Combined Public Papers 25.10.18

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Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group

Governing Body Meetings in Common in PUBLIC

to be held on Thursday 25th October 2018 at 2.30pm to 4.30pm

AGENDA

A=Approval R=Ratification S=Assurance D=Discussion I=Information Enc Lead A/R/S/D/I Time 1. Welcome Verbal Chair I 2:30 2. Apologies Verbal Chair I 3. Conflicts of Interests Enc. 01 Chair I 4. Quoracy Verbal SY I 5. Minutes of the last meeting held on 28/03/18 Enc. 02 Chair A 6. Actions of the last meeting held on 28/03/18 Enc. 03 Chair A

Standing Items 7. Accountable Officer’s Report Enc. 04 MW D/I 2:40 8. Finance Update Report Enc. 05 AM D/I 2:50 9. Quality Report Enc. 06 HJ S 3:00 10. Performance Report Enc. 07 ZJ S 3:10 11. Board Assurance Framework Enc. 08 SY I 3:20

Items for Discussion 12. Commissioning Intentions 2019/20 Enc. 09 CH I 3.30 13. Risk Strategy Enc. 10 SY I 3.40 Policies • IG Policy 14. Enc. 11 SY R 3.50 • IG Handbook • Privacy Policies 15. Managing Allegations of Abuse Policy Enc. 12 AH R 4:00

Committee Assurance Reports – issues to be raised by exception by the Chairs of the Committees Joint Communications and Engagement 16. Enc. 13 SH I 4:10 Committee 17. Commissioning Patient Council Highlight Report Enc. 14 AHe I Finance, Performance and Contracts Committee Enc. 15 18. AHe I Highlight Report To follow

Enc 00 Items for Information 19. Together We’re Better Update – September 2018 Enc. 16 I 20. Any Other Business/Close ALL I 4:15 21. Questions from the Public 4:20 22. Glossary of Terms (Enc. 17)

FOLLOWED BY: Confidential Governing Body Meeting at 4.30pm

Items for discussion 1. APMS Tender Award 2. New Committees Terms of Reference 3. Turnaround Board Terms of Reference 4. Transformation Programme - Older People’s Care

CONFLICTS OF INTEREST REGISTER 2018/19 GOVERNING BODY MEETING AS OF 20/09/2018

Employing Forename Surname Role in the CCG Directorships held in Ownership of private Shareholdings in health & Positions of authority Connection with Research Any other role or relationship which the public CCG private companies, PLCs companies, businesses, social care in field of health and voluntary,other funding/grants could perceive would impair or otherwise (CC/SAS/ consultancies social care organisation influence the individual's judgement or actions in SES) their CCG role

Financial Interest ( This Non-financial Non-financial person Indirect interests Actions taken to is where individuals may professional interests interests (This is where (This is where there is mitigate identified directly benefit financially (This is where an individual an individual may benefit a close association conflicts of interest SAS CCG Manu Agrawal Clinical Lead, Stafford Director of Rising Brook Chadsmoor Medical Practice Practice is a member and None None None Governing body member and Surrounds CCG GPF shareholder in GP First Ltd. Membership board member Manu Agrawal Medical (GP Federation) (2013 - CCG employee Services Ltd present) GP Partner AGR Property Investments Ltd

CC CCG Neil Chambers Lay Member - Old Hall Partnership None None None Voluntarily run a debt None Chair of Audit Committee Governance, Cannock Darlaston Town (1874) and benefits advice Chase CCG and Stafford Football Club surgery for a charity of and Surrounds CCG which I am a Chair of Trustees

CC CCG Gary Free Clinical Lead, Cannock None Partner at Red Lion Surgery Practice is a member and None None None Locum to practices across South StaffsFriends and Chase CCG shareholder in GP First Ltd. relatives working for organisations providing NHS (GP Federation) services to patients from South Staffs.

CC CCG Paul Gallagher Lay Member - Patient None None None None None None Chair of Quality Committee for the Southern CCGs Public Interest / Vice (Cannock Chase CCG, East Staffordshire CCG, Chair of Governing Body South East Staffordshire and Seisdon Peninsula for Cannock Chase CCG and Stafford and Surrounds CCG) Lay Member - Quality for Chair of the Individual Funding Requests Panel SAS CCG Gillian Hackett* Executive Assistant None None None None None None None

SAS CCG Paddy Hannigan Chair of Governing Body, None Partner at Holmcroft Surgery Practice is a member and None None None Spouse is a Consultant Neonatologist at University Stafford and Surrounds shareholder in GP First Ltd. Hospital North Midlands (UHNM) CCG (GP Federation)

SLT Cheryl Hardisty* Director of Strategic None None None None None None Role works across the 6 Staffordshire CCGs since Commissioining & 11/12/2017 Operations

SAS CCG Sue Harper Lay Member - Patient and None None None None None None Justice of the Peace, South Staffordshire Bench Public Interest/Vice Chair of Governing Body for Stafford and Surrounds CCG SES CCG Anne Heckels Lay Member - Patient and None None None None None None Member of Patient Participation Group at Spires Public Interest (PPI) / Practice Finance and Member of South Staffordshire and Shropshire Performance/Vice Chair Healthcare NHS Foundation Trust (SSSFT) of Governing Body for Family Member is an employee shareholder - NORR South East Staffordshire Consulting, providing architectural services to public and Seisdon Peninsula service CCG Employing Forename Surname Role in the CCG Directorships held in Ownership of private Shareholdings in health & Positions of authority Connection with Research Any other role or relationship which the public CCG private companies, PLCs companies, businesses, social care in field of health and voluntary,other funding/grants could perceive would impair or otherwise (CC/SAS/ consultancies social care organisation influence the individual's judgement or actions in SES) their CCG role

SLT Allison Heseltine* Deputy Director of Director/Company Secretary None None None None None Role works across the 6 Staffordshire CCGs Nursing, Quality and of Net Technology UK Safety Limited (Spouse's company) (01.08.2001 to present)

SAS CCG Marianne Holmes Clinical Lead, Stafford None Partner of Hazeldene House Practice is a member and None None None Governing Body member and Surrounds CCG Surgery shareholder in GP First Ltd. Membership Board member (GP Federation) - (01.04.13 CCG employee - present) Relative works for Pharmaceutical Company

CC CCG Mo Huda Chair of Governing Body, None Partner at Aelfgar Surgery Practice is a member and None None None AQP Provider uses practice for Ultrasound scans and Cannock Chase CCG shareholder in GP First Ltd. Hearing Aid (GP Federation) Chair Educational meetings for various PHARMA companies.

SLT Heather Johnstone* Director of Nursing and None None None None None None Role works across the 6 Staffordshire CCGs since Quality 11/12/2017 Spouse is employed by HEFT. Sibling working as a nurse for SSOTP Brother-in law works as an Occupational Health Nurse for Team Prevent at UHNM, providing occupational health across the health economy SES CCG Sukhdip Kaur Johal Locality Director for None None None None None None Govering Body Member Seisdon Peninsula 01.04.2016 - Looking at working in partnership with the South Staffordshire District Council and Staffordshire County Council in the One Public State redevelopment initiative (ongoing).

SAS CCG Lynn Millar* Director of Primary Care None None None None None None Role works across the 6 Staffordshire CCGs since 11/12/2017

SAS CCG Kate Millward Clinical Lead, Stafford None Partner at Mansion House Practice is a member and None None None Clinical Advisor in Quality & Safety for CCG and Surrounds CCG Surgery shareholder in GP First Ltd. (GP Federation)

SLT Alistair Mulvey* Chief Finance Officer None None None None None None Director of Finance for: Cannock Chase Clinical Commissioning Group North Staffordshire Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group Stoke on Trent Clinical Commissioning Group

SES CCG Ehtesham Noor Chair of Govenring Body, Partner at Darwin Medical None Patient with Type 1 None None None N SES&SP CCG Practice diabetes who self-funds Locality Director - Darwin Medical Practice is a glucose monitoring Lichfield and Burntwood member and shareholder in Author of book addressing Alexin stigma in depression and Darwin Medical Practice is a anxiety member and shareholder in Alexin Membership of South East Staffordshire Alliance Board

CC CCG Anna Onabolu Clinical Lead, Cannock None Partner at Nile Practice Practice is a member and None None None Spec Savers use practice Chase CCG shareholder in GP First Ltd. Training practice for GPs (GP Federation) Ultrasound diagnostic work Employing Forename Surname Role in the CCG Directorships held in Ownership of private Shareholdings in health & Positions of authority Connection with Research Any other role or relationship which the public CCG private companies, PLCs companies, businesses, social care in field of health and voluntary,other funding/grants could perceive would impair or otherwise (CC/SAS/ consultancies social care organisation influence the individual's judgement or actions in SES) their CCG role

SES CCG Douglas Robertson Secondary Care Associate Medical Director None None None None Received Role works across the 3 CCGs and North Consultant for: and consultant physician at Educational Grants Staffordshire CCG Cannock Chase CCG Leighton Hospital Crewe from, taken part in Clinical Lead for Planned Care in Staffordshire South East Staffordshire (Mid Cheshire Hospitals FT) clinical research for, Transformation programme and Seisdon Peninsula and have consulted Honorary Lecturer in Education at Warwick Medical CCG for, the School Stafford and Surrounds pharmaceutical CCG companies Takeda, Sanofi and NovoNordisk

CC CCG Mukesh Singh Clinical Lead, Cannock Director of Private Limited None Practice is a member and None None None General Practitoner at Horse Fair Practice Chase CCG Company shareholder in GP First Ltd. AQP Ultrasound with Physiological Measurements (GP Federation) Receives payment for non promotional lecturers on behalf of various pharma companies and for attending pharmaceutical advisory board meetings. Occasional sponsorship attending national and SES CCG Sekhar Singu Locality Director - None None Alexin Healthcare None None None General Practitioner at Tri Links Medical Practice Tamworth

SAS CCG Diana Smith Lay Member, Stafford None None None None None None Member of Labour Party and Surrounds CCG Member of Weeping Cross PPG Member of the Univewrsity of the Third Age (U3A)

SES CCG Lynne Smith Lay Member, None None None None None None Lay Member for Quality at East Staffordshire CCG Governance, South East since June 2013 Staffordshire & Sesidon Peninsula CCG

CC CCG Janet Toplis Lay Member, Cannock None None None Vice Chair of Adoption None None Chair of a Staffordshire Primary School Chase CCG and Permanence Member of High Street Practice, Cheslyn Hay PPG Panel for Walsall Borough Council Vice Chair of the Fostering Panel for Walsall Council SLT Marcus Warnes* Accountable Officer None None None None None None Accountable Officer for: Cannock Chase Clinical Commissioning Group North Staffordshire Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group Stoke on Trent Clinical Commissioning Group SLT Paul Winter Deputy Director of None None None None None None Role works across the 6 Staffordshire CCGs Corporate Services, Governance and Communications Employing Forename Surname Role in the CCG Directorships held in Ownership of private Shareholdings in health & Positions of authority Connection with Research Any other role or relationship which the public CCG private companies, PLCs companies, businesses, social care in field of health and voluntary,other funding/grants could perceive would impair or otherwise (CC/SAS/ consultancies social care organisation influence the individual's judgement or actions in SES) their CCG role

SLT Sally Young* Director of Corporate None None None None None None Role works across the 6 Staffordshire CCGs since Services, Governance 11/12/2017 and Communication * Individual/role works across Cannock Chase CCG, North Staffs CCG, South East Staffordshire & Seisdon Peninsual CCG, Stafford & Surrounds CCG and Stoke on Trent CCG. Item: 05 Enc: 02

Cannock Chase Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford and Surrounds Clinical Commissioning Group

Cannock Chase, South East Staffordshire and Seisdon Peninsula and Stafford and Surrounds Clinical Commissioning Groups Public Governing Body Meetings in Common 28th June 2018 2.30pm – 4.30pm Northfield Village, Stafford ST16 2RB

Members: 28/06/18 Quoracy Marcus Warnes (MW) Accountable Officer  Alistair Mulvey (AM) Chief Finance Officer  Heather Johnstone (HJ) Executive Director of Quality & Safety  Doug Robertson (DR) Secondary Care Consultant  Cannock Chase CCG Dr Mo Huda (MH) Chair CC CCG 

Dr Gary Free (GF) Clinical Leader  Dr Mukesh Singh (MS) Clinical Leader  Dr Anna Onabolu (AO) Clinical Leader  Paul Gallagher (PG) Vice Chair & Lay Member for PPI  Neil Chambers (NC) Lay Member for Governance  Janet Toplis (JT) Lay Member 

Stafford & Surrounds CCG Clinicalleast 2 Leaders Paddy Hannigan (PH) Chair SAS CCG  Sue Harper (SH) Lay Member for PPI and Vice Chair  Marianne Holmes (MHo) Clinical Lead 

Kate Millward (KM) Clinical Lead 6 Voting Members including Chair/Vice Chair, Chief  Manu Agrawal (MA) Clinical Lead 

officer/Chief Finance Officer, at least one lay member and at Diana Smith (DS) Lay Member  South East Staffordshire and Seisdon Peninsula CCG Shammy Noor (SN) Chair and Locality Director  Suky Johal (SJ) Locality Director  Sekhar Singu (SS) Locality Director 

Lynne Smith (LS) Lay Member for Governance Chair  5 members, 5 members, Paul Gallagher (PG) Lay Member for Quality and or Deputy  Anne Heckels (AHe) Lay Member for PPI, Finance & Performance and Vice Chair Chair the including  In Attendance: Sally Young (SY) Director of Corporate Services, Governance and Communications  Allison Heseltine (AH) Deputy Director of Nursing and Quality  Lynn Millar (LM) Director of Primary Care  Cheryl Hardisty (CH) Director of Commissioning and Operations  Zara Jones (ZJ) Director of Strategy, Planning and Performance  Craig Porter (CP) Managing Director (South)  Gill Hackett Executive Assistant – Minutes 

Action 1.0 Welcome PH welcomed everyone to the meeting.

PH announced that the meeting would be slightly shorter in order to give members

extra time to discuss governance arrangements and how to progress that piece of work.

2.0 Apologies Anna Onabolu and Zara Jones, Sekhar Singu Item: 05 Enc: 02

Action 3.0 Declaration of Conflicts of Interest All Governing Body Members confirmed no conflict of interest in relation to items on the Agenda other than those listed on the register.

It was noted that all practices would be asked to declare conflicts of interest in view of the new federations across the county.

SY reminded members about the Conflict of Interest Training and confirmed that the links to the online training would be re-circulated.

4.0 Quoracy SY reported that the meeting was quorate for all three CCGs.

5.0 Minutes of the last meeting The minutes of the meeting held on the 22nd March 2018 were APPROVED as a true and accurate record.

6.0 Actions of the last meeting Actions were noted on the Action Sheet.

7.0 Minutes of Extra ordinary SES-SP CCG meeting held 24/05/2018 Subject to the following amendments, the minutes of the meeting held on 24th May 2018 were APPROVED as a true and accurate record

• Page 2 – Kinver did not offer extended house hours, however if merged with Kingswinford there would be an opportunity to offer more services in a larger practice. Other reasons for the merger and move are due to the include economyies of scales; • Page 4 - She asked that if the NHSE view that the debt stayed with SES-SP CCG was this based on non-standard statutory guidance. • Replace “FOR: If Dudley CCG took the debt – All Members UNANIMOUSLY APPROVED the third option (SN, SJ, SS, DR,AM, PG, LS, MW)” with “The SESSP Governing Body approved the application for Moss Grove to transfer CCGs, subject to the legacy debt transferring with the practice and the SESSP CCG control total being adjusted by NHS-E to reflect the changing allocation”.

Page 3: add “In view of agreeing a transfer between CCG areas (albeit subject to the debt) being viewed as a precedent, LM stated that this was a unique case due to the practice having long established surgeries in 2 different CCG areas.

8.0 Accountable Officer’s Report MW briefed the board on the key items in his paper.

Financial position The three CCGs’ financial positions remained challenging, as they were across all six CCGs and as such, NHS England had asked for more regular meetings with AM and MW. Mw advised that AM would be meeting with NHSE finance colleagues every two weeks and MW would be meeting with Paul Watson monthly.

NHSE colleagues recognised the scale of the challenge we face and were being supportive in helping us to further develop our plans to mitigate the high level of risk in our plans. Additional resources have also been provided to strengthen our programme

Item: 05 Enc: 02

Action management capacity and capability.

The financial outturn for 2017/18 was a deficit of c£47m against a control total of a c£6m deficit.

For 2018/19, a combined control total for the three CCGs of a £26m deficit, a £20m deficit across all six CCGs, remains in place. There is still a significant gap between the CCGs’ plans and the control total that needs to be closed, which would be the focus of the escalation meetings.

NHS England Commissioning Capability Programme The CCGs successfully completed the commissioning capability programme, which as previously reported was a programme of support commissioned by NHSE designed to help challenged CCGs. The programme was tailored to the needs identified by the CCGs and focussed on areas such as governance, finance and strategic planning.

The feedback from the programme facilitators was very positive in terms of how seriously and enthusiastically we engaged with the programme and with them. The actions agreed at the end of the programme would enable us to make further progress on the priority areas we identified during the programme.

MW advised that he had asked for further support to enable the CCG to continue the progress made and NHSE were working on this for us. Buddying support via NHS Clinical Commissioners had already been arranged for Shammy Noor and MW. He was also meeting with the Leadership Academy about a tailored programme of OD support over the coming year.

Urgent Care System Challenges in the urgent care system remain across most of our main providers, despite it being summer. Of the three Staffordshire providers, Heart of England FT was the most challenged, with A&E 4 hours performance at c81% in April, but having dropped to 75% in January. DTOCs were also an issue with Staffordshire residents spending too long in hospital when ready to leave with daily average days lost to DTOCs at 47 in April.

UHNM remained the most challenged trust, not just in Staffordshire but nationally. Senior leaders continue to work together daily with NHSE and NHSI to take the appropriate measures to deliver the sustainable improvements required.

A&E 4 hours performance improved from c69% in December to c80% in April, with the County Hospital regularly exceeded 95% but Royal Stoke remained in the high 70%s. The daily average days lost to DTOCs in April was c69, an increase from 37 in December, but these are now on a downward trend.

MW explained that the actions being taken to improve performance across the Staffordshire system were well documented, with multi-agency discharge events (MADE) at the RSUH and County sites having been helpful in challenging acute and discharge processes and more effectively aligning out of hospital capacity to expedite timely discharge. The daily focus on flow and discharge across all our providers had contributed to improved performance and the reduction in EMS levels. MFFD and Green to Go (G2G) patients at UHNM have not reduced to the levels we have agreed as a system, so this remains an area of focus through our discharge to assess programme.

MW advised that CH was programme director for the urgent care programme for the 3

Item: 05 Enc: 02

Action STP.

Management of Change (MOC) MW announced that the MOC was now finished although it took 5/6 months. There were still 35 vacancies in the structure which had gone out to advert. These vacancies were mainly in admin and commissioning. MW advised that Zara Jones would be leaving the CCG on 6th August 2018.

MW stated that we needed to fill the vacancies and develop an OD plan in order to listen to staff and build some morale. He announced that there was a provisional date of 28th October for an away day for all 6 CCGs.

New Governance Arrangements MW explained that there would be a meeting held in common for all 6 CCGs either on 12th or 19th July to discuss the proposed governance arrangements with a hope to implement a new structure in August/September.

MS referred to the long delays in the hospitals and asked what were the reasons for the delays. MW responded that delayed DTOC were due to NHS, social care etc. All the delays in the north were HS delays, although the south was mixed but mainly social care. MW explained that there was a deficit in community services in the south that needed to be put right. MS stated that a lot of failed discharges were bad for the patients, GPs and primary care where the readmission rate was 90 days. PH asked if it was a hospital issue or a LTC management issue this is an interesting issue. MHo added that something was failing with D2A in Stafford.

GF stated that in Leicester they did D2A in 1990’s and asked why it would not be done now. He added that the work on GPs was remedial care work which was not general practice.

CH responded that D2A was well established in the north of the patch and that the clinical responsibility of D2A lay with the clinical discharger.

PG referred to the Capability and Capacity Programme and asked if PWC had told us anything about the organisation that we did not already know. MW responded that some of the learning materials had some good things on how to do things differently. MW advised that there were some helpful suggestions on how to become a high performance team and how we engage and communicate effectively with members etc.

The Governing Body Meetings in Common NOTED the contents of the report 9.0 Finance Update Report AM gave a brief outline of the financial situation for the CCGs:-

Plan Context NHS England had set the Staffordshire CCGs a combined 2018/19 deficit control total of £20m. The plan submitted delivers this control total position recognising the requirements to achieve a Staffordshire wide QIPP programme of £77.7m and that unmitigated net risk of £19.3m exists within the plan.

The Southern CCGs had a combined control total deficits of £26m. While the collective Staffordshire CCGs’ plans achieve the combined Staffordshire control total, the plans submitted for the Southern CCGs achieve a £2.8m adverse control total variance, i.e. a total deficit of £28.8m. This included a QIPP requirement of £37.1m, 5.42% of

Item: 05 Enc: 02

Action recurrent resource limit (RRL); the plans also highlighted a level of currently unmitigated risk of £11.7m.

Delivery of the requisite deficit control total for the Southern CCGs’ would facilitate access to £26m of Commissioner Support Funding (CSF). This, non-recurrent, nationally allocated support funding would be applied to achieve a break even position in year and, whilst this would not support the improvement in the underlying financial position, it would mean that the cumulative deficit of the CCGs did not increase above the 17/18 outturn level. Failure to achieve the required control total deficit position would mean that the CCGs are unable to access the CSF.

Month 2 Position Cannock, Stafford and South East Staffordshire CCGs have a year to date deficit at Month 2 of £4.8m which is £0.8m better than the planned deficit position agreed with NHS England.

The predominant driver of the better than anticipated position were non-recurrent gains from the previous financial year.

Pressures had emerged within the Acute Care sector (£0.6m) and Prescribing (£1.1m) but this was due to the phasing of the QIPP programme and had been more than offset by the previous year’s brought forward benefits and slippage on CHC investment (£0.3m).

The CCGs were still forecasting to achieve the agreed deficit control totals assuming delivery of the QIPP programme totalling £37.1m.

AM reported that the MOC was more distracting than anticipated and that 2 people had been brought in to supplement delivering the QIPP.

He advised that the Finance and Performance Committee had dedicated most of their last meeting to looking through the QIPP schemes and getting more information and assurance on them. AM added that there needed to be more clinical engagement around the schemes and added that there was an open invitation for all clinicians and executives to attend weekly PDSG meetings.

AM explained that he needed to go back to NHSE in about 2 months’ time to show them where the risks sat.

The Governing Body Meeting in Common RECEIVED and ACKNOWLEDGED the contents of the report

10.0 Quality Report HJ took the report as read and highlighted some specific items from the report.

She referred to the end of report which gave a summary of key issues and demonstrated how the JQC were working together.

Safety concerns were raised regarding the Anticoagulation Service across all providers impacting on primary care. The Joint Quality Committee had asked for an urgent update from the lead commissioner which was presented with a valuable discussion and agreed actions.

HJ also referred to the patient story which was presented to the JQC in June. She

Item: 05 Enc: 02

Action thanked the gentleman for sharing his wife’s experience and advised that the JQC had established regular contact with him in Stoke-on-Trent.

HJ reported that they had revisited progress and continued work on the Francis report in 2008 and that they were maximising what was shared and learned.

HJ reported that a large number of QIAs had been submitted in order to ensure all QIPP schemes had a QIA and thanked everyone who had contributed to that.

HJ advised that they would be piloting a Staffordshire and S-O-T wide JQC and would look at whether it would be taken forward and take the best practice.

GF raised concerns about OOH. HJ advised that OOH had a CQC review and all the team members were involved.

GF stated that anti coag was a problem across the patch and that shared care was a quality, safety and contractual issue. SN added that Mel Mahon was working on anti coag and that there was a clinical director dedicated to it. PH advised that this would be presented to Membership Boards in July. HJ responded and gave assurance that the shared care would be dealt with.

NC referred to the Francis report and asked if there were any more deaths since. HJ confirmed that there was no issue around maternity.

SY mentioned the Jonnie Meek case and explained the problems with the milk feed. HJ added that the child had complications. SY explained that the CCG agreed to get an independent clinician to review the case. An application was made to the Attorney General to have a 2nd inquest put in place and the original case overturned. This was now going to the High Court for a decision. HJ advised that we would not normally discuss this in a public meeting and wanted to make the board aware what we had done and continued a commitment by the former AO.

The Governing Bodies RECEIVED and ACKNOWLEDGED the contents of the report

11.0 Performance Report Colin Fynn introduced himself and reported on the performance report.

He advised that most of the providers across the region had seen an upward trend.

Urgent & Emergency Care • All core providers failed to meet the A&E standard in April. However, Burton will achieve the 95% standard in May. RAPs remain in place across all core providers. • All three CCGs had C.Diff cases in March. In total, across the three CCGs there were 8 reported C.Diff cases. There are mitigating plans in place at HEFT and RWT. All cases are subject to review at CQRM and a root cause analysis. • There were no cases of MRSA. • In April there was one EMSA breach for SES&SP. • UHNM were the only provider to incur a 12 hour trolley breach in April. UHNM had two trolley breaches. This is a significant improvement on Q4 2017/18. There were no breaches reported for our other main Providers. • Given the success of recent MADE events (UHNM) and the frequent daily Executive command and control MADE calls, the West Staffordshire A&E

Item: 05 Enc: 02

Action Delivery Board has agreed that two weeks prior to any Bank holiday MADE should be implemented.

Planned Care • All three CCGs failed the 92% RTT standard in April. SES&SP have failed for the 5th consecutive month, following a period of sustained achievement; this is largely due to an increase in backlog of patients at HEFT. Burton continue to achieve the standard at provider level and for SES&SP/Cannock patients. • Across the three CCGs there were 18 52 week breaches. Combined across the three CCGs, 12 out of the 18 breaches were at UHNM. Commissioners were currently issuing a contract variation to increase scrutiny on 52 week breaches and derive more robust assurances. • Over the past month data quality issues with Medway at UHNM which continue to be a significant contributory factor to the Trusts non-achieving position. UHNM is therefore working with their internal auditors KPMG to undertake a 18 week diagnostic sustainability review with the speciality teams. This piece of work was informing recovery and improvement plans, as well as work on data quality and waiting lists. This would also include in-depth Demand and Capacity work, which would eventually put UHNM in a position to forecast a recovery trajectory. • A Planned Care Board had been established at UHNM which has the remit for the recovery and sustainability of RTT. Commissioners have requested to be included in the membership of the Board rather than duplicate with the Planned Care Operation Group currently held at the CCGs and chaired by UHNM Planned Care AD. If agreed the Planned Care Board will be the forum whereby delivery against the recovery plan will be held to account.

Cancer • Due to a problem with national system closures, data split by CCG and provider is not available at the time of publication • CCG level data suggests a significant deterioration in the overall cancer performance for Cannock. Cannock achieved 3 out of the 8 cancer standards. SaS and SES&SP achieved 6 and 5 of the standards respectively. • Once the data has been published, performance will be reviewed.

Mental Health • All IAPT access and recovery standards have been met for 2017/18. local intelligence suggests continued achievement into M1 • The CCG will continue to monitor against the MH5YFV standards • SES&SP have not achieved the EIP standard in April. This is a quarterly standard and will be monitored. A CPN remains in place with actions targeting data quality and access. The Mental Health commissioner is monitoring achievement via Contract Review Boards.

Kate Millward arrived 1534

MA asked why the front of house streaming had been given to UHNM from Vocare. CH responded that this was a temporary arrangement whilst the action plan was in place and that this would be turned back on 23rd July if we received assurance from the provider.

NC stated that he had counted 46, 3 letter abbreviations which were not in the glossary for the public papers.

SH made a general comment that as things were changing with transformation and 7

Item: 05 Enc: 02

Action working in demand she asked how were these figures being shown and can they be shown in the future where the CCG had intervened. LM responded that we had a data pack and conduct weekly ward rounds. Although it was difficult to see that the intervention had an impact, but soft intelligence showed how the care had improved.

GF asked if there were any mitigating actions on RTT.

MW responded to SH’s question on impact on nursing homes and stated that each care home would have a GP and providers to support the care in the home. MW referred to Bradwell Hall in Newcastle which resulted in 25% reduction in admissions.

LM clarified that the enhanced service was clinically lead and was supported by Membership Boards and the specification message was this was a new way of working.

The Governing Bodies RECEIVED and ACKNOWLEDGED the contents of the report

12.0 Board Assurance Framework SY advised that there were a total of 11 risks on the Board Assurance Framework.

5 Extreme 6 High

SY advised that there was concern raised at the Audit Committee meeting in May. The Governing Body needed to show more concern on the risks and on how we did business. As Governing Body members you needed to be sighted on the risks of the CCGs.

SY reported that there was a draft Risk Management Strategy which was going to be presented to EMT in July and would then come back to Governing Body later.

PH stated that we did touch on risks elsewhere in the agenda, not just in the BAF section.

GF referred to the risk on urgent care and stated that he was not reassured and that the risk should not be reduced. There should be a plan in place. CH responded that there was a plan in place which sat as part of the STP programme and was about transformation of urgent care. ACTION: CH to circulate the plan to GB members. CH

AM referred to FPC risk and stated that we were going to miss the financial targets and the Governing Body should be coming back with a plan as to what we were going to do about it. This is where the Governing Body would be assured and not reassured.

ACTION: Chairs and SY coordinate how to make the BAF dynamic discussions. SY / Chairs The Governing Bodies RECEIVED and ACKNOWLEDGED the contents of the report

13.0 Safeguarding Children Supervision Policy HJ explained that this document defined the Safeguarding Children Supervision Policy for Cannock Chase, East Staffordshire, South East Staffordshire & Seisdon Peninsula, Stafford & Surrounds Clinical Commissioning Groups and was being presented for formal ratification from the Governing Body.

Item: 05 Enc: 02

Action AHe asked why it was presented as a new policy now. HJ responded that the Safeguarding Nurse felt that there was a gap and the CCGs needed this.

GF confirmed that an EIA has been undertaken.

The Governing Body Meetings in Common RATIFIED the Safeguarding Supervision Policy

14.0 Moss Grove Practice, Kinver – SES-SP CCG Governing Body LM gave a verbal update following the decision made to the Kinver practice in May.

She confirmed that the decision supported the transfer to Dudley CCG with two caveats 1. cumulative deficits were transferred to Dudley and 2. the control total adjusted.

Trish Thompson, NHSE understood the view and stated that the national and regional view was that that this was a SES-SP CCG debt and therefore placed the matter back to the CCG.

MW advised that the Finance Director from Dudley had called him to say that Dudley were going to submit an application tomorrow. If we were to support this, we would need to put in an application tomorrow.

LM advised that she had asked for a joint communications plan to be produced for practices. SN added that the SES-SP Governing Body was quite clear that it was about the quality of our patients. If Dudley were willing to ensure that the rest of our CCG patients would not come under hardship, they needed to do so by close of play tomorrow.

DR arrived 16:03

PH agreed that there would need to be a joint communications plan.

The Governing Bodies NOTED the current situation

15.0 IFR Process PH added an additional item to the agenda on the IFR Process in that the chairs of the CCG had the urgent authority to take the decision on the IFR process and wished to make the Governing Body aware that this decision needed to be made. Paul Winter explained that the IFR contract needed an urgent decision and asked the Chairs to use their emergency powers. On 19th June all 6 Chairs gave assent within 24 hours and stated that the Governing Body were being asked to ratify the decision.

PG advised that he chaired the IFR process and asked for the clinicians to agree.

CH added that the IFR team would be a single team going forward and that there were 50 cases that had not been actioned and we needed to get these actioned quickly.

The Governing Bodies RATIFIED the Chairs’ action on the IFR Process.

16.0 Stafford and Surrounds Membership Report PH took the report as read and highlighted the key issues discussed at the meeting on

6 March 2018:- 9

Item: 05 Enc: 02

Action • Locality Development Programme • Integrated Urgent Care • PMS Reinvestment • Draft Primary Care Committee Audit Report • Governance Arrangements and MOU • Amendments to Stafford and Surrounds Consultation • Constitution • IM&T Update • Workforce Update • APG Summary Report

The Governing Bodies RECEIVED and ACKNOWLEDGED the contents of the report

17.0 Cannock Chase Membership Report MH took the report as read and highlighted the key issues discussed at the meetings on 13 March 2018

• Integrated Urgent Care Centre • Membership Agreement 2018/19 • Cannock Membership Agreements

The Governing Bodies RECEIVED and ACKNOWLEDGED the contents of the report

18.0 Joint Tamworth & Lichfield Locality Report SN take as read and highlighted the key issues discussed at the meeting on 13 March and 10 April 2018: • Integrated Urgent Care Centre • PMS Reinvestment • Locality Board TORs • Micro-suction at Community Hospitals • Meds Optimisation Update

• Alzheimer’s Presentation • Rheumatology Team from BHFT • Clinical Practice Research Datalink • Clinical leadership

The Governing Bodies RECEIVED and ACKNOWLEDGED the contents of the report

19.0 Seisdon Peninsula Locality Report SN highlighted that there was one issue that required to be escalated to the Governing Body:-

Communication between SSOTP and practices in Seisdon regarding how service change was being implemented and how this was to be accessed with reference to the Retinopathy Screening. ACTION: CP agreed to pick this up with Jennie CP Collier and feedback to SJ outside of the meeting.

The Governing Bodies RECEIVED and ACKNOWLEDGED the contents of the report

20.0 Committee Assurance Reports Communications and Engagement Committee

SH stated that the Joint Communications & Engagement and Task and Finish Group 10

Item: 05 Enc: 02

Action discussed public engagement from the STP and that it was noted that there had not been suitable engagement with clinicians and GB members. She advised that the planned public engagement July 2018 would not now go ahead. Although she now felt more assured.

The 360 Degree survey was raised that highlighted a number issues and concerns and a question asked how was this being taken forward in the CCG. SH advised that it had been to the C&E committee and an action plan would be developed to come to a Governing Body in future. SY agreed that this would be brought back to Governing Body.

The Governing Bodies RECEIVED and ACKNOWLEDGED the contents of the report

21.0 Together We’re Better Update – June 2018 The Governing Body Meetings in Common NOTED the STP Update which had been distributed to Membership Boards and Governing Body Members.

PH stated that we were going to ask Simon Whitehouse to come to our governance meeting. SY added that we were trying to close that loop and that the decisions made by the STP would be following our governance processes. SY advised that Anna Collins would have a link role with the STP to ensure that everything went to the right committees at the right time.

HJ added that Anna Collins would need to see what the execs were already involved in with the STP.

22.0 Any Other Business There being no further business, the Chair closed the meeting at 16:23

23.0 Questions from the Public There were no questions from the public.

24.0 Date and time of next meeting in Public TBC

Item: 06 Enc: 03

Cannock Chase, South East Staffordshire and Seisdon Peninsula and Stafford and Surrounds Clinical Commissioning Groups Governing Body Meeting in Common

LIVE PUBLIC ACTION LIST

Outcome/update MEETING Responsible AGENDA ITEM REFERENCE Action DUE DATE (Completed Actions remain on the Action List for the following meeting DATE Officer and are then removed to the 'Completed' Worksheet) 21/06/2018 Update: There were 19 incidents categorised as harm to MA referred to the 19 patient safety incidents reported for WMAS and asked if there was a patients. The top trend for harm relates to harm occuring during the 22/03/2018 Quality Report 9 pattern to what harm was caused. ACTION: HJ confirmed that she would report with more 28/06/2018 HJ detail on patient safety incidents at the next meeting movement of patient. WMAS are working with the Commissioner to ensure actions are in place to address this. 22/02/2018 AOB - OD Session on GP Contracts 19 GH to arrange with Gulshan Kaul a future OD session on GP Contracts (GMS/PMS etc.) Ongoing GH Ongoing Update: AM & MW reviewing CCGs runing costs with National Audit 22/02/2018 Finance Update 8 AM agreed to share the an analysis of the CCGs running costs over the past few years 28/06/2018 AM office on 2/7/18 Update: Meeting scheduled 28/6/2018 has been postponed. SW has It was agreed that Simon Whitehouse be invited to an OD session to make a presentation to the 22/02/2018 Finance Update 8 Ongoing SY/GH been invited to the Governing Body Meetings in common for the six Governing Bodies on the STP. CCGs. CB to provide a presentation to a future Governing Body meeting on the work undertaken to 28/09/2017 2016/17 Annual Assessments 15 Ongoing AM/CB AM/CB will bring this back to a future meeting date on CHC. 22.02.18:

X:\CCG\Cannock Staffs and Surrounds\Corporate\Governance\Mtgs - Leg Require\03 Jt GB\Meetings in Common\2018-19\07 - 25 October 2018 - PUBLIC\PUBLIC\Enc 03 Draft JOINT CCG PUBLIC Actions List 22 03 18 1 of 1 Cannock Chase Clinical Commissioning Group East Staffs Clinical Commissioning Group North Staffs Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford & Surrounds Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group

REPORT TO: Cannock Chase Clinical Commissioning Group South East Staffordshire & Seisdon Peninsula Clinical Commissioning Group Stafford & Surrounds Clinical Commissioning Group

Enclosure: 04

Report to: Governing Body Meetings in Common in PUBLIC

Title: Accountable Officer’s Report

Meeting Date: Thursday 25th October 2018

Executive Lead(s): Exec Sign-Off Y/N Author(s): Marcus Warnes, Accountable Officer N/A Marcus Warnes, Accountable Officer

Clinical Lead(s) Reviewer: Links to the STP Y/N (if Y, which programme):

Action Required (select): Decision Discussion For Assurance / For Information 

Purpose of the Paper (Key Points + Executive Summary):

This report provides an update to the governing bodies around the current environment that the CCGs are operating in. The report highlights

• The first 6 months financial performance including QIPP delivery • The appointment of a Turnaround Director • A&E performance • An update on the NHS Delivery Unit System Diagnostic • Update on the CQC Local System Review programme • Progress on the development of the CCGs’ revised governance arrangements

The Governing Bodies are requested to: • Note the contents of the report.

Summary of risks relating to the proposal (inc. Ref. No. of risk it aligns to on Risk Register):

Implications: Legal and/or Risk N/A CQC N/A Patient Safety N/A Patient Engagement N/A Financial N/A

1 Cannock Chase Clinical Commissioning Group East Staffs Clinical Commissioning Group North Staffs Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford & Surrounds Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group

Sustainability N/A Workforce / Training N/A

Key Requirements: Yes No 1. Has a Quality Impact Assessment been completed?  Please provide detail within the body of the report

2. Has an Equality Impact Assessment been completed?  Please provide detail within the body of the report as to these considerations:

• Can you confirm an Equality Impact & Risk Assessment (EIRA: stage 1 & 2) has been completed; if not, what is the rationale for non-completion?

• Which if any of the nine Protected Groups were targeted for engagement and feedback to CCGs, and why those?

• Summarise any disaggregated feedback from local Protected Group reps about any negative impacts arising / recommendations (e.g. service improvements)

• What mitigation / re-shaping of services resulted for people from local Protected Groups (along the lines of ‘You Said: We Listened, We Did’?)

• Explain any ‘objective justification’ considerations, if applicable

Key Requirements: Yes No 3. Has Engagement activity taken place with Stakeholders / Practices /  Communities / Public and Patients Please provide detail within the body of the report

Recommendations / Action Required:

The Governing Bodies are asked to:

Note the content of the report

2 Cannock Chase Clinical Commissioning Group East Staffs Clinical Commissioning Group North Staffs Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford & Surrounds Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group

1.0 Financial and QIPP Position for 2018/19

1.1 At month 6, Cannock Chase, Stafford and Surrounds and South East Staffordshire and Seisdon Peninsular CCGs have a year to date deficit of £16.6m which is £3.2m worse than the planned position agreed with NHSE. The CCGs are forecasting an under delivery (mitigation-adjusted) of their control totals by £1.1m. Further details are contained within the Finance Report.

1.2 At Month 6 QIPP delivery forecast for the three CCGs is an under-delivery of £885k against a YTD plan of £6.9m.

1.3 As reported in September the CCGs remain in financial escalation with NHS England, and as recommended by NHSE, the CCGs have appointed an interim Turnaround Director, Wendy Farrington Chad, who commenced in post on 18th September 2018.

1.4 Alistair and I attended a financial escalation meeting with NHSE’s Regional Director on 4th October 2018. NHSE commissioned Deloitte to review the CCGs’ financial position and the drivers of the deficit, and the findings and recommendations informed the escalation meeting. The recommendations of the review are being used to support the CCGs fix and deliver this year’s plan and support development of a medium term financial plan to return to balance over the next few years.

2.0 A&E Performance

2.1 Performance across the urgent care system has again shown some improvement. At Month 5 (Aug 18) all three major local Trusts, UHNM, UHDB and RWT achieved in excess of 90% against the 95% standard. Detailed performance information is reported later in the agenda.

2.2 The CCGs continue to work with partners to manage demand and to ensure that sufficient bed and home based capacity is in place to facilitate timely discharge.

3.0 Staffordshire and Stoke-on-Trent Sustainability and Transformation Partnership (STP)

3.1 As reported last month, Staffordshire and Stoke-on-Trent is the subject of a joint diagnostic review being undertaken by the NHS Delivery Unit. The Delivery Unit includes both NHSE and NHS Improvement and is latest diagnostic of the Staffordshire system.

3.2 Staffordshire and Stoke-on-Trent are only the second system nationally to benefit from this intervention, which will include the diagnostic and a 12 week programme of supported implementation.

3.3 A series of workshops have been held to validate the findings of the diagnostic, the latest being held with the Health and Care Transformation Board on 20th September.

3.4 Work is progressing to implement the STP plan with the creation of integrated care teams to improve the quality of community care provided and avoid hospital admissions for the frail elderly being one key initiative.

3.5 Phase 1 of a Frailty Hub model commenced in Tamworth/Lichfield on 11th September 2018. Sir Neil McKay and Simon Worthington attended the Hub, providing positive feedback on development to date.

3 Cannock Chase Clinical Commissioning Group East Staffs Clinical Commissioning Group North Staffs Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford & Surrounds Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group

3.6 Engagement has been undertaken with each of the South Staffordshire Membership Boards and agreement reached on a localised model. Clinical Leads are working with the CCG Locality Team on the development of implementation plans.

4.0 CQC Local System Review

4.1 A further round of local system reviews have been announced. The Staffordshire system will be reviewed in October and Stoke-on-Trent will be subject to a review of progress in November. Work is underway with partners to prepare for both reviews.

4.2 The CQC intend to visit the Lichfield Frailty Hub on 23rd October 2018.

5.0 New Governance Arrangements

5.1 The Joint Strategic Commissioning Committee met for the first time on 27th September. Paddy Hannigan was elected as Chair of the meeting. Initial discussions focussed on the scheme of delegation and Terms of Reference along with areas of joint commissioning with the local authorities.

5.2 Governing body members are reminded that the key purpose of this Committee is to make strategic commissioning decisions across all six CCGs where it makes sense to do so and is a key committee to the effectiveness of the CCGs.

5.3 The establishment of Divisional Committees was discussed by Governing Body members for the 6 CCGs, at the extra-ordinary meeting in common, on 19th July 2018. The terms of reference for the South East and South West Divisional Committee have been shared for comment. The first meetings of the Committees are to be held on 24th and 31st October respectively.

6.0 Pre Consultation Business Case – The Future of Local Health Services

6.1 The pre-consultation business case (PCBC) relating to the future of health services in northern Staffordshire was presented to NHS England assurance panel on 17th August 2018 following which further recommendations were made.

6.2 A further version was approved by the North Staffordshire and Stoke on Trent Governing Bodies at an extraordinary meeting held on 18th September 2018. This final version was submitted to NHSE on 21st September 2018 and will be considered at a second regional review panel in October 2018.

6.3 Subject to approval by NHSE, the proposal will then ultimately go to the National Investment Committee in November 2018.

6.4 The Consultation Institute continues to work with the CCGs to quality assure the consultation process to ensure compliance with our legal duties and best practice.

6.5 The CCGs still expect that the consultation process will be concluded before the period of “Purdah” commencing in mid-March 2019, prior to local elections in May 2019.

7.0 Recommendations

7.1 The governing bodies are requested to note the contents of the report.

4 Cannock Chase Clinical Commissioning Group East Staffs Clinical Commissioning Group North Staffs Clinical Commissioning Group South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group Stafford & Surrounds Clinical Commissioning Group Stoke-on-Trent Clinical Commissioning Group

REPORT TO: Cannock Chase Clinical Commissioning Group South East Staffordshire & Seisdon Peninsula Clinical Commissioning Group Stafford & Surrounds Clinical Commissioning Group

Enclosure: 04

Report to: Governing Body Meetings in Common in PUBLIC

Title: Finance Report Month 6

Meeting Date: Thursday 25th October 2018

Executive Lead(s): Exec Sign-Off Y/N Author(s): Alistair Mulvey, Chief Finance Officer Y David Skelton, Financial Controller

Clinical Lead(s) Reviewer: Links to the STP Y/N (if Y, which programme): N/A

Action Required (select): Decision Discussion For Assurance / For Information 

Purpose of the Paper (Key Points + Executive Summary):

To present to members the financial performance at Month 6 (End of September 2018).

Plan Context Senior members of the Executive Management Team and NHS England have been involved in discussions regarding risk associated with delivering the control totals. Following the recent conclusion of an audit by Deloitte's commissioned by NHS England an overspend of £34.2m has been agreed against the Control Totals for 2018/19. This results in a Staffordshire wide performance of £54.2m against the planned control total with a net risk position of £18m mainly relating to UHNM, Local Authority and Winter Pressures. Cannock, Stafford and South East Staffordshire CCGs have combined control total deficits of £26m which remain unchanged. While the collective Staffordshire CCGs’ plans achieve the combined Staffordshire control total, the plans submitted for the Southern CCGs achieve a £2.8m adverse control total variance, i.e. a total deficit of £28.8m.This includes a QIPP requirement of £37.1m, 5.42% of recurrent resource limit (RRL); the plans also highlighted a level of currently unmitigated risk of £11.7m. Delivery of the requisite deficit control total for the Southern CCGs’ will facilitate access to £26m of Commissioner Support Funding (CSF). This, non-recurrent, nationally allocated support funding will be applied to achieve a break even position in year and, whilst this will not support the improvement in the underlying financial position, it will mean that the cumulative deficit of the CCGs does not increase above the 17/18 outturn level. Failure to achieve the required control total deficit position will mean that the CCGs are unable to access the CSF.

Month 6 Position Cannock, Stafford and South East Staffordshire CCGs have a year to date deficit at Month 6 of £16.8m which is £3.2m worse than the planned Control Total position agreed with NHS England.

Predominant drivers of that pressure is over performance against the University Hospitals Birmingham (historic Heart of England activity), West Midlands Ambulance Service and the Community element of the Midlands Partnership Foundation Trust offset by under performance within Continuing Healthcare.

The CCGs are forecasting to under deliver their control totals for the year by £1.1m.The "Do nothing" forecast results in a £17.2m variance from plan which is then mitigated down to the £1.1m with the inclusion of £9.1m QIPP, £2.3m UHNM fines and penalties, £3m contingency and £1.3m MPFT Community challenges.

Summary of risks relating to the proposal (inc. Ref. No. of risk it aligns to on Risk Register):

Implications: Legal and/or Risk Failure of the CCG to achieve its financial duty. CQC N/A Patient Safety N/A Patient Engagement N/A Must hit the control total and demonstrate that the CCG is sustainable over Financial the longer term. Sustainability See above Workforce / Training N/A