NHS Southwark Clinical Commissioning Group Annual General ... · AB introduced the presentation...

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1 Chair: Dr Jonty Heaversedge Chief Officer: Andrew Bland

The best possible health outcomes for Southwark people

NHS Southwark Clinical Commissioning Group

Annual General Meeting (AGM)

03 September 2015

Cambridge House

Minutes Governing Body Members Present: Dr Jonty Heaversedge (JH) CCG Chair, NHS Southwark Clinical

Commissioning Group (CCG) Andrew Bland (AB) Chief Officer, CCG Malcolm Hines (MH) Chief Financial Officer, CCG Professor Ami David (AD) Registered Nurse Member, CCG Dr Obi Ezeji (OE) Clinical Lead, CCG Dr Richard Gibbs (RG) Lay Member, CCG Dr Nancy Kuchemann (NK) Clinical Lead, CCG Robert Park (RP) Lay Member, CCG Dr Jane Cliffe (JC) Local Medical Committee Representative Professor John Moxham (JM) King’s Health Partners Gwen Kennedy (GK) Director of Quality and Safety, CCG Dr Jacques Mizan (JM) Clinical Lead, CCG Dr Noel Baxter (NB) Clinical Lead, CCG Alison Furey (AF) Public Health Consultant, Lambeth and

Southwark Council IN ATTENDANCE: * Rachael de Souza Corporate Business Manager, CCG (minutes) Rosemary Watts Head of Membership, Engagement and Equalities, CCG Kate Radcliffe Principal Associate, Communications and

Engagement, South East Commissioning Support Unit (SECSU)

Hayley Sloan Head of Transformation, CCG Lucy Ing Communications Manager, SECSU Caroline Ashton Chief Pharmacist, CCG Rebecca Scott Programme Director, CCG Kate Moriarty-Baker Head of Continuing Care and Safeguarding,

CCG David Smith Head of Transformation, CCG Nigel Smith Head of Pathway Commissioning, CCG Kieran Swann Head of Planning and CCG Assurance, CCG Julian Westcott Head of Finance, CCG

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Jean Young Head of Primary Care, Community and Children’s Commissioning, CCG Harpinder Priest Clinical Governance Manager, CCG Michelle Cleary Neighbourhood Development Manager, CCG Harprit Lally Extended Access Programme Manager, CCG

APOLOGIES:

Dr Yvonneke Roe (YR) Clinical Lead, CCG David Cooper (DC) Healthwatch, Southwark Dr Kathy Mc-Adam Freud (KM-F) Local Medical Committee representative Linda Drake (LD) Practice Nurse Member Dr Ruth Wallis (RW) Director of Public Health, Lambeth and

Southwark, Southwark Council *A list of attendees from the public are recorded at the end of the minutes

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Chair’s Welcome

JH welcomed attendees to this meeting, asking Governing Body

members to introduce themselves and provide details of their portfolios.

JH asked attendees to switch off mobile phones during the meeting, also advising that photographs would be taken during the meeting. He asked if anyone objected to this and if so, they could raise their hands so their objection could be noted. No hands were raised. He invited members of the public to help themselves to copies of the summary annual report. Governing Body members introduced themselves and explained their roles. Conflicts of Interest declarations were reviewed across Governing Body members. No conflicts of interest were declared JH asked AB to speak about progress made during the year and MH to outline key financial points from the past year. He said that the focus of this meeting was the CCG’s achievements in 2014-15 and our plans and actions for next year including:

NHS Southwark CCG’s plans for the year ahead

Working in partnerships with others and the value of collaborative partnerships

Working with partners in Lambeth and across London (particularly the Our Healthier South East London – the OHSEL

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programme)

Listening to our residents and helping people to manage their own health and wellbeing.

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Annual Report

AB introduced the presentation entitled ‘Annual Report/Key

achievements 2014/15’).

Challenges and achievements included programmes essential to

prevent Coronary Heart Disease (CHD), respiratory diseases and

cancer; all of which result in premature deaths of residents. We

are working hard with local providers in these areas.

We made progress in the past year with delivering the Primary

and Community Care Strategy and in establishing the Local Care

Networks (LCNs)

AB said Southwark had a high prevalence of obese children. For

this and some other issues, it was not always possible to find

solutions in Southwark alone, and therefore NHS Southwark CCG

was working with other partners across south east London.

Clinical Commissioning Groups were now working in partnership

with local populations to find value for money services offered

through commissioning

AB advised attendees that a formal process to identify funding for

a new health centre in Dulwich had taken place. In Dulwich, NHS

Southwark CCG worked in full partnership with stakeholders and

local residents to inform the development of the new health

centre.

In the borough, NHS Southwark CCG had commissioned

additional capacity from Guy’s and St Thomas’s NHS Foundation

Trust’s (GSTT’s) @Home services and the Enhanced Rapid

Response services. NHS Southwark CCG also worked with

community services to provide immediate access to enhanced

levels of therapy, social work and nursing

An enhanced multidisciplinary Learning Disability Intervention

Team had been commissioned to deliver specialist support to

families with children and young people with learning disabilities

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Southwark Council and NHS Southwark CCG developed and

implemented a joint Care Home Quality Improvement Strategy for

patients in Southwark’s nursing homes

With King’s Health Partners (KHP), the CCG established an

innovative ‘Three Dimensions for Diabetes’ project in September

2014.

The Better Care Fund involved working with the local authority –

the fund delivers investments exceeding £20m. We worked in

partnership with the two local authorities (Lambeth and

Southwark councils) and are making investments in primary care

(supported by an action plan)

On A&E, the CCG worked with King’s College Hospital NHS

Foundation Trust (KCH), developing a plan to improve

performance that resulted in reductions in people waiting over 52

weeks for surgery; there were 123 patients in April 2014 and this

dropped to nine in January 2015. The CCG also worked with

KCH to reduce 18 week waiters by 30% over that same

timeframe and the number of Southwark people attending A&E or

admitted as non-elective patients had also stabilised

At KCH at the beginning of the year, there were more than 101

people waiting significantly longer than national target times for

services - this situation reduced significantly for long waiters

Mixed sex accommodation breaches minimised, and improved

inpatients’ reports of their care experience were reported. MRSA

infections were also reported to be low for Southwark

Urgent two week cancer waiting times targets had been

consistently delivered. This means that cancer patients had been

seen by consultants quickly after referrals

Mental health services for Improving Access to Psychological

Therapies (IAPT) and dementia; Southwark and Lambeth were

within the top 4 or 5 high performers

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Strong arrangements for safeguarding adults and children were

already in place and we worked with the council to develop

initiatives for adults and children

The CCG managed several engagement programmes and events

in 2014/15, inviting views from patient about new developments.

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Annual Accounts

MH introduced the Annual Accounts - he said 2014/15 presented

challenges where it became necessary to make efficiency

savings of between 2% and 3% at the local level

The gross target expenditure target was £400,472,000 and the

performance level over the same period was £393,195,000. This

meant a surplus of £7,277,000 was achieved and therefore

available for NHS Southwark CCG in future years. The running

costs target was £7,621,000, against which the CCG expenditure

was £6,811,000. Running costs represents the CCG’s limits for

spending on staffing, rent, IT and other operational areas. NHS

Southwark CCG’s expenditure had come within targets set for

this financial year

The surplus was higher than originally planned (at £7,277,000)

against a plan of £5,972,000 for the year. The CCG reviewed

staff, support structures and rents, trimming staff budgets down

and re-negotiating some of the contracts in order to deliver large

savings on running costs in time for the 2015/16 financial year.

The CCG was able to deliver savings early, bringing about an

underspend of £810,000 on running costs

The National Continuing Care Risk Pool required a contribution

from NHS Southwark CCG. A rebate was made in 2014/15 to the

CCG of £869,000 and this contributed to a higher than planned

surplus for the CCG. This additional surplus was reported, as

required by NHS England and will be carried forward for the

benefit of NHS Southwark’s residents for future years

NHS Southwark CCG does not maintain capital assets (land or

buildings) on its accounts. All assets that belonged to Southwark

PCT before the creation of NHS Southwark CCG, were

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transferred to various organisations, including NHSE and

therefore the CCG has no assets

We are audited independently each year and, therefore, work

with KPMG (independent internal auditors) and Grant Thornton

(independent external auditors). This year we received a clean bill

of health from both auditors as, at the end of March 2015, NHS

Southwark CCG met all its statutory financial performance duties

The money spent during the year was largely on patient care.

Primary care had not been included as most primary care

expenditure was now managed by NHSE (the value being

approximately between £70m to £75m per annum)

For further details on the financial report, MH advised attendees

to review detailed information presented at the back of the full

annual report.

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Questions and Answers:

Barry Silverman said he would like NHS Southwark CCG to

carefully consider emergency admissions resulting from falls and

to what extent falls (in particular those caused by uneven

pavements in Southwark), resulted in A&E admissions

Action Point: JH agreed to explore the extent of emergency

admissions resulting from falls on uneven pavements in Southwark

with the local authority and respond at the Governing Body.

Barry Silverman also raised the issue of air quality in Southwark,

saying that in his opinion, this was a possible cause of increased

lung cancer.

NB clarified that the biggest issue for Southwark residents was related to

smoking. The CCG and the local authority were working collaborative to

reduce current smoking levels in local residents.

Steve Lancashire asked what work the CCG was doing with the

local authority under Section 106; Community Levy funds. This

was for the north of the borough to expand service for other areas

in addition to Dulwich.

MH advised the meeting that Section 106 referred to an agreement

under planning regulations between NHS Southwark CCG and the local

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authority where a contribution from local developers was made towards

a fund, where the agreement reached was that part of the levy was

allocated to projects leading to health improvements.

NHS Southwark CCG had discussions with the local authority regarding

Dulwich, Surrey Docks, Bermondsey Spa, Elephant and Castle, the

Aylesbury Estate and Peckham where major regeneration initiatives

were being led by the council. The discussions included multi-faceted

health services and levies and were designed to achieve a significant

contribution towards development of the estates as well as offering

cheaper housing.

MH advised there were going to be other opportunities in the future, with

new building projects coming on board, as was the case at Bankside.

NHS Southwark CCG will be able to review how creatively funds on

health budgets are being allocated. Local practices were working with

the CCG and the council to bid for regeneration programmes to improve

services for local residents. In addition, the Better Care Fund (BCF) will

become available to health related initiatives for the period of the next

four years. 2015 – 2016 will be the first of this four year period.

Dorothy Oxley was concerned about Continuing Care in care

homes as this issue related to recent CQC inspections. She

wanted to know how the CCG would work with people to facilitate

a better understanding of the process.

JH reassured Dorothy that the Continuing Care team worked jointly with

the local authority and a number of care homes to consider a wide range

of problems affecting elderly or vulnerable patients, including those with

long term conditions, mental health or other issues. Multi-disciplinary

assessments take place to ensure nurses work in collaboration with

social workers by using a multi-disciplinary approach.

Angela Stanworth said she had heard about financial issues

with King’s College Hospital NHS Foundation Trust (KCH) and

wanted to know how this could impact on patients.

MH said the CCG was working in partnership with KCH, Monitor and

NHS England (NHSE) to ensure financial recovery was realised over the

next five year period. Throughout this process, the CCG was monitoring

the quality of services that patients received. NB, Chair of the Clinical

Quality Review Group (CQRG) at KCH, assured the board that financial

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transition had no negative impacts on quality for patients.

AB said it was worth noting that financial issues at KCH was a result of

the trust expanding as an organisation (it now also included the Princess

Royal University Hospital (PRUH) in Bromley). In addition to that, KCH

was treating patients from Southwark, but in addition was managing

referrals from other boroughs across south London and Kent.

Paul Murphy from the Princess Street surgery asked for an

update on podiatry service provision as he reported difficulties

with accessing his local services.

JH advised that Caroline Gilmartin, the new Integrated Commissioning

Director who is starting in October, would have these services within her

portfolio. MK said services were accessible by self-referral or referral

from a GP. The CCG will investigate the issues raised by Mr. Murphy.

David Noakes, Liberal Democrat Councillor for Cathedral Ward

asked what measures the CCG was taking to ensure accidental access

of confidential information did not take place, especially in light of recent

releases of HIV patients’ names at the Dean Street clinic.

MH advised that Information Governance (IG) remained at the top end

of NHS Southwark CCG’s agenda. The CCG was in contact with local

trusts regularly to discuss IG. An IG toolkit was been provided and staff

expected to reach particular standards on processes used.

GK said all staff working in primary care in the CCG had been trained on

IG.

283/15

Patient stories - a composite video of six patient stories was played.

The video covered:

Alika’s story about experiencing a mental health crisis

Abi and her experiences in surviving cancer, where she was

treated at Guy’s and St Thomas’ NHS Foundation Trust

Jane’s knee replacement, being treated at King’s College

Hospital NHS Foundation Trust

Elizabeth experiences of looking after her mother

Sara’s story of being treated for a dissociative disorder

Linda’s planning for End of Life Care (Linda has been diagnosed

with terminal cancer).

284/15

After the video, MK said there could be no complacency. It was

necessary to take key messages from patient’s stories, such as those

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discussed in the video, and work to make services more patient-centred.

NHS Southwark CCG is focused on the delivery of innovation

programmes to support people in their every-day lives and in times of

crisis.

MK asked attendees to review the slide on innovation in the pack

entitled ‘Making Care Better for Southwark People’. MK said change

happened by enabling people to work together – this will be achieved by

changing ways in which people worked together.

Some new initiatives included:

- Partnerships with the local authority, voluntary and community

services. In south Southwark, NHS Southwark CCG is working to

expand social prescribing using this kind of model

- A ‘Street Triage’ for community and psychiatric services is being

introduced. Where necessary, this includes working with the

police to help people experiencing mental health crises

- Local Care Records; in emergency care, a clinician can access

patient records and obtain related data – this avoids some of

frustrations, such as those expressed by Elizabeth in her video

story i.e. inability of clinicians to access blood test results rapidly.

Other programmes included social prescribing, self-management

education, street triage, community rehabilitation, GSTT’s @Home

service and integrated care management.

MK said the CCG was working with colleagues in primary care and

GP Federations so pilots were becoming a more sustained way of

working with partners. He explained that some practices had come

together in groups (now called federations). The federations included

Improving Health (IHL) in the north of the borough and Quay Health

Solutions (QHS) in the south of the borough. The federations hold

contracts for services and quality improvement schemes for:

Extended primary care access

Population health management

Neighbourhood development incentive schemes.

Patients had access to new services through their GPs or the Out of

Hours (OOH) service, SELDOC.

MK emphasised that this innovation programme was being developed to

meet the needs of different people and was the result of listening to the

views of local people in a number of engagement events.

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Next steps in the Innovation Programme:

MK explained that people needed to work collaboratively in teams where

it will be necessary to go beyond primary care and across the whole

health system to find solutions – these are to be called Local Care

Networks (LCNs).

For the CCGs, this means having to radically assure a number of

incentives in commissioning. In the next 12 to 18 months, it will be

important to consider how commissioning is changing rapidly – the

outcomes will need to be clearly identified and this perspective will

emerge from engagement programmes taking place in the next 18

months. The structure of the contracts will also encourage increased

collaborative working between existing teams.

Over time, LCNs will be commissioned to deliver services and their

output will be measured on achievement of outcomes delivering

meaningful services to patients.

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Questions:

Angela Buckingham: said she had received feedback from patients

that a huge waste in medication occurred where doctors or nurses were

prescribing medications that did not agree with patients in the first

instance. She proposed a scheme could be set up to enable patients to

return un-used medications to practices.

Angela also felt that surgeries should receive monthly visits from breast

nurse specialists to determine whether conditions were urgent or non-

urgent.

JH said Angela’s comments on waste were helpful. It was not common

practise to return medications to practices but the CCG will review her

feedback.

Regarding Angela’s comments on breast screening – this will also be

reviewed by the CCG. A shared service across a number of practices

could work effectively. In this case, the breast nurse would visit those

practices sharing the service but it would not be feasible to enable

regular visits to every practice.

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Pat Lewis: referred to AB’s comments regarding those receiving

unequal starting points in health in their lifetime and where this was

dependent on the part of the borough they lived in. She asked what the

CCG could do better to address inequalities across the borough.

AB outlined that the CCG has access to a number of charts displaying

inequalities. We are working with our Public Health colleagues and

community based organisations to develop a deeper understanding of

underlying causes. Different contracts and incentives will support a

variety of commissioning options where taking a multi-agency approach

could better address underlying issues.

JH suggested that differences in life expectancies were usually driven by

peoples’ lifestyles - discussions are presently taking place with the

council at the Health and Wellbeing Board (HWB) level to address

health related inequalities. AF thought life changes could be improved

through increased education about leading healthier lifestyles, therefore

the CCG and local authority colleagues could achieve more effective

results through working collaboratively.

Tom White (Southwark Pensioner’s Action Group): referred to a

crisis incident that happened on the same day as the meeting. He gave

an account where two policemen were called on to deal with a mental

health patient – they took the patient to A&E.

JH referred Tom’s question to NK who said triage services

demonstrated good results to date with mental health patients taken by

the police to see mental health specialists. The main emphasis with

treatment of mental health patients was about taking preventative

measures to prevent getting into crisis. As people lead increasingly

complicated lives, a number of services needed to work together to

deliver consistent responses.

Esther Choutsedjem (member of a Patient Participation Group

(PPG): said she heard that a patient at KCH had been waiting for a long

while to see a physiotherapist. She wanted to know whether this was

indicative of quality issues at KCH.

NB advised Esther that issues on quality at KCH had been carefully

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monitored by the CQRG and to date there had been no substantive

reports of failing quality.

JH also informed Esther that our Integrated Governance and

Performance (IG&P) Committee advised that significant reductions in

long waiters at KCH were noted.

Closing remarks

JH thanked all members of the public in particular, and all

attendees for their attendance and contributions

Attendance Sheet

NHS Southwark Clinical Commissioning

Annual General Meeting

Thursday 03 September 2015

In attendance

1. Joy Monoute, Local resident

2. Barry Silverman, Member of the Engagement and Patient Experience

Committee (EPEC) and patient at Princess Street

3. Jacqueline Best-Vasell, Lambeth and Southwark MIND

4. Angela Buckingham, PPGt - Melbourne & Concordia Parkside

5. Martin Dodswell, Member of EPEC and patient at Albion Street surgery

6. Chin Ong

7. Linda Rugel

8. Angela Stanworth, Local resident

9. Alma Gray, member of EPEC and patient at Dulwich Medical Centre, Crystal

Palace Road

10. Darret Tomlin, Patient at Camberwell Green Surgery

11. Jean Attridge

12. Negga Mekonnen, Local resident

13. Eddie Murphy, Patient at Falmouth Road practice

14. Kathy Crawford

15. Olubemisoye Dada, Patient at Acorn and Gaumont surgery

16. Dorothy Oxley, Patient at The Gardens surgery

17. Steve Barber, Local resident

18. Aarti Gandesha, Manager, Healthwatch Southwark

19. Gemma Juma, Director, (Director, Dulwich Helpline and Southwark Churches

Care

20. Lauren Camacho, VoiceAbility

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21. Paul Murphy, GSTT Cardiac Support Group

22. Imogen Moore, Citizens UK

23. Councillor David Noakes, Liberal Democrat Councillor for Cathedral Ward

24. Jennifer Werner, (Southwark Safe Independent Living - SAIL

25. Mark Wess, Expert Witness Institute

26. Christian Tan, Local Resident

27. Rachael Henry, Southwark Safe Independent Living - SAIL

28. April Stamp, VoiceAbility

29. John Fraser, Local Resident – Lambeth

30. Patricia Lewis, Local resident

31. Heather Nicholson, Patient at Park Medical Centre

32. Alison Vine, CoolTan Arts

33. Penelope Dove, Peer Support (South London and Maudsley NHS Foundation

Trust ( SLaM)

34. Councillor Barrie Hargrove, Cabinet Member for Public Health, parks and

Leisure, Southwark Council

35. Jane Hopkins, Patient at Hambleden Clinic

36. Wendy Fisher, PPG member at Villa St. PPG

37. Robert Daly

38. Miss Baptiste, Local resident

39. Maria Murray

40. Catherine Negus, Research and Intelligence Officer, Healthwatch Southwark

41. Katy Wright, South East London Vision

42. Bina De, patient at Princess Street GP Practice

43. John King, Member of EPEC and patient at Hambleden Clinic

44. Jill Lockett, Director of Performance and Delivery, King’s Health Partners

45. Steve Lancashire, Local resident

46. Elizabeth-Rylance Watson, Patient at Forest Hill Group practice

47. Mahrukh Quereshi, ( Royal Free NHS Foundation Trust

48. Alice Goldsmith (Healthwatch Southwark)

49. Esther Choutsedjem, Patient at Lister – Hurley Group practice

50. Edwina Brockiesby, Silverfit

51. Verity McCrum, Auditory verbal UK

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