nhs southwark clinical commissioning group annual general ... · ab introduced the presentation...
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1 Chair: Dr Jonty Heaversedge Chief Officer: Andrew Bland
The best possible health outcomes for Southwark people
NHS Southwark Clinical Commissioning Group
Annual General Meeting (AGM)
03 September 2015
Cambridge House
Minutes Governing Body Members Present: Dr Jonty Heaversedge (JH) CCG Chair, NHS Southwark Clinical
Commissioning Group (CCG) Andrew Bland (AB) Chief Officer, CCG Malcolm Hines (MH) Chief Financial Officer, CCG Professor Ami David (AD) Registered Nurse Member, CCG Dr Obi Ezeji (OE) Clinical Lead, CCG Dr Richard Gibbs (RG) Lay Member, CCG Dr Nancy Kuchemann (NK) Clinical Lead, CCG Robert Park (RP) Lay Member, CCG Dr Jane Cliffe (JC) Local Medical Committee Representative Professor John Moxham (JM) King’s Health Partners Gwen Kennedy (GK) Director of Quality and Safety, CCG Dr Jacques Mizan (JM) Clinical Lead, CCG Dr Noel Baxter (NB) Clinical Lead, CCG Alison Furey (AF) Public Health Consultant, Lambeth and
Southwark Council IN ATTENDANCE: * Rachael de Souza Corporate Business Manager, CCG (minutes) Rosemary Watts Head of Membership, Engagement and Equalities, CCG Kate Radcliffe Principal Associate, Communications and
Engagement, South East Commissioning Support Unit (SECSU)
Hayley Sloan Head of Transformation, CCG Lucy Ing Communications Manager, SECSU Caroline Ashton Chief Pharmacist, CCG Rebecca Scott Programme Director, CCG Kate Moriarty-Baker Head of Continuing Care and Safeguarding,
CCG David Smith Head of Transformation, CCG Nigel Smith Head of Pathway Commissioning, CCG Kieran Swann Head of Planning and CCG Assurance, CCG Julian Westcott Head of Finance, CCG
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2 Chair: Dr Jonty Heaversedge Chief Officer: Andrew Bland
The best possible health outcomes for Southwark people
Jean Young Head of Primary Care, Community and Children’s Commissioning, CCG Harpinder Priest Clinical Governance Manager, CCG Michelle Cleary Neighbourhood Development Manager, CCG Harprit Lally Extended Access Programme Manager, CCG
APOLOGIES:
Dr Yvonneke Roe (YR) Clinical Lead, CCG David Cooper (DC) Healthwatch, Southwark Dr Kathy Mc-Adam Freud (KM-F) Local Medical Committee representative Linda Drake (LD) Practice Nurse Member Dr Ruth Wallis (RW) Director of Public Health, Lambeth and
Southwark, Southwark Council *A list of attendees from the public are recorded at the end of the minutes
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Chair’s Welcome
JH welcomed attendees to this meeting, asking Governing Body
members to introduce themselves and provide details of their portfolios.
JH asked attendees to switch off mobile phones during the meeting, also advising that photographs would be taken during the meeting. He asked if anyone objected to this and if so, they could raise their hands so their objection could be noted. No hands were raised. He invited members of the public to help themselves to copies of the summary annual report. Governing Body members introduced themselves and explained their roles. Conflicts of Interest declarations were reviewed across Governing Body members. No conflicts of interest were declared JH asked AB to speak about progress made during the year and MH to outline key financial points from the past year. He said that the focus of this meeting was the CCG’s achievements in 2014-15 and our plans and actions for next year including:
NHS Southwark CCG’s plans for the year ahead
Working in partnerships with others and the value of collaborative partnerships
Working with partners in Lambeth and across London (particularly the Our Healthier South East London – the OHSEL
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3 Chair: Dr Jonty Heaversedge Chief Officer: Andrew Bland
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programme)
Listening to our residents and helping people to manage their own health and wellbeing.
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Annual Report
AB introduced the presentation entitled ‘Annual Report/Key
achievements 2014/15’).
Challenges and achievements included programmes essential to
prevent Coronary Heart Disease (CHD), respiratory diseases and
cancer; all of which result in premature deaths of residents. We
are working hard with local providers in these areas.
We made progress in the past year with delivering the Primary
and Community Care Strategy and in establishing the Local Care
Networks (LCNs)
AB said Southwark had a high prevalence of obese children. For
this and some other issues, it was not always possible to find
solutions in Southwark alone, and therefore NHS Southwark CCG
was working with other partners across south east London.
Clinical Commissioning Groups were now working in partnership
with local populations to find value for money services offered
through commissioning
AB advised attendees that a formal process to identify funding for
a new health centre in Dulwich had taken place. In Dulwich, NHS
Southwark CCG worked in full partnership with stakeholders and
local residents to inform the development of the new health
centre.
In the borough, NHS Southwark CCG had commissioned
additional capacity from Guy’s and St Thomas’s NHS Foundation
Trust’s (GSTT’s) @Home services and the Enhanced Rapid
Response services. NHS Southwark CCG also worked with
community services to provide immediate access to enhanced
levels of therapy, social work and nursing
An enhanced multidisciplinary Learning Disability Intervention
Team had been commissioned to deliver specialist support to
families with children and young people with learning disabilities
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4 Chair: Dr Jonty Heaversedge Chief Officer: Andrew Bland
The best possible health outcomes for Southwark people
Southwark Council and NHS Southwark CCG developed and
implemented a joint Care Home Quality Improvement Strategy for
patients in Southwark’s nursing homes
With King’s Health Partners (KHP), the CCG established an
innovative ‘Three Dimensions for Diabetes’ project in September
2014.
The Better Care Fund involved working with the local authority –
the fund delivers investments exceeding £20m. We worked in
partnership with the two local authorities (Lambeth and
Southwark councils) and are making investments in primary care
(supported by an action plan)
On A&E, the CCG worked with King’s College Hospital NHS
Foundation Trust (KCH), developing a plan to improve
performance that resulted in reductions in people waiting over 52
weeks for surgery; there were 123 patients in April 2014 and this
dropped to nine in January 2015. The CCG also worked with
KCH to reduce 18 week waiters by 30% over that same
timeframe and the number of Southwark people attending A&E or
admitted as non-elective patients had also stabilised
At KCH at the beginning of the year, there were more than 101
people waiting significantly longer than national target times for
services - this situation reduced significantly for long waiters
Mixed sex accommodation breaches minimised, and improved
inpatients’ reports of their care experience were reported. MRSA
infections were also reported to be low for Southwark
Urgent two week cancer waiting times targets had been
consistently delivered. This means that cancer patients had been
seen by consultants quickly after referrals
Mental health services for Improving Access to Psychological
Therapies (IAPT) and dementia; Southwark and Lambeth were
within the top 4 or 5 high performers
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5 Chair: Dr Jonty Heaversedge Chief Officer: Andrew Bland
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Strong arrangements for safeguarding adults and children were
already in place and we worked with the council to develop
initiatives for adults and children
The CCG managed several engagement programmes and events
in 2014/15, inviting views from patient about new developments.
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Annual Accounts
MH introduced the Annual Accounts - he said 2014/15 presented
challenges where it became necessary to make efficiency
savings of between 2% and 3% at the local level
The gross target expenditure target was £400,472,000 and the
performance level over the same period was £393,195,000. This
meant a surplus of £7,277,000 was achieved and therefore
available for NHS Southwark CCG in future years. The running
costs target was £7,621,000, against which the CCG expenditure
was £6,811,000. Running costs represents the CCG’s limits for
spending on staffing, rent, IT and other operational areas. NHS
Southwark CCG’s expenditure had come within targets set for
this financial year
The surplus was higher than originally planned (at £7,277,000)
against a plan of £5,972,000 for the year. The CCG reviewed
staff, support structures and rents, trimming staff budgets down
and re-negotiating some of the contracts in order to deliver large
savings on running costs in time for the 2015/16 financial year.
The CCG was able to deliver savings early, bringing about an
underspend of £810,000 on running costs
The National Continuing Care Risk Pool required a contribution
from NHS Southwark CCG. A rebate was made in 2014/15 to the
CCG of £869,000 and this contributed to a higher than planned
surplus for the CCG. This additional surplus was reported, as
required by NHS England and will be carried forward for the
benefit of NHS Southwark’s residents for future years
NHS Southwark CCG does not maintain capital assets (land or
buildings) on its accounts. All assets that belonged to Southwark
PCT before the creation of NHS Southwark CCG, were
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transferred to various organisations, including NHSE and
therefore the CCG has no assets
We are audited independently each year and, therefore, work
with KPMG (independent internal auditors) and Grant Thornton
(independent external auditors). This year we received a clean bill
of health from both auditors as, at the end of March 2015, NHS
Southwark CCG met all its statutory financial performance duties
The money spent during the year was largely on patient care.
Primary care had not been included as most primary care
expenditure was now managed by NHSE (the value being
approximately between £70m to £75m per annum)
For further details on the financial report, MH advised attendees
to review detailed information presented at the back of the full
annual report.
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Questions and Answers:
Barry Silverman said he would like NHS Southwark CCG to
carefully consider emergency admissions resulting from falls and
to what extent falls (in particular those caused by uneven
pavements in Southwark), resulted in A&E admissions
Action Point: JH agreed to explore the extent of emergency
admissions resulting from falls on uneven pavements in Southwark
with the local authority and respond at the Governing Body.
Barry Silverman also raised the issue of air quality in Southwark,
saying that in his opinion, this was a possible cause of increased
lung cancer.
NB clarified that the biggest issue for Southwark residents was related to
smoking. The CCG and the local authority were working collaborative to
reduce current smoking levels in local residents.
Steve Lancashire asked what work the CCG was doing with the
local authority under Section 106; Community Levy funds. This
was for the north of the borough to expand service for other areas
in addition to Dulwich.
MH advised the meeting that Section 106 referred to an agreement
under planning regulations between NHS Southwark CCG and the local
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The best possible health outcomes for Southwark people
authority where a contribution from local developers was made towards
a fund, where the agreement reached was that part of the levy was
allocated to projects leading to health improvements.
NHS Southwark CCG had discussions with the local authority regarding
Dulwich, Surrey Docks, Bermondsey Spa, Elephant and Castle, the
Aylesbury Estate and Peckham where major regeneration initiatives
were being led by the council. The discussions included multi-faceted
health services and levies and were designed to achieve a significant
contribution towards development of the estates as well as offering
cheaper housing.
MH advised there were going to be other opportunities in the future, with
new building projects coming on board, as was the case at Bankside.
NHS Southwark CCG will be able to review how creatively funds on
health budgets are being allocated. Local practices were working with
the CCG and the council to bid for regeneration programmes to improve
services for local residents. In addition, the Better Care Fund (BCF) will
become available to health related initiatives for the period of the next
four years. 2015 – 2016 will be the first of this four year period.
Dorothy Oxley was concerned about Continuing Care in care
homes as this issue related to recent CQC inspections. She
wanted to know how the CCG would work with people to facilitate
a better understanding of the process.
JH reassured Dorothy that the Continuing Care team worked jointly with
the local authority and a number of care homes to consider a wide range
of problems affecting elderly or vulnerable patients, including those with
long term conditions, mental health or other issues. Multi-disciplinary
assessments take place to ensure nurses work in collaboration with
social workers by using a multi-disciplinary approach.
Angela Stanworth said she had heard about financial issues
with King’s College Hospital NHS Foundation Trust (KCH) and
wanted to know how this could impact on patients.
MH said the CCG was working in partnership with KCH, Monitor and
NHS England (NHSE) to ensure financial recovery was realised over the
next five year period. Throughout this process, the CCG was monitoring
the quality of services that patients received. NB, Chair of the Clinical
Quality Review Group (CQRG) at KCH, assured the board that financial
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The best possible health outcomes for Southwark people
transition had no negative impacts on quality for patients.
AB said it was worth noting that financial issues at KCH was a result of
the trust expanding as an organisation (it now also included the Princess
Royal University Hospital (PRUH) in Bromley). In addition to that, KCH
was treating patients from Southwark, but in addition was managing
referrals from other boroughs across south London and Kent.
Paul Murphy from the Princess Street surgery asked for an
update on podiatry service provision as he reported difficulties
with accessing his local services.
JH advised that Caroline Gilmartin, the new Integrated Commissioning
Director who is starting in October, would have these services within her
portfolio. MK said services were accessible by self-referral or referral
from a GP. The CCG will investigate the issues raised by Mr. Murphy.
David Noakes, Liberal Democrat Councillor for Cathedral Ward
asked what measures the CCG was taking to ensure accidental access
of confidential information did not take place, especially in light of recent
releases of HIV patients’ names at the Dean Street clinic.
MH advised that Information Governance (IG) remained at the top end
of NHS Southwark CCG’s agenda. The CCG was in contact with local
trusts regularly to discuss IG. An IG toolkit was been provided and staff
expected to reach particular standards on processes used.
GK said all staff working in primary care in the CCG had been trained on
IG.
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Patient stories - a composite video of six patient stories was played.
The video covered:
Alika’s story about experiencing a mental health crisis
Abi and her experiences in surviving cancer, where she was
treated at Guy’s and St Thomas’ NHS Foundation Trust
Jane’s knee replacement, being treated at King’s College
Hospital NHS Foundation Trust
Elizabeth experiences of looking after her mother
Sara’s story of being treated for a dissociative disorder
Linda’s planning for End of Life Care (Linda has been diagnosed
with terminal cancer).
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After the video, MK said there could be no complacency. It was
necessary to take key messages from patient’s stories, such as those
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The best possible health outcomes for Southwark people
discussed in the video, and work to make services more patient-centred.
NHS Southwark CCG is focused on the delivery of innovation
programmes to support people in their every-day lives and in times of
crisis.
MK asked attendees to review the slide on innovation in the pack
entitled ‘Making Care Better for Southwark People’. MK said change
happened by enabling people to work together – this will be achieved by
changing ways in which people worked together.
Some new initiatives included:
- Partnerships with the local authority, voluntary and community
services. In south Southwark, NHS Southwark CCG is working to
expand social prescribing using this kind of model
- A ‘Street Triage’ for community and psychiatric services is being
introduced. Where necessary, this includes working with the
police to help people experiencing mental health crises
- Local Care Records; in emergency care, a clinician can access
patient records and obtain related data – this avoids some of
frustrations, such as those expressed by Elizabeth in her video
story i.e. inability of clinicians to access blood test results rapidly.
Other programmes included social prescribing, self-management
education, street triage, community rehabilitation, GSTT’s @Home
service and integrated care management.
MK said the CCG was working with colleagues in primary care and
GP Federations so pilots were becoming a more sustained way of
working with partners. He explained that some practices had come
together in groups (now called federations). The federations included
Improving Health (IHL) in the north of the borough and Quay Health
Solutions (QHS) in the south of the borough. The federations hold
contracts for services and quality improvement schemes for:
Extended primary care access
Population health management
Neighbourhood development incentive schemes.
Patients had access to new services through their GPs or the Out of
Hours (OOH) service, SELDOC.
MK emphasised that this innovation programme was being developed to
meet the needs of different people and was the result of listening to the
views of local people in a number of engagement events.
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The best possible health outcomes for Southwark people
Next steps in the Innovation Programme:
MK explained that people needed to work collaboratively in teams where
it will be necessary to go beyond primary care and across the whole
health system to find solutions – these are to be called Local Care
Networks (LCNs).
For the CCGs, this means having to radically assure a number of
incentives in commissioning. In the next 12 to 18 months, it will be
important to consider how commissioning is changing rapidly – the
outcomes will need to be clearly identified and this perspective will
emerge from engagement programmes taking place in the next 18
months. The structure of the contracts will also encourage increased
collaborative working between existing teams.
Over time, LCNs will be commissioned to deliver services and their
output will be measured on achievement of outcomes delivering
meaningful services to patients.
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Questions:
Angela Buckingham: said she had received feedback from patients
that a huge waste in medication occurred where doctors or nurses were
prescribing medications that did not agree with patients in the first
instance. She proposed a scheme could be set up to enable patients to
return un-used medications to practices.
Angela also felt that surgeries should receive monthly visits from breast
nurse specialists to determine whether conditions were urgent or non-
urgent.
JH said Angela’s comments on waste were helpful. It was not common
practise to return medications to practices but the CCG will review her
feedback.
Regarding Angela’s comments on breast screening – this will also be
reviewed by the CCG. A shared service across a number of practices
could work effectively. In this case, the breast nurse would visit those
practices sharing the service but it would not be feasible to enable
regular visits to every practice.
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The best possible health outcomes for Southwark people
Pat Lewis: referred to AB’s comments regarding those receiving
unequal starting points in health in their lifetime and where this was
dependent on the part of the borough they lived in. She asked what the
CCG could do better to address inequalities across the borough.
AB outlined that the CCG has access to a number of charts displaying
inequalities. We are working with our Public Health colleagues and
community based organisations to develop a deeper understanding of
underlying causes. Different contracts and incentives will support a
variety of commissioning options where taking a multi-agency approach
could better address underlying issues.
JH suggested that differences in life expectancies were usually driven by
peoples’ lifestyles - discussions are presently taking place with the
council at the Health and Wellbeing Board (HWB) level to address
health related inequalities. AF thought life changes could be improved
through increased education about leading healthier lifestyles, therefore
the CCG and local authority colleagues could achieve more effective
results through working collaboratively.
Tom White (Southwark Pensioner’s Action Group): referred to a
crisis incident that happened on the same day as the meeting. He gave
an account where two policemen were called on to deal with a mental
health patient – they took the patient to A&E.
JH referred Tom’s question to NK who said triage services
demonstrated good results to date with mental health patients taken by
the police to see mental health specialists. The main emphasis with
treatment of mental health patients was about taking preventative
measures to prevent getting into crisis. As people lead increasingly
complicated lives, a number of services needed to work together to
deliver consistent responses.
Esther Choutsedjem (member of a Patient Participation Group
(PPG): said she heard that a patient at KCH had been waiting for a long
while to see a physiotherapist. She wanted to know whether this was
indicative of quality issues at KCH.
NB advised Esther that issues on quality at KCH had been carefully
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The best possible health outcomes for Southwark people
monitored by the CQRG and to date there had been no substantive
reports of failing quality.
JH also informed Esther that our Integrated Governance and
Performance (IG&P) Committee advised that significant reductions in
long waiters at KCH were noted.
Closing remarks
JH thanked all members of the public in particular, and all
attendees for their attendance and contributions
Attendance Sheet
NHS Southwark Clinical Commissioning
Annual General Meeting
Thursday 03 September 2015
In attendance
1. Joy Monoute, Local resident
2. Barry Silverman, Member of the Engagement and Patient Experience
Committee (EPEC) and patient at Princess Street
3. Jacqueline Best-Vasell, Lambeth and Southwark MIND
4. Angela Buckingham, PPGt - Melbourne & Concordia Parkside
5. Martin Dodswell, Member of EPEC and patient at Albion Street surgery
6. Chin Ong
7. Linda Rugel
8. Angela Stanworth, Local resident
9. Alma Gray, member of EPEC and patient at Dulwich Medical Centre, Crystal
Palace Road
10. Darret Tomlin, Patient at Camberwell Green Surgery
11. Jean Attridge
12. Negga Mekonnen, Local resident
13. Eddie Murphy, Patient at Falmouth Road practice
14. Kathy Crawford
15. Olubemisoye Dada, Patient at Acorn and Gaumont surgery
16. Dorothy Oxley, Patient at The Gardens surgery
17. Steve Barber, Local resident
18. Aarti Gandesha, Manager, Healthwatch Southwark
19. Gemma Juma, Director, (Director, Dulwich Helpline and Southwark Churches
Care
20. Lauren Camacho, VoiceAbility
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13 Chair: Dr Jonty Heaversedge Chief Officer: Andrew Bland
The best possible health outcomes for Southwark people
21. Paul Murphy, GSTT Cardiac Support Group
22. Imogen Moore, Citizens UK
23. Councillor David Noakes, Liberal Democrat Councillor for Cathedral Ward
24. Jennifer Werner, (Southwark Safe Independent Living - SAIL
25. Mark Wess, Expert Witness Institute
26. Christian Tan, Local Resident
27. Rachael Henry, Southwark Safe Independent Living - SAIL
28. April Stamp, VoiceAbility
29. John Fraser, Local Resident – Lambeth
30. Patricia Lewis, Local resident
31. Heather Nicholson, Patient at Park Medical Centre
32. Alison Vine, CoolTan Arts
33. Penelope Dove, Peer Support (South London and Maudsley NHS Foundation
Trust ( SLaM)
34. Councillor Barrie Hargrove, Cabinet Member for Public Health, parks and
Leisure, Southwark Council
35. Jane Hopkins, Patient at Hambleden Clinic
36. Wendy Fisher, PPG member at Villa St. PPG
37. Robert Daly
38. Miss Baptiste, Local resident
39. Maria Murray
40. Catherine Negus, Research and Intelligence Officer, Healthwatch Southwark
41. Katy Wright, South East London Vision
42. Bina De, patient at Princess Street GP Practice
43. John King, Member of EPEC and patient at Hambleden Clinic
44. Jill Lockett, Director of Performance and Delivery, King’s Health Partners
45. Steve Lancashire, Local resident
46. Elizabeth-Rylance Watson, Patient at Forest Hill Group practice
47. Mahrukh Quereshi, ( Royal Free NHS Foundation Trust
48. Alice Goldsmith (Healthwatch Southwark)
49. Esther Choutsedjem, Patient at Lister – Hurley Group practice
50. Edwina Brockiesby, Silverfit
51. Verity McCrum, Auditory verbal UK