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Kingston Clinical Commissioning Group Governing body Meeting in public

Date Tuesday, 2 July 2019

Report Title Minutes of Kingston CCG Governing Body in public – 7 May 2019

Lead Director Dr Naz Jivani, Governing Body Chair

Author Jo Dandridge, Governance & Business Lead

Agenda item 1.2 Attachment A

Purpose Approval Discussion Noting

43rd MEETING OF THE GOVERNING BODY IN PUBLIC HELD ON TUESDAY 7 MAY 2019, 15:00 – 17:00

In the Fraser Chapel, The King’s Centre, Chessington

MINUTES Attendance Log:

Voting members: 07.05.19 02.07.19 .09.19 .11.19 .01.20 .03.20

Dr Naz Jivani (NJ)

Chair SA

Sarah Blow (SB) Accountable Officer SWL Alliance

A

James Murray (JM)

Chief Finance Officer SWL Alliance

A

Tonia Michaelides (TM)

Managing Director, Kingston & Richmond CCGs

A

Paul Gallagher (PG)

Lay Member for audit, and Conflicts of Interest Guardian

SA

David Knowles (DK)

Vice Chair and Lay Member for finance and governance

A

Jim Smyllie (JS) Lay Member, patient & public involvement

A

Dr Phil Moore (PM)

Deputy Chair, Clinical SA

Dr Gareth Hull (GH)

GP A

Dr Annette Pautz (AP)

GP A

Dr Naeem Iqbal (NI)

GP A

Dr Pete Smith (PS)

GP A

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:

Voting members: 05.03.19

Nadeem Nayeem (NN)

Secondary Care Doctor A

Kathryn Yates (KY)

Nurse Lay Member SA

Non-voting members:

Liz Meerabeau (LM)

Healthwatch Member A

Atin Goel (AG)

Council of Members Chair

A

Iona Liddington (IL)

Director of Public Health A

In attendance on 05.03.19:

Neil Ferrelly Interim Local Director of Finance

Julia Travers Local Director of Commissioning

Fergus Keegan Local Director of Quality

Jo Dandridge Governance & Business Lead (Board Secretary)

KEY: A = Attended, DNA = Did not attend, SA = Sent Apology, SD = Sent Deputy

ACTION

1 STANDING ITEMS

1.1 WELCOME, APOLOGIES FOR ABSENCE AND QUORACY

David Knowles, vice chair welcomed all members present to the 43rd meeting in public of the Kingston Clinical Commissioning Group’s Governing Body.

Apologies for absence were received as per the attendance table.

It was confirmed that the meeting was quorate.

1.2 DECLARATION OF INTERESTS IN RESPECT OF ITEMS ON THE AGENDA Members were asked to declare any possible conflicts of interest in agenda items that had not already been declared on the CCG Register.

1.3 MINUTES OF THE CCG GOVERNING BODY MEETING ON 5 MARCH 2019 The minutes were agreed as an accurate record.

Attachment A1

1.4 MATTERS ARISING AND ROLLING ACTION LOG Members noted that all actions were either on track or completed. In response to a query raised by Liz Meerabeau in which she asked if the newly formed Kingston SEND Partnership Board minutes would be publicly available, members noted that the Director of Public Health would find out and provide a response.

Attachment A2

Director of Public Health

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ACTION

1.5 USE OF THE KINGSTON CCG SEAL Members were informed that the Kingston CCG seal had been used for the tripartite agreement between London Borough of Camden, London Borough of Islington, and Kingston CCG for the provision of drug and alcohol planned detox (residential) with the following organisations and an entry has been made on the CCGs Register:

Kaleidoscope

ANA Treatment Centres

Equinox Care Ltd

Westminster Drug Project Ltd

Cranstoun

Broadreach House

Western Counselling The governing body NOTED the use of the Kingston CCG seal.

Attachment A3

1.6 QUESTION TIME There had been no questions submitted prior to meeting.

1.7 ITEMS TAKEN IN PRIVATE ON 5 MARCH 2019:

Risk Share Agreement between Kingston & Richmond CCGs

Improving Healthcare Together 2020-30

Moving Forward Together

Kingston & Richmond Local Delivery Unit Senior Management Structure

1.8 ACCOUNTABLE OFFICER’S REPORT Sara Blow, provided a verbal report to the governing body on the first SWL clinical conference. The conference was attended by over 300 NHS and social care professionals from across the six boroughs to help design the clinical vision for SWL. Members noted that attendees were asked to share their experiences and expertise on six areas identified by the South West London Clinical Senate: Diabetes, Cardiovascular Disease, End of Life Care, Mental Health, Outpatient Transformation and Respiratory Care.

Members were informed that the output from the conference would be taken back to the SWL Clinical Senate and then be fed in to the SWL response to the NHS Long Term Plan. The governing body NOTED the accountable officer’s verbal report.

1.9 MANAGING DIRECTOR’S REPORT The governing body received the managing director’s report and members’ attention was drawn to the following points:

Attachment B

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ACTION

Ofsted visit Members noted that the focused Ofsted inspectors visit to the borough’s children’s services in March 2019 had concluded that overall most vulnerable adolescents in Kingston received a good service from social workers, who they found to be skilled, enthusiastic, tenacious and have high morale. Their report also noted three key areas for improvement and the CCG safeguarding children specialist staff will continue to work in partnership with the local authority to improve services to protect children and young people from harm across Kingston.

Mental health awareness week (13-19 May 2019) The theme for this year’s mental health awareness week is body image and a series of activities were being planned for staff.

NHS App

Over 7,000 GP practices in England are being technically connected to the NHS App gradually over the next few months. The app has also been released to Google Play and the Apple app store and can be downloaded free by patients to access a range of NHS services on a smartphone or tablet once their GP practice is connected. Members were aware of the many different software packages in operation within the NHS and how it can cause some confusion for patients. However, it was recognised that some systems were mandated nationally and others like DrLink were being implemented on a SW London basis.

The governing body NOTED the managing director’s report.

1.10 SOUTH WEST LONDON HEALTH & CARE PARTNERSHIP NEWS Members received attachment C, a copy of the SWL Health and Care Partnership News. The regular newsletter provides stakeholders with updates concerning the partnership’s developments, announcements and news. Members noted the latest edition included the following information:

Local Health and Care Plans

New perinatal mental health service for mothers

Jobs that Care

Connecting your Care

Diabetes Book and Learn Service

More GP appointments and online consultations

Partnership successful bids for funding

HSJ award shortlisting for November engagement events

Attachment C

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ACTION

Members attention was drawn to the ‘Jobs that Care’ programme developed in partnership with Health Education England. The programme aims to support local students in making their career decisions in the field of health and social care. The programme includes a play that takes the audience through three realistic scenes based in a GP surgery, a community setting and a hospital. There is also a ‘Jobs that Care’ game designed for pupils to learn about different roles within health and care. The governing body NOTED the SWL Health and Care Partnership News update.

2 COMMISSIONING

2.1

KINGSTON LOCAL HEALTH AND CARE PLAN UPDATE Members received attachment D, the latest draft local health and care plan discussion document which would be used for the next phase of engagement of the plan. Members noted that as part of the engagement on the discussion document, an online survey was being undertaken asking the following four questions:

1. Do you understand what we will be focusing on for the next two

years?

2. Do you agree with the actions we are proposing to improve the

health and care of local people over the next two years?

3. Is there anything missing in our plans that you would expect to see

there? If so, what?

4. Have you any other comments about the Health and Care Plan

discussion document?

Members noted that the discussion document is now being shared widely to give all partners involved in health and care delivery a further opportunity to review them. Members were also advised that during the month of May and into June, there will be further engagement of the plan with groups of local

people. Members commented on the huge challenge it must have been to collate and produce the local health and care plan discussion document and expressed their appreciation to all involved. In response to a question on publication of the discussion document and main routes for reaching the general public, members noted that it had been uploaded to Kingston Council’s website portal; was being circulated via the health and wellbeing board; already distributed to local providers and stakeholders; and through Healthwatch.

Attachment D

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ACTION

Members noted that within the discussion document there was a chapter on the significant financial challenges to be faced by the health and care system with increasing demands from an ageing population and the need to improve quality and respond to rising patient expectations without any additional resources available. The governing body NOTED the next steps in the development and production of the local health and care plan.

2.2 CQC SPECIAL EDUCATION NEEDS & DISABILITY (SEND) INSPECTION UPDATE The governing body received attachment E, a briefing paper to update on the key action that had been undertaken since the previous report was presented. Members noted that following submission of the final draft of the Written Statement of Action (WSoA) to Osfted and CQC, the local area received feedback that deemed it to be ‘fit for purpose in setting out how the local area will tackle the significant areas of weakness identified in the published report letter’ However, the letter also highlighted that the WSoA had not been submitted within the timeframe allowed of 70 working days from receipt of the final report. Members were advised that the delay was due to a Kingston Council scrutiny call-in and further work needed on the action plan before submission. With respect to the Designated Clinical Officer (DCO) members noted that approval was given at the December 2018 Finance Committee to recruit to a full time DCO post – 0.5 wte for Kingston and 0.5 wte for Richmond. The recruitment to the DCO role commenced in April 2019 and interviews planned for early May. Interim arrangements have been agreed to cover the DCO post for a 6 month period until a permanent post holder is appointed. Members were advised that there was ongoing monitoring of the transformation plans by the SEND Partnership Board whose membership had been refreshed and now included representatives from the CCG, council, Ofsted, Director of Education and other partners. Members recognised that it was not known when the Ofsted/CQC re-inspection would take place and therefore preparation was already underway to ensure internal processes were robust. Members also noted that a forthcoming meeting of the Integrated Quality Governance Committee (IQGC) would have its agenda dedicated to a quality review of children’s services to ensure oversight in this area. Fergus Keegan agreed to liaise with the chair of IQGC and progress this matter. The governing body NOTED the current progress and next steps.

Attachment E Fergus Keegan

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ACTION

2.3 INTEGRATED QUALITY GOVERNANCE COMMITTEE IN COMMON REPORT The governing body received attachment F, a report which covers the performance against the key indicators for all six SWL CCGs. It was noted that the SWL highlight report was month 8, as this was the latest report that had been approved. Members were advised of the following success for Kingston CCG:

The performance standard for RTT and diagnostics was achieved in November 2018 with outcomes of 94.16% and 99.52%

All the cancer standards were achieved with 2 week wait at 98.8% and 62 day at 95.6%

The Kingston IAPT service is working well, achieving above the expected standards

A&E performance at Kingston Hospital was 88.31% in December 2018, this was above the operating plan trajectory for the month of 88%

The following performance against the constitutional standards that were a cause for concern for Kingston CCG were highlighted as follows:

In terms of reducing the waiting list against the March 2018 outcome of 7,963 incomplete pathways, the position at the end of November was 9,370 against a plan of 9,590. This was a variance of 1,709 patients against the operating plan expectation.

There was 1 patient waiting over 52 weeks for treatment at Epsom & St Helier

The governing body NOTED the SWL Performance Highlight Report. Integrated Quality Governance Committee summary The governing body also received a summary of the discussions at the Integrated Quality Governance Committee meetings held in March and April 2019. The key points in the report that members were asked to note were as follows:

Performance across most national and local metrics are being achieved, including all cancer standards

St George’s Hospital has commenced reporting from January 2019, and this has meant that Kingston CCG has missed the 18 weeks RTT incomplete waiting time target for the months of January, February and March 2019. Kingston CCG is achieving the standard year to date (YTD)

The Kingston CCG dementia diagnosis rate and A&E standard at Kingston Hospital were not being met in 2018-19

Attachment F

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ACTION

The numbers of MRSA and C-Difficile bacteraemia are above targeted levels, with most identified cases being reported as community acquired

The only area where activity is outside of the 2% tolerance is first outpatient attendances, due to increases in cancer activity, and the reporting of diagnostic activity through SUS by St George’s.

Members noted the following areas where Kingston is in the worst quartile nationally of the Improvement and Assessment (IAF dashboard) for 2018-19:

Attendance at diabetic structured education (diabetes)

Completeness of the GP learning disability register

Dementia diagnosis rate

% of deaths with 3+ emergency admissions in last three months of life

Primary care transformation investment

Progress against Workforce Race Equality Standard (WRES)

Members also noted that reports had been presented to IQGC from the following Clinical Quality Review Group meetings:

Kingston Hospital Foundation Trust

Chelsea and Westminster NHS Trust

SWL Integrated Urgent Care

Hounslow and Richmond Community Healthcare Trust

SW London & St George’s NHS Mental Health Trust

Members were informed that Kingston and Richmond were commended by the London Learning Disability Mortality Review Programme (LeDeR) team for achieving an increase in completed reviews in Qtr 3 2018/19. Members sought clarification on any work taken forward around under represented ethnic minorities in relation to dementia diagnosis that had been raised at a previous meeting. Members attention was drawn to the red performance rating for access to cancer treatment within 62 days for a screening referral and noted this standard related to the endoscopy service which was not achieved in February 2019 due to a very small number of breaches. The governing body NOTED the Integrated Quality Governance committee summary report.

2.4 MONTH 12 FINANCE REPORT The governing body received attachment G, a copy of the Month 12 Finance Report that had been received by the Finance Committee at the most recent meeting.

Attachment G

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ACTION

Neil Ferrelly, Interim Local Director of Finance took the governing body through the Month 12 report, with the following areas of note:

Kingston CCG submitted draft accounts and annual report to NHS England on 24 April 2019, in line with national timetables

A surplus of £1,084k was reported which is £24k above the planned control total target. Therefore the CGC met its statutory duty to remain within its revenue resource limit.

Running cost expenditure of £3.792m was withint he running cost target allocation of £4.315m

The CCG met the Better Payments Practice target, cash targets and mental health investment standards target

Members were also advised of the following key issues:

Reported position for acute trusts reflects the agreements of balance exercise. Kingston Hospital reports a variance of £5m above plan, St George’s Hospital reports a variance of £0.9m below plan.

Mental health contracts includes costs for PICU and off-siting, which is part of a risk share agreement

Overall continuing care spend has seen 6% grown during 2018/19 compared to previous year. There has been 15% growth in personal health budget spend and funded nursing care has had a 5% reduction

Prescribing spend is based on April 2018 to January 2019 actual costs and includes the NSCO cost pressures of £680k and Category M drugs impact of £184k

Primary care delegated commissioning budget reports a forecast overspend of £512k. Main overspends relate to increase in global sum for 2018-19, increases in premises costs due to local authority rates increases and a rise in locum claims following the change in rules for making claims.

QIPP Kingston CCG has reported achievement of the planned QIPP savings of £9.8m based on month 11 data, despite under achievement on some transformational schemes.

The governing body NOTED the financial position at Month 12.

2.5 FINANCIAL PLAN 2019/20 REVISED BUDGETS The governing body received attachment H, a copy of the financial plan revised budgets for 2019/20. Members were reminded that in March 2019, the governing body agreed initial budgets based on a set of high level assumptions and noted that since then progress has been made to agree and sign contracts with all SWL NHS providers and also to reach agreement with out of sector providers.

Attachment H

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ACTION

Mental health investments (MHIS) have been made in line with expectations in the five year forward view; which has exceeded the expected MHIS for Kingston CCG Members noted that the CCG plan requires delivery of a significant QIPP programme to meet the required agreed total. The governing body APPROVED the revised budgets for 2019-20.

2.6 KINGSTON ALL AGE LEARNING DISABILITY STRATEGY – MAKING LIFE JOURNEYS The governing body received attachment I, a copy of the Kingston All Age Learning Disability Strategy – Making Life Journeys, the first joint health and social care strategy which had been co-produced by Kingston partners. Members noted that the aim of the strategy is to reduce health inequalities; maximize independence and wellbeing; and reduce stigma and discrimination for a group of people that face many barriers to having ‘ordinary’ lives. Members considered the strategy to be a really valuable piece of work and sought clarification on the monitoring process. In response, members were advised that progress would be led by Healthwatch with specialist health provision delivered by Your Healthcare CIC and would be reviewed by the health and wellbeing board. A clinical champion for learning disabilities was also being engaged and the CCG Integrated Quality Governance committee would have oversight of the outcome. It was also stressed that a single dashboard metric should be developed and reported through respective governance structures. Members were informed that an easy read version of the strategy had been produced and would be shared in the near future. The governing body APPROVED the agreed direction of travel for people with learning disabilities as described in the All Age Strategy for People with Learning Disabilities and the CCGs contribution in the delivery of the strategy. The governing body also NOTED that the strategy would be delivered via the All Age Learning Disability Partnership Board chaired by Kingston Healthwatch. The governing body also NOTED that the Health and Wellbeing Board would provide strategic oversight and hold to account the key strategic partners for the delivery of the strategy.

Attachment I

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ACTION

2.7 COUNCIL OF MEMBERS REPORT Members received attachment J, a report detailing items discussed at the most recent Council of Member meetings held in March and April 2019. This included updates on the following:

Kingston Medical Services contract - new KMS offer for 2019/20 and 2020/21 is ready to be issued

Presentation on ‘Our Path’, an online digital portal providing diabetes support and help for patients through education on nutrition, stress management, living with and managing symptoms of diabetes

The development of primary care networks within the borough

Presentation on DXS including future plans and timelines on changes to the system

Details of the new End of Life QOF

Withdrawal of End of Life locally commissioned service from last year and built into the KMS contract for 2019

Tonia Michaelides also gave an update on the NHS Long Term Plan and of the possible formation of a single CCG for SWL to address the ask of CCGs to make a 20% reduction in running costs. Discussion was held on how this reorganisation could look and the implications it may have locally. The governing body noted the Council of Members report.

Attachment J

3 GOVERNANCE/BUSINESS

3.1

MOVING FORWARD TOGETHER The governing body received attachment K, a report detailing the progress made to date with the Moving Forward Together programme. Members were reminded that the six CCGs in SW London had been working together for over a year now and were committed to ensuring that there are successful place based local systems supported “at scale” where necessary. However moving forward, a number of things will impact on how things currently operate which includes:

development of primary care networks;

strengthening of local health and care partnerships and the development of local health and care plans;

the development of system rather than commissioning/provider split and focus on the person rather than organisations;

the expectation in the NHS Long Term Plan that we will make a 20% reduction in management costs and will have one CCG across SW London.

This provides the opportunity to re-focus the way things work and it is therefore vitally important that we move forward together as individual boroughs and across SW London in a planned way.

Attachment K

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ACTION

The following approach is being taken:

• We are ensuring that clinical leadership is enhanced and the patient remains at the heart of everything we do

• We are committed to ensuring local accountability including financial delegation

• We are engaging with our GP members, local medical mommittees, local authorities, Healthwatch and other partners and listening to their views

• We are developing our case for change and considering what this means for local people

• We have received national guidance and are assessing what needs to be done, we would have to submit an application by September 2019 if we wish to progress

• We are putting in place a programme to support us with this work • We are building a bottom up approach to ensure a focus on local

people, partners and place Members were advised of the workshop being held on 17 May 2019 to discuss with all local partners the appetite for ‘place’ and to seek to determine the level of delegation required. Members also noted that the Council of Members had had in depth discussion at their recent meeting so they were fully up to speed and they endorsed the direction of travel. The governing body NOTED the progress made to date with the Moving Forward Together programme.

3.2 2018-21 MEDICINE OPTIMISATION PRIORITIES The governing body received attachment L, a copy of the key medicines optimisation focus areas for the medicines optimisation team in order to deliver the corporate objectives for Kingston CCG. The Director of Quality applauded the excellent work of the chief pharmacist and her team to develop the strategy and work programme and members were advised that the programme was being shared with other chief pharmacists as an example of good practice. The governing body NOTED the 2018-21 Medicine Optimisation Priorities.

Attachment L

4 FOR INFORMATION

4.1 BOARD ASSURANCE FRAMEWORK (BAF) Members received attachment M, the Board Assurance Framework summary document which forms the basis for the governing body to assess its position in respect of achieving its corporate objectives.

Attachment M

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ACTION Members noted that there were currently 27 risks identified on the risk register and of these 17 were high risks.

The governing body NOTED the Board Assurance Framework report.

4.2 SOUTH WEST LONDON COMMITTEES IN COMMON MINUTES OF MEETING HELD 26 FEBRUARY 2019 The governing body received a copy of the SWL Committee in Common Minutes of the meeting held on 26 February 2019 for information.

4.3 DATE OF NEXT MEETING Tuesday 2 July 2019, 3.00-5:00 at The King’s Centre, Chessington

5 PUBLIC QUESTION TIME

5.1 There were no questions submitted prior to the meeting. A member of the public informed members that Kingston Diabetes UK had been shortlisted for the ‘Inspire’ awards which are held each year to recognise the invaluable contribution of the volunteers and groups that go above and beyond for people living with diabetes, and to thank them for their commitment. Members were also informed that statistics show that 30% of people with diabetes also suffer with symptoms of depression.