Joined Up Care Board Minutes of the Meeting of Thursday 18 April 2019 09h00 to 12h00 Conference Room, Toll Bar House, Ilkeston CONFIRMED Present: Caroline Maley (CM) Chair, Derbyshire Healthcare NHSFT Dean Wallace (DWa) Director of Public Health, Derbyshire County Council Deborah Widdowson (DWi) Senior Delivery & Improvement Lead, NHS Improvement Ifti Majid (IM) Chief Executive, Derbyshire Healthcare NHSFT Jane Chapman (JC) Acting Locality Director, NHS John Rivers (JR) Chair, University Hospitals and Burton NHSFT Karen Ritchie (KR) Head of Engagement, JUCD Kath Markus (KM) GP & Chief Executive, LMC Derbyshire Lee Outhwaite (LO) JUCD Finance Lead & Director of Finance, Chesterfield Royal Hospital NHSFT Paul Tilson (PT) Managing Director, DHU Derbyshire Paul Wood (Chair) (PW) JUCD Chair Perveez Sadiq (PSa) Service Director, Adult Social Care Services, Derby City Council Phil Cox (PC) Deputy Chair, Derbyshire Health United Sean Thornton (ST) Assistant Director, Communications & Engagement, Derbyshire CCGs Stephen Lloyd (SL) Medical Director, Derbyshire CCGs Sukhi Mahil (SKM) STP Assistant Director, JUCD Tracy Allen (TA) Chief Executive, Derbyshire Community Health Services NHSFT Vikki Taylor (VT) STP Director, JUCD Apologies: Andy Smith (AS) Strategic Director of People Services, Derby City Council Avi Bhatia (AB) GP & CCG Chair Cate Edwynn (CE) Director of Public Health, Derby City Council Chris Clayton (CC) Chief Executive, NHS Derby and Derbyshire Clinical Commissioning Group Chris Sands (CS) Director of Finance, Derbyshire Community Health Services NHSFT David Whitney (DWh) Chair, Derbyshire Health United Duncan Gooch (DG) Chair, Erewash Health Limited Gavin Boyle (GB) Chief Executive, University Hospitals Derby & Burton NHSFT Helen Jones (HJ) Director of Adult Social Care, Derbyshire County Council Helen Phillips (HP) Chair, Chesterfield Royal Hospital Pauline Tagg (PT) Chair, EMAS Prem Singh (PS) Chair, Derbyshire Community Health Services NHSFT Rachel Gallyot (RG) Chair, East CCG Simon Morritt (SM) Chief Executive, Chesterfield Royal Hospital Stephen Bateman (SB) Chief Executive, Derbyshire Health United William Legge (WL) Director of Strategy & Transformation, EMAS In Attendance: Clive Newman (CN) Director of GP Development, NHS Derby and Derbyshire Clinical Commissioning Group (attended for item 6) Christine Urquhart (CU) Head of Cancer Commissioning, NHS Derby and Derbyshire Clinical Commissioning Group (attended for item 8) Paddy Kinsella (PK) GP Alliance Paul Hetherington (PH) Derbyshire LDR Programme Manager (attended for item 7) Peter Moore (PM) Executive Director for Strategy & Partnership, UHDB (attended on behalf of Gavin Boyle) Shanice Bailey (SBa) Programme Support Officer, JUCD (Scribe) Wayne Harrison (WH) Consultant in Public Health, Derby City Council (attended on behalf of Cate Edwynn)

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180419/1 Apologies and Minutes of the Previous Meeting Action The Chair welcomed members to the meeting and introductions were made. Apologies for absence were noted as reflected above.

The minutes from the meeting held on Thursday 21 March 2019 were agreed as an accurate record. 180419/2 Action Log 211218/6: STRATEGIC DIRECTION: Provider Alliance Group (PAG) Proposal LO advised that the work to disaggregate provider contracts to Place level would now be taken forward through the analytics leads; he intended to meet with them along with Craig Cook from the CCG to progress this work. He suggested that a further proposal and update would be brought back to the Board in 2 months.

TA suggested that this needed to be in the context of other work which was progressing in relation to a system PMO approach, resourcing, and how this related to the digital strategy refresh. The Board agreed.

All other actions were agenda items for the meeting or future items.

SL entered at 0906h 180419/3 Declarations of Interest (DOI) The Declarations of Interest were considered; the purpose was to record any conflicts of interest and confirm any other conflicts requiring inclusion.

The Board reviewed the register and confirmed the register was fully reflective and accurate. PW asked Board to note the removal of Dr Ben Milton from the register. 180419/4 SYSTEM OVERSIGHT: Chair’s Report (Lead Paul Wood) PW provided members with an update on key developments related to the STP on the period since the last JUCD Board Meeting.

Derbyshire Clinical Commissioning Groups (CCGs) Merger The merger of Erewash, Hardwick, North Derbyshire and Southern Derbyshire NHS Clinical Commissioning Groups was approved by NHS England resulting in the new NHS Derby and Derbyshire Clinical Commissioning Group becoming official on 1 April 2019.

The new CCG for Derby and Derbyshire would cover 116 city and county GP practices, serving a total population of 1,053,000. PW noted that this was a significant merger and Derbyshire was ahead of other areas in terms of mobilising to a single strategic commissioner; the function within the system was part of ongoing development as the system moved towards an Integrated Care System (ICS).

Development of the Strategic Commissioner Role and Functions JUCD STP has been invited to participate in Wave 5 of the National Commissioning Capability Programme (CCP) which will focus on the development of the strategic commissioner role and related functions.

System Organisational Development (OD) Programme As part of the Derbyshire wide OD Programme, a session facilitated by Angela Pedder, took place on 25 March 19. The audience for this session was Chairs, Non-Executive Directors (NED) and Lay Members; the purpose was to reflect on involvement and changing roles in the STP and how this might develop when transitioning to become an ICS to transform organisational thinking to support a system approach whilst balancing the respective sovereign needs. PW advised that overall the session was very positive and the need to continue coming Joined up Care Derbyshire Board 18 April 2019 Page 2 of 12

together in this way was fully supported to create a shared understanding and building a genuine system approach.

One of the key actions that came out of the session was for NED/Lay member involvement in the STP refresh and to undertake joint Board/Governing Body development sessions. There was also a request to ensure consistent reporting from the JUCD Board to each organisational Board/Governing Body to enable STP delivery to become part of their routine business.

Council colleagues were not available for this session but further work was planned to ensure this was tied in going forward.

JUCD STP System Operational Plan PW informed the Board that Derbyshire NHS organisations submitted their respective organisational operational plans on 4 April 2019, and the overarching system level Operational Plan was submitted on 11 April 2019. The Board noted the submission and the significant work undertaken by organisational leads and the STP core team to meet these deadlines.

System Infrastructure Funding Allocations 2019/20 The Board were asked to note the additional funding of £237,000 allocated by NHS Improvement and NHS England in 2019/20. It was noted that this would be the last year that this funding would be available. From 2020/21 onwards JUCD STP would be expected to wholly fund system leadership and system capacity. The funding would be transferred to NHS Derby and Derbyshire CCG in Q1 2019/20; marked as STP delivery funding. The allocation would be used to cover the costs of permanent and/or seconded staff directly involved in STP/ICS mobilisation and delivery, including the STP refresh. Any additional funding requirements over and above this allocation would continue to be supported based on previous agreements by the Board.

Derbyshire Public Health Recognised by Local Government Association (LGA) At the annual Public Health conference hosted by the LGA, Derbyshire County Council was recognised as one of the eight areas of good practice in embedding Public Health across the Council and within communities. Dean Wallace and team were congratulated for their hard work and efforts.

Hospital to Home wins Business Transformation award Derby City Council received the Business Transformation award at this year’s LGC Awards. The Hospital to Home (H2H) team had been based within the Royal Derby hospital since December 2016. The service aimed to reduce the time people remained in hospital for; instead allowing them to recover in their own homes, taking care of their emotional and physiological needs. The H2H team therefore won a notable award for effective discharge.

NHS England and NHS Improvement in the PW reported on staff changes to the single regional leadership team which came into effect from 1 April 2019 as advised by Dale Bywater, Regional Director for NHS England and NHS Improvement in the Midlands: • Director of Commissioning: Alison Tonge • Medical Director and Chief Clinical Information Officer: Dr Nigel Sturrock • Chief Nurse: Siobhan Heafield • Director of Performance and Improvement: Jeff Worrall • Director of Workforce and Organisational Development: Steve Morrison • Director of System Transformation: post not appointed to

During the transition period and as an interim solution, the model of three sub-regional

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localities for system specific contact and relationships would be retained. The localities would be led by a Director of Strategic Transformation/ Locality Director: • North Midlands (, Staffordshire, Derbyshire and ) : Fran Steele • (Hereford and Worcestershire, Birmingham and Solihull, Black Country and Coventry and Warwickshire): Rebecca Farmer and Julie Grant (interim arrangement) • Central Midlands (Northamptonshire, and ): Frances Shattock

CM advised of the importance of ensuring dates for OD events need to be planned well in advance to enable appropriate attendance. PW agreed and noted this needed to be factored in to future planning.

PK reported concerns regarding the lack of funding for GP engagement sessions to support suitable venues to be secured. PSa confirmed that the Derby City Chambers could be made available which would not require additional funding. The Board agreed that wherever possible the system should utilise venues which would not incur an additional cost and therefore all organisations were happy to support. IM reinforced the positivity in system partners offering room availability to GP colleagues as this gave a valuable message of system working and shared resources. VT confirmed she would have a conversation with PK to explore the VT mechanisms for GP colleagues to utilise NHS buildings and local authority buildings.

KM highlighted the need to understand the role of the emerging Primary Care Networks (PCNs) and Place Alliances and queried how the two would work together, being mindful of potential duplication. PW suggested for this to be drawn into the primary care section on the agenda along with the broader issue in Place and wider elements which were also due for discussion in a systematic way. 180419/5 SYSTEM OVERSIGHT: Derbyshire System Financial Plan & Planning Update LO informed the Board that the following four points would be covered in his update: 1. Month 11 position and projected year end position 2. 2019/20 Plan unified regulatory oversight 3. Next steps in relation to the finance work plan 4. Local government position

LO updated the Board on the position against the aggregated Derbyshire STP financial plan at month 11, and the status of the year end forecast. Month 11 was currently £15m off plan as an STP, which was largely attributed to the acute sector as both UHDB and CRH continued to report off-plan performance. He informed that further work was being undertaken to put remedial measures in place and it was anticipated that the system would break even at year end.

LO advised it was still unclear how the system would be held to account by regulators going forward as previously the mechanics were through individual performance review meetings with each organisation. LO suggested that as a system there was a need to ensure the STP was presenting common and consistent messages through to their respective Boards and to regulators through unified reporting; this would explain the system status and also what was being done as a consequence.

PW was in agreement and stated the importance of presenting as a system regardless of how the regulatory framework would work going forward. JR agreed and emphasised the importance of the system operating to the same set of financial assumptions in order to move from a regulatory environment to a suitable managed environment.

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VT advised Dale Bywater was in the process of arranging a session in May for STP system leaders, to jointly shape the future relationship between systems and Dales team; this could be an opportunity to influence how we would wish to work with regulators as a system going forward. DWi added Dale Bywater was holding a series of engagement meetings with Chief Execs and STP leads to facilitate engagement conversations with colleagues across the region. The outputs would then feed into May event noted above. DWi advised this was a transitional year so the intention was to continue with the governance arrangements currently in place on an interim basis, and the future arrangements would evolve from the discussions outlined.

LO discussed the summary of the 2019/20 financial position. Work continued to fully align and refine the analysis with the planning submissions, but the overall financial challenge for the system was £136.1m. This equated to a £66.6m provider CIP requirement and a £69.5m CCG QIPP requirement. LO advised that all contractual agreements were now in place with the exception of UHDB due to complexities with the Burton side of things needing to be worked through. He added that there remained a number of risks in the plans to deliver of £106m so there was a need to identify further opportunities to address this.

PSi questioned whether any of the approaches taken in 2018/19 had resulted in a shunt into 2019/20 or whether they were permanent fixes. LO stated there were not permanent fixes but rather a one off benefit but this would not cause any shunt into subsequent years.

LO then discussed further work that was underway and overseen by the Directors of Finance group and advised that he would bring a detailed work plan from the DoFs group to the next LO meeting. He highlighted one of the key activities progressing was in relation to the development of an approach to 2019/20 Risk Share Agreement.

IM viewed this as a sea change in how the system was now operating, however he raised concerns in relation to the potential for a fair share approach in the risk share agreement and added that there was further work required on this. IM added that ideally we would want to avoid finding ourselves in a position of risk share and there were some pre-noted conditions currently missing from the draft agreement which would impact that needed to be carefully thought through.

VT supported the points made and advised that Chris Sands was coordinating this significant piece of work on behalf of the FD’s; this was due for discussion at the System Executive VT meeting and following that discussion an overview would be brought back to the next JUCD Board.

LO added that the System Savings Planning Group had been established and the group were now working together to review the system savings plan. VT added the group was in its infancy but was already working well; Local Authority colleagues had been invited to the group to represent a true system group going forward.

LO concluded the system was now in a better position to engage with the Local Authority and this would be a critical element for the year ahead, particularly as there was a need to carve out finance and activity at Place level to enable management resource to be aligned more effectively.

PW asked members to note the report and discussion; highlighting the consensus to work with regulators with one system voice. He added that in relation to the risk share agreement it was important that the pre-conditions were properly thought through and reflected. 180419/6 STRATEGIC DIRECTION: Primary Care CN was welcomed to the Board to provide an update on Primary Care and to inform members

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of progress with regards to the GP Strategy & development of Primary Care Networks. CN asked the Board to note the outline GP strategy, agree the timetable for developing a full GP strategy, note the draft TOR for the GP Alliance Group and agree the draft TOR for the Primary Care Leadership Group. CN highlighted the following key points:

Governance: • Draft Terms of Reference for two new meetings within the governance arrangements were shared with the Board for consideration and decision to emphasise the strengthened accountability to the Board and the CCG co-commissioning Committee. These two groups were the Primary Care Leadership Group and GP Alliance. • Whilst the GP Alliance Group were newly developing it was not proposed that they would be formally accountable to the Board as the group needed to be supported to eventually become more formal but there was a need to assist in its growth in the first instance; initially the group would feed in through the Primary Care Leadership Group. The aim was for the Primary Care Leadership Group to report to the JUCD Board and act as the STP’s Primary Care Programme Board.

Primary Care Strategy: • CN recapped on the vision developed through the GP Alliance which was considered by the JUCD Board in February. He advised that this would now form the foundation for further development of the Primary Care Strategy which was required by NHSE & I by the end of June 2019. This deadline was a regional requirement ahead of the national submissions which would be fully integrated with the STP refresh. • CN advised that the key deadlines were as follows:

Primary Care Networks: • The GP Five Year Contract required the development of Primary Care Networks (PCNs) by 1st July 2019. CN delivered the presentation which summarised what the PCNs would be, the requirements, the process for agreeing the PCNs and the necessary timescales. • CN advised that the PCNs were intended to enable the provision of proactive, accessible, coordinated and more integrated primary and community care improving outcomes for patients. PCNs were small enough to give a sense of local ownership, but big enough to have impact across a 30-50K population. CN added that PCNs would comprise groupings of clinicians and wider staff sharing a vision for how to improve the care of their population.

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• CN confirmed PCN’s were GP led organisations and provided a platform for wider integration. • In 2019/20 a Direct Enhanced Service (DES) would be in place to enable practices to come together so that by 2021 they were operating in a more effective way with others.

CN highlighted the need to agree the PCN boundaries by May 2019 and set out the process: • To be developed and agreed ‘bottom up’ as far as possible (facilitated by the LMC / supported by the CCG) • Individual practices would need to consider their own position and if a practice wanted to switch networks, then they would need to speak first to local groups and then to the CCG (LMC/CCG would facilitate this discussion if necessary) • Assumptions that PCNs would be within existing STP ‘Place’ boundaries but prepared to consider some flexibility on this if all other criteria were satisfied • A panel would be established to clarify the weighing of the criteria and a system representative would need to be involved in this process • Ultimately the CCG would be responsible to NHSE/I for agreeing Network boundaries • In the event that the issues could not be resolved locally then the regional NHSE team would work with us to resolve outstanding issues in early June.

CN added that the approach would be GP led with population health and geographical coherence being a key factor; this was more than just historic relationships. Any differences of opinion would need to be noted but considered alongside the merits of whether any complex arrangements would outweigh the benefits. In terms of the size of the PCNs there could be some with a clear limit of a population size of 30K but some could be above 50k if there were clear benefits for example in Erewash there could be one PCN with neighbourhoods beneath. The board strongly endorsed the view that PCN boundaries should strongly relate to understood geographies and populations.

PK queried how the PCN and the primary Care Strategy would enable the shift in resources from secondary care. This generated a discussion in relation to the need to better articulate the currency going forward. Resources were currently understood in financial terms but this continued to pose problems conceptually as it limited wider thinking in relation to pathways.

KM commented, it was important to note that the strategy and vision was to increase the resource share into general practice, but this was not solely about money it was also people; which was really important as services move to working in a more integrated way. She added that it one size could not fit all 8 places due to varied population needs.

VT emphasised the importance of not only focusing on direct healthcare service delivery but also continuing to challenge ourselves to consider the other factors which impact on health and wellbeing such as housing and using those opportunities to influence change.

LO questioned why the Primary Care Strategy was built out of primary care as opposed to Place. KM advised that it was a national requirement, developed through a bottom up approach starting with PCNs and building around both Place and integrated care; it would be difficult for Place Alliances to develop a primary care strategy. The nuance between PCNs and integrated care in Place was recognised and the need to understand the interface between both, nationally and locally was something that would need to be worked through. TA added that there was confusion between the how PCN’s and Place will join together; Place had been designed differently locally to the national approach which was now emerging so this would need reviewing to prevent any more confusion of Places. SL stated that this was a Derbyshire wide strategy for PCNs and it was important not to get that confused with the operational Joined up Care Derbyshire Board 18 April 2019 Page 7 of 12

delivery required in Place.

PW referred to the structure set out in the Terms of Reference and the various task and finish groups. He said there was a need to ensure that these groups were also integrated with system wide work-streams; the GP Digital group in particular to ensure linkage with the system digital strategy. PW however did recognise the need to have specific group focusing on the primary care element as it was often difficult and complex for practitioners and practices to orientate themselves in the system. TA confirmed the digital task and finish group was embedded in the broader digital work through SL’s role as the overarching clinical information officer.

PW asked for clarity in relation to representatives from PCNs up to the JUCD Board. CN stated CC and SL had been in discussion with LMC and GP Alliance around GP provider leadership proposal for a combined function to represent on these groups; however how the GP Alliance SL members would represent general practice at meetings was still being worked through. SL advised that representation would be confirmed by June and he would report back at the June JUCD Board meeting.

VT noted the request to confirm a system representative to be involved in the assessment panel for PCNs and suggested a representative from DCHS to sit on the panel because of the need to work more closely with and integrate community providers. The Board members agreed and TA confirmed she would identify somebody from DCHS be involved in the process. It was also felt that Local Authority representatives should be added to the panel also. CN agreed and confirmed the additional panel members would be included.

180419/7 SYSTEM OVERSIGHT: Digital Strategy PH was welcomed to the Board to provide an update with TA in relation to the digital workstream. The key points from the presentation were as follows:

The Local Digital Roadmap (LDR): • In 2015 all health economies were required to create a joint LDR including all NHS and social care partners. Derbyshire LDR included all Derbyshire NHS organisations, Derby City and Derbyshire County Social Services as well as EMAS and DHU. • There were 5 work-streams in the Derbyshire LDR - Derbyshire Care Record, Information Sharing/IG, Infrastructure, Analytics and BI, System exploitation ‘maximising effectiveness’ • During 2018/19 the focus was on improving governance, establishing links with STP work-streams and delivering programmes which have resulted in the need to review and refresh the digital strategy for Derbyshire.

There were some key notable achievements through the LDR programme of work such as safely sharing patient data across extended access hubs – 100% of practices, 108,200 additional and flexible GP appointments across practices (ETTF capital investment funding) and shared records across community, mental health and social care to improve timeliness of care (HSLI capital investment funding).

TA highlighted that the NHS Long Term plan identified four critical priorities which the system

would need to respond to from a digital perspective, these were:

1. Full Provider digitisation

2. A connected and integrated Local Health and Care Record (LHCR) for every STP / ICS by

2022 - currently none in the East/West Midlands

3. Better use of data for research and planning

4. Transformed digital services for the public such as rolling out the NHS App but also

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Local Health Care Record Sharing (LHCRs) – ‘Lycras’ • A new approach to sharing medical records and health information, across ‘regional’ geographies (c. 7m populations) • Uses existing IT systems, upgraded to national FHIR (‘Fire’) standards – so should be relatively low cost/low complexity to implement • (Derbyshire, Nottinghamshire, Lincolnshire, Leicestershire and Northamptonshire) has been slow to adopt, but is now appointing central resources (hosted by Leicester Partnership) • Derbyshire was working with EM partners to establish a solution, funding had been earmarked as part of HSLI.

A comprehensive review of the digital strategic approach had been undertaken; it was noted that converge & connect strategy was still relevant, senior STP leadership was now established, there was good cross-organisational collaboration and HSLI funding has unlocked opportunities. Areas identified where further work is required include the recognition that digital is still seen as “IT” led, capability and resource challenges still exist, and a lack of patient/citizen facing service offers.

The intention was to refresh the digital strategy in response to the NHS LTP requirements and to improve alignment to JUCD STP. As the plans developed the digital link would also be strengthened so that support could be provided to help work-streams also develop plans with the digital requirements in mind. To enable this a framework of digital themes/ programmes had been created as follows: • Foundations - including cyber Security, Network Federation • Analytics - Population Health Management, Interoperability/Health Information Exchange, Operational Analytics • Innovation • People • Professionals - Interoperability / MIG, Shared care records, Care Planning, Digital Workforce and skills development • Digital skills development • Workforce development

KR raised a point in relation to interaction with citizens. KR was currently developing an interactive workshop which was due to be taken out to community seldom-heard groups; the purpose was to give citizens the opportunity to voice their opinions and gain a better understanding of JUCD. KR suggested this would provide a good platform to introduce the NHS App and asked for any high level questions that could be added to the workshop to gain feedback on public opinion with regards to going digital. TA agreed that would be helpful and KR/ TA would discuss further with KR.

CU entered at 1108h 180419/8 STRATEGIC DIRECTION: Reconfiguration of Cancer Alliances CU attended the Board meeting to highlight issues that needed consideration in relation to the reconfiguration of the Derbyshire STP Cancer footprint in the delivery of the National Cancer Transformation Agenda.

Currently, the Derbyshire Cancer STP footprint was split across 3 Cancer Alliances. The South of Derbyshire (Southern Derbyshire and Erewash area) was aligned to the East Midlands Cancer Alliance (EMCA); the North of Derbyshire (North Derbyshire and Hardwick area) was aligned to Cancer Alliance (SYCA); and West Midlands Cancer Alliance. This created an issue in relation to transformation funding to support the delivery of the National Cancer Joined up Care Derbyshire Board 18 April 2019 Page 9 of 12

Agenda as this was allocated to the Cancer Alliances and each had different approaches, for example in South Yorkshire a lot of the programmes were managed centrally whereas in the East Midlands there was a bidding process to release funds and West Midlands had allocated some funding to support transformation at the Burton site but the East Midlands Cancer Alliance had found additional funding to make up for the shortfall.

CU informed that the national ask now was to align all transformation funding to a single STP footprint and it was proposed that Derbyshire should be the footprint. She advised the benefits of this would be: • All constitutional cancer targets would be monitored across the whole footprint of Derbyshire including breach reporting • Funding mechanism would be population based at STP level • The Derbyshire footprint was co-terminus with the City and County Councils in relation to the prevention agenda and population health • From a digital perspective, alignment with a single lead Cancer Alliance would be highly advantageous as it would ensure a standard approach to deployment of IT systems, and adherence to a single set of technical and operational standards.

VT confirmed some of the previous challenges experienced in terms of trying to manage across three Cancer Alliances.

SL concurred that it made sense to align to one footprint as this was the direction of travel to an ICS and this was more than just the treatment aspect as it included diagnosis and care in the community.

LO queried the practical impact for supporting the recommendation and raised concerns in relation to the tertiary element of the treatment pathways from CRH to South Yorkshire. CU advised that the tertiary element and relationships would still be maintained due to existing and future cross-boundary patient flows.

PM added that from a UHDB there was a need for clarity in relation to the role and function of the Cancer Alliance; UHDB were currently working with Leicester to fix some tertiary elements and felt clarity would be needed in relation to how this would continue going forward. SL confirmed the role of the Cancer Alliances was take a holistic approach to Cancer pathways from prevention, diagnosis, treatment and living well with Cancer.

VT sought clarity on the view of the other two alliances and whether they supported the proposed approach. CU informed that the West Midlands were in support due to the current working relationship with Burton; South Yorkshires preference at this time was to continue in the current format.

PW concluded the discussion by outlining that based on the concerns raised and the need for further clarity in relation to the tertiary flows in particular; the recommendation could not be supported by the Board at this time. He suggested that further work was required to clearly articulate the benefits and ensure there were no adverse impacts; this needed to be considered in more detail by the Cancer Board in the first instance and then the outcomes of those CU consideration reported back to the JUCD Board. 180419/9 STRATEGIC DIRECTION: Strategic Intent Group SL introduced the Strategic Intent Group and asked members to consider the ways in which the group would support system transformational delivery.

SL described the group as being responsible for analysing clinical pathways from cradle to grave through a cross system approach to translate the opportunities of Right Care and other data Joined up Care Derbyshire Board 18 April 2019 Page 10 of 12

sources into clinical transformative care bundles. The aim is also to define the strategic intent on pathways for strategic provision by delivery groups to ensure a system wide common approach that addresses health inequalities, ensuring capture of best practices, and incorporating a strategic approach to prevention and self-care on a whole Derbyshire footprint.

In summary, SL described this group as having the potential to provide an ‘engine room’ to drive clinical transformation on a whole Derbyshire footprint. IM said that although conceptually he could understand the need to have something to strategically work such things through he raised concerns with regards to duplicated functions and potential contradiction from a mental health work-stream perspective. He felt this approach was already in place involving all suggested members of the Strategic Intent Group. He added that Programme leads were in place and they needed to act as the coordinators to oversee the programmes of work for their respective work-streams.

IM was concerned that this work appeared to be strategic commissioner led and approved through the CCG but the approach we were aiming to move towards was to ensure a whole system view right at the start of any transformational change thinking and planning.

CM agreed with the concerns raised and suggested that this approach needed further thought as part of the refresh of the STP governance alongside the STP refresh and move towards and ICS. SL reassured members that this group is being proposed to sit within the ICS space; for ICS development a collaborative approach is needed.

PW concluded by stating this work was not a finished article and there was a need to consider this further as part of the ICS developments and clarity around the strategic commissioning function. 180419/10 OPERATIONAL DELIVERY: Performance Report SKM raised awareness that A&E waiting time performance had increased by 1.1%, the first increase in performance over a three month period.

A&E Waiting Times: Respiratory cases had been high at both acute trusts, adding additional pressure to both A&E departments. SKM queried whether there was anything the system could do to respond to the extra presentations due to respiratory conditions. For example was the work being undertaken through the Disease Management Leads linked with Place targeting the most effective areas to avoid attendances at A&E?

PW suggested due to time constraints, the level of conversation needed was difficult. PW SKM suggested for Respiratory to be the main focus at a future Board for discussion.

The Board noted the report. 180419/11 STANDING AGENDA ITEMS: Communications and Engagement (Lead Sean Thornton) ST identified the 3 key messages for the system wide staff briefing following today’s meeting as:

1. Strategy for Primary Care and PCNs 2. Digital Development - update on achievements so far and the plans for the future 3. Update on Financial position as we exit 2018/19 into 2019/20 180419/12 STANDING AGENDA ITEMS: Any Other Business PM informed members that UHDB were in the process of finalising a revised strategy for the PM next 5 years and would like to bring this to the Board at a future meeting to note.

No additional items were raised requiring urgent consideration and therefore PW closed the meeting.

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Date of the Next Meeting The next meeting was scheduled to take place on Thursday 16 May 2019, 9.00am to 12.00pm, All to Conference Room, Toll Bar House, Ilkeston. Note

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