PGB-14-32
Minutes of Previous Meetings
18 February 2014
Extraordinary Meeting 18 March 2014
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GOVERNING BODY MEETING IN PUBLIC
BOARD ROOM, FRANCIS CRICK HOUSE
TUESDAY 18 FEBRUARY 2014
Present:
Dr Darin Seiger (DS) GP Chair
Paul Bevan (PBe) Lay Member – Governance
Peter Boylan (PB) Director of Nursing & Quality
Christina Edwards (CE), Lay Member – Nurse & Deputy Chair
Ben Gowland (BG) CEO and Accountable Officer
Roz Horton (RH) Lay Member – PPI
Dr. Raf Poggi (RaP) Assistant Clinical Chair & Clinical Director Kettering
Stuart Rees (SR) Chief Finance Officer
Kevin Thomas (KT) Lay Member – Governance
In attendance: Lisa Durant (LD) Director of Performance
Catherine Griffiths (CG) Interim Programme Director, Healthier
Northamptonshire (Item 11 only)
Kathryn Moody (KM) Director of Contracting & Procurement
Marianne Phillips (MP) Corporate Secretary
Eugene Sullivan (ES) External Consultant
1. Welcome and Introductions
DS welcomed those convened to the Governing Body Meeting in Public and thanked them for
their attendance.
2. Apologies for Absence
Apologies were received from Dr Matthew Davies, Assistant Clinical Chair & Clinical Chair
Daventry North; Dr Chris Bunch, Secondary Care Specialist; Richard Alsop, Chief Commissioning
Officer; and Rosemary Yule, Associate Lay Member – Governance.
Due notice of the meeting had been given in line with the Terms of Reference and the meeting
was quorate.
3. Declaration of Interests
DS and RaP declared an interest in Item 13 Local Enhanced Services as GPs. DS confirmed that
CE would take the Chair and that DS and RaP would leave the meeting room for this item.
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4. Top Organisational Risks
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SR took the Governing Body through the report and confirmed that the key risks to the
organisation remain the same as in the previous month.
SR noted that the objectives previously presented are under review in light of Healthier
Northamptonshire. The Audit and Risk Committee have discussed this and agreed that
objectives need to be reviewed in light of the risks they pose in order to operationalise these
documents.
5. Minutes of the Previous Meeting
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th
The Minutes of the meeting held on 17 December 2013 were agreed as an accurate record.
6. Action Log
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Top Organisational Risks – SR confirmed that the matching of risks against objectives is
underway and real examples will be used to ensure the document is pertinent to everyday
activity.
The remaining completed actions were noted.
7. Chair and Chief Executive’s Report
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DS highlighted certain aspects of the report, including a patient’s story on how he used his
Personal Health Budget to improve his wellbeing and long term mental health problems, noting
that the CCG’s vision to ensure patients have the best possible life from beginning to end is at
the heart of the work it undertakes.
Standing Items / Items for Approval
8. Finance Report
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The report was taken as read. SR highlighted the work underway to achieve the reduced year
end control total of £431k including the end of year positions agreed with Northampton
General Hospital and Northamptonshire Healthcare Foundation Trust. Positions are still to be
agreed with Kettering General Hospital and East Midlands Ambulance Service (EMAS). There is
a regional meeting with EMAS on 26th February 2014 and the end of year position will be
addressed at that meeting.
The Governing Body discussed the report, noting that all Out of County contracts present a
small risk to the end of year position; however realistic numbers have been planned for.
The Governing Body noted the report.
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9. Quality Innovation Productivity Performance (QIPP) Report
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LD took the Governing Body through the report highlighting the introduction of the ePMO
(Project Portfolio Management) system which will enable consistent reporting; and that a
review is underway of the £7.7m QIPP plans submitted for 2014/15.
The risks to the forecast outturn were raised and LD confirmed that activity based risks have
been mitigated for and that non-activity based risks are monitored through the Financial
Recovery Group.
LD confirmed that in order to ensure all stakeholders are committed to the projects, weekly
meetings of the Chief Executives are proving effective, together with the work undertaken by
the senior managers who are working closely with Providers to ensure QIPP is delivered across
the health economy.
LD explained that there was increased confidence in the achievement of QIPP for the new
financial year due to the reduced number of projects; the introduction of dedicated project
managers with clinical leads; and better systems in place to ensure visibility on progress early in
the year.
The Governing Body noted the report.
10. Quality and Performance Report
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LD took the Governing Body through the Performance report, highlighting key points and the
update on winter monies. LD confirmed that these monies are being used to support Urgent
Care and that the list of schemes will be reviewed to see what is taken through to the following
year.
The East Midlands Ambulance Service (EMAS) was discussed in light of its continued
underperformance and LD confirmed that EMAS senior attendance at the Urgent Care working
groups is now regular, that it has shown it is committed to plans to improve Urgent Care, and
that it is looking at handover delays and data quality. In terms of non-conveyance EMAS has
submitted a plan which is currently under review and KM confirmed that targets will be built in
to the contract.
The impact of the Frail & Elderly Crisis Hub was discussed, and LD confirmed that there is
evidence that its work is accelerating a small number of discharges per day, although the Trusts
would like to see a bigger impact and a review is underway to ascertain how to maximise the
model. RaP confirmed that discharge data could be circulated via email to the Governing Body.
ACTION: RaP
The Governing Body sought assurance that the safety of patients was not being compromised
when performance targets are not met and PB confirmed that all indicators are constantly
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monitored by the Quality Team and to date, there has been no evidence to cause concern for
patient safety. In addition the Trusts are being extensively monitored and assessed by their own
regulators in order that safety remains paramount.
The Quality report was taken as read and PB highlighted key points to note.
The CQC inspected Northampton General Hospital (NGH) in January and PB was invited to the
corroboration event where the inspectors shared their findings. The report from this inspection
will be published by the CQC on 25th March and will be brought to the Governing Body in April
2014.
ACTION: PB
In terms of Hospital Acquired Clostridium Difficile infections, both the Acute Trusts and
Northamptonshire Healthcare Foundation Trust are showing improvements and the numbers
are below trajectory. The concern lies in the community as it can be difficult to ascertain exactly
where an infection is contracted.
A report by the National Audit Office has been published on waiting times and NGH were
mentioned. PB has requested a response from NGH.
A second national report into the Cancer services at Colchester Hospital has been published and
PB has requested assurance from the Boards of the Northamptonshire Trusts that they have
read the report, and reviewed their own services in light of the findings.
Further to the Risk Summit held in relation to EMAS at the end of 2013, a follow up summit is
taking place on Monday 24th February 2014. PB will circulate the Minutes of this summit as
soon as they are published.
ACTION: PB
After due discussion the Governing Body noted the report.
CG joined the meeting.
11. Healthier Northamptonshire Update
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CG took the Governing Body through the report, noting that the draft two year Plan had been
submitted on 14th February 2014 and feedback from the Area Team is awaited. The next
submission is due on 5th March 2014.
The Governing Body discussed and noted the report.
CG left the meeting.
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Items for Discussion / Approval
12. Two Year Financial Plan
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SR took the Governing Body through the Plan which was submitted in first draft on 14th
February 2014, and the next steps. SR noted that CCG allocations going forward will be based
on GP List size. SR confirmed that the Finance, QIPP and Contracting Committee are closely
monitoring the development of the Plan to ensure it ties up with Healthier Northamptonshire.
The Governing Body noted the Plan and agreed the outlying serious financial issues, requesting
the strengthened QIPP challenge be reviewed and clarified in the next iteration that will be
discussed at the Finance, QIPP and Performance Committee and then brought back to the
Governing Body.
ACTION: SR
DS and RaP left the meeting due to a conflict of interest in item 13. CE took the Chair. The
meeting remained quorate.
13. Transforming Primary Care – Local Enhanced Services (LES)
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KT outlined the governance process undertaken whereby a waiver had been applied to allow
the GPs to discuss this item at Board of Director meetings to make recommendations to the
Governing Body and not to vote on any parts of this issue. As a result, the item is brought to the
Governing Body to make the ultimate decision.
KM explained that a number of contracts had been inherited from the Primary Care Trust and
are now required to be migrated onto a standard national NHS contract. Due to the need to
justify any procurement route used, all LES are being reviewed and placed in one of two
categories:
•
Category 1: Where contracts will be awarded directly to Practices due to the need for
access to Patient Identifiable data (which precludes an external bidder entering the
market).
•
Category 2: Contracts will remain with the existing Providers until a review has been
undertaken to assess which procurement route to take.
After due discussion the Governing Body agreed the two categories.
The Governing Body agreed to adopt the Unit of Care pricing Model.
The Governing Body agreed to use the NHS Standard Contract to commission services.
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The Governing Body agreed that the three remaining Specialist Care Contracts be rolled over
for another year to enable a review to be undertaken which will align with the Healthier
Northamptonshire work.
The Governing Body agreed to de-commission the following LES contracts:
•
•
•
•
•
Standard Care Homes LES – NHS Corby & Nene CCG’s
Minor Injuries (Standard) LES – NHS Nene CCG
Longlands Specialist Care Centre (Nene CCG, Daventry) – NHS Nene CCG
Renal, Weight & Medicine Management LESs (Kettering locality)
Favell House Respite beds LES (Northampton locality)
In relation to the ceasing of the Local Access Fund, the Governing Body agreed this on the
proviso that a scheme is established in its place.
Once this item was fully concluded, DS and RaP were invited to rejoin the meeting and DS took
the Chair. KM left to take part in an urgent teleconference with the Trusts at 1630. The meeting
remained quorate.
14. Information Governance Toolkit
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The report was taken as read and SR confirmed that against the required target of achieving
66% by year end, the CCG was currently at just over 40%. There is an action plan in place to
achieve the target and as the CCG’s Senior Information Risk Owner SR is reviewing all the
evidence to ensure it is adequate. A summary will be taken to the Audit and Risk Committee in
May.
After due discussion the Governing Body noted the report.
DS explained that due to SR’s need to join the teleconference as well, the next items would be
taken out of sequence in order that he could present them:
15. (Item 18 on Agenda) Business Continuity
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The paper was taken as read and SR confirmed that the Audit and Risk Committee had
discussed the Strategy and Policy presented and agreed that work is now needed to embed this
policy within the organisation and make them ‘living’ documents.
The Governing Body ratified the Business Continuity Strategy and Policy on the proviso that SR
provides a report back to the Governing Body showing how both documents have been
embedded within NHS Nene CCG.
ACTION: SR
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16. (Item 19 on Agenda) Risk Management
Risk Management Strategy
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Risk Management Policy
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SR again confirmed that the Audit and Risk Committee had discussed the Strategy and Policy
and that again, these documents will be embedded within NHS Nene CCG.
The Governing Body discussed the documents and agreed that more patient focus is required.
SR will liaise with PB to cross-reference the Quality Strategy. In addition, the risk appetite
statement needs further work and the wording around the development of the Strategy needs
to refer to the Executive Directors and not the Audit and Risk Committee. SR will undertake
further work and bring back to the Governing Body for ratification.
ACTION: SR
17. (Item 20 on Agenda) Conflicts of Interest Policy
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The Policy was taken as read and SR drew the Governing Body’s attention to the amendments
made to the Policy which had been approved by the Audit and Risk Committee.
The Governing Body ratified the Conflicts of Interest Policy.
18. (Item 21 on Agenda) IT Asset Management Policy
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The Policy was taken as read and SR explained that it was intended to clarify the process for
procuring and disposing of IT in light of recommendations from the Audit and Risk Committee.
The Governing Body ratified the IT Asset Management Policy.
19. (Item 29 on Agenda under AOB) Annual Reporting Timetable
SR explained that the first draft of the Annual Report and Accounts would need to be submitted
by 23 April 2014 which will then be audited in time for final submission on 6 June 2014.
SR will set up a training session to ensure all contributors are aware of the requirements and a
timetable of work is being created.
ACTION: SR
The Governing Body agreed that the Annual Report and Accounts (in order to fit in with
timescales) would be approved at a special meeting on 30 May 2014 to which the Governing
Body, Audit and Risk Committee and Finance, QIPP and Contracting Committee would be
invited. KT confirmed that the Accountable Officer would need to make a personal statement
on how the Governance Arrangements have been strengthened over the previous 12 months.
SR left to attend the urgent teleconference at 4.50pm. The meeting remained quorate.
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20. (Item 15 on Agenda) Organisational Values
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BG outlined the process undertaken to reach a set of values which resonate with the
Organisation as a whole and explained that this process had been overseen by the Values
Council. The Governing Body fully agreed to adopt the following values for NHS Nene CCG:
Effective, Compassionate, Supportive and Safe.
LD left to attend an important urgent care meeting to address the A&E urgent care issues at
4.55pm. The meeting remained quorate.
21. (Item 16 on Agenda) Looked After Children’s Annual Report 2012-2013
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PB confirmed that the report had been to the Joint Quality Committee and that a half-yearly
performance report has been requested. The 2013-2014 Annual Report will be brought to the
Governing Body in June 2014.
ACTION: PB
The Governing Body ratified the Looked After Children’s Annual Report 2012-2013.
22. (Item 17 on Agenda) Prevention & Control of Infection and Communicable Diseases
Strategy
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PB confirmed that the Countywide Strategy had been approved by the Joint Quality Committee.
The Governing Body ratified the Prevention & Control of Infection and Communicable Diseases
Strategy.
Items for Information and Minutes
23. (Item 22 on Agenda) Board of Directors Minutes
The Minutes were noted.
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24. (Item 23 on Agenda) Quality Committee Minutes
The Minutes were noted.
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25. (Item 24 on Agenda) Audit & Risk Committee Minutes
The Minutes were noted.
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26. (Item 25 on Agenda) Finance, QIPP and Contracting Minutes
The Minutes were noted.
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27. (Item 26 on Agenda) NCDE Minutes
The Minutes were noted.
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28. (Item 27 on Agenda) Healthier Northamptonshire Programme Board Minutes PGB-14-25
The Minutes were noted.
Focus Review
29. (Item 28 on Agenda) Top Organisational Risks – Review
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The Governing Body discussed the way in which items on the Agenda had addressed the top
organisational risks and agreed that each item had done so. It was again noted that the Risk
document is under review.
Any Other Business
As the item on the Agenda regarding Annual Reporting had been covered earlier in the
meeting, and there being no further business the meeting closed at 5.00pm. DS apologised to
the members of the public for the meeting over running.
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EXTRAORDINARY GOVERNING BODY MEETING IN PUBLIC
BOARDROOM, FRANCIS CRICK HOUSE
TUESDAY 18 MARCH 2014
Present:
Dr Darin Seiger (DS) GP Chair
Paul Bevan (PBe) Lay Member – Governance
Dr Chris Bunch (CB) Secondary Care Specialist
Dr Matthew Davies (MD) Assistant Clinical Chair & Clinical Director Daventry
North
Christina Edwards (CE), Lay Member – Nurse & Deputy Chair
Ben Gowland (BG) CEO and Accountable Officer
Roz Horton (RH) Lay Member – PPI
Dr. Raf Poggi (RaP) Assistant Clinical Chair & Clinical Director Kettering
Stuart Rees (SR) Chief Finance Officer
Kevin Thomas (KT) Lay Member – Governance
Rosemary Yule (RY) Associate Lay Member - Governance
In attendance: Catherine Griffiths (CG) Interim Programme Director Healthier
Northamptonshire (Item 4 only)
Pat McCarthy (PMC) Head of Joint Commissioning (Item 4 only)
Kathryn Moody (KM) Director of Contracting & Procurement
Marianne Phillips (MP) Corporate Secretary
Sue Smith (SS) Head of Prescribing and Medicines Management (Item 7 only)
Eugene Sullivan (ES) External Consultant
1. Welcome and Introductions
DS welcomed those convened to the extraordinary meeting in public.
2. Apologies for Absence
Apologies were received from Peter Boylan, Lisa Durant and Richard Alsop. PBe had previously
notified the Chair that he would need to leave the meeting at 3.00pm.
Due notice of the meeting had been given in line with the Terms of Reference and the meeting
was quorate.
3. Declarations of Interest
DS, MD and RaP declared a conflict of interest with items 5 and 7 on the agenda in their role as
GPs and it was agreed that they would leave the meeting for these items (which would be taken
together in order to minimise disruption) and which would be chaired by CE.
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Items for Discussion / Approval
4. Two Year Operational Plan
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BG introduced the Plan explaining that final submission is due on the 4th April 2014. KM took
the Governing Body through the Contracting aspects, SR through the Finance, CG through
Healthier Northamptonshire, and PMC through the Better Care Fund.
The inclusion of Quality Innovation Prevention and Productivity (QIPP) plans was discussed,
with SR confirming that the details would be set out and taken to the Finance, QIPP and
Contracting Committee at the end of the month. Any outstanding information would be
collated during QIPP Phase Two (during the first quarter).
KM confirmed that acceptable percentages have been identified in relation to Consultant to
Consultant referrals and in line with the policy for secondary care inherited referrals. Follow-up
work will be undertaken in quarter one.
Adequacy of data from Greater East Midlands Commissioning Support Unit (GEM CSU) was
discussed and SR confirmed that although the position is much improved in comparison to last
year, work is ongoing.
The Governing Body requested that the financial gap be set out month by month so that
progress can be monitored.
ACTION: SR
CG took the Governing Body through Healthier Northamptonshire and noted that work in
relation to Frail & Elderly already undertaken would be incorporated into the programme.
PMC updated the Governing Body on the Better Care Fund, explaining that the plan had been
submitted to the Health and Wellbeing Board and that feedback had been received from NHS
England and the Local Government Association, and all aspects had been rated amber or green.
PBe left the meeting at 3.00pm. The meeting remained quorate.
PMC noted that a Joint Commissioning Unit is planned to be in place by the end of the calendar
year in readiness for the commencement of the Better Care Fund in 2015.
The Governing Body requested that the range of Adult Social Care Services being protected be
set out.
ACTION: PMC
It was noted that monitoring of the targets within the plan would take place through the
Governing Body and SR will confirm how this will be carried out.
ACTION: SR
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The Governing Body approved the Two Year Operational Plan and recommended the inclusion
of QIPP detail in the next iteration.
CG and PMC left the meeting.
5. (Item 6 on Agenda) Information Governance Toolkit
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SR explained that it is a requirement of all public organisations to complete the toolkit and that
in order to ensure all areas were covered, all evidence had been zero based. Internal audit have
reviewed the toolkit and evidence provided and a further review by GEM CSU has been
undertaken. The maximum the CCG can achieve at level 2 is 66%. SR confirmed that since the
time of writing, the two outstanding standards have been met with the awaited auditors report
and the achievement of 97% of staff completing their Information Governance training.
SR confirmed that an action plan is underway to address the toolkit for next year.
The Governing Body approved the submission of the Information Governance Toolkit.
DS, MD and RaP left the meeting and CE took the Chair. The meeting remained quorate.
6. (Item 5 on Agenda) Primary Care Development Scheme
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KM explained that subsequent to the de-commissioning of the Local Access Fund (agreed at the
last Governing Body meeting) the proposal is a re-investment of £761,000 into a scheme to
support Urgent Care across the County. There are various conditions that Practices will need to
meet and data that must be submitted in order to be eligible for the funding.
The Governing Body discussed the scheme, noting that the submission of data will enable a
greater understanding of patient flow and variation but that it is imperative that action is taken
to impact Urgent Care as a result. The effect on Primary Care and the CCG was discussed in the
event that NHS England reject the scheme and SR confirmed that were that to happen, the CCG
would work with NHS England to refine the scheme until agreement is reached.
The Governing Body requested that (assuming the scheme is approved) reports be brought
back to show the learnings as the scheme progresses.
ACTION: KM
The Governing Body approved the Primary Care Development Scheme; the funding
methodology and the submission to NHS England for approval.
SS joined the meeting.
7. Prescribing Achievement Framework
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KM introduced the paper, confirming that the Prescribing Achievement Framework has been
successfully running in various guises for a number of years. The framework has been
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developed by the Medicines Management Team along with local advisors and prescribing leads.
Five new indicators have been introduced to the framework for the coming year and SS
confirmed that no drug is retired from the framework if it still needs active management. SS
also confirmed that Practices have to identify how they will spend the payment that they
receive to improve patient experience and care prior to its payment if they are successful in
achieving the targets.
After due discussion, the Governing Body approved the Prescribing Achievement Framework.
Any Other Business
DS, MD and RaP returned to the meeting and DS took the Chair.
There being no further business the meeting closed at 3.50pm.
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