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GOVERNING BODY MEETING 7 March 2019 9.30Am to 12.30Pm the Snow Room, West Offices, Station Rise, York YO1 6GA Prior to the Comm

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GOVERNING BODY MEETING 7 March 2019 9.30Am to 12.30Pm the Snow Room, West Offices, Station Rise, York YO1 6GA Prior to the Comm GOVERNING BODY MEETING 7 March 2019 9.30am to 12.30pm The Snow Room, West Offices, Station Rise, York YO1 6GA Prior to the commencement of the meeting a period of up to 20 minutes, starting at 9.30am, will be set aside for questions or comments from members of the public who have registered in advance their wish to participate. The agenda and associated papers will be available at: www.valeofyorkccg.nhs.uk AGENDA STANDING ITEMS – 9.50am 1. Verbal Apologies for absence To Note All 2. Verbal Declaration of Members’ To Note All Interests in the Business of the Meeting 3. Pages Minutes of the meeting held on To Approve All 5 to 20 3 January 2019 4. Verbal Matters arising from the All minutes 5. Pages Accountable Officer’s Report To Receive Phil Mettam 21 to 29 Accountable Officer 6. Pages Risk Update Report To Receive Phil Mettam 31 to 39 Accountable Officer Page 1 of 226 STRATEGIC – 10.20am 7. Pages Back to the Future: Annual To Receive Dr Lincoln Sargeant 41 to 42 Report of the Director of Public Director of Public Health Health for North Yorkshire for North Yorkshire 2018 Full report available at: http://www.nypartnerships.org. uk/dphreport2018 8. Pages Commissioning Intentions To Approve Phil Mettam 43 to 46 2019/20 Accountable Officer 9. Pages Services in the Community; To Approve Lisa Marriott 47 to 75 Improving Health and Tackling Head of Community Inequalities Strategy FINANCE AND PERFORMANCE – 11.20am 10. Pages Financial Performance Report To Receive Michael Ash-McMahon 77 to 96 2018/19 Month 10 Deputy Chief Finance Officer 11. Pages Quarter 3 Financial control, To Receive Michael Ash-McMahon 97 to planning and governance Deputy Chief Finance 104 assessment Officer 12. Pages Integrated Performance Report To Receive Caroline Alexander 105 to Month 9 Assistant Director of 149 Delivery and Performance ASSURANCE – 12.10pm 13. Pages Quality and Patient Experience To Receive Michelle Carrington 151 to Report Executive Director of 199 Quality and Nursing / Chief Nurse Page 2 of 226 RECEIVED ITEMS – 12.25pm Committee minutes are published as separate documents 14. Page Chair’s Report Executive Committee: 5 December 2018, 201 to 2 and 16 January and 6 February 2019 202 15. Pages Chair’s Report Finance and Performance Committee: 20 December 2018 203 to and 24 January 2019 204 16. Page Chair’s Report Primary Care Commissioning Committee: 24 January 205 2019 17. Pages Medicines Commissioning Committee: 12 December 2018 and 9 January 207 to 2019 222 18. Pages Joint Acute Commissioning Committee: 24 October and 28 November 223 to 2018 226 NEXT MEETING 19. Verbal 9.30am on 4 April 2019 at To Note All West Offices, Station Rise, York YO1 6GA CLOSE – 12.30pm EXCLUSION OF PRESS AND PUBLIC In accordance with Paragraph 8 of Schedule 2 of the Health and Social Care Act 2012 it is considered that it would not be in the public interest to permit press and public to attend this part of the meeting due to the nature of the business to be transacted as it contains commercially sensitive information which, if disclosed, may prejudice the commercial sustainability of a body. A glossary of commonly used terms is available at http://www.valeofyorkccg.nhs.uk/data/uploads/governing-body-papers/governing-body- glossary.pdf Page 3 of 226 This page is intentionally blank Page 4 of 226 Item 3 Minutes of the Meeting of the NHS Vale of York Clinical Commissioning Group Governing Body on 3 January 2019 at West Offices, York Present Dr Nigel Wells (NW) Clinical Chair Simon Bell (SB) Chief Finance Officer David Booker (DB) Lay Member and Finance and Performance Committee Chair Michelle Carrington (MC) Executive Director of Quality and Nursing/Chief Nurse Dr Helena Ebbs (HE) North Locality GP Representative Phil Goatley (PG) Lay Member and Audit Committee Chair Dr Arasu Kuppuswamy (AK) Consultant Psychiatrist, South West Yorkshire Partnership NHS Foundation Trust – Secondary Care Doctor Member Phil Mettam (PM) Accountable Officer Denise Nightingale (DN) Executive Director of Transformation, Complex Care and Mental Health Keith Ramsay (KR) Lay Member and Chair of Primary Care Commissioning Committee, Quality and Patient Experience Committee and Remuneration Committee Dr Kevin Smith (KS) Executive Director of Primary Care and Population Health Dr Ruth Walker (RW) South Locality GP Representative In Attendance (Non Voting) Caroline Alexander (CA) –item 8 Assistant Director of Performance and Delivery Abigail Combes (AC) – items 1-6 Head of Legal and Governance Dr Aaron Brown (AB) Local Medical Committee Liaison Officer, Selby and York Michèle Saidman (MS) Executive Assistant Apologies Sharon Stoltz (SS) Director of Public Health, City of York Council There were four members of the public present. The following matter was raised in the public questions allotted time. Fiona Benson on behalf of York Ambassadors for the Public Health Collaboration Management and treatment of metabolic disorders, including Diabetes and obesity, continues to be a major challenge. In December 2018 NHS Digital added The Diabetes.co.uk Low Carb Program (@LowCarbProgram) for diabetes Unconfirmed Minutes Page 5 of 226 management to their Apps Library (#NHSAppLibrary) with access free for patients with a voucher from their GP. The Royal College of General Practitioners also have an e-learning module for GPs 'Type 2 diabetes and Low GI Diet' available in their metabolic disorders e-learning section. Those, both here in the UK and internationally, who have adopted this approach are achieving positive outcomes in weight loss and improved metabolic health with many diabetic patients putting their condition into remission and coming off all medication. What plans does The Vale of York CCG have to support Primary Care Teams to offer the option of the effective low carbohydrate/glycaemic index approach? NW responded that there was a rolling education programme, mostly evening sessions, within the CCG for GPs and Practice Nurses which included diabetes. He emphasised that the CCG understands the importance of both prevention and preventing progression of diabetes. NW advised that the CCG was developing a programme of peer-led protected learning time events for GPs and Practice Nurses over the coming two years. The areas for inclusion would be discussed with them and may include diabetes. AGENDA STANDING ITEMS 1. Apologies As noted above. 2. Declaration of Members’ Interests in Relation to the Business of the Meeting There were no declarations of interest in the business of the meeting. All declarations were as per the Register of Interests. 3. Minutes of the Meeting held on 6 December 2018 In seeking approval of the minutes of 6 December NW noted that a question had been received about communication of this additional meeting; a response would be provided in this regard. Post meeting note: A response was provided on 9 January. The Governing Body: Approved the minutes of the meeting held on 6 December 2018. 4. Matters Arising from the Minutes There were no matters arising. Unconfirmed Minutes Page 6 of 226 5. Accountable Officer’s Report PM presented the report which provided an update on turnaround, local financial position and system recovery; acute service transformation; operational planning; continuing healthcare; joint commissioning; Care Quality Commission Local System Review; winter resilience; Better Care Fund; Humber, Coast and Vale Health and Care Partnership; planning for the UK’s exit from the European Union; and strategic and national issues. PM explained that the financial position was in line with that reported in November 2018, a forecast deficit for the end of the year of £18.6million, with Quality, Innovation, Productivity and Prevention (QIPP) forecasts and additional financial recovery actions remaining on plan. Whilst stabilisation was continuing PM noted areas of concern: aspects of the Aligned Incentive Contract with York Teaching Hospital NHS Foundation Trust and the completion of the continuing healthcare reconciliation position by NHS Scarborough and Ryedale CCG. With regard to the former PM reported that increased demand for urgent and emergency care at York Teaching Hospital NHS Foundation Trust, in line with the national position, was having a financial impact on partner organisations; the impact of the historic cost pressure from the latter was being assessed. PM noted that publication of the NHS 10-Year Plan had been delayed due to national issues including Brexit. This meant that financial resources to support the CCG’s priorities in 2019/20 had not yet been confirmed. PM advised that CCGs and providers were required to submit to their respective regulators joint activity plans aligning resources for 2019/20 from planning assumptions based on historic activity. PM however emphasised anticipation of being able to report another year of stabilisation of the CCG’s financial position and delivery of a modest improvement on the 2017/18 position. With regard to operational planning for 2019/20 PM commended the developing clinical networks. He explained the aim of moving to a non activity based pay framework, other than where required for national performance areas, and for future services within available resources through working jointly with primary and secondary care clinicians. PM highlighted that the progress in clinical leadership was an important milestone for the system and added that the Chief Executives and Directors of Finance of partner commissioners and providers across North Yorkshire and York were meeting on 15 January to discuss alignment of priorities from 2019/20 onwards within financial resources. PM referred to the CCG’s commissioning intentions for 2019/20 which continued to describe the priorities emanating from the public engagement that had informed the 2018/19 commissioning intentions and the national priorities including cancer. He explained that available resources would not be sufficient therefore a system, instead of an organisational, approach would be sought with a request to boards that health priorities should take precedence.
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