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CWHHE is a collaboration of Clinical Commissioning Groups: Central London, West London, Hammersmith & Fulham, Hounslow & Ealing

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CWHHE CLINICAL COMMISSIONING GROUP COLLABORATIVE

Performance Committee

Thursday 16th April 2015, 10:30am-12.00pm Room 5.4, 15 Marylebone Road

Members in attendance

Trevor Woolley (TW) Lay member, Hounslow CCG, Chair

Philip Young (PY) Lay member, CWHHE CCGs

Nicola Burbidge (NB) Chair, Hounslow CCG

Mohini Parmar (MP) Chair, Ealing CCG

Ruth O’Hare (RoH) Chair, Central London CCG

David Tomlinson (DT) Chief Financial Officer, CWHHE CCGs

John Riordan (JR) Secondary Care Member, Ealing CCG

Alan Hakim (AH) Secondary Care Member, CWHHE CCGs

Sue Jeffers (SJ) Hammersmith & Fulham CCG, Managing Director

Simon Hope (SH) Deputy Managing Director, West London CCG

Janet Cree (JC) Acting Managing Director, Hammersmith and Fulham CCG

James Eaton (JE) Associate Director of Performance and Delivery, CWHHE CCGs

Elizabeth Ogunoye (EO) Associate Director, NWL CCGs

Non-members in attendance

Elizabeth Youard (EY) Account Director for Imperial College Healthcare Trust, Hammersmith & Fulham CCG

Riordan Hill (RH) Governance Officer, CWHHE CCGs

Business Items Action

1. Welcome/apologies

1.1. Apologies were received from Clare Parker, Ben Westmancott and Kathryn Magson.

2. Declaration of interests

2.1. No interests in addition to those previously identified were declared at the meeting.

3. Minutes from previous meetings

3.1. The minutes from 16 March were approved as an accurate record of the meeting subject to the following change; all instances where David Tomlin was listed to be amended to read David Tomlinson.


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4. Matters arising

4.1. 4.2 David Tomlinson to draft a letter to the DH to address the issues

pertaining to property services and report back to this committee.

A draft version of the letter is currently being reviewed by Clare Parker and is due to be sent in the next month. New problems have arisen; Community Health Partnerships do not appear to be fit for purpose for claiming section 106 monies on schemes and there are suspicions that this may be a wider problem. This has been picked up by Ealing CCG but there hasn’t been a response. David Tomlinson is aware of these additional issues and is feeding them in to the conversations.

(DT)

4.2 5.5 Performance Team continues to monitor progress of the backlog of

patients at Imperial (ICHT) and will report back to this committee with an

update.

Imperial is on track to meet the agreed trajectory which is being monitored

weekly and have stated that the recovery date for RTT is December.

Discussions are currently ongoing regarding whether this could be

achieved earlier.

4.3 5.6 Check the specialist commissioning figures against standard

commissioning at ICHT.

A capacity and demand exercise is being completed which will provide

clarity on the numbers that will need to be delivered within the contract.

4.4 5.7 Get confirmation of what new methods have been adopted in an

attempt to reduce the backlog of patients at ICHT

It was reported there have been a significant amount of RTT backlog

validations since concerns were raised, which has contributed towards an

improving position

4.5 9.2 Escalating invoices – David Tomlinson to look at the process of

escalating invoices and consider any potential improvements that all 4

CCGs can pursue

The committee was informed this issue will be resolved by the end of May.

(DT)

5. A&E

5.1 Elizabeth Ogunoye introduced the A&E report and summarised the following points;

5.2 The A&E position has improved across the patch in Q4 in comparison to Q3 and is above both the London and national average for Q4.

Chelsea and Westminster Hospital (CW) achieved year to date target with 96.4%.


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5.3 West Middlesex Hospital (WMUH) achieved year to date target with 95.4%. A contract query has been issued due to poor performance in Q3. Work is on-going to reduce and maintain delayed transfers of care.

5.4 ICHT had not met the year to date target and had reported 93.7%, although performance had improved from 91.2% in Q3 to 92.0% in Q4.

The key points identified from the recent review were:

- There had been variation in demand across providers and sites. Further work is being undertaken to fully understand demand at both levels;

- non-elective admissions had increased by approximately 10 a day; - bed flow was affected by length of stay; - patients were being identified for discharge earlier in the day; and - additional consultants would be recruited to help with senior

leadership in A&E.

It had been agreed with the trust that A&E performance would be back on track to delivering the target by 26 April.

5.5 Ealing Hospital had achieved 97.03% for M12 but had not met the year to date target with 94.3%, which was attributed to poor performance in Q3.

5.6 The following responses emerged in discussion:

- performance for type 1 admissions remained poor; there was a

concern that by reviewing performance across all types as a whole

ran a risk of masking an important element of the care pathway.

- in response to non-elective admissions, figures were increasing

and the committee highlighted a need to obtain a holistic view on

performance.

- clarity was required on who is taking accountability for the

implementation and maintenance of the new processes and the

CCGs need to engage these people.

The committee was informed that the system resilience plan may begin to

answer the committee’s questions and highlight which part of the

organisations need to be engaged with.

5.7 ACTION: RoH, AH & JC to engage with others in commissioning to create a proposal on how additional influence can be made in Imperial to raise their standard of performance across the board, with urgent care as a particular example where this committee believe improvements can be made.

(RoH, AH, JC)

5.8 ACTION: Senior clinical conversation to be held in relation to ensuring that the changes to processes recommended by the McKinsey review are embedded.

JC


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6. Performance Report

6.1 Elizabeth Ogunoye introduced the Performance report and summarised the following points;

6.2 Cancer;

- work is on-going across the patch with providers looking at inter-hospital pathways and performance has improved; and

- WMUH and Ealing Hospital are improving and action plans are in place, both providers will be invited to present to this committee in May.

6.3 IAPT;

- Both Hammersmith & Fulham CCG and Hounslow CCG are meeting the trajectory,

- Ealing CCG missed the access target but is improving for Q4, - West London CCG is also improving and could meet the Q4 target, - Central London CCG has improved but will not achieve Q4. Joint

work is being undertaken with providers that focusses on the standards.

6.4 Dementia; the results published show all CCGs apart from Ealing CCG achieved their diagnosis rates.

7. Imperial update

7.1 Elizabeth Youard introduced the Imperial update and raised the following points;

7.2 Time is being spent formulating the 15/16 contracts to include detail about RTT capacity.

RTT issues related partly to a data quality problem. Imperial continues to show they have reduced the waiting lists.

The trust is currently working towards a level of 4000 in April with the intention of maintaining this level throughout the year.

Conversations had taken place about benchmarking against other trusts that have implemented Cerner in an effort to learn from other trusts.

7.3 The following questions emerged from the discussion;

- we need definitive dates for when RTT, choose and book, and cancer access will be resolved;

- a clear mechanism to monitor progress and provide assurances that progress is being made on these issues is required.

- what assurances can we take that issues pertaining to Cerner have been resolved? -

- we need to establish what a reasonable level of data quality issues in ICHT might be and identify where the trust is at compared to this.

- the committee requested clarity on the best forum for raising these issues with ICHT.

EY

8. Matters for escalation

8.1 No matters were escalated to the committee by CCG performance committees.


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9. Any other business

None.

Date of next meeting

Date and time of future meetings:

Thursday 21st May 10:00 – 12:00


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CWHHE CLINICAL COMMISSIONING GROUP COLLABORATIVE

Performance Committee

Thursday 21 May 2015, 10:00am-12.00pm Room 5.4, 15 Marylebone Road


Philip Young (PY) Lay member, CWHHE CCGs


Kathryn Magson (KM) Managing Director, Ealing CCG

Ruth O’Hare (RoH) Chair, Central London CCG

David Tomlinson (DT) Chief Financial Officer, CWHHE CCGs

Clare Parker (CP) Chief Officer, CWHHE CCGs

Alan Hakim (AH) Secondary Care Member, CWHHE CCGs

Sue Jeffers (SJ) Hammersmith & Fulham CCG, Managing Director


Janet Cree (JC) Acting Managing Director, Hammersmith and Fulham CCG

James Eaton (JE) Associate Director of Performance and Delivery, CWHHE CCGs

Elizabeth Ogunoye (EO) Associate Director, NWL CCGs

Simon Tucker (ST) Lay Member, West London CCG


Elizabeth Youard (EY) Account Director for Imperial College Healthcare Trust, Hammersmith & Fulham CCG

Riordan Hill (RH) Governance Officer, CWHHE CCGs

Jamie McFetters (JMc) Cancer Performance Manager, NWL CCGs

Afsana Safa (AS) Governing Body Member GP, Central London CCG

Vijay Taylor (VT) Governing Body Member, Ealing CCG


Aidan Fallon (AF) Interim Head of Strategic Governance, CWHHE CCGs

Helen Hardy (HH) Hillingdon Hospital NHS Foundation Trust

Wilson Jones (WJ) Deputy Director of Contracts, Brent CCG

Andy Howlett (AH) Deputy Director of Operations, WMUH

Sian Sutton (SS) Head of Cancer & Performance WMUH

Laura Berwick (LB) Cancer Manager, Chelsea & Westminster

Bernard Quinn (BQ) Director of Delivery & Performance, BHH CCGs

Helena Sage (HS) Quality Manager, BHH CCGs


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Philip Lunn (PL) Interim General Manager, LNWH

Philip Mackney (PM) Cancer lead, West London CCG

Michele Marshall (MM) Lead Cancer Clinician, LNWH

Gareth Gwynn (GG) Cancer Performance Manager, ICHT

Nicola Grinstead (NG) Chief Operating Officer, ICHT

Dr Katie Urch (KU) Cancer lead, ICHT

Tina Benson (TB) Director of Operations, LNWH



1.1. Apologies were received from Tim Spicer, John Riordan, Mohini Parmar Ben Westmancott and Trevor Woolley.


2.1. No interests in addition to those previously identified were declared at the meeting.

3. Minutes from previous meetings

3.1. The minutes from 16 April were approved as an accurate record of the meeting.

4. Matters arising

4.1. 4.2 David Tomlinson to draft a letter to the DH to address the issues

pertaining to property services and report back to this committee.

Property services had approached Brent, Harrow & Hillingdon CCGs for a

discussion on how to work together. David Tomlinson would hold a

meeting with Clare Parker w/c 25th May to decide on the content of the

letter. An update would be provided to the committee in June.

(DT)

4.2 9.2 David Tomlinson to look at the process of escalating invoices

and consider any potential improvements that all 4 CCGs can

pursue.

An update on these improvement to be provided in June as per the

previous update.


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4.3 5.7 RoH, AH & JC to engage with others in commissioning to create

a proposal on how additional influence can be made in Imperial to

raise their standard of performance across the board, with urgent

care as a particular example where this committee believe

improvements can be made.

Imperial College Healthcare Trust had been made aware that

improvements to A&E performance were expected to be seen in 4 weeks’

time. Alan Hakim, Janet Cree, Clare Parker and Tim Spicer to provide an

update to the committee when appropriate. It was agreed to remove Ruth

O’Hare’s name from the action and for ‘Imperial update’ to be removed as

a standing item from the Performance committee agenda.

4.4 5.8 Senior clinical conversation to be held in relation to ensuring that

the changes to processes recommended by the McKinsey review are

embedded.

No update provided at the meeting.

Duly noted: Clare Parker and chairs would discuss this with senior

colleagues at Imperial with a report back to this committee as appropriate

5. Performance report by exception

5.1 The committee noted the performance report.

6. Imperial update by exception

6.1 The committee noted the Imperial update.

7. Matters for escalation

7.1 No matters were escalated to the committee by CCG performance committees.


8.1 None.

9. Cancer – provider presentations

9.1 Jamie McFetters introduced the North West London Shared Cancer Pathways Improvement Joint Provider working group presentation which contained the following key points:

a) Over one third of 62 day breaches involved shared pathways between providers;

b) Significant improvement in performance could be achieved by improving joint pathways;

c) The four key priority areas are: urological, lung, gynecological and breast cancer including screening performance;


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d) Harrow, Hounslow, West London, Hillingdon, Central London & Hammersmith & Fulham CCGs all performed above both the national total (83.7%) and the operational standard (85%) in Q3,

e) Ealing CCG (81.5%) and Brent CCG fell below the national total and operational standard for Q3.

f) Harrow, Central London, Ealing, Brent and Hammersmith & Fulham CCGs performed below the national total and the operational standard for Q4;

g) West London CCG performed just above the national total with 82.3%, but failed to meet the operational standard of 85% in Q4;

h) Hounslow CCG and Hillingdon CCG performed above the national total and the operational standard in Q4.

i) Chelsea & Westminster Hospital NHS Foundation Trust, Imperial College Healthcare NHS Trust (ICHT), Northwest Hospitals NHS Trust/ North West Healthcare NHS Trust and Royal Brompton & Harefield NHS Trust did not meet the operational standard of 85%

j) The Hillingdon Hospitals NHS Foundation Trust and West Middlesex University Hospital NHS Trust (WMUH) both achieved above the operational standard with 93.7% and 90.5% respectively.

9.2 - A total of 98 breaches were recorded in Q4;

- reasons for 62 day breaches were multifactorial, most commonly consisting of individual delays of 7-10 days;

- common reasons reported across all pathways were;

Delays due to multiple multi-disciplinary team (MDT) discussions;

Deferring routine clinical decision making to MDTs;

Sub-optimal patient tracking/escalation of delays;

Delays in accessing and/or reporting diagnostics and,

Capacity to treat.

9.3 The following points arose while discussing the providers’ joint action plan:

Inter-provider diagnostics had mainly affected ICHT. Turnaround times for the lung and prostate pathway had been agreed which will give guarantees for patients returning to the referring site.

9.4 Weekly conference calls between each cancer unit had taken place, giving an opportunity for patients moving between sites to be discussed. Highlighting in-patients in advance of them transferring provided a better scope for advance planning.

9.5 Each trust was tackling videoconferencing independently and was developing their own plans around contracts, therefore timescales for this will vary. Interoperability was raised as an issue but this would be resolved by all trusts eventually using the same system. Shared specialists amongst trusts was welcomed by the committee as it will ensure that every MDT is quorate with decision makers.


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9.6 Macmillan navigators had been in post since the 27 April 2015 and were trained to support patients across the whole of the cancer pathway, acting as a single point of contact for new and existing patients. The navigators worked on a rotation basis on each tumour group to enable process learning. The committee was informed that a full report on the navigators will be presented to the committee in July, with an assessment on whether capacity should be increased due to be conducted in September.

9.7 While discussing timely pathways for Urology the committee queried the value in patients receiving MRI scans prior to a prostate biopsy, considering both the value of patient outcomes and value for money. If this did not make a difference to clinical outcomes it needed to be removed from the pathway.

Turnaround times have been agreed with ICHT for template biopsies and weekly slots had been allocated for WMUH.

9.8 The following quality requirement updates from each provider were as follows:

9.9 West Middlesex University Hospital (WMUH)

- WMUH was setting up a direct access endoscopy service; - There were challenges with timescales for ultrasound direct

access; - Issue were raised regarding availability of trained staff and

recruitment challenges that impact on provision of these services; - Achieving 80% on the holistic needs assessment (HNA).

9.10 Hillingdon Hospital (HH)

- HH was setting up a direct access endoscopy service; - HH are continuing to work with the third sector to provide health

and wellbeing events.

9.11 Royal Brompton Hospital (RBH)

- Direct access was less applicable to RBH, although direct access CT scans could be offered;

- Work continued on the survivorship requirements, challenging on HNA and treatment summary as a treatment provider;

- The hospital had provided the first health and wellbeing event, in March, with the Royal Marsden Hospital and Chelsea & Westminster hospital, on lung cancer.

9.12 London North West Healthcare trust (LNWH)

- LNWH was providing all direct access services although a challenge in achieving urgent ultrasound requirement was reported.

- The trust was working through reducing variation in practices across sites, particularly focusing on single post-merger MDTs.

- LNWH was currently achieving 60% HNA completion.


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9.13 Imperial College Healthcare Trust (ICHT)

- ICHT was not providing direct access endoscopy; - The trust was focusing on the urgent cancer referrals two-week

wait pathway; - Direct access ultrasound was part of the seven-day services work

programme. - The acute Oncology Service was now peer-review compliant. - The trust was implementing a new internal management of the

peer review process where each MDT had a quarterly update meeting with senior team.

- The trust was achieving 60% HNA completion.

It was agreed that the providers would return quarterly to this committee with an update on the actions.

9.14 The following actions were agreed;

ACTION: Convene lung cancer clinical group to agree timed pathway. Jamie McFetters to organise a meeting.

(JMc)

9.15 ACTION: All providers to implement an internal system to refer abnormal chest x-rays to the lung MDT or to urgent OPD appointment on lung cancer pathway – all providers to confirm pathway at next cancer performance committee.

(All providers)

9.16 ACTION: Expectation to see the work presented to the committee to be reflected in fewer 62 day breaches, particularly inter provide transfer breaches – all providers to demonstrate at next cancer performance committee.

(All providers)

9.17 ACTION: James Eaton to establish a programme of work to develop a cancer strategy for NWL.

(JE)

9.18 ACTION: Compliance against quality standards to be a focus of future board meetings – presentation by providers on compliance and progress at next cancer performance committee.

(All providers)

9.19 ACTION: Before meeting with providers there was an action ‘to explore a wide cancer strategy programme of work for CCG’s’. KM and JMc to meet with the TCST and advice on taking forward

(KM & JMc)

Date of next meeting


Thursday 18 June 10:00 – 12:00

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CWHHE Clinical Commissioning Group Collaborative


Philip Young (PY) Lay member for audit & governance CWHHE CCGs, Chair

Trevor Woolley (TW) (by ‘phone) Lay member Hounslow CCG

Tim Spicer (TS) Chair, Hammersmith and Fulham CCG


Ruth O’Hare (RO) Chair, Central London CCG


Rachel Garner (RG)

John Riordan (JR)

Vice-Chair, West London CCG

Secondary care consultant, Ealing CCG

Alan Hakim (AH) Secondary care consultant, CWHH CCGs

Clare Parker (CP) Chief officer, CWHHE CCGs

David Tomlinson (DT) Interim Chief finance officer, CWHHE CCGs


Sue Jeffers (SJ) Managing director, Hounslow CCG

Louise Proctor (LP) Managing director, West London CCG

Ben Westmancott (BW) Director of compliance, CWHHE CCGs

Neha Unadkat (NU) Deputy Managing Director, Out of Hospital

Helen Troalen (HT) Deputy Chief Finance Officer, CWHHE CCGs

Helen Pyecroft (HP) Programme Director, Whole Systems Programme

Andrew ? Whole Systems Programme (?)

Riordan Hill (RH) Governance Officer, CWHHE CCGs (Secretary)

Simon Carney (SC) Governance Officer, CWHHE CCGs

Business items Action


1.1. Apologies were received from Fiona Butler and Rohan Hewavisenti.


2.1. All GPs present declared a general interest as commissioners and providers. In particular,

Ruth O’Hare, Chair Central London CCG, declared an interest due to her role as a GP

provider of extended hours (Item 5a in particular). Declaration was agreed to be sufficient

and no recusal was necessary.

3. Minutes of previous meeting held on 19 March 2015

3.1. The minutes of the previous meetings were approved as an accurate record, subject to 5.2

being amended to make it clear that the contract information requirement would apply to all

providers.

4. Matters arising from the actions log

4.1 [4.1] Procurement Framework: a draft was nearing completion and would be presented at DT

Minutes of the Investment Committee meeting held on Thursday 23 April 2015 10.30–12.00

Room 5.4, 15 Marylebone Road

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the next meeting.

4.2 [10.1] OOH business case - Anticoagulation: confirmed as completed and could be removed from the Matters Arising matrix.

RH

5.

5a.

Out of Hospital Services

Extended Hours Business Case

5a.1 Rachel Garner introduced the item, explaining that the investment and support for primary

care development built on the CIS plan for 2014-15 and consisted of four key elements,

namely locality-based working, referrals to community services, reduction of non-elective

admissions and the prescribing standardisation scheme. The key new aspects centred

around the integration of operating plan targets and securing additional support for more

bespoke approaches to referrals standardisation.

5a.2 In discussion, the Committee sought assurances regarding the reliability of the SUS data

sets. RG recognised the risk of inaccuracies and explained that data quality audits were

undertaken last year and are planned again to build up necessary assurance and, in the

future, the move to referral wizard should reduce the dependency on SUS data.

5a.3 The Committee agreed that a corporate forum for discussing the longer-term recruitment,

training and retention at GP practices – particularly in relation to senior GPs and non-

medical clinicians - needed to be established to develop a strategy to address the significant

risks to sustained delivery of the OOHS strategy that these issues represented.

5a.4 The Committee approved the Business Case, subject to establishing the scope and methodology of the six-month EH project review. It also agreed that such a review must test the assumptions regarding the resource deployment between GP and Non-GP deliverers of patient services in practices.

LP / SJ

5a.5 The Committee also agreed that:

the six-month review of the LES system should be conducted jointly with NHSE; and

the thresholds for the quality markers to be shown to the Chair and AH to assure them on behalf of the Committee.

LP / SJ

5b. a) Transitional Transformation Funding – ESIG Q1

5b.1 The Committee expressed its disappointment that the paper only went up to Q1 and noted

that the paper was ‘for noting’ rather than ‘for approval’. It was agreed to that the paper

should be downgraded from ‘Confidential’ to ‘unclassified’.

5b.2 The Committee noted the paper and agreed that Q2-onwards paper should be presented

for discussion at its May meeting.

JB

5c. Contractual Model

5c.1 The item was introduced with a recap of the complicated journey to find an appropriate

contractual model. The original intention was to let a NHS standard contract with the

federation for delivery of Out of hospital (OOH) services. This created complications

surrounding the pensionability of payments, which in turn led to exploration of the APMS

contractual route which would have removed this issue. However, NHS England had

declined to delegate authority to allow this to happen. This has not been refused indefinitely,

rather to allow NHSE to review its policies. In the meantime, the current plan was to revert

back to the NHS standard contractual model. The Committee expressed its surprise at

NHSE’s position, given that it was bound to affect many, if not all, CCGs’ plans for such

contracting.

5c.2 The Committee noted the roll-over of existing contracts. It also noted that if the contracts are deemed to represent Single Tenders and thus require a waiver, it becomes an issue for

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the Audit Committee to approve and the Investment Committee to simply note.

5c.3 The Committee agreed that there was merit in exploring the options on how the contractual model could be taken forward, should NHSE delegate authority to CCGs in the future for APSM contracts to be adopted.

BW

6. WLCCG Whole Systems Business Case

6.1 The Committee discussed the business case in detail. It’s main concerns centred on a) the potential for duplication (of costs and efforts) with the current model of care work that was due to report in only a matter of weeks, b) how the impact and effectiveness (ie RoI) of the changes could be measured robustly, given the working assumptions were, in places untested, and c) ensuring that systems of payment to practices are adequately transparent.

6.2 The Committee accepted that the final approval rested with the Governing Body, which would benefit from seeing the holistic picture. It accepted that the plans were innovative and untested and there would need to be an element of trying it and see. The Committee also recognised that there was potential flexibility in the programme to adapt to changing circumstances and developments elsewhere (eg the model of care work) but felt its appetite for further assurances were justified. In summary, getting the feedback / learning loops targeted correctly was key.

6.3 The Committee agreed the paper, subject to: o the Chair meeting with MP and NB before the WLCCG Governing Board

meeting to ensure that both are assured that their concerns regarding the risk of duplication with the Model of Care work have been addressed; and

o that systems of payment are demonstrably transparent and accountable.

PY

7. WLCCG Commissioning Learning Set Plan 2015/16

7.1 The Committee was content with the plan, subject to:

a) a note being provided to the Committee setting out how GP Practices will

meet the financial targets relating to ‘Prescribing’ targets; and

b) the underlying Prescribing data that was used to develop the paper’s

assumptions being provided to the Chair and AH for their scrutiny and

assurance, on behalf of the Committee.

RG

RG

8. ECCG Paediatric Phlebotomy

8.1 The Committee approved the proposal, subject to the cost ‘per bleed’ remaining consistent around the Hounslow benchmark of £14. However, should the final cost of this proposal exceed that benchmark materially, then the proposal should return to the Committee for a final decision.

8.2 The Committee also agreed that the key principle that drives such proposals should, going forward, always be made explicit on each cover sheet, so as to provide decision-makers the correct context from the outset.

ALL

9. ECCG GP Ltd (federation) Readiness

9.1 The paper was introduced and it was reported that, following a number of iterations, the Panel has been satisfied that all the required evidence had been submitted. The main on-going piece of work related to finalising the finance and activity plan. The paper had been through executive board, F&P Committee and the governing body and was presented to the Investment Committee with a recommendation for final approval.

9.2 The Committee approved the paper, with thanks.


10.1 There was no other business.

11. Date and time of future meetings

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14 May 2015, 13.00 – 14.00, Room 5.4, MBR

18 June 2015, 12.00 - 13.30, Room 5.4, MBR

CWHHE is a collaboration between the Central London, West London, Hammersmith & Fulham, Hounslow and

Ealing Clinical Commissioning Groups

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CWHHE CLINICAL COMMISSIONING GROUPS COLLABORATIVE

Quality & Patient Safety Committee

Thursday 07 May 2015, 10:30 – 12:00 15 Marylebone Road


Trish Longdon (TL) Lay member, Hammersmith & Fulham CCG (Chair)

Jonathan Webster (JW) Director of Quality and Patient Safety, CWHHE CCGs

Tim Spicer (TS) Chair, Hammersmith and Fulham CCG


Neville Purssell (NP) Vice chair, Central London CCG

John Riordan (JR) Secondary Care Consultant, Ealing CCG

Simon Tucker (ST) Lay member, West London CCG

Alan Hakim (AH) Secondary Care Consultant, CWHHE CCGs

Ben Westmancott (BW) Director of Compliance, CWHHE CCGs

Non Members in attendance

Leigh Forsyth (LF) Assistant Director for Quality Improvement and Clinical Assurance, CWHHE CCGs

Mary Mullix (MM) Deputy Director of Quality, Nursing and Patient Safety, CWHHE CCGs

Nicky Brownjohn (NB) Associate Director for Safeguarding, CWHHE CCGs

Sue Pascoe (SP) Deputy Director for Care Home Quality Improvement & Clinical Assurance, CWHHE CCGs

Lizzie Wallman (LW) Assistant Director for Quality and Patient Safety, CWHHE CCGs

Samira Ben Omar (SBO) Assistant Director of Patient Experience & Equality, CWHHE CCGs

Nicola Clark (NC) Assistant Director of Patient Safety, CWHHE CCGs

Tandeep Fairman (TF) Head of Planning and Governance, Hounslow CCG (dialling in)

Riordan Hill (RH) Governance officer, CWHHE CCGs (secretary)

Minutes


1. Welcome/Apologies

1.1. Apologies were received from Rachel Garner. 2. Declaration of interests 2.1. There were no new declarations of interest. 3. HENWL

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

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3.1 Helen Mansfield introduced the HENWL Strategy: community nursing report which updated the committee on activities around nursing, community nursing and on-going activities such as the annual education planning cycle.

3.2 The committee was informed that two sessions that were held last year focused on community and primary care nursing which was an opportunity for stakeholders to see the data HENWL have used to demonstrate the supply and demand position and the resulting emerging recommendations in regard to commissioning. Providing support to students currently in the system was reported to be key challenge. The CCGs education leads have been leading on the OOH representation, working alongside Toyin Ajidele to assess what is currently available and any lessons learned from last year’s uptake.

3.3 It was suggested that improvements can be made in terms of engagement with employers and stakeholders and that plans on how to use the strategic investment funding for developing the workforce needed to be addressed. Letters have been sent to the each of the CCG Chairs outlining the planning processes and opportunities to engage.

3.4 The following points emerged in discussion;

- There are concerns about shortages in community nurses and practice nursing staff;

- There is a lot of work being done in this area, but it is somewhat disjointed and we

need a comprehensive picture of all activities and a clear strategic plan going

forward

- There is a need to explore the links between disciplines and offering module based

training to existing professionals (such as Pharmacists) instead of the standard 1

and 3 year programmes to enable up skilling and cross skilling of existing staff;

- Local people being able to work in their locality would increase sustainability;

- Nationally there are only 1200 trained school nurses – therefore the numbers of

trained school nurses in each area is small

- School nursing services are being restructured under public health, Mary Mullix has

undertaken to establish links with public health in the local authorities who now

have responsibilities for school nursing and soon health visiting (from October

2015)

3.5 The committee requested assurances around how these workforce issues are being tackled, specifically around the points raised above. TL agreed to take these concerns to the SaHF workforce group meeting that afternoon and to establish whether that group should take the lead in developing the strategic workforce direction. Trish Longdon asked that the issues raised are addressed and presented back to the committee in the coming months.

3.6 ACTION– Helen Mansfield to circulate the education plan that outlines recommendations around commissioning numbers.

(HM)

3.7 ACTION – Helen Mansfield to consider the committees comments regarding assurances for how the workforce issue is being tackled and use this to structure a response when presenting back July

(HM)

3.8 ACTION – Trish Longdon to raise workforce concerns to the SaHF workforce group meeting on Thursday 07 May to discuss if that group should take the lead in developing the strategic workforce direction.

TL


Page 3 of 6

4. Minutes of the last meeting – 26 March 2015

4.1 The minutes as previously circulated were approved as an accurate record of the meeting.

5. Matters arising

5.1 4.4 - CLCH workforce issue – Mary Mullix advised that School nursing services are being restructured under public health, and that she has undertaken to establish links with public health in the local authorities who now have responsibilities for school nursing and soon health visiting (from October 2015)

5.2 4.7 - Safeguarding children training – There were concerns around safeguarding children training in provider organisations, Nicky Brownjohn will provide an update to the committee in June .

5.3 4.9 – HENWL workforce - covered by agenda item number 3. All opportunities for NWL to consolidate workforce issues to go to HENWL.

5.4 7.1 – H&F highlight report - Pressure Ulcers – There were concerns regarding the number of pressure ulcers across all providers, Nicola Clarke to present a review to the committee in June highlighting area of concern and actions taken.

5.5 9.2 – Misdirected letters to GP practices – this issue was picked up by the LMC, closed.

5.6 3.1 – Northwick Park – Disaggregated data is now being received to enable discussions around issues specific to Ealing. Action closed

5.7 4.1 - CNWL near miss – Rachel Garner continues to work with CNWL to clarify internal processes for receipt and triage of referrals. Action closed

5.8 4.2 – CQG inspection dissemination process – Mary Mullix advised that CQC updates on action plans is a formal part of the CQG agenda which is reported on a monthly basis with quarterly deep dives in to specific areas of challenge. Action closed.

5.9 4.4 CLCH waiting time targets – Jonathan Webster informed the committee that this issue has been escalated to Leroy Cordle, Associate Director of Contracting. This has not been included in the current contract but the changes will be reflected in the next contract. Action closed

5.10 4.5 A&E Performance committee update – Jonathan Webster presented a draft process paper written with a strong focus on A&E but the problem is suspected to be wider than this. BENGER report contains a challenge coming back to CCGs about reporting methods; the committee needs to explore how this link can be strengthened. Action: Michael Roach and James Eaton to report back on progress in July

5.11 4.7 – Patient experience and engagement – Concerns were expressed regarding the quality of patient experience and engagement reports received from the trust, there was a request to create a patient experience template to facilitate reporting of appropriate information. Samira Ben Omar to present an update to the committee in June.

5.12 4.7 – Primary Care reporting on patient experience and engagement – Samira Ben Omar has been working with the patient experience leads for each CCG and in response to the request for a primary care patient experience and engagement report for CCG will present to the committee in June.

5.13 5.1 - Central London highlight ICHT patient tracking in cancer pathway – Jamie Mcfetters asked to clarify what the issues are with tracking patients through cancer pathways. Mary Mullix informed that an update will be provided to the committee in June. Mary Mullix to report back in June.


Page 4 of 6

5.14 6.1 - West London highlight report - SHSOP Contract – Sue Pascoe informed the committee that all primary care providers have been emailed and only two responses have been received. CCGs have funded a retainer payment equivalent to two weeks’ pay for staff that remain in these homes.

5.15 12.1 - Chronic fatigue service commissioning review – This has been included on the collaboration board agenda and the decision from that meeting will be reported back in June.

5.17 14.2 – CWHHE CCG equalities update – this is on HR committee agenda for 15th May. To be part of the broader HR management.

5.18 CWHHE CCG equalities update – This was covered by item 13 on the agenda. Action closed.

6. Central London CCG Highlight Report

6.1 Nothing to escalate.

7. West London CCG Highlight Report


8. Hammersmith and Fulham CCG Highlight Report

8.1 Route cause Analysis: Concerns were raised around the quality of reporting RCA investigations. With a number of RCA reports returned to Trusts to be rewritten, the committee is therefore not assured that the issue is being addressed. Training in relation to the contents of good root cause analysis has been organised by the CCGs patient safety team, and will be repeated again in July, all provider trusts will be strongly encouraged to attend.

8.2 Audit of Discharge Summaries at Imperial: the committee is not assured that the current discharge process at imperial trust is robust, raising particular concerns regarding outpatient letters and reported 8 week waits for MRI results. The Deputy Director of Quality, Nursing and Patient Safety raised this with the contracting team who agreed to consider this for future contract negotiations and potential in-year contract reviews.

8.3 Imperial Trust junior viability and clinical safety: Imperial trust reported their first Serious Incident that resulted in patient harm due to the delays caused by the management of the high demand. Concerns were raised that the trust has not developed a detailed plan to address the high level of demand and request that the Deputy Director of Quality, Nursing and Patient Safety to present a brief paper at the May (H&F Quality Committee) meeting. The committee noted this escalation. The Director of Quality, Nursing and Patient Safety has raised the issue with the CQG but acknowledges that Hammersmith & Fulham CCG as the lead commissioner had not been formally notified i.e. in writing by the Trust.

8.4 Neuro-surgery – concerns were raised about the level of support available for medical staff on rotation and the potential impact of this – to be followed up with HENWL.


Page 5 of 6

8.5 West London Mental Health Trust (WLMHT) – concerns related to the low level of serious incidents being reported. It was noted that WLMHT is not an outlier in comparison to other trusts. Serious Incident reporting has been discussed extensively at the CQG and for the last 3 months the trust has demonstrated an increase in reporting behaviours. This is demonstrated by an increase in incident reporting in all harm categories with the largest increase being in the ‘low’ and ‘no harm’. These are early indications of a positive reporting culture. Complaints, the trust have been asked to look at complaints in detail and it is expected that an in depth review of all complaints appears in the annual Patient Experience Report due in July’s CQG.

9. Hounslow CCG Highlight Report


10. Ealing CCG Highlight Report


11. Northwick Park Update

11.1 Tessa Sandal for is taking this forward in Ealing CCG. There are on-going conversations with London North West Hospitals regarding generation of site-specific reports for their hospitals. Ealing CCG will bring those reports to the Quality and Safety Committee once available.

12. Patient Safety Report

12.1 Nicola Clark introduced the Patient Safety report which summarised the following points;

- Commissioners and providers are reminded of the importance of timely reporting of incidents. Reporting numbers continue to increase with learning reflected in the in the reduction of repeated root causes.

- Work is required across all commissioned services on the transparency and candour in reports, including the use of accessible language

- A concerning number of reports that are being returned to the trusts for quality improvements have not been sent back to the CCG Patient safety team within 10 days. Associate Directors are seeking assurances that outstanding reports are being returned in a timely manner.

- New metrics will provide data on repeat causes and contributory factors to Serious Incidents in future reports

- CCGs have received tailored reports for their action and assurance. - The revised national framework when published will be reflected in the

collaborative patient safety strategy. - Pressure Ulcers continue to reflect a high level of human and financial cost and

providers must concentrate on investing in prevention of category 2 ulcers. Associate Directors are addressing improvements with all providers and will provide an update in June.

13. Equalities Update


Page 6 of 6

13.1 Samira Ben Omar introduced the Equalities briefing papers which provided a review of the current equalities work against the statutory requirements. The following points were summarised;

- The current Equality Delivery System (EDS) has been refreshed as EDS2 - CWHHE CCGs are meeting their Statutory EDS requirements - The EDS2 provides a useful implementation guide for both commissioners and

providers to ensure that the needs of those from the 9 protected characteristics groups covered under the 2010 and 2011 Equality Act are met,

- The four yearly equality objectives for clinical commissioning groups are to be part of a framework alongside the four goals from EDS2 and progress is to be published annually.

An assessment against these requirements the alongside areas for development in addition to statutory requirements was detailed in the report.

13.2 The committee discussed the need to focus on;

- Dedicated equality capacity of staffing at a CCG level; - Ensuring that there is accountability for equality at a senior level in each CCG; - Undertaking an exercise looking at population profiling and access; - Sense checking business cases and service changes to ensure that equality impact

assessments are taking place; - Developing workforce data; - Ensuring that CCGs are fulfilling their duty to reduce health inequalities as well as

promoting equalities.

13.3 ACTION: Samira Ben Omar to provide a brief summary of the committee’s conversation regarding equalities work required with a recommendation for each CCG to address what can be improved locally, highlighting the need to have a senior lead associated to these issues.

(SBO)

14. Any Other Business

14.1 The committee discussed the Summary Hospital-Level Mortality Indicator and the reasons behind the downward trend in the data at Ealing Hospital. Concerns were raised about how this relates to nurse staffing ratios as a low mortality rate seems counter intuitive. ACTION : Leigh Forsyth to progress with Jonathan Webster and Alan Hakim/ John Riordan

(LF) 15. For Noting

15.1 Building User Group minutes.

16. Date of the next meeting

16.1 4 June 2015

30 July 2015

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Central London, West London, Hammersmith & Fulham, Hounslow and Ealing CCGs

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

indicated otherwise

Tuesday 26 May 2015, 14.00 Rooms 5.1 / 5.2, 15 Marylebone Road, London NW1


All five CCGs

Philip Young (PY) Lay member for audit & governance CWHHE, Chair

Michael Morton (MM)

Central London CCG

Lay Member

West London CCG

Simon Tucker (ST) Lay member

Rohan Hewavisenti (RH)

Hammersmith and Fulham CCG

Lay member

Hounslow CCG

Trevor Woolley (TW), via ‘phone

Lay member

Raj Chandok (RC)

Ealing CCG

GP member, Ealing CCG



Philip Johnstone Director, KPMG External Audit, CWHH CCGs

Charlotte Goldrich Audit Manager, External Audit, CWHH CCGs

Clare Oliver Baker Tilly, Internal audit, CWHHE CCGs

Neil Hewitson (NH) KPMG – External Audit, CWHH CCGs

Sally-Anne Eldridge (SAE) KPMG, External Audit, CWHH CCGs

Angus Fish (AF) Deloitte, External Audit, Ealing CCG

Heather Bygrave (HB) Deloitte, External Audit, Ealing CCG


Matthew Bazeley MD, CL CCG

David Tomlinson (DT) Interim Chief Finance Officer, CWHHE CCGs


Helen Troalen (HT) Deputy CFO, CWHHE

Andrew Pike (AP) AD, Communications CWHHE

Simon Carney (SC) Interim Governance Officer, CWHHE (Secretary)

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Minutes



1.1. Apologies were received from Alan Hakim, Tim Spicer, Mohini Parmar, Ruth O’Hare, Fiona Butler and Nick Atkinson.

1.2. The Committee congratulated the contributors of papers to the meeting for their quality and recognised the work they represented.


2.1. No other interests were identified beyond those declared previously.

3. Minutes of meeting – 07 May 2015

3.1. The minutes were approved as an accurate record of the meeting, subject to the following:

amend Item 3 to reflect Central London and Hammersmith and Fulham’s

retrospective approval of the decisions taken on 16 April and 7 May (as

applicable);

4.1 – insert ‘reviewed’ at end of first sentence; and

6-10.3 – provide accurate wording apropos the expenditure split between

Acute and Community Services.

SC

SC HT

4. Matters arising and action log

4.1 4.2

Updates on progress against the actions since the last meeting were reviewed. The removal of completed actions from the action log was agreed, as was the carrying forward of those that remained outstanding. The Chair regarded item 3 on the matters arising matrix as not a matter for the Committee before the management report had benefited from any independent assurance.

SC SC

5. a-c: Central London CCG Annual Report, Accounts and Governance Statement

5.1 5.2 5.3

The External Auditors (KPMG) presented the main findings of their audit of the accounts, reporting that there were no qualifications to their opinion, as set out in the ISA260 report and letter of representation (paper 5c). The auditors thanked the CCG for its excellent co-operation throughout and reported that the process was notably smoother than the previous year. Helen Troalen highlighted three minor adjustments made since the circulation of the papers: redrafting on pages 5 and 21, removal of four related party disclosures that were erroneously included and the addition of Helen’s own pension data. The Committee sought clarification of a small number of issues and representations and agreed the following in relation to the Governance Statement:

the text relating to Gordon Hunting’s position should be amended to better-describe his role as an independent (but not lay) member;

the wording should be amended to clarify that the majority of spaces, rather than current incumbents, on the Governing Board were for GP members;

GP members should be informed explicitly about what their responsibilities

BW

BW

BW

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5.4

for representing their patients’ perspectives were; and

that authority should be delegated to the Chief Officer to finalise the sign-off sentence at the end of the Governance Statement.

In line with the Committee’s delegated authority from the Governing Body and, subject to the above, the Committee approved the Annual Report, Accounts and Governance Statement for signature, submission and thereafter publication.

BW / CP

CP

6. a-c: West London CCG Annual Report, Accounts and Governance Statement

6.1 6.2 6.3

The External Auditors (KPMG) presented the main findings of their audit of the accounts, reporting that there were no adjustments made nor qualifications to their opinion, as set out in the ISA260 report and letter of representation (paper 6c). Helen Troalen one minor change – page 32, text amended to reflect that there were five rather than four individuals ‘off payroll’. Following discussion, and in line with the Committee’s delegated authority from the Governing Body, the Committee approved the Annual Report, Accounts and Governance Statement for signature, submission and thereafter publication.

CP

7. a-c: Hammersmith & Fulham CCG Annual Report, Accounts and Governance Statement

7.1 7.2

The External Auditors (KPMG) presented the main findings of their audit of the accounts, reporting that there were no adjustments made nor qualifications to their opinion, as set out in the ISA260 report and letter of representation (paper 7c). Following discussion, and in line with the Committee’s delegated authority from the Governing Body, the Committee approved the Annual Report, Accounts and Governance Statement for signature, submission and thereafter publication.

CP

8. a-c: Hounslow CCG Annual Report, Accounts and Governance Statement

8.1 8.2

The External Auditors (KPMG) presented the main findings of their audit of the accounts, reporting that there were no adjustments made nor qualifications to their opinion, as set out in the ISA260 report and letter of representation (paper 8c). Following discussion, and in line with the Committee’s delegated authority from

the Governing Body, the Committee approved the Annual Report, Accounts and

Governance Statement for signature, submission and thereafter publication.

CP

9. a-c: Ealing CCG Annual Report, Accounts and Governance Statement

9.1 9.2 9.3

The External Auditors (Deloitte) presented the main findings of their audit of the accounts, reporting that there were no adjustments made nor qualifications to their opinion, as set out in the ISA260 report and letter of representation (paper 8c). The issue regarding unreliable pension information for one Governing Body member, leading to that person’s information being withdrawn from the remuneration report, was discussed. It was agreed that the narrative be clarified to reflect that it was the supplier of said information that had caused the issue. The Committee also agreed that:

HT

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9.4 9.5

the remuneration report be updated to reflect HT’s pension position; and

delete the rest of sentence from ‘in particular…’ onwards in the Letter of Representation.

In line with the Committee’s delegated authority from the Governing Body, the Committee approved the Annual Report, Accounts and Governance Statement for signature, submission and thereafter publication. The Committee asked that the treatment of the £230m or so of cash funding that was either owed to the CCGs or held off-balance sheet be discussed, particularly looking at how NHS England accounted for it

HT AF CP DT

10. Single Tender Waivers

10.1 The Committee noted the paper and welcomed the confirmation that the Audit Committee would be looking at the STW (and related) processes at its meeting on 2 July. The Committee agreed that, if appropriate and applicable, any further extension of the arrangements with McKinsey should be subjected to the new procedures.

DT

11. Any Other Business


Dates of next meetings:


Thursday 02 July 2015, 10.30 – 12.00; and

Thursday 01 October 2015, 10.00-11.30.

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Central London, West London, Hammersmith & Fulham, Hounslow and Ealing CCGs

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

indicated otherwise

Thursday 7 May 2015, 12.00 – 14.00 Room 5.4, 15 Marylebone Road, London NW1


All five CCGs

Philip Young (PY) Lay member for audit & governance CWHHE, Chair

Central London CCG

-

West London CCG

Simon Tucker (ST)

Lay member, West London CCG

Rohan Hewavisenti (RH)

Hammersmith and Fulham CCG

Lay member, H&F CCG

Hounslow CCG

Trevor Woolley (TW)

Lay member, Hounslow CCG

Raj Chandok (RC)

Ealing CCG

GP member, Ealing CCG

Alan Hakim (AH) Secondary Care Consultant, CWHH CCGs




Kiran Chauhan (KC) Deputy MD, Central London CCG

Tim Spicer (TS) Chair, Hammersmith & Fulham CCG

Nick Atkinson (NA) Baker Tilly, Internal audit, CWHHE CCGs

Neil Hewitson (NH) KPMG – External Audit, CWHH CCGs

Sally-Anne Eldridge (SAE) KPMG, External Audit, CWHH CCGs

Angus Fish (AF) Deloitte, External Audit, Ealing CCG


David Tomlinson (DT) Interim Chief Finance Officer, CWHHE CCGs


of 4

Helen Troalen (HT) Deputy CFO, CWHHE

Catherine Brown (CB) Communications Manager, CWHHE

Simon Carney (SC) Interim Governance Officer, CWHHE (Secretary)

Minutes



1.1. Apologies were received from Michael Morton, Matthew Bazeley and Fiona Butler. The Chair noted that Central London CCG was not quorate for this meeting.

1.2. The Committee congratulated the contributors of papers to the meeting for their quality. Particular thanks were recorded for the Finance Team, Catherine Brown (Communications) and Jo Howard (Governance and Compliance).


2.1. No other interests were identified beyond those declared previously.

3. Minutes of meeting – 16 April 2015

3.1. The minutes were approved as an accurate record of the meeting, subject to Hammersmith & Fulham and Central London’s confirmation of such in correspondence.

SC / RH / MM

4. Matters arising and action log

4.1. Updates on progress against the actions since the last meeting were reviewed. The removal of completed actions from the action log was agreed, as was the carrying forward of those that remained outstanding.

SC

5. Annual report and accounts guide

5.1. Helen Troalen introduced the Committee to the guide and explained each page in detail. The Committee noted the paper, with thanks.

6-10 CWHHE CCG’s 2014-15 Annual Accounts Summaries, Annual Reports and Governance Statements

6-10.1 The Committee agreed that detailed comments on the Annual Reports should be

dealt with via correspondence and discussion would focus on material issues,

concerns and questions of clarification. Many of the issues that arose out of the

individual CCG’s accounts and reports applied across the Collaborative and are

recorded as such.

6-10.2 What follows below are the key points and context of the discussion. Detailed

actions arising from the discussions are set out at Annex A.

6-10.3 The Committee felt that the accounting framework occasionally masked the

strategic movement of activity away from Acute to community services. Clare

Parker agreed that this apparently counter-strategy picture required unpacking in

the narratives of the Annual Reports.

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6-10.4 The Committee, while recognising that the trend for the prompt payment of

invoices was an improving one, was keen to devote some Committee attention

looking at an overview of the measures being put in place, and their impact, to

drive performance to the target levels. Helen Troalen confirmed that, during the

next Breaking the Cycle event, effort was planned on mapping the issue and

raising awareness across the Collaborative. A report after then should, therefore,

be possible.

6-10.5 The Committee was keen to see detailed explanations / breakdowns of the

apparent year-on-year increases (where applicable) in Employee Benefits and

Governing Body member remuneration.

6-10.5 The Committee sought assurances regarding the risk share arrangements, in

particular what mechanisms were in place to prevent the arrangement

inadvertently masking profligate expenditure. The issue was discussed in detail

and Clare Parker assured the Committee that the CCGs’ Finance and

Performance Committees scrutinise a detailed breakdown of the risk share

deployments on a monthly basis.

6-10.6 The Committee expressed its on-going discomfort that a number of interim staff

members had not provided the requisite assurances regarding their tax

arrangements. Helen Troalen explained that the majority of those whom had not

provided assurances were staff that had since left the CCGs’ employ. All new

interim staff were required contractually to be subject to proper tax and National

Insurance arrangements.

11. Single Tender Waivers

11.1 The Committee noted the paper and clarification that the contract was related to providing communications support during a period of unusually heavy commitments and significant complexity.

12 Any Other Business


Dates of next meetings:


Tuesday 26 May 2015, 14:00 – 17:00; and

Thursday 2 July 2015, 10.30 – 12.00.

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Annex A – Detailed actions arising from 7 May 2015 Audit Committee

Accounts summaries

1. Note to the Committee in July / Sept setting out results of the review of the invoice payment

process(es) and improvement measures put in place [Helen Troalen];

2. note clarifying what the £187k owed by the Ealing GP Federation is [Helen Troalen];

3. note clarifying how the extension of winter schemes into M1 are accounted for [Helen

Troalen];

4. [Ealing’s accounts summary, p9] – Employee Benefits: breakdown of the 70% year-on-year

increase [Helen Troalen];

5. [Ealing’s accounts summary, p9] - note explaining the increases in Member remuneration to

be drafted for inclusion in the accounts [Helen Troalen];

6. [Ealing’s accounts summary, p10] – explanatory note for the Committee setting out why the

percentage (of invoices paid on time) was higher by volume than by value [Helen Troalen];

7. [Ealing’s accounts summary, p11] – clarify (for the Committee) the provision for impairment:

was it in 13/14 and, if so, will it be written off? [Helen Troalen];

8. [Ealing’s accounts summary, p14] – check if we have provided for the ‘not agreed’ balances

[Helen Troalen];

9. [Ealing’s accounts summary, p15] – confirm to the Committee how much of the £20m ‘not

agreed’ have been so confirmed by budget holders;

10. share the analysis of the drivers behind the correlation between Acute and Mental Health

spending with the Committee [Chief Officer];

11. [West London’s accounts summary, p10] – Helen Troalen to clarify the comments relating to

misattributions;

Annual Reports

12. Federations, and the significance of ‘networks’ and ‘localities’, need unpacking explanation [Catherine Brown];

13. the explanation of Primary Care Co-Commissioning needs to be subjected to comprehensive redrafting to say how (we envisage) it working in practice so as to deliver the benefits listed [Catherine Brown];

14. the narrative needs to place the acute spend in context, given its size, illustrated with one or

two examples of how the direction of travel is to move spend from Acute to Community

[Catherine Brown];

Governance Statements 15. confirm Gordon Hunting’s status [Ben Westmancott / Kiran Chauhan]; and

Reporting back to the 26 May meeting 16. Table, alongside the final ARs, Accounts and Governance Statements, a schedule that sets

out the material changes to the drafts tabled on 7 May [Simon Carney / Catherine Brown].

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