NHS Brighton and Hove Clinical Commissioning Group (CCG) Governing Body Meeting held in Public
DRAFT Minutes
Date: Tuesday 9 February 2021 Time: 14:30-17:00 Location: Meeting held virtually (MS Teams)
Present: Chris Adcock (CA) Chief Finance Officer Representing Until 19 January 2021 Jim Hayburn Akeela Ahmed (AA) Lay Member, Patient and Public Engagement Faustina Bayo (FB) Associate Governing Body Lay Member Karen Breen (KB) Deputy Chief Executive Officer Jane Chandler (JC) Independent Clinical Member- Registered Nurse Justin Daniels (JD) Independent Secondary Care Clinician Adam Doyle (AD) Chief Executive Officer For items 1.7 and 3.1 to 5 Samantha Durrant (SD) Lay member – Finance and Performance May Gabriel (MG) Associate Governing Body Lay Member Gill Galliano (GG) Lay Vice Chair Elizabeth Gill (EG) Chief Medical Officer Nina Graham (NG) Locality Representative Andrew Hodson (AH) Clinical Chair Meeting Chair Jerry Luke (JL) Independent Clinical Member – GP and Local Medical Committee (LMC) Representative for Brighton and Hove Sangeetha Sornalingam Locality Representative (SS) Ian Wilson (IW) Deputy Director of Quality Representing Allison Cannon
In attendance: Lola Banjoko (LB) Executive Managing Director Nicola Bottomley (NB) Company Secretary David Cryer (DC) Executive Director of Strategy
Hugo Luck Associate Director, Primary and Representing Community Care Amy Galea Moosa Patel (MP) Corporate Governance Support Rob Persey (RP) Executive Director Health and Adult Social Care, Brighton and Hove City Council (BHCC) Alison Perry (AP) Governance Officer Minutes Terry Willows (TW) Executive Director of Corporate Governance
Apologies: Allison Cannon (AC) Chief Nursing Officer Amy Galea Executive Director, Primary Care Andrew Taylor (AT) Lay Member - Governance Alistair Hill (AH) Director of Public Health, BHCC
Jim Hayburn (JH) Chief Finance Officer Members of the public Two members of the public were in attendance
Item Item description Action ref 1. Welcome and apologies 1.1. Apologies and welcome The Chair welcomed all those attending.
The Chair noted that the meeting was being recorded and would be posted on the organisation’s website. Members of the public were admitted to observe the meeting, virtually.
Apologies for absence were received from the members listed above.
The Governing Body was quorate.
1.2. Declarations of conflicts of interest The Chair requested declarations of any interests relevant to the agenda items for the meeting.
The Governing Body noted that there were no new or no existing declarations of interest considered prejudicial to any of the agenda items.
1.3. Questions previously submitted by the public The Chair noted one question had been received from a member of
the public regarding How the Governors assured themselves that the "Discharge to Assess" policy at Brighton and Sussex University Hospitals NHS Trust (BSUH) ensured that people were being discharged to a safe environment with their immediate personal needs met.
The Chair provided a response that would be provided to the member of the public in writing following the meeting.
A record of the question and the full response is appended to these minutes at Appendix A.
1.4. Minutes of the previous meeting The Chair presented the draft minutes of the previous meeting and invited comments.
The Governing Body resolved to approve the minutes of its meeting held on 8 December 2020 as an accurate record.
1.5. Action Log The Governing Body reviewed the Action Log. There were three actions recommended for closure.
The following matters were highlighted:
Action 10 and Action 23 were linked to the Children and Young Persons (CYP) Mental Health Report and remained open.
The Governing Body resolved to note the Action Log and approve closure the three actions recommended for closure.
1.6. Report from Clinical Chair The Chair presented the report.
The following matters were highlighted:
The Chair welcomed the following new members to the NHS Brighton and Hove CCG Governing Body: o Sangeetha Sornalingam, Brighton and Hove CCG Locality Representative; o Akeela Armed, Lay Member, Patient and Public Engagement; o Justin Daniels, Independent Secondary Care Clinician; o Faustina Bayo and May Gabriel, Associate Governing Body Lay Members; and o Jim Hayburn, Chief Finance Officer.
The Chair thanked the outgoing members - Chris Adcock, Chief Finance Officer and Tim Caroe, Chief Medical Officer - on behalf of
the Governing Body as they had both made a huge contribution to the work of NHS Brighton and Hove CCG.
The Governing Body was advised that recent Locality meetings had an increased attendance.
The Chair highlighted the Primary Care input into the Covid-19 Vaccination Programme.
The Governing Body resolved to note the Clinical Chair’s written report.
1.7. Chief Executive Officer and Executive Managing Director Report Adam Doyle and Lola Banjoko presented the report, which provided an overview of the key updates of relevance to NHS Brighton and Hove CCG since the Governing Body’s December 2020 meeting.
Adam Doyle highlighted the following matters:
The significant hard work of the NHS and Care workforce (within the context of the significant pressures our NHS experienced over Christmas in the third wave of the Covid-19 pandemic) were recognised.
Following the update to the changes within the Governing Body highlighted by the Chair, Adam Doyle welcomed the incoming members and extended thanks to Chris Adcock and Tim Caroe for their work. Karen Breen was welcomed back to the CCG, after a period of absence.
The impact of the European Union exit continued to be monitored; no significant issues had been raised across the system to date.
Significant work continued on the Black, Asian and Minority Ethnic (BAME) disparities programme for both the population health and staff.
It was confirmed that the full report of the response to the CYP Mental Health Review would be presented to the Governing Body in April 2021.
Work continued on the programme including the recruitment of the new Programme Director. The new programme governance and reporting processes had been established.
It was recognised that the programme had been commissioned and approved by the CCG and the Local Authority.
The main areas of focus that would be taken forward were:
1. Access to services for Children to ensure a clear single point of access in each of the three Local Authority (LA) areas.
2. Seamless transition between CYP and Adult services, including extension of the i-Rock model across the whole of Sussex and to the 18-25 age bracket.
3. Work on the Digital programme.
4. Modelling for increased demand and capacity of Young People experiencing psychological issues or concerns regarding their well-being.
5. Work to be clear about crisis access to services for all people at all times across the system and access across the whole programme to those with eating disorders.
Lola Banjoko highlighted the following matter:
The report elevated work such as Hospice Care, Carers and Community equipment and provided an update from the Health and Wellbeing Group
The Governing Body resolved to note the report, including key updates for NHS Brighton and Hove CCG.
2. Strategic developments and other reports 2.1. Covid‐19 update Terry Willows presented an update on significant Covid-19 developments.
The following matters were highlighted:
Covid-19 infections in the Brighton and Hove community had peaked to 803 per 100,000 population on 4 January 2021. This was significantly higher than during previous waves of the pandemic and had since declined to 132 cases per 100,000 population.
Covid-19 positive patients in hospitals in Sussex had peaked at 925 on 12 January 2021. This had since declined to 533, of which there were 131 patients in BSUH.
Covid-19 infections requiring Critical Care had peaked to 170% of the usual bed baseline for Sussex during mid-January 2021. This had since declined to 140%.
Key metrics were improving, including staff sickness.
Modelling indicated that BSUH’s hospitals would see the percentage of their beds occupied by patients with Covid-19 declined to 5% by early April 2021.
Work had been carried out with the Community Trust, Independent sector beds and with Care Hotels to maximise community capacity.
Support from the Military had been put in place in hospitals. General Duty Officers were helping with logistical issues and a Discharge team was helping to mobilise patients.
Chris Adcock provided an update on the Mass Vaccination Programme:
The NHS in Sussex continued to progress its vaccination programme and was performing against trajectories to meet the target to offer everyone in the top four priority groups a first vaccine dose by 15 February 2021.
Primary Care Networks (PCNs) and NHS Brighton and Hove CCG colleagues had been working closely with the General Practitioners (GP) Federation, going to extraordinary efforts to achieve the position to date. It was noted that there was still much to do before 15 February 2021.
Work continued to ensure that vaccine supply and capacity remained in place to achieve the current cohort requirements.
The Vaccination programme was being refreshed ensuring plans for second vaccinations and further cohorts were robust, using lessons learned in the first phase of the Mass Vaccination programme.
The team were working to proactively ensure that all of the population are able to access a vaccine. Actively targeting the homeless population, in particular in the Brighton area and encouraging anyone over 70 to contact their GP to seek vaccination.
Work being undertaken to address inequalities in access and take up of vaccines included:
o Provision in resourcing and focus for forward looking plans in respect of this.
o Taking forward learning from the first part of the vaccination programme.
o Collating information produced nationally and locally by ethnically diverse communities and faith groups, with a specific desire to address vaccine hesitancy.
o Cascading information and developing local methods of reaching and increasing vaccine confidence of diverse communities across Sussex.
o Training over 100 vaccination champions across Sussex to assist in taking robust information into communities through trusted links.
o Gathering insight, reaching communities and ensuring response to concerns and issues in the appropriate way with partners, including the Voluntary and Community Sector (VCS), local community groups and District and Borough Councils.
o Sharing videos from clinicians, produced in community languages, with community leaders.
The following points were raised in discussion:
There had been a Covid-19 outbreak in 50 Care Homes across Sussex. Work continued to identify the cause of the outbreak with a refreshed focus on infection prevention.
Oversight of issues were being monitored with Public Health and Local Authority colleagues through Incident Management Team (IMT) weekly meetings, along with daily monitoring escalation to the Silver and Gold meetings to address the issue.
Homes were being revisited to ensure vaccination provision in line with plans.
There were currently 21 Care Homes in Brighton and Hove which had an outbreak of two or more cases, this was 13 less than the previous week and the number was reducing quite rapidly. There were a number of key reasons for the outbreak such as greater transmissibility of Covid-19 variants.
Where there had been outbreaks, there had been a strong system response across the City.
There would be a full de-brief in the near future. There was a monthly Covid-19 stocktake meeting which would report to the Governing Body through the Joint Sussex Quality Committee.
Emerging data on disadvantaged groups was being collated
nationally and would be incorporated into the local picture.
Thanks was extended to CCG Executives, PCNs, GPs and health professions for coming together and the extraordinary work that had taken place since December 2020 to make the programmes work.
The Governing Body resolved to note and take assurance from the update provided on Covid-19 developments and the system’s ongoing response.
2.2. Response to Health Inequalities Lola Banjoko and Rob Persey presented the report.
The following matters were highlighted:
Work continued with the Community and Voluntary sector (VCS) to understand what was driving health inequalities across the system.
Analysis had been put together across the system using data provided by the Council. It had highlighted clinical, physical and social vulnerability deprivation.
Work of the Council Vulnerable People Cell had highlighted that the level of deprivation for homeless people, carers, older people, BAME and digitally excluded had been affected by Covid-19. The effect was greater where these were interlinked.
A number of steps had been proposed including each organisation having a Health and Social equalities lead to engage the population.
Brighton and Hove place was a Pilot for Population Health Management, reviewing topics at system, place, neighbourhood and person level, seeking to imbed learning into existing programmes.
The Health and Wellbeing Strategy produced by the City Council was recognised in the report. Providing a focus to improve inequalities across Brighton and Hove and the system whilst acknowledging that Covid-19 had exacerbated the situation for particular communities.
The following points were raised in discussion:
Whether an improvement in uptake of Community Cancer screening had been seen in 2019-2020. Figures had not improved and this had been impacted by Covid-19.
Childhood poverty and childhood mental health issues were not
detailed within the report. The Covid-19 pandemic amplified the community picture. Within the Health and Wellbeing Strategy, there were four WELL’s: o Starting WELL o Living WELL o Ageing WELL o Dying WELL
Within the ‘Starting WELL’, there was a focus on (CYP), with a framework of key priority outcomes to deliver.
Work will also be carried out looking at poverty and employment post Covid-19 Implications.
Along with the Vulnerable People Cell, there was the CYP Board and the Mental Health Oversight Board which had fed into the key issues highlighted at place.
It was noted that the BAME groups were having a poorer experience when using services. To ensure that pathways were addressing these issues a Sussex-wide response to the BAME disparities work had been put in place at the beginning of the Covid-19 pandemic. This work involved the Chairs of the BAME voluntary organisations, co-chaired by AD and LB. The work addressed issues such as; Cultural Sensitivity, appropriateness of engagement, and communication. A number of reports had been commissioned through the BAME organisations that enabled the group to hear the views of the BAME community. An improvement programme was in place.
The Governing Body resolved to:
Note NHS Brighton and Hove CCG response to address Health Inequalities.
Take assurance from the update provided on NHS Brighton and Hove CCG’s emerging response to Health Inequalities findings.
Approve the Brighton and Hove Integrated Care Partnership (ICP) principles for addressing Health Inequalities.
Note recent data (Appendix 1) showing the impact of Covid-19 which demonstrated further demographic vulnerability, noting Clinical and Social Vulnerability and increased Health Inequalities.
Note the proposed next steps to;
a) Embed the agreed principles to respond to Health Inequalities at
place working with key partners.
b) Embed the agreed principles in the two identified placed based transformation programmes (ICP Homelessness and Out of Hospital programme)and ensure that Department of Work and Pensions and the Voluntary and Community Sector are fully engaged/involved in the strategy plans.
c) Support the work of the Sussex wide Population Health and Prevention Board at Place.
d) Support the delivery of and actions arising from the recommendations of the Sussex Black and Minority Ethnic Population Needs Review.
e) Develop a robust communications and engagement approach that is appropriate and culturally sensitive/competent, using updated modern tools co- developed with communities.
Action 25: Karen Breen to share the Health and Wellbeing Strategy KB and the CYP report with the Governing Body members 06/04/21
Action 26: Lola Banjoko to meet with the new members of the LB Governing Body to discuss in full the Response to Health Inequalities 06/04/21 programme work.
2.3. Update from System Reform Steering Group David Cryer presented the report.
The following matter was highlighted:
Following the significant amount of media coverage regarding the unpublished white paper, which contained proposed legislative changes to the NHS, a communication was sent to Governing Body Members/ partners and staff. When the white paper was published the Governing Body would review and discuss it at its March 2021 Seminar.
The Governing Body resolved to receive assurance from the discussions which took place at the System Reform Steering Group meeting on 15 December 2020 and to note the CCGs response to the NHS England / Improvement (NHSE/I) consultation Integrating Care: Next steps to building strong and effective integrated care systems across England.
3. Assurance and Committee Reports
3.1 Board Assurance Framework (BAF)
Terry Willows presented the Board Assurance Framework (BAF).
The following matters were highlighted:
The Audit and Assurance Committee (AAC) had reviewed the BAF and requested that strategic risks were refreshed in the current operating context.
The alert status of Corporate Goals A ‘Improved population health and patient experience’ and B ‘Restoring high quality and safe services prioritised to meet clinical needs’ had moved from stable to deteriorating positions. This reflected the current system pressures with regard to the Covid-19 pandemic. The CCG would consider how it would manage its ability to restore services going forward.
The alert status of Corporate Goal C ‘Improved Financial Performance’ had moved from a deteriorating to a stable position.
The alert status of Corporate Goal E ‘Effective and well led organisation with an empowered and inclusive workforce’ had moved from a stable to an improving position. This reflected that the recently approved People Plan and Workforce Race Equality Standard (WRES) Action Plan were beginning to have an impact.
The following points were raised in discussion:
The AAC felt that the BAF was a helpful tool, and recognised the need to keep the triangulation of information as an ongoing consideration.
The report was clear and transparent.
The Governing Body resolved to:
Review and approve the BAF as at 12 January 2021.
Take assurance on the progress towards, and controls and assurances around, each of the five Corporate Goals.
3.2 Finance and Performance 3.2.1 Report from the Finance and Performance Committee held 16 December 2020 and 28 January 2021 Samantha Durrant presented a report from the Finance and Performance (F&P) Committee meetings of 16 December 2020 and 28 January 2021.
The following matter was highlighted:
The report had been formatted to highlight key points for
discussion.
The following points were raised in discussion:
The Executive Team would work with members of the three CCGs, - who were part of the Joint F&P Committee, to provide clarity of the financial allocations given to the Sussex system for the second half of the financial year. This piece of work would be taken through the F&P Committee to the Governing Body at a future date.
The Governing Body resolved to take assurance from the discussions that took place at the Joint F&P Committee meetings on 16 December 2020 and 28 January 2021.
3.3 Restoration and Recovery 3.3.1 Report from the Joint Committee of the Sussex CCGs held 16 December 2020 and 20 January 2021 The Chair presented a report from meetings of the Joint Committee of the Sussex CCGs (JSC) held on 16 December 2020 and 20 January 2021.
The following points were raised in discussion:
The proposal of the CCGs transitioning into an Integrated Care System (ICS), and how the transition contributed to the success of the Vaccination roll out. The Governing Body agreed that the vaccination responses were both local and Sussex–wide in order for the plan to work, resulting in the Primary Care Team, Executive Teams, PCN and Sussex Community NHS Trust (SCFT) coming together to identify sites, and best practice. Overall working together had helped the joint effort across Sussex and the national roll out.
Scrutiny of the re-provision of Information Technology (IT) services proposed plan. The plan had been well scrutinised informally through the F&P Committee and formally through the JSC. Karen Breen proposed to facilitate a conversation with the relevant member of the JSC to provide an independent view from an assurance perspective. If required a meeting with the Executive Managing Director and discussion with the JSC Chair would follow to move this forward.
Related risks would be considered in full at the next AAC meeting.
The Governing Body resolved to receive assurance from the discussions that took place at the JSC meetings on 16 December 2020 and 20 January 2021.
Action 27: Karen Breen to facilitate a conversation regarding the re- KB provision of IT services with Jerry Luke and supported by Samantha 06/04/21 Durrant in her capacity as Lay for Finance and Performance and a member of the Joint Committee [Committee that received assurance] with particular reference to the engagement of Primary Care. If afterwards there are residual concerns, these will be reported back to JSC for their consideration.
3.4 Quality and Safety 3.4.1 Report from Joint Sussex Quality Committee held 13 January 2021 Jane Chandler presented a report from the Joint Sussex Quality Committee meeting of 13 January 2021.
The following matters were highlighted:
The Sussex Quality Committee had not been assured by the work carried out on CYP Emotional and Mental Health services, but recognised that it had been impacted by the Covid-19 Pandemic response.
The Committee commended the work carried out on the Covid-19 Mass Vaccination programme.
The Governing Body resolved to take assurance from the discussion that took place at the Joint Sussex Quality Committee’s meeting on 13 January 2021.
3.5 Audit and Risk 3.5.1 Report from Audit and Assurance Committee held 19 January 2021 Samantha Durrant presented a report from the Audit and Assurance Committee (AAC) meeting in common on 19 January 2021.
The Governing Body resolved to take assurance from the discussions that took place at the AACs’ meeting in common on 19 January 2021.
3.6 Primary Care 3.6.1 Report from Primary Care Commissioning Committee held 19 January 2021 Gill Galliano presented a report from the Primary Care Commissioning Committee (PCCC) meeting on 19 January 2021.
The Governing Body resolved to take assurance from the discussions that took place at the PCCCs’ meeting in common on 19 January 2021.
3.7 Other Committee reports 3.7.1 Report from the Joint Committee of NHS 111/ the Clinical Assessment Service (CAS) 24 November 2020, 15 December 2020 and 26 January 2021 Samantha Durrant presented a report from the Joint Committee of NHS 111/ the CAS meetings of 24 November 2020, 15 December 2020 and 26 January 2021.
The following matter was highlighted:
It had been an incredibly challenging time for the service to progress the transition within the pandemic landscape. The Committee recognised commissioning colleagues and the service provider, highlighting the Head of South East Coast Ambulance Service (SECAmb) NHS Foundation Trust who was very passionate about the service and a committed champion of future reform.
The following points were raised in discussion:
Measures in place to ensure control over use of 111 service was for the intended purpose and not unintended consequences. Part of the programme setup included a steering group with oversight of deployment and implementation ensuring the right level monitoring controls in place. It was agreed that the reporting mechanism would be structured to be a clear and detailed way to provide assurance which would be presented to the Governing Body through the F&P Committee.
The Committee had discussed that during the transition the deluge of issues that was expected did not happen and was assured that robust mechanisms were in place should the workload increase.
The Governing Body resolved to take assurance from the discussions that took place at the Kent Medway and Sussex (KMS) NHS 111 / CAS Joint Committee of the NHS Sussex and Kent CCGs meetings on 24 November 2020, 15 December 2020 and 26 January 2021.
4. Closing 4.1. Governing Body Forward Planner The CYP Mental Health Review would be presented to the Governing Body in April 2021.
The Governing Body resolved to note the Forward Planner.
4.2. Any Other Business (to be notified to the Chair at least two days before the meeting) There were no further matters of business.
4.3. Evaluation of the meeting The Governing Body reflected on:
A good and useful discussion around the health and equalities paper and the Covid-19 update.
4.4. Consideration of risks and any escalations to the Operational Risk Register or Board Assurance Framework There were no further risks were for escalation:
4.5. Matters for Delegation to the Governing Body Committees There were no further matters for delegation to the Governing Body Committees.
5. Date of Next Meeting 6 April 2021 14:30 – 17:00
Meeting to be held virtually
Meeting Close Resolution of items to be heard in private: The motion was carried that “In accordance with the provisions of Section 1(2) of the Public Bodies (Admission to Meetings) Act 1960, it is resolved that the representatives of the press and other members of the public are excluded from the second part of the Governing Body meeting on the grounds that it is prejudicial to the public interest due to the confidential nature of the business about to be transacted. This section of the meeting will be held in private.”
Freedom of Information Act: Those present at the meeting should be aware that their names and designation will be listed in the minutes of this Meeting, which may be released to members of the public on request.
Appendix A – Questions previously submitted by the Public
A member of the public asked:
1. How do the Governors assure themselves that the "Discharge to Assess" policy at Brighton and Sussex University Hospitals NHS Trust ensures that people are
being discharged to a safe environment with their immediate personal needs met, as often personal needs change during a hospital stay?
The discharge to assess policy and pathways for patients admitted to Brighton and Sussex University Hospitals NHS Trust are delivered by the local Discharge Hub and Integrated Discharge Team. The Discharge Hub is a clinically led, multi-agency team made up of acute, community and social care partners and they work together to ensure that patients’ needs for immediate ongoing care determine the discharge destination for each patient. Patients are only considered for discharge to assess pathways once clinicians in the acute hospital assess them to be medically ready for discharge. As patients’ care needs can change during a hospital stay this information is kept up to date throughout the day every day and is shared with the discharge hub.
To be assured of the effectiveness of discharge to assess pathways there are daily health and care system calls to review patients care needs and to match them to the right onward care settings. In addition there are regular senior operational oversight meetings that review numbers of patients medically ready for discharge and the numbers of patients that may become ‘not medically ready for discharge’ if their needs change during their acute hospital stay. This oversight also reviews the safety and effectiveness of discharges for both the discharging and subsequent admitting care setting and reviews necessary hospital readmissions drawing out any lessons to be learned and ensuring that these are acted on.
The CCG monitors providers of discharge to assess care settings and takes assurance that they are a safe environment through a range of measures. These include Care Quality Commission (CQC) ratings and inspection reports and information received from local health and care partner who visit services. There are mechanisms in place to monitor and act on concerns received.