1

NW London CCGs’ Shadow Joint Committee

Minutes of the meeting held on Thursday 6 September 2018,

15.00–17.00hrs

Members of the Committee:

Name: Role:

Marcia Saunders (MS)

Mark Easton (ME)

Alexandra Kalmis (AlK)

Dr Amol Kelshiker (AK)

Caroline Morison (CM)

Christine Vigars (CV)

Diane Jones (DJ)

Graham Hawkes (GH)

Dr Ian Goodman (IG)

Janet Cree (JC)

Jules Martin (JM)

Louise Proctor (LP)

Lindsey Wishart (LW)

Dr M C Patel (MCP)

Mary Clegg (MC)

Dr. Martin Lees (ML)

Melanie Smith (MeS)

Dr Nicola Burbidge (NB)

Neil Ferrelly (NF)

Dr Neville Purssell (NP)

Nicholas Young (NY)

Philip Young (PY)

Sheik Auladin (SA)

Dr Tim Spicer (TS)

Tessa Sandall (TeS)

Dr Vijay Taylor (VT)

Independent interim chair

Accountable Officer, NW London CCGs

Deputy MD, Harrow CCG

Chair, Harrow CCG

MD, Hillingdon CCG

Healthwatch Representative

Chief Nurse/ Director of Quality, NW London CCGs

Chief Executive Officer, Healthwatch Hillingdon

Chair, Hillingdon CCG

MD, Hammersmith & Fulham

MD, Central London CCG

MD, West London CCG

Lay member, audit and finance

Chair, Brent CCG

MD, Hounslow CCG

Secondary Care Consultant

Director of Public Health and Community Wellbeing, Brent Council

Chair, Hounslow CCG

Chief Finance Officer, NW London CCGs

Chair, Central London CCG

Lay member, patient representation

Lay member, audit and finance

MD, Brent CCG

Chair, Hammersmith & Fulham CCG

MD, Ealing CCG

Vice-Chair, Ealing CCG

Non-members in attendance:

Simon Carney (SC)

Alex Harris (AH)

Juliet Brown (JB)

Huw Wilson-Jones (HWJ)

Rory Hegarty (RH)

Head of Corporate Governance

Corporate Governance Officer, NW London CCGs

Interim STP Director

Interim Director of Acute Medical Commissioning

Director of Communications and Engagement

Apologies:

Dr Andrew Steeden Chair, West London CCG

Dr Mohini Parmar Chair, Ealing CCG

2

General business Action

for

1. Introductions, apologies and declarations of interest

The meeting was the first in which the Shadow Joint Committee was operating in public,

and the proceedings were also live-streamed. The Interim Independent Chair, Marcia

Saunders, began by thanking the events team at Brent Council for their assistance in

hosting the Committee.

The Committee expressed it warm appreciation of the contribution of Dr Amol Kelshiker

to the Committee, to Harrow CCG and to GP practices over many years and

congratulated him on his retirement.

Apologies were received from Andrew Steeden and Mohini Parmar – Vijay Taylor was in

attendance as substitute for the latter.

2. Minutes of the previous meeting held on 5 July 2018

The minutes of the previous meeting were approved as an accurate record of the proceedings.

Declarations of Interests Marcia Saunders reminded members to keep the interests register up to date as well as declaring them for specific agenda items. This included those attending in place of a member. There were no other declarations of interests. Graham Hawkes noted that he had not been included on the register of interests, and asked that the register of interests also reflect Hillingdon GPs’ involvement in integrated care partnerships. M C Patel reported that his return was in the process of being incorporated. 3. Actions Log

All actions were deemed closed as complete or covered by the meeting’s agenda. 4. Report of the Accountable Officer The report was introduced by Mark Easton as an update and an overview of his first one hundred days in post. Points of emphasis included:

Significant progress had been made in defining the new NW London structures and the role and remit of the Shadow Joint Committee.

Lay members had expressed a real desire to progress the new NW London structures.

The final NW London senior executive posts – the Director of Commissioning and the STP Director – were to be advertised in the coming few days.

The Strategy & Transformation Plan (STP) was being refreshed both to bring it

AH

3

up-to-date and to make it clearer and better organised.

The phrase “Accountable Care” was no longer operative, and “Integrated Care” was used as it reduced confusion with other healthcare systems.

Joint commissioning and finance Action for

5. Month 4 Financial Report

The item was introduced by the Chief Finance Officer, NW London CCGs, Neil Ferrelly. Points raised included the following:

1. Brent and Harrow’s figures were driven by overperformance on acute contracts.

2. Overspends on acute services were being offset with slippage in some reserves and one-off measures that would bring the CCGs back to a control total position.

3. QIPP (a productivity and savings programme for CCGs) had so far saved £29.4m and the full-year forecast was £108.5m, which was short of the programme by £20m.

4. The bulk of CCGs were delivering over 75% of their QIPP programmes. There had been work done with QIPP and finance leads to ensure that the schemes were being reported on a more consistent basis.

5. As requested, the report took a closer look at the challenges at the Royal Free hospital and action taken to mitigate them, such as mitigating growth in cost around outpatient procedures. There was also work being done to develop an understanding of whether there was anything that could be mobilised around critical care activity that could help at least the short-term position.

Discussion

6. The Committee expressed concern that the half-year position showed a £4m deficit and £49.1m of net risks. This concern was compounded by past experience indicating the the figures in the second half of the year would be more severe.

Action: NW London Finance Committee to consider issues relating to deficits and net risks and report back to the Shadow Joint Committee with recommendations.

7. On the Royal Free position, ME stated that one key issue was the hospital’s adoption of a different way of charging growth in non-elective to NW London CCGs than used elsewhere with other CCGs. London commissioners would need to act collectively to ensure that none of them were disadvantaged on purely geographical grounds.

8. NF noted that the reason for the increase in direct access was because it was a grouping of different activity items and therefore figures could change dramatically depending on the activity.

9. LW noted that CCGs would also need to maintain statutory responsibility for their own financial positions. Therefore prior to the NW London Finance Committee meeting, each CCG should look at their financial positions and test them robustly.

10. One of the reasons for Royal Free overspend could be a NW London-wide overall increase in outpatient first attendances, suggesting a larger referral rate.

NF / NWL JFC

4

6. Commissioning Intentions Process 2019/20

The item was introduced by the Interim Director of Acute Commissioning, Huw Wilson-

Jones. Points raised included the following:

1. Key messages for providers would be in relation to commissioning according to the

STP strategy.

2. NHS England planning guidance would be out at some stage and targets would be

delivered within the national planning guidance.

3. Quality needs would be highlighted and there was a desire to improve Care Quality

Commission results for our providers.

4. The Commissioning Intentions letter would be a strategic sector-wide notification that

would seek input from CCGs. This was on track to be released by the end of

September 2018.

Discussion

1. Each CCG would be liaising with public and patients and there would be a variety of

ways in which they would do so. Appropriate public and patient engagement was key

for any successful changes in services.

2. It was vital to have aggregation of communication from local to NW London-wide

commissioning. MDs were being closely worked with in order to develop this with

relevant directors.

3. AK stated that there was a need for more proactivity. There was also a need for

further discussion on Moorfields. He also added that the exercise of patient choice

was only informed by which choices were realistically available to patients.

4. HWJ noted that there were a series of workshops on the eRS (e-Referral System –

online appointment booking tool) rollout.

5. CV stated that it would be useful to do a review of patient and public involvement on

commissioning intentions. There should be an aim at a consistent approach across

NW London on public involvement.

6. MCP also noted that whilst there was a need for CCGs to work within their budget,

price was not the only factor driving commissioning decisions.

7. DJ stated that there needed to be a way to look at engagement done locally but also

to have an overarching view of that. ME added that the commissioning intentions

letter was the culmination of a whole series of engagement processes and there

should be nothing in there which would come as a surprise, as it was based on

conversations that had taken place over several years.

7. Strategic Objectives & Board Assurance Framework

The item was introduced by the Head of Corporate Governance, Simon Carney. Points raised in discussion included the following:

1. The strategic objectives in the BAF were suppoted by CCGs’ corporate and project risk registers.

2. LW noted that a number of the areas of focus had the Shadow Joint Committee as

5

the responsible Committee. Furthermore, many risk scores were very high. There was therefore a need include sufficient information alongside each entry to enable the responsible Committees to rigourously test the risks, as well as the controls and mitigations of them.

3. SC agreed and noted that the responsible committees for each of the risks was subject to debate and change. The current review of the risk management strategy would be looking at the risk reporting mechansims throughout the system.

4. MS stated that it would be helpful to have a forward-looking projection of the key risks as well as the retrospective / current position statements.

5. IG wondered if the risks on the first and second areas of focus were being lowered prematurely. SC responded that the drop in risks was directly linked to the controls reported and dates of their implementation. It was, however, for the Committee to challenge these and such challenge was noted.

6. ME stated that there was a need in future BAF discussions to focus on content rather than structure of the report itself. The Committee agreed.

7. AlK also added there was a need to have consistent flow from the local risk register to bodies responsible for joint commissioning. Again, such should be addressed in the review of the risk management strategy.

8. STP report

The item was introduced by the Interim STP Director, Juliet Brown. Points raised in introducing the item included the following:

1. One area that had not previously been given enough focus was children and young people. There had been discussions on effectively bringing programs together in order to help people keep well, particularly in responding in a time of crisis.

ACTION: That a future version of the STP report contain an account of the Children and Young People’s Wellness Strategy.

2. The first area of focus for the STP is prevention, and within that three focus areas had been identified – 1) alcohol abuse, 2) childhood obesity and 3) homelessness.

3. There had been a lot of excitement around digital health apps, particularly ones for diabetes.

4. Work was underway to improve the healthcare journeys (care events which patients undergo – from entry into the system until cease of treatment through discharge or otherwise) of people in care homes. There were now a number of training programmes for staff in NW London and a telemedicine service had gone live.

Discussion

1. In terms of mental health, a lot of work had been pulled together under the Like Minded programme (a mental health service transformation programme in NW London). There had also been advertising for senior positions and the mental health transformation was being put together. LW welcomed the assurances the report offered on progress regarding the Serious and Long-Term Mental Health Issues strand of work and agreed that such assurances ought to have appeared in the previous BAF paper. JB agreed to ensure this was fed in for future reports.

2. VT welcomed the work on prevention as it appeared that resources on prevention had been sacrificed for treatment. JB stated that funding issues had caused a delay

JB

JB

6

in getting prevention work off the ground.

3. JB noted that co-production of services with patients was vitally important, and there had been conversations already to begin some of that work.

ACTION: MCP requested more information on the governance structures around commissioning for obesity prevention.

4. GH noted that one area missing from this and the commissioning intentions item was the equity being done as a collaboration around planned procedures with a threshold and aligning these with the new guidance from NHS England.

5. JB stated that future versions of the report would be focused more on outcomes and less on narrative.

JB

JB

9. Services at the Royal Brompton Hospital

The item was introduced by Mark Easton. Points raised in discussion included the following:

1. The proposals were still at an early stage, and there was a need to consider what potential implications they could have more widely across the system.

2. Providers in NW London were putting together alternative proposals that would seek to retain services within NW London.

3. Whilst three-quarters of the services were commissioned by NHS England rather than the CCGs, the Committee noted that the impact of the changes was not just on those commissioned by NW London CCGs, but would feature, most significantly, residents of NW London as a whole as they comprised most of the patients – this fact was a key consideration for the Committee and its member CCGs.

4. There was no proposed change to the Royal Brompton site at Harefield Hospital.

5. Legal advice between the two sets of commissioners would be streamlined. NHS England had already reached out to user groups and there had been a NW London-wide meeting with Healthwatch.

6. There was a possibility that decisions made on this would be taken by a joint committee comprised of CCGs and NHS England.

7. The Committee was keen to understand the Trust’s strategic view of the medium and long-term aims and ambitions of their proposals.

8. ME added that there was a need to consider interdependencies with other providers and therefore a full strategic consideration. So far, there had not been enough information available to make a judgment and NW London engagement was crucial.

10. Update on the EqIA on the Establishment of the Joint Committee

The item was introduced by the Chief Nurse / Director of Quality, Diane Jones. The Committee noted the assessment and the improvements made to the Committee’s cover sheets. It agreed that those improvements represented an excellent start, but more care was required to build the quality of the content.

11. Report of the Collaboration Development Programme Board

The Committee noted the report.

12. Any other business

There was none.

7

Total meeting time: 110 minutes

The meeting was closed at 16.40hr

Date of next meeting: 4 October 2018 – venue to be confirmed.

8

Questions and Answers from the Public after the meeting closed:

Questions were raised by members of Brent Patient Voice around the STP & Strategic Outline Case (SOC) for Shaping a Healthier Future (SaHF). The Accountable Officer explained that the STP was a different document from the SOC for SaHF, and NHS Improvement had raised questions only on the latter. The forthcoming Joint Health Overview and Scrutiny Committee (18 September, 9.30am at Brent Civic Centre) would likely examine these issues in greater detail. Another question was raised around the meaning of “refreshing” the STP. The Interim STP Director stated that the STP had not been revised as such but progress had been assesed. The Chief Finance Officer also added that updated operational plans could follow after we receive updated planning guidance from NHS England. The Accountable Officer said we should be in a position to say more about this in December 2018 or January 2019. Other questions were raised on integrated care, consolidated contracts, SOC 1 and winter planning. The Accountable Officer confirmed that commissioners were working with regulators to ensure plans for winter were robust. On SOC modelling, it was important that the model was as clear and transparent as possible. There had also been a stocktake to examine integrated care at a borough level.

NW London CCGs’ Shadow Joint Committee

Thursday 1 November, 15.00–17.00hrs

Room: Bourg Room, Novotel, Hammersmtih International Centre 1, Shortlands, London W6 8DR

AGENDA

Time General business Doc Objective Lead

15.00

(5 mins)

Welcome, introductions and apologies for

absence

1. Register of interests

Paper For noting.

Marcia Saunders, interim chair

2. Minutes of the previous meeting – held on 6

September 2018 Paper For approval. Alex Harris

3. Actions log Paper For assurance. All

4. Report of the Accountable Officer Paper To note. Mark Easton

Joint commissioning

15.05

(55 mins)

5. M6 Financial report (including financial

recovery plan update) Paper Review.

Neil Ferrelly

6. M6 QIPP update Paper Review. Neil Ferrelly

7. Business Planning Update Paper Endorse. Huw Wilson-Jones

Joint strategy

16.00

(60 mins)

8. NHS in NW London: Overview of Strategic

Developments since 2012 and next steps Paper

To note current state & next steps.

Kevin Nicholson / Rory Hegarty

9. Health and Care Partnership governance

refresh Paper Discussion.

Mark Easton

10. Integrated Care in NW London Paper Discussion. Mark Easton

11. Update from the NW London Shadow Quality & Performance Committee

Paper Discussion. Diane Jones

12. Report from the Collaboration Development Programme Board

Paper

For assurance & to recognise progress towards delegated powers of the committee.

Mark Easton

13. Joint Committee cycle of meetings and business to be transacted

Paper Review. Ben Westmancott

16.55

(5 mins) 14. Any other business Verbal N/A

Marcia Saunders

Total meeting time: Up to 2 hours

Further information

If you have any questions or would like further information about the meeting, please contact Alex

Harris, Corporate Governance Officer at nwlccgs.collaboration@nhs.net

Public involvement

The meeting will be open to the public, with the exception of exempt items if and when these are

noted on the front of the agenda. After the meeting is over, there will be up to 30 minutes allowed

for questions from members of the public.

Members of the public are invited (but not required) to submit questions to the chair in advance of

the meeting so that, as far as possible, a more comprehensive answer can be given on the day. If

you would like to submit a question in advance of the meeting, please contact Alex Harris,

Corporate Governance Officer at nwlccgs.collaboration@nhs.net

Audio/Visual Recording of meetings

The proceedings of the Shadow Joint Committee will be webcast and available to the public to

live-stream. If you are attending the meeting, please be aware that there is a possibility that you

will be recorded and visible on the video feed.

Further assistance

If you have any specific needs with regard to accessibility, please contact

nwlccgs.collaboration@nhs.net in advance of the meeting.

The date of and location of the next meeting is:

6 December, Board Room, Westminster University, 309 Regent Street, London W1B 2HW

1 November meeting location

Nearest tube – Hammersmith (five minute walk)

Parking

Parking at Novotel is available on-site. Charge is as follows:

Residential parking - £1.50 / hour

Non-residential parking - £3.50 / hour

Members (as at 23 October 2018)

The current Terms of Reference that we are working towards sets the membership of the eventual Joint Committee as:

an independent chair;

all eight NW London CCG chairs;

NW London CCGs’ accountable officer;

NW London CCGs’ chief finance officer;

independent clinician;

NW London CCGs’ director of quality and nursing;

three lay members – to include one with a responsibility for audit and finance, and one with a responsibility for patient and public engagement;

one additional representative from the governing body of each CCG;

a Healthwatch representative; and

a Public Health representative.

Below reflects the Shadow Joint Committee’s progress towards meeting the current membership aspirations – the green boxes flags those categories that are ‘compliant’, orange ones indicate where the process of appointing has not yet been settled or completed. * = voting member

Independent Chair Marcia Saunders (interim)

NWL CCGs’ Chairs

Dr Ian Goodman, Hillingdon CCG *

Dr Nicola Burbidge, Hounslow CCG * Dr Andrew Steeden, West

London CCG * Dr Genevieve Small, Harrow

CCG *

Dr MC Patel, Brent CCG * Dr Tim Spicer, Hammersmith & Fulham CCG * Dr Mohini Parmar, Ealing CCG * Dr Neville Purssell, Central London CCG *

Accountable Officer Mark Easton, NW London CCGs *

Chief Finance Officer Neil Ferrelly, NW London CCGs *

Independent Clincian Dr Martin Lees, Consultant in Anaesthesia & Intensive Care Barts Heart Centre Barts Health *

Chief Nurse / Director of Quality

Diane Jones, NW London CCGs *

Lay Members (Formal appointment process required – to be three members)

Philip Young (audit and finance) * Lindsey Wishart (audit and finance) * Nicholas Young (patient representation) *

Nominated second CCG representatives

Jules Martin, MD, Central London CCG Janet Cree, MD, Hammersmith & Fulham CCG Caroline Morrison, MD, Hillingdon CCG

Tessa Sandall, MD, Ealing CCG Sheik Auladin, MD, Brent CCG Louise Proctor, MD, West London CCG Javina Sehgal, MD, Harrow CCG

Mary Clegg, MD, Hounslow CCG

Healthwatch Christine Vigars (for NW London), Graham Hawkes (CEO, Healthwatch Hillingdon)

Public Health Melanie Smith, Director of Public Health & Community Wellbeing, Brent Council

In attendance

Ben Westmancott (SRO, NW London Governance Development)

Juliet Brown, Interim STP Director

Alex Harris (officer), Corporate Governance, NW London CCGs (secretariat)

APPROVED 041018

Agenda item:

MINUTES of the Audit Committees

This is a meeting of the Audit Committees of the five CWHHE CCGs. Items apply to all five CCGs, unless indicated otherwise

Thursday 5 July 2018, 11:30 – 13:30 Room 5.4, 15 Marylebone Road

Members in attendance

CCG

Philip Young (PY) Lay member for Audit & Governance, CWHHE CCGs (Chair)

All five CCGs

Dr Raj Chandok (RC) GP Governing Body (Vice Chair) member (via ‘phone)

Ealing CCG

Trevor Woolley (TW) Lay member (via ‘phone) Hounslow CCG Nick Martin (NM) Lay member Hammersmith & Fulham

CCG None Lay member Central London CCG None Lay member West London CCG Non-Members in attendance

Neil Ferrelly (NF) Chief Finance Officer NWL CCGs John Leslie (JL) Deputy Chief Finance Officer Central London, West

London and Hammersmith & Fulham CCGs

Ben Westmancott (BW) Director of Compliance CWHHE CCGs Simon Carney (SC) Head of Corporate Governance,

(Secretary) CWHHE CCGs

Alice Donovan-Hart (ADH) Procurement Manager (item 5 only) NHS Shared Business Services

Maggie Gibbs (MG) Director of Human Resources (item 4 only)

NWL CCGs

Auditors in attendance

Leigh Lloyd-Thomas (LL) Partner / Public Sector Assurance BDO (external auditors) Nick Atkinson (NA) Partner RSM (internal auditors) Charlie Nicholl (CN) Counter fraud specialist RSM (internal auditors)

Page 1 of 5

APPROVED 041018

Minutes Business Items Action 1. Welcome/apologies 1.1 1.2

Apologies were received from Mark Easton, Diana Middleditch, Dr Tim Spicer and Dr Nicola Burbidge. It was noted that Central and West London CCGs were inquorate and would need to ratify decisions post-meeting.

2. Declaration of interests 2.1. There were no interests to record beyond those declared previously.

3. Minutes of previous meetings 3.1. 3

.1

The Committees agreed that the minutes of the meeting held on 22 May 2018 were a true and accurate record.

4. Matters arising and actions log 4.1. 4.2 4.3 4.4 4.5 4.6

Due to the limited time available, consideration of the action log was held over until the next substantive meeting. Matter arising

• HMRC Update – it was noted that nationally, HMRC had required CCGs to impose a withholding tax (20%) on all Continuing Healthcare (CHC) redress payments. NHS England was challenging this.

• Annual Reports and Accounts 2017/18 – lessons learned. The

Committees recommended that the Reports should, in future, be constrained to simply meeting central compliance requirements. They recommended to the SMT that separate public-facing, plain-English documents should be produced to help account for our activity against plans.

Action/s: CFO’s additional wording to the letters of representation to be appended to the minutes; and Consider the best use of CFO and CO time in signing the various parts of the 2018/19 ARAs Hammersmith & Fulham CCG Counter Fraud Authority – non-compliance with standards 1.8 and 1.9 - The committees were informed that the Chair and the NEL Audit Chair

NF / SC 212 BW213

DRAFT Page 2 of 5

APPROVED 041018

are meeting with NHS CFA on the meaning and proportionality of Standards 1.8 and 1.9 in the coming weeks and progress would be reported back to the Committees.

5. NWL procurement policy 5.1 5.2 5.3 5.4 5.5 5.6 5.7

Alice Donovan-Hart introduced the item and invited comments from the committees. The Committees emphasised the need for greater engagement with stakeholders throughout the revision process in order to smooth the process. Further questions remained about the Senior Management Team’s sign off of the policy, whether sufficient legal assurance had been received with regard to the policy’s fit with current and planned procurements and how, and when, the policy was to be implemented. Recognising the above alongside the need to progress the matter, the Committees approved the policy, subject to:

• SMT developing and agreeing an appropriate implementation plan and a specific and explicit ‘go live’ date;

• any legal advice and learning regarding live procurements being reflected as appropriate in the policy;

• the policy (including launch and implementation plan) being synchronised with BHH; and

• any named individuals in the policy being replaced with job / role titles.

ZD / BW / SC 214

6. Appraisal compliance 6.1 6.2 6.3 6.4

MG provided an update of the compliance figures thus far, expressing that there needs to be direct SMT accountability and supervision to drive the rate up; Action/s: SMT to provide answers to the Committees in October to the questions:

• The plans at Management level to increase the compliance rate; and

• How, in March 2019, would pay rises be approved if objectives had not been set and performance against them assessed?

MG215

7. NWL Audit Committees – draft terms of reference 7.1

The draft terms of reference were discussed, the Committees agreed that a model with fewer members was favoured, but with those members appointed according to the specific skills and experience they bring. Consequently, a model that created a large and unwieldy meeting (when doing so in common) was not supported.

DRAFT Page 3 of 5

APPROVED 041018

7.2 7.3

Action/s: An options paper was to be drafted for the Governance Design Group (GDG) in discussion with other lay and clinical stakeholders. It should set out three options –

a) chair is member of all 8 GBs, single member from each CCG (plus nominated deputies);

b) straight-forward single chair (on all 8 GBs), two other members from each CCG; or

c) as for ‘b)’ but with a number of members ‘common’ to more than one CCG.

All of the options were to be checked with NHS England.

SC / BW 216

8. Annual Audit Letters 2017/18 8.1

The letters were endorsed and thanks were given to those involved.

9. Internal Audit progress report 2018/19 9.1 9.2 9.3

NA introduced the report and asked the committees to note the content. STP Governance Audit – Audit Chairs both locally and nationally, had raised significant concerns, that the STP Governance was opaque, management driven, lacking in non-executive, as well as lay and public oversight. The fact that these concerns were raised in the recent past with still no lay involvement undertaken in the Audit seemed to further reinforce the anxieties. Action/s: Steps to immediately rectify the lack in engagement, specifically;

• NA and PY to meet and define next steps; and • BW to define the process from the SMT perspective.

NA / PY BW 217

10. Counter Fraud Annual Report 2018/19 10.1 10.2

It was noted that the detail of the NHS Counter Fraud Agency matter concerning Hammersmith & Fulham CCG was provided at item 4 on this agenda. The committees communicated that the report was comprehensive and informative.

11. ECCG Internal Audit opinion 11.1

The Secretary reported that between the paper being tabled and the meeting, the issues raised by the CCG had been noted and responded to by the Head of Internal Audit. It had been agreed, therefore, to withdraw the paper.

DRAFT Page 4 of 5

APPROVED 041018

12. Single Tender Waivers 12.1

The waivers presented below were noted:

1. C095 - Belbin Team Training Belbin £2,160 (delivery of Belbin Insight training for 20 individuals across the NWL Procurement Alliance)

2. C096 - Procurement process review and revision

Insight Executive Group £52,500 (provision of various subject matter expertise support to the NWL Procurement Alliance Programme)

3. H026 - Community Dermatology service

Concordia £575,045 (extension of Hounslow dermatology service provided by Concordia since July2013, to the end of March 2019)

13. Any other business 13.1

A meeting in common to be set up with the BHH CCGs for September 2018.

SC

Date of next meeting:

• 4 October 2018, 11:30 – 13:30

DRAFT Page 5 of 5

CWHHE CLINICAL COMMISSIONING GROUPS COLLABORATIVE Minutes

Quality & Performance Committee Thursday 26 April 2018, 11.30 – 1.00pm

15 Marylebone Road Members in attendance Mary Mullix (MM) Director of Quality, Nursing & Patient Safety, CWHHE CCG’s (Chair) Dr Mona Vaidya (MV) Vice Chair, Central London CCG Lizzy Bovill (LB) Programme Director – Central London CCG Team Ruth Sheridan (RS) Assistant Director of Quality, Improvement & Clinical Assurance Margie O’Connell (MO) Assistant Director of Quality Improvement and Clinical Assurance -

Central London CCG Michael Roach (MR) Assistant Director of Quality Improvement and Clinical Assurance,

West London CCG / CWHHE CCG’s Carmel Cahill (CC) Governing Body Lay member and quality lead, Ealing CCG Non-members in attendance Julie Fuller (JF) Geralyn Wynne (GW)

Complaints Manager CWHHE CCG’s Assistant Director of Commissioning – Integrated Care, Hounslow CCG

Natasha Patten (NP) Designated Clinical Officer, Ealing CCG Alison Markwell (AM) Designated Clinical Officer, CWHHE Safeguarding Pippa Street (PS) Deputy Director of Quality, Nursing and Patient Safety Richard Christou (RC) Designated Adult Safeguarding and Clinical Quality Manager (item 7) Julie Hulls (JH) Designated Nurse Safeguarding Children (Hounslow) (item 8) Mark Haggerty (MH) EPRR Lead, NWL CCGs (item 9) Prodine Kubalalika (PK) Lead Nurse – Infection Prevention and Control (item 5) Sue Pascoe (SP) Deputy Director for Care Home Quality Improvement (item 6) Alex Harris (AH) Corporate Governance Officer, NW London CCGs (minutes) Minutes

Business Items Action 1. Welcome & Apologies 1.1 1.2

Apologies were received from the West London CCG Quality and Performance Committee Chair, Dr Rachael Garner. Members noted that attendance at the meeting was sparse. A decision was nonetheless taken by members of the committee present to undertake the business of the committee to endorse or note the paper, with views from other members of the committee sought after the meeting. MM further advised that the papers present represented ongoing work that would potentially be undertaken by a joint quality committee and therefore there was still a case to be made for them to be seen by the

CWHHE is a collaboration between the Central London, West London, Hammersmith & Fulham, Hounslow and Ealing Clinical Commissioning Groups

Page 1 of 6

present members of the committee despite quorum not being achieved.

2. Declaration of interests 2.1 No further interests were declared other than those previously identified.

3. Minutes from the previous meeting 3.1

The minutes from the meeting on 5 October 2017 were agreed as a true and accurate record.

4. Matters arising and outstanding actions 4.1 4.2 4.3

Act.0083 - LAS has not been completely answered regarding triage; this needs to be taken back to the lead commissioners (Brent CCG). MM provided an update to the committee. The item was due to be on the agenda but had been taken into a wider performance meeting. LB stated she had emailed the medical director at LAS but had received no response. (REMAIN OPEN) Imperial RTT report – LB noted that since the last meeting Imperial have an RTT recovery trajectory. She was more assured than she had been previously, however there was still some way to go to deliver recovery. RTT would be brought back as a substantive item to the next meeting. OOHS 2016/17 Warfarin Audit, Summary Report – MM to pick up this work with Sue Jeffers to see if it can be taken forward.

LB142 MM174

Reports 5. Quarterly HCAI Report (Q3) (item taken out of sequence) 5.1 5.2 5.3 5.4 5.5 5.6 5.7

PK presented the item. She noted that Q3 numbers of Healthcare Associated Infections had gone down however in Q4 the objectives had been exceeded. Imperial had reported a few outbreaks of CPE. They were working closely with Public Health England and NHS England on this issue. The building itself was also very old, which was a risk factor in infection control – this was an issue also being worked on. Hounslow were likely to be the only CCG to meet their target for E-coli reduction. Ealing had reported the most MRSA and clostridium difficile (CDiff) infections. Work needed to be done in collaboration with primary health colleagues, GPs, etc. to see if something could be done to reduce these cases. PK responded to a question from MV on the cause of the CDiff infections in Ealing. PK noted that it was not correct to classify it as an “outbreak” per se,as these happened to patients in their own homes, or sometimes nursing homes. There was a need for greater understanding of what was happening. The sources of the diagnoses were community GPs and nursing homes. PK noted that the more detailed work into the CDiff infections would be undertaken by her team. There was no formal route for analysis, but it was acknowledged that something needed to be done to address the situation in Ealing. In response to a question from MM around working with other provider trusts not within the CWHHE geographical area, PK responded that infection control would be

CWHHE is a collaboration between the Central London, West London, Hammersmith & Fulham, Hounslow and Ealing Clinical Commissioning Groups

Page 2 of 6

5.8 5.9

managed between trusts. There was a good network within NW London and other trusts would no doubt keep other trusts informed of what was happening. Patients often moved around hospitals and ones who had developed infections were well-sighted. The committee gave thanks to PK for all her hard work, as she would be leaving CWHHE before the date of the next meeting. The Committee noted the report.

6. Safeguarding Annual report 2016/17 6.1 6.2 6.3 6.4 6.5

JH presented and gave an overview of the partners who were involved in the report. Through production of this report, it had been noted that the Safeguarding Health Outcome Framework was embedded in provider quality schedules, which assisted to prevent delays in reporting. Work in nursing homes had added value in that residents were supported in times of concern as well as feeding into transformation workstreams through the strategy and transformation team. Through research work, hydration for patients in care homes had been identified as requiring further support; and this was added to the infection control and prevention presentations. It had emerged that local authorities had limited capacity to deal with matters where there were Deprivation Of Liberty (DOL) issues; with members of the safeguarding team working through DOL assessments in care homes, particularly regarding any challenges of mental health capacity. The Committee approved the report for presentation at Governing Bodies.

7. Adult Safeguarding Policy (revised) 7.1 7.2 7.3 7.4 7.5

RC introduced the papers. CC noted that in the first sentence of the policy, Ealing had not been mentioned. PS asked if the policy would include a mention of modern slavery. RC stated that this was considered a form of abuse, therefore for the purpose of the policy it was not necessary to include this detail. There was a separate descriptor of what modern slavery entailed and involved, but this policy in question focused on the issues of referrals and concerns. JH added that a modern slavery strategy was also being developed. SP further outlined an ambition to have a joint adults and children’s safeguarding policy. In response to a question from MR, said that this would not be an appropriate policy for providers themselves to use. The policy had been developed in close consultation with CCG staff, and would not include enough detail to be appropriate for a contractor providing services. The Committee approved the report, subject to the amendment. Action: RC to send round a summary to CCGs about what was new in the policy. SP to agree a delivery plan with RC.

RC180 RC/SP 181

CWHHE is a collaboration between the Central London, West London, Hammersmith & Fulham, Hounslow and Ealing Clinical Commissioning Groups

Page 3 of 6

8. Quarterly Safeguarding Report Q2 17/18 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8

JH introduced the item. Designated adults were working with trusts, who were also submitting their own action plans to achieve training compliance. In Q2 there had been ESR issues. Assurance had been given that this was resolved and Q3 would show more positive CCG training figures. MR stated that the issues of some providers not being CPIS live was raised at CQG yesterday, and assurance was given that this would be addressed. Work was also being done on the Grenfell response and child sexual abuse. The female genital mutilation data reporting had been resolved. MR noted that some challenges around training related to the staff changes that were happening. The trust was working with safeguarding colleagues to mitigate that. JH responded to a question from PS, noting that a statement had been put out on all of the extranets in regard to modern slavery. In the Q1 report an ambition had been noted to use the report to undertake more detailed work on safeguarding themes. The Committee noted the themes for the Q3 report. MM added that there may not be a separate Q4 report in time for the next meeting due to the potential for there to be a Shadow Joint Quality and Performance Committee across NW London. RC noted that the target for Prevent training was 85% compliance by March 2018. This had not yet been met by one trust, however NHS England had said that compliance could also be met by e-learning. The Committee approved the report and the next steps to take this through local quality and safety committees.

9. Annual EPRR report 2017/18 9.1 9.2 9.3 9.4 9.5

MH introduced the report. MM noted that a lot of lessons had been learned since the Grenfell tower fire in public authorities understanding that whilst a legal duty of compliance may be met, there was still a need to work at a more local level on emerging issues. MH would be working with North Kensington recovery on the lessons of the Grenfell tower fire. Many emergency response teams would be looking to NW London for lessons to apply nationally. There was an on-going separate public inquiry on the Grenfell incident which would examine the first three days surrounding the fire and the emergency response. MR also added that there needed to be clear expectations on how to manage business as usual whilst supporting emergency response to incidents such as the Grenfell tower fire. LB also requested that the cover sheet be amended for governing bodies to reflect the work being undertaken to support the North Kensington recovery.

CWHHE is a collaboration between the Central London, West London, Hammersmith & Fulham, Hounslow and Ealing Clinical Commissioning Groups

Page 4 of 6

9.6 The Committee endorsed the paper.

10. Annual Complaints Report 2017/18 10.1 10.2 10.3 10.4

JF introduced the item. She advised members that more information on the complaints report was available if anyone requested it. There had been an increase in complaints, relating to wheelchair services. Members were informed that the wheelchairs procurement had been a long and technical piece of work, and the new service had only been in place for 18 months. However, there was a need to be clear on why such an increase had been seen. One reason could be that the increased levels of patient feedback had led to an increase in patient complaints. It was agreed further work to determine the themes was required. ACTION: For JF and SP to take away the work on complaints regarding the wheelchair service and investigate further. ACTION: A future session with the wheelchair service and patient carer forums had been discussed. JF to pick this up with Rachel Krausz, Acting Head of Service Transformation and Pathways.

JF/SP 182 JF183

11. Position report re CCGs’ Implementation of Children and Families Act 2014 11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8

AM and NP introduced the item. It was expected that either the Boroughs of Westminster or Royal Borough of Kensington and Chelsea would have an inspection this school term. The local authority was being closely worked with in order to plan and prepare for this. Issues had been raised in relation to waiting times for services. There was a new national trial of the Special Education Needs and Disabilities (SEND) tribunal which began on 3 April in which people could take their concerns around health, care and education and the tribunal could make non-binding judgments. Whilst these judgments were non-binding, there was an expectation that CCGs would follow their recommendations. Health professionals showed an increasingly better understanding of what they required. There was also a better relationship with SEND teams, which was essential for joint working. Further work needed to be done in order to have more accountable and easy to monitor action plans, so that boards had a good understanding of where they were. Strong links had been forged with national and local networks. There were challenges relating to commissioning of services across the 0-25 age range. There were also issues relating to services for the 19-25 age group, and a need for better understanding of joint commissioning between local authorities and CCGs needed to be developed. Waiting lists for autism assessments were also an issue; however this was a national problem. MV stated that there had been serious issues around the transition of young people at university, who had been seen by eating disorder services and then discharged with

CWHHE is a collaboration between the Central London, West London, Hammersmith & Fulham, Hounslow and Ealing Clinical Commissioning Groups

Page 5 of 6

11.9 11.10 11.11

no follow-up. There was a high instance, for example, of younger patients relapsing once they entered university. MV also added that there were issues around those diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) receiving a speculative diagnosis pre-university and experiencing challenges upon entering university. Concerns were expressed in respect of the ADHD services which had long waiting lists. MV also added that she had spoken with academics that emphasised the importance of quick access to ADHD service for young people. Eating disorder issues needed to be looked at separately outside of the meeting, as these typically did not fall within SEND. The Committee noted the paper and requested that it be brought back in revised form within six months.

CB184

12. Primary Care Quality and Performance Dashboard 12.1 12.2

GW introduced the item. She noted that once the CCG chairs had signed it off it would be going to the LMC for information. The Committee noted the paper and also that the paper would be sent to each CCG primary care committee following its sign off by Dr Amol Kelshiker (Clinical Lead, Primary Care, BHH).

GW185

13. Paediatric metric (KPI and quality reporting) 13.1 The Committee noted the report.

14. BAF risk 2.3 14.1 The Committee noted the report.

15. Any other business 15.1 There was none.

CWHHE is a collaboration between the Central London, West London, Hammersmith & Fulham, Hounslow and Ealing Clinical Commissioning Groups

Page 6 of 6