Governing body meeting - 1 October, 2020

Derby and Derbyshire CCG Governing Body Meeting in Public
Held on 1st October 2020 via Microsoft Teams
CONFIRMED

Present

Dr Avi Bhatia AB Clinical Chair

Richard Chapman RCp Chief Finance Officer

Dr Chris Clayton CC Chief Executive Officer

Dr Ruth Cooper RC Governing Body GP

Jill Dentith JD Lay Member for Governance

Dr Robyn Dewis RD Acting Director of Public Health – Derby City Council

Dr Buk Dhadda BD Governing Body GP

Helen Dillistone HD Executive Director of Corporate Strategy and Delivery

Ian Gibbard IG Lay Member for Audit

Zara Jones ZJ Executive Director of Commissioning Operations

Dr Steven Lloyd SL Medical Director

Simon McCandlish SM Lay Member for Patient and Public Involvement

Andrew Middleton AM Lay Member for Finance

Dr Emma Pizzey EP Governing Body GP

Brigid Stacey BS Chief Nursing Officer

Dr Greg Strachan GS Governing Body GP

Dr Merryl Watkins MW Governing Body GP

Martin Whittle MWh Lay Member for Patient and Public Involvement

Apologies:

Dr Penny Blackwell PB Governing Body GP

Dr Bruce Braithwaite BB Secondary Care Consultant

Professor Ian Shaw IS Lay Member for Primary Care Commissioning

Dean Wallace DW Director of Public Health – Derbyshire County Council

In attendance:

Dawn Litchfield DL Executive Assistant to the Governing Body / Minute Taker

Suzanne Pickering SP Head of Governance

Sean Thornton ST Assistant Director of Communications and Engagement

GBP/2021/063: Welcome, Apologies & Quoracy

Dr Avi Bhatia (AB) welcomed members to the meeting.

Apologies were received as above.

It was confirmed that the meeting was quorate.

GBP/2021/064: Questions from members of the public

AB advised that no questions were received from members of the public.

GBP/2021/ 065: Declarations of Interest

AB reminded committee members and visiting delegates of their obligation to declare any interests that they may have on any issues arising at Committee meetings which might conflict with the business of the CCG.

Declarations declared by members of the Governing Body are listed in the CCG’s Register of Interests and included with the meeting papers. The Register is also available either via the Executive Assistant to the Governing Body or the CCG website at the following link: www.derbyandderbyshireccg.nhs.uk.

No further declarations of interest were made and no changes were requested to the Register of Interests.

GBP/2021/ 066: Chair’s Report

AB provided a written report, a copy of which was circulated with the papers; the report was taken as read.

The Governing Body NOTED the contents of the report

GBP/2021/ 067: Chief Officer’s Report

Dr Chris Clayton (CC) provided a written report, a copy of which was circulated with the papers. The paper was taken as read and the following points of note were made:

Section 1 related particularly to the system response to the COVID-19 pandemic. Statements were made by the Prime Minister, the Chief Medical Officer and the Chief Scientific Officer last week explaining the gravity of the situation of the recent surge in COVID-19 cases, both locally and nationally, and the speed at which they must be responded to as a nation and individually. The Derbyshire Health and Social Care System continues to meet together 3 times weekly, with an option to increase the meeting frequency if required. There are several challenges currently being worked through including Winter Planning, and the promotion of flu vaccinations for vulnerable groups. Also of importance are our restoration and recovery programmes and the necessity to restore services through our Phase 3 response; the importance of restoring services and managing them as effectively as possible in order to improve the current waiting times was highlighted. CC quoted the message from the government advisers that “this is not someone else’s problem, it is all of our problem”; not one person or agency can respond to all of the challenges.

Section 2 provided details of how CC has filled his time; this clearly demonstrates continued partnership working across the System in response to the COVID-19 pandemic and developing the Integrated Care System (ICS) work, which CC has undertaken on behalf of the CCG.

Section 3 provided details of national developments, research and reports. CC highlighted the NHS COVID-19 app which has been

launched across England and Wales, and urged people to download it to help control the spread of coronavirus and protect themselves and their loved ones as case numbers rise.

Section 4 provided details of local news updates for Derbyshire which included testing information and details of the Derbyshire Dialogue public engagement event dates and topics.

The Governing Body NOTED the contents of the report

GBP/2021/ 068: The third phase response to COVID-19 – Joined up Care Derbyshire’s plan

On 31st July 2020, Simon Stevens and Amanda Pritchard detailed the objectives for the third phase of the NHS’ response to COVID-19. Zara Jones (ZJ) provided a summary of the Derbyshire response to the priorities of the next phase between September 2020 and March 2021. These priorities are to:

1. Accelerate the return of non-COVID-19 health services, making full use of the capacity available in the window of opportunity between now and winter

2. Preparation for winter alongside possible COVID-19 resurgence

3. Doing the above in a way that takes account of lessons learnt during the first COVID-19 peak, locks in beneficial changes, and explicitly tackles fundamental challenges including support for our staff, action on inequalities and prevention.

These priorities set out clear directives and deliverables for each system in taking forward the recovery work and the response to winter. Despite the ongoing challenges of restoring services, whilst also remaining vigilant of COVID-19 demand, a marked increase in delivery of NHS activity is anticipated in the next phase, compared to the first two phases. Being able to retain the key benefits and transformation seen over the last few months is key to operational working going forward.

A response to the National People Plan is being developed and will ensure that all staff are supported during what is going to be a very challenging period.

A framework for assessing the health inequality impacts of service restoration has been established, with leadership from all health and social care stakeholders, in order to ensure an effective response to the health inequality issues faced across Derby and Derbyshire.

A much improved position is now being demonstrated for planned care, with 85 to 90% of pre-COVID-19 activity levels restored. There is a clear focus on the long waiting lists that have built up during the pandemic; it is hoped that this backlog will be significantly reduced over the next few months through the positive work being undertaken.

Cancer care is another key area of work where continued efforts are being made to reduce the number of patients waiting more than 62 days for their first treatment. There is a much stronger positon now that the

screening programme has been restarted. More referrals are now being received and more patients are accessing care and treatment; the expected trajectories are forecast to be met.

The CCG aims to deliver the terms of the Mental Health Investment Standard in full this year, meeting all the key targets. IAPT services will be fully resumed. The 24/7 crisis helplines for all ages, established locally during the pandemic, will be retained. The CCG will continue to seek local psychiatric inpatient care closer to home.

Both primary and community care providers will be offering support to care homes in Derby and Derbyshire with enhanced clinical care being provided. A significantly expanded seasonal flu vaccination programme will be delivered this winter. Non-face-to-face care will be provided across all care settings, where clinically appropriate, using the digital methods deployed during the first phase of the pandemic; however, if patients do need to see a clinician face-to-face, the required capacity will be implemented over the winter period.

The CCG is in receipt of capital monies to be used to help Acute Trusts expand the capacity of their Emergency Departments (ED) in order to help better manage ED attendance volumes, whilst also maintaining social distancing and Infection Prevention and Control Measures. The CCG is also working with its partner organisations on initiatives such as ‘see and treat’ which result in less conveyances to hospital, and 111 First which will help patients to be managed in the most appropriate care setting and reduce ED attendances.

Any potential risks are being dealt with through the strong leadership of the Derbyshire system. Each CEO is heading up a particular Programme Board and, for any risks that do materialise mitigations are being set out in a timely manner in order to respond to the challenges faced.

Jill Dentith (JD) enquired how messages are being communicated with the local population on how to access services, and whether these communications are effective and getting through. ZJ responded that the Communications Team is working on a public-friendly set of messages for the Winter Plan and what the public need to do in order to help deliver it effectively. Multimedia messages are being used to convey the details in a clear manner through less technical terminology.

Andrew Middleton (AM) commented that upon reading through the list of initiatives he was repeatedly in awe of the grasp of the teams, but was unsure that this could all be achieved in the required timescales. He enquired if the public are signed up to 111 First and other alternatives to EDs for the treatment of low complexity, urgent issues. ZJ advised that 111 First is a national initiative that has been worked through with different systems across the country and is expected to be rolled out rapidly. It is a key demand management initiative that has been heavily researched both clinically and operationally. There is a carefully managed structure, linked to the A&E Delivery Board, to roll it out effectively in Derbyshire. DHU is signed up to it and is currently looking into the requirements to effectively deliver it. A Communications and Engagement Programme will be deployed to promote the alternatives available to A&E. AM suggested that the communications element should articulate that people are able to get

their concerns addressed without having a 6 hour wait in an ED.

Dr Steve Lloyd (SL) stated that, from a primary care perspective, 467k GP appointments were offered in July 2020; this is 90% of the July 2019 figure. 53% of these were face-to-face and 49% of patients were given same day appointments; this has further improved in August and September whilst operating within the infection control guidelines. Significant messages are being conveyed to the public that General Practices are open for business as usual.

Dr Merryl Watkins (MW) highlighted the fact that there is a need to reach out to those people who would normally walk into surgeries to make an appointment and who are not accessing digital systems for various reasons. There is a need to ensure that the new approaches are being adopted; this should be kept in mind as situations change.

Dr Buk Dhadda (BD) considered this to be an ambitious plan to the Phase 3 response. A key message is that the public need to be aware that the NHS is open for non-COVID-19 related illnesses.

The Governing Body NOTED the Joined up Care Derbyshire’s plan to meet the terms of the third phase of the NHS’ response to COVID-19

GBP/2021/ 069: National Rehabilitation Centre Update

ZJ advised that, further to discussions held at the last meeting, a response has been provided by DDCCG to the public consultation led by Nottingham and Nottinghamshire CCG (as the lead commissioner) on the development of the NHS Rehabilitation Centre. A copy of the response was provided for information.

Whilst in principle the CCG is supportive of the development, a number of issues have been raised as part of the consultation process, specifically:

The travel time for patients and carers from across Derby and Derbyshire is potentially understated.

There is some uncertainty about the wrap around services and impact on the community offer that would need to follow patients who are discharged from the new service at the NHSRC.

Seeking more information on the specifics of the impact assessment on the Kings Lodge service – with a particular analysis of the risk that staff could be ‘pulled’ to the new development, thus creating a series of unintended consequences for the services currently provided.

There are potential equity of care issues for patients who receive their rehabilitative care at the NHSRC versus the Kings Lodge site; fundamentally, it is unclear at this stage as to the criteria that would guide patients being referred to the NHSRC versus Kings Lodge.

Seeking greater clarity and further assurances on the cost neutrality of this development for all health systems within the East Midlands, with specific information required on the assumptions which underpin the length of stay and non-elective admission efficiencies that have been applied for Derby and Derbyshire demand.

Immediate next steps include:

Validating the financial impact assumptions with the NHSRC project team

Working with the NHSRC project team to respond to the specific issues raised

An update will be provided once this further information is received.

The Governing Body NOTED the CCG’s response to the Nottingham and Nottinghamshire CCG’s consultation on the development of the NHS Rehabilitation Centre

GBP/2021/ 070: Finance Report – Month 5

Richard Chapman (RCp) presented the Month 5 Finance Report. The

following points of note were made:

There is a temporary financial regime in place within the CCG for the 6 month period 1st April to 30th September 2020.

At month 5 the year to date overspend is £7.300m; this is driven by

£6.6m COVID-19 expenditure.

The forecast overspend for the 6 month period is £12.986m.

Non-recurrent allocations have been received to cover months 1 to 4 COVID-19 related costs. Other non-recurrent (Top-up) allocations of have been received to fund the YTD variances reported in months 1 to 4.

Allocations will be adjusted non-recurrently to reflect “expected expenditure” during this period. All CCGs are expected to breakeven for the period 1st April to 30th September 2020.

It is anticipated that further allocations will be received by the CCG in recognition of material expenditure contained within the month 5 position which is not yet funded.

NHSE/I recognised that the current 6 month allocations were calculated hurriedly and may be incomplete. The CCG identified 2 areas in which it believes errors were made, and has notified NHSE/I accordingly; these are:

Running cost allocations were based on an 11.8% reduction in the previous year’s outturn when they should have been based on the previous year’s allocation. The CCG had already prepared for the anticipated reduction in allocation and its 2019-20 outturn was lower than the previous year’s allocation. This error has reduced the 2020-21 allocation by 11.8% from where it should be.

The calculation appears not to have adjusted for the fact that

£7.7m of QIPP delivered in the last financial year was identified as non-recurrent.

These allocation shortfalls will have a contributory part year impact in the top up allocations received but it appears unlikely now that the allocations will be corrected; rather, the CCG will receive a “top-up” allocation which will bring it to breakeven for the period.

RCp updated that the position is moving very quickly at the moment. Yesterday details of service development funding was received for the remainder of the financial year however there is a lack of clarity on the COVID-19 costs, and costs for additional 111 activity. This has been raised as a system query, and system partners are currently assessing what this means in order to respond before the submission deadline in

October. The system is working more coherently than ever before to establish principles to hold itself to account moving forward.

The Governing Body NOTED:

The month 5 year to date and forecast positions

The temporary financial regime in place

The scenario model showing ongoing work in respect of full year outturn positions

The highlighted risks and mitigations

GBP/2021/071: Finance Committee Assurance Report and Annual Report – September, 2020

Andrew Middleton (AM) provided a verbal update following the Finance Committee meeting held on 24th September 2020. The following points of note were made:

RCp is faithful in his representation of this uncertain position.

The strengths need to be taken from this uncertain environment.

The Finance Team in on top of all issues as far as they can be and has got a good grip on the knowns and unknowns.

As ZJ has already indicated, there have been gains out of this crisis, the best features of which need to be retained, including the improved system wide working; there is now a very positive willingness to work together.

The Governing Body was reminded that the CCG continues to pay its suppliers on time.

The future system wide way of working will bring with it a system control total for next year.

This is a difficult and challenging year but the CCG has good teams which are seizing the positives from the transformation and challenges.

The Governing Body NOTED the contents of these reports for

assurance purposes

GBP/2021/072: Audit Committee Assurance Report and Annual Report – September, 2020

Ian Gibbard (IG) presented the Audit Committee Assurance Report for the meeting held on 17th September 2020. The following points of note were made:

The receipt of the annual audit letter from KPMG was noted; the letter summarised the key message on the review of the ISA 260 and the Annual Report and Accounts. KPMG congratulated the CCG on the clean, unqualified position of its Value for Money Statement and Regularity Statement.

One high risk issue was identified as the CCG ended the financial year 2019/20 with a pandemic: the scale of the challenge faced in delivering system savings to a pre-COVID-19 level as and when there is a return to business as usual.

It was noted that the Internal Audit and Counter Fraud Services contracts with 360 Assurance have been extended until 31st March

2022 under the terms of the existing contract. The original plan was to tender the contract from April 2021 however this is not practical due to other priorities, and the ability to run a tender process at this current time. The current lead 360 Assurance Audit Manager has been replaced in order to provide a degree of objectivity.

The Governing Body NOTED the contents of these reports for assurance purposes

GBP/2021/ 073: Engagement Committee Assurance Report and Annual Report –September 2020

Martin Whittle (MWh) presented the Engagement Committee Assurance Report for the meeting held on 16th September 2020. The following points of note were made:

An update on the progress being made with the recovery and restoration plans across the health and care system was received.

An update on the communications and engagement approaches being taken to support the identified actions and risks contained with the system’s Winter Plan was presented; this included a system-wide Communications Board coordinating all winter-related activity.

The System Insight Group continues to undertake good work and it is important not to lose the innovations produced.

A procurement process for a new Orthotics service provider was undertaken pre-COVID-19; there is now a need to undertake post-procurement engagement with service users. This is being taken forward with the new service provider following a pause due to the impact of COVID-19 on service use. A survey is to be developed for use with patients starting in October.

Andrew Middleton (AM) noted that, particularly in times of transformation, it is important that there is representation from all partner organisations; from the report it is apparent that it has been a challenge to obtain Derby City Council and Place representatives; he enquired if alternative members should be sought to provide a voice from these significant proportions of the population. MWh confirmed that it is a well-attended committee and that the membership is constantly being reviewed. He agreed to increase efforts to obtain City Council membership, however Place membership is somewhat of a hiatus at the moment.

Ian Gibbard (IG) reflected that this report indicated what a well organised Engagement Committee the CCG now has. Over the many years he has worked on commissioning bodies in Derbyshire there has always been something of this kind to demonstrate engagement with the public, but this is the most effective body he has ever seen. This is a credit to Martin who should be encouraged by this. MWh thanked IG for these kind words and agreed to pass the message on to members.

The Governing Body NOTED the contents of these reports for assurance purposes

GBP/2021/074: Governance Committee Assurance Report and Annual Report – September, 2020

Jill Dentith (JD) presented the Governance Committee Assurance Report for the meeting held on 10th September 2020. The following points of note were made:

The Committee approved the Career Break Policy and the Patient and Public Expenses Policy.

An update was received in relation to the Business Continuity and Emergency Planning Resilience and Response 2020/21 and the CCG remaining at Business Continuity Escalation Level 3 and reviewing its Business Continuity Plan arrangements on an ongoing basis.

An update was received on the Emergency Planning Resilience and Response Annual Assurance process for 2020/21.

It was noted that the recovery and restoration response is going well despite the challenges being faced.

Activity within the Incident Control Centre (ICC) is fairly low currently, however the CCG is well prepared to reinstate longer hours of operation and increased staffing and support should it be required.

The Workforce Race Equality Standard and Workforce Disability Equality Standard Action Plans demonstrated the ongoing good work being undertaken within the organisation. There are good links with the staff survey and the Big Conversation.

Positive discussions were held around new ways of working through engagement with staff, however a step back is now being taken due to recent announcements both nationally and locally in order to ensure staff safety.

An update was provided into ongoing health and safety work within the CCG.

The Committee approved its annual report which demonstrated the good work being undertaken. JD thanked colleagues who have participated in the Governance Committee for the positive challenges.

The Governing Body NOTED the contents of these reports for assurance purposes

GBP/2021/ 075: Primary Care Commissioning Committee Assurance Report and Annual Report – September 2020

Jill Dentith (JD) provided an update on the discussions held at the Primary Care Commissioning Committee meeting held on 23rd September 2020. The following points of note were made:

A Month 4 finance report was received for information.

The Committee’s annual report was approved for 2019/20.

Amendments were proposed to the Committee’s membership for Governing Body approval.

Consideration to be given as to how to engage better with Health and Wellbeing Boards and HealthWatch.

The following sub-committees Terms of Reference were received:

Primary Care Quality and Performance Review Sub Committee

Primary Care Workforce Steering Group

Estates Steering Group

General Practice Digital Sub Committee

The Governing Body NOTED the contents of these reports for assurance purposes

GBP/2021/ 076: Quality and Performance Committee Assurance Report and Annual Report – September 2020

Dr Buk Dhadda (BD) provided an update on the discussions held at the Quality and Performance Committee meeting held on 24th September 2020. The following points of note were made:

The Committee received the Winter Plan and will continue to receive monthly updates going forward.

During July 2020, Derbyshire was non-compliant in 6 of the 8 Cancer standards including the 62 day Urgent GP Referral to treatment at 78.8% (85% standard) and 31 day from Diagnosis to treatment at 95.7% (96% standard).

An update on the restoration and recovery of Continuing Health Care was received. It was noted that CHC processes were reinstated nationally from 1st September. The planned trajectories of the recovery plan were presented and it was noted that they were on track to deliver.

The Care Home Report updated on issues relating to concerns in the care home sector across the system. The Committee explored the potential risk of lack of capacity due to quality or financial issues and were assured that there were robust systems and processes across the system to address these concerns from both an immediate and long term perspective.

The Risk Register report was received and the Committee approved the reduction in risk score for risks 24 and 27 and supported the closure of risk 19.

Moving forward the Committee will receive updates on Phase 3 of the Recovery and Restoration.

The annual report was provided for information. BD thanked the teams that have worked with the Quality and Performance Committee for all the work they have done and their commitment and members for the input and challenges made at meetings.

The Governing Body NOTED the key performance and quality highlights and the actions taken to mitigate the risks and NOTED the Annual Report

GBP/2021/ 077: Integrated CCG Corporate and COVID-19 Risk Register Integration Report

Helen Dillistone (HD) presented this report advising that it highlights the areas of organisational risk that are recorded in DDCCG’s Corporate Risk Register as at 30th September 2020. It is a live management document which enables the organisation to understand its comprehensive risk profile, and provides an awareness of the wider risk environment. All risks are allocated to a Corporate Committee which reviews new and existing risks on a monthly basis and agrees the removal of fully mitigated risks.

One risk was recommended for closure:

Risk 19 – Derby City patients with complex wounds will not receive timely care or will face sub-optimal outcomes to their condition. There may also be an impact on patients with long term conditions who will face longer waits for their care due to GP practices managing caseloads of complex

wound care. This risk is recommended to be closed as during the COVID-19 period teams have continued to deliver wound care in the Derby City area. The waiting list has reduced significantly due to reduced demand during COVID-19 and the teams are managing the caseload.

The Governing Body:

RECEIVED the CCG Risk Register

APPROVED the closure of Risk 19

NOTED the reduction in risk score of risks 09, 16, 24, 27, 29 and 30

GBP/2021/ 078: Joined Up Care Derbyshire Board Update – September 2020

The Governing Body RECEIVED and NOTED this update

GBP/2021/ 079: Ratified Minutes of DDCCG’s Corporate Committees:

Audit Committee – 26.5.2020

Engagement Committee – 29.7.2020

Governance Committee – 8.7.2020

Primary Care Commissioning Committee – 26.8.2020

Quality and Performance Committee – 27.8.2020

The Governing Body RECEIVED and NOTED these minutes

GBP/2021/ 080: South Yorkshire and Bassetlaw Integrated Care System JCCCG CEO Report – September 2020

CC noted the similarity of agendas to those of DDCCG. Assurance was gained though the areas of mutual conversation.

The Governing Body RECEIVED and NOTED this report

GBP/2021/ 081: Joined Up Care Derbyshire Board meeting minutes – 16.7.2020

The Governing Body RECEIVED and NOTED these minutes

GBP/2021/ 082: Minutes of the Governing Body meeting held on 3rd September 2020

The minutes of the above meeting were agreed as a true and accurate record.

GBP/2021/ 083: Matters Arising / Action Log

There were no outstanding actions on the action log.

GBP/2021/ 084: Forward Planner

The Governing Body NOTED the Planner for information.

GBP/2021/ 085: Any Other Business

None raised.

DATE AND TIME OF NEXT MEETING

Thursday 5th November 2020 – 9.30am to 11.15am via Microsoft Teams

Signed by: ……………Dr Avi Bhatia………. Dated: ……5.11.2020……………

(Chair)