Disabilities

Stroke & Neurological Rehabilitation Service

Local Community Care Teams

Operational Resilience and Capacity Planning for 2014/15

Governing Body approved PIQ’s proposals (outlined in the minutes), to

enable appropriate commissioning and implementation as part of the

earmarked £250k within the £1,687,634 allocation and received the

Business Case/proposals in the future to help deliver urgent care system

resilience.

£5 per head for over 75s:-

Governing Body Members (Steve Allinson, Kathy Roe, Graham Curtis,

Celia Poole) approved all the bids recommended by PIQ, noting that

some business cases would be brought back for further discussion.

The Governing Body GPs who were not directly involved in the bids, did

not raise any concerns with the recommendations from PIQ.

1. Extension of Carers Project Funding for 15/16 Carers Primary Care

Liaison Role

PIQ recommended that the business case be brought back to October

PIQ.

PIQ noted the update on the Carers Primary Care Liaison role.

2. PTS Re-procurement

PIQ recommended consideration of the proposal and supported the

recommendations.

19

9

3. Avoiding Unplanned Admissions Enhanced Service Update

PIQ noted the update for the Avoiding Unplanned Admissions

Enhanced Service.

4. TFT Perfect Week

PIQ noted proposals to roll out the ‘perfect week’ process which would

commence on October 20th.

5. TARGET and Primary Care Education Update

PIQ noted the work undertaken by the Target Steering Group.

PIQ noted and recommended for approval the Terms of Reference for

the steering group.

PIQ recommended approval for the principle of a wider educational

format to draw in Secondary Care and Social Care.

PIQ considered provision of Locality and/or Practice based TARGETs to

actively facilitate local innovation/best practice in patient care.

6. RAID

PIQ recommended that the business case be brought back to PIQ and

that work be undertaken with Pennine Care to ensure assurance

around finances.

7. Age UK Star 131

PIQ felt that none of the options be recommended for approval at this

stage and that it be brought back to October PIQ for further discussion.

8. Parkinson Specialist Nurse

PIQ recommended approval to consider the inclusion of a Parkinson’s

Nurse Specialist as part of the Care Together Integration project with

the caveat that the post can be revisited if necessary.

Operational Resilience and Capacity Planning to 2014/15

Clare stated that the document set out how we will ensure that we are

able to provide a high quality and responsive health and social care

20

10

service in Tameside and Glossop throughout 2014/15 and beyond. It

encompassed the Operational Resilience and Capacity planning

requirements for 2014/15 and described what services will be in place

to meet expected demand and the agreed processes when the

demand on the system is greater than anticipated.

The Plan ensures that:-

Organisations are prepared for the anticipated demand in 2014/15;

Potential risks have been identified and contingencies have been

put in place;

The local escalation process is understood and has defined

escalation levels and triggers;

The impact of pressures on the levels of service, national targets and

finance are managed;

A process is in place to meet the reporting requirements of our

governing bodies;

Amir Hannan stated that it was a good resilience plan but there did not

appear to be enough investment into self care, and with a quarter of

practices offering on-line service, there was nothing in the plan to

encourage this. Clare stated that within the £250K, a paper would be

going to PIQ with some proposals and one suggestion was data

sharing.

Ram Jha asked who was responsible for the £1.7m, and in terms of the

Resilience Group, who decided the make-up of the membership in

view of the fact that there was no GP voice.

Clare Watson clarified that the Resilience Group was an overarching

group, discussed at previous Governing Body meetings. The

membership was from all partner organisations who work within

Tameside and Glossop and that the CCG does not have a collective

of GP Providers as yet. Alan Dow stated that the LMC would be the

closer link with respect to this.

Steve Allinson concurred stating that this was a system coming

together and was an opportunity to work collectively, which was our

vision.

A discussion took place on preventing admissions into hospital and

Amir Hannan stated that improving primary care access; having robust

Long Term Conditions management and more investment in the 3rd

Sector would help improve this situation.

21

11

The Commissioning Assembly

At this juncture Steve Allinson updated from a national meeting of

CCG leaders, outlining Simon Stevens key priorities:-

Meet 14/15 NHS Constitution Commitments

Stabilise delivery in 15/16

Drive the NHS 5 year forward look

Steve sensed that Simon Stevens sees CCGs very much as the local

system leader in their area and sensed also that he recognised a

greater maturity in CCGs than has previously been acknowledged.

Key messages from leaders of the national policy on co-commissioning

were:-

Engaging with your Area Team

Shaping strategy and investment

Delegated responsibilities

Governing Body received the Operational Resilience and Capacity

Planning to 2014/15.

2015/16 NHS Standard Contracts

Clare Watson updated the Governing Body on the contract round for

the next financial year. It detailed the high level deadlines for the

different phases in the process. It was noted that a more detailed plan

has been developed for operational use to ensure the CCG meets it

statutory requirements.

Graham Curtis asked that our Lay Advisors become involved in this

work, as they will have the responsibility for liaising with the public and

patients.

The Governing Body noted that the information gave assurance that

the contracting round fits within the Care Together programme and

delivers the CCG’s organisational objectives.

Health and Social Care Integration – Care Together

Kathy Roe provided an update for the Governing Body since the last

report and highlighted the formal position of Monitor and the national

announcement that they wish to develop a ‘full’ Integrated Care

Organisation from an NHS Foundation Trust.

22

12

It also highlighted the engagement activities which took place in

October and the work of the Delivery Unit.

Celia Poole asked who would be involved in the short-listing of the

external experts that Monitor was commissioning. It was noted that

Kathy Roe, Doreen Hounslea and Stephanie Butterworth from the Local

Authority were going to London on October 10th 2014 for 3 days.

Celia Poole also asked if a patient representative could be involved in

this process, however, it was noted that this was not a CCG process,

but Monitor’s, however Kathy Roe would suggest this to Monitor, given

it is indicative of the way we work.

Richard Bircher asked what Monitor might think about the fact that we

have not got the clinical model worked out as yet.

Kathy Roe stated that Monitor had both the CCG and Tameside

Hospital FT Strategies. The CCG has always said it wanted as many

services as possible locally however the CCG still needed evidence

from the THFT around quality and sustainability of their proposals.

In summary, the Governing Body noted the positive ongoing work with

Monitor to resolve the economy’s clinical and financial issues;

The Governing Body noted the formal announcement by Monitor of

their actions in relation to THFT and the appointment in due course of

external experts working across the economy

The Governing Body supported the work of the Delivery Unit in driving

the agenda forward and would receive a report to the next meeting

on the enabling work streams.

10 Integration Governance Audit and Risk Committee – verbal update

from October 1st meeting

Graham Curtis updated on the following key issues:-

SIRI Monitoring Group

It was noted that this Group did no longer exist, however, in future

when STEIS are recorded, they will be regularly monitored and

scrutinised by IGAR.

23

13

Waivers

The External Auditors felt that the IGAR Chair should be involved in the

waiver process as soon as possible for all business cases and that new

waivers should be drawn up for each financial year, where a waiver

crosses a financial year.

Conflict of Interest Policy

It was noted that the views from the Auditors had been noted and will

be included in the final version. Members were asked to provide any

comments back to Graham Curtis before the next IGAR meeting.

Review of Audit Committee Handbook

It was noted that Graham Curtis and David Walsh had met to review

the handbook and made appropriate changes in the work plan to

reflect best practice across all committees.

Terms of Reference

IGAR recommended that the Governing Body approve the Terms of

reference for the CCG committees, which had been presented to the

IGAR meeting earlier in the day. Governing Body gave their approval

to this recommendation.

It was noted that Alan Dow would need to take ‘Chairs Action’ on the

two which were to follow, given they would probably need to be

included in the Constitution, which was due to be submitted by

November 3rd. The Governing Body accepted IGAR’s

recommendations.

Updates from Directorates

It was noted that IGAR now has a standing invitation to each CCG

Directorate for Officers to present their current work areas/share their

ideas and plans. The Transformation Directorate was the first to

present.

11. Performance Report

Elaine Richardson updated on the current performance issues around

the development of the dashboards, including the summaries showing

the current and expected end of year performance for our Clinical

Challenges and Nursing and Quality along with dashboard summaries

for two of our main providers.

24

14

Elaine stated that feedback from Quarter 1 Checkpoint went well and

built a good case for the next checkpoint, particularly in terms of our

Governance. Alan Dow noted that he thought that having such a

Leadership and representation through the Lay Members, was

excellent, and it was a shame he could not make the next checkpoint

that had also been set on a Friday.

A discussion took place on Discharge Summaries and it was noted that

Joanna Bircher had been involved in informing the Terms of Reference

for a Working Group which will include clinicians and managers from

THFT and the CCG, looking at timeliness of the Summaries and the

quality and content.

Graham Curtis stated that the poor quality of discharge summaries was

detrimental to our patients, was not acceptable, and could not all be

attributed to Lorenzo problems.

The Governing Body however generally felt that things were improving

at the Trust and the level of engagement was getting better.

In general the Governing Body felt that some of the narratives and ‘Not

Applicable’ (NA’s) within the report were not helpful and sometimes

confusing. Elaine Richardson would raise this with the CSU.

Quality Dashboards for Primary Care were discussed and Elaine

Richardson stated that the CCG was currently looking at how to make

the existing format more comprehensive.

Provider dashboards outlining quality and waiting times for certain

procedures was also deemed important, as this was the type of

knowledge that really matters to patients.

Amir Hannan stated that some really good work had taken place on

the Long Term Conditions Dashboard and was now showing great

improvements in this area.

Yvonne Pritchard was assured to learn that there were improvements

around figures for breast feeding and under 18s conception rates were

excellent.

The Governing Body received the performance update.

12. Finance Report

Kathy Roe updated that the CCG is currently on track to meet all its

key financial duties. The financial position at the end of month 5 was

25

15

showing a surplus position of £4,166k. This was contributing to a planned

surplus position of £9,999k for the 2014/5 full year.

In terms of Care Together, Guy Wilkinson felt that the biggest challenge

would be robust validation at THFT. Kathy Roe stated that a lot of

‘behind the scenes’ internal auditing and validation was currently

being carried out across various specialities.

DNAs were discussed and it was noted that THFT were now piloting

multifaceted ways of reminding patients of their appointments, and this

should now discourage DNA’s.

Governing Body received the update particularly noting the planned

surplus; Care Together Sustainability Plan and also the level of risks

identified within the report.

13. Healthier Together Committee in Common Meeting Held on August 20th

2014

Steve Allinson stated that the minutes were self evident and held some

time ago. He stated however, that because of the various comments

from members around having a fair and rigorous consultation process

and not just a numbers game, Opinion Research Services had been

commissioned to oversee a focused evidence based outcome to the

consultation.

Steve stated that a key issue from the last meeting was that Leila

Williams had referenced an agreement to a document about how we

would respond to the Consultation and this would be explored and

clarified further with Leila Williams as there were some concerns.

The Top Gear Challenge was discussed, where it has been suggested

to invite members of the public to document their journeys to

Salford/UHSM (a visiting experience, not a Blue light experience). Given

the interest from the Governing Body, Steve said this could be explored

further for this patch and asked for any feedback, as further comments

and suggestions could still be fed back to the Consultation until the

end of October.

The Governing Body noted the update.

14. Tameside Health and Wellbeing Board Minutes 19th June 2014

Steve Allinson took the Governing Body through the minutes outlining

the following key issues:-

26

16

That the membership of the Health and Wellbeing Board be

amended to include four representatives from Tameside and

Glossop CCG.

The minutes stated that the Public Health Annual Report had

been received well by the HWBB however Steve stated that this

statement really undersold the commitment to the Annual

Report from members in the room as it was the whole health

economies collective ambition.

The Governing Body received the minutes.


Formal Thanks to Chair and Chief Operating Officer

On behalf of the Governing Body, Ram Jha formally thanked both Alan

Dow and Steve Allinson for their hard work and dedication in

navigating the CCG through some very challenging agendas over the

past year.

16. Date and Time of Next Meeting

November 5th 2014 at 1.p.m.

27

1

GOVERNING BODY MEETING HELD ON OCTOBER 1st 2014

ACTION LOG

TITLE

RESPONSIBLITY FOR ACTION

AND

OUTLINE OF ACTION

ACTIONED

OR

REFERRED TO THE

NEXT GB MEEETING

ACTIONS FROM

AUGUST GB MEETING

B/FWD

Healthier Together –

Consultation

Steve Allinson

Steve Allinson stated that at

the Committee in Common

Meeting, documentation was

received which set out how

the decision process would be

managed. This was a first

draft, and CCGs were making

contributions in terms of how it

could be improved.

Steve would keep

the Governing Body

apprised of

developments.

ACTIONS FROM

SEPTEMBER GB MEETING

B/fwd

Professional Portal for

concerns

Gill Gibson

Gill Gibson was in discussion

with Joanne Bircher in order to

feed back intelligence to the

CSU.

Gill to feedback

back intelligence

to the CSU

28

2

Matter Arising from the

draft PIQ Meeting – £5

per head over 75s -

scrutinising of previous

PIQ business cases for

consistency and

fairness

Graham Curtis

Graham had reassessed Hyde

and Stalybridge bids, and

checked the process with

Internal Audit.

It was noted that in February

2015 there would be a re-view

of all the bids and going

forwards there would need to

be assurance that the bids

evidence quality and value

for money for our public.

Graham would be writing out

to practices about the

process and expectations.

Graham to write out

to all practices

about the process

and expectations

of submitting bids.

A review of all the

bids would be

undertaken in

February 2015.

Health and Social Care

Integration – Care

Together

Kathy Roe

In terms of general

engagement in the enabling

work streams, Kathy stated

that there might be a

requirement to have ‘virtual’

communications for different

stages of development. All

these types of issues would be

addressed through the

Delivery Unit, going forwards.

General

engagement issues

in the enabling

work streams would

be addressed

through the

Delivery Unit, going

forwards

Performance Report

Nikki Leach

Nikki Leach had met with

Jamie Douglas outside the

meeting regarding pressure

ulcers.

It was noted that

there would shortly

be a whole health

economy

approach to this

issue and the new

process could also

be used to agree

29

3

KPI’s.

ACTIONS FROM

OCTOBER GB MEETING

Arriva/Patient Transport

Alan Dow

Alan Dow stated that three of

his patients had been

reluctant to go to hospital

through worry about difficulty

getting back. Other members

had similar anecdotal stories.

Steve Allinson

asked the

following:

Alan Dow to

have conversations

with his patients to

try to gain further

clarity on the exact

issues.

Work could

also be kicked-off

with PPGs.

Mental Capacity Act –

Safeguarding Update

Graham Curtis

It was noted that the CCG

was seeking legal advice in

terms of an application to the

Court of Protection.

Graham Curtis

agreed to put this

particular issue on

the Risk Register


Clare Watson

Alan Dow said that the CQC

would identify practices that

required support and was

developing a system of

declaring Practices in ‘Special

Measures’ as it did for

hospitals.

Clare Watson

agreed to follow

this up in terms of

when this was

being published

and what were the

Area Team’s

contingency plans

should there be a

30

4

local issue.

Performance Report

Elaine Richardson

On general the Governing

Body felt that some of the

narratives and ‘Not

Applicable’ (NA’s) within the

report were not helpful and

sometimes confusing.

Elaine Richardson

would raise this

with the CSU.

Healthier Together

Committee in Common

Meeting Held on

August 20th 2014

Steve Allinson

Steve stated that a key issue

from the last

st meeting was that Leila

Williams had referenced an

agreement to a document

about how we would respond

to the Consultation. This

would be explored and

clarified further with Leila

Williams as there were some

concerns.

The Top Gear Challenge was

discussed, where it has been

suggested to invite members

of the public to document

their journeys to Salford/UHSM

(a visiting experience, not a

Blue light experience).

Steve to clarify

Stev Steve said that this

could be explored

further for this patch

and asked for any

feedback, as

further comments

and suggestions

could still be fed

back to the

Consultation until

the end of October.

31


Title of Subject:

Draft October Public and Patient Involvement Committee

minutes

Date of paper:

8th October

Prepared By:

Celia Poole

History of paper:

Public and Patient Impact Committee held a meeting on

8th October 2014 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.

Executive Summary:

Key Issues discussed:

Patient Story – RAID (‘Rapid Access Interface and

Discharge’)

Members were introduced to the history of the paper on

RAID that had previously been presented to PIQ on 17th

September who had agreed in principle although financial

details were to be presented to PIQ in October for final

decision.

The current RAID service with Tameside General Hospital

delivers against 3 key areas:

- A&E liaison – to include mental health, alcohol abuse and

self harm

- Alcohol liaison – working with frequent flyers through an

assertive community outreach approach

- Older People’s liaison into the general hospital inpatient

setting for patients with delirium, depression and dementia

– to include support to staff in MAU and other wards

RAID has been in place via a 3 year CQUIN that is due to

end on 31st March 2015. Once an economic evaluation

from the University of Chester is completed a further paper

will be prepared to consider how this service can continue

and identify financial investment to support this.

Craig Gorton was invited as someone who has had

personal experience of accessing the RAID team, to speak

at PPIC and share his patient story.

- Communications and Engagement Structure

NL tabled a copy of the proposed structure for the

Communications and Engagement team and confirmed

that CMT have accepted the proposed structure to better

join up the internal infrastructure to support

32

communications and engagement.

- Media update

Adam Shepphard provided members with an update on

recent communications/media activity to include:

Healthier Together

AGM

111 Event

Winter Campaign

CCG Membership engagement – report of findings

NL took PPIC through the presentation slides shared and it

was noted that the presentation captured some of the

same key messages and issues that were noted during the

last meeting to include understanding workload of the

Practice Managers and strengthening support, recognition

that GPs engaging in the business of the CCG remains a

challenge.

Patient Friendly Dashboard

LR introduced the first presentation of the Patient Friendly

Delivery Dashboards. LR explained that following feedback

received earlier in the year commitment was made to

publish information on how we were performing.

Straight to test colonoscopy

RH took PPIC through the first presentation of the report on

Straight to test colonoscopy. Tameside FT in conjunction

with the CCG has been undertaking a pilot for straight to

test (STT) colonoscopy. The proposed pilot including

pathway has been used for QOF QP 6-8 indicators in

2013/14.

System Resilience

NL presented members with the first presentation of the

System Resilience Plan submitted by Elaine Richardson and

explained that at this stage this was for information only.

The CCG is required to lead a process across the local

health and social care economy to develop a local

Operation Resilience and Capacity Plan. The aim of the

plan is ensure the local health and social care economy

can operate as effectively as possible in delivering year-

round services to patients.

Recommendations required of

the Governing Body

(for Discussion and Decision)

To discuss and note the key issues discussed and agreed at

the meeting on 8th October 2014.

QIPP principles addressed by

proposal:

To receive the report


Celia Poole

33

V3

1

DRAFT MINUTES

Public and patient Impact Committee (PPIC)

Wednesday 8th October 2014 9.30am-11.30am

Boardroom, NCH Denton

Present:-

Celia Poole (CP) Governing Body Lay Member, CCG (Chair)

Nikki Leach (NL)

Clare Parker (CPa)

Louise Roberts (LR)

Lesley Surman (LS)

Nigel Caldwell (NC)

Charlotte Forrest (CF)

In attendance:-

Director of Nursing and Quality, CCG

Governing Body Nurse, CCG

Performance Improvement Manager, CCG (Transformation Rep)

Governing Body Lay Advisor, CCG

High Peak CVS

Scrutiny Support and Coordination Officer, TMBC

Adam Shepphard

Ricky Hind

Allison Kendall

Alan Alker

Anonymous

Clare Bromley

Head of Communications, GM CSU

Performance Improvement Officer, CCG (Part)

Pennine Care (Part)

Pennine Care (Part)

RAID volunteer/former service user of RAID (Part)

PA, Corporate Office (note taker)

1. Chairs Welcome, Introductions and Apologies

Apologies were received from:-

Anna Hynes Co-ordinator for the Health and Social Care Network, CVATs

Jane Ankrett Business Manager and Lead Nurse, Community Healthcare, SFT

Doreen Hounslea Care Together Programme Lead, CCG

Martin Carter Communications and Engagement Consultant, CCG

Dr Naveed Riyaz Locality GP, CCG

Dr Amir Hannan Governing Body GP Member, CCG

Yvonne Pritchard Governing Body Lay Advisor, CCG

Jean Hurlston Governing Body Lay Advisor, CCG

Peter Denton Healthwatch Manager, Healthwatch Tameside

Alison Lewin Deputy Director of Transformation, CCG

Karen Sykes Head of Safeguarding, Quality and Patient Safety, CCG

Tracy Turley Patient Experience Manager, CCG

Jo Baines Chief Officer, Volunteer Centre, Glossop

Julia Allen Equality and Diversity Consultant, GM CSU

Jane Birch Community Involvement Worker, Healthwatch Derbyshire

Tanya Nolan Community Involvement Worker, Healthwatch Derbyshire

CP welcomed everyone to the meeting and conducted round the table introductions.

Members welcomed Lesley Surman to the committee as newly appointed Governing Body Lay

Advisor.

34

V3

2

CP informed that as there was no GP/clinician attending the meeting we were not quorate

and therefore any decisions taken as chair will need to be circulated to those members not

present or request made for Governing Body ratification. CP agreed to take advice.

Action: CP

2. Declarations of interest

CPa declared an interest at item 6. ‘RAID’ in her role as Mental Health Commissioner.

NC declared an interest at item 5 ‘Care Together events’ for his involvement in those events.

3. Minutes of Previous meeting: 10th September 2014

The minutes of the previous meeting were agreed as an accurate record subject to a change

to page 4, item 7 to read: ‘Healthier Together local events in Tameside and Glossop were well

attended, with more people attending than in some areas of GM.’

4. Matters arising not otherwise on the agenda

The following actions were discussed:-

- Communication and Engagement Strategy including Implementation Plan

NL confirmed that representatives from Nursing and Quality and Transformation are included in

the ‘virtual reference group’.

CP informed that question had been raised as to where PPGs sit in that Virtual Reference Group

and agreed to raise this with Martin Carter for his consideration.

Action: CP

- Front sheets/checklist for submission of reports to PPIC

Julie Bell had liaised with CB regarding the use of front sheets/checklist to support reports

submitted to PPIC. CP asked attendees from the commissioning team if they felt the checklist

was useful and simple to use. They agreed that it was. NC added that it makes for helpful

reading too on receipt of papers in advance of the meetings.

CB to ensure that the front sheet/checklist is sent out via email on call out for agenda items.

Action: CB

6. Patient Story – RAID (‘Rapid Access Interface and Discharge’)

CP conducted round the table introductions to welcome Allison Kendall, Alan Alker and a

patient of RAID who joined the meeting at this point.

CPa introduced the history of the paper on RAID that had previously been presented to PIQ on

17th September. She explained that PIQ had been in agreement in principle although financial

details were to be presented to PIQ in October for final decision.

The current RAID service with Tameside General Hospital delivers against 3 key areas:

- A&E liaison – to include mental health, alcohol abuse and self harm

- Alcohol liaison – working with frequent flyers through an assertive community outreach

approach

- Older People’s liaison into the general hospital inpatient setting for patients with delirium,

depression and dementia – to include support to staff in MAU and other wards

35

V3

3

RAID has been in place via a 3 year CQUIN that is due to end on 31st March 2015. Once an

economic evaluation from the University of Chester is completed a further paper will be

prepared to consider how this service can continue and identify financial investment to support

this.

This patient was invited as someone who has had personal experience of accessing the RAID

team, to speak at PPIC and share his patient story.

He explained that a RAID worker first became involved on his admittance at Tameside General

Hospital for an alcohol related incident. He had been a frequent flyer at A&E with over 100

attendances which was significant reduced by the intervention of RAID.

He told of his on-going battle with alcohol addiction and how the care he received from

Tameside General Hospital together with the RAID service helped save his life whilst also

showing him respect and dignity. He highlighted the importance of the persistence of his case

worker for her determination to convince him that she was there to help and support him. He

explained that he received continued support from RAID as did his parents who were also

contacted and supported regularly by his case worker.

He has now rebuilt his life and is now a volunteer with the ALS team and offers support on ward

42 where he spent some of his time at Tameside General Hospital to give something back and

show his appreciation.

CP and members thanked the patient for sharing his story with us and how it highlights the

important work the RAID service provides.

Allan was asked how has RAID changed to previous support mechanisms and he replied that it

has put an extra dimension on resource for this support and meant they were able to link up

with difficult to reach patients.

CPa explained that approximately 100 people per month go through the RAID service as

opposed to 15/20 per month with the HIT team previously. This, in part, is due to an increase in

support to staff on wards via the RAID model on understanding how patients fall into the 3 key

areas. CPa noted that these figures can only be determined by case findings on the wards

and therefore agreed to endeavour to obtain figures from the alcohol team within A&E.

Action: CPa

CP queried where this sits with Care Together and CPar confirmed that this will form part of the

Outline Business Case at phase 4.

Members agreed for this to be taken forward to PIQ subject to GB ratification/agreement to

decisions made by members not in attendance.

NB: CPar left the meeting at 10.20am in order to attend a patient engagement event.

5. Communication and Engagement

- Communications and Engagement Structure

NL tabled a copy of the proposed structure for the Communications and Engagement team

and confirmed that CMT have accepted the proposed structure to better join up the internal

infrastructure to support communications and engagement.

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- Media update

Adam Shepphard provided members with an update on recent communications/media

activity to include:

Healthier Together

The last of the Healthier Together meetings had now taken place in Glossop.

Healthier Together had held a questions and answers time event which was attended by 25

people. The main concern was A&E shutting down and it was confirmed that no A&E will shut

down.

AS updated that although consultation has now ended, documentation can still be received

until the end of October.

NC noted that feedback from High Peak was the late planning and not being included in the

Greater Manchester consultation. There was also a question as to why this was pitched during

holiday season.

LS raised question as to why this was not a debate style and AS said that Healthier Together

stated that this did not generate a debate. PPIC agreed that this was a good point to make

with CP asking were Healthier Together asking for feedback. AS confirmed that there have not

been any specific questions asked to CCGs and feedback was fed in on an ad hoc weekly

basis during the consultation period.

It was further pointed out that there was no support for the public in completing the paperwork.

It was recognised that GM CCG can take learning from this consultation.

AGM

AS noted that the AGM took place a couple of weeks ago with staff receiving various

nominations and awards for care, compassion and competence. AS noted that this was a

good event and very different to how AGMs have run in the past.

111 Event

The Greater Manchester 111 public listening event took place. T&G CCG had been asked to

arrenge this at very short notice. There was a dozen people who attended and the feedback

was good overall.

There had been a formal complaint made to 111 regarding the lack of planning around the

timing of the event. AS agreed to clarify the detail of this complaint with Peter Denton for

accuracy.

Action: AS

Winter Campaign

ECN winter monies sign off this week.

NHS England campaign is now due to start in January so T&G CCG has come up with its own

for Oct mid November. Differ from our message to mitigate confusion.

Incorporate as many NHS England as possible.

AS took PPIC through a list of ideas on suggestions for materials used for the Winter Campaign

which included:

Leaflets and posters out

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V3

5

Direct communications to come out from GP Practices by electronic communication

with approximately 5% impact from each practice

Winter messages each week in reporter chronicle and both advertisers to people’s

homes

Production of a short animation - Richard Bircher has offered to write and perform a song

to support that animation to be displayed on facebook and screens within GP Practices.

AS updated that a business case will be written up later today and presented to the

Emergency Care Network (‘ECN’) on Friday.

NL noted that this will tie in with the Resilience Plan for winter planning/one off non recurrent

monies which will be discussed later on the agenda.

All agreed that there is a requirement to push on the updated website as a route for

communications about the winter campaign and other subsequent campaigns. AS agreed to

discuss this further with John Winter.

6. Care Together events update

NL noted that a series of workshop style events were happening to support patient/carer/public

engagement and inform the further development of Phase 1 and Phase 2 Outline Business

Cases for the Care Together Programme.

NL updated the progress of this as follows:

Following a process whereby competitive quotes were obtained, the CCG have entered

into an arrangement with CVAT (Ben Gilchrist)/High Peak CVS to set up and run these

events for the CCG

They are doing so at minimal cost (probably less than 3k)

The events are taking place in Glossop, Dukinfield and Hyde.

PPIC noted that further discussion was needed around the feedback from the event for

example the events not taking place in the evening meant this would have an impact on lack

of attendance and who could attend. Although it was recognised that this is a new approach

some evaluation will be necessary about whether it is the right approach. Some examples

would be consideration given to timings of the event, where the events are taking place i.e. not

just in town halls but parenting classes, soft play centres to capture different cohorts of people

like parents of babies and young children and in schools. NL noted that the CCG will be

strengthening links with Public Health and the Council to build on work already undertaken.

CP would welcome a round up lessons learned and feedback. NL agreed to provide further

feedback at the next meeting.

Action: NL

Important Note: Healthwatch Tameside are part of the CVAT family of organisations. This means

they have a mutual interest in each others’ activities. In order to retain the independence of

Healthwatch (which has a separate Board from the CVAT Board) the Care Together

engagement events were planned and led by CVAT core staff. Healthwatch staff did attend

the events purely as facilitators and have also been involved in the compilation & checking of

the draft report. It is important to note this as a potential conflict of interest in whatever

mechanism is used to record the ratification of the minutes.

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7. Communication and Engagement Strategy including Implementation Plan

NL noted that there had not been much change to the draft Communication and

Engagement Strategy presented to the last meeting. The recommendations within the strategy

have now moved to the implementation plan.

PPIC made the following comments/observations:

7.7 – would like to see creation of virtual member on that group

7.11 typo ‘pursing’

Page 8 - 7.2 on the second line one formal approved

Numbering needs sorting and the diagram on page 3 the bottom line is cut off

Under risks there is a specific risk around if this isn’t taken up and promoted by CCG

Board then it could failure to embrace with strategy.

Page 16 - removal of Martin’s title.

Page 14 - 9.14 – remove

NL to take questions and observations and feed back to Martin Carter.

Action: NL

8. CCG Membership engagement – report of findings

NL noted that item 9 of the minutes from the previous meeting provided Martin Carter with a

piece of work to write up his findings on GP engagement and proposals as to how to best

engage with GP Practices for example through locality leads and Practice Managers. This has

since been shared with Steve Allinson and Alan Dow for comments.

NL took PPIC through the presentation slides shared and it was noted that the presentation

captured some of the same key messages and issues that were noted during the last meeting

to include understanding workload of the Practice Managers and strengthening support,

recognition that GPs engaging in the business of the CCG remains a challenge. LS highlighted

at this point that one could state that there is a professional argument to GPs about a duty to

their patients to engage in CCG business.

NL agreed to capture the following views/comments and feedback from PPIC and feedback

to Martin.

Next Steps:

Discuss more widely (not wisely)

It is recognised that for some of the quick wins, Member Practices would need to meet

half way on some of the quick wins for example with a members section there was a

question around whether GPs would log in.

NL noted the importance of looking how the different localities function.

CP proposed that although not exclusive, making better use of the locality meetings

would be useful and having a process in place of understanding how engagement is

unique to each locality.

All agreed that the concept of bi annual conferences is a good one. They would also

request that we explore ideas of PPG representatives and locality meetings included.

1 to 1 visits to practices are a good idea but would need an agenda and a focus. NL

proposed that a member of the Nursing and Quality team be invited to the locality

meetings.

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CP noted that on slide 4 where it states to devolve responsibility is a bit ahead of itself as

we first need to cement the levels of engagement.

It was recognised that no GP was present it was agreed that NL would feedback any

comments/recommendations made where necessary to Martin Carter.

Action: NL

9. Patient Friendly Dashboard

LR introduced the first presentation of the Patient Friendly Delivery Dashboards. LR explained

that following feedback received earlier in the year commitment was made to publish

information on how we were performing.

Patients wanted simple, clear and concise information that showed how we were performing

against the service areas that mattered to them. In response LR developed patient friendly

delivery dashboards, designed to reflect what the public have said they want; to include

sufficient information to prompt patients and practices to know more about feel able to ask

more informed questions. The dashboards will be accessible through various websites and

designed to be printed off to be shared locally.

After some discussion, CP noted that the dashboards seems a simple solution and is satisfied

that it’s what patients want and require. PPIC are therefore happy for this to go to PIQ subject

to member’s approval/GB ratification.

10. Straight to test colonoscopy

RH took PPIC through the first presentation of the report on Straight to test colonoscopy.

Tameside FT in conjunction with the CCG has been undertaking a pilot for straight to test (STT)

colonoscopy. The proposed pilot including pathway has been used for QOF QP 6-8 indicators

in 2013/14.

The pilot has enabled eligible patients being referred directly for a colonoscopy rather than

attending a first out-patient appointment. This has expedited the patient pathway, reaching a

quicker diagnosis, often negating the need for a first out-patient and therefore freeing up

capacity in secondary care and it is proposed to roll the pathway out for routine patients.

RH explained that the data sets available review the period between March 2013 and February

2014 where a total of 172 eligible patients were referred via the STT pathway of which 11

decided not to have the test (patient choice). The key focus for the review was the impact on

waiting times and to see if there was any detrimental effect on conversion rates, the waiting

times were cut significantly and the conversion rates stayed the same.

RH therefore took PPIC some of the key findings.

PPIC agreed that the service does appear to have a positive impact on Average Waiting Times

and Patients’ experience.

PPIC agreed, on an informal basis, to this report being presented to PIQ subject to

ratification/approval from embers not in attendance.

40

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8

PPIC further commented that this was a good presentation from RH and CP added formal

thanks to all 3 commissioners for their presentations which were clear and precise in terms of

background and evidence of patient engagement from PPIC.

11. Any other business

- System Resilience

NL presented members with the first presentation of the System Resilience Plan submitted by

Elaine Richardson and explained that at this stage this was for information only.

The CCG is required to lead a process across the local health and social care economy to

develop a local Operation Resilience and Capacity Plan. The aim of the plan is ensure the

local health and social care economy can operate as effectively as possible in delivering year-

round services to patients.

NL explained that the CCG is required to set up a System Resilience Group; this is now

established with representatives from NHS T&G, THFT, TMBC, DCC, Stockport FT, Meridian,

Pennine Care, Go To Doc and NWA. The group has responsibility for the management of a non

recurrent central resilience allocation of £1,687,634.

The plan for that group is to build on successful work so far 2013/14. CP raised question of what

route we take to measure its effectiveness and all agreed that the KPIs already in place support

gathering evidence to each Business Case with the overarching impact on the different

markers discussed and monitored through the Emergency Care Network (’ECN’).

Healthwatch Derbyshire

CP updated PPIC that Healthwatch Derbyshire now had two new workers with their

responsibility for split areas across Derbyshire and it has been agreed that we will share papers

for this meeting with them and expect attendance at the next meeting in November. CB to

share contact names and email addresses with PPIC.

Action: CB

Patient experience update

Karen Sykes had provided chair with a brief update as follows:

The Customer Care team continue to receive patient experience feedback via direct verbal

contact complaints and PALs and patient opinion. The CAP group also continue to provide a

forum for gathering patient experience, a standing item on the CAP agenda is patient

experience story and this month they have received feedback from a Looked After Child about

her experience of health. The patient story will be presented to CAP at next week’s meeting.

Karen noted the development of patient experience from Looked After Children Update and

Karen intends to incorporate that valuable feedback and experience into the CCG reporting

mechanisms with the support of the Communications and Engagement Team. With Jean

Hurlston as the new Governing Body lay member strengthening links with young people and

children’s patient experience.

CP and NL noted that NHS England request people to take part in a survey on Primary Care

services. NL suggested that this be circulated to PPGs, PPIC and CAP via CB.

Action: CB

- Schedule of PPIC meeting dates 2015

Members noted the schedule of meeting dates for 2015 to note diaries accordingly.

Action: All

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12. Date and Time of next meeting – Wednesday 12th November 2014, 9.30am-11.30am,

Boardroom, New Century House

Meeting closed: 12.27pm

42


Title of Subject:

September final Quality Committee minutes

Date of paper: 24th September 2014

Prepared By: Celia Poole

History of paper: 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.

Executive Summary:

Key issues discussed:

GP Quality Improvement Lead update

Links with TFT

Discharge summaries

A proposal for the Quality Improvement Project was written and sent to TFT

on 11/7/14 after discussion at Clinical Congress. Process has now been

stalled as Naomi Ledwith was asked to hand it over to the TFT

Transformation Team and the lead for this team is not yet in post.

Meridian Quality report

More information is now included in the report on productivity and action

plan and progress is being tracked on that action plan.

Primary care Quality Improvement work

The Primary care web tool has been updated and there are now 4

practices with more than 6 outlying areas. Three of last year’s targeted

practices no longer appear on the list. The LIG is currently examining the

data and planning letters to practices. The LIG is planning a new set of

quality indicators for a local balanced scorecard to share at locality

meetings.


Quality Markers have been agreed and initial data collection shows that

locally we perform highly on data quality.

Professional Portal for concerns

GG noted that we are currently waiting for the CSU to send the service

specification and noted that this will be similar to the arrangements Bolton

have in place with a full time band 7 and the system used is likely to be

Datix as this is a system we are already familiar with.


Following on from the Care Home Communication workshop in May,

discussions have been taking place at locality meetings about moving

towards aligning care homes with GP practices for new registrations in

order to build up strong relationships between the teams. All localities have

shown some interest and the next step is to gather the number of

registrations by home and practice so that alignments can be decided.

Supporting Practice to use software that bolts-on to their medical systems

to improve the management of Long term conditions

JB is working with Sue Gilks from CSU to help practice to use the GRASP and

43

PINCER tools provided by PRIMIS that extract information from Practice

systems and give practice guidance of the management of their patients

with long-term conditions.

GP / Practice Educational Event

JB is working with Tom Dowling as GP Education lead in designing the

November Target event to celebrate good practice and help practices to

develop their knowledge and skills around Quality Improvement.

Safeguarding update (DoLs/Court of Protection)

Members discussed Deprivation of Safeguarding and where DoLs does not

apply then it goes to the Court of Protection.

The financial risk will be discussed further at Transition Board in terms of

pooled budgets. On receipt of further information out of Cheshire West

about the financial risk of 9/10 million pounds which included training of

best interest assessors for every person, it is thought that there is 40k set

aside for this and question was raised as to whether we have carried out

the financial risk exercise in a similar way to that of Cheshire West. It is

further thought that TMBC have 3 million pounds set aside for this and

discussion is required as to where this sits in Care Together.

Review of Breast Cancer Service – next steps

A paper has been presented to Trust UHSM, NHS England, NoE and to the

GM QSG where this issue was initially raised. Breast services have been

reviewed across GM and the Network presented a paper to AGG in July.

Informal updates have been received but no formal updates as yet. This

will be picked up at the interface and the contract and quality meeting.

Quarter 1 quality report

Members reviewed the Quarter 1 quality report. Work has been done with

SFT to support better reporting and noted that TFT are good at reporting.

Members discussed decision for the aim of having the report data

provided and members agreed that it was to gain assurance and to have

oversight of where the outliers are, and to monitor that appropriate key

actions are being dealt with.

CQUIN workshop

GG updated that a 15/16 CQUIN workshop is scheduled to take place on

24th November as an all day event to take place at New Century House

and invited members to attend if possible. GG will circulate further details

in due course.

Walkaround visits

GG urged members to sign up to carry out the scheduled announced and

unannounced visits as there are gaps in sign up for some of the scheduled

dates. GG agreed to have the schedule circulated to members for sign

up.

Recommendations

required of the

Governing Body

(for Discussion and

Decision)

To discuss and note the key issues discussed and agreed at the meeting on

24th September 2014.

QIPP principles

addressed by

Quality

44

proposal:

Direct questions to: Celia Poole

45

Final

1

NHS Tameside & Glossop

Quality Committee Minutes

Wednesday 24th September 2014 9.30am-12.30pm

Present:-

Celia Poole (CP)

Governing Body Lay Member, CCG (Chair)

Graham Curtis (GC)

Yvonne Pritchard (YP)

Jamie Douglas (JD)

Peter Denton (PD)

Joanna Bircher (JB)

Gill Gibson (GG)

Clare Parker (CPa)

Clare Watson (CW)

Governing Body Lay Member, CCG

Governing Body Lay Advisor, CCG

Governing Body GP Member, CCG

Healthwatch Manager, Tameside Healthwatch

GP/Clinical Quality Improvement Lead, CCG

Deputy Director of Nursing and Quality, CCG

Governing Body Nurse, CCG

Director of Transformation, CCG

In Attendance:-

Clare Bromley (CB) PA, Executive Secretariat, CCG (note taker)

1. Chair’s Welcome, Introduction and Apologies

The Chair introduced and welcomed everyone to the meeting. Apologies were received

from:-

Nikki Leach Director of Nursing and Quality, CCG

Gideon Smith Public Health Consultant, TMBC

Saif Ahmed Locality Clinical Lead, CCG

2. Declarations of interest

There were no declarations of interest to report.

3. Minutes of previous meeting: 27th August 2014

The minutes of the previous meeting were agreed as an accurate record.

Members carried out a review of actions carried out since the last meeting as follows:

4. Matters arising not otherwise on the agenda

Arriva

PD updated that he was still awaiting feedback following the research/survey undertaken by

Arriva. He has a meeting scheduled with Arriva the following day and will contact GG after

that meeting to discuss and agreed to provide Quality Committee with a more detailed

update at the next meeting.

Action: PD

Patient Portal

JB noted that a paper was not previously presented by Heather Palmer to PPIC about the

portal. JB further noted that interest to use this portal was highlighted at a recent locality

meeting.

46

Final

2

Meridian walkarounds

CP agreed to email Saif Ahmed to request an update on the walkarounds.

Action: CP

GC noted that the constitution document can be amended twice a year and is next due to

happen in November. It was also agreed that a wider discussion is needed on CCG

governance around PPIC and QC. CP suggested the Board Development as an opportunity

for discussion on this and agreed to make this proposal.

Action: CP

5. Standing items

GP Quality Improvement Lead update

Links with TFT

Discharge summaries

A proposal for the Quality Improvement Project was written and sent to TFT on 11/7/14 after

discussion at Clinical Congress. Process has now been stalled as Naomi Ledwith was asked to

hand it over to the TFT Transformation Team and the lead for this team is not yet in post.

TFT are currently closing the loop on the lessons learned divisions and the contact for this has

since been assigned to Angela Brearley. JB has sent a proposal which was well received.

Edna Cahill and Naomi Ledwith were looking into patient safety and it was noted that a letter

from GG and Nikki Leach on interim arrangements should be sent to Peter Weller on behalf of

Quality Committee.

Action: GG

Meridian Quality report

GG noted that more information was now included in the report on productivity and action

plan and progress is being tracked on that action plan.

Primary care Quality Improvement work

The Primary care web tool has been updated and we have 4 practices with more than 6 out-

lying areas. Two of these practices were part of last year’s targeted practices and two are

new to the list. Three of last year’s targeted practices no longer appear on the list.

The LIG is currently examining the data and planning letters to practices. The LIG is planning a

new set of quality indicators for a local balanced scorecard to share at locality meetings.


Quality Markers have been agreed and initial data collection shows that locally we perform

highly on data quality. Practices will be receiving individualised reports in the next 6-8 weeks

and JB will report a summary to Quality Committee.

Action: JB

Professional Portal for concerns

GG noted that we are currently waiting for the CSU to send the service specification and

noted that this will be similar to the arrangements Bolton have in place with a full time band 7

and the system used is likely to be Datix as this is a system we are already familiar with.

GG agreed to chase the CSU on progress for this and keep JB updated.

Action: GG

47

Final

3


Following on from the Care Home Communication workshop in May, discussions have been

taking place at locality meetings about moving towards aligning care homes with GP prac-

tices for new registrations in order to build up strong relationships between the teams. All lo-

calities have shown some interest and the next step is to gather the number of registrations by

home and practice so that alignments can be decided.

Supporting Practice to use software that bolts-on to their medical systems to improve the

management of Long term conditions

JB is working with Sue Gilks from CSU to help practice to use the GRASP and PINCER tools pro-

vided by PRIMIS that extract information from Practice systems and give practice guidance

of the management of their patients with long-term conditions. This piece of work is in the

very early stages and the tools are being promoted by NHSIQ. JB agreed to report further on

this at the next meeting in October.

Action: JB

GP / Practice Educational Event

JB is working with Tom Dowling as GP Education lead in designing the November Target

event to celebrate good practice and help practices to develop their knowledge and skills

around Quality Improvement.

Safeguarding update (DoLs/Court of Protection)

Received: Safeguarding Update for Quality Committee, August 2014

Quality Committee received the above update prepared by GG and noted its content.

Discussion took place about Deprivation of Safeguarding and where DoLs does not apply

then it goes to the Court of Protection.

Members recognized that this is a risk and it was agreed this should be put onto our risk

register as an interim measure and GG agreed to check with TMBC and Derbyshire.

The financial risk will be discussed further at Transition Board in terms of pooled budgets. On

receipt of further information out of Cheshire West about the financial risk of 9/10 million

pounds which included training of best interest assessors for every person, it is thought that

there is 40k set aside for this and question was raised as to whether we have carried out the

financial risk exercise in a similar way to that of Cheshire West. It is further thought that TMBC

have 3 million pounds set aside for this and discussion is required as to where this sits in Care

Together.

GG will investigate this and discuss further with Andrew Holt for TMBC and Derbyshire for

Glossop and to David Walsh with regards to T&G CCG.

Action: GG

6. Review of Breast Cancer Service – next steps

CW updated that a paper has since gone to Trust UHSM, NHS England, NoE and to the GM

QSG where this issue was initially raised.

48

Final

4

As lead commissioner for cancer, Trafford have now set up a review board and CW has

liaised with Gina Lawrence on how we can support that and is awaiting a response.

Breast services have been reviewed across GM and the Network presented a paper to AGG

in July. Informal updates have been received but no formal updates as yet. This will be

picked up at the interface and the contract and quality meeting.

CW agreed to formally chase this on behalf of Quality Committee and update further at the

next meeting in October.

Action: CW

7. Health Inequalities

This report was deferred to the October agenda in Gideon Smith’s absence. CB to note

forward planner for October.

Action: CB

8. Quarter 1 quality report

GG tabled the Quarter 1 quality report.

GG highlighted that work has been done with SFT to support better reporting and noted that

TFT are good at reporting.

CW noted that the provider is Meridian and the report does not show Pennine Care as lead

commissioner. CW noted that CSU do not include Pennine Care when reporting and would

therefore formally request this on behalf of Quality Committee.

Action: CW

PD queried Page 6 of the report on the figures on HCAI E Coli 37 and 6 as incorrect. PD

further highlighted that the report does not reflect what the figures shown means to patients.

CP raised the discussion for members to decide the aim of having the report data provided

and members agreed that it was to gain assurance and to have oversight of where the

outliers are, and to monitor that appropriate key actions are being dealt with.

GG agreed to feedback to CSU to include executive summary of the report in time for the

next meeting in October and the report would then be presented on a quarterly basis.

Action: GG

9. Review of Quality Committee’s Terms of Reference

Members reviewed the Terms of Reference and discussed the membership.

Membership was agreed as follows:

CCG Lay Member (Chair)

One or more additional Lay Member/Advisor

CCG Governing Body GP

Clinical Quality Improvement Lead for Primary Care

CCG Governing Body Nurse (Deputy Chair)

CCG Director of Nursing and Quality

Healthwatch representative

49

Final

5

CCG Quality Manager

CCG Designated Nurse Safeguarding

Locality GP

Director of Transformation

GC noted the two new Lay Advisors are Lesley Surman and Jean Hurlston and discussion is

required to see how they would fit into the membership in future. Members also felt that a

discussion was required around how many GPs attend Quality Committee and whether the

locality lead was required at all meetings. CP requested that this be discussed outside of this

meeting and GC agreed to raise this with CMT.

CB to make the agreed changes to membership and submit the ToR to IGAR.

Action: CB

JB agreed to submit the revised ToR for LIG at the next Quality Committee meeting in

October.

Action: JB

10. Any other business

CQUIN workshop

GG updated that a 15/16 CQUIN workshop is scheduled to take place on 24th November as

an all day event to take place at New Century House and invited members to attend if

possible. GG will circulate further details in due course.

Action: GG

Walkaround visits

GG urged members to sign up to carry out the scheduled announced and unannounced

visits as there are gaps in sign up for some of the scheduled dates. GG agreed to have the

schedule circulated to members for sign up.

Action: GG

12. Date and time of next meeting: Wednesday 22nd October 2014 9.30am-12.30pm,

Boardroom, New Century House

Meeting closed: 11.05am

50


Title of Subject:

NHS England Core Standards for

Emergency Preparedness, Resilience and

Response (EPRR)

2014-15 Assurance Process

Date of paper:

29th October 2014

Prepared By:

Brian Dillon / Nikki Leach

History of paper:

First presentation

Executive Summary: This paper describes the outcome of Tameside

and Glossop CCG’s self-assessment against the

relevant Core Standards and is accompanied by

the CCG’s statement of compliance and EPRR

Core Standards improvement plan.

Of the 20 EPRR Core Standards within scope of

the GM LHRP assurance process, there were 15

standards applicable to CCGs.

For Tameside and Glossop CCG, the breakdown

of the self-assessment was as follows:

Number of Core Standards assessed as

‘green’: 15


‘amber’: 0


‘red’: 0

The attached Statement of Compliance has

been signed by Nikki Leach Director of Nursing &

Quality (T&G CCG Accountable Emergency

Officer) as a declaration of this position.

51



(for Discussion and

Decision)

Governing Body is requested to receive self

assessment and confirm 2014/15 EPRR

compliance

QIPP principles addressed

by proposal:


Nikki Leach

52

NHS England Core Standards for Emergency Preparedness, Resilience and Response (EPRR) 2014-15 Assurance Process – Paper for Governing Body 1. Introduction In their letter of 12 August 2014, Mike Burrows and Kate Adern, as Co-Chairs of Greater Manchester (GM) Local Health Resilience Partnership (LHRP), wrote to Accountable Emergency Officers (AEOs) of GM NHS organisations to set out LHRP requirements for the assurance process against the 2014-15 NHS Core Standards for EPRR. The LHRP requested NHS organisations to:

1. Undertake a self-assessment against the relevant core standards identifying the level of compliance for each standard (red, amber, green)

2. Review their EPRR action plan developed from the 2013-14 assurance process and include further actions required from this year’s self-assessment within a revised EPRR Core Standards improvement plan

3. Complete a statement of compliance identifying the organisation’s overall level of compliance (full, substantial, partial, non-compliant)

4. Present the statement of compliance and improvement plan to the appropriate governing body

In addition, NHS provider organisations were requested to inform their relevant commissioning organisation(s) as to the outcome of their self-assessment. Using the information from providers alongside their own self-assessment results, CCG AEOs are asked to email a health economy update to GM LHRP by 21 November 2014. This paper describes the outcome of Tameside and Glossop CCG’s self-assessment against the relevant Core Standards and is accompanied by the CCG’s statement of compliance and EPRR Core Standards improvement plan. 2. CCG Assurance for GM LHRP Self-assessment of the CCG’s compliance against the EPRR Core Standards was undertaken by the North West Commissioning Support Unit (NWCSU) Resilience Team. The outcome of the self-assessment was shared with the AEO for Tameside and Glossop CCG, Nikki Leach, who reviewed the findings in order to determine the CCG’s overall level of compliance. Of the 20 EPRR Core Standards within scope of the GM LHRP assurance process, there were 15 standards applicable to CCGs.

53

For Tameside and Glossop CCG, the breakdown of the self-assessment was as follows:

Number of Core Standards assessed as ‘green’: 15 Number of Core Standards assessed as ‘amber’: 0 Number of Core Standards assessed as ‘red’: 0

3. Statement of compliance and improvement plan In light of the outcome of Tameside and Glossop CCG’s self-assessment, the CGG position for the 2014-15 EPRR Core Standards is one of full compliance. The attached Statement of Compliance has been signed by the CCG AEO as a declaration of this position.

54

Greater Manchester Emergency Preparedness, Resilience and

Response (EPRR) assurance 2014-15

STATEMENT OF COMPLIANCE

Tameside and Glossop CCG has undertaken a self-assessment against required areas of the NHS England Core Standards for EPRR v2.0

Following assessment, the organisation has been self-assessed as demonstrating the Full compliance level (from the four options in the table below) against the core standards.

Compliance Level Evaluation and Testing Conclusion

Full The plans and work programme in place appropriately address the entire core standards that the organisation is expected to achieve.

Substantial The plans and work programme in place do not appropriately address one or more the core standard themes, resulting in the organisation being exposed to unnecessary risk.

Partial The plans and work programme in place do not adequately address multiple core standard themes; resulting in the organisational exposure to a high level of risk.

Non-compliant The plans and work programme in place do not appropriately address several core standard themes leaving the organisation open to significant error in response and /or an unacceptably high level of risk.

Where areas require further action, this is detailed in the attached core standards improvement plan and will be reviewed in line with the Organisation’s EPRR governance arrangements. On this occasion there will be no requirement for an improvement plan.

I confirm that the above level of compliance with the core standards has been or will be confirmed to the organisation’s board / governing body.

__________________ _________________

Signed by the organisation’s Accountable Emergency Officer

5th November 2014 29th October 2014 Date of board / governing body meeting Date signed

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NHS Core Standards V2.0 West Yorkshire LHRP Assurance 2014-15 Introduction

NHS England Core Standards for Emergency preparedness, resilience and responsev2.0

Key:

Cells with a grey background relate to standards that are unchanged or

similar to last year's. Assessment against these standards is not required

in 2014/15

Cells with a white background relate to standards that are new or

substantially changed this year. Organisations should assess against

these standards if there is a 'Y' in the column for their organisation type

The attached EPRR Core Standards spreadsheet has 3 tabs: EPRR Core Standards tab - with core standards nos 1 - 37. HAZMAT/ CBRN core standards tab: with core standards 38- 51. Please note this is designed as a stand alone tab. HAZMAT/ CBRN equipment checklist: designed to support acute and ambulance service providers in core standard 43.

Amended by the West Yorkshire EPRR team by comparing the v2.0 core standards with the 2013-14 core standards. The results of this comparison are shown in the extra column (Column P on the main tab, J on the CBRN core standards tab. NHS Commissioning organisations need complete only the main 'EPRR Core Standards' tab. Providers of NHS-funded services should complete both the main tab and additionally the CBRN core standards tab. Acute and Ambulance Trusts should also complete the Hazmat CBRN Equipment Checklist tab. Organisations in GMshould self-assess against only the core standards on a white (not grey) background that include a 'Y' in the column for their organisation type.

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Core standard Clarifying information

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Evidence of assuranceIs this standard to be included in WY 2014/15 assurance

Self assessment RAG

Red = Not compliant with core standard and not in the EPRR work plan within the next 12 months.

Amber = Not compliant but evidence of progress and in the EPRR work plan for the next 12 months.

Green = fully compliant with core standard.

Governance

1 Organisations have a director level accountable emergency officer who is responsible for EPRR (including business continuity management) Y No - Old core standard

1

2

Organisations have an annual work programme to mitigate against identified risks and incorporate the lessons identified relating to EPRR (including details of training and exercises and past incidents) and improve response.

Lessons identified from your organisation and other partner organisations. NHS organisations and providers of NHS funded care treat EPRR (including business continuity) as a systematic and continuous process and have procedures and processes in place for updating and maintaining plans to ensure that they reflect: - the undertaking of risk assessments and any changes in that risk assessment(s)- lessons identified from exercises, emergencies and business continuity incidents- restructuring and changes in the organisations- changes in key personnel- changes in guidance and policy

Y

No - Old core standard 4.1

3

Organisations have an overarching framework or policy which sets out expectations of emergency preparedness, resilience and response.

Arrangements are put in place for emergency preparedness, resilience and response which: • Have a change control process and version control

• Take account of changing business objectives and processes

• Take account of any changes in the organisations functions and/ or organisational and structural and staff changes

• Take account of change in key suppliers and contractual arrangements

• Take account of any updates to risk assessment(s)

• Have a review schedule

• Use consistent unambiguous terminology,

• Identify who is responsible for making sure the policies and arrangements are updated, distributed and regularly tested;

• Key staff must know where to find policies and plans on the intranet or shared drive.

• Have an expectation that a lessons identified report should be produced following exercises, emergencies and /or business continuity

incidents and share for each exercise or incident and a corrective action plan put in place. • Include references to other sources of information and supporting documentation

Yes

Yes - New core standard

3. Achieved by the IRP in each CCG. Clarifies CCG approach /policy to EPRR. There is a Business Continuity Plan in place which intergrates fully across the organisation. Training and rescoucing for all staff is fully supported. The IRP is reviewed at regular intervals to account for changes wityhin the CCG and is further informed by the HERG. IRPs are accessible via Safe4 , accounts held by all On Call staff. The IRP is supported by a range of supplementary guides and plans to provide a fully integrated incident response capability.

4

The accountable emergency officer will ensure that the Board and/or Governing Body will receive as appropriate reports, no less frequently than annually, regarding EPRR, including reports on exercises undertaken by the organisation, significant incidents, and that adequate resources are made available to enable the organisation to meet the requirements of these core standards.

After every significant incident a report should go to the Board/ Governing Body (or appropriate delegated governing group) .Must include information about the organisation's position in relation to the NHS England EPRR core standards self assessment. Yes


4. Via regular meeting with AEO, HERG Updates and EPRR Breifing sheets monthly. This organisation fully supports EPRR and BCM processes. The AEO can report issues to Governing Body as required.

Duty to assess risk

5 Assess the risk, no less frequently than annually, of emergencies or business continuity incidents occurringwhich affect or may affect the ability of the organisation to deliver it's functions. Y No - Old core standards

4.2 & 7.13

6There is a process to ensure that the risk assessment(s) is in line with the organisational, Local HealthResilience Partnership, other relevant parties, community (Local Resilience Forum/ Borough Resilience Forum),and national risk registers.

YNo - Old core standard 4.2

7 There is a process to ensure that the risk assessment(s) is informed by, and consulted and shared with yourorganisation and relevant partners.

Other relevant parties could include COMAH site partners, PHE etc. Yes Yes - New core standard

7. Yes via HERGs and Standing item to identify risk and informGM LRF process.

Duty to maintain plans – emergency plans and business continuity plans

Incidents and emergencies (Incident Response Plan (IRP) (Major Incident Plan)) Yes 8. All covered by IRP with supplemenatry guides and GM level plans

corporate and service level Business Continuity (aligned to current nationally recognised BC standards) Yes BCP complete and in final version control HAZMAT/ CBRN - see separate checklist on tab overleafSevere Weather (heatwave, flooding, snow and cold weather) Yes This threat is covered by local Supplementary Guides and Plans

Pandemic Influenza Yes The GM Pandemic Influenza Plan is in place and will be used by the CCG.

Mass Countermeasures (eg mass prophylaxis, or mass vaccination)Mass CasualtiesFuel Disruption

YesFuel disruption realises consequences around BCM and are managed using IRP genric management processes supported by BCP.

Surge and Escalation Management (inc. links to appropriate clinical networks e.g. Burns, Trauma and Critical Care)

Yes

Surge and escalation is primarily a 'System Resilience' issue. However, the CCG IRP has capacity to respond to issues that escalate to 'significant ' incident to addess this threat.

Infectious Disease OutbreakYes

Outbreak - LA lead. However, this is managed from the GM Generic Outbreak Plan and CCG IRP systems have capacity to manage issues around this threat.

Evacuation Yes Evacuaion at both internal and external situations are respectively managed via the BCP or IRP.

LockdownUtilities, IT and Telecommunications Failure Yes These are BCP issues and managed via the BCM plan. Excess Deaths/ Mass Fatalitieshaving a Hazardous Area Response Team (HART) (in line with the current national service specification, including a vehicles and equipment replacement programme) firearms incidents in line with National Joint Operating Procedures;

9

Ensure that plans are prepared in line with current guidance and good practice which includes: • Aim of the plan, including links with plans of other responders

• Information about the specific hazard or contingency or site for which the plan has been prepared and realistic assumptions

• Trigger for activation of the plan, including alert and standby procedures

• Activation procedures

• Identification, roles and actions (including action cards) of incident response team

• Identification, roles and actions (including action cards) of support staff including communications

• Location of incident co-ordination centre (ICC) from which emergency or business continuity incident will be managed

• Generic roles of all parts of the organisation in relation to responding to emergencies or business continuity incidents

• Complementary generic arrangements of other responders (including acknowledgement of multi-agency working)

• Stand-down procedures, including debriefing and the process of recovery and returning to (new) normal processes

• Contact details of key personnel and relevant partner agencies

• Plan maintenance procedures

(Based on Cabinet Office publication Emergency Preparedness, Emergency Planning, Annexes 5B and 5C (2006))

Yes

• Being able to provide documentary evidence that plans are regularly monitored, reviewed and

systematically updated, based on sound assumptions:• Being able to provide evidence of an approval process for EPRR plans and documents

• Asking peers to review and comment on your plans via consultation

• Using identified good practice examples to develop emergency plans

• Adopting plans which are flexible, allowing for the unexpected and can be scaled up or down

• Version control and change process controls

• List of contributors

• References and list of sources

• Explain how to support patients, staff and relatives before, during and after an incident (including

counselling and mental health services).

Yes - based on old core standard 5 but with substantial changes.

9. CCG IRP has robust updating and review processes. Each plan contains all areas listed in 'evidence' opposite. Plans are peer reviewed via HERGs. The IRP is updated in line with guidance locally from NHS Greater Manchester Area Team and national NHS guidance. The IRP is a flexible management framework capable to incremental escalation in response to any adverse event. This plan is supported by a comprehensive 'Contact Directory' of key emergency contacts. Plans comply with cabinet Office Emergency Preparedness and Emergency Planning.

10

Arrangements include a procedure for determining whether an emergency or business continuity incident has occurred. And if an emergency or business continuity incident has occurred, whether this requires changing the deployment of resources or acquiring additional resources.

Enable an identified person to determine whether an emergency has occurred- Specify the procedure that person should adopt in making the decision- Specify who should be consulted before making the decision- Specify who should be informed once the decision has been made (including clinical staff)

Y

• Oncall Standards and expectations are set out• Include 24-hour arrangements for alerting managers and other key staff.

No - Old core standards 5.28 & 5.30

11

Arrangements include how to continue your organisation’s prioritised activities (critical activities) in the event of

an emergency or business continuity incident insofar as is practical. Decide: - Which activities and functions are critical- What is an acceptable level of service in the event of different types of emergency for all your services- Identifying in your risk assessments in what way emergencies and business continuity incidents threaten the performance of your organisation’s functions, especially critical activities

Y


12 Arrangements explain how VIP and/or high profile patients will be managed. This refers to both clinical (including HAZMAT incidents) management and media / communications management of VIPs and / or high profile management


13Preparedness is undertaken with the full engagement and co-operation of interested parties and key stakeholders (internal and external) who have a role in the plan and securing agreement to its content Y

• Specifiy who has been consulted on the relevant documents/ plans etc. No - Old core standard 5.17

14 Arrangements include a debrief process so as to identify learning and inform future arrangements Explain the de-briefing process (hot, local and multi-agency, cold)at the end of an incident. Y No - Old core standard 5.49

Command and Control (C2)

15

Arrangements demonstrate that there is a resilient single point of contact within the organisation, capable of receiving notification at all times of an emergency or business continuity incident; and with an ability to respond or escalate this notification to strategic and/or executive level, as necessary.

Organisation to have a 24/7 on call rota in place with access to strategic and/or executive level personnel

Y

Explain how the emergency on-call rota will be set up and managed over the short and longer term. No - Old core standard 5.31

16Those on-call must meet identified competencies and key knowledge and skills for staff. NHS England publised competencies are based upon National Occupation Standards .

YTraining is delivered at the level for which the individual is expected to operate (ie operational/ bronze, tactical/ silver and strategic/gold). for example strategic/gold level leadership is delivered via the 'Strategic Leadership in a Crisis' course and other similar courses.


8

Effective arrangements are in place to respond to the risks the organisation is exposed to, appropriate to the role, size and scope of the organisation, and there is a process to ensure the likely extent to which particular types of emergencies will place demands on your resources and capacity.

Have arrangements for (but not necessarily have a separate plan for) some or all of the following (organisation dependent) (NB, this list is not exhaustive):

Relevant plans:• demonstrate appropriate and sufficient equipment (inc. vehicles if relevant) to deliver the required responses• identify locations which patients can be transferred to if there is an incident that requires an evacuation;

• outline how, when required (for mental health services), Ministry of Justice approval will be gained for an

evacuation; • take into account how vulnerable adults and children can be managed to avoid admissions, and include appropriate focus on providing healthcare to displaced populations in rest centres;• include arrangements to co-ordinate and provide mental health support to patients and relatives, in collaboration with Social Care if necessary, during and after an incident as required;• make sure the mental health needs of patients involved in a significant incident or emergency are met and that they are discharged home with suitable support• ensure that the needs of self-presenters from a hazardous materials or chemical, biological, nuclear or

radiation incident are met.• for each of the types of emergency listed evidence can be either within existing response plans or as

stand alone arrangements, as appropriate.

Yes - based on old core standard 5 but with substantial changes.

• Ensuring accountaable emergency officer's commitment to the plans and giving a member of the executive management board and/or governing body overall responsibility for the Emergeny Preparedness Resilience and Response, and Business Continuity Management agendas• Having a documented process for capturing and taking forward the lessons identified from exercises and emergencies, including who is responsible.• Appointing an emergency preparedness, resilience and response (EPRR) professional(s) who can

demonstrate an understanding of EPRR principles.• Appointing a business continuity management (BCM) professional(s) who can demonstrate an understanding of BCM principles.• Being able to provide evidence of a documented and agreed corporate policy or framework for building resilience across the organisation so that EPRR and Business continuity issues are mainstreamed in processes, strategies and action plans across the organisation. • That there is an approporiate budget and staff resources in place to enable the organisation to meet the requirements of these core standards. This budget and resource should be proportionate to the size and scope of the organisation.

Risk assessments should take into account community risk registers and at the very least include reasonable worst-case scenarios for:• severe weather (including snow, heatwave, prolonged periods of cold weather and flooding);

• staff absence (including industrial action);

• the working environment, buildings and equipment (including denial of access);

• fuel shortages;

• Being able to provide documentary evidence of a regular process for monitoring, reviewing and updating

and approving risk assessments• Version control

• Consulting widely with relevant internal and external stakeholders during risk evaluation and analysis

stages• Assurances from suppliers which could include, statements of commitment to BC, accreditation,

business continuity plans.

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Self assessment RAG




17

Documents identify where and how the emergency or business continuity incident will be managed from, ie the Incident Co-ordination Centre (ICC), how the ICC will operate (including information management) and the key roles required within it, including the role of the loggist .

This should be proportionate to the size and scope of the organisation.

Y

Arrangements detail operating procedures to help manage the ICC (for example, set-up, contact lists etc.), contact details for all key stakeholders and flexible IT and staff arrangements so that they can operate more than one control/co0ordination centre and manage any events required.


18 Arrangements ensure that decisions are recorded and meetings are minuted during an emergency or business continuity incident. Y No - Old core standard

5.36

19Arrangements detail the process for completing, authorising and submitting situation reports (SITREPs) and/or commonly recognised information pictures (CRIP) / common operating picture (COP) during the emergency or business continuity incident response.

YNo - Old core standard 5.40

20 Arrangements to have access to 24-hour specialist adviser available for incidents involving firearms or chemical, biological, radiological, nuclear, explosive or hazardous materials, and support strategic/gold and tactical/silver command in managing these events.

Both acute and ambulance providers are expected to have in place arrangements for accessing specialist advice in the event of incidents chemical, biological, radiological, nuclear, explosive or hazardous materials

Yes - for acutes only (for YAS this is old core standard 9.8)

21 Arrangements to have access to 24-hour radiation protection supervisor available in line with local and national mutual aid arrangements;

Both acute and ambulance providers are expected to have arrangements in place for accessing specialist advice in the event of a radiation incident

Yes - for acutes only (for YAS this is old core standard 9.9)

Duty to communicate with the public

22 Arrangements demonstrate warning and informing processes for emergencies and business continuity incidents. Arrangements include a process to inform and advise the public by providing relevant timely information about the nature of the unfolding event and about: - Any immediate actions to be taken by responders- Actions the public can take- How further information can be obtained- The end of an emergency and the return to normal arrangementsCommunications arrangements/ protocols: - have regard to managing the media (including both on and off site implications)- include the process of communication with internal staff - consider what should be published on intranet/internet sites- have regard for the warning and informing arrangements of other Category 1 and 2 responders and other organisations.

Yes

• Have emergency communications response arrangements in place • Be able to demonstrate that you have considered which target audience you are aiming at or addressing in publishing materials (including staff, public and other agencies)• Communicating with the public to encourage and empower the community to help themselves in an emergency in a way which compliments the response of responders• Using lessons identified from previous information campaigns to inform the development of future campaigns• Setting up protocols with the media for warning and informing• Having an agreed media strategy which identifies and trains key staff in dealing with the media including nominating spokespeople and 'talking heads'.• Having a systematic process for tracking information flows and logging information requests and being able to deal with multiple requests for information as part of normal business processes.• Being able to demonstrate that publication of plans and assessments is part of a joined-up communications strategy and part of your organisation's warning and informing work.

Yes - based on old core standards 7.17 & 7.18 but with substantial changes.

22. For the CCG - Local media comms leads supported by 'CCG media guide in an emergency'. Additional comms via PHE and Local Authotrity. Joined up partner consulatation and liasion is achived via the HERGs. CCG has enhanced ICC procedures with all staff trained in this area.

23 Arrangements ensure the ability to communicate internally and externally during communication equipment failures Yes • Have arrangements in place for resilient communications, as far as reasonably practicable, based on

risk.Yes - New core standard

23. As above and via processes in BCPs. All staff have access to mobile networks.

Information Sharing – mandatory requirements

24

Arrangements contain information sharing protocols to ensure appropriate communication with partners. These must take into account and inclue DH (2007) Data Protection and Sharing – Guidance for Emergency Planners and Responders or any

guidance which supercedes this, the FOI Act 2000, the Data Protection Act 1998 and the CCA 2004 ‘duty to communicate with the public’, or

subsequent / additional legislation and/or guidance. Yes

• Where possible channelling formal information requests through as small as possible a number of knownroutes. • Sharing information via the Local Resilience Forum(s) / Borough Resilience Forum(s) and other groups.• Collectively developing an information sharing protocol with the Local Resilience Forum(s) / BoroughResilience Forum(s). • Social networking tools may be of use here.

Yes - Builds upon old standard 5.40

24. Via HERGs and CCG tactical coordination processes. LHRP is a standing item on quarterly HERGs. Information sharing is well developed in this CCG. Information governance , FOI and data protection issues are monitored by both CCG and NWCSU in communications protocols.

Co-operation

25 Organisations actively participate in or are represented at the Local Resilience Forum (or Borough Resilience Forum in London if appropriate) Y No - Old core standard

3.2

26 Demonstrate active engagement and co-operation with other category 1 and 2 responders in accordance with the CCA Yes Yes - New core

standard26. Via the HERGs - well developed

27 Arrangements include how mutual aid agreements will be requested, co-ordinated and maintained. NB: mutual aid agreements are wider than staff and should include equipment, services and supplies. Y No - Old core standard 5.34

28 Arrangements outline the procedure for responding to incidents which affect two or more Local Health Resilience Partnership (LHRP) areas or Local Resilience Forum (LRF) areas.


29 Arrangements outline the procedure for responding to incidents which affect two or more regions. Yes - New core standard

30

Arrangements demonstrate how organisations support NHS England locally in discharging its EPRR functions and duties

Examples include completing of SITREPs, cascading of information, supporting mutual aid discussions, prioritising activities and/or services etc. Yes


30. Via the HERG and LHRP - cross meetings with Health Protection and some borough resilience forums. This is achived primarily via the HERG and embedded in IRP and BCP.

31 Plans define how links will be made between NHS England, the Department of Health and PHE. Including how information relating to national emergencies will be co-ordinated and shared


32 Arrangements are in place to ensure an Local Health Resilience Partnership (LHRP) (and/or Patch LHRP for the London region) meets at least once every 6 months


33

Arrangements are in place to ensure attendance at all Local Health Resilience Partnership meetings at a director level Yes

Yes - builds upon old standard 3.1

33. This is achived by CCG represenation at LHRP and working with HERGs. There is also a HERG chairs meeting to ensure clear lines of expectation and two way communication are achieved.

• Attendance at or receipt of minutes from relevant Local Resilience Forum(s) / Borough Resilience

Forum(s) meetings, that meetings take place and memebership is quorat.• Treating the Local Resilience Forum(s) / Borough Resilience Forum(s) and the Local Health Resilience

Partnership as strategic level groups• Taking lessons learned from all resilience activities• Using the Local Resilience Forum(s) / Borough Resilience Forum(s) and the Local Health Resilience

Partnership to consider policy initiatives• Establish mutual aid agreements

• Identifying useful lessons from your own practice and those learned from collaboration with other responders and strategic thinking and using the Local Resilience Forum(s) / Borough Resilience Forum(s) and the Local Health Resilience Partnership to share them with colleagues• Having a list of contacts among both Cat. 1 and Cat 2. responders with in the Local Resilience Forum(s) / Borough Resilience Forum(s) area

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Training And Exercising

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Arrangements include a training plan with a training needs analysis and ongoing training of staff required to deliver the response to emergencies and business continuity incidents

• Staff are clear about their roles in a plan

• Training is linked to the National Occupational Standards and is relevant and proportionate to the organisation type. • Training is linked to Joint Emergency Response Interoperability Programme (JESIP) where appropriate

• Arrangements demonstrate the provision to train an appropriate number of staff and anyone else for whom training would be appropriate for the purpose of ensuring that the plan(s) is effective• Arrangements include providing training to an appropriate number of staff to ensure that warning and informing arrangements are effective

Yes

Yes - Builds upon old core standard 5.24

34. There is a training database noting those trained, what training has been delivered and refresher dates. Minimum standards for this CCG on call commanders require initial IRP and ICC training to achieve their role within the plans. All training complies with NOS and JESIP. In this CCG ALL staff are trained who carry out response on-call duties. This CCG has undergone and complete an incident managemnt training programme.

35

Arrangements include an ongoing exercising programme that includes an exercising needs analysis and informs future work.

• Exercises consider the need to validate plans and capabilities

• Arrangements must identify exercises which are relevant to local risks and meet the needs of the organisation type and of other interested

parties.• Arrangements are in line with NHS England requirements which include a six-monthly communications test, annual table-top exercise and live exercise at least once every three years.• If possible, these exercises should involve relevant interested parties. • Lessons identified must be acted on as part of continuous improvement.• Arrangements include provision for carrying out exercises for the purpose of ensuring warning and informing arrangements are effective

Yes

Yes - builds upon old core standard 5.25

35. CCG specific training is carried out. Most recently Exercise Mallard ( Multi-agency) 3 September 2014. This was for CCG on call response directors and managers. Exercise content / objectives are configured in collaboration with AEO to meet needs of local staff. All lessons, via de-brief reports appaer and are fed into IRP / ICC procedures. Short exercises are planned for future ICC training based upon recent TNA with CCG.

36Demonstrate organisation wide (including oncall personnel) appropriate participation in multi-agency exercises

YesYes - New core standard

36. Locally sourced staff from CCG particiapte in multi-agency exercises. e.g. local COMAH, Barnes Wallis, Brick Wall.

37

Preparedness ensures all incident commanders (oncall directors and managers) maintain a continuous personal development portfolio demonstrating training and/or incident /exercise participation.

Yes


37. A database is maintained for the CCG showing all EPRR training carried out by all individuals, directors and senior managers to maintain personal develpment, updating and refreshing. This database also includes what exercises they have attended.

30 October 2014 16:43 Compliance Level for EPRR Assurance: Full

• Taking lessons from all resilience activities and using the Local Resilience Forum(s) / Borough Resilience Forum(s) and the Local Health Resilience Partnership and network meetings to share good practice• Being able to demonstrate that people responsible for carrying out function in the plan are aware of their roles• Through direct and bilateral collaboration, requesting that other Cat 1. and Cat 2 responders take part in your exercises• Refer to the NHS England guidance and National Occupational Standards For Civil Contingencies when identifying training needs.• Developing and documenting a training and briefing programme for staff and key stakeholders• Being able to demonstrate lessons identified in exercises and emergencies and business continuity incidentshave been taken forward• Programme and schedule for future updates of training and exercising (with links to multi-agency

exercising where appropriate)• Communications exercise every 6 months, table top exercise annually and live exercise at least every

three years

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Title of Subject: Draft October PIQ Minutes

Date of paper: 15th October 2014

Prepared By: Graham Curtis

History of paper: n/a

Executive Summary: For Discussion and Recommendation

£5 per head Business Cases - Waterloo Medical Centre –

Additional Nurse for Over 75s Patients

PIQ did not recommend approval of the business case and

suggested it be refined and brought back to the next PIQ

meeting.

HT Practice – Enhanced Care of Patients Over 75s

PIQ recommended approval of the business case with the

caveat that clarity be sought around the risk to delivery.

System Resilience Primary Care Business Case

PIQ did not recommend approval of the business case.

Lockside Medical Centre – Proposal for Winter Monies


Effective use of Resources

Ratification

- Cataract Surgery

PIQ recommended ratification of the policy

- Pelvic Vein Embolisation


Extension of Carers Funding

PIQ recommended approval to support the extension of the carers

projects where recommended to March 2016.

Care Together Outline Business Cases

- Wellness Offer

PIQ noted the business case.

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- Drug & Alcohol Transformation


Prescribing Advice and Support - Benzodiazepine Reduction Nurse

PIQ recommended approval that the CCG commission a separate

service that encompasses the role of the Benzodiazepine Reduction

Nurse whilst allowing for a wider remit to support Medicines

Management Committee in achievement of LIS and other targets.

IAPT Investment

PIQ recommended approval that the CCG proceed with option 3 and

some consideration of option 4, which will produce a short-term

commissioning strategy enabling the service to meet the national target

of 15%.

Proposal for Additional Self-Management Courses

PIQ recommended approval for an additional four self management

courses to the end of March 2015.

Patient Friendly Delivery Dashboards

PIQ recommended approval of:-

- the draft dashboards and proposed indicators with the

comments suggested to be acknowledged

- agreement to publication on the CCG website and request

publication on

partners websites

- agreement to publishing quarterly updates to coincide with

NHS England’s

timetable for submission of performance/ Assurance

frameworks

Staveleigh Medical Centre, Clinical System Upgrade

.

GPs voted with the majority in favour of the business case. PIQ

endorsed option 3



(for Information, Discussion

or Decision)

CCG are asked to note and consider any recommendations within the

minutes for approval.


by proposal:

All

Direct questions to: Graham Curtis/Clare Watson

61

1

Draft Minutes of the PIQ Committee

Wednesday 15th October 2014, 12.30pm, Boardroom

Attending: Graham Curtis (Chair)

Dr Alan Dow – CCG Chair

Clare Watson – Director of Transformation

Kathy Roe – Chief Finance Officer

Nikki Leach – Director of Nursing

Dr Amir Hannan – CCG Governing Body Member

Dr Ram Jha - CCG Governing Body Member

Dr Guy Wilkinson - CCG Governing Body Member

Dr Tina Greenhough – CCG Governing Body Member

Dr Naveed Riyaz – Ashton Locality Lead

Dr Syed Asad Ali – Denton Locality Lead

Dr Andrew Hershon – Hyde Locality Lead

Dr Richard Bircher - CCG Governing Body Member

Dr Quang Nguyen – Medicines Management Clinical Lead

Dr Gideon Smith – Consultant in Public Health, TMBC

In Attendance: Michelle Rothwell – Head of Individual commissioning, Quality and

Patient Safety

Alison Lewin – Deputy Director of Transformation

Dr Simon Rushton – GP Clinical Lead for Urgent Care

Lesley Surman – PPG Representative for Simmondley Medical

Practice

Celia Poole – Lay Member

Alison Lewin – Deputy Director of Transformation

Clare Parker - Mental Health and Learning Disability Commissioning

Mgr

Louise Roberts – Head of Performance

Elaine Richardson – Strategic Programmes Manager

Wassiem Rafique – Commissioning Business Manager

Samantha Hogg – Commissioning Development Manager

Dr Samir Sadik – Waterloo Medical centre

Jean Hurlston – Lay Advisor

Stuart Allen – LDC Chair

Debbie Ashforth – Commissioning Business Manager

Debbie Bishop – TMBC

David Boulger – TMBC

John Winter – Consultant

Paul Nuttall – Locality Finance Manager

Peter Howarth – Head of Medicines Management

David Milner - Head of Finance – Locality Support Manager

Mike Woodhead – Finance Manager

Sarah Hadfield – Minute Taker

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http://nww.tamesideandglossop.nhs.uk/

2

1. Apologies for Absence

Steve Allinson/Saif Ahmed/Kathy Roe


SAA declared set up of a federation.

All GPs - Items 7, 9, 14

All other DOIs would be stated against relevant item.

3. Register of Interests

There were no items to declare or amend.

4. Minutes of the Previous Meeting

The minutes were agreed as a true record.

5. Matters Arising

Action: GC to contact DW around inclusion of IM&T Committee minutes for future

PIQ meetings.

Age UK – (deferred item from September meeting)

As agreed at the last PIQ meeting, C Parker presented the paper which was still

seeking recommendation. C Parker refreshed that the Star 131 day service

provided by Age UK which is also jointly funded by TMBC provides specialist

support to older people with mental health problems and has a particularly

significant strategic link to the Whittaker Unit. It functions as the main source of

referrals on for service users well enough to move on from the day hospital. Both

organisations authorised to extend the existing contract for twelve months with a

20% reduction in Tameside MBCs contribution through to 31st March 2014 in order

to allow time for a review of the service which has been completed. The contract

with TMBC will be discontinued from the 1st April 2015.

If PIQ agreed the preferred option 2 a CCG contribution would be required of

£104,260 as a conditional grant. CW asked if what the impact of this would be . C

Parker advised that the service may not be able to meet with as many patients

but the grant would allow Age UK to alleviate the shortfall and would be as step

towards integrating in line with the All Age MH outline business case.

GW asked whether this would be an option to be considered within the Better

Care Fund. MW advised that conversations could be had around this as it will be

formally pooled. CW added that this will also fit into to the Local Authorities

wellness offer.

PIQ recommended approval to proceed with option 2 where it would terminate

the TMBC element of the contract, handover to the CCG and continue for a

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further 12 months with a caveat that conversations are still held with TMBC around

disinvestments and joint commissioning.

For Discussion and Recommendation

6. Finance Update

MW gave the update for Finance and explained that the secondary care

overspend was currently forecasting and increase from £1.7m to £2.3m. Work was

ongoing to ensure that this was not due to any double counting. Issues within RTT

monies would be picked up via Finance Committee.

MW added that a revised draft of the Better Care Fund had been submitted.

7. Primary Care Update

DOI – TG/GW

CW updated her and JD had been involved in a meeting around APMS contracts

with the LAT. A health needs assessment would need to be carried out against

current contracts. Three of the contracts were to be extended by the LAT.

Droylsden and Guide Bridge till July 2015 and Ashton to August 2015. Millbrook

would not be extended and is due to expire in February 2015 but will be extended

by the LAT for a further six months. Assessments of these contracts will need to be

rolled out through Locality meetings during the next few months using local

intelligence to determine a proposal. This will then be presented to PIQ in January

to enable feedback to be given to the LAT.

Previous feedback has suggested negative views around cost. Any future

incentives within the contract would be at standard GMS value but through the

APMS vehicle. The contract is likely to be ten years with a five year break clause

and we would be unlikely to extend current arrangements if we went with this

proposal

CW reported a meeting which had taken place with RB and THFT discussing future

proposals of an Urgent Care model and how this may impact on the walk in

centre. Contract value of the Walk in centre is currently £35k but there is an

overspend in activity due to unregistered patients which totals around £42k.

SAA reported two practices on the APMS contract and asked whether they would

be eligible to inherit once the contract ends. CW explained that they would have

to remain part of the bidding process.

Action: CW to ensure that any presentations through locality meetings include the

LAT and CW/JD.

Action: CW to ensure feedback from meeting with AD/CW/JD and SA is

communica

ted out to member practices and via PIQ forum.

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8. Locality Issues

Denton

SAA asked whether there were any updates around co-commissioning. CW

reported that a clearer stance would be ready after the primary care meeting to

be held next week and would forward relevant NHSE guidance around next steps.

SAA updated that their over 75s business case was now in place and was

beginning show its effect positively.

Action: CW to circulate updated NHSE guidance around next steps for co-

commissioning.

Glossop

GW reported that with regards to resilience, Out of Hours were saying that this

would be uneconomical out of Glossop. GW asked if a costed up model for an

Out of Hours provision within Glossop could be considered. CW suggested that a

business case would be welcomed through the PIQ route.

Hyde

A Hershon reported that Brendan Ryan had recently attended a locality meeting

and that the response from GPs had been positive towards his approach. GPs felt

more informed and felt ‘in good hands’.

The over 75s business case for the Hyde locality was due to go live today. The

proposal was still awaiting some relevant documentation in terms of its

governance but felt happy to proceed at risk. Feedback will be given at

appropriate stages.

Stalybridge

RB updated for Stalybridge advising that Age UK would begin its recruitment

process shortly as part of the over 75s business case. MW added that there was

some preparatory work still to be completed before the contract was drawn up.

C Parker added that GPs had noted no contact made in relation to the

communications review with GPs. AD added that this had also been raised at the

Ashton locality and it was reported that a report was due to go to the Governing

Body meeting to then be fed into the locality meetings by early November.

RJ advised that LMC had raised concerns around extra work undertaken to

obtain patient consent in relation to the over 75s business case for Stalybridge and

Hyde. A Hershon advised that New Charter would have financial involvement

around this. C Parker added that in terms of data protection a privacy impact

assessment should be considered and that any risk is then to be managed

between New Charter and the GP.

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Ashton

NR advised that discussion had taken place around the care home work within

the locality. Feedback suggested that the seven aligned homes had seen an

improvement with better access to GPs. There were however issues around

midwifery led flu vaccinations. NL reported that AD had met with Gill Gibson and

this issue was being looked into.

9. £5 per head Business Cases

9.1 Waterloo Medical Centre – Additional Nurse for Over 75s Patients

SS presented the business case which would look to increase access for over 75s

and pro-actively contact them. This will help to reduce hospital admissions and

identify risks such as falls, and social deprivation factors. The practice would

employ a nurse specifically for this role for two hours per week who will contact

patients via phone, face to face in the practice and conduct any medicine

reviews.

SAA asked for clarification around the total of patients over 75. SS confirmed that

this number was 60 patients. GW asked whether these patients were all excluded

from the Admission avoidance DES. SS was unsure to the exact total but felt it was

a very small number. PN gave assurance that financially the business case was

sufficient.

Members felt that the proposals felt similar to core GMS practice. There was also

concern around proposals that the nurse would conduct a falls assessment via

telephone. It was also noted that there would need to be measurable outcomes

within the business case.

PIQ did not recommend approval of the business case and suggested it be

refined and brought back to the next PIQ meeting.

Action: PN to clarify list size number of Waterloo Medical Practice over 75s

Action: SS to work with LR to strengthen business case, ensure no duplication of

core GMS and admission avoidance, clarification of nurse role in line with

suggestions and include KPIs.

Action: NR to speak to SS to feedback suggestions and advise of next steps.

9.2 HT Practice – Enhanced Care of Patients Over 75s

QN presented the business case which proposes to promote proactive contact,

triage and to increase clinical access for over 75s. Should any work streams be

duplicated in line with Admission Avoidance DES or core GMS contract,

assurance is given that double counting will not be applied. 53 patients have

been excluded from the 402 patients eligible. Risks will be identified within factors

such as falls, social depravation factors and improving access to ongoing

medical needs. Clinical staff will be used to triage problems and implement

solutions.

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We propose to proactively contact our >75 yr old patients twice-yearly proactive

assessments. These proposals have also been discussed with the PPG at the

practice.

NL asked that the Safeguarding framework be referenced within the business

case. It was asked whether the GP sessional rate was correct as it totalled £163

per session. QN confirmed that this costing was correct and was based on

salaried rate. The risks to delivery were raised when one or more partner/nurse

may be absent. QN explained that this would be in an emergency case only.

PIQ recommended approval of the business case with the caveat that clarity be

sought around the risk to delivery.

Action: NL to forward safeguarding framework to QN.

Action: Relevant commissioner to ensure clarity is sough around the risk to

delivery.

Action: GC to write to GPs and advise outcome of business case.

10. System Resilience Primary Care Business Case

RB and SR presented the business case which sets out how General Practice would

support patients from November to March who have an urgent need for medical

care. There are two parts to the scheme both of which build on the good practice

already in place and would look to conduct earlier home visits and create same day

appointments. Research shows that earlier home visits can have a positive effect on

Length of stay within hospital. This would see an improved continuity of care which

will aid the patient more effectively.

A Hannan felt that the evidence base was good to see but challenged that his

practice did not currently operate in a way which would fit this proposal. It was also

raised why Primary Care would be the one looking to change when issues at the Trust

causing LOS should be identified. ER added that the Trust were looking at different

ways to operate in line with the system resilience monies and that a smooth flow

between the three organisations would work well with the model. TG felt that it was

difficult to control when patients present and questioned whether there was safe way

to put into practice as she would struggle to backfill within her own practice. RB

agreed that it would be difficult but achievable and took onboard that practices

would adopt differing targets. AL asked that any proposal considers any potential

duplication of the admission avoidance DES. SAA asked whether the set up of a

Federation may be able to adopt the work. GW added that we must also consider

the realisation of no recurrent funding after its six month pilot.


Action: GPs to relay comments back to SR for a revised business case to be

presented at the November meeting.

Action: GPs to consider full allocated £250k as a whole across localities and look into

an implemented plan.

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10.1 Lockside Medical Centre – Proposal for Winter Monies

RB presented the paper on behalf of Dr Joanna Bircher which would produce a two-

weekly newsletter focussing on self-care and local health provision distributed by post,

directly by a GP Practice to patients The pilot would run from November 2014 –

February 2015 and would decide content in consultation with our Patient Participation

group. Funding would be requested from the system resilience monies. It was noted

that the postage costs would amount to £340k per year. CW advised that a similar

proposal had been made at the Emergency Care Network meeting and had been

rejected. PH felt that you could adopt the same approach nut attach to

prescriptions. AH felt that some practices had access to emails and that a similar

model could use this method.


11. Perfect Week

CW informed that the Perfect Week would be rolled out by the Trust and on behalf of

all other partner organisation Monday 20th October. The premise is that it will focus on

Urgent Care throughout the week and provide intensive focus on achieving an

improved patient flow. Communications will be rolled out to practices and an

evaluation will be available following the week. CW added that the CCG welcomes

engagement from member practices in support of the event. A Hannan noted

concern that if focus was directed to this then other duties may not be undertaken.

JH asked whether public and patient participation will be considered during the

process. CW felt that this was a good suggestion and would clarify.

Action: CW to clarify and ensure public and patient participation is considered during

the perfect week.

12. Effective use of Resources

It was proposed that a quicker process be considered for the EUR consultation

process and whether or not this could be carried out through a virtual process.

Consultation

- Electrolysis and Laser Hair Removal for Hirsutism

GC questioned why we were paying for purely cosmetic reasons.

Action: QN to feedback concerns to the EUR panel

- Hair Replacement Technologies for Alopecia

It was asked whether there was equality across the board with regards to this

issue. It was thought that an Individual funding request may cover this.

- Invasive Treatments for Snoring

GS noted that he would not advise inclusion of the invasive treatment stated.

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- Rhinoplasty / Septoplasty / Septo-Rhinoplasty

In relation to Septo-Rhinoplasty, it was discussed that the procedure can

potentially be used as a way of obtaining corrective nose surgery for cosmetic

reasons. It was noted that any increase in requests for Septo-Rhinoplasty should

be closely monitored by the EUR panel.

Action: QN to feedback concerns to EUR and monitor any increase in requests for

Septo-Rhinoplasty to the EUR policy.

- Surgical Revision of Scarring

PIQ noted the policy

- Tattoo Removal

PIQ noted the policy

Ratification

- Cataract Surgery


- Pelvic Vein Embolisation


Action: GC to speak with QN/MR to determine appropriate process for EUR

governance.

13. Extension of Carers Funding

A business case was approved in July 2012 which identified a range of carers break

projects and schemes to support the delivery of our Joint Carers Strategy with TMBC

and Derbyshire County Council. Most of this funding will come to an end in March

2015 so PIQ are asked to recommend approval of continued funding for the carers

projects until March 2016. The work is aligned with Care Together and if agreed the

funding will be reviewed as part of the Phase 4 business cases. It will also ensure that

measurable quality outcomes will be developed in collaboration with carers.

GW asked why the carers funding was not included as part for the Better Care Fund

submission. GC added that this would be a holding policy until Better Care Fund and

Care Together was at a more finalised stage.

PIQ recommended approval to support the extension of the carers projects where

recommended to March 2016.

14. Care Together Outline Business Cases

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- Wellness Offer

COI - GW

Debbie Bishop from TMBC presented the business case which outlines its need for

change; and a suggested approach in relation to its redesign and realignment of health

and care services under the Care Together programme. The Business Case will look to

deliver Stage 1 of the workstream, which covers adults health improvement services (tier

1-2) with Stage 2 of the Wellness Offer to commence early next year which will include 0-

19 wellness services, Primary Care Enhanced services including NHS Healthcheck and

wider lifestyle determinants including linking pathways to housing support, employment

and financial resilience. A Wellness Needs Assessment has been developed as part of

the JSNA process, which will inform the development of the full business case. Key

elements to consider will include building upon the Mental Wellbeing Programme, use of

communications and social marketing and stakeholder, resident and community

engagement.

Full service reviews have been carried out by the Public Health team on all contracts in

scope and TMBC will also look to align our current budgets for mental health, social

marketing and MECC. However DCC have formally made TMBC aware of their intention

to withdraw funding from the existing Pennine Care Contract from the 1st December

2014. TMBC have subsequently varied the contract to reflect this with DCC formally

notifying Pennine Care FT that they will be re-commissioning the service covering

Glossop from 1st December 2014.

A Hannan noted his congratulations on the business case and felt that it showed a good

understanding of partnership working. A Hannan suggested as IM&T lead that he felt

that web services should lie within tier 0. TG felt concern around Pennine Care FT as they

had not been involved within any discussions or model. D Bishop explained that there

was a clinical lead on the group who has utilised resource of lists within Pennine Care

and that she felt that they are not missing just not reflected. C Poole felt that the

acknowledgment of the communication and engagement strategy would need to be

reflected. S Allen added that he would be keen to link in with the work in relation to

dental.

D Bishop acknowledge all comments and would incorporate these into the document.

CW asked that it also ensures alignment with the other business cases. GC questioned

why they were not going to the CCG Governing Body or Transition Board meeting.


Action: D Bishop to ensure correct governance arrangements is followed in relation to

the business case and that any recommendation of approval has an attached caveat

to sign off through the Delivery Unit meeting.

Action: D Bishop to ensure business case acknowledges the CCGs communication and

engagement strategy.

Action: D Bishop to liaise with MW to ensure CCG finance has appropriate overview of all

financial arrangements.

- Drug & Alcohol Transformation

COI - A Hannan

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David Boulger from TMBC presented the Phase 2 business case which sets out a direction

of travel for the future of Drug and Alcohol Treatment Services against a refreshed

strategic vision. The transformation project will consist of 4 stages including a

transformational redesign of community‐based treatment, rationalisation of

hospital‐based treatment, Integration between community‐based and hospital‐based

treatment and developing a more rounded approach. Key findings have identified that

the current Alcohol treatment system is insufficient to meet its current needs. There is also

a need to broaden the scope of the current drug treatment system to capture a wider

range of drug misusing behaviour. The business case proposes to go to market for a

single provider which will deliver to all substance misuse for young people up to age 25

and for adults over 25. It is also proposed that a ten year contract be awarded for this

model. The model will aspire to achieve exceptional, meaningful and sustained

outcomes and increase life expectancy from early intervention work.

T G felt that the work proposed was refreshing and that work around alcohol would be

key to its success. A Hannan spoke of the drug misuse work carried out within his

practice and felt that he would not want to destabilise any of this current work. GC

asked where Glossop would fit into these proposals. D Boulger explained that Derbyshire

had recently disinvested and planning was being carried out in preparation for Phase 2

which would determine clear pathways between community services. GC noted

caution of the recent disinvestment from the CAMHS pathway. ER felt that this planning

should start from stage one and that robust mechanisms would need to be in place with

services such as the RAID team who focus on A&E attendances.


15. Prescribing Advice and Support - Benzodiazepine Reduction Nurse

PH presented the business case explaining that prior to April 2013 Tameside and Glossop

PCT employed a Benzodiazepine Reduction Nurse to work with the Medicines

Management Team. The role also included support and partnership working with GP’s to

achieve these reductions. Once the CCG was formed the role was transferred to be

employed by Pennine Care and they were commissioned to provide this service. In

addition to this the Tameside drug and Alcohol Treatment System, commissioned by

TMBC are undertaking a system wide transformation and this does not reflect the role

within the scope of the Drug and Alcohol Treatment System tender. PIQ are asked to

consider whether the CCG should commission a separate service that encompasses the

role of the nurse or to request that this role be added into the bundle of service provision

considered in the Drug and Alcohol tender.

Members felt that the role should be integrated within the service to ensure value for

money. It was agreed that the role should be commissioned by the CCG until plans

within the Care Together remit are more robust. It was noted that this role would cover

Tameside and Glossop.

PIQ recommended approval that the CCG commission a separate service that

encompasses the role of the Benzodiazepine Reduction Nurse whilst allowing for a wider

remit to support Medicines Management Committee in achievement of LIS and other

targets.

16. IAPT Investment

C Parker explained that the CCG would get a quality premium payment for 14/15 of

£120k for achieving a 15% prevalence rate in IAPT. We are currently not on track to

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deliver against this target so are at risk of non-achievement of the payment. Work

carried out by the Intensive Support Team identified recommendations for commissioners

and service providers to work together to determine capacity and demand to deliver on

this target. Pennine Care have utilised the INSIGHT tool to determine what level of

resource is needed to meet the target and have given recommendation for Option 3

with some consideration of Option 4 for future service delivery.

DM explained that funding would initially be taken from the net 30k allocated but there

could be longer term issue should Pennine Care fail to deliver. CW felt that we must

ensure that next year’s contract values are costed at the right level.

PIQ recommended approval that the CCG proceed with option 3 and some

consideration of option 4, which will produce a short-term commissioning strategy

enabling the service to meet the national target of 15%.

17. High Level Commissioning Intentions for TFT & SFT

CW presented the paper which outlines the CCG’s commissioning intentions for 2015‐16

for SFT and TFT, and includes the Care Together Programme, Medicines Management,

Primary Care, Healthier Together and the Strategic Clinical Networks. CW added that

detail for those relating to TFT have been challenging and that these should be passed

through to localities and member practices for further input. More detail will be given at

the January meeting.

PIQ noted the update

18. GM CATS Update

CW referred to the exit work being undertaken around CATs. CW added that there

would be no wind down towards the end of the CATS contract exit which would cease

February 2016. This was likely to create a financial risk for the last two months of the

contract. Work was being undertaken with Care UK around wind down of the pathways


19. Tameside & Glossop Strategic Estates Plan 2014-15

CW explained that the CCG had recently submitted the high level strategic estates plan

for 2014-15. The plan outlines its intentions and sets the scene in line with the Care

Together agenda. A strategic estates group is to be set up and will assess where Primary

Care will fit in and how it utilises existing buildings such as APCC and Glossop PCC.


20. Locally Commissioned Services

This item was deferred until the November meeting.

21. Proposal for Additional Self-Management Courses

The paper updated work to date on the Self Management Courses and asks for PIQ

recommendation of an additional 4 courses to the end of March 2015. Due to the high

demand for places there are currently 32 patients on waiting lists who are unable to be

allocated to courses. The recurrent funding for self management courses will form part

of the Care Together Wellness Offer.

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PIQ recommended approval for an additional four self management courses to the end

of March 2015.

22. Patient Friendly Delivery Dashboards

ER explained that Louise Roberts had carried out this work which aimed to publish

performance related information to the public in a simple, clear and concise manner.

This would look to allow patients to be prompted to ask more informed questions. The

dashboards will show five areas of patient performance. Once approved the

dashboard will be available through relevant CCG websites.

It was felt that the year to date indicator was helpful but that the asterisks should be

removed. It was also noted that an area such as how often patients are seen could be

difficult to score. AH noted how differing targets locally and nationally may create issues

with perception. LS felt that the indicators should be consistent and in line with NHS

England scores.

PIQ recommended approval of:-

- the draft dashboards and proposed indicators with the comments suggested to

be acknowledged

- agreement to publication on the CCG website and request publication on

partners websites

- agreement to publishing quarterly updates to coincide with NHS England’s

timetable for submission of performance/ Assurance frameworks

23. Staveleigh Medical Centre, Clinical System Upgrade

It was noted that this discussion be led by GP peers and the GPs present were as follow -

GW, SAA, A Hannan, RJ, NR, TG

JW presented the business case on behalf of Dr John Doldon from Staveleigh Medical

Centre. JW explained that the practice currently uses EMIS PCS as the clinical system for

the practice. This will no longer be supported by EMIS from 31st March 2015 and there is

a requirement to move GP practices onto a fully supported centrally hosted system

solution. The business case asks for support of the technical requirements and funding

required to support the move. After moving there may be potential cost savings to the

organisation in relation to maintenance and support. Caution should be noted that

other practices could also adapt system moves and It is not known whether funds will be

available next financial year for clinical system migration.

It should also be noted that the IM&T Strategy Group did not support or reject this

request. Any recommendation would be presented the Local Area Team for ultimate

approval as new NHS England ruling states that any funding request for Capital must be

passed within our own governance arrangements.

RJ explained that all GP systems are not uniform and do not talk to each other which is

frustrating. GW explained that the GP system of choice was embedded within the GP

contract. A Hannan felt that system one was a good system once implemented and

would work well with community services. Single practice benefits however are not as

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good. SAA felt that it would make sense to adopt one system. TG felt that it should be

practice choice and did not see why it should be presented.

GPs voted with the majority in favour of the business case. PIQ endorsed option 3

Action: JW to feedback endorsement to NHS England for final approval

24. System Resilience Group Minutes

PIQ noted the minutes.

25. Emergency Care Network Minutes


26. Medicines Management Minutes


27. Dates for 2015

GC noted that the format of dates for the 2015 PIQ had changed and would be held in

the second week in the month starting from January. GC also urged that members

note the deadlines for papers as they would not be accepted after the time stated.

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Transformation Directorate Report – November 2014

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.

Directorate Wide Projects / Work Programmes

Greater Manchester working: The Directorate continue to work with colleagues across Greater Manchester, in neighbouring CCGs, the Local Area Team and the Strategic Clinical Network teams on a

number of areas, including Primary Care Commissioning, Cardiac & Stroke Commissioning, Mental Health, Integration, Heads of Commissioning, and Urgent Care Leads

Integration: The Directorate has the lead for the CCG in taking forward the service redesign element of the integration agenda, working with colleagues in social care and our provider organisations to develop models of care and business case proposals for integrated services. 11 Outline Business Cases have now

been approved via CCG, Local Authority and Integration governance processes.

Primary Care / Over 75 Business Cases: The Directorate, with colleagues from the finance team have supported our member practices to develop proposals for the use of funding to support their over 75

year old patients to reduce hospital admissions and improve support in the community / primary care.

2014-15 Contracts: The Directorate are working with colleagues in the finance team, nursing and quality directorate and the Commissioning Support Unit on the monitoring of our main contracts for 2014-15.

This includes CQUINS (including GM CQUINS), service specifications and KPIs. Local CQUINs for 2014-15 are focused on 4 main areas – Clinical Leadership: Adults and Transition, Clinical Leadership: Children,

Frail Elderly and Medicines Management. Discussions are due to commence imminently on the contract negotiation processes for 2015-16 contracts, which will include the development of commissioning

intentions and CQUINS (at a local and GM level).

Strategic Programmes / Planned Care & Cancer/Urgent Care

CCG Performance: The web based patient facing dashboards have been developed following

consultation with the public. These focus on key CCG standards covering areas that patients

highlighted as important to them.

LIG: Working with Quality Clinical Lead to develop practice and locality based performance analysis and reporting. The cancer packs provide practice and locality comparisons to promote discussion and sharing of ideas across practices.

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Urgent Care: 111 Dos being updated. Involved in service specification review. Working with THFT on Ambulatory Emergency Care to ensure effective use and identify areas for further development. Involved in NW review of PTS service specification ready for April 2015 re-procurement. Involved in Perfect Week Lets get flowing across T&G economy. Planned Care: Increasing Direct Access/Straight to Test Diagnostics: Finalising evaluation of the STT pilot. ISCATS: close down of existing contract and planning future configuration of services. Care Together: MSK and Ophthalmology are two of the phase one programmes.

Resilience planning 2014/15 The T&G health and social care economy plan was ‘assured with support’ reflecting challenges of Lorenzo and non-elective activity levels. The plan was tested as part of a GM exercise. Primary Care schemes to support non-elective pathways are being finalised. Schemes to avoid admissions; treat and discharge people promptly are being implemented through an integrated approach. Additional elective activity has resulted in increased pathway closures for long waiters. Reporting ongoing to provide assurance to NHSE

Mental Health & Learning Disability / Children & Families

Dementia: We are currently awaiting next steps for the Care Together outline business case for dementia. The Dementia Strategy Local Implementation Group has recently focused on priority 1: “good quality early diagnosis and intervention for all and easy access to care, support and advice following diagnosis,” which was led by the Memory Service Consultant and THFTs Consultant Lead for Dementia. The outcomes of these meetings will continue to feed into the outline business case/Dementia Strategy refresh. THFTs dementia CQUIN is continuing to improve; we are currently awaiting results for Q2. A recent North Dementia Symposium event took place aimed at helping commissioners improve local pathways for diagnosis and support; the event showcased models of care from around the country. NHS England recently published a NEW enhanced service to support the diagnosis of dementia in primary care; this enhanced service is in addition to and supports the existing dementia DES. Newly released dementia diagnosis data indicates that the CCGs estimated dementia diagnosis rate is 61.3% and the estimated prevalence for people with dementia is 2,722. This identifies a gap of 146 people who may benefit from access to support by way of a dementia diagnosis. NHS England will be rolling out a Data Quality Improvement Toolkit (DQT) in late October/early November to help practices identify likely or possible registered patients with dementia.

Mental Health: Pennine care have rebranded their IAPT service as “Healthy Minds” and opened up for self referrals. The CCG has also increased the investment in the service on a short term basis to aim to achieve the 15% prevalence target by March 2015. We were invited to get involved with World mental Health day by opening the event arranged by Pennine Care at Ashton Town hall. This was a successful day in raising awareness of mental health issues and services. A paper was presented at PIQ to support the continuation of the RAID CQUIN. This was agreed in principle but the detailed economic evaluation is needed before any final financial decisions can be made.

Children & Families Commissioning: Alan Ford new CYPF commissioner joined us on 1st October and is actively developing networks across TMBC, DCCC and the voluntary sector. Work streams and job plans are being developed in and around CAMHS, Maternity, LAC, Early years strategy and the OBC for CYP under the care together programme. The SEND agenda and governance with local authorities continues to be developed and move forward. A paper for PIQ is being drafted seeking the agreement CCG to publish its ‘local offer’, under the SEN reforms. The Designated Medical Officer (DMO) has been agreed in principal so hopefully this will materialise with an appointment the near future. The DMO will support the CCG in

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A workshop was held with all GM MH commissioners to set out priority areas for collaborative working for 15/16.

meeting its statutory responsibilities for children and young people with SEN and disabilities, primarily by providing a point of contact for local partners, when notifying parents and local authorities about children and young people they believe have, or may have, SEN or a disability, and when seeking advice on SEN or disabilities. The CAMHS redesign, working with Pennine Care, is progressing and mainly on track. Thoughts and recommendations for commissioning intensions for 2015 are developed with options around possible local CQUINS and/or a GM wide CQUIN to support the work being considered. Tameside has a disproportionate number of Children Looked After (CLA/LAC) due to the significant number of children placed in our area from out of area. This work under the national payment by result (PbR) tariff is not being captured resulting in a potential loss of income, which could be reinvested back into local services. A working group from the CCG with our partners is being developed to ensure we have the process to capture these monies to enable us to look how we can enhance service delivery for some of our most vulnerable children and young people.

Learning Disabilities: The Health and Social Care Joint self assessment Framework has been published. We will be working alongside commissioners and providers in Tameside & Glossop to complete this year’s submission by the deadline of 31st January 2015. The outline business case was shared at 3 public engagement events for further comments.

Long Term Conditions / Admission Avoidance / End of Life Care / Primary Care

Training End of Life: Unified DNACPR 132 people from the health and social care economy across Tameside and Glossop have been refreshed on the use of the DNACPR order in 4 sessions across the localities in 90 minute sessions at lunch time or early evening. There is one more session planned at the end of October in which 30 people are registered to attend. Feedback has been positive; the sessions were engaging and relevant. Some comments: “a welcome development and a good number in attendance” “I am now thinking that ADRT needs more

GSF Level 4: 20 practices in Tameside and Glossop have signed up to Level 4 of the GSF training programme. Following initial momentum, practices have been slow on the uptake due to other commitments but are hoping to engage in training by the end of 2014. We are encouraging use of GSF care plans and early prognostication as this is integral to our plans for the integrated palliative support service

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discussion with patients” “useful to know when it is appropriate to discuss this” “very informative and concise” “Patrick is a natural communicator” “comparing to statement of intent and ADRT was useful” (nurses comments) “well delivered, balanced discussion and good group involvement” The range of professional who have attended the sessions are GPs, practice nurses, care home nurses and assistants, care home managers and CHC nursing staff. The unified use of the policy to include general practice, the hospice, the community, care homes and out of hours is to be rolled out from 1st November 2014. The hospital will acknowledge use of the forms and review each decision but will continue to use their own policy and forms until further notice. We continue to engage with the hospital on this matter.

Text Santa Appeal: Age UK have successfully been awarded funding to support vulnerable people in our economy from the Text Santa Appeal. The project will deliver ‘wrap around’ cross service interventions to the most vulnerable people because of their frailty, illness, caring responsibilities, level of disability, home conditions or lack of social connections. This will involve providing 1x 60min home visit every 2 weeks to assess need and crisis intervention if necessary, 3 x 15min well-being telephone calls to individuals/carers/family members per week and a 30min weekly support visit. There were 22 nominations for vulnerable people across the localities, from a range of referral sources. Age UK have accepted all of the referrals and will now proceed to contacting the people and arranging the visits from November to February to prevent social isolation and hospital admissions over winter. The aim is that the patients and families/carers will continue to utilise Age UK services and become more integrated into the community, living well in future months and future winters. Age UK will develop case studies comparing the number of admissions and GP contacts this winter to previous winter periods where the person may have felt isolated. Along with this they would like to survey carers and family members on their satisfaction and confidence if the vulnerable person being more supported. As a health economy we would like to learn from the process and some understanding as to why there were such few referrals will be investigated to discover how teamwork and referrals can be improved in future campaigns.

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Dying Matters May 2014 Feedback: Following a successful Dying Matters Event in May we surveyed the attendees to measure impact of the areas of learning and development that were showcased at the event and gather feedback to inform the new service. There were over 90 attendees and 20% completed the survey. Everybody who attended found the event useful. “found the day inspiring and thought provoking. It has helped me to discuss funeral arrangements with a relative. Gave me the courage, thank you.” “really good and informative event” “i enjoyed the day from both a personal and professional perspective. The content of the day made me think about my own mortality and those close to me. What really struck me was the number of older people who die alone or left for long periods of time” A large proportion of attendees had since had a conversation about end of life issues with someone, and everybody found it more useful to talk about end of life issues. The majority of responders have thought more about advance care planning and making a will and some people have actually made a will. When asked about further resources, responders would prefer the main source of new information to be electronic. Some comments from the survey focus on communication and improvements we can make in the new service model. “need a clear and simple end of life pathway in place for families to understand” “continue to improve communication between teams” “use a specific document and ensure people are aware of the document to support end of life” “joined up thinking”

Medicines Management

Pharmacy Repeat Ordering Local Improvement Scheme (LIS):

The Pharmacy Repeat Ordering LIS supports QIPP in terms of cost efficiencies & improving quality by ensuring best practice & thus & improving patient safety. The LIS is now well underway & MMT is following up on incidents of poor practice, including pharmacies ordering on behalf of patients without making any contact with them and issues resulting from contacting patients by text message. MMT continue to work with both pharmacies & surgeries to resolve concerns & improve processes. Data from ePACT suggest the savings from the LIS are around £175,000, to end August 2014.S):

Local Authority Partnership Working: Continuing to work with Local Authority

colleagues, commissioned to administer Drug Misuse Pharmacy Enhanced Service on their

behalf. MMT are representing CCG on the Joint Strategic

Needs Assessment (JSNA) Steering Group & Pharmacy Needs Assessment (PNA) Steering

Group.

Health Care Acquired Infections: Within the context of organisational restructurings, challenging trajectories & a rise in c.diff numbers,

the MMT are working to try & ensure that the root cause analysis process provides data sufficient to

promptly learn & disseminate messages from cases such that we remain within trajectory. So far the

whole Health Economy is 14.8% below trajectory (-9 cases).

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Training In support of medicines and patient safety the

Medicines Management Technicians are continuing to provide training in Safe Handling of

Medicines to care home staff working within Tameside and Glossop and for RGNs (as part of

the PINK programme). The Technicians are currently also delivering a training programme for surgery reception staff

to support delivery of Pharmacy Repeat Ordering LIS.

Prescribing Support Medicines Management Technicians continue to

work in GP practices to support the achievement of Prescribing Local Improvement Scheme targets and identifying additional areas for consideration and work, all to support the delivery of 2014/15 QIPP

agenda. Prescribing data are sent out to each practice on a monthly basis.

Non-Medical Presc Continuing to support Non-Medical Prescribers (NMPs) to maintain appropriate governance within their practice, by leading training, providing ePACT prescribing information,

supporting production of P Lists etc. Also, facilitating clinicians to undertake Non Medical Prescribing qualifications & supporting them during their training, currently FIVE nurses & ONE pharmacist are undertaking training. T&G NMP register currently includes 52 nurse & two pharmacist NMPs. Also,

working with colleagues across Greater Manchester & the North West region to ensure sharing of good practice & effective networks for NMP Leads.

Greater Manchester: Members of the Medicines Management Team attend the GMMMG Board & Formulary sub-group ensuring that suitable strategic guidance is in place at GM level which is of benefit

to ourselves & other GM CCGs, for example the recently produced neuropathic pain guideline. The MMT represent the CCG’s interests in working with colleagues from other GM CCGs to agree the CSU medicines management service specification & KPIs to cover the next three years of service offering

from the CSU.

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

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Title of Subject:

Care Together

Date of paper:

October 2014

Prepared By:

Doreen Hounslea

History of paper:

The report presents a summary of the latest position in

respect of the Care Together Programme

Executive Summary:

To note the steady progress over the last month with a

number of notable milestones now set. The report

covers:

Update on developments with Monitor

Engagement with Patient and Public Events

Operational progress

Next Steps



(for Discussion and

Decision)

The Governing Body is asked to :

a. Note the progress of the Care Together Programme;

b. Note the appointment of the Consultation Institute to provide an independent assessment of the programme’s engagement with the public;

c. To support the key deliverables over the next 9 weeks and where possible ensure they are being progressed;

d. To receive a further update at the December meeting.

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Kathy Roe

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Tameside & Glossop’s

Care Together Programme

1

Tameside & Glossop CCG Governing Body Meeting - 5 November 2014

Integration Report - Update Introduction

1. This report provides an update for the Governing Body on the progress and developments within the Care Together Programme since the last meeting.

2. There continued to be steady progress over the last month with a number of notable

milestones now set. The report covers:

(i) Update on developments with Monitor; (ii) Engagement with Patient & Public Events (iii) Operational Progress (iv) Next Steps.

Update on developments within Monitor

3. As colleagues are aware Monitor formally announced on 12th September that “a team of experts is being sent to help turn Tameside Hospital NHS Foundation Trust into a new more integrated healthcare organisation. This is the first time the NHS will try to create a full Integrated Care Organisation at an NHS foundation trust”.

4. Monitor confirmed they took the action, which they state “should lead to long term

improvements to services for patients, because the trust is clinically and financially unsustainable in its current form”.

5. This very much builds on our plans locally to improve patient services across all pathways and is in keeping with the direction of travel first proposed by commissioners in 2012. The announcement by Monitor signals an important milestone in our journey.

6. The appointment of the team of experts is solely in the gift of Monitor as they as responsible for the procurement process. Whilst the three organisations within the economy have had an opportunity to share insights and views in respect of the service specification the final decision belongs to Monitor. We anticipate the announcement of the successful bidder to be made by the end of the month with a start date of early November.

7. Monitor has also confirmed they will attend the Tameside Health & Wellbeing Board in December accompanied by the leader of the successful team following an invite from Cllr. Kieran Quinn in his capacity as Chairman of the Health & Wellbeing Board. This offer to attend Health & Wellbeing meetings has also been extended to Derbyshire County Council and High Peak Borough Council.

8. In addition, Monitor has taken up the offer to be a member of the Transition Board

and attended the October meeting. They confirmed the procurement process was on track and that an announcement will be made at the end of October. The

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successful bidder should be known by the time of the Board meeting and will be confirmed then.

Engagement Events 9. Following the development of the nine Outline Business Cases it was agreed a

series of patient engagement events would take place across Tameside and Glossop. Tameside CVAT and High Peak CVS led and coordinated three events supported by the CCG and TMBC staff. The events took place in Bradbury House, Glossop, Hyde Town Hall and Dukinfield Town Hall. All were very informative and successful in gaining direct patient feedback with more events being planned for the coming months. The “round table” discussions, facilitated by CVAT staff, ensured flowing debate with perhaps one of the most challenging comment being “this [End of Life Pathway] looks good on paper and I would support it but how are you going to make it happen?” Whilst we can talk about our governance processes and tripartite working it will mean little if we do not deliver sustainable change across integrated pathways that patients can understand and experience first-hand.

10. In addition, a presentation was given to the 9th Tameside Training Consortium event

on 15th October attended by carers, Care Home and Nursing Home providers together with commissioners. This was an excellent event attend by over 100 people hearing a first-hand patient story; the legal requirements of staff training and development; the complexity of the Mental Capacity Act as well as the development and aspiration of the Care Together Programme. It is clear that when developing pathways we have to engage and consider the breadth of providers in the care sector and the implications of patient choice. This will be something that is picked up again when planning the next round of Market Days by commissioners.

11. As reported in a previous paper we wish to ensure our approach and engagement of the public is of the highest order. I am pleased to confirm that the Consultation Institute has been appointed to conduct an independent assessment of our approach and process across the Care Together Programme. A member of the Institute attended the public meeting at Dukinfield Town Hall and this will be followed up by a workshop facilitated by the Institute to share their approach to assessment and to gain a greater understanding of the scope of the programme. This work is being coordinated by the Nursing and Quality Directorate and regular reports will be made to the Governing Body once the timeline for their work has been agreed.

Operational Process 12. The Outline Business Cases (OBCs) are now managed via the Delivery Unit.

Working groups established to develop the OBCs are still meeting in various forms and are eager to progress to the next stage of implementation. There are several aspects to this and in the first instance they have been asked to progress all “quick wins” and to ensure the changes that do not require contractual negotiations are implemented. Examples include the development of joint policies and protocols; combined staff training; removal of duplicated processes and the agreed introduction to the use of “step up” beds as part of the CHHECT OBC from 3 November 2014.

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This will dovetail into the Resilience planning led by the Transformation Directorate for the winter months.

13. Interviews have taken place to appoint a Project Manager to drive the delivery of the

CHHECT business case. In fact two Project Managers have been appointed due to the need to also support and drive forwards the enabling workstreams, in particular the IM&T workstream. Both Project Managers commenced mid-October and are busy mapping and identifying the critical success factors and any barriers to change to ensure a smooth and transparent implementation plans.

14. To ensure all OBCs are running in parallel and to mitigate risk in respect of codependences of process and the interrelationship of delivery the first five OBCs are being mapped to assist the enabling workstreams and to identify the critical path and timeline for delivery. In addition, the leads for all OBCs are now meeting fortnightly to share progress and learn lessons from each other – the iterative nature of integration. The IM&T enabling workstream is a critical factor to the overall programme given the implications of patient care records and the sharing of data / information across primary, secondary and social care. Kathy Roe has agreed to be the lead Director for this workstream.

15. The development of the R.A.I.D. (Risk, Actions, Issues and Dependencies) Log is being rolled out and will be a feature of the Delivery Unit and Transition Board going forward.

16. The Location Specific Services (LSS) Task and Finish Group established to review the commissioning implications of the proposals will report at the end of October. This piece of work is commissioner led and incorporates the proposals from the OBCs. It involves the completion of an extremely detailed multi-layered spreadsheet to look at commissioning decisions on a line by line, service by services basis. This is a requirement from Monitor and in support they arranged for the analysts who developed the spreadsheet to meet members of the CCG and TMBC to walk them through the process. They were impressed with the level of detail being developed in support of the proposals locally and requested a second visit. This has given further confidence in the process and to the teams who must translate this work into potential contractual information. The final LSS output will be shared with the appointed team when they arrive in November as it will be important commissioners are clear where they believe all services must or should be provided from. Confirmation as to the final outcome of this work will be included in the December Board paper.

17. Discussions are ongoing as to the clinical model within THFT. This is critical to the overall quality and viability of the programme and its implications on the OBCs at this time are unknown. We are mindful that the team appointed by Monitor will shortly be in the community and we agreed to have this signed off by the time of their arrival. This will be a priority in the coming weeks and will be progressed via Chief Executives and clinical leads.

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Next Steps 18. As can be seen from the above the detail surrounding the mobilisation of the

programme is well underway. Decisions in respect of commissioning models and timescales will be subject to ongoing discussions.

19. In addition, the outcome of the piece of work sponsored by Monitor - assessment of

the commissioner’s ICO model and the capacity and capability of the economy to deliver a change programme of this scale - will have a bearing on our plans going forward. We will continue to press on and meetings are planned with the appointed team to ensure wherever possible existing meetings and reporting structures are utilised.

20. As we come to the end of the calendar year and the work of the programme becomes “mainstream” it may be timely to review the governance structure of the programme in the New Year. This was raised at the Transition Board as although we have been careful not to cut across the sovereignty of each organisation’s internal governance structure this is not always easy and we may inadvertently cut across a timeline. This will be discussed with the appropriate governance lead form each organisation with any proposed changes coming back to each Board.

21. As part of our forward plan to put in place the necessary steps and building blocks that will result in system reform the CCG has arranged for COBIC, a market leader in outcome based commissioning, to facilitate two workshops that will inform commissioner thinking and planning on how to get the best from outcome based commissioning, this will be open to staff from the three T & G organisations.

22. As discussed at various meetings over the past few weeks our window of opportunity to sign off key aspect of the programme is closing. There are approx. 9 weeks left until the end of the calendar year (at the time of writing). In that time we need, as minimum, to: To agree and sign off the joint vision statement for the economy; Agree the clinical model at THFT and any impact this may have on the OBCs; Map all interdependencies of the OBCs and sign off a critical path; Agree the commissioning model and our approach to establishing the “most

capable provider” to ensure we deliver enhance patient care; To agree any interim contractual relationships in respect of the OBCs that will

complement the longer term vision for the economy; To agree the basis of the pooled budget (including any phasing) and the model

that will be used e.g. Section 75 and its hosting arrangements; To ensure there is a joint communications function / plan across all three

organisations so that patients and wider public hear one joined up message from the care economy;

To receive an interim report from the Monitor appointed team that will indicate the independent view of our proposals so we can commence the new year fully committed to delivering the vision;

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To ensure business continuity is maintained over the winter months and that plans are in place to continue to deliver against existing targets and responsibilities.

To keep patients, carers and families at the heart of our decision making to provide a care sector that is reflective of their needs and integrated in its approach and affordable within the public purse.

23. The development of primary care and the role that it has in the future provision of

care services in Tameside & Glossop cannot be underestimated. This is an important aspect of the Care Together Programme and linked to the clinical model in the hospital; out of hospital care is critical to the overall success of our plans; it is reflected in national policy and has gained greater emphasis with the publication of NHS England’s Five Year Forward View.

24. This is being taken forward within the CCG and over the coming weeks and months

the outputs from this work must be dovetailed into the overall plan and timetable for Care Together. It is acknowledged that change is also taking place within Primary Care with the development of GP Federations; groups of practices coming together to further the development of Primary Care both in the delivery and bidding for services. The outcome and success of these proposals locally will have a fundamental bearing on the Care Together Programme.

25. This is a marathon not a sprint and we must continue to demonstrate our progress to

our community and partners. The Transition Board and Delivery Unit are fully aware of the above deliverables and their agendas will reflect this.

26. The Governing Body is asked to :

a. Note the progress of the Care Together Programme; b. Note the appointment of the Consultation Institute to provide an independent

assessment of the programme’s engagement with the public; c. To support the key deliverables over the next 9 weeks and where possible

ensure they are being progressed; d. To receive a further update at the December meeting.

Doreen Hounslea Programme Director November 2014

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Title of Subject:

Integrated Governance, Audit and Risk Committee

Date of paper:

October 1st 2014

Prepared By:

Graham Curtis

History of paper: Latest in the series of regular reports to the Governing

Body.

Executive Summary:

To update the Governing Body on the key issues

arising from the meeting on October 1st



(for Discussion and

Decision)

To receive the draft minutes.


Graham Curtis

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1

DRAFT

NHS TAMESIDE & GLOSSOP CCG

INTEGRATED GOVERNANCE AUDIT & RISK COMMITTEE

1 October 2014

PRESENT Graham Curtis – Chair

Yvonne Pritchard – Lay Advisor

Celia Poole – Lay Member (part)

Dr Richard Bircher – Governing Body GP

Lesley Surman – Lay Advisor

Jean Hurlston – Lay Advisor

IN ATTENDANCE Mark Heap – External Audit (from agenda item no 6 onwards)

Gareth Mills – External Audit (from agenda item no 6 onwards)

Lisa Warner – Internal Audit


David Walsh – Financial Consultant


Dr Alan Dow – Governing Body Chair

Lindsey Hulme – CSU – Financial Accounts

Lynn Jackson – for Agenda Item No 4

Paul Hague – for Agenda Item No 10.3

Joanne Keast – Admin Support

RISK

1. Action and matters arising from risk element of the minutes of 6 August

2014

All actions have been undertaken relating to the risk register.

2. Corporate Risk Register

DW explained that the risk register is now reviewed on a regular basis

through BIG (Business Implementation Group) and a separate meeting

of DW and GC. DW explained that there have not been any

fundamental changes or score changes since it was last presented. If

anyone has any questions they should be raised direct to DW.

3. Governing Body Assurance Framework

DW presented and explained that the CCG needs to agree the

Assurance Framework before December. Given timings of meeting he

requested GC takes Chair action in liaison with Alan Dow as Governing

Body Chair to agree the paper once it has been circulated for

comments to IGAR members. This was agreed by the Committee.

4. SIRI Monitoring Group

GC explained that the SIRI Monitoring Group no longer exists as the

monitoring is being done differently now. He explained that it is IGARs

job to monitor new and sign off SUI as they are required by the CCG.

Lynn Jackson (Nursing Directorate) attended the meeting and

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presented a paper. She explained that she meets with TFT regularly

along with colleagues from CSU. The Committee asked about Pennine

Acute as they do not appear on the schedule, nor do Central

Manchester or Stockport FT. LJ confirmed that she would speak to CSU

colleagues to see how this information can be included for the future.

The Committee requested this as a standing item and therefore LJ would

be requested to attend future meetings. JK agreed to send LJ dates of

future meetings.

Action: LJ to speak to CSU colleagues

JK for future dates

Thanks were expressed to LJ for attendance.

AUDIT - External Audit joined the meeting.

5. Apologies

Clare Symons – Governing Body Nurse / Caldicott Guardian

Tracey Simpson – Deputy CFO

6. Declaration of Interest

DW declared an interest in Agenda Item No 11.2 - Waivers.

7. Minutes of Previous Meeting held on 6 August 2014

Approved as a correct record.

8. Matters Arising / actions

Matters arising - Agenda Item No 6 – Minutes of previous meeting 2 April

2014 (Fraud issues – NHS England)

GC had not yet gathered a response but would speak to SA and report

back.

Action: GC

Matters Arising – Agenda item No 11 – Internal Audit

GC confirmed that meetings between him and internal audit are being

set up.

Agenda Item No 11 - Register of Waivers

CP requested the breakdown of monthly / daily rate entered on the

waiver register.

Action: JK / DW

External Audit confirmed that they had completed the work on Waivers

and would be presented later in the agenda.

Agenda Item No 11 – Register of Interests

DW confirmed actions had been completed and would be presented

later in the agenda.

CP entry amended as instructed.

Agenda item No 12 - Counter Fraud

JK confirm that the Fraud Policy will be presented to the December

meeting.

Action: JK / Beric Dawson

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Agenda Item No 15 – Self Assessment Checklist

A requirement of IGAR Chair is to appraise its members. GC is in the

process of finalising dates for RB and Clare Parker.

Agenda item No 16- IGAR Annual Report

GC confirmed the IGAR Annual Report has been presented to

Governing Body.

Agenda Item No 17 – Business Continuity Plans

Would be covered later in the agenda.

9. Training Reports from Committee Members

GC reported that he is due to attend and Audit Chair’s NHS England

event on 21 October in Manchester.

10. NWCSU Assurance

10.1 General Assurance

KR explained that there is a workshop scheduled for Friday to review the

make, share, buy intensions which both KR and Steve Allinson are

attending. The CCG are holding an internal meeting of CMT / BIG on 20

October to review our intensions / options. GC asked about the

implications should the number of organisation buying change.

Although this is still under discussion it was noted that CSU as from today

is a much bigger organisation which may impact on pricing.

10.2 Finance Assurance - Lindsey Hulme presented this item.

LH reported that the full time embedded CSU staff arrangements are

working well and have integrated as part of the team. She also

reported that as of today GMCSU no longer exists and is now known as

North West CSU. The Committee were re-assured that LH is working on

the structure of the new organisation for financial accounts. Other CSU

services were being discussed at present and the Committee would

continue to be updated at each meeting. LH will now be attending this

meeting on a regular basis.

10.3 Information Governance Assurance – Paul Hague presented

this item

PH outlined the work still to be finalised for the CCG regarding

identification of Asset Owners. He would report to future meetings on the

clarity and agreements reached. It was confirmed that the IG policy

review will be included within the CCG policy review timetable. The IG

Policies have been reviewed and once the new IGAR ToR have been

approved IGAR will be responsible for IG policy approval. It was agreed

once ToR are approved (later in this agenda) the policy would also be

approved. PH confirmed that everything required for the year end

submission is on track and will be actioned. PH agreed to speak to DW

regarding triggers for reviewing policies to ensure IG is taken into

account.

Action: PH / DW

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11. CCG Reports

11.1 Losses & Special Payment Register – nil return

11.2 Register of Waivers

GC reported that he has been involved in 2 waiver issues; one

relating to Hyde Locality and the other Stalybridge Locality with

regards over 75s business cases. He explained that he has done an

in-depth review of the Hyde waiver as they have appointed an

external partner, New Charter and there will be money going to

GPs to run a steering group all of which GC requires assurance on.

It was suggested that a review is undertaken in February to look at

VFM and performance. CW explained that the review will focus on

quality not quantity and will go back to PIQ. AD noted GC

thorough review. GC agreed to write to GPs to ask about progress

over the next few months.

Action: GC

A general discussion took place regarding expectations at the

beginning etc. KR added that this is a brand new innovation and

we need to take account of this during this process. External Audit

would support a letter being sent out to check on progress and a

review in February but took on board KR comments.

With regards Stalybridge Locality, there are 6 practices involved in

a similar process but with Age UK. There will be a meeting with

GC/External Audit/ KR /TS to go through processes.

11.2.1 External Audit Waiver Report

GM presented the report and explained T&G CCGs position

against other clients they have in the north. KR explained that she

would expect to see a higher number of entries on our register as

we have the innovative and unique care together programme.

There were some concerns over the number of CHC and IT issues

which appear on other organisations waiver register, GM was

asked to clarify as the committee didn’t feel the need to enter

CHC costs as they are another form of expenditure of healthcare.

The issue relating to tax for consultants was also raised and KR

agreed to liaise with Kate Calder regarding this to ensure we

comply with all tax process

Action: KR to speak to Kate Calder

It was felt that the IGAR Chair should be involved in the waiver

process as soon as possible for all cases and that a new waiver

should be drawn up for each financial year (if a waiver crosses a

financial year).

11.3 Register of Interests – noted.

DW explained that Internal Audit have made comments which he

will take on board and amend accordingly. The mitigation element

of entries has started to be completed for members, this is obviously

and ongoing issue and will be kept up to date. The Committee

requested the print on A3 size for the future.

11.4 Gifts and Hospitality – no updates.

11.5 Policy Review – noted.

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DW explained the spreadsheet and that BIG now monitor the

review of policies. The work plan will be updated for the next

meeting to include dates agreed and review dates.

Action: DW

11.5.1 Conflicts of Interest

Views from Auditors have been noted and will be included on the

final version. Members are asked to provide any comments back

to GC before the next meeting.

Action: All members / DW to update with GC

11.6 Business Continuity

The Finance Business Continuity plans were presented but to date

no others have been received although we are led to believe they

exist. DW agreed to chase up for the next meeting. DW explained

that the Finance plans include the details of what happens locally

should they be required.

Acton: DW

11.7 Scheme of Delegation – no updates

12. Performance Issues

GC gave the background to the new standing agenda item as the

Committee is required to hold Directors to account to what happening

within their area of work.

12.1 Care Together

KR gave a brief update. She explained that the governance

around Care Together has been reviewed and would provide a

much more detailed update at the next meeting when time

was not such a constraint.

Action: KR to update / JK for agenda

12.2 Transformation Update

CW gave an update on the workload of the Transformation

directorate:

9 business cases have been through the governance system

with phase 1 and 2 being presented to PIQ and signed off by

Governing Body.

Reviewing contracts to possible serve notice on those which

do not build into the ICO and look at possible changes in

providers in line with ICO

Working with Robin Monks looking at Strategic Estates. An

outline estates plan was submitted last week with a very short

turnaround time. This will build into the Strategic Estates plan

which will again be discussed at CMT before being presented

to a sub committee. GC requested a copy of the plan when

circulated around CMT.

Elective and non elective pressures - Capacity and resilience

monies are in place to support the system which requires

£1.7m. This is in line with Care Together plans.

2 new members of staff have commenced within the

Directorate – Wassiem Rafique and Alan Ford

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6

About to start the 15/16 contract round

BCF submission was completed on time with thanks to the

hard work of both the transformation and finance teams.

Primary care agenda / commissioning primary care – the

Governing Body is required to develop a Primary Care

Strategy. CW confirmed that the interviews for the Primary

Care Commissioning Role will be held on Friday 3 October.

Required to attend a meeting at NHS England explaining why

the targets were not med in July. CW explained that this was

a result of inadequate staffing levels at certain times at TFT.

The Trust will also be attending the meeting.

Perfect week in October – the main focus will be on urgent

care pathway

13. Counter Fraud

Deferred

14. Internal Audit

14.1 Internal Audit Progress Report

LW presented and explained that they are doing an audit on CHC with

the draft report to be issued shortly; they also have plans for the Care

Together work. All recommendations have been cleared; thanks were

expressed to DW/TS and the team. GC supported the appendix

timetable and the committee noted the report.

14.2 MIAA Briefing Papers – Noted.

15. External Audit

15.1 Progress Report

GM presented the progress report, explaining that planning is underway

for 14/15. He also explained that he has a meeting scheduled with

Tracey Simpson and Ben Jay from TMBC regarding ICO. The timetable

was noted as well as emerging issues with Monitor etc. Discussions are

underway with finance colleagues for accounts audit and LH asked if

she (CSU) could be involved in those. The report was noted by the

Committee.

16. Risk Management and Framework

DW explained that this needs to be reviewed by the Committee on an

annual basis and everyone needs to be sighted on its review. This was

for noting at this stage and will be brought back to a future meeting.

Noted.

17. Review of Audit Committee Handbook

GC reported that he had met with DW and reviewed the handbook

and made appropriate changes in the work plan to reflect best

practice. DW thanked Auditors for their documents.

18. Review Terms of Reference and Work Plan for IGAR

Work plan - deferred

Terms of Reference – agreed

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19. Review Constitution including Terms of Reference for all Sub Committees

The CMT Terms of Reference are being finalised and it was agreed that

they would be approved by Chair’s action. All other ToR reference

were noted and recommended for approval by Governing Body.

Action: GC


No other business was raised.


Wednesday 3 December 2014, 9.30 am Boardroom, NCH.

95


Title of Subject: Delivering Excellence, Compassionate, Cost Effective

Care – Governing Body Performance Update.

Date of paper: 30/10/14

Prepared By: Louise Roberts / Elaine Richardson

History of paper: Regular Updates are presented on a monthly basis to

Quality and CCG.

Executive Summary: This paper includes:

An update on current CCG performance

Our performance against our 2013/14 Prospectus

Our patient friendly dashboards

The dashboard summaries for Pennine Care FT and

Stockport FT and the quality report for Tameside FT



(for Information, Discussion

or Decision)

Governing Body are asked to note the

performance and identify any areas they would

like to scrutinise further.

Governing Body are asked to note the progress on

the development of the dashboards.


by proposal:

Delivery of NHS Tameside and Glossop’s Operating

Framework commitments for 2014/15.


Elaine Richardson/Clare Watson

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1

Delivering Excellence, Compassionate, Cost Effective Care

Governing Body Performance Development Update

November 2014

1. Introduction

1.1 This paper provides an update on CCG performance summarising the

current performance and how well we delivered on the outcomes we

aspired to in our 2013/14 Prospectus.

1.2 It focuses on the patient friendly dashboards and includes the

September dashboards that will be published so we can gain final

feedback from the public and partners.

1.3 The dashboard summaries for Pennine Care FT and Stockport FT and the

quality report for Tameside FT (THFT) are also included.

2 Current CCG Performance

2.1 There is currently a sharp focus from NHSE on delivering the A&E 4 hour

and Referral To Treatment Operational Standards. The expectation is

that we will support our providers in achieving the A&E 95% standard

from October 2014 to March 2015 and deliver an overall year position at

or above the 95% standard. The expectation for the Referral To

Treatment standards is that all three, Incomplete 92%, Non Admitted

Completed 95% and Admitted Completed 90% , will be achieved and

maintained at aggregate level from December 2014.

2.2 To enable the above, additional funding has been made available to

support non-elective plans and additional elective activity. An amnesty

has been agreed for Referral To Treatment standards for July to

November to account for the treatment of long waiters (over 18 weeks).

2.3 Across all our providers 487 of our patients who were long waiters were

treated during September which is 211 more than in 2013.

2.4 Since July we have seen 1092 long waiters treated, the majority being in

those specialities where local trusts asked for additional funding. These

are highlighted in yellow in the table below.

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2

Speciality Completed pathways over 18 weeks

(Jul to Sep 2014)

Cardiology 24

Cardiothoracic Surgery 1

Dermatology 34

Ear, Nose & Throat (ENT) 116

Gastroenterology 23

General Medicine 18

General Surgery 143

Geriatric Medicine 1

Gynaecology 137

Neurology 0

Neurosurgery 3

Ophthalmology 63

Oral Surgery 0

Plastic Surgery 7

Rheumatology 19

Thoracic Medicine 7

Trauma & Orthopaedics 260

Urology 56

Other 180

Total 1092

2.5 We are still unable to be sure that the number of people waiting over 18

weeks on incomplete pathways is dropping at THFT. Unfortunately, the

reduction we saw in August at our other providers has not been sustained.

2.6 Neurology is the only speciality where none of our patients who have not

yet been treated are waiting over 18 weeks.

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3

2.7 The above activity means that for September; 82.43% of our patients on

admitted pathways were treated in less than 18 weeks and 94.82% of our

non-admitted patients. 93.84% of our patients (not at THFT) who have

not yet been treated have been waiting less than 18 weeks.

2.8 Whilst seeing a slight improvement in our Diagnostic performance we are

still failing the standard at 1.38% particularly in endoscopy where 30

patients waited over 6 weeks. THFT, Central Manchester, Salford and

South Manchester all have patients waiting over 6 weeks.

2.9 Some AQP providers are still unable to submit activity to UNIFY but even

with the additional activity which is generally delivered within 4 weeks

we would not achieve the maximum 1% greater than 6 week standard.

2.10 We achieved the cancer standards except for the ‘62 day wait from

referral from NHS Cancer Screening Programme for suspected cancer to

first definitive treatment.’ We had one patient following bowel screening

who was not treated within 62 days and as there were only three

patients treated in total this resulted in failure of the standard.

2.11 THFT A&E performance was below standard in September at 94.98% and

Quarter 2 was failed at 93.22%. The performance has improved in

October 95.12% as at 28th October and the year to date is 94.45%. We

need to deliver an average of 95.5% for the rest of the year to recover

the standard.

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3 2013/14 Prospectus Outcome

3.1 We were required in 2013/14 to publish a prospectus and we developed

this, in line with our principle of ‘Listening to Patients’, with patients from

several Patient Participation Groups (PPGs). In our prospectus we

described what we planned to do and what we needed patients to do

to achieve a set of outcomes that would deliver the longer healthier lives

described in our vision.

3.2 We set the ambition for our outcomes from our aspirations for 2017 and

we made a commitment that we would publish how well we achieved

the outcomes we set out in our prospectus.

3.3 We had planned to provide updates throughout the year however it

proved impossible to obtain in year data for some of the outcomes we

had chosen.

3.4 We have now been able to provide a performance report that shows

how well we have done on all the outcomes in our prospectus. Some of

the public health measures use Tameside as a proxy, as the transfer of

Public Health to the separate local authorities has meant we are unable

to easily report on a Tameside and Glossop basis. One of the End of Life

outcomes cannot be measured at a local level so we have provided an

update of the training we have done to deliver care plans rather than

how many people have care plans.

3.5 The performance report can be found in appendix 1. It will be published

on the website and sent to PPGs.

3.6 We have made significant progress in a number of our Clinical

Challenges but none have been fully achieved and for some we face a

number of challenges to deliver the improvements in our services and

the outcomes they deliver. Our vision for longer healthier lives remains

and as we move into Care Together our commitment to supporting

people to remain well and able to live in their own homes we will

continue to strive to deliver the outcomes below.

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4 Patient Friendly Dashboards

4.1 Following further feedback from PIQ and patients, the patient friendly

dashboards are ready for initial publication and testing.

4.2 This initial release uses the national definitions for the key indicators

selected as this enables patients to compare local performance against

others on national websites. With this release we will be asking PPGs and

our focus groups to use the dashboards and feedback on how easy

these definitions are to understand. We will also be capturing more

general feedback on how easy the dashboards are to use and their

usefulness.

4.3 The dashboards are designed so people can select which of the five

performance areas they want to look at.

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4.4 The appropriate dashboard will then be displayed. The initial view will be

that of the CCG (latest versions can be found in appendix 2) but people

will be able to select each of the three main providers THFT, Central

Manchester and Stockport. The latest data available will be displayed

for each indicator which means some will be refreshed monthly, some

quarterly and some annually.

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7

4.5 Where possible a T&G patient perspective is given. However, this is not

possible for all indicators e.g. A&E. Following discussion at GB and PIQ a

decision was taken it was too confusing to explain on the dashboard

which data was T&G patients, which was a provider’s patients and

which was TMBC residents and to just show the most appropriate data.

4.6 The definition for each indicator can be accessed by clicking on the

indicator. There is also an explanation on this screen about whether the

data is T&G patients, provider patients or TMBC residents.

4.7 From the dashboard people can also access additional patient

comments. These will be sourced from ‘Patient Opinion’on a quarterly

basis. Should the number of comments increase dramatically only the

most recent ones will be extracted to the dashboards to avoid them

becoming unweildly. There will also be links to NHS Choices and other

relevant websites with patient comments.

4.8 There are still some outstanding issues around whether the dashboards

can be made available on our website before the end of November.

However, if this is not possible we will ask the practices who have been

invoved in their development to host them so they can be published and

tested as soon as possible.

4.9 We will contact PPGs and other patient groups to ask them to use the

dashboards both interactively and the printed version and provide

feedback on a range of areas. This feedback will be collated at the end

of December and used to focus further development.

103

8

4.10 The next version release planned for February/March will contain

summary plans that will show how we are working to sustain or improve

performance. We expect that these plans will be acessed by clicking on

the smiley face.

4.11 We also hope to have resolved how to enable pataients to raise queries

about the perfromance or services as we want the dashboards to

prompt a desire for futher information and develop our patients as

partners in our commissioning.

5 CCG Assurance

5.1 We are still awaiting feedback from the Quarter 1 assurance meeting.

However, planning is taking place for the Quarter 2 meeting which is

scheduled for 26th of November.

5.2 Greater Manchester Local Area Team (GM LAT) have indicated they

would like to discuss the following

Winterbourne

CHC funding

Tuberculosis

CCG governance arrangements

Emergency Preparedness, Resilience and Response assurance

Activity and planning

5.3 We have asked for a discussion on Care Together and what we need to

do to move to ‘Assured’ rather than being ‘Assured with Support’.

6 Provider Performance

6.1 The performance dashboards for Stockport FT and Pennine Care and

included along with the quality report for THFT (appendix 3).

Performance issues are being raised through contract quality and

performance meetings.

6.2 CSU are developing a single report that includes our three main

providers. It is anticipated that this will be available for the December

GB meeting.

7 2014/15 Dashboards

7.1 The Central BI dashboards are still not available for use. The main

indicators are covered but some areas are still not functioning correctly.

We are seeking assurance that the data available through the

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9

dashboards will support our more integrated approach to service

delivery.

8 Recommendation

8.1 Governing Body are asked to note the performance and identify any

areas they would like to scrutinise further.

8.2 Governing Body are asked to note the progress on the development of

the dashboards.

105

Indicator How we performed (latest data available)

9 out of 10 mothers booked into maternity services within the first 12 weeks of pregnancy J 9 out of 10 mothers booked into Maternity Services.

55 less mothers smoking at their time of delivery J There were 116 less mothers smoking.

Five less babies weighing less than 2.5Kg when born J There were 13 less babies in 2012 weighing less than 2.5kg.

At least 1000 of our babies breastfeeding at 6 to 8 weeks L 756 out of 3180 babies were breastfeeding at 6-8 Weeks old.

More children and parents getting help on mental health when they need it J There were 5595 New Contacts to Children's Mental Health Services.

Most of our children continuing to have the recommended vaccinations J Almost 94 out of 100 Children had the recommended Vaccinations.

2000 less adults smoking L There were 1258 less adults smoking.

Less than 5000 people in hospital because of alcohol use L There were 9491 people in hospital because of Alcohol.

900 adults who have lost weight and are no longer obese L There were 282 people attending our services who lost weight and are no longer obese in 2012/13.

Men living on average to 77 years K Male Life Expectancy in 2011 was 75.9 years, Office of National Statistics (ONS).

Women living on average to 81years K Female Life Expectancy in 2011 was 80.5 years, Office of National Statistics (ONS).

64 more people with Dementia recorded on a GP register J There were 280 more people on the Dementia Register.

One in three people with learning disabilities attending an annual health check K Just under 1 in 3 people with Learning Disabilities received an Annual Health Check in 2012/13.

One in three people with learning disabilities attending cancer screening L Less than 1 in 3 people with Learning Disabilities were screened for Cancer in 2012/13.

1500 more people supported by mental health services J There were 10851 New Contacts to Mental Health Services.

18 less people under 75 years old dying from CVD LThere were 13 less people under 75 years in 2012 dying from Cardiovascular Disease, Office of National

Statistics (ONS).

All our GPs recording more people with a long term condition on a register so they can invite them for

check ups J There were 2630 new patients with Long-Term Conditions recorded on the GP Register.

At least 235 people with respiratory disease stopping smoking J 291 people with Respiratory Disease stopped smoking.

Five less people under 75 years old dying from respiratory diseases LThere were 4 less people under 75 years in 2012 dying from Respiratory Diseases, Office of National Statistics

(ONS).

2013-14 Prospectus Indicators Report - T&G CCGC

hild

ren

& F

am

ilies

2013/14

Life

styl

e C

ho

ices

2013/14

Men

tal H

ealt

h

2013/14

Lon

g T

erm

Co

nd

itio

ns 2013/14

106

Indicator How we performed (latest data available)

Four out of five women invited going for Breast cancer screening L 3 out of 5 women were screened for Breast Cancer in 2012/13.

Four out of five women invited going for Cervical cancer screening L 3 out of 5 women were screened for Cervical Cancer in 2012/13.

Seven out of ten people sending back their bowel screening kit samples L5 out of 10 people sent back their Bowel screening kit samples and were screened for Bowel Cancer during the

first 9 months of 2013/14.

People turning up for 19 out of every 20 appointments L People turned up for 18 out of every 20 Outpatient Appointments.

95 out of 100 people being treated within 18 weeks J 96 out of 100 people were treated within 18 weeks for Non-admitted pathways.

Ten less people a day going to A&E when they could have been treated elsewhere J 17 less people a day turned up to A&E.

Five less people a day going to hospital when they could be treated at home J There were more than 8 people supported in the community instead of going to accident and emergency.

Elderly patients leaving hospital earlier and being treated at home or in a specialist centre L Elderly patients spent 1 day longer in hospital.

People dying in comfort and with dignity L 46 out of 100 people died in Comfort and with Dignity in 2011/12.

At least two in five people dying at home if they want to L Less than 2 in 5 people died within their own home in 2013.

More patients writing down their wishes about the care and treatment they want at the end of their life LHealth and social care end of life training is currently taking place. Numbers of patients with plans is not

currently available at a local level.

End

of

Life

2013/14

Pla

nn

ed C

are

& C

an

cer

2013/14

Urg

ent

Ca

re

2013/14

107

How quickly are patients seen? How healthy are we?

NHS Tameside and Glossop Performance Information for Patients

click on the boxes below to find out more information

How good are we at identifying conditions?

How safe are patients within our care?

What do patients say about our services?

108

Urgent Care WaitsTarget Outcome

A&E Patients are seen within 4 Hours 95.0 % 94.4 %

Ambulance reaches the patient within 8 minutes 75.0 % 70.5 %

Ambulance Handovers to Hospital Staff are within 30 minutes 2 375

Patient comment - "Sent to TFT A&E by GP. Seen within 20 minutes. Cannot praise the Nurses and Auxiliaries enough, They were brilliant and professional."

Cancer WaitsTarget Outcome

Urgent Cancer Cases Seen from Referral within 2 weeks 93.0 % 97.1 %

First Cancer treatment from Diagnosis within 31 Days 96.0 % 98.3 %

First Cancer treatment from Urgent Referral within 62 Days 85.0 % 88.5 %

Patient comment - "Presented at GP’s upon finding a lump in breast, referred straight away to TFT and appointment received for one week later. Had tests, examinations etc, results given

same day. Surgery couple of weeks later. Couldn’t have wished for ………...Click for further Comments

Referral To Treatment WaitsTarget Outcome

Admitted Patients wait less than 18 weeks for Treatment 90.0 % 88.5 %

Non-Admitted Patients wait less than 18 weeks for Treatment 95.0 % 96.5 %

Patients Currently Waiting less than 18 weeks for Treatment 92.0 % 94.1 %

Patient comment - "Patient reported that she was referred to a specialist for a sinus problem but has been informed it might be October before her 1st apt." ………...Click for further

Comments

Diagnostic WaitsTarget Outcome

Patients wait less than 6 weeks for ALL Diagnostic Test 99.0 % 98.49 %

Patients wait less than 6 weeks for an Endoscopic Diagnostic Test 99.0 % 96.99 %

Patients wait less than 6 weeks for a Non-Endoscopic Diagnostic Test 99.0 % 98.78 %

No comments at present

TAMESIDE & GLOSSOP CCG

Return to Main Menu

Sep-14 YTD

How quickly are patients seen?

109

Annual Vaccinations / ImmunisationTarget Outcome

Proportion of Children having the Recommended Vaccinations 90% 86%

Proportion of girls having the Cervical Cancer Vaccinations 90% 93%

Proportion of People over 65 having the Flu Vaccination 75% 76%

Health InequalitiesTarget Outcome

Annual Percentage of Adults that Smoke21% 24%

Number of Hospital admissions related to Alcohol 515 756

Annual Percentage of Adults and children that are Obese 12% 13%

Annual Healthy Life ExpectancyTarget Outcome

Average Potential Years of Life Lost for every 100 People 2.1 3

Average Healthy Life Expectancy - Males63 57

Average Healthy Life Expectancy - Females64 56

Annual MortalityTarget Outcome

Number of Under 75s dying from Cardio-Vascular Disease 138 203

Number of Under 75s dying from Cancer259 322

Number of Under 75s dying from Respiratory Disease 57 76


Return to Main Menu

Sep-14 YTD

How healthy are we?

110

Cancer SupportTarget Outcome

The Percentage of Cancer Patients Referred to Macmillan Nursing within 10 days of Referral 90 % 94 %

The Percentage of Urgent Cancer Patients Referred to Macmillan Nursing within 24 Hours of Referral 95 % 100 %

Percentage of Cancer Patients' Pre-Treatment data discussed and recorded by the Cancer Team 90 % 73 %

Mental Health SupportTarget Outcome

Percentage of People with Depression or Anxiety receiving Psychological Therapies 3 % 2 %

Percentage of People Completing Treatment and moving to Recovery 50 % 35 %

Percentage of Patients Discharged from Inpatient Care who are followed up within 7 days 95 % 100 %

Diagnosing Long-Term ConditionsTarget Outcome

Number of new diagnosed Patients of Atrial Fibrilation 108 494

Number of new diagnosed Patients of Diabetes649 1169

Number of new diagnosed Patients of COPD308 967

Health ChecksTarget Outcome

The number of people with Learning Disabilities receiving a Health Check 572 236

Diagnosis Rate for people with Dementia58.5 % 56.3 %

The Percentage of Dementia cases identified for Patients aged 75 and over 90.0 % 92.0 %


Return to Main Menu

Sep-14 YTD

How good are we at identifying & supporting health conditions?

111

Patient Experience of Personal Needs MetTarget Outcome

Did Patients get enough emotional support from Staff? (Score out of 10) 7 7

Did Eligible Patients get enough help from Staff to eat their meals (Score out of 10) 7.2 7.2

Did Patients feel they were treated with Dignity and Respect (Score out of 10) 8.8 8.8

Patient Experience of Primary CareTarget Outcome

Percentage of Patients having a Good Overall Experience of their GP Service 86 % 85 %

Percentage of Patients having a Good Overall Experience of their GP Out-of-hours Service 66 % 70 %

Percentage of Patients having a Good Overall Experience of their Dentist Service 84 % 84 %

Please click to go to NHS Choices web site

Patient Experience of Hospital CareTarget Outcome

Percentage of Patients who would recommend A&E Services to Family and Friends 86 % 79 %

Percentage of Patients who would recommend Inpatient Services to Family and Friends 94 % 94 %

Percentage of Patients who would recommend Maternity Services to Family and Friends 94 % 98 %

Please click to go to NHS Choices web site

Complaints and ComplimentsTarget Outcome

Number of Complaints Received from Patients187.5 197

Percentage of Complaints Acknowledged within 3 working days 95 % 99 %

Percentage of Complaints Responded to within agreed timescales 90 % 73 %


Return to Main Menu

Sep-14 YTD

What do patients say about our services?

112

http://www.nhs.uk/Pages/HomePage.aspx

http://www.nhs.uk/Pages/HomePage.aspx

Health and SafetyTarget Outcome

The Percentage of Staff that would recommend the Hospital as a place to work or receive Treatment 65 % 64 %

The Percentage of Staff receiving Health & Safety Training in the last 12 months 75 % 71 %

The Percentage of Staff who stated that the Incident Reporting Procedure is Fair and Effective 62 % 61 %

Incidents and HarmTarget Outcome

Number of Never Events Occuring0 1

Percentage of Patient Safety Incidents that are harmful 29 % 16 %

Potential Under-Reporting of Patient Safety Incidents resulting in Death or Severe harm 27 13

Healthcare Infections (HCAI)Target Outcome

Number of MRSA Infections 0 1

Number of C-Difficle Infections 33 34

Number of E-Coli Infections 33 54

Risk AssessmentsTarget Outcome

Percentage of Admitted Patients that are Risk-Assessed for VTE 96 % 96 %

Percentage of Admitted Patients that are Risk-Assessed on Nutrition 90 % 92 %

Percentage of Admitted Patients that are Risk-Assessed for Psychosis 96 % 93 %


Return to Main Menu

Sep-14 YTD

How safe are patients within our care?

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4 month trend key:

Performance is improving

No change to performance

Decline in performance

Performance dashboard—T&G Community Healthcare (September 2014)

Patient safety ThresholdYTD

Actual

YTD

RAG

4 month

trend

In month

actual

In month

RAG

No. of Cdi ff cases with community provider contact - 13 - 0 -

No. of avoidable community acquired Cdi ff cases 1 1 G 0 G

No. of MRSA cases with community provider contact - 0 - 0 -

No. of avoidable community acquired MRSA cases 0 0 G 0 G

No. of GDH cases with community provider contact - 12 - 2 -

No. of avoidable community acquired GDH cases 0 0 G 0 G

No. of ful l RCAs with IP team input - 1 - 0 -

No. of reported incidents i s minimum 1100 per year 1100 1146 - 168 -

No. of incidents categorised as a medication error - 61 - 4 -

No. of incidents categorised as wound care - 426 - 70 -

Number of SUIs - 0 - 0 -

Duty of candour (included in StEIS reports and RCAs) - 38 - 9 -

Number of never events - 1 - 0 -

Total no. of patients with grade 2+ pressure ulcer - 288 - 51 -No. of patients in the inpatient unit with grade 2+

pressure ulcer (avoidable)<15 0 G

0 G

Rate of patients on a caseload with a grade 2 or higher

pressure ulcer

<50 per

100052.542 R 52.452 R

No. of patients in the inpatient unit who have a fa l l

resulting in moderate or greater harm<38 23 G 4 G

% of venous ulcer wounds (grades 2-4) that have healed <

16 weeks from start of treatment70% 51% R 69% R

HCAI

Incidents and never events

Harm-free care

Patient experience ThresholdYTD

actualYTD RAG

4 month

trend

In month

actual

In month

RAG

Complaints & compliments

Compla ints received by T&G patients - 17 - 4 -

Compla ints - % responded to within timescale 85% 91.00% G 0.0% -

Compla ints - % satis fied with outcomes 75% 85.70% G 0.0% -

Compl iments - 97 - 0 -

Staffing & tra ining

Staff turnover 13% 10.55% G 10.55% G

Sickness level 4% 4.78% R 4.35% R% of s taff tra ined to adult protection level 1 in past

12 months95% 98.02%

G 98.02% G

% of s taff tra ined in domestic abuse in past 12

months95% 78.27% R 78.27% R

% of s taff tra ined in infection control in past 12

months95% 98.02%

G 98.02% G

Health Vis i tors s taffing level (wte)** 61.30 53.30 R 53.30 G

Referra l to treatment times (RTT) - overa l l

18 week maximum waits 95% 99.92% G 99.87% G

6 weeks maximum waits - diagnotics 99% 100% G 100.00% G

*Please note, figure is for whole time equivalent staff level

Service specific KPIs - exceptions ThresholdYTD

Actual

YTD

RAG

4 month

trend

In month

actual

In month

RAG

Patients take up a pulmonary rehab programme 480 175 R 36 R

75% of patients taking up complete the course 75% 60.2% R 35.7% -

70% of venous leg ulcers heal within 16 weeks 70% 51.2% R 58.7% R

Pulmonary rehabilitation

Tissue Viability

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Summary narrative

1. Pulmonary rehab – In September 36 patients were referred for Pulmonary Rehabilitation against a target of 40 despite the actions within the remedial action plan

being completed. The cumulative position of 175 is still short of the year to date target of 240. Further initiatives have been identified and scheduled to try to improve

referral rates further.

2. Sickness level – In month staff sickness has decreased to 4..5% from 5.04% which is still above the threshold. Year to date is 4.78% against a threshold of 4%. This is the

second month in a row that sickness levels have decreased.

3. Pressure ulcers – rate of patients on a (DN) caseload with a pressure ulcer of grade 2 or higher has reduced from August 2014 and now stands at 52.5452, meaning the

year to date actual is also over threshold (50 per 1,000) at 52.5452. Provider is investigating the causes of it being above the target since the start of the financial year.

The total number of patients with a grade 2+ pressure ulcer (known to T&G CH staff) was 51 in September 2014, as opposed to 43 in August 2014.

4. Reported incidents – the number of reported incidents in September 2014 for CCG commissioned services was 168, which is slightly higher than August at 155. The

Provider has been encouraged to report incidents as much as possible for reasons of transparency, therefore this represents good performance.

115

T&G CCG - PENNINE CARE MH PERFORMANCE DASHBOARD - September 2014 ACTIVITY

**NB - Where data is reported both by CCG and by Borough by the Provider; the information in this report will be reported by CCG only.

Inpatient ActivityThreshold

YTD

Actual /

Average

YTD RAG

3 month

Trend /

Average

In Month

Actual

In Month

RAGService Specific KPIs

Threshold

YTD

Actual /

Average

YTD RAG

3 month

Trend /

Average

In Month

Actual

In Month

RAG

Admissions VSMR

Total Admissions - 284 - - 48 - No. of clients on caseload at month end* 117 - - ↘ 111 R

Transfers into RHSD Wards - 6 - - 1 - Early Intervention

CAMHS Admissions to Adult Wards (16-17) - 0 - - 0 - No. of New Cases of Psychosis 44 16 R ↘ 3 R

Gatekeeping complete 95% 99.1% G ↗ 97.4% G Patients in Assessment Phase - 13 - - 0 -

Readmissions No. of People with Psychosis being seen at month end - - - → 115 -

28 Day Readmissions - 39 - - 6 - Crisis Resolution

90 Day Readmissions - 59 - - 10 - Number of Assessments - 974 - - 129 -

Mixed Sex Accomodation Number of Crisis Resolution Episodes 587 974 - ↘ 129 -

MSA Breaches 0 0 G → 0 G Number of Individuals Treated by Crisis Resolution - 285 - - 38 -

Delivering Single Sex Accomodation Survey Results - 100% G → 100% G Health Visiting

Length of Stay (LoS) & Bed Days Number of CPA discharges - 103 - - 18 -

Average LoS (trimmed) - in days* - 59 - - 37 - No. of CPA Discharges followed up in 7 days - 103 - - 18 -

Average LoS (untrimmed) - in days* - 77 - - 82 - % of CPA Discharges followed up in 7 days 95% 100% G → 100% G

Adult Wards - Length of Stay >=100 days - 9 - - 7 - IAPT KPIs**

Older Wards - Length of Stay >=100 days - 7 - - 4 - % Entering into Treatment 3.25% - - - 2.43 ROccupied Bed Days inc home leave days (Adults and Older

People) - 9872 - - 2133 - % Moving into Recovery 50% - - - 32.56 R

Home Leave Days (Adults and Older People) - 722 - - 249 - **Prevalence and Recovery Data reported Quarterly - Data for Q1

Discharges

Total Discharges (Adults and Older People) - 256 - - 45 -

Delayed Discharges days - 255 - - 2 -

*Average LoS is presented as an average across Adults and Older People only Admissions

Total Admissions - 6 - - 0 -

CAMHS Admissions to Adult Wards - 0 - - 0 -

Readmissions

28 day readmissions** - 1 - - 0 -

Referrals & Appointments 90 day readmissions** - 1 - - 0 -

GP Referrals to Consultant - 6 - - 2 - Length of Stay (LoS) & Bed Days

Other Referrals to Consultant - 583 - - 93 - Average LoS (trimmed) - in days* - 29 - - 0 -

New Appointments - DNA Rate* - 14.48% - ↗ 21.97% - Average LoS (untrimmed) - in days* - 258 - - 427 -

Follow Up Appointments - DNA Rate* - 21.85% - ↗ 24.09% - CAMHS Wards - Length of Stay >=42 days - 10 - - 5 -

Waiting Times - Adults Occupied Bed Days (inc home leave days) - 1238 - - 130 -

Seen Within 5 weeks 50% 88% - ↘ - - Home Leave Days - 386 - - 36 -

Seen Within 11 weeks 100% 100% - → - - Discharges

Seen Within 13 weeks 100% 100% - → - - Total Discharges - 11 - - 1 -

Waiting Times - Older People *Average LoS is presented as an average across all units

Seen Within 5 weeks 50% 66.6% - ↘ 50.0% - **Nothing reported - requested clarity from Provider

Seen Within 11 weeks** - - - - - -

Seen Within 13 weeks** - - - - - -

*Please note, percentage given is for both adults and older people combined

**Not reported this month in performance report 3 month trend key: VSMR

↗ Performance is Improving No. of clients on caseload at month end* 117 - - ↘ 111 R

→ No Change to Performance Early Intervention

↘ Decline in Performance No. of New Cases of Psychosis 44 16 R ↘ 3 R

IAPT KPIs**

% Entering into Treatment 3.25% - - - 2.43 R

% Moving into Recovery 50% - - - 32.56 R

In month

actual

In month

RAGExceptions

Threshold

YTD

Actual /

Average

YTD RAG3 month

trend

YTD RAG3 month

Trend /

Average

In Month

Actual

In Month

RAGOutpatient Activity

ThresholdYTD

Actual /

Average

In month

actual

In month

RAGCAMHS Activity

ThresholdYTD

Actual /

Average

YTD RAG3 month

trend

116

1

Title of Subject:

Finance Report Month 06

Date of paper:

4th November

Prepared By:

Kathy Roe, Chief Finance Officer

History of paper:

Executive Summary:

The CCG is currently on track to meet all its key financial

duties as set out in Appendix 8.1.

The financial position at the end of month 6 is a surplus

Position of £4,999k. This is contributing to a planned

surplus position of £9,999k for the 2014-15 full year.

Running costs are forecast to remain within the running

cost allocation by the end of the year. However this will

become increasingly more challenging as additional

support is required to support the Care Together

programme. A separate running cost paper will be

presented at CMT.

Acute budgets are showing a forecast overspend of

approximately (£2,379k), with notable pressures at

Central Manchester FT (£1,177k), UHSM (£728k),

Pennine Acute (£193k). Some of these pressures are

offset by Tameside FT although, as discussed on page 3,

we are aware that activity there has increased during

September.



(for Discussion and

Decision)

To note the financial position as at Month 6 and the forecast

outturn at this date.

To note the level of risks identified within this report.

Care Together Sustainability

Plan principles addressed

by proposal:


117

2

1. Contents Page

No Item Page

2. 2.1 2.2 2.3 2.4

Income and Expenditure Summary Commissioning Acute Commissioning Non Acute Commissioning Primary Care

3

4-5 6 7

3 Care Together and Sustainability Plan 8

4 Referrals 9

5 Top Five Acute Dashboard 10-11

6 News Update 12

7 Financial Risks 13

8

8.1 8.2 8.3 8.4

Appendices Key Financial Duties Cost Centre Summary Breakdown of Acute spend by Provider Locality Report

14 15 16 17

118

3

2.1 Income & Expenditure Summary

Table 1: Summary of Financial Position

Key Movements in Forecast:

Acute – (£622k) adverse movement which is due to overspends at a number of providers Central Manchester FT (£237k), Stockport FT (£139k), Salford Royal FT

(£85k), Wrightington Wigan & Leigh (£97k). Although the Tameside FT forecast has not significantly changed this month, we are aware that activity may have

increased in September SLAM figures - we need to analyse this movement to fully understand the impact in terms of core contract versus Referral To Treatment

(RTT) and resilience funded work.

Mental Health - £200k favourable movement due to Mental Health CHC underspend - following a review of the care setting/clients within the service.

Running Costs – (£33k) adverse movement due to additional IT spend.

Reserves – Due to the continued pressures in secondary care, a further £785k has been committed from reserves to balance the overall financial position.

119

4

2.2 Commissioning Acute Table 2: Summary of Acute Financial Position

Table 3: Top 5 Acute Providers performance broken down by POD – M5 SLAM

A&E NEL EL/DC Mat/ NELNE

Crit Care

Outpts Other Total

TFT (52) (106) 1,088 331 126 (103) (797) 487

CMFT (13) (18) (192) 89 (169) (172) (58) (533)

SFT (11) (244) 120 (53) 61 (27) 320 166

UHSM (5) (115) (145) 19 6 (38) (31) (309)

PAHT 1 (50) 38 (25) (60) 31 (48) (113)

Total (80) (533) 909 361 (36) (309) (614) (303)

This is also illustrated graphically within section 5 of the report.

Acute Position Secondary Care activity is showing continued signs of being higher than planned contract levels (see Table 2) with a forecast overspend of (£2,378k). CMFT CMFT is currently (£533k) based on month 5 SLAM data (see table 3). Day case/elective activity is currently (£192k) overspent, which is due to pressures within Trauma and Orthopaedics (£53k), Gastroenterology (£43k), Gynaecological Oncology (£24k) and Paediatric Surgery (£25k). We are also experiencing pressures on outpatients (£172k), due to pressures within Ophthalmology (£74k) linked to the Lucentis pathway. There are further overperformances within Gastroenterology (£23k) and Nephrology (£20k).

Tameside FT TFT is currently £487k underspent based on month 5 SLAM data. The (£797k) overperformance within “Other” (see table 3) is due to activity that is currently uncoded (£715k) as notified by the Trust within the month 5 flex file. This will be correctly allocated across all points of delivery. Non elective admissions are currently overperforming by (£106k). This can be broken down into two elements:

Ambulatory care overperformance (£969k); and

Other NEL admissions underperformance £863k There is some positive news here as more emphasis is on the expansion of ambulatory care pathways, which is in line with our Care Together service redesign intentions. Ambulatory care pathways allow patients who are safe to go home to be managed promptly, without the need for admission to hospital. Ambulatory care tariffs are a more efficient tariff for the local health economy as these are based on the non elective same day tariff. Non elective excess bed days are overspending by (£663k) due to overperformances in General Medicine (£228k), Geriatric Medicine (£234k), General Surgery (£85k) and Trauma & Orthopaedics (£64k). 2014-15 plans were set based on 2013-14 activity levels. An in depth analysis of excess bed day activity will be completed and will be discussed further with the Trust.

120

5

2.2 Commissioning Acute– Vascular

Table 4:Vascular Activty at Tameside FT & UHSM in 2014-15

Activity Plan

Actual Activity

Activity Variance

Apr – Aug Plan

£000’s

Apr – Aug Actual £000’s

Variance £000’s

Tameside FT

59 19 40 215 26 189

UHSM 7 28 (21) 30 140 (110)

Total 66 47 19 245 166 79

Figure 1: Vascular Spend against Planned levels in 2014-15

UHSM UHSM is currently (£309k) overspent (see table 3) which is due to pressures within elective/day case (£145k), driven by overperformances in Vascular Surgery (£110k) and Plastic Surgery (£64k). Vascular

It has been noted in previous reports that vascular elective spend has been

on the increase against planned levels in 2014-15 and notably at UHSM with

a current overperformance of (£110k) as at month 5.

Following an in depth review of Vascular spend, there is clear link between a

fall in vascular activity at Tameside FT and the increase seen at UHSM.

Table 4 shows a consolidated position of the two providers as at month 5,

which shows a net underperformance of £79k.

2014-15 plans were based on the physical activity carried out in 2013-14,

therefore the activity shifts are causing noticeable variances in the monthly

accounts in 2014-15, and this is further illustrated within Figure 1.

This activity shift was anticipated, as it was agreed between providers to

shift vascular from Tameside FT to UHSM and plastics from UHSM to

Tameside with no expected effect on CCG baselines as a whole.

This would usually warrant a budget realignment exercise to shift monies

from Tameside FT to UHSM. However, as we are now into the second half

of the year and 2015-16 budgets will be under discussion in January, it’s

more prudent to make a note of this investigation and continue to monitor

the situation with a view to amending 2015-16 contracts.

121

6

2.3 Commissioning Non Acute

Table 7: Summary of Commissioning Non Acute Financial Position

Figure 2: CHC Mental Health Forecast Spend split by Service

Mental Health

Mental Health budgets are forecasting an underspend of £623k at year end.

£519k of this underspend is in relation to non-CHC mental health

placements. This underspend is driven by the CHC team proactively

reviewing all mental health clients on a regular basis. This has led to the

care co-ordinators being able to move some clients in to step-down facilities

either via local authority funding, CHC fully funded or joint funded

placements.

Community Services

The Community contracts continue to deliver to plan as at month 6. The

year-end underspend is now forecast to be £16k; we have seen savings on

the Meridian Contract of £22k compared to last year and additional income

of £23.5k from TMBC towards the costs of the Integrated Response &

Intervention Service (IRIS).

Continuing Care

We are forecasting an overspend of (£505k) re fully-funded and joint-funded

CHC placements. This reflects an increase in patients, which is partly due to

the CHC team training the community teams and raising awareness of the

NHS’s responsibility for paying for care (particularly end of life care). This

awareness training is to prevent restitution claims in the future. There is

also an increase in people choosing to be cared for at home which can be

more expensive than being in 24 hour care. Some clients have also been re-

designated from Mental Health placements to CHC placements (see above).

122

7

2.4 Commissioning Primary Care

Table 8: Summary of Primary Care Financial Position

Table 9: Spend on Wound Dressings - (Epact) Data

Actual 2013-14 £000’s

Actual 2014-15 £000’s

Variance £000's

EPACT Data (April - July) 163 223 (60)

Figure 3:Spend on Wound Mgt & Other Dressings April14 – July14 vs April13 – July 13

GP Prescribing

Prescribing budgets are currently showing a marginal overspend of (£6k) based on 4

months’ prescribing data (Apr – July). Prescribing budgets are forecast to overspend by

(£136k) which is due to pressures within Nurse Medical Prescribing (this is subject to an

ongoing multi-disciplinary review from the CCG, CSU and Stockport FT – see further

information, below).

Nurse Medical Prescribing

In the July report it was noted that we had seen significant growth within Appliances and

Dressings - 22%. Further analysis has shown that the main driver of this spend is within

Wound Management & Other Dressings which has increased by (£60k) compared to

prescribing costs in 2013-14 as illustrated in Table 9. Figure 3 shows a breakdown of this

spend by Locality. The biggest area of growth is at Stockport Community (Nurse Medical

Prescribing) which has increased by (£56k) compared to the same period last year. There

has been a 44% increase in the number of Nurse prescribers (actual number increase 19).

We have asked SFT Community Services for a list of prescribers and relevant services to

enable us to pinpoint areas responsible for the bigger spends. This issue will also be

considered as part of 2015-16 contract setting.

Community Pharmacy Funding Settlement October 2014 – implications for CCGs

From 1st October, a change in way community pharmacies are remunerated for their

dispensing services to the NHS means that CCGs face a significant cost-pressure for the

remainder of the current financial year, whereas NHSE are set to see a reduction in costs.

The pressure for the CCG is estimated to be circa (£310k). This issue has recently been

discussed at Greater Manchester CFOs with a view to the potential transfer of funding

from NHSE to CCGs; and to ensure and maintain stability and delivery of financial plans.

Home Oxygen

Home oxygen costs are underspending by £64k to the end of month 6. This is a legacy of

the introduction of the home oxygen assessment service in 2013-14, which ensures

patients are prescribed oxygen appropriately, thus reducing spend on the contract.

123

8

3. Care Together Sustainability Plan

Table 10: Summary of Care Together Workstreams

Workstream Opening

Budget

Recurrent Future Budget

% Change

Expected Savings

£000's £000's % £000's

CHHECT - total 85,643 65,228 23.8% 20,415

Dementia 8,184 7,690 6.0% 494

Respiratory 8,979 8,050 10.3% 929

MSK 27,036 24,120 10.8% 2,916

Ophthalmology 7,461 6,925 7.2% 535

All Age Learning Disability 25,652 23,546 8.2% 2,106

Palliative Support Service 1,355 1,355 0.0% 0

Stroke &Neuro Rehab 3,405 3,169 6.9% 236

Local Community Care Team 19,806 16,241 18.0% 3,565

Wellness Offer

Drugs & Alcohol Transformation

Carers Children Specialist LTC –

Cardiology Joint Equipment

Service All Age Mental

Health Diagnostics Safeguarding Cancer

Admission Avoidance: Minors

Sexual Health

The 2014-15 element of the overall £74m Care Together gap is £5,141k. The CCG is on

target to achieve efficiencies, as reported previously this is split between £500k

Prescribing and £4,641k on Acute.

Care Together

The Care Together Programme is currently underway within the T&G CCG and TMBC.

The structure and governance of the programme is outlined below.

Two Project Managers have been appointed to support the implementation of the

transformation programme and to facilitate the launch of the enabling workstreams, in

particular CHHECT and IM&T.

Commissioning Executive

Representatives from CCG & TMBC providing strategic direction and oversight

of joint commissioning intentions under a section 75 arrangements and the

framework for outcome based contracts.

Shadow Board

Tripartite arrangement with representation from CCG, TMBC, THFT plus

Monitor.

Delivery Unit

Operational management with senior people appointed, in conjunction with

commissioner, to lead the delivery of the new IC FT organisation.

Audit Finance Quality Risk

124

9

4. Referrals

Hyde has a higher than average OP Referral Rate for Other and

Self Referrals but the lowest A&E and GP OP Referral Rate for

the top 5 specialties compared to the other localities.

Stalybridge has the highest Rate of GP OP Referrals for the Top 5

Specialties compared to the other localities, and the highest OP

Referral Rate for Physio, Gynaecology and Vascular Surgery.

The charts below show the Rate of Outpatient First Attendances Per 1000 weighted Population for the Top 5 Specialties at Tameside Hospital Foundation trust

for each of the T&G CCG Localities.

Source: SUS (All SUS data is assumed to be correct at the time of analysis)

Outpatient 1st Attendances of T&G Patients by Referral Type - Top 5 Specialties - 2014/15 YTD (Apr-Aug)

With the exception of the GP Referred OP Atts, Ashton has the

highest Rate of OP Referrals for all sources for the Top 5

Specialties, and the highest OP Referral Rate of T&O and

Paediatric Referrals.

Denton has the lowest OP Referral Rate overall for the top 5

specialties compared to the other localities.

Glossop has higher than average number of A&E and GP sourced OP

Referrals, but the lowest rate of Consultant OP Referrals compared

to the other localities.

0.0

5.0

10.0

15.0

20.0

25.0

T&O Physio Gynae Paeds Vas.Surg

ASHTON

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

T&O Physio Gynae Vas.Surg Derm

STALYBRIDGE

0.0

2.0

4.0

6.0

8.0

10.0

12.0

T&O Gynae Vas.Surg ENT Physio

GLOSSOP

0.0

2.0

4.0

6.0

8.0

10.0

12.0

T&O Gynae Vas.Surg Paeds Physio

HYDE

0.0

2.0

4.0

6.0

8.0

10.0

12.0

T&O Gynae Physio Vas.Surg Derm

DENTON

125

10

This will be discussed further at

5. Top 5 Acute Dashboard (Based on Month 5 SLAM).

Key Variances – (£244k) pressure on Non Elective admissions at SFT, (£192k) on

Elective/Daycase activity at CMFT. Significant underspend at Tameside across

Elective/Day Case £1,088k. However there is a significant amount of activity, £715k

which is currently uncoded within the month five flex file. This is currently being

shown under “Other” which explains the spike in the graph under Other.

Key Variances – 700 attendances (15%) overperformance in Ophthalmology at

CMFT linked to Lucentis. The overperformance at UHSM is Plastics activity which

has already been referenced earlier in the report. Significant overperformance at

UHSM in Outpatients 529 additional attendances which is due to Plastics.

126

11

5. Top 5 Acute Dashboard (Continued).

TFT performance in the main has remained below

planned levels since Oct 2013 (Introduction of Lorenzo).

Currently £487k under at month 5, however this is based

on flex data and is subject to change with £715k coded to

‘Other’ as referred on page 4.

CMFT year to date performance continues above

planned levels with a cumulative overperformance of

(£534k); however August activity was broadly in line

with planned levels.

SFT performance shows an underperformance of £166k.

In 2014-15 with the exception of May activity has

remained below planned levels.

127

12

6. News Update

5 Year Forward View

Health/Clinical news

Healthier Together

NHSE/DOH/CQC

The Chief Executive of the NHS in England, Simon Stevens,

published “The NHS Five Year Forward View” on 23 October

2014. The document sets out a bold and innovative vision

for the future of the NHS. A full copy of the document is

available online: http://www.england.nhs.uk/wp-

content/uploads/2014/10/5yfv-web.pdf

The Forward View recognises that more investment is

needed but also that more money without innovation and

reform will not solve the very serious problems facing the

NHS. What is needed is concerted and sustained action on

three broad fronts – managing demand, working more

efficiently and securing and making better use of increased

government funding.

The Forward View recognises that a ‘one-size-fits-all’

approach will not work and that local commissioners will

have greater freedom to design approaches and systems

which are best suited to the needs of their local

communities.

This bodes well for us locally as our Care Together

programme could become a beacon for the kind of system

redesign Simon Stevens envisages.

We believe that by sharing our work and ambition for Care Together with NHS England and Monitor, we will have helped to inform the thinking behind The Forward View. We look forward to working ever more closely with our partners and stakeholders – including patients, service users and local residents - over the coming months as we refine, discuss and put our plans in place.

New test helps identify best treatment

for ovarian cancer

A new test can help doctors identify ovarian

cancer more accurately and cut down on

instances of unnecessary surgery, claim

scientists. It is designed to help diagnose

different types and stages of ovarian cancer.

The developers, in Belgium and the UK, said

many women with cancer were not getting

the right treatment. The charity Ovarian

Cancer Action welcomed the test, saying early

identification was "much-needed". The test is

designed to distinguish accurately between

benign cysts and malignant tumours as well

as identify how aggressive tumours are. It

was developed by University of Leuven and

Imperial College London scientists to help the

patient get the right surgical treatment.

The NHS is failing to provide access to

24-hour support for the majority of

patients dying at home in England,

according to health charity Sue Ryder.

Around 92% of NHS clinical commissioning

groups (CCGs) do not provide round-the-clock

telephone help lines, the charity said.

Guidelines say there should be 24-hour

telephone services and the NHS says it is

"working hard to make changes". There are

half a million carers for terminal patients in

England.

Consultation documents are being accepted until the end of October We are still promoting filling in the consultation through our digital channels. We recently held three public Care Together Events - HT was discussed during those Twitter Activity* (as of 15/10/14) Over 200 specific Healthier Together tweets 880 clicks on the links within the tweets Reach: 685,000 users 85 likes 228 Retweets *please note this is not the full activity, and does not include and information where the @TGCCG account was being used from a smart device

Mental Health

This report shows what action the

government is taking to provide better

access to care in mental health services

within the next year, including national

waiting time standards for the first time.

It also sets out its vision for further

progress by 2020.

https://www.gov.uk/government/uploa

ds/system/uploads/attachment_data/fil

e/361648/mental-health-access.pdf

Open consultation:

Measures to improve the GDC’s

processes on fitness to practise

The Department of Health is seeking

views on proposals to make the GDC’s

early investigation stages of its fitness to

practise processes more effective and

efficient, through amendments to the

Dentists Act 1984

https://www.gov.uk/government/consul

tations/measures-to-improve-the-gdcs-

processes-on-fitness-to-practice

This consultation closes at 21 November

2014 11:45pm

128

http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf

http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/361648/mental-health-access.pdf



https://www.gov.uk/government/consultations/measures-to-improve-the-gdcs-processes-on-fitness-to-practice



13

7. Financial Risks

The following summary indicates the current assessment of the main financial risks that have to be managed and mitigated to enable the CCG to achieve its

statutory financial duties and its overall healthcare responsibilities in 2014-15:

Risk Rating (Current)

Key Risk Identified

Likeliho

od

Imp

act

Risk Sco

re

1. Prioritisation and control of expenditure within the CCG’s resource and cash allocations, whilst achieving all of its duties, meeting service demands, pressures and investing in service provision in line with approved strategic plans.

3 4 12

2. Implementation of the Care Together Programme, achieving the savings and redirection of resources required, whilst ensuring the availability of transitional funds to support the approved programme of transformation within a controlled and governed environment.

3 4 12

3. Ensuring the timely, accurate and appropriate business intelligence and service information is routinely made available and analysed to support and implement the CCG’s programme of work, monitor and address performance issues and to enable decisions to be taken to mitigate relevant risks and achieve the CCG’s duties.

3 4 12

These risks form part of the CCG’s overall Risk Register and Governing Body Assurance Framework. The risks are currently considered to be medium risks.

129

14

Appendix 8.1 – Key Financial Duties

Description of Financial Duties Year to date RAG

Year end Variance

£000's

RAG Description

1. Maintain expenditure with the revenue resource limit and deliver 1% surplus.

G G

The CCG is on track to deliver its planned surplus of £9,999k, which includes its mandatory 1% surplus in line with planning guidance.

2. Maintain expenditure within the allocated cash limit G G

There is no official cash target at the moment although a working group has been set up by NHSE to consider the issue. The CCG are currently working to 5% of the drawdown, or £250k, whichever is the lowest.

3. Maintain capital expenditure within delegated limit from the Area Team

G G

The CCG has been allocated £83k for the upgrade and renewal of IT infrastructure.

4. Ensure running costs are within £24.83 per head of population G G

CCG is currently on track to remain within running cost allocation.

5. Ensure a minimum of 0.5% contingency is held G G

CCG are currently holding a 0.5% contingency in line with NHSE planning guidance. At this stage of the year it is assumed that the full contingency reserve will be required to support any emerging pressures.

6. Ensure that 2.5% of funds are spent on approved non recurrent projects

G G All business cases have been submitted and these have now been approved by NHSE.

7. Ensure compliance with the better payment practice code (BPPC) G G

Cumulative values as at the end of September 2014 show NHS 100% by invoice value and 100% by invoice number. Non NHS 99.4% by value and 99.98% by number.

130

15

8. 2Appendix - Cost Centre Summary

131

16

8.3 Appendix – Breakdown of Acute Spend by Provider

YTD Budget £000’s

YTD Actual £000's

YTD Variance

£000's

Fcast YE Variance

£000's

X-year Variance

£000's

SLAM Variance

£000's

Acute – Foundation Trusts: 77,889 78,185 (296) (1,676) (634) (1,042)

Tameside FT 58,425 57,775 650 976 (24) 1,000

Central Manchester FT 10,664 11,284 (620) (1,555) (378) (1,177)

Stockport FT 5,207 5,023 184 (16) (164) 148

UHSM FT 2,212 2,580 (368) (748) (20) (728)

Salford Royal FT 877 902 (25) (62) 0 (62)

WWL FT 465 572 (107) (250) (48) (202)

Royal Bolton 39 49 (10) (21) 0 (21)

SLAM Variance

£000's

(192)

(192)

YTD Budget £000’s

YTD Actual £000's

YTD Variance

£000's

FcastYE Variance

£000's

X-year Variance

£000's

Acute – Trusts: 1,838 1,961 (123) (192) (0)

Pennine Acute NHS Trust 1,838 1,961 (123) (192) (0)

132

17

8.4 Appendix – Locality Report

133


Title of Subject:

Finance Committee draft Minutes

Date of paper:

October 1st 2014

Prepared By:

Yvonne Pritchard

History of paper:

Latest in a series of regular updates to the Governing

Body

Executive Summary:

The minutes summarise the key activities, actions and

decision made at the meeting.



(for Discussion and

Decision)

To receive the draft minutes


Yvonne Pritchard

134

1

DRAFT

NHS TAMESIDE & GLOSSOP

FINANCE COMMITTEE

Wednesday 1 October 2014

PRESENT: Yvonne Pritchard – Chair

Graham Curtis – Lay Member (part)

Jean Hurlston – Lay Adviser

Lesley Surman – Lay Adviser

Dr Alan Dow – CCG Chair

Dr Richard Bircher – GP Member

Dr Guy Wilkinson – GB Member (part)

Dr Asad Ali – Locality Lead



David Walsh – Finance Lead – PMO

David Milner- Locality Support Manager

Karen Ratzeburg – CSU Finance

Joanne Keast – Admin Support

1. Apologies

Tracey Simpson – Deputy Chief Finance Officer

2. Declaration of Interests

Nothing to declare

3. Minutes of previous meeting held on 6 August 2014

Approved. AA asked about iPads for members as the Committee attempts

to become paperless. KR reported that an iPad policy is currently being

developed.

4. Matters Arising / Actions

Agenda Item No 4 - Matters Arising – Ambulatory Care

CW asked AA to speak to Simon Rushton, clinician to clinician to discuss what

is required and take forward.

Action: AA

Agenda Item No 2 – Matters Arising - Finance Report Month 2

It was reported that CMT had discussed the process of bids and re-issued to

practices including who they should speak to in each department.

Agenda Item No 5 – Monthly Focus Report

CW agreed to discuss further with Philippa Robinson regarding issues with the

Network

Action: CW

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2

5. Quarterly Focus Report

Deferred

6. Finance Report – Month 5

Karen Ratzeburg commenced by explaining some issues around acute

forecasting. She accepted it was due to failings within CSU and apologized

on their behalf. A full investigation has taken place and there will be closer

working arrangements with the CCG in the future. She also confirmed that a

new report would be ready on Monday showing a more accurate forecast.

DM continued to highlight the following areas of the Finance report;

YTD acute position shows £1.7 m overspent

Underperformance at TFT of £867k on a YTD basis. There are still issues

with Lorenzo and in particular around undercounting of MAU activity.

A full review of this is underway with the trust.

Full year forecast under spend on Tameside contract is £1000k under

spend.

£287k YTD over performance at South Manchester, primarily related to

plastic surgery and vascular surgery. In part this is because of plastic

surgery daycase activity which had been scheduled to transfer from

South Manchester to Tameside has been delayed, also contributing to

the under spend at Tameside.

Central Manchester FT over spent by £496k. Pressures in Acute Kidney

Unit, daycase and ophthalmology outpatients.

CHC over performing by £350k. A driver for this is thought to be the

proactive active work the CHC team are doing so that eligible

patients are funded today, in order to avoid restitution claims in the

future

The CHC underspend is offset by an underspend in the budget for

mental health placements as part of an ongoing policy to proactively

review patients and move them on to suitable step down facilities in a

timely fashion.

Capital Expenditure

A paper on capital expenditure was tabled. For governance purposes it was

felt that this is the most appropriate place to be presented now and in the

future. As well as a brief explanation of how capital is devolved from NHS

England and governance arrangements the paper gives an update on GPIT

budgets. It shows that Tameside & Glossop CCG will receive £983k. DM

explained that Stephen Beswick has done a lot of work on this area and as

he has now left on secondment to CSU working on capital he will have

knowledge to take with him. It was noted that Primary care capital will

require CCG opinion in the future before further processing. It was also

explained that within the capital allocation, £83k has been allocated to

replace existing IT and desktop infrastructure in the CCG, this will generate a

significant (albeit non realizable) efficiency benefit. The revenue implications

(i.e. depreciations charges etc.) of capital spend for capital monies were

noted as an issue and one that the committee must be mindful of, but this is a

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3

national problem not just for T&G and any updates regarding this will be

brought back.

7. Pooled Budgets for 2015/16

KR presented the paper and explained that with regards care together we

need to look at how we move forward in pooled budgets. She explained

that we need to look at how, when (? From 1 April 2015), where (CCG or LA)

etc and this paper is devised to trigger the debate not for final decision

making today. She did ask members to think about the pool budget

arrangements and what they felt was the best for the CCG and forward any

comments back to her directly before the next meeting. She explained that

she would ideally like Finance committee to make a recommendation to

Governing Body at the November meetings, in order that appropriate

arrangements can be put in place for the start of the new financial year and

discussions with Auditors can take place. She explained that as we both

have the same audit teams the process should be more straight forward. The

option to be reviewed are:

1. Section 75 Agreement

2. Section 256 Agreement

3. Expand Better Care Fund

KR explained the benefits of the Local Authority hosting the pooled budgets

with regards VAT for some services and the flexibility of carry forward at the

year end. Other options include the CCG hosting, services which could

remain with the LA and we re-charge them. Initial thoughts included the

hosting not being an issue but more around the governance arrangements

around it. KR confirmed that the money would be ring fenced for the

services agreed and could not be spent on anything else without agreement

from both parties. KR agreed to work with GC and GW between now and

next meeting.

Action: All for comments back to KR

KR / GC / GW to work together on proposals

JK for next agenda


AA raised the issue of locality leads increasing weekly sessions from 1 to 1.5

which was agreed at the July PIQ. It was confirm that this was discussed at a

recent Remuneration Committee and letters would be issued shortly with

details.


The next meeting is scheduled for 5 November 2014 at 9.30 am Boardroom,

NHC

137


Title of Subject:

Locality Leads Minutes of Meeting – 28th October 2014

Date of paper:

31st October 2014

Prepared By:

Heather Palmer

History of paper:

N/A

Executive Summary:

The purpose of the clinical leads meeting will be to

act a clinical network across the five CCG Localities,

collecting and sharing experiences from the

respective constituent practices, acting as a conduit

between CCG Board and PIQ.

Martin Carter provided feedback on his recent

engagement with primary care. Martin had visited 12

practices and interviewed GPs/Practice Nurses and

Practice Managers during July-September. He had

also received a 41% response rate to questionnaires.

Martin advised of the common themes which

occurred from the responses and that the next steps

are the report of the findings have been produced

and are now with the CCG’s CE and Chair. The results

of the report would be shared with Locality Leads for

feeding back to their own localities.

Graham Curtis advised that the CCG had appointed

3 new Lay Members to the Governing Body and had

suggested that one Lay Member should be

‘allocated’ to each locality for their attendance at

locality meetings. Those present agreed they would

take this suggestion back to their own localities for a

decision on this and bring this back to the next

Locality Leads meeting. In addition Graham agreed

138

to produce a brief paper containing details of the lay

members and their roles.

Lynn Jackson and Slawomir Pawlik, attended to

explain the process for the 2015/16 CQUIN

Development. Lynn advised that they are keen to

hear of ideas for new improvement areas which will

be fed into the development workshop being held on

26th November.

Dr Richard Bircher advised of proposal to invest in

primary care. The paper contained three proposals

which were (1) Earlier Home Visits; (2) Same Day

Appointments; (3) Increased Capacity within GP to

cover expected demand over January. Those

present acknowledged the work which had been put

into these suggested options, and agreed that all 3

options should go forward for November PIQ

recommendation.

It was agreed that practice visits would commence

and that a standard ‘information pack’ would need

to be produced for all visits and this would be

discussed further at the joint Finance/Transformation

Team meeting.

Tori O’Hare advised of the current situation regarding

the BI Tools which was being developed by CSU.

Elaine Richardson sought the views of those present

regarding the possible production of a business case

for the next PIQ around introducing an electronic

flagging system for highlighting to NWAS all the

patients who had care plans in place via the

Unplanned Admissions DES. This would ensure that

NWAS crews were aware of the care plans and would

use by-pass numbers to contact the registered GP

prior to any admission. Those present agreed that

further work on this potential scheme should go

ahead.



(for Discussion and

To note the content of the minutes and actions being

taken forward.

139

Decision)


by proposal:

N/A


Dr Richard Bircher

140

Tameside & Glossop CCG

Locality Leads Meeting

Minutes from the meeting held on Tuesday 28th October 2014, Churchgate Surgery, Denton

Present:

Dr S Ahmed, Stalybridge Locality lead (Chair)

Dr N Riaz, Ashton Locality Lead

Dr J Bircher, Quality Improvement Clinical lead

Dr R Bircher, Urgent Care Lead

Graham Curtis, IGAR Chair, Lay Member

Peter Howarth, Head of Medicines Management

Elaine Richardson, Strategic Programmes Manager / Commissioning lead for planned care and

cancer

Heather Palmer, Commissioning Business Manager

Louise Roberts, Commissioning Business Manager

Alan Ford, Commissioning Business Manager

Martin Carter, CCG Interim Communications Manager

Tracey Simpson, Deputy Chief Finance Officer

1 Apologies

Clare Parker, David Milner, Dr A Hershon, Dr S Ali, Ali Lewin.

2 Notes of previous meeting

Approved as a true record of the meeting

3 Matters arising

Co-Commissioning – Elaine Richardson confirmed she had spoken to Clare Watson regarding co-

commissioning and sought clarification for Locality Leads. Dr Ahmed had recently viewed the

Local Area Team’s powerpoint slides on co-commissioning and he spoke regarding the current

APMS Contracts. Elaine advised that this item had been discussed at PIQ. It was noted that co-

commissioning would be the only agenda item for the next Primary Care Leads meeting.

ED Attendance Report - Elaine Richardson advised that this data was in the process of being

refreshed. Action: Elaine Richardson

Practice cancer data – it was agreed that the cancer data tabled at the last meeting would form

part of the data packs which would be used at forthcoming practice visits. Locality

Commissioning Managers need to ensure Ricky Hind is aware when visits are taking place so the

data is available in advance.

Locality Leads Sessions - It was noted that the additional locality leads sessions had now

commenced.

141

4. Feedback from the Practice Consultations

Martin Carter, CCG Interim Communications Manager attended to provide feedback on his recent

engagement with primary care. Martin had visited 12 practices and interviewed GPs/Practice

Nurses and Practice Managers during July-September. He had also received a 41% response rate

to questionnaires. Martin advised of the common themes which occurred from the responses

and that the next steps are the report of the findings have been produced and are now with the

CCG’s CE and Chair. The results of the report would be shared with Locality Leads for feeding

back to their own localities.

Graham Curtis advised that the CCG had appointed 3 new Lay Members to the Governing Body

and had suggested that one Lay Member should be ‘allocated’ to each locality for their

attendance at locality meetings. Those present agreed they would take this suggestion back to

their own localities for a decision on this and bring this back to the next Locality Leads meeting.

In addition Graham agreed to produce a brief paper containing details of the lay members and

their roles.

Action: Locality Leads/Graham Curtis

5. CQUIN Development for 2015/16

Lynn Jackson, CCG Quality Manager and Slawomir Pawlik, Senior Quality Manager CSU attended

to explain the process for the 2015/16 CQUIN Development. Tameside and Glossop are now in

the process of developing their local CQUINS with the process being led by the Nursing and

Quality Directorate. The CCG’s vision for 2014/15 is to incentivise innovation and practice which

supports the integrated care system outlined in the nine CCG business cases.

Lynn advised that they are keen to hear of ideas for new improvement areas which will be fed

into the development workshop being held on 26th November.

Those present suggested one possible CQUIN which will be fed into the event around having

access to the email of consultants to facilitate an MDT approach to the management of patients.

Lynn agreed to feed this suggestion into the event, and asked those present for any additional

suggestions to be forwarded onto her by email.

Action: Lynn Jackson/All

6. Primary Care System Resilience

Dr Richard Bircher tabled a paper containing proposals to invest in primary care to provide

quicker urgent care to patients. The paper contained three proposals which were (1) Earlier

Home Visits; (2) Same Day Appointments; (3) Increased Capacity within GP to cover expected

demand over January. Those present noted the contents of the paper and felt that options 1 and

2 could be implemented, although the question of whether these schemes would benefit larger

practices and disadvantage smaller practices was queried. In relation to option 3, Dr Ahmed

advised that his practice currently run Saturday morning surgeries which are not well attended

and felt that this option may not have the desired effect. Discussion around the marketing of

142

option 3 and of the limited timescale and patients’ expectations were also discussed. However,

those present acknowledged the work which had been put into these suggested options, and

agreed that all 3 options should go forward for November PIQ recommendation.

Action: Elaine Richardson/Richard Bircher

7. Practice Visits

Dr Ahmed advised that he intended to begin practice visits for the Stalybridge locality with Alan

Ford during November. Heather Palmer also said the Denton locality visits would be commencing

in December. It was agreed that a standard ‘information pack’ would need to be produced for all

visits and this would be discussed further at the joint Finance/Transformation Team meeting.

Action: Heather Palmer/Tori O’Hare

8. BI Data

Tori O’Hare advised of the current situation regarding the BI Tools which was being developed by

CSU. Concern was expressed by Dr Ahmed regarding the lack of practice level information for

locality meetings. Those present were assured that practice level data would be available for

locality meetings/visits shortly and this would be taken forward at the next joint

Finance/Transformation Team meeting.

Action: Tori O’Hare/Heather Palmer


Elaine Richardson sought the views of those present regarding the possible production of a

business case for the next PIQ around introducing an electronic flagging system for highlighting to

NWAS all the patients who had care plans in place via the Unplanned Admissions DES. This would

ensure that NWAS crews were aware of the care plans and would use by-pass numbers to

contact the registered GP prior to any admission. Those present agreed that further work on this

potential scheme should go ahead.

Action: Elaine Richardson

10. Next meeting

Next meeting to take place on Tuesday 25th November commencing at 12.30pm – 2.30pm at

Churchgate Surgery.

143

Shared Minutes of the Healthier Together Committees in Common Meeting held in Public Agenda Item Number A1.4 Date of meeting: 15th October 2014

Date of paper: 24.09.14

Subject: Healthier Together Committees in Common

Decision / Opinion Required: For approval

Author of paper and contact details:

L Murch [email protected]

Purpose of paper: For record of the Shared Minutes of the Healthier Together Committees in Common meeting held in public on 17 September 2014.

The item has been discussed previously at these meetings:

n/a

144

mailto:[email protected]

Title Minutes taken at the meeting of the Greater Manchester CCG Healthier

Together Committees in Committee

Author Lisa Murch

Version 0.3

Target Audience Healthier Together Committees in Common

Date Created 24/09/2014

Date of Issue 09/10/2014

To be Agreed 15/10/2014

Document Status (Draft/Final)

Draft

Description Greater Manchester CCG Healthier Together Committees in Common minutes of meeting

Document History:

Date Version Author Notes

24/09/2014 0.1 L Murch Draft minutes created

03/10/2014 0.2 L Murch With amendments from Leila Williams

09/10/2014 0.3 L Murch With amendments

Approved:

Signature:

Phil Watson CBE, Chairman

145

Greater Manchester CCG Healthier Together

Committees in Common (HTCiC)

ATTENDANCE

Confirm meeting of the 12 Committees of :

Bolton CCG Bury CCG Central Manchester CCG Heywood, Middleton & Rochdale CCG North Manchester CCG Oldham CCG Salford CCG South Manchester CCG Stockport CCG Tameside and Glossop CCG Trafford CCG Wigan Borough CCG

Other organisations in Attendance:

GM Service Transformation Hempsons

Members in Attendance:

Phil Watson CBE Dr Wirin Bhatiani Stuart North -Deputy for Dr Kiran Patel

Dr Michael Eeckelaers Dr Chris Duffy Simon Wootton -Deputy for Dr Martin Whiting

Denis Gizzi -Deputy for Dr Ian Wilkinson

Dr Paul Bishop Dr Ranjit Gill Joanne Newton -Deputy for Dr Bill Tamkin

Steve Allinson -Deputy for Dr Alan Dow

Dr Nigel Guest Frank Costello -Deputy for Dr Tim Dalton

Matthew Cunningham -Deputy for Jerry Hawker

Dr Debbie Austin Ken Griffiths Leila Williams

Independent Chair Bolton CCG Bury CCG Central Manchester CCG Heywood, Middleton & Rochdale CCG North Manchester CCG Oldham CCG Salford CCG Stockport CCG South Manchester CCG Tameside and Glossop CCG Trafford CCG Wigan Borough CCG East Cheshire CCG North Derbyshire CCG Chair of Healthier Together External Reference Group Director of Service Transformation Team

SHARED MINUTES OF MEETING

Wednesday 17th September 2014 The Lord Mayors Parlour, Manchester Town Hall, Albert Square, Manchester

Chair – Phil Watson CBE

146

Rachel Volland -Deputy for Alex Heritage Ian Williamson

Healthier Together Assistant Director Programme Management HT Lead CCG and SRO

Other Attendees: Hamish Stedman Steven Pleasant Martin McEwan Lisa Murch Warren Heppolette Christian Dingwall

Chair of Association of CCGs Governing Group Lead Local Authority Chief Executive for Health AGMA Representative Associate Director, NHS Greater Manchester Service Transformation Portfolio Support Manager, Service Transformation Team Strategic Director – Health & Social Care Reform Hempsons Solicitors

Members of the Public:

Nil

Apologies:

Dr Kiran Patel Dr Jerry Hawker Dr Martin Whiting Dr Ian Wilkinson Ian Williamson Alex Heritage Dr Bill Tamkin Dr Tim Dalton Dr Alan Dow

Bury CCG East Cheshire CCG North Manchester CCG Oldham CCG HT Lead CCG and SRO Healthier Together Programme Director South Manchester CCG Wigan Borough CCG Tameside & Glossop CCG

Quorate Requirements:

Achieved For a meeting at which no Category 1 decisions will be made, as close to 75% (in terms of whole numbers) of the voting members of the HTCiC are required to be in attendance or able to participate virtually by using video or telephone or web link or other live and uninterrupted conferencing facilities (9 out of the 12 voting members).

AGENDA

Item Paper/

Verbal Presenter

1. Welcome and Introductions Verbal Chair

1.1 Apologies for Absence Verbal Chair

1.2 Quorum Confirmation Verbal Chair

1.3 Declaration of Interests Verbal Chair

1.4 Confirmation of Part A Minutes Paper Chair

2. Consultation period and post consultation arrangements Paper Leila Williams

3. Update External Reference Group (ERG) Verbal Ken Griffiths

4. Updates from localities on consultation activities Verbal All

5. Any Other Business Verbal Chair

147

Item Paper/ Verbal

Presenter

6. Questions Verbal Chair

Date, Time & Venue of Next Meeting

15th October 2014, Mersey Suite, 3rd Floor, Piccadilly Place, Manchester

MEETING NARRATIVE & OUTCOMES

1 Welcome and Introductions

The Chair opened the meeting and noted that no members of the public were present.

1.1 Apologies for Absence

The Chair advised that apologies had been received from Kiran Patel, Jerry Hawker, Martin Whiting, Ian Wilkinson, Ian Williamson, Alex Heritage, Bill Tamkin, Tim Dalton and Alan Dow.

1.2 Quorum Confirmation

It was noted the meeting was quorate.

1.3 Declaration of Interests

It was established that there were no new Declarations of Interest to be recorded for this meeting and members were advised to indicate any interests arising during the course of the meeting immediately.

1.4. Minutes of the previous meeting held on 16th July 2014

Steve Allinson asked as part of the presentation on the consultation process has received clear instruction from his governing body that sight of the consultation feedback specific to Tameside & Glossop was requested to help inform decisions and the decision making process and Tameside & Glossop CCGs contribution to the CiC. With the above amendment the minutes were accepted as a true record.

ID Type Risk/Issue/Action/Decision/Outcome Description Owner

Action Feedback specific to Tameside & Glossop CCG from the consultation process to be provided.

HT Team

2. Consultation period and post consultation arrangements

Leila Williams presented the paper which gave a flavour of the consultation events that had taken place and those yet to take place up to 30th September 2014. The paper also included a proposal on “keeping the post box open” which allowed people who attended events right at the end of the consultation to send in their responses until mid-October 2014 to ORS. No further events or proactive communication would take place after 30th September 2014. Ian Williamson also stated that as organisations were responding to the consultation as well as acute Trusts, and groups of acute Trusts wanted to give CiC an opportunity to hear what some of

148

consultation responses from these organisations were, as well as to learn more about them which could take place during the time ORS were evaluating the responses but would need to make a decision about the format i.e. inviting comment on the criteria of the programme. Nigel Guest stated this should be limited to the scope of the programme. Hamish Steadman asked if the consultation was being extended and was legal advice needed. Leila Williams stated that it was not appropriate for the CiC to hear about any proposals until the consultation was closed, the post box was being kept open until 24th October. Taking on board the legal advice, given the box would be open, and then hearing from the providers would need to take place after that period. The CiC would also hear from lots of different people responding to the consultation and the providers could be asked to come and expand on their response. It would be very helpful to hear from the statutory and non-statutory organisations. Christian Dingwall advised that the CiC would need to be cautious about engaging with the providers and it would be very important that there was a completely fair and transparent and non discriminatory process. He would discuss with the central team and provide cautious advice. Debbie Austin confirmed that the High peak have been able to put forward transport information to feed into the Healthier Together options appraisal process. Leila Williams confirmed that this would be the case as well as any other information that comes from the consultation process that is deemed relevant. Su Long asked for clarification around the consultation formal closure date of 30th September and the post box remaining open until 24th October, that there would be no further consultation events etc. Had this been put in print and if not would it be an issue. Leila Williams confirmed that the central team would not be undertaking any consultation activities beyond 30th September but appreciated that some events bring run locally by CCGs could run into the first week of October but would be stakeholder events not consultation events.


Action HT Central Team to amend the paper following comments from HTCiC. HT Team

3. Update External Reference Group

Ken Griffiths gave a verbal update from the External Reference Group. External Reference Group members had undertaken up to 40 observations to date and he took the opportunity to thank those who gave up their own time to attend as observers. Feedback from the public debates has been positive including the style and quality of the presenters. Some staff events had also been observed, as well as attendance at some transport events, and the impact assessment events for stakeholder groups. Future work for the External Reference Group included checking processes, after the consultation the External Reference Group would provide assurance that the information had been gathered robustly, reported on accurately and also report on whether the engagement and communications process had been open and transparent. Finally the External Reference Group would be advising on whether the results of the engagement process had been taken into account as the options are developed. The chair thanked Ken Griffiths for the update.


Nil

149

4. Updates from localities on consultation activities

The Chair invited updates from each CiC Member on locality activities. Oldham Denis Gizzi advised that activities were continuing and a meeting was attended at the local Council of Mosques which was very positive. Bury Stuart North reported that the public debate went well with the Local Authority Council leader sitting on the panel. Religious groups meetings were in the diary, as well as a joint event with Salford with Jewish Orthodox community. Heywood, Middleton & Rochdale Chris Duffy advised the public debate was being held that evening, turnout for events in the local area had been low so far. North Manchester First event was cancelled and re-arranged for a further date this week. Wigan Frank Costello stated that 62 events had taken place in the local area since June 2014 mainly going to where the people are gathering already. 3 public meetings had taken place with an event last night that was predominantly Trust colleagues. South Manchester Joanne Newton advised that the public event was taking place on the 30th September in the local area. Trafford Nigel Guest updated on feedback from health and wellbeing board, a meeting of all Trafford GPs later this evening with the public debate next week. Tameside & Glossop Steve Allison reported that many people are asking “what next” and dealing with other local issues in relation to transport issues, especially in Glossop due to the road network. North Derbyshire Debbie Austin advised that two public events have taken place in the local area and one transport event. 120 attended the Buxton event with transport and access being the main issue for the public in the High Peak area. Further documents have also been requested. Stockport Ranjit Gill explained that there would be a total of 40 events held and the CCG had also attended a High Peak Borough Council meeting. He had participated in the GM public debate in the previous week which was well attended with lots of comments. Salford Paul Bishop advised that 48 attendees went to the Salford public event and the public debate was taking place the following week. Bolton Su Long advised that good attendance levels were reached at the public event but some frustration initially with the start time. The CCG had been helping the local hospital to ensure the consultation document was available and CCG staff had been attending the hospital to engage with patients and the public. Su Long also acknowledged the work of the Engagement Team at the CCG. East Cheshire Matthew Cunningham advised that the public meeting was taking place on 23rd September in

150

Wilmslow, with a Transport event on 25th September in Macclesfield. Direct mail out to local Councillors has taken place as well as a meeting with the local GPs. Central Manchester Mike Eecklears reported that the CCG AGM had taken place which included a session on the consultation. A GP meeting was taking place the following week next week and would encourage further distribution of the consultation document. Central Manchester had hosted the Core Cities CCG meeting that morning. Leila Williams had attended and presented the Healthier Together Programme with Ian Williamson, which was well received. Colleagues were very interested and gave a huge endorsement for the programme showing strong clinical leadership and support for the team. Leila Williams explained a collection of “bitesize” were now available on the Healthier Together website as well as an easy read version, an audio version and versions in a selection of other languages. CiC Members were also asked to ensure their updated consultation plans were sent into the central team.


Nil


There was no further business discussed.


Nil

6. Questions

As there were no members of the public present there were no questions raised. The chair thanked CiC members and closed the meeting.


Nil

OUTSTANDING ACTIONS FROM PREVIOUS MEETINGS ID Type Open Action Owner

Nil

CLOSED ACTIONS FROM PREVIOUS MEETINGS

ID Type Closed Action Owner

Action CCG Plans to be sent into the central team. HTCiC

151

SUMMARY OF NEW ACTIONS FROM THIS MEETING

ID Risk / Issue/ Action / Decision Description Owner

Nil

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Attendance: Steve Allinson NHS Tameside & Glossop CCG Trish Anderson NHS Wigan Borough CCG Rob Bellingham Greater Manchester LAT Wirin Bhatiani NHS Bolton CCG Alan Campbell NHS Salford CCG Julie Daines NHS Oldham CCG Tim Dalton NHS Wigan Borough CCG Andrea Dayson GM Association of CCGs Chris Duffy NHS Heywood, Middleton & Rochdale CCG Denis Gizzi NHS Oldham CCG Nigel Guest NHS Trafford CCG Warren Heppolette Health & Social Care Reform Gina Lawrence NHS Trafford CCG Su Long NHS Bolton CCG Wendy Meredith Bolton Council – Public Health Lesley Mort NHS Heywood, Middleton & Rochdale CCG Gaynor Mullins NHS Stockport CCG Stuart North NHS Bury CCG Jenny Scott NHS England – specialized Commissioning Hamish Stedman (Chair) NHS Salford CCG Bill Tamkin NHS South Manchester CCG Clare Watson NHS Tameside & Glossop CCG Martin Whiting NHS North Manchester CCG Ian Wilkinson NHS Oldham CCG Ian Williamson NHS Central Manchester CCG Apologies: Alan Dow NHS Tameside & Glossop Ranjit Gill NHS Stockport CCG Michael Eeckelaers NHS Central Manchester CCG In Attendance: Mike Burrows NHSE GM AT Sue Sutton NHS Blackpool CCG Alison Bali GM Association of CCGs Melissa Surgey GM Association of CCGs

GM ASSOCIATION OF CCGs: Association Governing Group (AGG)

Tuesday, 7 October 2014, 1:30 – 5:30pm

SALFORD & WORSLEY SUITES, ST JAMES’S HOUSE, SALFORD

MINUTES

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The Chair welcomed all to the meeting and introductions were made. The Chair introduced Melissa Surgey, the newly appointed Programme Manager. Gratitude was extended to Chris Duffy for chairing the last meeting. The minutes were accepted as an accurate record of the previous meeting. The Action Log was reviewed and the following noted: Agenda Item No.

ACTION OWNER PROGRESS

Item 2 Minutes of the Last Meeting (1.7.14)

SL to draft letter to Trusts for AGG members to comment/review

AD to chase up the outstanding ToR

SL AD

Completed Action completed. No gap identified and no further action required.

Item 3.1 Public Health GM Plan

WM to present the full strategy to a future meeting

WM On Forward Plan

Item 3.2 Health & Social Care Reform

WH is to attend the AGG Away Day which will provide opportunity for further discussion

WH to review the ToR in terms of membership initially followed by objective setting

WH WH

Completed On Agenda

Item 4.1 GP IT

Away Day programme to include discussion re: developing common approach to co-commissioning and specialised services

GM GP IT Strategy to be presented to future AGG meeting (? November)

Completed On Forward Plan

Item 4.2 GM Strategic Levy

Recommendation 4 not concluded and CFOs are asked to revisit at the next meeting.

Funding provided should have conditions regarding clearer processes and visible transformational plans

Consider an agreed approach to use of strategic levy – HT, GM vs local level at the Away Day

CFO’s

Action completed. Further discussion took place at CFOs meeting and resolution found and funding identified for specialised commissioning.

1. WELCOME & APOLOGIES FOR ABSENCE

2. MINUTES OF THE LAST MEETING (5.8.14)

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Item 4.3 Military Veterans Service

Any comments on the Service Specification to be sent to SM

SM to check on process of sending discharge summaries to GPs

SM to send financial data to JD (for CFOs)

SM to re-send evaluation of the service to CCGs

SM SM SM SM

All actions completed.

Item 5.1 NHS III Service

SA to circulate background information

SA Completed

Item 5.2 End Of Life

This item for discussion at future HoC/CFO – to make recommendations to a future AGG meeting

A Bali to liaise with Andrea Dayson to forward plan this item for a future AGG meeting

SN to write to COs re: any other host CCG funding arrangements

A review of networks – funding, accountability, governance to be undertaken at a future date

AB SN

Action completed Action completed AD reported that the only CCG funding activity (network) relates to the Cardiac Acute Transfer Service (hosted by SCN) and £40k to support the work of the Stroke Board

Item 5.3 Spec Comm

JS to share QIPP plans with HoCs and CFOs

Possible Away Day topic – co-commissioning/joint governance of specialised commissioning

JS Completed Completed

3.1 Healthier Together Budget The paper is to provide an update to the AGG on the budgets for the Health and Social Care programme for 2014/15. The detail had already been shared with the CFOs group. AGGs are requested to:

Note the revised split of the agreed 2014/15 budget.

Note the risks identified to this budget and the use of contingency.

Note the spend for Quarter 1 2014/15 which took the programme to consultation launch. 2014/15 Budget

Funding for the programme for 2014/15 was agreed by the GM ACCGs of £4m. Contributions to support primary care elements were agreed by the NHS England GM AT. The total budget for 2014/15 is £4.6m split by organisation in the table below:-

3. STRATEGIC WORK PROGRAMMES

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Contributions 2014/15 (£000s)

NHS Bolton CCG 393

NHS Bury CCG 247

NHS Central Manchester CCG 270

NHS Heywood, Middleton & Rochdale CCG 314

NHS North Manchester CCG 290

NHS Oldham CCG 341

NHS Salford CCG 374

NHS South Manchester CCG 236

NHS Stockport CCG 392

NHS Tameside and Glossop CCG 354

NHS Trafford CCG 306

NHS Wigan Borough CCG 471

Total CCG 3,988

NHS England GM 629

Total budget 4,617

A review of the detailed ‘bottom up’ 2014/15 budget has been completed. The revised forecast split of

spend for 2014/15 is:

The major changes that impact 14/15 budget are as follows:

The integrated care budget has been consolidated into the service redesign team

Increased budget to support the consultation due to additional activities being included and creative material being designed professionally

Additional month salary payment due to underpayment last year has been profiled across teams

Team NHS 1-7 WTE NHS 8+ WTE2

Sessional

Medical Staff Consultancy Contractors Non Pay Total

Management 259,060 2 226,830 96,000 581,890

PMO and

Corporate

Support 101,845 2 48,000 28,800 185,100 363,745

Business

Support 152,070 5 152,070

Comms &

Engagement 108,380 3 124,620 2 628,540 132,700 51,000 1,045,240

Finance &

Estates 13,860 0.6 197,760 3 765,565 6,375 983,560

Service

Redesign 71,790 2 374,825 6 98,050 166,760 22,400 733,825

Primary Care 70,320 2 227,765 3 83,280 55,970 437,335

Accomodation 318,805£ 318,805

TOTAL 416,420 12.6 1,285,875 18.0 408,160 1,608,865 190,275 706,875 4,616,470

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Management cost increased due to reclassification of Programme Director post from PMO & Corporate and extension of Medical Director post to equivalent support for remainder of financial year

Increase in backfill costs for SRO support (costs being clarified)

Extension of PRG chair costs for whole year

Reduction in the contingency which was previously shown under Finance & Estates consultancy costs to balance the budget to original cost envelope.

Contingency

It was recommended that a contingency was kept in the original budget. This was to reflect the risks to the budget outlined above. It was recommended that AGG receive a budget update paper in July to evaluate whether this contingency has been required. The contingency has been used in the revised budget. The main reasons for this are as follows:

The NHS E resource tracker shows 290 days of internal resource to complete assurance work – unbudgeted in the original estimates and so more reliant on additional consultant capacity

Unbudgeted McKinsey costs to support the assurance process adding expertise and capacity

Rework of consultation document resulting in additional costs with creative agency

Additional consultation costs due to additional activities in preparation and content

Deloitte invoice in dispute, due for resolution in October – budget reflects a worst case scenario

Phasing The revised 14/15 budget has been split into 3 phases:

Pre-consultation business case – April to June

Consultation – July to September

Evaluation and decision making – October to March

AGG are asked to;

Note the revised profile for the agreed 2014/15 budget

Note the Quarter 1 spend versus budget

Note the risks to the Healthier Together Programme budget

RECOMMENDATIONS:

Note the revised profile for the agreed 2014/15 budget

Note the Quarter 1 spend versus budget

Note the risks to the Healthier Together Programme budget Comments:

TD: questioned the circumstances by which most of the contingency fund had been used.

JD: responded that the paper presented a Q1 position and that due to the timing of the meeting it was not possible to provide further detail. However, the financial position was being updated and is subject to discussion at the CFOs meeting next week.

HS: confirmed that members had noted the contents of the paper and a revised budget position will be presented at the next meeting.

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3.2 Wider Leadership Programme WH provided an update on the Health & Social Care Reform work with a particular emphasis on the joint work with AGMA. The update follows the session at the Association’s recent time out session. The AGG at its last meeting considered a paper articulating a series of strategic objectives relating to Health & Social Care Reform. The scope of work proposes a series of shared strategic objectives:

Effectively aligning Health & Social Care Reform with Complex Dependency as part of Public Service Reform;

Implementation of the New Delivery Models for Integrated Care;

The Delivery of the Primary Care Strategy and the Development of the Primary Care Provider Organisations;

The Development of the Single Service Concept to support integration across Acute Trusts;

Supporting the Workforce Transformation to the new models of care;

Strategic Engagement with Public Health and Public Health England;

Realising the strength of our academic assets; and

Developing the conversation with Government to pursue national support for GM’s reform programme.

The same paper and proposed objectives have also been considered and supported by AGMA, engaging both Public Health and social care Directors within that process. Work is underway to capture the detail of delivery to describe actions, partners and capacity alignment.

Primary Care Transformation - The GM Primary Care Transformation Steering Group provides direction and oversight to ensure the delivery of the GM Primary Care Strategy. The group is able to engage both professional networks across primary care and key partners such as AGMA and Health Education England. The key enabling workstreams include:

Workforce Estates Organisational Development

IM&T Finance/Contracting

Healthier Together - A full Consultation Activity Report will be presented at the end of the formal period capturing the extent and impact of the publicity, engagement activity and consultation responses. A draft AGMA response has been developed through Cllr Smith and Cllr Morris and agreed by all Leaders at the GMCA on 26th September.

Integrated Care Delivery –a simple framework for Integrated Care Development has been established to support joint enabling work and help in establishing a common headline dashboard to track the extent of roll out of the new models and their impact on local systems.

The dashboard will use common outcome measures (most already available through the AQuA/ADASS data) and process measures (such as care plans completed, population covered by integrated neighbourhood teams, etc). Agreed measures of primary care development relating to the Healthier Together primary care standards will be incorporated. It is anticipated that this comparative dashboard then becomes available to CCGs and Councils through the ten Health & Wellbeing Boards.

The AGG noted:

The risks identified and requested that CFOs continue to review and report through to AGG

More detail on the use of the contingency also requested

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Public Service Reform - Complex Dependency - GM has accepted the invitation from DCLG to be an early adopter for phase 2 of the Troubled Families programme. As an early starter, GM is working with DCLG’s Troubled Families Unit on developing the programme, in particular around use of the Cost Savings Calculator, defining success for Payment by Results, and accessing data. Working Well referrals continue to increase supported further by a successful visit by the Shadow Minister for Employment and Welfare reform (Stephen Timms MP) who is keen to understand our learning from the implementation of the programme.

Work is taking place to develop a business plan to access government funds for a mental health and employment integration trailblazer. This pilot programme was announced in the GM Growth and Reform Deal.

GM has been successful in securing non-recurrent funding from DCLG, GM, to support localities adopting the Early Years new delivery model to move ‘Further, Faster’. This funding will support the upfront costs associated with implementing the model, such as buying assessment materials and training for the workforce. The developing data capture system which will electronically record the Early Years early adopter dataset is nearing completion.

Conversation with Government – CCG colleagues have been kept appraised of recent discussions to build on the City Deals which relate to Health & Social Care Reform. The information has been submitted and it is anticipated that the Health & Social Care Reform Leadership Advisory Group (See below) will provide the forum to shape GM’s input to those discussions.

Comments: WH: A shared (CCG and LA) business case had been submitted to Cabinet Office for funding for the mental health programme (supported by Sandy Bering) with a value of £5m and its implementation will be discussed through the HoC Group. National funding across all elements is available to the value of £1.2bn with potential funding for GM to the value of £300-350m – the outcome of that funding opportunity should be known shortly and will be communicated to CO, Clinical Chairs and CFOs. SN: if the bid is successful then it will require careful management. This would need to be managed internally before any announcement is made. This had not yet been discussed by Governing Bodies and would require consideration of delegation of decision making (possibly upwards) and accountability. HS: would require a sensible and credible conversation with the Treasury and are we at the stage of preparedness for this? WH: acknowledged and agreed with SN/HS comments and recognised the need for well rehearsed conversations to underpin any response. To do so would need the support of a ‘CCG team’ and that a reference group with Clinical Chair/CO/CFO/HoC would be required. SL: noted the exciting opportunity that this represented and noted that any delegation from CCG Boards is a much bigger conversation. The proposed group provides a bridge between CCGs and AGMA and there is a need to demonstrate that there is formal joint working between H&SC but CCG Boards have not ceded powers to it. IW: noted that it would be useful to have a paper which could be taken to CCG Boards. SA: agreed that the funding represented an exciting prospect but there needed to be clear plans on how it would be utilised. AGMA may wish to use this to drive the position of GM in a very different political direction eg devolution. TD: there is a need for clarity on our commitments in terms of the funding. WH: agreed to prepare a paper as suggested.

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HS: noted that this represented a significant opportunity a briefing for CCG Boards was required.

GOVERNANCE: Health & Social Care Reform Leadership Advisory Group At its last meeting the AGG received a proposal for the establishment of a Health & Social Care Reform Leadership Advisory Group. Further draft terms of reference have been considered and supported by AGMA through its Wider Leadership Team. AGMA CE representatives have been confirmed as Sir Howard Bernstein, Steven Pleasant and Sean Harris. CCG colleagues are asked to support the establishment of this group and confirm their nominees to the group. Further nominations could be considered but would need to manage the risk if CCG membership outnumbered the AGMA representation. Nominations for the Group based on SRO roles:-

Su Long

Ian Williamson

Hamish Stedman

Ranjit Gill Joint Leadership Engagement As the health & social care leadership has engaged on the development of strategic priorities and the revisions to the GM governance, broader leadership engagement would be beneficial in the short term. This has been proposed initially as a joint engagement event bringing together AGMA Chief Executives and CCG Accountable Officers. This might be the initiator of a wider leadership development process for GM Health & Social Care Reform which would support a deeper constituency engaging ADASS, DCS, DPHs and CCG Heads of Commissioning alongside Chief Executives and Chief Officers. GM is pursuing the possibility of support to this arrangement from the LGA and NHS Confederation. GM Health & Wellbeing Board This is the forum which provides the facility for direct engagement with elected leaders from GM’s Councils. It invites representation from clinical leaders of GM’s CCGs along with key partners from across the GM Public Service and Public Health England. On 8 August 2014 the GM Health & Wellbeing Board met to consider its role and priorities. At the facilitated session the Board agreed that the GM Health & Wellbeing Board will be a strategic partnership with an important symbolic presence. The Board will take a strong leadership role, hosting debate and challenging its membership and partners. The partnership focus will be central as the Board will provide the opportunity to bring together AGMA, CCG Clinical Leaders, Public Health England, NHS England, The Police & Crime Commissioner’s Office, GMP and GM Fire & Rescue, the community and voluntary and private sector, and universities in Greater Manchester. This Board will focus on a smaller number of strategic priorities, to include:

• Early years • Supporting people into work • Supporting older people

These three priorities represent a life-course approach, and align with the Greater Manchester Strategy and the developing GM Public’s Health Strategy.

RECOMMENDATIONS The AGG is asked to:

i. Consider the update and note the specific updates within the exception report;

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ii. Consider the revised Terms of Reference of the Health & Social Care Reform Leadership Advisory Group; and

iii. Nominate three CCG members of that group.

Comments Health & Social Care Reform Leadership Advisory Group ToR: WH: The ToR had been revised following comments received at a previous AGG meeting. 3 AGMA representatives have been nominated to the group. Nominations are requested from this group which could be more than 3, dedicated individuals or nominated based on the focus of the work at any given time. CD: noted that the membership did not include a representative from community services. WH: responded that this also included MH and that this would require further discussion. CD: noted that the Chief Executive member was to be drawn from a “Foundation Trust” which would preclude Pennine Acute. WH: responded that this would be amended to read “Acute Trust”. HS: indicated that the membership required further discussion. CD: cautioned that although the membership should be inclusive it should also not become too large. The nominations based on the SRO roles were approved and noted that these are initial nominations in order to progress with the establishment of the group and at some point in the future would require agreement by all 12. SA: questioned if the membership should include the CiC Chair since that stage of the HT programme would have concluded and therefore would have different governance requirements for the next stage. CD: also questioned this role within the proposed membership. IW: noted that CiC is a time limited role and therefore time limited on this group. TA: cautioned on potential conflicts of interest – the CiC Chair is not a representative of CCGs. The leadership group would be advisory not decision making. TD: noted the need to ensure there is appropriate feedback from the leadership group to CCGs as otherwise this would lead to disengagement. HS: noted the need for appropriate feedback from this and other groups eg GMH&WBB. WB: felt that the CiC Chair does not represent ‘anybody’ and agreed with TA’s point. HS: noted that the Chair (of EAG) had been established to align health and local authority for the HT programme and therefore moving forward was unsure of their membership. WB: the CiC has a very specific role and purpose and therefore should not be involved in anything else and removed from the paper. CD: with these additional commitments how are these roles to be back filled since individual capacity is being stretched? SN: noted the need to appropriately distribute skills to cover these areas as the principles of working together. HS: noted that the paper had outlined the discussions and cognisant of the risks/benefits, ToR may be short term, exclude CiC Chair from the group’s membership. If there are to be new ways of working this would have to be reflected in the ToR and appropriate feedback required. Currently, Mike Burrows is a member of the Wider Leadership Group that meets fortnightly either Tuesday pm/Friday am. In respect of the impending changes to the NHSE it has been suggested that it would be more appropriate for CCG input/leadership. 2 additional nominations to be sought through email by AD.

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ACTION:

WH to inform of the outcome of the funding bid to Clinical Chairs/COs/CFOs

WH to prepare a briefing in respect of the funding for use by CCG Boards

Nominations approved for Health & Social Care Reform Leadership Advisory Group as identified through SRP roles

AD to seek two further nominations for the Wider Leadership Group 3.3 Organisational Alignment Capability programme Mike Burrows was in attendance to provide an update on the Organisational Alignment Capability Programme as follows:

The changes to be described will hopefully provoke discussion regarding the future position of CCGs and the Association

The internal staff consultation with regard to the 15% reduction to running costs will conclude on 14 November.

An external 10% reduction and a further 5% reduction to the Executive Team to invest in other areas such as specialised commissioning and to strengthen the national strategy policy unit.

In the North, area teams will reduce from 9 to 4. The local (GM) team will cover a footprint which includes Lancashire (20 CCGs in total) with a single team of Directors.

The Area team is work closely with the Regional team and will likely mean that the hierarchical internal assurance process will reduce.

Currently the CCGs in Lancashire do not have a formal collective group and therefore represents a significant challenge for the new team.

‘Healthier Lancashire’ is driven by the Lancashire Area Team working with a range of partners including acute trusts.

In October 2015 the area team’s commissioning responsibility for 0-5year olds will transfer to local authority. No resource running cost is going to transfer as consequence of these changes.

It is expected the Area Team will also be devolved of other functions eg GP appraisal, some aspects of safety/quality reporting and legacy IT.

Appraisal and safety is enshrined in the legislation and therefore will require secondary legislation to devolve those responsibilities elsewhere.

An impact on CCGs is EPRR due to the bigger footprint.

The assurance relationship will be different, with one team and 20 CCGs and therefore naturally more distant. It is unlikely there will be quarterly assurance meetings but maintaining regular CCG meetings – further review will be required in to maximise the resource within the team.

Co-commissioning is an area where CCGs will have a bigger role and policy in this area is still developing. This provides an opportunity for the AGG to take on the leadership role within GM.

It is anticipated that there will be moves towards the new structure during November through to the first week in January. ‘Go live’ will be the first week in April but it is anticipated that the new structure will start to operate as soon as it is completed (probably early in the New Year).

Comments: AC: asked for further comment on specialised commissioning. MB: responded that this is to be strengthened with the 3 ‘patch based’ teams reporting to the Regional Team. JS: indicated that leadership will be at Regional level (not NW).

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MB: noted that during transition there will be no changes to the portfolio accept for neurology outpatients and specialised wheelchairs being transferred to CCGs. There are discussions regarding bariatric surgery and renal dialysis but neither has been confirmed for next year. This period of change provides an opportunity to rebase the specialised commissioning budget on population basis rather than institutions. It is intended that 2015-16 will be shadow reporting/shared governance by CCG footprint which will provide an opportunity to identify resource consumption by individual CCG. It is assumed that this would lead to consideration of those services that could transfer in 2016-17 – though these timescales are speculative at this stage. IW: acknowledged the reference to CCG leadership at GM level but also emphasised the importance of local leadership and will not necessarily mean that ‘everything will be done at GM level’. SA: thanked MB for the update and recognised the forthcoming change in relationship with the area team. It was important not to rush decisions in order to ‘fill the void’. Structures were in place to manage co-commissioning but queried the arrangements for other contractor groups eg. pharmacy, dentistry? MB: agreed there should be no need to ‘fill the void’ and that the transition will be gradual. There is work being undertaken to consider other contractor groups which may move into co-commissioning at some stage. RB: confirmed that these contractor groups are definitely excluded from the first phase and no timescale for them to be included had been agreed. DG: queried the reference to the term ‘feifdom’ MB: responded that there is a belief (held by some at national level) that some area teams have acted like SHAs – but it is the intention in the future that area teams will be administrative units. DG: voiced concerns of the use of the term designated commissioning rather than ‘co-commissioning’ particularly if there is to be no resource to do the ‘delegated’ tasks and asked for a view of how to effectively use the scarce resource. MB: confirmed there is no desire to transfer running cost resource and concerns if the area team has to oversee for example 20 joint committees. There is also anxiety that the team will have ’20 masters’ and there is much more work to be done between the area team and CCGs to identify how best to utilise the resource. RB: felt that GM was in a good position with the work that has already taken place with Gaynor Mullins leading on behalf of CCGs but difficult now as in the middle of the consultation. It is hoped to keep the primary care medical team together and possibly to lift into shared arrangements when there is clarity. SL: with the restructure of the team brings increased distance and queried the direction of travel in terms of level of scrutiny (national level) as this is significant and not always adding value. This would also be debated outside of the meeting. MB: agreed that there were areas that do not add value and it is hoped to recognise those areas which do add value and relinquish those that do not. JD: asked if the debate regarding additional resource was closed as other parts of the system are reporting differently. MB: responded that if there are any changes this will occur through commissioning at a national level and therefore cannot absolutely say no resource will transfer. GM: there is a process to work through co commissioning and in reality there will not be a huge amount of running costs and expertise is scarce. CCGs will have to think about system leadership within the fragmented system e.g. EPRR – what it means to be a system leader in crisis. There is a need to have conversations on how to ‘practically’ manage.

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MB: acknowledged EPRR is a risk area and anticipates more discussions nationally and regionally. The legislation is clear that the primary responder is the area team and changes to this would require secondary legislation. SN: requested that there be further discussion outside of the meeting regarding the leadership role and particularly in the context of NHSN, TDA, Monitor, Regional Specialised Commissioning etc. At next month’s meeting, the AGG will be asked to consider governance for urgent care and a proposal for a SRG at GM level. MB: there is an expectation of continued ‘closeness’ on some key issues and a significant part of the assurance will be focussed on urgent care. Members asked to note that the Area Team is not disappearing but the available resource will have to work differently. SN: asked members to note that Monitor has asked to attend AGG to update on procurement and competition rules which would provide the opportunity for a wider discussion. MB: noted there was an opportunity to revisit the Compact when the new team is in place. HS: emphasised the need to develop vision of how GM should work in the future/what is important – as there is a brief window of opportunity before the new structure is in place. There is a need to have a further OD session to discuss further how we work with each other and to undertake OD work with new structures. SN: agreed to develop a discussion paper for the next meeting. 3.4 Resourcing Proactive Primary Care Following the “Call to Action” from Dr. Ranjit Gill regarding increasing investment in primary care, a workshop to scope an appropriate methodology was held on 17th September 2014. The paper circulated provides a briefing on the workshop as well as requesting support for the proposed way forward; the creation of GM Primary Medical Care Standards. Crucial to note is the balance required between GM wide standards and additional, locally determined and complementary standards. GM wide Primary Medical Care Standards will bring the unwarranted variation into clear sight but more importantly will start to address this at scale and pace. The standards will need to be accompanied by relevant and effective KPIs and development/support plans. The initial workshop reviewed different approaches to increasing resource in primary care. Liverpool CCG presented 3 full years of data showing against their chosen metrics, considerable improvements in performance e.g. increased disease registers, uptake in screening as well as access and a reduction in secondary care attendances for primary care issues. Bolton CCG have developed the Liverpool Standards further and have agreed 17 standards with 45 KPIs through considerable engagement with their GP practices. Those present felt that this approach across Greater Manchester could be extremely beneficial in reducing variation and “levelling up” quality outcomes in a short timescale. Next Steps The workshop agreed that the creation of GM Primary Care standards should be proposed. They would need to shine a light on variation, be accompanied by KPIs and development/support plans and a

The AGG

SN to prepare a discussion paper for the next meeting

Need for an OD plan to support AGG leadership

To invite MONITOR to a AGG to understand their approach to re-procurement

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mechanism for claw-back and conflict management should improvements not be forthcoming. An agreed level of funding per patient for each practice across GM would be vital and would have to be delivered on a recurrent basis.

Workshop proposal The creation of two task and finish groups a Clinical Reference Group and a Business & Process Groupreporting on progress to the Primary Care Transformation Steering Group, chaired by Dr. Raj Patel with decisions referred to AGG. AGG is requested to:

Note the progress to date for the “Call to Action” in relation to increasing funding to Primary Care

Support the development of proposed GM wide Primary Medical Care Standards as a method to improve outcomes and reduce primary care variation at scale and pace

Confirm the creation of two specific task and finish groups

Request nominees and provide the necessary capacity to fulfil this role effectively

Request monthly updates on progress to the AGG Comments: WB: was pleased to see primary care investment on the agenda and although not personally able to attend the workshop on 17th September, Bolton CCG had been represented. Bolton was already 10 months into the process and WB emphasised the need for clear objectives e.g. increase investment in primary care, improve quality of standards and to consider equity of funding in primary care. There is a need to ensure that it is not perceived by CCG membership as a top down approach. The success in Bolton has been achieved by considerable engagement with the membership. There is also the need to consider that investment in primary care equates to additional work and therefore an appropriate balance is required. HS: acknowledged the need for ‘buy-in’ from the ‘bottom up’. The issues are investment, overarching standards (with local ‘flavour’) and dispersal of funding to CCGs. AC: noted the variability of primary care across GM, that there is more fragmentation/variability of investment and behaviours towards e.g. QOF are different. Salford is planning significant investment but this is not necessarily replicated in other areas. There is a need for integration conversations, support for core standards and the need to ensure public confidence in access, training and management of safeguarding. The need for the two groups referenced within the paper was questioned. WB: agreed that artificial separation can create more problems. DG: also in agreement and emphasised the need to describe how the framework will operate. It was noted that the Liverpool work presented at the workshop had been mostly undertaken pre-CCG (PCT) with practices that had similar demographics and therefore levelled the market with significant investment. This approach for adoption at GM level was queried but felt it could be imposed on members. RB: referenced that this was initially known as the Call to Action by Ranjit Gill and had originated from CCGs not the Area Team. This is quite rightly CCG territory and it is about CCGs working together rather than in a federated top down manner. The benefit of working together avoids duplication and was achieved when the community based standards were developed.

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IW: indicated support for the proposal but queried the funding - ? top slice and steer to be provided by AGG or CFOs? Reference was also made to the standards developed for HT and the need to ensure delivery. WB: noted that underpinning quality standards and KPIs is benchmarking of practices. There is a need for a baseline measurement which is difficult to achieve in a few weeks. There is considerable variation of practices and therefore benchmarking is a key and major part of work. This was easier to achieve in Liverpool because of the low starting point. TD: emphasised the need to include patient representation. GM: noted the importance of linking this work to co-commissioning and the link to standards and benchmarking which had been discussed but not reflected within the paper. NG: Lessons had been learnt from HT in respect of patient engagement and practices unhappy with standards and therefore engagement is crucial. Noted the need to be mindful of the HT programme. SL: emphasised the need at a GM level for clear commitments from all 12 to investment and commit to the standards. There is a need at this stage not to be engaged in the detail. HS: in summary, acknowledged alignment with co-commissioning, the need for an overarching framework with local ‘flavour’, need to engage with patients/clinicians, include benchmarking, consider the resource (where is it coming from?) and the consensus to support one group.

3.5 Service Transformation Proposal IW presented a paper that sets out the strategic direction of major transformation in GM, as commissioners and providers face future clinical and financial challenges.There will need to be a continuing programme of public sector reform and GM is very fortunate in that a strong, cohesive leadership community exists across health and social care to lead and deliver this challenging agenda.Over the last few years GM has delivered a number of significant major transformation programmes that have had a significant clinical, financial and strategic effect on health and care services.This work has been led by CCGs and Local authorities in GM and enabled and supported by the Service Transformation team. There are a number of existing and emerging transformation programmes for the GM CCGs: 1. Completion of the Healthier Together programme which will broadly involve:

Completion of the consultation and decision making processes

Co-ordination of implementation across the acute providers

Completion of NHS England assurance requirements, including the identification of the full Greater Manchester proposal for sustainability (the Paul Baumann solution)

2. Care Together which includes the reconfiguration of acute services at Tameside General Hospital.

3. Continuation of the Southern Sector challenged economy work which includes reconfiguration of acute services at University Hospitals of South Manchester, NHS Foundation Trust at Stepping Hill and potentially East Cheshire NHS Trust.

AGREED:

To support the establishment of a single (not two) next steps group

There is a need for an overarching framework with local ‘flavour’

Need to engage with patients/clinicians

To undertake benchmarking of GP practices

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4. North East sector which includes reconfiguration of acute services provided by Pennine Acute NHS Trust.

(The latter three transformation programmes are likely to need formal public consultation and the associated processes and assurance requirements). GMCCGs have committed resource to their major transformation programme up until the end of 2014/15. It is timely to confirm the resource that will be required to complete Healthier Together and to consider the further transformation CCGs will undertake in the next two years. Greater Manchester has a high national profile and reputation for its cohesive strategic leadership and successful delivery of challenging transformation programmes. The GM economy has worked together to launch the Healthier Together consultation as the first step in major strategic reform of health and care. This has been achieved despite significant challenges both politically and within the NHS.The quality of the work produced to withstand these challenges has been recognised and externally assurance by national bodies such as National Clinical Advisory Team (NCAT), Office of Government Commerce (OGC) Health Gateway Review and NHS England have given GM commissioners confidence in the process and the underpinning work produced by the Service Transformation team. Proposal It is proposed that the Major Transformation team’s core purpose will be the completion of all requirements of Healthier Together and the administration of GM level governance for major transformation.The expected products/ benefits for the 12 CCGs will be the successful completion and assurance of the following:

transport report - event summary, response to consultation and recommendations for changes

equalities assessment (legally required)

impact assessment (legal requirement)

consultation reach and engagement report

consultation response report

ERG report

any further analysis required as a result of consultation responses e.g. analysis of new models, analysis of new options, workforce, estates

Paul Baumann challenge - main issue outstanding from NHS

response to remaining (14) NHSE outstanding assurance items including "four tests"

Governance will need to be designed which will address the local and sector requirements.It is suggested that individual sectors/CCGs should commission support for their formal public consultation as they require.Clearly the pace and scale of transformation will vary across GM going forward, and it seems sensible that the funding of each major transformation programme be undertaken in sectors. The team turnover rates are high due to the successful nature of the work and the current national profile and the temporary nature of funding and commitment given to date. Commitment to the completion of Healthier Together and consequently the current core business of this team needs to be confirmed. GMCCGs, through a lead CCG approach, should continue to lead and manage the team.The team have been approached by other groups of CCGs in England for advice and support as they tackle major service transformation. It is proposed that such approaches for advice and support are accommodated where capacity allowsto reduce costs to GM CCGs wherever possible.

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The AAG is asked to: - a) recognise the work of the team to date. b) agree that the focus of the team going forward will be the completion of the Healthier Together

programme. This includes the decision making process, coordination of implementation and NHSE assurance. (The detail of the expected products / benefits is outlined in section 4). This work will be financially supported by the 12 CCGs.

c) agree that individual CCG, or multi CCG sector plans for major transformation, and especially any necessary public consultation will be commissioned separately (as those CCGs choose) i.e. this will not be funded by the 12 CCGs together.

d) agree that detailed budget and staffing plans will be developed by the team and the lead CCG, in conjunction with COs and CFOs. The budget for 2015/16 is expected to be less than that for 2014/15. The work that the budget will support is very significant, but the need to keep a downward pressure on costs is recognised, notwithstanding that the team costs remain as programme costs rather than management/ running costs.

e) note that the activities needed to be completed by the team in relation to Healthier Together post -consultation require some different skills to those in the team to date. For example, skills associated with the public consultation need to be replaced by those associated with decision making and financial business cases. 15 aspects of the NHSE assurance process must be completed before April 2015. As a result, HR advice has been taken from Salford Royal FT (employer) and Central Manchester CCG (host). So

a small number of vacancies in the team are in the process of being filled, internally where possible.

views will be sought from Chief Officers on the approach that the team takes and potential links with other teams.

views will be sought from Chief Financial Officers on the financing of the team and of major transformation more generally.

f) agree with the intention to include within the detailed work in (d), clarification of the primary care, community based care and public sector reform capacity, subject to further discussions with NHSE and AGMA.

g) consider further discussion about the scope of the work of the team in the future if CCGs are asked to inherit work from NHSE, as seems likely. Chief Officers were anxious at this stage to limit the role of the team as per b) above, but will be asked to reconsider this if it seems that collective work on (e.g. aspects of specialist commissioning) should be considered.

Comments: SN: absolute recognition that HT needs to be completed but with a small a core team as possible to deliver this with clear break points and ability to deal with judicial review should it be forthcoming. There is a need to identify points in the future when decisions will be needed. Sectors will commission support for their reconfiguration outwith HT through appropriate procurement process. DG: stated this had been discussed by Governing body who agreed to the principles. However, there are areas for serious consideration e.g. programme costs (rather than running costs) and would this be a feasible route in the future. If the team undertakes work on behalf of other economies then this converts into a business model and therefore should be procured on that basis. The issue of sector charging is (1) expensive (2) double payment as already paying at GM level. There is a need to consider the AGG decision against potential challenge and the view that would be taken by Monitor. There is a need for caution and ability to withstanding potential challenge.

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JD: the issue of programme costs is subject to discussion at the next CFOs meeting. Wigan CCG had prepared a framework (based on national guidance) to revisit what is considered running costs and consider where HT fits within it. Opinion is if programme is quality improvement it can legitimately be regarded as programme cost. Auditors would also be interested in any change and therefore would need to take advice. SA: there is a need to ensure management of a judicial review (should it be forthcoming) and the paper outlines reasonable next steps and the importance of ensuring clarity re: scope of the team (agreement with recommendation 2). TD: there is a need to ensure there is clarity about the ‘end’ of HT and concern that 9 months has been identified for analysis and unclear why this would take so long. HS: acknowledged this was a valid point and agreement is needed to define the end point of HT. There are concerns about how the team goes forward and potential to become CSU without authorisation. SN: agreed there is a need to define the end of the HT process which should include potential judicial review. If the HT team do bid for more work (e.g. sector level) what form of organisation is that/what is the governance? These were questions not for answer now but to consider the possible consequences and the need to ensure appropriate governance. The 9 month period for analysis covers that period of the general election and announcement by local politicians cannot take place before June. The budget next year based on the terms of the core team and timing of the end point. WB: in agreement that both the team and budget need to be small. Members asked to comment on what was needed over the next 2-3 years for implementation – what is required/what do we need to deliver it? Concerned that there is the HT team but with no clear objectives. AC: supportive of the need to conclude the HT workstream/identify the end point and what are the next steps. TA: welcomed the revised paper but concerned over the requirement to commit to the end point which extends into the next financial year. CCGs inherited the team/structure and concerns had been expressed by the Governing Body regarding governance as it sits outwith any formal organisation. It had questioned the need for the team (e.g. was it possible to buy same service from CSU?) and therefore could only commit funding to the end of the project – some funding possible beyond 1.4.15. JD: felt that Wigan was not alone in that view. There is a need to consider the next steps and the consequences of the decisions to be made. There are some permanent members of staff and therefore consideration needed e.g. redundancy / redeployment which may have cost consequences. IW: was encouraged by the determination of CCGs to commit to the end point of HT. It was acknowledged the need for further work – what is the end point/key milestones of the work till that point. The need for decision making timescale and coordination for implementation. Further discussion is required as soon as possible but discussion had been helpful and support appreciated. GL: asked members to note that the team were originally the Transformation Team (not HT) and was a valuable resource which had provided support to the Cancer Commissioning Board and therefore was ‘bigger’ than just HT. LM: there is a need to identify what work is required for system reform. Following discussion with LW there was acknowledgement for the need to ‘specify’ what is required of the team. There is clarity regarding the terms of engagement for HT but not at all clear what we would want to specify. There is a need to understand the skill set within the team. This requires further discussion at the next CO meeting. HS: in summary there is affirmation to continue to the culmination of HT, requires further discussion, acknowledged that the team is an asset and concerns that fragmentation will lead to its loss, no clarity

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yet on what GM requires/clarity required on objectives followed by identifying the skills needed to deliver. 4.1 Away Day – next steps AD provided an overview for the recent AGG away day next steps already covered by Warren Heppolette in terms of strategic objectives and Rob Bellingham for the Primary Care section. A refresh of the day was provided which included the AGG member’s aspirations, common themes for the future model of Primary Care and specialised commissioning. The latter debate raised a number of questions which have been fed back through to NHSE to support the continued discussions nationally. Big ticket items: agreed are what must be done and achieved at a GM level and once determined all CCGs continue to work as one. It was agree that we need to share intelligence more freely across CCGs again to support the reduction in duplications and support each other. We need to prioritise the current Lead CCG arrangements which may need further consideration to support the expected eroding of structures elsewhere in the system. We also need to manage the continued tension between membership organisation and Association and look to support decision making more effectively to ensure proactive use of AGG time. Part of this is ensuring we support our leads and supporting infrastructure. Big Ticket rankings:

Primary Care – case for investment and setting the standards

Building stronger strategic/leadership relationships – AGMA/AGG interface

Specialised commissioning in terms of reinventing the Lead Commissioning/Collaborative roles

Community Based Care

Healthier Together 2

Commissioning organisational support AGG achievements

12 speaking as 1

Lead CCGs arrangements

HT consultation

Governance arrangements Challenges

Changing landscape

AGG vs membership (tension)

Strategic vs local intent

4. ASSOCIATION OF CCGS

The AGG noted:

That the revised paper already considered through COOs was much clearer but still raised questions

For further discussion at Fridays COOs meeting

Need to consider what the GM plan is and then determine the support required

All agreed need to complete HT and define the endpoint

Need to consider the wider role of Service Transformation

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Priorities

The big ticket items CiCvs AGG comparision: AGG - Diffuse

- Exhausting - Fells like a free for all

CIC - Functioning - Committed - Clear agenda

AGG – no clearly identified priorities – continuing to fire fight CIC – managed programme with clear ambition GM Framework: Work sponsored by Mike Burrows through PA Consultancy to develop a programme/tool to manage the oversight of the totality of all GM Programmes. This will includes all CCG, strategic Clinical Network and Specialised Commissioning programmes. The aim will be to determine ownership, responsibilities, scope and risks. The benefits already identified through the development of the framework are that we have identified a number of areas of duplication which has been managed through determining ownership. Through the AT/CCG Directors meeting it was decided that the Association was best placed to continue the development and management of the programme which needed to be resourced to ensure that the system developed remains ‘live’. Melissa Surgey has been appointed to lead this work on behalf of the Association. This work may support the decision making process ensuring that all information is available to support governance processes. RECOMMENDATIONS

Agree a structured OD programme for AGG and supporting infrastructure

Prioritise the joint working AGG/AGMA leadership session Comments: SL : questioned if items had been managed by HoCs/CFOs why they would be presented to AGG. It might be helpful to review worked through examples with CFO/HoC Chair. JD: the CFOs/HoCs work through the detail and working with COs would make it more efficient. HS: there is a need to trust the infrastructure/individuals within it but acknowledged that the Association was still maturing (as were CCGs). CD: queried that first presentation to the AGG would be the first sight by clinicians. AD: responded that papers needing a clinical opinion would be sighted by clinicians through HoC internal CCG processes. LM: AGG should provide that initial direction to CFOs/HoCs and it was this step that was missing. JD: noted the need to balance Association finance items with statutory finance business.

The AGG:

Noted and supported the feedback acknowledging that further work required on decision processes at the next away day

AD to align the next away day with the leadership session to work with WH for planning purposes

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4.2 Ambulance Commissioning: PTS Procurement Stuart North and Sue Sutton described background and current position in relation to Patient Transport Services (PTS) in the North West (NW). The GM Urgent Care Leads Group haveprovided this Association Governing Group (AGG) with their collective view and recommendations. While supporting the regionally co-ordinated approach, the group is very keen to make use of the option to have a GM level group for work on the service specification, which links to the NW specification group (governance described in appendix 2). There is a recently established GM PTS Group, which reports to the Urgent Care Leads Group and it is intended that this will become the specification group. In taking this procurement forward the GM Urgent Care Leads have recognised the wider urgent care agenda in Greater Manchester in the context of operational demand and capacity. The Group has considered the establishment of a GM wide System Resilience Group and a full paper outlining the options and a potential way forward will be presented at the next AGG meeting. Named representatives for the GM and NW level groups are required, to allow for the service specification work to be done October to December 2014. It is intended to go out to the market in April 2015. RECOMMENDATIONS

Regionally co-ordinated procurement led by NHS Blackpool CCG with five county level “lots”.

Procurement expertise to be provided by Salford SBS including project managing specification changes, financial modelling, evaluation criteria and technical expertise (£4k per CCG approximately).

Standard specification with the option for county level “add-ons”.

Local county area Task & Finish Groups, led by the county area ambulance commissioning group, to develop these local “add-ons” and to link to the NW Procurement Governance arrangements.

Local county representatives to be nominated for inclusion on the NW level groups. Comments: SN: noted that following procurement the award of the tender by the 12 CCGs is a level B decision. GM support to the process will be provided by Jackie Bell (paramedic background), Deputy Head of Commissioning at Bolton CCG plus one other rep for the county. SS: noted that with Ian Mello had attended the Acute Director of Ops meeting and have agreed reciprocal quarterly attendance at meetings. SN: asked members to note that there is considerable debate regarding the Healthwatch survey which highlighted that at least half of patients had experienced being late for appointments over the previous 12 month period. The target is 90% which means 10% not being achieved for patients – these are patients who require treatment sessions 3 times per week. If the target was set higher this would have cost implications. SL: expressed concern regarding the performance targets and the need to learn from experience. A precedent was set last time when transitional costs were paid and if there is a change in provider there is the possibility of the same request. SN: felt it would be sensible to take legal advice on the point of paying transitional costs. AC: noted that following renal PTS transport changes (run by Salford Royal) agreed by the AGG 18 months ago, there is still dispute with Arriva. Although acknowledged funding was to be paid for the loss of income, the level of funding requested by Arriva is unreasonable.

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JS: noted that specialised commissioning had a significant proportion of information relating to the incident and offered support in terms of legacy information should it be required. SA: supportive of paper but urged upfront engagement with public/patients. Very concerned regarding the service as there had been incidents whereby patients had to cut short renal dialysis treatment sessions. WB: during the many public engagement events the dissatisfaction with the Arriva service had been expressed on many occasions. GM: confirmed support for the process described within the paper but noted that standards and KPIs were key elements. HS: in summary noted that members were supportive of the process described with local ‘flavour’ with strong recommendation that patient engagement is included within the process. AGG is to approve the KPIs before they are signed off within the specification.

5.1 GM CATS Contract Clare Watson as Chair of the Heads of Commissioners Group provided an overview of current performance issues and remedial actions being taken to ensure clinical pathways are safe and that the contract is being managed. Request for greater clinical engagement in the contract management and in the CATS agenda overall, particularly as part of the close down/contract exit, when decisions will need to be made about safe transfer of patients to other providers, and the changing of clinical pathways. Reminder to individual CCGs to agree their commissioning intentions for their contracted activity once the contract ends on 2nd February 2016. Important issue highlighted that due to the 56 day CATS pathway, commissioners will need to have new providers in place by December 2015. One of the key risks to CCGs is the ‘double paying’ of the CATS contract to 2nd February 2016 and any new provider from December 2015. NHS E contract with Care UK did not consider wind down/reduction in payment. CCGs are requested to:

Note the different work streams relating to the Care UK/GMCATS contract;

Note the role and actions that individual CCGs need to take re Submitting Commissioning Intentions and contract exit discussions with Care UK

Endorse the proposal that any service developments are managed through HoCs until JCAG is fully functioning;

Nominate Clinical Leads for the JCAG;

Decide which finance option the commissioners on the Exit Group negotiate with NHSE

5. CLINICAL WORK PROGRAMMES

The AGG:

Agreed recommended process

Jackie Bell nominated and confirmed as the GM representative

Due to continued patient dissatisfaction with the current provider need to ensure user experience is incorporated into the process

Would need to agree the KPIs and standards

When procurement starts the process will be a Level B decision

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Comments: CW: Commissioning Intentions deadlines had been put back a couple of times and represented a risk and therefore absolute deadline (for high level intentions) would have to be January. HS: noted that Bolton, North Manchester, Central Manchester and Trafford had not yet submitted their intentions though all members were asked to check submissions had been made. JD: asked if those CCGs that had submitted were clear in their commissioning intentions? CW: responded this was being addressed through the Operational Group. There is a mixture of clarity but not to a sufficient level to provide assurance across the system. Some CCGs are working together at neighbourhood/sector/across specialties. HS: noted the significant risk which had been and was being highlighted through the HoC Group. CW: noted that there was some duplication of conversation within the Operational Group and a lack of progress with commissioning intentions. TA: indicated that commissioning intentions had been submitted but was the assurance needed that it was being managed within CCGs (eg within service reviews)? CW: responded that there is a need to know the intentions from each individual CCG and at this point there is a lack of clarity from some CCGs. However, this represented a risk to the individual CCG (not GM). DG: thanked CW for the update and asked if the clarity lacking could be obtained by CW contacting each CCG to talk through the process? CW: responded that this would be addressed through the Operational Group who will consider the intentions/implications. There is no GM coordination of this unless CCGs request it. Members asked to note the risks in respect of contract exit. HS: emphasised the need to work together and the commissioning intentions when known may have the potential for procurement of the same service. However, the risks identified needed to be included on an AGG register and a further update is to be provided to a future meeting. LM: noted the need for clarity on the questions being asked to ensure the sufficient level of detail is provided.

5.2 Specialised Commissioning NHS England Commissioning Intentions published. NW provider WebEx to be held on 20th October 2014

Local commissioning intentions shared

Services to transfer to CCGs for April 2015 (specialised wheelchairs / OPD neurology)

Services to transfer to CCGs in future (renal dialysis / bariatric surgery)

Services to transfer to NHS England (specialised haematology / urology / oesophageal /familial hypercholesterolaemia)

Service specification compliance data published under each POC

Data is from June 2014

Intention to have very few provider derogations in place by March 2014

ACTION:

Outstanding CCGs to submit commissioning intentions as soon as possible and by the latest January

Members to check that commissioning intention submissions had been completed

Continues to be co-ordinated through HOCs to ensure GM opportunities are not lost

Financial risk to be included on AGG Risk Register

Further update to be provided to a future meeting

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NHS England consultation on restructure (OACP)

Aimed at working more effectively across national / regional / area teams

Additional posts in national specialised commissioning team

Merger of Area Teams

Co Commissioning - Emergent national thinking - North West co commissioning virtual group

Service updates:

Major trauma – The Expert Clinical Panelconvened was in unanimous agreement that GM should have the ambition to move to a single MTC on a single site within 2 years. This report will be used to inform the commissioning plan for major trauma in Greater Manchester.

Cardiac – North West stocktake completed to review service across NW

Vascular surgery – meeting held recently with CE’s of Pennine, UHSM, CMFT and Bolton to look at reaching agreement on 2 arterial sites. They have been given a clear timeline to agree a GM model after which procurement options will need to be considered.

Cystic fibrosis - significant capacity issues at South Manchester

Neurology - will form part of co-commissioning arrangements and therefore will work as a community to make sure the pathway is seamless. Noted that referrals from primary care have increased by 26% and work being undertaken with Ivan Benett (headache pathways) to address.

Specialised cancer– - Hepato-Biliary transfer from Pennine to CMFT - Urology – subject to procurement - Upper GI – subject to procurement - Gynaecology – transfer from CMFT to Christie

Comments: AC: highlighted the need for due process and diligence. It is important to ensure the right pathway / steps are in place for transferring services e.g. neurology. A level of frustration was expressed as there is no prior consultation with CCGs before decisions are made. JD: reminded members of the difficult experience over the past 18 months of rebasing budget allocations and reference made to population based allocations. Further detail is needed. JS: was in agreement with JD but no further details are available. 5.3 111 update SA provided an update on the NHS 111 Service:-

Currently approaching the procurement phase with ambition to deliver service from October 2015.

The process needs sign off by each CCG and information (advice on conflict of interest/decision making, options, service specification etc) had been circulated.

The service specification has been agreed by clinicians.

Details have also been sent regarding the proposed arrangements for actual procurement process, scoring regime and summary estimate of financial impact.

SA asked that members provide this sign off by no later than Monday, 13 October.

If members have known concerns/queries etc these should be expressed to SA by no later than cop Friday 10 October.

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Comments: CD: this is being addressed through CCG internal processes and noted concerns they were being asked to agree to a timescale of a date already passed. GL: noted difficulties with opening some of the documents and was unsure if in receipt of final versions. SA agreed to send full suite of final papers to COs. SN: noted that the GM specification and GM tender is a level B decision. This is a NW process and therefore delegated above GM to the NW.

ACTION:

Members to alert SA by COP Friday,10 October of any existing concerns to prevent sign off

All members to sign off procurement process plans by Monday, 13 October

SA to send full suite of final papers to each CO

Financial agreement has not been reached with Stockport. Delegates at the Greater Manchester Stroke Board have reported a ‘gap’ at the July and September meetings. The Chief Executive of SHFT has advised that the gap is c. £1.2m. Alan Campbell as lead SRO presented AGG with possible option if ongoing negotiations fail to reach conclusion. Subject to the analysis above, the CCGs have a number of options.

i) Agree differential funding for Stockport by paying more than the other two hyper-acute sites for the activity. This could be recurrent or as a bridging payment.

There are no identified funds for this;

It risks re-opening discussion with the other two sites. ii) Consider options to partly implement the service.

Would mean most of the conurbation benefitting but Stockport and surrounding areas not.

Difficult to justify to population. Consider alternative provider options

i) A different Trust

Would need significant work-up and agreement and some disinvestment from Stockport. ii) A different provider delivering service from Stockport.

There are precedents (e.g. Christie at Wigan, Oldham and Salford)

Would need agreement of Stockport and other provider. iii) Deliver the hyper-acute services from the other two sites only.

Would require more capacity at those sites;

Would require re-negotiation;

Would need to understand population flow issues and consequences to patients from High Peak and Cheshire access Stockport in the agreed model.

Summary: The GM plan is still to implement the full hyper acute stroke model early in 2015. Planning for this is largely in place with the key outstanding issue being the lack of agreement between commissioners and

6. ANY OTHER BUSINESS – Stroke Update

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Stockport FT on funding. It is still expected that the gap can be successfully resolved but if not, the paper presented summarises a number of alternative approaches. Comments: GL: need to avoid a ‘price war’. The same service specification applies to each hyperacute centre and therefore would strongly oppose accepting a different price for Stockport. SA: once all possible options have been exhausted with Stockport then cannot be held to ransom and therefore would need to source a different provider from that area. TD: agreed with GL and SA to stand firm. SL: queried if 3 centres were the correct amount for the population? AD: confirmed 3 centres correct for the population size. If two centres then this would mean a longer journey time (for south sector patients) but within the specification but also require significant additional capacity within Salford. GM: indicated discussion held with RG and of the opinion to stand firm on the price and if necessary identify another provider. AC: indicated that no alternative providers had been approached at this stage. The latest financial position relates to recurrent and non-recurrent funds. AC: indicated that regardless of the next steps, Stockport would have to be a District Stroke Centre (DSC) taking repatriated patients from the hyperacute centre. AD: indicated that the potential to identify an alternative provider may be the necessary lever for Stockport to accept the tariff arrangements. – IW: agreed with the general arguments being made and queried if the timing for implementation of January 2015 was fixed. AC: responded that the absolute deadline had to be the end of March. IW: indicated that the firm timetable was a means of forcing the issue and allowed AC a little flexibility if required. AC: explained that all changes needed transition and implementation. There had been service issues in respect of capacity, workforce, and IT which had been appropriately budgeted. The recurrent costs is the differential. JD: noted that the strategic levy had allocated transitional funding to support the centres which is still to be drawn upon. CD: concerned that the premature deaths from stroke amount to 8 per month and full implementation being delayed due to Stockport. DG: expressed concern over this monopoly behaviour and the possibility of this position occurring again when large service change is made. AC: agreed to proceed to try and broker agreement with Stockport at the existing cost level. If unsuccessful seek an alternative option – with the preferred option being to identify an alternative provider delivering the service from Stockport. AC: Agreed that should no agreement be reached with Stockport a recommendation for the preferred alternative option would be sought from the AGG in November. TA: if implementation occurred at the two other sites, this may be a lever for Stockport to agree. SN: cautioned the need to be clear about the rationale for the alternative provider. SA: commitment to deliver service in Stockport and demonstrate process taken. HS: reminded members that a delayed decision was experienced (Clinical Strategy Board) due to concerns about Stockport A&E performance.

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ACTION:

AC to continue to attempt to broker a deal with Stockport on existing cost base

If no agreement reached by the end of October, AC to make a recommendation to the November AGG to seek alternative provider operating from Stockport

7.1 HOC MINUTES (JULY 2014) Noted. 7.2 CFO MINUTES (JULY & AUGUST 2014) Noted. 7.3 HT HIGHLIGHT REPORT Noted. The next meeting will be held on Tuesday, 4 November 2014 at 08.30am, Salford &Worsley Suites, St James’s House, Salford.

Agenda Item No.

ACTION LOG OWNER

3.1 HT Budget Detail on the use of the contingency funding and continued reporting to AGG

JD

3.2 Wider Leadership Programme

To inform of the outcome of the funding bid to Clinical Chairs/COs/CFOs

To prepare a briefing in respect of the funding for use by CCG Boards

To seek two further nominations for the H&SC Wider Leadership Group

WH

WH

AD

3.3 OACP To prepare a discussion paper for the next meeting

Need for an OD plan to support AGG leadership

To invite MONITOR to an AGG meeting to understand their approach to re-procurement

SN AD AD

3.5 Service Transformation

For further discussion at the next COO meeting

To consider what the GM plan is and then determine the support required

Need to complete HT and define the endpoint

To consider the wider role of Service Transformation

COO IW

IW IW

DATE/TIME OF NEXT MEETING

7. ITEMS FOR INFORMATION ONLY

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4.1 AGG Away Day

Noted and supported the feedback – acknowledging that further work required on decision processes at the next Away Day

To align the next Away Day with the leadership session to work with WH For planning purposes

AD

AD

5.1 GM CATS Contract

To check commissioning intentions have been submitted

Financial risk to be included on AGG Risk Register

Further update to be provided to a future meeting

All AD CW

5.3 NHS 111 Service

To alert SA (by 10.10.14) of any existing concerns to prevent sign off

To sign off procurement process plans by 13.10.14

To send full suite of final papers to each COO

All

All SA

6. Stroke Update

To continue to attempt to broker a deal with Stockport on existing cost base

If no agreement is reached by the end of October, AC to make a recommendation to the November AGG to seek alternative provider operating from Stockport

AC

AC

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MINUTES of a meeting of the DERBYSHIRE HEALTH AND WELLBEING BOARD held on 4 September 2014 at Gothic Wharf, Cromford

PRESENT

Councillor D Allen (in the Chair)

T Allen DCHS NHS Trust P Coleman Derby Hospitals NHS Foundation Trust Dr D Collins North Derbyshire CCG Councillor J A Coyle Derbyshire County Council Councillor C A Hart Derbyshire County Council S James Derby Hospitals NHS Foundation Trust A Layzell Southern Derbyshire CCG D Lowe Derbyshire County Council M McElvaney Derbyshire County Council E Michel Derbyshire County Council Councillor C Neill Derbyshire County Council J Pendleton North Derbyshire CCG J Simmons HealthWatch Derbyshire P Singh DCHS NHS Trust J Smith South Derbyshire CVS M Todd Derbyshire Healtcare Foundation Trust Councillor A Western Derbyshire County Council Councillor B Wheeler South Derbyshire District Council Also in Attendance – S Hobbs (Derbyshire County Council), J Ilott (Derbyshire County Council) and J Vollor (Derbyshire County Council) Apologies for absence were submitted on behalf of S Allinson, F Bharmal, G Boyle, Dr A Dow and K Ritchie 27/14 MINUTES RESOLVED that the minutes of the meeting of the Board held on 3 April 2014 be confirmed as a correct record. 28/14 MATTERS ARISING – (a) Greater Manchester Healthier Together Programme (Minute No 20/14 refers) It was reported that the Chair of the Board and the Leader of the Council had met with Greater Manchester and would continue to discuss a range of proposals around the Healthier Together Programme. The consultation period closed at the end of September, and it was agreed that it was important to respond on behalf of the County Council. 29/14 IMPLEMENTATION OF THE BETTER CARE FUND – UPDATE National guidance had been issued in August 2013 and January 2014 which required all Health and Wellbeing Boards to approve and submit a local final

PUBLIC

Agenda Item 3

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Better Care Fund Plan by 4 April 2014. The Plans had to demonstrate the support of all partners including acute providers, meet a number of national conditions, and provide a baseline and trajectory against five national and one agreed local metric – Derbyshire had agreed this would be dementia diagnosis – against which the performance of the plan would be measured. 2014/15 was the preparatory year for the Better Care Fund. The full implementation of the developments within the plan and the financial allocations associated with the developments did not come into effect until 2015/16, and for Derbyshire, the BCF Plan assumed a pooled budget of £61,489m, which was made up of funding from existing resources. During April and May 2014, regional and national assurance had taken place to assess BCF plans against the national requirements. There had been a series of discussions between NHS England and Local Government around the levels of assurance BCF plans provided at this stage, in particular the ability of plans to demonstrate evidence based schemes to reduce avoidable emergency admissions to a sufficient level, and the involvement of acute providers in approving local plans. There was now a clear expectation that a local contingency/risk pool would need to operate, to be set out within the Section 75 agreement for each BCF with effect from 2015/16. If performance against the metrics did not reach the locally agreed thresholds, funds from the risk pool would be used to mitigate the financial consequences between partners. There was also an expectation that if local areas were falling short of their trajectories, additional support and oversight from NHS England and Local Government would be in place. Derbyshire’s BCF plan submissions on 4 April and 7 May had set out the level of contingency partners had agreed for the financial plan, and the Joint Commissioning Co-ordinating Group was leading the work needed to develop the Section 75 agreement and supporting risk sharing agreement. The Department of Health had made an announcement on 5 July 2014 setting out some fundamental changes to the BCF planning arrangements, and these would need to be taken into account in the Derbyshire BCF resubmission. Every Health and Wellbeing Board had been asked to sign off and resubmit its BCF Plan by no later than midday 19 September 2014. This would be followed by a regional and national assurance process using criteria. It was anticipated that by 3 October, all BCF plans would have been reviewed and assessed. The revised BCF template included some new questions, some revised questions and some were unchanged. There were a number of areas of change/concern to note in taking forward the local response, all of which were subject to further clarification and guidance. The guidance and templates to be completed were being updated on a regular basis, and these had additional annexes and questions for

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completion. The main areas where, nationally and locally, clarification was being sought were the definition of the 3.5% ambition for reducing emergency admissions, and clarification of the baseline figure being used; Section 75 agreements, including advice on risk sharing arrangements; Risk Stratification and Information Governance issues; and the BCF evidence base, interventions and their impact on metrics. The revised Technical Guidance issued on 18 August now included a section setting out ‘what good looks like’, with criteria for each section of the BCF template, and each BCF plan would be expected to meet the detailed requirements in the resubmission, as well as the review assurance criteria. The pace of changes to guidance and requirements being announced made it challenging to finalise the local agreements, but all parties were committed to achieving and completing the requirements of the BCF and to submit the plan on time. There was now a very strong emphasis on the avoidable emergency admissions metric, which would drive a number of potential changes and requirements:

Avoidable emergency admissions were the sole indicator underpinning the Pay for Performance element of the BCF, and this was on the basis that ‘a reduction in total emergency admissions was a clear indicator of the effectiveness of local health and care services in working better together to support people’s health and independence in the community’.

The original BCF metric had now been expanded to include all non-elective admissions

There was a change to the level of ambition for the emergency admissions metric. Each Health and Wellbeing Board had been asked to propose its own performance pot based on the level of ambition for reducing emergency admissions, with a guideline reduction of at least 3.5%

There was likely to be a greater level of risk for Derbyshire in achieving the performance levels within the BCF plan

There was more centralised and regular upward reporting requirements than anticipated, including three ‘checkpoint’ returns which had to be completed jointly by the CCGs and the County Council and submitted to NHS England

The pressure to achieve the reduction in non-elective admissions risked the BCF plan becoming focussed wholly on reducing the admissions within one financial year; and reduced the ability to implement medium term integration and preventions schemes

The original range of metrics against which the plan would be measured remained, as an indicator of local joint working and integration.

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Pay for performance had been re-introduced. A proportion of Derbyshire’s current performance allocation would be paid for delivery of the emergency admissions target. The proportion depended on the local level of ambition of the target. The amount of the Derbyshire BCF affected by the payment for performance was estimated to be £15m, of which approximately £5m would be the performance related element. At each of the four ‘payment points’, each CCG would be able to release money into the BCF pooled fund on the basis of performance to date. If the target was not achieved in a quarter, the amount relating to the activity not achieved would be held back by the CCGs for ‘remedial reallocation’. Where targets were met, the money would be released to the pooled budget and the decision on how funds would be spent had to be agreed between the CCGs and the Health and Wellbeing Board. The contingency plan part of the BCF also needed to include actions to be implemented in the event that the emergency admission target was not met. The remaining £10m had to be spent on NHS commissioned out-of-hospital services, and the funding had to be transferred by the CCGs into the pooled fund at the beginning of 2015/16. The revised BCF plan had to include a breakdown of spend, including the amount identified as NHS-commissioned spend. The approach reduced local flexibility in relation to risk pooling arrangements. The changes and risks they represented could jeopardise the progress already being made between partners in Derbyshire as plans were set out to transform health and care over the next five years. The change in focus could lead to increased tensions both nationally and locally due to the high level of emphasis being placed on NHS finances/activity. This could be seen to be detracting from other aspects of the vision for integration, affecting the overall balance of BCF plans for the future, and placing additional risks on Adult Care budgets. It was essential to jointly assess the local implications of the changes, work together on assessing the risks and mitigations, and agree any adjustments needed to the BCF plan together. In terms of the workplan, the work to digest the guidance and resubmit the BCF plan was being led by the Joint Commissioning Co-ordination Group. Consideration needed to be given to the feasibility of an additional Health and Wellbeing Board meeting ahead of submission, or to agree alternative sign-off arrangements. It had been agreed that, in the absence of the Chair of the Board, the leader of the Council would sign off the plan on behalf of the Board. The Joint Commissioning Co-ordination Group continued to meet to consider implications collectively and to provide assurance that preparations and various analyses were underway for the resubmission. Detailed actions were highlighted. The revised draft guidance required additional information on patient experience, and it also clarified the metric; that the national measure would not be in place in time to measure improvements in 2015/16. Health and

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Wellbeing Boards were asked to provide local plans in line with revised guidance. It was felt that the timescales for resubmission were likely to prevent wider engagement. The changes to the national arrangements for the BCF could lead to a reduction in the funds available within the Derbyshire BCF, depending on the pay for performance guidance, which had not yet been finalised. In addition, the level of officer time should not be underestimated. In terms of the guideline reduction of at least 3.5% for reducing emergency admissions, it was queried whether it had to be at this level, as Derbyshire’s performance was not currently at 3.5%. It was stated that a case could be put forward for it not to be, but a rang e of evidence would need to be shown. Tameside and Glossop CCG informed the Board of a process that had taken place in its area where there had been more flexibility, and this would be discussed further. RESOLVED to (1) approve the next steps/actions as set out in the report; (2) provide joint leadership and support in directing the work of the Joint Commissioning Co-ordination Group over the next period of BCF resubmission; and (3) approve that the leader of the Council sign off the BCF Plan resubmission, on behalf of the Health and Wellbeing Board.

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ITEM NO: 3 TAMESIDE HEALTH AND WELLBEING BOARD

7 August 2014

Commenced: 10.00 am Terminated: 11.30 am

PRESENT: Councillor Kieran Quinn (Chair) – Tameside MBC Councillor Allison Gwynne – Tameside MBC Councillor Brenda Warrington – Tameside MBC Steve Allinson – Clinical Commissioning Group Stephanie Butterworth – Tameside MBC Graham Curtis – Clinical Commissioning Group Alan Dow – Clinical Commissioning Group Ben Gilchrist – CVAT

Christina Greenhough – Clinical Commissioning Group Karen James – Tameside Hospital Foundation Trust Angela Hardman – Tameside MBC Michelle Lee – Stockport Foundation Trust Margaret O’Dwyer – NHS England Steven Pleasant – Tameside MBC Tony Powell – New Charter Housing Trust

Andy Searle – Tameside Adults Safeguarding Board Richard Spearing – Pennine Care Foundation Trust Clare Watson – Clinical Commissioning Group

IN ATTENDANCE: Debbie Bishop – Tameside MBC Jacqui Dorman – Tameside MBC Doreen Hounslea – Tameside MBC / Clinical Commissioning Group

Sandra Stewart – Tameside MBC Pam Williams – Tameside MBC

APOLOGIES: Councillor Lynn Travis

Caroline Ball – Greater Manchester Police Mike Tarver –Tameside Safeguarding Children Board

15. DECLARATIONS OF INTEREST There were no declarations of interest submitted by members of the Board. 16. MINUTES OF PREVIOUS MEETING The Minutes of the Health and Wellbeing Board held on 19 June 2014 were approved as a correct record subject to Michelle Lee, Stockport Foundation Trust, being added to the list of those present at the meeting. 17. MINUTES OF GM HEALTH AND WELLBEING BOARD The Minutes of the GM Health and Wellbeing Board held on 9 May 2014 were submitted for information.

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18. CARE TOGETHER PROGRAMME UPDATE Consideration was given to a report of the Executive Member (Adult Social Care and Wellbeing) and Programme Director (Care Together) which provided the Health and Wellbeing Board with an update on the Care Together Programme and the establishment and formal launch to the wider community of the Commissioner Executive. Considerable progress had been made over the last four months and the report covered the following areas:

Recap on the outcome of the feasibility phase of the work programme; Report and ongoing discussions with Monitor; Proposed model of care for citizens in the future; Development of outline business cases; and Next Steps.

The Health and Wellbeing Board was asked to note the progress of the Care Together Programme and the positive ongoing work with Monitor and Tameside Hospital NHS Foundation Trust to resolve the economy’s clinical and financial issues. It was intended that the work be taken forward jointly with the proposed revised governance arrangements including the Integration Board becoming the Transformation Board, with senior management from Tameside Hospital NHS Foundation Trust and the introduction of a Delivery Team / Unit. The launch of the Commissioning Executive would also underpin the roles and responsibilities of partners making a clear distinction between commissioner and provider by enabling the Transformation Board to focus its efforts on the delivery of a new model of care for citizens. A further update would be provided to the next meeting of the Health and Wellbeing Board. In relation to the Better Care Fund, all areas were now required to revise their plans in the light of updated policy framework released in July 2014 and supply additional information to ensure that they were in the best possible position to deliver their ambitions for more integrated health and social care. A first draft would need to be submitted to the NHS England Local Area Team by 27 August 2014 and the date for the final submission was noted as 19 September 2014. Specific support was being provided by NHS England Local Area Teams through regular checkpoint discussions in August and early September. A crucial element of assurance of plans was for the revised submission to be signed-off by the Health and Wellbeing Board. With this in mind and In view of the timescales involved, Tameside MBC, the Clinical Commissioning Group and Tameside Hospital Foundation Trust to approve the updated plan through their respective organisations. RESOLVED (i) That the progress of the Care Together Programme and launch of the

Commissioning Executive be noted. (ii) That the revised governance arrangements be agreed. (iii) That Tameside MBC, the Clinical Commissioning Group and Tameside Hospital

Foundation Trust approve the updated plan through their respective organisations for submission to the NHS Local Area Team by 19 September 2014.

19. NHS TAMESIDE AND GLOSSOP CLINICAL COMMISSIONING GROUP: FIVE YEAR

COMMISSIONING STRATEGY The Director of Transformation, Clinical Commissioning Group, advised that every clinical commissioning group was required to submit their five year strategy to NHS England including a plan on a page. The 2014/19 Strategy builds on the one published in 2012 and describing in detail how health and social care would come together and change over the next five years and had been developed jointly with Tameside MBC, Derbyshire County and High Peak Borough and through discussions with local service providers.

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The Strategy highlighted why there was a need for change and how the Clinical Commissioning Group aimed to improve healthy life expectancy and reduce health inequalities and explained the four levels of care being built through Care Together as follows:

Building up the strength of individuals and communities; Integrated teams based in localities; Specialist pathways; and Hospital based care.

It also introduced patient guides, providing examples of how services for local people would be different in the future through the experiences of three Tameside and Glossop residents. RESOLVED That the Tameside and Glossop Clinical Commissioning Group 2014/19 Strategy be received and the submitted plans noted. 20. PHARMACY NEEDS ASSESSMENT Consideration was given to a report of the Executive Member (Health and Neighbourhoods) and Director of Public Health and accompanying presentation advising of progress to date, highlighting early issues and suggesting links between the pharmacy needs assessment refresh process and other important current work streams. As reported to the Health and Wellbeing Board at its meeting on 19 June 2014, the pharmacy needs assessment was key to supporting the decision making process for new pharmacy applications in Tameside. However, it also reflected upon the wider public health potential of pharmacy across Tameside. It was noted that pharmacies were eager to extend their role in prevention by providing enhanced services given the increasing levels of people managing long term conditions. The footprint of pharmacies within and across local communities in Tameside also played an important role in terms of social capital. The provision of pharmacy services had been mapped which showed that there were 60 pharmacies in Tameside and 31 out of area pharmacies that were likely to be accessed by the residents of Tameside. Stakeholder engagement to date had included specific sessions with GPs in localities, key representative organisations and those producing pharmacy needs assessments in neighbouring areas. A public consultation exercise had been designed and a survey would be distributed via Healthwatch, Council Portals, pharmacists, GPs and patient groups at the beginning of August. It was explained that one of the main concerns becoming evident from stakeholders and the mapping of pharmacies was less about unmet need and more about potential over-provision leading to a competitive culture not in the best interests of healthy communities. Such issues were not covered in the original pharmacy needs assessment but the nature of pharmacy provision had changed in this short timescale quite substantially and there were now more out of Borough “e-pharmacies” providing a service to Tameside residents and the wider role of pharmacies providing wellbeing services was also expanding rapidly. RESOLVED That the update on progress with the pharmacy needs assessment and key emerging issues be noted. 21. PUBLIC HEALTH SECTOR LED IMPROVEMENT PROGRAMME Consideration was given to a report of the Executive Member (Health and Neighbourhoods) and the Director of Public Health advising that the Greater Manchester Public Health Network was facilitating a programme of work in partnership with Public Health England to develop a sector-led

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improvement approach to the Public Health Outcomes Framework measures. It aimed to enable local authorities to take responsibility for their own performance and improvement and for leading the delivery of improved outcomes for local people in their area. The approach was based on the principles of mutual support and assistance and involved a discrete process of self-assessment and peer review against the latest evidence base. The four measures chosen for the first round in 2013 were for smoking, healthy weight, NHS Health Checks and falls. Measures selected for 2014 were for flu vaccination, suicide, children’s injuries, breastfeeding and teenage conceptions. It was noted that Tameside had participated in both cohorts. Action plans had been produced following the 2013 round and the production of plans for 2014 was currently in progress. RESOLVED That the involvement of Tameside Public Health and local partners in the Greater Manchester Public Health Network Sector Led Improvement Programme be noted. 22. NORTH WEST PUBLIC HEALTH MANIFESTO The Executive Member (Health and Neighbourhoods) and Director of Public Health submitted a report advising that the first Manifesto for Public Health had been developed by Directors of Public Health in the North West raising awareness of important public health issues, both nationally and in the North West. It provided a coherent set of top ten priorities for Local Authorities, the NHS, Public Health England, policy makers, advocacy organisations and Government departments to consider for immediate implementation. The priorities were based on a robust evidence-based approach that if implemented in full would result in improvement the physical and mental health and wellbeing of the population and reducing health inequalities further and faster than current trajectories. Investment and implementation in the ten priorities would not only save countless lives but build a better quality of life for a new generation. RESOLVED That the North West Public Health Manifesto be supported and shared within respective organisations. 23. TAMESIDE ADULT SAFEGUARDING PARTNERSHIP ANNUAL REPORT 2013/14 The Executive Member (Adult Social Care and Wellbeing) introduced the Tameside Adult Safeguarding Partnership (TASP) Annual Report 2013/14, addressing the challenges and celebrating the achievements of the Partnership and outlining priorities for the next twelve months. Andy Searle, Independent Chair of TASP advised that the past year had seen continued challenges for public bodies linked to financial pressures and restructuring. However, closer working relationships between the Health and the Local Authority were becoming embedded in day to day activity. A strategic, operational and practical approach was being taken with an overall aim of improved outcomes for individuals being at the centre of all partnership work. TASP had embraced this approach which was evidenced within the principle groups. He felt that TASP was well positioned to respond to the introduction of the Care Act in 2015 putting adult safeguarding on a statutory footing. There would continue to be a flexible local approach to adult safeguarding supported centrally with guidance and good practice being shared across the country. There was still a considerable amount of work required to raise the awareness of adult abuse and neglect and the publicity that the Care Act would receive would be an opportunity to assist.

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In conclusion, TASP would continue to develop and refreshed and updated policy and procedures adopted within the last twelve months were evidence of this. Further examples were also contained within the Annual Report. RESOLVED That the content of the Tameside Adult Safeguarding Partnership Annual Report 2013/14 be noted. 24. POVERTY STRATEGY Consideration was given to a report of the Executive Member (Neighbourhoods and Health), Assistant Executive Director (Community Services) and Chief Executive of CVAT detailing the Tackling Poverty in Tameside: A Partnership Approach 2014-2017. The Council had signed up to the Greater Manchester Poverty Pledge and was committed to its objectives which included taking action on poverty and being a catalyst for change. It was reported that the Supportive Communities Partnership had identified priorities for Tameside and the Partnership had agreed to undertake consultation on these priorities via the Big Conversation. The consultation identified the following six key issues in order of priority:-

• Promoting initiatives to reduce energy bills; • Reducing the risk of debt; • Addressing food poverty; • All public services and strategies should consider their impact on people in poverty; • Improving income levels via the living wage; and • Working together by improving the co-ordination of voluntary and community services.

The action plan associated with the strategy was appended to the report and the identified the following key themes in the approach to tackling poverty:-

• Theme One: Working Together – by delivering actions through partnerships; • Theme Two: Prevention of Poverty – by delivering a resilient economy; and • Theme Three: Alleviating the impact of poverty – by supporting household to manage the

cost of living and improving access to services. Reference was made to the summary of key points, implementation of the strategy, equality and diversity and risks. Members of the Health and Wellbeing Board also noted and commented on the key statistical data of poverty in Tameside detailed in the report. RESOLVED That the Poverty Strategy and accompanying action plan be noted. 25. HEALTHWATCH TAMESIDE: ANNUAL REPORT AND BUSINESS PLAN The Board received a report of the Executive Member (Health and Neighbourhoods) and Chief Executive, Healthwatch Tameside, and accompanying presentation detailing the key achievements set out in the Healthwatch Annual Report 2013/14 during the set up and first year of operation of Healthwatch Tameside. In particular, reference was made to:

• Establishing Healthwatch as a Community Interest Company as part of the CVAT family; • Recruiting an independent chair and a board with a balance of elected and appointed

places; • Setting up and delivering a new information signposting service;

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• Establishing a successful volunteer Healthwatch Champion role which had enabled Healthwatch to have over 4,500 face to face contacts with members of the public;

• Collection and referral to service commissioners and providers of over 250 individual patient / service user stories; and

• Award winning collaborative working with other local Healthwatch organisations across Greater Manchester to review the effectiveness of Patient Transport Services and building on the work undertaken by Tameside LINk in 2012.

RESOLVED That the Healthwatch Annual Report 2013/14 be received and noted. 26. TAMESIDE HEALTH PROFILE 2014 Consideration was given to a report of the Executive Member (Health and Neighbourhoods) and the Director of Public Health providing an introduction for local authorities to enable understanding of the 2014 Health Profiles produced by Public Health England and providing a summary of the information contained and how Tameside compared to the rest of Greater Manchester. These profiles were designed to assist local government and health services when making their decisions and plans to improve people’s health and reduce health inequalities. The report also included a short summary of the changes in the 2014 health profile compared to the 2013 health profile where there had been significant improvements, slight improvements and areas where Tameside had shown a slight decline. RESOLVED That the content of the report be noted. 27. HEALTH AND WELLBEING BOARD FORWARD PLAN 2014/15 Consideration was given to an outline forward plan covering key issues associated with the Board’s duties and terms of reference. RESOLVED That the forward plan be approved. 28. DATE OF NEXT MEETING To note that the next meeting of the Health and Wellbeing Board will take place on Thursday 9 October 2014 commencing at 10.00 am. 29. DEVELOPMENT / TRAINING EVENTS The Chair advised that the details of development / training events that would assist Board members in undertaking their role or undertaking the business of the Board would be included on future agendas. 30. URGENT ITEMS The Chair advised that there were no urgent items for consideration at this meeting.

CHAIR

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