MEETING: Governing Body Item Number: 10.1 DATE: 27 October ... · 11.09.15 0.2 K Elliot With...

MEETING: Governing Body Item Number: 10.1 DATE: 27 October 2015

REPORT TITLE:

Shared minutes of the Healthier Together Committee in Common meeting held on the 15 July 2015

CORPORATE OBJECTIVE ADDRESSED:

Supporting our population to stay healthy and live longer in all areas of the Borough

REPORT AUTHOR:

Phil Watson CBE, Chairman

PRESENTED BY:

Trish Anderson

RECOMMENDATIONS/DECISION REQUIRED:

To receive for information

EXECUTIVE SUMMARY The Governing Body is asked to receive the shared minutes of the Healthier Together Committees in Common meeting held on the 15 July 2015 for information.

FURTHER ACTION REQUIRED:

None

EQUALITY AND DIVERSITY: Confirmed that any changes to service or procedure introduced as a

result of this report do not impact adversely on any of the protected groups covered by the Equality Act 2010.

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Shared Minutes of the Healthier Together Committees in Common Meeting held in Public Agenda Item Number 1.4 Date of meeting: TBC

Date of paper: 21.07.2015

Subject: Healthier Together Committees in Common

Decision / Opinion Required: For approval

Author of paper and contact details:

Lisa Murch [email protected]

Purpose of paper: For record of the Shared Minutes of the Healthier Together Committees in Common meeting held in public on 15th July 2015.

The item has been discussed previously at these meetings:

n/a

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mailto:[email protected]

Title Minutes taken at the meeting of the Greater Manchester CCG Healthier Together Committees in Committee

Author Lisa Murch

Version 0.1

Target Audience Healthier Together Committees in Common

Date Created 21.07.2015

Date of Issue 12.08.2015

To be Agreed 19.08.2015

Document Status (Draft/Final)

Draft

Description Greater Manchester CCG Healthier Together Committees in Common minutes of meeting 15/07/2015

Document History:

Date Version Author Notes

21.07.2015 0.1 L Murch Draft minutes created

11.09.15 0.2 K Elliot With amendments from Sophie Hargreaves

14.10.15 0.3 Hempsons Final amendments

Approved:

Signature:

Phil Watson CBE, Chairman

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Greater Manchester CCG Healthier Together

Committees in Common (HTCiC)

ATTENDANCE

Confirm meeting of the 12 Committees of :

Bolton CCG

Bury CCG

Central Manchester CCG

Heywood, Middleton & Rochdale CCG

North Manchester CCG

Oldham CCG

Salford CCG

South Manchester CCG

Stockport CCG

Tameside and Glossop CCG

Trafford CCG

Wigan Borough CCG

Other organisations in Attendance:

GM Service Transformation

Hempsons

Members in Attendance:

Phil Watson CBE

Dr Wirin Bhatiani

Stuart North

Dr Michael Eecklears

Dr Chris Duffy

Dr Martin Whiting

Julie Daines

Dr Paul Bishop

Dr Philip Burns

Dr Ranjit Gill

Dr Alan Dow

Dr Nigel Guest

Dr Tim Dalton

Independent Chair

Chair NHS Bolton CCG

Chief Officer NHS Bury CCG

Chair NHS Central Manchester CCG

Chair NHS Heywood Middleton & Rochdale CCG

Chief Clinical Officer NHS North Manchester CCG

Chief Financial Officer NHS Oldham CCG

Performance Lead NHS Salford CCG

Interim Chair NHS South Manchester CCG

Chair NHS Stockport CCG

Chair NHS Tameside & Glossop CCG

Chief Clinical Officer NHS Trafford CCG

Chair NHS Wigan Borough CCG

Other Attendees:

Ian Williamson

Leila Williams

Alex Heritage

Steven Pleasant

Chris Brookes

Claire Wilson

Chief Officer GM Health & Social Care Devolution SRO HT Programme

Director Service Transformation

Deputy Director Service Transformation

Lead Local Authority Chief Executive for Health AGMA Representative

Medical Director

Chair HT Finance & Investment Group

SHARED MINUTES OF MEETING

Wednesday 15th July 2015

Banqueting Hall, Town Hall, Manchester

Chair – Phil Watson CBE

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Matthew Cunningham

Beverley Smith

Jack Firth

Christian Dingwall

Lisa Murch

Sophie Hargreaves

Rob Bellingham

Clare Postlethwaite

Councillor J O’Brien

Dr Ivan Bennett

Nick Lees

Head of Corporate Services Eastern Cheshire CCG

Chief Transformation Officer North Derbyshire CCG

Chair Healthwatch Bolton

Legal Advisor Hempsons

Portfolio Support Manager / CiC Board Secretary

Associate Director Transformation

Director of Commissioning NHS England

Deputy Director of Finance Service Transformation

Chair, Joint Health Scrutiny Committee

Primary Care Transformation

Colorectal Surgeon and Healthier Together Champion

Apologies:

Dr Kiran Patel

Dr Ian Wilkinson

Denis Gizzi

Jerry Hawker

Fleur Blakeman

Chair NHS Bury CCG

Chief Clinical Officer NHS Oldham CCG

Managing Director NHS Oldham CCG

Chair Eastern Cheshire CCG

Director of Transformation NHS Eastern Cheshire CCG

Members of the Public attendance

Lawrence Dunhill

T Benjamin

Ann Day

Andy Whitefield

Chris O’Gorman

Ann Barnes

Lucy Kenderdine

Gina Lawrence

Melissa Surgey

David FA

Alison Whelan

E Collins

Nicola Onley

T Clarke

J Hartley

M Monaghan

Louise Hays

Ann Richardson

Wainan Kwok

Councillor Reid

Carol Mosedale

Donna Young

Alicia Custis

Colin Wasson

Ian Barker

Stephen Guilford

Sid Travers

David Jones

Mark Heywood

Rebecca Fletcher

Rob Smith

B McBride

HSJ

Healthwatch

UHSM

Eight Ninths

Stockport NHS Foundation Trust

Oldham Chronicle

Trafford CCG

GM Association of CCG’s

GM Shared Service

RCSENG

Bolton CCG

Trafford CCG

MCC Councillor

Stockport CCG

Hempsons



UHSM

UHSM

Trafford Council

Blackbox Medical Page 264

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G Poulter

R Bankroft

Paul Chandler

Joe Cookson

Shona Milton

Julia Hamer

Trish Anderson

Darren Banks

Maria Kildunne

Ken Griffiths

Brian O’Neil

Hugh Barett

Shirley Hamlett

C Wilson

Tommy Judge

Bev Craig

Joanne Hardy

Suzanne Richards

Sarah Judge

Monitor

Stockport Metropolitan Borough Council

Monitor

UHSM

Chief Accountable Officer Wigan CCG

CMFT

Healthwatch Stockport

Healthwatch Trafford

Manchester City Council


Stockport CCG





Quorate Requirements:

Achieved For a meeting at which no Category 1 decisions will be made, as close

to 75% (in terms of whole numbers) of the voting members of the HTCiC

are required to be in attendance or able to participate virtually by using

video or telephone or web link or other live and uninterrupted

conferencing facilities (9 out of the 12 voting members).

AGENDA

Item Paper/ Verbal Presenter

1. Welcome and Introductions Verbal Chair

1.1 Apologies for Absence Verbal Chair

1.2 Quorum Confirmation Verbal Chair

1.3 Declarations of Interests Verbal Chair

1.4 Confirmation of Minutes Paper Chair

2. Review from Greater Manchester Joint Health Scrutiny Committee

Verbal Cllr John O’Brien

3. Healthier Together Decision Making Management Report Presentation Various

4. Implementation Conditions Paper Leila Williams

5. NHS England Assurance Update Verbal Leila Williams

6. Proposed Agenda for August meeting Paper Chair

7. Any Other Business Verbal Chair

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Item Paper/ Verbal Presenter

8. Public Questions Verbal Chair

Date, Time & Venue of Next Meeting

Wednesday 19th August 2015, Mersey Suite, 3

rd Floor, 3 Piccadilly Place, Manchester, M1 3BN

MEETING NARRATIVE & OUTCOMES

1 Welcome and Introductions

The Chair welcomed all to the meeting and introductions were made.

1.1 Apologies for Absence

Apologies for absence were received from Dr Kiran Patel, Dr Ian Wilkinson, Denis Gizzi, Jerry Hawker and Fleur Blakeman.

1.2 Quorum Confirmation

It was noted the meeting was quorate.

1.3 Declaration of Interests

It was established that there were no declarations of interest to be recorded for this meeting but members were advised to indicate any interests arising during the course of the meeting immediately.

1.4 Minutes of the previous meeting held on 17th June 2015

The minutes were agreed as a true record with the addition of the information below. Regarding Primary Care, Alan Dow highlighted that this approach appeared to be headline driven rather than by identifying and investing in clinical priorities. Although the huge amount of public interest in the access standard needed to be acknowledged, Rob Bellingham assured this was not the case and that the aim was to transform primary care and outcomes.

ID Type Risk/Issue/Action/Decision/Outcome Description Owner

nil

2. Review from Greater Manchester Joint Health Scrutiny Committee

Councillor John O’Brien gave a verbal update that included advising that health scrutiny was included in the Health & Social Care Act and the role of the Committee was to review proposed changes and the impact of proposed changes. The programme began as safe and sustainable and then became Healthier Together, language was an issue early on and the consultation document was a prime example. The Committee looked at the workforce planning, primary care provision, movement of patient data (information did not follow the patient) and funding for primary care (movement of monies from acute). All points raised were addressed by the Service Transformation Team and Cllr O’Brien took the opportunity to thank the team for their efforts – they were always supportive and provided any information requested in an expedient and professional manner.

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Leila Williams thanked Cllr O’Brien and the Scrutiny Committee for their efforts and constructive criticism.


Nil

3. Healthier Together Decision Making Management Report

Ian Williamson SRO for the Programme introduced the presentation that brought together 3½ years

of work to improve care for patients. The Programme has been led by the 12 Greater Manchester

CCGs who are the decision makers here today.

Dr Chris Brookes presented the Case for Change and Vision that was for Greater Manchester to

have the best health and care in the country with no hospital currently meeting all of the GM Quality

and Safety Standards. Up to 300 lives could be saved in GM each year if the standards were met.

The Case for Change was endorsed by the CiC in January 2015 and the Chair asked the voting

members to confirm the endorsement. All 12 voting members confirmed this by show of hands.

Dr Ivan Bennett presented an update of progress with Primary & Joined Up Care, including the

agreed primary care standards. The Chair asked the voting members to vote if satisfactory

information had been received and suitable progress made to support the decision today. All 12

voting members confirmed this by show of hands.

Mr Nick Lees described the Future Model of Care and presented Lynda’s story. The Model of Care

was endorsed by the CiC in January 2015 and the Chair asked the voting members to confirm the

endorsement. All 12 voting members confirmed this by show of hands.

Alex Heritage presented an overview of the decision making criteria (including quality and safety,

travel and access and value for money) as well as public consultation results and the Integrated

Impact Assessment. Five decisions had previously been made, confirmation of the case for

change, confirmation of the model of care, review of alternative options, agreement of the decision

making criteria and on 17th June the number of single services. The decision today will be to select

a preferred option for implementation.

Dr Wirin Bhatiani presented the Integrated Impact Assessment (IIA) and equality conditions. The

Chair asked voting members to endorse the IIA and the equality conditions. All 12 voting members

confirmed this by show of hands.

A short break followed before the meeting resumed.

Alex Heritage presented information to support the decision making (decision making criteria, public

consultation results and Integrated Impact Assessment) and patient and partner videos were

shown. There were 4 options being considered today. First – Quality and Safety - The Clinical and

Patient Safety Group have appraised the quality and safety standards for each of the options. Dr

Paul Bishop described the role of the Clinical and Patient Safety Group and the working groups that

feed it and advised that from the work of the group, no quality and safety points were raised that

would allow for differentiating between the options.

Alex Heritage described the information used for the travel and access criterion that had been

provided by Transport for Greater Manchester and explained that following significant consultation

feedback and at the request of the Joint Overview and Scrutiny Committee, the data was expanded

to cover the population outside Greater Manchester who use Greater Manchester hospitals. The

expanded population information has been used for the decision making process. The Transport Page 267

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Advisory Group had looked at compliance with the three travel and access standards as part of the

group’s remit.

Dr Martin Whiting described the role of the Transport Advisory Group and what the analysis shows

in relation to each of the four options being considered.

Alex Heritage described the sub-criteria that had been considered in relation to transition i.e.

workforce, time to deliver, GM coherence (co-dependencies with other strategies), GM coherence

co-dependencies with other services and GM coherence assessment of single services, all of which

had been discussed at the HT Programme Board.

Ian Williamson endorsed and confirmed the work just described and highlighted that the time to

deliver was the same through options 4.1 to 4.4. The Providers in Greater Manchester had all

expressed a view on their preferred configuration of single services. The decision remains with the

Committees in Common to agree this. Implementation would take between two and three years to

complete and will involve changes at every site. Communication with the public would be essential

throughout the process. In relation to the independent report from North of England Senate

regarding the clinical co-dependencies, there was no significant impact for decision making

described.

Councillor O’Brien pointed out that this was not about money but about time to train staff and

implement.

Alex Heritage described the affordability and value for money criteria and advised that the baseline

had been updated since the pre consultation Business Case in light of consultation feedback, along

with updated assumptions (again in light of consultation feedback) in relation to costs of providing

the services and costs of new buildings. Alex Heritage also described the capital costs by each

option and the Net Present Value of each option along with sensitivity analyses undertaken. The

work had been externally assured by an independent company BDO.

Claire Wilson described the role of the Finance & Investment Group that was made up of finance

professionals from all GM provider and CCG organisations and the links with the Estates

Infrastructure and Data Modelling Groups. The assumptions were signed off by the groups who

were happy that these were appropriate and robust for the decision making.

Leila Williams explained that the implementation conditions would be discussed later but wanted to

reiterate the importance of ensuring that the world class standards are fully achieved and if

endorsed will need to be in place before any implementation goes ahead. There were 8 conditions

that would be considered with the paper in the later agenda item.

The Chair explained the process that would follow, all voting members as well as the

representatives from the outlying CCG areas in turn to comment on what they have heard followed

by legal advice by Christian Dingwall, the legal advisor, including process matters to consider when

making a decision. The discussion would then be summarised by Ian Williamson as Senior

Responsible Officer for the programme who would propose what would be the preferred option

from all comments before that is put to a vote.

The following section of the minutes has been documented as verbatim:-

The Chair - Okay thank you very much, just to explain to our members of the committee and members of the public the process we will be following from now on. I will ask all of the voting members and representatives from North Derbyshire and East Cheshire in turn to comment on what they have heard. Then our legal advisor, Christian Dingwall will advise the committee on those matters to take into account - process matters in making a decision. Then Ian Williamson as the Senior Responsible Officer will summarise the discussion and highlight what is to be the

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preferred option before that is put to a vote. So, that is the process that we intend to follow. Chair: Okay so first of all could I ask the representative from North Derbyshire who is Beverley Smith, Chief Transformation Officer North Derbyshire CCG to say a few words. Beverley Smith:- Thank you Chair. I think first of all on behalf of North Derbyshire CCG I would like to thank the Healthier Together Programme and the Committees in Common for ensuring we are fully included in the process and listening to our views. We will ensure that we continue to work together in such a cohesive fashion whatever the outcome is today. Firstly we fully support the direction of travel of the Greater Manchester Transformation Programme - Healthier Together that we have heard about so fully today. Our own programme in North Derbyshire Joined Up Care 21st Century is similar in our minds and our goals are equally the same. But our patient flow for acute services from our rural high peak locality is over the border into Greater Manchester and therefore the impact of this decision is considerable for our population. The compelling travel analysis has demonstrated the significant impact depending on the site selected for the people of High Peak. There is no reasonable alternative, we feel, other than a site in the south and in fact Stepping Hill Stockport is the only option, otherwise our patients will be severely at a disadvantage. Thank you for listening and we urge you to consider our view. Chair:- Thank you, now East Cheshire with Matthew Cunningham, Head of Corporate Services Eastern Cheshire CCG. Matthew Cunningham:- Thank you for the opportunity on behalf of Eastern Cheshire CCG and our 204,000 residents, many of which as you have seen in the slides today are deeply affected by the decision today. Just to reiterate we strongly support Greater Manchester to join up care systems and firmly believe that it is in the best interests of all patients, carers and their families. We strongly support the implementation of the Healthier Together standards and especially the work that has been taken around maximum travel times, which is a crucial factor for our local residents. I can also confirm that we also with our local neighboring hospital services issued a contract notice to them about their compliance in these care standards, in line with the hospitals in Greater Manchester. We absolutely agree that the single service model is beneficial for many patients but we hope that the implementation of this model does not take away the availability of hospital consultants to GP’s in Eastern Cheshire and across Greater Manchester. For the reasons we highlighted today, and also recognizing our formal response to the consultation, we do maintain the position that the implementation of an option where there isn’t a single service within the south or south east sector of Greater Manchester is not in the best interests of our local population.

Chair:- Thank you, so we now move on to the twelve voting members of the CCG’s from Greater Manchester starting with Trafford, Nigel Guest Chief Clinical Officer NHS Trafford CCG.

Nigel Guest:- Thank you Chair. I would just like to confirm I have the delegated authority to make this decision today. This has been a long but necessary journey and I am very confident that there has been a most robust and comprehensive process leading to this point. There has been extensive debate, as I am sure my colleagues would agree, amongst the voting members. We are all aware that we are voting for the whole of Greater Manchester and not simply for our localities. I think we should be proud in Greater Manchester and confident of the strength of our collaborative working as 12 CCG’s and our wider partners. I think this bodes very well for the future of devolution in Manchester as we work together further. It has not been an easy decision. It has not been taken lightly and the conditions associated I think are absolutely paramount to the successful implementation of the Healthier Together decision. Looking in more detail from the evidence we have seen today and the extensive work that has been done up until now, it is absolutely clear, from my point of view that the 4.4 group is certainly the only group that satisfies all parts of the transport requirements and within that group I have made consideration of the finances and also the provider configurations and so my decision when we take that vote shortly will be based on those particular aspects.

Chair:- Thank you, Salford, Paul Bishop, Performance Lead NHS Salford CCG.

Paul Bishop:- Thank you Chair, like Nigel I would like to reiterate that this has been a long journey

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and during the time of doing this I think we need to reflect that we have lost 300 lives for every year that we have taken to do this, that would have been saved had we achieved the best standards that Chris mentioned in Chelsea and Westminster. So, therefore in my mind we cannot continue the status quo, and we must make a decision today and we must make a decision that allows us to implement in the safest, fastest way achievable. Having said that, as the Chair of the HT Clinical and Patient Safety Group, the clinical and safety criteria do not allow differentiation. The only criteria that allows in my mind material difference between any of the options is travel and access and as such the only configuration which achieves the standards is a 4.4 with Stepping Hill Stockport as a specialist site for general surgery would achieve it. Certainly the 4.3 option would lead to 17,500 people unable to achieve that standard. I am heartened to see the conditions because I think, as hard as it has been getting to this point, I think we will have to put the same rigor if not greater into how we ensure safe implementation. Not only safe implementation but adherence to the standards otherwise we will not save those few hundred lives and as Chair of the CPSG I would just like to say that the clinical part of those standards I think that conditions 1 to 5 were accepted and encouraged by all the Clinical Directors that were present at that meeting and actually it was quite heartening to see the enthusiasm to share data, to look at independent data and to challenge each other that was present there, so I think that bodes well for the future. Out of the 4.4 options I think I will be steering towards 4.4a.

Chair:- Thank you, North Manchester, Dr Martin Whiting, Chief Clinical Officer NHS North Manchester CCG.

Martin Whiting:- Thank you Chair. To reiterate others comments I don’t think the position of doing nothing is an option. We should not lose sight of the 300 patients per year that died whilst we are deliberating and during the implementation period. So I agree with you to make a decision today. I also would echo colleagues’ comments on the implementation conditions and the way in which we control implementation is vital to the success of this programme. I am persuaded that the differences in the financial analysis between the four different options are not material and neither are any differences within patients safety and clinical safety and I think neither of those conditions are material. I agree the only significant difference is in travel and access and that favours Stepping Hill as the fourth site and that’s where my vote will go.

Chair:- Thank you, Wigan, Dr Tim Dalton, Chair NHS Wigan Borough CCG.

Tim Dalton:- Thank you Chair, Yes, this programme has really always been about quality and safety and each stage reminds us about that, reminds us about how we invest in high standards, so no matter what we do today I am really pleased that this is what will happen. I welcome the summary today about the decision making process and the extent of scrutiny by the support groups and governance structure is needed to make sure that the details of the criteria are robust. I am sure there are a number of issues, first of all care could be improved not only out of hospital in primary care and local care for those who are in hospital. The second thing which strikes me is the consultation exercise views being expressed and the extent of that consultation, the details, but specifically how we are going to use that to help shape things and take forward the plans since last summer. The third thing that has struck me was the coming together of our providers across the conurbation and am particularly struck with the consensus in the North West sector. Wigan and our local hospital has played a key part in working with the other two providers in the North West sector and to reach consensus about what is best for our patients. The fourth thing which strikes me is the degree of external validation we subjected ourselves to and received from both the North of England Scrutiny Committee, the North of England Senate, and the Greater Manchester and North Derbyshire scrutiny and also the Manchester scrutiny from BDO. I am struck of the need to make sure the conditions are truly in place to make this actually happen. We cannot afford not to make this decision today and to let this drift for the reasons previously mentioned. As others have said, on balance the only real difference I can see is the travel and access and therefore for me to choose the 4.4 options to make sure the 17,000 people of High Peak are suitably cared for.

Chair:- Thank you, Heywood Middleton and Rochdale, Dr Chris Duffy, Chair NHS Heywood Middleton & Rochdale CCG.

Chris Duffy:- Okay I will start off by confirming that I have got delegated authority from my

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associated colleagues to make this decision which in some ways is a blessing and in some ways a curse as leaving to attend the meeting this morning I genuinely hadn’t made up my mind as to which way I will be going. I had a conversation with my chief officer beforehand and she said what do you think the decision for the greater good is, we have been working for two and a half years, we have been working on quality and safety, planning, transition, value for money and transport and access. Through those I have been assured that there are no material differences between whatever option is used and whatever option is used it will lead to increase in standards and care of patients across Greater Manchester and the only difference is the travel and access. It has become clearer today that travel and access, the journey time it takes for 70,000 population, 30,000 of which the criteria will effect and that 30,000 is roughly 1% of the total population we are looking at. When we started we were doing this to save 300 lives across Greater Manchester, 1% of that is another 3 lives, and everything else is equal so why would I not choose to save those extra 3 lives so I come to the decision that we go for 4.4a.

Chair:- Thank you for that, Bolton, Dr Wirin Bhatiani, Chair NHS Bolton CCG

Wirin Bhatiani:- Thank you Chair. Like everyone else I acknowledge it has been a tough journey and I think the critical thing is how we go forward and how we implement our decision. I think we listened to the public to a great sense of consultation. I think we have listened to our hospitals, our providers, basically I do want to say about our Providers, because I think that as we are embarking on this journey we already have a quick win as we are not actually asking our hospitals to compete with each other, we are asking our hospitals to work with each other and there is evidence of that already. I think as Tim pointed out, I have been close to the work that providers in the North West Sector and have been struck by how our providers are learning to work together for the benefit of our patients. This is not about competition in hospitals, it is about working together and I think this is a really important quick win that we already achieved. We have set ourselves some standards and the important standards, as we have already heard, is that the travelling standards are the things that are distinguishing through the options. We ought to bear in mind that these standards should not only apply to our residents in Greater Manchester, but those residents outside of Greater Manchester that have already travelled into Greater Manchester to access our hospitals. I think it is an important part of the population that our hospitals serve and we must not let them down. So that is an important thing. Quality and safety is key, because this is not improving some of the hospitals, it is about improving all hospitals and this is an important message that we are here to improve the standards in all of our hospitals. We have heard and actually consulted patients in all of the hospitals. But we want those patients that require complex life threatening surgery, once in a lifetime episodes, to have the best possible chance and this is what this is all about. I do not think the finances are really key, I do not see that there is a great difference between some of the options. I do agree that size of a single service is important and there has to be a critical mass to really improve the quality and improve the clinical effectiveness of our workforce that to me is important and I have taken that into consideration in my decision making. So putting all of that together I think that option 4.4 is the key one. I would also say that my intention will be option 4.4 today.

Chair:- Thank you, Dr Philip Burns, Interim Chair NHS South Manchester CCG.

Philip Burns:- I agree with the other speakers, today is a very significant day when we make an historic and difficult decision to improve our healthcare system in Greater Manchester. Someone mentioned earlier about the tag line of Healthier Together and that would be everyone is a winner and I really do believe that everyone is a winner in this process from primary care, joined up care, hospital services, clinicians working for those services, it is a real change, a real opportunity here to change our health care system and achieve that aim which seems like a big challenge to have, for Greater Manchester to have the best health and care in the country. Acute abdominal surgery is a small part of that healthcare. It should be a once in a lifetime or never event for the most of our population. Those who do find themselves in that critical healthcare situation, they need to be confident that the right thing will be done by the right person at the right time. Today’s decision is to decide where the right place for that intervention should take place. I believe that we are taking a very significant step towards the vision that we set out today in all of our communication and it is really important that we do not talk about winners and losers, let me say it again everyone is a winner. The whole healthcare system will receive a major boost as a result of our decision today. It

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is not only about those having acute abdominal surgery that will benefit all patients using hospital and primary care services. We can today ensure that those services, particularly, in the hyper-acute situation of abdominal surgery receive the highest national and international standards. As the lead commissioner for University Hospital South Manchester, we are really proud to work with UHSM and very proud of what it has achieved there for our patients. We want to see their services flourish within the overall health economy of Greater Manchester and we recognise how important healthcare is to the economy of South Manchester and really contributes to our economic prosperity in what is being called out Northern Power House. UHSM makes an enormous contribution, not only to healthcare, but to research, education and employment. When we looked at our four versus five discussion the key pieces of evidence turned out to be the sustainability of the workforce in that. Today it has become very clear that the key piece of evidence, as others have mentioned is the accessibility and we cannot make a decision today that will deny access to a portion of the population that Greater Manchester serves and we do not have to make that decision, so my decision today is based on the criteria and standards on which we have consulted, it has to be the right decision for the populations which hospitals in Greater Manchester serve if we are going to save those 300 lives per year and as others have said I am keen to get cracking with that and keen to get implementation happening. Primary Care and integrated Community Services will enable us to do that and we must remember that 98% of our patients will use out of hospital services first. Really all of our NHS services need to improve and to modernise. I think my decision is the right decision for a clinical commissioner to make based on the evidence presented and again the key piece that differentiates here is the access so I am therefore pleased to recommend the 4.4 option and I think 4.4 option is recognised by the patients in our population as the right decision.

Chair:- Thank you, Dr Michael Eecklears, Chair NHS Central Manchester CCG.

Mike Eecklears:- Thank you Chair, and supportive comments of my colleagues so far I am reminded or we are reminding ourselves that we are commissioners and we have a statutory responsibility to improve the health of our population to provide the best services or best possible service we can for our patients. When we came together as a twelve it was very clear to us that with regard to Greater Manchester we could achieve much more together than we could as individuals in our work, particularly when we were focusing on improving standards of care in our hospitals, which as everyone has just heard is absolutely paramount to this mission. We have learnt a lot along the way. We have learnt about the importance of taking our Primary Care measures with us. We have learnt a lot about the importance of out of hospital integrated care and those areas remain very much a part of our day job. Collectively we realise that the big goal was what we could achieve across Greater Manchester by working together by developing what we described today as the model of care which would save lives of the population of the whole of Greater Manchester and of those areas that continue to use those services today. Like everybody we have looked at the evidence extensively summarised today, but we have had many, many hours pouring over the evidence and as it has been said in choosing the fourth site for the single service it became clear that the main differentiating factor was the very important one which was the travel and access time, so like my colleagues, it became pretty clear to me that if we were going to meet the standard for the Greater Manchester population and for the outer Greater Manchester population that use our services my choice is very clear one which is 4.4. I will go further to say that I was personally very impressed by the level of collaboration we have already seen with our possible providers and in helping decide which of the options in 4.4 I would support. I am reminded by the fact that the early discussions that had occurred between UHSM and CMFT, so South Manchester University Hospital and Central Manchester Foundation Trust, the potential of a real synergy of two of our great hospitals which I believe would benefit not only the Manchester population but the Greater Manchester population as a whole. I am minded that when you do come to vote, to vote for option 4.4 which would give us Stockport as the single service site and 4.4A would be my preferred choice.

Chair:- Thank you, Dr Alan Dow, Chair NHS Tameside & Glossop CCG

Alan Dow:- Thank you Chair, so on behalf of Tameside and Glossop and as a member of the committees in common, Greater Manchester wide. We started with a few considerations. Our local hospital was not to be a specialist site, but like all of the local non specialist hospitals will improve

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through the Healthier Together programme and that is something that we have seen unfold as the programme has developed. We did think that our specialists had a good idea to be a teaching hospital. It might be a foundation trust, it might be an international centre of excellence. What we heard from our public in the local consultation went along with that, in that they clearly chose quality over distance. We heard different view in Glossop, who said for their place, Stepping Hill was a good location. With the Healthier Together consultation, this fleshed out more details that there are those through Greater Manchester especially in the High Peak and other areas that use the Greater Manchester hospitals and so the populations that will be materially affected by the decisions we made within Greater Manchester. I was reminded of the clinical beginnings of the programme which was to reduce variation and in that regard and in the humanity of the situation I feel we have to consider those who are outside Greater Manchester in considering the humanitarian situation and actually taking the impact of the changes into account, particularly that of the people that will be most affected in the High Peak. Stepping Hill Hospital working to the Greater Manchester Healthier Together Standards could be a key piece of the jigsaw in reducing clinical variation both within and beyond Greater Manchester. The local providers outlined a statement to that effect. Stepping Hill Hospital is therefore the site that we would favour which would best address the clinical need and save the most lives.

Chair:- Thank you, Dr Ranjit Gill, Chair NHS Stockport CCG.

Ranjit Gill:- Thank you, Healthier Together is about consistent delivery of excellence by hospitals, sadly not seen in the English NHS and not seen especially in Greater Manchester. As clinical commissioners in the last three years we have created Healthier Together to change this, but we must deal with the root causes of the reasons for the current performance and I think part of the consistently excellent outcomes is to make prevention central to how the NHS provides care. Our decision must help make sure that from now on we prevent people from coming to avoidable harm any more. No hospital in Greater Manchester, as we heard, now consistently provides either the minimum standards or the excellent care that people expect and need. Before any single service is set up we determined that they must meet the minimum standards the NHS already sets. Only then can we designate any hospital as a fourth site and for it to be finally approved. To help make sure this happens we have set both pre conditions and conditions when implementation happens. There is a connection to devolution in these conditions. In particular one of these conditions is about the regulation of Hospitals and that is one of the root causes of why we are where we are because there is an incomplete, less than effective regulation of hospitals, so one of our conditions is that in future, the regulation of Greater Manchester Hospitals through the devolution changes were negotiated must be done jointly by Greater Manchester CCG’s and Monitor to address the current capacity and capability and leadership issues in our system. Employment for all future consultants’ appointments to single services to have at least a partial teaching hospital role is also a condition intended to deal with one of the root causes of why we are where we are. Only when these conditions can be met can we be sure that Healthier Together single services will deliver excellence every time a really sick person needs NHS care. Only with all our conditions met can I be confident that three years of hard work that we have gone through, the consultation we have gone through and so on, and everything we have heard, only then can I be confident. The criteria around travel and access is the key thing that leads me to conclude, I can be confident that a single service based in Stockport, working with Tameside and hopefully Macclesfield would deliver the consistent excellence that we at Stockport CCG require for the population of Stockport.

Chair:- Thank you, Julie Daines, Chief Financial Officer NHS Oldham CCG.

Julie Daines:- I would just like to confirm that I am here with the delegated authority of Oldham CCG today and I can be totally honest in that I have had no pre-conceptions in what decision I was going to be making in terms of the contribution to the Greater Manchester decision today when I walked in the door earlier on. I have considered the information that I have received today and also over the past few weeks and months. It is very clear that if I were making a decision on behalf of Oldham CCG alone and the population of Oldham CCG I would probably make a decision which would mean that potentially a combination of Pennine Acute hospitals and Tameside might be the best option for our CCG because that would mean that the majority of our population for Oldham would be in one single service. I am not here today to make a decision based on the Oldham population I am here, first of all, to make a decision based on the Greater Manchester population

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and also the neighbouring populations that utilise Greater Manchester services. I remind myself that I need to be strong about convictions that we have in Greater Manchester to improve our current health and performance across Greater Manchester through whichever single service we decide on today. I am also reminded that we have received proposals from the providers of Greater Manchester and Greater Manchester Hospitals as to how they will work together under those single service scenarios. Based on the evidence that we have heard today which has been summarised for all of us here today, the evidence indicates that Stepping Hill Hospital should be the core site based in Stockport. That option would mean the best NPV, has the highest NPV, best capital, lowest capital spend, no differentiation on quality and standards across the hospital options that we are choosing between today and also would address the information and the concern of High Peak, Derbyshire and East Cheshire in terms of travel and access and on behalf of Oldham CCG I have choose option 4.4a.

Chair:- Thank you, Stuart North, Chief Officer NHS Bury CCG.

Stuart North:- It is difficult to add anything to what my colleagues have already said. I think to start I agree that what I am most heartened by is the commitment of colleagues and the implementation conditions because that is going to be critical for us to deliver the improvements to the standards at all hospitals which is the reason why we are delivering this Healthier Together initiative. For the reasons that have been identified earlier in particular as regards travel, I will be voting for option 4.4 and as regards collaboration issues and feedback from providers it will be the option 4.4A, thank you.

Chair:- Thank you. Well that has been a very thorough look into the various comments from all of the CCG’s who are voting and the surrounding affected areas. I will now ask our legal representative Christian Dingwall to advice the other members of the committee on their legal duties. Christian.

Christian Dingwall - Thank you very much, the purpose of what I am about to say is to provide, especially for voting members, their responsibilities and duties in their decision making, but I think it is also to ensure that the public are informed about why and how the Committees in Common are proceeding in a particular way in their decision making. There are meeting in front of the public today, actually 12 committees because each CCG has appointed a committee and collectively these committees are known as the Committees in Common. Each of these committees has the same membership and meet simultaneously with a shared agenda and papers. Although there are 12 committees there is only going to be one decision that they take today because that decision will be on behalf of all 12 committees. The advantage that the members of the committees and indeed the public is that there is only 1 meeting, you do not have to sit through another 11 meetings. As members of the committees, each of the voting members has been duly authorised by his or her, so to speak, home CCG to be a member of all 12 committees and therefore when making this decision this is a decision on behalf of all 12 CCG’s. In making your decisions each of the voting members has to comply with the statutory duties of all 12 CCG’s. As a number of the voting members has already mentioned they are not simply making a decision on behalf of their home CCG, but on behalf of all 12 CCG’s and therefore to be aware of the statutory duties of all of the CCG’s. So what are these statutory duties that you must be aware of? An extremely important duty is the public sector equality duty as it applies across Greater Manchester. You must consider the public sector equality duty in respect of each of the CCG’s. You have been given a very considerable amount of information which enables you to do that on behalf of all 12 CCG’s. Many of your duties are specific duties under the National Health Service Act 2006. You have a duty to promote the NHS Constitution, you have a duty as to effectiveness and efficiency, a duty as to improvement of the quality of services, you have a duty in relation to the quality of primary care services, you have a duty as regards the reduction of inequalities, a duty to promote the involvement of patients, a duty as to patient choice, a duty to promote innovation, a duty in respect of research, a duty to promote education and training and a duty to promote integration. All of those are important matters for you to take account of and all of those are matters that are covered in the enormous amount of information before you. None of you can be mandated by your home CCG to vote in a particular way. Each of you has to make a decision that you come to on behalf of each of the 12 CCG’s and when you make your decision, you must make

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your decision on the information that is before you, that has been gathered for you by the programme team and as the information in the papers that has been prepared for this meeting and earlier meetings, but primarily this paperwork that is in front of you today. A really important consideration for you to bear in mind is that you are commissioners on behalf of the populations, collective populations of Greater Manchester, but nevertheless you must take account of the impact of your decision on other people who may be affected by your decision making and that has been considered in particular in relation to the people of North Derbyshire and East Cheshire. So, although you are not commissioning services on behalf of the population of North Derbyshire and East Cheshire you must nevertheless take account of the impact of your decision on that part of the population. If anybody has any questions about this I would be, if the voting members have any questions about this I would be happy to answer them, but otherwise I will leave it there Chair.

Chair:- Is that clear are there any questions? I think it was fairly clear, thank you. So now as indicated Ian Williamson, Chief Officer GM Health & Social Care Devolution SRO HT Programme, is the Senior Responsible Officer for the programme who will summarise what we have heard for the last three quarters of an hour.

Ian Williamson:- Thank you very much indeed I am going now to provide a brief summary of the members comments and propose a decision to be voted upon. It is important that there is, and is seen to be a clear set of reasons for the decisions that are made today. As I said at 2 o’clock, it seems like a long time ago, this is not a judgement of existing care at our hospitals. Great care is provided in all hospitals, although as it has been stated earlier by Dr Brookes none of those hospitals are currently achieving all of the standards of best care that we need for our patients. This decision is about the best geographical location of services to serve the populations best. With that said instead of winners and losers we believe that the whole population will be winners because this will result in saving 300 lives per year. As Christian Dingwall our legal advisor has confirmed that basically members are making decisions taking into account the whole population of Greater Manchester and also patients from outside Greater Manchester who use Greater Manchester hospitals. So the large weight of evidence that has been considered today and the preceding three and a half years since the programme began. Public consultation resulted in nearly 30,000 responses. We have listened to patients, the public and our partners. We have taken action as a result of that listening, for example, in relation to the needs of vulnerable patients and groups, for example, in relation to populations outside Greater Manchester and for example in the language that we use to describe the services that will be provided in hospitals in the future. The programme has also taken independent technical advice about the proposals. We have been scrutinised by NHS England, both before the consultation and after consultation in terms of our clinical proposals and the financial investment from this new way of working. NHS England have given their full assurance to this work. The programme genuinely combines improvement in primary care with community based care and hospital care, colleagues earlier today have confirmed their commitment to this in the meeting. Overall this programme has and retains the support of, the whole of Greater Manchester Health and Social Care Leadership Community covering hospitals, councils, as well as Clinical Commissioning Groups. We have discussed and we will be agreeing further conditions which are crucial to the implementation to ensure these improvements for patients are achieved. Decisions today are not the end of the process, we will not save the lives that we are aiming to without excellent implementation and that implementation requires us to hold ourselves and our providers to account based on the conditions that are being discussed. The case for change describes how 300 lives a year can be saved through these improvements and changes to hospital care. 35 extra senior hospital doctors will be employed to ensure that we achieve our outcomes and that standards rise for the whole population. So, the main criteria over which decisions will be made. I will particularly focus on those and whether the information clearly differentiates between the options as described by colleagues in the last few minutes. In terms of quality and safety, we expect standards of care that will be the best in the country and that none of our hospitals currently meet in total. In terms of transition we have considered issues of workforce, time to deliver and independent advice on co-dependencies. Our hospital providers have made clear that we will implement the changes best by focussing the new

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single services on the North West part of Greater Manchester, the North East part of Greater Manchester, the Central South part of Greater Manchester and South East part of Greater Manchester. That configuration will give us four single services of approximately the same population size. In terms of affordability and value for money we know that the configurations in the South of Greater Manchester offer the best value for money for the tax payer in overall financial terms and generally the lowest capital costs. In travel and access we know that the populations of North Derbyshire and East Cheshire who currently use our hospitals will only be able to reach the 45 minute emergency travel standard if they are served by Stepping Hill Hospital in Stockport. So on the basis of the evidence and of what has been said today I propose that we move to a vote on option 4.4A, which identifies Stepping Hill Hospital in Stockport as the fourth site providing high risk general surgery and creates 4 single services throughout Greater Manchester with the following geography and I will now explain the geography associated with option 4.4A. It will involve Wigan and Bolton hospitals working with Salford Hospital. It will involve North Manchester, Rochdale and Bury hospitals working with Oldham Hospital. It will involve Tameside Hospital working with Stockport hospital recognising the populations of North Derbyshire and East Cheshire which use Greater Manchester and it will involve South Manchester and Trafford Hospitals working with Central Manchester Hospital. Chair I request that you put option 4.4A to the vote.

Chair:- The proposal is that the Healthier Together committee resolve to select option 4.4A. Could I have a show of hands for all in favour voting members.


Category 1 Decision

Following these comments from each of the 12 voting members, a public vote was taken by a show of hands on the Category 1 decision: to select option 4.4A as the fourth site. The Committees in Common voted unanimously in favour of option 4.4a

4. Implementation Conditions

Leila Williams handed out hard copies of the paper that had been updated [I suggest that the minutes set out the implementation conditions set out in Leila’s paper] and asked if there were any additions that members wanted to put forward. Tim Dalton suggested that training as well as lay and patient representation should be made explicit. Ian Williamson agreed and suggested the detail around the additional content be worked on and brought back to the August meeting. Wirin Bhatiani supported the conditions but asked to expand on condition 8 to work over a longer period of time. Leila Williams outlined the additions that would be made to the paper. Condition 6 Formation of Single Service Research Hubs : There will be a description about training of the future workforce. Condition 7 Creation of GM implementation Governance : It will be made explicit that lay & patient representation will be at the forefront of the governance. Condition 8 Formation of a CCG and Regulatory Body Alliance to support implementation: Will seek to work on a long term basis with the healthcare regulators to ensure Healthier Together is fully achieved.

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The Chair proposed that the Committees in Common resolved to endorse the work on implementation and the implementation conditions and all 12 voting members endorsed this by show of hands.


5. NHS England Assurance Update

Leila Williams provided a verbal update that the programme has been subject to NHS England assurance process before, during and post consultation. The external assurance was completed a week ago with members of the programme presenting at the NHS England National Investment Committee. Assurance can be given to CiC that all the issues raised by NHS England have been answered including the issues around clinical co-dependencies. The detailed reports have been shared with CiC members. The Chair thanked Leila Williams for the verbal report.


nil

6. Proposed agenda for August meeting

The proposed agenda was agreed with an additional item being Implementation Conditions.


nil

7. Any Other Business

No further business was raised.


Nil

8. Public Questions

The Chair welcomed questions from members of the public. Paul Chandler from Monitor sought clarification on the Trusts who have not been designated specialists for general surgery will not necessarily be inhibited in developing further specialist services as a result of those decisions? Ian Williamson welcomed the presence and attendance of Monitor today and reiterated the views of the meeting earlier that we look forward very much to working with Monitor. In particular relation to the question it is a specialist question that requires detailed answer but will provide an answer now

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accepting the limitations of the answer. Healthier Together has a number of services which are within scope that have been decided upon today. The scope of Healthier Together does not include a wide range of other specialties that you refer to and therefore not directly affected by the decisions made today. Elizabeth Collins wanted to clarify as a member of the public – each voting member referred to there being no differential features between each of the options in terms of quality and safety – want to understand that correctly – does this mean there is nothing between each of the options in terms of quality and safety? Paul Bishop explained that where no difference was stated this is due to commissioning and implementing a new model of care so there is no basis on existing practice to compare that against, so if introducing a new model of care across all hospitals and increasing standards in all the hospitals then there is no difference between the options. David from Trafford – Following on from the previous question and after listening carefully it does seem the logic of the choice does rest on some clear assumptions and that there is no differentiation on quality and safety because there is an assumption being made that it will all be implemented as expected without side effects. So the question is is that a reasonable assumption to make or is there something to be factored in about those that are much closer now versus those that are much further away now to those standards and the risk inherent in making that assumption? The second linked assumption is the travel one, and want confirmation that those outside the GM boundary is it the case that the travel standards cannot be met by those by travelling to hospitals outside the GM boundary. Alex Heritage said there was further discussion around the implementation conditions and further work around the sequencing and the order in which this will be implemented, the CiC will continue to meet to debate and discuss the ordering of that and against those conditions will start to understand the workforce considerations in more detail, the capital programme and that will help decide which order and will produce a very clear communicated plan. In terms of the travel and access it has been made quite clear to members of those CCG’s that the population you referred to in Eastern Cheshire and North Derbyshire currently use GM hospitals and is very unlikely that the ambulance services of NWAS or EMAS would take those patients to a hospital in the other direction most notably Chesterfield, Sheffield or Stafford so the working assumption endorsed today that you have heard means we need to carefully consider that population that currently use GM services and will continue to use GM services. Joanne Harding – Trafford Councillor, Trafford residents have recently been through substantial changes to their hospital and loss of A&E Services from midnight to 8am and UHSM is actually the hospital that was specified as being the hospital that would help to pick up and take up the slack and we know that UHSM has been under incredible pressure in dealing with some of these extra numbers. What commitment will the CiC give in ensuring that UHSM retains the vital services that it provides for residents, the excellent tertiary services that it provides, and I think we all know that when changes are made to specialist surgery other services may well go such as the diagnostics, some of the clinical staff may well go and when the services are lost it inevitably does become a down grade of a hospital – what commitment will this committee give to ensure that UHSM retains these specialist services to ensure it provides excellent services to the residents of Trafford and Greater Manchester. Leila Williams explained that three independent clinical reviews have been conducted on the issues that you rightly raise and has been raised by staff at a number of hospitals. There are specialist services at nearly all hospitals in GM the detail can be found in the latest report from the Northern Clinical Senate and concluded there was no material impact on specialized services at any of our hospitals. Nigel Guest thanked Joanne Harding for the comments and understood the concerns about Trafford and in particular the work done in terms of the movement of some of the activity to UHSM. We have a commitment as commissioners in terms of maintaining high quality services at UHSM and Trafford commission approximately half of our activity there and want to maintain an excellent

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A&E Service which we know will expand through building work and will want to work with UHSM and its new partner to ensure services are protected at UHSM and have the most appropriate configuration of services between the two. Andy – Charge Nurse UHSM – of the 18 services identified by Healthier Together requiring support from emergency on site general surgical support – UHSM provides all 18 including some services that serve the whole of the North West – I respect the decision made today and appreciate it has been made in the best interests of the patients of GM but am concerned about how these potential decisions made today will impact the residents of the North West not just GM and with UHSM not being chosen as a specialist site my concern is that it will affect the ability to maintain these tertiary services in the future. Leila Williams – The CiC have heard evidence to say there is no reason why those 18 specialties cannot continue and it is important that as we work through implementation UHSM will clearly need a higher level of general surgical support than some of our other hospitals that have fewer specialist services and will need to work through that detail in terms of the implementation plan. There is a commitment to ensure that all our specialised services, those at UHSM, WWL, Fairfield and the way we provide integrated social care at Tameside – all of those are important issues for the CiC to continue to retain those at the level of standards they are currently provided. Nigel Guest added that he was aware as we all are of a requirement for having acute general surgical services to support the specialised services and he was assured after having conversations that appropriate provision would be made for those and not placing anyone at risk. David Jones – Consultant General Surgeon UHSM – Member of the Clinical Advisory Group for Healthier Together and happy to hear the last two pieces of re-assurance as he was a little surprised on the quality and safety as he understood the co-dependent services at UHSM were highly dependent on specialised general surgery and would just like to see those re-assurances that provision for highly specialised general surgery is there for the co-dependent patients i.e. heart patients? Leila Williams stated that there was complexity in the implementation and think what has become clear as the CiC has discussed the issue this afternoon – is why there are still 8 conditions around the implementation, the role of the teaching hospitals, the need for joint appointments and the way we wish our providers to work flexibly for the optimum benefit of patients across GM. Ian Barker – Stockport NHS Watch – possibly significant change coming late in the day for Healthier Together is GM Devolution – has this been considered in part and will it affect the programme and does anyone know when the public will be able to see what is happening in Devo Manc meetings? Ian Williamson – devolution has not been taken into account for the Healthier Together programme – the decision making for the programme is based on evidence that has been collected and it is true and has been referred to that we believe the devolution agreement gives greater opportunity for example to work more closely with regulators to ensure we have the best chance of implementation. More than happy to pick up separately around more information on devolution and appreciate that it has been moving very fast. David – Trafford – following up on the assurances and commitments and conditions – we do have in Trafford some experience of these and is not a happy story so would like to learn from past mistakes and suggest that if those assurances and commitments are written in paper and could be made the personal responsibility of the most senior decision makers with regular audit and made visibly public so the public may have a higher regard for them and do not feel they are inadequate or not worth the paper they are written on. Nigel Guest stated he was absolutely sure that each of the CiC members round the table will ensure the conditions that apply to the New Health Deal will be monitored and will be shared in terms of their performance management.

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There were no further questions and the Chair thanked all for attending and closed the meeting.

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REPORT TITLE:

Chairperson’s Report – Audit Committee


Function as an organisation that consistently delivers its statutory duties

REPORT AUTHOR:

Maurice Smith

PRESENTED BY:

Maurice Smith


Governing Body to note comments

EXECUTIVE SUMMARY A narrative report of the Audit Committee held on 16 September 2015.


As per agreed actions section.

EQUALITY AND DIVERSITY: Confirmed that any changes to service or procedure introduced as a result of

this report do not impact adversely on any of the protected groups covered by the Equality Act 2010.

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CHAIRPERSON’S REPORT

Chairperson’s Name Maurice Smith (Chair)

Committee Name Audit Committee

Date of Meeting Wednesday 16 September 2015

Name of Receiving Committee Governing Body

Date of Receiving Committee Meeting 27 October 2015

Officer Lead Mike Tate

The top 3 risks identified during the meeting & initials of lead with designated responsibility

1.

2.

3.

Attendance at the meeting#: Acceptable: some apologies.

Was the agenda fit for purpose and reflective of the committees Terms of Reference?

Yes

Narrative report outlining the key issues of the meeting

MIAA published two judgemental reports:

• Medicines Management – significant assurance; once medium recommendation;

• Raising Concerns – significant assurance – three medium recommendations. There are no ‘limited assurance’ reports. Implementation of previous actions is on schedule. It was resolved not to tender for Internal Audit services this year. External Audit published the Annual Audit letter. Fees for External Audit were agreed. Anti-fraud services gap report identified some gaps which are being filled. Spending above £50,000 on consultancy must be reported and approved. A tender waiver for the Community Link work programme was approved. In the light of the Financial Control Environment assessment it was resolved to appoint an independent, qualified accountant Member to the Committee and amend the Terms of Reference accordingly.

Agreed actions from the Meeting

Name of lead with designated responsibility

for the action/s 5.3 MIAA Insight

CH to send the guidance ‘Improving systems for Cost Recovery for Overseas Visitors’ to Grant Thornton for review and comment.

Craig Hall

# Excellent (well attended) Acceptable (some apologies) Unacceptable (not quorate)

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5.6 Future of Internal Audit Services JA to obtain benchmarking data from other CCGs to ensure MIAA are providing good value for money action this. Financial Control Environment Assessment (FCEA) MTh to clarify whether the Local Audit and Accountability Act 2014 enables a national body to make appointments and that the panel has to be independent of the Audit Committee.

Julie Ashurst

Mike Thomas

11.2 Consultancy Spending Controls MTa to speak to Trish Anderson re MS request to have sight of the lower value consultancy spend projects for information only.

Mike Tate

Chairperson’s Additional Comments

None.

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MEETING: GOVERNING BODY Item Number: 10.3 DATE: 27 October 2015

REPORT TITLE:

Chairperson’s Report - Clinical Governance Committee (2 September 2015)


CO 2: Commissioning high quality services, which reflect the populations' needs, delivering outcomes and patient experience within the resources available.

CO 3: Function as an effective commissioning organisation that puts patients first.

CO 4: Function as an organisation that consistently delivers its statutory duties and participates fully in Greater Manchester Devolution.

REPORT AUTHOR:

Dr A Atrey

PRESENTED BY:

Dr A Atrey


The Governing Body is asked to receive and note the report

EXECUTIVE SUMMARY Clinical Governance reporting is how the organisation will provide assurances on the safety and quality of services commissioned on behalf of the population of the Wigan Borough and in doing so will also seek to drive improvements in quality. The aim of this report is to provide the Wigan Borough Clinical Commissioning Group Governing Body with an overview of progress in the areas of:

� Quality and Safety; � Clinical Effectiveness; and � Patient Experience and Public Involvement


Any specific actions are noted within the report



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Chairperson’s Name Dr A Atrey

Committee Name Clinical Governance Committee

Date of Meeting 2 September 2015

Name of Receiving Committee Clinical Governance Committee

Date of Receiving Committee Meeting 7 October 2015 (Clinical Governance Committee) 27 October 2015 (Governing Body) 2 December 2015 (Audit Committee)

Officer Lead J Southworth, Director of Quality and Safety

The top 3 issues identified during the meeting & initials of lead with designated responsibility

1.

Winterbourne Update Report: WBCCG and the Local Authority continue to oversee the resettlement of patients on the Winterbourne View register. The Committee was informed that NHSE had held a meeting with WBCCG to discuss the ‘slow progress’ against planned discharge dates for Wigan patients. There had been a lack of engagement by the Local Authority, however, this is now being addressed and there is engagement at a senior level. Any changes to discharge dates will be reported to the Clinical Governance Committee. An update will be provided to the October Clinical Governance Committee meeting.

KG

2.

Westwood Lodge Nursing Centre – Care Quality Commission (CQC) Inspection Visits Update Position (12 August 2015): WWLFT commissions 20 Step Down beds at Westwood Lodge Nursing Centre to facilitate and support the discharge planning process, maintain patient flows and to prevent delayed transfers of care. Westwood Lodge is currently being monitored by the CQC following a report published on 11 May 2015. The Provider has produced an improvement plan to address the areas of concern which were deemed ‘inadequate’ and ‘requiring improvement’. This is also being monitored by Wigan Council and WWLFT. The CCG Care Home Quality Assurance Lead will visit Westwood Lodge on a bi-weekly basis and a further meeting will be held with the Council, WWLFT and the CCG to agree a collective approach to the ongoing monitoring of Westwood Lodge. It was agreed that the CCG Quality Team should discuss with WWLFT at the next QSSG meeting, the outcome of their performance monitoring at Westwood Lodge.

SF/JW/PL

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3.

Midwifery Services WWLFT Midwifery Report inclusive of Kirkup Position Statement and Action Plan: The report detailed two external reviews relating to maternity services that had been commissioned by WWLFT, following a number of historical complaints and medico-legal cases. The findings of the first review resulted in the commissioning of a further review. The second review focused specifically on the culture and leadership of the unit. Professional mediation was undertaken and an event took place in February 2015. WWLFT felt that this was a successful process. WWLFT has reviewed the recommendations from the Kirkup Report and developed two action plans – one is linked to Kirkup and the other is linked to the mediation process. This is monitored internally through the WWLFT Executive Committee. This report will be updated for submission to the WWLFT Board before the end of the year. It will then be shared with the QSSG and the Clinical Governance Committee.

SF

Attendance at the meeting: Acceptable


Yes

Narrative Report Outlining the Key Issues of the Meeting

SAFETY Draft Provider Serious Incidents and Never Events (SINE) Dashboard Template: The Committee discussed and accepted the revised format for a more concise SINE dashboard template. Serious Incidents and Never Events (SINE) Dashboard (Position as at 31 August 2015): The Committee reviewed and noted the content of the report. Winterbourne Update Report: WBCCG and the Local Authority continue to oversee the resettlement of patients on the Winterbourne View register. The Committee was informed that NHSE had held a meeting with WBCCG to discuss the ‘slow progress’ against planned discharge dates for Wigan patients. There had been a lack of engagement by the Local Authority, however, this is now being addressed and there is engagement at a senior level. Any changes to discharge dates will be reported to the Clinical Governance Committee. An update will be provided to the October Clinical Governance Committee meeting. Midwifery Services WWLFT Midwifery Report inclusive of Kirkup Position Statement and Action Plan: The report detailed two external reviews relating to maternity services that had been commissioned by WWLFT, following a number of historical complaints and medico-legal cases. The findings of

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the first review resulted in the commissioning of a further review. The second review focused specifically on the culture and leadership of the unit. Professional mediation was undertaken and an event took place in February 2015. WWLFT felt that this was a successful process. WWLFT has reviewed the recommendations from the Kirkup Report and developed two action plans – one is linked to Kirkup and the other is linked to the mediation process. This is monitored internally through the WWLFT Executive Committee. This report will be updated for submission to the WWLFT Board before the end of the year. It will then be shared with the QSSG and the Clinical Governance Committee. NHS England Thematic Review of GM Maternity Services – QSG Return: Maternity services are under an increased level of scrutiny and the GM Quality Surveillance Group had requested all CCGs to complete a proforma relating to the maternity services which they commission. The return has been completed and details expected outcomes and best practice. Safeguarding Serious Case Review Update: Child C and Child D Briefing Paper: The Committee was provided with an overview of two Serious Case Reviews (SCRs) in respect of Child C and Child D. The Committee reviewed the recommendations and progress against actions. The WBCCG Safeguarding Team will continue to work towards completion of all WBCCG outstanding actions. In addition, it will also continue to monitor commissioned health providers against their outstanding SCR actions via QSSG meetings. CLINICAL EFFECTIVENESS 5BPFT QSSG Chairperson’s Report (9 July 2015): The following issues were highlighted:

• CQC Hospital Intelligent Monitoring Report and Action Plan: This document was published in June 2015 and 7 risks were identified, one of which was identified as an elevated risk. The Trust had responded to the report and the CQC will monitor progress. The action plan was received at the QSSG meeting and an update on implementation was requested.

• Self-Harm Presentation: Whilst areas identified for improvement and issues of concern are discussed at QSSG meetings, the CCG Quality Team also considered that it is important to recognise positive issues/good practice. One particular area that has seen considerable improvement is the reduction of self-harm incidents on Cavendish Unit. The Team delivered a presentation titled, ‘Addressing Team Dynamics as the Foundation for Self Improvement. Cavendish Ward Self Injury Pathway’. The presentation demonstrated that implementation of the self-harm pathway had led to a 70% reduction in the number of self-harm incidents. The Trust is widening this work in other areas.

• Staff Survey: The CCG Quality Team had noted that satisfaction rates had deteriorated from the previous 2013 survey undertaken in 2013. An action plan has been developed to address the issues raised in the survey and this will be followed up at the QSSG meeting to be held in November 2015.

BCHFT QSSG Chairperson’s Report (16 July 2015): The following issues were highlighted:

• Safeguarding Training Provision: Compliance against Level 1 remains below target. The BCHCT Chief Nurse has now taken over ownership of safeguarding and this will fall within her portfolio. This will hopefully result in improvements in training compliance.

• District Nurse Staffing: Significant concerns had previously been reported relating to District Nurse staffing levels for Wigan Borough. This has since shown significant improvement and a further 4.3 WTE staff have been recruited with start dates in July and August 2015. The position will continue to be monitored by the QSSG meeting and the CCG Contract Performance Group.

• Medicines Management: The audit of Safe and Secure Handling of Medicines was presented

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to the QSSG. The report was considered to be comprehensive, however, there were concerns regarding the action plan. The report appeared to be anonymised making it difficult to determine the specific Wigan position. It was reported that there has been a change to the structure at senior level at BCHFT and Medicines Management now falls within the remit of Neil Fisher, Medical Director. LS has written to the Medical Director to request that the report is not anonymised and a response is awaited.

Westwood Lodge Nursing Centre – Care Quality Commission (CQC) Inspection Visits Update Position (12 August 2015): WWLFT commissions 20 Step Down beds at Westwood Lodge Nursing Centre to facilitate and support the discharge planning process, maintain patient flows and to prevent delayed transfers of care. Westwood Lodge is currently being monitored by the CQC following a report published on 11 May 2015. The Provider has produced an improvement plan to address the areas of concern which were deemed ‘inadequate’ and ‘requiring improvement’. This is also being monitored by Wigan Council and WWLFT. The CCG Care Home Quality Assurance Lead will visit Westwood Lodge on a bi-weekly basis and a further meeting will be held with the Council, WWLFT and the CCG to agree a collaborative approach to the ongoing monitoring of Westwood Lodge. It was agreed that the CCG Quality Team should discuss with WWLFT at the next QSSG meeting, the outcome of their performance monitoring at Westwood Lodge and whether WWLFT has explored any other procurement options.

Performance Report (Month 4): The Performance Report was received and areas which had dipped below target were highlighted to the Committee.

Medicines Management Post Payment Verification of Minor Ailment Schemes (MAS): The Medicines Management Team wished to gain assurance that Community Pharmacies are working to the SLA/Service Specification for the MAS. Following discussion with MIAA, it was agreed that the CCG would visit 10% of Pharmacies. Visits were undertaken to 8 Pharmacies. It was found that PPV and Contract Monitoring of the MAS has provided overall assurance that Pharmacy contractors across Wigan Borough are operating and claiming for services appropriately. Some areas for improvement were identified and these were mainly related to ensuring that care is taken when inputting claims on to the web based system to ensure it accurately reflects the consultations that have taken place and the provision of leaflets/information being given to patients being treated for certain conditions on the scheme. Each Pharmacy visited has been provided with an action plan and has confirmed that they will progress the identified actions. PH England/Diabetes UK: Expression of Interest to be First Wave Sites for the NHS Diabetes Prevention Programme: Diabetes UK is requesting expressions of interest from CCGs and Local Authorities in becoming first wave sites for the Diabetes Prevention Programme. The programme is intended to refer people at high risk of Type 2 diabetes into an intensive lifestyle intervention programme. It was agreed that this would be discussed with the CCG Strategy and Collaboration Directorate to ascertain whether an expression of interest could be submitted. HCAI Dashboard: The following cases had been reported in July 2015:

• CCG: MRSA: 0, C.difficile: 3

• Acute (WWLFT): MRSA: 0, C.difficile: 1

• Other Organisations: MRSA: 0, C.difficile: 3

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The ongoing total for C.difficile cases is 33 against an objective of 100 cases. PATIENT/SERVICE USER/CARER/STAFF EXPERIENCE:

• Patient Story – WWLFT: The Committee received a patient story describing a service user’s experience of care at WWLFT.

Agreed actions from the Meeting Name of lead with designated responsibility for the action/s

As noted within the DRAFT minutes of the meeting and actions log

As noted within the DRAFT minutes of the meeting and actions log


5BP CQC monitoring identified 7 areas of risk one rated as elevated risk. Action plan to deal with these awaited. WWLFT commissioned 2 external reviews of maternity services. Clinical Governance Committee awaits update. Increase in Clostridium difficile occurrences – paper to next Committee to discuss.

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REPORT TITLE:

Chairperson’s Report from the Corporate Governance Committee.


Corporate Objective 4: Function as an organisation that consistently delivers its statutory duties and participates fully in Greater Manchester Devolution.

REPORT AUTHOR:

Tony Ellis

PRESENTED BY:

For information only


N/A

EXECUTIVE SUMMARY Chairman’s report from the Corporate Governance Committee Meeting held on Tuesday 8 September 2015.


None

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EQUALITY AND DIVERSITY: Confirmed that any changes to service or procedure introduced as a result of this report do not impact adversely on any of the protected groups covered by the Equality Act 2010.


Chairperson’s Name Tony Ellis

Committee Name Corporate Governance Committee

Date of Meeting 8 September 2015


Date of Receiving Committee Meeting

27 October 2015

Officer Lead Julie Southworth


Audit Committee membership to include accountant MT

Social Media Policy to include additional guidance to staff AM

Coroner/Ombudsman reports to include updates TC

Attendance at the meeting#: Acceptable


Yes


The minutes were agreed as true and accurate. No additional declarations of interest offered. HR Progress Update: The undermentioned key related issues were highlighted:

• In July the CCG say 3 new starters and one leaver. However the CCG’s turnover rate remains significantly below the national and Greater Manchester CCG average.

• During July and August 10 posts were advertised.

• The CCG welcomed 6 apprentices in September.

• Short term and long term sickness remains low.

• The Training Group identified 6 organisational competencies which will be subject to renewal in October 2015.

• There will also be an additional appointment of a non-executive independent accountant to sit on the Audit Committee.

• New Social Medical Employee Usage Policy and the updated Probationary Review Policy were presented for approval.


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The Committee received the report. Communications Update: Report was circulated highlighting both communications and engagement activities from the last 2 months as listed below:

• To raise awareness of the CCG and to provide a benchmark for performance indicators a half-day will be spent in Wigan and Leigh Town Centres speaking to members of the public.

• Choose Well/Winter Pressures Campaign.

• Facebook Campaign

• Frail and Elderly service redesign.

• Workplace Charter

• New Public and Patient Engagement Officer joined the CCG in July

• Patients’ Forum continues to meet.

• Work continues with the Voluntary and Community Sector.

• WBCCG has been successful in their application to work with NHS England and Macmillan Cancer support.

The Committee received the report. Information Governance Update: The meeting was briefed on the progress to-date. The Information Governance Work plan for 2015/16 was circulated for information. Information Governance Mandatory Training will be completed during the designed period in November. In addition to this there will also be ongoing training and assessment throughout the year. The Committee received the report. Business Informatics Update: The meeting was briefed on the IM&T services which are being supplied to the CCG and general practice locations. The report gives an update of the current situation with Primary Care IT as well as performance updates of North West CSU across IM&T and IT Projects. The Committee received the report. Governance Team Activity Report: Circulated for assurance. This report provides an update for the Committee on activity at the CCG, highlighting:

• Governing Body Assurance Framework (GBAF).

• Risk Management and Incident Reporting

• Equality and Diversity

• Emergency Preparedness, Resilience and Response (EPRR)

• Outbreak Planning

• MP Letters, Freedom of Information Requests and Complaints.

• HM Coroner/Ombudsman Reports. The Committee received the report. EPRR: WBCCG undertook a self-assessment against the NHS England Core Standards for EPRR. Following this self-assessment and in line with the definitions of compliance, WBCCG declared itself as demonstrating full compliance against the EPRR code.

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The Committee received the report. Incident Reporting Annual Report 2014/15: The Incident Reporting Annual Report for 2014/15, incorporating Health and Safety information and advice was circulated for information and consideration. It was requested that the title of the report be changed to Health and Safety and Incident Reporting Annual Report. The Committee received the report. Sustainable Management Progress Report: The CCG is charged with demonstrating a commitment to promoting environmental and social sustainability and to meet both legal and social responsibilities through our actions as a corporate body and commissioner. For 2015/16 the CCG will ensure that further staff education is delivered and ensure that the CCG Sustainable Development Action Plan is regularly reviewed and evaluated. The Committee received the report. Items for Information: The following minutes were circulated for information:

• Information Governance Forum Minutes.

• Information Governance Review Minutes

• Health Economy Resilience Group.

• Joint Local Health Resilience Partnership. The Committee received the minutes. No other business was raised.


Name of lead with designated responsibility for the action/s

Social Media Policy amendment to wording to strengthen 8.4 of the policy.

TC/MS/KB

Title of the Incident Reporting Annual Report to be changed to Health and Safety and Incident Reporting Annual Report.

TC


N/A

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MEETING: Governing Body Item Number: 10.5 DATE: 27/10/2015

REPORT TITLE:

Chairperson’s Report – Finance and Performance Committee


Function as an organisation that consistently delivers its statutory duties

REPORT AUTHOR:

Mohan Kumar

PRESENTED BY:

Mohan Kumar


Governing Body to note comments

EXECUTIVE SUMMARY A narrative report of the Finance and Performance meeting held on 21 September 2015.


None.



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C:\moderngov\Data\AgendaItemDocs\8\3\8\AI00018838\$m1flvtku.docx


Chairperson’s Name Mohan Kumar (Chair)

Committee Name Finance and Performance Committee

Date of Meeting Monday 21 September 2015

Name of Receiving Committee Governing Body Meeting

Date of Receiving Committee Meeting 27/10 2015

Officer Lead Mike Tate


1. Community Nursing and therapies Project – need clarity over SMART outcomes

JM

2. QIPP gap and long term strategy

All

3.

Attendance at the meeting: Quorate.


Yes.

Narrative report outlining the key issues of the meeting The September meeting opened with a solemn message about the sad passing of Dr Deepak Trivedi, our Governing Body member. The minutes from the previous meeting were approved. The Chair read through the conflict of interest policy and invited members to declare any. The meeting commenced with Craig Hall’s presentation on Financial control Environment submission. Financial Control Environment (FCEA) – final submission CH advised the Committee that the FCEA was submitted in two parts; the actual return and the self-assessment. The FCEA requires the CCG to have either a qualified Audit Chair or an independent member of the Audit Committee in order to be compliant with the requirements of the Local Audit and Accountability Act 2014. As a result WBCCG will appoint a further lay member to the Audit Committee as an independent member with a CCAB or CIMA qualification. They will be a full voting member and would only be required to attend Audit Committee and not the Governing Body. This decision has been agreed by the CO.

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The CCG was also requested by NHSE to complete a self-assessment of Wigan’s Financial Control Environment. Return and assessment submitted to NHSE. The Committee noted the submission.

i) Commissioning Intentions 2016/17 KG presented the report. The commissioning intentions will be issued to providers at the end of September 2015. These have been shared with all Directors of Finance within GM. No feedback or comments received. JT was concerned that while there is a lot of work around shifting services into Primary Care and community there needs to be a better strategy for reinvestment and workforce development to enable this transformation. KG advised that all details are backed up with detailed business cases that include this information .The Committee accepted the commissioning intentions and MK thanked KG and her team for the level of work done.

i) Outpatient Project business case Jennie Collins delivered the presentation. The Committee noted that this business case has been seen by CRG. CM asked what the timescales were.

JC advised that they are looking at early next financial year on a phased basis for clinical safety purposes.

JS raised concern that there may not be enough space in LIFT buildings. SLT recognised that lots of plans for hub and spoke and need to overlay all different services to ensure no duplication. The Chair outlined the need for a transformational redesign that takes into account the patient journey from presentation into primary care to further referral as only by enhancing the standards the thresholds of shared management plans the Outpatient redesign will be successful.

ii) Community nursing and therapies (verbal update)

JM provided an update on options. The Governing Body is to make a decision at the October meeting as to whether BCHT are in a position to undertake the redesign. If a decision is made against this then an alternative procurement option will be sought. It was decided to have a further discussion outside of this meeting between MK, JM and MT so as to ensure the savings declared can be extracted through the suggested options and to ensure there were fail safe mechanism that do not give the locus of control to external stakeholders that can result in incomplete outcomes. The meeting will ensure we have a standby approach where as commissioners we can issue contract cessation and variation by appropriate deadline to free the savings from duplication and non delivery of services. The Committee agreed that the deadline can be deferred to 31 October 2015.

Winterbourne View update on performance against discharge plan KG presented the report. NHSE has met with WBCCG to discuss the slow progress against planned discharge dates for Wigan. A series of high level actions have been implemented and Local Authority engagement in the programme has been established.

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There are currently 10 patients on the WV register with very complex needs. Progress will be monitored via the Winterbourne View Operational Group which will now meet on a monthly basis rather than every 6 weeks. Any revised discharge dates will now need to be agreed at executive level prior to submission to NHSE. Dates for sign-off in the diary for 12 October with Donna Hall and 13 October with Trish Anderson. Detailed Gant charts covering key actions are being developed for each individual on the register. Deadline for completion is 16 September. The Committee accepted the report. RAID evaluation presentation Dr Rafik Salama (RS) delivered the presentation. University of Chester have been commissioned to undertake the evaluation.

• Total net savings are 501 + 2332 bed days = 2833 bed days

• This saving is calculated over 5 months, so total savings average to 19 beds/day

• This totals to ~ £900,000 total savings over 5 months (£318 cost of bed/day)

• Birmingham City Hospital showed a minimum of 40 beds/day saving, other boroughs showed between 10 and 20 beds/day

Suggestions:

• Shifting the RAID team’s focus from the A&E into the Ward/MAU setting, would significantly improve the estimated savings.

• Front door screening especially for dementia, depression and delirium.

• Studying community pathways and support after acute hospital discharge KG informed the Committee that the CCG will fund during pilot phase then the Acute Trust is to fund after that. This is something the CCG needs to consider. MT suggested the CCG needs to look into how this will be contracted. CM mentioned that the CCG would need to be clear on the starting point. RAID investment is part of the Better Care Fund (BCF) as non-recurrent investment. MK thinks it would be useful for the locality teams to get involved in primary care element of RAID where the assessments happen through Primary care referrals and avoid A&E part of the journey where possible. Questions: MK asked if other RAID sites are comparable in terms of catchment area? RS was not sure but will find out. The Committee agreed to continue to fund RAID within the commissioning intentions with the caveat that the details on the finances will be worked up further by the Commissioned Services team. The monthly Finance, Performance, QIPP and Activity reports were received and highlights discussed. Estates update (verbal update) JS updated the Committee that the Local Authority is putting Ashton Town Hall up for sale. There is ongoing work towards utilization review to ensure space is utilised for service transformation.

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The Committee received the update.



Item 5.2 2016/17 Commissioning Intentions Outpatient Project business case SLT recognised that there are a lot of plans for hubs and spokes and need to overlay all the different services to ensure there is no duplication. JD to note for the October agenda: Mapping and overlaying on the estate to be brought back to the next meeting

Kim Godsman

Chairperson’s Additional Comments The Ongoing QIPP Gap needs to be addressed by brave commissioning decisions that balance quality improvements, reduce duplication and engage clinicians in data validation.

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REPORT TITLE:

Chairperson’s Report from the Service Design and Implementation Committee held on the 15 September 2015


All objectives are met.

REPORT AUTHOR:

Dr Pete Marwick

PRESENTED BY:

Dr Pete Marwick


Receive for information.

EXECUTIVE SUMMARY The Governing Body is requested to receive the Chairperson’s report of the Service Design and Implementation Committee meeting held on the 15 September 2015 for information.




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Draft Version 1/Chairpersonsreport/200812


Chairperson’s Name Dr Pete Marwick

Committee Name Service Design & Implementation Committee

Date of Meeting Tuesday 15 September 2015


Date of Receiving Committee Meeting

27 October 2015

Officer Lead Ian Kewley


1. Not applied during this meeting

Attendance at the meeting#: Acceptable


Yes.


1. The Committee was quorate (50% attendance following the May review of Terms of Reference) but only one GP (Chair) was able to attend the meeting. This frailty of the process was discussed and the Terms of Reference will be reviewed in October. On this occasion no significant decision items were affected. 2. It is exciting to see the second Tranche of the Strategic Plan take form within Commissioning Intentions. This is a very large quantity of service design and implementation which will take place at the same time as residual implementation activity from 2014/15. In addition to this, the health care transformation is only a part of the broader changes to the economy as part of the Locality Plan. Adapting to this hugely increased portfolio of work will challenge all of the CCG governance processes. It is reassuring that the Wigan Leaders joint Tactical Programme Board has pre-empted the change in tempo and conducted a stocktake of its agenda, scope and activity. 3. The Community Nursing and Therapies Service project is an interesting service transformation for the Borough. Not only are the services involved the heart of the community care model, but also the model of service provision and collaboration between providers is a ‘litmus test’ for the future direction of local health (and social) care. Although there is ongoing negotiation of the detail, providers are showing the right level of ambition and commitment. 4. The Committee discussed the process currently used to analyse regulations and form recommendations in relation to procurement. It was agreed that the process needed further detailed discussion to ensure that recommendations were appropriately developed.

Risk



N/A


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