UNRATIFIED MINUTES

Nottingham North & East Clinical Commissioning Group Governing Body

Meeting Held 21st March 2017 at Gedling Civic Centre

Present Dr James Hopkinson (JH) Clinical Lead (Chair) Terry Allen (TA) Lay Member – Financial Management & Audit Jonathan Bemrose (JB) Chief Finance Officer Nichola Bramhall (NB) Registered Nurse, Director of Nursing & Quality Dr Ian Campbell (IC) GP Representative Janet Champion (JC) Deputy Chair – Lay Member PPI Dr Caitriona Kennedy (CK) GP Representative Dr Elaine Maddock (EM) GP Representative Dr Paramjit Panesar (PP) Assistant Clinical Chair Sam Walters (SW) Chief Officer Mike Wilkins (MW) Lay Member Primary Care In Attendance Hazel Buchanan (HB) Director of Operations Andy Hall (AH) Director of Outcomes and Information Sharon Pickett (SP) Deputy Chief Officer Apologies Paul McKay Service Director, Nottinghamshire County Council Dr Ben Teasdale (BT) Secondary Care Consultant

Agenda Items

Actions

GB 17/024 Welcome & Apologies James Hopkinson (JH) welcomed all to the meeting. Apologies were noted as above.

GB 17/025 Declarations of Interest JH reminded committee members of their obligation to declare any interest they may have on any issues arising at committee meetings which might conflict with the business of NNE Clinical Commissioning Group. Declarations of the Governing Body were listed in the CCG’s Register of Interests. JH noted that the Register was available either via the secretary to the Clinical Cabinet or the CCG website at the following link:

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http://www.nottinghamnortheastccg.nhs.uk/contact-us/freedom-of-information/conflicts-of-interest/ No additional conflicts of interest were declared above those already recorded on the CCG register of interests.

GB 17/026 Questions from the Public relating to the Agenda Emma Pearson (EP) confirmed that there had been no questions received by members of the public. There were no members of the public present.

GB 17/027 Minutes of the Governing Body Meetings The minutes of the Governing Body meeting held on 17th January 2017 and the Extra Ordinary Governing Body meeting held on the 10th February 2017 were presented for approval. The Governing Body Approved the minutes of the Governing Body Meeting held on the 17th January 2017 and 10th February 2017 subject to the amendment of grammatical errors. 13:38 – Dr Elaine Maddock arrived

GB 17/028 Matters arising and actions from the meeting held on 17th January and 10th February The matters arsing and action log were considered by the Governing Body. 17th January 2017 AOB – JH confirmed that the Lessons Learnt from public Governing Body questions had been received as an item for the agenda. 10th February 2017 EGB 17005: HB confirmed that the metrics on service value for lay members had been circulated. TA noted that he hadn’t received them, HB agreed to confirm distribution. The Governing Body Acknowledged the Matters Arising and Actions.

HB

GB 17/029 Chief Officer and Chair’s Report Sam Walters (SW) outlined key pieces of work and highlighted the following: Congenital Heart Disease NHS England Consultation NHS England had published a set of proposals in relation to the future commissioning of congenital heart disease. The proposals aimed to ensure a consistent standard of care for patients. The proposed service was based on a 3 tier model of care.

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The proposal outlined that level 2 specialist medical care and interventional cardiology should cease at NUH. The closest This specialist service being would be provided in Birmingham should the proposals go ahead. SW explained that the STP letter was for information and noted that the Greater Nottinghamshire Partners were awaiting the outcome to confirm if they were an accelerated STP site. The Governing Body acknowledged the Chief Officer’s Report.

FINANCE AND PERFORMANCE

GB 17/030 Finance Update Finance Report JB presented the Finance Report and highlighted the following points. JB confirmed that the CCG had achieved the required surplus and the rag rating in the report was incorrect. The surplus had been met due to the deep dive work and the focused programmes of work. JB noted that the efficiencies made to date were not classed as recurrent savings. If the overspend seen in month 8 had continued the CCG would not of achieved its Financial duty. Acute and Continuing Healthcare spend continued to be overspent and this would have an impact in 2017/18. Dr Elaine Maddock (EM) stated that there had been great achievements made by the CCG teams in meeting the financial duty and noted the work in meeting the QIPP target in relation to Continuing Health Care and Prescribing. JH agreed and thanked Jonathan and the Finance Team for their work. JH thanked the GP representatives for their hard work and confirmed that a letter would be sent to all practices to express his appreciation. Activity Report JB presented the Activity Report Dr Caitriona Kennedy noted that there had been large rises and reduction and highlighted Day Case as an example. JB explained that Day Case was driven by the Out Patients and there was a programme of work in relation to coding. The Governing Body approved the Finance Report and acknowledged the financial position.

JH

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GB 17/031 2017/18 Financial Plan and Opening Budget JB presented the Financial Plans and 2017/18 Budget Setting paper and highlighted the following points. There had been two escalation meetings with NHSE The NHS Operational Planning and Contracting Guidance 2017-19 set out a number of finance assumptions and business rules, JB highlighted the Mental health Investment Standard which was part of a National Policy. JB explained that the CCG had proposed a phased approach across the South CCGs but unfortunately the proposal was not successful. The total investment for Mental Health in the South CCG was £600. JB confirmed that there was an additional growth funds of £4 million The CCG had a programme allocation of £186.3 million that included 2.3% uplift and the Primary Care Co-Commissioning allocation. There were no reserves available for 2017/18 which posed significant risk in relation to mitigating any over performance throughout the year. There was a QIPP challenge of £12 million. JB explained that there was support provided from NHSE in the form of consultancy days with PWC. JB confirmed PWC were assisting with writing service specifications and undertaking actions that could be transacted. . JB drew attention to the 2017/18 budgets and confirmed that NHS contracts had been signed off at the financial stage however there was a possibility that there could be some minor adjustments to the budgets for the smaller contracts. The Governing Body Approved the 2017/18 Financial Plan and Opening Budget

GB 17/033 2017/18 Better Care Fund Plan JB presented the Better Care Fund Plan and highlighted the following points; The planning guidance had not been received and there were areas of the plan to finalise following the receipt of the guidance, JB requested that the Governing Body delegated the authority to approve the final plan to the Chief Officer. There were additional funds provided by the South CCGs to support Social Care. It was noted that following the National Budget announcement there was additional funding allocated to support Social Care which equated to £15 million for Nottinghamshire.

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There were a number of schemes identified as part of the Better Care Fund and their performance was monitored and reported on via the Performance Report. There was a focus on the non-elective and non-emergency care. JB confirmed that performance was reported to the Programme Board and the Better Care Fund Finance Group. Internal Audit had given Significant Assurance follow an internal audit on the Better Care Fund Programme. The Governing Body Delegated Authority to the Chief Officer to approve the final 2017/18 Better Care Fund Plan

GB 17/034 Detailed Financial Policies JB confirmed that following an internal audit of the financial systems in place, Full Assurance was awarded. The amendment to the Financial Policies included wording amended to reflect the practice in terms of usage of minor purchase orders. The Governing Body Approved the Detailed Financial Policies

GB 17/035 Performance Report March 2017 Andy Hall (AH) presented the Performance Report and the following points were noted; The format of the report had been amended to align with the Improvement and Assessment Framework. EM queried why Cancer Performance was different across the South CCGs. AH explained that the numbers of breeches werey small and it had been investigated previously and no operational differences had been identified. AH noted that the Performance Team tracked performance using various metrics which included a metric to report the number patients waiting 104+ days to commence treatment. Dr Paramjit Panesar (PP) queried how the CCG was receiving assurance that that action plans in place for the 4 hour waiting time standard were being progressed. SW explained that the A&E waiting times were being monitored via regular joint escalation meetings with NHS England and NHS Improvement. The CCGs have increased community capacity that has resulted in an additional 60 beds. SW explained that the additional beds have been available for a month and performance has improved and remained stable however there improvement was still necessary and NHSI were now investigating internal efficiencies within the hospital. AH informed the Governing Body that the Performance Team were working with Arriva to improve performance and confirmed that Arriva had committed to a number of cost containment programmes.

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Mike Wilkins queried the NUH performance in relation to the number of cancellation due to administrative errors. AH explained that the classifications were internal to NUH and the number of cancellations was small compared to other providers and often manifested by clinical capacity within the system. AH confirmed that the NUH performed well in the management of their Elective Appointments. The Governing Body Acknowledged the Performance Report March 2017

GB 17/036 Finance Information Group Highlights from the meeting held on the 13th March TA confirmed that the highlighted for the Finance Information Group has been included in the Finance Update.

Engagement and Involvement

GB 17/037 Equality and Diversity Update Hazel Buchanan (HB) presented the Equality and Diversity Update Report and explained that the CCG worked collaboratively with the South CCGs and NUH and confirmed that the Forum hoped to work more closely with Nottingham City CCG during 2017/18. HB explained that the CCG was required to report on the Workforce Race Equality Standard in 2016/17 and explained that a new Workforce Disability Equality Standard was going to be introduced during 2017/18. The Governing Body Acknowledged the Equality and Diversity Update

GB 17/038 Patient and Public Involvement Annual Report HB presented the Patient and Public Involvement (PPI) Annual Report and confirmed that the information would feature in the 2016/17 Annual Report. HB confirmed that PPI should be a golden thread in all the activities that the CCG undertake. HB confirmed that PPI had been strengthened during 2016/17 with the formation of the PPI Committee and the creation of the PPG and the PPI QIPP groups. The Big Health Debate campaign was developed to talk and engage with patients and the public about any proposed service change. HB confirmed that the Big Health branding would be used for campaigns during 2017/18. HB drew the attention of the Governing Body to the campaigns that have taken place during 2016/17.

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The Governing Body Approved the Patient and Public Involvement Annual Report

GB 17/039 Patient and Public Involvement (PPI) Committee Janet Champion (JC) presented the PPI Committee Terms of Reference and requested the approval of the Governing Body. Patient and Public Involvement (PPI) Committee Highlight Report JC presented the PPI Committee Highlight Report and confirmed that there were no items to escalate to the Governing Body. The Governing Body Approved the PPI Terms of Reference and acknowledged the PPI Highlight report.

GB 17/04 Governing Body Public Questions – Lessons Learnt JC presented the Lessons Learnt report and noted that it was a helpful exercise. JH noted that security wasn’t mentioned in the report and confirmed that the CCG would need to have more of an awareness of the environment when undertaking public consultation. The Governing Body Acknowledged Governing Body Public Questions – Lessons Learnt

Planning

GB17/041 NHS England – A&E Performance SW drew the attention of the letter to the Governing Body and explained that the 4 hour waiting standard was a high priority for both NHS England and NHS Improvement and meetings were scheduled fortnightly to review progress. The Governing Body Acknowledged the letter from NHS England – A&E Performance.

GB 17/042 Federative Working Update Dr Ian Campbell (IC) provided a update on the Federative Working and highlighted the following points; There had been 5 meeting and progress was steady. Legal advice had been sought to explore different models and the risks associated with them. A survey had been issued by Local Medical Council to all members and 14 responses had been received that highlighted

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concerns in relation to recruitment, income and work load. The preferred option was to establish a company limited by shares. Funding to support a federation was a concern and to date £8k had been spent for legal advice. A discussion took place in relation to how the Primary Care Home model and the Federation would work; it was agreed that a meeting would take place to discuss. Dr Caitriona Kennedy noted that the impact on her practice was not fully understood. IC agreed to meet with CK to discuss. MW queried how Federative Working aligns with the Primary Care Strategy. Sharon Pickett conformed that the members have been engaged and models discussed as part of the production of Strategy. The Governing Body Acknowledged the Federative Working Update.

IC/PP IC

GB 17/043 Clinical Cabinet Highlight Report JH presented the Clinical Cabinet Highlight Report and confirmed that there were no items to escalate to Governing Body. The Governing Body Acknowledged Clinical Cabinet Highlight Report

Quality

GB 17/044 Quarter 3 Quality Report Nichola Bramhall presented the Quarter 3 Quality Report and highlighted the following points; NB noted that there had been 25 C Diff and 0 cases of MRSA reported for NNE at the end of quarter. NB explained that some of the cases were avoidable and learning had been identified for NUH, GP and out of hours care. NB informed the Governing Body that there were concerns in relation to Maternity Care at NUH as the number of Serious Incidents (SI) that was being reported had dropped drastically. Assurance had been requested that had resulted in a number of retrospective SI being reported. A Director of Maternity had been recruited and maternity governance was to move into the corporate governance. SW requested that the Maternity Care concerns were fed back to the Contract Executive Board.

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NB confirmed that the trajectory for Transforming Care had been increased. NB explained that the CCG was monitored on the number of patients by NHS England and confirmed that NNE had on average one to two patients each month. NB confirmed that the Quality Team were going to undertake a quality review of the paediatrics service. The Governing Body Acknowledged Quarter 3 Quality Report

GB 17/045 Highlight report from the Open Session of the Safeguarding Committee meeting held on 10 January 2017 NB presented the highlight report and confirmed that there were no items to escalate to the Governing Body The Governing Body Acknowledged

GB 17/046 Highlight report from the Quality and Risk Committee meeting held on 2 February 2017 NB presented the highlight report and highlighted the following points to the governing Body members; The Quality Impact Assessments and Equality Impact Assessments logs were reviewed; NB explained that robust systems were now in place to ensure that the completion of the assessment were done in a timely manner and requested that the Governing Body support and reinforce this. The provider report for Mental Health highlighted that a number of key indicators were not being met and confirmed that a meeting was arranged to discuss. NB explained that there were continued difficulties in obtaining assurance from NHS Property Services in relation to Health and Safety meant the CCG has implemented an internal process. Due to issues with the e learning module in ESR there had been a reduction in Mandatory Training compliance that may impact on year end figures.

The Governing Body Acknowledged the Highlight report from the Quality and Risk Committee meeting held on 2 February 2017

GB 17/047 Highlight report from the Nottinghamshire Safeguarding Adults Board meeting held on 12 January 2017 NB presented the highlight report and confirmed that there were no items to escalate to the Governing Body

The Governing Body Acknowledged Highlight report from the Nottinghamshire Safeguarding Adults Board meeting held

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on 12 January 2017

Governance

Clinical Cabinet Terms of Reference HB presented the Clinical Cabinet Terms of Reference and highlighted changes the membership, the reporting duties of the Medicine Management Committee and the update of the standing agenda items. Terry Allen noted that in the areas of responsibility section there was no over reference to value for money. The Governing Body discussed and HB agreed to include value for money. The Governing Body Approved the Clinical Cabinet Terms of Reference

HB

Sustainable Development Management Plan (SDMP) update HNB presented the Sustainable Development Management Plan update and explained that carbon reduction was one of the CCG duties. In previous years Net Positive had progressed the SDMP with the Governance Leads but unfortunately they had gone in to liquidation. The CCG were investigating different options on how to progress the SDMP. The Governing Body Approved the Sustainable Development Management Plan update

Primary Care Commissioning Committee Highlight Report from the meeting held 2nd February 2017 MW presented the Primary Care Commissioning Committee Highlight Report from the meeting held 2nd February 2017 and confirmed that there were no items to escalated to the Governing Body. The Governing Body Acknowledged the Primary Care Commissioning Committee Highlight Report from the meeting held 2nd February 2017

Audit and Governance Highlight Report from the meeting held 18th January 2017

TA presented the Audit and Governance Highlight Report from

the meeting held 18th January 2017 and confirmed that the Terms of Reference for the Internal Audit reviews had been approved and the CCG was on plan to deliver the Internal Audit Plan. TA confirmed that there were no items to escalate to the

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Governing Body The Governing Body Acknowledged the Audit and Governance

Highlight Report from the meeting held 18th January 2017

Board Assurance Framework – March 2017 HB presented the Board Assurance Framework and highlighted the changes that had been made. JB noted that the risk score for Risk 2 had changed in November from 20 to 15 and should be further decrease to a score of 10. JB explained that this reduction was part of the annual cycle and it would likely increase again in April. The Governing Body Approved Board Assurance Framework – March 2017

Public Health Annual Report JH presented the Public Health Annual Report to the Governing Body members and noted that Public Health funding was ring fenced for another year. The Governing Body Acknowledged the Public Health Annual Report

DOCUMENTS

GB 17/045 Minutes a) East Midlands Affiliated Commissioning Committee

18.11.2016 b) Safeguarding Committee meeting held on 13 September

2016 c) Quality and Risk Committee meetings held on 27 October

2016 and 25 November 2016 (extraordinary) d) Nottinghamshire Safeguarding Adults Board meeting held on

13 October 2016 e) Finance & Information Group minutes 10th Januray 2017 f) Clinical Cabinet 18th January 2017 and 20th December 2016 g) IGMT Minutes September and December 2016 h) IGMT Highlight Report September and December 2016 i) A&E Delivery Board Minutes 06.12.16 and Action Log

January 2017 j) Primary Care Commissioning Committee 1st December

2016 No further comments were made in relation to the minutes. The Governing Body acknowledged the minutes.

GB 17/021 Reports a) Research Activity Report Q3 b) HWB Summary December 2016 No further comments were made in relation to the reports.

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The Governing Body acknowledged the reports.

CLOSING ITEMS

GB 17/022 Have the Public Questions been answered All questions received by the public have been answered and recorded in Appendix A

GB 17/023 Any other business CK noted that the E referral system was not allowing ENT referrals to made and explained that NUH had informed patients to contact their GP to make appointments. NB agreed to contact the Contract Lead.

NB

Date, Time and Venue of Next Meeting 17th May 2017 – 13:30 -16:30 Reception Room, Civic Centre, Arnot Hill Park, Nottingham

Confidential Motion The Chair invited the Board to adopt the following resolution: “That representatives of the press and other members of the public be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest” (Utilising the powers within Section 1(2) Public Bodies (Admission to Meetings) Act 1960). The Board so resolved and the remainder of the meeting was conducted in confidential session.